Role of adjuvant chemotherapy in patients with pathological stage I NSCLC with high-risk features.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 9022-9022
Author(s):  
Lubina Arjyal ◽  
Dipesh Uprety ◽  
Susan M Frankki ◽  
Andrew J Borgert ◽  
David E. Marinier
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Tumor Size ◽  
Stage I ◽  
Median Income ◽  
Pathological Stage ◽  
Kaplan Meier

9022 Background: Lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC). There is a lack of prospective data on the benefit of adjuvant chemotherapy (CT) in patients with negative margins but with high-risk features: lympho-vascular invasion (LVI) or visceral pleural invasion (VPI). We aimed to investigate the benefit of adjuvant CT in patients with pathological stage I NSCLC with high-risk features. Methods: The 2016 National Cancer Database was queried to identify patients with pathological stage I NSCLC (8th edition AJCC staging) diagnosed from 2010-2015 who received lobectomy/pneumonectomy with clear surgical margins. Patients were stratified into high risk (tumor size ≥2 cm with LVI and/or VPI) or low risk group. Multivariate Cox proportional hazards regression and propensity score matched Kaplan-Meier survival analysis were used to compare overall survival between those who received adjuvant CT and those who did not. Results: 34,556 patients were identified with 1114 (3.2%) receiving adjuvant CT. On multivariate Cox regression analysis, high risk tumors (hazard ratio [95% confidence interval] = 1.31 [1.25-1.38]) and lack of adjuvant chemotherapy (1.25 [1.09-1.44]) were associated with worse overall survival (OS). Additionally, male sex, age ≥ 60 years, higher comorbidity burden, lack of insurance, low facility volume, low median income, non-squamous histology were associated with worse OS. After propensity score matching, Kaplan-Meier survival analysis of the high risk subgroup (n = 2923) showed a significant difference in overall survival (OS) between those who received adjuvant CT (n = 1032, 5 year OS, 74.7%; 95% CI, 70.9%-78.0%) and those who did not (n = 1891, 5 year OS, 66.9%; CI, 63.9%-69.6%; p = 0.0002). In patients with no high risk factors for recurrence (n = 384), OS was not significantly different between the patients who received adjuvant CT (n = 78, 5 year OS, 75.8%; CI, 61.3%-85.5%) and those who did not receive adjuvant CT (n = 306, 5 year OS, 77.1%; CI, 70.0%-82.7%; p = 0.3). Conclusions: Our study showed better survival with adjuvant CT in patients with pathological stage I NSCLC who have tumor size greater than 2 cm, LVI and/or VPI.

Adjuvant chemotherapy for pathological stage I non-small cell lung cancer with high-risk factors for recurrence: A multicenter study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8500-8500 ◽  
Author(s):  
Yasuhiro Tsutani ◽  
Kentaro Imai ◽  
Hiroyuki Ito ◽  
Takahiro Mimae ◽  
Yoshihiro Miyata ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Stage I ◽  
Pathological Stage ◽  
Component Size ◽  
High Risk Factors ◽  
Invasive Component ◽  
Risk Factors For Recurrence ◽  
Lymphatic Permeation

8500 Background: The role of adjuvant chemotherapy for pathological stage I non-small cell lung cancer (NSCLC) is controversial. The purpose of this study was to investigate the effect of adjuvant chemotherapy for pathological stage I NSCLC with high-risk factors for recurrence. Methods: Prospectively collected data from 1,278 patients with pathological stage I (8th edition) NSCLC undergoing lobectomy were retrospectively analyzed. High-risk factors for recurrence were determined by multivariable Cox proportional hazards model for recurrence-free survival (RFS). RFS, overall survival (OS), and cancer-specific survival (CSS) were compared between patients who received adjuvant chemotherapy and those who did not. Results: In multivariable analysis, age (≥70 y; hazard ratio [HR], 2.14), invasive component size ( > 2 cm; HR, 1.60), visceral pleural invasion (HR, 1.81), lymphatic permeation (HR, 1.67), and vascular invasion (HR, 2.78) were identified as independent factors for RFS. In patients with high-risk factors for recurrence such as invasive component size of > 2 cm, visceral pleural invasion, lymphatic permeation, or vascular invasion (high-risk group; n = 641), RFS was significantly different between patients who received adjuvant chemotherapy (n = 222; 5-y RFS, 81.4%) and those who did not (n = 418; 5-y RFS, 73.8%; P = 0.023). OS and CSS were also significantly better in patients who received adjuvant chemotherapy (5-y OS, 92.7%; 5-y CSS, 95.0%) than in those who did not (5-y OS, 81.7%; P < 0.0001; 5-y CSS, 89.5%; P = 0.012). In patients without any high-risk factors for recurrence (low-risk group; n = 637), RFS was not significantly different between patients who received adjuvant chemotherapy (n = 83; 5-y RFS, 98.1%) and those who did not (n = 554; 5-y RFS, 95.7%; P = 0.30). OS and CSS were also not significantly different between patients who received adjuvant chemotherapy (5-y OS, 98.0%; 5-y CSS, 100%) and those who did not (5-y OS, 95.6%; P = 0.35; 5-y CSS, 99.4%; P = 0.52). Conclusions: Adjuvant chemotherapy may improve survival in patients with pathological stage I NSCLC who have high-risk factors for recurrence such as invasive component size of > 2 cm, visceral pleural invasion, lymphatic permeation, or vascular invasion.

