Cancer Investigation, 33:205–212, 2015 ISSN: 0735-7907 print / 1532-4192 online C 2015 Crown copyright Copyright DOI: 10.3109/07357907.2015.1019675
ORIGINAL ARTICLE
Identifying Prognostic Indicators in Staging Metastatic Sarcomas Using Hospital Episode Statistics Matthew Francis, Nicola Dennis, Jackie Charman, and Gill Lawrence
Cancer Invest Downloaded from informahealthcare.com by Emory University on 08/07/15 For personal use only.
Public Health England (West Midlands), Birmingham, United Kingdom clinical and pathological staging data are not available, using routine English NHS datasets.
Detailed staging data are currently not available for sarcoma patients. This paper uses Hospital Episodes Statistics (HES) data to identify patients with Stage IV disease at diagnosis. Cancer patients with a record of metastasis at diagnosis were identified by combining HES data with National Cancer Data Repository data. The presence of metastases at diagnosis varied with age, sarcoma morphological sub-type, and anatomical location. Survival rates for patients with metastases were significantly lower than for those without metastases. Although not a perfect substitute for detailed staging information, the method described provides a good proxy to identify patients with Stage IV disease.
MATERIALS AND METHODS The West Midlands Knowledge and Intelligence Team (KIT (WM)) is the National Cancer Intelligence Network analytical lead for sarcoma. Analyses undertaken by the lead analytical teams are often conducted using the National Cancer Data Repository (NCDR), a data source which contains details of all tumors and patients registered in England. The Hospital Episodes Statistics (HES) dataset is a record of all inpatient and day case hospital activity. It includes information relating to the hospital of admission, dates of patient admission and discharge, and information relating to treatment and diagnoses. The current HES dataset holds information for cancer patients admitted to hospital between April 1998 and March 2012. Sarcoma morphology codes were identified according to the World Health Organization Classification of Bone and Soft Tissue Sarcomas (version three) (5), and the International Classification of Diseases for Oncology (ICD-O3) (6). All tumors with a sarcoma morphology code diagnosed between 2000 and 2010 were extracted from the NCDR. Primary cancer site of diagnosis was recorded according to International Classification of Diseases (ICD-10; tenth edition) site codes (7). Sarcomas with an ICD-10 code relating to bone (C40 and C41) were classified as “bone sarcoma” and all other sarcomas were classified as “soft tissue sarcoma.” Sarcomas arising in the brain (ICD-10 site codes C70, C71, and C72) were excluded from the analysis due to inconsistencies in the recording of primitive neuroectodermal tumors (614 tumors in total). The UICC TNM staging system is applicable for the majority of soft tissue sarcoma types (2). In order to identify patients with Stage IV bone and soft tissue sarcomas at diagnosis, the HES records for each sarcoma patient were examined
Keywords: Sarcoma, Cancer, Metastases, Advanced stage cancer
INTRODUCTION Sarcomas are a rare group of heterogeneous malignant tumors which collectively account for around 1% of all invasive cancers diagnosed annually (1). Approximately 2,800 soft tissue and 450 bone sarcomas are diagnosed in England annually, with age-standardized incidence rates of 44 and 8 per million population, respectively. The majority of sarcomas are staged according to the International Union Against Cancer (UICC) TNM tumor staging classification (2). To stage soft tissue sarcomas accurately, information relating to tumor size, regional lymph node involvement, distant metastases, and histopathological grading is required. Tumor stage is a significant prognostic factor predicting outcome (3), and is also a key indicator when determining the treatment options available to the cancer patient (4). Historically, the English cancer registries have not recorded staging information for sarcoma, although measures are now in place to improve staging data collection. This study describes a method for identifying patients with Stage IV sarcoma, where
Correspondence to: Matthew Francis, Public Health England (West Midlands), 1st Floor, 5 St. Phillips Place, Birmingham, B3 2PW, UK. E-mail: [email protected] Received 08 October 2014; revised 29 January 2015; accepted 03 February 2015.
M. Francis et al.
Table 1. Bone Sarcoma Patient Demographics (Age at Diagnosis, Sex, Deprivation Quintile, and Ethnicity) and Tumor Characteristics (Morphological Subtype and Anatomical Location), and Variation in the Proportion of Patients in Each Group Having a Record of Metastases at Diagnosis
Cancer Invest Downloaded from informahealthcare.com by Emory University on 08/07/15 For personal use only.
