Accuracy of the CARG chemotherapy toxicity risk prediction tool in older Indian patients with cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24023-e24023
Author(s):  
Shreya Gattani ◽  
Vanita Noronha ◽  
Anant Ramaswamy ◽  
Renita Castelino ◽  
Vandhita Nair ◽  
...  

e24023 Background: Clinical judgement alone is inadequate in accurately predicting chemotherapy toxicity in older adult cancer patients. Hurria and colleagues developed and validated, the CARG score (range, 0–17) as a convenient and reliable tool for predicting chemotherapy toxicity in older cancer patients in America, however, its applicability in Indian patients is unknown. Methods: An observational retrospective and prospective study between 2018 and 2020 was conducted in the Department of Medical Oncology at Tata Memorial Hospital, Mumbai, India. The study was approved by the institutional ethics committee (IEC-III; Project No. 900596) and registered in the Clinical Trials Registry of India (CTRI/2020/04/024675). Written informed consent was obtained in the prospective part of the study. Patients aged ≥ 60 years and planned for systemic therapy were evaluated in the geriatric oncology clinic and their CARG score was calculated. Patients were stratified into low (0-4), intermediate (5-9) and high risk (10-17) based on the CARG scores. The CARG score was provided to the treating physicians, along with the results of the geriatric assessment. Chemotherapy-related toxicities were captured from the electronic medical record and graded as per the NCI CTCAE, version 4.0. Results: We assessed 130 patients, with a median age 69 years (IQR, 60 to 84); 72% patients were males. The common malignancies included gastrointestinal (52%) and lung (30%). Approximately 78% patients received polychemotherapy and 53% received full dose chemotherapy. Based on the CARG score, 28 (22%) patients belonged to low risk, 80 (61%) to intermediate risk and 22 (17%) to the high risk category. The AU-ROC of the CARG score in predicting grade 3-5 toxicities was 0.61 (95% CI, 0.51-0.71). The sensitivity and specificity of the CARG score in predicting grade 3-5 toxicities were 60.8% and 78.6%. Grade 3-5 toxicities occurred in 6/28 patients (21%) in the low risk group, compared to 62/102 patients (61%) in the intermediate /high risk group, p = 0.0002. There was also a significant difference in the time to development of grade 3-5 toxicities, which occurred at a median of 2.5 cycles (IQR, 1-3.8) in the intermediate /high risk group and at a median of 6 cycles (IQR, 3.5-8) in the low risk group, p = 0.0011. Conclusions: In older Indian patients with cancer, the CARG score reliably stratifies patients into low risk and intermediate/high risk categories, predicting both the occurrence and the time to occurrence of grade 3-5 toxicities from chemotherapy. The CARG score may aid the oncologist in estimating the risk-benefit ratio of chemotherapy. An important limitation was that we provided the CARG score to the treating oncologists prior to the start of chemotherapy, which may have resulted in alterations in the chemotherapy regimen and dose and may have impacted the CARG risk prediction model. Clinical trial information: CTRI/2020/04/024675.

2021 ◽  
Author(s):  
juanjuan Qiu ◽  
Li Xu ◽  
Yu Wang ◽  
Jia Zhang ◽  
Jiqiao Yang ◽  
...  

Abstract Background Although the results of gene testing can guide early breast cancer patients with HR+, HER2- to decide whether they need chemotherapy, there are still many patients worldwide whose problems cannot be solved well by genetic testing. Methods 144 735 patients with HR+, HER2-, pT1-3N0-1 breast cancer from the Surveillance, Epidemiology, and End Results database were included from 2010 to 2015. They were divided into chemotherapy (n = 38 392) and no chemotherapy (n = 106 343) group, and after propensity score matching, 23 297 pairs of patients were left. Overall survival (OS) and breast cancer-specific survival (BCSS) were tested by Kaplan–Meier plot and log-rank test and Cox proportional hazards regression model was used to identify independent prognostic factors. A nomogram was constructed and validated by C-index and calibrate curves. Patients were divided into high- or low-risk group according to their nomogram score using X-tile. Results Patients receiving chemotherapy had better OS before and after matching (p < 0.05) but BCSS was not significantly different between patients with and without chemotherapy after matching: hazard ratio (HR) 1.005 (95%CI 0.897, 1.126). Independent prognostic factors were included to construct the nomogram to predict BCSS of patients without chemotherapy. Patients in the high-risk group (score > 238) can get better OS HR 0.583 (0.507, 0.671) and BCSS HR 0.791 (0.663, 0.944) from chemotherapy but the low-risk group (score ≤ 238) cannot. Conclusion The well-validated nomogram and a risk stratification model was built. Patients in the high-risk group should receive chemotherapy while patients in low-risk group may be exempt from chemotherapy.


