scholarly journals The effect of age on cancer-specific mortality in patients with small renal masses: A population-based analysis

2018 ◽  
Vol 12 (7) ◽  
pp. E325-30 ◽  
Author(s):  
Marco Bandini ◽  
Michele Marchioni ◽  
Raisa S. Pompe ◽  
Zhe Tian ◽  
Tristan Martel ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Large Population ◽  
Population Based ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Fuhrman Grade ◽  
Hazard Ratios ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Effect Of Age

Introduction: Contemporary data regarding the effect of age, especially in elderly patients, on cancer-specific mortality (CSM) for pT1a renal cell carcinoma (RCC) are lacking. The objective of the current study is to evaluate CSM in a large population-based cohort of surgically treated pT1a RCC patients according to age groups.Methods: Within the Surveillance Epidemiology and End Results database (2000‒2013), we identified 37 121 pT1a RCC patients who underwent either partial or radical nephrectomy. The population was stratified into five groups according to decades: <50, 50‒59, 60‒69, 70‒79, and ≥80 years. The effect of age on CSM was evaluated using competing risks regression models according to Fuhrman grade (FG). Analyses were repeated in clear-cell RCC (ccRCC).Results: Patients aged 50‒59 (9615), 60‒69 (10 762), 70‒79 (7096), and ≥80 (1789) years demonstrated higher rate of CSM compared to patients aged <50 (7856) years (hazard ratios [HR] 2.11, 3.04, 4.47, and 7.56, respectively; all p<0.001). The effect of age on CSM in FG 1‒2 patients resulted in HRs ranging from 2.01‒8.23 for the same age decades (all p< 0.001). Similarly, the effect of age on CSM in FG 3‒4 patients resulted in HRs ranging from 2.38‒5.92, respectively (all p<0.001). Virtually the same results were recorded in ccRCC patients.Conclusions: Older age is associated with higher CSM in surgically treated patients with pT1a RCC. This effect seems to be more pronounced in patient with FG 1‒2 disease. This observation should be considered when making treatment decisions in elderly patients.

Rising Incidence and Incidence-Based Mortality of Thyroid Cancer in California, 2000-2017

2020 ◽  
Vol 105 (6) ◽  
pp. 1770-1777 ◽  
Author(s):  
Kimberly L Yan ◽  
Shanpeng Li ◽  
Chi-Hong Tseng ◽  
Jiyoon Kim ◽  
Dalena T Nguyen ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Large Population ◽  
Mortality Rates ◽  
Population Based ◽  
Papillary Thyroid ◽  
Annual Percent Change ◽  
Thyroid Cancers ◽  
Specific Mortality ◽  
Rising Incidence ◽  
Cancer Specific Mortality

Abstract Context The increased incidence of thyroid cancer globally over the past several decades is principally attributed to small, indolent papillary thyroid cancers. A possible concomitant increase in thyroid cancer-specific mortality remains debated. Objective The changes in thyroid cancer incidence and incidence-based mortality were assessed using a large population-based cohort over an 18-year period. Design & Patients A retrospective analysis of all thyroid cancers reported in the California Cancer Registry was performed (2000–2017). Age-adjusted incidence and incidence-based mortality rates were analyzed using a log-linear model to estimate annual percent change. Results We identified 69 684 individuals (76% female, median age 50 years) diagnosed with thyroid cancer. The incidence of thyroid cancer increased across all histological subtypes (papillary, follicular, medullary, and anaplastic) and all tumor sizes. The incidence increased from 6.43 to 11.13 per 100 000 person-years (average increase 4% per year; P &lt; 0.001) over the study period. Thyroid cancer-specific mortality rates increased on average by 1.7% per year (P &lt; 0.001). The increased mortality rates were greater in men (2.7% per year, P &lt; 0.001) and patients with larger tumors (2-4 cm) (3.4% per year, P &lt; 0.05). Conclusions Data from this statewide registry demonstrate that the incidence of thyroid cancer is increasing, and that this phenomenon is not restricted to small papillary thyroid cancers. Rising incidence in thyroid cancers of all sizes with concurrent increase of incidence-based mortality in men and those with larger tumors suggest a true increase in clinically significant disease.

Prognostic models for predicting overall survival and cancer-specific mortality in hepatocellular carcinoma: A competing risk analysis

2020 ◽  
Author(s):  
Kongying Lin ◽  
Qizhen Huang ◽  
Zongren Ding ◽  
Yongyi Zeng ◽  
Jingfeng Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Regression Model ◽  
Predictive Factors ◽  
Large Population ◽  
Population Based ◽  
Competing Risk ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Validation Set

