OS Rates Of Patients Research Articles

The importance of clinical and pathological features in bladder cancer and its effects on disease course

Objective: Bladder cancer (BC) is the most common malignancy of the urinary system and the incidence of BC varies regionally. Bladder cancer is more common in men than in women. Tumor stage and grade are the most important prognostic factors of BC. We aimed to describe the patterns of BC presentation and to examine the differences in the distribution of prognostic factors by gender, age, tumor size, and involvement region. Method: The patients diagnosed with BC (non-muscle invasive or muscle-invasive BC) were included. Intravesical treatment, tumor diameter, pathological grade, tumor involved area and tumor stage were recorded as variables. The survival rates of the patients were calculated for diverse clinical and pathological findings. Results:In a total of 124 patients, 23 (18.5%) of patients were female and 101(81.5%) of patients were male, the median age of all patients was 64 (IQR: 21-92). There were 36 % (41) patients in early-stage (stage 0 or stage insitu), 50.9 % (58) patients in stage 1, 7% (8) patients in stage 2, 4.4 %(5) patients in stage 3 and 1.8% (2) patients were in stage 4. There were significantly different OS rates of patients with BC in different stages (p 2.5cm (group 2). There was a significant difference between the overall survival rates of group 1 and group 2(p=0.02). There were 55 patients with low-grade BC and 38 of patients with high-grade BC, and the difference between their survival rates was statistically significant (p=0.001). Conclusions: Tumor stage, tumor diameter, and grade were demonstrated and confirmed as the crucial prognostic factors of bladder cancer. Additionally, lateral walls of bladder constitute the most commonly involved area, but their roles in the disease course still remain unclear.

112P - A retrospective analysis of the association between perioperative, post adjuvant carcinoembryonic antigen level and prognosis in stage III colorectal cancer

BackgroundCarcinoembryonic antigen (CEA) is the most widespread tumour marker of colorectal cancer, however, it is not helpful to judge for recurrence of the disease because of low sensitivity and specificity. It is recommended for patients who were diagnosed with pStage III colorectal cancer to receive adjuvant chemotherapy after curative resection and to measure CEA every 3 months. Moreover, It is reported that postoperative CEA level is more informative than preoperative CEA level about the impact for prognosis but the association between postoperative, post adjuvant CEA level and the prognosis is still unclear. This study aimed to evaluate whether perioperative and post adjuvant CEA level was useful for estimation of the prognosis in stage III CRC. MethodsThis retrospective study was conducted at the Cancer Institute Hospital of JFCR. A total of 567 consecutive patients who underwent curative resection for stage III colon adenocarcinoma and adjuvant chemotherapy in our hospital from March 2005 to December 2013 were identified. The patients who received bevacizumab as adjuvant chemotherapy and didn’t measure CEA were excluded. ResultsThe 3-year DFS rate in patients with normal preoperative CEA is superior to patients with high preoperative CEA (HR:1.59;95%CI:1.10-2.31, p = 0.014). There was no significant difference in the 5-year OD between the two groups (HR1.17;95%CI:0.62–2.20, p = 0.63). The 3-year DFS rate and 5-year OS rate in patients with normal postoperative CEA were superior to patients with high postoperative CEA (HR:2.18;95%CI:1.23–3.88, p = 0.0079, and HR:2.40;95%CI:1.02–5.69, p = 0.046). The 3-year DFS in patients with normal postadjuvant CEA was superior to patients with high postadjuvant CEA(HR1.79;95%CI:1.23–3.88, p = 0.022), whereas regarding the 5-year OS there was no significant difference between the two groups (HR2.10;95%CI:0.98–4.53, p = 0.057).In the multivariate analysis, the histological type and N-stage were predictive factors of OS. ConclusionsHigh postoperative and post adjuvant CEA level may be negative prognosis factors for OS in patients who underwent curative resection for stage III CRC. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

PC04.02 CON: ICI Is Enough

PC04.02 CON: ICI Is Enough

Clinical Efficacy of R-EDOCH Protocol in the Treatment of Newly Diagnosed Double Expression Lymphoma

