Difference In 5-year Overall Survival Research Articles

Trophoblast Cell Surface Antigen 2 (Trop2) in Chromophobe Renal Cell Carcinoma

Background: Overexpression of tumor-associated calcium signal transducer 2 (Trop2) is found in many tumor entities. The prognostic value of Trop2 in renal cell renal carcinoma (RCC), especially in nonclear cell RCC, is still unclear. Aim: The aim of this study was to evaluate the prognostic impact of Trop2 expression in a large cohort of patients with chromophobe (ch)RCC. Materials and Methods: Patients who underwent renal surgery due to chRCC were retrospectively evaluated. Tumor specimens were analyzed for Trop2 expression by immunohistochemistry. Results: Eighty-one chRCC patients were eligible for analysis, of these 24 (29.6%) patients were positive for Trop2. No significant associations were found for Trop2 expression and clinical attributes in patients with chRCC. The Kaplan-Meier analysis revealed no differences in 5-year overall survival for Trop2⁻ compared to Trop2⁺ (89.6% vs. 100.0%; p = 0.288). Conclusion: In chRCC, Trop2 expression is not associated with survival and other parameters of aggressiveness. Due to the rare incidence of chRCC, further studies with larger cohorts are warranted.

Impact of muscle mass loss assessed by computed tomography on the outcome of allogeneic stem cell transplantation

The definition of sarcopenia assessed by computed tomography (CT) varies among different reports, and few studies have examined the effect of muscle mass loss on the prognosis of post-hematopoietic cell transplantation (HCT). We retrospectively evaluated 172 patients who underwent an initial allogeneic HCT for acute leukemia at our institution. They were divided into 3 groups according to muscle mass measured at the third lumbar vertebra as assessed by CT. Patients with low muscle mass had a worse performance status, higher comorbidity index and higher disease risk. There was a significant difference in 2-year overall survival between the 3 groups, and worse overall survival (OS) was associated with lower muscle mass (p = 0.005). Muscle mass loss did not affect non-relapse mortality (p = 0.238) but was significantly associated with relapse (p = 0.067). Pre-transplant muscle mass loss may therefore reflect a poor prognosis for the primary disease.

Outcomes of laparoscopic total gastrectomy in elderly patients: a propensity score matching analysis.

This study evaluated the short-term outcomes and prognosis after laparoscopic total gastrectomy (LTG) in elderly patients aged ≥ 80years in a multicenter retrospective cohort study using propensity score matching. We retrospectively enrolled 440 patients who underwent curative LTG for gastric cancer at six institutions between January 2004 and December 2018. Patients were categorized into an elderly patient group (EG; age ≥ 80years) and non-elderly patient group (non-EG; age < 80years). Patients were matched using the following propensity score covariates: sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. Short-term outcomes and prognoses were compared. We identified 37 propensity score-matched pairs. The median operative time was significantly shorter, and postoperative stay was longer in the EG. In terms of postoperative outcomes, the rates of all complications were comparable. The median follow-up period of the EG and non-EG was 11.5 (1-106.4) months and 35.7 (1-110.0) months, respectively; there were significant differences in 5-year overall survival between the two groups (EG, 58.5% vs. non-EG, 91.5%; P = 0.031). However, there were no significant differences in 5-year disease-specific survival (EG, 62.1% vs. non-EG, 91.5%; P = 0.068) or 5-year disease-free survival (EG, 52.9% vs. non-EG, 60.8%; P = 0.132). LTG seems to be safe and feasible in elderly patients. LTG had a limited effect on morbidity, disease recurrence, and survival in elderly patients. Therefore, age should not prevent elderly patients from benefitting from LTG.

Factors influencing patterns of recurrence following pancreaticoduodenectomy for patients with distal bile duct cancer and ampulla of Vater cancer.

Backgrounds/AimsPancreaticoduodenectomy (PD) is a standard surgical procedure for patients with periampullary cancer. During the follow-up period after PD, recurrence can be observed in various places with different prognosis. The aim of this study was to clarify the pattern of recurrence and factors affecting the survival of patients with periampullary cancer.MethodsOverall, 88 patients who received PD for distal common bile duct cancer or ampulla of Vater cancer were finally included and their clinical characteristics were analyzed. Patients were divided into three groups: recurrence-free (RF) group, an isolated locoregional recurrence (LR) group, and a distant metastasis (DM) group. Prognostic factors affecting recurrence in each group were analyzed and a survival analysis was performed.ResultsPerineural invasion (PNI), T stage, and lymphovascular invasion (LVI) were significant risk factors for LR and PNI, lymph node metastasis, LVI, and T stage were associated with DM group compared to RF group in univariate analysis, respectively. N stage and PNI were significant risk factors (p = 0.046, p = 0.041) in overall survival of the LR and the DM groups. There was no significant difference in 5-year overall survival between the LR and DM groups.ConclusionsT stage was a significant risk factor of LR, while PNI was a significant risk factor of DM. There was no significant difference in overall survival depending on the site of recurrence.

Propensity Score-Matched Analysis of the Short- and Long-Term Outcomes of Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer.

