scholarly journals Survival benefit of induction chemotherapy for locally advanced nasopharyngeal carcinoma: prognosis based on a new risk estimation model

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Liu ◽  
Bolong Yu ◽  
Yunfan Luo ◽  
Junzheng Li ◽  
Xiaofei Yuan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Locally Advanced ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Time To Event ◽  
Free Survival ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Risk Patients

Abstract Background Although the National Comprehensive Cancer Network (NCCN) Guidelines recommend CCRT+AC and IC + CCRT as level 2A evidence for treatment of the locoregionally advanced NPC (II-IVa), IC + CCRT+AC could also be an alternative but it is seldom used because of the low completion rates. This article aimed to compare the effectiveness of the three radiotherapy regimens using a large-scale retrospective study. Methods This retrospective single center analysis enrolled 1812 diagnosed NPC patients at Nanfang Hospital from January 2005 to December 2015 and only 729 patients met the inclusion criteria and were analyzed. Patients without distant metastasis, age of 18–70 years, Karnofsky scores of at least 70,stage III-IVb, and adequate adequate bone marrow, liver and renal function. Were enrolled. Adverse events and other categorical variables were compared by Pearson chi-square test or Fishier exact test. Time-to-event data were described with the Kaplan-Meier curves, time-to-event intervals compared with the log-rank test. We did multivariable analyses with the Cox proportional hazards model to test the independent signifi cance of diff erent factors. Cox proportional hazards model was used to estimate the β regression coeffi cient, p value, and hazard ratio and its 95% CI for each of the selected risk predictors. Results The median follow-up time was 47 months. Kaplan-Meier analyses revealed no significant differences among three groups in 3-year failure-free survival (FFS, P = 0.225), 3-year overall survival (OS, P = 0.992), 3-year locoregional failure-free survival (LFFS, P = 0.549), and 3-year distant failure-free survival (DFFS, P = 0.174). Stratified survival analysis based on the risk scoring model revealed no differences in FFS, OS, LFFS, and DFFS between IC + CCRT and CCRT+AC groups for low-risk patients, however, the 3-year OS (88.3% vs. 77.6%, P = 0.049) and 3-year DFFS (84.0% vs.66.8%, P = 0.032) were respectively significantly better in IC + CCRT group compared with CCRT+AC group for high-risk patients. Conclusions Compared with CCRT+AC, IC + CCRT lowers distant metastasis rate and improves OS among patients with locally advanced NPC in high risk group.

scholarly journals Η προγνωστική σημασία της απόπτωσης στον καρκίνο του μαστού του ανθρώπου

2008 ◽  
Author(s):  
Θωμάς Τσουκαλάς
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Grade Iii

