Comparison of bimodality versus trimodality therapy for esophageal or gastroesophageal junction (GEJ) cancer: Experience from the Princess Margaret Cancer Centre.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 122-122
Author(s):  
Akina Natori ◽  
Hao-Wen Sim ◽  
Bryan Anthony Chan ◽  
Peiran Sun ◽  
Stephanie Moignard ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Gastroesophageal Junction ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Curative Intent ◽  
Trimodality Therapy ◽  
Treatment Algorithms ◽  
Multivariable Regression ◽  
Cancer Experience

122 Background: There are no phase 3 trials comparing definitive chemoradiation (bimodality) versus. perioperative chemoradiation (trimodality) for locoregional esophageal/GEJ cancer. Methods: A retrospective analysis (2011-2015) compared bimodality and trimodality therapy in patients (pts) with locoregional esophageal/GEJ cancer treated with curative intent. Overall survival (OS) and disease-free survival (DFS) were calculated from the date of diagnosis. Uni- and multivariable Cox proportional hazards regression adjusted for patient and disease factors. Results: Of 108 patients, 82 (76%) were male. Mean ages were 69.5 ± 11.0 years (bimodality; N = 41) and 60.5 ± 11.1 years (trimodality; N = 67). For bimodality pts, 37% had adenocarcinoma and 63% had squamous cell carcinoma (SCC). For trimodality pts, 79% had adenocarcinoma and 21% had SCC (p < 0.0001). Bimodality pts received a higher radiation dose compared to trimodality pts (50.1 ± 6.7 vs. 45.2 ± 6.4 Gy). Median follow-up was 49.3 months. We found no significant OS difference between bimodality (27.0 months) and trimodality therapy (29.8 months) in the overall cohort (p = 0.57) (4 year OS rate: 42% vs. 38%). In the subgroup with adenocarcinoma histology, trimodality therapy significantly improved OS and DFS compared to bimodality (OS: 31.8 vs. 10.4 months, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.18-0.66, p = 0.001; DFS: 15.0 vs. 6.7 months; HR 0.39, 95%CI 0.21-0.73, p = 0.003). In the SCC subgroup, median OS and DFS were similar (OS: not reached vs. 29.2 months, p = 0.48; DFS: 27.0 vs. 24.0, p = 0.96). Using multivariable regression with AIC backward selection, the only retained prognostic factors were treatment modality (p = 0.06) and histology (p = 0.01). Conclusions: Our findings support preferential use of trimodality therapy for pts with adenocarcinoma histology given superior OS and DFS, whereas bimodality and trimodality therapy appeared comparable in pts with SCC histology. Pending confirmation in a larger series with longer follow-up, these findings suggest differential treatment algorithms for locoregional esophageal and GEJ cancer based on tumor histology.

Comparison of chemoradiotherapy (CRT) with carboplatin/paclitaxel (CP) versus cisplatin/5-FU (CF) for esophageal or junctional cancer: Experience from the Princess Margaret Cancer Centre.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 126-126
Author(s):  
Hao-Wen Sim ◽  
Bryan Chan ◽  
Akina Natori ◽  
Charles Henry Lim ◽  
Di Maria Jiang ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Performance Status ◽  
Disease Free Survival ◽  
Complete Response ◽  
Cox Proportional Hazards ◽  
Definitive Treatment ◽  
Standard Regimen ◽  
Trimodality Therapy ◽  
Exact Test ◽  
Cancer Experience

