Five-year Conditional Survival Research Articles

Survival characteristics of Wilms Tumor, a reference developed from a longitudinal cohort study

BackgroundWilms tumor (WT) survival has been affected by the evolution in clinical and biological prognostic factors. Significant differences in survival rates indicate the need for further efforts to reduce these disparities. This study aims to evaluate the clinicopathological data impact on survival among patients after Wilm's diagnosis.MethodsThe study utilized the SEERStat Database to identify Wilms tumor patients, applying SEERStat software version 8.3.9.2 for data extraction. Selection criteria involved specific codes based on the International Classification of Diseases for Oncology (ICDO-3), excluding cases with unknown SEER stage, incomplete survival data, unknown size, or lymph node status. Statistical analyses, including Kaplan–Meier estimates and Cox regression models, were conducted using R software version 3.5. Standardized mortality ratios (SMR) were computed with SEER*Stat software, and relative and conditional survival analyses were performed to evaluate long-term survival outcomes.ResultsOf 2273 patients diagnosed with Wilms tumor, (1219 patients, 53.6% were females with an average age group of 3–8 years (50.2%). The overall mean survival after five years of diagnosis was 93.6% (2.6–94.7), and the overall mean survival rate was 92.5% (91.3–93.8) after ten years of diagnosis. Renal cancers were identified as the leading cause of death (77.3%), followed by nonrenal cancers (11%) and noncancer causes (11%). Additionally, robust relative survival rates of 98.10%, 92.80%, and 91.3% at one, five, and ten years, respectively, were observed, with corresponding five-year conditional survival rates indicating an increasing likelihood of survival with each additional year post-diagnosis. Univariate Cox regression identified significant prognostic factors: superior CSS for patients below 3 years (cHR 0.48) and poorer CSS for those older than 15 years (cHR 2.72), distant spread (cHR 10.24), regional spread (cHR 3.09), and unknown stage (cHR 4.97). In the multivariate model, age was not a significant predictor, but distant spread (aHR 9.22), regional spread (aHR 2.84), and unknown stage (aHR 4.98) were associated with worse CSS compared to localized tumors.ConclusionThis study delving into WT survival dynamics reveals a multifaceted landscape influenced by clinicopathological variables. This comprehensive understanding emphasizes the imperative for ongoing research and personalized interventions to refine survival rates and address nuanced challenges across age, stage, and tumor spread in WT patients.

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.

Impact of primary diagnosis on survival after heart transplant in female recipients of childbearing age: an analysis of the International Society for Heart and Lung Transplantation (ISHLT) Registry

Abstract Background Women undergoing heart transplantation (HT) for peripartum cardiomyopathy (PPCM) have been reported to have inferior post-transplant survival. Specific data on the impact of pre-transplant diagnosis on survival in female HT recipients of childbearing age are lacking, but important for pre-conception counseling of women considering a pregnancy. Methods Retrospective data analysis was conducted using the ISHLT Registry. The primary aim was to study the impact of pre-transplant diagnosis and alloimmunisation on post-transplant survival in women aged 15–45 yrs at time of HT. Secondary outcomes included the impact of primary diagnosis on conditional survival at 5, 10 and 15-yrs post HT. Results Of 121,501 HT recipients (Jan 1992–June 2018), 30,179 (24.8%) were women. 9,229 (7.6%) were 15–45 yrs at time of HT. Peripartum cardiomyopathy (PPCM) and congenital heart diseases (CHD) was the primary diagnosis in 8.9% and 9.3%, respectively. Overall median post-transplant survival was 15.2 yrs. Female with PPCM were associated with higher alloimmunisation (Figure 1). PPCM was associated with lower survival (median survival in PPCM vs CHD vs other: 9.1 years vs 15.2 years vs 15.5 years respectively, p&amp;lt;0.05). This was not entirely explained by higher alloimmunisation in this group (Figure 2A). Five-year conditional survival of recipients of childbearing age was significantly affected by primary diagnosis of PPCM, and by pediatric status at HT, defined as age &amp;lt;18-yrs (PPCM vs other diagnosis p&amp;lt;0.05; pediatric vs non-pediatric p 0.003), whilst 10- and 15-year conditional survival was not. The difference in 5-year conditional outcome between PPCM and other diagnosis, was not significant however when female recipients were grouped according to their level of alloimmunisation (Figure 2B). Conclusion PPCM as the primary indication for HT is associated with a worse post HT survival. Our data suggest that this is not entirely explained by alloimmunisation. The impact of previous PPCM appears to be greatest in the first 5 yrs post HT. Further research is needed to fully elucidate the mechanisms associated with worse survival in this group and help inform pre-conception counseling in those HT recipients considering a subsequent pregnancy. Funding Acknowledgement Type of funding sources: None.