Robotic gastrectomy (RG) has been rapidly adopted for gastric cancer (GC) treatment. However, the benefits of RG over laparoscopic gastrectomy (LG) for GC remain unclear. A total of 451 patients who underwent either RG (n = 83) or LG (n = 368) for GC were enrolled in this study. A 1:1 matched, propensity score-matched analysis was performed using the following factors: age, sex, body mass index, pT, pN, pStage, tumor location, vessel invasion, tumor markers, surgical procedure, reconstruction method, extent of lymphadenectomy, and Endoscopic Surgical Skill Qualification System qualified surgeon as an operator. The surgical outcomes of the two groups were compared. A well-balanced cohort of 158 patients was analyzed (n = 79 in the RG group, n = 79 in the LG group). Regarding the short-term outcomes, the respective blood loss volume, drain amylase content, and number of retrieved lymph nodes in the RG and LG groups were 38.62 ± 73.06 ml and 67.53 ± 108.20 ml (p < 0.05), 450 ± 371 IU/l and 1590 ± 6392 IU/l (p < 0.01), and 35.02 ± 15.51 and 25.28 ± 11.70 (p < 0.01). The morbidity rate was similar between the RG and LG groups (not significant [NS]). Regarding the long-term survival outcomes, there were no intergroup differences in 3-year overall survival (91.72% in the RG group vs. 83.39% in the LG group: NS) and 3-year, disease-free survival (93.31% in the vs. 90.44%: NS). RG was safe and contributed to better short-term outcomes and similar long-term survival outcomes compared with LG.

Comparison of Clinical Outcomes between Minimally Invasive (Laparoscopic and Robotic) and Open Extended Cholecystectomy

Background: Minimally invasive surgery (MIS), both laparoscopic and robotic surgery for gallbladder cancer (GBC) has rapidly increased recently, however, there is a lack of large multicenter studies of its safety and long-term outcome. Methods: Patients diagnosed with clinically suspected GBC who underwent EC from 2007 to 2020 in 3 large volume hepatobiliary centers were studied. EC was defined as a wedge resection of liver bed including cholecystectomy and regional lymphadenectomy Clinicopathologic data of O-EC and MIS-EC was analyzed and propensity score matching was performed to compare the short-term and long-term outcomes. Subgroup analysis of laparoscopic and robotic surgery was evaluated. Results: A total of 377 patients were included, O-EC and MIS-EC groups (laparoscopic EC: 40, robotic EC: 29) were 308 and 69 patients, respectively. Though MIS-EC group had a longer operative time (188.9 vs 238.1 minutes, p<0.001), shorter length of hospital stay (9.0 vs7.2 days, p=0.007), there was no difference in operative blood loss, complication rate, 30-day mortality rate. More lymph nodes were retrieved in O-EC (8.5 vs 7.1, p=0.044) and there was no significant difference in 3-year overall survival. In subgroup analysis of MIS-EC, laparoscopic EC had a longer operative time (264.4 vs 202.0 min, p=0.001), however, other perioperative outcomes and 3-year survival outcomes were comparable. Conclusion: MIS-EC is feasible with advantages of decreased length of stay and comparable survival to O-EC in GBC. Both laparoscopic and robotic EC had comparable perioperative and oncologic outcomes so it can be chosen according to the preference of the surgeon.

Growth Arrest-Specific 6 in Chromophobe Renal Cell Carcinoma.

Overexpression of tumor-associated growth arrest-specific protein 6 (Gas6) is found in many tumor entities. The prognostic value of Gas6 in renal cell carcinoma (RCC), especially in non-clear cell RCC, is still unclear. The aim of the study was to evaluate the prognostic impact of Gas6 expression in a large cohort of patients with chromophobe RCC (chRCC). Patients who underwent renal surgery due to chRCC were retrospectively evaluated. Tumor specimens were analyzed for Gas6 expression by immunohistochemistry. Eighty-one chRCC patients were eligible for analysis; of these, 24 (29.6%) patients were positive for Gas6. No significant associations were found for Gas6 expression and clinical attributes in patients with chRCC. The Kaplan-Meier analysis revealed no differences in 5-year overall survival for Gas6- compared to Gas6+ (89.6% vs. 100.0%; p = 0.288) tumors. In chRCC, Gas6 expression is not associated with survival and other parameters of aggressiveness. Due to the rare incidence of chRCC, further studies with larger cohorts are warranted.

Efficacy and Safety of Concurrent Chemoradiotherapy Combined With Induction Chemotherapy or Adjuvant Chemotherapy in Patients With Stage II-IVA Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis and Meta-Analysis.

