Final report from a registry study of patients with active cancer undergoing ecological staging.

Abstract

e22501 Background: The host-cancer relationship can be viewed as a set of tumor supportive and inhibitory interactions, that is as an ecosystem. An advantage of such a perspective might include a more dynamic understanding of the selection pressures affecting tumor evolution. If so then a means of detecting and measuring those forces would be of help in understanding that drive and point to potential therapeutic clinical interventions. Towards this goal a registry study of patients with invasive cancer was conducted to examine readily available clinical measures to inform an ecological staging system. Methods: Eligibility for registry participation included age of 18 years or older, active cancer requiring treatment, life expectancy estimated to be at least six months and willingness to provide informed consent for this IRB-approved study. Ecological staging was then conducted at entry assessing 22 separate clinical parameters from history, physical exam and laboratory known to effect tumor biology, grouped into eight profiles and scored using a trichotomization of data, increasing score corresponding to an increase in positive tumor selection. To aggregate data from the profiles, a geometric figure, an octamer, or ecogram, was constructed, vertices representing the net score of each of the eight profiles. We hypothesize that the area bounded by the polygon, ecogram area (EA) would reflect an index of adverse, tumor-supporting ecological influence. Overall survival was determined from time of diagnosis of cancer until time of registry closure. Results: 15 subjects, eight female, seven male, ages 53-84 (median 64) participated in the registry. Complete ecological staging was obtained from all participating subjects, an indication of feasibility for collection of such data in the clinic. Resulting EA ranged 12-fold (0-12.1) across subjects suggesting sensitivity of EA to differences in selection pressures among the participants; ecogram morphology from individual subjects demonstrated unique shapes, an indication of specificity for character of individual tumor ecological landscape. Mean overall survival for participants from time of cancer diagnosis was 265 weeks. For 12 subjects with advanced stage disease, overall survival was inversely related to ecogram area (r = -.45). Conclusions: Ecological staging of cancer from clinical parameters proved feasible in this registry study of patients with active cancer. Ecological information from those parameters when aggregated using a geometric figure, an ecogram, demonstrated both sensitivity and specificity for differences among participants. For those subjects with advanced stage disease, ecogram area was inversely related to overall cancer survival. Ecological staging may be a useful tool in gauging selection pressures affecting cancer evolutionary tendency and of potential benefit to oncologists in forecasting such development.