Relative Survival of Breast Cancer Patients in Iran

Background: The survival rate reflecting prognosis of breast cancer patients is usually estimated based on crudesurvival methods such as observed and cause-specific. In situations where data are based on population-cancerregistries, this method may produce biased estimations. This study therefore aimed to estimate the net survival ofbreast cancer based on relative survival. Materials and Methods: Data for 622 breast cancer patients diagnosedat the Iran Cancer Institute during 1990-95 and tracked till the end of 2000 were analyzed. For estimation ofrelative survival, Ederer’s second method and SAS (9.1) and STATA (11) software were used. Results: Threeyearrelative survivals of 85%, 90%, 80% and 67% were observed for age groups 15-44, 55-59, 60-74, and 75+years-old, respectively. A relative survival of approximately one was observed for two subsequent years forage-group 45-59 years-old. A value greater than one for two subsequent years of follow-up was observed in theage-group 60-74 years-old. Conclusions: Tracking the diagnosis of breast cancer, the relative survival decreasesas we go to higher age-groups. It is also perceived that through follow-up, relative survival first decreased andthen increased a little. The statistical cure point is acceptable for age group 45-59 years-old while for age-groups15-44 and 60-74 years old is a sign of low quality data for some follow-up intervals.     

Up-to-date estimates of long-term cancer survival in England and Wales

Cancer survival in England and Wales has improved over the last 30 years. However, cohort survival estimates delay recognition of these improvements. Here we show that period survival estimates, based on survival in a recent time period, suggest a more optimistic pattern for England and Wales than cohort-based measures for most cancers.British Journal of Cancer (2003) 89, 74-76. doi:10.1038/sj.bjc.6600976 www.bjcancer.com     

Comparison between Overall,Cause-specific,and Relative Survival Rates Based on Data from a Population-based Cancer Registry

Three kinds of survival rates are generally used depending on the purpose of the investigation: overall,cause-specific, and relative. The differences among these 3 survival rates are derived from their respectiveformulas; however, reports based on actual cancer registry data are few because of incomplete information andshort follow-up duration recorded on cancer registration. The aim of this study was to numerically and visuallycompare these 3 survival rates on the basis of data from the Nagasaki Prefecture Cancer Registry. Subjectswere patients diagnosed with cancer and registered in the registry between 1999 and 2003. We calculated theproportion of cause of death and 5-year survival rates. For lung, liver, or advanced stage cancers, the proportionsof cancer-related death were high and the differences in survival rates were small. For prostate or early stagecancers, the proportions of death from other causes were high and the differences in survival rates were large.We concluded that the differences among the 3 survival rates increased when the proportion of death from othercauses increased     

Long-term Survival Outcomes of ‘Low Risk’ Ductal Carcinoma in situ from a Territory-wide Cancer Registry

AimsThe LORIS trial is an ongoing phase III clinical trial on low risk ductal carcinoma in situ (DCIS). DCIS patients aged ≥46 years with screen-detected low/intermediate nuclear grade were considered low risk and were randomised into surveillance or standard surgery. Here we review the 10-year territory-wide breast cancer registry database and evaluate the clinical outcomes of low versus high risk DCIS patients.Materials and methodsThis was a retrospective study of a prospectively maintained territory-wide breast cancer registry in Hong Kong.ResultsBetween 1997 and 2006, 1391 DCIS patients were identified from the Hong Kong cancer registry breast cancer database. The mean age at diagnosis was 49.2 years (range 30–70). In total, 372 patients were classified as ‘low risk’, whereas the remaining 777 patients were classified as ‘high risk’. After a median follow-up of 11.6 years, the 10-year overall breast cancer-specific survival of the entire DCIS cohort was 1136/1149 (98.9%). Overall breast cancer-specific survival of low risk DCIS was 99.5%, whereas that in high risk DCIS was 98.6% (Log-rank test, P = 0.208).Forty-six (12.4%) patients in the LORIS low risk group did not receive surgery, whereas 93 (12%) patients in the LORIS high risk group did not receive surgery. The 10-year breast cancer-specific survival in the non-operated low risk DCIS group was 97.8%; that in the non-operated high risk DCIS group was 96.7% (P = 1).ConclusionLong-term survival of DCIS was excellent, especially in low risk DCIS, regardless of surgical treatment.     

