scholarly journals Neoadjuvant radiotherapy followed by surgery compared with surgery alone in the treatment of retroperitoneal sarcoma: a population-based comparison

2019 ◽  
Vol 26 (6) ◽  
Author(s):  
B. T. Turner ◽  
L. Hampton ◽  
D. Schiller ◽  
L. A. Mack ◽  
C. Robertson-More ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Local Recurrence ◽  
Tumour Size ◽  
Univariate Analysis ◽  
Multivisceral Resection ◽  
Population Based ◽  
Retroperitoneal Sarcoma ◽  
Fisher Exact Test ◽  
Tumour Grade ◽  
Neoadjuvant Radiotherapy

Introduction Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection.Methods Patients diagnosed with rps from February 1990 to October 2014 were identified in the Alberta Cancer Registry. Patients with complete gross resection of rps and no distant disease were included. Patient, tumour, treatment, and outcomes data were abstracted in a primary chart review. Baseline characteristics were compared using the Wilcoxon nonparametric test for continuous data and the Fisher exact test for dichotomous and categorical data. Survival was analyzed using Kaplan–Meier curves with log-rank test. Cox regression was performed to control for age, sex, tumour size, tumour grade, date of diagnosis, multivisceral resection, and intraoperative rupture.Results Resection alone was performed in 62 patients, and resection after nrt, in 40. Use of nrt was associated with multivisceral resection and negative microscopic margins. On univariate analysis, nrt was associated with superior median lrfs (89.3 months vs. 28.4 months, p = 0.04) and os (119.4 months vs. 75.9 months, p = 0.04). On multivariate analysis, nrt, younger age, and lower tumour grade predicted improved lrfs and os; sex, tumour size, date of diagnosis, multivisceral resection, and tumour rupture did not.Conclusions In this population-based study, nrt was associated with superior lrfs and os on both univariate and multivariate analysis. When feasible, nrt should be considered until a randomized controlled trial is completed.

Abstract 17: Prehospital Deterioration During Transport by Emergency Medical Services for Stroke Patients: A Population-Based Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sabreena J Gillow ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moonmaw ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Onset Time ◽  
Population Based ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Hospital Arrival ◽  
Neurologic Deterioration

Introduction: Stroke patients can experience neurological change in the prehospital setting. We sought to identify factors associated with prehospital neurologic deterioration. Methods: Among the Greater Cincinnati/Northern Kentucky region (pop. ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke, and included patients with age ≥20 and complete EMS records. Glasgow Coma Scale (GCS) at hospital arrival was compared with GCS evaluated by EMS, with decrease ≥2 points considered neurologic deterioration. Data obtained included age, sex, race, medical history, antiplatelet or anticoagulant use, stroke subtype [ischemic (IS), ICH, or SAH] and IS subtype (e.g., small vessel, large vessel, cardioembolic), seizure at onset, time from symptom onset to EMS arrival, time from EMS to hospital arrival, blood pressure and serum glucose on EMS arrival, and EMS level of training. Univariate analysis was completed using Wilcoxon rank sum test for continuous measures and chi-square or Fisher’s exact test for categorical measures. Multivariate analysis was completed on variables with p ≤ 0.20 in the univariate analysis. Results: Of 2708 total stroke patients, 1097 (870 IS, 176 ICH, 51 SAH) had EMS records (median [IQR] age 74 [61, 83] years; 56% female; 21% black). Onset to EMS arrival was ≤4.5 hours for 508 cases (46%), and median time from EMS to hospital arrival was 26 minutes. Neurological deterioration occurred in 129 cases (12%), including 9.1% of IS and 22% of ICH/SAH. In multivariate analysis, black race, atrial fibrillation, ICH or SAH subtype, and ALS transport were associated with neurological deterioration. Conclusion: Atrial fibrillation may predict prehospital deterioration in stroke, and preferential transport of patients with acute worsening to centers capable of managing hemorrhagic stroke may be justifiable. Further studies are needed to identify why race is associated with deterioration and potential areas of intervention.

