Terms Of Cancer-specific Survival Research Articles

Comparing trimodal therapy with radical cystectomy in muscle-invasive bladder cancer: an updated meta-analysis.

We conducted this meta-analysis to compare the two muscle-invasive bladder cancer (MIBC) treatment modalities in terms of cancer-specific survival (CSS) and other outcome indicators. A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. The search was conducted using various academic databases including Scopus, PubMed, Cochrane database, EMBASE, Chinese biomedical literature database, Wan fang databases, and China National Knowledge Internet databases between 1966 and December 2023. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) No. (CRD42023398977). This study included a total of 54,816 patients diagnosed with bladder cancer from 14 studies, of which 6,228 patients were assigned to the trimodal therapy (TMT) group and 48,588 patients were assigned to the radical cystectomy (RC) group. Based on the results, the RC group exhibited a higher rate of survival than the TMT group [pooled hazard ratio (HR) = 1.23, 95% CI: 1.18-1.28, Z = 1.46, P < 0.001]. In terms of CSS, patients in the RC group had a longer CSS compared with those in the TMT group (pooled HR = 1.47, 95% CI: 1.29-1.67, Z = 5.893, P < 0.001). Compared with RC, TMT is significantly associated with an increased risk of both types of mortality (pooled HR: 1.30, P < 0.001). Overall, the findings of this meta-analysis suggest that RC treatment may be associated with improved overall survival. Moreover, it was observed that cancer-specific survival was significantly prolonged among patients in the RC group as opposed to those who received TMT. In addition, it was shown that patients who received TMT exhibited a higher risk of all-cause mortality when compared with those who underwent RC.

A Territory-wide Study Investigating the Dose and Efficacy of Different Bacillus Calmette-Guérin Strains in Patients with Intermediate- and High-risk Non–muscle-invasive Bladder Cancer

BackgroundCurrent European Association of Urology (EAU) guidelines support adjuvant intravesical Bacillus Calmette-Guérin (BCG) treatment after Transurethral Resection of Bladder Tumor (TURB) for intermediate- or high-risk Non–Muscle-Invasive Bladder Cancer (NMIBC) patients, aiming to reduce the risk of tumor recurrence. The quality of data, however, does not allow definitive conclusions on whether different strains and dosages of BCG have different efficacies on long-term survival outcomes. ObjectiveTo evaluate the long-term survival outcomes of different strains and dosages of BCG in patients with NMIBC. Design, setting, and participantsAll NMIBC patients treated with intravesical BCG therapy from 2001 to 2020 were identified using a territory-wide database in Hong Kong. InterventionBCG strains and dosages (Connaught strain 81 mg, Connaught strain 27 mg, Tokyo strain 80 mg, and Danish strain 30 mg) were retrieved from medical records. Outcome measurements and statistical analysisOverall Survival (OS), Cancer-Specific Survival (CSS), Recurrence-Free Survival (RFS), and Progression-Free Survival (PFS) were analyzed using the Kaplan-Meier method. A multivariable Cox regression analysis was used to adjust potential confounding factors, and to estimate Hazard Ratio (HR) and 95% confidence interval (CI) of different BCG strains. A further subgroup analysis on adequate versus inadequate BCG treatment was performed. Results and limitationsA total of 2602 NMIBC patients treated with intravesical BCG were identified. Among them, 1291 (49.6%) received Connaught strain 81 mg, 199 (7.6%) received Connaught strain 27 mg, 1014 (39.0%) received Tokyo strain, and 98 (3.8%) received Danish strain. The median follow-up was 11.0 years. No statistically significant differences in OS, CSS, RFS, and PFS were detected among the different groups. At the multivariable analysis, the Connaught strain 27 mg group was inferior to the Connaught strain 81 mg group in terms of OS (HR: 1.26, 95% CI: 1.05–1.51), CSS (HR: 1.69, 95% CI: 1.08–2.66), and PFS (HR: 1.86, 95% CI: 1.20–2.88). Adequate BCG treatment was associated with improved OS (HR: 0.82, 95% CI: 0.73–0.92), CSS (HR: 0.64, 95% CI: 0.47–0.86), RFS (HR: 0.80, 95% CI: 0.70–0.92), and PFS (HR: 0.52, 95% CI: 0.39–0.68). Among patients treated with adequate BCG, at the multivariable analysis the Connaught strain 27 mg group showed worse results than the Connaught strain 81 mg group in terms of CSS (HR: 1.93, 95% CI: 1.07–3.51). Compared with the Connaught strain 81 mg group, both Tokyo and Danish strains had similar survival outcomes in the whole cohort and the adequate BCG treatment subgroup. ConclusionsOur findings suggest that adequate BCG remains the most important factor in optimizing survival outcomes in patients with intermediate- and high-risk NMIBC. No significant differences in survival outcomes were observed between full-dose Connaught, Tokyo, and Danish strains. Reduced-dose Connaught strain was associated with the worst survival outcomes. Patient summaryWe evaluated the efficacy of different strains and dosages of bacillus Calmette-Guérin (BCG) in patients with intermediate- or high-risk non–muscle-invasive bladder cancer in the past two decades in Hong Kong. We conclude no significant differences in long-term survival outcomes in terms of full-dose Connaught, Tokyo, and Danish strains, while reduced-dose Connaught strain was inferior to the full-dose group. Adequate BCG treatment benefits long-term survival.

