scholarly journals Prognostic factors in patients with vulvar cancer: the VULCAN study

2020 ◽  
Vol 30 (9) ◽  
pp. 1285-1291 ◽  
Author(s):  
Ignacio Zapardiel ◽  
Sara Iacoponi ◽  
Pluvio J Coronado ◽  
Kamil Zalewski ◽  
Frank Chen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Tumor Resection ◽  
Figo Stage ◽  
Primary Treatment ◽  
Resection Margins ◽  
Stromal Invasion ◽  
Case Volume

ObjectiveThis study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.MethodsThis international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.ResultsAfter excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget’s disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).ConclusionsAdvanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

Does time to completion of radiation treatment in locally advanced vulvar cancer impact survival?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5593-5593
Author(s):  
Nancy T. Nguyen ◽  
Xiao Zhao ◽  
Matthew Ponzini ◽  
Machelle Wilson ◽  
Gary S. Leiserowitz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Radiation Treatment ◽  
Locally Advanced ◽  
Group Versus ◽  
Figo Stage ◽  
Concurrent Chemotherapy ◽  
Stage Ii ◽  
Event Analysis

5593 Background: Although well established in cervical cancer, it is unclear whether time from initiation to completion of radiation therapy for vulvar cancer affects survival outcomes. We seek to assess if completion of radiation, either alone (RT) or as concurrent chemoradiation (CRT), within a planned timeframe in locally advanced squamous cell vulvar cancer impacts overall survival (OS). Methods: Women 18 years or older with FIGO stage II to IVA vulvar cancer who received external beam RT or CRT as part of their initial treatment course were identified from the National Cancer Database from 2004-2017. Patients with non-squamous cell carcinoma histology or who received systemic cytotoxic therapies as primary treatment were excluded. Patients who received less than 20 fractions of radiation were also excluded. Time to radiation completion was the number of days from the initiation to completion of radiation. The delay of radiation completion was calculated as the difference between the actual time to radiation completion and predicted duration of radiation. Types of treatment (RT and CRT) were both stratified into groups based on the delay of radiation completion, less than 7 days or greater than 7 days. Chi-square, Fisher Exact ANOVA and Kruskal-Wallis tests were used for analysis. Kaplan-Meier curves with log-rank tests were fit for univariate time-to-event analysis. Multivariable Cox proportional hazard models were fit to assess effects after controlling for confounding. Results: There were 2378 patients identified for analysis (n = 856 RT and n = 1522 CRT). Median age was 67 (IQR 56-78) and the CRT group was younger (p < 0.0001) than the RT group. The majority were white (88.35%) with advanced FIGO stage III or IVA (72.29 %) disease. Median dose of total radiation was 5720 cGy (IQR 5040-6300) with higher doses observed in the greater than 7 days delay group versus less than 7 days, (p < 0.0001). Median follow up was 27.2 (IQR 11.8-57.9) months. For both cohorts, completion of treatment with delay less than 7 days resulted in significant improvement in median survival when compared to treatment completion delay of more than 7 days: RT (Median OS 34.9 versus 21.6 months, p < 0.01) and CRT (58 versus 41.3 months, p < 0.01). On multivariate subset analysis, both completion of CRT and RT were associated with improved OS when treatment was completed with less than 7 days delay vs greater than 7 days delay, CRT (HR 0.869 [95%CI 0.758-0.997]), RT (HR 0.820 [95%CI 0.698-0.964]). Advanced FIGO stage IVA was associated with the greatest increase in hazard of death, (HR 1.758 [95%CI 1.516-2.039]), compared to FIGO stage II. Conclusions: Completion of radiation with less than 7 days delay is associated with improved overall survival, which is independent of concurrent chemotherapy. These findings suggest that strategies to minimize delays in radiation treatment are crucial in treating locally advanced vulvar cancer.

scholarly journals Prognostic Factors and Clinical Characteristics of Duodenal Adenocarcinoma With Survival: A Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Huapeng Sun ◽  
Yi Liu ◽  
Long Lv ◽  
Jingwen Li ◽  
Xiaofeng Liao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Curative Resection ◽  
Tumor Resection ◽  
Margin Status ◽  
High Expression ◽  
Duodenal Adenocarcinoma ◽  
Gastric Type ◽  
Duodenal Carcinoma

