Risk Of Mortality In Stage Research Articles

Early death incidence and prediction in stage IV large cell neuroendocrine carcinoma of the lung.

Nearly half of lung large cell neuroendocrine carcinoma (LCNEC) patients are diagnosed at an advanced stage and face a high early death risk. Our objective was to develop models for assessing early death risk in stage IV LCNEC patients. We used surveillance, epidemiology, and end results (SEER) databases to gather data on patients with stage IV LCNEC to construct models and conduct internal validation. Additionally, we collected a dataset from the Second Affiliated Hospital of Nanchang University for external validation. We used the Pearson correlation coefficient and variance inflation factor to identify collinearity among variables. Logistic regression analysis and least absolute shrinkage and selection operator analysis were employed to identify important independent prognostic factors. Prediction nomograms and network-based probability calculators were developed. The accuracy of the nomograms was evaluated using receiver operating characteristic curves. The goodness of fit of the nomograms was evaluated using the Hosmer-Lemeshow test and calibration curves. The clinical value of the models was assessed through decision curve analysis. We enrolled 816 patients from the surveillance, epidemiology, and end results database and randomly assigned them to a training group and a validation group at a 7:3 ratio. In the training group, we identified 9 factors closely associated with early death and included them in the prediction nomograms. The overall early death model achieved an area under the curve of 0.850 for the training group and 0.780 for the validation group. Regarding the cancer-specific early death model, the area under the curve was 0.853 for the training group and 0.769 for the validation group. The calibration curve and Hosmer-Lemeshow test both demonstrated a high level of consistency for the constructed nomograms. Additionally, decision curve analysis further confirmed the substantial clinical utility of the nomograms. We developed a reliable nomogram to predict the early mortality risk in stage IV LCNEC patients that can be a helpful tool for health care professionals to identify high-risk patients and create personalized treatment plans.

Recovery from Acute Kidney Injury and Long-Term Prognosis following Acute Myocardial Infarction.

We investigated the recovery pattern from acute kidney injury (AKI) following acute myocardial infarction (AMI) and its association with long-term mortality. The retrospective study included AMI patients (2002-2027), who developed AKI during hospitalization. Creatinine (Cr) measurements were collected and categorized into 24 h timeframes up to 7 days from AKI diagnosis. The following groups of recovery patterns were defined: rapid (24-48 h)/no rapid and early (72-144 h)/no early recovery. Specific cut-off points for recovery at each AKI stage and timeframe were determined through receiver operating characteristic (ROC) curves. The probability of long-term (up to 10 years) mortality as a post-AKI recovery was investigated using a survival approach. Out of 17,610 AMI patients, 1069 developed AKI. For stage 1 AKI, patients with a Cr ratio <1.5 at 24 h and/or <1.45 at 48 h were defined as 'rapid recovery'; for stages 2-3 AKI, a Cr ratio <2.5 at 96 h was defined as 'early recovery'. Mortality risk in stage 1 AKI was higher among the non-rapidly recovered: AdjHR = 1.407; 95% CI: 1.086-1.824; p = 0.010. Among stages 2-3 AKI patients, the risk for long-term mortality was higher among patients who did not recover in the early period: AdjHR = 1.742; 95% CI: 1.085-2.797; p = 0.022. The absence of rapid recovery in stage 1 AKI and lack of early recovery in stages 2-3 AKI are associated with higher long-term mortality.

Tailored mortality risk in stage I-II DTC patients by integrating ata stratification and response to initial therapy

Tailored mortality risk in stage I-II DTC patients by integrating ata stratification and response to initial therapy

Abstract 6315: Are a subset of patients at higher risk for mortality in stage III colon cancer: An analysis of the SEER database

