HER2-low and gastric cancer: A prognostic biomarker?

e16086 Background: The role of HER2 positive (HER2+) as a prognostic biomarker for gastric/gastroesophageal junction cancer (G-GEJC) is controversial. Recently, the HER2-low (HER2l) concept has emerged and proved to predict response to trastuzumab deruxtecan in metastatic scenario. Data on HER2l prognostic value are missing. Methods: All consecutive patients with metastatic G-GEJC, tested for HER2 in the primary tumor or in the metastatic tissue before initiating first-line therapy at A.C. Camargo Cancer Center, were retrospectively recruited. The primary objective was to compare the overall survival (OS: from the metastasis diagnosis to death by any cause) between HER2l and HER2 negative (HER2-) populations. Secondarily, we aimed to compare the first-line progression-free survival (PFS) between HER2l and HER2-, to analyze prognostic factors associated with OS and to compare the OS between HER2+ and HER2l/HER2-. The HER2 immunohistochemistry (IHC) tests were performed with the Ventana anti-HER2/neu kit, by specialized gastrointestinal pathologists of the study center, using the AJCC HER2 scoring criteria for gastric cancer. In situ hybridization (ISH) was done when IHC 2+ was detected. HER2+ were IHC 3+ or 2+ amplified by ISH; HER2l, 1+ or 2+ non-amplified; HER-, 0+. Kaplan-Meier curves, Log-Rank test and Cox regression were used for survival analysis. Cox regression was used for uni and multivariate analysis. Results: From June, 2008 to July, 2020, 398 patients were included (48 HER2+; 103 HER2l; 247 HER2-). The median follow-up was 31 months (m). Median age at diagnosis was 58 years; the majority were men (62.8%), caucasian (50.8%), with gastric (81% vs 19% GEJ), diffuse (50.3%), de novo metastatic (57.0%) tumors. In comparison to HER2l/HER2-, HER2+ group had superior rates of men, GEJC, intestinal subtype and non-visceral metastasis. Central nervous system metastases were uncommon, and proportionally higher in HER2+ tumors (HER2+: 6.2%; HER2l: 2.9%; HER2-: 2.0%; p = 0.27). There were no imbalances between HER2l and HER2- groups. The median OS was similar for HER2l and HER2- (13m for both; HR 1.0, 95%CI 0.76-1.31; p = 1.0), as it was the PFS (5m for both; HR 0.84, 95%CI 0.65-1.08; p = 0.18). These results did not vary on dependence of IHC + (0 vs 1 + vs 2+). HER2+ tumors had a superior median OS (17m vs 13m for HER2l/HER2-; HR 0.70, 95%CI 0.49-0.99; p = 0.046). When ungrouping HER2l/HER2-, this numerical difference remains, with a loss of statistical significance (17m vs 13m vs 13m; HR 0.87, 95%CI 0.74-1.02; p = 0.12). HER2+, > 1 line of treatment and metastasectomy were predictive for improved OS in multivariate analysis. HER2l was neither predictive for OS nor PFS. Conclusions: Although HER2-low emerged as a new predictive biomarker in metastatic gastric cancer, its prognostic value could not be proved in this study, with an absence of impact in OS. HER2+, however, was associated with improved survival.

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A genomic mutation signature predicts the clinical outcomes of immunotherapy and characterizes immunophenotypes in gastrointestinal cancer

npj Precision Oncology ◽

10.1038/s41698-021-00172-5 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Xi Jiao ◽

Xin Wei ◽

Shuang Li ◽

Chang Liu ◽

Huan Chen ◽

...

