PS02.032: PRETREATMENT INFLAMMATORY STATUS INFLUENCES THE PROGNOSIS OF CT4B ESOPHAGEAL CARCINOMA PATIENTS UNDERGOING DEFINITIVE CHEMORADIOTHERAPY

Abstract Background The outcome of definitive chemoradiotherapy (dCRT) for patients with cT4b esophageal carcinoma (EC) remains poor. Also, few studies focused on the prognostic factors in cT4b EC patients undergoing dCRT. Methods 80 patients undergoing dCRT for cT4b EC between 2006 and 2016 were retrospectively reviewed. All were in ECOG-PS 0–1. For evaluation of the pretreatment status, we employed demographic data, BMI, inflammatory marker (CRP), nutritional marker (Alb, prognostic nutritional index (PNI)) and tumor factors (clinical staging, pretreatment stenosis, tumor marker). Results There were 62 men with a mean age of 65 years (range, 41–83 years). 77 patients were squamous cell carcinoma, while 3 were adenocarcinoma. There were 12 (15%) patients with cM1 (lym) status. 36 (45.0%) patients had esophageal stenosis. 70 patients had cN + before dCRT, while 22 had cN + after dCRT. 30 patients (37.5%) had a CRP > 10 mg/l before dCRT, while 15 patients (18.8%) were in poor-nutritional status (PNI < 40). Of 80 patients, 1 patient gave up the treatment developing cerebral infarction. We analyzed survival in the 79 patients completing dCRT. Esophageal perforations were occurred in 5 (6.3%) patients. The 1- and 3-year overall survival rates were 59.8% and 38.3%, respectively. Salvage surgery was performed in 29 (36.3%) patients. R0 resection was achieved in 20 (69.0%) patients. Surgery-related death was developed in 3 patients. Pathological complete response was found in 10 (34.5%) patients. The 1- and 3-year overall survival rates of these 29 patients were 64.3% and 40.5%, respectively. Lastly, we evaluated prognostic factors in 79 patients. In univariable analysis, PNI < 40 (HR 2.43, 95% CI 1.19–4.63, P = 0.02), CRP ≥ 10 mg/l (HR 2.21, 95% CI 1.23–3.95, P = 0.01), pretreatment stenosis (HR 1.68, 95% CI 0.94–3.00, P = 0.08), cN + status after dCRT (HR 1.84, 95% CI 0.98–3.33, P = 0.06) were associated with poor prognosis. Subsequent multivariable Cox proportional hazards model revealed that CRP ≥ 10 mg/l (HR 2.00, 95% CI 1.03–3.81, P = 0.04) and cN + status after dCRT (HR 2.02, 95% CI 1.05–3.73, P = 0.03) were both independent risk factors for poor prognosis. Conclusion The outcome of dCRT for cT4b EC is acceptable. Pretreatment inflammatory status significantly influences the prognosis of patients undergoing dCRT. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Survival and prognostic factors in HIV-infected adults treated with Antiretroviral Therapy in a Malaysian referral hospital: A retrospective cohort study

10.21203/rs.2.15641/v1 ◽

2019 ◽

Author(s):

Lee Sing Chet ◽

Siti Azrin Ab Hamid ◽

Norsa'adah Bachok ◽

Suresh Kumar Chidambaram

Keyword(s):