126 Background: The optimal CRT regimen for neoadjuvant or definitive treatment of locoregional esophageal or gastroesophageal junctional (GEJ) cancer is uncertain. There has been no direct comparison between concurrent Cisplatin/5-FU (CF) as per the CALGB 9781 trial (50.4 Gy) or Carboplatin/Paclitaxel (CP) as per the CROSS trial (41.4 Gy). Methods: A retrospective analysis comparing CF and CP was performed in all patients (pts) with locoregional esophageal or GEJ cancer treated in 2012-2014. Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for age, performance status and Charlson comorbidity index. Pathological complete response (pCR) rates were compared using Fisher’s exact test. Results: 64/86 (74%) pts were male. Median age was 64 years (range: 34-84). Primary sites were esophageal (56%, with 60% squamous histology) and GEJ (44%, with 11% squamous). 22 pts received CRT in 2012 (100% CF), 33 pts in 2013 (58% CF, 42% CP) and 31 pts in 2014 (16% CF, 84% CP). Surgery was undertaken in 19 (41%) CF and 27 (68%) CP pts. Median follow-up was 38 months. We found no significant OS difference between CF and CP overall (HR 0.82, 95% CI: 0.43-1.56, p = 0.55) or in the subgroup having surgery (n = 46; HR 2.01, 95% CI: 0.62-6.55, p = 0.25). However, in the subgroup without surgery (n = 40), CF (n = 27) was superior to CP (n = 13)(HR 0.11, 95% CI: 0.03-0.38, p < 0.001). OS was similar by histology (adenocarcinoma/squamous) in all-comers (p = 0.96), and in CF (p = 0.66) and CP subgroups (p = 0.66). DFS results were similar to OS. There was a non-significant numerical difference in pCR rates between CF (31%) and CP (18%) (p = 0.45). Conclusions: Survival is similar for CF and CP CRT regimens in patients undergoing trimodality therapy. pCR rates were comparable but lower than previously reported. In contrast, in the absence of surgical resection, CP given for CRT results in significantly inferior outcomes. Clinicians may prefer CP for surgical candidates given its toxicity profile. However, when treating with definitive CRT, CF may be preferable to CP as a standard regimen.

Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 189-189
Author(s):  
Akina Natori ◽  
Bryan Chan ◽  
Hao-Wen Sim ◽  
Eric Xueyu Chen ◽  
Geoffrey Liu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Ecog Performance Status ◽  
Free Survival ◽  
Significant Survival ◽  
Comorbidity Index ◽  
Cancer Experience

189 Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥ 75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥ 75 years with GE cancer treated in 2012 and 2013. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 70 pts, median age was 82 years (range: 75-98), primary sites were esophageal (40%, with 61% squamous histology), GE junction (24%) and gastric (36%). Baseline characteristics included: PS: 0 (40%), 1 (39%), 2 (14%), 3 (7%); and CCI: 0 (36%), 1 (20%), 2 (21%), ≥ 3 (23%). Treatment received included surgery (33%), radiotherapy (RT) (31%); surgery plus adjuvant chemotherapy (chemo) and/or RT (9%); chemoradiation alone (7%) and 20% had no active treatment. In univariable analysis; age < 85 (p = 0.007) and surgery (p = 0.022) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analysis; age < 85 (HR 0.46, 95% CI: 0.23-0.94, p = 0.034), surgery (HR 0.32, 95% CI: 0.14-0.74, p = 0.008) and CCI < 2 (HR 0.52, 95% CI: 0.27-0.99, p = 0.048) were identified as independent predictors for improved OS. Age ≥ 85 was significantly associated with omission of surgery (OR 3.61, 95% CI: 1.13-14.01, p = 0.041) but in contrast, PS ≥ 2 (p = 0.475) and CCI ≥ 2 (p = 0.939) were not predictive. Conclusions: At our institution, very few pts ≥ 75 years received multimodality therapy for localized GE cancers. Surgery was the only treatment modality associated with a significant survival advantage, and additional chemo and/or RT did not further improve OS. The only predictor for having surgery was age. Consequently, future studies should consider comprehensive assessment for surgery so that eligible elderly pts can benefit.