Optimal management of renal cell carcinoma in octogenarians: Retrospective analysis using updated Korean Renal Cell Carcinoma (KORCC) database.

There is few of optimal management guideline in elderly patients with renal cell carcinoma (RCC). To compare the survival outcomes of octogenarian RCC group and younger RCC group after surgery using nationwide multi-institutional database. A total of 10,068 patients who underwent surgery for RCC were included in the current retrospective, multi-institutional study. A propensity score matching (PSM) analysis was conducted to control other confounding factors in analyzing survival outcomes of octogenarian and younger group RCCs. Kaplan-Meier curve analysis to calculate the survival estimates for cancer-specific survival (CSS) and overall survival (OS), and multivariate Cox-proportional hazard regression analyses to evaluate the significant variables associated with the survival outcomes were also performed. Both groups were well-balanced in all baseline characteristics. In a total cohort, Kaplan-Meier survival analysis showed a significantly decreased 5-year and 8-year CSS and OS in the octogenarian group compared with the younger group. However, in a PSM cohort, no significant differences were evident between the two groups in terms of CSS (5-year, 87.3% vs. 87.0%; 8-year, 82.2% vs. 78.9%, respectively, log-rank test, p = 0.964). In addition, age ≥ 80 years (HR, 1.199; 95% CI, 0.497-2.896, p = 0.686) was not a significant prognostic factor of CSS in a PSM cohort. The octogenarian RCC group after surgery had comparable survival outcomes compared with younger group after PSM analysis. For the life expectancy of octogenarian is getting longer, active treatment is considerable in patients with good performance status.

Occurrence and prognostic significance of different histology relative to urinary tract tumors: A SEER population-based study.

485 Background: To evaluate the prevalence and prognostic value of variant histology in urinary tract tumors according to primary location and metastatic status. Methods: Using the Surveillance, Epidemiology, and End Results registry (SEER, 2004-2015) databases, patients with urinary tract tumors were identified. Propensity Score Matching was used to balance the clinicopathologic features between different histologies. Kaplan-Meier plots were used to compare the cancer specific survival (CSS) and overall survival (OS) of different histologies. The cox regression analysis were also applied. Results: Of all 93,200 eligible patients with urinary tract tumors, 87,323 (93.7%) harbored bladder cancer (3,685 in M1 stage). Among them, urothelial tumors (UC) accounted for 96.67%, followed by squamous neoplasm (SCC), urachal carcinoma (Urachal), adenocarcinoma (Adeno), neuroendocrine tumors (NE) and tumor of Müllerian type (Müllerian). A total of 5877 (6.35%) harbored upper urinary tract tumors (950 in M1 stage). Among them, UC accounted for 96.39%, followed by SCC, Urachal, Müllerian, NE, Adeno. In patients with localized diseases, those with non-urothelial tumors had significantly worse prognosis in overall urinary tract tumors based on OS and CSS (P&lt;0.001). In terms of specific histology in bladder cancer (BC), patients with UC had most favorable prognosis, followed by Adeno, Urachal and Müllerian, while those with SCC and NE were associated with the worst survival outcomes. In patients with upper urinary tract tumors (UUTT), those with Müllerian had the best survival outcomes, followed by UC, while those with NE, Adeno, SCC, and Urachal had relatively worse prognosis. In M1 stage, although there was a statistical difference in OS and CSS between all patients with urothelial and non-urothelial tumors (P&lt;0.001), the 5-year survival rate (3.74%, 2.50%) and 5-year CSM (4.93%, 3.28%) were similar. In metastatic BC, there was no difference in OS among all histology. However, in terms of CSS, significant differences were still observed in patients with different histologies. In metastatic UUTT, no difference in survival was found among different histologies. After PSM, the similar results were observed in BC, while there is no statistical difference of survival among different histologies in UUTT, no matter the M stage. Cox analyses revealed that primary location, histology type, surgery, chemotherapy and M stage were the common and strong independent prognostic factors in both BC and UUTT. Conclusions: In urinary tract tumors, the incidence of different histology types between BC and UUTT is roughly similar. Overall, patient with variant histology have a worse prognosis than those with urothelial carcinoma. However, differences in survival among the histology types vary by primary location and metastatic status, especially the metastatic status.

