Presence Of Lung Metastases Research Articles

Is There a Role for Perioperative Pelvic Radiotherapy in Surgically Resected Stage IV Rectal Cancer?: A Propensity Score-matched Analysis.

This study aimed to determine whether perioperative pelvic radiotherapy (RT) improves outcomes in stage IV rectal cancer patients treated with primary surgical resection and systemic chemotherapy and to identify predictive factors for selection of patients for these approaches. We searched the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed between 2010 and 2015 with stage IV rectal cancer, but without brain or bone metastases. After applying the exclusion criteria, a total of 26,132 patients were included in the analysis; propensity score matching was used to balance their individual characteristics. Overall, 3283 (12.6%) patients received perioperative RT; the 3-year overall survival (OS) rates were 43.6% in the surgery group and 50.5% in the surgery with RT group (P<0.001). The survival benefit of RT was maintained after propensity score matching and multivariate adjustment (hazard ratio: 0.70; 95% confidence interval: 0.66-0.81; P<0.001). Interaction testing of the prognostic variables showed a significant interaction between RT and the presence of lung metastasis (P<0.001): the benefit of RT was observed only in patients without lung metastases (3 y OS 52.1% vs. 44.1%, P<0.001), but it was observed regardless of liver metastases. In addition, we developed a web-based calculator (http://bit.do/mRC_surv) to provide individualized estimates of OS benefit based on the receipt of perioperative pelvic RT. Perioperative pelvic RT significantly improved OS rates, especially in patients without lung metastases. We successfully developed a nomogram and web-based calculator that could predict survival benefit with the addition of RT for these patients.

Predicting Outcomes in Men With Metastatic Nonseminomatous Germ Cell Tumors (NSGCT): Results From the IGCCCG Update Consortium.

PURPOSEThe classification of the International Germ Cell Cancer Collaborative Group (IGCCCG) plays a pivotal role in the management of metastatic germ cell tumors but relies on data of patients treated between 1975 and 1990.MATERIALS AND METHODSData on 9,728 men with metastatic nonseminomatous germ cell tumors treated with cisplatin- and etoposide-based first-line chemotherapy between 1990 and 2013 were collected from 30 institutions or collaborative groups in Europe, North America, and Australia. Clinical trial and registry data were included. Primary end points were progression-free survival (PFS) and overall survival (OS). The survival estimates were updated for the current era. Additionally, a novel prognostic model for PFS was developed in 3,543 patients with complete information on potentially relevant variables. The results were validated in an independent data set.RESULTSCompared with the original IGCCCG publication, 5-year PFS remained similar in patients with good prognosis with 89% (87%-91%) versus 90% (95% CI, 89 to 91), but the 5-year OS increased from 92% (90%-94%) to 96% (95%-96%). In patients with intermediate prognosis, PFS remained similar with 75% (71%-79%) versus 78% (76%-80%) and the OS increased from 80% (76%-84%) to 89% (88%-91%). In patients with poor prognosis, the PFS increased from 41% (95% CI, 35 to 47) to 54% (95% CI, 52 to 56) and the OS from 48% (95% CI, 42 to 54) to 67% (95% CI, 65 to 69). A more granular prognostic model was developed and independently validated. This model identified a new cutoff of lactate dehydrogenase at a 2.5 upper limit of normal and increasing age and presence of lung metastases as additional adverse prognostic factors. An online calculator is provided (https://www.eortc.org/IGCCCG-Update).CONCLUSIONThe IGCCCG Update model improves individual prognostication in metastatic nonseminomatous germ cell tumors. Increasing age and lung metastases add granularity to the original IGCCCG classification as adverse prognostic factors.

Lung metastases in newly diagnosed hypopharyngeal cancer: a population-based study.

