Prognostic model for primary CNS lymphoma (PCNSL): Recursive partitioning analysis (RPA) of the MSKCC PCNSL population

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1531-1531 ◽  
Author(s):  
L. E. Abrey ◽  
L. Benporat ◽  
K. S. Panageas ◽  
J. Yahalom ◽  
L. M. Deangelis
Keyword(s):  
Overall Survival ◽  
Prognostic Model ◽  
Proportional Hazards ◽  
Prognostic Score ◽  
Performance Status ◽  
Univariate Analysis ◽  
Primary Cns Lymphoma ◽  
Cox Proportional Hazards ◽  
Cns Lymphoma ◽  
Analysis And Design

1531 Background: Increasingly there is a need to develop a simple prognostic score that can be used in the analysis and design of PCNSL studies as well as for clinical management. Recently the IELSG published a 3 group prognostic model incorporating patient age, performance status, serum LDH, location of brain lesions and CSF total protein; however, only 105 of their 378 patients had all of the variables available to develop this score. Methods: We analyzed 338 patients (median age 60; median KPS 70) seen and treated for PCNSL at MSKCC between 1983 and 2003. The median survival was 37 months and median follow up of surviving patients is 35 months. Univariate analysis of potential prognostic factors was performed using the Kaplan Meier product limit method. Significant univariate variables were included in a multivariate analysis using the Cox proportional hazards regression model. Patients were separately analyzed using the IELSG prognostic score. Finally, RPA was employed as an independent method of developing specific prognostic categories. Results: In the univariate analysis, age, hemiparesis, mental status changes, creatinine clearance and KPS were significant predictors of overall survival; in the multivariate model only age and KPS remained as significant predictors. 113 patients had adequate information (all 5 variables) to be analyzed using the IELSG prognostic score; while this correlated significantly with overall survival, the comparison between groups 2 and 3 was not statistically significant (p = 0.10). RPA of all 338 patients identified 3 subgroups: age ≤ 50 (median OS 9.2 y), age > 50 and KPS ≥ 70 (median OS 3.2 y) and age > 50 and KPS < 70 (median OS 1 y) that significantly separated our entire PCNSL population (p < 0.001). Conclusions: The use of RPA allows for easy discrimination of 3 prognostic groups of patients with PCNSL. In contrast to the IELSG score the MSK RPA classification includes information that is readily available on all patients and can be easily incorporated into the analysis or design of clinical research. No significant financial relationships to disclose.

Serum insulin to predict time to castration-resistant progression and overall survival in metastatic androgen-dependent prostate cancer (mADPCa).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16038-e16038
Author(s):  
Farshid Dayyani ◽  
Graciela M. Nogueras-Gonzalez ◽  
Rebecca Slack ◽  
Randall E. Millikan ◽  
Amado J. Zurita ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Cancer Progression ◽  
Proportional Hazards ◽  
Serum Insulin ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Insulin Levels ◽  
Castration Resistant

e16038 Background: Duration of response to androgen-deprivation therapy (ADT) is highly variable in patients with mADPC and prognostic markers are needed. Insulin resistance and hyperinsulinemia may contribute to prostate cancer progression. We hypothesized that pretreatment serum insulin levels would predict time to castration-resistant progression (PFS) and overall survival (OS). Methods: Sera from men treated on a randomized phase 3 trial of first line ADT vs. ADT plus chemotherapy were retrospectively analyzed using a multiplex ELISA for cytokines and angiogenic factors (CAFs). Univariate and multivariate Cox proportional hazards regression models were used to identify associations between CAFs and PFS/OS. Results: 66 pts were evaluable, 86% Caucasian, median age 72 yrs, median PSA 31.5ng/mL, 77% Gleason score of ≥8, and 53% high volume metastatic disease (HVM). Thirty-five pts received ADT; 31 pts received ADT+chemo. In univariate analysis, higher pretreatment insulin and C-peptide were positively correlated with PFS, whereas higher hepatocyte-growth factor (HGF), osteopontin (OPN) and HVM were negatively correlated with PFS. In multivariate analysis, only higher insulin was associated with longer PFS (HR=0.72, 95%CI 1.32 -0.87; p<0.001), whereas higher HGF and OPN were associated with reduced PFS (HR=1.82, 95%CI 0.59-2.83, p<0.01 and HR=1.81, 95%CI 1.18-2.47, p<0.001, respectively). Higher Insulin and Program Death 1 (PD1) were associated with longer OS on multivariate analysis (HR=0.78 p<0.02 and HR=0.55 p<0.02, respectively), whereas HVM and higher OPN were associated with reduced OS (HR=2.28 p<0.01 and HR=1.60 p<0.02). Using low insulin, high HGF and high OPN as 3 independent risk factors (RF), 3 distinct risk groups could predict PFS: good (zero RF), intermediate (1 or 2 RF) and poor risk (3 RF), with median PFS of 6.90, 1.97, and 0.86 years, respectively (p<0.001). Conclusions: Higher pretreatment insulin was associated with prolonged PFS and OS in men with mADPC treated with ADT. Our data suggest that insulin levels are a biomarker for sensitivity to ADT and highlight the complex interactions between metabolism and PCa progression.

