Role of Marital Status on the Prognosis in Esophagus Adenocarcinoma: a Real-World Competing Risk Analysis

Lan, Tian; Liu, Weiguo; Lu, Yunyan; Ren, Zheng; Luo, Hua; Shao, Xiaorong; He, Jinlan

doi:10.2217/fon-2020-0613

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…In a previous study, Wang et al 15 found that marital status was an independent factor affecting the prognosis of patients with Siewert II adenocarcinoma of the esophagogastric junction, as evidenced by worse OS in unmarried patients. Similarly, in male esophageal cancer patients, Lan et al 16 discovered that being unmarried functioned as an independent risk factor for CSS. The influence of marital status on the prognosis of patients with esophageal cancer may be linked to the care and emotional support provided by their partner during treatment and recovery.…”

Section: Discussionmentioning

confidence: 94%

Surgery Adherence and Survival Outcomes in Patients With Locally Advanced (IIA-IVA) Cancer of the Lower Esophagus: A SEER Database-Based Study

Liu,

Chen,

2024

The American Surgeon™

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Background Esophageal cancer is a prevalent malignant tumor of the upper gastrointestinal tract. The aim of this study was to examine the impact of surgical adherence on the prognosis of patients with locally advanced lower esophageal cancer and to analyze the factors that affect surgical adherence. Methods Patients diagnosed with locally advanced (IIA-IVA) lower esophageal cancer between 2004 and 2015 were screened from the Surveillance, Epidemiology, and End Results (SEER) database. We utilized multifactorial logistic regression to analyze the correlates affecting surgical adherence. Furthermore, we employed Kaplan-Meier curves and Cox regression to determine the impact of surgical adherence on cancer-specific survival (CSS) and overall survival (OS). Results Of the 4922 patients screened, 2372 individuals were advised to undergo surgery, out of which 2025 ultimately underwent the procedure while the remaining 347 refused. Lower surgical adherence was associated with older age, unmarried, SEER classification of “distant,” and squamous cell carcinoma. Adherence to surgery proved to be an independent factor affecting OS and CSS. The Cox regression analysis showed that patients who refused surgery had lower OS ( OR: 1.657; 95% CI: 1.429∼1.927; P < .001) and CSS ( OR: 1.487; 95% CI: 1.309∼1.690; P < .001) than those who underwent surgery. Kaplan-Meier curves showed that patients who underwent surgical treatment had a better prognosis. Discussion Good surgical adherence can improve the prognosis of patients with locally advanced (IIA-IVA) lower esophageal cancer, while poor surgical adherence is associated with older age, unmarried, SEER classification of “distant,” and squamous cell carcinoma.

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Section: Discussionmentioning

confidence: 94%

Surgery Adherence and Survival Outcomes in Patients With Locally Advanced (IIA-IVA) Cancer of the Lower Esophagus: A SEER Database-Based Study

Liu,

Chen,

2024

The American Surgeon™

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“…Recent years have witnessed a growing exploration of psychosocial factors in the context of malignant tumors. Marital status, among these critical psychosocial factors, has been substantiated to exert a pronounced influence on the etiology and survival prospects of numerous cancers, esophageal cancer included ( 30 – 33 ). A meta-analysis conducted in 2023 showed that married patients had higher OS and CSS rates than those who were unmarried, regardless of the type of cancer ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it unveiled that the older the age, the graver the patient's prognosis. The median age at which esophageal cancer is diagnosed typically hovers around 65 years, and with the gradual aging of the population, there is a noticeable increase in the proportion of elderly patients (28) Frontiers in Immunology frontiersin.org status, among these critical psychosocial factors, has been substantiated to exert a pronounced influence on the etiology and survival prospects of numerous cancers, esophageal cancer included (30)(31)(32)(33). A meta-analysis conducted in 2023 showed that married patients had higher OS and CSS rates than those who were unmarried, regardless of the type of cancer (34).…”

Section: B Amentioning

confidence: 99%

Survival benefit of combined immunotherapy and chemoradiotherapy in locally advanced unresectable esophageal cancer: an analysis based on the SEER database

Xie,

Zhang

2024

Front. Immunol.

