Survival trends of patients with metastatic pancreatic cancer: A Surveillance Epidemiology and End Results registry trend analysis from 1988 to 2008.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14544-e14544
Author(s):  
Mathias Worni ◽  
Ulrich Guller ◽  
Rebekah Ruth White ◽  
Ricardo Pietrobon ◽  
Thomas Cerny ◽  
...  
Keyword(s):  
Overall Survival ◽  
African American ◽  
Pancreatic Head ◽  
Palliative Radiotherapy ◽  
Tumor Location ◽  
Male Gender ◽  
The Body ◽  
Dismal Prognosis ◽  
Civil Status ◽  
American Ethnicity

e14544 Background: Pancreatic adenocarcinoma (PAC) is a disease with dismal prognosis. Only a minority of patients with PAC presents with a resectable tumor and can potentially be cured. Therapeutic options for non-resectable, metastatic tumors are limited and chemotherapy with or without radiation is purely palliative. The aim of the present study was twofold: first, to evaluate predictors of overall survival (OS), and second, to assess trends in OS and in the use of palliative radiotherapy among patients with metastatic PAC. Methods: Patients with metastatic PAC were extracted from the SEER cancer registry from 1988 to 2008. While SEER does contain information regarding radiotherapy and surgery, data on chemotherapy cannot be ascertained. Predictors and trends of OS were assessed using univariate and multivariable Cox proportional hazard models. The trend in use of radiotherapy was analyzed using univariate and multivariable logistic regression models. Results: Overall, 23,387 patients were included (mean age: 68.0±11.8 years); 47.0% of patients were female, tumor location was in the pancreatic head in 57.7% of all patients. Median OS was 3 months. In risk-adjusted analyses, tumor location in the pancreatic body/tail was associated with worse overall survival compared to tumors of the pancreatic head (HR: 1.10, CI: 1.07-1.13, p<0.001). Increasing age, African-American ethnicity, male gender, and non-married civil status were associated with significantly worse OS. From 1988 to 2008, OS increased from a median survival of 2 (95% CI: 2-2) to 3 months (CI: 3-4) months (HR per year: 0.978, CI: 0.976-0.981, p<0.001). From 1988 to 2008, radiotherapy use decreased from 13.2% to 5.8% (adj. OR per year: 0.95, CI: 0.93-0.96, p<0.001). Conclusions: Metastatic PAC remains a disease with poor prognosis with only minimal improvement in OS over a 20-year time-period. The use of palliative radiotherapy has decreased. Tumor location in the body/tail of the pancreas, increasing age, African-American ethnicity, male gender, and non-married civil status were associated with worse OS. Future research is needed to improve OS of metastatic PAC on a population-based level.

Locally advanced or metastatic pancreatic adenocarcinoma (PA): Prognostic factors for prolonged survival.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15134-e15134
Author(s):  
Anne Ploquin ◽  
Camille Cozzolino ◽  
Stephanie Truant ◽  
Guillaume Piessen ◽  
Christophe Desauw ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
Median Number ◽  
Tumor Location ◽  
Male Gender ◽  
Prolonged Survival ◽  
Predictive Values ◽  
Biological Variables

e15134 Background: Prognosis of pts with locally advanced or metastatic PA is poor, with median survival of 6-9 months. Yet, since the use of gemcitabine, some patients survive more than one year. Recently, FOLFIRINOX regimen yielded better results in selected patients, but with more toxicity. We assessed the value of baseline predictive factors of prolonged survival in non-selected pts treated with gemcitabine. Methods: We conducted a monocentric, retrospective study (1999 to 2010) on all pts treated for locally advanced or metastatic PA. Demographical, clinical, tumoral and biological variables were included into the analysis. The primary end-point was the 12 months survival. All parameters were assessed in univariate and multivariated analyses. We then built a prognostic scoring system integrating the independent prognostic factors. Results: The study was performed on 160 pts: median age 61.1 years, sex ratio (M/F) 93/67, ECOG 0-1/2-3: 60/98, jaundice 62 (38.8%), initially resectable : 36 (22.5%), intra-pancreatic primary location: head: 110 (68.8%), body: 19 (11.9%), tail: 27 (16.9%). The adenocarcinoma was histologically document in 124 cases (77.5%). The median number of metastasis sites was 1 (71.3% liver). The median Ca 19-9 concentration was 925 IU/ml. 155 pts (96.9%) received chemotherapy, of which 124 (80.0%) with gemcitabine in first line. Fifty-two patients (32.5%) were alive 12 months after diagnosis. In univariate analysis, male gender, PS, initial stage, differentiation, primary tumor location, Ca 19-9 were prognostic factors. In multivariate analysis, male gender, head or body locations and low Ca 19-9 concentration (< 111 IU/ml) were associated with a better prognosis. The score with a cut-off between 2 and 3 points was discriminant, with positive and negative predictive values of 64.7% IC-95% [59.2-70.2] and 75.3% IC-95% [74.4-76.2], respectively. The rate of correctly classified pts was 73.6% IC-95% [72.8-74.4]. Conclusions: Male gender, pancreatic head or body location, and Ca 19-9 < 111 are independent prognostic factors for prolonged survival. Further analyses are needed to determine more accurately pts suitable for gemcitabine or the more recently validated regimen FOLFIRINOX.

