Three-weekly cisplatin dose is accepted for standard treatment for concurrent chemo-radiotherapy in nasopharyngeal carcinoma. However, different chemotherapy schedules are presented in the ...literature.
We intend to compare toxicity and outcomes of high dose 3-weekly cisplatin versus low dose weekly-cisplatin and cumulative dose of cisplatin in the patients with nasopharyngeal carcinoma.
98 patients were included in the study, between 2010 and 2018. Cumulative doses of cisplatin (≥200mg/m2 and <200mg/m2) and different chemotherapy schedules (weekly and 3-weekly) were compared in terms of toxicity and survival. Besides prognostic factors including age, gender, T category, N category and radiotherapy technique were evaluated in uni-multivariate analysis.
Median follow-up time 41.5 months (range: 2–93 months). Five year overall survival, local relapse-free survival, regional recurrence-free survival and distant metastasis-free survival rates were; 68.9% vs. 90.3% (p=0.11); 66.2% vs. 81.6% (p=0.15); 87.3% vs. 95.7% (p=0.18); 80.1% vs. 76.1% (p=0.74) for the group treated weekly and 3 weekly, respectively. There was no statistically significant difference between groups. Five year overall survival, local relapse-free survival, regional recurrence-free survival and distant metastasis-free survival rates were; 78.2% vs. 49.2% (p=0.003); 75.8% vs. 47.9% (p=0.055); 91% vs. 87.1% (p=0.46); 80% vs. 72.2% (p=0.46) for the group treated ≥200mg/m2 and <200mg/m2 cumulative dose cisplatin. There was statistically significant difference between groups for overall survival and there was close to being statistically significant difference between groups for local relapse-free survival. Age, gender, T category, N category, chemotherapy schedules were not associated with prognosis in the uni-variety analysis. Radiotherapy technique and cumulative dose of cisplatin was associated with prognosis in uni-variate analysis (HR=0.21; 95% CI: 0.071–0.628; p=0.005 and HR=0.29; 95% CI: 0.125–0.686; p=0.003, respectively). Only cumulative dose of cisplatin was found as an independent prognostic factor in multivariate analysis (HR=0.36; 95% CI: 0.146–0.912; p=0.03). When toxicities were evaluated, such as hematological toxicity, dermatitis, mucositis, nausea and vomiting, there were no statistically significant differences between cumulative dose of cisplatin groups (<200mg/m2 and ≥200mg/m2) and chemotherapy schedules (3-weekly and weekly). But malnutrition was statistically significant higher in patients treated with 3-weekly cisplatin compared with patients treated with weekly cisplatin (p=0.001).
A cisplatin dose with ≥200mg/m2 is an independent prognostic factor for overall survival. Chemotherapy schedules weekly and 3-weekly have similar outcomes and adverse effects. If patients achieve ≥200mg/m2 dose of cumulative cisplatin, weekly chemotherapy schedules may be used safely and effectively in nasopharyngeal carcinoma patients.
Três doses semanais de cisplatina com quimiorradioterapia concomitante são aceitas como o tratamento padrão para carcinoma nasofaríngeo. No entanto, diferentes esquemas quimioterápicos são recomendados na literatura científica.
Comparar a toxicidade e os resultados de 3 doses altas semanais de cisplatina versus dose baixa semanal de cisplatina em pacientes com carcinoma nasofaríngeo e verificar a dose cumulativa de cisplatina.
Foram incluídos 98 pacientes, entre 2010 e 2018. As doses cumulativas de cisplatina (≥200mg/m2 e <200mg/m2) e diferentes esquemas de quimioterapia (semanal e a cada 3 semanas) foram comparadas em termos de toxicidade e sobrevida. Além disso, fatores prognósticos incluindo idade, sexo, categoria T, categoria N e técnica de radioterapia foram avaliados na análise uni-multivariada.
