C-reactive protein as a prognostic factor in advanced urothelial carcinoma receiving chemotherapy or immunotherapy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 436-436
Author(s):  
Yan Zhao ◽  
Gregory Russell Pond ◽  
Gurudatta Naik ◽  
Xiao X. Wei ◽  
Bradley Alexander McGregor ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Systemic Therapy ◽  
Systemic Chemotherapy ◽  
Performance Status ◽  
Serum Lactate Dehydrogenase ◽  
Prognostic Impact ◽  
C Reactive Protein ◽  
Visceral Metastasis ◽  
Reactive Protein ◽  
Platinum Based Chemotherapy

436 Background: Clinical prognostic factors have been reported for patients receiving systemic chemotherapy. We hypothesized that markers of tissue damage and inflammation may be prognostic. We conducted a retrospective study to evaluate the prognostic impact of serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) in patients with metastatic UC. Methods: We collected data for patients with metastatic UC receiving systemic therapy and measured serum LDH and CRP at baseline before initiating therapy. The variables collected were recognized clinical prognostic factors (performance status [PS], visceral metastasis, hemoglobin, albumin) and outcomes (time to failure [TTF], overall survival [OS]). TTF was defined as time from initiation of therapy to discontinuation of agent for any reason. LDH and CRP were evaluated on a log-continuous scale. The Kaplan-Meier method was used to estimate times to events. Cox proportional hazards regression and logistic regression were used to study the association of factors with TTF and OS. All tests were 2-sided and significance was defined as p≤0.05. Results: A total of 36 patients were available with a median age of 74 years. The systemic therapy was platinum-based chemotherapy in 18 patients (50%), PD1/PD-L1 inhibitor in 8 patients (22.2%) and the remaining received other agents (taxane or investigational). Twenty-nine (80.5%) had PS 0-1, 13 (36.1%) had visceral metastasis and 16 (44.4%) had received prior platinum-based chemotherapy. A total of 31 patients were evaluable for this analysis with 5 inevaluable due to missing data or inadequate follow-up. On multivariable analyses, only CRP was associated with TTF (HR 1.55 [95% CI: 1.10, 2.20], p = 0.013) and OS (HR 1.77 [95% CI1.10, 2.85], p = 0.018). The limitations of a small dataset and retrospective analysis apply. Conclusions: In patient with advanced UC receiving systemic chemotherapy or PD1/PD-L1 inhibitors as first-line or salvage therapy, CRP was significantly prognostic for both TTF and OS, while other factors were not. Given the potentially powerful prognostic impact of CRP, investigation in larger datasets is warranted to enable better prognostic stratification.

Improved prognostic classification of patients receiving salvage systemic therapy for advanced urothelial carcinoma.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 311-311 ◽  
Author(s):  
Guru Sonpavde ◽  
Gregory Russell Pond ◽  
Jonathan E. Rosenberg ◽  
Dean F. Bajorin ◽  
Ashley Marie Regazzi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Urothelial Carcinoma ◽  
Systemic Therapy ◽  
Proportional Hazards ◽  
Performance Status ◽  
Risk Groups ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
Phase Ii Trials ◽  
Advanced Urothelial Carcinoma

