Novel Histologic Categorization Based on Lauren Histotypes Conveys Prognostic Information for Gastroesophageal Junction Cancers—Analysis from a Large Single Center Cohort in Germany

Adenocarcinoma of the gastroesophageal junction (AEG) ranks among the most common cancers in the Western world with increasing incidence. However, the prognostic influence and applicability of the Lauren classification was not examined in detail before. The purpose of this analysis was to analyze the oncologic outcomes of GE-junction cancer related to the Lauren histotype in a large single center cohort. Data from the prospectively documented database of the Klinikum Rechts der Isar (TUM School of Medicine) for patients undergoing curatively intended oncologic resection for GE-junction cancer between 1984 and 2018 were extracted. Univariate and multivariate regression analyses were performed to identify predictors for overall survival. Kaplan-Meier analyses were done to investigate the survival rates according to the Lauren histotype. After identification of two distinct histologic categories with prognostic implications, propensity score matching (PSM) was performed to balance for confounders and evaluate its oncologic outcomes retrospectively. In the time period indicated, 1710 patients were treated for GE-junction cancer. Exclusion criteria were: R2-resections (n = 134), metastatic disease (n = 296), 30-day mortality (n = 45), Siewert type I (n = 21), and missing/incomplete data (n = 61). Finally, 1153 patients were analyzed. In a multiple variable analysis, age, UICC-stage, all Lauren histotypes, R-stage, and postoperative complications were significant predictors of overall survival. Kaplan Meier analysis demonstrated significant survival differences between intestinal, diffuse, and mixed Lauren-histotypes (p = 0.001 and p = 0.029). Survival rates were comparable between non-classifiable and intestinal Lauren-types (p = 0.16) and between diffuse and mixed types (p = 0.56). When combining non-classifiable, well, and moderately differentiated Lauren-types and combining poorly differentiated intestinal, diffuse, and mixed types, two highly prognostic groups were identified (p < 0.0001). This was confirmed after PSM for possible confounders. The Lauren histotypes demonstrate highly prognostic value after oncologic resection of GE-junction cancer (Siewert type II and type III) in a single center Western patient cohort. A simplified histotype classification based on Lauren subtypes revealed a clear distinction of prognostic groups and should be considered for further evaluation.

Download Full-text

Significance of Lauren Classification in Patients Undergoing Neoadjuvant/Perioperative Chemotherapy for Locally Advanced Gastric or Gastroesophageal Junction Cancers—Analysis from a Large Single Center Cohort in Germany

Cancers ◽

10.3390/cancers13020290 ◽

2021 ◽

Vol 13 (2) ◽

pp. 290 ◽

Cited By ~ 1

Author(s):

Rebekka Schirren ◽

Alexander Novotny ◽

Christian Oesterlin ◽

Julia Slotta-Huspenina ◽

Helmut Friess ◽

...

Keyword(s):

Overall Survival ◽

Median Survival ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

Survival Rates ◽

Multivariate Regression Analysis ◽

Perioperative Chemotherapy ◽

Kaplan Meier ◽

Lauren Histotype ◽

Mixed Types

Background: the purpose of this analysis was to analyze the outcomes of multimodal treatment that are related to Lauren histotypes in gastro-esophageal cancer (GEC). Methods: patients with GEC between 1986 and 2013 were analyzed. Uni- and multivariate regression analysis were performed to identify predictors for overall survival. Lauren histotype stratified overall survival (OS)-rates were analyzed by the Kaplan–Meier method. Further, propensity score matching (PSM) was performed to balance for confounders. Results: 1290 patients were analyzed. After PSM, the median survival was 32 months for patients undergoing primary surgery (PS) and 43 months for patients undergoing neoadjuvant chemotherapy (nCTx) ahead of surgery. For intestinal types, median survival time was 34 months (PS) vs. 52 months (nCTx+surgery) p = 0.07, 36 months (PS) vs. (31) months (nCTx+surgery) in diffuse types (p = 0.44) and 31 months (PS) vs. 62 months (nCTx+surgery) for mixed types (p = 0.28). Five-/Ten-year survival rates for intestinal, diffuse, and mixed types were 44/29%, 36/17%, and 43/33%, respectively. After PSM, Kaplan–Meier showed a survival benefit for patients undergoing nCTx+surgery in intestinal and mixed types. Conclusion: the Lauren histotype might be predictive for survival outcome in GEC-patients after neoadjuvant/perioperative chemotherapy.

