Nutritional status and primary tumour site in incurable cancer

ObjectivesWe aimed (1) to assess the nutritional status (NS) using different methods, according to the primary tumour site and (2) to evaluate the performance of these methods in patients with incurable cancer from a reference centre in Brazil.MethodsCross-sectional analysis of data from patients admitted to the palliative care unit of a reference cancer centre in Brazil, between July 2016 and March 2020. The primary tumour site was the independent variable and the NS using different methods were the dependent variables. Logistic regressions were performed.ResultsA total of 2,144 patients were included in the study. The most common primary tumour site was the upper gastrointestinal (GI) tract (18.0%), followed by gynaecological (17.6%) and head and neck (HN) (13.5%). Our results showed that patients with tumours of the upper GI tract followed by HN presented significantly higher risk of worse NS. In contrast, breast tumours, bone and connective tissues and melanoma presented inverse association. The gynaecological cancer was variably associated with nutritional impairment, according to the assessment method.ConclusionsPatients with incurable cancer present high prevalence of NS impairment, depending on the tumour site, shown to be elevated in patients with tumour in the upper GI tract.

Twenty-year experience with salvage total laryngectomy: lessons learned

Objective The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. Method A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. Results Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. Conclusion More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer

Background Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. Methods This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Results Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Conclusion Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

ETMR-01. TREATMENT OUTCOME OF TWO CASES WITH HIGH-GRADE NEUROEPITHELIAL TUMOR WITH BCOR ALTERATION

INTRODUCTION High grade neuroepithelial tumor with BCOR exon 15 internal tandem duplication (HGNET BCOR) is a recently described tumor entity of the central nervous system (CNS) with a distinct methylation profile and characteristic genetic alteration. We report the outcome of two cases after 1st line multimodality therapy. MATERIAL AND METHOD A 7 year old girl with a ventricular tumour and a 6 year old boy with a tumour in the occipital region with infiltration of the transverse and sigmoid sinus were both diagnosed based on histology and methylation with HGNET-BCOR. No spinal or liquor dissemination were found at diagnosis in both cases. Treatment consisted of radical resection of the tumour. In the case of the lesion with sinus infiltration residual tumour in the vessel could not be removed. Both children were postoperatively treated with radiotherapy (craniospinal 36 Gy and boost to 54 Gy), concomitant Vincristin and adjuvant Cisplatin, Lomustine and Vincristine. RESULTS The girl developed a local recurrence at the primary tumour site 18 months after diagnosis. Reoperation showed the same histology. Start of 2nd line chemotherapy with Temozolomid and Irinotecan is being discussed. The boy with sinus infiltration developed seven months after diagnosis multiple liver, lung and bone metastasis. Biopsy of a liver lesion showed HGNET-BCOR. He was treated with Temozolomid, Irinotecan and died nine months after diagnosis. CONCLUSION We report two cases with failure after 1st line treatment for HGNET-BCOR. To our knowledge HGNET-BCOR with development of hematological disease dissemination is a rare finding.

Risk of cancer-specific death for patients diagnosed with neuroendocrine tumors: A population-based analysis.

4605 Background: While patients with neuroendocrine tumours (NETs) are known to experience prolonged overall survival, the contribution of cancer-specific and non-cancer deaths is undefined. We examined cancer-specific and non-cancer death after NET diagnosis. Methods: We conducted a population-based retrospective cohort study of adult patients with NETs from 2001-2015 by linking administrative healthcare datasets. Using competing-risks methods, we estimated the cumulative incidence of cancer-specific and non-cancer death and stratified by primary NET site and metastatic status. Sub-distribution hazard models examined prognostic factors. Results: Among 8,607 included patients, median follow-up was 42 months (interquartile range: 17-82). The risk of cancer-specific was higher than that of non-cancer death, with 27.3% (95%CI: 26.3-28.4%) and 5.6% (95%CI: 5.1-6.1%) at 5 years. Cancer-specific deaths largely exceeded non-cancer deaths in synchronous and metachronous metastatic NETs. Patterns varied by primary tumour site, with highest risks of cancer-specific death in broncho-pulmonary and pancreatic NETs. For non-metastatic gastric, small intestine, colonic, and rectal NETs, the risk of non-cancer death exceeded that of cancer-specific deaths. Advancing age, higher material deprivation, and metastases were independently associated with higher hazards, and female sex and high comorbidity burden with lower hazards of cancer-specific death. Conclusions: Among all NETs, the risk of dying from cancer is higher than that of dying from other causes. Heterogeneity exists by primary NET site. Some patients with non-metastatic NETs are more likely to die from non-cancer than from cancer causes. This information is important for counselling, decision-making, and design of future trials. Cancer-specific mortality should be included in outcomes when assessing treatment strategies.

