Lower 5-year Overall Survival Research Articles

Long-term clinical and visual outcomes after surgical resection of pediatric pilocytic/pilomyxoid optic pathway gliomas.

The choice of treatment modality for optic pathway gliomas (OPGs) is controversial. Chemotherapy is widely regarded as first-line therapy; however, subtotal resections have been reported for decompression or salvage therapy as first- and second-line treatment. The goal of this study was to further investigate the role and efficacy of resection for OPGs. A retrospective chart review was performed on 83 children who underwent surgical treatment for OPGs between 1986 and 2014. Pathology was reviewed by a neuropathologist. Clinical outcomes, including progression-free survival (PFS), overall survival (OS), and complications, were analyzed. The 5- and 10-year PFS rates were 55% and 46%, respectively. The 5- and 10-year OS rates were 87% and 78%, respectively. The median extent of resection was 80% (range 30%-98%). Age less than 2 years at surgery and pilomyxoid features of the tumor were found to be associated with significantly lower 5-year OS. No difference was seen in PFS or OS of children treated with surgery as a first-line treatment compared with children with surgery as a second- or third-line treatment. Severe complications included new disabling visual deficit in 5%, focal neurological deficit in 8%, and infection in 2%. New hormone deficiency occurred in 22% of the children. Approximately half of all children experience a long-term benefit from resection both as primary treatment and as a second-line therapy after failure of primary treatment. Primary surgery does not appear to have a significant benefit for children younger than 2 years or tumors with pilomyxoid features. Given the risks associated with surgery, an interdisciplinary approach is needed to tailor the treatment plan to the individual characteristics of each child.

A novel preoperative plasma indicator to predict prognoses for patients with esophageal squamous cell carcinoma after radical esophagectomy: fibrinogen-to-lymphocyte ratio.

Purpose: The inflammatory microenvironment and hemostatic system are involved in several stages of tumor progression. The aim of this study was to assess the prognostic effect of fibrinogen-to-lymphocyte ratio (FLR) in esophageal squamous cell carcinoma (ESCC) patients who underwent radical esophagectomy.Patients and methods: We retrospectively reviewed 673 consecutive patients with ESCC who underwent radical esophagectomy from January 2009 to December 2012 at a major cancer hospital in Guangzhou, southern China. The cutoff points were defined by the X-tile software. The prognostic value of FLR for overall survival (OS), disease-free survival (DFS), and first-year mortality after surgery were analyzed using Cox proportional hazard regression model and logistic regression model. Survival was estimated by the Kaplan–Meier estimator and compared using the log-rank test.Results: The optimal cutoff point of FLR was 3.03. Compared with the FLR-low (≤3.03) group, the FLR-high (>3.03) group included older patients (χ2=7.267, P=0.007), showed higher postoperative overall morbidity (24.7% vs 14.8%, χ2=5.414, P=0.020) and tended to die within one year (23.5% vs 10.9%, χ2=10.871, P=0.001). The FLR-high group showed significant lower 5-year OS rates (41.2% vs 53.7%, log-rank=6.827, P=0.009) and 5-year DFS rates (35.3% vs 48.0%, log-rank=5.954, P=0.015) than the FLR-low group. Multivariate analyses suggested that high FLR was an independent negative predictor of OS (HR: 1.448, 95%CI: 1.073–1.952, P=0.015), DFS (HR: 1.445, 95%CI: 1.084–1.925, P=0.012) and first-year mortality (HR: 2.123, 95%CI: 1.157–3.898, P=0.015).Conclusion: The preoperative FLR level could be used as a simple, noninvasive, inexpensive, and potentially effective indicator to evaluate the prognosis of ESCC patients following radical esophagectomy.

Prospective validation of an institutional treatment strategy for T1N0M0 glottic carcinoma

IntroductionThe aim of this study was to assess the validity of a treatment strategy for T1N0 glottic squamous cell carcinoma. MethodsOne hundred and seventeen patients were prospectively treated according to institutional guidelines. using 1) laser microsurgery (L) for exophytic tumor, limited to one vocal cord, without extension to the anterior commissure or the vocal process of the arytenoid cartilage, 2) radiotherapy (RT) for large or infiltrative tumor reaching the anterior commissure or the vocal process of the arytenoid cartilage, poor endoscopic exposure and cT1b or 3) partial laryngectomy (PL) for tumor infiltrating the anterior commissure. Ninety-five patients were treated with RT and 22 with surgery alone (S) [L:19; PL:3]. ResultsThe 5-year overall survival (OS) and disease-specific survival (DSS) were 81.5% and 97.1% (median follow-up: 73 months), respectively. There was no statistically significant difference in OS or DSS between patients treated with RT or S (logrank test: p = 0.974 and 0.978). The 5-year ultimate local control rate reached 98.3%. The local control rate with larynx preservation was 94.9% with no difference between RT (94.7%) and S (95.5%) (χ2: p = 0.891). Continued smoking after RT was significantly associated with a lower 5-year OS (77.9% versus 87%), [HR 3.458; p = 0.043 (95%CI 1.010–11.837)]. ConclusionsFor patients with T1 glottic carcinoma, and based on our previous studies, these data prospectively confirm the oncologic validity of an institutional treatment strategy. Continued smoking after RT correlated with poor OS.