PurposeTo evaluate the efficacy and safety of induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) versus CCRT combined with adjuvant chemotherapy (AC) in patients with stage II–IVA nasopharyngeal carcinoma (NPC), we conducted a retrospective study and a meta-analysis combining the results of our studies.Patients and MethodsWe used the propensity score matching (PSM) to balance variables. A total of 168 patients were chosen by one-to-two PSM, including 101 patients with IC + CCRT and 67 cases with CCRT + AC. We used the Kaplan–Meier curve to compare survival outcomes and also used Cox regression analysis to determine independent prognostic factors. For meta-analysis, we determined the related studies by searching the PubMed database. We used STATA v12 software to perform meta-analysis of the extracted data and calculate pooled hazard ratios, 95% confidence intervals of survival outcomes, and risk ratios for the toxicities.ResultsIn this retrospective study, there was no significant difference in 5-year overall survival (76.9% vs. 79.0%, P = 0.966), progression-free survival (71.3% vs. 68.5%, P = 0.332), distant metastasis-free survival (80.5% vs. 74.2%, P = 0.140), and locoregional relapse-free survival (91.5% vs. 91.8%, P = 0.894) among patients with NPC with IC + CCRT versus CCRT + AC after PSM. For meta-analysis, six articles (including our study) reporting 1,052 cases of IC + CCRT and 883 cases of CCRT + AC were included in the meta-analysis. There was no difference of OS (pooled HR = 0.90, 95% CI: 0.63–1.29, P = 0.561), PFS (pooled HR = 1.07, 95% CI: 0.87–1.33, P = 0.633), DMFS (pooled HR= 0.98, 95% CI: 0.76-1.25, P=0.861), and LRRFS (pooled HR = 1.06, 95% CI: 0.76–1.48, P = 0.724).ConclusionThe efficacy of IC + CCRT and CCRT + AC was comparable in patients with stage II–IVA NPC. In terms of compliance and acute adverse reactions, IC + CCRT may be a potential therapeutic strategy.

Merkel Cell Polyomavirus Antibody Titer Predicts Recurrence-Free Survival.

Merkel cell polyomavirus (MCPyV) is associated with the development of Merkel cell carcinoma (MCC). Antibody (MCPyV-Ab) titers may have prognostic implications. This study evaluated the impact of the presence or absence of MCPyV-Ab on the 2-year overall survival (OS) and disease-free survival (DFS) of MCC patients. This single-center, IRB-approved, retrospective cohort study evaluated 51 adult patients with MCC from 2014 to 2021 using a prospectively maintained database. Patients were compared by MCPyV-Ab status, and Kaplan-Meier analysis was used to evaluate 2-year OS and DFS. Of the 51 patients, 13 (25.4%) were seropositive, 41 (80.4%) underwent wide excision, 40 (80.0%) received radiotherapy, and 43 (84.3%) received multimodal therapy. The median follow-up period was 15.5 months (range 1-69.5 months). The median 2-year OS of the entire cohort was not reached. The median 2-year OS was not reached for either the seronegative or the seropositive patients. The difference in 2-year OS between the groups was not statistically significant (p = 0.37). Eight patients, all seronegative, were never rendered disease-free and were removed from recurrence analysis. The seropositive patients experienced no recurrences. Of the 30 seronegative patients, 9 (30.0%) experienced recurrence. The median 2-year DFS of the entire cohort was not reached.The median 2-year DFS of the seronegative group was 22.2 months. The 2-year DFS was not reached for the seropositive cohort. Seropositivity conferred a significantly better 2-year DFS than seronegativity (p = 0.04). The MCPyV-Ab seropositive patients demonstrated improved 2-year DFS. The seropositive patients showed a strong trend toward improved 2-year OS, although the difference not statistically significant. This study substantiated the value of MCPyV-Ab assessment for MCC.

Evaluation of the association of health care system access with kidney cancer surgical outcomes for hispanic and non-hispanic white patients

To determine the impact of health care system access on outcomes for Hispanic and Non-Hispanic White patients with renal cell carcinoma (RCC).We retrospectively analyzed Hispanic and non-Hispanic White patients diagnosed with localized RCC between 2007 and 2020. We used Health Resources and Services Administration criteria to identify patients living in Medically Underserved Areas (MUA). Primary outcome all-cause mortality and cancer-specific survival using Log Rank test on Kaplan Meier Analysis. Secondary outcome was all-cause mortality and cancer specific survival on Cox Regression when adjusting for risk factors.We analyzed 774 patients, 246 (31.8%) Hispanic patients and 528 (68.2%) Non-Hispanic White patients. Hispanic ethnicity was associated with lower risk of ACM (HR 0.53, P = 0.019) and there was no difference for cancer specific survival (HR 0.57, P = 0.059). Living in a MUA was associated with worse all-cause mortality (P = 0.010) but not cancer specific survival (CSS) (P = 0.169). Comparing Hispanic and Non-Hispanic Whites, KMA revealed no difference in 5-year all-cause mortality (83.1% vs. 78.8%, P = 0.254) and 5-year CSS (85.7% vs. 85.4%, P = 0.403).Hispanics had lower all-cause mortality risk and no significant differences in 5-year overall survival and CSS compared to non-Hispanic Whites. Our findings indicate that tertiary referral centers may help mitigate inequalities in access to care.

Patient outcomes after non-curative endoscopic submucosal dissection for early colorectal cancer: a single-center, retrospective cohort study.

