Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

Introduction: Single ventricle physiology management is challenging, especially in low-income countries. Objective: To report the palliation outcomes of single ventricle patients in a developing African country. Methods: We retrospectively studied 83 consecutive patients subjected to single ventricle palliation in a single center between March 2011 and December 2017. Preoperative data, surgical factors, postoperative results, and survival outcomes were analyzed. The patients were divided by palliation stage: I (pulmonary artery banding [PAB] or Blalock–Taussig shunt [BTS]), II (Glenn procedure), or III (Fontan procedure). Results: Of the 83 patients who underwent palliation (stages I-III), 38 deaths were observed (31 after stage I, six after stage II, and one after stage III) for an overall mortality of 45.7%. The main causes of operative mortality were multiple organ dysfunction due to sepsis, shunt occlusion, and cardiogenic shock. Twenty-eight survivors were lost to follow-up (22 after stage I, six after stage II). Thirteen stage II survivors are still waiting for stage III. The mean follow-up was 366 ± 369 days. Five-year survival was 28.4 % for PAB and 30.1% for BTS, while that for stage II and III was 49.8% and 57.1%, respectively. Age (hazard ratio, 0.61; 95% confidence interval: 0.47-0.7; P = .000) and weight at surgery (hazard ratio, 0.45; 95% confidence interval: 0.31-0.64; P = .002) impacted survival. Conclusion: A high-mortality rate was observed in this initial experience, mainly in stage I patients. A large number of patients were lost to follow-up. A task force to improve outcomes is urgently required.

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Pattern of recurrence after curative resection of stage I-III duodenal adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.794 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 794-794

Author(s):

Andreina Colina ◽

Kanwal Pratap Singh Raghav ◽

Matthew H. G. Katz ◽

Prajnan Das ◽

Naruhiko Ikoma ◽

...

Keyword(s):

Neoadjuvant Therapy ◽

Median Time ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Cancer Center ◽

Radiographic Evaluation ◽

Duodenal Adenocarcinoma ◽

Time To Recurrence

794 Background: Duodenal adenocarcinoma (DA) is a rare cancer with limited data regarding the pattern of disease recurrence following resection. Methods: A retrospective review of 115 patients with Stage I-III DA from 3/1994 to 6/2018, at a single high-volume cancer center was conducted. Only patients (pts) who underwent a potentially curative surgical resection (R0/R1 margins) and had a postoperative follow-up radiographic evaluation were included. Periampullary adenocarcinomas were excluded. Clinicopathologic features and patterns of recurrence were compared across cohorts. Results: Of 76 patients who met inclusion criteria, 7 (9%) were stage I, 25 (33%) stage II, and 44 (57%) stage III. Histologic grade was moderate in 58% and poor in 38%. Median age was 63 years (range, 29-84), 38% were female, and R0 resection was 97%. Neoadjuvant therapy was given to 14% and adjuvant therapy to 61%. Radiation therapy (XRT) as either adjuvant/neoadjuvant therapy was used in 27%. Median follow-up was 44 (6-293) months. Median time to recurrence was 11mo, with 84% of recurrences occurring within 2 years. Median time to local recurrence (LR) vs. distant recurrence (DR) was 11mo vs. 12mo, respectively, p = 0.42. Stage impacted recurrence rate: 0% in stage 1 vs. 50% stage 2 vs. 71% stage 3 (p = 0.002). Median time to recurrence was 16mo for stage II and 11mo for stage III (p = 0.04). In total, 4 (5%) pts had LR only, 8 (10%) had LR concurrent with DR, and 32 (42%) had DR only. Recurrence distribution was similar across stage II (LR 8%, LR+DR 15%, DR 77%) and stage III (LR 10%, LR+DR 19%, DR 71%). LR was similar in patients that received XRT (10%) compared to those who did not (9%). Most common sites of DR were peritoneal (38%), liver (33%), distant lymph nodes (12%), and lung (10%). Conclusions: The recurrence pattern for resected DA is predominantly distant metastatic disease with the majority of recurrences occurring within the first two years. Future therapies should focus on improved systemic therapy, and surveillance should be most intensive in the first two years.

