Improvement In 5-year Survival Rate Research Articles

Conditional survival analysis and dynamic survival prediction for intracranial solitary-fibrous tumor/hemangiopericytoma

BackgroundAs the form of World Health Organization Central Nervous System (WHO CNS) tumor classifications is updated, there is a lack of research on outcomes for intracranial combined solitary-fibrous tumor and hemangiopericytoma (SFT/HPC). This study aimed to explore conditional survival (CS) pattern and develop a survival prediction tool for intracranial SFT/HPC patients.MethodsData of intracranial SFT/HPC patients was gathered from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The patients were split into training and validation groups at a 7:3 ratio for our analysis. CS is defined as the likelihood of surviving for a specified period of time (y years), given that the patient has survived x years after initial diagnosis. Then, we used this definition of CS to analyze the intracranial SFT/HPC patients. The least absolute shrinkage and selection operator (LASSO) regression and best subset regression (BSR) were employed to identify predictive factors. The Multivariate Cox regression analysis was applied to establish a novel CS-based nomogram, and a risk stratification system was developed using this model.ResultsFrom the SEER database, 401 patients who were diagnosed with intracranial SFT/HPC between 2000 and 2019 were identified. Among them, 280 were included in the training group and 121 were included in the internal validation group for analysis. Our study revealed that in intracranial SFT/HPC, 5-year survival rates saw significant improvement ranging from 78% at initial diagnosis to rates of 83%, 87%, 90%, and 95% with each successive year after surviving for 1–4 years. The LASSO regression and BSR identified patient age, tumor behavior, surgery and radiotherapy as predictors of CS-based nomogram development. A risk stratification system was also successfully constructed to facilitate the identification of high-risk patients.ConclusionThe CS pattern of intracranial SFT/HPC patients was outlined, revealing a notable improvement in 5-year survival rates after an added period of survival. Our newly-established CS-based nomogram and risk stratification system can provide a real-time dynamic survival estimation and facilitate the identification of high-risk patients, allowing clinicians to better guide treatment decision for these patients.

Progressive Improvement in 5-Year Survival Rates for Extremity Soft Tissue Sarcomas from 1999 to 2019.

Extremity soft-tissue sarcoma (ESTS) is a group of rare, heterogeneous malignancies. Previous studies have demonstrated a progressive improvement in 5-year survival rate over time, but recent trends are unknown. Therefore, this study aimed to provide an update on the clinical characteristics and 5-year survival rate of ESTS from 1999 to 2019. This retrospective cohort study used the Surveillance, Epidemiology, and End Results (SEER) database. Overall, 5,654 patients over the age of 15 years with primary ESTS diagnosed between 1999 and 2019 were included. Data on patient demographics, clinical characteristics, and survival were extracted. Patients were grouped by year of diagnosis: 1999-2005, 2006-2012, and 2013-2019. Kaplan-Meier and Cox proportional hazards regression analyses were performed. ESTS occurred primarily in the lower extremity (76.1%) and was frequently grade III (58.3%), >5 cm in size (69.9%), and without metastasis (77.9%) at diagnosis. Furthermore, there was a significant increase in the proportion of patients over age 60 (p < 0.001) and without metastasis (p < 0.001) over the study period. The 5-year survival rate successively improved, from 47% in 1999-2005, to 61% in 2006-2012, to 78% in 2013-2019. Similarly, in multivariate analysis, the mortality rate progressively declined from a hazard ratio (HR) of 3.4 in 1999-2005 to an HR of 2.1 in 2006-2012, with the 2013-2019 group having the best overall survival (p < 0.001). Age, tumor size, grade, and metastasis were negative prognostic factors for survival; radiation and surgery were positive prognostic factors. The 5-year overall survival rate for ESTS progressively improved over the 20-year study period, perhaps due to an increasing proportion of older patients diagnosed with local disease. These findings may also be related to earlier detection or more effective treatment over the study period.

Trends in incidence and survival of early-stage pancreatic ductal adenocarcinoma in the United States.