Verification of the Correlation between Progression-free Survival and Overall Survival Considering Magnitudes of Survival Postprogression in the Treatment of Four Types of Cancer

Background: With development and application of new and effective anti-cancer drugs, the median survivalpost-progression (SPP) is often prolonged, and the role of the median SPP on surrogacy performance shouldbe considered. To evaluate the impact of the median SPP on the correlation between progression-free survival(PFS) and overall survival (OS), we performed simulations for treatment of four types of cancer, advancedgastric cancer (AGC), metastatic colorectal cancer (MCC), glioblastoma (GBM), and advanced non-small-celllung cancer (ANSCLC). Materials and Methods: The effects of the median SPP on the statistical propertiesof OS and the correlation between PFS and OS were assessed. Further, comparisons were made between thesurrogacy performance based on real data from meta-analyses and simulation results with similar scenarios.Results: The probability of a significant gain in OS and HR for OS was decreased by an increase of the SPP/OS ratio or by a decrease of observed treatment benefit for PFS. Similarly, for each of the four types of cancer,the correlation between PFS and OS was reduced as the median SPP increased from 2 to 12 months. Except forANSCLC, for which the median SPP was equal to the true value, the simulated correlation between PFS and OSwas consistent with the values derived from meta-analyses for the other three kinds of cancer. Further, for thesethree types of cancer, when the median SPP was controlled at a designated level (i.e., < 4 months for AGC, < 12months for MCC, and <6 months for GBM), the correlation between PFS and OS was strong; and the powerof OS reached 34.9% at the minimum. Conclusions: PFS is an acceptable surrogate endpoint for OS under thecondition of controlling SPPs for AGC, MCC, and GBM at their limit levels; a similar conclusion cannot bemade for ANSCLC.     

Estimating expected survival probabilities for relative survival analysis--exploring the impact of including cancer patient mortality in the calculations

Relative survival is a widely used measure of cancer patient survival, defined as the observed survival of the cancer patients divided by the expected survival of a comparable group from the general population, free from the cancer under study. In practise, expected survival is usually calculated from general population life tables. Such estimates are known to be biased since they also include mortality from the cancer patients, but the bias is ignored since mortality among individuals with a specific cancer is thought to constitute only a small proportion of total mortality. Using the computerised population registers that exist in Sweden we had the unique opportunity to calculate expected survival both including and excluding individuals with cancer, and thereby estimate the size of the bias arising from using general population estimates. We also evaluated a simple method to adjust expected survival probabilities estimated from general population statistics as an aid to researchers who do not have access to computerised registers of the entire national population. Our results show that the bias is sufficiently small to be ignorable for most applications, notably for cancers with high or low mortality and for younger age groups (<60 years). However, the bias in relative survival estimates can be greater than 1 percent unit for older age groups for common cancers and even larger for all sites combined. For example, the bias in 10-year relative survival for men aged 75+ diagnosed with prostate cancer was 2.6 percent units, which we think is of sufficient magnitude to warrant adjustment.     

Cancer net survival on registry data: Use of the new unbiased Pohar‐Perme estimator and magnitude of the bias with the classical methods

Net survival, the survival which might occur if cancer was the only cause of death, is a major epidemiological indicator required for international or temporal comparisons. Recent findings have shown that all classical methods used for routine estimation of net survival from cancer‐registry data, sometimes called “relative‐survival methods,” provide biased estimates. Meanwhile, an unbiased estimator, the Pohar‐Perme estimator (PPE), was recently proposed. Using real data, we investigated the magnitude of the errors made by four “relative‐survival” methods (Ederer I, Hakulinen, Ederer II and a univariable regression model) vs. PPE as reference and examined the influence of time of follow‐up, cancer prognosis, and age on the errors made. The data concerned seven cancer sites (2,51,316 cases) collected by FRANCIM cancer registries. Net survivals were estimated at 5, 10 and 15 years postdiagnosis. At 5 years, the errors were generally small. At 10 years, in good‐prognosis cancers, the errors made in nonstandardized estimates with all classical methods were generally great (+2.7 to +9% points in prostate cancer) and increased in age‐class estimations (vs. 5‐year ones). At 15 years, in bad‐ or average‐prognosis cancers, the errors were often substantial whatever the nature of the estimation. In good‐prognosis cancers, the errors in nonstandardized estimates of all classical methods were great and sometimes very important. With all classical methods, great errors occurred in age‐class estimates resulting in errors in age‐standardized estimates (+0.4 to +3.2% points in breast cancer). In estimating net survival, cancer registries should abandon all classical methods and adopt the new Pohar‐Perme estimator.     

Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium

Background:

Observational studies have reported a modest association between obesity and risk of ovarian cancer; however, whether it is also associated with survival and whether this association varies for the different histologic subtypes are not clear. We undertook an international collaborative analysis to assess the association between body mass index (BMI), assessed shortly before diagnosis, progression-free survival (PFS), ovarian cancer-specific survival and overall survival (OS) among women with invasive ovarian cancer.

Methods:

We used original data from 21 studies, which included 12 390 women with ovarian carcinoma. We combined study-specific adjusted hazard ratios (HRs) using random-effects models to estimate pooled HRs (pHR). We further explored associations by histologic subtype.

Results:

Overall, 6715 (54%) deaths occurred during follow-up. A significant OS disadvantage was observed for women who were obese (BMI: 30–34.9, pHR: 1.10 (95% confidence intervals (CIs): 0.99–1.23); BMI: ⩾35, pHR: 1.12 (95% CI: 1.01–1.25)). Results were similar for PFS and ovarian cancer-specific survival. In analyses stratified by histologic subtype, associations were strongest for women with low-grade serous (pHR: 1.12 per 5 kg m⁻²) and endometrioid subtypes (pHR: 1.08 per 5 kg m⁻²), and more modest for the high-grade serous (pHR: 1.04 per 5 kg m⁻²) subtype, but only the association with high-grade serous cancers was significant.

Conclusions:

Higher BMI is associated with adverse survival among the majority of women with ovarian cancer.     

Conditional relative survival of cancer patients and conditional probability of death

BACKGROUND:

Little information is available on the conditional probabilities of death among patients who survive for >5 years after a diagnosis with cancer. The objective of this study was to estimate the conditional probabilities of death for breast cancer, prostate cancer, colorectal cancer, and lung cancer in France.

METHODS:

The study included data from the French Network of Cancer Registries from 205,562 patients aged <75 years who were diagnosed with cancer between 1989 and 1997. The conditional probabilities of death were calculated by using a relative survival regression model in which age was included as a covariate.

RESULTS:

After the first year and until 10 years after diagnosis, the annual probability of death decreased dramatically for colorectal cancer: It was the same in all age groups after 3 years, and it was approximately 1% at 10 years. For prostate cancer, the decrease was not as great, and the conditional probability of death remained higher among younger patients at >4% at 10 years. During the 3 years after diagnosis, the probability of death was greater for older patients with breast cancer; then, it decreased less for younger patients compared with older patients, leading to a greater conditional probability of death among younger patients at 4 years and up to 10 years. The annual probability of death in patients with lung cancer decreased for both sexes but remained substantially higher for men than for women, reaching approximately 8% and 5%, respectively, at 10 years.

CONCLUSIONS:

Further studies would facilitate a better understanding of the observed differences in relative survival within European countries. Cancer 2009. © 2009 American Cancer Society.     

上海市人群2002-2006年肝癌生存率分析

背景与目的：我国是肝癌高发地区。上海市最新监测数据显示,肝癌发病率居恶性肿瘤发病前列,疾病负担仍很大。该研究旨在分析上海地区肝癌患者生存率情况,为肝癌的防治提供基础数据。方法：根据上海市肿瘤登记处收集的2002—2006年肝癌登记和生存随访报告资料,采用寿命表法和Ederer Ⅱ法对肝癌患者的观察生存率(observed survival,OS)和相对生存率(relative survival,RS)及其相关人口学和疾病状况特征资料进行分析。结果：纳入分析的上海市2002—2006年诊断的肝癌病例20702例,1~5年OS分别为32.03%、21.63%、16.51%、13.66%和11.72%,1~5年RS分别为34.21%、23.93%、19.18%、16.84%和15.45%。男性OS较女性OS高,0~34岁年龄段患者OS高于其他年龄组,肝细胞癌的OS高于其他类型,Ⅰ期患者的OS明显高于Ⅲ期和Ⅳ期,市区和郊区居住肝癌患者生存情况差异无统计学意义(P<0.05)。过去30多年来,上海市肝癌患者5年OS和RS改善明显。结论：上海市肝癌患者的生存水平上升明显,但与其他常见恶性肿瘤相比,生存率仍较低,因此,进一步加强危险因素和高危人群的控制和干预是今后肝癌防治工作的重点。     

