Significant Prognostic Factors For Cancer-specific Survival Research Articles

Long-term oncological outcomes after radical prostatectomy in a non-university teaching hospital

The evaluation of oncological outcomes after radical prostatectomy (RP) is a major component of quality control in prostate cancer (PCa) centres. To evaluate the oncological outcomes after RP in a non-university teaching hospital and compare them with other high-volume PCa centres. This study included 1,161 patients after RP who were divided into two risk groups. Low-risk: localised PCa (pT2) and prostate-specific antigen (PSA)≤ 20 ng/ml, Gleason score (GS) 6-7b and pN0. High-risk: locally advanced PCa (≥pT3a) and/or PSA >20 ng/ml and/or GS≥ 8 and/or pN1. Risk groups and clinicopathological features were correlated to biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS) und overall survival (OS). The 10-year BCR-free survival, CSS und OS were 68.4%, 47.0% and 100% in the low-risk group and 87.4%, 89.0% and 73.9% in the high-risk group, respectively; the outcomes between risk groups were statistically significant (p<0.05). A multivariate Cox regression analysis was performed. GS was the most significant prognostic factor for CSS (p=0.00001) und BCR-free survival (p=0.00036). Nodal involvement (pN1) was strongly associated with CSS (p=0.00004). Age was the most important factor for overall survival in the high-risk group (p=0.0011). RP could be a curative treatment option for advanced PCa in selected cases. GS is the most important prognostic factor. Good oncological outcomes can also be achieved in non-university teaching hospitals.

Implications of Pretreatment Serum Carcinoembryonic Antigen Levels and Perineural Invasion with Staging, Prognosis, and Management in Stage I-III Colon Cancer after Surgery: A Retrospective Cohort Study in the SEER Database.

Pretreatment levels of serum carcinoembryonic antigen (CEA) and perineural invasion (PNI) are related to poor prognosis in colon cancer. We analyzed the CEA and PNI (defined as incorporation of carcinoembryonic antigen and perineural invasion (CP)-stage), which are included in the Tumor-Node-Metastasis (TNM) staging system of the American Joint Committee on Cancer (AJCC), and evaluated the survival prognosis of patients treated with surgery in I-III stage colon carcinoma. We employed a retrospective study for eligible colon carcinoma patients obtained from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Kaplan-Meier curve and Multivariate Cox regression analysis were used to analyze different TNM-CP stages for the cancer-specific survival (CSS) probabilities in colon cancer. In our study, CEA levels and PNI were significant prognostic factors (p < 0.05), and the newly proposed CP-stage was an independent prognostic index in stage I-III colon carcinoma after surgery. Multivariate Cox regression analyses indicated that CP1-stage was related to a 63.9% increased risk of cancer-specific mortality (hazard ratio (HR): 1.639, 95% confidence interval (CI): 1.544-1.739, p < 0.001), compared with CP0-stage in colon cancer. In respective TNM stages, the CP0-stage had an advantage over the CP1-stage for CSS (p < 0.001). Moreover, CP1-stage patients with node-negative colon cancer were contacted with similar or worse survival in comparison to CP0-stage patients with node-positive. For postoperative patients with stage I-III colon cancer, our study indicated that the CP stage is a significant prognostic factor for CSS, which deserves more clinical attention. It's worth noting that including the CP stage in the AJCC TNM staging system of colon carcinoma is beneficial to the survival prediction and clinical treatment.

Prognostic impacts of categorized postoperative complications in surgery for gastric cancer

BackgroundPostoperative complications generally aggravate postoperative prognosis and are correlated with both cancer-specific death and death from other causes. MethodsSubjects were 197 patients who underwent gastrectomy at Kyoto Chubu Medical Center. Cancer-specific survival (CSS) and non-CSS (NCSS) were compared between cases with and without complications. Major complications were classified into C-com and N-com groups based on their prognostic impact on CSS and NCSS, respectively. Uni- and multivariate analyses were conducted using clinicopathological factors. ResultsDuring the study period, 30 patients (15.2%) died from gastric cancer and 34 (17.3%) died from other causes. The incidence of postoperative complications was 16.8%. Sixteen patients with anastomosis leakage, pancreatic fistula, or organ/space surgical site infection had significantly poorer CSS, whereas 30 patients with pneumonia or passage obstruction had significantly poorer NCSS. These were defined as C-com and N-com cases, respectively. In the uni- and multivariate analyses, C-com was a significant prognostic factor for CSS (p = 0.002, p = 0.039) and N-com was a significant prognostic factor for NCSS (p < 0.0001, p = 0.004). C-reactive protein levels indicated intermediate and severe inflammation in N-com and C-com cases, respectively. ConclusionIn N-com cases, surgical stress caused disruption of essential organ function, whereas damage in C-com cases occurred mostly in the abdominal cavity but was a risk for cancer regrowth. Thus, different postoperative complications worsen patient prognosis after gastrectomy in different ways. To optimize surgical outcomes, improved selection of treatment strategies for different complication types may be important.

