Predicting overall survival for patients with periampullary carcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 376-376
Author(s):  
Vincent Yeung ◽  
Yutao Gong ◽  
Jialu Yu ◽  
Yan Yu ◽  
Bo Lu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Cox Regression ◽  
Model Performance ◽  
Positive Lymph Node ◽  
Tubular Adenocarcinoma ◽  
Tumor Differentiation ◽  
Tumor Histology ◽  
T Stage ◽  
Operative Care

376 Background: The purpose of this study was to develop a model predicting the overall survival of patients with peri-ampullary cancer (PAC) following resection, with or without adjuvant therapy. This will help guide physicians in providing optimal post-operative care. Methods: Patients treated between 2006-2012 in our institutional pancreatic tumor registry were analyzed. All patients underwent pancreaticoduodenectomy for PAC. 334 patients had adequate records for analysis and were used to develop a multivariate model based on Cox regression. The variables used in our analysis were age, gender, T-stage, tumor differentiation, positive lymph node ratio (# positive/total), positive resection margins, chemotherapy, radiation therapy (RT), and tumor histology. Multivariate Cox hazards regression tested significance. Model performance was evaluated by the concordance index (c-index). Results: Median age of the cohort was 65 years. 54% of the patients were male. Median follow-up time was 16 months. Median overall survival was 19 months. T-stages were as follows: 7% T1, 9% T2, 77% T3, and 8% T4. 27% of the patients had a positive tumor margin, 68% of patients had positive lymph node spread. 81% of the patients had tubular adenocarcinoma, 9% ampullary adenocarcinoma, 5% cholangiocarcinoma, and 4% duodenal carcinoma. T-stage, tumor differentiation, tumor histology, positive lymph node (PLN) ratio, and adjuvant chemotherapy had a statistically significant association with overall survival (Table 1). The model performance c-index was evaluated as 0.630 with 95% CI as [0.571, 0.690], from a bootstrapping internal validation test on 3-year-survival. Conclusions: This model shows promise in predicting survival following resection for patients with PAC. More patient cases and further analysis of additional factors including specific RT related parameters and specific chemotherapy regimen are needed for development of a more robust model. [Table: see text]

No relationship is indicated between FHIT expression and clinicopathologic prognostic parameters in early stage cervical carcinoma

2003 ◽  
Vol 13 (2) ◽  
pp. 192-196
Author(s):  
C. Baykal ◽  
A. Ayhan ◽  
A. Al ◽  
K. YÜCE ◽  
A. Ayhan
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Lymph Node Involvement ◽  
Depth Of Invasion ◽  
Prognostic Parameters ◽  
Node Involvement ◽  
Disease Free

In this study we investigated FHIT (Fragile Histidine Triad) protein alterations in cervical carcinomas to assess the relation of this gene with cervical cancer. Eighty-eight patients with surgically treated FIGO (International Federation of Gynecology and Obstetrics) stage IB carcinomas of the cervix were included in this study. Clinicopathologic prognostic factors were compared with FHIT expression status. Disease-free and overall survival was evaluated according to prognostic factors and FHIT expression. The FHIT gene was found to be depressed in 53% (47/88) of the tumors. None of the clinicopathologic prognostic parameters showed a correlation with FHIT expression. Univariate survival analysis with the Kaplan-Meier method showed that only the age of the patient is significantly correlated with disease-free survival. Interestingly, when the same analysis was done for 5-year overall survival; diameter of the primary tumor, depth of invasion, occurrence of lymph node involvement, and number of metastatic lymph nodes were found to be statistically significant. Furthermore, multivariate analysis with Cox regression revealed that lymph node involvement was the only independent variable for 5-year overall survival. In the present study there was no statistical correlation between FHIT expression and clinicopathologic prognostic factors or survival figures of the patients. These findings may be explained with the carcinogenic role of FHIT in tumoral progression but not in the tumoral development that takes place after the carcinogenetic period.

scholarly journals Cervical invasion, lymphovascular space invasion, and ovarian metastasis as predictors of lymph node metastasis and poor outcome on stages I to III endometrial cancers: a single-center retrospective study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Min Li ◽  
Shuwei Wu ◽  
Yangqin Xie ◽  
Xiaohui Zhang ◽  
Zhanyu Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Regression Models ◽  
Cox Regression ◽  
Myometrial Invasion ◽  
Ovarian Metastasis ◽  
Surgical Staging ◽  
Tumor Diameter ◽  
Node Metastasis