Management of Recurrent Retroperitoneal Sarcoma

2017 ◽  
Author(s):  
Armen Parsyan ◽  
Abha Gupta ◽  
Charles Catton ◽  
Rebecca Gladdy
Keyword(s):  
Local Recurrence ◽  
Surgical Resection ◽  
Multivisceral Resection ◽  
Distant Recurrence ◽  
Retroperitoneal Sarcoma ◽  
Key Words Chemotherapy ◽  
Pattern Of Failure ◽  
Mesenchymal Tumors ◽  
Retroperitoneal Sarcomas ◽  
High Level

Retroperitoneal sarcomas (RPSs) are a heterogeneous group of mesenchymal tumors. The mainstay of treatment of RPS is curative surgical resection, which often involves a multivisceral resection. The predominant pattern of failure in RPS is local recurrence, which poses significant management challenges and limits survival. There is a paucity of high-level evidence to guide the management of primary and recurrent RPS, mainly due to the rarity of the disease. This review highlights the challenges and decision making in the diagnosis and management of recurrent RPS.  This review contains 6 figures, 5 tables and 50 references Key words: chemotherapy, distant recurrence, leiomyosarcoma, liposarcoma, local recurrence, radiation therapy, retroperitoneal sarcoma, surgical resection 

scholarly journals Radiomics Analysis of Fat-Saturated T2-Weighted MRI Sequences for the Prediction of Prognosis in Soft Tissue Sarcoma of the Extremities and Trunk Treated With Neoadjuvant Radiotherapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Silin Chen ◽  
Ning Li ◽  
Yuan Tang ◽  
Bo Chen ◽  
Hui Fang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Survival Analysis ◽  
Prognostic Factors ◽  
Soft Tissue ◽  
Tumour Size ◽  
Curve Analysis ◽  
Rank Test ◽  
Neoadjuvant Radiotherapy ◽  
Log Rank Test ◽  
Tumour Location

PurposeTo create a prognostic prediction radiomics model for soft tissue sarcoma (STS) of the extremities and trunk treated with neoadjuvant radiotherapy.MethodsThis study included 62 patients with STS of the extremities and trunk who underwent magnetic resonance imaging (MRI) before neoadjuvant radiotherapy. After tumour segmentation and preprocessing, 851 radiomics features were extracted. The radiomics score was constructed according to the least absolute shrinkage and selection operator (LASSO) method. Survival analysis (disease-free survival; DFS) was performed using the log-rank test and Cox’s proportional hazards regression model. The nomogram model was established based on the log-rank test and Cox regression model. Harrell’s concordance index (C-index), calibration curve and receiver operating characteristic (ROC) curve analysis were used to evaluate the prognostic factors. The clinical utility of the model was assessed by decision curve analysis (DCA).ResultsThe univariate survival analysis showed that tumour location (p = 0.032), clinical stage (p = 0.022), tumour size (p = 0.005) and the radiomics score were correlated with DFS (p < 0.05). The multivariate analysis showed that tumour location, tumour size, and the radiomics score were independent prognostic factors for DFS (p < 0.05). The combined clinical-radiomics model based on the multivariate analysis showed the best predictive ability for DFS (C-index: 0.781; Area Under Curve: 0.791). DCA revealed that the use of the radiomics score-based nomogram was associated with better benefit gains relative to the prediction of 2-year DFS events than other models in the threshold probability range between 0.12 and 0.38.ConclusionThe radiomics score from pretreatment MRI is an independent prognostic factor for DFS in patients with STS of the extremities and trunk. The radiomics score-based nomogram could improve prognostic stratification ability and thus contribute to individualized therapy for STS patients.

The risk of debilitating falls in Manitobans living with prostate cancer (pc).

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 244-244
Author(s):  
Joel Roger Gingerich ◽  
Pascal Lambert ◽  
Malcolm Doupe ◽  
Paul Joseph Daeninck ◽  
Marshall W. Pitz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cumulative Incidence ◽  
Large Population ◽  
Univariate Analysis ◽  
Population Based ◽  
Community Dwelling ◽  
Low Grade ◽  
Population Based Study ◽  
Increased Risk

