Conditional survival analysis of stage Ⅲ and Ⅳ rectal cancer based on SEER database
Objective To analyze the changes in conditional survival(CS)of patients with stage Ⅲ and Ⅳ rectal cancer,and explore the factors of changes.Methods Rectal cancer patients with clinical or pathologic diagnosis of stage Ⅲ and Ⅳ from 2010 to 2015 were collected from the SEER database.CS was the probability of patients who had survived for X years surviving for another Y years.Independent risk factors were screened using Cox proportional regression analysis and Lasso analysis for both groups of cases,and CS subgroup analysis was performed based on the screened risk factors.Changes in risk factors were assessed by standardized difference(d).Results A total of 4 147 stage Ⅲ and 2 048 stage Ⅳ rectal cancer cases were collected.The overall survival(OS)of stage Ⅲ decreased year by year(95.2%→71.0%);the corresponding CS3 increased year by year(79.5%→82.9%).The OS of stage Ⅳ decreased year by year(69.1%→17.3%);the corresponding CS3 increased year by year(32.6%→68.3%).The rise in stage Ⅲ was much lower than that in stage Ⅳ(3.4%vs.35.7%).CS subgroup analysis showed that the independent risk factors of age≥50years,histologic grade Ⅱ～Ⅲ,T3～T4 staging,N2 staging,not receiving chemotherapy and CEA positivity persisted in stage Ⅲ(|d|>0.1),and the risk factors of non-marital status and histologic grade Ⅳ faded away(|d|>0.1→|d|<0.1);in stage Ⅳ,the independent risk factors of non-marital status,histological grade Ⅳ,not undergoing surgery,cleared lymph nodes<4 groups,not receiving radiotherapy,TX staging,bone metastasis,lung metastasis,not receiving radiotherapy,CEA positivity and tumor size>5cm persisted,and the risk of these factors of age≥50years,histological grade Ⅲ and T4 staging gradually disappeared.Conclusion Patients with stage Ⅲ and Ⅳ rectal cancer who survived beyond 2 years post-diagnosis demonstrate improved expected survival rates compared to initial estimates.Identification of time-dependent factors underscores the importance of continued aggressive interventions tailored to post-systemic therapy.
Conditional survival rateSEER databaseRectal cancer
万方数据
维普
