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Abstract Introduction Sinonasal melanomas are rare tumors with no comparative survival studies between Europe and the US. Objective To provide a population-based survival analysis between the two continents. Methods The European Cancer Registry (EUROCARE) and the United States Surveillance, Epidemiology, and End Results (SEER) databases were queried to identify patients diagnosed with sinonasal melanoma between 2000 and 2007. Relative survival (RS) data were grouped by age, gender, geographic region, extent of disease, and treatment modality. Results A total of 1,294 cases were identified between 2000 and 2007 (935 from EUROCARE-5 and 359 from SEER). Females were most commonly identified in Europe (56.4%) and in the US (54.9%). Patients over the age of 65 years comprised the greatest proportion of patients in Europe (70%) and in the US (71%). By region, Southern Europe had the highest 5-year RS (31.6%, 95% confidence interval [CI] = [21.3-42.5%]), and Eastern Europe the lowest (16.5%, [7.5-28.5%]). The aggregate European 5-year RS was 25.4% [21.8-29.1%] and the U.S. was (29.7%, [23.6-36%]). Conclusions Althoughincreasinginincidence, sinonasal melanomas remain rare. Women were more commonly affected. The most common age group was those older than 65 years, although age did not confer a prognostic value. The most common subsite was the nasalcavity followedbythe maxillarysinus.Five-yearRSwas similar betweencontinents withaninverse relationship between extentofdiseaseand survival. The treatment of choice throughout Europe and the US remains primarily surgical.
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Objective:To investigate prognostic factors for acral lentiginous melanoma (ALM) , and to construct a nomogram to verify the predictive value of these factors.Methods:Clinical data on 1 573 patients with ALM were collected from the Surveillance, Epidemiology, and End Results (SEER) database of National Cancer Institute in United States between 2004 and 2015. Data about patients′ age, gender, ulcer status, SEER staging, surgical protocols, T-, N- and M-staging, overall survival rates and disease-specific survival rates were extracted. Chi-square test was used to analyze the correlation of clinical characteristics with overall survival rates and melanoma-specific survival rates, and univariate and multivariate Cox proportional hazards regression models were used to investigate prognostic factors and establish predictive models.Results:Among the 1 537 patients with ALM, 714 were males, 823 were females, 818 were under 64 years of age, and 1 363 were Caucasian. Skin lesions occurred on the lower limbs and buttocks in 1 205 cases, and 974 cases had ulcers; according to the SEER staging, non-spread localized skin lesions were observed in 1 048 cases. There were significant differences in the mortality rate among patients of different ages at diagnosis, different gender, with different ulcer status, surgical status, and at different SEER stages, T-stages, N-stages and M-stages (all P < 0.001) . Univariate and multivariate Cox regression analysis showed that age ≥ 65 years, male, ulcers and distant lymph node metastasis in the SEER staging were associated with increased risk of death in the patients (all P < 0.05) , and the mortality rate was significantly higher in the patients with T2-, T3- or T4-stage ALM than in those with T1-stage ALM (all P < 0.05) , and higher in the patients with N1-, N2- and N3-stage ALM than in those with N0-stage ALM (all P < 0.05) . Conclusion:Age, gender, ulcer status, SEER stage, T-stage and N-stage are independent prognostic factors for overall survival rates and disease-specific survival rates of ALM.
