Longer Median Survival Time Research Articles

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy.

To explore the efficacy of sorafenib in treating hepatocellular carcinoma (HCC) and its relationship with the computed tomography (CT) and magnetic resonance imaging (MRI) features of HCC, analyze the prognostic factors of HCC patients treated with sorafenib, and investigate the relationship between imaging findings and outcomes. A total of 38 HCC patients who were treated with sorafenib from April 2009 to December 2010 were included in this study. HCCs were classified as good arterial supply and poor arterial supply according to the intensity enhancement on CT scan or MRI. Clinical data were collected and the survival time was calculated by Kaplan-Meier method. Among these 38 patients [35 (92.1%) were males] treated with sorafenib, the median age was (53.3±11.1) years. Tumors in 17 patients had good arterial supply while those in the remained 21 patients had poor arterial supply. The median survival time (MST) was 10.7 months (95% CI, 8.7-12.7) and the 1-year overall survival (OS) was 41.0%. The MST and 1-year OS in patients with tumors with good arterial supply were 12 months (range, 4-20 months) and 52.9%, respectively, compared with those of 7 months (range, 1-16 months) and 23.8% in patients with tumors with poor arterial supply (P=0.002). Patients with BCLC stage B tumors had longer MST and higher OS than those with BCLC stage C tumors, although the differences were not statistically significant. Multivariate analysis showed that arterial supply of tumors remained statistically predictive for OS (HR =0.22; 95% CI, 0.07-0.67; P=0.008). Arterial blood supply is an independent predictor for survival in HCC patients treated with sorafenib, and patients with tumors with good arterial supply benefit more than those with tumors with poor arterial supply.

Prognostic impact of different chemotherapy strategies on small cell esophageal carcinoma

To investigate the prognostic impact of different chemotherapy strategies on small cell esophageal carcinoma (SCEC). The clinical data of 62 patients with histologically confirmed SCEC treated in our department between January 2006 and April 2011 were retrospectively analyzed. There were 39 patients with limited stage (LS) and 23 patients with extensive stage (ES) SCEC according to the Veterans Administration Lung Study Group staging system. Cox's hazard regression model was used to determine the prognostic factors, and Chi-square test was used to detect the difference of frequencies among different groups. Kaplan-Meier and log-rank analyses were used to estimate and compare the survival rates. The chemotherapy combined with local therapy group was significantly better than chemotherapy alone group in median survival time (MST) (20.8 vs. 7.6 months, P<0.05). The MST was 18.0 months and the 1-, 2-, and 3-year overall survival rates (OS) were 68.8%, 38.6%, and 20.9%, respectively, for all the 62 patients. Etoposide plus cisplatin or carboplatin (EP/CP) did not result in significantly longer MST, compared with that of the cases treated by other combination chemotherapy (P>0.05, for either LS or ES cases). Multivariate analysis showed that the VALSG stage, the number of chemotherapy cycles (≥ 4), and treatment modality are independent prognostic factors (P<0.05). SCEC is a tumor characterized by high malignancy and poor prognosis. Chemotherapy combined with local therapy is an effective treatment for SCEC, and appropriate chemotherapy cycles (≥ 4) may improve the survival time. EP/CP, as commonly used multidrug chemotherapy regimen, is not superior to other combination chemotherapy.

Glutathione S-transferase P1 gene rs4147581 polymorphism predicts overall survival of patients with hepatocellular carcinoma: evidence from an enlarged study.

As the most important detoxifying enzymes in liver, glutathione S-transferases (GSTs) can protect hepatocytes against carcinogens. We conducted a large cohort study to investigate the prognostic value of single nucleotide polymorphisms (SNPs) in seven encoding genes of GSTs for hepatocellular carcinoma (HCC). Twelve SNPs were genotyped and correlated with overall survival in 469 HCC patients. The median follow-up time of all patients was 21 (range 3-60) months, and the median survival time was 22months. By the end of the study, 135 (28.8%) patients were alive. Only rs4147581 in GSTP1 gene exhibited a significant association with survival of HCC patients (P = 0.006), with its mutant allele bearing a significantly lower risk of death (hazard ratio, 0.71; 95% confidence interval 0.53-0.90), compared with the homozygous wide-type. A longer median survival time in patients with rs4147581 mutant allele was noticed than those homozygous wide-type (P = 0.03), and there was a marked adverse effect on survival conferred by smoking exposure in these patients. Conclusively, our findings provide supporting evidence for a contributory role of GSTP1 rs4147581 polymorphism in predicting the prognosis of HCC.

