Age-specific Survival Research Articles

Life after breast cancer: ‘Being’ a young African American survivor

ABSTRACT Objective: In the United States, 26,534 young women (≤45 years) were diagnosed with breast cancer in 2017. Young African American (AA) women have higher incidence and mortality rates than Whites and Hispanics. Yet, few published studies describe survivorship (life after breast cancer diagnosis) experiences among this group. Here, we explore the lived experience of young AA breast cancer survivorship (via quality of life [QOL]). Design: This phenomenological study was framed by the QOL Applied to Breast Cancer model. Fifteen young AA survivors from the Southern U. S. participated in two semi-structured interviews. Methods of transcendental phenomenology were used for data collection and analysis. Results: Five themes emerged from participants’ (mean age = 35 years; survivorship = 4 years) descriptions of survivorship experience: (1) actively managing spiritual self, (2) actively managing physical self, (3) actively managing psychological self, (4) actively managing social self, and (5) seeking survivorship knowledge. Participants perceived survivorship as a labile ‘new normal’ and ‘ongoing struggle,’ in which spirituality and survivorship knowledge were key to restructuring their lives. Conclusions: Survivorship among young AA survivors was more fluid and complex than the QOL model explained. Findings describe young AA breast cancer survivorship and indicate areas of potential strengths and distress. Healthcare providers and ancillary staff must exercise cultural competence to assess and anticipate young AA survivors’ needs and concerns. Implementing targeted survivorship interventions, accounting for cultural contexts (e.g. high spirituality) and need for age-specific survivorship information, may improve QOL among young AA survivors.

Comparing ageing and the effects of diet supplementation in wild vs. captive antler flies, Protopiophila litigata.

Few studies have simultaneously compared ageing within genetically similar populations in both laboratory and natural environments. Such comparisons are important for interpreting laboratory studies, because factors such as diet could affect ageing in environment-dependent ways. Using a natural population of antler flies (Protopiophila litigata), we conducted separate factorial experiments in 2012 and 2013 that compared age-specific male survival and mating success in laboratory cages versus a natural field environment while supplementing their diets with protein or sugar. We found consistent and substantial increases in both survival and mating rates in the laboratory compared to the field, but remarkably, despite these large differences actuarial ageing was only higher in the laboratory than in the field in 2012 and similar in the two environments in 2013. In both years, there was no difference between environments in reproductive ageing. We found that males fed protein had a higher mortality rate than males fed sugar (strong and low support in 2012 and 2013, respectively). In contrast, diet did not strongly impact average mating rates, actuarial ageing or reproductive ageing in either experiment. Our results provide the first evidence that the negative effect of protein on life span reported in many laboratory studies can also occur in wild populations, although perhaps less consistently. They also highlight how laboratory environments can influence life-history traits and suggest caution when extrapolating from the laboratory to the field.

Contrasting consequences of climate change for migratory geese: Predation, density dependence and carryover effects offset benefits of high-arctic warming.

Climate change is most rapid in the Arctic, posing both benefits and challenges for migratory herbivores. However, population-dynamic responses to climate change are generally difficult to predict, due to concurrent changes in other trophic levels. Migratory species are also exposed to contrasting climate trends and density regimes over the annual cycle. Thus, determining how climate change impacts their population dynamics requires an understanding of how weather directly or indirectly (through trophic interactions and carryover effects) affects reproduction and survival across migratory stages, while accounting for density dependence. Here, we analyse the overall implications of climate change for a local non-hunted population of high-arctic Svalbard barnacle geese, Branta leucopsis, using 28years of individual-based data. By identifying the main drivers of reproductive stages (egg production, hatching and fledging) and age-specific survival rates, we quantify their impact on population growth. Recent climate change in Svalbard enhanced egg production and hatching success through positive effects of advanced spring onset (snow melt) and warmer summers (i.e. earlier vegetation green-up) respectively. Contrastingly, there was a strong temporal decline in fledging probability due to increased local abundance of the Arctic fox, the main predator. While weather during the non-breeding season influenced geese through a positive effect of temperature (UK wintering grounds) on adult survival and a positive carryover effect of rainfall (spring stopover site in Norway) on egg production, these covariates showed no temporal trends. However, density-dependent effects occurred throughout the annual cycle, and the steadily increasing total flyway population size caused negative trends in overwinter survival and carryover effects on egg production. The combination of density-dependent processes and direct and indirect climate change effects across life history stages appeared to stabilize local population size. Our study emphasizes the need for holistic approaches when studying population-dynamic responses to global change in migratory species.

