Linking Cancer Mortality to Clinical Staging, Grading and Therapeutic Modalities, Over One Decade, Oncology Unit, Dubai Hospital, Dubai UAE 2019

Nezar Ahmed Salima, Hussain H, Raja Kathamuthu, Mohammed Tuffaha and Amna Al Mehairi

Published on: 2018-12-28

Abstract

Background: Improving cancer survival is a key challenge identified in ‘improving outcomes: a strategy for cancer, and stage at diagnosis is highly predictive of cancer mortality, and a possible explanation for the difference in cancer survival.

Objectives: To study the association between cancer mortality and clinical staging of the cancer cases, grading of the cancer cases, and clinical therapeutic protocols applied for cancer cases throughout 10 years of cancer admissions at oncology center, Dubai hospital, and Dubai health authority.

Methodology: Hospital based registry data we obtained retrospectively through oncology department registry Unit in Dubai Hospital for the period 2006 -2016, all admitted cases were included in the data analysis, they were male and females, all age groups and all nationalities. Data coding, data entry and data analysis were made utilizing SPSS 21 software, ethical standards were followed, and diagnosed and confirmed cases by Histopathology studies were considered only

Results: The current study showed that mortality rate of cancer patients admitted to oncology center at Dubai Hospital in 2005 12.9/1000, 14.4/1000 in 2006. 16.14/1000 in 2008, in 2009-2012 decline down and raise once again 2013 to 16.89/1000, after 2013 the mortality rate decline down to 7.24/1000, clinical staging has significant statistical association with cancer outcomes, as stage 5 cancer cases showed death about (33%) of the cancer cases), stage 4 cancer cases showed 12.9% death, stage 3 showed 6.4% death of total cancer cases and stage 1 and 2 revealed the least death 2.8%, P vale <0.05. Present study revealed significant association between cancer grading and cancer outcome as in grade 4 cancer showed highest death rate (18.7%) followed by grade 3 about( 15.7%, ), grade 2 (11.2%) and grade one about( 6.6%) P value showed <0.05. This study reflects significant statistical association between therapeutic protocol and the cancer outcome, the least death rate where shown among hormonal therapy 11.1% and adjuvant therapy (11.2%) and surgical therapy 11% while chemotherapy showed 21.8% death among all cancer cases. P value was <0.05.

Conclusion: The study concluded that cancer mortality has tactical significant association with clinical staging of cancer at time of diagnosis, cancer cases grading, therapeutic modalities applied and management protocol as well as well as gender.

Keywords

Cancer mortality; Staging; Grading; 10 years analysis; Dubai

Introduction

Improving cancer survival is a key challenge identified in ‘improving outcomes: a strategy for cancer [1]. Stage at diagnosis is highly predictive of cancer mortality, and a possible explanation for the difference in cancer survival between England and Europe is that a higher proportion of patients are diagnosed at a later stage in England [2-5]. The completeness of stage at diagnosis for cancers registered in England by the NCRS has improved greatly in recent years. Staging completeness now exceeds 80% for several major cancers (including breast, colorectal, lung, ovarian and prostate) diagnosed in 2012, allowing more robust analyses 

than have previously been possible. The remainder of staging data may be missing for various reasons: certain morphological tumor types have no formal agreed staging system; it was clinically inappropriate to stage the patient; diagnosis and/or treatment was outside the National Health Service; the patient died before staging was complete; or staging information was not transferred to the NCRS.

Objectives

To study the association between cancer mortality and clinical staging of the cancer cases, grading of the cancer cases, and clinical therapeutic protocols applied for cancer cases throughout 10 years of cancer admissions at oncology unit, Dubai hospital, and Dubai health authority.

Methodology

Hospital based registry data were obtained retrospectively through records review at oncology department registry Unit in Dubai Hospital for the period 2006 -2016, all admitted cases were included in the data analysis, they were male and females, all age groups and all nationalities. Only missing. Data coding, data entry and data analysis were made utilizing SPSS 21 software, ethical standards were followed, and diagnosed and confirmed cases by Histopathology studies were considered only. 

