Early Results of the Value of p53 in Predicting Survival in a Homogeneous Cohort of Patients with Invasive Bladder Cancer Treated with a Neoadjuvant Carboplatin-Based Regimen (M-CAVI)

1996 ◽  
Vol 82 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Antoni Ribas ◽  
Joaquim Bellmunt ◽  
Joan Albanell ◽  
Inés De Torres ◽  
Begoña Bermejo ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
P53 Protein ◽  
Univariate Analysis ◽  
Response To Therapy ◽  
Invasive Bladder Cancer ◽  
T Stage

Aims and Background Several reports on prognostic factors for infiltrating bladder cancer have given controversial results. We assessed the prognostic value of p53 nuclear overexpression together with known prognostic factors for survival in patients with invasive T2-4 NO MO bladder cancer treated with neoadjuvant chemotherapy. Study Design Thirty-five paraffi-nized tumor samples from initial transurethral resection of patients with bladder cancer were analyzed immunohistochemi-cally to detect overexpression of p53 protein. Patients were treated with 3 to 4 cycles of neoadjuvant methotrexate, carboplatin, and vinblastine (M-CAVI) and then underwent radical cystectomy. Prechemotherapy, treatment, and postchemotherapy factors were analyzed for correlation with survival by univariate and multivariate analysis. Fifty-seven percent of tumors were positive for p53 protein, 71.5% had grade III-IV tumors, and 72% had organ-confined disease. The median follow-up was 20 months (range 5-71+). Results By univariate analysis, the significant pretreatment factors were initial tumor (T) stage ( P <0.0001) and the male sex ( P = 0.03). Five postchemotherapy variables were found significant: surgery performed according to protocol ( P = 0.003), overall clinical ( P = 0.004), and overall pathologic ( P = 0.02) response to therapy, postchemotherapy pathologic stage ( P = 0.0002), and tumor status after surgery ( P = 0.0006). By multivariate analysis, the initial prechemotherapy T stage was the only factor that demonstrated independent significance. Conclusions Although the median follow-up of the study is still too short, in this group of patients treated with a neoadjuvant carboplatin-based regimen, a classical variable (prechemotherapy T stage) rather than p53 nuclear overexpression was an independent prognostic factor for survival. Further follow-up will be required to assess the value of p53 overexpression as a prognostic factor in invasive bladder cancer patients treated with neoadjuvant carboplatin-based chemotherapy.

Neoadjuvant chemotherapy for invasive bladder cancer: prognostic factors for survival of patients treated with M-VAC with 5-year follow-up.

1994 ◽  
Vol 12 (7) ◽  
pp. 1394-1401 ◽  
Author(s):  
P K Schultz ◽  
H W Herr ◽  
Z F Zhang ◽  
D F Bajorin ◽  
A Seidman ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Univariate Analysis ◽  
Invasive Bladder Cancer ◽  
Pathologic Stage ◽  
Muscle Invasive ◽  
Extravesical Disease

PURPOSE To determine survival in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and to analyze prechemotherapy and postchemotherapy factors for prognostic significance. PATIENTS AND METHODS The survival of 111 patients with T2-4N0M0 bladder cancer treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) was assessed. Prechemotherapy and postchemotherapy factors were analyzed for correlation with survival. Factors found to be significant on univariate analysis were subjected to multivariate analysis using Cox's proportional hazards model. RESULTS The median follow-up duration was 5.3 years. Initial tumor (T) stage (P = .0001), presence of ureteral obstruction (P = .0074), and presence of a palpable mass (P = .0039) were the only pretreatment factors found to be significant on univariate analysis. Postchemotherapy surgery was performed in 81 patients. In these cases, postchemotherapy clinical stage and pathologic stage were significant factors on univariate analysis. In the multivariate analysis, the initial prechemotherapy T stage and the postchemotherapy pathologic stage (pT stage) were the only two factors to demonstrate independent significance. An association between downstaging postchemotherapy and survival was observed for patients with extravesical disease (T < or = 3B) at the start of treatment. In this subset, the 5-year survival rate was 54% for patients with downstaging versus 12% for those without downstaging. This association was not observed for patients with bladder-confined disease (T < or = 3A) at presentation. CONCLUSION The stage of bladder cancer at presentation and at postchemotherapy pathologic staging are independent prognostic factors for long-term survival in patients treated with neoadjuvant chemotherapy. Downstaging after neoadjuvant chemotherapy was associated with improved survival in patients with muscle-invasive bladder cancers, but only for those with extravesical disease (T > or = 3B) pretreatment. Randomized comparisons will be required to assess the impact of chemotherapy on overall survival.