Expression and clinical significance of FOS-like antigen 1 in gastric adenocarcinoma

BackgroundThe overexpression of FOS-like antigen 1 (FOSL1) in several types of cancers was reported before. However, the expression and clinical significance of FOSL1 in gastric cancer (GC) have not been elucidated. Materials and methodsThe expression of FOSL1 in 105 cases of GCs was detected with immunohistochemistry, and the mRNA of FOSL1 was investigated with quantitative real-time polymerase chain reaction(qRT-PCR) in 15 pairs of GCs and tumor adjacent tissues. With Chi-square test or Fisher test, we analyzed the correlation between FOSL1 expression and clinicopathological factors. With univariate analysis, we evaluated the correlations between clinicopathological factors including FOSL1 and overall survival (OS) rates. With multivariate analysis, we identified the independent prognostic risk factors of GC. ResultsThe percentages of patients with low and high FOSL1 expression in our study accounted for 43.81% and 56.19%, respectively. The mRNA levels of FOSL1 in GCs were significantly higher than those in tumor adjacent tissues. FOSL1 expression was demonstrated to be significantly correlated with lymphatic invasion (P = 0.036) and TNM stage (P = 0.016). High expression of FOSL1 was significantly correlated with lower 5-year OS (P = 0.002), and FOSL1 expression was identified as an independent prognostic biomarker of GC (P = 0.001). ConclusionsFOSL1 is an independent prognostic biomarker of GC. Detecting FOSL1 expression could help stratify GC patients with high-risk and guide the precious treatment.

Colorectal liver metastases and concomitant extrahepatic disease: is resection justified? Single center survival analysis on 84 patients

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.

Decreased Overall Survival of Transanal vs. Transabdominal Resection of Early Rectal Cancer in Treatment Naïve Patients: A National Cancer Data Base Study

Previous data from the National Cancer Database (NCBD) showed increasing rates of transanal local excision for early rectal cancer despite a lack of evidence supporting its oncologic adequacy. The aim of this study is to update national trends, compare overall survival, and determine factors associated with survival in patients with stage I rectal cancer. Survival of 15, 149 patients with stage I rectal adenocarcinoma were examined retrospectively from 2004-2012. The rate of local excision over this time period was sustained at 22% (20.88 - 24.9%; p = 0.077). Five-year overall survival (OS) after transanal local excision was less than transabdominal standard resection (76.6% vs. 80.7%; p 4 cm, low volume centers, uninsured patients and increasing comorbidities. This is the first study of national data showing sustained use of transanal local excision over the past decade. Local excision has a lower 5-year OS compared to transabdominal standard resection. Transanal excision of early rectal cancer should be offered to select patients only after careful consideration of risk factors balanced against the decrease in overall survival.

Colorectal liver metastases and concomitant extrahepatic disease: is resection justified? Single center survival analysis on 84 patients

Background: Limited extrahepatic disease (EHD) in patients with colorectal liver metastases (CRLM) is no longer considered an absolute contraindication to resection. However the impact of the different sites of EHD on survival remains to be defined. Methods: Between 2000 and 2015, 702 patients underwent liver resection for CRLM at our Unit. Of these, 84 patients (11.8%) underwent resection of concomitant EHD and they are the object of our study. Results: Site of EHD was: lung in 27 patients (32.1%), hepatic pedicle lymph nodes (LN) in 38 (44.1%), peritoneum in 18 (19.0%), distant LN (inguinal and aortocaval sites) in 4 (4.8%). Sixty patients (71.4%) underwent preoperative chemotherapy (CT): 5-year overall survival (OS) after resection of CRLM and concomitant EHD was significantly higher in patients with response to CT than that in patients resected with progression (32.4% vs. 14.6%, respectively, p=0.01). Five-year OS of patients resected for liver-only CRLM was not significantly different from that of patients resected for CRLM and concomitant lung metastases (55.3% vs. 39.5%, respectively, p=ns). Resection of concomitant hepatic pedicle LN metastases was associated with a significantly lower 5-year OS (15.0%, p<0.001). Conclusion: In selected patients resection of concomitant lung metastases can be associated with similar OS to that of patients resected for liver-only disease. Presence of hepatic pedicle LN metastases is a poor prognostic factor and resection should be considered in patients showing response to CT.

