Cause-specific Survival In Patients Research Articles

442. POSTOPERATIVE ADJUVANT RADIOTHERAPY REDUCES LOCOREGIONAL RECURRENCE IN PATIENTS WITH BORDERLINE RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background borderline resectable esophageal squamous cell carcinoma (Br-ESCC) patients who underwent R0 resection had a significantly improved prognosis. However, local recurrence cannot be ignored. We sought to investigate the efficacy of postoperative adjuvant radiotherapy in reducing locoregional recurrence in patients with Br-ESCC. Methods we established a new resection status, Rbr+, which was defined as no clear boundary between the mass/scar and the outer aortic/tracheal membrane, no visible cancer remaining on the outer aortic/tracheal membrane, and a pathologically negative circumferential margin. patients with Br-ESCC who underwent curative esophagectomy at our center from January 2018 to December 2021 were eligible for this study. Patient characteristics, and perioperative variables were included in this study. univariable and multivariable analyses were performed to compare locoregional recurrence based on the logistic regression model. The Kaplan-Meier method and Cox proportional hazard model were used to compare overall and cause-specific survival. Results A total of 99 patients were included, among whom 27 (27.3%) had a locoregional recurrence. 71.7% (71/99) were classified as Rbr+ resection, and 28.3% (28/99) were classified as Rbr- resection. With a median postoperative follow-up of 55.3 months (range, 24.3-70.8 months), 25 patients out of 71 with Rbr+ resection suffered from local recurrence. However, 2 patients out of 28 with Rbr- resection suffered from locally recurrence. The locoregional recurrence was 25%(7/28) and 41.9%(18/43) in Rbr+ resection with and without postoperative adjuvant radiotherapy. While, the locoregional recurrence was 8.33%(1/12) and 6.25%(1/16) in Rbr- resection patients with and without postoperative adjuvant radiotherapy. Conclusion Rbr+ resection was independently associated with locoregional recurrence in patients with Br-ESCC. postoperative adjuvant radiotherapy was independently associated with overall and cause-specific survival in patients with Br-ESCC.

Real-world study of lymphadenectomy in patients with advanced epithelial ovarian cancer.

The evidence on the role of retroperitoneal lymphadenectomy is limited to less common histology subtypes of epithelial advanced ovarian cancer. This retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results Program from January 1, 2010, to December 31, 2019. Patients with stage III-IV epithelial ovarian cancer were included and divided into two groups based on whether they received retroperitoneal lymphadenectomy. The primary outcomes are overall survival (OS) and cause-specific survival (CSS). Among the 10 184 included patients, 5472 patients underwent debulking surgery with retroperitoneal lymphadenectomy, while 4712 patients only underwent debulking surgery. No differences were found in the baseline information between the two groups after propensity score matching. Retroperitoneal lymphadenectomy during debulking surgery was associated with improved 5-year OS (43.41% vs. 37.49%, p < 0.001) and 5-year CSS (46.43% vs. 41.79%, p < 0.001). Subgroup analysis further validate the retroperitoneal lymphadenectomy increased the 5-year OS and CSS in patients with high-grade serous cancer. Although the results were not validated in the less common ovarian cancer (including endometrial cancer, mucinous cancer, low-grade serous cancer, and clear cell cancer), the tendency showed patients with the above four subtypes may benefit from the lymphadenectomy which is restricted for small sample size after propensity score matching. This study revealed that retroperitoneal lymphadenectomy could further improve the survival outcome during debulking surgery in patients with advanced epithelial ovarian cancer. The conclusion was affected by the histology subtypes of ovarian cancer and further studies are needed to validate the conclusion in less common ovarian cancer.

The Impact of Economic Status on Cause-Specific Survival in Patients with Esophageal Adenocarcinoma in the United States: A Retrospective Analysis.

This study aims to evaluate the impact of economic status on the cause-specific survival (CSS) of patients with esophageal adenocarcinoma (EAC). Using propensity score matching (PSM), we analyzed data from 4676 patients with EAC, categorized into low household income (LHI) and high household income (HHI), sourced from the Surveillance, Epidemiology, and End Results database. Significant pre-PSM differences in age, gender, race, and tumor stage (T stage) were observed, necessitating PSM adjustment. The PSM incorporated these variables along with radiotherapy to balance the groups effectively. Kaplan-Meier curves and accelerated failure time (AFT) and random survival forest (RSF) models were used to assess the prognostic impacts. According to the pre-PSM data, a significant difference in CSS was observed between the LHI and HHI groups (median CSS = 1.25 years vs 1.50 years, P < .05). Post-PSM analysis maintained the result (P < .05). Using the AFT model, HHI was found to significantly enhance CSS (pre-PSM time ratio [TR] = 1.145, post-PSM TR = 1.146). Male gender (pre-PSM TR = 0.762, post-PSM TR = 0.819) and certain non-single marital statuses (such as divorced, pre- and post-TRs <1.000) are also prognostic risk factors for EAC (P values <.05). Additional significant prognostic risk factors for EAC included advanced American Joint Committee on Cancer stages (III and IV), higher tumor stages (T3 and T4), higher node stages (N1-N3), without surgery, and without chemotherapy, as identified using the AFT and/or RSF mothods. The results derived from the RSF model are consistent with those of the AFT model. Higher economic status is positively related to EAC CSS. Beyond standard clinical treatments, interventions such as enhancing socioeconomic support and preventive aspects, including intensive health education and EAC screening, could play a crucial role in improving EAC prognosis.

