Prognostic Factor For Cancer-specific Survival Research Articles

Abstract A69: Epidemiologic, clinical-pathologic, and therapeutic characterization and its correlation with ethnic ancestry in patients with colorectal cancer of the Barretos Cancer Hospital

Abstract Introduction: Colorectal cancer is the third most frequent neoplasm in the world population, with a wide geographical heterogeneity, being more frequent in developed countries than in developing countries. In Brazil, this neoplasm also ranks third in incidence, but has been increasing in recent years due to multiple factors such as diet, lifestyle, and aging populations. Most colorectal neoplasms are sporadic (85% of cases); the others are related to inherited susceptibility factors. Surgery is the main treatment modality in the initial stages (stages I to III). In stages IV, treatment will depend on the extent and location of metastases. Among several prognostic factors, the main ones are clinicopathologic, with special emphasis on staging. The ethnic structure of the population has been gaining prominence as another potential prognostic factor, and this becomes more pressing in the Brazilian population due to its great miscegenation. In Brazil, few studies have evaluated and characterized comprehensively the population of patients diagnosed with colorectal cancer. Objectives: In this study we intend to characterize the epidemiologic-clinical-pathologic and therapeutic aspects of a convenience series of about 1013 patients with colorectal cancer treated at the Hospital de Cancer de Barretos. We also intend to determine their genetic ancestry and correlate the ethnic structure of the patients with the remaining epidemiologic and clinical-pathologic data, in order to identify potential ancestral markers with clinical relevance. Materials and Methods: This is a retrospective cohort study of 1013 patients with colorectal cancer, admitted for treatment and follow-up at our institution between 2000 and 2014, where we performed an epidemiologic-clinical-pathologic and therapeutic characterization correlating with supposed prognostic factors such as the location of the primary tumor divided into right and left colon and genetically assessed ancestry. Results: The main characteristics were slightly male predominance, with the age group between 50 and 75 years being more frequent and EC II as the most representative (37.1%); the left/rectum was highlighted with 75% of the cases. No differences were observed in cancer-specific survival between the location of primary tumors. Tumor location on the left side was associated with the following characteristics: male, age less than 50 years, low-grade tumors, T1 and T2 tumors, and absence of synchronous tumors. We found that the main prognostic factors were staging, emergency surgery, angiolymphatic invasion, and primary tumor localization in the left colon. With regard to ancestral diseases, we observed that European ancestry was associated with patients who did not present synchronic tumors, presence of recurrence, while African ancestry was associated with young patients. However, we cannot confirm ancestry as a prognostic factor for cancer-specific survival. Conclusion: We performed one of the most complete characterizations of the main epidemiologic-clinical-pathologic factors and treatment in Brazilian patients with colorectal cancer, correlating with the genetically determined ancestry profile. We concluded that neither the location of the primary tumor nor the genetic ancestry was determinant as to the prognosis of our sample. Citation Format: Ronilson Oliveira Duraes, Rui M. V. Reis, Denise P. Guimaraes, Gustavo N. Berardinelli, Marco A. Oliveira, Cristovam S. Neto. Epidemiologic, clinical-pathologic, and therapeutic characterization and its correlation with ethnic ancestry in patients with colorectal cancer of the Barretos Cancer Hospital [abstract]. In: Proceedings of the AACR International Conference held in cooperation with the Latin American Cooperative Oncology Group (LACOG) on Translational Cancer Medicine; May 4-6, 2017; São Paulo, Brazil. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(1_Suppl):Abstract nr A69.

Low expression of DAB2IP predicts an unfavorable prognosis in human bladder carcinoma.

The DOC-2/DAB2 interactive protein (DAB2IP) is a novel member of the Ras GTPase-activating protein family, and its downregulation is an unfavorable prognostic factor in several human malignancies. In this study, we retrospectively analyzed clinicopathological features, outcomes, and DAB2IP expression in 77 patients with urothelial carcinoma of the bladder (UCB). Expression of DAB2IP and p-STAT3 was examined in tumors and in matched adjacent non-cancerous tissues, using immunohistochemistry. We found a marked reduction in the expression of DAB2IP in UCB specimens, which was significantly associated with advanced pathological stage (P=0.037), high pathological grade (P=0.016), and muscle invasion (P=0.004). Moreover, multivariate analysis identified DAB2IP as an independent prognostic factor of cancer-specific survival (hazard ratio [HR] =0.23, 95% confidence interval [CI] =0.07–0.78, P=0.018). Most importantly, DAB2IP was negatively correlated with p-STAT3 expression (P=0.009), which predicted a shorter overall survival in patients with UCB (HR =2.68, 95% CI =1.63–6.99, P=0.044). In conclusion, downregulation of DAB2IP is associated with features of biologically aggressive UCB and may be a promising biomarker in patients after radical cystectomy.