To investigate the clinical efficacy of R-EDOCH protocol in the treatment of newly diagnosed double expression lymphoma. The clinical data of 51 patients with newly diagnosed double expression lymphoma treated by R-EDOCH protocol were retrospectively analyzed in the period from May 2012 to October 2017, then overall remission rate (ORR), disease control rate (DCR), progression-free survival (PFS) rate and total survival (OS) rate were evaluated; moreover the patients were grouped according to IPI score and whether accepting hematopoietic stem cell transplantation(HSCT) and the clinical efficacy was compared. The ORR was 96.08% (49/51) and DCR was 100.00% (51/51) in all patients. Six cases out of 51 patients (11.76%) relapsed and progressed during the followed-up. The followed-up showed that 2 year-PFS rate and OS rate were 84.31% (43/51) and 94.12% (48/51) respectively. The ORR, SD rate, 2 year-PFS rate and OS rate in the patients with IPI 0-2 and 3-5 scores were no statistically different(p>0.05); the 2 year-PFS and OS rates between patients in subgroup of IPI 0-2 and 3-5 scores also were not statistically different (p>0.05), no matter whether the patients received auto-HSCT or not. The comparison of 2 year-PFS and OS rates in auto-HSCT patients and non-auto-HSCT patients showed no statistical difference(p>0.05). The R-EDOCH protocol in treatment of newly diagnosed double expression lymphoma possess the good overall clinical efficacy, the combination of R-EDOCH with auto-HSCT displays ascending trend of PFS.

Influence of lymph node dissection in patients undergoing radical nephrectomy for non-metastatic renal cell carcinoma: a systematic review and meta-analysis.

Whether lymph node dissection (LND) should be performed concomitantly with radical nephrectomy (RN) for non-metastatic renal carcinoma has still been controversial recently. We conducted a meta-analysis assessing oncologic outcomes of radical nephrectomy with lymph node dissection (LND) and without lymph node dissection (non-LND) in non-metastatic renal cell carcinoma (NMRCC). A systematic review was performed until April 2018 using a comprehensive search in PubMed, EMBASE, and Cochrane Library databases to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing radical nephrectomy with LND and radical nephrectomy with non-LND for cT1-T4NxM0 tumors. Furthermore, a subgroup analysis for locally advanced renal cell carcinoma (cT3-T4NxM0) was conducted. Thirteen studies on patients with LND and non- LND were identified and included in the analysis. LND group did not have a significantly better survival than non-LND group for cT1-T4NxM0 tumors (HR 0.93, 95% CI 0.78-1.11, p=0.45), However, in the subgroup of locally advanced renal cell carcinoma (cT3-T4NxM0), it showed a significantly better OS rate in patients who had undergone LND compared to those without LND (HR 0.73, 95% CI 0.60-0.90; p=0.003). LND offers better cancer control and better long-term survival in locally advanced renal cell carcinomas (cT3-T4NxM0). This conclusion should be confirmed by a prospective randomized clinical trial.

The prognostic significance of dynamic monitoring of minimal residual disease (MRD) status in patients with newly-diagnosed multiple myeloma

目的探讨多发性骨髓瘤（MM）患者微小残留病（MRD）动态变化及其与临床特征、治疗和预后的关系。方法纳入105例治疗后达到非常好的部分缓解（VGPR）的MM患者，采用多参数流式细胞术（MFC）动态监测MRD状态，结合临床数据和随访，进行Kaplan-Meier曲线及Cox回归等分析。结果①纳入本研究的疗效VGPR患者中，MRD转阴率为72.4%（76/105），中位转阴时间为3个月。②MRD阴性患者2年无进展生存（PFS）率明显高于MRD阳性患者（62.2%对41.3%，P=0.001），持续MRD阳性为PFS独立预后不良因素（HR=3.039，P=0.044）。③失去MRD阴性状态（转阳）患者预后劣于MRD持续阴性患者，二者中位PFS时间分别为18个月和未达到（P<0.001），中位总生存（OS）时间均未达到（P=0.002）。④MRD阴性持续时间≥12个月患者的2年PFS和OS率均显著高于对照组（PFS：77.7%对36.7%，P<0.001；OS：96.4%对57.9%，P<0.001）。随MRD阴性持续时间延长，复发/死亡风险显著降低（PFS：HR=0.865，P<0.001；OS：HR=0.823，P<0.001）。⑤高危细胞遗传学异常（CA）或不适合自体造血干细胞移植（ASCT）患者中，MRD阴性患者PFS延长（高危CA患者中位PFS：未达到对19个月，P=0.006；不适合ASCT患者中位PFS：未达到对25个月，P=0.052）。⑥应用硼替佐米治疗可明显延长MRD阴性持续时间（中位MRD阴性持续时间：25个月对10个月，P=0.034）。结论持续MRD阳性是MM独立的预后不良因素，MRD阴性持续时间是另一重要预后因素，而失去MRD阴性状态可能是复发的早期标志，故动态监测MRD有助于指导复发MM治疗时机的选择。

The impact of posthepatectomy liver failure on long-term survival after hepatectomy for colorectal liver metastasis