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ABSTRACT Purpose: Increased attention has been focused on the survival of renal cell carcinoma (RCC) patients with bone metastasis. This study proposed to establish and evaluate a nomogram for predicting the overall survival (OS) and cancer-specific survival (CSS) of RCC patients with bone metastasis. Materials and Methods: RCC patients with bone metastasis between 2010 and 2015 were captured from the surveillance, epidemiology and end results (SEER) database. Univariate and multivariate cox regressions were performed to assess the effects of clinical variables on OS and CSS. The nomogram based on the Cox hazards regression model was developed. Concordance index (C-index) and calibration curve were performed to evaluate the accuracy of nomogram models, receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were conducted to assess the predict performance. Results: A total of 2.471 eligible patients were enrolled in this study. The patients were assigned to primary (n=1.672) and validation (n=799) cohorts randomly. The 1-, 2-, and 3-year OS and CSS nomogram models were constructed based on age at diagnosis, sex, marital status, pathological grade, T-stage, N-stage, brain/liver/lung metastasis, surgery, radiotherapy and chemotherapy. The c for OS and CSS prediction was 0.730 (95% confidence interval [CI]: 0.719-0.741) and 0.714 (95%CI:0.702-0.726). The calibration curves showed significant agreement between nomogram models and actual observations. ROC and DCA indicated nomograms had better predict performance. Conclusions: The nomograms for predicting prognosis provided an accurate prediction of OS and CSS in RCC patients with bone metastasis, and contributed clinicians to optimize individualized treatment plans.
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Humans , Carcinoma, Renal Cell , Neoplasm Staging , SEER Program , Nomograms , Kidney NeoplasmsABSTRACT
Background: Healthcare personnel are a high-risk group for acquiring COVID-19 disease. They represent 4 to 20% of the total number of cases reported in different geographical areas. Aim: To describe an epidemiological surveillance strategy to detect symptoms compatible with SARS-CoV-2 infection and early case detection among healthcare personnel at a university hospital. Patients and Methods: We assessed 209 healthcare workers reporting symptoms suggestive of COVID-19 in a telephone counseling system. After a structured evaluation, the suggestions ranged from having a SARS-CoV-2 nasopharyngeal swab PCR test, consulting in the emergency room or at outpatient clinic or returning to work. Results: In 61% of assessed workers a coronavirus SARS-CoV-2 nasopharyngeal swab PCR was requested and 28 (22%) were positive. In a multivariate analysis, the clinical variables associated with a positive PCR test were the presence of fever, sudden loss of smell or taste, and a history of contact with a COVID-19 positive case. Conclusions: The telephone symptom monitoring program allowed the early detection of a significant number of healthcare officials with acute respiratory infection due to coronavirus SARS-CoV-2, it is easy to implement and has a low cost.
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Humans , Coronavirus Infections , Health Personnel , Fever , BetacoronavirusABSTRACT
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.
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PURPOSE: Few studies for occult breast cancer (OBC) have evaluated the effect of radiotherapy (RT) after mastectomy or axillary lymph node dissection (ALND) with/without breast surgery. Therefore, we investigated clinicopathologic factors of OBC with the impact of postoperative RT to determine its prognostic significance using large population-based data. MATERIALS AND METHODS: We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2013. A total of 1,045 eligible patients with OBC were identified. We compared overall survival (OS) using Cox proportional hazards regression with propensity score matching after verifying an imbalance of prognosticators between RT group (n=518) and non-RT group (n=479). RESULTS: Patients with age < 70 (p=0.033), married marital status (p < 0.001), undergoing ALND (p < 0.001), more examined lymph nodes (LNs) (p < 0.001), and more metastatic LNs (p < 0.001) were more likely to receive RT. Multivariate analysis after propensity score matching (n=798) showed that patients treated with RT survived significantly longer than those without RT (5-year OS, 81.5% vs. 78.3%; p=0.014). A significantly prolonged OS was observed when RT was given to patients treated with mastectomy (p=0.033), those treated with ALND (p=0.036), or those with more than seven metastatic LNs (p=0.016). CONCLUSION: RT may offer survival benefit in OBC even after mastectomy or ALND, especially in patients with more than seven metastatic LNs. Further prospective studies are needed to validate these findings.
