ABSTRACT
Objective To analyze the influencing factors of second primary cancer (SPC) in patients with acute lymphoblastic leukemia (ALL). Methods The Surveillance, Epidemiology and End Results database of the National Cancer Institute was used to extract data, and SEER*Stat program 8.4.0 was used to calculate the standardized incidence rate ratio (SIR) and absolute excess rate (AER). In addition, Cox regression models were used to estimate the hazard ratio (HR) of different age, race, sex, chemotherapy, and radiation and other factors for secondary tumors by R 4.2.1, and Kaplan-Meier method was used to plot the cumulative incidence. Results A total of 22 407 cases were included, and the person-years of follow-up were 142780.82. There was a total of 436 SPC cases, 32 of which developed multiple cancers. The median time of secondary cancers was 47.5 months. Patients with ALL had a higher risk of SPC than the general population (SIR=2.27; 95% , CI:2.07-2.50), and the most observed SPC was lymphatic and hematopoietic system, with an SIR of 6.96 (95% CI:5.94-8.11). The risk of SPC in ALL patients diagnosed in different time periods showed an upward trend, from 1.98 in 2000 to 2.38 in 2019. With the increase of age, the risk of SPC in ALL patients gradually decreased. Chemotherapy reduced the risk of SPC (HR=0.26; 95%CI: 0.19-0.36), while radiotherapy increased the risk of SPC by 59.60% (HR=1.57; 95% CI: 1.23-2.00). Conclusion In the future, chemotherapy is recommended for ALL patients to reduce radiation exposure during radiotherapy, and more attention should be paid to the health status of ALL patients within 1-5 years after their onset.
ABSTRACT
Objective:To evaluate the value of chemoradiotherapy and surgery in cervical esophageal cancer (CEC).Methods:Data of 459 patients with CEC from 2004 to 2017 were collected and retrospectively analyzed from the surveillance, epidemiology, and end results (SEER) database of National Cancer Institute (US). All patients were divided into the chemoradiotherapy group ( n=379) and surgery group ( n=80) according to the treatment methods. Survival analysis was performed by Kaplan-Meier method and survival curve was drawn. Multivariate survival analysis was conducted by Cox proportional hazards regression model. The death rate of different causes between two groups was calculated by cumulative incidence function (CIF). The differences of death rate between two groups were evaluated by Fine-Gray competing risk model. By analyzing the clinical characteristics and survival of CEC patients, the overall survival (OS) was compared between the surgery and chemoradiotherapy groups. Results:The 2- and 5-year survival rates in the chemoradiotherapy group were 43.1% and 22.4%, while those of the surgical group were 46.8% and 26.0%, respectively. No significant difference was observed in the OS between the chemoradiotherapy and surgery groups ( P=0.750). Cox multivariate analysis showed that treatment (surgery group vs. chemoradiotherapy group) was not an independent prognostic factor for OS. Based on the results of competing risk analysis, the risk of esophageal cancer-specific death in the chemoradiotherapy group was higher than that in the surgery group, and the difference was statistically significant between two groups ( P<0.001). The risk of other cause-specific death in the chemoradiotherapy group was lower than that in the surgery group ( P<0.001). The proportion of patients who died of oral, oropharyngeal, hypopharyngeal and laryngeal diseases in the surgery group was significantly higher than that in the chemoradiotherapy group(all P<0.001). Conclusions:No significant difference is observed in the OS of CEC patients treated with chemoradiotherapy or surgery. In the surgery group, the risk of esophageal cancer-specific death is lower, whereas the risk of other cause-specific death is higher compared with those in the chemoradiotherapy group.
