scholarly journals Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

2015 ◽  
Vol 6 (3) ◽  
pp. 22-28
Author(s):  
Joyutpal Das ◽  
Shahid Gilani
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Performance Status ◽  
Disease Onset ◽  
Significant Proportion ◽  
Poor Performance ◽  
Primary Site ◽  
University Hospital ◽  
Unknown Primary ◽  
Poor Performance Status

Abstract With the development of site-specific cancer therapy, identifying the primary origin allows the oncologist to personalise therapy for patients with the cancer of unknown primaries (CUPs). At present, immunohistochemistry (IHC) screening is the standard method used to postulate the primary site in CUP. In this retrospective study, we evaluated the prognostic benefit of identifying the primary site in CUP. All 84 patients who presented with suspected CUP to the Royal Stoke University Hospital between 2011 and 2012 were included in our study. Forty-eight percent (40/84) of these patients were unable to undergo necessary investigations to identify primary sites because of poor performance status. IHC screening was able to postulate the primary site in 59% (26/44) of the remaining patients with confirmed CUP. Therefore, the primary site was not identified in a significant proportion of patients with CUP. The median survival of confirmed CUP with probable primary site was 2.0 months (95% confidence interval (CI): 1.2 to 2.9 months), whereas the median survival of confirmed CUP with no probable primary site was 4.1 months (95% CI: 1.5 to 9.7 months). This difference in survival time was statistically significant. In addition, using the Cox regression model, we found that patients with confirmed CUP with primary sites had prognostically unfavourable diseases with a shorter median survival, regardless of the age of disease onset, gender, sites of metastases or number of metastases. One approach to improve the survival would be to start systemic therapy at the earliest possible opportunity rather than waiting for all investigation results, such as IHC.

Should all patients (pts) with advanced biliary cancers receive first-line treatment with cisplatin and gemcitabine (GC)?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 244-244
Author(s):  
Vanessa Costa Miranda ◽  
Luiza Dib-Faria ◽  
Maria Ignez Freitas Melro Braghiroli ◽  
Jorge Sabbaga ◽  
Daniel Fernandes Saragiotto ◽  
...  
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Poor Performance ◽  
Median Number ◽  
Poor Performance Status ◽  
Poor Survival ◽  
First Line ◽  
Dismal Prognosis

244 Background: GC is considered the standard of care for pts with advanced biliary tract cancer (BTC), providing median survival of nearly one year. (Valle J et al. NEJM 2010) Nevertheless, many pts experience poor outcomes, leading to a growing interest to identify pts who might benefit from such treatment. Here we aimed to investigate clinical and laboratory factors associated with poor survival among BTC pts treated with GC. Methods: We retrospectively evaluated all consecutive pts with advanced/metastatic BTC who received first line GC at the Instituto do Cancer do Estado de Sao Paulo, Brazil, in a 2 year-period. Clinical and laboratory variables that could influence pts’ outcomes were gathered from medical charts. Cox regression proportional hazard model was used to investigate the following prognostic factors for death: pre-treatment biliary deobstruction, baseline Ca 19.9, any GC interruptions or dose reductions, baseline ECOG status, Charlson Comorbidity Index (CCI) and age. P values < 0.05 in multivariable analysis were considered significant. Results: From January/2009 to July/2011, 72 pts were identified. The median age was 60 years (range 30-80 years), 45 pts (62.5%) were female and 50 (69.4%) presented baseline ECOG 0-1. The median number of cycles of CG was 4 (range 1-9). Grade 3 /4 neutropenia and thrombocytopenia occurred in 16.6% and 12.5% of pts, respectively. Median survival of the whole cohort was 9.53 months (95% CI: 6.2 - 11.4). Median survival in pts with ECOG 0/1 was 13.5 months (95% CI: 9,5 – NR) and among pts with ECOG 2/3 3,5 months (95% CI: 1-7). In the Cox multivariable model, ECOG 2 /3 versus 0/1 (HR: 8.4, 95% CI: 3.4 to 20.7; p<0.001) and CCI score ≥ 2 (HR: 9.5 95% CI: 1.6 to 55.3; p= 0.012) significantly predicted for poor survival. There was a trend for improved survival among pts who had biliary drainage before starting GC (HR: 2.3 95% CI: 1.0 - 5.3; p= 0.051). Conclusions: In this retrospective cohort of unselected pts with advanced BTC treated with first line GC, poor performance status and multiple comorbid illnesses were associated with dismal prognosis. Treatment with GC should be carefully discussed before being offered to these pts.

