Independent Predictor Of On Overall Survival Research Articles

A Novel Nomogram including AJCC Stages Could Better Predict Survival for NSCLC Patients Who Underwent Surgery: A Large Population-Based Study.

Objective In this study, we aimed to establish a novel nomogram model which was better than the current American Joint Committee on Cancer (AJCC) stage to predict survival for non-small-cell lung cancer (NSCLC) patients who underwent surgery. Patients and Methods. 19617 patients with initially diagnosed NSCLC were screened from Surveillance Epidemiology and End Results (SEER) database between 2010 and 2015. These patients were randomly divided into two groups including the training cohort and the validation cohort. The Cox proportional hazard model was used to analyze the influence of different variables on overall survival (OS). Then, using R software version 3.4.3, we constructed a nomogram and a risk classification system combined with some clinical parameters. We visualized the regression equation by nomogram after obtaining the regression coefficient in multivariate analysis. The concordance index (C-index) and calibration curve were used to perform the validation of nomogram. Receiver operating characteristic (ROC) curves were used to evaluate the clinical utility of the nomogram. Results Univariate and multivariate analyses demonstrated that seven factors including age, sex, stage, histology, surgery, and positive lymph nodes (all, P < 0.001) were independent predictors of OS. Among them, stage (C-index = 0.615), positive lymph nodes (C-index = 0.574), histology (C-index = 0.566), age (C-index = 0.563), and sex (C-index = 0.562) had a relatively strong ability to predict the OS. Based on these factors, we established and validated the predictive model by nomogram. The calibration curves showed good consistency between the actual OS and predicted OS. And the decision curves showed great clinical usefulness of the nomogram. Then, we built a risk classification system and divided NSCLC patients into two groups including high-risk group and low-risk group. The Kaplan–Meier curves revealed that OS in the two groups was accurately differentiated in the training cohort (P < 0.001). And then, we validated this result in the validation cohort which also showed that patients in the high-risk group had worse survival than those in the low-risk group. Conclusion The results proved that the nomogram model had better performance to predict survival for NSCLC patients who underwent surgery than AJCC stage. These tools may be helpful for clinicians to evaluate prognostic indicators of patients undergoing operation.

Does the Interval Between Hysterectomy and Start of Adjuvant Radiation Treatment Influence Survival in Women With Endometrial Carcinoma?: A National Cancer Database analysis.

The objective of this study was to analyze the impact of the time interval (TI) between hysterectomy and initiation of adjuvant radiation treatment (ART) on overall survival (OS) among women with early stage endometrial carcinoma (EC) using the National Cancer Database (NCDB). The NCDB was queried for women with the International Federation of Gynecology and Obstetrics (FIGO) stage I to II EC who underwent hysterectomy followed by ART. We examined the prognostic impact of TI on OS using the cutoff ≤8 or >8 weeks to initiate radiation treatment (RT). Two groups of patients were created. Kaplan-Meier curves were created for OS analysis. Predictors of OS were identified. A total 16,520 women were identified. The median follow-up time for the entire cohort was 59.1 months. Median age was 63 years, and 82% were FIGO stage I. Pelvic external beam RT alone was used in 9569 (58%) and vaginal brachytherapy alone in 4265 women (26%). In total, 10,040 women (61%) received RT ≤8 weeks. Delay in initiating RT >8 weeks was associated with shorter 5-year OS (P=0.048). Independent predictors of shorter OS includes older age, African American race, higher comorbidity burden, higher tumor grade, the presence of lymphovascular invasion and stage II tumors. Although TI in initiating RT was a significant predictor for OS in univariate analysis, its independent significance of OS was lost on multivariate analysis (P=0.28). Our study suggests that TI between hysterectomy and initiation of ART was not an independent predictor of OS in women with early stage EC.

Clinical management of adolescents and young adults suffering from sarcoma in the French Rhône-Alpes region: A prospective exhaustive cohort with 10 years follow up

IntroductionSurvival of adolescents and young adults (AYA) with sarcoma is lower than in younger patients. The objective of this study was to describe the regional healthcare circuits, the differences in the management between adult, paediatric and mixed units and to assess the prognostic impact of compliance with clinical practice guidelines (CPGs) on overall survival (OS) and on relapse free survival (RFS). Materials and methodsRetrospective analysis of the management and long term follow-up of all 13–25 year old patients with a sarcoma diagnosed in the Rhône-Alpes area between 2000 and 2005. Results140 patients satisfied inclusion criteria and were selected. The majority of 13–25 year old patients were treated in paediatric units. Joint management resulted in a higher rate of discussion in multidisciplinary tumour board, inclusion in clinical trials, and fertility preservation. Non-compliance with guidelines was observed in 65% of cases. Overall compliance was not reported to correlate to survival. Compliance of radiotherapy with CPG's seemed associated with a better prognosis for OS (HR = 0.20, 95% CI = [0.10–0.40]; p < 0.0001) and RFS (HR = 0.18, 95% CI = [0.09–0.37; p < 0.0001) as well as compliance of surgery for OS (HR = 0.43, 95% CI = [0.23–0.81]; p = 0.01). Multivariate Cox regression analysis revealed other independent predictors of OS like age at diagnosis, stage and histological subtype. ConclusionsManagement of AYA in joint units seems to improve the quality of care. Compliance of surgery and radiotherapy with CGP's seems to improve survival.