Evaluation of Elderly Patients with Hematological Malignancies By Two Different Geriatric Risk Scoring Systems: G8 and Flemish Version of the Triage Risk Screening Tool (fTRST)

Background: High burden of patients with hematological malignancies are diagnosed >65 years old. Since then, geriatric interventions can improve quality of life, compliance to therapy and overall survival. Geriatric screening is the best tool to access patients' prognosis. In this study, our aim is to identify our geriatric patients with different geriatric scoring systems to evaluate their prognostic value for overall survival (OS).Patients and Methods: We included 127 patients (age>65 years) with hematological malignancies and assessed two geriatric screening tools, G8 and Flemish version of the Triage Risk Screening Tool (fTRST) during a hospital visit at diagnosis or follow-up. G8 is considered normal if the score is >14, high risk patients in fTRST are defined as patients scored ≥ 2. OS was described using Kaplan-Meier plots, and comparisons were made using log-rank and Wilcoxon rank sum tests.Results: From 127 patients, 50 patients (39%) were newly diagnosed. The patient characteristics were defined in table. Patients under follow-up received median of 2 lines of treatment (range, 1-5); 11 patients (14%) treated with radiotherapy, 15 patients (19%) underwent autologous stem cell transplantation. Abnormal G8 score was detected in 120 patients (94%). High fTRST score was present in 72 patients (57%). Both abnormal G8 score and high fTRST score were detected more likely in follow-up patients (65% vs 40%, p=0.005).There was no statistical difference in 5-year OS in terms of abnormal G8 score or high fTRST score alone. In patients with both abnormal G8 and high fTRST scores had statistically significant lower 5-year OS compared to normal G8 and/or low fTRST scores (57% vs 85%, p=0.048) (figure).Conclusion: In investigation of two screening tools-G8 and fTRST, statistically significant survival advantage was shown if both scores were normal. DisclosuresCivriz Bozdag:MSD: Research Funding; NOVARTIS: Consultancy; TAKEDA: Consultancy. Özcan:Jazz: Other: Travel support; Roche: Honoraria, Research Funding; Takeda: Honoraria, Other: Travel payment, Research Funding; Janssen: Other: Travel Support, Research Funding; Celgene: Other: Travel support, Research Funding; Novartis: Research Funding; MSD: Research Funding; Abbvie: Other: Travel payment; BMS: Honoraria; Bayer: Research Funding; Jazz: Other; MSD: Other: travel support, Research Funding; Archigen: Research Funding. Ilhan:BMS: Speakers Bureau; Alexion: Speakers Bureau; Celgene: Speakers Bureau; Roche: Speakers Bureau.

Incidence, Characteristics and Outcomes of Patients with Cancer-Associated Venous Thromboembolism: A Retrospective Matched-Pair Analysis