633 Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with poor survival with nearly 80% mortality within the first year after diagnosis. There have been modest incremental improvements in survival over the last decade, however the reason for this improvement is unclear. The aim of this study is to evaluate the trends of diagnosis and survival in the last two decades using large public national databases. Methods: Incidence rates of PDAC between 2001 and 2020 (age-adjusted to the 2000 US standard population) were evaluated in the United States Cancer Statistics (USCS) database, representing approximately 98% of the US population. The data was analyzed with SEER*Stat using Joinpoint regression. A survival analysis was subsequently conducted using the American College of Surgeons’ (ACS) National Cancer Database (NCDB), of PDAC cases diagnosed between 2004 and 2015.Survival outcomes were stratified by AJCC stage. Kaplan-Meier survival curves were generated, and log-rank tests were conducted to assess differences in survival between stages. Cox proportional hazards model was employed to estimate hazard ratios and adjust for potential confounders. The analysis was performed with IBM SPSS 24. Results: From 2001 to 2020, the age-adjusted incidence rate of early-stage PDAC increased from 1.1 to 2.8 (per 100,000 person-years), while locally advanced PDAC increased from 3.6 to 4.3, and from 6.4 to 7.7 for metastatic PDAC (all p&lt;0.01). The Annual Percent Change (APC) was 5.7 for Early-Stage PDAC (95% CI 5.1-6.4), 1.4 for locally advanced (95% CI 0.8-1.9), and 0.8 for Metastatic PDAC (95% CI 0.6-1.1). The incidence rate ratio (IRR) almost doubled for early-stage PDAC, increasing from 0.10 to 0.19. Conversely, for metastatic and locally advanced stages, the IRR decreased from 0.58 to 0.52 and 0.32 to 0.29, respectively. Survival analysis revealed 5-year overall survival rates of 74%, 69%, 57%, and 33% for stages 0, IA, IB, and IIA, respectively, with an overall improvement from 2004 to 2015. This increase was consistent among all age groups, genders, and races. Stages IA and IB demonstrated larger increases 45.9% and 56.6%, respectively (IA: 47% in 2004 to 75% in 2015; IB: 38% in 2004 to 68% in 2015). Conclusions: This study highlights a marked increase in the incidence of early-stage PDAC, surpassing the overall incidence increase, suggesting improving diagnostic capabilities over the last two decades. Furthermore, the substantial improvement in 5-year survival rates for stages IA and IB indicates progress in the management of early-stage PDAC. These findings emphasize the importance of continued efforts in early detection and treatment strategies for PDAC.

Impact of Race and Age and their Interaction on Survival Outcomes in Patients With Diffuse Large B-Cell Lymphoma.

Advances in treatment for patients with Diffuse Large B-Cell Lymphoma (DLBCL) have led to improved patient outcomes but the magnitude of these disparities remains understudied with regards to improved survival outcomes. We sought to describe changes in DLBCL survival trends over time and explore potential differential survival patterns by patients' race/ethnicity and age. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980 to 009 and determined 5-year survival outcomes for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age. We identified 43,564 patients with DLBCL eligible for this study. Median age was 67 years (ages: 18-64=44.2%, 65-79=37.1%, 80+= 18.7%). Most patients were male (53.4%) and had advanced stage III/IV disease (40.0%). Most patients were White race (81.4%), followed by Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all races and age groups (odds ratio [OR] for 5-year survival with increasing year of diagnosis=1.05, P < .001). Patients in racial/ethnic minority groups (API: OR=0.86, P < .0001; Black: OR=0.57, P < .0001; AIAN: OR=0.51, P=.008; Hispanic: 0.76, P=0.291) and older adults (ages 65-79: OR=0.43, P < .0001; ages 80+: OR=0.13, P < .0001) had lower 5-year survival rates after adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR=1.05, P < .001; API: OR=1.04, P < .001; Black: OR=1.06, p<.001; AIAN: OR=1.05, P < .001; Hispanic: OR=1.05, P < .005) and age groups (ages 18-64: OR=1.06, P < .001; ages 65-79: OR=1.04, P < .001; ages 80+: OR=1.04, P < .001). Patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite persistently lower survival among patients in racial/ethnic minority groups and older adults.

