Comparison of Long-Term Survival Outcomes of T4a and T4b Colorectal Cancer

BackgroundAlthough T4b is known to have worse oncologic outcomes, it is unclear whether it truly shows a worse prognosis. This study aims to compare the survival differences between T4a and T4b.MethodsPatients who were pathologically diagnosed with T3 and T4 colorectal adenocarcinoma from 2010 to 2014 were included (T3, n = 1822; T4a, n = 424; T4b, n = 67). Overall survival (OS) and cancer-specific survival (CSS) were compared between T4a and T4b using the Kaplan-Meier method and log-rank test.ResultsIn stage II, T4a had better OS and CSS than T4b (5-year OS, 89.5% vs. 72.6%; 5-year CSS, 94.4% vs. 81.7%, all p < 0.05), however, in stage III, there were no significant differences in survivals between groups (all p > 0.05). In multivariable analysis, T classification was not an independent risk factor for OS (p > 0.05). However, for CSS, when respectively compared to T3, T4b (HR 3.53, p < 0.001) showed a relatively higher hazard ratio than T4a (HR 2.27, p < 0.001).ConclusionsT4a showed more favorable OS and CSS than T4b, especially in stage II. Our findings support the current AJCC guidelines, in which T4b is presented as a more advanced stage than T4a.

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Improved Long-Term Survival with Edaravone Therapy in Patients with Amyotrophic Lateral Sclerosis: A Retrospective Single-Center Study in Japan

Pharmaceuticals ◽

10.3390/ph14080705 ◽

2021 ◽

Vol 14 (8) ◽

pp. 705

Author(s):

Hideki Houzen ◽

Takahiro Kano ◽

Kazuhiro Horiuchi ◽

Masahiro Wakita ◽

Azusa Nagai ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Rank Test ◽

Positive Pressure ◽

Control Group ◽

Single Center ◽

Term Survival ◽

Long Term Survival ◽

Kaplan Meier ◽

Lateral Sclerosis

Reports on the long-term survival effect of edaravone, which was approved for the treatment of amyotrophic lateral sclerosis (ALS) in 2015 in Japan, are rare. Herein, we report our retrospective analysis of 45 consecutive patients with ALS who initially visited our hospital between 2013 and 2018. Of these, 22 patients were treated with edaravone for an average duration of 26.6 (range, 2–64) months, whereas the remaining patients were not treated with edaravone and comprised the control group. There were no differences in baseline demographics between the two groups. The primary endpoint was tracheostomy positive-pressure ventilation (TPPV) or death, and the follow-up period ended in December 2020. The survival rate was significantly better in the edaravone group than in the control group based on the Kaplan–Meier analysis, which revealed that the median survival durations were 49 (9–88) and 25 (8–41) months in the edaravone and control groups, respectively (p = 0.001, log-rank test). There were no serious edaravone-associated adverse effects during the study period. Overall, the findings of this single-center retrospective study suggest that edaravone might prolong survival in patients with ALS.

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Sleeve lobectomy an affidable lung sparing procedure

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17159 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17159-17159

Author(s):

G. Cavallesco ◽

P. Maniscalco ◽

F. Quarantotto ◽

F. Acerbis ◽

M. Santini ◽

...

Keyword(s):

