Survival for Chronic Lymphocytic Leukaemia (CLL) Patients in Hungary from 2000 to 2014 Based on the Single Payer's Database: A Nationwide Study

Abstract Background: Real-world evidence based analyses are gaining importance worldwide. They are especially useful to inform medical/scientific evidence setting, health policy decision-making, or health-economic modelling. Due to legislation for data of public interest set in Act LXIII of 2012, health care data recorded by the predominantly state-owned health insurance system are accessible in Hungary. The National Health Insurance Fund Administration (NHIFA) as single payer covers the total population of 10 million inhabitants, providing de-identified patient data on health care resource utilization and demographics upon request. Chronic lymphocytic leukaemia is an adult haematological malignancy. New therapies, e.g. BTKs need to find their place in therapy but the currently available information in Hungary on epidemiology, patient pathways and characteristics on population level are scarce. Aim: During the last decade numerous novel therapeutic options became available. Mortality as an important treatment outcome is of interest to understand any impact these novel agents may have. We evaluated overall survival during the period from 2000 – 2013 with the hypothesis that survival rate is strongly correlated with time of first diagnosis and subsequently availability of appropriate therapies. Methods: As part of a larger project called LYRICS (Lymphoma Real-Life Insight Core Survey) we have conducted a comprehensive retrospective analysis based on the NHIFA's database to map the CLL therapy landscape and outcomes in the last 14 years. The basis of the analysis was the claims database of inpatient and outpatient care (DRG based financing) and outpatient drug reimbursement system. Mortality rates were studied by non-parametric (Kaplan-Meier survival analysis) and semi-parametric (Cox proportional hazard regression) approaches. Results:The annual number of prevalent CLL patients is 3-4,000 with 8-900 newly diagnosed patients annually. The assessment was based on at least two relevant and confirmed C91.10 ICD diagnoses in inpatient or outpatient care. Kaplan-Meier curve estimates show the median overall survival from diagnosis is 80 months. The survival probability at one elapsed year is 91% in CLL patients diagnosed between the years 2002-2013, and 95% in the years between 2007-2013. The 4-year survival probability is 67% for patients diagnosed between the years of 2002-2013 and 78% for patients diagnosed between the years 2007-2013 (Figure 1 below). By fitting Cox model with age covariates, it can be shown that there is significant difference in relative risk (RR) of death in different age cohorts. The RR of death in the 60-69 age cohort is 1.5 times and in the 70-79 age cohort is more than 2 times higher than in the 50-59 age cohort of CLL patients. Figure 1 Survival analysis from first diagnosis by Kaplan-Meier method Figure 1. Survival analysis from first diagnosis by Kaplan-Meier method Conclusion: These results from this analyses show a significant increase of survival in Hungary over the last 15 years. The availability of treatment options have contributed to this increased survival probability. This population, real-world data confirms the relevance of age at first diagnosis as predictor for overall survival. Recently approved therapies in CLL, e.g. Ibrutinib are expected to further improve the mortality outcome for this patient group. Disclosures Gaudig: Janssen : Employment. Vályi-Nagy:Janssen-Cilag Ltd.: Consultancy. Takacs:Janssen-Cilag Ltd. Hungary: Employment. Bacskai:Healthware Consulting Ltd: Equity Ownership. Kozma:Janssen-Cilag Ltd. Hungary: Employment. Rakonczai:Healthware Consulting Ltd: Employment. Püspöki:Healthware Consulting Ltd: Employment.

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Eight-Gene Metabolic Signature Related with Tumor-Associated Macrophages Predicting Overall Survival for Hepatocellular Carcinoma

10.21203/rs.3.rs-36554/v1 ◽

2020 ◽

Author(s):