Prognostic Value of the Albumin-to-Globulin Ratio in Patients with Colorectal Cancer: A Meta-Analysis

Recently, the albumin-to-globulin ratio (AGR) has been investigated as a prognostic parameter in patients with colorectal cancer (CRC); however, the results remain inconsistent. We aimed to quantitatively identify the prognostic role of the AGR in CRC through meta-analysis. Combined hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to assess the prognostic value of the AGR for overall survival (OS), disease-free survival (DFS)/progression-free survival (PFS), and cancer-specific survival (CSS). The association between the AGR and clinicopathological factors was investigated using pooled odds ratios (ORs) and 95% CIs. Eleven studies, comprising 8,397 patients, were included in this meta-analysis. Our results demonstrated that a low AGR was significantly associated with poor OS (HR, 2.58; 95% CI, 1.90–3.51; p < 0.001) and poor DFS/PFS (HR, 2.11; 95% CI, 1.46–3.05; p < 0.001) in CRC. However, the AGR was not a significant prognostic factor for CSS (HR, 1.008; 95% CI, 0.372–2.730; p = 0.988). In addition, a low AGR was associated with patients aged ≥60 years (OR, 1.71; 95% CI, 1.54–1.89; p < 0.001). A low AGR was significantly associated with worse OS and inferior DFS/PFS in patients with CRC. Thus, AGR can be used as a cost-effective and reliable prognostic marker for CRC in clinical practice.

Impact of the neutrophil-to-lymphocyte ratio as a surgical prognostic factor in renal cell carcinoma with inferior-vena-cava tumor thrombus

BackgroundThe aim of this study is to evaluate the efficacy of radical nephrectomy with thrombectomy and to identify the prognostic factors for patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT). The role of the neutrophil-to-lymphocyte ratio (NLR), which has been reported to be a useful prognostic predictor for various solid cancers, was also investigated. MethodsFifty-five patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy in our hospital were retrospectively analyzed. The relationship between clinical characteristics and surgical outcome was examined using the Kaplan–Meier method. Univariate and multivariate analyses were carried out to determine the prognostic factors. ResultsThe median follow-up time after surgery was 44.2 months. Twenty-seven patients died of RCC, and 4 died of other disease at last follow-up. There were no patients with postoperative pulmonary embolism (PE) or deaths from PE. The median cancer-specific survival (CSS) and overall survival (OS) were 81.0 (95% confidence interval [CI]: 42.0–103.2) and 69.0 (95% CI: 34.3–81.5) months, respectively. Significant prognostic factors for CSS were distant metastasis (p = 0.045) and NLR ≥ 2.9 (p = 0.009). The only independent predictor for OS was the NLR ≥ 2.9 (p = 0.034). ConclusionsA high preoperative NLR level was an independent poor prognostic factor influencing CSS and OS of patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy. The NLR may be an available biomarker that helps with preoperative risk stratification.

Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer.

