Prognostic impact of local therapy of the primary tumor in metastatic breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1114-1114
Author(s):  
Isabelle Katrin Himsl ◽  
Nina Ditsch ◽  
Miriam Susanne Lenhard ◽  
Jutta Engel ◽  
Michael Untch ◽  
...  
Keyword(s):  
Stem Cells ◽  
Metastatic Disease ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Local Treatment ◽  
Local Therapy ◽  
Prognostic Impact ◽  
Tumor Stem Cells ◽  
Receptor Status ◽  
The Impact

1114 Background: MBC is an incurable disease and the treatment aims are palliative. It is not known whether the difference in OS is the result of a selection bias or caused by dissemination of tumor stem cells in pat. without surgery. Methods: To identify the impact of surgical therapy of the primary tumor, a mono-institutional retrospective review from 1990-2006 was done in primary MBC pts. Results: We identified 269 pts. with primary MBC, 63 of whom had received no surgical local treatment. Mean follow up is 65 m for pts., observed mortality 87%. Location of metastases were bone only (36%), visceral or soft tissue (one organ only, 19%), multiple organs (40%) and including CNS metastases (5%). 50% had G3 tumors, 25% negative receptor status, 7% non-resectable local disease and 57% symptomatic metastases. In univariate analysis, pat. without local treatment had a median OS of 14.4m, pts. with local therapy 28.1m (p<0.001). Pts. not receiving local treatment were significantly more likely to have multiorgan or CNS involvement (p< 0.001), symptoms at diagnosis (p=0.009), non-resectable tumor (p<0.001) and were more likely to die within the first 30d after diagnosis (p< 0.001). In multivariate analysis, local treatment had no significant impact on OS. The only significant variables were: number of involved organs, symptoms at diagnosis, receptor status, grading, and size of the local tumor. The effect of local treatment on OS was not homogenous across subgroups. Local treatment was a significant factor in tumors with only one involved organ or asymptomatic disease. In all other groups, local treatment did not result in an OS benefit. Conclusions: Our cohort showed significantly improved OS in univariate analysis if the breast primary tumor had been removed in metastatic disease. Yet, the decision for local treatment was biased by the extent and presentation of metastatic disease. Pts. with more advanced MBC seem not to benefit from removal of the primary tumor. However, we see significant influence in pts. with limited and asymptomatic MBC. The potential dissemination of tumor stem cells from the breast primary in metastatic but locally untreated disease may only influence prognosis in pts. with limited disease.

Impact of M1a and M1b staging in patients (pts) with metastatic colorectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3590-3590 ◽  
Author(s):  
Hagen F. Kennecke ◽  
Jason Yu ◽  
Sharlene Gill ◽  
Winson Y. Cheung ◽  
Charles Davic Blanke ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
Primary Tumors ◽  
7Th Edition ◽  
The Impact

3590 Background: In 2009, pts with M1 colorectal cancer were divided into two subsets for the American Joint Committee on Cancer (AJCC) 7th edition. Pts with metastases (mets) confined to one organ or site at initial diagnosis became stage M1a while multiple sites or peritoneal mets became M1b. The objectives of the study are to evaluate the impact of site of mets and M1a/b staging among pts with M1 colorectal cancer. Methods: All pts referred to the BC Cancer Agency from 1999-2007 with newly diagnosed M1 colon or rectal cancer were included. Demographic, treatment, and outcome data were prospectively collected. The prognostic impact of individual sites of mets was assessed by hazard ratio estimates from univariate Cox models. Multivariable Cox proportional-hazards models were used to determine variables associated with overall survival in the entire cohort and in those undergoing resection of their primary tumor. Results: 2,049 pts with M1 disease were included. Median age was 66 years; 71% had colonic origin; 70% had their primary tumor resected; and 69% received chemotherapy. In univariate analysis, solitary mets were associated with improved survival. In multivariable analysis, M1a/b status still had significant prognostic effect. The effect remained significant in the subgroup analysis of pts with resected primary tumors when histology, T and N stage were included. Conclusions: Pts with solitary mets, including peritoneum, have superior overall survival as compared to those with multiple sites of mets. AJCC 7th edition staging that includes M1a/b provides significant prognostic information and should be considered in clinical practice and trials of pts with M1 disease who otherwise have few prognostic factors. [Table: see text]

scholarly journals Prognostic Value and Optimal Candidates of Primary Tumor Surgery in Metastatic Adenoid Cystic Carcinoma of the Head and Neck: First Evidence from a Population-Based Study