Treatment and prognostic analysis of patients with leptomeningeal metastases from non-small cell lung cancer.

BackgroundLeptomeningeal metastases (LM) from non-small cell lung cancer (NSCLC) are associated with poor prognosis and optimal treatment for this subgroup of NSCLC patients is controversial. The purpose of this study is to evaluate treatment options and prognostic factors of NSCLC patients with LM.MethodsWe retrospectively analyzed data of 108 patients who had been diagnosed with LM from NSCLC between May 2006 and August 2013.ResultsThe median survival time (MST) of the 108 patients was 5.3 months, and the one-year survival rate was 23.7%. Forty-nine patients received whole brain radiotherapy (WBRT) and the MST of patients who received WBRT and those who did not were 6.4 and 4.3 months, respectively. Forty-two patients were treated with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) after being diagnosed with LM. These patients had prolonged survival (11.1 vs. 4.4 months). Patients who received concomitant WBRT and EGFR-TKIs had the longest MST (12.3 months). Eastern Cooperative Oncology Group performance status, whether patients received WBRT, and/or EGFR-TKIs were independent prognostic factors for patients with LM from NSCLC.ConclusionWBRT, EGFR-TKIs or combined therapy, could lead to better clinical outcomes for NSCLC patients with LM. EGFR-TKIs plus WBRT has the potential to be the standard strategy for LM in NSCLC patients.

Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy

Background: To explore the efficacy of sorafenib in treating hepatocellular carcinoma (HCC) and its relationship with the computed tomography (CT) and magnetic resonance imaging (MRI) features of HCC, analyze the prognostic factors of HCC patients treated with sorafenib, and investigate the relationship between imaging findings and outcomes. Methods: A total of 38 HCC patients who were treated with sorafenib from April 2009 to December 2010 were included in this study. HCCs were classified as good arterial supply and poor arterial supply according to the intensity enhancement on CT scan or MRI. Clinical data were collected and the survival time was calculated by Kaplan-Meier method. Results: Among these 38 patients [35 (92.1%) were males] treated with sorafenib, the median age was (53.3±11.1) years. Tumors in 17 patients had good arterial supply while those in the remained 21 patients had poor arterial supply. The median survival time (MST) was 10.7 months (95% CI, 8.7-12.7) and the 1-year overall survival (OS) was 41.0%. The MST and 1-year OS in patients with tumors with good arterial supply were 12 months (range, 4-20 months) and 52.9%, respectively, compared with those of 7 months (range, 1-16 months) and 23.8% in patients with tumors with poor arterial supply (P=0.002). Patients with BCLC stage B tumors had longer MST and higher OS than those with BCLC stage C tumors, although the differences were not statistically significant. Multivariate analysis showed that arterial supply of tumors remained statistically predictive for OS (HR =0.22; 95% CI, 0.07-0.67; P=0.008). Conclusions: Arterial blood supply is an independent predictor for survival in HCC patients treated with sorafenib, and patients with tumors with good arterial supply benefit more than those with tumors with poor arterial supply.

Cardiac rhabdomyosarcoma of the left atrium.

Cardiac rhabdomyosarcoma of the left atrium.

The Role of Epithelial–Mesenchymal Transition and IGF-1R Expression in Prediction of Gefitinib Activity as the Second-Line Treatment for Advanced Nonsmall-Cell Lung Cancer

