Dataset Information

Conditional Survival of Esophageal Cancer: An Analysis from the SEER Registry (1988-2011).

ABSTRACT: Conditional survival can provide valuable predictive information for both patients and caregivers for patients surviving over time. The purpose of this study was to estimate conditional survival for esophageal cancer patients through analysis of a national population-based cancer registry.This retrospective cohort study analyzed 64,433 patients within the Surveillance, Epidemiology, and End Results (SEER) data set who were diagnosed with esophageal cancer from 1988 to 2011. Covariates included cancer characteristics and demographics. Overall survival (defined as time from diagnosis until death), cause-specific survival (defined as time from diagnosis until death from cancer), and 5-year conditional survivals (the probability of surviving an additional 5 years) were calculated. Significant prognostic variables of univariate and multivariable models of survival were identified.The multivariable models of overall and cause-specific survivals included gender, age group, race, relationship status, year of diagnosis, site, grade, histology, and stage group. Although all patients showed an improvement in conditional survival over time, more dramatic improvements were seen in more advanced stage groups. At the 5-year mark, conditional cause-specific survival of distant stage (defined as having spread by direct extension or metastasis to distant organs, tissues, or lymph nodes) increased from 4% to 79%, whereas regional stage increased from 18% to 77% and localized stage increased from 38% to 85%.Conditional survival showed improving prognosis over time. Patients with advanced stage had the most dramatic improvement. Clinicians, caregivers, and patients with esophageal cancer can feel encouraged by the improving prognosis with each year survived. This information has practical implications regarding longitudinal follow-up guidelines and survivorship planning.

SUBMITTER: Kim E

PROVIDER: S-EPMC4581968 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Conditional Survival of Esophageal Cancer: An Analysis from the SEER Registry (1988-2011).

Kim Ellen E Koroukian Siran S Thomas Charles R CR

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 20151001 10

<h4>Introduction</h4>Conditional survival can provide valuable predictive information for both patients and caregivers for patients surviving over time. The purpose of this study was to estimate conditional survival for esophageal cancer patients through analysis of a national population-based cancer registry.<h4>Methods</h4>This retrospective cohort study analyzed 64,433 patients within the Surveillance, Epidemiology, and End Results (SEER) data set who were diagnosed with esophageal cancer fro ...[more]

PMID: 26322395

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Project description:BACKGROUND:Recent studies have indicated that the incidence of esophageal cancer has declined in the past decade in the U.S. However, trends in the incidence and survival have not been thoroughly examined. METHODS:Data from 46?063 patients with esophageal cancer between 1973 and 2015 were collected from the Surveillance, Epidemiology, and End Results database. The trends in the age-adjusted incidence and survival were analyzed using joinpoint regression models. RESULTS:The age-adjusted incidence of esophageal cancer increased from 5.55 to 7.44 per 100?000 person-years between 1973 and 2004. Later, it decreased at an annual percentage change of 1.23%. In the last 40?years, the strong male predominance increased slightly. Importantly, the percentage of patients with localized stage of squamous cell cancer decreased. It was observed that the incidence of esophageal squamous cell carcinoma declined since 1986, while the incidence of esophageal adenocarcinoma sharply increased since 1973 and surpassed the rate of squamous cell cancer, mainly due to the increase in the incidence among men. Consistently, the estimated 40-year limited-duration prevalence of esophageal adenocarcinoma was higher than that of esophageal squamous cell carcinoma. Additionally, we observed a modest but significant improvement in survival during the study period. CONCLUSION:The incidence of esophageal squamous cell carcinoma has decreased significantly over the past four decades in the U.S., while the incidence of adenocarcinoma has increased, particularly among men. Overall, the long-term survival of patients with esophageal cancer is poor but it has improved over the past decades, especially for the localized disease. KEY POINTS:Significant findings of the study The incidence of esophageal cancer has decreased at an annual percentage change of 1.23% since 2004. The incidence of esophageal adenocarcinoma has sharply increased since 1973 and surpassed the rate of squamous cell cancer, mainly due to the increase in the incidence among men. What this study adds There has been a shift in the prevalence of esophageal cancer histological subtypes over the past decades in the U.S. We found that the incidence of esophageal squamous cell carcinoma has continued to decrease, while the esophageal adenocarcinoma rate has continued to increase.

