Overall Cancer-specific Survival Research Articles

Alveolar Soft Part Sarcoma in the Female Genital Tract: Case Series with Literature Review and SEER Database Analysis.

Alveolar soft part sarcoma (ASPS) is a rare and distinct subtype of soft tissue sarcoma. This study aims to describe the unique presentation of ASPS in the female genital tract. Prognostic factors for cancer-specific overall survival (CSS) were evaluated using multivariate analyses. In our case series, we identified a novel TFE3-PRCC gene fusion in a 24-year-old unmarried patient with cervical ASPS who underwent fertility-sparing surgery and remained recurrence-free for 41 months. The other two patients underwent radical hysterectomy and bilateral salpingo-oophorectomy. At the time of writing, the two patients had been disease-free for 49 and 71 months, fluorescence in situ hybridization showed break-apart signals for the ASPL-TFE3 gene. Among the 55 cases with available information from the PubMed/Medline database, most presented with localized disease, and at the last follow-up, all patients were alive and 45 patients showed no evidence of disease. The 5-year CSS rate in the female genital tract cohort from SEER database was 86.2%. Multivariate analysis revealed that older age was associated with a 1.042-fold increased risk of cancer-specific mortality (HR=1.042, 95% CI 1.022-1.063, P < 0.001), involvement of soft tissue including the heart was associated with a 4.786-fold higher risk (HR=4.7868, 95% CI 1.681-13.623, P= 0.003), and regional infiltration and distant metastasis were associated with approximately 8.6-fold and 18-fold higher risk of cancer-specific mortality compared to local disease, respectively (HR=8.652, 95% CI 2.529-29.63, P = 0.001; HR=18.366, 95% CI 6.153-54.817, P< 0.001). Patients who underwent radical excision did not show reduced cancer-specific mortality compared to those who underwent local excision (HR=0.492, 95% CI 0.224-1.081, P = 0.078). Previously unrecognized genetic diversity exists in ASPS. Patients with ASPS in the female genital tract have the lowest likelihood of presenting with a distant disease and are associated with a more favorable survival outcome.

The trade-off of post-mastectomy radiotherapy usage for the breast cancer patients aged 70 years or older: a study based on SEER database

BackgroundThis study aimed to investigate the role of post-mastectomy radiotherapy (PMRT) in the female aged 70 years or older diagnosed with breast cancer, which is still controversial.MethodsThis retrospective study enrolled female breast cancer women aged 70 + years following mastectomy from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce covariable imbalance. A nomogram was created to predict the 1,3,5-years overall survival (OS) and divide patients into three risk groups.ResultsAfter matching, PMRT were associated with significant improvement in breast cancer-specific survival (BCSS) and OS (p < 0.001). By contrast, the BCSS and OS benefit from PMRT were not significant in patients with T1N1 tumor (BCSS: HR = 0.716, p = 0.249;OS:HR = 0.908, p = 0.572), and T2N1 tumor (BCSS:HR = 0.866, p = 0.289;OS:HR = 0.879, p = 0.166). Stratified by subtype, the HR+/HER-2- subtype and the HR-/HER-2- subtype (all p < 0.001) have a significant prolonged survival, yet not significant BCSS difference are shown in the HER-2 + tumor. In the low-risk group as determined by the nomogram, the use of PMRT did not significantly improve OS (p = 0.203).ConclusionsThis study demonstrated that PMRT improves the survival of females with elderly breast cancer, while for T1-2N1 breast cancer patients, the omission of PMRT could be considered. Furthermore, the nomogram we constructed could be used as a decision tool for the omission of PMRT in low-risk elderly patients.

Factors Associated with Early Mortality in Patients with Multiple Myeloma: A SEER Analysis

