Competing risk analysis of cardiovascular death in breast cancer: evidence from the SEER database
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ABSTRACT:
SUBMITTER: He J
PROVIDER: S-EPMC10774043 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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Project description:PurposeTo explore the impact of chemotherapy on the risk of cardiac-related death in astrocytoma patients.MethodsWe retrospectively evaluated astrocytoma patients diagnosed between 1,975 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database. Using Cox proportional hazards models, we compared the risks of cardiac-related death between a chemotherapy group and non-chemotherapy group. Competing-risks regression analyses were used to evaluate the difference in cardiac-related death. Also, propensity score matching (PSM) was employed to reduce confounding bias. The robustness of these findings was evaluated by sensitivity analysis, and E values were calculated.ResultsA total of 14,834 patients diagnosed with astrocytoma were included. Chemotherapy (HR = 0.625, 95%CI: 0.444-0.881) was associated with cardiac-related death in univariate Cox regression analysis. Chemotherapy was an independent prognostic factor for a lower risk of cardiac-related death before (HR = 0.579, 95%CI: 0.409-0.82, P = 0.002) and after PSM (HR = 0.550, 95%CI: 0.367-0.823 P = 0.004). Sensitivity analysis determined that the E-value of chemotherapy was 2.848 and 3.038 before and after PSM.ConclusionsChemotherapy did not increase the risk of cardiac-related death in astrocytoma patients. This study highlights that cardio-oncology teams should provide comprehensive care and long-term monitoring for cancer patients, especially those with an increased risk of cardiovascular disease.
| S-EPMC10167282 | biostudies-literature
Project description:Purpose: Chemotherapy is the clinically recommended treatment for patients with operable metaplastic breast carcinoma (MBC); however, its impact remains controversial. This study investigated the possible role of chemotherapy in the treatment of MBC. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify the operable MBC patients. The competing risk analysis along with the propensity score matching (PSM) method was performed to evaluate the effect of chemotherapy. Moreover, a competing risk nomogram was built to identify prognosis in patients with MBC. Results: Of the 1137 patients with MBC, 775 received chemotherapy and 362 did not receive chemotherapy. The 5-year cumulative incidence of breast cancer-specific death (BCSD) showed similar outcomes in both the Chemo and No-Chemo groups (21.1 vs. 24.3%, p = 0.57). Chemotherapy showed no apparent association with BCSD (HR, 1.07; 95% CI, 0.72-1.60; p = 0.72), even after subgroup analysis or PSM. Race, tumor size, lymph node status, and radiation were identified as the significant factors for MBC after a penalized variable selection process. In addition, a competing risk nomogram showed relatively good accuracy of prediction with a C-index of 0.766 (95% CI, 0.700-0.824). Conclusion: Our findings demonstrated that chemotherapy did not improve BCSD for operable MBC patients. Thus, it may indicate the need to reduce exposure to the current chemotherapy strategies for patients with resectable MBC. Additionally, some novel treatment strategies are required urgently to identify and target the potential biomarkers.
| S-EPMC8107469 | biostudies-literature
Project description:ObjectiveThere is limited information from population-based cancer registries regarding prognostic features of bilateral primary breast cancer (BPBC).MethodsFemale patients diagnosed with BPBC between 2004 and 2014 were randomly divided into training (n = 7740) and validation (n = 2579) cohorts from the Surveillance, Epidemiology, and End Results Database. We proposed five various models. Multivariate Cox hazard regression and competing risk analysis were to explore prognosis factors in training cohort. Competing risk nomograms were constructed to combine significant prognostic factors to predict the 3-year and the 5-year survival of patients with BPBC. At last, in the validation cohort, the new score performance was evaluated with respect to the area under curve, concordance index, net reclassification index and calibration curve.ResultsWe found out that age, interval time, lymph nodes invasion, tumor size, tumor grade and estrogen receptor status were independent prognostic factors in both multivariate Cox hazard regression analysis and competing risk analysis. Concordance index in the model of the worse characteristics was 0.816 (95% CI: 0.791-0.840), of the bilateral tumors was 0.819 (95% CI: 0.793-0.844), of the worse tumor was 0.807 (0.782-0.832), of the first tumor was 0.744 (0.728-0.763) and of the second tumor was 0.778 (0.762-0.794). Net reclassification index of the 3-year and the 5-year between them was 2.7% and -1.0%. The calibration curves showed high concordance between the nomogram prediction and actual observation.ConclusionThe prognosis of BPBC depended on bilateral tumors. The competing risk nomogram of the model of the worse characteristics may help clinicians predict survival simply and effectively. Metachronous bilateral breast cancer presented poorer survival than synchronous bilateral breast cancer.