Main Bronchus ◽

Rank Test ◽

Sleeve Lobectomy ◽

Term Survival ◽

Average Hospital ◽

Long Term Survival ◽

Kaplan Meier ◽

Significant Difference ◽

Similar Survival

17159 Background: Sleeve Lobectomy (Sl) is generally considered a surgical alternative of choice to Pneumonectomy (Pn) for the treatment of central NSCLC. The aim of this study is to value if the Sl could be really a Lung saving procedure that warrants right survivals, according to stage of disease, with acceptable perioperative risks. Methods: In 165 patients (67 Sl and 98 Pn) operated from 1995 to 2003 for NSCLC of main bronchus we have analyzed the hospital stay, morbidity and mortality within 30 days, long term survival. In 39 Sl and 46 Pn we compared spyrometric volume’s changes at a distance of 6–24 months from operation. Sl was performed where it was technically possible. Long term survivals had been separated and comparated according to pathologic stadium (TNM 1997) and lymphonodal involvement: all these data were estimated by Kaplan-Meier method and log rank test. All statistical data underwent SPSS elaboration and significant assumption for p < 0.05. Results: In our population of study we didn’t check any statistically significant’s differences comparing age, sex or preoperative Fev1. Complications occurred in 28% of cases where Sl was performed and in 36.7% after Pn with a mortality rate of 2.9% vs 5.1%. Average hospital staying was longer in patients underwent to Pneumonectomy. Long term survival (5 years) in Sl group is 36% and 24% in Pn group with a statistically significant difference P = 0.016, but this difference is not evident from the comparison between the two group’s survivals based on pathological stadium or lymphonodal involvement. Spyrometric values showed a global Fev1 reduction of 245 ml (−10%) after Sl procedure and 884ml (36.3%) after Pn with a significant difference of p = 0.0042. Conclusions: In this study Sl got similar survival results if not better, with those obtained after Pn. Moreover, Sl showed to be a lung sparing procedure with an acceptable operative risk. These data confirmed that SL is the gold standard surgical procedure in the treatment of central tumors where if technically possible. [Table: see text] No significant financial relationships to disclose.

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Effect of surgery and chemotherapy on long-term survival in infants with congenital glioblastoma: an integrated survival analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.5.peds20226 ◽

2020 ◽

Vol 26 (5) ◽

pp. 563-571 ◽

Cited By ~ 1

Author(s):

Victor M. Lu ◽

Kyle P. O’Connor ◽

Benjamin T. Himes ◽

Desmond A. Brown ◽

Cody L. Nesvick ◽

...

Keyword(s):

Survival Analysis ◽

Gestational Age ◽

Multivariable Analysis ◽

Postnatal Period ◽

Term Survival ◽

Initial Management ◽

Exact Test ◽

Kaplan Meier ◽

Autopsy Diagnosis

OBJECTIVEGlioblastoma (GBM) during infancy is rare, and the clinical outcomes of congenital GBM are not well understood. Correspondingly, the aim of this study was to present a long-term survivor case from the authors’ institution, and establish an integrated cohort of cases across the published literature to better understand the clinical course of this disease in this setting.METHODSThe authors report the outcomes of an institutional case of congenital GBM diagnosed within the first 3 months of life, and performed a comprehensive literature search for published cases from 2000 onward for an integrated survival analysis. All cases were integrated into 1 cohort, and Kaplan-Meier estimations, Fisher’s exact test, and logistic regression were used to interrogate the data.RESULTSThe integrated cohort of 40 congenital GBM cases consisted of 23 (58%) females and 17 (42%) males born at a median gestational age of 38 weeks (range 22–40 weeks). Estimates of overall survival (OS) at 1 month was 67%, at 1 year it was 59%, and at 10 years it was 45%, with statistically superior outcomes for subgroups in which patients survived to be treated by resection and chemotherapy. In the overall cohort, multivariable analysis confirmed resection (p < 0.01) and chemotherapy (p < 0.01) as independent predictors of superior OS. Gestational age > 38 weeks (p < 0.01), Apgar scores ≥ 7 at 5 minutes (p < 0.01), absence of prenatal hydrocephalus (p < 0.01), and vaginal delivery (p < 0.01) were associated with greater odds of surgical diagnosis versus autopsy diagnosis.CONCLUSIONSCongenital GBM can deviate from the expected poor prognosis of adult GBM in terms of OS. Both resection and chemotherapy confer statistically superior prognostic advantages in those patients who survive within the immediate postnatal period, and should be first-line considerations in the initial management of this rare disease.

