Association between chemotherapy and prognostic factors of survival in hepatocellular carcinoma: a SEER population-based cohort study

Hepatectomy and transplantation are the main surgical therapies for HCC patients, and radiotherapy or chemotherapy is often used as adjuvant treatment. Researches have evaluated the independent predictors of HCC, but evidence for factors predicting the efficacy of chemotherapy is rare. Patients diagnosed with HCC between 2010 and 2015 from the SEER database were included and randomly divided into non-chemotherapy and chemotherapy groups. The predictors of CSS and OS were analyzed with the Cox proportional-hazards regression model and Fine and Gray’s competing risk model. Although there was no significant difference in survival analysis between the chemotherapy and non-chemotherapy groups, the cumulative cancer-specific mortality of most HCC patients was decreased in the chemotherapy group. AJCC stage, tumor size, grade, surgery and radiotherapy were predictors of OS and CSS in the non-chemotherapy group, while AJCC stage, tumor size, AFP, grade and surgery in the chemotherapy group. Surgery combined with chemotherapy was applicable to all AJCC stage patients. Surgery was the major treatment option for patients in AJCC I and AJCC II stage, and chemotherapy in AJCC III and AJCC IV stage. In conclusion, the study provided population-based estimates of the prognostic factors in HCC patients with or without chemotherapy.

Correlation of ER PR receptors with other prognostic parameters of breast carcinoma

To study the MRM specimens for size, grade of the tumor, LVI and LN metastases and the ER/PR receptors of the tumor. To study the association of ER/PR status with the above mentioned prognostic parameters. This three-year study includes 72 histopathologically confirmed cases of carcinoma breast. The tumor type, grade, LNM, LVE were reported on H & E. The ER-PR study was done of all 72 cases. The tumor size, grade, LNM, LVE were correlated with receptor status. Out of 72 cases majority (53%) of cases were in 41-50 years of age group, and tumor size was between 2-4 cm in (54.16%) cases; majority were of grade II carcinoma (60%) of which 59% were ER-PR positive. Out of 46 cases with negative LNM and LVE, 30 cases (65%) were ER-PR positive. In our observation there is no association between higher histological grade and ER-PR status. No obvious correlation with tumor size was noted. But increase in tumor size could also be a poor predictor of ER-PR status. LNM, LVE is poor predictor of ER-PR status.

The Influence of Different Treatment Strategies on the Long-Term Prognosis of T1 Stage Esophageal Cancer Patients

ObjectiveTo compare the long-term prognosis effects of non-esophagectomy and esophagectomy on patients with T1 stage esophageal cancer.MethodsAll esophageal cancer patients in the study were included from the National Surveillance Epidemiology and End Results (SEER) database between 2005-2015. These patients were classified into non-esophagectomy group and esophagectomy group according to therapy methods and were compared in terms of esophagus cancer specific survival (ECSS) and overall survival (OS) rates.ResultsA total of 591 patients with T1 stage esophageal cancer were enrolled in this study, including 212 non-esophagectomy patients and 111 esophagectomy patients in the T1a subgroup and 37 non-esophagectomy patients and 140 esophagectomy patients in the T1b subgroup. In all T1 stage esophageal cancer patients, there was no difference in the effect of non-esophagectomy and esophagectomy on postoperative OS, but postoperative ECSS in patients treated with non-esophagectomy was significantly better than those treated with esophagectomy. Cox proportional hazards regression model analysis showed that the risk factors affecting ECSS included race, primary site, tumor size, grade, and AJCC stage but factors affecting OS only include tumor size, grade, and AJCC stage in T1 stage patients. In the subgroup analysis, there was no difference in either ECSS or OS between the non-esophagectomy group and the esophagectomy group in T1a patients. However, in T1b patients, the OS after esophagectomy was considerably better than that of non-esophagectomy.ConclusionsNon-esophagectomy, including a variety of non-invasive procedures, is a safe and available option for patients with T1a stage esophageal cancer. For some T1b esophageal cancer patients, esophagectomy cannot be replaced at present due to its diagnostic and therapeutic effect on lymph node metastasis.

