5-year Conditional Survival Research Articles

Conditional Survival After Hepatectomy for Colorectal Liver Metastasis: Results from the Colorectal Liver Operative Metastasis International Collaborative (COLOMIC).

Complete resection of colorectal liver metastasis (CLM) improves long-term survival in colorectal cancer. However, there is limited recent data on conditional survival (CS) as postoperative survival milestones are achieved post-hepatectomy. A retrospective analysis was performed on the penta-institutional Colorectal Liver Operative Metastasis International Collaborative (COLOMIC), with 906 consecutive CLM hepatectomy cases. CS was calculated using Bayes' theorem and Kaplan-Meier analysis. Additional CS analyses were performed on additional clinicopathologic risk factors, including colon cancer laterality, KRAS mutation status, and extrahepatic disease. The 5-year CS was 40.6%, 45.3%, 52.8%, and 65.3% at 0, 1, 2, and 3 years postoperatively, with significant improvements each year (p < 0.005). CS was not significantly different between right-sided and left-sided colorectal cancers by 3 years postoperatively. Patients with KRAS mutations had worse CS at all timepoints (p < 0.001). Extrahepatic disease was a poor prognostic factor for OS and CS (p < 0.001). However, CS for patients with KRAS mutations or extrahepatic disease improved significantly as 2-year, postoperative survival was achieved (p < 0.05). Five-year CS after hepatectomy for CLM improved with each passing year of survival postoperatively. Although extrahepatic disease and KRAS mutations are poor prognostic factors for OS, these populations still had improved CS after 2 years postoperatively.

An Analysis of Conditional Survival Rates for Ewing Sarcoma Patients

Using data from the Surveillance, Epidemiology, and End Results (SEER) Program based at the National Cancer Institute in the US, conditional survival rates are reported for 1,988 Ewing Sarcoma patients diagnosed during the period 2000-2015. These patients represent the experience of 26.5% of the US population. Specifically, 5-year conditional relative survival rates are calculated for these patients for the first eight years subsequent to diagnosis of their cancer by Extent of Disease (EOD) (Localized, Regional, and Distant as coded by the SEER Program), gender, and age (<18, 18 - 34, and 35+). Findings include showing how the conditional survival rate patterns improve over time and that there are differences by gender, age, and EOD.

Novel nomogram to predict biochemical recurrence-free survival after radical prostatectomy.

Conditional survival represents the probability of subsequent survival given that patients have already survived a certain length of time. Several models predict biochemical recurrence (BCR) after radical prostatectomy. However, none of them include postoperative prostate-specific antigen (PSA). We aimed to analyze BCR-free survival evolution over time and develop a nomogram incorporating the postoperative PSA value to predict BCR-free survival. We included patients treated with robot-assisted radical prostatectomy (RARP) for prostate cancer between 2009 and 2021 and calculated conditional survival. Cox proportional hazard regression analysis was used to assess the predictive variables of BCR. We developed a nomogram predicting BCR-free survival three and five years after RARP. We used c-index and decision curve analyses to compare the nomogram with the Cancer of the Prostate Risk Assessment post-Surgical (CAPRA-S) score. We included 718 patients. The overall 3- and 5-year BCR-free survival rates were 85.1% and 75.7%, respectively. The 5-year BCR-free survival rates increased to 78.9%, 82.9%, 85.2%, and 84.7% for patients surviving 1, 2, 3, and 4years without BCR, respectively. We developed a nomogram including the pathological Gleason score and T stage, positive surgical margin, PSA ≥ 0.05ng/mL at one year, and lymph node involvement to predict BCR at 3 and 5years postoperatively. Our nomogram presented a higher c-index (0.89) than the CAPRA-S score (0.78; p = 0.001) and a positive net benefit at 3 and 5years postoperatively in the decision curve analyses. The 5-year conditional BCR-free survival increased with survival without BCR. The developed nomogram significantly improved the accuracy in predicting BCR-free survival after RARP.

Individualized conditional survival nomograms for stage I-III early onset colorectal cancer patients.

