Univariate Prognostic Analysis Research Articles

Role of thoracic conformal radiotherapy in patients with extensive-stage small cell lung cancer

Objective To evaluate the role of thoracic three-dimensional conformal radiotherapy (3DCRT) in patients with extensive-stage small cell lung cancer (ES-SCLC).Methods A total of 171 patients with ES-SCLC admitted from 2004 to 2009 were included in the study.Eighty-six patients received thoracic 3DCRT and systemic chemotherapy (CT),while 85 patients received systemic CT alone.3DCRT was delivered at 1.5 Gy/fraction twice daily or 2.0 Gy/fraction once daily,with a total dose ranging from 40 to 62 Gy.The CT regimen consisted of carboplatin/cisplatin and etoposide.The survival time and survival rate were calculated by the Kaplan-Meier method,and the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis.Results The follow-up rate was 100％.The median overall survival (OS) time and the 2-and 5-year OS rates were 15 months,31.5％,and 2.4％,respectively,for all patients;they were 18 months,35.3％,and 2.4％,respectively,for the CT/3DCRT group,versus 12 months,14.5％,and 2.4％ for the CT group (P =0.023).The median progression-free survival (PFS) time and the 1-and 2-year PFS rates were 8 months,27.5％,and 2.4％,respectively,for all patients;they were 9 months,35.4％,and 6.0％,respectively,for the CT/3DCRT group,versus 6 months,20.5％,and 6.0％ for the CT group (P =0.004).In the CT/3DCRT group,the 22 patients who received 45 Gy at 1.5 Gy/fraction twice daily had a median PFS time of 11 months,versus 9 months for the 26 patients who received 60 Gy at 2.0 Gy/fraction once daily (P =0.037).Multivariate analysis revealed that receiving ≥ 4 cycles of CT (P =0.001) and 3DCRT (P =0.008) were favorable prognostic factors for OS.Conclusions Thoracic 3DCRT can improve the OS and PFS in patients with EDSCLC,and it has good efficacy when delivered with a total dose of 45 Gy at 1.5 Gy/fraction twice daily.Thoracic 3DCRT and receiving ≥4 cycles of CT are independent favorable prognostic factors for OS. Key words: Lung neoplasms/radiotherapy; Radiotherapy, three-dimensional conformal; Radiotherapy, hyperfraction; Prognosis

Expression and clinical significance of PDLIM2 in bladder carcinoma

Objective To investigate the expression of PDLIM2 mRNA in bladder urothelium carcinoma and clinical significance.To explore the values of PDLIM2 in the prediction of postoperative recurrence or progress and prognosis.Methods PDLIM2 mRNA was detected in 80 bladder cancer tissues and 10 normal bladder epithelium tissues by using reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time fluorescent quantitative polymerase chain reaction (FQ-PCR).Correlations between PDLIM2 and clinicopathological features and prognosis were investigated by statistical analyses.Results A significant down regulation of PDLIM2 mRNA expression was observed in the tumor tissues compared with the corresponding normal bladder tissues (P ＜ 0.05),the mean expression of PDLIM2 mRNA in the cancer samples was 49.8％.The expression level of PDLIM2 mRNA was negatively correlated with the tumor grade,clinical stage,number and size (P ＜ 0.05),but not with sex and age (P ＞ 0.05).Patients with low levels of PDLIM2 mRNA expression had a poor prognosis compared with those with a high expression (P ＜0.05).Univariate and multivariate logistic regression prognostic analyses revealed that PDLIM2 mRNA was an independent prognostic factor for disease-free survival in bladder cancer.Conclusion PDLIM2 is significant in the progression of bladder cancer and the status of PDLIM2 mRNA expression is a novel prognostic marker for predicting bladder cancer disease-free survival. Key words: Bladder urothelium carcinoma; PDLIM2; Reverse transcriptase-polymerase chain reaction; Real-time quantitative polymerase chain reaction ; Prognosis

Aberrant expression of monocarboxylate transporter 4 in tumour cells predicts an unfavourable outcome in patients with hepatocellular carcinoma

