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Lin JP, Chen XF, Wang P, He H, Chen WJ, Zhuang FN, Zhou H, Chen YJ, Wei WW, Liu SY, Wang F. Conditional Survival of Patients with Limited-Stage Small Cell Lung Cancer After Surgery: A National Real-World Cohort Study. Ann Surg Oncol 2024; 31:4250-4260. [PMID: 38334847 DOI: 10.1245/s10434-024-14983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The prognosis of limited-stage small cell lung cancer (LS-SCLC) after surgery usually is estimated at diagnosis, but how the prognosis actually evolves over time for patients who survived for a predefined time is unknown. METHODS Data on patients with a diagnosis of LS-SCLC after surgery between 2004 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. The 5-year conditional cancer-specific survival (CCSS) and conditional overall survival (COS) were calculated. RESULTS This study analyzed 997 patients (555 women, 55.7%) with a median age, of 67 years (interquartile range [IQR], 60-73 years). The 5-year CCSS and COS increased from 44.7% and 38.3%, respectively, at diagnosis to 83.7% and 67.9% at 5 years after diagnosis. Although there were large differences with different stages (stages I, II, and III) at diagnosis (respectively 59.5%, 28.4%; 28.1% for CCSS and 50.6%, 24.8%, and 23.6% for COS), the gap decreased with time, and the rates were similar after 5 years (respectively 85.0%, 80.3%, and 79.4% for CCSS; 65.6%, 56.9%, and 61.3% for COS). The 5-year conditional survival for the patients who received lobectomy was better than for those who received sublobectomy or pneumonectomy. Multivariable analyses showed that only age and resection type were independent predictors for CCSS and COS, respectively, throughout the period. CONCLUSION Conditional survival estimates for LS-SCLC generally increased over time, with the most significant improvement in patients with advanced stage of disease. Resection type and old age represented extremely important determinants of prognosis after a lengthy event-free follow-up period.
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Affiliation(s)
- Jun-Peng Lin
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Xiao-Feng Chen
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Peiyuan Wang
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Hao He
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Wei-Jie Chen
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Feng-Nian Zhuang
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Hang Zhou
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Yu-Jie Chen
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Wen-Wei Wei
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Shuo-Yan Liu
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China.
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China.
| | - Feng Wang
- Department of Thoracic Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China.
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China.
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Jovanoski N, Bowes K, Brown A, Belleli R, Di Maio D, Chadda S, Abogunrin S. Survival and quality-of-life outcomes in early-stage NSCLC patients: a literature review of real-world evidence. Lung Cancer Manag 2023; 12:LMT60. [PMID: 37693293 PMCID: PMC10485735 DOI: 10.2217/lmt-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023] Open
Abstract
Aim Assess the long-term survival and quality-of-life outcomes in early-stage NSCLC (eNSCLC) patients. Methods Review of long-term survival and quality-of-life after curative treatment in eNSCLC patients in observational studies. Results Disease-free proportion decreased in stage III vs stage I patients. Recurrence-free proportion decreased with age and disease stage. Advanced stage and vascular invasion increased risk of late recurrence. Conditional 5-year relative survival rates did not exceed 87%, indicating higher mortality in eNSCLC survivors. Lower conditional survival rates and relative survival rates were associated with older age and advanced disease. Survivors of eNSCLC had poorer physical quality-of-life. Conclusion Despite curative-intent therapy, survivors of eNSCLC still face significant risks of recurrence, excess mortality, and diminished quality-of-life.
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Affiliation(s)
- Nick Jovanoski
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Kathleen Bowes
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Audrey Brown
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Rossella Belleli
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Danilo Di Maio
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
| | - Shkun Chadda
- Genesis Research, West One, Forth Banks, Newcastle, NE1 3PA, UK
| | - Seye Abogunrin
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Building 002/OG18, CH-4070, Basel, Switzerland
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Liu W, Xiong J, Wang H, Li S, Lei Z, Jiang L, Cao J, Yang L, Guo H, Gao Q, Wang S, Zhang B. Racial disparities in conditional survival of patients with bladder cancer: a population-based study. BMC Urol 2023; 23:122. [PMID: 37464352 DOI: 10.1186/s12894-023-01293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Traditional estimates can only provide static predictions of cancer outcomes and cannot assess the evolving effect of race on patient survival. This study aims to reveal the dynamic survival of patients with bladder cancer and to explore the evolving effect of race on patient prognosis. METHODS Using data from the Surveillance, Epidemiology, and End Results (SEER) registry, 99,590 white, 6,036 African American, and 4,685 Asian/Pacific Islander (API) patients with bladder cancer were identified. Conditional cancer-specific survival (CSS) rates, which could reflect the dynamic survival prediction of cancer patients, represented the primary outcomes, and were estimated by the Kaplan-Meier algorithm. The evolving effect of race on patient survival was evaluated by multivariable Cox regression in combination with conditional survival (CS) estimates. RESULTS The 5-year CSS for African American patients who had survived 1, 2, 3, 4, or 5 years after definitive therapy improved from the baseline calculation by + 5.8 (84.4%), + 9.5 (87.4%), + 12.8 (90.0%), + 14.4 (91.3%), and + 14.7% (91.5%), respectively. The increasing trend also held for overall white and API patients, and for all patient subsets when CS was calculated according to different levels of sex, age, and disease stage. African Americans, despite having the worst survival at baseline, could have CSS comparable to their white and API counterparts after 4 years of survivorship. In addition, the risk of death for African Americans tended to decrease with increasing survival, and the risk was no longer significantly different from that of whites after 4 years of survival. CONCLUSIONS While having the worst initial predicted outcomes, African Americans may eventually achieve comparable survival to white and API patients given several years of survivorship. As patient survival increases, African American race may lose its role as an indicator of poorer prognosis.
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Affiliation(s)
- Wei Liu
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Xiong
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Honghao Wang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Shuo Li
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Zhentao Lei
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Lili Jiang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Jin Cao
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Lin Yang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Hongfeng Guo
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Qiang Gao
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Shenghan Wang
- Department of Urology, Aerospace Center Hospital, Beijing, China
- Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Bao Zhang
- Department of Urology, Aerospace Center Hospital, Beijing, China.
- Peking University Aerospace School of Clinical Medicine, Beijing, China.