Junyu Huo ◽

Yunjin Zang ◽

Hongjing Dong ◽

Xiaoqiang Liu ◽

Fu He ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Survival Analysis ◽

Risk Score ◽

Risk Group ◽

Cancer Genome ◽

Metabolic Reprogramming ◽

Tumor Associated Macrophages ◽

Kaplan Meier ◽

The Relationship

Abstract Background: In recent years, the relationship between tumor associated macrophages (TAMs) and solid tumors has become a research hotspot. The study aims at exploring the close relationship of TAMs with metabolic reprogramming genes in hepatocellular carcinoma(HCC), in order to provide a new way of treatment for HCC.Materials and methods: The study selected 343 HCC patients with complete survival information(survival time >= 1month) in the Cancer Genome Atlas (TCGA) as the study objects. Kaplan-Meier survival analysis assisted in figuring out the relationship between macrophage infiltration level and overall survival (OS), and Pearson correlation test to identify metabolic reprogramming genes(MRGs) related to tumor macrophage abundance. Lasso regression algorithm were conducted on prognosis related MRGs screened by Univariate Cox regression analysis and Kaplan-Meier survival analysis to construct the riskscore, another independent cohort (including 228 HCC patients) from the International Cancer Genome Consortium (ICGC) were used for external validation regarding the prognostic signature.Results: A risk score composed of 8 metabolic genes can accurately predict the OS of training cohort(TCGA) and testing cohort(ICGC). It is important that the risk score could widely used for people with different clinical characteristics, and is an independent predictor independent of other clinical factors affecting prognosis. As expected, high-risk group exhibited an obviously higher macrophage abundance relative to low-risk group, and the risk score presented a positive relation to the expression level of three commonly used immune checkpoints(PD1,PDL1,CTLA4).Conclusion: Our study constructed and validated a novel eight‑gene signature for predicting HCC patients’ OS, which possibly contributed to making clinical treatment decisions.

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Co-Expression of Coxsackievirus/Adenovirus Receptors and Desmoglein 2 in Lung Adenocarcinoma: A Comprehensive Analysis of Bioinformatics and Tissue Microarrays

Journal of Clinical Medicine ◽

10.3390/jcm9113693 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3693

Author(s):

Ching-Fu Weng ◽

Chi-Jung Huang ◽

Mei-Hsuan Wu ◽

Henry Hsin-Chung Lee ◽

Thai-Yen Ling

Keyword(s):

Overall Survival ◽

Survival Analysis ◽

Lung Adenocarcinoma ◽

Cox Regression ◽

Epithelial Mesenchymal Transition ◽

Early Stage ◽

The Cancer Genome Atlas ◽

Cancer Tissue ◽

Mesenchymal Transition ◽

Kaplan Meier

Introduction: Coxsackievirus/adenovirus receptors (CARs) and desmoglein-2 (DSG2) are similar molecules to adenovirus-based vectors in the cell membrane. They have been found to be associated with lung epithelial cell tumorigenesis and can be useful markers in predicting survival outcome in lung adenocarcinoma (LUAD). Methods: A gene ontology enrichment analysis disclosed that DSG2 was highly correlated with CAR. Survival analysis was then performed on 262 samples from the Cancer Genome Atlas, forming “Stage 1A” or “Stage 1B”. We therefore analyzed a tissue microarray (TMA) comprised of 108 lung samples and an immunohistochemical assay. Computer counting software was used to calculate the H-score of the immune intensity. Cox regression and Kaplan–Meier analyses were used to determine the prognostic value. Results: CAR and DSG2 genes are highly co-expressed in early stage LUAD and associated with significantly poorer survival (p = 0.0046). TMA also showed that CAR/DSG2 expressions were altered in lung cancer tissue. CAR in the TMA was correlated with proliferation, apoptosis, and epithelial–mesenchymal transition (EMT), while DSG2 was associated with proliferation only. The Kaplan–Meier survival analysis revealed that CAR, DSG2, or a co-expression of CAR/DSG2 was associated with poorer overall survival. Conclusions: The co-expression of CAR/DSG2 predicted a worse overall survival in LUAD. CAR combined with DSG2 expression can predict prognosis.

