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Survival prediction models for patients with anal carcinoma receiving definitive chemoradiation: A population-based study.

ABSTRACT: The present study aimed to develop two nomograms in order to predict cancer-specific survival (CSS) and overall survival (OS) of patients with anal carcinoma receiving definitive chemoradiotherapy. Data from studies including patients with anal carcinoma, who were determined to be positive histologically and diagnosed between 2004 and 2010, were obtained from the Surveillance, Epidemiology, and End Results database. Significant prognostic factors for CSS and OS of patients were screened to develop nomograms through univariate and multivariate analyses. Nomograms were validated using internal and external data. The predictive abilities of the generated models were evaluated by concordance index (C-index) and calibration curves. Risk stratification was performed for patients with the same TNM stage. A total of 1,473 patients and six independent prognostic factors for CSS and OS, namely age, sex, ethnicity, marital status at diagnosis, T stage and N stage, were included in the nomogram calculations. Calibration curves demonstrated that nomogram prediction was in high accordance with actual observation. The C-indices of nomograms were greater than those of models based on the sixth edition of the American Joint Committee on Cancer TNM staging system for CSS prediction (training cohort, 0.72 vs. 0.70; validation cohort, 0.68 vs. 0.62) and OS (training cohort, 0.70 vs. 0.66; validation cohort, 0.68 vs. 0.62). Survival curves demonstrated significant survival differences among the different risk groups. Nomograms were more accurate than the conventional TNM staging system in prognosis prediction. In addition, survival performances of patients with the same TNM stage could be further distinguished by risk stratification, which provided individualized prediction for patients. These survival prediction methods may aid clinicians in patient counseling and in selecting more individualized therapeutic strategies.

SUBMITTER: Wu Y

PROVIDER: S-EPMC6960384 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Survival prediction models for patients with anal carcinoma receiving definitive chemoradiation: A population-based study.

Wu Yinhang Y Han Xiaoyang X Li Yan Y Zhu Kunli K Yu Jinming J

Oncology letters 20191223 2

The present study aimed to develop two nomograms in order to predict cancer-specific survival (CSS) and overall survival (OS) of patients with anal carcinoma receiving definitive chemoradiotherapy. Data from studies including patients with anal carcinoma, who were determined to be positive histologically and diagnosed between 2004 and 2010, were obtained from the Surveillance, Epidemiology, and End Results database. Significant prognostic factors for CSS and OS of patients were screened to devel ...[more]

PMID: 32002033

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Project description:BackgroundAlthough the benefit of chemoradiation over radiation therapy alone has been shown in randomized trials for stage II to III squamous cell of the anus, this benefit is not clear for patients with stage I cancer. Nevertheless, most societal recommendations endorse chemoradiation for patients with stage I squamous cell carcinoma of the anus despite the lack of proven benefit and potential increase in toxicity.ObjectiveThe purpose of this study was to determine whether outcomes are improved with the addition of chemotherapy versus radiation alone for stage I squamous cell carcinoma of the anus.DesignThis was a cohort analysis using Surveillance, Epidemiology and End Results registry linked to Medicare from 1996 to 2011. Propensity-score methods were used to control for potential confounding.SettingsThis was a population-based study.PatientsMedicare eligible patients (age >65 y or with an eligible disability) with stage I squamous cell carcinoma of the anus treated with either definitive radiation alone or chemoradiation were included.InterventionsRadiation or chemoradiation was the intervention.Main outcome measuresOverall survival, disease-free survival, cause-specific survival, colostomy-free survival, and acute or late toxicities were measured.ResultsA total of 200 patients with squamous cell carcinoma of the anus were identified who received chemoradiation versus 99 treated with lone radiotherapy. Median age was 72 years and did not differ by treatment (p = 0.6). Patients receiving chemoradiation had improved unadjusted overall survival compared with lone radiotherapy, but after adjustment using propensity-score methods there was no difference in overall survival (HR = 0.7 (95% CI, 0.4-1.0)), cause-specific survival (HR = 0.7 (95% CI, 0.3-1.6)), colostomy-free survival (HR = 1.1 (95% CI, 0.5-2.5)), or disease-free survival (HR = 0.9 (95% CI, 0.6-1.4)). Chemoradiation was associated with an increased risk of select early and late toxicities.LimitationsThis is a retrospective series from an anonymous database. The data might not be relevant for younger, healthier patients.ConclusionsLone radiation may be associated with adequate oncologic outcomes when used to treat older and sicker patients with stage I anal cancer. Physicians should discuss the potential benefits and harms of adding chemotherapy for the treatment of these patients. See Video Abstract at http://links.lww.com/DCR/A628.