Conditional survival accounts for the time already survived after surgery and provides additional survival information. The aim was to assess conditional survival in stages I-III early onset colorectal cancer patients and to create nomograms predicting the conditional overall survival and cancer-specific survival after surgery. A total of 7058 patients who underwent surgical resection of early onset colorectal cancer were identified from surveillance, epidemiology and end results database. The formula used for conditional survival calculation was conditional survival(x|y)=S(x+y)/S(x), where S(x) represents the survival at x years. Conditional survival nomograms were then developed to predict the 5-year conditional overall survival and cancer-specific survival. The 5-year overall survival and cancer-specific survival after surgery increases gradually with additional survival time. Race, tumour site, grade, histology, T stage, N stage, lymph node ratio, preoperative carcinoma embryonic antigen level and perineural invasion status were independent predictors of cancer-specific survival, while age and sex were another two independent risk factors for overall survival. The nomograms based on these factors were successfully developed to predict 5-year overall survival and cancer-specific survival given 1-4years already survived. The probability of achieving postoperative 5-year overall survival and cancer-specific survival for early onset colorectal cancer increases gradually with additional time survived. The developed nomograms are fairly valuable and informative in facilitating clinical treatment and follow-up schemes.

370. EXTERNAL VALIDATION OF A NOMOGRAM PREDICTING CONDITIONAL SURVIVAL AFTER CURATIVE TREATMENT OF ESOPHAGEAL CANCER

Abstract To predict 5-year overall survival for esophageal cancer patients after neoadjuvant treatment followed by esophagectomy, recently a conditional survival nomogram was developed. This nomogram includes cN-stage, ypT-stage, ypN-stage, cardiac comorbidity, chyle leakage and pulmonary complications as independent predictors of survival. The aim of this study was to externally validate the conditional survival nomogram in a cohort of patients from another European high volume esophageal cancer center. We included consecutive patients with a resectable (cT1-4a, N0–3, M0) adeno- or squamous cell esophageal carcinoma between January 2004 and January 2016 who received neoadjuvant treatment followed by an esophagectomy in a tertiary referral center for esophageal cancer. Standard prognostic factors and nomogram specific data were collected. The discriminative ability of the nomogram for the prediction of 5-year overall survival was quantified by Harrell’s C-statistics, directly after surgery and given survival for 1, 2, 3 and 4 years already survived. Calibration of the conditional survival nomogram was visualized by plotting actual 5 years survival against predicted probabilities. 296 patients were included. The median overall survival was 48.1 months (95%CI:37.5–58.7). The probability to achieve 5-year overall survival directly after surgery was 45% and increased to 57%, 68%, 78% and 89% for each additional year survived. Prediction of 5-year overall survival differed from the observed survival with a calibration slope of 0.54, 0.55, 0.59, 0.73 and 1.09, directly after surgery and given 1, 2, 3, and 4 years already survived, respectively. The discriminative ability of the nomogram for 5-year survival was moderate with a C-statistics of 0.65, compared to a value of 0.70 in the original study. This study externally validated a model for conditional survival after neoadjuvant chemoradiotherapy and surgery for esophageal cancer. The proposed nomogram had a moderate predictive discrimination and accuracy for the derivation cohort, and therefore it should be updated for or used with caution in external cohorts for the prediction of conditional 5-year survival.

Instantaneous death risk, conditional survival and optimal surgery timing in cervical fracture patients with ankylosing spondylitis: A national multicentre retrospective study.

