Lower 5-year Overall Survival Research Articles

The Effects of Sarcopenia on Overall Survival and Postoperative Complications of Patients Undergoing Hepatic Resection for Primary or Metastatic Liver Cancer: A Systematic Review and Meta-Analysis.

Background: Colorectal cancer is the third most common cancer worldwide, and 20-30% of patients will develop liver metastases (CRLM) during their lifetime. Hepatocellular carcinoma (HCC) is also one of the most common cancers worldwide with increasing incidence. Hepatic resection represents the most effective treatment approach for both CRLM and HCC. Recently, sarcopenia has gained popularity as a prognostic index in order to assess the perioperative risk of hepatectomies. The aim of this study is to assess the effects of sarcopenia on the overall survival (OS), complication rates and mortality of patients undergoing liver resections for HCC or CRLM. Methods: A systematic literature search was performed for studies including patients undergoing hepatectomy for HCC or CRLM, and a meta-analysis of the data was performed. Results: Sarcopenic patients had a significantly lower 5-year OS compared to non-sarcopenic patients (43.8% vs. 63.6%, respectively; p < 0.01) and a significantly higher complication rate (35.4% vs. 23.1%, respectively; p = 0.002). Finally, no statistical correlation was found in mortality between sarcopenic and non-sarcopenic patients (p > 0.1). Conclusions: Sarcopenia was significantly associated with decreased 5-year OS and increased morbidity, but no difference was found with regard to postoperative mortality.

Preoperative BMI and long-term survival in NAFLD-associated hepatocellular carcinoma: A multicenter study revealing a paradox.

e16262 Background: As non-alcoholic fatty liver disease (NAFLD) emerges as a key factor in hepatocellular carcinoma (HCC) development, exacerbated by the global obesity epidemic, the prognostic role of body mass index (BMI) in NAFLD-HCC patients undergoing surgical resection remains unclear. This study aims to elucidate the impact of preoperative BMI on long-term outcomes after hepatectomy in patients with NAFLD-HCC, offering insights for more personalized treatment strategies. Methods: In this multicenter retrospective study, patients with early-stage (BCLC stage 0/A) NAFLD-HCC who underwent curative hepatectomy between 2009 and 2022 were analyzed. Based on preoperative BMI, patients were classified into lean ( &lt; 23.0 kg/m2), overweight (23.0-27.4 kg/m2), and obese (≥ 27.5 kg/m2) categories. The primary endpoints, overall survival (OS) and recurrence-free survival (RFS), were compared across these BMI groups. Results: This large multicenter cohort comprised 309 early-stage NAFLD-HCC patients: 66 lean, 176 overweight, and 67 obese. Liver-, tumor-, and surgery-related characteristics were similar across groups. Lean patients exhibited significantly lower 5-year OS and RFS (55.4% and 35.1%, respectively) compared to overweight patients (71.3% and 55.6%, P = 0.017 and P = 0.002), with outcomes comparable to obese patients (48.5% and 38.2%, P = 0.939 and P = 0.442). Multivariable Cox-regression analysis revealed lean BMI, but not obese BMI, as an independent predictor of decreased OS (HR: 1.69; 95%CI: 1.06-2.71; P = 0.029) and RFS (HR: 1.72; 95% CI: 1.17-2.52; P = 0.006). Conclusions: This study challenges conventional perceptions of BMI in cancer prognosis, revealing that lean NAFLD-HCC patients have poorer long-term surgical outcomes compared to their overweight and obese counterparts. These findings underscore the need for a nuanced understanding of BMI’s role in NAFLD-HCC management and prompt further investigation into the underlying biological mechanisms of this paradox.

Laparoscopic versus open hepatectomy for exophytic hepatocellular carcinoma: A multicenter propensity-matched comparative study.

e16268 Background: As laparoscopic hepatectomy (LH) gains traction in the surgical management of hepatocellular carcinoma (HCC), its efficacy for exophytic HCC, a subtype with unique surgical challenges, remains under scrutiny. This study aims to compare the long-term outcomes of LH with traditional open hepatectomy (OH) in treating exophytic HCC. Methods: A multicenter retrospective analysis was conducted on patients with solitary exophytic HCC undergoing LH or OH at 10 hepatobiliary centers. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were employed to balance the LH and OH groups for overall survival (OS) and recurrence-free survival (RFS) comparisons. Multivariable Cox-regression analysis determined the independent impact of surgical approach on OS and RFS. Results: The study included 270 patients, with 132 undergoing OH and 138 LH. Post-PSM, 97 matched pairs were analyzed. In this cohort, LH was associated with significantly lower 5-year OS (36.1% vs. 53.5%, P = 0.021) and RFS (31.7% vs. 44.9%, P = 0.013) compared to OH. Additionally, LH patients exhibited a higher rate of abdominal seeding metastases (19.6% vs. 8.2%, P = 0.023). Multivariable analysis in the PSM cohort revealed LH as an independent factor for reduced OS (HR, 1.62; 95% CI, 1.06-2.47; P = 0.025) and RFS (HR, 1.79; 95% CI, 1.22-2.64; P = 0.003), corroborated by IPTW cohort findings. Conclusions: This study indicates that LH may be less favorable than OH for exophytic HCC, potentially contraindicating its use in such cases. These findings highlight the necessity for further prospective research to refine surgical protocols for exophytic HCC.

