Non-cancer Survival Research Articles

Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis.

Several markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC. Multi-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio. 2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis). Elevated NLR was a significant predictor of ACM (HR 1.32, 95% CI: 1.07-1.64, p=0.003) and NCM (HR 1.79, 95% CI: 1.30-2.46, p<0.001) in MVA. Elevated De Ritis was a significant predictor of ACM (HR 2.04, 95% CI: 1.65-2.52), NCM (HR 1.84, 95% CI: 1.33-2.55, p<0.001), and CSM (HR 1.97, 95% CI:1.48-2.63, p<0.001). KMA revealed significant difference in 5-year overall survival (OS) (48% vs. 68%, p<0.001), non-cancer survival (NCS) (69% vs. 87%, p<0.001), and cancer-specific survival (CSS) (60% vs. 73%, p<0.001) for elevated versus non-elevated NLR. For PLR, there was a difference in 5-year OS (51% vs. 61%, p<0.001) and CSS (60% vs. 73%, p<0.001) with KMA. Elevated NLR was independently associated with worse ACM and NCM, while elevated De Ritis was predictive for CSM in addition to ACM and NCM. These differences may be useful in refining risk stratification with respect to cancer-related and non-cancer mortality in RCC patients and deserve further investigation.

MP47-16 DECLINE TO "SEVERE" CKD-S IS A PREDICTIVE MARKER FOR ALL-CAUSE AND NON-CANCER MORTALITY IN RENAL CELL CARCINOMA: ANALYSIS OF THE INTERNATIONAL MARKER CONSORTIUM FOR RENAL CANCER (INMARC)

You have accessJournal of UrologyCME1 May 2022MP47-16 DECLINE TO "SEVERE" CKD-S IS A PREDICTIVE MARKER FOR ALL-CAUSE AND NON-CANCER MORTALITY IN RENAL CELL CARCINOMA: ANALYSIS OF THE INTERNATIONAL MARKER CONSORTIUM FOR RENAL CANCER (INMARC) Mimi Nguyen, Arman Walia, Rekha Narasimhan, Ava Saidian, John Matthew Perry, Hajime Tanaka, Kevin Hakimi, Margaret Meagher, Dattatraya Patil, Yosuke Yasuda, Kazutaka Saito, Yasuhisa Fujii, Viraj Master, and Ithaar Derweesh Mimi NguyenMimi Nguyen More articles by this author , Arman WaliaArman Walia More articles by this author , Rekha NarasimhanRekha Narasimhan More articles by this author , Ava SaidianAva Saidian More articles by this author , John Matthew PerryJohn Matthew Perry More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Viraj MasterViraj Master More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Impact of surgically induced Chronic Kidney Disease (CKD-S) on outcomes in renal cell carcinoma (RCC) is controversial. We evaluated effects of worsening CKD-S on oncologic and non-oncologic survival outcomes in RCC. METHODS: We performed a retrospective multicenter analysis of patients who underwent Partial (PN) or Radical Nephrectomy (RN). Primary outcome was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM), cancer specific mortality (CSM), and de novo CKD-S Stage 4 [estimated glomerular filtration rate <30 mL/min/1.73m2). Patients were stratified by CKD stage: no CKD-S (eGFR≥60), de novo “moderate” CKD-S 3a (eGFR 59-45), de novo “moderate-severe” CKD-S 3b (eGFR 44-30) and de novo “severe” CKD-S 4 (eGFR 29-15). Multivariable analysis (MVA) was utilized to identify risk factors associated with development of CKD-S Stage 4 and mortality outcomes. Kaplan-Meier analysis (KMA) was utilized to evaluate for overall survival (OS), non-cancer survival (NCS), and cancer-specific survival (CSS) with respect to CKD-S categories. RESULTS: We analyzed 3239 patients [no CKD-S (n=1876), de novo CKD-S 3a (n=606), de novo CKD-S 3b (n=489) and de novo CKD-S 4 (n=268)]. On MVA, de novo CKD-S 4 was independently associated with ACM (HR 2.1, p <0.001) and NCM (OR 2.8, p <0.001), but not CSM (p=0.219); de novo CKD-S 3b was independently associated with ACM (HR 1.3, p=0.033) and NCM (OR 1.5, p=0.021), but not CSM (p=0.909); de novo CKD-S 3a was not predictive for any mortality outcomes (p=0.81-0.102). RN was independently associated with de novo CKD-S 4 (HR 1.4, p=0.047). Comparing no CKD, CKD-S 3a, CKD-S 3b and CKD-S 4, KMA demonstrated worsening outcomes with progressive CKD-S stage: 5 year OS 84% vs. 78% vs. 71% vs. 60%, p <0.001; 5 year NCS 93% vs. 87% vs. 83% vs. 72%, p <0.001; 5 year CSS, 91% vs. 92% vs. 86% vs. 83%, p <0.001 (Figure). CONCLUSIONS: Development of CKD-S Stage 3b and 4, but not Stage 3a, was associated with worsened ACM and NCM. Worsening CKD-S was not associated with increased oncological risk. While RN was predictive of “severe” CKD-S, decision to proceed with nephron preservation via PN should be individualized based on oncological risk and risk of functional decline to CKD-S 3b or 4, and not CKD-S 3. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e816 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mimi Nguyen More articles by this author Arman Walia More articles by this author Rekha Narasimhan More articles by this author Ava Saidian More articles by this author John Matthew Perry More articles by this author Hajime Tanaka More articles by this author Kevin Hakimi More articles by this author Margaret Meagher More articles by this author Dattatraya Patil More articles by this author Yosuke Yasuda More articles by this author Kazutaka Saito More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Brachytherapy and non-cancer mortality in patients with oral cavity and oropharynx SCCs

