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Bilateral primary breast cancer (BPBC) patients have a worse prognosis. Tools for accurately predicting mortality risk in patients with BPBC are lacking in clinical practice. We aimed to develop a clinically useful prediction model for the death of BPBC patients. A total of 19,245 BPBC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 were randomly divided into the training set (n = 13,471) and test set (5,774). Models for predicting the 1-, 3- and 5-year death risk of BPBC patients were developed. Multivariate Cox regression analysis was used to develop the all-cause death prediction model, and competitive risk analysis was used to establish the cancer-specific death prediction model. The performance of the model was assessed by calculating the area under the receiver operating characteristic curve (AUC) with 95% confidence interval (CI), sensitivity, specificity and accuracy. Age, married status, interval time and first and second tumor's status were associated with both all-cause death and cancer-specific death (all P < 0.05). The AUC of Cox regression models predicted 1-, 3- and 5-year all-cause death was 0.854 (95% CI, 0.835–0.874), 0.838 (95% CI, 0.823–0.852) and 0.799 (95% CI, 0.785–0.812), respectively. The AUC of competitive risk models to predict 1-, 3- and 5-year cancer-specific death was 0.878 (95% CI, 0.859–0.897), 0.866 (95% CI, 0.852–0.879) and 0.854 (95% CI, 0.841–0.867), respectively. Nomograms were developed to predict all-cause death and cancer-specific death in BPBC patients, which may provide tools for clinicians to predict the death risk of BPBC patients. [ABSTRACT FROM AUTHOR]

Purpose: Among non-small cell lung cancers (NSCLC), 5 years is a benchmark in cancer control and treatment, but a certain percentage of cases recur after 5 years. The long-term post-recurrence outcomes remain controversial. To examine the accurate prognostic factors associated with survival and cancer recurrence among 5-year survivors, a landmark analysis that considered competing risks was performed. Methods: Complete resection of NSCLC was performed in 2482 patients between January 2003 and December 2015. A total of 1431 patients were 5-year survivors without recurrence. A landmark time analysis was applied to the overall survival (OS) and recurrence-free survival (RFS) from 5 years after surgery, and the findings were calculated using the Kaplan–Meier method. The cumulative incidence of cause-specific death and recurrence was estimated using the cumulative incidence function, while carefully considering the competing risks. Results: Postoperative recurrence was detected in 732 patients, of whom 68 (9.3%) had recurrence after 5 years. The median follow-up period was 8.2 years. In the competing risk analysis, the independent poor prognostic factors associated with cause-specific death were age ≥ 75 years, lymph node metastasis and pleural invasion. Conclusions: Patients requiring a follow-up for > 5 years were aged ≥ 75 years and had either lymph node metastasis or pleural invasion. [ABSTRACT FROM AUTHOR]

Astrocytoma is a type of adult-type diffuse gliomas that includes diffuse astrocytoma (DA) and anaplastic astrocytoma (AA). However, comprehensive investigations into the risk assessment and prognosis of DA and AA using population-based studies remain noticeably scarce. In this study, we developed 2 predictive nomograms to evaluate the susceptibility and prognosis associated with DA and AA. The study cohort comprised 3837 individuals diagnosed with DA or AA between 2010 and 2019 selected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent predictors were identified and used to construct the nomograms for overall death and cancer-specific death rates. The performance of the models was assessed using C-index, calibration curves, and receiver operating characteristic curve, and the clinical applicability was evaluated using decision curve analysis. The receiver operating characteristic curves in this study show excellent clinical applicability and predictive power. Notably, the area under the curves of the training and verification queues was higher than 0.80, thereby cementing the models' precision. Additionally, the calibration plots demonstrate that the anticipated mortality rates strikingly match the measured values. This alignment of figures is sustained in the validation cohort. Furthermore, the decision curve analysis corroborates the models' translational potential, reinforcing their relevance within real-world clinical settings. The presented nomograms have not only exhibited good predictive performance but also showcased pragmatic clinical utility in prognosticating patient outcomes. Significantly, this will undoubtedly serve as a valuable asset for oncologists, facilitating informed treatment decisions and meticulous follow-up planning. [ABSTRACT FROM AUTHOR]

Abstract Background The role of adjuvant chemotherapy (AC) in stage III rectal cancer (RC) has been argued based on evidence from its use in colon cancer. Previous trials have analysed disease-free and overall survivals as endpoints, rather than disease recurrence. This study compares the competing risks incidences of recurrence and cancer-specific death between patients who did and did not receive AC for stage III RC. Methods Consecutive patients who underwent a potentially curative resection for stage III RC (1995–2019) at Concord Hospital, Sydney, Australia, were studied. AC was considered following multidisciplinary discussion. Primary outcome measures were the competing risks incidences of disease recurrence and cancer-specific death. Associations between these outcomes and use of AC (and other variables) were tested by regression modelling. Results Some 338 patients (213 male, mean age 64.4 years [SD12.7]) were included. Of these, 208 received AC. The use of AC was associated with resection year (adjusted OR [aOR] 1.74, 95%CI 1.27–2.38); age ≥75 years (aOR0.04, 95%CI 0.02–0.12); peripheral vascular disease (aOR0.08, 95%CI 0.01–0.74); and postoperative abdomino-pelvic abscess (aOR0.23, 95%CI 0.07–0.81). One hundred fifty-seven patients (46.5%) were diagnosed with recurrence; death due to RC occurred in 119 (35.2%). After adjustment for the competing risk of non-cancer death, neither recurrence nor RC-specific death was associated with AC (HR0.97, 95%CI 0.70–1.33 and HR0.72, 95%CI 0.50–1.03, respectively). Conclusion This study found no significant difference in either recurrence or cancer-specific death between patients who did and did not receive AC following curative resection for stage III RC.