Comparison of adjuvant chemotherapy, chemoradiation, and chemotherapy followed by chemoradiation for resected stage I-II pancreatic cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 372-372
Author(s):  
Sung Jun Ma ◽  
Gregory Hermann ◽  
Kavitha M Prezzano ◽  
Lucas M Serra ◽  
Austin J Iovoli ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Concurrent Chemoradiation ◽  
Forest Plot

372 Background: Prior National Cancer Database (NCDB) studies have demonstrated an overall survival (OS) benefit for adjuvant concurrent chemoradiation (CRT) compared to chemotherapy alone. Given the more recent adoption of postoperative chemotherapy followed by concurrent chemoradiation (C+CRT), this NCDB analysis evaluates the clinical outcomes of C+CRT compared to CRT alone or adjuvant chemotherapy alone (C) for resected pancreatic cancer. Methods: The NCDB was queried for primary stage I-II, cT1-3N0-1M0, resected pancreatic adenocarcinoma treated with adjuvant C, CRT, or C+CRT (2004-2015). Patients treated with C+CRT were compared with those treated with C (cohort C) or with CRT (cohort CRT). The primary endpoint was overall survival (OS). Baseline patient, tumor, and treatment characteristics were examined. Kaplan-Meier analysis, multivariable Cox proportional hazards method, forest plot, and propensity score matching were used. Results: Among 5667 patients (n = 3031 for C, n = 1307 for CRT, n = 1329 for C+CRT), median follow-up was 34.7 months, 45.2 months, and 39.7 months for the C, CRT, and C+CRT cohorts, respectively. In the multivariable analysis for all patients, C (HR 1.31, p < 0.001) and CRT (HR 1.24, p < 0.001) were associated with worse mortality compared to C+CRT. Treatment interactions were seen among pathologically node positive disease. C+CRT was favored in 1-3 (HR 0.74, p < 0.001) and 4+ (HR 0.75, p < 0.001) positive lymph node disease when compared to C or CRT alone, but none of the treatment options were significantly favored in node negative disease (HR 0.96, p = 0.67). Using 1:1 propensity score matching, 2152 patients for cohort C and 1774 patients for cohort CRT were matched. C+CRT remained significant for improved OS for both cohort C (median OS 23.3 vs 20.0 months, p < 0.001) and cohort CRT (median OS 23.4 vs 20.8 months, p < 0.001). Conclusions: This NCDB study using propensity score matched analysis demonstrates an OS benefit for C+CRT compared to C or CRT alone following surgical resection of pancreatic cancer. Most of this benefit is in patients with positive lymph nodes.

Effectiveness of Adjuvant Chemotherapy for Locally Advanced Bladder Cancer

2016 ◽  
Vol 34 (8) ◽  
pp. 825-832 ◽  
Author(s):  
Matthew D. Galsky ◽  
Kristian D. Stensland ◽  
Erin Moshier ◽  
John P. Sfakianos ◽  
Russell B. McBride ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Observational Study ◽  
Performance Status ◽  
Locally Advanced ◽  
Median Income ◽  
Advanced Bladder Cancer ◽  
The Impact