Comparison of chemoradiotherapy (CRT) using carboplatin/paclitaxel (CP) versus cisplatin/5-FU (CF) for esophageal or gastroesophageal junctional (GEJ) cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4053-4053 ◽  
Author(s):  
Hao-Wen Sim ◽  
Bryan Anthony Chan ◽  
Akina Natori ◽  
Charles Henry Lim ◽  
Di Maria Jiang ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Performance Status ◽  
Disease Free Survival ◽  
Standard Of Care ◽  
Cox Proportional Hazards ◽  
Definitive Treatment ◽  
Current Standard ◽  
Standard Regimen ◽  
Trimodality Therapy ◽  
Significant Difference

4053 Background: For resectable esophageal or GEJ cancer, trimodality therapy improves survival compared to surgery alone and represents the current standard of care. The optimal CRT regimen for neoadjuvant or definitive treatment of locoregional esophageal or GEJ cancer remains uncertain. Methods: A retrospective comparison of CF and CP for locoregional esophageal or GEJ cancer (2011-2015) was performed. Overall survival (OS) and disease-free survival (DFS) were assessed using multivariable Cox proportional hazards regression, controlling for age, performance status and Charlson comorbidity index. Results: 101 patients (pts) were identified (61 CF, 40 CP). 75% were male. Median age was 62 years (range 30-84). Primary sites were esophageal (52%, with 65% squamous histology) and GEJ (48%). Surgery was undertaken in 34 (56%) CF and 27 (68%) CP pts. Median follow-up was 43 months. Overall, there was a non-significant trend for improved OS with CF compared to CP (HR 0.61, 95% CI 0.33-1.14, p = 0.12). In the subgroup having surgery (N = 61), we found no significant difference in OS (HR 0.99, 95% CI 0.39-2.55, p = 0.99). In the subgroup without surgery (N = 40), CF was significantly superior to CP (HR 0.21, 95% CI 0.08-0.53, p < 0.001). Comparing only pts in this subgroup who received equitable radiation doses (N = 33), CF was still significantly superior to CP (HR 0.09, 95% CI 0.03-0.32, p < 0.001). OS was similar by histology (adenocarcinoma/squamous) in all-comers (p = 0.54), and in CF (p = 0.90) and CP subgroups (p = 0.63). DFS results corresponded with OS. There was a non-significant numerical difference in pCR rates between CF (31%) and CP (18%) (p = 0.35), which were lower than previously reported. Conclusions: Survival is similar for CF and CP CRT regimens in pts undergoing trimodality therapy, but for those who do not proceed to surgery, it appears that CF is more effective than CP. Clinicians may prefer CP for surgical candidates given its favourable toxicity profile. However, when treating with definitive CRT, CF may be preferable to CP as a standard regimen.

Outcomes for patients ≥75 years with localized gastroesophageal cancer: Experience from the Princess Margaret Cancer Centre.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10037-10037
Author(s):  
Akina Natori ◽  
Bryan Anthony Chan ◽  
Hao-Wen Sim ◽  
Lucy Xiaolu Ma ◽  
Daniel Yokom ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Performance Status ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Optimal Treatment ◽  
Gastric Disease ◽  
Ecog Performance Status ◽  
Disease Site ◽  
Radiotherapy Alone ◽  
Cancer Experience

