Positive Regional Nodes Research Articles

Delayed time to radiation and overall survival in Merkel cell carcinoma.

Clinically localized Merkel cell carcinoma (MCC) is commonly treated with surgical excision and radiotherapy. The relationship between time to adjuvant radiotherapy and overall survival (OS) remains understudied. This retrospective study used data from the National Cancer Database (2006-2019). Patients with clinically localized MCC who received surgical excision and adjuvant radiotherapy were included. Multivariate regressions were used to account for various patient and tumor factors. The primary outcome was 5-year OS, and the secondary outcome was time from diagnosis to adjuvant radiation (TTR). Of the 1965 patients included, most were male (n = 1242, 63.2%) and white (n = 1915, 97.5%), and the median age was 74 years (interquartile range [IQR]: 66-81). The median TTR was 83 days (IQR: 65-106). A total of 83.6% of patients received radiotherapy to the primary site, 21.3% to the draining nodal basin, 17.1% to both, and 12.2% whose target location of radiotherapy was not recorded in the data. TTR of ≥79 days (the 45th percentile) was associated with worse OS on both univariate and multivariate analyses (log-rank p = 0.0014; hazard ratio [HR]: 1.258, 95% confidence interval [CI]: 1.055-1.500, p = 0.010). This persisted on sub-analyses of patients <80 years old (n = 1407; HR: 1.380, 95% CI: 1.080-1.764, p = 0.010) and of patients with Charlson comorbidity index (CCI) of 0 (n = 1411; HR: 1.284, 95% CI: 1.034-1.595, p = 0.024). Factors associated with delayed TTR included greater age (p = 0.039), male sex (p = 0.04), CCI > 1 (p = 0.036), academic facility (p < 0.001), rural county (p = 0.034), AJCC T2 stage (p = 0.010), negative margins (p = 0.017), 2+ pathologically positive regional nodes (p = 0.011), and margin size >2 cm (p = 0.015). Delayed radiotherapy (≥79 days) was associated with worse OS of MCC patients. Further study in controlled cohorts is needed to ascertain this relationship.

WTP3.1 Histological stage and five-year recurrence/survival in patients who undergo pancreatoduodenectomy for ampullary adenocarcinoma

Abstract Aims Patients with ampullary adenocarcinoma (AA) may be offered pancreatoduodenectomy (PD) with curative-intent providing they are appropriate surgical candidates. This study aimed to investigate and quantify the relationship between histological T and N stage, and five-year recurrence/survival in this group. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, n=1484). Patients with AA were grouped by their T stage and N stage, and five-year recurrence/survival rates were compared using Fisher’s exact test. Results 394 patients (27%) had AA. T1, T2, T3 and T4 disease affected 46 (12%), 131 (33%), 130 (33%), and 86 (22%) patients, respectively (Tx: 1). Five-year recurrence was 11%, 35%, 53% and 65%, respectively. Patients with T3-4 disease (vs T1-2) had significantly higher rates of five-year recurrence (OR: 3.4, 95% CI: 2.2-5.2). Five-year survival was 78%, 65%, 45% and 36% in patients with T1, T2, T3 and T4 disease, respectively. Patients with T1-2 disease (vs T3-4) had significantly higher rates of five-year survival (OR: 3.1, 95% CI: 2.0-4.7). Concerning nodal status, 154 patients (39%) had no lymph node involvement and 239 (61%) had positive regional lymph nodes (could not be assessed in one patient). Patients with N0 disease (vs N1) had lower five-year recurrence (OR: 0.3, 95% CI: 0.2-0.4) and higher five-year survival (OR: 4.5, 95% CI: 2.7-6.6) rates. Conclusion In our multicentre study of AA patients who underwent PD, increasing T and N histological stages were found to correlate with increased five-year recurrence and reduced five-year survival rates.