RESULTS OF USING ADJUVANT PERFUSION CHEMOTHERAPY IN RADICAL TREATMENT OF INFILTRATIVE GASTRIC CANCER

Relevance: Given the high biological aggressiveness of infiltrative gastric cancer warranting a need for a multimodal approach to its radical treatment employing adjuvant perfusion thermochemotherapy (HIPEC) and systemic adjuvant polychemotherapy, the goal of the present study was to assess the efficacy and expediency of such an approach.&#x0D; The study aimed to evaluate the effectiveness of a combination of HIPEC and systemic adjuvant polychemotherapy in patients radically operated on for infiltrative forms of gastric cancer pT4a-bN0-3M0.&#x0D; Methods: The study examined the long-term results of radical treatment for gastric cancer in 141 patients (pT4a-bN0-3M0, Borrmann type III-IV). Of them, 18 patients underwent a multimodal treatment, including radical surgery in combination with HIPEC and systemic adjuvant polychemotherapy (ACT) (oxaliplatin 100 mg/m2 (on day 1 of the cycle), capecitabine 1,000 mg/m2 or tegafur 10-15 mg/kg (2 times per day, on days 1-14 of the cycle, with a 7-day break between cycles, 8 cycles) – HIPEC/ACT group. For comparison purposes, we used the data on 55 radically operated patients (surgery control) and 68 other patients who underwent radical surgery in combination with HIPEC (cisplatin 50 mg/m2 + doxorubicin 50 mg/m2, 420C, one hour). The long-term treatment results were evaluated using competing risks analysis, the Kaplan-Meier multiplier method, and multivariate analysis (Cox and Fine-Gray models).&#x0D; Results: The multimodal treatment group showed a decrease in unfavorable outcomes associated with tumor progression – β = -2.14;&#x0D; RR 0.12 (95% CI 0.04-0.38), р&lt;0.001, as well as a decrease in the risk of carcinomatosis – β = -1.99; RR 0.14 (95% CI 0.04-0.44), р&lt;0,001; and improvement in 5-year survival rates (as compared with the control groups), viz.: adjusted survival – 81.9±9.5% (р=0.003); progression-free survival – 82.2±9.3% (р&lt;0.001); and dissemination-free survival – 81.9±9.5% (р&lt;0.001).&#x0D; Conclusion: It is advisable to supplement the standard approach for infiltrative gastric cancer (radical surgery and systemic polychemotherapy) with perfusion HIPEC to prolong the remission of the tumor process.

RESULTS OF USING ADJUVANT PERFUSION CHEMOTHERAPY IN RADICAL TREATMENT OF INFILTRATIVE GASTRIC CANCER

Relevance: Given the high biological aggressiveness of infiltrative gastric cancer warranting a need for a multimodal approach to its radical treatment employing adjuvant perfusion thermochemotherapy (HIPEC) and systemic adjuvant polychemotherapy, the goal of the present study was to assess the efficacy and expediency of such an approach.&#x0D; The study aimed to evaluate the effectiveness of a combination of HIPEC and systemic adjuvant polychemotherapy in patients radically operated on for infiltrative forms of gastric cancer pT4a-bN0-3M0.&#x0D; Methods: The study examined the long-term results of radical treatment for gastric cancer in 141 patients (pT4a-bN0-3M0, Borrmann type III-IV). Of them, 18 patients underwent a multimodal treatment, including radical surgery in combination with HIPEC and systemic adjuvant polychemotherapy (ACT) (oxaliplatin 100 mg/m2 (on day 1 of the cycle), capecitabine 1,000 mg/m2 or tegafur 10-15 mg/kg (2 times per day, on days 1-14 of the cycle, with a 7-day break between cycles, 8 cycles) – HIPEC/ACT group. For comparison purposes, we used the data on 55 radically operated patients (surgery control) and 68 other patients who underwent radical surgery in combination with HIPEC (cisplatin 50 mg/m2 + doxorubicin 50 mg/m2, 420C, one hour). The long-term treatment results were evaluated using competing risks analysis, the Kaplan-Meier multiplier method, and multivariate analysis (Cox and Fine-Gray models).&#x0D; Results: The multimodal treatment group showed a decrease in unfavorable outcomes associated with tumor progression – β = -2.14;&#x0D; RR 0.12 (95% CI 0.04-0.38), р&lt;0.001, as well as a decrease in the risk of carcinomatosis – β = -1.99; RR 0.14 (95% CI 0.04-0.44), р&lt;0,001; and improvement in 5-year survival rates (as compared with the control groups), viz.: adjusted survival – 81.9±9.5% (р=0.003); progression-free survival – 82.2±9.3% (р&lt;0.001); and dissemination-free survival – 81.9±9.5% (р&lt;0.001).&#x0D; Conclusion: It is advisable to supplement the standard approach for infiltrative gastric cancer (radical surgery and systemic polychemotherapy) with perfusion HIPEC to prolong the remission of the tumor process.

