Pancreatic ductal adenocarcinoma (PDAC), BRCA: Detailed analysis and outcomes of cohort from Memorial Sloan Kettering Cancer Center (MSK).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 708-708
Author(s):  
Parisa Momtaz ◽  
Catherine Anne O'Connor ◽  
Joanne F. Chou ◽  
Marinela Capanu ◽  
Kenneth H. Yu ◽  
...  
Keyword(s):  
Stage Iv ◽  
Ductal Adenocarcinoma ◽  
Cancer Center ◽  
Clinicopathologic Characteristics ◽  
Entire Cohort ◽  
Disease Biology ◽  
Kaplan Meier ◽  
Significant Difference ◽  
History Of ◽  
Associated Malignancy

708 Background: Given encouraging responses of platinum agents and poly-ADP ribose polymerase inhibitors (PARPi) in BRCA mutated (mut) PDAC, we sought to identify patients (pts) with BRCA mut PDAC treated at MSKCC and to evaluate outcome. Methods: Institutional database at MSK with IRB approval was queried for PDAC germline (g) or somatic (s) BRCA1/2 mut. Genomic profiling, clinicopathologic characteristics and outcomes were collected. Overall survival (OS) from diagnosis was estimated using Kaplan-Meier method. Results: n = 126 with BRCA1/2 mut PDAC were identified between 1/2011-12/2018. n = 77 (61%) male and median age of 62 (range 24-85) at diagnosis. n = 78 (62%) had g BRCA mut (n = 21 BRCA1; n = 57 BRCA2). n = 54 (43%) had a family history of BRCA-related malignancies; 35pts (28%) with a personal history of other BRCA-associated malignancy. n = 66 (52%) AJCC stage IV; of these 43pts (65%) received platinum-based therapy with a partial response (PR) in 35pts (81%); median duration 7 months (m) (range 0.5-39m). n = 40 (32%) received ≥ 4 lines of therapy (range 1-6 lines). n = 44 (35%) received PARPi and 11% (n = 14) received immunotherapy. Median OS for the entire cohort 32.1 m (95% CI 23.9, 42.6). Median OS for stage I-II 49.9m (95% CI 38.5,-); stage III 43m (95% CI 33.9,-) and stage IV 19.1m (95% CI 19.1 16.1,25.8). We did not observe a statistically significant difference in OS between BRCA1 vs BRCA2 pts. Conclusions: BRCA mut PDAC constitutes a small but likely distinct biologic subgroup. Improved OS was notable relative to historical data, possibly due to the integration of platinum and PARPi therapy and possibly due to contribution from disease biology. [Table: see text]

Clinical outcomes and survival of patients (pts) with sarcomatoid metastatic renal cell carcinoma (smRCC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 535-535
Author(s):  
Srinivas Kiran Tantravahi ◽  
David D. Stenehjem ◽  
Archana Agarwal ◽  
Sri Lakshmi S. Kollepara ◽  
Julia Anne Batten ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Integration Site ◽  
Risk Scores ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Beta Catenin ◽  
First Line ◽  
Clinicopathologic Characteristics ◽  
Entire Cohort ◽  
Significant Difference

