Clinical Characteristics and Risk Factors Analysis for the Recurrence of Pelvic Endodermal Sinus Tumors

Abstract Background: This study investigated the clinicopathological characteristics and factors influencing the recurrence of pelvic endodermal sinus tumor. Methods: Fifty-four cases were retrospectively analyzed from at the Zhejiang Cancer Hospital. Imaging and serological indicators were used to determine whether disease recurred, to evaluate progression-free survival, and to compare the influence of related factors on disease recurrence. SPSS 19.0 software was used for statistical analysis. Statistical significance was defined as p < 0.05. Results: The median age at initial treatment was 21 years (range, 11–52 years). Six patients had extragonadal endodermal sinus tumor, and four had histological features of endodermal sinus tumor combined with embryonal carcinoma. Thirty-nine patients underwent fertility-preserving surgery, 18 patients had a childbearing history, and eight patients had residual tumor after initial treatment. Twenty-six patients had a tumor diameter of more than 15 cm, and 30 patients had a serum α‑fetoprotein level greater than 10,000 ng/mL before initial management. The median follow-up time was 47.5 months (range, 14–212 months). During follow-up, 15 patients experience recurrence, with a recurrence rate of 27.8% and a 5-year PFS rate of 61.1%. In univariate analysis, the International Federation of Gynecology and Obstetrics stage (stage III-IV VS. I-II; HR= 10.054 p<0.001), residual tumor (yes VS. no for the first surgery; HR=5.014 p=0.001), histological features (endodermal sinus tumor combined with embryonal carcinoma VS. endodermal sinus tumor; HR=4.130 p=0.018), and use of platinum-based chemotherapy (courses≥3 VS. courses<3; HR= 0.188 p=0.004) were independent factors influencing recurrence; age, childbearing history, tumor site, tumor size, and serum α-fetoprotein level before initial management did not affect recurrence. In multivariate analysis, only stage was an independent risk factor for progression-free survival（stage III-IV VS. I-II; HR=6.923 p=0.019）. Conclusions: Stage is a prognostic factor for recurrence of pelvic endodermal sinus tumor. The first surgery should remove the tumor as completely as possible, and initial treatment should require a sufficient dose and full course of platinum-based chemotherapy, which may reduce the recurrence rate. Patients with endodermal sinus tumor and embryonal carcinoma may have increased susceptibility of recurrence.

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Value of Tumor Markers in the Treatment of Endodermal Sinus Tumors and Choriocarcinomas in the Pineal Region

Neurosurgery ◽

10.1227/00006123-197910000-00015 ◽

1979 ◽

Vol 5 (4) ◽

pp. 485-488 ◽

Cited By ~ 23

Author(s):

Jens Haase ◽

Kirsten Nielsen

Keyword(s):

Tumor Markers ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Embryonal Carcinoma ◽

Residual Tumor ◽

Pineal Region ◽

Alpha Fetoprotein ◽

Endodermal Sinus Tumor ◽

Sinus Tumor

Abstract A case of embryonal carcinoma in the pineal region of a 17-year-old boy is presented. The tumor included elements of choriocarcinoma and endodermal sinus tumor, and the use of human chorionic gonadotropin and alpha-fetoprotein as tumor markers is discussed. The markers were demonstrated both within the tumor and in the cerebrospinal fluid (CSF) and blood. The patient was treated with a postoperative program of irradiation and cancer chemotherapy, and at follow-up examination 20 months after operation no signs of residual tumor were present. It is suggested that human chorionic gonadotropin and alpha-fetoprotein should be measured in the blood and CSF before the treatment of midline tumors.

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Determining the utility of intraoperative magnetic resonance imaging for transsphenoidal surgery: a retrospective study

Journal of Neurosurgery ◽

10.3171/2013.9.jns122207 ◽

2014 ◽

Vol 120 (2) ◽

pp. 346-356 ◽

Cited By ~ 30

Author(s):

Jan Coburger ◽

Ralph König ◽

Klaus Seitz ◽

Ute Bäzner ◽

Christian Rainer Wirtz ◽

...

