Significant Difference In Overall Survival Rate Research Articles

Long-term survival analysis of ultrasound-guided percutaneous microwave ablation for hepatocellular carcinoma conforming to the Milan criteria: primary versus recurrent HCC

Background This study compared long-term outcomes between patients with initial hepatocellular carcinoma (IHCC) and those with recurrent HCC (RHCC) treated with microwave ablation (MWA). Methods This retrospective study included 425 patients with HCCs (294 IHCCs and 131 RHCCs) within the Milan criteria who were treated with ultrasound-guided percutaneous MWA between January 2008 and November 2021. All patients with RHCC had previously undergone MWA for initial HCC. Overall survival (OS) and recurrence-free survival (RFS) rates were compared between the IHCC and RHCC groups before and after propensity score matching (PSM). Results Before matching, the 1-, 3-, 5-, and 10-year OS rates in the IHCC group were 95.9%, 78.5%, 60.2%, and 42.5%, respectively, which were significantly higher than those in the RHCC group (93.8%, 70.0%, 42.0%, and 6.6%, respectively). This difference remained significant after PSM. However, subgroup analyses suggested that there were no significant differences in OS rates between IHCC and RHCC in patients with solitary HCC ≤3.0 cm, AFP ≤200 ng/mL, ablative margins ≥0.5 cm, or Albumin-Bilirubin (ALBI) grade 1. RFS was significantly higher in IHCC than in RHCC before and after PSM, as well as in subgroup analyses. ALBI grade (hazard ratio (HR), 2.38; 95% CI: 1.46–3.86; p < 0.001), serum AFP level (HR, 2.07; 95% CI: 1.19–3.62; p = 0.010) and ablative margins (HR, 0.18; 95% CI: 0.06-0.59; p = 0.005) were independent prognostic factors for OS of RHCC. Serum AFP(HR, 1.29; 95% CI: 1.02–1.63, p = 0.036) level was the only factor associated with RFS in RHCC. Conclusions MWA yielded comparable OS in IHCC and RHCC patients with solitary HCC ≤3.0 cm, AFP ≤200 ng/mL, ablative margins ≥0.5 cm, or ALBI grade 1.

Association of high-risk comorbidity with overall survival among patients with gastric cancer and its sex-specific differences in China: a retrospective observational cohort study

BackgroundConcomitant diseases often occur in cancer patients and are important in decision-making regarding treatments. However, information regarding the prognostic relevance of comorbidities for mortality risk is still limited among Chinese gastric cancer (GC) patients. This study aimed to investigate the association between comorbidities and 3-year mortality risk.MethodsThis retrospective study enrolled 376 GC patients undergoing radical gastrectomy at the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2019. Demographic and clinicopathological information and treatment outcomes were collected. Patients were divided into low-, moderate- and high-risk comorbidity groups based on their Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) scores. Kaplan-Meier survival and Cox regression analyses were used to examine 3-year overall survival (OS) and mortality risk for each group.ResultsThe median follow-up time was 43.5 months, and 40.2% (151/376) of GC patients had died at the last follow-up. There were significant differences in OS rates between ACCI-based comorbidity groups (76.56; 64.51; 54.55%, log-rank P = 0.011) but not between CCI-based comorbidity groups (log-rank P = 0.16). The high-risk comorbidity group based on the ACCI remained a significant prognostic factor for 3-year OS in multivariate analysis, with an increased mortality risk (hazard ratio [HR], 1.99; 95% CI, 1.15–3.44). Subgroup analysis revealed that this pattern only held for male GC patients but not for female patients.ConclusionThe present study suggested that high-risk comorbidities were significantly associated with a higher mortality risk, particularly in Chinese male GC patients. Moreover, the ACCI score was an independent prognostic factor of long-term mortality.

Clinical Outcomes of Patients with Breast Implant- Associated Anaplastic Large- Cell Lymphoma (BIA-ALCL) Treated with Chemotherapy and Brentuximab Vedotin