| S-EPMC6912037 | biostudies-literature
Project description:IntroductionDue to the lack of randomized controlled trial, the effectiveness and oncological safety of nipple-excising breast-conserving therapy (NE-BCT) for female breast cancer (FBC) remains unclear. We aimed to explore and investigate the prognostic value of NE-BCT versus nipple-sparing breast-conserving therapy (NS-BCT) for patients with early FBC.MethodsIn this cohort study, data between NE-BCT and NS-BCT groups of 276,661 patients diagnosed with tumor-node-metastasis (TNM) stage 0-III FBC from 1998 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. Propensity score matching analysis, Kaplan-Meier, X-tile, Cox proportional hazards model, and competing risk model were performed to evaluate the effectiveness and oncological safety for patients in NE-BCT and NS-BCT groups.ResultsA total of 1,731 (0.63%) patients received NE-BCT (NE-BCT group) and 274,930 (99.37%) patients received NS-BCT (NS-BCT group); 44,070 subjects died after a median follow-up time of 77 months (ranging from 1 to 227 months). In the propensity score matching (PSM) cohort, NE-BCT was found to be an adversely independent prognostic factor affecting overall survival (OS) [hazard ratio (HR), 1.24; 95% CI, 1.06-1.45, p=0.0078]. Subjects in NE-BCT group had similar breast-cancer-specific survival (BCSS) (HR, 1.15; 95%CI, 0.88-1.52, p=0.30) and worse other-causes-specific death (OCSD) (HR, 1.217; 95%CI, 1.002-1.478, p=0.048<0.05) in comparison with those in the NS-BCT group.ConclusionsOur study demonstrated that the administration of NE-BCT is oncologically safe and reliable and can be widely recommended in clinics for women with non-metastatic breast cancer.
| S-EPMC9048049 | biostudies-literature
Project description:BackgroundSentinel lymph node (SLN) biopsy has been widely recognized as an excellent surgical and staging procedure for early-stage breast cancer, and its development has greatly improved the detection of micrometastases. However, the axillary treatment of micrometastasis has been the subject of much debate.MethodsWe identified 427,131 women diagnosed with breast cancer from 2010 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients whose nodal status was micrometastases (pTxN1miM0) were classified into two groups: the SLNB only group and SLNB with complete ALND group, and we used these classifications to carry out propensity-score matching (PSM) analysis. The primary and secondary endpoints were OS and BCSS, respectively. We then implemented the Kaplan-Meier method and Cox proportional hazard model and used Fine and Gray competitive risk regression to identify factors associated with the risk of all-cause mortality.ResultsAfter the PSM, 1,833 pairs were included in total. The SLNB with complete ALND showed no significant difference in OS (HR=1.04, 95% CI: 0.84-1.28, P=0.73) or BCSS (HR= 1.03, 95% CI: 0.79-1.35, P=0.82) compared to the SLNB only group, and axillary treatment was not associated with breast cancer-specific death (BCSD) (HR=1.13, 95% CI: 0.86-1.48, P=0.400) or other cause-specific death (OCSD) (HR=0.98, 95% CI:0.70-1.38, P=0.920). There was no statistically significant difference in the cumulative incidence of BCSD (Grey's test, P=0.819) or OCSD (Grey's test, P=0.788) for between the two groups either. For different molecular subtypes, patients in the SLNB only group showed no statistically significant differences from those in the SLNB with complete ALND group with Luminal A (HR=1.00, 95% CI:0.76-1.32, P=0.98) or Luminal B (HR=0.82, 95% CI:0.42-1.62, P=0.55) but similar OS to HER2-enriched (HR=1.58, 95% CI:0.81-3.07, P=0.19) or triple negative breast cancers (HR=1.18, 95% CI:0.76-1.81, P=0.46).ConclusionsOur results suggest that in early breast cancer patients with micrometastasis, complete ALND does not seem to be required and that SLNB suffices to control locoregional and distant disease, with no significant adverse effects on survival compared to complete ALND.