BackgroundPostoperative complications affect both the short-term and long-term outcomes. The aim of this study was to identify specific prognostic factors among complications after hepatectomy for colorectal liver metastasis (CRLM). MethodsBetween 2002 and 2014, 427 patients underwent initial hepatectomy for CRLM. The clinicopathological parameters including postoperative complications were evaluated to identify the prognostic factors for the overall (OS) and relapse-free survival (RFS). ResultsOne hundred and forty-nine patients (34%) developed postoperative complications, including surgical site infection (n = 49, 11.4%), bile leakage (n = 41, 9.6%), posthepatectomy liver failure (PHLF) (n = 26, 6.0%), and pulmonary complication (n = 20, 4.6%). The independent predictors of RFS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, bilateral CRLMs, ≥5 CRLMs, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year RFS rates in patients with and without PHLF were 8% and 32%, respectively (P < 0.001). The independent prognostic factors for OS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, positive surgical margins, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year OS rates in patients with and without PHLF were 31% and 63%, respectively (P = 0.004). ConclusionsAmong the complications, only PHLF was associated with decreased long-term survival after hepatectomy for CRLM as well as tumor-specific prognostic factors.

134P - A retrospective analysis of the association between perioperative carcinoembryonic antigen level and prognosis in stage III colorectal cancer

Abstract Background Carcinoembryonic antigen (CEA) is the most widespread tumour marker of colorectal cancer, however, it is not helpful to judge for recurrence of the disease because of low sensitivity and specificity. It is recommended for patients who were diagnosed with pStage III colorectal cancer to receive adjuvant chemotherapy after curative resection and to measure CEA every 3 months. Moreover, It is reported that postoperative CEA level is more informative than preoperative CEA level about the impact for prognosis but the association between postoperative, post adjuvant CEA level and the prognosis is still unclear. This study aimed to evaluate whether perioperative and post adjuvant CEA level was useful for estimation of the prognosis in stage III CRC. Methods This retrospective study was conducted at the Cancer Institute Hospital of JFCR. A total of 567 consecutive patients who underwent curative resection for stage III colon adenocarcinoma and adjuvant chemotherapy in our hospital from March 2005 to December 2013 were identified. The patients who received bevacizumab as adjuvant chemotherapy and didn’t measure CEA were excluded. Results The 3-year DFS rate in patients with normal preoperative CEA is superior to patients with high preoperative CEA (HR:1.59;95%CI:1.10-2.31, p = 0.014). There was no significant difference in the 5-year OD between the two groups (HR1.17;95%CI:0.62–2.20, p = 0.63). The 3-year DFS rate and 5-year OS rate in patients with normal postoperative CEA were superior to patients with high postoperative CEA (HR:2.18;95%CI:1.23–3.88, p = 0.0079, and HR:2.40;95%CI:1.02–5.69, p = 0.046). The 3-year DFS in patients with normal postadjuvant CEA was superior to patients with high postadjuvant CEA(HR1.79;95%CI:1.23–3.88, p = 0.022), whereas regarding the 5-year OS there was no significant difference between the two groups (HR2.10;95%CI:0.98–4.53, p = 0.057).In the multivariate analysis, the histological type and N-stage were predictive factors of OS. Conclusions High postoperative and post adjuvant CEA level may be negative prognosis factors for OS in patients who underwent curative resection for stage III CRC. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

ICE Regimen for Relapsed/Refractory Bone and Soft Tissue Sarcomas in Children.

The outcome of bone and soft tissue sarcomas (BST) after relapse has very poor prognosis with survival rates less than 39%. Unfortunately there are not many treatment options, but promising responses have been reported with ifosfamide, etoposide and carboplatin (ICE). Therefore, we planned a study for children with recurrent/refractory BST treated with ICE regimen to evaluate their demographic features, responses to treatment and outcome. Patients with primary diagnosis of BST and treated with ICE regimen at the time of first or subsequent relapse, progression or unresponsive disease were selected for study. The files were retrospectively evaluated. Thirty of sixty-six patients had metastatic disease at relapse. Patients received median 5 cycles of ICE and were followed-up median 16.3 months. Overall survival rates were 83% and 62% at 1st and 2nd year. The ORR to the regimen was 43%. Survival rates were significantly higher in good responders (3-year EFS and OS rates: 50% vs. 8% and 78% vs. 14%; p<0.0001 and p<0.0001). Survival rates for non-metastatic disease were 42% and 75% for EFS and OS and higher than patients with metastases at relapse (p<0.001 and p<0.0001). EFS and OS rates of patients with rhabdomyosarcoma were 42% and 69%. No grade 3 or 4 renal toxicity was documented. ICE combination improves the outcome of relapsed or refractory sarcomas and it might serve as second line treatment. Patients with no metastases at relapse would benefit more than others with metastatic disease.

Effect of multiagent chemotherapy and chemoradiotherapy on rates of resection and survival in patients with locally advanced pancreatic cancer: a National Cancer Database Analysis.

