Single Center Experience of Prognostic Factors and Survival Outcomes Among Veterans with MDS: A Retrospective Analysis

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4970-4970
Author(s):  
Premal D Lulla ◽  
Sarvari Venkata Yellapragada ◽  
Zahida Yasin ◽  
Carlos E. Arce-Lara
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Growth Factors ◽  
Alcohol Use ◽  
Iron Overload ◽  
Median Survival ◽  
Performance Status ◽  
Age At Diagnosis ◽  
Ecog Performance Status ◽  
Transfusion Dependency

Abstract Abstract 4970 Background: While the epidemiologic and demographic characteristics of veterans with MDS have been established (Komrokji et. al, 2009), there is no data on prognostic factors. Several factors including age (Kim SH et. al, 2010), sex (Nosslinger et al 2010), ferritin (Armand et. al 2007), MCV (Wang et. al 2010), use of growth factors (Jaderstan et. al 2008), and co-morbidities (Sperr et. al 2010) independent of the established WHO prognostic scoring system (WPSS) (Malcovati et. al 2007) have been shown to impact survival in MDS. The purpose of this study is to highlight major survival determinants among veterans with an emphasis on transfusion dependency and ferritin. Materials and Methods: Charts of 88 unselected patients (87 males) with a pathological diagnosis of MDS from January 2000 to December 2008 at the Michael E. Debakey VA Medical Center in Houston, Texas were included. The following data was collected at diagnosis: demographics, smoking, alcohol use, initial ECOG performance status, hematological data, cytogenetics, HIV and hepatitis status. Transfusion dependency was defined as needing more than 1 unit of packed red cells each month for 4 consecutive months at anytime after diagnosis. 50 patients had 4 or more ferritin readings spread over a minimum of 4 months, to compute a meaningful mean increase in ferritin per year (MIF). Administration of growth factors, treatment with Azacytidine, Decitabine or Lenalidomide was analyzed as categorical data (intervention or no intervention). Univariate survival analysis was performed using GraphPad Prism 5.0, and Kaplan-Meier curves were computed. Multivariate analysis on significant variables was performed using the Cox model on MedCalc Statistics Software (version 11.3). Results: Demographic factors: The median age at diagnosis was 73 (53-91) with a median OS of 520 days (13-2234). 9 patients (10.2%) progressed to AML at a median time to progression of 159 days (74-614), all with IPSS scores > 1 at diagnosis. Distribution [N (Median OS)] among WHO sub-groups were as follows: RA: 22(659), RARS: 10(1020), RCMD: 39(638), RAEB-1: 5(228), RAEB-2: 9(170), 5q-: 3(521). Age, race, tobacco, alcohol use, hepatitis, HIV status were not significant prognostic variables. Performance status (ECOG) > 2 (p=0.012), and blood group O were the only significant variables on univariate analysis (p=0.029). Hematologic factors: Initial Hb < 8 g/dl, IPSS(Greenberg et. al, 1997) scores > 1.0, transfusion dependency, cytogenetic abnormalities, MIF > 200 per year, MCV < 100 and use of erythropoetin were significant variables in predicting OS on univariable analysis. On multivariate analysis, IPSS scores > 1.0 (p=0.01), transfusion dependency (p=0.0029), ECOG performance status > 2 (p=0.0421) and MIF > 200 (p=0.0294) were independent significant prognostic factors. In the sub-group of MDS without excess blasts (Cermak et. al, 2009), transfusion dependency and MIF > 200 per year were highly significant variables (p<0.0001). Use of Azacitidine (8), decitabine (8) or lenalidomide (4) did not impact survival (p=0.63), although only 14 patients overall received one or more of these treatments. Conclusion: Veteran's with MDS pose a unique population, being predominantly male, older age at diagnosis and with potentially poorer performance status. Based on the above results, these patients had a poorer median survival (1.42 years) than expected from established data (2.1 years, Komrokji et. al 2009). The established prognostic factors, the IPSS scores and transfusion dependency expectedly were independent predictors of OS. Iron overload is rapidly becoming a leading problem in the management of MDS. This is most evident in the transfusion dependent MDS patient without excess blasts with better prognosis and longer median survival, for iron overload to manifest its deleterious effects. MIF values > 200 were intended to represent populations at higher risk for developing iron overload. Interestingly, MIF was independent of transfusion dependency in predicting OS. This highlights the need for prospective studies to establish the role of ferritin and its rise over time to identify populations at risk for iron overload and mortality thereof. The clinical question of benefit from chelation therapy in these patients remains. Disclosures: No relevant conflicts of interest to declare.

