Effect of time to initiation of adjuvant chemotherapy on survival in resected pancreatic cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 368-368
Author(s):  
Katelin Anne Mirkin ◽  
Christopher S Hollenbeak ◽  
Joyce Wong
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Resection ◽  
Survival Benefit ◽  
Term Survival ◽  
Lower Odds ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Time To Initiation ◽  
The Impact

368 Background: Pancreatic cancer carries a grim prognosis. Surgical resection followed by adjuvant chemotherapy is standard of care, but little is known about the temporal relationship of chemotherapy initiation and survival. This study analyzed the impact of time to initiation of adjuvant chemotherapy on survival in patients with resected pancreatic cancer. Methods: The National Cancer Data Base (2003-2011) was retrospectively reviewed for patients with clinical stages 1-3 resected pancreatic carcinoma. Time to chemotherapy was stratified at the 12-week post-operative timepoint. Univariate statistics, Kaplan-Meier estimates, and Cox proportional hazard modeling were performed. Results: 5,205 patients who had undergone surgical resection alone, 3,144 patients who had undergone surgical resection and adjuvant chemotherapy initiated at or before 12 weeks, and 906 patients who had undergone surgical resection followed by adjuvant therapy started after 12 weeks were included. Patients who received chemotherapy > 12 weeks tended to be older, have more co-morbidities, receive treatment at academic centers, and undergo whipple procedures. In all pathologic disease stages, adjuvant chemotherapy conferred a significant survival benefit over surgical resection alone (p < 0.0001). However, there was no significant overall survival benefit for patients receiving adjuvant chemotherapy before 12 weeks as compared to after (p = 0.85). When stratified by pathological stage, there was still no significant survival benefit for earlier initiation of chemotherapy (£ vs. > 12 weeks): stage I, p = 0.16, stage II, p = 0.12, stage III, p = 0.38. After controlling for patient, disease, and surgery characteristics, patients who received adjuvant chemotherapy after 12 weeks had a 31% lower odds of mortality at 5 years, while those who initiated it before 12 weeks had a 34% lower odds (p < 0.0001, p < 0.0001 respectively), versus surgery-alone. Conclusions: Earlier initiation of adjuvant chemotherapy does not significantly impact long-term survival in patients with resected pancreatic cancer. However, because adjuvant chemotherapy confers a survival benefit, delayed chemotherapy should be offered when appropriate.

scholarly journals 51 Timing of adjuvant treatments on glioblastoma survival: A retrospective cohort analysis based on the national cancer database

2018 ◽  
Vol 45 (S3) ◽  
pp. S11-S12
Author(s):  
Ping Zhu ◽  
Xianglin L. Du ◽  
Yoshua Esquenazi ◽  
Jay-Jiguang Zhu
Keyword(s):  
Adjuvant Treatment ◽  
Survival Benefit ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
High Dose ◽  
National Cancer Database ◽  
Risk Of Death ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
The Impact

Few studies investigated the associations between intervention modalities, timing, and survival in glioblastoma (GBM) patients. A total of 20511 eligible GBM patients underwent biopsy and craniotomy surgeries followed by adjuvant treatments (2005-2014) were derived from the National Cancer Database (NCDB). The time intervals (days) from the date of diagnosis to the initiation date of adjuvant treatment [radiation therapy only (RT), chemotherapy only, concurrent chemoradiation (CRT), or non-concurrent RT and chemotherapy] were categorized into quartiles (Q1-Q4). Kaplan-Meier method and Cox proportional hazards regression were applied for survival analysis. Multivariate logistic regression was performed to compare differences in treatment timing, intervention modalities, and secondary outcomes. The patients underwent biopsy obtained significant survival benefit by having delayed adjuvant treatment [comparing to Q1, Q2: HR (hazard ratio), 0.88, Q3: HR, 0.86]. For patients underwent resection, the prolonged waiting time of adjuvant treatment had 5-6% reduced risk of death [comparing to Q1, Q2: HR, 0.95; Q3: HR, 0.94]. Patients received more RT fractions [comparing to 10-29 fractions, 30-33 fractions: HR: 0.62 (biopsy), 0.62 (resection); ≥34 fractions: HR: 0.53 (biopsy), 0.62 (resection)] and high-dose RT [comparing to 34-46 Gy, 50-60 Gy: HR: 0.91 (biopsy), 0.95 (resection); ≥ 60 Gy: HR: 0.77 (biopsy), 0.88 (resection)] experienced significantly superior survival in both biopsy and resection groups. The impact of timing to adjuvant treatment on GBM survival varied by surgery procedures. Having adjuvant treatment initiated within 21 days for both biopsy and craniotomy groups may not guarantee a significant survival benefit. More RT fractions and high-dose RT are associated with better GBM survival.