Effects of Adjuvant Chemotherapy on Early-onset Stage II Colon Cancer at Different Tumor Sites.

Left-sided colon cancer (LSCC) and right-sided colon cancer (RSCC) have shown distinct clinical and prognostic features. We investigated the effect of adjuvant chemotherapy (ACT) on cause-specific survival (CSS) in patients with stage II LSCC and RSCC. Using the Surveillance, Epidemiology and End Results (SEER) database, a cohort of patients with stage II colon cancer, aged between 20 and 49 years was identified. Both Cox proportional hazards regression and Kaplan-Meier survival analysis as well as propensity score matching were used. Overall, 5633 patients were eligible. Patients with RSCC were more likely to be male, black, and younger, with a poor grade and histologic type, and were more likely to have more regional nodes examined and larger tumor size. After propensity score matching, CSS was significantly superior in patients with RSCC compared to those with LSCC (Hazard Ratio (HR): 0.80, 95% CI: 0.68-0.95, P =0.01). However, no survival benefit was observed for patients with LSCC after ACT (HR: 1.10, 95% CI: 0.90-1.35, P =0.35), and surprisingly, ACT was found to do more harm than good in patients with RSCC (HR: 1.31, 95% CI: 1.05-1.63, P =0.02). Even among patients with high-risk features such as T4 stage and regional nodes examined<12 in both groups, ACT still did not improve CSS except for T4 stage LSCC (HR: 0.65, 95% CI: 0.44-0.97, P =0.02). The results of this analysis indicate that the prognosis of RSCC is better than that of LSCC in stage II colon cancer, and ACT did not improve CSS in patients with either LSCC or RSCC. Even in patients with parts of high-risk features, ACT still did not improve CSS, except for T4 stage LSCC.

Importance of the Number and Location of Lymph Node Metastasis in Oropharyngeal Cancer.

The 8th edition of the American Joint Committee on Cancer staging system classifies oropharyngeal cancer (OPC) by the expression of p16. The discrepancy observed in this system between pathological and clinical N-stages in p16-positive OPC has provoked controversy. Therefore, this study investigated prognostic factors not included in the new staging system for p16-positive OPC patients. Patients with non-metastatic OPC receiving radiotherapy were reviewed. Clinical lymph node statuses were reassessed based on contrast-enhanced computed tomography and fluorodeoxyglucose positron emission tomography. Overall survival (OS) and cause-specific survival (CSS) were analyzed using multivariate analyses to adjust baseline imbalances. In total, 166 OPC patients were reviewed. Among them, 81 patients with p16-positive were analyzed. Three or more lymph node metastases (LNM) were observed in 21 p16-positive OPCs. Retropharyngeal lymph node metastasis (Rp) was found in 12. Three-year OS, CSS, and progression-free survival rates in p16-positive patients were 76, 88, and 81%, respectively. In multivariate analyses of p16-positive OPC, LNM ≥3 was a prognostic factor of OS (hazard ratio=9.30, p<0.001) and CSS (hazard ratio=17.80, p=0.005). Rp was associated with poor CSS (hazard ratio=8.73, p=0.03). In N0-1 p16-positive patients, LNM ≥3 trended to be associated with poor OS (hazard ratio=3.93, p=0.06). CSS in patients with Rp was unfavorable (hazard ratio=70.16, p=0.05). LNM ≥3 and Rp may be predictive of OS and CCS in p16-positive OPC. These are also possibly used to subcategorize p16-positive cN0-1 OPC. Further validation of lymph node staging is needed to refine the clinical staging system.

Resection of primary lesion with chemotherapy improves the survival of patients with metastatic colorectal neuroendocrine carcinoma.

