Trends in Time to Diagnosis of Colon Cancer and Impact on Clinical Outcomes

BACKGROUND: There has been a rapid increase in screening for colorectal cancer (CRC) over the past several years in North America. This could paradoxically lead to worsening outcomes if the system is not adapted to deal with the increased demand. For example, this could create increased wait times for endoscopy and delayed time to CRC diagnosis, which could worsen clinical outcomes such as stage at diagnosis and/or survival. No previous Canadian study has evaluated the association between time to CRC diagnosis and clinical outcomes.METHODS: The present historical cohort study used Manitoba’s population-based cancer registry and Manitoba Health administrative databases. The effect of time to diagnosis on patient survival was evaluated using Cox regression analysis with adjustment for stage at diagnosis, grade of CRC, age, sex, socioeconomic status, comorbidity index score and year of CRC diagnosis. The association between time to diagnosis and CRC stage at diagnosis was evaluated using multivariate logistic regression analysis.RESULTS: The median time to CRC diagnosis increased significantly from 72 days (95% CI 61 days to 83 days) in 2004 to 105 days (95% CI 64 days to 129 days) in the first three months of 2009 (P=0.04). There was no significant association between time to diagnosis and survival. Individuals with the longest time to diagnosis were less likely to have stage III/IV CRC at diagnosis (quartile 4 versus quartile 1: OR 0.50 [95% CI 0.33 to 0.75).CONCLUSION: Time to CRC diagnosis is continuing to increase in Manitoba. Although the present study did not detect a significant negative clinical effect of increasing time to diagnosis, additional studies are required.

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Role of Disease Modifying Treatment in the Risk of Alloimmunization in Transfused Patients with Myelodysplastic Syndromes: A Population-Based Study

Blood ◽

10.1182/blood-2019-123357 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4253-4253

Author(s):

Hanne Rozema ◽

Robby Kibbelaar ◽

Nic Veeger ◽

Mels Hoogendoorn ◽

Eric van Roon

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Cox Regression ◽

Population Based ◽

Incidence Rates ◽

Blood Products ◽

Cox Regression Analysis ◽

In The Beginning ◽

Observation Period

The majority of patients with myelodysplastic syndromes (MDS) require regular red blood cell (RBC) transfusions. Alloimmunization (AI) against blood products is an adverse event, causing time-consuming RBC compatibility testing. The reported incidence of AI in MDS patients varies greatly. Even though different studies on AI in MDS patients have been performed, there are still knowledge gaps. Current literature has not yet fully identified the risk factors and dynamics of AI in individual patients, nor has the influence of disease modifying treatment (DMT) been explored. Therefore, we performed this study to evaluate the effect of DMT on AI. An observational, population-based study, using the HemoBase registry, was performed including all newly diagnosed MDS patients between 2005 and 2017 in Friesland, a province of the Netherlands. All available information about treatment and transfusions, including transfusion dates, types, and treatment regimens, was collected from the electronic health records and laboratory systems. Follow-up occurred through March 2019. For our patient cohort, blood products were matched for AB0 and RhD, and transfused per the 'type and screen' policy (i.e. electronic matching of blood group phenotype between patient and donor). After a positive antibody screening, antibody identification and Rh/K phenotyping was performed and subsequent blood products were (cross)matched accordingly. The observation period was counted from first transfusion until last transfusion or first AI event. Univariate analyses and cumulative frequency distributions were performed to study possible risk factors and dynamics of AI. DMT was defined as hypomethylating agents, lenalidomide, chemotherapy and monoclonal antibodies. The effect of DMT as a temporary risk period on the risk of AI was estimated with incidence rates, relative risks (RR) and hazard ratios (HR) using a cox regression analysis. Follow-up was limited to 24 months for the cox regression analysis to avoid possible bias by survival differences. Statistical analyses were performed using IBM SPSS 24 and SAS 9.4. Out of 292 MDS patients, 236 patients received transfusions and were included in this study, covering 463 years of follow-up. AI occurred in 24 patients (10%). AI occurred mostly in the beginning of the observation period: Eighteen patients (75%) were alloimmunized after receiving 20 units of RBCs, whereas 22 patients (92%) showed AI after 45 units of RBCs (Figure 1). We found no significant risk factors for AI in MDS patients at baseline. DMT was given to 67 patients (28%) during the observation period. Patients on DMT received more RBC transfusions than patients that did not receive DMT (median of 33 (range: 3-154) and 11 (range: 0-322) RBC units respectively, p<0,001). Four AI events (6%) occurred in patients on DMT and 20 AI events (12%) occurred in patients not on DMT. Cox regression analysis of the first 24 months of follow-up showed an HR of 0.30 (95% CI: 0.07-1.31; p=0.11). The incidence rates per 100 person-years were 3.19 and 5.92 respectively. The corresponding RR was 0.54 (95% CI: 0.16-1.48; p=0.26). Based on our results, we conclude that the incidence of AI in an unselected, real world MDS population receiving RBC transfusions is 10% and predominantly occurred in the beginning of follow-up. Risk factors for AI at baseline could not be identified. Our data showed that patients on DMT received significantly more RBC transfusions but were less susceptible to AI. Therefore, extensive matching of blood products may not be necessary for patients on DMT. Larger studies are needed to confirm the protective effect of DMT on AI. Disclosures Rozema: Celgene: Other: Financial support for visiting MDS Foundation conference.

