scholarly journals The Implications of Treatment Delays In Adjuvant Therapy For Resected Cholangiocarcinoma Patients

2021 ◽  
Author(s):  
Matthew Parsons ◽  
Shane Lloyd ◽  
Skyler Johnson ◽  
Courtney Scaife ◽  
Heloisa Soares ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adjuvant Therapy ◽  
Median Time ◽  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Treatment Delays ◽  
Doubly Robust Estimation ◽  
Doubly Robust ◽  
The Impact

Abstract Purpose: To understand factors associated with timing of adjuvant therapy for cholangiocarcinoma and the impact of delays on overall survival (OS).Methods: Data from the National Cancer Database (NCDB) for patients with non-metastatic bile duct cancer from 2004 to 2015 were analyzed. Patients were included only if they underwent surgery and adjuvant chemotherapy and/or radiotherapy (RT). Patients who underwent neoadjuvant or palliative treatments were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients initiating therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling.Results: In total, 7,733 of 17,363 (45%) patients underwent adjuvant treatment. The median time to adjuvant therapy initiation was 59 days (interquartile range 45-78 days). Age over 65, black and Hispanic race, and treatment with RT alone were associated with later initiation of adjuvant treatment. Patients with larger tumors and high grade disease were more likely to initiate treatment early. After propensity score weighting, there was an OS decrement to initiation of treatment beyond the median of 59 days after surgery. Conclusions: We identified characteristics that are related to the timing of adjuvant therapy in patients with biliary cancers. There was an OS decrement associated with delays beyond the median time point of 59 days. This finding may be especially relevant given the treatment delays seen as a result of COVID-19.

The implications of treatment delays in adjuvant therapy for cholangiocarcinoma patients.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 291-291
Author(s):  
Matthew Parsons ◽  
Shane Lloyd ◽  
Skyler B Johnson ◽  
Courtney L. Scaife ◽  
Ignacio Garrido-Laguna ◽  
...  
Keyword(s):  
Propensity Score ◽  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Study Cohort ◽  
Time Points ◽  
Factors Associated ◽  
Post Surgery ◽  
Significant Difference ◽  
Doubly Robust Estimation ◽  
The Impact

291 Background: To understand the factors associated with timing of adjuvant therapy in the management of intrahepatic and extrahepatic cholangiocarcinoma and the impact of delays on overall survival (OS). Methods: Data from the NCDB for patients with pathologically proven non-metastatic adenocarcinoma of the bile ducts from 2004 to 2014 were pooled and screened. Patients were included only if they underwent surgery and adjuvant chemotherapy (CMT) and/or radiotherapy (RT). Patients who underwent neoadjuvant therapy or received CMT or RT with palliative intent were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, OS was compared between patients who had initiation of adjuvant therapy past various time points using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling. Results: In total, 7,422 patients in our analysis underwent adjuvant treatment. This represented 43% of the study cohort of 17,123 patients. Of the patients who underwent adjuvant treatment, 3,956 (53%) initiated adjuvant therapy by two months, 6,234 (84%) by 3 months and 6,987 (94%) by four months. High-grade disease, macroscopically positive margins, tumors larger than five centimeters, and unknown LVSI status, were associated with earlier initiation of adjuvant treatment at two months or earlier. Patients who received early adjuvant therapy were also more likely to be treated with a combination of CMT and RT. Factors associated with delay of adjuvant therapy beyond three months post-surgery included Charlson scores of one or greater and Hispanic race. After propensity score weighting, there was no survival difference between groups when comparing initiation of adjuvant therapy before or after two, three or four month time points Conclusions: We identified a number of patient characteristics related to the timing of initiating adjuvant therapy in patients with biliary cancers. There were no significant difference in OS associated with delaying adjuvant therapy beyond two, three or four month time-points. Our findings are relevant in the era of COVID-19 when minimizing patient exposure to health-care settings during a pandemic may need to be considered when deciding on the timing of adjuvant therapy. If a delay is necessary, our results suggest that there is no survival detriment to initiating adjuvant therapy beyond three or four months after surgery for biliary cancers.