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Zhang Q, Dai Y, Liu H, Sun W, Huang Y, Gong Z, Dai S, Kong H, Xie W. Causes of death and conditional survival estimates of long-term lung cancer survivors. Front Immunol 2022; 13:1012247. [PMID: 36211420 PMCID: PMC9537558 DOI: 10.3389/fimmu.2022.1012247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Lung cancer ranks the leading cause of cancer-related death worldwide. This retrospective cohort study was designed to determine time-dependent death hazards of diverse causes and conditional survival of lung cancer. Methods We collected 816,436 lung cancer cases during 2000-2015 in the SEER database, after exclusion, 612,100 cases were enrolled for data analyses. Cancer-specific survival, overall survival and dynamic death hazard were assessed in this study. Additionally, based on the FDA approval time of Nivolumab in 2015, we evaluated the effect of immunotherapy on metastatic patients’ survival by comparing cases in 2016-2018 (immunotherapy era, n=7135) and those in 2013-2016 (non-immunotherapy era, n=42061). Results Of the 612,100 patients, 285,705 were women, the mean (SD) age was 68.3 (11.0) years old. 252,558 patients were characterized as lung adenocarcinoma, 133,302 cases were lung squamous cell carcinoma, and only 78,700 cases were small cell lung carcinomas. TNM stage was I in 140,518 cases, II in 38,225 cases, III in 159,095 cases, and IV in 274,262 patients. 164,394 cases underwent surgical intervention. The 5-y overall survival and cancer-specific survival were 54.2% and 73.8%, respectively. The 5-y conditional survival rate of cancer-specific survival is improved in a time-dependent pattern, while conditional overall survival tends to be steady after 5-y follow-up. Except from age, hazard disparities of other risk factors (such as stage and surgery) diminished over time according to the conditional survival curves. After 8 years since diagnosis, mortality hazard from other causes became higher than that from lung cancer. This critical time point was earlier in elder patients while was postponed in patients with advanced stages. Moreover, both cancer-specific survival and overall survival of metastatic patients in immunotherapy era were significantly better than those in non-immunotherapy era (P<0.001), indicating that immunotherapeutic intervention indeed bring remarkable benefits to advanced lung cancer patients. Conclusions Our findings expand on previous studies by demonstrating that non-lung-cancer related death risk becomes more and more predominant over the course of follow-up, and we establish a personalized web-based calculator to determine this critical time point for long-term survivors. We also confirmed the survival benefit of advanced lung cancer patients in immunotherapy era.
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Affiliation(s)
- Qun Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuan Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongda Liu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenkui Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuming Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng Gong
- The Jackson Laboratory, Bar Harbor, ME, United States
| | - Shanlin Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Kong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Weiping Xie, ; Hui Kong,
| | - Weiping Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Weiping Xie, ; Hui Kong,
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5
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Shin DW, Cho JH, Yoo JE, Cho J, Yoon DW, Lee G, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM. Conditional Survival of Surgically Treated Patients with Lung Cancer: A Comprehensive Analyses of Overall, Recurrence-free, and Relative Survival. Cancer Res Treat 2021; 53:1057-1071. [PMID: 33705624 PMCID: PMC8524014 DOI: 10.4143/crt.2020.1308] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/06/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Survival probability changes over time in cancer survivors. This study examined conditional survival in patients undergoing curative resection for non-small cell lung cancer (NSCLC). Materials and Methods Five-year conditional recurrence-free survival (CRFS), conditional overall survival (COS), and conditional relative survival (CRS) up to 10 years after surgery were calculated in patients who underwent NSCLC resection from 1994 to 2016. These rates were stratified according to age, sex, year of diagnosis, pathological stage, tumor histology, smoking status, comorbidity, and lung function. Results Five-year CRFS increased from 65.6% at baseline to 90.9% at 10 years after surgery. Early differences in 5-year CRFS according to stratified patient characteristics disappeared, except for age: older patients exhibited persistently lower 5-year CRFS. Five-year COS increased from 72.7% to 78.3% at 8 years and then decreased to 75.4% at 10 years. Five-year CRS increased from 79.0% at baseline to 86.8% at 10 years. Older age and higher pathologic stage were associated with lower 5-year COS and CRS up to 10 years after surgery. Female patients, those with adenocarcinoma histology, non-smokers, patient without comorbidities and had good lung function showed higher COS and CRS. Conclusion CRFS improved over time, but significant risk remained after 5 years. CRS slightly improved over time but did not reach 90%, suggesting significant excess mortality compared to the general population. Age and stage remained significant predictors of conditional survival several years after surgery. Our conditional survival estimates should help clinicians and patients make informed treatment and personal life decisions based on survivorship status.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Eun Yoo
- Healthcare system Gangnan Center, Seoul National University Hospital, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.,Cancer Education Center, Samsung Medical Center, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea.,Departments of Health, Behavior, and Society and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dong Woog Yoon
- Department of Thoracic and Cardiovascular Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - Genehee Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Fan X, Liang Y, Bai Y, Yang C, Xu S. Conditional survival rate estimates of lobectomy, segmentectomy and wedge resection for stage IA1 non-small cell lung cancer: A population-based study. Oncol Lett 2020; 20:1607-1618. [PMID: 32724402 PMCID: PMC7377117 DOI: 10.3892/ol.2020.11713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/27/2020] [Indexed: 11/06/2022] Open
Abstract
Conditional survival rate (CSR) is defined as the dynamic possibility of survival, considering the changes in the survival risk over time. The present study aimed to compare the CSR of the surgical procedures for stage IA1 non-small cell lung cancer (NSCLC). Overall, data for 2,535 patients with stage IA1 NSCLC after lobectomy, segmentectomy or wedge resection were obtained from the Surveillance, Epidemiology and End Results database, and the overall survival (OS) rates were subsequently compared. CSR estimates, the possibility of patients who had already survived × years, to survive further y years, was calculated as CSR=S(x+y)/S(x), where S is the survival rate at a particular point in time. A Cox regression model and propensity-score matching were used to adjust confounding factors. There were no statistical differences in the OS among the three surgical procedures, except that OS of patients who underwent a lobectomy was improved compared with the wedge resection. The CSR of surviving to the 5th year after operation improved gradually over time. The 3-year CSR of lobectomy or segmentectomy was higher compared with that of the wedge resection. Moreover, the 3-year CSR of segmentectomy was higher compared with that of lobectomy from the 3rd year after surgery, particularly in some specific situations, such as female sex, patients ≥66 years old, patients with squamous cell carcinoma or patients with poor tumor differentiation. The present study is the first report to compare CSR following lobectomy, segmentectomy and wedge resection for patients with stage IA1 NSCLC, to the best of our knowledge. These findings indicated that lobectomy is the most conservative surgical procedure for stage IA1 NSCLC and raises questions regarding improved long-term prognosis of segmentectomy in some subsets of patients.
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Affiliation(s)
- Xiaoxi Fan
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yicheng Liang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunpeng Bai
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Chunlu Yang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Shun Xu
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Wu GX, Ituarte PH, Ferrell B, Sun V, Erhunmwunsee L, Raz DJ, Kim JY. Causes of Death and Hospitalization in Long-term Lung Cancer Survivors: A Population-based Appraisal. Clin Lung Cancer 2020; 21:204-213. [DOI: 10.1016/j.cllc.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/20/2019] [Accepted: 08/24/2019] [Indexed: 12/17/2022]
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Liang Y, Fan X, Bai Y, Huang D, Yang C. Conditional survival analysis of four treatment strategies for patients with stage I non-small cell lung cancer. Oncol Lett 2019; 18:1089-1098. [PMID: 31423169 PMCID: PMC6607325 DOI: 10.3892/ol.2019.10413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 04/15/2019] [Indexed: 12/24/2022] Open
Abstract
Conditional survival (CS) is used to describe dynamic survival possibility, taking account of the change in the survival risk that occurs with longevity. The present study aimed to explore the CS of four treatment strategies for stage I non-small cell lung cancer (NSCLC), staged according to the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control NSCLC staging system. Using the Surveillance, Epidemiology and End Results Program cohort obtained between 2004-2014, the current study first extracted data for 27,116 patients with stage I NSCLC. The actuarial cancer-specific survival rates (ACSs) and conditional cancer-specific survival rates of four treatment strategies were then compared. ACS was assessed using the Kaplan-Meier method and a log-rank test. The 3-year conditional cancer-specific survival (CCS3) of patients who had already survived for n years was calculated as CCS3=ACS(n+3)/ACS(n). Cox regression and propensity-score matching (PSM) was applied to adjust confounding factors. The 5-year ACS of patients who underwent lobectomy, sublobar resection, radiation and observation was 80.3, 72.0, 40.8 and 19.6%, respectively. The 5-year CCS3 of patients who underwent lobectomy, sublobar resection, radiation and observation was 91.7, 86.4, 77.0 and 58.2%, respectively. CCS3 increased with an increase in survival time and patients who underwent lobectomy had the highest CCS3 estimates and flattest growth, with the smallest survival gap between CCS3 and ACS. The results were similar in the PSM analysis. In conclusion, CS estimates may provide a more accurate survival prediction for patients with stage I NSCLC, and may assist with treatment decisions and surveillance strategies. In addition, the current study provided evidence that suggests lobectomy may be the optimal treatment strategy for stage I NSCLC compared with sublobar resection.