BackgroundThe treatment patterns and outcomes for patients after non-curative endoscopic submucosal dissection (ESD) remain controversial, particularly among those requiring preservation of the anal sphincter or advanced age. This retrospective study aimed to investigate the treatment patterns and outcomes in patients after non-curative ESD for early colorectal cancer (CRC).MethodsThis was a retrospective review in Chinese patients who received non-curative ESD for early CRC, and who were treated in the Cancer Hospital at the Chinese Academy of Medical Sciences from 2010 to 2019. Demographic parameters, clinicopathologic features, treatment patterns, and clinical outcomes were analyzed.ResultsOf the 180 patients who received non-curative ESD, 85 received additional surgery; the remaining 95 patients were kept under surveillance only. Patients in the surveillance-only group tended to be older than those in the additional surgery group. Furthermore, tumors in the surveillance-only group were located in the rectum significantly more often, were better differentiated with a shallower depth of invasion and less perineuronal invasion than in the additional surgery group; there were fewer high-risk factors for residual cancer or lymph node (LN) metastasis in the surveillance-only group compared with the additional surgery group. There was no significant difference in 5-year overall survival (OS) (92.6% versus 92.7%, P=0.355), 5-year disease-free survival (DFS) (94.7% versus 91.9%, P=0.340), 5-year cancer-specific survival (CSS) (93.8% versus 92.7%, P=0.791), or total recurrence rates (4.7% versus 9.5%, P=0.217) between the additional surgery and surveillance-only groups, respectively.ConclusionsESD results in favorable outcomes for patients with early CRC. Surveillance in patients who receive non-curative ESD may be an alternative option for those with advanced age and fewer high-risk factors for residual cancer or LN metastasis.

The Impact of Trial Eligibility Criteria on Outcomes in a Nationwide Cohort of Newly Diagnosed DLBCL Patients Treated with R-CHOP

Background: Generalizability of results from clinical trials with narrow in-/exclusion criteria are a concern as significant deviations in efficacy or toxicity may occur when treatments are used in populations of elderly and more comorbid patients. The cost-effectiveness of novel therapies may also be less favorable if real-world treatment effects are inferior to clinical trial results. In diffuse large B-cell lymphoma (DLBCL), a recent US study showed that baseline organ function-based eligibility criteria had substantial impact on survival with ineligible patients being at higher risk of dying from progressive lymphoma (1).Aims: The present study explored the impact of commonly used in-/exclusion criteria in key completed and ongoing first line DLBCL trials on survival in a Danish population-based study of patients with de novo DLBCL.Patients and methods: DLBCL patients enrolled in the Danish Lymphoma Registry (LYFO) and treated with R-CHOP in the period 2008-19 were screened for completeness of data to match trial eligibility criteria. The key organ/hematology eligibility criteria of completed or ongoing all-comers DLBCL studies (REMoDL-B, Goya, Polarix and Hovon84) were collected (bilirubin, ALAT, creatinine, eGFR, leucocytes, neutrophils, thrombocytes and ECOG).First, high-level trial matching on disease risk group (Ann Arbor, bulky disease, international prognostic index (IPI)) and age-groups were performed so that patients assessed for trial eligibility had a relevant risk profile. Subsequently, patients were divided into eligible or ineligible based on selected in/exclusion criteria. For each trial, overall survival (OS) from treatment start were compared for eligible and ineligible patients using inverse probability of treatment weighted Kaplan-Meier and log-rank tests. Crude OS and OS adjusted for residual imbalances in IPI and age were estimated. When possible, the OS curves from standard arms of the original trials were superimposed on OS plots. For each trial, the Shapley value of each criterion was calculated, using the HRs as well as the 5y restricted loss of lifetimes (RLOLs). The Shapley value measures the average influence of each eligibility criterion on the estimated IPI- and age-adjusted HR/5y RLOL.Results: A total of 3,150 R-CHOP treated DLBCL patients without discordant low-grade lymphoma were identified in the surveyed period. A total of 1,666 patients (52.89% of surveyed population) were available for the REMoDL-B trial, 1,431 (45.43%) for Goya, 1,125 (35.71%) for Polarix, and 1,432 (45.46%) for Hovon84. The variations of numbers for each trial evaluation were explained by trial inclusion criteria and missing data in LYFO. Crude OS estimates for patients with and without all necessary information were similar (data not shown).OS curves for eligible and ineligible patients are shown in Figure 1 and, when possible, with superimposed trial results (Goya, REMoDL-B, Hovon84). Survival differences between trial eligible and ineligible patients were robust to further adjustment of imbalances in age and IPI.Associated crude and adjusted 2 and 5-year OS rates for trial eligible and ineligible are shown in Table 1. The largest numerical difference in 2-year crude OS between eligible and ineligible was observed in the REMoDL-B trial (ineligible had 26% lower 2-year OS rate). The largest numerical difference in 2-year OS adjusted for IPI and age between eligible and ineligible was observed for the Polarix trial (ineligible had 17% lower 2-year OS rate). The strongest drivers of OS differences between trial eligible and ineligible patients in terms of the tested eligibility criteria were thrombocyte count (HR-contribution calculated from Shapley values -0.11; -0.14) and ECOG (HR-contribution -0.09; -0.21). Liver function parameters (bilirubin and ALAT) had low impact on OS (HR-contribution 0.00; -0.05 and 0.00; 0.07).Conclusions: The present population-based study confirms that trial ineligible patients have worse survival even after adjustments in imbalances in age and disease risk category. Thus, trial eligibility criteria have substantial impact on generalizability of results to a wider unselected population. Interestingly, the trial eligible patients identified in the present study had very similar outcomes to R-CHOP treated patients in the original trials supporting the possible use of RWD as synthetic control arms. [Display omitted] DisclosuresMaurer: Kite Pharma: Membership on an entity's Board of Directors or advisory committees; Morphosys: Membership on an entity's Board of Directors or advisory committees, Research Funding; Nanostring: Research Funding; Genentech: Research Funding; Celgene: Research Funding; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees. Jørgensen: Novartis: Consultancy; Gilead: Consultancy; Roche: Consultancy; Celgene: Consultancy. Larsen: BMS: Consultancy; Novartis: Consultancy; Celgene: Consultancy; Odense University Hospital, Denmark: Current Employment; Gilead: Consultancy. Clausen: Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel expences ASH 2019; Gilead: Consultancy, Other: Travel expences 15th ICML ; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Poulsen: Abbvie: Consultancy; Janssen: Consultancy. El-Galaly: Abbvie: Other: Speakers fee; ROCHE Ltd: Ended employment in the past 24 months.