Postoperative radiotherapy might be a risk factor for second primary lung cancer: A population-based study.

BackgroundSurgery is the main curative therapeutic strategy for patients with initial primary lung cancer (IPLC). Most international guidelines recommend regular follow-ups after discharge to monitor patients for tumor recurrence and metastasis. As the overall survival (OS) in patients with lung cancer improves, their risk of secondary primary lung cancer (SPLC) increases. Previous studies on such patients lack separate assessment of different survival outcomes and evaluation of high-risk factors for SPLC. Therefore, we aimed to determine the correlation between high-risk factors and causes of death in patients with SPLC, based on the Surveillance, Epidemiology, and End Results (SEER) database.MethodsWe screened the SEER database for patients with IPLC and SPLC from 2004 to 2015 and included only patients who underwent surgery since the IPLC and in whom the cancer was pathologically verified of an International Classification of Diseases grade of 0-3 and to be non-small-cell lung cancer. The standardized incidence ratio (SIR) was calculated between variables and SPLC. Multivariable Cox proportional-hazards regression analyses were conducted to calculate the correlation of different variables with overall survival (OS) and cancer-specific survival (CSS). A competing-risk model was conducted for SPLC. The effect of baseline bias on survival outcomes by performing propensity score matching analysis in a 1: 6 ratio (SPLC: IPLC).ResultsFor patients aged 0-49 years, the overall SIR was higher in older patients, reaching a maximum of 27.74 in those aged 40-49 years, and at 11.63 in patients aged 50-59 years. The overall SIR was higher for patients who were more recently diagnosed with IPLC and increased with time after diagnosis. Male sex, SPLC (hazard ratio, 1.6173; 95% confidence interval, 1.5505-1.6869; P < 0.001), cancer grade III or IV, lower lobe of the lung, advanced stage and postoperative radiotherapy (PORT) were independently detrimental to OS. In terms of CSS, PORT was a high-risk factor.ConclusionsPostoperative radiotherapy is a risk factor for second primary lung cancer and detrimental to overall and cancer-specific survival in patients who had initial primary lung cancer. These data support the need for life-long follow-up of patients who undergo treatment for IPLC to screen for SPLC.

Is red blood cell distribution width a prognostic factor for colorectal cancer? A meta-analysis.

BackgroundRDW might be an easy and cost-effective pre-operative prognostic factor for cancer patients. The aim of the current study was to analyze whether red blood cell distribution width (RDW) was a prognostic factor for colorectal cancer (CRC) patients who underwent radical surgery.MethodsWe conducted the searching strategy in three databases including the PubMed, Embase and Cochrane Library from the inception to May 07, 2022, to find eligible studies. In this meta-analysis, we focused on the prognosis. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS).ResultsA total of seven studies involving 7,541 patients were included in this meta-analysis. After pooling up the HRs, red blood cell distribution width-coefficient of variation (RDW-CV) was not an independent prognostic factor of OS (HR = 1.48, I2 = 90%, 95% CI = 0.93 to 2.36, P = 0.10), however, red blood cell distribution width-standard deviation (RDW-SD) was an independent prognostic factor of OS (HR = 1.99, I2 = 0%, 95% CI = 1.59 to 2.49, P < 0.01). As for DFS, we found that RDW-CV (HR = 1.51, I2 = 83%, 95% CI = 0.94 to 2.43, P = 0.09 < 0.10) and RDW-SD (HR = 1.77, I2 = 56%, 95% CI = 0.91 to 3.43, P = 0.09 < 0.10) were both the independent prognostic factors. In terms of CSS, we found that RDW-CV was not an independent prognostic factor (HR = 1.23, I2 = 95%, 95% CI = 0.72 to 2.10, P = 0.46).ConclusionRDW-SD was an independent prognostic factor of OS and DFS, and RDW-CV was an independent prognostic factor of DFS.

Active surveillance in small renal masses

Active surveillance is one of the options available for management of renal masses smaller than 4 cm with a suspicion of malignancy in association with nephrectomy and ablative procedures. In general, small renal masses grow slowly and have a very low metastatic potential, but exceptions occur. Active surveillance is generally offered in the elderly with high comorbidities but there is a lack of validated data in other patient demographics. Data from younger and healthier patients are gradually emerging and have shown promising results but still require further validation. Computed tomography (CT), magnetic resonance imagin (MRI), and ultrasonography (US) are all acceptable imaging modalities for surveillance of renal masses, but CT is the most commonly used. Intervals of surveillance differs from study to study, but the most common schedule is 3, 6, and 12 months after initiation, then annually. The cut off point for delayed intervention is growth &gt; 0.5 cm/year or absolute size &gt; 4 cm. Oncologic outcome is comparable to nephrectomy and ablation in terms of cancer-specific survival. Quality of life for patients undergoing active surveillance is also comparable but is significantly lower in those with confirmed malignant biopsy results. Cost of active surveillance is as a rule more cost effective than nephrectomy or ablation.