Conditional survival in patients with gallbladder cancer

BackgroundConditional survival (CS) has been established as a clinically relevant prognostic factor for cancer survivors, and the CS in gallbladder (GB) cancer has not yet been fully evaluated. In this study, we evaluated the cancer-specific CS rate and cancer-specific survival (CSS) rate in patients with GB cancer at multiple time points and investigated prognostic factors which affect cancer-specific CS rate to provide more accurate survival information.MethodsBetween 2004 and 2013, a total of 9760 patients with GB cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) data. The 3-year cancer-specific CS rate was calculated using the covariate-adjusted survival function in the Cox model for each year since diagnosis, and the results were analyzed together with the adjusted CSS rates at the same time points. Cox proportional hazards regression was performed to ascertain the individual contribution of factors associated with CSS rate at diagnosis and cancer-specific CS rates at 1, 3, and 5 years after diagnosis.ResultsThe adjusted 5-year CSS rate was 26.1%. The adjusted 3-year cancer-specific CS rates at 1, 2, 3, 4, and 5 years after diagnosis were 55.5, 72.2, 81.5, 86.8, and 90.5%, respectively. At the time of diagnosis, age, race, histology, grade, T, N, and M categories, surgery, radiotherapy, insurance status, and marriage status were significant prognostic factors of CSS. Five years after diagnosis, however, T and M categories were significant prognostic factors for survivors (P = 0.007 and P = 0.009, respectively), whereas surgery and radiotherapy were not.ConclusionsT and M categories were significant prognostic factors even 5 years after the initial diagnosis, whereas local treatments at the time of diagnosis were not, suggesting that patients with GB cancer at high risks might need further adjuvant therapy after primary treatments. The combined analysis of CSS and cancer-specific CS rates offered more accurate survival information for patients who have already survived a certain period of time after diagnosis.

Clinical significance of Fusobacterium nucleatum, epithelial-mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients.

Colorectal cancer (CRC) is a common digestive malignancy and emerging studies have closely linked its initiation and development with gut microbiota changes. Fusobacterium nucleatum (Fn) has been recently identified as a pathogenic bacteria for CRC; however, its prognostic significance for patients is poorly investigated and is less for patients within late stage. Therefore, in this study, we made efforts to analyze its level and prognostic significance in a retrospective cohort of 280 stage III/IV CRC patients. We found that the Fn level was abnormally high in tumor tissues and correlated with tumor invasion, lymph node metastasis status, and distant metastasis. We also identified it as an independent adverse prognostic factor for cancer-specific survival (CSS) and disease-free survival (DFS). The following subgroup analysis indicated that Fn level could stratify CSS and DFS in stage IIIB/C and IV patients but failed in stage IIIA patients. In addition, stage III/IV patients with low Fn level were found to benefit more from adjuvant chemotherapy than those with high Fn level, in terms of DFS. Finally, we analyzed the expression and clinical significance of epithelial-to-mesenchymal transition (EMT) markers (E-cadherin and N-cadherin) and cancer stem cell (CSC) markers (Nanog, Oct-4, and Sox-2) in CRC tissues. The results indicated that N-cadherin, Nanog, Oct-4, and Sox-2 were adverse prognostic factors in these patients, while the opposite was true for E-cadherin. More importantly, expression of E-cadherin, N-cadherin, and Nanog was significantly correlated with Fn level in tumor tissues, suggesting the potential involvement of Fn in EMT-CSC cross talk during CRC progression. Taken together, these findings indicate that Fn is a novel predictive biomarker for clinical management in stage III/IV patients, and targeting Fn may be an effective adjuvant approach for preventing CRC metastasis and chemotherapy resistance.

Validation of the Pretreatment Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in a Large Cohort of Chinese Patients with Upper Tract Urothelial Carcinoma.

Background:The pretreatment neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prognostic factor in various types of carcinomas. The aim of this study was to investigate the prognostic value of pretreatment NLR in a large cohort of Chinese patients with upper tract urothelial carcinoma (UTUC).Methods:We retrospectively analyzed the medical data of 656 UTUC patients who underwent radical nephroureterectomy (RNU) from 2001 to 2011 at Peking University First Hospital. Receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff point of pretreatment NLR. Uni- and multi-variate analyses were used to identify the prognostic factors for cancer-specific survival (CSS) and intravesical recurrence-free survival (IVRFS).Results:The optimal cutoff point of pretreatment NLR was 2.40 by ROC curves, by which patients with high NLR (NLR ≥2.40) and low NLR (NLR <2.40) accounted for 314 (47.9%) and 342 (52.1%) patients, respectively. Patients with a high pretreatment NLR tended to have high tumor grades (χ2 = 15.725, P < 0.001), high tumor stages (χ2 = 25.416, P < 0.001), tumor sizes >5 cm (χ2 = 8.213, P = 0.005), ipsilateral hydronephrosis (χ2 = 4.624, P = 0.033), and concomitant carcinoma in situ (CIS) (χ2 = 9.517, P = 0.003). A high pretreatment NLR (hazard ratio [HR] = 1.820, P = 0.001), main tumor diameter >5 cm (HR = 1.789, P = 0.009), lymph node metastasis (HR = 1.863, P = 0.024), and high tumor stage (HR = 1.745, P < 0.001) independently predicted poor CSS after surgery, while only concomitant carcinoma in situ (CIS) (HR = 2.164, P = 0.034), ureteroscopy before surgery (HR = 1.701, P = 0.015), and high tumor grade (HR = 1.645, P = 0.018) were independent predictors of IVRFS after RNU.Conclusions:The pretreatment NLR was related to some adverse clinicopathological features and was an independent predictor of CSS, although not IVRFS, in Chinese UTUC patients.

