Relative Survival Probabilities Research Articles

Programmable Release of Chemotherapeutics from Ferrocene-Based Injectable Hydrogels Slows Melanoma Growth.

Hydrogel-based injectable drug delivery systems provide temporally and spatially controlled drug release with reduced adverse effects on healthy tissues. Therefore, they represent a promising therapeutic option for unresectable solid tumor entities. In this study, a peptide-starPEG/hyaluronic acid-based physical hydrogel is modified with ferrocene to provide a programmable drug release orchestrated by matrix-drug interaction and local reactive oxygen species (ROS). The injectable ROS-responsive hydrogel (hiROSponse) exhibits adequate biocompatibility and biodegradability, which are important for clinical applications. HiROSponse is loaded with the two cytostatic drugs (hiROSponsedox/ptx) doxorubicin (dox) and paclitaxel (ptx). Dox is a hydrophilic compound and its release is mainly controlled by Fickian diffusion, while the hydrophobic interactions between ptx and ferrocene can control its release and thus be regulated by the oxidation of ferrocene to the more hydrophilic state of ferrocenium. In a syngeneic malignant melanoma-bearing mouse model, hiROSponsedox/ptx slows tumor growth without causing adverse side effects and doubles the relative survival probability. Programmable release is further demonstrated in a tumor model with a low physiological ROS level, where dox release, low dose local irradiation, and the resulting ROS-triggered ptx release lead to tumor growth inhibition and increased survival.

Prediagnostic use of menopausal hormone therapy and long-term survival of localized epithelial ovarian cancer: The Extreme study.

Use of menopausal hormone therapy (MHT) prior to an epithelial ovarian cancer (EOC) diagnosis has been suggested to be associated with improved survival. In a recent nationwide cohort study, we found that prediagnostic long-term MHT use, especially estrogen therapy (ET), was associated with improved long-term survival in women with nonlocalized EOC. Our aim was to investigate the influence of prediagnostic MHT use on long-term survival among women with localized EOC in the same nationwide study. Our study cohort comprised all women aged 50 years or older with an EOC diagnosis in Denmark 2000-2014 (n = 2097) identified from the Extreme study. We collected information on usage of systemic ET and estrogen plus progestin therapy (EPT) from the Danish National Prescription Registry. By using pseudo-values, 5- and 10-year absolute and relative survival probabilities were estimated with 95% confidence intervals (CIs) while adjusting for histology, comorbidity, and income. Relative survival probabilities >1 indicate better survival. The 5-year absolute survival probabilities were 61% and 56%, respectively, among women who were nonusers and users of prediagnostic MHT, whereas these numbers were 46% and 41%, respectively, regarding 10-year survival. Use of MHT was not significantly associated with an improved 5- or 10-year survival in women with localized EOC (5-year relative survival probability = 0.95, 95% CI: 0.89-1.02; 10-year relative survival probability = 0.92, 95% CI: 0.84-1.02). Similar findings were seen for systemic ET or EPT use. Our findings do not suggest a positive benefit from prediagnostic MHT use on long-term survival of localized EOC.

From leaves to the whole tree: Mistletoe effects on the productivity, water relations, and demography of a Neotropical savanna tree

AbstractTrees' responses to mistletoes occur at multiple organization levels (e.g., leaf, individual, population), yet integrating these multi‐scale responses is still challenging. Here, we compared the traits of infected versus uninfected trees over multiple scales, from leaf anatomy and physiology to canopy allometries and individual growth rate and survivorship. We tested the hypotheses that mistletoes lead in the host (1) the production of leaves with a conservative resource‐use strategy, (2) more mechanically stable canopies and (3) reductions in growth and survival probability in the trees they infect. We addressed these hypotheses in the widespread savanna tree Vochysia thyrsoidea and xylem‐tapping mistletoe Psittacanthus robustus in the Brazilian Cerrado, a global biodiversity hotspot. We found that (1) mistletoe infection did not affect key traits associated with resource conservativeness, such as leaf mass per area (LMA) and carbon assimilation rates (A). Likewise, (2) hosts did not increase the mechanical safety of their trunks in response to mistletoe infection since infected and uninfected trees had a similar allometric scaling between height and crown volume against stem diameter. (3) At the population level, both the relative growth rate and survival probability decreased as the number of parasites increased. However, zero growth and a 50% chance of mortality were estimated to occur in a minority of heavily infected trees (>7 and 14 parasites, respectively). Our results challenge the idea that mistletoes have a ubiquitous negative impact on their hosts. We highlight, therefore, the need for clarifying the mechanisms that allow trees to maintain their functioning even in the face of mistletoe parasitism.

