Survival Outcomes In Cancer Patients Research Articles

Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside.

Mucositis is one of the most common debilitating side effects related to chemotherapy (CT), radiation therapy (RT), targeted agents and immunotherapy. It is a complex process potentially involving any portion of the gastrointestinal tract and injuring the mucosa, leading to inflammatory or ulcerative lesions. Mechanisms and clinical presentation can differ according both to the anatomic site involved (oral or gastrointestinal) and the treatment received. Understanding the pathophysiology and management of mucosal injury as a secondary effect of anti-cancer treatment is an important area of clinical research. Prophylaxis, early diagnosis, and adequate management of complications are essential to increase therapeutic success and, thus, improve the survival outcomes of cancer patients. This review focuses on the pathobiology and management guidelines for mucositis, a secondary effect of old and new anti-cancer treatments, highlighting recent advances in prevention and discussing future research options.

The prognostic value of patient-reported outcomes (PROs) for survival outcomes in cancer patients: A systematic review.

e18223 Background: Several studies have indicated that PROs may independently predict survival outcomes across various cancer populations. We aimed to synthesize current evidence in this research area and to investigate methodological quality of these studies. Methods: We conducted a systematic review of published studies (from January 2016 to December 2017) in oncology, which included at least one PRO domain in a multivariable prognostic model for survival outcomes. We used absolute and relative frequencies to assess the main characteristics of the studies, including tumor site, type of PRO questionnaire, type of PROs assessed (e.g., symptoms or functional scales) and their statistical significance for survival outcomes. As such studies pose important statistical challenges, we also investigated methodological issues based on a comprehensive set of predefined criteria. Results: Out of 385 candidate articles, 65 studies met eligibility criteria. Out of these, n = 56 (86%) reported at least one PRO as a statistically significant prognostic factor in a multivariable prognostic model and thirty-two studies (49%) were done with patients with metastatic/advanced cancer. Overall, the most used instrument to assess PROs was the EORTC QLQ-C30 questionnaire (n = 29, 45%) and the most frequent tumors were lung (n = 18, 28%), esophagogastric (EG) and gynaecological (GY) cancer (each n = 11, 17%). Among these, statistically significant prognostic PRO scales from the EORTC-QLQC30 included fatigue, pain and appetite loss for lung; nausea/vomiting, pain, dyspnea, appetite loss and constipation for EG and physical and role functioning for GY. With respect to methodological quality, we found important drawbacks. For example, only 24% assessed multicollinearity among PRO scales and only 29% assessed performance of the prognostic multivariable model (e.g., evaluating discrimination and calibration). Conclusions: In recent years, a remarkable number of studies has found that PROs provide prognostic information beyond well-established clinical and socio-demographic factors. However, some key methodological limitations have been found, which deserve special attention in future studies.

A conundrum in cancer quality measurement: Performance on long-term survival reflects performance a long time ago.

e18222 Background: Long term outcomes, such as five-year survival following cancer treatment, are widely accepted as important metrics of cancer care quality. But because they take years to accrue, they reflect the quality of care delivered in the past. The objective of this study was to delineate to what extent measures of long term outcomes related to cancer care could be reliably used to predict care quality in future periods. Methods: Taking advantage of FFS Medicare data from related studies, we assessed survival of cancer patients at one and four years by hospital for four separate index years 2006, 2011-2013. We assembled pairs of years across which we could compare risk adjusted outcomes separated by one year (2011 to 2012; 2012 to 2013), two years (2011 to 2013), and five through seven years comparing 2006 to 2011, 2012, or 2013 respectively. The outcome was risk adjusted mortality rates at the hospital level determined by dividing the observed number of deaths by an expected number, adjusting for age, and median income level of the zip code of residence. For each hospital and for every pair of analytic years we separately compared the correlation of one and four-year risk adjusted mortality using both Pearson and Spearman correlation statistics. A mixed effects model was fit to determine if size and year gap between measurements could explain possible differences in the correlation of hospital performance, while controlling for hospitals as a random effect. Results: There were 1,640 hospitals and more than 350,000 patients in each analysis year. Focusing on the correlation of the four year survival outcomes, the highest volume hospitals have significantly higher correlations compared to the other hospital categories (P < 0.001). The greater the elapsed time between measurement periods the lower the correlation. But in the mixed model analysis neither time elapsed between measurement periods (p = 0.51) nor the interaction between time elapsed and hospital volume (p = 0.95) were significant. Analyses of one-year outcomes produced similar findings. Conclusions: Performance on four-year survival outcomes of cancer patients was reasonably correlated for large volume hospitals, but less so for hospitals with lower volumes.

