scholarly journals Expression of Selected Epithelial-Mesenchymal Transition Transcription Factors in Endometrial Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Paweł Sadłecki ◽  
Jakub Jóźwicki ◽  
Paulina Antosik ◽  
Małgorzata Walentowicz-Sadłecka
Keyword(s):  
Multivariate Analysis ◽  
Endometrial Cancer ◽  
Transcription Factors ◽  
Wall Thickness ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Uterine Wall ◽  
Type Ii ◽  
Therapeutic Decisions

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. The aim of this study was to analyze the expression of SNAIL, SLUG, TWIST1, TWIST2, ZEB1, and ZEB 2 in primary tumor and the correlation with morphological and clinical characteristics of EC. The study included 158 patients with EC after surgical treatments: total hysterectomy and lymphadenectomy. The percentages of EC specimens testing positively for the EMT transcription factors were 84.5% for SNAIL, 92.2% for SLUG, 10.9% for TWIST1, 100% for TWIST2, 89% for ZEB1, and 98% for ZEB2. The expression of SLUG in patients with FIGO stage III or IV, type II EC, myometrial invasion ≥ 50 % of the uterine wall thickness, and adnexal involvement and in patients with distant metastases was significantly higher. SLUG and ZEB2 expressions were identified as significant predictors of higher FIGO stages (III or IV) on univariate analysis. The overexpression of SLUG was a significant predictor of more aggressive type II EC, myometrial   invasion ≥ 50 % of the uterine wall thickness, and distant metastases on both univariate and multivariate analysis. Moreover, the overexpression of SLUG and ZEB2 was shown to be significant predictors of adnexal involvement on univariate analysis. ZEB 2 overexpression was identified in multivariate analysis as another independent predictor associated with a lesser likelihood of type II EC. Both univariate and multivariate analyses demonstrated that SLUG expression was the only predictor of 5-year survival in the study group. The overexpression of SLUG was associated with a significant increase in mortality hazard on univariate analysis and was shown to be a highly significant predictor of death on multivariate analysis. Conclusions. Selected proteins of the EMT pathway play a role in endometrial carcinogenesis; SLUG and ZEB2 expressions in the primary tumor might predict clinical outcomes in EC and drive therapeutic decisions regarding adjuvant treatment in patients with this malignancy.

scholarly journals Only peak thyroglobulin concentration on day 1 and 3 of rhTSH-aided RAI adjuvant treatment has prognostic implications in differentiated thyroid cancer

2021 ◽  
Author(s):  
Aleksandra Ledwon ◽  
Ewa Paliczka-Cieślik ◽  
Aleksandra Syguła ◽  
Tomasz Olczyk ◽  
Aleksandra Kropińska ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Treatment Failure ◽  
Adjuvant Treatment ◽  
Prognostic Value ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Thyroid Stimulating Hormone ◽  
Human Thyroid ◽  
Serum Thyroglobulin ◽  
Thyroid Hormone Withdrawal

Abstract Objective In patients with differentiated thyroid carcinoma (DTC), serum thyroglobulin levels measured at the time of remnant ablation after thyroid hormone withdrawal were shown to have prognostic value for disease-free status. We sought to evaluate serial thyroglobulin measurements at the time of recombinant human thyroid-stimulating hormone (rhTSH)-aided iodine 131 (131I) adjuvant treatment as prognostic markers of DTC. Methods Six hundred-fifty patients with DTC given total/near-total thyroidectomy and adjuvant radioiodine post-rhTSH stimulation were evaluated. Thyroglobulin was measured on day 1 (Tg1; at the time of the first rhTSH injection), day 3 (Tg3; 1 day after the second, final rhTSH injection), and day 6 (Tg6; 3 days post-radioiodine administration). Treatment failure was defined as histopathologically confirmed locoregional recurrence, or radiologically-evident distant metastases (signs of disease on computer tomography (CT) or magnetic resonance imaging (MRI), or abnormal foci of radioiodine or [18F] fluorodeoxyglucose ([18F]FDG) uptake. Results In univariate analysis, Tg1 (p < 0.001) and Tg3 (p < 0.001), but not Tg6, were significantly associated with structural recurrence. In multivariate analysis of the overall cohort, only Tg3 was independently associated with structural recurrence. In multivariate analysis of the subgroup (n = 561) with anti-Tg antibodies titers below the institutional cut-off, 115 IU/mL, Tg1 was an independent prognostic marker. Tg1 and Tg3 cutoffs to best predict structural recurrence were established at 0.7 ng/mL and 1.4 ng/mL, respectively. Conclusions Tg1 and Tg3, measurements made after rhTSH stimulation but before radioiodine treatment, independently predict a low risk of treatment failure in patients with DTC. Levels measured post-radioiodine application (e.g., Tg6) are highly variable, lack prognostic value, and hence can be omitted.