Neoadjuvant chemotherapy followed by surgery versus concurrent chemoradiotherapy in patients with stage IIB cervical squamous cell carcinoma: a retrospective cohort study

PurposeThis study aims to compare treatment outcomes between neoadjuvant chemotherapy (NACT) followed by surgery and concurrent chemoradiotherapy (CCRT) in patients with stage IIB cervical squamous cell carcinoma (CSCC).Materials and methodsWe conducted a retrospective cohort study involving patients with stage IIB CSCC treated at Guangxi Medical University Cancer Hospital between June 2012 and June 2019. We compared overall survival (OS), locoregional-free survival (LRFS), and distant metastasis-free survival (DMFS) between the NACT + surgery and CCRT groups.ResultsA total of 257 patients were enrolled: 165 underwent NACT + surgery and 92 received CCRT. Before propensity score matching, the NACT + surgery group exhibited lower 5-year OS (68.2% vs. 85.6%; hazard ratio [HR] = 2.50, 95% confidence interval [CI]: 1.26–4.96; P = 0.009), LRFS (85.2% vs. 96.9%; HR = 5.88, 95% CI: 1.33–25.94; P = 0.019), and DMFS (81.9% vs. 97.4%; HR = 6.65, 95% CI: 1.51–29.23; P = 0.012) compared to the CCRT group. After propensity score matching, OS, LRFS, and DMFS remained worse in the NACT + surgery group compared to the CCRT group.ConclusionNACT followed by surgery is associated with decreased OS, LRFS, and DMFS compared to CCRT among patients with stage IIB CSCC.

Prognostic analysis of childhood T-lymphoblastic lymphoma treated with leukemia regimen

To investigate the prognosis of childhood T-lymphoblastic lymphoma (T-LBL) treated with acute lymphoblastic leukemia (ALL) regimen and related influencing factors. A retrospective analysis was performed for the prognostic characteristics of 29 children with T-LBL who were treated with ALL regimen (ALL-2009 or CCCG-ALL-2015 regimen) from May 2010 to May 2022. The 29 children with T-LBL had a 5-year overall survival (OS) rate of 84%±7% and an event-free survival (EFS) rate of 81%±8%. The children with B systemic symptoms (unexplained fever >38°C for more than 3 days; night sweats; weight loss >10% within 6 months) at initial diagnosis had a lower 5-year EFS rate compared to the children without B symptoms (P<0.05). The children with platelet count >400×109/L and involvement of both mediastinum and lymph nodes at initial diagnosis had lower 5-year OS rates (P<0.05). There were no significant differences in 5-year OS and EFS rates between the children treated with CCCG-ALL-2015 regimen and those treated with ALL-2009 regimen (P>0.05). Compared with the ALL-2009 regimen, the CCCG-ALL-2015 regimen reduced the frequency of high-dose methotrexate chemotherapy and the incidence rate of severe infections (P<0.05). The ALL regimen is safe and effective in children with T-LBL. Children with B systemic symptoms, platelet count >400×109/L, and involvement of both mediastinum and lymph nodes at initial diagnosis tend to have a poor prognosis. Reduction in the frequency of high-dose methotrexate chemotherapy can reduce the incidence rate of severe infections, but it does not affect prognosis.

The differential expression of AFF3 in cervical cancer and its correlation with clinicopathological features and prognosis

Background Cervical cancer (CC) is the second most common malignancy in women, and identifying biomarkers of CC is crucial for prognosis prediction. Here, we investigated the expression of AF4/FMR2 Family Member 3 (AFF3) in CC and its association with clinicopathological features and prognosis. Methods Tumour and adjacent tissues, along with clinicopathological features and follow-up information, were collected from 78 patients. AFF3 expression was assessed using quantitative real-time polymerase chain reaction and Western blotting. The correlation between AFF3 expression and CC symptoms was using chi-square test. The 5-year overall survival (OS) was analysed using the Kaplan-Meier method. The Univariate analysis of prognostic risk factors was conducted using the COX proportional hazards model, followed by multivariate COX regression analysis including variables with p < 0.01. Results AFF3 expression was downregulated in CC, and its levels were correlated with lymph node metastasis (LNM) and International Federation of Gynaecology and Obstetrics (FIGO) stage. Patients with low AFF3 expression had a lower 5-year OS rate (52.78%, 19/36). Postoperative survival was reduced in patients with histological grade 3 (G3), myometrial invasion (depth ≥ 1/2), lymphovascular space invasion, LNM, and advanced FIGO stage. Low expression of AFF3 (HR: 2.848, 95% CI: 1.144–7.090) and histological grade G3 (HR: 4.393, 95% CI: 1.663–11.607) were identified as independent prognostic risk factors in CC patients. Conclusion Low expression of AFF3 and histological G3 are independent predictors of poor prognosis in CC patients, suggesting that AFF3 could serve as a potential biomarker for prognostic assessment in CC.

The evolution and impact of sarcopenia in severe aplastic anaemia survivors following allogeneic haematopoietic cell transplantation.