Current population-based estimates of the incidence and prognosis of lung metastases of hypopharyngeal cancer are lacking. The purpose of the study is to characterize the incidence proportions and survival probability of patients with hypopharyngeal cancer and lung metastases. We identified 2714 adult patients diagnosed with hypopharyngeal cancer between 2010 and 2014 for whom the status of lung metastases was known from the SEER database. Multivariable logistic and Cox regression models were performed to identify the risk factors associated with the presence of lung metastases at diagnosis and 5-year all-cause mortality, respectively. We identified 128 patients with lung metastases at the time of diagnosis of hypopharyngeal cancer. Females were less likely to have lung metastases. Incidences of lung metastases were higher among patients with histological grade III/IV. For each 10mm increase in tumor size, the odds of having lung metastases increased by 6.6%. Patients with lung metastases had a shorter survival time. Our study provides insight into the epidemiology of lung metastases in patients with hypopharyngeal cancer. When the tumor is diagnosed, we should pay close attention to the sex, race, tumor size and histological grade to quickly detect the distant metastases.

An observational retrospective analysis of the main metastatic site and corresponding locoregional treatment as a prognostic factor in metastatic gastric cancer.

Despite novel drugs, the prognosis for patients with metastatic gastric cancer remains poor. In rare instances, locoregional therapies are used in addition to standard chemotherapy in patients with oligometastatic involvement. This type of approach has not been supported by solid published evidence. The aim of the present retrospective study was to assess the prognostic impact of factors such as metastatic site, tumour histology and locoregional treatment in patients with metastatic gastric cancer. A total of 184 patients with metastatic gastric or gastroesophageal junction adenocarcinoma who received at least one line of palliative therapy with doublet or triplet chemotherapy were enrolled in the current analysis. Median overall survival (OS) was 8.32 months (95% CI, 7.02–9.41) and median progression-free survival (PFS) was 4.16 months (95% CI, 3.24–5.08). Lung metastases vs. other sites of metastatic involvement [hazard ratio (HR), 0.27; P=0.0133] and intestinal histology (HR, 0.48; P=0.08) were significantly associated with an improved OS. Improved PFS was also observed (HR, 0.49; P=0.10 and HR, 0.72; P=0.08 for lung metastases and intestinal histology, respectively). Second line chemotherapy and locoregional treatment of metastases (surgery or radiotherapy) were associated with improved OS (HR, 0.52; P<0.0001 and HR, 0.35; P<0.0001, respectively). Multivariate analysis confirmed an independent prognostic role for OS only for locoregional treatment, second line treatment and intestinal histology. The present results suggested that the presence of lung metastases alone was not a relevant prognostic factor and was influenced by the availability of further lines of treatment or by locoregional treatments. Locoregional treatments in patients with oligometastatic disease should be offered as they allow prolonged survival in patients with otherwise relatively short life expectancy.

Recent Imaging Advancements for Lung Metastases in Children with Sarcoma.

In children and adolescents affected by musculoskeletal sarcomas (both soft tissue and bone sarcomas), the presence of lung metastases is a frequent complication, that should be known since the patient's prognosis, as management, and treatment depend on it. During the staging phase, the detection of lung metastases should be sensitive and specific, and it should be carried out by minimizing the radiation exposure. To deal with this problem, imaging has reached important goals in recent years, thanks to the development of cone-beam CT or low-dose computed tomography, with some new iterative reconstruction methods, such as Veo and ASIR. Imaging is also fundamental for the possibility to perform lung biopsies under CT guidance, with less morbidity, less time-consumption, and shorter recovery time, compared to surgical biopsies.Moreover, important results have also been demonstrated in the treatment of lung metastases, due to the improvement of new mini-invasive image-guided percutaneous thermal ablation procedures, which proved to be safe and effective also in young patients.

A Comparison of Liver-Directed Therapy and Systemic Therapy for the Treatment of Liver Metastases in Patients with Gastrointestinal Neuroendocrine Tumors: Analysis of the California Cancer Registry