Distant metastases after diagnosis: Racial disparities in breast cancer outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1084-1084
Author(s):  
Julia Blanter ◽  
Ilana Ramer ◽  
Justina Ray ◽  
Emily J. Gallagher ◽  
Nina A. Bickell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Black Women ◽  
Racial Disparities ◽  
Late Stage ◽  
White Women ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Stage At Diagnosis

1084 Background: Black women diagnosed with breast cancer are more likely to have a poor prognosis, regardless of breast cancer subtype. Despite having a lower incidence rate of breast cancer when compared to white women, black women have the highest breast cancer death rate of all racial and ethnic groups, a characteristic often attributed to late stage at diagnosis. Distant metastases are considered the leading cause of death from breast cancer. We performed a follow up study of women with breast cancer in the Mount Sinai Health System (MSHS) to determine differences in distant metastases rates among black versus white women. Methods: Women were initially recruited as part of an NIH funded cross-sectional study from 2013-2020 to examine the link between insulin resistance (IR) and breast cancer prognosis. Women self-identified as black or white race. Data was collected via retrospective analysis of electronic medical records (EMR) between September 2020-January 2021. Distant metastases at diagnosis was defined as evidence of metastases in a secondary organ (not lymph node). Stage at diagnosis was recorded for all patients. Distant metastases after diagnosis was defined as evidence of metastases at any time after initiation of treatment. Univariate analysis was performed using Fisher’s exact test, multivariate analysis was performed by binary logistic regression, and results expressed as odds ratio (OR) and 95% confidence interval (CI). A p value <0.05 was considered statistically significant. Results: We identified 441 women enrolled in the IR study within the MSHS (340 white women, 101 black women). Median follow up time for all women was 2.95 years (median = 3.12 years for white and 2.51 years for black women (p=0.017)). Among these patients, 11 developed distant metastases after diagnosis: 4 (1.2%) white and 7 (6.9%) black (p=0.004). Multivariate analysis adjusting for age, race and stage at diagnosis revealed that black women were more likely to have distant metastasis (OR 5.8, CI 1.3-25.2), as were younger women (OR for age (years) 0.9, CI 0.9-1.0), and those with more advanced stage at diagnosis. Conclusions: Black women demonstrated a far higher percentage of distant metastases after diagnosis even when accounting for age and stage. These findings suggest that racial disparities still exist in the development of distant metastases, independent from a late-stage diagnosis. The source of existing disparities needs to be further understood and may be found in surveillance, treatment differences, or follow up.

Survival after locoregional recurrence in patients after breast cancer surgery.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 141-141
Author(s):  
T. Osako ◽  
R. Nishimura ◽  
Y. Okumura ◽  
R. Tashima ◽  
Y. Toyozumi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Primary Tumor ◽  
Locoregional Recurrence ◽  
Distant Metastases ◽  
Breast Conserving Therapy ◽  
Breast Cancer Surgery ◽  
Systemic Metastasis