Keyword(s):

Transsphenoidal Surgery ◽

High Field ◽

Progression Free Survival ◽

Residual Tumor ◽

Conventional Group ◽

Free Survival ◽

Kaplan Meier ◽

Remission Rates ◽

Biochemical Remission

Object Intraoperative MRI (iMRI) provides updated information for neuronavigational purposes and assessments on the status of resection during transsphenoidal surgery (TSS). The high-field technique additionally provides information about vascular structures at risk and precise information about extrasellar residual tumor, making it readily available during the procedure. The imaging, however, extends the duration of surgery. To evaluate the benefit of this technique, the authors conducted a retrospective study to compare postoperative outcome and residual tumor in patients who underwent conventional microsurgical TSS with and without iMRI. Methods A total of 143 patients were assessed. A cohort of 67 patients who had undergone surgery before introduction of iMRI was compared with 76 patients who had undergone surgery since iMRI became routine in TSS at the authors' institution. Residual tumor, complications, hormone dependency, biochemical remission rates, and improvement of vision were assessed at 6-month follow-up. A volumetric evaluation of residual tumor was performed in cases of parasellar tumor extension. Results The majority of patients in both groups suffered from nonfunctioning pituitary adenomas. At the 6-month follow-up assessment, vision improved in 31% of patients who underwent iMRI-assisted surgery versus 23% in the conventional group. One instance of postoperative intrasellar bleeding was found in the conventional group. No major complications were found in the iMRI group. Minor complications were seen in 9% of patients in the iMRI group and in 5% of those in the conventional group. No differences between groups were found for hormone dependency and biochemical remission rates. Time of surgery was significantly lower in the conventional treatment group. Overall a residual tumor was found after surgery in 35% of the iMRI group, and 41% of the conventional surgery group harbored a residual tumor. Total resection was achieved as intended significantly more often in the iMRI group (91%) than in the conventional group (73%) (p < 0.034). Patients with a planned subtotal resection showed higher mean volumes of residual tumor in the conventional group. There was a significantly lower incidence of intrasellar tumor remnants in the iMRI group than in the conventional group. Progression-free survival after 30 months was higher according to Kaplan-Meier analysis with the use of iMRI, but a statistically significant difference could not be shown. Conclusions The use of high-field iMRI leads to a significantly higher rate of complete resection. In parasellar tumors a lower residual volume and a significantly lower rate of intrasellar tumor remnants were shown with the technique. So far, long-term follow-up is limited for iMRI. However, after 2 years Kaplan-Meier analyses show a distinctly higher progression-free survival in the iMRI group. No significant benefit of iMRI was found for biochemical remission rates and improvement of vision. Even though the surgical time was longer with the adjunct use of iMRI, it did not increase the complication rate significantly. The authors therefore recommend routine use of high-field iMRI for pituitary surgery, if this technique is available at the particular center.

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Updated Analysis of KEYNOTE-024: Pembrolizumab Versus Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer With PD-L1 Tumor Proportion Score of 50% or Greater

Journal of Clinical Oncology ◽

10.1200/jco.18.00149 ◽

2019 ◽

Vol 37 (7) ◽

pp. 537-546 ◽

Cited By ~ 275

Author(s):

Martin Reck ◽

Delvys Rodríguez–Abreu ◽

Andrew G. Robinson ◽

Rina Hui ◽

Tibor Csőszi ◽

...