Abstract Background: High-risk features (HRF) increase mortality for Stage II colon cancer (CC). These HRF include pathologic T4 disease, perineural invasion (PNI), lymphovascular invasion (LVI), an inadequate lymphadenectomy (less than 12 lymph nodes harvested) and poorly differentiated tumors. The presence of two or more HRF has an additive impact on survival for patients with Stage II CC. While T4 and disease greater than N1a raise the risk of mortality in Stage III CC, the effect of the other accepted HRF in patients with Stage III CC has not been studied. Materials and Methods: Surveillance, Epidemiology and End Results (SEER) (2010 - 2017) was used to identify patients with Stage III and IV CC. Patients with Stage III CC were then further classified by the presence of zero, 1, or 2 or more of the following HRF: pathologic T4, PNI, inadequate lymphadenectomy, or poor differentiation. Overall (OS) and cause-specific (CS) survival were calculated. Results: 57,640 patients with Stage III or IV CC were identified. 35,760 (62%) patients had Stage III disease and 21,880 (38%) had Stage IV disease. Among patients with Stage III disease, 16,733 (46.8%) had no HRF, 12,703 (35.5%) had 1 HRF and 6,324 (17.7%) had 2 or more HRF. For patients with 1 HRF, 4,610 (36.3%) had poor differentiation, 2,339 (18.4%) had PNI, 3,673 (28.9%) had T4 disease, and 2,078 (16.4%) had an inadequate nodal harvest. Patients with Stage III CC without HRF had the best OS (73.3%) and CS (81.4%,). This was followed by Stage III with 1 HRF (OS 63.7%, CS 71.6%) and Stage III with 2 or more HRF (OS 44%, CS 51%). Patients with Stage IV disease had the worst OS (18.1%) and CS (20.4%) (p&amp;lt;0.05). For patients with 1 HRF, pathologic T4 conferred worse OS (57.2%) and CS (63.2%), compared to PNI (OS 66.4%, CS 73.7%), inadequate lymphadenectomy (OS 64.6%, CS 74.9%) and poor differentiation (OS 66.6%, CS 75.4%) (p&amp;lt;0.01). Conclusion: HRF have a cumulative influence on OS and CS in patients with Stage III CC. The presence of multiple HRF should be considered higher risk for patients with Stage III disease. Citation Format: Luv N. Hajirawala, Yong Yi, Michelle A. Bergeron, Danielle A. Dooley, Guy R. Orangio, Elyse R. Bevier-Rawls, Kurt G. Davis, Jeffrey S. Barton. Are a subset of patients at higher risk for mortality in stage III colon cancer: An analysis of the SEER database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6315.

Malignant peritoneal cytology and increased mortality risk in stage I non-endometrioid endometrial cancer

ObjectiveTo examine the survival of women with stage I non-endometrioid endometrial cancer with malignant peritoneal cytology. MethodsA retrospective observational cohort study was conducted to examine the National Cancer Institute's Surveillance, Epidemiology, and End Results Program from 2010 to 2016. Women with stage I serous, clear cell, carcinosarcoma, undifferentiated, and mixed endometrial cancer with known peritoneal cytology results at hysterectomy were examined (N = 4506). Propensity score inverse probability of treatment weighting was used to balance the measured covariates, and survival outcomes were assessed according to peritoneal cytology results. ResultsMalignant peritoneal cytology was reported in 401 (8.9%) women. In multivariable analysis, older age, serous histology, and large tumors were associated with an increased likelihood of malignant peritoneal cytology (all, P < 0.05). In a propensity score weighted model, malignant peritoneal cytology was associated with a nearly two-fold increase in all-cause mortality risk compared to negative peritoneal cytology (5-year rates, 63.4% versus 80.2%, hazard ratio 2.18, 95% confidence interval 1.78–2.66). In sensitivity analyses, malignant peritoneal cytology was associated with decreased overall survival in old and young age groups, serous, clear cell, carcinosarcoma, and mixed histology groups, stage T1a disease, and staged and unstaged cases, but not for stage T1b disease. Difference in 5-year overall survival rates between the malignant and negative peritoneal cytology groups was particularly large among those with clear cell histology (24.0%), stage T1a disease (19.4%), aged >78 years (18.2%), and serous tumors (17.6%). ConclusionMalignant peritoneal cytology can be prevalent in stage I non-endometrioid endometrial cancer. Our study suggests that malignant peritoneal cytology is a prognostic factor for decreased survival in stage I non-endometrioid endometrial cancer.

Severe OSA associated with higher risk of mortality in stage III and IV lung cancer.

