Worst 5-year Overall Survival Research Articles

Clinical and Demographic Factors, Treatment Patterns, and Overall Survival Associated With Rare Triple-Negative Breast Carcinomas in the US

Triple-negative breast cancers are known collectively to demonstrate a more aggressive clinical course and earlier recurrence than cancers of other histological subtypes. However, the literature on rare triple-negative breast cancers and the association of histological type with survival and risk of metastasis is sparse. To present the clinical and demographic characteristics, treatment patterns, and overall survival (OS) for histologically rare (<10% of breast cancers) triple-negative breast cancer types: medullary carcinoma, adenoid cystic carcinoma, and metaplastic breast carcinoma. This cohort study was performed in the US using data reported by the National Cancer Database between 2010 and 2016. Confirmed cases of medullary carcinoma, adenoid cystic carcinoma, and metaplastic breast cancer were analyzed. Univariable analyses and multivariable Cox regression models were performed. Data analysis was performed from April to May 2020. The primary outcome was 5-year OS. Secondary outcomes included site of metastasis, effect of immunohistochemistry, management, and 2-year mortality. A total of 8479 patients with breast cancer (mean [SD] age; 62.6 [14.3] years; 8435 women [99.48%]) were analyzed. Metaplastic carcinoma was the most commonly diagnosed histological type in this cohort, with 6867 patients (81%), followed by 1357 (16%) with adenoid cystic carcinoma and only 255 (3%) with medullary carcinoma. Medullary carcinoma presented earlier in life, at a median (interquartile range) age of 53 (45-62) years, compared with 62 (53-72) years for patients with adenoid cystic carcinoma and 63 (52-74) years for patients with metaplastic carcinoma. The proportion of tumors with triple-negative immunohistochemistry varied by histological type for medullary carcinoma (57 patients [22.4%]), adenoid cystic carcinoma (653 patients [48.1%]), and metaplastic carcinoma (3637 patients [53.0%]). Patients with adenoid cystic carcinoma were less likely to receive radiotherapy (711 patients [52.4%]) and chemotherapy (175 patients [12.9%]) compared with patients with medullary carcinoma (radiotherapy, 156 patients [61.2%]; chemotherapy, 190 patients [74.5%]) and metaplastic carcinoma (radiotherapy, 3416 patients [49.7%]; chemotherapy, 4709 patients [68.6%]). The 5-year OS rate was superior for patients with medullary (91.7%) and adenoid cystic carcinoma (88.4%) compared with patients with metaplastic carcinoma (63.1%). The 5-year mortality rate for adenoid cystic carcinoma was 8.33% vs 36.91% for metaplastic carcinoma. Nationally, over the course of 7 years, medullary carcinoma was most common and metaplastic carcinoma had the worst 5-year OS among the rare histological breast cancer subtypes analyzed. Factors associated with a poor prognosis for metaplastic carcinoma included advanced stage, lung metastasis, older age, and not receiving chemotherapy or radiation therapy. Future research focusing on rare subtypes of breast cancer is desirable and could inform the optimal management of these relatively understudied carcinomas.

Rare triple-negative breast cancers (TNBC): An NCDB analysis.

e19253 Background: The literature on rare triple negative breast cancer (TNBC) histology types is sparse; herein we present the clinical demographic and treatment patterns as well as overall survival (OS) for rare (&lt; 10%) types of breast cancers that typically present as TNBCs: Medullary carcinoma (MedC), Adenoid cystic carcinoma (ACC), and Metaplastic breast cancer (MetC). Methods: Records of patients with a confirmed diagnosis of MedC, ACC, and MetC between 2010 and 2016 in the National Cancer Database (NCDB) were analyzed. Patients with an unknown stage were excluded. Univariate analyses and multivariable Cox-regression models were performed in SAS v. 9.4. Results: A total of 8,479 records were analyzed. MetC was the most commonly diagnosed histologic type in our cohort with 6,867 (81%) patients versus 255 (3.0%) MedC patients and 1,357 (16%) ACC patients. MedC presented earlier in life, with a median age of 53 years versus 62 years for ACC patients, and 63 years for MetC patients. The proportion of TNBC varied by histology type for MedC (70.4%), ACC (77.0%), and MetC (79.0 %). Patients with ACC were less likely to receive radiotherapy (52.4%) and chemotherapy (12.9%) compared to MedC (61.2%, 74.5%) and MetC (49.7%, 68.6%) respectively. On Cox multivariate regression, age ≥60 (HR 4.7), stage ≥3 [compared to patients with stage 0&amp;1] (HR 5.7), and not receiving radiotherapy (HR 2.0) or chemotherapy (HR 1.25) conferred worse overall survival for MedC. Similarly, among patients with ACC, age ≥60 (HR 3.5), stage ≥3 (HR 5.3), and lymph node involvement (HR 4.8) were adverse prognostic indicators as well as not receiving radiation therapy (HR 1.47). Among MetC, lung metastasis (HR 2.6), stage ≥3 (HR 4.5), but also not receiving chemotherapy (HR 1.8) or radiation therapy (HR 1.47) was associated with worse survival outcomes. All p-values for cox regression is &lt;0.0001. The 5-year OS was 92.6% for patients with MedC, 92.0% for ACC patients, 69.3% for MetC patients; all p-values &lt;0.0001. Conclusions: This analysis describes rare types of TNBCs: MedC (most common), ACC, and MetC. We noted heterogeneity among these 3 rare types of TNBC, with the worst 5-year OS noted for MetC. Poor prognostic factors for MetC include advanced stage, lung metastasis, older age, and not receiving chemotherapy or radiation therapy. Future research focusing on rare subtypes of breast cancer is desirable and would potentially inform the optimal management of these breast carcinomas.