ABSTRACT
Abstract Objective: This study aimed to investigate the demographic and clinicopathological characteristics, and survival outcomes of subglottic Squamous Cell Carcinoma (SCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Demographic and clinicopathological information, including age, sex, race, tumor size, histologic grade, clinical/TNM stage, tumor invasion extent, Lymph Node Metastasis (LNM) extent, size of metastatic lymph nodes, LNM ratio and treatment data, of 842 subglottic SCC patients diagnosed between 1996 and 2016 were acquired. Kaplan-Meier survival analyses were performed to assess the effects of clinicopathological characteristics, treatment modalities, surgical procedures, and adjuvant therapies on overall survival and cancer-specific survival. Results: Subglottic SCC was more frequent among males aged 60-70 years, with low-grade but locally advanced lesions without local or distant metastases. Age and several primary tumor/LNM related variables were independent risk factors for overall survival and cancer specific survival. Advanced-stage and high-grade disease led to unfavorable prognosis. The most common treatment modality and surgical procedure were surgery plus radiotherapy and total laryngectomy, respectively. Surgery plus radiotherapy provided favorable 5-year survival outcomes, while total laryngectomy had the worst. Surgery plus adjuvant therapy showed better survival outcomes than surgery alone. Conclusion: This study confirmed the rarity of subglottic SCC. Patients with subglottic SCCs suffered poor prognosis especially for those with advanced-stage or high-grade lesions. The prognosis of subglottic SCC remained poor over the years, despite recent progress in cancer therapies. Surgery plus adjuvant therapy improved the survival outcome. Although larynx preservation surgery was beneficial for early-stage disease, total laryngectomy was favored for patients with advanced tumors. Level of evidence: Level 4.
ABSTRACT
Objective:To explore the impacts of postoperative radiotherapy on long-term survival of the patients with resectable locally advanced (T 3-4and/or N +) biliary tract cancers (BTCs) and to analyze the prognostic factors. Methods:The patients with locally advanced gallbladder cancer ( n=1 922) and the patients with extrahepatic biliary duct cancer ( n=3 408) who received surgical resection during 2006-2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. They were grouped according to different treatment schemes (only surgery and surgery + radiation). The propensity score matching (PSM) method was employed to adjust the differences in baseline prognostic characteristics between patients who received only surgery and those treated with surgery+ radiation. The role of the two treatment schemes on the survival of the patients was analyzed using the Kaplan-Meier method and the prognosis factors were assessed using the Cox regression. Results:The 1 174 patients with gallbladder cancers and the 2 144 patients with extrahepatic biliary duct cancer were respectively matched according to propensity scores. The postoperative radiotherapy showed a significant advantage in 5-year cancer-specific survival (CSS) compared to only surgery for both the patients with gallbladder cancer ( χ2=35.73, P< 0.001) and those with extrahepatic biliary duct cancer ( χ2=9.878, P=0.002). After adjusting related covariates, independent prognostic factors for all the patients included pathological grading, T status, N status, treatment pattern, and age. For the patients with extrahepatic biliary duct cancer, independent prognostic factors also included race and year of diagnosis. The benefits of postoperative radiotherapy were observed in various clinicopathologic characteristics except for the patients with T 1-2 gallbladder cancer and the extrahepatic biliary duct cancer patients with a pathological grade of Ⅰ-Ⅱ and N 0 status or with age ≥ 70. Conclusions:Long-term survival benefits can be gained through postoperative radiotherapy for the patients with resectable locally advanced (T 3-4 and/or N+ ) BTCs. However, adjuvant radiation should be cautiously adopted for the patients with T 1-2 gallbladder cancer and the extrahepatic biliary duct cancer patients with a pathological grade of I-Ⅱ and N 0 status or with age ≥70.