Download Full-text

Histopathologic Response Is a Positive Predictor of Overall Survival in Patients Undergoing Neoadjuvant/Perioperative Chemotherapy for Locally Advanced Gastric or Gastroesophageal Junction Cancers—Analysis from a Large Single Center Cohort in Germany

Cancers ◽

10.3390/cancers12082244 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2244

Author(s):

Rebekka Schirren ◽

Alexander Novotny ◽

Helmut Friess ◽

Daniel Reim

Keyword(s):

Overall Survival ◽

Clinical Stage ◽

Univariate Analysis ◽

Gastroesophageal Junction ◽

Locally Advanced ◽

Multivariate Regression Analysis ◽

Perioperative Chemotherapy ◽

Single Center ◽

Histopathologic Response ◽

Lauren Histotype

There is conflicting evidence regarding the efficacy of neoadjuvant/perioperative chemotherapy (NCT) for gastro-esophageal cancer (GEC) on overall survival. This study aimed to analyze the outcomes of multimodal treatments in a large single center cohort. We performed a retrospective analysis of patients treated with NCT, followed by intended curative oncological surgery for locally advanced gastric cancer. Uni- and multivariate regression analysis were performed to identify the predictors of overall survival. From over 3000 patients, 702 eligible patients were analyzed. In the univariate analysis clinical stage, application of preoperative PLF, requirement of surgical extension, UICC-stage, grading, R-status, Lauren histotype, and HPR were the prognostic survival factors. In multivariate analysis PLF regimen, UICC-stages, R-status, Lauren histotype, and histopathologic regression (HPR) were significant predictors of overall survival. Overall HPR-rate was 26.9%. HPR was highest in the cT2cN0 stage (55.9%), and lowest in the cT3/4 cN+ stage (21.6%). FLOT demonstrated the highest HPR (37.5%). Independent predictors for HPR were the clinical stage and grading. Kaplan Meier analyses demonstrated significant survival benefits for the responding patients (p < 0.0001). HPR after NCT was an important prognostic factor to predict overall survival for locally advanced GEC. FLOT should be the preferred regimen in patients undergoing NCT ahead of surgery.

Download Full-text

Efficacy of perioperative chemotherapy for synovial sarcoma: a retrospective analysis of a Nationwide database in Japan

BMC Cancer ◽

10.1186/s12885-021-08485-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gang Xu ◽

Hisaki Aiba ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Overall Survival ◽

