Other-cause Survival Research Articles

Post-radical gastrectomy long-term survival and etiologies of mortalities in older adult patients greater than 80years of age with gastric cancer.

Patients aged >80-years-old with gastric cancer are commonly excluded from clinical trials, and no consensus exists regarding surgical indications and outcomes in older patients. In this study, we analyzed the post-gastrectomy long-term survival and etiologies of mortality in older patients with gastric cancer. Patients aged >80-years-old with pathological stages I-III primary gastric cancer who undergone radical gastrectomies, between May 2006 and March 2017, were included in the study. Eligible patients were categorized into 3 age cohorts: <85-, 85-90-, and >90-years-old. The primary outcome was the overall survival. The etiologies of mortalities were compared. Survival curves were compared using the log-rank test. Prognostic factors were identified by multivariate analysis, using the Cox proportional hazards regression model. The median follow-up duration was 59months. Of the 353 patients, 269 (76.2%), 71 (20.1%), and 13 (3.7%) were categorized into the <85-, 85-90-, >90-years-old age cohorts, respectively. Older patients had a poorer overall survival (p=0.003) and statistically significant difference in the other-cause survival (p<0.001). The multivariate analysis revealed that age was not an independent prognostic factor for overall or cancer-specific survival. However, an age >90-years-old was an independent prognostic factor for the other-cause survival. In patients aged >80-years-old with gastric cancer who had undergone gastrectomies, mortalities from other diseases increased with age; while mortalities from gastric cancer did not. An age of ≥90-years-old was an independent prognostic factor for mortalities from other diseases.

Impact of preoperative prealbumin levels on long-term prognosis in patients with gastric cancer after gastrectomy: a retrospective cohort study.

The relationship between preoperative prealbumin levels and long-term prognoses in patients with gastric cancer after gastrectomy has not been fully investigated. This study clarified the effect of preoperative prealbumin levels on the long-term prognosis of patients with gastric cancer after gastrectomy. This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStage I-III gastric cancer and whose preoperative prealbumin levels were measured between May 2006 and March 2017. Participants were categorized according to their preoperative prealbumin levels into high (≥22mg/dL), moderate (15-22mg/dL), and low (<15mg/dL) groups. The overall survival (OS) in the three groups was compared using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis. The median follow-up duration was 66months. Of 4732 patients, 3649 (77.2%) were classified as high, 925 (19.6%) as moderate, and 158 (3.3%) as low. Lower prealbumin levels were associated with poorer prognoses (P<0.001). Multivariate analysis showed that prealbumin levels of 15-22mg/dL [hazard ratio (HR): 1.576, 95% confidence interval (CI): 1.353-1.835, P<0.001] and <15mg/dL (HR: 1.769, 95% CI: 1.376-2.276, P<0.001) were independent poor prognostic factors for OS. When analyzed according to the cause of death, prealbumin levels were associated with other-cause survival, but not cancer-specific survival. Preoperative prealbumin levels correlated with OS in patients with gastric cancer after gastrectomy; the lower the prealbumin level, the worse is the prognosis. Prealbumin levels may be associated with other-cause survival.

Fair comparisons of cause-specific and relative survival by accounting for the systematic removal of patients from risk-sets