BackgroundTo explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC).MethodsPatients with LARC who underwent radical surgery after NCRT between Ja 22nuary 2012 and March 2019 were studied. Body composition parameters, including skeletal muscle area (SMA), muscle density (MD), visceral fat area (VFA), total abdominal fat area (TAFA), and subcutaneous fat area (SFA), was identified at the third lumbar vertebra level on computed tomography (CT). The patients were divided into two groups based on the sex-specific quartile values of SMA, MD, VFA, TAFA, SFA, and body composition change. Patient characteristics, short- and long-term postoperative complications, survival, and tumor response were analyzed.ResultsA total of 122 eligible patients were enrolled. Body composition parameters, except MD, were strongly correlated with BMI (p < 0.001). Pre-NCRT low MD (p = 0.04) and TAFA loss (p = 0.02) were significantly correlated with short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for both disease-free survival (DFS) (HR 2.611, 95% CI 1.129–6.040, p = 0.025) and cancer-specific survival (CSS) (HR 3.124, 95% CI 1.030–9.472, p = 0.044) in the Cox regression multivariate analysis. Multivariate logistic regression analysis identified post-NCRT SFA (OR 3.425, 95% CI 1.392–8.427, p = 0.007) and SFA loss (OR 3.358, 95% CI 1.214–9.289, p = 0.02) as independent risk factors for tumor regression grade (TRG) and downstaging, respectively.ConclusionPre-NCRT low MD and TAFA loss were related to a high incidence of short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for CSS and DFS. Post-NCRT SFA and SFA loss were independent risk factors for TRG and downstaging, respectively.

FAN score comprising fibrosis-4 index, albumin\u2013bilirubin score and neutrophil\u2013lymphocyte ratio is a prognostic marker of urothelial carcinoma patients treated with pembrolizumab

It is important to identify prognostic and predictive markers of metastatic urothelial carcinoma (mUC) treated with immunocheckpoint inhibitors. We sought to establish a prognostic marker for patients with mUC treated with pembrolizumab based on only blood test results. We included 165 patients with mUC in the discovery cohort and 103 with mUC who were treated with pembrolizumab in the validation cohort. Multivariate and Cox regression analyses were used to analyse the data. In the discovery cohort, the fibrosis-4 index (hazard ratio [HR]: 2.13, 95% confidence interval [CI] 1.20–3.76, p = 0.010), albumin–bilirubin score (HR 1.91, 95% CI 1.27–2.88, p = 0.002), and neutrophil–lymphocyte ratio (HR: 1.84, 95% CI 1.22–2.79, p = 0.004) were independent significant prognostic factors. We established a ‘FAN score’ that included these three aforementioned items, which were assigned one point each. We divided patients into the 0–1 point (n = 116) and 2–3 points (n = 49) groups. The FAN score was a significant prognostic marker for cancer-specific survival (CSS) (HR 1.48, 95% CI 1.19–1.83, p < 0.001) along with the Eastern Cooperative Oncology Group Performance Status. The FAN score was also a prognostic factor of progression-free survival (PFS) (HR: 1.25, 95% CI 1.01–1.54, p = 0.036) along with the presence of liver metastasis. In the validation cohort, the FAN score was a significant prognostic factor for CSS (HR: 1.48, 95% CI 1.19–1.85, p = 0.001) and PFS (HR: 1.29, 95% CI 1.02–1.62, p = 0.034). We established the FAN score as a prognostic marker for patients with mUC treated with pembrolizumab.

Clinical Significance of Pre-to-Postoperative Dynamics of Aspartate Transaminase/Alanine Transaminase Ratio in Predicting the Prognosis of Renal Cell Carcinoma after Surgical Treatment.

Background This study is aimed at examining the prognostic role of pre-to-postoperative dynamics of De Ritis ratio (aspartate aminotransaminase (AST)/alanine aminotransaminase (ALT)) in patients with nonmetastatic renal cell carcinoma (RCC) following radical nephrectomy. Methods We retrospectively reviewed the records of 670 patients who underwent radical nephrectomy for nonmetastatic RCC between 1996 and 2012 at our institution. The cutoff points for preoperative (=1.0) and postoperative AST/ALT ratios (=1.12) were assigned based on the median values. We categorized patients into four groups according to the dynamics of AST/ALT ratios: group 1 (lower (≤1.0) ⟶ lower (≤1.12)), group 2 (lower (≤1.0) ⟶ higher (>1.12)), group 3 (higher (>1.0) ⟶ lower (≤1.12)), and group 4 (higher (>1.0) → higher (>1.12)). Results When grouped by a preoperative AST/ALT ratio alone, the groups were not statistically different in cancer-specific survival (CSS) or overall survival (OS). In contrast, in Kaplan-Meier analysis, CSS (P = 0.0296) and OS (P = 0.0324) were both significantly shorter with an increased postoperative AST/ALT ratio. According to the pre-to-postoperative dynamics of the AST/ALT ratio, group 2 (lower (≤1.0) ⟶ higher (>1.12)) had a significantly lower CSS (P = 0.0028) and OS (P = 0.0194) than the other groups. On multivariate Cox regression analysis, the pre-to-postoperative dynamics of the AST/ALT ratio were a significant prognostic factor for CSS (hazard ratio, HR = 3.45) and OS (HR = 2.18). Conclusion This study is the first to suggest that the dynamics of the pre-to-postoperative De Ritis ratio represent an independent prognostic factor for RCC patients following nephrectomy.