Objective: Except for EGFR gene mutation, there is still lack of predictive factors for gefitinib activity as the second-line treatments for advanced NSCLC with wild-type (WT) EGFR or patients with mutant EGFR but showed poor response. Our purpose was to assess the predictive value of epithelial-mesenchymal transition (EMT) and IGF-1R for gefitinib efficacy as the second-line treatment for NSCLC. Methods: 53 advanced NSCLC patients who accepted gefitinib as the second-line treatment were enrolled in this study. Expression of E-cadherin, vimentin, and IGF-1R was determined by immunohistochemistry. EGFR gene mutation was determined by liquidchip technique. Results: The positive rate of EMT, IGF-1R, and EGFR gene mutation was 54.7%, 58.5%, and 39.6%, respectively. EMT (−) was positively correlated with EGFR gene mutation (p = .034) and EMT (+) was associated with IGF-1R (+) (p = .000). EMT (−) was associated with a significantly higher objective response rate (ORR) for all the 53 patients (41.7% vs. 6.9%, p = .024) and showed a higher ORR tendency than EMT (+) in EGFR mutation patients (50.0% vs. 28.6%) and WT EGFR patients (20.0% vs. 4.5%) (p > .05). EMT (−) showed a significant longer median survival time (MST) than EMT (+) for all 53 patients (8 months vs. 4 months) and WT EGFR patients (6 months vs. 3 months) (p < .05). IGF-1R (−) showed a higher ORR tendency than IGF-1R (+) in EGFR mutation patients (54% vs. 30%) and WT EGFR patients (18.2% vs. 4.8%) (p > .05). Conclusion: EMT is correlated with efficacy of gefitinib as the second-line treatment for NSCLC, and combined detection of EMT and IGF-1R may be used as new predictors besides EGFR mutation, especially for patients with WT EGFR.

Chemotherapy plus radiotherapy (CT-RT) versus RT alone for patients with anaplastic oligodendroglioma: Long-term results of the RTOG 9402 phase III study.

2008b Background: Anaplastic oligodendrogliomas, pure (AO) and mixed (AOA), are chemosensitive tumors, especially if co-deleted for chromosomes 1p and 19q, but whether addition of CT to RT prolongs overall survival (OS), is unknown. Methods: In the RTOG 9402 Phase III trial, patients (pts) with AO/AOA were randomly assigned to PCV [procarbazine, CCNU (lomustine) and vincristine] followed by immediate RT vs. immediate RT alone. Early analysis showed no OS benefit for the PCV+RT group but combined therapy was associated with a longer progression-free survival (PFS). It also showed that the finding of 1p/19q co-deletion was associated with a longer OS independent of treatment. The current analysis has a median follow up of 11.3 years (yrs). Results: Two hundred ninety-one patients were randomized, 148 to PCV+RT and 143 to RT. PCV+RT was associated with longer PFS [2.5 vs. 1.7 yrs, hazard ratio (HR) 0.68, 95% confidence interval (CI) (0.53, 0.88), P = 0.003] and the 1p/19q co-deletion with a longer Median Survival Time (MST) [8.7 vs. 2.7 yrs, HR 0.41, 95% CI (0.30, 0.55), P &lt; 0.001]. For the entire cohort, there was no difference in MST by treatment [4.6 yrs for PCV+RT vs. 4.7 yrs for RT, HR 0.79, 95% CI (0.60, 1.04), P = 0.1]. However, patients with 1p/19q co-deleted tumors lived much longer after PCV+RT (n = 59) than after RT (n = 67) [14.7 vs. 7.3 yrs, HR 0.59, 95% CI (0.37, 0.95), P = 0.03]. There was no difference in MST by treatment in pts without the 1p/19q co-deletion [n=137; 2.6 vs. 2.7 yrs, HR 0.85, 95% CI (0.58, 1.23), P = 0.39]. Re-operation rates upon progression were similar between treatment arms in co-deleted pts (43%, PCV+RT vs. 54%, RT) but salvage CT rates were higher in the RT arm [57% vs. 81% (P = 0.04)]. Conclusions: PCV followed by immediate RT was a highly effective therapy for patients with 1p/19q co-deleted AO/AOA. In this setting, 1p/19q co-deletion was both prognostic and predictive, and the early PFS benefit in co-deleted cases was a harbinger of their longer OS. [This work was supported by RTOG grants U10 CA21661 and U10 CA32115, NCCTG grant U10 CA25224, ECOG grants CA17145 and CA21115, SWOG grant CA32102, and CCOP grant U10 CA37422 from the National Cancer Institute (NCI)]

Abstract 736: RTOG 0320:A phase III trial comparing whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone versus WBRT with temozolomide (TMZ) or erlotinib for non-small cell lung cancer (NSCLC) and 1-3 brain metastases