Long-term outcomes of periampullary adenocarcinomas after pancreaticoduodenectomy – a peruvian multi-institutional study

Background: Reports of periampullary adenocarcinomas are scarce in Latin-America. Pancreatic adenocarcinoma (PA) has the highest incidence in western countries, but also worse survival compared to distal bile duct (DBD), ampullary (AA) and duodenal (DA) adenocarcinomas, even after being resected by pancreaticoduodenectomy (PD). In this study, we analyze the survival of patients with resected periampullary adenocarcinomas and determined factors that influence this outcome. Methods: We retrospectively analyzed patients undergoing PD for periampullary adenocarcinoma from 2002 to 2011 in the three major pancreatic surgery centers in Peru. Postoperative mortalities (90-day) were excluded. Clinicopathologic features that may influence overall survival (OS) were collected and analyzed by Kaplan–Meier method. Log-Rank test and Cox regression modelling were used for univariate and multivariate analysis, respectively. Results: 473 Periampullary adenocarcinomas (153 PA, 258 AA, 33 DBD and 29 DA) treated by PD were identified. 5-year OS was 34% with a median survival of 28 months for the entire cohort. PA was associated with the worst 5-year OS (11%) compared to DBD (24%), DA (41%) and AA (47%), respectively (p < 0.01). Predictors of poor survival were site of primary, age ≥ 70 years, tumor size ≥ 2.5 cm, high-grade tumors, nodal metastases, lymphovascular invasion, perineural invasion and positive resection margin. On multivariate analysis, site of primary and nodal metastases were the strongest predictors of survival. Conclusion: We report the oncologic outcomes of the largest multi-institutional series of resected periampullary adenocarcinomas in Peru and Latin-America. AA is the most frequently resected tumor and portent the best prognosis, while PA has the worst OS. Patient selection could account for differences with reports of developed countries.Table 1Univariate and multivariate analysis of predictors of OS in patients undergoing PD for periampullary adenocarcinomasVariableNumber of patients5 years OSUnivariate analysisMultivariate analysisHazzard ratio (95% CI)PHazzard ratio (95% CI)PSex Man21780(37%) Woman25679 (31%)1.1 (0.9–1.4)0.304––Age <70 years332118 (36%) ≥70 years14141 (29%)1.3 (1.1–1.7)0.0171.4 (1.1–1.8)0.008Tumor size <2.5 cm14676 (41%) ≥2.5 cm28783 (29%)1.5 (1.2–1.9)0.0011.1 (0.8–1.4)0.549Site of primary Pancreas15317 (11%)ReferenceReference Distal Bile Duct333 (24%)0.6(0.4–0.9)<0.0010.7 (0.4–1.0)0.008 Duodenum2912 (41%)0.3 (0.2–0.6)0.0080.6 (0.3–0.9)0.036 Ampulla of Vater258122 (47%)0.3 (0.2–0.4)<0.0010.5 (0.4–0.7)<0.001Nodal metastases Negative237116 (49%) Positive23643 (18%)2.5 (2.0–3.1)<0.0011.7 (1.3–2.2).<0.001Degree of differentiation G115772 (46%) G2 + G3 + G431687 (23%)1.8 (1.4–2.3)<0.0011.4 (1.1–1.8)0.016Lymphovascular invasion Negative17294 (55%) Positive30165 (22%)2.7 (2.1–3.4)<0.00115.(1.1–2.1)0.011Invasionperineural Negative240115 (48%) Positive23344 (19%)2.4 (1.9–3.0)<0.0011.2 (0.9–1.6)0.205Resection margin Negative419153 (37%) Positive546 (11%)2.8 (2.4–3.9)<0.0011.6 (1.1–1.3)0.007OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated. Open table in a new tab OS, overall survival; PD, pancreaticoduodenectomy; CI, confidence interval; G1, well differentiated; G2 moderately differentiated; G3 poorly differentiated; G4, undifferentiated.

Cutaneous Angiosarcoma: A Single-Institution Experience

Cutaneous angiosarcoma (CAS) is a rare, aggressive vascular sarcoma with a poor prognosis, historically associated with 5-year overall survival (OS) rates between 10 and 30%. This is a single-institution retrospective review of patients treated for CAS from 1999-2011. Demographics, primary tumor characteristics, treatment, and outcomes were analyzed. A total of 88 patients were identified (median age 70years and 57% female). Median tumor size was 3cm. Median follow-up was 22months. The 5-year OS and recurrence-free survival (RFS) were 35.2 and 32.3%, respectively; median was 22.1months. Also, 36 patients (41%) received surgery alone, 7 (8%) received XRT alone, and 41 (47%) received surgery and XRT. Of the 67 of 88 patients who were disease-free after treatment, 33 (50%) recurred (median of 12.3months). Surgery alone had the highest 5-year OS (46.9%) and RFS (39.9%) (p=ns). Four presentation groups were identified: (1) XRT-induced, n=30 (34%), 26 of 30 occurred in females with a prior breast cancer, (2) sporadic CAS on head and neck (H/N), n=38, (3) sporadic CAS on trunk/extremities, n=13, and (4) Stewart-Treves n=7. Those with trunk/extremity CAS had the highest 5-year OS (64.8%), with H/N CAS having the worst 5-year OS (21.5%). On MV analysis, only tumor size <5cm correlated with improved OS (p=0.014). In this large series, there appears to be a better overall prognosis than historically reported, especially in Stewart-Treves and CAS on trunk or extremities. While surgery alone was associated with better OS and RFS compared with other treatment modalities, this was not statistically significant. Tumor size was a significant prognostic factor for OS.