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.

Tools for survivorship care planning in uterine serous carcinoma (497)

Tools for survivorship care planning in uterine serous carcinoma (497)

Textbook Outcome as a Quality Metric in Living and Deceased Donor Kidney Transplantation.

BACKGROUND:Quality in kidney transplantation is measured using 1-year patient and graft survival. Because 1-year patient and graft survival exceed 95%, this metric fails to measure a spectrum of quality. Textbook outcomes (TO) are a composite quality metric offering greater depth and resolution. We studied TO after living donor (LD) and deceased donor (DD) kidney transplantation.STUDY DESIGN:United Network for Organ Sharing data for 69,165 transplant recipients between 2013 and 2017 were analyzed. TO was defined as patient and graft survival of 1 year or greater, 1-year glomerular filtration rate of greater than 40 mL/min, absence of delayed graft function, length of stay of 5 days or less, no readmissions during the first 6 months, and no episodes of rejection during the first year after transplantation. Bivariate analysis identified characteristics associated with TO, and covariates were incorporated into multivariable models. Five-year conditional survival was measured, and center TO rates were corrected for case complexity to allow center-level comparisons.RESULTS:The national average TO rates were 54.1% and 31.7% for LD and DD transplant recipients. The hazard ratio for death at 5 years for recipients who did not experience TO was 1.92 (95% CI 1.68 to 2.18, p ≤ 0.0001) for LD transplant recipients and 2.08 (95% CI 1.93 to 2.24, p ≤ 0.0001) for DD transplant recipients. Center-level comparisons identify 18% and 24% of centers under-performing in LD and DD transplantation. High rates of TO do not correlate with transplantation center volume.CONCLUSION:Kidney transplant recipients who experience TO have superior long-term survival. Textbook outcomes add value to the current standards of 1-year patient and graft survival.

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.

Textbook Outcome as a Quality Metric in Liver Transplantation.

Background.Quality in liver transplantation (LT) is currently measured using 1-y patient and graft survival. Because patient and graft survival rates now exceed 90%, more informative metrics are needed. Textbook outcomes (TOs) describe ideal patient outcomes after surgery. This study critically evaluates TO as a quality metric in LT.Methods.United Network for Organ Sharing data for 25 887 adult LT recipients were used to define TO as patient and graft survival >1 y, length of stay ≤10 d, 0 readmissions within 6 mo, absence of rejection, and bilirubin <3 mg/dL between months 2 and 12 post-LT. Univariate analysis identified donor and recipient characteristics associated with TO. Covariates were analyzed using purposeful selection to construct a multivariable model, and impactful variables were incorporated as linear predictors into a nomogram. Five-year conditional survival was tested, and center TO rates were corrected for case complexity to allow for center-level comparisons.Results.The national average TO rate is 37.4% (95% confidence interval, 36.8%-38.0%). The hazard ratio for death at 5 y for patients who do not experience TO is 1.22 (95% confidence interval, 1.11-1.34; P ≤ 0.0001). Our nomogram predicts TO with a C-statistic of 0.68. Center-level comparisons identify 31% of centers as high performing and 21% of centers as below average. High rates of TO correlate only weakly with center volume.Conclusions.The composite quality metric of TO after LT incorporates holistic outcome measures and is an important measure of quality in addition to 1-y patient and graft survival.

