• Title/Summary/Keyword: Survival and hazard analysis

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Clinical Outcome in Gamma Knife Radiosurgery for Metastatic Brain Tumors from the Primary Breast Cancer : Prognostic Factors in Local Treatment Failure and Survival

  • Choi, Seung Won;Kwon, Do Hoon;Kim, Chang Jin
    • Journal of Korean Neurosurgical Society
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    • v.54 no.4
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    • pp.329-335
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    • 2013
  • Objective : Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods : From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. Results : In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 $mm^3$ (range, 4.5-27745 mm3) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 $mm^3$ was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p<0.001, and hazard risk=1.46, p=0.046, respectively). Conclusion : GKRS has shown to be an effective and safe treatment modality for treating brain metastases of primary breast cancer. Most metastatic brain lesions initially respond to GKRS, though, many patients have further CNS progression in subsequent periods. Patients with poor Karnofsky performance status and multiple metastatic lesions are at risk of CNS progression and poor survival, and a more frequent and strict surveillance protocol is suggested in such high-risk groups.

Hepatic Re-resection Versus Transarterial Chemoembolization for the Treatment of Recurrent Hepatocellular Carcinoma after Initial Resection: a Systematic Review and Meta-analysis

  • Wang, Di-Ya;Liu, Lei;Qi, Xing-Shun;Su, Chun-Ping;Chen, Xue;Liu, Xu;Chen, Jiang;Li, Hong-Yu;Guo, Xiao-Zhong
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.13
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    • pp.5573-5578
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    • 2015
  • Background: A systematic review and meta-analysis were performed to compare the post-recurrence survival with hepatic re-resection versus transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC) after initial resection. Materials and Methods: All relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analysis was performed according to country. Sensitivity analysis was performed in studies which clearly reported the recurrent regions, in moderate/high-quality studies, in studies published in full-text form, and in studies published after 2005. Results: In total, twelve papers were included in our study. Five and seven of them were of moderate- and poor-quality, respectively. The overall meta-analysis demonstrated a statistically significantly higher post-recurrence survival in the hepatic re-resection group than in those undergoing TACE (HR=0.64, 95%CI=0.52-0.79, P<0.0001). Heterogeneity was statistically significant and statistical significance remained in the subgroup analysis. Sensitivity analyses were also consistent with the overall analysis. Conclusions: Hepatic re-resection might provide a better post-recurrence survival than TACE for recurrent HCC after initial resection. However, considering the low quality of published studies and the potential bias of treatment selection, further randomized trials should be warranted to confirm these findings.

Racial and Social Economic Factors Impact on the Cause Specific Survival of Pancreatic Cancer: A SEER Survey

  • Cheung, Rex
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.1
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    • pp.159-163
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    • 2013
  • Background: This study used Surveillance, Epidemiology and End Results (SEER) pancreatic cancer data to identify predictive models and potential socio-economic disparities in pancreatic cancer outcome. Materials and Methods: For risk modeling, Kaplan Meier method was used for cause specific survival analysis. The Kolmogorov-Smirnov's test was used to compare survival curves. The Cox proportional hazard method was applied for multivariate analysis. The area under the ROC curve was computed for predictors of absolute risk of death, optimized to improve efficiency. Results: This study included 58,747 patients. The mean follow up time (S.D.) was 7.6 (10.6) months. SEER stage and grade were strongly predictive univariates. Sex, race, and three socio-economic factors (county level family income, rural-urban residence status, and county level education attainment) were independent multivariate predictors. Racial and socio-economic factors were associated with about 2% difference in absolute cause specific survival. Conclusions: This study s found significant effects of socio-economic factors on pancreas cancer outcome. These data may generate hypotheses for trials to eliminate these outcome disparities.

Racial and Socioeconomic Disparities in Malignant Carcinoid Cancer Cause Specific Survival: Analysis of the Surveillance, Epidemiology and End Results National Cancer Registry

  • Cheung, Rex
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7117-7120
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    • 2013
  • Background: This study hypothesized living in a poor neighborhood decreased the cause specific survival in individuals suffering from carcinoid carcinomas. Surveillance, Epidemiology and End Results (SEER) carcinoid carcinoma data were used to identify potential socioeconomic disparities in outcome. Materials and Methods: This study analyzed socioeconomic, staging and treatment factors available in the SEER database for carcinoid carcinomas. The Kaplan-Meier method was used to analyze time to events and the Kolmogorov-Smirnov test to compare survival curves. The Cox proportional hazard method was employed for multivariate analysis. Areas under the receiver operating characteristic curves (ROCs) were computed to screen the predictors for further analysis. Results: There were 38,546 patients diagnosed from 1973 to 2009 included in this study. The mean follow up time (S.D.) was 68.1 (70.7) months. SEER stage was the most predictive factor of outcome (ROC area of 0.79). 16.4% of patients were un-staged. Race/ethnicity, rural urban residence and county level family income were significant predictors of cause specific survival on multivariate analysis, these accounting for about 5% of the difference in actuarial cause specific survival at 20 years of follow up. Conclusions: This study found poorer cause specific survival of carcinoid carcinomas of individuals living in poor and rural neighborhoods.

