scholarly journals Evaluation of Traditional Prognostic Factors for Stage I-III Colorectal Cancer Patients Who Survived for Over Five Years After Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Dakui Luo ◽  
Yufei Yang ◽  
Zezhi Shan ◽  
Qi Liu ◽  
Sanjun Cai ◽  
...  

The aim of this study was to explore the prognostic factors in stage I-III colorectal cancer (CRC) patients who had survived for over five years. A total of 9754 stage I-III CRC patients who received curative surgery in the Department of Colorectal Surgery, Fudan University Shanghai Cancer Center were enrolled in this study. Of them, 3640 patients had survived for over five years after surgery. Univariate and multivariate Cox regression analyses were performed in the entire cohort and those who had survived for over five years. Compared with patients in the entire cohort, patients who had survived for over five years were more likely to be younger, have less disease of signet ring cell histology, perineural invasion and vascular invasion, more well differentiated tumors and stage I disease. In the entire cohort, increased age, signet ring cell, poor differentiation, more advanced pathological stage, perineural invasion and vascular invasion were inversely associated with disease-free survival (DFS) and overall survival (OS) using multivariable Cox regression analyses. Only age, pathological stage and perineural invasion remained significant in patients who had survived for over five years. Moreover, tumor location was an independent factor for OS in this subgroup. Predictors for prognosis of CRC change over time. Age, pathological stage and perineural invasion deserve more attention among patients who have survived for over five years.

2021 ◽  
Vol 20 ◽  
pp. 153303382110279
Author(s):  
Qinping Guo ◽  
Yinquan Wang ◽  
Jie An ◽  
Siben Wang ◽  
Xiushan Dong ◽  
...  

Background: The aim of our study was to develop a nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with gastric signet ring cell carcinoma (GSRC). Methods: GSRC patients from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly assigned to the training and validation sets. Multivariate Cox regression analyses screened for OS and CSS independent risk factors and nomograms were constructed. Results: A total of 7,149 eligible GSRC patients were identified, including 4,766 in the training set and 2,383 in the validation set. Multivariate Cox regression analysis showed that gender, marital status, race, AJCC stage, TNM stage, surgery and chemotherapy were independent risk factors for both OS and CSS. Based on the results of the multivariate Cox regression analysis, prognostic nomograms were constructed for OS and CSS. In the training set, the C-index was 0.754 (95% CI = 0.746-0.762) for the OS nomogram and 0.762 (95% CI: 0.753-0.771) for the CSS nomogram. In the internal validation, the C-index for the OS nomogram was 0.758 (95% CI: 0.746-0.770), while the C-index for the CSS nomogram was 0.762 (95% CI: 0.749-0.775). Compared with TNM stage and SEER stage, the nomogram had better predictive ability. In addition, the calibration curves also showed good consistency between the predicted and actual 3-year and 5-year OS and CSS. Conclusion: The nomogram can effectively predict OS and CSS in patients with GSRC, which may help clinicians to personalize prognostic assessments and clinical decisions.


2021 ◽  
Author(s):  
Yangyang Xie ◽  
Xue Song ◽  
Haimin Jin ◽  
Zhongkai Ni ◽  
Xiaowen Li ◽  
...  

Abstract Background: The dismal prognosis of gastric signet ring cell carcinoma (GSRC) is a global problem. The current study is conducted to comprehensively evaluate clinicopathological features and survival outcomes in GSRC patients stratified by anatomic subsites. Then predictive nomograms are constructed and validated to improve the effectiveness of personalized management.Method: The patients diagnosed with GSRC were recruited from the online SEER database. The influence of anatomic subsites on overall survival (OS) and cancer-specific survival (CSS) was evaluated using multivariate Cox regression and Kaplan-Meier analysis. Then we employed propensity score matching (PSM) technique to decrease selection bias and balance patients’ epidemiological factors. Predictive nomograms were constructed and validated.Results: Multivariate Cox regression demonstrated that the patients with overlapping gastric cancer (OGC) suffered the highest mortality risk for OS (HR, 1.29; 95%CI, 1.23-1.36; P<0.001) and CSS (HR, 1.33; 95%CI, 1.28-1.37; P<0.001). Age, TNM stage, tumor localization, tumor size, surgery and chemotherapy presented a highly significant relationship with OS and CSS. Following subgroup and PSM analysis, OGC patients were confirmed to have the worst OS and CSS. Then nomograms predicting 6 months, 12 months and 36 months OS and CSS were constructed. The calibration curves and reveiver operating characteristic curves demonstrated the great performance of the nomograms.Conclusion: We identified anatomic subsites as a predictor of survival in those with GSRC. Patients with OGC suffered the highest mortality risk. The proposed nomograms allowed a relatively accurate survival prediction for GSRC patients.