Σκοπός αυτής της προσπάθειας είναι να μελετηθεί η απόπτωση και η ποσοτική της έκφραση, που είναι ο αποπτωτικός δείκτης (ΑΙ), στο πορογενές αδενοκαρκίνωμα του μαστού, μη ειδικού τύπου (NST) και τα ευρήματα να συσχετισθούν με τον μιτωτικό δείκτη (ΜΙ), τον βαθμό κακοήθειας, το μέγεθος του όγκου, τη διήθηση των σύστοιχων μασχαλιαίων λεμφαδένων, το στάδιο της νόσου, τους ορμονικούς υποδοχείς, την ηλικία, την εμμηνοπαυσιακή κατάσταση και την ανοσοϊστοχημική έκφραση των ογκοπρωτεϊνών Bcl2 και ρ53. Για τον σκοπό της μελέτης, επίσης θα εκτιμηθεί η σχέση του μιτωτικού δείκτη (ΜΙ) με τους ίδιους κλινικοπαθολογοανατομικούς παράγοντες και με την ανοσοϊστοχημική έκφραση των ογκοπρωτεϊνών Bcl2 και ρ53. Τέλος ο αποπτωτικός δείκτης (ΑΙ), ο μιτωτικός δείκτης (ΜΙ), οι παραπάνω κλινικοπαθολογοανατομικοί παράγοντες και η έκφραση των Bcl2 και ρ53 ογκοπρωτεϊνών θα συσχετισθεί με την επιβίωση ελεύθερη υποτροπής (Relapse Free Survival, RFS) των ασθενών.Η μελέτη περιλαμβάνει 175 ασθενείς με πορογενές αδενοκαρκίνωμα του μαστού, μη ειδικού τύπου (NST), και ο χρόνος παρακολούθησης ήταν 15 περίπου χρόνια. Συγκεκριμένα οι ασθενείς παρακολουθήθηκαν από 3 μήνες έως 191 μήνες, με ενδιάμεσο χρόνο παρακολούθησης 171 μήνες και μέσο όρο παρακολούθησης 125 μήνες.Η ανοσοϊστοχημική έκφραση των Bcl2 και ρ53 ογκοπρωτεϊνών έγινε σε 84 (εκ των 175) ασθενείς και ο χρόνος παρακολούθησης ήταν ο ίδιος.Η εκτίμηση του αποπτωτικού και μιτωτικού δείκτη έγινε με βάση τα μορφολογικά χαρακτηριστικά σε τομές παραφίνης και χρώση ηωσίνης-αιματοξυλίνης και ορίσθηκε ως ο μέσος όρος των κυττάρων που βρίσκονται σε απόπτωση και μίτωση, αντίστοιχα, σε 20 ΟΠ μεγάλης μεγέθυνσης (χ 400).Στη στατιστική ανάλυση οι αποπτωτικοί και μιτωτικοί δείκτες των ομάδων εκφράστηκαν ως μέση τιμή, η σύγκριση των συνεχών μεταβλητών έγινε με στατιστικό έλεγχο t και η σύγκριση των κατηγορικών μεταβλητών έγινε με έλεγχο χ2. Ο πολυπαραγοντικός έλεγχος του ΑΙ με τις υπόλοιπες μεταβλητές έγινε με πολυμεταβλητό μοντέλο γραμμικής παλινδρόμησης. Η ανάλυση της επιβίωσης ελεύθερης υποτροπής (RFS) έγινε με την μέθοδο Kaplan-Meier και η πολυπαραγοντική ανάλυση επιβίωσης έγινε με το μοντέλο αναλογικού κινδύνου του Cox (proportional hazards model).Από την ανάλυση των αποτελεσμάτων της μελέτης προέκυψε ότι ο αποπτωτικός δείκτης (ΑΙ) έχει ισχυρή και θετική σχέση με τον μιτωτικό δείκτη (ΜΙ) (p < 0,001), με τον βαθμό κακοήθειας (από τον έλεγχο όλων των ομάδων ανά Grade p < 0,001) και το μέγεθος του όγκου (p < 0,001) ενώ παρουσιάζει αρνητική συσχέτιση με τους ορμονικούς υποδοχείς (p = 0,003).Δεν φαίνεται να υπάρχει συσχέτιση του αποπτωτικού δείκτη με τη διήθηση των σύστοιχων μασχαλιαίων λεμφαδένων, το στάδιο της νόσου, την ηλικία και την εμμηνοπαυσιακή κατάσταση.Ο μιτωτικός δείκτης (ΜΙ) σε σχέση με τους παραπάνω κλινικοπαθολογοανατομικούς δείκτες παρουσιάζει τις ίδιες συσχετίσεις δηλαδή έχει ανάλογη σχέση με τον βαθμό κακοήθειας, το μέγεθος του όγκου και αντίστροφη σχέση με τους ορμονικούς υποδοχείς. Όμως δεν φαίνεται να σχετίζεται με τη διήθηση των σύστοιχων μασχαλιαίων λεμφαδένων, το στάδιο της νόσου, την ηλικία και την εμμηνοπαυσιακή κατάσταση. Αναφορικά με την ανοσοϊστολογική έκφραση των Bcl2 και ρ53 ογκοπρωτεϊνών, ο αποπτωτικός δείκτης (ΑΙ) και ο μιτωτικός δείκτης (ΜΙ) έχουν θετική σχέση με την ρ53 ογκοπρωτεΐνη (p = 0,001 και p = 0,008 αντίστοιχα). Σε σχέση με την ογκοπρωτεΐνη Bcl2 ο αποπτωτικός δείκτης έχει αντίστροφη σχέση (p = 0,006) ενώ δεν φαίνεται να υπάρχει συσχέτιση μεταξύ του μιτωτικού δείκτη (ΜΙ) και της Bcl2 ογκοπρωτεΐνης (p = 0,06). Έτσι όγκοι με θετική ανοσοϊστοχημική έκφραση της Bcl2 ογκοπρωτεΐνης και αρνητική έκφραση της p53 φαίνεται να έχουν χαμηλό αποπτωτικό δείκτη (ΑΙ).