Keyword(s):

Gastrointestinal Cancer ◽

Prognostic Value ◽

Cox Regression ◽

Prognostic Biomarker ◽

Cancer Center ◽

Genomic Profile ◽

Prognostic Signature ◽

Powerful Predictor ◽

Potential Biomarker ◽

Peking University

AbstractThe association between genetic variations and immunotherapy benefit has been widely recognized, while such evidence in gastrointestinal cancer remains limited. We analyzed the genomic profile of 227 immunotherapeutic gastrointestinal cancer patients treated with immunotherapy, from the Memorial Sloan Kettering (MSK) Cancer Center cohort. A gastrointestinal immune prognostic signature (GIPS) was constructed using LASSO Cox regression. Based on this signature, patients were classified into two subgroups with distinctive prognoses (p < 0.001). The prognostic value of the GIPS was consistently validated in the Janjigian and Pender cohort (N = 54) and Peking University Cancer Hospital cohort (N = 92). Multivariate analysis revealed that the GIPS was an independent prognostic biomarker. Notably, the GIPS-high tumor was indicative of a T-cell-inflamed phenotype and immune activation. The findings demonstrated that GIPS was a powerful predictor of immunotherapeutic survival in gastrointestinal cancer and may serve as a potential biomarker guiding immunotherapy treatment decisions.

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Real-world outcomes of first-line U.S. patients with unresectable advanced or metastatic gastroesophageal adenocarcinoma by primary tumor location.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.304 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 304-304

Author(s):

Veena Shankaran ◽

Hong Xiao ◽

David Bertwistle ◽

Ying Zhang ◽

Pranav Abraham ◽

...

Keyword(s):

Gastric Cancer ◽

Real World ◽

Gastroesophageal Junction ◽

Tumor Location ◽

Rank Test ◽

First Line ◽

Eligibility Criteria ◽

Cox Models ◽

Significant Difference ◽

Gastroesophageal Adenocarcinoma

304 Background: Gastric cancer clinical trials are inconsistent in their inclusion of esophageal adenocarcinoma (EAC). Thus it is uncertain if outcomes are similar among subgroups of gastroesophageal adenocarcinoma. The aim of this study was to compare baseline characteristics and clinical outcomes of US patients with EAC versus Gastroesophageal Junction Cancer (GEJC) and Gastric Cancer (GC) treated in real world clinical settings. Methods: Adult patients with unresectable, advanced or metastatic GC, GEJC, or EAC diagnosed between January 2011 and November 2018 were identified from the Flatiron Health database. Patients with a positive HER2 test, or who received trastuzumab, were excluded. Overall survival (OS) was defined as time from first-line (1L) treatment initiation to death or loss of follow-up. Survival analyses were conducted using Kaplan-Meier methods with log-rank test and Cox models. Results: A total of 3052 patients (969 EAC and 2083 GEJC/GC) met eligibility criteria. Out of all EAC patients, 90% were males and 76% were white. Within the GEJC/GC patients, 67% were males and 57% were white. Median age was 66 years for both cohorts while proportion with ECOG PS of 0 or 1 was 78% for EAC and 84% for GEJC/GC among patients with ECOG scores. The proportion of patients receiving 1L treatment was comparable (78% for EAC, 76% for GEJC/GC) across groups with FOLFOX being the most frequent treatment (25% for EAC and 29% for GEJC/GC). There was no significant difference in OS between the two groups, with median OS of 9.1 and 9.6 months for EAC and GEJC/GC, respectively (HR 0.957, 95% CI: 0.863 - 1.062, p = 0.41). Conclusions: In this US real-world analysis, OS did not differ significantly between patients with EAC and patients with GEJC/GC who received 1L treatment, suggesting that these two populations may have comparable survival benefit from systemic therapy.

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The Research and Analysis of Bring Perigastric Tumor Deposits into The Staging of Primary Gastric Cancer

10.21203/rs.3.rs-26143/v3 ◽

2020 ◽

Author(s):

Xinxin Wang ◽

Zhaoyang Wang ◽

Tianyu Xie ◽

Shuo Li ◽

Di Wu ◽

...