Abstract Background The aim of this study is to determine pathological factors that increase the risk of LNM and indicate poor survival of patients diagnosed with endometrial cancer and treated with surgical staging. Method Between January 2010 and November 2018, we enrolled 874 eligible patients who received staging surgery in the First Affiliated Hospital of Anhui Medical University. The roles of prognostic risk factors, such as age, histological subtype, tumor grade, myometrial infiltration, tumor diameter, cervical infiltration, lymphopoiesis space invasion (LVSI), CA125, and ascites, were evaluated. Multivariable logistic regression models were used to identify the predictors of LNM. Kaplan–Meier and COX regression models were utilized to study the overall survival. Results Multivariable regression analysis confirmed cervical stromal invasion (OR 3.412, 95% CI 1.631–7.141; P < 0.01), LVSI (OR 2.542, 95% CI 1.061–6.004; P = 0.04) and ovarian metastasis (OR 6.236, 95% CI 1.561–24.904; P = 0.01) as significant predictors of nodal dissemination. Furthermore, pathological pattern (P = 0.03), myometrial invasion (OR 2.70, 95% CI 1.139–6.40; P = 0.01), and lymph node metastasis (OR 9.675, 95% CI 3.708–25.245; P < 0.01) were independent predictors of decreased overall survival. Conclusions Cervical invasion, lymphopoiesis space invasion, and ovarian metastasis significantly convey the risk of LNM. Pathological type, myometrial invasion, and lymph node metastasis are all important predictors of survival and should be scheduled for completion when possible in the surgical staging procedure.

366 CLINICAL NOMOGRAM MODEL FOR RECURRENT LARYNGEAL NERVE LYMPH NODE METASTASIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A RETROSPECTIVE MULTICENTER STUDY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
D Tian ◽  
X He ◽  
Y Yang ◽  
L Chen
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Tumor Size ◽  
Tumor Location ◽  
Laryngeal Nerve ◽  
Tumor Differentiation ◽  
Node Metastasis ◽  
T Stage ◽  
Positive Groups

Abstract   Recurrent laryngeal nerve lymph node metastasis (RLN LNM) is not rare in patients with esophageal cancer. We aimed to explore the risk factors for RLN LNM and to develop a nomogram predicting the likelihood of RLN LNM in esophageal squamous cell carcinoma (ESCC) patients. Methods We retrospectively reviewed patients with ESCC who underwent esophagectomy as well as recurrent laryngeal nerve lymph node dissection between May 2015 and February 2019 at two different institutions. The patients were divided into negative and positive groups according to the presence of RLN LNM. Risk factors for RLN LNM were evaluated by univariate and multivariate analyses. A nomogram was constructed for presentation of the final model. Results A total of 390 patients with ESCC were included in this study. The differences in tumor location, tumor differentiation, T stage, tumor size and carcinoembryonic antigen (CEA) between the negative (N = 270) and positive groups (N = 120) RLN LNM were significant (P &lt; 0.05). Multivariate analysis indicated that the tumor location (OR = 0.520, 95% CI: 0.361–0.749, P &lt; 0.001), tumor differentiation (OR = 2.279, 95% CI: 1.586–3.276, P &lt; 0.001), T stage (OR = 1.436, 95% CI: 1.029–2.003, P = 0.033), tumor size (OR = 1.781, 95% CI: 1.021–3.106, P = 0.042) and CEA (OR = 1.206, 95% CI: 1.003–1.450, P = 0.046) were independent risk factors for RLN LNM. A nomogram with these variables had good predictive accuracy (c-index: 0.716). Conclusion Tumor location, tumor differentiation, T stage, tumor size and CEA may predict the risk of RLN LNM. We created a nomogram predicting the likelihood of RLN LNM in patients with ESCC.