Background BIA-ALCL is a rare form of CD30-positive, ALK-negative ALCL associated with textured breast implants. Patients with stage I BIA-ALCL have disease limited to the capsule which can be completely resected to achieve cure. Advanced stages of disease with capsular invasion, lymph node involvement and/or distant spread require more therapeutic interventions, including radiation (XRT), chemotherapy (CTX), or immunotherapy (ADC). Chemotherapy treatments are similar to those for systemic ALCL and often include anti-CD30 ADC brentuximab vedotin (BV). This study aims to compare outcomes between patients (pts) with advanced BIA-ALCL treated with adjuvant CTX and BV versus those without treatment (Tx). Methods This study is a single institution, IRB approved retrospective chart review, wherein we examined newly diagnosed pts with BIA-ALCL and review of literature between 2008 and 2022. Variables collected included age, radiologic imaging, stage, surgical procedure, pathology review, and laboratory data. Data on treatment and progression, including response to frontline CTX and BV-based therapy, was also analyzed. Overall survival (OS) was the primary endpoint of the study. R studio version 4.2.1 was used for statistical analysis. Results In a cohort of 130 pts (71 MDACC pts and 59 literature review pts) with BIA-ALCL, the median age was 53 years (range, 29-77). The indication for implants were as follows: 69 (53%) for cosmetic purpose, 45 (35%) for breast reconstruction following breast cancer, and 1 due to fibrocystic changes. Twenty-five pts with a history of breast cancer had a recorded history of Tx including CTX, radiation, and hormonal therapy. There were 61 pts (47%) with silicone implants, 30 (23%) with saline, and 3 (2%) had both silicone and saline; implant filling was not available for 36 pts (28%). In terms of types of implants: 61 (47%) had Allergan/McGhan/Inamed (A/M/I), 3 (2%) had A/M/I and implants from other companies, 1 had A/M/I and Mentor (1%), 5 (4%) had Mentor, 2 (2%) had Mentor and other companies, and 7 (5%) had implants from other companies; data was not available for 51 (39%) pts. All 82 pts for whom data was available had textured implants. The average time between implant placement and diagnosis was 12.8 years. On initial clinical presentation, 97 (75%, n=130) pts had swelling, 95 (73%, n= 130) had effusions, 22 (17%, n=130) had lymphadenopathy (LAD), and 7 (5%, n=130) had other clinical presentations such as contractures and rash. Stage included: I- 42%, II- 12%, III-7%, and IV-4%. Overall, 54 (52%) pts did not receive Tx (CTX and BV) and 50 (48%) pts did. Among pts that received no treatment (n=54), 96% had effusions and among pts who had Tx (n= 50), 74% had effusions (p=0.003). Fewer pts on the Tx arm underwent capsulectomy versus those who did not receive Tx: 17 (37.6%) vs 25 (56.8%), p= 0.001). For CTX pts 86% (n=43) pts received CHOP or CHOP-like regimens. Seven (14%) received BV only while 6 (12%) had CTX + BV. A median of 5.1 months passed between diagnosis of BIA-ALCL and starting CTX. Eighty-eight (68%) pts achieved complete remission, 6 (5%) pts were alive with disease, 7 (5%) pts died from disease and 3 (2%) pts died from unrelated diseases. Endpoint response was not available for 26 pts. Most pts who did not receive CTX had Stage I and were treated with complete capsulectomy. We compared the overall survival amongst pts with no Tx, CTX, CTX + BV, and BV. The survival probability of pts receiving CTX and CTX + BV was lower (0.9 and 0.63, respectively) as the disease was similar to systemic ALCL. Overall, there was no significant difference in OS rate (p=0.054) among all four groups of pts. Conclusion Complete surgical excision continues to play a central role in the management of pts with BIA-ALCL. Although most pts with BI-ALCL have excellent outcomes, a subset of pts with advanced stage disease has a more aggressive course and need CTX or BV. Given the smaller numbers of pts with various CTX combinations, prospective studies are required to evaluate the beneficial role of BV in pts with advanced BIA-ALCL. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Comparison of ATG-Based Immunosuppressive Treatment and Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Transfusion-Dependent Non-Severe Aplastic Anemia: A Single Center, Retrospective Analysis

Transfusion-dependent non-severe aplastic anemia (TD-NSAA) refers to aplastic anemia (AA) that is dependent on blood transfusion but does not fulfilling the criteria for severe AA (SAA). It has been clear that allogeneic hematopoietic stem cell transplantation (HSCT) and anti-thymocyte globulin (ATG)-based immunosuppressive therapy (IST) is the front line for the treatment of SAA, but there is no consensus on the treatment timing and strategy for TD-NSAA. The natural history observation reported that the progress-free survival (PFS) of TD-NSAA at 60 months after diagnosis is around 62%, but decreased significantly to 22% at 120 months. In China, the practical guideline recommends cyclosporine-based IST with or without hematopoietic stimulating regimes (such as androgens) as initial treatment, and further treated as SAA if no response was observed after 6 months management. As reported, the hematopoietic response of ATG-based IST was much better than CsA-based IST (75% Vs. 55.8%, 6-month) for TD-NSAA, however, the relapse and clonal expansion are still the unavoidable events. For HSCT, the long-term PFS is much better than IST for SAA, but the complications (including graft versus host disease, various infection, etc.), transplantation related mortality, as well as donor availability still limited its application. At present, there is limited data compared the efficiency of HSCT and IST for TD-NSAA. With the development of haplo-identical transplantation in China, most TD-NSAA own a donor, and we also performed HSCT for those young patients after informed consent. Herein, we respectively compared the efficiency of ATG-based IST and HSCT for TD-NSAA, and also analyzed the risk factors that contribute to the overall survival (OS) as well as event free survival (EFS). During Jul 2011 to Dec 2019, 97 TD-NSAA patients were diagnosed in our cohort, among them, 5 only received supportive treatment, 30 received CsA-based IST with or without androgen, and the other 62 patients received HSCT or ATG-based IST therapy. We further analyzed the efficiency and prognosis of 55 patients aged 16-60 years old who received HSCT or ATG-based IST therapy. Among them, 27 (49.09%) patients received ATG-based IST, and the others performed HSCT (including 14 from sibling donor, 7 from haplo-identical donor and 7 from unrelated donor) (the baseline information showed in Table1). Results showed that the 12-month overall response rate (ORR) of ATG-based IST and HSCT were 48.1% (with 18.52% CR) and 78.57% (with 60.71% CR), respectively (P=0.04, Fig A). The median time of achieving transfusion-free was 94(35-205) and 24(11-139) days, respectively in ATG-based IST and HSCT group (P<0.001, Fig B). The 5-year OS and EFS rates were 54.9±13.3% and 34.5±12.1% in ATG-based IST group respectively, and 70.0±9.0% and 62.6±9.6% in HSCT group, while no statistically differences was observed (Fig C and D). To explore the possible influencing factors of 5-year OS and EFS, we performed COX regression analysis based on age, disease duration, baseline absolute neutrophil count (ANC), hemoglobin (HB), platelet count (PLT), serum ferritin (SF), lymphocyte percentage, and CD4/CD8 ratio. Univariate analysis showed that disease duration, baseline HB, SF, and ANC may affect OS and EFS of patients in ATG-based IST group (Table 2), and multivariate analysis showed that SF≧1000ng/ml was an independent risk factor for OS in ATG-based IST group. While in the HSCT group, patients with disease duration≧20 months had a higher risk of events (Table 3). The subgroup analysis showed that in HSCT group, patients with disease duration of 6 to 20 months had a lower risk of events (HR=0.196, 95%CI: 0.046-0.832); the HR of the group <6 months and ≥20 months were not statistically significant (Fig E). TD-NSAA patients with disease duration between 6 months and 20 months had a higher EFS rate in HSCT group than that in ATG-based IST group (Fig F). The subgroup analysis of mortality was not statistically significant (Fig G). To conclusion, TD-NSAA patients should be actively treated, patients with shorter disease duration and no iron overload may achieve a better response. The 12-month ORR in the HSCT group was higher than that in the IST group, but there was no significant difference in OS rate and EFS rate, even there is a great difference tendency. For TD-NSAA patients with a disease duration between 6 to 20 months, HSCT has a higher EFS rate than IST, which may be a better choice. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