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Dysgerminoma of the ovary 35 years on: A single institutional experience

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16523 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16523-e16523

Author(s):

D. Vicus ◽

M. Beiner ◽

S. Klachook ◽

L. Le ◽

O. Ginsburg ◽

...

Keyword(s):

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Bilateral Oophorectomy ◽

Long Term Outcome ◽

Fertility Sparing ◽

Institutional Experience ◽

Stage Ia ◽

Ovarian Dysgerminoma

e16523 Background: Ovarian dysgerminomas are rare but are relatively more common in women under 20 years of age in whom fertility is likely to be an issue. The aim of this study was to review our institutional experience in treating patients (pts) diagnosed with pure dysgerminoma. Methods: We performed a retrospective chart review of all pts diagnosed with ovarian dysgerminoma at the Princess Margaret Hospital, Toronto, between 1970 and 2005. Results: 65 pts were diagnosed with ovarian dysgerminoma, median age 21.9 years (range 8.1–64.1 yrs). 40 pts (62.5%) presented with FIGO stage IA disease; 3 (4.7%) stage IB; 6 (9.4%) stage IC; 2 (3.1%) stage II; and 13 (20.3%) at stage III, 1 unknown. Initial management was surgical for all pts: unilateral oopherectomy 47 pts (72.2%), 14 (21.5%) bilateral oophorectomy ± hysterectomy (12 pts), 3 (4.6%) cystectomy alone. 17 pts received chemotherapy, 15 adjuvant and 2 for residual disease (all post 1988); 8 for stage I, 1 for stage II, and 8 for stage III. 12 pts received etoposide and cisplatin (EP); 4 bleomycin, etoposide, and cisplatin (BEP); and 1 vincristine and cisplatin. 20 pts received adjuvant radiotherapy (all prior to 1985); 14 stage I; 1 stage II; and 5 stage III. 1 pt received a combination of adjuvant chemotherapy and radiation. 6 (9.2%) pts recurred all within 19 months of initial diagnosis. 5 of the 6 pts that recurred had stage IA disease treated with a unilateral oophorectomy, 1 received adjuvant EP. 1 pt with stage IIIC disease recurred following bilateral oophorectomy + hysterectomy and radiotherapy. Treatment of recurrent disease was by salvage surgery and chemotherapy (3 pts), radiotherapy (2 pts), and EP (1 pt). All pts who recurred responded to treatment and were alive at last follow up, median follow up 22.5 yrs (range 9.3–31.4 yrs). Median follow up, all pts, was 10.5 yrs (range 1.1 to 31.9 yrs). 15 pts attempted to conceive posttreatment; 6 had received adjuvant treatment; 4 EP; and 2 whole abdominal radiotherapy. 13 successful pregnancies and 13 live births were reported in 9 women (3 had received adjuvant EP). Conclusions: The long-term outcome of patients with an ovarian dysgerminoma is excellent. Recurrences occured within 2 years of diagnosis and are treatable. Patients can be treated with fertility sparing surgery and can expect good reproductive outcomes. No significant financial relationships to disclose.

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Insurance Status Effect on Laryngeal Cancer Survival: A Population Based Study

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211044231 ◽

2021 ◽

pp. 000348942110442

Author(s):

Nicholas B. Abt ◽

Lauren E. Miller ◽

Anuraag Parikh ◽

Neil Bhattacharyya

Keyword(s):

Cancer Patients ◽

Laryngeal Cancer ◽

Stage Iv ◽

Hazard Ratio ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Insurance Status ◽