Plant sex changes the outcome of ant–plant interactions in a facultative myrmecophytic cactus

Abstract In exchange for extrafloral nectar, ants deter herbivores from the plants decreasing the herbivore damage, and increasing plant performance in terms of growth and survival. Plants of different sexes may exhibit differences in the investment of resources for defence, thereby differentially decreasing the amount of energy available to other physiological processes. In this context, little is known about sex‐related differences in the outcome of ant–plant interactions in plants bearing extrafloral nectaries (EFNs). In the present study, we conducted ant‐exclusion experiments in the field to test for sex‐related differences in the outcome of ant–plant interactions in vegetative and reproductive buds of Opuntia robusta in individuals of different sexes in two populations: trioecious and dioecious. We applied tanglefoot to some plant and others were allowed ant access, and measured herbivory, relative growth rates and survival probabilities of buds during the growing season when EFNs are active. We counted the number of ants foraging in EFNs of flowers and cladodes of different sexes. We hypothesized that differences in resource investment to defence between sexes change the outcome of ant–plant interactions in terms of the number of ants foraging on EFNs, herbivory, growth, and survival probabilities. Our results suggest sex‐specific strategies in the investment of resources for defence mediated by EFNs in O. robusta, wherein males, females and hermaphrodites from both populations respond differentially to ant presence and herbivores. These sex‐related differences affected the outcome of the ant–plant interactions, influencing changes in number of ants foraging on EFNs, and the resulting herbivory, growth and survival of flowers and cladodes among the different sexes and among populations. Our results suggest that the maintenance of EFNs in O. robusta is costly, reflecting some trade‐offs between growth/survival and defence. Buds visited by ants tended to grow slowly and survive worse in the trioecious population; in the dioecious population they grew slower but survived better. Overall, a greater number of ants visiting EFNs was related to lower herbivore damage, greater growth and survival of flowers and cladodes. Our study underscores the importance of considering plant sex in the outcome of ant–plant interactions. Read the free Plain Language Summary for this article on the Journal blog.

Survival Among Acute Myeloid Leukemia Patients Conditional on Years Already Survived and Relative to the General Population in the United States

Background: Prognostic models for AML patients (pts) predict outcomes based on clinical and cytogenetic features at diagnosis. However, as a pt lives beyond the initial date of diagnosis following treatment, his/her estimated survival period improves and these models lose accuracy. Conditional survival (CS) probability estimations use the time a pt has survived since diagnosis to improve on prognostic accuracy and provide personalized survival information. Here we report population-level, 5-yr relative cancer survival probabilities of AML pts conditional on having already survived ≥1 yr(s) after diagnosis.Methods: A total of 13,933 adult AML cases diagnosed during 2000-2009, and followed through 2014 were assembled from all 18 registries of the Surveillance, Epidemiology and End Results (SEER). Pts who did not receive chemotherapy in the first 3 months after diagnosis were excluded. Survival probabilities were calculated using the SEER Survival System (SEER*Stat). We calculated relative survival (RS) probability estimates that compare survival in the pt cohort relative to the expected survival of the general population (matched for age, sex, race and calendar period over a standard follow-up time). Trends in 5-year RS estimates conditional on already having survived 0-5 years from diagnosis were modeled using regression modeling. Estimates were adjusted for age group [adolescents and young adults (AYA) (18-39 yrs); middle-aged (40-59 yrs) and elderly (> 60 yrs)], yr of diagnosis, years already survived (YAS), sex and race. We performed subset analyses for AML categories with adequate sample size for analysis in SEER - AML with myelodysplasia (MDS)-related changes or AML-MRC (n = 794), core-binding factor (CBF) AML (n = 462) and acute promyelocytic leukemia (APL) (n = 1499). Tests of significance were based on two-sided hypothesis at the .05 level. Analyses were performed using STATA.Results: Figure 1A shows survival of all AML pts relative to the expected survival of the general population by age groups. At 10 yrs after diagnosis, the RS probabilities of AML (all categories) was 50% for AYA, 35% for middle-aged and 10% for elderly cohort. When conditioned on YAS, the estimated 5-year RS probabilities of AML pts consistently improved with successive yrs as shown in Figure 1B. Figures 2A-2C show RS probability estimates for specific AML categories by age subgroups - 10-yr RS was highest for APL [80% - AYA, 70% - middle-aged, 50% - elderly] as expected but surprisingly lower than expected in CBF-AML [65% in AYA group, 50% in middle-aged and 30% in elderly]. Figures 2D-2F illustrate the influence of AML categories and advancing age on CS estimates. The estimated 5-yr RS probabilities when conditioned on successive YAS increased for all age groups and for each AML category. The 5-yr relative CS was highest in APL pts among all AML categories and almost reached 100% for all three age groups, thereby approximating survival of the general population. Pts with CBF-AML had high 5-yr relative CS probabilities of 90% in all age groups, consistent with their favorable prognosis. The 5-yr conditional RS probability for AML-MRC exceeded 90% and 80% for AYA and middle-aged groups, respectively but reached only 60% in the older cohort. AML-MRC is considered a biologically heterogeneous disease and this finding suggests a biologically aggressive course in older patients. In multivariable analyses, the 5-yr RS estimates were significantly lower in > 60 yrs cohort (vs. 18-39 yrs, 36.09% drop (95% CI, 35.81-36.09)] but better in females (vs. males, 5.07% improvement (95% CI, 4.89-5.25), with YAS [conditioned on 1 to 5 YAS, 5-yr RS improved from 19.92% (95% CI, 15.03-24.81) to 53.77% (95% CI, 49.55-57.98)] and in recent treatment period [2006-2009 vs, 2002-2005, 9.07% improvement (95% CI, 8.93-9.21).Conclusions: Following treatment completion, survival prognosis in AML can be further refined using a population-derived, 5-yr CS estimates based on YAS. While CBF-AML is often considered “favorable-risk” AML, long-term RS probabilities belied this, with unexpectedly lower survival probabilities (~30-65% at 10 yrs). This data suggests the need for a longer period of leukemia surveillance following treatment completion. RS and CS information can be applied clinically at the individual level and can be used in the design of clinical trials to determine appropriate length of follow up. [Display omitted] DisclosuresAdvani:Takeda/ Millenium: Research Funding; Pfizer: Consultancy. Gerds:CTI BioPharma: Consultancy; Incyte: Consultancy. Majhail:Anthem, Inc.: Consultancy; Sanofi: Honoraria. Sekeres:Celgene: Membership on an entity's Board of Directors or advisory committees.