Οι γυναίκες που υποτροπίασαν είχαν υψηλότερο αποπτωτικό δείκτη απ' αυτές που δεν εμφάνισαν υποτροπή (p = 0,001) ενώ ο μιτωτικός δείκτης ήταν κατά μέσο όρο υψηλότερος σ' αυτές που εμφάνισαν υποτροπή (p = 0,059). Επίσης οι γυναίκες που υποτροπίασαν είχαν όγκους μεγάλου μεγέθους (p = 0,007) με υψηλό βαθμό κακοήθειας (Grade III) (p = 0,02) και το μεγαλύτερο ποσοστό υποτροπής παρατηρήθηκε σε ασθενείς σταδίου IIIΑ.Ο χρόνος εμφάνισης της υποτροπής ήταν μικρότερος (< 60 μήνες) στις γυναίκες με υψηλό αποπτωτικό και μιτωτικό δείκτη (p = 0,002, p = 0,004 αντίστοιχα και μεγάλους όγκους (p = 0,007).Η επιβίωση ελεύθερης υποτροπής ήταν μεγαλύτερη στις ασθενείς με μικρό μέγεθος όγκου (p = 0,003), χωρίς διηθημένους λεμφαδένες (Ν0) στη σύστοιχη μασχάλη (p = 0,016 με Ν2 και p = 0,055 Ν1 με Ν2), σταδίου Ι (p = 0,01 με ΙΙΒ και p = 0,001 με IIIΑ) με θετικούς υποδοχείς (p = 0,04). Δεν παρατηρήθηκε διαφορά στην επιβίωση ελεύθερης υποτροπής μεταξύ προ- και μεταεμμηνοπαυσιακών γυναικών και μεταξύ γυναικών με θετική (+)/αρνητική (-) έκφραση των ογκοπρωτεϊνών Bcl2 και ρ53.Σ’ αυτήν τη μελέτη, οι ασθενείς που είχαν χαμηλό αποπτωτικό δείκτη (ΑΙ < 1,8) είχαν μεγαλύτερη επιβίωση ελεύθερη υποτροπής και μπορεί να χαρακτηριστεί σαν ομάδα «καλής πρόγνωσης» σε σχέση με τις ασθενείς με υψηλό αποπτωτικό δείκτη (ΑΙ > 1,8) που μπορεί να χαρακτηριστεί σαν ομάδα «υψηλού κινδύνου» (p < 0,005).Η πολυπαραγοντική ανάλυση της σχέσης του αποπτωτικού δείκτη (ΑΙ) με τους κλινικοπαθολογικούς παράγοντες που μελετήθηκαν και η πολυπαραγοντική ανάλυση επιβίωσης έδειξε, στην παρούσα μελέτη, ότι ο αποπτωτικός δείκτης περιλαμβάνει πληροφορία από αυτούς τους παράγοντες και έχει μεγάλη σημασία για την επιβίωση ελεύθερη υποτροπής. Συνεπώς θα μπορούσε να χρησιμοποιηθεί -πιθανόν- σαν ένας σημαντικός προγνωστικός παράγοντας που συμπυκνώνει πληροφορίες για τον καρκίνο του μαστού και -τουλάχιστον στο δείγμα αυτό των ασθενών- θα μπορούσε να χρησιμοποιηθεί από μόνος του σαν ένας ανεξάρτητος προγνωστικός παράγοντας για την αξιολόγηση του κινδύνου υποτροπής των ασθενών με καρκίνο του μαστού.Σημαντικό πλεονέκτημα της παρούσας μελέτης είναι ο σχετικά μεγάλος αριθμός των ασθενών που παρακολουθήθηκαν (175) και το μεγάλο χρονικό διάστημα παρακολούθησης (ενδιάμεσος χρόνος παρακολούθησης 171 μήνες).Η απόδειξη μιας ανεξάρτητης τιμής για τον αποπτωτικό δείκτη μας επιτρέπει τη γενική του χρήση στην κλινική πράξη και μας παρέχει τη δυνατότητα να κάνουμε προβλέψεις για την πιθανότητα επιβίωσης των ασθενών με καρκίνο του μαστού. Σ’ αυτήν την περίπτωση, ο αποπτωτικός δείκτης θα μπορούσε να αποτελέσει έναν ανεξάρτητο προγνωστικό παράγοντα με βάση το οποίο οι ασθενείς με καρκίνο του μαστού θα μπορούσαν να κατηγοριοποιηθούν σε ασθενείς υψηλού, μεσαίου ή χαμηλού κινδύνου υποτροπής.