Keyword(s):

Gastric Cancer ◽

Regression Model ◽

Cox Regression ◽

Survival Curve ◽

Statistical Significance ◽

Tnm Staging ◽

Gastric Body ◽

Rank Test ◽

Control Group ◽

Primary Gastric Cancer

Abstract Background: The current significance of perigastric tumor deposits (TDs) in gastric cancer (GC) for indicating prognosis remains unclear. The aim of this study was to assess the prognostic value of perigastric TDs and a new TNM staging involving TDs for GC.Methods: The pathological data of 6672 patients with GC who underwent gastrectomy or operation of gastric cancer with other diseases between January 1, 2012 and December 31, 2017 at Chinese PLA General Hospital were analyzed retrospectively. The patients were divided into tumor deposits positive (TD+) group and tumor deposits negative (TD-) group. The differences between TD+ and TD- were analyzed by binary Logistic regression model. To draw survival curves, we used Kaplan-Meier methods. Multivariate Cox regression model and Log-rank test was used to analyze the data.Results: Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC of which 237 were males (69.91%) and 102 females (30.09%) (2.32:1). The median age was 59 years (ranging from 27 to 78 years). No significant differences were detected between the two groups. Univariate and multivariate survival analysis both indicated that GC patients with positive TDs had poorer prognosis than those with negative TDs (p<0.05). The 1-, 3-and 5-year overall survival rates of GC patients with TDs were 68.3%, 19.6%, and 11.2%, respectively, and were significantly poorer than those of the staged matched control group. There was statistical significance between the location of TDs and patient survival in patients with gastric cancer (p＜0.05). A new TNM staging was formulated according to the TDs location. When TDs appear on the gastric body, the original T1, T2, T3 stages change to T4a, and T4a, T4b change to T4b; when TDs appear in the lesser curvature, the previous N0, N1, N2, N3 stage change to N3; when the TDs located in the greater curvature or the distant tissue, the patient should be categorized as M1. After using the new stage, the survival curve of patients with TDs was closer to that of patients without TDs in each pTNM staging.Conclusion: 1. Tumor deposits is a bad prognostic factor in patients with primary gastric cancer. 2. The location of tumor deposits is associated with the prognosis of patients with primary gastric cancer. 3. The new stage is more suitable for patients with tumor deposits of gastric cancer.

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TUG1 acts as a biomarker to predict the relapse of gastric cancer after endoscopic submucosal dissection (EMR)

Archives of Medical Science ◽

10.5114/aoms/118872 ◽

2021 ◽

Author(s):

Jianhua Wang ◽

Yanping Hao ◽

Tingting Yu ◽

Liang Han ◽

Ping Xu

Keyword(s):

Gastric Cancer ◽

Cell Proliferation ◽

Signaling Pathway ◽

Prognostic Value ◽

Target Gene ◽

Prognostic Biomarker ◽

Rank Test ◽

Log Rank Test ◽

Mtt Assays ◽

Free Rate

IntroductionMiR-382 was reported to act as a prognostic biomarker for the relapse of gastric cancer (GC) after endoscopic mucosal resection (EMR). In addition, TUG1 was reported to regulate cell proliferation via sponging miR-382. Therefore, in this study, we aimed to investigate the value of TUG1 in predicting post-EMR relapse of GC.Material and methodsLog rank test was utilized to analyze relapse-free rate and validate the prognostic value of TUG1 in predicting post-EMR GC relapse. Real-time PCR, Western Blot and luciferase assays were performed to clarify the regulatory relationships among TUG1, miR-382 and CD44, thus establishing a TUG1/miR-382/CD44 signaling pathway. Moreover, MTT assays were conducted to observe the effect of TUG1 on cell proliferation and post-EMR GC relapse.ResultsThe AUC of the high TUG1 expression group was obviously smaller than that of the low TUG1 expression group, which indicated that the expression of TUG1 could be used as a prognostic biomarker to predict the risk of post-EMR GC relapse. In addition, a negative correlation was found between miR-382 expression and the expression of its endogenous competing RNA TUG1. Furthermore, miR-382 was shown to inhibit the expression of its target gene CD44. Finally, a TUG1/miR-382/CD44 signaling pathway was established and was implicated in post-EMR recurrence of GC, and the overexpression of TUG1 was shown to promote the proliferation of GC cells.ConclusionsReduced expression of TUG1 could inhibit the proliferation of GC cells and increase the expression of miR-382, which in turn down-regulated CD44 expression and lowered the risk of post-EMR GC relapse.