244 Background: Falls and fall-related injuries are important patient safety problems. Some studies suggest that pc patients have higher fall rates, however the severity of these falls is unknown. We sought to measure if pc patients are at increased risk of a debilitating fall requiring hospitalization. Methods: This is a retrospective population-based study utilizing the Manitoba Cancer Registry and Manitoba Health administrative databases. Our cohort consists of all community-dwelling patients living in Manitoba Canada who were diagnosed with pc between 2004 and 2008. These individuals were matched by age, sex, and time of diagnosis with up to three cancer-free controls. Debilitating falls were defined as falls/fractures requiring hospitalization and were identified using ICD-9 and -10 billing codes. A competing risk model was used to compare debilitating falls between the pc and cancer-free cohorts and expressed as sub-hazard ratios. Follow-up ended December 31, 2009. Results: 2,903 pc patients were identified along with 8,686 matched controls. The mean age was 69.3 and 68.8 respectively. The median follow-up was 3.05 years. Debilitating falls were identified in 109 patients (3.8%) with pc and 345 (4%) matched controls. The cumulative incidence of debilitating falls for those with pc vs cancer-free controls were: 1.08% vs. 1.13% at 1-year and 5.25% vs. 5.96% at five years of follow-up (SHR = 0.95, 95% CI = 0.77 – 1.18, p = 0.65). On univariate analysis, patients with stage IV pc were at higher risk of falls compared to matched controls. This difference was not significant on multivariate analysis though (SHR = 1.19, 95% CI = 0.74 – 1.89, p = 0.48). On multivariate analysis, patients with a Gleason score of ≤6 experienced a reduced risk of debilitating falls compared to matched controls (SHR = 0.44, 95% CI = 0.27 – 0.72, p = 0.001), whereas patients with other Gleason scores did not. The analysis was similar when patients with fractures were excluded. Conclusions: In this large population-based study, the 1- and 5-year cumulative incidence of debilitating falls did not differ significantly for patients with vs without pc. In fact, compared to matched controls, low grade pc patients were less likely to experience a debilitating fall.

Impact of Immune response-associated gene polymorphisms on tumor response in rectal cancer patients treated with capecitabine +/- oxaliplatine and radiation in the ACCORD-12/PRODIGE-2 phase III trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15151-e15151
Author(s):  
Valerie Boige ◽  
Caroline Mollevi ◽  
Nathalie Chaput ◽  
Sophie Gourgou ◽  
David Azria ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Tumor Response ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Phase Iii ◽  
P Value ◽  
Neoadjuvant Radiotherapy ◽  
Predictive Values ◽  
Phase Iii Trial

e15151 Background: We examined whether 133 germline polymorphisms (SNPs) in 15 candidate genes (CSF1R, IL8RA, TLR4, IL10, IL10RA, CTLA4, IL2, IL2RA, TGF b1, ICOS, IL13, IL13RA2, IFNgR, IL15 and IL15RA) would predict clinical outcome in the ACCORD-12 phase III trial which randomly compared neoadjuvant radiotherapy (RT) plus capecitabine (CAP45) with dose-intensified RT plus capecitabine and oxaliplatin (CAPOX50) in T3-4 Nx M0 resectable rectal cancer. Methods: A candidate-gene association study was conducted in 316 patients (n = 161 in the CAPOX50 and n = 155 in the CAP45 arm). The primary end-point was tumor response according to the Dworak score in each arm. Logistic regressions were used to assess univariate/multivariate associations. The Storey and Tibshirani method based on the control of false discovery rate was used ( q-value < 0.10 (adjusted p-value) considered as true discovery). Multivariate models adjusted on treatment arm and T stage were performed to determine prognostic and predictive values of SNPs for tumor response. Results: In univariate analysis, two SNPs in IL2RA (rs11256456: OR = 5.1 [2.38; 11] and rs706781: OR = 4.2 [1.98 ; 8.74]) were significantly associated with the Dworak score in the CAP45 arm, and one in IL2RA the CAPOX50 arm (rs2104286: OR = 0.11 [0.01 ; 0.90]. All were confirmed in the multivariate analysis. A significant haplotypic effect was observed in the CAP-45 arm (p = 0.0001). Interaction was significant for IL2RA rs11256456 ( p= 0.03) and rs706781 ( p= 0.002) and no significant for IL2RA rs2104286 ( p= 0.722), suggesting a predictive deleterious effect the first two ones for response to oxaliplatin-based chemoRT, and a prognostic effect of the third one for response to chemoRT (+/- oxaliplatin). None of the three IL2RA SNPs were correlated with survival in the multivariate analysis. Conclusions: This pharmacogenetic analysis shows that SNPs in IL2RA have a significant association with response to chemoRT with capecitabine in patients with locally advanced rectal cancer. Their predictive effect may identify patients in whom oxaliplatin addition to chemoRT is deleterious.