OSA has been associated with increased cancer incidence and mortality. The aim of this study was to investigate cancer-related mortality, overall survival, and progression-free survival in patients with suspected OSA and lung cancer. This was a case series analysis of lung cancer from a sleep cohort with suspected OSA between 2009 and 2014. The AHI, hypoxia index, and survival outcome were recorded. Immunohistochemistry was used to analyze hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor expression in tumor pathology. In the sleep cohort comprising 8,261 patients, a total of 23 patients had lung cancer. The incidence of lung cancer was significantly higher in the sleep cohort than in the entire adult population in Taiwan (crude incidence rate: 242.1 vs 51.5 per 10⁵ persons, P < .01). The 3-year cancer-related mortality was 25% in AHI < 15 events/h, 50% in AHI 15-29 events/h, and 80% in AHI ≥ 30 events/h (χ² test for trend, P = .03). In Kaplan-Meier survival analysis, patients with stage III-IV lung cancer and AHI < 30 events/h exhibited significantly better overall survival (P = .02) and progression-free survival (P = .02) than patients with severe OSA. Overexpression of HIF-1α and vascular endothelial growth factor was shown in 63% and 45% of lung tumor samples. Overexpression of HIF-1α was positively associated with AHI (P = .04). In this preliminary case series, severe OSA is associated with an increased risk of cancer mortality in patients with stage III-IV lung cancer. AHI was significantly associated with HIF-1α overexpression.

Individualized Prediction of Early Post-Treatment Mortality Risk in Stage I Non-Small Cell Lung Cancer: A Machine Learning-Based Approach

In stage I non-small cell lung cancer (NSCLC), the STARS/ROSEL pooled analysis showed worse overall survival (OS) but equivalent cancer-specific survival with surgical resection compared to stereotactic body radiation therapy (SBRT), with other studies demonstrating interaction effects between early post-treatment mortality and age. Therefore, appropriate patient selection is essential to optimize survival outcomes. We utilize predictive modeling using machine learning (ML) of mortality risk at 90 days post-treatment in stage I NSCLC patients. Patients with T1-T2aN0M0 NSCLC, diagnosed from 2004 to 2015, were identified using the National Cancer Database and divided into separate surgery and SBRT cohorts. All patients were censored 90 days after receipt of definitive treatment. Training and validation sets were formed by a randomized 80%/20% split. Features (age, histology, tumor size, and comorbidity score) were pre-specified based on predictors of post-treatment mortality identified in literature. Three different ML approaches were tested: 1) a Cox proportional hazards (CPH) linear model, 2) a survival Support Vector Machine (SVM) model, and 3) a gradient-boosted regression tree (GBRT) model using Cox proportional hazard loss. Hyperparameter tuning was performed manually using grid search techniques. Model performance was evaluated using Harrell’s concordance index (CI). Feature importance and interaction effects were modeled using Shapley additive explanations (SHAP) values applied to the GBRT model. The open-source scikit-survival library in Python 3.7 was used for all analyses. We identified 118,087 stage I NSCLC patients (81.0%) receiving surgery and 27,659 receiving SBRT (19.0%). Within the surgery cohort, the GBRT model had the best performance (CI=0.689), as compared to the SVM model (0.673) and CPH model (0.672). Within the SBRT cohort, similarly, the GBRT model performed the best (CI=0.591) compared to the SVM model (CI=0.572) and CPH model (0.570). Based on feature importance rankings, age had the highest importance in both the surgery and SBRT cohorts. When using SHAP values to model nonlinear interaction effects between age and treatment received, an inflection point was identified between age 73 and 74, indicating GBRT model predictions of generally greater 90-day post-treatment mortality with SBRT in patients age 18-73 and greater risk with surgery in patients age 74+. We describe a ML-based approach for analyzing comparative 90-day post-treatment mortality risk between surgery and SBRT in stage I NSCLC. We found an inflection point in the interaction between age and treatment modality, underscoring the need for patient selection when assessing treatment options. Our findings may aid individualized decision-making in early stage NSCLC.

