Population-based Survival Analysis Research Articles

A Real-World, Population-Based Retrospective Analysis of Therapeutic Survival for Recurrent Localized Renal Cell Carcinoma After Nephrectomy.

We retrospectively analyzed therapeutic strategies and risk factors for overall survival (OS) in disease recurrence following curative nephrectomy for localized renal cell carcinoma (loRCC) using the Korean National Cancer Registry Database. We selected 1295 recurrent loRCC patients who underwent either partial or radical nephrectomy from 2007–2013. Patients were excluded for age <19 years, secondary RCC, multiple primary tumors, other SEER stages except for a localized or regional stage, postoperative recurrence within 3-month, and non-nephrectomized cases. Four therapeutic groups were statistically analyzed for OS and risk factors: surgery (OP, 12.0%), other systemic therapy (OST, 59.5%), radiotherapy (RT, 2.8%), and targeted therapy (TT, 25.8%). The overall mortality rate for recurrent loRCC was 32.5%, including 82.4% for RCC-related deaths. The baseline comparison among groups showed statistical differences for the diagnostic age of cancer and the SEER stage (p<0.05). Multivariate analysis of OS showed significance for the TT (hazard ratio [HR]: 6.27), OST (HR: 7.05), and RT (HR: 7.47) groups compared with the OP group, along with significance for the sex, SEER stage, and the time from nephrectomy to treatment for disease recurrence (p<0.05). The median OS curve showed a significantly better OS in the OP group (54.9 months) compared with the TT, OST, and RT groups (41.7, 42.9, and 38.0 months, respectively; p<0.001). In conclusion, the surgery-treated group had the best OS among the different therapeutic strategies for recurrent loRCC after nephrectomy, and the importance of the time from nephrectomy to secondary treatment was a significant prognostic factor.

Optimal use of radiotherapy in the definitive treatment of non-bulky IB-IIA cervical cancer: A population-based long-term survival analysis.

PurposeAlthough current clinical guidelines recommend surgery or radiotherapy for non-bulky IB-IIA cervical cancer, clinical data supporting the curative role of radiotherapy in the early-stage disease are insufficient. We evaluated the prognostic implications of definitive radiotherapy and determined its optimal use in clinical practice.MethodsPatients with non-bulky (<4 cm) IB-IIA cervical cancer who underwent hysterectomy or primary radiotherapy between 1988 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Based on the use of brachytherapy and/or chemotherapy, the primary radiotherapy group was classified into three cohorts: hysterectomy vs. radiotherapy overall, with/without brachytherapy and/or chemotherapy (cohort A); radiotherapy and brachytherapy with/without chemotherapy (patients with external beam radiation alone were excluded, cohort B); radiotherapy with brachytherapy and chemotherapy (patients who did not receive chemotherapy were additionally excluded, cohort C). Disease-specific survival (DSS) after hysterectomy was compared to that after primary radiotherapy in each cohort.ResultsAmong the 9,391 initially identified patients, 1,762, 1,244, and 750 patients were classified into cohorts A, B, and C, respectively, after propensity score matching. In cohort A, DSS after primary radiotherapy was inferior to that after hysterectomy (P = 0.001). In cohort B, a trend toward differential survival in favor of hysterectomy was observed with marginal significance (P = 0.061). However, in cohort C, DSS after primary radiotherapy was not significantly different to that after hysterectomy (P = 0.127). According to hazard rate function plots, patients receiving external beam radiation alone had an increased short-term risk of disease-specific mortality, whereas patients without evidence of chemotherapy had a distinct late risk surge at approximately 15 years of follow-up.ConclusionOptimizing radiotherapy methods with brachytherapy and the use of chemotherapy should be considered for the long-term curative efficacy of primary radiotherapy for non-bulky IB-IIA cervical cancer. Further studies are warranted to corroborate our results.