391 Background: The role of multiagent chemotherapy (MAC) has not been prospectively investigated in LAPC and data are extrapolated from randomized trials in patients with metastatic disease. Data regarding the use of chemoradiation (CRT) for LAPC is mixed and similarly there is no prospective data investigating its use after MAC. Herein, we investigate clinical outcomes associated with the use of MAC and CRT. Methods: The National Cancer Database (NCDB) was utilized to identify LAPC patients treated with single agent chemotherapy (SAC), MAC, surgery, and/or CRT. Univariate (UVA) and multivariate (MVA) Cox regression were performed to identify the impact of MAC and CRT on surgical resection and median overall survival (mOS) rates. Results: From 2004-2014, a total of 10139 patients were identified. The median age was 66 years (range 22-90) with median follow up of 49 months (46-52 months); 49.9% were male and 50.1% female. All patients had clinical stage 3/T4 disease irrespective of nodal metastases. All patients who received post-op RT were excluded. Surgical resection was performed in 506 (5%) patients. Median OS rates for patients who received SAC vs. MAC was 9.8 months vs 13.7 months (p &lt; 0.001), respectively. Median OS rates for patients who received SAC/MAC vs. SAC/MAC+CRT was 9.9 months vs. 12.9 months (p &lt; 0.001), respectively. Odds ratio for undergoing surgical resection in patients receiving MAC vs. MAC+RT was not significant. Of the 5% of patients who underwent resection after neoadjuvant therapy, mOS for those who received MAC vs. MAC+RT were 19.4 months and 25.6 months (p = 0.001), respectively. Conclusions: Median OS was improved in patients receiving MAC versus SAC. The use of CRT after chemotherapy led to increased mOS compared to chemotherapy alone. In all patients undergoing surgical resection, the addition of neoadjuvant CRT after MAC led to improved mOS rates. Treatment with MAC followed by CRT should be utilized for all patients with LAPC.

Association of delayed commencement of adjuvant chemotherapy (AC) with inferior survival in colon cancer patients with stage II and III diseases: A national population-based cohort study.

669 Background: To evaluate factors affecting the delay ( ≥ 8 weeks) of AC and the impact of chemotherapy delay on survival in patients with colon cancer(CC). Methods: The study cohort consisted of patients with stage II and III colon cancer, diagnosed between January 1, 2011 and December 31, 2012, who underwent curative resection and AC at all hospitals registered in the Korean Health Insurance Review and Assessment Service (HIRA). Detailed clinical data are from monitoring and evaluation of quality of colon cancer care. Results: Among 5355 patients, 154 (2.9%) received AC more than 8 weeks after surgery. Based on multivariate analysis, risk factors associated with AC delay ≥ 8 weeks were: older age [65 to 74 years (hazard ratio, HR = 1.48) and 75 years (HR = 1.69), p = 0.0354], medical aid status in health security system (HR = 1.76, p = 0.0345), emergency surgery (HR = 2.43, p = 0.0002), and chemotherapy with fluoropyrimidine (HR = 1.49, p = 0.0373). Independent prognostic factors for inferior OS included AC delay ≥ 8 weeks (HR = 1.49, p = 0.0365), older age [65 to 74 years (HR = 1.94) and 75 years (HR = 3.41), p &lt; 0.0001], TNM III stage (HR = 2.46, p &lt; 0.0001), emergency surgery (HR = 1.89, p &lt; 0.0001), ASA score with 3 or higher (HR = 1.50, p &lt; 0.0001), and higher transfusion amount (HR = 1.09, p = 0.0392). OS rates in patients with stage II / III CCs according to delay of AC using 8 weeks cutoff showed inferior OS in the delayed chemotherapy group (p = 0.008).Detailed OS rates were 97.81% at 1 year, 93.77% at 2 year, 89.62% at 3 year, and 85.79% at 4 year in the chemotherapy group within 8weeks. In the delayed chemotherapy group ≥ 8 weeks, OS rates were 96.1% at 1 year, 87.66% at 2 year, 80.98% at 3 year, and 80.2% at 4 year. Conclusions: This national population-based cohort study shows that delayed commencement of AC, defined as ≥ 8 weeks, is associated with inferior OS in CC patients with stage II / III. To reduce the proportion of patients receiving delayed AC, multidimensional aspects such as health insurance status or age should be considered. Based on our results, the time of commencement of chemotherapy can be incorporated as another quality indicator for colon cancer care.