2021 ◽  
Author(s):  
Di Zhang
Keyword(s):  
Adenoid Cystic Carcinoma ◽  
Head And Neck ◽  
Primary Tumor ◽  
Prognostic Value ◽  
Univariate Analysis ◽  
Initial Diagnosis ◽  
Prognostic Impact ◽  
Tumor Surgery ◽  
Adenoid Cystic ◽  
The Impact

Abstract Objective: The prognostic value of primary tumor surgery (PTS) for patients with metastatic adenoid cystic carcinoma of the head and neck (HNACC) at initial diagnosis has never been studied. The aims of this study were to determine the prognostic significance and identify optimal candidates of PTS.Materials and Methods: Patients with metastatic HNACC (stage IVC) at initial diagnosis were identified from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2015. Correlated variables, including age, sex, race, tumor stage, metastatic site, treatment, and survival information were extracted. Kaplan-Meier analysis, log-rank test, and multivariate Cox regression model were performed to evaluate the impact of PTS on survival outcomes, including overall survival (OS) and cancer-specific survival (CSS).Results: Overall, 155 patients were identified from database. Of those, 93 (60%) patients underwent palliative PTS. Patients with lung metastasis alone were more likely undergo PTS (c2=15.042, P=0.002). The univariate analysis showed that PTS were associated with significantly improved survival than no-PTS (P=0.001 for CSS; P＜0.001 for OS). The median CSS for patients who received PTS and those who did not receive PTS were 64.0 and 22.0 months, respectively. The median OS for patients who received PTS and those without PTS were 43.0 and 16.0 months, respectively. Notably, in multivariate model, the OS of patients who underwent PTS was better than that of patients who did not (HR=0.586, P=0.017), but there was no significantly improvement in CSS. In addition, subgroup analyses further revealed that patients with T3-4 or N0 stage might benefit from PTS.Conclusion: PTS signifi­cantly improved OS in patients with metastatic HNACC. Besides, PTS had a favorable prognostic impact on highly-selected patients, namely T3-4 and N0 stage, which could be adopted in future clinical practice. Further multicenter prospective studies are still needed to verify these outcomes.

scholarly journals Impact of Cytogenetics on Outcome of Patients with MDS or Secondary AML Undergoing Allogeneic HSCT from HLA-Identical Siblings: A Retrospective Analysis of the EBMT-CLWP.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2653-2653 ◽  
Author(s):  
Francesco Onida ◽  
Ronald Brand ◽  
Anja van Biezen ◽  
Renee M. Barge ◽  
Leo F. Verdonck ◽  
...  
Keyword(s):  
Stem Cells ◽  
High Risk ◽  
Retrospective Analysis ◽  
Univariate Analysis ◽  
Complete Information ◽  
Risk Groups ◽  
Prognostic Impact ◽  
Cox Models ◽  
The Impact ◽  
Good Risk