Role of Surgical Treatment in Primary Intestinal Non-Hodgkin Lymphomas: A SEER Population-Based Survival Analysis

Background: Evidence regarding the need for surgery for primary intestinal non-Hodgkin lymphoma (PINHL) patients with chemotherapy is limited and controversial. However, there is a lack of large-scale multicenter studies for the specific analysis of this population. We aimed to investigate the specific impact of surgery on survival in a large cohort of PINHL patients (aged >18 years) with chemotherapy. Methods: For this retrospective cohort study, data from PINHL patients (aged >18 years) with chemotherapy between 1983 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database through strict acceptance and discharge standards. The primary and secondary objectives were to access improved overall survival (OS) and improved cancer-specific survival (CSS) with surgery, respectively. In addition to multiple regression analysis and stratification analysis adjusted for confounding factors, propensity score matching (PSM) analysis was used to explore the reliability of the results to further control for confounding factors. Findings: Data were collected from the SEER database for 8398 patients; 3537 met inclusion criteria. The median survival was 53 months. Multivariate regression analysis showed that patients with surgery and chemotherapy had significantly better OS (hazard ratio [HR] 0·83, 95% confidence interval [CI] 0·75–0·93; P=0·0009) and CSS (HR 0·87, 95% CI 0·77–0·99; P=0·0404) compared with the non-operation group after adjusting for age, gender, race, marital status, year of diagnosis, Ann Arbor stage, histology, tumor size, and radiation. In particular, histological subgroup analyses showed that patients with primary intestinal diffuse large B-cell lymphoma had a better prognosis with chemotherapy plus surgery compared with the non-operation group (HR 0·71, 95% CI 0·60–0·84; P for interaction=0·0067). After PSM analysis, compared with non-surgery, surgery remained associated with improved OS (HR 0·77, 95% CI 0·68–0·87; P<0·0001) and improved CSS (HR 0·82, 95% CI 0·72–0·95; P=0·008) adjusted for baseline differences. Interpretation: In the large cohort of PINHL patients with chemotherapy older than 18 years, surgery was associated with significantly improved OS and CSS before and after PSM analysis. Funding: Supported by grants from the National Natural Science Foundation of China (grant no. 81873147) and the Natural Science Foundation of Guangdong Province (grant no. 2020A1515011177). Declaration of Interest: All the authors declared that they have no conflict of interest.

Splenic Marginal Zone Lymphoma: French Registries Population-Based Treatment and Survival Analyses (2002-2014)

Background. Splenic Marginal Zone Lymphoma (SMZL) is a rare indolent B-cell lymphoma characterized by a massive splenomegaly and a moderate lymphocytosis. There is no standard of care for SMZL so far. The treatment is indicated if constitutional symptoms, massive splenomegaly and/or cytopenia, after a watch and wait period that is highly variable. Rituximab with or without chemotherapy, chemotherapy, and splenectomy are valid treatment approaches. Our objectives were to describe the characteristics of the patients with SMZL retrospectively collected from a French population database, to analyze the treatments received in first line (Tt1) and in second line (Tt2) in term of efficacy, and to describe their outcome. Methods. We extracted the patients with a diagnostic of SMZL from the 3 French specialized registries databases (Basse-Normandie, Gironde and Côte d'Or; 3,6 M inhabitants) according to ICD-O-3 classification, cases coded as 9689/3 included between 2002 and 2014, with a follow-up until January 1rst, 2018. Demographic and clinical variables including clinical presentation, morphology and treatments at the first line and the second line were collected and reviewed by hematological experts in lymphoma (CT,XT,MM). World population standardized (WSP) incidence rate, observed survival (OS), net survival (NS: disease specific survival) were estimated using STATA v15. Results. 284 patients met inclusion criteria. The WSP incidence rate was 0.30/100,000 p-y. Clinical characteristics were: median age of 72-y-old (31 - 93), male (n=148, 52%), Ann-Arbor Stage I-II (n=40, 15%), Stage IV (n= 230, 81 %), first malignancy (n=47, 17%), Hb &amp;lt; 8g/dL (n=15, 5%), Plaq &amp;lt; 80 G/L (n=38, 13%). A clonal B-cells blood involvement was present in 96% of cases with a RHM score of 0-2 in 84%. With a median follow-up at 7 years, the 5-year OS and NS were respectively 65% (59-70) and 74% (67-82). Among 283 pts with Tt1 information, 232 were actively treated (82%). In Tt1, a splenectomy alone was performed in 93 cases (40%); rituximab was used alone in 12 cases (5); 39 (17%) received chemotherapy alone and 65 (28%) a combination R-chemotherapy. 61% of patients were treated within 3 months from diagnosis, others had a 17 months median delay. A CR after Tt1 was obtained in 71 cases (31%), a partial response or stable disease were found in 86 cases (37%). Relapse or progression were observed in 32 cases (20%). The median TTNT was 29 months (m); being quite equivalent in patients treated with other treatment than in patients with splenectomy alone (17.3 m vs 16.4 m, p = 0.1). Among 221 cases with Tt2 information, 57 were actively treated (25%). A splenectomy alone was performed in 3 cases (5%); rituximab was used alone in 5 cases (9%); 7 (12%) received chemotherapy alone and 40 (70%) had R-Chemotherapy. A CR was obtained in 25 cases (44%), a PR or stable disease was found in 17 cases (30%). Relapse or progression were observed in 7 cases (17%). The median TTNT was 13 m. Transformation in diffuse large B-cell lymphoma was observed in 21 cases (1 in untreated patient, 16 after Tt1 and 4 afterTt2). The 5-y NS was significantly better in patients treated by splenectomy alone than in other patients (91% vs 72%, p=0.002). Conclusion: This study reports the real world data of SMZL from cancer registries over 12 years with a long follow-up. New drugs and strategies are in need to improve the results of conservative approaches in SMZL. Disclosures Thieblemont: Cellectis: Speakers Bureau; Roche, Amgen, Kyte Gilead, Celgene, Abbvie, Novartis, Cellectis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Roche, Hospita: Research Funding. OffLabel Disclosure: Rituximab used in treated patients

