Ampullary adenocarcinoma: Defining predictors of survival and the impact of adjuvant therapy following surgical resection for stage I disease

2018 ◽  
Vol 117 (7) ◽  
pp. 1500-1508 ◽  
Author(s):  
Zachary E. Stiles ◽  
Stephen W. Behrman ◽  
Jeremiah L. Deneve ◽  
Evan S. Glazer ◽  
Lei Dong ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Stage I ◽  
Ampullary Adenocarcinoma ◽  
The Impact

Utilization and Impact of Adjuvant Therapy after Surgical Resection in Stage I Ampullary Adenocarcinoma

2017 ◽  
Vol 225 (4) ◽  
pp. e129
Author(s):  
Zachary Stiles ◽  
Stephen W. Behrman ◽  
Jeremiah L. Deneve ◽  
Evan S. Glazer ◽  
Paxton V. Dickson
Keyword(s):  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Stage I ◽  
Ampullary Adenocarcinoma

Natural history and prognosis of untreated stage I epithelial ovarian carcinoma.

1996 ◽  
Vol 14 (11) ◽  
pp. 2968-2975 ◽  
Author(s):  
F Y Ahmed ◽  
E Wiltshaw ◽  
R P A'Hern ◽  
B Nicol ◽  
J Shepherd ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Natural History ◽  
Adjuvant Therapy ◽  
Physical Examination ◽  
Ct Scan ◽  
Prognostic Significance ◽  
Stage I ◽  
Gynecology And Obstetrics ◽  
Serum Ca125 ◽  
The Impact

PURPOSE The aim of this study was to investigate the independent significance of prognostic factors in stage I invasive epithelial ovarian cancer (EOC). PATIENTS AND METHODS Between 1980 and 1994, all patients with stage I EOC (borderline tumors excluded) following surgical resection were entered onto this study. No patient received adjuvant therapy and patients were monitored as follows: years 1 to 2-physical examination and serum CA125 every 3 months and computed tomographic (CT) scan every 6 months; years 3 to 5-physical examination and serum CA125 every 6 months and CT scan yearly; years 5 to 10-annual physical examination and serum CA125, with CT scan if clinically indicated. RESULTS A total of 194 patients entered the study. The median patient age was 54 years (range, 15 to 83), and the median follow-up duration 54 months (range, 7 to 157). Five-year survival rates were as follows: stage IA, 93.7%; stage IB, 92%; and stage IC, 84%. Multivariate analysis using Cox's regression identified grade (P < .001), presence of ascites (P = .05), and surface tumor (P < .01) as independent poor prognostic factors. International Federation of Gynecology and Obstetrics (FIGO) substage did not appear to have independent prognostic significance. Intraoperative capsule rupture was not found to be prognostically significant. The impact of pre-operative rupture remains unclear. CONCLUSION This is an important series, as no patient received adjuvant therapy, and represents the natural history of surgically resected stage I EOC.

Survival impact of neoadjuvant therapy in resected pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 367-367
Author(s):  
Katelin Anne Mirkin ◽  
Christopher S Hollenbeak ◽  
Joyce Wong
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Median Survival ◽  
Clinical Stage ◽  
Stage I ◽  
Median Income ◽  
Stage Disease ◽  
Surgery First ◽  
The Impact

367 Background: Pancreatic cancer carries a dismal prognosis, with surgical resection and adjuvant therapy offering the only hope for long-term survival. In recent years, neoadjuvant therapy (NAT) has been employed to optimize outcomes. This study evaluates the impact of NAT on survival in patients with resected stage I-III pancreatic cancer. Methods: The National Cancer Data Base (2003-2011) was analyzed for patients with clinical stage I-III resected carcinoma of the pancreas who underwent NAT or surgery first +/- adjuvant therapy. Univariate statistics were used to compare characteristics between groups. Analysis of variance and Kaplan Meier analyses were used to compare median survival for each clinical stage of disease. Multivariate analyses were performed using a Cox proportional hazards model. Results: 16,122 patients who underwent NAT and 16,869 patients who underwent surgery-first were included. Patients who underwent NAT tended to be younger, covered by private insurance, have a higher median income, greater comorbidities, higher clinical stage disease, and undergo a whipple. Additionally, NAT patients had a greater number of positive regional lymph nodes (9 vs. 6, respectively), although a similar number of nodes retrieved, and higher pathological stage disease. In patients with clinical stage I disease, adjuvant therapy was associated with improved median survival than NAT and surgery-alone (24.8, 18.5, 17.9 months, p < 0.0001, respectively). However, in stage II, adjuvant and NAT offered similar median survival, which was improved over surgery-alone (20.5, 20.1, and 12.4 months, p < 0.0001, respectively). In stage III, NAT had improved median survival than the other groups (19.6, 14.2, 8.6 months, p < 0.0001, respectively). In the multivariate survival analysis, patients who received NAT had a 22% lower hazard of mortality up to 5 years as compared to adjuvant therapy (p < 0.0001). Conclusions: Neoadjuvant therapy in advanced stage pancreatic cancer confers a survival benefit and may allow more patients to undergo surgery; NAT appears to offer similar survival as adjuvant therapy in early stage pancreatic cancer.