Impact of stage and grade on conditional survival in 173,211 women with endometrioid endometrial carcinoma

<h3>Objectives:</h3> Survival is often discussed in terms of five-year survival. However, conditional survival expresses the probability of survival as a function of time already survived. The purpose of this study was to investigate the impact of stage and grade on overall survival, conditional survival and relative mortality risk in women with endometrioid endometrial carcinoma (EEC). <h3>Methods:</h3> Eligible participants were diagnosed following surgery with low grade (LG)-EEC (grade 1/2) or high grade (HG)-EEC (grade 3) between 2004 and 2014 in the National Cancer Database. Survival was compared by stage with log-rank test and with multivariate Cox modeling in LG-EEC or HG-EEC. Five-year conditional survival was evaluated by stage using Kaplan-Meier method in women with LG-EEC or HG-EEC who survived 1 to 5 years after diagnosis. Standardized mortality ratio (SMR) defined as the ratio of observed to expected number of deaths was estimated based on the mortality risk of general US population matched by age and race. <h3>Results:</h3> There were 147,944 women with LG-EEC (85.9% stage I, 5.7% stage II, 7.4% stage III, 1.0% stage IV) and 25,267 with HG-EEC (57.4% stage I, 8.7% stage II, 24.7% stage III, 9.3% stage IV). Stage was an independent poor prognostic factor in LG-EEC and HG-EEC (Fig. 1A). Adjusted HR was 1.67, 2.88 and 7.25 for stage II, III and IV vs. I LG-EEC and 1.78, 3.20 and 6.73 for stage II, III and IV vs I HG-EEC, respectively (<i>P<0.0001</i>). Five-year conditional survival for women with stage I, II or III LG-EEC or with stage I HG-EEC changed minimally after surviving at least 1 and up through 5 years (Fig. 1B). In contrast, five-year conditional survival improved in women with stage IV LG-EEC from 48.7% to 58.1% and 69.4% after surviving 2 and 4 years, and in women with stage II HG-EEC from 65.4% to 73.8% and 80.4% after surviving 3 and 5 years, respectively (Fig. 1B). More rapid and incremental improvements in conditional survival occurred after surviving 1, 2, 3 and 5-years for women with either stage III HG-EEC (52.4% to 57.2%, 64.7%, 69.2% and 75.3%) or stage IV HG-EEC (24.9% to 35.7%, 49.2%, 63.4% and 75.0%, respectively (Fig. 1B). SMR represents the age- and race-matched mortality risk of a member in the cohort compared with the general population. The change in SMR over time mirrored the change in conditional survival and dropped from 10.73 to 5.37 in women with stage IV LG-EEC, 4.08 to 2.33 with stage II HG-EEC, 7.34 to 3.27 with stage III HG-EEC and 19.50 to 3.42 with stage IV HG-EEC after surviving 5 years (Fig. 1C). <h3>Conclusions:</h3> Prognosis for EEC improves over time in almost all groups with the most significant improvement in women with advanced stage and high-grade disease. Conditional survival provides clinicians and patients with an informative incremental recalibration in prognosis during the milestones of survivorship advancing shared decision-making across the continuum of care regarding treatment and surveillance.

Mechanically Supported Early Graft Failure After Heart Transplantation

BackgroundThe occurrence of early graft failure (EGF) after heart transplantation (Htx) often requires a mechanical circulatory support (MCS) therapy. The aims of our study were to identify risk factors of mechanically supported severe EGF and evaluate their impact on both early and late outcomes. MethodsBetween January 2000 and December 2019, 499 consecutive adult patients underwent Htx at our institution. Severe EGF was defined as the need for extracorporeal life support (ECLS) within 24 hours after surgery. All available recipient and donor variables were retrospectively analyzed. ResultsOverall, EGF occurred in 58 (11.6%) patients. Post-Htx peripheral or central ECLS was necessary in 32 (6.4%) cases. Independent predictors of severe EGF were, in the recipient group, preoperative transpulmonary gradient (TPG) >12 mm Hg (odds ratio [OR] 4.1, P = .013), preoperative inotropic score >10 (OR 7.3, P = .0001), and pre-Htx ECLS support (OR 5.2, P = .015), while in the donors, a Eurotransplant donor score ≥17 (OR 8.5, P = .005). The absence of EGF was related with a better survival at 1 year and 5 years (94% and 85%, respectively) compared with EGF requiring ECLS population (36% and 28% at 1 year and 5 years, respectively; P < .001). A five-year conditional survival rate did not differ significantly (85% no EGF vs 83% EGF requiring ECLS). ConclusionBoth donor and recipient factors may influence EGF occurrence. Post-Htx ECLS may impact negatively early; however, patients weaned from ECLS eventually benefit from such a rescue treatment with outcomes comparable with Htx patients who did not suffer EGF.

