Population-based Propensity Score Matching Analysis Research Articles

A population-based propensity score matching analysis of risk factors and the impact on survival associated with refusal of cancer-directed surgery in patients with prostate cancer

Cancer-directed surgeries (CDS) play a crucial role in prostate cancer (PCa) management along with possible survival and therapeutic benefits. However, barriers such as socioeconomic factors may affect patients’ decision of refusing recommended CDS. This study aimed to uncover risk factors and the impact on survival associated with CDS refusal. We retrospectively reviewed the Surveillance, Epidemiology, and End Results database for patients diagnosed with PCa between 2000 and 2019. Multiple sociodemographic and clinical characteristics were extracted to assess predictors for physicians’ surgical recommendations and patients’ surgical refusal, respectively. Propensity score matching was performed to balance the covariates. The impact of surgical refusal on mortality risk was also investigated. A total of 185,540 patients were included. The physician’s recommendation of CDS was significantly influenced by the patient’s age, race, income, home location, diagnosis year, Gleason score, prostate-specific antigen (PSA), and TNM stage. About 5.6% PCa patients refused CDS, most of whom were older, non-White race, lack of partners, living outside of metropolitan areas, with higher PSA or lower clinical TNM stage. Patients who refused CDS had an increased risk of cancer-specific mortality and overall mortality than those who performed CDS. Physicians may weigh a host of sociodemographic and clinical factors prior to making a CDS recommendation. Patients’ refusal of recommended CDS affected survival and was potentially modifiable by certain sociodemographic factors. Physicians should fully consider the hindrances behind patients’ CDS refusal to improve patient-doctor shared decision-making, guide patients toward the best alternative and achieve better outcomes.

Disparities in Coronavirus Disease 2019 Clinical Outcomes and Vaccination Coverage Among Migrants With Human Immunodeficiency Virus in the PISCIS Cohort: A Population-Based Propensity Score-Matched Analysis.

Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors. Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression. The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants. MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19-associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.

Comparison of post-hepatectomy long-term survival outcome between non-colorectal non-neuroendocrine and colorectal liver metastases: A population-based propensity-score matching analysis

BackgroundHepatectomy is an established treatment for colorectal liver metastasis (CLM) or neuroendocrine liver metastasis. However, its role in non-colorectal non-neuroendocrine liver metastasis (NCNNLM) is controversial. This study aims to compare long-term survival outcomes after hepatectomy between NCNNLM and CLM in a population-based cohort. MethodsFrom 2009 to 2018, curative hepatectomy were performed in 964 patients with NCNNLM (n ​= ​133) or CLM (n ​= ​831). Propensity score (PS) matching was performed. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. ResultsThere were 133 patients in the NCNNLM group and 266 patients in the CLM group. The mortality (1.5 ​% vs 1.5 ​%) and morbidity (19.5 ​% vs 20.3 ​%) rates were comparable between the two groups. There was no statistically significant difference in 5-year overall (48.9 ​% vs 39.8 ​%) and recurrence-free (25.1 ​% vs 23.4 ​%) survival rates between NCNNLM and CLM groups. A high pre-operative serum bilirubin level, severe postoperative complications and multiple tumors were independent prognostic factors for poor survival. ConclusionHepatectomy for selected patients with NCNNLM can achieve similar long-term oncological outcomes as those with CLM. High serum bilirubin, severe postoperative complication and multiple tumors are poor prognostic factors for survival.

Clinical characteristic-assisted surgical benefit stratification for resection of primary tumor in patients with advanced primary malignant bone neoplasms: a population-based propensity score-matched analysis.