BackgroundIn population-based cancer studies it is common to try to isolate the impact of cancer by estimating net survival. Net survival is defined as the probability of surviving cancer in the absence of any other-causes of death. Net survival can be estimated either in the cause-specific or relative survival framework. Cause-specific survival considers deaths from the cancer as the event of interest. Relative survival incorporates general population expected mortality rates to represent the other-cause mortality rate. Estimation approaches in both frameworks are impacted by the systematic removal of patients from the risk-set, commonly referred to as informative censoring in the cause-specific framework. In the relative survival framework, the Pohar Perme estimator combats the effect of this systematic removal of patients through weighting. When the two frameworks have been compared, informative censoring is rarely accounted for in the cause-specific framework. MethodsWe investigate the use of weighted cause-specific Kaplan-Meier estimates to overcome the impact of informative censoring and compared approaches to defining weights. Individuals remaining in the risk-set are upweighted using their predicted other-cause survival obtained through various model-based approaches. We also compare weights derived from expected mortality rates. We applied the approaches to US cancer registry data and conducted a simulation study. ResultsUsing weighted cause-specific estimates provides a better estimate of marginal net survival. The unweighted Kaplan-Meier estimates have a similar bias to the Ederer II method for relative survival. Weighted Kaplan-Meier estimates are unbiased and similar to the Pohar Perme estimator. There was little variation between the several weighting approaches. ConclusionIn comparisons of cause-specific and relative survival, it is important to compare “like-with-like”, therefore, a weighted approach should be considered for both frameworks. If researchers are interested in obtaining net measures in a cause-specific framework, then weighting is needed to account for informative censoring.

Impact of Preoperative Nutritional Assessment on Other-Cause Survival after Gastrectomy in Patients with Gastric Cancer.

This study aimed to clarify the factors associated with death due to other diseases after a gastrectomy for gastric cancer. This retrospective cohort study included consecutive patients who had undergone gastrectomy between April 2008 and June 2018 for primary stage II-III gastric cancer. The primary outcome was other-cause survival. To identify prognostic factors for other-cause survival for univariate analysis, we used a Cox proportional hazard regression model. A total of 512 patients met the inclusion criteria. The average age was 67.93 years, and the average body mass index was 22.75 kg/m2, with 84 (16.4%) being moderately malnourished and 88 (17.2%) being severely malnourished, as defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria. The other-cause survival for the malnourished group was significantly worse than that for the normal group (p < 0.001). The prognosis was worse when the severity of malnutrition was worse (p < 0.001). Multivariate analysis showed that severe malnutrition was significantly independent of prognostic factors for other-cause survival (hazard ratio: 3.310; 95% confidence interval: 1.426-7.682; p = 0.005). Undernutrition, as defined by the GLIM criteria, is useful for the preoperative prediction of death due to other diseases after gastrectomy in patients with advanced gastric cancer.

A New Personalized Oral Cancer Survival Calculator to Estimate Risk of Death From Both Oral Cancer and Other Causes

Standard cancer prognosis models typically do not include much specificity in characterizing competing illnesses or general health status when providing prognosis estimates, limiting their utility for individuals, who must consider their cancer in the context of their overall health. This is especially true for patients with oral cancer, who frequently have competing illnesses. To describe a statistical framework and accompanying new publicly available calculator that provides personalized estimates of the probability of a patient surviving or dying from cancer or other causes, using oral cancer as the first data set. The models used data from the Surveillance, Epidemiology, and End Results (SEER) 18 registry (2000 to 2011), SEER-Medicare linked files, and the National Health Interview Survey (NHIS) (1986 to 2009). Statistical methods developed to calculate natural life expectancy in the absence of the cancer, cancer-specific survival, and other-cause survival were applied to oral cancer data and internally validated with 10-fold cross-validation. Eligible participants were aged between 20 and 94 years with oral squamous cell carcinoma. Histologically confirmed oral cancer, general health status, smoking, and selected serious comorbid conditions. Probabilities of surviving or dying from the cancer or from other causes, and life expectancy in the absence of the cancer. A total of 22 392 patients with oral squamous cell carcinoma (13 544 male [60.5%]; 1476 Asian and Pacific Islander [6.7%]; 1792 Black [8.0%], 1589 Hispanic [7.2%], 17 300 White [78.1%]) and 402 626 NHIS interviewees were included in this calculator designed for public use for patients ages 20 to 86 years with newly diagnosed oral cancer to obtain estimates of health status-adjusted age, life expectancy in the absence of the cancer, and the probability of surviving, dying from the cancer, or dying from other causes within 1 to 10 years after diagnosis. The models in the calculator estimated that patients with oral cancer have a higher risk of death from other causes than their matched US population, and that this risk increases by stage. The models developed for the calculator demonstrate that survival estimates that exclude the effects of coexisting conditions can lead to underestimates or overestimates of survival. This new calculator approach will be broadly applicable for developing future prognostic models of cancer and noncancer aspects of a person's health in other cancers; as registries develop more linkages, available covariates will become broader, strengthening future tools.