A multistate model for follicular lymphoma (FL) patients (pts) who experience early progression.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18164-e18164
Author(s):  
Hiromi Terawaki ◽  
Caglar Caglayan ◽  
Qiushi Chen ◽  
Ashish Rai ◽  
Turgay Ayer ◽  
...  
Keyword(s):  
Markov Model ◽  
Median Time ◽  
Median Survival ◽  
Proportional Hazards ◽  
Treatment Strategies ◽  
Initial Therapy ◽  
Observation Time ◽  
Cox Proportional Hazards ◽  
Health States ◽  
The Impact

e18164 Background: FL is the second most frequent lymphoma subtype. Approximately 20% of FL pts experience disease progression within two years of initial chemo-immunotherapy. Currently, there is no standard of care approach for treatment of these pts. Methods: Using Surveillance, Epidemiology, and End Results (SEER) registry data from 2000 through 2009 linked to Medicare claims data through 2011, we identified pts who received second line therapy within 2 years of their initial therapy and incorporated their clinical, demographic, treatment, and outcomes data into a multi-state Markov model to study the impact of first, second and third line therapies. Treatments were categorized as rituximab (R), R-cyclophosphamide and vincristine (RCVP), R- cyclophosphamide, hydroxydaunorubicin, and vincristine (RCHOP), and other R-containing regimens. The Aalen-Johansen estimator was used to estimate the likelihood of being in 1 of 4 health states: dead or alive following treatment (TX) 1, 2 or 3. A Cox proportional hazards regression model was fitted for each possible transition between the model states to identify significant factors affecting time of progression to the next line treatment or death. Results: Data for 5234 pts were incorporated into the model. The median observation time before TX1 was 1.4 months (range 0-125 months). Overall, the median time from TX1 to TX2 was 3.1 (95% CI 2.9-3.2) months and median survival was 33.3 (32.2-34.3) months. For pts who received R, RCVP, and RCHOP as TX1, the median time to TX2 (range) was 5.4 (4.9-5.8), 4.2 (3.6-4.7), and 3.3 (2.9-3.5) months, respectively. These treatments were associated with a median survival of 33 (31-35), 31 (28-32), and 36 (34-39) months, respectively. For pts who received R, RCVP, and RCHOP as TX2 the median time to TX3 was 5.0 (4.3- 5.3), 3.2 (2.7-3.9), and 2.7 (2.3-3.1) months, respectively. Conclusions: This multi-state Markov model using SEER-Medicare data, provides means to examine sequential treatment strategies that influence outcomes for pts with poor-risk FL and factors that influence transition points within each strategy. This modeling approach can help identify where interventions can have the greatest impact for these pts with unmet clinical needs.

Is a delay in ALK inhibitor initiation associated with poorer survival? A retrospective analysis based on real-world data.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18240-e18240
Author(s):  
Daniel Sheinson ◽  
William Bruce Wong ◽  
Ning Wu ◽  
Aaron Scott Mansfield
Keyword(s):  
Median Time ◽  
Proportional Hazards ◽  
Fold Increase ◽  
Cox Proportional Hazards ◽  
Real World Data ◽  
Alk Inhibitor ◽  
Immortal Time Bias ◽  
Early Cohort ◽  
The Impact ◽  
Test Result

e18240 Background: The time between a patient’s positive biomarker test result and initiation of targeted therapy may vary due to a number of factors, including the use of chemotherapy prior to or after the biomarker test result. The objective of this study was two-fold: first, to investigate the impact of delayed ALK inhibitor (ALKi) therapy on overall survival (OS) and second, to examine the association between the use of chemotherapy prior to or after biomarker testing and OS. Methods: The Flatiron Health EHR-derived database was used to identify patients with ALK-positive (ALK+) advanced NSCLC diagnosed between 1/1/2011 - 9/30/2018. The median time from ALK+ test result to ALKi start was used to separate patients into early versus delayed treatment cohorts. To account for potential immortal time bias, times from ALK+ test result to ALKi start from the delayed cohort were sampled with replacement and used to create modified index dates among the early cohort. Cox proportional hazards models adjusting for baseline characteristics (i.e. ECOG) were used to assess the association between delayed ALKi start and OS and the use of chemotherapy with OS. Results: 422 patients with ALK+ aNSCLC were included in this analysis with a median time from test result to ALKi start of 3 weeks. 88 patients (20.9%) received chemotherapy prior to starting their ALKi. Delayed ALKi use was associated with a 2.3 fold increase in risk of mortality (HR [95% CI]: 2.30 [1.28, 4.15], p < 0.01). There was no difference in survival observed between those who had received chemotherapy prior to initiating their ALKi and those who did not receive chemotherapy (HR [95% CI]: 0.99 [0.62, 1.58]). Among those who initiated chemotherapy prior to their ALK+ test result, the continued use of chemotherapy prior to initiating an ALKi did not result in differences in OS compared to those who switched to an ALKi without continuing chemotherapy (HR [95% CI]: 1.03 [0.44, 2.41]). Conclusions: Delayed initiation of ALKi may result in poor outcomes in patients with ALK+ NSCLC. Receipt of chemotherapy prior to ALKi or the duration of chemotherapy did not impact survival. Future strategies to improve the time to therapy initiation may be useful in improving patient outcomes.

