Kim Ellen, Koroukian Siran, Thomas Charles R
*Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland, Ohio; †Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio; and ‡Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
J Thorac Oncol. 2015 Oct;10(10):1490-7. doi: 10.1097/JTO.0000000000000649.
Conditional survival can provide valuable predictive information for both patients and caregivers for patients surviving over time. The purpose of this study was to estimate conditional survival for esophageal cancer patients through analysis of a national population-based cancer registry.
This retrospective cohort study analyzed 64,433 patients within the Surveillance, Epidemiology, and End Results (SEER) data set who were diagnosed with esophageal cancer from 1988 to 2011. Covariates included cancer characteristics and demographics. Overall survival (defined as time from diagnosis until death), cause-specific survival (defined as time from diagnosis until death from cancer), and 5-year conditional survivals (the probability of surviving an additional 5 years) were calculated. Significant prognostic variables of univariate and multivariable models of survival were identified.
The multivariable models of overall and cause-specific survivals included gender, age group, race, relationship status, year of diagnosis, site, grade, histology, and stage group. Although all patients showed an improvement in conditional survival over time, more dramatic improvements were seen in more advanced stage groups. At the 5-year mark, conditional cause-specific survival of distant stage (defined as having spread by direct extension or metastasis to distant organs, tissues, or lymph nodes) increased from 4% to 79%, whereas regional stage increased from 18% to 77% and localized stage increased from 38% to 85%.
Conditional survival showed improving prognosis over time. Patients with advanced stage had the most dramatic improvement. Clinicians, caregivers, and patients with esophageal cancer can feel encouraged by the improving prognosis with each year survived. This information has practical implications regarding longitudinal follow-up guidelines and survivorship planning.
条件生存可为随时间存活的患者及其护理人员提供有价值的预测信息。本研究的目的是通过分析基于全国人群的癌症登记数据来估计食管癌患者的条件生存情况。
这项回顾性队列研究分析了监测、流行病学和最终结果（SEER）数据集中1988年至2011年被诊断为食管癌的64433例患者。协变量包括癌症特征和人口统计学信息。计算了总生存（定义为从诊断到死亡的时间）、特定病因生存（定义为从诊断到死于癌症的时间）和5年条件生存（额外存活5年的概率）。确定了生存单变量和多变量模型的显著预后变量。
总生存和特定病因生存的多变量模型包括性别、年龄组、种族、婚姻状况、诊断年份、部位、分级、组织学类型和分期组。尽管所有患者的条件生存都随时间有所改善，但在更晚期的分期组中改善更为显著。在5年时，远处转移期（定义为通过直接蔓延或转移至远处器官、组织或淋巴结）的条件特定病因生存从4%增加到79%，区域期从18%增加到77%，局限期从38%增加到85%。
条件生存显示预后随时间有所改善。晚期患者的改善最为显著。食管癌患者、临床医生和护理人员可以因每年存活带来的预后改善而受到鼓舞。这些信息对于纵向随访指南和生存规划具有实际意义。