Survival Among Acute Lymphocytic Leukemia Patients Conditional on Years Already Survived and Relative to the General Population in the United States

Background: Prognostic models for acute lymphocytic leukemia (ALL) patients (pts) become less meaningful and less accurate for ongoing cancer survivors. As a result, conditional survival (CS), which represents the probability that a cancer pt survives additional years (yrs), given that the pt has already survived a given number of yrs, has emerged as a more clinically relevant measure of prognosis for pts who have survived several yrs beyond diagnosis and treatment. Here we report population-level, 5-yr relative cancer survival probabilities conditional on having already survived ≥1 yr(s) after diagnosis in ALL cases diagnosed during 2000-2009, and followed through 2014.Methods: A total of 4,553 adult ALL cases were assembled from April 2017 release of all 18 registries of the Surveillance, Epidemiology and End Results (SEER). Pts who did not receive chemotherapy in the first 3 months after diagnosis were excluded. All survival estimates reported here refer to relative survival (RS), which is survival in the pt cohort relative to the expected survival of the general population (matched for age, sex, race and calendar period over a standard follow-up time). Survival probabilities were calculated using the SEER Survival System (SEER*Stat). Trends in 5-year RS estimates conditional on already having survived 0-5 years from diagnosis were modeled using regression modeling. Estimates were adjusted for age group [adolescents and young adults (AYA) (18-39 yrs); middle-aged (40-59 yrs) and elderly (> 60 yrs)], yr of diagnosis, years already survived (YAS), sex and race. We also performed subset analyses for following ALL morphologic categories - B-cell, T-cell and ALL of unknown lineage (UL). Tests of significance were based on two-sided hypothesis at the .05 level. All analyses were performed using STATA.Results: Figures 1A-1C show RS probability estimates for specific ALL categories by age subgroups - the 10-yr RS for T-cell ALL [40% - AYA, 27% - middle-aged, 15% - elderly], was not significantly different than that of B-cell ALL [40% - AYA, 25% - middle-aged, 14% - > 60 yrs] or ALL of UL. Overall, RS estimates were dismal for elderly age group for all three ALL categories. Figures 2D-2F illustrate the large influence of YAS on CS estimates. The estimated 5-year RS probabilities when conditioned on successive YAS increased for all age groups and for each of the ALL categories examined with the exception of ALL of UL in the > 60 age cohort. In the AYA age cohort, the CS converged to >90% in all ALL subtypes following 5 YAS. In the middle-aged cohort, the CS reached 90% in the ALL of UL subtype, 82% in the B-cell ALL subtype and 84% in the T-cell ALL subtype. Largest difference in CS estimates was seen in the elderly cohort with 5 YAS - similar for B-cell ALL and T-cell ALL (83% and 89%, respectively) but low at 65% for ALL of UL. In multivariable analyses, the 5-yr RS estimates were significantly lower in > 60 yrs cohort across all subtypes (vs. AYA, 19.09% drop (B-cell ALL) (95% CI, 18.20-19.98); 18.9% drop (T-cell ALL) (95% CI 18.12-19.68); 28.02% drop (ALL of UL) (95% CI 27.16-28.89)], males across B-cell ALL and T-cell ALL [ vs . females, 4.14% drop (B-cell ALL) (95% CI 3.75-4.52); 3.02% drop (T-cell ALL) (95% CI 2.67-3.37)], and blacks across B-cell ALL and T-cell ALL [ vs. whites, 13.35% drop (B-cell ALL) (95% CI, 12.25-14.45); 11.68% drop (T-cell ALL) (95% CI 10.86-12.50)], but showed improvement over time across all groups [2006-2009 vs 2000-2005, 12.02% improvement (B-cell ALL) (95% CI 12.35-12.89); 9.95% improvement (T-cell ALL) (95% CI 9.70-10.19); 4.81% improvement (ALL of UL) (95% CI (4.17-5.46)] and almost identical improvement with YAS across all subtypes [5 yrs vs. < 1 yr survived, 55.82% improvement (B-cell ALL) (95% CI 49.54-62.10)].Conclusions: Following treatment completion, survival prognosis in ALL can be further refined using a population-derived, 5-yr CS estimates based on YAS. While the AYA group had the best RS estimates compared to the older age cohorts, it was still low at 40% at 10-yr mark. RS estimates were not influenced by ALL subtype. With more number of yrs survived following diagnosis and treatment, probability of survival improved for all except for elderly with ALL of UL. RS and CS information can be applied clinically at the individual level and can be used in the design of clinical trials to determine appropriate length of follow up for more accurate survival analysis. [Display omitted] DisclosuresAdvani:Takeda/ Millenium: Research Funding; Pfizer: Consultancy. Gerds:Incyte: Consultancy; CTI BioPharma: Consultancy. Majhail:Sanofi: Honoraria; Anthem, Inc.: Consultancy. Sekeres:Celgene: Membership on an entity's Board of Directors or advisory committees.

