Sex, Race, and Age Disparities in the Improvement of Survival for Gastrointestinal Cancer over Time

Trend Analysis of Lung Cancer Incidence and Mortality in Xiamen (2011-2020)

Objective

To analyze the trends of lung cancer incidence and mortality in Xiamen from 2011 to 2020 and provide some clues for the lung cancer prevention and control.

Methods

The data was obtained from the Xiamen City Cancer Register in Fujian Province, China. The data was updated on Sep 30, 2023. The codes of C33-C34 were used to identify the lung cancer. The newly diagnosed lung cancer patients during the period of 2011-2020 in Xiamen City were included in the evaluation of incidence and mortality and Cox analysis.

Results

A total of 11408 lung cancer patients were enrolled. The crude incidence rate was 52.78 per 100000 and the age-standardized incidence rate (ASIWR) was 40.67 per 100000 from 2011 to 2020. Both the crude incidence rate of lung cancer (AAPC =5.92, P value <0.001) and ASIWR (AAPC = 4.93, P value <0.001) showed increasing trends. The crude incidence rate in female increased 4.90 times faster as that in male (AAPC: 12.34/2.52). The crude mortality rate and the age-standardized mortality rate (ASMWR) were 37.25 per 100000 and 28.30 per100000. The 5-year age-standardized relative survival rate (ARS) was 18.62% (95% CI: 17.63-19.67%). The 5-year ARS was higher in women than men (26.35% vs 15.28%) and higher in urban than rural areas (21.44% vs 11.96%). Patients with lower education levels had significantly lower ARS than those with higher education (14.66% vs 31.53%). The 5-year ARS improved notably from 2016-2020 compared to 2011-2015 (22.23% vs 13.21%). Farmers had the lowest ARS among occupations [13.34% (95% CI:11.93-14.92%)]. There were all increasing trends in 1-year, 3-year, 5-year, and 10-year ARS rates between 2011 and 2020 (all P values of AAPC<0.05).

Conclusion

Lung cancer incidence in Xiamen increased, while mortality decreased with improved survival. Developing more perfect need to consider the differences in the social environment and other factors.

The American College of Surgeons Geriatric Surgery Verification Program and the Practicing Colorectal Surgeon

The population is aging and older adults are increasingly undergoing surgery. Colorectal surgeons need to understand the risks inherent in the care of older adults and identify concrete ways to improve the quality of care for this vulnerable population. Goals for the practicing colorectal surgeon include: 1) introduce the American College of Surgeons’ (ACS) Geriatric Surgery Verification (GSV) Program and understand the intersection with colorectal surgery, 2) examine the 30 evidence-based GSV standards and how they can achieve better outcomes after colorectal surgery, and 3) outline the value and benefits for colorectal surgeons of implementing such a program.

Racial/Ethnic Disparities in Survival Among Women Diagnosed with Invasive Cancer of the Anal Canal: an Analysis of Surveillance, Epidemiology, and End Results (SEER) Data

OBJECTIVE

To identify differences in survival among women diagnosed with cancer of the anal canal from varying racial and ethnic backgrounds.

METHODS

Data from the Surveillance, Epidemiology and End Results (SEER) registry between the years of 1975 and 2016 were analyzed, which included 19,048 women with cancer of the anal canal. Multivariable Cox proportional hazard regression (HRs) was performed to examine the relative risk of dying among women with anal cancer. Multivariable odds ratios (ORs) with 95% confidence intervals (CIs) were used to examine odds of highly fatal disease (death within 12 months from diagnosis).

RESULTS

Non-Hispanic Black women (n = 1694) had greater risk of dying when compared with non-Hispanic White women (n = 15,821) with anal cancer (HR = 1.26, CI: 1.17-1.35), independent of other prognostic indicators. Stratifying by age at diagnosis, risk of death was highest for non-Hispanic Black women diagnosed younger than age 50 years compared with non-Hispanic White women of similar age (HR = 1.60, CI: 1.34-1.89), and lowest for Hispanic women (n = 1533) older than 74 years at diagnosis (HR = 0.80, CI: 0.69-0.92). Stratifying by stage at diagnosis, disparities were not observed. When comparing across years of diagnoses, non-Hispanic Black women consistently had poorer survival compared with non-Hispanic White women diagnosed in the same year intervals. Finally, non-Hispanic Black women had greater odds of highly fatal disease (OR = 1.23, CI: 1.08-1.40) compared with non-Hispanic White women.

