scholarly journals Immune Score Predicts Outcomes of Gastric Cancer Patients Treated with Adjuvant Chemoradiotherapy

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Wei Zou ◽  
Meng-long Zhou ◽  
Ling-yi Zhang ◽  
Jia-ning Yang ◽  
Wang Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Staging System ◽  
Adjuvant Chemoradiotherapy ◽  
Prognostic Impact ◽  
Clinical Parameters ◽  
Cell Counts ◽  
Immune Score

Background. Substantial evidence has demonstrated that tumor-infiltrating lymphocytes (TILs) are correlated with patient prognosis. The TIL-based immune score (IS) affects prognosis in various cancers, but its prognostic impact in gastric cancer (GC) patients treated with adjuvant chemoradiotherapy remains unclear. Methods. A total of 101 GC patients who received chemoradiotherapy after gastrectomy were retrospectively analyzed in this study. Immunohistochemistry staining for CD3+ and CD8+ T-cell counts in both tumor center (CT) and invasive margin (IM) regions was built into the IS. Patients were then divided into three groups based on their differential IS levels. The correlation between IS and clinical parameters was analyzed. The prognostic impact of IS and clinical parameters was evaluated using Kaplan–Meier analysis and Cox proportional hazard regression analysis. Receiver operating characteristic (ROC) curves were plotted to compare the area under the curve (AUC) of IS with other clinical parameters. Nomograms for disease-free survival (DFS) and overall survival (OS) prediction were constructed based on the identified parameters. Results. Finally, 20 (19.8%), 57 (56.4%), and 24 (23.8%) GC patients were identified with low, intermediate, and high IS levels, respectively. GC patients with higher IS levels exhibited better DFS ( p  < 0.001) and OS ( p  < 0.001). IS was an independent prognostic factor for both DFS ( p  < 0.001) and OS ( p  < 0.001) in multivariate analysis. IS presented a better predictive ability than the traditional pathological tumor-node-metastasis (pTNM) staging system (AUC: 0.801 vs. 0.677 and 0.800 vs. 0.660, respectively) with respect to both DFS and OS. The C-index of the nomograms for DFS and OS prediction was 0.737 and 0.774, respectively. Conclusions. IS is a strong predictive factor for both DFS and OS in GC patients treated with adjuvant chemoradiotherapy, which may complement the traditional pTNM staging system.

scholarly journals Improving Risk Stratification of Early Oral Tongue Cancer with TNM-Immune (TNM-I) Staging System

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3235
Author(s):  
Alhadi Almangush ◽  
Ibrahim O. Bello ◽  
Ilkka Heikkinen ◽  
Jaana Hagström ◽  
Caj Haglund ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tongue Cancer ◽  
Early Stage ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Staging System ◽  
Oral Tongue ◽  
Oral Tongue Cancer ◽  
Important Player ◽  
Infiltrating Lymphocytes

Although patients with early-stage oral tongue squamous cell carcinoma (OTSCC) show better survival than those with advanced disease, there is still a number of early-stage cases who will suffer from recurrence, cancer-related mortality and worse overall survival. Incorporation of an immune descriptive factor in the staging system can aid in improving risk assessment of early OTSCC. A total of 290 cases of early-stage OTSCC re-classified according to the American Joint Committee on Cancer (AJCC 8) staging were included in this study. Scores of tumor-infiltrating lymphocytes (TILs) were divided as low or high and incorporated in TNM AJCC 8 to form our proposed TNM-Immune system. Using AJCC 8, there were no significant differences in survival between T1 and T2 tumors (p > 0.05). Our proposed TNM-Immune staging system allowed for significant discrimination in risk between tumors of T1N0M0-Immune vs. T2N0M0-Immune. The latter associated with a worse overall survival with hazard ratio (HR) of 2.87 (95% CI 1.92–4.28; p < 0.001); HR of 2.41 (95% CI 1.26–4.60; p = 0.008) for disease-specific survival; and HR of 1.97 (95% CI 1.13–3.43; p = 0.017) for disease-free survival. The TNM-Immune staging system showed a powerful ability to identify cases with worse survival. The immune response is an important player which can be assessed by evaluating TILs, and it can be implemented in the staging criteria of early OTSCC. TNM-Immune staging forms a step towards a more personalized classification of early OTSCC.