scholarly journals Evaluation of Changes on World Stock Exchanges in Connection with the SARS-CoV-2 Pandemic. Survival Analysis Methods

Risks ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 121
Author(s):  
Beata Bieszk-Stolorz ◽  
Krzysztof Dmytrów
Keyword(s):  
Survival Analysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Stock Exchange ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Stock Exchanges ◽  
Analysis Methods ◽  
Hazards Model ◽  
Kaplan Meier

The aim of our research was to compare the intensity of decline and then increase in the value of basic stock indices during the SARS-CoV-2 coronavirus pandemic in 2020. The survival analysis methods used to assess the risk of decline and chance of rise of the indices were: Kaplan–Meier estimator, logit model, and the Cox proportional hazards model. We observed the highest intensity of decline in the European stock exchanges, followed by the American and Asian plus Australian ones (after the fourth and eighth week since the peak). The highest risk of decline was in America, then in Europe, followed by Asia and Australia. The lowest risk was in Africa. The intensity of increase was the highest in the fourth and eleventh week since the minimal value had been reached. The highest odds of increase were in the American stock exchanges, followed by the European and Asian (including Australia and Oceania), and the lowest in the African ones. The odds and intensity of increase in the stock exchange indices varied from continent to continent. The increase was faster than the initial decline.

scholarly journals Association between milk and yogurt intake and mortality: a community-based cohort study (Yamagata study)

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Akiko Nakanishi ◽  
Erika Homma ◽  
Tsukasa Osaki ◽  
Ri Sho ◽  
Masayoshi Souri ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Hazard Analysis ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Milk Intake ◽  
Community Based ◽  
Hazards Model ◽  
Kaplan Meier

Abstract Background Dairy products are known as health-promoting foods. This study prospectively examined the association between milk and yogurt intake and mortality in a community-based population. Methods The study population comprised of 14,264 subjects aged 40–74 years who participated in an annual health checkup. The frequency of yogurt and milk intake was categorized as none (< 1/month), low (< 1/week), moderate (1–6/week), and high (> 1/day) intake. The association between yogurt and milk intake and total, cardiovascular, and cancer-related mortalities was determined using the Cox proportional hazards model. Results During the follow-up period, there were 265 total deaths, 40 cardiovascular deaths and 90 cancer-related deaths. Kaplan–Meier analysis showed that the total mortality in high/moderate/low yogurt intake and moderate/low milk intake groups was lower than that in none group (log-rank, P < 0.01). In the multivariate Cox proportional hazard analysis adjusted for possible confounders, the hazard ratio (HR) for total mortality significantly decreased in high/moderate yogurt intake group (HR: 0.62, 95% confidence interval [CI]: 0.42–0.91 for high intake, HR: 0.70, 95%CI: 0.49–0.99 for moderate intake) and moderate milk intake group (HR: 0.67, 95% CI: 0.46–0.97) compared with the none yogurt and milk intake groups. A similar association was observed for cancer-related mortality, but not for cardiovascular mortality. Conclusions Our study showed that yogurt and milk intake was independently associated with a decrease in total and cancer-related mortalities in the Japanese population.

Inter-pregnancy interval and later pediatric cardiovascular health of the offspring – a population-based cohort study

2020 ◽  
pp. 1-5
Author(s):  
Majdi Imterat ◽  
Tamar Wainstock ◽  
Eyal Sheiner ◽  
Gali Pariente
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cardiovascular Morbidity ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Inter Pregnancy Interval