Prognostic Relevance of Cytogenetic Chromosomal Abnormalities on Outcome Among AL Amyloidosis Patients in the Netherlands

Introduction Systemic light chain (AL) amyloidosis is a clonal plasma cell neoplasm, that carries a poor prognosis. Treatment is adapted from protocols as used in MM, and include bortezomib-based (PI) regimens with or without stem cell transplantation (SCT). PI-based regimens have improved treatment responses and outcomes. Cytogenetic analysis has become an important tool in the diagnostic process of plasma cell disorders, and evidence for prognostic significance of specific genetic abnormalities in relation to therapy efficacy is recognized in systemic AL amyloidosis. Thus far, this prognostic significance has been evaluated in single center institutions.Aim This nationwide, population-based study aimed to assess the impact of cytogenetic abnormalities on hematological response and survival among patients with systemic AL amyloidosis treated with PI-based regimens.Methods We identified 349 patients ≥18 years with systemic AL amyloidosis diagnosed between 2017 and 2019 in the Netherlands Cancer Registry, with survival follow-up until February 1, 2021. Data on therapeutic strategy was known for all individual patients. The cytogenetic aberrations studied include gain(1q), hyperdiploidy, del(17p), and IGH rearrangements, i.e. t(11;14), t(4;14), t(14;16), and t(v;14q32) (non-specified IGH rearrangement). Hematological response and overall survival (OS) were evaluated in relation to cytogenetic aberrations. OS was defined as death by any cause post-diagnosis. Uni- and multivariable analysis for establishing independent predictors of OS, i.e. age, sex, cytogenetic assessment and SCT, was performed using Cox regression. Patients diagnosed at autopsy (n=4), patients who did not start first-line therapy (n=64) or received other therapies (n=37), and patients with systemic AL amyloidosis related to Waldenström Macroglobulinemia (n=10) were excluded.Results In our analytic cohort, 234 patients (median age 67 years; 62% males) were treated with PI-based regimens. Of these patients, 153 (65%) were ≤70 years at diagnosis. SCT was performed in 70 (30%) patients following PI-based regimens. For 170 (73%) patients, cytogenetic assessment was performed. IGH rearrangements were observed in 76 patients (45%), comprised of t(11;14) in 27 patients, t(4;14) in 3 patients, t(14;16) in 2 patients and non-specified IGH rearrangements in 44 patients. Furthermore, 26 patients carried a gain(1q), 4 patients a del(17p), and 33 patients were hyperdiploid. Due to the limited patient number with del(17p), response and OS was not evaluated for this subgroup.A complete remission (CR; n=53), very good partial response (VGPR; n=66), or partial remission (PR; n=55) was accomplished for 74% of the patients, ≥VGPR for 51% of the patients. The reached hematological response was irrespective of the detected cytogenetic abnormalities. In detail, ≥VGPR was 56% for patients with a t(11;14), 62% for patients with a gain(1q), 55% for patients with hyperdiploidy, and 50% for patients with an IGH rearrangement and this was not statistical significant different from patients without these cytogenetic abnormalities.The 3-year OS was 61% for patients treated with PI-based regimens. For patients with a cytogenetic assessment (n=170), there was no significant difference in 3-year OS between patients with or without a t(11;14) (69% vs. 66%, respectively; p=0.70), with or without gain(1q) (57% vs. 68%, respectively; p=0.58), with or without hyperdiploidy (72% vs. 65%, respectively; p=0.63), or with or without an IGH rearrangement (59% vs. 72%; p=0.21). Only SCT was an independent predictor for reduced risk of mortality in uni- and multivariable analyses, overall as well as for the specific cytogenetic subgroups.Conclusion In this Dutch ‘real world’ population of AL amyloidosis patients treated with PI-based regimens, 74% had a ≥PR and 51% had ≥VGPR. The 3-year OS was 61%. We evaluated the cytogenetic data of 170 patients, but could not confirm a relation between PI-based regimens and outcome, overall as well as in specific cytogenetic subgroups. Patient numbers of the cytogenetic subgroups were low and we could not determine the partner gene in 44 patients with an IGH rearrangement. To the best of our knowledge, this is the first population-based study to evaluate the prognostic relevance of cytogenetic abnormalities in relation to hematological response and OS among systemic AL amyloidosis patients. DisclosuresMinnema: Alnylam: Consultancy; Kite/Gilead: Consultancy; Jansen-Cilag: Consultancy; BMS: Honoraria; Celgene: Other: Hospitality.

