Median Overall Survival For Women Research Articles

Optimizing the Care of Malignant Bowel Obstruction in Patients With Advanced Gynecologic Cancer.

PURPOSE:Malignant bowel obstruction (MBO) is a common and distressing complication in women with advanced gynecologic cancer. A pilot, interprofessional MBO program was launched in 2016 at a large Canadian tertiary cancer center to integrate these patients’ complex care needs across multiple disciplines and support women with MBO.METHOD:Retrospective analysis to evaluate the outcomes of women with advanced gynecologic cancer who were admitted to hospital because of MBO, before (2014 to 2016: baseline group) and after (2016 to 2018) implementation of the MBO program.RESULTS:Of the 169 women evaluated, 106 and 63 were in the baseline group and MBO program group, respectively. Most had ovarian cancer (n = 124; 73%) and had small-bowel obstruction (n = 131; 78%). There was a significantly shorter cumulative hospital length of stay (LOSsum) within the first 60 days of MBO diagnosis in the MBO program group compared with the baseline group (13 v 22 days, respectively; adjusted P = .006). The median overall survival for women treated in the MBO program was also significantly longer compared with the baseline group (243 v 99 days, respectively; adjusted P = .002). Using the interprofessional MBO care platform, a greater proportion of patients received palliative chemotherapy (83% v 56%) and less surgery (11% v 21%) in the MBO program group than in the baseline group, respectively. A subgroup of women (n = 11) received total parenteral nutrition for longer than 6 months.CONCLUSION:Implementation of a comprehensive, interprofessional MBO program significantly affects patient care and may improve outcomes. Unique to this MBO program is an integrated outpatient model of care and education that empowers patients to recognize MBO symptoms for early intervention.

Role of adjuvant chemotherapy in the management of non-granulosa cell ovarian sex cord-stromal tumors.

ObjectiveTo investigate the role of adjuvant chemotherapy (CT) in the management of ovarian non-granulosa cell (GC) sex cord-stromal tumors (SCSTs).MethodsThe National Cancer Database was accessed and patients diagnosed between 2004 and 2013 with a malignant non-GC SCST were selected. Overall survival (OS) was evaluated with Kaplan-Meier curves and compared with the log-rank test. Multivariate survival analysis was performed with Cox regression. Factors associated with the administration of CT were evaluated with the chi-square test and binary logistic regression.ResultsA total of 391 patients were identified. The majority had a Sertoli-Leydig cell tumor (SLCT) (73.2%) and early stage disease (84.8%). A total of 203 (51.9%) patients received CT. Advanced disease stage, younger age, high-grade histology, White race, large tumor size and SLCT histology were associated with administration of CT. For patients with early stage disease, there was no difference in OS between those who did (n=134) and did not receive CT (n=157), p=0.40; 5-year OS rates were 81.7% and 84.6%, respectively. No mortality benefit was observed (hazard ratio=0.73; 95% confidence interval=0.38–1.4) after controlling for tumor histology. Median OS of women with advanced stage disease who received CT (n=41) was 34.96 months compared to 15.51 months for those who did not (n=11), p=0.013.ConclusionAdjuvant CT was associated with improved survival for patients with advanced stage non-GC SCSTs. No clear benefit was found for those with early stage disease.

Acute Myeloid Leukemia Following Gynecologic Cancer in the Era of Platinum-Based Chemotherapy.