An evaluation based on relative treatment intensity in older patients treated with reduced-dose R-THP-COP therapy for diffuse large B-cell lymphoma: A multicenter retrospective cohort study

IntroductionThe number of older patients with diffuse large B-cell lymphoma (DLBCL) is increasing. Although the standard treatment for newly diagnosed younger patients with DLBCL has been established, no consensus has been reached regarding the optimal chemotherapy intensity and regimen for older patients with DLBCL. In addition, no method for evaluating treatment intensity in retrospective studies when different numbers of chemotherapy courses are administered has been elucidated. Materials and MethodsA multicenter retrospective analysis was conducted to evaluate the outcomes of a reduced-dose R-THP-COP regimen, which included 30 mg/m2 of pirarubicin, in 54 patients with DLBCL who were aged ≥75. To assess treatment intensity, we defined the relative treatment intensity (RTI) as the number of courses administered multiplied by the relative dose intensity (RDI). ResultsThe estimated four-year overall survival rates (OS) of the patients aged 75–80 and ≥ 80 were 55.1% and 60.6%, respectively. There was no significant difference in four-year OS between these age groups. In our cohort, there was no significant difference in the estimated four-year OS between the patients who received reduced-dose R-THP-COP at an RDI of ≥61% and those that received it at an RDI of <61% (P = 0.35). On the other hand, the patients who received reduced-dose R-THP-COP at an RTI of ≥2.7 exhibited a significantly higher estimated four-year OS than those treated at an RTI of <2.7 (68.5% vs. 28.7%; P < 0.001). Multivariate analysis revealed that the RTI was a significant independent predictor of OS. The cumulative incidence of treatment-related mortality (TRM) at one year was 4.2% and 3.4% in the 75–80 and ≥ 80 age groups, respectively. The cumulative incidence of TRM was significantly worse among the patients with Charlson Comorbidity Index (CCI) scores of ≥2 than among those with CCI scores of 0 or 1. DiscussionOur study suggests that the reduced-dose R-THP-COP regimen is a suitable treatment option for older patients with DLBCL, especially those with CCI scores of <2. Our study also showed that the RTI may be a valuable tool for assessing treatment intensity in retrospective studies involving older patients.

Prognostic Analysis of Individualized Treatments of Malignant Tumors Primary From Maxillary Sinus.

To investigate the prognosis and quality of life for primary malignant maxillary sinus tumors. This was a retrospective analysis. 164 patients diagnosed with primary malignant maxillary sinus tumors between 2005 and 2018 were recruited. Patients were treated according to the pathological type and the lesion range. Prognostic differences of different pathological types, surgical resection methods, repair methods, treatment methods, and different local recurrence sites were analyzed. Survival analysis and prognostic factors analysis were performed. Overall survival (OS) rate was 74.7% at 3 years, 60.5% at 5 years, and 45.8% at 10 years. Disease-free survival (DFS) rate was 67.2% at 3 years, 45.6% at 5 years, and 30.8% at 10 years. There was significant difference in OS rate among different pathological types (χ2 = 14.18, P < 0.05). The order of 5-year OS rate was as follows: malignant transformation of inverted Papilloma (77.7%) > adenoid cystic carcinoma (74.1%) > squamous cell carcinoma (48.4%) > sarcoma (22.1%). The order of disease-free survival was as follows: total maxillary resection > subtotal maxillary resection > endoscopic nasal tumor resection ≥enlarged maxillary resection, the 5-year DFS rate were 68.6%, 53.5%, 46.2%, and 42.9%, respectively. The OS of postoperative radiotherapy was significantly better than that of preoperative radiotherapy (χ2 = 7.16, P < 0.05). There was significant difference in OS between recurrent and non-recurrent patients (χ2 = 68.57, P < 0.05). The pathological type and the timing of radiotherapy are independent prognostic factors for primary malignant tumor of maxillary sinus. In addition, different local surgical resection methods are independent factors affecting the recurrence rate.

