Radiation therapy is associated with improved survival in patients with pancreatic adenocarcinoma: results of a study from the Surveillance, Epidemiology, and End Results (SEER) registry data

BACKGROUND: The role of adjuvant radiation therapy in pancreatic cancer is controversial. For the current study, the authors evaluated the effect of preoperative and postoperative radiation therapy on survival in patients with pancreatic adenocarcinoma. METHODS: The analysis included 3008 patients who were reported to the Surveillance, Epidemiology, and End Results registry of the National Cancer Institute from 1988 to 2002 who had adenocarcinoma of the pancreas and who underwent cancer-directed surgery. A retrospective analysis of overall survival and cancer-specific survival for these patients was performed using the Kaplan-Meier method. Comparative risks of mortality were evaluated by using multivariate-adjusted Cox regression models. RESULTS: Of 3008 patients, 1267 (42%) received radiation therapy. Overall survival improved significantly in patients who received radiation therapy, with a median survival of 17 months and a 5-year overall survival rate of 13% in patients who received radiation compared with 12 months and 9.7%, respectively, for patients who did not receive radiation therapy (P < .0001). On multivariate analysis, radiation therapy was associated with improvement in overall survival in patients who had direct extension beyond the pancreas and/or regional lymph node involvement (P < .01) but not in patients with T1-T2N0M0 disease (P > .05). Radiation therapy was associated with improvement in cause-specific survival in patients who had regional lymph node involvement (P < .02) but not in patients who had T1-2N0M0 disease or direct extension beyond the pancreas without lymph node involvement (P > .05). Differences in overall and cause-specific survival among patients who received preoperative versus postoperative radiation therapy did not reach statistical significance. CONCLUSIONS: Radiation therapy was associated with improved survival compared with cancer-directed surgery without radiation in patients with adenocarcinoma of the pancreas.     

Survival and prognostic factors for postoperative primary appendiceal cancer: a retrospective cohort study based on the Surveillance,Epidemiology, and End Results database

BackgroundThe factors affecting the postoperative survival of patients with primary appendiceal cancer (PAC) have yet to be fully explored. And there are no clear guidelines for adjuvant treatment after appendectomy. Whether chemotherapy can prolong patient survival after appendectomy, is critical in guiding postoperative medications. The majority of studies on appendiceal cancer are single case reports, and they focused on the incidence of appendiceal cancer. The present study aimed to investigate the survival characteristics of patients with primary appendiceal cancer after surgery using the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThe data of 2,891 cases of primary appendiceal cancer between 2004 to 2015 were obtained from the SEER database and subjected to survival analysis using the Kaplan-Meier method and Cox proportional-hazards model. The annual percentage change (APC) was calculated using the weighted least squares method.ResultsThe overall age-adjusted incidence rate per 100,000 population steadily increased from 0.58 in 2004 to 1.63 in 2015. For patients who received chemotherapy, the median overall survival (OS) was 65 months and the 5-year OS rate was 51.9%, and for patients who did not receive chemotherapy or whose chemotherapy status was unknown, the median OS was not reached and the 5-year OS rate was 78.9%. Age [35< age <69: hazard radio (HR) =2.147; 95% confidence interval (CI): 1.442–3.197, P<0.001; age >69: HR =5.259; 95% CI: 3.485–7.937, P<0.001], race (White race: HR =0.728; 95% CI: 0.590–0.899, P=0.003), histologic type (mucinous neoplasm: HR =0.690; 95% CI: 0.580–0.821, P<0.001; malignant carcinoid: HR =0.657; 95% CI: 0.536–0.806, P<0.001), grade (II: HR =1.794; 95% CI: 1.471–2.187, P<0.001; III: HR =2.905; 95% CI: 2.318–3.640, P<0.001; IV: HR =3.128; 95% CI: 2.159–4.533, P<0.001), and stage (localized: HR =0.236; 95% CI: 0.194–0.287, P<0.001; regional: HR =0.425; 95% CI: 0.362–0.499, P<0.001) were identified as independent predictors of survival. And after adjusting for known factors (age, sex, race, tumor size, marital status, histologic type, grade, stage), chemotherapy (HR =1.220; 95% CI: 1.050–1.417, P=0.009) was revealed to be an independent indicator of poor prognosis.ConclusionsThere was an increasing trend in the incidence of appendiceal cancer in the United States between 2004 and 2015. Chemotherapy was revealed to be an independent indicator of poor prognosis, which provide valuable insight into the therapy of primary appendiceal cancer. Large clinical trials of chemotherapy and targeted therapy for appendiceal cancer are urgently needed.     