Abstract Background: A previous phase III RTOG study subset analysis demonstrated improvement in overall survival (OS) with the addition of SRS to WBRT in NSCLC patients with 1 to 3 brain metastases. As both TMZ and erlotinib are known to cross the blood brain barrier (potentially providing radiosensitization), and have documented activity in NSCLC, a phase III study was designed to test whether either of these drugs would improve outcome of WBRT/SRS. Methods: NSCLC patients (n=126) with 1-3 brain metastases were randomized (10/2005 to 8/2009; study closed prematurely due to slow accrual) to receive WBRT (2.5 Gy x 15 to 37.5Gy) + SRS alone, vs. WBRT/SRS with TMZ (75mg/m2/D x 21) or erlotinib (150mg/D). Erlotinib or TMZ (150-200 mg/m2/D x 5/mo) could be given in the drug arms post-WBRT/SRS at the discretion of the investigator. The primary endpoint was overall survival (OS). Results: Arms were stratified by RTOG recursive partitioning analysis (RPA) class and balanced for prognostic variables including the Graded Prognostic Assessment (GPA) score. Neither the addition of erlotinib nor TMZ to WBRT/SRS resulted in an improvement in OS, or time to CNS progression compared to WBRT/SRS alone. Patients in the WBRT/SRS arm had longer MST (Median Survival Time) (13.4 mo, 95% CI = 6.5-20.8 mo.) compared to the WBRT+SRS+ erlotinib (6.1 mo, 95% CI = 3.6-12.1 mo)[Hazard ratio (≥2 / α1) and 95% CI; 1.47 (0.92 to 2.36)], or TMZ (6.3 mo, 95% CI= 3.4-10.1 mo.) [Hazard ratio (β3 / α1) and 95% CI; 1.43 (0.89 to 2.31)]. This surprising result was not related to excess toxicity. In fact, patients experiencing grade 3+ Adverse Events (AE) appear to have longer OS than those patients without grade 3+ AE for both drug arms. The WBRT/SRS arm had significantly less deterioration in performance status at 6 mo. There were no significant differences between arms for steroid dependence at 6 mo, or causes of death. Conclusion: The addition of either TMZ or erlotinib to WBRT/SRS in this unselected population of NSCLC patients with 1-3 brain metastases provided no clinical advantage. Treatment with WBRT/SRS alone appeared to result in superior outcome data (compared to the addition of TMZ or erlotinib) relative to OS in this limited data set. Detailed analysis to date provides no obvious explanation for these unexpected results. Support: RTOG grant U10 CA21661, and CCOP grant U10 CA37422 from the National Cancer Institute (NCI) Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 736. doi:1538-7445.AM2012-736

Galactosylated chitosan/5-fluorouracil nanoparticles inhibit mouse hepatic cancer growth and its side effects

To observe the curative effect of galactosylated chitosan (GC)/5-fluorouracil (5-FU) nanoparticles in liver caner mice and its side effects. The GC/5-FU nanoparticle is a nanomaterial made by coupling GC and 5-FU. The release experiment was performed in vitro. The orthotropic liver cancer mouse models were established and divided into control, GC, 5-FU and GC/5-FU groups. Mice in the control and GC group received an intravenous injection of 200 μL saline and GC, respectively. Mice in the 5-FU and GC/5-FU groups received 200 μL (containing 0.371 mg 5-FU) 5-FU and GC/5-FU, respectively. The tumor weight and survival time were observed. The cell cycle and apoptosis in tumor tissues were monitored by flow cytometry. The expression of p53, Bax, Bcl-2, caspase-3 and poly adenosine 50-diphosphate-ribose polymerase 1 (PARP-1) was detected by immunohistochemistry, reverse transcription-polymerase chain reaction and Western blot. The serum blood biochemical parameters and cytotoxic activity of natural killer (NK) cell and cytotoxicity T lymphocyte (CTL) were measured. The GC/5-FU nanoparticle is a sustained release system. The drug loading was 6.12% ± 1.36%, the encapsulation efficiency was 81.82% ± 5.32%, and the Zeta potential was 10.34 ± 1.43 mV. The tumor weight in the GC/5-FU group (0.4361 ± 0.1153 g vs 1.5801 ± 0.2821 g, P < 0.001) and the 5-FU (0.7932 ± 0.1283 g vs 1.5801 ± 0.2821 g, P < 0.001) was significantly lower than that in the control group; GC/5-FU treatment can significantly lower the tumor weight (0.4361 ± 0.1153 g vs 0.7932 ± 0.1283 g, P < 0.001), and the longest median survival time was seen in the GC/5-FU group, compared with the control (12 d vs 30 d, P < 0.001), GC (13 d vs 30 d, P < 0.001) and 5-FU groups (17 d vs 30 d, P < 0.001). Flow cytometry revealed that compared with the control, GC/5-FU caused a higher rate of G0-G1 arrest (52.79% ± 13.42% vs 23.92% ± 9.09%, P = 0.014 ) and apoptosis (2.55% ± 1.10% vs 11.13% ± 11.73%, P < 0.001) in hepatic cancer cells. Analysis of the apoptosis pathways showed that GC/5-FU upregulated the expression of p53 at both the protein and the mRNA levels, which in turn lowered the ratio of Bcl-2/Bax expression; this led to the release of cytochrome C into the cytosol from the mitochondria and the subsequent activation of caspase-3. Upregulation of caspase-3 expression decreased the PARP-1 at both the mRNA and the protein levels, which contributed to apoptosis. 5-FU increased the levels of aspartate aminotransferase and alanine aminotransferase, and decreased the numbers of platelet, white blood cell and lymphocyte and cytotoxic activities of CTL and NK cells, however, there were no such side effects in the GC/5-FU group. GC/5-FU nanoparticles can significantly inhibit the growth of liver cancer in mice via the p53 apoptosis pathway, and relieve the side effects and immunosuppression of 5-FU.