Phase III Trial to Compare Adjuvant Chemotherapy With Capecitabine and Cisplatin Versus Concurrent Chemoradiotherapy in Gastric Cancer: Final Report of the Adjuvant Chemoradiotherapy in Stomach Tumors Trial, Including Survival and Subset Analyses

2015 ◽  
Vol 33 (28) ◽  
pp. 3130-3136 ◽  
Author(s):  
Se Hoon Park ◽  
Tae Sung Sohn ◽  
Jeeyun Lee ◽  
Do Hoon Lim ◽  
Min Eui Hong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Phase Iii ◽  
Adjuvant Chemoradiotherapy ◽  
Final Report ◽  
D2 Lymph Node Dissection ◽  
Node Positive ◽  
Stomach Tumors

Purpose The Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) trial tested whether the addition of radiotherapy to adjuvant chemotherapy improved disease-free survival (DFS) in patients with D2-resected gastric cancer (GC). Patients and Methods Between November 2004 and April 2008, 458 patients with GC who received gastrectomy with D2 lymph node dissection were randomly assigned to either six cycles of adjuvant chemotherapy with capecitabine and cisplatin (XP) or to two cycles of XP followed by chemoradiotherapy and then two additional cycles of XP (XPRT). This final update contains the first publication of overall survival (OS), together with updated DFS and subset analyses. Results With 7 years of follow-up, DFS remained similar between treatment arms (hazard ratio [HR], 0.740; 95% CI, 0.520 to 1.050; P = .0922). OS also was similar (HR, 1.130; 95% CI, 0.775 to 1.647; P = .5272). The effect of the addition of radiotherapy on DFS and OS differed by Lauren classification (interaction P = .04 for DFS; interaction P = .03 for OS) and lymph node ratio (interaction P < .01 for DFS; interaction P < .01 for OS). Subgroup analyses also showed that chemoradiotherapy significantly improved DFS in patients with node-positive disease and with intestinal-type GC. There was a similar trend for DFS and OS by stage of disease. Conclusion In D2-resected GC, both adjuvant chemotherapy and chemoradiotherapy are tolerated and equally beneficial in preventing relapse. Because results suggest a significant DFS effect of chemoradiotherapy in subsets of patients, the ARTIST 2 trial evaluating adjuvant chemotherapy and chemoradiotherapy in patients with node-positive, D2-resected GC is under way.

Prognostic impact of the NFKB1 insertion/deletion promoter polymorphism on survival in patients with surgically resected gastric cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15638-e15638
Author(s):  
S. Kim ◽  
J. Kim ◽  
Y. Chae ◽  
S. Sohn ◽  
J. Moon ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
Disease Free Survival ◽  
Promoter Polymorphism ◽  
Prognostic Impact ◽  
Free Survival ◽  
Multivariate Survival ◽  
Pcr Rflp ◽  
Promoter Gene ◽  
Rflp Assay

e15638 Background: The present study analyzed the functional insertion/deletion polymorphism in the promoter region of NKFB1 gene and their impact on the prognosis for patients with gastric adenocarcinoma. Methods: Five hundred and three consecutive patients with surgically resected gastric adenocarcinoma were enrolled in the present study. The genomic DNA was extracted from paraffin-embedded tissue and the -94 insertion/deletion ATTG polymorphism of NFKB1 determined using a PCR- RFLP assay. Results: The NFKB1 promoter gene polymorphism was successfully amplified in 97.8% of the cases. There were no sexual differences in relation to the genotype and allele. No correlation was observed between the frequency of the genotype or allele and the T, N, or M stage. The multivariate survival analysis showed no association between the NFKB1 -94 insertion/deletion promoter polymorphism and the disease-free survival or overall survival of the patients with gastric cancer. Conclusions: The functional NFKB1 promoter polymorphism was not found to be a prognostic marker for Korean patients with surgically resected gastric adenocarcinoma. No significant financial relationships to disclose.

Adjuvant chemotherapy with or without concurrent radiotherapy in stage IB patients with gastric cancer: Subgroup analysis of the adjuvant chemoradiotherapy in stomach tumors (ARTIST) phase III trial.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 95-95
Author(s):  
Haa-na Song ◽  
Jinhyun Cho ◽  
Ki Sun Jung ◽  
Su Jin Lee ◽  
Seung Tae Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Subgroup Analysis ◽  
Staging System ◽  
Stage Ii ◽  
Phase Iii ◽  
Adjuvant Chemoradiotherapy ◽  
Stage Migration ◽  
Stage Ib ◽  
Stomach Tumors