Project description:ImportanceManagement of the primary tumor site in patients with metastatic breast cancer remains controversial.ObjectiveTo evaluate the patterns of receipt of initial breast surgery for female patients with stage IV breast cancer in the United States, with particular attention to women who survived at least 10 years.Design, setting, and participantsA retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) program. Female patients diagnosed as having stage IV breast cancer between 1988 and 2011 and who did not receive radiation therapy as part of the first course of treatment were included (N = 21 372). Kaplan-Meier estimates of median survival and descriptive statistics were used to compare patient and tumor characteristics by receipt of breast surgery at diagnosis. A Royston-Parmar survival model and logistic regression analysis assessed demographic and clinical factors associated with survival and prolonged survival (of at least 10 years).Main outcomes and measuresDifferences in survival, particularly survival of at least 10 years, by receipt of initial surgery to the primary tumor.ResultsAmong the 21 372 patients, the median survival increased from 20 months (1988-1991) to 26 months (2007-2011). During this time, the rate of surgery declined (odds ratio [OR], 0.16; 95% CI, 0.12-0.21). Even so, receipt of surgery was associated with improved survival in multivariate analysis, which controlled for patient and clinical characteristics, along with time period (hazard ratio, 0.60; 95% CI, 0.57-0.63). For women diagnosed as having cancer before 2002 (n = 7504), survival of at least 10 years was seen in 9.6% (n = 353) and 2.9% (n = 107) of those who did and did not receive surgery, respectively (OR, 3.61; 95% CI, 2.89-4.50). In multivariate analysis, survival of at least 10 years was associated with receipt of surgery (odds ratio, 2.80; 95% CI, 2.08-3.77), hormone receptor-positive disease (OR, 1.76; 95% CI, 1.25-2.48), older age (OR, 0.41; 95% CI, 0.32-0.54), larger tumor size (OR, 0.37; 95% CI, 0.27-0.51), marital status of being separated at the time of diagnosis (OR, 0.67; 95% CI, 0.51-0.88), and more recent year of diagnosis (OR, 1.43; 95% CI, 1.02-1.99).Conclusions and relevanceSurvival in stage IV breast cancer has improved and is increasingly of prolonged duration, particularly for some women undergoing initial breast surgery. As systemic therapy advances provide better control of distant disease in stage IV breast cancer, and as women present with lower distant disease burdens, these findings on initial surgery to the primary tumor may be of importance.

Project description:BackgroundTo estimate the adjusted conditional overall survival (COS) in patients with esophageal cancer after receiving various treatment modalities via a national population-based database, and to investigate the possible time-dependent effects.Materials and methodsEligible patients diagnosed with esophageal cancer between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. The Kaplan-Meier method was used to calculate conventional survival time. The inverse probability of treatment weighting method was used to estimate the adjusted COS in patients receiving different treatment modalities. Landmark analysis was employed to investigate the possible time-dependent effects of different treatment modalities in patients who had survived a certain period of time.ResultsA total of 25,232 patients were included in the final analysis. The conventional 5-year overall survival was 19.3%. The 5-year adjusted COS increased most for the first 3 years, and increased slightly afterwards. In patients with regional esophageal or gastroesophageal junction cancer, stage-specific analysis showed that surgery only and preoperative radiation therapy benefited most for patients with localized disease, preoperative radiation therapy plus surgery benefited regional, and preoperative radiation therapy plus surgery benefited distant disease, with the 5-year adjusted COS given patients had survived 3 years being 67.0% (95% CI 65.2%-68.7%), 59.9% (95% CI 58.3%-61.5%), 58.4% (95% CI 56.3%-60.5%), and 61.8% (95% CI 59.5%-64.1%), respectively. In time-dependent analysis, the benefits of surgery only in localized cases were prominent within 48 months after diagnosis. Preoperative radiation therapy showed long-lasting benefits in patients with regional disease. In patients with distant disease, all treatment modalities showed similar and short-term effects.ConclusionsThe adjusted COS in patients with esophageal cancer increased as time accrued after receiving various treatment modalities. The time-dependent effects in specific tumor stage provided a dynamic view on optimization of treatment strategies.

Dataset Information

Conditional Survival of Esophageal Cancer: An Analysis from the SEER Registry (1988-2011).

Publications

Conditional Survival of Esophageal Cancer: An Analysis from the SEER Registry (1988-2011).

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