BackgroundOral cavity and oropharyngeal squamous cell cancers (OC-OPSCC) display high cancer-specific mortality and increased non-cancer mortality. We examined cause of death in patients treated for OC-OPSCC with brachytherapy, chemotherapy, external beam radiation, surgery, or combination of modalities. We hypothesized that brachytherapy does not increase non-cancer mortality comparably with external beam radiation. MethodsA database was constructed from institutional tumor registry and electronic medical record data from all patients with first OC-OPSCC diagnosis at our institution between 2000 and 2010, excluding patients with a second primary cancer at diagnosis. The primary outcome was association between treatment modality and non-cancer mortality. ResultsOf 693 eligible patients, 460 were deceased; 84 from primary malignancy and 96 from a non-primary cancer cause, including 24 with a second primary cancer. 193 patients received brachytherapy. Cox proportional hazards regression was performed on treatment regimen, stratified by AJCC stage, race, and sex. Age, smoking history, and alcohol had HRs for death of 1.05 (p < 0.005), 1.37 (p = 0.106), and 2.24 (p < 0.005), respectively, while brachytherapy had a 0.53 HR (p < 0.005) for death. Non-smoking OPC patients had an 88% 5-year OS, suggesting these were largely HPV-driven cancers. In smoking OPC patients, 5-year OS was 61%. Non-cancer mortality HR of 0.36 for brachytherapy-treated patients. ConclusionWe report non-cancer mortality from a cohort of curatively treated OC-OPSCC and show a significant correlation between brachytherapy and non-cancer survival, independent of remission status. The impact of brachytherapy in OPC was strongest in smokers.

MP45-05 IMPACT OF ELEVATED C-REACTIVE PROTEIN ON SURVIVAL OUTCOMES IN SMALL RENAL MASSES: ANALYSIS OF THE INMARC REGISTRY