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Prognostic factors (PF) in advanced hepatocellular carcinoma (AHCC): Multivariate analysis and comparison between staging systems (SS) in patients (pts) treated at Memorial Sloan-Kettering Cancer Center (MSKCC)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4601 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4601-4601 ◽

Cited By ~ 1

Author(s):

F. D. Huitzil ◽

M. Capanu ◽

G. Jacobs ◽

W. Smith ◽

E. O’Reilly ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Multivariate Analysis ◽

Patient Population ◽

Cox Regression ◽

Prognostic Index ◽

Locoregional Therapy ◽

Rank Test ◽

Cancer Center ◽

Advanced Hepatocellular Carcinoma ◽

Staging Systems

4601 Background: Several SS have been proposed in hepatocellular carcinoma. These include TNM, Okuda, Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), and Barcelona Clinic Liver Cancer (BCLC). There is no consensus as to what constitutes the best SS for use by oncologists for pts with AHCC with no locoregional therapy options. We propose to define the PF and compare SS in this patient population. SS may help select pts for systemic therapy, predict outcome, and help in clinical trial design for AHCC. Methods: We retrospectively identified pts with AHCC treated at MSKCC between 2001 and 2006. Clinical, laboratory, tumor characteristics and all four SS were recorded. Survival (S) was measured from the date of development of AHCC to the date of death. S was estimated using Kaplan-Meier’s method, differences in S were tested using the log rank test. A Cox regression model was used for the multivariate analysis. A second Cox regression was done to compare SS and was expressed using the Akaike information (AI) criterion. AI helps determine which SS is the most informative of S. A low AI is favorable. Results: We identified 280 pts. Data on the first 101 pts analyzed are presented. Median age 61 years; 71% males, 29% females; 60% Caucasians, 9% Black, 24% Asians and 5% Hispanics. Etiologies included HCV 24%, HBV 38%, and alcohol 22%. Child Pugh score: A in 65% and B in 29% of pts. Multivariate analysis independent PF for S were albumin (p=0.0358), alkaline phosphatase (ALP) (p=0.001), identified etiology (p=0.008), abdominal pain (p=0.001) and liver tumor extent (more or less than 50% of the liver) (p=0.0043). AI ranked SS as follows: TNM 6th (588.991), TNM 5th (591.373), BCLC (541.095), Okuda (540.490), CLIP (537.8), and CUPI (526.483). CUPI S was 19.47 months (m) for low, 5.89 m for medium, and 1.36 m for high risk pts. Conclusions: Pts with AHCC who are treated by oncologists in this US-based population have distinct PF. CUPI provided the best prognostic information for our patient population. CUPI may be suggested as the SS to use clinically for AHCC. These results need prospective validation. No significant financial relationships to disclose.

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A large multicenter study evaluating prognosis and chemosensitivity of metastatic colorectal cancers with microsatellite instability.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.3536 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 3536-3536 ◽

Cited By ~ 4

Author(s):

David Tougeron ◽

Benjamin Sueur ◽

David Sefrioui ◽

Lucie Gentilhomme ◽

Thierry Lecomte ◽

...

Keyword(s):

