Analysis Of Long-term Survivors Research Articles

Erratum to updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases.

[This corrects the article DOI: 10.21037/jgo.2017.03.10.].

Functional Outcomes in Veterans With Intermediate- and High-Risk Oropharyngeal Squamous Cell Carcinoma: Analysis of Long-Term Survivors

Functional Outcomes in Veterans With Intermediate- and High-Risk Oropharyngeal Squamous Cell Carcinoma: Analysis of Long-Term Survivors

AFT survival model to capture the rate of aging and age-specific mortality trajectories among first-allogeneic hematopoietic stem cells transplant patients.

Accelerated failure time (AFT) model is commonly applied in engineering studies to address the failure rate of a machine. In humans, survival profile of transplant patients is among the rare scenarios whereby AFT is applicable. To date, it is uncertain whether reliable risk estimates and age-specific mortality trajectories have been published using conventional statistics approach. By investigating mortality trajectory, the rate of aging d(log(μ(x)))/dx of Hematopoietic Stem Cells Transplants (HSCTs) patients who had underwent first-allogeneic transplants can be obtained, and to unveil the possibility of elasticity of human aging rate in HSCTs. A modified parametric frailty survival model was introduced to the survival profiles of 11,160 patients who had underwent first-allogeneic HSCTs in the United States between 1995 and 2006; data was shared by Center for International Bone and Marrow Transplant Research. In comparison to stratification, the modification permits two entities in relation to time to be presented; age and calendar time. To consider its application in empirical studies, the data contains arbitrary right-censoring, a statistical condition which is preferred by choice in many transplant studies. The finalized multivariate AFT model was adjusted for clinical and demographic covariates, and age-specific mortality trajectories were presented by donor source and post-transplant time-lapse intervals. Two unexpected findings are presented: i) an inverse J-shaped hazard in unrelated donor-source t≤100-day; ii) convergence of unrelated-related hazard lines in 100-day<t ≤ 365-day suggests maximum manifestation of senescence among survivors. Analyses of long-term survivors (t>365-day) must consider for periodic medical improvements, and transplant year as a standalone time-variable is not sufficient for statistical adjustment in the finalized multivariate model. In relevance to clinical studies, biennial event-history analysis and age-specific mortality trajectories of long-term survivors provide a more relevant intervention audit report for transplant protocols than the popular statistical presentation; i.e. survival probabilities among donor-source.

Updated survival outcomes and analysis of long-term survivors from the MORE study on safety and efficacy of radioembolization in patients with unresectable colorectal cancer liver metastases.

The Metastatic colorectal cancer liver metastases Outcomes after RadioEmbolization (MORE) study was a retrospective analysis of 606 patients with unresectable colorectal liver metastases treated with radioembolization (RE) using 90Y-labeled resin microspheres. The first analysis of this study was completed with a last patient follow-up of 77.7 months. We now provide an updated survival analysis through September 15, 2016, with a last patient follow-up of 125 months. 90Y-RE was considered for patients with advanced liver-only or liver-dominant metastatic colorectal cancer which was deemed not suitable for surgery, ablation, or systemic therapy, and which had progressed or become refractory to at least one line of systemic therapy. All patients with a diagnosis of metastatic colorectal cancer who had received at least 1 RE treatment and 1 follow-up visit were included in the analysis. Patients were treated between July 2002 and December 2011 at one of 11 U.S. tertiary care centers. Data were collected at baseline, on the day of the first 90Y-RE treatment (day 0), and at all subsequent visits or until death. Patient medical charts and/or public records were accessed to obtain dates of death. Dates of death were obtained for 574 out of a total of 606 patients, and overall survival (OS) data analyzed. Updated median OS was 10.0 months (95% CI: 9.2-11.8 months) at a median follow-up of 9.5 months versus the originally reported median OS of 9.6 months (95% CI: 9.0-11.1 months) at a follow-up of 8.6 months in the first MORE analysis. Patients received a median (range) of 2 (0 to 6) lines of chemotherapy. Baseline characteristics and factors significantly associated with patient survival (P<0.01) are consistent with those reported in the first safety analysis of the MORE study. These factors include poor ECOG performance status, markers of advanced disease such as increased extent of tumor-to-target liver involvement, poor baseline liver function, pre-treatment anemia, lung shunt fraction, and number of lines of prior chemotherapy. Patient age did not significantly affect survival outcomes. Long-term follow-up confirms that 90Y-RE treatment offers favorable survival benefits for patients with unresectable metastatic colorectal cancer, even among patients who received 3 or more prior lines of chemotherapy. Our analysis also supports earlier reported prognostic factors for survival after 90Y-RE. Overall, our updated analysis confirms that 90Y-RE treatment provided a meaningful response and survival advantage for MORE patients across all ages and across diverse community and academic centers in the U.S.

