Racial-Sex Disparities--A Challenging Battle Against Cancer Mortality in the USA

Construction of a predictive model for clinical survival in male patients with non-metastatic rectal adenocarcinoma

BACKGROUND

No clinical prediction model is available for non-metastatic rectal adenocarcinoma in males. Based on demographic and clinicopathological characteristics, we constructed a survival prediction model for the study population.

METHODS

At a ratio of 7:3, 3450 eligible patients were divided into training and validation sets. Optimal cutoff values were calculated using X-tile software. Cox proportional hazards regression was used to find prognostic factors for cancer-specific survival (CSS) and overall survival (OS). Corresponding nomogram prognostic models were also constructed based on predictors.The validity, discriminative ability, predictability, and clinical usefulness of the model were analyzed and assessed.

RESULTS

We identified predictors of survival in the target population and successfully constructed nomograms. In the nomogram prediction model for OS and CSS, the C-index was 0.724 and 0.735, respectively, for the training group and 0.754 and 0.760, respectively, for the validation group. In the validation group, the area under the curve (AUC) of the receiver operating characteristic curve for OS and CSS nomograms was 0.768 and 0.769, respectively, for the 3-year survival rate and 0.755 and 0.747, respectively, for the 5-year survival rate. Kaplan-Meier Survival Curves showed excellent risk discrimination performance of the nomogram (P < 0.05) Calibration curves, time-dependent AUC and decision curve analysis showed that the prediction model constructed in this study had excellent clinical prediction and decision ability and performed better than the TNM staging system.

CONCLUSION

Our nomogram is helpful to evaluate the prognosis of non-metastatic male patients with rectal adenocarcinoma and has guiding significance for clinical treatment.

Construction of a clinical survival prognostic model for middle-aged and elderly patients with stage III rectal adenocarcinoma

BACKGROUND

Nomograms for prognosis prediction in colorectal cancer patients are few, and prognostic indicators differ with age.

AIM

To construct a new nomogram survival prediction tool for middle-aged and elderly patients with stage III rectal adenocarcinoma.

METHODS

A total of 2773 eligible patients were divided into the training cohort (70%) and the validation cohort (30%). Optimal cutoff values were calculated using the X-tile software for continuous variables. Univariate and multivariate Cox proportional hazards regression analyses were used to determine overall survival (OS) and cancer-specific survival (CSS)-related prognostic factors. Two nomograms were successfully constructed. The discriminant and predictive ability and clinical usefulness of the model were also assessed by multiple methods of analysis.

RESULTS

The 95%CI in the training group was 0.719 (0.690-0.749) and 0.733 (0.702-0.74), while that in the validation group was 0.739 (0.696-0.782) and 0.750 (0.701-0.800) for the OS and CSS nomogram prediction models, respectively. In the validation group, the AUC of the three-year survival rate was 0.762 and 0.770, while the AUC of the five-year survival rate was 0.722 and 0.744 for the OS and CSS nomograms, respectively. The nomogram distinguishes all-cause mortality from cancer-specific mortality in patients with different risk grades. The time-dependent AUC and decision curve analysis showed that the nomogram had good clinical predictive ability and decision efficacy and was significantly better than the tumor-node-metastases staging system.

CONCLUSION

The survival prediction model constructed in this study is helpful in evaluating the prognosis of patients and can aid physicians in clinical diagnosis and treatment.

Prediction of cancer-specific survival and overall survival in middle-aged and older patients with rectal adenocarcinoma using a nomogram model

•

Summarise the established knowledge on this subject.1

Middle-aged and older patients are at high risk of rectal adenocarcinoma; however, studies comprehensively analysing its predictors and the construction of visual nomogram models are limited.

2

Most studies that reported on the prediction of colorectal cancer-related survival models had limited samples and included data from a single centre. The included predictors were limited, or the evaluation indicators were not easy to obtain, greatly limiting clinical application.

3

With the advancement of medical care, the clinical outcomes of patients with rectal adenocarcinoma have changed. Therefore, new, more comprehensive, and practical indicators are required for constructing clinical prediction models to effectively determine the prognosis of patients.

•

What are the significant and/or new findings of this study?1

We included demographic and clinicopathological data from thousands of middle-aged and elderly patients with rectal adenocarcinoma to find relevant prognostic factors. New cut-offs were developed and used for the construction of nomograms.

2

The nomogram constructed this time has excellent predictive ability and clinical decision-making ability, and has good clinical practicability.

3

The nomogram survival prediction model constructed this time can effectively help evaluate the prognosis of middle-aged and elderly patients with rectal adenocarcinoma and guide the selection of clinical treatment measures.

Objective

To develop a new nomogram tool for predicting survival in middle-aged and elderly patients with rectal adenocarcinoma.

Methods

A total of 6,116 patients were randomly assigned in a 7:3 ratio to training and validation cohorts. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS) in the training set, and two nomogram prognostic models were constructed. The validity, accuracy, discrimination, predictive ability, and clinical utility of the models were assessed based on the concordance index (C-index), area under the receiver operating characteristics (ROC) curve, time-dependent area under the ROC curve (AUC), Kaplan-Meier survival curve, and decision curve analyses.

Results

Predictors of OS and CSS were identified, and nomograms were successfully constructed. The calibration discrimination for both the OS and CSS nomogram prediction models was good (C-index: 0.763 and 0.787, respectively). The AUC showed excellent predictive performance, and the calibration curve exhibited significant predictive power for both nomograms. The time-dependent AUC showed that the predictive ability of the predictor-based nomogram was better than that of the TNM stage. The nomograms successfully discriminated high-, medium-, and low-risk patients for all-cause and cancer-specific mortality. The decision curve demonstrated that the nomograms are useful with respect to good decision power.

