Impact of Delay in Treatment Initiation on Overall Survival in Laryngeal Cancers

2018 ◽  
Vol 160 (4) ◽  
pp. 651-657 ◽  
Author(s):  
Anvesh Reddy Kompelli ◽  
Hong Li ◽  
David Michael Neskey
Keyword(s):  
At Risk ◽  
Overall Survival ◽  
Laryngeal Cancer ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Multivariate Logistic Regression Analysis ◽  
Delayed Treatment ◽  
Recursive Partition ◽  
Delay In Treatment ◽  
Time Point

Objective Delayed treatment significantly affects survival in head and neck cancer, but defining delays for specific subsites remains controversial. The purpose of this study is to elicit the time point for delay in treatment initiation in all laryngeal cancers using a large cohort of patients within the National Cancer Database (NCDB). Study Design A retrospective cohort study. Setting NCDB. Subjects and Methods Patients with laryngeal cancer within the NCDB from 2006 to 2014 were identified. A recursive partition analysis (RPA) was performed to identify the time point at which delay contributed to increased hazard. Patients were stratified into 3 groups: no delay, at risk, and overtly delayed. Kaplan-Meier method was used to compare overall survival of these cohorts. Multivariate logistic regression analysis was used to identify predictors of delay. A multivariate Cox regression model was used to identify the final covariates that significantly affect overall survival. Results RPA identified the threshold for delay becomes significant at 46 days and exceeds baseline hazard at 73 days. Delay beyond 73 days is associated with a 16.1-month decrease in median survival ( P < .001). To ensure this was not due to any confounding variables, a subsequent Cox multivariate regression confirmed a significantly increased adjusted hazard ratio (HR) for patients who were at risk or delayed (adjusted HR [confidence interval], 1.09 [1.04-1.15] and 1.26 [1.18-1.35], respectively). Conclusion Treatment of laryngeal cancer requires a multidisciplinary approach, and coordinating this care can take time. Our study highlights that delay beyond 46 to 73 days significantly affects survival and identifies patients experiencing these delays.

scholarly journals Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

2015 ◽  
Vol 33 (26) ◽  
pp. 2841-2847 ◽  
Author(s):  
Alexi A. Wright ◽  
Angel Cronin ◽  
Dana E. Milne ◽  
Michael A. Bookman ◽  
Robert A. Burger ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Clinical Practice ◽  
Propensity Score ◽  
National Comprehensive Cancer Network ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Matched Sample ◽  
Cancer Network ◽  
Trial Participants

Purpose A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice. Patients and Methods Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score–matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias. Results Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score–matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47). Conclusion Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

scholarly journals Development and Validation of Novel Nomograms for Predicting Specific Distant Metastatic Sites and Overall Survival of Patients With Soft Tissue Sarcoma

2021 ◽  
Vol 20 ◽  
pp. 153303382199782
Author(s):  
QiHao Tu ◽  
Chuan Hu ◽  
Hao Zhang ◽  
Meng Kong ◽  
Chen Peng ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Clinical Decision Making ◽  
Cox Regression ◽  
External Validation ◽  
Multivariate Logistic Regression Analysis ◽  
Good Discrimination ◽  
Metastatic Sites

Purpose: The goal of this study is to construct nomograms to effectively predict the distant metastatic sites and overall survival (OS) of soft tissue sarcoma (STS) patients. Methods: STS case data between 2010 and 2015 for retrospective study were gathered from public databases. According to the chi-square and multivariate logistic regression analysis determined independent predictive factors of specific metastatic sites, the nomograms based on these factors were consturced. Subsequently, combined metastatic information a nomogram to predict 1-, 2-, and 3-year OS of STS patients was developed. The performance of models was validated by the area under the curve (AUC), calibration plots, and decision curve analyses (DCA). Results: A total of 7001 STS patients were included in this retrospective study, including 4901 cases in the training group and the remaining 2,100 patients in the validation group. Three nomograms were established to predict lung, liver and bone metastasis, and satisfactory results have been obtained by internal and external validation. The AUCs for predicting lung, liver, and bone metastases in the training cohort were 0.796, 0.799, and 0.766, respectively, and in the validation cohort were 0.807, 0.787, and 0.775, respectively, which means that the nomograms have good discrimination. The calibration curves showed that the models have high precision, and the DCA manifested that the nomograms have great clinical application prospects. Through univariate and multivariate COX regression analyses, 8 independent prognosis factors of age, grade, histological type, tumor size, surgery, chemotherapy, radiatiotherapy and lung metastasis were determined. A nomogram was then constructed to predict the 1-, 2-, and 3-years OS, which has a good performance in both internal and external validations. Conclusion: The nomograms for predicting specific metastatic sites and OS have good discrimination, accuracy and clinical applicability. The models could accurately predict the metastatic risk and survival information, and help clinical decision-making.