Efficacy of adjuvant chemotherapy with S-1 in patients with positive peritoneal cytology (CY1) who underwent R1 surgery.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 84-84
Author(s):  
M. Terashima ◽  
E. Bando ◽  
M. Tokunaga ◽  
Y. Tanizawa ◽  
T. Kawamura ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Dissection ◽  
Survival Benefit ◽  
Residual Tumor ◽  
Peritoneal Cytology ◽  
Node Dissection ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Positive Peritoneal Cytology

84 Background: In recent TNM classification, positive peritoneal cytology (CY1) is regarded as M1 disease and classified into stage IV. However, the prognosis of the CY1 patients underwent R1 surgery (microscopic residual tumor) is considered to be relatively better than those underwent R2 surgery (macroscopic residual tumor). Adjuvant chemotherapy with S-1 had demonstrated significant survival benefit in stage II and III gastric cancer in Japan. However, the efficacy of adjuvant S-1 in patients with relatively more advanced stage had not been investigated. Therefore, we investigated the efficacy of adjuvant chemotherapy with S-1 in CY1 patients underwent R1 surgery. Methods: Among the 2,202 patients with gastric cancer treated at our department between September 2002 and July 2009, a total of 105 patients with CY1 and underwent R1 surgery were included in this study. Clinocopathological features and survival were retrospectively analyzed using prospectively registered data base system. Results: There were 64 male and 41 female patients. The median age was 61 years old. Eighty-five patients had T4a or T4b tumor and 96 patients had lymph node metastasis. Seventy-eight patients had undifferentiated type of tumor. In 83 patients, adjuvant chemotherapy with S-1 had been performed. In the uni-variate analysis, only the extent of lymph node dissection (D2) and the adjuvant chemotherapy with S-1 demonstrated significant survival benefit. In multi-variable analysis using Cox proportional hazarded model, N-factor, extent of lymph node dissection (D2 vs D1), and adjuvant chemotherapy with S-1 were selected as independent prognostic factors. The median survival time and 5-year survival rate in patients underwent R1 resection with D2 lymphadenectomy and adjuvant S-1 treatment were 42 months and 46%, respectively. Conclusions: In patients with CY1 and underwent R1 surgery, adjuvant chemotherapy with S-1 demonstrated significant survival benefit. In patients with positive peritoneal cytology without other non-curative factors, D2 lymph node dissection and adjuvant chemotherapy using S-1 is recommended. No significant financial relationships to disclose.

scholarly journals Impact of limb salvage versus amputation on overall survival in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database

2020 ◽  
Author(s):  
Daniel R. Evans ◽  
Alexander Lazarides ◽  
Julia D. Visgauss ◽  
Jason A. Somarelli ◽  
Dan G. Blazer III ◽  
...  
Keyword(s):  
Overall Survival ◽  
Limb Salvage ◽  
Survival Benefit ◽  
Surgical Techniques ◽  
National Cancer Database ◽  
Significant Survival Benefit ◽  
Significant Survival ◽  
Treatment Paradigm ◽  
High Grade Osteosarcoma ◽  
The Impact

Abstract Background: Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the impact of the type of surgical resection on overall survival in the era of modern limb salvage. Methods: Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. Results: From a total of 3,421 patients, 2,634 underwent limb salvage and 787 underwent amputation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p<0.001). This survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.74; p=0.001). Chemotherapy and negative surgical margins were also independently associated with survival.Conclusion: Limb salvage is associated with a significant survival benefit over amputation, even when controlling for potentially confounding variables and differences between cohorts.