Does up-front definitive surgical resection with delayed chemotherapy in patients with stage IV rectal cancer compromise overall survival?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 586-586
Author(s):  
Bindu V. Manyam ◽  
Shlomo A. Koyfman ◽  
Davendra Sohal ◽  
Ismail Mallick ◽  
Chandana A. Reddy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Surgical Resection ◽  
Proportional Hazards ◽  
Performance Status ◽  
Rectal Adenocarcinoma ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Significant Difference ◽  
Poorly Differentiated

586 Background: Definitive resection of the primary is frequently part of the management of patients (pts) with stage IV rectal cancer with good performance status and low volume of systemic metastases. It is unclear whether delaying systemic therapy for up front surgical management of the primary compromises overall survival (OS). Methods: Pts with metastatic rectal adenocarcinoma who received definitive surgical resection between 1998-2011 were identified in an IRB approved registry. The sequencing of CT and surgery, and the use of perioperative radiation therapy (RT), was at the discretion of treating physicians. Preoperative chemotherapy (Pre-CT) regimens included 5-fluorouracil (5-FU) +/- leukovorin (LV), capecitabine, 5-FU/LV/oxaliplatin +/- avastin, or 5-FU/LV/irinocetan. RT dose was typically 50.4 Gy. OS was measured from the date of diagnosis. Baseline variables were compared using the Chi-square and unpaired t-tests. OS was calculated using the Kaplan Meier method. Univariate (UVA) and multivariate analysis (MVA) were performed using Cox proportional hazards regression to identify variables associated with OS. Results: In this study of 115 pts, 75 (65%) were treated with pre-CT, while 40 (35%) were treated with up front surgery. Of the pts who received surgery up front, 3 (8%) received RT and of the pts who received pre-CT, 62 (83%) received RT. The cohort was predominantly male (70%) with a median age of 57, median KPS of 80, and median follow-up of 24.1 months. 94% of pts had T3/T4 tumors, 80% had N+ disease, and 33% had poorly differentiated tumors. Liver directed therapy (LDT) was performed in 61% of pts. There was no significant difference in OS (32.3 vs. 32 months; p = 0.24) between pts treated with pre-CT and those who received surgery up front, respectively. UVA demonstrated that pre-CT was not associated with OS (HR 1.26; p = 0.544). MVA demonstrated that pts with poorly differentiated tumors (HR 2.04; p = 0.007) and those that did not undergo LDT (HR 2.45; p = 0.001) had inferior survival. Conclusions: Delaying systemic chemotherapy in order to achieve local control with surgical resection up front does not appear to impact OS in pts with stage IV rectal cancer.

The neutrophil to lymphocyte ratio as a prognostic factor among a diverse population with advanced pancreatic cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15729-e15729
Author(s):  
Michael Shusterman ◽  
Erin Jou ◽  
Andreas Kaubisch ◽  
Jennifer W. Chuy ◽  
Lakshmi Rajdev ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Metastatic Disease ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Advanced Pancreatic Cancer ◽  
Cox Proportional Hazards ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio

e15729 Background: The neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammatory response, has been suggested as a prognostic marker in patients with pancreatic adenocarcinoma (PAC). Black and Hispanic patients have been underrepresented in studies evaluating the significance of NLR in PAC. We investigated the prognostic significance of NLR in patients with advanced PAC treated at the Montefiore-Einstein Center for Cancer Care (MECCC) in the Bronx, NY. Methods: We included patients who were chemotherapy naive and treated for unresectable or metastatic PAC at MECCC between 2006 and 2015. Demographics, clinical characteristics and treatment data were collected. Overall survival was determined by the Kaplan-Meier method and Cox proportional-hazards models were built to assess survival differences adjusting for clinically relevant and statistically significant variables. Results: 201 patients were included in the study. Median age was 65 (range 32, 90). 52% were male. 41 were White (19%), 71 Black (33%), 71 Hispanic (33%), and 33 Other (15.3%). 66 (30.6%) had unresectable disease and 135 (62.5%) metastatic disease. An NLR ≥ 4 was associated with a worse OS compared to an NLR ≤ 4 (median 10 vs. 16.4 months; HR 1.895; 95% CI 1.390, 2.585; P < 0.0001). Predictors of worse OS on univariate analysis were ever smoker status (HR 1.365; P = 0.05), metastatic disease (HR 1.736; P = 0.001), and albumin ≤ 3.5 g/dL (HR 2.558; P< 0.0001). An NLR ≥ 4 on multivariate analysis remained significantly associated with worse OS (HR 1.665; 95% CI 1.188, 2.334; P = 0.003) after adjusting for age, gender, ever smoker status, metastatic disease, and albumin. Conclusions: In a cohort with significant minority patient representation, an NLR ≥ 4 was associated with significantly worse overall survival in patients with advanced pancreatic cancer. An elevated NLR in advanced PAC may be an important independent predictor to risk stratify patients and predict poor OS in future analyses.

Factors associated with receipt and overall survival of concurrent chemoradiotherapy versus single modality therapy in unresectable stage III NSCLC.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18191-e18191
Author(s):  
Jorge E. Gomez ◽  
Kellie Ryan ◽  
Priyanka J. Bobbili ◽  
Akanksha Dua ◽  
Maral DerSarkissian ◽  
...  
Keyword(s):  
Overall Survival ◽  
Systemic Therapy ◽  
Concurrent Chemoradiotherapy ◽  
Proportional Hazards ◽  
Performance Status ◽  
Cox Proportional Hazards ◽  
Stage Iii ◽  
Unresectable Stage ◽  
Stage Iii Nsclc ◽  
Single Modality

e18191 Background: While concurrent chemoradiotherapy (cCRT) is standard of care for patients (pts) with unresectable stage III non-small cell lung cancer (NSCLC), some pts receive single modality therapy. This study identified predictors of therapy and differences in overall survival (OS) in a Medicare population. Methods: This retrospective study used Surveillance, Epidemiology and End Results -Medicare data (2009-2014). Stage III NSCLC pts aged ≥65 yrs, with ≥1 claim for systemic therapy or radiotherapy (RT) within 90 days of diagnosis were included. cCRT pts had overlapping claims for chemotherapy and RT ≤90 days from start of therapy; remaining pts were grouped by first therapy received. Sequential CRT patients and those with surgical resection of tumor were excluded from this analysis. Logistic regression was used to analyze predictors of cCRT. Multivariable Cox proportional hazards models were used to compare OS between therapies. Results: Of 4,544 pts identified, 51% received cCRT, 21% systemic therapy, and 27% RT. Across groups, cCRT patients were likely younger (p < 0.001), White (p < 0.001), male (p = 0.015), and with a good predicted performance status (PS) (p < 0.001). After adjustment, several variables were predictive of receiving cCRT (Table). Median OS was 14.7 months (mo) for cCRT vs. 10.9 mo for systemic therapy (adjusted hazard ratio [HR]: 1.36, 95% CI: 1.24-1.49, p < 0.001) vs. 7.8 mo for RT (adjusted HR: 1.55, 95% CI: 1.42-1.69, p < 0.001). Conclusions: Only 51% of pts received cCRT. Age, race, stage, PS and comorbidity index were predictive of cCRT. Given the survival benefit, physicians should be encouraged to pursue cCRT in all eligible pts. Further efforts to develop less morbid therapies are critical in this population. [Table: see text]

Treatment of Primary CNS Lymphoma with Induction High-Dose Methotrexate, Temozolomide, Rituximab Followed by Consolidation Cytarabine/Etoposide: A Pilot Study with Biomarker Analysis.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1364-1364 ◽  
Author(s):  
Samar Issa ◽  
Arthur Shen ◽  
Jon Karch ◽  
Cigall Kadoch ◽  
Marc Shuman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Performance Status ◽  
Primary Cns Lymphoma ◽  
Immunohistochemical Analysis ◽  
Cns Lymphoma ◽  
High Dose ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Brain Irradiation ◽  
Biomarker Analysis