Was bei Tumorpatienten mit Atemwegsstenosen die Prognose bestimmt: Erst Rekanalisierung, im Anschluss andere Therapieoptionen nicht versäumen

2020 ◽  
Vol 8 (3) ◽  
pp. 148-149
Author(s):  
Manfred Wagner
Keyword(s):  
Prognostic Factors ◽  
Performance Status ◽  
Survival Rates ◽  
Poor Performance ◽  
University Hospital ◽  
Poor Performance Status ◽  
Poor Survival ◽  
Interventional Bronchoscopy ◽  
Cox Proportional Hazard Regression ◽  
One Year

Background: Malignant central airway obstruction (MCAO) occurs in 20–30% of patients with primary pulmonary malignancy. Although bronchoscopic intervention is widely performed to treat MCAO, little data exist on the prognosis of interventional bronchoscopy. Therefore, we evaluated the clinical outcomes and prognostic factors of bronchoscopic interventions in patients with MCAO due to primary pulmonary malignancy. Methods: This retrospective study was conducted at a university hospital and included 224 patients who received interventional bronchoscopy from 2004 to 2017, excluding patients with salivary gland-type tumor. A multivariable Cox proportional hazard regression analysis was used to identify independent prognostic factors associated with survival after the first bronchoscopic intervention. Results: Among 224 patients, 191 (85.3%) were males, and the median age was 63 years. The most common histological type of malignancy was squamous cell carcinoma (71.0%). Technical success was achieved in 93.7% of patients. Acute complications and procedure-related death occurred in 15.6 and 1.3% of patients, respectively. The median survival time was 7.0 months, and survival rates at one year and two years were 39.7 and 28.3%, respectively. Poor survival was associated with underlying chronic pulmonary disease, poor performance status, extended lesion, extrinsic or mixed lesion, and MCAO due to disease progression and not receiving adjuvant treatment after bronchoscopic intervention. Conclusions: Interventional bronchoscopy could be a safe and effective procedure for patients who have MCAO due to primary pulmonary malignancy. In addition, we found several prognostic factors for poor survival after intervention, which will help clinicians determine the best candidates for bronchoscopic intervention.

scholarly journals Survival outcome differences based on treatments used and knowledge of the primary tumour site for patients with cancer of unknown and known primary in Ontario

2018 ◽  
Vol 25 (5) ◽  
Author(s):  
C. S. Kim ◽  
M. B. Hannouf ◽  
S. Sarma ◽  
G. B. Rodrigues ◽  
P. K. Rogan ◽  
...  
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Metastatic Cancer ◽  
Primary Tumour ◽  
Primary Site ◽  
Unknown Primary ◽  
Survival Outcomes ◽  
Tumour Site ◽  
Ontario Health Insurance Plan ◽  
Primary Tumour Site