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Affiliation(s)
- Yicheng Liang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xiaoxi Fan
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunpeng Bai
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Dejian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Chunlu Yang
- Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Zhang G, Li R, Deng Y, Zhao L. Conditional survival of patients with hepatocellular carcinoma: results from the Surveillance, Epidemiology, and End Results registry. Expert Rev Gastroenterol Hepatol 2018. [PMID: 29543072 DOI: 10.1080/17474124.2018.1453806] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Compared with overall survival, conditional survival is a more relevant measure of prognosis in surviving patients over time. The aim of this study was to describe the conditional survival of patients with hepatocellular carcinoma according to different prognostic variables through an analysis of a national population-based cancer registry. METHODS We analyzed data from 3,082 hepatocellular carcinoma patients who were diagnosed between 2004 and 2014. RESULTS The conditional overall and cause-specific survival improved from 37.6% to 68.9% and 45% to 79.1%, respectively, in the entire study population. The conditional overall and cause-specific survival improved from 32.6% to 69.3% and 40.1% to 74.8%, respectively, in patients aged 65 to 74 years. The conditional overall and cause-specific survival improved from 8.4% to 44.1% and 12.1% to 66.1%, respectively, in the stage IVB group. The conditional overall and cause-specific survival improved from 32.8% to 71.4% and 40.3% to 78.4%, respectively, in the positive/elevated AFP group. CONCLUSIONS Conditional survival exhibited an improved prognosis over time. For hepatocellular carcinoma patients who survived for a specific period of time after diagnosis, more dramatic improvements occurred in patients aged 65-74 years, patients with AJCC stage IVB, and patients with a positive/elevated AFP value.
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Affiliation(s)
- Guoqing Zhang
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Renfeng Li
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Yilei Deng
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Longshuan Zhao
- a Department of Hepatobiliary and pancreatic surgery , First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
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Prognostic Factors as a Function of Disease-free Interval After Definitive (Chemo)radiation for Non-Small Cell Lung Cancer Using Conditional Survival Analysis. Am J Clin Oncol 2017; 41:46-52. [PMID: 26535988 DOI: 10.1097/coc.0000000000000235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We analyzed overall and disease-free survival (OS and DFS) after definitive (chemo)radiation for stage III non-small cell lung cancer with 2 statistical methods: Kaplan-Meier (KM) analysis, with diagnosis as index date, and conditional survival (CS) analysis, with a variety of disease-free index dates, and determined whether prognostic factors varied based on the reference date. MATERIALS AND METHODS All 651 patients analyzed received definitive (chemo)radiotherapy for stage III non-small cell lung cancer in November 1998 to December 2010 at a single institution; all had Karnofsky performance status scores ≥60 and received ≥60 Gy. OS and DFS were first calculated with the KM method, and then CS was used to calculate 2 outcomes: OS conditioned on DFS time (OS|DFS) and DFS conditioned on DFS time (DFS|DFS). Factors predicting OS and DFS conditioned on 1-, 2-, and 3-year DFS were sought in univariate and multivariate analyses. RESULTS KM analysis produced 1-, 2-, and 3-year DFS rates of 48%, 30%, and 26%; OS rates were 64%, 41%, and 29%. By CS analysis, both OS|DFS and DFS|DFS showed an increase in 5-year OS after 6 months, and CS after 30 months approached 100%. On multivariate analyses, age and concurrent chemoradiation predicted OS|DFS; age, smoking history, tumor histology, disease stage, and radiation dose predicted DFS|DFS. CONCLUSIONS CS analysis showed that the probability of long-term survival increases sharply after 6 months with no evidence of disease; factors predicting survival differed based on the method and endpoint used.
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Kim W, Lee HY, Jung SH, Woo MA, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Han J, Jeong JY, Choi JY, Lee KS. Dynamic prognostication using conditional survival analysis for patients with operable lung adenocarcinoma. Oncotarget 2017; 8:32201-32211. [PMID: 27793026 PMCID: PMC5458278 DOI: 10.18632/oncotarget.12920] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/21/2016] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate conditional survival among patients with surgically resected stage I-IIIa lung adenocarcinoma and identify changes in prognostic contributions for various prognostic factors over time. PATIENTS AND METHODS We performed conditional survival analysis at each t0 (=0, 1, 2, 3, 4, 5 years) for 723 consecutive patients who underwent surgical resection for lung adenocarcinoma, stratified by various clinico-demographic features, as well as pathologic and imaging (tumor-shadow disappearance ratio [TDR] on CT and maximum standardized uptake value [SUVmax] on PET) characteristics. Uni- and multivariableCox regression analyses were performed to evaluate relationships between those variables and conditional survival. RESULTS Three-year conditional overall survival (OS) and disease-free survival (DFS) were 92.12% and 75.51% at baseline, but improved steadily up to 98.33% and 95.95% at 5 years after surgery. In contrast to demographic factors, pathologic (stage, subtype, pathologic grade and differentiation) and radiologic factors (TDR and SUVmax) maintained a statistically significant association with subseqeunt 3-year OS until 3 years after surgery. According to the multivariableanalysis, high SUVmax and low TDR value were independent predictors of subsequent 3-year OS and DFS at baseline, 1 and 2 years after surgery, respectively. CONCLUSION Our findings based on CS provide theoretical background for clinicians to plan longer period of surveillance following lung adenocarcinoma resection in survivors with preoperatively high SUVmax and low TDR on PET-CT and chest CT, respectively.