Prognostic Factors and Outcome of Human Herpesvirus 8–Associated Primary Effusion Lymphoma in Patients With AIDS

2005 ◽  
Vol 23 (19) ◽  
pp. 4372-4380 ◽  
Author(s):  
Emmanuelle Boulanger ◽  
Laurence Gérard ◽  
Jean Gabarre ◽  
Jean-Michel Molina ◽  
Christophe Rapp ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Median Survival ◽  
Primary Effusion Lymphoma ◽  
Performance Status ◽  
Human Herpesvirus ◽  
Disease Free Survival ◽  
Hazard Ratio ◽  
Human Herpesvirus 8 ◽  
Herpesvirus 8

PurposePrimary effusion lymphoma (PEL) is a rare high-grade B-cell non-Hodgkin's lymphoma associated with Kaposi sarcoma–associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8) infection, and is mostly observed in the course of HIV infection. The prognosis is poor, with reported median survival time shorter than 6 months. To date, no prognostic factor has been identified in this subset of lymphoma.Patients and MethodsWe describe here a large series of HIV-infected patients with PEL, including 28 cases diagnosed in six centers during an 11-year time period. Prognosis analysis was performed using a Cox proportional hazard regression model. Statistically significant covariates were further analyzed in a forward, stepwise multivariate model.ResultsAfter a median follow-up of 3.8 years (range, 10 months to 10.8 years), nine patients (32%) were still alive, and eight of them remained progression free. The median survival was 6.2 months, and the 1-year overall survival rate was 39.3%. Fourteen patients (50%) achieved complete remission, with a 1-year disease-free survival rate at 78.6%. In a multivariate analysis, only a performance status more than 2 (hazard ratio, 5.84; 95% CI, 1.76 to 19.33) and the absence of highly active antiretroviral therapy (HAART) before PEL diagnosis (hazard ratio, 3.26; 95% CI, 1.14 to 9.34) were found to be independent predictors for shorter survival.ConclusionBased on a retrospective series of 28 patients, two prognostic factors were identified as being independently associated with impaired clinical outcome in HIV-related PEL—(1) a poor performance status and (2) the absence of HAART before PEL diagnosis.

Post Transplant Lymphoproliferative Disorders (PTLD) after Solid Organ Transplant: Cleveland Clinic Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3008-3008 ◽  
Author(s):  
Deepa Jagadeesh ◽  
Sharjeel Hooda ◽  
Kathleen B Fenner ◽  
Lisa Rybicki ◽  
Robert M Dean ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Median Time ◽  
Research Funding ◽  
Lung Transplant ◽  
Lymphoproliferative Disorders ◽  
Large Cohort ◽  
Age At Diagnosis ◽  
Solid Organ ◽  
Post Transplant