Keyword(s):

Lung Cancer ◽

Failure Time ◽

Progression Free Survival ◽

Small Cell ◽

Structural Failure ◽

Small Cell Lung ◽

Free Survival ◽

Inverse Probability ◽

Platinum Based Chemotherapy

Purpose In the randomized, open-label, phase III KEYNOTE-024 study, pembrolizumab significantly improved progression-free survival and overall survival (OS) compared with platinum-based chemotherapy in patients with previously untreated advanced non–small-cell lung cancer (NSCLC) with a programmed death ligand 1 tumor proportion score of 50% or greater and without EGFR/ALK aberrations. We report an updated OS and tolerability analysis, including analyses adjusting for potential bias introduced by crossover from chemotherapy to pembrolizumab. Patients and Methods Patients were randomly assigned to pembrolizumab 200 mg every 3 weeks (for up to 2 years) or investigator’s choice of platinum-based chemotherapy (four to six cycles). Patients assigned to chemotherapy could cross over to pembrolizumab upon meeting eligibility criteria. The primary end point was progression-free survival; OS was an important key secondary end point. Crossover adjustment analysis was done using the following three methods: simplified two-stage method, rank-preserving structural failure time, and inverse probability of censoring weighting. Results Three hundred five patients were randomly assigned (pembrolizumab, n = 154; chemotherapy, n = 151). At data cutoff (July 10, 2017; median follow-up, 25.2 months), 73 patients in the pembrolizumab arm and 96 in the chemotherapy arm had died. Median OS was 30.0 months (95% CI, 18.3 months to not reached) with pembrolizumab and 14.2 months (95% CI, 9.8 to 19.0 months) with chemotherapy (hazard ratio, 0.63; 95% CI, 0.47 to 0.86). Eighty-two patients assigned to chemotherapy crossed over on study to receive pembrolizumab. When adjusted for crossover using the two-stage method, the hazard ratio for OS for pembrolizumab versus chemotherapy was 0.49 (95% CI, 0.34 to 0.69); results using rank-preserving structural failure time and inverse probability of censoring weighting were similar. Treatment-related grade 3 to 5 adverse events were less frequent with pembrolizumab compared with chemotherapy (31.2% v 53.3%, respectively). Conclusion With prolonged follow-up, first-line pembrolizumab monotherapy continues to demonstrate an OS benefit over chemotherapy in patients with previously untreated, advanced NSCLC without EGFR/ALK aberrations, despite crossover from the control arm to pembrolizumab as subsequent therapy.

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Use of HE4 and CA125 to predict surgical outcome and for prognostic value for progression-free survival (PFS) and overall survival (OS) in primary epithelial ovarian cancer (EOC) patients (pts).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5034 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5034-5034

Author(s):

Ioana Braicu ◽

Radoslav Chekerov ◽

Rolf Richter ◽

Ignace B. Vergote ◽

Sven Mahner ◽

...

Keyword(s):

Surgical Outcome ◽

Progression Free Survival ◽

Residual Tumor ◽

Free Survival ◽

Over Expression ◽

Primary Epithelial Ovarian Cancer ◽

Predictive Role ◽

First Diagnosis

5034 Background: Optimal surgical cytoreduction and response to platinum (P) based chemotherapy (ChTh) remain the cornerstones of therapeutic management of primary EOC. Aim of this study was to analyze the predictive role of HE4 and CA125 as biomarkers (BM) for clinical outcome in primary EOC pts at diagnosis and during subsequent follow-up. Methods: In the European OVCAD project 275 pts with primary EOC were enrolled. Pts were eligible if radical cytoreductive surgery and P-based ChTh were applied. Plasma collected at first diagnosis and 6 months after 1st line ChTh in P-sensitive pts was analyzed for HE4 and CA125 levels using ELISA and Luminex technique, respectively. Results: Complete cytoreduction with no residual tumor disease (RTD) was obtained in 69.9% pts. HE4 and CA125 expression in plasma at first diagnosis correlated with RTD, p = 0.002 and p=0.002, respectively. The sensitivity (SE) and specificity (SP) of the combinative use of both BM in predicting RTD was 64.8% and 73.5%, respectively. Pts having over-expression of both BM in plasma had a 6.1 greater risk for RTD (p<0.001, OR: 6.107, 95% CI 2.41-15.46). P-resistance occurred more frequently when both BM were over-expressed (p=0.028, OR= 3.1, 95%CI 1.13-8.46). Elevated BM levels during follow-up predicted recurrence (SE 90% and SP 71% for CA125 ≥55U/ml; SE 72.7% and SP 81.4% for HE4 ≥150pM) and when HE4 or CA125 were positive, a SE of 86.4% and SP of 72.9% were achieved. Elevated CA125 and HE4 at 6 months following adjuvant therapy was associated with significantly poorer PFS (p<0.001, HR 9.6, 95%CI 3.93-23.44 with elevated HE4 or CA125, and HR=50.52, 95%CI 14.44-176.78, with elevated HE4 and CA125) and OS (p<0.001, HR=7.42 95%CI 1.43-38.42 with elevated HE4 or CA125 and HR=28.38 95%CI 6.50-123.97 with elevated HE4 and CA125). Conclusions: The combinative use of HE4 and CA125 appears to have a significant value in predicting optimal surgical outcome and development of P resistance disease in EOC pts. Elevated plasma levels 6 months after 1st line ChTh significantly correlate with OS and PFS in P-sensitive pts.