Synovial Sarcoma ◽

Survival Rates ◽

Surgical Margin ◽

Oncologic Outcomes ◽

Wide Resection ◽

Perioperative Chemotherapy ◽

Relapse Free Survival ◽

Free Survival ◽

Distant Relapse

Abstract Background Synovial sarcoma is an aggressive but chemosensitive soft-tissue tumor. We retrospectively analyzed the efficacy of perioperative chemotherapy for synovial sarcoma with data from the nationwide database, Bone and Soft Tissue Tumor Registry in Japan. Methods This study included 316 patients diagnosed with synovial sarcoma between 2006 and 2012. Oncologic outcomes were analyzed using a Cox-hazard regression model. Moreover, the effects of perioperative chemotherapy on outcomes were evaluated using a matched-pair analysis. The oncologic outcomes of patients who did or did not receive chemotherapy were compared (cx + and cx-). Results Multivariate analysis revealed significant correlations of age (over 40, hazard ratio [HR] = 0.61, p = 0.043), margin status (marginal resection, HR = 0.18, p < 0.001 and intralesional resection, HR = 0.30, p = 0.013 versus wide resection) with overall survival; surgical margin type (marginal resection, HR = 0.14, p = 0.001 and intralesional resection, HR = 0.09, p = 0.035 versus wide resection) with local recurrence; and postoperative local recurrence (HR = 0.30, p = 0.027) and surgical margin (marginal resection, HR = 0.31, p = 0.023 versus wide resection) with distant relapse-free survival. Before propensity score matching, perioperative chemotherapy was mainly administered for young patients and patients with deeper tumor locations, larger tumors, more advanced-stage disease, and trunk location. The 3-year overall survival, local control, and distant relapse-free survival rates were 79.8%/89.3% (HR = 0.64, p = 0.114), 89.6%/93.0% (HR = 0.37, p = 0.171) and 71.4%/84.5% (HR = 0.60, p = 0.089) in the cx+/cx- groups, respectively. After propensity score matching, 152 patients were selected such that the patient demographics were nearly identical in both groups. The 3-year overall survival, local control, and distant relapse-free survival rates were 71.5%/86.0% (HR = 0.48, p = 0.055), 92.5%/93.3% (HR = 0.51, p = 0.436) and 68.4%/83.9% (HR = 0.47, p = 0.046) in the cx+/cx- groups, respectively. Conclusion This large-sample study indicated that the margin status and postoperative disease control were associated directly or indirectly with improved oncologic outcomes. However, the efficacy of perioperative chemotherapy for survival outcomes in synovial sarcoma patients was not proven in this Japanese database analysis.

Download Full-text

Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

International Journal of Colorectal Disease ◽

10.1007/s00384-021-04005-6 ◽

2021 ◽

Author(s):

Claudius E. Degro ◽

Richard Strozynski ◽

Florian N. Loch ◽

Christian Schineis ◽

Fiona Speichinger ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Blood Level ◽

Proportional Hazards ◽

Survival Rates ◽

Cox Proportional Hazards ◽

Stage I ◽

Cancer Stage ◽

Single Center ◽

Significant Difference

Abstract Purpose Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. Methods In total, 417 patients with colon cancer stage I–IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan–Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. Results Our study showed no significant difference of the overall survival between rCC and lCC stage I–IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1–123.5), CEA (carcinoembryonic antigen) blood level > 100 µg/l (HR: 3.3; CI 95%: 1.2–9.0), increased lymph node ratio of 0.6–1.0 (HR: 5.3; CI 95%: 1.7–16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7–2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9–91.9), CEA blood level 20.1–100 µg/l (HR: 5.4; CI 95%: 2.4–12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0–49.0), and severe surgical complications (Clavien-Dindo III–IV) (HR: 2.9; CI 95%: 1.5–5.5) were identified as predictors of a diminished overall survival. Conclusion Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients.

Download Full-text

OP0294 SJÖGREN’S SYNDROME ASSOCIATED LYMPHOMAS: CLINICAL DESCRIPTION AND 10-YEAR SURVIVAL

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2400 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 180-181

Author(s):

L. Chatzis ◽

V. Pezoulas ◽

A. Goules ◽

I. Stergiou ◽

C. Mavragani ◽

...

Keyword(s):