| S-EPMC9713815 | biostudies-literature
Project description:BackgroundLaryngeal carcinoma is one of the most common types of head and neck tumors. The mortality rate in patients with laryngeal cancer has not declined in recent years. Previous studies have shown that laryngeal cancer mortality is related to the extent of laryngeal cancer, the proportion of lymph node metastases, treatment modalities, and postoperative lifestyle habits. Thus, early identifying patients at high risk of laryngeal cancer-specific death is of great clinical importance. However, in the presence of competing risk, the existing survival models based on Cox proportional hazards model may be biased in estimating tumor-specific mortality. In this study, we developed and validated a nomogram based on competitive risk analysis for patients with laryngeal cancer.MethodsWe used SEER*Stat (Version 4.6.1) software to identify patients in the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with laryngeal cancer between 2000 and 2019 as study subjects. The collected data included demographic data, the primary site of laryngeal cancer, the histological type of tumor, tumor size, and other variables. After excluding cases with missing information, the entire cohort was randomly split into a training cohort and a validation cohort at a 7:3 ratio. The training cohort was used in building the model while the validation cohort was used to validate the model. Univariate and multivariate Fine&Gray regression analyses were used to screen statistically significant variables, and the model performance was measured by establishing a consistency index, receiver operating characteristic curve (ROC), and calibration curves.ResultsAfter excluding cases with missing information, 3,805 patients (2,264 in the training cohort and 1,141 in the validation cohort) were included in the study and followed for a median of 16 months. A total of 411 died of laryngeal cancer, and 2,104 patients died from other causes. Among 3,805 patients, the vast majority was male (80.9%), and Caucasian (77.2%), and aged 60-80 years old (58.4%).ConclusionsAdvanced age and keratinized SCC are risk factors for laryngeal cancer-specific death. These high-risk patients should be given more attention and closer monitoring in clinical practice.
| S-EPMC10009558 | biostudies-literature
Project description:Locally advanced cervical carcinoma (LACC) remains a significant global health challenge owing to its high recurrence rates and poor outcomes, despite current treatments. This study aimed to develop a comprehensive risk stratification model for LACC by integrating Cox regression and competing risk analyses. This was done to improve clinical decision making. We analyzed data from 3428 patients with LACC registered in the Surveillance, Epidemiology, and End Results program and diagnosed them between 2010 and 2015. Cox regression and competing risk analyses were used to identify the prognostic factors. We constructed and validated nomograms for overall survival (OS) and disease-specific survival (DSS). Multivariate Cox regression identified key prognostic factors for OS, including advanced International Federation of Gynecology and Obstetrics stage, age, marital status, ethnicity, and tumor size. Notably, International Federation of Gynecology and Obstetrics stages IIIA, IIIB, and IVA had hazard ratios of 2.227, 2.451, and 4.852, respectively, significantly increasing the mortality risk compared to stage IB2. Ethnic disparities were evident, with African Americans facing a 39.8% higher risk than Caucasians did. Competing risk analyses confirmed the significance of these factors in DSS, particularly tumor size. Our nomogram demonstrated high predictive accuracy, with area under the curve values ranging from 0.706 to 0.784 for DSS and 0.717 to 0.781 for OS. Calibration plots and decision curve analyses further validated the clinical utility of this nomogram. We present effective nomograms for LACC risk stratification that incorporate multiple prognostic factors. These models provide a refined approach for individualized patient management and have the potential to significantly enhance therapeutic strategies for LACC.
| S-EPMC11557032 | biostudies-literature
Project description:BackgroundBreast cancer with lung metastases (BCLM) is a serious condition that often leads to early death. This study aims to screen the risk factors of early death in BCLM patients and establish a simple and accurate nomogram prediction model. Identifying prognostic markers and developing accurate prediction models can help guide clinical decision-making.MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was used to analyze a sizable sample of data, encompassing 4,238 BCLM patients diagnosed between 2010 and 2015. Stepwise regression was used to manage the collinearity of variables and to construct a prediction model based on the histogram. The results were subjected to internal validation and contrasted with those of related investigations.ResultsOf the 4,238 BCLM patients in this study, 3,232 did not die early. Of the 1,006 premature deaths, 891 were cancer specific. Lymph node involvement, tumor size, age, and race were all recognized as prognostic markers for premature mortality. A nomogram was constructed based on these factors to reliably predict cancer-specific death and early all-cause death.ConclusionsThis study gives new insights into the prognosis of individuals with BCLM and finds critical prognostic variables for early mortality. The created nomogram might assist physicians in identifying individuals at high risk of early mortality and making treatment options.
| S-EPMC11558301 | biostudies-literature
Project description:BackgroundThoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed.ObjectiveWe aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age.MethodsWe identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis.Results1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2-22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2-1.02) for 75-year old patients.ConclusionIn patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection.
| S-EPMC10854185 | biostudies-literature
Project description:There are different characteristics of BC in developing countries and developed countries. We intended to study the factors which influence the survival and prognosis of BC between southern China and the United States. (a) To study the two groups BC patients in southern China from 2001 to 2016 and SEER database from 1975 to 2016. (b) To register, collect and analyze the clinicopathological features and treatment information. Our study found that there are significant differences in tumor size, positive lymph node status and KI-67 between southern China and SEER cohort (P < 0.000). The positive lymph node status may be one of the causes of difference of morbidity and mortality of BC patients in China. Furthermore, the differences in treatment methods may also account for the differences between China and seer databases.
| S-EPMC9213543 | biostudies-literature