141 Background: The purpose of this study was to investigate factors for survival after locoregional recurrence in patients who underwent mastectomy or breast-conserving therapy (BCT) for primary breast cancer in our hospital. Methods: Out of 3,332 patients operated on from 1989 to 2008, 50 patients had chest wall recurrences after mastectomy (CWR), 40 patients had regional nodal recurrences (RNR), and 24 patients had ipsilateral breast tumor recurrences (IBTR) from 1997 to 2008. To investigate the prognostic factors for survival after locoregional recurrence, we conducted uni- and multivariate analyses of these cases. Results: The median follow-up time was 49.2 months. The 5-year survivals after recurrence of the patients with CWR, RNR and IBRT were 52%, 28%, and 68%, respectively. And the 10-year survivals were 15%, 0%, and 62%, respectively. Furthermore, the 5-year distant metastasis-free survivals were 24%, 13%, and 59%, respectively. In a multivariate analysis of the patients with CWR, type of recurrent nodules (diffuse/single, RR 21.0, p= 0.001), pT (T3 or 4 /T1, RR 11.4, p=0.01), pN (N3/N0, RR 15.5, p= 0.03), Ki67 of primary tumor (>50%/<20%, RR6.7, p=0.02) and ER of the primary tumor (+ / -, RR 2.6, p = 0.02) were independent prognostic factors. In a multivariate analysis of RNR, the method of first line salvage therapy (local /local + systemic, RR 16.1, p = 0.01) was only an independent prognostic factor. In the cases of IBTR, there were no independent prognostic factors for survival after recurrence. Conclusions: Although CWR developed distant metastases within 5 years, the survival depended upon the several biological factors. RNR developed distant metastases within a few years and provided poor prognosis. These suggested that RNR would be the first appearance of systemic metastasis not local disease. In contrast, IBTR provided better prognosis and a salvage treatment cured about 60% of the patients.

scholarly journals The pattern of distant metastasis and clinicopathological factors associated with de-novo metastatic cervical cancer: a retrospective analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 191
Author(s):  
J. Kannan ◽  
Amit Saklani ◽  
Srigopal Mohanty ◽  
Kiranmayee Narapaneni ◽  
Deepak George ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Multivariate Analysis ◽  
Cancer Patients ◽  
Distant Metastasis ◽  
Primary Tumor ◽  
De Novo ◽  
Univariate Analysis ◽  
High Grade ◽  
Newly Diagnosed ◽  
Factors Associated

Background: Metastatic cervical cancer carries poor prognosis. The factors associated with distant metastasis in newly diagnosed cervical cancer patients are not clear.Methods: A retrospective analytical study was performed to study the pattern of distant metastasis, and to evaluate the factors associated with de-novo metastatic cervical cancer. Univariate and multivariate analysis (by MANOVA) were used to evaluate the association. P≤0.05 was considered significant.Results: Out of 1321 newly diagnosed cervical cancer patients, 54 (4.1%) had de-novo metastatic disease and most of which (81%) were found at single site. Common sites of distant metastasis were non-regional nodes, followed by liver, lung, peritoneum and bone. Univariate analysis showed the factors associated with de-novo metastasis were non squamous subtype, high grade histology, bulky primary tumor (>4 cm), pelvic/para-aortic lymphadenopathy, and hydroureteronephrosis. Multivariate analysis revealed the factors associated with de-novo metastasis were bulky primary tumor (>4 cm), high grade histology, pelvic/para aortic lymphadenopathy, hydroureteronephrosis.Conclusions: Newly diagnosed cervical cancer patients with bulky primary tumor, high grade histology, pelvic or para aortic lymphadenopathy, hydroureteronephrosis are associated with higher risk of de-novo distant metastasis.

Do pathological parameters of primary tumor correlate with overall survival (OS) of metastatic clear-cell renal cell carcinoma (ccRCC)?

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 549-549
Author(s):  
Umberto Basso ◽  
Marco Maruzzo ◽  
Anna Paola Fraccon ◽  
Teodoro Sava ◽  
Francesco Massari ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Primary Tumor ◽  
Clinical Laboratory ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Fuhrman Grade ◽  
Metastatic Setting ◽  
N Stage ◽  
Grade 3