A Meta-Analysis Comparing Lobectomy versus Segmentectomy in Stage I Non-Small Cell Lung Cancer

  • Lim, Tae Yoon;Park, Samina;Kang, Chang Hyun
    • Journal of Chest Surgery
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    • v.52 no.4
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    • pp.195-204
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    • 2019
  • Lobectomy is considered the standard strategy for early-stage non-small cell lung cancer (NSCLC). However, sublobar resection for NSCLC has recently received increased attention. The objective of this study was to compare 5-year survival, recurrence-free survival, postoperative mortality, and postoperative morbidities in patients who received segmentectomy versus those who received lobectomy through a meta-analysis. Sixteen studies were included and the combined hazard ratios or odds ratios were calculated. The results revealed that the 5-year survival rate after segmentectomy was comparable to that of lobectomy for stage IA NSCLC. However, segmentectomy for stage I NSCLC had lower rates of postoperative mortality and morbidities than lobectomy.

The seven-year cumulative survival rate of Osstem implants

  • Kim, Young-Kyun;Kim, Bum-Su;Yun, Pil-Young;Mun, Sang-Un;Yi, Yang-Jin;Kim, Su-Gwan;Jeong, Kyung-In
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.40 no.2
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    • pp.68-75
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    • 2014
  • Objectives: This study was performed to analyze the cumulative survival rate of Osstem implants (Osstem Implant Co., Ltd.) over a seven-year period. Materials and Methods: A total of 105 patients who had 467 Osstem implants that were placed at the Section of Dentistry, Seoul National University Bundang Hospital (Seongnam, Korea) from June 2003 through December 2005 were analyzed. The life table method and a cross-tubulation analysis, log rank test were used to evaluate the survival curve and the influence that the prognostic factors. The prognostic factors, i.e., age and gender of patients, diameter and length, type of implants, bone graft history and loading time were determined with a Cox proportional hazard model based on logistic regression analysis. Results: The seven-year cumulative survival rate of Osstem implants was 95.37%. The Cox proportional hazard model revealed that the following factors had a significant influence on survival rate; increased diameter, reduced prosthetic loading period and performance of bone grafting. Conclusion: The osstem implants showed satisfactory results over the seven-year study period.

Survival Factors and Survival Rates of Foreign-invested Companies (외국인투자기업 생존율 및 영향요인)

  • Seong, Kil-Yong
    • The Journal of the Korea Contents Association
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    • v.19 no.5
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    • pp.287-295
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    • 2019
  • This study was conducted to analyze firm survival rate and impact factors of survival of Foreign-invested Companies in Korea which is between 2006 and 2017. An empirical analysis of the survival factors of firms used explanatory variables such as characteristics of the and 3 firm dummy and 2 firm factors, financial variables of 3 profitability and 3 stability factors. The Kaplan-Meier method was chosen to perform analyses on the survival rates, Cox Proportional Hazard Model took to conduct on the impact factors. As a result of the impact factors of Foreign-invested Companies survival, Ownership (OS), Labour (NE ) of characteristics of the firm had positive effects. The Gross Sales Profit (GSP), Net Profit (NP ) and Operating Profit (OP ) of the financial characteristics had a positive effect. Additional Asset (LA ) had positive effects and Capital (LC), Debt (LB ) had a negative effect. Other factors did not produce significant results.

Analysis of Industrial Accidents Data with Survival Model (생존분석 모형을 활용한 산업재해 데이터의 분석)

  • Baik, Jaiwook
    • Industry Promotion Research
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    • v.5 no.1
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    • pp.1-11
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    • 2020
  • The purpose of this study is to analyze the industrial accidents data with survival model. EDA approach is used to explore the relationship between two variables and among three variables for the past 10 years of industrial accidents data. Survival models are also tried. Survival curve drops more rapidly for the business with fewer employees as time goes by. Industrial accidents occur more often as the total number of industrial accidents gets larger and as the number of employees gets smaller. Agriculture, fishing and forestry have a higher level of industrial accidents than construction while service industry and 'transportation·storage and telecommunication' have a fewer number of industrial accidents than construction. Korea Safety and Health Agency's and Ministry of Employment and Labor's involvement were not effective but Civilian's was. Recurrent event data analysis reveals all most the same result as for non-recurrent data analysis.