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP45)1 Sep 2021MP45-05 IMPACT OF ELEVATED C-REACTIVE PROTEIN ON SURVIVAL OUTCOMES IN SMALL RENAL MASSES: ANALYSIS OF THE INMARC REGISTRY Margaret Meagher, Dattatraya Patil, Kazutaka Saito, Devin Patel, Juan Javier-Desloges, Fady Ghali, Kevin Hakimi, Shady Soliman, Julia Yuan, Fang Wan, Yasuhisa Fujii, Viraj Master, and Ithaar Derweesh Margaret MeagherMargaret Meagher More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Devin PatelDevin Patel More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , Fady GhaliFady Ghali More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Shady SolimanShady Soliman More articles by this author , Julia YuanJulia Yuan More articles by this author , Fang WanFang Wan More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Viraj MasterViraj Master More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002066.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of small renal masses (SRM) represents a therapeutic quandary given the low oncologic risk of most tumors and increasing incidental detection. We investigated the impact of elevated C-reactive protein (CRP) on survival outcomes and competing sources of mortality in a cohort of patients with renal cell carcinoma (RCC) and clinical tumor size ≤3 cm. METHODS: Multi-institutional retrospective analysis the International Marker Consortium for Renal Cancer (INMARC) of patients with SRM (clinical tumor size ≤3cm) managed by surgery. The cohort was divided into elevated CRP (≥0.5 ng/dL) vs. non-elevated CRP (<0.5 0.5 ng/dL) for descriptive analyses. Primary outcome was non-cancer mortality (NCM). Secondary outcomes included All Cause Mortality (ACM) and progression. Cox-regression analysis was used to elucidate predictive factors for NCM, ACM, and progression. Kaplan Meier Analysis (KMA) was performed to analyze 5 year Overall Survival (OS), Non-Cancer Survival (NCS), Cancer-Specific Survival (CSS), and Progression-Free Survival (PFS). RESULTS: 1014 patients were analyzed (586 non-elevated CRP, 428 elevated CRP). Elevated CRP patients were younger (57.0 vs. 59.5 years, p=0.001) with more diabetes (28.5% vs. 10.4%, p<0.001). Cox-regression revealed increasing age (HR=1.1, p=0.001) and elevated CRP (HR=10.2, <0.001) as independent risk factors for ACM. Increasing age (HR=1.04, p=0.001) and elevated CRP (HR=10.3, p<0.001) were also independently associated with worsened NCM, while high tumor grade (HR=2.4, p=0.012) but not elevated CRP (p=0.275) was an independent risk factor for progression. For elevated CRP, KMA revealed 5 year OS, NCS and CSS of 83%, 86%, and 95%, respectively. For non elevated CRP, KMA revealed 5 year OS, NCS and CSS of 98%, 98%, and 100%. CONCLUSIONS: Elevated CRP was an independent predictor of ACM and NCM, but not progression in patients with SRM. Patients with elevated CRP had lower OS and NCS compared to CSS. In such patients, oncologic risk stratification through biopsy should be considered prior to offering treatment and indolent or low-grade neoplasms should be strongly considered for non-surgical management. Patients with non elevated CRP had similar OS, NCS and CSS, and as such, primary surgical intervention may be considered from a more favorable risk benefit standpoint. Further investigation is requisite. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e804-e804 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Meagher More articles by this author Dattatraya Patil More articles by this author Kazutaka Saito More articles by this author Devin Patel More articles by this author Juan Javier-Desloges More articles by this author Fady Ghali More articles by this author Kevin Hakimi More articles by this author Shady Soliman More articles by this author Julia Yuan More articles by this author Fang Wan More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Loading ...

Patterns of failure after definitive treatment for T4a larynx cancer in the Veterans Affairs Health System.

