Impact of next-generation sequencing (NGS) in patients with high grade glioma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13541-e13541
Author(s):  
Tariq Zuheir Kewan ◽  
Fahrettin Covut ◽  
Bicky Thapa ◽  
Timothy Peter Spiro ◽  
Abdo S. Haddad ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cleveland Clinic ◽  
High Grade Glioma ◽  
Rank Test ◽  
High Grade ◽  
Cox Regression Analysis ◽  
Off Label ◽  
Grade Iii

e13541 Background: Clinical utility of NGS in high grade glioma patients remain debatable. Methods: We reviewed patients who underwent Foundation One NGS between 7/2013 and 10/2018 after high-grade glioma diagnosis at Cleveland Clinic. Overall survival (OS) and progression free survival (PFS) were estimated by the Kaplan-Meier method and compared by log-rank test. Cox regression analysis was performed to identify predictors of OS. Results: We identified 153 patients, 130 (85%) had glioblastoma multiforme (GBM) and 23 (15%) had grade III glioma, 51 (33%) were female, and median age at diagnosis was 58 (range: 18 – 92). Sixteen (10%) patients had secondary glioma and 34 (22%) had multilobar involvement. ECOG performance score at diagnosis was 0 or 1, 2, and ≥ 3 for 79 (52%), 54 (35%), and 13 (9%) patients, respectively. Glioma was surgically resected for 112 (73%) patients, 85 (56%) had total and 27 (18%) had subtotal resection, whereas other 41 (27%) patients underwent biopsy only. Radiotherapy, temozolomide, and bevacizumab were given to 132 (86%), 129 (84%), and 67 (44%) patients, respectively. NGS revealed median of 5 mutated genes (range: 0 – 19), commonly mutated genes were TERT (63%), CDKN2AB (60%), EGFR (42%), TP53 (42%), PTEN (38%), and IDH1/2 (20%). Two patients received bevacizumab for KDR amplification, 1 received off-label lapatinib for EGFR amplification, and 3 received off-label everolimus for multiple mutations. Median follow-up was 18 months. Three-year OS and PFS for patients with GBM vs grade III glioma were 29% (95% CI: 22 – 39) vs 78% (95% CI: 63 – 97) and 17% (95% CI: 11 – 25) vs 74% (95% CI: 58 – 94), respectively (p < 0.0001 for both). On univariable analysis, each 10 increase in age, ECOG ≥3 vs < 3, grade IV vs III glioma, surgical resection vs biopsy, radiotherapy, temozolomide, bevacizumab, and IDH / TP53 / EGFR / TERT / PTEN / CDKN2AB / ATRX mutations predicted OS (p < 0.01 for all). On multivariable analysis, ECOG ≥3 vs < 3, grade IV vs III glioma, surgical resection vs biopsy, temozolomide, bevacizumab, PTEN and CDKN2AB mutations have remained to predict OS (p < 0.01 for all). Conclusions: In our cohort, NGS results provided additional prognostic value, however led to change in the management for only 4% of patients with high-grade glioma.

scholarly journals The Prognostic Value of the Prognostic Nutritional Index in Operable High-Grade Glioma Patients and the Establishment of a Nomogram

2022 ◽  
Vol 11 ◽  
Author(s):  
Qian He ◽  
Wei Zhao ◽  
Qinglan Ren
Keyword(s):  
Regression Analysis ◽  
Prognostic Factor ◽  
Prognostic Value ◽  
Cox Regression ◽  
High Grade Glioma ◽  
Independent Prognostic Factor ◽  
High Grade ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Grade Iii

