scholarly journals Down-Grading of Ipsilateral Hydronephrosis by Neoadjuvant Chemotherapy Correlates with Favorable Oncological Outcomes in Patients Undergoing Radical Nephroureterectomy for Ureteral Carcinoma

Diagnostics ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 10 ◽  
Author(s):  
Makito Miyake ◽  
Nagaaki Marugami ◽  
Yuya Fujiwara ◽  
Kazumasa Komura ◽  
Teruo Inamoto ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Advanced Disease ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Prognostic Impact ◽  
Radical Nephroureterectomy ◽  
Cancer Specific Survival ◽  
Locally Advanced Disease ◽  
Ureteral Carcinoma ◽  
The Impact

Few studies have analyzed the details of neoadjuvant chemotherapy (NAC)-induced changes in patients with upper tract urothelial carcinoma. This study aimed to describe the impact of down-grading ipsilateral hydronephrosis by NAC for ureteral carcinoma. An observational study was conducted in 32 patients with cT1-3N0M0 ureteral carcinoma treated with NAC and radical nephroureterectomy. Hydronephrosis was classified into five grades based on computed tomography findings. We focused on the differences between the baseline and post-NAC status of ipsilateral hydronephrosis, radiographic tumor response, and blood markers. Down-grading, no change, and up-grading was observed in 10 (31%), 21 (66%), and 1 (3%) patients, respectively. In univariate analysis, locally advanced disease (cT3), severe hydronephrosis (grade 3/4) at baseline, no change/up-grading of hydronephrosis after NAC, and pathological lymphovascular involvement were identified as potential prognostic factors of progression-free and cancer-specific survival after radical nephroureterectomy. Locally advanced disease (cT3) at baseline and no change/up-grading of hydronephrosis by NAC were independently associated with poor progression-free survival. Notably, none of the patients with NAC-induced down-grading of hydronephrosis died of ureteral carcinoma during the follow-up. We reported the prognostic impact of down-grading of ipsilateral hydronephrosis, which could serve as a useful aid or clinical marker for decision-making.

scholarly journals Prognostic Impact of Stromal Immune Infiltration before and after Neoadjuvant Chemotherapy (NAC) in Triple Negative Inflammatory Breast Cancers (TNIBC) Treated with Dose-Dense Dose-Intense NAC

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2657
Author(s):  
Luca Campedel ◽  
Paul Blanc-Durand ◽  
Asker Bin Asker ◽  
Jacqueline Lehmann-Che ◽  
Caroline Cuvier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative ◽  
Univariate Analysis ◽  
Tumor Infiltrating Lymphocytes ◽  
Complete Response ◽  
Prognostic Impact ◽  
Breast Cancers ◽  
Dose Dense ◽  
The Impact

Inflammatory breast cancers are very aggressive, and among them, triple negative breast cancer (TNBC) has the worst prognosis. While many studies have investigated the association between tumor-infiltrating lymphocytes (TIL) before neoadjuvant chemotherapy (NAC) and outcome in TNBC, the impact of post-NAC TIL and TIL variation in triple negative inflammatory breast cancer (TNIBC) outcome is unknown. Between January 2010 to December 2018, all patients with TNIBC seen at the breast disease unit (Saint-Louis Hospital) were treated with dose-dense dose-intense NAC. The main objective of the study was to determine factors associated with event-free survival (EFS), particularly pathological complete response (pCR), pre- and post-NAC TIL, delta TIL and post-NAC lymphovascular invasion (LVI). After univariate analysis, post-NAC LVI (HR 2.06; CI 1.13–3.74; p = 0.02), high post-NAC TIL (HR 1.81; CI 1.07–3.06; p = 0.03) and positive delta TIL (HR 2.20; CI 1.36–3.52; p = 0.001) were significantly associated with impaired EFS. After multivariate analysis, only a positive TIL variation remained negatively associated with EFS (HR 1.88; CI 1.05–3.35; p = 0.01). TNIBC patients treated with intensive NAC who present TIL enrichment after NAC have a high risk of relapse, which could be used as a prognostic marker in TNIBC and could help to choose adjuvant post-NAC treatment.