Association of Mu-Opioid Receptor Expression With Long-Term Survival and Perineural Nerve Invasion in Patients Undergoing Surgery for Ovarian Cancer

BackgroundOpioids are widely used during primary debulking surgery (PDS) for ovarian cancers, and a high mu-opioid receptor (MOR) expression predicts worse cancer outcomes. However, the impact of MOR expression on survival outcomes in ovarian cancers is still not clear.MethodsA retrospective cohort study was conducted in patients who underwent PDS in ovarian cancer patients. MOR expression was measured in tumor and normal tissue. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included perineural invasion (PNI), intraoperative sufentanil consumption, length of stay (LOS), and verbal numerical rating scale (VNRS) on postoperative day 1 (POD1), POD3, and POD5.ResultsAfter propensity score matching, a total of 366 patients were finally enrolled in this study. There were no significant differences in OS rates in patients with high versus low levels of MOR (1-year OS: 82.9% versus 83.3%, 3-year: 57.8% versus 59.1%, 5-year: 22.4% versus 23.1%,respectively) in the ovarian cancers. There were no significant differences in DFS between the groups. Intraoperative sufentanil consumption was higher in the MOR high-expression group compared with the MOR low-expression group. Tumors expressing high levels of MOR showed higher rates of PNI. VNRS in the MOR high-expression group was higher on POD1.ConclusionMOR is not an independent predictor of worse survival in ovarian cancers but is associated with high rates of perineural invasion.

Clinical Efficacy of Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer Patients with Liver Metastases: A Network Meta-Analysis of Nine Randomized Controlled Trials.

PurposeThis network meta-analysis (NMA) was conducted to compare the efficacy of immune checkpoint inhibitors in advanced non–small cell lung cancer (NSCLC) patients with liver metastases.Materials and MethodsEnglish literature was retrieved from the PubMed, American Society of Clinical Oncology, and European Society for Medical Oncology databases from January 2015 to January 2021. We pooled the overall survival (OS) and progression-free survival (PFS) hazard ratios (HRs) using an NMA and ranked treatments by the surface under the cumulative ranking curve. Publication bias was evaluated by Begg’s and Egger’s tests. STATA 15.0 was used for the sensitivity analysis, and the remaining statistical analyses were performed using R 4.0.2.ResultsNine eligible phase III randomized controlled trials were included, including 1,141 patients with liver metastases. Pembrolizumab+chemotherapy ranked highest, followed by atezolizumab+bevacizumab+chemotherapy and nivolumab. However, no significant difference in OS rates was observed across these three treatments (HR, 0.98; 95% confidence interval [CI], 0.43 to 2.22 for pembrolizumab+chemotherapy vs. atezolizumab+bevacizumab+chemotherapy; HR, 0.91; 95% CI, 0.52 to 1.57 for pembrolizumab+chemotherapy vs. nivolumab). Regarding the PFS rate, atezolizumab+bevacizumab+chemotherapy and pembrolizumab+chemotherapy ranked highest and no significant difference was observed between them (HR, 0.79; 95% CI, 0.36 to 1.70 for atezolizumab+bevacizumab+chemotherapy vs. pembrolizumab+chemotherapy).ConclusionPembrolizumab+chemotherapy, atezolizumab+bevacizumab+chemotherapy, and nivolumab were superior to other treatments in NSCLC patients with liver metastases. These new findings may help clinicians better select therapeutic strategies for NSCLC patients with liver metastases.

High Expression of Bone Marrow VEGF in Patients with Acute Leukemia and Its Correlation with Prognosis

To detect the level of vascular endothelial growth factor (VEGF) in bone marrow of patients with non-M3 acute leukemia (AL), and estimate its relationship with prognosis. From January 2016 to December 2019, 114 patients with AL in department of Hematology, Wuwei People's Hospital were selected as study group, and 25 healthy volunteers were enrolled as control group. The concentration of VEGF in bone marrow was detected by ELISA. The patients were divided into high and low concentration group according to the level of VEGF. The overall survival (OS) and event-free survival (EFS) were compared among different groups. The level of VEGF in patients with AL was significantly higher than that in the control group. The median OS and EFS in the low concentration group was 34.5 and 32 months, respectively, while, in the high concentration group was 30 and 26 months, respectively. The differences between the two groups were statistically significant (P=0.010). There were significant differences in OS rate (P=0.035) and EFS rate (P=0.026) between low and high concentration group. Multivariate analysis showed that high VEGF concentration was an independent risk factor affecting OS (HR=2.619, 95%CI 1.070-6.406, P=0.035) and EFS (HR=2.221, 95%CI 1.074-4.552, P=0.031) in AL patients. VEGF highly expresses in the bone marrow of patients with AL at initial diagnosis and relapse, and shows adverse effects on the prognosis.

Prognostic Significance of Serum Insulin-Like Growth Factor-1 in Hepatocellular Cancer Patients: A Validation Study.