Abstract TMP5: Vessel Status Findings in Patient Candidates Transferred for Endovascular Treatment. Data From Catalonia’s Code Stroke Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alan Flores ◽  
Xavier Ustrell ◽  
Laia Seró ◽  
Anna Pellisé ◽  
Jaume Viñas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Population Based ◽  
Time Intervals ◽  
Anterior Circulation ◽  
Stroke Registry ◽  
Lower Baseline ◽  
Treatment Data ◽  
Basilar Occlusion ◽  
Distal Occlusion

The aim of this study was to determine changes in vessel status between PSC and CSC according to site and occlusion level, rtPA-treatment, and pre-specified time intervals. Methods: Observational, multicenter study, from a prospective, government-mandated, population-based registry. We selected data from candidates to EVT with documented LVO at PSC who were transferred to CSC from January 2017 to June 2019. We used clinical variables and time intervals as the Symptom-Onset to Vascular-Imaging at CSC (SOTVI2). The primary endpoint was defined as no-occlusion/distal occlusion ineligible for EVT at CSC arrival (NOEVTatCSC) as was utilized. Results: From 589 patients, 37% received rtPA. Rate of NOEVTatCSC was 10.5% (n: 62) and 87% were treated with rtPA, being 35.8% of causes to exclude EVT at CSC arrival. In univariate analysis, lower baseline-NIHSS (median 12 vs. 16 p<0.01), RACE-scale (median 5 vs. 6; p=0.04) and SOTVI2-time (mean-minutes 268.7 vs. 317.2; p=0.04), rtPA treatment (13.7% Vs. 5.0%; p<0.01), and M2 occlusion (16.8% Vs. 9%; p= 0.02) were associated with NOEVTatCSC. In multivariate analysis, only rtPA-treatment was associated with NOEVTatCSC (OR: 4.65, 95%CI: 1.73-12.4, p= 0.003). In the rtPA subgroup, Basilar occlusion (28% Vs. 12%; p=0.04), lower baseline-NIHSS (13 Vs. 16; p<0.01) and SOTVI2 times ≤240 minutes (28.9% Vs. 15.4%; p=0.02) were associated with NOEVTatCSC. In Multivariate analysis SOVI2 ≤240 minutes (OR: 2.109 95%CI: 1.008-4.401, p=0.04) emerged as the only predictor of NOEVTatCSC. Changes in the vessel status according to initial occlusion at PSC in anterior circulation were observed, and occurred in both; proximal and distal direction. In 11.2% of cases, occlusion site at CSC was more proximal than at PSC. Conclusion: In patient candidates for EVT transferred from PSC to CSC, NOEVTatCSC is infrequent making the need of a second vascular study before the angiogram at CSC arguable. Despite of its modest effect, tPA-treatment at PSC is the only factor associated with NOEVTatCSC. This could be most relevant in basilar occlusions and in the first 4-hours. Changes in the vessel status according to initial occlusion in PSC occur in anterior circulation. Future studies addressed to determine factors related to these changes are warranted.

Management of Recurrent Retroperitoneal Sarcoma

2017 ◽  
Author(s):  
Armen Parsyan ◽  
Abha Gupta ◽  
Charles Catton ◽  
Rebecca Gladdy
Keyword(s):  
Local Recurrence ◽  
Surgical Resection ◽  
Multivisceral Resection ◽  
Distant Recurrence ◽  
Retroperitoneal Sarcoma ◽  
Key Words Chemotherapy ◽  
Pattern Of Failure ◽  
Mesenchymal Tumors ◽  
Retroperitoneal Sarcomas ◽  
High Level

Retroperitoneal sarcomas (RPSs) are a heterogeneous group of mesenchymal tumors. The mainstay of treatment of RPS is curative surgical resection, which often involves a multivisceral resection. The predominant pattern of failure in RPS is local recurrence, which poses significant management challenges and limits survival. There is a paucity of high-level evidence to guide the management of primary and recurrent RPS, mainly due to the rarity of the disease. This review highlights the challenges and decision making in the diagnosis and management of recurrent RPS.  Key words: chemotherapy, distant recurrence, leiomyosarcoma, liposarcoma, local recurrence, radiation therapy, retroperitoneal sarcoma, surgical resection 

