Outcomes for metastatic colorectal cancer (mCRC) based on microsatellite instability.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 759-759 ◽  
Author(s):  
Timothy Jay Price ◽  
Christos Stelios Karapetis ◽  
Young Joanne ◽  
Amitesh Roy ◽  
Rob Padbury ◽  
...  
Keyword(s):  
Microsatellite Instability ◽  
Early Stage ◽  
Stage Iv ◽  
Patient Characteristics ◽  
Population Based ◽  
Survival Outcomes ◽  
Treatment Pathways ◽  
Stage Disease ◽  
Stage Iv Disease ◽  
Population Based Registry

759 Background: Microsatellite instability (MSI) has been associated with improved survival outcomes in early stage CRC. In stage IV disease, MSI represents only 3-5% of cases and currently the prognostic implications are less clear. There is however evolving evidence that treatment pathways should include anti-PD-1 antibodies given the encouraging results in heavily pre-treated MSI mCRC patients. We undertook an analysis of the South Australian mCRC population based registry to explore the relevance of MSI status in this population based registry. Methods: The registry was analysed to assess patient characteristics and survival outcomes comparing patients with MSI or microsatellite stable (MSS) disease. K-M survival analysis was used to assess OS. Results: 4359 patients are registered on the data base. 598 (14%) patients had been tested for MSI. 62 (10.1%) of these patients had demonstrable MSI. Patient characteristics and outcomes are summarized in the table. There are statistically higher rates of right sided primary, poorly differentiated pathology and BRAF mutation in the MSI group associated with a trend to reduced survival. Chemotherapy and biological therapy received in the MSI v MSS groups was as follows; 5FU 31% v 25%, 5FU/irinotecan 17% v 12%, 5FU/oxaliplatin 52% v 58%, bevacizumab 31% v 42%, anti-EGFR 0 v 4.6%. Conclusions: The patient characteristics of MSI mCRC are in keeping with those previously reported. MSI in this population based mCRC registry is not associated with a favorable outcome as seen in earlier stage disease compared to patients with MSS disease. The trend to poorer outcomes may support routine testing and potentially an alternate treatment pathway, which may include PD-1 inhibitors.[Table: see text]

scholarly journals A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer

2020 ◽  
Author(s):  
Christine Brezden-Masley ◽  
Kelly E. Fathers ◽  
Megan E. Coombes ◽  
Behin Pourmirza ◽  
Cloris Xue ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Early Stage ◽  
Stage Iv ◽  
Population Based ◽  
Stage I ◽  
Publicly Funded ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Care Costs

Abstract Purpose We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC). Methods We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I–III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. Results Overall, 4535 patients with stage I–III and 354 with stage IV HER2+ BC were identified. Most patients with stage I–III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I–III HER2+ BC. Conclusion Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC.

Disease complexity and economic burden on patients with colon cancer in the SEER-Medicare population.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 30-30 ◽  
Author(s):  
Maria Alma Rodriguez ◽  
Lee Cheng ◽  
Alma Yvette DeJesus ◽  
Hui Zhao ◽  
Sharon Hermes Giordano
Keyword(s):  
Colon Cancer ◽  
Survival Time ◽  
Cancer Care ◽  
Early Stage ◽  
Stage Iv ◽  
Disease Stage ◽  
Comorbid Conditions ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Stage Iv Disease