BackgroundThe mortality rate in patients with ankylosing spondylitis (AS) and cervical fracture is relatively high.ObjectivesThis study aimed to investigate the instantaneous death risk and conditional survival (CS) in patients with AS and cervical fracture. We also studied the relationship between surgical timing and the incidence of complications.MethodsThis national multicentre retrospective study included 459 patients with AS and cervical fractures between 2003 and 2019. The hazard function was used to determine the risk of instantaneous death. The five-year CS was calculated to show the dynamic changes in prognosis.ResultsThe instantaneous death risk was relatively high in the first 6 months and gradually decreased over time in patients with AS and cervical fracture. For patients who did not undergo surgery, the instantaneous risk of death was relatively high in the first 15 months and gradually decreased over time. For patients with American Spinal Injury Association impairment scale (ASIA) A and B, the 5-year CS was 55.3% at baseline, and improved steadily to 88.4% at 2 years. Odds ratios (ORs) for pneumonia, electrolyte disturbance, respiratory insufficiency, and phlebothrombosis decreased as the surgery timing increased.ConclusionDeaths occurred mainly in the first 6 months after injury and gradually decreased over time. Our study highlights the need for continued surveillance and care in patients with AS with cervical fractures and provides useful survival estimates for both surgeons and patients. We also observed that early surgery can significantly increase functional recovery, and decrease the incidence of complications and rehospitalisation.

639P Conditional survival in MM and impact of prognostic factors over time

Overall Survival (OS) estimates from diagnosis are important for predicting prognosis and guiding treatment selection in newly diagnosed patients, but do not consider the number of years already survived. Conditional survival (CS) estimates provide updated survival predictions over the disease course. Previous studies suggest that improvement in CS is less pronounced in multiple myeloma (MM) compared to other malignancies. It is unclear whether high-risk (HR) factors in MM retain their prognostic impact over time. This study was conducted to estimate CS at 1 to 5 years from diagnosis and evaluate the impact of baseline prognostic factors on CS over time in newly diagnosed MM patients. This is a retrospective study including 2556 MM patients diagnosed between 2004-2019. CS (t|s), defined as the probability of surviving additional t years given survival of s years, was estimated at 1 to 5 years from diagnosis using the conditional Kaplan-Meier method. The impact of baseline characteristics on CS was estimated using conditional Cox proportional hazards model. The median age was 64 years and 62% were male; >90% received novel-agent based induction; 46% had transplant within 1 year of diagnosis. The median follow-up was 6.2 years, and median OS was 7.5 years. The 5-year CS estimates at s=0, 1, 2, 3, and 5 years were 0.64, 0.61, 0.61, 0.61, and 0.58, respectively. On multivariate analysis, age ≥ 65 and proteasome inhibitor (PI)+Immunomodulatory (IMiD)-based induction retained prognostic significance at 5 years from diagnosis. The adverse impact of HR IgH translocations, 1q gain and ISS 3 was not significant at 5 years. Chromosome 17 abnormality predicted worse CS at 1 year, but not at 3 or 5 years from diagnosis (table).Table: 639PMultivariate CSVariableDiagnosisyear 1year 3year 5HRPHRPHRPHRPAge≥651.60<0.011.57<0.011.48<0.011.95<0.01Calcium ≥111.59<0.011.63<0.011.05NS1.05NSISS III1.74<0.011.75<0.011.80<0.011.52NSEarly transplant0.57<0.010.64<0.010.61<0.010.69NSPI+IMiD induction0.59<0.010.630.010.660.040.530.04LDH > 2221.29NS1.15NS1.13NS0.89NSCh17 abnormality1.53<0.011.430.021.32NS1.16NSHR IgH translocation1.90<0.011.97<0.011.550.041.51NSMonosomy 131.13NS1.09NS1.05NS0.86NS1q gain1.34<0.011.310.031.500.011.38NSSignificant P values are bolded. NS: not significant. Open table in a new tab Significant P values are bolded. NS: not significant. In a large cohort of MM patients treated with novel agents, CS was stable at 1 to 5 years from diagnosis. The adverse prognostic impact of HR cytogenetic factors and advanced ISS stage decreased over time.

