Neoadjuvant Cisplatin Chemotherapy Before Chemoradiation: A Flawed Paradigm?

2007 ◽  
Vol 25 (33) ◽  
pp. 5281-5286 ◽  
Author(s):  
Rob Glynne-Jones ◽  
Peter Hoskin
Keyword(s):  
Local Treatment ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Free Survival ◽  
Palliative Intent ◽  
New Strategy ◽  
Meta Analyses ◽  
Disease Free ◽  
Selection Of Patients ◽  
Selection Of

Effective chemotherapy (CT) treatment of solid tumors emerged with the introduction of anthracyclines and platinum CT in the late 1970s, at first with palliative intent, and later extended into the adjuvant setting. High response rates led to the belief that systemic CT might improve locoregional control and also decrease the risk of distant metastases. A new strategy advocated cisplatin-based neoadjuvant CT (NACT) before definitive local treatment—either surgery or radiotherapy (RT). Response to NACT was viewed as a favorable prognostic sign, which allows the selection of patients most likely to benefit from RT or chemoradiotherapy (CRT). The aim of this discussion is to raise the debate regarding NACT in reducing metastases, improving local control and selecting out good responders for nonsurgical treatment in the following sites: head and neck, esophagus, cervix, anus, nasopharynx, and bladder; as well as non–small-cell lung cancer. NACT has almost invariably failed to deliver an improved outcome in terms of disease-free survival (DFS) or overall survival (OS) when delivered before RT or CRT in all solid tumor sites. The evidence that NACT may improve outcome in terms of DFS or OS is strongest when it is administered before surgical resection, but remains scant before RT or CRT. Taxane-containing regimens look more promising than does cisplatin NACT, but have not been shown to improve on concurrent CRT. Future meta-analyses should compare induction CT followed by RT and induction followed by CRT versus RT or CRT alone.

TP1.2.3Oncological Outcomes of Organ Preservation Strategies - Local Excision Procedures and ‘Watchful Waiting’ In Management of Low Rectal Cancers – A Systematic Review And Meta-Analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
A R Aspari ◽  
V Ramesh ◽  
G Kumar ◽  
S N Narayanasamy ◽  
A O Gumber ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Local Recurrence ◽  
Organ Preservation ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Free Survival ◽  
Rectal Cancers ◽  
Disease Free

Abstract Objective To evaluate local recurrence, metastases, and survival outcomes of `wait and watch’ (WW) strategy and local excision (LE) of tumours, in comparison to the present standard practice of total mesorectal excision (TME) for locally advanced rectal cancers. Data Sources MEDLINE, EMBASE, PubMed databases, and sources of Grey literature. Study Selection Randomised and non-randomised prospective studies, retrospective studies with propensity-score-matched analyses. Data Extraction and Synthesis These were carried out independently by two reviewers. A random-effects methodology was used for meta-analyses. Data was presented keeping with the 27-item PRISMA checklist. Main Outcomes The primary outcomes of interest were local recurrence, distant metastases, disease-free-survival and overall-survival, which were assessed in comparison to those associated with radical surgeries (TME). Results 7 of the 16 studies in the systematic review were included for the quantitative synthesis and meta-analysis. Local recurrence rates were comparable amongst patients in WW group and LE group to those undergoing TME. [Risk ratio (RR) 3.07/1.41; 95% Confidence Interval (CI) 0.86-10.95/0.66-3.01; P = 0.08/P=0.89 respectively]. Rates of distant metastases in the WW group and LE group were comparable to those undergoing TME [RR = 0.71/0.94; 95% CI 0.22-2.30/0.55-1.61; P = 0.56/ P = 0.83 respectively]. The median 3-year disease-free survival among patients undergoing WW, LE procedure, and TME were 88%, 80%, and 78.2% respectively; and the median 3-year overall survival among the three groups were 96%, 93%, and 89.5% respectively. Conclusions and Relevance Organ-preservation strategies appear to be a viable treatment option in the management of rectal-cancers. Further research is warranted to provide stronger levels of evidence on organ-preservation strategies.

scholarly journals Therapeutic Concepts for Oligometastatic Gastrointestinal Tumours