Remnant Liver Ischemia as a Prognostic Factor for Cancer-Specific Survival After Resection of Colorectal Liver Metastases

Ischemia-reperfusion injury during hepatic resection has been shown to accelerate progression of liver cancer. However, the prognostic relevance of remnant liver ischemia (RLI) after resection of colorectal liver metastases (CLMs) is unknown to date. To assess the prognostic influence of RLI after resection of CLMs and to identify correlates of greater extent of RLI. This study was a retrospective analysis at The University of Texas MD Anderson Cancer Center based on prospectively collected data. The study identified 202 patients who underwent curative resection of CLMs between January 1, 2008, and December 31, 2014, and had enhanced computed tomographic images obtained within 30 days after surgery. Remnant liver ischemia was defined as reduced or absent contrast enhancement during the portal phase. Postoperative RLI was classified as grade 0 (none), 1 (marginal), 2 (partial), 3 (segmental), or 4 (necrotic) as previously defined. Experienced members of the surgical team retrospectively performed imaging assessments. Team members were masked to the postoperative outcomes. Survival after resection was stratified by RLI grade. Predictors of RLI grade 2 or higher and survival were identified. Among 202 patients (median [range] age, 56 [27-87] years; 84 female), the RLI grades were as follows: grade 0 (105 patients), grade 1 (47 patients), grade 2 (45 patients), grade 3 (5 patients), and grade 4 (0 patients). Recurrence-free survival (RFS) and cancer-specific survival (CSS) rates after hepatic resection were worse in patients with RLI grade 2 or higher vs grade 1 or lower (RFS at 3 years, 6.4% [3 of 50] vs 39.2% [60 of 152]; P < .001 and CSS at 5 years, 20.7% [10 of 50] vs 63.7% [97 of 152]; P < .001). A largest metastasis at least 3 cm (OR, 2.74; 95% CI, 1.35-5.70; P = .005), multiple CLMs (OR, 2.51; 95% CI, 1.25-5.24; P = .009), and nonanatomic resection (odds ratio [OR], 3.29; 95% CI, 1.52-7.63; P = .002) were associated with RLI grade 2 or higher. A largest metastasis at least 3 cm (hazard ratio [HR], 1.70; 95% CI, 1.01-2.88; P = .045), mutant RAS (HR, 2.15; 95% CI, 1.27-3.64; P = .005), and RLI grade 2 or higher (HR, 2.90; 95% CI, 1.69-4.84; P < .001) were associated with worse CSS. In this study, remnant liver ischemia grade 2 or higher was associated with worse CSS after resection of CLMs. High-quality anatomic surgery to minimize RLI after resection is essential.

A Novel Prognostic Scoring System Using Inflammatory Response Biomarkers for Esophageal Squamous Cell Carcinoma

BackgroundWe describe a novel scoring system, namely the inflammatory response biomarker (IRB) score. The aim of this study is to evaluate the clinical value of IRB score in patients undergoing curative resection for esophageal squamous cell carcinoma (SCC).MethodsWe retrospectively reviewed patients who underwent curative esophagectomy. We evaluated IRB score in both non-elderly (<70 years) and elderly (≥70 years) SCC patients. The IRB score was determined as follows: a high lymphocyte-to-monocyte ratio (LMR) (>4), a high neutrophil-to-lymphocyte ratio (NLR) (>1.6), and a low platelet-to-lymphocyte ratio (PLR) (<147) were each scored as 1, and the remaining values were scored as 0; the individual scores were then summed to produce the IRB score (range 0−3).ResultsUnivariate analyses demonstrated that the TNM pStage (p < 0.0001), tumor size (p = 0.002), LMR (p = 0.0057), PLR (p = 0.0328) and IRB score (p = 0.0003) were significant risk factors for a worse prognosis. On multivariate analysis, the TNM pStage (p < 0.0001) and IRB score (p = 0.0227) were independently associated with worse prognosis in overall patients. Among non-elderly patients, multivariate analyses demonstrated that the pStage (p = 0.0015) and IRB score (p = 0.0356) were independent risk factors for a worse prognosis. Among elderly patients, multivariate analysis demonstrated that the pStage (p = 0.0016), and IRB score (p = 0.0102) were independent risk factors for a worse prognosis.ConclusionThe present study provides evidence that the preoperative IRB score can be considered a promising independent prognostic factor of cancer-specific survival in patients undergoing curative resection for SCC, and that its predictive ability is useful in both non-elderly and elderly patients.

