Ruben Carmona1, Sachin Gulaya1, James D Murphy1, Brent S Rose2, John Wu1, Sonal Noticewala1, Michael T McHale3, Catheryn M Yashar1, Florin Vaida4, Loren K Mell5. 1. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California. 2. Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts. 3. Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California. 4. Department of Family and Preventive Medicine, Biostatistics and Bioinformatics, University of California San Diego Medical Center, San Diego, California. 5. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California. Electronic address: lmell@ucsd.edu.
Abstract
PURPOSE/OBJECTIVES(S): Early-stage endometrial cancer patients are at higher risk of noncancer mortality than of cancer mortality. Competing event models incorporating comorbidity could help identify women most likely to benefit from treatment intensification. METHODS AND MATERIALS: 67,397 women with stage I-II endometrioid adenocarcinoma after total hysterectomy diagnosed from 1988 to 2009 were identified in Surveillance, Epidemiology, and End Results (SEER) and linked SEER-Medicare databases. Using demographic and clinical information, including comorbidity, we sought to develop and validate a risk score to predict the incidence of competing mortality. RESULTS: In the validation cohort, increasing competing mortality risk score was associated with increased risk of noncancer mortality (subdistribution hazard ratio [SDHR], 1.92; 95% confidence interval [CI], 1.60-2.30) and decreased risk of endometrial cancer mortality (SDHR, 0.61; 95% CI, 0.55-0.78). Controlling for other variables, Charlson Comorbidity Index (CCI) = 1 (SDHR, 1.62; 95% CI, 1.45-1.82) and CCI >1 (SDHR, 3.31; 95% CI, 2.74-4.01) were associated with increased risk of noncancer mortality. The 10-year cumulative incidences of competing mortality within low-, medium-, and high-risk strata were 27.3% (95% CI, 25.2%-29.4%), 34.6% (95% CI, 32.5%-36.7%), and 50.3% (95% CI, 48.2%-52.6%), respectively. With increasing competing mortality risk score, we observed a significant decline in omega (ω), indicating a diminishing likelihood of benefit from treatment intensification. CONCLUSION: Comorbidity and other factors influence the risk of competing mortality among patients with early-stage endometrial cancer. Competing event models could improve our ability to identify patients likely to benefit from treatment intensification.
PURPOSE/OBJECTIVES(S): Early-stage endometrial cancer patients are at higher risk of noncancer mortality than of cancer mortality. Competing event models incorporating comorbidity could help identify women most likely to benefit from treatment intensification. METHODS AND MATERIALS: 67,397 women with stage I-II endometrioid adenocarcinoma after total hysterectomy diagnosed from 1988 to 2009 were identified in Surveillance, Epidemiology, and End Results (SEER) and linked SEER-Medicare databases. Using demographic and clinical information, including comorbidity, we sought to develop and validate a risk score to predict the incidence of competing mortality. RESULTS: In the validation cohort, increasing competing mortality risk score was associated with increased risk of noncancer mortality (subdistribution hazard ratio [SDHR], 1.92; 95% confidence interval [CI], 1.60-2.30) and decreased risk of endometrial cancer mortality (SDHR, 0.61; 95% CI, 0.55-0.78). Controlling for other variables, Charlson Comorbidity Index (CCI) = 1 (SDHR, 1.62; 95% CI, 1.45-1.82) and CCI >1 (SDHR, 3.31; 95% CI, 2.74-4.01) were associated with increased risk of noncancer mortality. The 10-year cumulative incidences of competing mortality within low-, medium-, and high-risk strata were 27.3% (95% CI, 25.2%-29.4%), 34.6% (95% CI, 32.5%-36.7%), and 50.3% (95% CI, 48.2%-52.6%), respectively. With increasing competing mortality risk score, we observed a significant decline in omega (ω), indicating a diminishing likelihood of benefit from treatment intensification. CONCLUSION: Comorbidity and other factors influence the risk of competing mortality among patients with early-stage endometrial cancer. Competing event models could improve our ability to identify patients likely to benefit from treatment intensification.
Authors: Iwona Podzielinski; Marcus E Randall; Patrick J Breheny; Pedro F Escobar; David E Cohn; Allison M Quick; Junzo P Chino; Micael Lopez-Acevedo; Jana L Seitz; Jennifer E Zook; Leigh G Seamon Journal: Gynecol Oncol Date: 2011-10-19 Impact factor: 5.482
Authors: Pauline T Truong; Hosam A Kader; Barbara Lacy; Mary Lesperance; Mary V MacNeil; Eric Berthelet; Elissa McMurtrie; Skaria Alexander Journal: Am J Clin Oncol Date: 2005-04 Impact factor: 2.339
Authors: C L Creutzberg; W L van Putten; P C Koper; M L Lybeert; J J Jobsen; C C Wárlám-Rodenhuis; K A De Winter; L C Lutgens; A C van den Bergh; E van de Steen-Banasik; H Beerman; M van Lent Journal: Lancet Date: 2000-04-22 Impact factor: 79.321
Authors: Loren K Mell; Hanjie Shen; Phuc Felix Nguyen-Tân; David I Rosenthal; Kaveh Zakeri; Lucas K Vitzthum; Steven J Frank; Peter B Schiff; Andy M Trotti; James A Bonner; Christopher U Jones; Sue S Yom; Wade L Thorstad; Stuart J Wong; George Shenouda; John A Ridge; Qiang E Zhang; Quynh-Thu Le Journal: Clin Cancer Res Date: 2019-08-16 Impact factor: 12.531