30 Background: The relatively high cost of cancer care is receiving national attention. Treating cancer includes not only managing this illness, but also the complications and exacerbation of the patients’ underlying comorbid conditions. The purpose of this study was to analyze how the charges for colon cancer care are affected by the complexity of the patients’ underlying health problems. Methods: We searched the Surveillance, Epidemiology, and End Results-Medicare database to identify patients diagnosed with colon cancer from 2009 through 2011. The estimated charges of the patients’ Medicare claims were stratified by survival time, disease stage, patient age, and comorbidity number. We defined patients’ 12 months of care as the 1 month immediately preceding cancer diagnosis plus the 11 months immediately following diagnosis. Results: We identified 10,822 patients newly diagnosed with colon cancer during the study period. Of those patients, one quarter died within 11 months after diagnosis. Treatment for early-stage cancer was significantly less expensive than treatment for advanced disease. For patients with early-stage disease, the charges for surgery, chemotherapy, and/or radiation therapy constituted a smaller contribution to the overall care charges. For patients with advanced-stage disease, the substantially higher overall care charges were largely due to charges for chemotherapy and/or biotherapy. Among patients with the same disease stage at diagnosis (except for patients stage IV disease), those with a survival time of less than 12 months incurred higher charges than those with a survival time of 12 months or more did. Regardless of disease stage, survival time, or age, patients with one and two or more comorbid conditions incurred statistically significant higher charges (7.0% and 29.7%, respectively) than those with no comorbid conditions. Conclusions: These findings demonstrate the important contribution of disease complexity among patients with cancer to the analysis of resource utilization. Using overall cancer care cost or reimbursement models that do not incorporate disease complexity may negatively affect hospitals that care for a high proportion of patients with complex conditions.

Microsatellite frameshift variants in SGO1 of gastric cancer are not always associated with MSI status

2020 ◽  
pp. jclinpath-2020-206934
Author(s):  
Tomohiro Sugiyama ◽  
Moriya Iwaizumi ◽  
Terumi Taniguchi ◽  
Satoshi Suzuki ◽  
Shinya Tani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Microsatellite Instability ◽  
Mismatch Repair ◽  
Gastrointestinal Cancer ◽  
Early Stage ◽  
Stage Iv ◽  
Cancer Resection ◽  
Deficient Mismatch Repair ◽  
Gastric Cancer Resection ◽  
Genemapper Software

AimsAlthough frameshift variants in the microsatellite area of shugoshin 1 (SGO1) have been reported in the context of microsatellite instability-high (MSI-H)/deficient mismatch repair gastrointestinal cancer, most have been evaluated only in early stage I–III patients, and only two of its five microsatellite regions have been evaluated. Therefore, we investigated the frequency and MSI status of microsatellite frameshift variants in gastric cancer cases, including stage IV.MethodsIn a total of 55 cases, 30 gastric cancer resection and 25 non-resection cases, DNA was extracted from both tumour and normal parts and PCR was performed. The variant was confirmed by TA cloning, and MSI was evaluated using GeneMapper software.ResultsA frameshift variant of c.973delA was observed in 16 of the 45 evaluable cases. Its frequency was 35.6%. Of the 25 cases that could be assessed for MSI status, two cases of MSI-H were associated with the c.973delA SGO1 variant. However, c.973delA SGO1 variant was also observed in four cases of microsatellite stable.ConclusionOur study shows that SGO1 frameshift variants are not always associated with MSI status.

Treatment Outcomes and Relative Dose Intensity of Chemotherapy in Slovene Patients With Advanced Hodgkin Lymphoma

2022 ◽  
Author(s):  
Samo Rozman ◽  
Nina Ružić Gorenjec ◽  
Barbara Jezeršek Novaković
Keyword(s):  
Hodgkin Lymphoma ◽  
Proportional Hazards ◽  
Stage Iv ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Relative Dose Intensity ◽  
Cox Proportional Hazards Models ◽  
Stage Disease ◽  
Stage Iv Disease

Abstract This retrospective study was undertaken to investigate the association of relative dose intensity (RDI) with the outcome of Hodgkin lymphoma (HL) patients with advanced stage disease receiving ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). A total of 114 HL patients treated between 2004 and 2013 were enrolled for evaluation. RDI calculations were based on a Hryniuk's model. The association of variables with overall survival (OS) and progression-free survival (PFS) was analysed using univariate and multivariate Cox proportional hazards models. The median age of patients was 39 years, majority of patients were males and had stage IV disease. Fifty-four patients received ABVD and 60 received BEACOPP chemotherapy with 24 and 4 deaths, respectively. Patients in BEACOPP group were significantly younger with lower Charlson comorbidity index (CCI) in comparison with ABVD group, making the comparison of groups impossible. In ABVD group, RDI was not significantly associated with OS (p=0.590) or PFS (p=0.354) in a multivariate model where age was controlled. The low number of events prevented the analysis in the BEACOPP group. Patients' age was strongly associated with both OS and PFS: all statistically significant predictors for OS and PFS from univariate analyses (chemotherapy regimen, CCI, RDI) lost its effect in multivariate analyses where age was controlled. Based on our observations, we can conclude that RDI is not associated with the OS or PFS after the age is controlled, neither in all patients combined nor in individual chemotherapy groups.