Background: Treatment advances over the past two decades have improved overall survival in patients with multiple myeloma (MM). However, early mortality continues to be an issue that requires better characterization. We sought to explore the impact of newer therapeutics and practices on early mortality (within 2 years) with the latest SEER dataset. Using the dataset, we also evaluated whether improvement in early mortality differed based on race-ethnicity. Methods: We identified 78,121 patients with MM from the SEER Research Plus Data 17 Registries (2000-2019) in SEER*Stat 8.4.0. Cases were selected by the following criteria: histologic type (ICD-O3 = 9732-9733), microscopically confirmed, diagnosis in 2000-2017, and age from 18-99 years old. Logistic regression was performed to assess relationship with early mortality, defined as overall survival less than or equal to two years (Table 1). Age, gender, self-identified race-ethnicity, cause of death (COD), socioeconomic status (SES), year of diagnosis, and geographic region of diagnoses were all variables initially evaluated. The final logistic regression model was then based on age, gender, self-identified race-ethnicity, and year of diagnosis (split into three-year groups) as predictors. The first quartile age group (18-58), male gender, non-Hispanic White (NHW) race, and year of diagnosis between 2000-2002 were utilized as reference groups. Analysis was performed in RStudio 4.1.2. Of the predictors chosen in the logistic regression model, race-ethnicity was examined further. Yearly 2-year overall survival (OS) and relative survival (RS) of MM from 2001-2017 by race-ethnicity with 95% confidence intervals were exported from SEER*Stat 8.4.0 (Figure 2). We also specifically looked at 2-year RS to evaluate for cancer-specific survival in absence of other causes of death. Results: Female patients with MM had lower odds of experiencing early mortality (OR 0.895, 0.863-0.918, p=<0.01). Non-Hispanic Blacks (NHB) and Hispanics had higher odds of experiencing early mortality (OR 1.130, 1.084-1.179, p=<0.01 and OR 1.268, 1.206-1.333, p=<0.01). Older age was also associated with increased early mortality. The odds of early mortality appeared greater in regions outside the northeast. Finally, the odds of early mortality decreased for patients diagnosed with MM between 2000-2014, but stayed stable in 2015-2017. Examining 2-yr OS and RS from 2001-2017, there is overall improvement during the period as well, but the differences between race-ethnicities (NHW vs NHB and NHW vs Hispanics) were not statistically significant. Conclusion: The introduction of novel therapies has revolutionized the care of patients with MM. This is reflected by our data showing overall decreasing odds of early mortality from 2000-2014. However, there is no significant improvement further in 2015-2017. Importantly, we see improvement in 2-year survival (cancer-specific survival and OS) for all racial-ethnic groups over time. This trend overall parallels the FDA approvals of novel therapies such as bortezomib in 2003, lenalidomide (Revlimid) in 2006, and daratumumab in 2015. In addition, we note some disparities in terms of early mortality based on race-ethnicity, age, and region. Further investigation is warranted to explore the etiologies behind these disparities, possibly evaluating disease biology, treatments, comorbidities, and insurance information. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinicopathologic and genomic features of high-grade pattern and their subclasses in lung adenocarcinoma

IntroductionRecent lung adenocarcinoma (LUAD) grading system proposed by the International Association for the Study of Lung Cancer (IASLC) has emphasized the proportion of high-grade patterns (HGPs). We aimed to evaluate the clinicopathologic and genomic characteristics associated with HGP which has not yet been fully investigated. MethodsTissue samples from 174 patients who underwent surgical resection of LUAD from January to December 2015 were histologically evaluated. Proportions of HGPs, including solid, micropapillary, cribriform, and complex glandular patterns, were individually quantified. Prognostic implications of HGP proportion, both as a continuous variable and as subclasses divided by cutoffs of 20%, 50%, and 90% (low-intermediate grade [LIG], HGP <20%; high grade 1 [HG1], 20-<50%, HG2, 50-<90%; HG3, ≥90%) were evaluated. Different clinicopathologic factors and genomic alterations according to the HGP subclasses were assessed. ResultsRelative hazards of the HGP gradually elevated as its proportion increased over 20%, the cut-off value established by the IASLC grading system, and the cancer-specific overall survival (OS) of HG1 subclass was not significantly decreased compared to the LIG subclass on univariate analysis. However, further subgrouping showed significantly increased frequencies of male, advanced stage tumors, lymphovascular invasion, and spread through alveolar space in higher HGP subclasses. Also, common LUAD driver mutations, particularly EGFR mutations, were less frequent, whereas alterations in TP53 and cell cycle pathway-related genes were more frequent. Higher HGP subclasses and TP53 gene alteration were associated with shorter cancer-specific OS and RFS in multivariate survival analysis. ConclusionsHGP subclasses of LUAD displayed distinct clinicopathological characteristics and genomic alterations, including TP53 and cell cycle pathway, emphasizing the clinical value of these subclasses in LUAD. Higher HGP subclass and alteration in TP53 may be markers of poor post-operative survival.

Potential prognostic value of the lymph node ratio and its correlation with circulating sex hormone concentration in pathological T1/2 breast cancer patients: a retrospective study.