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Analysis of CK5/6 and EGFR and Its Effect on Prognosis of Triple Negative Breast Cancer

Frontiers in Oncology ◽

10.3389/fonc.2020.575317 ◽

2021 ◽

Vol 10 ◽

Author(s):

Zhen Wang ◽

Lei Liu ◽

Ying Li ◽

Zi’an Song ◽

Yi Jing ◽

...

Keyword(s):

Breast Cancer ◽

Regression Analysis ◽

Neoadjuvant Chemotherapy ◽

Triple Negative Breast Cancer ◽

Triple Negative ◽

Cox Regression ◽

Multivariate Logistic Regression Analysis ◽

Pathological Examination ◽

Cox Regression Analysis ◽

Tumor Stages

BackgroundTriple-negative breast cancer (TNBC) is considered to be higher grade, more aggressive and have a poorer prognosis than other types of breast cancer. Discover biomarkers in TNBC for risk stratification and treatments that improve prognosis are in dire need.MethodsClinical data of 195 patients with triple negative breast cancer confirmed by pathological examination and received neoadjuvant chemotherapy (NAC) were collected. The expression levels of EGFR and CK5/6 were measured before and after NAC, and the relationship between EGFR and CK5/6 expression and its effect on prognosis of chemotherapy was analyzed.ResultsThe overall response rate (ORR) was 86.2% and the pathological complete remission rate (pCR) was 29.2%. Univariate and multivariate logistic regression analysis showed that cT (clinical Tumor stages) stage was an independent factor affecting chemotherapy outcome. Multivariate Cox regression analysis showed pCR, chemotherapy effect, ypT, ypN, histological grades, and post- NAC expression of CK5/6 significantly affected prognosis. The prognosis of CK5/6-positive patients after NAC was worse than that of CK5/6-negative patients (p=0.036). Changes in CK5/6 and EGFR expression did not significantly affect the effect of chemotherapy, but changes from positive to negative expression of these two markers are associated with a tendency to improve prognosis.ConclusionFor late-stage triple negative breast cancer patients receiving NAC, patients who achieved pCR had a better prognosis than those with non- pCR. Patients with the change in expression of EGFR and CK5/6 from positive to negative after neoadjuvant chemotherapy predicted a better prognosis than the change from negative to positive group.

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Abstract 15416: Impact of Acute Hyperglycemia on Microvascular Damage and Long-term Clinical Outcomes in Patients With ST-elevation Myocardial Infarction

Circulation ◽

10.1161/circ.132.suppl_3.15416 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tetsuo Horimatsu ◽

Kenichi Fujii ◽

Masashi Fukunaga ◽

Machiko Nishimura ◽

Ten Saita ◽

...

Keyword(s):