Abstract Background: Post transplant lymphoproliferative disorders (PTLD) are rare pathologically and clinically heterogeneous diseases arising in the setting of immunosuppression following hematopoietic stem cell and solid organ transplants (SOT). Our understanding of PTLD is restricted by its low incidence and heterogeneous treatment approaches, resulting in paucity of data. We sought to further describe characteristics and outcomes in PTLD patients who underwent treatment at our institution. Methods and Patients: We performed a retrospective study to describe our institutional experience in a relatively large cohort of PTLD patients after SOT. Patient and disease characteristics were examined and prognostic factors for survival were determined using univariate and multivariate Cox analysis. Results: Between May 1987 to January 2014, 98 patients with a confirmed diagnosis of PTLD underwent treatment at our institution. Median time from SOT to PTLD diagnosis was 60 months with median follow of 68 months from PTLD diagnosis. Baseline characteristics include male gender 77%, ECOG performance status (PS) 0-1 in 61%, and stage III-IV 69% with a median age at diagnosis of 47 years. Most common transplanted organ included heart 30%, lung 24%, kidney 20% and liver 19% and median time from SOT to PTLD diagnosis was 60 months. Most cases had monomorphic histology (81%) and were EBV+ (82%). Graft involvement and rejection were observed in 32% and 43% respectively. Of the 84% with extranodal (EN) involvement, gastrointestinal tract (37%) and lung (27%) were the common sites, while 3.2% had bone marrow (BM) involvement. Central nervous system (CNS) was involved in 11% of the cases. Only 58% received rituximab as part of the initial therapy, as significant part of our cohort was treated prior to rituximab era. Reduction in immunosuppression (73%), chemotherapy (40%), radiation (11%) and surgery (8%) were utilized either as single modality or in combination for treatment. Of the 66 patients with response data, 59% had complete response (CR) and 14% had progressive disease (PD). Relapse occurred in 23% of cases. Median overall survival (OS) from diagnosis of PTLD was 6 years (Figure 1), but in rituximab treated patients it was 8 years. On univariate analysis, higher age at diagnosis (HR 1.19, 95% CI 1.01-1.40, p=0.033), lung transplant (HR 2.42, 95% CI 1.36-4.33, p=0.003), higher IPI (HR 1.83, 95% CI 1.40-2.39, p=<0.001), decreased PS (HR 2.43, 95% CI 1.70-3.48, p=<0.001), and platelet count <200,000 (HR 2.84, 95% CI 1.27-6.33, p=0.011) were associated with lower OS, whereas liver transplant (HR 0.24, 95% CI 0.09-0.68, p=0.007) and GI involvement (HR 0.47, 95% CI 0.24-0.95, p=0.036) predicted better OS. Rituximab treatment (Figure 2) and achieving CR were associated with better OS. Histology, EN involvement, and EBV status were not significant predictors for survival. On multivariate analysis only lung transplant, IPI, and PS were predictive for OS. Lung transplant patients had a higher risk of mortality compared to other SOT (HR 2.63, 95% CI 1.39-4.95, p=0.003). Both higher IPI (HR 1.66, 95% CI 1.18-2.32, p=0.003) and poor PS (HR 1.94, 95% CI 1.27-2.96, p=0.002) were associated with inferior OS. Conclusions: In this large cohort of PTLD patients after SOT, lung transplants, higher IPI and poor PS were identified as poor prognostic factors for OS on both univariate and multivariate analysis. Rituximab treatment was a favorable prognostic factor for OS that resulted in prolonged survival observed in this cohort. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures Hill: Millenium: Research Funding; Novartis: Research Funding.

Impact of surgery and chemotherapy on survival in patients with advanced cholangiocarcinoma: A multivariate analysis in a cohort of 242 consecutive patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4133-4133
Author(s):  
C. Dreyer ◽  
C. Le Tourneau ◽  
S. Faivre ◽  
V. Paradis ◽  
Q. Zhan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Median Survival ◽  
Tumor Size ◽  
Positive Impact ◽  
Univariate Analysis ◽  
Lymph Node Involvement ◽  
Node Involvement ◽  
The Impact

4133 Background: Cholangiocarcinoma remains an orphan disease for which prospective studies are missing to evaluate the impact of systemic chemotherapy on survival. Methods: Univariate and multivariate analysis of parameters that might impact survival were analyzed in a cohort of 242 consecutive patients with cholangiocarcinoma treated in a single institution between 2000 and 2004. Variables were WHO performance status (PS), age, symptoms, tumor size, extent of the disease, lymph node involvement, site of metastasis, tumor markers, pathology, and type of treatment including surgery, chemotherapy and radiotherapy. Results: Statistically significant prognostic factors of survival in univariate analysis are displayed in the table : In multivariate analysis, PS, tumor size and surgery were independent prognostic factors. Subgroup analysis demonstrated that in patients with advanced diseases (lymph node involvement, peritoneal carcinomatosis and/or distant metastasis), patients who had no surgery benefited of chemotherapy (median survival 13.1 versus 7.4 months in patients with/without chemotherapy, p = 0.006). Moreover, survival was further improved when patients could benefit of chemotherapy following total and/or partial resection (median survival 22.9 versus 13.0 months in patients with/without chemotherapy, p = 0.03). Conclusions: This study strongly suggests the positive impact on survival of multimodality approaches including surgery and chemotherapy in patients with advanced cholangiocarcinoma. [Table: see text] No significant financial relationships to disclose.

