Survival of upper tract urothelial carcinoma: A population-based analysis.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 257-257 ◽  
Author(s):  
Sima P. Porten ◽  
Vancheswaran Gopalakrishnan ◽  
Graciela M. Nogueras-Gonzalez ◽  
Ashish M. Kamat ◽  
Arlene O. Siefker-Radtke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Urothelial Carcinoma ◽  
Competing Risks ◽  
Renal Pelvis ◽  
Population Based ◽  
Disease Specific Survival ◽  
Gender And Race ◽  
Upper Tract ◽  
Disease Specific

257 Background: Urothelial carcinoma involving the upper tract (UTUC) accounts for only 5% of urothelial malignancies; thus the majority of data are from single institution series or highly selected patient populations. We sought to examine contemporary trends in overall (OS) and disease-specific survival (DSS) for UTUC using a large, population based dataset. Methods: Patients within the Surveillance, Epidemiology, and End Results (SEER) database with de novo UTUC from 1973-2008 were included and analyzed in 5 year increments to evaluate disease trends. Univariate and multivariate for OS and DSS competing risks analysis were performed adjusting for age, gender, and race for renal pelvis and ureteral tumors. Results: A total of 14,237 patients met inclusion criteria. For renal pelvis tumors (n=9,318), overall survival was 54.4% at 3 years. On multivariate analysis factors that were significant predictors of OS were: age (HR 1.03, p<0.001), and year of diagnosis (HR 1.32, p<0.001). Competing risks regression estimated DSS of 60.5% at 5 years, with male gender, black race, and year of diagnosis remaining significant after adjusting for covariates (p<0.05). For ureteral tumors (n=4,919), overall survival was 56.1% at 3 years. On multivariate analysis, age was a significant predictor of OS (2.73, 95%CI 2.52-2.93, p<0.001). Competing risks regression estimated DSS of 61.9% at 5 years, with female race, and year of diagnosis remaining significant after adjusting for covariates (p<0.05). For both renal pelvis and ureteral tumors, the more contemporary era (1997-2002, 2003-2008) showed worse survival than prior eras (p<0.05). Conclusions: Disease-specific survival for patients with renal pelvis and ureteral UTUC appears to be worse in the contemporary era. While sociodemographic factors (age, gender, and race) appear to impact prognosis, it is unclear what factors may be contributing to this decline. This data adds to the growing literature supporting a paradigm change in the treatment of this disease.

Prognostic Factors Influencing Survival in Solitary Plasmacytoma: A SEER Database Analysis.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1670-1670
Author(s):  
Paul Mehan ◽  
Giridharan Ramsingh ◽  
Jingqin Luo ◽  
Daniel Morgansztern ◽  
Ravi Vij
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Solitary Plasmacytoma ◽  
Seer Database ◽  
Disease Specific Survival ◽  
Factors Influencing ◽  
Younger Age ◽  
Disease Specific