Does grandparental care select for a longer lifespan in non-human mammals?

Abstract Several non-human mammalian species provide grandparental care but remain fertile until death, unlike our species. This might call into question the ‘grandmother hypothesis’ that the ability to provide grandparental care, associated with an increase in the cost of breeding with age, promote the early cessation of reproduction. Here, we analyse individual longevity records from non-human mammals to determine whether the few species with grandparental care also stand out among mammals in terms of age-specific survival patterns. Indeed, females of species with grandparental care lived on average 43% longer than males (range: 24–61%), compared with 12% in other polygynous species (95% quantile: −8 to 30%), because of low baseline mortality rates and delayed onset of actuarial senescence. We discuss this finding with respect to the ‘stopping early’ vs. ‘living longer’ debate. We review the role of the environmental context and of the decrease in offspring performance with maternal age (Lansing effect). We formalize the idea of a continuum of parental–grandparental allocation instead of a discrete switch to grandparental care only. Lastly, we suggest that the evolution of menopause has been driven by different forces in different species.

Partnership for defining the impact of 12 selected rare CNS tumors: a report from the CBTRUS and the NCI-CONNECT.

Population-based cancer statistics, including histology-specific incidence, prevalence, and survival are essential to evaluating the total burden due to disease in a population. The National Cancer Institute's (NCI) Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) was developed to better understand tumor biology and patient outcomes for 12 selected brain and other central nervous system (CNS) tumor histologies that are rare in adults to improve approaches to care and treatment. The aim of this study was to determine the incidence, prevalence, and survival of these selected rare histologies. Data from the Central Brain Tumor Registry of the United States (CBTRUS) from 2000 to 2014 were used to calculate average annual age-adjusted incidence rates (AAIR) per 100,000 population overall and by sex, race, ethnicity, and age. NCI's Surveillance, Epidemiology and End Results (SEER) data were used to calculate relative survival (RS) estimates. Point prevalence for 2014 was estimated using annual age-specific incidence and survival from CBTRUS and SEER, respectively. Overall AAIR was 1.47 per 100,000 for all 12 rare histologies combined, with the highest histology-specific incidence in oligodendrogliomas (AAIR = 0.40/100,000). Overall, most histologies were more common in males, adults (age 40 + ), Whites, and non-Hispanics. Ependymomas were the most prevalent histology at 4.11 per 100,000; followed by oligodendrogliomas at 3.68 per 100,000. Relative survival at 1-, 5-, and 10-years was 82.3%, 64.0%, and 55.4%, respectively for all 12 selected brain and other CNS tumor types combined. Ependymomas had the highest RS (1-year = 94.2%, 5-year = 83.9%, 10-year = 78.6%) and gliosarcomas had the lowest relative survival rate (1-year = 42.5%, 5-year = 5.6%, 10-year = 2.9%) at all three time points. Incidence and prevalence of these rare brain and other CNS tumor histologies have not been previously reported. Along with survival, these data provide a statistical foundation to understand the impact of these cancers and provide important disease-specific data for the design of prospective clinical trials.

Life expectancy and disparities in survival among HIV-infected people receiving antiretroviral therapy: an observational cohort study in Kathmandu, Nepal

IntroductionThe advent of antiretroviral therapy (ART) has dramatically slowed down the progression of HIV. This study assesses the disparities in survival, life expectancy and determinants of survival among HIV-infected people...

Outcome of Patients with Soft-Tissue Sarcomas: An Age-Specific Conditional Survival Analysis.