Multivariate Analysis ◽

Cox Regression ◽

Univariate Analysis ◽

Objective Response ◽

Prospective Trial ◽

Prognostic Index ◽

Rank Test ◽

Colorectal Cancers ◽

First Line ◽

Peritoneal Carcinosis

3536 Background: Deficient Mismatch Repair (dMMR) in colorectal cancers (CRC) represent 12% of all tumors. In non-metastatic CRC setting, dMMR are associated with good prognosis but also with resistance to adjuvant 5-FU chemotherapy. In metastatic CRC (mCRC) setting, dMMR is found in less than 5% and its influence on prognosis and treatment response is little known. Methods: This multicenter retrospective study included all consecutive patients with dMMR mCRC treated between 2005 and 2015 in 17 centers. The Kaplan-Meier method was used to calculate overall survival (OS) and progression-free survival (PFS). Prognostic variables were evaluated in univariate analysis using the Log rank test and in multivariate analysis using the Cox regression model. Results: A total of 198 patients with dMMR mCRC were included (median age 64.6 years). dMMR mCRC were mostly diagnosed with synchronous metastases (59%) and frequent peritoneal carcinosis (43%). Lynch syndrome was found in 34% of cases and 36% of tumors had a BRAFV600E mutation. Median OS was 20.6 months. A low risk Kohne's prognostic index (HR = 0.40 [0.22-0.72], p = 0.02) and absence of peritoneal carcinosis (HR = 0.51 [0.29-0.90], p = 0.02) were associated with better OS in multivariate analysis. Main first-line regimens were 5FU-based (n = 20), oxaliplatin-based (n = 75) or irinotecan-based (n = 46) chemotherapy. Median PFS on first-line treatment was 5.9 months. The objective response rate (ORR) was 0%, 19% and 36% for 5FU-based, oxaliplatin-based and irinotecan-based chemotherapies, respectively (p = 0.02). A trend for a longer PFS (3.3, 5.5 and 10.2 months, respectively, p = 0.06) and OS (17.7, 21.1 and 34.2 months, respectively, p = 0.05) was also observed for irinotecan-based chemotherapy. The addition of bevacizumab to chemotherapy was associated with a significant increase of ORR (p = 0.01) and PFS (p = 0.04) as compared to the addition of an anti-EGFR therapy. Conclusions: This study suggests that dMMR mCRC are associated with poor prognosis and chemoresistance, especially to 5FU-based chemotherapy. Efficacy of irinotecan and bevacizumab should be evaluated in a prospective trial in combination with immune checkpoint inhibitors.

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The Research and Analysis of Bring Perigastric Tumor Deposits into The Staging of Primary Gastric Cancer

10.21203/rs.3.rs-26143/v1 ◽

2020 ◽

Author(s):

xinxin wang ◽

zhaoyang wang ◽

tianyu xie ◽

shuo li ◽

di wu ◽

...

Keyword(s):

Gastric Cancer ◽

Regression Model ◽

Cox Regression ◽

Survival Curve ◽

Statistical Significance ◽

Tnm Staging ◽

Gastric Body ◽

Rank Test ◽

Binary Logistic Regression Model ◽

Primary Gastric Cancer

Abstract Background: The current significance of perigastric tumor deposits (TDs) in gastriccancer (GC) for indicating prognosis remains unclear. The aim of this study was to assess the prognostic value of perigastric TDs and a new TNM staging involving TDs for GC.Methods: The pathological data of 6672 patients with GC who underwent gastrectomy or operation of gastric cancer with other diseases between January 1, 2012 and December31, 2017 at Chinese PLA General Hospital were analyzed retrospectively. The patients were divided into tumor deposits positive (TD+) group and tumor deposits negative (TD-) group. The differences between TD+ and TD- were analyzed by binary Logistic regression model. To draw survival curves, we used Kaplan-Meier methods. Multivariate Cox regression model and Log-rank test was used to analyze the data.Results:Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC of which 237were males (69.91%) and 102 females (30.09%) (2.32:1). The median age was 59 years (ranging from 27 to 78 years). No significant differences were detected between the two groups. Univariate and multivariate survival analysis both indicated that GC patients with positive TDs had poorer prognosis than those with negative TDs (p<0.05). The 1-, 3-and 5-year overall survival rates of GC patients with TDswere68.3%, 19.6%, and 11.2%, respectively, and weresignificantly poorer than those of the staged matched control group.There was statistical significance between thelocation of TDs and patient survival in patients with gastric cancer (p＜0.05). A new TNM staging was formulated according to the TDs location.When TDs appear on the gastric body,the original T1, T2, T3stages change to T4a, and T4a, T4b change to T4b;whenTDs appear in the lesser curvature, the previous N0, N1, N2, N3 stage change to N3;when the TDs located in the greater curvature or the distant tissue, the patient should be categorized as M1. After using the new stage, the survival curve of patients with TDs was closer to that of patients without TDs in each pTNM staging.Conclusion: 1. Tumor deposits is a bad prognostic factor in patients with primary gastric cancer. 2. The location of tumor deposits is associated with the prognosis of patients with primary gastric cancer.3.The new stage is more suitable for patients with tumor deposits of gastric cancer.