Abstract A05: Nomograms based on the SEER database for predicting the prognosis of pulmonary large-cell neuroendocrine carcinoma: A population-based STROBE cohort study

Abstract Background: This work aimed at the development and validation of nomograms for predicting patient survival cancer-specific survival (CSS) and overall survival (OS) in the context of pulmonary large-cell neuroendocrine carcinoma (LCNEC). Material and Methods: Based on the SEER database, patients were selected who received diagnosis between the period 2004 and 2014, through the Surveillance, Epidemiology, and End Results (SEER) database. Variables were subjected to univariate and multivariate studies, performed through Cox’s Proportional Hazards Regression model. The 3- and 5-year CSS and OS were predicted based on a nomogram constructed from prognostic factors that were independent. The accuracy of the nomogram was evaluated using discrimination and calibration plots. Results: From 1,837 eligible patients based on the SEER database, assignment of 1,276 patients was done to the training set, while that of 561 patients was done to the validation set. Multivariate analyses revealed that age, laterality, tumor size, N stage, M stage, surgery, and chemotherapy were significant prognostic factors for CSS, while those of OS were age, laterality, tumor size, surgery, N and M stages, chemotherapy, and radiation. The concordance index (C-index) for CSS was 0.781 (95% CI: 0.766-0.796) and 0.754 (95% CI: 0.730-0.778) for the internal and external validations, respectively. The values for OS were 0.791 (95%CI: 0.776-0.806) and 0.775 (95% CI: 0.751-0.799), respectively. For the training and the validation sets, discrimination in terms of prediction of OS and CSS was better in the nomograms against the SEER summary stage as well as AJCC TNM staging systems (6th edition) (P&amp;lt;0.001). The CSS and OS predicted by the nomograms closely corresponded to actual observation as shown by calibration plots. Conclusion: Prediction of the 3- and 5-year CSS and OS of patients with pulmonary LCNEC by nomograms with higher accuracy than existing staging models was demonstrated. Note: This abstract was not presented at the conference. Citation Format: Hong-fen Wu. Nomograms based on the SEER database for predicting the prognosis of pulmonary large-cell neuroendocrine carcinoma: A population-based STROBE cohort study [abstract]. In: Proceedings of the AACR Special Conference on the Evolving Landscape of Cancer Modeling; 2020 Mar 2-5; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2020;80(11 Suppl):Abstract nr A05.

The effect of renal function change on renal cell carcinoma patients with tumor thrombus after nephrectomy and thrombectomy: a large Chinese center experience