Primary tumor resection (PTR) is the standard treatment for patients with primary malignant bone neoplasms (PMBNs). However, it remains unclear whether patients with advanced PMBNs still benefit from PTR. This study aimed to develop a prediction model to estimate the beneficial probability of PTR for this population. This study extracted data from patients diagnosed with advanced PMBNs, as recorded in the Surveillance, Epidemiology, and End Results (SEER) database, with the period from 2004 to 2015. The patient cohort was then bifurcated into two groups: those who underwent surgical procedures and the non-surgery group. Propensity score matching (PSM) was utilized to mitigate any confounding factors in the study. The survival rates of patients from both the surgical and non-surgery groups were evaluated using Kaplan-Meier (K-M) curves analysis. Moreover, the study used this method to assess the capacity of the nomogram to distinguish patients likely to derive benefits from surgical intervention. The study was grounded in the hypothesis that patients who underwent PTR and survived beyond the median overall survival (OS) time would potentially benefit from the surgery. Subsequently, logistic regression analysis was performed to ascertain significant predictors, facilitating the development of a nomogram. This nomogram was subjected to both internal and external validation using receiver operating characteristic curves, area under the curve analysis, calibration plots, and decision curve analysis. The SEER database provided a total of 839 eligible patients for the study, among which 536 (63.9%) underwent PTR. Following a 2:1 PSM analysis, patients were classified into two groups: 364 patients in the surgery group and 182 patients in the non-surgery group. Both K-M curves and multivariate Cox regression analysis revealed that patients who received PTR had a longer survival duration, observed both before and after PSM. Crucial factors such as age, M stage, and tumor size were identified to be significantly correlated with surgical benefits in patients with advanced PMBNs. Subsequently, a nomogram was developed that uses these independent predictors. The validation of this predictive model confirmed its high accuracy and excellent discrimination ability of the nomogram to distinguish patients who would most likely benefit from surgical intervention. In this study, we devised a user-friendly nomogram to forecast the likehood of surgical benefits for patients diagnosed with advanced PMBNs. This tool facilitates the identification of the most suitable candidates for PTR, thus promoting more discerning and effective use of surgical intervention in this patient population.

Association of chemotherapy and comorbidities with overall survival in elderly patients with early breast cancer: a French population-based propensity score-matched analysis.

Additional systemic treatment for early breast cancer in elderly is challenged by increasing comorbidities with age. We aimed to examine the effect of additional chemotherapy on overall survival in patients aged 70years or older and the impact of comorbidities on chemotherapy benefit. This retrospective monocentric cohort study includes data from all patients aged 70years and older who underwent surgery for an early breast cancer from 1997 to 2016. A propensity score analysis allowed adjustment for chemotherapy prescription preferences based on tumour characteristics. Of 15,599 patients who had surgery for an early breast cancer, 1743 (11.2%) over 70years old were included, of whom 269 (15.4%) had received additional chemotherapy. Median follow-up was 5.3years. Multivariate analyses on the propensity-score weighted cohort (n = 1 354) identified improved overall survival in patients with chemotherapy versus without (HR 0.54, 95% CI 0.31-0.92). Chronic obstructive pulmonary disease (HR, 2.16, 95% CI 1.40-3.34) and polypharmacy (HR 1.40, 95%CI 1.07-1.84) were associated with worse overall survival. No statistically significant interactions were identified between these comorbidities and chemotherapy prescription. Additional chemotherapy in elderly with early breast cancer is feasible and associated with overall survival benefit, supporting the importance of chemotherapy considerations in this population, and of avoiding undertreatment based on chronological age considerations alone.

Antenatal corticosteroids and outcomes of small for gestational age infants born at 24-31 gestational weeks: a population-based propensity score matching analysis.

To evaluate the effect of antenatal corticosteroid (ACS) treatment on neonatal outcomes in small for gestational age (SGA) infants born at 24-31 gestational weeks compared with non-SGA infants. A population-based retrospective study was conducted that analyzed clinical data from the Neonatal Research Network of Japan database, which enrolls neonates born at < 32 gestational weeks and weighing 1500g or less (n = 22,414). Propensity score matching (with the ratio of ACS to no-ACS groups of 1:1) was performed in SGA (n = 7028) and non-SGA (n = 15,386) infants, respectively. Univariate logistic and interaction analyses were performed to compare the short-term neonatal outcomes of infants with and without ACS treatment in utero. In the SGA and non-SGA infants, ACS treatment significantly reduced in-hospital mortality (odds ratio 0.67 95% confidence interval [0.50-0.88] and 0.62 [0.50-0.78], respectively), respiratory distress syndrome (0.77 [0.69-0.87] and 0.63 [0.58-0.68], respectively), and composite adverse outcomes (0.73 [0.58-0.91] and 0.57 [0.50-0.65], respectively). ACS treatment also significantly reduced intraventricular hemorrhage (grade III/IV), periventricular leukomalacia, and sepsis in the non-SGA infants, but not in the SGA infants. However, interaction analyses revealed no significant differences between the SGA and non-SGA infants in the efficacy of ACS treatment on short-term outcomes except for respiratory distress syndrome. ACS treatment was associated with beneficial effects on mortality, respiratory distress syndrome, and adverse composite outcomes in extremely and very preterm SGA infants, with similar efficacy on all neonatal outcomes except for respiratory distress syndrome observed in the non-SGA infants.