Survival of Newly Diagnosed T-Cell Lymphoma (TCL) in the Modern Era: Investigation of Prognostic Factors with Critical Examination of Therapy in a Multicenter US Cohort.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2728-2728
Author(s):  
Andrew M. Evens ◽  
Tatyana Feldman ◽  
Aimee Kroll ◽  
Lori S. Muffly ◽  
Eric Winer ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
T Cell ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Response To Therapy ◽  
Critical Examination ◽  
Newly Diagnosed ◽  
Stage Disease

Abstract Abstract 2728 Background: TCLs are uncommon malignancies consisting of heterogeneous pathologic subtypes and outcomes. Despite development of prognostic models, there is little data of outcomes in large cohorts examining the impact of frontline therapy and the role of consolidative stem cell transplantation (SCT). Methods: We performed a multi-center retrospective analysis of a large cohort of newly diagnosed mature TCLs (non-cutaneous) from 2000–2010 across 9 U.S. academic centers. We examined detailed information regarding patient characteristics and treatment(s) received. Further, we determined prognostic factors for associations with survival in univariate analysis and multivariate Cox regression proportional models. Results: Among 402 cases of mature TCL, 341 had complete treatment and follow-up data. This included 107 cases of peripheral TCL (PTCL NOS), 89 anaplastic large cell lymphoma (ALCL), 77 angioimmunoblastic TCL (AITL), 23 NK/TCL, 20 acute t-cell leukemia/lymphoma (ATLL), 10 enteropathy-associated TCL (EATCL), 7 subcutaneous panniculitis-like TCL (SCPTCL), 5 hepatosplenic TCL (HSL), and 4 transformed CTCL (t-CTCL) cases. 60% of pts were men and the median age was 62 years (range 18–95). At initial diagnosis, performance status was 2–4 in 36%, B symptoms in 47%, elevated LDH in 55%, anemia in 64%, and hypoalbuminemia in 46% at baseline. 74% of pts had advanced-stage disease, 29% had bone marrow involvement, 52% had other (non-marrow) extranodal sites, and only 9% had bulky disease >7cm. Twenty-three pts received only palliative therapy all of whom survived <3.5 months. Among the remaining 318 pts, CHOP-like therapy was the most common initial regimen (74%; 5% of which included etoposide), 7% hyperCVAD/MA, 3% EPOCH, 2% CMED, 2% gemcitabine-based, 2% ifosfamide-based, and 10% other. 21% received radiation therapy (RT) as part of initial treatment, while 34 pts (11%) received a SCT in 1st remission (85% autologous). Overall response to therapy was 73% (61% complete), while 24% had primary refractory disease. With a median follow-up of 38 months (6–109), 3-year progression-free survival (PFS) and overall survival (OS) for all pts were 32% and 52%, respectively (Figure). Factors predictive of outcome by univariate analysis are detailed in the Table (includes differential survival by WHO subtype and PIT and IPI). On multivariable regression analysis of pre-treatment factors, only Ann Arbor stage I/II remained significant (PFS: HR 0.59 [95%CI 0.38–0.93], p=0.023); and OS: HR 0.46 [95%CI 0.25–0.85], p=0.013). Regarding induction treatment, the only impact based on regimens received were inferior outcomes with CMED or EPOCH therapy; these findings persisted on multivariate analysis. The addition of etoposide to CHOP did not appear to impact outcome, although those numbers were small. Notably, consolidative SCT portended significantly improved survival on multivariate analysis when controlling for gender, LDH, albumin, and stage (PFS: HR 0.46 [95%CI 0.24–0.89], p=0.02; and OS: 0.43 [95%CI 0.19–0.99], p=0.04), but this did not reach significance when adjusting for response to 1st therapy (PFS: HR 0.55 [95%CI 0.28–1.08], p=0.08; OS: HR 0.47 [95%CI 0.17–1.29], p=0.14). Conclusions: In this large US cohort of TCL, response, PFS, and OS compared favorably with historical controls. Further, we documented that NK/TCL, AITL, and ALCL (ALK+ and negative) were all associated with improved OS vs PTCL NOS. On multivariable analysis, limited-stage disease was the predominant predictive factor for survival. Additionally, consolidative SCT was associated with improved PFS and OS, however this benefit appeared to be nullified after controlling for initial response. Disclosures: No relevant conflicts of interest to declare.