Trends in the improvement in survival among patients with diffuse large B-cell lymphoma (DLBCL).

147 Background: Advances in treatment for patients with DLBCL have led to improved patient outcomes, but whether disparities exist with regards to improved survival outcomes remains understudied. We sought to describe changes in DLBCL survival rates over time and explore potential differential survival patterns by patients’ race and age. Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980-2009 and determined 5-year survival rates for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age. Results: We identified 43,564 patients with DLBCL eligible for this study (median age 67 years [ages: 18-64 = 44.2%, 65-79 = 37.1%, 80+ = 18.7%], 53% male, 40% stage III/IV). Most were White race (81.4%), followed by race/ethnic groups of Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all patients (odds ratio (OR) for 5-year survival with increasing year of diagnosis = 1.05, p &lt;.001). Patients in race/ethnic minority groups (API: OR = 0.86, p &lt;.0001; Black: OR = 0.57, p &lt;.0001; AIAN: OR = 0.51, p =.008) and older adults (ages 65-79: OR = 0.43, p &lt;.0001; ages 80+: OR = 0.13, p &lt;.0001) had worse 5-year survival rates adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR = 1.05, p &lt;.001; API: OR = 1.04, p &lt;.001; Black: OR = 1.06, p &lt;.001; Hispanic: OR = 1.05, p &lt;.005; AIAN: OR = 1.05, p &lt;.001) and age groups (ages 18-64: OR = 1.06, p &lt;.001; ages 65-79: OR = 1.04, p &lt;.001; ages 80+: OR = 1.04, p &lt;.001). Conclusions: In this analysis of SEER data, we found that patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite ongoing disparities demonstrating worse survival among patients in race/ethnic minority groups and older adults. Notably, we did not find differential improvement in the odds of 5-year survival within subgroups of race and age, underscoring the need for ongoing investigations to address disparities in cancer care delivery and outcomes.

Fibronectin-1 modulated by the long noncoding RNA OIP5-AS1/miR-200b-3p axis contributes to doxorubicin resistance of osteosarcoma cells.

Chemoresistance has been an obstacle in the further improvement of 5-year survival rates of osteosarcoma (OS) patients, but the underlying mechanism of chemo-resistance remains unclear. A comprehensive analysis of mRNAs and noncoding RNAs related to OS chemo-resistance could help solve this problem. In the current study, we first identified that fibronectin-1 (FN1), screened by microarray analysis in three paired chemo-resistant and chemo-sensitive OS cell lines, was significantly upregulated in the chemo-resistant OS cell lines and tissues and was related to unfavourable prognosis. Further functional assays revealed that FN1 inhibition greatly increased the sensitivity of OS cells to doxorubicin in vitro and in vivo, whereas FN1 overexpression had the opposite effect. Moreover, mechanistic investigation demonstrated, by a series of assays that included luciferase reporter gene, RNA immunoprecipitation, RNA pull-down and rescue assays, that FN1 expression was regulated by the oncogenic long noncoding RNA (lncRNA) OIP5-AS1 through sponging miR-200b-3p. Thus, these results indicated the role and potential application of the lncRNA OIP5-AS1/miR-200b-3p/FN1 regulatory pathway as a promising target in treatment of OS chemo-resistance.

Improvement in 5-Year Survival Rates for the Most Common Types of Cancer, 1975-2012.