95 Background: To evaluate the risk of recurrence in patients with pathologically staged Ib, according to the American Joint Committee on Cancer (AJCC) 2002 staging system, gastric cancer (GC) in the phase III adjuvant chemoradiotherapy in stomach tumors (ARTIST) trial. Methods: Among 458 GC patients enrolled in ARTIST, 99 had stage Ib (T2N0 or T1N1) disease. Patients were randomly assigned to receive adjuvant chemoradiotherapy with capecitabine plus cisplatin (XP, n = 50)) or chemoradiotherapy (XPRT, n = 49). Kaplan-Meier method was used to calculate disease-free survival (DFS). Cox proportional hazard models were employed to determine associations between the addition of radiotherapy to XP and DFS after adjustment for patient and disease characteristics. Additionally, analyses were performed according to the AJCC 2010 staging system. Results: With 7 years of follow-up, there were 18 recurrences. The 5-year DFS rates were 88% and 84% in XP and XPRT patients, respectively (P = 0.537). When we reviewed the pathologic stages of the patients according to the AJCC 2010 system, stage migration from Ib to II occurred in 71% of the patients: 98% of the T2N0 patients were reclassified as T3N0, and 42% of the T1N1 patients were reclassified as T1N2. The patients classified as stage Ib according to the AJCC 2002 system and reclassified as stage II exhibited worse, although statistically insignificant, prognosis than the patients who remained in stage Ib (5-year DFS 83% vs. 93%, P = 0.183, HR 1.178, 95% CI 0.420-3.311, P = 0.158). When we compared 5-year DFS in 70 stage II (AJCC 2010 system) patients, the addition of radiotherapy to XP chemotherapy resulted, although again statistically insignificant (P = 0.234), in worse outcome in XPRT arm (77%) than in XPRT arm (88%). Conclusions: This subgroup analysis confirms the clinical relevance of the AJCC 2010 staging system in GC. The role of adjuvant chemotherapy in stage II GC warrants further investigation.

The Novel Histologic International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society Classification System of Lung Adenocarcinoma Is a Stage-Independent Predictor of Survival

2012 ◽  
Vol 30 (13) ◽  
pp. 1438-1446 ◽  
Author(s):  
Arne Warth ◽  
Thomas Muley ◽  
Michael Meister ◽  
Albrecht Stenzinger ◽  
Michael Thomas ◽  
...  
Keyword(s):  
Lung Cancer ◽  
International Association ◽  
Disease Free Survival ◽  
American Thoracic Society ◽  
Adjuvant Chemoradiotherapy ◽  
Prognostic Impact ◽  
The Novel ◽  
European Respiratory Society ◽  
Tumor Stages ◽  
Survival Pattern

Purpose Our aim was to analyze and validate the prognostic impact of the novel International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) proposal for an architectural classification of invasive pulmonary adenocarcinomas (ADCs) across all tumor stages. Patients and Methods The architectural pattern of a large cohort of 500 patients with resected ADCs (stages I to IV) was retrospectively analyzed in 5% increments and classified according to their predominant architecture (lepidic, acinar, solid, papillary, or micropapillary), as proposed by the IASLC/ATS/ERS. Subsequently, histomorphologic data were correlated with clinical data, adjuvant therapy, and patient outcome. Results Overall survival differed significantly between lepidic (78.5 months), acinar (67.3 months), solid (58.1 months), papillary (48.9 months), and micropapillary (44.9 months) predominant ADCs (P = .007). When patterns were lumped into groups, this resulted in even more pronounced differences in survival (pattern group 1, 78.5 months; group 2, 67.3 months; group 3, 57.2 months; P = .001). Comparable differences were observed for overall, disease-specific, and disease-free survival. Pattern and pattern groups were stage- and therapy-independent prognosticators for all three survival parameters. Survival differences according to patterns were influenced by adjuvant chemoradiotherapy; in particular, solid-predominant tumors had an improved prognosis with adjuvant radiotherapy. The predominant pattern was tightly linked to the risk of developing nodal metastases (P < .001). Conclusion Besides all recent molecular progress, architectural grading of pulmonary ADCs according to the novel IASLC/ATS/ERS scheme is a rapid, straightforward, and efficient discriminator for patient prognosis and may support patient stratification for adjuvant chemoradiotherapy. It should be part of an integrated clinical, morphologic, and molecular subtyping to further improve ADC treatment.

scholarly journals Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3554
Author(s):  
Vincent Balaya ◽  
Benedetta Guani ◽  
Laurent Magaud ◽  
Hélène Bonsang-Kitzis ◽  
Charlotte Ngô ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Disease Free Survival ◽  
Staging System ◽  
Lymph Node Biopsy ◽  
Disease Stage ◽  
Prognostic Impact ◽  
Gynecology And Obstetrics ◽  
Figo Classification ◽  
Lymphovascular Space Invasion