BackgroundStudies confirmed the predictive value of the prognostic nutrition index (PNI) in many malignant tumors. However, it did not reach a consensus in glioma. Therefore, this study investigated the prognostic value of preoperative PNI in operable high-grade glioma and established a nomogram.MethodsClinical data of high-grade glioma patients were retrospectively analyzed. The primary endpoint was overall survival (OS). Survival analysis was conducted by the Kaplan–Meier method, log-rank test, and Cox regression analysis. A nomogram was established. The prediction effect of the nomogram covering PNI was verified by area under the curve (AUC).ResultsA total of 91 operable high-grade glioma patients were included. Kaplan–Meier analysis showed that among grade IV gliomas (n = 55), patients with higher PNI (&gt;44) showed a trend of OS benefit (p = 0.138). In grade III glioma (n = 36), patients with higher PNI (&gt;47) had longer OS (p = 0.023). However, the intersecting Kaplan–Meier curve suggested that there may be some confounding factors. Cox regression analysis showed that higher PNI was an independent prognostic factor for grade IV glioma (HR = 0.388, p = 0.040). In grade III glioma, there was no statistically relationship between PNI levels and prognosis. When evaluating the prognostic ability of PNI alone by ROC, the AUC in grade III and IV gliomas was low, indicating that PNI alone had poor predictive power for OS. Interestingly, we found that the nomogram including preoperative PNI, age, extent of resection, number of gliomas, and MGMT methylation status could predict the prognosis of patients with grade IV glioma well.ConclusionThe PNI level before surgery was an independent prognostic factor for patients with grade IV glioma. The nomogram covering PNI in patients with grade IV glioma also proved the value of PNI. However, the value of PNI in grade III glioma needs to be further evaluated. More prospective studies are needed to verify this conclusion.

Plasmin(ogen) serves as a favorable biomarker for prediction of survival in advanced high-grade serous ovarian cancer

2017 ◽  
Vol 398 (7) ◽  
pp. 765-773 ◽  
Author(s):  
Shuo Zhao ◽  
Julia Dorn ◽  
Rudolf Napieralski ◽  
Axel Walch ◽  
Sandra Diersch ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Positive Staining ◽  
Mrna Levels ◽  
High Grade ◽  
Serous Ovarian Cancer ◽  
Data Set ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract In serous ovarian cancer, the clinical relevance of tumor cell-expressed plasmin(ogen) (PLG) has not yet been evaluated. Due to its proteolytic activity, plasmin supports tumorigenesis, however, angiostatin(-like) fragments, derived from PLG, can also function as potent anti-tumorigenic factors. In the present study, we assessed PLG protein expression in 103 cases of advanced high-grade serous ovarian cancer (FIGO III/IV) by immunohistochemistry (IHC). In 70/103 cases, positive staining of tumor cells was observed. In univariate Cox regression analysis, PLG staining was positively associated with prolonged overall survival (OS) [hazard ratio (HR)=0.59, p=0.026] of the patients. In multivariable analysis, PLG, together with residual tumor mass, remained a statistically significant independent prognostic marker (HR=0.49, p=0.009). In another small patient cohort (n=29), we assessed mRNA expression levels of PLG by quantitative PCR. Here, elevated PLG mRNA levels were also significantly associated with prolonged OS of patients (Kaplan-Meier analysis; p=0.001). This finding was validated by in silico analysis of a microarray data set (n=398) from The Cancer Genome Atlas (Kaplan-Meier analysis; p=0.031). In summary, these data indicate that elevated PLG expression represents a favorable prognostic biomarker in advanced (FIGO III/IV) high-grade serous ovarian cancer.

scholarly journals Prognostic Factors in Elderly Patients with High-grade Gliomas: A Retrospective Analysis of 24 Cases

2018 ◽  
Vol 09 (03) ◽  
pp. 312-316 ◽  
Author(s):  
Meenu Gupta ◽  
Saurabh Bansal ◽  
Deep Shankar Pruthi ◽  
Manju Saini ◽  
Nadia Shirazi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Elderly Patients ◽  
Retrospective Analysis ◽  
Cox Regression ◽  
Rank Test ◽  
Karnofsky Performance Scale ◽  
High Grade ◽  
Concomitant Chemotherapy ◽  
Cox Regression Analysis ◽  
High Grade Gliomas

ABSTRACT Background and Objectives: Due to the aging of the population, diagnosis of high-grade gliomas (HGGs) in the elderly is becoming more common. The purpose of this study was to report our experience in 24 elderly patients with HGGs and evaluate the value of different prognostic factors. Design and Setting: Retrospective analysis of 24 elderly patients of ≥60 years with newly diagnosed HGGs, who were treated at our department between January 2009 and December 2012, was done. Patients and Methods: Age, gender, Karnofsky performance scale (KPS) score, extent of surgery, and use of temozolomide were evaluated using univariate and multivariate analyses. Survival was determined using the Kaplan–Meier method, and differences were compared using the log-rank test. Cox regression analysis was conducted to identify the independent prognostic factors. Results: The median overall survival of the patient cohort was 10 months. The 1- and 2-year survival rates were 45.8% and 16.6%, respectively. The analysis revealed that KPS score and use of concomitant chemotherapy were significant prognostic factors. Conclusion: The results of our analyses demonstrate that KPS score and use of concomitant chemotherapy yield encouraging outcomes in elderly patients with HGGs, validating the results published in research papers.