MP62-03 IMPACT OF LYMPHOVASCULAR INVASION ON OVERALL SURVIVAL IN PATIENTS WITH PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY STRATIFIED BY PATHOLOGICAL TUMOR STAGE

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-03 IMPACT OF LYMPHOVASCULAR INVASION ON OVERALL SURVIVAL IN PATIENTS WITH PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY STRATIFIED BY PATHOLOGICAL TUMOR STAGE Marcus Jamil*, Jacob Keeley, Akshay Sood, Deepansh Dalela, Sohrab Arora, Isaac Palma-Zamora, Natalija Kovacevic, Chandler Bronkema, Nikola Rakic, Alyssa Danno, James Peabody, Mani Menon, Craig Rogers, and Firas Abdollah Marcus Jamil*Marcus Jamil* More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Akshay SoodAkshay Sood More articles by this author , Deepansh DalelaDeepansh Dalela More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Isaac Palma-ZamoraIsaac Palma-Zamora More articles by this author , Natalija KovacevicNatalija Kovacevic More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Nikola RakicNikola Rakic More articles by this author , Alyssa DannoAlyssa Danno More articles by this author , James PeabodyJames Peabody More articles by this author , Mani MenonMani Menon More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The detrimental impact of lymphovascular invasion (LVI) in prostate cancer (PCa) on the risk of biochemical recurrence has been previously described. However, the impact of LVI on overall survival (OS) is not clear. The aim of this study was to evaluate the prognostic ability of LVI as a predictor of OS stratified by pathological tumor stage. METHODS: We examined all men with non-metastatic PCa who were treated with radical prostatectomy between 2004 and 2015 years within the National Cancer Database. Only those with information on the presence LVI on final pathological analysis were included (n=232,704). Patients were stratified according to final pathological T stage (pT2, pT3a and pT3b). Kaplan-Meier curves estimated survival in each individual sub-group based on LVI status. Moreover, Cox proportional hazards assessed the relationship between LVI and OS after adjusting for all available covariates. RESULTS: Median (IQR) age and PSA were 62 (56 – 67) years and 5.6 (4.3 - 8.2) ng/ml, respectively. Overall, 174,838 (75.1%), 40,281 (17.3%) and 17,585 (7.6%) of patients had pT2, pT3a and pT3b disease, respectively. Median follow-up was 42.7 months (27.1 – 58.7). At 10-years, the OS in LVI vs. non-LVI patients was 93.9% vs 95.0% in pT2 (0.0004), 92.7% vs 94.8% in pT3a (<0.0001), and 86.1% vs 91.6% in pT3b (<0.0001). On multivariable analysis, LVI status was not an independent predictor of OS in pT2 disease (hazard ratio [HR]: 1.11, 95% confidence interval [CI] 0.92 – 1.35, p = 0.2). Conversely, in pT3a and pT3b disease, presence of LVI had 1.2-fold (95%CI: 1.03–1.44, p=0.02) and 1.4-fold (95%CI: 1.22–1.61, p=<0.001) higher overall mortality than their counterparts without LVI. CONCLUSIONS: Our report is the first to demonstrate the detrimental impact of LVI on OS in locally advanced disease (pT3a and higher). This information may prove valuable when risk stratifying based on final pathology and in counseling patients regarding outcomes in addition to determining the necessity of further treatment. Source of Funding: HFHS © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e946-e946 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Jamil* More articles by this author Jacob Keeley More articles by this author Akshay Sood More articles by this author Deepansh Dalela More articles by this author Sohrab Arora More articles by this author Isaac Palma-Zamora More articles by this author Natalija Kovacevic More articles by this author Chandler Bronkema More articles by this author Nikola Rakic More articles by this author Alyssa Danno More articles by this author James Peabody More articles by this author Mani Menon More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

Optimal Timing of Cabazitaxel Introduction for Japanese Patients With Metastatic Castration-resistant Prostate Cancer.

Limited information is available to help physicians decide when to introduce cabazitaxel for metastatic castration-resistant prostate cancer (mCRPC) patients. The objective of this study was to assess the optimal timing of cabazitaxel introduction. The clinical outcomes of 66 mCRPC patients receiving cabazitaxel following failure of docetaxel were retrospectively analyzed. Among the parameters possibly affecting the timing of cabazitaxel introduction, only an increased prostate-specific antigen (PSA) value from the diagnosis of CRPC had a significant impact on overall survival (OS) after the introduction of cabazitaxel. Furthermore, there was a significant correlation between the increased PSA value from the diagnosis of CRPC and the baseline PSA value at cabazitaxel introduction. Multivariate analysis showed that only the baseline PSA value at cabazitaxel introduction is an independent predictor of OS. A comparatively low PSA value could be an alternative index suggesting the optimal timing for cabazitaxel introduction.

Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database.

Guidelines recommend that retroperitoneal sarcoma (RPS) be managed in a reference sarcoma center (RSC), but the benefit remains to be demonstrated. This study investigated the impact of initial surgery performed within the NetSarc network on overall survival (OS). NetSarc is a network of 26 RSCs with specialized multidisciplinary tumor boards (MDTs) that is funded by the French NCI. Since 2010, presentation to an MDT and second pathological review are mandatory for sarcoma patients, and data have been collected in a nationwide database. We extracted data for all patients who received surgery in or outside the network and who presented at a NetSarc center (NSC) for primary nonmetastatic RPS between 2010 and 2017. A total of 2945 patients were included: 1078 (36.6%) underwent the first surgery in an NSC, and 1867 (63.4%) in an out-of-network center. The median number of operations at an NSC during the study period was 23 (range: 3-209), and the corresponding median was 1 (range: 1-2) at out-of-network centers. The diagnostic procedures followed significantly more clinical practice guidelines within NetSarc, where there were significantly more first R0 resections [452 (41.9%) vs. 230 (12.3%)]. The OS was significantly superior for patients treated within NetSarc, with a 2-year OS of 87% vs. 70% (p < 0.001). In the multivariate analysis, surgery within an NSC was an independent predictor of OS, with a twofold lower odds ratio of death. In this national study, surgery for primary RPS within an NSC was associated with a better OS.

The impact of age and ageing on hepatocarcinoma surgery: Short- and long-term outcomes in a multicentre propensity-matched cohort.

Management of malignancy in elderly patients is challenging. We aimed to assess the impact of age and ageing on overall survival (OS), recurrence-free survival (RFS), tumour-specific survival (TSS) and potential years of life lost (PYLL) after surgery for hepatocarcinoma (HCC). Consecutive patients treated for HCC between 2005 and 2015 were evaluated. Patients were divided according to age-decade. Afterwards, elderly patients (≥75years) were compared with patients <75years. A 1:1 propensity matching was used to reduce the risk of bias. Survival was estimated by Kaplan-Meier method and Cox regression analysis. Four hundred and thirty-nine patients were stratified: group 1 (age ≤55, n=72), group 2 (age: 56-65, n=133), group 3 (age: 66-74, n=141) and group 4 (age ≥75, n=93). Group 1 had the highest median PYLL (27.6, IQR 24.6-32.5) while group 4 the lowest (2.0, IQR 0-9.6; P<0.001). Comparing elderly vs younger, there were no significant differences in terms of OS (P=0.054), TSS (P=0.321) and RFS (P=0.240). Ageing was the only variable associated with post-operative complications (OR: 2.51; 95% CI: 1.23-5.13; P=0.025) and liver-related morbidity was an independent predictor of OS. (HR 2.49, 95% CI: 1.34-4.64, P=0.004). Ageing per se is not an absolute contraindication for liver resection, given the acceptable oncologic long-term prognosis, but the worse short-term outcomes in the elderly should induce an accurate patient selection.

Analysis of survival and objective response (OR) in patients with hepatocellular carcinoma in a phase III study of lenvatinib (REFLECT).

186 Background: In REFLECT, Lenvatinib (LEN) demonstrated treatment effect on overall survival (OS) by statistical confirmation of noninferiority to sorafenib (SOR). OR rates for LEN versus SOR were: 24% versus 9% by investigator review and 41% versus 12% by independent review (Kudo et al 2018). Since the relationship between OR and OS in phase III HCC studies is unclear, we explored the relationship between OR and OS in REFLECT. Methods: OR assessed by investigators per mRECIST were used to analyze the association between OR and OS of pts treated with LEN or SOR. The median OS of responders (CR or PR) was compared to that of nonresponders (SD, PD, or UNK/NE) irrespective of treatment. Landmark analyses were performed by OR status at several fixed time points as sensitivity analyses, and the effect on OS was evaluated by Cox regression with OR as a time-dependent covariate, with other prognostic factors. Results: Median OS was 22.4 months for responders and 11.4 months for nonresponders. Hazard ratios (HR) of landmark analyses at 2, 4, and 6 months were 0.75 (95% CI, 0.57–0.98), 0.72 (95% CI, 0.56–0.92), and 0.73 (95% CI, 0.57–0.93). Independent predictors of OS based on unstratified Cox regression are in the table. Conclusions: In REFLECT, OR was an independent predictor of OS in pts with HCC regardless of treatment. The results indicate this correlation is worth further investigation. Clinical trial information: NCT01761266. [Table: see text]

Outcomes for Metastatic Colorectal Cancer Based on Microsatellite Instability: Results from the South Australian Metastatic Colorectal Cancer Registry.

