Median Actual Survival Research Articles

Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival.

Simple SummaryIncreased options for cancer treatment have made the prediction of prognosis an important factor in therapeutic decision making. The aim of this study was to assess the clinical significance of prognosis–scoring systems and to identify predictors for 6–month mortality after palliative surgery. The median actual survival period was longer than the predicted life expectancy based on the revised Tokuhashi score and new Katagiri score. However, 21.3% of patients died of cancers within 6 months after palliative surgery. A statistical analysis showed that a higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for poor survival. Our findings suggest the need for careful consideration to determine if palliative surgery is the best option for a patient with these negative prognostic factors, regardless of life expectancy predicted based on a prognosis score.Prediction of prognosis is a key factor in therapeutic decision making due to recent the development of therapeutic options for spinal metastases. The aim of the study was to examine predictive scoring systems and identify prognostic factors for 6–month mortality after palliative surgery. The participants were 75 patients with spinal metastases who underwent palliative surgery and had a minimum follow–up period of 1 year. Associations of actual survival with categories based on the revised Tokuhashi score and new Katagiri score were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors for 6–month mortality after palliative surgery. The median actual survival period was longer than those predicted using the scoring systems. However, 21.3% of patients died of cancers within 6 months after surgery. A higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for 6–month mortality. There was no association of mortality with primary site, severity of sarcopenia, or other biomarkers. These results suggest that careful consideration is needed to determine whether palliative surgery is the best option for patients with a high preoperative CRP/albumin ratio and/or absence of postoperative adjuvant therapy, regardless of predictions made from scoring systems.

Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer

Accuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPNI preoperatively in resectable PDAC of the pancreatic head. Retrospective study design was approved by institutional review board. Preoperative CT-series of 46 patients with resectable PDAC were evaluated by two independent observers. Plexus Pancreaticus Capitalis-II (PPC-II) was assessed as this area is more susceptible for EPNI. All patients underwent surgery with dedicated histopathology, which served as the reference standard. Histologically EPNI was confirmed in 63.1%. Sensitivity of MDCT was 93.1% (95% confidence interval (CI) 77.23% to 99.15%), specificity 64.7% (95% CI 38.33% to 85.79%) with area under the curve (AUC) 0.789 for the first observer. Positive predictive value (PPV) was 81.82% (95% CI 70.12% to 89.62%), negative predictive value (NPV—84.62% (95% CI 57.98% to 95.64%) with diagnostic accuracy of 82.61% (95% CI 68.58% to 92.18%). Interobserver agreement showed k-value of 0.893 ({p} < 0.001), which represents very good agreement between observers. Median actual survival in patients without EPNI was 30 months (95% CI 18.284–41.716), in patients with EPNI—13 months (95% CI 12.115–13.885). CT provides sufficient diagnostic information to detect PPC-II invasion in patients with resectable PDAC of the pancreatic head. Preoperative detection of EPNI might be an additional argument to perform neoadjuvant chemotherapy in patients with resectable PDAC. It should be included in preoperative evaluation form of CT-findings.

Validation of the prognosis in palliative care study predictor models in terminal cancer patients.

BackgroundPrognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice.MethodsThis study included 202 advanced cancer patients who were admitted to the cancer hospital's palliative care ward from November 2011 to February 2013. On admission, physicians recorded the PiPS-A, PiPS-B, and doctor's survival estimates in inpatients.ResultsThe median survival across PiPS-A categories was 9, 28, and 33 days, and the median survival across PiPS-B was 9.5, 27, and 43 days. The median actual survival was 25 days; overall accuracy between the PiPS-A, PiPS-B, doctor's estimates of survival, and actual survival was 52.0%, 49.5%, and 46.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'days' showed a sensitivity of 48.4% and 64.1%, and specificity of 87.7%, and 77.5%, respectively. The PiPS-A and PiPS-B groups for survival in 'weeks' showed a sensitivity of 59.2%, and 44.7%, and specificity of 61.6%, and 64.7%, respectively. The PiPS-A and PiPS-B 'months' group showed a sensitivity of 37.1% and 37.1%, and specificity of 74.9% and 78.4%, respectively. The 'weeks' and 'months' groups showed significantly prolonged survival rates than 'days' group did in both PiPS-A and PiPS-B, by the Kaplan-Meier method.ConclusionThe PiPS predictor models effectively predicted the survival ≥14 days in terminal cancer patients, and were superior to doctor's estimates.