To evaluate the effect of resection of primary lesion and chemotherapy on survival of patients with metastatic colorectal neuroendocrine carcinoma (CRNEC). Clinical data of 393 patients with metastatic CRNECs between January 2010 and December 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, including 171 patients who received resection of primary lesion and 221 patients who did not undergo surgery. With the propensity score matching method 172 non-operated patients were selected as controls. Kaplan-Meier method and Log-rank test were used to evaluate the survival differences, while the prognostic factors were analyzed by Cox proportional-hazards model. Metastatic CRNEC patients from January 2001 to December 2021 in Affiliated Jinhua Hospital, Zhejiang University School of Medicine were selected for validation. Compared with non-operated patients, patients who received resection had longer cause-specific survival ( P<0.05). Patients with resected positive lymph nodes>8 had a poorer prognosis compared to those with resected positive lymph nodes≤8 ( P<0.05). Multivariate analysis showed that gender, location of primary lesion and treatments were independent risk factors for cause-specific survival in patients with metastatic CRNEC (all P<0.05). For metastatic CRNEC patients with resection of primary lesion, rectal neuroendocrine carcinoma, positive resected lymph nodes≤8 and resection of primary lesion combined with chemotherapy were associated with better cause-specific survival (all P<0.05). Patients with metastatic CRNEC may benefit from resection of primary lesion, and resection of primary lesion combined with chemotherapy might be the better strategy for metastatic CRNECs. The number of positive lymph nodes resected is correlated with the prognosis of patients.

Mohs micrographic surgery versus wide local excision for eyelid melanoma: An analysis of a national database

Although eyelid melanomas represent less than 1% of eyelid neoplasms, they have the worst prognosis. Wide local excision (WLE) and Mohs micrographic surgery (MMS) are mainstay treatment options. We conducted a retrospective analysis to assess all-cause and cause-specific mortality rates in patients undergoing WLE or MMS for eyelid melanoma. A retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) registry was performed for eyelid melanoma treated with WLE or MMS. Cases were limited to American Joint Committee on Cancer (AJCC) stage T1 primary malignancies. A total of 45 cases of WLE were identified along with 48 cases of MMS for eyelid melanoma. There was no significant difference between subgroups in age group, sex, race, ethnicity, marital status at diagnosis, AJCC N stage, AJCC M stage, melanoma histology, chemotherapy use, and radiotherapy use. Among the cohort, all tumors were unilateral. Kaplan-Meier analysis with log-rank demonstrated no significant difference between MMS and WLE subgroups with regard to overall survival (P=0.662) and cancer-specific survival (P=0.494). Cox regression adjusting for variables with α<0.10 and found no significant difference in all-cause mortality (HR, 0.923; 95% CI 0.310-2.747; P=0.885) or cancer-specific mortality (HR, 0.518; 95% CI 0.047-5.711; P=0.591) when patients who underwent MMS were compared to those who underwent WLE. While our study is limited by a small number of patients, our analysis demonstrated no significant difference in all-cause or cause-specific survival for patients with eyelid melanoma treated with MMS compared with WLE. In areas requiring preservation of tissue due to cosmetic or functional purposes, MMS is a reasonable surgical approach.

CT-based skeletal muscle loss for predicting poor survival in patients with hepatocellular carcinoma experiencing curative hepatectomy plus adjuvant transarterial chemoembolization: a preliminary retrospective study

BackgroundTo evaluate the prognostic value of skeletal muscle index (SMI) and its change in patients with hepatocellular carcinoma (HCC) experiencing curative hepatectomy plus adjuvant transarterial chemoembolization (TACE).Materials and methodsA total of 62 patients with HCC who underwent adjuvant TACE after curative hepatectomy were analysed retrospectively. Skeletal muscle area at the third lumbar level was quantitated using computed tomography images and was normalized for height squared to obtain skeletal muscle index (SMI). Skeletal muscle loss (SML) over 6 months was computed with two SMIs before and after hepatectomy plus adjuvant TACE. Correlation analyses were preformed to investigate factors associated with SML. The curves of cause-specific survival (CSS) were analysed using the Kaplan–Meier method. A Cox proportional hazards model was used to assess prognostic factors.ResultsLow SMI was diagnosed in 23(37.1%) patients preoperatively. The median SML standardized by 6 months was − 1.6% in the entire cohort. Liver cirrhosis and microvascular invasion correlated negatively with SML, respectively (r = − 0.320, P = 0.002; r = − 0.243, P = 0.021). Higher SML (< − 2.42%) predicted a significant reduction in CSS (P = 0.001), whereas low SMI did not(P = 0.687). Following the multivariate analysis for CSS, AFP > 400 ng/ml (HR, 5.643; 95%CI, 3.608–17.833; P < 0.001) and SML < − 2.42%(HR, 6.586; 95%CI, 3.610–22.210; P < 0.001) were independent predictors for poor CSS.ConclusionsSkeletal muscle loss during hepatectomy plus adjuvant TACE was remarkable. Higher SML was an independent risk factor for CSS in patients with HCC, especially those with liver cirrhosis.