Feasibility and clinical impact of next-generation sequencing (NGS) in patients with stage IV or recurrent malignancies.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14697-e14697
Author(s):  
Fahrettin Covut ◽  
Tariq Zuheir Kewan ◽  
Bicky Thapa ◽  
Abdo S. Haddad ◽  
Timothy Peter Spiro ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Systemic Therapy ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cleveland Clinic ◽  
Stage Iv ◽  
Solid Cancer ◽  
Recurrent Cancer ◽  
Cox Regression Analysis ◽  
Best Response

e14697 Background: Feasibility and outcomes of routine NGS in patients with stage IV or recurrent malignancies remain debatable. Methods: We reviewed patients who underwent Foundation One NGS between 9/2012 and 10/2018 after diagnosis of stage IV or recurrent solid cancer at Cleveland Clinic. Overall survival (OS) was estimated by the Kaplan-Meier method. Logistic and Cox regression analysis were performed to identify predictors of receiving targeted gene therapy (TGT) and OS, respectively. Results: We identified 1699 patients, 825 (49%) were female, 1634 (96%) had stage IV and 65 (4%) had recurrent cancer. At diagnosis of stage IV/recurrent cancer, median age was 61 (range: 18 – 94) and ECOG performance score was 0, 1, and ≥ 2 for 578 (34%), 859 (51%), and 258 (15%) patients, respectively. Most common primary cancers were lung (20%), colorectal (17%), urothelial/prostate (12%), and breast (10%). NGS revealed median of 4 mutated genes (range: 0 – 34), ≥ 1 FDA approved TGT was available in 505 (30%) and 1114 (66%) patients for the same and different primary cancer, respectively. Overall, 219 (13%) patients received 247 lines of TGT for median of 3 months (range: 0.1 – 62) based on NGS results. TGT use was via clinical trials for 49 (22%) and off-label for 83 (38%) patients. Best response was complete/partial response for 63 (29%) and stable disease for 40 (18%) patients. Commonly targeted genes were EGFR (12%), ERBB2/3 (11%), BRAF (10%), BRCA1/2 (8%), and PIK3CA (7%). Median follow-up after diagnosis of stage IV/recurrent cancer was 19 months. Two-year OS for TGT and no TGT cohorts were 70% (95% CI: 64 – 77) and 55% (95% CI: 53 – 58), respectively (p < 0.0001). On multivariable analysis, ECOG ( < 2vs ≥2), systemic therapy between diagnosis of stage IV/recurrent cancer and NGS (≥2 vs < 2 lines), and each 1 increase in number of mutated genes were predictors of receiving TGT (p < 0.05 for all). On multivariable analysis, age (≤65 vs > 65), ECOG ( < 2vs ≥2), stage (recurrent vs IV), and systemic therapy before NGS (≥2 vs < 2 lines) predicted longer OS (p < 0.01 for all). Conclusions: In this large cohort, NGS provided further therapeutic options including clinical trials for approximately 1 out of 10 patients with stage IV or recurrent cancer.

Primary Metastatic Osteosarcoma: Presentation and Outcome of Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

2003 ◽  
Vol 21 (10) ◽  
pp. 2011-2018 ◽  
Author(s):  
Leo Kager ◽  
Andreas Zoubek ◽  
Ulrike Pötschger ◽  
Ulrike Kastner ◽  
Silke Flege ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Primary Tumor ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Study Group ◽  
High Grade ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
Metastatic Osteosarcoma ◽  
Organ Systems