P1-163 - The Estimation of Life-Time for the Patients who Acquired Resistance to Standard Chemotherapies

ABSTRACT Background Prognostication is important for the advanced cancer patients to make the most for the rest of their life. We examined the accuracy of oncologist clinical predictions of survival (CPS) and the factors that oncologists referred to in cancer patients who acquired resistance to the standard chemotherapies. We also examined how oncologists share the information about the survival with patients and their family. Methods Fourteen oncologists treating major adult solid malignancies (breast, lung, gastrointestinal, pancreatic, gynecologic cancer and sarcoma) participated in this observational prospective cohort study between October 2010 and October 2011. The oncologists were asked to fill in the questionnaire about CPS when patients acquired resistance to the standard chemotherapies. Results The data of 52 patients were available for analysis. The median CPS was 92 days [interquartile range (IQR), 61–168 days], and the median actual survival (AS) was 80 days (IQR, 35–148 days). The median difference between CPS and AS (|CPS - AS|) was 21 days (IQR, -26 to 50 days). The Spearman correlation between CPS and AS was 0.66 (P Conclusions Oncologists' predictions generally correlated with AS. As long as the prediction of survival is based on the prognostic factors that oncologists referred to, CPS can be correct to within as least 4 weeks.

The estimation of life-time for the patients who acquired resistance to standard chemotherapies.

e19535 Background: Prognostication is important for the advanced cancer patients to make the most for the rest of their life. We examined the accuracy of oncologists’ clinical predictions of survival (CPS) and the factors that oncologists referred to in cancer patients who acquired resistance to standard chemotherapies. We also examined how oncologists share the information about the survival with patients and their family. Methods: Fourteen oncologists treating major adult solid malignancies (breast, lung, gastrointestinal, pancreatic, gynecologic cancer and sarcoma) participated in this observational prospective cohort study between Oct 2010 and Oct 2011. The oncologists were asked to fill in the questionnaire about CPS when patients acquired resistance to standard chemotherapies. Results: The data of 52 patients were available for analysis. The median CPS was 92 days (Interquartile range [IQR], 61 - 168), and the median actual survival (AS) was 80 days (IQR, 35 to 148). The median difference between CPS and AS (|CPS-AS|) was 21 (IQR, -26 to 50) days. According to Pearson correlation between CPS and AS (r = 0.55, p &lt; 0.001), log(CPS) and log(AS) (r = 0.69, p &lt; 0.001) and spearman correlation between CPS and AS (r = 0.66, p &lt; 0.001), it was statistically considered CPS corresponded to AS. The proportion of patients with |CPS-AS| were as follows; within a week, 6%; within 2 weeks, 14%; and within 4weeks, 42%. Concordance rate between CPS and AS was more accurate in gastric and ovarian cancer while it depended on the oncologists. Although, age, oral intake, the number of chemotherapy regimens and the prognostic factors that oncologists referred to were not related with |CPS-AS|. Eighteen patients (35 %) were informed about the prognosis and thirty-seven patients (71 %) were provided with information about palliative care unit. Thirty-three patients (64 %) received best supportive care alone and eighteen patients (35 %) received further chemotherapies. Conclusions: Oncologists’ predictions generally correlated with AS. As long as the prediction of survival is based on the prognostic factors that oncologists referred to, CPS can be correct to within as least 4 weeks.