Myocardial Infarction ◽

Regression Analysis ◽

Clinical Outcomes ◽

Glucose Level ◽

Multivariate Logistic Regression Analysis ◽

Diabetic Patients ◽

Microvascular Damage ◽

Acute Hyperglycemia ◽

Cox Regression Analysis

Introduction: We have recently reported the cause of microcirculatory damage after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients can be evaluated by analyzing the thermodilution-derived coronary blood flow pattern (CBFP), and only the capillary destruction pattern was associated with poor mid-term clinical outcomes. In this study, we extend our research on the contribution of acute hyperglycemia on microcirculatory damage and long-term clinical outcomes in STEMI patient. Methods: Ninety-seven consecutive STEMI patients undergoing primary PCI were prospectively enrolled. Using a pressure sensor/thermistor-tipped guidewire, CBFP was assessed from the thermodilution-curves immediately after successful PCI. All patients were classified into 3 groups according to the shape of thermodilution curve: no microvascular damaged group (n=47), arteriole microemboli group (n=33), or capillary destruction group (n=17). Blood glucose levels were measured on admission. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, myocardial infarction, and heart failure rehospitalization within 3 years. Results: Mean admission glucose level was significantly higher in the capillary destruction group than in the microemboli and no microvascular damaged groups (259±134, 162±66, and 153±60 mg/dL, respectively, p<0.0001). These findings were similar when the analysis was limited to non-diabetic patients. The incidence of MACE was also higher in the capillary destruction group compared with the microemboli and no microvascular damaged groups (71, 19, and 16%, respectively, p<0.0001). On multivariate Cox regression analysis, the capillary destruction pattern was the independent predictor of MACE (hazard ratio, 9.41; 95%CI 2.28-38.8; p=0.001). In the multivariate logistic regression analysis, higher glucose level on admission remained as an independent risk factor of the capillary destruction pattern (per 10mg/dL increase, odds ratio, 1.10; 95%CI 1.10-1.22; p=0.002). Conclusions: Hyperglycemia on admission increases the risk of microvascular damage secondary to the capillary destruction and subsequent poor long-term clinical outcomes in STEMI patients.

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Association of change in AFP > 15 ng/ml/month with stage at diagnosis and mortality in patients with hepatocellular carcinoma (HCC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.255 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 255-255

Author(s):

Ysabel Ilagan-Ying ◽

David Edward Kaplan ◽

Tamar H. Taddei ◽

Basile Njei

Keyword(s):

Regression Analysis ◽

Liver Disease ◽

Cox Regression ◽

Tumor Staging ◽

Tumor Burden ◽

Stage At Diagnosis ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Chart Abstraction ◽

Stage D

255 Background: In a recent study, a change in AFP > 15 ng/ml/month was associated with poor post-transplant HCC survival. We hypothesized that change in AFP is associated with stage of HCC at diagnosis and mortality. Methods: Patients with potential HCC from 2008-2010 were identified by querying the Veterans Administration Corporate Data Warehouse. Diagnostic confirmation and tumor staging was obtained by manual chart abstraction. Dates of death were ascertained and censored from 12/31/2014. Logistic regression analysis was performed to determine the association between change in AFP and stage at diagnosis. Multivariable cox regression analysis adjusting for severity of liver disease was performed to determine the association between change in AFP and all-cause mortality. Results: Of 3,988 HCC cases, change in AFP > 15 ng/ml/month was associated with presentation at BCLC stage B (OR 2.26, CI 1.54-3.33, p < 0.001) and C (OR 3.39, CI 2.25-5.01, p < 0.001). There was no statistically significant association between AFP > 15 ng/ml/month with stage BCLC 0 or A (early HCC), or with BCLC stage D, likely reflecting a greater burden of liver disease severity over tumor burden in Stage D. Change in AFP > 15 ng/ml/month was associated with increased all-cause mortality (HR 1.49, CI 1.37-1.62, p < 0.001). Conclusions: In a large cohort of US Veterans with HCC, change in AFP > 15 ng/ml/month may be a useful prognostic marker for presentation with advanced stage cancer and all-cause mortality.

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Outcomes of patients with nonmetastatic gastric adenocarcinoma according to perioperative treatment strategy: a real-world, population-based study

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2021-0113 ◽

2021 ◽

Vol 10 (15) ◽

pp. 1143-1151

Author(s):

Omar Abdel-Rahman

Keyword(s):