scholarly journals P-OGC35 Does Adjuvant Chemotherapy Provide Additional Survival Benefit AfterNeoadjuvant Chemotherapy or Chemoradiotherapy and Esophagectomy forEsophageal Adenocarcinoma?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Sivesh Kamarajah ◽  
Sheraz Markar ◽  
Alexander Phillips ◽  
Victoria Kunene ◽  
David Fackrell ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Survival Benefit ◽  
Cox Regression ◽  
National Cancer Data Base ◽  
Future Research ◽  
Term Survival ◽  
Node Negative ◽  
Cancer Data ◽  
Significant Survival

Abstract Background The evidence assessing the additional benefits of adjuvant chemotherapy (AC) following neoadjuvant therapy (NAT; i.e. chemotherapy or chemoradiotherapy) and esophagectomy for esophageal adenocarcinoma (EAC) are limited. This study aimed to determine whether AC improves long-term survival in patients receiving NAT and esophagectomy. Methods Patients receiving esophagectomy for EAC following NAT from 2004 - 2016 were identified from the National Cancer Data Base (NCDB). Patients with survival &lt; 6 months were excluded to account for immortality bias. Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival. Results Overall 12,972 (91%) did not receive AC and 1,255 (9%) received AC. After PSM there were 2,485 who received AC and 1,254 who did not. After matching, AC was associated with improved survival (median: 38.5 vs 32.3 months, p &lt; 0.001), which remained after multivariable adjustment (HR: 0.78, CI 95% : 0.71 - 0.87, p &lt; 0.001). On multivariable interaction analyses, this benefit persisted in subgroup analysis for nodal status: N0 (HR: 0.85, CI 95% : 0.69 - 0.96, p = 0.039), N1 (HR: 0.66, CI 95% : 0.56 - 0.78, p &lt; 0.001), N2/3 (HR: 0.80, CI 95% : 0.66 - 0.97, p = 0.024) and margin status: R0 (HR: 0.77, CI 95% : 0.69 - 0.86, p &lt; 0.001), R1 (HR: 0.60, CI 95% : 0.43 - 0.85, p = 0.004). Further, patients with stable disease following NAT (HR: 0.60, CI 95% : 0.59 - 0.80, p &lt; 0.001) or downstaged (HR: 0.80, CI 95% : 0.68 - 0.95, p = 0.009) disease had significant survival benefit after AC, but not patients with upstaged disease. Conclusions AC following NAT and esophagectomy is associated with improved survival, even in node-negative and margin-negative disease. NAT response appears crucial in identifying patients who will benefit maximally from AC, and thus future research must be focused on identifying tumors that respond to chemotherapy to maximize this prognostic benefit.

scholarly journals Prognostic value of ESR2 expression on adjuvant chemotherapy in completely resected NSCLC

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243891
Author(s):  
Hongliang Yu ◽  
Dayong Gu ◽  
Pudong Qian
Keyword(s):  
Gene Expression ◽  
Adjuvant Chemotherapy ◽  
Survival Benefit ◽  
Prognostic Value ◽  
Complete Resection ◽  
Validation Group ◽  
Discovery Cohort ◽  
Significant Survival Benefit ◽  
Resected Nsclc ◽  
Significant Survival

