1
|
La Rocca E, De Santis MC, Silvestri M, Ortolan E, Valenti M, Folli S, de Braud FG, Bianchi GV, Scaperrotta GP, Apolone G, Daidone MG, Cappelletti V, Pruneri G, Di Cosimo S. Early stage breast cancer follow-up in real-world clinical practice: the added value of cell free circulating tumor DNA. J Cancer Res Clin Oncol 2022; 148:1543-1550. [PMID: 35396978 PMCID: PMC9114063 DOI: 10.1007/s00432-022-03990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose Physical examinations and annual mammography (minimal follow-up) are as effective as laboratory/imaging tests (intensive follow-up) in detecting breast cancer (BC) recurrence. This statement is now challenged by the availability of new diagnostic tools for asymptomatic cases. Herein, we analyzed current practices and circulating tumor DNA (ctDNA) in monitoring high-risk BC patients treated with curative intent in a comprehensive cancer center. Patients and methods Forty-two consecutive triple negative BC patients undergoing neoadjuvant therapy and surgery were prospectively enrolled. Data from plasma samples and surveillance procedures were analyzed to report the diagnostic pattern of relapsed cases, i.e., by symptoms, follow-up procedures and ctDNA. Results Besides minimal follow-up, 97% and 79% of patients had at least 1 non-recommended imaging and laboratory tests for surveillance purposes. During a median follow-up of 5.1(IQR, 4.1–5.9) years, 13 events occurred (1 contralateral BC, 1 loco-regional recurrence, 10 metastases, and 1 death). Five recurrent cases were diagnosed by intensive follow-up, 5 by symptoms, and 2 incidentally. ctDNA antedated disseminated disease in all evaluable cases excepted two with bone-only and single liver metastases. The mean time from ctDNA detection to suspicious findings at follow-up imaging was 3.81(SD, 2.68), and to definitive recurrence diagnosis 8(SD, 2.98) months. ctDNA was undetectable in the absence of disease and in two suspected cases not subsequently confirmed. Conclusions Some relapses are still symptomatic despite the extensive use of intensive follow-up. ctDNA is a specific test, sensitive enough to detect recurrence before other methods, suitable for clarifying equivocal imaging, and exploitable for salvage therapy in asymptomatic BC survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-03990-7.
Collapse
Affiliation(s)
- E La Rocca
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M C De Santis
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiation Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Silvestri
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - E Ortolan
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Valenti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Folli
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Breast Cancer Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - F G de Braud
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - G V Bianchi
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G P Scaperrotta
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Radiology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M G Daidone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - V Cappelletti
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Pruneri
- Breast Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy.,Department of Pathology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - S Di Cosimo
- Biomarkers Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| |
Collapse
|
2
|
Hester LL, Park SI, Wood WA, Stürmer T, Brookhart MA, Lund JL. Cause-specific mortality among Medicare beneficiaries with newly diagnosed non-Hodgkin lymphoma subtypes. Cancer 2018; 125:1101-1112. [PMID: 30548238 DOI: 10.1002/cncr.31821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/27/2018] [Accepted: 08/31/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND As the US population ages and non-Hodgkin lymphoma (NHL)-specific mortality declines, deaths from causes other than NHL will become increasingly important in treatment decision making for older patients with NHL. The objective of the current study was to describe how the 5-year cumulative incidence of NHL-specific and other-cause mortality varies by subtype, age, comorbidity level, and time since diagnosis in older patients. METHODS Using the Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims, patients aged ≥66 years were identified at the time of diagnosis with a first, primary NHL diagnosis from 2004 through 2013. Death certificate data and Fine-Gray competing risks models were used to estimate the 5-year cumulative incidence of NHL-specific and other-cause mortality by NHL subtype, age, and comorbidity level. Estimates were displayed over time using stacked cumulative incidence curves. RESULTS Among 30,666 patients with NHL, 32% died of NHL and 13% died of other causes within 5 years of diagnosis. The cumulative incidence of other-cause mortality increased with age and comorbidity level for all subtypes. Among patients with aggressive NHL subtypes, NHL-specific mortality exceeded other-cause mortality across all age groups, comorbidity levels, and number of years after diagnosis. For patients with indolent NHL subtypes, other-cause mortality was similar to or exceeded NHL-specific mortality, especially among older patients with severe comorbidity or with the indolent marginal zone, lymphoplasmacytic, and mycosis fungoides subtypes. CONCLUSIONS The findings of the current study suggest that mortality from causes other than NHL are important for patients of an older age, with a higher comorbidity level, and with indolent disease. Evidence from the current study can guide the development of tools for estimating individual prognosis that inform treatment discussions in patients with NHL.