Overall Survival ◽

T Cell ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Histologic Type ◽

Single Center ◽

Event Free Survival ◽

Survival Curves ◽

Free Survival ◽

Kaplan Meier

Background:Sjögren’s Syndrome (SS) is a chronic systemic autoimmune disease of unknown etiology, carrying the highest lymphoma risk among autoimmune diseases, with significant impact on mortality and morbidity of patients.Objectives:To describe: i) the clinical phenotype of SS, ii) the histologic type, stage, treatment options regarding lymphomas and iii) the prognosis of patients with SS related lymphoproliferative disorders.Methods:Eight hundred and fifteen consecutive SS patients’ records from a single center fulfilling the 2016 ACR/EULAR were reviewed retrospectively for the purpose of this study. One hundred twenty-one patients with a diagnosis of non-Hodgkin Lymphoma (NHL) were identified and enrolled in the study population. Cumulative clinical, laboratory and histologic data were recorded and overall survival as well as event free survival curves were constructed using the Kaplan-Meier method. An event was defined as a disease progression, lymphoma relapse, treatment failure, histologic transformation, development of a 2nd lymphoma or death from any cause.Results:From 121 pSS patients with lymphoma the most common histologic type encountered was MALT lymphoma (92/121, 76,0%) followed by DLBCL (11/121, 9.0%) and NMZL (8/119, 6.6%). The remaining 10 patients had various lymphomas of B (follicular, lymphoplasmacytic, chronic lymphocytic leukemia} and T cell origin (peripheral T cell lymphoma not otherwise specified, primary cutaneous T cell lymphoma, angioimmunoblastic t-cell lymphoma). Permanent salivary gland enlargement (66.1%, 80/121), palpable purpura (34,7% 42/121), peripheral nervous involvement (9,9%, 12/121), interstitial lung disease (8,2%, 10/121) presence of serum cryoglobulins (38,7%, 43/111) and C4 hypocomplementemia (69,8% 81/116) present at least 1 year before the development of lymphoma were the main pSS related features. The median age at lymphoma diagnosis was 58 years old (range 29-82) while MALT lymphomas developed earlier compared to DLBCL from pSS diagnosis (8 vs 3 OR= 3.84, 95%CI: 0.29 to 10.46; p=0.0266). The commonest biopsy proven extranodal sites included the labial minor salivary (43,8% patients) and parotid glands (30,5%) while 11% of patients had more than 1 extranodal sites affected. Bone marrow involvement was evident in 24,3% of patients (29/119) while nodal involvement in 35,5% (42/118). The majority of patients (65%) had limited disease (stage I or II). A watch and wait therapeutic policy was chosen in 40 patients while the rest received rituximab with or without chemotherapy. The 10-year survival and event free rates were 79% and 45,5% for MALT lymphomas, 40,9% and 24,2% for DLBCL and 46% and 31% for NMZL respectively (Figure 1). The Mantel-Cox log-rank comparison of the overall survival curves revealed a statistically significant difference (p=0.0016) among lymphoma subtypes.Figure 1.Overall and event free survival of SS-associated lymphoma patients. A. Kaplan-Meier overall survival analysis. B. A Kaplan-Meier event free survival analysis.Conclusion:This is the largest single center series of SS- associated lymphoma patients, providing a detailed description of SS and lymphoma related features, combined with a 10-year survival and event free curves for the first time in the literature.Disclosure of Interests:None declared.

Download Full-text

Multi-modal Ultrasonic Diagnosis and Prognosis for Primary Thyroid Lymphoma Invasiveness

10.21203/rs.3.rs-629680/v1 ◽

2021 ◽

Author(s):

Chenjuan Peng ◽

Chen Yang ◽

Jincao Yao ◽

LingYan Zhou ◽

Jingjing Xu ◽

...

Keyword(s):

Poor Prognosis ◽

Survival Rates ◽

Diagnostic Value ◽

Thyroid Lymphoma ◽

Diagnosis And Prognosis ◽

Kaplan Meier ◽

Primary Thyroid Lymphoma ◽

Ultrasonic Images ◽

Mixed Types ◽

Thyroid Capsule

Abstract Objective Sixty-nine patients with primary thyroid lymphoma (PTL) were evaluated for diagnostic value and prognosis for PTL invasiveness. Methods We retrospectively (2008–2019) analyzed multi-modal ultrasonic images and clinical characteristics from pathologically confirmed PTL patients. These patients were divided into aggressive PTL(n=46) and indolent PTL(n=23). Results Age(>70 years old) and elevated LDH (lactase dehydrogenase) were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffused, and 24 mixed. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), and differences were statistically significant (P = 0.000). Elastography, invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We observed statistical difference in OS(overall survival rates) between aggressive and indolent PTL(p=0.032). Single factor Kaplan-Meier (K-M) analysis showed that: age > 70 years old, aggressive pathology, Ki67>30%, elastography scored >3 were positively correlated with the risk of poor prognosis of PTL (P < 0.05).Conclusions Multi-modal ultrasound provides accurate ultrasonographic information, e.g., ultrasound patterns, elastography, invaded thyroid capsules, and hypervascularity, which facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients with age > 70 years old, aggressive pathology, Ki67>30%, elastography scored >3 are more likely to have poor prognosis.

