Cutaneous melanoma survival rates of the elderly are not worse than those of the young, yet they have some specific differences

Abstract Objective: The aim of this study was to clarify the prognostic value of the pathological lymph node ratio for elderly and non-elderly gastric cancer patients and to evaluate whether there is a difference in the survival of patients with the same LNR (Lymph Node Ratio).Materials and Methods: A total of 222 patients diagnosed with locally advanced gastric cancer and who underwent gastrectomy were included. The patients were divided into two groups according to age. Clinicopathological properties of the two groups were compared. Potential prognostic factors affecting survival were analyzed. Subsequently, the effect of lymphadenectomy and LNR on survival in both groups was evaluated. Results: Significant differences were detected in terms of the location of primary lesions, hemoglobin and albumin levels between elderly patients and non-elderly patients (p < .05). Overall survival (OS) was significantly worse in elderly patients (22 months vs. 67 months, p<0.001). The survival rates in elderly patients were significantly lower from those of non-elderly in the subgroup LNR Stage 2 (12.1% vs. 47.9 %, P = 0.004) and LNR Stage 3 classification (9.1% vs. 34.1%, P = 0.039). LNR was found to be significant for OS with a cut-off point of 0.18. Conclusion: A survival difference was found between the elderly and non-elderly patients with the same LNR. LNR was found to be an independent factor for survival especially in elderly patients. Survival was found to be further decreased in elderly patients compared to non-elderly patients with increasing LNR.

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Long-Term Results of Kidney Transplantation in the Elderly: Comparison between Different Donor Settings

Journal of Clinical Medicine ◽

10.3390/jcm10225308 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5308

Author(s):

Renana Yemini ◽

Ruth Rahamimov ◽

Ronen Ghinea ◽

Eytan Mor

Keyword(s):

Graft Survival ◽

Cox Regression ◽

Survival Rates ◽

The Elderly ◽

Long Term Results ◽

Live Donor ◽

Allocation Policy ◽

Cox Regression Analysis ◽

Factors Associated

With scarce organ supply, a selection of suitable elderly candidates for transplant is needed, as well as auditing the long-term outcomes after transplant. We conducted an observational cohort study among our patient cohort >60 years old with a long follow up. (1). Patients and Methods: We used our database to study the results after transplant for 593 patients >60 years old who underwent a transplant between 2000–2017. The outcome was compared between live donor (LD; n = 257) recipients, an old-to-old (OTO, n = 215) group using an extended criteria donor (ECD) kidney, and a young-to-old (YTO, n = 123) group using a standard-criteria donor. The Kaplan−Meir method was used to calculate the patient and graft survival and Cox regression analysis in order to find risk factors associated with death. (2). Results: The 5- and 10-year patient survival was significantly better in the LD group (92.7% and 66.9%) compared with the OTO group (73.3% and 42.8%) and YTO group (70.9% and 40.6%) (p < 0.0001). The 5- and 10-year graft survival rates were 90.3% and 68.5% (LD), 61.7% and 30.9% (OTO), and 64.1% and 39.9%, respectively (YTO group; p < 0.0001 between the LD and the two DD groups). There was no difference in outcome between patients in their 60’s and their 70’s. Factors associated with mortality included: age (HR-1.060), DM (HR-1.773), IHD (HR-1.510), and LD/DD (HR-2.865). (3). Conclusions: Our 17-years of experience seems to justify the rational of an old-to-old allocation policy in the elderly population. Live-donor transplant should be encouraged whenever possible. Each individual decision of elderly candidates for transplant should be based on the patient’s comorbidity and predicted life expectancy.

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P81 Cutaneous melanoma in the elderly

Critical Reviews in Oncology/Hematology ◽

10.1016/s1040-8428(09)70119-2 ◽

2009 ◽

Vol 72 (1) ◽

pp. S47-S48

Author(s):

A. Testori ◽

J. Soteldo ◽

D. Sances ◽

G. Mazzarol ◽

G. Trifirò ◽

...