Background: The aim of this study was to assess the prognostic impact of Lymphovascular space invasion (LVSI) in IB1 stage of the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) classification for cervical cancer. Methods: A secondary analysis of two French prospective multicentric trials on Sentinel Lymph node biopsy for cervical cancer was performed. Patients with 2009 FIGO IB1 stage who underwent radical surgery between January 2005 and July 2012 from 28 French expert centers were included. The stage was modified retrospectively according to the new 2018 FIGO staging system. Results: According to the 2009 FIGO classification, 246 patients had IB1 disease stage and fulfilled the inclusion criteria. The median follow-up was 48 months (4–127). Twenty patients (8.1%) experienced a recurrence, and the 5-year Disease Free Survival (DFS) was 90.0%. Compared to 2018 IB1 staged patients, new IB2 had significantly decreased 5-year DFS, 78.6% vs. 92.9%, p = 0.006 whereas IIIC patients had similar 5-year DFS (91.7%, p = 0.95). In the subgroup of patients with FIGO 2018 IB1 stage, the presence of LVSI was associated with a significant decrease in DFS (82.5% vs. 95.8%, p = 0.04). Conclusions: LVSI is associated with decreased 5-year DFS in IB1 2018 FIGO stage and LVSI status should be considered in early-stage cervical cancer for a more precise risk assessment.

Prognostic impact of lymph node retrieval and ratio in gastric cancer: A single-center U.S. experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 17-17
Author(s):  
Joyce Wong ◽  
Shams Rahman ◽  
Nadia Saeed ◽  
Hui-Yi Lin ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Free Survival ◽  
Lymph Node Retrieval ◽  
Node Ratio ◽  
Disease Free

17 Background: Recommendations for extended lymphadenectomy in gastric cancer is thought to be associated with improved overall survival (OS), although defining adequate lymphadenectomy remains controversial. Methods: A single-institution, prospectively-maintained database of patients referred for surgical care of gastric cancer was reviewed. Patients were stratified by number of examined lymph nodes (eLN): <5, 6-10, 11-15, and >15 and positive LNs (LN+) stratified by 0, 1-2, 3-6, 7-15, and >15. Lymph node ratio (LN+:eLN) was evaluated, stratified by 0, 0.01-0.2, 0.21-0.5, and >0.5. Disease-free-survival (DFS) and OS were the primary endpoints, determined by Kaplan-Meier analyses. Results: From 1997-2012, 222 patients were included; most were male (N=122, 55%) with median age 67 (range 17-92) years. Of 220 (99%) patients surgically explored, 164 (74%) ultimately underwent resection. Median OS of the entire cohort was 22 months. Gender, ethnicity, and smoking status did not impact OS. Pathologic factors such as perineural invasion, lymphovascular invasion, and poor differentiation adversely affected OS, P<0.05. A median 14 lymph nodes (LN) were retrieved (range 0-45), with a median of one positive LN (range 0-31). No OS or disease-free survival (DFS) difference was observed when comparing <5, 6-10, 11-15, and >15 eLN, P=0.30. LN+ affected both OS and DFS: median OS was 52 months for 0 LN+ and decreased to 21 months with 1-2 LN+, 34 months 3-6 LN+, 25 months 7-15 LN+, and 11.5 months with >15 LN+. Similarly, median DFS decreased from 35 months with 0 LN+ to 19 months with 1-2 LN+, 9 months with 3-6 LN+, 13.5 months with 7-15 LN+, and 7.5 months with >15 LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months for ratio of 0, 37 months for 0.01-0.2, 27 months for 0.21-0.5, and 12 months for >0.5, P<0.0001. DFS was similar: 35months for ratio of 0, 22 months for 0.01-0.2, 13 months for 0.21-0.5, and 7 months for >0.5, P<0.0001. Conclusions: Extent of lymphadenectomy does not impact OS or DFS. Presence of LN+ adversely impacts OS and DFS. Lymph node ratio may be a better prognostic indicator than number of eLN or LN+ in gastric cancer.

