Hormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of ...inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i.ObjectiveHormone positive breast cancer is a tumor with high mortality. Combining antihormonal therapy with cyclin dependent kinase 4/6 inhibitors (CDK4/6i) has resulted in longer survival. The effect of inflammatory parameters such as c-reactive protein and c-reactive protein/lymphocyte ratio (CLR) on efficacy and survival in CDK4/6i treatment is unknown. In our study, we aimed to investigate the role of CLR and some parameters in predicting progression-free survival (PFS) with CDK4/6i.This retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method.MethodsThis retrospective cohort study included 78 patients with denovo and recurrent metastatic breast cancer treated with CDK4/6i. Cut off values for the prediction of mortality by various numerical parameter scores were performed by ROC Curve analysis. The effect of clinical variables, inflammatory and histopathological parameters on survival was analyzed by Kaplan-Meier method.Neutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006).ResultsNeutrophil/lymphocyte ratio (NLR) and CLR were statistically significant in predicting mortality (p < 0.05). Ki67 and CLR were correlated with PFS. Age and CLR were correlated with OS (p < 0.05). CLR was statistically significant for both PFS (p = 0.022) and OS (p = 0.006).In patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.ConclusionIn patients with metastatic hormone-positive breast cancer using CDK4/6i, low CLR and low Ki67 were correlated with longer PFS duration.
Background: Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and ...oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution.
Materials and Methods: We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan-Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively.
Results:
Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 95% confidence interval: 2.15-8.34; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value.
Conclusions:
This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for "PLNR," prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.
In this article, we present a case of diffuse follicular variant papillary thyroid carcinoma with pituitary metastasis, which is a rare cause of pituitary metastasis. The follicular variant of ...papillary thyroid carcinoma is an uncommon variant of papillary carcinoma. A 74-year-old male was presented with weakness, fatigue, and a decreased appetite. The patient was diagnosed with secondary adrenal and thyroid insufficiencies. Imaging revealed a pituitary mass with suprasellar extension, right cavernous sinus invasion, and optic chiasm compression. Thyroid ultrasonography revealed a nodule with a maximum size of 7.2cm in the right lobe. Cytological examination via fine-needle aspiration suggested papillary thyroid cancer. Total thyroidectomy with central and right lateral neck dissection confirmed the diagnosis of diffuse follicular variant of papillary thyroid carcinoma. Owing to visual field defects, the patient underwent transsphenoidal surgery. Histological and immunohistochemical evaluations confirmed pituitary metastasis from the papillary thyroid cancer. Radioactive iodine treatment and gamma knife radiotherapy of the pituitary gland were performed. The initiation of sorafenib treatment was deemed appropriate during the follow-up. A significant decrease in the thyroglobulin levels was observed after sorafenib treatment. Pituitary metastasis should be considered in patients diagnosed with hypopituitarism and pituitary lesions at initial evaluation. The presence of visual field defects may be an indication for neurosurgical intervention and guide both diagnosis and treatment. The management of papillary thyroid cancer and the role of treatment modalities in prognosis depend on the biological behavior of the tumor. Early diagnosis and multidisciplinary management are crucial for the treatment of these patients.
•Lorlatinib is highly extracranial (EC) and intracranial (IC) effective for ALK+ or ROS1+ in advanced NSCLC.•Response rates (RR) of EC 60% and IC 62% for ALK + and EC and IC RR of 62% and 67% for ...ROS1+, respectively.•Mean duration of therapy (DoT) for ALK + was 23.9 ± 1.6 months and median overall survival (mOS) 89.1 ± 19.6 months.•ROS1 + cohort had a median DoT of 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months.
Lorlatinib is a third-generation tyrosine-kinases inhibitor (TKI) targeting ALK/ROS1 fusions. The FDA has approved lorlatinib for TKI-pretreated ALK(+) NSCLC, while its approval for ROS1(+) is still pending. Here we present the largest real-world data of NSCLC patients harboring ALK/ROS1 rearrangements treated with lorlatinib.