Soft-tissue sarcomas (STSs) are a group of rare cancers that can occur at any age. Prognostic outcomes of patients with STS are usually established at the time of the patient's initial disease presentation. Conditional survival affords a dynamic prediction of prognosis for patients surviving a given period after diagnosis. Estimates of conditional survival can provide crucial prognostic information for patients and caregivers, guide subsequent cancer follow-up schedules, and impact decisions regarding management. This study aims to estimate conditional survival and prognostic factors in patients with STS according to age at diagnosis (≤75 years and ≥75 years). A total of 6,043 patients with nonmetastatic STS at first diagnosis who underwent complete surgical resection (R0 or R1) were assessed. Cox proportional hazards regression was used to establish prognostic factors of conditional metastasis-free survival and overall survival at 1, 2, and 5 years after diagnosis. Elderly patients have more adverse prognostic features at presentation and tend to receive less aggressive treatment than do younger patients. However, at baseline as well as at each conditional survival time point, the 5-year estimated probability of metastatic relapse decreases in both young and elderly patients and is almost identical in both groups at 2 years and 5 years after initial diagnosis. Prognostic factors for metastatic relapse and death change as patient survival time increases in both young and elderly patients. Grade, the strongest prognostic factor for metastatic relapse and death at baseline, is no longer predictive of metastatic relapse in patients surviving 5 years after initial diagnosis. Leiomyosarcoma is the histological subtype associated with the highest risk of metastatic relapse and death in young patients surviving 5 years after initial diagnosis. The positive impact on the outcome of peri-operative treatments tends to decrease and disappears in patients surviving 5 years after initial diagnosis. Conditional survival estimates show clinically relevant variations according to time since first diagnosis in both young and elderly patients with STS. These results can help STS survivors adjust their view of the future and STS care providers plan patient follow-up. For patients with sarcoma who are followed up years after being treated for their disease, a common scenario is for the patient and caregivers to ask practitioners what the longer-term prognosis may be. The question posed to practitioners may be, "Doc, am I now cured? It's been 5 years since we finished treatment." Survival probability changes for patients who survive a given period of time after diagnosis, and their prognosis is more accurately described using conditional survival. By analyzing more than 6,000 sarcoma patients, an overall improvement was found in the risk of relapse as patients conditionally survive. Prognostic factors for metastatic relapse and death change as patient survival time increases in both young and elderly patients.

Integrating Multiple Data Types to Connect Ecological Theory and Data Among Levels

Ecological theories often encompass multiple levels of biological organization, such as genes, individuals, populations, and communities. Despite substantial progress toward ecological theory spanning multiple levels, ecological data rarely are connected in this way. This is unfortunate because different types of ecological data often emerge from the same underlying processes and, therefore, are naturally connected among levels. Here, we describe an approach to integrate data collected at multiple levels (e.g., individuals, populations) in a single statistical analysis. The resulting integrated models make full use of existing data and might strengthen links between statistical ecology and ecological models and theories that span multiple levels of organization. Integrated models are increasingly feasible due to recent advances in computational statistics, which allow fast calculations of multiple likelihoods that depend on complex mechanistic models. We discuss recently developed integrated models and outline a simple application using data on freshwater fishes in south-eastern Australia. Available data on freshwater fishes include population survey data, mark-recapture data, and individual growth trajectories. We use these data to estimate age-specific survival and reproduction from size-structured data, accounting for imperfect detection of individuals. Given that such parameter estimates would be infeasible without an integrated model, we argue that integrated models will strengthen ecological theory by connecting theoretical and mathematical models directly to empirical data. Although integrated models remain conceptually and computationally challenging, integrating ecological data among levels is likely to be an important step toward unifying ecology among levels.

Clinicopathological characteristics and treatment strategies for young lung cancer patients.

The reported age-specific survival rates of lung cancer patients have been largely inconsistent. Management strategies for younger patients and treatment outcomes are not well characterized. Out of the 4,697 lung cancer patients with treatment history at Tokyo Medical University Hospital between January 2000 and December 2014, 266 patients were <49 years of age. Patient characteristics were investigated, and the association of overall survival (OS) with age, sex, stage, and histological type were investigated. The 1-, 3-, and 5-year survival rates in the ≤49 years age group were 82.9%, 64.6%, and 57.0%. Among surgical cases, the survival rate of patients in the ≤49 years age group was significantly better than that in the 50-69 and ≥70 years age groups (P=0.29 and P<0.0001, respectively). In comparison with the OS rate with clinical stages, I, II, and III (but not with clinical stage IV) in the older than 50 years age group, the rates in the ≤49 years age group were better. The 1-, 3-, and 5-year OS rates of females were higher than those of their males. The 1-, 3-, and 5-year OS rates for lung adenocarcinoma patients were higher than that of lung non-adenocarcinoma patients. Despite the higher proportion of advanced disease, the postoperative survival rate of the younger was higher than that of the older. Aggressive multimodality treatments, including surgery, are more feasible and effective for younger patients as compared with that in older patients.