Impact of Primary Site and Era of Diagnosis on Mortality in Patients with Extranodal Marginal Zone Lymphoma in the United States: A Population-Based Study

Introduction: Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (EMZL) is the most common subtype of MZL. EMZL can affect multiple organs throughout the body, and the management depends on the primary site of involvement and extent of disease. The most common primary site is the stomach, but other sites can be involved including the breasts, eyes, lungs, salivary glands, and skin. The last population-based survival analysis of EZML included follow-up through 2009 (Olszewski and Castillo, 2013). Given the paucity of population-based analyses of EMZL in the contemporary time-period, we sought to provide an updated analysis of disease-specific mortality and site-associated mortality using the Surveillance, Epidemiology, and End Results (SEER)-18 database. Method: We included adult patients with EMZL diagnosed between 2000-2017 who were 18-84 years old at the time of diagnosis. We excluded patients with a history of malignancy prior to EMZL, those with missing survival times and those with central nervous system involvement. Patients were divided into two cohorts based on period of diagnosis (era-1: 2000-2008, and era-2: 2009-2017). Five-year relative survival (RS) was estimated using the Pohar-Perme method. The risk of EMZL-specific death was estimated by calculating the cumulative incidence function (CIF). The difference between CIF distributions was tested with the Pepe-Mori test. The competing risks of EMZL-specific death and death from other causes were modeled using Fine and Gray regression. All tests of differences were performed at a two-sided alpha of 0.05. Results: We included a total of 11,597 patients with EMZL. Table 1 shows the baseline characteristics. Among the entire cohort, the median age at diagnosis was 63 years (IQR = 53-72). There was a slight female predominance (55%), and most patients were Non-Hispanic White (65%). Five-year RS was 95% (95% CI = 94-96%) during era-1 and 96% (95-97%) during era-2. There was a significant reduction in the cumulative incidence of EMZL-specific death between era-1 and era-2 (p &amp;lt; 0.001, Figure 1A) but not death from other causes (p = 0.35, Figure 1B). The cumulative incidence of EMZL-specific death varied according to EMZL subtype (Figure 2). In our multivariable competing risks model after adjusting for confounders (Table 2), EZMLs arising from the genitourinary (GU) tract had the worst prognosis [subhazard ratio (SHR) = 2.06, 95% CI=1.30-3.27, p=0.002], whereas EZMLs arising from the skin and connective tissue had the best prognosis [SHR = 0.66, 95% CI = 0.48 - 0.91, p = 0.01]. Conclusion: In this updated population-based analysis of EZML that includes patients treated in the contemporaneous time-period, we found that patients diagnosed with EZML in the most recent era had a significantly better prognosis. Additionally, we noted that the outcomes varied depending on primary site of involvement. Patients with EZMLs involving the GU tract had the worst prognosis, whereas patients with primary sites in the skin and connective tissue had the best prognosis. It is important to study the biology of EMZL involving the GU tract to design better therapeutic options to improve the outcomes. Disclosures Epperla: Pharmacyclics: Honoraria; Verastem Oncology: Speakers Bureau.

