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Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis.

ABSTRACT: PURPOSE:This study aimed to determine the probability and prognostic factors of colon cancer-specific mortality (CCSM) and noncancer-specific mortality (NCSM) for patients with stage I/II colon cancer and evaluate the association of age on cause-specific mortality. MATERIALS AND METHODS:From Surveillance, Epidemiology, and End Results (SEER) database, we identified 33152 patients with stage I/II colon cancer undergoing surgery between 2004 and 2011. The cumulative incidence of CCSM and NCSM was calculated, and competing risk analysis was performed to investigate prognostic factors for cause-specific mortality. RESULTS:In patients <50, 50-75, and >75 years of age, 5-year cumulative incidence of CCSM was 5.7%, 7.8%, and 16.1%, respectively (overall, 10.6%); 5-year cumulative incidence of NCSM was 2.2%, 7.1%, and 26.9%, respectively (overall, 13.8%). The probability of CCSM and NCSM increased with advanced age. The 5-year cumulative incidence of CCSM was higher than NCSM in patients <50 years of age, whereas lower in patients >75 years of age. The probability of CCSM and NCSM was similar in patients 50-75 years of age. Competing-risk multivariable analysis demonstrated that increasing age was a strong predictor of CCSM (per year increase, SHR 1.03,95% confidence interval [CI]: 1.03-1.04). Age was most predictive of NCSM: (per year increase, SHR 1.08, 95% CI: 1.08-1.08). CONCLUSION:Age was significantly associated with an increased cumulative incidence of CCSM and NCSM of patients with stage I/II colon cancer underwent surgery. NCSM was a significant competing event and should be adequately considered when performing survival analysis.

SUBMITTER: Cai H

PROVIDER: S-EPMC7567365 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis.

Cai Huajun H Zhang Yiyi Y Liu Xing X Jiang Weizhong W Chen Zhifen Z Li Shoufeng S Guan Guoxian G

PloS one 20201016 10

<h4>Purpose</h4>This study aimed to determine the probability and prognostic factors of colon cancer-specific mortality (CCSM) and noncancer-specific mortality (NCSM) for patients with stage I/II colon cancer and evaluate the association of age on cause-specific mortality.<h4>Materials and methods</h4>From Surveillance, Epidemiology, and End Results (SEER) database, we identified 33152 patients with stage I/II colon cancer undergoing surgery between 2004 and 2011. The cumulative incidence of CCS ...[more]

PMID: 33064784

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Project description:IntroductionParotid-gland carcinoma (PGC) is a relatively rare tumor that comprises a group of heterogeneous histologic subtypes. We used the Surveillance, Epidemiology, and End Results (SEER) program database to apply a competing-risks analysis to PGC patients, and then established and validated predictive nomograms for PGC.MethodsSpecific screening criteria were applied to identify PGC patients and extract their clinical and other characteristics from the SEER database. We used the cumulative incidence function to estimate the cumulative incidence rates of PGC-specific death (GCD) and other cause-specific death (OCD), and tested for differences between groups using Gray's test. We then identified independent prognostic factors by applying the Fine-Gray proportional subdistribution hazard approach, and constructed predictive nomograms based on the results. Calibration curves and the concordance index (C-index) were employed to validate the nomograms.ResultsWe finally identified 4,075 eligible PGC patients who had been added to the SEER database from 2004 to 2015. Their 1-, 3-, and 5-year cumulative incidence rates of GCD were 10.1%, 21.6%, and 25.7%, respectively, while those of OCD were 2.9%, 6.6%, and 9.0%. Age, race, World Health Organization histologic risk classification, differentiation grade, American Joint Committee on Cancer (AJCC) T stage, AJCC N stage, AJCC M stage, and RS (radiotherapy and surgery status) were independent predictors of GCD, while those of OCD were age, sex, marital status, AJCC T stage, AJCC M stage, and RS. These factors were integrated for constructing predictive nomograms. The results for calibration curves and the C-index suggested that the nomograms were well calibrated and had good discrimination ability.ConclusionWe have used the SEER database to establish-to the best of our knowledge-the first competing-risks nomograms for predicting the 1-, 3-, and 5-year cause-specific mortality in PGC. The nomograms showed relatively good performance and can be used in clinical practice to assist clinicians in individualized treatment decision-making.