BackgroundThe Child–Turcotte–Pugh score (CTP) is the most commonly used tool to assess hepatic reserve and predict survival in hepatocellular cancer (HCC). The CTP stratification accuracy has been questioned and attempts have been made to improve the objectivity of the system. Serum insulin-like growth factor-1 (IGF-1)-CTP has been proposed to improve CTP prognostic accuracy. We aimed to validate the IGF-CTP score in our patient population.Patients and MethodsA total of 84 diagnosed HCC patients were enrolled prospectively. IGF-CTP scores in addition to CTP scores were calculated. C-index was used to compare the prognostic significance of the two scoring systems and overall survival (OS).ResultsCirrhosis was present in 48 (57.1%) patients, 35 (41.7%) patients were non-cirrhotic, 36 (42.8%) patients were hepatitis B (HBV) positive, and 8 (9.5%) patients were hepatitis C (HCV) positive. Serum IGF-1 levels were significantly lower in cirrhotic compared with non-cirrhotic patients (p=0.04). There was a significant difference in OS rates of patients with serum IGF-1 level <50 ng/mL and patients with serum IGF-1 levels ≥50 ng/mL (p=0.02); the OS rates were 6.5 and 14.8 months, respectively (p=0.02). The median OS of all patients was 7.38 months (95% CI: 5.89–13.79). The estimated C-index for CTP and IGF-CTP scores was 0.605 (95% CI: 0.538, 0.672) and 0.599 (95% CI: 0.543, 0.655), respectively. The U statistics indicated that the C-indices between two scoring systems are not statistically different (P= 0.91).ConclusionThis study evaluated IGF-1 levels and the IGF-CTP classification in a predominantly HBV (+) cohort of HCC patients with 41.7% non-cirrhotic. Although the prognostic value was similar, among patients with CTP-A, class those reclassified as IGF-CTP B had shorter OS than those with IGF-CTP score A. Thus, further validations of IGF-CTP score in similar populations may add additional value as a stratification tool to predict HCC outcome.

Abstract 410: Interaction between CAFs and CD8+ T in non-small cell lung cancer (NSCLC) affects prognosis and efficacy of immunotherapy

Abstract Background: Tumor infiltrating stromal cells and immune cells are the main components of the tumor microenvironment. Cancer-associated fibroblasts (CAFs) make up the bulk of cancer stroma and play a key role in tumor progression. Evidence indicates that CAFs are highly related to treatment response and prognosis. However, the effect of CAFs on immunotherapy response still remains unknown. Methods: RNA-seq and clinical data were downloaded from TCGA and GEO. The sva package was used to remove batch effects. The ssGSEA algorithm was used to assess the level of infiltration of 24 immune cells and fibroblasts from each sample. ImmuneScore was calculated using the ESTIMATE method to characterize the degree of immune infiltration. OS and DFS were analyzed using the K-M method. GO enrichment analysis is used to identify the biological process of genes. The TIDE algorithm and subclass mapping were used to predict the clinical response to immune checkpoint blockade. Results: We evaluated the infiltration abundance of 24 types of immune cells and fibroblasts in 1768 NSCLC samples. Positive correlation between immune infiltration and CAFs infiltration through multiple methods (immune cells, Immunescore, and clustering of immune cells) (Kruskal-Wallis and Pearson test, p &amp;lt; 0.05) were found. There were only two types of immune cells in two cohorts are beneficial for prognosis, but the number of IMFRs (Immune cells / CAFs) that are positive correlated with prognosis is more than half of the total number of classes (log-rank test; P &amp;lt; 0.05). Univariate cox regression analysis showed that almost all IMFRs tended to be favorable for prognosis. This phenomenon is called “CAFs-mediated immune resistance pattern (CMIRP)”. At the best cut-off point, patients with high fibroblast content had worse prognosis (log-rank test; P &amp;lt;0.05). The prognostic performance of CD8+ T cells was not robust, but CD8+ T cells /fibroblasts (CFR) can effectively distinguish the overall survival (OS) rate of NSCLC patients [n = 1588; hazard ratio (HR), 0.66; 95% confidence interval (CI),0.56-0.78; P &amp;lt; 0.001]. and DFS rate (n = 504; HR,0.46; 95% CI, 0.34-0.62; P &amp;lt; 0.001). Multivariate analysis revealed that CFR was an independent prognostic biomarker for OS. Among the 33 independent TCGA cohorts, 29 cohorts showed a significant positive correlation between CD8 T cells and CAFs (Pearson test, P &amp;lt; 0.05). High CFR was beneficial for OS (HR, 0.72,95% CI, 0.67-0.78, P &amp;lt; 0.001). Next, we defined CFR high and CFR low groups in NSCLC, and found significant difference in OS rates between subgroups (log-rank test, P &amp;lt; 0.0001). Differential genes analysis indicate that that CFR high samples were enriched with immune activation pathways including T cell activation, cytolysis, and Antigen presentation, while CFR low was associated with immunosuppression including activation of transforming growth factor β and epithelia-mesenchymal transition. Finally, The TIDE predicted the likelihood of immunotherapy response in all NSCLC tumors. The responders had a higher CFR (Kruskal-Wallis test, P &amp;lt; 0.0001). The Submap algorithm suggested that the CFR high subgroup was more sensitive to PD-1 treatment (Bonferroni corrected, P &amp;lt; 0.01). Conclusion: The “CMIRP” we proposed shed light on a more accurate assessment of immune status. CFR is a potential marker for prognosis and predictive efficacy of immunotherapy in NSCLC. Citation Format: Xinlong Zheng, Dongqiang Zeng, Pansong Li, Wenying Pen, Xuan Gao, Zhipeng Zhou, Jing Bai, Junhui Li, Jianming Ding, Deqiang Wang, Suya Zheng, Gen Lin. Interaction between CAFs and CD8+ T in non-small cell lung cancer (NSCLC) affects prognosis and efficacy of immunotherapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 410.