scholarly journals Predictors of Survival in Adrenocortical Carcinoma: An Analysis From the National Cancer Database

2018 ◽  
Vol 103 (9) ◽  
pp. 3566-3573 ◽  
Author(s):  
Sri Harsha Tella ◽  
Anuhya Kommalapati ◽  
Subhashini Yaturu ◽  
Electron Kebebew
Keyword(s):  
Surgical Resection ◽  
Adrenocortical Carcinoma ◽  
Poor Prognosis ◽  
Stage Iv ◽  
Tumor Grade ◽  
Disease Stage ◽  
Survival Outcomes ◽  
National Cancer Database ◽  
Stage Iv Disease ◽  
Comorbidity Index

Abstract Context Adrenocortical carcinoma (ACC) is rare; knowledge about prognostic factors and survival outcomes is limited. Objective To describe predictors of survival and overall survival (OS) outcomes. Design and Patients Retrospective analysis of data from the National Cancer Database (NCDB) from 2004 to 2015 on 3185 patients with pathologically confirmed ACC. Main Outcome Measures Baseline description, survival outcomes, and predictors of survival were evaluated in patients with ACC. Results Median age at ACC diagnosis was 55 (range: 18 to 90) years; did not differ significantly by sex or stage of the disease at diagnosis. On multivariate analysis, increasing age, higher Charlson-Deyo comorbidity index score, high tumor grade, and no surgical therapy (all P < 0.0001); and stage IV disease (P = 0.002) and lymphadenectomy during surgery (P = 0.02) were associated with poor prognosis. Patients with stage I-III disease treated with surgical resection had significantly better median OS (63 vs 8 months; P < 0.001). In stage IV disease, better median OS occurred in patients treated with surgery (19 vs 6 months; P < 0.001), and postsurgical radiation (29 vs 10 months; P < 0.001) or chemotherapy (22 vs 13 months; P = 0.004). Conclusion OS varied with increasing age, higher comorbidity index, grade, and stage of ACC at presentation. There was improved survival with surgical resection of primary tumor, irrespective of disease stage; postsurgical chemotherapy or radiation was of benefit only in stage IV disease.

Correlation of Bcl-2 Rearrangement With Clinical Characteristics and Outcome in Indolent Follicular Lymphoma

Blood ◽  
1999 ◽  
Vol 93 (9) ◽  
pp. 3081-3087 ◽  
Author(s):  
Armando López-Guillermo ◽  
Fernando Cabanillas ◽  
Timothy I. McDonnell ◽  
Peter McLaughlin ◽  
Terry Smith ◽  
...  
Keyword(s):  
Early Stage ◽  
Stage Iv ◽  
Complete Response ◽  
Polymerase Chain Reaction Method ◽  
Lymph Node Biopsy ◽  
Free Survival ◽  
Stage Iv Disease ◽  
Grade Ii ◽  
Polymerase Chain ◽  
Follicular Lymphomas