2020 ◽  
Vol 36 (5) ◽  
pp. 359-363
Author(s):  
Jens Ricke ◽  
Christoph Benedikt Westphalen ◽  
Max Seidensticker
Keyword(s):  
Treatment Guidelines ◽  
Local Treatment ◽  
Disease Free Survival ◽  
Free Survival ◽  
Organ Systems ◽  
Therapeutic Concepts ◽  
Gastrointestinal Tumours ◽  
Definition Of ◽  
Disease Free ◽  
Systemic Therapies

<b><i>Background:</i></b> Clinical trials have proven a survival benefit from applying local therapies for oligometastatic cancers of various origin. <b><i>Summary:</i></b> Today, the definition of oligometa­static disease is based on limited lesion numbers and organ systems involved. Treatment guidelines by the European Organisation for Research and Treatment of Cancer (EORTC), European Society for Medical Oncology (ESMO) and several other groups suggest a threshold of up to 5 tumours. Established biological markers indicating the aggressiveness of a given tumour (and therefore suggesting local treatment only or the addition of or complete switch to systemic therapies) are missing, except for disease-free survival, the only recommended parameter for patient selection beyond lesion count. <b><i>Key Message:</i></b> The following article discusses clinical implications as well as local techniques established for the treatment of oligometastatic disease.

Can High Dose Therapy Change the Course of Low Grade Lymphoma? A Study Considering Patients as Their Own Control.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1882-1882
Author(s):  
Stephane Vignot ◽  
Nicolas Mounier ◽  
Guillaume Sergent ◽  
Pauline Brice ◽  
Jean-Pierre Marolleau ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Tumor Burden ◽  
High Dose ◽  
Low Grade ◽  
High Dose Therapy ◽  
Free Survival ◽  
Dose Therapy ◽  
New Strategy ◽  
Disease Free

Abstract Low grade lymphoma patients (pts) have an indolent evolution with median survival ranging between 8–10 years. During disease’s course, high dose therapy (HDT) and autologous stem-cell transplantation (ASCT) can be considered as an alternative to sequential chemotherapies. However, efficacy of this strategy remains controversial. The purpose of our study is to evaluate ASCT efficacy by comparing retrospectively for each pts disease free survival (DFS) after ASCT with DFS observed with pts’ last chemotherapy regimen (LCR) just before intensification. Between apr 1988 and feb 2002, 109 low grade lymphoma pts were treated with HDT and ASCT in our department, 61 were male, the median age was 49 yrs [range 28–65]. Histological subtypes were mostly follicular small cell (86 %). At time of diagnosis, LDH were normal for 85 pts; 60 pts had high tumor burden. IPI was 0 for 16 %, 1 for 70 % and 2 for 14 %. Prior to ASCT, pts had experienced a median of 2 progressions (range 1 to 5). At time of graft, 102 pts present complete or partial response and 7 pts present stable disease. Two principal intensification chemo regimens were used before ASCT: VP16/cyclophosphamide in 84 pts and BEAM in 12. TBI was associated for 86 pts. At June 2002, the median follow up was 6.4 yrs from diagnosis and 4.5 yrs from ASCT. 3 years after ASCT, survival rate was 72 % and DFS rate was 50 %. Median DFS decreased with nb of progression (p=0.02): Median DFS according to nb of progression Nb of progression 1 2 3 > 3 Nb pts (%) 17 (16) 57 (52) 28 (26) 7 (6) Median DFS in yrs 6.4 5.1 1.8 1.0 Considering pt with more than 1 progression (n=92) as his own control, DFS was longer after ASCT than after LCR for 61 % of pts. Median DFS was 2.5 yrs after ASCT and 2.0 yrs after LCR. At 3 yrs, DFS rate was 48 % after ASCT and 37 % after LCR (p<0,001): Figure Figure This study demonstrates that HDT and ASCT significantly increase DFS in comparison with the LCR for low grade lymphoma patients. Such methodology could be useful to evaluate new strategy incorporating monoclonal antibody.

