Independent Predictor Of On Overall Survival Research Articles

Clinical Outcome of Tertiary Surgical Cytoreduction in Patients with Recurrent Epithelial Ovarian Cancer

The value of tertiary cytoreductive surgery (TCS) on overall survival (OS) of patients with relapsed epithelial ovarian cancer (ROC) is not well defined. Aim of the present study was to evaluate the operative and clinical outcome after TCS. We systematically evaluated all consecutive patients undergoing TCS. Tumor dissemination pattern, operative morbidity, residual tumor, and survival are described based on a validated intraoperative documentation tool. Predictors of survival and complete tumor resection are analyzed with Cox regression or logistic regression models. Between October 2000 and December 2008, 135 patients (median age, 51 years; range, 22-80 years) of mainly initial FIGO stage ≥ III (106 patients, 78.5%) were evaluated. In 53 patients (39.3%) a complete tumor-resection was obtained. The 1-month operative mortality was 6%. During a median follow-up period of 9.6 months (range, 0.1-75 months), 78 patients (57.8%) died, while 52 patients (38.5%) experienced a further relapse. Median OS was 19.1 months for the total collective (95% confidence interval [95% CI], 14.84-23.35). Median OS was 37.8 months (95% CI, 12.7-62.7) for patients without residual tumor; versus 19.0 months (95% CI, 9.8-28.2) for residual tumor ≤ 1 cm and 6.9 months (95% CI, 3.05-10.7) for residual tumor > 1 cm (P < .001). The presence of peritoneal carcinomatosis did not seem to significantly affect OS. Complete tumor resection was identified as the strongest predictor of OS. Other independent predictors of OS were interval to primary diagnosis ≥ 3 years (hazard ratio [HR], 0.28; 95% CI, 0.14-0.59) and serous papillary histology (HR, 0.23; 95% CI, 0.09-0.56). A total of 42 patients (31.1%) presented at least 1 major complication. Multivariate analysis identified tumor involvement of the middle abdomen and peritoneal carcinomatosis as independent predictors of complete tumor resection. Postoperative tumor residual disease remains the strongest predictor of survival even in TCS setting. To identify the optimal candidates for TCS, the predictive value of ascites and peritoneal carcinomatosis should be confirmed by future prospective trials.

Significance of thromboembolic phenomena occurring before and during chemoradiotherapy for localized carcinoma of the esophagus and gastroesophageal junction

Thromboembolic event (TEE) is the most common complication and a second cause of mortality in cancer patients. Multiple hypotheses for occurrence of TEE have been proposed. There are no reports on the frequency/impact of TEE in localized gastroesophageal cancer patients. We hypothesized that TEE at baseline and during chemoradiotherapy (CTRT) in gastroesophageal cancer patients would have an impact on overall survival (OS) of these patients. All consecutive patients with gastroesophageal cancer undergoing CTRT from 2001 to 2004 were eligible for this analysis. Baseline and subsequent TEEs were documented and correlated with patient characteristics and OS. One hundred ninety-eight patients were analyzed. TEEs were documented in 9.6% of the patients. At baseline, TEEs were documented in 4.0% of the patients. During CTRT, TEEs were documented in 6.1% of the patients. Pulmonary embolism (43.5%) and lower extremity venous thromboses (39%) were the most frequent TEEs. Median OS for patients with a TEE occurring at anytime was 17.7 versus 32.0 months for patients who never developed a TEE (P = 0.014). TEEs at baseline correlated with poor median survival: 13.1 versus 30.7 months for those without a TEE (P = 0.029). In a multivariable analysis, TEE at baseline and/or during CTRT was an independent predictor of OS (hazard ratio, 1.818; P = 0.040). Our data are the first to document the frequency of TEE in gastroesophageal cancer patients undergoing CTRT, and that TEE is an independent prognosticator of OS. Active research to prevent and treat TEEs is needed to improve survival of patients with localized gastroesophageal cancer.

Independent prognostic value of the rest/activity circadian rhythm on overall survival (OS) in patients (pts) with metastatic colorectal cancer (MCC) receiving first line chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin: A companion study to EORTC 05963

3553 Background: In tumor bearing rodents, disruption of the rest/activity rhythm (RAR) results in faster tumor growth and a shorter OS (Cancer Res 64:7879, JNCI 94:690, Cell 111:41). In single institution prospective trials on pts with metastatic breast cancer (JNCI 92:994) and MCC (Clin Cancer Res 6:3038), a disrupted circadian rhythm also results in a shorter OS. In this multicenter prospective trial, we studied the prognostic value of the RAR in MCC patients receiving first line FOLFOX-2 vs. 4-day chronomodulated infusion of the same drugs. Methods: To assess the RAR, 130 pts out of 564 pts in 9 centers wore a wrist-watch (actigraph), which recorded the number of wrist movements per minute for 3 days before starting therapy. Two RAR parameters, validated in previous clinical studies, were calculated: the autocorrelation coefficient at 24h (r24), indicating the robustness of the activity pattern over a period of 24 hours, and the dichotomy index (I<O), quantifying the differences in activity distribution between the rest phase and the active phase. The prognostic values of r24 and I<O were assessed by the logistic regression model for response and toxicity and by the Cox Proportional Hazard model for OS. Results: RAR parameters were not predictive for response or toxicity. When RAR parameters were categorized into quartiles, r24 and I<O were detected as potential prognostic factors for OS in a univariate analysis. The relative risk of death was 1.31 fold larger in the lowest vs highest I<O quartile. In a Cox Proportional Hazard model, I<O was confirmed as an independent predictor of OS (p < 0.0003) along with CEA ≥ 50 ng/ml (p = <0.0001), WHO PS 1 or 2 (P = 0.0129) and number of metastatic sites ≥ 2 (p = 0.039). Using the bootstrap technique, I<O had a 70% probability of inclusion in the Cox model, making it one of the strongest prognostic factors for OS. Conclusions: This multicenter prospective study establishes the strong and independent prognostic value of the rest/activity circadian rhythm for the overall survival of patients with metastatic colorectal cancer. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Sanofi research funding for the EORTC 05963 trial