MP39-15 YAP EXPRESSION PLAYS IMPORTANT ROLES IN MALIGNANT AGGRESSIVENESS BY REGULATING THE INFILTRATION OF CD57 + NATURAL KILLER CELLS, CD68 + MACROPHAGES, AND MAST CELLS AND THE EXPRESSION OF VEGF-A AND PD-L1 IN CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Basic Research & Pathophysiology I (MP39)1 Sep 2021MP39-15 YAP EXPRESSION PLAYS IMPORTANT ROLES IN MALIGNANT AGGRESSIVENESS BY REGULATING THE INFILTRATION OF CD57+ NATURAL KILLER CELLS, CD68+ MACROPHAGES, AND MAST CELLS AND THE EXPRESSION OF VEGF-A AND PD-L1 IN CLEAR CELL RENAL CELL CARCINOMA Kojiro Ohba, Yasuyoshi Miyata, Junki Harada, Tsuyoshi Matsuda, Tsubasa Kondo, Asato Otsubo, Yuta Mukae, Hidenori Ito, Hiroki Kurata, Kensuke Mitsunari, Hideki Sakai, Tomohiro Matsuo, and Yasushi Mochizuki Kojiro OhbaKojiro Ohba More articles by this author , Yasuyoshi MiyataYasuyoshi Miyata More articles by this author , Junki HaradaJunki Harada More articles by this author , Tsuyoshi MatsudaTsuyoshi Matsuda More articles by this author , Tsubasa KondoTsubasa Kondo More articles by this author , Asato OtsuboAsato Otsubo More articles by this author , Yuta MukaeYuta Mukae More articles by this author , Hidenori ItoHidenori Ito More articles by this author , Hiroki KurataHiroki Kurata More articles by this author , Kensuke MitsunariKensuke Mitsunari More articles by this author , Hideki SakaiHideki Sakai More articles by this author , Tomohiro MatsuoTomohiro Matsuo More articles by this author , and Yasushi MochizukiYasushi Mochizuki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002054.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Hippo signalling pathway is known as a critical regulator of malignant aggressiveness, and Yes-associated protein (YAP) is the most important downstream effector in this pathway. Although, YAP has pro-oncogenic activities, its detailed mechanisms are not fully understood. Recently, YAP has been reported to play important roles in tumour immunity, by regulating tumour-infiltrating lymphocytes and vascular endothelial growth factor (VEGF)-A and programmed cell death ligand 1 (PD-L1). However, the relationships between YAP expression, the densities of macrophages, natural killer (NK) cells, and mast cells; and VEGF-A and PD-L1 expression in human clear cell renal cell carcinoma (ccRCC) are not clear. METHODS: In 157 ccRCC tissues, the expression levels of YAP and VEGF-A were evaluated by immunohistochemistry, according to the percentage of positively stained cells and staining intensity. The densities of CD57+ NK cells, CD68+ macrophages, and mast cells were calculated as the number of positively stained cells per high-power field (HPF). All examinations were performed using immunohistochemical staining. RESULTS: Positive expression of YAP was significantly associated with high tumor grade, high pT stage, the presence of metastasis, and poor cause-specific survival in patients with ccRCC (p<0.001). CD57+ NK cell density was significantly lower (p<0.001) in YAP-positive tissues (mean±SD, 22.1 ± 8.0/HPF) than in YAP-negative tissues (33.1 ± 8.4/HPF). In contrast, CD68+ macrophage density was significantly higher (p<0.001) in YAP-positive tissues (44.2±14.5/HPF) than that in YAP-negative tissues (29.3±9.8/HPF). Similarly, YAP expression was positively correlated with mast cell density (p<0.001). However, H-scores of PD-L1 were significantly lower (p<0.001) in YAP-positive tissues (6.6±9.6) than in YAP-negative tissues (3.1±6.0). In addition, a similar positive correlation was detected between YAP expression and VEGF-A expression (p<0.001). CD57+ NK cell, CD68+ macrophage, and mast cell density and VEGF-A and PD-L1 expression were all significantly associated with pathological features. CONCLUSIONS: YAP expression was positively associated with tumour growth, invasion, and metastasis by stimulating the infiltration of CD58+ macrophages and mast cells into cancer tissues; increasing the expression of VEGF-A and PD-L1 in cancer cells; and suppressing the infiltration of CD57+ NK cells. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e710-e710 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kojiro Ohba More articles by this author Yasuyoshi Miyata More articles by this author Junki Harada More articles by this author Tsuyoshi Matsuda More articles by this author Tsubasa Kondo More articles by this author Asato Otsubo More articles by this author Yuta Mukae More articles by this author Hidenori Ito More articles by this author Hiroki Kurata More articles by this author Kensuke Mitsunari More articles by this author Hideki Sakai More articles by this author Tomohiro Matsuo More articles by this author Yasushi Mochizuki More articles by this author Expand All Advertisement Loading ...