An Analysis from the WM UK Rory Morrison Registry - How Does Waldenström's Macroglobulinemia Affect Younger Patients?

Introduction Waldenström's macroglobulinaemia (WM), an indolent IgM-secreting non-Hodgkin's B-cell lymphoplasmacytic lymphoma, has a reported average age of diagnosis of 65-70 years. and it is often regarded as a disease of the elderly. However, a significant proportion of patients are diagnosed at a younger age and data about this cohort is relatively limited, partly because of the low disease incidence. We seek to further elucidate the characteristics and impact of the disease in the younger patient cohort. Methods The WMUK Rory Morrison Registry (RMR) was searched for all patients younger than 60 years on day of diagnosis. Demographics, disease characteristics, treatment information and survival status were collected retrospectively. Results of patient reported outcome measures (PROMs) were collated. Results 269 patients from 16 UK centres were identified, with years of diagnosis between 1978 and 2018. Analysis focused on 235 patients who fulfilled diagnostic criteria for WM. Patient characteristics are shown in table 1. M:F ratio was 1.61:1 of which 158 patients were Caucasian, 17 Asian, 5 Black, 3 mixed and 6 of other ethnicity, 56 unrecorded. Bone marrow results were available in 156 patients from time of diagnosis, with a median infiltration of 40%. MYD88 L265P was found in 61/74 patients (82.4%) and CXCR4 mutation in 14/39 patients (35.9%). Median Hb was 114/L (range 33-170), platelet count 250x109/L (range 24-689), IgM 19 (range 0-65) and B2-microglobulin 2.7mcg/mL (range 0.5-56.3). The baseline IPSSWM scores were available for 115 patients. 9 patients were anti-MAG antibody positive and 11 had cryoglobulins. Treatment was received by 164 patients (69.8%). The median time from diagnosis to treatment was 2.5 months, range 0-312 months; 69 patients had one line, 32 two lines, 31 three lines, 12 four lines, and 20 five or more lines.14% received R-CHOP as first line therapy, 12.2% DRC,12.2% R-Bendamustine, 7.3% Rituximab monotherapy, 6.7% R-CVP and 6.7% chlorambucil. However, since 2010 DRC and R-Bendamustine were the most frequent. Following first line treatment, 14.7% achieved CR, 55.3% PR or VGPR, 11.9% MR and 14% had SD or PD. At some point in their disease course, high-grade transformation (HGT) was noted in 2 patients and CNS involvement in 10. 30 patients had undergone autologous and six patients allogenic transplantation. Complete, up to date survival information was available for 188 patients, of who 40 patients were deceased (median time from diagnosis 116 months, range 14-451 months). Unfortunately, cause of death was available for only 8 patients at time of analysis, including disease-related in 4, sepsis in 2, HGT in 1 and subdural haemorrhage in 1. One-, 5- and 10-year overall survival (OS) rates were 99.5%, 90% and 81.1%. There was a significant difference in OS according to IPSSWM risk (log rank, P &amp;lt;0.005), with a 5-year OS rate of 92.% for the low risk, 79% for the intermediate, and 38% for the high risk group. There was no significant difference in OS rates according to age group. Of 164 patients asked about their level of disease understanding on a scale of 0-10, the median rating was 0 (average rating 1.85). Only eight patients rated it as 10. Functional information was available for 62 patients, of who 42 (67.7%) had impairment in their ability to go for a walk outside, eight patients (12.9%) required assistance with self-care and one patient (1.6%) was fully dependent on others for personal care. 32 patients (51.6%) needed to spend some or most of their day in a bed or chair. 29 patients (47.8%) had suffered significant financial difficulties because of their diagnosis. Of 59 patients who responded about psychological wellbeing, 36 patients (61%) described feeling depressed. One patient described feeling 'very' depressed, 8 patients 'moderately' depressed and 27 patients 'slightly' depressed. Conclusion A significant proportion of patients with WM are diagnosed under the age of 60 years, and despite its limitations, this retrospective analysis of a large cohort of younger patients illustrates the evolving treatment landscape in the UK. To be expected, WM significant impacts on quality of life and psychological and financial wellbeing in a cohort who would expect to be in work. Encouragingly, OS rates are generally good, although a high IPSSWM risk carries a markedly lower 5-year OS rate also in the younger cohort. A more detailed analysis is underway to explore these issues further. Disclosures McCarthy: Janssen: Honoraria, Other: Educational grant to attend meetings . Pratt:Binding Site, Amgen, Takeda, Janssen, Gilead: Consultancy, Honoraria, Other: Travel support. D'Sa:Janssen: Honoraria, Research Funding.

Decrease in skeletal muscle index 1 year after radical cystectomy as a prognostic indicator in patients with urothelial bladder cancer.