549 Background: T and N stage, Fuhrman grade, necrosis and sarcomatoid features in the primary tumor are key prognostic factors for relapse of ccRCC, but they are not part of Heng's algorithm applied to predict OS in the metastatic setting, which instead is based on 6 clinical/laboratory items. Methods: Retrospective analysis on correlation between pathological parameters and OS (from start of first-line targeted therapy) and Heng's prognostic factors in a multicenter cohort of pts with advanced ccRCC, all of whom had undergone surgery on the kidney. Results: From 2006 to 2012, data of 903 eligible metastatic pts were collected from 33 Italian Oncology Institutions, median age 66 years, 72.6% males, 36.4 metastatic at diagnosis. After a median observation of 42 mo, 70,5% of pts died, estimated OS is 28.5 mo. Heng good prognosis pts were 14.45%, intermediate 69.1% and poor 16.45%. Univariate analysis showed that all pathological parameters significantly correlated with OS: T stage 3-4 vs 1-2 (HR 1.3), N1 vs N0 (1.3), Fuhrman grade 3-4 vs 1-2 (1.7) presence of necrosis (1.5) and sarcomatoid features (1,6). All pathological parameters had a strong correlation with a time to metastases < 1 year, while only weak correlations were found with the other clinical prognostic items of Heng's model. At multivariate analysis only N stage showed an independent impact on OS (table). Conclusions: T3-4 stage, N1, Fuhrman grade 3-4, presence of necrosis and sarcomatoid features negatively affect OS of metastatic ccRCC, but clinical items of Heng's model confirm to have a more robust prognostic significance at multivariate analysis. [Table: see text]

Polymorphisms of pluripotency transcription factors for predicting cetuximab efficacy in metastatic colorectal cancer: Data from FIRE-3 and TRIBE trials.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 98-98
Author(s):  
Hiroyuki Arai ◽  
Joshua Millstein ◽  
Fotios Loupakis ◽  
Sebastian Stintzing ◽  
Jingyuan Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Transcription Factors ◽  
Metastatic Colorectal Cancer ◽  
Univariate Analysis ◽  
Cox Proportional Hazards Model ◽  
Predictive Values ◽  
Cancer Data ◽  
In Fire ◽  
Encoding Genes

98 Background: Cancer stem cells are subpopulation of cancer cells characterized by the self-renewal ability, and primarily maintained by a network of pluripotency transcription factors (PTFs). Despite their chemo-resistant phenotype, recent clinical trials data show cetuximab (Cet) is more beneficial for a subset of metastatic colorectal cancer (mCRC) categorized in a mesenchymal/stem-like subtype based on transcriptomic classifications. We investigated whether single nucleotide polymorphisms (SNPs) in PTF encoding genes have predictive values for the efficacy of Cet in mCRC patients. Methods: Genomic and clinical data from three independent cohorts of patient treated with first-line chemotherapy ( n = 451, in total) were tested: Cet cohort (FOLFIRI+Cet arm in FIRE-3 trial, n = 129); bevacizumab (Bev) cohort 1 (FOLFIRI+Bev arm in FIRE-3 trial, n = 107) and Bev cohort 2 (FOLFIRI+Bev arm in TRIBE trial, n = 215), as controls. Genomic DNA extracted from blood samples was genotyped using an OncoArray (Illumina, Inc., San Diego, CA, USA). Eight SNPs in PTF encoding genes ( NANOG rs11055786, NANOG rs11055767, NANOGP8 rs2168958, NANOGP8 rs9944179, POU5F1 rs3130501, POU5F1 rs3130932, SOX2 rs11915160, and MYC rs3891248) were tested for association with progression-free survival (PFS) and overall survival (OS), using Cox proportional hazards model. Results: In the Cet cohort, three SNPs were significantly associated with PFS in univariate analysis: NANOG rs11055767 (C/C vs any A allele, hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.42–0.94, log-rank p = 0.02), NANOGP8 rs2168958 (A/A vs any C allele, HR = 2.12, 95% CI = 1.36–3.29, log-rank p < 0.01), and NANOGP8 rs9944179 (G/G vs any A allele, HR = 3.68, 95% CI = 1.46–9.31, log-rank p < 0.01). Multivariate analysis confirmed the significance in NANOGP8 rs2168958 and NANOGP8 rs9944179. Furthermore, two SNPs were significantly associated with OS in multivariate analysis: POU5F1 rs313051 (G/G vs any A allele, HR = 0.46, 95% CI = 0.22–0.99, adjusted p = 0.04) and POU5F1 rs3130932 (A/A vs any C allele, HR = 0.46, 95% CI = 0.22–0.93, adjusted p = 0.03). Both in the Bev cohorts 1 and 2, no significant associations between the SNPs and clinical outcomes were observed. Conclusions: The current findings suggest that polymorphisms in the PTF genes could be predictive markers for Cet in patients with mCRC. Further studies are warranted to validate the predictive utility.