Effects of mediastinal lymph node dissection in colorectal cancer-related pulmonary metastasectomy.

BackgroundThe benefits of mediastinal lymph node dissection (MLND) in colorectal cancer‐related pulmonary metastasectomy (PM) have been poorly reported. This study aimed to determine whether MLND affects survival in patients undergoing PM and to identify the prognostic factors for survival.MethodsWe retrospectively reviewed 275 patients who had undergone colorectal cancer‐related PM from January 2010 to December 2016. MLND was defined as the resection of at least six mediastinal lymph node stations according to the International Association for the Study of Lung Cancer criteria (N1, ≥3 stations; N2, ≥3 stations). The propensity score matching method was used to reduce bias.ResultsThirty‐three (12%) patients underwent MLND, and 13 (4.7%) patients had mediastinal lymph node involvement. This study showed no difference in 5‐year overall survival (no MLND, 52.7% vs. MLND, 53.5%; p = 0.81). On multivariable analysis, negative prognostic factors for overall survival were preoperative carcinoembryonic antigen (CEA) level (p < 0.001), a higher number of metastatic nodules (p < 0.001), metastatic nodule size ≥2 cm (p < 0.001), and lymph node involvement (p = 0.006).ConclusionsMediastinal lymph node involvement, preoperative CEA level, higher metastatic nodule number, and nodule size negatively affected survival whereas MLND in PM was not associated with survival.

Long-Term Outcomes of Watch & Wait (W&W) after Neoadjuvant Treatment in Patients With Rectal Cancer

To compare the outcomes of W&W strategy in patients with locally advanced rectal cancer who achieve complete clinical response (cCR) after neoadjuvant therapy, with those pathological complete response (pCR) after total mesorectal excision (TME).This is a retrospective cohort analysis study. 1014 Patients of histologically proven with locally advanced rectal adenocarcinoma who had received neoadjuvant chemotherapy were eligible between January 2014 and December 2019. In whom we included patients who had cCR offered management with W&W strategy after completing long-course concurrent chemoradiotherapy or short-course sequential chemoradiotherapy, no distant metastases within 6 months after treatment, follow-up ≥1 year, and patients who did not have cCR but pCR after TME. The primary endpoints were 3-year and 5-year overall survival (OS), colostomy-free survival (CFS), disease-free survival (DFS), non-local regrowth disease-free survival (non- regrowth DFS), and organ preservation rate. For comparative analysis, we also derived one-to-one paired cohorts of W&W versus pCR using propensity-score matching (PSM).118 patients were enrolled, 49 of whom had cCR and managed by W&W, 69 had pCR, with a median follow-up period of 49.5 months (IQR 12.1-79.9). No difference in 3-year OS (97.1% vs 96.7%) and 5-year OS (93.8% vs 90.9%, P = 0.696) between W&W and pCR, but patients managed by W&W had significantly better 3-year and 5-year CFS (89.1% vs 43.5%, P < 0.0001). Six patients had local regrowth managed by W&W, while no local recurrence in the pCR group, which had better 3-year DFS (83.6% vs 97%) and 5-year DFS (83.6% vs 91.2%, P = 0.047). However, after salvage surgery, no significantly difference in 3-year non-regrowth DFS (95.9% vs 97%) and 5-year non-regrowth DFS (92.8% vs 97%, P = 0.407) between these two groups. In the PSM analysis (34 patients in each group), absolutely better CFS (90.1% vs 26.5%, P < 0.0001) were noted in the W&W group, but no differences in other survival between groups. A median interval of 17.5 weeks was observed for achieving cCR, while only 23.9% of patients achieved cCR within 5 to 12 weeks from radiation completion. Patients with short-course sequential chemoradiotherapy achieved cCR significantly later when compared with those with long-course concurrent chemoradiotherapy (19 vs 9.8 wk, P < 0.0001).The long-term outcomes of W&W strategy in patients with locally advanced rectal cancer were not inferior to that of those with pCR. 87.7% of patients had successful rectum preservation in W&W group, although patients may require a longer interval for efficacy assessment.

