Conditional Relative Survival Of Cancer Patients And Conditional Probability Of Death: A French National Database Analysis

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Main Category: Cancer / Oncology
Also Included In: Prostate / Prostate Cancer;  Colorectal Cancer
Article Date: 16 Aug 2009 - 0:00 PDT

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UroToday.com - Patients often ask at what milestone year after treatment for cancer they might consider their risk to be minimal for a recurrence. This time point decreases much of the anxiety patients live with. There is little information about the conditional probability of death among patients greater than 5 years after a diagnosis of cancer.

A study in the online edition of Cancer, by Dr. Anne-Marie Bouvier and associates used a French national database to estimate the conditional probabilities of death for cancers of the breast, prostate, colon and lung in France.

The database included 205,562 incident cancer cases diagnosed between 1989 and 1997 in patients 15 years of age and older in 12 French administrative areas that cover 15% of the French population. The relative survival was defined as the ratio of the observed survival in the cancer patients under study to the expected survival of a general population with similar sex, age and year of death. This reflects the excess mortality in the cancer patient group relative to the background mortality. The probability of death between time t0 and t1, conditional on having survived until t0, is related directly to the excess mortality rate.

For prostate cancer, the 5-year relative survival rate differed according to age at diagnosis, increasing from 70% in men age <55 years at diagnosis to 83% in men age >65 years. The gap increased 10 years after diagnosis with a difference of 15 points between the 2 age groups (57% vs. 72%). The 10-year relative survival rate conditional on patients surviving 5 years after diagnosis was the worst for the youngest patients, but did not vary with age at diagnosis. In the first year after diagnosis, the probability of dying was low and was slightly higher for men aged <55 years at diagnosis (6.9%) compared withholder men (4%). In the second year it increased and then progressively decreased after year two until year seven for all age groups. From year 8 to year 10 the probability of dying increased for all age groups. The probability of dying during the tenth year was 4.4% for men ages 15-54 at diagnosis, 3% for men who were ages 55-64 at diagnosis, and 3.1% for men who were greater than 65 years at diagnosis.

For colorectal cancer, from years 1 to 10 after diagnosis the annual probability of death decreased dramatically. It was the same for all age groups after 3 years and was 1% at 10 years. For patients with breast cancer, during the 3 years after diagnosis the probability of death was greater for older patients, but it decreased less for younger patients compared with older patients. This led to a greater conditional probability of death among younger patients at 4 years and up to 10 years. For lung cancer patients, the annual probability of death decreased for both sexes but remained higher for men than women, at 8% and 5%, respectively at 10 years.

Bouvier AM, Remontet L, Hédelin G, Launoy G, Jooste V, Grosclaude P, Belot A, Lacour B, Estève J, Bossard N, Faivre J; for The Association of the French Cancer Registries (FRANCIM)
Cancer. 2009 Jun 30. (Epub ahead of print)
10.1002/cncr.24489

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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