The aim of the present study was to estimate the risk of therapy-related acute myeloid leukemia (t-AML) in patients with gynecologic malignancies receiving chemotherapy using a population-based database. The National Cancer Institute's Surveillance, Epidemiology, and End Results database was accessed, and a cohort of women diagnosed with a primary ovarian, uterine, or cervical malignancy between January 1, 1992, and December 31, 2014, who received chemotherapy was selected. Those who subsequently developed AML were identified. Standardized incidence ratio (SIR) with 95% confidence intervals (CIs) and excess risk (ER) per 10,000 persons were calculated. Median overall survival of women with t-AML was calculated following generation of Kaplan-Meier curves. We identified 60,130 women who met the inclusion criteria; 56.4%, 19.4%, and 24.2% were diagnosed with ovarian, cervical, and uterine cancer, respectively. A total of 79 patients (0.13%) developed t-AML. The calculated SIR was 4.41 (95% CI, 3.49-5.50). For women with ovarian, cervical, and uterine cancer, the SIRs were 4.25 (95% CI, 3.13-5.66), 5.33 (95% CI, 2.92-8.95), and 4.26, (95% CI, 2.52-6.73), respectively. The highest risk was observed among women younger than 50 years (SIR, 11.69; 95% CI, 7.56-17.25). Median interval between gynecologic cancer and t-AML diagnosis was 40 months (range, 3-218 months), whereas median OS following the diagnosis of t-AML was 4 months (95% CI, 1.52-6.48 months). Therapy-related AML following chemotherapy treatment for a gynecologic malignancy is a very rare late treatment-related event associated with a poor prognosis.

Results of hysterectomy for persistent cervical cancer after complete radiotherapy in Srinagarind Hospital

Objectives: To analyze the survival outcomes and to determine the surgical complication of patients with persistent cervical cancer who had undergone hysterectomy after completion of radiotherapy at Srinagarind Hospital, Khon Kaen University, Thailand between January 1996 and December 2010. Methods: The medical records of patients who met the study criteria were reviewed. The inclusion criteria are all patients who have residual cervical cancer after complete radiation therapy and biopsy proven. Extracted data included patient’s age, stage, histological subtype, type of radiotherapy received, type of hysterectomy procedure, pathological results, surgical complications, and survival. Results: Forty-three women suitable for study inclusion were identified. The majority of women (53.5%) were in stage IIB. Thirteen (30.2%) women received concurrent chemoradiation while the remaining 30 (69.8%) underwent radiotherapy alone. Thirty-four (79.1%) women underwent extrafascial hysterectomy (EH) while the remaining 9 (20.9%) underwent radical hysterectomy (RH). Median operative time and median amount of estimated blood loss were higher among women undergoing RH compared to those who underwent EH. Overall, grade III-IV complications were noted in 34.9% of patients. The rate of grade III-IV complications was higher among women undergoing RH compared to those in EH group (44.4% vs. 32.4%, respectively). The 5-year survival rate of all women was 54.6%. Median overall survival of all patients was 6.25 years. Median overall survival of women undergoing RH was comparable to those who underwent EH (6.25 years vs. 6.84 years, respectively). Conclusion: Hysterectomy in women who were initially treated with curative intent radiotherapy but subsequently found to have residual tumor may improve survival outcomes, allowing a 5-year survival rate of approximately 55%. The incidence of severe complication was considerably high particularly among those women who had undergone radical hysterectomy.

Lymph node metastases as only qualifier for stage IV serous ovarian cancer confers longer survival than other sites of distant disease – a Swedish Gynecologic Cancer Group (SweGCG) study

Background: The International Federation of Gynecology and Obstetrics (FIGO) ovarian cancer staging system includes no sub-stage for lymph nodes (LN) as only distant disease manifestation. We explore the prognostic implication of LN as only stage IV classifier in serous ovarian cancer.Method: This is a nation-wide, population-based study on 551 women with serous stage IV cancers diagnosed between 2009–2014. We compare overall survival (OS) in women with LN as only distant metastatic site to those with pleural metastases only and to patients with other/multiple stage IV manifestations. Cox regression models were used for uni- and multivariable estimations.Results: Of 551stage IV cases, distant metastatic site was registered in 433. Median OS for women with LN (n = 51) was 41.4 months, compared to 25.2 and 26.8 months for patients with pleural (n = 195) or other/multiple (n = 187) distant metastases (p = .0007). The corresponding five-year survival rates were 32, 11 and 22%, respectively. Multivariable analyzes confirmed shorter survival for women with pleural (HR 2.99, p = .001) or other/multiple distant sites (HR 2.67, p = .007), as compared to LN cases. LN only patients lived 9.1 months longer after primary than after interval surgery, but this difference was not significant (p = .245).Conclusion: Women with stage IV serous ovarian cancer having lymph nodes as only distant metastatic site live longer than other stage IV patients.