Stage II Differentiated Thyroid Cancer Is a High-Risk Disease in Patients

The mortality risk of stage II differentiated thyroid cancer (DTC) based on the American Joint Committee on Cancer (AJCC) staging system requires further investigation. Retrospective study of DTC in the US Surveillance, Epidemiology, and End Results program for disease-specific mortality risk in various AJCC stages, with patient age stratification of stage II disease. Using AJCC staging system 6.0, hazard ratios (HRs) of mortality for stage II DTC in patients <45 yo and patients ≥45 yo and stages III, IVA, IVB, and IVC compared with stage I were 46.95, 4.95, 9.82, 57.37, 222.10, and 468.68, respectively, showing a robustly higher mortality risk in stage II disease in patients <45 yo than in older patients (P < 0.001), comparable with stage IVA (P = 0.482). Similar results were obtained with AJCC 7.0. With AJCC 8.0, HRs of mortality for stage II in patients <55 yo and patients ≥55 yo and stages III, IVA, and IVB compared with stage I were 75.16, 11.23, 69.45, 134.94, and 235.70, respectively, showing a robustly higher risk in stage II disease in patients <55 yo than in older patients (P < 0.001), comparable with stage III (P = 0.57). Kaplan-Meier survival curves displayed a sharp decline with stage II disease in patients <45/55 yo compared with older patients. The mortality risk of stage II DTC was sharply differentiated at patient age 45/55 years, being robustly high in younger patients and comparable with stage III/IVA. This emphasizes the importance of considering age when managing stage II DTC and not treating it as a uniformly low-risk disease.

The use of chemotherapy in older patients with stage II and III colon cancer: Variation by age and era of diagnosis.

We aim to examine the use and outcomes of adjuvant chemotherapy in older patients with stage II and III colon cancer. Using data from the SEER-Medicare database, we analyzed patients aged 66 or greater, diagnosed with stage II or III colon cancer between 1991 and 2007 who received surgery. Using Medicare claims, receipt of adjuvant chemotherapy was identified, and compared between age bands. Logistic regression modeling was performed to assess predictors of receipt of adjuvant chemotherapy, and Cox proportional hazards modeling was performed to assess predictors of mortality. A total of 31,990 patients were identified: 4371 aged 66-69, 6922 (70-74), 7673 (75-79), 6807 (80-84), 4266 (85-89), and 1951 (90+). The percent starting adjuvant chemotherapy decreased by age cohort: 57% in the 66-69 age cohort, 48% (70-74), 37% (75-79), 20% (80-84), 8% (85-89), and 1% (90+). Multivariable analysis showed that stage III disease was the strongest positive predictor of chemotherapy receipt. Multivariable analysis for mortality risk showed that adjuvant chemotherapy was associated with an increased risk of mortality in stage II patients. Adjuvant chemotherapy was associated with a decreased risk of mortality in stage III patients, consistent across all age cohorts, with the exception of the 90+ cohort, in whom adjuvant chemotherapy appeared to increase mortality. Administration of adjuvant chemotherapy for stage II/III colon cancer decreases with advancing age, but improved outcomes are seen in stage III patients under 90 years of age.

Utilization and Role of Adjuvant Radiotherapy and Chemotherapy for Uterine Clear Cell Carcinoma: A National Cancer Data Base Analysis.

Because of the rarity of uterine clear cell carcinoma (UCCC), a National Cancer Data Base analysis was conducted to evaluate practice patterns and implications of adjuvant therapy. The National Cancer Data Base was queried for UCCC patients diagnosed from 1998 to 2011. Patients receiving neoadjuvant therapy, lacking surgical staging, or having follow-up time shorter than 6 months were excluded. Factors associated with utilization were assessed using logistic regression. To define the probability of receiving chemotherapy and radiotherapy (CT + RT), propensity scores with inverse probability of treatment weighting (IPTW) were calculated using multivariable logistic regression. Log-rank test and multivariable IPTW-adjusted Cox proportional hazards modeling were then conducted. A total of 2504 patients were identified, with a median follow-up of 65.5 months. Most patients had FIGO (International Federation of Gynecology and Obstetrics) stage I to II UCCC (71.4%). Adjuvant RT alone, CT alone, or CT + RT was given in 35.3%, 9.5%, and 11.7%, respectively. Among those receiving RT, external beam was the most common modality (69.4%). Later year of diagnosis (>2005: odds ratio [OR], 4.42; 95% confidence interval [95% CI], 2.44-8.01), higher FIGO stage (IIIA-IIIC2: OR, 6.34; 95% CI, 3.93-10.24), larger tumor size (3.6-5.0 cm: OR, 3.40; 95% CI, 1.76-6.55), and lymph node dissection (OR, 4.22; 95% CI, 1.60-11.15) were associated with a higher chance of receiving CT + RT. With IPTW-adjusted multivariable analysis, CT + RT significantly decreased mortality risk in stage III to IVA patients (hazards ratio, 0.41; 95% CI, 0.22-0.77), trending toward benefit in stage I to II patients (hazards ratio, 0.53; 95% CI, 0.27-1.07). In this hospital-based registry analysis of UCCC, adjuvant CT + RT significantly reduced the risk of death, reaching statistical significance for stage III to IVA patients.