Gastric Cancer ◽

Regression Analysis ◽

Adjuvant Chemotherapy ◽

Treatment Strategy ◽

Cox Regression ◽

Population Based ◽

Survival Outcomes ◽

Perioperative Chemotherapy ◽

Cox Regression Analysis ◽

Perioperative Treatment

Aim: To assess the survival outcomes of patients with nonmetastatic gastric cancer according to the type of perioperative treatment strategy used (surgery-only, adjuvant chemo-radiotherapy, adjuvant chemotherapy, perioperative chemotherapy) in a population-based setting. Materials & methods: Surveillance, Epidemiology and End Results research-plus database was explored, and patients with nonmetastatic gastric cancer who were treated with an oncologic surgery were reviewed. Multivariable Cox regression analysis was used to examine the impact of treatment strategy on overall and cancer-specific survival. Results: A total of 11,526 patients were found to be eligible and they were included in the current analysis. Looking at the percentages of different treatment strategies throughout the study years (2006–2017), the use of the following strategies increased: adjuvant chemotherapy (20.1 vs 10.6%), and perioperative chemotherapy (21.3 vs 0.5%); while the use of the following strategies decreased: surgery only (36.2 vs 58.2%), and adjuvant chemo-radiotherapy (22.4 vs 30.6%). Using multivariable Cox regression analysis, the following factors were associated with worse overall survival: older age (hazard [HR]: 1.021; 95% CI: 1.018–1.023), males (HR: 1.09; 95% CI: 1.04–1.14), Black race (HR: 1.11; 95% CI: 1.04–1.19), cardia subsite (HR: 1.09; 95% CI: 1.02–1.17), grade 3–4 (HR:1.32; 95% CI: 1.25–1.40), diffuse histology (HR: 1.46; 95% CI: 1.35–1.58), clinically node positive (HR:1.43; 95% CI: 1.34–1.53), total gastrectomy (HR: 1.20; 95% CI: 1.13–1.28), and surgery-only approach (HR: 1.65; 95% CI: 1.55–1.75). Conclusion: Among patients with localized gastric cancer, patients who were treated with surgery-only, and to a less extent, patients who were treated with surgery followed by adjuvant chemotherapy have worse survival outcomes; while those treated with perioperative chemotherapy have the best survival outcomes.

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A New Risk Score Based on Eight Hepatocellular Carcinoma- Immune Gene Expression Can Predict the Prognosis of the Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.766072 ◽

2021 ◽

Vol 11 ◽

Author(s):

Dingde Ye ◽

Yaping Liu ◽

Guoqiang Li ◽

Beicheng Sun ◽

Jin Peng ◽

...

Keyword(s):

Gene Expression ◽

Hepatocellular Carcinoma ◽

Regression Analysis ◽

Clinical Outcomes ◽

Gene Expression Data ◽

Clinical Characteristics ◽

Cox Regression ◽

Expression Data ◽

Database Analysis ◽

Cox Regression Analysis

BackgroundHepatocellular carcinoma (HCC) is one of the malignant tumors with high morbidity and mortality worldwide. Immunotherapy has emerged as an increasingly important cancer treatment modality. However, the potential relationship between immune genes and HCC still needs to be explored. The purpose of this study is to construct a new prognostic risk signature to predict the prognosis of HCC patients based on the expression of immune-related genes (IRGs) and explore its potential mechanism.MethodsWe analyzed the gene expression data of 332 HCC patient samples and 46 adjacent normal tissues samples (Solid Tissue Normal including cirrhotic tissue) in The Cancer Genome Atlas (TCGA) database and clinical characteristics. We analyzed the gene expression data, identified differentially expressed IRGs in HCC tissues, filtered IRGs with prognostic value to construct an IRG signature, and classified patients into high and low gene expression groups based on the expression of IRGs in their tumor tissues. We also investigated the potential molecular mechanisms of IRGs through a bioinformatics approach using Protein-Protein Interaction (PPI) network, Kyoto Encyclopedia of Genes and Genomes (KEGG) database analysis and Gene Ontology (GO) database analysis. Differentially expressed IRGs associated with significant clinical outcomes (SIRGs) were identified by univariate Cox regression analysis. An immune-related risk score model (IRRSM) was established based on Lasso Cox regression analysis and multivariate Cox regression analysis. Based on the IRRSM, the immune score of the patients was calculated, and the patients were divided into high-risk and low-risk patients according to the median score, and the differences in survival between the two groups were compared. Then, the correlation analysis between the IRRSM and clinical characteristics was performed, and the IRRSM was validated using the International Cancer Genome Consortium (ICGC) database.ResultsThe IRRSM was eventually constructed and confirmed to be an independent prognostic model for HCC patients. The IRRSM was shown to be positively correlated with the infiltration of four types of immune cells.ConclusionOur results showed that some SIRGs have potential value for predicting the prognosis and clinical outcomes of HCC patients. IRGs affect the prognosis of HCC patients by regulating the tumor immune microenvironment (TIME). This study provides a new insight for immune research and treatment strategies in HCC patients.