Prognostic significance of examined lymph node count in older patients with stage T1N0M0 pulmonary carcinoid tumours: a population-based propensity score-matched analysis.

The optimal number of examined lymph nodes (ELNs) for older early-stage pulmonary carcinoid tumour (PC) patients is unknown. To explore the prognostic effect of the ELN count in older patients with stage T1N0M0 PC resection. Clinical data from the Surveillance, Epidemiology, and End Results database on stage T1N0M0 PC older patients (age ≥ 65years) who underwent sublobar resection and lobectomy between 2000 and 2018 were retrospectively analysed for two ELNs-stratified (≥ 7 vs. < 7 ELNs) propensity score-matched (PSM) groups. Overall survival (OS) was calculated and compared with Kaplan-Meier analysis and log-rank test, respectively, and the independent prognostic factors were estimated using a Cox proportional hazard model. Among 1077 participants (median dissected LN 4; mean ELNs 6.19 ± 7.04), 393 (36.49%) in the ≥ 7 ELNs group had better 5- and 10-year OS than the < 7 ELNs group (before PSM: 5-year OS = 93.01 vs. 85.22%, 10-year OS = 72.38 vs. 58.99%, p < 0.001; after PSM: 5-year OS = 93.12 vs. 85.97%, 10-year OS = 75.25 vs. 60.03%, p = 0.001). Subgroup analysis stratified by histologic type and surgical method showed a similar survival trend. Age-stratified analysis showed that, compared with the < 7 ELNs group, the ≥ 7 ELNs group had better 5- and 10-year OS but only better 5-year OS in participants > 75years. Compared with the < 7 ELNs group, subgroup analysis by tumour size showed superior OS with 1.1-3.0cm tumours in the ≥ 7 ELNs group, but no significant intergroup difference with tumours < 1.0cm. Multivariate Cox analysis showed ≥ 7 ELNs was associated with improved OS. Higher ELNs correlated with increased long-term survival in older early‑stage PC patients, and a minimum of 7 ELNs are recommended for prognostication in these patients (especially those aged 65-75years, with tumour size 1.1-3.0cm).

Squamous cell carcinoma predicts worse prognosis than adenocarcinoma in stage IA lung cancer patients: A population-based propensity score matching analysis.

BackgroundAlthough numerous studies have reported the association between histological types and the prognosis of IA non-small-cell lung cancer (NSCLC) patients, few studies have deeply investigated the impact of pathology on the outcome of NSCLC patients. In this study, we comprehensively explored whether the type of histology influenced the outcome of IA-stage NSCLC patients.MethodsThe study population was obtained from the Surveillance, Epidemiology, and End Results (SEER) program, which is supported by the National Cancer Institute of the United States. To avoid potential bias, the method of propensity score matching (PSM) was used to obtain a balanced cohort for further analysis.ResultsThe results from univariate and multivariate regression models showed that lung squamous cell carcinoma (LSQCC) patients were at a significantly greater risk of undergoing shorter overall survival (OS) and lung cancer–specific survival (LCSS). After PSM analysis, LSQCC was still closely associated with a reduction in OS and LCSS. All of these suggested that the histological type was an independent prognostic factor for OS and LCSS.ConclusionOur study demonstrated that squamous cell carcinoma predicted worse OS and LCSS in IA-stage NSCLC patients compared with lung adenocarcinoma (LUAD). We suggest that the outcomes of LSQCC and LUAD are very different and that the two histological types should be differently analyzed.

Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis.