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Anti-GD2 immunotherapy in adults with high-risk neuroblastoma (HR-NB): The Memorial Sloan Kettering Cancer Center (MSKCC) experience.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10550 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10550-10550 ◽

Cited By ~ 1

Author(s):

Maya Suzuki ◽

Brian H. Kushner ◽

Kim Kramer ◽

Ellen M. Basu ◽

Stephen S. Roberts ◽

...

Keyword(s):

Multivariate Analysis ◽

Cox Regression ◽

Univariate Analysis ◽

Rank Test ◽

Cancer Center ◽

Mycn Amplification ◽

Cell Transplant ◽

Adult Onset ◽

Term Survival ◽

Stage 4

10550 Background: The diagnosis of NB in adulthood is rare and little is known about its biology and clinical course. There is no established therapy for adult NB. Anti-GD2 immunotherapy is now standard in children with HR-NB but its use has not been reported in adults. Methods: After obtaining IRB waiver, records of all patients with adult-onset (≥18 years) NB seen at MSKCC between 1983 and 2015 were reviewed. Overall survival (OS) was tested by log-rank test. Cox-regression was used for multivariate analysis. Results: The subjects were 42 adults (median: 25; range18-71 years); 23 male and 19 female. Five, 1, 1 and 35 patients had INSS stage 1, 2, 3 and 4 disease, respectively. Genetic abnormalities included somatic ATRX (59%) and ALK mutations (43%) but not MYCN-amplification. 16 patients remain alive at a median follow-up of 5.3 years. OS for non-stage 4 patients was superior to stage 4 (median survival 14.6 vs 5.3 years; p < 0.05). However 5/7 patients with < stage 4 NB progressed to stage 4. Among 35 stage 4 patients, 4 achieved complete remission (CR) after induction chemotherapy and surgery, 11 underwent autologous stem cell transplant (ASCT) and 15 received multiple cycles of anti-GD2 antibodies 3F8 or hu3F8 without complications. In univariate analysis, patients ≤ 29 years old (n = 24) at diagnosis, those achieving CR, and those receiving anti-GD2 antibodies had superior OS (p < 0.05 for each). ASCT was not beneficial (p = 0.3 for ASCT vs no ASCT). For stage 4 patients, anti-GD2 immunotherapy was associated with favorable OS in multivariate analysis (95% CI of anti-GD2 antibody: 1.270 to 7.990). Conclusions: Adult-onset stage 4 NB demonstrates a high incidence of somatic mutations and is only partially chemosensitive. However, 3F8/hu3F8-based anti-GD2 immunotherapy appears to improve long-term survival and is well tolerated.

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Comparison between local and extended field radiotherapy, including regional nodes radiotherapy, in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.142 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 142-142

Author(s):

Yukihiro Nakatani ◽

Ken Kato ◽

Hirokazu Shoji ◽

Satoru Iwasa ◽

Yoshitaka Honma ◽

...

Keyword(s):