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Impact of adjuvant chemotherapy and cumulative cisplatin dose in locally advanced nasopharyngeal carcinoma (LA-NPC) treated with definitive chemoradiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6046 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6046-6046

Author(s):

Marc Oliva Bernal ◽

Shao Hui Huang ◽

Rachel Taylor ◽

Jie Su ◽

Wei Xu ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Locally Advanced ◽

Multivariable Analysis ◽

Stage Iv ◽

Stage Ii ◽

Rank Test ◽

High Dose ◽

Free Survival ◽

Kaplan Meier

6046 Background: Total cumulative cisplatin dose (CDDP-D) (concurrent/induction/adjuvant) in multimodality therapy for LA-NPC has been associated with survival at centers in Asia. We evaluated the survival impact of adjuvant chemotherapy (adj chemo) and total CDDP-D in a large, single institution Canadian cohort of LA-NPC. Methods: Patients (Pts) withWHO type II and III LA-NPC treated with concurrent IMRT with high-dose CDDP and adj chemo with CDDP/Carboplatin and 5-FU (maximum total/adjuvant CDDP-D= 540/240 mg/m2) between 2003-2016 were analyzed. EBER status was tested by ISH. Staging was classified by UICC/AJCC7thedition TNM. Kaplan-Meier 5-year (5y) for overall survival (OS) and recurrence-free survival (RFS) were calculated and compared by log-rank test betweenstage, adj chemo (yes vs no) and total CDDP-D (>300 vs ≤300mg/m2). Multivariable analysis (MVA) identified survival predictors. Results: A total of 312 pts were evaluated: median age = 49.8 (range 17.4-75.9); EBER+/-/unknown=67%/1%/32%; stage II/III/IV=2%/51%/47%; T4=36%; N3=17%; adj chemo=83% (21% switched to carboplatin); median total/adjuvant CDDP-D=380/160 mg/m2; median follow-up 7.6 years (range 0.6-14.9). 5y OS differed by stage II-III vs IV (95% vs 80%, p<0.001) and total CDDP-D >300 vs ≤300mg/m2 (89% vs 83%, p=0.02). Adj chemo and total CDDP-D impacted 5y OS in stage IV (table). 5y RFS was higher in stage IV with total CDDP-D >300 vs ≤300mg/m2 (74% vs 59%, p=0.03), with a trend in locoregional control (LRC) (91% vs 80%, p=0.05) but not significant on distant control (DC) (78% vs 72%, p=0.36). Conclusions: Total CDDP-D >300 mg/m2 impacts OS in the overall cohort. The benefit of adj chemo and total CDDP-D on OS and RFS is significant in stage IV but not stage II-III LA-NPC, mainly due to higher LRC rather than DC. [Table: see text]

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Long-term Results after Carpentier-Edwards Pericardial Aortic Valve Implantation, with Attention to the Impact of Age

The Heart Surgery Forum ◽

10.1532/hsf98.20101140 ◽

2011 ◽

Vol 14 (3) ◽

pp. 160 ◽

Cited By ~ 9

Author(s):

Karl F. Welke ◽

YingXing Wu ◽

Gary L. Grunkemeier ◽

Aftab Ahmad ◽

Albert Starr

Keyword(s):

