Prognostic value of c-myc proto-oncogene overexpression in early invasive carcinoma of the cervix.

1990 ◽  
Vol 8 (11) ◽  
pp. 1789-1796 ◽  
Author(s):  
J Bourhis ◽  
M G Le ◽  
M Barrois ◽  
A Gerbaulet ◽  
D Jeannel ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Normal Level ◽  
Invasive Carcinoma ◽  
Proportional Hazards Model ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Nodal Status ◽  
Rank Test ◽  
Myc Gene ◽  
Risk Of Relapse

The prognostic effect of c-myc oncogene overexpression was assessed in a multivariate analysis of 93 patients with invasive carcinoma of the cervix, stage Ib, IIa, and IIb proximal. The treatment was based on the association of brachytherapy-colpohysterectomy and lymphadenectomy. Analysis of c-myc gene expression was done using Northern and slot blot hybridization techniques. Overexpression of c-myc (ie, levels at least three times the mean observed in normal tissues) was present in 33% of the tumors. The proportion of carcinomas with c-myc overexpression significantly increased with the size of the primary tumor (P = .04). No relationship was found between c-myc overexpression and the other clinical and histologic parameters, including the nodal status. The relative risk of relapse (overall, pelvic failure, distant metastases) was analyzed in a Cox's proportional hazards model. Three factors were significantly related to the risk of overall relapse when the multivariate analysis was performed, namely, the tumor size, the nodal status, and c-myc expression. A combination of c-myc expression and the nodal status provided a very accurate indication of the risk of relapse. Indeed, patients with negative nodes had a 3-year disease-free survival rate of 93% (95% confidence interval [Cl], 79% to 98%) when c-myc was expressed at a normal level, whereas this rate was only 51% (95% Cl, 26% to 63%) when c-myc was overexpressed (log-rank test, P = .02). In addition, in the subgroup of patients with positive nodes, this rate was 44% (95% Cl, 25% to 77%) and 15% (95% Cl, 4% to 49%) when c-myc gene was expressed at normal level, or overexpressed, respectively. Finally, c-myc gene overexpression was, in the multivariate analysis, the first factor selected by the model regarding the risk of distant metastases.

scholarly journals The Effectiveness of Surgery-Based Treatment in Advanced Oropharyngeal Cancers

2021 ◽  
Vol 64 (7) ◽  
pp. 486-490
Author(s):  
Young-Chan Kim ◽  
Hyeongeun Kim ◽  
Jiwon Kwak ◽  
Hoyoung Lee ◽  
Kwang-Yoon Jung ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Treatment Group ◽  
Proportional Hazards Model ◽  
Significant Risk ◽  
Disease Free Survival ◽  
Treatment Method ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Primary Surgery ◽  
Lower Stage

Background and Objectives Oropharyngeal cancers (OPCs) can be staged down to a lower stage with p16 positivity and de-escalated therapy has been the common practice. The aim of this study is to evaluate the survival outcomes based on various clinical factors in advanced OPC patients. Subjects and Method A total of 58 OPC patients in the stage IVA based on the American Joint Committee on Cancer 7th edition were treated with primary surgery or primary chemoradiation therapy from 2010 to 2016. A survival analysis was carried out using the Kaplan- Meier method, log-rank test, and Cox proportional hazards model. Results The median follow-up was 39.5 months. Thirty-eight and 20 patients received surgery- based and radiation therapy (RT)-based treatments, respectively. Clinical T-stage and treatment method were significant risk factors for 5-year disease-free survival (DFS) rate, and the treatment method was the only significant risk factor for overall-survival (OS) rate. 5-year DFS rate in the surgery-based treatment and RT-based treatment was 76.1% and 36.0% (p=0.001). On multivariate analysis, the surgery-based treatment group was associated with a significantly reduced hazard of death [the hazard ratio (HR) for the radiation-based treatment was 6.565 compared to the surgery-based treatment, p=0.002]. 5-year OS rate in the surgery-based treatment and RT-based treatment was 91.1% and 53.4% (p=0.003), respectively. On the multivariate analysis, the surgery-based treatment group was associated with a significantly reduced hazard of death (the HR for the radiation-based treatment was 7.544 compared to the surgerybased treatment, p=0.012). Conclusion The primary surgery-based treatment for advanced OPC showed a better survival outcome than the primary radiation-based treatment, irrespective of p16 positivity.