Microsatellite instability (MSI) is the molecular marker for DNA mismatch repair deficiency (dMMR) in colorectal cancer (CRC) and has been associated with better survival outcomes in early stage disease. In metastatic CRC (mCRC), outcomes for patients with MSI are less clear. There is evolving evidence that treatment pathways for MSI CRC should include programmed-death 1 (PD-1) antibodies. An analysis was performed to explore the impact of MSI status on overall survival (OS) in mCRC. South Australian Metastatic CRC Registry data were analysed to assess patient characteristics and survival outcomes, comparing patients with MSI CRC with those whose tumours were microsatellite stable (MSS). Kaplan-Meier survival analysis was used to assess OS. Cox regression analysis was undertaken to assess the independence of MSI as a prognostic factor. Of 4359 patients registered on the database, 598 (14%) had been tested for, and 62 (10.1%) of these patients had, demonstrable MSI. There were significantly higher rates of right-sided primary (p < 0.001), poorly differentiated pathology (p = 0.002), and BRAF V600E mutation (p < 0.001) in the MSI group. The MSI group were also less likely to receive chemotherapy (p < 0.001) or to have liver surgery, but more likely to be diagnosed at an early stage. The median overall survival was 9.5months for those with MSI CRC versus 21.3months for MSS CRC patients (p = 0.052). Cox regression analysis indicated that MSI was not an independent predictor of OS. Independent predictors of better OS included having liver surgery for metastasis, having chemotherapy, and being initially diagnosed at an early stage. Only 14% of patients with mCRC were tested for MSI, and 1 in 10 were found to be MSI high. The clinical characteristics of MSI mCRC are in keeping with those previously reported. MSI in this population-based registry was associated with a numerically lower survival which did not attain statistical significance.

The Effect of Histological Subtypes on Outcomes of Stage IV Epithelial Ovarian Cancer.

Introduction: To examined survival outcome by histological subtypes in de novo stage IV epithelial ovarian cancer (EOC).Methods: Between 2004 and 2015, patients with stage IV EOC were included using the Surveillance, Epidemiology, and End Results program. The effects of histological subtypes on overall survival (OS) were assessed using Kaplan–Meier and multivariable Cox regression analyses.Results: We identified 5,953 patients including 5,351 (89.9%), 249 (4.2%), 145 (2.4%), and 208 (3.4%) patients with high-grade serous, endometrioid, mucinous, and clear cell subtypes, respectively. The 5-year OS rates were 28.1, 38.6, 14.2, and 18.8% in patients with high-grade serous, endometrioid, mucinous, and 18.8% clear cell subtypes, respectively, (p < 0.001). Multivariate analyses indicated that histological subtype was an independent predictor of OS. Using the high-grade serous subtype as a reference, OS was comparable for the endometrioid subtype (hazard ratio (HR) 0.915, 95% confidence interval) (CI 0.772–1.085, p = 0.305), but significantly lower for mucinous (HR 3.292, 95% CI 2.701–4.011, p < 0.001) and clear cell subtypes (HR 1.820, 95% CI 1.546–2.141, p < 0.001). Patients with no residual tumor had better OS in the high-grade serous and endometrioid subtypes compared to patients with residual tumors. However, the residual tumor size was not a prognostic factor for OS in mucinous and clear cell carcinoma.Conclusions: Our study suggest a markedly mortality rate in patients with stage IV mucinous and clear cell carcinoma, but better survival in patients with high-grade serous and endometrioid subtypes. Aggressive radical surgery to leave no residual disease would improve survival for high-grade serous and endometrioid carcinoma. More studies are needed to assess the value of aggressive radical surgery in patients with mucinous and clear cell subtypes.

The Impact of Epidemiological Factors and Treatment Interventions on Survival in Patients With Signet Ring Cell Carcinoma of the Pancreas.

Primary pancreatic signet ring cell carcinoma (SRCC) is a rare histologic variant of pancreatic carcinoma. A population-based analysis of pancreatic SRCC was performed to determine the predictive effects of epidemiological factors and treatment interventions on overall survival (OS) and disease-specific survival (DSS). The Surveillance, Epidemiology, and End Results registry was searched for pancreatic SRCC cases diagnosed between January 1, 1973 and December 31, 2013. Statistical analysis was performed using the Fisher exact test, χ(2) analysis, Kaplan-Meier method, log-rank test, and Cox proportional hazards regression. The mean age among 497 patients was 66.6 years (SD, 11.9). Most patients were white (82.7%) and male (54.5%). The 1-, 2-, and 5-year OS rates were 17%, 9%, and 4%, respectively, while the corresponding 1-, 2-, and 5-year rates for DSS were 18%, 10%, and 5%, respectively. On univariable analysis; age, site, grade, stage, and treatment were predictive of OS and DSS (P<0.05). On multivariable analysis; radiation improved OS and DSS (adjusted hazard ratio [aHR], 0.592 and 0.589, respectively), pancreatectomy improved OS and DSS (aHR, 0.360 and 0.355, respectively), and combination therapy improved OS and DSS (aHR, 0.295 and 0.286, respectively). Age, site, and stage were also independent predictors of OS and DSS. Subgroup analysis demonstrated treatment to be an independent predictor of OS and DSS in localized/regional disease, in distant disease, and in patients diagnosed between 2000 and 2013. Age, site, stage, and treatment independently predict OS and DSS in pancreatic SRCC.