BackgroundTo evaluate the clinical risk factors that influence the overall survival in patients with duodenal adenocarcinoma (DA) after tumor resection.MethodsThis study retrospectively analyzed 188 patients who underwent tumor resection for DA between January 2005 and June 2020 at Xiangyang Central Hospital.ResultsThe median survival of the patients who underwent resectional operation was 54 months, longer than of those who underwent palliative surgery (20.8 months) (2,916.17; 95% CI, 916.3−9,280.5; p &lt; 0.001). Survival of non-ampullary duodenal carcinoma patients (50.3 months; 95% CI, 39.7−61.8) was similar to that of ampullary duodenal carcinoma patients (59.3 months; 95% CI, 38.6−66.7) but was significantly better than that of papillary adenocarcinoma patients (38.9 months; 95% CI, 29.8−54.8; p = 0.386). Those with intestinal-type ductal adenocarcinomas had a longer median overall survival than those with the gastric type (61.8 vs. 46.7 months; p &lt; 0.01) or pancreatic type (32.2 months; p &lt; 0.001). Clinical DA samples had significantly diverse expressions of ATG12, IRS2, and IGF2. Higher expressions of the ATG12 and IRS2 proteins were significantly correlated with worse survival. Multivariate Cox regression analysis revealed that lymph node metastasis (hazard ratio (HR), 6.44; 95% CI, 3.68−11.27; p &lt; 0.0001), margin status (HR, 4.94; 95% CI, 2.85−8.54; p &lt; 0.0001), and high expression of ATG12 (HR, 1.89; 95% CI, 1.17−3.06; p = 0.0099) were independent prognostic factors negatively associated with survival in patients undergoing curative resection. There was no survival difference between the groups with ampullary, non-ampullary, and papillary adenocarcinomas treated with adjuvant chemotherapy (p = 0.973).ConclusionGastric/pancreatic type, high expression of ATG12, lymph node metastases, and margin status were negative prognosticators of survival in patients with DAs than in those with tumor anatomical location. Curative resection is the best treatment option for appropriate patients.

scholarly journals Assessment of prognostic factors in extracranial germ cell tumors in children

2021 ◽  
Vol 67 (6) ◽  
pp. 829-836
Author(s):  
Symbat Salieva ◽  
Riza Boranbayeva ◽  
Bakhram Zhumadullayev ◽  
Ergali Sarsekbayev ◽  
Oleg Bydanov
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Germ Cell ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Tumor Resection ◽  
Germ Cell Tumors ◽  
Morphological Structure ◽  
High Sensitivity

Germ cell neoplasms in the group of benign and malignant tumors heterogeneous in morphological structure, clinical features and prognosis. A special characteristic of germ cell tumors is their high sensitivity to platinum-containing chemotherapy, which allows cure of up to 80–90% patients. However 20–25% of patients with a common type have overall survival rate of less than 50%. The aim of the study is to assess the survival rate of children with extracranial germ cell tumors and to identify adverse risk factors. Methods. The study includes 116 children with extracranial germ cell tumors treated from 2013 to September 2009. Treatment consisted of tumor resection and platinum based on platinum chemotherapy. Survival rate was assessed by the Kaplan-Mayer method. Prognostic factors are determined according to IGCCCG, MaGIC, MAKEI, RODO. Results. Overall and event free survival rates were 79±5% and 76±4%, respectively. The worst overall survival had patients with extragonadal tumors, advanced stages of a disease, high initial level of AFP (≥10 000 ng/ml), non-seminoma version of state treasury bills and extra pulmonary metastases. Conclusion. Survival rate in children with extracranial germ cell tumors depends on the prognostic factors. Statistically significant predictors of the poor prognosis were extragonadal localization of a tumor and the AFP level ≥10 000 ng/ml.