VEGF-B, VEGF-A, FLT-1, KDR, ERBB2, EGFR, GRB2, RAC1, CDH1 and HYAL-1 Genes Expression Analysis in Canine Mammary Gland Tumors and the Association with Tumor ClinicoPathological Parameters and Dog Breed Assessment

Canine mammary gland tumors (CMTs) are one of the most prevalent cancers in dogs and a good model for human breast cancer (BC), however gene expression analysis of CMTs is scarce. Although divergence of genes expression has been found in BC of different human races, no such research of different dog’s breeds has been done. The purpose of this study was to investigate expression of the VEGF-B, VEGF-A, FLT-1, KDR, ERBB2, EGFR, GRB2, RAC1, CDH1 and HYAL-1 genes of canine mammary carcinomas, compare the expression levels with clinicopathological parameters and analyze expression disparities between different breeds. Carcinomas and adjacent tissues were collected from female dogs to perform routine histopathology, immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qRT-PCR). We found that VEGF-B and EGFR genes were overexpressed in the mammary gland carcinomas compared to adjacent tissue. VEGF-B gene expression had associations with different parameters (tumor size, grade, and absence of metastasis). Furthermore, differences in VEGF-B, FLT1, ERBB2, GRB2, RAC1, CDH1 and HYAL-1 genes expression have been found in different breed dogs (German Shepherd, Yorkshire Terrier) and mixed-breed dogs indicating that a dog’s breed could determine a molecular difference, outcome of cancer and should be accounted as a confounding factor in the future gene expression research.

Correlation ER/PR status of Breast Carcinoma with Tumor size, Tumor grade, Lymphovascular emboli, Lymph node metastasis and the distant metastasis

Breast cancer is the most frequent cancer in females in the world and is the second most common cancer in India after cervical cancer. The breast cancer is second most common reason of loss of existence in each developed and additionally most of the growing countries. For the appraisal of prognosis of breast cancer commonly followed is the NOTTINGHAM PROGNOSTIC INDEX (NPI) which includes- tumor size, histological tumor grade, lymph node metastasis and hormone receptor status. These prognostic component help in administration and therapeutic requirement of breast cancer patient.1. To study the MRM specimens for size, grade of the tumor, LVI and LN metastases and the ER/PR receptors of the tumor. 2.To study the association of ER/PR status with the above mentioned prognostic parameters.This three-year study includes 50 histopathologically confirmed cases of carcinoma breast. The tumor type, grade, LNM, LVE were reported on H & E. The ER-PR study was done of all 50 cases. The tumor size, grade, NM, LVE were correlated with receptor status. Out of 50 cases majority (7.5%) of cases were in 41-50 years of age group, and tumor size was between 2-4 cm in (17.5%) cases; majority were of grade II carcinoma (17.5%) of which 13% were ER-PR positive. Out of 35 cases with negative LNM and LVE, 26 cases (13%) were ER-PR positive.In our observation there is no association between higher histological grade and ER-PR status. No obvious correlation with tumor size was noted. But increase in tumor size could also be a poor predictor of ER-PR status. LNM, LVE is poor predictor of ER-PR status.

Association between chemotherapy and prognostic factors of survival in hepatocellular carcinoma: a SEER population‑based cohort study