P-216 Impact of delay in treatment initiation in Overall Survival in Head and Neck Cancer

Oral Oncology ◽  
2021 ◽  
Vol 118 ◽  
pp. 3
Author(s):  
Dahiana Amarillo ◽  
Gabriel Herrera ◽  
Gisela Lara ◽  
Eugenia Muñóz ◽  
Silvana Sanchez ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Treatment Initiation ◽  
Delay In Treatment

scholarly journals Low expression of CIP4 in predicting worse overall survival: A potential biomarker for laryngeal cancer

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0253545
Author(s):  
Lucheng Fang ◽  
Licai Shi ◽  
Wen Wang ◽  
Xiu Wu ◽  
Tingting Hu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Wnt Signaling ◽  
Signaling Pathways ◽  
Laryngeal Cancer ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Gene Set Enrichment Analysis ◽  
Kaplan Meier ◽  
Potential Biomarker ◽  
The Relationship

Previous reports indicate that Cdc42-interacting protein-4 (CIP4) has previously been reported to plays an important role in the progression of various cancers. However, its correlation with laryngeal cancer (LC) remains unreported. Data from TCGA and GEO databases were used to evaluate the role of CIP4 in LC. Based on GEO and TCGA datasets, we analyzed the differences in CIP4 expression between normal and tumor samples. The Wilcoxon signed-rank test was used to analyze the relationship between clinical features and CIP4. Cox regression and the Kaplan-Meier analyses were used to identify the clinical characteristics associated with the overall survival. Also, the GEPIA database was used to confirm the relationship between CIP4 and overall survival. Lastly, Gene Set Enrichment Analysis (GSEA) was performed based on the TCGA dataset. CIP4 expression in LC was significantly associated with gender and tumor stage (p-values<0.05). Similar to GEPIA validation, Kaplan-Meier survival analysis demonstrated that LC with CIP4-low exhibited a worse prognosis than that with CIP4-high. Univariate analysis revealed that CIP4-high significantly correlated with better overall survival (HR: 0.522, 95% CI: 0.293–0.830, P = 0.026). Besides, multivariate analysis revealed that CIP4 remained independently associated with the overall survival (HR: 0.61, 95% CI: 0.326–0.912, P = 0.012). GSEA showed that the p53, WNT signaling, TGF-β signaling pathways, etc. were enriched in a phenotype high CIP4 expression. In summary, the CIP4 gene is a potential prognostic molecular marker for patients diagnosed with laryngeal cancer. Moreover, the p53, WNT signaling, and TGF-β signaling pathways are potentially associated with CIP4 in LC.

scholarly journals Time to Treatment Initiation and Survival in Adult Localized High-Grade Bone Sarcoma

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Joshua M. Lawrenz ◽  
Joseph Featherall ◽  
Gannon L. Curtis ◽  
Jaiben George ◽  
Yuxuan Jin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Bone Sarcoma ◽  
High Grade ◽  
Time To Treatment ◽  
Primary Bone Sarcoma ◽  
Primary Bone ◽  
Time To Treatment Initiation

Objective. Few studies have evaluated the prognostic implication of the length of time from diagnosis to treatment initiation in bone sarcoma. The purpose of this study is to determine if time to treatment initiation (TTI) influences overall survival in adults diagnosed with primary bone sarcoma. Methods. A retrospective analysis of the National Cancer Database identified 2,122 patients who met inclusion criteria with localized, high-grade bone sarcoma diagnosed between 2004 and 2012. TTI was defined as length of time in days from diagnosis to initiation of treatment. Patient, disease-specific, and healthcare-related factors were also assessed for their association with overall survival. Kruskal-Wallis analysis was utilized for univariate analysis, and Cox regression modeling identified covariates associated with overall survival. Results. Any 10-day increase in TTI was not associated with decreased overall survival (hazard ratio (HR) = 1.00; P=0.72). No differences in survival were detected at 1 year, 5 years, and 10 years, when comparing patients with TTI = 14, 30, 60, 90, and 150 days. Decreased survival was significantly associated P<0.05 with patient ages of 51–70 years (HR = 1.66; P=0.004) and > 71 years (HR = 2.89; P<0.001), Charlson/Deyo score ≥2 (HR = 2.02; P<0.001), pelvic tumor site (HR = 1.58; P<0.001), tumor size >8 cm (HR = 1.52; P<0.001), radiation (HR = 1.81; P<0.001) as index treatment, and residing a distance of 51–100 miles from the treatment center (HR = 1.30; P=0.012). Increased survival was significantly associated P<0.05 with chordoma (HR = 0.27; P=0.010), chondrosarcoma (HR = 0.75; P=0.002), treatment at an academic center (HR = 0.64; P=0.039), and a private (HR = 0.67; P=0.006) or Medicare (HR = 0.71; P=0.043) insurer. A transition in care was not associated with a survival disadvantage (HR = 0.90; P=0.14). Conclusions. Longer TTI was not associated with decreased overall survival in localized, high-grade primary bone sarcoma in adults. This is important in counseling patients, who may delay treatment to receive a second opinion or seek referral to a higher volume sarcoma center.