Selection of Unrelated Allogeneic Hematopoietic Cell Donors Based on KIR3DL1 Allotypes Is Feasible and Results in Improved Disease-Free Survival in Transplant Recipients with MDS and AML

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 990-990
Author(s):  
Brian C. Shaffer ◽  
Glenn Heller ◽  
Jean-Benoit Le Luduec ◽  
Jack Vahradian ◽  
Miguel Perales ◽  
...  
Keyword(s):  
Research Funding ◽  
Disease Free Survival ◽  
Hematopoietic Cell ◽  
No Donors ◽  
Free Survival ◽  
Inhibitory Signal ◽  
Improved Outcomes ◽  
High Degree ◽  
Disease Free ◽  
Selection Of

Abstract Donor natural killer (NK) cells impart a potent anti-leukemia effect after allogeneic hematopoietic cell transplantation (allo HCT). The killer Ig-like receptors (KIR) play a central role in modulating NK effector function. Chief among them, the inhibitory KIR3DL1 exhibits a high degree of allelic polymorphism. We previously demonstrated that highly expressed KIR3DL1 alleles (KIR3DL1 allele groups *001 and *002) bind preferentially to HLA-Bw4 with I80 to confer a high degree of inhibitory signaling. Similarly, poorly expressed KIR3DL1 alleles (KIR3DL1 allele groups *005 and *007) bind to HLA-Bw4 with T80 to confer a strong inhibitory signal. In a retrospective cohort of 299 patients undergoing allo HCT for AML, we demonstrated that these highly inhibitory donor KIR3DL1/recipient HLA-Bw combinations (KIR3DL1-HIGH) resulted in a greater incidence of recipient relapse when compared to other donor/recipient KIR3DL1/HLA-Bw pairings with low or absent inhibitory signal (KIR3DL1-LOW/NO). (Giglio F et al, ASH Annual Meeting Abstracts, 2012) Here, we evaluated whether it was feasible to prospectively type and use KIR3DL1 allotypes in unrelated allo HCT donor selection, and whether this intervention would result in improved outcomes in patients undergoing transplant for AML and MDS. We performed PCR-SSP based intermediate resolution KIR3DL1 allele typing on all unrelated adult donors evaluated for patients with MDS and AML at our center from 2013 to present as previously described. (Boudreau J et al, PLoS One, 2014) KIR3DL1 status was provided to the treating physicians, who made the final donor selection. A total of 941 prospective allo HCT donors underwent high resolution HLA typing and KIR3DL1 allotyping for 252 patients (median per patient = 4, range 1-12). Among all donors evaluated, 27% were found to be KIR3DL1-HIGH when considering the respective recipient HLA-Bw. Having multiple donors evaluated improved the likelihood of avoiding a KIR3DL1-HIGH donor: Among recipients with one donor evaluated, 27% had only KIR3DL1-HIGH donors available compared to 12% in recipients with 2-3 donors evaluated and 4% for recipients with >3 donors evaluated (P < 0.0001). Among all evaluated patients, 41% had both KIR3DL1-HIGH and KIR3DL1-LOW/NO donors available, indicating a potential selection based on KIR3DL1 was possible. Among 252 patients evaluated, 115 proceeded to allo HCT (48 with MDS, 67 with AML). The median age at transplant was 62 years (range 3.6-78). Donors were HLA matched in 105 transplants and were single loci mismatched in 10 transplants. Conditioning was myeloablative in 73 (11 with total body irradiation). GVHD prophylaxis was with ex vivo CD34+ selection in 65 patients and with tacrolimus/methotrexate in the remaining patients. The median follow-up in transplanted patients was 13.1 months (range 0.5-43.3 months). On univariate analysis, the 2-year disease-free survival was 64% (95% confidence interval: 54-76%) in those with KIR3DL1-LOW/NO donors versus 39% (22-68%) in recipients with KIR3DL1-HIGH donors (P = 0.05). The incidence of relapse was similar but favored patients with KIR3DL1-LOW/NO donors (26% [15-37%] versus 35% [13-57%], P = 0.5). 2-year overall survival was similar between those with KIR3DL1-LOW/NO versus KIR3DL1-HIGH donors (75% [65-86%] versus 69% [52-91%], P = 0.43). The time from the initiation of a formalized donor search to transplant did not differ between recipients with KIR3DL1-LOW/NO versus KIR3DL1-HIGH donors (median 81 v. 83 days, respectively, P = 0.97). Recipients with KIR3DL1-LOW/NO donors were CIBMTR Transplant Risk Score low = 53, intermediate = 6, and high = 33; whereas recipients of KIR3DL1-HIGH donors were low = 17, intermediate = 2, and high = 4 (P = 0.15). These results indicate that disease severity and transplant urgency did not influence whether a KIR3DL1-LOW/NO donor was able to be selected. In summary, these prospective data on 115 patients from a single center support improved outcomes in patients with AML and MDS undergoing unrelated donor allo HCT using a donor with low or absent KIR3DL1 inhibition. A multi-center, prospective study to evaluate the prospective use of HLA and KIR genotype based selection of URDs for patients undergoing allo HCT for AML is underway (NCT02450708). Figure 1. Figure 1. Figure 2. Figure 2. Disclosures Kernan: Gentium: Research Funding; The National Cancer Institute of the National Institutes of Health: Research Funding.