Cause of death for patients with breast cancer: discordance between death certificates and medical files, and impact on survival estimates

BackgroundRegistration and coding of cause of death is prone to error since determining the exact underlying condition leading directly to death is challenging. In this study, causes of death from the death certificates were compared to patients’ medical files interpreted by experts at University Hospitals Leuven (UHL), to assess concordance between sources and its impact on cancer survival assessment.MethodsBreast cancer patients treated at UHL (2009–2014) (follow-up until December 31st 2016) were included in this study. Cause of death was obtained from death certificates and expert-reviewed medical files at UHL. Agreement was calculated using Cohen’s kappa coefficient. Cause-specific survival (CSS) was calculated using the Kaplan-Meier method and the relative survival probability (RS) using the Ederer II and Pohar Perme method.ResultsA total of 2862 patients, of whom 354 died, were included. We found an agreement of 84.7% (kappa-value of 0.69 (95% C.I.: 0.62–0.77)) between death certificates and medical files. Death certificates had 10.7% false positive and 4.5% false negative rates. However, five-year CSS and RS measures were comparable for both sources.ConclusionFor breast cancer patients included in our study, fair agreement of cause of death was seen between death certificates and medical files with similar CSS and RS estimations.

Conditional Relative Survival of Ovarian Cancer: A Korean National Cancer Registry Study.

ObjectiveConditional relative survival (CRS) rates, which take into account changes in prognosis over time, are useful estimates for survivors and their clinicians as they make medical and personal decisions. We aimed to present the 5-year relative conditional survival probabilities of patients diagnosed with ovarian cancer from 1997–2016.MethodsThis nationwide retrospective cohort study used data from the Korean Central Cancer Registry. Patients diagnosed with ovarian cancer between 1997 and 2016 were included. CRS rates were calculated stratified by age at diagnosis, cancer stage, histology, treatment received, year of diagnosis, and social deprivation index.ResultsThe 5-year relative survival rate at the time of diagnosis was 61.1% for all cases. The probability of surviving an additional 5 years, conditioned on having already survived 1, 2, 3, 4, and 5 years after diagnosis was 65.0, 69.5, 74.6, 79.3, and 83.9%, respectively. Patients with poorer initial survival estimates (older, distant stage, serous histology) generally showed the largest increases in CRS over time. The probability of death was highest in the first year after diagnosis (11.8%), and the conditional probability of death in the 2nd, 3rd, 4th, and 5th years declined to 9.4%, 7.9%, 6.1%, and 5.2%, respectively.ConclusionCRS rates for patients with ovarian cancer increased with each year they survived, but this did not reach the level of ‘no excess mortality’ even 5 years after diagnosis. The largest improvements in CRS were observed in patients with poorer initial prognoses. Our findings provide updated prognosis to ovarian cancer survivors and clinicians.