O tempo médio de seguimento foi de 41,5 meses (intervalo: 2–93 meses). Sobrevida global de cinco anos, sobrevida livre de recidiva local, sobrevida livre de recidiva regional e sobrevida livre de metástases a distância foram: 68,9% vs. 90,3% (p=0,11); 66,2% vs. 81,6% (p=0,15); 87,3% vs. 95,7% (p=0,18); e 80,1% vs. 76,1% (p=0,74) para os grupos tratados semanalmente e 3 x/semana, respectivamente. Não houve diferença estatisticamente significante entre os grupos. Taxas de sobrevida global, sobrevida livre de recidiva local, sobrevida livre de recidiva regional e sobrevida livre de metástases à distância em cinco anos foram; 78,2% vs. 49,2% (p=0,003); 75,8% vs. 47,9% (p=0,055); 91% vs. 87,1% (p=0,46); 80% vs. 72,2% (p=0,46) para o grupo tratado com ≥200mg/m2 e <200mg/m2 de dose cumulativa de cisplatina. Houve diferença estatisticamente significante entre os grupos para sobrevida global e houve uma diferença quase estatisticamente significante entre os grupos para sobrevida livre de recidiva local. Idade, sexo, categoria T, categoria N e esquemas de quimioterapia não foram associados ao prognóstico na análise univariada. A técnica de radioterapia e dose cumulativa de cisplatina foram associadas ao prognóstico na análise univariada (HR=0,21; IC 95%: 0,071±0,628; p=0,005 e HR=0,29; IC 95%: 0,125±0,686; p=0,003, respectivamente). Apenas a dose cumulativa de cisplatina foi considerada um fator prognóstico independente na análise multivariada (HR=0,36; IC 95%: 0,146±0,912; p=0,03). Quando as toxicidades foram avaliadas, como toxicidade hematológica, dermatite, mucosite, náusea e vômito, não houve diferença estatisticamente significante entre a dose cumulativa dos grupos cisplatina (<200mg/m2 e ≥200mg/m2) e esquemas de quimioterapia (semanal e a cada 3 semanas). Entretanto, a desnutrição foi estatisticamente maior em pacientes tratados com cisplatina a cada 3 semanas em comparação com pacientes tratados com cisplatina semanalmente (p=0,001).
Uma dose de cisplatina ≥200mg/m2 é fator prognóstico independente para sobrevida global. Os esquemas de quimioterapia semanais e a cada 3 semanas têm resultados e efeitos adversos semelhantes. Se os pacientes atingirem uma dose cumulativa ≥200mg/m2 de cisplatina, os esquemas semanais de quimioterapia podem ser usados com segurança e eficácia em pacientes com carcinoma nasofaríngeo.
Abstract
Introduction
We aimed to assess the effect of VEGF-A, PDGF-BB, and c-Met expression levels on survival in patients with metastatic colorectal cancer receiving bevacizumab therapies.
Patients ...and methods
A total of 105 patients diagnosed with metastatic colorectal cancer between the years 2006 and 2016 were included in the research retrospectively.
Results
The progression-free survival (PFS) durations of patients with high expression levels of VEGF-A and with low expression levels of VEGF-A were 11 months and 10 months (p = 0.44), respectively. The PFS durations of patients with high PDGF-BB expression and low PDGF-BB expression were 12 months and 10 months (p = 0.16), respectively, while the PFS durations of patients with high and low c-Met expression were 8 months and 13 months (p = 0.005), respectively. Metastatic overall survival was 27 months and 18 months (p = 0.05) in patients with high and low VEGF-A expression levels, respectively, 31 months and 21 months (p = 0.16) in patients with high and low PDGF-BB expression levels, respectively, and 21 months and 26 months (p = 0.11) in patients with high and low c-Met expression levels, respectively.
Conclusion
The results of this research revealed a high c-Met expression relationship with worse PFS and low VEGF-A expression associated with poor metastatic overall survival in patients with metastatic colorectal cancer receiving bevacizumab therapies.
