scholarly journals Symptom Relief is the Most Significant Prognostic Factor for Unresectable Locally Advanced/Recurrent Pancreatic Cancer Receiving Chemoradiotherapy: Analysis of 65 Cases

Author(s):  
Ting Jiang ◽  
Jingxian Shen ◽  
Shuang Liu ◽  
Qing Liu ◽  
Weiwei Xiao ◽  
...  

Abstract BackgroundPancreatic cancer is the fourth leading cause of cancer-related death throughout the world. For local advanced and recurrent pancreatic cancer (LAPC/LRPC), chemoradiotherapy (CRT) is a main choice which may prolong their survival and ease patients’ symptoms.MethodsWe constructed a database of 65 patients with LAPC/LRPC treated from June, 2004 to February, 2018. We used log-rank test to evaluate the different overall survival (OS) rates of all factors involved, and used cox regression model to find out independent prognostic factors for these patients.ResultsThe median OS time for 65 eligible patients was 23.6 months. 47 (72.3%) and 18 (27.7%) patients had unresectable LAPC and LRPC, and median OS time was 17.2 and 40.7 months (P= 0.02), respectively. The mean biological effective dose (BED) to gross tumor volume (GTV) was 64.8Gy (46.7-85.5 Gy). 11(16.9%) and 54(83.1%) patients had BED> 72 Gy and BED≤ 72 Gy, and their mOS was 31.8 and 21.9 months (P= 0.08), respectively. Simultaneous dose boost to interval GTV (GTVin) was applied to 23 patients (35.4%). Patients with large GTV volume (≥ 109.2 cm3) may benefit from radiation dose boost (mOS: 27.6 vs. 5.3 months, P= 0.004). Patients with symptom relief including relief of pain, jaundice, and/or diarrhea had higher OS rates than those without response (mOS: 25.7 vs. 13.2 months, P< 0.01) and multivariate cox regression analysis suggested symptom relief was the most significant prognostic factor for OS (HR= 0.44, 95%CI 0.35-2.36, P= 0.02).ConclusionCRT with simultaneous integrated boost of radiation dose may bring survival benefit for LAPC/LRPC patients with bulk tumor. Symptom relief is the most significant prognostic factor for LAPC/LRPC patients after comprehensive CRT.

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4500-4500
Author(s):  
R. T. Shroff ◽  
M. M. Javle ◽  
X. Dong ◽  
V. S. Kumar ◽  
S. Krishnan ◽  
...  

4500 Background: The IGFR pathway is activated in pancreatic cancer and may result in aggressive disease course. The study of single nucleotide polymorphisms (SNPs) involved in this pathway may provide prognostic information and predict response to IGFR directed agents. We investigated IGFR pathway SNPs in patients with LAPC. Methods: We evaluated 39 SNPs from 7 candidate genes in the IGFR pathway (IGF1R, IGF2R, IGF1, IGF2, IRS1, IRS2, IGFBP3) in 105 LAPC patients. DNA extraction from whole blood was performed using the Qiagen Flexigene DNA and Promega Maxwell 16 kits. Genotyping was performed using the Sequenom method. Overall survival was measured from date of diagnosis to date of death or last follow-up. Kaplan-Meier plot, log-rank test, and Cox regression were used to compare survival of patients according to genotype corrected for previously identified prognostic factors, including induction chemotherapy, CA 19–9, albumin, LDH, hemoglobin and Karnofsky performance status (KPS). Results: Median survival time (MST) was 15 months (95% CI 13.3–16.7). Induction chemotherapy, LDH, CA 19–9 level, hemoglobin, and KPS were not significantly associated with survival. Serum albumin and three SNPs of the IGF pathway (IGF1R IVS20–3431A>G, IRS1 G971R, and IGF2 *4352A>G) were significantly associated with prognosis ( Table ). Two of the three genotypes remained as significant predictors for survival in Cox regression analysis when adjusted for clinical factors. A significant combined genotype effect was observed wherein patients with all three deleterious alleles had significantly worse survival than those with only two or one (10 vs. 16.3 vs. 21.3 months, p< 0.0001). Conclusions: These data suggest that SNPs in the IGFR pathway genes may have prognostic value for LAPC patients. This information may identify population subgroups that could benefit from IGFR-targeted agents. [Table: see text] No significant financial relationships to disclose.