A Risk Stratification Model Using Quantification of Circulating Plasma Cells in Multiple Myeloma Prior to Autologous Stem Cell Transplantation in the Era of Novel Agents

Background: The presence of circulating plasma cells (CPCs) is associated with an adverse prognosis in multiple myeloma along the entire spectrum of disease. However, the impact of CPCs prior to autologous stem cell transplantation (ASCT) has not been defined in the era of novel agents. The objective of this study is to assess the impact of the presence and number of CPCs before transplant using 6-color multiparameter flow cytometry (MFC). We also explored the additional prognostic implications of CPCs over the current paradigm for risk stratification at transplant, including high-risk (HR) cytogenetics and disease status at transplant by the IMWG criteria. Methods: A total of 1113 consecutive patients transplanted between 2007 and 2015 in Mayo Clinic were included in the study. Flow-cytometry of peripheral blood to identify clonal CPCs is routinely performed in all patients before ASCT in Mayo Clinic, Rochester. The mononuclear cells from peripheral blood samples are isolated by Ficoll gradient and subsequently stained with antibodies to CD19, CD38, CD45, CD138 and cytoplasmic kappa (κ) and lambda (λ) immunoglobulin light chains. Clonality is assessed by light chain restriction (κ:λ expression ratio of 4:1 [κ restricted] or 150,000 cellular events. For samples where less than 150,000 clonal events are examined, the number of final clonal events is adjusted to 150,000 events. HR cytogenetics by fluorescence in situ hybridization (FISH) on bone marrow (BM) plasma cells was defined by one of the following abnormalities: t(4;14), del(17p), t(14;16), t(14;20) or +1q, detected at any time point from diagnosis to transplant. Patients who had insufficient plasma cells for FISH analysis in BM specimens were not included in the denominator to calculate the percentage of patients with HR cytogenetics. The primary end-points of this study were post-transplant response, PFS and OS. Result: CPCs were detected in 238 out of 1113 (21.4%) patients, with the median number of CPCs being 82 (range, 1-102381) per 150,000 events. The median age of patients at transplant was 62 years. A total of 1097 (99%) patients had received novel agent based induction therapy with PIs and IMiDs, including 458 (41%) patients who had received both PIs and IMiDs. 401 (36%) patients had received post-transplant maintenance or consolidation therapy. The frequency of t(4;14) in BMPCs was significantly higher in patients with CPCs compared to those without [15.2 vs 7.0% for t(4;14); P P 400 (n=51; 4.6%). The number of patients achieving stringent complete response post-transplant in groups with no CPCs, 0 400 was 310 (36%), 31 (16%) and 3 (6%) respectively ( P P P 400 had an increased risk of death, independent of the presence of HR cytogenetics and disease status at transplant. Conclusion: Our study shows the strong negative prognostic impact of CPCs prior to transplant on post-transplant response and survival in MM in the era of novel agents. The proposed risk stratification model can be easily employed with simple equipment and should be routinely incorporated in the pre-transplant workup. Detailed epigenomic, genomic and transcriptomic analysis of CPCs is urgently needed to uncover the biological basis of resistance to both high-dose cytotoxic therapy and novel agents and identify potential avenues of targeted therapy against CPCs. Disclosures Kumar: Onyx: Consultancy, Research Funding; Kesios: Consultancy; Celgene: Consultancy, Research Funding; Glycomimetics: Consultancy; AbbVie: Research Funding; BMS: Consultancy; Sanofi: Consultancy, Research Funding; Skyline: Honoraria, Membership on an entity9s Board of Directors or advisory committees; Millennium: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Array BioPharma: Consultancy, Research Funding; Noxxon Pharma: Consultancy, Research Funding. Dispenzieri: Takeda: Membership on an entity9s Board of Directors or advisory committees, Research Funding; Alnylam: Research Funding; GSK: Membership on an entity9s Board of Directors or advisory committees; pfizer: Research Funding; Prothena: Membership on an entity9s Board of Directors or advisory committees; Celgene: Research Funding; Jannsen: Research Funding. Kapoor: Celgene: Research Funding; Amgen: Research Funding; Takeda: Research Funding. Gertz: Sandoz Inc: Honoraria; NCI Frederick: Honoraria; Celgene: Honoraria; Alnylam Pharmaceuticals: Research Funding; GSK: Honoraria; Novartis: Research Funding; Research to Practice: Honoraria, Speakers Bureau; Med Learning Group: Honoraria, Speakers Bureau; Ionis: Research Funding; Prothena Therapeutics: Research Funding; Annexon Biosciences: Research Funding.

Combined measurements of tumor number and size helps estimate the outcome of resection of Barcelona clinic liver cancer stage B hepatocellular carcinoma.