Background Hepatectomy and transplantation are the main surgical therapies for HCC patients, and radiotherapy or chemotherapy is often used as the adjuvant treatment. Researches have evaluated the independent predictors of HCC, but evidence for factors predicting the efficacy of chemotherapy is rare. Methods Patients diagnosed with HCC between 2010 and 2015 from the SEER database were included and randomly divided into non-chemotherapy and chemotherapy groups. The predictors of CSS and OS were analyzed with the Cox proportional-hazards regression model and Fine and Gray’s competing risk model. Results Although there was no significant difference in survival analysis between the chemotherapy and non-chemotherapy groups, the cumulative cancer-specific mortality of most HCC patients were decreased in chemotherapy group. AJCC stage, tumor size, grade, surgery and radiotherapy were predictors of OS and CSS in non-chemotherapy group, while AJCC stage, tumor size, AFP, grade and surgery in chemotherapy group. Surgery combined with chemotherapy was applicable to all AJCC stage patients. Surgery was the major treatment option for patients in AJCC Ⅰ and AJCC Ⅱ stage, and chemotherapy in AJCC Ⅲ and AJCC Ⅳ stage. Conclusions In conclusion, the study provided population-based estimates of the prognostic factors in HCC patients with or without chemotherapy.

Risk Factors for Lymph Node Metastasis of Soft Tissue Sarcomas of the Head, Neck and Extremities, And the Clinical Significance of Negative Lymph Node Dissection

Background: To determine the risk factors for lymph node metastasis (LNM) of soft tissue sarcomas (STS) of the head, neck, and extremities, and the clinical outcome of negative lymph node dissection (NLND). Methods: We pooled patients of STS using the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2015. Logistics regression analysis to identify risk factors for LNM, the Cox proportional hazards model and Fine-Grey’s model were used for survival analysis, Propensity score matching analysis (PSM) was further used to clarify the impact of NLND on patient prognosis.Results: A total of 3,276 patients were enrolled in our study, of whom 283 (8.6%) developed LNM. Rhabdomyosarcoma had the highest rate of LNM (25.3%), followed by clear cell sarcoma (16.8%) and epithelioid sarcoma (12.4%), while leiomyosarcoma had the lowest rate of LNM (1.3%). Sex, tumor size, grade, histology, and site were significantly associated with LNM. Age, tumor size, grade, stage, histology, and marital status were independent prognostic factors for the cancer-specific survival for patients without LNM. For specific histologic subtypes of STS, NLND significantly improves overall survival (HR: 0.718, 95%CI, 0.535-0.962; P=0.026) and cancer-specific survival (HR: 0.699, 95%CI, 0.506-0.967; P=0.031) and reduces cancer-specific mortality (Gray’s test, P=0.017). However, for patients with leiomyosarcoma, NLND did not improve overall survival (P=0.46) or reduce cancer-specific mortality (Gray’s test, P=0.772).Conclusions: We identified the rate of LNM and risk factors for LNM in STS of the head, neck and extremities. In addition, prophylactic NLND treatment is necessary and has a clinical benefit for patients with STS who are at high risk for LNM, but has no significant impact on the prognosis of patients with leiomyosarcoma.

Development and validation of prognostic nomograms for patients with colon neuroendocrine neoplasms

Background Colon neuroendocrine neoplasms (NENs) have one of the poorest median overall survival (OS) rates among all NENs. The American Joint Committee on Cancer (AJCC) tumor–node–metastasis (TNM) staging system—currently the most commonly used prediction model—has limited prediction accuracy because it does not include parameters such as age, sex, and treatment. The aim of this study was to construct nomograms containing various clinically important parameters to predict the prognosis of patients with colon NENs more accurately. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database, we performed a retrospective analysis of colon NENs diagnosed from 1975 to 2016. Data were collected from 1196 patients; almost half were female (617/1196, 51.6%), and the average age was 61.94 ± 13.05 years. Based on the age triple cut-off values, there were 396 (33.1%), 408 (34.1%), and 392 (32.8%) patients in age groups 0–55 years, 55–67 years, and ≥ 68 years, respectively. Patients were randomized into training and validation cohorts (3:1). Independent prognostic factors were used for construction of nomograms to precisely predict OS and cancer-specific survival (CSS) in patients with colon NENs. Results Multivariate analysis showed that age ≥ 68 years, sex, tumor size, grade, chemotherapy, N stage, and M stage were independent predictors of OS. In the validation cohort, the Concordance index (C-index) values of the OS and CSS nomograms were 0.8345 (95% confidence interval [CI], 0.8044–0.8646) and 0.8209 (95% CI, 0.7808–0.861), respectively. C-index also indicated superior performance of both nomograms (C-index 0.8347 for OS and 0.8668 for CSS) compared with the AJCC TNM classification (C-index 0.7159 for OS and 0.7366 for CSS). Conclusions We established and validated new nomograms for more precise prediction of OS and CSS in patients with colon NENs to facilitate individualized clinical decisions.