Analysis of long-term survivors with cardiac AL amyloidosis

Cardiac AL amyloidosis (CA) is generally known as a severe disease with very poor prognosis. Here we retrospectively examined seven patients with CA in our cohort who achieved long-term survival. All six patients who underwent high-dose melphalan and autologous stem cell transplantation (ASCT) survived for >3 years, whereas four patients survived for >5 years. Patients who underwent ASCT had prompt hematological responses, and five patients showed organ responses. ASCT helps to achieve a quick and deep hematological response required for long-term survival in patients with CA. New agents have been implemented for the treatment of CA. However, the risks and benefits of each treatment modality should be considered according to patient condition, thus making the best use of ASCT in combination with new agents for the treatment of CA.

Abstract P2-16-09: Retrospective analysis of long-term survivors with HER2+ metastatic breast cancer (MBC) treated with trastuzumab in a community setting

Abstract Background: The median survival for patients (pts) receiving trastuzumab (T) in the metastatic setting is approximately 3 years. There are limited data on real world use and outcomes in T treated pts who live longer than 3 years. The objective of this study was to identify and characterize pts with HER2+ MBC who initiated treatment with T (alone or in combination) in a community setting and to determine their treatment patterns and outcomes, including duration of treatment, overall survival (OS) and time to permanent discontinuation of T. Methods: A retrospective observational study was performed using the IKnowMed electronic medical record (EMR) used by the US Oncology Network with the primary time period of 2007 through Dec. 2012. Eligible pts had at least 2 visits at practice locations with full EMR capability. Pts on T when the EMR was implemented had chart review to determine the dates of diagnosis and start of T treatment. Results: The study population included 1856 women with HER2+ MBC who started T (alone or in combination with chemotherapy or hormonal therapy); 873 presented with MBC and 983 developed recurrence following diagnosis of early-stage disease. The median age was 58, range 23 to 96, 59% had ER+ cancer, 64% were postmenopausal and 35% had multiple sites of disease at presentation. Median OS for the entire group was 40.9 months and the median time to permanent discontinuation of T was slightly less, at 39.9 months. Interestingly, the median OS and duration of T use were similar in the recurrent MBC population and in the population who presented with de novo MBC. The proportion of pts receiving T and OS by year are presented (Table). Thirty-two percent of pts are still alive at 6 years, with 17% continuing to receive T. Outcomes of 1856 Patients Treated with TrastuzumabYear1356Pts still receiving T (%)82%53%27%17%OS (%)84%54%36%32% Ongoing analysis will evaluate whether there are pt and treatment characteristics that may predict for longer term OS. Conclusions: Using an EMR database we identified 1856 women with HER2+ MBC who initiated treatment with T (alone or in combination) with one third still alive at 5 years and 27% still on T. Future research that focuses on understanding the characteristics of this population can potentially improve care for women with HER2+ MBC with T and newer anti-HER2 agents. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-09.

Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis

Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube≥2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving ≤60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.

Clinical analysis of long-term survivors for unresectable hepatocellular carcinoma

Objective The objectives of this study were to evaluate the long-term results with multimodality therapy, and to clarify the clinicopathologic of features of patients surviving ≥ 3 years for unresectable hepatocellular carcinoma (HCC).