The tumour cell microenvironment, which includes local oxygen saturation, pericellular pH and stromal cells, can modulate tumour progression. This study determined the prognostic impact of infiltrating tumour-associated macrophages and the expression of monocarboxylate transporter 4 (MCT4) and glypican 3 (GPC3) in hepatocellular carcinoma (HCC) clinical specimens. A total of 225 cases of resected HCC were subjected to immunohistochemical analyses of CD68, CD204, MCT4 and GPC3. Immunoreactivities and other common clinicopathological parameters were subjected to univariate prognostic analyses for overall survival (OS, n=225) and disease-free survival (DFS, n=222). All variables with prognostic impact were further analysed in multivariate analysis. Increased intratumoural infiltration of CD204-positive or MCT4-positive macrophages suggested shorter OS (P=0.015 or P=0.001 respectively), but DFS was not altered. The GPC3 score (with an emphasis on circumferential immunoreactivity) was correlated with shorter OS and DFS. Aberrant expression of MCT4 in HCC cells was observed in a subset of HCC cases (21%, 47/225). In those cases, significantly poorer OS (P<0.0001) and DFS (P=0.0003) were observed, and there was a positive correlation with the intratumoural infiltration of CD204- or MCT4-positive macrophages and the GPC3 score. Multivariate analysis showed that aberrant MCT4 expression in HCC cells was an independent prognostic factor for shorter OS (P=0.018) and DFS (P=0.006) after resection of HCC. Aberrant expression of MCT4 in carcinoma cells serves as a novel, independent prognostic factor for HCC, indicating a poorer patient outcome.

C4.4A highly expressed in HER2-positive human breast cancers may indicate a good prognosis

The aim of our study was to investigate the association of C4.4A expression in breast tumors with both patients' clinicopathological characteristics and outcomes in order to clarify the significance of C4.4A in breast cancer. Primary breast cancer patients (n = 125, stage I-III) who had undergone breast mastectomy or breast-conserving surgery at our hospital between 2005 and 2011 were recruited for this study. Tumor samples were obtained from surgical specimens and expression status of C4.4A, estrogen receptors, progesterone receptors, human epidermal growth factor receptor 2 (HER2) and Ki67 was analyzed immunohistochemically, while HER2 amplification was examined using fluorescence in situ hybridization. Multivariate analysis showed that HER2 positivity was the only independent predictive factor for C4.4A expression (odds ratio 5.31, 95 % confidence interval 2.04-15.72; P < 0.001). Univariate prognostic analysis of the relationship between C4.4A and disease-free survival showed that survival of patients with C4.4A-positive tumors was longer than that of patients with C4.4A-negative tumors in the HER2-positive subset (P = 0.004) while there was no significant difference in patient outcome according to C4.4A status for total patients (median observation period 37 months, range 1-92 months; P = 0.223). We established a positive relationship between C4.4A and HER2 status, suggesting that C4.4A expression may be a prognostic factor for HER2-positive breast cancer patients.

Analysis of therapeutic effects of radiochemotherapy and chemotherapy alone in patients with advanced gastric cancer after gastrectomy

Objective To investigate the therapeutic effects and toxic effects of radiochemotherapy versus chemotherapy alone in patients with advanced gastric cancer after gastrectomy.Methods A total of 183 patients with stage Ⅱ-Ⅳ (M0) gastric cancer,who received treatment after gastrectomy from 2004 to 2010,were included in the study.Of the 183 patients,64 received radiochemotherapy after gastrectomy,and 119 received chemotherapy alone after gastrectomy.The survival rates and hematological and gastrointestinal toxic effects were compared between the two groups;survival difference was also analyzed after the patients were stratified by TNM stage,number of metastatic lymph nodes,and extent of lymph node dissection (D0,D1,and D2).The Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparing toxic effects between the two groups.Results The follow-up rate was 87.8％ ;72 patients were followed up for at least 3 years,and 29 patients for at least 5 years.The 1-,3-,and 5-year survival rates for the radiochemotherapy group were 86％,62％,and 55％,respectively,as compared with 77％,53％,and 43％ for the chemotherapy group (P =0.079).There were no significant differences in grade 3-4 hematological and gastrointestinal toxic effects between the two groups (P =0.363 and 0.617).The univariate analysis showed that radiochemotherapy had a significantly better survival benefit than chemotherapy alone in patients with stage ⅢB-Ⅳ (M0) gastric cancer,patients who underwent D0 lymph node dissection,and patients with more than 6 metastatic lymph nodes (P =0.022,0.025,and 0.021).Conclusions Compared with chemotherapy alone,radiochemotherapy tends to improve survival in patients with gastric cancer after gastrectomy,and its toxic effects are tolerable.The patients with stage ⅢB-Ⅳ (M0) gastric cancer,patients who undergo D0 lymph node dissection,and patients with more than 6 metastatic lymph nodes can benefit from radiochemotherapy. Key words: Gastric neoplasms/radiochemotherapy; Gastric neoplasms/chemotherapy; Prognosis

Prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma after radiochemotherapy