BackgroundThis study aimed to conduct a comparative analysis of the survival rates after segmentectomy, wedge resection, or lobectomy in patients with cStage IA lung squamous cell carcinoma (SCC).MethodsWe enrolled 4,316 patients who had cStage IA lung SCC from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards model was conducted to recognize the potential risk factors for overall survival (OS) and lung cancer-specific survival (LCSS). To eliminate potential biases of included patients, the propensity score matching (PSM) method was used. OS and LCSS rates were compared among three groups stratified according to tumor size.ResultsKaplan–Meier analyses revealed no statistical differences in the rates of OS and LCSS between wedge resection (WR) and segmentectomy (SG) groups for patients who had cStage IA cancers. In patients with tumors ≤ 1 cm, LCSS favored lobectomy (Lob) compared to segmentectomy (SG), but a similar survival rate was obtained for wedge resection (WR) and lobectomy (Lob). For patients with tumors sized 1.1 to 2 cm, lobectomy had improved OS and LCSS rates compared to the segmentectomy or wedge resection groups, with the exception of a similar OS rate for lobectomy and segmentectomy. For tumors sized 2.1 to 3 cm, lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy, except that lobectomy conferred a similar LCSS rate compared to segmentectomy. Multivariable analyses showed that patients aged ≥75 and tumor sizes of >2 to ≤3 cm were potential risk factors for OS and LCSS, while lobectomy and first malignant primary indicator were considered protective factors. The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS rate.ConclusionsThe tumor size can influence the surgical procedure recommended for individuals with cStage IA lung SCC. For patients with tumors ≤1 cm, lobectomy is the recommended approach, and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled. For tumors >1 to ≤3 cm, lobectomy showed better survival outcomes than sublobar resection. Our findings require further validation by randomized controlled trial (RCT) or other evidence.

Survival benefit from axillary surgery in patients aged 70 years or older with clinically node-negative breast cancer: A population-based propensity-score matched analysis

BackgroundOlder patients with breast cancer have good prognosis and most die from diseases other than breast cancer. Previous studies suggested that the surgical extent in older patients could be reduced. We aimed to compare survival outcomes in patients aged ≥70 years with clinically node-negative breast cancer, based on whether axillary surgery was performed. MethodsA total of 2,995 patients with breast cancer aged ≥70 years who underwent breast surgery were included in the Korean Breast Cancer Registry. Patients were classified into two groups according to the performance of axillary surgery. We used propensity score matching for demographic and treatment factors to minimize selection bias. We compared the 5-year overall survival (OS) and breast cancer-specific survival (BCSS). ResultsAmong 708 patients after 3:1 propensity score matching, 531 underwent breast surgery with axillary surgery and 177 underwent breast surgery alone. Of all patients, 51.7% had T1 stage, and 73.2% underwent mastectomy. Approximately 31.2% of patients received chemotherapy. Among patients who did not undergo axillary surgery, the 5-year OS and BCSS rates were 85.2% and 96.7%, respectively. The hazard ratio of axillary surgery for OS was 0.943 (95% confidence interval 0.652–1.365, p = 0.757), indicating no significant difference between two groups. ConclusionsOur study demonstrates that axillary surgery in a matched cohort of older patients with breast cancer and clinically negative nodes does not provide a survival benefit compared to patients undergoing breast surgery alone. These findings suggest that axillary surgery may be safely omitted in a select group of patients aged ≥70 years with clinically node-negative cancer. Further studies are needed to identify potential candidates for omitting axillary surgery.

Mental health and wellbeing among people with informal caring responsibilities across different time points during the COVID-19 pandemic: a population-based propensity score matching analysis.

Due to a prolonged period of national and regional lockdown measures during the coronavirus (COVID-19) pandemic, there has been an increase reliance on informal care for informal carers. In light of this, the current study compared the experiences of carers and non-carers on various mental health and wellbeing measures across six key time points during the pandemic. Data analysed were from the University College London (UCL) COVID -19 Social Study. Our study focused on six time points in England: (1) the first national lockdown (March-April 2020); (2) the beginning of first lockdown rules easing (May 2020); (3) the second national lockdown (November 2020); (4) the third national lockdown (January 2021); (5) the easing of the third lockdown (March 2021); and (6) the end of restrictions (July-August 2021). We considered five mental health and wellbeing measures: depressive symptoms, anxiety symptoms, loneliness, life satisfaction, and sense of being worthwhile. Propensity score matching was applied for the analyses. We found that informal carers experienced higher levels of depressive and anxiety symptoms than non-carers across much of the pandemic. During the first national lockdown, carers also experienced a higher sense of life being worthwhile. No association was found between informal caring responsibilities and levels of loneliness and life satisfaction. Given that carers are an essential national healthcare support, especially during a pandemic, it is crucial to integrate carers' needs into healthcare planning and delivery. These results highlight that there is a pressing need to provide adequate and targeted mental health support for carers during and following this pandemic.