WTP3.8 Histological stage and five-year outcomes in patients who undergo pancreatoduodenectomy for distal cholangiocarcinoma: an international multicentre study

Abstract Aims Patients with a distal cholangiocarcinoma (CC) may be offered pancreatoduodenectomy (PD) with curative-intent providing they are appropriate surgical candidates. Patients with early disease are known to have better outcomes. This study aimed to investigate and quantify the relationship between histological stage and five-year recurrence/survival. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre study of PD outcomes (29 centres in 8 countries, n=1484). CC patients were grouped by their T stage and N stage, and five-year recurrence/survival rates were compared using Fisher’s exact test. Results A total of 205 patients (13.8%) had CC confirmed. The number of patients with T1, T2, T3 and T4 disease was 11 (5%), 25 (12%), 158 (78%), and 8 (4%), respectively (Tx: 3). Five-year recurrence was 9%, 32%, 70% and 75%, respectively. T1-2 patients (vs T3-4) had lower rates of five-year recurrence (OR: 0.1, 95% CI: 0.1-0.3). Five-year survival was 90%, 60%, 23% and 38% in patients with T1, T2, T3 and T4 disease, respectively. T1-2 patients (vs T3-4) had higher rates of five-year survival (OR: 5.8, 95% CI: 2.8-12.3). 69 patients (34%) had no lymph node involvement and 136 (66%) had positive regional lymph nodes. N0 patients (vs N1) had lower five-year recurrence (OR: 0.3, 95% CI: 0.1-0.5) and higher five-year survival (OR: 4.5, 95% CI: 2.4-8.7) rates. Conclusions In our multicentre study of PD outcomes, increasing T and N histological stages were found to correlate with increased five-year recurrence and reduced five-year survival rates in patients with CC.

The high-risk features and effect of postoperative radiotherapy on survival for patients with surgically treated stage IIIA-N2 non-small cell lung cancer

ObjectivesAlthough postoperative radiotherapy (PORT) could reduce the incidence of local recurrence in patients with IIIA-N2 non-small cell lung cancer (NSCLC), the role of PORT on survival in patients with surgically treated stage IIIA-N2 NSCLC remains controversial. Therefore, this study was designed to evaluate the effect of PORT on survival for patients with surgically treated stage IIIA-N2 NSCLC.Materials and methodsThis study population was chosen from the Surveillance, Epidemiology, and End Results database. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) and cancer special survival (CSS) outcomes. To balance baseline characteristics between the non-PORT group and PORT group, propensity score matching (PSM) with 1:1 propensity nearest-neighbor match by 0.001 matching tolerance was conducted by R software. Furthermore, a Kaplan–Meier curve was used to visualize the OS and CSS between the PORT group and non-PORT group survival probability.ResultsOf all evaluated cases, 4511 with IIIA-N2 NSCLC were eligible for inclusion, of which 1920 were enrolled into the PORT group. On univariate analysis and multivariate analysis, sex, age, year of diagnosis, race, histologic type, T stage, PORT, use of chemotherapy, and positive regional nodes were significantly associated with OS and CSS in IIIA-N2 NSCLC (P < 0.05). However, PORT was not significantly associated with OS (univariate HR = 0.92, 95%CI 0.85–0.99, P = 0.02; multivariate HR = 1.01, 95%CI 0.93–1.08, P = 0.91) and CSS (univariate HR = 0.92, 95%CI 0.85–1.01, P = 0.06; multivariate HR = 1.103 95%CI 0.94–1.12, P = 0.56) in IIIA-N2 NSCLC. Meanwhile, after PSM, neither OS nor CSS did differ significantly between the non-PORT group and PORT group (OS HR = 1.08, 95%CI 0.98–1.19, P = 0.12; CSS HR = 1.10, 95%CI 0.99–1.23, P = 0.07).ConclusionPORT did not contribute to a survival benefit in patients with surgically treated stage IIIA-N2 NSCLC.

Nomogram predicting overall prognosis for invasive micropapillary carcinoma of the breast: a SEER-based population study

ObjectivesThe prognosis of invasive micropapillary carcinoma (IMPC) of the breast is determined by many clinicopathological factors. This study aims to identify prognostic factors and develop reliable nomogram to predict the...

