26 (edited by eli Sun, 31 Mar 2013 11:28:01)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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.

29 (edited by 2000miler Sun, 31 Mar 2013 15:13:19)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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(8):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.

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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.

32 (edited by 2000miler Sun, 31 Mar 2013 16:40:57)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi 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

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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 April

Willow

34 (edited by 2000miler Mon, 01 Apr 2013 08:45:03)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

35 (edited by 2000miler Sat, 01 Jun 2013 14:44:19)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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

https://sites.google.com/site/bbairdsr/ccsur.png

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

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.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Could be, but the median intrahepatic cc tumor size in my database for both men and women is 8.0 cm (maximum dimension), so it appears that both sexes wait about the same time before checking it out, although growth may be faster in one sex.

Bruce

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

The following survival plot compares cc.org patients who have had radioembolization and traditional chemo with patients who have had radioembolization, traditional chemo and targeted agents.

My database only has 11 patients with just chemo and 8 with chemo and targeted agents, so the plots are ragged and definitely not statisticallhy significant, as illustrated by a "p" of 0.916.  However, Percy wanted to see this comparison so I am including it in this topic for all to see.

Bruce

https://sites.google.com/site/bbairdsr/ccrad1.png

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi,
Thanks Bruce,
As far as the p value is so high , the graph is too rough or poor  in  data to prove one of my thinking that patient over 60 or 65 will do much poor after radioembo than those who are younger in age having chemotherapy either with or without targeted agents.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

I asked my surgeon what group has best survivability, he said intrahepatic, in his experience, has the best odds for long term survival, or cure as he called it.The numbers in this group are a little different, at that time he said he had numerous patients survive beyond 5 years when statistics seem to stop.

41 (edited by 2000miler Mon, 22 Apr 2013 20:01:15)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Below is a plot comparing survival statistics for the 12 major US Cancer Centers as a group, other US cancer facilities, and non-US cancer facilities  The 12 major US Cancer Centers are those listed in the following link for this organization.

http://www.cholangiocarcinoma.org/major … enters.htm

If a patient was treated at one of these centers or just received a second opinion from one or more of them, that patient was included in this category.

The other US cancer facilities contain all the other cancer facilities in the United States which are not listed as a major cancer center.  This list contains a lot of facilities which cc patients have highly recommended and, in some cases, were the only ones that would do certain cc surgeries.

The non-US cancer facilites include all the cancer facilities outside the US.

The statistics on the comparison have a chisq of 10.6, 2 degrees of freedom, p=0.00488.

Median survivals for the three groups are as follows:

Major US Cancer Centers = 2.21 years
Other US Cancer Facilities = 1.90 years
Non-US Cancer Facilities = 1.32 years

Bruce Baird

https://sites.google.com/site/bbairdsr/cchos1.png

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

A member asked me the following question off-line and my answer may be of interest to other members.

Qustion:
How does it look for someone with CC to be opened up by a surgeon and then be closed because of spread that the scans didn't pick up?

My Answer:
I have compiled data for 557 members so far.  Of these 557 members, I have 159 patients who had surgery to perform a resection.  Of these 159, a total of 25 (15.7%) of these surgeries failed mostly because the cancer had spread and the spread had not been detected by prior scans and other tests.

Bruce Baird

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi,Bruce,
Good job and well done.
May I have the %  of extra and intrahepatic in your compiled data  and the stage of the disease mentioned above.
Thanks.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

IHCC - 20%
Perihilar - 16%
ECC - 40%
CC - 24%

The ECC may be higher than expected because I collected some data by searching on "Whipple" since I needed more ECC data for one of my planned analyses to compare survival data for all three types.

Many members don't break their CC down to a lower classification, so I leave that data as just CC.

Most members don't supply the stage of their cc.  For the 25 total cases I only have 5 stages reported, 1 - I or II, 1 - II, and 3 - IV.  I suspect the stage IV data reported are restaged data as most surgeons would not resect a stage IV, unless it was stage IVA like my wife.

Below are 19 explanations that I have recorded for the failed surgeries.

1. Failed surgery, cancer had seeded
2. Liver resection failed due to extensive spreading of tumor throughout abdominal cavity
3. Attempted resection on 7/14/08 failed, found spots on liver & 2 small spots on belly wall
4. Attempted resection on 3/25/09 failed, found >10 tumors on LNs near aorta, outside liver
5. Attempted resection in Aug 2005 failed because a few LNs were involved
6. Failed surgery on 11/01/06, blood vessel involvement, GB removed, nicked portal vein.
7. Failed Whipple on 4/28/08 due to finding two spots on liver
8. Failed Whipple on 3/5/07 due to spread to hepatic vein & aorta
9. Failed Whipple found cancer spread to pancreas, liver & other parts
10. Failed 11/15/07 Whipple found cancer spread to GB, liver, duodenum, LNs & around artery
11. Surgery on 12/13/05  failed due to spread to omentum
12. Failed surgery because of mets to main artery found during surgery. GB with mets removed.
13. Failed Whipple found cancer on pancreas & it wasn't contained
14. Failed Whipple found cancer spread. Later spread to liver, pancreas & some LNs.
15. Surgery failed
16. Surgery failed, found 2 small nodules of cancer in right lobe not detected by CT, removed them.
17. Failed resection on 8/5/11, found unknown small lesions.  Ablated all lesions & tumor
18. Attempted resection on 10/30/08 failed, cancer spread
19. Failed surgery on 2/21/07. Tumor tangled around the hepatic vein & arteries

Bruce Baird

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Hi, Bruce,

You deserve a big THANKYOU.
In my opinion, 8 of those cases can  be completely successful if they were falling into the hands of experienced liver surgeons.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce...a big thank you is coming your way.  Your detailed work is very much appreciated.
How is your wife coming along?  We have not received a report on her for quite some time.
Hoping and wishing for the best,
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Many thanks for this work that you are doing Bruce!!

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

48 (edited by 2000miler Mon, 27 May 2013 21:34:49)

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

I just ordered a DVD with the SEER (Surveillance, Epidemiology, and End Results) data for 1973-2010.  They didn't ask for any money, so I guess it's free.  The DVD has the SEER Stat software, SEER binary data for use with the SEER Stat software, and ASCII data which I can use in the R statistical program.

The SEER data contains data for all types of cancer including intrahepatic, perihilar, and extrahepatic cc.  The paper by Olivier Farges, et al, which reported research done to develop the AJCC 7th edition TNM staging of patients with resectable intrahepatic cholangiocarcinoma used an earlier version of the SEER data.  That version contained data for 598 patients who had undergone cancer-directed surgery for IHCC.  Because of the large size of the database, survival statistics developed using this data should be very statistically significant.

Bruce Baird

Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice.  ALWAYS seek the advice of your physician or other qualified health care provider.

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Bruce....I am looking forward to receiving your report and comments. Thanks so much.
Hugs,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: Cholangiocarcinoma.org Statistics (CONTAINS SURVIVAL STATISTICS)

Thanks for that Bruce and I too am looking forward to what you present to us here from the SEER data. Thanks very much.

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.