Sublobar resection versus lobectomy for patients with stage T1-2N0M0 pulmonary typical carcinoid tumours: a population-based propensity score matching analysis.

OBJECTIVESIt is widely accepted that surgical resection of localized pulmonary typical carcinoid (TC) tumours remains the primary curative modality. However, the optimal extent of resection remains controversial. This study aimed to investigate the survival rates of patients with stage T1-2N0M0 TC tumours who underwent sublobar resection or lobectomy.METHODSWe queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery after being diagnosed with stage T1-2N0M0 TCs from 2004 to 2016. Propensity score matching (PSM) analysis was used to equalize the baseline characteristics between the sublobar resection group and the lobectomy group. Kaplan–Meier analysis and the Cox proportional hazard model were performed for survival analysis.RESULTSOf the 2469 patients included, 658 (26.65%) underwent sublobar resection and 1811 (73.35%) underwent lobectomy. All 2469 patients were analysed with PSM and, following PSM, 812 patients were included in the final analysis and divided into 2 groups of 406 patients. In the matched cohort, Kaplan–Meier analysis demonstrated no significant difference in survival curves between the sublobar resection and lobectomy groups in patients with stage T1-2N0M0 TC tumours [5-year overall survival (OS) = 90.78% vs 93.30%; hazard ratio 1.18, 95% confidence interval: 0.77–1.80; P = 0.505]. Subgroup analysis by tumour size showed that the sublobar resection group was identical to the lobectomy group in OS for tumours ≤3.0 cm. In addition, no difference in OS between surgical groups was observed in any subgroups. In the multivariable Cox analysis, age ≤65 years, female sex, married status and adequate lymph node assessment (≥5) were associated with improved OS, whereas the extent of resection was not.CONCLUSIONSSublobar resection seems to be associated with similar survival to lobectomy for stage T1-2N0M0 TC tumours if lymph node assessment is performed adequately. This analysis suggests that sublobar resection should be considered an appropriate alternative for stage T1-2N0M0 TC tumours. However, further validations are needed in large, multicentre prospective studies.

Oncologic outcomes of fertility-sparing surgery in early stage epithelial ovarian cancer: a population-based propensity score-matched analysis.

To evaluate the safety of fertility-sparing surgery (FSS) in reproductive women (younger than 50years) with early epithelial ovarian cancer (EOC). Reproductive women diagnosed with stage I EOC in the Surveillance, Epidemiology and End Results (SEER) database were identified. Surgeries that did not undergo hysterectomy and/or bilateral salpingo-oophorectomy were categorized as FSS, whereas non-FSS included bilateral salpingo-oophorectomy and hysterectomy. Propensity-score matching (PSM) was conducted to balance the covariates. Risk factor was identified by COX analysis. Kaplan-Meier curves were performed to evaluate the overall survival (OS) and cancer-specific survival (CSS). 3556 patients with stage I EOC were identified and divided into non-FSS group and FSS group. After PSM, 625 pairs of patients with stage I EOC were included. FSS was not inferior to non-FSS in the OS curve [HR 0.9127, 95% CI (0.6971 ~ 0.1.195), P = 0.5174; HR: 0.9378, 95% CI (0.6358 ~ 0.1.383), P = 0.7460] and the CSS curve [HR 0.8284, 95% CI (0.5932 ~ 1.157), P = 0.2949; HR 0.9003, 95% CI (0.5470 ~ 1.482), P = 0.6803] both in overall cohort and in matched cohort. Univariate COX analysis identified older age (45-49), moderate-differentiated to un-differentiation grade, IC stage, bigger tumor size (> 10cm) and chemotherapy as risk factors of prognostic outcome (P < 0.1). Not only in univariate subgroup analyses but also in bivariate factors subgroup analysis, the evidence was not enough to regard FSS as a harmful factor compared with non-FSS. Fertility-sparing surgery was comparable to non-FSS in terms of survival in reproductive women with stage I EOC. Patients with high-risk factors could also consider FSS as an effective alternative compared with non-FSS.