Experience of cetuximab in the salvage treatment for recurrent/metastatic oral squamous cell carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16006-e16006
Author(s):  
Jin-Ching Lin ◽  
Shih-An Liu ◽  
Chen-Chi Wang ◽  
Ching-Ping Wang
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Oral Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Response Rate ◽  
Karnofsky Performance Status ◽  
Univariate Analysis ◽  
Disease Extent

e16006 Background: We investigated the efficacy, toxicity, and prognostic factors of salvage chemotherapy plus cetuximab in patients with recurrent/metastatic oral squamous cell carcinoma (OSCC). Methods: A total of 30 patients with recurrent/metastatic OSCC were treated by an outpatient weekly multi-drug combination chemotherapy plus cetuximab 400 mg/m2 loading in day 1, then 250 mg/m2 every week. The major chemotherapy regimen consisted of MEMOCLUB (methotrexate 30 mg/m2 d1, epirubicin 30 mg/m2 d1, alternating with mitomycin-C 4 mg/m2 d8, oncovin 1 mg/m2 d8, cisplatin 25 mg/m2 d8, leucovorin 120 mg/m2 d8, 5-fluorouracil 1000 mg/m2 d8, and bleomycin 10 mg/m2 d8) or GV (gemcitabine 1000mg/m2 d1, and vinorelbine 25 mg/m2 d8). Results: Baseline characteristics are as followings: median age=45 (range 32-73); male/female=28/2; Karnofsky performance status 80%/70%/60%/50%=7/18/3/2. Most patients had heavily treated history — first recurrence in 11 cases, second recurrence in 6, and third or more recurrence in 13. The disease extent consists of 25 (83.3%) locoregional recurrences, 3 (10.0%) distant metastasis, and 2 (6.7%) locoregional + metastatic diseases. Grade 3/4 toxicity included leucopenia (46.7%), anemia (33.3%), thrombocytopenia (6.7%), mucositis (6.7%) and skin rashes (20.0%). We obtained a high overall response rate of 66.7% (7 CR, 13 PR, 6 SD, 3 PD, and 1 unevaluable). So far, there are 22 deaths and 8 alive. The overall survival time ranges from 48-1365 days with a median of 312 days. One-year overall survival rate is 49%. Two favorable prognostic factors were found by univariate analysis- disease extent (locoregional vs. distant disease, HR=0.1509, 95%CI=0.0008-0.0592) and tumor response (CR+PR vs. SD+PD, HR=0.2255, 95%CI=0.0277-0.2984). Conclusions: Cetuximab plus weekly outpatient multi-drug chemotherapy has a high response rate and encouraging survival with acceptable toxicity in recurrent/metastatic OSCC patients.

The effect of facility volume on treatment guideline compliance and overall survival in oral tongue squamous cell carcinoma.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 17-17 ◽  
Author(s):  
Samantha Tam ◽  
Xianglin L. Du ◽  
Carol M. Lewis ◽  
Jose-Miguel Yamal ◽  
Randal S. Weber
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tongue Cancer ◽  
High Volume ◽  
Oral Tongue ◽  
Case Volume ◽  
Guideline Compliance ◽  
Oral Tongue Cancer

17 Background: National treatment guidelines guide cancer care using the best available evidence and understanding the drivers of guideline compliance is essential to identifying modifiable factors to improve quality of care. This study aims to explore the impact of facility volume on the rate of guideline compliance in patients with oral tongue cancer and its effect on overall survival. Methods: Using National Cancer Database from 2004 to 2013, this retrospective cohort study investigated patients undergoing curative surgical treatment for oral tongue squamous cell carcinoma. Patients were divided into three tertiles according to mean annual case volume at their treatment facility. Guideline compliance was based on the National Comprehensive Cancer Network oral cavity cancer guidelines. Predictors of guideline compliance and overall survival were determined using multiple logistic regression and Cox Proportional Hazards models. Results: Guideline compliant care was delivered in 54.5% of the 35,810 eligible patients. Those treated at intermediate volume facilities had 1.75 times greater odds of receipt of guideline compliant care (95% CI = 1.57-1.96) and 2.14 times greater in high volume facilities (95% CI = 1.91-2.40) compared to low volume facilities. Guideline compliance (adjusted hazard ratio [HRadj] = 0.78, 95% CI = 0.72-0.84) and treatment at a high volume facility (HRadj= 0.88, 95% CI = 0.80-0.98) were independent predictors of overall survival. Conclusions: Facility volume independently predicted guideline compliance in oral tongue cancer. Guideline compliance and treatment at a high case volume facility were predictors of overall survival. Clinicians should apply guideline compliant care regardless of practice setting and treatment at higher volume centers should be considered.

