Poor Overall Survival In Multivariate Analysis Research Articles

Discrete Perineural Invasion Focus Number in Quantification for T1-T2 Oral Squamous Cell Carcinoma.

Perineural invasion (PNI) has been an established poor prognostic feature for T1-T2 oral squamous cell carcinoma (OSCC). Different presentations and amounts of PNI are commonly observed, but PNI is currently recorded as being present or absent. This study asked whether the quantification of PNI provides additional information for early OSCC. Retrospective cohort study. Tertiary referral medical center. Pathologic reevaluations were performed for 314 patients with T1-T2 OSCC who underwent curative surgery from June 2001 to August 2009. A novel parameter, PNI focus number, was defined for PNI quantification. With 5 PNI foci as the cutoff, patients were categorized into 3 groups: no PNI (0 PNI foci), low PNI (PNI foci, 1-5), and high PNI (PNI foci >5). Rate of cervical lymph node metastasis (LN+), 5-year disease-specific survival (DSS), and 5-year overall survival (OS) were analyzed among these groups. PNI focus number independently predicted for LN+, poor DSS, and poor OS in multivariate analysis after controlling for T classification, lymphovascular invasion, differentiation, margin, and tumor thickness. The 5-year DSS demonstrated a dose-dependent decrease among the 3 groups (no PNI, 88.6%; low PNI, 75.2%; high PNI, 33.8%; P < .001). Moreover, the 5-year DSS of the high PNI group was significantly worse than that of the low PNI group. PNI focus number can be a novel parameter for PNI quantification in early OSCC. Although optimal quantification methods still require further investigation, this study offers clear clinical support for the nerve-tumor interaction hypothesis and advocates further mechanistic research for the exploration of PNI-related treatment concepts for OSCC.

Survival gain with re-Op/RT for recurred high-grade gliomas depends upon risk groups

IntroductionA majority of high-grade gliomas relapse despite combined surgery, radiotherapy and chemotherapy. There is no consensus on standard treatment for recurrent high-grade gliomas, or defined efficacy of adjuvant re-RT after re-Op. This retrospective study evaluated the benefit and safety of re-RT after re-Op (re-Op/RT). Materials and methodsA total of 84 patients with recurrent high-grade gliomas who underwent reoperation from 2009 to 2015 were analyzed. All patients received neurosurgical intervention and adjuvant radiotherapy previously before recurrence. At recurrence and after reoperation, treatment options were discussed in multidisciplinary clinic or brain tumor joint conference. For re-RT, cumulative EQD2 (equivalent dose in 2 Gy fractions at α/β = 2) was below 106.9 Gy. ResultMedian progression free survival (PFS) was 6.5 months; 3.5 months with re-Op, 9.0 months with re-Op/RT (p = 0.025). Age <50, time interval to recur ≥12 months, WHO pathologic grade III, methylated MGMT promotor, and re-RT were factors enhancing PFS in the multivariate analysis. Median overall survival (OS) was 18.3 months: 12.7 months with re-Op, and 28.1 months with re-Op/RT (p = 0.066). Three risk factors (age >50, WHO grade IV, and unmethylated promoter of MGMT) were significantly associated with poor OS in multivariate analysis. Benefit of re-RT in both OS and PFS was established in patients carrying 2 or more risk factors. During re-RT, 4 patients (8%) had grade 2 or higher toxicity, and 3 patients (6%) did not complete re-RT. No radionecrosis was observed. ConclusionRe-RT after re-Op was tolerable with a cumulative median EQD2 of 99.3 Gy and resulted in clear benefit in PFS and marginal gain in OS. Survival gain with re-Op/RT was more prominent in patients with two or more risk factors (age ≥50, WHO pathologic grade IV, unmethylated MGMT promoter), and needs to be validated.

P08.34 Overall survival of primary high-grade gliomas of supra- and infratentorial midline structures