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Humans , Breast Neoplasms , Breast , Cohort Studies , Epidemiology , Lymph Node Excision , Lymph Nodes , Marital Status , Mastectomy , Multivariate Analysis , Propensity Score , Prospective Studies , Radiotherapy , Retrospective Studies , SEER ProgramABSTRACT
PURPOSE: Conditional survival (CS) provides important information on survival for a period of time after diagnosis. Currently, information on CS patterns of patients with nasopharyngeal carcinoma (NPC) is lacking. We aimed to analyze survival rate over time and estimate CS for NPC patients using a national population-based registry. MATERIALS AND METHODS: Patients diagnosed with NPC between 1973 and 2007 with at least 5-year follow-up were identified from the Surveillance Epidemiology End Results registry. Traditional survival rates and crude CS estimateswere calculated using Kaplan-Meier analysis. Risk-adjusted survival curves were plotted from the proportional hazards model using the correct group prognosis method. RESULTS: For 7,713 patients analyzed, adjusted baseline 5-year overall survival improved significantly from 36.0% in patients diagnosed in 1973-1979, 41.7% in 1980-1989, 46.6% in 1990-1999, to 54.7% in 2000-2007 (p < 0.01). CS analysis demonstrated that for every additional year survived, adjusted probability of surviving the next 5 years increased from 66.7% (localized), 54.0% (regional), and 35.3% (distant) at the time of diagnosis, to 83.7% (localized), 75.0% (regional), and 62.2% (distant) for patients who had survived 5 years. Adjusted 5-year CS differed among age, sex, tumor histology, ethnicity, and stage subgroups initially, but converged with time. CONCLUSION: Treatment outcomes of NPC patients have greatly improved over the decades. Increases in CS become more prominent in patients with distant disease than in those with localized or regional disease as patients survive longer. CS provides more dynamic prognostic information for patients who have survived a period of time after diagnosis.
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Humans , Diagnosis , Epidemiology , Follow-Up Studies , Kaplan-Meier Estimate , Methods , Nasopharyngeal Neoplasms , Prognosis , Proportional Hazards Models , SEER Program , Survival RateABSTRACT
Objective To investigate the prognosis factors of patients with non-functional pancreatic neuroendocrine carcinoma (NF-PanNEC).Methods The patients with NF-PanNEC confirmed by pathology from 2004 to 2015 were collected from the Surveillance,Epidemiology,and End Results (SEER) database of the American National Cancer Institute.The MatchIt package in the R software was used to perform propensitymatching analysis of surgery,radiotherapy and chemotherapy.The Kaplan-Meier method was used to calculate the cumulative survival rate,and the significant difference was evaluated by the log-rank test.Then the Cox multivariate regression analysis was applied to evaluate the prognostic factors of NF-PanNEC patients.Results A total of 2 603 NF-PanNEC patients were included in the analysis.Univariate analysis showed that the age of diagnosis (x2 =123.8,P ＜ 0.001),gender (x2 =7.3,P =0.007),marital status (x2 =26.7,P ＜ 0.001),primary site of tumor (x2 =47.8,P ＜ 0.001),degree of tumor differentiation (x2 =628.7,P ＜ 0.001),American Joint Committee on Cancer (AJCC) stage (x2 =811.7,P ＜0.001),T stage (x2 =425.9,P ＜ 0.001),N stage (x2 =272.3,P ＜ 0.001),M stage (x2 =779.8,P ＜ 0.001),surgery (x2 =962.6,P ＜ 0.001),chemotherapy (x2 =21.9,P ＜ 0.001) were associated with the prognosis of NF-PanNEC patients.No correlation was observed between radiotherapy and the prognosis of NF-PanNEC patients (x2 =0.1,P =0.750).Multivariate Cox regression analysis showed that older diagnostic age (≥74 years old vs.≤56 years old,HR =2.20,95 ％ CI:1.84-2.62,P ＜ 0.001),male (male vs.female,HR =1.14,95 ％ CI为1.01 ～1.29,P =0.035),single or divorced or widowed (single or divorced vs.married,HR =1.26,95 ％ CI:1.10-1.45,P =0.001;widowed vs.married,HR =1.29,95％ CI:1.04-1.61,P =0.022),head of pancreas (tail of pancreas vs.head of pancreas,HR =0.85,95％ CI:0.73-0.99,P =0.033),poor differentiation (grade Ⅳvs.grade Ⅰ,HR=3.75,95％CI:2.70-5.20,P＜0.001),late AJCC stage (stage Ⅳ vs.stage Ⅰ,HR =5.72,95％ CI:4.23-7.73,P ＜ 0.001),no surgery treatment (yes vs.no,HR =0.37,95％ CI:0.30-0.44,P ＜ 0.001) were significant prognostic risk factors for NF-PanNEC patients,and chemotherapy was not independent prognostic factor (yes vs.no,HR=1.00,95％CI:0.88-1.13,P=0.958).Conclusion The older diagnostic age,single or divorced or windowed,head of pancreas,poor differentiation,late AJCC stage and no surgery treatment are significant prognostic risk factors for NF-PanNEC patients.Radiotherapy and chemotherapy may not improve the prognosis of NF-PanNEC patients.