2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 128-128 ◽  
Author(s):  
Lauren McLendon Postlewait ◽  
Malcolm Hart Squires ◽  
David A. Kooby ◽  
George A. Poultsides ◽  
Sharon M. Weber ◽  
...  

128 Background: Conflicting data exist on the prognostic implication of signet ring cell (SRC) histology in gastric adenocarcinoma (GAC). Our aim was to assess the association of SRC with recurrence and survival in patients undergoing resection of GAC. Methods: All pts who underwent curative intent resection for GAC from 2000 to 2012 at 7 academic institutions comprising the US Gastric Cancer Collaborative were included. 30-day mortalities were excluded. Survival analyses included Kaplan Meier log rank and multivariate Cox regression. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS). Stage-specific analysis was performed. Results: Of 965 pts, 768 met inclusion criteria. SRC was present in 39.5% and was associated with female gender (52.9% vs 38.6%; p<0.001), younger age (61 vs 67 yrs; p<0.001), poor differentiation (94.8% vs 50.3%; p<0.001), perineural invasion (PNI: 41.4% vs 23%; p<0.001), distal location (82.2% vs 70.1%; p<0.001), receipt of adjuvant therapy (63% vs 51.2%; p=0.002), and more advanced stage (Stage 3: 55.2% vs 36.5%; p<0.001). SRC was associated with earlier recurrence (56.7mo vs median not reached (MNR); p=0.009) and decreased OS (33.7mo vs 46.6mo; p=0.011). When accounting for other adverse pathologic features, PNI (HR 1.57; p=0.016) and higher TNM stage (HR 2.63; p<0.001) were associated with decreased RFS, but SRC was not. PNI (HR 1.53; p=0.006), higher TNM Stage (HR 2.10; p<0.001), greater size (HR 1.05; p=0.014), and adjuvant therapy (HR 0.50; p<0.001) were associated with OS. SRC was not an independent predictor of OS. Stage-specific analysis showed no association between SRC and RFS or OS in Stage 1 or 3. In Stage 2, SRC was associated with earlier recurrence (38.1mo vs MNR; p=0.005) but not OS. The negative association of SRC with decreased RFS persisted in multivariate analysis (HR 3.11; p=0.015). Conclusions: Signet ring histology is associated with other adverse pathologic features including higher grade and higher TNM stage but is not independently associated with reduced RFS or OS. Identification of signet ring histology during preoperative evaluation should not, in isolation, dictate treatment strategy.


2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 321-321
Author(s):  
Michael K. Turgeon ◽  
Adriana C. Gamboa ◽  
Manali Rupji ◽  
Rachel M. Lee ◽  
Jeffrey M. Switchenko ◽  
...  

321 Background: Upfront surgery is standard of care for stage I gastric cancer. Despite this, many clinicians administer preoperative therapy for clinical stage I disease with signet ring cell histology, given its aggressive biology. We aimed to assess the validity of this practice. Methods: The National Cancer Database (2004-2015) was reviewed for pts with non-metastatic signet ring cell gastric cancer who underwent treatment with surgery alone, perioperative chemotherapy, neoadjuvant therapy, or adjuvant therapy. Analysis was stratified by preoperative clinical stage and pathologic stage. Primary outcome was overall survival (OS). Results: Of 3000 pts, median age was 61 (IQR: 51-70). 34% were clinical stage I (n = 1018) of which 53% received surgery alone (n = 542), 5% perioperative chemotherapy (n = 47), 12% neoadjuvant therapy (n = 125), and 30% adjuvant therapy (n = 304). Median follow-up was 26 mos. For clinical stage I disease, surgery alone was associated with improved median OS (108 mos) when compared to perioperative chemotherapy (80 mos), neoadjuvant therapy (41 mos), or adjuvant therapy (73 mos, all p < 0.001). For pathologic stage I, surgery alone had equivalent survival to perioperative and adjuvant therapy (5-yr OS: 81 vs 82 vs 79%, p = 0.22). Concordance between clinical and pathologic stage I was 56%, specifically, 41% of clinical stage I pts were upstaged to pathologic stage II (44%) and stage III (56%). Adjuvant therapy for these pts was associated with improved median OS compared to pretreatment (perioperative chemotherapy / neoadjuvant therapy) for those upstaged to pathologic stage II (122 vs 37mos, p < 0.001) or stage III (40 vs 18mos, p < 0.001) disease. Conclusions: Our stage-stratified study demonstrates improved survival with upfront surgery for clinical stage I signet ring cell gastric cancer. Despite 41% of clinical stage I pts being upstaged to stage II or III on final pathology, adjuvant therapy offers a favorable rescue strategy, with improved outcomes compared to those treated preoperatively. Surgery alone also affords similar survival for pathologic stage I disease compared to multimodal therapy. This study challenges the intrinsic bias to over-treat stage I signet ring cell gastric cancer.