High Epithelial Cell Adhesion Molecule–Positive Circulating Tumor Cell Count Predicts Poor Survival of Patients with Unresectable Hepatocellular Carcinoma Treated with Transcatheter Arterial Chemoembolization

PurposeTo assess the role of epithelial cell adhesion molecule (EpCAM)–positive circulating tumor cell (CTC) count in predicting survival outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma (HCC). Materials and MethodsEpCAM-positive CTC counts were prospectively determined via CellSearch in peripheral blood of 97 patients with unresectable HCC treated with chemoembolization. The impact of each CTC cutoff point on overall survival (OS) was evaluated by univariate Cox regression analysis. Based on hazard ratio, patients were divided into 3 groups with low (CTC count 0/1), moderate (CTC count 2–5), and high (CTC count ≥ 6) levels. Correlation of CTC counts with survival was assessed by Cox proportional-hazards model. ResultsEighty-nine patients met inclusion criteria and were enrolled. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = .049) and progression-free survival (PFS; P = .007) in patients treated with chemoembolization. After adjustment for confounding factors, mortality risks in the high- and moderate-level groups were 2.819 times (95% confidence interval [CI], 1.218–6.526; P = .016) and 1.301 times (95% CI, 0.630–2.685; P = .477) greater, respectively, than in the low-level group. The risk of progression was 3.705 fold higher in the high-level group (95% CI, 1.628–8.433; P = .002) and 1.648 fold higher in the moderate-level group (95% CI, 0.843–3.223; P = .144) vs the low-level group. ConclusionsHigh EpCAM-positive CTC count predicts poor survival of patients with unresectable HCC treated with chemoembolization.

3:36 PM Abstract No. 275 ■ FEATURED ABSTRACT EpCAM-positive circulating tumor cells independently predict poor outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma

To assess the role of epithelial cell adhesion molecule (EpCAM)-positive circulating tumor cell (CTC) count in predicting outcomes of transcatheter arterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC). EpCAM-positive CTC counts were prospectively determined in peripheral blood of 97 patients with unresectable HCC treated with TACE, using CellSearch system. The impact of each cutoff point (each CTC value) on overall survival (OS) was evaluated by the univariate Cox regression analysis. Based on the hazard ratio (HR), the patients were divided into 3 groups: low risk (CTC = 0 and 1), moderate risk (CTC = 2-5) and high risk (CTC≥6) groups. Cox proportional hazards model was used to assess the correlation of CTC counts with outcomes. Eighty-nine patients were enrolled in this study according to patient-selection criteria. The low risk group was used as the control group for univariate Cox analysis. Mortality risk in the high risk and moderate risk groups was 4.164 (95% Confidence Interval [CI], 2.042-8.492, P = 0.000) and 1.695 (95%CI, 0.883-3.253, P = 0.113) times higher, respectively, than that in the low-risk group. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = 0.049) and progression-free survival (PFS) (P = 0.007) in patients treated with TACE. After adjustment for confounding factors, the mortality risk in the high risk and moderate risk groups was 2.819 times (95%CI, 1.218-6.526, P = 0.016) and 1.301 times (95%CI, 0.630-2.685, P = 0.477) higher than that in the low risk group. EpCAM-positive CTC count can independently predict poor outcomes of TACE in patients with unresectable HCC.

Abstract P5-23-06: Metastatic pattern in stage IV male breast cancer at initial diagnosis: A population-based study