Objective: To investigate the effect of albumin to alkaline phosphatase ratio (AALPR) at survival in patients with metastatic bone sarcomas. Patients and Methods: 60 patients with metastatic bone ...sarcomas were included in the study. The relationship between AALPR before chemotherapy and overal survival (OS) and progression free survival (PFS) was evaluated with Cox regression multivariate analysis. Results: Of the patients in the study, 25 (58.3%) were osteosarcoma, 16 (26.7%) Ewing's sarcoma, 5 (8.3%) chondrosarcoma and 4 (6.7%) giant cell bone tumor. AALPR was 0.039 obtained in ROC analysis. The median PFS and OS at AALPR ≥ 0.039 group was statistically significantly higher than the group with <0.039 (p=0.006, p=0.003). AALPR <0.039 was found to be associated with poor OS and PFS (OS, HR=1.778, 95% CI, 1.211-1.912, p=0.023 - PFS, HR=4.782, 95% CI, 1.963-11,647, p=0.001 ). Conclusion: In our study, low AALPR value before chemotherapy was associated with poor OS and PFS in patients with metastatic bone sarcoma. Low AALPR has been associated with poor OS and PFS in many cancer types, but the association of AALPR with survival at bone sarcoma patients has not been evaluated previously. Our study is the first in the literature to investigate this issue. AALPR can be used as an inexpensive and simple marker to evaluate the prognosis of patients. However, studies with larger number of patients are needed to give more precise results.
Amaç: Metastatik kemik sarkomu hastalarında albümin-alkalen fosfataz oranının (AALPO) sağ kalıma etkisini araştırmak. Hasta ve Yöntem: Çalışmaya metastatik evrede olan 60 kemik sarkomu hastası dahil edildi. Kemoterapi öncesi bakılan AALPO ile genel sağkalım (GS) ve progresyonsuz sağkalım (PS) arasındaki ilişki Cox regresyonu multivariate analizi ile değerlendirildi. Bulgular: Çalışmaya alınan hastaların 25 (%58.3)’i osteosarkom, 16 (%26.7)’si Ewing sarkomu, 5(%8.3)’ü kondrosarkom ve 4 (%6.7)’ü dev hücreli kemik tümörüydü. ROC analizi ile elde edilen AALPO değeri 0.039 olarak bulundu. AALPO ≥ 0,039 grubundaki medyan PS ve GS, <0,039 olan gruba göre istatistiksel olarak anlamlı derecede yüksekti (p=0.006, p=0.003). AALPO <0.039 (HR=1.778, %95 Cl, 1.211-1.912, p=0.023) olması düşük genel GS ile ilişkili ve (HR=4.782, %95 Cl, 1.963-11.647, p=0.001) olması düşük PS ile ilişkili bulundu. Sonuç: Çalışmamızda metastatik kemik sarkomlu hastalarda kemoterapi öncesi düşük AALPO değeri, kötü GS ve PS ile ilişkili bulunmuştur. Daha önce birçok kanser türünde düşük AALPO kötü GS ve PS ile ilişkili bulunmuştur ancak daha önce kemik kanseri hastalarında AALPO’nun sağ kalım ile ilişkisi değerlendirilmemiştir. Çalışmamız literatürde bu konuyu araştıran ilk çalışmadır. AALPO, hastaların prognozunu değerlendirmede ucuz ve basit bir belirteç olarak kullanılabilir. Ancak daha kesin sonuçlar söylemek için daha fazla hasta sayısı ile yapılacak çalışmalara ihtiyaç vardır.
Prior studies showed a relationship between serum albumin and the albumin to globulin ratio with different types of cancer. We aimed to evaluate the predictive value of the albumin-globulin ratio ...(AGR) for survival of patients with lung adenocarcinoma.
This retrospective study included 240 lung adenocarcinoma patients. Biochemical parameters before chemotherapy were collected and survival status was obtained from the hospital registry. The AGR was calculated using the equation AGR=albumin/ (total protein-albumin) and ranked from lowest to highest, the total number of patients being divided into three equal tertiles according to the AGR values. Furthermore, AGR was divided into two groups (low and high tertiles) for ROC curve analysis. Cox model analysis was used to evaluate the prognostic value of AGR and AGR tertiles.