Abstract Background: Mortality due to hepatocellular carcinoma (HCC), which is the most common liver cancer, is often overestimated because of deaths from other causes. This study was conducted to estimate the probability of cancer-specific mortality (CSM) of patients with HCC and establish a competing risk nomogram for predicting the CSM of among these patients HCC using a large population-based cohort. Methods: Patients diagnosed with HCC between 2004 and 2015 were identified from the Surveillance Epidemiology and End Results Program. CSM and overall survival (OS) were the endpoints of the study. A competing risk nomogram for predicting CSM was built using the Fine and Gray regression model, and the nomogram for predicting OS was constructed with the Cox proportional hazard regression model, and 10-fold cross-validation was performed for the entire set. Results: A total of 34,957 patients were included in the study and randomly divided into a training set and validation set at a ratio of 7:3. Multivariate analysis identified age, race, surgical therapy, chemotherapy, radiotherapy, tumour diameter, and tumour staging as the independent predictive factors of CSM. In addition to these factors, sex and marital status were also identified as independent predictive factors of OS. Using these factors, corresponding nomograms were constructed for CSM and OS. In the validation set, the 5 year concordance-indices of the two nomogram models were estimated as 0.746 and 0.74. Calibration curves revealed good consistency between model predictions and observed outcomes. Furthermore, based on the results of cumulative incidence function analysis and Kaplan-Meier analysis, patients were categorised into four distinct risk subgroups, supporting the predictive performance of the models. Conclusions: In this population-based analysis, we developed and validated nomograms for individualized prediction of CSM and OS in patients with HCC.

Fracture Risk in Patients with Myasthenia Gravis: A Population-Based Cohort Study

2021 ◽  
pp. 1-8
Author(s):  
Charles Kassardjian ◽  
Jessica Widdifield ◽  
J. Michael Paterson ◽  
Alexander Kopp ◽  
Chenthila Nagamuthu ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Lower Risk ◽  
Cox Regression ◽  
Large Population ◽  
Population Based ◽  
Osteoporosis Prevention ◽  
Inception Cohort ◽  
Hazard Ratios ◽  
Multiple Covariates ◽  
Region Of Residence

Background: Prednisone is a common treatment for myasthenia gravis (MG), and osteoporosis is a known potential risk of chronic prednisone therapy. Objective: Our aim was to evaluate the risk of serious fractures in a population-based cohort of MG patients. Methods: An inception cohort of patients with MG was identified from administrative health data in Ontario, Canada between April 1, 2002 and December 31, 2015. For each MG patient, we matched 4 general population comparators based on age, sex, and region of residence. Fractures were identified through emergency department and hospitalization data. Crude overall rates and sex-specific rates of fractures were calculated for the MG and comparator groups, as well as rates of specific fractures. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Results: Among 3,823 incident MG patients (followed for a mean of 5 years), 188 (4.9%) experienced a fracture compared with 741 (4.8%) fractures amongst 15,292 matched comparators. Crude fracture rates were not different between the MG cohort and matched comparators (8.71 vs. 7.98 per 1000 patient years), overall and in men and women separately. After controlling for multiple covariates, MG patients had a significantly lower risk of fracture than comparators (HR 0.74, 95% CI 0.63–0.88). Conclusions: In this large, population-based cohort of incident MG patients, MG patients were at lower risk of a major fracture than comparators. The reasons for this finding are unclear but may highlight the importance osteoporosis prevention.

scholarly journals Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Yeop Lee ◽  
Hun Lee ◽  
Ji Sung Lee ◽  
Sol Ah Han ◽  
Yoon Jeon Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Cox Regression ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Population Based ◽  
Angle Closure ◽  
Charlson Comorbidity Index Score ◽  
All Cause Mortality ◽  
Specific Mortality

AbstractThis population-based, retrospective cohort study aimed to evaluate the association between glaucoma surgery and all-cause and cause-specific mortality among Korean elderly patients with glaucoma. A total of 16210 elderly patients (aged ≥ 60 years) diagnosed with glaucoma between 2003 and 2012 were included, and their insurance data were analyzed. The participants were categorized into a glaucoma surgery cohort (n = 487), which included individuals who had diagnostic codes for open angle glaucoma (OAG) or angle closure glaucoma (ACG) and codes for glaucoma surgery, and a glaucoma diagnosis cohort (n = 15,723), which included patients who had codes for OAG and ACG but not for glaucoma surgery. Sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities were included as covariates. Cox regression models were used to assess the association between glaucoma surgery and mortality. The incidence of all-cause mortality was 34.76/1,000 person-years and 27.88/1,000 person-years in the glaucoma surgery and diagnosis groups, respectively. The adjusted hazard ratio (HR) for all-cause mortality associated with glaucoma surgery was 1.31 (95% confidence interval [CI], 1.05–1.62, P = 0.014). The adjusted HR for mortality due to a neurologic cause was significant (HR = 2.66, 95% CI 1.18–6.00, P = 0.018). The adjusted HRs for mortality due to cancer (HR = 2.03, 95% CI 1.07–3.83, P = 0.029) and accident or trauma (HR = 4.00, 95% CI 1.55–10.34, P = 0.004) associated with glaucoma surgery for ACG were significant as well. Glaucoma surgery was associated with an increase of mortality in elderly patients with glaucoma. In particular, the risk of mortality associated with glaucoma surgery due to neurologic causes was significant.

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