Aortic Valve ◽

Older Patients ◽

Long Term Results ◽

Rank Test ◽

Term Survival ◽

Younger Patients ◽

Kaplan Meier ◽

Valve Implantation ◽

The Impact

Background: The purpose of this study was to determine long-term patient survival and valve durability for Carpentier-Edwards pericardial valves (Edwards Lifesciences) implanted in the aortic position, with specific attention to the impact of patient age.Methods: We performed a retrospective cohort study of 2168 patients who underwent implantation of a Carpentier-Edwards pericardial aortic valve between 1991 and 2008. The mean follow-up time was 4.5 years. Primary outcomes of interest were mortality and valve explantation. Survival curves and event-free curves were obtained with the Kaplan-Meier method and compared with the log-rank test.Results: Survival was 92% at 1 year, 73% at 5 years, 38% at 10 years, and 18% at 15 years. Although the mortality rate of younger patients was worse than in the general population, older patients had significantly better survival than their contemporaries. Age was the independent variable most significantly associated with explantation. There was an early hazard phase for patients between 21 and 49 years of age, such that the freedom from explantation was 89% at 3 years. By 10 years, the freedom from explantation was 58% for patients 21 to 49 years of age, compared with 68% for patients 50 to 64 years, 93% for patients 65 to 74 years, and 99% for patients 75 years of age and older.Conclusion: We found good long-term survival and durability. Older patients had excellent freedom from explantation, whereas younger patients fared worse. As our population ages, this information becomes increasingly important. Assessing the durability of this pericardial aortic valve may aid in predicting the durability of the transcatheter aortic valves that share the same leaflets.

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Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-021-10257-x ◽

2021 ◽

Author(s):

Keiichiro Mori ◽

Vidit Sharma ◽

Eva M. Comperat ◽

Shun Sato ◽

Ekaterina Laukhtina ◽

...

Keyword(s):

Prostate Cancer ◽

Cox Regression ◽

Multivariable Analysis ◽

Rank Test ◽

Prognostic Impact ◽

Grade Group ◽

Cancer Specific Survival ◽

Kaplan Meier ◽

Pathologic Features ◽

Increased Risk

Abstract Background Grade group (GG) 4 prostate cancer (PC) is considered a single entity; however, there are questions regarding prognostic heterogeneity. This study assessed the prognostic differences among various Gleason scores (GSs) classified as GG 4 PC on biopsy before radical prostatectomy (RP). Methods We conducted a multicenter retrospective study, and a total of 1791 patients (GS 3 + 5: 190; GS 4 + 4: 1557; and GS 5 + 3: 44) with biopsy GG 4 were included for analysis. Biochemical recurrence (BCR)-free survival, cancer-specific survival, and overall survival were analyzed using the Kaplan–Meier method and the log-rank test. Logistic regression analysis was performed to identify factors associated with high-risk surgical pathologic features. Cox regression models were used to analyze time-dependent oncologic endpoints. Results Over a median follow-up of 75 months, 750 patients (41.9%) experienced BCR, 146 (8.2%) died of any causes, and 57 (3.2%) died of PC. Biopsy GS 5 + 3 was associated with significantly higher rates of GS upgrading in RP specimens than GS 3 + 5 and GS 4 + 4. On multivariable analysis adjusted for clinicopathologic features, different GSs within GG 4 were significantly associated with BCR (p = 0.03) but not PC-specific or all-cause mortality. Study limitations include the lack of central pathological specimen evaluation. Conclusions Patients with GG 4 at biopsy exhibited some limited biological and clinical heterogeneity. Specifically, GS 5 + 3 had an increased risk of GS upgrading. This can help individualize patients’ counseling and encourage further study to refine biopsy specimen-based GG classification.

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Association of prior pelvic radiation with long-term oncologic outcomes following radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.308 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 308-308

Author(s):

Harras B. Zaid ◽

Matthew K. Tollefson ◽

Igor Frank ◽

William P. Parker ◽

Robert Houston Thompson ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Progression Free Survival ◽