BackgroundThe lymph node ratio (LNR) is an additional informative factor complementing anatomic TNM staging in breast cancer patients. The aim of this study was to evaluate the role of LNR in the cancer-specific and overall survival (OS) in a cohort of pT1/2 breast cancer patients and examine its correlation with circulating sex hormone concentrations in postmenopausal cases of the cohort from eastern China islands.MethodsClinical and pathological characteristics, preoperational sex hormone and tumor markers concentrations, and breast cancer-specific survival (BCSS) and OS were analyzed retrospectively in 732 pathological T1/2 breast cancer patients.ResultsThe LNR was calculated, and the cut-off value was defined as 0.042 by receiver operative characteristic (ROC) curve according to the patient’s mortalities. Patients with LNR ≥0.042 exhibited worse BCSS and OS than others (P<0.001) in pT1/2 breast cancer. Among patients with non-triple negative breast cancer (TNBC) and TNBC subtypes, the LNR ≥0.042 group also exhibited worse BCSS and OS than the LNR <0.042 group (P=0.003, 0.001, and P=0.032, 0.001, respectively). In univariate analysis, unfavorable BCSS and OS were both related with LNR ≥0.042 (P=0.001, <0.001). However multivariate analysis demonstrated TNBC subtypes were independent predictor for BCSS and OS [hazard ratio (HR) =1.449, 95% CI: 1.097–1.914, P=0.009; HR =1.365, 95% CI: 1.093–1.705, P=0.006, respectively]. Notably, Pearson or spearman correlation analysis revealed follicle-stimulating hormone (FSH) and, luteinizing hormone (LH) levels were significantly negatively associated with the LNR (P=0.007, 0.011, respectively) in postmenopausal cases, whereas CA153, CA125 and CEA were positively correlated with it (P<0.001, <0.001, 0.001, respectively) in all cases.ConclusionsAmong pT1/2 breast cancer patients from eastern China islands, the LNR is a predictive prognosis factor; a higher LNR seems to correlate with a worse survival outcome both overall and in the subgroups. Strikingly, the current results reveal that serum FSH and LH level inversely associated with axillary node invasion in postmenopausal cases, whereas tumor markers directly related with it. The LNR is an informative factor complementing TNM staging.

Thoracoscopic Lobectomy Versus Sublobar Resection for pStage I Geriatric Non-Small Cell Lung Cancer.

ObjectivesThe choice of resection method for geriatric patients with early-stage non-small cell lung cancer (NSCLC) remains contentious. This study aimed to evaluate survival and perioperative outcomes after thoracoscopic lobectomy resection (LR) or sublobar resection (SR) in patients aged ≥75 years with pathologic stage (pStage) I NSCLC.Materials and MethodsWe retrospectively examined 258 consecutive patients aged ≥75 years with pStage I NSCLC who underwent thoracoscopic tumor resection at our institute from 2011 to 2018. Propensity score matching (PSM) analysis identified 60 patients in each group for comparison of survival-related parameters, including disease-free survival (DFS), lung cancer-specific overall survival (OS), and non-lung cancer-specific OS, using the Kaplan-Meier analysis.ResultsLR and SR were performed in 84 (32.6%) and 174 (67.4%) patients aged ≥75 years, respectively. The LR group had younger patients, better performance status, larger tumor sizes, and deeper tumor location than the SR group. Multivariate studies showed that the resection method was not a prognostic factor for OS. The two PSM-matched groups were not significantly different with respect to lung cancer-specific OS (p = 0.116), non-lung cancer-specific OS (p = 0.408), and DFS (p = 0.597). SR helped achieve better perioperative outcomes than LR, including fewer postoperative complications (10.0% vs. 28.3%, p = 0.011), shorter operative times (p < 0.001), decreased blood loss (p = 0.026), and shorter chest tube duration (p = 0.010) and hospital stays (p = 0.035).ConclusionsThoracoscopic SR may provide similar oncological outcomes to LR, but may be a safer and more feasible surgical method for geriatric patients with pStage I NSCLC.