Abstract Cytogenetics (CG) represent one of the most important factors in determining survival for pts with MDS, being therefore required by the IPSS to predict life-expectancy. However, the impact of CG on outcome of pts undergoing allo-HSCT for MDS is unknown. The aim of this EBMT-CLWP study was to carry out a retrospective analysis of the impact of CG on overall survival (OS), relapse-free survival (RFS), relapse probability (REL), and transplant related mortality (TRM) in pts with MDS/sAML undergoing allo-HSCT from HLA-identical siblings. Data from 1506 pts with MDS/sAML who underwent a first allograft from HLA-identical siblings from 1984 to 2004 reported to EBMT were assessed. The following covariates were included: CG (good- vs standard- vs high-risk according to the IPSS); stage at HSCT (untreated vs treated in CR vs treated not in CR); FAB classification (RA/RARS vs RAEB/CMML vs RAEB-t/sAML); age (as a continuous covariate in the COX models); time from dx to HSCT (<5 vs 5 to 8 vs > 8 months); calendar year in which HSCT was performed; type of conditioning (standard vs RIC); source of stem cells (BM vs PB). A complete information dataset was available in 692 pts, who are the subject of this analysis. 20% of pts had RA or RARS, 28% had RAEB or CMML, and 52% had RAEB-t or sAML. Age was ≥50 years in 30%. CG classified 55% of pts as good-, 24% as intermediate-, and 21% as high-risk. At the time of HSCT, 38% were untreated; among treated pts, 222 (52%) were in CR. A RIC regimen was administered to 93 pts (13%). Source of stem cell was PB in 38%. By univariate analysis, subdivision of pts in the IPSS risk-categories for CG associated with significantly different OS (at 60 mos, alive pts in good-, interm.-, and high-risk groups were 47%, 40% and 31%, respectively), RFS (alive pts at 60 mos 40%, 35% and 21%, respectively), relapse probability (34%, 35% and 57% at 60 mos, respectively) and TRM (33%, 42% and 46% at 60 mos, respectively). By multivariate COX analysis, age and CG associated with all the outcome variables (for OS, high- vs good-risk HR 1.4; interm.- vs good-risk HR 1.2; p<0.02). OS, RFS and REL were also determined by FAB category (for OS, RAEB-t/sAML vs RA/RARS HR 1.5, p<0.01) as well as by stage at HSCT (for OS, CR vs untreated HR 0.65, p<0.005). Conditioning intensity associated both with TRM (reduced vs standard HR 0.5, p<0.01) and REL (reduced vs standard HR 1.63, p<0.02). Concerning REL, the interval between dx and HSCT was also significant, whereas the source of stem cells associated only with OS (PB vs BM HR 0.78, p<0.05). In summary, this study provides evidence that CG have strong prognostic impact on outcome of pts undergoing allo-HSCT from HLA-identical siblings for MDS/sAML and should be taken into consideration when selecting candidates for this treatment strategy. Detailed analyses will be presented.

scholarly journals Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Wu ◽  
Yu-Chen Wang ◽  
Wen-Jie Luo ◽  
Bo-Dai ◽  
Ding-Wei Ye ◽  
...  
Keyword(s):  
Regression Model ◽  
Competing Risks ◽  
Primary Tumor ◽  
Cox Regression ◽  
Radical Surgery ◽  
Large Population ◽  
Local Therapy ◽  
Primary Site ◽  
Urethral Carcinoma ◽  
The Impact

Abstract Background Primary urethral carcinoma (PUC) is a rare genitourinary malignancy with a relatively poor prognosis. The aim of this study was to examine the impact of surgery on survival of patients diagnosed with PUC. Methods A total of 1544 PUC patients diagnosed between 2004 and 2016 were identified based on the SEER database. The Kaplan-Meier estimate and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). The multivariate Cox regression model and competing risks regression model were used to identify independent risk factors of OS and cancer-specific survival (CSS). Results The 5-yr OS was significantly better in patients who received either local therapy (39.8%) or radical surgery (44.7%) compared to patients receiving no surgery of the primary site (21.5%) (p < 0.001). Both local therapy and radical surgery were each independently associated with decreased CSM, with predicted 5-yr cumulative incidence of 45.4 and 43.3%, respectively, compared to 64.7% for patients receiving no surgery of the primary site (p < 0.001). Multivariate analyses demonstrated that primary site surgery was independently associated with better OS (local therapy, p = 0.037; radical surgery, p < 0.001) and decreased CSM (p = 0.003). Similar results were noted regardless of age, sex, T stage, N stage, and AJCC prognostic groups based on subgroup analysis. However, patients with M1 disease who underwent primary site surgery did not exhibit any survival benefit. Conclusion Surgery for the primary tumor conferred a survival advantage in non-metastatic PUC patients.