Overall Survival ◽

Cohort Study ◽

Prognostic Factors ◽

Antiretroviral Therapy ◽

Haemoglobin Level ◽

Retrospective Cohort ◽

Survival Rates ◽

Baseline Haemoglobin ◽

History Of ◽

Overall Survival Rates

Abstract Background: It is well established that antiretroviral therapy (ART) is beneficial in reducing the mortality among patients with human immunodeficiency virus (HIV). In Malaysia, there is lack of study and information regarding the overall survival rates and prognostic factors for survival in HIV-infected adults treated with ART. Therefore, this study aimed to assess and compare the survival rates as well as to identify the prognostic factors for survival among HIV adults in Malaysia.Methods: A retrospective cohort study was conducted by reviewing the medical records of HIV patients who started ART between year 2007 and 2016 at a tertiary referral hospital in Malaysia. ART-naive adults aged 15 years and above were included and those who were transferred out were excluded. After applying inclusion and exclusion criteria, there were 339 cases eligible in this study. Systematic sampling method was applied. Kaplan Meier survival curve and log-rank test were used to compare the overall survival rates. Cox proportional hazards regression was applied to determine the prognostic factors for survival.Results: The estimated overall survival rates were 95.9%, 93.8%, 90.4%, 84.9%, and 72.8% at 6 months, 1 year, 3 years, 5 years and 10 years, respectively. The overall survival rates were significantly different according to age group (p<0.001), employment status (p<0.001), transmission mode (p=0.003), and history of illicit drug use (p=0.017), baseline CD4 cell count (p<0.001), baseline haemoglobin level (p<0.001), tuberculosis co-infection (p<0.001), hepatitis co-infection (p=0.008), first NRTI (p<0.001) and history of defaults (p=0.021). Based on multiple Cox regression, patients who were anaemic had 3.76 times (95% CI: 1.97, 7.18; p<0.001) higher hazard of death than their non-anaemic counterparts. The hazard risk was 2.09 times (95% CI: 1.10, 3.96; p=0.024) higher among HIV patients co-infected with tuberculosis compared to those who were not. Conclusion: Overall survival rates were higher than low-income countries but lower than in high-income countries, and comparable with middle-income countries. Low baseline haemoglobin level and tuberculosis co-infection were strong prognostic factors for HIV survival

Download Full-text

FA03.02: IS SURGERY STILL NECESSARY IN RESECTABLE OESOPHAGEAL CANCER? META-ANALYSES OF DEFINITIVE CHEMORADIOTHERAPY VERSUS TRIMODALITY THERAPY

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa03.02 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 6-6

Author(s):

Daan Voeten ◽

Chantal Den Bakker ◽

Donald Van Der Peet

Keyword(s):

Systematic Review ◽

Overall Survival ◽

Survival Rates ◽

Oesophageal Carcinoma ◽

Risk Of Bias ◽

Survival Advantage ◽

Definitive Chemoradiotherapy ◽

Trimodality Therapy ◽

Meta Analyses ◽

Overall Survival Rates

Abstract Background Standard therapy for resectable oesophageal carcinoma is trimodality therapy (TMT) consisting of neoadjuvant chemoradiotherapy and oesophagectomy. Evidence of survival advantage of TMT over organ preserving definitive chemoradiotherapy (dCRT) is inconclusive. The aim of this study is to compare survival between TMT and dCRT. Methods A systematic review and meta-analyses were conducted. Randomised controlled trials and observational studies on primary resectable, curatively treated, oesophageal carcinoma patients above 18 years were included. Three online databases were searched for studies comparing TMT with dCRT. Primary outcomes were two-, three- and five-year overall survival rates. Risk of bias was assessed using the Cochrane risk of bias tools for RCTs and cohort studies. Results Thirty-two studies described in 35 articles were included in this systematic review, thirty-three were included in the meta-analyses. Two-, three- and five-year overall survival was significantly lower in dCRT compared to TMT, with relative risks (RR) of 0.69 (95%CI, 0.57–0.83), 0.76 (95%CI, 0.63–0.92), and 0.57 (95%CI, 0.47–0.71) respectively. However, when only analysing studies with equal patient groups at baseline no differences for two-, three- and five-year overall survival were found with RRs of 0.83 (95%CI, 0.62–1.10), 0.81 (95%CI 0.57–1.14), 0.63 (95%CI, 0.36–1.12). The forest plot for three-year overall survival is presented in figure 1. Figure 1. 3 year overall survival rates Conclusion Despite limitations of the available evidence these meta-analyses suggest there is no survival advantage for TMT over dCRT, assuming comparable groups at baseline. Selection of surgical candidates in oesophageal carcinoma should be part of personalised and tailored care. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Follicular large-cell lymphoma: intermediate or low grade?