Prognostic value of lemur tyrosine kinase-3 (LMTK3) polymorphism in Japanese (J) patients (PTS) with localized gastric adenocarcinoma (GAC).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4088-4088
Author(s):  
Afsaneh Barzi ◽  
Takeru Wakatsuki ◽  
Wu Zhang ◽  
Dongyun Yang ◽  
Fotios Loupakis ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Gender Disparity ◽  
Rank Test ◽  
Tissue Samples ◽  
Direct Dna Sequencing ◽  
Estrogen Exposure ◽  
Increased Risk

4088 Background: LMTK3 is an estrogen receptor α (ERα) regulator. Recent studies show that [rs808419(r8) and rs9989661(r9)] and LMTK3 expression are prognostic in breast and colon cancers. Our group demonstrated that r9AA is associated with shorter time to recurrence in Caucasian(C) and Hispanic(H) females(F) with GAC. We investigated the significance of LMTK3 polymorphism in J PTS with GAC. Methods: Blood or tissue samples of 169 J PTS who had surgery with/without adjuvant chemotherapy (ACT) were analyzed. Genomic DNA was extracted using the QIAmp kit; all samples were analyzed using PCR-based direct DNA-sequencing. The endpoints of the study were disease-free survival (DFS) and overall survival (OS). Kaplan-Meier curves and log-rank test were used for univariate analysis. Multivariate analysis was performed to test the interaction between polymorphism and gender adjusting for other variables. Results: 60 F and 109 males were enrolled in this study, 17% stage(s) IB, 31% s II, 36% s III, 17% s IV (AJCC-6). The median age was 67(31-88). 65% of PTS received S-1 based ACT. Median follow-up was 4 years(ys). Prognosis was worse in men with r9 AA than AG/GG, at 1 year 67% (95% CI 40-83%) with AA vs 99% (95% CI 91-99%) of AG/GG were alive (p= 0.039). Median survival was not reached in the AG/GG group; in the AA group median DFS and OS was 1yr (p= 0.03) and 2ys (p= 0.039) respectively. In the multivariate analysis adjusting for s, age, and ACT, males carrying AA had increased risk of disease recurrence (HR 3.84 95%CI 1.86-7.92, p< 0.001) and dying (HR 3.47 95%CI 1.58-7.62 p=0.002) compared to those with AG/GG (HR=1, reference). Conclusions: r9 AA was associated with significantly worse DFS and OS in J male with GAC. These results confirm our previous findings that LMTK3 is an independent prognostic factor for localized GAC; interestingly the relationship between gender and prognostic significance is the opposite in J vs. C/H. The gender disparity can be due to the differences in the etiology (histological subtypes), management strategies, allele frequency, and degree of estrogen exposure in the two populations. Additional studies are warranted to identify the underlying biological mechanism.

Pathologic response and disease-free survival (DFS) after neoadjuvant trastuzumab (T) for HER2+ breast cancer (BC): Results from the National Cancer Institute (NCI) of Mexico.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11533-e11533
Author(s):  
Cynthia Mayte Villarreal-Garza ◽  
Enrique Soto-Perez-de-Celis ◽  
Erika Sifuentes ◽  
Yanin Chavarri Guerra ◽  
Santiago Ruano ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Ductal Carcinoma ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Rank Test ◽  
Her2 Breast Cancer

