Improved survival with adjuvant external-beam radiation therapy in lymph node-negative pancreatic cancer: a United States population-based assessment

BACKGROUND: Although chemoradiation often is administered as an adjuvant to pancreatic cancer surgery, recent reports have disputed the benefit of radiation therapy. The objective of this study was to determine the effect of adjuvant radiation therapy in patients with locally confined, lymph node-negative (N0) pancreatic cancer. METHODS: The Surveillance, Epidemiology, and End Results registry was used to identify patients who had undergone cancer-directed surgery for N0 pancreatic adenocarcinoma between 1988 and 2003. Kaplan-Meier survival curves were constructed to compare overall survival between patients who did and did not receive adjuvant external-beam radiation therapy (EBRT). Multivariate Cox regression analysis was used to determine the prognostic significance of EBRT when additional clinicopathologic factors were assessed. The analysis also examined the potential treatment selection bias of patients with survival <3 months. RESULTS: A cohort of 1930 surgical patients with N0 disease was identified. The median survival was 17 months. Irradiated patients had significantly better survival compared with nonirradiated patients (20 months vs 15 months, respectively; P < .001). On multivariate analysis, adjuvant EBRT (hazard ratio [HR], 0.72; 95% confidence interval [95% CI], 0.63-0.82; P < .001), age, grade, tumor classification, and tumor location were independent predictors of survival. When patients with survival <3 months were excluded from the analysis, no difference in survival between the EBRT group and the nonradiation group was noted on univariate comparison (P value not significant). However, on multivariate analysis, EBRT remained an independent predictor of improved overall survival (HR, 0.87; 95% CI, 0.75-1.00; P = .044). CONCLUSIONS: Adjuvant EBRT was associated with improved survival in patients with operable, N0 pancreatic cancer. Its use should be considered in patients who have early-stage N0 disease.     

Pregnancy in association with a newly diagnosed cancer: a population-based epidemiologic assessment

Cancer patients who were pregnant at the time of cancer diagnosis were identified by the National Cancer Registry of the German Democratic Republic for the years 1970 through 1979. A total of 355 such cases occurred in women aged 15-44, and during the same period 2, 103, 112 live births were registered. Rank by site in order of decreasing frequency was cervix, breast, ovary, lymphoma, melanoma, brain and leukemia. On the basis of general female population rates, 555.8 cases were expected, giving a significantly reduced observed to expected ratio (O/E) of 0.64. O/E ratios rose with age. The O/E for invasive carcinoma of the cervix was significantly elevated at 1.15; carcinoma in situ of the cervix occurred significantly less frequently than expected (O/E = 0.57). For breast, brain, melanoma and leukemia, significantly fewer cases were observed than expected. Explanations considered for the low number of pregnancy-associated incident cancer cases include underreporting of pregnancy-associated cancer, altered tumor progression in pregnancy or decreased fertility in women with early neoplastic disease.     

Poorer survival of elderly patients with ovarian cancer: a population-based study

OBJECTIVE: To compare ovarian cancer survival in elderly and young patients. MATERIAL AND METHODS: Using the Geneva Cancer Registry, we identify women diagnosed with primary ovarian cancer between 1980 and 1998. We compared tumors characteristics, treatment patterns of young patients (70 years) by logistic regression. To evaluate the effect of age on prognosis, we compared disease specific survival by Cox proportional hazard analysis, taking into account other prognostic factors. RESULTS: This study included 285 patient aged 70 years and 451相似文献   

Effect of young age on prostate cancer survival: a population-based assessment (United States)

Objective: To assess whether men diagnosed with prostate cancer at younger ages have a poorer prognosis. The influence of select factors (race, marital status, stage, histological grade, histology, presence of comorbid cancer, and time of diagnosis) on the relation between age at diagnosis and survival was considered. Methods: Analyses were based on 289,809 men diagnosed with malignant prostate cancer, ages 40 years and older in the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 1997, actively followed for vital status through 31 December 1998. Cases diagnosed through autopsy or death certificate were excluded. Five-year relative survival and Cox proportional hazards were used for assessment. Results: Five-year relative survival increased, leveled off, and then decreased over the age span. This pattern was most pronounced in men with advanced stage and poor grade tumors. Conditional death hazards that showed significantly higher hazard ratios in younger age groups (i.e. 40–44 and 45–49) represented local/regional stage and poorly differentiated/undifferentiated tumors, distant stage and moderately differentiated, poorly differentiated/undifferentiated, or unknown grade; and unknown stage and unknown grade. The influence of young age on prostate cancer prognosis for advanced stage and poorly differentiated/undifferentiated cases was not significantly influenced by year of diagnosis or race. Conclusions: Younger age is a prognostic factor for prostate cancer survival. The relationship between young age at diagnosis and survival is significantly influenced by stage and histological grade at diagnosis.     