Sorafenib in hepatocellular carcinoma: efficacy and predictive factors

ObjectiveTo evaluate the efficacy and safety in patients with hepatocellular carcinoma treated with sorafenib and determine the predictive factors for survival. MethodsFrom April 2009 to December 2010, all patients with hepatocellular carcinoma treated with sorafenib were included in the study. Clinical data and survival time were collected. Survival analysis was conducted using the Kaplan-Meier method, and predictive factors for survival were analysed using the Cox's model. ResultsA total of 51 patients were included in the study, the median time of follow-up was 10 months (range 1–22). All the 51 patients had one or more adverse events, of which 2 patients died of upper gastrointestinal bleeding and 6 patients discontinued treatment. The mean survival time was 11 months and 1-year survival was 60.8%. On univariate analysis, the median survival time of patients with tumors of BCLC A, B and C were 17, 12.5 and 8.5 months, and 1-year survival were 71.4%, 61.1%, and 23.1%, respectively (P=0.006). Compared with those with mild and poor arterial supply tumors, patients with good arterial supply tumors had longer median survival time (12 months vs 8 months and 9 months) and higher 1-year survival (52.0% vs 30.8% and 38.5%) (P=0.037). Patients with portal invasion had shorter median survival time and lower 1-year survival (8.5 months vs 13 months and 57.6% vs 16.7%, respectively) than those without (P=0.012). Patients with prealbumin ⩾170 mg/L had longer median survival time and higher 1-year survival (13.5 months vs 9 months and 55.6% vs 36.4%, respectively) than those with prealbumin <170 mg/L (P=0.016). Early tumor BCLC staging and high level of prealbumin were independent predictive factors for survival on multivariate analysis using Cox's regression model, the hazard ratio were 3.69 (95%CI: 1.30–10.53, P=0.015) and 3.53 (95%CI: 1.40–8.91, P=0.008) respectively. ConclusionUpper gastrointestinal bleeding was a severe event need to be concerned in patients with hepatocellular carcinoma treated with sorafenib. Patients with high level of prealbumin could benefit more from sorafenib treatment, and prealbumin could be a predictor for survival in HCC patients treated with sorafenib.