The outcome of patients with triple negative breast cancer: Evidence for a favorable ethnic subgroup? The Turkish Oncology Group experience

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22158-e22158
Author(s):  
Y. Eralp ◽  
G. Basaran ◽  
M. Dogan ◽  
D. Dincol ◽  
S. Demirci ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Advanced Disease ◽  
Locally Advanced ◽  
National Registry ◽  
Prognostic Impact ◽  
Nodal Involvement ◽  
Locally Advanced Disease

e22158 Background: Triple negative breast cancer (TNBC) is generally considered as a poorer prognostic subgroup, with a propensity for earlier relapse and visceral involvement. The aim of this study is to evaluate the outcome of non-metastatic TNBC patients in a National registry setting and identify clinical and pathologic variables associated with survival. Methods: From a retrospective registry cohort of 296 TNBC patients treated and followed between 1993–2007, we identified 248 patients with early stage disease, with follow-up of at least 12 months. The prognostic impact of several clinical variables were evaluated by the Kaplan-Meier and Cox multivariate anayses. Results: Median age was 48. The majority of the patient group had invasive ductal carcinoma (n:204, 82.3%). Distribution by stage was as follows: stage 1: 49 (19.8%), st 2: 125 (50.4%), st 3: 69 (27.8%). Excluding 11 patients, all had received adjuvant chemotherapy. 5 year overall survival (OS) and disease-free survival (DFS) rates were 84±2.7 % and 69±3.3%, respectively. Median survival after initial recurrence was 20 months. Sites of relapse were as follows: lung: 26 (36.1%), liver:8 (11.1%), brain: 8 (11.1%), bone: 14 (19.4%), skin/lymphatic: 7 (9.7%). Univariate analysis revealed locally advanced disease (p:0.0001), larger tumor size (p:0.004), nodal positivity (p<0.00001), and extent of nodal involvement as significant factors for DFS; whereas, locally advanced disease (p:0.0099) and extent of nodal involvement (p:0.018) were identified as prognostic factors with an impact on OS. Multivariate analysis revealed locally advanced disease (HR: 3.3, p:0.02, 95% CI: 0.14–0.64) and extent of nodal involvement (HR:4.3, p:0.033, 95% CI: 0.059–0.88) as significant independent prognostic factors for DFS and OS, respectively. Conclusions: The outcome of patients with TNBC in this National registry cohort is comparable to other subsets with similar prognostic features and do not support the generally accepted notion that TNBC entails poor prognosis. It may be speculated that there may be inherent ethnic differences leading to distinctive tumor behaviour. Further translational research is required to identify molecular prognostic groups within the TN subset. No significant financial relationships to disclose.

Neoadjuvant chemotherapy for elderly patients with locally advanced disease: Are we doing enough?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 389-389
Author(s):  
Andres Correa ◽  
Elizabeth Handorf ◽  
Shreyas Joshi ◽  
Benjamin T. Ristau ◽  
Miki Haifler ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Older Patients ◽  
Advanced Disease ◽  
Interaction Analysis ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Multivariate Logistic Regression Analysis ◽  
Cancer Data ◽  
Locally Advanced Disease

389 Background: The administration of neoadjuvant chemotherapy (NAC) for patients with muscle invasive urothelial carcinoma improves overall survival. Recent reports have shown that the survival benefit may be greater in patients with locally advanced disease. Our objective was to assess the utilization of NAC by stage and age using a large national tumor registry. Methods: Patients who underwent radical cystectomy for cT2-4 N0-1 M0 urothelial carcinoma diagnosed between 2003-2012 were selected from the National Cancer Data Base. We excluded those with planned radiation therapy or who received palliative care. A multivariate logistic regression analysis was constructed to identify factors that affected administration of NAC. Covariates included were clinical stage, age, race, sex, insurance status, income, Charlson index, clinical stage group, demographic location, facility location, and diagnosis year. We also used interaction terms in the regression model to determine if stage effects differed by age group. Results: A total of 16,248 patients met inclusion criteria for the study. The use of NAC increased over the study period with 6% of eligible patients receiving NAC in 2003 vs. 27.7% in 2012 (p < 0.001).Increasing utilization of NAC was noted with increasing stage (cT2N0: 15.7%; cT3N0: 19.8%; cT4N0/TanyN1: 20.9%, p < 0.001) and decreasing NAC utilization was noted with increasing age ( < 65 years: 18.5%; 65-74 years: 18.5%; ≥ 75 years: 9.0%, p < 0.001). Following adjustment, increasing clinical stage was associated with an increase in the administration of NAC, (cT3N0 OR 1.46 [CI 1.24-1.71]; T4/TanyN1 OR 1.88 [CI 1.62-2.18]) compared to cT2 disease. In comparison, increasing age (age 65-74 years OR 0.78 (CI 0.68-0.88]; age ≥ 75 years OR 0.37 [CI 0.33-0.43]) was associated with decreased utilization of NAC compared to patients < 65 years. On interaction analysis the effect of higher stage on the likelihood of receiving NAC was attenuated in older patients ( ≥ 75 years). Conclusions: The administration NAC has increased over the last 10 years and is more likely to be given to patients with locally advanced disease or early nodal stage. However, this trend is substantially attenuated in older patients ( ≥ 75 years).