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.7.1349 ◽

1994 ◽

Vol 12 (7) ◽

pp. 1349-1357 ◽

Cited By ~ 61

Author(s):

N L Bartlett ◽

M Rizeq ◽

R F Dorfman ◽

J Halpern ◽

S J Horning

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Medical Center ◽

Performance Status ◽

Survival Rates ◽

Large Cell ◽

Poor Performance Status ◽

Low Grade ◽

Curative Intent ◽

Overall Survival Rates

PURPOSE To evaluate the benefit of anthracycline-based chemotherapy, identify prognostic factors, and determine the value of the International Prognostic Factors Index for patients with follicular large-cell (FLC) lymphoma. PATIENTS AND METHODS This retrospective study includes 96 patients with FLC lymphoma treated at Stanford University Medical Center between 1969 and 1991. Fifty-five patients received doxorubicin plus cyclophosphamide-containing chemotherapy regimens, 21 patients received other chemotherapy regimens, 15 patients received radiotherapy only, and five patients received no initial therapy. Thirty-four patients had stage I or II disease and 62 patients had stage III or IV disease. RESULTS With a median follow-up duration of 5.2 years (range, 1 to 18), the actuarial 5- and 10-year overall survival rates were 75% and 54%, with actuarial 5- and 10-year freedom from progression (FFP) rates of 53% and 42%, respectively. Patients treated with chemotherapy regimens that contained both doxorubicin and cyclophosphamide had a superior actuarial 10-year FFP rate (55% v 25%, P = .06) and overall survival rate (65% v 42%, P = .04) compared with patients treated with other chemotherapy regimens. Only one patient treated with doxorubicin plus cyclophosphamide relapsed after 3 years. In the multivariate analysis, discordant lymphoma and treatment with chemotherapy regimens not containing both cyclophosphamide and doxorubicin predicted for worse FFP and overall survival rates. In addition, poor performance status and increasing areas of diffuse histology predicted for a worse survival, while anemia and male sex predicted for a worse FFP. The age-specific International Index was useful in predicting outcome; however, few patients with FLC lymphoma had high-risk features. CONCLUSION The plateau in FFP implies that patients with FLC lymphoma enjoy sustained remissions after standard anthracycline-based chemotherapy. FLC lymphoma should continue to be approached as an intermediate-grade lymphoma with curative intent.

Download Full-text

Individualized Radiation Dose Escalation Based on the Decrease in Tumor FDG Uptake and Normal Tissue Constraints Improve Survival in Patients With Esophageal Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/1533034615627583 ◽

2016 ◽

Vol 16 (1) ◽

pp. 75-80 ◽

Cited By ~ 6

Author(s):

Jinbo Ma ◽

Zhaoyang Wang ◽

Chengde Wang ◽

Ercheng Chen ◽

Yaozong Dong ◽

...

Keyword(s):