Impact of salvage cytotoxic chemotherapy on prognosis in patients with recurrence after radical cystectomy: a multi-institutional retrospective study

BackgroundIn patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients.MethodsIn this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS).ResultsMultivariate analyses showed that liver metastasis after RC (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR 1.92; 95% CI 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy.ConclusionsThe present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein/Albumin Ratio in Luminal Breast Cancers With HER2-Negativity.

PurposeThis study was determined to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR) prior to surgery in luminal breast cancers (BC) with HER2-negativity.MethodsThe clinical data of 708 HER2-negative luminal BC patients from January 2013 to December 2016 were retrospectively collected and analyzed. The optimal cut-off value of NLR and CAR were determined via receiver operating characteristic (ROC) curve. The disease-free survival (DFS) and cancer specific survival (CSS) rates were estimated using the Kaplan−Meier method. Cox univariate and multivariate proportional hazards regression models were performed to identify significant predictors of DFS and CSS simultaneously.ResultsThe mean age of the patients diagnosed was 52.43 years (range, 15–95 years), and the median follow-up was 62.71 months (range, 12-92 months). Univariate and multivariate analysis confirmed that NLR ≥2.2 was significantly associated with worse DFS (HR=2.886, 95%CI=1.756-4.745, p<0.001), and same results were obtained in terms of CSS (HR=3.999, 95%CI=2.002-7.987, p<0.001). Similarly, CAR ≥0.07 was independently and significantly associated with poor DFS (HR=3.858, 95%CI=2.346-6.345, p<0.001) and CSS (HR=6.563, 95%CI=3.558-12.106, p<0.001).ConclusionPreoperative evaluation of NLR and CAR were significant and independent prognostic indicators for luminal breast cancers with HER2-negativity.

Clinicopathologic features, treatment, survival, and prognostic factors of combined hepatocellular and cholangiocarcinoma: A nomogram development based on SEER database and validation in multicenter study

PurposeThe aim of the study was to comprehensively understand the combined hepatocellular and cholangiocarcinoma (CHC) and develop a nomogram for prognostic prediction of CHC. MethodsData were collected from the Surveillance, Epidemiology and End Results (SEER) database (year 2004–2014). Propensity-score matching (PSM) was used to match the demographic characteristic of the CHC versus hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). A nomogram model was established to predict the prognosis in terms of cancer specific survival (CSS). The established nomogram was externally validated by a multicenter cohort. ResultsA total of 71,756 patients enrolled in our study including 62,877 HCC patients, 566 CHC patients, and 8303 ICC patients. The CHC, HCC, and ICC are not exactly similar in clinical characteristic. After PSM, the CSS of CHC was better than HCC but comparable to ICC. Tumor size, M stage, surgery, chemotherapy, and surgery were independently prognostic factors of CHC and were included in the establishment of novel nomogram.The c-index of the novel nomogram in SEER training set and multicenter validation was 0.779 and 0.780, respectively, which indicated that the model was with better discrimination power. In addition, decision curve analyses proved the favorable potential clinical effect of the predictive model. Lastly, a risk classification based on nomogram also verified the reliability of the model. ConclusionCHC had better survival than HCC but was comparable to ICC. The nomogram was established based on tumor size, M stage, chemotherapy, surgery, and radiotherapy and well validated by external multicenter cohort.

Combinatory statuses of tumor stromal percentage and tumor infiltrating lymphocytes as prognostic factors in stage III colorectal cancers.

Tumor stroma and tumor-infiltrating lymphocytes (TILs) are major constituents of the tumor microenvironment, although they have different effects on the prognosis of patients with colorectal cancer (CRC). Combinatory statuses of tumor-stromal percentage (TSP) and TILs are expected to provide more powerful prognostic information but have never been studied in CRCs. Stage III CRCs from patients (n=487) treated with adjuvant chemotherapy were assessed for their TSP and CD3-TIL or CD8-TIL densities using computer-aided methodology. With cut-off values set at median values for intraepithelial TIL (iTIL) and stromal TIL (sTIL) densities, CRCs were sorted into low and high iTIL or sTIL groups. CRCs were classified into five quintile (Q1-Q5) groups according to their TSP and divided into high TSP (Q5) and low TSP (Q1-4) groups. The combination of CD8 iTIL density and TSP was found to be an independent prognostic parameter in multivariate survival analysis in terms of cancer-specific survival and recurrence-free survival. CRCs with low CD8 iTIL density and high TSP showed the worst survival. The combinatory status showed more prognostic power than CD8 iTIL density or TSP alone. Multivariate survival analysis in an independent cohort of stage III CRC validated the prognostic power of the combinatory statuses. The findings suggest that the combinatory status might serve as a prognostic parameter in stage III CRCs. Further research in a large-scale cohort of patients with stage III CRC is needed to validate the prognostic power of the combinatory status.