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Fludarabine Plus I-131 Tositumomab as Initial Treatment for Follicular Lymphoma: Half of Patients In Remission at Over 10 Years Median Followup.

Blood ◽

10.1182/blood.v116.21.1785.1785 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1785-1785

Author(s):

Peter Martin ◽

Morton Coleman ◽

Richard R. Furman ◽

Shankar Vallabhajosula ◽

Dong Sun Kim ◽

...

Keyword(s):

Follicular Lymphoma ◽

Initial Treatment ◽

Phase Ii Trial ◽

Progression Free Survival ◽

Front Line ◽

Free Survival ◽

Sequential Combination ◽

Intent To Treat

Abstract Abstract 1785 Background: The sequential combination of chemotherapy and radioimmunotherapy has been shown to be effective front-line treatment for patients with follicular lymphoma (FL). We report ten-year followup results of a phase II trial of abbreviated fludarabine followed by tositumomab and I-131 tositumomab in patients with untreated follicular lymphoma. Methods: Patients with untreated follicular lymphoma received fludarabine 25 mg/m2/d for five days every five weeks for three cycles followed in six to eight weeks by tositumomab and I-131 tositumomab. Results: Thirty-eight patients were enrolled. One patient was withdrawn due to ineligible histology. The median age of eligible patients was 53 years, median time from diagnosis was 3.5 months, and 43% of patients had a high-risk FLIPI score. Two patients did not receive radioimmunotherapy; one patient had a myocardial infarction during fludarabine and was not evaluable, and one patient had persistent cytopenias following three cycles of fludarabine. All 35 patients that completed the regimen responded (ORR 100%). With a median follow-up of 128.5 months for all 37 eligible patients, the 10-year intent-to-treat overall survival is 69% and the progression-free survival is 51%. Seventeen patients have progressed (range 2–102 months). Sixteen patients remain in remission with no evidence of disease more than ten years from enrollment. Only four patients have relapsed beyond five years. Four patients have developed MDS (range 16–84 months), one of whom evolved to AML. Conclusions: Fludarabine followed by tositumomab and I-131 tositumomab is very effective at inducing long-lasting complete remissions in FL. The efficacy and long-term safety of sequential chemotherapy plus radioimmunotherapy should continue to be evaluated in the context of the range of therapeutic options for the initial treatment of follicular lymphoma. Disclosures: Furman: GSK: Speakers Bureau. Leonard:GSK: Consultancy.

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Lower starting dose of afatinib for the treatment of metastatic lung adenocarcinoma harboring exon 21 and exon 19 mutations

BMC Cancer ◽

10.1186/s12885-021-08235-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi-Chieh Chen ◽

Ming-Ju Tsai ◽

Mei-Hsuan Lee ◽

Chia-Yu Kuo ◽

Mei-Chiou Shen ◽

...