Outcomes with definitive local treatment to the primary site in non-nasopharyngeal head and neck squamous cell carcinoma patients with synchronous distant metastasis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18014-e18014
Author(s):  
Steven Borson ◽  
Yongli Shuai ◽  
Barton Branstetter ◽  
Marci Lee Nilsen ◽  
Marion Hughes ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Head And Neck ◽  
Distant Metastasis ◽  
Univariate Analysis ◽  
Local Treatment ◽  
Local Therapy ◽  
Distant Disease ◽  
Neck Disease ◽  
Metastatic Sites ◽  
Synchronous Distant Metastasis

e18014 Background: Data on the efficacy of including definitive local therapy to the primary head and neck disease (PHN) for non-nasopharyngeal head and neck squamous cell carcinoma (HNSCC) patients with synchronous distant metastasis are lacking. Methods: In this single institution retrospective study, we evaluated the outcomes of patients treated from 2000-2020 at UPMC for non-nasopharyngeal HNSCC with synchronous distant metastasis whose therapy included definitive therapy to the PHN. We evaluated overall survival (OS), calculated as date of diagnosis to date of death and progression free survival (PFS), calculated as date of diagnosis to date of death or progression. Based on an initial univariate analysis, the potential significant predictors were evaluated further in the multiple covariates Cox model via stepwise procedures. The relative mortality rates were summarized with hazard ratio (HR), with HR > 1.0 corresponding to increased mortality. Results: A total of 40 patients met inclusion criteria. The median age was 61, primary sites included 52.5% oropharynx (48% HPV +), 40% larynx/hypopharynx, 7.5% oral cavity, and 85% had a solitary metastatic lesion, most commonly in the lung. Definitive treatment of the PHN was with surgery (55%) or chemoradiation (45%), and 45% also underwent local treatment for all distant disease. The median PFS was 8.6 months (95% CI, 6.4-11.6), and OS was 14.2 months (95% CI, 10.9-27.5). In the 28% of patients that received induction therapy, there was a two-fold increase in median OS to 27.5 vs. 13.7 months, p = 0.06. In the 33% of patients that received anti-PD-1 mAb immunotherapy (IO), the median OS was significantly increased to 41.7 months (95% CI, 8.7-NR) vs. 12.1 months (95% CI, 8.4-14.4), p = 0.01, with a numeric increase in PFS as well (11.3 vs. 8.2 months respectively, p = 0.07). Notably no difference in PFS or OS was seen with type of local therapy to the PHN, receipt of local treatment to all distant disease, by HPV status, or year of diagnosis. In multivariate analysis including induction and other variables significant in univariate analysis (age, number of metastatic sites), IO was independently associated with improved OS (HR 3.123 (No IO vs. IO) (95% CI, 1.198-8.137), p = 0.02), as was age and number of metastatic sites. In the patients that received IO started as part of induction the median PFS and OS were 19.5 and 45.5 months respectively. Conclusions: We observed impressive survival in select non-nasopharyngeal HNSCC patients with synchronous distant metastasis treated with definitive local therapy to the primary head and neck disease in addition to induction and/or IO, with IO independently associated with improved OS. To our knowledge this is the first evaluation of the efficacy of definitive local therapy and IO in this population. Prospective evaluation is warranted.

scholarly journals Prognostic Impact of Stromal Immune Infiltration before and after Neoadjuvant Chemotherapy (NAC) in Triple Negative Inflammatory Breast Cancers (TNIBC) Treated with Dose-Dense Dose-Intense NAC

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2657
Author(s):  
Luca Campedel ◽  
Paul Blanc-Durand ◽  
Asker Bin Asker ◽  
Jacqueline Lehmann-Che ◽  
Caroline Cuvier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative ◽  
Univariate Analysis ◽  
Tumor Infiltrating Lymphocytes ◽  
Complete Response ◽  
Prognostic Impact ◽  
Breast Cancers ◽  
Dose Dense ◽  
The Impact