Metabolic syndrome and upper tract urothelial carcinoma: A retrospective analysis from a large Chinese cohort.

452 Background: Metabolic syndrome (MetS) has been reported to be associated with poor survival outcomes in cancer patients. However, the role of MetS in upper tract urothelial carcinoma (UTUC) has yet to be explored. We aim to investigate the prognostic value of MetS in UTUC after radical nephroureterectomy (RNU). Methods: A total of 644 patients with UTUC after RNU were identified at West China Hospital from May 2003 to December 2016. MetS was defined as the co-existence of three or more of five components (obesity, hypertension, elevated fasting glucose, decreased high-density lipoprotein-cholesterol and hypertriglyceridemia). Logistic and Cox regression analyses was performed to evaluate the associations of MetS with pathological features and survival outcomes. Decision curve analysis was performed to determine the clinical utility of the prediction models. Results: Of 644 patients, 157 (24.4%) had MetS. Over a median follow-up of 39 months, 269 (41.8%) experienced disease recurrence, 233 (36.2%) died and 185 (28.7%) died of UTUC. MetS was independently associated with high-grade disease (odds ratio [OR]: 2.01, P = 0.005), advanced pT stage (≥ pT3, OR: 1.54, P = 0.027) and lymphovascular invasion (OR: 1.71, P = 0.03). Multivariate Cox regression analysis showed that MetS was an independent factor for decreased cancer-specific survival (CSS, HR: 1.38, 95% CI: 1.01-1.89, P = 0.042) but not for RFS (HR: 1.27, 95% CI: 0.97-1.67, P = 0.078) and OS (HR: 1.24, 95% CI: 0.95-1.62, P = 0.121). The estimated c-index of the multivariate models for CSS was 0.763 compared with 0.769 when MetS added. Conclusions: MetS is a negative prognostic factor in UTUC. Further studies of MetS in UTUC are demanded.

The role of celecoxib for colorectal cancer treatment: a systematic review

Background: Some evidence has suggested that the Cox-2 inhibitor, celecoxib, might improve the survival outcomes in cancer patients. However, the association between celecoxib use and treatment response in colorectal cancer (CRC) patients remains controversial. Thus, a summary on current evidence was performed. Methods: We conducted an electronic search using (PubMed, Web of Science, Embase, and CNKI) to identify relevant peer-reviewed articles, up to March 2018. Eligible study designs included randomized controlled trials (RCTs) and uncontrolled trials (UCTs) with the single experimental arm. The included trials evaluated the effect of adding celecoxib to conventional treatments for patients with CRC on overall response rate (ORR), disease control rate (DCR), pathological response, survival indices, and toxicities. Results: The final analysis included 12 trials with a total of 621 patients. In this study, a qualitative summary and meta-analysis was performed due to insufficient RCTs. The addition of celecoxib showed improvement of pathological response but had no effects on ORR (RR =1.09; 95% CI, 0.62–1.92; P=0.76) and DCR (RR =1.09; 95% CI, 0.94–1.27; P=0.25). The impact of celecoxib on survival indices remains unclear. Meta-analysis on toxicities suggests that celecoxib is well tolerated with a decreased risk of oral mucositis (RR =0.35; 95% CI, 0.18–0.67; P=0.002). Conclusions: Results showed the potential benefits of celecoxib in the treatment of resectable CRC compared with chemotherapy or chemoradiotherapy alone, but there were no effects on ORR/DCR or survival indices. The safety profile was identified in the meta-analysis among CRC patients. The benefit versus harm needs to be carefully considered when celecoxib is recommended in patients with a history of cardiac diseases. In this review, part of the evidence was evaluated from non-RCTs, so further well-designed RCTs in this field are urgently required to confirm our finding.