e11533 Background: The most accurate definition of pathologic complete response (pCR) in HER2+ BC patients (pts) receiving T-based neoadjuvant chemotherapy associated with improved DFS is controversial, particularly regarding the role of residual ductal carcinoma in situ (ypTis) and focal invasive residuals (ypT1mic). The effect of pCR on DFS in various subgroups of HER2+ BC is also uncertain. Methods: Pts with localized HER2+ BC that received T-based neoadjuvant chemotherapy at NCI between January 2007 and May 2012 were identified. We conducted an exploratory analysis of DFS in pts according to their tumor response. DFS curves were derived from Kaplan-Meier estimates and compared by log-rank test. Multivariate analysis was performed using Cox’s regression model. Results: 243 pts were included for analysis. Median follow-up was 39 months (mo). 49% of pts had no invasive and no in situ residuals at surgery (ypT0), 14.4% had ypTis/ypT1mic residuals and 36.6% had gross residual BC. DFS was significantly superior in pts with both ypT0 and ypTis/ypT1mic (no gross invasive residual BC) compared with those with gross residual disease (60.6 and 62.7 mo respectively vs. 51.6 mo, p=0.011 and 0.017). There was no difference in DFS between ypT0 and ypTis/ypT1mic pts (p=0.402). The rate of no gross invasive residual BC was significantly superior in pts with ER-PR- tumors compared with patients with ER+/PR+ tumors (69.9% vs. 56.7%, p=0.034). No gross invasive residual BC was associated with improved DFS in pts with HER2+ ER-/PR- (60.3 vs. 49.0 mo; p=0.005), as opposed to HER2+ ER+/PR+ tumors (61.0 vs. 51.6 mo; p=0.100). Multivariate analysis showed that tumor size (p=0.013) and no gross invasive residual BC (p=0.13) were associated with improved DFS in all subgroups. Conclusions: The absence of gross invasive residual BC was associated with improved DFS in pts with HER2+ BC treated with T-based neoadjuvant chemotherapy, particularly in those with HER2+ ER-/PR- BC. Our data suggest a comparable DFS in HER2+ BC patients with no gross invasive residual BC regardless of the presence or absence of both ypTis and ypT1mic disease after neoadjuvant treatment.

scholarly journals Radioactive iodine in the treatment of medullary thyroid carcinoma: a controlled multicenter study

2013 ◽  
Vol 168 (5) ◽  
pp. 779-786 ◽  
Author(s):  
J A A Meijer ◽  
L E H Bakker ◽  
G D Valk ◽  
W W de Herder ◽  
J H W de Wilt ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Multicenter Study ◽  
Radioactive Iodine ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Medullary Thyroid ◽  
Clinical Appearance ◽  
Significant Difference

ObjectiveRadioactive iodine (RAI) therapy in medullary thyroid carcinoma (MTC) is applied in some centers, based on the assumption that cross-irradiation from thyroid follicular cells may be beneficial. However, no systematic studies on the effect of RAI treatment in MTC have been performed. The aim of this study was to analyze the effect of RAI treatment on survival in MTC patients.DesignRetrospective multicenter study in eight University Medical Centers in The Netherlands.MethodsTwo hundred and ninety three MTC patients without distant metastases who had undergone a total thyroidectomy were included between 1980 and 2007. Patients were stratified by clinical appearance, hereditary stage, screening status, and localization. All patients underwent regular surgical treatment with additional RAI treatment in 61 patients. Main outcome measures were disease-free survival (DFS) and disease-specific survival (DSS). Cure was defined as biochemical and radiological absence of disease.ResultsIn multivariate analysis, stratification according to clinical appearance (P=0.72), hereditary stage (P=0.96), localization (P=0.69), and screening status (P=0.31) revealed no significant effects of RAI treatment on DFS. Multivariate analysis showed no significant difference in DSS for the two groups stratified according to clinical appearance (P=0.14). Owing to limited number of events, multivariate analysis was not possible for DSS in the other groups of stratification.ConclusionsBased on the results of the present analysis, we conclude that RAI has no place in the treatment of MTC.

Distant metastasis in head and neck cancer: Baseline factors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16021-e16021
Author(s):  
Rahul Krishnatry ◽  
Tejpal Gupta ◽  
Vedang Murthy ◽  
Sudhir Vasudevan Nair ◽  
Deepa Nair ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Rank Test ◽  
Advanced Tumor