Sarcopenia is a potential risk factor for adverse outcomes in haematopoietic cell transplantation (HSCT) recipients. We aimed to explore longitudinal body changesin muscle and adipose mass and their prognostic value in allogeneic HSCT-treated severe aplastic anaemia (SAA) patients. We retrospectively analysed consecutive SAA patients who underwent allogeneic HSCT between January 2017 and March 2022. Measurements of pectoral muscle and corresponding subcutaneous fat mass were obtained via chest computed tomography at baseline and at 1month, 3months, 6months, and 12months following HSCT. Sarcopenia was defined as pectoral muscle index (PMI) lower than the sex-specific median at baseline. Changes in body composition over time were evaluated by generalized estimating equations. Cox regression models were used to investigate prognostic factors affecting overall survival (OS) and failure-free survival (FFS). A nomogram was constructed from the Cox regression model for OS. We included 298 adult SAA patients (including 129 females and 169 males) with a median age of 31years [interquartile range (IQR), 24-39years] at baseline. Sarcopenia was present in 148 (148/298, 50%) patients at baseline, 218 (218/285, 76%) patients post-1month, 209 (209/262, 80%) patients post-3month, 169 (169/218, 78%) patients post-6month, and 129 (129/181, 71%) patients post-12month. A significant decrease in pectoral muscle mass was observed in SAA patients from the time of transplant to 1year after HSCT, and the greatest reduction occurred in post 1-3months (P<0.001). The sarcopenia group exhibited significantly lower 5-year OS (90.6% vs. 100%, log-rank P=0.039) and 5-year FFS (89.2% vs. 100%, log-rank P=0.021) than the nonsarcopenia group at baseline. Sarcopenia at baseline (hazard ratio, HR, 6.344; 95% confidence interval, CI: 1.570-25.538; P=0.01; and HR, 3.275; 95% CI: 1.159-9.252; P=0.025, respectively) and the delta value of the PMI at 6months post-transplantation (ΔPMI6) (HR, 0.531; 95% CI: 0.374-0.756; P<0.001; and HR, 0.666; 95% CI: 0.505-0.879; P=0.004, respectively) were demonstrated to be independent prognostic factors for OS and FFS in SAA patients undergoing HSCT, and were used to construct the nomogram. The C-index of the nomogram was 0.75, and the calibration plot showed good agreement between the predictions made by the nomogram and actual observations. Sarcopenia persists in SAA patients from the time of transplant to the 1-year follow-up after HSCT. Both sarcopenia at baseline and at 6months following HSCT are associated with poor clinical outcomes, especially in patients with persistent muscle mass loss up to 6months after transplantation.

Abstract 4871: Colorectal cancer incidence and overall survival by race, stage, and age: A SEER database analysis, 2009-2020

Abstract Introduction: In the United States, colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer-related deaths. Although incidence rates of CRC have been decreasing overall, recent studies suggest a shift in demographics, specifically an increase in the number of new CRC cases among younger individuals and a higher incidence among those who identify as non-Hispanic Native American/Alaska Native. To examine the latest trends in incidence and overall survival (OS) among adults with CRC in the United States, we conducted an observational study using the Surveillance, Epidemiology, and End Results (SEER) Program database. Methods: Patients aged ≥18 years with newly diagnosed CRC between January 1, 2009, and December 31, 2020 were identified in the SEER 17 database. Age-adjusted incidence rates for CRC were calculated by race/ethnicity and age groups (18-49, 50-64, and ≥65 years) from 2009 to 2020. Kaplan-Meier curves were generated to examine 5-year OS by race/ethnicity, stage, and age groups. Results: There were 429,218 CRC cases identified with a median age of 67 years. Most were male (52.4%) with stage 0-II CRC (51.4%). Most patients identified as non-Hispanic White (66.3%), followed by non-Hispanic Black (11.5%), non-Hispanic Asian/Pacific Islander (8.9%), non-Hispanic Native American/Alaska Native (0.7%), and Hispanic of any race (12.7%). The age-adjusted incidence rate between 2009 and 2020 was 51.9 per 100,000 persons; incidence decreased from 59.5 per 100,000 persons in 2009 to 44.2 per 100,000 persons in 2020, with male patients having a higher incidence rate than female patients. By 2020, non-Hispanic Native American/Alaska Native patients had the highest incidence rate (54.5 per 100,000 persons) followed by non-Hispanic Black patients (50.6 per 100,000 persons). CRC incidence rates increased slightly for age &amp;lt;50 years (10.5 to 12.9 per 100,000 persons) and decreased for ages 50-64 (74.6 to 63.9 per 100,000 persons) and ≥65 years (222.4 to 136.1 per 100,000 persons). Non-Hispanic Black patients (53%), age ≥65 years (47%), and those with stage III-IV CRC (41%) had a lower 5-year OS from 2015 to 2019 compared to patients who were non-Hispanic White (57%), aged 50-64 (68%) and &amp;lt;50 years (70%), and with stage 0-II CRC (77%). Conclusion: Our results confirm a slight increase in CRC incidence among younger (&amp;lt;50 years) individuals over the 2009-2020 time period. Patients who were non-Hispanic Native American/Alaska Native had the highest CRC incidence rate and patients who were non-Hispanic Black had the poorest OS. Targeted preventative efforts such as CRC screening programs in addition to improved access to care/treatment may be needed to reduce the number of new cases and improve outcomes among historically underserved groups. Citation Format: Alicia C. McDonald, Seongjung Joo, Jiemin Ma, Mayur M. Amonkar, Changxia Shao, Kaushal Desai, Anne C. Deitz. Colorectal cancer incidence and overall survival by race, stage, and age: A SEER database analysis, 2009-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4871.