Purpose: Tumors in parts of the colon other than the transverse colon have been well studied, but little is known about adenocarcinoma of the transverse colon (ATC).The aim of this study was to construct nomograms using competing-risk model for accurately predicting the probability of cancer-specific and non-cancer-specific death in patients with ATC. Methods: Data on eligible patients recorded during 2000–2019 in the Surveillance, Epidemiology, and End Results database were extracted and screened. Factors that influencing prognosis were screened for death from ATC (DATC) and death from other causes (DOC) using competing-risk analysis, including univariate and multivariate analyses based on Gray's test and the Fine–Gray model, respectively. Independent prognostic factors were identified and nomograms were constructed. For comparison, we also constructed a Cox model and an AJCC stage-only competing-risk model (AJCC model) for patients with DATC. Performance evaluations of the nomograms and comparison between the models were performed using calibration plots, Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves, and the areas under the ROC curve (AUCs). The nomograms and models were validated using a validation cohort. The net reclassification index, integrated discrimination improvement, decision curves, and risk stratification were not assessed because no accepted methods were suited for competing-risk model. Results: This study included 21,469 patients with ATC, and 17 and 9 independent influencing factors were identified for the construction of DATC nomograms (DATCN) and DOC nomograms (DOCN), respectively. In both the training and validation cohorts, the calibration curves indicated good agreement between the nomogram-based predictions and the actual observations in the two nomograms, respectively. The C-index of the DATCN was higher than 80% (80.3–83.3%) at 1, 3 and 5 years in both the training and validation cohorts, significantly outperforming the AJCC (76.7–78%) and Cox (75.4–79.5%) model. The C-index of the DOCN was also higher than 69% (69.0–73.6%). In terms of ROC curves at each time point, those of the DATCN were very close to the upper-left corner of the coordinate axis in both the training and validation cohorts, and their AUCs were larger than 84% (84.2–85.4%).The AUCs of the AJCC (78.4–81.1%) and Cox (79.4–81.5%) models were significantly lower (p < 0.05), and the curves were closer to the diagonal. The ROC curves of the DOCN was similar to those of the DATCN, and the AUCs were 68.5–74%. The DATCN and DOCN therefore had good consistency, accuracy, and stability, respectively. Conclusion: This study was the first to construct competing-risk nomograms for ATC. These nomograms have proved useful for accurately assessing patient prognoses and allowing more-individualized follow-up strategies, thereby reducing the mortality. [ABSTRACT FROM AUTHOR]

Abstract Background A considerable number of elderly patients with colorectal cancer (CRC) die of non‐CRC‐related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation‐27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non‐CRC‐related death in elderly CRC patients is not known. Methods The study population comprised 364 patients aged 80 years or more who received curative resection for stage I–III CRC between 2000 and 2016. The association of each index with non‐CRC‐related death was compared by competing‐risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time‐dependent receiver‐operating characteristic (ROC) analysis. Results There were 85 deaths (40 CRC‐related and 45 non‐CRC‐related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non‐CRC‐related death. In proportional subdistribution hazards regression, risk of non‐CRC‐related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91–3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08–6.81). Time‐dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5‐year observation period. Conclusions The majority of deaths in elderly patients with CRC were not CRC‐related. CONUT score was the most useful predictor of non‐CRC‐related death in these patients.

Purpose: Recently, competing risk nomograms were widely applied to predict prognosis in numerous tumors other than chordoma. Here, we aimed to construct and validate a competing-risk-based prognostic nomogram to predict 3- and 5-year cancer-specific death (CSD) in patients with spinal and pelvic chordoma. Methods: All chordoma patient data were abstracted from the Surveillance, Epidemiology, and End Results (SEER) resource, and a total of 485 chordoma patients were eventually included in this study. Multivariate competing risk model and multivariate Cox model were used to determine independent prognostic factors, respectively, and the results of the two models were compared. Nomogram was employed to visualize the competing risk model. The discrimination, calibration, and clinical utility of this model were evaluated by Harrell concordance index (C-index), time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Ten-fold cross-validation was further utilized to validate the prognostic nomogram. Results: Significant prognostic factors affecting CSD were age (P = 0.016), localized involvement (P < 0.0001), and radical resection (P < 0.001) in the multivariate competing risk model. C-indexes were 0.799 and 0.76, and AUC were 0.812 and 0.778 for 3- and 5-year CSD. Calibration plots demonstrated the nomogram was well-fitted, and DCA indicated good clinical utility. The nomogram showed good performance in the 10-fold cross-validation. Conclusion: We successfully built the first competing-risk-based nomogram to predict clinical outcomes in patients with spinal and pelvic chordoma. This well-established nomogram hopes to help clinicians with precise prognostic assessment and thus improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: A considerable number of elderly patients with colorectal cancer (CRC) die of non‐CRC‐related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation‐27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non‐CRC‐related death in elderly CRC patients is not known. Methods: The study population comprised 364 patients aged 80 years or more who received curative resection for stage I–III CRC between 2000 and 2016. The association of each index with non‐CRC‐related death was compared by competing‐risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time‐dependent receiver‐operating characteristic (ROC) analysis. Results: There were 85 deaths (40 CRC‐related and 45 non‐CRC‐related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non‐CRC‐related death. In proportional subdistribution hazards regression, risk of non‐CRC‐related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91–3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08–6.81). Time‐dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5‐year observation period. Conclusions: The majority of deaths in elderly patients with CRC were not CRC‐related. CONUT score was the most useful predictor of non‐CRC‐related death in these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Esophageal cancer (EC) is a common and lethal carcinoma; however, the effectiveness and feasibility of the chemo- and radio-therapy (CRT) for the elderly patients (≥ 70 years) with surgery have not been fully discussed. The purpose of this study was to investigate the potential effect of CRT on the prognosis. Methods A total of 1085 patients (534 CRT patients vs. 551 non-CRT patients) from 1998 to 2016 were collected from the Surveillance, Epidemiology, and End Results database according to the inclusion and exclusion criteria. Using the competing risk regression and survival analysis, an overall estimation of the effectiveness of CRT was performed on a well-balanced cohort via performing propensity score matching. Then, the specific impact of CRT on high- (n = 557) and low-risk (n = 528) cohorts derived from the nomogram’s risk quantification for every patient were further evaluated respectively. Additionally, the advantages of the nomogram model and the conventional tumor, node, metastasis (TNM, 6th revision) staging system were compared. Results A better survival outcome was observed among patients receiving both surgery and CRT than those who underwent surgery alone (HR: 0.55, 95% CI 0.45–0.68, P