2021 ◽  
Author(s):  
Yali Zhong ◽  
Xiaobin Luo ◽  
Fubing Yang ◽  
Xinling Song

Abstract Object: Immune related genes play an important role in the process of tumor genesis and development. Therefore, we aim to find the Immune genes which are related to the prognosis of glioma patients, and to explore the infiltration of Immune cells in glioma microenvironment. Methods We downloaded the data of the glioma samples from the CGGA database, and performed batch correction to screen the primary glioma samples for subsequent analysis. Then the ESTIMATE algorithm was used to deal with the Stromal scores and Immune scores of the primary glioma samples, and the difference was analyzed. Then the common Immune related genes (IRGs) were obtained by intersecting with the Immune genes in the ImmPort database. Moreover, we used common IRGs to construct protein-protein interaction (PPI) networks, from which we screened the top 30 genes with high connectivity, and Lasso regression was used to screen the IRGs. Lastly, we obtained the combined genes, which were overlapped both in the top 30 high-connection genes and Lasso regression genes. The final genes were used to construct COX risk prediction models. The accuracy of the model were verified by the TCGA glioma data, and the model genes were analyzed for Immune-related pathways, as well as the Hallmark and KEGG enrichment. Additionally, we used CIBERSOFT algorithm to estimate the Immune cell content of the samples, and analyzed the differences, correlations and survival of the Immune cells in high and low risk groups. Results Firstly, a total of 117 IRGs were obtained from the gene sets, which were overlapped in the data of Stromal score, Immune score and ImmPort database. Secondly, the top 30 genes were selected after the PPI network, and another 26 genes were screened out after the Lasso regression algorithm. And then, six coexist IRGs were obtained from the intersecting sets. Furthermore, the COX risk prediction model was constructed and tested, showing that the overall survival rate of the high-risk group was about 50% of that of the low-risk group. We observed that the high-risk group were enriched in Immune response and Immune process. Most importantly, in KEGG pathways, the high-risk groups were mainly enriched in p53 signaling pathway, JAK-STAT signaling pathway, pathways in cancer and cell cycle. By estimating the Immune cell contents, we also found that the Immune cell Plasma cells, T cells CD8, T cells CD4 naïve, T cells regulatory (Tregs), Macrophages M0 and Neutrophils were higher in high-risk groups, when compared to the low-risk group, with significant difference. Finally, the correlation analysis showed that the degree of Immune infiltration in high-risk groups was related to T cells regulatory (Tregs), Macrophages M0 and Neutrophils. Conclusion A COX risk prediction model of 6 genes was successfully constructed, which was enriched in Immune-related pathways. Meanwhile, survival analysis and TCGA data validation revealed significant differences in the model genes in the overall survival of the glioma patients, and the degree of Immune infiltration in the model was associated with T cells regulatory (Tregs), Macrophages M0 and Neutrophils.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Nishimoto ◽  
Y Yamashita ◽  
T Morimoto ◽  
S Saga ◽  
Y Sato ◽  
...  