535 Background: SmRCC is a rare variant of RCC associated with poor outcome. No definitive therapeutic recommendations exist. We present survival outcomes in pts with smRCC treated with systemic therapy. Methods: From a single institutional database (years 2000-2012), we identified 21 pts with documented sarcomatoid features who received systemic therapy. Survival was assessed in the overall cohort and in subgroups divided by clinicopathologic characteristics, including the extent of sarcomatoid features, and Memorial Sloan-Kettering Cancer Center (MSKCC) risk criteria. Sarcomatoid component of the tumor was classified by predominant (≥20%) and non-predominant (<20%). Immunohistochemistry (IHC) analysis was performed for mammalian target of rapamycin (mTOR) signaling, phosphorylated ribosomal protein S6, proviral integration site proteins (PIM 1,2,3), Beta-catenin, E-cadherin, phosphatase and tensin homolog (PTEN), U3 small nucleolar ribonucleoprotein (IMP-3), p53, and epithelial membrane antigen (EMA) on tumor samples, where available. Results: 21 pts were included with a median age of 62 years (range 39-74) and 13 pts were male (62%). One pt received first line cytotoxic chemotherapy, 3 pts received first line immunotherapy, and 17 pts received targeted therapy. Pts belonged to the following MSKCC risk categories: 1 (5%) favorable, 13 (62%) intermediate and 7 (33%) poor risk. Median overall survival (OS) of the entire cohort was 249 days (95% CI 161-519 days). Median OS in pts stratified as MSKCC poor, intermediate, and good risk was 2556, 430, and 137 days respectively (Poor vs Intermediate HR 4.38, p = 0.0159, CI 1.30-19.90). There was no significant difference in OS in pts with sarcomatoid predominant disease vs. non-predominant disease (234 vs 286 days, p = 0.744, HR 0.85, CI 0.31-2.39). Conclusions: Overall OS in pts with smRCC is inferior compared to that reported in clear cell variant mRCC. Although MSKCC risk scores may be useful in determining prognosis, further studies are needed to identify relevant biomarkers and define the optimal therapeutic strategy for this disease. Correlation of survival outcomes with the IHC profile of tumors will be presented.

Clinicopathologic differences and survival of Hispanics (H) versus Non-Hispanic Whites (NHW) with gastric cancer (GC) at a Majority Minority Cancer Center in South Texas.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 208-208
Author(s):  
Cesar Ivan Barron ◽  
Brian Hernandez ◽  
Devalingam Mahalingam ◽  
Joel Michalek ◽  
Sukeshi R. Patel
Keyword(s):  
Stage Iv ◽  
Incidence Rates ◽  
South Texas ◽  
Rank Test ◽  
Cancer Center ◽  
Cancer Treatments ◽  
Kaplan Meier ◽  
Significant Difference ◽  
H Pylori ◽  
Worse Prognosis

208 Background: Incidence rates for GC have shown to be increased in H vs NHW in studies. With a higher incidence of GC in South Texas compared to the rest of US, South Texas H have more than twice the incidence of GC than NHW with possibly worse survivals. However, these patients are not included in the SEER database, and the etiology of worse survival is unclear. To date, evaluation of a South Texas population with a more homogeneous H population has not been undertaken. Therefore, we chose to evaluate differences in clinical and histopathologic features in H vs NHW with GC at our South Texas NCI-designated cancer center where the homogenous H population is the majority. Methods: Retrospective analysis of GC patients from 2000-2016 at the Cancer Therapy and Research Center, San Antonio, TX. Median overall survival (mOS) was estimated from Kaplan-Meier curves and groups were statistically compared with the log rank test. Results: 168 patients with H 64% (n = 108), NHW 36% (n = 60). Median age 59 years (26-94): H 59.6 vs NHW 58.8 years. Females: H 48% vs NHW 37%. ECOG 0-1: H 48% vs NHW 53% (p = 0.46). Common Locations: H (Antrum 30%, Body 30%, GEJ 16%, Cardia 7%, Fundus 3%) vs NHW (Antrum 23%, Body 40%, GEJ 18%, Cardia 2%, Fundus 2%) (see table). Poorly differentiated: H 58.3% vs NHW 48.3% (P = 1). Stage IV at diagnosis: H 42% vs NHW 23% (P = 0.22). Diffuse-type: H 38% vs NHW 30% (P = 0.41); Intestinal-type: H 9% vs NHW 10% (P = 0.78). No significant difference in regards to Her2, H pylori, location of metastases. mOS: H 11 months (95% CI: 7-14) vs NHW 9.5 months (95% CI 6-n/a), p = 0.66. Conclusions: Despite historical worse prognosis of GC in H, at our majority minority cancer center in South Texas,H did not have a worse prognosis than NHW, and significant differences were not observed in clinicopathologic features. Prospective studies of H patients with GC should investigate differences in epidemiology, pathogenesis, and molecular signatures of GC between both groups to identify variables that correlate with survival and predict efficacy to cancer treatments. [Table: see text]

scholarly journals The impact of prior urethral sling on artificial urinary sphincter outcomes

