Predictors and Treatment Outcomes of Pediatric Osteosarcoma in Diverse Socioeconomic Backgrounds in Southeast Asia: A Retrospective Multicenter Study.

BACKGROUND: Pediatric osteosarcoma outcomes among developed and developing countries have not been previously compared. Countries in Southeast Asia (SEA) have a wide variety of socioeconomic statuses. A multi-institutional retrospective study was conducted to determine the prognostic factors and outcomes for pediatric osteosarcoma in SEA. METHODS: Pediatric patients with osteosarcoma treated between 1998 and 2017 in 4 SEA pediatric oncology centers were studied. Countries were classified using the World Bank Atlas method. Kaplan-Meier method and Cox's Proportion Hazard Model were applied to estimate survival outcomes and identify prognostic factors. RESULTS: In all, 149 patients with osteosarcoma with a mean age of 12.48±3.66 years were enrolled. The localized to metastatic disease ratio was 1.5:1. The 5-year overall survival (OS) and event-free survival (EFS) were 53.8% and 42%, respectively. Prognostic factors associated with outcomes were country, stage of disease, MTX-containing regimens, and surgery type (p-value <0.05). In patients with localized disease, EFS was superior with limb-salvage surgery (62%) than amputation or rotationplasty (40%) (p-value 0.009). MTX-containing chemotherapies provided higher OS (45.3%) and EFS (37.9%) than non-MTX regimens (12.3% and 10.7%, respectively) among metastatic patients (p-value 0.004 and 0.005, respectively). Metastatic disease was an independent prognostic factor for death but not relapse outcome.  Conclusion: The disease outcomes in SEA were acceptable compared to developed countries. The stage of disease was the only independent prognostic factor. MTX-containing regimens and limb-salvage surgery should be considered where possible.

Assessment of Survival Model Performance Following Inclusion of Epstein-Barr Virus DNA Status in Conventional TNM Staging Groups in Epstein-Barr Virus-Related Nasopharyngeal Carcinoma.

Importance: Nonanatomic prognostic factors complement the traditional anatomic staging system and could be incorporated into the tumor-node-metastasis (TNM) framework. Several diseases have incorporated nonanatomic prognostic factors into the determination of TNM staging groups. Objective: To refine TNM staging groups for Epstein-Barr virus (EBV)-related nonmetastatic nasopharyngeal carcinoma (NPC) by incorporating EBV DNA status. Design, Setting, and Participants: This multicenter prognostic study included patients with NPC treated with radiotherapy at 2 hospitals in China from January 2008 to December 2016. Progression-free survival and overall survival according to EBV DNA status and the TNM staging system were compared. Recursive partitioning analysis (RPA) combined with supervised clustering was applied to derive prognostic groupings, and then a refined RPA staging schema was developed, validated, and compared with existing staging schemes. Statistical analyses were conducted from October 1, 2020, to June 15, 2021. Exposures: Curative intensity-modulated radiotherapy with or without platinum-based chemotherapy. Main Outcomes and Measures: The primary end point was progression-free survival. The performance of the staging system was assessed using the time-dependent area under the receiver operating characteristic curves and the TNM stage system's evaluation methodology. Results: A total of 2354 patients (1709 men [72.6%]; median [interquartile range] age, 45 [38-53] years) were split into training (1372 [58.3%]), internal validation (672 [28.5%]), and external validation (310 [13.2%]) cohorts. Pretreatment EBV DNA was detected in 1338 (56.8%) patients. EBV DNA status was an independent prognostic factor: lower survival probability by higher TNM stage was evident in EBV DNA-positive patients but not in those with EBV DNA-negative disease. After integrating EBV DNA status and TNM stage, nonmetastatic NPC cases were categorized into RPA-I (T1-3N0 or EBV DNA-negative T1-3N1 cancers), RPA-II (EBV DNA-positive T1-3N1-2 or EBV DNA-negative T1-3N2-3/T4N0-3 cancers), and RPA-III (EBV DNA-positive T4N0-3/T1-3N3 cancers) groups, each with distinctly different prognosis. This system of RPA staging outperformed the current TNM stage system and 2 reported RPA staging schemes. These results were internally and externally validated. Conclusions and Relevance: An RPA-based staging system for EBV-related NPC cases was associated with improved outcomes. This staging system may facilitate prognostic stratification and clinical trial designs.