Improved Survival in Patients with End-Stage Cancer Treated with Coenzyme Q10 and other Antioxidants: A Pilot Study

This pilot study evaluated the survival of patients with end-stage cancer who received supplements of coenzyme Q(10) and a mixture of other antioxidants (e.g. vitamin C, selenium, folic acid and beta-carotene). During a period of 9 years, 41 patients who had end-stage cancer were included. Forty patients were followed until death and one patient was lost to follow-up and presumed dead. Primary cancers were located in the breast, brain, lungs, kidneys, pancreas, oesophagus, stomach, colon, prostate, ovaries and skin. The median predicted survival time was calculated from Kaplan-Meier curves for each patient at inclusion. Median predicted survival was 12 months (range 3 - 29 months), whereas median actual survival was 17 months (1 - 120 months), which is > 40% longer than the median predicted survival. Mean actual survival was 28.8 months versus 11.9 months for mean predicted survival. Ten patients (24%) survived for less time than predicted, whereas 31 (76%) survived for longer. Treatments were very well tolerated with few adverse effects.

Abstract 2307: Seattle Heart Failure Model Overestimates Time to Mortality in Patients Referred for Heart Transplantation

Background : Accurate determination of time to death in advanced heart failure (HF) patients is critical for appropriate transplant candidate selection. Recently, Seattle Heart Failure Model (SHFM) was introduced to assess HF prognosis, however it was developed from a general HF population and its accuracy in advanced HF patients has not been reported. Methods : We collected data on 51 advanced HF patients referred for transplant evaluation who died during follow-up (mean age 57.4±17.5 years, 70.1% male, and 56.9% white). Time to death prediction by the SHFM was assessed by plotting actuarial survival time vs. model error (=predicted-actual). Gender and race based stratified analysis were also performed. Results : Median ejection fraction was 0.15 (25%–75%: 0.10 – 0.25), heart rate was 87±19 bpm, and systolic blood pressure was 117±22 mmHg. Overall 90.2% patients were on ACE inhibitor or angiotensin receptor blockers, 82.4% on beta-blockers, and 74.6% had a defibrillator implanted. Median expected survival by the SHFM was 6.4 (3.8 –9.7) years. Median actual survival was 2.0 (1.1–3.9) years. Residual analysis showed that the SHFM overestimated survival by 3.8 (1.5– 6.5) years, p&lt;0.001, Fig 1 . Overall 86.3% patients lived shorter than projected survival. The SHFM overestimated survival more in black vs. white patients (4.5 years, 25%–75%: 2.3–7.9 years in blacks vs. 2.8 years, 25%–75%: 0.7– 6.0 years in whites, p=0.07). No significant gender differences were noted. Conclusion : The SHFM significantly overestimates survival in advanced HF patients referred for transplantation, especially in blacks. Further studies are needed to modify and validate the SHFM in these patients.

Single-agent pemetrexed in patients with advanced and metastatic hepatoma

14064 Background: The incidence of hepatoma is rising in the United States, primarily due to the increase in the prevalence of hepatitis C. Surgical treatments are rarely an option for patients with advanced hepatoma, and while chemotherapy, particularly with doxorubicin-based regimens, has marginally prolonged survival, response rates have been poor with the burden of high toxicity. Pemetrexed, a folate antimetabolite, has demonstrated activity in hepatoma cell lines with a manageable toxicity profile, making it a potentially useful agent in hepatocellular carcinoma. Methods: A multicenter, Phase II study was conducted to assess the response rate and evaluate the toxicity profile of single-agent pemetrexed (ALIMTA) in first-line patients with advanced or metastatic hepatoma. Pemetrexed 600 mg/m2 IV was administered on Day 1 of each 21-day cycle until disease progression (PD). Patients were premedicated with dexamethasone 4 mg PO BID and received daily folic acid 350–1000 μg PO and Vitamin B12 1000 μg IM every 9 weeks. Results: This nonrandomized study employed Simon’s 2-stage design. There were 21 eligible patients enrolled in the first stage, and all 21 patients were enrolled within 4 months of trial opening. Median age was 72 years (range, 44–88), and most patients were white (62%) and male (81%). Ten percent (10%) had an ECOG PS of 2, 48% Stage IV disease, 52% prior surgery, and 33% tumors of unknown histological grade. The plan was to stop accrual if ≤2 responders were observed among the 21 patients. Of the 21 patients, 3 had SD, 2 had early toxicities (renal/liver failure, sepsis), 15 progressed, and 1 was noncompliant. The trial was closed due to lack of response. The most common Grade 3 hematological toxicities were neutropenia 6/21 (28.6%) and thrombocytopenia 3/21 (14.3%). One patient experienced both Grade 3 nausea and vomiting. There were no Grade 4 toxicities. There were 10 on-study deaths: 9 PD and 1 liver failure. None of the deaths were drug-related. The median actual survival was 2.5 months (range, &lt;1–8). Conclusions: While pemetrexed was well tolerated in this patient population, it was not active. Most adverse events were related to disease state, not study treatment. Supported by Eli Lilly and Company, Indianapolis, IN [Table: see text]