The association of postoperative morbidity and age on 5-year survival after colorectal surgery in the elderly population: a nationwide cohort study.

This study aimed to evaluate the association of age and postoperative morbidity on 5-year overall survival (OS) after elective surgery for colorectal cancer. Patients undergoing elective, curatively intended surgery for colorectal cancer Union for International Cancer Control Stages I-III between January 2014 and December 2019 were selected from four Danish nationwide healthcare databases. Patients were divided into four groups: group I 65-69 years old; group II 70-74 years old; group III 75-79 years old; and group IV ≥80 years old. Propensity score matching was used to reduce potential confounding bias. The primary outcome was the association of age and postoperative morbidity with 5-year OS. The secondary outcome was conditional survival, given that the patient had already survived the first 90 days after surgery. After propensity score matching with a 1:1 ratio, group II contained 2221 patients; group III 952 patients; and group IV 320 patients. There was no significant difference in 5-year OS between group I (reference) and groups II and III (P = 0.4 and P = 0.9, respectively). Patients with severe postoperative complications within 30 days after surgery had a significantly decreased OS (P < 0.01); however, when patients who died within the first 90 days were excluded from the analysis, the differences in 5-year OS were less pronounced across all age groups. Postoperative morbidity, and not patient age, was associated with a lower 5-year OS. Long-term survival for patients who experience a complication is similar to patients who did not have a complication when conditioning on 90 days of survival.

Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma.

Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in patients operated on for primary localized RPS. We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs. In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity. Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.

Gross total resection and survival outcomes in elderly patients with spinal chordoma: a SEER-based analysis.

The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups. The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality. There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762). GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.

Prognosis of Stage I Endometrial Cancer According to the FIGO 2023 Classification Taking into Account Molecular Changes.

Optimum risk stratification in an early stage of endometrial cancer (EC) combines molecular and clinicopathological features. The purpose of the study was to determine the prognostic value of molecular classification and traditional pathological factors in a sample group of patients with stage I EC according to the FIGO 2023 criteria, to achieve a more personalized approach to patient care and treatment. The immunohistochemistry for p53 and mismatch repair (MMR) proteins, and DNA sequencing for POLE exonuclease domain and clinicopathological parameters, including disease disease-free survival (DFS) and overall survival (OS) in 139 patients, were analyzed. It has been shown that the independent recurrence risk factors are stage IC (p < 0.001), aggressive histological types EC (p < 0.001), and the presence of p53abn protein immunoexpression (p = 0.009). Stage IC (p = 0.018), aggressive histological types EC (p = 0.025) and the presence of p53abn protein immunoexpression (p = 0.010) were all significantly associated with lower 5-year OS rates. Our research studies confirm that the molecular category corresponds to a different prognosis in clinical stage I EC according to the new 2023 FIGO classification, with POLEmut cases presenting the best outcomes and p53abn cases showing the worst outcomes. Beyond the previous routine clinicopathological assessment, the new EC staging system represents an important step toward improving our ability to stratify IC stage EC risk.

Radical versus Local Surgical Excision for Early Rectal Cancer: A Systematic Review and Meta-Analysis.

Radical excision (RE) for rectal cancer carries a higher risk of mortality and morbidity, while local excision (LE) could decrease these postoperative risks. However, the long-term benefit of LE is still debatable. To study the effectiveness of LE versus RE in T1 and T2 rectal cancer. A systematic review and meta-analysis was conducted using key databases like PubMed and ClinicalTrials.gov. Only cohort studies and randomized controlled trials were included. RevMan 5.4 tool was used for data analysis. Both clinical and statistical heterogeneity of the studies were assessed, and I2 >75% was considered as highly heterogeneous. The primary outcomes being measured were 5-year overall survival (OS) and 5-year disease free survival (DFS). A subgroup analysis of patients with T1-only was also conducted, without adjuvant chemo/radiotherapy. A total of 18 studies were included for final meta-analysis. Four were RCTs, while the other 15 were retrospective cohort studies. One included study had data from both RCT and non-RCT study groups. Nine studies were multicentered or national studies while nine were unicentral.There was no difference in risk ratio (RR) between OS: RR 0.95, 95% Confidence Interval (CI) [0.91, 0.99] and DFS: RR 0.93, 95% CI [0.87, 1.01]. There were lower hazards ratios in OS: RR 1.41, 95% CI [1.14, 1.74] and DFS: RR 1.95, 95% CI [1.36, 2.78] with radical, as compared to LE. Lower recurrence rate was associated with RE. Random effect model was used due to clinical heterogeneity between studies (different surgical procedures, tumor staging, adjuvant chemo or radiotherapy). LE for early-stage rectal cancer has lower 5-year OS and DFS than RE, with higher local recurrence rate. However, LE is associated with lower early postoperative mortality, morbidity and length of stay as compared to RE.