Abstract Recent evidence suggests that a long inter-pregnancy interval (IPI: time interval between live birth and estimated time of conception of subsequent pregnancy) poses a risk for adverse short-term perinatal outcome. We aimed to study the effect of short (<6 months) and long (>60 months) IPI on long-term cardiovascular morbidity of the offspring. A population-based cohort study was performed in which all singleton live births in parturients with at least one previous birth were included. Hospitalizations of the offspring up to the age of 18 years involving cardiovascular diseases and according to IPI length were evaluated. Intermediate interval, between 6 and 60 months, was considered the reference. Kaplan–Meier survival curves were used to compare the cumulative morbidity incidence between the groups. Cox proportional hazards model was used to control for confounders. During the study period, 161,793 deliveries met the inclusion criteria. Of them, 14.1% (n = 22,851) occurred in parturient following a short IPI, 78.6% (n = 127,146) following an intermediate IPI, and 7.3% (n = 11,796) following a long IPI. Total hospitalizations of the offspring, involving cardiovascular morbidity, were comparable between the groups. The Kaplan–Meier survival curves demonstrated similar cumulative incidences of cardiovascular morbidity in all groups. In a Cox proportional hazards model, short and long IPI did not appear as independent risk factors for later pediatric cardiovascular morbidity of the offspring (adjusted HR 0.97, 95% CI 0.80–1.18; adjusted HR 1.01, 95% CI 0.83–1.37, for short and long IPI, respectively). In our population, extreme IPIs do not appear to impact long-term cardiovascular hospitalizations of offspring.

scholarly journals Risk Factors for Mortality in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis

2015 ◽  
Vol 35 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Fan Zhang ◽  
Hong Liu ◽  
Xiaoli Gong ◽  
Fuyou Liu ◽  
Youming Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Patient Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Kaplan Meier

ObjectiveThe intent of this study was to evaluate the clinical outcome and risk factors affecting mortality of the continuous ambulatory peritoneal dialysis (CAPD) patients in a single peritoneal dialysis (PD) center over a period of 10 years.Patients and methodsWe retrospectively analyzed patients on PD from June 2001 to June 2011. The clinical and biochemical data were collected from the medical records. Clinical variables included gender, age at the start of PD, smoking status, body mass index (BMI), cause of end-stage renal disease (ESRD), presence of diabetes mellitus and blood pressure. Biochemical variables included hemoglobin, urine volume, residual renal function (RRF), serum albumin, blood urea nitrogen (BUN), creatinine, total cholesterol, triglyceride, comorbidities, and outcomes. Survival curves were made by the Kaplan-Meier method. Univariate and multivariate analyses to identify mortality risk factors were performed using the Cox proportional hazard regression model.ResultsA total of 421 patients were enrolled, 269 of whom were male (63.9%). The mean age at the start of PD was 57.9 ± 14.8 years. Chronic glomerulonephritis was the most common cause of ESRD (39.4%). Estimation of patient survival by Kaplan-Meier was 92.5%, 80.2%, 74.4%, and 55.7% at 1, 3, 5, and 10 years, respectively. Patient survival was associated with age (hazard ratio [HR]: 1.641 [1.027 – 2.622], p = 0.038), cardiovascular disease (HR: 1.731 [1.08 – 2.774], p = 0.023), hypertriglyceridemia (HR: 1.782 [1.11 – 2.858], p = 0.017) in the Cox proportional hazards model analysis. Estimation of technique survival by Kaplan-Meier was 86.7%, 68.8%, 55.7%, and 37.4% at 1, 3, 5, and 10 years, respectively. In the Cox proportional hazards model analysis, age (HR: 1.672 [1.176 – 2.377], p = 0.004) and hypertriglyceridemia (HR: 1.511 [1.050 – 2.174], p = 0.026) predicted technique failure.ConclusionThe PD patients in our center exhibited comparable or even superior patient survival and technical survival rates, compared with reports from other centers in China and other countries.

Comorbidities and Myelodysplatic Syndromes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2789-2789 ◽  
Author(s):  
Kiran Naqvi ◽  
Guillermo Garcia-Manero ◽  
Sagar Sardesai ◽  
Jeong Oh ◽  
Sherry Pierce ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Median Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Comorbidity Scores ◽  
Severe Comorbidity