Objective: To examine the independent prognostic value of ALN status in patients with stage III CRC. Summary of Background Data: Early CRC staging classified nodal involvement by level of involved nodes in the operative specimen, including both locoregional and apical node status, in contrast to the American Joint Committee on Cancer/tumor nodes metastasis (TNM) system where tumors are classified by the number of nodes involved. Whether ALN status has independent prognostic value remains controversial. Methods: Consecutive patients who underwent curative resection for Stage III CRC from 1995 to 2012 at Concord Hospital, Sydney, Australia were studied. ALN status was classified as: (i) ALN absent, (ii) ALN present but not histologically involved, (iii) ALN present and involved. Outcomes were the competing risks incidence of CRC recurrence and CRC-specific death. Associations between these outcomes and ALN status were compared with TNM N status results. Results: In 706 patients, 69 (9.8%) had an involved ALN, 398 (56.4%) had an uninvolved ALN and 239 (33.9%) had no ALN identified. ALN status was not associated with tumor recurrence [adjusted hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.84–1.26] or CRC-specific death (HR 1.14, CI 0.91–1.43). However, associations persisted between TNM N-status and both recurrence (HR 1.58, CI 1.21–2.06) and CRC-specific death (HR 1.59, CI 1.19–2.12). Conclusions: No further prognostic information was conferred by ALN status in patients with stage III CRC beyond that provided by TNM N status. ALN status is not considered to be a useful additional component in routine TNM staging of CRC. [ABSTRACT FROM AUTHOR]

Background: Esophageal cancer (EC) is a common and lethal carcinoma; however, the effectiveness and feasibility of the chemo- and radio-therapy (CRT) for the elderly patients (≥ 70 years) with surgery have not been fully discussed. The purpose of this study was to investigate the potential effect of CRT on the prognosis.Methods: A total of 1085 patients (534 CRT patients vs. 551 non-CRT patients) from 1998 to 2016 were collected from the Surveillance, Epidemiology, and End Results database according to the inclusion and exclusion criteria. Using the competing risk regression and survival analysis, an overall estimation of the effectiveness of CRT was performed on a well-balanced cohort via performing propensity score matching. Then, the specific impact of CRT on high- (n = 557) and low-risk (n = 528) cohorts derived from the nomogram's risk quantification for every patient were further evaluated respectively. Additionally, the advantages of the nomogram model and the conventional tumor, node, metastasis (TNM, 6th revision) staging system were compared.Results: A better survival outcome was observed among patients receiving both surgery and CRT than those who underwent surgery alone (HR: 0.55, 95% CI 0.45-0.68, P < 0.001), especially for those with tumors characterized by poor differentiation, large tumor size, advanced T staging, lymphatic metastasis, and distant metastasis (HR: 0.48, 95% CI 0.39-0.59, P < 0.001), while no benefit was observed among the low-risk patients. Furthermore, the newly established nomogram model might be better than the TNM (6th revision) staging system but more data needed.Conclusion: Aggressive treatments, such as surgery, chemotherapy, and radiotherapy, were considered effective for selected elderly patients with EC according to the newly established nomogram model. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective analysis.Objective: The aim of this study was to develop and validate a competing-risk-based prognostic model and a nomogram for predicting the three- and five-year probability of cancer-specific death (CSD) in patients with spinal and pelvic chondrosarcoma.Summary Of Background Data: The issue of competing risk has rarely been addressed and discussed in survival analysis of bone sarcoma. In addition, the Fine and Gray model, a more accurate method for survival analysis in the context of competing risk, has also been less reported in prognostic study of chondrosarcoma.Methods: A total of 623 patients with spinal or pelvic chondrosarcoma were identified from the SEER database and were divided into a training and a validation cohort. These two cohorts were used to develop and validate a prognostic model to predict the 3- and 5-year probability of CSD, considering non-CSD as competing risk. The C-index, calibration plot, and decision curve analysis were used to assess the predictive performance and clinical utility of the model.Results: Older age (subdistribution hazards ratio [SHR]: 1.02, 95% confidence interval [CI]: 1.01∼1.03; P = 0.013), high grade (SHR: 2.68, 95% CI: 1.80∼3.99; P < 0.001), regional involvement (SHR: 1.66, 95% CI: 1.06∼2.58; P = 0.026), distant metastasis (SHR: 5.18, 95% CI: 3.11∼8.62; P < 0.001) and radical resection (SHR: 0.38, 95% CI: 0.24∼0.60; P < 0.001) were significantly associated with the incidence of CSD. These factors were used to build a competing-risk-based model and a nomogram to predict CSD. The C-index, calibration plot, and decision curve analysis indicated that the nomogram performs well in predicting CSD and is suitable for clinical use.Conclusion: A competing-risk based prognostic model is developed to predict the probability of CSD of patients with spinal and pelvic chondrosarcoma. This nomogram performs well and is suitable for clinical use.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