Improved survival of patients with rectal cancer since 1980: a population-based study

The treatment of rectal cancer has changed over the last two decades as far as surgical techniques and radiotherapy are concerned. We studied the changes in patterns of care for patients with rectal cancer and the effect on prognosis. All patients with cancer of the rectum or rectosigmoid in South-east Netherlands, diagnosed in the period of 1980-2000, were included in our analyses (n=3635). The use of surgery as the only treatment decreased from 62% in the period of 1980-1989 to 42% in the period of 1995-2000, whereas the combination of surgery and radiotherapy increased from 26 to 40%. The use of postoperative radiotherapy decreased from 25 to 4%, while preoperative radiotherapy increased from 1 to 35%. Patients aged 75 years or older were less likely to receive radiotherapy. After adjustment for age, gender, tumour stage and tumour site, significant improvements in the relative risk of death were observed between the periods of 1995-2000 and 1980-1989 for patients under 60 years of age (Relative Risk (RR)=0.45; 95% Confidence Interval (CI)=0.35-0.58) and those 60-74 years old (RR=0.62; 95% CI 0.53-0.72). No improvement in the risk of death was found for patients aged 75 years and over. No improvements in the distribution of tumour stage were observed, making it very likely that the continuing increase in population-based survival among patients aged <75 years results from the shift from postoperative to preoperative radiotherapy, the development of the total mesorectal excision technique and the related tendency to subspecialisation of surgeons in colorectal cancer surgery.     

Differences in cancer survival by sex: a population-based study using cancer registry data

Purpose

Few large-scale studies have investigated sex differences in cancer survival and little is known about their temporal and age-related patterns.

Methods

We used cancer registry data for first primary cancers diagnosed between 1982 and 2015 in Victoria, Australia. Cases were followed until the end of 2015 through linkage to death registries. Differences in survival were assessed for 25 cancers using the Pohar-Perme estimator of net survival and the excess mortality rate ratio (EMRR) adjusting for age and year of diagnosis.

Results

Five-year net survival for all cancers combined was lower for men (47.1%; 95% CI 46.9–47.4) than women (52.0%; 95% CI 51.7–52.3); EMRR 1.13 (95% CI 1.12–1.14; p?<?0.001). A survival disadvantage for men was observed for 11 cancers: head and neck, esophagus, colorectum, pancreas, lung, bone, melanoma, mesothelioma, kidney, thyroid, and non-Hodgkin lymphoma. In contrast, women had lower survival from cancers of the bladder, renal pelvis, and ureter. For the majority of cancers with survival differences, the EMRR decreased with increasing age at diagnosis; for colorectal, esophageal, and kidney cancer, the EMRR increased with time since diagnosis.

Conclusion

Identifying the underlying reasons behind sex differences in cancer survival is necessary to address inequalities, which may improve outcomes for men and women.

     

Disparities in survival after female breast cancer diagnosis: a population-based study

Background

Despite advances in treatment and increased screening, female breast cancer survival is affected by race, ethnicity, and socioeconomic status (SES). The purpose of this study was to substantiate disparities in breast cancer mortality in a large and unique dataset containing 7 distinct racial groups, 31 comorbidities, demographic and clinical/pathological patient characteristics, and neighborhood poverty information.

Methods

Florida Cancer Data System registry (1996–2007) linked with the Agency for Health Care Administration and U.S. Census tract (n = 127,754) explored median survival and 1-, 3-, and 5-year survival rates by the Kaplan–Meier method. Log-rank tests compared survival curves by race/ethnicity/SES. Cox proportional hazards regression models were used to obtain unadjusted and adjusted hazard ratios (HR) and 95 % confidence intervals.