BackgroundAlthough the Barcelona Clinic Liver Cancer (BCLC) staging system suggests that patients with stage B hepatocellular carcinoma (HCC) should be treated with transcatheter arterial chemoembolization instead of surgical treatment, recent studies indicated that the prognosis of surgical resection for patients with BCLC stage B HCC was better than that of TACE. However, the portion of patients with stage B that will achieve better outcomes from surgical treatment remains unclear. In this study, we identified risk factors that influence the prognosis of BCLC stage B HCC after R0 surgical resection to determine whether some patients with stage B HCC may benefit more from R0 resection than other patients and to provide a guideline to estimate the tendency.MethodsThe clinical data of 78 patients with BCLC stage B HCC after R0 surgical treatment within 11 years were analyzed retrospectively, using relapse or death as the endpoint. Kaplan-Meier survival and Cox regression analyses were used to study prognosis (disease-free survival, DFS and overall survival, OS) and independent risk factors.ResultsFor all stage B patients, 1-, 2-, and 5-year DFS rates were 62.5, 36.4, and 16.6 %, respectively. Cumulative tumor size >5.0 cm and tumor number ≥4 were independent prognostic risk factors for DFS. The 1-, 2-, and 5- year DFS rates and OS rates of patients with at least one of these two factors were 49.0, 17.2, and 7.4 % (for DFS), and 78.6, 54.8, and 13.4 % (for OS), respectively, which were significantly lower than patients without these two factors (77.8, 58.3, and 27.2 % for DFS, and 94.4, 83.3,and 51.8 % for OS, respectively, P < 0.01).ConclusionsThe analyses indicated that the outcomes of R0 resection were much better for patients with BCLC stage B HCC with two or three tumors and cumulative tumor sizes of ≤5.0 but >3.0 cm than other patients with stage B.

Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer.

The present study aimed to investigate the independent prognostic values of the pre-operative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in patients with colorectal cancer (CRC). The present study retrospectively analyzed the data of 216 patients with CRC from a single hospital. The clinicopathological characteristics of the patients were compared and prognostic factors were evaluated. NLR and PLR were associated with tumor differentiation status and the tumor diameter, respectively, and PLR was also associated with the primary tumor classification (T classification). Furthermore, NLR and PLR were positively associated with each other (R2=0.5368; P<0.0001). Univariate analyses indicated that stage II and III patients with a high NLR (≥4.98; P<0.001) or PLR (≥246.36; P<0.001) possessed a significantly poorer 5-year OS rate compared with those with a low NLR or PLR. Post-operative adjuvant chemotherapy improved the 5-year OS rate in patients with a high NLR or PLR. Multivariate analyses indicated that NLR and PLR were independent prognostic factors [NLR, relative risk (RR)=4.074 and P<0.001; PLR, RR=2.029 and P=0.029] in patients with CRC, and were associated with the T classification, lymph node metastasis and post-operative adjuvant chemotherapy response of patients. Additionally, the area under the curve (AUC) was 0.748 for NLR (95% CI, 0.684-0.804; P<0.0001) and 0.690 for PLR (95% CI, 0.623-0.751; P<0.0001). The RR and AUC indicated that NLR was the superior predictive factor in patients with CRC. In conclusion, the pre-operative NLR and PLR were significant independent prognostic factors in patients with CRC, and NLR was more effective as a prognostic marker compared with PLR. Adjuvant chemotherapy appeared to be more effective in CRC patients with a higher NLR or PLR.

Is a modification of the radiotherapeutic target volume necessary after resection of glioblastomas with opening of the ventricles?

Extensive surgical resection of centrally localized, newly diagnosed glioblastoma can lead to opening ventricles and therefore carries a potential risk of spreading tumor cells into the cebrospinal fluid. However, whether ventricle opening consequently implies a greater frequency of distant tumor recurrence after radiation therapy-and, therefore, reduced survival-remains unknown. Therefore, is an adaption of target volumes in radiation therapy necessary to account for a potential tumor cell spread into the ventricle system? The present study assessed the resection statuses of 311 primary-glioblastoma patients who underwent radiation therapy. Overall, in 78 cases (25.1%) the ventricle system was opened during surgical resection. This study assessed the connection between ventricle opening and progression-free survival, overall survival, and distant and multifocal recurrence. OS rates of patients that underwent gross total resection were superior to patients with subtotal resection (p=0.002). PFS (p=0.53) and OS (p=0.18) did not differ due to ventricle opening during surgical resection. However, in a subsample of STR cases increased survival was observed when the ventricle system was opened (16.8 vs. 14.3months; p=0.03). The occurrence of distant (p=0.75) and contralateral recurrence (p=0.87) was not influenced by ventricle opening. Newly diagnosed glioblastoma patients whose ventricle systems were opened during microsurgical resection did not experience decreased survival or show increased likelihoods of distant and contralateral progressions following radiation therapy. In short, patients profit from surgical resections that are as extensive as reasonably possible, even if this entails ventricle opening. Thus, additional inclusion of the ventricles in the radiation therapy target volume after ventricle opening does not seem to be indicated.

PROGNOSTIC IMPACT OF NEOADJUVANT CHEMOTHERAPY ON JUVENILE NASOPHARYNGEAL CARCINOMA.