Objective To analyze the prognostic impact of degree of bone metastasis in patients with nasopharyngeal carcinoma (NPC) after radiochemotherapy.Methods A retrospective analysis was performed on the prognosis of 109 NPC patients who had bone metastases after radiochemotherapy in Nanfang Hospital from June 1997 to December 2007.The Kaplan-Meier method was used to calculate survival rates; the log-rank test was used for univariate prognostic analysis; the Cox regression model was used for multivariate prognostic analysis.Results The 5-year follow-up rate was 97.2％.The 1-,2-,3-,and 5-year overall survival rates for all patients were 67.9％,48.6％,32.9％,and 17.4％,respectively.The 1-,2-,3-,and 5-year survival rates for the 43 patients with not more than 3 bone metastases and the 66 patients with more than 3 bone metastases were 90.7％ vs.53.0％,81.4％ vs.27.3％,72.1％ vs.6.2％,and 34.9％ vs.4.2％,respectively (P=0.000).In the patients with more than 3 bone metastases,the 1-,2-,3-,and 5-year survival rates for those with and without other metastatic sites were 56.5％ vs.72.1％,21.7％ vs.30.2％,3.1％ vs.13.0％,and 0.0％ vs.6.5％,respectively (P=0.866).The multivariate analysis showed that more than 3 bone metastases were an adverse prognostic factor in the patients (P =0.000).Conclusions The number of bone metastases is an important prognostic factor in NPC patients after radiochemotherapy.Patients with not more than 3 bone metastases have better survival than those with more than 3 bone metastases,and aggressive treatment should be considered.In addition,the staging system of NPC needs to be improved. Key words: Nasopharyngeal neoplasms/radiotherapy ; Nasopharyngeal neoplasms/chemotherapy ; Bone metastasis ; Prognosis

Neoadjuvant chemotherapy using concurrent docetaxel/CDDP/5-FU (DCF) in esophageal squamous cell carcinoma and its excellent short-term prognosis.

e15122 Background: Neoadjuvant chemotherapy (NAC) using 5-FU/CDDP (FP) followed by surgery is a standard treatment for esophageal squamous cell carcinoma (ESCC). However, this therapy often encountered progression during the early course of treatment. We are developing the novel NAC using Docetaxel/CDDP/5-FU (DCF). Methods: Thirty eight patients who underwent DCF NAC in cStage II/III ESCC was compared with the 41 counterparts treated by FP NAC. Docetaxel and CDDP were both given to 70-75 mg/ m2 with concurrent 5-FU at 750 mg/m2in 3 cycles. Median follow-up term of DCF NAC reached 18 months. Results: In DCF NAC, grade 3 adverse effects (AEs) were recognized in 97% (37/38), however non-hematological AEs exhibited 8% in stomatitis and 5% in anorexia, and completion rate of the DCF NAC was 86 %. In terms of PR+CR rate, DCF NAC was remarkably more excellent (33/38: 86.8%) than FP NAC (24/41: 58.5%)(P=0.0050). In DCF NAC therapy, 30 patients underwent surgery including 24 R0 esophagectomy, whereas another 8 patients selected definitive chemoradiation therapy. We experienced 3 patients with a pathologic complete response (ypCR)(10%) in DCF NAC. The 1st univariate prognostic analysis for progression free survival (PFS) among all the cases with NAC revealed that significant factors were R0 resection (P&lt;0.0001), cT factor (P=0.0098), and NAC modality (P=0.1), and multivariate proportional hazard model identified these 3 factors as independent prognostic factors (IPFs). We then performed the 2nd stage multivariate prognostic analysis limited to R0 cases including pathologic factors for PFS. The univariate negative prognostic factors were FP NAC (P=0.0064), ypT3 (P=0.032), ypN3 (P=0.0017), ypv2/3 (P=0.0072), as well as cT3 (P=0.033), and multivariate analysis identified only NAC modality. DCF NAC was significantly associated with less frequency of ypT3 (P=0.019) and ypv2/3(P=0.013). Conclusions: Novel DCF NAC for ESCC demonstrated high response rates, and is promising for excellent survival in R0 cases, with acceptable feasibility. It improved the patient survival through downstage of the significant prognostic factors.

Analysis of prognostic factors and prognostic indices in breast cancer patients with brain metastases after whole-brain radiotherapy