e18006 Background: Both chemoradiotherapy (CRT) and total laryngectomy (TL) with adjuvant therapy are curative-intent treatment options for patients with T4a larynx cancer. Disease recurrence is a known negative prognosicator, but differences in recurrence patterns and the subsequent survival associations are not well characterized. To address this knowledge gap, we present long-term recurrence and survival outcomes from a novel longitudinal data source. Methods: Retrospective study of non-metastatic T4a larynx cancer patients diagnosed between 2000-2017 who underwent curative-intent treatment (TL with adjuvant therapy or primary CRT) from the VA Informatics and Computing Infrastructure database. Adjuvant therapy consisted of either postoperative radiotherapy (RT) or CRT. Fine-Gray and Cox models were used to evaluate primary outcomes – time to locoregional recurrence and distant recurrence. Secondary outcomes included overall survival (OS), cancer-specific survival (CSS), non-cancer specific survival (NCSS), and disease-free survival (DFS). These multivariable models accounted for age, race, alcohol history, smoking status, education and income, Charlson-Deyo score, N-classification, and tumor subsite. Results: The study included 1,114 patients with a median follow-up time of 63.3 months among those alive at last follow up. In the TL group, adjuvant RT was used in 69% and adjuvant CRT was used in 31%. Median time to first recurrence was 24.4 months with overall incidence of 28.5% locoregional and 9.5% distant recurrence. Primary CRT patients had higher rates of locoregional (37.2 vs. 22.9%) and distant recurrence (13.3 vs. 7.0%) (p &lt; 0.0001). Median OS was 27.3 months for CRT (95% CI: 23.6-32.4 months) and 47.5 months (95% CI: 39.6-52.1 months) for TL. Median DFS was 14.1 months for CRT (95% CI:12.5-17.2 months) and 37.9 months (95% CI 31.2-47.5 months) for TL. On multivariable analysis compared to CRT, TL was associated with longer time to locoregional (HR 0.50, 95% CI:0.40-0.61) and distant recurrence (HR 0.50, 95% CI:0.34-0.73). Having N+ disease increased risk of distant recurrence (HR 2.20, 95% CI:1.42-3.41). TL was associated with improved OS (HR 0.78, 95% CI:0.67 – 0.91), CSS (HR 0.73, 95% CI:0.59 – 0.89), and DFS (HR 0.58, 95% CI 0.49-0.69) compared to CRT; NCSS was equivalent between groups (HR 1.09, 95% CI:0.88-1.35). Of the CRT patients with locoregional failures, 67/163 (41.1%) were salvaged with surgery. Conclusions: In this cohort of T4a larynx cancer patients, surgical management demonstrated favorable recurrence and survival results. TL with adjuvant therapy was associated with significantly lower incidence of both locoregional and distant recurrence and increased OS, CSS and DFS compared to CRT. Lower probability of disease recurrence, in addition to a survival advantage, should be considered as an important advantage to up-front surgery.

Claims-Based Approach to Predict Cause-Specific Survival in Men With Prostate Cancer.

Treatment decisions about localized prostate cancer depend on accurate estimation of the patient's life expectancy. Current cancer and noncancer survival models use a limited number of predefined variables, which could restrict their predictive capability. We explored a technique to create more comprehensive survival prediction models using insurance claims data from a large administrative data set. These data contain substantial information about medical diagnoses and procedures, and thus may provide a broader reflection of each patient's health. We identified 57,011 Medicare beneficiaries with localized prostate cancer diagnosed between 2004 and 2009. We constructed separate cancer survival and noncancer survival prediction models using a training data set and assessed performance on a test data set. Potential model inputs included clinical and demographic covariates, and 8,971 distinct insurance claim codes describing comorbid diseases, procedures, surgeries, and diagnostic tests. We used a least absolute shrinkage and selection operator technique to identify predictive variables in the final survival models. Each model's predictive capacity was compared with existing survival models with a metric of explained randomness (ρ2) ranging from 0 to 1, with 1 indicating an ideal prediction. Our noncancer survival model included 143 covariates and had improved survival prediction (ρ2 = 0.60) compared with the Charlson comorbidity index (ρ2 = 0.26) and Elixhauser comorbidity index (ρ2 = 0.26). Our cancer-specific survival model included nine covariates, and had similar survival predictions (ρ2 = 0.71) to the Memorial Sloan Kettering prediction model (ρ2 = 0.68). Survival prediction models using high-dimensional variable selection techniques applied to claims data show promise, particularly with noncancer survival prediction. After further validation, these analyses could inform clinical decisions for men with prostate cancer.

1127P - Brachytherapy and non-cancer mortality in patients with oral cavity and oropharynx SCCs