ABSTRACTPurpose The present study aimed to determine whether sarcopenia after radical cystectomy (RC) could predict overall survival (OS) in patients with urothelial bladder cancer (UBC).Materials and Methods The lumbar skeletal muscle index (SMI) of 80 patients was measured before and 1 year after RC. The prognostic significance of sarcopenia and SMI decrease after RC were evaluated using Kaplan–Meier analysis and a multivariable Cox regression model.Results Of 80 patients, 26 (32.5%) experienced sarcopenia before RC, whereas 40 (50.0%) experienced sarcopenia after RC. The median SMI change was -2.2 cm2/m2. Patients with sarcopenia after RC had a higher pathological T stage and tumor grade than patients without sarcopenia. Furthermore, the overall mortality rate was significantly higher in patients with sarcopenia than in those without sarcopenia 1 year after RC. The median follow-up time was 46.2 months, during which 22 patients died. Kaplan-Meier estimates showed a significant difference in OS rates based on sarcopenia (P=0.012) and SMI decrease (P=0.025). Multivariable Cox regression analysis showed that SMI decrease (≥2.2 cm2/m2) was an independent predictor of OS (hazard ratio: 2.68, confidence interval: 1.007-7.719, P = 0.048).Conclusions The decrease in SMI after surgery might be a negative prognostic factor for OS in patients who underwent RC to treat UBC.

A retrospective multicenter study of sublingual gland carcinoma in Japan

ObjectiveSalivary gland carcinoma is rare among head and neck cancers. Sublingual gland carcinoma, a type of salivary gland carcinoma, is even rarer; therefore, the number of cases at a single institute is too small for sufficient evaluation of tumor characteristics. We conducted a multicenter, retrospective analysis of sublingual gland carcinomas in patients who visited 12 institutions associated with the Kyoto Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group. MethodsThirteen previously untreated patients who visited the institutions between 2006 and 2015 were enrolled. The overall survival (OS) and disease-free survival (DFS) rates for all patients and by disease stage were analyzed. Statistical analyses were performed for all patients with respect to disease stage. ResultsEight of thirteen patients were diagnosed with adenoid cystic carcinoma on pathological study. A significant difference in OS rate was observed between patients with Stage I–III and Stage IV disease; however, the difference in DFS rate by disease stage was not significant. ConclusionStage IV disease was identified as a poor prognostic factor in patients with sublingual gland carcinoma. However, even patients with Stage I–III disease experienced relatively short DFS. Distant metastasis is a serious problem among patients with sublingual gland carcinoma.

Evaluation of Hepatic Resection in Liver Metastasis of Gastric Cancer

Gastric cancer is the second most common malignancy globally and the third most common cause of cancer-related deaths in Japan. In gastric cancer, benefit of surgical resection of liver metastasis, which was shown in colorectal cancer, is not well established. The present study aimed to examine the feasibility of hepatic resection for liver metastasis of gastric cancer. In this retrospective study, we reviewed the medical records of 10 patients with liver-only metastases of gastric cancer who underwent hepatectomy among 2043 patients with gastric cancer who underwent gastric resection between January and December 2016 at a single institution in Japan. Median 1-, 3-, and 5-year overall survival (OS) rates were 78.0%, 33.3%, and 22.2%, respectively, among 10 patients who underwent hepatic resection. There was a significant difference in OS rates between tumors measuring ≥ 5 cm and < 5 cm (hazard ratio [HR] 6.524, 95% confidence interval [CI] 1.145–37.171, p = 0.035). The longest survival was 205 months for one patient who was alive at the time of the analysis. Hepatic resection of liver metastasis in gastric cancer was associated with long-term survival in some patients. Additionally, primary tumor size was associated with long-term survival.

Meta-analysis of segmentectomy versus wedge resection in stage IA non-small-cell lung cancer.

BackgroundAlthough limited resection was once considered the surgical treatment for patients with Phase IA non-small-cell lung cancer (NSCLC), there has been an ongoing controversial surgical indication for wedge resection and segmentectomy in recent years. The objective of this study was to compare overall survival (OS) and disease-free survival (DFS) of segmentectomy and wedge resection for early stage NSCLC, using a meta-analysis.MethodsSystematic research was conducted using four online databases to search for studies published before 2017. The DFS and OS for early stage NSCLC after segmentectomy and wedge resection were compared. The studies were selected according to rigorous predefined inclusion criteria, and meta-analyzed using the log (hazard ratio; ln[HR]) and its standard error (SE) calculations.ResultsIncluded in this meta-analysis were nine studies, published from 2006 to 2017, with a total of 7,272 patients. Survival outcome of segmentectomy was comparable to wedge resections for stage IA lung cancer because of OS (similar hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.83–1.05, P=0.26) and DFS (similar HR: 0.81, 95% CI: 0.60–1.09, P=0.17). Nevertheless, for stage IA NSCLC with tumor size ≤2 cm, segmentectomy was superior to wedge resection (combined HR: 0.82, 95% CI: 0.70–0.97, P=0.02). However, there were no significant differences in OS rates, 1.07 (95% CI: 0.78–1.46, P=0.68), between segmentectomy and wedge resection for IA NSCLC with a tumor size of ≤1 cm.ConclusionThis study concluded that segmentectomy could achieve better OS than wedge resection for stage IA NSCLC with a tumor size of ≤2 cm. However, surgeons could conduct segmentectomy and wedge resection for NSCLC ≤1 cm according to patient profile and the location of tumor. These results should be confirmed by further randomized clinical trials.