Analysis of Long-term Survivors After Surgical Resection for Pancreatic Cancer

The purpose of this study was to determine the outcome of surgical resection for pancreatic cancer and to characterize the clinicopathologic features of actual long-term survivors. Of the 789 pancreatic cancer patients, we retrospectively analyzed 242 patients who underwent an operation between 1985 and 1999. Surgical resection with curative intent was performed in 123 patients. We analyzed the overall results of surgical treatment, compared the clinicopathologic features between long-term and short-term survivors, and reevaluated the histological slides of the long-term survivors. Median survival and cumulative 5-year survival rate after surgical resection were 14.8 months and 12.1%. Tumor size, American Joint Committee on Cancer stage, resection margin involvement, and lymph node metastases were the significant prognostic factors. Eleven patients survived for more than 5 years. Some patients with poor prognostic factors such as lymph node metastasis and big tumor size survived for more than 5 years. Histological reevaluation in the long-term survivors revealed 4 cases of variant adenocarcinoma (anaplastic carcinoma, mucinous noncystic adenocarcinoma [n = 2], and undifferentiated carcinoma). Active surgical resection should be attempted even in patients with poor prognostic factors. As there were various types of pathology among the long-term survivors, typical ductal adenocarcinoma of the pancreas might have a poorer survival rate.

Long term follow up and analysis of long term survivors in patients treated with paclitaxel-based concurrent chemo/radiation therapy for locally advanced non-small cell lung cancer

For patients with locally advanced non-small cell lung cancer (LANSCLC), concurrent chemotherapy/radiation therapy (RT) has become the standard of care. Three multi-institutional phase II studies with paclitaxel-based chemotherapeutic regimen given concurrently with RT for patients with LANSCLC were performed from March of 1994 to May of 1997. We sought to determine mature data from this database of patients, as well as to perform analysis of a cohort of patients who have achieved long term survival (LTS) when treated with this regimen. Database of these patients was analyzed retrospectively upon longer follow up, with median follow up for the three studies being 498 days (range 11-2905 days, average 780 days). Weight loss limitation for the three studies was liberal: weight loss <10% and <15% 3 months preceding diagnosis (LUN-27 and LUN-63, respectively), and no weight loss limitation for LUN-56. The 4-year overall survival (OS) for the three trials was 16.3%, and 2-year progression free survival (PFS) was 25.7%. Statistical analysis of the long term survivors (OS > 4 years) was performed, and performance status (PS) was found to be a significant factor predictive of LTS. PS of 0 compared to 1 yielded a 2.5-fold increased likelihood of LTS (p = .04). There was also a trend (p = .067) for responders (complete or partial response) to yield a five-fold likelihood of LTS compared to non-responders (stable or progressive disease). Our results support the efficacy of combined modality therapy (CMT) for patients with LANSCLC even despite our more liberal weight loss eligibility criteria. Furthermore, our analysis indicates that LTS is more likely to be achievable in patients with PS = 0 compared to 1 when treated with CMT for LANSCLC.

P-589 Combined modality therapy (CMT) using concurrent radiation therapy (RT) with paclitaxel based chemotherapeutic regimen in locally advanced non-small cell lung cancer (LANSCLC): Long term follow up and analysis of long term survivors

P-589 Combined modality therapy (CMT) using concurrent radiation therapy (RT) with paclitaxel based chemotherapeutic regimen in locally advanced non-small cell lung cancer (LANSCLC): Long term follow up and analysis of long term survivors

The significance of surgery for bulky N2 small-cell lung cancer: a clinical and in vitro analysis of long-term survivors.