e16021 Background: Loco-regional relapse is predominant pattern of failure in locally advanced head & neck squamous cell cancer (HNSCC). Distant metastasis (DM) is increasingly detected on follow-up. this study attempts to identify baseline patient, tumor & treatment characteristics which determine poor survival in radically treated HNSCC patients developing DM. Methods: Clinical outcome audit of HNSCC receiving radical treatment from 1990-2010 in a single HNCC radiotherapy (RT) clinic who developed DM, using electronic search of a prospectively maintained database. The Disease free survival (DFS) & overall survival (OS) were calculated using Kaplan Meier method. The Log rank test & Cox regression (p< 0.05 significant) were used for univariate & multivariate analysis respectively. Results: 104 HNC patients developed DM, baseline characteristics are shown in table 1. DM was detected at a median of 7(IQR 3-14) months from treatment completion & median survival after diagnosis of DM was 2.6 (0-6) months. The median DFS & OS were 19(13-26), 21.5(16-29) months respectively. On univariate analysis, factors affecting DFS & OS were advanced tumor and nodal stage, perinodal extension & treatment factors (surgery & RT gap >30 days). On multivariate analysis stage and PNE remained significant for DFS while only stage showed significance for OS. Conclusions: Locally advanced stage of presentation (stage IV, T4, N2+) is the most important baseline factor determining poor outcome in HNC patients developing DM. Trials for aggressive primary systemic treatment (chemotherapy, targeted agents) are needed. [Table: see text]

Clusterin expression (CLU) as a prognostic marker in colorectal carcinoma (CCR).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 563-563
Author(s):  
Julia Alcaide ◽  
Antonio Rueda ◽  
Isabel Rodrigo ◽  
Teresa Tellez ◽  
Rafael Funez ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Normal Mucosa ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Staining Procedure ◽  
Positive Staining

563 Background: Increased CLU is involved in malignant progression and anticlusterin treatment with antisense oligonucleotides enhances apoptosis induced by several citotoxics. However, clinical significance of CLU expression in human CRCs has been scarcely studied. We investigated whether changes in CLU could be related to carcinogenesis and survival (sv) of CRC patients (pts). Methods: Formalin-fixed and paraffin-embedded specimens were examined from 31 adenomas and 103 CRCs resected at Costa del Sol Hospital. The study was approved by Research Ethics Committee. Immunohistochemistry using monoclonal anti-α chain clusterin antibody (Upstate-Millipore, Watford, England) was performed, following standard staining procedure. CLU was scored as negative (CLU–) (no staining) or positive (CLU +) (>10% of tumor cells with strong staining). Cytoplasmic CLU in tumors was evaluated for cancer cells only, and in normal mucosa for epithelial cells only. Sv curves were calculated and plotted according to Kaplan-Meier method. Predictors that were significant at p<0.10 in univariate analysis, were entered into a Cox proportional hazards model for multivariate analysis, remaining significant at p<0.05. Results: Median follow-up was 54 months. Median age was 70 years (45-91). TNM stage distribution was: I (13%), II (48%), III (25%) and IV (14%). Epithelial normal cells were always CLU-, but 16% (5/31) of adenomas was CLU+ and this percentage increased in CRCs (30%, 31/103). Positive staining always presented an apical cytoplasmic pattern. Recurrence was more frequent in CLU+ (61%,19/ 31) than in CLU- tumors (37%, 27/72) and CLU was significantly associated with lower disease-free survival (DFS) (p<0.05). In multivariate analysis, CLU and stage remained significant independent prognostic factors for DFS (Table). Conclusions: CLU has a role in colon carcinogenesis and prognostic value. CLU is associated with decreased DFS among pts with CRCs. These findings have important implications for identifying CRC pts with more aggressive tumors who may benefit from targeted therapy against clusterin. [Table: see text]

scholarly journals Prognostic Factor in Patients with Advanced, Inoperable Thymic Carcinoma: An Application of the Lung Immune Prognostic Index

2021 ◽  
Author(s):  
Taisuke Araki ◽  
Kazunari Tateishi ◽  
Masamichi Komatsu ◽  
Kei Sonehara ◽  
Shintaro Kanda ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Thymic Carcinoma ◽  
Proportional Hazards Model ◽  
Palliative Chemotherapy ◽  
Prognostic Index ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Clinical Value