The impact of neoadjuvant and/or adjuvant treatment modalities in resectable gastric cancer (rGC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16564-e16564
Author(s):  
Camille Ng ◽  
Sungjin Kim ◽  
Michelle Guan ◽  
Andrew Eugene Hendifar ◽  
Haesoo Kim ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Pathologic Complete Response ◽  
Cox Proportional Hazards ◽  
Surgical Margins ◽  
Treatment Modalities ◽  
Adjuvant Radiation ◽  
Perioperative Therapy ◽  
Risk Of Death ◽  
The Impact

e16564 Background: In rGC ( > cT2), we investigated the impact of various neoadjuvant and/or adjuvant treatment modalities on pathologic complete response (pCR), surgical margins, and overall survival (OS). Methods: The National Cancer Database (NCDB) was interrogated to identify rGC patients (pts) between 2004-2015. Gastric adenocarcinoma cases that were cT2-T4b, any N, M0 and underwent definitive surgery were included. We analyzed the association of 9 treatment groups: neoadjuvant chemoradiation only (nCRT), neoadjuvant chemo only (nCT), adjuvant chemo only (aCT), adjuvant chemoradiation only (aCRT), neoadjuvant chemo and adjuvant radiation (nCTaRT), received any chemo at all (any CT), received any chemoradiation at all (any CRT), received any radiation at all (any RT), and no perioperative therapy (NT) across 3 endpoints: pCR, margin status, and OS using logistic regression and Cox proportional hazards models with adjustment for baseline characteristics. Results: From 183,204 GC cases screened, a total 3061 pts were available with a median follow-up of 41.6 mos and median OS of 29.0 mos. On multivariable analyses, nCRT was associated with the greatest odds of having a pCR (odds ratio or OR 59.6, 95% confidence interval (CI) 10.6-334.1, p < 0.001) with NT as the reference. Having received any RT (OR 0.42, 0.10-1.86), nCRT (OR 0.68, 0.33-1.37), or nCT (OR 0.83, 0.60-1.15) was associated with the lowest odds for having positive surgical margins although none reached p < 0.05. For OS, having received any CT (hazard ratio or HR 0.41, 0.35-0.48) was associated with the lowest risk of death followed by nCRT (HR 0.48, 0.35-0.66), aCT (HR 0.52, 0.43-0.62), aCRT (HR 0.55, 0.48-0.63), any CRT (HR 0.61, 0.41-0.91), nCT (HR 0.62, 0.54-0.71), and nCTaRT (HR 0.67, 0.52-0.87, all p < 0.05). Median OS was greatest in pts treated with any CT (53.9 mos) followed by nCRT (39.1 mos) and aCT (36.1 mos) with 2-year OS rates being 65.6% (95% CI 61.3-69.5%), 63.6% (52.3-73.0%), and 59.7% (54.2-64.7%), respectively. Conclusions: Although nCRT had a high pCR rate, receipt of any CT (neoadjuvant and/or adjuvant) afforded the greatest OS in this modality-by-modality comparison in a large cohort of rGC pts.