Adjuvant Methotrexate, Vinblastine and Cisplatin Chemotherapy for Invasive Transitional Cell Carcinoma: Taiwan Experience

Purpose The feasibility of adjuvant cisplatin, methotrexate and vinblastine chemotherapy was evaluated in Taiwanese patients with invasive transitional cell carcinoma at high risk for recurrence. Materials and Methods We assigned 56 patients with high risk transitional cell carcinoma (vascular or lymphatic invasion in the primary tumor, poorly differentiated stage P2, P3, P4 or N + and M0) to receive adjuvant chemotherapy after radical urological surgery. The chemotherapy consisted of 40 mg./m. 2 methotrexate and 4 mg./m. 2 vinblastine on days 1 and 8, and 100 mg./m. 2 cisplatin on day 2 given in 6 courses at 21-day intervals. Results Median followup was 44 months. An average of 4.63 cycles of chemotherapy was administered. The median actual survival was 44 months, and the 1 and 3-year survival probabilities were 92 percent and 50 percent, respectively. The median disease-free survival was 15.5 months, and the 1 and 3-year disease-free survival probabilities were 66 percent and 28 percent, respectively. Only 5 (9 percent) and 1 (2 percent) patients had grades 3 and 4 leukopenia, respectively, and none died of sepsis. Conclusions The use of adjuvant cisplatin, methotrexate and vinblastine chemotherapy in patients with invasive transitional cell carcinoma at high risk for recurrence is feasible with tolerable toxicity but randomized controlled trials will be required to assess the benefit.

Immunotherapy of gastrointestinal cancer with monoclonal antibodies.

Twenty patients with widespread metastatic colorectal carcinoma were infused with 500 mg of the cytotoxic IgG2a monoclonal antibody 17-1A preincubated with autologous peripheral blood leukocytes. Ten patients showed no benefit from such therapy and ten died, with a mean survival time of 7.6 +/- 4.5 months after treatment and a median survival of 6 months. In ten additional patients, the course of disease was modified by antibody therapy; disease in five of these patients stabilized, while tumor size in the other five patients decreased after therapy. Median actual survival in this group of ten patients is presently 24 months; four of these patients died of disease progression within a mean of 15 +/- 5 months. Duration of response was 10.5 +/- 6.7 months after antibody treatment. Treatment tolerance for these 20 patients was excellent in all but one patient, who experienced an anaphylactic reaction during a second infusion with 17-1A.

A comparison between a single agent short course chemotherapy regimen and a quadruple prolonged course regimen for small-cell bronchogenic carcinoma of limited extent

Sixty-eight patients with inoperable but ‘limited’ stage small-cell carcinoma of the bronchus were treated with two different chemotherapy regimens. Thirty-four patients received methotrexate, cyclophosphamide, procarbazine and vincristine in standard dose over a 2-year schedule. Thirty-four patients received cyclophosphamide alone over a period of 3 months. The groups were evenly balanced with respect to clinical details which are fully described. Toxicity was acceptable. The median actual survival for the whole group was 11 months, the 1-year, 2-year and 4-year survival being 48%, 30% and 1.5% respectively. There was no statistically significant difference in survival between those classified as responders and those as non-responders, nor between the groups treated with the two different regimens. There was a high local recurrence rate.