Genomic Alterations Important for the Prognosis in Patients with Follicular Lymphoma Treated on SWOG Study S0016

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2678-2678
Author(s):  
Xiaoyu Qu ◽  
Hongli Li ◽  
Oliver W Press ◽  
Lisa M. Rimsza ◽  
Rita M. Braziel ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Follicular Lymphoma ◽  
Research Funding ◽  
Univariate Analysis ◽  
Bulky Disease ◽  
Therapeutic Decisions ◽  
Genomic Array ◽  
Genomic Aberrations ◽  
Tissue Specimens ◽  
Array Testing

Abstract Background: FL is a common, indolent, yet typically incurable disease characterized by clinical and genetic heterogeneity. Recent studies suggested that TNFRSF14 mutation and 1p36 deletion were associated with worse outcome in FL and that TNFAIP3 mutation on 6q occurred at FL transformation. However, no genomic biomarkers are currently in clinical use for prognostic and therapeutic decisions. We aimed to identify novel genomic aberrations associated with prognosis of patients with FL in the context of a randomized cooperative group trial (Press 2013 JCO). Patients and Methods: We employed a comprehensive genomic array testing strategy to assess the common genomic abnormalities, including copy number aberrations (CNAs), copy-neutral loss-of-heterozygosity (cnLOH), and common cancer gene mutations. Our study set includes all patients enrolled in the SWOG FL study S0016 with available pre-treatment tissue specimens (n=250). To date, chromosome genomic array testing (CGAT) has been performed on archived formalin-fixed, paraffin embedded (FFPE) lymphoma tissue specimens from 158 patients. A SWOG pathologist reviewed all tissues prior to CGAT to ensure that each sample met the diagnostic criteria for FL and had at least 30% tumor content. The OncoScan platform was used for CGAT with data analysis performed by Nexus Express. Statistical analysis was performed using the Cox-proportional hazard regression model. Hazard ratio (HR) and 95% confidence interval (CI) were estimated from the multivariate model. For this exploratory analysis, statistical significance was determined at an alpha-level of 0.05 without adjustment for multiple comparisons. Results: Most samples (>90%) showed multiple chromosome abnormalities (median 10, range 1-65). The most frequently affected chromosome arms were: 1p (49.3%), 6q (41.7%), 6p (40.5%), 1q (38.6%), 16p or 22q (36%), and 18q (35.4%). Specific common CNAs were deletions of 1p, 6q, and 10q, gains of X, 1q, 2p, 7, 8q, 12q, 17q, and 18, and cnLOH of 1p, 6p, and 16p. Point mutations were not identified. Univariate analysis for progression free survival (PFS) identified several aberrations (of the 94 aberrations assessed) significantly associated with prognosis at unadjusted .05 level; these include gain of 12p, 17q, 18q, and Yp, deletions of 2q, 6q, 8q, 9p, and Yq, and deletion or cnLOH of 9p and 10q. Multivariate analysis adjusting for FLIPI risk, bulky disease, and combined serum β2M and LDH levels demonstrated that selected markers, including deletion or cnLOH of 9p and 10q and gain of 12p and 17q, remained significant for PFS (HR 2.0 for 9p, 0.5 for 10q, 2.8 for 12p, and 2.0 for 17q), while FLIPI risk and serum β2M/LDH levels were no longer significant. In particular, estimated two-year PFS was lower in patients with 9p deletion or cnLOH (60% vs 77%), gain of 12p (62% vs 78%), and gain of 17q (59% vs 80%) compared with those without. Conclusion: We confirmed the frequent 1p and 6q deletions in FL reported in literature. In addition, we identified several genomic aberrations that may be prognostic of FL patients. Among these, deletions and cnLOH of CDKN2A (9p), PTEN (10q) and CREBBP (16p) are of significant interest for their known tumor suppressor functions. Gain of 12p, 17q, and 18q may also help identify oncogenes and other activating tumorigenic processes relevant to disease progression and survival. Multivariate analysis suggested that the genomic aberrations might add to currently utilized clinical risk stratification as a means to identify high risk patients at diagnosis of follicular lymphoma. Support: This work was supported by Affymetrix Inc., NIH/NCI National Clinical Trials Network (NCTN) grants CA180888 and CA180819, and in part by GlaxoSmithKline. Disclosures Hsi: Abbvie: Research Funding; Cellerent Therapeutics: Research Funding; Eli Lilly: Research Funding; Onyx: Honoraria; Seattle Genetics: Honoraria. Smith:Pharmacyclics: Consultancy; Celgene: Consultancy. Fang:Affymetrix: Research Funding.