Results

Native Americans had the lowest median survival (7.4 years) and Asians had the highest (12.6 years). For the univariate analysis, worse survival was seen for blacks (HR = 1.44; p < 0.001) and better survival for Asians (HR = 0.71; p < 0.001), Asian Indians or Pakistanis (HR = 0.65; p = 0.013), and Hispanics (HR = 0.92; p < 0.001). Multivariate analysis demonstrated sustained survival detriment for blacks (HR = 1.28; p < 0.001) and improved survival for Hispanics (HR = 0.90; p = 0.001). For SES, there was an incremental improvement in survival for each higher SES category in all analyses (p < 0.001).

Conclusions

Utilizing a large enriched state cancer registry controlling for multiple demographic, clinical, and comorbidities, we fully explored survival disparities in female breast cancer and found certain aspects of race, ethnicity, and SES to remain significantly associated with breast cancer survival. More research is needed to uncover the source of these ongoing disparities.     

Laryngeal cancer survival in Zaragoza (Spain): a population-based study

Objective  

This article aims to study larynx cancer survival from the Population-Based Cancer Registry of Zaragoza, Spain, for the period 1978–2002.     

Time-trends in survival in young women with breast cancer in a SEER population-based study

Mortality improvements in young women with breast cancer (BC) may be attributable to treatment advances; screening likely plays a less significant role as mammography is not recommended <40. We examined time-trends in outcome in a cohort of young women. Our goal was to determine the contributions of treatment and screening to mortality improvements and evaluate whether differential outcomes by ER status exist. Using SEER, patients (73,447) were divided into three categories by diagnosis year (1990–1994, 1995–1999, 2000–2004) and also categorized as <40 or 40–50 years. Multivariate analysis was done to investigate the association of survival with time period for both age groups by ER status. Hazard ratios (HR) for mortality in women 40–50 with ER positive BC declined over time. With 1990–1994 as referent, the HR in 1995–1999 was 0.77 (0.69–0.86) and 0.65 (0.59–0.71) in 2000–2004 (p < 0.001). Women <40 with ER positive BC also had improvements over time. In ER negative patients, the degree of improvements over time was less than that seen in ER positive women. We report a survival disparity over time in young women by ER status. Patients with ER negative disease have not had the degree of improvements over time as seen in ER positive disease. Therefore, mortality improvements in young women with ER positive BC may be attributed to treatment advances with endocrine agents.     

Rurality and survival differences in lung cancer: a large population-based multivariate analysis

Several studies have suggested rural health disadvantages. In France, studies on rural-urban patterns of lung cancer survival have yielded conflicting results. The aim of this analysis was to determine whether rural residence was associated with poor survival in three French counties. The database consisted of all primary lung cancer cases diagnosed in 2000 and 2001 collected through the Doubs cancer registry. A degree of rurality, obtained from socio-demographic and farming parameters of the 1999 French census treated with factor analysis, was attributed to each patient according to his/her place of residence. Among the 802 patients, 21% resided in rural areas, 11% were semi-urban inhabitants and 68% were urban residents. Survival differed significantly between these three rurality categories (p=0.04), with 2-year survival rates of 18, 29 and 24%, respectively. Using a Cox model, rural areas were significantly correlated with poor survival as compared with semi-urban areas (OR=1.42; 95% confidence interval=1.06-1.90; p=0.02). There was no survival difference between semi-urban and urban patients (OR=1.18; 95% confidence interval=0.91-1.53; p=0.21). Patient and tumour characteristics, especially stage and staging procedures, as well as first line treatment, did not vary with the degree of rurality. In conclusion, rurality has to be considered as a strong prognostic factor. Several intricate factors might be hypothesized such as increasing time to diagnosis leading to heavier tumour burden, worse treatment compliance and socioeconomic status. Before practical interventions can be proposed, prospective studies are warranted with further definition of rural risk factors for decreased survival in rural lung cancer patients.     

Trends in prostate cancer survival in Spain: results from population-based cancer registries

Introduction

The aim of this study is to analyse the evolution of the survival of patients diagnosed with prostate cancer during the period 1995?C2003.

Material and methods

This is a population survival study of incident cases of prostate cancer in four Spanish areas: Basque Country, Girona, Murcia and Navarra. We calculated the relative survival (RS) at 5 years and its 95% confidence intervals using a cohort analysis and adjusted for age. To assess the trend in survival between the periods (1995?C1999 and 2000?C2003) a Poisson regression model was used, adjusting for age, region and period, obtaining the relative risk of death.