A Surveillance, Epidemiology, and End Results analysis of small cell carcinoma of the bladder: epidemiology, prognostic variables, and treatment trends

BACKGROUND:

Small cell carcinoma of the urinary bladder (SCCB) is difficult to characterize and study because of its rarity. For the current study, a large population‐based database was used to address ill‐defined clinical parameters for this disease.

METHODS:

The authors analyzed the incidence, sociodemographics, prognostic variables, and treatment trends of this cancer in the Surveillance, Epidemiology, and End Results (SEER) limited database (1991‐2005). The SEER‐Medicare database (1991‐2005) was used to estimate chemotherapy use.

RESULTS:

There were 642 patients in the SEER limited dataset. From 1991 to 2005, the incidence of SCCB increased significantly from 0.05 to 0.14 cases per 100,000 population (P < .01; approximately 500 new cases of SCCB per year, representing 0.7% of all bladder malignancies). The median overall survival was 11 months. Elderly Caucasian men were the most commonly affected (ratio of Caucasians to non‐Caucasians, 10:1; ratio of men to women, 3:1; median age, 73 years). Age, race, marital status, and TNM staging were identified as independent prognostic variables (P < .05). Patients who had stage IV disease without distant metastasis (ie, positive lymph node status) had overall and cancer‐specific survival rates similar to those of patients who had stage I through III disease, but they had significantly better survival compared with patients who had distant metastasis (P < .0001). Transurethral resection of the bladder tumor became the most common surgical treatment (P < .0001), representing 55% of patients from 2001 to 2005. The receipt of radiation and chemotherapy did not change significantly during the study period.

CONCLUSIONS:

These comprehensive data delineated the patient population for this rare disease, described several independent prognostic variables, and demonstrated clear treatment trends for this disease. The results suggest that a simpler staging system (ie, limited stage vs extensive stage) may be appropriate for patients with SCCB. Cancer 2011;. © 2011 American Cancer Society.     

Improved survival in patients with lymph node-positive gastric cancer who received preoperative radiation: an analysis of the Surveillance, Epidemiology, and End Results database

BACKGROUND:

Several trials have been conducted to determine the feasibility of preoperative radiotherapy (RT) for gastric cancer. However, the absolute benefit from radiotherapy remains to be defined. In this study, the authors examined the use of preoperative RT (Pre‐RT) and postoperative RT (PORT) in patients with gastric cancer from the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS:

The overall survival of patients who had nonmetastatic, resected gastric cancer between 2000 and 2006 was analyzed from the SEER database. Kaplan‐Meier survival curves comparing Pre‐RT, PORT, and no RT (No‐RT) were analyzed using the log‐rank test. A multivariate analysis (MVA) was conducted using Cox proportional hazards regression.

RESULTS:

The authors identified 10,251 patients. There was no survival benefit for patients who received Pre‐RT or PORT compared with No‐RT patients for the entire cohort. Conversely, among lymph node‐positive patients, there was a significant survival benefit from both Pre‐RT and PORT compared with No‐RT (log‐rank test: PORT, P < .0001; Pre‐RT, P = .0261). The median survival and 5‐year overall survival among lymph node‐positive patients were 22 months and 24%, respectively, for Pre‐RT;29 months and 34%, respectively, for PORT; and 19 months and 20%, respectively, for No‐RT. MVA demonstrated that Pre‐RT, PORT, and removing ≥15 lymph nodes were independent predictors of improved survival, whereas tumor classification, lymph node status, tumor size, and tumor location were independent predictors of death.