Abstract P3-09-01: Odds of the triple negative subtype and survival of stages 1–3 breast cancer: Variation by race/ethnicity

Abstract Background: Triple negative (TN) breast cancer is known to be more common in black and Hispanic women and associated with poor survival. This study assesses the differences in the odds and survival of the TN versus the ER+/PR+/HER2− (the most common subtype) by race/ethnicity separately for AJCC stages 1, 2, and 3. Methods: Using the California Cancer Registry for years 2000–2010, we examined 91,393 cases of stages 1–3 TN and ER+/PR+/HER2− first primary female invasive breast cancer. Race/ethnicity was defined as white, black, Hispanic, and Asian/Pacific Islander (API). Logistic regression was used to assess the association of race with odds of the TN subtype. Kaplan-Meier was used to compute 6-year survival. Cox proportional hazards was used to assess the risk of mortality of the TN subtype by race adjusting for age, grade, year of diagnosis, and socioeconomic status. All analyses were run separately for stages 1, 2, and 3. Results: The table shows the distribution of the TN and ER+/PR+/HER2-subtypes by stage and race/ethnicity. Blacks had increased odds of the TN compared with whites for stages 1 (OR = 2.24; 95%CI=1.96–2.56); 2 (OR = 2.01; 95%CI=1.81–2.25) and 3 (OR = 2.00; 95%CI=1.66–2.40). Hispanics had increased odds for the TN in stages 1 (OR = 1.23; 95%CI=1.11–1.35) and 2(OR = 1.20; 95%CI=1.11–1.31). APIs had decreased odds of the TN in stages 2 (OR = 0.85; 95%CI=0.77–0.93) and 3 (OR = 0.77; 95%CI=0.64–0.92). KM survival showed that APIs had the best 72 month survival for the TN in stages 1 (86%), 2 (78%), and 3(59%). Hazard ratios (HRs) indicated that all races with TN had the same risk of mortality in stage 1. Only in stage 2 did blacks have an increased risk of mortality (HR = 1.17; 95%CI=1.02–1.36) while APIs had a decreased risk (HR = 0.78; 95%CI=0.65–0.94). In stage 3, Hispanics (HR = 0.85; 95%CI=0.72–0.99) and APIs (HR = 0.70; 95%CI=0.55–0.89) had decreased risk of mortality compared with whites. Conclusions: Race/ethnicity is an important factor for survival of the TN subtype: 1. Although blacks and Hispanics are more likely to have the TN subtype, blacks have an increased risk of mortality compared with whites only in stage 2.2. For stage 1, all races have the same risk of mortality.3. Hispanics have decreased risk of mortality in stage 3.4. APIs have decreased risk of mortality in both stages 2 and 3. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-09-01.