MP22-12 THE ASSOCIATION OF BASELINE FRAILTY WITH SURVIVAL AMONG OLDER ADULTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP22-12 THE ASSOCIATION OF BASELINE FRAILTY WITH SURVIVAL AMONG OLDER ADULTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER John Ernandez, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, MA Boston, Simon Kim, Joaquim Bellmunt, Nima Aghdam, Aria Olumi, Dae Kim, and Boris Gershman John ErnandezJohn Ernandez More articles by this author , Sumedh KaulSumedh Kaul More articles by this author , Aaron FleishmanAaron Fleishman More articles by this author , Ruslan KoretsRuslan Korets More articles by this author , Peter ChangPeter Chang More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , MA BostonMA Boston More articles by this author , Simon KimSimon Kim More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Nima AghdamNima Aghdam More articles by this author , Aria OlumiAria Olumi More articles by this author , Dae KimDae Kim More articles by this author , and Boris GershmanBoris Gershman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty is increasingly recognized as an important component of geriatric assessment in older adults and an important predictor of clinical outcomes. We hypothesized that baseline frailty is an independent predictor of survival for older adults undergoing radical cystectomy (RC) for bladder cancer. Herein, we examined the associations of a validated, claims-based frailty index (CFI) with survival in a large, population-based cohort. METHODS: Using the SEER-Medicare linked database, we identified older adults aged 66-89 years diagnosed with Tany Nany cM0 urothelial carcinoma of the bladder from 2000-2017 who underwent RC. Baseline CFI was calculated using a 12-month pre-diagnosis period. The associations of CFI with survival outcomes were assessed using the Kaplan-Meier method and Cox multivariable regression. RESULTS: A total of 5,916 patients were included in the study cohort, including 3,389 who were robust (CFI <0.15), 2,247 who were pre-frail (CFI 0.15 to <0.25), 232 who were mildly frail (CFI 0.25 to <0.35), and 48 who were moderately-to-severely frail (CFI ≥0.35). Median follow-up was 37.0 (IQR 16.0-84.0) months. During follow-up, a total of 3,998 deaths occurred. Before adjustment, increasing level of frailty as reflected by the CFI was associated with worse cancer-specific survival (Figure 1), other-cause survival and overall survival. In multivariable modelling, increasing CFI was independently associated with worse overall, cancer-specific, and other-cause survival (Table 1). CONCLUSIONS: Among older adults undergoing RC for bladder cancer, increasing baseline frailty as measured by the CFI was associated with worse survival outcomes, even after adjustment for patient and tumor characteristics. The CFI may be a useful tool for identifying at-risk older adults undergoing RC for bladder cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e301 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Ernandez More articles by this author Sumedh Kaul More articles by this author Aaron Fleishman More articles by this author Ruslan Korets More articles by this author Peter Chang More articles by this author Andrew Wagner More articles by this author MA Boston More articles by this author Simon Kim More articles by this author Joaquim Bellmunt More articles by this author Nima Aghdam More articles by this author Aria Olumi More articles by this author Dae Kim More articles by this author Boris Gershman More articles by this author Expand All Advertisement PDF downloadLoading ...

The impact of the preoperative hand grip strength on the long-term outcomes after gastrectomy for advanced gastric cancer.

