Conditional survival after surgery for patients with penile cancer

Differences in overall survival of penile cancer patients versus population-based controls

PURPOSE

To assess whether 5-year overall survival (OS) of squamous cell carcinoma of the penis (SCCP) patients differs from age-matched male population-based controls.

METHODS

We relied on the Surveillance Epidemiology and End Results database (2004-2018) to identify newly diagnosed (2004-2013) SCCP patients. For each case, we simulated an age-matched control (Monte Carlo simulation), relying on the Social Security Administration (SSA) Life Tables with 5 years of follow-up. We compared OS between SCCP patients and population-based controls in a stage-specific fashion. Smoothed cumulative incidence plots displayed cancer-specific mortality (CSM) versus other-cause mortality (OCM).

RESULTS

Of 2282 SCCP patients, the stage distribution was as follows: stage I 976 (43%) versus stage II 826 (36%) versus stage III 302 (13%) versus stage IV 178 (8%). At 5 years, OS of SCCP patients versus age-matched population-based controls was as follows: stage I 63% versus 80% (Δ = 17%), stage II 50% versus 80% (Δ = 30%), stage III 39% versus 84% (Δ = 45%), stage IV 26% versus 87% (Δ = 61%). At 5 years, CSM versus OCM in SCCP patients according to stage was as follows: stage I 12% versus 24%, stage II 22% versus 28%, stage III 47% versus 14%, and stage IV 60% versus 14%.

CONCLUSION

SCCP patients exhibit worse OS across all stages. The difference in OS at 5 years between SCCP and age-matched male population-based controls ranged from 17% to 61%. At 5 years, CSM accounted for 12% to 60% of all deaths, across all stages.

Racial disparities in conditional survival of patients with bladder cancer: a population-based study

BACKGROUND

Traditional estimates can only provide static predictions of cancer outcomes and cannot assess the evolving effect of race on patient survival. This study aims to reveal the dynamic survival of patients with bladder cancer and to explore the evolving effect of race on patient prognosis.

METHODS

Using data from the Surveillance, Epidemiology, and End Results (SEER) registry, 99,590 white, 6,036 African American, and 4,685 Asian/Pacific Islander (API) patients with bladder cancer were identified. Conditional cancer-specific survival (CSS) rates, which could reflect the dynamic survival prediction of cancer patients, represented the primary outcomes, and were estimated by the Kaplan-Meier algorithm. The evolving effect of race on patient survival was evaluated by multivariable Cox regression in combination with conditional survival (CS) estimates.

RESULTS

The 5-year CSS for African American patients who had survived 1, 2, 3, 4, or 5 years after definitive therapy improved from the baseline calculation by + 5.8 (84.4%), + 9.5 (87.4%), + 12.8 (90.0%), + 14.4 (91.3%), and + 14.7% (91.5%), respectively. The increasing trend also held for overall white and API patients, and for all patient subsets when CS was calculated according to different levels of sex, age, and disease stage. African Americans, despite having the worst survival at baseline, could have CSS comparable to their white and API counterparts after 4 years of survivorship. In addition, the risk of death for African Americans tended to decrease with increasing survival, and the risk was no longer significantly different from that of whites after 4 years of survival.

CONCLUSIONS

While having the worst initial predicted outcomes, African Americans may eventually achieve comparable survival to white and API patients given several years of survivorship. As patient survival increases, African American race may lose its role as an indicator of poorer prognosis.

Prediction of conditional survival in esophageal cancer in a population-based cohort study

BACKGROUND

The authors aimed to produce a prediction model for survival at any given date after surgery for esophageal cancer (conditional survival), which has not been done previously.

MATERIALS AND METHODS

Using joint density functions, the authors developed and validated a prediction model for all-cause and disease-specific mortality after surgery with esophagectomy, for esophageal cancer, conditional on postsurgery survival time. The model performance was assessed by the area under the receiver operating characteristic curve (AUC) and risk calibration, with internal cross-validation. The derivation cohort was a nationwide Swedish population-based cohort of 1027 patients treated in 1987-2010, with follow-up throughout 2016. This validation cohort was another Swedish population-based cohort of 558 patients treated in 2011-2013, with follow-up throughout 2018.