123 patients were enrolled retrospectively (data cut-off 1/1/2019). Lorlatinib was administered through an early access program for patients with no other available therapy. Outcome and response were defined by each investigator upon RECIST 1.1 criteria.
106 ALK(+) and 17 ROS1(+) patients recruited from 8 different countries. The ALK(+) cohort included 50 % males, 73 % never-smokers and 68 % with brain metastases. Extracranial (EC) and intracranial (IC) response rates (RR) were 60 % and 62 %, with disease control rates (DCR) of 91 % and 88 % respectively. Mean duration of therapy (DoT) was 23.9 ± 1.6 months and median overall survival (mOS) was 89.1 ± 19.6 months. ROS1 cohort enrolled 53 % males, 65 % never-smokers and 65 % had brain metastases. EC and IC RR were 62 % and 67 % with DCR of 92 % and 78 % respectively. Median DoT was 18.1 ± 2.5 months and mOS of 90.3 ± 24.4 months. OS and DoT in both cohorts were not significantly correlated with line of therapy nor other parameters.
The most common adverse events of any grade were peripheral edema (48 %), hyperlipidemia (47 %), weight gain (25 %) and fatigue (30 %). CNS adverse events such as cognitive effect of grade 1–2 were reported in 18 % of patients.
Lorlatinib shows outstanding EC/IC efficacy in ALK/ROS1(+) NSCLC. The observed mOS of 89 ± 19 months in ALK(+) NSCLC supports previous reports, while mOS from of 90 ± 24 months is unprecedented for ROS1(+) NSCLC.
Çoklu Primer Tümörler-Tek Merkez Deneyimi İmamoğlu, Gökşen İnanç; Eren, Tülay; Şahin, Süleyman ...
Dicle tıp dergisi,
12/2017, Letnik:
44, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Objective: Although new advances in early diagnosis and treatments of oncologic diseases have resulted in improved survival rates, second primary malignancies may occur as a result of prolonged ...follow-up durations related to increased survival rates. There are many factors for the development of secondary primary tumors. Most importantly, elderly patients are more likely to be exposed to carcinogens in long term. Multiple primary tumors are usually seen as either metachronus or synchronous, depending on the timeline between the diagnosis of two malignancies. While synchronous diseases often occur as a result of exposure to the similar carcinogens, metachronous diseases are likely to be associated with adverse effects of the treatment of primary tumors. This single-center study aimed to investigate the clinicopathological features of patients with multiple primary tumors between January 2007 and December 2016, including a total of 56 patients, 20 of whom were synchronous and 36 were metachronous. The most common cancer pairs have been found to be colon-lung and prostate-bladder in men and breast-thyroid, and breast-colon in women. Method: Between January 2007 and December 2017, the files of our patients with multiple primary tumors (MPT) were reviewed retrospectively and it was determined that 56 patients had multiple primary tumors. Gender and age of the patients were determined. In which organs the tumor developed, when it developed, the etiologic findings that could be found, survival rates were investigated. All statistical analyzes were performed with Package for Social Sciences (SPSS v 15.0, SPSS Inc., Chicago, IL, USA). Result: Synchronous diseases are often seen as a consequence of exposure to similar carcinogens, while metachronous diseases are likely to be associated with side effects of treatment of primary tumors.
Background: The relapses of colorectal cancer (CRC) frequently occur in 2 years period after the time of diagnosis. However, a considerable proportion of patients relapse in the late period.
Aim: The ...aim of the present study is to define the factors predicting the early and late relapses of patients with early stage CRC.
Materials and Methods: A total of 250 patients with CRC, who relapsed after completion of primary therapy between 2005 and 2014, were enrolled in the study. According to the time of relapse, patients were divided into two groups as follows: Early relapse (Group 1: Within first 24 months) and late relapse (Group 2: Later than 24 months). Clinicopathological features and survival rates of the two groups were compared.