Uninsured Patients ◽

Status Effect

Objective: To analyze insurance status effect on overall survival (OS) and disease-specific survival (DSS) in laryngeal cancer. Study Design: Cross-sectional population analysis. Setting: Surveillance, Epidemiology, and End Results (SEER) database. Participants: Laryngeal cancer patients from 2007 to 2016. Main Outcome Measures: Kaplan-Meier method with log-rank statistic analyzed OS and DSS by insurance status. Multivariable cox proportional hazard modeling generated survival prognostic factors. Results: Of 19 667 laryngeal cancer cases, initial disease presentation was stage I: 7770 patients (39.5%), stage II: 3337 patients (17.0%), stage III: 3289 patients (16.7%), and stage IV: 5226 patients (26.6%). Patients had non-Medicaid insurance (15 523, 78.9%), had Medicaid (3306, 16.8%), or were uninsured (891, 4.5%). Mean and median OS for insured, Medicaid, and uninsured patients were 60.5, 49.6, and 56.6 and 74.0, 40.0, and 65.0 months, respectively. Following multivariable analysis, OS for insured, Medicaid, and uninsured patients was stage I: 87.9, 82.8, and 88.4 ( P < .001), stage II: 79.1, 75.1, and 78.3 ( P = .12), stage III: 68.7, 66.1, and 72.1 ( P = .11), and stage IV: 57.1, 51.7, and 50.3 ( P < .001) months. DSS mean survival times were 77.0, 65.8, and 67.7 months ( P < .001) for insured, Medicaid, and uninsured patients. Age (HR: 1.02/year, P < .001) and black (HR: 1.15, P = .001) compared to white race predicted worse survival. Compared to insured status, Medicaid insurance carried a death hazard ratio of 1.40 ( P < .001) and uninsured status had a death hazard ratio of 1.40 ( P < .001). Conclusion: Insured laryngeal cancer patients had prolonged OS and DSS compared to Medicaid and uninsured patients. Medicaid patients had equivalent survival outcomes to uninsured patients. Level of Evidence: 2c.

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Cancer-specific survival by stage of bladder and urinary tract cancers and factors collected by Mallorca Cancer Registry associated to survival.

10.21203/rs.2.22589/v2 ◽

2020 ◽

Author(s):

Maria Ramos ◽

Joana Ripoll ◽

Juan José Montaño ◽

Jaume Pons ◽

Alberto Ameijide ◽

...

Keyword(s):

Urinary Tract ◽

Cancer Registry ◽

Cox Model ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Cancer Specific Survival ◽

Non Invasive

Abstract Background: Information about survival by stage in bladder cancer is scarce. Objectives: 1) to find out the distribution of bladder and urinary tract cancers by stage; 2) to determine cancer-specific survival by stage of bladder and urinary tract cancers; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers.Methods: Incident bladder and urinary tract cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with codes C65–C68 (ICD-O 3) with any behaviour. DCO cases were excluded. We collected: sex; age; date and method of diagnosis; histology (ICD-O 3); T, N, M and stage at the time of diagnosis; and date of follow-up or death. End of follow up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Actuarial and Kaplan-Meier methods and Cox regression models were used.Results: 2060 cases were identified. 15% were women and 65.2% were 65 years or older. 3.7% had no stage (benign or undetermined behaviour) and 12.5% had unknown stage. After MI, 35.7% were in stage Ta (non-invasive papillary carcinoma), 3.1% in stage Tis (carcinoma in situ), 33.3% in stage I, 11.9 % in Stage II, 4.7% in stage III, and 11.1% in stage IV. Survival was 73% at 5 years. Survival by stage: 98% at stage Ta, 88% at stage Tis, 84% at stage I, 44% at stage II, 33% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage were associated with survival.Conclusion: Bladder and urinary tract cancers survival vary greatly with stage. The percentage of non-invasive cancers was high. Stage, age and histology are associated to survival, but sex has no association.

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Neuro developmental outcome of preterm babies with hypoxic ischemic encephalopathy

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192035 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1315

Author(s):

Ramya H. S. ◽

Rajendra Prasad T. C. ◽

Nisar Ahamed A. R. ◽

Muragesh Awati ◽

Maria George

Keyword(s):

Preterm Infants ◽

Stage I ◽

Stage Ii ◽

Hypoxic Ischemic Encephalopathy ◽

Stage Iii ◽

Research Centre ◽

Long Term Outcome ◽

Preterm Babies ◽

Ischemic Encephalopathy

Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.