Inguinal lymph node density as a powerful predictor of cancer specific survival in patients with node-positive penile cancer.

Penile cancer (PC) is an aggressive malignancy in which the most important prognostic factor for cancer specific survival (CSS) is the involvement of regional lymph nodes (LNs). Lymph node density (LND) could become a superior prognostic tool for CSS, by accounting for both extent of dissection and nodal disease burden. We aim to validate LND as a prognostic factor for CSS in a contemporary series of patients with PC treated and followed at a single high-volume center, treating more than 25 PC patients per year, over a 13-year period. Clinical charts of all patients with PC who underwent surgical treatment between 2007 and 2020 were reviewed. Clinicopathological data was collected and analyzed retrospectively. We only included patients with ≥ 8 LNs removed in a unilateral ILND or ≥16 LNs when a bilateral approach was used. We attempted to find an optimal threshold for LND, capable of maximizing effect difference in terms of CSS and RFS between dichotomized groups. To determine this threshold, we used the chi-squared and the Mann-Whitney tests, and it was required to fulfill the proportional hazards assumption. We assessed different thresholds previously reported in the literature. In our study the optimal threshold for LND was determined to be ≤ 20% Descriptive statistics were used to summarize patient characteristics, CSS and RFS were graphically represented by Kaplan-Meier estimates. Harrell's C index for CSS and RFS were calculated for LND and pN stage, to determine which variable has a superior predictive capacity RESULTS: We identified 110 patients with PC who underwent ILND at our institution, of these, 87 were node-positive and were included in the final analysis. Overall estimates of CSS showed a 3-year CSS of 43% (95% CI: 32-54), the estimated 3-year CSS for the patients with a LND ≤ 20% was 69% (95% CI: 50-82) and 26% (95% CI: 14-39) in the group with a LND >20% (Log-rank P = 0.001). The estimated 3-year RFS for the patients with LND ≤ 20% was 61% (95% CI: 42-76) and 30% (95% CI: 16-44) in the group with a LND >20% (Log-rank P = 0.009). The results of univariate analysis indicate that in patients with a LND >20% the risk for cancer specific mortality was increased (HR 2.68; 95% CI: 1.45-4.98, P = 0.002) compared with LND ≤ 20%. In the and Cox multivariate analysis after Adjusting for age and pN stage the association increased (HR 2.73; 95%, CI 1.38-5.40, P = 0.004). Harrell´s C index for CSS was 0.63 for LND vs. 0.54 for pN stage, suggesting a 9% higher concordance for LND and CSS. Lymph node density stands as a promising tool for risk-stratifying patients with node-positive PC after ILND. In this retrospective study, LND was a significant predictor of CSS and RFS when using a LND >20% threshold, and also showed a superior predictive ability than pN stage. These results support the use of the LND parameter in clinical practice with a final goal to improve risk stratification, and individualized adjuvant treatment decision-making to patients with high-risk of cancer specific mortality.

Postoperative radioiodine therapy impact on survival in poorly differentiated thyroid carcinoma: a population-based study.

PurposeThe true impact of postoperative radioiodine therapy on survival has been controversial for patients with poorly differentiated thyroid carcinoma (PDTC). We aimed to determine the impact of postoperative radioiodine on survival in PDTC through a population-based study.MethodsData on patients with PDTC were collected from the US SEER database (2004 to 2015). Patients were divided into the radioiodine group and nonradioiodine group. Survival comparison between groups was evaluated by Kaplan–Meier curves, log-rank test and multivariate Cox regression analysis. Akaike information criterion was used to select variables in the nomogram. The performance of the nomogram was assessed by discrimination (C-index) and calibration plots.ResultsThe radioiodine group had more aggressive features, such as advanced tumor node metastasis stage and radical surgery, compared to the nonradioiodine group. PDTC patients receiving radioiodine therapy had a significant survival advantage in terms of overall survival (OS) (P = 0.001) but not in terms of cancer-specific survival (P = 0.083). Multivariate analysis revealed radioiodine therapy was an independent favorable factor for OS in PDTC patients (hazard ratio = 0.57; 95% CI, 0.44–0.75, P < 0.001). Subgroup analysis identified patients’ characteristics favoring radioiodine therapy. The nomogram (age, tumor size, extension, neck lymph nodes metastasis and radioiodine therapy) of OS for predicting 3-, 5- and 10-year OS probability showed good discrimination (C-index, 0.797) and calibration power.ConclusionPostoperative radioiodine therapy can prolong the long-term OS in patients with PDTC, and is an independent favorable prognostic factor for those patients. Further prospective studies are warranted.