Inflammatory breast cancers are very aggressive, and among them, triple negative breast cancer (TNBC) has the worst prognosis. While many studies have investigated the association between tumor-infiltrating lymphocytes (TIL) before neoadjuvant chemotherapy (NAC) and outcome in TNBC, the impact of post-NAC TIL and TIL variation in triple negative inflammatory breast cancer (TNIBC) outcome is unknown. Between January 2010 to December 2018, all patients with TNIBC seen at the breast disease unit (Saint-Louis Hospital) were treated with dose-dense dose-intense NAC. The main objective of the study was to determine factors associated with event-free survival (EFS), particularly pathological complete response (pCR), pre- and post-NAC TIL, delta TIL and post-NAC lymphovascular invasion (LVI). After univariate analysis, post-NAC LVI (HR 2.06; CI 1.13–3.74; p = 0.02), high post-NAC TIL (HR 1.81; CI 1.07–3.06; p = 0.03) and positive delta TIL (HR 2.20; CI 1.36–3.52; p = 0.001) were significantly associated with impaired EFS. After multivariate analysis, only a positive TIL variation remained negatively associated with EFS (HR 1.88; CI 1.05–3.35; p = 0.01). TNIBC patients treated with intensive NAC who present TIL enrichment after NAC have a high risk of relapse, which could be used as a prognostic marker in TNIBC and could help to choose adjuvant post-NAC treatment.

scholarly journals Local Resection of Primary Tumor in Upfront Stage IV Breast Cancer

Breast Care ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. 411-417 ◽  
Author(s):  
Thomas Kolben ◽  
Theresa M. Kolben ◽  
Isabelle Himsl ◽  
Tom Degenhardt ◽  
Jutta Engel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Local Therapy ◽  
Stage Iv ◽  
Organ System ◽  
Asymptomatic Patients ◽  
Local Surgery ◽  
Stage Iv Breast Cancer

Background: This study aimed to identify the association of local surgery of the primary tumor in metastatic breast cancer (MBC) patients with overall survival (OS) and prognostic factors. Patients and Methods: Patients with primary MBC (1990-2006) were included in our retrospective analysis (n = 236). 83.1% had surgery for the primary tumor. OS was evaluated using Kaplan-Meier estimates. Predictive factors for OS were determined. Results: Median follow-up was 123 months for all patients still alive at the time of analysis. In univariate analysis, patients with surgery of the primary tumor had significantly prolonged OS (28.9 vs. 23.9 months). Within the surgery group, patients with MBC limited to 1 organ system had a better outcome (39.3 vs. 24.9 months), as did asymptomatic patients. Independent risk factors for shorter OS were hormone receptor negativity, symptoms, and involvement of ≥ 1 organ system. Conclusion: Patient selection for local therapy was confounded by a more favorable profile and a lesser tumor burden before surgery, which might implicate a bias. Nevertheless, our univariate results indicate that local surgery of the primary tumor in MBC patients could be considered as part of the therapeutic regimen in selected patients. However, larger patient numbers are needed to prove these findings in the multivariate model.

Prognostic Impact of Hematopoietic Recovery After Fludarabine, IV Busulfan and Antithymocyte Globulins (FB2 regimen) Reduced-Intensity Conditioning Regimen (RIC) Allogeneic Stem Cell Transplantation (allo-SCT)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4483-4483
Author(s):  
Amandine Lebourgeois ◽  
Marion Loirat ◽  
Benoit Tessoulin ◽  
Elsa Lestang ◽  
Pierre Peterlin ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Conditioning Regimen ◽  
Prognostic Impact ◽  
Immune Recovery ◽  
Post Transplant ◽  
Factors Associated ◽  
Before And After ◽  
Circulating Lymphocytes ◽  
The Impact