Epidemiology and outcomes of anorectal melanomas: A national database analysis.

e21572 Background: Anorectal melanoma is a rare but aggressive type of melanoma, arising primarily from the mucosal epithelium from the anorectal tract. Knowledge of this rare etiology has been limited given its low incidence. This study aims to characterize the epidemiology and treatment outcomes of anorectal melanoma using a national database. Methods: The Surveillance, Epidemiology and End Results (SEER) Database was queried to identify patients with biopsy-proven anorectal melanoma. The following information was retrieved: tumor site, grade, stage, intervention, lymph node histology, and survival information for oncology codes as per the international classification of diseases. Statistical analysis was performed with Stata 15.1 (STATA Corp., College Station, TX, USA). Results: The age-adjusted anorectal melanoma annual incidence rates have been stable approximately 0.4-0.5 per 1 million from 2000 to 2019. Of the 823 biopsy-proven confirmed cases of anorectal melanoma from 2000 to 2018, 150 (18.2%) received chemotherapy, 182 (22.1%) received radiotherapy, 55 (6.7%) received chemoradiation, while 619 (75.2%) of the population received surgery alone or combined with chemotherapy and/or radiotherapy. Statistically significant improvement in survival was noted in treatment strategies that utilized surgery with and without chemotherapy and/or radiotherapy (median survival time 22 vs 9 months, p &lt; 0.0001). Patients with positive regional lymph nodes on pathology were associated with worse prognosis (median survival time 15 vs 37 months, p &lt; 0.0001). Outcomes did not differ based on sex (p = 0.810) and race (p = 0.372). Conclusions: Incidence of anorectal melanoma in the United States has been stable in the last twenty years. Treatment strategies including surgical resection should be adopted if possible to achieve improved survival outcomes.

A nomogram for predicting survival in patients with skin non-keratinizing large cell squamous cell carcinoma: A study based on the Surveillance, Epidemiology, and End Results database.

This study aimed to develop and validate a nomogram for predicting cancer-specific survival (CSS) in patients with non-keratinized large cell squamous cell carcinoma (NKLCSCC) at 3, 5, and 8 years after diagnosis. Data on SCC patients were collected from the Surveillance, Epidemiology, and End Results database. Training (70%) and validation (30%) cohorts were generated using random selection of patients. Independent prognostic factors were selected using the backward stepwise Cox regression model. To predict the CSS rates in patients with NKLCSCC at 3, 5, and 8 years after diagnosis, all of the factors were incorporated into the nomogram. Indicators such as the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), calibration curve, and decision-curve analysis (DCA) were then used to validate the performance of the nomogram. This study included 9,811 patients with NKLCSCC. Twelve prognostic factors were identified by Cox regression analysis in the training cohort, which were age, number of regional nodes examined, number of positive regional nodes, sex, race, marital status, American Joint Committee on Cancer (AJCC) stage, surgery status, chemotherapy status, radiotherapy status, summary stage, and income. The constructed nomogram was validated both internally and externally. The nomogram had good discrimination ability, as indicated by the comparatively high C-indices and AUC values. The nomogram was properly calibrated, as indicated by the calibration curves. Our nomogram was superior to the AJCC model, as illustrated by its superior NRI and IDI values. DCA curves indicated the clinical usability of the nomogram. The first nomogram for prognosis predictions of patients with NKLCSCC has been developed and verified. Its performance and usability demonstrated that the nomogram could be utilized in clinical settings. However, additional external verification is still required.

Assessing survival time of outpatients with cervical cancer: at the university of Gondar referral hospital using the Bayesian approach

BackgroundCervical cancer is the 4th most common cancer in women worldwide. as well as the 4th most common cause of cancer-related death. The main objective of this study was to identify factors that affect the survival time of outpatients with cervical cancer.MethodsA retrolective study including outpatients with cervical cancer was carried out in a hospital. To achieve the aim, 322 outpatients with cervical cancer were included in the study based on the data taken from the medical records of patients enrolled from May 15, 2018, to May 15, 2022, at the University of Gondar referral hospital, Gondar, Ethiopia. The Kaplan–Meier plots and log-rank test were used for the comparison of survival functions; the Cox-PH model and Bayesian parametric survival models were used to analyze the survival times of outpatients with cervical cancer. Integrated nested Laplace approximation methods have been applied.ResultsOut of a total of 322 patients, 118 (36.6%) died as outpatients. The estimated median survival time for patients was 42 months. Using model selection criteria, the Bayesian log-normal accelerated failure time model was found to be appropriate. According to the results of this model, oral contraceptive use, HIV, stage, grade, co-morbid disease, history of abortion, weight, histology type, FIGO stage, radiation, chemotherapy, LVSI, metastatic number, regional nodes examined, and tumor size all have a significant impact on the survival time of outpatients with cervical cancer. The Bayesian log-normal accelerated failure time model accurately predicted the survival time of cervical cancer outpatients.ConclusionsThe findings of this study suggested that reductions in weight, treatment, the presence of comorbid disease, the presence of HIV, squamous cell histology type, having a history of abortion, oral contraceptive use, a large tumor size, an increase in the International Federation of Gynecologists and Obstetricians stage, an increase in metastasis number, an increase in grade, positive regional nodes, lymphatic vascular space invasion, and late stages of cancer all shortened the survival time of cervical cancer outpatients.