IntroductionPatients with cancer of unknown primary (cup) have pathologically confirmed metastatic tumours with unidentifiable primary tumours. Currently, very little is known about the relationship between the treatment of patients with cup and their survival outcomes. Thus, we compared oncologic treatment and survival outcomes for patients in Ontario with cup against those for a cohort of patients with metastatic cancer of known primary site.Methods Using the Ontario Cancer Registry and the Same-Day Surgery and Discharge Abstract databases maintained by the Canadian Institute for Health Information, we identified all Ontario patients diagnosed with metastatic cancer between 1 January 2000 and 31 December 2005. Ontario Health Insurance Plan treatment records were linked to identify codes for surgery, chemotherapy, or therapeutic radiation related to oncology. Multivariable Cox regression models were constructed, adjusting for histology, age, sex, and comorbidities.Results In 45,347 patients (96.3%), the primary tumour site was identifiable, and in 1743 patients (3.7%), cup was diagnosed. Among the main tumour sites, cup ranked as the 6th largest. The mean Charlson score was significantly higher (p < 0.0001) in patients with cup (1.88) than in those with a known primary (1.42). Overall median survival was 1.9 months for patients with cup compared with 11.9 months for all patients with a known-primary cancer. Receipt of treatment was more likely for patients with a known primary site (n = 35,012, 77.2%) than for those with cup (n = 891, 51.1%). Among patients with a known primary site, median survival was significantly higher for treated than for untreated patients (19.0 months vs. 2.2 months, p < 0.0001). Among patients with cup, median survival was also higher for treated than for untreated patients (3.6 months vs. 1.1 months, p < 0.0001).Conclusions In Ontario, patients with cup experience significantly lower survival than do patients with metastatic cancer of a known primary site. Treatment is associated with significantly increased survival both for patients with cup and for those with metastatic cancer of a known primary site.

scholarly journals Palliative care and end-of-life measure outcomes: Experience of a tertiary care institute from South India

2018 ◽  
Vol 07 (03) ◽  
pp. 210-213
Author(s):  
Praveen Adusumilli ◽  
Lingaraj Nayak ◽  
Vidya Viswanath ◽  
Leela Digumarti ◽  
Raghunadha Rao Digumarti
Keyword(s):  
Palliative Care ◽  
Median Time ◽  
Performance Status ◽  
Tertiary Care ◽  
Quality Criterion ◽  
Poor Performance ◽  
Primary Objective ◽  
Unknown Primary ◽  
Poor Performance Status ◽  
Terminally Ill Cancer Patients

Abstract Introduction: Desisting from disease directed treatment in the past weeks of life is a quality criterion in oncology service. Patients with advanced cancer have unrealistic expectations from chemotherapy and hold on to it as a great source of hope. Many oncologists continue futile and unnecessary treatments, instead of conveying to the patients the lack of benefit, resulting in delayed referral for palliative care (PC). Materials and Methods: This is a retrospective analysis of case records from June 2014 to December 2015. The primary objective was to study, how far back in time terminally ill cancer patients received definitive cancer directed therapy (DCDT). Apart from patient demographics, the diagnosis, stage, and details of DCDT, and death were captured. PC referral data were recorded. DCDT to death was taken as treatment-free interval (TFI). Analysis was performed using IBM SPSS Statistics for Windows, Version 20. Results: A total of 292 case records were evaluated. Seventy-three had inadequate treatment details. Hence, 219 records were analyzed. PC referral was done in 78.5% of patients. Only best supportive care (BSC) without any DCDT was given in 27 patients. The most common reason for BSC was a poor performance status in 92.5%. The median time from PC referral till death was 43.5 days (range: 1–518 days). Chemotherapy was the most common DCDT in 52.9% of patients. The median time from DCDT and death was 49 days (range: 0–359 days). Cervical and ovarian cancers patients had the longest TFI ; shortest in unknown primary. Most patients died at home (70.4%). Patients receiving PC preferred home or hospice as place of death. Of the 80 patients given hospice care, 39 (36.5%) died in the hospice. Conclusion: While DCDT needs to be started at the right time, it should also be discontinued when futile. Early involvement of the PC team, even while patients are on DCDT makes the transition smoother and more meaningful.

Simple prognostic model to predict survival in patients with undifferentiated carcinoma of unknown primary site.