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Risk Factors for the Morbidity and Prognosis of Lung Metastases in Newly Diagnosed Ovarian Carcinoma: A Large Population-based Study

10.21203/rs.3.rs-737681/v1 ◽

2021 ◽

Author(s):

Shuning Ding ◽

Kaibo Guo ◽

Linqin Wu ◽

Dongxu Li ◽

Peipei Wang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ovarian Carcinoma ◽

Cox Regression ◽

Lung Metastases ◽

Population Based ◽

Ca 125 ◽

Newly Diagnosed ◽

Cox Regression Analysis

Abstract Background: To evaluate the risk factors for the morbidity and prognosis of lung metastases (LM) in patients with newly diagnosed ovarian carcinoma (OC). Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) dataset, OC patients from 2010 and 2016 were retrospectively analyzed. Risk factors for the morbidity of LM in OC patients and their survival were assessed by logistic regression analysis and Kaplan-Meier and Gray method, respectively. Cox regression analysis was performed to identify risk factors for the prognosis of OC patients with LM, and their prognostic potentials were further validated by two established nomograms.Results: There are 27,123 eligible OC patients were enrolled in the study, with the morbidity of LM at 5.61% (1,521/27,123). Logistic regression models illustrated that T3 stage [odds ratio (OR)=2.74, 95%CI=2.09-3.66, P<0.01], advanced N stage (OR=1.86, 95%CI=1.62-2.14, P<0.01), and the prevalence of bone metastasis (OR=3.78, 95%CI=2.79-5.11, P<0.01), brain metastasis (OR=4.67, 95%CI=2.50-8.63, P<0.01) and liver metastasis (OR=3.60, 95%CI=3.14-4.12, P<0.01) were all significantly correlated with the morbidity of LM in OC patients. Median survival for OC patients with LM was 11 months (interquartile range, 3 to 25 months). Cox regression analyses illustrated over 80 years of age [hazard ratio (HR)=2.52, 95%CI=2.33-2.72, P<0.01] and positive expression of cancer antigen 125 (CA-125, HR=1.63, 95%CI=1.47-1.82, P<0.01) were significantly correlated with the high mortality of LM, while chemotherapy (HR=0.62, 95%CI=0.59-0.65, P<0.01) was significantly correlated with the low mortality. Two nomograms were established to examine the concordance index (C-index), calibration curves, the area under the curve (AUC), decision curve analyses (DCAs) and clinical impact curves (CICs), which validated the prognostic potentials of identified risk factors in OC patients with LM. Conclusion: The population-based cohort study provides references for guiding clinical screening and individualized treatment of OC patients with LM.

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Impact of Non-Hepatic Hyperammonemia on Mortality in Intensive Care Unit Patients: A Retrospective Cohort Study

10.21203/rs.3.rs-129350/v1 ◽

2020 ◽

Author(s):

Jae Heon Kim ◽

Hankyu Jeon ◽

Sang Soo Lee ◽

Hee Jin Kim ◽

Ra Ri Cha ◽

...

Keyword(s):

Intensive Care Unit ◽

Regression Analysis ◽

Intensive Care ◽

Cox Regression ◽

Multivariate Logistic Regression Analysis ◽

Hepatic Disease ◽

Cox Regression Analysis ◽

Entire Cohort ◽

Factors Associated ◽

The Impact

Abstract Background: The effect of hyperammonemia on the mortality in patients with liver cirrhosis is well documented. However, little is known about the impact of hyperammonemia on mortality in intensive care unit patients without hepatic disease. We aimed to investigate factors associated with non-hepatic hyperammonemia in intensive care unit patients and evaluate the factors related to 90-day mortality. Methods: Between February 2016 and February 2020, 972 cases in 948 intensive care unit patients without hepatic disease were retrospectively enrolled and classified as hyperammonemia grades 0 (≤80 µg/dL; n=585 (60.2%)), 1 (≤160 µg/dL; n=291 (29.9%)), 2 (≤240 µg/dL; n=55 (5.7%)), and 3 (>240 µg/dL; n=41 (4.2%)). Factors associated with hyperammonemia and 90-day mortality were evaluated by multivariate logistic regression analysis and Cox regression analysis, respectively. Kaplan-Meier survival curves for 90-day mortality were constructed.Results: The independent risk factors for hyperammonemia were male sex (odds ratio, 1.517), age (0.984 per year), acute brain failure (2.467), acute kidney injury (1.437), prothrombin time-international normalized ratio (2.272 per unit), and albumin (0.694 per g/dL). The 90-day mortality rate in the entire cohort was 24.3% and gradually increased with increasing hyperammonemia grade at admission (17.9%, 28.2%, 43.6%, and 61.0% in patients with grades 0, 1, 2, and 3, respectively). Additionally, non-hepatic hyperammonemia was an independent predictor of 90-day mortality in intensive care unit patients. Conclusions: Non-hepatic hyperammonemia is common (39.8%) and associated with 90-day mortality in intensive care unit patients. Therefore, clinicians must examine serum ammonia levels in patients before admission to intensive care unit.