Utility of a modified age-adjusted Charlson Comorbidity Index in predicting cause-specific survival among patients with gastric cancer

IntroductionThe current study aimed to evaluate the ability of a modified version of the age-adjusted Charlson Comorbidity Index (mACCI) in predicting cause-specific survival (CSS) among patients with gastric cancer who underwent curative gastrectomy and compared it with the conventional ACCI. Materials and methodsPatients who underwent gastrectomy for gastric cancer from 2007 to 2016 (n = 2885) were included. A mACCI was established by excluding scores for other malignancies, such as other cancers, leukemia, and lymphoma. After determining the optimal cutoff ACCI and mACCI values for CSS, clinicopathological factors and survival outcomes were assessed according to the ACCI and mACCI. ResultsBoth ACCI and mACCI were identified as independent prognostic factors for overall survival (p < 0.001 and p < 0.001, respectively). However, only mACCI was identified as an independent prognostic factor for CSS (p < 0.001). The present study suggested that mACCI was a better indicator of CSS in patients with gastric cancer who underwent curative gastrectomy than ACCI. ConclusionOur findings showed that the mACCI was a strong predictor of CSS in patients with gastric cancer who underwent curative gastrectomy. We believe that the mACCI will become a novel marker that would guide treatment decisions for patients with gastric cancer suffering from comorbidities.

The Association Between Race and 5-year Survival in Patients With Clear Cell Renal Cell Carcinoma: A Cohort Study

To determine if race was associated with 5-year cause-specific survival in patients with clear cell renal cell carcinoma. Outcomes were investigated using the Surveillance Epidemiology and End Results database with data from 13 states between the years 2007-2015. Covariates included age, sex, insurance, marital status, and tumor stage at diagnosis. Patients <18 years old or with missing data for race, survival time or insurance status were excluded. Cox regression models were used to determine associations through hazard ratios (HR) with 95% confidence intervals (CI) and to adjust for covariates. A total of 8421 subjects were included in the analysis. After adjustment, there was no association between race and 5-year cause-specific survival in patients with ccRCC (Black- HR: 0.96, 95%CI: 0.83,1.12; American Indian/Alaskan- HR: 1.01, 95%CI: 0.75,1.36; Asian Pacific Islander- HR: 0.99, 95%CI: 0.82,1.12). Older individuals and those with regional or distant tumors showed an increased hazard of death, while females and insured patients showed decreased hazard. Our study found that race was not associated with 5-year cause-specific survival from clear cell renal cell carcinoma. However inferior overall survival in Blacks with RCC has been well demonstrated in the literature. Our findings suggest that differences in survival may not be driven by cause-specific factors such as renal cell carcinoma, but rather social determinants of health which disproportionality affect Black patients. Further studies with more power that incorporate information on income, comorbidities, education status, and access to care are therefore necessary.

Prognostic Performance of Different Lymph Node Staging Systems in Patients With Small Bowel Neuroendocrine Tumors.

Background: The prognostic significance of the lymph node (LN) classification for small bowel neuroendocrine tumors (SBNETs) remains unknown. The aim of the present study was to evaluate and compare the prognostic assessment of different LN staging systems.Methods: Patients with SBNETs were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The X-tile program was used to determine the cutoff value of the resected lymph nodes (RLNs), negative lymph nodes (NLNs), lymph node ratio (LNR), and the log odds of positive lymph nodes (LODDS). Survival analyses were performed using Kaplan–Meier curves with log-rank test. Logistic regression analysis was used to evaluate the differences between different periods. Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of different LN staging systems on cause-specific survival (CSS). The relative discriminative abilities of the different LN staging systems were assessed using the Akaike information criterion (AIC) and the Harrell consistency index (HCI).Result: A total of 3,680 patients were diagnosed with SBNETs between 1988 and 2014 from the SEER database. A significant difference over time (1988–1999 vs. 2000–2014) was seen in age (P <0.001), tumor differentiation (P <0.001), T stage (P <0.001), and RLN (P <0.001) subgroups. Multivariate Cox survival analysis identified that LN status stratified by the number of RLNs, NLNs, LNR, and LODDS all predicted CSS in patients with SBNETs (all P <0.05), whereas the number of positive lymph nodes (PLNs) failed (P = 0.452). When assessed using categorical variables, LODDS staging systems showed the best prognostic performance (HCI: 0.766, AIC: 7,575.154) in the whole population. Further analysis based on different RLNs after eliminating the missing data showed that when the RLNs are <12, the LODDS (HCI: 0.769, AIC: 1,088.731) maintained the best prognostic performance as well when the RLNs are ≥12 (HCI: 0.835, AIC: 825.692). Among patients with LNR scores of 0 or 1, there was a residual heterogeneity of outcomes that were better stratified and characterized by the LODDS.Conclusion: LODDS was a better predicator of survival when LN status was stratified as a categorical variable and should be considered when assessing the prognosis of patients with SBNETs to allow a more reliable means to stratify patient survival.