Until recently, stage III small-cell lung cancer (SCLC) has not been considered an indication for surgical treatment, however, stable subculture has become possible in about 80% of the patients with SCLC in our hospital. Therefore, we have been performing surgery for all patients with cStage I-III resectable tumors and giving combined-modality therapy based on the sensitivity assay in vitro since April 1982. In the present study, we reviewed 30 consecutive patients with cStage III and pStage III SCLC, including 27 with N2 disease who underwent surgery between 1982 and 1992, 7 of whom (23%) survived disease-free for over 5 years. We examined the cell characteristics in vitro and the actual treatment of five patients with bulky N2 lesions, four of whom were long-term survivors and one of whom died 11 months after surgery, as controls for comparison with the long-term survivors. Based on the results of the cell characteristics in vitro, SCLC was determined to be a heterogeneous tumor. Thus, surgical excision of the primary tumor with adjuvant therapy might be necessary to achieve long-term survival and maintain good performance status, and to improve quality of life in patients with bulky N2 SCLC by eliminating drug-resistant tumor cells within the primary tumor.

Self-Reported Worries Among Long-Term Survivors of Childhood Cancer and Their Peers

This study examined sell-reported worries of long-lerm survivors or' childhood cancer. Three stages of analysis were conducted. Stage I included a comparative analysis of long-term survivors and young people without a history oi cancer. Stage 2 drew on a hospital-based sample of long-term survivors and a qualitative analysis of the open-ended comments from a panel of 20 additional survivors, to examine the reliability and validity of the results from Stage I. Stage 3 examined factors that influenced variation in degree of worries among survivors in the first sample. Hie findings suggest that in several related areas of general health and self-image, the survivors worried less than the comparison sample did. However, in areas related specifically to cancer, the survivors1 degree of worry was higher than the degree reported by the comparison sample. These results are discussed in the context of the debate about the prevalence of psychopathology and psychological distress among long-term survivors of childhood cancer.

Analysis of long-term survivors with small-cell lung cancer : Skarin AT. Dana-Farber Cancer Center, 44 Binney Street, Boston, MA 02115. Chest 1993;103:Suppl. 440S–4S

Analysis of long-term survivors with small-cell lung cancer : Skarin AT. Dana-Farber Cancer Center, 44 Binney Street, Boston, MA 02115. Chest 1993;103:Suppl. 440S–4S

Analysis of Long-term Survivors With Small-Cell Lung Cancer

Survival among patients with small-cell lung cancer (SCLC) appears to have improved over the last 15 years. However, 2- to 3-year survival is still only 10% to 25% for patients with limited disease and 1% to 2% for those with extensive disease. Moreover, relapse of SCLC and the development of other cancers are common in patients surviving beyond 2 years. Clearly, new innovative therapy is needed, and continued research with recently developed agents is warranted. Modern multimodality therapy may have a role in patients with surgically resectable stage I or II disease, but development of better chemotherapy, bone marrow transplantation, hyperfractionation radiotherapy, and radiosensitizers will be necessary for most SCLC patients. Recently discovered prognostic indicators should help target individual SCLC patients for specific intensive treatments designed to prolong survival and achieve a cure.

Results of Resection of Pulmonary Metastases and Analysis of Long Term Survivors

From 1977 to 1988, 84 resections of pulmonary metastases were performed, and 55 patients were followed for more than two years. Their cumulative survival rates were 76. 4% at one year, 39. 6% at three years and 26. 4% at five years, with a median survival time of 35 months. The prognosis was somewhat influenced by tumor doubling time (TDT), disease free interval (DFI) and the number of metastases. A TDT of more than 70 days and a DFI of more than 12 months were favorable prognostic factors. Some metastatic tumors grow rapidly after a long dormant period. Patients with such tumors have a chance to be cured by tumor resection when there are few metastases in the lungs and no evidence of metastasis in other organs Multimodal treatment, including repeated thoracotomies, contributes to prolongation of survival.

上顎洞癌長期経過例の分析 他部位癌長期生存例との対比

An analysis of long-term survivors after curative treatment of maxillary cancer in our clinic evaluated the influence of various factors on the prognosis.The results of combined treatments were promising. It is important to plan treatments which combine irradiation or chemotherapy with surgery.The authors also analyzed the clinical findings and mental and physical care of elderly survivors of maxillary cancer and compared the results with those in patients with cancers of other regions.