IntroductionCancer and its treatments are well-recognized risk factors for the development of venous thromboembolism (VTE). The occurrence of VTE has been associated with an increased mortality in patients with cancer. Here we retrospectively reviewed the incidence and characteristics of cancer-associated thrombosis (CAT) in a large cohort of cancer patients treated at our institution as well as compared treatment outcomes of this group of patients with a 1:1 matched pair group of cancer patients without CAT.MethodsData of consecutive patients, 18 years of age or older, with a newly diagnosis of both hematologic malignancies or solid tumors who diagnosed and treated either as an inpatient or outpatient setting at our institution between 2011 to 2015 were included in this analysis. Patients who received anticoagulants for the purpose of either prophylaxis or treatment within 2 weeks before cancer diagnosis and who did not have a histologically confirmed a cancer diagnosis or complete follow up data were excluded from the study.To compare the outcomes of cancer patients with and without CAT, cancer patients who did not experience CAT were randomly selected from the same database and were matched individually (1:1) to cancer patients with CAT based on age, sex, cancer type and stage (limited or advanced) to form a matched cohort of patients as control.Primary outcome was cumulative incidence of CAT at 6 months and 1 year after cancer diagnosis, while incidence of recurrent VTE, major and minor bleeding, relapse, non-relapse mortality (NRM), overall survival (OS) and progression-free survival (PFS) were analyzed as secondary outcomes.CAT was defined as at least 1 site of venous thrombosis confirmed by imaging results, which occurred anytime after the initial diagnosis, during the treatment or follow-up.ResultsTotal 2,291 newly diagnosed cancer patients (633 patients with hematologic malignancies and 1,658 patients with solid cancers) with a median age of 58 years (range 18-93 years) were included in the analysis.CAT was developed in 83 patients (52 females and 31 males) with a median age of 61 year (range 20-85 years). The cumulative incidence of CAT at 6 months and 1 year was 2.7% and 3.4%, respectively. The median time from cancer diagnosis to the diagnosis of CAT was 3.2 months (range 1- 62 months).Sites of VTE were deep vein thrombosis in extremities (N=46; 55.4%), pulmonary embolism (N=6; 7.2%), splanchnic vein thrombosis (N=9; 10.8%) and cerebral venous sinus thrombosis (N=5, 6%). Seventeen patients (20%) developed more than 1 site of VTE. Sixty-nine (83%) cases with CAT were diagnosed in patients with hematologic malignancies including 35, 22 and 12 cases with lymphoma, acute leukemia and myeloproliferative neoplasms, respectively. Overall the incidence was 10.9% in hematologic malignancies and 0.8% in solid tumors. The majority of the CAT cases occurred in advanced stage cancers (66 patients; 79.5%) while 13 cases (15.7%) were diagnosed during ambulatory chemotherapy treatment. None of the patients with CAT received prophylaxis anticoagulant during cancer treatment or follow up period. Characteristics of patients with CAT are summarized in Table 1.Of 83 patients with CAT, 66 patients were treated with anticoagulants, while inferior vena cava filter was used in 8 patients (9.6%). The cumulative incidence of total bleeding events at 1 year was 21.1% whereas cumulative incidence of major bleeding was 6.8%. The cumulative incidence of recurrent thrombosis at 1 year was 8.3%.Cancer patients who developed CAT had both a significantly higher NRM (26.2% vs. 13% at 1 year, p=0.004) (Figure 1A) and relapse rate (63.3% vs. 43.5% at 5 years, p=0.002) (Figure 1B) when compared with control group, which resulted in a significantly lower 5-year OS (24.9% vs. 62.7%; p<0.0001) (Figure 1C) and PFS (16.9% vs. 46%; p<0.0001) (Figure 1D).Advanced stage cancer and development of CAT were associated with poor OS in a multivariable analysis with HR of 6.9 (95%CI 2.7-17.7) and 3.9 (95%CI 2.2-7.0), respectively. Both factors also independently predicted risk of relapse with HR of 4.6 (95%CI 1.8-11.6, p=0.001) and 3.4 (95%CI 1.7-6.8, p<0.0001), respectively.ConclusionsDevelopment of CAT is associated with an increased NRM, relapse rate and poor survival in patients with cancer. Effective strategies to prevent CAT especially in high-risk cancer patients are needed to help improve outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A US Registry-Based Assessment of Use and Impact of Chemotherapy in Stage I HER2-Positive Breast Cancer.

Background: Despite the paucity of evidence supporting chemotherapy in the treatment of node-negative, HER2-positive breast cancer measuring <2 cm, use of trastuzumab-based chemotherapy has increased over the past decade. Therefore, we used the National Cancer Database to evaluate the use and impact of chemotherapy on survival in this population. Methods: We identified female patients aged 18 to 70 years with node-negative, HER2-positive breast cancer measuring <2 cm. A propensity-matched cohort model was used to control for risk factors known to influence survival. Primary end points assessed were receipt of chemotherapy and overall survival (OS). Results: In our propensity-matched cohort model (n=8,222), adjuvant chemotherapy (ACT) was associated with a lower 5-year OS rate in T1mi breast cancer (n=626; 89.1% [95% CI, 81.8%-93.5%] vs 99.1% [96.6%-99.8%]), no significant effect in T1a disease (n=2,901; 95.4% [93.2%-96.9%] vs 96.9% [94.1%-98.3%]), and improved 5-year OS in T1b (n=2,340; 97.1% [95.1%-98.4%] vs 92.3% [88.5%-94.9%]) and T1c tumors (n=2,355; 95.9% [93.5%-97.5%] vs 91.5% [88.4%-93.9%]). In the entire cohort of 21,148 patients who met the inclusion criteria, ACT was associated with lower 5-year OS in T1mi (89.6% [83.7%-93.4%] vs 98.1% [96.6%-98.9%]) and T1a tumors (94.9% [92.9%-96.3%] vs 96.5% [94.6%-97.7%]), and improved 5-year OS in T1b (96.8% [95.6%-97.7%] vs 92.3% [88.7%-94.8%]) and T1c tumors (95.8% [94.9%-96.5%] vs 91.6% [88.5%-93.9%]). Increased use of ACT was observed over the study period. From 2010 to 2013, annual treatment rates were 71.5%, 72.4%, 73.3%, and 74.4%, respectively (trend test, P<.0001). Conclusions: Our data support the use of ACT for HER2-positive, node-negative T1b and T1c breast cancer, whereas no benefit was observed for ACT in T1mi and T1a HER2-positive, node-negative breast cancer. Although use of ACT is increasing in node-negative, HER2-positive breast cancer <2 cm, our findings caution against its use in the smallest of these tumors (T1mi and T1a) due to lack of survival benefit.