Dynamic evaluation of postoperative survival in intrahepatic cholangiocarcinoma patients who did not undergo lymphadenectomy: a multicenter study

Background The prognosis of Intrahepatic cholangiocarcinoma (ICC) patients who did not undergo lymphadenectomy is difficult to assess. This study aims to have a dynamic evaluation on the postoperative survival of ICC patients by calculating conditional survival. Methods Relevant data were from patients treated in 12 large-scale hospitals from December 2011 to December 2017. The influence of relevant clinical baseline data on the prognosis of ICC patients was analyzed by Cox regression. Conditional survival (CS) is a method that may predict the prognostic probability dynamically. For a patient with x years of survival, the 1-year CS (CS1) may be calculated as CS1= OS(x + 1)/OS(x). Result A total of 361 patients who met the criteria were included in the study. Conditional survival (CS) means that the patients’ prognosis varies with survival time, meanwhile, relevant factors affecting the prognosis have a time-varying effect. The probability of survival assessed by CS1 increased year by year and the 1,2,3-year survival improved from 68.4% to 87.8%, while the postoperative actuarial OS decreased from 69.4% at 1 years to 36.9% at 3 years. Conclusions In terms of CS, the estimated survival for ICC varies with the increase of survival time after excision. Patients who live longer were likely to live longer. At the same time, with the passage of time, the role of the original adverse factors of the tumor would gradually decrease. Conditional survival allows a more accurate assessment of ICC patients who did not undergo lymphadenectomy.

A Composite End Point of Graft Status and eGFR at 1 Year to Improve the Scientific Registry of Transplant Recipients' Five-Tier Rating System.

Performance of kidney transplant programs in the United States is monitored and publicly reported by the Scientific Registry of Transplant Recipients (SRTR). With relatively few allograft failure events per program and increasing homogeneity in program performance, quantifying meaningful differences in program competency based only on 1-year survival rates is challenging. We explored whether the traditional end point of allograft failure at 1 year can be improved by incorporating a measure of allograft function (i.e., eGFR) into a composite end point. We divided SRTR data from 2008 through 2018 into a training and validation set and recreated SRTR tiers, using the traditional and composite end points. The conditional 5-year deceased donor allograft survival and 5-year eGFR were then assessed using each approach. Compared with the traditional end point, the composite end point of graft failure or eGFR <30 ml/min per 1.73 m2 at 1-year post-transplant performed better in stratifying transplant programs based on long-term deceased donor graft survival. For tiers 1 through 5 respectively, the 5-year conditional graft survival was 72.9%, 74.8%, 75.4%, 77.0%, and 79.7% using the traditional end point and 71.1%, 74.4%, 76.9%, 77.0%, and 78.4% with the composite end point. Additionally, with the five-tier system derived from the composite end point, programs in tier 3, tier 4, and tier 5 had significantly higher mean eGFRs at 5 years compared with programs in tier 1. There were no significant eGFR differences among tiers derived from the traditional end point alone. This proof-of-concept study suggests that a composite end point incorporating allograft function may improve the post-transplant component of the five-tier system by better differentiating between transplant programs with respect to long-term graft outcomes.

Refined efficacy and outcome estimates of surgical treatment in oldest-old patients with glioblastomas based on competing risk model and conditional survival analysis: A surveillance, epidemiology, and end results population-based study

Background and purposeTo determine the refined estimates of the surgical effects on the short- and long-term prognoses of oldest-old patients (aged ≥80 years) with glioblastomas. Materials and methodsUsing the Surveillance, Epidemiology, and End Results registry, we identified the oldest-old patients with glioblastomas between 2005 and 2016. Propensity score matching, Kaplan–Meier analysis, Cox regression analysis, and competing risk model were used to assess the curative efficacy of the surgical treatments. Stratification and interaction analysis were performed to explore the potential interaction effects. The conditional survival rates were calculated to explore the longitudinal change in the survival probability over time. ResultsThis study enrolled 3309 patients with a median overall survival of 3 months. The overall survival differed significantly among the different surgical groups. Considering the gross total resection as reference, subtotal resection presented adjusted subdistribution hazard ratio (95% confidence interval) of 1.197 (1.052–1.362; p < 0.001); biopsy/partial resection, 1.242 (1.083–1.424; p = 0.002); and no surgery, 1.309 (1.145–1.497; p < 0.006). Age ≥ 83 years, widowed/other status, tumor size 4–5 cm, and temporal tumors showed significant interaction effects. The adjusted subdistribution hazard ratio of radical resection was 0.729 (0.645–0.825; p < 0.001). Based on disease-specific survival, the 1-year survival rate was 18% and 26% for the non-radical and radical surgery groups, respectively. The 1-year conditional survival rates in the second year were 54% and 39% in the non-radical and radical surgery groups, respectively. The 3-year survival rates were 10% in both the groups. ConclusionsRadical surgery may have short-term benefits in the oldest-old patients with glioblastoma, with a significant increase in the 1-year survival rate. However, its contribution in the long-term outcome is limited due to decreased conditional survival rates from the second year after surgery. Prudent patient selection and improved postoperative management may be needed to promote the therapeutic efficacy of tumor resection synergistically.