New pre-treatment eosinophil-related ratios as prognostic biomarkers for survival outcomes in endometrial cancer

BackgroundSystemic inflammation has long been related with adverse survival outcomes in cancer patients, and its biomarkers, such as the Neutrophil-to-Lymphocyte Ratio (NLR), are recognized as poor prognostic indicators. However, the role of eosinophils in this field has been largely overlooked. Here, we describe two new pre-treatment biomarkers, expressed as Eosinophil-to-Lymphocytes Ratio (ELR) and Eosinophil*Neutrophil-to-Lymphocytes ratio (ENLR), and we analyse their impact on prognosis of endometrial cancer (EC) patients.MethodsA total of 163 consecutive patients diagnosed with EC and treated with postoperative radiotherapy +/− chemotherapy in our institution from January 2011 to December 2015 were evaluated. The cohort was divided in two groups applying the cut-off value of 0.1 and 0.5 according to ROC curve for pre-treatment ELR and ENLR, respectively. After patients’ stratification according to the ESMO-ESGO-ESTRO modified risk assessment, subgroup analyses were conducted.ResultsHigher values of ELR and ENLR were associated with worse OS (p = 0.004 and p = 0.010, respectively). On univariate analysis, the factors associated with shorter OS were ELR ≥ 0.1 (HR = 2.9, p = 0.017), ENLR ≥ 0.5 (HR = 3.0, p = 0.015), advanced FIGO stage (HR = 3.4, p = 0.007), endometrioid histology (HR = 0.26, p = 0.003) and ESMO-ESGO-ESTRO high-risk (HR = 10.2, p = 0.023). On multivariate Cox regression, higher ELR and ENLR were independently associated with a worse outcome adjusted for the standardly applied prognostic factors.ConclusionsIncreased values of ELR and ENLR portend worse OS in EC, especially in patients classified by the ESMO-ESGO-ESTRO guidelines as a high-risk group. To our best knowledge, this is the first report describing eosinophils-related ratios as prognostic biomarkers in malignant tumours.

P3.01-11 Depression and Inflammation in Patients with EGFR-Mutated Non-Small Cell Lung Cancer

Although depression appears to be associated with worse survival outcomes in cancer patients, the underlying mechanisms and basis of this association remain unknown. EGFR mutations have been associated with improved treatment response and prognosis in advanced non-small lung cancer (NSCLC). However, previous reports have described a positive association between this genotype and depression. This relationship could be at least partially explained by TNFa-mediated inflammation, which activates the hypothalamus-pituitary-adrenocortical (HPA) axis, leading to tryptophan depletion through the stimulation of indoleamine 2,3 dioxygenase. 32 patients diagnosed with metastatic NSCLC with an EGFR mutation were enrolled and followed monthly. In all cases patients were evaluated using the Self-rating depression scale (SDS) and the Numeric Rating Scale (NRS) in order to obtain a detailed evaluation of the initial symptoms and a qualitative assessment of the state of depression. In parallel we measured TNFa levels in serum/plasma (MaxDiscovery™ Human TNF-α ELISA Test Kit) upon receipt of genotype report, 4 and 12 weeks after initiating the targeted therapy, and at the time of progression. We examined differences between patients with and without depression with respect to the TNFa, as well as impact on various outcomes. Mean age was 58.9 years (+/- 12.4), 22 (68.8%) were women and 94% had an ECOG <2. Nineteen patients (59.4%) carried a del19, 8 (25%) had L858R, 2 (6.3%) L858R+T790M, 2 (6.3%) G719S and one patient had a del19+S768I (3.1%). Median follow-up was 15.4 months (95%CI 2.8-32.0), overall survival (OS) was 28.1 months (95%CI 25.5-30.6) and median progression-free survival (PFS) to first-line TKI was 13.1 months (95%CI 9.6-16.6).37.5% (n=12) of patients self-reported depression; in 25, 9.4 and 3.1% the clinical manifestations were mild (SDS 50-59; supportive psychotherapy), moderate (SDS 60-69; requirement of antidepressants) and severe (SDS 70 and above; required hospitalization). Depression was significantly associated with moderate-to-severe basal dyspnea (p=0.043), with brain metastases (p=0.003), and poor performance status (p=0.021). The average TNF at the time of genotype report was 12.2 pg/mL (SD±4.1), and was significantly higher in those who manifested depression (p=0.03). TNF levels increased 11% at 4 weeks and 75% at 12 weeks. Depression did not influence OS or first-line PFS. Mild to moderate depression is prevalent in patients with lung cancer harboring EGFR mutations. As previously reported, TNFa levels are elevated in patients with lung cancer and depression, particularly in the first 12 weeks post-treatment, a finding attributable to inflammation.