Validation of ELN 2022 Risk Classification in Patients Diagnosed with AML Undergoing Allogeneic Hematopoietic Cell Transplantation

Background: In 2022, the European LeukemiaNet (ELN) updated their guidelines (Döhner H et al., Blood 2022) for risk allocation of patients with acute myeloid leukemia (AML) based on essential genetic features at diagnosis as defined in the newest classifications (Arber D et al., Blood 2022, Khoury JD et al., Leukemia 2022). Methods: Retrospective analysis of the 147 consecutive patients diagnosed with AML and available genetic information who underwent alloHCT in a complete morphological response (CR) between 2011 and 2021 in a single institution (HCB). Data was collected retrospectively and updated in July 2023. G-banding karyotype, FISH, qualitative and quantitative PCR and targeted Next Generation Sequencing were assessed at diagnosis to classify patients according to ELN 2022 risk classification. Our primary goal was to validate the ELN 2022 risk classification in patients undergoing alloHCT analyzing overall survival (OS). Secondary objectives were analyzing leukemia-free survival (LFS), 24-month cumulative incidence of relapse (CIR) and in the different molecular subgroups within the ELN2022 risk groups. Results: The main patient, disease-related and transplant characteristics are displayed in Figure 1. Overall, the median age was 52 years (range 18-70), 53.7% of the patients males, with 88% of the patients undergoing alloHCT in CR1. Twenty-two patients could not be classified through NGS assessment between 2011 and 2016 and included in the intermediate risk category due to normal karyotype and wildtype recurrent abnormalities measured by PCR. Patients in the adverse-risk group were older (p &amp;lt;0.001) and underwent alloHCT less often with undetectable measurable residual disease (p = 0.006). Moreover, patients in the favorable or intermediate risk group underwent alloHCT more often in CR2 or CR3 (p = 0.02). In addition, alloHCT characteristics were similar for all the patients included. With a 67-month median follow-up for LFS (95CI: 55-76), the median OS and LFS in patients classified into the favorable and intermediate risk groups were not reached (5-year OS and LFS rate in favorable risk group: 81% (95CI: 73-89) and 72% (95CI: 63-81). 5-year OS and LFS rate in intermediate risk group: 62% (95CI: 56-68) and 64% (95CI: 58-70). Patients included in the adverse risk group had an OS and LFS of 23.7 months (15.3-NR, p &amp;lt;0.001 between intermediate and adverse risk. Figure 1B) and 15.2 months (5.79-NR, p=0.015) respectively, with a significant lower 5-year OS rate (40%, 95CI: 34-46), LFS rate (38%, 95CI: 32-44) and a higher CIR (18% in the favorable risk group (95%CI: 11-26) vs. 20% in the intermediate risk group (95%CI: 18-23) vs. 40% in the adverse risk group (95%CI: 38-44), p = 0.024). Based on these results, a subanalysis was conducted in the patients classified into the adverse group. Those patients diagnosed with complex karyotype, inv(3), t(3;3), del(17p) and/or TP53 mutated were reassessed into a new risk category group called: Adverse-Plus (AdvP).No different baseline characteristics between the AdvP patients and the other subgroups were found. AdvP patients presented a shorter OS (NR in the rest of subgroups vs. 8.73 months in AdvP, p &amp;lt; 0.001 for AdvP vs. adverse risk. Figure 1C), LFS (NR in the rest of subgroups vs. 5.2 months, p &amp;lt; 0.001), and a higher CIR (62.5% in the AdvP group, p &amp;lt;0.001 between adverse risk and AdvP). Interestingly, using this four-group classification including AdvP, the other risk groups presented similar OS, LFS, and CIR without statistical differences in between them Summary/Conclussion: ELN2022 risk classification discriminates properly accurate in patients undergoing alloHCT. Reclassifying AML adverse risk patients diagnosed with complex karyotype, inv(3), t(3;3), del(17p) and/or TP53 mutated in a different subgroup should be considered due to a much worse prognosis after alloHCT, although it remains mandatory in first complete response.

Prognosis Influence of Additional Chromosome Abnormalities in Newly Diagnosed Acute Promyelocytic Leukemia with t(15;17)(q22;q21)

