Prognostic Role Of Age Research Articles

Differences in the Prognostic Role of Age, Extent of Resection, and Tumor Grade between Astrocytoma IDHmt and Oligodendroglioma: A Single-Center Cohort Study.

IDH-mutant glioma is classified as oligodendroglioma or astrocytoma based on 1p19q-codeletion. Whether prognostic factors are similar between these tumor types is not well understood. Retrospective cohort study. Molecular characterization was performed with targeted next-generation sequencing. Tumor volumes were calculated using semiautomatic 3D segmentation on all pre- and post-operative MRI scans. Overall survival was assessed with the Cox-proportional hazards model. A total of 383 patients with newly diagnosed IDH-mutant glioma were followed up for a median of 7.2 years. Grades 3 and 4 patients had significantly lower Karnofsky performance, with tumors having more contrast enhancement. Patients also received more aggressive postsurgery treatment. Postoperative tumor volume is significantly and independently associated with survival (HR, per cm3 1.19; 95% CI, 1.03-1.39) in IDH-mutant glioma. A separate analysis of oligodendroglioma and astrocytoma showed a significant association of postoperative tumor volume in astrocytoma but not in oligodendroglioma. Higher age and histologic tumor grade were associated with worse survival in patients with oligodendroglioma but not with astrocytoma. Our data support an initial strategy of extensive resection in patients with oligodendroglioma and astrocytoma. Other important prognostic factors differ between these tumor types, urging researchers and clinicians to keep treating these tumors as separate entities.

The prognostic role of age in primary cutaneous B-cell lymphoma: a proposal derived from a population-based registry.

A few prognostic predicting systems existed for primary cutaneous B-cell lymphoma (PCBCL). However, none of them took age into consideration. We sought to declare the prognostic role of age in PCBCL. A total of 4859 patients were identified in the surveillance, epidemiology and end results data, spanning 1975-2016. The association between age and survival was determined using unadjusted and adjusted proportional hazard analysis. There was a uni-modal distribution of age, with most in the seventh decade (22%), followed by the sixth and eighth decades (19%). As a continuous variable, age was demonstrated to have an adverse effect on overall survival (OS, HR, 1.077, 95% CI 1.073-1.082, p = 0.000) and cancer-specific survival (CSS, HR, 1.099, 95% CI 1.092-1.106, p = 0.000) after adjusted proportional hazard analysis. Patients aged ≤ 60years had significantly higher survival rates than those aged > 60 (5-year OS was 93% vs 64%, 10-year OS was 90% vs 45%, p = 0.000; 5-year CSS was 98% vs 80%, 10-year CSS 96% was 62%, p = 0.000). Similar survival trends were also observed in different sub-group analyses, including disease with different stages (p = 0.000), different histology subgroups (p = 0.000), and different sites (p = 0.000). Age has an important effect on overall survival and cancer-specific survival. The addition of age to the primary site, histology, and stage improves predicting long-term outcomes in cutaneous B-cell lymphoma.

Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks.

Objectives:The purposes of this study are to describe the epidemiology of pericardial and tunica vaginalis testis mesothelioma and assess the role of asbestos exposure for these rare diseases.Methods:Based on incident pericardial and tunica vaginalis testis mesothelioma cases collected from the Italian national mesothelioma registry (ReNaM) in the period 1993–2015, incidence rates, survival median period and prognostic factors have been evaluated. A case–control study has been performed to analyze the association with asbestos exposure (occupational and non-occupational) for these diseases.Results:Between 1993 and 2015, 58 pericardial (20 women and 38 men) and 80 tunica vaginalis testis mesothelioma cases have been registered with a mean annual standardized (world standard population as reference) incidence rates of 0.049 (per million) in men and 0.023 in women for the pericardial site, and 0.095 for tunica vaginalis testis mesothelioma. Occupational exposure to asbestos was significantly associated with the risk of the diseases [odds ratio (OR) 3.68, 95% confidence interval (CI) 1.85–7.31 and OR 3.42, 95% CI 1.93–6.04 in pericardial and tunica vaginalis testis mesothelioma, respectively]. The median survival was 2.5 months for pericardial and 33.0 months for tunica vaginalis testis mesotheliomas. Age was the main predictive factor for survival for both anatomical sites.Conclusions:For the first time in an analytical study, asbestos exposure was associated with pericardial and tunica vaginalis testis mesothelioma risk, supporting the causal role of asbestos for all anatomical sites. The extreme rarity of the diseases, the poor survival and the prognostic role of age have been confirmed based on population and nationwide mesothelioma registry data.