scholarly journals Clinical value evaluation of microRNA-324-3p and other available biomarkers in patients with HBV-infection-related hepatocellular carcinoma

2021 ◽  
Author(s):  
Li Zhao ◽  
Qian Yang ◽  
Jianbo Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Hepatitis B ◽  
Diagnostic Performance ◽  
Cox Regression ◽  
Hbv Infection ◽  
Healthy Controls ◽  
Survival Prognosis ◽  
Diagnosis And Prognosis ◽  
Hcc Cells

Abstract Background Patients with hepatitis B virus (HBV) infection are at high risk of hepatocellular carcinoma (HCC). This study aimed to evaluate the expression of microRNA-324-3p (miR-324-3p) in HBV-related HCC, and explore the clinical significance of serum miR-324-3p and other available biomarkers in the diagnosis and prognosis of HBV-related HCC. Methods Expression of miR-324-3p in HBV-infection-related cells and patients was estimated using quantitative real-time PCR. The receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance of serum miR-324-3p, AFP and PIVKA-II in the differentiation of HBV-related HCC from healthy controls and chronic hepatitis B (CHB). The relationship between serum miR-324-3p and patients’ clinical features was assessed using Chi-square test, and the value of miR-324-3p to predict overall survival prognosis was evaluated using Kaplan-Meier methods and Cox regression assay in patients with HBV-related HCC. Results HBV-related HCC cells had significantly increased miR-324-3p compared with normal and HBV-unrelated HCC cells, and serum miR-324-3p in HCC patients with HBV infection was also higher than that in healthy controls and CHB. Serum miR-324-3p had relatively high diagnostic accuracy for the screening of HCC case with HBV infection, and the combination of miR-324-3p, AFP and PIVKA-II showed the improved diagnostic performance. Additionally, high serum miR-324-2p in HBV-related HCC patients was associated with cirrhosis, tumor size, clinical stage and poor overall survival prognosis. Conclusion Serum increased miR-324-3p may be involved in the progression of HBV-related hepatitis to HCC, and may serve as a candidate biomarker for the diagnosis and prognosis of HBV-related HCC.

scholarly journals Identification of novel cell glycolysis related gene signature predicting survival in patients with breast cancer

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Feng Jiang ◽  
Chuyan Wu ◽  
Ming Wang ◽  
Ke Wei ◽  
Jimei Wang
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Single Gene ◽  
Prediction Method ◽  
Gene Signature ◽  
The Cancer Genome Atlas ◽  
Cox Models ◽  
Normal Tissues ◽  
Predictive Risk

AbstractOne of the most frequently identified tumors and a contributing cause of death in women is breast cancer (BC). Many biomarkers associated with survival and prognosis were identified in previous studies through database mining. Nevertheless, the predictive capabilities of single-gene biomarkers are not accurate enough. Genetic signatures can be an enhanced prediction method. This research analyzed data from The Cancer Genome Atlas (TCGA) for the detection of a new genetic signature to predict BC prognosis. Profiling of mRNA expression was carried out in samples of patients with TCGA BC (n = 1222). Gene set enrichment research has been undertaken to classify gene sets that vary greatly between BC tissues and normal tissues. Cox models for additive hazards regression were used to classify genes that were strongly linked to overall survival. A subsequent Cox regression multivariate analysis was used to construct a predictive risk parameter model. Kaplan–Meier survival predictions and log-rank validation have been used to verify the value of risk prediction parameters. Seven genes (PGK1, CACNA1H, IL13RA1, SDC1, AK3, NUP43, SDC3) correlated with glycolysis were shown to be strongly linked to overall survival. Depending on the 7-gene-signature, 1222 BC patients were classified into subgroups of high/low-risk. Certain variables have not impaired the prognostic potential of the seven-gene signature. A seven-gene signature correlated with cellular glycolysis was developed to predict the survival of BC patients. The results include insight into cellular glycolysis mechanisms and the detection of patients with poor BC prognosis.

scholarly journals Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuepeng Cao ◽  
Qing Chen ◽  
Zhizhan Ni ◽  
Feng Wu ◽  
Chenshen Huang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Emergency Surgery ◽  
Perineural Invasion ◽  
Cox Regression ◽  
Colonic Obstruction ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Cox Regression Analysis ◽  
Self Expanding Metal Stents