scholarly journals Evaluation of the response rate of chemo-radiation and brachytherapy in patients with locally advanced carcinoma cervix in a tertiary care center

2020 ◽  
Vol 8 (4) ◽  
pp. 1361
Author(s):  
Sukanya Semwal ◽  
Jaskaran S. Sethi ◽  
Munish Gairola ◽  
David K. Simson ◽  
Rajendra Kumar ◽  
...  
Keyword(s):  
Survival Rate ◽  
Local Recurrence ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Carcinoma Cervix ◽  
Free Survival ◽  
Advanced Carcinoma ◽  
Disease Free

Background: Incidence and mortality estimates are used to measure the burden of cancer in a population and survival estimates are ideal for evaluating the outcome of cancer control activities. Survival studies evaluate the quality and quantity of life of a group of patients after diagnosing the disease. The patient survival after the diagnosis of cervical cancer is indirectly influenced by socio-economic factors. The present study was carried out with an aim to evaluate the success rate of chemo-radiation followed by brachytherapy to the patients of locally advanced carcinoma (Ca.) cervix in a tertiary care center.Methods: All cases were staged according to the International Federation of Gynaecologists and Oncologists (FIGO) staging system. To illustrate the observed survival of cancer patients Kaplan-Meier curve was plotted. All the patients, except one, completed chemo-radiation and were retrospectively analyzed for the presence of local residual disease, local recurrence, distant metastases, radiation reactions, disease-free survival, and overall survival.Results: There were 22 patients of Carcinoma cervix reported in the radiation oncology department in the year 2018 and 2019. The overall treatment time ranged from 30 days to 178 days, with a median of 63 days. All the patients had a complete response after the treatment. The median follow-up time for all the patients was 15 months. Three patients had a metastatic recurrence and one patient developed distant metastases as well as local recurrence. Overall survival rate was 100% while the disease-free survival rate was 81.82%.Conclusions: The response to chemo-radiation in the treatment of locally advanced Carcinoma cervix is comparable to historic data and is well tolerated.

Obstructive and perforative colonic carcinoma: patterns of failure.

1985 ◽  
Vol 3 (3) ◽  
pp. 379-384 ◽  
Author(s):  
C Willett ◽  
J E Tepper ◽  
A Cohen ◽  
E Orlow ◽  
C Welch
Keyword(s):  
Massachusetts General Hospital ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Local Failure ◽  
Colonic Carcinoma ◽  
Control Group ◽  
Free Survival ◽  
Failure Patterns ◽  
Disease Free

Carcinoma of the colon complicated by obstruction or perforation has been recognized as having a poorer prognosis than tumors without obstruction or perforation. To clarify the natural history, failure patterns, and implications for adjuvant treatment after resection with curative intent, a review of the recent Massachusetts General Hospital (MGH) experience was undertaken. From 1970 to 1977, 77 patients with obstructive colonic carcinoma and 34 patients with localized perforation at the tumor site were identified and compared with a control group of 400 patients without obstruction or perforation undergoing curative resection. All patients were observed for a minimum of five years or until the patient's death. The actuarial five-year survival and disease-free survival rates in patients with obstruction was 31% and 44%, respectively, in contrast to 59% and 75% in control patients. For patients with localized perforation, the five-year actuarial survival and disease-free survival rates were 44% and 35%, respectively. Of the 77 patients with obstructing tumors, 32 patients (42%) developed local failure--nine with local failure only and 23 patients with local failure and distant metastases. Thirty-four patients (44%) developed distant metastases. Fifteen (44%) patients of 34 with perforative colonic carcinoma had local failure. Distant metastases occurred in 15 patients (44%). The incidence of local failure and distant metastases in the control group was 14% and 21%, respectively. The rate of local failure and distant metastases increased with stage and was generally higher stage for stage than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation of plasma TIMP-1 levels and disease-free survival in primary colorectal cancer independent of serum CEA levels