BackgroundOral cavity and oropharyngeal squamous cell cancers (OC-OPSCC) display high cancer mortality. Aspiration, infection, other complications or treatment, and age- and substance-related comorbidities contribute to non-cancer mortality. This single-institution study examines cause of death in patients treated for OC-OPSCC with brachytherapy, chemotherapy, external beam radiation, surgery, or combination of modalities. We hypothesize that brachytherapy results in lower non-cancer mortality. MethodsIRB approval was obtained. Our institution’s Tumor Registry and electronic medical record were used to identify patients with a first OC-OPSCC diagnosis between 2000-2010. Patients with a second primary cancer at diagnosis were excluded. The primary outcome was association between treatment modality and non-cancer mortality. Secondary outcomes were effects of comorbidities on death, specific causes of non-cancer mortality, and cancer mortality. ResultsOf 693 eligible patients, 460 were deceased. 84 died of the primary malignancy. Non-primary cancer cause of death was determined in 96 patients; 24 died from a second primary. 193 patients received brachytherapy. Cox proportional hazards regression was performed on treatment regimen, exposures, and non-cancer mortality, stratified by AJCC stage, race, and sex. Age, smoking, and alcohol were associated with worse survival, with HRs of 1.03 (p<0.005), 1.36 (p<0.11), and 2.23 (p<0.005), respectively. Brachytherapy had a notable 0.52HR (p<0.005). Non-smoking OPC patients had a 76% 5-year overall survival (OS), suggesting these were largely HPV-driven cancers. In smokers with OPC, OS was 33% at 5 years, with a HR of 0.35 for brachytherapy-treated patients. ConclusionsWe report non-cancer mortality from an extensively annotated cohort of curatively treated OC-OPSCC. We show a significant correlation between receipt of brachytherapy and non-cancer survival, independent of remission status. Potential explanations include improved disease control, patient selection, and reduced exposure to external beam radiation. Although HPV status was not available, OPC in non-smokers displayed OS characteristic for HPV-associated cancer. The impact of brachytherapy in OPC was strongest in smokers. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureS. Mehra: Research grant / Funding (institution): DePuy Synthes Educational Grant for Yale Head and Neck Surgery Fellowship. B. Burtness: Advisory / Consultancy: Aduro; Advisory / Consultancy: Alligator Biosciences; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Celgene; Advisory / Consultancy: Cue Biopharma; Advisory / Consultancy: Genentech/Roche; Advisory / Consultancy: Glaxo Smith Kline; Advisory / Consultancy: IDDI; Advisory / Consultancy: Merck. All other authors have declared no conflicts of interest.

Using tumor genomic profile testing and comorbidity level to personalize chemotherapy decisions among older patients with early-stage breast cancer.

e12055 Background: Under-representation of women ages 65+ (“older”) in the trials may limit clinical translation of results to this growing population. We used simulation modeling to estimate chemotherapy outcomes by age and comorbidity level among older women with early stage, estrogen-receptor+/HER2- breast cancers with an Oncotype DX score of 26+. Methods: A discrete-time stochastic state-transition model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups of women based on age (65-69, 70-74, 75-79, and 80-89) and comorbidity levels (no/low, moderate, and severe). Age-, comorbidity-specific non-cancer survival was derived from a random 5% sample of women enrolled in the Medicare Part A and B program from 1992 to 2005 and included in the SEER areas. Outcomes included life years (LYs), quality-adjusted life years (QALYs), and breast cancer and other-cause mortality with chemoendocrine therapy or endocrine therapy alone. Sensitivity analysis tested the impact on outcomes of varying values of uncertain parameters. Results: Women with life expectancies of ≥ 7 years had net gains of 0.17 to 0.45 LYs (2.0-5.4 months) with chemotherapy; this group was mainly women aged 65-69 and 70-74 with no/low or moderate comorbidity. Women destined to develop distant recurrence gained between 4.2-10.4 months. LYs were reduced by chemotherapy toxicity. The majority of women died of other causes, ranging from 59% to 98% across all age groups and comorbidity levels, but chemotherapy reduced breast cancer mortality by 14.5% and 25.7% among women ages 65-69 and 70-74 with no/low comorbidity, respectively. Results were robust in sensitivity analyses, and chemotherapy improved all outcomes as treatment efficacy increased, assuming no change in toxicity. Conclusions: Older women with early stage, estrogen-receptor+/HER2- breast cancers with Oncotype DX scores of 26+ may benefit from chemotherapy, when both conditions of age &lt;75 and comorbidity at no/low or moderate level can be met. Personalized treatment decisions for older women will ultimately depend on comorbidity-specific lifespan and individual preferences for the balance of benefits and harms of chemotherapy.