Histological grading based on poorly differentiated clusters is predictive of tumour response and clinical outcome in rectal carcinoma treated with neoadjuvant chemoradiotherapy.

The clinical outcome of patients with locally advanced rectal cancer who undergo neoadjuvant chemoradiotherapy (CRT) is influenced by the tumour response to treatment, which is reflected by tumour regression grade and post-treatment (y) TNM stage. Little is known about the prognostic value of pretreatment histopathological features of the tumour that may be useful to discriminate potential non-responders and to design tailored therapeutic strategies. In this study, we aimed to investigate the prognostic role of poorly differentiated clusters (PDCs) of neoplastic cells in pretreatment biopsies of patients with rectal cancer treated with neoadjuvant CRT. Grading based on PDC counting was retrospectively applied to 204 pretreatment endoscopic biopsies of rectal carcinomas from patients treated with neoadjuvant CRT and surgery. Interobserver agreement in the assessment of PDC grade was good. High PDC grade was significantly associated with high yT stage (P=0.044), yM+ status (P=0.0004), and unchanged TNM stage or TNM upstaging (P=0.032). In addition, high PDC grade was a significant and independent prognostic factor for cancer-specific survival. PDC grade may be assessed in preoperative biopsies of rectal cancer with good reproducibility. High PDC grade in a pretreatment tumour is significantly associated with a poor response to therapy. Hence, we suggest that PDC grading might be used as a significant predictive and prognostic factor in patients with locally advanced rectal cancer who are treated with neoadjuvant CRT, and to identify high-risk patients who need surgery and adjuvant chemotherapy.

Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

PurposeWe investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC). Materials and methodsWe reviewed the data of 266 patients with pT3aN0M0 RCC who underwent nephrectomy and divided them into the following 5 groups according to the site of invasion: perinephric invasion (PNI), sinus fat invasion (SFI), PNI and SFI without renal vein invasion (RVI) (i.e., PNI+SFI), RVI, and RVI with PNI and/or SFI (RVI+PNI±SFI). Subgroup analysis was performed to verify the differences in prognosis according to the extent of renal vein invasion using Cox regression models. ResultsA total of 111 patients (41.7%) experienced recurrence and 59 patients (22.2%) died of disease during follow-up (median = 58.1mo; interquartile range: 37.2–86.5). Patients with RVI showed significantly poorer outcomes than those with fat invasion in terms of 5-year recurrence-free survival (34.3% vs. 62.2%, P<0.001) and cancer-specific survival (62.8% vs. 84.1%; P<0.001). In multivariate analysis, RVI was an independent prognostic factor for recurrence and survival. In 94 patients with RVI, the 5-year recurrence-free survival rates were 50.0%, 33.9%, and 8.9% for the thrombus-only, the vascular wall invasion with negative surgical margin, and the vascular wall invasion with positive surgical margin groups, respectively (P<0.001), and the cancer-specific survival rates were 82.3%, 56.6%, and 20.0%, respectively (P<0.001). Wall invasion was the only independent prognostic factor for cancer-specific survival in these patients. ConclusionsPatients with pT3aN0M0 RCC with RVI have a significantly poorer prognosis than those with fat invasion. The prognosis differs according to the extent of RVI. Wall invasion should be considered a negative prognostic indicator in patients with T3a RCC.

MP54-18 THE USE OF URETHRAL FROZEN SECTION DURING RADICAL CYSTECTOMY MAY IMPROVE CANCER-SPECIFIC AND RECURRENCE-FREE SURVIVAL