Estimation of Relative Hazard between Groups of Cancer patients in North West Nigeria

A problem in population-based cancer survival analysis is the estimation of relative hazard between patients with different characteristics handled in the same registry center. In this work, we use the Cox proportional hazard model to find an estimated hazard ratio between two patients having different characteristics. The procedure was then fitted has been applied on the data collected from Ahmadu Bello University Teaching Hospital (ABUTH) Zaria Cancer Registry Center. The result indicated that female and frail patients are more prone to failure than male and non frail patients respectively.

Semiparametric estimation of the cure fraction in population-based cancer survival analysis.

With rapid development in medical research, the treatment of diseases including cancer has progressed dramatically and those survivors may die from causes other than the one under study, especially among elderly patients. Motivated by the Surveillance, Epidemiology, and End Results (SEER) female breast cancer study, background mortality is incorporated into the mixture cure proportional hazards (MCPH) model to improve the cure fraction estimation in population-based cancer studies. Here, that patients are "cured" is defined as when the mortality rate of the individuals in diseased group returns to the same level as that expected in the general population, where the population level mortality is presented by the mortality table of the United States. The semiparametric estimation method based on the EM algorithm for the MCPH model with background mortality (MCPH+BM) is further developed and validated via comprehensive simulation studies. Real data analysis shows that the proposed semiparametric MCPH+BM model may provide more accurate estimation in population-level cancer study.

Acral lentiginous melanoma: Population-based analysis of incidence and survival in United States from 1993 to 2013.

e22108 Background: Acral Lentiginous melanoma (ALM) is a rare form of cutaneous melanoma with aggressive nature. This study investigates the incidence and survival patterns in patients diagnosed with ALM in USA from 1993-2013 using data from the Surveillance, Epidemiology, and End Results (SEER) Registry. Methods: The 18 cancer registries of SEER program were used to identify patients diagnosed with ALM according to international classification of diseases for oncology (ICDO-3) codes. Age adjusted incidence rates in addition to 5 and 10-year relative survival rates were calculated. Results: 2189 patients were included in this retrospective study.The age-adjusted incidence rate of ALM was 2.11 per million person-years.Hispanic whites had highest incidence rates of ALM among all racial subgroups ( 2.58, p = 0.005). Incidence of ALM was higher between 2003-2013 compared to 1993-2003 (2.3 vs 1.9).Median age at diagnosis was 61.68 years. 53.9 % were female. Our study population was dominated by Non-Hispanic Whites (69.2%) followed by Hispanic Whites (13.5%), Blacks (8.2%), Asians or Pacific Islanders (7.3%) and other races (1.8%). stage III was the most frequent (24.7%) followed by stage I (20.9%). In terms of tumor thickness, 43.2 % presented with T3 thickness at the time of diagnosis. The ALM 5 - and 10-year survival rates were highest in age &lt; 40, females, T1, non ulcerated, lymph node negative lesions ( p &lt; 0.05). Among racial subgroups, non Hispanic whites had highest survival rates (83 vs 74 % ). Asian/Pacific Islanders (75.1%vs 49.8%) had lowest survival rates followed Hispanic whites ( 76.4 % vs 63.9 ) and Blacks (74.7 vs 71.5 %) ( p = 0.19). Conclusions: ALM is rare subtype of cutaneous melanoma with increased incidence in people of color. Patients present with increased tumor thickness and advanced stage at the time of diagnosis. Poor survival rates are seen among Asian/Pacific Islanders and Hispanic whites.

A population-based analysis of breast cancer incidence and survival by subtype in Ontario women.