COVID-19 Infection and Incidence of Myocarditis: A Multi-Site Population-Based Propensity Score-Matched Analysis.

BackgroundCardiovascular complications from COVID-19 include myocarditis, acute myocardial infarction, heart failure, and others. Population-level data is lacking about the relationship between COVID-19 and cardiovascular complications; therefore, we conducted a study to examine the incidence of myocarditis, acute myocardial infarction (AMI), heart failure (HF) after COVID-19 infection.MethodsRetrospective cohort study using de-identified data from 50 health systems across the United States. Cohort groups were created using patients ≥18 who were admitted to hospitals for respiratory illness with COVID-19 in 2020 and respiratory illness without COVID-19 for 2020 and 2019. There were 107,699 patients with COVID-19, 77,499 patients with respiratory illness in 2020, and 112,898 patients in 2019. The COVID-19 group was matched to each respiratory illness group by propensity score. Patients with prior specific cardiovascular events such as myocarditis, AMI, HF were excluded. The primary outcome was myocarditis, and secondary outcomes were AMI and HF.ResultsIn the COVID-19 group, 79 (0.12%) patients had new-onset myocarditis compared to 29 (0.04%) patients in the non-COVID-19 control (Pneumonia/flu) group Odd's Ratio (OR), (OR 2.73, CI 95%, 1.78-4.18). In the COVID-19 group, 1512 patients developed HF compared to 2,659 patients in the non-COVID-19 group (OR 0.49, CI 95%, 0.46-0.52). 1125 patients in COVID-19 group had AMI compared to 1243 patients in non-COVID-19 group (OR 0.87, CI 95%, 0.80-0.94).ConclusionCOVID-19 was associated with a 2-3-fold higher risk of myocarditis. Unexpectedly, lower rates of HF diagnosis reflect challenges faced due to the severity of lung disease leading to obscuring physical exam findings required for HF diagnosis and early mortality before a diagnosis of HF was made.

Primary Pericardial Mesothelioma: A Population-Based Propensity Score-Matched Analysis

Primary pericardial mesothelioma is a rare malignancy of the mesothelial lining of the pericardium. This study aimed to evaluate the clinical characteristics and survival outcomes of these patients using a United States population-based cancer database. We queried the Surveillance, Epidemiology, and End Results program (1973-2015). Primary pericardial mesothelioma patients with complete follow-up data were included, and primary pleural mesothelioma patients were identified as controls. Propensity-score matching was used to balance individual characteristics. Kaplan-Meier analysis and log-rank tests were performed to compare overall survival. Forty-one primary pericardial mesothelioma and 15,970 primary pleural mesothelioma patients were identified. Before matching, when compared to the pleural mesothelioma counterparts, primary pericardial mesothelioma patients were younger (median 57 vs 73 years, P < 0.001), more likely to be female (46.3% vs 20.2%, P < 0.001), more likely to be nonwhite (24.4% vs 8.4%, P=0.001), and less likely to have been diagnosed in the most recent study decade (2006-2015, 34.1% vs 43.5%, P=0.002). The overall 1- and 2-year survival rates were 22.0% and 12.2%, with a median survival of 2 months (IQR: 1-6). After 1:2 nearest neighbor propensity-score matching, 38 pericardial mesothelioma and 76 matched pleural mesothelioma cases were identified. The 2 matched groups had comparable baseline characteristics, including age, sex, race, year of diagnosis, histological type, and cancer history. Compared to their pleural mesothelioma counterparts, primary pericardial mesothelioma patients were less likely to receive chemotherapy (23.7% vs 50.0%, P=0.01) and had worse overall survival (median survival: 2 vs 10 months, log-rank P=0.006). Primary pericardial mesothelioma has worse survival outcomes than pleural mesothelioma, with a median survival of only 2 months. These patients should seek care from experienced multidisciplinary teams at tertiary care centers that handle high volumes of mesothelioma patients.