Objective To analyse the prognostic factors and 5 prognostic indices in breast cancer patients with brain metastases after whole-brain radiotherapy (WBRT).Methods Log-rank test (for univariate prognostic analysis) and Cox regression analysis (for multivariate prognostic analysis) were performed in 99 breast cancer patients with BM who received WBRT from January 2006 to February 2010.The sensitivities and specificities of prognostic indices,including recursive partitioning analysis (RPA),graded prognostic assessment (GPA),basic score for brain metastases (BSBM),Rades,and Carsten,were calculated and compared.Results The median follow-up was 49 months; the median survival was 10 months.The univariate analysis showed that age,Karnofsky performance score (KPS) at the diagnosis of BM,presence of extracranial metastases,primary tumor control,number of BM,and systemic treatment after WBRT were significantly correlated with overall survival (x2 =0.00-55.51,P =0.000-0.013).The multivariate analysis showed that KPS of ＜ 70 and systemic treatment after WBRT were significantly correlated with overall survival (x2 =35.26,P =0.000;x2 =7.21,P =0.007).In predicting ≤3 months of survival for breast cancer patients with BM,the sensitivities and specificities of RPA,GPA,BSBM,Rades,and Carsten were 100％ and 85％,95％ and 62％,95％ and 86％,95％ and 84％,and 95％ and 85％,respectively.Conclusions Systemic treatment after WBRT can improve overall survival in breast cancer patients with BM.In predicting ≤3 months of survival,RPA is the most sensitive index,and BSBM is the most specific index. Key words: Neoplasms brain metastases, breast; Whole-brain radiotherapy ; Prognosis ; Prognostic indexes score

Prognostic analysis of cervical, upper-thoracic, middle-thoracic, and lower-thoracic esophageal cancers in 781 patients mainly receiving three-dimensional radiotherapy

Objective To investigate the different therapeutic effects of three-dimensional radiotherapy in the patients with cervical,upper-thoracic,middle-thoracic,and lower-thoracic esophageal cancer (EC) and the prognostic factors.Methods From September 2003 to January 2009,781 patients with T1-T4 esophageal squamous cell carcinoma received conventional fractionated three-dimensional radiotherapy.Of all the patients,31 had cervical EC,210 had upper-thoracic EC,427 had middle-thoracic EC,and 113 had lower-thoracic EC.The prescribed doses ranged from 50 Gy to 70 Gy,with a median value of 60 Gy.A total of 197 patients received chemotherapy.Kaplan-Meier method was used to calculate the survival rate; Logrank test was used for univariate prognostic analysis; Cox regression test was used for multivariate prognostic analysis.Results The follow-up rate was 95.8％.A total of 128 patients were followed up for more than 5 years.The 1-,3-,and 5-year survival rates of the patients with cervical EC,upper-thoracic EC,middle-thoracic EC,and lower-thoracic EC were 83.9％,67.4％,and 58.1％,80.4％,47.4％,and 35.5％,63.7％,30.2％,and 21.9％,and 69.9％,33.6％,and 28.8％,respectively.There were no significant differences in survival rate between the cervical EC cases and upperthoracic EC cases (x2 =3.03,P =0.082) and between the middle-thoracic EC cases and lower-thoracic EC cases (x2 =1.35,P =0.246).But the cervical EC cases showed significantly higher survival rate than the middle-thoracic and lower-thoracic EC cases (x2 =11.64,P =0.001 ; x2 =7.37,P =0.007),and so was the comparison between upper-thoracic EC cases and middle-thoracic and lower-thoracic EC cases (x2 =17.74,P =0.000; x2 ＝ 4.41,P =0.036).The patients with cervical EC and upper-thoracic EC showed significantly higher 1-,3-,and 5-year survival rates than those with middle-thoracic EC and lower-thoracic EC (80.8％,50.0％,and 38.7％ vs.65.0％,30.9％,and 23.4％,x2 =23.01,P =0.000).Compared with those with cervical EC and upper-thoracic EC,the patients with middle-thoracic EC and lower-thoracic EC showed significantly larger gross tumor volume (GTV) (48.22 cm3 vs.34.74 cm3,Z =5.80,P =0.000),significantly larger lesion length (5.20 cm vs.4.80 cm,Z =2.36,P =0.018),and significantly older age (67 years vs.63 years,Z =2.82,P =0.005).Multivariate analysis showed that lesion length (measured by barium meal),tumor location,non-surgical N stage,and GTV were prognostic factors (x2 =4.13,P =0.042 ;x2 =10.01,P =0.002 ; x2 =10.34,P =0.001 ; x2 =11.19,P =0.001).Conclusions The therapeutic effect of three-dimensional radiotherapy is better in the patients with cervical EC and upperthoracic EC than in those with middle-thoracic EC and lower-thoracic EC. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy, three-dimensional; Prognosis

Prognostic Significance of AKT/mTOR and MAPK Pathways and Antitumor Effect of mTOR Inhibitor in NF1-Related and Sporadic Malignant Peripheral Nerve Sheath Tumors

Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma with poor prognosis. MPNSTs occur frequently in patients with neurofibromatosis type 1 (NF1), in which NF1 gene deficiency leads to Ras hyperactivation. Ras activation causes the subsequent activation of the AKT/mTOR and Raf/MEK/ERK pathways and regulates cellular functions. However, the activation profiles of the AKT/mTOR and MAPK pathways in MPNSTs are poorly understood. The purposes of this study are to examine the correlation between the activation of these pathways and clinicopathologic or prognostic factors and to identify candidate target molecules in MPNST. Moreover, we assessed the antitumor effects of the inhibitor of candidate target. Immunohistochemistry was conducted to evaluate the activation profiles of AKT/mTOR and MAPK pathways using 135 tumor specimens. Immunohistochemical expressions were confirmed by Western blotting. Then, an in vitro study was conducted to examine the antitumor effect of the mTOR inhibitor on MPNST cell lines. Phosphorylated-AKT (p-AKT), p-mTOR, p-S6RP, p-p70S6K, p-4E-BP1, p-MEK1/2, and p-ERK1/2 expressions were positive in 58.2%, 47.3%, 53.8%, 57.1%, 62.6%, 93.4%, and 81.3% of primary MPNSTs, respectively. Positivity for each factor showed no difference between NF1-related and sporadic MPNSTs. Univariate prognostic analysis revealed that p-AKT, p-mTOR, and p-S6RP expressions were associated with poor prognosis. Furthermore, activation of each p-mTOR and p-S6RP was an independent poor prognostic factor by multivariate analysis. mTOR inhibition by Everolimus showed antitumor activity on MPNST cell lines in vitro. mTOR inhibition is a potential treatment option for both NF1-related and sporadic MPNSTs.

Long-term results of elderly nasopharyngeal carcinoma treated with conventional radiotherapy alone in 95 cases

Objective To evaluate the outcomes and toxicities of elderly nasopharyngeal carcinoma (NPC) treated with conventional radiotherapy alone.Methods From January 1995 to December 1998,95 newly diagnosed nasopharyngeai carcinoma with age ≥65 years treated in our hospital.The clinical data were analyzed retrospectively.Kaplan-Meier method was used for analysis of local-regional control survival and distant metastasis-free survival. The Logrank test was used for univariate prognostic analysis and Cox regression was used for multivariable prognostic analysis.Results The follow-up rate was 98％.The 3-,5- and 8-year local-regional control (LRC) and distant metastasis-free survival (DMFS) rates were 89％,87％,84％ and 85％,79％,79％,respectively. The most common acute toxicities were grade1-2 leukopenia (36％),skin reaction (64％) and mucositis (66％).The most frequent late toxicities were hearing impairment (8％),trismus ( 10％ ) and radiation-induced cranial neuropathy (5％).In univariate analysis,interruption of radiotherapy ( χ2 =7.45,P =0.006 ) and regional neck lymph nodes response (χ2 =4.17,P=0.041 ) was the prognostic factors for LRC,T stage (χ2 =4.16,P=0.032),N stage ( χ2 =4.66,P =0.031 ) and interruption of radiotherapy ( χ2 =9.42,P =0.002 ) was the prognostic factors for DMFS. In multivariable analysis,interruption of radiotherapy and the regional neck lymph nodes response were the prognostic factors for LRC (χ2=6.19,P=0.013 and χ2=12.16,P=0.002;respectively),N stage and radiotherapy interruption were prognostic factors for DMFS.(χ2=15.06,P =0.000 and χ2 =21.62,P =0.000 ; respectively ).Conclusions Conventional radiotherapy alone for elder NPC can produce satisfactory results with acceptable treatment-relative toxicities.Our experience showed that the early N stage,without radiotherapy interruption and good regional lymph nodes response had a good longterm prognosis. Key words: Nasopharyngeal neoplasms, elderly/radiotherapy; Radiotherapy, conventional; Prognosis

Bone and/or joint attachment is a risk factor for local recurrence of myxofibrosarcoma

BackgroundMyxofibrosarcoma is characterized by a high local recurrence rate despite optimal surgical treatment. The definition of prognostic factors for recurrence offers high-risk patients a closer follow-up and a multi-disciplinary therapeutic approach. MethodsA cohort of 23 patients treated for primary myxofibrosarcoma was retrospectively analyzed. The patients (sex and age), tumors (size, stage, tumor location, bone and/or joint attachment), radiological findings (abnormal signal extension in MRI), histological findings (FNCLCC grade and microscopic extension along the muscle fascia), and treatment (surgical margin) characteristics were included in univariate prognostic factor analysis. ResultsAfter a median follow-up of 63.3 months (range 15–191), the overall recurrence rate was 34.7%. Median time between initial surgery and recurrence was 24.8 months (range 8–52). Inadequate surgical margins (p = 0.026) and bone and/or joint attachment (p = 0.001) were associated with an increased recurrence rate. ConclusionFor the further improvement of local recurrence-free survival of patients with myxofibrosarcoma, accurate diagnosis of the tumor extension and adequate planning for the surgical margin should be focused on in cases with bone and/or joint attachment.