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Affiliation(s)
- Wooil Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sin-Ho Jung
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Ah Woo
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yun Jeong
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Kyungpook National University Medical, Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Conditional Survival of Esophageal Cancer: An Analysis from the SEER Registry (1988-2011). J Thorac Oncol 2016; 10:1490-7. [PMID: 26322395 DOI: 10.1097/jto.0000000000000649] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Conditional survival can provide valuable predictive information for both patients and caregivers for patients surviving over time. The purpose of this study was to estimate conditional survival for esophageal cancer patients through analysis of a national population-based cancer registry. METHODS This retrospective cohort study analyzed 64,433 patients within the Surveillance, Epidemiology, and End Results (SEER) data set who were diagnosed with esophageal cancer from 1988 to 2011. Covariates included cancer characteristics and demographics. Overall survival (defined as time from diagnosis until death), cause-specific survival (defined as time from diagnosis until death from cancer), and 5-year conditional survivals (the probability of surviving an additional 5 years) were calculated. Significant prognostic variables of univariate and multivariable models of survival were identified. RESULTS The multivariable models of overall and cause-specific survivals included gender, age group, race, relationship status, year of diagnosis, site, grade, histology, and stage group. Although all patients showed an improvement in conditional survival over time, more dramatic improvements were seen in more advanced stage groups. At the 5-year mark, conditional cause-specific survival of distant stage (defined as having spread by direct extension or metastasis to distant organs, tissues, or lymph nodes) increased from 4% to 79%, whereas regional stage increased from 18% to 77% and localized stage increased from 38% to 85%. CONCLUSIONS Conditional survival showed improving prognosis over time. Patients with advanced stage had the most dramatic improvement. Clinicians, caregivers, and patients with esophageal cancer can feel encouraged by the improving prognosis with each year survived. This information has practical implications regarding longitudinal follow-up guidelines and survivorship planning.
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Withrow DR, Racey CS, Jamal S. A critical review of methods for assessing cancer survival disparities in indigenous population. Ann Epidemiol 2016; 26:579-591. [PMID: 27431064 DOI: 10.1016/j.annepidem.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE An increasing cancer burden among indigenous populations has led to a growing literature about survival disparities between indigenous and nonindigenous persons. We aim to describe and appraise methods used to measure cancer survival in indigenous persons in the United States, Canada, Australia, and New Zealand. METHODS We searched Medline, Web of Science, and EMBASE for articles published between 1990 and 2015 that estimated survival in populations indigenous to one of these four countries. We gathered information about data sources, analytical methods, and the extent to which threats to validity were discussed. RESULTS The search retrieved 83 articles. The most common approach to survival analysis was cause-specific survival (n = 49). Thirty-eight articles measured all-cause survival and 11 measured excess mortality attributable to cancer (relative survival). Three sources of information bias common to all studies (ethnic misclassification, incomplete case ascertainment, and incomplete death ascertainment) were acknowledged in a minority of articles. CONCLUSIONS The methodological considerations we present here are shared with studies of cancer survival across other subpopulations. We urge future researchers on this and related topics to clearly describe their data sources, to justify analytic choices, and to fully discuss the potential impact of those choices on the results and interpretation.
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Affiliation(s)
- Diana R Withrow
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada; Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - C Sarai Racey
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sehar Jamal
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada
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Fukui T, Okasaka T, Kawaguchi K, Fukumoto K, Nakamura S, Hakiri S, Ozeki N, Yokoi K. Conditional Survival After Surgical Intervention in Patients With Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 101:1877-82. [DOI: 10.1016/j.athoracsur.2015.11.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/28/2015] [Accepted: 11/30/2015] [Indexed: 12/24/2022]
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Conditional Survival in Anal Carcinoma Using the National Population-Based Survey of Epidemiology and End Results Database (1988-2012). Dis Colon Rectum 2016; 59:291-8. [PMID: 26953987 DOI: 10.1097/dcr.0000000000000555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Conditional survival can provide valuable information for both patients and healthcare providers about the changing prognosis in surviving patients over time. OBJECTIVE This study estimated conditional survival for patients with anal cancer in the United States through analysis of a national population-based cancer registry. DESIGN Log-rank test identified significant covariates of cause-specific survival (defined as time from diagnosis until death from anal cancer). Significant covariates were considered in the multivariable regression of cause-specific survival using Cox proportional hazards models. SETTINGS Covariates included cancer stage and demographic variables. PATIENTS Patients in Surveillance, Epidemiology, and End Results regions diagnosed with anal squamous cell carcinoma as their first and only cancer diagnosis from 1988 to 2012 were selected from this database, and 5145 patients were included in the retrospective cohort study. MAIN OUTCOME MEASURE Five-year conditional survival stratified by each variable in the final Cox models was measured RESULTS : The final multivariable models of overall and cause-specific survivals included stage, grade, sex, age, race, and relationship status. Over the first 6 years after diagnosis, conditional survival of distant stage increased from 37% to 89%, whereas regional stage increased from 65% to 93% and localized stage increased from 84% to 96%. The other variables had increasing prognosis as well, but the subgroups increased at a more similar rate over time. LIMITATIONS The data source used does not include information on chemotherapy treatment, patient comorbidities, or socioeconomic status. CONCLUSIONS Conditional survival showed improvement over time. Patients with advanced stage had the greatest improvement in conditional survival. This is the first study to provide specific conditional survival probabilities for patients with anal cancer.
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Conditional survival of malignant thymoma using national population-based surveillance, epidemiology, and end results (SEER) registry (1973-2011). J Thorac Oncol 2015; 10:701-7. [PMID: 25590603 DOI: 10.1097/jto.0000000000000472] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Thymoma is a rare and unique tumor with a long natural history that makes it difficult to study. Consequently, there is a dearth of prospective diagnostic or therapeutic clinical trials. To our knowledge, there has not been an analysis of conditional survival of thymoma in the literature. The specific aim of this study was to study the 5-year conditional survivals of a large population of thymoma patients. METHODS Cases of thymoma were extracted from the Surveillance, Epidemiology, and End Results registry (1973-2011) and categorized into Masaoka-Koga stage groupings. The primary outcomes compared overall survival (OS), cause specific survival (CSS), and 5-year conditional OS and CSS, by stage. OS and CSS were calculated using the Kaplan-Meier method with the log-rank test for significance using SAS v9.3. Conditional survival was the probability of surviving an additional 5 years at any point in follow-up, and used analysis of variance to test significance. RESULTS A total of 2182 patients met inclusion criteria and were categorized as Masaoka-Koga stage groupings of I and IIA ("localized," 24%), IIB ("regional," 16%), III and IV ("distant," 50%), and unknown (10%). Median age was 56 (18-91), and 53% were male. Earlier stages had better OS (p < 0.0001) and CSS (p < 0.0001). Twenty-year OS for local, regional, and distant stages were 42%, 30%, and 18%, respectively. Conditional survivals remained largely unchanged throughout follow-up. CONCLUSIONS Conditional survival provides more relevant survival estimates for patients during follow-up. Further studies should investigate the possibility that thymoma should be considered a chronic disease.
