Post-mastectomy radiotherapy is associated with improved overall survival in T3N0 patients who do not receive chemotherapy

Almahariq, Muayad; Quinn, Thomas J.; Siddiqui, Z.A.; Thompson, Andrew; Jawad, M.S.; Chen, Peter Y.; Gustafson, G.; Dilworth, J.T.

doi:10.1016/j.radonc.2020.01.022

Cited by 15 publications

(19 citation statements)

References 28 publications

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“…Covariates with p < 0.1 in the UVA were incorporated in multivariate Cox proportional hazards regression modeling using backward stepwise methodology to mitigate collinearity of variables and overfitting of the final MVA model. These methods were performed as described in our previous work [13].…”

Section: Discussionmentioning

confidence: 99%

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The Association of Radiation Therapy and Chemotherapy on Overall Survival in Merkel Cell Carcinoma: A Population-Based Analysis

Vayntraub¹,

Tayeb²,

Squires³

et al. 2021

Cureus

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Purpose/objective(s)Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neoplasm traditionally managed with surgical resection followed by radiotherapy (RT). With the recent approval of checkpoint inhibitors, chemotherapy is less commonly utilized. We analyzed the impact of RT and chemotherapy on overall survival (OS) in patients with MCC using Surveillance, Epidemiology, and End Results (SEER), a population-level database. Materials and methodsWe performed retrospective analyses on SEER 18 Custom Data registries for MCC (ICD-0-3 8247). Data from 1980 to 2016 was queried for analysis, and an initial list of 9,792 patients was populated (ICD: C00, C07.9, C44, C80.9). Selection for cases with chemotherapy and RT status, single primary tumor, primary tumor location and surgery treatment type yielded 5,002 cases for analysis. Baseline characteristics were compared with Chi-square or Mann-Whitney U test. Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment weighting (IPTW) was used to account for indication bias. ResultsMedian follow-up time was 178 months (68 to 217 months). Independent prognostic factors positively correlated with increased OS, for both unadjusted Multivariate analysis and IPTW adjusted MVA were age, male sex, year of diagnosis, stage, RT status, and chemotherapy status. On adjusted MVA, use of chemotherapy was associated with worse OS (hazard ratio: 1.22 [95% CI 1.1-1.35], p<0.001), whereas RT was associated with improved OS (HR:0.9 [95% CI, 0.83-0.97], p=0.008). ConclusionsThe current study demonstrates that RT is associated with improved survival for patients with MCC. Chemotherapy was associated with worse OS. This supports the recent clinical shift towards immune checkpoints inhibitors as standard of care in the metastatic setting, and promising trials in the adjuvant and advanced settings.

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Section: Discussionmentioning

confidence: 99%

“…A PS-matched analysis was performed to account for indication bias. Propensity scores were estimated using binary logistic regression modeling for receipt of no/unknown chemotherapy or chemotherapy [13]. Next, IPTW were calculated as 1/PS and 1/(1-PS) [14].…”

Section: Discussionmentioning

confidence: 99%

The Association of Radiation Therapy and Chemotherapy on Overall Survival in Merkel Cell Carcinoma: A Population-Based Analysis

Vayntraub¹,

Tayeb²,

Squires³

et al. 2021

Cureus

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“…Multivariable analysis (MVA) of patient characteristics and OS was performed using Cox proportional hazards regression modeling. Covariates with P<0.1 in the UVA were incorporated in multivariable cox proportional hazards regression modeling using backward stepwise methodology to mitigate collinearity of variables and overfitting of the final MVA model (21).…”

Section: Discussionmentioning

confidence: 99%

A population-based analysis of chemoradiation versus radiation alone in the definitive treatment of patients with stage I–II squamous cell carcinoma of the anus