Overall Survival ◽

Radiation Dose ◽

Esophageal Carcinoma ◽

Dose Escalation ◽

Normal Tissue ◽

Metabolic Response ◽

Survival Rates ◽

Complete Metabolic Response ◽

Computer Tomography Scan ◽

Overall Survival Rates

Background: To determine whether individualized radiation dose escalation after planned chemoradiation based on the decrease in tumor and normal tissue constraints can improve survival in patients with esophageal carcinoma. Methods: From August 2005 to December 2010, 112 patients with squamous esophageal carcinoma were treated with radical concurrent chemoradiation. Patients received positron emission tomography-computer tomography scan twice, before radiation and after radiation dose of 50.4 Gy. All patients were noncomplete metabolic response groups according to the Response Evaluation Criteria in solid tumors. Only 52 patients with noncomplete metabolic response received individualized dose escalation based on tumor and normal tissue constraints. Survival and treatment failure were observed and analyzed using SPSS (13.0). Results: The rate of complete metabolic response for patients with noncomplete metabolic response after dose escalation reached 17.3% (9 of 52). The 2-year overall survival rates for patients with noncomplete metabolic response in the conventional and dose-escalation groups were 20.5% and 42.8%, respectively( P = .001). The 2-year local control rates for patients were 35.7% and 76.2%, respectively ( P = .002). When patients were classified into partial metabolic response and no metabolic response, 2-year overall survival rates for patients with partial metabolic response were significantly different in conventional and dose-escalation groups (33.8% vs 78.4%; P = .000). The 2-year overall survival rates for patients with no metabolic response in two groups (8.6% vs 15.1%) did not significantly differ ( P = .917). Conclusion: Individualized radiation dose escalation has the potential to improve survival in patients with esophageal carcinoma according to increased rate of complete metabolic response. However, further trials are needed to confirm this and to identify patients who may benefit from dose escalation.

Download Full-text

Survival of colorectal cancer patients in Brunei Darussalam: comparison between 2002–09 and 2010–17

BMC Cancer ◽

10.1186/s12885-021-08224-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shirley H. F. Lee ◽

Hanif Abdul Rahman ◽

Nadiah Abidin ◽

Sok King Ong ◽

Elvynna Leong ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Splenic Flexure ◽

Transverse Colon ◽

Survival Rates ◽

Brunei Darussalam ◽

Hazard Ratios ◽

Significant Difference ◽

Overall Survival Rates

Abstract Background Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide. It is the second leading cause of cancer death in men and women in Brunei Darussalam in 2017, posing a major burden on society. Methods This retrospective cohort study (n = 1035 patients diagnosed with CRC in Brunei Darussalam from 1st January 2002 until 31st December 2017) aims to compare the overall survival rates of CRC patients (2002–2017), to compare survival rates between two study periods (2002–2009 and 2010–2017) and to identify prognostic factors of CRC. Kaplan-Meier estimator and log-rank tests were performed to analyse the overall survival rates of CRC patients. Multiple Cox regression was performed to determine the prognostic factors of CRC with adjusted hazard ratios (Adj. HRs) reported. Results The 1-, 3- and 5-year survival rates of CRC patients are 78.6, 62.5, and 56.0% respectively from 2002 to 2017. The 1-, 3-, and 5-year survival rates of CRC patients for 2002–2009 are 82.2, 69.6, and 64.7%; 77.0, 59.1, and 51.3% for 2010–2017 respectively. A significant difference in CRC patients’ survival rate was observed between the two study periods, age groups, ethnic groups, cancer stages, and sites of cancer (p < 0.05). The Adjusted Hazard Ratios (Adj. HRs) were significantly higher in the 2010–17 period (Adj. HR = 1.78, p < 0.001), older age group ( ≥ 60 years) (Adj. HR = 1.93, p = 0.005), distant cancer (Adj. HR = 4.69, p < 0.010), tumor at transverse colon and splenic flexure of colon (Adj. HR = 2.44, p = 0.009), and lower in the Chinese(Adj. HR = 0.63, p = 0.003). Conclusion This study highlights the lower survival rates of CRC patients in 2010–2017, Malays, older patients, distant cancer, and tumors located at the latter half of the proximal colon (transverse colon), and predominantly LCRC (splenic flexure, descending colon, sigmoid colon, overlapping lesion colon and colon (NOS), as well as the rectosigmoid junction and rectum (NOS)). Age, ethnicity, cancer stage, and tumor location are significant prognostic factors for CRC. These findings underscore the importance of public health policies and programmes to enhance awareness on CRC from screening to developing strategies for early detection and management, to reduce CRC-associated mortality.

