To evaluate the treatment parameters, recurrence patterns, survival outcomes, and associated prognostic factors in patients with oral squamous cell carcinoma (OSCC) having pathologically positive ...cervical nodes with extra-capsular extension (ECE) following a multi-modal treatment.
This is a retrospective audit from a single institute involving 137 consecutive patients of OSCC who underwent curative surgery and on histopathology had positive cervical lymph nodes with ECE. The study encompassed the period from January 1, 2017, to December 31, 2022. Univariate analyses and multivariate analysis were carried out using the Kaplan-Meier method with log-rank testing and Cox regression with the forward conditional method respectively.
Out of 137 patients, 108 (78.8%) were male, and the median age at diagnosis was 49 years (IQR: 40-59 years). The most frequently affected sites of OSCC at presentation were the buccal mucosa/gingiva-buccal sulcus/retro molar trigone in 72 (52.6%), followed by the tongue in 59 (43.1%) and hard palate in 6 (4.4%). Neo-adjuvant chemotherapy was prescribed for 13 (9.5%) patients. All underwent radical surgery, which included composite resection in 66 (48.1%), glossectomy in 54 (39.4%) and wide excision in 17 (12.4%). Reconstruction procedures were performed in 122 (89.1%) cases, with 98 involving pedicle myocutaneous mucosal flap (PMMC) and 24 involving free flaps. All patients underwent modified radical neck dissection (MRND) comprising unilateral (UMRND) in 66 (48.2%), and bilateral (BMRND) in 71 (51.8%). Adjuvant treatment included radiotherapy (RT) alone in 18 (13.1%) and radiotherapy with concurrent chemotherapy (CRT) in 100 (73%).
Pathological primary tumor stages were distributed as follows: T1 in 6 (4.4%), T2 in 17 (12.4%), T3 in 45 (32.8%), and T4 in 69 (50.4%). Among them, 31 (22.6%) exhibited close margins (≤ 5 mm), and one had a microscopically positive margin at primary. The median lymph node yield was 59 (IQR: 40-81), with a median of 4 positive nodes (IQR: 4-6). Most commonly, positive lymph nodes were found in ipsilateral cervical level IB in 106 (77.4%), followed by level II in 101 (73.7%). Cervical nodes with evidence of positive ECE were predominantly located in level IB (n=85, 62%), followed by level II (n=62, 45.3%). Positive nodes were also observed in levels IV and V in 17 (12.4%), and more than 5 positive cervical nodes were present in 54 (39.4%).
At a median follow-up duration of 40 months, the outcomes were as follows: 74 (54%) remained disease-free, 57 (41.6%) experienced disease recurrence, and 6 (4.4%) were lost to follow-up. The pattern of recurrence was further characterized as follows: isolated local failure (LF) in 15 (10.9%), isolated regional failure (RF) in 9 (6.6%), combined loco-regional failure (LRF) in 10 (7.3%), isolated distant failure in 11 (8%), local and distant failure in 5 (3.6%), and regional and distant failure in 7 (5.1%). Among the LFs, the predominant recurrences were observed within post-operative flaps in 21 (70%), at the skull base, and the infratemporal fossa (ITF) in 6 (20%). Regional failure (RF) occurred in 26 patients, and the pattern of regional failure was stratified based on the extent of neck dissection and the presence of ECE in initially pathologically positive cervical nodes, as detailed in Table 01. RF involving only one level is seen in 12 (46.2%). Contralateral RF in unaddressed neck regions was observed in one-third of patients 4/13 (30.8%) with URMND. Three of these cases (75%) showed recurrence at the same ECE level, while one case (25%) showed recurrence at a different level. A total distant failure was observed in 23 (16.8%), with the most common sites being the lung in 14, bone in 13, non-regional lymph nodes in 6, and other sites in 10.
The 2-year survival estimates for disease-free survival (DFS), loco-regional control (LRC), and overall survival (OS) are presented in Table 02. Multivariate analysis indicated that worse 2-year DFS and OS were significantly associated with the non-cohesive pattern of invasion (p= 0.001), positive nodes at levels IV and V (p= 0.017), presence of > 5 positive nodes (p-value = 0.016), and not receipt of adjuvant concurrent chemotherapy (p = 0.001).