Efficacy and Safety of Selumetinib Compared with Current Therapies for Advanced Cancer: a Meta-analysis

  • Shen, Chen-Tian;Qiu, Zhong-Ling;Luo, Quan-Yong
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.5
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    • pp.2369-2374
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    • 2014
  • Background and Aim: Selumetinib is a promising and interesting targeted therapy agent as it may reverse radioiodine uptake in patients with radioiodine-refractory differentiated thyroid cancer. We conduct this metaanalysis to compare the efficacy and safety of selumetinib with current therapies in patients with advanced cancer. Methods: An electronic search was conducted using PubMed/ Medicine, EMBASE and Cochrane library databases. Statistical analyses were carried out using either random-effects or fixed-effects models according to the heterogeneity of eligible studies. Results: Six eligible trials involved 601 patients were identified. Compared with current therapies, treatment schedules with selumetinib did not improve progression free survival (hazard ratio, 0.91; 95%CI 0.70-1.17, P= 0.448), but did identify better clinical benefits (odds ratio, 1.24; 95%CI 0.69-2.24, P = 0.472) and less disease progression (hazard ratio, 0.72; 95%CI 0.51-1.00, P = 0.052) though its impact was not statistically significant. Sub-group analysis resulted in significantly improved progression free survival (hazard ratio, 0.61; 95%CI 0.49-0.57, P = 0.00), clinical benefits (odds ratio, 3.04; 95%CI 1.60-5.77, P = 0.001) and reduced disease progression (hazard ratio, 0.35; 95%CI 0.18-0.67, P = 0.001) in patients administrated selumetinib. Dermatitis acneiform (risk ratio, 9.775; 95%CI 3.143-30.395, P = 0.00) and peripheral edema (risk ratio, 2.371; 95%CI 1.690-3.327, P = 0.00) are the most frequently observed adverse effects associated with selumetinib. Conclusions: Compared with current chemotherapy, selumetinib has modest clinical activity as monotherapy in patients with advanced cancer, but combinations of selumetinib with cytotoxic agents in patients with BRAF or KRAS mutations hold great promise for cancer treatment. Dermatitis acneiform and peripheral edema are the most frequently observed adverse effects in patients with selumetinib.

Epidemiology and Survival of Hepatocellular Carcinoma in North-east Peninsular Malaysia

  • Norsa'adah, Bachok;Nurhazalini-Zayani, Che Ghazali Che
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6955-6959
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    • 2013
  • The incidence of hepatocellular carcinoma (HCC) is relatively high in Southeast Asia. Globally, HCC has a high fatality rate and short survival. The objectives of this retrospective cohort study were to review the epidemiology and survival of HCC patients at a tertiary centre in north-east of Peninsular Malaysia. Subjects were adult HCC patients diagnosed by histopathology or radio-imaging. Secondary liver carcinoma was excluded. Kaplan Meier and multiple Cox proportional hazard survival analyses were used. Only 210 HCC cases from years 1987-2008, were included in the final analysis. The number of cases was increasing annually. The mean age was 55.0 (SD 13.9) years with male:female ratio of 3.7:1. Approximately 57.6% had positive hepatitis B virus, 2.4% hepatitis C virus, 20% liver cirrhosis and 8.1% chronic liver disease. Only 2.9% had family history and 9.0% had frequently consumed alcohol. Most patients presented with abdominal pain or discomfort and had hepatomegaly, 47.9% had an elevated ${\alpha}$-fetoprotein level of 800 IU/ml or more, 51.9% had multiple tumors and 44.8% involved multiple liver lobes. Approximately 63.3% were in stage 3 and 23.4% in stage 4, and 82.9% did not receive any treatment. The overall median survival time was 1.9 months (95% confidence interval (CI): 1.5, 2.3). The 1-month, 6-month, 1-year and 2-year survival rates were 71.8%, 23.3%, 13.0% and 7.3% respectively. Significant prognostic factors were Malay ethnicity [Adjusted hazard ratio (AHR) 1.6; 95%CI: 1.0, 2.5; p=0.030], no chemotherapy [AHR 1.7; 95%CI: 1.1, 2.5; p=0.017] and Child-Pugh class C [AHR 2.6; 95%CI: 1.4, 4.9; p=0.002]. HCC in our study affected a wide age range, mostly male, in advanced stage of disease, with no treatment and very low survival rates. Primary prevention should be advocated in view of late presentation and difficulty of treatment. Vaccination of hepatitis virus and avoidance of liver toxins are to be encouraged.