Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)
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Perhaps women will go to the doctor sooner rather than take tums for a year as most men do before looking into stomach pain at the doctors.
Below is the first survival plot that I have made showing the impact of resection. Instead of plotting resection against no resection, I decided to divide no resection into two groups, those where resection was denied a patient because of distant mets and where it was denied for other reasons such as blood vessel involvement. Since distant mets (M1) are responsible for the highest stage level of cc (IVB for intrahepatic and perihilar cc and IV for extrahepatic cc), I assumed there would be a considerable separation in the distant mets vs. no distant mets curves. Surprisingly, there was very little.
Statistics for the data was chisq = 63.5, 2 degrees of freedom, and p=1.64e-14. Medians survivals were 3.373 years for resections, 0.914 years for no resection with no distant mets, and 0.753 years for no resection with distant mets.
Bruce
Hi Willow,
I have your sister in my database along with her getting radioembolization, but I have her separated from the main cc group since she may have mixed IHCC & HCC. That’s why she didn’t show up on my list. I also have lulu07 and holly22a with this same mixed diagnosis in this group. The group also contains JeffG, a 10 year survivor, who in an early post stated that they couldn’t determine if he had cc or gallbladder cancer, and many others who had other cancers or there was no evidence that they, or someone they knew, had cc.
Bruce
My sister stats:
Age 49 at dx in Aug ’12
Only symptom pain at night upper rt abdomen (never has had jaundice or stents)
Intrahepatic CC possibly a combo type hybrid w Hepatocellular carcinoma
Stage 3 Main Portal vein invasion and multiple tumors in liver but no lymph nodes or distant mets at dx
Chemo gem/Cis tried short time (3mos) but too hard on blood counts and so never completed a full cycle and meanwhile tumors grew.
Radioembolization Jan ’13
Waiting to have scans in AprilHi Percy,
I am producing these plots as I gather sufficient data for the plot to be statistically significant. I have generated other plots and found them to be statistically insignificant (p>.05), so I haven’t posted them.
A this time I am trying to create a plot comparing survival for the following three variables:
(1) Patients who were initially diagnosed with distant mets and could not be resected.
(2) Patients who were initially diagnosed with other than distant mets and could not be resected.
(3) Patients who were resected both initially and at a later time, but did not have a transplant.Eventually, I will get around to plots which include comparisons between the three types of CC (intrahepatic, perihilar, and extrahepatic) types of chemo, radioembolization, etc., but I need to wait to build up the database before doing this, because I know I just do not have enough data for the more detailed categories.
Of course, if you would like to search the posts and develop an Excel spreadsheet with the variables in which you are interested, I would be more than happy to enter them into the R program and produce the survival curves for you.
Bruce
Yes, I’ve seen a few papers that refer to radioembolization with yttrium microspheres as brachytherapy. Brachytherapy is a generic term that describes any kind of therapy where radiation source is placed inside the body. Radioembolization is a sub-type of brachytherapy.
Eli – Thanks for the clarification of brachytherapy & radioembolization. I believe I connected the two together from the title of the following paper on PubMed.
Bruce
J Vasc Interv Radiol. 2006 Aug;17(
:1251-78.Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations.
Salem R, Thurston KG.
Source
Department of Radiology, Robert H. Lurie Comprehensive Cancer, 676 North St Clair, Suite 800, Chicago, Illinois 60611, USA. r-salem@northwestern.edu
Erratum in
J Vasc Interv Radiol. 2006 Oct;17(10):1594.Abstract
Microsphere and particle technology represent the next-generation agents that have formed the basis of interventional oncology, an evolving subspecialty of interventional radiology. One of these platforms, yttrium-90 microspheres, is rapidly being adopted in the medical community as an adjunctive therapeutic tool in the management of primary and secondary liver malignancies. Given the complexity of the treatment algorithm of patients who may be candidates for this therapy and the need for clinical guidance, a comprehensive review of the methodologic and technical considerations was undertaken. This experience is based on more than 900 (90)Y infusions performed over a 5-year period.
Thanks Eli, I record CC type, surgical margins and node involvement, but not surgical complications.
About 15% of the members of cc.org do not post about themselves or family members or friends that have pure cc. Some of these members discuss medical issues or people with gallbladder cancer or mixed cancers, etc. About 6% of the members include those with multiple IDs or those who discuss the same patient as other members. Of the remainder, a little under half of the members don’t report the CC type of give me enough clues to figure it out. As a result I can identify CC type for about 43% of the members. I have surgeries for about 26% of the members, and surgical margins for about 70%of the surgeries. I have negative and positive node data, but I am missing a lot of those, although it might be safe to assume that most nodes are negative if they are not mentioned in the posts.
As you suggest, my sample right now probably is not large enough to test your hypotheses, but I’ll check them out and see what I get.
Bruce
Bruce,
Just a quick comment about this:
2000miler wrote:So far, I have compiled data for 15% of the patients on these discussion boards and have found only 12 who have had radioembolization. Most of the 12 did not use the term “radioembolization,” but called it brachytherapy (3), Sir-spheres (5), Theraspheres (3), and spheres (1).Brachytherapy and radioembolization are not necessarily the same types of treatments. You can’t lump the two together when you do the analysis.