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2017MP54-18 THE USE OF URETHRAL FROZEN SECTION DURING RADICAL CYSTECTOMY MAY IMPROVE CANCER-SPECIFIC AND RECURRENCE-FREE SURVIVAL benoit peyronnet, gregory verhoest, quentin alimi, lauranne tondut, vivien graffeille, romain mathieu, andrea manunta, karim bensalah, francois guille, solene-florence kammerer-jacquet, and nathalie rioux-leclercq benoit peyronnetbenoit peyronnet More articles by this author , gregory verhoestgregory verhoest More articles by this author , quentin alimiquentin alimi More articles by this author , lauranne tondutlauranne tondut More articles by this author , vivien graffeillevivien graffeille More articles by this author , romain mathieuromain mathieu More articles by this author , andrea manuntaandrea manunta More articles by this author , karim bensalahkarim bensalah More articles by this author , francois guillefrancois guille More articles by this author , solene-florence kammerer-jacquetsolene-florence kammerer-jacquet More articles by this author , and nathalie rioux-leclercqnathalie rioux-leclercq More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1690AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Routine use of urethral and uretreral frozen section (FS) during radical cystectomy for bladder cancer is a controversial issue with contradictory findings concerning ureteral FS and very few data concerning urethral FS. Moreover, previous reports aimed to assess the impact of positive FS on oncological outcomes but none have compared the impact of FS vs. no FS on oncological ouctomes. The objective of this study was to evaluate the impact of urethral and ureteral FS use on oncological outcomes after radical cystectomy for bladder cancer. METHODS All patients who underwent a radical cystectomy for bladder cancer between 1995 and 2015 were included in a single-center retrospective study. The use of ureteral and urethral FS varied according to surgeons preference (routine for some, never for others) but not according to the tumors' characteristics. Patients were divided into different groups according to the use of ureteral and/or urethral FS (FS vs. no FS). Preoperative data and the rate of positive margins were compared between groups. The prognostic factors for cancer-specific survival (CSS) and recurrence-free survival (RFS) were sought in univariate analysis using the log-rank test and in multivariate analysis using a cox regression model. RESULTS Out of 329 patients included in this study, ureteral FS were performed in 132 (40%) and urethral FS in 183 (56%) respectivley respectively. Thirteen urethral FS were positive (7.1%) resulting in 10 additional urethrectomy. Fourteen ureteral FS (10.6%) were invaded resulting in 8 additional ureteral resections and 1 nephroureterectomy. The use of urethral FS was associated with a decrease in positive margins rate (6% vs. 23%; RR = 0.27; p <0.0001). Conversely, the use of ureteral FS had no impact on the rate of positive margins (12% vs.14%; RR = 0.85; p = 0.58). The use of ureteral FS had no impact on survival whereas the routine use of urethral FS was a prognostic factor for RFS and CSS in univariate (5-years RFS: 51.5% vs. 32%; p <0.0001 and 5-year CSS: 65.1% vs. 50.5%) and multivariate analysis (HR = 1.7; p= 0.003 and HR=1.4; p=0.04 respectively). CONCLUSIONS This study is the first to asses the impact of urethral and ureteral FS use on oncological outcomes after radical cystectomy. The routine use of urethral FS was associated with adecreased rate of positive surgical margins and improved recurrence-free survival and cancer-specific survival. Conversely, the use of ureteral frozen section had no impact on oncological outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e728-e729 Advertisement Copyright & Permissions© 2017MetricsAuthor Information benoit peyronnet More articles by this author gregory verhoest More articles by this author quentin alimi More articles by this author lauranne tondut More articles by this author vivien graffeille More articles by this author romain mathieu More articles by this author andrea manunta More articles by this author karim bensalah More articles by this author francois guille More articles by this author solene-florence kammerer-jacquet More articles by this author nathalie rioux-leclercq More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic Factors for Isolated Locoregional Recurrences in Colon Cancer and Survival After Salvage Surgery: a Cohort Study

The purpose of this study was to establish the factors affecting development of locoregional recurrence (LR) and survival following salvage surgery in patients operated on for stage I–III colon adenocancer with curative purposes and using a standard technique by an experienced surgeon in elective circumstances. This was a cohort study of patients diagnosed with colon cancer, operated on (n = 312) between January 2003 and 2015. Isolated LR was detected in 15 patients (4.8%) among 312 consecutive patients (99.7% R0 resection) in a mean follow-up period of 60.5 months. The most important prognostic factors affecting LR development were found to be R1 resection, pT4 tumor (tm), postoperative development of morbidity, T4 tm, N2 tm, and mucinous tm. All patients who were detected to have isolated LR were re-operated with curative intent (80% R0). Prognostic factors for cancer-specific survival (CSS) in those cases were development of distant metastasis, localization of the recurrent tumor (pelvis), and symptomatic patient. Mean survival in the whole series was 125.2 months and 5-year CSS was 89%, while respective values in cases with development of LR were 47.4 months and 54.4%, respectively. Although development of isolated LR worsens the prognosis considerably, a long survival and even cure can be provided in some patients. Survival is closely related with resectability and localization of the recurrent tumor and development of distant metastasis. Close follow-up of high-risk patients, early diagnosis and treatment in patients with development of recurrence, experienced team and standardized curative surgery, and a multidisciplinary approach improve the prognosis.