Conditional estimates for uterine serous cancer: Tools for survivorship counseling and planning

ObjectivesDevelop conditional survival and risk-assessment estimates for uterine serous carcinoma (USC) overall and stratified by stage as tools for annual survivorship counseling and care planning. MethodsPatients in the National Cancer Data Base diagnosed between 2004 and 2014 with stage I-IV USC were eligible. Individuals missing stage or survival data or with multiple malignancies were excluded. Five-year conditional survival was estimated using the stage-stratified Kaplan-Meier method annually during follow-up. A standardized mortality ratio (SMR) estimated the proportion of observed to expected deaths in the U.S. adjusted for year, age, and race. The relationships between prognostic factors and survival were studied using multivariate Cox modeling at diagnosis and conditioned on surviving 5-years. ResultsThere were 14,575 participants, including 43% with stage I, 8% with stage II, 29% with stage III, and 20% with stage IV USC. Five-year survival at diagnosis vs. after surviving 5-years was 52% vs. 75% overall, 77% vs. 81% for stage I, 57% vs. 72% for stage II, 40% vs. 66% for stage III, and 17% vs. 60% for stage IV USC, respectively (P < 0.0001). Incremental improvements in 5-year conditional survival and reductions in SMR tracked with annual follow-up and higher stage. The adjusted risk of death at diagnosis vs. after surviving 5-years was 1.15 vs. 1.40 per 5-year increase of age, 1.26 vs. 1.68 for Medicaid insurance, 3.92 vs. 2.48 for stage III disease, and 6.65 vs. 2.79 for stage IV disease, respectively (P < 0.0001). ConclusionIn USC, the evolution of conditional survival permits annual reassessments of prognosis to tailor survivorship counseling and care planning.

Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit.

Background: In this study, we assessed the mid-term outcomes of patients who received a heart donation from a marginal donor (MD), and compared them with those who received an organ from a standard donor (SD). Methods: All patients who underwent HTx between January 2012 and December 2020 were enrolled at a single institution. The primary endpoints were early and long-term survival of MD recipients. Risk factors for primary graft failure (PGF) and mortality in MD recipients were also analyzed. The secondary endpoint was the comparison of survival of MD versus SD recipients. Results: In total, 238 patients underwent HTx, 64 (26.9%) of whom received an organ from an MD. Hospital mortality in the MD recipient cohort was 23%, with an estimated 1 and 5-year survival of 70% (59.2–82.7) and 68.1% (57.1–81), respectively. A multivariate analysis in MD recipients showed that decreased renal function and increased inotropic support of recipients were associated with higher mortality (p = 0.04 and p = 0.03). Cold ischemic time (p = 0.03) and increased donor inotropic support (p = 0.04) were independent risk factors for PGF. Overall survival was higher in SD than MD (85% vs. 68% at 5 years, log-rank = 0.008). However, risk-adjusted mortality (p = 0.2) and 5-year conditional survival (log-rank = 0.6) were comparable. Conclusions: Selected MDs are a valuable resource for expanding the cardiac donor pool, showing promising results. The use of MDs after prolonged ischemic times, increased inotropic support of the MD or the recipient and decreased renal function are associated with worse outcomes.