Abstract The t(14;18) translocation, which involves the bcl-2oncogene, occurs in follicular lymphomas (FL) at two common sites: the major breakpoint region (MBR) and the minor cluster region (mcr). The biological and clinical significance of these breakpoints is unknown. The bcl-2 breakpoint site was determined in 247 previously untreated patients (49% men; median age 52 years) with indolent FL (155 grade I, 83 grade II, and 8 grade III) to correlate it with pretreatment characteristics, response, and outcome. The bcl-2 breakpoint site was determined by a polymerase chain reaction method of peripheral blood (all cases), bone marrows (149 cases), and fresh lymph node biopsy specimens (68 cases). The breakpoint site occurred at MBR in 175 cases (71%) and atmcr in 27 (11%). In 45 cases (18%), no breakpoint was detected (germline). No significant relationship was found between the rearrangements and the expression of BLC-2 and BAXproteins. Patients’ germline for MBR and mcr tended to present more frequently with stage IV disease and higher β2-microglobulin (β2M) levels, whereas mcr-rearranged patients presented more frequently with early stage and normal β2M. The complete response rate of germline patients was significantly lower than that of MBR and mcr patients. An estimated 3-year failure-free survival (FFS) for mcr, MBR, and germline cases was 95%, 76%, and 57%, respectively (P < .001). Thebcl-2 breakpoint site was independent of serum β2M and lactate dehydrogenase in its correlation with FFS. In conclusion, thebcl-2 rearrangement site is an important prognostic factor in indolent FL, useful to identify patients who may require different treatment.

scholarly journals Metastatic patterns and survival outcomes in patients with stage IV colon cancer: A population‐based analysis

2019 ◽  
Vol 9 (1) ◽  
pp. 361-373 ◽  
Author(s):  
Jiwei Wang ◽  
Song Li ◽  
Yanna Liu ◽  
Chunquan Zhang ◽  
Honglang Li ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Stage Iv ◽  
Population Based ◽  
Survival Outcomes ◽  
Metastatic Patterns

scholarly journals Spermatic Cord Lymphoma: A Case Report and Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Satoru Taguchi ◽  
Sayuri Takahashi ◽  
Katsuyuki Iida ◽  
Takashi Mizutani ◽  
Kazumi Yamaguchi ◽  
...  
Keyword(s):  
Spermatic Cord ◽  
Poor Prognosis ◽  
Early Stage ◽  
Treatment Options ◽  
Multidisciplinary Treatment ◽  
Stage Iv ◽  
Recommended Treatment ◽  
Testicular Lymphoma ◽  
Stage Iv Disease ◽  
Primary Testicular Lymphoma

Spermatic cord lymphoma is a rare lethal disease. It has a poor prognosis even in stage I or II disease when treated locally, therefore, multidisciplinary treatment for early stage is recommended. On the other hand, the treatment of choice for stage III or IV spermatic cord lymphoma remains to be determined. It is said that spermatic cord lymphoma is clinicopathologically similar to primary testicular lymphoma, therefore the treatment of spermatic cord lymphoma has often been determined by reference to the recommended treatment for primary testicular lymphoma. Here we report a new case of spermatic cord lymphoma, which was found in stage IV disease. We also review thirty-three cases which have been reported as spermatic cord lymphoma to date, and discuss treatment options.

Clear-cell cancer of the ovary—is it chemosensitive?

2005 ◽  
Vol 15 (3) ◽  
pp. 432-437
Author(s):  
S. Pather ◽  
M. A. Quinn
Keyword(s):  
Clear Cell ◽  
Early Stage ◽  
Cell Cancer ◽  
Stage Iv ◽  
Stage I ◽  
High Recurrence Rate ◽  
Second Line ◽  
Early Stage Disease ◽  
Chemotherapeutic Regimen ◽  
Stage Disease

The records of all patients with clear-cell ovarian cancer (CCC) who underwent complete surgical staging and chemotherapy between 1984 and 2001 were reviewed and 39 patients identified as suitable for study. The mean patient age was 56 years, and the stage distribution was as follows: stage I, 53%; stage II, 13%; stage III, 32%; and stage IV, 2%. One in three patients with stage I disease developed recurrent disease despite adjuvant chemotherapy. Seventy percent of tumors demonstrated a response to combination carboplatin and paclitaxel. Tumors which had either a partial response or failed to respond to first-line chemotherapy demonstrated no response to second-line nonplatinum chemotherapy. Endometriosis was identified in 31% of tumors, and 18% of patients developed deep venous thrombosis (DVT); however, neither endometriosis nor DVT was associated with a poorer outcome. CCC has a high recurrence rate in early-stage disease despite adjuvant treatment with cytotoxic chemotherapy. Advanced disease does respond to carboplatin and paclitaxel, which should be the chemotherapeutic regimen of choice. New second-line agents are urgently required.

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