Abstract Background: The prognostic implications of palliative chemotherapy for advanced or recurrent thymic carcinomas require full elucidation. The lung immune prognostic index (LIPI) is a novel prognostic index whose effectiveness has recently been reported in lung cancer patients. This study aimed to evaluate the LIPI’s clinical value in advanced or recurrent thymic carcinoma patients. Methods: We retrospectively analyzed 41 advanced or recurrent thymic carcinoma patients undergoing palliative chemotherapy between January 2001 and December 2020. Survival-time analysis was conducted using the Kaplan–Meier method and log-rank test. Multivariate analysis using the Cox proportional hazards model was performed to investigate the LIPI’s predictive and/or prognostic value.Results: Median progression-free survival (PFS) for first line chemotherapy and overall survival (OS) were significantly longer in the good-LIPI group (LIPI: 0) than in the intermediate/poor-LIPI group (LIPI: 1 or 2) (PFS: 13.4 vs. 6.8 months, p=0.0425; OS: 48.2 vs. 28.9 months, p=0.00506.). Multivariate analysis revealed that serum albumin <3.5 g/dL and an intermediate/poor LIPI were independent adverse prognostic factors for OS. Moreover, an intermediate/poor LIPI was the only adverse prognostic factor for PFS. Conclusions: Our study indicates that the LIPI is a potential prognostic marker in patients with advanced or recurrent thymic carcinoma undergoing palliative chemotherapy.

Whole-brain radiotherapy in NSCLC patients with brain metastasis: Who benefits and by how much?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18068-e18068
Author(s):  
Pooja Jain ◽  
Amir H Montazeri ◽  
Farida Alam ◽  
Chinnamani Eswarvee ◽  
David J. Husband ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Brain Metastasis ◽  
Proportional Hazards Model ◽  
Dose Fractionation ◽  
Rank Test ◽  
Whole Brain ◽  
Radiotherapy Dose ◽  
Nsclc Patients

e18068 Background: NSCLC patients with brain metastasis have poor survival even with whole brain radiation therapy (WBRT) alone or in combination with surgery (S+WBRT). The aim of the audit was to identify any prognostic factors which can aid treatment decisions. Methods: A retrospective study of patients with brain metastasis from NSCLC, diagnosed between July 2008 and December 2010 was carried out. Patient characteristics, RPA score at the time of presentation, treatment modality, radiotherapy dose fractionation, time to progression, date of death and primary or secondary presentation were collected. The data was analysed using descriptive statistics; overall survival was calculated using the Kaplan-Meier estimates and compared with the Log-rank test. Multivariate analysis was carried using the Proportional Hazards Model. Results: Of the 156 patients included, 52% presented as primary manifestation and 48% as secondary. The mean age of the audit population was 64.4 year, with 60% of patients falling in the RPA II category. Histology was not available in 27 (18%) of the patients. Majority (79%) were treated with WBRT alone, 3 patients had stereotactic radiosurgery in combination with WBRT and 19% had S+WBRT. 9 (6%) patients did not complete WBRT. Median follow up is 3.8 months (0.5-34.5). Overall survival (OS) for the whole group is 4 months. Better survival was seen with S + WBRT (8 vs. 4 months, p <0.01) and primary presentation (5 vs. 4 months, p=0.009). RPA classification significantly influenced survival in the S + WBRT arm (12 months vs. 7 months for RPA I, p=0.009). On multivariate analysis of the various prognostic factors in the WBRT group, RPA classification and higher RT dose (30 Gy/10#) were associated with better survival (OR 2.3 95%CI 1.6-3.4). Patients treated with SRS have the best survival (11 months). Conclusions: RPA classification is the strongest predictor for outcome following treatment for brain metastasis. These findings can assist in better patient selection and optimising radiotherapy dose fractionation to improve survival outcome. It will be interesting to see if QUARTZ trial supports these findings and clarify the benefit of WBRT in patients with NSCLC.

Analysis of the GERCOR index in KRAS Exon2 WT patients with mCRC treated with salvage-line cetuximab-based chemotherapy: HGCSG0901.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 781-781
Author(s):  
Ayumu Hosokawa ◽  
Satoshi Yuki ◽  
Hiroshi Nakatsumi ◽  
Kazuteru Hatanaka ◽  
Yasushi Tsuji ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Performance Status ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Prognostic Impact ◽  
Significant Difference