scholarly journals Obesity is Associated with Upgrading in Prostate Cancers

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 221-225 ◽  
Author(s):  
Mustafa Sungur ◽  
Selahattin Çalışkan
Keyword(s):  
Radical Prostatectomy ◽  
Advanced Disease ◽  
Locally Advanced ◽  
High Grade ◽  
Locally Advanced Disease ◽  
Oncological Results ◽  
The Difference ◽  
Prostate Cancers ◽  
The Impact ◽  
The Relationship

Abstract Background: Prostate cancer (PCa) is the second most common cancer and sixth most common cause of cancer associated death among men in the world. Multiple studies demonstrated the relationship between obesity and PCa in the recent years. Aim: The present study aimed to investigate the impact of obesity on postoperative oncological results after radical prostatectomy. Materials and methods: A total of 110 patients who were treated radical prostatectomy between January 2011 and April 2016 were analyzed retrospectively. The patients who had information about age, height, weight, biopsy results, PSA level and pathological results were recorded. The patients were classified to three groups according to the BMI; normal (BMI<25 kg/m2), overweight (BMI>25 and <30 kg/m2) and obese (BMI>30 kg/m2). Results: The present study included 101 patients. Of these patients; 26, 57 and 18 patients were in groups respectively. The age at the presentation and PSA level was lower and higher than the other patients. The proportion of locally advanced disease and high grade PCa were the highest in obese patients at prostatectomy specimen examination. The upgrading is significantly associated with obesity. Conclusion: This study demonstrated that obese men are younger and had higher PSA concentration at the diagnosis of PCa. High grade PCa, locally advanced disease and upgrading was seen much more in patients with BMI>30 kg/m2 at final pathology. The difference reached significance for upgrading between groups.

Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series

2021 ◽  
pp. 039156032110351
Author(s):  
Alessandro Uleri ◽  
Rodolfo Hurle ◽  
Roberto Contieri ◽  
Pietro Diana ◽  
Nicolòmaria Buffi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Advanced Disease ◽  
Independent Predictor ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Small Sample ◽  
Locally Advanced Disease ◽  
Increased Risk

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

Impact of KRAS mutational status on outcomes in patients with pancreatic cancer (PDAC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4142-4142
Author(s):  
Lucy Xiaolu Ma ◽  
Gun Ho Jang ◽  
Amy Zhang ◽  
Robert Edward Denroche ◽  
Anna Dodd ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Advanced Disease ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
First Line ◽  
Kras Mutations ◽  
Kaplan Meier ◽  
Mutational Status ◽  
Translational Research Program ◽  
The Impact

