Abstract:The accuracy rate for the first course of cancer treatment was affected by the cancer type and the experience of cancer registrars, but it was not affected by the workload of cancer registrars. We recommend that cancer registrars with basic licenses upgrade to advanced licenses as soon as possible. Medical record collaboration should establish documentation for checklist of radiotherapy and surgical operation records.
“…According to Cancer Registry Annual Report published by Ministry of Health and Welfare, Taiwan in 2018 1 , the total number of patients diagnosed with melanoma during 1997–2012 was 3057, which was close to the cohort number of this study. The Taiwan Cancer Registry Annual Report was based on the Taiwan Cancer Registry database, which provides complete core information for cancer cases in Taiwan 17 , 18 . Figure 1 Design and flowchart of patient selection.…”
Cutaneous malignant melanoma is a rare but fatal disease in East Asia. Despite its increasing incidence, a general lack of awareness about the disease was noted. This study aims to provide population-based prognostic analysis of melanoma with sentinel lymph node biopsy (SLNB) in Taiwan. We conducted this retrospective cohort study using the data from Taiwan National Health Insurance Research Database during 1997–2013. The study cohort contains 3284 patients. The 5-year survival rates of patients undergoing SLNB and not undergoing SLNB were 45.5% and 33.6%. In multivariate analysis, age ≥ 80 years [adjusted hazard ratio (aHR) = 2.15] and male (aHR = 1.19) were associated with a poorer prognosis, while high social economic status (SES) (aHR = 0.69) and undergoing SLNB (aHR = 0.84) were good prognostic factors. Old age and low SES were associated with lower percentages of patients undergoing SLNB (P < 0.001). E-value analysis suggested robustness to unmeasured confounding. In conclusion, undergoing SLNB was associated with a better prognosis. The poor prognosis of old age and low SES may be due to decreased percentages of patients undergoing SLNB. Therefore, we recommend that SLNB should be performed on patients, especially in old age or low SES, who are candidates for SLNB according to current guidelines to achieve maximal survival.
“…According to Cancer Registry Annual Report published by Ministry of Health and Welfare, Taiwan in 2018 1 , the total number of patients diagnosed with melanoma during 1997–2012 was 3057, which was close to the cohort number of this study. The Taiwan Cancer Registry Annual Report was based on the Taiwan Cancer Registry database, which provides complete core information for cancer cases in Taiwan 17 , 18 . Figure 1 Design and flowchart of patient selection.…”
Cutaneous malignant melanoma is a rare but fatal disease in East Asia. Despite its increasing incidence, a general lack of awareness about the disease was noted. This study aims to provide population-based prognostic analysis of melanoma with sentinel lymph node biopsy (SLNB) in Taiwan. We conducted this retrospective cohort study using the data from Taiwan National Health Insurance Research Database during 1997–2013. The study cohort contains 3284 patients. The 5-year survival rates of patients undergoing SLNB and not undergoing SLNB were 45.5% and 33.6%. In multivariate analysis, age ≥ 80 years [adjusted hazard ratio (aHR) = 2.15] and male (aHR = 1.19) were associated with a poorer prognosis, while high social economic status (SES) (aHR = 0.69) and undergoing SLNB (aHR = 0.84) were good prognostic factors. Old age and low SES were associated with lower percentages of patients undergoing SLNB (P < 0.001). E-value analysis suggested robustness to unmeasured confounding. In conclusion, undergoing SLNB was associated with a better prognosis. The poor prognosis of old age and low SES may be due to decreased percentages of patients undergoing SLNB. Therefore, we recommend that SLNB should be performed on patients, especially in old age or low SES, who are candidates for SLNB according to current guidelines to achieve maximal survival.