2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 760-760
Author(s):  
Laurent Mineur ◽  
Eric François ◽  
Jean Marc Phelip ◽  
Rosine Guimbaud ◽  
Carine Plassot ◽  
...  

760 Background: Pts included in clinical trials represent the unusual population in mCRC. This study aims to provide oncologist with a better understanding of the potential benefit of CT with CTX in older patients with mCRC KRAS wild type and evaluate prognostic variables on the PFS including the age. Methods: Premium cancer study is a French multicentre prospective community-based registry. 493 pts enrolled and 487 included between September 2009 to March 2012 from 94 French centers and physicians. Pts had to provide written informed consent and protocol submitted to regulatory authorities. Predefined efficacy endpoints was PFS. CTX was administrated at 250 mg/m2 weekly (n=100; 20.3%) or 500 mg/m2 every 2 weeks (n=380;77,2%), other n=13; 2.5%) CT regimen choice was at physician’s discretion.. The main analysis is PFS as well as analysis of prognostic factors of this PFS (29 items including age (< 65 years n=229; 65-74 years n= 165.; ≥75years n=93). Univariate analysis was performed for each covariate, PFS was estimated by Kaplan-Meier curves and compared by log-rank test. univariable Cox regression analysis was used to assess the association between each variable and outcome. Multivariable stepwise Cox models were then fitted for final variable selection of prognostic factors on PFS. Results: Univariate significant prognostic factors for PFS are OMS (0-1 vs 2-3), Tobacco, Site of tumor (right vs other), Number of metastatic organ (1 vs 2-3), Resecability of metastatic disease defined before CT (definitively non resectable metastases vs possible resectable), Surgery of mCRC, folliculitis or xerosis or paronychia grade 0-1 vs 2-4. Age was unidentified as a prognostic factor in univariate analysis. Four factors were independently associated with a better PFS: xerosis [hazard ratio (HR0,651); 95% confidence interval (CI) 0,494-0,857], (WHO PS) 0–1 (HR0,519 ; 95% CI 0,371–0,726) and folliculitis (HR 0,711; 95% CI0,558–0,956) metastases surgery 0,287(CI 0,205-0,403). Conclusions: CTX in combination with standard CT is effective, age is not identified as a prognostic factor for the PFS. Both groups of pts based on age benefit from CTX.


2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 475-475
Author(s):  
Ryo Kanata ◽  
Masato Ozaka ◽  
Seita Kataoka ◽  
Kazunaga Ishigaki ◽  
Ikuhiro Yamada ◽  
...  

475 Background: In Japan, adjuvant chemotherapy with S-1 for 6 months is standard care for resected pancreatic cancer. However, the efficacy of chemotherapy for recurrent pancreatic cancer(RPC) after adjuvant S-1 chemotherapy is not well evaluated. Methods: Medical records were retrospectively reviewed for consecutive patients who had RPC after adjuvant S-1 treatment and received chemotherapy between April 2013 and July 2016. Recurrence free interval (RFI) was defined as the interval from adjuvant S-1 initiation to cancer recurrence. Overall survival (OS) and progression free survival (PFS) after 1st line chemotherapy for RPC were compared between patients with RFIs of shorter than 6 month (Group S) and longer than 6 months (Group L). Results: In the 53 patients evaluated, the median duration of adjuvant S-1 chemotherapy was 5.1 months, and the median RFI was 8.3 months. After recurrence, they received Gemcitabine alone (20 patients), Gemcitabine+nab-paclitaxel (28 patients), modified FOLFIRINOX (one patient), and other regimen (4 patients). In all patients, the median PFS was 7.3 months and the median OS was 14.8 months. When compered in two groups (group S and group L), median OS in group S and group L was 6.7 months (95% confidence interval(CI): 4.2-12.9) and NA (95% CI: 13 months-NA) , respectively (p < 0.001), and median PFS was 3.8 months (95%CI: 2.5-9.1) and 7.3 months (95%CI: 3.9-15.3), respectively (p = 0.11). Multivariate Cox regression analysis revealed CEA < 4.0 mg/dl before chemotherapy and an RFI of ≥ 6 months were significantly associated with longer survival. Conclusions: These data suggest that RFI < 6 months is a surrogate marker for a poor prognosis in patients with RPC.