Serum tissue polypeptide antigen in bladder cancer as a tumor marker: a prospective study.

1997 ◽  
Vol 15 (12) ◽  
pp. 3446-3450 ◽  
Author(s):  
C Maulard-Durdux ◽  
M E Toubert ◽  
C Hennequin ◽  
M Housset
Keyword(s):  
Bladder Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Prospective Study ◽  
Tumor Stage ◽  
Invasive Bladder Cancer ◽  
Tissue Polypeptide Antigen ◽  
End Of Treatment ◽  
A Prospective Study

PURPOSE Tissue polypeptide antigen (TPA) is a differentiation and proliferation tissue marker of epithelia. Increased serum levels were found in some patients with invasive bladder cancer. We present the results of a prospective study that evaluated the role of serum TPA (S-TPA) in bladder carcinoma. PATIENTS AND METHODS The series included 167 patients treated for invasive bladder cancer between 1989 and 1996. S-TPA concentrations were measured by radioimmunoassay before treatment, at the end of treatment, and during follow-up evaluation. The upper normal limit of the test was set at 80 UI/L. RESULTS With a specificity of 100%, the diagnostic sensitivity was 46%. Pretherapeutic S-TPA levels were significantly correlated with tumor stage (T2 v T3 and T4; P = .02), with nodal stage (N0 v N1 and N2; P = .00001), and with metastatic stage (M0 v M1; P = 10[-6]), but not with histologic grading (grade 1 and 2 v 3). In the subset of patients with normal pretherapeutic S-TPA levels, 95% had no residual disease at the end of treatment, compared with 53% of patients with initial elevated S-TPA (P = 10[-8]). Among patients who achieved a complete response, 27% experienced a relapse, with an increase of S-TPA in 72% of cases. The mean follow-up time was 20 +/- 17 months. For patients with normal pretherapeutic S-TPA levels, 3-year overall survival and disease-free survival rates were 76% and 67% respectively. These were 46% (P = .001) and 25% (P = 10[-7]), respectively, for patients with high pretherapeutic S-TPA. Multivariate analysis showed that S-TPA was an independent prognostic factor for survival (P = .03). CONCLUSION In invasive bladder cancer, S-TPA level is correlated with initial tumor stage. It is a valuable parameter for follow-up evaluation and appears to be a prognostic factor in multivariate analysis.

Survival and prognostic factors after complete response to first-line cisplatin-based chemotherapy in patients with advanced testicular seminoma: The Instituto Nacional de Enfermedades Neoplásicas experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15036-e15036
Author(s):  
Silvia P. Neciosup ◽  
David Callacondo ◽  
Oliver Rua ◽  
Jose Ernesto Rojas ◽  
Jose Quesada ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Univariate Analysis ◽  
Testicular Tumor ◽  
Complete Response ◽  
Independent Prognostic Factor ◽  
First Line ◽  
Testicular Seminoma