Breast cancer (bca) is the type of cancer most frequently diagnosed among women in Canada. Breast cancer is categorized into various molecular subtypes by the expression of estrogen receptor (er), progesterone receptor (pgr), and her2 (human epidermal growth factor receptor 2). Currently, Canada has no national cancer registry with epidemiology data by subtype. Thus, we conducted a study to determine incidence, survival, and clinicopathologic characteristics by bca subtype [triple negative breast cancer (tnbc); her2+; and hormone receptor-positive (hr+), her2-] in Canadian women newly diagnosed with bca. Female patients diagnosed between 1 April 2012 and 31 March 2016 (fiscal 2012-2015) were identified in the Ontario Cancer Registry, and individual patient data were linked to data in provincial health administrative databases. Descriptive statistics and Kaplan-Meier curves were generated. In this cohort, 3277 women (9.5%) had tnbc, 4902 (14.3%) had her2+ bca, and 22,247 (64.8%) had hr+, her2-breast cancer. The annual incidence was 15 per 100,000 for the tnbc group, 21-23 per 100,000 for the her2+ group, and 97-105 per 100,000 for the hr+, her2- group. The lowest median overall survival (mos) of 8.9 months was observed in women with clinical stage iv tnbc. In comparison, the mos was 37.3 months in those with her2+ disease and 35.2 months in those with and hr+, her2- metastatic bca. In the present study, the most recent and largest administrative database analysis of a Canadian population to date, we observed a subtype distribution consistent with previously reported data, together with comparable annual incidence and overall survival patterns.

Population-based analysis of survival in spinal muscular atrophy

To investigate probabilities of survival and its surrogate, that is, mechanical ventilation, in patients with spinal muscular atrophy (SMA). We studied survival in a population-based cohort on clinical prevalence of genetically confirmed, treatment-naive patients with SMA, stratified for best acquired motor milestone (i.e., none: type 1a/b; head control in supine position or rolling: type 1c; sitting independently: type 2a; standing: type 2b; walking: type 3a/b; adult onset: type 4). We also assessed the need for mechanical ventilation as a surrogate endpoint for survival. We included 307 patients with a total follow-up of 7,141 person-years. Median survival was 9 days in SMA type 1a, 7.7 months in type 1b, and 17.0 years in type 1c. Patients with type 2a had endpoint-free survival probabilities of 74.2% and 61.5% at ages 40 and 60 years, respectively. Endpoint-free survival of SMA types 2b, 3, and 4 was relatively normal, at least within the first 60 years of life. Patients with SMA types 1c and 2a required mechanical ventilation more frequently and from younger ages compared to patients with milder SMA types. In our cohort, patients ventilated up to 12 h/d progressed not gradually, but abruptly, to ≥16 h/d. Shortened endpoint-free survival is an important characteristic of SMA types 1 and 2a, but not types 2b, 3, and 4. For SMA types 1c and 2a, the age at which initiation of mechanical ventilation is necessary may be a more suitable endpoint than the arbitrarily set 16 h/d.

Population-based SEER analysis of survival in colorectal cancer patients with or without resection of lung and liver metastases

BackgroundApproximately one third of all patients with CRC present with, or subsequently develop, colorectal liver metastases (CRLM). The objective of this population-based analysis was to assess the impact of resection of liver only, lung only and liver and lung metastases on survival in patients with metastatic colorectal cancer (mCRC) and resected primary tumor.MethodsTen thousand three hundred twenty-five patients diagnosed with mCRC between 2010 and 2015 with resected primary were identified in the Surveillance, Epidemiology and End Results (SEER) database. Overall, (OS) and cancer-specific survival (CSS) were analyzed by Cox regression with multivariable, inverse propensity weight, near far matching and propensity score adjustment.ResultsThe majority (79.4%) of patients had only liver metastases, 7.8% only lung metastases and 12.8% metastases of lung and liver. 3-year OS was 44.5 and 27.5% for patients with and without metastasectomy (HR = 0.62, 95% CI: 0.58–0.65, P < 0.001). Metastasectomy uniformly improved CSS in patients with liver metastases (HR = 0.72, 95% CI: 0.67–0.77, P < 0.001) but not in patients with lung metastases (HR = 0.84, 95% CI: 0.62–1.12, P = 0.232) and combined liver and lung metastases (HR = 0.89, 95% CI: 0.75–1.06, P = 0.196) in multivariable analysis. Adjustment by inverse propensity weight, near far matching and propensity score and analysis of OS yielded similar results.ConclusionsThis is the first SEER analysis assessing the impact of metastasectomy in mCRC patients with removed primary tumor on survival. The analysis provides compelling evidence of a statistically significant and clinically relevant increase in OS and CSS for liver resection but not for metastasectomy of lung or both sites.