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Incidence and characterization of venous thromboembolic events (VTE) in patients with pancreatic cancer: Effect of timing of VTE on survival.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.4037 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 4037-4037

Author(s):

Maithili A Shethia ◽

Aparna Hegde ◽

Xiao Zhou ◽

Michael J. Overman ◽

Saroj Vadhan-Raj

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Survival Analysis ◽

Kaplan Meier ◽

Hazard Ratios ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

One Year ◽

The Impact

4037 Background: Patients (pts) with pancreatic cancer are at high risk for VTE, and the occurrence of VTE can affect pts’ prognosis. The purpose of this study was to evaluate the incidence of VTE and the impact of timing of VTE (early vs. late) on survival. Methods: Medical record of 260 pts with pancreatic cancer, newly referred to UT MDACC during one year period from 1/1/2006 to 12/31/2006, were reviewed for the incidence of VTE during a 2-year follow-up period from the date of diagnosis. All VTE episodes were confirmed by radiologic studies. Survival analysis was conducted using Kaplan-Meier analysis and Cox proportional hazard models. Results: Of the 260 pts, 47 pts (18%) had 51 episodes of VTE during the 2-year follow-up. The median age of the pts with VTE was 61 years (range: 28-86) and 53% were males. Of the 47 pts with VTE, 27 (57%) had PE, 19 (40%) had DVT and 1 had concurrent PE/DVT. Three pts had recurrent VTE during the study period. Median follow-up time for OS was 192 days (range: 1-1652 days). Kaplan-Meier Survival analysis showed that those who developed VTE earlier (within 30 or 90 days) had shorter median overall survival (OS) compared with those who had VTE beyond these time points. The hazard ratios, 95% CI, and median OS at 1 year are summarized in the table below. Conclusions: The incidence of VTE is high in pts with pancreatic cancer. The timing of VTE had a significant impact on OS; pts who had an early development of VTE had a shorter overall survival. [Table: see text]

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Comprehensive analysis of alternative splicing and transcriptome related to the prognosis of cervical squamous cell cancer

10.21203/rs.3.rs-28212/v1 ◽

2020 ◽

Author(s):

Chen Li ◽

Fang Yan ◽

Gang Chen ◽

Qiang Li ◽

Hua Xian ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Survival Probability ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Adherens Junction ◽

Comprehensive Analysis ◽

Mrna Splicing ◽

Kaplan Meier ◽

Alternative Mrna Splicing

Abstract Background: Cervical squamous cell cancer (CESC) is a common malignancy tumor with high incidence and mortality in women globally. Increasing studies have indicated that there was an indivisible association between alternative mRNA splicing (AS) and multiple types of cancer. However, comprehensive analysis of alternative mRNA splicing events is scarce in CESC. Methods: In this study, alternative mRNA splicing events data and clinical information of 216 CESC patients were downloaded from TCGA SpliceSeq database and TCGA website. We used identified survival-associated splicing events (SASEs) to construct prognostic signatures. Kaplan-Meier survival analysis and receiver operating characteristic (ROC) curve were performed to evaluate the clinical value of prognostic signatures. A nomogram was carried out to quantitatively predict individuals’ survival probability. Regulatory network between splicing factors (SFs) and SASE was analyzed to explore the upstream regulators of a certain SASE. Additionally, we explored potential downstream pathways of a certain SASE. Results: A total of 41776 alternative splicing events in 9961 genes were collected. After sorting out SASEs, multivariable regression analysis was used to acquire 70 SASEs that could be independent prognostic factors for overall survival in CESC. Kaplan-Meier survival analyses showed that the difference was statistically significant (P＜0.01). The area under ROC curve (AUC) for all AS pattern was 0.932. A nomogram was constructed with a concordance index of 0.82 to predict individuals’ survival probability. EIF3A positively regulated SEC23A-27346-AP with highest correlation coefficient (P＜0.001, R=0.69). Besides, the most significant SASEs and KEGG pathways were SEC23A-27346-AP and adherens junction pathway (P=0.02, R=0.65). Conclusions: Prognostic signatures of survival-associated splicing events were independent prognostic factors for overall survival among CESC patients. A nomogram could quantitatively predict individuals’ survival probability. Moreover, we proposed that splicing factor EIF3A positively regulated SEC23A-27346-AP, and adherens junction pathway may be the downstream pathway of SEC23A-27346-AP. The aforementioned signaling pathway could play a crucial role in the development of CESC.