2020 ◽  

Purpose: The present study aims to evaluate the incidence of signet ring cell (SRC) histology in patients with gastric cancer and its prognostic significance on the disease stage. Methods: Between November 2006 and September 2019, 309 patients were reviewed retrospectively in Kartal Koşuyolu High Specialization Training and Research Hospital Gastroenterology Surgery clinic in Turkey and the clinicopathological features and survival status were examined in the presence of ring cell histology. Results: Of the patients, 71.4% had gastric cancer with a non-SRC histology and 28.6% had an SRC histology. The presence of an SRC histology was found to be associated with young age (p=0.007), advanced depth of wall invasion (p=0.001), number of positive lymph nodes (p=0.022) and presence of vascular invasion (p=0.044). The presence of an SRC histology was associated with good prognosis in patients with stage I gastric cancer (p=0.045), but with poor prognosis in patients with stage III disease (p=0.034). The study found no significant association between stage II disease and overall survival. Conclusions: The present study found survival to be associated with good prognosis in stage I, and poor prognosis in stage III among patients with gastric cancer with SRC histology. No prognostic significance could be established for overall survival.


2019 ◽  
Vol 39 (7) ◽  
Author(s):  
Baochun Wang ◽  
Juntao Zeng ◽  
Yuren Liu

Abstract Due to insufficient quantitative evaluation of the clinic-pathological features and prognosis of young colorectal cancer (CRC) with mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRC), the aim of our study was to develop a nomogram to identify the prognostic predictors for overall survival (OS) in this patient population. We retrospectively evaluated the patient records of MAC and SRC patients aged ≤ 40 years. Kaplan–Meier analysis and log-rank testing were performed to estimate OS. A nomogram predicting OS was created for risk quantitation and decision tree analysis was performed for patient grouping. With a median follow-up of 36.5 months, we included a total of 90 young CRC patients for analysis. The overall cumulate 5-year OS rate was 57.7% (95% confidence interval (CI): 45.1–68.5%). The estimated 5-year OS was 62.9% (95% CI: 48.5–74.3%) for MAC and 37.3% (95% CI: 14.4–61.2%) for SRC (P=0.021). The recurrence rate was significantly greater in the SRC group compared with the mucinous group (52.4 compared with 26.1%, P=0.047). In the multivariate Cox regression model, preoperative carcinoembryonic antigen (CEA) levels and cycles of adjuvant chemotherapy (CT) were found to be an independent prognostic factor for OS (hazard ratio (HR): 2.43; 95% CI: 1.13–5.62, P=0.024; HR: 0.21; 95% CI: 0.083–0.57, P=0.002, respectively). Nomograms predicting 3- and 5-year OS were established that performed well (concordance index (c-indexes) of 0.636, 95% CI: 0.549–723) for OS. For MAC and SRC disease, a greater proportion of young patients present with advanced disease, and the prognosis for young SRC patients is poorer than MAC. Furthermore, preoperative CEA levels and cycles of adjuvant CT seem to independently affect the OS in this patient population.


2021 ◽  
Vol 2021 ◽  
pp. 1-15
Author(s):  
Hui Wang ◽  
Yao Peng ◽  
Qi Huang ◽  
Jingjing Wu ◽  
Mingjun Zhang

Background. Nomograms were established to predict the survival for gastric signet ring cell carcinoma (GSRC) in young and middle-aged adults. Material and Methods. Eligible patients with GSRC from 2004 to 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database and then divided into a training and a testing cohort in proportion. Independent prognostic factors were picked by univariate and multivariate Cox regression analysis to set up nomograms. The predictive effect and clinical value of nomograms were evaluated by the concordance index (C-index), calibration curves, and receiver operating characteristic curve (ROC). Results. A total of 1686 GSRC patients were subsumed into this case for analysis, including a training ( n = 1180 ) and a testing cohort ( n = 506 ). Independent risk factors related to overall survival (OS) and cancer-specific survival (CSS) comprised of race, TNM stage, tumor size, number of positive lymph nodes (PLNE), and chemotherapy. For OS, the C-indexes of the training and testing cohorts were 0.737 and 0.752, while for CSS, C-indexes were, respectively, 0.749 and 0.751. These revealed that nomograms accurately predicted OS and CSS. Calibration curves and ROC demonstrated the apparent superiority of nomograms. Conclusion. We built a well-understood and comprehensive prognostic assessment model for GSRC, which provided an individualized survival prediction in the form of a quantitative score that can be considered for clinical practice.