The influence of marital status on the survival of patients with operable gastrointestinal stromal tumor: A SEER-based study.

Marital status has been demonstrated as a predictive factor for prognosis in diverse malignancies, but its role in the survival of gastrointestinal stromal tumor (GIST) remains unclear. This study was aimed to investigate the impact of marital status on the overall survival (OS) and cancer-specific survival (CSS) of operable GIST cases, by using data from Surveillance, Epidemiology, and End Results (SEER) database. In total, 6582 GIST patients between 1973 and 2013 were identified from SEER database. Univariate and multivariate analyses demonstrated the marital status as an independent predictive factor for survival. Married group had better 5-year OS and CSS than unmarried group (OS: 79.2% vs 71.3%, P<.001; CSS: 88.9% vs 84.8%, P<.001). And compared to married, divorced/separated, and single group, widowed group had the lowest 5-year OS and CSS (61.3% and 82.2%). Further subgroup analyses validated the relationship between marital status and survival among all SEER stages and different age groups. And additional sensitivity analyses according to other clinicopathological features confirmed that married cases had higher survival rate than unmarried cases. In conclusion, marriage could be a protective prognostic factor for survival, and widowed patients had a higher risk of death.

Cancerous esophageal stenosis before treatment was significantly correlated to poor prognosis of patients with esophageal cancer: a meta-analysis

Cancerous esophageal stenosis encountered during endoscopic ultrasonography before treatment was observed in about 30% of esophageal cancer patients. Since the pT stage in TNM classification measures only the depth of infiltration but not the growth to esophagus, it is interesting to know whether tumor growth into the esophagus (and eventual stenosis) is of added value in prognostic assessment. However, the impact of esophageal stenosis on survival of esophageal cancer patient remains unclear. Therefore, we conducted a meta-analysis focusing on current topic for the first time. A systematic literature search in PubMed and EMBASE was conducted to identify relevant studies up to 14 March 2018. Data of 5-year overall survival (OS) was extracted and analysed. A total of five cohort studies consisting of 1,282 patients (278 patients with cancerous esophageal stenosis before treatment and 1,004 patients without) with esophageal cancer treated with surgery, chemoradiotherapy, or palliative therapy were included for analysis. Meta-analysis showed that patients with esophageal stenosis had significantly lower 5-year OS [22.3% and 33.0%, respectively; risk ratio (RR) =1.21; 95% CI, 1.11-1.32; P<0.001; I2=27.1%] than those without. No heterogeneity or publication bias was observed during analysis. Patients with cancerous esophageal stenosis identified by endoscopy before treatment had significantly poorer survival than those without. High-quality studies with appropriate adjustments for confounding factor are needed to confirm the findings.

CD133 expression correlates with clinicopathologic features and poor prognosis of colorectal cancer patients: An updated meta-analysis of 37 studies.

Background:CD133 has been identified as a putative cancer stem cell marker in colorectal cancer (CRC). However, the clinicopathological and prognostic significance of CD133 in CRC patients remains controversial. Thus, we conducted a meta-analysis to quantitatively evaluate the above issues.Methods:We collected a comprehensive literature search from PubMed, Web of Science, and Embase database up to September 20, 2016 examining CD133 and clinical features of colorectal cancer patients. We used the odds ratio (OR) with 95% confidence interval (CI) to estimate the effects by overall and stratified analysis.Results:The overall result of our meta-analysis indicated that CD133 expression was positively correlated with T category, distant metastasis, lymphatic invasion, and vascular invasion. Moreover, patients with higher CD133 expression had a poorer overall survival (OS) (HR=2.01, P < .001) and a lower 5-year OS rate (OR = 3.26, P < .001) than those with lower expression. Disease-free survival (DFS) and 5-year DFS rate were similar with the above results. Though the correlation between CD133 expression with the clinical characteristic was not positive in some ways when we analyzed the different subgroup. The prognostic value of CD133 expression for 5-year OS rate of CRC patients was noticeable in spite of different patients’ region, multiple antibodies used in studies, various cut-off values of CD133 expression, and adjuvant therapy situation of patients.Conclusion:CD133 is a useful predictive or prognostic biomarker for CRC in clinical assessment and may serve as a potential therapeutic target for CRC.