2016 ◽  
Vol 10 (11-12) ◽  
pp. 405 ◽  
Author(s):  
Matthew J. Ziegelmann ◽  
Brian J. Linder ◽  
Marcelino E. Rivera ◽  
Boyd R. Viers ◽  
Daniel S. Elliott
Keyword(s):  
Retrospective Chart Review ◽  
Artificial Urinary Sphincter ◽  
Device Failure ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Urinary Sphincter ◽  
Device Infection ◽  
Significant Difference ◽  
History Of ◽  
The Impact

Introduction: We sought to evaluate device outcomes in men who underwent primary artificial urinary sphincter (AUS) placement after failed male urethral sling (MUS).Methods: We performed a retrospective chart review of 990 men who underwent an AUS procedure between 2003 and 2014. Of these, 540 were primary AUS placements, including 30 (5.5%) with a history of MUS. AUS revisions and explantations were compared between men stratified by the presence of prior sling. Hazard ratios (HR) adjusting for competing risks were used to determine the association with prior sling and AUS outcomes (infection/ erosion, urethral atrophy, and mechanical malfunction), while overall device failure was estimated using Kaplan-Meier and Coxregression analysis.Results: There was no significant difference in age, body mass index, prior prostatectomy, or pelvic radiation when stratified by history of MUS. However, patients with a history of MUS were more likely to have undergone prior collagen injection (p=0.01). On univariate and multivariate analysis, prior MUS was not associated with device failure (HR 1.54; p=0.27). Three-year overall device survival did not significantly differ between those with and without prior MUS (70% vs. 85%; p=0.21). Also, there were no significant differences in the incidence of device infection/erosion, mechanical malfunction, and urethral atrophy.Conclusions: AUS remains a viable treatment option for men with persistent or recurrent stress urinary incontinence after MUS. However, while not statistically significant, we identified a trend towards lower three-year device outcomes in patients with prior urethral sling. These findings indicate the need for longer-term studies to determine if slings pose an increased hazard.

Treatment Outcomes in Completely Resected Stage I to Stage IV Uterine Carcinosarcoma With Rhabdomyosarcoma Differentiation

2013 ◽  
Vol 23 (9) ◽  
pp. 1635-1641 ◽  
Author(s):  
Vicky Makker ◽  
Sara J. Kravetz ◽  
Jacqueline Gallagher ◽  
Oana-Paula Orodel ◽  
Qin Zhou ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Group Versus ◽  
Stage Iv ◽  
Stage I ◽  
Cancer Center ◽  
Uterine Carcinosarcoma ◽  
Entire Cohort ◽  
Gynecology And Obstetrics ◽  
Resected Stage

ObjectiveTo evaluate overall survival (OS) and progression-free survival (PFS) after adjuvant therapy in stage I to stage IV uterine carcinosarcoma with rhabdomyosarcoma differentiation.MethodsMemorial Sloan-Kettering Cancer Center medical records from 1990 to 2012 were reviewed. Patients who received chemotherapy with or without radiation therapy (RT), or RT alone, for completely resected stage I to stage IV uterine carcinosarcoma with rhabdomyosarcoma differentiation were included.ResultsOf 53 patients, International Federation of Gynecology and Obstetrics stage distribution was as follows: I, 13 (24.5%); II, 8 (15.1%); III, 13 (24.5%); and IV, 19 (35.9%). Forty-one (77.4%) of 53 patients received adjuvant chemotherapy, and 34% of the patients who received chemotherapy also received pelvic RT or intravaginal brachytherapy (IVRT). Twelve (22.6%) of the 53 patients received only pelvic RT with/without IVRT. Paclitaxel-carboplatin was the most commonly used adjuvant chemotherapy treatment. The median PFS for the entire cohort was 13.4 months (95% confidence interval [CI], 10.5–17.0). The median OS for the entire cohort was 23.0 months (95% CI, 16.9–34.3). The median PFS periods by stage were 15.9 months for stages I/II versus 11.2 months for stages III/IV (P= 0.012). Median OS was not reached in the early-stage cohort. The median OS for the late-stage cohort was 20.9 months (P= 0.004). The median PFS periods by treatment were 10.4 months for pelvic RT with/without IVRT group versus 13.1 months for chemotherapy with/without pelvic RT with/without IVRT group (P= 0.498). The median OS periods by treatment were 23.6 months for chemotherapy with/without pelvic RT with/without IVRT group versus 16.9 months for pelvic RT with/without IVRT group (P= 0.501).ConclusionThe results suggest that chemotherapy alone or in combination with RT is associated with longer PFS and OS compared to RT alone. Only the stage of disease significantly affected PFS and OS.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Predictors for survival in hepatocellular carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14640-e14640
Author(s):  
Glen I. Misek ◽  
Venkata K Jayanti
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Treatment Initiation ◽  
Early Stage ◽  
Survival Rates ◽  
Stage Iv ◽  
First Line ◽  
Kaplan Meier ◽  
History Of ◽  
One Year