PATTERN OF MMP2 AND MMP9 EXPRESSION DEPENDS ON BREAST CANCER PATIENTS' AGE.

Despite the large number of studies devoted to the study of the features of tumor microenvironment in breast cancer (BCa), presently there is no consensus on the features of MMP-2 and MMP-9 expression in the tumor tissue of BCa patients depending on the age. The aim of the study was to investigate the relationship between MMP-2 and -9 expression at the protein and mRNA levels in BCa tissues and the clinical and pathological features of BCapatientsin different age groups. The expression level of MMP-2 and -9in the BCa tissue of patients of two age groups (< 45 years and > 45 years) was studied using the bioinformatics method (UALCAN database), immunohistochemical method, and real-time PCR. It was established that a characteristic feature of BCa in young patients is the low level of MMP2 mRNA against the background of increased expression of this gelatinase at the protein level, as well as decreased expression of MMP9 at both the mRNA and protein levels. When analyzing the correlation of the gelatinase expression indices in BCa tissue of young patients, depending on the clinical and pathological features, a significantly lower level of MMP-2 expression was recorded in BCa cases of stage II compared to the indices of stage I cases. High expression of MMP-2 and -9 was recorded in BCa tissue in node-positive cases and the basal molecular BCa subtype. The identified relationship between the expression of the studied gelatinases and such indices of BCa malignancy as its stage, positive regional lymph node status, and the molecular BCa subtype in young patients indicates the need for further research of the features of the tumor microenvironment to predict the cancer aggressiveness.

Prepubertal Children with Papillary Thyroid Carcinoma Present with More Invasive Disease Than Adolescents and Young Adults.

Introduction: Pediatric papillary thyroid carcinomas (PTCs) are more invasive than adult PTCs. No large, contemporary cohort study has been conducted to determine whether younger children are at higher risk for advanced disease at presentation compared to adolescents. We aimed to describe pediatric PTC and contextualize its characteristics with a young adult comparison cohort. Methods: The National Cancer Database was interrogated for pediatric and young adult PTCs diagnosed between 2004 and 2017. Clinical variables were compared between prepubertal (≤10 years old), adolescent (11-18 years old), and young adult (19-39 years old) groups. Multivariable logistic regression modeling for independent predictors of metastases was conducted. A subanalysis of microcarcinomas (size ≤10 mm) was performed. Results: A total of 4860 pediatric (prepubertal n = 274, adolescents n = 4586) and 101,159 young adult patients were included. Prepubertal patients presented with more extensive burden of disease, including significantly larger primary tumors, higher prevalence of nodal and distant metastases, and increased frequency of features such as lymphovascular invasion, and extrathyroidal extension (ETE). Prepubertal age was an independent predictor of positive regional nodes (adjusted odds ratio [AOR] = 1.36 [95% confidence interval {CI} 1.01-1.84], p = 0.04) and distant metastatic disease (AOR = 3.12 [CI 1.96-4.96], p < 0.001). However, there was no difference in survival between groups (p = 0.32). Prepubertal age independently predicted lymph node metastases for microcarcinomas (AOR = 2.19 [CI 1.10-4.36], p = 0.03). Prepubertal (n = 41) versus adolescent (n = 937) patient age was associated with gross ETE (p = 0.004), even with primary tumors ≤1 cm in size. Conclusions: Patients aged <11 years old present with more advanced disease than adolescents, with a higher likelihood of nodal and distant metastatic disease at time of diagnosis, although survival is high. Prepubertal children undergo more extensive treatment, likely reflective of more invasive disease at the outset, even in the setting of a subcentimeter primary tumor.

Nephron sparing surgery outcomes in Wilms' tumor: is it ready for primetime?