A better way to do small-for-size liver transplantation in rats

Establishing a model for small-for-size liver transplantation is the basis for this study of partial and living donor graft liver transplantation. This study aims to explore a simpler and more effective way of establishing a 30% small-for-size liver transplantation in rats. Sprague-Dawley rats were selected as the donors and recipients. Small-for-size orthotopic liver transplantation was performed using Kamada's two-cuff method. The donor's liver was flushed via the abdominal aorta and hepatectomy was performed in situ. The animals were divided into three groups depending on the graft selected, with 40 pairs of rats in each group. In group I, the median lobe of the liver was used as graft; in group II, the right half of the median lobe and the right lobe were used as graft; and in group III, the median and right lobes were used as graft. In groups I and II, the bodyweights of donors were the same as those of recipients; however, in group III the bodyweights of donors were 100-120 g less than those of the recipients. The duration needed for transplantation, the 7-day survival rates, and the technical complication rates were compared among these three groups. The time required for hepatectomy was shorter in group III compared with groups I and II (8.8±0.7 min vs. 11.5±1.1 min and 10.1±1.0 min, P = 0.001). The cold ischemia time for the grafts, the anhepatic times, and the transplantation times for the recipients were not significantly different among the three groups. Compared with groups I and II, the incidence of bleeding, bile leakage, and inferior vena caval strictures were significantly decreased in group III (P<0.05). No significant differences between the three groups were found based on other complications after the operation (P>0.05). Group III had better 7-day survival rates and longer median survival times but the differences were not statistically significant. The method of small for donor bodyweight using the median and right lobes for grafting may be a more effective and simpler way of establishing a 30% small-for-size liver transplantation in rats, as shown by the shorter hepatectomy time and the occurrence of fewer complications after the operation.

Prognosis of acute kidney injury in dogs using RIFLE (Risk, Injury, Failure, Loss and End-stage renal failure)-like criteria

A retrospective case-series study evaluated the prognosis of 853 dogs with acute kidney injury (AKI) based on the RIFLE (Risk, Injury, Failure, Loss and End-stage renal failure) criteria, derived from...

Prognosis of small-cell lung cancer since the introduction of amrubicin

Several studies have demonstrated the effectiveness of amrubicin (AMR) in small-cell lung cancer (SCLC). This study aimed to assess the change in the prognosis of SCLC before and after the commercial availability of AMR. We retrospectively analyzed data from 243 patients with newly diagnosed SCLC. Patients diagnosed before the start of the sale of AMR (January 1997-May 2002) constituted Group A, and patients diagnosed after its introduction (December 2002-December 2006), constituted Group B. The overall survival and demographic factors of the 2 groups were compared. Similar comparisons were also performed on subsets. Median survival time (MST) was 313 days for Group A and 388 days for Group B (P=0.031). Group B with limited disease (LD) demonstrated a significantly longer median survival time (321 vs. 506 days; P=0.022) than Group A, whereas no significant difference was noted between the groups of patients with extensive disease (ED) (296 vs. 280 days; P=0.895). In the subset of refractory relapse of LD, the MST was clearly longer in Group B than in Group A (220 vs. 321 days; P<0.001). Multivariate analysis for LD patients indicated that performance status (hazard ratio 2.072; P=0.003) and commercial availability of AMR (0.596; P=0.022) are significant factors. The present study has demonstrated prolonged survival times for LD patients since the start of the sale of AMR. The use of AMR in ED patients requires further investigations.

Significance of volume-reduction surgery for far-advanced gastric cancer during treatment with novel anticancer agents

We retrospectively assessed the survival benefit of novel anticancer agents (NACA) after volume-reduction surgery for far-advanced gastric cancer (FAGC). From 1995 to 2005, 41 patients with FAGC underwent chemotherapy after volume-reduction surgery. Those treated since 2000 who received NACA were referred to as group A, and those treated before 2000, who received anticancer agents other than NACA, were referred to as group B. In addition, 21 patients with unresectable gastric cancer treated since 2000 who received NACA were referred to as group C. We investigated the significance of volume-reduction surgery during treatment with NACA. The median survival time (MST) was significantly prolonged in group A (626 days) compared to group B (364 days; P = 0.0156). Multivariate analysis showed that having one noncurative factor (NCF), and the use of NACA, were factors that contributed to survival time. Comparison between the subgroup of group A that had one NCF and the subgroup that had two or more NCFs revealed MSTs of 700 days and 180 days, respectively, with a significantly longer MST among the patients with one NCF (P = 0.0021). In addition, no difference from the MST of 333 days in group C was seen among the group A patients with two or more NCFs. The postoperative survival time of patients with one NCF was prolonged by the advent of NACA, but no significant prolongation was observed in the patients with two or more NCFs.