Construction and validation of the prognostic model for patients with neuroendocrine cervical carcinoma: a competing risk nomogram analysis

PurposeNeuroendocrine cervical carcinoma (NECC) is an uncommon malignancy of the female reproductive system. This study aimed to evaluate cancer-specific mortality and to construct prognostic nomograms for predicting the survival of patients with NECC.Methodswe assembled the patients with NECC diagnosed between 2004 to 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Meanwhile, we identified other patients with NECC from the Wenling Maternal and Child Health Care Hospital between 2002 to 2017. Fine and Gray’s test and Kaplan–Meier methods were used to evaluate cancer-specific mortality and overall survival (OS) rates, respectively. Nomograms were constructed for predicting cancer-specific survival (CSS) and OS for patients with NECC. The developed nomograms were validated both internally and externally.Resultsa total of 894 patients with NECC were extracted from the SEER database, then classified into the training cohort (n = 628) and the internal validation cohort (n = 266). Besides, 106 patients from the Wenling Maternal and Child Health Care Hospital served as an external validation cohort. Nomograms for predicting CSS and OS were constructed on clinical predictors. The validation of nomograms was calculated by calibration curves and concordance indexes (C-indexes). Furthermore, the developed nomograms presented higher areas under the receiver operating characteristic (ROC) curves when compared to the FIGO staging system.Conclusionswe established the first competing risk nomograms to predict the survival of patients with NECC. Such a model with high predictive accuracy could be a practical tool for clinicians.

Survival benefit of resection surgery for lung adenocarcinoma with bone metastases and a post-operative prognosis nomogram establishment and validation.

Surgical resection is not usually recommended for lung adenocarcinoma (LUAD) patients with bone metastases. However, the criteria for surgery are constantly being adjusted and there is a need to focus on the prognostic role of cancer-directed surgery (CDS) for bone metastatic LUAD patients investigate the factors influencing survival of CDS. We determined the survival benefit of CDS for LUAD patients with bone metastases and to develop a prognostic nomogram to predict overall survival (OS) for patients after surgery. LUAD patients with bone metastases from the Surveillance, Epidemiology, and End Results (SEER) database between 2010-2015 were included and divided into CDS and non-CDS groups. The propensity score matching (PSM) was used to balance baseline characteristics. We used Kaplan-Meier curves and log-rank tests to compare cancer-specific survival (CSS) and OS between the two groups. Patients underwent CDS were randomly divided into training and validation cohorts to develop and validate a nomogram model to predict postoperative prognosis outcome-OS. Patients who underwent CDS had a better OS and CSS than those who did not underwent CDS (e.g., 1-year OS rate: 56.9% vs. 30.1%). Independent prognostic factors were selected by Cox regression analysis for CDS patients including age, sex, race, histological grade, N stage, and chemotherapy, and a nomogram was constructed to predict 1-, 2-, and 3-year OS after surgery according to the prognostic factors. The calibration curve and receiver operating characteristic (ROC) curve for the nomogram showed the model had a high predictive accuracy. [Area under the curve (AUC) at 1, 2, and 3 years in the training cohort were 0.735, 0.756 and 0.782, and in the validation cohort were 0.703, 0.758 and 0.836, respectively]. In addition, patients were divided into high-risk and low-risk groups based on prognostic scores, and Kaplan-Meier curves showed significant differences in prognosis between the two groups. These results indicated that patients with bone metastasis of LUAD received survival benefit from CDS. The prognostic nomograms could assist clinicians in specifying individualized assessments, but further research is needed.

Limited stage mantle cell lymphoma: Results of overall survival based on treatment modality using SEER database.

e19566 Background: Limited stage mantle cell lymphoma (MCL) (stage I-II) is rare and occurs in 5-15% of patients. The ideal treatment approach among radiation (RT), chemotherapy (CT), chemoradiotherapy (CRT) or close monitoring (NT) has not been defined. Methods: A retrospective analysis of SEER database (1975 to 2018) was conducted for patients with stage I-II MCL to compare overall survival (OS) among the various treatment modalities in patients &gt;18 years. We excluded patients lacking information on demographic characteristics and survival. Patients were analyzed in 4 groups; RT only, CT only, CRT and no treatment groups. ANOVA test and Chi-square test were used to evaluate parametric and non-parametric variables between groups, respectively. Cancer specific survival (CSS) and OS were assessed by Kaplan-Meier. SPSS 26.0 was used for data analysis. Results: There were in total 2266 patients with limited stage MCL. Median age was 71 years (61-78.25) and predominantly male (65.7%). Stage I MCL was noted in 55.6% and stage II in 44.4% of the patients. The number of patients in each group; RT only, CT only, CRT and NT along with the OS are presented in Table. CSS among these four groups showed no statistically significant differences (p &lt;0.26). OS showed that CT only group has worse survival compared to RT only and CRT groups (p &lt;0.001). CRT has no significant difference in survival compared to RT only (p&lt;0.001). NT was associated with poorest survival rates (p&lt;0.001). Conclusions: In limited stage MCL, RT only and CRT resulted in superior OS compared to CT only. Results suggest a role for incorporation of RT in treatment regimens. One limitation of the study is that the SEER database lacks the ability to distinguish between no receipt of therapy versus lack of availability of data.[Table: see text]