Download Full-text

Pediatric Patients with Adrenal Neuroblastoma: A SEER Analysis, 2004–2013

The American Surgeon ◽

10.1177/000313482008600232 ◽

2020 ◽

Vol 86 (2) ◽

pp. 127-133

Author(s):

Shengxiang Chen ◽

Wenfeng Tang ◽

Randong Yang ◽

Xiaoxiao Hu ◽

Zhongrong Li

Keyword(s):

Overall Survival ◽

Pediatric Patients ◽

Cox Regression ◽

Demographic Data ◽

Survival Rates ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Survival Difference ◽

Tumor Management ◽

End Results

Adrenal neuroblastoma (NB) is a relatively common malignancy in children. The Surveillance, Epidemiology, and End Results database was used to present demographic data and a survival analysis with the aim of making tumor management better. The Surveillance, Epidemiology, and End Results database was used to search pediatric patients (age £16 years) with NB from 2004 to 2013. The Kaplan-Meier method was used to calculate the overall survival. And, we used Cox regression analysis to determine hazard ratios for prognostic variables. Independent prognostic factors were selected into the nomogram to predict individual's three-, five-, and seven-year overall survival. The study included a total of 1870 pediatric patients with NB in our cohort. Overall, three-, five-, and seven-year survival rates for adrenal NB were 0.777, 0.701, and 0.665, respectively, whereas the rates for nonadrenal NB were 0.891, 0.859, and 0.832, respectively. The multivariate analysis identified age >1 year, no complete resection (CR)/CR, radiation, and regional/distant metastasis as independent predictors of mortality for adrenal NB. Concordance index of the nomogram was 0.665 (95% confidence interval, 0.627–0.703). Pediatric patients with adrenal NB have significantly worse survival than those with nonadrenal NB. Adrenal NB with age <1 year, treated with surgery, no radiation, and localized tumor leads to a better survival. There was no survival difference for patients to receive CR and no CR.

Download Full-text

Case series of ventriculopleural shunts in adults: a single-center experience

Journal of Neurosurgery ◽

10.3171/2016.4.jns16641 ◽

2016 ◽

Vol 126 (6) ◽

pp. 2010-2016 ◽

Cited By ~ 6

Author(s):

Claudia Craven ◽

Hasan Asif ◽

Amna Farrukh ◽

Flavia Somavilla ◽

Ahmed K. Toma ◽

...

Keyword(s):

Survival Rates ◽

Case Series ◽

Mantel Test ◽

Single Center ◽

Retrospective Case ◽

Distal Catheter ◽

Single Center Experience ◽

Kaplan Meier ◽

Shunt Survival ◽

Ventriculopleural Shunt

OBJECTIVEThe peritoneal cavity is widely used as the destination of choice for cerebrospinal fluid shunts. Various alternative sites have been used, particularly in the presence of certain contraindications. The pleural cavity has been used; however, a paucity of evidence details ventriculopleural (VPL) shunt survival, complication, and revision rates in adults. The aim of this study was to present a single center's experience with VPL shunts, identifying complication, revision, and survival rates.METHODSA single-center, retrospective case series analysis was conducted for VPL shunt insertions and revisions over a period of 5 years. Demographic as well as clinical data were collected. Ventriculopleural shunt survival was assessed using Kaplan-Meier curves and the log rank (Cox-Mantel) test.RESULTSTwenty-two VPL shunts were inserted in 19 patients. Median survival of the VPL shunts was 14 months. Pathological indication for the VPL shunt did not significantly affect survival. A total of 10 complications was observed: 2 infections, 2 cases of overdrainage, 2 obstructions, 1 distal catheter retraction, 2 symptomatic pleural effusions, and 1 asymptomatic pleural effusion.CONCLUSIONSVentriculopleural shunting is a safe and viable second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. While VPL shunts have a high revision rate, their complication rate is comparable to that of VP shunts. Ventriculopleural shunt survival can be improved by careful patient selection and the implementation of a combination of valves with antisiphon devices.