Impact of adjuvant therapies on survival in patients with cholangiocarcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 360-360
Author(s):  
Laura Dover ◽  
Rojymon Jacob ◽  
Thomas Wang ◽  
Robert Oster ◽  
Derek Dubay
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Cox Regression ◽  
Tumor Stage ◽  
Rank Test ◽  
Resection Margins ◽  
Positive Margins ◽  
Number Of Patients ◽  
The Impact

360 Background: Surgical resection is the only curative option for Cholangiocarcinoma (CC) and currently there are no clear guidelines for adjuvant therapy following resection. Given the high incidence of local and distant recurrences following resection, we evaluated the impact of adjuvant chemotherapy or chemoradiation (CRT) on median survival (OS). Methods: A retrospective review was performed identifying all patients with CC who underwent curative surgical resection at our institution between 2002 and 2012. Patients who underwent aborted or palliative procedures were excluded. Survival estimates were quantified using Kaplan Meier curves, and differences between groups were compared with the log-rank test and Cox regression models. Results: During the study period, 103 patients underwent curative resection for CC at our institution. Tumor location was intrahepatic, perihilar and distal in 37% (n=38), 23% (n=24) and 40% (n=41) respectively. A total of 49 (48%) patients received adjuvant chemotherapy (n= 28) or CRT (n=21). Observation with no additional therapy was employed in the remaining 54 (52%) patients. No patient was treated using radiation alone. OS was 21.4 and 41.4 months (m) for those receiving adjuvant therapy versus observation (p=0.08). OS for adjuvant therapy versus observation were 28.4 m and 19.4 m respectively, if surgical margins were positive (p=0.036); and 79.1 m and 26.3 m respectively (p=0.4) with negative resection margins. OS was 41.4 m and 38.0 m with adjuvant chemo versus CRT respectively (p=0.1). Tumor stage was the only statistically significant pathologic indicator of outcome (p=0.019). Conclusions: A trend towards significant improvement in OS was observed with the use of adjuvant therapy among all patients following resection of CC. Adjuvant therapy significantly improved OS among CC patients with positive margins of resection. The small number of patients with negative margins of resection also benefitted, though not significantly. These data suggest that while adjuvant therapy should be considered for all patients irrespective of margin status; patients with positive margins are likely to benefit the most.

The impact of tumor genomic profile on the effectiveness of adjuvant chemotherapy in resectable intrahepatic cholangiocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 474-474
Author(s):  
Rebecca Marcus ◽  
Heather A. Lillemoe ◽  
Reham Abdel-Wahab ◽  
Rachna T. Shroff ◽  
Milind M. Javle ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Surgical Resection ◽  
Idh1 Mutation ◽  
Genetic Mutations ◽  
Genomic Profiling ◽  
Genomic Profile ◽  
Lower Stage ◽  
Incidence And Mortality ◽  
The Impact