PurposeMultiple factors have been shown to be tied to the prognosis of individuals with parotid cancer (PC); however, there are limited numbers of reliable as well as straightforward tools available for clinical estimation of individualized mortality. Here, a competing risk nomogram was established to assess the risk of cancer-specific deaths (CSD) in individuals with PC.MethodsData of PC patients analyzed in this work were retrieved from the Surveillance, Epidemiology, and End Results (SEER) data repository and the First Affiliated Hospital of Nanchang University (China). Univariate Lasso regression coupled with multivariate Cox assessments were adopted to explore the predictive factors influencing CSD. The cumulative incidence function (CIF) coupled with the Fine-Gray proportional hazards model was employed to determine the risk indicators tied to CSD as per the univariate, as well as multivariate analyses conducted in the R software. Finally, we created and validated a nomogram to forecast the 3- and 5-year CSD likelihood.ResultsOverall, 1,467 PC patients were identified from the SEER data repository, with the 3- and 5-year CSD CIF after diagnosis being 21.4% and 24.1%, respectively. The univariate along with the Lasso regression data revealed that nine independent risk factors were tied to CSD in the test dataset (n = 1,035) retrieved from the SEER data repository. Additionally, multivariate data of Fine-Gray proportional subdistribution hazards model illustrated that N stage, Age, T stage, Histologic, M stage, grade, surgery, and radiation were independent risk factors influencing CSD in an individual with PC in the test dataset (p

ObjectivesHerein, we purposed to establish and verify a competing risk nomogram for estimating the risk of cancer-specific death (CSD) in Maxillary Sinus Carcinoma (MSC) patients.MethodsThe data of individuals with MSC used in this study was abstracted from the (SEER) Surveillance, Epidemiology, and End Results data resource as well as from the First Affiliated Hospital of Nanchang University (China). The risk predictors linked to CSD were identified using the CIF (cumulative incidence function) along with the Fine-Gray proportional hazards model on the basis of univariate analysis coupled with multivariate analysis implemented in the R-software. After that, a nomogram was created and verified to estimate the three- and five-year CSD probability.ResultsOverall, 478 individuals with MSC were enrolled from the SEER data resource, with a 3- and 5-year cumulative incidence of CSD after diagnosis of 42.1% and 44.3%, respectively. The Fine-Gray analysis illustrated that age, histological type, N stage, grade, surgery, and T stage were independent predictors linked to CSD in the SEER-training data set (n = 343). These variables were incorporated in the prediction nomogram. The nomogram was well calibrated and it demonstrated a remarkable estimation accuracy in the internal validation data set (n = 135) abstracted from the SEER data resource and the external validation data set (n = 200). The nomograms were well-calibrated and had a good discriminative ability with concordance indexes (c-indexes) of 0.810, 0.761, and 0.755 for the 3- and 5-year prognosis prediction of MSC-specific mortality in the training cohort, internal validation, and external validation cohort, respectively.ConclusionsThe competing risk nomogram constructed herein proved to be an optimal assistant tool for estimating CSD in individuals with MSC.

Purpose: Multiple factors have been shown to be tied to the prognosis of individuals with parotid cancer (PC); however, there are limited numbers of reliable as well as straightforward tools available for clinical estimation of individualized mortality. Here, a competing risk nomogram was established to assess the risk of cancer-specific deaths (CSD) in individuals with PC. Methods: Data of PC patients analyzed in this work were retrieved from the Surveillance, Epidemiology, and End Results (SEER) data repository and the First Affiliated Hospital of Nanchang University (China). Univariate Lasso regression coupled with multivariate Cox assessments were adopted to explore the predictive factors influencing CSD. The cumulative incidence function (CIF) coupled with the Fine-Gray proportional hazards model was employed to determine the risk indicators tied to CSD as per the univariate, as well as multivariate analyses conducted in the R software. Finally, we created and validated a nomogram to forecast the 3- and 5-year CSD likelihood. Results: Overall, 1,467 PC patients were identified from the SEER data repository, with the 3- and 5-year CSD CIF after diagnosis being 21.4% and 24.1%, respectively. The univariate along with the Lasso regression data revealed that nine independent risk factors were tied to CSD in the test dataset (n = 1,035) retrieved from the SEER data repository. Additionally, multivariate data of Fine-Gray proportional subdistribution hazards model illustrated that N stage, Age, T stage, Histologic, M stage, grade, surgery, and radiation were independent risk factors influencing CSD in an individual with PC in the test dataset (p < 0.05). Based on optimization performed using the Bayesian information criterion (BIC), six variables were incorporated in the prognostic nomogram. In the internal SEER data repository verification dataset (n = 432) and the external medical center verification dataset (n = 473), our nomogram was well calibrated and exhibited considerable estimation efficiency. Conclusion: The competing risk nomogram presented here can be used for assessing cancer-specific mortality in PC patients. [ABSTRACT FROM AUTHOR]