Phase III multicenter web-based study demonstrating survival equivalents of nonplatinum-based chemotherapy for advanced non-small cell lung cancer (NSCLC): Subgroup analysis from D0112

8100 Background: Based on limited data, NSCLC guidelines from ASCO includes non-platinum (non-P) therapy. D0112 provided the highest evidence supporting this guideline. Survival for this non-P and a carboplatin combination were equivalent. Recently, treatment choices and duration are based on subgroups of NSCLC. This report addresses the outcomes for subgroups from this trial. Methods: Eligibility patients (pts) with IIIB/IV NSCLC, performance status (PS) 0–2, and no prior chemotherapy. Randomized pts were stratified by stage (IIIB vs IV) and PS (0–1 vs 2) to arm A: carboplatin + docetaxel or arm B: gemcitabine + docetaxel. Therapy duration following 6 cycles was at the discretion of the investigator. Gender, histology, stage, PS, prior radiation, and central nervous system (CNS) metastasis were identified as independent variables. Multivariable analysis was performed using a proportional hazards regression. Wald test was performed. Treatment effect for each subgroups was evaluated. Results: Median follow-up time for 930 pts was 25.3 mos with 754 deaths. Median survival time (MST) for both treatment groups was 7.9 mos. Non-P arm was non-inferior to the platinum arm, unadjusted hazard ratio of 1.03 (95% confidence interval: 0.89 to 1.18) p = 0.017. By Wald tests, female (p = 0.002), IIIB (p = 0.025), adenocarcinoma (p = 0.002), and PS 0 (p < 0.001) had longer MST. Relative risk for each subgroups was not different for either treatment arm. Pts with non- squamous, no CNS disease and PS 0–1 had a MST of 9.5 mos. 314 pts (34%) received 6 cycles of therapy. Beyond 6 cycles, 163 pts received additional therapy and 151 pts had chemotherapy discontinued without disease progression. MSTs were 15.2 mos (1-yr 66%) and 13.1 mos (1-yr 55%) (p = 0.13), respectively. SAEs were more common for pts with more than 6 cycles (24% of pts) compared to treatment discontinued (16% of pts). Conclusions: For the palliative care of advanced NSCLC, non-P-based chemotherapy provides equivalent survival to carboplatin-based therapy. Females, intrathoracic disease, adenocarcinoma, and good PS do better with either therapy. This trial like others raises questions about the appropriate duration of therapy for incurable NSCLC. No significant financial relationships to disclose.

Malignant meningiomas: a retrospective study of 22 cases.

Malignant (anaplastic) meningioma constitutes a rare subset of meningioma. The aim of the study was to study clinical features and management of malignant meningiomas. Twenty-two patients with malignant meningiomas were surgically treated in our department between January 1986 and January 2005 in Qilu hospital, and we reviewed each patient's clinical records, radiological findings, operative reports, and pathological examinations. Simpson grade I resection was achieved in 16 cases and grade II resection in 6 cases. Postoperative radiotherapy was performed in all patients. No death occurred during the perioperative period in this series. The follow-up period ranged from six months to ten years. Overall 5-year survival and recurrence-free survival estimates were 36.4 and 27.3%, respectively. 16 patients with Simpson Grade I resection had longer median survival times than 6 patients with Simpson Grade II resection (70 months compared with 10 months, p = 0.0001). Only tumor location (p = 0.016) and Simpson grade of surgical resection (p = 0.002) had an impact on outcome according to a Cox regression analysis. Surgical resection and adjuvant radiotherapy are the main treatments for malignant meningiomas, and the degree of tumor removal is the leading factor determining postoperative recurrence and survival.

Validation of IPSS criteria in more than 1,600 MDS patients

7079 Myelodysplastic syndromes (MDS) are a diverse group of clonal stem cell disorders characterized by bone marrow failure, dysmyelopoiesis and peripheral cytopenias and affecting predominantly an elderly population. The International Prognostic Scoring System (IPSS) incorporates the number of peripheral cytopenias, percentage of bone marrow blasts and chromosomal abnormalities and assigns a score to predict survival and risk of disease progression to AML. Using the extensive MDS database at the University of Massachusetts we analyzed survival time in relation to IPSS scoring and also its various individual components, i.e. blast percentage, number of cell lines involved and the number of karyotype abnormalities in 1,200+ patients. The overall median survival time in 1,424 MDS patients as a group was 2.9 years. IPSS low group had the longest median survival time of 7.5 years with IPSS Int-1 3.6 years. There was minimal difference in the median survival time between IPSS Int-2 and IPSS high risk group 1.2 and 1.1 years respectively. These results were significant for a P value of &lt;0.0001. The median survival time for blasts &lt;5% was 5.3 years and blast 5–10% was 1.7 years. Interestingly, there was minimal survival difference between median survival time for blasts 11–20% and blasts &gt;20% showing 1.2 years and 1.3 years respectively. Again, these results were significant for a P value of &lt;0.0001. The median survival time for the number of cytopenias involved was also calculated with 0, 1, 2 and 3 numbers of cytopenias showing 6.4 years, 4.4 years, 2.6 years and 1.8 years respectively, with P value of &lt;0.0001. The median survival time for normal karyotype versus one or two karyotype abnormality was 4.9 years, 2.6 years and 2.4 years respectively. Three or more karyotype abnormalities showed a median survival time of 0.8 years. The P value was again significant (&lt;0.0001). Our results not only validate the prognostic value of IPSS scoring system as a whole but also its various individual prognostic indicators. No significant financial relationships to disclose.