Purpose: To determine demographic data and define prognostic factors for long-term outcome in patients presenting with high-grade osteosarcoma of bone with clinically detectable metastases at initial presentation. Patients and Methods: Of 1,765 patients with newly diagnosed, previously untreated high-grade osteosarcomas of bone registered in the neoadjuvant Cooperative Osteosarcoma Study Group studies before 1999, 202 patients (11.4%) had proven metastases at diagnosis and therefore were enrolled onto an analysis of demographic-, tumor-, and treatment-related variables, response, and survival. The intended therapeutic strategy included pre- and postoperative multiagent chemotherapy as well as aggressive surgery of all resectable lesions. Results: With a median follow-up of 1.9 years (5.5 years for survivors), 60 patients were alive, 37 of whom were in continuously complete surgical remission. Actuarial overall survival rates at 5 and 10 (same value for 15) years were 29% (SE = 3%) and 24% (SE = 4%), respectively. In univariate analysis, survival was significantly correlated with patient age, site of the primary tumor, number and location of metastases, number of involved organ systems, histologic response of the primary tumor to preoperative chemotherapy, and completeness and time point of surgical resection of all tumor sites. However, after multivariate Cox regression analysis, only multiple metastases at diagnosis (relative hazard rate [RHR] = 2.3) and macroscopically incomplete surgical resection (RHR = 2.4) remained significantly associated with inferior outcomes. Conclusion: The number of metastases at diagnosis and the completeness of surgical resection of all clinically detected tumor sites are of independent prognostic value in patients with proven primary metastatic osteosarcoma.

scholarly journals TAMI-54. THE PRESENCE OF IMMUNE CELL INFILTRATES IN THE TISSUE MICROENVIRONMENT OF HIGH-GRADE GLIOMAS AND THEIR ASSOCIATION WITH OVERALL SURVIVAL

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii225-ii225
Author(s):  
Anupam Rishi ◽  
Homan Mohammadi ◽  
Daniela Martir ◽  
Eric Welsh ◽  
Timothy Robinson ◽  
...  
Keyword(s):  
Gene Expression ◽  
Overall Survival ◽  
Surgical Resection ◽  
Immune Cell ◽  
Cox Regression ◽  
Tumor Biology ◽  
Rank Test ◽  
High Grade ◽  
High Grade Gliomas ◽  
Grade 3

Abstract OBJECTIVE Tumor-associated microglia and macrophages (TAMs) influence brain tumor biology and promote tumor-proliferating phenotype. Studies have shown these cell types predict outcomes in various tumor sites with limited evidence in high-grade gliomas (HGG). In this study, we assessed the presence of immune cell infiltrate (ICI) and overall survival (OS) in HGGs. METHODS A total of 97 consecutively treated patients with primary HGG with complete gene expression profiling were identified from our IRB-approved institutional tissue biorepository. Patients underwent primary surgical resection between 02/2004 and 03/2011. Gene expression levels were assessed by Affymetrix Hu-RSTA assays (Affymetrix; Santa Clara, CA). CIBERSORT estimated the presence of ICI via gene expression deconvolution. Tumor characteristics and the presence of 22 individual ICI subtypes were assessed with respect to OS. Time-to-event analyses were performed with Kaplan-Meier estimates and compared via log-rank test. Associations between the ICI and outcomes were explored using Cox-regression. P&lt; 0.05 (two-tailed) was considered statistically significant. RESULTS Median follow-up from primary surgical resection was 12.8 months (range: 0.1-162.8), and median age was 58 years (20-85). Most patients were male (n=63; 65%) and had grade 4 tumors (n=71; 73%). OS differed by grade with 24-month actuarial OS rates of 81% and 34% (P&lt; 0.0001) for grade 3 and 4 gliomas, respectively. The presence of M0 (HR 2.2; 95% CI 1.4-3.6; P=0.001), M1 (HR 1.8; 95%CI 1.1-2.9; P=0.01), and M2 macrophages (HR 1.9; 95%CI 1.2-3.2; P=0.007) predicted OS. No other ICI subtypes were predictive of OS. The presence of M0- and M2-polarized macrophages were more common in grade 4 compared to grade 3 gliomas 46% vs. 11% (P=0.002) and 69% vs. 31% (P=0.0007), respectively. CONCLUSION The increased presence of non-polarized or M2 TAMs within the glioma microenvironment was significantly associated with OS in HGG. Their presence may serve as unique stratification and a potential therapeutic target.