Keyword(s):

Cutaneous Melanoma ◽

The Elderly

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La chirurgia conservativa renale nell'anziano: Kidney preserving surgery in the elderly

Urologia Journal ◽

10.1177/039156039806500210 ◽

1998 ◽

Vol 65 (2) ◽

pp. 243-245

Author(s):

C. Tallarigo ◽

G. Novella ◽

F. Mastroeni ◽

L.G. Luciani ◽

V. Ortalda

Keyword(s):

Renal Function ◽

Survival Rates ◽

The Elderly ◽

Conservative Surgery ◽

Limiting Factor ◽

Renal Neoplasm ◽

Renal Surgery ◽

Surgery In The Elderly ◽

Disease Free ◽

Dialytic Treatment

Conservative renal surgery has recently been extended to elderly patients who have decreased renal function and reduced survival rates in the case of dialytic treatment. Furthermore, age is no longer a limiting factor despite the increased anethesiological risk. Fifteen cases of renal neoplasm in patients over 70, who had undergone conservative surgery, were reviewed: 14 are alive and disease-free after 14-135 months and 1 died from unrelated causes. It is concluded that conservative renal surgery has a role even in the elderly.

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Influence of Comorbidity on Outcome after Pulmonary Resection in the Elderly

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230701500406 ◽

2007 ◽

Vol 15 (4) ◽

pp. 297-302 ◽

Cited By ~ 7

Author(s):

Morris Beshay ◽

Patrick Dorn ◽

Hans-Beat Ris ◽

Ralph A Schmid

Keyword(s):

Pulmonary Resection ◽

Preoperative Evaluation ◽

Lung Resection ◽

Survival Rates ◽

Age Groups ◽

The Elderly ◽

Major Complications ◽

Proper Patient Selection ◽

Significant Difference ◽

Group 3

The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60–75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.

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Non-Hodgkin's Lymphoma in the Elderly: A Retrospective Evaluation of Toxicity Related to Aggressive vs. Conservative Treatments

Tumori Journal ◽

10.1177/030089168807400410 ◽

1988 ◽

Vol 74 (4) ◽

pp. 433-438 ◽

Cited By ~ 3

Author(s):

Umberto Tirelli ◽

Vittorina Zagonel ◽

Rachele Volpe ◽

Mauro G. Trovo ◽

Antonino Carbone

Keyword(s):

Elderly Patients ◽

Hodgkin’S Lymphoma ◽

Randomized Trials ◽

Survival Rates ◽

The Elderly ◽

Hodgkin's Lymphoma ◽

Severe Toxicity ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Significant Difference

The outcome of 70 elderly patients aged 65 years or more (median, 71 years) with non-Hodgkin's lymphoma (NHL) treated between 1973 and 1981 with aggressive (AM) or conservative modalities (CM) was retrospectively evaluated. A significantly higher incidence of lethal and severe toxicity was observed in patients treated with AM than in those treated with CM (32 % vs 3 %, p < 0.01), with 10 % treatment related deaths in the AM group. Only 56 % of the deaths were attributed to NHL; other major causes were treatment-related deaths, infection and cardiac diseases. No significant difference in response and survival was found between AM and CM groups (complete remission rates were 35 % vs 42 %, and 10 year survival rates were 31 % vs 19 %, respectively), but the prevalence of stages III-IV in patients treated with AM makes these results meaningless. Prospective randomized trials with AM vs CM are clearly needed in elderly patients with advanced unfavorable NHL.

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Dissecting the Lymphatic System to Predict Melanoma Metastasis

Frontiers in Oncology ◽

10.3389/fonc.2020.576190 ◽

2020 ◽

Vol 10 ◽

Author(s):

Rishi Suresh ◽

Arturas Ziemys ◽

Ashley M. Holder

Keyword(s):

Cutaneous Melanoma ◽

Lymphatic System ◽

Survival Rates ◽

Metastatic Potential ◽

The United States ◽

Molecular Characteristics ◽

High Survival ◽

Melanoma Metastasis ◽

Metastatic Risk ◽

Ajcc Staging

Melanoma is the most lethal form of skin cancer in the United States. Current American Joint Committee on Cancer (AJCC) staging uses Breslow depth and ulceration as the two primary tumor factors that predict metastatic risk in cutaneous melanoma. Early disease stages are generally associated with high survival rates. However, in some cases, patients with thin melanomas develop advanced disease, suggesting other factors may contribute to the metastatic potential of an individual patient’s melanoma. This review focuses on the role of the lymphatic system in the metastasis of cutaneous melanoma, from recent discoveries in mechanisms of lymphangiogenesis to elements of the lymphatic system that ultimately may aid clinicians in determining which patients are at highest risk. Ultimately, this review highlights the need to integrate pathological, morphological, and molecular characteristics of lymphatics into a “biomarker” for metastatic potential.