Prognostic Value of Immunophenotype In Infant ALL – Results of the INTERFANT'99 Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2700-2700
Author(s):  
Tomasz Szczepanski ◽  
Lukasz Sedek ◽  
Paola de Lorenzo ◽  
Martin Schrappe ◽  
Richard Ratei ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Antigen Expression ◽  
White Blood Count ◽  
Study Cohort ◽  
Fisher Exact Test ◽  
Cns Involvement ◽  
Equal Distribution ◽  
Entire Study

Abstract Abstract 2700 Objective: Infant acute lymphoblastic leukemia (ALL) is characterized by distinct biological and clinical features. In this study, we aimed at detailed evaluation of infant ALL immunophenotype based on the large cohort of patients treated homogeneously on INTERFANT'99 protocol. Patients and Methods: We were able to obtain sufficient flow cytometry based immunophenotypic data from 286 (130 boys and 156 girls) of 483 infant ALL cases treated on INTERFANT'99 protocols. The distribution of patient and leukemia characteristics as well as clinical outcome were very similar to the entire study cohort (Pieters et al, Lancet 2007; 370: 240–250). The positivity for a certain antigen was defined at the cut-off value of >20% of cells expressing this antigen. In B-cell precursor ALL (BCP-ALL), evaluated antigens included CD10, CD20, CD34, myeloid markers (CD13, CD33, CD15 and/or CD65) and NG2 antigen assessed with 7.1 antibody. The strength of association between characteristics (patient's age and gender, initial white blood count [WBC], CNS involvement, presence of MLL gene rearrangements, prednisone response [PR]) and antigen expression was analyzed with Fisher exact test adjusted for multiple comparisons. Univariate analysis of outcome by immunophenotype was based on event free survival (EFS) and compared by log-rank test. Multivariate analysis was performed using Cox model in MLL-rearranged cases. P values < 0.05 were considered to be significant. Results: Altogether, 272 cases of infant BCP-ALL and 14 of infant T-ALL were analyzed. Most BCP-ALL cases were CD10 negative (66%), CD20 negative (88%), CD34 positive (60%), and NG2 positive (58%). Co-expression of myeloid antigens was less frequent and concerned CD13 in 8%, CD33 in 17%, CD15 in 31%, and CD65 in 28%. CD10 negativity and NG2 expression were significantly more frequent in younger infants, patients with initial high leukocytosis and with MLL rearrangements. CD34 expression was observed more frequently in younger infants, while CD20 positivity was significantly associated with lower initial leukocytosis and absence of MLL rearrangement. For myeloid antigen expression, the only significant association was more frequent CNS involvement in infants with CD13+ and/or CD33+ BCP-ALL. Analysis of outcome showed significantly better prognosis for CD10 positivity (4-year EFS of 56.3 as compared to 37.2 for CD10 negative BCP-ALL), absence of NG2 expression (4-year EFS of 63.9 as compared to 34.9 for NG2 positive BCP-ALL) and CD33 negativity (4-year EFS of 47.6 as compared to 27.7 for CD33 positive BCP-ALL). There was also a trend towards better outcome in CD20 positive infant BCP-ALL. While CD10 negativity and NG2 positivity were associated with well-known high-risk features, prognostic significance of CD33 expression is somewhat more difficult to explain. Of note, CD10 negativity was not associated to a worst outcome in MLL-rearranged patients. Moreover, in this subset, multivariate analysis showed that none of the markers analyzed had independent prognostic significance, after adjustment for sex, age at diagnosis, WBC and PR. In rare infant T-ALL cases, we observed equal distribution to different immunophenotypic subgroups as defined by EGIL classification. Conclusion: Infant BCP-ALL has distinct immunophenotypic features. However, immunophenotype has no independent prognostic relevance when MLL, age, WBC, PR and other factors are included. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic Factors and Survival Analysis of Patients with Triple Negative Breast Cancer - A Retrospective Study from a Tertiary Care Teaching Hospital in Kerala

2021 ◽  
Vol 8 (18) ◽  
pp. 1287-1292
Author(s):  
Binitha Tresa Thomas ◽  
Preeya Vasanthakumary ◽  
Ancy Joseph
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Growth Factor ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Tumour Size ◽  
Univariate Analysis ◽  
Nodal Density