Radical nephrectomy is the gold standard in Wilms tumor (WT) treatment and is combined with adjuvant treatment in early stage disease or performed after neo adjuvant therapy in advanced disease. With the development of novel adjuvant and neoadjuvant therapeutic strategies, there is increasing interest in organ preserving procedures in several adult malignancies. Potential long-term complications of living with a single kidney include hyperfiltration syndrome, hypertension, and fluid retention. If NSS (Nephron Sparing Surgery) were to be adopted for the treatment of WT it would be necessary to preserve the gains in Overall Survival (OS) seen with current treatment protocols. With this in mind we undertook a study of outcomes of NSS performed in the USA using a large population-based registry. We retrospectively queried the SEER Research Plus 18-registries Database 2010-2018 for patients 18years old or younger with Wilms tumor as determined by ICD-O-3 code 8960. Clinical and demographic data was extracted, and statistical analysis was performed in GraphPad PRISM 9 with bivariate analysis and log-rank analysis to determine survival. 1087 patients with Wilms tumor were identified. 73 (6.72%) underwent nephron-sparing surgery. The final cohort consisted of 45 patients (64%) who underwent unilateral NSS and 25 patients (36%) who underwent bilateral NSS. Three were excluded from analysis due to non-renal origin of tumor. Mean age was 3.214years (std dev 3.807). Demographics were similar between the groups, apart from younger age associated with bilateral tumor (p = 0.0441). No differences were found between radiation use (p = 0.4280), chemotherapy use (p = 0.5479), tumor size (p = 0.2186), positive regional lymph nodes (p = 0.707). Log-rank analysis demonstrated that cancer-specific survival was not significantly different between unilateral and bilateral NSS or radical nephrectomy (p = 0.4539). NSS may preserve renal function long-term, an important consideration in the pediatric population. Prospective study is necessary to select the appropriate patient subsets who may benefit from NSS in WT.

Demographics, pattern of practice and clinical outcomes in rectal squamous cell carcinoma.

The aim of this study was to describe the baseline clinical features, treatment patterns and outcomes in rectal squamous cell carcinoma (SCC). This is a retrospective study of patients with rectal SCC treated at the Princess Margaret Cancer Centre (Toronto, Canada) between 1 January 1995 and 31 December 2020. Clinical factors associated with locoregional failure (LRF), distant metastases (DM), disease-free survival (DFS) and overall survival (OS), such as age, sex, HIV status, T-category, nodal status, grade and primary treatment, were investigated with univariate analysis (UVA). Twenty nine patients with rectal SCC were analysed with a median follow-up of 7.4 years (range 0.3-20.4 years). The median age at diagnosis was 52 years, with the majority presenting with clinical T3 disease or higher (n=21, 72%) and positive regional lymph nodes (n=16, 55%), while more than quarter of patients (28%) had metastatic disease. Definitive chemoradiation was the treatment modality of choice in more than half of all cases (n=17, 59%) with a response rate of 100%. The 10-year cumulative incidence of LRF and DM was, respectively, 12% (95% CI 1.8%-32.9%) and 31% (95% CI: 12.0%-52.6%). The 5- and 10-year OS was 82% (95% CI 66.1%-100%). UVA revealed a trend towards an association of male gender (hazard ratio=4.65, 95% CI 0.9%-24.1; p=0.067) and primary surgical treatment (hazard ratio=0.76, 95% CI 0.09-6.34; p=0.061) with DFS. Definitive chemoradiation is an effective and preferred treatment for rectal SCC allowing for sphincter preservation with complete clinical response observed in all patients.

Impact of Induction Chemotherapy Antecedent to Long Course Neoadjuvant Concurrent Chemo-Radiotherapy on Clinical Outcomes of Patients with Carcinoma Rectum: Retrospective Audit from a Tertiary Cancer Center