Collapse
Affiliation(s)
- Laura L Hester
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Janssen Research & Development, LLC, Titusville, New Jersey
| | - Steven I Park
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Hematology and Oncology, Levine Cancer Institute, Charlotte, North Carolina
| | - William A Wood
- Leukemia, Lymphoma, and Myeloma Program, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
3
|
Feuer EJ, Rabin BA, Zou Z, Wang Z, Xiong X, Ellis JL, Steiner JF, Cynkin L, Nekhlyudov L, Bayliss E, Hankey BF. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator SEER*CSC: validation in a managed care setting. J Natl Cancer Inst Monogr 2015; 2014:265-74. [PMID: 25417240 DOI: 10.1093/jncimonographs/lgu021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nomograms for prostate and colorectal cancer are included in the Surveillance, Epidemiology, and End Results (SEER) Cancer Survival Calculator, under development by the National Cancer Institute. They are based on the National Cancer Institute's SEER data, coupled with Medicare data, to estimate the probabilities of surviving or dying from cancer or from other causes based on a set of patient and tumor characteristics. The nomograms provide estimates of survival that are specific to the characteristics of the tumor, age, race, gender, and the overall health of a patient. These nomograms have been internally validated using the SEER data. In this paper, we externally validate the nomograms using data from Kaiser Permanente Colorado. METHODS The SEER Cancer Survival Calculator was externally validated using time-dependent area under the Receiver Operating Characteristic curve statistics and calibration plots for retrospective cohorts of 1102 prostate cancer and 990 colorectal cancer patients from Kaiser Permanente Colorado. RESULTS The time-dependent area under the Receiver Operating Characteristic curve statistics were computed for one, three, five, seven, and 10 year(s) postdiagnosis for prostate and colorectal cancer and ranged from 0.77 to 0.89 for death from cancer and from 0.72 to 0.81 for death from other causes. The calibration plots indicated a very good fit of the model for death from cancer for colorectal cancer and for the higher risk group for prostate cancer. For the lower risk groups for prostate cancer (<10% chance of dying of prostate cancer in 10 years), the model predicted slightly worse prognosis than observed. Except for the lowest risk group for colorectal cancer, the models for death from other causes for both prostate and colorectal cancer predicted slightly worse prognosis than observed. CONCLUSIONS The results of the external validation indicated that the colorectal and prostate cancer nomograms are reliable tools for physicians and patients to use to obtain information on prognosis and assist in establishing priorities for both treatment of the cancer and other conditions, particularly when a patient is elderly and/or has significant comorbidities. The slightly better than predicted risk of death from other causes in a health maintenance organization (HMO) setting may be due to an overall healthier population and the integrated management of disease relative to the overall population (as represented by SEER).
Collapse
Affiliation(s)
- Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Borsika A Rabin
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Zhaohui Zou
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Zhuoqiao Wang
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Xiaoqin Xiong
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Jennifer L Ellis
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - John F Steiner
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Laurie Cynkin
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Larissa Nekhlyudov
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Elizabeth Bayliss
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH)
| | - Benjamin F Hankey
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD (EJF, LC); Cancer Research Network Cancer Communication Research Center (BAR); and Institute for Health Research (JLE, JFS), Kaiser Permanente Colorado, Denver, CO; Information Management Services, Inc., Calverton, MD (ZZ, ZW, XX); Department of Family Medicine, University of Colorado School of Medicine, Denver, CO (EB); Department of Population Medicine, Harvard Medical School, Boston, MA (LN); CANSTAT, Plano, TX (BFH).
| |
Collapse
|
4
|
Mariotto AB, Noone AM, Howlader N, Cho H, Keel GE, Garshell J, Woloshin S, Schwartz LM. Cancer survival: an overview of measures, uses, and interpretation. J Natl Cancer Inst Monogr 2014; 2014:145-86. [PMID: 25417231 PMCID: PMC4829054 DOI: 10.1093/jncimonographs/lgu024] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Survival statistics are of great interest to patients, clinicians, researchers, and policy makers. Although seemingly simple, survival can be confusing: there are many different survival measures with a plethora of names and statistical methods developed to answer different questions. This paper aims to describe and disseminate different survival measures and their interpretation in less technical language. In addition, we introduce templates to summarize cancer survival statistic organized by their specific purpose: research and policy versus prognosis and clinical decision making.
Collapse
Affiliation(s)
- Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS).
| | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Nadia Howlader
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Hyunsoon Cho
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Gretchen E Keel
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Jessica Garshell
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Steven Woloshin
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| | - Lisa M Schwartz
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (AM, AN, NH, HC); Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si Gyeonggi-do, Korea (HC); Information Management Services, Inc., Calverton MD (GEK, JG); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, Geisel School of Medicine at Dartmouth, Hanover, NH, Department of Veterans Affairs Medical Center, Veterans Affairs Outcomes Group, White River Junction, VT (SW, LMS)
| |
Collapse
|