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Long - term follow - up results of single port laparoscopic colectomy for colon cancers

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2020.3.7 ◽

2020 ◽

Vol 10 (3) ◽

Author(s):

Trung Vỹ Phạm ◽

Keyword(s):

Colon Cancer ◽

Laparoscopic Surgery ◽

Single Port ◽

Surgical Techniques ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Long Term Results

Tóm tắt Mục tiêu: Đánh giá kết quả phẫu thuật nội soi một cổng (PTNSMC) ung thư đại tràng có theo dõi và đánh giá kết quả sống còn sau mổ. Đối tượng nghiên cứu: Nghiên cứu tiến cứu gồm 114 người bệnh (NB) ung thư đại tràng (UTĐT) được phẫu thuật nội soi một cổng từ tháng 12/2011 được theo dõi đến tháng 12/2018 tại Bệnh viện Trung ương Huế. Kết quả: Tuổi trung bình (TB) 57,1 ± 14,2 tuổi (25 - 87), tỷ lệ nam/nữ 1,6/1, tăng CEA trước mổ 54,4%, kích thước u TB 4,9 ± 2,5cm (1 - 7,5). Phương pháp phẫu thuật: cắt nửa đại tràng phải 73,7%, cắt nửa đại tràng trái 14,9%, cắt đoạn đại tràng sigma 11,4%, đặt thêm 1 trocar hỗ trợ 16,7%, không có tử vong cũng như các tai biến trong mổ. Thời gian phẫu thuật 163,5 ± 75,5 phút (120 - 290), số hạch thu được 16,2 ± 4,5 hạch (12 - 25), thời gian nằm viện 7,5 ± 6,1 ngày (6 - 15). Giai đoạn (GĐ): GĐ1: 30,7%; GĐ2: 43,9%; GĐ3: 25,4%. Thời gian theo dõi 38,2 ± 17,5 tháng (6 - 84), 5 NB tái phát tại vùng 4,4%, 3 NB tiến triển di căn xa 2,6%. Sống còn toàn bộ sau 2 năm 96,2%, sau 5 năm 75,7%, sống còn 5 năm theo giai đoạn: GĐ1: 90,9%; GĐ2: 71,6%; GĐ3: 20,8% (p< 0,0001). Kết luận: Phẫu thuật nội soi một cổng ung thư đại tràng là khả thi và an toàn, giá trị thẩm mỹ là vết rạch ngắn, được che phủ bởi rốn. Kết quả lâu dài về mặt ung thư học là tương tự với phẫu thuật nội soi truyền thống trong ung thư đại tràng. Abstract Objectives: Evaluation of results of single port laparoscopic surgery (SPLS) for colon cancer with follow up of survival. Materials and methods: Prospective study of 114 patients suffering from colon cancer underwent SPLS from December 2011, were followed up until December 2018 at Hue Central Hospital. Results: Average age was 57.1 ± 14.2 years (25 - 87), male/female was 1.6/1, pre-operative elevated level of CEA was 54.4%, average tumor size 4.9 ± 2.5cm (1 - 7.5). Surgical techniques included right hemicolectomy 73.7%, left hemicolectomy 14.9% and sigmoidectomy 11.4%, additional one more trocar was 16.7%. No death and nor complications were observed during surgery. Time of surgery was 163.5 ± 75.5 minutes (120 - 290), mean lymph nodes harvest 16.2 ± 4.5 nodes (12 - 25), mean hospital lenght stay was 7.5 ± 6.1 days (6 - 15). Stage I: 30.7%; stage II: 43.9%; stage III: 25.4%. Follow-up time was 38.2 ± 17.5 months (6 - 84), local recurrence was in 5 patients accounted for 4.4%, 3 patients with distal metastasis 2.6%, overall survival rates after 2 years accounted for 96.2%, after 5 years in 75.7%, 5 years of survival according to stage were : stage I in 90.9%, stage II in 71.6%, stage III in 20.8% (p <0, 0001). Conclusion: Single port laparoscopic surgery for colon cancer is feasible and safe, cosmetic aspect is a short incision, hidden by the umbilicus. Long-term results in oncology are equivalent to conventional laparoscopic surgery. Keywords: Colon cancer, Single port laparoscopic surgery.

