Survival Statistics Gone Awry

Gudjonsson, Birgir

doi:10.1097/00004836-200208000-00011

Cited by 46 publications

(17 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, surgical resection in patients with localized pancreatic cancer is still underused [14]. Retrospective analyses of data from patients treated in our department between 1996 and 2005 revealed a 5-year survival rate of 20% for R0 patients, which is in agreement with the literature, even though some authors deny the existence of 5-year survivors [4]. With respect to the classification of the pancreatic head resections evaluated retrospectively, the percentage of R1 resections (22.6%) also mirrors the literature [12, 15, 23, 27].…”

Section: Discussionsupporting

confidence: 80%

The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials

Gaedcke

Gunawan

Grade

et al. 2009

Langenbecks Arch Surg

131

View full text Add to dashboard Cite

PurposeThe prognosis of patients with pancreatic cancer remains poor, even after potentially curative R0 resection. This discrepancy may be due to the histopathological misclassification of R1 cases as curative resections (R0) in the past.Materials and methodsTo test this hypothesis, color coding of all resection margins and organ surfaces as part of a standardized histopathological workup was implemented and prospectively tested on 100 pancreatic head specimens.ResultsThirty-five patients were excluded from the analysis owing to the pathohistological diagnosis; only pancreatic ductal adenocarcinoma, distal bile duct adenocarcinoma, and periampullary adenocarcinoma were included. Applying the International Union Against Cancer criteria, 32 cancer resections were classified R0 (49.2%), while 33 cases turned out to be R1 resections (50.8%). The mesopancreas was infiltrated in 22 of the 33 R1 resection specimens (66.6%). It proved to be the only site of tumor infiltration in 17 specimens (51.5%). Applying the Royal College of Pathologists’ criteria, 46 resections were classified R1 (70.8%). As expected, the mesopancreas again was the most frequent site of noncurative resection (n = 27; 58.7%).ConclusionUsing the intensified histopathological workup for pancreatic head cancer specimens resulted in an increased rate of R1 resections and the mesopancreas represents the primary site for positive resection margins. Such results are of relevance for patients’ stratification in clinical trials.

show abstract

Section: Discussionsupporting

confidence: 80%

The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials

Gaedcke

Gunawan

Grade

et al. 2009

Langenbecks Arch Surg

131

View full text Add to dashboard Cite

show abstract

“…It is usually too late for operation. 2) As mentioned by Gudjonsson [26], hospital-based follow-up studies tended to backtrack and figure out the actual number of survivors from the actuarial figures without knowing how many patients were lost to follow-up and when. Since Kaplan-Meier method has no limitation and no compulsory explanation on losses (censoring), the survival rates by Kaplan-Meier methods would be overestimated as increased censoring happened especially for those hospital-based pancreatic cancer studies.…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Survival Rate of Population-Based Pancreatic Cancer Patients: Shanghai Cancer Registry 2004–2009

Luo

Xiao

et al. 2013

PLoS ONE

View full text Add to dashboard Cite

BackgroundPancreatic cancer is a devastating disease with dismal prognosis. Large population-based evidence on its survival rate and influence factors is lacking in China.ObjectiveThis study aimed to depict the demographic factors, tumor characteristics, incidence rate and survival rate of pancreatic cancer cases in urban China.MethodsThe demographic factors, tumor characteristics were collected for all the pancreatic cancer cases identified during 2004 to 2009 from the Shanghai Cancer Registry. The survival time was ascertained through linkage of the Shanghai Cancer Registry and the Shanghai Vital Statistics Registry. The deadline of death certificates was the end of December 2012. Kaplan-Meier method and Cox proportional-hazards regression model were used to explore the survival rate and influence factors.Results11,672 new pancreatic cancer cases were identified among Shanghai residency during 2004 to 2009. The crude incidence rate of pancreatic cancer was increasing from 12.80/100,000 in 2004 to 15.66/100,000 in 2009, while the standardized incidence rate was about 6.70/100,000 and didn't change a lot. The overall 5-year survival rate was 4.1% and the median survival time was 3.9 (95% Confidence Interval (CI) 3.8–4.0) months. Subjects had received surgical resection had improved survival (HR = 0.742, 95% CI: 0.634–0.868) than its counterparts. In adjusted multivariable Cox proportional-hazard models, factors associated with poor survival included older age at diagnosis (age > = 70 years: hazard ratio (HR) = 1.827, 95% CI: 1.614–2.067), male sex (HR = 1.155, 95% CI: 1.041–1.281), distant disease at diagnosis (HR = 1.257, 95% CI: 1.061–1.488), positive lymph node (HR = 1.236, 95% CI: 1.085–1.408), tumor stage (Stage IV HR = 2.817, 95% CI: 2.029–3.909).ConclusionThe age-adjusted incidence rate was stable and overall survival rate was low among pancreatic cancer patients of Shanghai residency. Early detection and improved treatment strategies are needed to improve prognosis for this deadly disease.

show abstract

“…The actual number of survivors with actuarial calculation is therefore known in 205 of the 424 reports or 48.3%. The actuarial and actual percentage figures can therefore be compared, as demonstrated previously [29, 30], and reveal that the actuarial percentage is on average 2.75 higher than the actual percentage. This figure has therefore been used to estimate the number of survivors and the survival percentage in the relevant studies where only the actuarial percentage has been published.…”

Section: Survival Calculationsmentioning

confidence: 86%

Pancreatic Cancer: 80 Years of Surgery—Percentage and Repetitions

Gudjonsson¹

2016

HPB Surgery

Self Cite

View full text Add to dashboard Cite

Objective. The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be $79,800 per patient and for each resection $164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage. Methods. Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented. Results. The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial percentage is on average 2.75 higher. Detailed information on the original group (TN), number of resections, and actual number of survivors is reported in only 10.6% of the papers. Repetition occurs when the patients from a certain year are reported several times from the same institution or include survivors from many institutions or countries. Each 5-year survivor may be reported several times. Conclusion. Assuming a 10% resection rate and correcting for repetitions and the life table percentage the overall actual survival rate is hardly more than 0.3%.

show abstract

Survival Statistics Gone Awry

Cited by 46 publications

References 45 publications

The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials

The mesopancreas is the primary site for R1 resection in pancreatic head cancer: relevance for clinical trials

The Incidence and Survival Rate of Population-Based Pancreatic Cancer Patients: Shanghai Cancer Registry 2004–2009

Pancreatic Cancer: 80 Years of Surgery—Percentage and Repetitions

Contact Info

Product

Resources

About