e15036 Background: The IGCCCG classification, used to guide the management of metastatic seminomas may underestimate the predictive value of other prognostic factors. We aimed to identify prognostic factors for long term survival in patients with advanced testicular seminoma who achieved a complete response to first line cisplatin based chemotherapy. Methods: A retrospective analysis was carried out on 101 patients with advanced testicular seminoma who received induction cisplatin based chemotherapy between 1990 and 2010.Data regarding clinical and laboratory parameters that may influence the overall survival (OS) or progression free survival (PFS) were collected from clinical records. Univariate analysis was performed using the Kaplan-Meier method, while Cox regression modeling was used for multivariate analysis. Results: The mean follow up time was 8.4 years. 9 (9%) patients died and 16 (16%) developed relapse. The 10 year OS and PFS rates were 91% and 84%. In univariate analysis, a testicular tumor ≥5.5cm and a retroperitoneal metastases ≥16 cm were associated with poor OS and PFS. The prechemotherapy LDH levels ≥2.4xUNL and age ≤36 years showed a trend to shorter PFS. Multivariate analysis showed that only the retroperitoneal metastases ≥16 cm was significant independent prognostic factor for OS (p=0.04, HR 3.86; 95% CI, 1.03-14.41) and PFS (p=0.05, HR 3.17; 95% CI, 0.99-10.15). Age ≤36 years (p=0.03, HR 4.29; 95% CI, 1.12-16.34) was also an independent prognostic factor for PFS. Conclusions: The presence of a retroperitoneal metastases ≥16 cm, a testicular tumor ≥5.5cm and age ≤36 years are associated with decreased OS and/or PFS in patients who achieved a complete response to first line cisplatin based chemotherapy. The use of these factors may assist the elaboration and implementation of new prognostic models that can guide the follow-up and management of patients with advanced testicular seminomas.

scholarly journals PROGNOSTIC FACTORS OF RENAL TUMOR RECURRENCE AFTER RADICAL NEPHRECTOMY

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
G Martínez Izquierdo ◽  
A R Arnaiz Pérez ◽  
E Escolano Fernández ◽  
M Merayo Álvarez ◽  
B Carrasco Aguilera ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Radical Nephrectomy ◽  
Univariate Analysis ◽  
Malignant Neoplasms ◽  
Histopathological Analysis ◽  
Chi Square ◽  
Renal Sinus ◽  
Chi Square Test

Abstract INTRODUCTION Renal cell carcinoma (RCC) represents 3% of overall malignant neoplasms in adults. However, its aetiology has not been clearly established. Although surgery represents the cornerstone in treatment, recurrence postoperative rates are around 20-30%, what implies prognostic factors search must be mandatory in order to help to plan de follow-up and the different adjuvant therapy possibilities available in case they were necessary. MATERIAL AND METHODS A retrospective observational study was carried out in 110 patients who underwent radical nephrectomy between 2004 and 2018, with the aim of identifying possible prognostic factors of recurrence of RCC after these surgeries. Preoperative data (epidemiological, comorbidities and laboratory tests), surgical, pathological and variables related to follow-up were taken into account. A univariate and multivariate analysis were performed, using chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 53.5 months (SD = 35.8), time in which 19 patients had a recurrence of RCC after radical nephrectomy (17.2%). Histopathological items such as the surgical piece size, the nodal and microvascular invasion, the renal sinus invasion and the presence of necrosis in the surgical piece were associated with RCC recurrence in the univariate analysis, while only the presence of necrosis in the surgical piece showed a significant result in the multivariate analysis (p = 0.004). CONCLUSIONS Histopathological analysis, highlighting the presence of necrosis in the histological sample, was proved to be the main risk factor of RCC recurrence.

scholarly journals Impact of Superselective Intra-Arterial and Systemic Chemoradiotherapy for Gingival Carcinoma; Analysis of Treatment Outcomes and Prognostic Factors

2020 ◽  
Author(s):  
Yuki Mukai ◽  
Yuichiro Hayashi ◽  
Izumi Koike ◽  
Toshiyuki Koizumi ◽  
Madoka Sugiura ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Clinical Stage ◽  
Performance Status ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Free Survival