Abstract Abstract 4483 Introduction: RIC regimens are increasingly used prior to allo-SCT. The FB2 regimen (Fludarabine 120–150 mg/m2 + IV Busulfan 6.4 mg/Kg + ATG Thymoglobuline 5mg/Kg) is currently the most widely used RIC regimen in many European centres. This retrospective analysis aimed to assess the hematopoietic and immune recovery in a homogeneously treated cohort of 53 patients (males: n=33; median age: 59 years (range: 22–70)) who received the FB2 regimen between January 2007 and October 2010 in our department. Patients and Methods: Diagnoses were as follow: AML n=23; ALL n=1; biphenotypic leukemia n=1; lymphoma n=16; myelodysplastic syndrome n=9; multiple myeloma n=3. Nineteen patients (36%) had received a prior autologous SCT. The majority of patients (n=40, 75.5%) were transplanted in complete remission. Thirty patients received a graft from a matched sibling donor (56.5%). All patients, but one (who received unmanipulated bone marrow) received G-CSF-mobilized PBSCs. GVHD prophylaxis consisted of cyclosporine (CsA) alone in patients transplanted with an HLA-identical sibling, and CsA+ mycophenolate mofetyl in other cases. None of the patients received G-CSF during aplasia following transplant while nine patients received erythropoietin before day+100. Results: Engraftment was achieved in 96% of patients (n=51). Median times for neutrophils (n=51) and platelets (n=22) recovery were 17 days (range: 0–39) and 10 days (range: 4–186), respectively. The majority of patients (n=31, 58%) did not receive platelet support during aplasia. The cumulative incidences of grade II-IV and grade III-IV acute GVHD were 30% and 15%, respectively, while overall incidence of chronic extensive GVHD was 33%. With a median follow-up of 19 months (range: 2–53), the 2-year OS, DFS, relapse incidence, and NRM were 63%, 59.5%, 35% and 6%, respectively. In univariate analysis, when regarding pre-transplant factors associated with outcome, the only factor correlated with a significantly higher 2-year OS and DFS was a higher total circulating lymphocytes count at transplant (> 730/mm3) (OS: 81.5% vs 43.2%, p=0.01; DFS: 73.2% vs 45.5%, p=0.03). Regarding post-transplant factors, we found that higher recovery of leukocytes (>5000/mm3) (2-year OS: 78% vs 46%, p=0.007; 2-year DFS: 70% vs 48%, p=0.08), neutrophils (>3230/mm3) (2-year OS: 76% vs 50%, p=0.02; 2-year DFS: 67.5% vs 52.0%, p=0.09), and monocytes (>590/mm3) (2-year OS: 80% vs 47%, p=0.004; 2-year DFS: 75% vs 42%, p=0.007) at day+30 post-transplant were the most significant factors associated with outcome. In multivariate analysis, the only independent factors associated with a significantly higher OS and DFS were a better immune status at transplant (lymphocytes count >730/mm3; HR 0.22; 95%CI: 0.08–0.63, p=0.005; and HR: 0.29; 95%CI: 0.12–0.71, p=0.006, respectively) and a higher monocytes count at day+30 post-transplant (>590/mm3) (HR: 0.24; 95%CI: 0.08–0.66, p=0.006; and HR: 0.28; 95%CI: 0.11– 0.68, p=0.005; respectively). Conclusion: These results suggest that hematopoietic status and recovery before and after FB2 RIC allo-SCT can be significant predictors of outcome. This paves the way for future studies aiming to closely monitor the kinetics of immune recovery after RIC allo-SCT and to evaluate the impact of growth factors and other immunostimulatory cytokines in the setting of RIC allo-SCT. Disclosures: No relevant conflicts of interest to declare.

Impact of response to prior chemotherapy (RTPC) on outcomes in second-line therapy for advanced urothelial carcinoma (UC): Implications for trial design.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4539-4539
Author(s):  
Gregory Russell Pond ◽  
Joaquim Bellmunt ◽  
Ronan Fougeray ◽  
Toni K. Choueiri ◽  
Angela Q. Qu ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Multivariable Analysis ◽  
Prognostic Impact ◽  
Second Line ◽  
Phase Ii Trials ◽  
Second Line Therapy ◽  
Prior Chemotherapy ◽  
Prior Therapy ◽  
Line Therapy ◽  
The Impact