Abstract PS7-63: Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study

Abstract Introduction Accurate information on cause of death is essential for correct breast cancer-specific mortality assessment. However, registration and coding of cause of death is prone to error since determining the exact underlying condition related to the death is challenging. In this study, an expert review of medical files was done to determine the principal cause of death for breast cancer patients of a Belgian tertiary hospital. The retrieved cause of death was compared to death certificate information to assess concordance between both sources. Secondly, the impact of discordant reporting on cause-specific survival (CSS) and other net survival approaches were examined. Methods Breast cancer patients diagnosed and treated at University Hospitals Leuven (UHL) between 2009 and 2014 with follow-up until December 31st, 2016, were included in the study. Information on cause of death was obtained from death certificates (following ICD-10 rules) and medical files. The latter were reviewed by a board of experts at UHL. Agreement was calculated using Cohen’s kappa coefficient, and reasons for discordant reporting were assessed. CSS was calculated based on cause of death information from both sources using the Kaplan-Meier method. These survival estimates were compared to the relative survival probability (RS) using the Ederer II and Pohar Perme method. Results A total of 2,862 patients were included, of whom 354 died after a median follow-up of 54.6 months. We found overall substantial agreement (kappa-value of 0.69 (95% C.I.: 0.62-0.77)) between cause of death reported by death certificates and medical files (Table 1). In 84.8% of cases, there was concordance between both methods. When comparing to medical files, misattribution of breast cancer-specific death in death certificates (4.5% of cases) was linked to the presence of comorbidities (43.7%), metastases (37.5%), or unspecified causes (18.8%). Five-year CSS based on medical files (93.1% (95% C.I.: 91.9-94.1)) was only slightly higher compared to CSS based on death certificates (92.3% (95% C.I.: 91.2-93.4)). RS measures using Ederer II and Pohar Perme were comparable to CSS measures. Conclusions Overall, substantial agreement of cause of death was seen between death certificates and medical files. Attribution of cause death to comorbidities was the most common reason for discordant reporting of breast cancer-specific death. Five-year breast cancer-specific survival was slightly higher based on cause of death information from medical files, compared to death certificates. Periodic reviews and implementation of ICD-10 guidelines for classification of cause of death could improve accuracy in cause of death annotation. Table 1: Discordance for the principal cause of death between medical files and death certificatesmedical filesother causesbreast cancerdeath certificatesother causes136 (38.4%)16 (4.5%)152 (42.9%)breast cancer38 (10.7%)164 (46.3%)202 (57.1%)174 (49.2%)180 (50.9%)354 (100%) Citation Format: Hava Izci, Tim Tambuyzer, Jessica Vandeven, Jérôme Xicluna, Hans Wildiers, Kevin Punie, Nynke Willers, Eva Oldenburger, Els Van Nieuwenhuysen, Patrick Berteloot, Ann Smeets, Ines Nevelsteen, Liesbet Van Eycken, Harlinde De Schutter, Patrick Neven, Geert Silversmit, Freija Verdoodt. Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-63.

Prognostic impact of socioeconomic status on long-term survival of non-localized epithelial ovarian cancer ꟷ The Extreme study

ObjectiveTo examine the influence of socioeconomic status (SES) on long-term survival of non-localized ovarian cancer. MethodsAll women in Denmark with a first diagnosis of non-localized epithelial ovarian cancer 1982–2007 were identified in the Cancer Registry and/or the Pathology Registry and followed up until December 2017. The survival probability was estimated after respectively 5 and 10 years, using so-called pseudo observations, and analyzed according to education, income, and marital status defined from nationwide registries. ResultsThe study cohort included 6486 women, and the estimated 5- and 10-year survival probabilities were 21.4% and 12.7%, respectively. Compared to women with short education, the 5-year survival probability was 7% higher for women with medium (relative survival probability = 1.07, 95% CI: 0.97, 1.19) and long education (relative survival probability = 1.07, 95% CI: 0.93, 1.24). Compared with married women, the 5-year survival probability for divorced women/widower was slightly lower (0.85, 95% CI: 0.69, 1.04) and for unmarried women slightly higher (1.08, 95% CI: 0.94, 1.23). Finally, the probability of being alive 5 years after diagnosis was 1.09 times higher (95% CI: 0.95, 1.24) for medium-income women and 1.23 times higher (95% CI: 1.08, 1.41) for high-income women compared with low-income women. Similar patterns were observed for 10-year survival. ConclusionsNon-localized ovarian cancer patients have a poor prognosis. Our data suggest that among Danish women with advanced ovarian cancer, higher personal income is associated with slightly higher probability of long-term survival, whereas education and marital status did not affect the probability of long-term survival.

