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Title: Validated Competing Event Model for the Stage I-II Endometrial Cancer Population

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 diminishingmore » 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.« less

Authors:
; ;  [1];  [2]; ;  [1];  [3];  [1];  [4];  [1]
  1. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California (United States)
  2. Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts (United States)
  3. Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California San Diego, La Jolla, California (United States)
  4. Department of Family and Preventive Medicine, Biostatistics and Bioinformatics, University of California San Diego Medical Center, San Diego, California (United States)
Publication Date:
OSTI Identifier:
22420376
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 89; Journal Issue: 4; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; DIAGNOSIS; EPIDEMIOLOGY; HAZARDS; MEDICAL SURVEILLANCE; MORTALITY; PATIENTS; WOMEN

Citation Formats

Carmona, Ruben, Gulaya, Sachin, Murphy, James D., Rose, Brent S., Wu, John, Noticewala, Sonal, McHale, Michael T., Yashar, Catheryn M., Vaida, Florin, and Mell, Loren K., E-mail: lmell@ucsd.edu. Validated Competing Event Model for the Stage I-II Endometrial Cancer Population. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.03.047.
Carmona, Ruben, Gulaya, Sachin, Murphy, James D., Rose, Brent S., Wu, John, Noticewala, Sonal, McHale, Michael T., Yashar, Catheryn M., Vaida, Florin, & Mell, Loren K., E-mail: lmell@ucsd.edu. Validated Competing Event Model for the Stage I-II Endometrial Cancer Population. United States. doi:10.1016/J.IJROBP.2014.03.047.
Carmona, Ruben, Gulaya, Sachin, Murphy, James D., Rose, Brent S., Wu, John, Noticewala, Sonal, McHale, Michael T., Yashar, Catheryn M., Vaida, Florin, and Mell, Loren K., E-mail: lmell@ucsd.edu. Tue . "Validated Competing Event Model for the Stage I-II Endometrial Cancer Population". United States. doi:10.1016/J.IJROBP.2014.03.047.
@article{osti_22420376,
title = {Validated Competing Event Model for the Stage I-II Endometrial Cancer Population},
author = {Carmona, Ruben and Gulaya, Sachin and Murphy, James D. and Rose, Brent S. and Wu, John and Noticewala, Sonal and McHale, Michael T. and Yashar, Catheryn M. and Vaida, Florin and Mell, Loren K., E-mail: lmell@ucsd.edu},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2014.03.047},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 89,
place = {United States},
year = {Tue Jul 15 00:00:00 EDT 2014},
month = {Tue Jul 15 00:00:00 EDT 2014}
}