Examining Surgical Outcomes for Thoracic Cancers within a Clinical Setting: A Clinical Epidemiologic Perspective

Surgical outcomes;Clinical epidemiology;Esophageal Adenocarcinoma;Non-small cell lung cancer;HIV-related lung cancer;Epidemiology

Hooker, Craig MitchellKanarek, Norma F. ;

Johns Hopkins University

关键词: Surgical outcomes;    Clinical epidemiology;    Esophageal Adenocarcinoma;    Non-small cell lung cancer;    HIV-related lung cancer;    Epidemiology;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39339/HOOKER-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

AbstractBackground: Lung and esophageal cancer rank among cancers associated with the highest mortality both in the United States and the World. Surgical intervention provides the best opportunity for cure for these cancers.Objectives: The objective was to identify factors associated with outcomes in surgical patients with thoracic cancers within a single hospital setting. We sought to achieve this goal with three aims, 1) examine the association between adjuvant chemotherapy and mortality among esophageal adenocarcinoma patients who received combined neoadjuvant chemoradiation therapy followed by surgery, 2) investigate differences by race on recommendation for surgery and survival among early stage non-small cell lung cancer (NSCLC) patients, and 3) determine the effect of HIV infection on post-surgical outcomes among NSCLC patients.Methods: Data from the Johns Hopkins Hospital Cancer Registry were used for the retrospective cohort study designs and analyses. The Kaplan-Meier method was used to illustrate time to postoperative events. To estimate associations with postoperative mortality we applied Cox proportional hazards regression models. Poisson regression with robust variance was used to estimate the prevalence ratio of surgical recommendation. Results: Aim 1: There was a long-term survival benefit following surgery for patients who received adjuvant chemotherapy compared to no adjuvant chemotherapy (median survival in months: 37.9 vs. 24.7; p=0.057, respectively). Receipt of adjuvant chemotherapy was associated with a 25% decrease in the aHR for postoperative mortality compared to patients who did not receive adjuvant chemotherapy (0.75; 95% CI 0.55-1.01). Aim 2: Black patients were 8% less likely to be recommended surgical resection as compared to white patients (crude RR=0.92, 95% CI 0.86-0.98), but this association became null after controlling for patient-, tumor-, and physician-related factors (aRR=0.99, 95% CI 0.93-1.05). There was no significant association between race and mortality (aHR=1.17, 95% CI 0.89-1.55).Aim 3: The median survival time for HIV-infected cancer patients was significantly shorter than for HIV-unspecified patients (26 vs. 48 months; p=0.001). Mortality among HIV-infected patients was more than threefold that of HIV-unspecified patients (aHR=3.08; 95% CI 1.85-5.13). When additional surgical characteristics were modeled in a matched sub-cohort, the association remained statistically significant (aHR=2.31; 95% CI 1.11-4.81). Conclusions: Adjuvant chemotherapy for patients with locally advanced esophageal adenocarcinoma was associated with reduced postoperative mortality compared to no adjuvant chemotherapy. Race was not independently associated with surgical recommendation or mortality for early stage NSCLC. After surgery, HIV-infected NSCLC patients have poorer survival than HIV-unspecified NSCLC patients.Thesis Advisor:Elizabeth A. Platz, ScD, MPH, Department of EpidemiologyThesis Readers:Norma Kanarek, PhD, MPH, Department of Environmental Health Sciences (chair)Lisa P. Jacobson, ScD, MS, Department of EpidemiologyMalcolm V. Brock, MD, Departments of Surgery and OncologyElizabeth Sugar, PhD, Department of Biostatistics Gregory D. Kirk, MD, PhD, MPH, Department of Epidemiology