e14640 Background: The global incidence of HCC is over 700,000 patients making it the sixth leading cancer and the prognosis is poor with a 5 year survival of 11%. It is important to understand if there are differences in survival based on the presence of Hepatitis B or C or alcohol cirrhosis, ethnicity and/or treatments employed in various stages of the disease. Methods: A robust global retrospective study of HCC patients was conducted with nearly 4,000 patient records from US, Germany, France, Spain, Italy, China and South Korea in 2011. Of these nearly 800 included deceased patients. These records were analyzed to study if any known factors such as ethnicity, presence of Hepatitis B, Hepatitis C or alcohol cirrhosis and/or treatments used at diagnosis could serve as predictors for survival. Kaplan-Meier curves were plotted to understand the differences in survival based on ethnicity, Child-Pugh status and treatments employed at various stages. Results: One year survival is lower in China/ Korea compared to US and EU, however, five year survival rates are comparable across regions. Associated hepatitis or cirrhosis does not convey any differences in one year survival whether patients received sorafenib as first line treatment or not. Statistically significant higher one year survival rates are observed for HCC patients in Europe and USA receiving transarterial chemoembolization (TACE) compared with patients receiving sorafenib first line. However, in China and Korea there is no such difference. Across all three regions: USA, EU and Asia there is no difference in survival in stage IV patients receiving sorafenib or no sorafenib. No significant differences in one year survival are seen in USA, EU and Asia for patients with Hepatitis C or B or cirrhosis compared to those with no history of liver disease. The Child-Pugh C patients had lower survival compared to Child-Pugh A or B patients. Conclusions: Early diagnosis of HCC, early intervention and treatment appear to show survival benefits as opposed to drug treatment with sorafenib initiated in the later stages of the disease. Efforts should increase for screening, early detection and treatment initiation at early stage to improve outcomes in HCC patients.

Prediction of survival in patients with muscle-invasive bladder cancer (MIBC) by neutrophil (NTP) infiltration in benign lymph nodes (LNs).

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 273-273
Author(s):  
Sumanta Kumar Pal ◽  
Wei Liang ◽  
Richard Jove ◽  
Bertram E. Yuh ◽  
Kevin Chan ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Clinical Stage ◽  
Growth Factor Receptor ◽  
Rank Test ◽  
Metastatic Niche ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Initial Cohort ◽  
Muscle Invasive