The therapeutic advancements over the last decade have dramatically improved the prognosis and decreased the mortality of acute promyelocytic leukemia (APL). Some patients still recur repeatedly, and the poor curative effect of some patients has become a challenging issue. Survival may be impacted by additional concurrent mechanisms linked to additional chromosome abnormalities (ACA) as a potential pathogenic factor. Therefore, to confirm the role of ACA, we retrospectively analyzed the characteristics and prognostic impact of ACA in a series of newly diagnosed APL patients with t(15;17)(q22;q21). First, we assessed the characteristics of chromosomal abnormalities. Of these 268 patients, 208 (77.6%) had the t(15;17) as the only abnormality and 60 (22.4%) had the t(15;17) with ACA. Based on the number of ACA, the evaluable cohort of APL patients with t(15;17) was further divided into four groups: no ACA, one ACA, two ACA, and three or more ACA, with respective frequencies of 77.24%, 13.81%, 5.22%, and 3.73%. Trisomy 8 was the most frequently observed ACA, alone or combined with other anomalies in 23 cases (39.0%). Second, there was no significant difference presented in main clinical characteristics and response to therapy between the groups t(15;17) with alone and t(15;17) with ACA ( p＞0.05). Similarly, no significant impact was observed in clinical features and response to therapy, such as median white blood cells, platelets, hemoglobin, and the rate of hematologic complete remission between patients with trisomy 8 and patients with other ACA ( p＞0.05). Third, the influence of ACA on prognosis in APL patients with a median follow-up time of 47 months (range 1-89 months) was analyzed. There was still no significant difference in APL patients between the group t(15;17) alone and the group t(15;17) with ACA for the incidence of 5-year overall survival(OS) (90.8% vs. 86.8%, p=0.531) and 5-year disease-free survival (DFS) (89.7% vs. 85.8%, p=0.301). Interestingly, patients in APL with trisomy 8 had a poorer 5-year OS than those with other ACA (91.8% vs. 69.6%, p=0.033) and unaffected 5-year DFS (88.9% vs. 88.2%, p=0.919). The OS and DFS were similar between patients with 0 to 2 ACA and patients with 3 or more ACA ( p=0.294, p=0.283, respectively). Otherwise, no statistical difference was demonstrated for the incidence of OS ( p=0.515) and DFS (p=0.383) among the groups based on the number of ACA besides t(15;17). Finally, the old patients with age ≥60 years were shown to have lower 5-year OS compared with young patients(67.9% vs. 94.0%, p ＜0.001) and unaffected 5-year DFS (94.3% vs. 87.8%, p=0.430). The association between age and ACA on the prognosis of APL was observed. Either Cox analysis of age and ACA or combined with age and trisomy 8, it was all indicated that age ≥60 years was only an adverse prognostic factor for survival ( p＜0.001, HR = 4.627, 95% CI: 2.144-9.982; p＜0.001, HR = 4.412, 95% CI: 2.037-9.553, respectively). It should be noted that OS significantly among the following groups of patients: ＜60 years without ACA, ≥60 years without ACA,＜60 years with ACA, and ≥60 years with ACA ( p＜0.001). The 5-year OS rates were 92.9%, 97.9%, 80.6%, and 52.5%. Overall, the group≥60 years with ACA had worse OS compared to the groups ≥60 years without ACA and＜60 years without ACA ( p＜0.001, p＜0.001, respectively ). The group＜60 years with ACA had lower OS compared to the group ≥60 years without ACA ( p＜0.001). Our results suggested that trisomy 8 as the most common ACA seemed to be an adverse but not independent predictive factor in APL with t(15;17), while the ACA besides t(15;17) did not confer poor prognosis in APL. Elderly patients with ACA appeared to have worse OS.

Investigation of Age-Specific Differences in Survival and Cause of Death Among Diffuse Large B-Cell Lymphoma Patients with and without HIV in the Modern Era of Antiretroviral Therapy: A Population-Based Analysis from 2010 to 2017

Introduction Despite improved prognosis with combined antiretroviral therapy (cART) among patients with human immunodeficiency virus (PWHIV) diagnosed with diffuse large B-cell lymphoma (DLBCL), population-based studies suggest inferior survival rates compared to patients without HIV. Uncertainty remains about the persistence of this survival difference across age groups. Examining outcomes across ages may help identify higher-risk groups in the current era of cART, providing insights for designing and conducting age-specific interventions. Methods A retrospective population-based cohort was conducted using US population-based cancer registry data among patients aged 15-79 years with newly diagnosed DLBCL from 2010 to 2017, with follow-up through 2019. The 2010-2017 period reflects the availability of integrase inhibitors and the introduction of distinct lymphoma subtypes to the World Health Organization classification system in cancer registries. HIV status was reported at lymphoma diagnosis. Patients were classified into three age groups: adolescents and young adults (AYAs, 15-39 years), adults (40-59 years), and older adults (60-79 years). Overall survival (OS) was defined from diagnosis to death of any cause. Probabilities were estimated using the Kaplan-Meier method and compared with the log-rank test. Multivariable Cox regression models were fitted to assess all-cause mortality, adjusting for cancer stage, race/ethnicity, sex, year of diagnosis, and age. We estimated the cumulative incidence of infections and HIV-related deaths using the competing risk method. Results Patient characteristics: A total of 26,905 DLBCL patients were identified (1,030 PWHIV and 25,758 patients without HIV). Compared to patients without HIV, PWHIV were younger (median age at diagnosis 48 years vs. 62 years), predominantly male (85% vs. 56%), more likely to be non-Hispanic Black (38% vs. 8%) and Hispanic (24% vs. 18%), and more likely to have advanced-stage disease at diagnosis (71% vs. 56%) (Table 1). OS in DLBCL PWHIV vs. patients without HIV:Within each age group, OS was significantly lower among PWHIV with DLBCL compared to patients without HIV(Table 1 and Figure 1). With a median follow-up of 67 months, 5-year OS was particularly low among AYAs (53% vs. 87%, p&amp;lt;0.0001) and adults (48% vs. 74%, p&amp;lt;0.0001). Similarly, older adults experienced lower 5-year OS rates (45% vs. 57%, p&amp;lt;0.0001). Multivariable Cox models suggest that PWHIV has an increased risk of all-cause mortality within each age group (Figure 1). OS in different age groups by HIV status: For PWHIV, age was not a significant factor for increased all-cause mortality, with 5-year OS rates ranging from 45% in adults to 53% in AYAs (p=0.170). Conversely, in DLBCL patients without HIV, AYAs had superior 5-year OS rates (87%, p&amp;lt;0.001) compared to adults (74%) and older adults (57%). Cause of death by HIV status: Among both PWHIV and without HIV, lymphoma/leukemia-related mortality was the most common cause of death reported in death certificates (47% and 73% respectively). However, the 5-year cumulative incidence of infection mortality was higher among PWHIV (range 3-4% across age groups) compared to patients without HIV (1% across age groups). For PWHIV, other HIV-related mortality had a 5-year cumulative incidence ranging from 9% to 14% across age groups. Results stratified by cancer stage (early- or advanced-stage disease) were consistent with those presented above. Conclusion This study highlights worse outcomes among PWHIV diagnosed with DLBCL compared to patients without HIV within each age group at the population level in the modern era of cART, notably among AYAs. Unlike the findings in DLBCL patients without HIV, age was not significantly associated with mortality among PWHIV with DLBCL. Future studies should explore age-specific demographic, biological, or healthcare system factors mediating these outcome disparities. The considerable HIV-related mortality suggests refining HIV surveillance approaches among PWHIV with DLBCL in prospective studies or clinical trials. Identifying the optimal integration of chemotherapy and cART may improve outcomes in this vulnerable population.