The correlation of the hand grip strength (HGS) and long-term outcomes after gastrectomy for gastric cancer patients is unknown. This study reveals the impact of the pre-operative HGS on the post-operative survival in gastric cancer patients. This study is a retrospective cohort of consecutive patients who underwent gastrectomy for primary p-T2 (MP) or more advanced gastric cancer from September 2014 to April 2018 with records of pre-operative HGS. The high and low HGS groups were compared by Kaplan-Meier survival analyses for the overall survival (OS), cancer-specific survival (CSS), other-cause survival (OCS), and disease-free survival (DFS). Of the 96 patients, 35 (36.5%) were in the low HGS group, and 61 (63.5%) were in the high HGS group. The OS was significantly worse in the low HGS group than in the high HGS group (P = 0.013). There was no marked difference in the CSS (P = 0.214) or DFS (P = 0.675) between the groups, but the OCS was worse in the low HGS group than in the high HGS group (P = 0.029). Multivariate analyses of the prognostic factors concluded that a low HGS (P = 0.031) and open surgery (P = 0.011) were significant independent factors. A low pre-operative HGS is an independent predictor of a poor prognosis after gastrectomy for patients with advanced gastric cancer and may increase the risk of other causes of death.

Impact of Laterality on Cumulative Survival in Patients Diagnosed with Retinoblastoma: A Retrospective Cohort Analysis of 1925 Cases in the Surveillance, Epidemiology, and End Results (SEER) Program.

BackgroundRetinoblastoma is an intraocular cancer with potentially severe clinical consequences if left untreated. Diagnostic and clinical management guidelines are strictly dependent on nature of laterality. This analysis aims to characterize the influence of laterality on survival in patients diagnosed with retinoblastoma.MethodsThis retrospective cohort analysis utilized the Surveillance, Epidemiology, and End Results (SEER) program for population-based clinical data from 1975 to 2016, a period of 41 years. Univariable and multivariable Cox regression assessed survival with laterality as the primary independent predictor of mortality. Adjustment for demographical and clinical variables was performed.ResultsN = 1925 patients with a valid cause of death classification. Mean±SD age was 2.35±2.020 years (range 0–74). At the time of diagnosis, 819 (42.1%) patients were between 0 and 1 year of age, 469 (24.1%) patients were between 1 and 2 years, 350 (18.0%) patients were between 2 and 3 years, 147 (7.6%) patients were between 3 and 4 years, and 68 (3.5%) patients were between 4 and 5 years of age. The hazard of univariable cause-specific death is 55.6% and 52.9% lower for retinoblastoma patients with left-sided origin and right-sided origin as compared to patients with bilateral origin, respectively (HR = 0.444, CI 0.247–0.800, p = 0.007; HR = 0.471, CI 0.267–0.832, p = 0.009). After adjusting for confounding variables, the hazard of other-cause death for retinoblastoma patients is significantly less for left-sided origin (HR = 0.364, CI 0.140–0.946, p = 0.038) and right-sided origin (HR = 0.190, CI 0.066–0.549, p = 0.002) as compared to patients with retinoblastomas of bilateral origin.ConclusionPrognostication of survival is significantly influenced by the nature of laterality in retinoblastoma. Unilateral retinoblastomas showcase increased promise for long-term cause-specific and other-cause survival compared to cases of retinoblastoma arising from bilateral origin.

Prostate Cancer Survival and Mortality according to a 13-year retrospective cohort study in Brazil: Competing-Risk Analysis.

To analyze cancer-specific mortality (CSM) and other-cause mortality (OCM) among patients with prostate cancer that initiated treatment in the Brazilian Unified Health System (SUS), between 2002 and 2010, in Brazil. Retrospective observational study that used the National Oncological Database, which was developed by record-linkage techniques used to integrate data from SUS Information Systems, namely: Outpatient (SIA-SUS), Hospital (SIH-SUS), and Mortality (SIM-SUS). Cancer-specific and other-cause survival probabilities were estimated by the time elapsed between the date of the first treatment until the patients' deaths or the end of the study, from 2002 until 2015. The Fine-Gray model for competing risk was used to estimate factors associated with patients' risk of death. Of the 112,856 studied patients, the average age was 70.5 years, 21% died due to prostate cancer, and 25% due to other causes. Specific survival in 160 months was 75%, and other-cause survival was 67%. For CSM, the main factors associated with patients' risk of death were: stage IV (AHR = 2.91; 95%CI 2.73 - 3.11), systemic treatment (AHR = 2.10; 95%CI 2.00 - 2.22), and combined surgery (AHR = 2.30, 95%CI 2.18 - 2.42). As for OCM, the main factors associated with patients' risk of death were age and comorbidities. The analyzed patients with prostate cancer were older and died mainly from other causes, probably due to the presence of comorbidities associated with the tumor.