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22040-e22040
Author(s):  
H. J. Nielsen ◽  
N. Brünner ◽  
I. J. Christensen
Keyword(s):  
Colorectal Cancer ◽  
Local Recurrence ◽  
Prognostic Markers ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Disease Stage ◽  
Free Survival ◽  
Preoperative Serum ◽  
Serum Cea ◽  
Disease Free

e22040 Background: Introduction of independent prognostic markers may play a significant role in future treatment of early stage colorectal cancer (CRC). CEA is still the only recommended (ASCO and EGTM) serological marker in CRC. However, Tissue Inhibitor of Metallo Proteinases-1 (TIMP-1), which is a glycoprotein that acts as an inhibitor of most of the active matrix metalloproteinases, has previously been shown to carry independent prognostic information in patients with primary CRC. The purpose of the present study was to assess the combination of preoperative serum CEA and plasma TIMP-1as prognostic markers in patients undergoing resection for primary CRC. Methods: In the present prospective study serum and plasma samples were collected before surgery from 422 patients with primary CRC stage I-III. CEA was determined in serum by a commercial assay and TIMP-1 was determined in plasma using a thoroughly validated, in-house ELISA. Time to recurrence or death of CRC was registered and the association to serum CEA and plasma TIMP-1 levels were studied in a Cox multivariate model including age, gender, disease stage and tumor location. Hazard ratios and 95% confidence intervals (HR (95%CI)) for disease free survival (DFS) were calculated. Results: An event was recorded in 186 patients, 75 had local recurrence, 103 had a distant metastases (28 of these patients had both local recurrence and distant metastases) and 36 died from their cancer without a registered recurrence. Scoring CEA and TIMP-1 as continuous variables on a logarithmic scale (base 2), both serum CEA and plasma TIMP-1 were statistically significant in a multivariable analysis with HR=1.12 (1.03–1.21) and HR=1.51 (1.12–2.04), respectively. Additional calculations of low CEA plus low TIMP-1, high CEA plus low TIMP-1, low CEA plus high TIMP-1 and high CEA plus high TIMP-1 showed that high plasma TIMP-1 levels carried prominent information of poor prognosis independent of CEA. Conclusions: Preoperative serum CEA and plasma TIMP-1 levels were independent predictors of disease free survival for patients with primary CRC. Combination of the two proteins showed that TIMP-1 was a prominent predictor of poor DFS independent of CEA. [Table: see text]

Evaluating Mortality with Erythropoietin Stimulating Agents (ESAs) in the Oncology Setting: The Importance of Selecting Trials That Include Survival or Loco-Regional Tumor Control as a Primary Endpoint

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4681-4681
Author(s):  
Athena T Samaras ◽  
Sara E Barnato ◽  
Benjamin Kim ◽  
Stephen Y Lai ◽  
A. Oliver Sartor ◽  
...  
Keyword(s):  
Overall Survival ◽  
Primary Outcome ◽  
Disease Free Survival ◽  
Progression Free Survival ◽  
Tumor Control ◽  
Free Survival ◽  
Primary Endpoints ◽  
Meta Analyses ◽  
Disease Free ◽  
Safety Signals