Background Prognostic biomarker, which can inform the treatment outcome of adjuvant chemotherapy (ACT) after complete resection of early-stage non-small cell lung cancer (NSCLC), is urgently needed for the personalized treatment of these patients. Patients and methods The prognostic value of gene expression of the estrogen receptor (ER) on the effect of ACT in completely resected NSCLC was investigated in the present study. Two independent datasets from Gene Expression Omnibus (GEO) with a total of 309 patients were included in this study. The prognostic value of ER gene expression on ACT’s efficacy was evaluated by survival analysis and Cox hazards models. Results We found a consistent and significant prognostic value of ERβ (ESR2) expression for ACT’s efficacy in completely resected NSCLC in both of the two independent cohorts. After multivariate adjustment, a significant survival benefit of ACT was observed in patients with low expression of ESR2, with a hazard ratio (HR) of 0.19 (95%CI 0.05–0.82, p = 0.026) in the discovery cohort and an HR of 0.27 (95%CI 0.10–0.76, p = 0.012) in the validation group. No significant benefit of ACT in the subgroup of patients with high expression of ESR2 was observed, with an HR of 0.80 (95%CI 0.31–2.09, p = 0.644) in the discovery cohort and an HR of 1.05 (95%CI 0.48–2.29, p = 0.896) in the validation group. Conclusion A significant survival benefit from ACT was observed in patients with low ESR2 expression. No significant survival benefit was observed in patients with high ESR2 expression. Detection of ESR2 expression in NSCLC may help personalize its treatment after complete resection.

scholarly journals Adjuvant Chemotherapy for T1 Node-Positive Colon Cancers Provides Significant Survival Benefit

2014 ◽  
Vol 57 (12) ◽  
pp. 1341-1348 ◽  
Author(s):  
Asvin M. Ganapathi ◽  
Paul J. Speicher ◽  
Brian R. Englum ◽  
Anthony W. Castleberry ◽  
John Migaly ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Survival Benefit ◽  
Node Positive ◽  
Colon Cancers ◽  
Significant Survival Benefit ◽  
Significant Survival

QS48. The Impact of Age on Surgical Resection Rates and Long-Term Survival in Patients With Locoregional Pancreatic Cancer

2009 ◽  
Vol 151 (2) ◽  
pp. 284
Author(s):  
T.S. Riall ◽  
Y. Kuo ◽  
C.M. Townsend ◽  
J. Freeman ◽  
W. Nealon ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

The impact of pancreatic cancer resection in the era of effective systemic treatment.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 722-722
Author(s):  
Yaacov Richard Lawrence ◽  
Ofer Margalit ◽  
Galia Jacobson ◽  
Liat Hamer ◽  
Uri Amit ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Surgical Resection ◽  
Systemic Treatment ◽  
Locally Advanced ◽  
Tumor Resection ◽  
Phase Iii ◽  
Term Survival ◽  
Systemic Treatments ◽  
Metastatic Setting ◽  
The Impact

722 Background: Surgical resection is the only curative modality in pancreatic cancer, yet the vast majority of patients undergoing surgery succumb of their disease. No randomized studies have been performed to assess the survival impact of the procedure. We hypothesized that in the era of effective systemic treatments, the survival advantage of surgical resection would be lessened. Methods: A meta-analysis of published phase III clinical trials in pancreatic cancer in both the post resection adjuvant setting and the locally advanced metastatic setting, based upon indirect aggregate data. Data was stratified based upon the systemic agents used. Patients from trials arms for which there were not complementary data sets with/without surgical resection were excluded. Primary endpoint was 3 year overall survival (OS). Results: Trials were published between 1997 and 2018. A total of 2722 patients were included in the data analysis, of whom 1645 underwent tumor resection and 814 were metastatic. Median follow-up was 40 months. Analyses were performed of five systemic options with / without tumor resection. Across the trials averaged 3 yr OS was 0%, 0.8%, 0%, and 3.8% for 5FU, gemcitabine, gemcitabine + capecitabine, & FOLFIRINOX respectively; and 18.1%, 30.0%, 37.9%, 42.5%, and 62.5% for the same systemic treatments delivered following surgical resection. Hence the additive impact of surgical resection on absolute 3 yr OS was only 18.1% in the absence of systemic treatment, but 30.0%, 37.1%, 42.5% and 58.8% in the presence of 5FU, gemcitabine, gemcitabine + capecitabine, FOLFIRINOX respectively. Conclusions: Within the limitations of this analysis, it appears that our hypothesis was incorrect, and that the opposite is true. The introduction of effective systemic therapies has greatly increased the impact of pancreatic surgery on long-term survival in pancreatic cancer. Consequently, every effort should be made to bring patients to curative resection.

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