MP16-07 USEFULNESS OF INFLAMMATORY MARKER DYNAMICS ONE MONTH AFTER THE FIRST-LINE TARGETED THERAPY INITIATION FOR PFS PREDICTION IN PATIENTS WITH METASTATIC CLEAR CELL RENAL CELL CARCINOMA

MP16-07 USEFULNESS OF INFLAMMATORY MARKER DYNAMICS ONE MONTH AFTER THE FIRST-LINE TARGETED THERAPY INITIATION FOR PFS PREDICTION IN PATIENTS WITH METASTATIC CLEAR CELL RENAL CELL CARCINOMA

Extracapsular extension in prediction of the efficacy of postoperative radiotherapy in the treatment of stage IIIA—N2 non-small cell lung cancer

Objective To investigate the value of extracapsular extension (ECE) in prediction of the efficacy of postoperative radiotherapy (PORT) in the treatment of stage ⅢA—N2 non-small cell lung cancer (NSCLC). Methods From 2008 to 2009, 220 patients with stage ⅢA—N2 NSCLC who received surgical treatment were enrolled as subjects. All patients received postoperative chemotherapy and 43 out of them received PORT. Those patients were divided into ECE (+ ) group and ECE (-) group, which were further divided into subgroups according to whether PORT was applied or not. Progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and analyzed using log-rank test. Univariate and multivariate prognostic analyses were conducted using the log-rank test and the Cox model, respectively. Results The univariate analysis showed that the ECE (-) group had significantly improved PFS and OS rates than the ECE (+ ) group (P=0.000, 0.000). In the ECE (+ ) group, there were no significant differences in PFS or OS rate between the PORT subgroup and the non-PORT subgroup (P=0.584, 0.723). In the ECE (-) group, the PORT subgroup had a significantly improved PFS rate than the non-PORT subgroup (P=0.039), while there was no significant difference in OS rate between the two subgroups (P=0.125). The multivariate analysis indicated that ECE was an independent prognostic factor for PFS and OS rates in patients with stage ⅢA—N2 NSCLC (P=0.001, 0.020). Conclusions ECE is an independent prognostic factor for stage ⅢA—N2 NSCLC and promises to provide a basis for the use of PORT in the treatment of stage ⅢA—N2 NSCLC. Key words: Carcinoma, non-small cell lung/postoperative chemotherapy; Carcinoma, non-small cell lung/postoperative radiotherapy; Extracapsular extension; Prognostic factor

Retrospective study of treatment outcomes after postoperative chemoradiotherapy in Japanese oral squamous cell carcinoma patients with risk factors of recurrence

The purpose of this study was to investigate the feasibility of postoperative concomitant chemoradiotherapy (CRT) with cisplatin (CDDP), and compare the prognosis in 3 groups-without postoperative therapy (S-only), with radiotherapy (RT) alone (S+RT), and with CRT (S+CRT)-in oral squamous cell carcinoma (OSCC) patients at high risk of recurrence. Clinicopathologic data and treatment modality were investigated. Endpoints evaluated were locoregional control (LRC), relapse-free survival, overall survival (OS), and type of recurrence. The S+CRT group was associated with a better LRC rate than the S-only (P<.001) and S+RT groups (P=.044). However, there was no significant difference in OS rates between the S+RT and S+CRT groups. The addition of concomitant CDDP to postoperative RT improved LRC. However, there may be no benefit from the addition of concomitant CDDP to postoperative RT for improvement of distant metastasis and OS rates in OSCC patients.

Transarterial Chemoembolization versus Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma after Resection within Barcelona Clinic Liver Cancer Stage 0/A: A Retrospective Comparative Study

PurposeTo compare outcomes of transarterial chemoembolization with radiofrequency (RF) ablation in treatment of recurrent hepatocellular carcinoma (HCC) after resection within Barcelona Clinic Liver Cancer (BCLC) stage 0/A. Materials and MethodsFrom January 2007 to December 2011, 110 consecutive patients with recurrent HCC meeting BCLC stage 0/A criteria underwent transarterial chemoembolization (n = 78; mean tumor size, 1.9 cm ± 1.0) or RF ablation (n = 32; mean tumor size, 1.9 cm ± 0.6) as initial treatment. The primary outcome was overall survival (OS). Kaplan-Meier method was used to construct survival curves, which were compared by log-rank test. Prognostic factors for OS were analyzed using univariate and multivariate Cox proportional hazard models. ResultsNo significant differences between baseline clinical characteristics of the 2 treatment groups were identified. The 1-, 3-, and 5-year OS rates were 89.7%, 61.0%, and 36.6% for the transarterial chemoembolization group and 90.1%, 72.8%, and 60.0% for the RF ablation group. There was no significant difference in OS rates between the groups (P = .159). Subgroup analysis indicated that RF ablation achieved better survival than transarterial chemoembolization among patients ≤ 55 years old and patients with BCLC stage 0 (P = .036 and P = .045). Multivariate analysis revealed that serum albumin (≤ 35 g/L) (hazard ratio = 2.797; 95% confidence interval, 1.366–2.726; P = .005) and α-fetoprotein (> 400 ng/mL) (HR = 2.336; 95% CI, 1.210–4.508; P = .011) levels before treatment were 2 significant risk factors for poor prognosis. ConclusionsTransarterial chemoembolization might provide a similar OS as RF ablation in patients with recurrent BCLC stage A HCC. However, RF ablation could provide better OS in patients with recurrent BCLC stage 0 HCC.