The comparison of censored quantile regression methods in prognosis factors of breast cancer survival.

The Cox proportional hazards model is a widely used statistical method for the censored data that model the hazard rate rather than survival time. To overcome complexity of interpreting hazard ratio, quantile regression was introduced for censored data with more straightforward interpretation. Different methods for analyzing censored data using quantile regression model, have been introduced. The quantile regression approach models the quantile function of failure time and investigates the covariate effects in different quantiles. In this model, the covariate effects can be changed for patients with different risk and is a flexible model for controlling the heterogeneity of covariate effects. We illustrated and compared five methods in quantile regression for right censored data included Portnoy, Wang and Wang, Bottai and Zhang, Yang and De Backer methods. The comparison was made through the use of these methods in modeling the survival time of breast cancer. According to the results of quantile regression models, tumor grade and stage of the disease were identified as significant factors affecting 20th percentile of survival time. In Bottai and Zhang method, 20th percentile of survival time for a case with higher unit of stage decreased about 14 months and 20th percentile of survival time for a case with higher grade decreased about 13 months. The quantile regression models acted the same to determine prognostic factors of breast cancer survival in most of the time. The estimated coefficients of five methods were close to each other for quantiles lower than 0.1 and they were different from quantiles upper than 0.1.

Survival of patients newly diagnosed with colorectal cancer and with a history of previous cancer.

Patients with previous cancer are often excluded from clinical trials despite limited evidence about their prognosis. We examined the effect of previous cancer on overall and colorectal cancer (CRC)-specific survival of patients newly diagnosed with CRC. This population-based cohort study from the U.S.A. included patients aged ≥66 years and diagnosed with CRC between 2005 and 2015 in linked Surveillance, Epidemiology, and End Results-Medicare data. We estimated the stage-specific effects of a previous cancer on overall survival using Cox regression and on CRC-specific survival using competing risk regression. We also examined the effect of previous cancer type, timing, and stage on overall survival. Of 112,769 patients, 14.1% were previously diagnosed with another cancer--commonly prostate (32.9%) or breast (19.4%) cancer, with many (47.1%) diagnosed <5 years of CRC. For all CRC stages except IV, in which there was no difference, patients with previous cancer (vs. without) had worse overall survival. However, patients with previous cancer had improved CRC-specific survival. Overall survival for those with stage 0-III CRC varied by previous cancer type, timing, and stage; for example, patients with previous melanoma had overall survival equivalent to those with no previous cancer. Our results indicate that, in general, CRC patients with previous cancer have worse overall survival but superior CRC-specific survival. Given their equivalent survival to those without previous cancer, patients with previous melanoma and those with stage IV CRC with any type of previous cancer should be eligible to participate in clinical trials.

Validation of Stage N3 of the Eighth Edition AJCC Staging System for Nasopharyngeal Carcinoma.

OBJECTIVES: To validate stage nodal (N)3 of the 8th edition American Joint Committee on Cancer (AJCC) staging system for nasopharyngeal carcinoma (NPC). METHODS: This retrospective cohort study extracted NPC patients from the Surveillance, Epidemiology, and End Results database between 2004 and 2016. Pathologically confirmed patients with complete data of level IV, N3a, and N3b lymph node metastasis were investigated. The included patients were divided into level IV, N3a, and N3b groups. Five-year overall survival (OS) and cancer-specific survival (CSS) were compared among the three groups. RESULTS: A total of 693 patients were included: 285 (41.13%) patients in the level IV group, 124 (17.89%) patients in the N3a group, and 284 (40.98%) patients in the N3b group. The 5-year OS (57.1%, 55.0%, and 55.2%) and CSS (64.4%, 63.5%, and 64.4%) were not different among the level IV, N3a, and N3b groups. Multivariate regression analysis revealed that N stage was not an independent prognostic factor for OS (hazard ratio [HR] = 1.03, 95% confidence interval [CI]: 0.91-1.17; P = .65) or CSS (HR = 1.03, 95% CI: 0.89-1.19; P = .70). CONCLUSION: Stage N3 of the 8th edition AJCC staging system for NPC is reasonable. LEVEL OF EVIDENCE: III Laryngoscope, 131:535-540, 2021.