Tumor Wide Horizontal Invasion Predicts Local Recurrence for Scrotal Extramammary Paget\u2019s Disease

Extramammary Paget’s disease (EMPD) is a rare malignancy, and little was known about its prognostic factors and optimal treatment. In the current study, we aimed to discuss clinical and pathological features of scrotal EMPD and determine the prognostic factors for cancer-specific survival and local recurrence. A total of 206 patients with scrotal EMPD lesions surgically treated at our institute were studied. All clinical and pathological data were reviewed. Immunohistochemical staining of TP53 and Ki67 was examined as well. At the last follow-up, 175 patients (84.95%) were alive. Twelve patients (5.83%) had died of the disease due to distant metastases. Fifteen patients (7.28%) developed local recurrences of scrotal EMPD. Ki67 expression was significantly elevated in patients with wide horizontal invasion (P = 0.003). In univariate analysis, high invasion level, presence of nodule, presence of lymphovascular invasion, adnexa invasion, lymph node metastasis and high p53 expression were significant factors for poor cancer-specific survival. In multivariate analysis, high p53 expression was significantly correlated with poor cancer-specific survival. Wide horizontal invasion was independently correlated with local recurrence-free survival of scrotal EMPD. In conclusion, wide horizontal invasion is an independent risk factor for local recurrence-free survival in the patients with scrotal EMPD.

Association between smoking at diagnosis and cause‐specific survival in patients with rectal cancer: Results from a population‐based analysis of 10,794 cases

Currently, the 5-year survival rate for rectal cancer remains at <60%. The identification of potentially modifiable prognostic factors would be of considerable public health importance. A few studies have suggested associations between smoking and survival in rectal cancer; however, the evidence is inconsistent, and most of these studies were relatively small. In a large population-based cohort study, we investigated whether smoking at diagnosis is an independent prognostic factor for cancer-specific survival in rectal cancer and whether the association varies by sex, age, or treatment. Rectal cancers (ICD10 C19-20) diagnosed between 1994 and 2012 were abstracted from the National Cancer Registry Ireland and classified by smoking status at diagnosis. Follow-up was for 5 years or until December 31, 2012. Multivariable Cox proportional hazards models were used to compare cancer-specific death rates in current smokers, ex-smokers, and never smokers. Subgroup analyses by age at diagnosis, sex, and treatment were conducted. A total of 10,794 rectal cancers were diagnosed. At diagnosis, 25% were current smokers, 24% were ex-smokers, and 51% were never smokers. Compared with never smokers, current smokers had a significantly greater rate of death from cancer (multivariable hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.06-1.24), but ex-smokers did not (HR, 1.02; 95% CI, 0.94-1.11). The association was slightly stronger in men (current versus never smokers: HR = 1.13, 95% CI, 1.02-1.24) than females (HR, 1.05; 95% CI, 0.90-1.23), but the test for interaction was not significant (P = .75). The effect of smoking was not modified by age or receipt of tumor-directed surgery, radiotherapy, or chemotherapy. Rectal cancer patients who smoke at diagnosis have a statistically significant increased cancer death rate. Elucidation of the underlying mechanisms is urgently required. Cancer 2017;123:2543-50. © 2017 American Cancer Society.

Dramatic impact of blood transfusion on cancer-specific survival after radical cystectomy irrespective of tumor stage

Objective: The aim of the present study was to determine the influence of intraoperative and postoperative blood transfusion on cancer-specific outcome.Materials and methods: Follow-up data were collected from 722 patients undergoing radical cystectomy for urothelial carcinoma of the bladder (UCB) between 2004 and 2014. Median follow-up was 26 months (interquartile range 12–61 months). Outcome was analyzed in relation to the amount of intraoperative and postoperative blood transfusion and different tumor stages. The primary endpoint was cancer-specific survival (CSS) after cystectomy. Kaplan–Meier analysis with log-rank test and Cox regression models were used.Results: Intraoperative blood transfusion was given in 36% (263/722) and postoperative blood transfusion in 18% (132/722). In patients with and without intraoperative blood transfusion, 5 year CSS was 48% and 67%, respectively (p < .001). In patients with and without postoperative blood transfusion, 5 year CSS was 48% and 63%, respectively (p < .001). The number of transfused red blood cell (RBC) units [intraoperatively: hazard ratio (HR) = 1.08, 95% confidence interval (CI) 1.01–1.15, p = .023; postoperatively: HR = 1.14, 95% CI 1.07–1.21, p < .001] was an independent prognostic factor for CSS. The dose-dependent negative effect of transfusions was also found in favorable subgroups (pT1 tumor, hemoglobin ≥13 mg/dl, p = .004) and in a high-volume surgeon subgroup (n = 244, p < .001).Conclusions: Blood transfusions during and after radical cystectomy were independent prognostic factors for CSS in this retrospective study. Therefore, efforts should be made to reduce the necessity of intraoperative and postoperative blood transfusion in cystectomy patients.