Applications of competing risks analysis in public health

In medical and public health research, survival statistics are of particular interest as they can reflect patient prognoses and improvements in health care systems. However, measures of survival differ in their use and interpretation depending on how they deal with competing causes of death. Cause-specific survival estimates survival function based on the event of interest while treating other events as censored, thereby representing the “net” impact of cancer on survival. On the other hand, cumulative incidence function and subdistribution hazard consider the number of subjects experiencing competing risks in their formulations, thereby providing measures for investigating the patients’ actual prognoses. In this paper, we review competing risks survival models used in public health study. We introduce the concept of competing risks methods and compare these with traditional net approaches (e.g. relative and cause-specific). We demonstrate how competing risks analysis can be used in population-based cancer survival analysis utilizing the Surveillance, Epidemiology, and End Result (SEER) cancer registry data. As the scope of public health study has extended beyond prognosis and risk prediction, competing risks analysis has been applied in such studies as well. We further discuss the uptake of the competing risks approach in personalized and precision medicine. Various methods and applications used in risk predicting prognostic models with competing risks are reviewed, aiming to provide effective analytical tools for researchers who plan to implement competing risks models on public health studies.

Examining the roles of surgery and chemoradiation in hypopharynx cancer: a study of the National Cancer Database

There are few data specifically addressing hypopharynx cancer and thus treatment decisions for it are often extrapolated from laryngeal cancer experiences. We conducted a large population-based analysis of treatment patterns and survival in hypopharynx cancer with the National Cancer Database (NCDB), which to our knowledge has not been done for a non-medicare cohort.

Racial disparities in uterine and ovarian carcinosarcoma: A population-based analysis of treatment and survival

ObjectiveTo investigate racial disparities in uterine carcinosarcoma (UCS) and ovarian carcinosarcoma (OCS) in Commission on Cancer®-accredited facilities. MethodsNon-Hispanic Black (NHB) and non-Hispanic White (NHW) women in the National Cancer Database diagnosed with stage I-IV UCS or OCS between 2004 and 2014 were eligible. Differences by disease site or race were compared using Chi-square test and multivariate Cox analysis. ResultsThere were 2830 NHBs and 7366 NHWs with UCS, and 280 NHBs and 2586 NHWs with OCS. Diagnosis of UCS was more common in NHBs (11.5%) vs. NHWs (3.7%) and increased with age (P < .0001). OCS diagnosis remained <5% in both races and all ages. NHBs with UCS or OCS were more common in the South and more likely to have a comorbidity score ≥ 1, low neighborhood income and Medicaid or no insurance (P < .0001). Diagnosis at stage II-IV was more common in NHBs than NHWs with UCS but not OCS. NHBs with both UCS and OCS were less likely to undergo surgery and to achieve no gross residual disease with surgery (P = .002). Risk of death in NHB vs. NHW patients with UCS was 1.38 after adjustment for demographic factors and dropped after sequential adjustment for comorbidity score, neighborhood income, insurance status, stage and treatment by 4%, 16%, 7%, 19% and 10%, respectively, leaving 43.5% of the racial disparity in survival unexplained. In contrast, risk of death in NHBs vs. NHWs with OCS was 1.19 after adjustment for demographic factors and became insignificant after adjustment for comorbidity. Race was an independent prognostic factor in UCS but not in OCS. ConclusionsRacial disparities exist in characteristics, treatment and survival in UCS and OCS with distinctions that merit additional research.

Population-Based Brain Tumor Survival Analysis via Spatial- and Temporal-Smoothing.

In cancer research, population-based survival analysis has played an important role. In this article, we conduct survival analysis on patients with brain tumors using the SEER (Surveillance, Epidemiology, and End Results) database from the NCI (National Cancer Institute). It has been recognized that cancer survival models have spatial and temporal variations which are caused by multiple factors, but such variations are usually not “abrupt” (that is, they should be smooth). As such, spatially and temporally pooling all data and analyzing each spatial/temporal point separately are either inappropriate or ineffective. In this article, we develop and implement a spatial- and temporal-smoothing technique, which can effectively accommodate spatial/temporal variations and realize information borrowing across spatial/temporal points. Simulation demonstrates effectiveness of the proposed approach in improving estimation. Data on a total of 123,571 patients with brain tumors diagnosed between 1911 and 2010 from 16 SEER sites is analyzed. Findings different from separate estimation and simple pooling are made. Overall, this study may provide a practically useful way for modeling the survival of brain tumor (and other cancers) using population data.