Abstract P3-09-02: The HER2 –positive subtypes by stage and race/ethnicity

Abstract HER2-positivity is often associated with poor survival. The purpose of this study is to determine if there are differences in mortality among the HER-positive subtypes when stratified by stage and race/ethnicity. Methods: Using the California Cancer Registry for years 2000–2010, we examined 99,897 cases of stages 1–3 ER+/PR+/HER2− and all HER2-positive first primary female invasive breast cancers. Race/ethnicity was defined as white, black, Hispanic, and Asian/Pacific Islander (API). Kaplan-Meier (KM) and the Log-Rank test were used to compute 6-year survival. Cox proportional hazards was used to assess the risk of mortality of each of the HER2-positive subtypes when compared with the ER+/PR+/HER2− subtype (the most common subtype). All analyses were adjusted for age, grade, year of diagnosis (&amp;lt;2007, 2007+), and socioeconomic status and run separately by race for stages 1, 2, and 3. Results: For all stages combined, of the subtypes comprising the luminal B-HER2 positive category, the ER+/PR+/HER2+ had the best survival (85%), only 2% less than the ER+/PR+/HER2−. When compared with the ER+/PR+/HER2− subtype, no difference in KM survival was noted for stage 1 luminal B (ER+/PR+/HER2+;ER+/PR−/HER2+; ER−/PR+/HER2+). Both had 90% 72-month survival. The ER−/PR−/HER2+ had 88% survival (p &amp;lt; 0.02). For stage 2, luminal B had 83% survival and ER−/PR−/HER2+ had 76% survival. Both were significantly different (p &amp;lt; 0.001) from the ER+/PR+/HER2− subtype (86%). The luminal B had 68% survival and the ER−/PR−/HER2+ had 55% survival for stage 3. Both were statistically significantly worse (p &amp;lt;.006) than the ER+/PR+/HER2− (72%). Adjusted mortality for the ER+/PR+/HER2+ was only increased for blacks in stage 1 (HR = 1.59; 95%CI=1.09–2.33). Mortality for the ER−/PR−/HER2+ was increased for whites in all stages; for blacks in stages 1 (HR = 1.82; 95%CI=1.11–3.00) and 3 (HR = 1.90; 95%CI=1.36–2.66); for Hispanics in stages 2 (HR = 1.58; 95%CI=1.28–1.95) and 3 (HR = 2.19; 95%CI=1.73–2.78); and APIs only in stage 2 (HR = 1.70; 95%CI=1.31–2.19) Year of diagnosis made no difference in risk of mortality in stage 1 for any race. For stage 2, blacks had slightly reduced mortality if diagnosed in 2007 or later, and for stage 3, all races except blacks had reduced risk of mortality when diagnosed in 2007 or later. Conclusions: 1. There is variation in survival among the luminal B-HER2 positive subtypes.2. The driving force behind the increased mortality of the HER2 positive subtype is the ER−/PR−/HER2+ subtype, the molecularly defined HER2 overexpressing subtype.3. Year of diagnosis does not influence survival in stage 1 for any race.4. There are differences in mortality among the HER2 positive subtypes when stratifying by stage and race and adjusting for age, grade, year of diagnosis, and SES. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-09-02.

Prognostic Factors and Survival in Stomach Cancer – Analysis of 15 Years of Data from a Referral Hospital in Iran and Evaluation of International Variation

Background: Stomach cancer is the most common cancer among Iranian men. We studied survival rates and prognostic factors of stomach cancer in a referral hospital in Tehran, Iran. Patients and Methods: We followed 367 stomach cancer patients hospitalized between 1991 and 2007 in the Baqyiatallah Hospital. We estimated survival rates overall and among operable patients exclusively. Hazard ratios (HR) for the different prognostic factors were estimated with the Cox regression model. Furthermore, we studied international variations in stage distribution and 5year survival for stomach cancer. Results: Overall, 5year survival of stomach cancer was low (14%), and the majority of patients (53%) were diagnosed at stage IV. Stage, tumor size, age, and gender were statistically significant prognostic factors. Relative risk of mortality in stage IV compared to stage IA was 9.9 (95% confidence interval 5.8–16.9). The highest 5year survival was reported from Japan, particularly among screening detected patients (89.4%). Among operable patients, 5year survival was 32.6% in France, 26% in the USA, and 30.5% in China, which was close to the rates estimated in our study (24%). Conclusions: Due to stomach cancer being frequently diagnosed in advanced stages, its prognosis is poor in Iran. Early diagnosis and downstaging strategies need to be prioritized to improve the prognosis of stomach cancer.