Results: Of 250 patients, 151 (60.4%) (Group 1) were relapsed within the first 24 months after completion of the primary therapy and 105 (39.6%) were relapsed later than 24 months. The patients with T1-T2 and Grade I tumors were relapsed in late period (P < 0.05). The rates of administered systemic chemotherapy and targeted therapies after relapse were similar in both groups. The median overall survival rates in patients relapsed within the first 24 months and after 24 months were 18 months and 21 months, respectively (P = 0.05).
Conclusions: In patients with CRC, the time duration of relapse after completion of the operation and adjuvant chemotherapy was a prognostic factor. Grade I and superficial tumors (T1-T2) are the predictors of late relapses (after >24 months). The patients relapsed within the first 24 months after primary therapy had poor prognosis compared to those who relapsed in late period.
Aim
The goal of this study is to evaluate possible factors affecting the survival of patients treated with gonadotropin‐releasing hormone (GnRH) analogues.
Methods
Demographic characteristics, ...treatment modalities, overall survival (OS) and the possible factors affecting the survival a total of 554 premenopausal breast cancer patients in Turkey evaluated retrospectively.
Results
The median duration of GnRH analogues use was 22 ± 13.6 (range, 1–87) months. Patients were divided into three groups according to the duration of GNRH analogues use; 4–12 months (Group A), 13–24 months (Group B) and ≥25 months (Group C). Overall, 530 patients were analyzed; 23.2%, 45.8%, 30.9% of the patients were in Group A, B and C, respectively. The median follow‐up duration was 34 ± 30.3 (range, 4–188) months. The OS in patients ≤35 years of age was found to be significantly longer than that of patients >35 years of age in Group B (log rank, P = 0.023). The disease‐free survival of the patients in Group A was significantly shorter than that of patients in Group C (log rank, P = 0.003). The OS of Group A patients was significantly shorter in comparison to that of Group B and Group C patients (log rank, P = 0.000) and the OS of Group B patients was significantly shorter than Group C (log rank, P = 0,000).
Conclusion
There is currently no definite data on the optimal duration of GnRH analogues use. One of the important results of this study that will provide an insight to the future studies is the improvement gained in OS by the increase in the duration of GnRH analogues use.
Background
PET–CT is important for evaluating the cancer stage preoperatively. In patients with locally advanced disease, who are candidates for curative treatment modalities following computed ...tomography (CT) and ultrasonography evaluation, PET–CT can show distant metastases and spare patients unnecessary surgical interventions. We aimed to evaluate the contribution of PET–CT scans compared to conventional imaging studies on the change of treatment plan in patients with locally advanced esophagogastric cancer from neoadjuvant to palliative setting.
Materials and methods
In this study, 91 patients with histopathologically proven diagnosis of esophageal or gastric cancer in our clinic between the years 2010–2014 were included. Prior to PET–CT evaluation, all of the patients were evaluated with thorax and abdomen computed tomography. Seventy-six of these patients were further evaluated by PET–CT due to ambiguous findings on computed tomography and 15 of them for staging purposes. The patients, who were shown to have distant metastases on conventional radiological imaging, were excluded from the study population.
Results
Ninety-one patients were included in the study. Their median age was 57 (range 30–80) years and three-quarters of the patients were male. Most of the patients were evaluated by PET–CT due to suspicion of distant metastasis (83.5 %). Primary sites of the tumors on PET–CT were: esophagus 38.5 % and stomach 61.5 %. Between CT and PET–CT tumor stage and pathological lymphadenopathy concordance rates were 75.8, and 69.2 %, respectively. On PET–CT evaluation 47.3 % of patients had distant metastasis. New metastases were detected in 34.1 % of patients by PET–CT despite entering to scanning field of tomography. Following the PET–CT evaluation due to detected metastasis, 47.3 % of patients’ treatment plan was changed from neoadjuvant to palliative therapy.
Conclusion
In the current study, 47.3 % (
n
= 43) of patients had distant metastasis that were not detected by CT evaluation. These patients were spared unnecessary surgical interventions. Evaluating the locally advanced gastric and esophageal cancer patients for PET–CT new metastasis could be indicated when the treatment plan of these patients would be changed from curative to palliative.
PDF