Abstract Background: Male breast cancer (MaBC) is a relatively uncommon disease, representing less than 1% of all breast cancers. Although men tend to present at more advanced stages, the prognostic influence of metastatic pattern (MP), sites of metastases and factors associated with specific organ involvement are unknown. The primary aim of this study was to analyze the influence of MP compared with other biologic and clinical factors in the survival of patients (pts) with stage IV breast cancer at initial diagnosis (BCID). Secondary aims were to describe sites of metastases and evaluate factors associated with specific sites of metastatic spread. Methods: We evaluated men with microscopically confirmed stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results (SEER) 18 registries program from 2010 to 2014. Pts with other primary tumor either before or after breast cancer were excluded. MP was categorized as bone only, visceral (lung, liver or brain), bone and visceral and other. Pt characteristics were compared between MP. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with specific sites of metastases. Results: We included 136 pts. Median age was 63 years (range 28-91). At diagnosis, bone only metastases represented 31.6% of pts, visceral 16.2%, bone and visceral 38.2% and other 14%. Median OS for the entire cohort was 33 months (95% CI 19 months – not reached). Bone was the most common site of metastases (69.9%), followed by lung (44.9%), liver (14%) and brain (8.1%). OS rate at 3 years by MP was: bone only 46.05%, visceral 53.57%, bone and visceral 37.23% and other 70.56% (p=0.41). There were no significant differences in pt or tumor characteristics between MP. However, in adjusted logistic regression, triple negative (TN) and ER/PR+/HER2+ tumors had higher odds of brain metastases than ER/PR+/HER2- (all p&amp;lt;0.05). Also, ER/PR+/HER2+ tumors had higher odds of liver metastases (p=0.027). Univariate analysis showed that older age (HR 1.7; p=0.03), no surgery (HR2.5; p=0.005), TN tumors (HR 5.6; p&amp;lt;0.001) and pts with brain metastases (HR 4.2; p&amp;lt;0.001) had worse prognosis. In multivariate analysis, TN subtype (HR 4.2; p=0.001) and pts with brain metastases (HR 3.44; p=0.012) had significantly shorter OS. Conclusions: To our knowledge, this is the first study of MP in MaBC. The cohort had an acceptable median OS which did not differ significantly according to MP. Although brain metastases were less common, it is important to recognize their worse prognosis. Independent predictors of OS included tumor subtype and brain metastases. Tumor subtype had a clear influence on specific sites of metastases, particularly for brain and liver involvement. Citation Format: Leone JP, Leone BA, Zwenger AO, Vallejo CT, Romero AO, Machiavelli MR, Perez JE, Leone J. Metastatic pattern in stage IV male breast cancer at initial diagnosis: A population-based study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-06.

Lymph node ratio as prognosticator in floor of mouth squamous cell carcinoma patients

BackgroundRecently, lymph node ratio (LNR) has been recognized as an important prognosticator for oral squamous cell carcinoma (OSCC). However, its relevance for the specific subsite floor of mouth (FOM) has not been investigated. This study was conducted to elucidate the prognostic significance of LNR for the subsite FOM among other prognostic factors. MethodsA retrospective study of 155 patients with FOM SCC who received primary curative resection and neck dissection was conducted. We analyzed the impact of LNR among other clinicopathologic variables on overall survival (OS) in univariate and multivariate analysis. ResultsIn univariate analysis, patients detected with LNR ≤ 0.07 (cutoff-point: 0.07) showed an 85% 5-year OS rate, whereas for patients with LNR > 0.07 the OS rate reached 25% after 5-years (p < 0.001). The 5-year DFS rate was 72% for patients with LNR ≤ 0.07; on the contrary, patients with LNR > 0.07 the 5-year DFS rate was 17% (p < 0.001). LNR was detected as an independent predictor of OS in multivariate analysis (p = 0.032) for the subsite FOM. ConclusionWe concluded that LNR is an important predictor of prognosis in patients with FOM SCC, LNR should be considered in the choice of adjuvant treatment for these patients.

The Prognostic Impact of Ventricular Opening in Glioblastoma Surgery: A Retrospective Single Center Analysis.

Ventricular opening during glioblastoma (GBM) resection is controversial. Sufficient evidence regarding its prognostic role is missing. We investigated the impact of ventricular opening on overall survival (OS), hydrocephalus development, and postoperative morbidity in patients with GBM. Patients who underwent primary GBM resection between 2006 and 2013 were assessed retrospectively. Established predictors for overall survival (age, Karnofsky Performance Status, extent of resection, O-6-methylguanine-DNA methyltransferase promoter methylation status, isocitrate dehydrogenase mutation status) and further clinical data (postoperative status, further treatment, preoperative tumor volume, proximity to the ventricle) were included in univariate and multivariate analyses. Thirteen (5.7%) of 229 patients developed a hydrocephalus. Multivariate logistic regression showed that neither ventricular opening, tumor size, proximity to the ventricle, nor extent of resection were significant risk factors for hydrocephalus. Ventricular opening did not delay postoperative therapy and was not associated with neurological morbidity. Kaplan-Meier analysis demonstrated that patients who underwent ventricular opening (n= 114) exhibited a median OS of 14.3 months (12.9-16.5), whereas patients who did not undergo ventricular opening (n= 115) exhibited a median OS of 18.6 months (16.1-20.8). However, multivariate Cox regression (n= 134) did not confirm ventricular opening as an independent negative predictor of OS (risk ratio 1.09, P= 0.77). Instead, it showed that a greater preoperative tumor volume >22.8 cm3 was a negative predictor of OS (risk ratio 1.76, P= 0.02). Because extent of resection is a strong independent predictor of OS and ventricular opening is safe, neurosurgeons should consider ventricular opening to achieve maximal tumor resection.

Impact of Morphological Status on Long-Term Outcome Among Patients Undergoing Liver Surgery for Intrahepatic Cholangiocarcinoma.