Refusal of surgery results in inferior survival in esophageal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 364-364
Author(s):  
Matthew Parsons ◽  
Randa Tao ◽  
Shane Lloyd ◽  
Skyler Bryce Johnson ◽  
Courtney L. Scaife ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Standard Of Care ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Trimodality Therapy ◽  
Chi Squared ◽  
Doubly Robust Estimation ◽  
Doubly Robust

364 Background: Trimodality therapy with chemoradiation followed by surgery is the standard of care for non-metastatic esophageal cancer. Some patients refuse surgery and this information is captured in the National Cancer Database (NCDB). We sought to understand factors associated with refusal of surgery in these patients and to compare their survival rates with those who undergo surgery. Methods: Data from the NCDB for patients with pathologically proven non-metastatic esophageal cancer from 2006 to 2013 were pooled and screened. Patients with T1N0M0 disease were excluded. Pearson’s chi-squared test and multivariate logistic regression analyses were used to assess the distribution of demographic, clinical, and treatment factors. After propensity-score matching with inverse probability of treatment weighting, overall survival (OS) was compared between patients who refused surgery and those who had surgery using Kaplan Meier analyses and doubly-robust estimation with multivariate Cox proportional hazards modeling. Results: We found 890 of 18,942 patients (4.6%) refused surgery. Older patients, females, those with squamous histology, patients insured by Medicare and those who received radiation therapy (RT) were more likely to refuse. Patients who had N1 disease, high incomes, those who received chemotherapy and those who lived farther from care were more likely to have surgery. The initial 6 month OS was not significantly different between patients who refused surgery and those who had surgery (93.5% vs 95.1% P= 0.064). However, five-year OS was significantly lower in patients who refused (16.4% vs. 38.4% P< .01). This survival decrement was observed uniquely in patients with both adenocarcinoma and squamous cell carcinoma histology. Among those who refused surgery, the OS decrement was mitigated by increasing RT doses. In those who received over 54 Gy of RT, there was no statistical difference in OS between the groups (HR = 0.84, 95% CI 0.65-1.09). Conclusions: We identified a number of patient characteristics that are related to the refusal of surgery in esophageal cancer. Refusal of surgery was related to a decrease in OS in propensity weighted cohorts. This survival decrement may be mitigated by RT in a dose dependent fashion.

scholarly journals Relationship between procedural characteristics and cerebrovascular events after transcatheter aortic valve replacement

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000816 ◽  
Author(s):  
Kashish Goel ◽  
Vuyisile T Nkomo ◽  
Joshua P Slusser ◽  
Ryan Lennon ◽  
Robert D Brown ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Propensity Score ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Transcatheter Aortic Valve ◽  
Increased Risk ◽  
The Impact

ObjectivesThe objective was to assess the impact of procedural characteristics on risk of stroke or transient ischaemic attack (TIA) after transcatheter aortic valve replacement (TAVR).MethodsWe included 370 consecutive patients who underwent balloon-expandable TAVR from 1 November 2008 to 30 June 2014. Procedural characteristics that may be associated with stroke/TIA were assessed. The primary outcome was stroke/TIA at 30 days. A propensity score was constructed using a logistic regression model with 29 parameters. Cox proportional hazards models were used with a propensity score covariate.ResultsMean age was 80.9±7.9 years and mean Society of Thoracic Surgeons score was 8.3±5.0. The total number of balloon dilations ranged from 2 to 7. Out of 370 patients, 13 patients (3.5%) suffered stroke/TIA in the first 30 days after TAVR. In univariate analysis, postdeployment balloon dilation (PD) (HR 3.8, 95% CI 1.24 to 11.61; p=0.02) and emergent cardiopulmonary bypass (CPB) (HR 9.66, 95% CI 2.66 to 35.15; p<0.001) were significantly associated with 30-day stroke/TIA. In the multivariable Cox-proportional hazards model, PD (HR 4.95, 95% CI 1.02 to 24.03; p=0.04) and emergent CPB (HR 7.15, 95% CI 1.39 to 36.89; p=0.02) were independently associated with increased risk of 30-day stroke/TIA after adjusting for propensity score, total number of balloon dilations and periprosthetic regurgitation.ConclusionPostdilation as compared with total number of dilations, and emergent CPB were independently associated with increased risk of clinical neurological events in the first 30 days after TAVR. Reduction in balloon postdilation with appropriate valve sizing may reduce the risk of stroke or TIA after TAVR.