Project description:Bariatric surgery is effective in reducing all-cause and cause-specific long-term mortality. Whether the long-term mortality benefit of surgery applies to all ages at which surgery is performed is not known.To examine whether gastric bypass surgery is equally effective in reducing mortality in groups undergoing surgery at different ages.All-cause and cause-specific mortality rates and hazard ratios (HRs) were estimated from a retrospective cohort within 4 categories defined by age at surgery: younger than 35 years, 35 through 44 years, 45 through 54 years, and 55 through 74 years. Mean follow-up was 7.2 years. Patients undergoing gastric bypass surgery seen at a private surgical practice from January 1, 1984, through December 31, 2002, were studied. Data analysis was performed from June 12, 2013, to September 6, 2015. A cohort of 7925 patients undergoing gastric bypass surgery and 7925 group-matched, severely obese individuals who did not undergo surgery were identified through driver license records. Matching criteria included year of surgery to year of driver license application, sex, 5-year age groups, and 3 body mass index categories.Roux-en-Y gastric bypass surgery.All-cause and cause-specific mortality compared between those undergoing and not undergoing gastric bypass surgery using HRs.Among the 7925 patients who underwent gastric bypass surgery, the mean (SD) age at surgery was 39.5?(10.5) years, and the mean (SD) presurgical body mass index was 45.3?(7.4). Compared with 7925 matched individuals not undergoing surgery, adjusted all-cause mortality after gastric bypass surgery was significantly lower for patients 35 through 44 years old (HR, 0.54; 95% CI, 0.38-0.77), 45 through 54 years old (HR, 0.43; 95% CI, 0.30-0.62), and 55 through 74 years old (HR, 0.50; 95% CI, 0.31-0.79; P?<?.003 for all) but was not lower for those younger than 35 years (HR, 1.22; 95% CI, 0.82-1.81; P = .34). The lack of mortality benefit in those undergoing gastric bypass surgery at ages younger than 35 years primarily derived from a significantly higher number of externally caused deaths (HR, 2.53; 95% CI, 1.27-5.07; P = .009), particularly among women (HR, 3.08; 95% CI, 1.4-6.7; P = .005). Patients undergoing gastric bypass surgery had a significantly lower age-related increase in mortality than severely obese individuals not undergoing surgery (P?=?.001).Gastric bypass surgery was associated with improved long-term survival for all patients undergoing surgery at ages older than 35 years, with externally caused deaths only elevated in younger women. Gastric bypass surgery is protective against mortality even for older patients and also reduces the age-related increase in mortality observed in severely obese individuals not undergoing surgery.