Survival of Young Versus Old Patients With Oral Cavity Squamous Cell Carcinoma: A Meta-Analysis.

OBJECTIVE/HYPOTHESIS: To assess whether young patients with oral cavity squamous cell carcinoma (OCSCC) demonstrate worse oncologic outcomes than older patients after definitive therapy. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A medical librarian composed a search strategy to identify relevant studies in Medline, Embase, Scopus, and other major databases (Prospero registration number CRD42019127974). Inclusion criteria were adults with histologically diagnosed OCSCC that underwent treatment, comparator groups with an age cutoff of 40 years old, and reported survival outcomes. Articles were excluded if they contained patients with oropharyngeal squamous cell carcinoma or patients treated for palliative intent. Overall survival hazard ratios were analyzed with a meta-analysis. RESULTS: There were 23,382 patients with OCSCC that were treated with definitive therapy from 22 included studies. The pooled cohort contained 2,238 (10%) patients ≤40 years of age. Oral tongue was the most common subsite in both the younger (n = 1,961, 91%) and older (n = 18,047, 88%) cohorts. The majority of OCSCCs were either T1 or T2, representing 859 (80%) malignancies in younger patients and 8,126 (77%) malignancies in older patients. A meta-analysis of nine studies demonstrated that younger patients did not experience worse survival outcomes than older patients (hazard ratio = 0.97, 95% confidence interval = 0.66-1.41). CONCLUSIONS: Young adults with OCSCC experienced similar oncologic outcomes as older patients with OCSCC after definitive treatment. Until compelling evidence demonstrates clinically relevant differences between these two cohorts, their approach to management should be similar. Future studies should consider comorbidities and using age 40 as a standard age cutoff to provide more uniform data moving forward. Laryngoscope, 131:1310-1319, 2021.

Epidemiology of male breast cancer.

BACKGROUND: Due to its rarity, few studies have characterized the epidemiology of male breast cancer. The purpose of this study was to determine survival and risk factors for male breast cancer in a large U.S. METHODS: In this study, 19,795 male patients with breast cancer were identified from the National Cancer Database (2004-2014). Patient demographics, tumor characteristics and treatments were analyzed by using descriptive statistics. We used multivariate Cox regression and Kaplan Meier analysis. RESULTS: Over 10 years, the incidence of male breast cancer increased from 7.2% to 10.3%, while mortality decreased from 11% to 3.8%. Socioeconomic factors predicting mortality included income medium, and high vs low (HR = 0.78; 0.68), private vs no insurance (HR = 0.73) and the academic research facility vs community cancer center (HR = 0.79). Significant predictors of all-cause mortality included age (HR = 1.04), tumor size (HR = 1.01), hormone receptor expression (HR = 0.8) and cancer stage I vs II, III, and IV at the time of diagnosis (HR = 1.5, 2.7, 4.4, 9.9 respectively). Other predictors of mortality include surgery (HR = 0.4), chemotherapy (HR = 0.8), radiation (HR = 0.8), and hormonal therapy (HR-0.8). CONCLUSIONS: Socioeconomic factors, cancer stage, tumor characteristics (size and grade), and high Charlson-Dayo score contributed to higher mortality among male patients diagnosed with breast cancer. Surgery was most effective, followed by radiation, chemotherapy, and hormonal therapy. Patients with positive ER or PR expression demonstrated better survival. Adjusting for socioeconomic factors, biomarker identification and timely, appropriately chosen treatment are likely to reduce the risk for mortality.