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Prognostic Factors for Survival After 2-CdA-Based Therapy for Symptomatic Waldenström Macroglobulinemia (WM) Stratify Patients Into Low- and High-Risk Groups.

Blood ◽

10.1182/blood.v114.22.1668.1668 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1668-1668

Author(s):

Sheeba K Thomas ◽

Lei Feng ◽

Kay B Delasalle ◽

Michael Wang ◽

Jatin J Shah ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Retrospective Studies ◽

Risk Group ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Primary Therapy ◽

Intermediate Risk

Abstract Abstract 1668 Poster Board I-694 Introduction Retrospective studies performed by others between 2001-2009, have identified various prognostic factors for survival among patients with symptomatic WM. These include hemoglobin, platelet count, albumin, and β2-micrglobulin (β2M) at varied cutoffs, as well as gender, age, IgM level, monoclonal (M) protein level, hyperviscosity syndrome, prior therapy, presence of splenomegaly/organomegaly, stage as defined by the International Staging System for multiple myeloma (ISSMM) and risk score as defined by the International prognostic scoring system for Waldenström macroglobulinemia (IPSSWM). Methods We retrospectively analyzed our experience with 80 previously untreated patients with symptomatic WM who participated on one of four 2-chlorodeoxyadenosine (2-CdA)-based clinical trials between 3/90-5/02, to identify factors predicting overall survival. Patients received either 2 consecutive 4-6 week courses of 2-CdA at 1.5 mg/m2 subcutaneously three times daily for 7 days (d) alone (10 patients), with prednisone (Pred) at 60 mg/m2 orally (po) d1-7 (21 patients), with cyclophosphamide (Cy) at 40 mg/m2 po twice daily (bid) for 7d (31 patients), or with Cy at 40 mg/m2 po bid for 7d + rituximab (Rit) at 375 mg/m2 intravenously weekly for 4 weeks (18 patients). Overall survival (OS) from the start of therapy was censored as of April 1, 2009. Predictive factors identified by multivariate analysis in other retrospective studies, as well as other clinically relevant factors, were evaluated. Results Median age of patients was 62.1 years (range 35.9-80.1), and 41 were male. Median hemoglobin was 10 g/dL (5.6-15.6), platelet count was 243 K/μL (26-654), albumin was 4.1 g/dL (2.5-5.4), and β2M was 3.3 mg/L (1.4-15.9). Splenomegaly and lymphadenopathy (≥ 2 cm) were present in 29.1% and 28.8% of patients, respectively. By ISSMM, 38 patients were Stage I, 29 were Stage II, and 13 were Stage III. By IPSSWM, 24 patients were low-risk, 45 were intermediate-risk, and 11 were high-risk. With a median follow-up of 9.9 years (yrs; range 0.9-16.8), median OS for all patients was 8.9yrs (0.1 yrs-not reached (NR)). By univariate analysis, age <65y, primary therapy (2CdA/Cy/Rit >2CdA/Cy > 2CdA >2CdA/Pred), albumin ≥3.5 g/dL, B2M <3.5 mg/L vs. 3.5-5.5 mg/L vs. >5.5 mg/L, ISSMM and IPSSWM, were all significant (p< 0.05). In multi-covariate models, primary therapy (2CdA/Cy/Rit vs. other 2CdA regimens), age, ISSMM, and IPSSWM remained significant. Removing the 2CdA/Pred cohort (which had the poorest OS) from the analysis of primary therapy, the trend toward superior OS with 2CdA/Cy/Rit vs. 2CdA+2CdA/Cy persisted (NR vs. 9.2 yrs), but did not reach statistical significance (p=0.12). Median OS for patients of age <65 yrs was 15.4 yrs compared with 6.2 yrs for those age ≥65 yrs (p=0.03). ISSMM stage I disease was associated with a median OS of 12.5 yrs, while stage II was 6.3 yrs, and stage III was 6.0 yrs (p=0.02). By comparison, median OS has not yet been reached among those classified as having low-risk disease by IPSSWM, while the intermediate-risk group has a median OS of 6.5 yrs, and the high-risk group has a median OS of 5.8 yrs (p=0.03). Conclusion Both ISSMM and IPSSWM are predictive of overall survival among patients with symptomatic WM treated first-line with 2CdA-based regimens. In our experience, rates of 10 year OS were better stratified by age, <65 yrs (62%) vs. ≥65 yrs (30%), and IPSSWM risk score, low (63%) vs. intermediate (46%) vs. high (24%), than by ISSMM stage (stage I [58%] vs. stage II [49%] vs. stage III [0%]). Novel therapeutic strategies are needed to improve the survival of patients with WM who are of older age, or who have high-risk IPSSWM or higher stage ISSMM disease. Longer follow-up is needed to confirm the trend toward improved survival seen with the addition of rituximab to 2CdA-based therapy. Disclosures No relevant conflicts of interest to declare.