1995 ◽  
Vol 13 (7) ◽  
pp. 1720-1725 ◽  
Author(s):  
A van der Gaast ◽  
J Verweij ◽  
A S Planting ◽  
W C Hop ◽  
G Stoter
Keyword(s):  
Alkaline Phosphatase ◽  
Prognostic Factors ◽  
Median Survival ◽  
Performance Status ◽  
Primary Site ◽  
Survival Duration ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Carcinoma Of Unknown Primary ◽  
Median Survival Duration

PURPOSE We performed this study to identify prognostic factors in a subgroup of patients with carcinoma of unknown primary site treated with cisplatin combination chemotherapy. PATIENTS AND METHODS Seventy-nine patients with poorly differentiated adenocarcinoma or undifferentiated carcinoma of unknown primary site were treated on two consecutive phase II chemotherapy protocols. The first protocol consisted of treatment with 3-week courses of cisplatin, etoposide, and bleomycin (BEP). In the second protocol, cisplatin was administered weekly combined with oral administration of etoposide (DDP/VP). To identify prognostic factors, univariate and multivariate analyses were conducted. RESULTS In the univariate analysis, performance status, histology, liver or bone metastases, and serum levels of alkaline phosphatase and AST were significant variables to predict survival. In the multivariate analysis, performance status and alkaline phosphatase were the most important prognostic factors. CONCLUSION Good-prognosis patients had a performance score of 0 (World Health Organization [WHO]) and an alkaline phosphatase serum level less than 1.25 times the upper limit of normal (N). These patients had a median survival duration greater than 4 years. Intermediate-prognosis patients were characterized by either a WHO performance status < or = 1 or an alkaline phosphatase level > or = 1.25 N. These patients had a median survival duration of 10 months and a 4-year survival rate of only 15%. The poor-prognosis group had both a WHO performance status > or = 1 and an alkaline phosphatase level > or = 1.25 N. These patients had a median survival duration of only 4 months and none survived beyond 14 months. Treatment strategies for these three groups are discussed. It is suggested that this prognostic model be validated in other patients series.

scholarly journals Sarcomatoid carcinoma presenting as cancers of unknown primary: a clinicopathological portrait

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ryan W. Huey ◽  
Shalini Makawita ◽  
Lianchun Xiao ◽  
Aurelio Matamoros ◽  
Jeannelyn S. Estrella ◽  
...  
Keyword(s):  
Molecular Diagnostics ◽  
Performance Status ◽  
Sarcomatoid Carcinoma ◽  
Poor Performance ◽  
Rank Test ◽  
Unknown Primary ◽  
Trial Participation ◽  
Poor Performance Status ◽  
Rare Presentation ◽  
Entire Cohort

Abstract Background Sarcomatoid carcinoma of unknown primary (SCUP) is a rare entity of either poorly differentiated carcinoma with sarcoma-like differentiation or a true mixed lineage neoplasm. Limited data regarding clinicopathological profile and management exists. Methods We retrospectively reviewed the MD Anderson Cancer of Unknown Primary database and tumor registry to identify 48 SCUP patients between 2001 and 2017. Patient characteristics, pathology, molecular diagnostics, treatments, and outcomes were obtained. Kaplan-Meier method was used to estimate overall survival (OS) and compared using log rank test. Results Median age at diagnosis was 59 years (range 27–86). Majority of patients were female (58%) and presented with ≥3 metastatic sites (52%), commonly lymph node (50%), bone (42%), lung (27%), and liver (21%). First line treatment included chemotherapy (35%), surgery (27%), and radiation (24%). Gemcitabine and docetaxel (18%) was the most common chemotherapy regimen. Median OS for entire cohort was 11 months (95% CI: 5.6 to 16.4). Poor performance status (PS), > 1 metastatic site, elevated lactate dehydrogenase (LDH), and high neutrophil-to-lymphocyte ratio (NLR) were significantly associated with worse OS on univariate analyses. On multivariate analyses, poor PS (HR 8.7; 95%CI: 3.0–25.0; p <  0.001) and high NLR (HR 3.4; 95%CI: 1.3–8.8; p = 0.011) emerged as independent prognostic factors for OS. Conclusions SCUP is a rare presentation with an aggressive clinical course and limited survival. Diagnosis is difficult to make and requires careful review and synthesis of histology, immunohistochemistry, and molecular diagnostics. Chemotherapy resistance remains a challenge. Early mutational profiling is warranted, and clinical trial participation should be encouraged for this subset.