Clinicopathological characteristics and prognosis of breast cancer with special histological types: A surveillance, epidemiology, and end results database analysis.

OBJECTIVES: To explore the clinicopathological features and prognosis of breast cancer with special histological types. MATERIALS AND METHODS: The information of breast cancer patients was obtained from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2016). Comparative analyses were performed to explore the difference in clinicopathological characteristics and propensity score matching (PSM) was used to weaken the effects from clinical profiles. Survival analysis was conducted to investigate the prognostic effects from histological types, and the prognostic factors of this group of patients were identified with the univariate COX proportional model. RESULTS: A total of 242863 breast cancer patients were eligible, of which 230213 individuals were ductal breast cancer (IDC) and 12650 individuals were special breast lesions, respectively. Comparatively, special breast cancer had a lower histological grade, a smaller tumor size, a lower proportion of nodal involvement and distant metastasis, in addition to a higher proportion of triple-negative subtype. The overall prognosis of special histological breast cancer was comparable to IDC, while the survival of HER2 enriched breast cancer was in favor of special breast cancer. With the PSM performance, the prognosis exhibited an inferior profile in the metaplastic breast cancer and was significantly favorable to apocrine, medullary, micropapillary, and papillary breast cancer. CONCLUSION: This study revealed that the special histological breast cancer presented distinct clinicopathological characteristics and great heterogeneity in the prognosis among diverse histological subtypes.

Development and validation of prognostic nomograms for pseudomyxoma peritonei patients after surgery: A population-based study.

BACKGROUND: The aim of study was to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with pseudomyxoma peritonei (PMP) and compare the predictive accuracy with the American Joint Committee on Cancer (AJCC) staging system. METHODS: Data of 4959 PMP patients who underwent surgical resection were collected between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. All included patients were divided into training (n = 3307) and validation (n = 1652) cohorts. The Kaplan-Meier method and Cox proportional hazard model were applied. Nomograms were validated by discrimination and calibration. Finally, concordance index (C-index) was used to compare the predictive performance of nomograms with that of the AJCC staging system. RESULTS: According to the univariate and multivariate analyses of training sets, both nomograms for predicting OS and CSS combining age, grade, location, N stage, M stage, and chemotherapy were identified. Nomograms predicting OS also incorporated T stage and the number of lymph nodes removed (LNR). The calibration curves showed good consistency between predicted and actual observed survival. Moreover, C-index values demonstrated that the nomograms predicting both OS and CSS were superior to the AJCC staging system in both cohorts. CONCLUSION: We successfully developed and validated prognostic nomograms for predicting OS and CSS in PMP patients. Two nomograms were more accurate and applicable than the AJCC staging system for predicting patient survival, which may help clinicians stratify patients into different risk groups, tailor individualized treatment, and accurately predict patient survival in PMP.

Effect of multidisciplinary team care on the risk of recurrence in breast cancer patients: A national matched cohort study.

BACKGROUND: Cancer has been the leading cause of death in the past decade in Taiwan, with breast cancer being the most common type of cancer in females. Very few studies looked at the risk of recurrence in patients who received multidisciplinary team (MDT) care. We analyzed the influence of MDT on the risk of recurrence and death in breast cancer patients. METHOD: In this retrospective study, we included newly diagnosed patients from 2004 to 2010. The study included 9,266 breast cancer patients who were enrolled in MDT care and 9,266 patients who were not. The study used log-rank test to analyze patients' characteristics, hospital characteristics, cancer staging, and treatment methods to compare the recurrence rates in MDT care and non-MDT care participants. We used Cox proportional hazards model to examine the effect of MDT and associated factors on the risk of recurrence and mortality of breast cancer patients. RESULTS: Relative risk of recurrence was lower for patients who received MDT care than for patients who did not (HR, 0.84; 95%CI: 0.70-0.99) after matching. The mortality risk for breast cancer patients with relapse was 8.48 times (95%CI: 7.53-9.54) than that for patients without relapse. CONCLUSIONS: The relative risk of recurrence and death was significantly lower for breast cancer patients who received MDT care than for those who did not. We suggest that MDT care be implanted in the National Health Policy settings of breast cancer patients.