The Correlation Between Survival Benefit of Preoperative Radiotherapy and Pretreatment Carcinoembryonic Antigen Level in Locally Advanced Rectal Cancer.

BackgroundPreoperative radiotherapy followed by radical surgery is the standard treatment for locally advanced rectal cancer; however, its long-term survival benefit remains controversial. This study aimed to determine the relationship between pretreatment carcinoembryonic antigen (CEA) levels and the long-term prognosis of preoperative radiotherapy in locally advanced rectal cancer (LARC) patients.MethodsData of LARC patients who underwent surgery between 2011 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database, and patients were accordingly divided into surgery (S) group and radiotherapy followed by surgery (RT+S) group. The primary outcomes were cancer-specific survival (CSS) and cancer-specific mortality (CSM). CSS was evaluated using Kaplan-Meier analysis, while CSM was evaluated using a competitive risk model. Subgroup analysis was also conducted, which was stratified by pretreatment CEA levels.ResultsA total of 2,760 patients were eligible for this study, including 350 (12.7%) patients in the S group and 2,410 (87.3%) in the RT+S group. There were no significant differences in the CSS and CSM rates at 1, 3, and 4 years between the S and RT+S groups before and after PSM (all p > 0.05). Pretreatment CEA levels were independently associated with CSS and CSM after adjusting for age, sex, stage, pathological factors, and treatment factors (all p < 0.05). Subgroup analysis showed that preoperative radiotherapy would benefit patients with elevated CEA in terms of CSS and CSM (both p < 0.05) but not those patients with normal CEA (both p > 0.05). Further analysis showed that preoperative radiotherapy was an independent protective factor for CSS and CSM in patients with elevated CEA levels (both p < 0.05).ConclusionsPretreatment CEA level may be considered a potential biomarker to screen LACR patients who would benefit from preoperative radiotherapy in terms of long-term prognosis.

Prognostic significance of bladder neck involvement in non-muscle-invasive bladder cancer: A SEER database analysis with 19,919 patients.

PurposeTo study prognostic values of bladder neck involvement (BNI) and survival outcomes in non‐muscle‐invasive bladder cancer (NMIBC).Method and materialsThe national Surveillance, Epidemiology, and End Results database (2004–2015) was applied to gain further insight into the prognostic values of BNI and 19,919 patients diagnosed with NMIBC were included in our study. We used the Kaplan–Meier method with the log‐rank test and subgroup analyses to evaluate cancer‐specific survival (CSS) and overall survival (OS). In addition, the multivariable Cox proportional hazard model and propensity score matching (PSM) were utilized.ResultsIn all, 3446 patients with BNI and 16,473 patients with sites except for bladder neck were enrolled in our study. Compared with other sites, a tendency toward a higher proportion of higher grade (p < 0.001), bigger tumor size (p < 0.001), and more patients with T1 and Tis stage (p < 0.001) was seen in BNI group. After 1:1 PSM, 3425 matched pairs were selected. Under the survival analyses, the BNI group had a lower survival probability in both OS (p = 0.0056) and CSS analyses (p < 0.0001) in NMIBC patients. However, in the subgroup analysis, only observed in the Ta and T1 stage in terms of CSS (all p < 0.05), and patients with Tis stage failed to show statistical survival differences (p > 0.05). In addition, subgroups stratified by tumor size and grade all revealed poor prognosis of BNI in NMIBC patients. Moreover, better survival outcomes of OS were observed in BNI patients who received radical cystectomy (p = 0.02) or chemotherapy (p < 0.001) multivariable Cox regression after PSM revealed that the BNI group had a higher risk of overall mortality (OM) (BNI vs. other sites hazards ratios [HR]: 1.127, 95% CI: 1.154–1.437, p < 0.001) and cancer‐specific mortality (CSM) (BNI vs. other sites HR: 1.127, 95% CI: 1.039–1.223, p < 0.001), while before PSM, similar situations were only existed in CSM (BNI vs. other sites HR: 1.288, 95% CI: 1.154–1.437, p < 0.001).ConclusionsThe prognosis of BNI was poorer than that of the other sites. BNI was an independent risk factor for OM and CSM in patients with NMIBC, especially for those with Ta or T1 stage.