Prognostic factors in prostate cancer patients treated by radical external beam radiotherapy.

The aim of this paper was to analyze, retrospectively, in prostate cancer patients treated in our Centre with external beam radiotherapy, the prognostic factors and their impact on the outcome in terms of cancer-specific survival (CSS), biochemical disease-free survival (BDFS) and clinical disease-free survival (CDFS). From October 1999 and March 2012, 1080 patients were treated with radiotherapy at our Institution: 87% of them were classified as ≤cT2, 83% had a Gleason Score (GS) ≤7, their mean of iPSA was 18 ng/mL, and the rate of clinical positive nodes was 1%. The mean follow-up was 81 months. The statistically significant prognostic factors for all groups of patients at both, univariate and multivariate analysis, were the GS and the iPSA. In intermediate- and high- or very-high-risk patients at multivariate analysis other prognostic factors for CSS were positive nodes on computed tomography (CT) scan and rectal preparation during the treatment; for BDFS, the prognostic factors were patient risk classification, positive lymph nodes on CT scan and rectal/bladder preparation; for CDFS, the prognostic factors were the number of positive core on biopsy (P=0.003), positive lymph nodes on CT scan, and radiotherapy (RT) dose. In high/very-high risk patient group at multivariate analysis other prognostic factors for CSS were clinical/radiological stage and RT dose, for BDFS they were adjuvant hormone therapy, clinical/radiological stage, and RT dose >77.7 Gy, and for CDFS they were clinical/radiological stage and RT dose >77.7 Gy. The results of this study confirm the prognostic factors described in the recent literature, with the addition of rectal/bladder preparation, generally known for its effect on toxicity but not yet on outcome.

A Novel Predictor of Survival with Renal Cell Carcinoma After Nephrectomy.

To validate plasma fibrinogen and serum cholesterol levels as prognostic factors for patients with renal cell carcinoma (RCC) and to explore the prognostic value of their combination. Medical data for 1360 RCC patients after nephrectomy were collected. X-tile software was used to determine the cutoff values. The association between clinicopathological factors and fibrinogen and cholesterol levels was determined, and factors predicting survival were examined by multivariate analysis. The median follow-up was 67 months (interquartile range 36-74 months). On univariate and multivariate analysis, both preoperative plasma fibrinogen and serum cholesterol were independent prognostic factors of cancer-specific survival (CSS) and progression-free survival (PFS). By combining the two factors, we developed a novel index, fibrinogen-cholesterol (FC) score and found it to have better prognostic accuracy than the two factors alone. FC was an independent prognostic factor for both CSS (FC score = 1: hazard ratio [HR] = 3.207, 95% confidence interval [CI] = 1.775-5.793; FC score = 2: HR = 5.516, 95% CI = 2.891-10.527) and PFS (FC score = 1: HR = 2.178, 95% CI = 1.545-3.071; FC score = 2: HR = 3.709, 95% CI = 2.355-5.840). Both preoperative plasma fibrinogen and serum cholesterol levels are independent prognostic factors for CSS and PFS in RCC patients after nephrectomy. A novel indicator, FC score, could be considered a novel preoperative prognostic index in RCC.

Hepatocellular carcinoma biology predicts survival outcome after liver transplantation in the USA.

The aim of this study is to evaluate the clinicopathologic prognostic factors of cancer-specific survival (CSS) in hepatocellular carcinoma (HCC) patients who underwent liver transplantation (LT) stratified by tumor size. From the Surveillance, Epidemiology, and End Results (SEER) 18 registries (2004-2012), we retrieved data of 570 patients who underwent LT for a solitary primary HCC lesion ≤5cm. A two multivariable Cox models were constructed to identify prognostic factors of CSS in a two different tumor sizes (2cm cutoff). Out of 570 HCC patients (median age 57years), 16% had microvascular invasion (MVI) and 12% had a poorly differentiated tumor. Male sex (odds ratio [OR] 2.6), tumor size >2cm (OR 1.78), elevated AFP (OR 2.31), and poor tumor differentiation (OR 2.59) are significant predictors of MVI. With a median follow up of 41.5months (range 1-107months), the 5-year CSS rate was 90% in the absence of MVI compared to 75% in the presence of MVI (p<0.001). Multivariate models revealed that age ≥60years (hazard ratio [HR] 2.08), MVI (HR 2.26), and poor tumor differentiation (HR 2.42), were significant risk factors of a dismal CSS with HCC size >2cm, but not with HCC ≤2cm. Primary HCC tumor size ≤2cm had an excellent prognosis after LT and was not affect by the presence of MVI or poor tumor differentiation.