Conditional Survival Analysis for Spinal Chondrosarcoma Patients After Surgical Resection.

Retrospective analysis. To evaluate conditional survival after surgical resection for spinal chondrosarcoma patients. Survival estimates are usually reported as survival from the time of surgery, but survival probabilities can change over time. Conditional survival, which is a measure of prognosis for patients who have survived a defined period of time, may be more clinically precise and relevant. However, data on conditional survival for spinal chondrosarcoma patients after surgical resection are still lacking. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify 436 spinal chondrosarcoma patients who underwent surgical resection from 1994 and 2013. Kaplan-Meier analyses and Cox regression modeling were performed to evaluate prognostic factors associated with overall survival. Five-year conditional survival (i.e., probability of surviving an additional 5 years, given that a patient has already survived x years) was calculated as 5-CS(x) = OS(x+5)/OS(x). The effect of prognostic factors on conditional survival was also explored. Four hundred thirty six patients were included in the study cohort. Overall, 1-, 3-, and 5-year overall survival were 92.8%, 79.1%, and 70.3%, respectively. Five-year conditional survival at 1, 3, and 5 years after surgery were 72.9%, 79.0%, and 87.5%. The overall survival rates were lower in cases of age more than or equal to 60 years, male patient, dedifferentiated subtype, Grade III tumor, tumor size more than or equal to 10 cm, distant metastasis, and radiotherapy. Conditional survival improved over time in each subgroup divided by age, sex, race, year of diagnosis, grade, tumor size, extent of disease (EOD), and radiotherapy. In addition, patients with the least favorable prognosis at baseline experienced the greatest increase in 5-year conditional survival over time (e.g., Grade I/II: 78.0%-89.7%, Δ11.7% vs. Grade III: 36.5%-66.6%, Δ30.1%; Localized/Regional: 72.9%-88.1%, Δ15.2% vs. Distant: 43.5%-74.1%, Δ30.6%). Conditional survival for spinal chondrosarcoma patients after surgical resection improves over time, especially for patients with initial high-risk characteristics. Information derived from conditional survival analysis may provide individualized approaches to surveillance and treatment of spinal chondrosarcoma. 4.

Colorectal cancer liver metastases (crlm) resection: Multidisciplinary specialized care increases 5-year conditional survival