Long-Term Survivors Following Pediatric Heart Transplantation: A PHTS Database Analysis

<h3>Purpose</h3> Short-term outcomes following pediatric heart transplantation have improved over time with 1-year survival of over 90%, but comparable improvements in longer-term survival continues to have important barriers. We sought to investigate long-term outcomes following pediatric heart transplantation and to identify favorable factors associated with long-term survival. <h3>Methods</h3> The Pediatric Heart Transplant Society (PHTS) database was queried for pediatric heart transplant recipients from 1993-2010. Patients with graft survival ≥10 years were compared to the general cohort and to patients with follow up ≥3 but <10 years. Kaplan-Meier analysis was used to evaluate overall survival and 3-year conditional survival. Factors associated with graft loss after 3-year conditional survival were identified using Cox proportional hazard modeling. <h3>Results</h3> 3,436 patients were transplanted between 1993-2010, of whom 1355 (39.4%) had ≥10 years of follow up (median 13.7 years (range 10.0-27.5)). Of those surviving to 10 years post-transplant, 84.4% and 74.3% survived to 15 and 20 years, respectively. Of the complete PHTS cohort, overall survival at 15 years was 53.3%. Patients <1 year at transplant who survived to 10 years had improved survival compared to other age groups (Figure). In 10-year survivors, the leading cause of subsequent mortality was cardiac allograft vasculopathy (CAV). Risk factors for graft loss after 3 years post-transplant were age, female gender, African American race, use of steroids at 2 years, rejection (particularly with hemodynamic compromise) and CAV (p-value for all <0.05). Use of mTORi was not associated with long-term survival. <h3>Conclusion</h3> Heart transplantation remains an effective therapy in pediatric patients with a growing number of long-term survivors. Of modifiable risk factors, cessation of steroids may provide long-term survival benefit. Additional studies on social determinants of health are warranted to address increased mortality among African Americans.

Prognostic variables for conditional survival in patients with esophageal squamous cell carcinoma who underwent minimally invasive surgery

BackgroundEsophageal squamous cell carcinoma (ESCC) survival is mainly reported at the time of treatment. Conditional survival is another prognostic tool to evaluate ESCC patients who has survived more than one year since treatment.MethodsWe analyzed data from 705 ESCC patients who underwent minimally invasive surgery between 2013 and 2016. Using the Kaplan–Meier method, we computed a 5-year relative conditional survival. We also investigated the prognostic factors associated with survival using Cox proportional hazards models.ResultsConditional survival improved over time for all cohorts of ESCC patients who survived a period after surgery. The greatest improve in conditional survival were observed in patients 2 years after surgery. In addition, the results of the Cox survival model from the time of surgery, T stage (p < 0.001), N stage (p < 0.001), and anastomotic leak (p = 0.022), were significantly associated with survival. However, the results of the Cox survival model from 2 years after surgery, N stage (p < 0.001), and anastomotic leak (p = 0.032) were significantly associated with survival.ConclusionFor ESCC patients who survived a period after surgery, the largest increases in conditional survival were observed in patients 2 years after surgery. We suggest that patients with anastomotic leakage and higher T and N stages should be strictly screened according to various time, and that conditional survival should be used as a powerful prognostic tool for ESCC patients.

Conditional survival estimates for merkel cell carcinoma reveal the dynamic nature of prognostication.

Conditional survival (CS) analysis has emerged as a dynamic prognostication methodology. The goal of this study was to determine disease-specific CS rates in Merkel cell carcinoma (MCC). This retrospective study included patients with MCC from the Surveillance Epidemiology and End Results (SEER) registry (1988-2016). Stage-specific 5-year MCC-specific CS rates for study and survivor cohorts were estimated, and the significance of clinicopathologic factors to predict 1-year MCC-specific death was evaluated using multivariate logistic regression. Within stage, 5-year CS survival rates improved with increasing survivorship. Pathologic Stage I patients had the highest 5-year CS rate at diagnosis (89.1%) but the smallest increase over time (96% among 5-year survivors). Stage IV patients experienced the greatest change in 5-year CS rates from 25.4% (at diagnosis) to 88% (5-year survivors). At diagnosis stage, age, sex, and primary site were all significantly associated with 1-year MCC-related death in the multivariate analysis. In contrast, among 5-year survivors only sex and age at diagnosis were significant predictors. MCC CS rates improved across all disease stages over time. Additionally, the relationships of prognostic factors with 1-year MCC-death changed with increasing survivorship. This perspective can provide a foundation for informed decision-making.