Development and Validation of a Nomogram-Based Prognostic Evaluation Model for Sarcomatoid Hepatocellular Carcinoma.

INTRODUCTION: Sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of liver cancer with extremely poor prognosis. This study aimed to identify the prognostic factors and develop an exclusive and efficient nomogram to predict cancer-specific survival (CSS) for SHC. METHODS: The data on patients diagnosed with SHC from January 1973 to December 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database, and these patients were included as the training cohort. Least absolute shrinkage and selection operator (LASSO) and Cox proportional hazards regression analyses were used to identify the prognostic risk factors and construct a nomogram. The predictive accuracy and discriminative ability of the nomogram were determined using concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Decision curve analysis (DCA) was used to compare the clinical benefits of the prognostic evaluation model (PEM) with that of the American Joint Committee on Cancer (AJCC) staging system. The results were validated with an external validation cohort. RESULTS: In total, 116 patients with SHC were included in the training cohort. Multivariate Cox analysis revealed M stage (distant metastasis), primary tumor surgery, and chemotherapy to be associated with CSS, and along with tumor size, an integrated PEM was constructed. A calibration curve for the probability of survival showed good agreement between the nomogram and actual observation. The C-index value of the nomogram for predicting CSS and AJCC was 0.853 and 0.649, respectively. In the validation cohort, the C-index value of the PEM discrimination was better than that of the Barcelona Clinic Liver Cancer (BCLC) staging system, CLIP score, and Okuda staging system, and no statistical difference was observed with eighth edition of the AJCC staging system and Izumi staging system. CONCLUSION: The proposed four-factor nomogram of PEM could accurately predict the prognosis of SHC and could be used in clinical practice.

The Role of 18F-FDG PET/CT in staging of gallbladder carcinomas.

BACKGROUND/AIMS: Gallbladder Carcinoma (GBC) is the most common and aggressive tumor of the biliary tract. Patients are typically diagnosed during advanced stages, and the mean overall survival is short. In our study, we aimed to demonstrate the uptake patterns of 18F-FDG PET/CT in GBC, as well as its association with survival and diagnostic value during the initial stage. MATERIALS AND METHODS: Overall, 17 patients with GBC were retrospectively included in the study. 18F-FDG PET/CT study was performed for pretreatment staging. Two different standardized uptake values (SUVmax and SUVmean), metabolic tumor volume 40% (MTV40), and tumor lesion glycolysis (TLG) of the primary tumors were compared between the clinical and histopathological groups. RESULTS: Of the 17 patients, 11 were women (64.7%), and 6 (35.3%) were men. The mean age of the patients was 69.7±8.8 years. 18F-FDG uptake was detected in all lesions. Mean SUVmax was calculated to be 15.4±13.7 (median=10.6, range=3.4-46.8). All distant metastases (52.9%) were detected in the liver. Semiquantitative metabolic parameters (SUVmax and SUVmean, MTV40, and TLG) obtained from patients with distant metastasis were not significantly higher than those without distant metastasis. Similar results were obtained in patients with and without nodal metastasis. No statistically significant intergroup difference was observed regarding metabolic parameters. However, a statistically significant negative correlation was observed between the patient's age and the SUVmax of the primary lesion and metastatic lymph nodes (r=-0.564, p=0.018). During 10.7±10.4 months of mean follow-up, the mean survival of patients with distant metastases (6.1±11.0 months) was significantly shorter than that of patients with no organ metastases (15.8±7.1 months). CONCLUSION: In our study, distant metastases and age were observed to be crucial prognostic factors in patients with gallbladder carcinoma (GBC). In addition, we believe that 18F-FDG PET/CT imaging will help to stage the GBC, detect nodal and distant metastasis, and evaluate the metabolic state of gallbladder lesions.

A SEER population analysis of stage IB resected gastric cancer: who can benefit from adjuvant therapy?