Abstract Background: We compared outcomes and toxicity between radiation therapy (RT) with concurrent retrograde super-selective intra-arterial chemotherapy (IACRT) and RT with concurrent systemic chemoradiotherapy (SCRT), for gingival carcinoma (GC).　Methods: We included 84 consecutive patients who were treated for GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n=66; SCRT group: n=18).Results: Median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT group: 60 Gy; SCRT group:69 Gy). At 3 years, the two groups significantly differed in overall survival (OS; IACRT: 78.75%, 95% confidence interval [CI]: 66.00–87.62; SCRT: 50.37%, 95% CI: 27.58–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.64%, 95% CI: 62.69–85.17; SCRT: 41.96%, 95% CI: 17.65–70.90; P = 0.028) and local control (LC; IACRT: 77.17%, 95% CI: 64.23–86.41; SCRT: 41.96%, 95% CI: 17.65–70.90; P = 0.015). In univariate analysis, age ≥ 65, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with poor OS (P < 0.05). Patients with poorer PS had significantly worse PFS.Conclusions: This is the first report to compare outcomes from IACRT and SCRT among patients with GC. IACRT is an effective and organ-preserving treatment for GC.Trial registration: retrospectively registered

Prognostic Factors for Myelodysplastic Syndrome in the Veteran Population: Single Institution Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4622-4622
Author(s):  
Michael Axelson ◽  
Shirisha Reddy ◽  
Crystal Lumby ◽  
Sue Sivess-Franks ◽  
Jonathan Dowell ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Blood Transfusion ◽  
Cox Regression ◽  
Medical Center ◽  
Univariate Analysis ◽  
Single Institution ◽  
Number Of Patients

Abstract Background: Myelodyplastic syndrome (MDS) is the disease of the elderly and increasingly common in the veteran population. Here we report a single institution experience with MDS at the Dallas VA Medical Center. Patients and Method: From a period of 1998–2007, eighty three pts were identified out of which 54 pts had bone marrow (BM) biopsy proven diagnosis of MDS. Overall survival (OS) analysis with dependent variables (Age at diagnosis, IPSS Score, WHO morphologic diagnosis, number of blood and platelet transfusions required, Hb level, ANC, cytogenetics, blast percentage, BM cellularity at diagnosis) were conducted by selection method “foreward” and only these significant variables were used in the Cox regression for multivariate analysis. Methods of Kaplan and Meier were used to generate OS curves. Results: The median age of diagnosis was 74 yrs with a median follow up time of 12.5 months. The WHO morphologic subtype was RA/RARS (n=13), Del5q (n=1), RCMD/RCMDRS (n=34), RAEB1 (n=3), RAEB2 (n=1), missing (n=2). The distribution of IPSS score was 0 (n=25); 0.5 (n=15); 1.0 (n=8), 1.5 (n=4), missing (n=2). Five pts had treatment related MDS and 3 pts transformed to AML. One patient had concurrent MGUS and one patient developed multiple myeloma. At diagnosis, 23 pts had a hemoglobin (Hb) value of less than 10g/dl. Only 4 pts had ANC less than 500; sixteen pts had ANC 500–1800 and 34 pts had normal counts. A majority of pts had normal cytogenetics (n=37), 5 pts had good risk, 5 pts had intermediate risk and 7 pts had poor risk cytogenetics. Six pts had hypocellular (<30%) BM at diagnosis whereas 16 pts had a hypercellular marrow (> 50%). Only 4 pts had more than 5% blast in the BM. Twenty nine pts eventually became blood transfusion dependent and 12 pts needed platelet transfusion at some point. Thirty six pts were treated with erythropoietin (with or without neupogen) and 13 pts received some type of disease modifying therapy (5-azacytidine/lenalidomide/ATG/clinical trial). The mean survival time was 106 months. Median survival was not reached at the time of analysis. In the univariate analysis, IPSS score (p=0.003), No. of blood transfusions (p=0.028), cytogenetics (p=0.0001) and blast percentage (p=0.0015), were statistically significant. BM cellularity (p=0.06) and Hb level (p=0.09) showed a trend towards significance. On multivariate analysis, Hb greater than 10 (HR 0.08; p=0.011), abnormal cytogenetics (HR 4.2; p=0.001), BM Blast > 5% (p=0.026) and BM cellularity < 30% (HR 4.6; p=0.033) emerged as the significant predictors of overall survival. IPSS score or Blood transfusion requirement did not pan out to be significant. Conclusion: MDS in the veteran population may be different from general population and may have unique predictors of survival. A larger number of patients and longer duration of follow up is required to further evaluate these prognostic factors.