Abstract Background/Introduction Patients with cancer-associated venous thromboembolisms (VTEs) have a markedly higher risk of recurrence as well as bleeding, compared to those without, leading to difficulty in achieving a good risk-to-benefit balance with anticoagulation therapy. Thus, the assessment of the risk of recurrence in an individual patient is essential. The modified Ottawa score has been developed to predict the risk of recurrence in patients with cancer-associated VTEs during anticoagulation therapy, however, the validity of the score is still controversial. Purpose We aimed to evaluate the utility and limitations of the modified Ottawa score in the risk stratification of recurrent VTEs in patients with cancer-associated VTEs. Methods The COMMAND VTE Registry is a multicenter retrospective registry enrolling 3027 consecutive patients with acute symptomatic VTEs among 29 Japanese centers between January 2010 and August 2014. The present study population consisted of 614 cancer-associated VTE patients with anticoagulation therapy beyond 10 days after the diagnosis, who were divided into 3 groups; High-risk group with a modified Ottawa score ≥1, Intermediate-risk group with a score = 0, and Low-risk group with a score ≤−1. To evaluate the discriminating power of the modified Ottawa score for recurrence, we described the receiver operating characteristic curve with a C-statistic, and evaluated the positive likelihood ratio as the predictive performance of the score for recurrence in each subgroup. Results The high-risk group accounted for 202 patients (33%), intermediate-risk group for 269 (44%), and low-risk group for 143 (23%). During the first 6 months of anticoagulation therapy, recurrent VTEs occurred in 39 patients. The cumulative incidence of recurrent VTEs substantially increased in the higher risk categories by the modified Ottawa score (High-risk group: 13.6%, Intermediate-risk group: 5.9%, and Low-risk group: 3.0%, Log-rank P=0.02) (Figure 1). The discriminating power of the score was modest with a C-statistic of 0.63 (95% CI 0.55–0.71). The positive likelihood ratios as the predictive performance of the score were 1.71 in the high-risk group, 0.81 in the intermediate-risk group, and 0.42 in the low-risk group. Women and patients with prior VTEs had numerically higher cumulative 6-month incidences of recurrent VTEs compared with those without, while patients with lung cancer, breast cancer, and without metastasis had numerically lower cumulative 6-month incidences of recurrent VTEs. Depending on the presence or absence of each score component, the risks of recurrence seemed to differ in the low-, intermediate-, and high-risk groups. Conclusions The risks of recurrence in patients with cancer-associated VTEs substantially increased in the higher risk categories by using the modified Ottawa score, but the discriminating power of the score for recurrence was modest with a widely variable impact of each score component on recurrence. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation


Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2732
Author(s):  
Seo Hee Choi ◽  
Young Seok Kim ◽  
Jesang Yu ◽  
Taek-Keun Nam ◽  
Jae-Sung Kim ◽  
...  

Purpose: This nationwide multi-institutional study analyzed the patterns of care and outcomes of external beam radiotherapy (EBRT) in localized prostate cancer patients. We compared various risk classification tools and assessed the need for refinements in current radiotherapy (RT) schemes. Methods and Materials: We included non-metastatic prostate cancer patients treated with primary EBRT from 2001 to 2015 in this study. Data of 1573 patients from 17 institutions were analyzed and re-grouped using a risk stratification tool with the highest predictive power for biochemical failure-free survival (BCFFS). We evaluated BCFFS, overall survival (OS), and toxicity rates. Results: With a median follow-up of 75 months, 5- and 10-year BCFFS rates were 82% and 60%, and 5- and 10-year OS rates were 95% and 83%, respectively. NCCN risk classification revealed the highest predictive power (AUC = 0.556, 95% CI 0.524–0.588; p < 0.001). Gleason score, iPSA < 12 ng/mL, intensity-modulated RT (IMRT), and ≥179 Gy1.5 (EQD2, 77 Gy) were independently significant for BCFFS (all p < 0.05). IMRT and ≥179 Gy1.5 were significant factors in the high-risk group, whereas ≥170 Gy1.5 (EQD2, 72 Gy) was significant in the intermediate-risk group and no significant impact of dose was observed in the low-risk group. Both BCFFS and OS improved significantly when ≥179 Gy1.5 was delivered using IMRT and hypofractionation in the high-risk group without increasing toxicities. Conclusions: With NCCN risk classification, dose escalation with modern high-precision techniques might increase survivals in the high-risk group, but not in the low-risk group, although mature results of prospective studies are awaited.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2547-2547
Author(s):  
Rahima Jamal ◽  
Bingshu E Chen ◽  
Gergana Hristova ◽  
Lesley Seymour ◽  
Sarit E. Assouline