CXCR4-CXCL12 axis and distant metastatic outgrowth in head and neck malignancy

Background: To analyze whether distant metastatic outgrowth in different head and neck malignancies (HNM) underlies the CXCR4-CXCL12 axis as overriding molecular mechanism. Methods: Clinic-pathological data of 1,250 HNM was included. HNM were collected due to different capability to exhibit distant metastasis comprising basal cell, squamous cell, and adenoid-cystic carcinoma as well as melanoma. MMP2/9, TIMP1/2, CXCR4, and CXCL12 immunohistochemistry was done in 190 randomly selected specimens.Results: Immunohistochemistry visualized a significant increase in MMP2/9, TIMP1/2, CXCR4, and CXCL12 protein expression following the clinical occurrence of distant metastasis. CXCR4, CXCL12, and TIMP2-expression significantly increases with number of affected organs by distant metastasis. Cox regression demonstrated CXCR4-overexpression and advanced T-status being independent risk factors of distant metastasis associated death.Conclusion: The CXCR4-CXCL12 axis is associated with the occurrence of distant metastases in different HNM. The increased risk of distant metastasis associated death was identified at primary tumour site and, therefore, potentially influences further treatment protocols.

Novel patient risk factors and validation of a difficulty scoring system in laparoscopic repeat hepatectomy

The indications for laparoscopic liver resection have expanded; however, the safety and benefits of laparoscopic repeat hepatectomy (LRH) remain unclear. We retrospectively reviewed data from 137 patients who underwent partial hepatectomy or left lateral sectionectomy without thoracotomy. We compared patients’ clinical factors using a difficulty scoring system for LRH. We defined factors associated with blood loss volumes in the 75th percentile or above as risk factors for bleeding in open repeat hepatectomy, and determined whether these factors were useful for LRH risk assessment. Open repeat hepatectomy and LRH was performed in 96 and 41 patients, respectively. Four of 41 (9.8%) patients undergoing LRH were converted to laparotomy. Blood loss volume was significantly greater in the intermediate-risk group than in the low-risk group (P = 0.046). Multivariate analysis revealed that the presence of tumours located adjacent and caudal or dorsal to the primary tumour site was an independent risk factor for bleeding in LRH (odds ratio 3.21, 95% confidence interval 1.16–8.88, P = 0.024). Our study validated the usefulness of a difficulty scoring system, identified patient factors that predicted the difficulty of LRH, and presented a novel difficulty scoring system for LRH based on an existing difficulty scoring system.

Predictive Factors of Response to Sunitinib in Imatinib-Resistant Gastrointestinal Stromal Tumors (GISTs): A Multi-Institutional Study

Imatinib 400 mg is the standard of care for medical treatment of advanced GISTs. In the majority of cases, however, GISTs eventually develop resistance to imatinib. The optimal second line treatment has not been established yet and imatinib dose escalation (800 mg) or sunitinib represent two feasible options. The objective of this retrospective, multi-institutional, study is to analyze the validity of several parameters as possible predictive factors of response to sunitinib after imatinib failure. We reviewed 128 metastatic GISTs treated with sunitinib between January 2007 to June 2017. Primary tumour site, metastatic site, c-KIT/PDGFR-α mutational status, PET-FDG status and type of disease progression to sunitinib were assessed as possible predictive factors of response. This study identifies the gastric site of primary tumor as a predictive factor to sunitinib efficacy in second line setting. The mutational status (GIST WT), the site of metastasis (peritoneum) and the FDG-PET status (negative), although not statistically significant, seem to be elements of increased activity for sunitinib treatment. These results provide the rationale to drive physician for sunitinib choice in second line setting for metastatic GISTs, to improve patients selection and to maximize the benefit from the treatment, on the basis of possible predictive factors of response.