<h3>Purpose/Objective(s)</h3> The paradigm of management of locally advanced rectal (T3/4; T1-4N1-2) cancers (LARC) have been shifting to induction chemotherapy (NACT) with long course neoadjuvant chemo-radiotherapy (NACRT) followed by total mesorectal excision (TME) inching towards total neoadjuvant therapy approach. We aimed to evaluate the outcomes of NACRT alone (Arm A) versus NACT followed by NACRT (Arm B) in LARC treated at our center. <h3>Materials/Methods</h3> Data of 101 patients of LARC (March 2013 – Jan 2021) were retrieved for this retrospective analysis. NACT in Arm B consisted of 2 cycles of CAPOX [oxaliplatin (130 mg/m² day 1) and capecitabine (1000 mg/m² twice daily for 14 days) repeated every 3 weeks]. Radiotherapy (RT) in both the arms was 50.4 Gray in 28 fractions with capecitabine 825 mg/m² twice daily on days of RT. All patients underwent TME. Adjuvant chemotherapy (ACT) consisted of CAPOX regimen. Pathological complete response (pCR) and overall complete response OCR (pCR plus near complete response) were defined as per modified Ryan grading system. Disease-free survival (DFS) and overall survival (OS) were assessed with Kaplan Meier method. <h3>Results</h3> Patient characteristics are summarized in Table 1. Median number of NACT cycles in Arm B was two (range 2-4). Median radiotherapy dose was 50.4 Gray. pCR rates were 12.7% in arm B and 7.3% (3/41) in arm A (p=0.516). OCR rates were 28.3% (17/60) in Arm B vs 12.1% (5/41) in Arm A (p=0.044). 2-Year DFS and OS in Arm A versus B were 47.5% vs. 73.9% (p=0.781) and 54.3% vs 67.3% (p= 0.371) respectively. Patients with pCR vs no pCR had better 2-year DFS and OS 88.9% vs 50.1% (p = 0.009) and 83.3% vs 55.4% (p = 0.015) respectively. Patients with OCR vs no OCR had better 2-year DFS and OS 88.5% vs 45.2% (p = 0.009) and 94.4% vs 51% (p = 0.015) respectively. Patients with positive circumferential margin (CRM) and regional node at presentation had poorer DFS 18.6% vs 83.6% (p=0.03) and 42.7% vs 54.9% (p=0.004) respectively. <h3>Conclusion</h3> NACT prior to NACTRT leads to higher OCR rates in LARC. pCR and OCR predicted better DFS and OS and positive CRM and node positivity at presentation portended poorer outcome in our cohort of patients.

The Value of Radiotherapy in Patients With Resectable Stage IIIA Non–Small-Cell Lung Cancer in the Era of Individualized Treatment: A Population-Based Analysis

IntroductionNo consensus has been achieved on the benefit of radiotherapy for resected stage IIIA NSCLC patients. The division of stage IIIA has changed significantly in 2017. This study aims to explore the effects of radiotherapy on the survival of patients with resectable stage IIIA NSCLC in the new era. Patients and MethodsPatients diagnosed with NSCLC between 2010 and 2018 were identified in the 8th edition TNM classification from the Surveillance, Epidemiology, and End Results database. A nomogram was developed by integrating all independent predictors for lung cancer-specific survival (LCSS). The Propensity Score Matching (PSM) and subgroup analysis were applied to mitigate potential bias. Survival analyses were conducted using the Kaplan Meier curves and Cox proportional hazards regression. ResultsA total of 2632 stage IIIA NSCLC patients were enrolled. The C-index of the nomogram for the prediction of LCSS was 0.636 (95% CI, 0.616-0.656). In the group of patients with N2 stage who featured more than 5 positive regional lymph nodes, compared with non-PORT, PORT did prolong postoperative survival time (50 vs. 31 months; P= .005). N2 patients with visceral pleural invasion (VPI), older (age >65), or had a larger tumor (size >3 cm) could also benefit from adjuvant radiotherapy. ConclusionTreatment protocol for stage IIIA NSCLC patients should be individualized. Based on our findings, N2 patients with more than 5 positive regional lymph nodes, VPI, larger tumor size (greater than 3 cm), and older (age above 65) could benefit from adjuvant radiotherapy. Further well-designed randomized trials are warranted.

Prognostic value of lymphocyte-related systemic inflammatory biomarkers in triple negative breast cancer.

The aim was to evaluate inflammatory biomarkers as prognostic factors in patients with triple negativbreast cancer. We have collected data from 143 patients and evaluated using Chi-Squared test, Wilcoxon–Mann–Whitney test and Cox regression. We found a relationship between high neutrophil- to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammation index and local advancement features: tumor (T3/T4) (P = 0.0001, P = 0.0198, P = 0.0001), positive regional lymph nodes (P = 0.0014, P = 0.0075, P = 0.0206). In the multivariate analysis metastatic disease, worse performance status and high NLR (Hazard ratio: 4.48 [2.05–9.80], P=0.0002; 2.23 [1.24–4.03], P=0.0010; 2.23 [1.24–4.03], P=0.0075) were adverse prognostic factors. High neutrophil-to-lymphocyte ratio with worse performance status turned out an adverse independent prognostic factors.