P.220 Extirpation of ossifying fibroma using the Le Fort I approach

Primary spinal primitive neuroectodermal tumors are extremely rare entities. The purpose of this study was to analyze the differences in clinical and imaging characteristics and outcomes between primary spinal central PNETs (cPNETs) and peripheral PNETs (pPNETs).There were 25 consecutive patients with primary spinal primitive neuroectodermal tumors enrolled. The diagnosis was cPNET in 6 patients with negative CD99 expression and pPNET in 19 patients with positive CD99 expression. Gross total resection (GTR) was achieved in 12 patients, subtotal resection was performed in 9 patients, and partial resection was performed in 4 patients. Postoperative chemotherapy was given to 14 patients, and radiotherapy was given to 16 patients.The age at diagnosis was significantly younger in the cPNET group (mean 12.8 years) compared with the pPNET group (mean 22.5 years) (P = 0.040); the 2 pathologies did not show a significant difference in prognosis. GTR (P = 0.041), radiotherapy (P = 0.008), and GTR with radiotherapy (P = 0.009) were significant factors leading to a higher 2-year survival rate. Kaplan-Meier analysis showed that radiotherapy (P < 0.001) and GTR with radiotherapy (P = 0.040) resulted in a longer median survival time. Patients who underwent GTR, chemotherapy, and radiotherapy all together had the highest 1-year (100.0%) and 2-year (71.4%) survival rates and the longest median survival time (32 months).Patients with spinal cPNETs were younger compared with patients with pPNETs. The prognosis of spinal cPNETs and pPNETs was poor with no significant difference between the entities. The most beneficial treatment modality is GTR combined with adjuvant radiotherapy and chemotherapy.

Phase III Trial of Chemotherapy Plus Radiotherapy Compared With Radiotherapy Alone for Pure and Mixed Anaplastic Oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial 9402

Anaplastic oligodendroglioma (AO) and anaplastic oligoastrocytoma (AOA) are treated with surgery and radiotherapy (RT) at diagnosis, but they also respond to procarbazine, lomustine, and vincristine (PCV), raising the possibility that early chemotherapy will improve survival. Furthermore, better outcomes in AO have been associated with 1p and 19q allelic loss. Patients with AO and AOA were randomly assigned to PCV chemotherapy followed by RT versus postoperative RT alone. The primary end point was overall survival. The status of 1p and 19q alleles was assessed by fluorescence in situ hybridization. Two hundred eighty-nine eligible patients were randomly assigned to either PCV plus RT (n = 147) or RT alone (n = 142). At progression, 80% of patients randomly assigned to RT had chemotherapy. With 3-year follow-up on most patients, the median survival times were similar (4.9 years after PCV plus RT v 4.7 years after RT alone; hazard ratio [HR] = 0.90; 95% CI, 0.66 to 1.24; P = .26). Progression-free survival time favored PCV plus RT (2.6 years v 1.7 years for RT alone; HR = 0.69; 95% CI, 0.52 to 0.91; P = .004), but 65% of patients experienced grade 3 or 4 toxicity, and one patient died. Patients with tumors lacking 1p and 19q (46%) compared with tumors not lacking 1p and 19q had longer median survival times (> 7 v 2.8 years, respectively; P < or = .001); longer progression-free survival was most apparent in this subset. For patients with AO and AOA, PCV plus RT does not prolong survival. Longer progression-free survival after PCV plus RT is associated with significant toxicity. Tumors lacking 1p and 19q alleles are less aggressive or more responsive or both.