SBRT for Central Tumors in Early Stage NSCLC Patients

For NSCLC patients treated with SBRT, we investigated if proximity to the proximal bronchial tree is associated with non-cancer death. From 2006-2013 patients with a single early stage NSCLC tumors were irradiated with CBCT guided SBRT (median dose 54 Gy in 3 fractions) in 5 institutes. Patients with progressive disease, metastases, or second cancers at the time of death were scored as death from cancer; all other deceased patients were scored as non-cancer death. Treatment plans were collected, and the main and lobar bronchi were automatically delineated using atlas based segmentation. For each patient the shortest distance from the edge of the GTV to the proximal bronchial tree (PBT) was determined. Patients were stratified into 3 groups; GTV≥2 cm from the PBT (peripheral (A); RTOG 0236), GTV ≥1 cm and < 2 cm from the PBT (B), and GTV <1 cm from the PBT (C). Actuarial non-cancer survival at 1y, 2y and 5y were determined (i.e., death from cancer was censored). Association between the stratified distance of the GTV to the PBT and non-cancer death were evaluated using univariate Cox regression (at the P<0.05 level), and compared to the association with cause specific survival to test for competing mortality risk. Finally, the stratified distance was included in a multivariate Cox analysis, also including; age, gender, performance status, comorbidity index, lung-function FEV1, Mean Lung Dose, tumor diameter, and smoking history. Seven hundred sixty-nine patients were identified with a median age of 75 y. Median Biologically Equivalent Dose (a/b = 10 Gy) was 126 Gy, 180 Gy and 227 Gy for group C, B, and A, respectively, with 33, 71 and 665 patients per group. Median GTV diameter was 4.1 cm (1.1-7.0), 2.7 cm (0.9-5.7) and 2.2 cm (0.7-6.5) for groups C, B, and A, respectively. Survival rates were lower for patients in group C (Table 1) with a Hazard ratio (HR) of 2.91 (P < 0.001). Patients in group B had a lower, non-significant HR of 0.87 (P = 0.554). The association with cause specific survival showed a significantly higher HR (2.45, P = 0.036) for patients in group C with respect to A, but not B. In the multivariate Cox analysis, the stratified distance from the GTV to PBT was significantly associated with non-cancer death (group C: P<0.001, HR = 3.56, group B: P = 0.319, HR = 0.79), as well as age (P = 0.001, HR = 1.03), performance status (P<0.001, HR = 0.30) and lung-function FEV1 (P = 0.004, HR = 0.99). Patients with a tumor < 1 cm from the proximal bronchial tree had 3.56 fold higher risk of non-cancer death than patients with a peripheral tumor. Delivered dose distributions will be further studied.Tabled 1Abstract 35; Table 1 Actuarial survival for non-cancer death for (A) GTV≥2 cm from the PBT (peripheral; RTOG 0236), (B) GTV ≥1 cm and < 2 cm from the PBT, and (C) GTV <1 cm from the PBTTotal (#)1 year survival (%)2 year survival (%)5 year survival (%)A: GTV ≥ 2 cm665917748B: GTV ≥ 1 cm and < 2 cm71917658C: GTVs < 1cm33773814 Open table in a new tab

Maximal Oxygen Uptake—Risk Predictor of NSCLC Resection in Patients With Comorbid Emphysema: Lessons From NETT

We compared VO2 max values from ACCP Guidelines and from NETT's homogenous NULPD surrogate for predicting operative mortalities. Estimated mid and long-term non-cancer related survival in NETT's subset was also obtained. NETT and ACCP Guideline VO2 max values were similar in the "low" and "mid" risk operative mortality categories but NETT's "high" risk subset showed lower mortality (14% vs. 26%). Estimated non-cancer related survival in NETT "low", "mid" and "high" risk VO2 max categories at two and eight years were 100%, 74%, 59% and 48%, 26%, 14%, respectively. The lower predicted risk in NETT's "high- risk" subset raises the possibility of extending indications for potential curative resection in selected patients. The NETT surrogate also provides hitherto unavailable estimate on long-term non-cancer related survival after potential curative resection of NSCLC and suggests that the operation does not shorten eight-year longevity.

Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients.

BackgroundIndigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia.MethodsA cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998–2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models.ResultsOverall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83).ConclusionIn this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.