Demographic Age at diagnosis 0–29 30–59 60+ Sex Male Female Deprivation Least deprived 2 3 4 Most deprived Ethnicity White Black Asian Other Ethnicity not known Morphological subtype Osteosarcoma Chondrosarcoma Ewing’s sarcoma Chordoma Sarcoma, NOS Other subtype Tumor location Lower extremity Pelvic Upper extremity Skull and face Undefined bones Ribs Vertebral column Extremity – not defined Total
No.
%
No admitted to NHS hospital
No with metastases
Metastases as a % of inpatient admissions
Odds ratio
p value 0.001 0.954 0.006
1,653 1,487 1,462
36% 32% 32%
1,622 1,415 1,363
412 228 273
25% 16% 20%
1.01 Base 0.99 1.37
2,663 1,939
58% 42%
2,544 1,856
534 379
21% 20%
1.04 Base
0.590 —
911 946 960 856 929
20% 21% 21% 19% 20%
861 896 925 822 896
182 183 200 162 186
21% 20% 22% 20% 21%
Base 0.96 0.98 0.91 0.97
— 0.770 0.864 0.453 0.837
3,028 137 150 70 1,217
66% 3% 3% 2% 26%
2,997 135 149 70 1,049
628 29 30 9 217
21% 21% 20% 13% 21%
Base 1.08 0.87 0.48 0.97
— 0.722 0.537 0.050 0.733
1,466 1,532 680 282 123 519
32% 33% 15% 6% 3% 11%
1,426 1,430 674 269 118 483
358 166 241 25 42 81
25% 12% 36% 9% 36% 17%
Base 0.32 1.58 0.23 1.18 0.61
— 0.000 0.000 0.000 0.430 0.001
1,724 701 625 491 417 296 285 63
37% 15% 14% 11% 9% 6% 6% 1%
1,663 674 594 473 388 279 270 59
350 189 82 30 140 56 56 10
21% 28% 14% 6% 36% 20% 21% 17%
Base 1.71 0.69 0.30 2.10 1.22 1.14 1.01
— 0.000 0.008 0.000 0.000 0.243 0.464 0.971
4,400
913
21%
4,602
Odds ratios for comparisons were considered to be significantly different if they had p values of
ORIGINAL ARTICLE
Identifying Prognostic Indicators in Staging Metastatic Sarcomas Using Hospital Episode Statistics Matthew Francis, Nicola Dennis, Jackie Charman, and Gill Lawrence
Cancer Invest Downloaded from informahealthcare.com by Emory University on 08/07/15 For personal use only.
Public Health England (West Midlands), Birmingham, United Kingdom clinical and pathological staging data are not available, using routine English NHS datasets.
Detailed staging data are currently not available for sarcoma patients. This paper uses Hospital Episodes Statistics (HES) data to identify patients with Stage IV disease at diagnosis. Cancer patients with a record of metastasis at diagnosis were identified by combining HES data with National Cancer Data Repository data. The presence of metastases at diagnosis varied with age, sarcoma morphological sub-type, and anatomical location. Survival rates for patients with metastases were significantly lower than for those without metastases. Although not a perfect substitute for detailed staging information, the method described provides a good proxy to identify patients with Stage IV disease.