Other and All-Cause Mortality among Men Diagnosed with Prostate Cancer in the PLCO Trial

Men with prostate cancer have high cause-specific survival, and most deaths are from other causes. This study aimed to investigate other and all-cause mortality in a large cancer screening cohort. From the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial cohort, we selected men diagnosed with prostate cancer from 1994-2014. We examined other and all-cause survival by prostate cancer risk level, defined as the D'Amico categories for localized disease (low, intermediate and high risk) plus nonlocalized disease. We developed 3 Cox proportional hazards models to assess the relationship between risk level and survival. Model I controlled for age, race, study arm and diagnosis year. Model II additionally controlled for other demographic and medical history factors. Model III additionally controlled for initial treatment. Of 76,672 men in PLCO and 10,859 prostate cancer cases, 9,248 (85.2%) had known prostate cancer risk level (mean±SD age 70.4±6.2 years). Median followup time from diagnosis was 10.8 years (IQR 6.8-15.0). Of 3,318 deaths 81% were from other causes. Compared to the low risk group, other-cause mortality HRs were 1.13 (95% CI 1.04-1.23), 1.35 (95% CI 1.21-1.50) and 1.63 (95% CI 1.35-1.97) for intermediate risk, high risk and advanced disease, respectively, in model II. Model III HRs were similar to model II except for advanced disease, where the HR decreased to 1.35. Other-cause survival was greater in lower vs higher risk disease, even after controlling for lifestyle characteristics and comorbidities. Further research is needed to identify factors contributing to this higher other-cause mortality to help mitigate the risk.

Dose Escalation for Prostate Adenocarcinoma: A Long-Term Update on the Outcomes of a Phase 3, Single Institution Randomized Clinical Trial

To determine the long-term outcomes for prostate adenocarcinoma when escalating radiation dose from 70Gy to 78Gy. Between 1993 and 1998, 301 patients with biopsy-proven clinical stage T1b-T3 prostate adenocarcinoma, any prostate-specific antigen level, and any Gleason score were randomized to 70Gy in 35 fractions versus 78Gy in 39 fractions of photon radiation therapy using a 4-field box technique without hormone deprivation therapy. The primary outcome was powered to detect a 15% difference in biochemical or clinical failure. Secondary outcomes included survival, prostate cancer mortality, biochemical failure, local failure, nodal failure, distant failure, and secondary malignancy rates. With a median follow-up of 14.3years, the cumulative incidence of 15-year biochemical or clinical failure was 18.9% versus 12.0% in the 70Gy versus 78Gy arms, respectively (subhazard ratio [sHR], 0.61; 95% confidence interval [CI], 0.38-0.98; Fine-Gray P=.042). The 15-year cumulative incidence of distant metastasis was 3.4% versus 1.1%, respectively (sHR, 0.33; 95% CI, 0.13-0.82; Fine-Gray P=.018). The 15-year cumulative incidence of prostate cancer-specific mortality was 6.2% versus 3.2%, respectively, (sHR, 0.52; 95% CI, 0.27-0.98; Fine-Gray P=.045). There were no differences in overall survival (HR, 1.10; 95% CI, 0.84-1.45; log rank P=.469) or other-cause survival (sHR, 1.33; 95% CI, 0.99-1.79; Fine-Gray P=.061). Salvage therapy was more common in the 70Gy arm, at 38.7% versus 21.9% in the 78Gy arm (P=.002). There was a 2.3% secondary solid malignancy rate (1 bladder, 6 rectal) within the radiation treatment field, which was not significantly different between treatment arms. Dose escalation by 8Gy (78Gy vs 70Gy) provided a sustained improvement in biochemical and clinical failure, which translated into lower salvage rates and improved prostate cancer-specific mortality, but not overall survival. Long-term follow-up demonstrated a low incidence of potential solid tumor secondary malignancies.