Optimal use of adjuvant chemotherapy in stage II colorectal cancer

The prognosis of stage II colorectal cancer varies. Whether or not to perform adjuvant chemotherapy on patients with stage II colorectal cancer is a controversial issue. The aims of this study were to identify relevant risk factors for the prognosis of stage II colorectal cancer and to evaluate the need for adjuvant chemotherapy. Between January 2000 and January 2005, 443 patients with stage II colorectal cancer who had received radical surgery at the Sun Yat-sen University Cancer Center were retrospectively analyzed. The overall survival rates and survival curves were analyzed using the Kaplan-Meier method and log-rank test. Univariate and multivariate prognostic analyses were performed using the Cox regression model. Patients with certain important risk factors were analyzed according to whether they received adjuvant chemotherapy, and four chemotherapeutic regimens were classified into sub-groups and analyzed. Univariate analyses showed that intestinal obstruction or perforation, type 2 diabetes mellitus, an inadequate surgical margin, and sampling of less than 12 lymph nodes were risk factors that correlated with poor prognosis. Patients with an intestinal obstruction or perforation and insufficient lymph node samples achieved higher 5-year survival rates with adjuvant chemotherapy than with surgery alone. Intestinal obstruction or perforation, sampling of less than 12 lymph nodes, and inadequate surgical margins were identified as risk factors for poor survival, and patients with either of the first two factors benefited from adjuvant chemotherapy. Moreover, the use of capecitabine alone may be insufficient for patients with an intestinal obstruction or perforation.

Analysis of prognostic factors in lymph node-negative advanced gastric cancer patients

To investigate the prognostic factors of lymph node-negative advanced gastric cancer patients in order to guide adjunctive therapy and surveillance tragedy. A total of 236 advanced gastric cancer patients with no less than 12 retrieved lymph nodes and without lymph node metastasis from Fujian Provincial Hospital between 1998 and 2008 were collected retrospectively. Univariate and multivariate prognostic analysis were performed. Two hundred and twenty-four patients(94.9%) were followed up and 5-year overall and disease-free survival rates were 75.2% and 66.4% respectively. Univariate prognostic analysis showed that depth of infiltration, Lauren histotype and retrieved lymph nodes were associated with 5-year overall survival(all P<0.05). Multivariate prognostic analysis testified that depth of infiltration was independent prognostic predictor(P<0.05). Recurrent rates of T2 and T3 patients were 5.8%(8/138) and 14.0%(12/86),5-year overall survival rates were 82.5% and 59.0%, 5-year disease-free survival rates were 70.4% and 52.2% respectively. These differences were all statistically significant (all P<0.05). T2N0 gastric cancer patients have a better prognosis than T3N0 patients. Depth of infiltration should be considered to stratify lymph node-negative gastric cancer patients for an adjunctive treatment and follow-up scheduling.

Radiotherapy for and prognosis of breast cancer patients with local-regional recurrence after mastectomy

Controversies remain regarding the therapeutic principle for and prognosis of breast cancer patients with isolated local-regional recurrence after mastectomy. This study was to evaluate the role of radiotherapy in treating these patients and to investigate the prognosis. Clinical data of 255 breast cancer patients with chest-wall and/or regional lymph node recurrence as first failure after mastectomy from 1990 to 2005 were analyzed. All patients received radiotherapy for recurrence. The median follow-up time was 45 months (9 months-15.5 years). The median disease-free interval (DFI) was 22 months (2-260 months); it was 37 months in patients with positive hormonal receptor and 17 months in those with unknown or negative receptor. The 2-, 5-, and 8-year overall survival (OS) rates were 86.4%, 56.5%, and 35.0%, respectively. The median survival time was 79 months. The 2-, 5-and, 8-year local control rates were 6.1%, 36.3%, and 27.6%, respectively. Univariate prognostic analysis showed that DFI, site and number of recurrence, receptor status, short-term therapeutic response, initial T status and axillary involvement significantly affected the survival (all P<0.05); multivariate analysis showed that DFI, receptor status, site and number of recurrence were independent prognostic factors. Prognostic index was established to classify the patients. The 2-, 5-and 8-year OS rates were 100%, 91.6%, and 56.4% in the favorable prognosis group, 88.1%, 59.1%, and 36.8% in the medium prognosis group, 68.0%, 8.5%, and 0 in the poor prognosis group (P<0.001). Radiotherapy is effective for breast cancer patients with isolated local-regional recurrence after mastectomy. Prognostic index could be applied to predict the prognosis.