648 Oncological outcomes and non-cancer specific survival of partial nephrectomy for renal cell carcinoma: A single center matched-pair comparison with radical nephrectomy

648 Oncological outcomes and non-cancer specific survival of partial nephrectomy for renal cell carcinoma: A single center matched-pair comparison with radical nephrectomy

Life tables adjusted for comorbidity more accurately estimate noncancer survival for recently diagnosed cancer patients

ObjectivesTo provide cancer patients and clinicians with more accurate estimates of a patient's life expectancy with respect to noncancer mortality, we estimated comorbidity-adjusted life tables and health-adjusted age. Study Design and SettingUsing data from the Surveillance Epidemiology and End Results–Medicare database, we estimated comorbidity scores that reflect the health status of people who are 66 years of age and older in the year before cancer diagnosis. Noncancer survival by comorbidity score was estimated for each age, race, and sex. Health-adjusted age was estimated by systematically comparing the noncancer survival models with US life tables. ResultsComorbidity, cancer status, sex, and race are all important predictors of noncancer survival; however, their relative impact on noncancer survival decreases as age increases. Survival models by comorbidity better predicted noncancer survival than the US life tables. The health-adjusted age and national life tables can be consulted to provide an approximate estimate of a person's life expectancy, for example, the health-adjusted age of a black man aged 75 years with no comorbidities is 67 years, giving him a life expectancy of 13 years. ConclusionThe health-adjusted age and the life tables adjusted by age, race, sex, and comorbidity can provide important information to facilitate decision making about treatment for cancer and other conditions.

Biomarkers associated with metabolic syndrome, endometrioid adenocarcinoma (EC) of the uterus, and disease prognosis

Objective: Literature suggests obesity represents a significant risk factor for the development of EC and other health problems such diabetes mellitus (DM) and cardiovascular disease (CVD). Breast cancer literature suggests inflammatory biomarkers associated with adiposity are associated with cancer and non-cancer survival outcomes. Our objective was to determine whether inflammatory biomarkers associated with obesity and metabolic syndrome in patients with EC are associated with multiple clinicopathologic factors, including disease recurrence and overall survival.

A gene expression signature to predicit overall, prostate cancer, and non–prostate cancer survival.

51 Background: For prostate cancer patients, prostate cancer specific and non-prostate cancer specific survival have the same importance. This study aimed at identifying expression biomarkers that can predict prostate cancer specific, non-prostate cancer specific and overall survival at diagnosis. Methods: Selected ESCGPs (embryonic stem cell gene predictors) and control genes were analyzed by multiplex quantitative PCR using prostate fine-needle aspiration samples taken at diagnosis from a Swedish cohort of 189 prostate cancer patients diagnosed between 1986 and 2000. Of all patients, 97.9% had overall and cancer-specific survival data and 77.9% were primarily treated only by hormone therapy. The cohort was divided into one discovery and two validation subsets. Univariate and multivariate Cox proportional hazard ratios and Kaplan-Meier plots were used for the survival analysis. A published dataset was used for external validation. Results: An expression signature of F3, VGLL3 and IGFBP3, was sufficient to categorize the patients into high-risk, intermediate-risk and low-risk subtypes. The median overall survival of the subtypes was 3.23, 4.00 and 9.85 years respectively. The difference corresponded to HRs of 5.86 (95% CI 2.91-11.78, P&lt;0.001) for the high-risk and 3.45 (95% CI 1.79-6.66, P&lt;0.001) for the intermediate-risk compared to the low-risk subtype. This signature is significant in correlation to overall, cancer-specific and non-cancer specific survival in both univariate and multivariate analyses including common clinical parameters. Conclusions: These results suggest that these novel expression biomarkers and the expression signature could be used to improve the accuracy of the currently available clinical tools for predicting overall, cancer-specific and non-cancer specific survival and selecting patients with potential survival benefit from hormone treatment.

Biomarkers associated with metabolic syndrome, endometrioid adenocarcinoma (EC) of the uterus, and disease prognosis

Objectives: Literature suggests that obesity represents a significant risk factor for the development of EC as well as development of other health problems such diabetes mellitus, cardiovascular disease, and depression. Breast cancer literature also suggests that inflammatory biomarkers associated with adiposity are associated with long term cancer and non-cancer survival outcomes. Our objective was to determine whether inflammatory biomarkers associated with obesity and metabolic syndrome in patients with EC are associated with multiple clinicopathological factors including disease recurrence and overall survival.