scholarly journals Radiotherapy for glioblastoma patients with poor performance status

2021 ◽  
Author(s):  
Christina Schröder ◽  
Dorothee Gramatzki ◽  
Erwin Vu ◽  
Matthias Guckenberger ◽  
Nicolaus Andratschke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Systemic Treatment ◽  
Performance Status ◽  
Poor Performance ◽  
Primary Diagnosis ◽  
University Hospital ◽  
Poor Performance Status ◽  
First Line ◽  
Postoperative Performance ◽  
Line Setting

Abstract Purpose There is limited information on treatment recommendations for glioblastoma patients with poor performance status. Here, we aim to evaluate the association of radiotherapy on survival in glioblastoma patients presenting with poor postoperative performance status in first-line setting. Methods We retrospectively analyzed data of 93 glioblastoma patients presenting with poor postoperative performance status (ECOG 2–4) at the University Hospital Zurich, Switzerland, in the years 2005–2019. A total of 43 patients received radiotherapy with or without systemic therapy in the first-line setting, whereas 50 patients received no additive local or systemic treatment after initial biopsy or resection. Overall survival was calculated from primary diagnosis and from the end of radiotherapy. In addition, factors influencing survival were analyzed. Results Median overall survival from primary diagnosis was 6.2 months in the radiotherapy group (95% CI 6.2–14.8 weeks, range 2–149 weeks) and 2.3 months in the group without additive treatment (95% CI 1.3–7.4 weeks, range 0–28 weeks) (p < 0.001). This survival benefit was confirmed by landmark analyses. Factors associated with overall survival were extent of resection and administration of radiotherapy with or without systemic treatment. Median survival from end of radiotherapy was 3 months (95% CI 4.3–21.7 weeks, range 0–72 weeks), with 25.6% (n = 11) early termination of treatment and 83.7% (n = 36) requiring radiotherapy as in-patients. Performance status improved in 27.9% (n = 12) of patients after radiotherapy. Conclusion In this retrospective single-institution analysis, radiotherapy improved overall survival in patients with poor performance status, especially in patients who were amendable to neurosurgical resection.

Attendance at National Cancer Institute Cancer Centers (NCI-CC) by older adults with myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18020-e18020
Author(s):  
Tanya Marya Wildes ◽  
Mark A Fiala
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Performance Status ◽  
Tertiary Care ◽  
Community Setting ◽  
Poor Performance ◽  
Lower Mortality ◽  
Mortality Data ◽  
Poor Performance Status ◽  
Nationally Representative