With recent ovarian cancer screening studies showing no clinically significant mortality benefit, preventing this disease, identifying high-risk populations, and extending survival remain priorities. However, several challenges are impeding progress in ovarian cancer research. With most studies capturing exposure information from 10 or more years ago, evaluation of how changing patterns of exposures, such as new oral contraceptive formulations and increased intrauterine device use, might influence ovarian cancer risk and survival is difficult. Risk factors for ovarian cancer should be evaluated in the context of tumor histotypes, which have unique molecular features and cells of origin; this is a task that requires large collaborative studies to achieve meaningful sample sizes. Importantly, identification of novel modifiable risk factors, in addition to those currently known to reduce risk (eg, childbearing, tubal ligation, oral contraceptive use), is needed; this is not feasibly implemented at a population level. In this Commentary, we describe important gaps in knowledge and propose new approaches to advance epidemiologic research to improve ovarian cancer prevention and survival, including updated classification of tumors, collection of data on changing and novel exposures, longer follow-up on existing studies, evaluation of diverse populations, development of better risk prediction models, and collaborating prospectively with consortia to develop protocols for new studies that will allow seamless integration for future pooled analyses.

Current Gaps in Ovarian Cancer Epidemiology: The Need for New Population-Based Research.

With recent ovarian cancer screening studies showing no clinically significant mortality benefit, preventing this disease, identifying high-risk populations, and extending survival remain priorities. However, several challenges are impeding progress in ovarian cancer research. With most studies capturing exposure information from 10 or more years ago, evaluation of how changing patterns of exposures, such as new oral contraceptive formulations and increased intrauterine device use, might influence ovarian cancer risk and survival is difficult. Risk factors for ovarian cancer should be evaluated in the context of tumor histotypes, which have unique molecular features and cells of origin; this is a task that requires large collaborative studies to achieve meaningful sample sizes. Importantly, identification of novel modifiable risk factors, in addition to those currently known to reduce risk (eg, childbearing, tubal ligation, oral contraceptive use), is needed; this is not feasibly implemented at a population level. In this Commentary, we describe important gaps in knowledge and propose new approaches to advance epidemiologic research to improve ovarian cancer prevention and survival, including updated classification of tumors, collection of data on changing and novel exposures, longer follow-up on existing studies, evaluation of diverse populations, development of better risk prediction models, and collaborating prospectively with consortia to develop protocols for new studies that will allow seamless integration for future pooled analyses.

Trends in incidence and survival for upper tract urothelial cancer (UTUC) in the state of Victoria--Australia.

To investigate the incidence and mortality trends of upper tract urothelial cancers (UTUC) in Victoria over the last decade. Age-adjusted incidence and mortality rates were calculated for UTUC. These were identified using data from the Victorian Cancer Registry from 2001 until 2011 based on histological diagnoses. Age at diagnosis, sex and demographical location were compared. The age-standardised incidence of UTUC remained stable from 2001 to 2011. There were 278 deaths from UTUC over this period with an overall 5-year survival rate of 32%. There was no significant difference in survival between 2001-06 and 2007-11 (30% vs 36%, respectively). Lower age at diagnosis was associated with a significant improvement in survival (P = 0.01). Sex and geographical location appeared to have no effect on survival. The 5-year survival rates for UTUC in Victoria are poor, particularly in comparison to worldwide data. In contrast to worldwide trends, the incidence of UTUC appears to be stable. No significant improvement in 5-year survival rates over the short study period was identified. These findings highlight the difficulties in managing this rare yet deadly malignancy.

On the validity of using increases in 5-year survival rates to measure success in the fight against cancer.