scholarly journals The Relationship Between Age, Gender, Race, Diabetes and Obesity on Clinical Outcomes in a Large Cohort of Patients Hospitalized for Covid-19 in Metropolitan Detroit

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A351-A351
Author(s):  
Jaspreet Hehar ◽  
Erika Todter ◽  
Sharon Wu Lahiri
Keyword(s):  
African American ◽  
African Americans ◽  
Inflammatory Markers ◽  
Severe Disease ◽  
Significant Proportion ◽  
Male Gender ◽  
Icu Admission ◽  
Henry Ford ◽  
Poor Outcomes ◽  
American Ethnicity

Abstract The Severe Acute Respiratory Syndrome Coronavirus-2 infection has resulted in a global pandemic with survival statistics 95–99%, however severe disease has been described. This is a retrospective cohort study of patients &gt; age 18 admitted to Henry Ford Health System in Detroit from March 1 - June 1, 2020 for COVID-19 infection with aims to: 1. Determine the incidence of poor outcomes (mechanical ventilation (MV), ICU admission, death, and venous thromboembolism (VTE)), 2. Describe the clinical characteristics of this group, and 3. Evaluate relationships between demographics, diabetes mellitus (DM), obesity, and inflammatory markers on outcomes. We hypothesized that older age, male gender, African American ethnicity, DM, obesity, and elevated inflammatory markers would predict poor outcomes. 8751 inpatients were included, of whom 682 (7.79%) required MV, 867 (9.91%) were admitted to the ICU, 753 (8.6%) died, and 430 (4.91%) had VTE. 4447 (50.8%) were African American, 4951 (56.6%) female, 5152 (58.9%) &gt; age 50, and 2068 (23.6%) had DM. Of those who had BMI and A1c recorded, 2556 (50.2%) had BMI &gt;30 kg/m2 and 1138 (74.3%) had A1c &gt;5.7%. Analyses controlling for demographics and comorbidities found that age and male gender were significant predictors of MV (OR = 1.031; CI= 1.025–1.037; P &lt; 0.0001, OR =2.023; CI= 1.700–2.407; P&lt;0.0001), ICU admission (OR 1.024; CI= 1.018–1.029; P&lt;0.0001, OR 1.824; CI= 1.561–2.130; P&lt;0.001), death (OR 1.077; CI= 1.069–1.085; P&lt;0.0001, OR 1.823; CI= 1.521–2.185; P&lt;0.0001), and VTE (OR 1.021; CI= 1.014–1.028; P&lt;0.001, OR 1.293; CI= 1.043–1.603; P=0.0193). African American, compared to Caucasian ethnicity, was significantly associated with MV (OR 1.437; CI= 1.131–1.825; P=0.0009) and ICU admission (OR 1.428; CI= 1.150–1.773; P=0.0002), but not VTE. African Americans had significantly lower odds of death relative to Caucasians (OR 0.765; CI=0.604–0.969; P=0.0200). DM predicted MV (OR 1.999; CI= 1.677–2.383; P&lt;0.0001), ICU admission (OR 2.014; CI= 1.717–2.364; P&lt;0.0001), death (OR 1.501; CI= 1.250–1.803; P&lt;0.0001), and VTE (OR 1.468; CI= 1.171–1.840; P=0.0009). Obesity predicted MV (OR 1.540; CI= 1.284–1.847; P&lt;0.0001) and ICU admission (OR 1.395; CI= 1.186–1.642; P&lt;0.0001) but not death or VTE. All inflammatory markers (D-dimer, ferritin, CRP, IL-6 and procalcitonin) were significantly correlated with MV and death. 3 of the 5 markers were also predictive of both ICU admission and VTE. This large retrospective study of a diverse population with a significant proportion of African Americans highlights the importance of taking age, male gender, African American ethnicity, presence of DM and obesity into account when determining risk of poor outcomes. These results contribute to the growing data on disparities in health care which have become more evident during this pandemic and the need to address this when designing public policy.