Objective: The benefit of adjuvant therapy (AT) remains controversial in stage IB gastric cancer (GC). This study aimed to offer a reference for the rational indications of AT.Methods: We retrospectively included 1216 stage IB GC who experienced curative surgery from the SEER database between 2004 and 2015. These patients were allocated into two groups: Group AT and Group surgery alone (Group SA). We established a nomogram to predict OS and then divided whole cohort into low-risk and high-risk groups based on the OS predicted by the nomogram.Results: Six variables, which were significantly related with OS of entire patients after matched, were incorporated in the nomogram. These variables were age, examined lymph nodes, tumor site, marital, family income and stage IB. The C-index of the model was 0.637 and the calibration curve showed that the anticipated values were in accordance with the actual values. The decision curve demonstrated that the optimal clinical impact was achieved when the threshold possibility was 0-56%. Then, the entire cohort was separated into low-risk (≤159 points) as well as high-risk (>159 points) groups based on the projected 5-year OS of recursive partitioning analysis. Group SA revealed a significantly poorer OS than Group AT for high-risk patients (p < .001); on the other hand, there was a comparable OS for low-risk patients (p = .361).Conclusions: We have developed an effective, intuitional and applied prognostic tool to clinical decision-making. For stage IB GC after surgical resection, AT was only recommended for high-risk patients. However, AT may be dispensable for low-risk patients.

The natural history of untreated muscle-invasive bladder cancer.

OBJECTIVE: To describe the natural history of untreated muscle-invasive bladder cancer (MIBC) and compare the oncological outcomes of treated and untreated patients. PATIENTS AND METHODS: We utilised a database encompassing all patients with newly diagnosed bladder cancer in Stockholm, Sweden between 1995 and 1996. The median follow-up for survivors was 14.4 years. Overall, 538 patients were diagnosed with bladder cancer of whom 126 had clinically localised MIBC. Patients were divided into two groups: those who received radical cystectomy or radiation therapy, and those who did not receive any form of treatment. Multivariable Cox or competing-risks regressions were adopted to predict metastasis, overall survival (OS), and cancer-specific mortality (CSM), when appropriate. Analyses were adjusted for age at diagnosis, sex, tumour stage, clinical N stage, and treatment. RESULTS: In all, 64 (51%) patients did not receive any definitive local treatment. In the untreated group, the median (interquartile range) age at diagnosis was 79 (63-83) vs 69 (63-74) years in the treated group (P < 0.001). Overall, 109 patients died during follow-up. At 6 months after diagnosis, 38% of the untreated patients had developed metastatic disease and 41% had CSM. The 5-year OS rate for untreated and treated patients was 5% (95% confidence interval [CI] 1, 12%) vs 48% (95% CI 36, 60%), respectively. Patients not receiving any treatment had a 5-year cumulative incidence of CSM of 86% (95% CI 75, 94%) vs 48% (95% CI 36, 60%) for treated patients. Untreated patients had a higher risk of progression to metastatic disease (hazard ratio [HR] 2.40, 95% CI 1.28, 4.51; P = 0.006), death from any cause (HR 2.63, 95% CI 1.65, 4.19; P < 0.001) and CSM (subdistribution HR 2.02, 95% CI 1.24, 3.30; P = 0.004). CONCLUSIONS: Untreated patients with MIBC are at very high risk of near-term CSM. These findings may help balance the risks vs benefits of integrating curative intent therapy particularly in older patients with MIBC.

Trajectories of returning to work and its impact on survival in survivors with oral cancer: A 5-year follow-up study.