Download Full-text

Extramedullary Acute Leukemias prior to and after Allogeneic Hematopoietic Stem Cell Transplantation: a Single Center Study.

Blood ◽

10.1182/blood.v112.11.3262.3262 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3262-3262

Author(s):

Michael Stadler ◽

Helmut Diedrich ◽

Elke Dammann ◽

Stefanie Buchholz ◽

Eva Mischak-Weissinger ◽

...

Keyword(s):

Overall Survival ◽

Philadelphia Chromosome ◽

Single Center ◽

Acute Leukemias ◽

Hematopoietic Stem ◽

Graft Versus Leukemia ◽

Kaplan Meier ◽

Single Center Study ◽

Center Study

Abstract BACKGROUND: Extramedullary acute leukemias (EM AL) following allogeneic hematopoietic stem cell transplantation (allo-SCT) are rare, but devastating events. Little is known about their incidence (0.05% to 30% according to registry data and small series, respectively), biology (sanctuary sites? uneven graft-versus-leukemia efficacy?), risk factors (acute myeloid leukemia, AML, with FAB M4 or M5? Philadelphia chromosome positive acute lymphoblastic leukemia, ALL? conditioning with busulfan?), treatment, and outcome. Our purpose was to compare clinical features and outcome of EM AL occurring prior to and after allo-SCT in a large cohort of patients. PATIENTS AND METHODS: In this single center, retrospective analysis, we report on 350 consecutive patients who received an allo-SCT for acute leukemias at our institution in the decade between January 1998 to December 2007, allowing for at least six months of follow-up until July 2008. 160 were females and 190 males, with a median age of 48 years (range: 17 to 71). 191 had been diagnosed with de novo AML, 78 with AML secondary after myelodysplasia or myeloproliferative disease (sAML), and 81 with ALL. According to molecular, cytogenetic and response criteria, 47 were considered standard and 303 high risk patients. 118 of 350 patients (34%) suffered a relapse after allo-SCT. RESULTS: Of the 350 patients, 42 (12%) had extramedullary manifestations prior to allo- SCT: 20 within the central nervous system (CNS), 16 cutaneous or lymphonodular, 2 musculoskeletal, and 4 urogenital manifestations. 21 of 350 patients (6%; 13 AML, 6 ALL, 2 sAML) had EM AL relapses after allo-SCT: 8 CNS, 6 cutaneous or lymphonodular, 5 musculoskeletal, and 2 urogenital; EM relapses were associated with marrow recurrences in 11 of 21 patients. However, there was little overlap between the EM AL groups prior to and after allo-SCT: only 6 patients belonged to both groups, and only 3 patients actually relapsed in the same EM compartment as before allo-SCT. After a median follow-up of 16 months (range: 0 to 122), survival probabilities at 5 years were 42% for patients without EM AL compared to 34% for EM AL patients prior to allo-SCT (not significant), and 12% for all acute leukaemia relapses versus 13% for EM AL patients after allo-SCT (not significant). For the latter, factors associated with adverse outcome included: no complete remission at allo-SCT (p = 0.081), reduced intensity conditioning (p = 0.034), prior donor lymphocyte infusions (DLI) (p = 0.034), and relapse within the first year after allo- SCT (p = 0.0017). Conversely, gender, age, diagnosis, AML FAB subtype, Philadelphia chromosome positive ALL, EM AL before allo-SCT, busulfan as part of the conditioning regimen, donor status, human leukocyte antigen (HLA) match, and graft-versus-hostdisease (GvHD) before EM relapse did not play a significant role for survival of patients with EM AL after allo-SCT. CONCLUSION: In this largest single-center study to date, extramedullary acute leukemias occured quite frequently both prior to and after allo HSCT. Patients with or without EM AL had comparable outcomes, both in continuous remission or relapse. Since EM AL occurred at identical sites in different patients prior to or after allo-SCT, and since some patients with EM AL after allo-SCT are cured due to a graft-versus-leukemia effect, the concept of “disease sanctuaries” seems unlikely. We speculate that temporo-spatial changes in immune surveillance might be mechanisms involved. Local blast control, e.g. through radiation, and systemic chemotherapeutic as well as immunomodulatory approaches may help to improve the prognosis of patients with EM AL both prior to and after allo-SCT. Figure: Kaplan-Meier-curves for overall survival:  (prior to Tx): 308 patients without EM AL (dotted line) versus 42 patients with EM AL (solid line)  (post Tx): 97 patients without EM AL relapse (dotted line) versus 21 patients with EM AL relapse (solid line) Figure:. Kaplan-Meier-curves for overall survival:  (prior to Tx): 308 patients without EM AL (dotted line) versus 42 patients with EM AL (solid line)  (post Tx): 97 patients without EM AL relapse (dotted line) versus 21 patients with EM AL relapse (solid line)