RESULTS

The model predictors were age, sex, education, tumor histology, chemo(radio)therapy, tumor stage, resection margin status, and reoperation. The medians of AUC after internal cross-validation in the derivation cohort were 0.74 (95% CI: 0.69-0.78) for 3-year all-cause mortality, 0.76 (95% CI: 0.72-0.79) for 5-year all-cause mortality, 0.74 (95% CI: 0.70-0.78) for 3-year disease-specific mortality, and 0.75 (95% CI: 0.72-0.79) for 5-year disease-specific mortality. The corresponding AUC values in the validation cohort ranged from 0.71 to 0.73. The model showed good agreement between observed and predicted risks. Complete results for conditional survival any given date between 1 and 5 years of surgery are available from an interactive web-tool: https://sites.google.com/view/pcsec/home .

CONCLUSION

This novel prediction model provided accurate estimates of conditional survival any time after esophageal cancer surgery. The web-tool may help guide postoperative treatment and follow-up.

Venous thrombosis, multiple carcinomatous foci and differences in metastatic pathways of penile carcinoma

The aim of the present study was to explore the life-threatening complications and metastatic pathways of penile squamous cell carcinoma (SCC), as numerous patients with penile cancer are relatively young, are of good general health and have no visceral metastasis, yet have poor survival rates. A total of 94 patients with SCC of the penis who were surgically treated were included in the current study. The coagulation parameters, including prothrombin time (PT), fibrinogen and D-dimer, were analyzed. The patients' age ranged from 25 to 95 years (mean ± standard deviation, 53.3±1.4 years). A total of 77 patients (81.9%) underwent partial penectomy and 17 (18.1%) underwent radical penectomy. The PT was significantly different between patients whose tumour invaded the corpora cavenosum and those whose tumour had not invaded, and between patients with and without pelvic lymph node metastasis. A negative correlation was obtained between PT and pelvic lymph node metastasis. In addition, six typical SCC cases and one metastatic penile carcinoma case manifested with multiple carcinomatous foci, embolisms and evidence of a metastatic pathway occurring simultaneously with tumour progression were presented. The present study indicated that venous thrombosis is one of the life-threatening complications of advanced penile cancer. Furthermore, multiple carcinomatous foci were detected in histological images. Of note, direct clinical evidence for different metastatic pathways of primary and secondary penile carcinoma was provided.

Conditional cancer-specific survival after radical hepatectomy in patients with nonmetastatic intrahepatic cholangiocarcinoma

OBJECTIVES

To examine conditional survival (CS) in patients with non-metastatic intrahepatic cholangiocarcinoma (nmICC) after surgical treatment according to pT and pN stages.

METHODS

A total of 608 patients were included. Conditional three-year cancer-specific mortality estimates were obtained according to pT and pN stages. Multivariable Cox regression analysis was applied to predict factors affecting cancer-specific mortality (CSM).

RESULTS

According to substages based on pT and pN status, 109 patients (17.9%) with pT1aN0, 96 (15.8%) with pT1bN0, 205 (33.7%) with pT2N0, 82(13.5%) with pT3-5N0, and 116 (19.1%) with pTanyN1 were identified. Conditional CSM-free estimates increased from 75% to 87%, 66% to 70%, 53% to 86%, and 36 to 54% after three years of event-free follow-up in pT1b, pT2, pT3-4N0, and pTanyN1 patients, respectively, whereas it decreased from 87% to 79% in pT1aN0 patients. Based on multivariable analysis, patients with pT2N0 (hazard ratio [HR] 2.0 p < .01), pT3-4N0 (HR 2,7 p < .01), and pTanyN1-3 (HR 4.8 p < .01) had higher CSM than patients with pT1aN0 at baseline.

CONCLUSIONS

CS varied across stage categories in nmICC patients after surgery, and it was important in individualized clinical counseling and decision-making for nmICC.