Objectives: Herein, we purposed to establish and verify a competing risk nomogram for estimating the risk of cancer-specific death (CSD) in Maxillary Sinus Carcinoma (MSC) patients. Methods: The data of individuals with MSC used in this study was abstracted from the (SEER) Surveillance, Epidemiology, and End Results data resource as well as from the First Affiliated Hospital of Nanchang University (China). The risk predictors linked to CSD were identified using the CIF (cumulative incidence function) along with the Fine-Gray proportional hazards model on the basis of univariate analysis coupled with multivariate analysis implemented in the R-software. After that, a nomogram was created and verified to estimate the three- and five-year CSD probability. Results: Overall, 478 individuals with MSC were enrolled from the SEER data resource, with a 3- and 5-year cumulative incidence of CSD after diagnosis of 42.1% and 44.3%, respectively. The Fine-Gray analysis illustrated that age, histological type, N stage, grade, surgery, and T stage were independent predictors linked to CSD in the SEER-training data set (n = 343). These variables were incorporated in the prediction nomogram. The nomogram was well calibrated and it demonstrated a remarkable estimation accuracy in the internal validation data set (n = 135) abstracted from the SEER data resource and the external validation data set (n = 200). The nomograms were well-calibrated and had a good discriminative ability with concordance indexes (c-indexes) of 0.810, 0.761, and 0.755 for the 3- and 5-year prognosis prediction of MSC-specific mortality in the training cohort, internal validation, and external validation cohort, respectively. Conclusions: The competing risk nomogram constructed herein proved to be an optimal assistant tool for estimating CSD in individuals with MSC. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to develop and validate a competing risk nomogram to determine the probability of cancer‐specific death in buccal mucosa cancer (BMC) patients. Materials and Methods: We examined the records of BMC patients in the Surveillance, Epidemiology, and End Results (SEER) Program and First Affiliated Hospital of Nanchang University (China). We adopted the cumulative incidence function and Fine–Gray proportional hazards model based on univariate and multivariate analyses by R‐software to identify the risk factors associated with cancer‐specific death. Subsequently, a nomogram was developed and validated to predict the 3‐ and 5‐year probability of cancer‐specific death. Results: In 1,286 BMC patients identified from SEER database, cumulative incidences of cancer‐specific death after diagnosis were 33.4% and 35.5% for 3 and 5 years, respectively. In the training cohort (n = 902) from SEER database, the Fine–Gray model indicated that age, Tumor Node Metastasis (TNM) stages, grade, surgery, and histological type were independent risk factors associated with cancer‐specific death, based on which a prognostic nomogram was developed. In the internal validation cohort from SEER database (n = 384) and the external validation cohort from our medical center (n = 174), the nomogram was well calibrated and showed remarkable prediction performance. Conclusion: The nomogram created herein may prove to be a good assistant tool for assessing the prognosis of BMC patients. [ABSTRACT FROM AUTHOR]

Cancer‐specific death (CSD) and non‐cancer‐specific death (non‐CSD) after stereotactic body radiotherapy (SBRT) for pulmonary oligometastases have not been studied in detail. The aim of this study was to determine the cumulative incidences of CSD and non‐CSD and to reveal prognostic factors. Data from a large survey of SBRT for pulmonary oligometastases were used for analyses, and patients with unknown cause of death were excluded from current analyses. CSD was primary cancer death and non‐CSD was non‐primary cancer death including a series of cancer treatment‐related deaths. Cumulative incidences were calculated using the Kaplan‐Meier method and a stratified Cox regression model was used for multivariate analyses (MVA). Fifty‐two patients with an unknown death were excluded and a total of 1326 patients was selected. CSD and non‐CSD occurred in 375 and 109 patients, respectively. The median OS period was 53.2 months and the cumulative incidences of 1‐, 3‐, and 5‐year CSD vs. non‐CSD rates were 6.5% vs. 2.3%, 29.5% vs. 8.6%, and 41.2% vs. 11.0%, respectively. In MVA, the incidence of CSD was related to performance status (1 vs. 0; p < 0.001, 2–3 vs. 0; p = 0.011), oligometastatic state (sync‐oligometastases vs. oligo‐recurrence, p = 0.026) and maximum tumor diameter (p = 0.009), and the incidence of non‐CSD was related to age (p = 0.001), sex (p = 0.030), performance status (2–3 vs. 0; p = 0.002), and irradiated tumor‐located lung lobe (left lower lobe vs. other lobes, p = 0.036). CSD was main cause of death, but non‐CSD was not rare after SBRT. Prognostic factors for CSD and non‐CSD were different, and an understanding of the factors would help in treatment. [ABSTRACT FROM AUTHOR]

Background: The incidence of rectal cancer has meaningfully increased in young patients. However, quantitative evaluation for the competing data of early-onset rectal cancer is lacking. So, we performed a competing risk analysis to calculate the cumulative incidence of death for patients with early-onset rectal cancer and developed a nomogram to predict the probability of cancer-specific mortality for these patients. Methods: We abstracted data of patients with early-onset rectal cancer between 2004 and 2016 by using the Surveillance, Epidemiology, and End Results program database. The cumulative incidence function was used to calculate the crude cancer-specific mortality of early-onset rectal cancer. Fine and Gray's proportional sub-distribution hazard model was adopted to explore the risk factors of cancer-specific death. Then, we establish a nomogram to predict their 3-, 5-, and 10-year probabilities. Results: We identified 9917 patients with early-onset rectal cancer, and they were randomly divided into training (n = 6941) and validation (n = 2976) cohorts. In the training cohort, the 3-, 5-, and 10-year cumulative incidences of cancer-specific death after diagnosis for early-onset rectal cancer were 11.4%, 19.9%, and 28.8%, respectively. Fine and Gray's model showed that sex, race, marital status, histology, T stage, N stage, M stage, examined lymph nodes, and pretreatment carcinoembryonic antigen were independently associated with cancer-specific mortality. Such factors were selected to develop a prognostic nomogram. Conclusion: The competing risk nomogram has an ideal performance for predictive cancer-specific mortality in early-onset rectal cancer. [ABSTRACT FROM AUTHOR]

Objective This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancer-specific death (CSD) and poor colorectal cancer-specific survival (CSS). Methods A total of 76,858 eligible patients from the surveillance, epidemiology, and end results (SEER) database were included in this study. The Cox proportional hazard regression model and the Chow test were used to determine a suitable cutoff age for defining the older group. Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups. A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD). Kaplan–Meier survival curves were plotted to compare CSS between groups. Also, a Cox regression model was used to validate the results. External validation was performed on data from 1998 to 2003 retrieved from the SEER database. Results Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n = 51,915,

Aim: This study aimed to examine how malnutrition, as reflected by the Geriatric Nutritional Risk Index (GNRI), is associated with colorectal cancer (CRC) recurrence and cause of death., Methods: Consecutive stage I-III CRC patients (n = 601) were divided into two groups using GNRI 98 as the cutoff. The relationship of GNRI with overall survival (OS) and recurrence-free survival (RFS) was evaluated, followed by competing risk analysis to determine prognostic factors of non-CRC-related death, and hazard function analysis to examine changes in the risk of recurrence and death., Results: Median body mass index was lower in the low GNRI group than in the high GNRI group (19.8 vs. 23.5; p < 0.001). After adjusting for known prognostic factors, a low GNRI was independently associated with reduced OS/RFS, and was a significant predictor of non-CRC-related death. The risk of recurrence was higher and peaked earlier in the low GNRI group than in the high GNRI group, although after 3 years, both groups had a similar risk. Meanwhile, the low GNRI group had a higher risk of non-CRC-related death over the course of 5 years., Conclusion: It is important to consider preoperative nutritional status along with the cancer stage when developing strategies to improve outcomes for CRC patients., (© 2023 Wiley Periodicals LLC.)