Keyword(s):

Lung Adenocarcinoma ◽

Initial Treatment ◽

Progression Free Survival ◽

Egfr Mutations ◽

Free Survival ◽

Lung Cancer Patients ◽

Platinum Based Chemotherapy ◽

Starting Dose ◽

Metastatic Lung ◽

Medical University

Abstract Background Afatinib has shown favorable response rates (RRs) and longer progression free survival (PFS) in lung cancer patients harboring EGFR mutations compared with standard platinum-based chemotherapy. However, serious adverse drug reactions (ADRs) limit the clinical application of afatinib. Methods We designed a retrospective study, enrolling all patients with metastatic lung adenocarcinoma who were diagnosed and treated with 30 or 40 mg daily afatinib as their initial treatment in three Kaohsiung Medical University-affiliated hospitals in Taiwan. Results A total of 179 patients were enrolled in the study, of which 102 (57%) and 77 (43%) received 30 mg and 40 mg afatinib daily as their initial treatment, respectively. The patients initially using 30 mg afatinib daily had a similar RR (75% vs. 83%, p = 0.1672), median PFS (14.5 vs. 14.8 months, log-rank p = 0.4649), and median OS (34.0 vs. 25.2 months, log-rank p = 0.5982) compared with those initially using 40 mg afatinib daily. Patients initially receiving 30 mg afatinib daily had fewer ADRs compared with those using 40 mg daily. The overall incidence of moderate and severe ADRs was significantly lower in patients receiving 30 mg afatinib daily compared with those using 40 mg daily (49% vs. 77%, p = 0.002); similar findings was observed in terms of severe ADRs (7% vs. 24%, p < 0.0001). Conclusion Patients receiving 30 mg afatinib daily as their initial treatment had similar RR, PFS, OS, but significantly fewer serious ADRs, as compared with those using 40 mg as their starting dose.

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Thalidomide and Dexamethasone Induction Therapy Is Associated with Superior Progression-Free Survival after Autotransplant for Myeloma.

Blood ◽

10.1182/blood.v106.11.1171.1171 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1171-1171

Author(s):

Dan T. Vogl ◽

Selina Luger ◽

David L. Porter ◽

Elise A. Chong ◽

Stephen J. Schuster ◽

...

Keyword(s):

Stem Cell ◽

Induction Therapy ◽

Initial Treatment ◽

Progression Free Survival ◽

Initial Therapy ◽

High Dose ◽

Free Survival ◽

Autologous Transplant ◽

High Dose Melphalan

Abstract BACKGROUND: High-dose melphalan with autologous stem cell support improves survival when incorporated in the initial treatment of multiple myeloma. Published data show that induction thalidomide and dexamethasone (Thal/Dex) has a higher response rate than dexamethasone alone (Dex) or anthracycline induction (VAD or DVD), but the effect of initial induction therapy on outcomes after autologous transplant remains unclear. PATIENTS: We reviewed the records of 164 patients who received high-dose melphalan with autologous stem cell support as part of initial therapy for multiple myeloma at the University of Pennsylvania. Median age was 55 years (range 25 – 72). Durie-Salmon stage at diagnosis was II in 27% and III in 70% of patients. Induction regimens included VAD (62%), DVD (12%), Thal/Dex (11%), Dex (5%), and more than one regimen (10%). Post-transplant therapies for consolidation or maintenance included thalidomide (7%), interferon (23%), tandem autologous transplant (4%), non-myeloablative allogeneic transplant (7%), autologous co-stimulated T-cell infusion (14%), or observation until progression (45%). Patients who received Thal/Dex initial therapy were not significantly different than those receiving anthracycline-containing induction regimens (VAD/DVD), except for lower serum creatinine (median 0.9 vs 1.1 mg/dl; p=0.01), with a trend toward lower beta-2 microglobulin (B2M) and correspondingly lower ISS stage. RESULTS: Median overall follow-up is 29 months (range 7–120). Thal/Dex induction trended towards a higher Very Good Partial Response (VGPR) rate than anthracycline induction (29% vs 14%, p=NS) and a higher overall response rate (76% vs 68%, p=NS). All of the patients who received Thal/Dex as induction therapy are alive, with a median follow-up of 23 months (range 13 – 34), while overall survival in the anthracycline induction group is 85% at 2 years. Progression-free survival at 2 years is 93% for Thal/Dex induction and 58% for VAD/DVD (HR 0.12, p=0.039). The improvement in progression-free survival persists in Cox regression models that include creatinine and either B2M or ISS stage. CONCLUSION: In myeloma patients who undergo autologous stem cell transplant, thalidomide and dexamethasone induction may result in improved progression-free survival compared with VAD or DVD. Further studies of initial therapies for myeloma should assess long-term outcomes after autologous transplant. Progression Free Survival, By Initial Treatment Progression Free Survival, By Initial Treatment