ABSTRACT
@#Objective To analyze the factors affecting the prognosis of patients with primary tracheal malignancy, and establish a nomogram model for prediction its prognosis. Methods A total of 557 patients diagnosed with primary tracheal malignancy from 1975 to 2016 in the Surveillance, Epidemiology, and End Results Data were collected. The factors affecting the overall survival rate of primary tracheal malignancy were screened and modeled by univariate and multivariate Cox regression analysis. The nomogram prediction model was performed by R 3.6.2 software. Using the C-index, calibration curves and receiver operating characteristic (ROC) curve to evaluate the consistency and predictive ability of the nomogram prediction model. Results The median survival time of 557 patients with primary tracheal malignancy was 21 months, and overall survival rates of the 1-year, 3-year and 5-year were 59.1%±2.1%, 42.5%±2.1%, and 35.4%±2.2%. Univariate and multivariate Cox regression analysis showed that age, histology, surgery, radiotherapy, tumor size, tumor extension and the range of lymph node involvement were independent risk factors affecting the prognosis of patients with primary tracheal malignancy (P<0.05). Based on the above 7 risk factors to establish the nomogram prediction model, the C-index was 0.775 (95%CI 0.751-0.799). The calibration curve showed that the prediction model established in this study had a good agreement with the actual survival rate of the 1 year, 3 year and 5 years. The area under curve of 1-year, 3-year and 5-year predicting overall survival rates was 0.837, 0.827 and 0.836, which showed that the model had a high predictive power. Conclusion The nomogram prediction model established in this study has a good predictive ability, high discrimination and accuracy, and high clinical value. It is useful for the screening of high-risk groups and the formulation of personalized diagnosis and treatment plans, and can be used as an evaluation tool for prognostic monitoring of patients with primary tracheal malignancy.
ABSTRACT
Objective: To investigate the effect of different organ metastases on clinical prognosis in patients with small cell lung cancer (SCLC). Methods: A total of 10 347 SCLC patients with distant metastases (M1) obtained from the surveillance, epidemiology, and end results (SEER) database between 2010 and 2013 were enrolled in this study. The median duration of follow-up was 4 months and the median age was 67 years. According to metastatic sites, the patients were divided into six groups: bone metastasis group, brain metastasis group, liver metastasis group, lung metastasis group, none group (no metastasis found in the bone, brain, liver or lung) and multi-organ metastasis (MOM) group (2 or more organ metastases found in the bone, brain, liver or lung). The effects of different organ metastases on clinical prognosis in SCLC patients were analyzed. Results: MOM was the most common pathway of metastasis, accounting for 32.8% (3 396/10 347), followed by liver metastasis (19.0%, 1 971/10 347), brain metastasis (12.1%, 1 251/10 347) and bone metastasis (10.0%, 1 033/10 347). The mortality rates associated with bone, brain, liver and lung metastases and MOM were 77.2% (797/1 033), 74.1% (927/1 251), 82.4% (1 625/1 971), 73.4% (504/687), and 81.6% (2 770/3 396), respectively. Compared with the none group, the MOM and liver metastasis groups had higher hazard ratio (HR) (95% confdence interval [CI] of 1.80 (1.66-1.96) and 1.69 (1.54-1.85), respectively, followed by bone and brain metastasis groups with HR (95% CI) of 1.24 (1.12-1.39) and 1.28 (1.16-1.42) (all P<0.001). Lung metastasis group had a lowest HR (95% CI) of 1.07 (0.95-1.21) (P = 0.27). Conclusion: MOM and liver metastases are associated with the worst prognosis and the highest mortality in SCLC patients, followed by bone, brain and lung metastases. Therefore, for the SCLC patients with distant metastasis, different treatments should be carried out according to involved organs, and treatment should be strengthened in patients with liver metastasis and MOM.