BackgroundTo explore the influencing factors of perioperative renal function change and their relationship with prognosis on renal cell carcinoma (RCC) patients with tumor thrombus after nephrectomy and thrombectomy.MethodsThe clinical and pathological data of 135 patients with RCC and tumor thrombus, who underwent nephrectomy and thrombectomy at Peking University Third Hospital from May 2015 to July 2018, was retrospectively analyzed. Absolute change in estimated glomerular filtration rate (eGFR) (ACE) and percent change in eGFR (PCE) were calculated by preoperative and postoperative renal function. Linear regression analysis was used to explore the influencing factors of ACE and PCE, and logistic regression analysis was used to explore the influencing factors of worse postoperative renal function [eGFR≤60 mL/(min × 1.73 m^2)]. Cancer-specific survival (CSS) was estimated by Kaplan-Meier method and multivariate Cox regression, which were used to explore the effect of ACE and PCE on prognosis.ResultsOf all the 135 patients, 101 patients (74.8%) were male and 34 patients (25.2%) were female. The mean preoperative eGFR was 73.9 ± 21.8 mL/(min × 1.73 m^2) and postoperative eGFR was 69.5 ± 25.2 mL/(min × 1.73 m^2). In multivariate linear regression analysis, preoperative eGFR (P < 0.001) and pathological type (P = 0.038) were significant predictive factors of ACE. In aspect of PCE, preoperative eGFR (P < 0.001) and pathological type (P = 0.002) were significant predictors. In multivariate logistic regression analysis, preoperative eGFR (P = 0.016) was the only risk factor of predicting worse postoperative renal function. During follow-up, 22 patients (16.3%) were dead due to RCC. According to ROC analysis, the cut off value of ACE and PCE was 13.9 and 0.16, respectively. ACE> 13.9 and PCE > 0.16 indicated worse CSS (P = 0.006 and P = 0.047, respectively). However, in multivariate Cox regression analysis of several related factors, perinephric tissues invasion (P = 0.001), sarcomatoid differentiation (P = 0.001) and ACE> 13.9 (P = 0.002) were significant prognostic factors for CSS. PCE > 0.16 seemed to be not (P = 0.055).ConclusionWe explored several clinicopathological risk factors of predicting renal function change and their relationship with prognosis of RCC patients with tumor thrombus after nephrectomy and thrombectomy. The renal function change, which was associated with preoperative eGFR and pathological type, was prognostic risk factor for CSS and ACE> 13.9 indicated the worse prognosis.

Survival prediction models for patients with anal carcinoma receiving definitive chemoradiation: A population-based study.

The present study aimed to develop two nomograms in order to predict cancer-specific survival (CSS) and overall survival (OS) of patients with anal carcinoma receiving definitive chemoradiotherapy. Data from studies including patients with anal carcinoma, who were determined to be positive histologically and diagnosed between 2004 and 2010, were obtained from the Surveillance, Epidemiology, and End Results database. Significant prognostic factors for CSS and OS of patients were screened to develop nomograms through univariate and multivariate analyses. Nomograms were validated using internal and external data. The predictive abilities of the generated models were evaluated by concordance index (C-index) and calibration curves. Risk stratification was performed for patients with the same TNM stage. A total of 1,473 patients and six independent prognostic factors for CSS and OS, namely age, sex, ethnicity, marital status at diagnosis, T stage and N stage, were included in the nomogram calculations. Calibration curves demonstrated that nomogram prediction was in high accordance with actual observation. The C-indices of nomograms were greater than those of models based on the sixth edition of the American Joint Committee on Cancer TNM staging system for CSS prediction (training cohort, 0.72 vs. 0.70; validation cohort, 0.68 vs. 0.62) and OS (training cohort, 0.70 vs. 0.66; validation cohort, 0.68 vs. 0.62). Survival curves demonstrated significant survival differences among the different risk groups. Nomograms were more accurate than the conventional TNM staging system in prognosis prediction. In addition, survival performances of patients with the same TNM stage could be further distinguished by risk stratification, which provided individualized prediction for patients. These survival prediction methods may aid clinicians in patient counseling and in selecting more individualized therapeutic strategies.

Preoperative Evaluation Of Serum CA-125 Levels Maybe A More Significantly Prognostic Factor In Low To Intermediate-risk Endometrial Carcinoma: A Multi-institutional Study