Obesity Drives Prognosis in Women with Metastatic Breast Cancer

Obesity is an American epidemic that is linked to increased incidence of cancer, increased toxicity and worse cancer outcomes compared with their normal weight counterparts despite receiving the same therapies. Since glucose metabolism has been implicated in intracranial progression, we hypothesized that obese patients with breast cancer metastases may have worse survival. We retrospectively identified 57 patients with stage IV breast cancer with brain metastases from all subtypes of breast cancer who were treated with some form of local therapy including radiation therapy +/- surgery. Radiation was delivered as whole brain radiation (WBRT) to a median dose of 3000 cGy with a median number of 4 lesions treated, or stereotactic radiosurgery (SRS) to a median dose of 2100 cGy in a single fraction with a median number of 3 brain lesions treated. Kaplan Meier curves were generated for overall survival data and Mantel-Cox regression was performed to detect differences in groups. Median overall survival for all comers was 40 months (mos) from time of initial diagnosis. Body mass index (BMI) cutoff for overweight was 25kg/m2. Of the 57 patients included in the analysis, 24 had a BMI under 25 kg/m2 and 33 had a BMI greater than or equal to 25 kg/m2. There were 20 women with triple negative tumors, 14 with HER-2 positive tumors, 6 with ER/PR positive tumors and 10 with triple positive tumors. Tumor subtype was balanced between the two groups. Median overall survival for women with a BMI < 25 kg/m2 was 54 mos whereas in women with a BMI ≥ 25 kg/m2 this decreased to 28 mos (p=0.02). Median survival after diagnosis of brain metastases was 18.4 mos in the BMI < 25kg/m2 group versus 6.8 mos in the BMI ≥ 25kg/m2 group (p=0.001). Hazard ratio of death after diagnosis of brain metastases for women in the overweight and obese categories was 2.7 (CI: 1.239 to 5.903). Survival did not differ between groups treated with WBRT versus those treated with SRS. While the majority of tumors were triple negative, receptor status did not appear to significantly impact OS. Women were also analyzed by their breast cancer-specific graded prognostic assessment and no significant difference in survival after diagnosis of brain metastases was detected. Lastly, we attempted to quantify the effect of BMI on OS using an exponential curve fit to our data and found that increased BMI decreases survival in an exponential decay fashion (R2=0.59). Based on these data, we postulate that obesity may play in important role in the prognosis of metastatic breast cancer, specifically those patients with brain metastases. Glucose metabolism and the Warburg effect are particularly relevant in CNS disease and obesity may have a significant effect of the host’s metabolism leaving them susceptible to more aggressive disease. Innovative therapies directed at metabolism are needed to improve outcomes in metastatic breast cancer. Future work should focus on incorporating BMI in treatment decisions and outcome predictions.

Rethinking clinical trial design: maximizing the results from each clinical trial participant

Breast cancer remains the most common cancer diagnosed in women. Triple negative breast cancers (TNBC) especially remain difficult to treat with poorer prognosis than hormone receptor and HER2-neu positive tumors. Although relatively responsive to neoadjuvant chemotherapy with pathological complete response (pCR) of up to 50%, for those who don’t achieve a pCR the outcome is poor (1). The hallmark of TNBC is the development of chemoresistant metastatic disease, with the highest frequency of metastases in the first 1–2 years after completing chemotherapy, a rate 2–3 times higher than non-TNBC subtypes (2). The median overall survival for women with metastatic TNBC remains a dismal 12 months, with worse outcomes in patients with CNS metastases (3). As such, the need for developing new therapies TNBC is particularly pressing.

Treatment outcomes in stage IIIA non–small-cell lung cancer in a community cancer center

Treatment outcomes for non-small-cell lung cancer (NSCLC) patients diagnosed at stage IIIA have been analyzed in many studies, which generally involve patients younger and healthier than the average patient with this disease. To analyze demographics and treatment outcomes in patients with stage IIIA NSCLC at a community cancer center. We reviewed charts of 226 patients diagnosed with stage IIIA NSCLC from January 2003 to December 2008 treated at our community cancer center. Results Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively. Median overall survival for all patients and sequentially and concurrently treated chemoradiation patients were 18 months, and 18 months, and 20 months, respectively. Median overall survival for women and men was 24 months and 16 months, respectively. Study design was retrospective and some medical records were not available. However, this population is likely representative of patients treated in similar settings. In our population, advanced age and male gender were associated with lower median survival. Responses to concurrent and sequential chemoradiation seemed to differ based on age group, which may be useful as a prognostic guideline for similar populations.