ABSTRACT
Background: Melanoma is an aggressive skin cancer with a high mortality rate. The incidence of melanoma has increased in recent years from 1:1500 in 1935 to 1:50 in 2011. The aim of this study is to investigate survival by race/ethnicity, taking site into account, among melanoma patients in the United States.Methods: This study is a secondary analysis of the Surveillance, Epidemiology, and End Results (SEER) Program. SEER collects data through a non-concurrent cohort study design. The sample size was 185219 participants. The chi-square test was used to examine the association between categorical variables. Kaplan-Meier survival analysis was used to estimate the overall survival curve and to estimate the survival curve per race/ethnicity. Collinearity was assessed using Pearson correlation. Cox proportional hazards regression was used to calculate the unadjusted and adjusted hazard ratios (HR).Results: Non-Hispanic White (NHW) and Other patients were older in age (70 years or older), while non-Hispanic Black (NHB) and Hispanic patients were younger (30-39 years). Melanoma in NHW patients was mostly located in trunk whereas melanoma for NHB, Hispanic and Other patients was mostly located in the lower limbs. For all races/ethnicities except for NHB, more individuals were diagnosed between 2002 and 2011. Patients with melanoma in upper limbs lived more frequently. Fewer women died (6.8%) compared to men (17.1%). Patients who were diagnosed between the ages of 30-39 were more likely to die. NHB had an adjusted HR of 3 (95% CI 2.7, 3.3) compared to NHW. The adjusted HR of lower limb was 1.6 (95% CI 1.5, 1,6) compared to the reference group (Head and Neck). The hazard for trunk and lower limb were about the same as the reference. Those who were 70 years or older had an adjusted HR of 2.2 (95% CI 2.0, 2.4). Women had an adjusted HR of 0.4 (95% CI 0.4, 0.5), and diagnosis during the decade 1982-1991 had an adjusted HR of 2.6 (95% CI 2.4, 2.7).Conclusions: NHB patients and patients of ages 30-39 years were more likely to die. The poorest survival was for diagnosis between 1982 and 1991. However, more individuals were diagnosed between 2002 and 2011. The lower limb had a worse prognosis with adjusted HR of 1.6 (95% CI 1.5, 1,6), and more men were diagnosed than women.
ABSTRACT
Objective To study the component ratios of pancreatic carcinoma,and prognosis of patients with the different pathological types.Methods The data of 92 011 pancreatic carcinoma patients who were diagnosed by the definite pathological method from 2004 to 2014 were extracted from the US SEER database.The life table was used to calculate the 1-,3-and 5-year survival rates.The Kaplan-Meier was used to construct the survival curves of the patients.The Cox univariate analysis was applied to evaluate the HR of the different pathological types,and the x2 test and independent sample t-test were used to evaluate the base line data.Results The overall 5-year survival of 92 011 pancreatic carcinoma patients was 7.6％.The median survival time was 8.8 months and the component ratios of the pancreatic ductal adenocarcinoma (PDAC),pancreatic epithelium cancer bedside the PDAC,neuroendocrine tumors,undifferentiated carcinoma,mesenchymal carcinoma and rare cancer unclassified were 85.78％,6.40％,6.67％,0.97％,0.10％ and 0.08％,respectively.The differences were statistically significant between the baseline data such as age,gender,race and position (P ＜ 0.05).The overall 5-year survivals of the PDAC,pancreaticepithelium cancer beside the PDAC,neuroendocrine tumors,undifferentiated carcinoma,mesenchymal carcinoma and rare cancer unclassified were 4.2％,13.4％,49.2％,5.0％,29.2％ and 24.5％,respectively,and the median survival times were 5 months,7 months,58 months,2 months,26 months and 7 months respectively.The distant metastasis rate of neuroendocrine carcinoma was the lowest (35.0％).The undifferentiated carcinoma was the most prone to distant metastases (65.2％).Basically,half of the other types of pancreatic cancer had metastasis at the time of diagnosis.In pancreatic epithelium cancer beside the PDAC,the high to low 5-year survival rates were solid pseudopapillary carcinoma (87.3％),cystadenocarcinoma (36.8％),intraductal papillary mucinous neoplasm (36.5％),acinar cell carcinoma (20.0％),and pancreatic adenocarcinoma mixed with other subtypes (19.7％).The incidence of the other types of pancreatic carcinoma was less than 8％,such as mucinous carcinoma,squamous cell carcinoma,adenosquamous carcinoma and signet ring cell carcinoma.In neuroendocrine tumor,the 5-year survival rate of insulinoma (77.1％) was higher than those of neuroendocrine tumor (malignant) (NET,62.0％) and neuroendocrine carcinoma (NEC,46.5％).Conclusion The prognosis of pancreatic carcinoma was poor,and the pathological types had a significant impact on the prognosis of the patients.