Association of intratumoral PD-L1 expression with survival of patients with Epstein-Barr virus-associated gastric cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15590-e15590
Author(s):  
Jong Gwang Kim ◽  
Byung Woog Kang ◽  
Yee Soo Chae ◽  
Soo Jung Lee ◽  
In Hee Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Epstein Barr Virus ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Barr Virus ◽  
Significant Difference ◽  
Epstein Barr

e15590 Background: The present study analyzed the expression of tumoral (t-) PD-L1/L2 and stromal (str-) PD-L1/L2, and their impacts on the survival of a relatively large group of Epstein-Barr virus (EBV)-associated gastric cancer (EBVaGC). Methods: After reviewing 1318 consecutive cases of surgically resected or endoscopic submucosal dissected gastric cancers, 120 patients were identified as EBV-positive using EBV-encoded RNA in situ hybridization. Immunohistochemistry of PD-L1 and PD-L2 was carried out and the intensity was scored as an intensity score 0 (no staining), 1 (weak intensity), 2 (intermediate intensity), and 3 (high intensity). The expression was also evaluated in tumor tissues and stromal immune cells and divided into two groups (2 and 3 were interpreted as a positive result). Results: Among the 120 patients, 57 patients (47.5%) and 66 patients (55.0%) were determined as t-PD-L1-positive and str-PD-L1 positive, while 23 patients (19.2%) and 41 patients (34.2%) were determined as t-PD-L2-positive and str-PD-L2 positive. In a univariate analysis, t-PD-L1-positive was significantly associated shorter disease-free survival (DFS, P = 0.032), yet not overall survival (P = 0.482). In a multivariate analysis using a Cox proportional hazard model adjusted for age, pTNM stage, gender, WHO classification, and tumor-infiltrating lymphocytes, t-PD-L1 positivity was independently associated with poor DFS (Hazard ratio = 4.183, P = 0.044). Meanwhile, in the univariate analysis, t-PD-L2-positive and str-PD-L2-positive showed a better DFS trend than t-PD-L2-negative and str-PD-L2-negative, respectively (P = 0.071 and P = 0.092). However, t-PD-L2 and str-PD-L2 expressions showed no prognostic significance on DFS in the multivariate analysis. Conclusions: The level of t-PD-L1 expression represents a significant difference for DFS in patients with EBVaGC. The current findings support the concept that PD-L1 may be a prognostic parameter for predicting patient outcome and act as a therapeutic target in EBVaGC.

scholarly journals Programmed death ligand 1 (PD-L1) in colon cancer and its interaction with budding and tumor-infiltrating lymphocytes (TILs) as tumor-host antagonists

2021 ◽  
Author(s):  
Corinna Lang-Schwarz ◽  
Balint Melcher ◽  
Arndt Hartmann ◽  
Simone Bertz ◽  
Theresa Dregelies ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Immune Therapy ◽  
Disease Free Survival ◽  
Tumor Infiltrating Lymphocytes ◽  
Treatment Decisions ◽  
Tumor Budding ◽  
Prognostic Impact ◽  
Programmed Death Ligand 1 ◽  
Programmed Death ◽  
Infiltrating Lymphocytes

Abstract Purpose To analyze the role of programmed death ligand 1 (PD-L1) immunohistochemisty in the context of tumor microenvironment in colon cancer (CC) with focus on the interaction between tumor budding and tumor-infiltrating lymphocytes (TILs) and to elucidate its potential value for immunooncologic treatment decisions. Methods Three hundred forty seven patients with CC, stages I to IV, were enrolled. PD-L1 immunohistochemistry was performed using two different antibodies (clone 22C3 pharmDx, Agilent and clone QR1, Quartett). Tumor proportion score (TPS) as well as immune cell score (IC) was assessed. Budding and TILs were assessed according to the criteria of the International Tumor Budding Consensus Conference (ITBCC) and International TILs Working Group (ITWG). Correlation analyses as well as survival analyses were performed. Results PD-L1 positivity significantly correlated with TILs > 5% and MMR deficiency, and PD-L1-positive cases (overall and IC) showed significantly longer overall survival (OS) with both antibodies.The parameters “high grade,” “right-sidedness,” and “TILS > 5% regardless of MMR status” evolved as potential parameters for additional immunological treatment decisions. Additionally, TPS positivity correlated with low budding. More PD-L1-positive cases were seen in both high TIL groups. The low budding/high TIL group showed longer disease-free survival and longer OS in PD-L1-positive cases. Conclusion Overall, PD-L1 positivity correlated with markers of good prognosis. PD-L1 immunohistochemistry was able to identify parameters as additional potential candidates for immune therapy. Furthermore, it was able to stratify patients within the low budding/high TIL group with significant prognostic impact.

Sign in / Sign up

Export Citation Format

Share Document