Phase II single institution study of sequential biochemotherapy (BCT) for patients (pts) with stage IV melanoma (M)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8580-8580
Author(s):  
P. R. Bojanapally ◽  
D. T. Alexandrescu ◽  
V. Rusciano ◽  
P. H. Wiernik ◽  
J. P. Dutcher
Keyword(s):  
Median Survival ◽  
Phase Ii ◽  
Performance Status ◽  
Single Agent ◽  
Stage Iv ◽  
Experimental Therapy ◽  
Ecog Performance Status ◽  
Maximum Benefit ◽  
Prospective Phase ◽  
Metastatic Sites

8580 Background: The utility of BCT for M remains controversial. A prospective phase II study was conducted to assess the clinical benefit of BCT in patients with stage IV M. Methods: Between March 2005 and March 2006 11 pts (6 Male and 5 Female with a median age of 54 (range 36 - 82)) with metastatic M were treated with paclitaxel 225 mg/m2 via continuous 24 hour IV infusion every 3 wks for 4 cycles or maximum benefit followed by HD IL2, 1.33 mg/m2 every 8 hours for 5 days of wk1 and wk3 based on pts tolerance to a maximum of 12 doses per wk. 2 Male pts received IL2 followed by paclitaxel. Pts had a ECOG performance status of 0 - 2, with a median time of 60 months since diagnosis of disease (range 7 to 240 months). 11 pts (92%) had multiple metastatic sites (50% had lung mets, 58% had liver mets) and 4 pts (33%) had prior chemotherapy or immunotherapy. Results: Of the 13 assessable pts one achieved a PR after paclitaxel and CR after IL2 continuing at 20+ months. One had SD for 1 year after receiving HD IL2 and SD for 6 months while on paclitaxel independently, One had PR for 6 months on paclitaxel and one had MR with paclitaxel for 3 months. 9 pts (69%) had PD on paclitaxel and again on IL2, with a median survival from treatment of 7 months, 2 of these got no IL2 due to rapid PD. An overall response rate of 30% (1 CR on paclitaxel + IL2 , 1 PR on paclitaxel, 2 SD (including MR) on paclitaxel) was seen with a median survival from treatment of 15 months. Conclusions: In this study there may be prolonged survival among responders, which may be due to synergy of sequential BCT, or may reflect single agent activity of each drug. BCT should still be considered as an experimental therapy and further evaluated. No significant financial relationships to disclose.

Smoking and prognostic factors in advanced non-small cell lung cancer (NSCLC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18048-18048
Author(s):  
S. Altug ◽  
C. Li ◽  
M. Marek ◽  
S. Guclu ◽  
Y. Kim ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Performance Status ◽  
Clinical Importance ◽  
Stage Iv ◽  
Routine Care ◽  
Disease Stage ◽  
Curative Surgery ◽  
Ecog Performance Status ◽  
Eligibility Criteria ◽  
Secondary Endpoints

18048 Background: The aim of this prospective, multi-country, observational study (B9E-AA-B004) is to estimate the effect of prognostic factors, including continued smoking during therapy, on treatment outcomes in patients (pts) with advanced NSCLC receiving first- line chemotherapy with a gemcitabine (gem)-platinum combination as part of their routine care. Methods: Major eligibility criteria included: tissue diagnosis of advanced stage IIIB/IV NSCLC not amenable to curative surgery/radiotherapy; no prior chemotherapy; ECOG performance status (PS) 0 or 1; and written informed consent. A predictive model was constructed and validated by splitting the data at random by centre into two datasets in a ratio of 3:1 Construction:Validation. The primary and secondary endpoints are the effect of prognostic factors on survival and selected adverse events (AEs), respectively. The association of smoking with outcomes was tested in the Construction dataset. Results: This interim analysis to assess the effect of prognostic factors on AEs occurred when all pts had completed treatment. 1214 pts were enrolled: 75.1% male; mean age 60.5 yr, range 23–86 yr; 57.1% Stage IV; 66.2% PS 1; 69.4% received gem-cis, 30.5% gem-carb; 25.7% had never smoked, 70.8% had ever smoked and 11.2% continued smoking during therapy. 22.0% of pts had =1 AE. After variable selection in the Construction database (891 pts) the following factors were associated with an AE possibly related to therapy: disease stage (IV vs III, odds ratio (OR) =1.48, p=0.034), weight loss >10% (OR=0.60, p=0.017), age (<70 vs =70, OR=0.66, p=0.046), treatment (gem- carb vs gem-cis, OR=1.5, p=0.04), pain at baseline (present vs absent, OR=1.5, p=0.03), country (OR vs Taiwan ranged from 0.32 (Israel) to 4.2 (Egypt), p<0.0001). Sex (F vs M, OR=0.86) was then added to the model because of its clinical importance. There was a trend towards a higher probability of an AE with continued smoking during therapy (OR=1.4), but this was not statistically significant (p=0.28). Conclusions: This model can be used to improve the prediction of whether patients are likely to experience treatment-related AEs. While the trend was for a greater AE rate in pts who continued to smoke during therapy, this was not proven. [Table: see text]