MATERIALS AND METHODS The West Midlands Knowledge and Intelligence Team (KIT (WM)) is the National Cancer Intelligence Network analytical lead for sarcoma. Analyses undertaken by the lead analytical teams are often conducted using the National Cancer Data Repository (NCDR), a data source which contains details of all tumors and patients registered in England. The Hospital Episodes Statistics (HES) dataset is a record of all inpatient and day case hospital activity. It includes information relating to the hospital of admission, dates of patient admission and discharge, and information relating to treatment and diagnoses. The current HES dataset holds information for cancer patients admitted to hospital between April 1998 and March 2012. Sarcoma morphology codes were identified according to the World Health Organization Classification of Bone and Soft Tissue Sarcomas (version three) (5), and the International Classification of Diseases for Oncology (ICD-O3) (6). All tumors with a sarcoma morphology code diagnosed between 2000 and 2010 were extracted from the NCDR. Primary cancer site of diagnosis was recorded according to International Classification of Diseases (ICD-10; tenth edition) site codes (7). Sarcomas with an ICD-10 code relating to bone (C40 and C41) were classified as “bone sarcoma” and all other sarcomas were classified as “soft tissue sarcoma.” Sarcomas arising in the brain (ICD-10 site codes C70, C71, and C72) were excluded from the analysis due to inconsistencies in the recording of primitive neuroectodermal tumors (614 tumors in total). The UICC TNM staging system is applicable for the majority of soft tissue sarcoma types (2). In order to identify patients with Stage IV bone and soft tissue sarcomas at diagnosis, the HES records for each sarcoma patient were examined
Keywords: Sarcoma, Cancer, Metastases, Advanced stage cancer
INTRODUCTION Sarcomas are a rare group of heterogeneous malignant tumors which collectively account for around 1% of all invasive cancers diagnosed annually (1). Approximately 2,800 soft tissue and 450 bone sarcomas are diagnosed in England annually, with age-standardized incidence rates of 44 and 8 per million population, respectively. The majority of sarcomas are staged according to the International Union Against Cancer (UICC) TNM tumor staging classification (2). To stage soft tissue sarcomas accurately, information relating to tumor size, regional lymph node involvement, distant metastases, and histopathological grading is required. Tumor stage is a significant prognostic factor predicting outcome (3), and is also a key indicator when determining the treatment options available to the cancer patient (4). Historically, the English cancer registries have not recorded staging information for sarcoma, although measures are now in place to improve staging data collection. This study describes a method for identifying patients with Stage IV sarcoma, where
Correspondence to: Matthew Francis, Public Health England (West Midlands), 1st Floor, 5 St. Phillips Place, Birmingham, B3 2PW, UK. E-mail: [email protected] Received 08 October 2014; revised 29 January 2015; accepted 03 February 2015.
M. Francis et al.
Table 1. Bone Sarcoma Patient Demographics (Age at Diagnosis, Sex, Deprivation Quintile, and Ethnicity) and Tumor Characteristics (Morphological Subtype and Anatomical Location), and Variation in the Proportion of Patients in Each Group Having a Record of Metastases at Diagnosis
Cancer Invest Downloaded from informahealthcare.com by Emory University on 08/07/15 For personal use only.
Demographic Age at diagnosis 0–29 30–59 60+ Sex Male Female Deprivation Least deprived 2 3 4 Most deprived Ethnicity White Black Asian Other Ethnicity not known Morphological subtype Osteosarcoma Chondrosarcoma Ewing’s sarcoma Chordoma Sarcoma, NOS Other subtype Tumor location Lower extremity Pelvic Upper extremity Skull and face Undefined bones Ribs Vertebral column Extremity – not defined Total
No.
%
No admitted to NHS hospital
No with metastases
Metastases as a % of inpatient admissions
Odds ratio
p value 0.001 0.954 0.006
1,653 1,487 1,462
36% 32% 32%
1,622 1,415 1,363
412 228 273
25% 16% 20%
1.01 Base 0.99 1.37
2,663 1,939
58% 42%
2,544 1,856
534 379
21% 20%
1.04 Base
0.590 —
911 946 960 856 929
20% 21% 21% 19% 20%
861 896 925 822 896
182 183 200 162 186
21% 20% 22% 20% 21%
Base 0.96 0.98 0.91 0.97
— 0.770 0.864 0.453 0.837
3,028 137 150 70 1,217
66% 3% 3% 2% 26%
2,997 135 149 70 1,049
628 29 30 9 217
21% 21% 20% 13% 21%
Base 1.08 0.87 0.48 0.97
— 0.722 0.537 0.050 0.733
1,466 1,532 680 282 123 519
32% 33% 15% 6% 3% 11%
1,426 1,430 674 269 118 483
358 166 241 25 42 81
25% 12% 36% 9% 36% 17%
Base 0.32 1.58 0.23 1.18 0.61
— 0.000 0.000 0.000 0.430 0.001
1,724 701 625 491 417 296 285 63
37% 15% 14% 11% 9% 6% 6% 1%
1,663 674 594 473 388 279 270 59
350 189 82 30 140 56 56 10
21% 28% 14% 6% 36% 20% 21% 17%
Base 1.71 0.69 0.30 2.10 1.22 1.14 1.01
— 0.000 0.008 0.000 0.000 0.243 0.464 0.971
4,400
913
21%
4,602
Odds ratios for comparisons were considered to be significantly different if they had p values of