Abstract Solitary plasmacytoma (PCM) is a focal, neoplastic, plasma cell disorder without evidence of systemic disease. While PCM is a clinically distinct entity, survival can be limited by progression to multiple myeloma. Prior studies have attempted to identify factors influencing survival in PCM but have been limited by small patient cohorts. This study identified 1472 patients with PCM using the SEER database between 1988 and 2004. The median age of the patients was 64 years (range 12–97), 65.4% male, 34.6% female, 83% Caucasians, 10.7% African Americans and 6.3% other races. 63.8% had medullary PCM and 36.2% extramedullary PCM. 84% of medullary PCM occurred in axial skeleton and the rest in appendicular skeleton. Extramedullary PCM most frequently occurred in the head and neck region (51.4%) followed by skin/subcutaneous tissue (16.2%), GI tract 6% and other sites (26.4%). 55.2% were treated with radiation therapy alone, 29.5% with radiation therapy and surgery and 15.3% with surgery alone. 558 died during this period and the mean overall survival was 6.83 years (range, 0–16.9). The cause of death was multiple myeloma in 49.6%, other cancers 20.9% and cardiovascular diseases 12.9%. In all patients, survival probability at one year was 87.6% (95% CI, 85–89%), at five years was 58.9% (95% CI, 56–62%), and at 10 years was 40.0% (95% CI, 36–44%). The five year overall survival in the ≤40yo cohort was 83.5% as compared to 76.7% and 44.8% in the 40–60yo and &gt;60yo groups, respectively (p&lt;0.0001). The five year disease specific survival probability in the ≤40yo cohort was 94.5% as compared to 86.0% and 66.2% in the 40–60yo group and &gt;60yo group, respectively (p&lt;0.0001) (figure 1)). Overall survival in the extramedullary PCM was 65.9% at five years as compared to 54.6% in the medullary PCM (p&lt;0.0001) and the disease specific survival in the extramedullary PCM was 86.2% compared to 70.1% in the medullary PCM (p&lt;0.0001) (figure 1). Multivariate analysis of disease specific survival revealed that younger age, male gender, extramedullary type, and race other than African American or Caucasian were favorable prognostic factors (Table 1). Younger age, extramedullary site, treatment with XRT + surgery, and race other than African Americans were associated with improved overall survival by multivariate analysis (Table 1). To our knowledge, this is the largest published review of survival in PCM. This study identifies several prognostic risk factors influencing survival in PCM. These risk factors can be used to identify patients at high risk for progression to multiple myeloma. Those at highest risk could be considered for future trials comparing adjuvant systemic therapy compared to local therapy alone. Table 1. Multivariate Analysis of Prognostic Factors Disease Specific Survival Overall Survival Variable Category HR 95% CI P HR 95%CI P Abbreviations: HR, Hazard Ratio; Q, Confidence Inverval Sex Female --- -- --- -- --- --- Male 0.74 0.58~ 0.94 0.01 0.95 0.80~1.13 0.57 Age &lt;40yo --- --- --- --- --- --- 40–60yo 2.68 115~ 6.2 0.02 1.74 1.04~2.91 0.03 &gt;60yo 6.94 3.06~ 15.73 &lt;0.01 5.55 3.40~9.06 &lt;0.01 Race Black --- --- --- --- --- --- White 0.74 0.52~ 1.06 0.1 0.72 0.56~0.92 0.01 Others 0.31 0.13~ 0.75 &lt;0.01 0.48 0.29~0.79 &lt;0.01 Primary Site Extramedullary --- --- --- --- --- --- Medullary 2.35 1.74~.3.18 &lt;0.01 1.37 1.13~1.65 &lt;0.01 Treatment Surgery Only --- --- --- --- --- --- XRT Only 0.90 0.62~ 1.31 0.59 0.82 0.64~1.04 0.10 XRT + Surgery 0.84 0.55~1.26 0.39 0.68 0.52~0.89 &lt;0.01 Period 1988–1993 --- --- --- --- --- --- 1994–1999 0.96 0.72~1.30 0.8 0.96 0.78~1.19 0.74 2000–2004 0.94 0.68~1.30 0.7 0.94 0.75~1.18 0.6 Figure 1: Figure 1:.

Germ cell cancer (GCC): Long-term survival after treatment with bleomycin (B), etoposide (E), and cisplatin (P) in a large cohort.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4533-4533 ◽  
Author(s):  
Maria Gry Gundgaard ◽  
Jakob Lauritsen ◽  
Mette Sakso Mortensen ◽  
Mads Agerbaek ◽  
Niels Vilstrup Holm ◽  
...  
Keyword(s):  
Overall Survival ◽  
Germ Cell ◽  
Standard Treatment ◽  
Cell Cancer ◽  
Population Based ◽  
Germ Cell Cancer ◽  
Disease Specific Survival ◽  
Vital Status ◽  
Prognostic Group ◽  
Disease Specific

4533 Background: In 1997 the International Germ Cell Cancer Collaborative Group presented a classification dividing patients into a good, intermediate, and poor prognostic group for metastatic GCC with 5-year survival information. However, only a minor part of these patients were treated with today’s standard treatment. We present the first nationwide and population based study of overall survival (OS) and disease specific survival (DSS) in a large cohort of GCC patients treated with BEP. Methods: A nationwide and population based clinical database covering GCC patients diagnosed 1984-2007 was constructed, including 4,683 GCC cases. Through merging with national administrative registers, information on vital status and cause of death for all patients until November 30, 2012, was obtained. Results: The 5-year OS for the whole database cohort was 96%. A total of 1,584 patients were treated with BEP (1,099 patients with primary metastatic disease, 485 patients relapsed from stage I). Until 2001, the standard treatment was 4 cycles of BEP, after 2001 patients with good prognosis had 3 cycles of BEP. Overall survival (OS) and disease specific survival (DSS) with 95% confidence intervals (95% CI) (Table), median observation time was 13.8 years. Conclusions: This cohort study showed improved OS for GCC patients across all prognostic groups since 1997, in particular regarding the poor prognostic group. The present result is based on a large number of cases established in a population based fashion, with long follow up time and unbiased information covering all cohort members including detailed clinical information and vital status of all patients. [Table: see text]

scholarly journals The effect of tumor location on overall survival for pT2-4 bladder and upper tract urothelial carcinoma following radical surgery