To evaluate the prognostic role of preoperative serum CA-125 levels in different ESMO-ESGO-ESTRO risk classification in early-stage endometrial carcinoma (EC) from long-term data of a multi-institutional analysis. The material for the current study was derived from a total of 1108 patients with early-stage EC from a multi-institutional analysis in China between 2000 and 2016. The eligibility criteria included the primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy, stage I and II disease (FIGO 2009 staging) with complete clinicopathologic and follow-up information, serum CA-125 levels were evaluated preoperatively. Risk classification according to ESMO-ESGO-ESTRO Consensus. Time to any event was measured from the day RT started. Overall survival (OS), cancer-specific survival (CSS), disease free survival (DFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were calculated using the Kaplan–Meier method, Cox proportional hazards regression model was used for multivariate analysis. The cut-off values of CA-125 were obtained using receiver operating characteristic curves (ROC). Statistical analyses were performed with statistical analysis software. A total of 447 patients were enrolled. The median follow-up time was 49 months. The median age was 56 years. Stage Ia/b disease represented 90.6% of the cohort, low to intermediate-risk group62.9%. Patients mainly received VBT alone (65.8%, n = 294). The 5-year OS, DFS, CSS, LRFS, and DMFS rates for all patients were 95.2%, 89.5%, 97.1%, 92.8%, and 90.7% respectively. Subgroup analysis revealed that age>60, preoperative serum CA-125>35U/ml, and grade were found to be significant prognostic factors for CSS in low to intermediate-risk group(p = 0.032, 0.002, and 0.031). The best cut-off values for preoperative serum CA-125 of low to intermediate-risk and high-intermediate to high-risk diseases were 20.35U/mL (AUC = 0.825, p = 0.013) and 17.21 U/mL(AUC = 0.681, p = 0.042), respectively. Preoperative serum CA-125 had no significant prognostic effect on OS and DFS. Preoperative evaluation of serum CA-125 level maybe a more significantly prognostic factor for CSS in low to intermediate-risk EC than high-intermediate to high-risk diseases, but it may not be useful for predicting OS and DFS.

Role of free testosterone levels in patients with metastatic castration-resistant prostate cancer receiving second-line therapy.

A range of new treatment options has recently become available for patients with advanced metastatic castration-resistant prostate cancer (mCRPC). Androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone is continued when performing chemotherapy or androgen deprivation with new second-generation therapeutic agents such as enzalutamide or abiraterone acetate. Despite the fact that free testosterone (FT) is the biologically active form, it is common practice that androgen suppression is monitored via total testosterone levels only. The aim of the present study was to evaluate the role of FT as a prognostic biomarker for cancer-specific survival (CSS) and its feasibility as an ADT monitoring biomarker in patients with mCRPC for the first time. The requirement for continued ADT in mCRPC patients is discussed within the basis of the current literature. A total of 34 patients with continuous measurements of FT levels and mCRPC status underwent therapy with docetaxel, abiraterone acetate, enzalutamide, cabozantinib, carboplatin or cabazitaxel. Data were obtained from the Departments of Urology and Urological Oncology, Hannover Medical School (Hannover, Germany) between March 2009 and April 2014. A cutoff point of 0.5 pg/ml was used to discriminate between patients according to FT levels. Statistical evaluation of CSS was performed by applying Kaplan Meier survival estimates, multivariate Cox regression analyses and log-rank tests. The median age of all 34 patients was 72 years (range, 51–86 years). The mean follow-up interval was 16.1 months (range, 0.7–55.6 months). Despite the fact that all patients were undergoing androgen deprivation, the mean serum FT levels for each patient varied; the mean FT concentration in the cohort was 0.328 pg/ml, ranging from 0.01–9.1 pg/ml. A notable difference with regard to CSS was observed for patients with regard to serum FT concentration; CSS was significantly longer for patients with a serum FT level below the cutoff level (43.6 vs. 17.3 months, respectively, P=0.0063). Upon multivariate Cox regression analysis, the mean FT concentration during treatment remained a significant prognostic factor for CSS (hazard ratio, 1.22; 95% confidence interval, 1.03–1.43; P=0.0182). In conclusion, in patients with mCRPC, the serum FT level is a strong predictor of CSS in patients under therapy with second-line anti-hormonal therapeutic medication and chemotherapy. It may be concluded that FT levels should be included into the routine control of androgen suppression while under treatment with ADT and second-generation hormonal therapy.

Ureteral Involvement Is Associated with Poor Prognosis in Upper Urinary Tract Urothelial Carcinoma Patients Treated by Nephroureterectomy: A Multicenter Database Study

BackgroundThe prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis. ObjectiveTo investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU). Design, setting, and participantsIn this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17–77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both–regional (having both renal pelvic and ureteral tumors). The ureteral and both–regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact. InterventionAll patients underwent RNU. Outcome measurements and statistical analysisThe prognostic impact of tumor location on survival was analyzed. Results and limitationsThe renal pelvic, ureteral, and both–regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both–regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both–regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both–regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p=0.006) and PFS (HR: 1.35; p=0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design. ConclusionsThe presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis. Patient summaryWe demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy.

Prognostic value of lymph node density in high-grade salivary gland cancers.