Age-adjusted Charlson Comorbidity Index as a prognostic factor for radical prostatectomy outcomes of very high-risk prostate cancer patients.

PurposeProstate cancer (PC) is a devastating and heterogeneous condition with diverse treatment options. When selecting treatments for patients with very high-risk PC, clinicians must consider patient comorbidities. We investigated the efficacy of the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for patient outcomes after radical prostatectomy (RP).Materials and methodsWe retrospectively investigated the medical records of PC patients at our institution who underwent RP from 1992 to 2010. Very high-risk PC was defined according to National Comprehensive Cancer Network guidelines. Patients with incomplete medical records or who had received neoadjuvant therapy were excluded. Preoperative comorbidity was evaluated by the ACCI, and the prognostic efficacy of the ACCI was analyzed using univariable and multivariable Cox regression, competing risk regression model and Kaplan-Meier curves.ResultsOur final analysis included 228 men with a median age of 66 years (interquartile range 62–71) and median prostate specific antigen of 10.7 ng/mL. There were 41 (18%) patients with an ACCI score >3 and 88 (38.6%) patients with a biopsy Gleason score >8. Preoperative evaluation revealed that 159 patients (69.7%) had a non-organ confined tumor (≥T3). Following RP, 8-year prostate cancer-specific survival (PCSS) and overall survival (OS) rates were 91.6% and 83.4%, respectively. Competing risk regression analysis revealed that ACCI was significantly associated with other-cause survival and OS (p<0.05).ConclusionThe ACCI is an effective prognostic factor for other-cause survival and OS in very high-risk PC patients. RP should be considered carefully for patients with an ACCI score >3.

Survival benefits from postoperative radiation therapy on lymph node positive patients with pancreatic adenocarcinoma

The benefit of combining postoperative radiation therapy (PORT) with chemotherapy for resected patients with pancreatic adenocarcinoma is controversial. We sought to determine the effects of PORT on survival in patients with pancreatic adenocarcinoma who underwent primary site surgery. Patients with pancreatic adenocarcinoma receiving primary tumor surgery between 1988 and 2012 were identified from the Surveillance, Epidemiology and End Results (SEER) database. We estimated the association between PORT and other clinicopathologic factors and survival. In total, 5304 patients were identified who underwent pancreatic resection including 2093 patients who had PORT and 3211 patients who had no PORT. Median overall, cancer-specific, and other-cause survival were 19.0, 20.0, and 196.0 months, respectively, with PORT versus 14.0, 15.0, and 163.0 months, respectively, without PORT (all P < 0.001). Subset analysis revealed that the benefit of PORT was limited to patients with N1 disease. Median overall, cancer-specific, and other-cause survival for patients with N1 disease were 18.0, 18.0, and NA months, respectively, with PORT versus 12.0, 13.0, and 154.0 months, respectively, without PORT (all P < 0.001). Regardless the number of positive lymph node count (PLN) and lymph node ratio (LNR), PORT was always associated with increased survival on multivariate analysis in patients with N1 disease (all P < 0.001). In summary, survival benefits might be obtained from PORT on lymph node positive patients with pancreatic adenocarcinoma.

Primary Tumor Resection Is Associated with Improved Survival in Stage IV Colorectal Cancer: An Instrumental Variable Analysis.