BackgroundThe 5-year survival rate of cancer patients is the most commonly used statistic to reflect improvements in the war against cancer. This idea, however, was refuted based on an analysis showing that changes in 5-year survival over time bear no relationship with changes in cancer mortality.MethodsHere we show that progress in the fight against cancer can be evaluated by analyzing the association between 5-year survival rates and mortality rates normalized by the incidence (mortality over incidence, MOI). Changes in mortality rates are caused by improved clinical management as well as changing incidence rates, and since the latter can mask the effects of the former, it can also mask the correlation between survival and mortality rates. However, MOI is a more robust quantity and reflects improvements in cancer outcomes by overcoming the masking effect of changing incidence rates. Using population-based statistics for the US and the European Nordic countries, we determined the association of changes in 5-year survival rates and MOI.ResultsWe observed a strong correlation between changes in 5-year survival rates of cancer patients and changes in the MOI for all the countries tested. This finding demonstrates that there is no reason to assume that the improvements in 5-year survival rates are artificial. We obtained consistent results when examining the subset of cancer types whose incidence did not increase, suggesting that over-diagnosis does not obscure the results.ConclusionsWe have demonstrated, via the negative correlation between changes in 5-year survival rates and changes in MOI, that increases in 5-year survival rates reflect real improvements over time made in the clinical management of cancer. Furthermore, we found that increases in 5-year survival rates are not predominantly artificial byproducts of lead-time bias, as implied in the literature. The survival measure alone can therefore be used for a rough approximation of the amount of progress in the clinical management of cancer, but should ideally be used with other measures.

Status of hepatocellular carcinoma in South Korea.

In South Korea, liver cancer is the 4th most common cancer in men and 6th most common cancer in women. However, the incidences of liver cancer among Korean men and women have been declining from 1999 to 2010. The reason for the declining incidence appears secondary to decreased hepatitis B virus (HBV) infection, which is the leading risk factor for hepatocellular carcinoma (HCC), with successful implementation of HBV vaccination since 1983. Despite recent advances in the treatment of HCC, including liver transplantation (LT), radiofrequency ablation (RFA), transarterial embolization, and the use of molecularly targeted agents, many patients cannot be cured due to the advanced stage of HCC at the time of diagnosis in South Korea. While the 5-year survival rate of HCC patients in Korea is relatively lower than other cancers, it has been gradually increased from the early 1990s to the late 2000s. The reason for the improvement in 5-year survival rates is attributed that early detection of HCC becomes possible by well-established surveillance program in high-risk populations for HCC in Korea. In Korea, national surveillance program for HCC was established in 2003, in which repeated applications of screening tests [serum α-fetoprotein (AFP) and liver ultrasound] at 6-month intervals have been recommended in patients at high risk for developing HCC, such as men and women older than 40 years of age with positive hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV) or underlying liver cirrhosis. It is essential that the nationwide surveillance program for HCC should be effectively executed in high-risk patients for developing HCC. Optimal application of multidisciplinary team approach and active involvement in clinical studies with new agents in HCC patients are critically important not only for the management of advanced HCC patients but also for the improvement in natural history and therapeutic outcomes of HCC patients in the future.

Cholangiocarcinoma in a Young Woman With Perinatally Acquired HIV

Cholangiocarcinoma in a Young Woman With Perinatally Acquired HIV

Targeted therapy for esophagogastric cancers: a review

The incidence of esophagogastric cancers is increasing rapidly in the Western population. Despite better understanding of the biology and intense research in the treatment of these cancers, the long-term survival remains poor both in the locally advanced and metastatic settings. The addition of combined modality strategies has resulted in modest improvement in 5-year survival rates. A number of biologic agents targeting epidermal-derived growth factor receptor, vascular endothelial derived growth factor and its receptor, and mammalian target of rapamycin (mTOR) are being currently evaluated in Phase II and III clinical trials. Some of these, like trastuzumab, cetuximab, and bevacizumab, have shown promising results. This review provides a brief overview of the recent developments in biologic agents for the treatment of esophagogastric cancers.