What Is the Appropriate Dose Attenuation System of RCHOP for Elderly DLBCL Patients? - A Single Institutional Analysis in 115 Cosecutive Patients From Japan -

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3639-3639
Author(s):  
Akira Tanimura ◽  
Risen Hirai ◽  
Atsushi Sato ◽  
Miki Nakamura ◽  
Masataka Takeshita ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Age Related

Abstract Abstract 3639 Background: The combination therapy of RCHOP [rituximab (R), cyclophosphamide (CY), doxorubicin (DOX), vincristine (VCR), and prednisone (PSL)] is a standardized treatment for diffuse large B-cell lymphoma (DLBCL). However, its clinical outcome is worse in elderly patients because of comorbidities, age-related decrease in organ function, and impaired drug metabolism. If possible, the dose of RCHOP in elderly patients and patients with comorbidities should be adjusted appropriately. Since 2005, we have used a unified dose attenuation system for RCHOP according to the age and comorbidities of patients. This study retrospectively verified this system. Patients/Methods: We analyzed 115 consecutive DLBCL patients treated at our institute from September 2001, when rituximab was approved in Japan, to December 2010. From September 2001 to August 2005, 33 patients received dose adjustment of RCHOP according to the physician's discretion (PHY group). From September 2005, 82 patients received RCHOP according to the unified dose attenuation system (UNI group). In the UNI group, patients younger than 60 years received the standard RCHOP dose [R, 375 mg/m2; CY, 750 mg/m2; DOX, 50 mg/m2; VCR, 1.4 mg/m2 (max 2.0 mg/body); PSL, 100 mg/m2]. In patients older than 60 years, the doses of CY, DOX, VCR, PSL, and R were attenuated as shown in Table 1. In addition to age, the doses of CY, DOX, and VCR were adjusted according to organ functions (Table 2). The two groups were compared statistically. Results: The median age of patients was 70 years (range, 38–91), with 70.4% of patients classified as stage III or IV DLBCL, 40.4% with an international prognostic index (IPI) score of 0–2, and 70.2% with a ECOG performance status (PS) of 0 or 1. Low serum albumin levels (under normal range) were observed in 50.5% patients, and a high Charlson comorbidity index (CCI) score of >1 was found in 58.3%. The characteristics of the patients in the two groups were almost similar. The UNI system was completed in 94% of patients. The complete response (CR) rate was 63% in all patients (UNI group, 73%; PHY group, 39%; P = 0.0006). Univariate analysis revealed that better prognostic factors for CR were a low IPI score, better PS, and the UNI group. In the multivariate analysis, only the UNI group was a significantly better prognostic factor for CR. With a median follow-up of 26 months, the 5-year event-free survival (EFS) and overall survival (OS) were 39.3% and 68% in all patients, 43% and 72% in the UNI group, and 27% and 59% (5-year EFS; P = 0.0083, 5-year OS; P = 0.16) in the PHY group, respectively. Multivariate analysis showed that better prognostic factors for EFS were a low IPI score, a low CCI score, and the UNI group, and that for OS were low IPI and low CCI scores. In elderly patients aged >70 years (N = 59), the CR rates were 81% and 13% in the UNI and PHY groups, respectively (P = 0.0004), with OS in the UNI group being longer than that in the PHY group (72% vs. 59%; P = 0.02; Fig.1). In the UNI group, patient age did not affect the CR rate (<70, 71% vs. 70–79, 83% vs. >79, 79%; P = 0.56) or 5-year OS (<70, 76% vs. 70–79, 70% vs. >79, 66%; P = 0.58). The actual dose of CY, DOX, and VCR compared with the standard RCHOP dose was 64% and 26%, 63% and 16%, and 63% and 21% in the UNI and PHY groups, respectively. Disease progression during treatment, discontinuation of therapy, and death during treatment were observed in 10% and 15%, 5% and 24%, and 5% and 3% in the UNI and PHY groups, respectively. Nineteen patients (23%) from the UNI group died over a median follow-up of 15 months, while 15 patients (45%) of the PHY group died over a median follow-up period of 29 months. Lymphoma-related deaths were 12 (14%) in the UNI group and 8 (24%) in the PHY group. Five secondary primary malignancies (SPM) were observed (1 colon cancer and 1 breast cancer in the PHY group, and 1 lung cancer and 2 myelodysplastic syndrome in the UNI group). Four deaths were related to SPM. Conclusion: The unified dose attenuation system determined by the patients' age and comorbidities may achieve an effective dose level and better prognosis in elderly DLBCL patients. Disclosures: No relevant conflicts of interest to declare.