PO-1165 Dosimetric parameters in hypofractionated radiotherapy in NSCLC cohort during SARS-COV-2 pandemia

Purpose or Objective: Moderate hypofractionation has been more popular in the last years, however no standard dosimetric parameters has been stablished. The majority of the dose-volume-constraints (DVCs) published refer to conventional 2 Gy/ fraction. In this study, we analyse different dosimetric parameters in patients (pts) with non-small cell lung cancer (NSCLC) treated with concomitant radiochemotherapy (RCT) or radiotherapy (RT) alone with radical intention and hypofractionated scheme in pandemic era. Due to the lack of consensus on this aspect, we analyse the relationship between tolerance to treatment and dosimetric parameters to aid its use in the clinic. Materials and Methods: Retrospective and multicentric study of 49 pts with locally advanced NSCLC treated from November 2019 to December 2020. During SARS-CoV-2 pandemic, hypofractionated schedules have allowed to decrease the duration of thoracic radiotherapy. The hypofractionated scheme used was 20 fractions of 2.75 Gy/daily (total dose 55 Gy, BED10=70 Gy). 3-dimensional conformal radiation therapy (3DCRT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) were allowed. We report gross tumour volume (GTV), planning tumour volume (PTV) and D98% and D95% PTV. Organ-at-risk (OARs) examined included lungs- GTV (V20<35% and mean-dose<20Gy), heart (V25<10%) and oesophagus (V50<40% and mean-dose<34 Gy). To evaluate toxicity during the treatment, we use CTCAE v.5 scale. Results: Mean GTV was 85.6 cc (3.3cc-581.3cc) and mean PTV was 268.8 cc (13cc-1047.4cc). Mean D98% PTV was 53 Gy and mean D95% PTV was 53.8 Gy. Most pts had G1-G2 cardiac toxicity like pericarditis, oesophagitis and pneumonitis. Only two pts (4%) had G3 oesophagitis and G3 pneumonitis (2%). No grade 4-5 toxicity was reported. In the analysis of DVCs, lungs-GTV V20<35% and lungs-GTV mean-dose < 20 Gy were associated with more pneumonitis regardless of grade (p 0.018 and p 0.027). In terms of oesophagitis, V50<40%, was associated with more oesophagitis regardless of grade (p 0.037). Mean dose < 34 Gy in oesophagus and heart DVCs were no associated with more toxicity in our study. There were not differences between T stage (<T3 vs ≥ T3) and N stage (<N2 vs ≥ N2) and mean PTV (p 0.55 and p 0.178). There were not differences in terms of cancer-specific survival and PTV (p 0.195). Conclusion: In moderately hypofractionation, it is important to consider that dosimetric parameters cannot be the same as in standard fractionation (2 Gy/fraction). Due to changing radiotherapy technique, DVCs may need to be adjusted based on different dose distribution. According to our results, hypofractionated radiotherapy in NSCLC is well-tolerated with low rates of grade 3-4- 5 toxicity but lungs-GTV V20<35%, lungs-GTV mean-dose < 20 Gy and oesophagus V50<40% were associated with more toxicity regardless of grade. Because of that, we consider it worth investigating the relationship between dosimetric parameters and toxicity in order to reach a consensus in daily clinical practice.

Surgery or Non-surgical Treatment of ≤8 mm Non-small Cell Lung Cancer: A Population-Based Study.

Background: Timing for intervention of small indeterminate pulmonary nodules has long been a topic of debate given the low incidence of malignancy and difficulty in obtaining a definite preoperative diagnosis. We sought to determine survival outcomes of surgical and non-surgical managements in non-small cell lung cancer (NSCLC) ≤8 mm, which may provide a reference for prospective decision-making for patients with suspected NSCLC.Method: A total of 1,652 patients with Stage IA NSCLC ≤8 mm were identified from the Surveillance, Epidemiology, and End Results (SEER) database and categorized into surgery and non-surgery groups. Chi-square test, t-test and Mann-Whitney U test were used to compare the baseline characteristics between groups. Survival curves were depicted using Kaplan-Meier method and compared by log-rank test. Cox proportional hazard model was used for univariate and multivariate analyses. Adjustment of confounding factors between groups was performed by propensity score matching.Results: The surgery and non-surgery groups included 1,438 and 208 patients, respectively. Patients in surgery group demonstrated superior survival outcome than patients in non-surgery group both before [overall survival (OS): HR, 16.22; 95% CI, 11.48–22.91, p < 0.001; cancer-specific survival (CSS): HR, 49.6; 95% CI, 31.09–79.11, p < 0.001] and after (OS: HR, 3.12; 95% CI, 2.40–4.05, p < 0.001; CSS: HR, 3.85; 95% CI, 2.74–5.40, p < 0.001) propensity score matching. The 30-day mortality rates were 3.1 and 12.0% in surgery and non-surgery groups, respectively. Multivariate analysis suggested age, sex, race, tumor size, grade, pathological stage were all independent prognostic factors in patients with ≤8 mm NSCLC. A comparison of surgical resections revealed a survival superiority of lobectomy over sub-lobectomy. In terms of CSS, no statistically significant difference was found between segmentectomy and wedge resection.Conclusion: The current SEER database showed better prognosis of surgical resection than non-surgical treatment in patients with ≤8 mm NSCLC. However, the factors that should be essentially included in the proper propensity-matched analysis, such as comorbidity, cardiopulmonary function and performance status were unavailable and the true superiority or inferiority should be examined further by ongoing randomized trial, especially comparing surgery and stereotactic body irradiation.