Abstract Abstract 2789 Poster Board II-765 Background: Cancer patients often experience comorbidities that may affect their therapeutic options, prognosis, and outcome (1). Limited studies have evaluated the characteristics and impact of comorbidities in myelodysplastic syndromes (MDS). The aim of this study was to determine the effect of comorbidities on the survival of patients with MDS. Methods: We reviewed the medical records of 500 consecutive MDS patients who presented to MD Anderson Cancer Center from January 2002 to June 2004. The Adult Comorbidity Evaluation-27 (ACE-27), a validated 27-item comorbidity index for cancer patients (2), was used to assess the severity of comorbid conditions. For each patient, we obtained demographic data and specific staging information based on the International Prognostic Scoring System (IPSS). We also collected information on stem cell transplantation (SCT), mortality and survival. Kaplan-Meier methods and log-rank tests were used to assess survival. Multivariate analysis was performed using the Cox Proportional Hazards Model. Results: Of the 500 patients included in this study, 327 (65.4%) were male, and 436 (87.9%) were white; median age at presentation was 66.6 years (17.7, 93.5); mean duration of follow-up was 23.5 months (0, 88). A total of 49% of patients had IPSS intermediate-1 or lower risk. The ACE-27 comorbidity scores were as follows: none, 106 patients (21.2%); mild, 213 (42.6%); moderate, 108 (21.6%); and severe, 73 (14.6%). Three hundred and eighty one (76.2%) patients died, and 44 (8.8%) patients underwent SCT. Overall median survival using the Kaplan-Meier method was 17.6 months. Median survival according to ACE-27 scores was: 27.9 months for no comorbidity, 18.9 months for mild comorbidity, 15.2 months for moderate comorbidity, and 9.7 months for severe comorbidity. This trend reached statistical significance (p < 0.0001). The median survival by IPSS ranged from 40.9 months for patients in the low risk group versus 8.1 months for those in the high risk category (p < 0.0001). The hazards ratio obtained from the multivariate Cox Proportional Hazards Model was 1.5 and 2.0 for moderate and severe comorbidity scores when adjusted for age and IPSS (p < 0.0001). A linear trend was also observed between the severity of comorbidity and having received SCT (p = 0.001). Of the 44 patients who had SCT, 21 (47.7%) died. The median survival of patients who did not undergo stem cell transplantation ranged from 22.7 months for patients with no comorbidity to 9.3 months for patients with severe comorbidity (p = 0.0002). Conclusion: Comorbidities had a significant impact on the survival of patients with myelodysplastic syndrome. Patients with higher ACE-27 comorbidity scores had a shorter survival than those with no comorbidity, independent of their age and the IPSS risk group. Also patients with comorbid conditions received SCT less often than those without comorbidity. A comprehensive assessment of comorbidity is therefore needed to determine the prognosis in patients with MDS. References: (1) Extermann M. Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol. 2000;35:181-200. (1) Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291:2441-47. Disclosures: No relevant conflicts of interest to declare.

Clinical features and outcomes of secondary somatic malignancy (SSM) arising from teratoma in late relapse germ cell tumor (GCT).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 518-518
Author(s):  
Nathan Colin Wong ◽  
Shawn Dason ◽  
Lucas W. Dean ◽  
Sumit Isharwal ◽  
Mark Donoghue ◽  
...  
Keyword(s):  
Median Time ◽  
Surgical Resection ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Late Relapse ◽  
Hazards Model ◽  
Kaplan Meier

518 Background: Late relapse (>2 years) GCT is associated with an increased rate of SSM. We report our experience with SSM in the setting of late relapse and determine predictors of overall survival (OS). Methods: From 1985 to 2018, 46 patients with GCT and SSM at late relapse were identified. Clinical and pathologic parameters were reviewed. The Kaplan-Meier method was used to estimate OS from time of relapse and a Cox proportional hazards model to assess predictors of OS. Results: Of 46 men (44 testicular primary, 2 mediastinal primary), median time to late relapse with SSM was 10.4 years (range, 2.3 - 38.1). Most (n=27, 59%) were symptomatic at presentation but 11 were detected by elevated tumor markers (AFP 8, HCG 2, both 1) and 8 by surveillance imaging. SSMs were adenocarcinoma (25), sarcoma (14), poorly differentiated neoplasm (3), Wilms (2), PNET (1) and glioma (1). Median time to relapse was longer for adenocarcinoma vs other histotypes of SSM (14.6 vs 4.1 years, p < 0.001). The initial site of relapse was the retroperitoneum (RP, 26), pelvis (7), lung (6), retrocrural space (3), mediastinum (2), neck (1) and duodenum (1). Only 10 of 26 men with late relapse in the RP had undergone prior RPLND (all at outside institutions; variable templates) with histology in 7/10 showing teratoma. The other 16 men had received chemotherapy only (8), orchiectomy only for stage I (3), RPLND aborted due to cardiac arrest (1), and unknown (4). All 46 late relapses were managed with surgical resection; 26 also received chemotherapy (16 SSM-directed, 10 GCT-directed). Overall, 12 patients died and the median OS was 14.2 years. On univariable analysis, symptomatic presentation (HR = 3.1), SSM at multiple sites (HR = 3.9), extra-RP disease (HR: 3.9), and incomplete/no resection of SSM (HR = 3.6) predicted mortality. On multivariable analysis, only extra-RP disease was independently associated with inferior OS (5-year OS, 82 vs 52%, p = 0.017). Conclusions: SSM is an important potential complication of late relapse GCT and seems to be associated with the lack of resection of retroperitoneal metastases. Early identification and complete surgical resection prior to SSM arising in extra-RP sites is critical to optimizing outcomes.