Earthquake Disaster Rescue Model Based on Complex Adaptive System Theory

China is located in the intersection area of two seismic zones. Due to this special geographical location, earthquake disasters occur frequently in China. Earthquake emergency rescue work is one of the key construction works of disaster prevention and mitigation in China. This paper mainly studies the earthquake disaster rescue model based on the complex adaptive system theory and establishes the earthquake disaster rescue model by analyzing the complex adaptive system theory and combining the earthquake rescue process. In this paper, through the task allocation mechanism task, the disaster rescue task is divided into simple task and complex task, and the executive task subject is divided into single task subject and multitask subject. On the basis of considering the shortest emergency rescue time goal and the goal of maximizing the deployment utility of rescue team, the reasonable deployment of a rescue team is realized through a complex adaptive system, that is, the deployment utility of the rescue team is maximized. In this paper, the simulation experiment and comparison of the earthquake disaster rescue model based on the complex adaptive system theory are carried out. The experimental results show that the model used in this paper is better than the other two models in terms of algorithm convergence, rescue number, and overall score; in different scenarios, the relative survival probability of the model in this paper is 58.92%, 67.85%, and 77.46%, and the proportion of the wounded rescued is 66.31%, 76.45%, and 83.06%, which were higher than those of the other two models. The earthquake disaster rescue model based on the complex adaptive system theory proposed in this paper provides an effective theoretical basis and method system for postdisaster emergency rescue decision making and enhances and improves the emergency response ability to deal with large-scale geological disaster events.

Impact of an organised population screening programme for colorectal cancer: Measurement after first and second rounds.

The first and second rounds of the Basque programme for organised colorectal cancer screening were implemented between 2009 and 2014. Our objective was to measure the changes in incidence, tumour, node, metastasis staging distribution and tumour, node, metastasis-adjusted survival of patients with colorectal cancer from 2003 to 2014. Colorectal cancer cases with screening (patients <70 years old) and without screening (patients ≥70 years old) were compared during three four-year periods: 2003-2006, 2007-2010 and 2011-2014 (fully implemented phase). Cox regression, five-year relative survival and cancer probability of death were calculated for each four-year period, age group and tumour, node, metastasis stage. Adjusted incidence rates were analysed by joinpoint regression. In an analysis of 23,301 cases of colorectal cancer, the incidence in patients younger than 70 years in 2013 showed a 17% annual decrease. The survival hazard ratios for stages I, II and III for 2003-2006 and 2007-2010 were compared to those for 2011-2014. From the first to the third period, diagnosis in the early stages (I and II) rose from 45.1% to 50.9% in the younger patient group and remained stable in the older group (49.6% and 49.4%). Additionally, the five-year relative survival rate increased significantly from 0.67 to 0.82 in those patients younger than 70 years, whereas in patients 70 years or older the rate did not change significantly (0.61 and 0.65). The screening reduced incidence and improved survival by anticipating the diagnosis and by reducing mortality for each tumour, node, metastasis stage in the target population. The effect on survival could also be due to lead-time bias.

Improved survival in patients with head and neck cancer treated in higher volume centres: A population-based study in Belgium

ObjectivesThe study investigated the association between hospital volume and observed survival of patients with a head and neck squamous cell carcinoma (HNSCC). MethodsOverall, 9245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry. This database was coupled with other databases providing information on diagnostic and therapeutic procedures, vital status, and comorbidities. The overall and relative survival probabilities were estimated using the Kaplan-Meier and the Ederer II methods, respectively. The relation between hospital volume and observed survival since diagnosis was then assessed using Cox proportional hazard models adjusted for potential confounders. ResultsThe care for patients with HNSCC in Belgium was dispersed over more than 99 centres with half of the centres treating four or less patients with HNSCC per year. Survival probabilities were significantly better for patients treated in higher volume centres (>20 patients/year): the median survival of patients treated in these centres was 1.1 year longer (5.1 versus 4.0 years) than in lower volume centres. This association was confirmed in analyses taking the case-mix between hospitals into account: the hazard to die of any cause decreased on average with 0.4% per increase of one additionally treated patient. Beyond 20 assigned patients per year, there was no further decrease in the hazard to die. ConclusionsStatistically significant and clinically relevant improved survival probabilities were obtained in patients treated in higher volume centres (>20 patients/year) compared with their peers treated in lower volume centres. This supports the recommendation to concentrate the care for patients with HNSCC in reference centres.

Deconstructing sociality: the types of social connections that predict longevity in a group-living primate.