Body Mass Index Recovery after Lung Transplant for Cystic Fibrosis.

Rationale: Many lung transplant recipients with cystic fibrosis (CF) have low preoperative body mass index (BMI); however, post-transplant BMI recovery is not well understood. Objectives: To evaluate BMI recovery (⩾18.5 kg/m2) among CF lung transplant recipients with low preoperative BMI and to investigate the association of survival with BMI recovery. Methods: The United Network for Organ Sharing and CF Foundation patient registries (June 2005-December 2016) were used to identify CF lung transplant recipients. Among recipients surviving ⩾1 year, Cox modeling compared post-transplant 1-year conditional survival between recipients with low (<17 and 17-18.49 kg/m2) versus normal preoperative BMI, stratified by BMI recovery. Results: Of 1,977 CF lung transplant recipients, 272 (14%) and 449 (23%) had a preoperative BMI of <17 and 17-18.49 kg/m2, respectively. For subgroups with a BMI of <17 and 17-18.49 kg/m2, 29% versus 49%, respectively, of those alive at 1 year recovered their BMI. Among recipients with low preoperative BMI, adjusted post-transplant 1-year conditional survival was worse than that in those with preoperative BMI ⩾ 18.5 kg/m2; however, BMI recovery mitigated this. Preoperative BMI < 17 kg/m2 had an adjusted hazard ratio of 1.29 (95% confidence interval [CI], 0.92-1.81) with BMI recovery versus 1.57 (95% CI, 1.09-2.25) without recovery, and preoperative BMI 17-18.49 kg/m2 had an adjusted hazard ratio of 1.28 (95% CI, 1.02-1.61) with BMI recovery versus 1.72 (95% CI, 1.14-2.59) without recovery. Conclusions: Patients with lower preoperative BMI were less likely to achieve BMI recovery within 1 year. However, for those who did, BMI recovery within 1 year after transplant was associated with longer survival.

Conditional relative survival of patients with endometrial cancer: a Korean National Cancer Registry study.

ObjectiveThe purpose of this study was to estimate 5-year conditional relative survival (5Y CRS) rates of endometrial cancer (EC) in Korea accounting for time already survived. Subgroup-specific estimates stratified by various patient characteristics were also presented.MethodsUsing the data from the Korean Central Cancer Registry, 5Y CRS rates were calculated in patients who were diagnosed with EC between 1998 and 2017. The CRS rates were presented by year of diagnosis, age at diagnosis, histology, cancer stage, and treatment received.ResultsThe 5-year relative survival rate at the time of diagnosis was 89.0% for all cases. The probability of surviving an additional 5 years (i.e., 5Y CRS), if the patient survived 1, 2, 3, 4, and 5 years after diagnosis was 91.8%, 94.1%, 95.6%, 96.5%, and 97.3%, respectively. Patients with poor initial prognoses, i.e., those who were older, had non-endometrioid histology, and high stage, showed the largest improvements in 5Y CRS, reaching >90% for most subgroups, except those with serous histology (88.4%) and distant stage (77.7%). Patients aged ≥70 years had the highest probability of death in the 1st and 2nd years after diagnosis (13.8 and 11.0%), but the conditional probability of death in the 3rd, 4th, and 5th years declined rapidly to 7.3%, 4.5%, and 3.7%, respectively.ConclusionThe CRS rates for patients with EC improved with increased time elapsed from diagnosis. The greatest improvements in 5Y CRS were observed among patients who were older, those with non-endometrioid histology, and those with more advanced disease.