Prognostic factors in metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9051-9051
Author(s):  
D. R. Minor ◽  
M. Kashani-Sabet ◽  
D. Moore ◽  
C. Kim ◽  
S. S. Venna ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Metastatic Melanoma ◽  
Median Survival ◽  
Performance Status ◽  
Intensive Therapy ◽  
Stage Iv ◽  
Treatment Center ◽  
Term Survival ◽  
Melanoma Patients

9051 Background: Patients with stage IV metastatic melanoma are usually felt to be incurable with a median survival of 6.4 months and a 5-year survival of only 2%. Biochemotherapy has shown promise with long-term survival in selected patients. We felt the study of prognostic factors would determine which patients might benefit the most from this intensive therapy. Methods: 135 consecutive patients with stage IV melanoma treated with decrescendo biochemotherapy followed by maintenance immunotherapy at one melanoma treatment center were studied to determine the most important prognostic factors; these factors were then validated by analysis of 133 patients treated in a multi-center trial at other institutions. Patients were treated using the inpatient regimen of O'Day (JCO23:710s,2005 abstract). Results: Median overall survival (OS) was 16.6 months with 1-year survival of 70% and 5-year survival of 28%. Median progression-free survival (PFS) was 7.6 months with 15% progression-free at 5 years. PFS curves showed no relapses after 30 months, so remissions were durable. For OS performance status 0, normal LDH, stage M1a, and non-visceral sites of metastases were favorable prognostic factors. For PFS performance status 0, normal LDH, female sex, age <50 and stage M1a were favorable prognostic factors Multivariate analysis demonstrated two important prognostic factors for survival: normal serum LDH and the presence of either skin or nodes as one of the sites of metastatic disease. The group with normal LDH and skin or node metastases had a relatively good prognosis with median survival of 44 months and a 5-year survival of 38%. Conversely patients with elevated LDH without any skin or nodal metastases had a poor prognosis, with no long-term survivors. Conclusions: Metastatic melanoma patients treated with biochemotherapy and maintenance immunotherapy that have either a normal LDH or skin or nodes as one of their metastatic sites may have durable remissions of their disease, and this therapy should be studied further in these groups. [Table: see text]

Immune self-tuning in renal cell carcinoma patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22069-e22069
Author(s):  
A. Busse ◽  
A. Asemissen ◽  
A. Schmittel ◽  
K. Zimmermann ◽  
K. Miller ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Mrna Expression ◽  
Renal Cell ◽  
Performance Status ◽  
Ecog Performance Status ◽  
Foxp3 Mrna ◽  
Expression Levels ◽  
Mrna Expression Levels