273 Background: In preclinical models, NTPs appear to establish a pre−metastatic niche that fosters the invasion of metastases (Kowanetz et al PNAS 2010). This observation still requires clinical validation in MIBC. Methods: Benign LN tissue was obtained from patients (pts) who had undergone cystectomy and LN dissection for documented MIBC. Immunohistochemical (IHC) staining for CD15, a NTP marker, was performed for the entire cohort. Phosphorylated signal transducer and activator of transcription 3 (pSTAT3), vascular endothelial growth factor receptor−1 (VEGFR1), and CD68 (a macrophage marker) were further assessed in an initial cohort (detailed subsequently) via IHC. Positively staining cells were counted and averaged over 8 high power fields (hpfs). Pts were stratified by the median cell count for each biomarker. Analyses of overall survival (OS) were performed using the Kaplan−Meier method and log−rank test. Results: In an initial cohort of 19 pts who had received no neoadjuvant chemotherapy (NC), a median CD15 count of 284/hpf was noted. Median OS was higher in those pts with low CD15 as compared to high CD15 (158.7 mos v 36.9 mos, P=0.02). Median OS was also improved in those with high pSTAT3 v low pSTAT3 (not reached v 106.4 mos, P=0.04), but no difference was noted in OS in groups stratified by clinical stage, VEGFR1 staining, or CD68 staining. To determine if the prognostic value of CD15 staining was retained in pts with exposure to NC, the cohort was expanded to include an additional 36 pts who had received either preoperative GC (n=17) or MVAC (n=19) chemotherapy. In this group, no significant difference in OS was noted based using the previously applied CD15 cutoff. Conclusions: NTP recruitment to benign LNs may be prognostic of OS in pts with MIBC who have not received NC. pSTAT3, a putative mediator of NTP recruitment, may play a role in this phenomenon. VEGFR1 and CD68, which may mediate pre−metastatic niche through a different mechanism, do not predict OS in our dataset (Kaplan et al Nature 2005). Bolstered by these findings, the prognostic value of NTP recruitment will be examined prospectively in SWOG 1011, a trial comparing limited v extended LN dissection in pts with MIBC.

Understanding the comorbidome and its effect on survival in colorectal cancer.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 210-210
Author(s):  
Erin Elizabeth Hahn ◽  
Ernest Shen ◽  
Janet S. Lee ◽  
Corrine E. Munoz-Plaza ◽  
Carly Parry ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Latent Class ◽  
Stage Iv ◽  
Charlson Comorbidity Index Score ◽  
Multiple Chronic Conditions ◽  
Comorbid Conditions ◽  
Personalized Care ◽  
Kaplan Meier ◽  
Significant Difference

210 Background: Effectively managing comorbidities is an essential component of high-quality cancer care. Evidence suggests colorectal cancer (CRC) patients with multiple comorbid conditions are less likely to complete standard treatments and can have lower rates of survival. In order to provide personalized care, it is critical to understand how comorbid conditions cluster within CRC patients. Methods: We identified Kaiser Permanente Southern California CRC patients diagnosed with first malignancy between 01/01/2008 - 12/31/2013. We used latent class analysis to identify clinically useful phenotypes defined by combinations of comorbidities at diagnosis, and compared survival using the Kaplan-Meier method. Results: The cohort included 7803 patients: 52% male; average age at diagnosis 66 years (SD: 13); 22% Hispanic, 15% Black, 9% Asian, 52% White; 42% Stage I, 22% Stage II, 22% Stage III, and 14% Stage IV. One-fifth of patients had a Charlson comorbidity index score of ≥ 4. We found 4 distinct classes (Lo-Mendell-Rubin p<0.001). Class 1 was relatively healthy with few comorbidities (Table). Class 2 included individuals with cardiovascular diseases; those in Class 3 had complicated diabetes. Class 4 members had multiple chronic conditions, including diabetes with micro- and macrovascular complications. Kaplan-Meier estimates revealed a statistically significant difference in overall survival by class (log rank p<0.001). Conclusions: We identified 4 clinically distinct classes of comorbid conditions in CRC patients. These data can be used to inform personalized care for CRC patients throughout the cancer care continuum. [Table: see text]

Heterogeneous growth rates of pancreatic adenocarcinoma by retrospective analysis of CT imaging data.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 248-248
Author(s):  
Tanner Mortenson ◽  
Allison Bigeh ◽  
Yighua Chen ◽  
Michael Malek-Ahmadi ◽  
Kewei Chen ◽  
...  
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Screening Method ◽  
The United States ◽  
Ct Imaging ◽  
Rate Of Change ◽  
Ductal Adenocarcinoma ◽  
Cancer Center ◽  
Area Change ◽  
Significant Difference