Aim: Stage I small-cell lung cancer (SCLC) is a potentially curable disease that needs timely and multidisciplinary management. The aim of this study was to evaluate the probability of cause-specific mortality for patients with stage I SCLC. Material & methods: We identified patients in the SEER database and constructed a proportional subdistribution hazard model to evaluate cancer-specific mortality. A nomogram was built based on Fine and Gray competing risk regression model. Results: A total of 864 stage I SCLC patients were identified. The 5-year cumulative incidence of SCLC-specific mortality was 56.2%, while that for other causes of death was 17.3%. The c-index for the prognostic prediction model was 0.66. Besides, the nomogram was well calibrated. Conclusion: Our nomogram might serve as a reference for clinicians when evaluating the prognosis of stage I SCLC. [ABSTRACT FROM AUTHOR]

Aim: The recommended standard of care for patients after resection of Stage III colon cancer is adjuvant 5‐fluorouracil based chemotherapy – FOLFOX (fluorouracil, leucovorin with oxaliplatin) – or CAPOX (capecitabine, oxaliplatin). This may be modified in older patients or depending on comorbidity. This has been challenged recently as the apparent benefit of adjuvant chemotherapy may arise from improvements in surgery or preoperative imaging or pathology staging. This study compares recurrence and colon‐cancer‐specific death between patients who received postoperative adjuvant chemotherapy and those who did not. Method: Prospectively recorded data from 363 consecutive patients who had a resection for Stage III colonic adenocarcinoma between 1995 and 2010 inclusive were analysed. Surviving patients were followed for at least 5 years. The suitability of patients for chemotherapy was discussed routinely at multidisciplinary team meetings. The incidence of recurrence and colon‐cancer‐specific death was evaluated by competing risk methods. Results: After adjustment for the competing risk of non‐colorectal cancer death, there was no significant difference in recurrence between the 204 patients who received chemotherapy and the 159 who did not [hazard ratio (HR) 0.94, 95% CI 0.66–1.32, P = 0.700) and no significant difference in colon‐cancer‐specific death (HR 0.73, 95% CI 0.50–1.04, P = 0.084; HR 0.88, 95% CI 0.57–1.36, P = 0.577 after adjustment for relevant covariates). Conclusion: These findings question the routine use of chemotherapy after complete mesocolic excision for Stage III colon cancer. Recurrence and cancer‐specific death, assessed by competing risk methods, should be the standard outcomes for evaluating the effectiveness of adjuvant chemotherapy after potentially curative resection. [ABSTRACT FROM AUTHOR]

Background To explore the impact of age on all-cause death and cancer-specific death in patients with pancreatic duct adenocarcinoma (PDAC) undergoing surgery. Materials and methods Individuals with PDAC undergoing surgery between 2004 and 2013 (N = 11,138) were retrospectively studied from the Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The impact of age on all-cause death and cancer-specific death was assessed using Cox regression model and competing risk model respectively. Results Multivariate Cox regression analysis indicated that the risks of all-cause death increased with age: hazard ratios (95% confidence interval, 95%CI) were 1.10 (1.04–1.17), 1.31 (1.23–1.38), 1.47 (1.35–1.61) for groups 61–70 years, 71–80 years, and >80 years, respectively, compared with ≤60 years. Multivariate competing risk analysis indicated that the risk of cancer-specific death was similar between patients ≤60 years and 61–70 years (subhazard ratio 0.93; 95% confidence interval 0.87–1.00), but decreased in patients 71–80 years (subhazard ratio 0.84; 95%CI 0.79–0.90) and >80 years (subhazard ratio 0.76; 95%CI 0.68–0.85). Conclusion Age at diagnosis appeared to be an independent predictor of prognosis, with reverse impacts on all-cause death and cancer-specific death. [ABSTRACT FROM AUTHOR]