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Characteristics of patient pathways in Hungary

Orvosi Hetilap ◽

10.1556/oh.2011.29043 ◽

2011 ◽

Vol 152 (9) ◽

pp. 338-343

Author(s):

Miklós Gresz

Keyword(s):

Health Care ◽

Health Insurance ◽

National Health Insurance ◽

Outpatient Care ◽

Insurance Fund ◽

Health Insurance Fund ◽

Outpatient Services ◽

The Past ◽

Patient Pathways ◽

Insured Patients

Over the past four years, there were nearly 250 million registered visits of insured patients in outpatient services in Hungary according to the database of the National Health Insurance Fund. In the process of renewal of health care system it is extremely important to analyze the characteristics of patient pathways. With the analysis of registered visits between 2007 and 2010 the author shows that 65%-96% (average 86%) of the insured patients used the services of outpatient care in the county of their living. This figure was the lowest (65%) in Pest County, which is the service area of several providers located in Budapest. Author presents and analyses the characteristics of patient pathways in different counties of Hungary. Orv. Hetil., 2011, 152, 338–343.

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Identification of a Six-Gene SLC Family Signature With Prognostic Value in Patients With Lung Adenocarcinoma

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.803198 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jing Zhu ◽

Yong Mou ◽

Shenglan Ye ◽

Hongling Hu ◽

Rujuan Wang ◽

...

Keyword(s):

Overall Survival ◽

T Cells ◽

Survival Analysis ◽

Immune Cell ◽

Cox Regression ◽

Risk Group ◽

Low Risk ◽

Prognostic Signature ◽

Kaplan Meier ◽

Immune Cell Infiltrates

Given the importance of solute carrier (SLC) proteins in maintaining cellular metabolic homeostasis and that their dysregulation contributes to cancer progression, here we constructed a robust SLC family signature for lung adenocarcinoma (LUAD) patient stratification. Transcriptomic profiles and relevant clinical information of LUAD patients were downloaded from the TCGA and GEO databases. SLC family genes differentially expressed between LUAD tissues and adjacent normal tissues were identified using limma in R. Of these, prognosis-related SLC family genes were further screened out and used to construct a novel SLC family-based signature in the training cohort. The accuracy of the prognostic signature was assessed in the testing cohort, the entire cohort, and the external GSE72094 cohort. Correlations between the prognostic signature and the tumor immune microenvironment and immune cell infiltrates were further explored. We found that seventy percent of SLC family genes (279/397) were differentially expressed between LUAC tissues and adjacent normal. Twenty-six genes with p-values < 0.05 in univariate Cox regression analysis and Kaplan-Meier survival analysis were regarded as prognosis-related SLC family genes, six of which were used to construct a prognostic signature for patient classification into high- and low-risk groups. Kaplan-Meier survival analysis in all internal and external cohorts revealed a better overall survival for patients in the low-risk group than those in the high-risk group. Univariate and multivariate Cox regression analyses indicated that the derived risk score was an independent prognostic factor for LUAD patients. Moreover, a nomogram based on the six-gene signature and clinicopathological factors was developed for clinical application. High-risk patients had lower stromal, immune, and ESTIMATE scores and higher tumor purities than those in the low-risk group. The proportions of infiltrating naive CD4 T cells, activated memory CD4 T cells, M0 macrophages, resting dendritic cells, resting mast cells, activated mast cells, and eosinophils were significantly different between the high- and low-risk prognostic groups. In all, the six-gene SLC family signature is of satisfactory accuracy and generalizability for predicting overall survival in patients with LUAD. Furthermore, this prognostics signature is related to tumor immune status and distinct immune cell infiltrates in the tumor microenvironment.

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Ethnic Disparities in Hodgkin's Lymphoma (HL): A Large-Scale Population Based Analysis of Hispanics with HL in Texas

Blood ◽

10.1182/blood-2020-137230 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 29-30

Author(s):

Sushanth Kakarla ◽

Gerardo Manuel Rosas ◽

Sarah Allison Smith ◽

Brian Warnecke ◽

Joel E Michalek ◽

...