Optimizing Treatment in Intermediate-Risk Prostate Cancer: Secondary Analysis of a Randomized Phase 3 Trial

To identify patients with intermediate-risk prostate cancer (IRPC) benefiting from de-escalation of androgen deprivation therapy (ADT) and/or dose escalated radiation therapy (DERT), we performed a secondary analysis of a phase 3 trial by measuring biochemical failure (BF), distant metastases, prostate cancer-specific mortality, overall survival (OS), and distant metastases-free survival (DMFS) rates according to prognostic intermediate risk factors (IRF). The initial trial randomized 600 patients with IRPC to a 3-arm trial with 200 patients per arm, consisting of 6 months of ADT plus 70 Gy radiation therapy (ADT+RT70) versus ADT plus a DERT of 76 Gy (ADT+DERT76) versus DERT of 76 Gy alone (DERT76). We performed an analysis based on IRF: clinical stage, prostate-specific antigen level, Gleason score, percentage of positive biopsy cores (PBC) ≥50%, and Gleason pattern. Patients were allocated to 2 groups: favorable intermediate risk (FIR), defined as patients with only 1 IRF without Gleason pattern 4+3 or PBC ≥50%; and unfavorable intermediate risk (UIR), defined as all other patients. BF, distant metastases, prostate cancer-specific mortality, OS, and DMFS were compared between FIR and UIR. The median follow-up was 11.3 years (interquartile range, 10.9-11.7). In the FIR cohort, BF and OS were not significantly different between arms. UIR patients had significantly worse DMFS (hazard ratio [95% confidence interval], 1.61 [1.20-2.15]; P=.026) and OS (1.51 [1.12-2.04]; P=.0495) and a nonsignificant higher cumulative incidence of BF rate (1.55 [0.98-2.47]; P=.08). In UIR patients, a significant improvement in BF was seen in the arms receiving ADT compared to DERT76 alone. On multivariable analysis, Gleason pattern 4+3 and prostate-specific antigen >10 ng/mL independently affected BF and OS, regardless of the treatment arm. In IRPC, therapeutic optimization appears possible. To avoid ADT side effects, DERT76 alone appears sufficient in patients harboring only 1 risk factor without Gleason pattern 4+3 and PBC ≥50% (FIR). All other UIR patients seem to benefit from ADT+DERT76.

Outcomes of 556 consecutive patients with stage I-III colon cancer managed in a single center over 10 years.

BackgroundThe Bank of Cyprus Oncology Center is the largest cancer center in Cyprus, providing standalone oncology services to a population of just under a million.MethodsThe aim of the study was to calculate disease-free survival (DFS) and overall survival (OS) for consecutive patients with stage I-III colon cancer over a 10-year period, by collecting retrospective data from patients’ medical charts.ResultsWe identified 556 patients with a median age at diagnosis of 67 (range 18-88). The majority of them were male (60%). Just over half of stage II patients received chemotherapy: capecitabine (44%) and FOLFOX/CapeOx (7%). Treatment administered in stage III was as follows: CapeOx (48%); FOLFOX (28%); capecitabine (12%); 5-fluorouracil (4%); and 8% received no treatment. DFS at 5 years was: stage I 90%; stage II 85%; and stage III 69%. Cancer-specific OS at 5 years was: stage I 94%; stage II 93%; and stage III 81%. Favorable outcomes were also maintained at 10 years (stage I 94%; stage II 84%; and stage III 70%). On multivariate analysis, only stage was statistically significant as a prognostic factor, whereas high-risk features (pT4±pN2), disease location (right vs. left), and age >70 years old did not reach statistical significance.ConclusionsDespite our country’s fragmented healthcare system, with multiple referring surgeons from the private and public sectors, the outcomes achieved were highly consistent with those published in the international literature. This can be attributed to optimal multidisciplinary management and follow-up care.

Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esophageal carcinoma.