Abstract P4-08-35: Young age at diagnosis is associated with worse prognosis in the luminal A breast cancer subtype. A retrospective institutional cohort study

Abstract Background: Breast cancer (BCA) presents with distinct molecular subtypes, each associated with different patterns of relapse, drug sensitivity, and prognosis. Although age at diagnosis is a recognized independent prognostic risk factor, its relative importance among molecular subtypes is not well documented. The aim of this study was to evaluate the prognostic role of age at diagnosis among BCA patients of different immunohistochemical subtypes (LuminalA, LuminalB, Her2, Triple-negative). Methods: We conducted a retrospective study of women with invasive BCA undergoing surgery at the Johns Hopkins Hospital from January 2000 - December 2016, excluding patients presenting with stage IV breast cancer. Patients were stratified into three age groups: ≤ 40, 41-60, and > 60 years, and multivariable analysis was performed using Cox regression. To explore age-related differences in gene expression, we identified differentially expressed genes (DEG) between age groups among BCA subtypes in the TCGA dataset. Finally, we identified key driver genes within DEG using a weighted gene co-expression network analysis. Results: Our cohort included 3,524 patients with a median follow-up of 85.1 months. LuminalA breast cancer patients had significantly lower 5-year Disease Free Survival (DFS) and Distant Metastasis-Free Survival (DMFS) in the ≤ 40 year age group compared to the 40-60 year age group (HR=2.69, 95%CI: 1.72 - 4.23 and HR=2.95, 95%CI: 1.78 - 4.90, respectively), while the other molecular subtypes showed no significant association of DFS or DMFS with age. Age was a stronger predictor of 5- year DFS and 5-year DMFS than tumor grade or proliferative index (Ki67) in LuminalA BCA patients, but not other subtypes. Gene expression data were obtained from 1097 BCA TCGA patients, divided into two groups (≤40y, n=36; >40y, n=455). We identified 374 DEG between ≤40y and >40y LuminalA BCA subsets. The DEG were enriched in 7 pathways, and the WGCNA analysis identified two modules of co-expressed genes. No age group-specific DEG were identified in non-LuminalA subtypes. Conclusion: Age at diagnosis may be an important prognostic factor in LuminalA BCA and may improve risk stratification and personalized therapy. Prospective studies are needed to further evaluate the prognostic value of age in this subset of BCA patients. Citation Format: Liu Z, Sahli Z, Wang Y, Wolff AC, Cope L, Umbricht CB. Young age at diagnosis is associated with worse prognosis in the luminal A breast cancer subtype. A retrospective institutional cohort study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-35.

354P - The prognostic role of age in salvage re-irridiation applied patients with recurrent glioblastoma: A meta-analysis

354P - The prognostic role of age in salvage re-irridiation applied patients with recurrent glioblastoma: A meta-analysis

Prognostic significance of number of lymph node metastasis on survival in patients with pathological T3 esophageal carcinoma.

The aim of this study was to evaluate the impact of the number of metastatic lymph nodes (MLN) and other risk factors on survival in patients with pathological T3 (pT3) esophageal carcinoma who were treated by esophagectomy. We analyzed 70 patients who received primary curative resection for pT3 esophageal cancer from 1997 to 2011. The prognostic role of age, gender, tumor location, cell type, pathological lymph node status (pN), number of MLNs (<3 vs ≥3), metastatic lymph node ratio (MLR), type of resection, local recurrence, and distant metastasis on overall survival (OS) were examined by univariate and multivariate analyses. Survival curves were calculated using Kaplan-Meier method and survival differences were assessed by log-rank test. A receiver operating characteristic analysis was used to determine the optimum cut-off point for the MLR. The median follow-up time was 42 (range, 8-128) months, and the 1-, 3- and 5-year OS rates were 78.6%, 38.1%, and 22.5%, respectively. Tumor location, pN, the number of MLNs, local recurrence, and distant metastasis had a significant effect on OS in the univariate analysis. In the multivariate model, the number of MLNs (p=0.02; hazard ratio (HR), 2.1; 95% confidence interval (CI), 1.1-4.1) and distant metastasis (p=0.007; HR, 5.1; 95% CI, 1.5-16.8) were independent risk factors for OS. Patients with pT3 esophageal cancer who have 3 or more MLNs and distant metastasis have a poor OS, and this result can be used as a factor for better estimation of prognosis.