474 Background: The incidence and mortality of ICC is rising in the U.S. While surgical resection currently offers the only potential for cure, the role of adjuvant chemotherapy is not well defined. Tumor genomic profiling is increasingly used to make adjuvant therapy decisions for malignancies. The purpose of this project was to evaluate the correlation between tumor genomic profile and the ability of adjuvant chemotherapy to prevent ICC recurrence after resection. Methods: A retrospective review of 49 patients with ICC undergoing surgical resection and comprehensive tumor genomic profiling was performed. The median age at diagnosis was 56 years (range: 21-72 yrs), 67% were female, and 67% were Caucasian. At resection, 20% had stage I disease, 43% stage II, 29% stage III, and 8% stage IV. Over 90% had moderately or poorly differentiated adenocarcinoma. Clinically relevant genetic mutations (those targeted by anticancer drugs currently on the market or required for entry into a mechanism-driven clinical trial) were evaluated using Foundation Medicine testing. Results: The median recurrence free survival (RFS) for the entire cohort was 9 months (range: 1-55 mo). 59% of patients received adjuvant chemotherapy – 66% gemcitabine-based treatment and 31% capecitabine-based. The most prevalent mutations were FGFR2 (28%), CDKN2A/B (24%), IDH1 (17%), and ARID1A (17%). Median RFS for the adjuvantly treated group was 12 months (range: 3-55 mo), and the presence of any clinically relevant mutation was associated with worse RFS (x vs. y, p = 0.03). IDH1 (30%), BAP1 (25%), and PBRM1 (20%) were most frequently mutated amongst patients who did not receive adjuvant therapy, and their median RFS was 5 months (range: 1-54 mo). Lack of an IDH1 mutation correlated with worse RFS (p = 0.02), while lower stage correlated with improved RFS (p = 0.01). Conclusions: For patients with ICC undergoing resection and adjuvant chemotherapy, the presence of clinically relevant genetic mutations is associated with reduced RFS. To gain further insight into the influence of tumor genomic profile on the effectiveness of adjuvant chemotherapy for this patient population, a multicenter collaborative effort is needed.

The natural history and effect of adjuvant therapy on resected AJCC stage I-II lymph node-negative pancreatic cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 264-264
Author(s):  
Shaun McKenzie ◽  
Bin Huang ◽  
Thomas Tucker ◽  
Patrick McGrath ◽  
Dennie V. Jones ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
Early Stage ◽  
Stage I ◽  
Lymph Node Status ◽  
Node Negative ◽  
The Impact

264 Background: Previous investigation has suggested that early stage, lymph node negative pancreatic adenocarcinoma (PAC) has a relatively good prognosis and adjuvant therapy provides little benefit over surgery alone. The purpose of our trial was to evaluate patients with stage I-II PAC receiving surgical resection to determine their clinical characteristics, overall outcome, and the impact of adjuvant therapy on survival. Methods: Utilizing the population-based registry data from the Kentucky Cancer Registry (KCR) we identified patients with lymph node negative, AJCC I-II, PAC who underwent pancreatic resection during the years of 1995-2008. Patients were further stratified by receipt of surgery alone versus surgery with adjuvant chemotherapy or chemoradiation. Clinical and pathologic data included patient demographics, tumor characteristics, and lymph node status. Kaplan-Meier and Cox-regression survival analyses were performed. Results: During the study period, 203 patients meeting criteria were identified from the KCR. Median survival (MS) for the entire cohort was 21.7 months. The majority of patients were >70 years old, Caucasian, had well or moderately differentiated tumors and tumors <5cm. 46% (n=94) and 54% (n=109) of patients had stage I and II disease respectively. When stratified by surgery only (n=119, 59%) versus adjuvant therapy (n=84, 41%), only younger age predicted receipt of adjuvant therapy (p=0.002). Adjuvant therapy provided no benefit over surgery alone regardless of stage (stage I MS: 21.5 vs. 24.7 months, p=0.97 and stage II MS: 24.2 vs. 18.0, p=0.13, respectively). By multivariate analysis, only tumor size >5cm predicted worse survival (HR 2.32, CI 1.21-4.45, p=0.012). Age, stage, adjuvant therapy, differentiation, and lymph node retrieval had no impact on survival. Conclusions: Our data indicate that the survival for surgically resected early stage, lymph node negative pancreatic adenocarcinoma remains poor and is not improved by the addition of adjuvant chemotherapy. These findings should be considered when designing future adjuvant therapy trials for this deadly disease.