Predictive value of dynamic change of haemoglobin levels during therapy on treatment outcomes in patients with Enneking stage IIB extremity osteosarcoma

BackgroundWe aimed to investigate the roles of hemoglobin (Hb) concentrations and dynamic change during treatment on outcomes of patients with extremity osteosarcoma.MethodsWe retrospectively analysed 133 patients with Enneking stage IIB extremity osteosarcoma who underwent standard treatments, including univariate and multivariate analyses of patient charateritics, Hb concentrations and changes during pretreatment, neoadjuvant, adjuvant chemotherapy, and decreased Hb levels (ΔHb) to assess their prognostic value in 5-year overall survival (OS) and lung metastasis-free survival (LMFS).ResultsFive-year OS or LMFS were similar between patients who were anaemic and non-anaemic during pretreatment, neoadjuvant or adjuvant chemotherapy. Patients with continuously decreasing Hb had lower 5-year OS (52.3%) than those without continuous Hb decrease (68.5%, P = 0.04). Patients with ΔHb > 7.6 g/L had lower 5-year OS (57.5%) than those with ΔHb ≤7.6 g/L (75.8%, P = 0.04). However, continuous Hb decrease had no prognostic effect on 5-year LMFS. Subgroup analyses showed that patients who were anaemic during pretreatment, neoadjuvant, or adjuvant chemotherapy with ΔHb ≤7.6 g/L had better outcomes than those with ΔHb > 7.6 g/L (P < 0.05, for both).ConclusionDynamic Hb decrease and ΔHb > 7.6 predicted poor5-year OS in patients with Enneking stage IIB extremity osteosarcoma. Attempts to correct anaemia and their effects on outcomes for osteosarcoma patients should be investigated in future trials.

MP87-06 SARCOPENIA RATHER THAN OBESITY MAY BE ASSOCIATED WITH SURVIVAL AMONG PATIENTS WITH METASTATIC OR CASTRATE RESISTANT PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) IV1 Apr 2018MP87-06 SARCOPENIA RATHER THAN OBESITY MAY BE ASSOCIATED WITH SURVIVAL AMONG PATIENTS WITH METASTATIC OR CASTRATE RESISTANT PROSTATE CANCER Svetlana Avulova, Blair T. Stocks, Zachary Glaser, David F. Penson, and Kelvin A. Moses Svetlana AvulovaSvetlana Avulova More articles by this author , Blair T. StocksBlair T. Stocks More articles by this author , Zachary GlaserZachary Glaser More articles by this author , David F. PensonDavid F. Penson More articles by this author , and Kelvin A. MosesKelvin A. Moses More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2906AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The obesity paradox and its impact on cancer related mortality has been previously observed. In diagnosis of prostate cancer, higher BMI is associated with greater risk of having non-organ confined disease but in men with metastatic disease with better overall survival. We hypothesize that sarcopenia (muscle mass <550mm2/m2) rather than obesity (BMI>30kg/m2) is associated with overall survival in men with metastatic or castrate resistant prostate cancer (mPCa/CRPC). METHODS All patients with mPCa/CRPC who had a CT abdomen and pelvis scan near presentation to the Vanderbilt Comprehensive Prostate Cancer Clinic were eligible. Demographic and pathologic information were extracted from the electronic record under IRB-protocol. Muscle mass was estimated by measuring the cross sectional area of the psoas muscle at L3 vertebrae and normalized to patient height. Overall survival (OS) was estimated using the Kaplan-Meier method and survival estimates compared with log-rank test. Multivariate analyses using Cox proportional hazard models were also performed. RESULTS Complete clinicopathological data was available for 170 patients. On univariate analyses, obesity, sarcopenia, PSA at presentation and age were significantly associated with overall survival. Obesity was associated with a higher 3-year OS than non-obese men (86% vs.74%, p=0.01530) and sarcopenia was associated with a lower 3-year OS (69% vs. 83%, p 0.0005). In multivariate analysis, sarcopenia approached statistical significance, HR of 2.13 (CI 0.98-4.61, p=0.057) whereas obesity was no longer associated with OS (HR 0.56, CI 0.20-1.46, p=0.271). CONCLUSIONS We demonstrate that sarcopenia may be associated with worse overall survival in patients with mPCa/CRPC and although obesity appears to be protective, this relationship is not evident among patients with sarcopenia. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1189 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Svetlana Avulova More articles by this author Blair T. Stocks More articles by this author Zachary Glaser More articles by this author David F. Penson More articles by this author Kelvin A. Moses More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The impact of the neutrophil:lymphocyte ratio in response and survival of patients with de novo diffuse large B-cell lymphoma