PurposeTo compare the outcomes of patients with gastrointestinal neuroendocrine tumor liver metastases treated with liver-directed therapy (LDT) to those treated with systemic therapy (ST) in a statewide cancer database. Materials and MethodsA retrospective study was performed of patients with metastatic gastrointestinal tract neuroendocrine tumors treated with either LDT or ST alone between the years 2000–2012 in the California Cancer Registry. Overall survival and disease-specific survival were assessed using multivariable Cox proportional hazards analysis and propensity score matching. ResultsA total of 154 patients (ST, n = 87 and LDT, n = 67) were studied. The median overall survival and disease-specific survival for patients that received ST was 29 and 35 months versus 51 and >60 months for patients that received LDT. On multivariate analysis, LDT and the resection of the primary tumor were associated with improved survival (hazard ratio [HR] 0.52, P = .002; HR 0.43, P = .001). Non-white race, Medicaid/uninsured status, and the presence of lung metastases were associated with poor survival (HR 1.76, P = .014; HR 2.29, P = .009; and HR 1.79, P = .031). Propensity score matching demonstrated an improvement in disease-specific survival for LDT compared to ST (HR 0.53, P = .036). The improvement in overall survival on propensity score matching did not achieve statistical significance (HR 0.70, P = .199). ConclusionsLDT is associated with improved overall and disease-specific survival as compared to ST in patients with gastrointestinal neuroendocrine tumor liver metastases. Further investigation is needed to determine whether combination or sequential treatment can improve outcomes in this population.

Risk factors and survival outcomes of laryngeal squamous cell carcinoma patients with lung metastasis: A population-based study

ObjectiveIt remains elusive which factors may influence the morbidity and mortality of lung metastasis (LM) in Laryngeal Squamous Cell Carcinoma (LSCC) patients. The aim of the present study was to investigate factors influencing LM and the survival outcomes of LSCC patients with LM. MethodsWe identified 10,935 patients with LSCC from 2010 to 2014 using the Surveillance, Epidemiology and End Results database. Multivariate logistic regression analysis was used to determine the factors associated with the presence of LM. Multivariate cox regression analysis was used to identify covariates associated with increased all-cause mortality in patients with LM. ResultsAmong 10,935 patients with LSCC, 232 (2.12%) patients had LM. The median survival time of patients with LM was 8 months, and 8.37% of patients survived after 3 years. Patients with age ≥ 60 years old, unmarried status, supraglottis, overlapping lesion of larynx, subglottis, pathological grade III, T4 stage, N1 stage, N2 stage, N3 stage and bone, brain or liver metastases were more likely to have LM. Survival analysis showed that chemotherapy and radiotherapy suggested better survival of LSCC patients with LM while pathological grade IV was associated with an increased all-cause mortality. ConclusionThe incidence of LSCC patients with LM varied by age, married status, and tumor subtypes. LSCC patients with LM had poor survival, and only 8.37% of patients survived after 3 years. However, chemotherapy and radiotherapy were found as independent favorable prognostic factors for survival.

Alopecia neoplastica: An uncommon presentation of metastatic breast carcinoma

&lt;p&gt;Cutaneous metastasis may correspond to the initial clinical presentation of hidden internal malignancies. In patients presenting said neoplasia, clinical manifestations of breast cancer reaches 23.9%. Considering that neoplastic alopecia appears as an unusual pattern of the said metastasis, this report describes a case of such uncommon neoplastic alopecia which presents itself as a cutaneous metastasis of rapid progression in a patient with prior breast cancer history. We present a 47-year-old female patient reporting lesions at the scalp, and who was asymptomatic with a 1-year evolution. The patient reported prior breast cancer history and presence of lung metastasis, and was undergoing chemotherapy at the time of consultation. A dermatological evaluation showed only a nodular lesion with erythematous surface and a diameter measuring about 4 cm, firm in consistency, and immovable. She was routed to the Department of Dermatological Surgery, and the results from histopathology were consistent with a diagnosis of metastatic breast adenocarcinoma. Neoplastic alopecia appears as an unusual form of cutaneous metastasis which is predominantly described in association with breast cancer. The lesion’s clinical features play a crucial role at the differential diagnosis, as the presence of erythema could distinguish neoplastic alopecia from alopecia areata. The existence of cutaneous metastasis leads to unfavorable outcomes. As a conclusion, cutaneous evaluation of patients is essential for treating visceral metastases, since the forms of cutaneous metastasis are diverse and can also affect the scalp.&lt;/p&gt;