Patient Characteristics ◽

Disease Recurrence ◽

Oncologic Outcomes ◽

Rank Test ◽

Cancer Specific Survival ◽

Kaplan Meier ◽

Surgical Complexity

308 Background: Receipt of pelvic radiotherapy (PRT) prior to radical cystectomy (RC) has unclear association on oncologic outcomes. Methods: The Mayo Clinic Cystectomy Registry was queried to review 2139 patients undergoing RC for M0 bladder cancer between 1990 and 2010. We then identified patients receiving PRT prior to RC, and matched these cases to non-radiated controls (~1:2) on the basis of age, sex, receipt of neoadjuvant chemotherapy, and pathologic T and N stages. Cancer-specific survival (CSS), and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: Of 2139 patients undergoing RC, 104 (4.9%) had received PRT prior to surgery. These patients were matched to 191 non-radiated control patients (no PRT). Overall, patients were well-matched on disease and patient characteristics. Median follow-up was 9.6 years (IQR 6.0, 14.8). During this time, 108 patients experienced disease recurrence and 218 died, including 122 who died from bladder cancer. Five-year CSS among patients who did versus did not receive PRT was 55% versus 63% (p=0.10), while the 5-year PFS was 55% versus 61% (p=0.32). Furthermore, the pattern of disease recurrence (abdominal/visceral, urothelial, local/pelvic, thoracic, soft tissue/other) did not differ between the no PRT and PRT groups (all p>0.05). Conclusions: Receipt of PRT prior to RC is not associated with worse oncologic outcomes. While prior PRT may increase surgical complexity, CSS, PFS, and patterns of recurrence are similar to patients who have not received PRT.

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Outcomes for patients with borderline resectable (BR) and locally advanced (LA) pancreatic cancer (PC) treated with induction FOLFIRINOX (FFX) +/- radiation (RT) followed by surgery compared to induction FFX followed by consolidative RT.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.437 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 437-437

Author(s):

Michael Cecchini ◽

Joseph Miccio ◽

Jay Pahade ◽

Jill Lacy ◽

Ronald R Salem ◽

...

Keyword(s):

Locally Advanced ◽

Rank Test ◽

Vascular Involvement ◽

Cancer Center ◽

R0 Resection ◽

Borderline Resectable ◽

Term Survival ◽

Kaplan Meier

437 Background: Induction FFX for PC deemed either BR or LA at diagnosis provides an opportunity to downstage pts with the aim of an R0 surgery. The addition of RT after induction FFX may further downstage. However, there is a paucity of data regarding long-term survival for BR and LA patients successfully downstaged and resected. We performed a retrospective review of BR and LA PC treated with induction FFX +/- RT followed by surgery or consolidative RT at the Yale Cancer Center (YCC) to assess survival in these two cohorts. Methods: Clinical data was abstracted for pts with BR or LA PC who had surgery or received consolidative RT without surgery after induction FFX +/- RT at the YCC from 2010-2018. Surgical pts were re-reviewed by a radiologist to assess vascular involvement (BR vs. LA) using NCCN criteria. PFS and OS for surgery and consolidative RT were analyzed by the Kaplan-Meier method. Survival was compared via the log rank test. Results: 102 pts met inclusion criteria (BR=47, LA=55), 41 pts had surgery [BR=29/47 (62%) LA=12/55 (22%)] and 61 pts had consolidative RT [(BR= 18/47 (38%), LA= 43/55 (78%)] after induction FFX. 18 surgery pts received RT prior to resection and all surgery pts had R0 resection. Median follow up was 25 mo (range 5 – 97). Median PFS with surgery was 22 mo (95% CI 15 – 59) vs 14 mo (95% CI 10.9 – 20.1) with consolidative RT (p<0.001), while OS with surgery was 42 mo (95% CI 25-NR) vs 20 mo (95% CI 17-25) without surgery (p<0.001). For pts with ≥ 2 yr follow up, 12/22 (55%) surgery pts and 17/18 (94%) consolidative RT pts relapsed. For pts with ≥ 3 yr follow up, 6/12 (50%) surgery pts and 10/10 (100%) consolidative RT pts relapsed. 2 yr PFS and OS was 45% (95% CI 28-61) and 74% (95% CI 57 – 86) with surgery versus 15% (95% CI 7-27) and 40% (95% CI 26-53) with consolidative RT. Conclusions: Surgery was associated with a high R0 rate and prolonged PFS and OS compared to consolidative RT in pts with BR and LA PC after FFX +/- RT. However, survival benefit was not statistically significant when selecting only LA pts although numbers are limited.