2547 Background: Strict criteria are used to limit toxicity for patients (pts) enrolled in phase I/II clinical trials, but the ability to survive beyond 12 weeks, a common inclusion criterion, is subjective and error-prone. A prognostic score with 3 variables was designed and validated as an independent predictor of OS in pts with solid tumors included in phase I trials (Arkenau, JCO 2009). We examined the ability of objective measures to predict OS and risk of grade ≥3 toxicity in pts with hematologic malignancies enrolled in early-phase trials. Methods: A retrospective analysis was conducted on 290 pts in Phase I (79 pts) and II (211 pts) trials from the NCIC - Clinical Trials Group and our institution from 1995 to 2009. Only pts with survival data up to 90 days were included. Univariate model (UVA) was used to identify factors significantly associated with OS. A Cox proportional hazards model (MVA) included all factors identified from the UVA. Six prognostic factors were identified in the MVA, and each assigned a score of 0 or 1. Pts were categorized as high or low risk based on the total scores that they received, ≥3 were assigned to the high risk group, and a ≤2 to the low risk group. Kaplan-Meier method was used to generate the survival distribution for the high and low risk groups. Multivariate logistic regression was used to identify the risk factors for grade ≥3 toxicity. Results: The overall median survival was 238 days (95% CI 237 to 331), and 27% of pts had grade ≥ 3 toxicity. In the MVA, albumin (alb), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), lymphocytes, platelets (plts) and diagnosis were significantly associated with OS. Pts in the low risk group had a median survival of 10.6 months, relative to 2.4 months among pts in the high risk group. Survival at 90 days was 80% in lower risk vs. 36% in the high risk group. In addition, the MVA for toxicity showed that alb, ALP, LDH, plts and performance status were significantly associated with grade ≥3 toxicity. Conclusions: Our model predicts OS, 90 day survival and risk of grade ≥ 3 toxicity among pts with hematologic malignancies entered in Phase I/II trials. Future work will include a linear predictor score based on MVA to refine the prediction model. The model will also be validated using another dataset.


2021 ◽  
Vol 10 ◽  
Author(s):  
Ruyue Zhang ◽  
Qingwen Zhu ◽  
Detao Yin ◽  
Zhe Yang ◽  
Jinxiu Guo ◽  
...  

BackgroundAutophagy is a “self-feeding” phenomenon of cells, which is crucial in mammalian development. Long non-coding RNA (lncRNA) is a new regulatory factor for cell autophagy, which can regulate the process of autophagy to affect tumor progression. However, poor attention has been paid to the roles of autophagy-related lncRNAs in breast cancer.ObjectiveThis study aimed to construct an autophagy-related lncRNA signature that can effectively predict the prognosis of breast cancer patients and explore the potential functions of these lncRNAs.MethodsThe RNA sequencing (RNA-Seq) data of breast cancer patients was collected from The Cancer Genome Atlas (TCGA) database and the GSE20685 database. Multivariate Cox analysis was implemented to produce an autophagy-related lncRNA signature in the TCGA cohort. The signature was then validated in the GSE20685 cohort. The receiver operator characteristic (ROC) curve was performed to evaluate the predictive ability of the signature. Gene set enrichment analysis (GSEA) was used to explore the potential functions based on the signature. Finally, the study developed a nomogram and internal verification based on the autophagy-related lncRNAs.ResultsA signature composed of 9 autophagy-related lncRNAs was determined as a prognostic model, and 1,109 breast cancer patients were divided into high-risk group and low-risk group based on median risk score of the signature. Further analysis demonstrated that the over survival (OS) of breast cancer patients in the high-risk group was poorer than that in the low-risk group based on the prognostic signature. The area under the curve (AUC) of ROC curve verified the sensitivity and specificity of this signature. Additionally, we confirmed the signature is an independent factor and found it may be correlated to the progression of breast cancer. GSEA showed gene sets were notably enriched in carcinogenic activation pathways and autophagy-related pathways. The qRT-PCR identified 5 lncRNAs with significantly differential expression in breast cancer cells based on the 9 lncRNAs of the prognostic model, and the results were consistent with the tissues.ConclusionIn summary, our signature has potential predictive value in the prognosis of breast cancer and these autophagy-related lncRNAs may play significant roles in the diagnosis and treatment of breast cancer.


2021 ◽  
Author(s):  
Yaping Zhou ◽  
Liu Yang ◽  
Xiangxin Zhang ◽  
Xiaotong Zhao ◽  
Jianfeng Fu ◽  
...  