Outcomes of HTLV-1 Carriers with Diffuse Large B-Cell Lymphoma: A Single-Center Retrospective Matched Cohort Study

BackgroundThe human T-cell lymphotropic virus type 1 (HTLV-1) is associated with aggressive diseases, such as adult T-cell leukemia/lymphoma (ATLL). However, less is known on the impact of HTLV-1 infection in non-ATLL hematologic malignancies. We aimed to investigate if HTLV-1 carriers with diffuse large B-cell lymphoma (DLBCL) have worse survival outcomes than non-HTLV-1 carriers.Materials and MethodsWe performed a single-center retrospective cohort study by matching HTLV-1 carriers to non-carriers based on age, sex, Ann Arbor stage, and year of diagnosis. Our outcomes of interest were overall survival (OS) and progression-free survival (PFS). The Kaplan-Meier method was used to estimate OS and PFS between carriers and non-carriers. We fitted multivariate Cox regression models to assess the mortality and recurrence/disease progression risk of HTLV-1 infection.ResultsA total of 188 patients, 66 with HTLV-1 infection and 122 without HTLV-1, were included in the study. HTLV-1 carriers had higher extranodal involvement than non-carriers (47% vs. 27%, P = .010). With a median follow-up of 78 months (95% CI: 41-90 months), HTLV-1 carriers had a similar 5 year OS (41% vs. 42%, P = .940) and PFS (34% vs. 32%, P = .691) compared to non-carriers. In the multivariate Cox analysis, HTLV-1 infection was not associated with worse OS (aHR: 0.98, 95% CI: 0.64-1.50) or PFS (aHR: 0.90, 95% CI: 0.60-1.34).ConclusionHTLV-1 carriers with DLBCL did not have worse survival outcomes compared to non-carriers. Our results suggest that clinicians should follow standard guidelines for DLBCL management on HTLV-1 seropositive patients.     

Calculating age-adjusted cancer survival estimates when age-specific data are sparse: an empirical evaluation of various methods

We evaluated empirically the performance of various methods of calculating age-adjusted survival estimates when age-specific data are sparse. We have illustrated that a recently proposed alternative method of age adjustment involving the use of balanced age groups or age truncation may be useful for enhancing calculability and reliability of adjusted survival estimates.     

Association of supratotal resection with progression-free survival,malignant transformation,and overall survival in lower-grade gliomas

BackgroundSupratotal resection is advocated in lower-grade gliomas (LGGs) based on theoretical advantages but with limited verification of functional risk and data on oncological outcomes. We assessed the association of supratotal resection in molecularly defined LGGs with oncological outcomes.MethodsIncluded were 460 presumptive LGGs; 404 resected; 347 were LGGs, 319 isocitrate dehydrogenase (IDH)–mutated, 28 wildtype. All patients had clinical, imaging, and molecular data. Resection aimed at supratotal resection without any patient or tumor a priori selection. The association of extent of resection (EOR), categorized on volumetric fluid attenuated inversion recovery images as residual tumor volume, along with postsurgical management with progression-free survival (PFS), malignant (M)PFS, and overall survival (OS) assessed by univariate, multivariate, and propensity score analysis. The study mainly focused on IDH-mutated LGGs, the “typical LGGs.”ResultsMedian follow-up was 6.8 years (interquartile range, 5–8). Out of 319 IDH-mutated LGGs, 190 (59.6%) progressed, median PFS: 4.7 years (95% CI: 4–5.3). Total and supratotal resection obtained in 39% and 35% of patients with IDH1-mutated tumors. In IDH-mutated tumors, most patients in the partial/subtotal group progressed, 82.4% in total, only 6 (5.4%) in supratotal. Median PFS was 29 months (95% CI: 25–36) in subtotal, 46 months (95% CI: 38–48) in total, while at 92 months, PFS in supratotal was 94.0%. There was no association with molecular subtypes and grade. At random forest analysis, PFS strongly associated with EOR, radiotherapy, and previous treatment. In the propensity score analysis, EOR associated with PFS (hazard ratio, 0.03; 95% CI: 0.01–0.13). MPFS occurred in 32.1% of subtotal total groups; 1 event in supratotal. EOR, grade III, previous treatment correlated to MPFS. At random forest analysis, OS associated with EOR as well.ConclusionsSupratotal resection strongly associated with PFS, MPFS, and OS in LGGs, regardless of molecular subtypes and grade, right from the beginning of clinical presentation.     