“…The original data for our primary analysis were retrieved from the TCR database. The TCR provides complete core information for cancer cases in Taiwan that meet the criteria for high data quality [11, 12]. Its data source consists of 19 medical centers and a district hospital specializing in cancer research, Koo Foundation Sun Yat-Sen Cancer Center.…”
Section: Methodsmentioning
confidence: 99%
“…Tumor grade, lymph vessel or vascular invasion, breast cancer subtype, and pathologic stage were categorical variables. Breast cancer subtypes were categorized as proposed by Blows [12] and Cheng [13], with grouping into three major subtypes: (1) luminal-like subtype (HR+ and HER2−), (2) HER2 subtype (HER2+), and (3) triple-negative subtype (HR− and HER2−). For tumor grade, 1 means the well differentiated or differentiated; 2 means moderately differentiated, moderately well differentiated, or intermediate differentiation; and 3 means poorly differentiated, dedifferentiated, undifferentiated, or anaplastic.…”
Background
This study aimed to develop a prognostic model to predict the breast cancer-specific survival and overall survival for breast cancer patients in Asia and to demonstrate a significant difference in clinical outcomes between Asian and non-Asian patients.
Methods
We developed our prognostic models by applying a multivariate Cox proportional hazards model to Taiwan Cancer Registry (TCR) data. A data-splitting strategy was used for internal validation, and a multivariable fractional polynomial approach was adopted for prognostic continuous variables. Subjects who were Asian, black, or white in the US-based Surveillance, Epidemiology, and End Results (SEER) database were analyzed for external validation. Model discrimination and calibration were evaluated in both internal and external datasets.
Results
In the internal validation, both training data and testing data calibrated well and generated good area under the ROC curves (AUC; 0.865 in training data and 0.846 in testing data). In the external validation, although the AUC values were larger than 0.85 in all populations, a lack of model calibration in non-Asian groups revealed that racial differences had a significant impact on the prediction of breast cancer mortality. For the calibration of breast cancer-specific mortality,
P
values < 0.001 at 1 year and 0.018 at 4 years in whites, and
P
values ≤ 0.001 at 1 and 2 years and 0.032 at 3 years in blacks, indicated that there were significant differences (
P
value < 0.05) between the predicted mortality and the observed mortality. Our model generally underestimated the mortality of the black population. In the white population, our model underestimated mortality at 1 year and overestimated it at 4 years. And in the Asian population, all
P
values > 0.05, indicating predicted mortality and actual mortality at 1 to 4 years were consistent.
Conclusions
We developed and validated a pioneering prognostic model that especially benefits breast cancer patients in Asia. This study can serve as an important reference for breast cancer prediction in the future.
Electronic supplementary material
The online version of this article (10.1186/s13058-019-1172-6) contains supplementary material, which is available to authorized users.
“…43 A previous validation study showed good accuracy in the details of radiotherapy and chemotherapy treatment. 44 Third, due to the lack of laboratory data and imaging data, we could not compare the biochemical failure survival between the IGRT and non-IGRT groups. However, this is not an obstacle for our primary endpoint, OS.…”
Objectives: Image-guided radiotherapy (IGRT) is a recommended advanced radiation technique that is associated with fewer acute and chronic toxicities. However, one Phase III trial showed worse overall survival in the IGRT arm. The purpose of this observational study is to evaluate the impact of IGRT on overall survival. Methods: We used the Taiwan Cancer Registry Database to enroll cT1-4N0M0 prostate cancer patients who received definitive radiotherapy between 2011 and 2015. We used inverse probability treatment weighting (IPW) to construct balanced IGRT and non-IGRT groups. We compared the overall survival of those in the IGRT and non-IGRT groups. Supplementary analyses (SA) were performed with alternative covariates in propensity score (PS) models and PS approaches. The incidence rates of prostate cancer mortality (IPCM), other cancer mortality (IOCM), and cardiovascular mortality (ICVM) were also evaluated. Results: There were 360 patients in the IGRT arm and 476 patients in the non-IGRT arm. The median follow-up time was 50 months. The 5-year overall survival was 88% in the IGRT arm and 86% in the non-IGRT arm (adjusted hazard ratio [HR] of death = 0.93; 95% CI, 0.61–1.45; p = 0.77). The SA also showed no significant differences in the overall survival between those in the IGRT and non-IGRT arms. Both groups did not significantly differ in terms of IPCM, IOCM, and ICVM. Conclusions: The overall survival of localized prostate cancer patients who underwent IGRT was not inferior to those who did not. Advances in knowledge: We demonstrated that the overall survival for prostate cancer patients with IGRT was not worse than those who did not undergo IGRT; this important outcome comparison has not been previously examined in the general population.
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