Purpose Given that randomized trials exploring adjuvant chemotherapy for bladder cancer have been underpowered and/or terminated prematurely, yielding inconsistent results and creating an evidence gap, we sought to compare the effectiveness of cystectomy versus cystectomy plus adjuvant chemotherapy in real-world patients. Patients and Methods We conducted an observational study to compare the effectiveness of adjuvant chemotherapy versus observation postcystectomy in patients with pathologic T3-4 and/or pathologic node-positive bladder cancer using the National Cancer Data Base. We compared overall survival using propensity score (–adjusted, –stratified, –weighted, and –matched) analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to examine the impact of performance status. Results A total of 5,653 patients met study inclusion criteria; 23% received adjuvant chemotherapy postcystectomy. Chemotherapy-treated patients were younger and more likely to have private insurance, live in areas with a higher median income and higher percentage of high school–educated residents, and have lymph node involvement and positive surgical margins (P < .05 for all comparisons). Stratified analyses adjusted for propensity score demonstrated an improvement in overall survival with adjuvant chemotherapy (hazard ratio, 0.70; 95% CI, 0.64 to 0.76), and similar results were achieved with propensity score matching and weighting. The association between adjuvant chemotherapy and improved survival was consistent in subset analyses and was robust to the effects of poor performance status. Conclusion In this observational study, adjuvant chemotherapy was associated with improved survival in patients with locally advanced bladder cancer. Although neoadjuvant chemotherapy remains the preferred approach based on level I evidence, these data lend further support for the use of adjuvant chemotherapy in patients with locally advanced bladder cancer postcystectomy who did not receive chemotherapy preoperatively.

scholarly journals Sex Disparities in Thyroid Cancer: A SEER Population Study

2021 ◽  
Author(s):  
Peng Li ◽  
Ying Ding ◽  
Mengyuan Liu ◽  
Wenlong Wang ◽  
Xinying Li
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Cancer Patients ◽  
Tumor Size ◽  
Median Income ◽  
Male And Female ◽  
Kaplan Meier ◽  
Sex Disparities ◽  
Male Patients

Abstract Background: The incidence and mortality of thyroid cancer vary according to race and sex. Male and female thyroid cancer patients are also given differences in some clinical characteristics, such as tumor size and distant metastasis. However, whether there are sex differences in the prognosis of thyroid cancer remains controversial. Therefore, the present study is intended to explore the relationship between sex and prognosis of patients with thyroid cancer and to provide guidelines for the treatment and management of thyroid cancer patients.Methods: A retrospective analysis of patients with pathologically proven thyroid cancer from the Surveillance, Epidemiology and End Results database. The sex disparities in the prognosis of different cohorts derived by propensity score matching was investigated using Cox proportional hazards models and Kaplan–Meier functions. Results: Among 41,270 female and 13,188 male with thyroid cancer, sex was an independent prognostic factor for overall (OS) and cancer-specific (CSS) survival (HR=1.632, 95%CI=1.499-1.777, P<0.001; HR= 1.473, 95% CI= 1.245-1.741, P<0.001). Male developed a larger tumor size (17.44 vs. 23.51cm) and had a larger proportion of metastasis (lymph nodes: 33.2 vs. 21.0%; distant: 2.3 vs. 0.9%), through female had a higher incidence and were diagnosed with thyroid cancer at an earlier age (47.98 vs. 52.45 years old). Survival month of male patients was significantly lower than that of female patients (72.39 vs. 76.8 months). In Kaplan-Meier analyses of cohorts derived by propensity score matching, OS and CSS declined more sharply for male (P<0.01). The mean number (2.0 vs 4.0) and mean ratio (0.192 vs 0.297) of positive nodes supported that male patients have a worse prognosis. Factors including race, age, surgery, histology recode, T, N, M stage and combined summary stage affected the CSS of male and female, plus median income had an extra impact in male (≥$55000 versus <$55,000: HR= 0.739, 95% CI= 0.574-0.953, P= 0.020).Conclusion: Thyroid cancer is a tumor with a female prevalence but a male bias in poor prognosis. Sex was an independent prognostic factor for OS and CSS. Other factors including race, age, income, histological type, surgery, T, N, M stage influenced OS of male and female with thyroid cancer. But race had no impact on CSS of thyroid cancer patients and median income only affected male CSS.