scholarly journals Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Jianping Hu ◽  
Chunlin Zhang ◽  
Kunpeng Zhu ◽  
Lei Zhang ◽  
Tao Cai ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Survival Rates ◽  
Tumor Resection ◽  
Limb Salvage Surgery ◽  
Related Factors

Purpose. The aim of this study was to assess the treatment-related factors associated with local recurrence and overall survival of patients with osteosarcoma treated with limb-salvage surgery. Patients and Methods. Treatment-related factors were analyzed to evaluate their effects on local recurrence-free survival (LRFS) and overall survival (OS) in 182 patients from 2004 to 2013. Results. The mean length of follow-up was 73.4 ± 34.7 months (median, 68 months; range, 12-173 months), and 63 patients died by the end of the follow-up. The 5-year and 10-year overall survival rates were 68.6 ± 6.6% and 59.4 ± 10.6%, respectively. Univariate analysis showed that treatment-related prognostic factors for overall survival were prolonged symptom intervals >=60 days, biopsy/tumor resection performed by different centers, previous medical history, incomplete preoperative chemotherapy (<8 weeks), and prolonged postoperative interval >21 days. In the multivariate analysis, biopsy/tumor resection performed by different centers, incomplete implementation of planned new adjuvant chemotherapy, and delayed resumption of postoperative chemotherapy (>21 days) were risk factors for poor prognosis; biopsy/tumor resection performed by different centers and tumor necrosis <90% were independent predictors of local recurrence. Conclusion. For localized osteosarcoma treated with limb-salvage surgery, it is necessary to optimize timely standard chemotherapy and to resume postoperative chemotherapy to improve survival rates. Biopsies should be performed at experienced institutions in cases of developing local recurrence.

scholarly journals PROGNOSTIC FACTORS AND SURVIVAL ANALYSIS IN ESOPHAGEAL CARCINOMA

2016 ◽  
Vol 29 (3) ◽  
pp. 138-141 ◽  
Author(s):  
Francisco TUSTUMI ◽  
Cintia Mayumi Sakurai KIMURA ◽  
Flavio Roberto TAKEDA ◽  
Rodrigo Hideki UEMA ◽  
Rubens Antônio Aissar SALUM ◽  
...  
Keyword(s):  
Overall Survival ◽  
Weight Loss ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Clinical Stage ◽  
Curative Intent ◽  
Poor Differentiation

ABSTRACT Background: Despite recent advances in diagnosis and treatment, esophageal cancer still has high mortality. Prognostic factors associated with patient and with disease itself are multiple and poorly explored. Aim: Assess prognostic variables in esophageal cancer patients. Methods: Retrospective review of all patients with esophageal cancer in an oncology referral center. They were divided according to histological diagnosis (444 squamous cell carcinoma patients and 105 adenocarcinoma), and their demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival. Results: No difference was noted between squamous cell carcinoma and esophageal adenocarcinoma overall survival curves. Squamous cell carcinoma presented 22.8% survival after five years against 20.2% for adenocarcinoma. When considering only patients treated with curative intent resection, after five years squamous cell carcinoma survival rate was 56.6 and adenocarcinoma, 58%. In patients with squamous cell carcinoma, poor differentiation histology and tumor size were associated with worse oncology stage, but this was not evidenced in adenocarcinoma. Conclusion: Weight loss (kg), BMI variation (kg/m²) and percentage of weight loss are factors that predict worse stage at diagnosis in the squamous cell carcinoma. In adenocarcinoma, these findings were not statistically significant.