Genetically heterogeneous mice exhibit a female survival advantage that is age- and site-specific: Results from a large multi-site study.

The female survival advantage is a robust characteristic of human longevity. However, underlying mechanisms are not understood, and rodent models exhibiting a female advantage are lacking. Here, we report that the genetically heterogeneous (UM‐HET3) mice used by the National Institute on Aging Interventions Testing Program (ITP) are such a model. Analysis of age‐specific survival of 3,690 control ITP mice revealed a female survival advantage paralleling that of humans. As in humans, the female advantage in mice was greatest in early adulthood, peaking around 350 days of age and diminishing progressively thereafter. This persistent finding was observed at three geographically distinct sites and in six separate cohorts over a 10‐year period. Because males weigh more than females and bodyweight is often inversely related to lifespan, we examined sex differences in the relationship between bodyweight and survival. Although present in both sexes, the inverse relationship between bodyweight and longevity was much stronger in males, indicating that male mortality is more influenced by bodyweight than is female mortality. In addition, male survival varied more across site and cohort than female survival, suggesting greater resistance of females to environmental modulators of survival. Notably, at 24 months the relationship between bodyweight and longevity shifted from negative to positive in both sexes, similar to the human condition in advanced age. These results indicate that the UM‐HET3 mouse models the human female survival advantage and provide evidence for greater resilience of females to modulators of survival.

A natural history model for planning prostate cancer testing: Calibration and validation using Swedish registry data.

Recent prostate cancer screening trials have given conflicting results and it is unclear how to reduce prostate cancer mortality while minimising overdiagnosis and overtreatment. Prostate cancer testing is a partially observable process, and planning for testing requires either extrapolation from randomised controlled trials or, more flexibly, modelling of the cancer natural history. An existing US prostate cancer natural history model (Gulati et al, Biostatistics 2010;11:707-719) did not model for differences in survival between Gleason 6 and 7 cancers and predicted too few Gleason 7 cancers for contemporary Sweden. We re-implemented and re-calibrated the US model to Sweden. We extended the model to more finely describe the disease states, their time to biopsy-detectable cancer and prostate cancer survival. We first calibrated the model to the incidence rate ratio observed in the European Randomised Study of Screening for Prostate Cancer (ERSPC) together with age-specific cancer staging observed in the Stockholm PSA (prostate-specific antigen) and Biopsy Register; we then calibrated age-specific survival by disease states under contemporary testing and treatment using the Swedish National Prostate Cancer Register. After calibration, we were able to closely match observed prostate cancer incidence trends in Sweden. Assuming that patients detected at an earlier stage by screening receive a commensurate survival improvement, we find that the calibrated model replicates the observed mortality reduction in a simulation of ERSPC. Using the resulting model, we predicted incidence and mortality following the introduction of regular testing. Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55–69 years was predicted to reduce prostate cancer incidence by 14% and increase prostate cancer mortality by 2%. The model is open source and suitable for planning for effective prostate cancer screening into the future.

Long-term decline of juvenile survival in German Red Kites

The Red Kite (Milvus milvus) is a raptor species of conservation concern in Europe and especially in Germany, where about 50% of all breeding pairs are found. Agricultural intensification and deteriorating food availability, but also anthropogenic mortality due to poisoning and collisions, are major threats for the species throughout its strongly restricted distributional range. Despite the great influence of mortality on the population size of the long-lived Red Kite, information on current age-specific survival probabilities and their change over time is lacking. We analyse a long-term dataset of > 29,000 Red Kites marked with metal rings and about 1500 recoveries of dead birds from 1970 to 2015 with a multinomial ring-recovery model. We model age-dependent recovery probability, based on separate datasets of birds marked as nestlings and as adults/immatures, and thereby estimate juvenile, subadult and adult survival probability over nearly 50 years for a major part of the German Red Kite population. The results show a substantial long-term decline in juvenile survival of more than 40% from the 1970s until today. Furthermore, from 1974 to 2014, adult survival probability shows a consistently decreasing trend (− 0.26% year−1). We estimate the recovery probability for dead Red Kites in the first year (as juveniles) to be two times lower than that for birds that reach subadult/adult age. Also, the recovery probabilities of all age classes show a decreasing trend over time except for the last years. The spatial and temporal distributions of juvenile Red Kite recoveries suggest an increase in mortality at the breeding grounds, but in > 60% of cases the cause of death is unknown. The age-structured differences in recovery probability potentially highlight differences in the most important causes of mortality; however, further investigation of the cause of death in all ages classes is required to gain a more accurate picture. Our study provides valuable data for a better understanding of Red Kite demography and ongoing changes in population size.