Analysis of Nonsurgical Treatment Options for Metastatic Rectal Cancer

IntroductionUsing a large national registry, we investigated patterns of care and overall survival (OS) for metastatic rectal cancer patients treated with chemotherapy or radiotherapy (RT), or with a multimodal approach. Patients and MethodsAdult patients with metastatic rectal cancer who did not undergo resection diagnosed from 2004 to 2014 were included. Kaplan-Meier, log-rank, and Cox regression analyses were performed. ResultsWe identified 2385 patients. Of these, 1020 patients (43%) received chemotherapy alone, 228 (10%) received RT alone, 850 (36%) received chemotherapy and RT, and 287 (12%) received no treatment. Receipt of chemotherapy alone increased over the study period, and receipt of chemoradiotherapy decreased (P < .01). The only factor predictive of receiving any RT on multivariate analysis was clinical stage T3 disease. Factors predictive of OS on multivariate analysis included receipt of chemotherapy, Hispanic race, income greater than $46,000, and presence of lung metastasis. The OS for patients treated with chemotherapy and RT was not significantly different than chemotherapy alone. Five-year OS with chemotherapy alone, RT alone, chemoradiotherapy, and no treatment were, respectively, 84%, 56%, 79%, and 46%. ConclusionMetastatic rectal cancer patients with T3 tumors were more likely to receive RT. Local RT does not improve survival for patients with metastatic rectal cancer who do not also undergo surgery. The use of chemotherapy alone for metastatic rectal cancer is increasing, and chemotherapy is associated with higher OS compared to no treatment and RT alone. This remained true even in patients older than 80 years.

Lung metastases in low-risk gestational trophoblastic neoplasia: a retrospective cohort study.

Presence of lung metastases in low-risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease-specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country. Historical cohort study. Charing Cross Hospital, United Kingdom. A total of 1040 low-risk GTN patients treated with methotrexate (MTX) between 2002 and 2016 were identified: 65 with lung metastases (group 1) and 975 without metastases (group 2). Baseline characteristics, MTX resistance, survival and recurrence rates were recorded and compared between both groups. MTX resistance, recurrence rate and survival. The occurrence of MTX resistance and median number of MTX courses to achieve remission was significantly higher in patients with lung metastases than patients without metastases (60% versus 38.9%, P=0.001; and nine versus six courses, P<0.001). All choriocarcinoma patients (n=4) with lung metastases developed MTX resistance. The recurrence rate was also higher in group I (9.2% versus 2.7%; P=0.012). Disease-specific survival was 100% in both groups. The presence of lung metastases at the start of MTX therapy is associated with increased incidence of MTX resistance and recurrence in low-risk GTN without affecting overall survival, which remains 100%. However, individuals with low-risk choriocarcinoma with lung metastases are likely to become resistant to MTX and primary multi-agent chemotherapy should be considered. The presence of lung metastases appears to increase the risk of recurrence in low-risk GTN, but does not affect overall cure rates and survival.

Predictive Nomograms for Synchronous Liver and Lung Metastasis in Colon Cancer.

The risk of distant metastasis may be estimated using predictive nomograms. The purpose of this study is to develop nomograms that may assess the risk of synchronous metastasis in patients with colon cancer. A retrospective analysis of the Surveillance Epidemiology and End Results database between 2010 and 2014. Logistic regression was performed to identify factors associated with synchronous liver and lung metastasis. Overall, 117,934 patients with colon cancer (59,076 [50.1%] males, mean age 68.3 ± 13.7 years) were included, of which 16,135 (13.7%) had liver metastasis and 4601 (3.9%) had lung metastasis at diagnosis. Age, sex, race, tumor location, tumor grade, CEA levels, perineural invasion, and T and N stage were associated with the presence of liver metastasis. Age, sex, race, tumor location, tumor grade, CEA levels, perineural invasion, T stage, N stage, and presence of liver metastasis were associated with the presence of lung metastasis. These variables were used to construct predictive nomograms. The c-indexes for both predictive models were 0.97. In this study, we constructed predictive nomograms for the presence of synchronous liver and lung metastasis in patients with colon cancer that may be used to quantitatively assess the risk of synchronous metastatic disease.