CONCLUSION

Non-Hispanic Black women with anal cancer continue to experience poorer survival compared with non-Hispanic White women, whereas disparities were not identified for Hispanic women.

Preoperative Bilirubin-Adjusted Carbohydrate Antigen 19-9 as a Prognostic Factor for Extrahepatic Cholangiocarcinoma Patients at a Single Center

Purpose

The aims of our study were to investigate the prognostic impact of the rate of preoperative serum carbohydrate antigen 19-9/bilirubin (CA19-9/BR) on patients with extrahepatic bile duct cancer.

Patients and Methods

We collected clinical data from 89 patients who underwent surgery for extrahepatic cholangiocarcinoma (ECC) at Peking Union Medical College Hospital between January 2012 and December 2017. The Kaplan–Meier analysis for univariate analysis and the Cox proportional hazards models for multivariate analysis were used to determine possible independent prognostic factors.

Results

CA19-9/BR was classified as elevated compared with normal based on the upper serum normal values of CA19-9 (37 U/mL) and bilirubin (1.5 mg/dL), which gives a cut-off at 25 U/mL/mg/dL. Univariate analysis showed that the overall survival of patients with a high CA19-9/BR ratio was significantly worse compared with patients with a low CA19-9/BR ratio (Hazard Ratio [HR] 2.149; 95% Confidence Interval [95% CI] 1.027–4.495; P=0.042). Multivariate analysis revealed that a high CA19-9/BR ratio (HR 3.250; 95% CI 1.165–9.067; P=0.024), low differentiation (HR 3.551; 95% CI 1.231–10.244; P=0.019), and positive margin (HR 2.555; 95% CI 1.111–5.875; P=0.027) remained independent prognostic factors after adjusting for age at diagnosis, maximal diameters, and other possible factors.

Conclusion

The preoperative CA19-9/BR ratio is a good prognostic factor in predicting survival in ECC patients and closer follow-up is recommended in patients with a higher CA19-9/BR ratio before surgery.

Influence of marital status on small intestinal adenocarcinoma survival: an analysis of the Surveillance, Epidemiology, and End Results (SEER) database

Aim

No studies have been published on the relationship between marital status and outcomes in small intestinal cancers. The present study was conducted to explore the influence of marital status on small intestinal adenocarcinoma survival based on the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

Data from eligible patients diagnosed with small intestinal adenocarcinoma between 2004 and 2015 were extracted from the SEER database. Patients were categorized into married group (including common law) and unmarried group (including single [never married], widowed, divorced, separated, and unmarried or domestic partner). The primary endpoints were 5-year overall survival (OS) and 5-year cancer-specific survival (CSS). A survival curve was generated by the Kaplan–Meier method, and the survival rate differences were estimated by a log-rank test. A multivariate Cox proportional hazard model was used to evaluate the independent risk factors for survival.

Results

A total of 6,747 small intestinal adenocarcinoma patients were enrolled, including 3,862 married and 2,885 unmarried patients. The 5-year OS and 5-year CSS were significantly greater in married patients than in unmarried patients (27.1 vs 18.8% for OS and 45.7 vs 39.3% for CSS, both P<0.001). After adjusting for age, insurance status, tumor primary site, TNM stage, tumor grade, tumor histology, and surgery, the multivariate Cox proportional hazards model showed that marriage is an independent protective factor for OS (HR =0.789, 95% CI: 0.745–0.836, P<0.001) and CSS (HR =0.794, 95% CI: 0.736–0.857, P<0.001).

Conclusion

Married small intestinal adenocarcinoma patients have better OS and CSS than unmarried patients. Psychological and economic supports from the spouses of married patients may contribute to improvements in survival.