Impact of mastectomy in women with stage IV HER2+ breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12515-e12515
Author(s):  
Arslan Babar ◽  
Fahrettin Covut ◽  
Tariq Zuheir Kewan ◽  
Shafia Rahman ◽  
Stephen R. Grobmyer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Cleveland Clinic ◽  
Stage Iv ◽  
Rank Test ◽  
Breast Radiotherapy ◽  
Her2 Breast Cancer ◽  
Stage Iv Breast Cancer

e12515 Background: Women with stage IV HER2+ breast cancer typically have longer overall survival (OS) compared to other breast cancer subsets due to the effectiveness of dual anti HER-2 antibody therapy. The role of mastectomy remains controversial. Methods: We reviewed patients who were diagnosed with stage IV HER2+ breast cancer between 2/2015 and 12/2017 at Cleveland Clinic. Overall survival (OS) was estimated by the Kaplan-Meier method, and compared by the log-rank test. Univariable and multivariable analysis were performed using Cox regression to identify predictors of OS. Results: We identified 47 patients, with a median age of 58 (range: 22 – 87). Twenty-eight (60%) and 14 (30%) patients had ER+ and PR+ disease, respectively. Four patients had brain metastasis at time of stage IV diagnosis. All patients received systemic therapy. 17 (36%) patients underwent mastectomy after diagnosis of stage IV breast cancer,. Of the 30 (64%) patients who did not undergo mastectomy, 24 (80%), 2 (7%), and 4 (13%) were treated with both chemotherapy and HER2-directed therapy, chemotherapy alone, and HER2-directed therapy alone, respectively. Breast radiotherapy was performed on 9 (53%) and 8 (27%) patients in mastectomy and no mastectomy cohorts, respectively. Median follow-up time was 22 months . The two-year OS for mastectomy and no mastectomy cohorts were 94% (95% CI: 83 – 100) and 50% (95% CI: 33 – 76), respectively (p=0.009). On univariable analysis, only mastectomy vs no mastectomy (HR: 0.18, 95% CI: 0.04 – 0.80, p=0.025) predicted OS. On multivariable analysis, mastectomy vs no mastectomy has remained to be statistically significant predictor of OS (HR: 0.08, 95% CI: 0.01 – 0.66, p=0.019), whereas age, chemotherapy, HER2-directed therapy, and breast radiation were not independent predictors of improved OS (p>0.05). Conclusions: In our cohort, mastectomy was an independent predictor of longer OS in women with stage IV HER2+ breast cancer.

scholarly journals Low-Dose Aspirin as Primary Prophylaxis for Cardiovascular Events in Rheumatoid Arthritis: An Italian Multicentre Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Daniela Iacono ◽  
Serena Fasano ◽  
Ilenia Pantano ◽  
Virginia D’Abrosca ◽  
Piero Ruscitti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Low Dose ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Primary Prophylaxis ◽  
Treated Group ◽  
Rank Test ◽  
Cox Regression Analysis ◽  
Log Rank Test ◽  
Kaplan Meier

Objective. To investigate the role of acetylsalicylic acid (ASA) in reducing the incidence of cardiovascular (CV) events in an Italian multicentre rheumatoid arthritis (RA) inception cohort. Methods. The clinical charts of RA patients consecutively admitted to 4 Italian centres for their 1st visit from November 1, 2000, to December 31, 2015, and followed up till December 2016 were retrospectively investigated for the incidence of CV events. Patients were subdivided into two groups, namely, ASA- and non-ASA-treated groups. The Kaplan–Meier curve and log-rank test were used to investigate differences in event-free survival. Cox regression analysis was carried out to identify factors associated with CV event occurrence. Results. Seven hundred forty-six consecutive RA patients were enrolled and followed up for a median of 5.6 years (range 2.9–8.9 years). The incidence rate (IR) of CV events was 8/1000 person-years (p-ys) in the overall cohort. The IR of CV events was significantly lower in the ASA-treated group with respect to the non-ASA-treated group (IR 1.7 vs. 11.8/1000 p-ys; p=0.0002). The CV event-free rate was longer in ASA-treated patients than in non-ASA-treated patients (log-rank test 12.8; p=0.0003). At multivariable analysis, arterial hypertension (HR 9.3) and hypercholesterolemia (HR 2.8) resulted to be positive predictors and ASA (HR 0.09) and hydroxychloroquine (HCQ) (HR 0.22) to be negative predictors. Conclusion. The IR of CV events in our Italian multicentre cohort was lower than that reported in other European and non-European cohorts. Low-dose ASA may have a role in the primary prophylaxis of CV events in RA patients.