e22069 Background: Renal cell carcinoma (RCC) cells can inhibit protective antitumor immunity by secretion of immunosuppressive factors leading to the induction of regulatory T cells. The objective of this study was to investigate the prognostic impact of mRNA expression levels of IL10, TGFβ and forkhead box transcription factor (FoxP3) mRNA in peripheral blood mononuclear cells (PBMCs) of metastatic RCC patients before receiving treatment with sorafenib. Methods: PBMCs of 46 patients were assessed for their expression levels of TGFβ, IL10 and FoxP3 by quantitative RT-PCR. Clinical features considered included ECOG performance status, hemoglobin, alkaline phosphatase, and calcium concentrations. Disease evaluation was performed every 8 weeks following RECIST criteria. Relationship between pre-treatment factors and survival were examined in univariate analyses and subsequently by multivariate analysis using a stepwise Cox regression model. Results: In contrast to FoxP3, mRNA expression levels of IL10 and TGFβ were significantly higher in the 46 RCC patients compared to healthy volunteers: Median expression levels [ratio marker /housekeeping gene PBGD] were 5.56E-05 vs 2.05E-04 (P=0.034) for IL10 and 7.38E-02 vs 3.04E- 01 (P=0.023) for TGFβ. Univariate analysis revealed a negative prognostic influence of IL10 on progression free survival (p=0.04) and on overall survival, although not significant (P= 0.063). Surprisingly, high TGFβ and FoxP3 expression levels had a positive influence on progression free (P<0.001 and P=0.047, respectively) and overall survival (P<0.001 and P= 0.031, respectively). In the multivariate analysis low ECOG performance status and high TGFβ mRNA expression levels were independently associated with worse progression free (P=0.001 and P=0.054,) and worse overall survival (P=0. 006 and P< 0.001, respectively). Conclusions: RCC caused an immune-suppressive phenotype in PBMC characterized by increased mRNA expression levels of IL10 and TGFβ. Surprisingly, in contrast to IL10, a high TGFβ mRNA expression level was an independent good prognostic factor. Whether this observation can be attributed to recently described immune promoting functions of TGFβ needs to be determined. No significant financial relationships to disclose.

Subanalyses of the outcome of two carboplatin-based regimens in the treatment of advanced NSCLC

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19067-e19067
Author(s):  
O. Hansen ◽  
T. K. Schytte ◽  
K. H. Hansen ◽  
P. Sørensen
Keyword(s):  
Prognostic Factors ◽  
Median Survival ◽  
Advanced Nsclc ◽  
Chemotherapy Regimen ◽  
Performance Status ◽  
Weekly Schedule ◽  
Standard Regimen ◽  
And Gender ◽  
Better Than

e19067 Background: Recent data suggest that various chemotherapy regimen may have different efficacy in subsets of patients (pts.) with advanced NSCLC. For that reason we studied if it was also the case for two Carboplatin regimens, Carboplatin-Vinorelbine (CV) and Carboplatin-Gemcitabine (CG), which were used as standard treatments in our centre for two periods Methods: From 1998–2007, 800 consecutive pts. were treated with a 3-weekly schedule of C, AUC=5, plus either V (30 mg/m2 d.1+8), or G (1000 mg/m2 d.1+8) for 4–6 cycles. CV was used as the standard regimen 1998 - 2003, and CG, 2004 - 2007. All pts. were followed to death, and most data have been prospectively recorded, but supplemented with retrospectively collected data from pts. files. The endpoint of this study was crude survival. The data was analysed according to performance status (PS), gender, age, and histology (adenoca., squamous, other NSCLC) Results: 313 pts. were treated with CV, 487 with CG. Median, 1 yr and 2 yr survival was for CV: 8.6 m, 34% and 15%, and for CG: 8.6 m, 37% and 12%, p=0.32. Analysed by histology, adenoca.'s had better median survival, 9.7 m., than non-adenoca., 8.1 m, p= .002, females better than males 10.0 m. vs. 7.9 m., p=.008, and PS 0–1 better than PS=2, 10.0 m. vs. 4.7 m. (p=.000). Age was of no importance. Cox-analyses was performed separately in the two genders. In females, PS 0–1, adenoca. and CG regimen were statistically significant favourable prognostic factors while in males only PS 0–1 were of significance. In the 379 pts. with adenoca., PS and gender were of significance while the chemotherapy was of borderline significance (p=.06). In non- adenoca.'s, only PS was of significance Conclusions: While CV and CG were overall equal effective in the treatment of NSCLC, CG may be the superior regimen in females, and in adenoca.'s. No trends for differential efficacy was found in any other subset of patients [Table: see text]

Impact of socioeconomic status on treatment outcome in patients with advanced esophagogastric cancer in Northern Ireland