Abstract Background: There is no consensus on the optimal treatment for patients diagnosed with primary CNS lymphoma (PCNSL). The goals of this study were: to determine the safety and efficacy of a methotrexate (MTX)-based induction therapy followed by high-dose consolidation chemotherapy and the elimination or deferral of whole brain irradiation, to identify molecular markers in PCNSL which predict sensitivity to chemotherapy and outcome. Methods: 23 newly diagnosed, CD20-positive, immunocompetent PCNSL patients were treated with combination high-dose intravenous MTX (8 gm/m2), temozolomide (150 mg/m2/day) and intravenous rituximab (375 mg/m2) (MTR). Patients in complete remission (CR) after eight courses of MTX were offered consolidation with high-dose cytarabine (2 g/m2 x 8 doses) and etoposide (40 mg/kg over 96 hours) (AE). Candidate markers of outcome in PCNSL were identified by gene expression profile analysis of an independent, multicenter dataset of PCNSL tumors. Immunohistochemical analysis of one of these markers, death-associated protein-1 (DAP-1), was performed on paraffin sections of tumors from 18 of the patients treated with the MTR regimen. Results: MTR induction followed by AE consolidation was well tolerated with no treatment-related mortality or evidence for neurotoxicity. Thirteen patients (56.5%) attained CR with induction; 8 received consolidation; 5 in CR refused AE. Median progression-free (PFS) and overall survival (OS) has not yet been reached with a median follow-up of 33 months. Karnovsky performance status (KPS) correlated with improved survival (p<0.0281). Expression by lymphoma cells of DAP-1, a regulator of apoptosis, was associated with improved progression-free survival (p<0.03) and overall survival (p<0.038). Conclusions: Combination MTR followed by AE is well tolerated in PCNSL. PFS appears at least similar to regimens that contain whole brain irradiation. A multi-center study has been initiated to further evaluate this regimen. DAP-1 may be a tumor suppressor whose expression in PCNSL predicts a favorable response to MTX-based therapy.

scholarly journals Prognostic Variables of Younger-Aged Cervical Carcinoma Patients: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Emmanuel Kwateng Drokow ◽  
Lanlan Xu ◽  
Gloria Selorm Akpabla ◽  
Hafiz Abdul Waqas Ahmed ◽  
Juanjuan Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Lymph Node ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Surgical Margin ◽  
Cox Proportional Hazards ◽  
Tumour Stage ◽  
Younger Women ◽  
Node Metastases

Purpose. The prevalence of carcinoma of the cervix is increasing in younger women. This study aimed to evaluate the sociodemographic, pathological, and clinical features, prognosis, and treatment of women aged ≤35 years with carcinoma of the cervix (CC). Methods and Materials. We retrospectively analysed the clinical information of 352 younger women with carcinoma of the cervix aged ≤35 years at the Gynaecological Oncology Department of Zhengzhou University People’s Hospital from April 2000 to January 2018. The overall survival was evaluated with the Kaplan–Meier model, and the log-ranked analysis was compared with the univariate analysis to determine prognostic survival-related risk factors. Cox Proportional Hazards analysis was further used in analysing parameters correlated with survival after univariate analysis. A p value <0.05 was considered statistically significant. SPSS version 23.0 was used for the data analysis. Results. The most frequent histopathological type observed in the selected 352 younger women was squamous cell carcinoma (SCC) (n = 221, 62.9%), adenocarcinoma (n = 125, 35.5%), and adenosquamous carcinoma (n = 6, 1.7%). The 5-year overall survival time was 80.5%. The prognostic risk factors discovered through univariate analysis were tumour stage (IA1-IIB vs. IIIA-IVA) (89.2% vs. 35.1%: p value = 0.002), histological type (SCC vs. non-SCC) (95.7% vs. 56.2%: p value = 0.001), surgical margin (negative vs. positive) (90.9% vs. 41.2%: p value = 0.001), and pelvic lymph node metastasis (no vs. yes) (93.4% vs. 39.2%: p value = .001). The Cox proportional hazards test demonstrated that lymph node metastases ([HR] = 2.924, 95% CI: 1.432–7.426; p = 0.014 ), tumour stage IIIA-IVA ([HR] = 3.765, 95% CI: 1.398–9.765; p = 0.016 ), and surgical margin ([HR] = 2.167, 95% CI: 1.987–9.554; p = 0.019 ) were independent prognostic risk factors for overall survival in younger women with cervical carcinoma. Conclusion. In conclusion, the status of lymph node metastases, tumour stage, and surgical margin and the type of histopathology substantially influence the rate of survival.