Adjuvant chemotherapy for high-risk pathological stage I non-small cell lung cancer

2021 ◽  
Author(s):  
Yasuhiro Tsutani ◽  
Kentaro Imai ◽  
Hiroyuki Ito ◽  
Yoshihiro Miyata ◽  
Norihiko Ikeda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Stage I ◽  
Pathological Stage ◽  
Small Cell Lung

A retrospective analysis of the demographic profile and clinical outcomes of stage III colon cancer patients treated with adjuvant chemotherapy in a real-world perspective.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 648-648
Author(s):  
Praveen Ramakrishnan Geethakumari ◽  
Sherry Pomerantz ◽  
John Charles Leighton
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Survival Analysis ◽  
Adjuvant Chemotherapy ◽  
Retrospective Analysis ◽  
Real World ◽  
Stage Iii ◽  
Eligibility Criteria ◽  
Stage Iii Colon Cancer ◽  
Kaplan Meier

648 Background: It is standard to use results of randomized controlled trials (RCT’s) for therapeutic decisions in community oncology. However participant selection in trial environments may not reflect real-world scenario. We aim to perform a retrospective analysis of patient profile and treatment outcomes in a community cancer center. Methods: Patients with stage III colon cancer offered adjuvant chemotherapy after curative resection from 2003-2010 (N=177) were reviewed. Eighty-seven patients with complete medical records were analyzed. Patient eligibility was assessed on criteria from the MOSAIC and NSABP C-07 trials. Eligible and ineligible patients were compared using Fisher’s exact test, Student’s t-test and Kaplan-Meier survival analysis. Results: The study group (females: 53%) with mean age of 65 years, was predominantly African American (60%). ECOG performance status was ≥ 2 in 13% patients. Only 29% satisfied all standard eligibility criteria. Ineligibility characteristics included age > 75 years (21%), non-malignant severe systemic disease (10%) and > 42 days from surgery to chemotherapy (39%). Seventy-five patients (86%) received chemotherapy. Chemotherapy regimens included FOLFOX (51%), FLOX (10%), FL (29%) and Capecitabine (8%). Total planned dose had to be modified in 64% patients with mean doses of 89% 5-fluorouracil and 79% oxaliplatin employed. The 3-year disease free survival (DFS) was 53% and 5-year overall survival (OS) was 56%. Age ≥ 69 years was significantly associated with poor 3-year DFS (P=0.013). On Kaplan-Meier survival analysis, the ineligible patient group had significantly reduced overall survival (hazard ratio, 2.88; 95% CI, 1.05-4.82; P= 0.037). Conclusions: This pilot venture studied adjuvant management of Stage III colon cancer in a real-world setting. Our results reveal that over 70% patients did not meet standard eligibility criteria and show decreased 5-year OS among these patients that needs to be addressed in future prospective RCT’s.

scholarly journals Basal Cell Carcinoma of the External Genitalia: A Population-Based Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Xi Chen ◽  
Yulong Hou ◽  
Can Chen ◽  
Guan Jiang
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Basal Cell Carcinoma ◽  
Tumor Size ◽  
Survival Outcomes ◽  
Clinicopathologic Features ◽  
Distant Disease ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Disease Specific

IntroductionBasal cell carcinoma (BCC) located on the genitalia is rare; data on the clinicopathologic features and survival outcomes are only available through case reports and small case series studies.PurposeThis study aimed to explore the epidemiology and identify the prognostic factors of genital BCCs.MethodsWe queried the 18 registries of the Surveillance, Epidemiology, and End Results database for patients with primary BCCs of the genital skin from 2000 through 2017. The primary endpoint was overall survival (OS) and disease specific survival (DSS). Kaplan-Meier survival analysis was conducted to assess the impact of clinicopathological variables on OS and DSS. Multivariate Cox proportional hazards model was performed to evaluate risk factors for OS.ResultsA total of 1,607 cases of genital BCCs were identified. The cohort was composed of 1,352 women (84.1%) and 255 men (15.9%). The median (P25, P75) age of the entire cohort was 73(63–82)years. White patients accounted for 87.2% of the cases. For women and men, the most common site of involvement was the labia majora (89.6%) and scrotum (74.5%), respectively. The majority of patients with genital BCC had localized disease (75.5%). Kaplan-Meier survival analysis showed that female genital BCCs experienced better DSS than men (209.1 months vs 194.8 months); for men, BCCs located on the scrotum had better DSS and OS than those on the penis (P &lt; 0.05 for both endpoints). All patients with distant disease died of disease-specific death, and the average survival time was 8.2 months. Multivariate analysis revealed that age, primary site, and stage were independent determinants of OS for men, while tumor size, histologic subtype, and race were not. For women, factors associated with worse OS included increasing age, tumor size more than 2 cm, and distant disease; factors associated with a decreased risk included “other” and “unknown” races.ConclusionThe prognosis of genital BCCs is excellent, while the survival of distant disease is very poor. Despite similar clinicopathologic features and overall survival outcomes, men and women should be treated as two different entities when making survival predictions.