A Population-Based Analysis of Incidence, Mortality, and Survival in Testicular Cancer Patients in Lithuania.

Background and objectives: The aim of this study was to analyze trends in testicular cancer incidence, mortality, and survival in Lithuania during the period 1998–2013. Materials and Methods: The study was based on all cases of testicular cancer reported to the Lithuanian Cancer Registry between 1998 and 2013. Age group-specific rates and standardized rates were calculated using the direct method (European standard population). The Joinpoint regression model was used to provide the annual percentage change (APC). Five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population. Results: During the study period, the age-standardized incidence rate of testicular cancer increased from 1.97 to 3.45 per 100,000, with APC of 2.97% (95% CI 0.9 to 5.1). Incidence rate of seminomas changed from 0.71 to 1.54 per 100,000, with APC of 2.61% (95% CI −0.4 to 5.7), and the incidence rate of non-seminomas increased from 0.84 to 1.83 per 100,000, with APC of 4.16% (95% CI 1.6 to 6.8). The mortality rate of testicular cancer in Lithuania during this period declined from 0.78 to 0.51 per 100,000, with APC of −2.91% (95% CI −5.5 to −0.3). Relative five-year survival ratio for the period 2009–2013 was 89.39% (95% CI 82.2 to 94.4). In our study, the overall five-year relative survival increased slightly (10.1%) from 2004–2008 to 2009–2013 (from 79.3% to 89.4%). Conclusions: A moderate increase of testicular cancer incidence has been observed in Lithuania between the years 1998 and 2013, while the mortality rate decreased. The five-year relative survival increased according to different period estimates; however, the results could have been higher if a multidisciplinary approach to diagnostics and management in the concerned centers had been implemented in Lithuania as in other countries.

Radiation therapy's efficacy on tongue cancer: a population-based survival analysis.

ObjectiveTo identify survival outcomes for patients with oral tongue cancer and the effects of different prognostic factors on survival.MethodsA study was performed with the Surveillance, Epidemiology, and End Results database to confirm whether survival improved in patients who had received radiation therapy along with surgery compared with others who had received surgery alone.ResultsA total of 9,474 patients were included as respondents in the study. Of the group, 2,759 patients had been treated by surgery along with radiotherapy, while 6,714 just had received only surgery. The survival was higher in patients who had been treated by both surgery and radiotherapy. Moreover, old age (P<0.001), being black (P<0.001), distant stage (P<0.001), first malignant primary indicator (P<0.001), being unmarried (P<0.001), and surgery only (P<0.001) were confirmed as significant risk factors associated with low survival rates. Age 50 years and above (hazard ratio: 1.712, 95% CI: 1.550–1.890) was also a significant risk factor. Nevertheless, grade and sex were not independent risk factors. The multivariate model also showed that being black, distant stage, age below 50 years, sex, being unmarried, and surgery were found to be associated with low survival rates (P<0.001).ConclusionOf the patients with tongue cancer, the group treated by both radiation and surgery had better prognosis than the group that had received surgery only. Also, survival showed no difference in terms of sex among the total tongue cancer population, whereas prognosis was found to differ between two genders in the group that had received both radiation therapy and surgery. Nonetheless, grade was not a risk factor for patients with tongue cancer.