Survival trends of 89,543 patients with metastatic colorectal cancer: A population-based analysis.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 476-476
Author(s):  
Ulrich Guller ◽  
Ignazio Tarantino ◽  
Anthony W. Castleberry ◽  
Lukas Brugger ◽  
Dieter Koeberle ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
African Americans ◽  
Metastatic Colorectal Cancer ◽  
Public Health Problem ◽  
Tumor Location ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Major Public Health Problem ◽  
Civil Status

476 Background: Metastatic colorectal cancer remains among the most common causes for cancer death and is a major public health problem. While overall survival improvements have been achieved in clinical trials, it is unknown how much this progress translated into increased survival on a population-based level. Methods: The SEER (Surveillance Epidemiology and End Results) registry was queried from 1988 to 2008. Patients with metastatic colorectal cancer were included. Multivariable adjusted Cox proportional hazards regression analyses were used. Results: In total, 89,543 patients were included. Median age was 67.1 years, 47.2% were female, 79.7% Caucasian. Median overall survival was 11 months, which increased from 8 months in 1988 to 14 months in 2008 (75% increase). In patients <= 65 years, overall survival increased from 9 months in 1988 to 20 months in 2008 (122% increase), in patients above 65 years from 7 months in 1988 to 9 months in 2008 (29% increase). In Cox proportional analyses, later year of treatment (hazard ratio=HR: 0.973 per year [95% CI: 0.972-0.975], p<0.001), tumor location in the rectum (HR: 0.72 [95% CI: 0.71 - 0.74]; p<0.001), married civil status (HR: 0.85, [95% CI: 0.84 - 0.86]; p<0.001), and cancer-directed surgery (HR: 0.44, [95% CI: 0.43 – 0.45]; p<0.001) were associated with better overall survival, while patients above 65 years (HR: 1.48, [95% CI: 1.46 - 1.51]; p<0.001) and African-Americans (HR: 1.08, [95%CI: 1.06 - 1.11], p<0.001) had worse survival. Conclusions: Tumor location in the rectum, married civil status and cancer-directed surgery are associated with significantly improved overall survival while elderly and African-Americans have worse outcomes. Moreover, a statistically significant and clinically relevant overall survival increase from 1988 to 2008 was found for metastatic colorectal cancer patients. However, most progress is observed in patients aged below 65 years, while the overall survival increase in the elderly is modest. Further studies among elderly patients assessing the reasons for the lack of a parallel survival increase are warranted.

scholarly journals Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort

2021 ◽  
Author(s):  
Even Hovig Fyllingen ◽  
Lars Eirik Bø ◽  
Ingerid Reinertsen ◽  
Asgeir Store Jakola ◽  
Lisa Millgård Sagberg ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Elderly Patients ◽  
Temporal Lobe ◽  
Third Ventricle ◽  
Tumor Location ◽  
Population Based ◽  
Independent Effect ◽  
Precentral Gyrus ◽  
The Third

Abstract Purpose Previous studies on the effect of tumor location on overall survival in glioblastoma have found conflicting results. Based on statistical maps, we sought to explore the effect of tumor location on overall survival in a population-based cohort of patients with glioblastoma and IDH wild-type astrocytoma WHO grade II–III with radiological necrosis. Methods Patients were divided into three groups based on overall survival: < 6 months, 6–24 months, and > 24 months. Statistical maps exploring differences in tumor location between these three groups were calculated from pre-treatment magnetic resonance imaging scans. Based on the results, multivariable Cox regression analyses were performed to explore the possible independent effect of centrally located tumors compared to known prognostic factors by use of distance from center of the third ventricle to contrast-enhancing tumor border in centimeters as a continuous variable. Results A total of 215 patients were included in the statistical maps. Central tumor location (corpus callosum, basal ganglia) was associated with overall survival < 6 months. There was also a reduced overall survival in patients with tumors in the left temporal lobe pole. Tumors in the dorsomedial right temporal lobe and the white matter region involving the left anterior paracentral gyrus/dorsal supplementary motor area/medial precentral gyrus were associated with overall survival > 24 months. Increased distance from center of the third ventricle to contrast-enhancing tumor border was a positive prognostic factor for survival in elderly patients, but less so in younger patients. Conclusions Central tumor location was associated with worse prognosis. Distance from center of the third ventricle to contrast-enhancing tumor border may be a pragmatic prognostic factor in elderly patients.