Improved outcome and selection bias in primary breast surgery for patients with metastatic breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1098-1098
Author(s):  
Lejla Hadzikadic Gusic ◽  
John Falcone ◽  
Kandace P. McGuire ◽  
Atilla Soran ◽  
Emilia Diego ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Metastatic Breast Cancer ◽  
Surgical Treatment ◽  
Metastatic Disease ◽  
Primary Tumor ◽  
Breast Surgery ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Surgery Group

1098 Background: Retrospective studies showing improved survival in patients with metastatic breast cancer (MBC) who undergo surgical treatment of the primary tumor have been criticized for bias in favor of younger, healthier women with lower disease burden. We attempted to identify these biases in our population. Methods: Our institutional cancer registry was queried for patients with MBC from 1994-2010. Demographics, clinical, radiologic and pathologic staging, as well as treatments and outcomes were recorded. Surgical and non-surgical groups were compared for differences in overall survival (OS) and clinicopathologic variables, including comorbidities, using uni- and multivariate analysis. Results: Ninety-one patients with metastatic disease identified within 3 months of initial diagnosis were eligible. 53% (48 pts) had primary breast surgery and 47% (43 pts) did not undergo surgery. Patients in the surgery group were younger on univariate analysis (mean age 53 vs. 62, p<0.01). Neither BMI (mean 30 vs. 29 kg/m²) nor Charlson comorbidity score (mean 6 in both groups) were significantly different, p=NS. Bone metastases were more common in the surgery group (48 vs. 26%) and multiple metastases in the non-surgery group (35 vs. 17%), p<0.05. Patients in the non-surgery group had ≥ 1 visceral metastasis when compared to the surgery group (62 vs. 35%), p<0.05. Higher OS was demonstrated in the surgery group both with Kaplan Meier curves (p<0.05) and univariate analysis (mean 3 vs. 2 yrs, 95% CI 2.6, 3.7), p<0.05. Survival was higher in the surgery group (p<0.01), at 1 year, but this difference did not persist at 3 and 5 years. On multivariate analysis, only difference in age remained significant (p<0.01). Conclusions: Our study supports existing data that women with MBC who have surgical treatment of the primary tumor have an improved survivorship. However, it also suggests a bias towards increased use of surgery in patients who are younger with smaller burden of metastatic disease. We did not find a bias in favor of healthier patients. Further study to determine the mechanism and magnitude of benefit of primary tumor extirpation is still needed.

Reducing futile thoracotomy rates in PET-CT staged non small cell lung cancer: Clinical risk factors from a population-based review.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7551-7551
Author(s):  
Martin Smoragiewicz ◽  
Janessa J. Laskin ◽  
Don Wilson ◽  
Katherine Ramsden ◽  
Yongliang Zhai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tumor Size ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Clinical Risk Factors ◽  
Primary Tumor Size ◽  
N2 Disease ◽  
Pet Ct ◽  
Pathologic N2