Abstract Background: LncRNA may be involved in the occurrence, metastasis, and chemical reaction of hepatocellular carcinoma (HCC) through various pathways associated with autophagy. Therefore, it is urgent to reveal more autophagy-related lncRNAs, explore these lncRNAs' clinical significance, and find new targeted treatment strategies. Methods: In our study, RNA-seq and clinical data of normal and HCC patients were obtained from the TCGA database, and autophagy genes were obtained from the human autophagy database. Results: The risk prediction model containing seven autophagy-related lncRNAs was constructed. Overall survival (OS) curves show that the high-risk group patients significantly shorter than the low-risk group (P=2.292e-10), and the five years survival rate of the high-risk group (HR 0.286, 95%CI 0.199-0.411) is less than half of the low-risk group (HR 0.694, 95%CI 0.547-0.77). Univariate Cox regression indicated that risk score of the risk prediction model (P<0.001, 95%CI 1.210-1.389 ), T (P<0.001, 95%CI 1.443-2.287), and stage (P<0.001 ,95%CI 1.466-2.408 ) were independent prognostic indicators. However, only the risk score remains the independent prognostic indicator(P<0.001, 95%CI 1.197-1.400 ) based on the multivariate analysis. This risk model's prediction efficiency is significantly higher than other clinicopathological factors for 1-, 3- and 5-year survival rate prediction (AUC are 0.853, 0.794, and 0.764, respectively). Remarkably, the 7 autophagy-related lncRNAs may participate in Spliceosome, Cell cycle, RNA transport, DNA replication, and mRNA surveillance pathway and be related to the biological process of RNA splicing and mRNA splicing. Conclusion: In conclusion, the 7 autophagy-related lncRNAs might be promising prognostic and therapeutic targets for HCC.


Author(s):  
Menha Swellam ◽  
Hekmat M EL Magdoub ◽  
May A Shawki ◽  
Marwa Adel ◽  
Mona M Hefny ◽  
...  

Author(s):  
Yan Fan ◽  
Hong Shen ◽  
Brandon Stacey ◽  
David Zhao ◽  
Robert J. Applegate ◽  
...  

AbstractThe purpose of this study was to explore the utility of echocardiography and the EuroSCORE II in stratifying patients with low-gradient severe aortic stenosis (LG SAS) and preserved left ventricular ejection fraction (LVEF ≥ 50%) with or without aortic valve intervention (AVI). The study included 323 patients with LG SAS (aortic valve area ≤ 1.0 cm2 and mean pressure gradient < 40 mmHg). Patients were divided into two groups: a high-risk group (EuroSCORE II ≥ 4%, n = 115) and a low-risk group (EuroSCORE II < 4%, n = 208). Echocardiographic and clinical characteristics were analyzed. All-cause mortality was used as a clinical outcome during mean follow-up of 2 ± 1.3 years. Two-year cumulative survival was significantly lower in the high-risk group than the low-risk patients (62.3% vs. 81.7%, p = 0.001). AVI tended to reduce mortality in the high-risk patients (70% vs. 59%; p = 0.065). It did not significantly reduce mortality in the low-risk patients (82.8% with AVI vs. 81.2%, p = 0.68). Multivariable analysis identified heart failure, renal dysfunction and stroke volume index (SVi) as independent predictors for mortality. The study suggested that individualization of AVI based on risk stratification could be considered in a patient with LG SAS and preserved LVEF.


Author(s):  
Johannes Korth ◽  
Benjamin Wilde ◽  
Sebastian Dolff ◽  
Jasmin Frisch ◽  
Michael Jahn ◽  
...  

SARS-CoV-2 is a worldwide challenge for the medical sector. Healthcare workers (HCW) are a cohort vulnerable to SARS-CoV-2 infection due to frequent and close contact with COVID-19 patients. However, they are also well trained and equipped with protective gear. The SARS-CoV-2 IgG antibody status was assessed at three different time points in 450 HCW of the University Hospital Essen in Germany. HCW were stratified according to contact frequencies with COVID-19 patients in (I) a high-risk group with daily contacts with known COVID-19 patients (n = 338), (II) an intermediate-risk group with daily contacts with non-COVID-19 patients (n = 78), and (III) a low-risk group without patient contacts (n = 34). The overall seroprevalence increased from 2.2% in March–May to 4.0% in June–July to 5.1% in October–December. The SARS-CoV-2 IgG detection rate was not significantly different between the high-risk group (1.8%; 3.8%; 5.5%), the intermediate-risk group (5.1%; 6.3%; 6.1%), and the low-risk group (0%, 0%, 0%). The overall SARS-CoV-2 seroprevalence remained low in HCW in western Germany one year after the outbreak of COVID-19 in Germany, and hygiene standards seemed to be effective in preventing patient-to-staff virus transmission.


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