Effect of the TERT mutation on the prognosis of patients with urothelial carcinoma: a systematic review and meta-analysis

BackgroundTelomerase reverse transcriptase (TERT) mutation represents the most prevalent genetic mutation found in urothelial carcinoma (UC) and holds potential as a prognostic indicator for tumor outcomes. However, the association between TERT mutation and prognosis in UC patients remains poorly elucidated due to conflicting findings in existing literature. Therefore, this study aimed to investigate the effect of the TERT mutation on the survival of UC patients.MethodsWe systematically searched the PubMed, Embase, and Cochrane Library databases for studies that investigated the relationship between the TERT mutation and the prognosis of UC patients. Endpoints included the 2-year and 5-year recurrence-free survival (RFS) and overall survival (OS). The Newcastle–Ottawa Scale (NOS) tool was used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis.ResultsNine studies with a total of 1,552 patients were included in the analysis. Two studies were prospective, and seven were retrospective. The TERT promoter mutation was associated with a lower 2-year OS (relative risk [RR] = 0.92, 95% confidence interval [CI] 0.86–0.98; P = 0.007) and a lower 5-year OS (RR = 0.80, 95% CI 0.68–0.94; P = 0.008) compared with the TERT wild type. However, no significantly differences were found between two groups in terms of HR for OS (hazard ratio [HR] = 1.29, 95% CI 0.80–2.08; P = 0.29). Furthermore, we investigated the differences in RFS and disease-specific survival (DSS) between the two groups.ConclusionThe TERT mutation increases the risk of death and decreases the survival time of UC patients. TERT may be a valuable marker with individual prognostic value.

Autologous Transplant (auto-HCT) Is Associated with Improved Clinical Outcomes Compared to CAR-T Therapy in Patients (pts) with Large B-Cell Lymphoma (LBCL) Achieving a Complete Remission

Introduction: CAR-T therapy is the standard of care for pts with relapsed LBCL as early as in the second line in those with early relapse or with primary refractory disease. In practice, pts who are intended to receive CAR-T, commonly require interim therapy before leukapheresis, wherein a small fraction may achieve a complete remission (CR). Having chemosensitive disease, these pts can be considered for auto-HCT. Also, there are reports indicating the efficacy of CAR-T therapy in CR pts (Strati et al., Haematologica, 2023; Wudhikarn et al., Blood Adv, 2022). We compared the outcome of pts with LBCL who received CAR-T vs. auto-HCT while in a CR. Methods: Pts aged 18-75 years with DLBCL or primary mediastinal lymphoma who received CAR-T (between 2018-2021) or auto-HCT (between 2015-2021) while in a CR by PET or CT were included in this analysis using the data from the Center for International Blood &amp; Marrow Transplant Research (CIBMTR) registry. Primary endpoints included progression-free survival (PFS) and overall survival (OS). Treatment-related mortality (TRM) and relapse rate were among the secondary endpoints. Results: We identified 360 pts with LBCL who were in a CR before receiving CAR-T (n=79, tisa-cel 53%, axi-cel 46%, and liso-cel 1%) or auto-HCT (n=281). Median follow-up was 24.7 months (range 3.3-49.4) for the CAR-T cohort and 49.7 months (range 3.0-95.4) for the auto-HCT cohort. Selected baseline characteristics are shown in Table 1. CRs were confirmed by PET scan in 90% of CAR-T pts and 99.6% of auto-CAR-T pts (p &amp;lt; 0.01). The most common lymphodepletion regimen for CAR-T was Cy/Flu (82.3%) and the most common conditioning regimen for auto-HCT was BEAM (77.6%). Thirty-seven (13.2%) of auto-HCT pts had a later CAR-T but no pts from the CAR-T cohort had subsequent auto-HCT. In univariate analysis, treatment with CAR-T was associated with a higher rate of relapse at 2 years (48% vs. 27.8%; p &amp;lt; 0.001), a lower rate of 2-year PFS (47.8% vs. 66.2%; p &amp;lt; 0.001) and lower 2-year OS (65.6% vs. 78.9%; p=0.037). There was no difference in rates of 2-year TRM (4.1% vs. 5.9%; p=0.673). Similarly, focusing on patients with early (12 months) treatment failure (CAR-T =57 and auto-HCT=163), treatment with CAR-T was associated with a higher 2-year relapse rate (45.9% vs. 22.8%; p &amp;lt;0.001) and an inferior 2-year PFS (48.3% vs.70.9%.; p &amp;lt;0.001) compared to auto-HCT (figure-2) while there was no difference in 2-year OS or TRM. In the multivariable analysis of outcomes, treatment with CAR-T was associated with higher risk of relapse (HR 2.18; p &amp;lt; 0.0001) and an inferior PFS (HR 1.83; p=0.0011) compared to auto-HCT. There was no difference in the risk of TRM (HR 0.59; p=0.36) or OS (HR 1.44; p=0.12). Conclusions: In pts with relapsed LBCL who achieve a CR, treatment with auto-HCT is associated with a lower relapse rate and an improved PFS compared to CAR-T, including in pts with early treatment failure (within 12 months). These results are in line with previously reported improved clinical outcomes with auto-HCT compared to CAR-T in pts in partial remission (Shadman et al. Blood, 2022). The data support utilization of auto-HCT in pts with relapsed LBCL achieving a CR.

Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy

Clinicians may be confronted with patients refusing recommended adjuvant therapy (AT) after the primary resection of an advanced oral squamous cell carcinoma (OSCC). However, for this tumor entity, data are lacking regarding the oncological outcomes and associated factors after refusal of AT. To evaluate the difference in survival and disease recurrence for patients with and without recommended AT after resection of advanced OSCC. In this single-center retrospective matched cohort study, patients with advanced OSCC who refused recommended AT between January 2010 and December 2021 were matched 1:1 according to Union for International Cancer Control tumor staging with patients who completed AT. Patients with advanced OSCC who refused or completed recommended AT between 2010 and 2021. The primary outcome of this study was the comparison of overall survival (OS) and recurrence-free survival (RFS) between the 2 study groups. A total of 82 patients (mean [SD] age at time of surgery, 68.0 [11.3] years; 38 [46.3%] female, 44 [53.7%] male) with and without AT (41 per study group) were included in the analysis. Patients refusing AT developed more frequent disease recurrence than patients who completed AT (61.0% vs 26.8%; difference, 34.2%; odds ratio, 4.26; 95% CI, 1.68-10.84). In addition, patients who refused AT presented with lower 2-year OS (72.7% vs 88.6%; difference, 15.9%; 95% CI, 8.6%-40.6%) and much lower 2-year RFS (39.1% vs 74.2%; difference, 35.1%; 95% CI, 0.2%-70.5%). In the patient cohort who rejected AT, a worse OS was associated with female sex (48.6% vs 90.5%; difference, 41.9%; 95% CI, 0.6%-84.4%), pT1-2 category (57.1% vs 92.3%; difference, 35.2%; 95% CI, 3.3%-73.6%), and pN1 or higher category (61.2% vs 82.6%; difference, 21.4%; 95% CI, 14.1%-56.8%). Lower RFS was associated with female sex (37.9% vs 90.9%; difference, 53.0%; 95% CI, 8.0%-97.9%), advanced T category (pT3-4, 35.3% vs 80.0%; difference, 44.7%; 95% CI, 6.4%-95.3%), lymph node yield of 20 or greater (31.4% vs 80.6%; difference, 49.2%; 95% CI, 4.9%-93.4%), and lymph node ratio of less than 4.6% (36.6% vs 84.4%; difference, 47.8%; 95% CI, 1.8%-93.1%). In this cohort study of patients with advanced OSCC, refusal of AT was associated with worse oncological outcomes. The prevalence of disease recurrence during follow-up was 34% higher in patients who refused AT than in patients who completed AT. The results from this study may assist clinicians in guiding patients who are considering refusal of or withdrawal from AT.

Predictors and survival outcomes of having less than 12 harvested lymph nodes in proctectomy for rectal cancer.

Current recommendations suggest that a minimum of 12 lymph nodes (LNs) should be harvested during curative rectal cancer resection. We aimed to assess predictors and survival outcomes of harvesting < 12 lymph nodes in rectal cancer surgery. A retrospective case-control analysis of factors associated with harvesting < 12 LNs in rectal cancer surgery was conducted. Data were derived from the National Cancer Database 2010-2019. Univariate and multivariate binary logistic regression analyses were performed to determine predictors of harvesting < 12 LNs. Association between harvesting < 12 LNs and 5-year overall survival (OS) was assessed using Cox regression and Kaplan Meier statistics. 67,529 patients (60.8% male; mean age: 61.2 ± 12.5years) were included. Median number of harvested LNs was 15 (IQR: 11-20); 27.1% of patients had < 12 harvested LNs. Independent predictors of harvesting < 12 LNs were older age (OR: 1.016;p < 0.001), neoadjuvant systemic treatment (OR: 1.522;p < 0.001), neoadjuvant radiation treatment (OR: 1.367;p < 0.001), longer duration of radiation therapy (OR: 1.003;p < 0.001) and abdominoperineal resection (OR: 1.071;p = 0.017). Higher clinical TNM stage and tumor grade, pull-through coloanal anastomosis, and minimally invasive surgery were independently associated with ≥ 12 harvested LNs. < 12 harvested LNs was independently associated with lower 5-year OS (HR: 1.24;p < 0.001) and shorter mean OS (96.7 vs 102.8months;p < 0.001) than ≥ 12 harvested LNs. Older age, open resection, and neoadjuvant therapy were independent predictors of < 12 harvested LNs. Conversely, higher clinical TNM stage and tumor grade, coloanal anastomosis, and minimally invasive surgery were predictive of ≥ 12 harvested LNs. < 12 LNs harvested was associated with lower OS.