Keyword(s):

Overall Survival ◽

Survival Time ◽

Survival Probability ◽

Research Funding ◽

Private Insurance ◽

Statistical Testing ◽

Statistical Computing ◽

P Value ◽

Poverty Index ◽

Kaplan Meier

BACKGROUND: It is estimated that 8480 persons in USA will be diagnosed with Hodgkin Lymphoma (HL) in 2020 accounting to approximately 0.5% of all new cancer diagnoses. The advent of new treatment options has improved the outcomes of this disease and 5-year relative survival rate is 87.4% currently. However, studies have shown that outcomes of HL have been worse in Hispanics (Annals of Oncology, PMID: 22241896) especially in late stage disease and HI experience up to a 35% higher risk of HL specific mortality than whites (AACR,PMID: 26826029). There is an unmet need in the field and dossiers on underrepresented ethnic minorities need to be carefully considered, compared to existing data. Our study aims to compare survival outcomes in Hispanics (HI) vs Non-Hispanics (NH) with HL and to our knowledge this is the largest cohort of patients from an area that represents a large proportion of HI population in the USA. METHODS: This is a retrospective study that examines HL patients obtained from Texas Cancer Registry (TCR) database between 2006-2016 and identified by the International Classification of Diseases for Oncology Third Edition (ICD-O-3) code list. All patient data was provided to us de-identified. Standard demographic variables collected include gender, race, ethnicity, dates at diagnosis and death, primary payer at diagnosis, subtype of lymphoma, stage, treatment modality, poverty index among others. Categorical outcomes were summarized with frequencies and percentages while age (years), the only continuously distributed outcome was summarized with the mean and standard deviation. The significance of variation in the distribution of categorical outcomes with ethnicity (HI vs NH) was assessed with Fisher's Exact tests or Pearson's Chi-square tests as appropriate; age was assessed with T-tests or Wilcoxon tests as appropriate. Survival time (years) was measured from date of primary diagnosis to death. Patients not coded as dead were considered censored on survival time at the date last seen. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. At risk tables were computed based on the Kaplan-Meier estimate of the survival curve. All statistical testing was two-sided with a significance level of 5%. Corrections for multiple testing were not applied. The R language [R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria] was used throughout. RESULTS: We identified 6353 patients with HL, of which 1843 were HI (29%), 4510 NH (71%). Median age of diagnosis in HI was 41.3 vs 42.3 in NH (p = 0.084). Males were more frequently affected, 56.5% in HI vs 54.8 in NH (p = 0.213). Most frequent poverty index bracket for HI was between 20-100% vs 10-19.9% for NH (p < 0.001). Most frequent payment model amongst both groups was private insurance with 28.1% in HI vs 45.1% in NH (p < 0.001). Metro/non-border most frequent locality amongst both groups (p value n/a) with Harris county accounting to 15.7% of HL in HI vs 16.5% of HL in NH. Bexar county accounted for 12.5% of HL in HI vs 5.2% of HL in NH. Most common stage at diagnosis in both groups was III/IV with 43% in HI vs 33.7% in NH (p < 0.001). In both groups most frequent chemotherapy included multiple agents, 57.1% in HI vs 48.8% in NH (p < 0.001). Majority in both groups neither got any radiation, 77% in HI vs 76.5% in NH (p = 0.208) nor hematologic transplant, 92% in HI vs 88.6% in NH (p = 0.01). We found the median overall survival time in HI was 10.5 years vs 10.8 years in NH; the overall survival probability for HI vs NH at 2 years was 0.8 [CI 0.771-0.811] vs 0.85 [CI 0.83-0.853], at 5 years was 0.72 [CI 0.694-0.743] vs 0.77 [CI 0.753-0.782] and at 10 years was 0.60 [CI 0.544-0.646] vs 0.65 [CI 0.615-0.679]. CONCLUSION: Our study demonstrates that amongst the population of Texas, HI patients with HL have a statistically significant worse overall survival probability (p value < 0.0001) when compared to NH patients with HL. It is of paramount importance that outcomes for all racial and ethnic groups continue to improve but very little is known about the basis for these differences. This warrants a deeper investigation into the biological and non-biological determinants for these differences. Figure Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

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Arsenic Trioxide with Ascorbic Acid and High-Dose Melphalan: A New Preparative Regimen for Autologous Hematopoietic Stem Cell Transplantation for Multiple Myeloma.