Primary tumor resection (PTR) is recommended for patients with unresectable stage IV colorectal cancer (CRC) who present with symptoms related to their primary tumor. However, the survival benefit of PTR for asymptomatic patients is controversial. We investigated the change in PTR rates and the contribution of PTR to survival in patients with unresectable stage IV CRC over the past two decades in the United States. Clinicopathological factors and long-term survival were compared for 44 514 patients diagnosed with unresectable stage IV CRC from January 1, 1988, through December 31, 2010, who had or had not undergone PTR. Multivariable Cox regression and the instrumental variable method were used to identify independent factors for survival. Of the 44 514 patients with unresectable stage IV CRC, 27 931 (62.7%) had undergone PTR. The annual rate of PTR decreased from 74.4% to 50.2% diagnosed in 1988 and 2010, and the median overall survival increased for both PTR and non-PTR patients. Instrumental variable analyses revealed that PTR was associated with better overall, cancer-specific, and other-cause survival of patients with unresectable stage IV CRC.

Understanding the impact of socioeconomic differences in breast cancer survival in England and Wales: Avoidable deaths and potential gain in expectation of life

BackgroundSocioeconomic differences in cancer patient survival are known to exist for women diagnosed with breast cancer. Standard metrics tend not to place great emphasis on evaluating the actual impact of these differences. MethodsWe used two alternative, but related, methods of reporting the impact of socioeconomic differences for breast cancer patients in England and Wales. We calculated the average gain in life years for each patient should socioeconomic differences in relative survival be removed and show how this is related to the number of all-cause deaths that could be postponed by removing socioeconomic differences in cancer patient survival. ResultsOur results indicate that deprivation differences for women with breast cancer exist and result in women from more deprived areas losing a larger proportion of their life due to a diagnosis of cancer. We also estimate that on average 1.1 years could be gained for a 60 year old breast cancer patient in the most deprived group by improving their relative survival to match the least deprived group. However, our results also show that deprivation differences in general survival have a large impact on life expectancy; showing that over two-thirds of the gap in differential life expectancy is explained by differences in other-cause survival. ConclusionSocioeconomic differences in relative survival have an impact on life expectancy for patients and result in higher early mortality for more deprived patients. However, differences in general survival across socioeconomic groups explain a larger proportion of the deprivation gap in life expectancy for breast cancer patients.

Overdetection of recurrence after radical prostatectomy: estimates based on patient and tumor characteristics.

Prostate-specific antigen recurrence (PSA-R) after radical prostatectomy (RP) can occur years before metastasis. This study estimates the chance that an untreated PSA-R would not progress to clinical metastasis within the patient's lifetime, that is, that recurrence is overdetected. Times from PSA-R to metastasis were estimated from patients with RP treated at Johns Hopkins University (Baltimore, MD) who did not receive salvage treatment (n = 441) at PSA-R. Times to other-cause death were based on U.S. life tables adjusted to reflect other-cause survival among RP cases in the Surveillance, Epidemiology, and End Results (SEER) registry. We used competing risks simulation to estimate lower bounds on the chance that other-cause death would precede clinical metastasis for patients with disease characteristics at diagnosis based on the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database (n = 4,455). Cumulative incidence of PSA-R in CaPSURE was 13.6% at 5 years and 19.9% at 10 years. The risk of other-cause death among patients with RP in SEER was 60% lower than the age-matched U.S. population. At least 9.1% of patients with PSA-R <5 years after RP and at least 15.6% of patients with PSA-R 5 to 10 years after RP were overdetected. At least 31.4% of patients over the age of 70 years at diagnosis, who recurred <10 years of diagnosis, were overdetected. This analysis indicates that PSA-R after RP may be overdetected, with risk depending on patient age and tumor characteristics. The potential for overdetection of recurrence confirms the need for approaches to determine whether and when to initiate salvage therapies.

Assessing non-cancer-related health status of US cancer patients: other-cause survival and comorbidity prevalence.