Clinicopathologic predictors of distant metastasis in head and neck cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6086-6086
Author(s):  
F. C. Holsinger ◽  
W. Dong ◽  
N. Bekele ◽  
R. S. Weber ◽  
M. S. Kies ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Distant Metastasis ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Primary Presentation

6086 Background: Despite advances in achieving improved locoregional control for patients with head and neck cancer (HNC), overall survival has not improved in the last 30 years. Several studies have implicated distant metastasis as a potential cause, hindering progress in the treatment of HNC. However, little is known about which patients fail systemically. We therefore sought to identify clinico-pathological factors that are associated with distant metastasis as the only cite of failure. Methods: We retrospectively studied 389 patients with head neck squamous cell carcinomas with distant metastases as the primary site of failure excluding all patients with locoregional recurrence and those receiving chemotherapy at primary presentation. The median follow up period was 5.3 years. An estimate of the risk of DM and DM free survival by prognostic factors was calculated using multivariate analysis and Cox proportional modeling. Results: Overall, 11% (43/389) of the patients developed DM. With univariate analysis, site of the tumor arising within the laryngopharynx, T stage (T3–4), N stage>2, and metastasis to level IV were significantly associated with DM. However, using Cox proportional hazards regression modeling, two clinicopathologic variables, N classification >N2b and diminishing degree of histologic differenention, were found to be most significantly associated with the development of systemic, distant metastasis. For patients staged as N2b or N2c, there was a relative risk (RR) of 6.13 (95% CI: 2.61 - 14.38; p < 0.0001) for developing DM. For patients staged as N3, the RR was 8.23 (95% CI: 2.39 - 28.38; p < 0.001). For patients with poorly differently HNSCC, RR was 11.01 (95% CI: 1.42 - 85.15; p = 0.022) Conclusions: Recognizing patients at primary presentation with tumors with the highest risk for the development of DM might le us to selectively treat them aggressively with systemic therapy to eradicate the tumor, thus improving overall survival rates. No significant financial relationships to disclose.

scholarly journals Low preoperative serum ALB level is independently associated with poor overall survival in endometrial cancer patients

2020 ◽  
Author(s):  
Jia Lei ◽  
Yue Wang ◽  
Xiangqian Guo ◽  
Shuping Yan ◽  
Dimeng Ma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Prognostic Factor ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Independent Prognostic Factor ◽  
Poor Overall Survival ◽  
Preoperative Serum

Aim: To reveal the prognostic significance of serum albumin (ALB) concentration in endometrial cancer (EC) patients in China. Patients & methods: 345 EC patients were enrolled in a single center, and the preoperative serum ALB concentration were measured. Kaplan–Meier curve analysis and Cox proportional hazards regression model were performed to evaluate the associations between ALB concentration and overall survival (OS) of EC patients. Results: The EC patients with lower preoperative serum ALB concentration exhibited a significantly poorer OS (p < 0.05). Univariate analysis and multivariate analysis indicated that serum ALB concentration was an independent prognostic factor of unfavorable OS for EC patients. Conclusion: Our results showing that ALB concentration may serve as an independent prognostic factor for EC patients.

scholarly journals Glycemic Control as an Early Prognostic Marker in Advanced Pancreatic Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Ipek Alpertunga ◽  
Rabail Sadiq ◽  
Deep Pandya ◽  
Tammy Lo ◽  
Maxim Dulgher ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Proportional Hazards ◽  
Performance Status ◽  
Univariate Analysis ◽  
Advanced Pancreatic Cancer ◽  
Community Setting ◽  
Cox Proportional Hazards ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Pre Treatment