scholarly journals Impact of Prior Cancer History on Outcomes in Thymoma

2020 ◽  
Author(s):  
Shilong Wu ◽  
Mengyang Liu ◽  
Weixue Cui ◽  
Guilin Peng ◽  
Jianxing He
Keyword(s):  
Overall Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cancer History ◽  
Treatment Methods ◽  
Hazards Model ◽  
Kaplan Meier ◽  
The Impact

Abstract Background Thymoma is an uncommon intrathoracic malignant tumor and has a long natural history. It is uncertain whether the survival of thymoma patient is affected by prior cancer history. Finding out the impact of a prior cancer history on thymoma survival has important implications for both decision making and research. Method The Surveillance, Epidemiology, and End Results (SEER) database was queried for thymoma patients diagnosed between 1975 and 2015. Kaplan-Meier methods and Cox proportional hazards model were used to analyze overall survival across a variety of stages, age, and treatment methods with a prior cancer history or not. Results A total of 3604 patients with thymoma were identified including 507 (14.1%) with a prior cancer history. The 10-year survival rate of patients with a prior cancer history (53.8%) was worse than those without a prior cancer history (40.32%, 95%CI 35.24-45.33, P < 0.0001). However, adjusted analyses showed that the impact of a prior cancer history was heterogenous across age and treatment methods. In subset analyses, prior cancer history was associated with worse survival among patients who were treated with chemoradiotherapy (HR: 2.80, 95% CI: 1.51-5.20, P = 0.001) and age ≤ 65 years (HR: 1.33, 95%CI: 1.02-1.73, P = 0.036). Conclusions Prior cancer history provides an inferior overall survival for patients with thymoma. But it does not worsen the survival in some subgroups and these thymoma patients should not be excluded from clinical trials.

A multivariate analysis of prognostic factors from assure (E2805): Adjuvant sorafenib or sunitinib for unfavorable renal carcinoma.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 618-618
Author(s):  
Naomi B. Haas ◽  
Judith Manola ◽  
Robert G. Uzzo ◽  
Keith Flaherty ◽  
Michael Pins ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Clear Cell ◽  
Locally Advanced ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Risk Category ◽  
Fuhrman Grade ◽  
Hazards Model ◽  
Postoperative Setting

618 Background: Previous post-surgical prognostic nomograms for clear cell RCC are based upon TNM stage, PS, Fuhrman grade, and sometimes presence of necrosis. 1943 patients (pts) with locally advanced renal cell carcinoma (RCC) participated in the ASSURE trial of one year of sunitinib daily for 4 wks of a 6 wk cycle, sorafenib daily, or placebo, then treated for up to 9 cycles. Of these, 1541 pts had clear cell predominant features. There were no significant differences in DFS (median 5.7 years) between either of the experimental arms and placebo, in the total or clear cell population. We investigated site-reported clinical and surgical factors associated with prolonged DFS. Methods: Patients were staged according to the AJCC 2007 version. Factors considered in addition to those in the final model shown below were age, race/ethnicity, histology, risk category and PS as stratified, and 10 other specific baseline symptoms. A Cox proportional hazards model was built including factors that significantly changed the -2 log likelihood ratio (Collett). Results: Shorter DFS was associated with higher age, stage and Fuhrman grade, male sex, PS > 0, open vs. laparoscopic surgical approach, low hemoglobin and diagnosis based on presence of symptoms. Conclusions: The association of stage, grade, age, and PS with outcome confirms previous analyses in resectable disease. The same factors which predict outcome in metastatic disease now clearly confer relapse risk in the postoperative setting. Clinical trial information: NCT00326898. [Table: see text]

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