The log odds of negative lymph nodes/T stage: a new prognostic and predictive tool for resected gastric cancer patients

PurposeWhen only the TNM classification is used to predict survival in gastric cancer (GC) patients, the impact of the degree of lymphadenectomy on the prognosis is neglected. This study aimed to establish a more effective nomogram based on the log odds of negative lymph nodes/T stage ratio (LONT) to predict survival in surgically treated GC patients.MethodsThe data of resected GC patients were extracted from the Surveillance, Epidemiology, and End Results Program (SEER) database. Univariate and multivariate Cox regression analyses were used to identify the significant prognostic factors. The prognostic performance was assessed using a calibration plot, concordance index (C-index), and area under the (time-dependent receiver operating characteristic) curve (AUC) to compare the predicted survival probability based on the nomogram score groups.ResultsThe results showed LONT as an independent prognostic factor for cancer-specific survival (CSS) and overall survival (OS), independent of clinicopathological factors. After removing potential redundancy, only LONT, T stage, N stage, location and age were used in the final nomogram model. The model had a higher C-index (0.736 ± 0.012) and AUC (0.798) than the TNM staging system (0.685 ± 0.012 and 0.744). The nomogram score could predict a significant survival difference between any two adjacent groups in terms of CSS and OS.ConclusionHigh LONT is associated with improved survival of gastric cancer patients, independent of other clinicopathological factors. The prognostic nomogram model based on LONT could effectively predict CSS and OS for resectable GC patients.

Comparison of oncologic and functional outcomes between radical nephroureterectomy and segmental ureterectomy for upper urinary tract urothelial carcinoma

This study aims to compare oncologic and functional outcomes after radical nephroureterectomy (RNU) and segmental ureterectomy (SU) in patients with upper urinary tract urothelial carcinoma (UTUC). We retrospectively collected data on patients who underwent either RNU or SU of UTUC. Propensity score matching was performed among 394 cases to yield a final cohort of 40 RNU and 40 SU cases. Kaplan–Meier analysis and the log-rank test were used to compare overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and intravesical recurrence-free survival (IVRFS) between the groups. We also compared the change in postoperative estimated glomerular filtration rate (eGFR). There was no significant difference in terms of CSS, PFS, and IVRFS between the RNU and SU groups, but the RNU group had a better OS than the SU group (p = 0.032). Postoperative eGFR was better preserved in the SU group than in the RNU group (p < 0.001). SU provides comparable CSS, PFS, and IVRFS for patients with UTUC compared to RNU, even in patients with advanced-stage and/or high-grade cancer. Further, SU achieves better preservation of renal function.

Development and external validation of a nomogram for predicting the effect of tumor size on cancer-specific survival of resected gallbladder cancer: a population-based study

The impact of tumor size on account of the long-term survival results in gallbladder cancer (GBC) patients has been controversial. It is urgent necessary to identify the optimal cut-off value of tumor size in resected GBC, and we attempted to integrate tumor size with other prognostic factors into a prognostic nomogram to predict the cancer-specific survival (CSS) of GBC patients. 1639 patients with resected GBC were extracted from the Surveillance, Epidemiology and End Results (SEER) database. X-tile program was used to identify the optimal cut-off value of tumor size. A nomogram including tumor size was established to predict 1-, 3- and 5-year CSS based on the independent risk factors chosen by univariate and multivariable cox analyses. The precision of the nomogram for predicting survival was validated with Harrell's concordance index (C-index), calibration curves, and receiver operating characteristic curve (ROC) internally and externally. Patients with GBC were classified into 1-13mm, 14-63mm and 64mm subgroup based on the optimal cut-off for tumor size in terms of CSS. The nomogram according to the independent factors was well calibrated and displayed better discrimination power than 7th tumor-node-metastasis (TNM) stage systems. The results demonstrated that increased tumor size is closely associated with the worse CSS. Our novel nomogram, which outperforms the conventional TNM staging system, showed satisfactory accuracy and clinically practicality for predicting the outcome of resected GBC patients.