Survival of Preterm Neonates and its Determinants in Teaching Hospitals of Addis Ababa University

Background: Practicing in a setting where survival of preterm labor is unknown and at best a guess is usually challenging particularly in counseling patients about the outcome of the preterm neonate. The objective of this study was to determine gestational age specific survival of preterm deliveries and its determinants in three teaching hospitals of Addis Ababa University College of health science. Methods: A prospective cross sectional descriptive study was conducted on newborns delivered from January 1 to June 30, 2017 before gestational age of 37 completed weeks at the three teaching hospitals. Results: Among 9927 neonates delivered during the study period, 415 (4.2%) were preterm. Of the preterm neonates 407 fulfill the inclusion criteria and analyzed. The cumulative survival rate for preterm babies at the three teaching hospitals is 74.4%. The survival rate of preterm neonates is zero %, 9.1%, 31.8%, 55.2%, 57.6%, 77.4%, 90.4%, 98.6% and 98.8% for GA of 28, 29, 30, 31, 32, 33, 34, 35, and 36 weeks respectively. Majority of neonatal deaths occurs with in the first 2 days (52.5%) and two third (67.1%) of the deaths occurs with in the first 3 days. Birth weight of 1500 grams or above (AOR 3.5, 95% CI 1.5-8.1, P <0.01), GA increment by one week (AOR 2.4, 95% CI 1.9-3.2, P<0.001) and married mother (AOR 3.9, 95% CI 1.2- 12 P< 0.05) are associated with a better chance of neonatal survival in this study. Neonates who required resuscitation after delivery have lower probability of survival (AOR 0.3, 95% CI 0.12-0.64, P< 0.01). Significant association were not found between neonatal outcome and sex of the neonate, parity, duration of labor, duration of ROM, preeclampsia, IUGR, administration of dexamethasone and other maternal socio demographic factors when adjusted for other confounding factors. Conclusion: Preterm neonates delivered prior to 31 weeks of GA have very low survival rate. So instead of iatrogenically delivering newborn prior to this GA, especially for fetal indication, efforts to push pregnancy at least till 31 weeks should be encouraged for better neonatal outcome. Critical attention should be paid on resuscitative intervention and the first 3 days of life to mitigate factors contributing to high preterm babies’ loss at this particular time. A study to assess the quality of care and cause of very low survival rate of preterm infants is recommended.

Bacterial diet and weak cadmium stress affect the survivability of Caenorhabditis elegans and its resistance to severe stress

Stress may have negative or positive effects in dependence of its intensity (hormesis). We studied this phenomenon in Caenorhabditis elegans by applying weak or severe abiotic (cadmium, CdCl2) and/or biotic stress (different bacterial diets) during cultivation/breeding of the worms and determining their developmental speed or survival and performing transcriptome profiling and RT-qPCR analyses to explore the genetic basis of the detected phenotypic differences. To specify weak or severe stress, developmental speed was measured at different cadmium concentrations, and survival assays were carried out on different bacterial species as feed for the worms. These studies showed that 0.1 μmol/L or 10 mmol/L of CdCl2 were weak or severe abiotic stressors, and that E. coli HT115 or Chitinophaga arvensicola feeding can be considered as weak or severe biotic stress. Extensive phenotypic studies on wild type (WT) and different signaling mutants (e.g., kgb-1Δ and pmk-1Δ) and genetic studies on WT revealed, inter alia, the following results. WT worms bred on E. coli OP50, which is a known cause of high lipid levels in the worms, showed high resistance to severe abiotic stress and elevated gene expression for protein biosynthesis. WT worms bred under weak biotic stress (E. coli HT115 feeding which causes lower lipid levels) showed an elevated resistance to severe biotic stress, elevated gene expression for the innate immune response and signaling but reduced gene expression for protein biosynthesis. WT worms bred under weak biotic and abiotic stress (E. coli HT115 feeding plus 0.1 μmol/L of CdCl2) showed high resistance to severe biotic stress, elevated expression of DAF-16 target genes (e.g., genes for small heat shock proteins) but further reduced gene expression for protein biosynthesis. WT worms bred under weak biotic but higher abiotic stress (E. coli HT115 feeding plus 10 μmol/L of CdCl2) showed re-intensified gene expression for the innate immune response, signaling, and protein biosynthesis, which, however, did not caused a higher resistance to severe biotic stress. E. coli OP50 feeding as well as weak abiotic and biotic stress during incubations also improved the age-specific survival probability of adult WT worms. Thus, this study showed that a bacterial diet resulting in higher levels of energy resources in the worms (E. coli OP50 feeding) or weak abiotic and biotic stress promote the resistance to severe abiotic or biotic stress and the age-specific survival probability of WT.