The influence of morphological status on the long-term outcome of patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC) is poorly defined. We sought to study the impact of morphological status on overall survival (OS) of patients undergoing curative-intent resection for ICC. A total of 1083 patients who underwent liver resection for ICC between 1990 and 2015 were identified. Data on clinicopathological characteristics, operative details, and morphological status were recorded and analyzed. A propensity score-matched analysis was performed to reduce confounding biases. Among 1083 patients, 941(86.9%) had a mass-forming (MF) or intraductal-growth (IG) type, while 142 (13.1%) had a periductal-infiltrating (PI) or MF with PI components (MF+PI) ICC. Patients with an MF/IG ICC had a 5-year OS of 41.8% (95% confidence interval [CI] 37.7-45.9) compared with 25.5% (95% CI 17.3-34.4) for patients with a PI/MF+PI (p<0.001). Morphological type was found to be an independent predictor of OS as patients with a PI/MF+PI ICC had a higher hazard of death (hazard ratio [HR] 1.42, 95% CI 1.11-1.82; p=0.006) compared with patients who had an MF/IG ICC. Compared with T1a-T1b-T2 MF/IG tumors, T1a-T1b-T2 PI/MF+PI and T3-T4 PI/MF+PI tumors were associated with an increased risk of death (HR 1.47 vs. 3.59). Conversely, patients with T3-T4 MF/IG tumors had a similar risk of death compared with T1a-T1b-T2 MF/IG patients (p=0.95). Among patients undergoing curative-intent resection of ICC, morphological status was a predictor of long-term outcome. Patients with PI or MF+PI ICC had an approximately 45% increased risk of death long-term compared with patients who had an MF or IG ICC.

Abstract P1-12-02: Prognostic factors and survival according to tumor subtype in women presenting with breast cancer brain metastases at initial diagnosis

Abstract Background: Breast cancer represents one of the most common causes of brain metastases. The occurrence of this event is a catastrophic complication of metastatic breast cancer, associated with poor prognosis. However, the presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Because of this, the prognostic assessment and management of patients (pts) who present with BMIBCD is very challenging. The aim of this study was to analyze the influence of tumor subtype compared with other prognostic factors in the survival of pts who present with BMIBCD. Methods: We evaluated women with brain metastases at the time of initial diagnosis of microscopically confirmed breast cancer, reported to the Surveillance, Epidemiology and End Results (SEER) 18 registries program from 2010 to 2013. Pts with other primary malignancy either before or after breast cancer were excluded. Pt characteristics were compared between tumor subtypes. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS). Results: Seven hundred forty pts were included. Median age was 60 years (range 26-93). After a median follow-up of 6 months (range 1-48), median OS for the whole population was 10 months and 20.7% of pts were alive at 36 months. At diagnosis, brain was the only site of metastasis in 125 pts, whereas 66.2% of pts had metastases in bone, 33.2% in liver and 44.7% in lung. Tumor subtype distribution was: 46.6% hormone receptor (HR)+/HER2-, 17% HR+/HER2+, 14.1% HR-/HER2+ and 22.3% triple negative (TN). Pts with TN brain metastases had higher grade (p&amp;lt;0.0001), higher rate of brain only (p=0.001) and lung metastases (p=0.03), had lower rates of bone metastases (p&amp;lt;0.0001) and were more likely to die from breast cancer (p&amp;lt;0.0001). Univariate analysis showed that older age (p=0.0002), black race (p=0.004), lobular histology (p=0.01), unmarried pts (p=0.01), the presence of liver (p&amp;lt;0.0001) and lung metastases (p=0.002) and TN pts (median OS 6 months; p&amp;lt;0.0001) had worse prognosis. The HR+/HER2+ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8; p=0.001), lobular histology (hazard ratio 2.08; p=0.006), TN subtype (hazard ratio 2.25; p&amp;lt;0.001), liver metastases (hazard ratio 1.6; p=0.001) and unmarried pts (hazard ratio 1.39; p=0.04) had significantly shorter OS. Race, tumor grade, bone metastases, lung metastases and brain only metastases had no association with OS. Conclusions: To our knowledge, this is the largest study of BMIBCD. Although the prognosis of these pts is generally poor, it is important to notice that 20.7% of pts were still alive 3 years after diagnosis. There were substantial differences in OS according to tumor subtype, TN pts had the shortest OS. HR+/HER2- represented the largest proportion of cases, therefore these pts should not be ignored when designing clinical trials for pts with brain metastases. In addition to tumor subtype, other independent predictors of OS are age at diagnosis, marital status, histology and liver metastases. Citation Format: Leone JP, Leone J, Zwenger AO, Iturbe J, Leone BA, Vallejo CT. Prognostic factors and survival according to tumor subtype in women presenting with breast cancer brain metastases at initial diagnosis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-12-02.