4539 Background: Performance status (PS), hemoglobin (Hb), liver metastasis (LM), and time from prior chemotherapy (TFPC) are significant prognostic factors in second-line therapy for advanced UC. Setting of prior chemotherapy, i.e., metastatic or perioperative, has not appeared significant. However, the impact of prior chemosensitivity is unclear, which may confound trial interpretation. Hence, we examined the prognostic impact of RTPC, when prior therapy was given for metastatic disease. Methods: Six phase II trials evaluating second-line chemotherapy and/or biologics (n=504) were pooled. Patients who received prior therapy for metastatic disease were eligible for analysis if data regarding Hb, LM, PS, and TFPC were available. Response by RECIST to first-line therapy was recorded. Progression-Free Survival (PFS) and overall survival (OS) were calculated from the date of registration using the Kaplan-Meier method. Results: 275 pts were evaluable for analysis. Patients received gemcitabine-paclitaxel, cyclophosphamide-paclitaxel, pazopanib, docetaxel plus vandetanib/placebo or vinflunine (2 trials). Those with prior response (n=111) had a median (95% CI) OS of 8.0 (6.8-9.4) months (mo) and PFS of 3.0 (2.6-4.0), compared with OS and PFS of 5.9 (5.0-6.6) mo and 2.6 (2.0-2.8) for those without prior response (n=164). Multivariable analysis did not reveal an independent impact of RTPC on PFS or OS (Table). Conclusions: RTPC in patients receiving prior chemotherapy for metastatic disease did not confer an independent prognostic impact with second-line therapy for advanced UC. Patients who received prior chemotherapy in peri-operative or metastatic settings may be enrolled in the same second-line trial stratified for PS, anemia, LM and TFPC. [Table: see text]

Brain metastases in patients with urothelial carcinoma.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 282-282
Author(s):  
Helen Jane Boyle ◽  
Emilie Lavergne ◽  
Jean Pierre Droz ◽  
Nathalie Bonnin ◽  
Aude Flechon
Keyword(s):  
Brain Metastases ◽  
Urothelial Carcinoma ◽  
Metastatic Disease ◽  
Cox Model ◽  
Brain Mri ◽  
Brain Lesion ◽  
Local Treatment ◽  
Local Therapy ◽  
Initial Diagnosis ◽  
Initial Presentation

282 Background: Muscle invasive urothelial cancers are infrequent. Patients (pts) with metastatic disease have poor prognosis. Brain metastases (BM) are rare. The aim of this retrospective study is to analyse the characteristics, the treatment and the evolution of patients with BM treated in a single centre. Methods: Thirty pts with BM were identified among the 1591 pts with urothelial carcinoma seen at the Centre Léon Bérard, between 1994 and 2011. The study population was described, overall survival (OS) from diagnosis of BM was estimated by Kaplan-Meier method and prognostic factors were explored using a Cox model. Results: Twenty seven pts in our series were male. Median age at initial diagnosis was 60 years (range: 33.9-78.9 years). Twenty two pts had primary bladder tumours and 8 upper urinary tract tumours. Twenty four pts underwent surgery for their primary lesion, 2 received chemoradiotherapy and 4 did not receive any radical local treatment. Six pts had metastatic disease at initial presentation: 3 were operated on. Median delay between initial diagnosis and BM was 16.6 months (range: 0-56.4 months), 3 patients had BM at initial presentation. Median time between first metastases and BM was 10 months (range=0-52 months). Eleven patients developed BM as one of the first sites of metastases. BM were symptomatic in 28 pts: specific neurological symptoms (n=25), headaches (n=6), epilepsy (n=2). For the 2 other pts, they were discovered on a systematic brain MRI. Eighteen pts had cerebral metastases only, 5 pts had cerebellar metastases only, 6 had both; the last patient had cerebral, cerebellar and meningeal involvement. Half of the pts had only 1 brain lesion. Five pts were operated on: 4 received postoperative radiotherapy; 19 patients were given radiotherapy alone and 6 did not get any local therapy. In this series, median OS from diagnosis of BM was 3.4 months (IC95% [2.2-10.3]). Only the administration of chemotherapy after the diagnosis of BM was significantly associated with OS; probably because only fit enough patients were offered treatment. Conclusions: Prognosis of patients with urothelial carcinoma and BM is poor; however some patients have long survivals. Treatment is not codified as there is little data in the literature.

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