Cancer survival in Kampala, Uganda

Epidemiological data on the occurrence of cancer in sub-Saharan Africa are sparse, and population-based cancer survival data are even more difficult to obtain due to various logistic difficulties. The population-based Cancer Registry of Kampala, Uganda, has followed up the vital status of all registered cancer patients with one of the 14 most common forms of cancer, who were diagnosed and registered between 1993 and 1997 in the study area. We report 5-year absolute and relative survival estimates of the Ugandan patients and compare them with those of black American patients diagnosed in the same years and included in the SEER Program of the United States. In general, the prognosis of cancer patients in Uganda was very poor. Differences in survival between the two patient populations were particularly dramatic for those cancer types for which early diagnosis and effective treatment is possible. For example, 5-year relative survival was as low as 8.3% for colorectal cancer and 17.7% for cervical cancer in Uganda, compared with 54.2 and 63.9%, respectively, for black American patients. The collection of good-quality follow-up data was possible in the African environment. The very poor prognosis of Ugandan patients is most likely explained by the lack of access to early diagnosis and treatment options in the country. On the policy level, the results underscore the importance of the consistent application of the national cancer control programme guidelines as outlined by the World Health Organization.     

Mean overall survival gain with aflibercept plus FOLFIRI vs placebo plus FOLFIRI in patients with previously treated metastatic colorectal cancer

Background:

Mean survival in cancer trials can be estimated with statistical techniques to extrapolate study survival curves. This methodology was applied to data from the VELOUR trial, where use of the novel biologic aflibercept (ziv-aflibercept in the United States) in combination with fluorouracil+leucovorin+irinotecan (FOLFIRI), had significantly increased median overall survival (OS) by 1.44 months, vs placebo plus FOLFIRI in patients with metastatic colorectal cancer (mCRC) resistant to, or that had progressed following, an oxaliplatin-containing regimen.

Methods:

Parametric survival analyses were used to identify distributions with the best fit to the empirical VELOUR data. Mean OS for the two treatment groups (and pre-defined subgroups) was calculated from the fitted curves over a 15-year survival period.

Results:

Overall, the log-logistic distribution was the best-fitting for both treatment arms and, with it, the estimated difference in mean OS over 15 years between aflibercept+FOLFIRI and placebo+FOLFIRI was 4.7 months. In addition, the survival advantage with aflibercept was at least 3 months for the ITT population, whichever distribution was used to extrapolate survival.

Conclusion:

Extrapolation of survival curves suggests the mean OS difference for aflibercept in the VELOUR trial is at least 3 months in the ITT population and selected subgroups.     

非小细胞肺癌袖式切除术的预后分析

背景与目的：肺叶袖式切除术是一种针对中央型肺癌的手术，它保留正常肺组织从而尽可能保留患者的肺功能，同时，它也可以用于治疗因心肺的禁忌证而无法耐受全肺切除的患者。方法：我们针对接受肺叶袖式切除的非小细胞肺癌患者的肿瘤分期，对其预后情况进行了回顾性研究，从而判断此类手术的可行性。结果：患者手术后总生存率（overall survival，OS）为66.92%，无疾病生存率（disease-free survival ，DFS）为50.56 %。结论：通过本研究，我们发现肺叶袖式切除有较低的死亡率和并发症发生率。该手术可以保护患者的术后肺功能，可作为中央型非小细胞肺癌（non-small cell lung cancer，NSCLC）患者的一种手术选择。