Poorer prognosis of ovarian squamous cell carcinoma than serous carcinoma: a propensity score matching analysis based on the SEER database

BackgroundOvarian squamous cell carcinoma (SCC) is a rare cancer with possible poor survival, however no direct evidence supports this viewpoint and the independent prognostic factors are controversial. Patients with ovarian SCC and serous carcinoma (SC) who were diagnosed between 2004 and 2016 were selected using the recent released SEER database. Propensity score matching was used to balance the characteristics of the two groups. The difference of survival between patients with ovarian SCC and SC was explored using Kaplan-Meier method. Cox regression analyses were performed to further identify the independent prognostic factors among patients with ovarian SCC.ResultsOf 15,286 patients (15,106 SC cases and 180 SCC cases), 304 were identified in the matched cohort (200 SC cases and 104 SCC cases). The overall survival and cause-specific survival for patients with SCC were significantly poorer (Plog-rank < 0.001). The median survival time was 21 months for SCC and 95 months for SC. Patients who underwent bilateral salpingo-oophorectomy with hysterectomy and omentectomy seemed to have a better outcome. In multivariate analysis, older age at diagnosis, larger tumor size, bilateral and FIGO stage IV malignancy were the independent risk factors for poor disease outcome.ConclusionsThe prognosis of ovarian SCC is worse than ovarian SC. Older age at diagnosis, advanced disease stage, larger tumor size and bilateral malignancy are the independent risk factors for poor survival.

Disparities in Ocular and Periocular Cancer Outcomes: Assessing Survival in Patients of Hispanic Origin.

A nationwide cancer database was used to perform a retrospective cohort study to compare the overall survival and cause-specific survival in patients with ocular and periocular cancer from varying Hispanic origins. A total of 19,831 cases from the Surveillance, Epidemiology, and End Results (SEER) registries between 1973 and 2015 were obtained for analysis. All-cause and cause-specific mortality risk, with adjustment for age group, sex, race, tumor site, tumor histology, grade, summary stage, laterality, surgery status, radiotherapy status, and chemotherapy status, was examined using Cox proportional hazard models. Of the patients included 19,194 patients were non-Spanish-Hispanic-Latino, and 637 patients were Spanish-Hispanic Latino. The Spanish-Hispanic-Latino population was further subdivided as 398 of Mexican origin, 44 of Puerto Rican origin, 135 of South or Central American (excluding Brazil) origin, and 60 of other Spanish/Hispanic origin (including Europe origin). The mean (+/-SD) follow-up period was 98.57 (+/-93.23) months. In adjusted Cox regression, patients of Spanish-Hispanic-Latino origin demonstrated increased all-cause (HR, 1.173; 95% CI 1.022-1.347; P = 0.023) and cancer-specific mortality (HR, 1.328; 95% CI 1.099-1.604; P = 0.003) as compared to their non-Spanish-Hispanic-Latino counterparts. Upon subclassification by Hispanic origin, patients of Mexican origin had significantly increased all-cause (HR, 1.229; 95% CI 1.032-1.464; P = 0.021) and cancer-specific mortality (HR, 1.516; 95% CI 1.204-1.909; P < .001) and patients with other Hispanic/Spanish origin, including Europe, had significantly increased all-cause (HR, 1.627; 95% CI 1.16-2.28; P =0.005), but not cancer-specific (HR, 1.243; 95% CI 0.734-2.104; P = 0.418) mortality. Patients of Puerto Rican origin and South or Central American (excluding Brazil) origin had no significant difference in all-cause or cancer-specific mortality compared to those of non-Spanish-Hispanic-Latino origin. Mortality risk from ocular and periocular cancers varies extensively by specific Hispanic origin. A greater understanding of these disparities is essential to identify vulnerable populations and provide adequate treatment to optimize long-term outcomes.