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Outcomes of Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) Vs. Classical Hodgkin Lymphoma (cHL) at Princess Margaret Cancer Centre

Blood ◽

10.1182/blood.v126.23.3863.3863 ◽

2015 ◽

Vol 126 (23) ◽

pp. 3863-3863 ◽

Cited By ~ 5

Author(s):

Jeffery Ames ◽

Manjula Maganti ◽

Bethany E Monteith ◽

David C. Hodgson ◽

Vishal Kukreti ◽

...

Keyword(s):

Regression Model ◽

Hodgkin Lymphoma ◽

Research Funding ◽

Hazard Ratio ◽

Stage I ◽

Age At Diagnosis ◽

Stage Iii ◽

Response To Treatment ◽

Cancer Centre

Abstract Background: Treatment of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is controversial. While management generally follows that of classical HL (cHL), NLPHL demonstrates many biologic differences from cHL, and such patients (pts) are often excluded from prospective trials of novel therapies. The purpose of this study was to describe the characteristics and treatment outcomes of pts with NLPHL at the Princess Margaret Cancer Centre (PM) compared to those with cHL, with both groups managed following the same treatment algorithms according to stage at presentation. Methods: We identified 820 pts registered in our Lymphoma database from 1999 to 2013 who had primary treatment at PM; 50 had NLPHL and 770 had cHL. The outcomes of the two groups were compared utilizing the whole cohort as well as a 1:3 propensity score-matched subcohort. Propensity scores were calculated based on a logistic regression model with the probability of belonging to the NLPHL group as dependent variable. Pts were matched based on age, gender, treatment received, stage, extranodal disease and follow-up time. A competing risks approach was used to estimate the probability of relapse and Gray's test and Fine and Gray model were used to study significance between groups. A Cox regression model and the log-rank test were used to compare disease free survival (DFS). Results: Median age at diagnosis of pts with NLPHL was 38 years (range 12-73) and 28 years (4-88) for those with cHL (p=0.006); 20% of NLPHL pts were female versus 44% with cHL (p=0.008). Similar proportions of pts with NLPHL and cHL presented with stage I/II lymphoma (84% vs 73%, p=0.083) but extranodal (E) disease was less common in NLPHL (4% v 25%, p=0.006). Treatment received: NLPHL: radiation (IFRT) alone 26%, chemotherapy alone 20%, combined modality therapy (CMT) 54%; CHL: IFRT alone 2%; chemotherapy alone 24%; CMT 74%. Chemotherapy consisted of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD). The median follow-up time (range) was 7.7 (1.5-15.2) years in the NLPHL group versus 5.2 (0.03-15.9) years in the cHL group. There was no difference in DFS or relapse rate between pts who were diagnosed with cHL and NLPHL (p >0.7). Pts with stage III/IV NLPHL had the poorest outcome with the highest rate of relapse at 5 years (53.1%) compared