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Metastatic melanoma in the elderly: Case series of clinical outcome and immune characteristics

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20018 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20018-e20018

Author(s):

U. P. Hegde ◽

N. Chakraborty ◽

A. Chhabra ◽

S. Ray

Keyword(s):

Immune System ◽

Clinical Outcome ◽

Elderly Patients ◽

Metastatic Melanoma ◽

Cutaneous Melanoma ◽

Proliferative Activity ◽

The Elderly ◽

High Dose ◽

The Impact

e20018 Background: Cutaneous melanoma incidence is rapidly rising in the elderly population. Imbalances of the immune system are described due to aging associated changes between CD4+, CD8+, T helper (Th) 1, Th 2 and T regulatory and T effector lymphocytes (lym). We describe clinical outcome in 10 elderly patients (pts) with cutaneous metastatic melanoma (CMM) and results of the immune studies done in a subgroup. Methods: Between October 2002 and October 2008, 10 elderly pts with treatment naïve CMM, 6 males and 4 female, median ages 76, range 57–84 years were treated at the University of Connecticut Health Center. Metastatic sites included soft tissue in 2 patients (pts), lung and/or liver with lymph node (LN) involvement (6 pts) and distant LN metastasis (2pts). Eight pts opted for treatment and received single or combination chemotherapy (5pts), high dose Interleukin 2 (2 pts), complete tumor resection followed by tumor derived heat shock protein vaccine (1 pt on clinical trial) and bio chemotherapy (1pt). One patient declined treatment (included in follow up). In vitro immune characteristics were studied in HLA-A2 positive subgroup (5pts) and included cytotoxic T lym (CTL) generation against self and non self peptides (Mart-1 27–35 and influenza MP derived peptide flu 58–66), proliferative activity of CD4+ lym in response to anti CD3 antibody under Th1 and Th2 conditions and regulatory T lym activity of CD4+CD25+ lym against CTL. Results: All patients tolerated treatments well resulting in 1 complete response, 4 partial responses, and 4 stable diseases. During 6 year follow up period, 6 patients died while 4 patients are living (one with disease). The median survival of all patients is 28.1 month (mo) while in those surviving (4pts) is 72 mo. Immune studies revealed preserved proliferative activity of CD4+ lym with stronger Th1 induction than Th2. The CTL responses to self and non self antigens were preserved while regulatory T lym showed weak activity against CTL. Conclusions: Some elderly patients with metastatic melanoma demonstrate improved outcomes and favorable immune characteristics. Further studies are needed to understand the impact of aging immune system on cutaneous melanoma. No significant financial relationships to disclose.

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Analyses of the immunologically relevant gene transcript by qRT-PCR in primary cutaneous melanoma by the young and the elderly.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e21135 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e21135-e21135

Author(s):

Upendra P. Hegde ◽

Soheil Sam Dadras ◽

Phil Kerr ◽

Nitya Chakraborty ◽

Jane grant-Kels ◽

...