O14 Optimising the management of primary breast cancer in older women

Introduction The risk of breast cancer increases with age and our global population is ageing. By 2040 the number of breast cancer cases diagnosed per year worldwide will double and over 40% of these will be in patients aged 70 or over. Despite this, there are few treatment guidelines specific to breast cancer in older women and none which consider the unique biological differences of this cohort. Method Surgical and core needle biopsy (CNB) specimens were obtained from an existing series of 1,785 women over the age of 70 with primary breast cancer, treated in a single institution with long-term (37+ years) follow-up. Of this cohort, 813 had primary surgical treatment. As part of previous work, it was possible to construct good quality tissue microarrays (TMAs) in 575 surgical specimens and 693 CNB specimens. Immunohistochemical staining for 32 biomarkers has been performed in all of the available TMAs. Association between histological score for each biomarker and tumour size, grade, recurrence rate, breast cancer specific and overall survival is currently being investigated in the whole cohort. Results Results to date have revealed a unique biological cluster in older women with primary breast cancer that is not seen in a comparative younger cohort. In the future, bioinformatics analysis will determine which biomarkers and in what combination, can predict chance of recurrence/overall survival in this cohort. Conclusions This information will be used to create a prognostic tool specific to assist older women with decision making regarding primary treatment of breast cancer.

Impact of breast cancer risk factors on clinically relevant prognostic biomarkers for primary breast cancer

Purpose In addition to impacting incidence, risk factors for breast cancer may also influence recurrence and survival from the disease. However, it is unclear how these factors affect combinatorial biomarkers for aiding treatment decision-making in breast cancer. Methods Patients were 8179 women with histologically confirmed invasive breast cancer, diagnosed and treated in a large cancer hospital in Beijing, China. Individual clinicopathological (tumor size, grade, lymph nodes) and immunohistochemical (IHC: ER, PR, HER2, KI67) markers were used to define clinically relevant combinatorial prognostic biomarkers, including the Nottingham Prognostic Index (NPI: combining size, grade, nodes) and IHC4 score (combining ER, PR, HER2, KI67). Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between breast cancer risk factors and quartiles (Q1–Q4) of NPI and IHC4 were assessed in multivariable polytomous logistic regression models. Results Overall, increasing parity (ORtrend(95% CI) = 1.20(1.05–1.37);Ptrend = 0.007), overweight (OR(95% CI)vs normal = 1.60(1.29–1.98)), and obesity (OR(95% CI) vs normal = 2.12(1.43–3.14)) were associated with higher likelihood of developing tumors with high (Q4) versus low (Q1) NPI score. Conversely, increasing age (ORtrend(95% CI) = 0.75(0.66–0.84);Ptrend < 0.001) and positive family history of breast cancer (FHBC) (OR(95% CI) = 0.66(0.45–0.95)) were inversely associated with NPI. Only body mass index (BMI) was associated with IHC4, with overweight (OR(95% CI) vs normal = 0.82(0.66–1.02)) and obese (OR(95% CI) vs normal = 0.52(0.36–0.76)) women less likely to develop high IHC4 tumors. Notably, elevated BMI was associated with higher NPI irrespective of hormone receptor-expression status. Conclusions Our findings indicate that factors affecting breast cancer incidence, particularly age, parity, FHBC, and BMI, may impact clinically relevant prognostic biomarkers with implications for surveillance, prognostication, and counseling.