Conclusion

Our nomogram survival prediction models may aid in evaluating the prognosis of middle-aged and older patients with rectal adenocarcinoma and guiding the selection of the clinical treatment measures.

Racial and ethnic disparities in mortality from gastric and esophageal adenocarcinoma

Background

Racial/ethnic differences in mortality have not been well studied for either non‐cardia gastric cancer (NCGC) or cardia gastric cancer (CGC). The aim of this study was to examine the US mortality rates for these cancer subtypes, as well as esophageal adenocarcinoma (EAC) as a comparator.

Methods

We identified 14 164 individuals who died from NCGC, 5235 from CGC, and 13 982 from EAC in the Surveillance, Epidemiology, and End Results database between 2004 and 2016. Age‐adjusted incidence‐based mortality rates and corresponding annual percent changes (APCs) were calculated. Analyses were stratified by race/ethnicity, age, and stage of disease at diagnosis.

Results

The mortality rate in NCGC was two‐ to threefold higher in blacks, Hispanics, and Asians/Pacific Islanders (PI) than non‐Hispanic whites, and was significant across all age groups and stages of disease (P < .01). Mortality in CGC was higher in non‐Hispanic whites than blacks and Asians/PI, particularly in individuals in the 50‐64 year age group and those with stage IV disease. Mortality in EAC was two‐ to sixfold higher in non‐Hispanic whites than all other groups across all age groups and stages of disease. From 2004 to 2016, mortality rates were stable across all racial/ethnic groups in NCGC and CGC, and in minority groups with EAC, but have been rising in non‐Hispanic whites with EAC (APC 3.03, 95% CI 0.17‐5.96).

Conclusions

This is the largest study of incidence‐based mortality in CGC and NCGC and demonstrates racial/ethnic differences in mortality between these subtypes. Mortality rates for NCGC are highest in minority groups, and have been stable in recent years despite declining incidence. Mortality rates for CGC are marginally higher in middle‐aged non‐Hispanic whites with advanced disease, though have remained stable. In contrast, mortality in EAC has been rising for non‐Hispanic whites, in parallel to incidence. Further studies are needed to refine prevention strategies for high‐risk individuals dying from these specific cancer subtypes.

Social Determinants of Cardiovascular Disease among Michigan Residents: A Call to Action for Population Health Initiatives

OBJECTIVE

Little is known about the cardiovascular health (CVH) and social determinants of cardiovascular diseases (SDCVDs) among Michigan residents by race and ethnicity. Therefore, the objective of this cross-sectional study was to determine the CVH of Michigan residents and to examine the relationship between CVH and SDCVDs by race/ethnicity and age.

METHODOLOGY

Michigan-level data consisting of 10,889 participants was extracted from the 2017 Behavioral Risk Factor Surveillance System data. Descriptive statistics examined the adjusted proportions of the CVH measures and determined the adjusted mean CVH score for the SDCVDs among racial/ethnic groups by age. Generalized ordinal logistic regression analyses assessed the relationship between residents' CVH and SDCVDs by racial/ethnic status. All analyses were performed using STATA MP14.

RESULTS

Residents from each racial/ethnic group did not meet the criteria for ideal BMI. The mean CVH score was found to be low for Black (2.65; 95% CI, 2.41-2.89) and Hispanic (2.84; 95% CI, 2.29-3.40) residents ≥ 50 years old with a high school degree or less. Black residents unemployed for more than a year were less likely to have a high CVH score (OR = 0.45; 95% CI, 0.21-80.97) compared with Black residents employed for wages.

CONCLUSION

Michigan residents' CVH is lacking across multiple dimensions. Multifaceted population health initiatives are warranted to address influential SDCVDs to diminish the CVH disparities identified across racial/ethnic and age groups.

Stomach cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

BACKGROUND

Stomach cancer was a leading cause of cancer-related deaths early in the 20th century and has steadily declined over the last century in the United States. Although incidence and death rates are now low, stomach cancer remains an important cause of morbidity and mortality in black, Asian and Pacific Islander, and American Indian/Alaska Native populations.

METHODS

Data from the CONCORD-2 study were used to analyze stomach cancer survival among males and females aged 15 to 99 years who were diagnosed in 37 states covering 80% of the US population. Survival analyses were corrected for background mortality using state-specific and race-specific (white and black) life tables and age-standardized using the International Cancer Survival Standard weights. Net survival is presented up to 5 years after diagnosis by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting Surveillance, Epidemiology, and End Results Summary Stage 2000 data from 2004.

RESULTS

Almost one-third of stomach cancers were diagnosed at a distant stage among both whites and blacks. Age-standardized 5-year net survival increased between 2001 to 2003 and 2004 to 2009 (26.1% and 29%, respectively), and no differences were observed by race. The 1-year, 3-year, and 5-year survival estimates were 53.1%, 33.8%, and 29%, respectively. Survival improved in most states. Survival by stage was 64% (local), 28.2% (regional), and 5.3% (distant).

CONCLUSIONS

The current results indicate high fatality for stomach cancer, especially soon after diagnosis. Although improvements in stomach cancer survival were observed, survival remained relatively low for both blacks and whites. Primary prevention through the control of well-established risk factors would be expected to have the greatest impact on further reducing deaths from stomach cancer. Cancer 2017;123:4994-5013. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.