Comparative analysis of resected duodenal and ampullary adenocarcinoma.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 362-362
Author(s):  
Angelena Crown ◽  
Alicia M Edwards ◽  
Flavio G. Rocha ◽  
Vincent J. Picozzi ◽  
Scott Helton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Nodes ◽  
Surgical Complications ◽  
Cox Regression ◽  
Ampullary Adenocarcinoma ◽  
Curative Intent ◽  
T Stage ◽  
Survival Difference ◽  
Pathologic Features ◽  
Positive Lymph Nodes

362 Background: Duodenal and ampullary adenocarcinomas are rare gastrointestinal cancers that share similar anatomic location and treatment strategy. We report a single-institution experience regarding the association between clinicopathologic features, treatment, and survival outcomes. Methods: A retrospective review of all patients resected with curative intent for duodenal adenocarcinoma (DUO) between 2005-2015 and ampullary adenocarcinoma (AMP) between 2011-2015 at VMMC was performed. For AMP, histologic subtyping into intestinal (IT) and pancreatobiliary (PB) phenotypes was determined. Demographic and clinicopathologic parameters were compared between DUO and AMP patients using Chi-square test. Overall survival was calculated using Kaplan-Meier analysis and prognostic factors were identified by univariate Cox regression. Results: Patients with DUO (n = 44) presented at higher T-stage (p = 0.002) and with larger tumors (4.35cm vs 2.33cm, p < 0.001) than AMP patients (n = 46). DUO patients had a higher rate of surgical complications (68% vs 41%, p = 0.01) with a trend for more pancreatic fistulas (36% vs 20%, p = 0.08). There was no difference in median overall survival between groups. Factors positively influencing survival included Caucasian race (p = 0.02) and normal CA19-9 level at diagnosis (p = 0.01). Tumor factors negatively influencing survival included positive lymph nodes (p = 0.04), lymphovascular invasion (p = 0.001), and perineural invasion (p = 0.02). Within AMP, the PB subtype presented at higher T-stage (p = 0.01) and with more positive lymph nodes (p = 0.03) than IT. There was no difference in survival between subtypes. Majority received adjuvant chemotherapy (88.8% in AMP, 76.3% in DUO), fewer received adjuvant radiotherapy (23.3% in AMP, 30% in DUO), but no survival difference was seen. Conclusions: DUO presents with larger tumors and higher T-stage than AMP and is associated with more surgical complications. The PB phenotype has more advanced pathologic features than IT. No survival difference was seen between anatomic locations or subtypes. Better surgical and chemotherapeutic strategies may be needed to overcome high risk features. Longer follow-up with more patients is needed to confirm these findings.

Extent of lymph node resection and effect on pancreatic cancer overall survival.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 682-682
Author(s):  
Brian Cox ◽  
Nicholas Manguso ◽  
Humair Quadri ◽  
Jessica Crystal ◽  
Katelyn Mae Atkins ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Logistic Regression ◽  
Lymph Node ◽  
Cox Regression ◽  
Survival Curve ◽  
Regression Analyses ◽  
Kaplan Meier ◽  
The Impact ◽  
Meier Survival Curve

682 Background: Lymph node (LN) metastases affect overall survival (OS) in pancreatic cancer (PC). However, a LN sampling threshold does not exist. We examined the impact of nodal sampling on overall survival (OS). Methods: Patients with Stage I-III PC ≥55 years old who underwent curative resection from 2004-2016 were identified from the National Cancer Database (NCDB). After adjusting for age, gender, grade, stage, and Charlson-Deyo score, multiple binomial logistic regression analyses assessed the impact of the LN ratio (LNR) on OS. LNR was defined as the number of positive LN over the number of LN examined. Regression analyses, a Cox-Regression, and a Kaplan-Meier survival curve assessed how many LN should be sampled. Results: A total of 13,673 patients, median age 69 years (55-90), were included. Most were Caucasian (86.6%) males with Charlson-Deyo scores ≤ 1 (90.3%) and moderately to poorly differentiated PC (90.1%). Median number of LN examined was 15 (1-75) with a median of 1 positive LN (0-35). As expected, increased number of positive LNs was associated with reduced OS, p < 0.001. After data normalization, an increasing LNR was associated with a 12-fold likelihood of death [OR: 11.9, p < 0.001 (CI 6.0, 23.7)]. Subsequent regression models established evaluation of ≥ 16 LNs as the greatest predictor of OS. A regression model evaluating < or ≥ 16 lymph nodes was performed to ascertain the effects of age, gender, ethnicity, grade, stage, and LN examined on OS. The logistic regression model correctly classified 74.5% of cases with a specificity of 99.6% (p < 0.001). Examination of < 16 LN, Caucasian race, grade, stage, and higher Charlson-Deyo scores were significantly associated with decreased OS. If ≥ 16 LNs were examined, patients had a 1.5-fold likelihood of better OS, p < 0.001 (CI 1.4, 1.6). An adjusted Cox Regression showed increased HR of 1.2, p < 0.001 (CI 1.1, 1.2) and an unadjusted Kaplan Meier survival curve predicted ≥ 16 LN examined are associated with an increase in OS of 2.8 months [log-rank: 32.0, p < 0.001]. Conclusions: Patients undergoing curative intent resection for PC should have adequate nodal sampling. Stratification of patients by LNR may provide useful information of OS. Examination of ≥ 16 LNs impacts OS in patients with Stage I-III PC.