Background: Non-cancer-specific death (NCSD) is an important factor that needs to be considered in patients with malignancy, as it can affect their long-term prognosis. In particular, the effect of age on patients with hepatocellular carcinoma (HCC) after hepatectomy requires clarification. This study aims to examine the impact of age on patients with HCC after hepatectomy and to identify independent risk factors of survival., Methods: Patients with HCC that fell within the Milan Criteria and had undergone curative hepatectomy were included in this study. The patients were divided into two groups: young patients (age <70) and elderly patients (age ≥70). Perioperative complications, cancer-specific death (CSD), recurrence, and NCSD were all recorded and analyzed. Multivariate analyses were performed to identify independent risk factors of survival using Fine and Gray's competing-risk regression model., Results: Among 1,354 analytic patients, 1,068 (78.7%) were stratified into the young group and 286 (21.3%) into the elderly group. The elderly group had a higher 5-year cumulative incidence of NCSD (12.6% vs. 3.7% for the young group, P < 0.001), but lower 5-year cumulative incidences of recurrence (20.3% vs. 21.1% for the young group, P = 0.041) and CSD (14.3% vs. 15.5% for the young group, P = 0.066). Multivariate competing-risk regression analyses revealed that age was independently associated with NCSD (subdistribution hazard ratio (SHR) 3.003, 95%CI: 2.082-4.330, P < 0.001), but not with recurrence (SHR 0.837, 95%CI: 0.659-1.060, P = 0.120) or CSD (SHR 0.736, 95%CI: 0.537-1.020, P = 0.158)., Conclusion: For patients with early-stage HCC after hepatectomy, older age was independently associated with NCSD, but not recurrence and CSD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: In patients with bladder cancer (BCa) preoperative staging with 11C-choline positron emission tomography-computed tomography (PET/CT) could be used to derive prognostic information and hence stratify patients preoperatively with respect to disease management. Methods: From June 2004 to May 2007, 44 patients with localized BCa were staged with 11C-choline PET/CT before radical cystectomy. The results of imaging were correlated to overall survival (OS) and cumulative incidence of cancer-specific death (CSD). Results: There was no statistically significant difference in OS and CSD between the patient groups when stratified for organ-confined versus non-organ-confined disease or lymph node involvement defined by either 11C-choline PET/CT (OS: p = 0.262, hazard ratio [HR] = 1.60; p = 0.527, HR = 0.76; CSD: p = 0.144, HR = 2.25; p = 0.976, HR = 0.98) or CT (OS: p = 0.518, HR = 1.34; p = 0.228, HR = 1.67; CSD: p = 0.323, HR = 1.90; p = 0.136, HR = 2.38). The limitation of this study is the small number of included patients. Conclusion: In our prospective trial neither CT nor 11C-choline PET/CT were able to sufficiently predict OS or CSD in BCa patients treated with radical cystectomy albeit trends and moderately increased HRs could be demonstrated without significant differences between CT or 11C-choline PET/CT. However, these trends might prove statistically significant in bigger patient cohorts. Therefore initial transsectional imaging might be of clinical relevance in respect to prognosis and could play a role in the counseling of BCa patients. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Summary: Prostate cancer remains a major health problem in the United States. Established clinicopathologic parameters such as Gleason score, T stage, and prostate-specific antigen levels are currently the guiding tools for prognostication and disease management. The addition of biomarkers could increase the accuracy of these parameters for predicting disease progression, response to therapy, and survival. In this regard, the goal of this study was to evaluate minichromosome maintenance complex protein 2 and Ki-67 immunohistochemical expression as predictors of outcome in prostate cancer. For this purpose, 11 tissue microarrays were constructed using tumor and nontumor samples from 428 patients. Patients were divided into short-term (mean, 2.9 years) and long-term (mean, 14.1 years) follow-up groups. End points were biochemical recurrence for the short-term follow-up group and prostate cancer–related death for the long-term follow-up group. All men in the long-term follow-up group had biochemical recurrence at the time of recruitment. Expression of both markers was higher in tumor than in nontumor glands. Percentage of minichromosome maintenance complex protein 2 was associated with Gleason score in both groups. Percentage of Ki-67 was associated with Gleason score and pathologic stage only in the short-term follow-up group. Higher minichromosome maintenance complex protein 2 percentages were associated with biochemical recurrence in the short-term follow-up group. In the long-term follow-up group, neither minichromosome maintenance complex protein 2 nor Ki-67 levels predicted prostate cancer death. In conclusion, our results suggest that in patients treated by radical prostatectomy for clinically localized prostate cancer, immunohistochemistry for minichromosome maintenance complex protein 2 expression could be used to predict biochemical recurrence, independent of other known clinicopathologic factors. [ABSTRACT FROM AUTHOR]

The identification of the TMPRSS2:ERG fusion in prostate cancer suggests that distinct molecular subtypes may define risk for disease progression. In surgical series, TMPRSS2:ERG fusion was identified in 50% of the tumors. Here, we report on a population-based cohort of men with localized prostate cancers followed by expectant (watchful waiting) therapy with 15% (17/111) TMPRSS2:ERG fusion. We identified a statistically significant association between TMPRSS2:ERG fusion and prostate cancer specific death (cumulative incidence ratio=2.7, P<0.01, 95% confidence interval=1.3–5.8). Quantitative reverse-transcription–polymerase chain reaction demonstrated high estrogen-regulated gene (ERG) expression to be associated with TMPRSS2:ERG fusion (P<0.005). These data suggest that TMPRSS2:ERG fusion prostate cancers may have a more aggressive phenotype, possibly mediated through increased ERG expression.Oncogene (2007) 26, 4596–4599; doi:10.1038/sj.onc.1210237; published online 22 January 2007 [ABSTRACT FROM AUTHOR]

Background: The current prognostic methods for primary fallopian tube carcinoma (PFTC) are inadequate. This study is the first to use a competing-risks model to perform an accurate analysis of the prognostic factors for PFTC cause-specific death (CSD). We used the model to established a nomogram for the 3-, 5-, and 8-year CSD rates based on the identified prognostic factors., Methods: This study selected 1,924 patients from the SEER (Surveillance, Epidemiology, and End Results) database. The cumulative incidence function (CIF) was used in univariate analyses, and Gray's test was used to determine the intergroup difference in the CIF. We then used the subdistribution proportional hazards model in a multivariate analysis. We finally used the prognostic factors identified in the analysis of the competing-risks model to construct a 3-, 5-, and 8-year CSD nomogram for PFTC patients. The concordance index (C-index) and calibration plots were used to evaluate the discrimination ability and consistency of the model., Results: The subdistribution proportional hazards model showed that age, histological type, FIGO stage, and the log of the ratio between the numbers of positive and negative lymph nodes (LODDS) were independent prognostic factors for CSD. The 3-, 5-, and 8-year C-indexes were 0.744, 0.744, and 0.733 in the training cohort, and 0.737, 0.748, and 0.721 in the validation cohort. In the calibration plots, the forecast lines were very close to the reference lines., Conclusions: This study is the first to analyze the prognostic factors for PFTC based on a competing-risks model. This model indicates that age, histological type, FIGO stage, and LODDS are significant prognostic factors affecting CSD in PFTC patients. We have also constructed the first 3-, 5-, and 8-year CSD nomogram for PFTC patients. This nomogram exhibits good discrimination ability and accuracy and can help clinicians to provide individualized prognostic analysis for PFTC patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-5398). All authors report grants from National Social Science Foundation of China (grant No. 16BGL183), during the conduct of the study., (2021 Annals of Translational Medicine. All rights reserved.)