4142 Background: KRAS mutations (m) (KRASm) are present in over 90% of pancreatic adenocarcinomas (PDAC) with a predominance of G12 substitutions. KRAS wildtype (WT) PDAC relies on alternate oncogenic drivers, and the prognostic impact of these remains unknown. We evaluated alterations in WT PDAC and explored the impact of specific KRASm and WT status on survival. Methods: WGS and RNAseq were performed on 570 patients (pts) ascertained through our translational research program from 2012-2021, of which 443 were included for overall survival (OS) analyses. This included 176 pts with resected and 267 pts with advanced PDAC enrolled on the COMPASS trial (NCT02750657). The latter cohort underwent biopsies prior to treatment with first line gemcitabine-nab-paclitaxel or mFOLFIRINOX as per physician choice. The Kaplan-Meier and Cox proportional hazards methods were used to estimate OS. Results: KRAS WT PDAC (n = 52) represented 9% of pts, and these cases trended to be younger than pts with KRASm (median age 61 vs 65 years p = 0.1). In resected cases, the most common alterations in WT PDAC (n = 23) included GNASm (n = 6) and BRAFm/fusions (n = 5). In advanced WT PDAC (n = 27), alterations in BRAF (n = 11) and ERBB2/3/4 (n = 6) were most prevalent. Oncogenic fusions (NTRK, NRG1, BRAF/RAF, ROS1, others) were identified in 9 pts. The BRAF in-frame deletion p.486_491del represented the most common single variant in WT PDAC, with organoid profiling revealing sensitivity to both 3rd generation BRAF inhibitors and MEK inhibition. In resected PDAC, multivariable analyses documented higher stage (p = 0.043), lack of adjuvant chemotherapy (p < 0.001), and the KRAS G12D variant (p = 0.004) as poor prognostic variables. In advanced disease, neither WT PDAC nor KRAS specific alleles had an impact on prognosis (median OS WT = 8.5 mths, G12D = 8.2, G12V = 10.0, G12R = 12.0, others = 9.2, p = 0.73); the basal-like RNA subtype conferred inferior OS (p < 0.001). A targeted therapeutic approach following first line chemotherapy was undertaken in 10% of pts with advanced PDAC: MMRd (n = 1), homologous recombination deficiency (HRD) (n = 19), KRASG12C (n = 1), CDK4/6 amplification (n = 3), ERBB family alterations (n = 2), BRAF variants (n = 2). OS in this group was superior (14.7 vs 8.8 mths, p = 0.04), mainly driven by HRD-PDAC where KRASm were present in 89%. Conclusions: In our dataset, KRAS G12D is associated with inferior OS in resected PDAC, however KRAS mutational status was not prognostic in advanced disease. This suggests that improved OS in the WT PDAC population can only be achieved if there is accelerated access to targeted drugs for pts.

scholarly journals Can 3T multiparametric magnetic resonance imaging accurately detect prostate cancer extracapsular extension?

2013 ◽  
Vol 7 (11-12) ◽  
pp. 699 ◽  
Author(s):  
Yannick Cerantola ◽  
Massimo Valerio ◽  
Aida Kawkabani Marchini ◽  
Jean-Yves Meuwly ◽  
Patrice Jichlinski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Magnetic Resonance ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Resonance Imaging ◽  
Extracapsular Extension ◽  
Predictive Values ◽  
Locally Advanced Disease ◽  
Multiparametric Magnetic Resonance Imaging

Background: Accurate staging is essential to determine the correct management of patients diagnosed with prostate cancer. We assess the accuracy of 3T multiparametric magnetic resonance imaging (MRI) with endorectal coil (3TemMRI) in detecting prostate cancer local extension.Methods: We retrospectively reviewed charts from January 2008 to July 2012 from all patients undergoing radical prostatectomy. Patients were only included if 3TemMRI and radical prostatectomywere performed at our institution. Based on the presence of extracapsular extension (ECE) at 3TemMRI, prostate cancer was dichotomized into locally advanced or organ-confined disease. The accuracy of 3TemMRI local staging was then evaluated using definitive pathology as a reference.Results: Overall, 177 radical prostatectomies were performed within the timeframe. After applying exclusion criteria, 60 patients were included in the final analysis. The mean patient age was 67 ± 7 (standard deviation) years. Mean prostate-specific antigen value was 12.7 ± 12.7 ng/L. Based on preoperative characteristics, we considered 38 of the 60 patients (63%) patients high risk. 3TemMRI identified an organ-confined tumour in 46 patients and locally advanced disease in 14 patients. When correlated to final pathology, 3TemMRI specificity, sensitivity, negative and positive predictive values, and accuracy in detecting locally advanced prostate cancer were 90%, 35%, 57%, 79% and 62%, respectively.Interpretation: This study shows that the use of preoperative 3TemMRI can be used to identify organ-confined prostate cancer when locally advanced disease is suspected.

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