7551 Background: The use of PET-CT in staging NSCLC reduces futile thoracotomy (FT) rates to approximately 30%. We aimed to identify pre-operative clinical risk factors for FT in patients (pts) staged with PET-CT. Methods: The British Columbia Cancer Agency (BCCA) provides care to 4.5 million people. A retrospective chart review was conducted on all pts referred to the BCCA in 2009-2010 who had staging PET-CT and thoracotomy for NSCLC. Exclusion criteria: tri-modality therapy, clinical N2 disease, or cancer within 5 years. FT was defined as benign lung lesion, exploratory thoracotomy, pathologic N2 disease, stage IIIB/IV, or recurrence or death < 1 year of surgery (sx). The FT and non-FT groups were compared with the Fisher test in univariate analysis and logistic regression model multivariate analysis. Results: 108 pts met inclusion criteria. Baseline characteristics: male 42%, median age 67 (45-82), ECOG 0-1/+2: 85%/15%, never/former/current smoker 18.5/42.5/39%, weight loss >10% 9%. Disease characteristics: nonsquamous/ squamous histology 72/28%, median primary tumor size 3.2 cm, median SUVmax 10.1, PET + N1 24%. Median time from PET to sx 29 days. 29% pts received adjuvant chemotherapy. Thoracotomy was futile in 27 pts (25%); 14 recurred < 1 yr of sx, 10 pathologic N2 and 1 each incomplete resection, pleural disease at sx, death within 1 yr. On univariate analysis, PET + N1 (odds ratio [OR] 3.77, p 0.008) and primary tumor size > 3.2cm (OR 2.93, p 0.026) were associated with FT. On multivariate analysis, ECOG >1 (OR 4.57, p 0.017), PET + N1 status (OR 4.24, p 0.006) and primary tumor size > 3.2cm (OR 2.87, p 0.039) were associated with FT. Among the 26 pts wth PET + N1, 44% underwent FT; 23% due to N2 disease, 19% relapsed within 1 yr, 4% incomplete sx. 27% had mediastinoscopy or EBUS staging. Among the 82 pts with PET – N1,18% underwent FT; 5% due to N2 disease, 11% relapsed < 1 yr, 2% pleural dx or death < 1 yr. Conclusions: Pre-operative ECOG >1, primary tumor size > 3.2 cm and PET + N1 are associated with higher rates of FT in NSCLC. PET + N1 disease corresponds to higher rates of N2 disease and surgical staging may reduce FT in this population. These factors should be taken into consideration to reduce FT rates in NSCLC.

Effect of adjuvant radiotherapy (RT) on overall survival (OS) for node positive head and neck squamous cell carcinoma (HNSCC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6087-6087
Author(s):  
A. Lavaf ◽  
E. Genden ◽  
S. Packer ◽  
J. Kao
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Distant Metastases ◽  
High Risk Population ◽  
Cancer Specific Survival ◽  
Absolute Increase ◽  
Node Positive ◽  
Stage 4

6087 Background: Although adjuvant RT is often recommended for locally advanced HNSCC, its effect on OS or cancer-specific survival (CSS) has not been clearly demonstrated. Methods: Within the Surveillance, Epidemiology, and End Results (SEER) Database, we selected patients with locally invasive but node negative (SEER stage 2) or node positive HNSCC (SEER stage 3–4) treated either with surgery alone (S) or surgery and radiation (S+RT). This analysis included 13,145 patients from the SEER 17 database diagnosed between 1988 and 2001. Exclusion criteria included distant metastases, no RT records or death within 3 months of surgery. The median follow-up was 4.7 years. Results: Adjuvant RT was utilized in 55% of patients with stage 2 and 84% of stage 3–4 HNSCC. For Stage 2 HNSCC, adjuvant RT was associated with lower 5 year OS on univariate analysis (46.32% for S+RT vs. 49.76% for S, p=0.016) but not on multivariate analysis (HR 1.00, p=0.93). For Stage 3 HNSCC, RT improved 5 year OS associated with RT on univariate analysis (52% for S + RT vs. 41% for S, p<0.001) and multivariate analysis (HR 0.80, p=0.002). For Stage 4 HNSCC, RT significantly improved 5 year OS on univariate analysis (35% for S + RT vs. 25% for S, p<0.001) and multivariate analysis (HR 0.75, p<0.001). The addition of RT improved 5 year CSS for both stage 3 (59.7% vs. 51.4%) and stage 4 HNSCC (42.1% vs. 32.8%). Conclusions: In the largest reported analysis of adjuvant RT in locally advanced HNSCC, adjuvant RT results in an approximately 10% absolute increase in 5-year CSS and OS for node-positive HNSCC compared to S alone. The absolute benefit of RT is underestimated on univariate analysis because patients with poor prognostic factors are more frequently selected for adjuvant RT. Outcomes in this high-risk population remain suboptimal, emphasizing the need for continued investigation of innovative treatment approaches. No significant financial relationships to disclose.

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