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Small bowel carcinoid: Location isn’t everything.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.292 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 292-292

Author(s):

Danielle M. Hari ◽

Heidi M Hari Reich ◽

Anna Mary Leung ◽

Ji Hey Hey Lee ◽

Myung-Shin Sim ◽

...

Keyword(s):

Regression Analysis ◽

Small Bowel ◽

Cox Regression ◽

Population Based ◽

Primary Site ◽

Tnm Stage ◽

Diagnostic Methods ◽

Site Location ◽

Cox Regression Analysis ◽

Kaplan Meier

292 Background: Contemporary data has revealed that small bowel carcinoid (SBC) accounts for the majority of gastrointestinal carcinoids. However, data remains limited regarding prognostic factors that impact survival for SBC patients. Using a population-based analysis, we investigate the significance of the primary site of disease for SBC. Methods: The Surveillance, Epidemiology, and End Results database was queried for histologically confirmed SBC between the years 1988 and 2009. Patients were excluded if adequate demographic and staging information was unknown. Overall and disease survival curves (OS and DSS respectively) were analyzed using the Kaplan-Meier method and compared using Log rank testing. Log rank and multivariate Cox regression analysis was used to identify predictors of survival using age, year of diagnosis, race, gender, tumor histology/size/location, TNM stage, number of lymph nodes (LNs) examined and percent of LNs with metastases. Results: Of the 3,834 patients analyzed, the mean age was 62.13 years and 51.2% were male. Median follow up was 50 months. The 10-year OS (63%) and DSS (91%) for duodenal primaries was statistically significant when compared to jejunal (53%, 74%), ileal (50%, 68%) and overlapping primaries (50%, 78%), (p = 0.0290 and < 0.0001, respectively). However, more the 90% of duodenal primaries had stage I and II disease only. On multivariate Cox regression analysis, after adjusting for multiple factors, primary site location was not a significant predictor of survival (p = 0.948 for OS and = 0.625 DSS) while TNM stage, age, tumor size and number of LNs examined portend improved OS and DSS. Conclusions: This population-based study of SBC over the past 30 years refutes the concept that the location of the SBC influences survival. A key element to consider is that more than 90% of duodenal primaries present at early stages. Further screening and diagnostic methods to detect other SBC primary sites could significantly impact survival.

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Effect of cumulative dexamethasone dose during concomitant chemoradiation on lymphopenia in patients with newly diagnosed glioblastoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14533 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14533-e14533

Author(s):

Stephen Ahn ◽

Jae-Sung Park ◽

Jin Ho Song ◽

Sin-Soo Jeun ◽

Yong-Kil Hong

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Cox Regression ◽

Performance Status ◽

Multivariate Logistic Regression Analysis ◽

Newly Diagnosed ◽

Cox Regression Analysis ◽

Female Sex ◽

Concomitant Chemoradiation ◽

Independent Risk Factors

e14533 Background: Lymphopenia frequently occurs after concomitant chemoradiation (CCRT) in patients with glioblastoma (GBM) and is associated with worse overall survival (OS). A few studies have tried to identify risk factors for lymphopenia; however, the results were not clear. We aimed to identify potential risk factors for lymphopenia, focusing on the use of dexamethasone to control cerebral edema in patients with GBM. Methods: The electronic medical records of 180 patients with newly diagnosed GBM treated at our institution between 2009 and 2017 were retrospectively examined. Acute lymphopenia was defined as TLC (total lymphocyte count) less than 1,000 cells/mm3 at 4 weeks after completion of CCRT. Multivariate logistic regression analysis was used to identify independent risk factors for lymphopenia, and Cox regression analysis was used to identify independent risk factors for OS. Results: Of the 125 eligible patients, 40 patients (32.0%) developed acute lymphopenia. Female sex and median daily dexamethasone dose > 2mg after initiation of CCRT were independent risk factors for acute lymphopenia on multivariate analysis. Acute lymphopenia, extent of surgical resection, and performance status were associated with OS; however, dexamethasone use itself was not an independent risk factor for poor OS. Conclusions: Female sex, median daily dexamethasone dose > 2 mg after initiation of CCRT until four weeks after completion of CCRT may be associated with acute lymphopenia. However, dexamethasone use itself did not affect OS in patients newly diagnosed with GBM. These results should be validated by further prospective studies controlling for other confounding factors.

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