Download Full-text

Comparison of survival rates in carcinoma in situ of the breast treated with total mastectomy to breast-conserving surgery and radiotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.519 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 519-519 ◽

Cited By ~ 1

Author(s):

M. N. Ibrahim ◽

Z. Abdullah ◽

L. Healy ◽

C. Murphy ◽

I. Y. Yousif ◽

...

Keyword(s):

Overall Survival ◽

Proportional Hazards ◽

Survival Rates ◽

Breast Conserving Surgery ◽

Cox Proportional Hazards ◽

Disease Specific Survival ◽

Total Mastectomy ◽

Kaplan Meier ◽

Disease Specific

519 Background: Carcinoma in situ (CIS) of the breast is a precancerous lesion with the potential to progress to invasive cancer. In 2003, CIS accounted for 19% of all newly diagnosed invasive and non-invasive breast lesions combined in the United States. Current treatment options are mastectomy ± tamoxifen, and breast-conserving surgery with radiotherapy ± tamoxifen. As there are no randomized comparisons of these 2 treatments, data from the Surveillance Epidemiology and End Results (SEER) database was used to compare their survival rates. Methods: 88,285 patients were identified with CIS from 1988 - 2003. Of these, 27,728 patients were treated with a total mastectomy, and 25,240 patients received breast-conserving surgery with radiotherapy. Kaplan-Meier survival analyses and Cox proportional hazards regression were used to compare overall survival and disease specific survival at 5 and 10 years. Results: Kaplan-Meier analyses demonstrated 5 year overall survival rates for total mastectomy vs. breast conserving surgery with radiotherapy of 95.46% vs. 97.59% respectively (Log-rank P < 0.0001). The 5 year rates for disease specific survival were 99.16% vs. 99.72% respectively (Log-rank P < 0.0001). At 10 years the overall survival rates had fallen to 91.96% vs. 96.09% respectively (Log-rank P < 0.0001). The 10 year disease specific survival rates were 98.61% vs. 99.50% respectively (Log-rank P < 0.0001). Cox proportional hazards regression demonstrated a relative risk of 0.847 (95% confidence interval (CI) 0.790 - 0.907) and 1.110 (95% CI 0.931 - 1.324) for 5 year overall survival and disease specific survival respectively, when total mastectomy was compared with breast conserving surgery and radiotherapy. At 10 years, the relative risks were 0.865 (95% CI 0.820 - 0.913) and 1.035 (95% CI 0.900 - 1.190) for overall survival and disease specific survival respectively. Conclusions: Overall, when looking at disease-specific survival rates by multi-variate analysis, there does not appear to be a significant difference between total mastectomy and breast-conserving surgery with radiotherapy in the treatment of CIS. No significant financial relationships to disclose.

Download Full-text