Esophageal Cancer ◽

Multivariate Analysis ◽

Adverse Events ◽

Cox Regression ◽

Statistical Significance ◽

Concurrent Chemotherapy ◽

Rank Test ◽

Early Esophageal Cancer ◽

Extended Field ◽

Cause Specific Survival

142 Background: Extended field (EF) radiotherapy including regional nodes, has been adopted for the treatment of esophageal squamous cell carcinoma (ESCC), but it sometimes causes severe radiation-related adverse events. The purpose of this study is to compare local-field (LF) to EF radiotherapy administered as chemoradiotherapy (CRT) in early esophageal cancer. Methods: Selection criteria included histologically proven T1bN0M0 ESCC, performance status (PS) 0-1, adequate organ function and no other active malignancy. Data on patients who received CRT concurrently with 5-FU and cisplatin between Jan. 2000 and Dec. 2012 in our hospital were evaluated. All patients received radiotherapy at a dose of 60Gy without a planned break. The clinical target volume (CTV) of LF included gross tumor volume (GTV) plus 3-cm superior and inferior margins, and that of EF included GTV plus regional lymph nodes. Overall survivals (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. The Cox regression model was used for multivariate analysis. Adverse events were graded according to the CTCAE v.4.0. Results: The characteristics of the EF group (n = 120) and LF group (n = 79) are: Median age, 68.0 years and 65.0 years; male/female, 106/14 and 67/12; PS 0/1, 93/27 and 63/18; median tumor length, 40.6mm and 35.4mm, respectively. The complete response rates were 90.0% and 98.7%, respectively. The median follow-up periods were 103 months and 69 months, respectively. The 5-year overall and cause-specific survival rates were 74.5% and 90.6%, 89.5% and 91.8%, respectively. According to a multivariate analysis, EF was a significant negative prognostic factor for OS (hazard ratio = 2.88, p = 0.002) but not for cause-specific survival. Cardiopulmonary toxicities of grade 3 or greater were observed more frequently in the EF group (p = 0.035), with statistical significance. Treatment-related death occurred at 6.7% and 1.3%, respectively, in the two groups. Conclusions: It is suggested that radiation with LF may be better than EF in combination with concurrent chemotherapy in early esophageal cancer (T1bN0M0).

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Management of renal masses in an octogenarian cohort: Is there a right approach?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.497 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 497-497

Author(s):

Jude Nawlo ◽

Dominic H. Tang ◽

Juan Chipollini ◽

Scott Michael Gilbert ◽

Michael Adam Poch ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Creatinine Clearance ◽

Cox Regression ◽

Statistical Significance ◽

Eastern Cooperative Oncology Group ◽

Cancer Center ◽

Management Options ◽

Renal Masses

497 Background: Although several guidelines outline management options for patients with renal masses, few studies describe treatment strategies and outcomes in octogenarians. We sought to review outcomes in this population managed with active surveillance (AS), partial nephrectomy (PN), or radical nephrectomy (RN). Methods: Data were collected on 113 octogenarian patients referred for management of renal masses at Moffitt Cancer Center between 2000 and 2013. Patients were treated with AS, PN, or RN. Univariate and multivariable Cox regression models measured association of management modality and survival. Kaplan-Meier survival analysis was used for overall survival and log-rank tests were used to compare survival curves. Covariates include age, Eastern Cooperative Oncology Group (ECOG) score, clinical and pathologic stage, tumor size, creatinine, creatinine clearance, and overall survival. Results: Out of 113 patients, 27 (22%) underwent AS, 33 (26.8%) underwent PN, and 53 (43%) underwent RN. The mean age was 83 years (range, 80-92). AS patients had a higher mean age (84 years) than PN patients (81.9 years), but not with RN patients (83 years) (p=0.008). At a median follow-up of 30.6 months (IQR 9.9-56), 13 (48%), 10 (30.3%), and 29 (54.7%) patients died from any cause in AS, PN, and RN patients respectively. PN patients tended to have a longer median overall survival at 81 months versus 55.8 and 57 months for AS and RN respectively, but this did not reach statistical significance on univariate (p=0.588) or multivariate analysis (p=0.29). On subgroup analysis of cT1a patients, there was also no difference in overall survival among treatment arms on univariate (p=0.654) and multivariate analysis (p=0.47). At 1 year follow-up, there was no difference in creatinine levels between treatment arms (p=0.331). However, mean creatinine clearance was lower in RN patients (35.8 ml/min) compared to AS (50.7 ml/min) and PN (48.1 ml/min) (p=0.024). Conclusions: Active treatment with PN and RN may not provide a survival advantage among octogenarians. Renal function was inferior in RN patients but comparable between AS and PN patients at 1 year follow-up.

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