Adjuvant chemotherapy and survival in women aged 70 years and older with triple-negative breast cancer: a Swedish population-based propensity score-matched analysis

Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer associated with poor survival, in which adjuvant systemic treatments are limited to chemotherapy. Due to competing mortality risks and comorbidities, older patients with TNBC are often undertreated with adjuvant chemotherapy, and clinical trials on this problem are scarce, despite a growing patient population. This study aimed to assess outcomes for patients aged 70 years and older with TNBC with or without chemotherapy in a national population-based registry, to provide information that can assist in treatment decisions for these patients. In this population-based registry study, data on all patients aged 70 years and older diagnosed with primary early TNBC (larger than 5 mm in diameter and without distant metastasis) and surgically treated between Jan 1, 2009, and Dec 31, 2016, were retrieved from the Swedish National Breast Cancer Register, the Swedish Patient Register, and the Swedish Cause of Death Register. Patients with incomplete data (on oestrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2 status, surgical procedure in the breast, or information about chemotherapy) were excluded. A propensity score-matched (PSM) model was used to examine the outcomes of adjuvant chemotherapy on 5-year breast cancer-specific survival (BCSS) and 5-year overall survival (OS), adjusted for age, tumour size, tumour grade, nodal status, and comorbidities. Of 1130 women eligible for analysis, 368 (32·6%) received adjuvant chemotherapy, 45 (4·0%) received neoadjuvant treatment, and 717 (63·5%) did not receive chemotherapy. 5-year BCSS was significantly improved in patients who received adjuvant chemotherapy (85% [95% CI 81-89]) compared with patients who did not receive chemotherapy (68% [64-72]; p<0·0001). A similar benefit was observed in 5-year OS (79% [95% CI 75-84] vs 49% [45-53]; p<0·0001). In our PSM analysis, 5-year BCSS in patients treated with adjuvant chemotherapy was 83% (95% CI 78-89), versus 73% (67-80; p=0·014) in patients not treated with chemotherapy. 5-year OS in patients treated with adjuvant chemotherapy was 75% (95% CI 69-82), versus 63% (57-71; p=0·029) in patients who did not receive chemotherapy. In this PSM registry analysis of surgically treated female patients aged 70 years and older with TNBC without distant metastasis, we identified a significant benefit both in 5-year BCSS and 5-year OS with adjuvant chemotherapy versus no chemotherapy, which persisted when adjusting for age and comorbidities. These results underline the importance of considering adjuvant chemotherapy in older patients. Knut and Alice Wallenberg Foundation, Assar Gabrielsson Foundation.

Effect on survival of local treatment in patients with low prostate-specific antigen, high Gleason score prostate cancer: a population-based propensity score-matched analysis.

Emerging data suggest that in patients with low prostate-specific antigen (PSA) and high Gleason score, prostate cancer (PCa) is more aggressive and more likely to be related to genomic characteristics of neuroendocrinology. However, the evidence for the advantages of local treatment (LT) for these men is lacking. Hence, we investigated survival in men with low-PSA values and high-grade (Gleason score 8-10) PCa according to the treatment of the primary tumor. Kaplan-Meier survival analysis was applied to analyze the effects on overall survival (OS) and cancer-specific survival (CSS) according to the different treatments of the primary tumor. Multivariable Cox proportional hazards survival regression analysis calculated the CSS after propensity score matching (PSM) in 2 cohorts according to treatment type. The treatment types included the following: (I) LT versus non-LT (NLT) and (II) radical prostatectomy (RP) versus radiotherapy (RT). In the Surveillance, Epidemiology, and End Results (SEER) database [2004-2014], we identified 14,208 patients newly diagnosed with low PSA values (10 ng/mL or less), with a Gleason score 8-10, and cT1-4N0M0 prostate adenocarcinoma. After the first PSM, of the 3,512 PCa patients, 1,576 underwent LT and 1,576 underwent NLT. After the second PSM, of the 792 PCa patients, 396 underwent RP, and 396 underwent RT. The 5- and 10-year OS rates for LT vs. NLT patients were 90% and 73% versus 69% and 39%, respectively, while the 5- and 10-year CSS rates for LT vs. NLT patients were 98% and 94% versus 89% and 79%, respectively. Subsequent multivariate survival analysis showed that LT was associated with lower likelihood of PCa mortality relative to NLT [hazard ratio (HR), 0.19; 95% confidence interval (CI), 0.14-0.26, P<0.001], also in RP versus RT (HR, 0.26; 95% CI, 0.12-0.54, P<0.001). In patients with low PSA values, Gleason score 8-10, and localized PCa, LT resulted in higher survival compared with NLT. Within LT, RP provided the most benefit relative to RT.