to other groups (23.4%, 12.4% and 2.8%), and the lowest DFS at 5 years (47% vs. 97%, 85% and 74%, p<0.001). Pts with stage III/IV NLPHL were 2.9 times more likely to experience relapse than pts with stage III/IV cHL (p-0.03 (95% CI: 1.1-7.5)). Among the 50 pts with NLPHL, 47 could be matched with pts with cHL (n=126, Table 1). The response to treatment was similar between the matched pt groups, with 44 (94%) pts achieving CR/CRu/PR in the NLPHL group and 118 (94%) with cHL. As was seen for the whole cohort, no difference in the probability of relapse or DFS between the matched NLPHL and cHL pts (relapse at 5y:11.2% v 21.4%, DFS at 5y: 89 % vs. 75% p=NS); however, the hazard ratio for relapse for pts with stage III/IV NLPHL vs cHL was 3.0 (95% CI 0.83-10.9, p=0.09); relapse probability by subtype and stage is shown in figure 1. DFS at 5 years: NLPHL stage I/II 97%, stage III/IV 47%; cHL stage I/II 78%, stage III/IV 58% ; hazard ratio for DFS for pts with stage III/IV NLPHL vs cHL 2.0 (95% CI 0.53-7.6, p=0.31); Four pts with NLPHL and 1 with cHL developed a second lymphoma (4 DLBCL, 1 plasmablastic). Conclusion: Within the limits of relatively small patient numbers, the prognosis of pts with early stage NLPHL is excellent when treated with CMT approaches used for cHL, or IFRT alone, while pts with stage III/IV disease appear to have a high rate of recurrence with ABVD; alternative regimens should be considered in these patients. Table 1. Characteristics of matched cohorts Covariate CHL (N=126)N (%) NLPHL (N=47)N (%) Age at Diagnosis (yrs) Median (range) 36 (12-73) 36 (4-86) Gender % Female Male 29 (23.0) 97 (77.0) 10 (21.3) 37 (78.7) Treatment Chemotherapy CMT IFRT 25 (19.8) 85 (67.5) 16 (12.7) 10 (21.3) 27 (57.4) 10 (21.3) Stage I/II III/IV 108 (85.7) 18 (14.3) 39 (83.0) 8 (17.0) Extranodal N Y 119(94.4) 7(5.6) 45 (95.7) 2 (4.3) Response to Treatment CR/CRu/PR NR/SD 118 (93.7) 8 (6.3) 44 (93.6) 3 (6.4) Status Alive Death 110 16 45 2 Cause of Death HL or treatment toxicity Other/unknown alive 6 9 110 1 1 45 Competing risk (Relapse) No Relapse Relapse (incl PD) Death without Relapse 94 25 7 38 9 - Figure 1. Relapse probability according to stage, histology Figure 1. Relapse probability according to stage, histology Disclosures Kukreti: Roche: Honoraria; Lundbeck: Honoraria; Amgen: Honoraria; Celgene: Honoraria; Janssen Ortho: Honoraria. Kuruvilla:Seattle Genetics: Honoraria, Research Funding; Karyopharm: Honoraria, Research Funding; Roche Canada: Honoraria. Crump:Celgene: Honoraria; Sanofi: Honoraria; Seattle Genetics: Honoraria.

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Cause-specific survival by stage of bladder and urinary tract cancers and factors collected by Mallorca Cancer Registry associated to survival

10.21203/rs.2.22589/v1 ◽

2020 ◽

Author(s):

Maria Ramos ◽

Joana Ripoll ◽

Juanjo Montaño ◽

Jaume Pons ◽

Alberto Ameijide ◽

...