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Primary ocular adnexal MALT lymphoma (POAML): A long-term follow up study of 114 patients (pts)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7593 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7593-7593 ◽

Cited By ~ 1

Author(s):

K. Tanimoto ◽

A. Kaneko ◽

S. Suzuki ◽

N. Sekiguchi ◽

T. Watanabe ◽

...

Keyword(s):

Progression Free Survival ◽

Initial Therapy ◽

Significant Prognostic Factor ◽

Time To Progression ◽

Initial Management ◽

Free Survival ◽

Significant Difference ◽

Long Term Follow Up

7593 Background: Although POAML is a recently recognized distinct entity, its natural history, prognostic factors, behavior of progression and death, and standard initial management have not been fully elucidated. Methods: 114 pts with a histologically verified POAML treated at our institution between 1970 and 2003 were retrospectively analyzed. Results: With a median follow-up duration of 5.7 years (0.6–34.0), estimated overall survival (OS) rate and progression-free survival (PFS) rate at 10 years was 89% and 57%, respectively. Older pts (>60) showed significantly worse OS (p=0.002). However, other clinical factors did not affect significantly OS or PFS. 13 (11%) pts died, but only 3 (3%) due to progressive lymphoma. 31 (27%) pts progressed, 7(6%) at systemic diseases, 8 (7%) at contra lateral sites, and 16 (14%) at the same sites, and only 2 (2%) transformed high-grade lymphoma. All 8 pts who progressed at contra lateral sites were limited to those who had involved initially in the orbit (p=0.036) and their time to progression was significantly longer (p=0.039). Pts who received initially radiation-containing therapy were superior in PFS but not OS than those initially treated with other modalities (p=0.016 and 0.091, respectively). Moreover, when we compared the outcomes of no initial therapy cohort and immediate therapy cohort, there was no significant difference in OS and PFS (p=0.499 and 0.073, respectively). Conclusions: The majority of pts with POAML showed the behaviors of very indolent diseases, and only age was significant prognostic factor. Our preliminary observation suggesting that no initial therapy is an acceptable approach for selected pts (Ann Oncol 2006;17:135–40) was further confirmed in this study for all cohorts. Considering the possible heterogeneity of POAML among initial sites suggested by the present study and the genetic heterogeneity revealed by our previous study (Blood 2005;106:289a), further investigations on POAML are warranted. No significant financial relationships to disclose.

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Genetic polymorphisms in hMSH2 and hMLH1 genes are associated with prognosis in epithelial ovarian cancer patients

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000368 ◽

2019 ◽

Vol 29 (7) ◽

pp. 1148-1155 ◽

Cited By ~ 3

Author(s):