One of the most extensive collections of real-world data on patients with oral squamous cell carcinoma who have positive cervical nodes with extracapsular extension reveals consistently unfavorable outcomes and highlights the effectiveness of adjuvant multimodal treatments. The recurrence pattern not only involves loco-regional relapses but also frequently includes distant metastases. Alongside, our findings suggest that all cervical nodal regions are at risk for failure and warrant aggressive loco-regional and systemic treatments.
Primary subglottic Squamous Cell Carcinoma (SCC) is a rare malignancy that accounts for only 1–3% of all laryngeal carcinomas. The selection of therapeutic approaches depends on disease stage and ...clinical presentation. There are multiple therapeutic options for SCC, including chemotherapy (CTX) and adjuvant radiotherapy (ART). Owing to its rarity, there is no consensus on the best option for improving survival rates. We aimed to explore survival outcomes in terms of overall survival (OS) and cancer-specific survival (CSS) among patients diagnosed with localized SCC who underwent various treatment modalities.
Data from 2000 to 2019 were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Patients who met any of the following criteria were excluded: diagnosis not confirmed by histology, not first tumor or other malignancies in the body, not localized stage or metastasis, and unknown data. Chi-square tests were used to compare clinicopathological features, while survival rates and prognostic factors were identified using the Kaplan-Meier estimator, log-rank tests, and Cox proportional hazard regression.
The study population comprised 476 patients. Among them 70 patients with “Surgery,” 101 patients with “CTX,” 89 patients with “Surgery + ART”, 22 with “Surgery + ART + CTX” and 194 “None.” Most patients (68.9%) were 60 years or older, with a median age of 62 years. The largest racial group was white (82.6%; n=328). A total of 79% of the patients had a tumor size greater than 2 cm, followed by 14.1% for 1-2 cm and 6.9% for less than 1 cm. The median tumor size was 2 cm. “Surgery + ART” had the most favorable survival outcome with a 5-year OS of 67.2%, followed by “Surgery” (54.5%), “Surgery + ART + CTX” (93%), “CTX” (51.2%) and then “None” with (46.4%). In terms of CSS, “Surgery + ART” had the most favorable survival outcome with a 5-year CSS of 55.5%, followed by “Surgery + ART + CTX” (55.4%), “CTX” (55.4%) and then “None” with (51.9%) and then “Surgery” (44.3%). Significant differences were found in OS but not CSS between the groups (P<0.0003 and P<0.56, respectively). Older age was a poor prognostic factor for the OS and CSS. White race was a good prognostic factor in OS only. Multivariable analysis confirmed that there is statistically significant difference between the effect of all therapeutic groups on OS, “Surgery + ART” (HR=0.46, 95%CI:0.3-0.7). However, there was no statistical difference in CSS (HR=0.8, 95%CI:0.57-1.4).
The results of this study showed that “Surgery + ART” had the most favorable effect on OS and CSS in SCC patients. Multicenter, prospective studies are required to validate and build upon these findings. However, our results provide a starting point for better understanding of these rare cancers.
Due to the rarity of supraglottic squamous cell carcinoma and its relatively poor outcomes, there is a consensus treatment strategy. Additionally, treatment trends over time have focused on ...organ-preservation therapy rather than on improving survival rates. Our goal was to determine whether there were any significant differences in overall survival (OS) and cancer-specific survival (CSS) among the therapeutic options for localized SCC using a large sample.
Data between 2000 and 2019 were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Patients with a diagnosis not confirmed by histology, not the first tumor or other malignancies in the body, not localized stage or with metastasis, and unknown data were excluded. Chi-square tests were used to compare clinicopathological features, while the Kaplan-Meier estimator, log-rank tests, and Cox proportional hazard regression were used to identify survival rates and prognostic factors.