2009 ◽  
Vol 16 (4) ◽  
pp. 1241-1249 ◽  
Author(s):  
Claudio Zamagni ◽  
Ralph M Wirtz ◽  
Pierandrea De Iaco ◽  
Marta Rosati ◽  
Elke Veltrup ◽  
...  

Oestrogen receptors (ESRs) regulate the growth and differentiation of normal ovarian epithelia. However, to date their role as biomarkers in the clinical setting of ovarian cancer remains unclear. In view of potential endocrine treatment options, we tested the role of ESR1 mRNA expression in ovarian cancer in the context of a neo-adjuvant chemotherapy trial. Study participants had epithelial ovarian or peritoneal carcinoma unsuitable for optimal upfront surgery and were treated with neo-adjuvant platinum-based chemotherapy before surgery. RNA was isolated from frozen tumour biopsies before treatment. RNA expression of ESR1 was determined by microarray and reverse transcriptase kinetic PCR technologies. The prognostic value of ESR1 was tested using univariate and multivariate Cox proportional hazards models, Kaplan–Meier survival statistics and the log-rank test. ESR1 positively correlates with proliferation markers and histopathological grading. ESR1 was a significant predictor of survival as a continuous variable in the univariate Cox regression analysis. In multivariate analysis, elevated baseline ESR1 mRNA levels predicted prolonged progression-free survival (P=0.041) and overall survival (P=0.01) after neo-adjuvant chemotherapy, independently of pathological grade and age. We conclude that pretreatment ESR1 mRNA is associated with tumour growth and is a strong prognostic factor in ovarian cancer, independent of the strongest clinical parameters used in clinical routine. We suggest that ESR1 mRNA status should be considered in order to minimize possible confounding effects in ovarian cancer clinical trials, and that early treatment with anti-hormonal agents based on reliable hormone receptor status determination is worth investigating.


2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Vladan Zivaljevic ◽  
Katarina Tausanovic ◽  
Ivan Paunovic ◽  
Aleksandar Diklic ◽  
Nevena Kalezic ◽  
...  

Background.Anaplastic thyroid cancer (ATC) is one of the tumors with the shortest survival in human medicine.Aim.The aim was to determine the importance of age in survival of patients with ATC.Material and Methods. We analyzed the data on 150 patients diagnosed with ATC in the period from 1995 to 2006. The Kaplan-Meier method and log-rank test were used to determine overall survival. Prognostic factors were identified by univariate and multivariate Cox regression analysis.Results.The youngest patient was 35 years old and the oldest was 89 years old. According to univariate regression analysis, age was significantly associated with longer survival in patients with ATC. In multivariate regression analysis, patients age, presence of longstanding goiter, whether surgical treatment is carried out or not, type of surgery, tumor multicentricity, presence of distant metastases, histologically proven preexistent papillary carcinoma, radioiodine therapy, and postoperative radiotherapy were included. According to multivariate analysis, besides surgery (P=0.000, OR = 0.43, 95% CI = 0.29–0.63), only patients age (P=0.023, OR = 0.68, 95% CI = 0.49–0.95) was independent prognostic factor of favorable survival in patients with ATC.Conclusion. Age is a factor that was independently associated with survival time in ATC. Anaplastic thyroid cancer has the best prognosis in patients younger than 50 years.


Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2036
Author(s):  
Mirang Lee ◽  
Wooil Kwon ◽  
Hongbeom Kim ◽  
Yoonhyeong Byun ◽  
Youngmin Han ◽  
...  

Identification of prognostic factors is important to improve treatment outcomes in pancreatic cancer. This study aimed to investigate the effect of the location of pancreatic cancer on survival and to determine whether it was a significant prognostic factor. Altogether, 2483 patients diagnosed with pancreatic cancer were examined. Comparative analysis of clinicopathologic characteristics, survival analysis, and multivariate analysis were performed. Cancers of the pancreatic head or the uncinate process were present in 49.5% of patients. The head/uncinate cancers had more clinical T1/T2 tumors (59.4% vs. 35.5%, p < 0.001) and a significantly higher 5-year survival rate (8.9% vs. 7.3%, p < 0.001) than the body/tail cancers. The 5-year survival rate in patients with head/uncinate cancers was significantly lower in the resectable (p = 0.014) and the locally advanced groups (p = 0.007). In patients who underwent resection with curative intent, the 5-year survival rate was lower in the head/uncinate group (p = 0.046). The overall outcome of the head/uncinate cancers was better than the body/tail cancers, due to the high proportion of resectable cases. In patients who underwent curative resection, the head/uncinate cancers had a higher number of T1/T2 tumors, but worse outcomes. In the multivariate analysis, tumor location was not an independent prognostic factor for pancreatic cancer.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7017-7017 ◽  
Author(s):  
Hiroaki Okamoto ◽  
Shinji Atagi ◽  
Masaaki Kawahara ◽  
Akira Yokoyama ◽  
Nobuyuki Yamamoto ◽  
...  