Project description:ObjectivesTo determine if bilateral salpingo-oophorectomy, compared with ovarian conservation, is associated with all cause or cause specific death in women undergoing hysterectomy for non-malignant disease, and to determine how this association varies with age at surgery.DesignPopulation based cohort study.SettingOntario, Canada from 1 January 1996 to 31 December 2015, and follow-up to 31 December 2017.Participants200 549 women (aged 30-70 years) undergoing non-malignant hysterectomy, stratified into premenopausal (<45 years), menopausal transition (45-49 years), early menopausal (50-54 years), and late menopausal (≥55 years) groups according to age at surgery; median follow-up was 12 years (interquartile range 7-17).ExposuresBilateral salpingo-oophorectomy versus ovarian conservation.Main outcomes measuresThe primary outcome was all cause death. Secondary outcomes were non-cancer and cancer death. Within each age group, overlap propensity score weighted survival models were used to examine the association between bilateral salpingo-oophorectomy and mortality outcomes, while adjusting for demographic characteristics, gynaecological conditions, and comorbidities. To account for comparisons in four age groups, P<0.0125 was considered statistically significant.ResultsBilateral salpingo-oophorectomy was performed in 19%, 41%, 69%, and 81% of women aged <45, 45-49, 50-54, and ≥55 years, respectively. The procedure was associated with increased rates of all cause death in women aged <45 years (hazard ratio 1.31, 95% confidence interval 1.18 to 1.45, P<0.001; number needed to harm 71 at 20 years) and 45-49 years (1.16, 1.04 to 1.30, P=0.007; 152 at 20 years), but not in women aged 50-54 years (0.83, 0.72 to 0.97, P=0.018) or ≥55 years (0.92, 0.82 to 1.03, P=0.16). Findings in women aged <50 years were driven largely by increased non-cancer death. In secondary analyses identifying a possible change in the association between bilateral salpingo-oophorectomy and all cause death with advancing age at surgery, the hazard ratio gradually decreased during the menopausal transition and remained around 1 at all ages thereafter.ConclusionIn this observational study, bilateral salpingo-oophorectomy at non-malignant hysterectomy appeared to be associated with increased all cause mortality in women aged <50 years, but not in those aged ≥50 years. While caution is warranted when considering bilateral salpingo-oophorectomy in premenopausal women without indication, this strategy for ovarian cancer risk reduction does not appear to be detrimental to survival in postmenopausal women.

Project description:ImportanceTwin pregnancies account for 3% of live births but experience substantially more perinatal morbidity and mortality than singleton pregnancies. Optimizing the timing of birth is a key strategy in improving twin pregnancy outcomes. Current UK and US policies are based on observational studies of perinatal mortality and not on longer-term effects. The association of timing of birth with long-term childhood outcomes among twins is uncertain.ObjectiveTo identify the optimal gestation week for birth of twin infants by calculating the week of birth associated with the lowest risk of short-term and long-term adverse outcomes (perinatal mortality and special educational need [SEN] at school).Design, setting, and participantsThis population-based, data-linkage cohort study included 43 133 twin infants born at a gestational age of 34 weeks onward between January 1, 1980, and December 31, 2015, in Scotland. The data were analyzed from June 1, 2017, to March 1, 2019.ExposuresGestational age (in weeks) at the time of birth.Main outcomes and measuresThe primary outcomes were extended perinatal mortality and a record of SEN (?1 of intellectual disabilities, dyslexia, physical or motor impairment, language or speech disorder, autistic spectrum disorder, and social, emotional, or behavioral difficulties) at school (children aged 4-18 years). To infer the consequence of the gestational age at birth, clinical outcomes of twin infants born at each week of gestation from 34 weeks onward were compared with those of twin infants remaining in utero thereafter.ResultsOf the total 43 133 twin infants included in the study, 21 696 (50.3%) were females. Although maternity records were available for all infants, 9519 sex-discordant twin children were linked to their educational data, of whom 1069 (13.8%) had a record of SEN. Compared with twins remaining in utero (n?=?26?172), birth at any gestational age from 34 to 37 weeks was associated with increased odds of perinatal death (ie, adjusted odds ratio [AOR], 1.99; 95% CI, 1.53-2.69 at 36 weeks [n?=?8056]) and increased risk of SEN at school (AOR, 1.39; 95% CI, 1.11-1.74, for birth at 36 weeks compared with 37 weeks). In a competing risk analysis, the risks of stillbirth and neonatal death were balanced at 37 weeks (risk difference, 2.05; 95% CI, 0.8-3.3).Conclusions and relevanceThe findings of this study suggest that, in the absence of a medical complication, twins should not be routinely delivered before 37 completed weeks of gestation. These findings may help optimize shared decision-making around the timing of twin birth.

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Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis.

Publications

Association of age and cause-special mortality in patients with stage I/ II colon cancer: A population-based competing risk analysis.

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