Objective Measures of Pre-Transplant Physiologic Fitness Are Strong Predictors of Very-Short Term Transplantation Related Mortality

Background Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for many hematological malignancies, however high mortality associated with the procedure remains a significant obstacle. Predictors of intermediate- and long-term treatment-related mortality (TRM) have been established, including two well-validated scoring systems (HCT-CI, Sorror 2005; EBMT, Gratwohl 2012). These scores reflect overall comorbidity burden (HCT-CI) and disease status together with specifics of the transplant procedure (EBMT). Early mortality post-HSCT may be related closely to the patient's immediate physiological state at the time of HSCT. We hypothesized that clinical laboratory values taken at the time of admission for HSCT may give a useful representation of physiological age and fitness for transplant, and thus be highly predictive of early (100 day) and very-early (30 day) treatment-related mortality (TRM).Methods This was a retrospective study on a cohort of patients who underwent HSCT at a single center for any indication between 2000 and 2014. Hematology and chemistry laboratory data were collected from the time of admission for transplantation, prior to the initiation of conditioning regimens. Variables representing bone marrow function (neutrophils, platelets, hemoglobin), kidney function (creatinine clearance estimated by EPI), liver function (total bilirubin, AST, ALT), nutritional status (albumin) as well as age were included in a Fine & Gray Competing Risk regression at time-points of 30, 100 and 365 days. Cumulative incidence curves were constructed for variables deemed significant at each time-point.Results A total of 1,045 patients were included in this study. The median patient age was 52 (IQR 39-60). Myeloablative conditioning was used for 274 patients (26.2%) while reduced-intensity conditioning was used for 765 patients (73.2%). 568 (54.4%) patients received transplants from sibling donors, and 477 (45.6%) patients received grafts from unrelated donors. Risk associated with individual laboratory biomarkers changed over the course of the first year post-transplantation. Creatinine clearance, albumin and total bilirubin were strong predictors of early mortality (p < 0.01) at 30 days, with hazard ratios of 4.5, 3 and 2.6 respectively. Notably, the prognostic weight of these variables decreased over time. In contrast, the prognostic role of age became evident only later in the first year (table 1). Cumulative incidence of TRM in patients with creatinine clearance < 60 mL/min (fig. 1a) and with albumin < 3.5 g/dL (fig. 1b) showed markedly poorer outcomes over time, with especially strong effect in the immediate aftermath of transplantation.Conclusions Our study demonstrates that common laboratory biomarkers of physiological fitness and biological age are strong determinants of early transplantation-related mortality. These markers are complimentary to existing prognostic models, which utilize broader comorbidity categories (HCT-CI) or specifics of the transplantation procedure (EBMT score) to predict medium and long-term survival trends. Laboratory variables are readily-available objective measures, and may be of particular importance when assessing fitness for the initial transplantation procedure. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The prognostic role of age in oral cancer. A clinical study