Prognostic markers including immune and inflammatory factors predict outcomes in patients receiving postoperative radiation therapy for cholangiocarcinoma.

This study aimed to analyze treatment outcomes and prognostic markers, including immune and inflammatory factors, of postoperative radiation therapy (RT) administered to patients with cholangiocarcinoma (CCA). We retrospectively included 59 patients with CCA who underwent surgery and postoperative RT with curative intent from 2004 to 2019. Patients received external irradiation (50Gy in 25 fractions) using three-dimensional RT. We analyzed prognostic factors of inflammation, such as pre-RT platelet count, hemoglobin, lymphocyte count ratio (LCR) of the leukocyte count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR). Tumor stages were distributed as follows: I (n=8), II (n=25), III (n=15), and IVA (n=11). The median follow-up was 24 months. Two-year overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and locoregional control (LRC) rates were 59.5%, 62.0%, 40.1%, and 66.7%, respectively. Univariate analysis revealed that lower LCR was significantly associated with shorter PFS (p=0.0446). There was no significant difference between the median baseline values of PLR and NLR; and age ≥75, positive regional lymph node metastases (N+), and chemotherapy after RT were significantly associated with poor OS. Multivariate analysis revealed a significant association of N+ with worse OS, PFS, and CSS and that lower LCR was significantly associated with better PFS (p=0.0234). Among late toxicity events, two patients (3.38%) were suspected with therapy-related liver toxicity. Lower LCR before RT was a better prognostic factor for postoperative RT of patients with CCA.

The role of postoperative radiation therapy in stage I–III male breast cancer: A population-based study from the surveillance, epidemiology, and End Results database

BackgroundThis study aimed to investigate the role of postoperative radiation therapy in a large population-based cohort of patients with stage I–III male breast cancer (MaBC). MethodsPatients with stage I–III breast cancer treated with surgery were selected from the Surveillance, Epidemiology, and End Results cancer database from 2010 to 2015. Multivariate logistic regression identified the predictors of radiation therapy administration. Multivariate Cox regression model was used to evaluate the predictors of survival. ResultsWe identified 1321 patients. Age, stage, positive regional nodes, surgical procedure, and HER2 status were strong predictors of radiation therapy administration. There was no difference between patients who received radiation therapy and those who did not (P = 0.46); however, after propensity score matching, it was associated with improved OS (P = 0.04). In the multivariate analysis of the unmatched cohort, the factors associated with better OS were administration of radiation therapy and chemotherapy. In the subset analysis of the unmatched cohort, postoperative radiation therapy was associated with improved OS in men undergoing breast-conserving surgery (BCS), with four or more node-positive or larger primary tumours (T3/T4). Furthermore, we found no benefit of radiation therapy, regardless of the type of axillary surgery in mastectomy (MS). In older MaBC patients with T1-2N1 who underwent MS, radiation therapy showed no significant effects, regardless of chemotherapy. ConclusionPostoperative radiation therapy could improve the survival of MaBC patients undergoing BCS, with four or more node-positive or larger primary tumours. Moreover, it should be carefully considered in patients undergoing MS and older T1-2N1 patients.

Impact of Positive Lymph Nodes and Resection Margin Status on the Overall Survival of Patients with Resected Perihilar Cholangiocarcinoma: The ENSCCA Registry.

Simple SummaryLymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients after resection for perihilar cholangiocarcinoma (pCCA). The aim of current study was to assess the prognostic value of positive lymph nodes and resection margin status on OS. We found a major negative effect of positive lymph nodes on survival and recurrence, which, surprisingly, was independent of margin status. ECOG performance status, positive lymph nodes, and the grade of tumor differentiation were found as the main independent indicators of oncological outcome. This suggests that tumor biology and performance status have a higher impact on survival than extended or radical surgery.Background: Lymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients who underwent resection for perihilar cholangiocarcinoma (pCCA). However, the prognostic value of positive lymph nodes independently from resection margin status on OS has not been evaluated. Methods: From the European Cholangiocarcinoma (ENSCCA) registry, patients who underwent resection for pCCA between 1994 and 2021 were included in this retrospective cohort study. The primary outcome was OS stratified for resection margin and lymph node status. The secondary outcome was recurrence-free survival. Results: A total of 325 patients from 11 different centers and six European countries were included. Of these, 194 (59.7%) patients had negative resection margins. In 113 (34.8%) patients, positive lymph nodes were found. Lymph node status, histological grade, and ECOG performance status were independent prognostic factors for survival. The median OS for N0R0, N0R1, N+R0, and N+R1 was 38, 30, 18, and 12 months, respectively (p < 0.001). Conclusion: These data indicate that in the presence of positive regional lymph nodes, resection margin status does not determine OS or RFS in patients with pCCA. Achieving negative margins in patients with positive nodes should not come at the expense of more extensive surgery and associated higher mortality.