Although surgical resection is a mainstay in the management of esophageal carcinoma (EC), its postoperative outcomes remain unsatisfactory. To optimize surgical strategies for EC, a simple method of stratifying patients according to risk factors is desired. Controlling nutritional status (CONUT), the prognostic nutritional index (PNI), transthyretin and transferrin are nutritional parameters used to predict the long-term outcomes of EC patients. We aimed to comparatively evaluate the prognostic significance of these four markers, measured preoperatively, in patients with operable EC. In total, 224 patients undergoing surgical resection for EC were retrospectively reviewed. Overall/cancer-specific survivals (OS/CSS) were estimated applying the Cox proportional hazard model to univariate and multivariate analyses. PNI, transthyretin and transferrin levels were treated as continuous variables in these analyses. Preoperative CONUT had significant associations with tumor location, depth and preoperative irradiation. The other three markers all showed significant relationships with age and tumor depth. On univariate Cox regression analysis, preoperative CONUT, PNI, transthyretin and transferrin all correlated significantly with OS and CSS. On multivariate Cox regression analysis, the preoperative transthyretin level was identified as an independent predictor of OS (HR 0.51 per 10mg/dL increase, 95% CI 0.29-0.88, p = 0.017) and CSS (HR 0.50, 95% CI 0.27-0.91, p = 0.027) as well as tumor depth, nodal metastasis and preoperative irradiation, while the other three parameters were not. Preoperative transthyretin, as a continuous variable, independently predicted both OS and CSS in resectable EC patients, appearing to be the best prognosticator among conventional nutrition-related parameters.

The Elevation in Preoperative Procalcitonin Is Associated with a Poor Prognosis for Patients Undergoing Resection for Colorectal Cancer

Background: Procalcitonin (PCT) is a well-known marker for bacterial infection; however, the clinical significance of PCT in the long-term prognosis after colorectal cancer (CRC) surgery remains unclear. Methods: This is a retrospective review of 277 patients that underwent CRC surgery to investigate the relationship between preoperative PCT, clinicopathological condition, cancer-specific overall survival (OS), and relapse-free survival (RFS). Results: Median follow-up interval was 5.0 years in all patients. Thirty-six patients developed recurrence, and 46 patients died due to recurrences or metastases of CRC. Preoperative PCT levels were highest in Stage IV patients. The cancer-specific OS in patients with Stage IV/PCT ≤0.05 ng/mL was significantly higher than those with Stage IV/PCT >0.05 ng/mL (3 years survival; 42.3 vs. 14.3%, p = 0.0413). On multivariate analysis, gender, TNM classification, and PCT were identified as significant risk factors for cancer-specific OS in patients with Stage I–III CRC. The cancer-specific OS rate of these patients with PCT ≥0.08 ng/mL, compared with PCT <0.08 ng/mL, was significantly decreased (5 years survival; 59.1 vs. 92.7%, p < 0.0001). TNM classification was finally identified as an independent risk factor for cancer-specific RFS in these patients by multivariate analysis. Conclusion: High preoperative PCT values in CRC patients appeared to be associated with poor OS but not RFS following surgical treatments.

Analysis of Copy-Number Variations and Feline Mammary Carcinoma Survival

Feline mammary carcinomas (FMCs) are highly malignant. As the disease-free survival (DFS) and overall survival (OS) are short, prognostication is crucial. Copy-number variations (CNVs) analysis by next-generation sequencing serves to identify critical cancer-related genomic regions. Thirty-three female cats with FMCs were followed during two years after surgery. Tumours represented tubulopapillary and solid carcinomas encompassing six molecular subtypes. Regardless of the histopathological diagnosis, molecular subtypes showed important differences in survival. Luminal A tumours exhibited the highest DFS (p = 0.002) and cancer-specific OS (p = 0.001), and the lowest amount of CNVs (p = 0.0001). In contrast, basal-like triple-negative FMCs had the worst outcome (DFS, p < 0.0001; and OS, p < 0.00001) and were the most aberrant (p = 0.05). In the multivariate analysis, copy-number losses (CNLs) in chromosome B1 (1–23 Mb) harbouring several tumour-repressors (e.g. CSMD1, MTUS1, MSR1, DBC2, and TUSC3) negatively influenced DFS. Whereas, copy-number gains (CNGs) in B4 (1–29 Mb) and F2 (64–82.3 Mb) comprising epithelial to mesenchymal transition genes and metastasis-promoting transcription factors (e.g. GATA3, VIM, ZEB1, and MYC) negatively influenced DFS and cancer-specific OS. These data evidence an association between specific CNVs in chromosomes B1, B4 and F2, and poor prognosis in FMCs.