PurposeImpaired glucose metabolism is present in most patients with pancreatic ductal adenocarcinoma (PDAC). Whereas previous studies have focused on pre-treatment glycemic indices and prognosis in those with concomitant diabetes, the effects of glycemic control during chemotherapy treatment on prognosis, in patients with and without diabetes, have not been well characterized. We examined the relationship between early glycemic control and overall survival (OS) in a cohort of patients with advanced PDAC treated in a community setting.Patients and MethodsSeventy-three patients with advanced PDAC (38% with diabetes) receiving chemotherapy while participating in a biobanking clinical trial were included. Clinical characteristics and laboratory results during 1 year were obtained from the electronic medical record. Kaplan-Meier estimate, log-rank test and hazard ratios were computed to assess the effect of glycemic control on OS. The Cox proportional hazards regression model was applied to ascertain the significance of glycemic control with other survival variables.ResultsOne thousand four hundred eighteen random blood glucose (RBG) values were analyzed. In accord with previous findings, a 50% decline in the serum tumor marker CA 19-9 at any time was predictive of survival (P=0.0002). In univariate analysis, an elevated pre-treatment average RBG, 3-month average RBG (RBG-3) and the FOLFIRINOX regimen were associated with longer survival. Based on ROC analysis (AUC=0.82), an RBG-3 of 120 mg/dl was determined to be the optimal cutoff to predict 12-month survival. In multivariate analysis that included age, stage, BMI, performance status, presence of diabetes, and chemotherapy regimen, only RBG-3 maintained significance: an RBG-3 ≤120 mg/dl predicted for improved OS compared to &gt;120 mg/dl (19 vs. 9 months; HR=0.37, P=0.002). In contrast, an early decline in CA 19-9 could not predict OS.ConclusionLower glucose levels during the first 3 months of treatment for advanced PDAC predict for improved OS in patients both with and without diabetes. These results suggest that RBG-3 may be a novel prognostic biomarker worthy of confirmation in a larger patient cohort and that studies exploring a possible cause and effect of this novel survival-linked relationship are warranted.

Timeliness of adjuvant chemotherapy in patients with resected pancreatic cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18038-e18038
Author(s):  
David Deng ◽  
Winson Y. Cheung
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Proportional Hazards ◽  
Performance Status ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Study Cohort ◽  
Ecog Performance Status

e18038 Background: Timeliness of adjuvant chemotherapy is an important predictor of survival for patients with breast and colorectal cancer whereby long delays has been shown to detrimentally impact outcomes. The effects of adjuvant treatment timing remain largely unknown for early pancreatic cancer. This study aims to identify independent predictors of treatment timeliness and overall survival in this patient population. Methods: We conducted a retrospective, population-based analysis of 179 patients with resected pancreatic cancer who subsequently started adjuvant chemotherapy between 2008 and 2014 at any 1 of 6 cancer centers across British Columbia, Canada. Logistic regression was used to identify predictive factors for adjuvant chemotherapy timing. Prognostic factors for survival were ascertained using multivariate Cox proportional hazards models. Results: Our study cohort included 91 men (51%) and 88 women (49%). At time of diagnosis, 145 patients (81%) had nodal involvement and 107 patients (60%) had good ECOG performance status (ECOG 0-1). The median age of diagnosis was 67 (range 37-85) years. The median interval between surgery and start of adjuvant chemotherapy was 70 (range 19-46) days. Abnormal bilirubin was the only factor significantly correlated with delayed chemotherapy (OR, 3.89; 95% CI, 1.55-9.73; P = 0.004). Median overall survival was 468 days following resection (95% CI, 425-538). Multivariate survival analysis showed that high CA 19-9 levels (HR, 2.44, 95% CI: 1.36-4.40, P = 0.003) and abnormal bilirubin (HR, 0.40; 95% CI, 0.22-0.73; P = 0.003) were prognostic factors for overall survival. Median survival for patients who waited up to 35, 70 or 105 days for chemotherapy following resection were 588 days (95% CI, 270-776), 490 days (95% CI, 360-688) and 466 days (95% CI, 432-538) respectively. Overall, timeliness was not predictive of survival (HR, 1.12; 95% CI, 0.64-1.97; P= 0.70). Conclusions: Patients with hyperbilirubinema experienced delays in adjuvant chemotherapy, likely due to the need for relief of biliary obstruction and subsequent recovery. However, timeliness of adjuvant chemotherapy did not influence outcomes, suggesting that treatment should still be considered irrespective of timing.

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