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Brzezniak C, Satram-Hoang S, Goertz HP, Reyes C, Gunuganti A, Gallagher C, Carter CA. Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military. J Gen Intern Med 2015; 30:1406-12. [PMID: 25805503 PMCID: PMC4579211 DOI: 10.1007/s11606-015-3280-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 02/04/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in the United States (US) Military and worldwide, with non-small cell lung cancer (NSCLC) accounting for 87 % of cases. OBJECTIVES Using a US military cohort who receives equal and open access to healthcare, we sought to examine demographic, clinical features and outcomes with NSCLC. DESIGN AND PARTICIPANTS We conducted a retrospective cohort analysis of 4,751 patients, aged ≥ 18 years and diagnosed with a first primary NSCLC between 1 January 2003 and 31 December 2013 in the US Department of Defense (DoD) cancer registry. MAIN MEASURES Differences by patient and disease characteristics were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival. RESULTS The mean age at diagnosis was 66 years, 64 % were male, 72 % were Caucasian, 41 % were diagnosed at early stage, 77 % received treatment and 82 % had a history of tobacco use. Mean age at diagnosis was highest among Caucasians (67 years) and lowest among African Americans (AA; 62 years). Asian/Pacific Islanders (PI) were more likely to be female (p < 0.0001), have adenocarcinoma histology (p = 0.0003) and less likely to have a history of tobacco use (p < 0.0001) compared to other racial/ethnic groups. In multivariable survival analysis, older age, male gender, increasing stage, not receiving treatment, and tobacco history were associated with higher mortality risk. Untreated patients exhibited a 39 % higher mortality risk compared to treated patients (HR = 1.39; 95%CI = 1.23-1.57). Compared to Caucasian patients, Asian/PIs demonstrated a 20 % lower risk of death (HR = 0.80; 95%CI = 0.66-0.96). There was no difference in mortality risk between AAs and Hispanics compared to Caucasians. CONCLUSION The lack of significant outcome disparity between AAs and Caucasians and the earlier stage at diagnosis than usually seen in civilian populations suggest that equal access to healthcare may play a role in early detection and survival.
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Affiliation(s)
- Christina Brzezniak
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889-5600, USA
| | - Sacha Satram-Hoang
- Q.D. Research, Inc, 8777 Auburn Folsom Road Suite C501, Granite Bay, 95746, CA, USA
| | | | - Carolina Reyes
- Genentech, Inc, 1 DNA Way, South San Francisco, 94080, CA, USA
| | - Ashok Gunuganti
- Q.D. Research, Inc, 8777 Auburn Folsom Road Suite C501, Granite Bay, 95746, CA, USA
| | - Christopher Gallagher
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving St NW C2149, Washington, 20010, DC, USA
| | - Corey A Carter
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889-5600, USA.
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Wen S, Zhou W, Li CM, Hu J, Hu XM, Chen P, Shao GL, Guo WH. Ki-67 as a prognostic marker in early-stage non-small cell lung cancer in Asian patients: a meta-analysis of published studies involving 32 studies. BMC Cancer 2015; 15:520. [PMID: 26174366 PMCID: PMC4502553 DOI: 10.1186/s12885-015-1524-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 06/26/2015] [Indexed: 11/27/2022] Open
Abstract
Background Despite the large number of published papers analyzing the prognostic role of Ki-67 in NSCLC, it is still not considered an established factor for routine use in clinical practice. The present meta-analysis summarizes and analyses the associations between Ki-67 expression and clinical outcome in NSCLC patients. Methods PubMed, Cochrane, and Embase databases were searched systematically using identical search strategies. The impacts of Ki-67 expression on survival in patients with NSCLC and NSCLC subtypes were evaluated. Furthermore, the association between Ki-67 expression and the clinicopathological features of NSCLC were evaluated. Results In total, 32 studies from 30 articles met the inclusion criteria, involving 5600 patients. Meta-analysis results suggested that high Ki-67 expression was negatively associated with overall survival (OS; HR = 1.59, 95 % CI 1.35-1.88, P < 0.001) and disease-free survival (DFS; HR = 2.21, 95 % CI 1.43-3.42, P < 0.001) in NSCLC patients. Analysis of the different subgroups of NSCLC suggested that the negative association between high Ki-67 expression and OS and DFS in Asian NSCLC patients was stronger than that in non-Asian NSCLC patients, particularly in early-stage (Stage I-II) adenocarcinoma (ADC) patients. Additionally, while high expression was more common in males, smokers, and those with poorer differentiation, there was no correlation between high Ki-67 expression and age or lymph node status. Importantly, significant correlations between high Ki-67 expression and clinicopathological features (males, higher tumor stage, poor differentiation) were seen only in Asian NSCLC patients. Conclusions The present meta-analysis indicated that elevated Ki-67 expression was associated with a poorer outcome in NSCLC patients, particularly in early-stage Asian ADC patients. Studies with larger numbers of patients are needed to validate our findings. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1524-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Song Wen
- Department of Interventional Radiology, Zhejiang tumor hospital, Hangzhou, 310022, China. .,Interventional Room of Oncology, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
| | - Wei Zhou
- Department of Vascular Surgery, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
| | - Chun-Ming Li
- Department of Dermatology, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
| | - Juan Hu
- Department of Medical, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
| | - Xiao-Ming Hu
- Interventional Room of Oncology, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
| | - Ping Chen
- Interventional Room of Oncology, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
| | - Guo-Liang Shao
- Department of Interventional Radiology, Zhejiang tumor hospital, Hangzhou, 310022, China.
| | - Wu-Hua Guo
- Department of Gastroenterology, Second Affiliated Hospital, Nanchang University, Nanchang, 330006, China.
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Janssen-Heijnen MLG, van Erning FN, De Ruysscher DK, Coebergh JWW, Groen HJM. Variation in causes of death in patients with non-small cell lung cancer according to stage and time since diagnosis. Ann Oncol 2015; 26:902-907. [PMID: 25672893 DOI: 10.1093/annonc/mdv061] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 01/25/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Many patients with non-small cell lung cancer (NSCLC) die within the first few years of diagnosis, and considerable excess mortality remains even after 5 years. We investigated the death rate and the distribution of causes of death for NSCLC patients by age and stage at diagnosis during long-term follow-up. PATIENTS AND METHODS All 72 021 patients aged 45-89 years diagnosed with stage I-III NSCLC between 1989 and 2008 in the Netherlands and who died up till 2011 were derived from the Netherlands Cancer Registry and linked with the database of Statistics Netherlands for underlying causes of death. Mortality ratios and proportional distribution of causes of death were calculated during 5 time periods after diagnosis of NSCLC (up to 15 years). RESULTS Median follow-up was 9.6 years (range: 0-23 years). Lung cancer was the predominant cause of death in the first 6 years after diagnosis (being 80%-85% and ∼90% up to 3 years for localized and locally advanced disease, respectively, and ∼60%-75% and ∼75%-85% during years 4-6 for both stage groups, respectively). Thereafter, lung cancer as cause of death proportionally decreased with time since diagnosis, but remained over 30%. Hence, cardiovascular diseases and chronic obstructive pulmonary diseases (COPD) became more important causes of death, especially for patients aged >60 years at diagnosis (up to 34% for cardiovascular diseases and up to 19% for COPD). CONCLUSIONS With time, the relative contribution of cardiovascular and COPD causes of death increased, although the absolute contribution of lung cancer remained high in non-metastatic NSCLC. Therefore, managing morbidity of these diseases remains relevant.