Keyword(s):

Urinary Tract ◽

Cancer Registry ◽

Cox Model ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Non Invasive ◽

Cause Specific Survival

Abstract Background: 1) to find out the distribution of bladder and urinary tract cancers by stage; 2) to determine cause-specific survival by stage of bladder and urinary tract cancers; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers.Methods: Incident bladder and urinary tract cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with codes C65–C68 according to the ICD-O 3rd edition with any behaviour. Cases identified exclusively through the death certificate were excluded. We collected the following data: sex; age; date and method of diagnosis; histology according to the ICD-O 3rd edition; T, N, M and stage at the time of diagnosis; and date of follow-up or death. End point of follow-up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Cases with benign or indeterminate behaviour were excluded for the survival analysis. Actuarial and Kaplan-Meier methods and Cox regression models were used for survival analysis.Results: 2060 cases were identified. 15% were women and 65.2% were 65 years or older. 93.6% consisted of bladder and other urinary tracts. 55.7% were papillary transitional neoplasia, 37.7% solid transitional, 0.6% microcytic, and the rest of other histology. 3.7% had no stage (benign or undetermined behaviour) and 12.5% had unknown stage. After MI, 35.7% were in stage 0a (non-invasive papillary carcinoma), 3.1% in stage 0is (carcinoma in situ), 33.3% in stage I, 11.9 % in Stage II, 4.7% in stage III, and 11.1% in stage IV. Survival was 73% at 5 years. Survival by stage: 98% at stage 0a, 88% at stage 0is, 84% at stage I, 44% at stage II, 33% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage were associated with survival.Conclusion: Bladder and urinary tract cancers survival vary greatly with stage, among both non-invasive and invasive cases.

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Cancer-specific survival by stage of bladder cancer and factors collected by Mallorca Cancer Registry associated to survival

BMC Cancer ◽

10.1186/s12885-021-08418-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

J. Ripoll ◽

M. Ramos ◽

J. Montaño ◽

J. Pons ◽

A. Ameijide ◽

...

Keyword(s):

Bladder Cancer ◽

Survival Analysis ◽

Cancer Registry ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Cancer Specific Survival ◽

Non Invasive

Abstract Background Information about survival by stage in bladder cancer is scarce, as well as about survival of non-invasive bladder cancer. The aims of this study are: 1) to find out the distribution of bladder cancer by stage; 2) to determine cancer-specific survival by stage of bladder cancer; 3) to identify factors that explain and predict the likelihood of survival and the risk of dying from these cancers. Methods Incident bladder cancer cases diagnosed between 2006 and 2011 were identified through the Mallorca Cancer Registry. Inclusion criteria: cases with code C67 according to the ICD-O 3rd edition with any behaviour and any histology, except lymphomas and small cell carcinomas. Cases identified exclusively through the death certificate were excluded. We collected the following data: sex; age; date and method of diagnosis; histology according to the ICD-O 3rd edition; T, N, M and stage at the time of diagnosis; and date of follow-up or death. End point of follow-up was 31 December 2015. Multiple imputation (MI) was performed to estimate cases with unknown stage. Cases with benign or indeterminate behaviour were excluded for the survival analysis. Actuarial and Kaplan-Meier methods and Cox regression models were used for survival analysis. Results One thousand nine hundred fourteen cases were identified. 14% were women and 65.4% were 65 years or older. 3.9% had no stage (benign or undetermined behaviour) and 11.5% had unknown stage. After MI, 37.5% were in stage Ta (non-invasive papillary carcinoma), 3.2% in stage Tis (carcinoma in situ), 34.3% in stage I, 11.7% in Stage II, 4.3% in stage III, and 9.0% in stage IV. Survival was 76% at 5 years. Survival by stage: 98% at stage Ta, 90% at stage Tis, 85% at stage I, 45% at stage II, 35% at stage III, and 7% at stage IV. The Cox model showed that age, histology, and stage, but not sex, were associated with survival. Conclusion Bladder cancer survival vary greatly with stage, among both non-invasive and invasive cases. The percentage of non-invasive cancers is high. Stage, age, and histology are associated to survival.

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