Impact of analgesia on cancer recurrence and mortality within 5 years after stage I non-small cell lung cancer resection

2021 ◽  
pp. 030089162110200
Author(s):  
Giulio Luca Rosboch ◽  
Edoardo Ceraolo ◽  
Ilaria De Domenici ◽  
Francesco Guerrera ◽  
Eleonora Balzani ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Propensity Score ◽  
Small Cell Lung Cancer ◽  
Cumulative Incidence ◽  
Cancer Recurrence ◽  
Small Cell ◽  
Stage I ◽  
Small Cell Lung ◽  
Perioperative Analgesia

Objective: The choice of analgesia after cancer surgery may play a role in the onset of cancer recurrence. Particularly opioids seem to promote cancer cell proliferation and migration. Based on this consideration, we assessed the impact of perioperative analgesia choice on cancer recurrence after curative surgery for stage I non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed the records of all patients undergoing lung resection for stage I NSCLC between January 2005 and December 2012. Patients received analgesia either by peridural (PERI group) or intravenous analgesia with opioids (EV group). Follow-up was concluded in August 2019. Five-year cumulative incidence of recurrence and overall survival were evaluated and adjusted using a propensity score matching method. Results: A total of 382 patients were evaluated, 312 belonging to the PERI group (81.7%) and 70 to the EV group (18.3%). There was no statistically significant difference between the two groups in 5-year cumulative incidence of recurrence ( p = 0.679) or overall survival rates ( p = 0.767). These results were confirmed after adjustment for propensity score matching for cumulative incidence of recurrence ( p = 0.925) or overall survival ( p = 0.663). Conclusions: We found no evidence suggesting an association between perioperative analgesia choice and recurrence-free survival or overall survival in patients undergoing surgical resection of stage I NSCLC.

scholarly journals Gastric Cancer Treatments and Survival Trends in the United States

2020 ◽  
Vol 28 (1) ◽  
pp. 138-151
Author(s):  
Kelly A. Stahl ◽  
Elizabeth J. Olecki ◽  
Matthew E. Dixon ◽  
June S. Peng ◽  
Madeline B. Torres ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Stage Iv ◽  
The United States ◽  
Current Treatment ◽  
Stage I ◽  
Stage Ii ◽  
Chi Square ◽  
Specific Guideline ◽  
Kaplan Meier

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.

scholarly journals Management of stage I and II nonsmall cell lung cancer

2016 ◽  
Vol 49 (1) ◽  
pp. 1600764 ◽  
Author(s):  
Fiona McDonald ◽  
Michèle De Waele ◽  
Lizza E. L. Hendriks ◽  
Corinne Faivre-Finn ◽  
Anne-Marie C. Dingemans ◽  
...  
Keyword(s):  
Lung Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Cell Lung Cancer ◽  
Targeted Therapies ◽  
Nonsmall Cell Lung Cancer ◽  
Stage I ◽  
Ageing Population ◽  
Randomised Trials ◽  
Long Term Outcome

The incidence of stage I and II nonsmall cell lung cancer is likely to increase with the ageing population and introduction of screening for high-risk individuals. Optimal management requires multidisciplinary collaboration. Local treatments include surgery and radiotherapy and these are currently combined with (neo)adjuvant chemotherapy in specific cases to improve long-term outcome. Targeted therapies and immunotherapy may also become important therapeutic modalities in this patient group. For resectable disease in patients with low cardiopulmonary risk, complete surgical resection with lobectomy remains the gold standard. Minimally invasive techniques, conservative and sublobar resections are suitable for a subset of patients. Data are emerging that radiotherapy, especially stereotactic body radiation therapy, is a valid alternative in compromised patients who are high-risk candidates for surgery. Whether this is also true for good surgical candidates remains to be evaluated in randomised trials. In specific subgroups adjuvant chemotherapy has been shown to prolong survival; however, patient selection remains important. Neoadjuvant chemotherapy may yield similar results as adjuvant chemotherapy. The role of targeted therapies and immunotherapy in early stage nonsmall cell lung cancer has not yet been determined and results of randomised trials are awaited.

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