To investigate the role of lymph node density (LND) as an independent prognostic factor in high-grade salivary gland cancers. All 87 patients with high-grade salivary gland cancers underwent curative surgery combined with neck dissection and most of them received postoperative radiotherapy or chemoradiotherapy. LND was calculated as the ratio of positive lymph nodes to total lymph nodes harvested. Clinicopathologic variables associated with cancer-specific survival (CSS) and overall survival (OS) were identified by univariate and multivariate analyses using the Cox-proportional hazards model. Salivary duct carcinoma was the most common tumor (54%), followed by carcinoma ex pleomorphic adenoma (22%), and others. The 5-year CSS and OS were 50.9% and 49.6%, respectively, during a median follow-up of 61 months. In univariate analysis, tumor site, pathologic nodal stage, overall tumor-node-metastasis (TNM) stage, primary tumor size > 3 cm, lymphovascular invasion, perineural invasion, extranodal extension, number of metastatic lymph nodes, and LND > 4.0 were significant prognostic factors for CSS and OS (P < 0.05 each). Tumor site, perineural invasion, and LND were independent prognostic factors for both CSS and OS in multivariate analysis (P < 0.01). Our findings support the prognostic value of LND for high-grade salivary gland cancers.

Prognostic significance of lymphovascular invasion in upper urinary tract urothelial carcinoma is influenced by tumor location.

To examine the prognostic value of lymphovascular invasion (LVI) in different tumor locations (i.e., renal pelvis and ureter) of upper urinary tract urothelial carcinoma (UTUC). Data from a total of 250 patients with nonmetastatic UTUC who received radical nephroureterectomy between 2004 and 2010 at our institution were analyzed retrospectively. The significance of LVI and other relevant factors on cancer-specific survival (CSS), metastasis-free survival (MFS), and intraluminal recurrence-free survival (IRFS) were evaluated. Lymphovascular invasion was present in 60 patients (24 %) and was related to advanced pathological T stage (P < 0.001), higher tumor grade (P < 0.001), lymph node metastasis (P = 0.005), and pyelocaliceal tumor location (P = 0.002). By Kaplan-Meier analysis, LVI was found to be significantly correlated with worse CSS and MFS but not with IRFS. Multivariate analysis showed that high pathological T stage and regional lymph node involvement were significant prognostic factors for CSS and MFS, and LVI was an independent predictor for MFS (hazard ratio 1.71, 95 % confidence interval 1.00-2.93, P = 0.049). In patients with ureteral tumors, LVI represented the only significant prognosticator for both CSS and MFS in multivariate analysis. The prognostic value of LVI was not observed in pyelocaliceal tumors. The implication of LVI on prognosis, particularly in ureteral tumors but not in pyelocaliceal tumors, may imply diverse disease characteristics between different tumor locations among UTUC. LVI is essential to identify patients at high risk for metastasis/mortality and can facilitate treatment planning and surveillance strategies, especially in patients with ureteral tumors.

Expression of p53, p21 and cyclin D1 in penile cancer: p53 predicts poor prognosis

AimsTo evaluate the role of p53, p21 and cyclin D1 expression in patients with penile cancer (PC).MethodsParaffin-embedded tissues from PC specimens from six pathology departments were subjected to a central...

Role of radiotherapy in early glottic carcinoma

Early glottic carcinoma has a high local control prospect with radiotherapy. This review evaluates a single center's experience. All patients from 1967 to 2006 diagnosed with Tis/T1/T2/N0 early glottic carcinoma treated definitively with radiotherapy at Prince of Wales Hospital were reviewed. Local control and cancer-specific survival (CSS) rates were primary endpoints, and the impact of various factors on these outcomes was statistically analyzed. This review of 522 patients includes 24 with Tis, 356 with T1, and 142 with T2. Ultimate local control rates were as follows: Tis 87.5%, T1 94.7%, and T2 84.5%. Multivariate analysis found fitness for surgery, no involvement of anterior commissure, normal cord movement, and radiotherapy dose >60 Gy significant for local control. Fitness for surgery, no involvement of the anterior commissure, normal cord movement, and no ventricular involvement were significant prognostic factors for CSS. Definitive radiotherapy for early glottic carcinoma provides high local control rates, with the option of surgical salvage to achieve ultimate local control.