Impact of breast surgery on survival of patients with stage IV breast cancer: a SEER population-based propensity score matching analysis.

BackgroundBreast surgery for stage IV breast cancer remains controversial. The aim of this study was to investigate the impact of breast surgery on survival of stage IV breast cancer patients based on the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015.MethodsIn total, 13,034 patients were selected and divided into surgery and non-surgery groups. Univariate and multivariable analyses were conducted to determine factors related to survival. Propensity score matching method was utilized to achieve balanced covariates across different groups. One-to-one (1:1) PSM was conducted to construct a matched sample consisting of pairs of surgery and non-surgery subjects. Breast cancer-specific survival (BCSS) and overall survival (OS) of the two groups were assessed by Kaplan–Meier plots and Cox proportional hazard regression models. Stratified analysis according to different variables was also performed.ResultsPatients treated with breast surgery were more likely to be younger, smaller tumor size, more advanced nodal status, higher histology grade and higher proportion of bone-only metastasis. Those who received chemotherapy and radiotherapy also tended to be treated with surgery. After adjustment for potential confounders, breast surgery group exhibited a better survival both in BCSS (HR = 0.557, 95% CI [0.523–0.594], p < 0.001) and OS (HR = 0.571, 95% CI [0.537–0.607], p < 0.001). After propensity score matching, the surgery and non-surgery group consisted of 2,269 patients respectively. The median survival time was 43 months for the surgery group and 27 months for the non-surgery group. Kaplan–Meier curves indicated that breast surgery could clearly improve both the BCSS and OS for patients with stage IV breast cancer. On multivariate analysis, surgery group was associated with a better survival compared with the non-surgery group (BCSS: HR = 0.542, 95% CI [0.499–0.589], p < 0.001; OS: HR = 0.555, 95% CI [0.512–0.601], p < 0.001). Furthermore, this survival advantage persisted in all subgroups irrespective of age, race, tumor size, nodal status, histology grade, molecular subtype, chemotherapy status, radiotherapy status or status of distant metastasis.ConclusionOur study provided additional evidence that patients with stage IV breast cancer could benefit from breast surgery and it might play a more important role in multimodality therapy.

Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis

BackgroundThe decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization.MethodsA total of 570,250 individuals identified from the 2002–2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4.ResultsPSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05).ConclusionSubstance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.

Survival comparison of Three histological subtypes of lung squamous cell carcinoma: A population-based propensity score matching analysis

ObjectivesThis study is aimed to analyze the survival differences among patients with lung basaloid squamous cell carcinoma (BSCC), keratinizing squamous cell carcinoma (KSCC), and nonkeratinizing squamous cell carcinoma (NKSCC), and explore the prognostic factors of patients with lung BSCC. Materials and MethodsWe searched the information of 4743 patients with lung SCC between 2005 and 2014 from the SEER database. Propensity score matching (PSM) was used to adjust confounding factors. The overall survival (OS), cancer-specific survival (CSS), and cumulative incidence of cancer-specific mortality (CSM) were estimated with a comparative analysis. A competing risks regression model was conducted to identify the prognostic factors of lung BSCC. ResultsAfter PSM, patients with lung BSCC had a higher CSS rate than those with lung KSCC or NKSCC (5-year CSS rate: 50.4 % vs. 37.7 % vs. 38.5 %, p = 0.033 and p = 0.033). The cumulative incidence of CSM was lower for patients with lung BSCC than those with lung KSCC or NKSCC (5-year CSM rate: 46.4 % vs. 56.9 % vs. 56.4 %, p = 0.046 and p = 0.042), which were similar to the results before PSM. As for patients with lung KSCC and NKSCC, there was no survival differences between them (5-year CSS rate: 37.7 % vs. 38.5 %, p = 0.997). The competing risks regression analysis showed that T stage, N stage, M stage and surgery were independent prognostic factors for patients with lung BSCC (all p < 0.05). ConclusionsPatients with lung BSCC had a better survival than those with lung KSCC or NKSCC, while no survival differences were found between lung KSCC and NKSCC. T stage, N stage, M stage and surgery were independent prognostic factors for patients with lung BSCC.