10037 Background: The optimal treatment and outcome for elderly patients (pts) with localized gastroesophageal (GE) cancer remains unclear as they are underrepresented in clinical trials. We aimed to assess survival in pts ≥75 years according to treatment received. Methods: A retrospective analysis was performed for all pts aged ≥75 years with GE cancer treated in 2012-2014. Frailty was measured using the Charlson comorbidity index (CCI) and ECOG performance status (PS). Overall survival (OS) and disease-free survival (DFS) were assessed via uni- and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors impacting treatment choices. Results: Of 105 pts, median age was 81 years (range: 75-99), primary sites were esophageal (55%, with 43% squamous histology) and gastric (45%). Baseline characteristics included: PS: 0 (31%), 1 (42%), 2 (16%), 3 (10%), 4 (1%); and CCI: 0 (34%), 1 (25%), 2 (19%), ≥3 (22%). Treatment received included radiotherapy alone (RT) (31%); surgery alone (29%); surgery plus adjuvant chemotherapy (chemo) and/or RT (14%); chemoradiation alone (7%) and supportive care (18%). In univariable analyses; age < 85 (p = 0.003), PS < 2 (p = 0.03) and surgery (p < 0.001) were associated with improved OS. Chemo and RT, either alone or in combination, did not significantly improve OS. In multivariable analyses; surgery (HR 0.38, 95% CI 0.21-0.70, p = 0.002) was the only independent predictor for improved OS. Patients with good PS (p = 0.01), gastric disease site (p = 0.01) and adenocarcinoma histology (p = 0.02) were more likely to undergo surgery. Conclusions: At our institution, relatively few pts ≥75 years received multimodality therapy for localized GE cancers. Those pts ≥75 years who underwent surgery had excellent outcomes, but they were well-selected. Comprehensive assessment should be considered for pts ≥75 years with localized GE cancer to ensure optimal treatment selection, particularly given the potential benefit of surgery.

High-dose carmustine (BCNU), etoposide (VP-16), cytarabine (Ara-C), and cyclophosphamide-BVAC with autologous transplant (ASCT) in relapsed and refractory Hodgkin disease (HD): Long-term follow-up of 89 patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8068-8068
Author(s):  
T. Iyengar ◽  
M. Hayashi ◽  
C. Leopold ◽  
B. J. Smith ◽  
R. Gingrich ◽  
...  
Keyword(s):  
Survival Data ◽  
Proportional Hazards ◽  
Conditioning Regimen ◽  
Disease Free Survival ◽  
High Dose Chemotherapy ◽  
Cox Proportional Hazards ◽  
High Dose ◽  
Preparative Regimen ◽  
The Impact

8068 Background: High dose chemotherapy followed by ASCT has been established as the therapy for refractory and relapsed HD. Relapse remains the primary contributor to an unsuccessful outcome after ASCT. Intensification of the conditioning regimen is one means of decreasing relapse and improving results. We report our experience with an augmented preparative regimen in patients (pts) with relapsed or refractory HD undergoing ASCT. Methods: Retrospective analysis of 89 consecutive pts from October 1984 to October 2004. All pts received high-dose chemotherapy with BCNU 600mg/m2 IV day -8, Etoposide 400mg/m2/day days -7, -6, -5, and -4, Ara-C 3gm/m2 IV every 12 hours for 8 doses starting day -7, and Cyclophosphamide 90mg/kg IV on day-2 followed by bone marrow (40 pts), peripheral blood (43 pts) or both (6 pts) rescue. Ten pts received planned XRT post-transplant. Survival data were estimated using Kaplan-Meier curves. Cox proportional hazards regression was used to assess the impact of variables on disease-free survival (DFS) and overall survival (OS). Results: A total of 89 pts were identified. Median age was 31 (range 16–62); 51 pts (57.3%) had received one prior therapy at the time of transplant. At transplant only 28 pts (34.6%) were in CR; 79.8% had sensitive disease (CR plus PR).Time to transplant was < 1 year for 17% of pts. With a median follow-up of 811 days, the 5 and 10-year DFS rates were 63.3% and 60.4%, respectively. The estimated 5 and 10- year OS rates were 47.3% and 33.7%. The rate of secondary malignancies at 10 years was 7.8%. Lack of B symptoms and stage at transplant were associated with improved DFS (p= 0.01 and p= 0.0005, respectively) and OS (p=0.002 and p=0.02, respectively). Patients with primary induction failure and resistant relapse did as well as patients with sensitive disease. Conclusions: Though ASCT has been beneficial in prolonging DFS and OS in pts with chemosensitive HD, there has been conflicting data regarding refractory disease. We propose that an intensified regimen, i.e. BVAC, may be of benefit in that setting. Only a large randomized trial can determine whether intensification of the preparative regimen can improve OS for such a population. No significant financial relationships to disclose.