Prognostic analysis of 443 cases of stage II colorectal cancer and the value of adjuvant chemotherapy

Prognosis of stage II colorectal cancer varies. Whether or not to perform adjuvant chemotherapy on patients with stage II colorectal cancer is controversial. This study was to explore the prognostic factors for the patients with stage II colorectal cancer and evaluate the effect and the necessity of adjuvant chemotherapy. Between January 2000 and January 2005, 443 patients with stage II colorectal cancer receiving radical surgery at Sun Yat-sen University Cancer Center were retrospectively analyzed. The overall survival rate and survival curve were analyzed using the Kaplan-Meier method and the log-rank test. The univariate and multivariate prognostic analyses were performed by the Cox regression model. Patients with or without chemotherapy (Xelox/Folfox regimen) with high-risk factors were analyzed respectively. The median follow-up time was 59 months, and the 3-and 5-year survival rates were 88.4% and 82.5%, respectively. Univariate analysis showed that intestinal obstruction or perforation, diabetes mellitus, inadequate surgical margin, and the number of sampled nodes < 9 were poor prognostic factors. Patients with intestinal obstruction or perforation, the number of sampled nodes < 9 achieved higher 5-year survival (80% and 86%) undergoing adjuvant chemotherapy than those receiving surgery alone (67% and 64%). The prognosis of colorectal cancer patients with intestinal obstruction or perforation, diabetes mellitus, inadequate surgical margin, and the number of sampled nodes < 9 are relatively poor. Adjuvant chemotherapy is recommended to patients with intestinal obstruction, perforation or sampled nodes < 9.

Preoperative Serum CA19-9 and Dissected Peripancreatic Tissue Margin as Determiners of Long-Term Survival in Pancreatic Cancer

Pancreatic cancer, a particularly deadly form of malignancy, has increased in the last decade worldwide. The purpose of this study is to identify markers for determining and identifying possible long-term survivors in cases of advanced pancreatic cancer. 117 patients with pancreatic ductal carcinoma, including 89 with invasive tubular adenocarcinoma of the pancreas, Japan Pancreas Society (JPS) stage III-IVb patients, who underwent tumor resection between 1986 and 2006. Univariate prognostic analyses of the 5-year disease-specific survival (DSS) revealed that JPS stage (P < 0.0001), preoperative serum carbohydrate antigen 19-9 (CA19-9) level (preCA19-9; P < 0.0001), dissected peripancreatic tissue margin (DPM; P < 0.0001), residual tumor (R factor; P = 0.0007), lymph node metastasis density over 10% (ND10; P = 0.006), volume of the stromal connective tissue (stroma factor; P = 0.008), growth pattern (P = 0.01), and histology (P = 0.03) were all significantly associated with poor outcome in advanced pancreatic cancer. Multivariate logistic analysis confirmed that preCA19-9 [P = 0.0006, relative risk (RR) = 2.16] and DPM (P = 0.04, RR = 1.62) were prognostic factors that remained, independent of JPS stage (P = 0.001). The higher preCA19-9 was, the worse the prognosis was. Astonishingly, among JPS stage III cases, 76.9% of the patients with preCA19-9 below 37 U/ml survived more than 5 years. This, combined with an analysis of DPM, allowed us to identify those with the potentiality for long-term survival. Our results reveal for the first time that it is possible with JPS stage III-IVb invasive tubular adenocarcinomas of the pancreas to differentiate prognostic groups and potential survival rates, like with other cancers.

Lymph Node Metastasis Density and Growth Pattern as Independent Prognostic Factors in Advanced Esophageal Squamous Cell Carcinoma

Esophageal cancer is one of the leading types of cancer, and it is a particularly deadly form of malignancy. TNM classification is the most common staging system, but it has been reported that prognosis is not reflected adequately by this classification. The purpose of this study was to clarify independent prognostic factors in esophageal squamous cell carcinoma (ESCC), a dominant type of esophageal cancer in Japan, to broaden the staging system to improve its predictive value. Thus staging could be expanded to make the prognosis a valuable clinical tool, and to improve knowledge of the biological traits of advanced ESCC. The present study included 121 patients with advanced ESCC (stage II to IVA) treated by esophagectomy between 1990 and 2003 at the Kitasato University Higashi Hospital. Univariate prognostic analysis of the disease-specific survival revealed that TNM stage (p < 0.0001), lymph node metastasis density over 10% (ND10; p < 0.0001), R-category (p = 0.003), intramural metastasis within the esophagus (IM; p = 0.009), growth pattern (p = 0.01), and size of tumor (p = 0.02) were significantly associated with a poor outcome in advanced ESCC. Multivariate analysis confirmed that growth pattern (p = 0.02, HR = 3.1) and ND10 (p = 0.02, HR = 2.0) were finally remnant prognostic factors independent of TNM stage. Growth pattern was prominent in stage II, whereas ND10 was directly proportional to stage progression and characteristics to stage IV disease. Interestingly, ND20, the most malignant phenotype of ESCC, was the only prognostic determinant, even in stage IV disease. From the present study, we concluded that progression of lymph node density is characteristic of a life-threatening phenotype of advanced ESCC, and it should be employed as a therapeutic target to improve patient survival. Growth pattern is an alternative target characteristic of less advanced ESCC. Both of these parameters may be applied as useful clinical tools in the management of patients with advanced esophageal cancer.