903O - Redefining the IGCCCG classification in advanced non-seminoma

BackgroundThe International Germ Cell Cancer Collaborative Group (IGCCCG) has been the reference classification for assessing prognosis in men with advanced non-seminomatous germ-cell tumors (NSGCT) for more than 20 years and it relied on 5202 cases treated between 1975 and 1990. MethodsAn international consortium (30 centers/groups) contributed data on 9530 advanced NSGCT patients treated with cisplatin/etoposide based first line chemotherapy between 1990 and 2013 in prospective cohorts or clinical trials. Updated 5-year progression-free (PFS) and overall survival (OS) rates were calculated. A subset of 4874 patients with complete information on components of IGCCCG, age and lung metastases were split into training (3536) and validation sets (1338). Prognostic factors for PFS were identified in the training set (alpha=0.05) by Cox model, including (transformed) continuous factors and interactions. ResultsCompared to the 1997 IGCCCG figures, the contemporary 5-year PFS was unchanged for good and intermediate, but significantly improved for poor risk patients; whereas 5-year OS was substantially better for all risk groups (Table). The subgroup with complete data was unbiased. Besides traditional IGCCCG components, we identified older age and lung metastases as negative determinants of PFS. A nomogram including AFP, HCG (both continuous), LDH>2.5xnormal, mediastinal primary, non-pulmonary visceral metastases, age (linear) and lung metastases, with several interactions was built. Its c-index was 0.745 in the training set compared to 0.701 for the 1997 IGCCCG.Table903OTable5-year PFS IGCCCG 19975-year PFS contemporary5-year OS IGCCCG 19975-year OS contemporaryGood89 (87 – 91%)90 (89 - 91%)91 (89 - 93%)96 (95 - 97%)Intermediate75 (71 – 79%)78 (76 - 80%)79 (75 - 83%)89 (88 - 91%)Poor41 (35 – 47%)54 (52 - 56%)48 (42 - 54%)67 (65 - 69%) ConclusionsIn this modern series, PFS improved for poor risk patients, while OS improved in all IGCCCG risk groups. A new prognostic model including older age and presence of lung metastases as additional negative factors is proposed. Independent validation and comparison to the IGCCCG 1997 are being conducted and will tell if the model can identify patient subgroups who may require intensified treatment. Legal entity responsible for the studyThe International Germ Cell Cancer Collaborative Group (IGCCCG). FundingSwiss Cancer Foundation. DisclosureS. Gillessen: Advisory / Consultancy: AAA International, Active Biotech, Amgen, Astellas Pharma, Bayer, Bristol-Myers Squibb, CellSearch, Clovis, CureVac, Dendreon, ESSA Pharmaceuticals, Ferring, Innocrin Pharmaceuticals, Janssen Cilag, MaxiVAX SA, Millennium, Nectar, Novartis, Orion, Pfizer,; Licensing / Royalties: Co-inventor on patent application (WO 2009138392 A1) for a method for biomarker discover (granted in China, Europe, Japan and the US). R. de Wit: Honoraria (self): Merck, Sanofi, Bayer, Janssen, Roche and Clovis. R.A. Huddart: Honoraria (self): Janssen; Advisory / Consultancy, Research grant / Funding (self), Travel / Accommodation / Expenses: MSD; Advisory / Consultancy, Speaker Bureau / Expert testimony, Travel / Accommodation / Expenses: Roche; Advisory / Consultancy: Bristol-Myers Squibb; Research grant / Funding (self): CRUK; Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Nektar. All other authors have declared no conflicts of interest.