 

Results

The current study showed that mortality rate of cancer patients admitted to oncology center at Dubai Hospital in 2005 12.9/1000, 14.4/1000 in 2006. 16.14/1000 in 2008, in 2009-2012 decline down and raise once again 2013 to 16.89/1000, after 2013 the 

mortality rate decline down to 7.24/1000 as shown in (Figure 1). Present study revealed significant association between grade and patient status as in grade 4 cancer showed highest death rate (18.7%) followed by grade 3 about ( 15.7%, ), grade 2 (11.2%) and grade one about( 6.6%) P value showed <0.05 as in (Table 1,2). (Table 3,4) showed that clinical staging has significant statistical association with cancer outcomes, as stage 5 cancer cases showed death about (33% of the cancer cases ), stage 4 cancer cases showed 12.9% death, stage 3 showed 6.4% death of total cancer cases and stage 1 and 2 revealed the least death 2.8%, P vale was <0.05. This study reflects significant statistical association between therapeutic protocol and the cancer outcome, the least death rate where shown among hormonal therapy 11.1% and adjuvant therapy (11.2%) and surgical therapy 11% while chemotherapy showed 21.8% death among all cancer cases, since P value was <0.05 (Table 5,6).

Discussions

The current study showed that cancer mortality significantly associated with Cancer grading, cancer staging and cancer treatment modality, P value was <0.05. this finding was in similar with other studies finding which reveals that Early-stage presentation is more likely in younger persons for ovarian and prostate cancers, and for screening age for colorectal and breast cancers. Early-stage presentation is (marginally) less likely in the more income-deprived. The analysis clarifies the expected patterns of survival, and it shows that age and stage have the greatest association on the absolute value of the 1-year survival and the adjusted excess mortality rate ratio for early mortality, whereas for sex, income deprivation and geographic area of residence the impact is smaller. For sex, the fact that the rate ratios are close to unity implies that some of the difference in relative survival by sex is driven by age and stage case-mix, concordant with earlier [6]. Excess mortality rate ratios between the least and most deprived of up to 1.4 are seen, and in colorectal cancer the associated difference in relative survival is 6.5%. This rate ratio is broadly in agreement with previously calculated mortality rate ratios of ∼1.1 per increment in income deprivation quintile [7]. But could also be influenced by variables outside the model, including comorbidity, differential uptake of potentially curative treatment and the frequency of emergency presentation, all of which are higher in the more income-deprived. Survival by stage has been previously published for the UK for cancers diagnosed in 2004 [8-10]. Again, direct comparison is complicated by differences in methodology and the differing definition of the tumor cohorts. However, it appears that breast and colon cancers exhibit the largest improvement in stage-specific survival for later stage cancers, whereas lung cancer has greater improvements for earlier-stage cancers. differing definition of the tumor cohorts. However, it appears that breast and colon cancers exhibit the largest improvement in stage-specific survival for later stage cancers, whereas lung cancer has greater improvements for earlier-stage cancers. 

Conclusion

The study concluded that cancer mortality has tactical significant association with clinical staging of cancer at time of diagnosis, cancer cases grading, therapeutic modalities applied and management protocol as well as well as gender. Histologic grade was shown to be a significant prognostic factor.

Recommendation

Revising cancer survival trend to be clearly linked to cancer clinical staging at time of diagnosis, grading and selected therapeutic protocol.

Ethical Consideration

Research ethics standards has been adhered to throughout all study phases.

Conflict of interest

The authors declared that there is no conflict of interest in regards of current study.