Prognostic factors in advanced gastric cancer after second-line treatment.

201 Background: Advanced gastric cancer (AGC) is a highly lethal disease worldwide with a median overall survival (OS) of less than 12 months. Ramucirumab was the first targeted agent to show survival benefit in the second-line (2L) treatment of AGD. From the REGARD trial, women exhibited a trend towards a worse survival when compared to men. Methods: We retrospectively analyzed the outcome of a Spanish cohort of 55 AGC patients who had received at least two consecutive chemotherapy lines of treatment at our institution. We preselected some clinical parameters (age, gender, Lauren subtype, Her-2 status, grade of differentiation, primary tumor localization and resection, TNM stage, neoadjuvant/adjuvant administration, mono/polychemotherapy in 2L, irinotecan- or taxane-based 2L, Trastuzumab treatment, and administration of third-lines [3L]) to be tested as potential prognostic factors. We focused our analysis on the gender effect in OS after 2L treatment in AGC. The SPSS software package was used for all statistical analyses (Mann-Whitney U test, Chi Square, Kaplan-Meier, Cox regression). Results: Women, diffuse subtype, poorly differentiated tumors, sub-cardia location, single-agent 2L and 3L administration were the clinical characteristics with a significant shorter OS by the univariable analysis. Median OS of women (5 months, 95%CI 3.9-6.0) was significant lower than that in men (13 months, 95%CI 7.9-18.0) by both Log-Rank and Breslow tests (p 0.002). We found no significant differences in age, progression-free survival or time-on-treatment between men and women. Female gender was significantly associated with more taxane-based 2L and with less 3L treatment administration. When 3L treatment administration was excluded in the multivariable analysis, female gender was the only independent prognostic factor of all the clinical parameters included in our review (HR 0.33, 95%CI 0.15-0.75, p 0.008). Conclusions: Our retrospective study found that gender, Lauren subtype, grade of differentiation, primary tumor location, polychemotherapy and 3L administration may be potential prognostic factors in AGC after 2L treatment. Female gender was an independent prognostic factor in our Spanish cohort.

Abstract P3-06-04: Differences in survival among women with primary and secondary metastatic breast cancer

Abstract Background Retrospective analyses have shown survival differences in patients with primary metastatic breast cancer (PMBC) in comparison to patients with secondary metastatic breast cancer (SMBC). A subgroup analysis of 2,708 patients with metastatic breast cancer from two prospective non-interventional studies (NIS) allows exploring this hypothesis. The Her2-positive-NIS investigated trastuzumab therapy for Her2 positive metastatic disease additional to predominantly first line chemotherapy. The second NIS observed bevacizumab therapy for predominantly Her2 negative disease additional to chemotherapy as first- line option. Methods Information on PMBC or SMBC was available in 2,401 patients diagnosed with metastatic breast cancer and treated with targeted therapy between 2000 and 2011. Previously endocrine therapy in palliative status was allowed. Progression free survival (PFS) was defined as the time from the start of antibody therapy to disease progression or death; overall survival (OS) was defined as the time from the start of targeted therapy with antibody to death of any cause; PFS and OS were estimated by Kaplan-Meier product limit method. Results 570 (24%) women had PMBC and 1831 (76%) had SMBC. Median follow-up was 23 months (range: 0.2 - 137). Median PFS in patients with PMBC and SMBC was 13.0 and 10.4 months, respectively (p = 0.0043); median OS for women with PMBC and SMBC was 33.5 and 28.5 months, respectively (p = 0.0023). 5 years after start of the study treatment 28% patients with primary and 23% with secondary metastatic disease were alive. Conclusion In a population of breast cancer patients treated with modern antibody therapies, woman with PMBC live significantly longer than those with SMBC. A possible explanation for this observation might be a negative selection process of patients suffering from secondary disease in spite of adequate primary treatment. Every fourth patients with metastatic breast cancer is a long survivor. The clinical-pathological characteristics and risk factors for this group are unclear. Prospective trials including translational investigations for these patient populations are needed. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-04.