Prognostic value and clinical significance of long noncoding RNA CASC2 in human malignancies: a meta-analysis.

PurposeThis meta-analysis aimed to assess the prognostic value of long noncoding RNA cancer susceptibility candidate 2 (CASC2) in human tumors.Materials and methodsWe searched the available databases up to December 2017. Pooled hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were used to examine the prognostic impact of CASC2 on overall survival (OS) in patients diagnosed with malignancies.ResultsA total of eight studies with 663 cancer patients were enrolled. Our results showed that high CASC2 expression level was associated with a favorable OS (HR=0.437, 95% CI: 0.345–0.554). The significant results were not altered by stratified analysis according to cancer type, sample size, follow-up months, and HR estimation method. A significant association of glioma tumor stage with CASC2 expression was detected (III–IV vs I–II: odds ratio=2.126, 95% CI: 1.032–4.378). CASC2 could be used as an independent prognostic factor for OS (HR=0.450, 95% CI: 0.336–0.602). Sensitivity analysis showed that no single study changed the pooled results significantly. Begg’s funnel plot and Egger’s test showed that no publication bias was detected.ConclusionHigh expression level of CASC2 is associated with favorable survival outcome for cancer patients, and CASC2 could be used as a prognostic predictor for cancers.

Prediction of Overall Survival and Novel Classification of Patients with Gastric Cancer Using the Survival Recurrent Network

Artificial neural networks (ANNs) have been applied to many prediction and classification problems, and could also be used to develop a prediction model of survival outcomes for cancer patients. The aim of this study is to develop a prediction model of survival outcomes for patients with gastric cancer using an ANN. This study enrolled 1243 patients with stage IIA-IV gastric cancer who underwent D2 gastrectomy from January 2007 to June 2010. We used a recurrent neural network (RNN) to make the survival recurrent network (SRN), and patients were randomly sorted into a training set (80%) and a test set (20%). Fivefold cross-validation was performed with the training set, and the optimized model was evaluated with the test set. Receiver operating characteristic (ROC) curves and area under the curves (AUCs) were evaluated, and we compared the survival curves of the American Joint Committee on Cancer (AJCC) 8th stage groups with those of the groups classified by the SRN-predicted survival probability. The test data showed that the ROC AUC of the SRN was 0.81 at the fifth year. The SRN-predicted survival corresponded closely with the actual survival in the calibration curve, and the survival outcome could be more discriminately classified by using the SRN than by using the AJCC staging system. SRN was a more powerful tool for predicting the survival rates of gastric cancer patients than conventional TNM staging, and may also provide a more flexible and expandable method when compared with fixed prediction models such as nomograms.