Establishment of prognostic nomogram for high-grade parotid gland mucoepidermoid carcinoma based on the SEER database.

Purpose: We aim to investigate the clinical factors that affect the prognosis of overall survival (OS) for patients with high-grade parotid gland mucoepidermoid carcinoma (high-grade pMEC) and construct a nomogram for prognosis prediction. Subjects and method: Totally, 519 patients diagnosed as high-grade pMEC from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015 were reviewed. Independent prognostic factors for OS were identified by univariate and multivariate Cox regression analyses. Nomogram was generated to predict the individual's 3- and 5- year OS rates by using R software. Prediction ability was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and model calibration was evaluated through calibration plots. Decision curve analysis (DCA) was used to assess the clinical usefulness and net benefit. Results: The results of univariate analysis demonstrated that age, AJCC stage, T stage, N stage, M stage, extraparenchymal lesions, regional lymph nodes status, lymph node dissection status, radiotherapy, chemotherapy, and surgery were significantly correlated with the OS (P < 0.05). Multivariate Cox regression analyses showed that older age at diagnosis, advanced AJCC stage, and positive regional lymph nodes were independent risk factors for OS. In addition, the present study revealed that radiotherapy and surgery were independent protective factors for OS (P < 0.05). The nomograms showed accurate prognostic ability that individually predict 3-years and 5-years overall survival (OS) rates based on age, AJCC stage, regional lymph nodes status, radiotherapy, and surgery. The area under the receiver operating characteristic (ROC) curve (AUC) of the nomogram used to predict the 3-year and 5-year overall survival rate were 0.779 and 0.793, indicating that the model had a good predictive power for the overall survival in high-grade pMEC patient. Conclusions: Using the SEER database, we performed univariate and multivariate analyses to determine independent prognostic factors in high-grade pMEC patients. Subsequently, we constructed and validated a prognostic nomogram to predict 3-and 5-year OS rates based on the SEER database and can assist clinicians to intuitively evaluate prognosis of high-grade pMEC patients.

A Nomogram for Predicting Cancer-Specific Survival in Children With Wilms Tumor: A Study Based on SEER Database and External Validation in China.

BackgroundWilms tumor (WT) is the most common tumor in children. We aim to construct a nomogram to predict the cancer-specific survival (CSS) of WT in children and externally validate in China.MethodsWe downloaded the clinicopathological data of children with WT from 2004 to 2018 in the SEER database. At the same time, we used the clinicopathological data collected previously for all children with WT between 2013 and 2018 at Children's Hospital of Chongqing Medical University (Chongqing, China). We analyzed the difference in survival between the patients in the SEER database and our hospital. Cox regression analysis was used to screen for significant risk factors. Based on these factors, a nomogram was constructed to predict the CSS of children with WT. Calibration curve, concordance index (C-index), the area under the receiver operating curve (AUC) and decision curve analysis (DCA) was used to evaluate the accuracy and reliability of the model.ResultsWe included 1,045 children with WT in the SEER database. At the same time, we collected 112 children with WT in our hospital. The Kaplan-Meier curve suggested that children in China with WT had a higher mortality rate than those in the United States. Cox regression analysis revealed that age, lymph node density (LND), and tumor stage were significant prognostic factors for the patients in the SEER database. However, the patients in our hospital only confirmed that the tumor stage and the number of positive regional lymph nodes were significant factors. The prediction model established by the SEER database had been validated internally and externally to prove that it had good accuracy and reliability.ConclusionWe have constructed a survival prognosis prediction model for children with WT, which has been validated internally and externally to prove accuracy and reliability.