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Affiliation(s)
- M L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo; Department of Epidemiology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht.
| | - F N van Erning
- Department of Research, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands
| | - D K De Ruysscher
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - J W W Coebergh
- Department of Research, Comprehensive Cancer Centre The Netherlands, Eindhoven, The Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Real-world treatment patterns and costs in a US Medicare population with metastatic squamous non-small cell lung cancer. Lung Cancer 2014; 87:176-85. [PMID: 25532680 DOI: 10.1016/j.lungcan.2014.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/02/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Despite advances in the treatment of nonsquamous non-small cell lung cancer (NSCLC), therapeutic choices and overall disease course for squamous NSCLC have remained relatively unchanged over the past several years. We provide a detailed account of current treatment patterns, healthcare use, and survival in real-world clinical settings for metastatic squamous NSCLC. MATERIALS AND METHODS Patients aged ≥65 years with metastatic squamous NSCLC diagnosed 2001-2009 were identified and followed through 2010 using the Surveillance, Epidemiology and End Results-Medicare database. Treatment patterns were descriptively analyzed. Multivariate logistic regressions were estimated to identify predictors of treatment pattern events; generalized linear models were estimated for total all-cause and NSCLC-related costs to assess cost drivers. RESULTS Of 17,133 patients, 72% received cancer-directed therapy (surgery, radiation, chemotherapy, or biologic therapy), whereas 28% received only supportive care. Median survival was significantly longer in patients receiving cancer-directed therapy (8 months) than in patients receiving supportive care only (2 months) (P<0.0001). An agent-specific first-line chemotherapy regimen was identified for 91% of the 7700 patients who received chemotherapy. Among these, the most common first-line regimen was carboplatin-paclitaxel combination therapy (46%). Common second-line regimens were gemcitabine monotherapy (16%) and pemetrexed monotherapy (11%). Factors associated with decreased odds of receiving cancer-directed treatment were black versus white race (OR, 0.72; 95% CI, 0.64-0.82), residence in the West versus South (OR, 0.73; 95% CI, 0.66-0.81), and metastatic disease at initial diagnosis versus progression to metastatic disease (OR, 0.77; 95% CI, 0.70-0.84). CONCLUSIONS Our study shows that prognosis remains poor for patients with metastatic squamous NSCLC, even among those receiving treatment, but particularly for patients limited to supportive care only, highlighting the continuing unmet medical need in this population. Additionally, our analysis indicates that selections for second-line and third-line chemotherapies are not necessarily consistent with National Comprehensive Cancer Network guidelines.
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Prospective Observational Comparison of Clinical Outcomes Between African-American and Caucasian Patients Receiving Second-Line Treatment With Pemetrexed for Advanced Non–Small-Cell Lung Cancer. Clin Lung Cancer 2013; 14:726-35. [DOI: 10.1016/j.cllc.2013.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022]
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Traeger L, Cannon S, Pirl WF, Park ER. Depression and undertreatment of depression: potential risks and outcomes in black patients with lung cancer. J Psychosoc Oncol 2013; 31:123-35. [PMID: 23514250 DOI: 10.1080/07347332.2012.761320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the United States, Black men are at higher risk than White men for lung cancer mortality whereas rates are comparable between Black and White women. This article draws from empirical work in lung cancer, mental health, and health disparities to highlight that race and depression may overlap in predicting lower treatment access and utilization and poorer quality of life among patients. Racial barriers to depression identification and treatment in the general population may compound these risks. Prospective data are needed to examine whether depression plays a role in racial disparities in lung cancer outcomes.
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Affiliation(s)
- Lara Traeger
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital, Boston, MA, USA.
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Wang SJ, Wissel AR, Ord CB, Kalpathy-Cramer J, Fuller CD, Holland JM, Gross ND. Individualized estimation of conditional survival for patients with head and neck cancer. Otolaryngol Head Neck Surg 2011; 145:71-3. [PMID: 21493289 DOI: 10.1177/0194599811401793] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Survival for cancer patients is usually only reported as survival from time of diagnosis. For patients who survive 1 or more years after diagnosis, however, survival probability changes over time and is more accurately depicted by conditional survival. The specific aim of this project was to build a survival regression model and Web-based tool to make individualized estimates of conditional survival for patients with head and neck cancer based on tumor and patient characteristics. Using data from the Surveillance, Epidemiology, and End Results (SEER) database, a prediction modeling tool was built that can estimate prognosis for patients with head and neck cancer who have already survived a period of time after diagnosis. Having more accurate prognostic information may empower both patients and clinicians to make more appropriate decisions regarding follow-up, surveillance testing, and future treatment.
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Affiliation(s)
- Samuel J Wang
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.
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Chirikos TN, Roetzheim RG, McCarthy EP, Iezzoni LI. Cost disparities in lung cancer treatment by disability status, sex, and race. Disabil Health J 2011; 1:108-15. [PMID: 19881893 DOI: 10.1016/j.dhjo.2008.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The recent literature contains numerous reports of disparities in the diagnosis, treatment, and outcomes of lung cancer across a growing list of population subgroups, including disability status. A common assumption is that disparities stem mainly from variations in the level and type of treatment resources available to specific subgroups. Few studies, however, have directly measured resource differentials. Since policy makers identify reducing health disparities as a critical priority, this study examined whether cumulative Medicare costs (resource consumption) for lung cancer treatment differ across eight patient subgroups defined by disability status, sex, and race. HYPOTHESIS Treatment disparities across the eight subgroups will be reflected in variations in the cumulative cost profiles of those subgroups, controlling for other plausible cost drivers. Failure to detect statistically significant differentials in these cost profiles implies that treatment disparities stem from factors other than access to, and utilization of, health care services. METHODS Linked SEER-Medicare data were used to construct cost profiles by service type and treatment phase for roughly 80,000 incident lung cancer cases in patients aged 45 to 85 years at diagnosis. Multiple regression models then tested for cost differentials across the eight subgroups, controlling for various patient and disease characteristics. RESULTS Significant cost differentials were detected, some unanticipated. Women tended to have higher treatment costs than men; they also had more favorable survivals. Nonwhites also tended to have higher treatment costs than whites, although they had significantly shorter survivals. On average, men with disabilities consumed the fewest treatment resources and had the shortest survivals. Mixed results were obtained for women with disabilities. CONCLUSIONS Among others, the findings suggest that reducing disparities will take more than just improving access to health care. Special attention must be paid to lung cancer patients with disabilities by both policy makers and clinicians.
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Affiliation(s)
- Thomas N Chirikos
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL 33612, USA.
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Cetin K, Ettinger DS, Hei YJ, O'Malley CD. Survival by histologic subtype in stage IV nonsmall cell lung cancer based on data from the Surveillance, Epidemiology and End Results Program. Clin Epidemiol 2011; 3:139-48. [PMID: 21607015 PMCID: PMC3096514 DOI: 10.2147/clep.s17191] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 12/12/2022] Open
Abstract
Background: The role of histology in the targeted management of nonsmall cell lung cancer (NSCLC) has garnered renewed attention in recent years. We provide contemporary population-based estimates of survival and an assessment of important prognostic factors in stage IV NSCLC by major histologic subtype. Methods: Using data from the Surveillance, Epidemiology and End Results (SEER) Program, we stratified 51,749 incident stage IV NSCLC patients (1988–2003 with follow-up through 2006) by major histologic subtype. We used Kaplan–Meier and Cox proportional hazards methods to describe overall survival and the prognostic influence of select patient, tumor, and treatment characteristics for each histologic subgroup. Results: Survival was highest in patients with bronchioloalveolar adenocarcinoma (1-year survival: 29.1%) and lowest in those with large cell tumors (1-year survival: 12.8%). Diagnosis in later years, female gender, younger age, either Asian/Pacific Islander or Hispanic race/ethnicity, lower tumor grade, and surgery or beam radiation as part of first-line treatment were generally independently associated with a decreased risk of death, but the prognostic significance of some of these factors (age, ethnicity, tumor grade) varied according to histologic subtype. Conclusion: Findings demonstrate a poor prognosis across histologic subtypes in stage IV NSCLC patients but highlight differences in both absolute survival and the relative importance of select prognostic factors by histologic subclassification. More research using other sources of population-based data could help clarify the role of histology in the presentation, management, and prognosis of late-stage NSCLC.