Download Full-text

Relative Stability Of Plasma Cells Immunophenotype In Multiple Myeloma Over Time

Blood ◽

10.1182/blood.v122.21.1885.1885 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1885-1885

Author(s):

Benoit Tessoulin ◽

Steven Legouill ◽

Marion Eveillard ◽

Nelly Robillard ◽

Soraya Wuilleme ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Plasma Cells ◽

Conflicts Of Interest ◽

Survival Rates ◽

Prospective Trial ◽

Multiparameter Flow Cytometry ◽

Single Centre ◽

Over Time ◽

Overall Survival Rates

Abstract Emerging evidence indicates that multiple myeloma (MM) can follow a number of evolutionary pathways over a patient’s disease course. Recently, genomic data have shown the coexistence in many patients of several tumour types, which could be either genetically stable, evolving linearly or be constituted of heterogeneous clonal mixtures with predominant clones shifting over time (Keats, Blood 2012;120:1067-1076). Little is known however of immunophenotypic evolution of the myeloma cells (MM cells) during MM progression. In a retrospective single-centre analysis of tumoral immunophenotypes, we examined sequential bone marrow or peripheral blood samples from 51 MM patients. Multiparameter flow cytometry was performed to assess MM phenotype using CD38 and CD138 expression as well as intracytoplasmic light chain usage restriction in most cases. The presence or absence of CD19, CD20, CD27, CD28, CD56 or CD117 on the MM cells’surface was investigated additionally. A median of 4 of the latter antigens was examined per sample. Most MM cells were homogeneous in the expression or absence of expression of the differentiation antigens investigated. Immunophenotype changes were defined as the loss or gain of at least 1 antigen. Whenever partial expression of one or several antigens was observed on MM cells, indicating MM subsets, the presence of subclones was suspected. Samples were obtained at diagnosis and relapse for 33 MM patients, and during consecutive relapses for 18. The total amount of analysed samples was 109, with a median of 2 samples per patient (range: 2-3). A modification of immunophenotype occurred in 22 patients (43%), with one antigen change (68%), two antigens changes (18%) or three antigens changes (14%). Immunophenotypic changes are summarized in table 1. For 20% of the cases or more, this involved CD28 (n=11, balanced gain or loss) or CD27 (n=7, mostly loss). CD56 expression, scarcely negative on the first assessment, was gained at relapse in three cases. Other antigens were expressed in a stable fashion over time. Eighteen (35%) of the patients had at least a subclone on the first immunophenotype, which was lost and/or modified in 14 / 18 patients at time of subsequent relapse. There was no significant impact of immunophenotypic modifications on overall survival rates Similarly, the presence of a subclone at first examination, or the immunophenotypic change of this subclone over time was not associated with differences in overall survival rates. In conclusion, this retrospective single centre study demonstrates that the immunophenotype of MM cells is mostly stable during the course of the disease. When changes occur, they do not seem to affect the clinical course of the patients. These preliminary results need confirmation on a larger and prospective trial. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Effect of weight loss on survival in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy and surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24076 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24076-e24076

Author(s):

Tao Li

Keyword(s):

Overall Survival ◽

Weight Loss ◽

Esophageal Cancer ◽

Esophageal Carcinoma ◽

Survival Rates ◽

Neoadjuvant Chemoradiotherapy ◽

Severe Weight Loss ◽

Low Weight ◽

Weight Loss Group ◽

Overall Survival Rates

e24076 Background: This study aimed to determine the impact of weight loss during neoadjuvant chemoradiotherapy on the survival of patients with esophageal carcinoma. Methods: We retrospectively examined 102 consecutive patients with esophageal carcinoma who underwent neoadjuvant chemoradiotherapy followed by radical resection at Sichuan Cancer Hospital & Institute between 2003 and 2017. The patients were divided into three groups based on the amount of body weight lost during neoadjuvant chemoradiotherapy: severe weight loss (>10%), high weight loss (5%–10%), and low weight loss (<5%). The correlations of weight loss with toxicity, progression-free survival, and overall survival were investigated. Results: The median overall survival was 49.7 months in the low weight loss group compared with 35.4 and 25.1 months in the high and severe weight loss groups ( P = 0.041). The 1-year overall survival rates in the severe, high, and low weight loss groups were 62.5%, 85.0%, and 90.7%, respectively; the corresponding 3-year overall survival rates were 21.9%, 47.3%, and 68.8%, respectively, and the corresponding 5-year overall survival rates were 21.9%, 31.0%, and 44.4%, respectively. The multivariate analysis indicated that a pathological complete response and severe weight loss were independent prognostic factors for overall survival. Any leukopenia ( P = 0.024), leukopenia of at least grade 3 ( P = 0.021), and anemia ( P = 0.042) occurred more frequently in the severe weight loss group. Conclusions: Weight loss during neoadjuvant CRT is an independent and adverse prognostic factor in esophageal carcinoma patients, whereas a stable weight confers a better prognosis. Keywords: esophageal cancer, prognosis, weight loss, neoadjuvant chemoradiotherapy, toxicity.