The mean survival time for each tertile was: for the 1st 9.8 months (95%CI:7.765-11.848), 2nd 15.4 months (95%CI:12.685-18.186), and 3rd 19.9 months (95%CI:16.495-23.455) (p<0.001). Kaplan-Meier curves showed significantly higher survival rates with the third and high tertiles of AGR in comparison with the first and low tertiles, respectively. At multivariate analysis low levels of albumin and AGR, low tertile of AGR and high performance status remained an independent predictors of mortality.
Low AGR was a significant predictor of long-term mortality in patients with lung adenocarcinoma. Serum albumin measurement and calculation of AGR are easily accessible and cheap to use for predicting mortality in patients with lung adenocarcinoma.
In subgroups of breast cancer, the shortest disease-free and overall survival was observed in basaloid and human epidermal growth factor receptor-2 groups. CK5/6 expression is a marker used in ...diagnosing breast cancers in basaloid group and is associated with a poor prognosis. Similarly, loss of tumor suppressor gene PTEN and a high expression of c-Met has been associated with poor prognosis in breast cancer and many other cancers. In this study, we aimed to determine the effect of CK5/6 and c-Met expressions, and PTEN loss on the disease prognosis in triple-negative breast cancer patients. Ninety-seven patients pathologically diagnosed with triple-negative breast cancer were enrolled. The clinical and pathological characteristics of the patients were recorded. c-Met, PTEN, and CK5/6 expressions were evaluated with immunohistochemical methods from paraffin blocks. The median age of patients was 47 years. CK5/6 positivity was 50.5 %, PTEN loss was 44.3 %, and high c-Met expression was detected in 53.6 %. In multivariate analysis, predictors of the recurrence were loss of PTEN (HR = 2.99;
P
= 0.004), high c-Met expression (HR = 2.05;
P
= 0.06), CK5/6 expression (HR = 2.99;
P
= 0.02), increase in the number of metastatic lymph nodes (HR = 1.11;
P
= 0.001), and an increase in tumor size (HR = 1.226;
P
= 0.01). Also, PTEN loss (HR = 2.43;
P
= 0.05), CK5/6 expression (HR = 3.74;
P
= 0.01), and N2–3 tumors compared to negatives (HR = 3.63;
P
= 0.01) were associated with death. PTEN loss correlated with those of lymphovascular invasion. There was a correlation between CK5/6 expression and the number of metastatic lymph nodes. Also, a correlation was found among cancers with highly expressed levels of c-Met, T1–2 tumors, and high-grade tumors. The classical markers, lymph node involvement and tumor size, were found to be of prognostic value; however, high c-Met and CK5/6 expressions, and PTEN loss were found to increase risk of recurrence and death in patients with triple-negative breast cancer.
Objectives: To analyze the relationship between clinical features, hormonal receptor status, and survival in patients who were diagnosed with medullary breast cancer (MBC). Methods: Demographic ...characteristics, histopathological features, and survival statuses of 201 patients diagnosed with MBC between 1995 and 2015 were retrospectively recorded. Survival analyses were conducted with uni- and multivariate cox regression analysis. Results: Median follow-up time was 54 (4-272) months. Median patient age at the time of diagnosis was 47 years old (26-90). Of the patients, 91.5% were triple negative. Five-year recurrence free survival time (RFS) rate was 87.4% and overalll survival (OS) rate 95.7%. For RFS, progesterone receptor (PR) negativity, atypical histopathological evaluation, absence of lymphovascular invasion, smaller tumor, lower nodal involvement were found to be favourable prognostic factors by univariate analysis (p<0.05). The PR negativity and smaller tumor were found to be favourable factors by univariate analysis (p<0.05). However, none of these factors were determined as significant independent prognostic factors for OS (p>0.05). Conclusion: Turkish MBC patients exhibited good prognosis, which was comparable with survival outcomes achieved in the literature. The PR negativity was related to a better RFS and OS rates.
To investigate clinicopathological features in patients with recurrent colorectal cancer within 1 year and more than 1 year after curative resection.