scholarly journals Different surgical outcome and follow up status between dMMR and pMMR colorectal cancer patients who fulfilled with Amsterdam-II criteria

2020 ◽  
Author(s):  
Ciyuan Sun ◽  
Jyming Chiang ◽  
Tseching Chen ◽  
Hsinyun Hung ◽  
Jengfu You
Keyword(s):  
Colorectal Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Mismatch Repair Gene ◽  
Recurrence Rates ◽  
Repair Gene

Abstract Background：Although hereditary non-polyposis colorectal cancer (HNPCC) could be subtyped into proficient or deficient mismatch repair gene expression (pMMR or dMMR), distinct clinical features between these two subgroups patients was rare reported. Methods：We retrospectively analyzed 175 hereditary non-polyposis colorectal cancer (HNPCC) patients between January 1995 to December 2012. Cox proportional hazards model was used to compare the differences between two subgroups. Results：Significant differences of disease free survival (DFS) and overall survival (OS) exist between dMMR and pMMR. In addition to other factors including younger mean age of diagnosis for dMMR patients (48.6 years v.s. 54.3 years), operation type (more extended colectomy for dMMR 35.8% v.s. 14.5%), tumor location (right colon predominance for dMMR 61.7% v.s. 27.3% and more rectum cases for pMMR 41.8% v.s. 11.7%), tumor differentiation (more poor differentiation for dMMR 23.3% v.s. 9.0%), N staging (more N0 cases for dMMR 70.8% v.s. 50.9%), more frequently presence of extra-colonic tumors for dMMR (16.7% v.s.1.8%) and lower recurrence rates (9.1% v.s.35.3%). Significantly different cumulative incidence of developing metachronous colorectal cancer were observed with 6.18 for pMMR patients and 20.57 person-years for dMMR patients (p<0.001). Conclusions：Distinct clinicopathological features significantly exist between dMMR and pMMR subtypes patient, MMR status should be consider to tailor operation types and follow up surveillance between these two subgroups patients who all fulfilled with Amsterdam-II criteria.

scholarly journals Different surgical outcome and follow up status between dMMR and pMMR colorectal cancer patients who fulfilled with Amsterdam-II criteria

2020 ◽  
Author(s):  
Ciyuan Sun ◽  
Jyming Chiang ◽  
Tseching Chen ◽  
Hsinyun Hung ◽  
Jengfu You
Keyword(s):  
Colorectal Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Mismatch Repair Gene ◽  
Recurrence Rates ◽  
Repair Gene

Abstract Background Although hereditary non-polyposis colorectal cancer (HNPCC) could be subtyped into proficient or deficient mismatch repair gene expression (pMMR or dMMR), distinct clinical features between these two subgroups patients was rare reported. Methods We retrospectively analyzed 175 hereditary non-polyposis colorectal cancer (HNPCC) patients between January 1995 to December 2012. Cox proportional hazards model was used to compare the differences between two subgroups. Results Significant differences of disease free survival (DFS) and overall survival (OS) exist between dMMR and pMMR. In addition to other factors including younger mean age of diagnosis for dMMR patients (48.6 years v.s. 54.3 years), operation type (more extended colectomy for dMMR 35.8% v.s. 14.5%), tumor location (right colon predominance for dMMR 61.7% v.s. 27.3% and more rectum cases for pMMR 41.8% v.s. 11 .7%), tumor differentiation (more poor differentiation for dMMR 23.3% v.s. 9.0%), N staging (more N0 cases for dMMR 70.8% v.s. 50 .9%), more frequently presence of extra-colonic tumors for dMMR (16.7% v.s. 1.8%) and lower recurrence rates (9.1% v.s.35 .3%). Significantly different cumulative incidence of developing metachronous colorectal cancer were observed with 6.18 for pMMR patients and 20.57 person-years for dMMR patients ( p <0.001). Conclusions Distinct clinicopathological features significantly exist between dMMR and pMMR subtypes patient, MMR status should be consider to tailor operation types and follow up surveillance between these two subgroups patients who all fulfilled with Amsterdam-II criteria.