CONCLUSIONS:

The current results supported the use of Pre‐RT in select patients with gastric cancer. However, additional trials will be needed to confirm these findings. Cancer 2011;. © 2011 American Cancer Society.     

A comparison of the demographics, clinical features, and survival of patients with adenoid cystic carcinoma of major and minor salivary glands versus less common sites within the Surveillance, Epidemiology, and End Results registry

BACKGROUND:

The scientific literature to date lacks population‐based studies on the demographics, clinical features, and survival of patients with adenoid cystic carcinoma (ACC) of different anatomic sites.

METHODS:

The authors identified 5349 patients who had ACC of the major salivary glands (N = 1850), minor salivary glands (N = 2077), breast (N = 696), skin (N = 291), lung and bronchus (N = 203), female genital system (N = 132), and eye and orbit (N = 100) from the Surveillance, Epidemiology, and End Results (SEER) registry. Differences in demographics, clinical features, and survival of patients were assessed.

RESULTS:

ACC of the eye and orbit was associated with younger age at presentation (mean age,49.9 years). ACC of the skin or breast tended to present with less aggressive prognostic features, whereas ACC of the lung and bronchus or eye and orbit tended to present with more aggressive prognostic features. In a multivariate survival analysis of patients who presented with localized disease, patients with ACC of the breast (hazard ratio [HR], 0.40) or skin (HR, 0.40) had a significantly lower risk death than patients with ACC of the major salivary glands; whereas patients with ACC of the lung and bronchus (HR, 3.72) or the eye and orbit (HR, 3.67) had a significantly higher risk. For patients who presented with regional disease, the only clear prognostic difference in multivariate analysis was that patients with ACC of skin fared significantly better.

CONCLUSIONS:

The demographics and clinical features of patients with ACC differ by disease site. The current results indicated that site may be an important predictor of survival for patients who present with localized disease but is less important for patients who present with regional disease. Cancer 2012. © 2011 American Cancer Society.     

Comparison of prognostic factors of esophageal cancer between a Chinese cohort and the Surveillance,Epidemiology, and End Results (SEER) database: a retrospective cohort study

BackgroundEsophageal cancer is a highly aggressive, early metastasis gastrointestinal malignancy, with geographic differences in prognosis. It is unknown whether there are differences in the survival in different regions among esophageal cancer patients who underwent the treatments. This study was to explore the influencing factors of esophageal cancer survival in patients from China and the Surveillance, Epidemiology, and End Results (SEER) database.MethodsThe retrospective cohort study were conducted with 605 Chinese esophageal cancer patients in the Wuxi People’s Hospital and 2,351 patients from the SEER database. The demographic and clinical data were collected from the two cohort, respectively. The outcome was the death during the follow-up. The follow-up ended on November 30, 2021. The Cox proportional hazards model was used in the univariate and multivariate survival analyses, with hazard ratio (HR) and 95% confidence interval (CI).ResultsIn group one, the following were identified as the prognostic factors: female gender (HR =0.568; 95% CI: 0.398–0.811), T3 and T4 stages (HR =3.312; 95% CI: 2.493–4.401), N2 and N3 stages (HR =3.562; 95% CI: 2.631–4.824), and other subtypes of cancer (HR =0.393; 95% CI: 0.223–0.693). The following prognostic were factors identified in group two: age ≥65 years (HR =1.16; 95% CI: 1.058–1.276), female gender (HR =0.843; 95% CI: 0.752–0.945), T3 and T4 stages (HR =1.523; 95% CI: 1.373–1.690), M1 stage (HR =2.554; 95% CI: 2.303–2.832), treatment with surgery and chemotherapy (HR =0.507; 95% CI: 0.457–0.562), and other subtypes of cancer (HR =1.432; 95% CI: 1.298–1.581).ConclusionsThere may be some differences in prognostic factors between Chinese and American patients with esophageal cancer. It is indicated that different management strategies of esophageal cancer should be considered in different populations to improve the prognosis of patients.