2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 120-120
Author(s):  
Dilsa Mizrak Kaya ◽  
Graciela M. Nogueras-Gonzalez ◽  
Jeannelyn Estrella ◽  
Kazuto Harada ◽  
Fatemeh Ghazanfari Amlashi ◽  
...  

120 Background: Surgery is the best option to cure localized GAC. When surgery is not possible due to comorbidities or patient refusal, definitive chemoradiation is an option. We report on one of the largest cohorts of GAC patients who did not have surgery. Methods: We identified 71 patients with localized GAC who received chemo/chemoradiation therapy but did not have surgery. We assessed various endpoints (overall survival [OS] and recurrence-free survival [RFS]). Clinical complete response (cCR; negative post therapy biopsy and no evidence of cancer by imaging) was also assessed. Results: The median follow-up time was 1.8 years (range; 0.4-10.6). Most of the patients were men (64.8%) and the median age was 73 years (range; 30-96). Reason for not having surgery included comorbidities in 34 (47.9%), poor performance status 14 (19.7%), and patient refusal 23 (32.4%). Most of the patients (80.3%) received chemoradiation and 14 (19.7%) could receive only chemotherapy. Of all 71 patients, 32 (45.1%) achieved to a cCR. For the entire cohort, the median OS was 2.1 years (95% Cl 0.98-1.02). The estimated OS rates at 2 and 5 years were 46.5% and 11.3%, respectively. The median OS and the median RFS for patients with cCR were 2.3 and 1.8 years (95% Cl 0.97-1.01), respectively. Female gender (HR 0.47, 95% Cl 0.25-0.91, p = 0.024) and chemoradiation (HR 0.36, 95% Cl 0.16-0.85; p = 0.019) were independently associated with longer OS in the multivariate analysis. Histologic grade and the presence of signet ring cell had no effect on OS. Conclusions: Our data show that patients with localized GAC who do not undergo surgery have a low but measurable 5-year OS rate of 11.3%.


2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 110-110 ◽  
Author(s):  
Hitoshi Katai ◽  
Yoshiaki Iwasaki ◽  
Masanori Terashima ◽  
Junki Mizusawa ◽  
Hiroshi Katayama ◽  
...  

110 Background: We previously reported that the superiority of neoadjuvant chemotherapy (NAC) with S-1 plus cisplatin was not demonstrated for schirrhous or similar macroscopic type (type 4 or large type 3) gastric cancer. However, overall survival (OS) in both arms was better than previous reports (3-year OS: 62.4% in gastrectomy plus adjuvant S-1 [arm A] and 60.9% in NAC followed by gastrectomy plus adjuvant S-1 [arm B]). Therefore, we explored whether histology and peritoneal cytology are associated with treatment effect. Methods: After staging laparoscopy, a total of 300 eligible patients with clinically resectable disease were randomized to arm A, or arm B. In this report, treatment effect was explored in key subgroups such as histology and peritoneal cytology using the data from JCOG0501. Cox regression model was used to investigate the interaction between arms and subgroups. Results: Hazard ratio (HR) classified by histology (excluding one missing) was 0.686 (95% CI: 0.414-1.138) for non-signet type (n = 123) and 1.158 (95% CI: 0.805-1.666) for signet type (n = 176) (p = 0.098 for interaction). HR by peritoneal cytology was 0.870 (95%CI: 0.616-1.228) for the negative (n = 240) and 1.051 (95% CI: 0.598-1.845) for the positive (n = 60) (p = 0.513 for interaction). 3 year-OS of signet ring cell histology was 63.2% (95% CI: 52.2-72.4) in arm A and 51.7% (95% CI: 40.9-61.5) in arm B, that of non-signet ring cell histology was 62.3% (95% CI: 48.9-73.1) in arm A and 74.2% (95% CI: 61.4-83.3) in arm B, and that of peritoneal cytology positive was 35.7% (95% CI: 18.9-53.0) in arm A and 25.0% in arm B (95% CI: 11.8-40.7), and that of peritoneal cytology negative was 68.6% (95% CI: 59.5-76.1) in arm A and 70.6% (95% CI: 61.5-77.9) in arm B. Conclusions: NAC might be beneficial for non-signet ring cell histology. Considering the survival results, primary surgery followed by S-1 could be recommended for this disease even though histology was signet ring cell type or peritoneal cytology was positive. Clinical trial information: UMIN000000279.


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