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Purposes To examine the factors related to the choice of cytoreductive nephrectomy (CN) for patients with metastatic clear cell renal cell carcinoma (mCCRCC), and compare the population-based survival rates of patients treated with or without surgery in the modern targeted therapy era. Materials and Methods From 2006 to 2009, patients with mCCRCC were identified from SEER database. The factors that affected patients to be submitted to CN were examined and propensity scores for each patient were calculated. Then patients were matched based upon propensity scores. Univariable and multivariable cox regression models were used to compare survival rates of patients treated with or without surgery. Finally, sensitivity analysis for the cox model on a hazard ratio scale was performed. Results Age, race, tumor size, T stage and N stage were associated with nephrectomy univariablely. After the match based upon propensity scores, the 1-, 2-, and 3-year cancer-specific survival rate estimates were 45.1%, 27.9%, and 21.7% for the no-surgery group vs 70.6%, 52.2%, and 41.7% for the surgery group, respectively (hazard ratio 0.42, 95%CI: 0.35-0.52, log-rank P<0.001). In multivariable Cox proportional hazard regression model, race, T stage, N stage and median household income were significantly associated with survival. Sensitivity analysis on a hazard ratio scale indicated that the hazard ratio might be above 1.00 only when the unknown factor had an opposite effect on survival which was 3-fold than CN. Conclusion The results of our study showed that CN significantly improves the survival of patients with metastatic CCRCC even in the targeted therapy era. .
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Female , Humans , Male , Middle Aged , /genetics , Cell Movement , Cell Proliferation , Carcinoma, Non-Small-Cell Lung/genetics , Lung Neoplasms/genetics , RNA Interference , /metabolism , Cell Line, Tumor , Carcinoma, Non-Small-Cell Lung/metabolism , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Gene Expression Regulation, Neoplastic , Kaplan-Meier Estimate , Lung Neoplasms/metabolism , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Neoplasm Staging , Risk Factors , RNA, Messenger/metabolism , Time Factors , TransfectionABSTRACT
OBJECTIVE: Today in United States, about one in eight women have been affected with breast cancer over their lifetime. Up to today, some various prediction models using SEER (Surveillance Epidemiology and End Results) datasets have been proposed in past studies. However, appropriate methods for predicting the 5 years survival rate of breast cancer have not established. In this study, we evaluate those models to predict the survival rate of breast cancer patients. METHODS: Five data mining algorithms (Artificial Neural Network, Naive Bayes , Decision Trees (ID3) and Decision Trees(J48)) besides a most generally used statistical method (Logistic Regression) were used to evaluate the prediction models using a dataset (37,256 follow-up cases from 1992 to 1997). We also used 10-fold cross-validation methods to assess the unbiased estimate of the five prediction models for comparison of performance of each method. RESULTS: The accuracy was 85.8+/-0.2%, 84.3+/-1.4%, 83.9+/-0.2%, 82.3+/-0.2%, 75.1+/-0.2% for the Logistic Regression, Artificial Neural, Naive Bayes, Decision Trees (ID3), Decision Trees(J48), respectively. Although the accuracy of Logistic Regression showed the highest performances, the Decision Trees (J48) was the lowest one. CONCLUSIONS: The accuracy of Logistic Regression was the best performances, on the other hand Decision Trees (J48) was the worst. Artificial Neural Network indicated relatively high performance.