Prognostic significance of perioperative nutritional parameters in patients with gastric cancer

It has been suggested that nutritional status is related to the survival outcomes of cancer patients. The purpose of the current research is to evaluate the importance of the prognosis of various nutritional parameters during the perioperative period in patients with gastric cancer. This study enrolled patients with gastric cancer who underwent D2 gastrectomy at the Department of Surgery, Samsung Medical Center, in 2008. The prognostic significance of nutritional parameters was analyzed, along with other clinical and pathological variables, preoperatively and postoperatively at 3, 6, and 12 months. The total number of patients was 1415. The mean values of nutritional parameters, weight, body mass index (BMI), hemoglobin, total cholesterol, and total lymphocyte count (TLC) decreased significantly over time after surgery. On the contrary, albumin and prognostic nutritional index (PNI) score increased significantly during the postoperative follow-up period. Preoperatively, low BMI (<18.5kg/m2) and low TLC level (<1000permm3) were revealed as independent prognostic factors in multivariate analysis. Low preoperative TLC level and decline in PNI (ΔPNI<-2.2) at postoperative 3 months; low preoperative TLC level and decline in TLC (ΔTLC<-279.9permm3) at postoperative 6 months; and low preoperative BMI, albumin, and TLC levels at postoperative 12 months were independent nutritional prognostic indicators. Various perioperative nutritional parameters were confirmed as independent prognostic factors in patients with gastric cancer. Our results imply prognostic benefit from careful nutritional support for patients with poor nutritional parameters.

Photodynamic Priming Mitigates Chemotherapeutic Selection Pressures and Improves Drug Delivery.

Physiologic barriers to drug delivery and selection for drug resistance limit survival outcomes in cancer patients. In this study, we present preclinical evidence that a subtumoricidal photodynamic priming (PDP) strategy can relieve drug delivery barriers in the tumor microenvironment to safely widen the therapeutic window of a nanoformulated cytotoxic drug. In orthotopic xenograft models of pancreatic cancer, combining PDP with nanoliposomal irinotecan (nal-IRI) prevented tumor relapse, reduced metastasis, and increased both progression-free survival and 1-year disease-free survival. PDP enabled these durable improvements by targeting multiple tumor compartments to (i) increase intratumoral drug accumulation by >10-fold, (ii) increase the duration of drug exposure above a critical therapeutic threshold, and (iii) attenuate surges in CD44 and CXCR4 expression, which mediate chemoresistance often observed after multicycle chemotherapy. Overall, our results offer preclinical proof of concept for the effectiveness of PDP to minimize risks of tumor relapse, progression, and drug resistance and to extend patient survival.Significance: A biophysical priming approach overcomes key treatment barriers, significantly reduces metastases, and prolongs survival in orthotopic models of human pancreatic cancer. Cancer Res; 78(2); 558-71. ©2017 AACR.

Highlights from Recent Cancer Literature

Highlights from Recent Cancer Literature

Survival Outcomes in Cancer Patients Predicted by a Partial EMT Gene Expression Scoring Metric.

Metastasis is a significant contributor to morbidity and mortality for many cancer patients and remains a major obstacle for effective treatment. In many tissue types, metastasis is fueled by the epithelial-to-mesenchymal transition (EMT)-a dynamic process characterized by phenotypic and morphologic changes concomitant with increased migratory and invasive potential. Recent experimental and theoretical evidence suggests that cells can be stably halted en route to EMT in a hybrid E/M phenotype. Cells in this phenotype tend to move collectively, forming clusters of circulating tumor cells that are key tumor-initiating agents. Here, we developed an inferential model built on the gene expression of multiple cancer subtypes to devise an EMT metric that characterizes the degree to which a given cell line exhibits hybrid E/M features. Our model identified drivers and fine-tuners of epithelial-mesenchymal plasticity and recapitulated the behavior observed in multiple in vitro experiments across cancer types. We also predicted and experimentally validated the hybrid E/M status of certain cancer cell lines, including DU145 and A549. Finally, we demonstrated the relevance of predicted EMT scores to patient survival and observed that the role of the hybrid E/M phenotype in characterizing tumor aggressiveness is tissue and subtype specific. Our algorithm is a promising tool to quantify the EMT spectrum, to investigate the correlation of EMT score with cancer treatment response and survival, and to provide an important metric for systematic clinical risk stratification and treatment. Cancer Res; 77(22); 6415-28. ©2017 AACR.