Transplantation For Hcc: A National Analysis Of Recipient Selection Criteria

Presenter: Mackenzie Morris MD | University of Cincinnati Background: Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy with the Milan criteria being the standard to identify and prioritize patients for liver transplantation (LT). However, many centers in the United States are now performing LT in patients beyond Milan. In this study, we evaluated the outcomes of patients within and outside of Milan at LT as well as the impact of downstaging on outcomes after LT. Methods: The United Network of Organ Sharing (UNOS) database was queried for all patients with a diagnosis of HCC who underwent LT from 2009 to 2019. Pediatric patients and those without tumor-specific data were excluded. Patients were divided into three groups at LT: within Milan criteria (within Milan), within the University of California San Francisco (UCSF) criteria but beyond Milan (beyond Milan, within UCSF), and beyond both Milan and UCSF criteria (beyond UCSF) at the time of LT. Additionally, a subset analysis was performed for patients originally outside Milan, but within Milan or within UCSF at the time of LT. The cause of death variable was used to identify patients who died due to HCC in order to examine cause-specific survival. Results: A total of 16,883 patients (within Milan, n=16,165; beyond Milan, within UCSF, n=535; beyond UCSF, n=183) were identified who met inclusion criteria with a median follow-up of 2.9 (1.0-5.1) years. Kaplan-Meier survival analysis revealed a decreased overall and HCC cause-specific survival in patients within and beyond UCSF compared to those within Milan (p<0.01). In multivariate analysis of overall survival adjusting for recipient and donor specific factors, beyond Milan criteria, AFP > 90 mg/dL, and liver-directed therapy were associated with increased risk of death (Figure - black). In multivariate analysis for HCC cause-specific survival, beyond Milan criteria, AFP >90 mg/dL, and liver-directed therapy were associated with increased risk of death (Figure – grey). Finally, a subset analysis revealed no difference in overall survival in patients who were always within Milan (3-year survival of 82%) compared to those originally outside Milan but downstaged to within Milan (78%) or within UCSF at the time of LT (82%, p=0.44). Conclusion: UCSF criteria have been increasingly proposed to allow for expansion of patients who are able to undergo liver transplantation, but this expansion is not without risk of worse survival. However, patients who are down-staged to within UCSF may have similar Results to those always within Milan or those down-staged to within Milan.

Uveal melanoma-associated survival in Scotland.

The Scottish Ocular Oncology Service (SOOS) manages all patients with uveal melanoma (UM) in Scotland. Our aim was to determine the long-term all-cause and cause-specific survival of patients with UM, irrespective of treatment modality. A retrospective single-centre cohort study including all patients diagnosed with UM by the SOOS between 1/1/1998 and 31/12/2002. Data from the SOOS database were correlated with death records held by National Records of Scotland, which provided date, and all listed causes, of death for all deceased patients. Two hundred and eighteen patients were newly diagnosed with UM between 1/1/1998 and 31/12/2002. One hundred and fifteen (52.8%) were female. The mean (median) age at diagnosis was 63(65) years (range: 16-89). Of 179 choroidal melanomas, melanoma-specific survival was 92.3%, 87.4% and 83.8% at 5, 10 and 15 years, respectively. Cancer-specific survival was 85.8%, 71.8% and 62.3%. All-cause survival was 81.6% (146/179), 62.0% (111/179) and 46.7% (computed, fraction inexpressible). Of 26 ciliary body melanomas, melanoma-specific survival was 87.2%, 81.3% and 81.3% at 5, 10 and 15 years. Cancer-specific survival was 62.9%, 40.6% and 40.6%. All-cause survival was 61.5% (16/26), 38.5% (10/26) and 26.9% (7/26). Of 13 iris melanomas, at all three timepoints (5/10/15 years), melanoma-specific survival was 100%, cancer-specific survival was 92.3%, and all-cause survival was 76.9% (10/13). Correlation of SOOS and national records survival data confirms 15-year melanoma-specific survival of 83.8%, 81.3% and 100% for choroidal, ciliary body and iris melanomas, respectively. We can now provide accurate survival data to our patients in Scotland.

Nomograms for predicting the overall and cause-specific survival in patients with malignant peripheral nerve sheath tumor: a population-based study.