Carbohydrate Antigen 19-9 Is an Invasive Malignancy Preoperative Prognostic Factor for Intraductal Papillary Mucinous Neoplasms

2021 ◽  
pp. 1-9
Author(s):  
Shuji Suzuki ◽  
Mitsugi Shimoda ◽  
Jiro Shimazaki ◽  
Yukio Oshiro ◽  
Kiyotaka Nishda ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Prognostic Factor ◽  
Pancreatic Duct ◽  
Univariate Analysis ◽  
Carbohydrate Antigen ◽  
Independent Prognostic Factor ◽  
Mural Nodule ◽  
Macroscopic Type ◽  
Duct Diameter

<b><i>Introduction:</i></b> This study aimed to determine the preoperative clinicophysiological and postoperative clinicopathological predictors of malignancy in patients with intraductal papillary mucinous neoplasm (IPMN). <b><i>Methods:</i></b> This was a retrospective observational study. We included 121 patients (73 men and 48 women; mean age: 68.7 years) who had undergone pancreatic resection for IPMN between 2007 and 2018. These patients were grouped into invasive carcinoma (IPMN-INV, <i>N</i> = 21) and low/high-grade IPMN (IPMN-LG/HG, <i>N</i> = 100) groups. Univariate and multivariate analyses of clinicophysiological parameters were carried out. These parameters were also compared between the IPMN-INV/HG (<i>N</i> = 53) and IPMN-LG (<i>N</i> = 68) groups. Survival analyses according to macroscopic type and IPMN subtypes were performed. <b><i>Results:</i></b> On univariate analysis, age (<i>p</i> = 0.038), carbohydrate antigen (CA) 19-9 (<i>p</i> &#x3c; 0.001), IPMN macroscopic type (<i>p</i> = 0.001), IPMN subtype (<i>p</i> &#x3c; 0.001), pancreatic duct diameter (<i>p</i> &#x3c; 0.001), and mural nodule (<i>p</i> = 0.042), between IPMN-INV and IPMN-LG/HG were found to be significant prognostic factors of malignancy. CA 19-9 was found to be an independent prognostic factor of IPMN malignancy on multivariate analysis (<i>p</i> = 0.035). The 1-, 3-, and 5-year overall survival (OS) rates of the IPMN-INV and IPMN-LG/HG groups were 94.4/100%, 94.4/100%, and 67.2/100%, respectively. The OS rate in the IPMN-LG/HG group was significantly higher than that in the IPMN-INV group (<i>p</i> &#x3c; 0.001). On univariate analysis, platelet (<i>p</i> = 0.043), CA 19-9 (<i>p</i> = 0.039), prognostic nutritional index (<i>p</i> = 0.034), platelet/lymphocyte ratio (<i>p</i> = 0.01), IPMN macroscopic type (<i>p</i> &#x3c; 0.001), IPMN subtype (<i>p</i> &#x3c; 0.001), pancreatic duct diameter (<i>p</i> = 0.036), and mural nodule (<i>p</i> = 0.032) between IPMN-INV/HG and IPMN-LG were found to be significant prognostic factors of malignancy. On multivariate analysis, CA 19-9 was found to be an independent prognostic factor (<i>p</i> = 0.042) between IPMN-INV/HG and IPMN-LG of malignancy. The 1-, 3-, and 5-year OS rates of the IPMN-INV/HG and IPMN-LG groups were 97.9/100%, 97.9/100%, and 82.6/100%, respectively. The OS rate was significantly higher in the IPMN-LG group than in the IPMN-INV/HG group (<i>p</i> = 0.03). No significant differences in survival were observed in patients with macroscopic tumors (<i>p</i>= 0.544). <b><i>Conclusion:</i></b> CA 19-9 is an independent invasive malignancy predictor of IPMN.

Sign in / Sign up

Export Citation Format

Share Document