scholarly journals P14.21 Tehila Kaisman-Elbaz MD/PhD

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii71-iii71
Author(s):  
T Kaisman-Elbaz ◽  
Y Elbaz ◽  
V Merkin ◽  
L Dym ◽  
A Noy ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
False Discovery Rate ◽  
Medical Center ◽  
Tumor Resection ◽  
Multiple Hypothesis Testing ◽  
Hemoglobin Level ◽  
Distribution Width ◽  
False Discovery ◽  
Dismal Prognosis

Abstract BACKGROUND Glioblastoma is known for its dismal prognosis though its dependency on patients’ readily available RBCs parameters defining the patient’s anemic status such as hemoglobin level and Red blood cells distribution Width (RDW) is not fully established. Several works demonstrated a connection between low hemoglobin level or high RDW values to overall glioblastoma patient’s survival, but in other works, a clear connection was not found. This study addresses this unclarity. MATERIAL AND METHODS In this work, 170 glioblastoma patients, diagnosed and treated in Soroka University Medical Center (SUMC) in the last 12 years were retrospectively inspected for their survival dependency on pre-operative RBCs parameters using multivariate analysis followed by false discovery rate procedure due to the multiple hypothesis testing. A survival stratification tree and Kaplan-Meier survival curves that indicate the patient’s prognosis according to these parameters were prepared. RESULTS Beside KPS>70 and tumor resection supplemented by oncological treatment, age<70 (HR=0.4, 95% CI 0.24–0.65), low hemoglobin level (HR=1.79, 95% CI 1.06–2.99) and RDW<14% (HR=0.57, 95% CI 0.37–0.88) were found to be prognostic to patients’ overall survival in multivariate analysis, accounting for false discovery rate of less than 5%. CONCLUSION A survival stratification highlighted a non-anemic subgroup of nearly 30% of the cohort’s patients whose median overall survival was 21.1 months (95% CI 16.2–27.2) - higher than the average Stupp protocol overall median survival of about 15 months. A discussion on the beneficial or detrimental effect of RBCs parameters on glioblastoma prognosis and its possible causes is given.

The clinical course and role of surgery in pediatric malignant peripheral nerve sheath tumors: a database study

2021 ◽  
pp. 1-8
Author(s):  
Victor M. Lu ◽  
Shelly Wang ◽  
David J. Daniels ◽  
Robert J. Spinner ◽  
Allan D. Levi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Peripheral Nerve ◽  
Pediatric Patients ◽  
Clinical Course ◽  
The Body ◽  
National Database ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath

OBJECTIVE Malignant peripheral nerve sheath tumors (MPNSTs) are rare tumors found throughout the body, with their clinical course in children still not completely understood. Correspondingly, this study aimed to determine survival outcomes and specific clinical predictors of survival in this population from a large national database. METHODS All patients with MPNSTs aged ≤ 18 years in the US National Cancer Database (NCDB) between 2005 and 2016 were retrospectively reviewed. Data were summarized, and overall survival was modeled using Kaplan-Meier and Cox regression analyses. RESULTS A total of 251 pediatric patients with MPNSTs (132 [53%] females and 119 [47%] males) were identified; the mean age at diagnosis was 13.1 years (range 1–18 years). There were 84 (33%) MPNSTs located in the extremities, 127 (51%) were smaller than 1 cm, and 22 (9%) had metastasis at the time of diagnosis. In terms of treatment, surgery was pursued in 187 patients (74%), chemotherapy in 116 patients (46%), and radiation therapy in 129 patients (61%). The 5-year overall survival rate was estimated at 52% (95% CI 45%–59%), with a median survival of 64 months (range 36–136 months). Multivariate regression revealed that older age (HR 1.10, p < 0.01), metastases at the time of diagnosis (HR 2.14, p = 0.01), and undergoing biopsy only (HR 2.98, p < 0.01) significantly and independently predicted a shorter overall survival. Chemotherapy and radiation therapy were not statistically significant. CONCLUSIONS In this study, the authors found that older patient age, tumor metastases at the time of diagnosis, and undergoing only biopsy significantly and independently predicted poorer outcomes. Only approximately half of patients survived to 5 years. These results have shown a clear survival benefit in pursuing maximal safe resection in pediatric patients with MPNSTs. As such, judicious workup with meticulous resection by an expert team should be considered the standard of care for these tumors in children.

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