scholarly journals Does post-operative radiotherapy improve the treatment outcomes of intracranial hemangiopericytoma? A retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jianbiao Xiao ◽  
Lanwei Xu ◽  
Yi Ding ◽  
Wei Wang ◽  
Fen Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Local Control ◽  
Proportional Hazards ◽  
Intensity Modulated Radiotherapy ◽  
Cox Proportional Hazards ◽  
Matched Pair ◽  
Propensity Score Method ◽  
Chi Square ◽  
Radiotherapy Group ◽  
The Impact

Abstract Background Intracranial hemangiopericytoma is a rare disease and surgery is the mainstay treatment. Although postoperative adjuvant radiotherapy is often used, there are no reports comparing different radiotherapy techniques. The purpose of this study is to analyze the impact of post-operative radiotherapy and different radiotherapy technique on the results in patients with intracranial hemangiopericytoma (HPC). Methods We retrospectively reviewed 66 intracranial HPC patients treated between 1999 and 2019 including 29 with surgery followed by radiotherapy (11 with intensity-modulated radiotherapy (IMRT) and 18 with stereotactic radiosurgery (SRS)) and 37 with surgery alone. Chi-square test was used to compare the clinical characteristic between the groups. The Kaplan-Meier method was used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariate Cox proportional hazards models were used to examine prognostic factors of survival. We also underwent a matched-pair analysis by using the propensity score method. Results The crude local control rates were 58.6% in the surgery plus post-operative radiotherapy group (PORT) and 67.6% in the surgery alone group (p = 0.453). In the subgroup analysis of the PORT patients, local controls were 72.7% in the IMRT group and 50% in the SRS group (p = 0.228). The median OS in the PORT and surgery groups were 122 months and 98 months, respectively (p = 0.169). The median RFS was 96 months in the PORT group and 72 months in the surgery alone group (p = 0.714). Regarding radiotherapy technique, the median OS and RFS of the SRS group were not significantly different from those in the IMRT group (p = 0.256, 0.960). The median RFS were 112 and 72 months for pathology grade II and III patients, respectively (p = 0.001). Propensity score matching did not change the observed results. Conclusion In this retrospective analysis, PORT did not improve the local control rates nor the survivals. The local control rates after IMRT and SRS were similar even though the IMRT technique had a much higher biological dose compared with the SRS technique.

scholarly journals Refusal of surgery and survival outcomes in endometrial cancer

2021 ◽  
pp. ijgc-2021-002692
Author(s):  
Alli M Straubhar ◽  
Matthew W Parsons ◽  
Samual Francis ◽  
David Gaffney ◽  
Kathryn A Maurer
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Factors Associated ◽  
Doubly Robust Estimation ◽  
The Impact

ObjectivesThe goal of this study was to determine the impact refusal of surgery has on overall survival in patients with endometrial cancer.MethodsFrom January 2004 to December 2015, the National Cancer Database was queried for patients with pathologically proven endometrial cancer who were recommended surgery and refused. Inverse probability of treatment weighting was used to account for differences in baseline characteristics between patients who underwent surgery and those who refused. Kaplan–Meier analyses and doubly robust estimation with multivariate Cox proportional hazards modeling were used to analyze overall survival.ResultsOf the 300 675 patients identified, 534 patients (0.2%) were recommended surgical treatment but refused: 18% (95/534) were age ≤40 years. The 5-year overall survival for all patients who refused surgery was significantly decreased compared with patients who underwent surgery (29.2% vs 71.9%, P<0.01). This was demonstrated at ages 41–64 years (65.5% vs 91.0%, P<0.01) and ≥65 years (23.4% vs 75.3%, P<0.01). The 5-year overall survival did not meet statistical significance at age ≤40 years (90.1% vs 87.8% P<0.19). However, there were few patients in this cohort. On multivariate analysis, factors associated with refusal of surgery included: Medicaid insurance, Black race, Hispanic Race, Charlson Comorbidity Index scores of 2 or greater, stage II or III, and if patient received external beam radiation therapy alone. Factors associated with undergoing surgery included: age greater than 41, stage IB, and if the patient received brachytherapy.ConclusionsRefusal of surgery for endometrial cancer is uncommon and leads to decreased overall survival.

The impact of palliative resection (PR) of the primary tumor on overall survival (OS) in metastatic colorectal cancer (mCRC).