BACKGROUND: A return to work (RTW) is a challenge for survivors of oral cancer. Further light could be shed on the RTW of patients with oral cancer, which remains largely uninvestigated. The objective of this study was to investigate the trajectories of RTW and their impact on survival in workers with oral cancer. METHODS: In total, 12,222 workers who were newly diagnosed with oral cancer were identified during the period from 2004 to 2015 and were included in this cohort study. The associations between independent variables and RTW were analyzed using Cox proportional hazard models. RESULTS: Overall, 8793 workers returned to work in the first years after a diagnosis of oral cancer. Chemotherapy (hazard ratio [HR], 0.88; 95% CI, 0.78-0.99) and radiation therapy (HR, 0.83; 95% CI, 0.75-0.92) were inversely associated with RTW. Patients who had received surgical treatment (HR, 1.24; 95% CI, 1.01-1.53) were more likely to RTW. Employees with stage I (HR, 1.66; 95% CI, 1.47-1.87), stage II (HR, 1.52; 95% CI, 1.35-1.72), and stage III (HR, 1.32; 95% CI, 1.16-1.51) disease were associated with an increased likelihood of RTW in the fifth year after diagnosis. Kaplan-Meier survival analysis demonstrated better survival for the RTW group versus the non-RTW group in patients with stage III and IV oral cancer (P < .001). The fully adjusted HR indicated that the RTW group had significantly better outcomes than the non-RTW group in all-cause mortality (P < .001; HR, 0.36; 95% CI, 0.33-0.39). CONCLUSIONS: Sociodemographic and medical factors affect the RTW of cancer survivors. RTW may have a beneficial effect on survival of patients with oral cancer.

Type of preoperative therapy and stage-specific survival after surgery for rectal cancer: a nationwide population-based cohort study.

Preoperative chemoradiation therapy (CRT) may induce downstaging in rectal cancer (RC). Short-course radiation therapy (SC-RT) with immediate surgery does not cause substantial downstaging. However, the TNM classification adds the "y" prefix in both groups to indicate possible treatment effects. We aim to compare stage-specific survival in these patients. RC patients treated with surgery only, preoperative SC-RT followed by surgery within 10 days, or preoperative CRT, and diagnosed between 2008 and 2014 were included in this population-based study. Clinicopathological and outcome characteristics were analyzed. The study included 11,925 patients. Large discrepancies existed between clinical and pathological stages after surgery only. Surgery-only patients were older with more comorbidities compared with SC-RT and CRT and had worse 5-year survival (64%, 76%, and 74%, respectively; p < 0.001). Five-year survival for stage I was similar after CRT and SC-RT (85% vs. 85%; p = 0.167) and comparable between CRT-treated patients with stage I and those reaching a pathological complete response (pCR; 85% vs. 89%; p = 0.113). CRT was independently associated with worse overall survival compared with SC-RT for stage II (HR 1.57 [95%CI 1.27-1.95]; p < 0.001) and stage III (HR 1.43 [95%CI 1.23-1.70]; p < 0.001). Stage I disease after CRT has an excellent prognosis, comparable with pCR and with same-stage SC-RT-treated patients without regression. Stage II or III after CRT has worse prognosis than after SC-RT with immediate surgery. TNM should take the impact of preoperative therapy type on stage-specific survival into account. In addition, clinical stage was a poor predictor of pathological stage.

Impact of age on stage-specific mortality in patients with gastric cancer: A long-term prospective cohort study.

Controversies exist regarding the impact of age on gastric cancer-related mortality according to cancer stage. In our prospective cohort study, we evaluated the impact of age on stage-specific mortality in patients with gastric cancer. Between 2002 and 2006, patients with newly diagnosed gastric cancer were recruited from two university-affiliated hospitals in Korea. Follow-up data were updated regularly based on medical records and telephone surveys. Patients were classified into four subgroups according to age: <50, 50-59, 60-69, and 70-79 years. A total of 448 patients were followed up for 81.6 months (interquartile range, 25.0-139.3 months). The number of patients with stage I, II, III, and IV disease was 247, 74, 88, and 39, respectively. Overall, age was an independent risk factor for gastric cancer-specific mortality (hazard ratio [HR], [95% confidence interval (CI)]: 1.53 [0.91-2.57], 1.88 [1.21-2.91], and 2.64 [1.69-4.14] in the 50-59, 60-69, and 70-79 years groups, respectively, with the <50 years group as reference). In patients with stage I and II gastric cancer, the 70-79 years group was associated with a significantly higher rate of cancer-specific mortality than the <50 years group (stage I: HR [95% CI], 9.55 [2.11-43.12]; stage II: HR [95% CI], 7.17 [2.32-22.18]). However, age was not an independently associated factor for cancer-specific mortality in patients with stage III and IV gastric cancer. Although age was an independent risk factor for gastric cancer-related mortality in patients with gastric cancer, its impact may differ depending on the stage of cancer.