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Biochemical failure after treatment for localized prostate cancer: Does original therapeutic modality affect long-term survival?

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.65 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 65-65

Author(s):

Chad A. Reichard ◽

Evan Kovac ◽

Jay P. Ciezki ◽

Rahul D. Tendulkar ◽

Eric A. Klein ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Biochemical Failure ◽

Localized Prostate Cancer ◽

Definitive Treatment ◽

Rank Test ◽

Cancer Specific Survival ◽

Term Survival ◽

Long Term Survival

65 Background: Mortality among men with biochemical failure (BF) after treatment is variable. We examined the long-term survival of men with BF to determine if differences exist, depending on original treatment modality. Methods: Between 1995 and 2008, 6,084 patients underwent treatment for clinically localized prostate cancer at our institution (4,276 underwent radical prostatectomy (RP); 1,808 underwent EBRT). Clinical information and follow up data was obtained from prospectively maintained databases. Survival was assessed using log rank test. Results: 526 (12%) patients had BF defined by PSA > 0.4 after RP. 326 (18%) patients had BF after EBRT, defined as PSA nadir +2. 197 (60%) of EBRT patients received ADT as neoadjuvant/concurrent/adjuvant therapy. Median overall survival was 154 months (95%CI 148-157) versus 129 months (95%CI 123-135) for RP and EBRT respectively (p<.0001). Median prostate cancer specific survival was 125 months (95%CI 93-148) versus 107 months (95%CI 92-123) for RP and EBRT respectively (p=0.17). There was no difference in prostate cancer specific survival between treatments among patients in D’Amico intermediate and high risk groups. Conclusions: In patients with biochemical recurrence after definitive treatment, patients treated with RP have improved overall survival compared to patients treated with EBRT. However, there is no difference among treatment groups in prostate cancer specific survival.

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Association of perioperative venous thromboembolism with long-term oncologic outcomes following radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.364 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 364-364

Author(s):

Harras B. Zaid ◽

Matthew K. Tollefson ◽

Igor Frank ◽

William P. Parker ◽

Robert Houston Thompson ◽

...

Keyword(s):

Venous Thromboembolism ◽

Radical Cystectomy ◽

Disease Recurrence ◽

Cancer Prognosis ◽

Oncologic Outcomes ◽

Rank Test ◽

Perioperative Morbidity ◽

Kaplan Meier ◽

Significant Difference

364 Background: Venous thromboembolism (VTE) has been reported to occur in 2-5% of patients undergoing radical cystectomy (RC). While VTE is an important cause of perioperative morbidity, the association of these events with long-term cancer prognosis has not been established. Herein, we evaluated the association of perioperative VTE with patients’ risk of subsequent disease recurrence and mortality. Methods: We reviewed 2889 patients undergoing RC between 1980−2009 at the Mayo Clinic to identify patients diagnosed with a VTE within 90 days of RC. These cases were then matched in a 1:2 fashion to control patients undergoing RC who did not develop VTE. Matching was performed on the basis of age, BMI, receipt of neoadjuvant chemotherapy, and pathologic T and N stages. Recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) were estimated utilizing the Kaplan-Meier method and compared with the log-rank test. Results: A total of 132 patients with a VTE within 90 days of RC were identified, accounting for 4.6% of all patients analyzed. These cases were matched to 257 controls per criteria noted above, and were overall well-matched. Of the 389 patients in this study, median follow-up after RC was 9.2 years, during which time 152 (39%) patients experienced recurrence and 306 (78%) died, including 157 (40%) who died of bladder cancer. We found no significant difference in 5-year RFS (59% versus 61%; p = 0.75); CSS (57% versus 64%; p = 0.13); or OS (45% versus 50%; p = 0.15) between patients with versus without perioperative VTE, respectively. Conclusions: We found that VTE within 90 days of RC did not significantly impact long-term cancer outcomes. While these events represent an important cause of perioperative morbidity, no interaction with oncologic control was noted, and patients may be counseled accordingly.

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