Wengang Si ◽

Shan Kang ◽

Haiyan Sun ◽

Juan Chen ◽

Shiru Cao ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cancer Patients ◽

Genetic Polymorphisms ◽

Cox Regression ◽

Progression Free Survival ◽

Allele Frequencies ◽

Free Survival ◽

Platinum Based Chemotherapy

ObjectiveDNA mismatch repair deficiency is not only thought to promote tumorigenesis but is also suggested to be associated with platinum-based chemotherapy treatment. In this study, we investigated the effects of two genetic polymorphisms in the hMSH2 and hMLH1 genes on the risk of epithelial ovarian cancer and the clinical outcome of patients treated with platinum-based chemotherapy.MethodsA case-control study was performed in 536 epithelial ovarian cancer patients and 532 control women. Genotypes of two polymorphisms were determined by the polymerase chain reaction/ligase detection reaction method. Pearson Chi-square test was used to evaluate genotype distributions and allele frequencies in the patients and controls. Kaplan-Meier survival curves, and univariate and multivariate Cox regression models were used to analyze the effect of polymorphisms on patients’ prognoses.ResultsThe genotype and allele frequencies of the rs2303428 and rs1800734 polymorphisms were not significantly different between the case and control groups. Compared with wild homozygous genotype, the presence of variant alleles (heterozygous and variant homozygous genotypes) did not affect the risk of developing epithelial ovarian cancer. However, survival analysis showed that the rs2303428 polymorphism was related to the prognosis of epithelial ovarian cancer patients. Compared with the TT genotype, patients carrying the C allele had a shorter progression-free survival during the 3- and 5-year follow-up (HR 1.41, 95% CI 1.07 to 1.87 and HR 1.56, 95% CI 1.12 to 2.16, respectively). For the rs1800734 polymorphism, the A allele may significantly increase patients’ progression-free survival compared with the GG genotype in the 5-year follow-up (HR 0.66, 95% CI 0.44 to 0.98).ConclusionOur research suggests that genetic polymorphisms in hMSH2 and hMLH1 may indicate the clinical progression of epithelial ovarian cancer patients treated with platinum-based chemotherapy.

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Active surveillance for nodular lymphocyte-predominant Hodgkin lymphoma

Blood ◽

10.1182/blood-2018-10-877761 ◽

2019 ◽

Vol 133 (20) ◽

pp. 2121-2129 ◽

Cited By ~ 17

Author(s):

Sven Borchmann ◽

Erel Joffe ◽

Craig H. Moskowitz ◽

Andrew D. Zelenetz ◽

Ariela Noy ◽

...

Keyword(s):

Overall Survival ◽

Hodgkin Lymphoma ◽

Active Surveillance ◽

Management Strategy ◽

Progression Free Survival ◽

Cancer Center ◽

Initial Management ◽

Free Survival ◽

Radiotherapy Alone

Abstract Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of lymphoma that, like other Hodgkin lymphomas, has historically been treated aggressively. However, in most cases, NLPHL has an indolent course, which raises the question of to what extent these patients require aggressive upfront treatment. We describe the management and outcomes of consecutive NLPHL patients diagnosed at Memorial Sloan Kettering Cancer Center (MSK), with a focus on evaluating active surveillance. All patients aged 16 years or older diagnosed and followed at MSK between 1974 and 2016 were included. Treatment outcomes were compared between management with active surveillance and other strategies. We identified 163 consecutive patients who were treated with radiotherapy alone (46%), active surveillance (23%), chemotherapy (16%), combined modality (12%), or rituximab monotherapy (4%). Median follow-up was 69 months. Five-year progression-free survival (PFS), second PFS (PFS2), and overall survival (OS) estimates were 85% (95% confidence interval [CI], 78-90), 97% (95% CI, 92-99), and 99% (95% CI, 95-100), respectively. Only 1 of 7 deaths was lymphoma related. Patients managed with active surveillance had slightly shorter PFS than those receiving any active treatment, with 5-year PFS of 77% (95% CI, 56-89) vs 87% (95% CI, 79-92; P = .017). This difference did not translate into better PFS2 or OS. Only 10 patients managed with active surveillance (27%) eventually required treatment, after a median of 61 months, and none died. NLPHL has an excellent prognosis. Within the limitations of a retrospective analysis, active surveillance is a viable initial management strategy for selected NLPHL patients.

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