Trends in Colorectal Cancer Incidence and Survival in Iowa SEER Data: The Timing of It All

BackgroundColorectal cancer (CRC) is common worldwide, with 140,250 diagnoses and 50,630 deaths estimated for the United States in 2018. Guidelines current to the most recent individuals in our analysis suggested regular screenings beginning at age 50 have reduced the incidence of CRC. However, the incidence continues to rise among those under 50. Less is known about survival following CRC diagnosis, but research has suggested that younger cases may also have worse survival. However, we hypothesize that younger individuals are generally healthier with fewer comorbidities, leading to the potential for better survival following diagnosis. Materials and MethodsWe utilized the Surveillance, Epidemiology, and End Results data to estimate and assess both spatial and temporal variation in age-specific colorectal cancer incidence and survival in Iowa. ResultsBoth overall and older-onset colorectal cancer incidence began to decline in the early 2000s, whereas younger-onset incidences decreased until the late 1980s but then increased steeply through the 2000s. The risk for those younger than 50 years of age first exceeded the risk for those 50 years or older in 2007. Survival times did increase for overall CRC, older-onset CRC, and young-onset CRC throughout the study period, with young-onset CRC increasing at a higher rate. The spatial variation assessment indicated that the survival was positively associated with several variables of interest, most notably disparities including better access to healthcare and higher sociodemographic status. ConclusionIn conclusion, results suggest that regular colorectal screenings could reduce incidence and mortality in people under 50.

Life lived and left: Estimating age-specific survival in stable populations with unknown ages

Demographers sometimes observe remaining lifespans in populations of individuals of unknown age. Such populations may have an age structure that is approximately stable. To estimate life tables for these populations, it is useful to know the relationship b

Survival following rectal cancer surgery: does the age matter?

Introduction: Information regarding rectal cancer surgery outcomes and survival benefits in the elderly is sparse. Radical rectal surgery can be associated with substantial morbidity and mortality. We investigated age-specific survival for patients undergoing radical rectal surgery to determine outcomes in elderly patientsMethods: Over a 10-year period data on all patients who underwent rectal cancer surgery was performed. Patients were grouped according to age and eight other variables including cancer stage (Duke’s/TNM). Data analysed using computer program R. Kaplan–Meier survival curves estimated for age groups and compared using a modified log-rank permutation test. Survival curves fitted using Cox proportional hazard models and hazard ratios obtainedResults: About 374 patients underwent surgery. Survival percentages at 1 year by age group are 91.3% for age <50, and 75.5% for age >80. At 5 years these are 87.0% for age <50 and 57.1% for >80. Overall the variation among the survival curves for the age groups is significant (p < .001). The hazard ratio for over the 80+ with the age group <50 as the reference is 4.79 (95% CI: 1.44–15.92) and is significant (p = .011)Conclusion: Overall survival is significantly less in the elderly. There is a striking reduction in survival in >80 year olds in the first post-operative year. This study highlights that care must be taken in deciding whether radical surgery should be offered to those patients and careful consideration is given to allow the best overall survival and quality of life.