311 Background: Previously identified prognostic factors in patients (pts) receiving salvage systemic therapy for advanced urothelial carcinoma (UC) include performance status (PS), liver metastasis (LM), hemoglobin (Hb) and time from prior chemotherapy (TFPC). Given the prognostic impact of peripheral blood neutrophils (N), lymphocytes (L), thrombocytes (T) and albumin (Alb) in other malignancies, we investigated their impact in the salvage setting of advanced UC. Methods: Phase II trials of salvage systemic therapy were utilized. Data on N, L, T and Alb were required in addition to TFPC, Hb, PS and LM status. N, L, T and Alb were categorized as normal, <lower limit of normal (LLN) and >upper limit of normal (ULN). Cox proportional hazards regression was used to evaluate their association with overall survival (OS). An optimal regression model was constructed using forward stepwise selection and risk groups defined using number of identified adverse risk factors. Trial was a stratification factor. Results: Data was obtained from 10 trials accruing 708 pts. Of these, 682 pts had available TFPC, Hb, PS and LM status, while 631, 554, 649 and 491 had N, L, T and Alb available. Median OS was 6.8 (95% CI: 6.0-7.0) months. Neutrophilia (N>ULN), thrombocytosis (T>ULN) and hypoalbuminemia (Alb <LLN) were significant poor prognostic factors for OS on univariate analyses. After adjustment for TFPC <3 months, Hb <10 g/dl, PS >0 and LM status, only thrombocytosis and hypoalbuminemia remained significant (Table). Risk groups were constructed. Median OS was 8.8, 6.3, 5.0 and 3.8 months for n=290, 220, 123 and 49 patients with 0-1, 2, 3 and ≥4 factors. This 6-factor prognostic model was internally validated with an improvement in the c-index from 0.564 to 0.590. Conclusions: The addition of hypoalbuminemia and thrombocytosis to TFPC, Hb, PS and LM status enhanced the prognostic risk groupings in pts receiving salvage systemic therapy for advanced UC. [Table: see text]

scholarly journals Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review

TH Open ◽  
2021 ◽  
Vol 05 (03) ◽  
pp. e461-e469
Author(s):  
Sandra Lee ◽  
Anika Shenoy ◽  
Daniel Shi ◽  
Mootaz Husien ◽  
Pablo E. Serrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Venous Thromboembolism ◽  
Prognostic Factor ◽  
Systemic Therapy ◽  
Performance Status ◽  
Risk Of Bias ◽  
Tumor Type ◽  
Platinum Based Chemotherapy ◽  
Increased Risk

Abstract Background Patients undergoing systemic cancer therapy are susceptible to developing venous thromboembolism (VTE). The most pertinent prognostic factors for VTE remain unclear. This systematic review aims to summarize prognostic factors associated with VTE in this population. Methods MEDLINE, Embase, and CENTRAL databases were searched for observational or randomized studies that used multivariable analysis adjusted for tumor type and/or metastatic disease to model the risk of VTE. Adjusted effect estimates for each prognostic factor were collected for all of the included studies. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Results From 5,988 search results, 15 eligible studies and 42 prognostic factors were identified. A total of 8,554 patients of whom 456 (5.33%) developed VTE were included. Fourteen studies had a high risk of bias and one study had a moderate risk. The most commonly reported prognostic factors include age, gender, tumor site, metastasis, performance status, and systemic therapy type. Poor performance status and the use of platinum-based chemotherapy compounds were associated with an increased risk of VTE across the majority of studies. The evidence to suggest that the other prognostic factors identified were associated with VTE development was inconclusive. Several individual studies identified novel biomarkers for VTE. Heterogeneity in statistical methods and prognostic factor definitions across studies precluded meta-analysis. Conclusion Overall, many prognostic factors were identified; however, the evidence for association with development of VTE for most of the factors is inconclusive. Findings were limited by high heterogeneity and risk of bias in the included studies.

scholarly journals Prognostic factors for venous thromboembolism in patients with solid tumours on systemic therapy: A systematic review

TH Open ◽  
2021 ◽  
Author(s):  
Sandra Lee ◽  
Anika Shenoy ◽  
Daniel Shi ◽  
Mootaz Husien ◽  
Pablo E. Serrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Venous Thromboembolism ◽  
Prognostic Factor ◽  
Systemic Therapy ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Risk Of Bias ◽  
Platinum Based Chemotherapy ◽  
Increased Risk