BACKGROUND Breast cancer is now the most common cancer in Indian women, having recently surpassed cervical cancer in incidence. Triple negative breast cancer (TNBC), which accounts for 15 % of all the breast cancers is an aggressive type seen in younger women with early signs of metastasis, has a poor prognosis due to systemic recurrence and its refractoriness to conventional adjuvant therapy. The purpose of this study was to look into the various prognostic factors associated with 5 years disease-free survival (DFS) and overall survival (OS) in TNBC. METHODS This retrospective study included 67 patients with complete treatment and followup (median 57 months) presented and treated in the Department of Radiotherapy, Kottayam, between January 2011 and December 2012. The Kaplan-Meier approach was used to analyse survival. Using the log-rank test, univariate analysis of prognostic factors was completed. Using the Cox regression process, multivariate analysis was performed on IBM SPSS version 20. RESULTS The average age was 51.36 ± 11.393 (median, 51.36 years; range 30.0 – 80.0 years), with a median of 50 months, the five-year OS was 65.7 % and DFS was found to be 59.7 % with a median of 45 months, suggesting aggressive nature and poor TNBC survival. Univariate analysis of prognostic factor, clinical stage (cN) and positive nodes (pN) status, clinical tumour size, lympho-vascular invasion (LVI), grade, and nodal density were found to have a significant impact on DFS. Except tumour grade and LVI all were found to be associated with OS. Multivariate analysis, clinical tumour size and pathological nodal status had a significant impact on OS and DFS. CONCLUSIONS TNBC is an aggressive subtype of breast cancer in younger patients with a high risk of metastasis to visceral organs with inherent molecular subtypes and immunological heterogeneity. For treatment of TNBC, targeted estimated glomerular filtration rate (EGFR), fibroblast growth factor receptor 2 (FGFR2), vascular endothelial growth factor (VEGF), and mechanistic target of rapamycin (mTOR) receptor based initial treatment setting will improve the outcome dramatically and will fill the unmet clinical needs. KEYWORDS TNBC, Recurrence, OS, DFS, Nodal Density

Anaemia in patients with transitional cell carcinoma (TCC) of the bladder treated with radiotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14569-14569
Author(s):  
C. Joynson ◽  
P. Symonds ◽  
S. Sundar
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Local Recurrence ◽  
Haemoglobin Level ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Transitional Cell ◽  
Prognostic Indicators ◽  
Significant Difference ◽  
The Impact

14569 Background: Treatment of muscle invasive TCC of the bladder with radiotherapy allows organ preservation and is frequently used in the UK especially in patients not medically fit for cystectomy. Anaemia is known to be an indicator of poor response to radiotherapy in head and neck and cervical carcinomas. This study describes the prevalence and type of anaemia in patients with TCC of the bladder and looks at the impact anaemia has on treatment outcome. Methods: Retrospective review of notes was performed on patients treated radically between 1992 and1997. Potential patient, tumour and treatment prognostic indicators were reported. Patients were labelled as being anaemic if their pre treatment haemoglobin level was below the normal range (below 13.5g/dl for men and below 11.5g/dl for women). Time to local recurrence, metastases and overall survival was recorded. Recurrence free survival and overall survival actuarial estimations were done using the Kaplan Meier method and compared by log rank testing. Multivariate analysis was carried out using Cox Regression method, correcting for potential confounding factors. Results: Data on 100 patients were available for analysis. 52 patients were anaemic with 75% of these having a normochromic, normocytic anaemia. Univariate analysis showed no significant difference in time to local recurrence, a trend to shorter time to metastases, and a significant reduction in overall survival in anaemic patients (p = 0.04). Two year survival was 43% and 22% for non anaemic and anaemic patients respectively. Multivariate analysis using covariates tumour stage, grade, and serum creatinine found anaemia to be poor prognostic indicator for overall survival (p = 0.005) and time to metastases (p = 0.003). Conclusions: Anaemia is highly prevalent in patients with bladder cancer. This retrospective study shows anaemic patients to have a worse outcome with radiotherapy treatment than patients with a normal haemoglobin level. This is not accounted for by a difference in local control which may be expected from hypoxic radiobiological principles. Anaemia may be indicative of more aggressive malignancy or sub clinical metastases. No significant financial relationships to disclose.

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