The problem of malignant tumors developing in a young age is a topic of special importance and subject of intensive research. The occurrence of oral cavity tumors shows a decreasing trend worldwide, while the incidences of oral squamous cell carcinoma diagnosed at young adulthood is increasing. The etiology of tumors developing in young age is not yet fully understood, however, it can be stated that the usual high-risk behavioral patterns (i.e. smoking and alcohol abuse) play only a minor role in this patient group, if any. Our own observations indicate a higher regional and locoregional relapse for these patients and, although they turn for help early, at an early stage of the disease, a lower chance of survival. The target of our research was to analyze the differences in certain etiological, pathological and clinical parameters of our own patient group consisting of both young and older patients. The data of 105 young (<50 years) and, as a control group, 105 older (>50 years) patients were analyzed. The patients have undergone surgery and, if necessary, radiotherapy and/or chemotherapy. The tumor-specific survival was determined at 36 months. Our study aimed at understanding the relationship between the clinical prognostic factors (stage, localization, anamnestic time), smoking habits, gender and age of the patients. Relationship between cancer occurrence (local, locoregional relapse) and survival rate, as well as age and survival rate were analyzed. We found that young patients report themselves for treatment at an early stage. Smoking and alcohol abuse were considerably less. When a relapse occurs, it occurs more frequently and earlier than at older patients. The most decisive correlation was observed between age and anamnestic time, age and number of cigarettes smoked, age and time elapsed until relapse, as well as age and cancer-specific survival. Moreover, cancer-specific survival of patients younger than 50 years of age was found significantly shorter than in the control group.

Age as prognostic factor in patients with osteosarcoma

Age at diagnosis is a well known prognostic factor in many different malignancies; its significance for patients with osteosarcoma is however controversial. To gain more insight in the prognostic role of age, we performed a retrospective study at our institute. We included 102 patients with de-novo osteosarcoma and formed three age groups to evaluate age specific survival rates: ≤ 14years, 15–19years and 20–40years. Differences in outcome between patients aged 15–19years treated at either the pediatric department or the adult department of oncology were evaluated. The 5-year overall survival rate (OSR) of the whole population was 53.5%±1.5%. OSR of 70.6%±0.8% was seen in patients≤14years old, 52.5%±1.1% in patients 15–19years old and 33.3%±0.9% in the patients aged 20–40years (p=0.01). Significant differences were observed with regard to stage at presentation (higher in older age groups), size of the tumor (larger in younger age groups) and histological response (more good responders in younger age groups). No significant difference was seen between outcomes of patients aged 15–19years treated at the pediatric or adult oncology department. In conclusion, younger patients have a significantly better outcome than older patients.

Role of endocrine responsiveness and adjuvant therapy in very young women (&lt; 35 years) with operable breast cancer and node negative disease

558 Background: Breast cancer rarely occurs in young women. There is limited knowledge about prognosis, and treatment effects in the population with node negative disease, largely dependent upon older series and extrapolation of data from older age cohorts. Methods: We evaluated biological features and adjuvant treatment recommendations for 841 premenopausal consecutive patients with pT1–3, pN0 and M0, operated and counseled for medical therapy from April 1997 to December 2001. We evaluated also, the prognostic role of age and adjuvant treatment. Median follow-up was 49.9. Results: Very young women (101, 12%) were more likely to have tumors with absent ER (42% v 17.6%, p &lt; .0001) and PgR (48% v 23.2%, p &lt; .0001), &gt; 2 cm (36.7% v 24.8%; p = .002), grade 3 (53.9% v 33.5%; p = .0009) and elevated Ki-67 (68.5% v 51.6%; p = .002), when compared with older patients (740, 88%). Younger patients (compared with older patients) with endocrine responsive disease were prescribed more chemotherapy (67.2% v 44.3%; p = .0009) but endocrine adjuvant therapy was prescribed in a similar percentage in both groups (93.1% v 96% p = .30). A statistically significant difference in disease-free survival (DFS), risk of distant metastases and overall survival (OS) was observed at the multivariate analysis for younger patients (HR = 4.44; 95% CI, 2.53 to 7.78, p &lt; .0001 for DFS; HR = 3.23; 95% CI, 1.32 to 7.94, p = .011 for distant metastases; HR = 2.89; 95% CI, 1.06 to 7.87, p = .038 for OS). An increased risk for younger age was observed for patients with endocrine responsive disease (ER ≥ 1%) (HR = 5.17; 95% CI, 2.72 to 9.83, p &lt; .0001 for DFS) in particular if endocrine therapy was not performed (HR = 7.77; 95% CI, 1.98 to 30.6, p = .003 for DFS). Conclusions: We conclude that compared with less young premenopausal patients, the very young women presenting with breast cancer and ipsilateral axilla negative for disease, are at larger chance of relapse. Endocrine therapies are crucial in patients with endocrine responsive disease. No significant financial relationships to disclose.