scholarly journals NIMG-27. THRESHOLD VALUES OF EARLY METABOLIC CHANGES IN 1H MRSI METABOLIC METRICS PREDICTIVE FOR SURVIVAL IN PATIENTS WITH NEWLY DIAGNOSED HIGH-GRADE GLIOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii153-ii153
Author(s):  
Samir Patel ◽  
Michael Wang ◽  
Keith Wachowicz ◽  
Atiyah Yahya ◽  
Albert Murtha ◽  
...  
Keyword(s):  
Cox Regression ◽  
High Grade Glioma ◽  
Concurrent Chemotherapy ◽  
Rank Test ◽  
Normal Brain ◽  
High Grade ◽  
Newly Diagnosed ◽  
Threshold Values ◽  
Early Assessment ◽  
Clinical Role

Abstract BACKGROUND The purpose of this study was to evaluate the association of specific threshold values for changes in metabolic metrics measured from 1H magnetic resonance spectroscopic imaging (MRSI) to survival of patients with high-grade glioma treated with multimodality therapy. METHODS Forty-four patients with newly diagnosed high-grade glioma were prospectively enrolled. Serial MRI and MRS scans were performed at baseline, week 4 of radiation therapy (RT), and two months post-RT to measure tumor choline, creatine, and N-acetylaspartate (NAA) normalized to contralateral normal brain. Serial changes in metabolites were assessed using the Wilcoxon signed-rank test. Cox regression analyses adjusted for patient age, KPS, and delivery of concurrent chemotherapy were used to assess the association of changes in metabolic metrics with survival. RESULTS Median follow-up time was 13.4 years, and vital status was available for 95.1% of patients. Mean normalized choline, creatine and choline/creatine decreased significantly after baseline to post-RT in the overall group of patients (all P &lt; 05). Overall survival (OS) was longer in patients with ≤ 20% increase (vs. &gt; 20%) in normalized choline (P = .024) or choline/NAA (P = .024) from baseline to week 4 of RT. During this period, progression-free survival (PFS) was longer in with patients ≤ 40% increase (vs. &gt; 40%) in normalized choline (P = .013). From mid-RT to post-RT, ≤ 40% decrease (vs. &gt; 40%) in normalized choline/NAA (P &lt; .001) or choline/creatine (P = .014), or ≤ 40% increase (vs. &gt; 40%) in NAA/creatine (P = .030) were associated with reduced median OS. CONCLUSIONS Threshold values for serial changes in choline metrics on MRSI associated with OS and PFS were identified. These findings suggest a potential clinical role for MRSI to provide an early assessment of treatment response, and could enable risk-adapted therapy in clinical trial development and clinical practice.

scholarly journals The Role of Chemotherapy in the Survival Benefits of Patients Aged Older Than 40 Years With Osteosarcoma

2021 ◽  
Vol 20 ◽  
pp. 153303382110661
Author(s):  
Zhiyou Cao ◽  
Yuelin Zhang ◽  
Qiang Xu ◽  
Xiaolong Yu ◽  
Xuqiang Liu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Survival Benefit ◽  
Cox Regression ◽  
Rank Test ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Stratified Analysis ◽  
The Impact ◽  
Grade Iii

Objectives: The value of chemotherapy in the survival benefits of patients aged > 40 years with osteosarcoma is controversial. We aimed to explore the impact of chemotherapy on the survival benefits of patients aged >40 years with osteosarcoma. Methods: The Surveillance, Epidemiology, and End Results database was used to select eligible patients. The selected patients were divided into the chemotherapy and non-chemotherapy groups. Logistic regression analysis was performed to investigate the potential factors contributing to the selection of chemotherapy. The overall survival (OS) and cancer-specific survival (CSS) of the two groups were compared using the Kaplan–Meier method with a log-rank test. Cox proportional risk models were used to determine the prognostic factors for OS and CSS. Stratified analysis was performed according to tumour grade and stage. Results: A total of 1032 eligible patients were included in our analysis. Of these, 586 and 446 patients were in the chemotherapy and nonchemotherapy groups, respectively. Multivariate logistic analysis indicated that grade III/IV and distant stage were associated with chemotherapy. Kaplan–Meier plots showed that patients did not achieve an improved OS or CSS after receiving chemotherapy. Cox regression analysis indicated that age > 60 years, axial, grade III/IV, and regional and distant stage were independent risk factors for poor prognosis in both OS and CSS. Stratified analysis revealed a survival benefit from chemotherapy in patients with grade III/IV and distant stage. Conclusions: Chemotherapy did not significantly improve OS and CSS in patients aged > 40 years with osteosarcoma. In this age group, survival benefit from chemotherapy was observed in patients with high-grade tumours (grade III/IV) and metastasis (distant stage).

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