Overall Survival In Metastatic Patients Research Articles

P-0109 - Performance Status Remained the Most Important Prognostic Factor in Pancreas Cancer Patients, Single Center Experience

with pancreas cancer were retrospectively evaluated. We evaluated clinical, pathological and treatment characteristics of the patients and survival outcome. Modifications in dose intensity either by reduction of the planned dose or delay in treatment was noted. Statistical analysis was performed using SPSS Software version 15.0. Results: The patients’ median age was 61 (range, 20–83) years. The numbers of male and female patients were 121 (62.7%) and 72 (37.3%), respectively. Primary tumor locations were head, body and tail and unknown in 115 (59.6%), 43 (22.3%), 25 (12.9%) and 10 (5.2%) respectively. Locally advanced and resectable, locally advanced unresectable and metastatic stages were seen in 26 (13.5%), 54 (28.0%) and 113 (58.5%) patients respectively. Liver was the primary metastatic site, diagnosed in 90 (46.6%) patients. Other metastatic sites were peritoneum, lung and combined. Adjuvant treatments were operation, chemoradiotherapy, and chemotherapy or combinations in total 26 (13.5%). Coronary artery disease was common comorbidity, occurring in 17 (8.8%) patients. First line chemotherapy (gemcitabine or gemcitabine plus platin) and second line chemotherapy (oxaliplatin based as FOLFOX or XELOX) were received by 69 (35.8%) and 24 (12.4%) of patients respectively. Partial response and stabile disease offirst line chemotherapy were 22 (31.9%) and 17 (%24.6) respectively. Only short duration of stabile disease was achieved with second line therapy. The median overall survival (OS) and follow up time were 6.0 (CI: 4.6-7.4) months and 6.0 (0-75) months respectively. Only 8 patients were alive but others were all dead at the end of study. One year months survival rate was 30.0%. Median OS was differed in locally advanced-resectable, locally advanced-unresectable and metastatic stages respectively (17.0 months vs 9.0 months vs 4.0 months, p = 0.000). Overall survival was better in better ECOG performance status (ECOG 0-2) than worse ECOG performance status on diagnosis (13.3 months vs. 3.0 months, p = 0.000). Overall survival was also better in younger age groups than elderly (8.0 months vs. 6.0 months, p = 0.018). Sex, dose intensity, tumor localisations, adjuvant treatment, hypertension, diabetes or smoking status had no effect on OS. Chemotherapy had correlated with better OS in metastatic patients (7.0 months vs 1.0 months, p = 0.000) but this effect did not significant in locally advanced pancreas cancer patients (9.0 months vs 8.0 months, p = 0.393). Initial weight loss was also correlated with poor survival (4.0 months vs.9.0 months, p = 0.000). Multivariate analysis showed that only the ECOG performance status was an independent predictor of survival HR = 6,433, P = 0.000). Conclusion: Survival was rarely increased with any type of chemotherapy commonly used in pancreas cancer patients, performance status remained the most important prognostic factor. Prognostic effects of new treatment modalities such as folforinox or nab-paclitaxel combination treatments are also awaited.

Abstract P2-10-32: Sialyl LewisX and inflammatory mediators in breast cancer patients: biological correlations and prognostic value

Abstract Background: Cytokines and chemokines are known to be involved in tumor growth and progression of disease. Sialyl LewisX (sLeX), a ligand for adhesion molecule E-selectin, is known to affect inflammatory processes and an elevated level is associated with tumor metastasis. Therefore, we assessed serum levels of sLeX and cytokines/chemokines in patients with non-invasive ductal carcinoma in situ (DCIS), early invasive breast cancer (EBC), or metastatic breast cancer (MBC). Patients and Methods: Sera from 250 patients (26 DCIS, 157 EBC, 67 MBC) and 43 healthy donors (HD) were assayed for sLeX using an immunoassay kit (CSLEX; Nittobo Medical Co. Ltd., Japan) and a panel of cytokines and chemokines using a multiplex assay kit. Differences in serum markers between patients and HD, and among patient groups were determined using the Kruskal-Wallis and Mann-Whitney tests. Spearman's correlation determined the non-parametric correlation between the serum levels of sLeX and the inflammatory mediators. The receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC) analyses were used to determine the sensitivity and specificity of a given cut-off value for a particular serum marker. Results: The median sLeX level tended to increase with the stage of disease: MBC > EBC > DCIS albeit without significant differences among the disease stages. Among MBC patients, patients with sLeX below 1.75 U/mL had significantly improved overall survival (OS, mean survival 11.1 vs. 33.7 months, P = 0.002) and progression-free survival (PFS, mean survival 9.7 vs. 20.9 months, p = 0.042). The Hazard Ratio of high sLeX for OS was 5.5 (95% CI 1.6 to 18.9, p = 0.007) and 2.3 for PFS (95% CI 1.0 to 5.2, P = 0.048). EBC and MBC patients have significantly higher serum levels of IL-1, IL-1RA, IL-6, IL-8, MCP-1, MCP-3, and MIP-1βthan those of HD. In addition, there were positive correlations between the serum levels of sLeX and cytokines IL-1β, IL-1RA, IL-2, IL-8, MIP-1β, and MCP-3. The AUC for sLeX was 0.598 (P = 0.016), and a cut-off of 3.13 pg/mL distinguished hormone receptor (HR)-positive from HR-negative patients (χ2 = 4.0, P = 0.045). Likewise, the AUC for TNF-α was 0.620 (P = 0.003), and a cut-off 7.18 pg/mL distinguished HR-positive from HR-negative patients (χ2 = 12.6, P < 0.001). Using a cut-off value established by ROC curves, few MBC patients (9 of 66, 13.6%) had a serum IL-2 level > 7.1 pg/mL compared to 57 of 185 (30.8%) non-MBC patients (χ2 = 7.4, P = 0.007), suggesting that metastatic disease may be associated with immune suppression related to low serum IL-2. Conversely, 31of 66 (47%) MBC patients had a serum MCP-1 level > 750 pg/mL vs. 37 of 185 non-MBC patients (20%) (χ2 = 23.8, P < 0.0001), suggesting that a high level of MCP-1 may play an important role in metastasis. Conclusion: Serum levels of sLeX were able to distinguish HR-positive from HR-negative patients and predict overall survival in metastatic patients. Serum sLeX and some inflammatory mediators tended to increase with the severity of disease, and together may facilitate local invasion of tumor cells. Furthermore, serum levels of MCP-1 and IL-2 may have prognostic value in breast cancer patients. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-32.