781 Background: The GERCOR index (GI) based on performance status and serum LDH was reported to be useful to predict survival for patients with previously untreated mCRC. However, in the salvage setting, the validity of the GI has not been reported in patients treated with cetuximab (Cmab)-based chemotherapy. Methods: 269 patients with mCRC treated with Cmab contained chemotherapy were retrospectively registered from 27 centers in Japan. This analysis was included in the KRAS Exon2 wild type patients who were refractory to or intolerant of 5-FU / irinotecan/ oxaliplatin and were never administered anti-EGFR-antibody. Univariate and multivariate analysis for overall survival (OS) were performed using patient characteristics. Survival analyses were performed with the Kaplan-Meier method, log-rank test and the Cox proportional hazards model. The analysis was also designed to determine whether the GERCOR index could be extended to progression-free survival (PFS). Results: All data were available for prognostic categorization in 132 patients. Median OS and PFS were 9.8 and 4.3 months. The distribution and median OS / PFS for GI were as follows: low risk (L)(n = 28; 17.9/3.8 months), intermediate risk (I)(n = 52; 12.2/5.0 months), and high risk (H)(n = 52; 7.5/4.1 months). For OS, there was significant difference between L and H (p < 0.001) and between I and H (p < 0.001), but not between L and I (p = 0.076). For PFS, there was significant difference between I and H (p = 0.017), but not between L and I (p = 0.407), and between L and H (p = 0.222). In the Cox multivariate analysis, GI showed an independent prognostic impact (L vs. I ; HR 2.195, p=0.003 / L vs. H ; HR 4.028, p<0.001), but not predictive impact (L vs. I ; HR 0.987, p=0.958 / L vs. H ; HR 1.314, p=0.268). Conclusions: In this analysis, GI might be a prognostic factor in salvage treatment with Cmab-based chemotherapy.

Aspirin use and survival in head and neck squamous cell cancer (HNC) patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6042-6042 ◽  
Author(s):  
Hind Rafei ◽  
Catherine Lumley ◽  
Jim Han ◽  
Thomas M. Kaffenberger ◽  
Jessica H. Maxwell
Keyword(s):  
Early Stage ◽  
Medical Center ◽  
Cell Cancer ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Pi3k Pathway ◽  
Rank Test ◽  
Washington Dc ◽  
Kaplan Meier ◽  
Treatment Data

6042 Background: The phosphatidylinositol-3-kinase (PI3K) signaling pathway is the most common genetic alteration in HNC, particularly in oropharynx cancers (OPC). Up-regulation of the PI3K pathway enhances the production of prostaglandins inhibiting apoptosis in cancer cells. We hypothesized that aspirin (ASA) improves survival in HNC patients (pts) by counteracting the effects of prostaglandins. Methods: This is an IRB-approved retrospective cohort study of 584 veterans with HNC treated at the Washington DC Veterans Affairs Medical Center between 1995 and 2015. Charts were reviewed for clinical-pathologic and treatment data; recurrence/distant metastases; cause of death; and for the number, date and dose of ASA prescriptions. Pts who filled more than one prescription, excluding refills, after diagnosis of HNC were considered ASA users. All others were considered non-ASA users. The Kaplan-Meier method and log-rank test were used to compare disease-free survival (DFS) and disease-specific survival (DSS) between users and non-users. Results: 332 pts met inclusion criteria. Primary subsites included oropharynx (n = 146), larynx (n = 105), oral cavity (n = 62), and hypopharynx (n = 19). 86 pts were ASA users after diagnosis (25.9%) and more likely to be older (p = 0.002), African American (p = 0.03), never-alcohol users (p = 0.044), and have early stage cancer (I/II; p < 0.0005) compared to non-ASA users. Among all HNC pts, ASA users demonstrated significantly better 5-year (y) DSS (82%) compared to non users (43%; p = 0.009). 5-y DFS was also significantly higher among users (72%) vs non users (39%; p < 0.001). Among the OPC pts, 5-y DSS was higher for ASA users (74%) vs non users (41%; p = 0.024). 5-y DFS was also better for users (72%) vs non users (39%; p = 0.004). For stages III and IV, 5-y DFS was significantly higher among ASA users (64%) vs non users (44%; p = 0.035). 5-y DSS was higher as well in users (69%) vs non users (44%) but p = 0.098. On multivariate analysis, aspirin use remained an independent prognostic factor associated with improved DSS and DFS when accounting for age, race, gender, subsite, stage, tobacco and alcohol use. Conclusions: Aspirin use following diagnosis and curative treatment of HNC is associated with improved DSS and DFS.

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