Adjuvant lapatinib in women with early-stage HER2-positive breast cancer (HER2+ BC): Analysis of the hormone receptor-negative subgroup of the intent-to-treat (ITT) population of the TEACH trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 596-596
Author(s):  
Ian Edward Smith ◽  
Dianne M Finkelstein ◽  
Joyce O'Shaughnessy ◽  
Beverly Moy ◽  
Bent Ejlertsen ◽  
...  
Keyword(s):  
Hormone Receptor ◽  
Proportional Hazards ◽  
Early Stage ◽  
Controlled Trial ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Her2 Positive ◽  
Double Blind ◽  
Initial Recurrence

596 Background: TEACH is a randomized, double-blind, placebo (P)-controlled trial evaluating lapatinib (L) in reducing relapse risk in trastuzumab -naive patients (pts) previously treated with chemotherapy for HER2+ BC. The primary results (presented at SABCS 2011) showed a hazard ratio (HR) for disease-free survival (DFS) in L arm compared with P of 0.83 (95% confidence interval [CI] 0.70-1.00; stratified log-rank 2-sided P=.053). The predefined hormone receptor negative subgroup was analyzed, which in contrast to the hormone receptor positive subgroup of the ITT population (N=3147) had a significantly improved DFS. Methods: 3161 HER2+ BC pts (Stage I-IIIc) were randomized 1:1 to L daily or P for 1 year (yr). Primary endpoint was DFS in the ITT population. Central nervous system (CNS) recurrence rate was a secondary endpoint. A subgroup analysis by Cox Proportional Hazards Regression Models was performed for the hormone receptor negative pts from the ITT population. Results: 1288 pts (41%) comprised the hormone receptor negative subgroup of the ITT (L:639, and P:649). Median time from diagnosis to randomization was 2.4 (0.3-15) yrs, median follow-up was 4 yrs. Median age for this subgroup was 53 (24-87) yrs. With 85 events in L arm and 128 in P arm, the HR for DFS for hormone receptor negative pts was 0.68 (95%CI 0.52-0.89) favoring L. Most hormone receptor negative subgroups showed benefit for L: pts up to 1 yr from diagnosis (HR 0.64; 95%CI 0.41-0.99), node negative (HR 0.57; 95%CI 0.35-0.92), premenopausal (HR 0.59, 95%CI 0.37-0.94), and those who received prior anthracycline chemotherapy without taxanes (HR 0.63; 95%CI 0.43-0.92). Node positive patients had a trend to benefit from L (HR 0.74; 95%CI 0.53-1.03). CNS as one site of initial recurrence occurred in 1% in L (n=7) and P (n=8) arms. Conclusions: Lapatinib improved DFS in patients early or late in follow-up from diagnosis of HER2+, hormone receptor negative BC. Similar subset analyses are important in other large adjuvant anti-HER2 therapy trials. Results might provide a better understanding of the subtypes of HER2+ disease and help to further individualized therapy.

Resected pancreatic cancer (PC): Impact of adjuvant therapy (Rx) at a high-volume center (HVC) on overall survival (OS).

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 191-191 ◽  
Author(s):  
Margaret T Mandelson ◽  
Vincent J. Picozzi
Keyword(s):  
Proportional Hazards ◽  
Average Distance ◽  
Univariate Analysis ◽  
High Volume ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Resection Margins ◽  
Curative Intent ◽  
The Impact