References

  1. Improving Outcomes: A Strategy for Cancer. Department of Health: London, UK. 2011.
  2. Sant M, Allemani C, Capocaccia R, Hakulinen T, Aareleid T, Coebergh JW, et al. Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe. Int J Cancer. 2003; 106: 416-422.
  3. Foot C, Harrison T. How to improve cancer survival: Explaining Englands relatively poor rates. The Kings Fund, 2011.
  4. Walters S, Maringe C, Butler J, Rachet B, Barrett-Lee P, et al. Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study. Br J Cancer. 2013; 108: 1195-1208.
  5. Walters S, Maringe M, Coleman P, Peake M, Butler J, et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the United Kingdom: a population-based study, 2004-2007. Thorax. 2013; 68: 551-564.
  6. McPhail S, Johnson S, Greenberg D, Peake M, Rous B. Stage at diagnosis and early mortality from cancer in England. Br J Cancer. 2015; 112: 108-115.
  7. McPhail S, Elliss-Brookes L, Shelton J, Ives A, Greenslade M, Vernon S, et al. Emergency presentation of cancer and short-term mortality. Br J Cancer. 2013; 109: 2027-2034.
  8. Peake MD. Deprivation, distance and death in lung cancer. Thorax. 2014; 70: 108-109.
  9. Maringe C, Walters S, Butler J, Coleman MP, Hacker N, Hanna L, et al. Stage at diagnosis and ovarian cancer survival: evidence from the International Cancer Benchmarking Partnership. Gynecol Oncol. 2012; 127: 75-82.
  10. Suzuki K, Nagai K, Yoshida J, Nishimura M, Takahashi K, Yokose T, et al. Conventional clinic pathologic prognostic factors in surgically resected no small cell lung carcinoma. A comparison of prognostic factors for each pathologic TNM stage based on multivariate analyses. Cancer. 1999; 86: 1976-1984.
  11. Khan OA, Fitzgerald JJ, Field ML, Soomro I, Beggs FD, Morgan WE, et al. Histological determinants of survival in completely resected T1-2N1M0 no small cell cancer of the lung. Ann Thorac Surg. 2004; 77: 1173-1178.
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  14. AJCC Cancer staging handbook. 6th New York: Springer Verlag; 2002.

 

Figures

Figure 1: Mortality rate per 1000 admitted cancer case per year of all cancers.

Tables

Table 1: Association between Grading and cancer outcome.

Grading

Alive with Disease

Alive without Disease

Death

Missing follow up patients

Grade 1

142 (31.1%)

86 (18.9%)

30 (6.6%)

198 (43.5%)

Grade 2

586 (40.2%)

169 (11.6%)

164 (11.2%)

540 (39.4%)

Grade 3

388 (37.6%)

118 (11.4%)

162 (15.7%)

363 (35.2%)

Grade 4

40 (32.5%)

7 (5.7%)

29 (18.7%)

47 (38.2%)

Unknown Grade

1263 (35.5%)

440 (12.4%)

627 (17.6%)

1229 (34.5%)

Table 2: Chi-square analysis between Grading and outcome.

 

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

101.513a

16

0

Likelihood Ratio

106.435

16

0

N of Valid Cases

6628

   

Table 3: Association between cancer clinical staging cases and the cancer outcome.

Staging

Alive with Disease

Alive without Disease

Death

Missing follow up patients

Stage 1

46 (25.8%)

80 (44.9%)

5 (2.8%)

47 (26.5%)

Stage 2

436 (39.2%)

216 (19.4%)

39 (3.5%)

421 (37.8%)

Stage 3

396 (42.9%)

165 (17.9%)

59 (6.4%)

303 (32.8%)

Stage 4

386 (44.2%)

109 (12.5%)

113 (12.9%)

265 (30.5%)

Stage 5

512 (32.5%)

46 (2.9%)

520 (33.0%)

496 (31.5%)

Unknown stage

643 (32.7%)

204 (10.4%)

276 (14.0%)

845 (42.9%)

Table 4: Chi-square analysis between staging and outcome.

 

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

969.189a

20

0

Likelihood Ratio

934.937

20

0

N of Valid Cases

6628

   

Table 5: Association between treatment and cancer outcome.

 

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

1884.649a

16

0

Likelihood Ratio

2090.813

16

0

N of Valid Cases

6628

 

 

Table 6: Chi-square analysis between treatment and outcome.

 

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

1884.649a

16

0

Likelihood Ratio

2090.813

16

0

N of Valid Cases

6628