7017 Background: We previously reported the superiority of combined chemo-radiotherapy (CRT) over RT alone in elderly pts with locally advanced NSCLC (Atagi et al. ECCO2011). One and a half years follow-up data from last accrual are presented. Methods: Pts older than 70 years with unresectable stage III NSCLC were randomized to either RT alone (RT arm), a total dose of 60 Gy, or CRT arm including the same RT plus concurrent chemotherapy with carboplatin 30 mg/m2/day, 5 days/week × 20 days. The primary endpoint was overall survival (OS). The planned sample size was 100 pts in each arm with one-sided alpha of 5% and 80% power to detect a difference in median survival time (MST) from 10 months in RT arm to 15 months in CRT arm. Results: Between Sep 2003 and May 2010, 200 pts were randomized. Baseline characteristics were similar in the RT (n=100) vs CRT (n=100) arms: median age, 77 vs 77 years; stage IIIB (n), 46 vs 49; PS 0/1/2 (n), 41/55/4 vs 41/56/3. The second planned interim analysis was performed 10 months after the completion of accrual. In accordance with the pre-specified stopping rule, the JCOG Data and Safety Monitoring Committee recommended early publication of this trial because of the difference in OS favoring the CRT arm. In the updated analysis, OS was better in the CRT arm than the RT arm (HR = .64, 95% CI = .46-.89, one-sided p = .0033 by stratified log-rank test). In each arm (RT/CRT), MST was 16.5 mo/22.4 mo with 3-year OS of 14.3%/34.6%, response rate of 44.9%/54.6% (p=.201) and median progression-free survival of 6.9 mo/8.9 mo (p=.003). Gr 3/4 toxicities were (RT/CRT): neutropenia 0%/57.3%, infection 4.1%/12.5%, dysphagia 0%/1.0%, late RT toxicities 7.4%/7.5%. The pattern of relapse site and post-protocol treatment were almost similar between the arms. Even after an adjustment by the Cox regression analysis with six variables [stage, PS, sex, age, histology, smoking status], CRT arm showed better survival (HR=.71, p=.038). Conclusions: The CRT using daily carboplatin is considered to be the standard treatment for elderly pts with locally advanced NSCLC.


2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Minyong Kang ◽  
Seung Jea Shin ◽  
Hyun Hwan Sung ◽  
Hwang Gyun Jeon ◽  
Byong Chang Jeong ◽  
...  

Background. This study is aimed at examining the prognostic role of pre-to-postoperative dynamics of De Ritis ratio (aspartate aminotransaminase (AST)/alanine aminotransaminase (ALT)) in patients with nonmetastatic renal cell carcinoma (RCC) following radical nephrectomy. Methods. We retrospectively reviewed the records of 670 patients who underwent radical nephrectomy for nonmetastatic RCC between 1996 and 2012 at our institution. The cutoff points for preoperative (=1.0) and postoperative AST/ALT ratios (=1.12) were assigned based on the median values. We categorized patients into four groups according to the dynamics of AST/ALT ratios: group 1 (lower (≤1.0) ⟶ lower (≤1.12)), group 2 (lower (≤1.0) ⟶ higher (>1.12)), group 3 (higher (>1.0) ⟶ lower (≤1.12)), and group 4 (higher (>1.0) → higher (>1.12)). Results. When grouped by a preoperative AST/ALT ratio alone, the groups were not statistically different in cancer-specific survival (CSS) or overall survival (OS). In contrast, in Kaplan-Meier analysis, CSS (P=0.0296) and OS (P=0.0324) were both significantly shorter with an increased postoperative AST/ALT ratio. According to the pre-to-postoperative dynamics of the AST/ALT ratio, group 2 (lower (≤1.0) ⟶ higher (>1.12)) had a significantly lower CSS (P=0.0028) and OS (P=0.0194) than the other groups. On multivariate Cox regression analysis, the pre-to-postoperative dynamics of the AST/ALT ratio were a significant prognostic factor for CSS (hazard ratio, HR=3.45) and OS (HR=2.18). Conclusion. This study is the first to suggest that the dynamics of the pre-to-postoperative De Ritis ratio represent an independent prognostic factor for RCC patients following nephrectomy.