The reverse Warburg effect is likely to be an Achilles' heel of cancer that can be exploited for cancer therapy.

Although survival outcomes of cancer patients have been improved dramatically via conventional chemotherapy and targeted therapy over the last decades, there are still some tough clinical challenges that badly needs to be overcome, such as anticancer drug resistance, inevitable recurrences, cancer progression and metastasis. Simultaneously, accumulated evidence demonstrates that aberrant glucose metabolism termed ‘the Warburg effect’ in cancer cell is closely associated with malignant phenotypes. In 2009, a novel ‘two-compartment metabolic coupling’ model, also named ‘the reverse Warburg effect’, was proposed and attracted lots of attention. Based on this new model, we consider whether this new viewpoint can be exploited for improving the existent anti-cancer therapeutic strategies. Our review focuses on the paradigm shift from ‘the Warburg effect’ to ‘the reverse Warburg effect’, the features and molecular mechanisms of ‘the reverse Warburg effect’, and then we discuss its significance in fundamental researches and clinical practice.

Cancer incidence in patients with hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by deficiency in endoglin, an angiogenic protein. We previously showed that HHT, in which systemic endoglin expression is reduced, was associated with better survival outcomes in cancer patients (Duarte et al. in Cancer Epidemiol Biomarkers Prev 23:117-125, 2014). Here, we evaluated whether HHT was associated with reduced cancer incidence. A matched case-control analysis using SEER Medicare was conducted to evaluate the effect of HHT on diagnosis with breast, colorectal, lung, or prostate cancer between 2000 and 2007 (n=633,162). Cancer and non-cancer patients were matched on age, sex, SEER registry region, and length of the ascertainment period for HHT. We assessed crude association using a McNemar's test and then adjusted for demographic variables, cancer type, cancer stage, comorbidities, and ascertainment period with a conditional logistic regression model for cancer incidence. The McNemar's test showed no significant association between HHT and cancer incidence (p=0.74). Adjusting for covariates with the conditional logistic regression model did not change the result [HHT odds ratio 0.978; 95% CI (0.795, 1.204)]. The lack of association between HHT and cancer incidence is unexpected given the previously discovered significant association between HHT and improved survival outcomes (Duarte et al. in Cancer Epidemiol Biomarkers Prev 23:117-125, 2014). We conclude that the protective effect of reduced systemic endoglin expression in cancer is specific to cancer progression through its effect on vascularization and other stromal effects but does not extend to cancer initiation.

Tumor vasculogenic mimicry predicts poor prognosis in cancer patients: a meta-analysis.

Vasculogenic mimicry (VM) is the formation of vascular channels by tumor cells or tumor cell-derived, trans-differentiated cells in highly aggressive, solid tumors. However, the disease features and prognostic value of VM for overall survival of cancer patients remain controversial. To systematically investigate the roles of VM in cancer progression and its prognostic values, we performed a meta-analysis based on 36 studies (33 eligible articles) including 3609 patients. The pooled hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to assess the relationship between VM and overall survival in cancer patients. Vasculogenic mimicry was significantly associated with cancer differentiation, lymph node metastasis, distant metastasis, and TNM stage. The prognostic value of VM was significant in overall survival (HR 2.16; 95% CI 1.98-2.38; P<0.001). Analyses stratified by confounders, such as cancer type, ethnicity, VM detection methods, sample size, and Newcastle-Ottawa quality score, found similar significant results. The presence of VM predicts poorer survival outcomes in cancer patients.

Documentation of Palliative Radiation Therapy Response in the Last Six Months of Life: Are We Capturing the Data?