With advances in prevention, screening, and treatment, cancer patients are living longer; hence, non-cancer-related health status will likely play a larger role in determining their life expectancy. In this study, we present a novel method for characterizing non-cancer--related health status of cancer patients using population-based cancer registry data. We assessed non-cancer-related health status in the context of survival from other causes of death and prevalence of comorbidities. Data from the Surveillance, Epidemiology, and End Results program (2000-2006) were used to analyze cancer patients' survival probabilities by cause of death. Other-cause survival was estimated using a left-truncated survival method with the hazard of death due to other causes characterized as a function of age. Surveillance, Epidemiology, and End Results data linked to Medicare claims (1992-2005) were used to quantify comorbidity prevalence. Relative to the US population, survival from a non-cancer-related death was higher for patients diagnosed with early stage breast and prostate cancer but lower for lung cancer patients at all stages. Lung cancer patients had worse comorbidity status than did other cancer patients. The present study represents the first attempt to evaluate the non-cancer-related health status of US cancer patients by cancer site (breast, prostate, colorectal, and lung) and stage. The findings provide insight into non-cancer-related health issues among cancer patients and their risk of dying from other causes.

Abstract 3583: Elevated inflammatory and hematological markers and survival in patients with renal cell carcinoma

Abstract Background: Growing evidence suggests the hypothesis that inflammatory and hematological markers may be related to cancer risk and survival; however, there is limited evidence for its relationship to renal cell carcinoma (RCC) survival. We therefore examined whether preoperative clinical biomarkers related to inflammatory and hematological responses, including erythrocyte sedimentation rate [ESR], alkaline phosphatase [ALP], white blood cell [WBC] count, hemoglobin [Hb] and hematocrit [Hct], predicted prognosis and survival in RCC patients. Methods: Data were collected retrospectively from 1,543 RCC patients treated with either radical- (n=1,259) or partial nephrectomy (n=284) in the Department of Urology at the Samsung Medical Center between 1994 and 2008. The primary endpoint evaluated was overall survival (OS), cancer-specific survival (CSS) and other-cause survival (OCS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models with adjustment for other clinical risk factors for RCC mortality. Results: During a median follow-up of 44 months, a total of 208 (13%) patients died of all-cause, 174 (11%) died of cancer and the other 35 died of other-cause (2%). We found statistically significant associations of decreasing OS and CSS with increasing levels of ESR; HRs (95% CIs) were 1.64 (1.03-2.61; p-trend=0.009) for OS and 2.24 (1.29-3.88; p-trend=0.001) for CSS comparing top with bottom tertiles. Also, increase in ALP levels was associated with decreasing OS and CSS; comparing top with bottom tertiles, HR (95% CI) were 2.01 (1.30-3.11; p-trend=0.002) for OS and 2.27 (1.37-3.74; p-trend=0.002) for CSS. There was no association for OCS in relation to levels of ESR and ALP. For hematological markers, we found increasing OS, CSS, and OCS with increasing levels of Hb and Hct. Notably, inverse association was stronger for OCS than OS or CSS; HRs (95% CI)s for OCS were 0.24 (0.09-0.68; p-trend=0.006) for Hb and 0.14 (0.05-0.41; p-trend&amp;lt;0.001) for Hct. In sensitivity analyses in which we excluded patients who died during the first 2 years of follow-up (n=98) or those who had metastasis (n=90), similar patterns of the associations were observed. When we limited the analysis to patients who did not have weight loss or symptom or those who had low stage, we still found improved OS or CSS with decreasing levels of ESR and ALP or increasing levels of Hb and Hct. Conclusions: These findings from a large clinical-based cohort suggest that increasing levels of inflammatory prognostic indicators, but decreasing levels of hematological markers are associated with worse survival among RCC patients treated with nephrectomy. Our findings support the hypothesis that ESR, ALP, Hb and Hct could be potential prognostic indicators for RCC survival. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3583. doi:1538-7445.AM2012-3583