Identifying factors associated with increased mortality risk in stage I NSCLC

Identifying factors associated with increased mortality risk in stage I NSCLC

Prognostic factors for survival of stage I nonsmall cell lung cancer patients

Platinum-based adjuvant chemotherapy in randomized trials has failed to provide a survival benefit in patients with resected stage I nonsmall cell lung cancer (NSCLC). Using data from the California Cancer Registry (CCR), we explored factors that had detrimental effects on survival in patients with stage I NSCLC to identify a subset of patients at high risk for disease recurrence and subsequent mortality. Between 1989 and 2003, 19,702 incident cases of stage I NSCLC in the CCR were identified and subgrouped into stage IA and IB disease. Patient demographic factors, tumor characteristics, and treatment delivered were examined. Kaplan-Meier survival curves were calculated to estimate survival rates. Cox proportional-hazards ratios were used to identify independent prognostic factors for survival. Advanced age at diagnosis, male sex, low socioeconomic status (SES), nonsurgical treatment, and poor histologic grade (stage IA NSCLC: hazards ratio [HR], 1.13; 95% confidence interval [95% CI], 1.08-1.19; stage IB NSCLC: HR, 1.11; 95% CI, 1.07-1.16) were associated with increased mortality risk on multivariate analysis. Non-upper lobe tumor location (right middle lobe, right and left lower lobes) and tumor size > or =4 cm (vs <4 cm: HR, 1.23; 95% CI, 1.15-1.30) were additional factors that increased the risk of mortality among patients with stage IB disease. Bronchioloalveolar carcinoma and Asian ethnicity were associated with decreased mortality risk in stage I NSCLC. Stage I NSCLC with poorly differentiated histology and stage IB NSCLC with non-upper lobar tumor location or tumor size > or =4 cm carried an increased mortality risk.

Mortality risk for stage I NSCLC with poor histologic grade, tumor size ≥4 cm, and non-upper lobe tumor location: An epidemiologic study of 19,702 patients in the California Cancer Registry from 1989 to 2003

7558 Background: Platinum-based adjuvant chemotherapy in randomized trials has failed to provide a survival benefit in stage I non-small-cell lung cancer (NSCLC). Using data from California Cancer Registry (CCR), we explored factors that have detrimental effect on survival in stage I NSCLC to identify a subset of patients at high risk for relapse and subsequent mortality. Methods: 19,702 stage I NSCLC cases in the CCR from 1989 to 2003 were identified and subgrouped into stage IA &amp; IB disease. Patient demographic factors, tumor characteristics and treatment delivered were examined. Kaplan-Meier survival curves were calculated to estimate survival rates. Cox proportional hazards ratios were used to identify independent prognostic factors for survival. Results: Advanced age at diagnosis, male sex, low socioeconomic status (SES), non-surgical treatment &amp; poorly-differentiated histologic grade (stage IA: hazard ratio [HR] = 1.14; 95% confidence interval [CI]: 1.08–1.19 &amp; stage IB: HR = 1.11; 95% CI: 1.07–1.16) were factors identified with increased mortality risk on multivariate analysis. Non-upper lobe tumor location (RML/RLL/LLL) and tumor size ≥ 4 cm (vs &lt; 4 cm; HR = 1.22; 95% CI: 1.15–1.30) were additional factors with increased mortality risk among stage IB patients. Conversely, bronchioloalveolar carcinoma (BAC)(vs adenocarcinoma: stage IA: HR = 0.81; 95% CI: 0.72–0.91 &amp; stage IB: HR = 0.87, 95% CI: 0.77–0.98) &amp; Asian ethnicity (vs Caucasian: stage IA: HR = 0.81, 95% CI: 0.70–0.94 &amp; stage IB: HR = 0.80, 95% CI: 0.72–0.90) were associated with decreased mortality risk in stage I NSCLC. Lobectomy had the lowest HRs for death among all surgical techniques for both stage IA &amp; IB NSCLC in the Cox proportional hazards model. Conclusions: Poorly-differentiated stage IA &amp; IB NSCLC and stage IB NSCLC located in non-upper lobes or tumor size ≥ 4 cm carried an increased mortality risk on adjusted analysis. No significant financial relationships to disclose. [Table: see text]