scholarly journals Development and Validation of Nomograms to Predict Prognosis of Oral and Oropharyngeal Mucoepidermoid Carcinoma: A SEER-Based Study

2020 ◽  
Author(s):  
muyuan liu ◽  
Litian Tong ◽  
Manbin Xu ◽  
Xiang Xu ◽  
Bin Liang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Mucoepidermoid Carcinoma ◽  
Cox Regression ◽  
Seer Database ◽  
Disease Specific Survival ◽  
Cox Regression Analysis ◽  
T Stage ◽  
N Stage ◽  
Disease Specific

Abstract Background: Due to the low incidence of mucoepidermoid carcinoma, there lacks sufficient studies for determining optimal treatment and predicting prognosis. The purpose of this study was to develop prognostic nomograms, to predict overall survival and disease-specific survival (DSS) of oral and oropharyngeal mucoepidermoid carcinoma patients, using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. Methods: Clinicopathological and follow-up data of patients diagnosed with oral and oropharyngeal mucoepidermoid carcinoma between 2004 and 2017 were collected from the SEER database. The Kaplan-Meier method with the log-rank test was employed to identify single prognostic factors. Multivariate Cox regression was utilized to identify independent prognostic factors. C-index, area under the ROC curve (AUC) and calibration curves were used to assess performance of the prognostic nomograms. Results: A total of 1230 patients with oral and oropharyngeal mucoepidermoid carcinoma were enrolled in the present study. After multivariate Cox regression analysis, age, sex, tumor subsite, T stage, N stage, M stage, grade and surgery were identified as independent prognostic factors for overall survival. T stage, N stage, M stage, grade and surgery were identified as independent prognostic factors for disease-specific survival. Nomograms were constructed to predict the overall survival and disease-specific survival based on the independent prognostic factors. The fitted nomograms possessed excellent prediction accuracy, with a C-index of 0.899 for OS prediction and 0.893 for DSS prediction. Internal validation by computing the bootstrap calibration plots, using the validation set, indicated excellent performance by the nomograms. Conclusion: The prognostic nomograms developed, based on individual clinicopathological characteristics, in the present study, accurately predicted the overall survival and disease-specific survival of patients with oral and oropharyngeal mucoepidermoid carcinoma.

scholarly journals Association of a CT-Based Clinical and Radiomics Score of Non-Small Cell Lung Cancer (NSCLC) with Lymph Node Status and Overall Survival

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1432 ◽  
Author(s):  
Francesca Botta ◽  
Sara Raimondi ◽  
Lisa Rinaldi ◽  
Federica Bellerba ◽  
Federica Corso ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Logistic Regression ◽  
Lymph Node ◽  
Model Performance ◽  
Low Risk ◽  
Lymph Node Status ◽  
Multivariable Logistic Regression Analysis ◽  
Ct Reconstruction ◽  
Reconstruction Algorithms

Background: To evaluate whether a model based on radiomic and clinical features may be associated with lymph node (LN) status and overall survival (OS) in lung cancer (LC) patients; to evaluate whether CT reconstruction algorithms may influence the model performance. Methods: patients operated on for LC with a pathological stage up to T3N1 were retrospectively selected and divided into training and validation sets. For the prediction of positive LNs and OS, the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression model was used; univariable and multivariable logistic regression analysis assessed the association of clinical-radiomic variables and endpoints. All tests were repeated after dividing the groups according to the CT reconstruction algorithm. p-values < 0.05 were considered significant. Results: 270 patients were included and divided into training (n = 180) and validation sets (n = 90). Transfissural extension was significantly associated with positive LNs. For OS prediction, high- and low-risk groups were different according to the radiomics score, also after dividing the two groups according to reconstruction algorithms. Conclusions: a combined clinical–radiomics model was not superior to a single clinical or single radiomics model to predict positive LNs. A radiomics model was able to separate high-risk and low-risk patients for OS; CTs reconstructed with Iterative Reconstructions (IR) algorithm showed the best model performance.