Head and Neck Cancer with Lung Metastases: Treatment Challenges

Background:Head and neck cancer has predilection of metastasising to the lung, bones or liver. The site of metastasis usually depends on the primary tumour location, the staging and the regional spread of the tumour. Patients with distant metastasis are predicted to have a poor prognosis with low survival rate. Oligometastasis is the term used for an intermediate biologic state of restricted metastatic capacity with limited number and sites of organ with metastasis. It is also defined by 5 or less than 5 metastatic lesion in a disease with a controlled primary tumour.Case Reports:In this case series, we have reported three cases of head and neck carcinomas that pose treatment dilemmas because of lung metastases. First case is a gentleman with laryngeal carcinoma with multiple small lung metastases where the treatment options of surgery versus chemoradiation was debated. The second case is a gentleman with low grade mucoepidermoid carcinoma of the parotid gland with suspicious lung spread of disease. Lastly is a patient with papillary thyroid carcinoma with florid lung metastases who completed chemoradiation.Conclusion:The presence of lung metastases does not necessarily mean that the prospect of surviving is poor for the patient. It is necessary to determine the best choice of treatment yielding the best quality of life to maximize the survival period for these patients.

Occurrence, risk factors, and outcomes of bone cement implantation syndrome after hemi and total hip arthroplasty in cancer patients.

Patients undergoing cement fixation for hip arthroplasty are at increased risk of developing bone cement implantation syndrome (BCIS). We sought to determine: what is the occurrence of BCIS in patients with cancer after hip arthroplasty? What are the risk factors in patients with cancer for the development of this syndrome? What is the outcome for patients with cancer having BCIS? We identified 374 patients with cancer who underwent cemented hip arthroplasty between 2010 and 2014. Patient characteristics, operative variables, and outcomes were collected. BCIS occurred in 279 (75%) patients. A total of 353 (94%) patients had bone metastases and 179 (48%) patients had lung metastases at the time of surgery. Age greater than 60 (hazard ratio [HR] 2.09, P = .02) and the presence of lung metastases (HR 1.77, P = .019) were associated with increased risk of BCIS. Increased perioperative use of vasopressors (HR 1.72, P = .023) and increased hospital stay beyond 10 days (HR 2.67, P = .003) was associated with BCIS. BCIS is a frequent clinical event in patients with cancer undergoing femoral cemented arthroplasty with increased risk for patients over age 60 and those with compromised lung function due to lung metastases and lung cancer. Patients who develop BCIS are more likely to require longer postoperative hospitalization. Careful preoperative assessment and intraoperative communication are crucial steps to reduce the consequences of BCIS.

Clinical significance of tumor miR-21, miR-221, miR-143, and miR-106a as biomarkers in patients with osteosarcoma.

To investigate the expression of miR-21, miR-221, miR-143, and miR-106a in patients' osteosarcoma samples, and to explore the correlation between these microRNAs (miRNAs) and the clinical stage of osteosarcoma. RNA was extracted from tumor and tumor-adjacent normal bone tissues from 94 patients with osteosarcoma. RNA reverse-transcription was carried out using an miRNA reverse transcription kit. The levels of miR-21, miR-221, miR-143, and miR-106a in osteosarcoma and normal bone tissues were analyzed by real-time polymerase chain reaction using SYBR Premix Ex Taq™II. The expression levels of miR-21, mirR-221, and miR-106a were significantly higher in 90.42%, 84.04%, and 92.55 % of the osteosarcoma samples compared to the adjacent normal tissues (P<0.05), respectively. While the expression of miR-143 was significantly lower compared to the adjacent normal tissues (P <0.05). Moreover, the expression levels of miR-21 and miR-221 were positively correlated with the Enneking clinical stage and the presence of lung metastasis (P <0.05), while the expression levels of miR-143 and miR-106a showed a significant inverse and direct correlation respectively, with the tumor grade. The upregulation of miR-21, miR-221, and miR-106a, as well as the down-regulation of miR-143 were correlated with the pathological stage, tumor grade, and lung metastasis. Therefore, the levels of these miRNAs can serve as potential biomarkers for the early diagnosis of osteosarcoma, and can be used as potential therapeutic targets.