Abstract Background Bridge to elective surgery (BTS) using self-expanding metal stents (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, studies regarding the long-term impact of BTS are limited and have reported unclear results. Methods A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence. Results Forty-nine patients in both the BTS and ES groups were matched. Patients in the BTS group more often underwent laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall survival was significantly lower in patients with stent insertion (41 vs. 65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less favorable in the BTS group. In multivariate Cox regression analysis, stenting (hazard ratio(HR) = 2.309(1.052–5.066), p = 0.037), surgical AEs (HR = 1.394 (1.053–1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116–2.607), p = 0.014) were positively correlated with overall survival in matched patients. Conclusions Self-expanding metal stents as “a bridge to surgery” are associated with more perineural invasion, a higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.

scholarly journals EP4 as a Negative Prognostic Factor in Patients with Vulvar Cancer

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1410
Author(s):  
Anna Buchholz ◽  
Aurelia Vattai ◽  
Sophie Fürst ◽  
Theresa Vilsmaier ◽  
Christina Kuhn ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Vulvar Cancer ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Common Finding ◽  
Cancer Tissue ◽  
Vulvar Carcinoma ◽  
Tissue Samples

New prognostic factors and targeted therapies are urgently needed to improve therapeutic outcomes in vulvar cancer patients and to reduce therapy related morbidity. Previous studies demonstrated the important role of prostaglandin receptors in inflammation and carcinogenesis in a variety of tumor entities. In this study, we aimed to investigate the expression of EP4 in vulvar cancer tissue and its association with clinicopathological data and its prognostic relevance on survival. Immunohistochemistry was performed on tumor specimens of 157 patients with vulvar cancer treated in the Department of Obstetrics and Gynecology, Ludwig-Maximilian-University of Munich, Germany, between 1990 and 2008. The expression of EP4 was analyzed using the well-established semiquantitative immunoreactivity score (IRS) and EP4 expression levels were correlated with clinicopathological data and patients’ survival. To specify the tumor-associated immune cells, immunofluorescence double staining was performed on tissue samples. In vitro experiments including 5-Bromo-2′-Deoxyuridine (BrdU) proliferation assay and 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromid (MTT) viability assay were conducted in order to examine the effect of EP4 antagonist L-161,982 on vulvar carcinoma cells. EP4 expression was a common finding in in the analyzed vulvar cancer tissue. EP4 expression correlated significantly with tumor size and FIGO classification and differed significantly between keratinizing vulvar carcinoma and nonkeratinizing carcinoma. Survival analysis showed a significant correlation of high EP4 expression with poorer overall survival (p = 0.001) and a trending correlation between high EP4 expression and shorter disease-free survival (p = 0.069). Cox regression revealed EP4 as an independent prognostic factor for overall survival when other factors were taken into account. We could show in vitro that EP4 antagonism attenuates both viability and proliferation of vulvar cancer cells. In order to evaluate EP4 as a prognostic marker and possible target for endocrinological therapy, more research is needed on the influence of EP4 in the tumor environment and its impact in vulvar carcinoma.

scholarly journals Effects of marital status on overall and cancer-specific survival in laryngeal cancer patients: a population-based study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhao Ding ◽  
Deshun Yu ◽  
Hefeng Li ◽  
Yueming Ding
Keyword(s):  
Marital Status ◽  
Cancer Patients ◽  
Laryngeal Cancer ◽  
Cox Regression ◽  
Group Analysis ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Prognostic Effect ◽  
The Difference

AbstractMarital status has long been recognized as an important prognostic factor for many cancers, however its’ prognostic effect for patients with laryngeal cancer has not been fully examined. We retrospectively analyzed 8834 laryngeal cancer patients in the Surveillance Epidemiology and End Results database from 2004 to 2010. Patients were divided into four groups: married, widowed, single, and divorced/separated. The difference in overall survival (OS) and cancer-specific survival (CSS) of the various marital subgroups were calculated using the Kaplan–Meier curve. Multivariate Cox regression analysis screened for independent prognostic factors. Propensity score matching (PSM) was also conducted to minimize selection bias. We included 8834 eligible patients (4817 married, 894 widowed, 1732 single and 1391 divorced/separated) with laryngeal cancer. The 5-year OS and CSS of married, widowed, single, and separated/divorced patients were examined. Univariate and multivariate analyses found marital status to be an independent predictor of survival. Subgroup survival analysis showed that the OS and CSS rates in widowed patients were always the lowest in the various American Joint Committee on Cancer stages, irrespective of sex. Widowed patients demonstrated worse OS and CSS in the 1:1 matched group analysis. Among patients with laryngeal cancer, widowed patients represented the highest-risk group, with the lowest OS and CSS.

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