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Andrew W. Tam ◽  
Christine Liaw ◽  
Eric Li ◽  
Andrew B. Katims ◽  
Rollin K. Say ◽  
...  
Keyword(s):  
Overall Survival ◽  
Urothelial Carcinoma ◽  
Renal Pelvis ◽  
Cox Regression ◽  
Tumor Location ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Risk Of Mortality ◽  
Bladder Urothelial Carcinoma ◽  
Definitive Surgery

Introduction: Historically, staging and treatment for upper tract urothelial carcinoma were extrapolated from bladder urothelial carcinoma literature. However, embryological, genetic, and anatomical differences exist between them. We sought to explore the relationship between location of urothelial cancer and overall survival (OS). Methods: Data was culled from the National Cancer Database from 2004–2015. Patients with pT2-pT4 treated with definitive surgery were included; those with metastatic disease or who received neoadjuvant or adjuvant treatment were excluded. Patients were stratified by tumor location and pathological stage. The primary outcome was OS. Secondary outcomes were predictors of mortality in each pT stage stratum. Results: A total of 11 330 patients with bladder, 954 patients with ureteral, and 1943 patients with renal pelvis urothelial carcinoma were analyzed. Mean followup was 43.3, 39.4, and 41.4 months for bladder, ureteral, and renal pelvis, respectively. On univariable analysis, ureteral pT2 was associated with worse OS compared to both bladder (61.3 vs. 80.4 months, p=0.007) and renal pelvis (61.3 vs. 80.5 months, p=0.014). Renal pelvis pT3 was associated with improved OS compared to both bladder (42.5 vs. 28.6 months, p=0.003) and ureteral (42.5 vs. 25.7 months, p<0.001). Renal pelvis pT4 had decreased survival compared to bladder (11.4 vs. 17.7 months, p<0.001). On multivariable Cox regression, only renal pelvis pT3 was associated with a 20% decreased risk of mortality compared to bladder pT3 (hazard ratio 0.80, 95% confidence interval 0.72–0.88, p<0.001). Conclusions: Renal pelvis pT3 is associated with lower mortality. Mutational and embryological differences may play a role in this disparity.

Adjuvant chemotherapy for upper-tract urothelial carcinoma: A systematic review and meta-analysis of available studies.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 330-330
Author(s):  
Jeffrey J. Leow ◽  
Steven L. Chang ◽  
Toni K. Choueiri ◽  
Joaquim Bellmunt
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Upper Tract Urothelial Carcinoma ◽  
Sufficient Data ◽  
Disease Specific Survival ◽  
Q Statistic ◽  
Disease Specific

330 Background: Upper-tract urothelial carcinoma (UTUC) accounts for less than 5% of all urothelial cancers. Adjuvant chemotherapy (AC) for UTUC may improve survival outcomes, but currently available evidence is limited. Methods: A comprehensive literature review was performed to identify all studies comparing AC with control for patients with UTUC. The search included the Medline, Embase, Cochrane Central Register of Controlled Trials databases, and abstracts from the American Society of Clinical Oncology meetings up to June 2013. An updated systematic review and meta-analysis was performed. Results: A total of 9 retrospective cohort studies were identified (Table). For disease-specific survival, 6 studies had sufficient data (AC: n=406, control: n=1,227), with a pooled hazard ratio of 0.64 in favor of AC over control (95% CI: 0.41 to 0.99; p=0.047). Between-trial heterogeneity was not significant based on the Cochran Q statistic (p=0.14) and I2 = 40% (95% CI=0-76). Four studies had sufficient data for overall survival (AC: n=228, control: n=685), with a pooled hazard ratio of 1.06 (95% CI: 0.52 to 2.13; p=0.88). Between-trial heterogeneity was observed based on the Cochran Q statistic (p=0.03) and I2(68%, 95% CI: 7-89). There were no randomized trials investigating the role of AC for UTUC. Conclusions: There appears to be a significant benefit in disease-specific survival, but not overall survival, for AC in UTUC. While limited by the retrospective nature of studies and relatively small sample size, this analysis may be helpful in guiding the oncologic management of UTUC. [Table: see text]

scholarly journals Obesity Is Associated With Worse Overall Survival in Women With Low-Grade Papillary Serous Epithelial Ovarian Cancer

2014 ◽  
Vol 24 (4) ◽  
pp. 670-675 ◽  
Author(s):  
Rebecca Ann Previs ◽  
Joshua Kilgore ◽  
Renatta Craven ◽  
Gloria Broadwater ◽  
Sarah Bean ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Confidence Interval ◽  
Low Grade ◽  
Disease Specific Survival ◽  
Serous Epithelial Ovarian Cancer ◽  
Optimal Tumor ◽  
Disease Specific