Background: Patients undergoing systemic cancer therapy are susceptible to developing venous thromboembolism (VTE). The most pertinent prognostic factors for VTE remain unclear. This systematic review aims to summarize prognostic factors associated with VTE in this population. Methods: MEDLINE, Embase, and CENTRAL databases were searched for observational or randomized studies that used multivariable analysis adjusted for tumour type and/or metastatic disease to model the risk of VTE. Adjusted effect estimates for each prognostic factor were collected for all of the included studies. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Results: From 5,988 search results, 15 eligible studies and 42 prognostic factors were identified. A total of 8,554 patients of whom 456 (5.33%) developed VTE were included. Fourteen studies had a high risk of bias and one study had a moderate risk. The most commonly reported prognostic factors include age, gender, tumour site, metastasis, performance status, and systemic therapy type. Poor performance status and the use of platinum-based chemotherapy compounds were associated with an increased risk of VTE across the majority of studies. The evidence to suggest that the other prognostic factors identified were associated with VTE development was inconclusive. Several individual studies identified novel biomarkers for VTE. Heterogeneity in statistical methods and prognostic factor definitions across studies precluded meta-analysis. Conclusion: Overall, many prognostic factors were identified; however, the evidence for association with development of VTE for most of the factors is inconclusive. Findings were limited by high heterogeneity and risk of bias in the included studies.

Impact of prior platinum on patients receiving salvage systemic therapy for advanced urothelial carcinoma (UC).

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 386-386 ◽  
Author(s):  
Guru Sonpavde ◽  
Gregory Russell Pond ◽  
Giuseppe di Lorenzo ◽  
Carlo Buonerba ◽  
Antonio Rozzi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Combination Chemotherapy ◽  
Salvage Therapy ◽  
Systemic Chemotherapy ◽  
Single Agent ◽  
Prognostic Impact ◽  
First Line ◽  
Platinum Based Chemotherapy ◽  
Platinum Group ◽  
The Impact

386 Background: Trials of salvage therapy for advanced UC have required prior platinum-based therapy. This practice requires scrutiny since non-platinum-based first-line therapy may be offered to cisplatin-ineligible patients (pts). We examined the impact of prior exposure to first-line platinum vs. non-platinum based chemotherapy on overall survival (OS) with salvage systemic chemotherapy. Methods: Data of pts receiving salvage systemic chemotherapy were collected retrospectively or from trials. Data on prior first-line platinum exposure were required in addition to the known prognostic factors: treatment free interval, hemoglobin, performance status, albumin and liver metastasis status. Cox proportional hazards regression was used to evaluate their association with OS after accounting for salvage therapy with single agent chemotherapy or combination chemotherapy. Results: Data was obtained from 455 pts exposed to prior platinum and 37 pts not exposed to prior platinum. In the group exposed to prior platinum, salvage therapy consisted of a single agent taxane (n = 184) and taxane containing combination chemotherapy (n = 271). In the group not exposed to prior platinum, salvage therapy consisted of single agent taxane or vinflunine (n = 20), single agent 5-fluorouracil (n = 1), taxane containing combination chemotherapy (n = 12), carboplatin-based combinations (n = 2) and cisplatin-based combinations (n = 2). The median OS for the prior platinum group was 7.8 (95% CI: 7.0, 8.1) months (mo), and for the prior non-platinum group was 9.0 (6.0, 11.0) mo (p = 0.50). In a multivariable analysis including major prognostic factors and after controlling for single agent or combination salvage chemotherapy, prior platinum vs. no prior platinum exposure conferred no independent impact on OS (HR 1.10 [0.75, 1.64], p = 0.62). Conclusions: Prior platinum vs. non-platinum based chemotherapy did not confer a prognostic impact on OS after accounting for major prognostic factors in pts receiving salvage systemic chemotherapy for advanced UC. Lack of exposure to prior platinum should not disqualify pts from inclusion in trials of salvage therapy after accounting for the 5 known prognostic factors.

scholarly journals Predictors and trajectory of performance status in patients with advanced cancer: A secondary data analysis of the international European Palliative Care Cancer Symptom study

2018 ◽  
Vol 33 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Jason W Boland ◽  
Victoria Allgar ◽  
Elaine G Boland ◽  
Stein Kaasa ◽  
Marianne J Hjermstad ◽  
...  
Keyword(s):  
Palliative Care ◽  
Data Analysis ◽  
Physical Function ◽  
Advanced Cancer ◽  
Independent Living ◽  
Performance Status ◽  
Secondary Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Explanatory Factors