Many species use social interactions to cope with challenges in their environment and a growing number of studies show that individuals which are well-connected to their group have higher fitness than socially isolated individuals. However, there are many ways to be 'well-connected' and it is unclear which aspects of sociality drive fitness benefits. Being well-connected can be conceptualized in four main ways: individuals can be socially integrated by engaging in a high rate of social behaviour or having many partners; they can have strong and stable connections to favoured partners; they can indirectly connect to the broader group structure; or directly engage in a high rate of beneficial behaviours, such as grooming. In this study, we use survival models and long-term data in adult female rhesus macaques (Macaca mulatta) to compare the fitness outcomes of multiple measures of social connectedness. Females that maintained strong connections to favoured partners had the highest relative survival probability, as did females well-integrated owing to forming many weak connections. We found no survival benefits to being structurally well-connected or engaging in high rates of grooming. Being well-connected to favoured partners could provide fitness benefits by, for example, increasing the efficacy of coordinated or mutualistic behaviours.

Racial/ethnic, age and sex disparities in leukemia survival among adults in the United States during 1973-2014 period.

There has been marked improvement in leukemia survival, particularly among children in recent time. However, the long-term trends in survival among adult leukemia patients and the associated sex and racial survival disparities are not well understood. We, therefore, evaluated the secular trends in survival improvement of leukemia patients from 1973 through 2014, using Surveillance Epidemiology and End-Result Survey Program (SEER) data. ICD-O-3 morphology codes were used to group leukemia into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML). Survival analysis for each leukemia type stratified by race/ethnicity, age, sex was performed to generate relative survival probability estimates for the baseline time period of 1973 through 1979. Hazard ratios (HR) and respective 95% confidence intervals (CIs) for survival within subsequent 10-year time periods by race, age and sex were calculated using Cox proportional hazard models. Of the 83,255 leukemia patients for the current analysis, the 5-year survival of patients with ALL, AML, CLL, and CML during 1973–1979 were 42.0%, 6.5%, 66.5%, and 20.9%, respectively. Compared to the baseline, there were substantial improvements of leukemia-specific survival in 2010–2014 among African-American (81.0%) and Asian (80.0%) patients with CML and among 20–49 year of age with CLL (96.0%). African-American patients, those with AML and those older than 75 years of age had the lowest survival improvements. Asians experienced some of the largest survival improvements during the study period. Others, including African-American and the elderly, have not benefited as much from advances in leukemia treatment.

Using a combinatorial auction-based approach for simulation of cooperative rescue operations in disaster relief

In practice, we experience low efficiency of search and rescue (SAR) frequently in disaster relief. Here, we will optimize the SAR through agent-based simulation. In the kind of cases described here, rescue teams are characterized by different capabilities, and the tasks often require different capabilities to complete. To this end, a combinatorial auction-based task allocation scheme is used to develop a cooperative rescue plan for the heterogeneous rescue teams. Then, we illustrate the proposed cooperative rescue plan in different scenarios with the case of landslide disaster relief. The simulation results indicate that the combinatorial auction-based cooperative rescue plan would increase victims’ relative survival probability by 13.8–16.3%, increase the ratio of survivors getting rescued by 10.7–12.7%, and decrease the average elapsed time for one site getting rescued by 19.0–26.6%. The proposed rescue plan outperforms the rescue plan based on the F-Max-Sum a little bit. The robustness analysis shows that the proposed rescue plan is relatively reliable on condition that both the search radius and scope of cooperation are larger than thresholds. Furthermore, we have investigated how the number of rescue teams influences the rescue efficiency.

Increasing incidence and survival of head and neck cancers in Denmark: a nation-wide study from 1980 to 2014

Background The purpose of the study was to determine trends in age-adjusted incidence rates (AAIR) and survival probability in head and neck cancers (HNCs) in the Danish population from 1980 to 2014. Material and methods All patients registered with HNC in the nationwide Danish Cancer Registry from 1980 to 2014 were included. We evaluated the AAIR per 100,000 and the average annual percent change (AAPC). The relative survival probability at 5 years was calculated in relation to gender, anatomical location and histology, and we constructed age-period-cohort models of incidence. Results About 34,606 patients were included (64.7% men). The AAIR increased from 9.1 per 100,000 in 1980 to 17.4 per 100,000 in 2014 with an AAPC of 2.1%. The greatest incidence increase was observed in oropharyngeal cancer (AAPC: 5.4%) followed by hypopharyngeal cancer (AAPC: 4.2%). Adenocarcinomas had the highest AAPC (5.0%) followed by squamous cell carcinomas (AAPC: 2.0%). The AAPC was significantly higher in women (2.4%) compared with men (1.6%). For all HNC patients, the relative survival at 5 years rose significantly from 49.0% in 1980–1984 to 62.4% in 2010–2014. Women had a significantly higher survival than men with a relative survival of 61.7% compared to 50.0% in men. Laryngeal cancer had the best survival probability of cancers in the upper aerodigestive tract with hypopharyngeal cancer having the poorest survival. Conclusion This nation-wide study showed a significant rise in incidence of HNC for men and women along with a significant increase in relative survival. Oropharyngeal cancer had the highest increase in incidence followed by hypopharyngeal cancer which showed the poorest survival of HNCs.