ABSTRACT Objective: To study the efficiency of neoadjuvant chemotherapy (NACT) and the impact of CT response on prognosis of juvenile nasopharyngeal carcinoma (NPC). Materials and Methods: From 1995 to 2005, 108 non-metastatic NPC patients younger than 25 years old were treated with NACT at Salah Azaiz Institute.The Median age of patients was 17 year-old and the male/female ratio was 1.6. According to the 2002 TNM staging system, T3-T4 tumors and N3 nodal status rates were 64% and 52%, respectively. All patients had undifferentiated carcinoma and received three cycles of CT combining doxorubicin and cisplatin followed by conventional RT with a total dose of 70 Gy to the primary tumor and the cervical areas initially involved, and 54 Gy to the remaining cervical areas. Tumor response to NACT was assessed after the third cycle on the basis of clinical examination (100%) and CT-scan of the nasopharynx (66%). Response was evaluated according to WHO criteria. Results: The overall CT response rate was 88% at cervical lymph node (complete response (CR): 35%, partial response (PR): 53%) and 83% at primary tumor (CR: 20%, PR: 63%). A complete remission at the end of the treatment program was observed in 91% of cases. Five-year DFS and OS rates were 75% and 81%, respectively. A no response (NR) or progressive disease (PD) after NACT at both cervical nodes and primary tumor had a statistically significant pejorative impact on DFS (p<0.001 and p=0.04, respectively) and OS (p<0.001 and p=0.037). Five-year DFS and OS rates of patients in CR after initial CT at cervical nodes was significantly better than the other patients (PR, NR, or PD) (94% vs. 66% and 94% vs. 73%, respectively). Conclusion: Our results showed that NPC is a very chemosensitive neoplasm and suggest that a regimen of induction CT followed by RT is feasible and can provide excellent antitumor effect in juvenile NPC. The prognosis was influenced by response to initial CT; the DFS and OS were better in patients with a good response to CT. RT dose reduction to good responders could be an interesting therapeutic approach in order to limit long-term sequelae.

FOLFOXIRI plus bevacizumab (bev) versus FOLFIRI plus bev as first-line treatment of metastatic colorectal cancer (mCRC): Updated survival results of the phase III TRIBE trial by the GONO group.

657 Background: The phase III TRIBE trial met its primary endpoint, by demonstrating that first-line FOLFOXIRI plus bev significantly prolongs PFS, as compared to FOLFIRI plus bev. Also RECIST response rate, early response rate and deepness of response were significantly increased. At the first statistical analysis, with a median follow-up of 32.2 months, OS results were considered preliminary. Methods: Between July 2008 and May 2011, 508 patients were randomized to either FOLFIRI plus bev (arm A, n=256) or FOLFOXIRI plus bev (arm B, n=252). Both treatments were administered for a maximum of 12 cycles followed by 5FU/bev until progression. Results: At a median follow-up of 48.1 months, 374 deaths were recorded (Arm A=200 vs. Arm B=174). Median OS for Arm B vs. Arm A was 29.8 vs. 25.8 months (HR=0.80, 95% CI, 0.65-0.98, p=0.030). Long-term survival rates are reported in Table 1. Treatment effect was consistent across all analyzed subgroups. Among clinical variables, ECOG performance status of 1 or 2, right-sided primary tumor, synchronous metastases, disease not confined to the liver, unresected primary tumor, high Kohne score negatively affected prognosis at univariate analyses. At an exploratory model accounting for these variables, adjusted HR for treatment effect on OS was 0.77 (95% CI, 0.61-0.96, p=0.020). Conclusions: FOLFOXIRI plus bev improves survival of mCRC patients, as compared to FOLFIRI plus bev. The estimated 5-years OS rate of patients treated with FOLFOXIRI plus bev was equal to 24.9%, with an absolute benefit of 12.5% compared to controls. FOLFOXIRI plus bev represents a valuable option for the upfront treatment of mCRC. Clinical trial information: NCT00719797. [Table: see text]

Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

Many medical associations recommend nephron-sparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm. A PubMed search was carried out using keywords "partial nephrectomy" and "nephron sparing" for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5- and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates. This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%. We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

Prognostic factors in stage IB gastric cancer.

To identify the subset of patients with stage IB gastric cancer with an unfavorable prognosis. Overall survival (OS) rates were examined in 103 patients with stage IB (T1N1M0 and T2N0M0) gastric cancer between January 2000 and December 2011. Univariate and multivariate analyses were performed to identify risk factors using a Cox proportional hazards model. The OS rates of patients with T1N1 and T2N0 cancer were 89.2% and 94.1% at 5-years, respectively. Both univariate and multivariate analyses demonstrated that tumor location was the only significant prognostic factor. The OS rate was 81.8% at 5-years when the tumor was located in the upper third of the stomach and was 95.5% at 5-years when the tumor was located in the middle or lower third of the stomach (P = 0.0093). These data may suggest that tumor location is associated with survival in patients with stage IB gastric cancer.