Clinical outcomes of stereotactic body radiation therapy for T2N0M0 non-small cell lung cancer

Objective To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients. Methods By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT, the overall survival, progression-free survival, cancer-specific survival and adverse effects were determined. Results The median follow-up was 18.4 months. The 1-, 2-, and 3-year overall survival rates were 92.2%, 92.2% and 80.6%, respectively. The corresponding cause-specific survivals were 95.7%, 95.7% and 83.7%. The progression-free survivals were 70.2%, 54.1% and 40.6%. The local control rates were 100%, 94.4%, and 94.4%. The regional controls were 84.2%, 72.1%, and 54.1%; and distant controls were 84.6%, 72.4% and 64.3%, respectively. Twenty patients (66.7%) developed symptoms of grade 1 radiation-related toxicities: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 radiation pneumonitis, and one patient experienced grade 4 radiation pneumonitis. Conclusions SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities. Key words: Stereotactic body radiation therapy; Non-small cell lung cancer; Overall survival; Progression-free survival; Cause-specific survival

The benefit of radical prostatectomy in patients with lymph node-positive prostate cancer: a systematic review and Meta-analysis

Objective To evaluate the benefit of radical prostatectomy (RP) in patients with lymph node-positive prostate cancer. Methods A systematic review of the studies about radical prostatectomy for the prognosis of node-positive prostate cancer was performed. An electronic search was completed on the basis of PubMed, Embase, Cochrane library, China Biology Medicine disc(CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang database from inception up to November 2018. The outcomes are overall survival (OS) and cancer-specific survival(CSS). Results Six studies incorporating 7 890 patients were eligible for the present meta-analysis. 6 247 patients underwent RP, the remaining 1 643 patients did not undergo RP. Lymph node-positive patients treated with RP had improved OS (HR=0.55, 95%CI 0.49-0.62, P<0.001) and CSS (HR=0.49, 95%CI 0.42-0.57, P<0.001). Conclusions Radical prostatectomy may be a beneficial option for patients with lymph node metastases at initial diagnosis, which also improve the OS and CSS. More randomized controlled trials are needed to give more evidence further. Key words: Prostatic neoplasms; Lymph node-positive; Radical prostatectomy; Meta analysis

Survival benefit of radiotherapy in metastatic esophageal cancer: a population-based study

Background: Population-based estimates of survival benefits of radiotherapy on metastatic esophageal cancer (EC) are lacking. The aim of this study was to analyze survival benefits of radiotherapy in patients with metastatic EC at the time of cancer diagnosis. Methods: Patients with metastatic EC were selected from Surveillance, Epidemiology, and End Results databases. The covariates included radiotherapy status, age, sex, insurance, histological type, differentiation, metastatic sites (bone, brain, liver, lung), and chemotherapy. Propensity score matching model was used to reduce bias of patients’ selection. Median overall survival (OS) and cancer-specific survival (CSS) were compared and Cox regression analysis was performed. Results: A total of 4,761 patients with metastatic EC met the selection criteria. It was found that radiotherapy significantly improved 2-year OS (P=0.020) and 2-year CSS (P=0.009) in matched patients. In the propensity score model (N=3,672), Cox regression analysis demonstrated that radiotherapy was an independent prognostic factor which associated with a longer OS (P Conclusions: The population-based study demonstrated that patients with metastatic EC might benefit from radiotherapy. This data supports the proposal to change the current management for patients with metastatic EC.

Analysis of prognostic factors and nomogram for predicting survival for patients with locally resectable esophageal cancer after preoperative chemoradiation therapy

Objective The SEER database was utilized to analyze the prognosis and related factors for patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy. A nomogram for predicting survival was established to provide reference for screening patients receiving preoperative chemoradiotherapy. Methods Patients diagnosed with stage T1b-4aN0-3M0(7th version AJCC in 2010) resectable esophageal cancer receiving preoperative chemoradiotherapy between 2010 and 2015 were selected from the SEER database. The survival rate was determined by Kaplan-Meier method. The univariate analysis was performed by log-rank test. The multivariate analysis was conducted by Cox test. The nomogram for survival prediction was established by using R software. The predicting accuracy of the nomogram was evaluated by C-index and calibration curve. Results A total of 1 697 eligible patients were included. Univariate analysis showed that sex, T stage, N stage and tumor differentiation were significantly associated with overall survival (OS) and cancer-specific survival rate (CSS)(all P<0.001), and age (P=0.027) was significantly correlated with OS.Multivariate analysis demonstrated that age, sex, tumor differentiation and N stage were significantly associated with OS.Sex, tumor differentiation, T stage and N stage were significantly correlated with CSS (all P<0.05). After the prognostic factors were included into the nomogram, the C-index for 5-year OS and CSS was 0.60 and 0.61.The model for predicting survival of patients with esophageal squamous cell cancer was established by using the same method. The C-index for the OS and CSS was 0.62 and 0.64. Conclusions Sex, clinical stage and tumor differentiation are prognostic factors of CSS in patients with locally resectable esophageal cancer undergoing preoperative chemoradiotherapy followed by surgery. The nomogram established according to the data above can provide certain reference for the selection of preoperative chemoradiotherapy combined with surgery. Key words: Esophageal neoplasms/preoperative chemoradiotherapy; Prognosis; Nomogram model