Survival prediction and conditional survival of primary central nervous system lymphoma: A population-based study

BackgroundPrimary central nervous system lymphoma is a rare and highly aggressive type of non-Hodgkin lymphoma. This study used population-based data to evaluate the clinical characteristics and prognostic factors of primary central nervous system lymphoma and develop a prediction model to estimate survival. MethodsPatients’ data were extracted from the Surveillance, Epidemiology, and End Results database. Significant prognostic factors were identified using univariate and multivariate Cox regression analyses. Conditional survival estimates were calculated as CS(x y) = S(x + y)/S(X), and a nomogram was built to predict patient prognosis. ResultsIn total, 2563 patients with primary central nervous system lymphoma were included. Multivariate Cox analysis showed that age at diagnosis, sex, histology, tumor site, surgery, chemotherapy, and marital status were independent prognostic factors of overall survival. The 1-year conditional survival increased with time, and our nomogram model showed favorable discriminative ability. ConclusionAt the population level, our study found that gross total resection and chemotherapy improved the prognosis of patients with primary central nervous system lymphoma. However, the prognosis of black patients was poor. Conditional survival provided a more accurate and dynamic survival estimate. Moreover, our nomogram had a good performance and could help predict the overall survival of these patients.

Impact of Tumor Burden Score on Conditional Survival after Curative-Intent Resection for Hepatocellular Carcinoma: A Multi-Institutional Analysis.

The impact of tumor burden score (TBS) on conditional survival (CS) among patients undergoing curative-intent resection of hepatocellular carcinoma (HCC) has not been examined to date. Patients who underwent liver resection of HCC between 2000 and 2017 were identified from a multi-institutional database. The impact of TBS and other clinicopathologic factors on 3-year conditional survival (CS3) was examined. Among 1,040 patients, 263 (25.3%) patients had low TBS, 668 (64.2%) had medium TBS and 109 (10.5%) had high TBS. TBS was strongly associated with OS; 5-year OS was 39.0% among patients with high TBS compared with 61.1% and 79.4% among patients with medium and low TBS, respectively (p < 0.001). While actuarial survival decreased as time elapsed from resection, CS increased over time irrespective of TBS. The largest differences between 3-year actuarial survival and CS3 were noted among patients with high TBS (5-years postoperatively; CS3: 78.7% vs. 3-year actuarial survival: 30.7%). The effect of adverse clinicopathologic factors including high TBS, poor/undifferentiated tumor grade, microvascular invasion, liver capsule involvement, and positive margins on prognosis decreased over time. CS rates among patients who underwent resection for HCC increased as patients survived additional years, irrespective of TBS. CS estimates can be used to provide important dynamic information relative to the changing survival probability after resection of HCC.

Conditional Survival and Annual Hazard Estimates of Classical Hodgkin Lymphoma.

BackgroundIn the present study, we have tried to understand how the level of risk and survival probability changes over time for patients with classical Hodgkin’s lymphoma by employing conditional survival and annual hazard as dynamic estimates of prognosis and survival.MethodsThis retrospective study reviewed the clinical data of patients with newly diagnosed classical Hodgkin’s lymphoma admitted to Peking University Cancer Hospital between January 1, 2008, and December 31, 2017. Conditional survival and annual hazard rate were defined as the survival probability and yearly event rate, respectively, assuming that patients have survived for a defined time.ResultsA total of 384 patients were included (median age, 32 years; range, 6–77 years), of which 218 (56.8%) patients had early-stage disease. The median follow-up time was 41.3 months. The 5-year conditional overall survival (COS) rates remained favorable and showed an increase from 89% at treatment to 94% at year 5, while the 5-year conditional failure-free survival (CFFS) rate increased from 70% at treatment to 96% at year 5. The annual hazard of failure decreased from over 15% at diagnosis to less than 5% after 3 years. Early-stage patients had constantly lower annual estimates for hazard of death (range, 0–3.0%) and failure (range, 0–14.3%). However, the hazard of failure in advanced-stage patients decreased from 24.2% at diagnosis to below 8% after 3 years, whereas the hazard of death was always at relatively low levels. Patients with a high IPS risk score (≥3) had significantly lower COS and CFFS during the first 4 years. Patients who received the BEACOPP regimen had better 5-year COS and 5-year CFFS than those who received the ABVD regimen.ConclusionThe survival probability increased and hazard of failure decreased over time.