191 Background: Surgical outcomes for resected PC are known to be superior at HVCs. However, the impact of adjuvant (Rx) performed at HVCs is less studied. We examined the impact of site of adjuvant Rx administration on our resected patients (pts). Methods: Eligible pts were diagnosed 2003-2014 and resected at HVC. Pts were excluded for neoadjuvant Rx, synchronous cancer, death/lost to follow-up within 3 months or contraindications (e.g. morbidity) to adjuvant Rx.. Pts were also excluded if they refused adjuvant treatment or if a community oncologist (CC) was not identified in the medical record or in the western Washington population-based cancer registry. Pt and tumor characteristics were compared in univariate analysis and survival was calculated from date of diagnosis to death or last follow-up. Five year OS was estimated by the Kaplan Meier method and compared using Cox proportional hazards modeling to evaluate the impact of HVC adjuvant Rx on OS while adjusting for potential confounding factors. Results: 245 pts were eligible for study: 139 (57%) treated at HVC, 106 (43%) treated at CC. HVC and CC pts were similar with respect to stage and tumor size, nodal status, resection margins and average distance travelled to HVC. They differed by age (HVC: 63.1, CC: 68.2 p < 0.01). Median and 5-yr OS was 36 mos and 33%. Median OS for HVC vs CC was 44 mos vs. 28 mos (p < 0.01), and 5yr OS was 38.6% vs. 24.8% (p < 0.01), adjustment for age did not alter our findings. Conclusions: 1) With respect to adjuvant Rx for resected PC, HVC and CC pts differed with respect to age only. 2) Both median and 5- yr OS was statistically superior at HVC vs CC. 3) Our study supports the use of HVCs for all Rx components for PC treated with curative intent. 4) Ongoing investigation of patterns of care and their impact on OS in PC is warranted.

Various clinical outcomes in patients with esophageal or gastroesophageal junction (E-GEJ) adenocarcinoma undergoing trimodality therapy: Prognostic implications.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15053-e15053
Author(s):  
Akihiro Suzuki ◽  
Lianchun Xiao ◽  
Takashi Taketa ◽  
Kazuki Sudo ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Proportional Hazards ◽  
Univariate Analysis ◽  
Gastroesophageal Junction ◽  
Selection Procedure ◽  
Complete Response ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
P Value ◽  
Trimodality Therapy

e15053 Background: Preoperative chemoradiation (trimodality therapy) has the strongest evidence in trimodality-eligible patients with esophageal or gastroesophageal junction (E-GEJ) adenocarcinoma. Pathological complete response (pathCR) and clinical complete response (clinCR) are independent prognostic factors. We hypothesized that pathCR is associated with best prognosis. Methods: Patients with E-GEJ adenocarcinoma undergoing trimodality therapy were identified from the prospectively maintained database at our institution. The Log rank test, univariate and multivariate Cox proportional hazards regression analysis were applied for the survival analysis. Variables with p value < 0.15 in the univariate analysis were included in the multivariate analysis, the backward selection procedure was used for the model selection. Variables with P value < 0.05 were considered statistically significant. Results: For 314 esophageal cancer patients, the median follow-up time was 44.0 months (95% CI; 34.2-50.9). 107 of 314 patients died at this analysis. 80 patients (25.5%) had a pathCR. 160 patients (51.0%) had a clinCR prior to surgery but did not have pathCR. The remaining 74 (23.6%) had <pathCR and <clinCR. Median OS were: not achieved in pathCR patients, 82.8 months (95% CI; 63.9, NA) in clinCR patients and 27. 6 months (95% CI; 19.4, NA) <pathCR/<clinCR (p<0.001). The median recurrence-free survival (RFS) were: 79.6 months (95% CI; 37.4, NA) in pathCR patients, 67.4 months (95% CI; 31.8, NA) in clinCR patients and 13.5 months (95% CI; 10.4, 21.4) in <pathCR/<clinCR (p<0.001). In multivariate analysis, no lymph node metastasis (p<0.001), not poorly differentiated adenocarcinoma (p=0.002) and pathCR (p=0.02), and cCR (p<0.001) were independent prognosticators of OS and RFS. Conclusions: pathCR and clinCR are associated with a better survival ourtcome compared to patients without pathCR/clinCRand may be helpful in devising new therapeutic and surveillance strategies.

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