Prognostic Value Of GELF Criteria and FLIPI2 For Newly Diagnosed Follicular Lymphoma Receiving R-CHOP Chemotherapy

Follicular lymphoma (FL) is the most frequent low-grade lymphoma and survival duration is heterogeneous. Follicular lymphoma international prognostic index 2 (FLIPI2) is a useful prognostic tool for the identification of patients with FL at different risk in the rituximab era. On the other hand, Groupe d'Etude des Lymphomas Folliculaires (GELF) criteria is defined for patients in whom immediate therapy is necessary. In this study, we determined the value of FLIPI2 and GELF criteria as prognostic tools for follicular lymphoma.Among 181 consecutive FL patients newly diagnosed in our institute from 2000 to 2011, data of FLIPI2 and GELF criteria were available for 147 patients. Of the 147 patients, a total of 102 patients were diagnosed as clinical stage II to IV and received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) based chemotherapy. The remaining 45 patients were treated with CHOP like regimens or other treatment modalities. Of the 102 patients who had rituximab usage, 2 patients (2%) received rituximab maintenance therapy. Detailed patients characteristics were shown in Table 1. Survival analysis was carried out using the Kaplan–Meier product-limit method.Table 1Baseline patients' characteristics (stage ≥II, received R-CHOP)ALL (n=102)Cross-validation cohort (n=65)n (%)n (%)Sex (Male)45 (44)33 (51)Median age (range)58.5 (39-84)58 (39-79)Age (>60)38 (37)24 (37)ECOG PS (>1)2 (2)1 (2)Stage ≥III85 (83)52 (80)Bulky (≥7 cm)19 (19)13 (20)Serum LDH level (>normal)29 (28)19(28)Histology (Grade1/2/3)15/74/1110/46/8FLIPI2Low17 (17)14 (22)Intermediate58 (57)38 (58)High27 (26)13 (20)GELF criteria (High)56 (55)32 (49)Rituximab maintenance2(2)1(2)First, we performed analysis using 102 patients who were diagnosed as clinical stage II to IV and received R-CHOP based chemotherapy. With a median follow-up of 6.3 years (range: 0.7-14.0 years), the 6-year overall (OS) and progression-free survival rates (PFS) of the 102 patients were 89% (95%CI: 78 to 98) and 62% (95%CI: 51 to 71), respectively. According to FLIPI2, three risk groups (low risk, intermediate risk and poor risk) were separated in OS analysis. Estimated 6-year OS rates in patients with high and low tumor burden defined by GELF were 82% and 98%, respectively (P=0.02, Log-rank). PFS rates of patients with high tumor burden defined by GELF criteria were worse compared to those with low tumor burden (53% vs. 72%, p=0.02, Log-rank). When we divided patients into two group using both FLIPI2 and GELF criteria (FLIPI2-GELF combined model), patients, who had high tumor burden defined by GELF criteria and who were classified intermediate risk or poor risk group defined by FLIPI2 (FLIPI2-GELF high) showed worse OS rates compared to the remaining (FLIPI2-GELF low) patients (83% vs. 95%, p=0.03, Log-rank). Patients with FLIPI2-GELF high also represented worse PFS rates compared to FLIPI2-GELF low patients (51% vs. 72%, p<0.01, Log-rank). The results suggested that FLIPI2-GELF combined model could more precisely separate patients into each risk group.For validation, we next performed cross-validation analysis using 65 patients who were diagnosed as clinical stage II to IV and received R-CHOP based chemotherapy. The patients were selected from the first cohort of 102 cases (Table 1). With a median follow-up of 6.2 years (range: 0.7-14.0 years), estimated 6-year OS rates in patients with high and low tumor burden defined by GELF were 80% and 97%, respectively (P=0.03, Log-rank). Estimated 6-year PFS rates in patients with high and low tumor burden defined by GELF were 51% and 66%, respectively (P=0.12, Log-rank). Using FLIPI2-GELF combined model, estimated 6-year OS rates in patients with FLIPI2-GELF high and low were 78% and 97%, respectively (P=0.02, Log-rank). Estimated 6-year PFS rates in patients with FLIPI2-GELF high and low were 47% and 68%, respectively (P=0.04, Log-rank). In 147 cases treated with R-CHOP, CHOP based regimens,or other treatment modalities, FLIPI2-GELF combined model also could divide the two group in OS (p=0.01) and PFS (p<0.01) analyses.In conclusion, we confirmed GELF criteria could be used for reproducible prognostic tool for newly diagnosed follicular lymphoma receiving R-CHOP based chemotherapy. GELF criteria combined with FLIPI2 might be a more precise and repeatable prognostic indicator for survival after first-line therapy in patients with follicular lymphoma. Disclosures:No relevant conflicts of interest to declare.