PS02.233: PRETREATMENT PROGNOSTIC FACTORS IN PATIENTS WITH RESECTABLE CSTAGE II-IV THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background Background Advanced esophageal cancer patients often develop tumor recurrence even after curative resection. Inexpensive and easily available prognostic factors are expected in daily clinical practice. The aim of this study was to identify the prognostic factors in patients with resectable cStage II-IV thoracic esophageal squamous cell carcinoma. Methods Patients and Methods The study included 118 patients who underwent esophagectomy with curative intent for resectable cStage II-IV thoracic ESCC between January 2000 and December 2014. Time-dependent receiver operating characteristic curve analyses for 3-year overall survival (OS) as the endpoint were calculated, and the maximal Youden index was estimated to set the cut-off value for continuous variables. Survival rates were calculated by Kaplan-Meier method, and survival curves were compared using log-rank test. Univariate analysis and multivariate analysis for OS were conducted with Cox proportional hazards models. Results Results The median follow-up period was 33 months (1–160 months). The 5-year OS rate for the entire study population was 52.2%. In univariate analysis, age (70 &lt; ), sex, performance statue, American Society of Anesthesiologists Physical Status (ASA), serum squamous cell carcinoma antigen level (1.2 ng/ml &lt; ), lymphocyte count (≤ 1172/μl), serum albumin level (≤ 3.7 g/dl), total cholesterol level (≤ 193 mg/dl), and C-reactive protein level (0.28 &lt; mg/dl) were significantly associated with OS. In multivariate analysis, ASA (HR for ASA 2: 1.457, 95%CI 0.594–3.579; HR for ASA 3: 7.427, 95%CI 2.189–25.199; P = 0.001) and total cholesterol level (HR 0.506, 95% CI 0.261–0.983; P = 0.044) were independent prognostic factors for OS. The 5-year relapse free survival (RFS), cancer specific survival (CSS) and OS were 58.4%, 74.5% and 67.5% in high- total cholesterol group, and 38.7%, 51.3% and 39.1% in low- total cholesterol group, respectively (P = 0.031 in RFS, P = 0.004 in CSS, and P = 0.002 in OS). Conclusion Our findings showed that pretreatment total cholesterol level and ASA are independent prognostic factors of overall survival in patients with resectable cStage II-IV thoracic esophageal squamous cell carcinoma. Disclosure All authors have declared no conflicts of interest.

Influence of Extent of Lymph Node Evaluation on Survival for Pathologically Lymph Node Negative Non-Small Cell Lung Cancer.

Despite previous retrospective reports that the number of lymph nodes resected at curative intent surgery for lung cancer correlates with overall survival (OS), no consensus exists regarding the minimal nor optimal number of lymph nodes to resect at curative lung cancer surgery. We studied subjects in the Surveillance Epidemiology and End Results Database (SEER) diagnosed with non-small cell lung cancer between 2000 and 2011 who underwent either lobectomy or pneumonectomy and had pathologic negative nodal evaluation. We excluded patients with sublobar resection and/or no lymph node evaluation. We examined associations between number of lymph nodes evaluated and OS/lung cancer-specific survival by multivariable Cox regression; and predictors of evaluation of more lymph nodes. Among the 33,463 patients in our sample, a median of 7 lymph nodes were evaluated. We found that lung cancer-specific survival and OS improved with increasing lymph node evaluation up to 16 to 18 lymph nodes (hazard ratio, 0.77 [95% confidence interval, 0.70-0.85] and 0.78 [95% confidence interval, 0.72-0.86], respectively). There was little additional improvement in outcomes with evaluation of >16 to 18 lymph nodes. Blacks, Hispanics, females, and patients from distinct geographical regions were less likely to have 16 or more lymph nodes evaluated. There was a consistently increasing survival benefit associated with a more extensive lymph node evaluation at lung cancer resection, up to 16 to 18 lymph nodes removed. The median number of nodes evaluated was, however, only 7, suggesting that setting a goal of ≥16 examined lymph nodes may lead to improved survival outcomes, and reduce disparities in care.