Smoking at diagnosis significantly decreases 5‐year cancer‐specific survival in a population‐based cohort of 18 166 colon cancer patients

Accumulating evidence suggests smoking may adversely affect cancer patients' outcomes. Previous studies of smoking and survival in colon cancer have been limited by size and/or lack of a population basis and results have been inconsistent. To investigate in a large population-based cohort whether smoking status at diagnosis is an independent prognostic factor for cancer-specific survival in colon cancer and whether treatment modifies any impact of smoking. Colon adenocarcinomas diagnosed between 1994 and 2012 were abstracted from the National Cancer Registry Ireland, and classified by smoking status at diagnosis. Cancer-specific death rates over 5 years were compared in current, ex- and never smokers using multivariable Cox proportional hazards models, and subgroup analyses by treatment (combinations of cancer-directed surgery and chemotherapy) were conducted. Of 18 166 colon cancers, 20% of patients were current smokers, 23% ex-smokers and 57% never smokers. Compared to never smokers, current smokers had a significantly raised cancer death rate [multivariable hazard ratio (HR) = 1.14, 95% CI: 1.07-1.12]. There was a significant interaction between treatment and smoking (P = 0.03). In those who had cancer-directed surgery only, but not other groups, current smokers had a significantly increased cancer death rate compared to never smokers (HR = 1.21, 95% CI: 1.09-1.34). Smoking at diagnosis is an independent prognostic factor for colon cancer. The limitation of the association to surgically-treated patients suggests that the underlying mechanism(s) may be related to surgery. While further research is needed to elucidate mechanisms, continued efforts to encourage smoking prevention and cessation may yield benefits in terms of improved survival from colon cancer.

Validation of a novel prognostic scoring system using inflammatory response biomarkers in patients undergoing curative thoracoscopic esophagectomy for esophageal squamous cell carcinoma.

BackgroundSystemic inflammatory markers, including the lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio have been shown to predict postoperative recurrence and survival in various types of cancer. However, their role in esophageal cancer has yet to be determined. This study aimed to evaluate the prognostic significance of an inflammatory response biomarker (IRB) score, independent of conventional clinicopathological criteria, in patients with esophageal cancer undergoing curative resection.Patients and methodsWe retrospectively reviewed a database containing the medical records of 147 consecutive patients who underwent curative esophagectomy for esophageal squamous cell carcinoma. The IRB score was determined as follows: a low lymphocyte-to-monocyte ratio (<4), a low neutrophil-to-lymphocyte ratio (<1.6), and a high platelet-to-lymphocyte ratio (>147), which were each scored as 1, with all remaining values scored as 0. The scores were added together to produce the IRB score (range: 0–3).ResultsAn IRB score of 2–3 (hazard ratio: 6.023, 95% confidence interval: 1.675–13.078; P<0.01) was identified as an independent poor prognostic factor of cancer-specific survival (CSS) in a multivariate logic regression analysis. The 5-year CSS rates in patients with the IRB scores of 0−1, 2, and 3 were 37.8%, 67.8%, and 72.5%, respectively. As determined by Kaplan–Meier analysis and the log-rank test, these differences were significant (P<0.001).ConclusionThe IRB score can predict the systemic inflammatory response as accurately as conventional tumor markers and is useful for determining CSS in patients with esophageal cancer undergoing curative thoracoscopic esophagectomy.

Preoperative Gamma-Glutamyltransferase Is Associated with Cancer-Specific Survival and Recurrence-Free Survival of Nonmetastatic Renal Cell Carcinoma with Venous Tumor Thrombus.

Introduction. To evaluate the prognostic significance of preoperative gamma-glutamyltransferase (GGT) on the subgroup of nonmetastatic renal cell carcinoma (RCC) with venous tumor thrombus. Materials and Methods. We retrospectively reviewed the institutional database and collected the medical data of 156 patients with nonmetastatic RCC with venous tumor thrombus between March 2004 and December 2014. Kaplan-Meier and Cox regression analyses were applied to determine the prognostic factors for cancer-specific survival (CSS) and recurrence-free survival (RFS). Results. The median value and optimal cutoff point of preoperative GGT were 23.0 and 37.5 IU/L, respectively. In the entire cohort, 67 (42.9%) patients experienced disease recurrence, and 46 (29.5%) patients died. Kaplan-Meier analysis revealed that the CSS and RFS rates were lower in patients with preoperative GGT ≥ 37.5 IU/L than in those with preoperative GGT < 37.5 IU/L. Multivariate Cox proportional hazard analysis demonstrated that high preoperative GGT was significantly associated with shorter CSS (hazard ratio [HR]: 2.115; 95% CI: 1.164–3.843; p = 0.014) and RFS (HR: 1.955; 95% CI: 1.166–3.276; p = 0.011), after adjusting other covariates. Conclusions. Preoperative GGT can serve as an independent prognostic biomarker of nonmetastatic RCC patients with venous tumor thrombus. Further prospective study is warranted to confirm our results.