Presenter: Jaime Kruger MD | Hospital das Clinicas - University of Sao Paulo Background: Half of patients bearing colorectal tumors are expected to develop liver metastases at some point of their disease. Liver resection is considered the best treatment in order to achieve long-term survival and, sometimes, cure. Along the past two decades 5-year survival has increased after liver resection, mostly due to improved surgical and oncological care. Our institution incorporated a dedicated cancer center during it`s experience on the management of CRLM and witnessed the impact of multidisciplinary specialized care on the survival of patients operated for CRLM. Beyond cumulative survival curves, conditional survival is an interesting tool as it describes expected survival during follow-up, a forward-looking information. We sought to evaluate overall and five-year conditional survival of consecutive patients operated for the treatment of CRLM at the Liver Surgery Unit – Hospital das Clinicas – University of Sao Paulo after the institution of a specialized multidisciplinary cancer center. Methods: Retrospective analysis comparing two institutional periods in the management of CRLM. Consecutive patients undergoing liver resection with curative intent and histologically confirmed diagnosis of MHCR, between January 2000 and December 2015 (follow up until December 2018). ERA 1 corresponded to the initial experience (January 2000 through February 2009) and ERA 2 (March 2009 to December 2015) corresponded to the period after the adoption of specialized oncologic multidisciplinary care. Demographic profile, oncological data, operative outcomes and survival analysis were performed, including 5-year conditional survival. Results: 383 patients were submitted to 402 hepatectomies, 98 patients were operated during ERA 1 and 285 during ERA 2. During ERA 1 patients presented higher levels of CEA (177.0 ng/dL vs. 70.3 ng/dL p<0.001), greater mean size of the largest resected tumor (47.5 mm vs. 33.9 mm p<0.001). In ERA 2 there were more synchronous (70.0% vs. 58.5% p=0.041), bilobar (22.3% vs. 34.8% p=0.025) and multinodular CRLM (22.8% vs. 11.5% p=0.031). During ERA2 exposure to preoperative chemotherapy was more frequent (77.3% vs. 34.1% p<0.001), predominantly oxaliplatin based. Operative results indicated that ERA 2 employed mostly minor (65.9% vs. 42.6% p<0.001) and non-anatomical resections (40.7% vs.12.8% p<0.001). Operative complications (ERA 1 32.3% vs. ERA 2 36.3% p=0.481) and overall mortality were similar between studied periods. Surgical margins did not vary significantly between ERAS. Median follow up was 42.0 months for the whole cohort (ERA1 35.5 months; ERA2 43.0 months). Overall survival in 5 years was 34.5% for ERA 1 and 48.0% for ERA 2 (p=0.011). During follow up years 1 to 5, 5-year conditional survival varied from 35.0% to 62.0% in ERA 1 and from 45.9% to 63.6% in ERA 2. being greater in every follow up year in ERA 2. Conclusion: The changes along time in the multidisciplinary specialized care to CRLM resulted in increased overall and conditional survival in ERA 2.

Redefining Conditional Overall and Disease-Free Survival After Curative Resection for Intrahepatic Cholangiocarcinoma: a Multi-institutional, International Study of 1221 patients

ObjectivesTo assess conditional survival (CS) according to recurrence status, as well as conditional disease-free survival (cDFS) among patients with intrahepatic cholangiocarcinoma (ICC). MethodsCS and cDFS were evaluated among ICC patients who underwent curative-intent resection for ICC by using a multi-institutional database. Five-year CS (CS5) at “x” years was calculated separately for patients who did and did not experience recurrence. The cDFS3 at “x” years was defined as the chance to be disease-free for an additional 3 years after not having experienced a recurrence for “x” years postoperatively. ResultsAmong 1221 patients, median OS was 36.8 months. While estimated actuarial OS decreased over time, CS5 increased as patients survived over longer periods of time and reached 93.9% at 4 years among 139 patients who did not experience a recurrence. Among the 725 (59.4%) patients who did experience a tumor recurrence, CS5 decreased to 17.7% the first postoperative year; however, CS5 subsequently increased to 79.7% for 81 patients who had survived 4 years after surgery. While actuarial DFS decreased from 54.6% at 1 year to 28.2% at 5 years, estimated cDFS3 following liver resection increased over time. Of note, patients with known risk factors for recurrence had even more marked improvements in cDFS3 over subsequent years versus patients without risk factors for recurrence. ConclusionCS and cDFS changed over time according to the presence of disease-specific risk factors, as well as the presence of recurrence.

Changing odds of survival over time among patients undergoing surgical resection of extremity soft tissue sarcoma.