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Affiliation(s)
- Karynsa Cetin
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
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Wang SJ, Wissel AR, Luh JY, Fuller CD, Kalpathy-Cramer J, Thomas CR. An interactive tool for individualized estimation of conditional survival in rectal cancer. Ann Surg Oncol 2011; 18:1547-52. [PMID: 21207162 DOI: 10.1245/s10434-010-1512-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Samuel J Wang
- Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA.
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Fesinmeyer MD, Goulart B, Blough DK, Buchwald D, Ramsey SD. Lung cancer histology, stage, treatment, and survival in American Indians and Alaska Natives and whites. Cancer 2010; 116:4810-6. [PMID: 20597131 DOI: 10.1002/cncr.25410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies of lung cancer disparities between American Indians and Alaska Natives (AIANs) and whites have yielded mixed results. To the authors' knowledge, no studies to date have investigated whether race-based differences in histology could explain survival disparities. METHODS Data were obtained on AIANs and whites with lung cancer from the 17 population-based cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) program from 1973 to 2006. Logistic regression was used to determine whether race and other covariates were associated with histology, stage at diagnosis, and receipt of surgery. Cox regression was used to determine the risk of death associated with race, after adjusting for histology, stage, and other covariates. RESULTS Histology, but not race, was found to be associated with stage at diagnosis, and both race and stage were found to be associated with histology. AIANs were less likely to receive surgery than whites, after adjusting for patient and tumor characteristics. Survival improved for both AIANs and whites after 2000, compared with the 1973 through 1999 period, but survival was consistently shorter for AIANs. The association between AIAN race and decreased survival was strongest in the later time period. CONCLUSIONS Lung cancer histology appears to be associated with tumor characteristics, treatment, and survival. AIAN race is associated with tumor histology, receipt of surgery, and survival. In the future, studies with access to smoking data, patient comorbidity information, and health systems-level data will be able to identify factors responsible for the disparities observed in these analyses.
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Affiliation(s)
- Megan Dann Fesinmeyer
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Janssen-Heijnen ML, Gondos A, Bray F, Hakulinen T, Brewster DH, Brenner H, Coebergh JWW. Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers. J Clin Oncol 2010; 28:2520-8. [DOI: 10.1200/jco.2009.25.9697] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose When cancer survivors wish to receive accurate information on their current prognosis during follow-up, conditional 5-year relative survival may be most suitable. We have estimated conditional 5-year relative survival for 13 cancers using a large European database—European Network for Indicators on Cancer (EUNICE)—of 10 dedicated long-standing cancer registries across Europe. Patients and Methods Patients age 15 years and older diagnosed between 1985 and 2004 were included. Conditional 5-year relative survival for each age group was computed for every additional year survived up to 10 years. Period analysis with follow-up period 2000 to 2004 was used. Results All patients with cutaneous melanoma or colorectal, endometrial, or testis cancer and younger patients with stomach, glottis, cervix, ovary, or thyroid cancer or non-Hodgkin's lymphoma exhibited hardly any excess mortality (conditional 5-year relative survival > 95%) given that they were alive at a defined time point within 10 years of initial diagnosis. However, patients with supraglottis, lung, breast, and kidney cancer, as well as older patients with most cancers exhibited substantial excess mortality (conditional 5-year relative survival < 90%). Initial differences in relative survival at diagnosis between age groups largely disappeared with time since initial diagnosis for melanoma, or stomach, colorectal, corpus uteri, or testicular cancer but persisted for patients diagnosed with other tumors. Differences between stage groups became smaller over time or disappeared. Conclusion Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age, and can help serve as a guide for cancer survivors in planning for their future and for doctors in planning schedules for surveillance.
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Affiliation(s)
- Maryska L.G. Janssen-Heijnen
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Adam Gondos
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Freddie Bray
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Timo Hakulinen
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - David H. Brewster
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Hermann Brenner
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
| | - Jan-Willem W. Coebergh
- From the Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; The Cancer Registry of Norway, Institute of Population-Based Cancer Research; Department of Biostatistics, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway; Finnish
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Zamboni BA, Yothers G, Choi M, Fuller CD, Dignam JJ, Raich PC, Thomas CR, O'Connell MJ, Wolmark N, Wang SJ. Conditional survival and the choice of conditioning set for patients with colon cancer: an analysis of NSABP trials C-03 through C-07. J Clin Oncol 2010; 28:2544-8. [PMID: 20406942 DOI: 10.1200/jco.2009.23.0573] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Colon cancer overall survival (OS) is usually computed from the time of diagnosis. Survival gives the initial prognosis but does not reflect how prognosis changes with changing hazard rates over time. Conditional survival (probability of surviving y additional years given they have survived x years [CS or OS|OS]) is an alternative measure that accounts for elapsed time since diagnosis, providing more relevant prognostic information. We extend the concept of CS to condition on the set of patients alive, recurrence-free, and second primary cancer-free (disease-free survival [OS|DFS]). PATIENTS AND METHODS Using data from National Surgical Adjuvant Breast and Bowel Project trials C-03 through C-07, 5-year OS|DFS was calculated on patients who were disease free up to 5 years after diagnosis, stratified by age, stage, nodal status, and performance status (PS). RESULTS For stage II, OS|DFS improved from 87% to 92% at 5 years. For stage III, OS|DFS improved from 69% to 88%. Patients younger than 50 years showed OS|DFS improvement from 79% to 95%; those older than 70 years showed no sustained increase in OS|DFS. Node-negative patients with > or = 12 nodes resected showed little change (89% to 94%); those with more than four positive nodes showed an improvement (57% to 86%). Patients with a PS of 0 or 1 demonstrated a small improvement; those with a PS of 2 did not (64% to 58%). CONCLUSION Prognosis improves over time for almost all groups of patients with colon cancer, especially those with positive nodes. OS|DFS is a more relevant measure of prognosis for those who have already survived disease free a period of time after diagnosis.