Keyword(s):

Cutaneous Melanoma ◽

Statistical Significance ◽

The Elderly ◽

Gene Transcript ◽

Gene Expressions ◽

Primary Cutaneous Melanoma ◽

Total Rna ◽

Qrt Pcr ◽

Significant Difference ◽

Relevant Gene

e21135 Background: To understand the dynamics of anti tumor immune responses (IR) in the setting of the ageing immune system, we examined immunologically relevant gene transcripts in formalin fixed paraffin embedded (FFPE) primary cutaneous melanoma (PCM) samples derived from five young (age <50 years) and five elderly (age >or=70 years) patients by qRT-PCR. Methods: A total of 10 FFPE tumor blocks were collected between 2004-2007 of patients with PCM at the University of Connecticut Health Center. Total RNA was extracted from FFPE tissue sections and random primed cDNA was generated. Pre amplification using pooled Taqman assays and Universal PCR Master Mix (Applied Biosystems, USA) was performed for 14 cycles to ensure an adequate amount of starting material for qPCR. Using 15 ng total RNA, the quantification of human IR genes (IL-2, INFg, TNFa, TGFb1, IL-10, Foxp3, and IDO-1) and transcripts of succinate dehydrogenase (SDHA) (as endogenous control) was accomplished by qRT-PCR amplification of a cDNA using TaqMan Universal PCR Master Mix and TaqMan gene expressions assay probes. All reaction assays including that of SDHA were performed in triplicate on an ABI 7500 Fast system (Applied Biosystems). Cycle threshold (Ct) values for each mRNA were normalized to SDHA (DCT) and represented as RQ=2-DCT. The average RQ was calculated for all ten samples in both cohorts and Student’s T-test was performed to evaluate the statistical significance of the IR gene expression. Results: While no significant difference of expression of Th1 cytokines (IL-2, IFNg, TNFa) or Th2/3 cytokines (IL-10, TGFb) could be detected within the two groups, FOXp3 expression was significantly decreased in PCM in the elderly. Conclusions: Our results suggest ageing may be associated with less regulatory responses in situ in PCM and that more expanded analyses of the nature of the IR in PCM are likely to provide information with implications on prognosis and immune based treatment options for elderly PCM subjects.

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The Outcome of Combined-Modality Therapy for Stage III Non–Small-Cell Lung Cancer in the Elderly

Journal of Clinical Oncology ◽

10.1200/jco.2003.12.019 ◽

2003 ◽

Vol 21 (17) ◽

pp. 3201-3206 ◽

Cited By ~ 176

Author(s):

Steven E. Schild ◽

Philip J. Stella ◽

Susan M. Geyer ◽

James A. Bonner ◽

William L. McGinnis ◽

...

Keyword(s):

Elderly Patients ◽

Advanced Nsclc ◽

Combined Modality Therapy ◽

Locally Advanced ◽

Survival Rates ◽

The Elderly ◽

Small Cell Lung ◽

Combined Modality ◽

Locally Advanced Nsclc ◽

To Receive

Purpose: The North Central Cancer Treatment Group performed a phase III trial to determine whether chemotherapy plus either bid radiation therapy (RT) or daily (qd) RT resulted in a better outcome for patients with stage III non–small-cell lung cancer (NSCLC). No difference in survival was identified between the two arms. This secondary analysis was performed to examine the relationship between patient age and outcome. Patients and Methods: Two hundred forty-six patients were randomized to receive etoposide plus cisplatin and either RT qd or split-course RT bid. This retrospective study compared the outcomes of patients aged ≥70 years (“elderly patients”) with those of younger individuals. Of the 244 assessable patients, 63 (26%) were elderly, and 181 (74%) were younger individuals. Results: The 2-year and 5-year survival rates were 39% and 18%, respectively, in patients younger than 70 years, compared with 36% and 13%, respectively, in elderly patients (P = .4). Grade 4+ toxicity occurred in 62% of patients younger than 70 years compared with 81% of elderly patients (P = .007). Grade 4+ hematologic toxicity occurred in 56% of patients younger than 70 years, compared with 78% of elderly patients (P = .003). Grade 4+ pneumonitis occurred in 1% of those younger than 70 years, compared with 6% of elderly patients (P = .02). Conclusion: Toxicity, especially myelosuppression and pneumonitis, was more pronounced in the elderly patients receiving combined-modality therapy for locally advanced NSCLC. Despite increased toxicity, elderly patients have survival rates equivalent to younger individuals. Therefore, fit, elderly patients with locally advanced NSCLC should be encouraged to receive combined-modality therapy, preferably on clinical trials with cautious, judicious monitoring. Future studies should explore ways to decrease toxicity of therapy in elderly patients.

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