Blood ◽

10.1182/blood.v106.11.1159.1159 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1159-1159 ◽

Cited By ~ 2

Author(s):

Muzaffar H. Qazilbash ◽

Marilyn S. Davis ◽

Aleman Ana ◽

Linda Roden ◽

Floralyn Libunao ◽

...

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Ascorbic Acid ◽

Arsenic Trioxide ◽

Survival Probability ◽

Progression Free Survival ◽

High Dose ◽

Free Survival ◽

Kaplan Meier ◽

The Impact

Abstract Backround: Arsenic trioxide (ATO), an active agent against multiple myeloma, has been shown to be synergistic with melphalan both in vitro and in vivo. We conducted a phase I/II trial to determine the safety and efficacy of a combination of arsenic trioxide, melphalan and ascorbic acid (AA) as prepaprative regimen in patients undergoing high-dose therapy (HDT) and autologous hematopoietic progenitor cell transplantation (AHPCT) for multiple myeloma (MM). We also assessed the impact ATO levels on melphalan pharmacokinetics (PK), engraftment and toxicity. Methods: Twenty-five patients with secretory myeloma (11 females, 14 males median age: 53, range: 49 – 69) were treated b/w 4/04 and 1/05. All patient received melphalan 100 mg/m2 IV on days -4 and -3 and AA 1000 mg/day IV on days −9 to −3. Patients were randomized to 3 arms; no ATO (arm 1), ATO 0.15 mg/kg IV on days −9 to −3 (arm 2) and ATO 0.25 mg/kg IV on days −9 to −3 (arm 3). Seven patients had a prior autograft. Median CD34 cells dose infused was 4.4 x 106/kg (range 2.3–10.9). Results: Patients were evenly matched except for a high median β2m level (3.6 vs. 2.4 in arms 1 and 2, p=0.04) in arm 3. With a median F/U of 7.1 months post autograft, no dose-limiting toxicity or non-relapse mortality was seen. Median ATO level on day 0 in arms 1, 2 and 3 were 0.2, 26.3 and 46.2 ng/ml, respectively. Toxicity was limited grade I or II nausea, vomitting and diarrhea. Median time to neutrophil engraftment (ANC >500/dl) was 9 days. There were no engraftment failures or delays in the ATO arms. Response rates (RR) are shown in Table 1. With a median F/U of 7.1 months (range, 6.4 – 8.9 months), the progression-free survival (PFS) and overall survival (OS) are as shown in Figure 1. There was no significant difference in RR, PFS or OS between the 3 arms. Melphalan PK was not altered by ATO pretreatment. Conclusions: Arsenic trioxide, given in combination with melphalan and ascorbic acid as preparative regimen, is safe and well tolerated. A longer follow up is needed to determine the impact of this combination on survival. Response Rate at 3-Month Evaluation Response at 3 months CR PR MR SD PD p = 0.55 CR = complete response, PR = partial response, MR = minimal response, SD = stable disease, PD = progressive disease Arm 1 (no ATO) 1 5 0 1 1 Arm 2 (ATO 0.15) 1 5 2 0 1 Arm 3 (ATO 0.25) 0 7 0 0 0 Figure 1. The Kaplan-Meier estimates for progression-free survival probability (N=25). Figure 1. The Kaplan-Meier estimates for progression-free survival probability (N=25). Figure 2. The Kaplan-Meier estimates for overall survival probability (N=25). Figure 2. The Kaplan-Meier estimates for overall survival probability (N=25).