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20531-e20531
Author(s):  
Y. Manikyam ◽  
G. G. Hanna ◽  
R. J. Harte ◽  
P. G. Henry ◽  
R. F. Houston ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Northern Ireland ◽  
Median Survival ◽  
Performance Status ◽  
Locally Advanced ◽  
Ecog Performance Status ◽  
Disease Extent ◽  
Esophagogastric Cancer ◽  
And Performance ◽  
The Impact

e20531 Background: The survival advantage for combination chemotherapy in advanced gastroesophageal adenocarcinoma is well documented. Epirubicin and cisplatin in combination with either 5FU (ECF) or capecitabine (ECX) result in response rates of 35–46% and a median survival of around 9 months in RCT. We report the impact of socioeconomic status on the outcome of ECF and ECX treatment in advanced gastroesophageal cancer patients in Northern Ireland between 2000 and 2007. Methods: All patients with advanced esophageal (O), gastric (G), or esophagogastric junction (OGJ) adenocarcinoma, receiving palliative chemotherapy from January 2000 to August 2007, were identified from our institutional database. Baseline demographics, clinical characteristics, treatment details, and clinical outcomes were recorded. Patients receiving chemotherapy in a clinical trial were excluded. Survival was estimated using the Kaplan-Meier method. Deprivation was assessed using the patient's home address deprivation index (DPI) (Northern Ireland Multiple Deprivation Measure 2005; May 2005. Northern Ireland Statistics and Research Agency. www.nisra.gov.uk ). Results: 274 eligible patients (m=200, f=74, O=114, OGJ=19, G=141) were identified. Median age was 62 years (range 22–83). 172 (62.8%) had ECOG performance status 0 or 1. 231 patients (84.3%) had metastatic disease, 43 (15.7%) had locally advanced disease. 216 (78.8%) patients received ECF and 58 (21.2%) patients received ECX. Overall median survival was 7.3 months. Treatment response and performance status were strong predictors of survival, however disease extent did not influence survival. Median survival was significantly longer in those with DPIs in the upper two quintiles than the lower 3 quintiles (9.5 months vs. 6.8 months, p=0.032). Conclusions: Outcomes achieved with palliative ECF/ECX treatment are similar to the reference clinical trials. Socioeconomic deprivation is significantly associated with reduced survival in this group of patients and is unrelated to disease extent at presentation; however it may be related to nutritional status and comorbidity and requires further investigation. No significant financial relationships to disclose.

QTc interval in advanced cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20658-e20658
Author(s):  
D. Trivanovic ◽  
R. Dobrila-Dintinjana ◽  
Z. Mavric ◽  
D. Stimac ◽  
M. Petkovic
Keyword(s):  
Prognostic Factors ◽  
Advanced Cancer ◽  
Median Survival ◽  
Cardiac Disease ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Solid Cancer ◽  
Qtc Interval ◽  
One Year

e20658 Background: The purpose is to identify prognostic factors that may have impact on survival in patients with advanced cancer. Methods: We retrospectively reviewed the data of patients who had biopsy proven advanced solid cancer disease in stage IV and no history or evidence of any prior cardiac disease. Univariate and multivariate stepwise Cox proportional hazard regression analysis were performed to identify independent predictors of one year survival. Results: Between 1/01 and 9/05, 143 patients (83 male and 60 female) with advanced cancers were evaluated in our institution. The primary site of disease was lung (28%), pancreas (19%), colon (15%), rectum (13%), breast (12%), and other (13%). The median follow-up was 12,5 months, median overall survival (OS) was 8.1 months, and 1-year OS rate was 62%. Median age was 65 years. OS was significantly related to the following pre-treatment prognostic factors: Age ≥65 (years), anaemia (hemoglobin level <13.2 g/dl), Eastern Cooperative Oncology Group performance status (ECOG PS) 0–1, and prolonged QTc interval in electrocardiogram (ECG). However, multivariate analysis revealed only prolonged QTc as independent prognostic parameter with 1-y survival status. Using 440 ms as the cut off value, the QTc interval was prolonged in 32 patients (22%) with median survival of 45 days and normal in 111 patients (78%) with median survival of 280 days. During the one-year 25 patients (78%) died in group with prolonged QTc interval while in group with normal QTc interval died 63 patients (57%). Conclusions: The results of our study indicate that a prolonged QTc interval (> 440 ms) is an adverse prognostic sign in patients with advanced cancer and without cardiac disease which correlates with increased mortality rates within one year after the diagnosis. Our findings suggest that QTc prolongation may be a good adjunct in risk stratification of patients with advanced cancer who are being considered for aggressive treatment regimens. [Table: see text] No significant financial relationships to disclose.

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