Parzen¹,

Vayntraub²,

Squires³

et al. 2021

J Gastrointest Oncol

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Background: The optimal management of patients with stage I-II squamous cell carcinoma (SCC) of the anus is controversial. The current study evaluates the efficacy of combined chemotherapy and radiation therapy (CRT) versus radiation therapy (RT) alone in the treatment of these patients using the Surveillance, Epidemiology, and End Results (SEER) registries.Methods: SEER 18 Custom Data registries were queried for patients with stage I-II SCC of the anus.Univariate analysis (UVA) and multivariable analysis (MVA) using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment weighting (IPTW) was used to account for indication bias.Results: A total of 4,288 patients with stage I-II disease were identified, of whom 3,982 (93%) underwent CRT and 306 (7%) underwent RT. Median follow-up was 42 months. Approximately 30.8% had T1 disease and 69.2% had T2-T3 disease. The IPTW-adjusted 5-year overall survival (OS) was 76.7%, with no significant differences between the CRT and RT groups (77% vs. 73.5%, P=0.33). On multivariate IPTWadjusted analysis, the lack of association between CRT use and OS was upheld (HR, 0.84, 95% CI, 0.65-1.08, P=0.2). On subgroup analyses, 5-year OS was 86% with CRT (n=1,216) and 84.2% with RT (n=103) (P=0.74) in stage I (T1N0) patients, while 5-year OS was 72.8% with CRT (n=2,766) and 66.4% with RT (n=203) (P=0.13) in stage II (T2-3N0) patients. CRT was associated with improved median OS in stage II patients (119 months vs. not reached, P=0.04). Conclusions:The current study suggests that omission of concurrent chemotherapy is not associated with inferior OS in patients with stage I SCC of the anus. However, combined chemoradiation was superior to radiation alone in patients with stage II disease. Prospective evidence is needed to optimize clinical decisionmaking in this patient population.

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“…Subsequently, inverse probability of treatment weights (IPTW) were calculated as 1/PS and 1/(1-PS) (20). Finally, IPTW-adjusted UVA KM and doubly robust MVA cox proportional hazards regression modeling was performed (21)(22)(23). Subgroup analyses were assessed for heterogeneity using I2.…”

Section: Original Articlementioning

confidence: 99%

Rectal cancer in young patients: incidence and outcome disparities

Quinn¹,

Kabolizadeh²

2020

J Gastrointest Oncol

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Background: There is an alarming rise in incidence among young patients with rectal cancer. The National Cancer Database (NCDB) and Surveillance, Epidemiology, and End Results Analysis (SEER) databases may help identify population level disparities in incidence and cancer-related outcomes. Methods: A total of 197,178 patients within the SEER 18 registry and 221,886 patients from the NCDB database with rectal cancer were evaluated in this retrospective cohort study. The analyzed cohort consisted of young (<50), white or African American patients. Indication bias was mitigated by conducting inverse probability of treatment weighted analysis using binary logistic regression modeling to determine propensity score for being white or African American. Results: A total of 6,144 young patients were identified from the SEER 18 registry and a total of 17,819 young patients were identified from the NCDB. From 1990 to 2016, there was a significant change in rectal cancer incidence, with a steadily increasing APC of 3.06 (P<0.05). The was no overall change in age-adjusted APC among young African American patients (APC 0.00, P=1); however, there was a significant increase among young white patients (APC 2.97, P<0.05). There was an increased incidence for both stage III and IV among young rectal cancer patients, with an age-adjusted APC of 5.35 and 3.83, respectively (P<0.05). After propensity score matching and inverse probability of treatment weighting, young African Americans had worse overall survival in both the NCDB and SEER (HR 1.1-1.3, P<0.05) databases. This disparity was also seen for cancer-specific survival (HR 1.5, P=0.002). Conclusions:The current study adds to the growing body of literature demonstrating an alarming increase in incidence of rectal cancer among young patients. Moreover, the incidence appears to be increasing particularly among young white patients and driven by stage III disease.

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Post-mastectomy radiotherapy is associated with improved overall survival in T3N0 patients who do not receive chemotherapy

Cited by 15 publications

References 28 publications

The Association of Radiation Therapy and Chemotherapy on Overall Survival in Merkel Cell Carcinoma: A Population-Based Analysis

The Association of Radiation Therapy and Chemotherapy on Overall Survival in Merkel Cell Carcinoma: A Population-Based Analysis

A population-based analysis of chemoradiation versus radiation alone in the definitive treatment of patients with stage I–II squamous cell carcinoma of the anus

Rectal cancer in young patients: incidence and outcome disparities

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