Malignant peripheral nerve sheath tumor (MPNST) is extremely rare in soft tissue sarcoma, with a high rate of recurrence and metastasis. Due to its rarity, the epidemiological features and prognostic factors are still uncertain. Moreover, nomograms for patients with MPNST have not been constructed and validated until now. Patients diagnosed with MPNST between 1973 and 2014 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Survival analysis, machine learning and Lasso regression were used to identify the prognostic factors for overall survival (OS) and cause-specific survival (CSS). Significant prognostic factors were integrated to construct nomograms and then the nomograms were validated externally with a separate cohort from our own institution. A total of 689 patients were included in the training set and 42 patients in the validation set. Multivariate analysis suggested that age, histology, historic stage and chemotherapy were independent prognostic factors for OS and primary site, surgery, historic stage and chemotherapy for CSS. The nomograms based on multivariate models were developed and validated for predicting 3- and 5-year OS and CSS, with a C-index of 0.686 and 0.707, respectively. In the external validation set, the C-index was 0.700 for OS and 0.722 for CSS. ICD-O-3 histology, historic stage and chemotherapy were independent prognostic factors for OS and primary site, surgery, historic stage and chemotherapy for CSS. The constructed nomograms could provide individual prediction for MPNST patients and assist oncologists in making accurate survival evaluation.

Primary testicular lymphoma: A SEER analysis of 1,169 cases.

Primary testicular lymphoma (PTL) is a rare lymphoid malignancy. The present retrospective study aimed to investigate the demographic characteristics and survival of patients with PTL, as well as the associated prognostic factors, using a population-based database. All adults diagnosed with PTL in the Surveillance, Epidemiology, and End Results database were identified between 1973 and 2013. The Kaplan-Meier method was used to estimate cause-specific survival (CSS). Log-rank test or multivariate Cox regression model was used to assess the influence of demographic and clinical parameters on CSS. A total of 1,169 patients with PTL were identified from the database, and the median age was 70 years. The predominant histological subtype was diffuse large B-cell lymphoma, which affected 82.9% (970/1,169) of patients, and 68.6% (802/1,169) of patients had early stage disease (stages I–II). Patients >70 years, those diagnosed at the earlier time period, or those who had advanced-stage symptoms had the worst 5-year CSS rates; however, treatment with rituximab significantly improved the 5-year CSS. In conclusion, this retrospective study presented data from the largest cohort of patients with PTL and described the effects of rituximab on the CSS of patients with PTL.

The effect of marital status on the survival of patients with bladder urothelial carcinoma: A SEER database analysis.

To identify whether marital status is associated with survival in patients with bladder urothelial carcinoma (UC). Using Surveillance, Epidemiology, and End Results population-based data, 133,846 patients diagnosed with bladder UC between 1988 and 2009 were identified. Kaplan–Meier methods and multivariable Cox regression models were used for survival analyses and evaluation of the association between marital status and survival, after controlling for gender, age, race, primary site, tumor (topography), lymph node, metastasis stage, pathological grading, and surgery. Patients in the married group had a higher proportion of men within group comparisons, more often white, older, earlier clinical stage at diagnosis, surgical treatment, all of which were statistically significant (P < .001). Widowed patients had the worst bladder UC cause-specific survival (CSS) compared with married, never married, and so on groups classified by stage and grade. The 5-year CSS of widowed patients compared with that of married patients was, respectively, all (P < .001), 89.8% versus 95.8% at noninvasive papillary carcinoma stage, 84.1% versus 91.6% at occur in situ stage, 74.3% versus 86.1% at I stage, 41.2% versus 61.6% at II stage, 39.2 versus 52.5% at III stage, and 8.8% versus 17.0% at IV stage. Widowed patients tend to have a significantly higher risk of bladder-cancer-specific mortality. Marital status was relevant to improved CSS in patients with bladder UC.

The effect of lymphadenectomy in advanced ovarian cancer according to residual tumor status: A population-based study

BackgroundWe investigated the effect of lymphadenectomy on the survival outcomes of patients with advanced epithelial ovarian cancer in the Surveillance, Epidemiology, and End Results database according to residual disease status. MethodsWe evaluated 3048 patients with International Federation of Gynecology and Obstetrics stage-IIIC–IV epithelial ovarian cancer. We assessed the effect of lymphadenectomy stratified by residual disease size on cause-specific survival (CSS). ResultsA total of 1904 (62.5%) patients received lymphadenectomy, and 1355 (71.2%) patients had nodal metastases. Lymph-node status had no significant association with residual tumor size in the lymphadenectomy group. In multivariate analysis, lymphadenectomy was associated with a significantly better CSS and was an independent prognostic factor for CSS. Patients with >10 lymph nodes removed had better CSS compared with non-lymphadenectomy and 1–10 lymph nodes removed groups. Lymphadenectomy was associated with a significantly better CSS in patients with no gross residual tumor, but not in patients with residual tumor ≤1 cm or >1 cm. ConclusionsLymphadenectomy is significantly associated with a better survival outcome in patients advanced ovarian cancer, but its positive effect diminishes as residual tumor size increases.