Predictive Factors for Response and Survival in a Cohort of Oligometastatic Patients Treated With Stereotactic Body Radiation Therapy

This study evaluated patients, treatment, or disease characteristics that could predict response to stereotactic body radiation therapy (SBRT) and survival in a database of patients with oligometastatic disease from different solid tumors. Patients treated with SBRT for oligometastatic disease between 2014 and 2015 were included. Patients were defined as oligometastatic if they were affected by a maximum of 5 active lesions in 3 different sites. They had to be treated with SBRT with radical intent. The study included 358 patients. With a median follow-up of 31.83months, local control at 6 and 24months was 94.6% and 78.9%, respectively. Distant progression was recorded in 279 patients (77.9%). Progression-free survival at 6 and 24months was 66.1% and 18.4%, respectively. At last follow-up, 195 patients (54.5%) were still alive in 59 cases with no evidence of disease. The median overall survival (OS) was 34.7months (95% confidence interval, 29.66-43.83). OS at 6 and 24months was 96.07% and 63.57%, respectively. On multivariable analysis, the presence of lung metastases (hazard ratio [HR], 0.50 [0.33-0.75]; P=.001) and nodal metastases (HR, 0.44 [0.24-0.78]; P=.005) was related to longer OS. Primary lung cancer (HR, 1.89 [1.14-3.13]; P=.013), increasing age (HR, 1.02 [1.01-1.04]; P=.002), and the presence of metastatic sites other than the irradiated ones (HR, 2.19 [1.39-3.43]; P=.001) were all independent predictors of shorter OS. Local response was associated with OS. SBRT for patients with oligometastatic disease is effective. Local response is strongly correlated with patients'' prognosis, also underlying its relevance in a metastatic setting.

The presence of lung metastases does not influence survival in liver metastatic colorectal cancer

Background: The indications for liver resection of colorectal cancer liver metastases (CRCLM) are continuously expanding and the presence of extra-hepatic metastases are no longer a contraindication for hepatic resection. The aim of the study was to investigate factors influencing survival among patients with CRCLM. Methods: Patients diagnosed with CRC during 2008 in the region of Stockholm, Sweden, were identified through the Swedish Colorectal Cancer Register and followed for 5 years. Additional information on liver and lung metastatic pattern were retrieved from patient electronic charts. Factors influencing overall survival (OS) were examined using Cox proportional hazards model with 95 per cent confidence interval (c.i.). Results: In this population-based study of 1026 patients with CRC, liver and lung metastases were diagnosed in 26.5% and 16.9%, respectively. Lung metastases were more likely diagnosed in left-sided and rectal cancer as compared to right-sided cancer (19.7% vs. 13.2%, p=0.010). The presence of lung metastases did not significantly influence OS in multivariate analysis, neither in the entire CRC cohort (HR 1.23, c.i. 0.93 to 1.62) or in patients with liver metastatic CRC (HR 1.11, c.i. 0.80 to 1.53). Conclusion: Based on these results, one could speculate in wheatear a subset of patients with inoperable lung metastases – excluding the patient from liver resection of concomitant liver metastases – still could benefit from hepatic surgery.

The presence of lung metastases does not influence survival in liver metastatic colorectal cancer

The presence of lung metastases does not influence survival in liver metastatic colorectal cancer

Clinicopathological and immunohistochemical analysis of autoimmune regulator expression in patients with osteosarcoma.

Autoimmune regulator (AIRE) is a transcription factor that is expressed in medullary thymic epithelial cells. It plays an essential role in central tolerance by eliminating self-reactive T cells. Recently, extrathymic AIRE-expressing cells have been revealed, which are associated with peripheral tolerance. Moreover, AIRE expression has been demonstrated in skin tumors and breast cancer. However, the expression of AIRE in osteosarcoma is unknown. We used immunohistochemistry to investigate AIRE expression in biopsy samples from 43 patients with conventional osteosarcoma and statistically analyzed the association between AIRE expression and clinicopathological characteristics. High AIRE expression was detected in 25 patients (58.1%), and significantly associated with the presence of lung metastasis (P = 0.014) and an increased number of forkhead box P3-positive tumor-infiltrating lymphocytes (regulatory T cells) (P = 0.014). The overall survival rate for all osteosarcoma patients with high AIRE expression was significantly shorter than that for those with low AIRE expression (P = 0.046). In a subgroup analysis of American Joint Committee on Cancer stage II patients who underwent complete surgical resection and conventional chemotherapy, the overall survival and metastasis-free survival rates were significantly shorter for patients with high AIRE expression than for those with low AIRE expression (P = 0.019 and P < 0.01, respectively). High AIRE expression was confirmed to be an independent poor prognostic factor for both overall survival (hazard ratio: 3.841, P = 0.038) and metastasis-free survival (hazard ratio: 4.348, P = 0.022) in the multivariate analysis. The evaluation of AIRE expression may be useful for stratifying osteosarcoma patients for more effective clinical follow-up.