Adjuvant radiation therapy in node-positive vulvar cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5609-5609
Author(s):  
Eric Xanthopoulos ◽  
Surbhi Grover ◽  
Michael Nino Corradetti ◽  
Margaret Mangaali ◽  
Marina Heskel ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Vulvar Cancer ◽  
Cox Regression ◽  
Positive Lymph Node ◽  
Adjuvant Radiation ◽  
Node Positive ◽  
Positive Lymph Nodes

5609 Background: Adjuvant radiation (RT) has been demonstrated to improve overall survival (OS) in vulvar cancer patients with 2+ positive lymph nodes, but its role in patients with one positive lymph node is uncertain. We report on the largest and longest study of survival in patients with and without radiation following surgery in patients with vulvar cancer. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified node-positive women with squamous cell carcinoma of the vulva treated with and without external beam radiation following surgery. The Kaplan-Meier approach, log-rank tests and Cox modeling assessed OS. Results: All results are listed as women without vs with adjuvant radiation. From 1988 – 2008, 420 patients received surgery alone vs 753 women who received adjuvant radiation. Patient characteristics were well balanced across cohorts, including tumors ≤ or > than 2 cm (p = 0.31), grade (p = 0.41), marital status (p = 0.20), provider type (p = 0.49), and AJCC stage (p = 0.35). Both groups also had similar incidence of biopsy of any kind (p = 0.40), lymph node dissection (p = 0.77), median number of nodes excised (p = 0.12), and type of surgery (p = 0.49). Median age (75 vs 70 y, p <0.01) and race (94% vs 89% white, p = 0.01) were adjusted using Cox regression. Median survivor follow-up was 45 m (range 0 - 236 m). Adjuvant radiation was associated with survival across all node-positive patients (22 vs 29 m, p <0.01), as well as in the subset of women with just one positive lymph node (37 vs 70 m, p <0.01) or 2+ positive lymph nodes (14 vs 18 m, p <0.01). On multivariable Cox regression, adjuvant radiation (95% CI 0.85 - 0.96), diameter (CI 1.28 - 2.01), marital status (CI 0.65 - 0.93), the number of positive nodes (CI 1.06 - 1.11), and the ratio of positive-to-excised nodes (CI 1.61 - 2.98) were all associated with survival (p <0.01 for each). Conclusions: The largest cohort study of node-positive squamous cell carcinoma of the vulva suggests adjuvant radiation is associated with OS.Studies have reported that adjuvant radiation may provide a survival benefit in women with 2+ positive lymph nodes. Our findings suggest patients with one positive lymph node also may benefit from adjuvant radiation.

scholarly journals TBL1XR1 Is Highly Expressed in Gastric Cancer and Predicts Poor Prognosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Fang Liu ◽  
Yuan He ◽  
Qinghua Cao ◽  
Ni Liu ◽  
Wenhui Zhang
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Cox Regression ◽  
Biological Significance ◽  
High Expression ◽  
Human Gastric Cancer ◽  
Mrna Levels ◽  
Poor Overall Survival ◽  
Cox Regression Analysis

Objective. To investigate the expression of transducin- (β-) like 1 X-linked receptor 1 (TBL1XR1) in human gastric cancer (GC) and its correlation with prognostic and biologic significance.Methods. TBL1XR1 mRNA expression was analyzed in gastric cancer using a microarray dataset (GSE2701) from the Gene Expression Omnibus (GEO). Immunohistochemistry (IHC) analysis of TBL1XR1 was performed on GC tissue microarray (TMA) to assess its prognostic and biological significance in 334 patients of GC.Results. Analysis of GSE2701 showed that the mRNA levels of TBL1XR1 were significantly elevated in primary gastric tumor and lymph node tissues than normal gastric tissues (P<0.05). The same results of TBL1XR1 protein level were observed by IHC staining in 334 GC tissues. 204 of 334 (60.1%) primary gastric cancer tissues showed high expression of TBL1XR1 protein. TBL1XR1 overexpression was significantly correlated with lymph node metastasis (P=0.000) and advanced TNM stage (P=0.001). Moreover, high levels of TBL1XR1 predicted worse overall survival (P=0.015). Multivariate Cox regression analysis indicated that high expression of TBL1XR1 was an independent prognostic factor for poor overall survival (HR, 0.525; 95% confidence interval, 0.367–0.752;P=0.005).Conclusion. This present study demonstrates that TBL1XR1 is overexpressed in gastric cancer and may be a potential predictor and therapeutic target for GC patients.

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