Results

The number of patients diagnosed during the 1995?C1999 period was 6493 and 8331 in the period 2000?C03. The RS at 5 years adjusted for age increased significantly, from 75.3% (95% CI 73.3?C77.2) in the period 1995?C99 to 85% (95% CI 83.4?C86.4) in the period 2000?C03.

Conclusion

In Spain the survival of patients with prostate cancer has increased significantly from 1999 to 2003, probably due to the advancement in diagnosis produced by the opportunistic screening of prostate-specific antigen (PSA). Differences in the dissemination and use of the PSA level could explain the observed geographic differences in the increase of survival. It would be necessary to carry out studies to quantify the produced overdiagnosis by screening with PSA in prostate cancer.     

Better survival in patients with metastasised kidney cancer after nephrectomy: a population-based study in the Netherlands

Aim

Cytoreductive nephrectomy is considered beneficial in patients with metastasised kidney cancer but only a minority of these patients undergo cytoreductive surgery. Factors associated with nephrectomy and the independent effect of nephrectomy on survival were evaluated in this study.

Methods

Patients were selected from the population-based cancer registry and detailed data were retrieved from clinical files. Factors associated with nephrectomy were evaluated by logistic regression analyses. Cox proportional hazard regression analysis was performed to evaluate factors associated with survival; a propensity score reflecting the probability of being treated surgically was included in order to adjust for confounding by indication.

Results

37.5% of 328 patients diagnosed with metastatic kidney cancer between 1999 and 2005 underwent nephrectomy. Patients with a low performance score, high age, ?2 comorbid conditions, ?2 metastases, low or high BMI, weight loss, elevated lactate dehydrogenase, elevated alkaline phosphatase, female gender and liver or bone metastases were less likely to be treated surgically. Three year survival was 25% and 4% for patients with and without nephrectomy, respectively (p < 0.001). After adjustment for other prognostic factors including the propensity score, nephrectomy remained significantly associated with better survival (Hazard ratio: 0.52, 95% Confidence interval: 0.37-0.73).

Conclusions

Even after accounting for prognostic profile, patients still benefit from a nephrectomy; an approximately 50% reduction in mortality was observed. It is, therefore, recommended that patients with metastasised disease receive cytoreductive surgery when there is no contraindication. Trial results on cytoreductive surgery combined with targeted molecular therapeutics are awaited for.     

Prospective associations of depression with survival: a population-based cohort study in patients with newly diagnosed breast cancer

Psychological factors may influence survival in breast cancer patients but results of previous research are inconclusive. This prospective population-based study tested whether depression predicts mortality in breast cancer patients. Routinely collected depression screening data were merged with electronically archived provincial cancer registry data and censored data from British Columbia Vital Statistics (extracted in December 2012). Cox proportional-hazards regression analyses were conducted to predict all-cause and breast cancer-specific mortality as a function of depression after controlling for biomedical confounders. Of 1,646 patients, 1,604 had breast cancer stages I–III and 42 had stage IV breast cancer. 176 (11.0 %) versus 28 (66.7 %) were deceased after a median follow-up of 76 months. In patients with curable breast cancer, depression predicted all-cause (HR = 1.54 (95 % CI 1.06–2.25); p = 0.024), but not breast cancer-specific mortality (HR = 1.51 (95 % CI 0.95–2.41); p = 0.084). No association was shown for metastatic disease. Stage-specific analyses demonstrated a 2–2.5-fold increase in breast cancer-specific and all-cause mortality in patients with stage I and II disease, but not in patients with stage III or IV breast cancer. In stage I breast cancer patients, age moderated effects of depression such that depressed younger patients diagnosed at age 45 (i.e., mean age ?1SD) showed a ninefold (HR = 9.82 (95 % CI 2.26–42.68); p = 0.002) increase in all-cause mortality and depressed patients at 57 a 3.7-fold (HR = 3.69 (95 % CI 1.44–9.48); p = 0.007) increase, while no association was evident in older patients at age 69 (mean age +1SD). Depression is strongly associated with mortality in younger patients with early stage breast cancer.