80 is the new 60: Implications of Irrational Exuberance Regarding Longevity on Prostate Cancer Treatment Decisions

80 is the new 60: Implications of Irrational Exuberance Regarding Longevity on Prostate Cancer Treatment Decisions

Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy?

To investigate whether radical nephrectomy (RN) and nephron-sparing surgery (NSS) for T1 renal cell carcinoma influence renal function, oncological outcome or survival rate. A retrospective study was performed, including 290 nephrectomies for tumours of a diameter of less than 7 cm; 174 radical nephrectomies were compared to 116 nephron-sparing surgeries. Preoperative and pathological data were compared between the two groups. The glomerular filtration rate was estimated using the abbreviated Modification of Diet and Renal Disease (MDRD4) study equation. The evolution of renal function was analysed from 6 months to 4 years after surgery, and the oncological outcomes were evaluated by means of cancer and non-cancer survival curves. The results showed a major impairment in renal function in the RN group compared to those who underwent NSS (25 vs 7 ml/min/1.73 m², 6 months after surgery), a difference that was maintained over time. Moreover, patients undergoing RN had a greater chance of developing renal failure. Overall, the survival curves showed a higher mortality rate for the RN group (p = 0.034), although the cancer-specific mortality rate did not show any statistically significant differences (p = 0.079). For stage T1 renal cortical tumours, NSS should, whenever possible, be regarded as the primary therapeutic option, given that it obtains similar oncological outcomes to RN and preserves renal function, which seems to translate into a lower overall mortality rate.

The impact of young age on cancer-specific and non-cancer-related survival after surgery for colorectal cancer: 10-year follow-up

Background:It has been reported that although young patients present with more advanced disease, when adjusted for stage, cancer-specific survival is not different after surgery for colorectal cancer. However, few studies have examined non-cancer survival in young patients and 10-year survival has rarely been reported. Moreover, the largest study included patients of old age as a comparator. The aim of this study was to compare cancer-specific and non-cancer-related survival at 10 years in a young age cohort and a middle age cohort in patients undergoing surgery for colorectal cancer.Methods:Two thousand and seventy seven patients who underwent surgery for colorectal cancer between 1991 and 1994 in 11 hospitals in Scotland were included in the study. Ten-year cancer-specific and non-cancer-related survival and the hazard ratios (HR) were calculated according to age groups (<45/45–54/55–64/65–74 years).Results:On follow-up, 1066 patients died of their cancer and 369 died of non-cancer-related causes. At 10 years, overall survival was 32%, cancer-specific was 45%, and non-cancer-related survival was 72%. On multivariate analysis of all factors, sex (HR 0.77, 95% CI 0.68–0.88, P<0.001), mode of presentation (HR 1.64, 95% CI 1.44–1.87, P<0.01), Dukes’ stage (HR 2.69, 95% CI 2.49–2.90, P<0.001), and specialisation (HR 1.24, 95% CI 1.04–1.44, P<0.01) were independently associated with cancer-specific survival. On multivariate analysis of all factors, age (HR 2.46, 2.04–2.97, P<0.001), sex (HR 0.56, 0.45–0.70, P<0.001), and deprivation (HR 1.16, 1.10–1.24, P<0.001) were independently associated with non-cancer-related survival.Conclusion:The results of this study confirm that young age does not have a negative impact on cancer-specific survival. Moreover, they show that, with 10-year follow-up, young age does not have a negative impact on non-cancer-related survival.

The relationship between gamma glutamyl transferase and survival in patients undergoing potentially curative resection for colorectal cancer

Introduction: A large population study recently reported elevated gamma-glutamyl-transferase (GGT) was associated with poorer cancer and non-cancer survival (Kazemi-Shirazi, 2007). In cancer patients the basis of this observation is unclear. One hypothesis is that oxidative stress associated with tumour burden or systemic inflammation may be responsible. This study examines the prognostic value of elevated GGT and its relationship with tumour stage and the systemic-inflammatory-response (Glasgow Prognostic Score (GPS), McMillan, 2007) in primary operable colorectal cancer.