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 509-509
Author(s):  
Gillian Gresham ◽  
Daniel John Renouf ◽  
Matthew Chan ◽  
Winson Y. Cheung
Keyword(s):  
Propensity Score ◽  
Primary Tumor ◽  
Proportional Hazards ◽  
Early Stage ◽  
Significant Proportion ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Entire Cohort ◽  
Cox Proportional Hazards Models ◽  
The Impact

509 Background: The role of PR of the primary tumor in mCRC remains unclear. Using population-based data, we explored the impact of PR on OS. Methods: Patients (pts) with mCRC who were referred to 1 of 5 regional cancer centers in British Columbia between 2006 and 2008 were reviewed (n=802). Pts with prior early stage CRC who relapsed with mCRC were excluded (n=285). We conducted survival analysis using Kaplan Meier methods and determined adjusted hazard ratios (HR) for death using Cox proportional hazards models. A secondary propensity score matched analysis was performed to control for baseline differences between pts who underwent PR and those who did not. Results: A total of 517 pts with mCRC were identified: median age was 63 years (range 23-93), 54% were men, 55% had ECOG 0-1, 76% had a colon primary, and 31% had >1 metastatic site. The majority (n=378; 73%) underwent PR of the primary tumor and a significant proportion (n=327; 63%) received palliative chemotherapy (CT). Compared to pts without PR, those with PR were more likely to be men (62 vs 51%, p=0.03), aged <65 years (63 vs 52%, p=0.03), ECOG 0-1 (61 vs 38%, p<0.0001), and receive palliative CT (68 vs 50%, p=0.0004). PR was associated with improved median OS across groups (Table). The benefit of PR on prognosis persisted in multivariate analysis (HR for death 0.56, 95%CI 0.43-0.72, p<0.0001 for entire cohort; HR 0.51, 95%CI 0.37-0.70, p<0.0001 for individuals who were treated with CT; and HR 0.54, 95%CI 0.34-0.84, p=0.007 for those who did not receive CT). In a propensity score matched analysis that considered age, gender, ECOG, and receipt of palliative CT, prognosis continued to be more favorable in the PR group (HR 0.66, 95% CI 0.50-0.86, p=0.0019). Conclusions: In this population-based analysis, PR of the primary tumor in mCRC was associated with a significant OS benefit. [Table: see text]

Effect of Obesity on Prognosis After Early-Stage Breast Cancer

2011 ◽  
Vol 29 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Marianne Ewertz ◽  
Maj-Britt Jensen ◽  
Katrín Á. Gunnarsdóttir ◽  
Inger Højris ◽  
Erik H. Jakobsen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Adjuvant Treatment ◽  
Proportional Hazards ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Distant Metastases ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
The Impact

Purpose This study was performed to characterize the impact of obesity on the risk of breast cancer recurrence and death as a result of breast cancer or other causes in relation to adjuvant treatment. Patients and Methods Information on body mass index (BMI) at diagnosis was available for 18,967 (35%) of 53,816 women treated for early-stage breast cancer in Denmark between 1977 and 2006 with complete follow-up for first events (locoregional recurrences and distant metastases) up to 10 years and for death up to 30 years. Information was available on prognostic factors and adjuvant treatment for all patients. Univariate analyses were used to compare the associations of known prognostic factors and risks of recurrence or death according to BMI categories. Cox proportional hazards regression models were used to assess the influence of BMI after adjusting for other factors. Results Patients with a BMI of 30 kg/m2 or more were older and had more advanced disease at diagnosis compared with patients with a BMI below 25 kg/m2 (P < .001). When data were adjusted for disease characteristics, the risk of developing distant metastases after 10 years was significantly increased by 46%, and the risk of dying as a result of breast cancer after 30 years was significantly increased by 38% for patients with a BMI of 30 kg/m2 or more. BMI had no influence on the risk of locoregional recurrences. Both chemotherapy and endocrine therapy seemed to be less effective after 10 or more years for patients with BMIs greater than 30 kg/m2. Conclusion Obesity is an independent prognostic factor for developing distant metastases and for death as a result of breast cancer; the effects of adjuvant therapy seem to be lost more rapidly in patients with breast cancer and obesity.

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