Download Full-text

Poor Prognostic Factors after Repeat Hepatectomy for Recurrent Hepatocellular Carcinoma in the Modern Era

The American Surgeon ◽

10.1177/000313481207800431 ◽

2012 ◽

Vol 78 (4) ◽

pp. 419-425 ◽

Cited By ~ 6

Author(s):

Eiji Tsujita ◽

Yo-Ichi Yamashita ◽

Kazuki Takeishi ◽

Ayumi Matsuyama ◽

Shin-Ichi Tsutsui ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Survival Rates ◽

Repeat Hepatectomy ◽

Recurrent Hepatocellular Carcinoma ◽

The Poor ◽

Estimated Blood Loss ◽

Poor Outcomes ◽

Overall Survival Rates

The purpose of this study was to determine the poor prognostic factors after repeat hepatectomy (Hx) in patients with recurrent hepatocellular carcinoma (HCC). Overall survival rates and clinicopathological variables in 112 patients with repeat Hx from 1992 to 2010 were compared with those in 531 patients who underwent a primary Hx. To clarify the poor prognosis factors after repeat Hx, survival data among 112 patients were univariately and multivariately analyzed. Overall survival after repeat Hx was similar for that of the patients who underwent a primary Hx. The mean age of repeat Hx group was significantly higher, and a well-preserved liver function was recognized than the primary Hx group. Multivariate analysis revealed that: 1) indocyanine green retention rate at 15 minutes; 2) disease-free interval; 3) tumor size; 4) portal vein invasion at primary Hx; 5) gender; and 6) estimated blood loss to be an independent and significant poor prognostic factors. The overall 3-year postrecurrence overall survival rates were 100, 91.3, 59.6, and 0 per cent at risk number (R) R0, R1/2, R3, R4, respectively ( P < 0.05). Repeat Hx provided a good compatible prognosis with primary Hx. In our findings, five risk factors to predict poor outcomes after repeat Hx were useful. Patients with recurrent HCC do not have universally poor outcomes, and our simple scoring system using five poor prognostic factors could serve to advise the prognosis and the potential benefit for patient selection about repeat Hx.

Download Full-text

Long-Term Survival Results of a Randomized Trial Comparing Gemcitabine Plus Cisplatin, With Methotrexate, Vinblastine, Doxorubicin, Plus Cisplatin in Patients With Bladder Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.07.757 ◽

2005 ◽

Vol 23 (21) ◽

pp. 4602-4608 ◽

Cited By ~ 1004

Author(s):

Hans von der Maase ◽

Lisa Sengelov ◽

James T. Roberts ◽

Sergio Ricci ◽

Luigi Dogliotti ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Locally Advanced ◽