We retrospectively evaluated 103 patients with ...disease recurrence before versus after 1 year of resection. Thirty-two patients (31%) were diagnosed with recurrence less than 1 year after curative resection for colorectal cancer (early recurrence) and 71 (69%) after more than 1 year (non-early recurrence).
The early recurrence group displayed a significantly lower overall survival rate for both colon cancer (p=0, 01) and rectal cancer (p<0.001). Inadequate lymph node dissection was a significant predictor for early relapse. There were no statistically significant differences in clinicopathological variables such as age, sex, primary tumor localization, stage, depth of invasion, lymphovascular invasion and perineural invasion between the early and non-early recurrence groups. However, a K-ras mutation subgroup was significantly associated with early recurrence (p<0.001).
Poor survival is associated with early recurrence for patients undergoing resection for non-metastatic colorectal cancer, as well as K-ras mutation.
Micro-Abstract Although there has been an increase in overall and progression-free survival with the use of novel targeted therapies in metastatic renal cell carcinoma (mRCC) in recent times, ...predictive markers to determine which patients would benefit from tyrosine kinase inhibitor therapies are needed. The late recurrence might be a predictive marker for response to sunitinib treatment in patients with mRCC.
Objective: The correlation between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the prognosis of different cancers has been determined by a series of studies. The ...role of these inflammatory markers as definitive prognostic factors in bladder cancer is controversial. This research was conducted to explore the prognostic worth of pretreatment inflammatory markers including NLR and PLR in metastatic bladder cancer (mBC) patients receiving first-line chemotherapy. Materials and Methods: We retrospectively appraised 71 patients diagnosed with mBC from August 2005 to November 2017. According to the threshold values that were identified by receiver operating characteristic (ROC) curve analysis, the NLR and PLR were each divided into two groups: first, less than or equal to2.93 and >2.93, and second, less than or equal to168.9 and >168.9 respectively. The Cox proportional hazards model was applied to uncover the probable predictors of progression-free survival (PFS) and overall survival (OS). Results: Findings obtained by univariate analysis determined that an elevated NLR, a high PLR, and the onset of anemia were significantly correlated with poorer OS. Additionally, a significant relationship was found between an elevated NLR and reduced PFS. In the multiple analysis, an elevated NLR was identified as an independent predictor for both, reduced OS (Odds Ratio (OR): 5.58, 95% Confidence interval (CI): 2.80-11.13, p<0.05) and PFS (OR: 3.43, 95% CI: 1.92-6.12, p<0.05). Conclusion: Findings of this research revealed that NLR was an independent prognostic tool of PFS and OS in mBC patients undergoing first-line chemotherapy. Keywords: Metastatic bladder cancer, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognosis
Background
Soft tissue sarcomas (STSs) are rare malignant tumors of embryogenic mesoderm origin. Primary thoracic STSs account for a small percentage of all STSs and limited published information is ...available. This study aimed to identify the prognostic factors for thoracic STSs and evaluate the disease's clinical outcomes.
Methods
The medical records of 109 patients with thoracic STSs who were treated between 2003 and 2013 were retrospectively reviewed. Patients' survival rates were analyzed and potential prognostic factors evaluated.
Results
The median follow‐up period was 29 months (range: 1–121 months). STSs were most frequently localized on the chest wall (n = 42; 38.5%) and lungs (n = 42; 38.5%). The most common histological types were malignant fibrous histiocytoma (n = 23; 21.1%), liposarcoma (n = 17; 15.6%), and leiomyosarcoma (n = 16; 14.7%). The median survival time of all patients was 40.3 months (95% confidence interval, 14.22–66.37 months), with one and five‐year survival rates of 93.4% and 63.5%, respectively. Univariate analysis of all groups revealed that metastatic stage, unresectability, tumor diameter of >10 cm, tumor location other than the chest wall, and grade 3 diseases were predictable of poor survival. However, only grade 3 diseases and tumor location other than the chest wall were confirmed by multivariate analysis as poor prognostic factors.
Conclusions
Primary thoracic STSs are rarely seen malignant tumors. Our results indicated that patients with low‐grade tumors and those localized on the chest wall often experienced better survival outcomes.
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