Abstract In February 2008, we reported increased risks of mortality (hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.01–1.20) and venous thromboembolism (VTE) (relative risk (RR) 1.57, 95% CI 1.31–1.87) among anemic cancer patients. Fifty-one trials including 13,611 patients and 38 trials including 8,172 patients were included in the mortality and VTE analyses, respectively. At ASH 2007, we reported that trials within the nephrology setting that measure survival as a primary or secondary safety endpoint should be used over trials that measure efficacy as a primary or secondary endpoint to detect significant safety signals. Herein, we compare the percentage of trials and patients included in various published meta-analyses within the cancer setting that prospectively evaluated overall survival, disease-free survival, progression-free survival and/or loco-regional tumor control as a primary outcome, to determine whether these studies can better identify safety signals than studies that do not include these primary endpoints. Randomized trials of ESA administration to anemic cancer patients that evaluated survival or loco-regional control as primary endpoints were selected for review. Overviews published since 2006 were identified in Medline databases. HRs for mortality and 95% CIs were evaluated for the survival-focused meta-analyses and published overviews. A subset analysis of our 2008 meta-analysis including studies that prospectively evaluated overall survival, disease-free survival, progression-free survival and/or loco-regional tumor control as a primary outcome resulted in an increased risk of mortality (hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.04, 1.35). Among recently reported meta-analyses, safety signals are most apparent when the percentage of patients and trials that evaluated survival or loco-regional tumor control as a primary outcome is greatest, emphasizing the importance of trial selection when conducting safety-focused meta-analyses. Wilson et al. 2007 Bohlius et al. 2006 Seidenfeld et al. 2006 Bennett et al. 2008 Bennett et al. subset analysis 2008 # of trials (# of patients) 28 (5,308) 42 (8,167) 35 (6,918) 51 (13,611) 14 (5,785) Median/Mean # of patients 146/216 147/201 147/201 223/271 370/413 % of trials included that prospectively evaluated overall survival, disease –free survival, progression-free survival, or loco-regional tumor control as a primary outcome (# included, total #) 7.1% (2/28) 16.7% (7/42) 17.1% (6/35) 27.5% (14/51) 100% (14/14) % of patients included that prospectively evaluated overall survival, disease –free survival, progression-free survival, or loco-regional tumor control as a primary outcome (# included, total #) 24.3% (1,290/5,308) 26.7% (2,181/8,167) 29..9% (2,068/6,918) 39.1% (5,324/13,611) 100% (5,787/5,787) HR for mortality(95% CI) 1.03 (0.92–1.16) 1.08 (0.99–1.18) 1.11 (0.99–1.23) 1.10 (1.01–1.20) 1.18 (1.04, 1.35)

Multimodality treatment of synovialsarcoma: A single institution experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22530-e22530
Author(s):  
Daniela Greto ◽  
Camilla Delli Paoli ◽  
Giulio Francolini ◽  
Carlotta Becherini ◽  
Luca Dominici ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Soft Tissue Sarcomas ◽  
Disease Free Survival ◽  
Multimodality Treatment ◽  
Distant Metastases ◽  
Free Survival ◽  
Kaplan Meier ◽  
University Of Florence ◽  
The Impact ◽  
Disease Free

e22530 Background: Synovialsarcoma (SS) is a relatively rare cancer, accounting for 8% of all Soft-Tissue Sarcomas (STS). Identifying prognostic factors could allow to improve treatment strategy for this disease. Methods: Data of 52 patients treated at University of Florence between 1999 and 2016 were retrospectively analysed. Patients and treatment features (Table 1) were correlated with outcome. Results: At a median follow-up of 8.4 years, 9 deaths, 3 local recurrences (LR) and 19 distant metastases (DM) have occurred (17,3%, 5,8% and 36,5%, respectively). Survival Kaplan-Meier analysis showed that Overall survival (OS), Local recurrence disease free survival (DFS-LR) and Distant metastases disease free survival (DFS-DM) were 74,5%, 90% and 59,3%, respectively. Size>10 cm was the only significant predictor of OS (p=0,004). Age>40, size>10 cm and G3 significantly influenced DFS-DM (p=0,043, p=0,002 and p=0,002, respectively). Cox univariate regression analysis confirmed the impact of size on OS (HR 5.8, 95% CI 1.37-24.43, p=0,017). Size (HR 5.06, 95% CI 1.73-14.79, p=0.003) and Grade (7.19, 95% CI 1.65-31.37, p=0.009) influenced DFS-DM. G3 was the only independent prognostic factor associated with DFS-DM. Conclusions: These data confirm that age, size and grade significantly influence outcome in patients affected by SS. Further studies are needed in order to develop tailored treatment strategies in this setting. [Table: see text]

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