Survival Rates ◽

Progression Free Survival ◽

Term Survival ◽

Free Survival ◽

Visceral Metastases ◽

Overall Survival Rates

Purpose To compare long-term survival in patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium treated with gemcitabine/cisplatin (GC) or methotrexate/vinblastine/doxorubicin/cisplatin (MVAC). Patients and Methods Efficacy data from a large randomized phase III study of GC versus MVAC were updated. Time-to-event analyses were performed on the observed distributions of overall and progression-free survival. Results A total of 405 patients were randomly assigned: 203 to the GC arm and 202 to the MVAC arm. At the time of analysis, 347 patients had died (GC arm, 176 patients; MVAC arm, 171 patients). Overall survival was similar in both arms (hazard ratio [HR], 1.09; 95% CI, 0.88 to 1.34; P = .66) with a median survival of 14.0 months for GC and 15.2 months for MVAC. The 5-year overall survival rates were 13.0% and 15.3%, respectively (P = .53). The median progression-free survival was 7.7 months for GC and 8.3 months for MVAC, with an HR of 1.09. The 5-year progression-free survival rates were 9.8% and 11.3%, respectively (P = .63). Significant prognostic factors favoring overall survival included performance score (> 70), TNM staging (M0 v M1), low/normal alkaline phosphatase level, number of disease sites (≤ three), and the absence of visceral metastases. By adjusting for these prognostic factors, the HR was 0.99 for overall survival and 1.01 for progression-free survival. The 5-year overall survival rates for patients with and without visceral metastases were 6.8% and 20.9%, respectively. Conclusion Long-term overall and progression-free survival after treatment with GC or MVAC are similar. These results strengthen the role of GC as a standard of care in patients with locally advanced or metastatic TCC.

Download Full-text

Nomograms predict survival outcome of Klatskin tumors patients

PeerJ ◽

10.7717/peerj.8570 ◽

2020 ◽

Vol 8 ◽

pp. e8570

Author(s):

Feng Qi ◽

Bin Zhou ◽

Jinglin Xia

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Prognostic Factors ◽

Lymph Node ◽

Intrahepatic Cholangiocarcinoma ◽

Poor Prognosis ◽

Survival Rates ◽

Klatskin Tumor ◽

Tumor Patients ◽

Klatskin Tumors

Objective Klatskin tumors are rare, malignant tumors of the biliary system with a poor prognosis for patient survival. The current understanding of these tumors is limited to a small number of case reports or case series; therefore, we examined prognostic factors of this disease. Methods A population cohort study was conducted in patients selected from the Surveillance, Epidemiology, and End Results (SEER) database with a Klatskin tumor that was histologically diagnosed between 2004 to 2014. Propensity-matching (PSM) analysis was performed to determine the overall survival (OS) among those with a Klatskin tumor (KCC), intrahepatic cholangiocarcinoma (ICCA), or hepatocellular carcinoma (HCC). The nomogram was based on 317 eligible Klatskin tumor patients and its predictive accuracy and discriminatory ability were determined using the concordance index (C-index). Results Kaplan-Meier analysis showed that patients with Klatskin tumors had significantly worse overall survival rates (1-year OS = 26.2%, 2-year OS = 10.7%, 3-year OS = 3.4%) than those with intrahepatic cholangiocarcinoma (1-year OS = 62.2%, 2-year OS = 36.4%, 3-year OS = 19.1%, p < 0.001) or hepatocellular carcinoma (1-year OS = 72.4% , 2-year OS = 48.5%, 3-year OS = 36.2%, p < 0.001). A poor prognosis was also significantly associated with older age, higher grade, SEER historic stage, and lymph node metastasis. Local destruction of the tumor (HR = 0.635, 95% CI [0.421–0.956], p = 0.03) and surgery (HR = 0.434, 95% [CI 0.328–0.574], p < 0.001) were independent protective factors. Multivariate Cox analysis showed that older age, SEER historic stage, and lymph node metastases (HR = 1.468, 95% CI [1.008–2.139], p = 0.046) were independent prognostic factors of poor survival rates in Klatskin tumor patients, while cancer-directed surgery was an independent protective factor (HR = 0.555, 95% CI [0.316–0.977], p = 0.041). The prognostic and protective factors were included in the nomogram (C-index for survival = 0.651; 95% CI [0.607–0.695]). Conclusions The Klatskin tumor group had poorer rates of OS and cancer-specific survival than the ICCA and HCC groups. Early detection and diagnosis were associated with a higher rate of OS in Klatskin tumor patients.

Download Full-text