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Affiliation(s)
- Beth A Zamboni
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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Racial and Ethnic Diversity in Lung Cancer. Lung Cancer 2010. [DOI: 10.1007/978-1-60761-524-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bleyer A, Choi M, Fuller CD, Thomas CR, Wang SJ. Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol 2009; 36:460-7. [PMID: 19835741 DOI: 10.1053/j.seminoncol.2009.07.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cancer prognosis is usually reported in terms of survival from time of diagnosis. For patients surviving a period of time after diagnosis, conditional survival (CS) accounts for changing risk over time. This report provides information on how CS in cancer patients changes as a function of age at diagnosis. Using data from the US Surveillance, Epidemiology and End Results database, we examined survival for patients diagnosed between 1973 and 2002. The average annual percent change (AAPC) in CS during the first 5 years after diagnosis was evaluated for the 14 most common cancers occurring in young adults, defined as 15- to 39-year-olds, and how they compared with cancers that are more common in older and younger patients. For all cancers, young adult patients had less CS improvement over time than younger or older patients, and this difference was most pronounced in those aged 20 to 29 years (45% below the mean). Eleven of the 14 most common cancers in 15- to 39-year-olds either had a lower CS improvement after diagnosis than either younger or older patients, or than just the older patients. Young adults with leukemia had the greatest improvement in CS over time. In conclusion, young adults with cancer have not enjoyed the same improvement in CS over time compared with other age groups. Explanations for this deficit include the biologic nature of the type of cancers in young adults and less effective therapies for patients in the age group. Regardless of the reasons, the deficit is yet another challenge faced by young adult patients that merits further study.
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JONES L, DOEBBELING CCARNEY. Primary care utilization patterns before and after lung cancer diagnosis. Eur J Cancer Care (Engl) 2009; 18:165-73. [DOI: 10.1111/j.1365-2354.2008.00940.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Samuel J. Wang
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
| | - C. David Fuller
- Department of Radiation Oncology and Graduate Division of Radiological Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jong-Sung Kim
- Department of Mathematics and Statistics, Portland State University, Portland, OR
| | - Charles R. Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR
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Choi M, Fuller CD, Thomas CR, Wang SJ. Conditional survival in ovarian cancer: results from the SEER dataset 1988-2001. Gynecol Oncol 2008; 109:203-9. [PMID: 18329082 DOI: 10.1016/j.ygyno.2008.01.033] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 01/22/2008] [Accepted: 01/30/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Survival statistics for patients with ovarian cancer are typically reported in terms of survival from time of diagnosis. For patients who have survived a period of time since diagnosis, however, conditional survival (CS) is a more clinically relevant measure, as it accounts for the changes in risk over time. The purpose of this study was to estimate CS for ovarian cancer patients through analysis of large-scale cancer registry data. METHODS Ovarian cancer cases were extracted from the Surveillance, Epidemiology, and End Results (SEER 17) database from the National Cancer Institute (NCI) for patients diagnosed between 1988-2001. Five-year relative CS calculations were performed with stratification by age, race, stage, histology, and grade for patients who had already survived up to 5 years from diagnosis. RESULTS The 5-year overall relative CS improved over time for up to 5 years after diagnosis for ovarian cancer patients. The largest gains in CS over time were seen for patients with advanced stage disease, poor grade, and serous and undifferentiated epithelioid histologies. For patients with stage IV disease, 5-year CS more than tripled over the first 5 years of surveillance (17%-56%). Among histological types, patients with undifferentiated epithelioid histology saw 5-year CS rise from 29% at diagnosis to 84% after 5 years. CONCLUSIONS Prognosis improves over time for almost all groups of ovarian cancer patients. For ovarian cancer survivors, CS provides a more relevant measure of prognosis than conventional survival estimates that are made at the time of diagnosis.
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Affiliation(s)
- Mehee Choi
- Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Wang SJ, Emery R, Fuller CD, Kim JS, Sittig DF, Thomas CR. Conditional survival in gastric cancer: a SEER database analysis. Gastric Cancer 2008; 10:153-8. [PMID: 17922092 DOI: 10.1007/s10120-007-0424-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 05/02/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer survival is typically reported in terms of survival from the time of diagnosis. Conditional survival is a more relevant measure of prognosis for patients who have already survived 1 or more years since diagnosis. METHODS Using the Surveillance, Epidemiology, and End Results (SEER 17) database from the National Cancer Institute, we analyzed data from 20 018 gastric cancer patients diagnosed between 1988 and 1998. Using the life-table method, we computed 5-year relative conditional survival, grouped by summary stage, age, sex, and ethnicity, for patients who had already survived up to 5 years from diagnosis. RESULTS Relative conditional survival improves over time for all groups of gastric cancer patients who survive a period of time after diagnosis. The largest gains in conditional survival were seen in patients with advanced stage disease. In general, females showed better survival than males. When grouped by ethnicity, Asians continued to have improved survival compared to other ethnic categories, even at 5 years out from diagnosis. CONCLUSION For gastric cancer patients who survive a period of time after diagnosis, the largest increases in conditional survival are seen for patients with advanced stage disease and for those less than 65 years old. Conditional survival can provide more relevant prognostic information than survival from the time of diagnosis for gastric cancer patients who survive a period of time after diagnosis.
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Affiliation(s)
- Samuel J Wang
- Department of Radiation Medicine, MC KPV4, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
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Jones LE, Doebbeling CC. Beyond the Traditional Prognostic Indicators: The Impact of Primary Care Utilization on Cancer Survival. J Clin Oncol 2007; 25:5793-9. [DOI: 10.1200/jco.2007.13.6127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To our knowledge to date, the effect of primary care utilization on health outcomes in cancer patients has not been described. The objective of this study was to investigate the impact of primary care utilization within 6 months of cancer diagnosis on survival in patients with lung cancer. Patients and Methods We used electronic medical record data (1997 to 2005) to identify male veterans with incident lung cancers (N = 323). Primary care utilization was assessed in the 6 months after cancer diagnosis. Patients were observed from cancer diagnosis to death or to last date of health care utilization (ie, censoring date). Univariate and multivariate Cox proportional hazards models tested whether primary care utilization was associated with improved survival. Multivariate analyses adjusted for demographic and clinical characteristics. Results During an average follow-up of 16.6 months, 259 patients died. In multivariate analysis, the risk of death was 36% (hazard ratio [HR], 0.64; 95% CI, 0.45 to 0.90), 56% (HR, 0.44; 95% CI, 0.29 to 0.65), and 57% (HR, 0.43; 05% CI, 0.29 to 0.64) lower for patients who had one, two, or at least three primary care visits, respectively, in the first 6 months after cancer diagnosis as compared with those without primary care utilization. The median survival duration (P < .0001, log-rank test) was 3.68, 7.52, 13.88, and 13.75 months for patients with no, one, two, or at least three primary care visits, respectively. Conclusion Primary care utilization in the early phase of cancer treatment has a marked effect that results in a reduced mortality risk in patients with incident lung cancer. Additional research is required to determine how and why primary care utilization is an important prognostic indicator of prolonged survival in patients with lung cancer.
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Affiliation(s)
- Laura E. Jones
- From the Roudebush Veterans Affairs Medical Center, Center of Excellence on Implementing Evidence-Based Practice; Department of Internal Medicine, Indiana University School of Medicine; and Regenstrief Institute, Indianapolis, IN
| | - Caroline Carney Doebbeling
- From the Roudebush Veterans Affairs Medical Center, Center of Excellence on Implementing Evidence-Based Practice; Department of Internal Medicine, Indiana University School of Medicine; and Regenstrief Institute, Indianapolis, IN
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