The neutrophil:lymphocyte ratio (NLR) has emerged as prognostic in patients with hematological malignancies. We aimed at evaluating the NLR as predictive for complete response (CR) and prognostic for progression-free (PFS) and overall survival (OS) in a study cohort of 121 Peruvian patients with diffuse large B-cell lymphoma (DLCBL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). Patients with an NLR ≥6 (n = 28) were more likely to have a performance status ECOG ≥2 (74% vs. 23%; p < 0.001). NLR ≥6 was associated with lower CR rate to R-CHOP (46% vs. 74%; p = 0.02) and there was a trend towards significance in multivariate regression analyses (OR 0.36, 95% CI 0.11–1.00; p = 0.05). Patients with NLR ≥6 had lower 5-year PFS rate (39% vs. 72%; p < 0.001) and lower 5-year OS rate (46% vs. 75%; p = 0.001) than patients with NLR <6 and was an independent adverse factor for PFS (HR 2.43, 95% CI 1.21–4.87; p = 0.01) and OS (HR 2.68, 95% CI 1.31–5.47; p = 0.007) in multivariate Cox regression analyses. NLR ≥6 was prognostic of PFS and OS after adjusting for the International Prognostic Index and the NCCN-IPI scores. In conclusion, the NLR could add predictive and prognostic value to well established prognostic tools in DLBCL.

Prognostic value of preoperative lymphocyte-monocyte ratio in patients with ovarian clear cell carcinoma.

Objective: The aim of the present study was to determine the prognostic significances of markers of preoperative systemic inflammatory response (SIR) in patients with ovarian clear cell carcinoma (OCCC).Methods: A total of 109 patients diagnosed with OCCC that underwent primary cytoreductive surgery and adjuvant platinum-based chemotherapy from 2009 to 2012 were enrolled in this retrospective study. SIR markers were calculated from complete blood cell counts determined before surgery. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). Prognostic significances with respect to overall survival (OS) and progression-free survival (PFS) were determined by Kaplan-Meier curve and multivariate Cox regression analysis.Results: The optimized NLR, LMR and PLR cut-off values as determined by ROC curve analysis for PFS and OS were 2.3, 4.2, and 123.6, respectively. When the cohort was divided using these optimized cut-offs, NLR and LMR were found to be significantly associated with clinicopathologic factors, NLR with FIGO stage, the presence of malignant ascites, and platinum response, and LMR with FIGO stage, lymph node metastasis, malignant ascites, and platinum response. Kaplan-Meier analysis revealed a high NLR (> 2.3) was significantly associated with low 5-year PFS and OS rates and that a high LMR was significantly associated with high 5-year PFS and OS rates. Multivariate analysis identified FIGO stage, residual mass, and platinum response as independent prognostic factors of PFS, and FIGO stage, residual mass, platinum response, and LMR as independent prognostic factors of OS.Conclusions: Markers of systemic inflammatory response provide useful prognostic information and lymphocyte-to-monocyte ratio is the most reliable independent prognostic factor of overall survival in patients with ovarian clear cell carcinoma.

Presentation, Treatment, and Long-Term Outcome of Intrasellar Chordoma: A Pooled Analysis of Institutional, SEER (Surveillance Epidemiology and End Results), and Published Data.