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BackgroundWhile simultaneous chemoradiotherapy remains the established therapeutic modality for patients afflicted with locally advanced esophageal cancer, the effectiveness of this radical approach falls short of the desired outcome. Numerous investigations have illuminated the prospect of enhancing therapeutic efficacy through the amalgamation of chemoradiotherapy and immunotherapeutic interventions. Consequently, we embarked on an examination to scrutinize the potential survival advantages conferred by the confluence of chemoradiotherapy and immunotherapy in relation to locally advanced unresectable esophageal carcinoma, drawing upon the extensive SEER database for our analysis.MethodsWe extracted clinicopathological attributes and survival statistics of patients afflicted with locally advanced unresectable esophageal carcinoma, diagnosed within the temporal span encompassing the years 2004-2014 and 2019-2020, from the extensive SEER database. To discern disparities in both overall survival (OS) and cancer-specific survival (CSS) between the cohorts subjected to chemoradiotherapy combined with immunotherapy and chemoradiotherapy alone, we employed analytical tools such as Kaplan-Meier analysis, the Log-rank test, the Cox regression proportional risk model, and propensity-matched score (PSM) methodology.ResultsA total of 7,758 eligible patients were encompassed in this research, with 6,395 individuals having undergone chemoradiotherapy alone, while 1,363 patients received the combined treatment of chemoradiotherapy and immunotherapy. After 1:4 propensity score matching, 6,447 patients were successfully harmonized, yielding a well-balanced cohort. The Kaplan-Meier curves demonstrated a substantial enhancement in OS (P = 0.0091) and CSS (P < 0.001) for the group subjected to chemoradiotherapy combined with immunotherapy as compared to chemoradiotherapy alone. Further multivariable analysis with PSM confirmed that chemoradiotherapy combined with immunotherapy benefits OS(HR=0.89, 95% CI 0.81-0.98) and CSS (HR=0.68, 95% CI 0.61-0.76). In addition, Univariable and multivariable Cox regression analyses of the matched patient groups unveiled several independent prognostic factors for OS and CSS, including sex, age, marital status, tumor location, tumor size, pathologic grade, SEER historic staging, and treatment modality. Among these factors, being female, married, and receiving chemoradiotherapy combined with immunotherapy emerged as independent protective factors, while age exceeding 75 years, non-superior segment tumor location, tumor size greater than 6 cm, Grade 3-4 pathology, and regional SEER historic staging were all found to be independent risk factors. The survival advantage of the chemoradiotherapy combined with the immunotherapy group over the chemoradiotherapy alone group was substantial.ConclusionsThis investigation furnishes compelling evidence that the integration of immunotherapy with chemoradiotherapy confers a noteworthy survival advantage when contrasted with conventional chemoradiotherapy for individuals grappling with locally advanced unresectable esophageal carcinoma.

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“…However, due to a lack of demographic information, the AJCC system is not a perfect predictor of CSS in EC patients. Previous studies have confirmed that age at diagnosis, gender, race, marital status, and occupation are significantly associated with cancer survival (8)(9)(10). In the establishment of prognostic models for patients with EC, the prognostic value is limited due to the relatively limited sample size (11,12).…”

Section: Discussionmentioning

confidence: 99%

Sex differences in cancer-specific survival for locally advanced esophageal cancer after neoadjuvant chemoradiotherapy: A population-based analysis

Wang

Zhang

et al. 2022

Front. Surg.

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ObjectiveNeoadjuvant chemoradiotherapy (nCRT) is the recommended standard treatment for locally advanced esophageal cancer (LA-EC). This study aimed to determine whether sex makes a difference in cancer-specific survival (CSS) and construct a novel nomogram model to predict CSS for LA-EC after nCRT based on the SEER database.MethodsPatients coded by 04–15 were identified from the SEER database. Patients with systemic treatment and radiotherapy before surgery were defined as nCRT. We further divided this population into a training group and a verification group at a ratio of 7:3. Univariate and multivariate cox analyses were applied to determine the prognostic risk factors based on the training cohort, and then the Nomogram model was established. The area under the curve (AUC) was used to evaluate the predictive ability of the model. We used the calibration curve to evaluate the consistency between the predicted status and actual status and decision curve analysis (DCA) to evaluate the clinical value. We used X-tile software to determine the best cut-off value of nomogram scores and divided the population into low-risk, medium-risk, and high-risk groups, and Kaplan-Meier analysis was applied to compare the CSS.ResultsA total of 2096 LA-EC patients were included for further analysis, with 1,540 in the training cohort and 656 in the validation group. Male (HR: 1.29, 95% CI, 1.04 −1.58), T stage, N stage, and M stage were identified as independent risk factors of CSS based on the training cohort. A Nomogram model was constructed to predict the 3-, 5- and 7-years CSS. ROC curve and AUC confirmed that this nomogram has median discrimination ability. The calibration curve showed good agreement between predicted status and actual status. The DCA curves confirmed the clinical value. Kaplan-Meier analysis indicated that patients in the high-risk subgroup had poorer CSS in both the training cohort and validation cohort (P < 0.001).ConclusionMale patients had poorer CSS in LA-EC patients after nCRT. A nomogram model composed of sex, T stage, N stage, and M stage was constructed to identify the high-risk population and provide a personalized follow-up plan.

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Role of Marital Status on the Prognosis in Esophagus Adenocarcinoma: a Real-World Competing Risk Analysis

Cited by 4 publications

References 24 publications

Surgery Adherence and Survival Outcomes in Patients With Locally Advanced (IIA-IVA) Cancer of the Lower Esophagus: A SEER Database-Based Study

Surgery Adherence and Survival Outcomes in Patients With Locally Advanced (IIA-IVA) Cancer of the Lower Esophagus: A SEER Database-Based Study

Survival benefit of combined immunotherapy and chemoradiotherapy in locally advanced unresectable esophageal cancer: an analysis based on the SEER database

Sex differences in cancer-specific survival for locally advanced esophageal cancer after neoadjuvant chemoradiotherapy: A population-based analysis

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