Evaluating and Predicting the Probability of Death in Patients with Non-Metastatic Osteosarcoma: A Population-Based Study.

BACKGROUND Osteosarcoma is one of the most common bone tumors, with strong local aggressiveness and early metastasis. The aim of this study was to describe the epidemiological data and evaluate the prognostic factors for overall survival (OS) and cause-specific survival (CSS) in patients with non-metastatic osteosarcoma. MATERIAL AND METHODS Patients histologically diagnosed with non-metastatic osteosarcoma between 2005 and 2014 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Survival analysis, machine learning, and Lasso regression were used to identify the prognostic factors for OS and CSS, and the accuracy of the nomograms was tested and compared with the American Joint Committee on Cancer (AJCC) staging systems. RESULTS The entire cohort comprised 1000 patients with non-metastatic osteosarcoma. The multivariable analysis suggested that age, tumor size, grade, and American Joint Committee on Cancer (AJCC) T staging were independent prognostic factors for OS and CSS. Additionally, the nomograms based on these results could better predict probability of OS (Internal validation C-index, 0.7095) and CSS (0.7100) compared with the sixth (OS: 0.613; CSS: 0.628) and seventh edition AJCC staging systems (0.602, 0.613). CONCLUSIONS Relatively young age and low histopathological grade were favorable factors for both OS and CSS. Nomograms based on multivariable models worked well in predicting the probability of death for patients with non-metastatic osteosarcoma.

Challenging AJCC 8 Staging for Soft Tissue Sarcoma Using the NCDB.

PURPOSE: To determine whether the new American Joint Committee on Cancer (AJCC) 8 grouping of soft tissue sarcoma (STS) with nodal disease (N1M0) and metastatic disease (M1) as stage IV correctly represents the prognosis of these previously separate patient groups, using the National Cancer Database. METHODS AND MATERIALS: Adults with STS identified in the 2004 to 2014 National Cancer Database, classified by the World Health Organization 2013 system into 10 histologic subgroups, were grouped according to AJCC 8 staging and analyzed according to demographic characteristics, histology, primary site, disease extent, and adjuvant treatment. Primary retroperitoneal sites, "other/unusual" histologic subgroups, and those with delays in therapy (>180 days from diagnosis) were excluded. We used χ2 tests, Cox proportional hazard models, and propensity-score matched analyses. RESULTS: Of 82,987 patients identified, 55,417 met inclusion criteria; 29,855 (53.9%) were male, and 25,262 (46.1%) were female. Median age was 60 years (range, 18-90 years). Overall survival (OS) of STS of all sites was significantly different between N1M0 and N0-1M1 patients at 5 years (34.4%; [95% confidence interval {CI}, 30.1%-38.8%] vs 10.1% [95% CI, 9%-11%], respectively) and 10 years (27.3% [95% CI, 22.5%- 32.2%] vs 5.4% [95% CI, 4.5%-6.5%], respectively; log-rank test, P < .001). For STS of trunk and extremities in N1M0 and N0-1M1 patients, the N1M0 cohort was associated with significantly greater OS on multivariate Cox proportional hazards models (hazard ratio, 0.48; 95% CI, 0.41-0.58; P < .001), and this OS difference remained significant for propensity-matched cohorts of all primary sites (HR, 0.53; 95% CI, 0.44-0.64; P < .001). CONCLUSIONS: In adult STS, including those of the trunk and extremity, OS is superior with N1M0 compared with N0-1M1 disease. These results suggest that the AJCC 8th edition grouping of N1 and M1 patients into stage IV may obscure the more favorable prognosis of patients with N1M0 disease.