Conditional survival rates of buccal and tongue cancer patients: how far does the benefit go?

Survival trends of patients with oral and oropharyngeal cancer treated at a cancer center in São Paulo, Brazil

OBJECTIVE

We aimed to estimate the overall survival (OS) and conditional survival (CS) in patients diagnosed with oral and oropharyngeal squamous cell carcinoma (SCC) and to determine their survival trends.

METHODS

The study included all consecutive patients treated at the A.C. Camargo Cancer Center for oral or oropharyngeal SCC between 2001 and 2012. Data were obtained from the Hospital Cancer Registry. OS and CS were analyzed using the Kaplan-Meier method to evaluate the probability of survival with Cox predictor models.

RESULTS

Data of 505 oral and 380 oropharyngeal SCC patients obtained in 2001-2006 and 2007-2012 were analyzed. Most of the oral SCC (59%) and oropharyngeal SCC (90%) patients had stages III-IV SCC. The 5-year OS for patients with oral SCC was 51.7%, with no significant difference between the first and second periods. The CS rates in 2007-2012 were 65% after the first year and 86% up to the fifth year. For oropharyngeal SCC, the 5-year OS rate was 45.0% in the first period. The survival rate increased to 49.1% from 2007 to 2012, with a reduction in the risk of death (HR=0.69;0.52-09.2). The CS estimates from 2007 to 2012 were 59% after the first year and 75% up to the fifth year.

CONCLUSION

Survival across the two time periods remained stable for oral SCC but showed a significant increase for oropharyngeal SCC, possibly because of improvements in the patients' response to radiotherapy, such as intensity-modulated radiation therapy, and the use of more accurate diagnostic imaging approaches.

Conditional relative survival in head and neck squamous cell carcinoma: Permanent excess mortality risk for long-term survivors

BACKGROUND

Dynamic predictions on head and neck cancer survival could offer, besides improved patient counseling, insight into long-term effects of tumor- and patient-based characteristics on survival. Theoretically, there could be a certain time period after diagnosis after which the patient returns to a population risk on survival.

METHODS

In all, 7255 patients with a primary head and neck squamous cell carcinoma (HNSCC) aged 25 to 90 years, diagnosed between January 1980 and January 2004 in The Netherlands, were included. Conditional 5-year relative survival for every additional year survived was computed.

RESULTS

The overall conditional relative prognosis reached a plateau after approximately 4 years; a permanent 20% to 25% excess mortality for long-term HNSCC survivors remained.

CONCLUSIONS

Conditional 5-year relative survival for patients with HNSCC remains poorer compared to age- and sex-matched counterparts in the general population, even when alive at 15 years after diagnosis. We assume that this is caused by an excess comorbidity in these patients, mainly due to smoking and alcohol abuse.

When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects

OBJECTIVE

To report the latest conditional survival estimates for patients with cancer in Queensland, Australia.

DESIGN, SETTING AND PARTICIPANTS

Descriptive study of state-wide population-based data from the Queensland Cancer Registry on patients aged 15-89 years who were diagnosed with invasive cancer between 1982 and 2007.

MAIN OUTCOME MEASURE

Conditional 5-year relative survival for the 13 most common types of invasive cancer, and all cancers combined.

RESULTS

The prognosis for patients with cancer generally improves with each additional year that they survive. A significant excess in mortality compared with the general population ceases to occur within 10 years after diagnosis for survivors of stomach, colorectal, cervical and thyroid cancer and melanoma, with these groups having a conditional 5-year relative survival of at least 95% after 10 years. For the remaining cancers we studied (pancreatic, lung, breast, prostate, kidney, and bladder cancer, non-Hodgkin lymphoma, and leukaemia), conditional 5-year relative survival estimates (at 10 years after diagnosis) ranged from 82% to 94%, suggesting that patients in these cohorts continue to have poorer survival compared with the age-matched general population.

CONCLUSIONS

Estimates of conditional survival have the potential to provide useful information for cancer clinicians, patients and their carers as they are confronted by personal and surveillance-related decisions. This knowledge may be effective in building realistic hope and helping people manage uncertainty about the future. We suggest that measures of conditional survival be incorporated into routine statistical reporting in Australia.

An interactive tool for individualized estimation of conditional survival in rectal cancer

BACKGROUND

For rectal cancer patients who have already survived a period of time after diagnosis, survival probability changes and is more accurately depicted by conditional survival. The specific aim of this study was to develop an interactive tool for individualized estimation of changing prognosis for rectal cancer patients.

METHODS

A multivariate Cox proportional hazards (CPH) survival model was constructed using data from rectal cancer patients diagnosed from 1994 to 2003 from the Surveillance, Epidemiology, and End Results (SEER) database. Age, race, sex, and stage were used as covariates in the survival prediction model. The primary outcome variable was overall survival conditional on having survived up to 5 years from diagnosis.

RESULTS

Data from 42,830 rectal cancer patients met the inclusion criteria. The multivariate CPH model showed age, race, sex, and stage as significant independent predictors of survival. The survival prediction model demonstrated good calibration and discrimination, with a bootstrap-corrected concordance index of 0.75. A web-based prediction tool was built from this regression model that can compute individualized estimates of changing prognosis over time.

CONCLUSIONS

An interactive prediction modeling tool can estimate prognosis for rectal cancer patients who have already survived a period of time after diagnosis and treatment. Having more accurate prognostic information can empower both patients and clinicians to be able to make more appropriate decisions regarding follow-up, surveillance testing, and future treatment.

Conditional survival among cancer patients in the United States

PURPOSE

To report 5-year relative cancer survival probabilities conditional on having already survived > or = 1 years after the initial diagnosis for 11 cancer sites, diagnosed during 1990-2001 and followed through 2006.

METHODS

Analyses are based on 1,151,496 cancer cases in population-based cancer registries in the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.

RESULTS

The 5-year relative conditional survival probability tended to improve with each year already survived. Improvement was greatest for more lethal cancers (e.g., lung or pancreas) and for cases with a more advanced stage at diagnosis. The 5-year relative survival probability conditional on already having survived 5 years exceeded 90% for locally staged prostate cancer, melanoma (whites only), breast cancer (females only), corpus uteri cancer, urinary bladder cancer, Hodgkin's lymphoma, rectal cancer, colon cancer, ovary cancer, and pancreatic cancer. Only lung cancer did not reach 90%. For these cancer sites combined, 5-year relative survival probability conditional on already having survived 5 years averaged about 85% for regionally staged disease, 68% for distant staged disease, and 87% for unknown staged disease. The 5-year relative conditional survival probability tended to be significantly lower among patients diagnosed at older ages, among males, among nonwhites, and among those diagnosed during 1990-1995 compared with later years.

CONCLUSION

Conditional survival probability estimation provides further useful prognostic information to cancer patients, tailored to the time already survived since diagnosis.