Project description:BackgroundOverall survival (OS) is the most patient-relevant outcome in oncology; however, in early cancers, large sample sizes and extended follow-up durations are needed to detect statistically significant differences in OS between interventions. Use of early time-to-event outcomes as surrogates for OS can help facilitate faster approval of cancer therapies. In locally advanced head and neck squamous cell carcinoma (LA-HNSCC), event-free survival (EFS) was previously evaluated as a surrogate outcome (Michiels 2009) and demonstrated a strong correlation with OS. The current study aimed to further assess the correlation between EFS and OS in LA-HNSCC using an updated systematic literature review (SLR) focusing on patients receiving definitive chemoradiation therapy (CRT).MethodsAn SLR was conducted on May 27, 2021 to identify randomized controlled trials assessing radiotherapy alone or CRT in the target population. Studies assessing CRT and reporting hazard ratios (HRs) or Kaplan-Meier data for OS and EFS were eligible for the analysis. CRT included any systemic treatments administered concurrently or sequentially with radiation therapy. Trial-level EFS/OS correlations were assessed using regression models, and the relationship strength was measured with Pearson correlation coefficient (R). Correlations were assessed across all CRT trials and in trial subsets assessing concurrent CRT, sequential CRT, RT+cisplatin, targeted therapies and intensity-modulated RT. Subgroup analysis was conducted among trials with similar EFS definitions (i.e. EFS including disease progression and/or death as events) and longer length of follow-up (i.e.≥ 5 years).ResultsThe SLR identified 149 trials of which 31 were included in the analysis. A strong correlation between EFS and OS was observed in the overall analysis of all CRT trials (R=0.85, 95% confidence interval: 0.72-0.93). Similar results were obtained in the sensitivity analyses of trials assessing concurrent CRT (R=0.88), sequential CRT (R=0.83), RT+cisplatin (R=0.82), targeted therapies (R=0.83) and intensity-modulated RT (R=0.86), as well as in trials with similar EFS definitions (R=0.87), with longer follow-up (R=0.81).ConclusionEFS was strongly correlated with OS in this trial-level analysis. Future research using individual patient-level data can further investigate if EFS could be considered a suitable early clinical endpoint for evaluation of CRT regimens in LA-HNSCC patients receiving definitive CRT.

Project description:ImportanceDefinitive chemoradiation for anal cancer is effective but may be associated with toxic effects, and some patients may not be able to complete the planned treatment. Identifying factors associated with treatment interruption and noncompletion is important to target quality improvement efforts.ObjectiveTo identify rates of chemoradiation treatment interruption or noncompletion and factors associated with this among patients with anal cancer treated in routine clinical practice.Design, setting, and participantsIn this population-based, retrospective cohort study, the Ontario Cancer Registry was used to identify all incident cases of squamous cell anal cancer treated with curative-intent radiation from 2007 to 2015 in Ontario, Canada. Final analysis of data was performed on August 9, 2019.ExposuresCurative-intent radiation therapy.Main outcomes and measuresTreatment interruption was defined as more than 7 days between fractions of radiation. Radiation completion was defined as receipt of 45 Gy or more and 25 fractions of radiation. Chemoradiation completion was defined as radiation completion and 2 doses of combination chemotherapy. Associations between patient factors and treatment interruption and noncompletion were estimated with log-binomial models. Cox proportional hazard models were used to estimate the association of treatment interruption or noncompletion with all-cause death, cancer-specific death, and the combined outcome of colostomy or death.ResultsOverall, 1125 patients with stage I-III anal cancer were treated with curative-intent radiation. Treatment interruptions occurred in 262 (23%). Radiation and chemoradiation noncompletion occurred in 199 (18%) and 280 (25%), respectively. No associations were found to correlate with an increased risk of treatment interruption. Patients older than 70 years were less likely to complete chemoradiation (risk ratio [RR], 0.60; 95% CI, 0.52-0.70), compared with those younger than 50 years. Patients with a higher number of comorbidities were also less likely to complete chemoradiation (RR, 0.70; 95% CI, 0.51-0.95). Patients who did not complete chemoradiation had a higher risk of requiring salvage abdominoperineal resection (RR, 1.54; 95% CI, 1.03, 2.31), overall death (hazard ratio [HR], 1.54; 95% CI, 1.23-1.92), cancer-specific death (HR, 1.59; 95% CI, 1.14-2.22), and colostomy or death (HR, 1.80; 95% CI: 1.10-2.93). Treatment interruptions longer than 7 days were not associated with death.Conclusions and relevanceMany patients undergoing curative-intent chemoradiation for anal cancer experienced treatment interruption or noncompletion. Quality improvement initiatives to optimize treatment continuity and completion are needed.

Dataset Information

Survival prediction models for patients with anal carcinoma receiving definitive chemoradiation: A population-based study.

Publications

Survival prediction models for patients with anal carcinoma receiving definitive chemoradiation: A population-based study.

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