Stratified survival of resected and overall pancreatic cancer patients in Europe and the USA in the early twenty-first century: a large, international population-based study

BackgroundThe prognosis of pancreatic cancer (PaC) strongly varies across different stages and age groups, which has unfortunately not been well recorded in the literature. This international population-based study aimed to provide tumor-node-metastasis (TNM) stage- and age-specific survival estimates and trends in resected and overall (resected and unresected) PaC in the early twenty-first century.MethodsUsing data from the US Surveillance, Epidemiology, and End Results-18 Program and the national cancer registries of the Netherlands, Belgium, Norway, and Slovenia, short-term and long-term overall survival results stratified by TNM stage and age in resected and overall primary PaC, irrespective of being microscopically confirmed or not, in 2003–2014 were computed using the Kaplan-Meier method. The temporal survival trends over three predefined periods (2003–2005, 2006–2008, and 2009–2011) were further examined using the log-rank test.ResultsIn total, data for 125,183 patients were analyzed. Overall, age-stratified 3-year survival was 20–34% (< 60 years), 14–25% (60–69 years), and 9–13% (≥ 70 years) in stages I–II PaC; and 2–5% (< 60 years), 1–2% (60–69 years), and < 1–1% (≥ 70 years) in stages III–IV cancer. Patients who underwent operation had higher 3-year survival in each stage and age group (stages I–II: 23–39% (< 60 years), 16–31% (60–69 years), and 17–30% (≥ 70 years); stages III–IV: 5–19% (< 70 years) and 2–14% (≥ 70 years)). Perioperative survival also decreased with advancing stage and older age (stages I–II: 98–100% (< 60 years), 97–99% (60–69 years), and 94–99% (≥ 70 years); stages III–IV: 94–99% (< 70 years) and 81–96% (≥ 70 years)). Between 2003 and 2005 and 2009–2011, for overall PaC, both short-term and long-term survival improvements were observed in all countries except Belgium; for resected disease, short-term improvements were present only in the USA and Slovenia, but long-term improvements were observed in all countries except Slovenia, with stage-specific variations.ConclusionsOur large international study provides TNM stage- and age-specific population-based survival in overall and resected PaC that will facilitate clinical counseling. While the survival expectations for patients with resected PaC are substantially higher than the widely available and known dismal survival predictions for overall patients, conclusions on the benefits of resection cannot be made from this observational study. Patients with advanced-stage disease and/or older age should undergo careful risk assessment before treatment. Limited but inspiring improvement in survival is observed.

Rectal cancer patients younger than 50 years lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease.

The incidence of rectal cancer in patients younger than 50 years is increasing. To test the hypothesis that the biology in this younger cohort may differ, this study compared survival patterns, stratifying patients according to National Comprehensive Cancer Network (NCCN) guideline-driven care and age. The National Cancer Data Base was queried for patients treated with curative-intent transabdominal resections with negative surgical margins for stage I to III rectal cancer between 2004 and 2014. Outcomes and overall survival for patients younger than 50 years and patients 50 years old or older were compared by subgroups based on NCCN guideline-driven care. A total of 43,106 patients were analyzed. Younger patients were more likely to be female and minorities, to be diagnosed at a higher stage, and to have travelled further to be treated at academic/integrated centers. Short- and long-term outcomes were significantly better for patients younger than 50 years, with age-specific survival rates calculated. Younger patients were more likely to receive radiation treatment outside NCCN guidelines for stage I disease. In younger patients, the administration of neoadjuvant chemoradiation for stage II and III disease was not associated with an overall survival benefit. Age-specific survival data for patients with rectal cancer treated with curative intent do not support an overall survival benefit from NCCN guideline-driven therapy for stage II and III patients younger than 50 years. These data suggest that early-onset disease may differ biologically and in its response to multimodality therapy.

Fecundity and Egg Laying in Helicoverpa armigera (Lepidoptera: Noctuidae): Model Development and Field Validation.

Models can be useful to help understand population dynamics of insects under diverse environmental conditions and in developing strategies to better manage pest species. Adult longevity and fecundity of Helicoverpa armigera (Hübner) were evaluated against a wide range of constant temperatures (15, 20, 25, 30, 35, and 37.5°C). The modified Sharpe and DeMichele model described adult aging rate and was used to estimate adult physiological age. Maximum fecundity of H. armigera was 973 eggs per female at 25°C decreasing to 72 eggs per female at 37.5°C. The relationship between adult fecundity and temperature was well described by an extreme value function. Age-specific cumulative oviposition rate and age-specific survival rate were well described by a two-parameter Weibull function and sigmoid function, respectively. An oviposition model was developed using three temperature-dependent components: total fecundity, age-specific oviposition rate, and age-specific survival rate. The oviposition model was validated against independent field data and described the pattern of field occurrence of H. armigera egg numbers very well. Our model will be a useful component for population modeling of H. armigera and can be independently used for the timing of sprays in management programs targeting this key pest species.