Uterine Leiomyosarcoma

The aim of this study was to analyze and compare the clinicopathologic characteristics, treatment, and survival in patients with uterine leiomyosarcoma (ULMS) during the last 10 years in 3 referral academic centers. All patients with ULMS who underwent treatment at the participating institutions between January 1, 2000, and December 31, 2010, were identified from the tumor registry database. In each case, the diagnosis was confirmed by a dedicated gynecologic pathologist following postsurgery pathology review. The Kaplan-Meier method was used to generate overall survival (OS) data. Factors predictive of outcome were compared using the log-rank test and Cox regression analysis. Analysis of 167 women with ULMS with adequate follow-up was performed. One hundred twenty-eight patients (77%) were initially managed at the participating institutions, and 39 (23%) were referred after initial management at a different institution. Ninety-two (55%) had stage I disease, 7 (4%) had stage II, 18 (11%) stage III, and 50 (30%) had stage IV disease. The median OS for women with stage I was 75 months, for stage II 66 months, stage III 34 months, and stage IV 20 months (P < 0.001). For patients with early stage (I and II), race, lower grade, smaller tumor size (<11 cm), low number of mitosis (<25/10 high-power field [HPF]), lymphovascular space invasion, and presence of necrosis were identified as variables with prognostic influence on survival in the univariate analysis. A Cox proportional hazards model identified size 11 cm or greater (hazard ratio, 5.9; P < 0.001) and mitotic count of 25/10 HPF or greater (hazard ratio, 2.3; P = 0.05) as independent predictors of OS. For patients with late stage (stage III and IV), race, stage III versus IV, lower grade, smaller tumor size (<11 cm), and low number of mitosis (<25/10 HPF) were all associated with significantly improved OS. A Cox proportional hazards model identified mitotic count of 25/10 HPF or greater (P = 0.01) as independent predictor of OS. In early stage, size of the tumor and number of mitosis were associated to survival. In contrast to late stage, only mitotic count was associated to survival.

Risk of second primary malignancies in women with cervical cancer: A population-based study in Taiwan over a 30-year period

ObjectiveStudies conducted in Western countries have reported an increased risk for second primary malignancies after cervical cancer. There is little documentation of ethnic differences in this increased risk, and most of the Asian studies are hospital-based studies with small case numbers. MethodsUsing population-based data from the Taiwan Cancer Registry for the period 1979–2008, we quantified standardized incidence ratios (SIRs) among 52,972 women with initial diagnoses of cervical cancer. ResultsAmong the 52,972 women, 3061 (5.78%) developed second primary cancers during 433,571 person-years of follow-up. Overall, the SIR for developing a subsequent second cancer was significantly greater than that of the general population (1.36 [95% CI, 1.32–1.41]). There was a greater risk for cancers of the esophagus, stomach, small intestine, rectum, lung, bone, non-melanoma skin, uterine corpus, vagina/vulva, bladder, kidney, and leukemia. When further examining age at diagnosis of cervical cancer (<50 and ≥50) for these 12 sites, we found that the risk of second cancers (SIR, <50 and ≥50: 3.08 vs. 1.63) was higher not only in younger patients, except for non-melanoma skin cancer and endometrial cancer, but also within the first 5years after diagnosis of cervical cancer. The median overall survival for women with cervical cancer was 18.58years. The second cancers had a negative impact on overall survival after adjusting for age (P<0.001). ConclusionsSIR for second cancers was significantly greater than the general population in cervical cancer patients. A young age at the diagnosis of cervical cancer predicted an increased risk. The second cancers worsened overall survival.