Abstract P6-09-21: Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis

Background: Stage IV breast cancer at initial diagnosis (BCID) can be recognized in approximately 5% of all breast neoplasms. Clinical outcomes of these patients (pts) are highly variable and depend on tumor biology and pt characteristics. The prognostic influence of metastatic pattern (MP) at initial presentation and factors associated with specific organ involvement have been understudied. The primary aim of this study was to analyze the influence of MP compared with other biologic and clinical factors in the survival of pts with stage IV BCID. The secondary aim was to evaluate factors associated with specific sites of metastatic spread. Methods: We evaluated women with microscopically confirmed stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results (SEER) 18 registries program from 2010 to 2013. Pts with other primary tumor either before or after breast cancer were excluded. MP was categorized as bone only, visceral (lung, liver or brain), bone and visceral and other. Pt characteristics were compared between MP. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with specific sites of metastases. Results: We included 9143 pts. Median age was 61 years (range 19-102). Median OS for the entire cohort was 28 months (95% CI 27-29 months). At diagnosis, bone only metastases represented 37.5% of pts, visceral 21.9%, bone and visceral 28.8% and other 11.9%. Median OS by MP was: bone only 38 months, visceral 21 months, bone and visceral 19 months and other 33 months (p Conclusions: To our knowledge, this is the largest study of MP in stage IV BCID. There were substantial differences in prognosis according to MP, bone only was the most common MP and had the best OS, whereas bone and visceral MP had the worst prognosis. We observed significant differences in pt characteristics according to MP. Independent predictors of OS included age at diagnosis, race, marital status, tumor grade, tumor subtype and MP. There was a clear influence of tumor subtype among other factors on specific sites of metastases. Our study identified several prognostic factors that could guide therapy selection in treatment naive pts.Background: Stage IV breast cancer at initial diagnosis (BCID) can be recognized in approximately 5% of all breast neoplasms. Clinical outcomes of these patients (pts) are highly variable and depend on tumor biology and pt characteristics. The prognostic influence of metastatic pattern (MP) at initial presentation and factors associated with specific organ involvement have been understudied. The primary aim of this study was to analyze the influence of MP compared with other biologic and clinical factors in the survival of pts with stage IV BCID. The secondary aim was to evaluate factors associated with specific sites of metastatic spread. Methods: We evaluated women with microscopically confirmed stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results (SEER) 18 registries program from 2010 to 2013. Pts with other primary tumor either before or after breast cancer were excluded. MP was categorized as bone only, visceral (lung, liver or brain), bone and visceral and other. Pt characteristics were compared between MP. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with specific sites of metastases. Results: We included 9143 pts. Median age was 61 years (range 19-102). Median OS for the entire cohort was 28 months (95% CI 27-29 months). At diagnosis, bone only metastases represented 37.5% of pts, visceral 21.9%, bone and visceral 28.8% and other 11.9%. Median OS by MP was: bone only 38 months, visceral 21 months, bone and visceral 19 months and other 33 months (p Conclusions: To our knowledge, this is the largest study of MP in stage IV BCID. There were substantial differences in prognosis according to MP, bone only was the most common MP and had the best OS, whereas bone and visceral MP had the worst prognosis. We observed significant differences in pt characteristics according to MP. Independent predictors of OS included age at diagnosis, race, marital status, tumor grade, tumor subtype and MP. There was a clear influence of tumor subtype among other factors on specific sites of metastases. Our study identified several prognostic factors that could guide therapy selection in treatment naive pts. Citation Format: Leone BA, Vallejo CT, Romero AO, Machiavelli MR, Perez JE, Leone J, Leone JP. Prognostic impact of metastatic pattern in stage IV breast cancer at initial diagnosis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-21.

Prognostic factors and survival according to tumour subtype in women presenting with breast cancer brain metastases at initial diagnosis

BackgroundThe presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Hence, the prognostic assessment and management of these patients is very challenging. The aim of this study was to analyse the influence of tumour subtype compared with other prognostic factors in the survival of patients with BMIBCD. MethodsWe evaluated women with BMIBCD, reported to Surveillance, Epidemiology and End Results program from 2010 to 2013. Patients with other primary malignancy were excluded. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS). ResultsWe included 740 patients. Median OS for the whole population was 10 months, and 20.7% of patients were alive at 36 months. Tumour subtype distribution was: 46.6% hormone receptor (HR)+/HER2−, 17% HR+/HER2+, 14.1% HR−/HER2+ and 22.3% triple-negative. Univariate analysis showed that the presence of liver metastases, lung metastases and triple-negative patients (median OS 6 months) had worse prognosis. The HR+/HER2+ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8), lobular histology (hazard ratio 2.08), triple-negative subtype (hazard ratio 2.25), liver metastases (hazard ratio 1.6) and unmarried patients (hazard ratio 1.39) had significantly shorter OS. ConclusionsAlthough the prognosis of patients with BMIBCD is generally poor, 20.7% were still alive 3 years after the diagnosis. There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, marital status, histology and liver metastases.