Chordoma that occurs primarily in the sella turcica is rare and presents unique treatment challenges. The purpose of this study was to determine common features, treatment approaches, and survival characteristics of intrasellar chordoma. Institutional databases, the SEER (Surveillance Epidemiology and End Results) database, and PubMed/EMBASE were queried for chordoma with a primarily intrasellar component. The SEER database was also queried for adult skull base chordoma. Patient-level data were extracted where available. Kaplan-Meier survival analyses were conducted. Among 80 cases, the mean age at presentation was 55.6 (standard deviation, 15.9), with a female predominance (1.16:1.00). Patients experienced symptoms for a mean duration of 19.0 months, including cranial nerve deficits, hypopituitarism, and hyperprolactinemia. Among patients receiving treatment, 77.5% underwent surgery. In addition, less than half of the patients (n= 34, 47.3%) received adjuvant radiation therapy. The 5-year overall survival (OS) of intrasellar chordoma was 60.0% (standard error [SE], 6.9). Patients aged 40 years and younger had a 5-year OS of 80.8% (SE, 12.2), compared with patients older than 40 years, who had an OS of 55.4% (SE, 7.7) (Mantel-Cox, P= 0.044). Males experienced a lower 5-year OS (44.0; SE, 9.7) than did females (76.8; SE, 8.5), (Mantel-Cox, P= 0.003). Median OS was greater in patients with skull base chordoma than in patients with intrasellar chordoma (Mantel-Cox, P= 0.046). Intrasellar chordoma presents frequently with visual disturbances and hyperprolactinemia and has a slightly higher incidence in females. Young age predicts a better prognosis. Intrasellar chordoma has a lower overall survival than has skull base chordoma.

Utility of chemoradioselection for the optimization of treatment intensity in advanced hypopharyngeal and laryngeal carcinoma.

Definitive concomitant chemoradiotherapy (CRT) with high-dose cis-platinum (CDDP) is a current standard protocol for advanced laryngeal and hypopharyngeal cancer sparing surgery for salvage. However, this modality is associated with limited feasibility and frequent sever toxicities. In the present study, a ‘chemoradioselection’ protocol with minimal toxicity was developed using initial response to CRT as a biomarker for patient selection. Between 2000, March and 2012, September 123 patients with stage III (44), IV (79) laryngeal (64) and hypopharyngeal carcinoma (59) excluding T4 cases were enrolled to this protocol. Two cycles of split (15 mg/m2 ×5 days, 2000–2008) or bolus (80 mg/m2, 2009-present) CDDP was concurrently administered. Tumor responses were evaluated after 40 Gy of CRT and 64 responders (chemoradioselected, CRS) received further CRT up to 70 Gy, while radical surgery was recommended for the 59 non-responders (N-CRS), and 34 underwent surgery (N-CRS-ope). The remaining 25 patients who refused surgery (N-CRS-refu) were treated with continuous CRT. The 5-year overall survival (OS) and disease-specific survival (DSS) were 67, and 77%, respectively. The CRS demonstrated favorable 5-year OS (73%) and laryngo-esophageal dysfunction-free survival (LEDFS, 69%) rates. In contrast, the N-CRS-refu showed significantly lower 5-year OS (47%) compared with CRS (73%) and N-CRS-ope (70%) (P=0.0193), and significantly lower 5-year LEDFS (20%) compared with the CRS (69%) (P<0.0001). On multivariate analyses, including T, N, primary site and planned treatment (CRS + N-CRS-ope) or not (N-CRS-refu), unplanned treatment alone showed a significant correlation with poor OS [hazard ratio (HR), 2.584; 95% confidence interval (CI), 1.313–4.354; P=0.007). Chemoradioselection reflects the biological aggressiveness of each tumor, and is able to segregate patients for functional laryngeal preservation with moderate intensity CRT (150–160 mg/m2 of CDDP) from those who would be better treated with surgery. This strategy may be useful for the optimization of the therapeutic intensity.

Tissue and plasma levels of galectins in patients with high grade serous ovarian carcinoma as new predictive biomarkers

Galectins are moving closer to center stage in detecting glycosylation aberration in cancer cells. Here, we have investigated the expression of galectins in ovarian cancer (OC) and examined their potential as biomarkers in tissues and blood plasma samples of high grade serous ovarian carcinoma (HGSC) patients. In tissues, we found that increased protein expression of stromal gal-1 and epithelial gal-8/9 was associated with a poor response to treatment of HGSC patients. Gal-8/9 were both independent predictors of chemoresistance and overall survival (OS), respectively. This galectin signature increased the predictive value of the cancer antigen 125 (CA125) on 5-year disease-free survival (DFS), post-chemotherapy treatment and 5-year OS. In CA125LOW patients, epithelial gal-9 was associated with a lower 5-year OS while stromal gal-1 and epithelial gal-8 were both associated with a lower 5-year DFS. Such negative predictive value of gal-8 and gal-9 was also found using plasma samples. In both cases, high plasma levels of gal-8 and gal-9 was associated with a lower OS and DFS. Overall, these data suggest that galectins may be promising biomarkers to identify subgroups of HGSC patients with poorer prognosis. Our study also contributes to better define the heterogeneity of the disease.