6110 patients were included in the study. Among them, 855 patients underwent 'Surgery,’ 1420 patients received 'CTX’ (chemotherapy), 32 had 'Surgery + CTX,’ 635 patients underwent 'Surgery + ART’ (adjuvant radiation therapy), 224 had 'Surgery + ART + CTX,’ and 2944 received 'None.’ Most patients (61.2%) were 60 years or older, with a median age of 63 years. The largest racial group was white (84.3%; n=5150). A total of 76.7% of the patients had a tumor size of 1-2 cm, followed by 17.4% for tumors > 2 cm, and 6.0% for tumors measuring < 1 cm. The median tumor size was 1.8 cm. 'Surgery’ had the most favorable survival outcome with a 5-year OS of 66.1%, followed by 'Surgery + ART + CTX’ (62%), 'Surgery + ART’ (58%), 'None’ with (48.4%), 'CTX’ (47.9%), and then 'Surgery + CTX’ with (36.4%). In terms of CSS, 'Surgery + ART’ had the most favorable survival outcome with a 5-year CSS of 92.8%, followed by 'Surgery + CTX’ (90.6%), 'Surgery + ART + CTX’ (89%), 'CTX’ (88%), 'Surgery’ (87.1%), and then 'None’ with (85.9%). Significant differences were found in OS and CSS between the therapeutic groups (P<0.0001) for both OS and CSS. Older age, male sex, 1-2 cm tumor size, > 2 cm tumor size, and 'Surgery + CTX’ were poor prognostic factors for OS. Older age and tumor size of > 2 cm were poor prognostic factors for CSS. However, 1-2 a tumor size was a good prognostic factor for CSS. Multivariable analysis confirmed a statistically significant difference between the effects of all therapeutic groups on OS and CSS. Table1 Display omitted
Our study showed significant variations in the survival outcomes among patients with supraglottic SCC. Therefore, this underscores the need for personalized treatment strategies for patients with supraglottic SCC and encourages further research to validate and expand upon these results for improved outcomes in this rare cancer.
Our aim was to develop and validate a nomogram for predicting the in-hospital 14-day (14 d) and 28-day (28 d) survival rates of patients with coronavirus disease 2019 (COVID-19).
Clinical data of ...patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from December 2022 to February 2023 and the north campus of Shanghai Ninth People's Hospital from April 2022 to June 2022 were collected. A total of 408 patients from Renmin Hospital of Wuhan University were selected as the training cohort, and 151 patients from Shanghai Ninth People's Hospital were selected as the verification cohort. Independent variables were screened using Cox regression analysis, and a nomogram was constructed using R software. The prediction accuracy of the nomogram was evaluated using the receiver operating characteristic (ROC) curve, C-index, and calibration curve. Decision curve analysis was used to evaluate the clinical application value of the model. The nomogram was externally validated using a validation cohort.
In total, 559 patients with severe/critical COVID-19 were included in this study, of whom 179 (32.02 %) died. Multivariate Cox regression analysis showed that age >80 years hazard ratio (HR) = 1.539, 95 % confidence interval (CI): 1.027–2.306, P = 0.037, history of diabetes (HR = 1.741, 95 % CI: 1.253–2.420, P = 0.001), high APACHE II score (HR = 1.083, 95 % CI: 1.042–1.126, P < 0.001), sepsis (HR = 2.387, 95 % CI: 1.707–3.338, P < 0.001), high neutrophil-to-lymphocyte ratio (NLR) (HR = 1.010, 95 % CI: 1.003–1.017, P = 0.007), and high D-dimer level (HR = 1.005, 95 % CI: 1.001–1.009, P = 0.028) were independent risk factors for 14 d and 28 d survival rates, whereas COVID-19 vaccination (HR = 0.625, 95 % CI: 0.440–0.886, P = 0.008) was a protective factor affecting prognosis. ROC curve analysis showed that the area under the curve (AUC) of the 14 d and 28 d hospital survival rates in the training cohort was 0.765 (95 % CI: 0.641–0.923) and 0.814 (95 % CI: 0.702–0.938), respectively, and the AUC of the 14 d and 28 d hospital survival rates in the verification cohort was 0.898 (95 % CI: 0.765–0.962) and 0.875 (95 % CI: 0.741–0.945), respectively. The calibration curves of 14 d and 28 d hospital survival showed that the predicted probability of the model agreed well with the actual probability. Decision curve analysis (DCA) showed that the nomogram has high clinical application value.
In-hospital survival rates of patients with COVID-19 were predicted using a nomogram, which will help clinicians in make appropriate clinical decisions.
Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding ...how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.
We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone.
Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5–24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates—a measure of relative inequality—increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7–87·2), and for men in Singapore, at 81·3 years (78·8–83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016.
Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled.
Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
Reply to K.H. Eng et al Trinquart, Ludovic; Jacot, Justine; Conner, Sarah C ...
Journal of clinical oncology,
02/2017, Letnik:
35, Številka:
4
Journal Article
The benefit of neoadjuvant chemoradiotherapy in resectable and borderline resectable pancreatic cancer remains controversial. Initial results of the PREOPANC trial failed to demonstrate a ...statistically significant overall survival (OS) benefit. The long-term results are reported.