Which side is better? The impact of primary tumor side in early stage colorectal cancer (CRC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15106-e15106
Author(s):  
Margaret Lee ◽  
Andrew Mackinlay ◽  
Christine Semira ◽  
Antonio Jose Jimeno ◽  
Belinda Lee ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Primary Tumor ◽  
Early Stage ◽  
Stage Iv ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Early Stage Disease ◽  
Stage Iv Disease ◽  
The Impact

e15106 Background: Multiple studies have indicated the prognostic and potential predictive significance of primary tumor side in metastatic CRC. To date, the few studies examining its impact in early stage disease have either combined data across multiple stages or restricted analysis to overall survival (OS) data. A by stage analysis of the impact of tumor side on recurrence risk is critical if it is to impact adjuvant therapy decisions. Methods: We examined data from a multi-site Australian registry of consecutive patients diagnosed from 2003-2016. Tumors at and distal to the splenic flexure, including the rectum, were considered a left primary (LP). Rectal patients treated with initial chemoradiation were excluded. Clinico-pathologic and outcome data were examined. Data analysis was provided by the healthcare group at IBM Research Australia. Results: A total of 6123 patients were identified, of which 1046 (17.1%) had initial stage I, 1892 (30.9%) had stage II, 1708 (27.9%) had stage III, and 1477 (24.1%) had stage IV disease. Most patients were male (55.2%), and had a LP (n = 3818, 62.4%). Median age at diagnosis was 68.8 years, was higher in patients with a right primary (RP) (71.6 versus 67.0 years for LP, p < 0.001), with more females in the RP group (51.1% vs 41.0% for LP, p < 0.001). The proportion of RP varied by stage, highest in stage II (44.9%), lowest in stage IV (31.5%). For all stage IV disease, including metachronous cases, OS was worse with a RP (HR 1.32, 95% CI 1.14-1.53). For early stage cases, distant recurrence free survival (DRFS) was similar for RP vs LP for stage I (HR 0.63, 95% CI 0.32-1.23), better for stage II RP (HR 0.72, 95% CI 0.55-0.95) and worse for stage III RP disease (HR 1.22, 1.01-1.48). OS did not differ for RP vs LP for stage I or II disease, but was worse for stage III disease with a RP (HR 1.39, 95% CI 1.13-1.70). Furthermore, post recurrence survival was poorer in stage III RP disease (HR 1.61, 95% CI 1.33-1.96). Conclusions: Primary tumor side has potential as an important prognostic marker in early stage CRC. Our novel finding of a variable impact by stage indicate that an assessment of cohorts where recurrence data is available is critical to fully understanding the implications of tumor side for adjuvant therapy decision making.

The impact of length of hospitalization following surgical resection of stage I non-small cell lung cancer on long-term survival

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7584-7584
Author(s):  
A. Kilic ◽  
M. J. Schuchert ◽  
J. R. Landreneau ◽  
J. P. Landreneau ◽  
A. Oostdyk ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Surgical Resection ◽  
Tumor Stage ◽  
Stage I ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

7584 Background: The aim of this study was to evaluate the impact of length of hospital stay (LOS) following surgical resection of stage I non-small cell lung cancer (NSCLC) on long-term survival. Methods: We reviewed the records of patients undergoing surgical resection for stage I NSCLC at our institution between 1990–2003. Patients not surviving hospitalization related to their surgery were excluded from analysis. Multivariate analysis was utilized to evaluate the impact of age, gender, tumor histology, tumor stage, LOS, and type of operation (lobar or sublobar) on long-term (>5 year) survival. As a secondary analysis, Kaplan-Meier survival curves of patients stratified according to LOS were compared using the log-rank test. Two-tailed p-values less than 0.05 were considered statistically significant. Results: A total of 730 patients underwent lobectomy (n=518) or sublobar resection during the study time period. There were 18 (2.5%) operative or in-hospital mortalities. Median LOS was 6 (range 1–81) and 7 (range 1–46) days in the lobar and sublobar cohorts, respectively. Patients with a longer hospital stay (≥14 days) had significantly worse 5- and 10-year overall survival rates as compared to those with a shorter hospitalization (lobectomy: 5-year- 60.3% vs 33.8%; 10-year-27.3% vs 8.4%; p<0.001; sublobar: 5-year-44.3% vs 11.7%; 10-year-9.9% vs 0%; p=0.006). There were 171 patients with extended clinical follow-up who had survived at least 5 years (mean follow-up = 88.1 ± 2.0 months). Multivariate analysis demonstrated that LOS predicted long-term survival independent of patient age, gender, tumor histology, tumor stage, and type of operation (p=0.013). Conclusions: LOS following surgical resection of stage I NSCLC is an independent predictor of long-term survival. These survival differences related to hospital stay may be related to underlying medical co-morbidities important to the decision making regarding therapy of patients with otherwise resectable stage I lung cancer. Prospective assessment of medical co-morbidities may be an important initiative for future treatment planning of early stage lung cancer patients. No significant financial relationships to disclose.

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