e18020 Background: Older adults with myeloma (MM) have poorer survival than younger patients. NCI-CC attendance is associated with superior outcomes in many cancers. Studies show that older adults are reluctant to be treated in university settings and are more likely to be treated in the community setting. We aimed to define the factors associated with NCI-CC attendance in older adults with mm from a nationally representative sample and its association with survival. Methods: We identified all mm cases in the SEER-Medicare linked database from 2000-2011. Included cases were enrolled in Medicare Part A and B > 1 year prior to diagnosis; we excluded those enrolled at age < 65. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered an NCI-CC; attendance was defined as ≥2 separate claims from an NCI-CC in the 1-year after mm diagnosis. CM were calculated using the Charlson Comorbidity (CM) Index (CCI). Poor performance status indicators (PSi) were coded as present or absent. Logistic regression was performed to determine if age was associated with NCI-CC attendance. Cox regression was determined the association of NCI-CC attendance with survival. Results: 21,843 cases were included; median age was 77 years. Overall 10.6% of the cohort attended an NCI-CC. Increasing age was associated with decreasing NCI-CC attendance rates: 18.6% (age 65-69), 13.9% (age 70-74), 9.0% (age 75-79) and 6.0% (age ≥80). After controlling for race, gender, socioeconomic status, and urban/rural regions, increasing age, poor PSi and CCI were each associated with lower odds of NCI-CC attendance [Age: OR 0.925/year (95% CI 0.92-0.93); Poor PSi: OR 0.87 (CI 0.76-1.00); CM: 0.94/CCI point (CI 0.90-0.97)]. After controlling for sociodemographics, PS and CCI, NCI-CC attendance was associated with lower mortality [HR 0.74 (95% CI 0.70-0.78)]. Conclusions: With increasing age, poor PS indicators and CM, pts are less likely to attend an NCI-CC. After controlling for other prognostic factors, attendance at an NCI-CC was associated with lower mortality. Data from trials in older mm pts from NCI-CC or other tertiary care centers must be viewed with caveat that pts tend to have better PS and fewer CM.

Chromosome 1 abnormalities and clinical outcomes in multiple myeloma in the era of novel agents.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8044-8044
Author(s):  
Smith Giri ◽  
Scott F. Huntington ◽  
Rong Wang ◽  
Amer Methqal Zeidan ◽  
Nikolai Alexandrovich Podoltsev ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Cox Regression ◽  
Performance Status ◽  
Poor Performance ◽  
Total Sample ◽  
Chromosome 1 ◽  
Poor Performance Status ◽  
Cox Regression Analysis ◽  
Entire Cohort

8044 Background: Abnormalities of chromosome 1 (C1A) are common genetic mutations in patients (pts) with Multiple Myeloma (MM). While several small studies have reported worse outcomes for C1A, the prevalence, real-world treatment and outcomes for pts with C1A are unknown. Methods: We used the Flatiron Health Electronic Health Record (EHR)-derived database to identify pts with newly diagnosed MM from 01/2011 to 03/2018 with Fluorescence In situ Hybridization (FISH) testing within 90 days of diagnosis and defined lines of therapy. We identified pts with C1A and other high-risk mutations (HRM; 17p deletion, t14;16 and t4;14). Pts were followed until 3/31/2018 or death. The primary outcome was overall survival (OS). We used Kaplan Meier methods and compared OS for pts with/without C1A using log-rank tests stratified for HRM. We used Cox regression analysis to compare OS across groups, adjusting for age, gender, performance status, stage, HRM and treatment (triple regimen vs other). Results: The total sample included 3,578 pts: median age at diagnosis was 69 yrs (IQR 31-85), with 54% males and 60% whites. IgG(57%) and IgA(22%) were the most common M-protein subtypes. At baseline, 844 (24%) had C1A. Pts with C1A had higher stage (ISS III 35% vs 26%; p < 0.01) and other HRM (27% vs 14%, p < 0.01). Common first line-therapies included bortezomib(V), lenalidomide(R) and dexamethasone (D) (35%), RD (20%) followed by VD(15%). Use of VRD was higher with C1A vs without (40% vs 33% respectively, p < 0.01). Median OS was 66.9 months for the entire cohort and was lower for pts with C1A vs without (median OS 46.6 vs 70.1 months; log rank p < 0.01). Multivariable Cox survival analysis showed that C1A was independently associated with worse OS (adjusted HR 1.64; 95% CI 1.23-2.19); p < 0.01). Other predictors of worse survival included older age, black ethnicity, higher ISS stage, poor performance status and HRM. Conclusions: In this large study of real-world practice, C1A was associated with inferior OS independent of other HRM, despite higher use of VRD. Future studies are needed to assess whether specific regimens improve outcomes for C1A compared to patients without HRM.

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