A multivariate analysis of a series of 382 primary retroperitoneal sarcomas (RPS)

10065 Background: A national retrospective study was conducted by the French Association of Surgery on primary RPS in order to define the best type of surgery and determine prognostic factors for abdominal recurrence and patient survival. There is still no consensus concerning the precise value of the extent of surgery and additional treatment modalities. Methods: Types of surgery were classified as: “systematic complete resection”, which is a systematic or partial resection of non-involved contiguous organs to achieve wide margins, “contiguously involved organ resection” and “simple complete resection”, a resection of the tumor with grossly negative margins. Survival was determined with the Kaplan-Meier method. Univariate and multivariate prognostic analyses were performed using logrank test and Cox model. Results: Data of 382 pts operated between 1985 and 2005 were retrospectively reviewed. Median age was 57 years (range 14–87). Median tumor size was 18 cm. Systematic complete resection, contiguously involved organ resection and simple complete resection were performed for 134 (35%), 153 (40%) and 87 (23%) pts, respectively. Eight pts (2%) had a biopsy without resection and 45 pts (12%) had macroscopic residual disease. Tumor was spilled during surgery for 76 pts (20%). Systematic complete resection and no spilling of the tumor were highly correlated with the number of pts operated by center (p-values &lt;10-4). Histologic negative margins (136 pts, 36%) were highly correlated with systematic complete resection (p-value &lt;10-4). Chemotherapy and radiotherapy were given to 135 (35%) and 122 pts (32%). Median survival was 6 years whereas median time to abdominal recurrence and metastasis were 4 and 15 years, respectively. On multivariate analysis, pre op biopsy, low grade, no spilling of the tumor, negative margins and number of pts operated by center were the significant factors predicting abdominal recurrence control whereas low grade, no spilling of the tumor and no macroscopic residual disease significantly predicted better overall survival. Conclusions: Tumor grade and quality of surgery were the two main prognostic factors for abdominal recurrence and overall survival. Surgical experience of these rare tumors and systematic complete resection decreased abdominal recurrence rate. No significant financial relationships to disclose.

Low serum albumin levels and liver metastasis are powerful prognostic markers for survival in patients with carcinomas of unknown primary site

BACKGROUND. The authors investigated how lymphopenia and low serum albumin levels correlate with the prognosis of patients with carcinoma of unknown primary (CUP). METHODS. Univariate and multivariate prognostic factor analyses were conducted in a population of 317 consecutive patients with CUP who were evaluated at the Cross Cancer Institute of Edmonton, Alberta, Canada, from 1998 to 2004. RESULTS. The results from multivariate analysis showed that patients who had a performance status � 2 (using the World Health Organization scale), a high overall comorbidity score (on the Adult Comorbidity Evaluation 27), liver metastasis, elevated serum lactate dehydrogenase (LDH) levels, lymphopenia (defined as an absolute lymphocyte count � 0.7 � 10 9 /L), and low serum albumin levels had a worse prognosis. Based on the observation that the presence of liver metastasis and low serum albumin levels were the most powerful adverse prognostic factors, a classification scheme was delineated that took those 2 variables into account. A group of good-risk patients (no liver metastasis and normal serum albumin levels) and a group of poor-risk patients (liver metastasis and/or low serum albumin levels) were identified with median survivals of 371 days and 103 days, respectively (P < .0001). This classification was validated further in an independent data set of 124 patients who were evaluated at 2 French cancer centers: Among those patients, the median survival was 378 days in the good-risk group and 90 days in the poor-risk group (P < .0001). The new prognostic model substantially outperformed the previous standard prognostic model, which was based on performance status and serum LDH levels. CONCLUSIONS. Lymphopenia and low serum albumin levels were identified as 2 new independent markers of prognosis in patients with CUP. Although the authors confirmed the validity of the previous prognostic model, they developed and validated a more powerful, simple model based on the 2 most powerful adverse prognostic factors: liver metastasis and low serum albumin levels. These findings were confirmed in an independent cohort of patients with CUP, and consideration of the authors’ improved prognostic model for survival of patients with CUP is warranted. Cancer 2006:107:2698–705. � 2006 American Cancer Society.