Introduction and Objectives: Identifying patients with prostate cancer (CaP) who will ultimately develop bone metastasis (BM) or die of disease is essential. Alkaline phosphatase velocity (APV) has been shown to predict overall survival (OS) and bone metastasis-free survival (BMFS) in an earlier study of an equal access military patient cohort of patients with castrate-resistant prostate cancer (CRPC). To confirm these findings, we examined a cohort of patients from a high-volume cancer center to validate a previous observation that faster alkaline phosphatase (AP) kinetics are predictive of OS and BMFS in this second cohort of patients.Materials and Methods: A retrospective cohort study was conducted of patients with CRPC treated at Memorial Sloan Kettering Cancer Center between 1989 and 2010. All patients who received androgen deprivation therapy (ADT) as primary treatment in response to a rising PSA after definitive surgery for CaP were eligible. For those who received primary ADT or surgery followed by ADT, CRPC was defined as one rising PSA value after a PSA nadir ≤4ng/ml, and confirmed by a second rising PSA value, with concurrently documented testosterone levels <50ng/dl. APV was computed as the slope of the linear regression line of all AP values (>2 values per patient) plotted against time. Study outcome included BMFS and OS. Univariable Kaplan-Meier analysis was used to examine time-to-event outcomes. Multivariable Cox proportional hazards regression analysis was used to model time to BMFS and OS.Results: Of 89 patients with CRPC with evaluable data and CRPC, 17 (19%) experienced BM and 26 (29%) died. APV was dichotomized at the uppermost quartile split of all observed APV values:≥5.42U/l/y vs. the lower 3 quartiles combined,<5.42U/l/y. Patients with faster APV had significantly worse outcomes, including faster progression to BM and poorer OS when compared with those with slower APV (P = 0.0451 and P = 0.0109, respectively). There was strong correlation between PSA doubling time (PSADT) (<10,≥10mo) and APV (≥5.42U/l/y vs.<5.42U/l/y) (P = 0.0289), preventing simultaneous evaluation of both factors in multivariable analysis. Kaplan-Meier analysis showed that PSADT was also predictive of BM and OS (log-rank P<0.0001). Separate multivariable Cox proportional hazards regression models were used to examine PSADT and APV, as predictors of each study outcome (BMFS and OS). Both PSADT and APV were strongly predictive of BMFS and OS (respectively).Conclusions: APV and PSADT were predictors of BM and OS in patients with CRPC, respectively. These data are additional evidence of the potential value of AP kinetics in patients with advanced CaP. Prospective studies will be required to clarify these associations. However, given the restrictions on the current patient population in excluding metastatic disease within 12 months of ADT and a PSA nadir >4ng/ml, the findings are not inappropriately generalized to other men. [ABSTRACT FROM AUTHOR]

Background: To explore the impact of age on all-cause death and cancer-specific death in patients with pancreatic duct adenocarcinoma (PDAC) undergoing surgery., Materials and Methods: Individuals with PDAC undergoing surgery between 2004 and 2013 (N = 11,138) were retrospectively studied from the Surveillance, Epidemiology, and End Results (SEER) cancer registry database. The impact of age on all-cause death and cancer-specific death was assessed using Cox regression model and competing risk model respectively., Results: Multivariate Cox regression analysis indicated that the risks of all-cause death increased with age: hazard ratios (95% confidence interval, 95%CI) were 1.10 (1.04-1.17), 1.31 (1.23-1.38), 1.47 (1.35-1.61) for groups 61-70 years, 71-80 years, and >80 years, respectively, compared with ≤60 years. Multivariate competing risk analysis indicated that the risk of cancer-specific death was similar between patients ≤60 years and 61-70 years (subhazard ratio 0.93; 95% confidence interval 0.87-1.00), but decreased in patients 71-80 years (subhazard ratio 0.84; 95%CI 0.79-0.90) and >80 years (subhazard ratio 0.76; 95%CI 0.68-0.85)., Conclusion: Age at diagnosis appeared to be an independent predictor of prognosis, with reverse impacts on all-cause death and cancer-specific death., (Copyright © 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Objective: We evaluated the patients who are candidates for active surveillance and treated with radical prostatectomy. These patients were compared with other patients who had not met the criteria of active surveillance., Methods: In total, 135 patients were included in the study. The patients were divided into two groups. The patients in Group 1 had less than three positive cores, Gleason 6 (3 + 3) and PSA level equal to or less than 10 ng/ml. Patients in Group 2 had three or more positive cores, Gleason 6 (3 + 3) and PSA level equal to or higher than 10 ng/ml. Pathological results of each groups were compared., Results: The patients' ages were between 52 and 76, and 50 and 77 in groups 1 and 2, retrospectively. There were 69 and 66 patients in groups 1 and 2, retrospectively. The mean age of patients, PSA levels, PSA density, and prostate volumes were 63.89 ± 5.89 years, 5.82 ± 1.84 ng/ml, 0.14 ± 0.07 and 51.21 ± 31.75 cc (Group 1) and 65.77 ± 6.36 years, 13.65 ± 17.11 ng/ml, 0.63 ± 1.03 and 45.44 ± 26.77 cc (Group 2). T2a, T2c, T3a and T3b were reported in 28 patients, 36 patients, 3 patients and 2 patients after pathological evaluation in Group 1,respectively. T2a, T2c, T3a and T3b were reported in 13 patients, 47 patients, 5 patients and 1 patient in the other group, respectively., Conclusion: The final pathology showed that there is no difference in the positive surgical margin, proportion of insignificant prostate cancer and Gleason upgrading between groups. The clinicians must be aware of the fact that active surveillance can be misdiagnosed in some patients (Tab. 2, Ref. 20).