Smoking Cessation Interventions During Chemoradiotherapy for Locally Advanced Cervical Cancer: A Missed Opportunity?

Smoking cessation education and intervention have been well-studied in patients with cervical dysplasia or smoking-related malignancies in efforts to improve health outcomes. Though smoking is associated with worse outcomes after chemoradiotherapy (CRT) for local advanced cervical cancer (LACC), the utilization and impact of smoking cessation interventions on patients with LACC during CRT and follow-up is unknown. We hypothesize that tobacco cessation interventions are under-utilized during CRT for LACC.Patients with LACC treated with definitive CRT from 2009 -2019 were identified from an IRB-approved retrospective institutional database. Smoking cessation education encounters with the institutional tobacco treatment program (TTP) during CRT and follow-up were identified within the electronic medical record. TTP encounters included counseling with or without pharmacologic therapy/nicotine replacement. Overall survival (OS) calculated with the Kaplan-Meier method. Fisher's exact and Wilcoxon rank sum tests were performed to identify differences in patients who quit smoking versus those who continued to smoke.Of 220 patients with LACC treated with CRT, 61 (28%) were smoking at time of diagnosis. Median follow-up from date of LACC diagnosis was 25 months. Smoking cessation education was provided to 39 patients (63.9%); however only 9 patients (15%) received these services during CRT. At last follow-up, 18 patients (29.5%) had quit smoking; nearly half of these patients (8/18, 44%) attempted cessation during CRT, while some patients (5/18, 27%) quit over one year after cancer diagnosis. The overall rate of smoking cessation was 23.1% (9/39) for patients who underwent counseling and 40.9% (9/22) for those who did not. After LACC diagnosis, the median time to first cessation attempt was 61 days, while median time to the first TTP interaction was 196 days. No significant difference in 3-year OS was found between patients who quit smoking compared to those who continued smoking (73% vs 56%, P = 0.7). There was also no difference in FIGO stage (P = 0.34), nodal status (P = 0.78), age (P = 0.50), or pack years smoking (P = 0.25) between patients who quit smoking and those who continued smoking.Most patients continued smoking after CRT for LACC, though cessation rates are higher than the national average (< 10%). Patients can successfully quit smoking during CRT, though few patients receive formal tobacco cessation counseling during treatment. Smoking cessation interventions should be maximized during CRT; however, interventions should also continue as part of a longitudinal, person-centered survivorship plan. Future work will attempt to ensure the success of smoking cessation attempts in patients with LACC by early referral to the TTP to augment cancer treatment and improve overall patient health and outcomes.E.S. Hollis: None. E. Ruebush: None. E. Davies: None. S. Paraghamian: None. A.A. Weiner: None.

Dose Escalated Radiation Therapy for Glioblastoma Multiforme: An International Systematic Review and Meta-Analysis of 22 Prospective Trials.

Limited evidence is available on the utility of dose-escalated radiation therapy (DE-RT) with or without temozolomide (TMZ) versus standard-of-care radiation therapy (SoC-RT) for patients with newly diagnosed glioblastoma multiforme. We performed a systematic review/meta-analysis to compare overall survival (OS) and progression-free survival (PFS) between DE-RT and SoC-RT. We used a Population, Intervention, Control, Outcomes, Study Design/Preferred Reporting Items for Systematic Reviews and Meta-analyses/Meta-analysis of Observational Studies in Epidemiology selection criterion to identify studies. The primary and secondary outcomes were 1-year OS and 1-year PFS, respectively. Outcomes and comparisons were subdivided based on receipt of TMZ and MGMT status. DE-RT was defined based on equivalent dose calculations. Random effects meta-analyses using the Knapp-Hartung correction, arcsine transformation, and restricted maximum likelihood method were conducted. Meta-regression was used to compare therapeutic (eg, DE-RT or TMZ) and pathologic characteristics (eg, MGMT methylation status) using the Wald-type test. Across 22 published studies, 2198 patients with glioblastoma multiforme were included; 507 received DE-RT. One-year OS after DE-RT alone was higher than SoC-RT alone (46.3% vs 23.4%; P=.02) as was 1-year PFS (17.9% vs 5.3%; P=.02). No significant difference in 1-year OS (73.2% vs 64.4%; P=.23) or 1-year PFS (44.5% vs 44.3%; P=.33) between DE-RT+TMZ and SoC-RT+TMZ was noted. No difference in 1-year OS was noted between DE-RT+TMZ and SoC-RT+TMZ in either MGMT methylated (83.2% vs 73.2%; P=.23) or MGMT unmethylated (72.6% vs 50.6%; P=.16) patients. DE-RT alone resulted in superior PFS and OS versus SoC-RT alone. DE-RT+TMZ did not lead to improved outcomes versus SoC-RT+TMZ. No differential benefit based on MGMT status was found. Future studies are warranted to define which subgroups benefit most from DE-RT.

An adapted European LeukemiaNet genetic risk stratification for acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplant. A CIBMTR analysis.