In this multicenter, phase III trial, patients with resectable and borderline resectable pancreatic cancer were randomly assigned (1:1) to neoadjuvant chemoradiotherapy or upfront surgery in 16 Dutch centers. Neoadjuvant chemoradiotherapy consisted of three cycles of gemcitabine combined with 36 Gy radiotherapy in 15 fractions during the second cycle. After restaging, patients underwent surgery followed by four cycles of adjuvant gemcitabine. Patients in the upfront surgery group underwent surgery followed by six cycles of adjuvant gemcitabine. The primary outcome was OS by intention-to-treat. No safety data were collected beyond the initial report of the trial.
Between April 24, 2013, and July 25, 2017, 246 eligible patients were randomly assigned to neoadjuvant chemoradiotherapy (n = 119) and upfront surgery (n = 127). At a median follow-up of 59 months, the OS was better in the neoadjuvant chemoradiotherapy group than in the upfront surgery group (hazard ratio, 0.73; 95% CI, 0.56 to 0.96;
= .025). Although the difference in median survival was only 1.4 months (15.7 months
14.3 months), the 5-year OS rate was 20.5% (95% CI, 14.2 to 29.8) with neoadjuvant chemoradiotherapy and 6.5% (95% CI, 3.1 to 13.7) with upfront surgery. The effect of neoadjuvant chemoradiotherapy was consistent across the prespecified subgroups, including resectable and borderline resectable pancreatic cancer.
Neoadjuvant gemcitabine-based chemoradiotherapy followed by surgery and adjuvant gemcitabine improves OS compared with upfront surgery and adjuvant gemcitabine in resectable and borderline resectable pancreatic cancer.
The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2019.
Incidence, survival, and prevalence rates of ...cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2019, with survival follow-up until December 31, 2020. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea.
In 2019, newly diagnosed cancer cases and deaths from cancer were reported as 254,718 (ASR, 275.4 per 100,000) and 81,203 (ASR, 72.2 per 100,000), respectively. For the first time, lung cancer (n=29,960) became the most frequent cancer in Korea, excluding thyroid cancer. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% annually from 2012 to 2015, thereafter, followed by nonsignificant changes. The incidence of thyroid cancer increased again from 2016 (annual percentage change, 6.2%). Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.7% from 2002 to 2013; 3.3% from 2013 to 2019). The 5-year relative survival between 2015 and 2019 was 70.7%, which contributed to prevalent cases reaching over 2 million in 2019.
Cancer survival rates have improved over the past decades, but the number of newly diagnosed cancers is still increasing, with some cancers showing only marginal improvement in survival outcomes. As the number of cancer survivors increases, a comprehensive cancer control strategy should be implemented in line with the changing aspects of cancer statistics.
To evaluate the trends in survival for infants with critical congenital heart defects (CCHDs) and to examine the potential impact of timing of diagnosis and other prognostic factors on survival.
We ...performed a retrospective population-based cohort study in infants born with structural congenital heart defects (CHDs) between 1979 and 2005 and ascertained by the Metropolitan Atlanta Congenital Defects Program. We estimated Kaplan-Meier survival probabilities for 12 CCHD phenotypes by birth era and timing of diagnosis among infants without noncardiac defects or chromosomal disorders and used stratified Cox proportional hazards models to assess potential prognostic factors.
Of 1 056 541 births, there were 6965 infants with CHDs (1830 with CCHDs). One-year survival was 75.2% for those with CCHDs (n = 1336) vs 97.1% for those with noncritical CHDs (n = 3530; P < .001). One-year survival for infants with CCHDs improved from 67.4% for the 1979-1993 birth era to 82.5% for the 1994-2005 era (P < .001). One-year survival was 71.7% for infants with CCHDs diagnosed at ≤1 day of age (n = 890) vs 82.5% for those with CCHDs diagnosed at >1 day of age (n = 405; P < .001). There was a significantly higher risk of 1-year mortality for infants with an earlier birth era, earlier diagnosis, and low birth weight and whose mothers were <30 years old.
One-year survival for infants with CCHDs has been improving over time, yet mortality remains high. Later diagnosis is associated with improved 1-year survival. These benchmark data and identified prognostic factors may aid future evaluations of the impact of pulse oximetry screening on survival from CCHDs.
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