The Role of Adjuvant Chemotherapy for Localized Squamous Cell Esophageal Cancer: Current Japanese Standard and the Unending Role of the Drawing Board

Esophageal cancer is the sixth most common cause of death for men and, among the various gastrointestinal malignancies, it is considered to possess a relatively high malignant potential. Major causes of the difficulties in the management of this clinical entity are largely related to its clinicopathological characteristics, particularly the high frequency of complex patterns of lymph node metastasis. As a result of intense discussion beginning approximately 30 years ago, radical esophagectomy with threefield lymphadenectomy has become established in leading institutes in Asia since the mid 1980 s. Although relatively acceptable long-term outcomes have been reported, one can claim by no means that substantial evidence of survival benefit has been proved by large-scale, randomized, controlled trials (RCT). Even in the high-volume centers in Asia, further improvement of 5-year survival rates by surgery alone appears to be extremely unlikely. Therefore, optimization of multimodal treatments for localized and resectable clinical stage II/III esophageal cancer is one of the most important topics in this field. Several clinical trials in the west have demonstrated the superiority of preoperative chemoradiation therapy compared with surgery alone. However, it must be admitted that one of the most conspicuous features, and one that in the minds of many constitutes a critical limitation of the above-mentioned western studies, has been the extremely poor outcome of the surgery-alone groups. On the other hand, Japanese surgeons believe that the relatively acceptable local tumor control by transthoracic radical esophagectomy obviates the need for preoperative radiation therapy, especially because the inevitable fibrotic changes induced by radiation would negatively affect the quality of the surgical approach. Therefore, many Asian physicians treating patients with esophageal squamous cell carcinoma hesitate to apply directly the presently available results of ‘‘Western evidence’’ to ‘‘Eastern’’ esophageal cancer, in which the environment of latter is different from the former. The Japan Clinical Oncology Group (JCOG) has conducted multicenter, multimodality, prospective, clinical trials for the treatment of esophageal cancer for more than 30 years, giving full regard to these considerations. Recently, a JCOG study (JCOG9907) demonstrated significantly better overall survival after preoperative chemotherapy with two courses of cisplatin plus 5-fluorouracil followed by surgery compared with postoperative chemotherapy for resectable cStageII/III thoracic squamous cell esophageal cancer. Since publication of the results of the JCOG9907 study, preoperative chemotherapy followed by radical esophagectomy has been accepted as the standard therapeutic approach to resectable cStage II/III esophageal cancer in Japan. On the other hand, it cannot be denied that the JCOG9907 study has aroused several controversies among some extremely knowledgeable experts who are seeking to examine and interpret the present study as much scientific rigor as possible. In a recent editorial article, Ajani et al. mentioned problems that they noted in the study design of JCOG9907. As representatives of the JCOG Esophageal Cancer Study Group, we would like to respond to their specific criticisms to encourage further understanding Society of Surgical Oncology 2012

Risk Factors and Control Strategies for the Rapidly Rising Rate of Breast Cancer in Korea

Due to the aging population and tremendous changes in life style over the past decades, cancer has been the leading cause of death in Korea. The incidence rate of breast cancer is the second highest in Korea, and it has shown an annual increase of 6.8% for the past 6 years. The major risk factors of breast cancer in Korean women are as follows: Early menarche, late menopause, late full-term pregnancy (FTP), and low numbers of FTP. Height and body mass index increased the risk of breast cancer in postmenopausal women only. There are ethnic variations in breast cancer due to the differences in genetic susceptibility or exposure to etiologic agent. With the epidemiological evidences on the possibility of further increase of breast cancer in Korea, the Korean Government began implementing the National Cancer Screening Program against breast cancer in 2002. Five-year survival rates for female breast cancer have improved significantly from 78.0% in early 1993-1995 to 90.0% in 2004-2008. This data indicate that improvement of the survival rate may be partially due to the early diagnosis of breast cancer as well as the increased public awareness about the significance of early detection and organized cancer screening program. The current primary prevention programs are geared towards strengthening national prevention campaigns. In accordance with the improvement in 5-year survival rate, the overall cancer mortality has started to decrease. However, breast cancer death rate and incidence rates are still increasing, which need further organized effort by the Korean Government.