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Role of adjuvant chemotherapy in patients with pathological stage I NSCLC with high-risk features.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.9022 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 9022-9022

Author(s):

Lubina Arjyal ◽

Dipesh Uprety ◽

Susan M Frankki ◽

Andrew J Borgert ◽

David E. Marinier

Keyword(s):

Overall Survival ◽

Survival Analysis ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Propensity Score ◽

Tumor Size ◽

Stage I ◽

Median Income ◽

Pathological Stage ◽

Kaplan Meier

9022 Background: Lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC). There is a lack of prospective data on the benefit of adjuvant chemotherapy (CT) in patients with negative margins but with high-risk features: lympho-vascular invasion (LVI) or visceral pleural invasion (VPI). We aimed to investigate the benefit of adjuvant CT in patients with pathological stage I NSCLC with high-risk features. Methods: The 2016 National Cancer Database was queried to identify patients with pathological stage I NSCLC (8th edition AJCC staging) diagnosed from 2010-2015 who received lobectomy/pneumonectomy with clear surgical margins. Patients were stratified into high risk (tumor size ≥2 cm with LVI and/or VPI) or low risk group. Multivariate Cox proportional hazards regression and propensity score matched Kaplan-Meier survival analysis were used to compare overall survival between those who received adjuvant CT and those who did not. Results: 34,556 patients were identified with 1114 (3.2%) receiving adjuvant CT. On multivariate Cox regression analysis, high risk tumors (hazard ratio [95% confidence interval] = 1.31 [1.25-1.38]) and lack of adjuvant chemotherapy (1.25 [1.09-1.44]) were associated with worse overall survival (OS). Additionally, male sex, age ≥ 60 years, higher comorbidity burden, lack of insurance, low facility volume, low median income, non-squamous histology were associated with worse OS. After propensity score matching, Kaplan-Meier survival analysis of the high risk subgroup (n = 2923) showed a significant difference in overall survival (OS) between those who received adjuvant CT (n = 1032, 5 year OS, 74.7%; 95% CI, 70.9%-78.0%) and those who did not (n = 1891, 5 year OS, 66.9%; CI, 63.9%-69.6%; p = 0.0002). In patients with no high risk factors for recurrence (n = 384), OS was not significantly different between the patients who received adjuvant CT (n = 78, 5 year OS, 75.8%; CI, 61.3%-85.5%) and those who did not receive adjuvant CT (n = 306, 5 year OS, 77.1%; CI, 70.0%-82.7%; p = 0.3). Conclusions: Our study showed better survival with adjuvant CT in patients with pathological stage I NSCLC who have tumor size greater than 2 cm, LVI and/or VPI.

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Mean platelet volume and platelet distribution width serve as prognostic biomarkers in skull base chordoma: a retrospective study

BMC Cancer ◽

10.1186/s12885-020-07497-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mingxuan Li ◽

Jiwei Bai ◽

Shuai Wang ◽

Yixuan Zhai ◽

Shuheng Zhang ◽

...

Keyword(s):

Overall Survival ◽

Survival Analysis ◽

Retrospective Study ◽

Skull Base ◽

Mean Platelet Volume ◽

Platelet Distribution Width ◽

Platelet Volume ◽

Distribution Width ◽

Kaplan Meier ◽

Skull Base Chordoma

Abstract Background Increasing studies have demonstrated that activated platelets play an essential role in tumour progression. However, the level and prognostic role of platelet indices in chordoma patients remain unclear. The aim of the current study was to characterize the prognostic performance of platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) in skull base chordoma patients. Methods 187 primary skull base chordoma patients between January 2008 and September 2014 were enrolled in this retrospective study. The optimal cut-off values were determined by X-tile software, and the correlations between PLT, MPV, PDW and clinicopathological features were further analysed. Kaplan-Meier curve and Cox regression analysis were used for survival analysis. Results The values of preoperative PTL, MPV and PDW ranged from 104 to 501 × 109/L, 6.7 to 14.2 fl, and 7.8 to 26.2%, respectively. Elevated PLT was associated with larger tumour volume (p = 0.002). Kaplan-Meier survival analysis revealed that increased MPV and PDW were associated with shorter overall survival (p = 0.022 and 0.008, respectively). Importantly, multivariate Cox analysis demonstrated that elevated PDW was an independent unfavourable predictive factor for overall survival (hazard ratio (HR), 2.154, 95% confidence interval (CI), 1.258–3.688, p = 0.005). Conclusions Our data show that elevated MPV and PDW are associated with poor outcomes in skull base chordoma and that PDW may be helpful to identify patients with high risk.

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