248 Background: Pancreatic ductal adenocarcinoma (PDAC) remains the fourth leading cause of cancer death in the United States. Despite its high mortality, there is no effective screening method or frequency. The purpose of this study is to retrospectively evaluate prediagnostic CT images in order to identify growth rate and determine a potential surveillance frequency for at risk patients. Methods: 188 PDAC patients were seen at Banner MD Anderson Cancer Center (BMDACC) from 1/1/2012 to 12/31/2015. 24 patients met the final inclusion and exclusion criteria. Tumor area on CT imaging was then evaluated for rate of change prior to diagnosis. Both absolute and relative areas were plotted against time prior to diagnosis at 3, 6, 9, 12, 24, 36, 48, 60, and 72 months. Results: With two exceptions, no evidence of malignancy was identifiable at two or more years prior to diagnosis. Growth rates per year varied significantly. Absolute area change ranged from 1.7 cm2/yr to 139.22 cm2/yr; relative area change ranged from 1.17 to 7.15. Assuming a spherical mass, these relative changes correspond to relative volume change (ratio) per year of 1.27 and 19.13; the equivalent linear tumor doubling times are 3.7 years and 20 days respectively. Student’s T-test yielded no significant difference for relative growth, absolute growth, PFS, or OS between male and female patients. Conclusions: The heterogeneity in growth rate has significant implications for potential screening of PDAC. Screening interval greater than 1 year is feasible with other slow growing tumors. However, annual screening is not feasible for rapidly growing PDAC. Based on our findings, screening may need to be as frequent as 3-month intervals which would incur significant economic cost. Further correlation of prediagnostic growth rate with molecular changes may be necessary to discover the driver of this heterogeneous growth pattern.

Impact of care at Memorial Sloan Kettering Cancer Center (MSKCC): A comprehensive cancer center on overall survival (OS) in patients (pts) with AJCC stage IV pancreas adenocarcinoma (PDAC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18128-e18128
Author(s):  
Fiona Boland ◽  
Ahmad Cheema ◽  
Maeve Aine Lowery ◽  
Kenneth H. Yu ◽  
Anna M. Varghese ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rates ◽  
Stage Iv ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Contributing Factors ◽  
Term Survival ◽  
Entire Cohort ◽  
Line Therapy ◽  
Centralized Care

e18128 Background: PDAC has a rising incidence and relatively static mortality rates. Current cytotoxic regimens confer median survivals of 8.5- 11 months (Von Hoff, Conroy, et al. NEJM 2013, 2011). National Cancer Institute-designated Comprehensive Cancer Centers potentially allow greater access to multidisciplinary consultation for complex cancer care. Although the widespread benefits of NCICCCs are acknowledged, there is limited data demonstrating superior outcomes for patients treated at these centers. Methods: Patients with stage IV PDAC, diagnosed between 01/01/13 and 12/31/14, were identified and followed until death or 12/31/2016. These patients had care centralized to MSKCC and the analysis was conducted to evaluate key patient (pt) and disease characteristics, systemic therapies and outcomes.Survival times were calculated from the date of diagnosis. Results: N=391 pts identified, 210 males (54%), 181 females (46%). Median age 66 years (range 27-91). Table 1 outlines key points. For entire cohort, median overall survival (mOS): 11.4 + 9 months, 1-year (yr) and 2-yr survival rates (SR) of 48% and 15.1% respectively. N= 165 (42%) received mFOLFIRINOX-based regimen as 1st-line therapy with mOS 13.2 + 8.9 months, 1-yr and 2-yr SR of 59.4.% and 20% respectively. N= 118 (30.1%) received gemcitabine + nab-paclitaxel- based regimen as 1st line therapy had a mOS of 11.6 + 9 months with 1-yr and 2-yr SR of 49.1% and 16.2% respectively. Conclusions: At MSKCC, a major referral center for PDAC, outcomes for stage IV disease compare favorably to contemporary trial outcomes with notable 2-yr survivorship (long-term survival analysis of MPACT trial showed 1-yr and 2-yr SR of 35% and 10% respectively). Contributing factors likely reflect multidisciplinary expertize, patient selection and biases. Centralized care for complex illnesses may improve outcomes. [Table: see text]

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