Background: Performance status, a predictor of cancer survival, and ability to maintain independent living deteriorate in advanced disease. Understanding predictors of performance status trajectory could help identify those at risk of functional deterioration, target support for independent living and reduce service costs. The relationship between symptoms, analgesics and performance status is poorly delineated. Aim: The aim of this study is to determine whether demographics, analgesics, disease characteristics, quality-of-life domains and C-reactive protein predict the trajectory of Karnofsky Performance Status (KPS) in patients with advanced cancer. Design: The study design is the secondary data analysis of the international prospective, longitudinal European Palliative Care Cancer Symptom study (ClinicalTrials.gov: NCT01362816). A multivariable regression model was built for KPS area under the curve per day (AUC). Setting and participants: This included adults with advanced, incurable cancer receiving palliative care, without severe cognitive impairment and who were not imminently dying ( n = 1739). Results: The mean daily KPS AUC ( n = 1052) was 41.1 (standard deviation = 14.1). Opioids ( p < 0.001), co-analgesics ( p = 0.023), poorer physical functioning ( p < 0.001) and appetite loss ( p = 0.009) at baseline were explanatory factors for lower KPS AUC. A subgroup analysis of participants with C-reactive protein data ( n = 240) showed that only C-reactive protein ( p = 0.040) and physical function ( p < 0.001) were associated with lower KPS AUC. Conclusion: This study is novel in determining explanatory factors for subsequent functional trajectories in an international dataset and identifying systemic inflammation as a candidate therapeutic target to improve functional performance. The effect of interventions targeting physical function, appetite and inflammation, such as those used for cachexia management, on maintaining functional status in patients with advanced cancer needs to be investigated.

scholarly journals Prognostic Value of C-Reactive Protein, Glasgow Prognostic Score, and C-Reactive Protein-to-Albumin Ratio in Colorectal Cancer

2021 ◽  
Vol 9 ◽  
Author(s):  
Jiahui Zhou ◽  
Wene Wei ◽  
Hu Hou ◽  
Shufang Ning ◽  
Jilin Li ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Roc Curve ◽  
Prognostic Score ◽  
Glasgow Prognostic Score ◽  
Stage I ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein

Background: Emerging evidence suggests that inflammatory response biomarkers are predictive factors that can improve the accuracy of colorectal cancer (CRC) prognoses. We aimed to evaluate the prognostic significance of C-reactive protein (CRP), the Glasgow Prognostic Score (GPS), and the CRP-to-albumin ratio (CAR) in CRC.Methods: Overall, 307 stage I–III CRC patients and 72 colorectal liver metastases (CRLM) patients were enrolled between October 2013 and September 2019. We investigated the correlation between the pretreatment CRP, GPS, and CAR and the clinicopathological characteristics. The Cox proportional hazards model was used for univariate or multivariate analysis to assess potential prognostic factors. A receiver operating characteristic (ROC) curve was constructed to evaluate the predictive value of each prognostic score. We established CRC survival nomograms based on the prognostic scores of inflammation.Results: The optimal cutoff levels for the CAR for overall survival (OS) in all CRC patients, stage I–III CRC patients, and CRLM patients were 0.16, 0.14, and 0.25, respectively. Kaplan–Meier analysis and log-rank tests demonstrated that patients with high CRP, CAR, and GPS had poorer OS in CRC, both in the cohorts of stage I–III patients and CRLM patients. In the different cohorts of CRC patients, the area under the ROC curve (AUC) of these three markers were all high. Multivariate analysis indicated that the location of the primary tumor, pathological differentiation, and pretreatment carcinoembryonic antigen (CEA), CRP, GPS, and CAR were independent prognostic factors for OS in stage I–III patients and that CRP, GPS, and CAR were independent prognostic factors for OS in CRLM patients. The predictors in the prediction nomograms included the pretreatment CRP, GPS, and CAR.Conclusions: CRP, GPS, and CAR have independent prognostic values in patients with CRC. Furthermore, the survival nomograms based on CRP, GPS, and CAR can provide more valuable clinical significance.