Brachytherapy: radiation therapy where the source of radiation is placed inside the body. It is also known as internal radiation therapy.
Radioembolization: radiation therapy where the source of radiation is delivered to the tumor through the blood stream.
When the patients use the term “brachytherapy”, you cannot assume they had radioembolization.
Hi,
1.Can you use age 60 instead of 58 to give me a better idea about the picture about the graphs you draw. it may be better for comparison of other medical studies.
2.I would like to see the following graphs if you have time.A. radioembo treatment vs adjuvant chemotherapy in survival outcome .
or length of survival if they still alive. .(ie: use the time of both the staring time for radioembo treatment and the adjuvant chemotherapy, and not the time of DX.). you can included the sex and age(60) on the graph. if you wants to.Please check my email to you first.
God bless
Hi Bruce,
2000miler wrote:However, women >= 58 have the second highest percentage of surgeries, but have the lowest survivability, so that confuses the issue.I can think of a few other factors that may explain this confusing result. Type of CC (intrahepatic/perihilar/extrahepatic), surgical margins (R0/R1 vs. R2), nodal involvement, surgery complications. Not sure if you have enough data to test these factors.
2000miler wrote:This raises the question, why do women have a higher percentage of surgeries than men?I can think of two possible explanations:
1. Women get diagnosed at an earlier stage than men. If true, the question becomes: why do women get diagnosed earlier than men?
2. The percentage of CC types (intrahepatic/perihilar/extrahepatic) differs between women and men. It is possible that one CC type is more likely to be resectable than the other.
It is also possible that #1 and #2 are linked. Could it be that women are more likely to be diagnosed with CC type that causes symptoms at an earlier stage?
Eli
Eli – I calculated the percentage of surgeries for the four cases shown in the plot above and found that it could have considerable impact, but it is not the only factor.
The percent of patients who underwent surgeries is as follows. The percentage is calculated from a subset of the above data used in the above plot since I did not have surgery data on all the patients used in that plot.
1. F < 58: 52.2%
2. F >= 58: 41.9%
3. M >= 58: 37.7%
4. M < 58: 36.6% So, the 52.2% for women < 58 years could be a major factor in them having the longest survivability. However, women >= 58 have the second highest percentage of surgeries, but have the lowest survivability, so that confuses the issue. Men had about the same percentage of surgeries and had about the same survivability, so that appears to be reasonable.This raises the question, why do women have a higher percentage of surgeries than men?
I would create another plot for 8 variables where I would take sex, age, and surgery into account, but the result would be some ragged lines since I don’t have enough death data, especially for women who have had surgery. I’m going to have to compile some more data from the posts before I’m ready to do that.
Bruce
Hi Percy,
So far, I have compiled data for 15% of the patients on these discussion boards and have found only 12 who have had radioembolization. Most of the 12 did not use the term “radioembolization,” but called it brachytherapy (3), Sir-spheres (5), Theraspheres (3), and spheres (1). Based on the present 2,438 members on these boards, a rough estimate of the total would be 80.
I might have missed some of the treatments, especially if they were done well after a patient was dx with cc and especially if the member had many posts.
The breakdown of the patients who had radioembolization is as follows:
Brachytherapy:
M, 46, Transplant, still alive at last post, 4.38 years after dx
M, 58, No surgery, lived 5.41 years after dx
F, 66, Transplant, still alive at last post, 1.49 years aftr dxSir-spheres:
F, 45, No surgery, lived 1.51 years after dx
F, 58, No surgery, lived 3.21 years after dx
F, 51, No surgery, lived 0.95 years after dx
F, 56, No surgery, lived 2.47 years after dx
M, 67, Resection, lived 7.64 years after dxTheraspheres:
M, 77, No surgery, lived 0.73 years after dx
F, 25, No surgery, still alive at last post, 1.56 years after dx
F, ?, Transplant, still alive at last post, 1.24 years after dxSpheres:
M, 60, No surgery, lived 2.31 years after dx.I don’t have any data on duration between start of treatment & final outcome.
Bruce
Hi, Bruce,
Can you tell me how many of us( patients) on this discussion board ,based on your research data collection,had radioembolization done, their age,sex,duration between the start of treatment and final outcome, and the end point( ie:survival result)?
Thanks,
God bless.I combined both sex and age on one survival plot, and it appears women younger than 58 years fare the best, while women 58 and older fare the worst. The big outlier in the group is our over 10 year survivor, barb, who was 59 when she was diagnosed. I didn’t have her age for the previous age analysis, but I have since found it. If I had broken the age groups at > 59 years instead of < 58 years, she would have been in the younger group. Age doesn't seem to have that much impact on male survivability. Statistics on the plotted data is chisq = 14.4, 3 degrees of freedom, p=0.00237. Median survivals for the groups are:
Females < 58 yrs. = 3.592 yrs.
Females >= 58 yrs. = 0.876 yrs.
Males < 58 yrs. = 1.517 yrs.
Males >= 58 yrs. = 1.418 yrs.Bruce
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