2020 ◽  
Author(s):  
Xiao Li ◽  
Xiaoli Zhang ◽  
Jie Liu

Abstract Background : Tumour subtype have a significant effect on bone metastasis in breast cancer, but population-based estimates of the prognosis of bone metastases at diagnosis of breast cancer are lacking. The aim of this study was to analyse the influence of tumour subtype and other factors in the prognostic and survival of patients with bone metastases of breast cancer. Methods : Using the Surveillance, Epidemiology, and End Results Program (SEER) data of 2012 to 2016 conducted a retrospective cohort study to investigate stage IV patients with bone metastases in breast cancer. Stage IV Patients characteristic according subtype were compared using chi-square, overall survival (OS), prognostic factor calculated using the Kaplan-Meier method and the Cox proportional hazards model. Results : A total of 3384 stage IV patients were included in this study. 63.42% were HR+/HER2-, 19.86% were HR+/HER2+, 9.34% were HR-/HER2-, and 7.39% were HR-/HER2+. Median OS for the whole population was 38 months, and 33.9% of the patients were alive at five-year. The median OS and five-year survival rate among the different molecular subtype of breast cancer stage IV patients are significant differences ( p <0.05). Multivariate Cox regression analysis showed that age of 55-59 (HR=1.270 ), black race ( HR=1.317 ), grade in III or IV ( HR=1.960 ), HR-/HER2- (HR=2.808), lung metastases (HR=1.378), live metastases (HR=2.085), brain metastases (HR=1.903) are independent risk factors of prognosis; married (HR=0.819 ), HR+/HER2+ (HR=0.631 ), HR-/HER2+ (HR=0.716), insurance (HR=0.587 ) and surgery (HR=0.504) are independent protection factors of prognosis. There is interaction between HR+/HER2+ subtype and other metastases (except bone metastases, HR=0.694, 95%CI: 0.485-0.992),but interaction between race and substype did not reach significance on prognosis. Conclusions : There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, race, marital status, insurance, grade, surgery and visceral metastases. There is interaction between HR+/HER2+ subtype and other metastases (except bone metastases) on prognosis. Tumour subtype, as a significant prognostic factor, warrant further investigation. Keywords : Breast cancer, Bone metastases, Tumour subtype, Prognosis factor, Survival


2021 ◽  
Author(s):  
Mustafa Korkmaz ◽  
Melek Karakurt Eryılmaz ◽  
Mehmet zahid koçak ◽  
Aykut Demirkıran ◽  
mustafa Karaağaç ◽  
...  

Abstract Backgrounds: We aimed to investigate whether the HALP score is a predictive marker in patients with recurrent GBM who were given bevacizumab plus irinotecan.Methods: We compared the survival of patients followed up in our clinic with the diagnosis of recurrent GBM and treated with bevacizumab plus irinotecan, according to HALP score.Results: Median PFS and OS were 4.5 (0.9-14.9) and 8 (0.9-21.3) months, respectively. The median PFS of the low HALP score group was 1.85 (1.3-3.37) months, and of the high HALP score group was 4.96 (0.9-14.9) months (p=0.03). The OS of the high HALP score group (9.63 [7.28-11.9]) was statistically higher compared with low HALP score group (2.26 [0.88-3.65]) (p<0.001). In univariate analysis HALP score was a significant prognostic factor; patients with low HALP score had a poorer prognosis than high HALP score (HR: 0.063, p<0.001). The multivariate analysis showed that HALP score (p=0.003), and residual tumor (p=0.029) were significant prognostic factors. In multivariate Cox regression analysis, low HALP score was a significant poor prognostic factor for OS compared with high HALP score (HR: 0.063, p<0.001). Conclusion: We showed that the HALP score at the start of treatment is an independent prognostic factor for PFS and OS in patients with recurrent GBM treated with bevacizumab plus irinotecan. The HALP score, which can be easily calculated by routine tests before chemotherapy, can be used as a predictive marker for bevacizumab treatment decision.


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