Squamous cell carcinoma of the oral tongue: a 25-year, single institution experience

2008 ◽  
Vol 123 (1) ◽  
pp. 114-120 ◽  
Author(s):  
M S Mosleh-Shirazi ◽  
M Mohammadianpanah ◽  
M A Mosleh-Shirazi
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Univariate Analysis ◽  
Disease Stage ◽  
Treatment Schedule ◽  
Oral Tongue ◽  
Single Institution

AbstractAim:To report the characteristics, prognostic factors and treatment outcomes of 102 patients with squamous cell carcinoma of the oral tongue treated and followed up at a single institution over a 25-year period.Patients and methods:This retrospective study was carried out by auditing the medical records of 102 patients diagnosed with squamous cell carcinoma of the oral tongue and treated at our institution between 1982 and 2007. Patient follow up ranged from nine to 310 months (median 35 months). Fifty per cent of the patients were treated with surgery followed by a combination of chemotherapy and radiotherapy (43.1 per cent received concurrent chemoradiation and 6.9 per cent received sequential chemotherapy and radiotherapy), whereas 29.4 per cent received surgery followed by adjuvant radiotherapy alone. The remaining patients (20.6 per cent) did not undergo surgery and were treated with definitive radiotherapy with or without chemotherapy.Results:There were 48 men and 54 women. The age at presentation was 19–85 years (median 57 years). The peak incidence was observed between 60 and 70 years. Resection margins were clear in 75 per cent of patients and involved in 25 per cent. Stage I disease was found in 11.8 per cent of patients, stage II in 34.3 per cent, stage III in 22.5 per cent and stage IV in 31.4 per cent. The five-year disease-free survival and overall survival were 65.7 and 72.5 per cent, respectively. Thirty-five patients suffered recurrence after treatment, 74.0 per cent of them at the site of initial cervical nodal involvement. Univariate analysis for overall survival revealed the following as prognostic factors: treatment schedule (surgical vs non-surgical; p < 0.001); age (<60 years vs ≥60 years; p = 0.038); extent of cervical lymph node involvement (p = 0.015); primary tumour stage (p < 0.001); node stage (p = 0.034); and disease stage (p = 0.013). However, on multivariate analysis, only non-surgical treatment (p = 0.001) and advanced disease stage (p = 0.05) were found to have a negative influence on survival.Conclusions:Our limited data suggest that, in Iran, squamous cell carcinoma of the oral tongue tends to present at a locally advanced stage, with a high frequency of locoregional failure and a poor outcome. Combined modality therapy should be considered for the majority of patients with squamous cell carcinoma of the tongue.

scholarly journals Vulvar cancer: Patterns of recurrence and clinicopathological prognostic factors involved in recurrent cases

2016 ◽  
Author(s):  
Keyword(s):  
Prognostic Factors ◽  
Lymph Node ◽  
Vulvar Cancer ◽  
Resection Margins ◽  
Lymph Node Status ◽  
Depth Of Invasion ◽  
Nodal Involvement ◽  
Lateral Lymph Node ◽  
Node Status ◽  
Patterns Of Recurrence

Objective: Vulvar cancer is a rare disease, with an incidence of 0.6% of all female malignancies. With the advances in management of carcinoma vulva to individualisation of treatment to reduce the psychosexual impact an aggressive treatment can have, it is imperative to understand the patterns of recurrence and the common prognostic factors involved. The aim of this study was to determine prognostic variables for recurrence and survival and to identify patterns of recurrence in patients with vulvar cancer. Materials and Methods: All patients (n=87) with primary vulvar cancer treated at the Rajiv Gandhi Cancer Institute between January, 2006 to January, 2015 who underwent surgery were retrospectively analysed regarding the prognostic relevance of different clinicopathological variables. Recurrences were evaluated with regard to their characteristics and localisation and the variables associated with them were analyzed. Results: Age, stage of tumor, size of tumor, location of tumor (central or lateral), lymph node metastasis, depth of invasion and involvement of resection margins, associated intraepithelial abnormality predicted disease-free and overall survival. In multivariate analysis, lymph node status and positive margin status was the most important independent prognostic factor (p = 0.002). Irrespective of the initial nodal involvement, recurrences occurred primarily in the vulvar region. Conclusion: Inguinofemoral lymph node status and adequate margins at initial diagnosis is of critical prognostic importance for patients with vulvar cancer. Further tumour biological characteristics need to be identified to stratify patients with nodal involvement for adjuvant radiotherapy of the vulva to prevent local recurrences.

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