Abstract 425: BIRD0796, p38δ inhibitor, inhibits cholangiocarcinoma cell EGI-1 migration in a p53-dependent manner

Abstract Cholangiocarcinoma (CC) is a devastating cancer, which affects any area of the bile ducts. The new cases of CC have increased in the Western countries. Besides, CC is also an endemic in several Southeast Asia countries such as Thailand and Myanmar. CC is notoriously challenging to diagnose and treat. Currently, only surgical resection is associated with improvement of 5-year survival rate. However, distant metastases, extensive regional lymph node metastasis and vascular encasement or invasion preclude surgical resection. Our previous report showed that the p38δ gene expression was up-regulated in CC tumor sample as well as in CC cell lines. In this study, we further found that inhibition of p38δ by BIRD0796, a p38 δ inhibitor impaired migration ability in CC cell line EGI-1 in vitro (p = 0.006232). The result was further confirmed with p38δ siRNA knowdown (p = 0.0005) and plasmid over-expression experiments (p = 0.003). Interestingly, BIRD0796 did not exhibit similar inhibition effect on migration in TGB cells (p &amp;gt; 0.05). Analysis of p53 gene sequences revealed that there is a frame shift mutation (c.525 526insGCGC) in TGB cells but not any of functional mutation in EGI-1 cells. It indicates that the migration inhibition effect of BIRD0796 in CC metastasis may dependent on p53. Our results suggest that BIRD0796 may be a potential chemotherapeutic compound for CC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 425.

Experience of surgical treatment for cervical esophageal carcinoma

To summarize the experience of surgical treatment for cervical esophageal carcinoma. Clinical and follow-up data of 82 patients with cervical esophageal carcinoma undergone surgical treatment in Henan Provincial Cancer Hospital from Dec. 1993 to Dec. 2005 were analyzed retrospectively. The difference of the therapeutic regimen and 5-year survival rate of these patients were evaluated. Before 1997, patients mainly underwent surgical therapy solely (27 cases). After 1997, 50 cases received surgical therapy following neoadjuvant radiotherapy (multimodality group), except 5 early-stage cases received surgical therapy solely. Seventy-three patients underwent esophagectomy without thoracotomy, including 21 cases of invert-stripping of the esophagus, and 52 cases of blunt denudation of esophagus. Nine patients underwent transthoracic esophagectomy. Concurrent monolateral or bilateral cervical lymph node dissection accounted for 14 cases and combined organ resection 12 cases. No serious hemorrhage and tracheal or bronchial tearing occurred. No hospital death occurred. Postoperative complications were found in 14 patients, and the incidence of complication was 19.5%. In sole surgery group, upper incised margins of 5 patients were confirmed to be positive. The laryngeal function of 26 patients in sole surgery group was preserved, while 47 patients in multimodality group preserved. Lymph node metastasis occurred in 14 cases, including 13 cases cervical lymph node metastasis (monolateral 9, bilateral 4) and 1 case of upper mediastinal lymph node metastasis. During follow-up, 3 patients were lost. The total 5-year survival rate was 43%. The patients in multimodality group had higher 5-year survival rate as compared to those in sole surgery group. (50.2% vs 33.9%,chi(2 )=7.17,P=0.007). The 5-year survival rates of patients with transthoracic esophagectomy, esophagectomy plus concurrent monolateral or bilateral cervical lymph nodes dissection or combined organ resection were 36.5%, 45.8% and 33.3% respectively. All the 5-year survival rates of these subgroups were lower as compared to multimodality group. For patients with early stage cervical esophageal carcinoma and with proximal end of residual normal esophagus longer than 2 cm, the optimal therapy should be surgery. For most of the patients, surgery combined with neoadjuvant radiotherapy is the ideal therapeutic strategy, which can lower the risk of positive revised margin, improve the possibility of preserving the laryngeal function and result in the improvement of 5-year survival rate. Esophagectomy without thoracotomy should be preferred. Combined organ resection or bilateral lymph node dissection should be chosen carefully because these operating procedures may lead to severe injury and function lose.

A discussion of general prostate cancer screening versus targeted diagnosis in younger men

Although widely practiced, population-based screening for prostate cancer has not been proven or disproven to alter the disease-specific mortality in randomized, controlled trials. However, the prostate-specific antigen era (1988-present) has brought marked stage migration and improvements in 5-year survival rates that are encouraging. Targeted screening or case findings may be appropriate for high-risk men, including those with a positive family history of prostate cancer, and the use of prostate-specific antigen testing may be appropriate for younger men who are more commonly requesting to be screened.