Cytogenetic and molecular abnormalities are known to influence post-transplant outcomes in acute myeloid leukemia (AML) but data assessing the prognostic value of combined genetic models in the HCT setting are limited. We developed an adapted European LeukemiaNet (aELN) risk classification based on available genetic data reported to the Center for International Blood and Marrow Transplant Research, to predict post-transplant outcomes in 2289 adult AML patients transplanted in first remission, between 2013 and 2017. Patients were stratified according to aELN into three groups: favorable (Fav, N = 181), intermediate (IM, N = 1185), and adverse (Adv, N = 923). Univariate analysis demonstrated significant differences in 2-year overall survival (OS) (Fav: 67.7%, IM: 64.9% and Adv: 53.9%; p < 0.001); disease-free survival (DFS) (Fav: 57.8%, IM: 55.5% and Adv: 45.3; p < 0.001) and relapse (Fav: 28%, IM: 27.5% and Adv: 37.5%; p < 0.001). Multivariate analysis (MVA) revealed no differences in outcomes between the Fav and IM groups, thus they were combined. On MVA, patients in the Adv risk group had the highest risk of relapse (HR 1.47 p ≤ 0.001) and inferior DFS (HR 1.35 p < 0.001) and OS (HR 1.39 p < 0.001), even using myeloablative conditioning or in those without the pre-HCT measurable-residual disease. Novel approaches to mitigate relapse in this high-risk group are urgently needed.

The Stage Migration Should be Reconsidered in Stage IIIA Rectal Cancer: Based on Propensity Score Analysis

BackgroundFew studies have compared the survival outcomes of stages II and IIIA rectal cancer patients who did not receive neoadjuvant treatment. This study aimed to compare oncologic outcomes between 2 groups. Patients and MethodsThis study analyzed stage II or IIIA rectal cancer patients who underwent radical operation without neoadjuvant treatment between 1996 and 2013. The 3:1 propensity score analysis was used to adjust for several variables. After propensity score matching, 364 stage II rectal cancer, and 172 stage IIIA rectal cancer patients were analyzed. ResultsThere were no significant differences in 5-year overall survival or disease-free survival rates between the 2 groups. When stage II rectal cancer was subdivided into stages IIA, IIB, and IIC, the 5-year DFS and OS rates of stage IIIA rectal cancer patients were similar to those of stage IIA cancer patients. Moreover, stage IIIA rectal cancer patients showed a statistically significantly better survival rates than stage IIC rectal cancer patients. ConclusionStage IIIA group showed similar survival outcomes compared to stage IIA and IIB group and significantly better outcomes than stage IIC group. Thus, it should be considered to classify stage IIIA as a subgroup of stage II rather than as a subgroup of stage III rectal cancer. It should be also be considered to change to determine whether to do adjuvant treatment according to stage II rectal cancer.

Retrospective study of thyroid invasion and central lymph node metastasis in 124 patients with hypopharyngeal carcinoma

Objective: To investigate the characteristics of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma, and the impact on survival rate and quality of life. Methods: A retrospective analysis of 124 cases (122 males and 2 females with age range from 36 to 78 years old) with laryngopharyngeal squamous cell carcinoma who were initially treated in the Department of Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2014 to December 2017 was performed. The clinical data included tumor location, pathological T stage, pathological N stage, invasion of thyroid gland, central lymph node metastasis, surgical procedures and so on. Patients were grouped according to if presence of thyroid invasion and central lymph node metastasis. With follow-up, the survival was analyzed by Kaplan-Meier method, and tumor recurrence and metastasis were evaluated. Results: Of the patients, 12 patients had thyroid involvement and 5 patients had central lymph node metastasis. The incidence of thyroid involvement was 8.16% (8/98) in pyriform sinus, 1/18 in posterior pharyngeal wall and 3/8 in posterior cricoid wall, with statistically significant difference (χ2=15.076,P=0.008). The incidence of central lymph node metastasis was 1.02% (1/98) in pyriform sinus, 3/18 in posterior pharyngeal wall and 1/8 in posterior cricoid wall, also with statistically significant difference (χ2=11.205, P=0.008). There was no statistical correlation between thyroid invasion or central lymph node metastasis and gender, smoking or alcohol exposure history and tumor pathological differentiation (all P>0.05). The 3-year overall survival rate was 80.65% and the 3-year recurrence free rate was 85.48%. Totally 24 patients died in 3 years, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. Local recurrence occurred in 18 patients, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. There was no significant difference in survival between patients with and without thyroid invasion and central lymph node metastasis (all P>0.05). There were significantly difference in 3-year overall survival and relapse-free survival among the groups with different T stages, N stages, pathological stages and tumor pathological differentiation levels (all P<0.05). There were significantly differences in the levels of serum calcium and FT3 between the groups with or without thyroid invasion and central lymph node metastasis (all P<0.05). Conclusion: The incidences of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma are rare, and the risk of occurrence is related to the primary site of tumor. Comprehensive evaluation, correct decision-making and accurate treatment could be helpful to cure radically the tumor, to prevent recurrence and to improve the quality of life of patients.