Epithelial-myoepithelial carcinoma: a population-based survival analysis

BackgroundEpithelial-myoepithelial carcinoma is an uncommon malignant neoplasm seen most frequently in the salivary glands, representing approximately 1 to 2% of salivary gland tumors. Less than 600 cases have been reported in the literature since its initial description in 1972. The aim of this study was to examine demographic, site, stage, and survival factors in patients with epithelial-myoepithelial carcinoma.MethodsThe 1973–2014 SEER (Surveillance, Epidemiology, and End Results) cancer database was queried for patients treated for epithelial-myoepithelial carcinoma. The data was analyzed for patient T (tumor), N (nodal), and M (metastasis) stage, tumor site, and demographic characteristics. The Kaplan-Meier model was used to estimate actuarial survival.ResultsA total of 468 patients were identified. White patients represented 78.0% of the total. There were 291 female patients and 177 male patients. Overall 5-, 10-, and 20-year survival was 72.7%, 59.5%, and 38.3%, respectively. Mean survival time was 165.5 months. Parotid gland was the most common site with 57.7% of patients, with submandibular gland representing 9.8% of patients. Distant metastasis (M) status was unknown in 33.3%, with 2.6% being M1, 3.0% being MX, and 61.1% M0. Nodal metastasis (N) status was unknown in 33.3%, while 4.4% were N+, 4.7% were NX, and 57.5% were N0. 88.2% of patients had surgery as part or all of the treatment regimen. Univariate Kaplan-Meier analysis showed that AJCC overall stage, primary tumor (T) stage, nodal (N) stage, presence of distant metastasis (M1), age at diagnosis, race, and non-surgical treatment significantly affected survival. On multivariate analysis age, race, AJCC stage, T, N, M stage, and treatment type were significant.ConclusionsEpithelial-myoepithelial carcinoma is a malignant, histologically biphasic neoplasm most frequently seen in the parotid gland. The nodal and distant metastasis rates are low. Age at diagnosis, race, AJCC stage, T, N, M stage, and treatment type all significantly affected survival.

Hypertension and All-Cause Mortality in China: A Population-Based Cohort Study and Survival Analyses

Background: The effects of hypertension on all-cause mortality in the Chinese have rarely been reported. Methods: To compare all-cause mortality between hypertensive and normotensive participants in the China Health and Nutrition Survey (CHNS) from 1989 to 2011. Findings: During a total of 150,720 person years of follow-up (average follow-up of 10.5 years), 987 participants died, including 358 hypertensive participants, and the overall mortality rate was 6.88%. Survival analysis using Cox proportional hazard models revealed that the risk of mortality was increased in severely hypertensive women (HR 2.05; 95% CI 1.12-3.73) and treated (but uncontrolled) hypertensive men (HR 1.78; 95% CI 1.08-2.92) compared to mildly hypertensive participants. However, there were no significant differences in the mortality risk identified for other groups, including the treated (controlled and uncontrolled) hypertension group. Moreover, when compared with normotensive participants using cohort analysis, high blood pressure was found to have a protective effect on survival; in particular, the risk of mortality was significantly lower in mildly hypertensive participants (RR 0.63, 95% CI 0.53-0.74) and and treated (but uncontrolled) hypertensive men (RR 0.63; 95% CI 0.39-1.00). The finding that high blood pressure was not associated with excess all-cause mortality was further confirmed using birth cohort analysis, and there were no significant differences in all-cause mortality identified between normotensive and hypertensive participants in the populations born in the 1930s, 1940s or 1950s. Interpretation: Severely hypertensive women and treated (but uncontrolled) hypertensive men were found to have a worse survival; however, patients with mild hypertension had longer survival than normotensive in the Chinese population. Funding Statement: This study was funded by the National Natural Science Foundation of China (81172666), Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, China; Caroline Population Center, the University of North Carolina at Chapel Hill, National Institutes of Health (NIH) (R01-HD30880, DK056350, R24HD050924 and R01-HD38700) and Fogarty International Center, NIH. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that no conflicts of interest exist for the submission of this manuscript. Ethics Approval Statement: Ethics permission was obtained from the Institute for Nutrition and Food Safety and China Center for Disease Control (China CDC).

Male patients with resected IIIA-N2 non-small-cell lung cancer may benefit from postoperative radiotherapy: a population-based survival analysis.

Our analysis was performed to assess the efficacy of postoperative radiotherapy (PORT) on the survival for pathologic IIIA-N2 Non-small-cell lung cancer patients. We identified 2949patients from 2004 to 2013 in the SEER database. Propensity score-matching was used to reduce the selection bias. Overall survival (OS), cancer-specific survival (CSS) and the factors associated with survival prognosis were evaluated. There was no significant difference in OS and CSS between PORT and non-PORT groups. However, subgroup analysis revealed an OS (p=0.007) and CSS (p=0.006) detrimental for male patients not receiving PORT. Multivariate analysis showed that old age, male sex, high pathologic grade, squamous carcinoma, bigger tumor size and larger number of positive lymph nodes had a negative impact on survival. PORT could improve OS and CSS in male patients with resected IIIA-N2 non-small-cell lung cancer.