ObjectiveThe objective of this study was to evaluate prognostic risk factors for survival in women with low-grade serous epithelial ovarian cancer (LGSC).MethodsA multicenter retrospective analysis of patients with LGSC was conducted. Potential epidemiologic risk factors evaluated included obesity, age, parity, race, smoking, oral contraceptive pill and/or hormonal replacement therapy use, and previous hysterectomy or surgery on fallopian tubes and/or ovaries. Additional factors included stage, extent of debulking, residual disease, and disease status.ResultsEighty-one patients were identified, and pathologic diagnosis was independently confirmed. Median age at diagnosis was 56 years (range, 21–86 years). Thirty-four percent were obese, and 80% had optimally debulked disease. Forty-six percent were alive, 14% with disease, whereas 25% were dead of disease, 2% died of intercurrent disease, and 27% had an unknown status. In a univariate analysis, optimal surgical debulking was associated with improved progression-free survival (P= 0.01), disease-specific survival (P= 0.03), and overall survival (OS) (P< 0.001) and body mass index with worse OS (P= 0.05). On multivariate analysis, obesity (hazard ratio, 2.8; 95% confidence interval, 1.05–7.3;P= 0.04) and optimal tumor debulking (hazard ratio, 0.05; 95% confidence interval, 0.008–0.29;P= 0.001) were a significant predictor of OS.ConclusionsIn a multivariate analysis, obesity and optimal tumor cytoreduction were significant predictors of OS. However, obesity was not associated with worse disease-specific survival, suggesting that mortality of obese patients with LGSC may result from other comorbidities. Interventions addressing obesity may improve survival for women diagnosed with LGSC, and further study is warranted to address the role of obesity in LGSC.

Survival after nephroureterectomy for upper tract urothelial carcinoma: A population-based competing-risks analysis

2013 ◽  
Vol 21 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Giorgio Gandaglia ◽  
Marco Bianchi ◽  
Quoc-Dien Trinh ◽  
Andreas Becker ◽  
Alexandre Larouche ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Competing Risks ◽  
Population Based ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Competing Risks Analysis

Oral cavity squamous cell carcinoma in patients aged 80 or older: Risk factors, treatment, and outcome

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6064-6064
Author(s):  
C. Ortholan ◽  
R. Bensadoun ◽  
A. Italiano ◽  
S. Teman ◽  
O. Dassonville ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Oral Cavity ◽  
Elderly Patients ◽  
Squamous Cell ◽  
Early Stage ◽  
Disease Specific Survival ◽  
Curative Intent ◽  
Disease Specific

6064 Background: We have recently reported a large series of patients aged ≥ 80 years showing that in this population about half of head and neck squamous cell carcinomas (SCC) are located in the oral cavity. There are no specific data on this cancer location outcome in elderly patients. Therefore, we report here the experience of two French cancer centers in the treatment of oral cavity SCC in patients aged ≥ 80 years. Methods: Two hundred sixty patients aged ≥ 80 years with a primary oral cavity SCC were included in this retrospective analysis. Results: Sex ratio was near to 1. The risk factor distribution was significantly different between men and women: tobacco/alcohol consumption (66.3% vs 15.8%, p < 0.001), history of leukoplakia/lichen planus/oral traumatism (10.8% vs 55.3%, p = 0.002). Two hundred patients received a loco regional (LR) treatment with a curative intent (surgery and/or radiotherapy), 29 with a palliative intent and 31 did not receive a LR treatment. Curative treatments were delivered according to the institution policy in 56 patients (28%).The median disease specific survival (DSS) was 16.9 months. In multivariate analysis, independent prognostic factors were stage (HR = 0.45 [0.29–0.69], p < 0.001), and curative intent of treatment (HR = 0.28 [0.17–0.45], p < 0.001). Median overall survival (OS) was 13.9 months. In multivariate analysis, the independent prognostic factors for OS were age (HR = 0.63 [0.33–0.76], p < 0.001), stage (HR = 0.61 [0.40–0.91], p = 0,016), and curative intent of treatment (HR = 0.41 [0.23–0.71], p < 0.001. In patients treated with a curative intent, the standard treatment was not associated with improved overall survival or disease specific survival as compared with those treated with an adapted treatment. However, prophylactic lymph node treatment in early stage cancer decreased the rate of nodal recurrence from 38% to 6% (p = 0.01). Conclusions: This study emphasizes the need for prospective evaluation of standard and adapted schedules in elderly patients with oral cavity cancer. No significant financial relationships to disclose.

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