While survival after surgical treatment of extremity soft tissue sarcoma (STS) is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant as it accounts for time already survived. We compared actuarial survival and CS of STS patients. We analyzed 567 patients who underwent surgery for localized extremity STS. Actuarial survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to evaluate factors associated with disease-specific survival. Five-year CS (CS5) estimates at "χ" year(s) after surgery were calculated as CS5 = S(χ + 5)/S(χ). Whereas actuarial survival decreased over time, CS5 increased. The postsurgical 1-, 3-, and 5-year CS5 values were 84.5%, 90.0%, and 93.8%, respectively, whereas the 6-, 8-, and 10-year actuarial survival rates were 82.0%, 79.4%, and 78.5%, respectively. The calculated CS5 exceeded actuarial survival especially in patients with risk factors such as large tumor size and Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grades 2 and 3 tumors. Patients with tumor size ≥5 cm had an actuarial survival of 73.9% at 10 years compared to a CS5 of 95.4% in patients alive at 5 years. Likewise, patients with FNCLCC grade 3 tumors had an actuarial survival of 71.1% at 10 years compared to a CS5 of 96.0% in patients alive at 5 years. Survival estimation by determination of CS can be dynamic and accurate especially in high-risk patients. CS can be useful for survival prediction and clinical decision making in extremity STS patients.

Conditional survival for pediatric and adolescent patients with cancer: Implications for survivorship care

PurposeFew studies have evaluated conditional survival (probability of surviving y years given patients have already survived x years) for pediatric/adolescent patients diagnosed with cancer. To provide more accurate information on ongoing survival, we evaluate conditional survival for pediatric and adolescent patients with cancer. MethodsThe statewide Utah Cancer Registry identified 3344 patients born in Utah diagnosed with cancer at ages 0–21 years, from 1973 to 2009. The Utah Population Database provided demographic information. We estimated five-year conditional survival at diagnosis, and one and three years after diagnosis, by risk factors such as cancer type, sex, diagnosis age and treatment era (1973–1994 vs. 1995–2009). ResultsConditional survival estimates at one (85.1%, 95% CI: 83.7–86.5) and three years (92.9%, 95% CI: 91.8–93.9) after diagnosis were significantly higher than survival at diagnosis (77.2%, 95% CI: 75.6–78.9), although results varied by cancer type and initial prognosis. Diagnosis age affected survival for cancers where age is a risk factor. For example, five-year survival at one year after diagnosis was higher for younger (≤18 months of age) patients compared to older (>18 months) patients with neuroblastoma (95.4%, 95% CI: 90.9–99.9 vs. 56.8%, 95% CI: 41.8–71.7, p<0.001). Conditional survival improved over time for many cancers. Minimal differences were observed by sex. ConclusionSubstantial improvements were observed in conditional survival at one and three years after diagnosis compared with survival at diagnosis. Several risk factors affected these outcomes. Clearer understandings of survival will help in administering effective survivorship care and decreasing prognosis-related anxiety/stress for patients and families.

Conditional Survival Among Patients With Carcinoma of the Lung

One- and 5-year probabilities of survival or death change once a patient has already survived > or = 1 year after diagnosis. The current paper reports these probabilities for lung cancer patients according to histologic subtype, stage, and age at diagnosis. Cumulative observed survival rates were calculated and compared among 95,283 patients with histologically confirmed lung cancer (diagnosed from 1983 to 1992 and followed through 1995) by the life-table method using population-based tumor registries participating in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. On the basis of the cumulative survival estimates, we derived the probability of death in the next year, conditioned on having already survived to the start of the year (annual hazards), and the probability of survival conditioned on having already survived > or = 1 year (conditional survival). These rates were reported according to histologic subtype, stage, and age groups. At the time of diagnosis, annual hazard rates differ greatly among histologic subtypes. However, by 5 years after diagnosis, the rates become similar. Bronchioloalveolar carcinoma displays the lowest annual hazards and small-cell carcinoma displays the highest annual hazards. Stage-age subcategories within histologic subtypes continue to show large differences in annual hazard rates. Five-year conditional survival probabilities are also reported, providing survival information that is consistent to that obtained from the annual hazards. One- and 5-year prognosis for lung cancer patients is influenced by years already survived and histology, stage, and age at diagnosis. Annual hazards and conditional survival provides useful and more relevant information than conventional survival estimates for patients and their physicians. These statistics can be directly obtained from cumulative survival estimates and should be more widely reported.