Stage-specific Conditional Survival Among Young (Age Below 50 y) Versus Older (Age 50 y and Above) Adults With Colorectal Cancer in the United States

Individualized conditional survival nomograms for stage I-III early onset colorectal cancer patients

OBJECTIVE

Conditional survival accounts for the time already survived after surgery and provides additional survival information. The aim was to assess conditional survival in stages I-III early onset colorectal cancer patients and to create nomograms predicting the conditional overall survival and cancer-specific survival after surgery.

METHODS

A total of 7058 patients who underwent surgical resection of early onset colorectal cancer were identified from surveillance, epidemiology and end results database. The formula used for conditional survival calculation was conditional survival(x|y) = S(x + y)/S(x), where S(x) represents the survival at x years. Conditional survival nomograms were then developed to predict the 5-year conditional overall survival and cancer-specific survival.

RESULTS

The 5-year overall survival and cancer-specific survival after surgery increases gradually with additional survival time. Race, tumour site, grade, histology, T stage, N stage, lymph node ratio, preoperative carcinoma embryonic antigen level and perineural invasion status were independent predictors of cancer-specific survival, while age and sex were another two independent risk factors for overall survival. The nomograms based on these factors were successfully developed to predict 5-year overall survival and cancer-specific survival given 1-4 years already survived.

CONCLUSION

The probability of achieving postoperative 5-year overall survival and cancer-specific survival for early onset colorectal cancer increases gradually with additional time survived. The developed nomograms are fairly valuable and informative in facilitating clinical treatment and follow-up schemes.

S1417CD: A Prospective Multicenter Cooperative Group-Led Study of Financial Hardship in Metastatic Colorectal Cancer Patients

BACKGROUND

Financial toxicity is a growing problem in oncology, but no prior studies have prospectively measured the financial impact of cancer treatment in a diverse national cohort of newly diagnosed cancer patients. S1417CD was the first cooperative group-led multicenter prospective cohort study to evaluate financial hardship in metastatic colorectal cancer (mCRC) patients.

METHODS

Patients aged 18 years or older within 120 days of mCRC diagnosis completed quarterly questionnaires for 12 months. We estimated the cumulative incidence of major financial hardship (MFH), defined as 1 or more of increased debt, new loans from family and/or friends, selling or refinancing home, or 20% or more income decline. We evaluated the association between patient characteristics and MFH using multivariate cox regression and the association between MFH and quality of life using linear regression.

RESULTS

A total of 380 patients (median age = 59.9 years) were enrolled; 77.7% were White, 98.0% insured, and 56.5% had annual income of $50 000 or less. Cumulative incidence of MFH at 12 months was 71.3% (95% confidence interval = 65.7% to 76.1%). Age, race, marital status, and income (split at $50 000 per year) were not statistically significantly associated with MFH. However, income less than $100 000 and total assets less than $100 000 were both associated with greater MFH. MFH at 3 months was associated with decreased social functioning and quality of life at 6 months.

CONCLUSIONS

Nearly 3 out of 4 mCRC patients experienced MFH despite access to health insurance. These findings underscore the need for clinic and policy solutions that protect cancer patients from financial harm.

Conditional survival after surgical resection of primary retroperitoneal tumors: a population-based study

Background

The purpose of this study was to assess conditional survival (CS) after resection of primary retroperitoneal tumors (RPTs).

Methods

The data of 1594 patients with primary RPTs who underwent surgery between 2004 and 2016 were retrieved from the Surveillance Epidemiology and End Results (SEER) database. Multivariate Cox analysis was used to identify prognostic factors affecting overall survival (OS) and cancer-specific survival (CSS). CS was used to calculate the probability of survival for an additional 3 years after the patient had survived x years, according to the formulas: COS3 = OS (x + 3) /OS (x) and CCSS3 = CSS (x + 3)/CSS (x).

Results

The 1-, 3-, and 5-year OS rates of all patients were 89.8, 71.8, and 60.8%, while the 1-, 3-, and 5-year CSS rates were 91.9, 77.1, and 67.8%, respectively. Age, sex, FNCLCC grade, size, multifocality, histology, and chemotherapy were independent prognostic factors for OS and CSS. Among patients who survived for 1, 3, and 5 years, the COS3 rates were 72.9, 77.9, and 79.3%, and the CCSS3 rates were 78.1, 82.7, and 85.8%, respectively. Patients with poor clinicopathological characteristics achieved greater improvements in COS3 and CCSS3 rates, and the survival gaps between OS and COS3, as well as CSS and CCSS3 were more obvious.

Conclusion

Postoperative CS of RPTs was dynamic and increased over time. CS increased more significantly in patients with poor clinicopathological characteristics.