Metformin and aspirin treatment could lead to an improved survival rate for Type 2 diabetic patients with stage II and III colorectal adenocarcinoma relative to non-diabetic patients.

Metformin, the drug of choice in the treatment of type 2 diabetes mellitus (DM2), in addition to aspirin (ASA), the drug prescribed for cardioprotection of diabetic and non-diabetic patients, have an inhibitory effect on cancer cell survival. The present population-based study conducted in the province of Trieste (Italy), aimed to investigate the prevalence of DM2 in patients with colorectal adenocarcinoma (CRC) and survival for CRC in diabetic and nondiabetic patients. All permanent residents diagnosed with a CRC between 2004 and 2007 were ascertained through the regional health information system. CRC-specific and relative survival probabilities were computed for each group of patients defined by CRC stage, presence or absence of DM2 treated with metformin, and presence or absence of daily ASA therapy. A total of 515 CRC patients without DM2 and 156 with DM2 treated with metformin were enrolled in the study. At the time of CRC diagnosis, 71 (14%) nondiabetic and 39 (25%) diabetic patients were taking ASA daily. The five-year relative survival for stage III CRC was 101% [95% confidence interval (CI)=76-126] in the 18 patients with DM2 treated with metformin and ASA, 55% (95% CI=31-78) in the 23 without DM2 treated with ASA, 55% (95% CI=45-65) in the 150 without DM2 not taking ASA, and 29% (95% CI=13-45) in the 43 with DM2 treated with metformin, however not with ASA. The findings support the hypothesis of a possible inhibitory effect of metformin and ASA on CRC cells. Randomized controlled trials are required to verify this hypothesis.

Simulation Optimization of Search and Rescue in Disaster Relief Based on Distributed Auction Mechanism

In this paper, we optimize the search and rescue (SAR) in disaster relief through agent-based simulation. We simulate rescue teams’ search behaviors with the improved Truncated Lévy walks. Then we propose a cooperative rescue plan based on a distributed auction mechanism, and illustrate it with the case of landslide disaster relief. The simulation is conducted in three scenarios, including “fatal”, “serious” and “normal”. Compared with the non-cooperative rescue plan, the proposed rescue plan in this paper would increase victims’ relative survival probability by 7–15%, increase the ratio of survivors getting rescued by 5.3–12.9%, and decrease the average elapsed time for one site getting rescued by 16.6–21.6%. The robustness analysis shows that search radius can affect the rescue efficiency significantly, while the scope of cooperation cannot. The sensitivity analysis shows that the two parameters, the time limit for completing rescue operations in one buried site and the maximum turning angle for next step, both have a great influence on rescue efficiency, and there exists optimal value for both of them in view of rescue efficiency.

Ethnic disparities in cancer incidence and survival among the oldest old in the United States

ABSTRACTObjective: To examine potential ethnic disparities in cancer incidence and survival rates among the oldest old using data from the SEER Program.Design: Cases diagnosed with one of the leading four cancer sites (lung and bronchus, colon and rectum, female breast, prostate) and four cancer sites (stomach, liver and intrahepatic bile duct, gallbladder, and cervical) that disproportionally affect Hispanics were reported to one of 18 SEER registries. Differences in cancer incidence were examined for cases aged ≥85 years diagnosed during the most recent 5-year time period (2009–2013) and, to examine changes over time, from 1992 to 2013. Five-year relative cancer survival probability was examined for Hispanics and non-Hispanics aged ≥85 years diagnosed 2006–2012.Results: From 2009 to 2013, non-Hispanics aged ≥85 years had higher incidence rates compared to Hispanics for colon and rectum, lung and bronchus, female breast, and prostate cancers. Five-year survival probability for cancers of all stages combined was higher for non-Hispanics than Hispanics in this age group. However, Hispanics had higher survival probability of colon and rectum and lung and bronchus cancers diagnosed at regional (colon and rectum: 67.2% vs. 60.5%; lung and bronchus: 15.9% vs. 12.7%) and distant (colon and rectum: 5.4% vs. 3.8%; lung and bronchus: 2.8% vs. 2.2%) stages than non-Hispanics, respectively.Conclusion: Ethnic differences in cancer incidence and survival probability exist for the ≥85 population. Continued efforts are needed to understand and reduce ethnic disparities in cancer prevention and treatment for this population.