AbstractObjective:In literature recent and roubust data on the prognosis of patients with high grade gliomas (HGG) of WHO III° and IV° stratified by resectability, molecular features and different treatment modalities are available. However, little is known about outcome of patients with HGG´s located in supra- and infratentorial midline structures like corpus callosum, basal ganglia and brainstem. In this study we evaluate overall survival (OS) and influencing factors of patients with de novo HGG specifically in those structures.Patients and Methods:In a single center retrospective analysis we screened our database for all adult patients with primary HGG in midline structures diagnosed by stereotactic biopsy (SB) between January 1996 and March 2015. We evaluated OS and analyzed factors (MGMT status, treatment after SB, age, gender, Karnofsky Score (KPS), localization) influencing OS using Whitney-Mann-U and Chi-square test as well as cox regression analysis.Results.122 patients with HGG receiving stereotactic biopsy procedures (median age: 56.3 (22–82) years; median KPS: 80 (50–100)%. Histology revealed glioma WHO III° in 31.1% and WHO IV° in 68.9%. Lesions were localized in corpus callosum (50.0%), basal ganglia (18.9%), thalamus (9.0%), pineal region (2.5%), sella (0.8%), brainstem (18.9%). Median overall survival (mOS) was 6.3 months (95% CI, 3.6–9.0%), for WHO III°: 13.6 months (95% CI 5.6–21.6) and WHO IV°: 4.9 months (95 % CI, 3.2–6.6). Patients were treated as follows: no specific tumor therapy (13.1%, 2 WHO III° and 15 WHO IV°; mOS 1.1 months) or various Tumor specific therapy regimens (WHO III° 34 (32.4%) patients mOS 15.5 month [95% CI 7.4–23.6]), (WHO IV° 65 (61.9%) patients mOS 10.6 months). In 6 patients (5.7%) the type of adjuvant therapy is unknown. MGMT promotor methylation status was available for 46 tumor treated patients (18 WHO III°, 28 WHO IV°). mOS of patients with WHO IV tumors was significantly worse than WHO III° (p<0.0001). Any tumor specific treatment improved survival significantly (p=0.005). Poor condition (KPS<70) and no tumor specific therapy were the significant factors for poor OS in multivariate analysis (adjusted HR 1.88 CI95% 1.03–3.92 p=0.04 and 11.09 CI95% 5.24–23.35 p<0.0001 respectively).Conclusion:Overall survival de novo HGG’s especially of WHO IV located in midline structures is poor. Specific tumor treatment improves survival significantly. Treatment decision should be based on the patient’s clinical status for the best quality of life.

Periodic acid-Schiff-positive loops and networks as a prognostic factor in oral mucosal melanoma.

The prognostic factors of oral mucosal melanoma (OMM), a rare and aggressive neoplasm, remain to be determined. The aim of this study is to investigate the prognostic significance of vasculogenic mimicry in OMM. The clinical data of 62 patients with primary OMM treated in Shanghai Ninth People's Hospital from April 2007 to April 2012 were retrieved and analyzed retrospectively. Staining of periodic acid-Schiff (PAS) and CD31 immunohistochemistry were performed to evaluate the prognostic value of PAS-positive patterns, blood lakes, and microvascular density. PAS-positive loops and networks (P<0.001) as well as blood lakes (P=0.040) were found to be predictors of overall survival (OS). The presence of PAS-positive loops and networks was an independent prognostic factor of poor OS in multivariate analysis (P=0.002). Although the presence of PAS-positive loops and networks was associated with hematogenous metastasis (P=0.041) and lymphogenous metastasis (P=0.041), it was not an independent predictor of both types of metastasis in multivariate analysis. Microvascular density was not associated with OS (P=0.627) and metastasis of OMM patients. PAS-positive loops and networks have a significant prognostic value in OMM. Detection of PAS-positive patterns may lead to better staging and serve as a prognostic parameter of OMM.

Radio(chemo)therapy for locally advanced squamous cell carcinoma of the esophagus: long-term outcome.

The purpose of this work is to report the long-term outcomes of three-dimensional conformal radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). A retrospective analysis of patients treated with radio(chemo)therapy between 1988 and 2011 at Klinikum rechts der Isar, Technische Universität München was performed. In all, 168 patients received radio(chemo)therapy for ESCC in curative intention. The median follow-up time was 91 months (range 1-212 months). There were 128 men and 40 women with a median age of 63 years. Selection criteria for radio(chemo)therapy were unfit for surgery and/or unresectable primary tumor (n = 146, 87 %) or patients' choice (n = 22, 13 %). The majority of the patients received a combination of cisplatin and 5-fluorouracil chemotherapy with 54 Gy in 30 fractions of radiotherapy. The median overall survival (OS) was 20 months (95 % confidence interval 17-23 months). The OS at 2 and 5 years for the whole cohort was 41 ± 4 % and 22 ± 3 %, respectively. Forty patients (24 %) suffered an in-field recurrence. The most common acute nonhematologic toxicity >grade 2 was dysphagia in 35 % of the patients. Acute hematologic toxicity > grade 2 was recorded in 14 % of the patients. There was no grade 5 toxicity observed during the study. Poor ECOG performance status (0-1 vs. 2-3, HR = 1.70, p = 0.002) and weight loss ≥ 10 % before the start of therapy (HR = 1.99, p = 0.001) were among the factors significantly associated with poor OS in multivariate analysis. Three-dimensional conformal definitive radio(chemo)therapy is well tolerated and leads to long-term survival in more than 20 % of patients with advanced disease and/or contraindication to surgery. However, 24 % in-field recurrence remains a major concern. Prospective trials are warranted to assess if a well-tailored conformal radiochemotherapy can improve the local control and obviate the need for surgical resection in patients with good general condition and potentially resectable tumors.