Ovarian Metastasis Is Associated with Retroperitoneal Lymph Node Relapses in Women Treated for Colorectal Peritoneal Carcinomatosis

To analyze the patterns of recurrence and the prognostic impact of ovarian metastases (OM) in a population of women with colorectal peritoneal carcinomatosis (CRPC) treated with curative intent. Data from all consecutive women with CRPC who underwent curatively intended complete cytoreductive surgery (CRS) plus intraperitoneal chemotherapy at our institution were retrieved from a prospective database. A bilateral oophorectomy or a complementary unilateral oophorectomy was systematically performed during CRS. From 1994 to 2009, among 105 women who underwent CRS plus intraperitoneal chemotherapy for CRPC, 62 (60 %) had OM. Women with and without OM had comparable peritoneal cancer index (PCI) scores (10 vs. 12, respectively, p = 0.09). After a median follow-up of 60 (range 5-145) months, median overall survival of women with OM did not differ statistically from that of women without OM (respectively, 36 and 40 months; p = 0.75). Relapses occurred in 82 % of the patients, distributed similarly between the two groups except for retroperitoneal lymph node recurrence, which occurred in 19 patients (18 %), including 18 with OM. The only predictive factor for a retroperitoneal relapse was a history of OM (p = 0.0012). Retroperitoneal lymph node recurrence seems to be linked to OM originating from colorectal cancer and could worsen the prognosis. A systematic lymphadenectomy could be evaluated in women with isolated OM or very limited peritoneal carcinomatosis to analyze the incidence of invaded lymph nodes and study its potential benefit on survival.

Anastrozole and fulvestrant—combination to unlock efficacy

Compared with anastrozole alone, the combination of fulvestrant and anastrozole significantly improved time without disease progression and extended the median overall survival of women with endocrine-responsive metastatic breast cancer; offering a new standard-of-care for these women. Unfortunately, information about the efficacy of the combination in the adjuvant setting is not available.

The prognostic significance of single hormone receptor positive metastatic breast cancer: An analysis of three randomised phase III trials of aromatase inhibitors

We analysed the outcomes of women with metastatic breast cancer (MBC) from three randomised phase III trials of aromatase inhibitors according to oestrogen receptor (ER) and progesterone receptor (PgR) status. Both receptors were analysed in 1010 of the 1870 women (54%), including 31 that were ER-/PgR-, which were excluded. Of the remaining 979, 726 (74%) were ER+/PgR+ but 253 were single hormone receptor positive (213 ER+/PgR-, 40 ER-/PgR+). Although there were no differences in clinical benefit or time to progression, the median overall survival of women with ER+/PgR+ tumours was significantly longer than those with single HR positive tumours (800 versus 600 days, p = 0·01). In women with ER+ tumours, the median overall survival of those with tumours that were also PgR+ was significantly longer than those that were PgR- (800 versus 625 days, p = 0·02). The PgR status is an important prognostic factor for survival in MBC.

Lung cancer in never-smokers: A single institutional experience

17044 Background: Approximately 10% of patients (pts) with lung cancer do not have a history of tobacco smoking. The clinical presentation and outcomes of pts with LCINS have not been well characterized in the Western population. Methods: We reviewed our institutional tumor registry to identify patients with lung cancer from 1992 to 2002. Data regarding tobacco smoking, stage, histology and survival were collected. Results: Of the 5417 consecutive pts diagnosed with lung cancer, 254 were determined to be never-smokers with confirmed pathologic diagnosis of non-small cell lung cancer (NSCLC). The table below describes the patient demographics. The five-year survival for the entire population with LCINS was 22.56%, with 37 pts surviving beyond five years. The median overall survival for women was 21.08 months (95% CI 14.03–23.37) and for men 13.5 months (95% CI 8.5–32.492); p = 0.73. Among the different histologic subtypes, broncho-alveolar carcinoma was associated with better median overall survival of 61.67 months (p &lt; 0.0001). The median overall survival by TNM stage: I (71 months), II (32 months), III (15 months), and IV (6 months). Conclusions: 1. LCINS affects predominantly women. 2. Adenocarcinoma is the most common histological type. 3. Brain and bone are the most common sites of metastases. [Table: see text] No significant financial relationships to disclose.