The prognostic impact of bone metastasis in urothelial carcinoma treated with first-line platinum-based chemotherapy.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 415-415
Author(s):  
Husam Alqaisi ◽  
Zachary William Neil Veitch ◽  
Carlos Stecca ◽  
Jeenan Kaiser ◽  
Scott A. North ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Performance Status ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
Prognostic Impact ◽  
First Line ◽  
Ecog Performance Status ◽  
Cancer Centre ◽  
Platinum Based Chemotherapy ◽  
Line Setting

415 Background: Metastatic urothelial carcinoma (mUC) is an aggressive disease with a median overall survival (OS) of ≈ 15 months. In the first-line setting, key prognostic factors include ECOG performance status, white blood cell count, and response to treatment per the Galsky nomogram. Bone metastases (BM) in mUC are associated with morbidity and mortality but are grouped with visceral disease; hence, their impact on prognosis is not well established. We aimed to assess the survival impact of BM in mUC patients treated with first-line platinum-based chemotherapy (PBC). Methods: A retrospective collection of patient and tumor characteristics, with clinical response to treatment (complete response [CR], partial response [PR]; stable disease [SD] or progressive disease [PD]) for patients treated at Princess Margaret Cancer Centre, Tom Baker Cancer Centre, and Cross Cancer Institute from 2005-2018 was performed. Progression-free survival (PFS) and OS were estimated using the Kaplan-Meier method. Univariate (UVA) followed by multivariate analysis (MVA) of patient variables [Cox] using PFS and OS was performed. Results: Overall 376 mUC patients were included; 222 (59%) had soft-tissue metastases (STM) only, 70 (19%) had bone-only metastases, and 84 (22%) had both STM and BM. Overall, 35% had PR or CR, 19% had SD, and 39% had PD (7%: unknown response). The median PFS and OS for the whole cohort were 5.6 months (95%CI: 4.8-6.4) and 9.7 months (95% CI: 8.8-10.8) respectively. Select UVA by metastatic site showed inferior PFS for bone-only (p=0.03) and combination STM and BM (p=0.017). Only combination STM and BM were significant on UVA for OS (p=0.002). MVA showed that bone-only metastases (p=0.03) and ECOG 3-4 (p<0.0001) were associated with worse PFS (Table). Predictors of worse OS were the combination of STM and BM (p=0.02), ECOG 3-4 (p=0.001), and WBCs ≥ULN (p=0.02), (Table). Conclusions: BM are a significant predictor of worse outcomes for mUC patients treated with first-line PBC. Consideration as a treatment stratification factor for future studies is suggested. Strategies for the treatment of mUC patients with BM (ie: bone targeted agents) in the first-line setting should be addressed in future trials. [Table: see text]

scholarly journals Neutrophil-lymphocyte ratio in metastatic breast cancer is not an independent predictor of survival, but depends on other variables

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Alejandra Ivars Rubio ◽  
Juan Carlos Yufera ◽  
Pilar de la Morena ◽  
Ana Fernández Sánchez ◽  
Esther Navarro Manzano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Metastatic Breast Cancer ◽  
Performance Status ◽  
Univariate Analysis ◽  
Metastatic Breast ◽  
Prognostic Impact ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

AbstractThe prognostic impact of neutrophil-lymphocyte ratio (NLR) in metastatic breast cancer (MBC) has been previously evaluated in early and metastatic mixed breast cancer cohorts or without considering other relevant prognostic factors. Our aim was to determine whether NLR prognostic and predictive value in MBC was dependent on other clinical variables. We studied a consecutive retrospective cohort of patients with MBC from a single centre, with any type of first line systemic treatment. The association of NLR at diagnosis of metastasis with progression free survival (PFS) and overall survival (OS) was evaluated using Cox univariate and multivariate proportional hazard models. In the full cohort, that included 263 MBC patients, a higher than the median (>2.32) NLR was significantly associated with OS in the univariate analysis (HR 1.36, 95% CI 1.00–1.83), but the association was non-significant (HR 1.12, 95% CI 0.80–1.56) when other clinical covariates (performance status, stage at diagnosis, CNS involvement, visceral disease and visceral crisis) were included in the multivariate analysis. No significant association was observed for PFS. In conclusion, MBC patients with higher baseline NLR had worse overall survival, but the prognostic impact of NLR is likely derived from its association with other relevant clinical prognostic factors.

Sign in / Sign up

Export Citation Format

Share Document