Abstract P1-07-11: Risk factors for the development of brain metastases (BM) in 506 patients with HER2-positive breast cancer (HER2+ BC): A single institutional retrospective analysis

Abstract Introduction: BC is the most common malignancy in women. HER2+ BC is the 2nd leading cause of BM after lung cancer. The prognosis of BC patients with BM is poor. Determining risk factors for the development of BM is warranted in order to establish more accurate screening for patients at risk. Material and Methods: This is a retrospective analysis of patients with HER2+ BC treated at Institut Jules Bordet, Belgium, between 2000 and 2014. Patients' charts were reviewed for disease characteristics, treatment regimens for primary and metastatic disease as well as clinical outcomes. Statistical analyses were conducted with SAS 9.4 using Cox regression analyses, log-rank test and Kaplan-Meier method. Results: A total of 506 patients with HER2+ BC were included in the analysis. Median age was 52.7 years (range, 21.5-89.2 years). In total, 138 (27.3%) were diagnosed with metastatic BC and 74 (14.6%) had BM. Among the 138 metastatic patients, 12 (8.7%) had BM as a first site of metastatic disease and 3 (2.2%) developed BM as only site of distant relapse. Median overall survival (OS) for patients with BM was 1.74 years (range, one month-3.2 years). In multivariate analysis, risk factors for the development of BM at time-point of initial BC diagnosis were de-novo metastatic disease (hazard ratio [HR] 4.46; p&amp;lt;0.0001), postmenopausal status (HR 16.65; p&amp;lt;0.0001), and adjuvant breast radiotherapy (HR 1.79; p=0.0198). Identified risk-factors for BM at the time-point of metastatic disease were postmenopausal status (HR 1.90; p=0.0464), the presence of lung metastases (HR 2.61; p=0.0004), an interval of more than one year between initial BC diagnosis and development of metastatic disease (HR 1.91; p=0.0179) and age of &amp;lt;40 years (HR 1.78; p=0.0353). In this cohort, biological factors such as hormone receptor status, degree of HER2 amplification and tumor grade had no impact on the development of BM both in univariate and multivariate analysis. Furthermore, the type of systemic treatment in the adjuvant or metastatic setting (chemotherapy, anti-HER2 treatment) did not modulate the risk for BM. The combination of local treatment (surgery, stereotactic radiosurgery [SRS] or whole brain radiotherapy [WBRT]) and anti-HER2 directed therapy as first-line therapy for BM was associated with an improvement in overall survival (OS) that was more pronounced for tyrosine kinase inhibitors (HR 0.13; 95% confidence interval [CI] 0.05-0.33); p&amp;lt;0.0001) than for trastuzumab and/or pertuzumab (HR 0.53; 95% CI 0.24-1.15; p=0.1085). Conclusion: The development of BM is a common complication in patients experiencing metastatic HER2+ BC. Until now, no imaging screening for BM is recommended in this patient population. Compared to WBRT, surgery and SRS are associated with an improvement in OS and/or less cognitive impairment. However, these treatment approaches are limited to patients with less extensive BM disease. In this context, randomized trials examining the role of MRI screening for BM in metastatic HER2+ BC with high risk features are warranted. Citation Format: Maurer C, Tulpin L, Dumitrescu C, de Azambuja E, Moreau M, Paesmans M, Nogaret J-M, Piccart M, Awada A. Risk factors for the development of brain metastases (BM) in 506 patients with HER2-positive breast cancer (HER2+ BC): A single institutional retrospective analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-11.