The integration of palliative care and standard oncologic care improves quality of life, symptoms, and survival outcomes in cancer patients. Radiation oncologists (RO) provide palliative services to many of these patients near the end of life. We sought to determine how RO document the management of symptoms for oncology patients receiving palliative radiation therapy (RT) for metastatic disease at the end of life. RO electronic medical records were retrospectively reviewed for 3,128 cancer patients from a single academic institution that had at least one hospital contact within their last 6 months of life. From this decedent database, patients with metastatic disease who received palliative RT were identified. All RO clinical notes within patients’ last 6 months of life were reviewed for documentation of symptoms, management, response to treatment, and subsequent disposition, including referrals to hospice and palliative care. There were 572 clinical encounters among 203 patients (2008-2011), ranging in age from 19-88 years old. Clinical notes included follow-up (FU) (n=111), end of treatment (EOT) (n=231), reevaluation (n=83), and consult notes (n=138). The most common documented symptom was pain (n=262), followed by neurologic symptoms (n=23). Pain score was documented 34% of the time with an average score of 6.8 (range 0-10). Patients reported an average of 1.4 pain sites per encounter with the most common sites being back (n=58) and hips (n=47). This was addressed in the treatment plan 86% of the time. The documented method of addressing symptoms included RT 74% of the time, further workup 11%, medication 7%, and a combination of treatments the remainder of the time. Response to prior RT was reported 40% of the time. There was a reported improvement in symptoms following RT in 30% of EOT notes, no improvement in 17%, no mention of response in 52%, and the focus was new pain due to recurrence in 1%. There was a reported improvement in symptoms following RT in 40% of FU notes, no improvement in 11%, no mention of response in 20%, and the focus was new pain in 29%. Overall though, 65% of patients (n=131) did not have any FU to evaluate. When RO provide palliative RT to patients with metastatic disease at the end of life, documentation consistently demonstrates RO address pain as a part of the plan. Still, a large number of patients lack documentation regarding the outcome of the intervention. Proper documentation is crucial for communication between palliative specialists and to ensure the most efficient and effective therapies are delivered during end of life. Our institution desires to implement a standardized assessment and follow-up form, gauging patients’ symptomatic control and perceived response to treatment, to facilitate improved multidisciplinary palliative care and referral. Outcome of this intervention is eagerly anticipated.

The Prognostic Significance of the Early Postoperative Neutrophil-to-Lymphocyte Ratio in Patients with Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy.

Because the pretreatment neutrophil-to-lymphocyte ratio (NLR) is a reliable prognostic factor, the authors of this study hypothesized that posttreatment NLR also predicts the survival outcome for cancer patients. The study investigated the clinicopathologic features according to postoperative NLR and determined the prognostic significance of early postoperative NLR for bladder cancer patients undergoing radical cystectomy (RC). The study reviewed 385 bladder cancer patients treated with RC and pelvic lymph node dissection at the authors' institution between 1999 and 2012. The primary end points of the study were cancer-specific survival (CSS) and overall survival (OS) estimates from the Kaplan-Meier analysis. Multivariate Cox regression analysis was adopted to identify the independent prognostic factors for oncologic outcomes after surgery. Patients with elevated postoperative NLR (≥2.0) had higher rates of advanced pathologic tumor stage (≥pT3), lymphovascular invasion, and lymph node involvement. Notably, they showed poorer CSS and OS rates than patients with a postoperative NLR lower than 2.0. Additionally, patients with pre- and postoperative elevated NLR (≥2.1 → ≥2.0) demonstrated worse oncologic outcomes than other groups of NLR changes. Multivariate analysis showed that early postoperative NLR remained a key predictor for CSS and OS. When divided by pathologic T or N stage, patients with localized pathologic T stage or pN0 status showed significant differences in survival according to early postoperative NLR. In summary, postoperative NLR in the early recovery period can be a valuable biomarker for predicting oncologic outcomes for bladder cancer patients undergoing RC.

Survival outcome of cancer patients with pericardial effusions.

9573 Background: Pericardial effusion is a common finding in cancer patients and can be related to the tumor infiltration of the pericardial space or can be secondary to cancer therapy (chemotherap...

Utilizing nomogram-predicted outcomes as the control group in randomized clinical trials.

6592 Background: Phase III randomized clinical trials require a large study population to demonstrate improved outcomes. Validated nomograms exist that predict survival outcomes for cancer patients...