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1.
Elias Jabbour Maral DerSarkissian Mei Sheng Duh Nora McCormick Wendy Y. Cheng Lisa J. McGarry Ariadne Souroutzidis Hui Huang Susan O’Brien Farhad Ravandi Hagop M. Kantarjian 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(4):257-265
Introduction
Complete molecular response (CMR) and 2- and 3-year overall survival (OS) were compared for patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) who had undergone front-line combination chemotherapy plus ponatinib versus combination therapy plus earlier generation tyrosine kinase inhibitors (TKIs; imatinib, dasatinib, and nilotinib).Patients and Methods
We identified 26 Ph+ ALL studies: 25 of earlier generation TKIs and 1 of ponatinib. The outcomes from studies of combination chemotherapy plus earlier generation TKIs were summarized using pooled estimates with 95% confidence intervals (CIs) from a random-effects meta-analysis. A binomial distribution was assumed to calculate the 95% CIs for the results from the single-arm combination chemotherapy plus ponatinib trial. Adjusted logistic meta-regression analyses were used to compare the outcomes between the TKI groups.Results
The percentage of patients achieving a CMR was greater with combination chemotherapy plus ponatinib (79%) than the pooled percentage of patients achieving a CMR with combination chemotherapy plus earlier generation TKIs (34%). Greater OS was observed with ponatinib compared with the pooled OS for earlier generation TKIs (2-year, 83% vs. 58%; 3-year, 79% vs. 50%). Odds ratios for ponatinib versus earlier generation TKIs were 6.09 (95% CI, 1.16-31.90; P = .034) for CMR, 3.70 (95% CI, 0.93-14.73; P = .062) for 2-year OS, and 4.49 (95% CI, 1.00-20.13; P = .050) for 3-year OS.Conclusion
Ponatinib plus chemotherapy might be associated with better outcomes than chemotherapy with earlier generation TKIs in patients with newly diagnosed Ph+ ALL. 相似文献2.
Peter Gibbs Volker Heinemann Navesh K. Sharma Julien Taieb Jens Ricke Marc Peeters Michael Findlay Bridget Robinson Christopher Jackson Andrew Strickland Val Gebski Mark Van Buskirk Huaqing Zhao Guy van Hazel 《Clinical colorectal cancer》2018,17(4):e617-e629
Background
The primary tumor side is emerging as a major prognostic factor for patients with metastatic colorectal cancer (mCRC). We examined the survival data from 2 randomized studies to determine whether the outcomes differ between patients with mCRC with right-sided primary (RSP) tumors and those with left-sided primary (LSP) tumors after selective internal radiation therapy (SIRT) plus mFOLFOX6 (folinic acid [leucovorin], 5-fluorouracil, oxaliplatin) chemotherapy, versus chemotherapy alone.Patients and Methods
Separate and combined analyses were performed on the data from the SIRFLOX and FOXFIRE global trials, which compared chemotherapy plus SIRT with chemotherapy alone for patients with mCRC liver metastases. The primary tumor side data were prospectively collected. The principal outcome measure was overall survival (OS) stratified by treatment and primary tumor side.Results
In the combined analysis of all 739 patients enrolled, SIRT had no effect on OS (median OS, 24.3 vs. 24.6 months; hazard ratio [HR], 1.021; P = .810). For the 179 patients (24.2%) with a RSP tumor, OS was improved with the addition of SIRT (median, 22.0 vs. 17.1 months HR, 0.641; P = .008). The addition of SIRT was not associated with a significant difference in OS among the 540 patients with a LSP tumor (median, 24.6 vs. 26.6 months; HR, 1.120; P = .264). A test of treatment interaction by primary tumor side was statistically significant for RSP and SIRT (P = .002).Conclusion
The addition of SIRT for patients with RSP tumors, but not for those with LSP tumors, was associated with a statistically and clinically significant OS gain. 相似文献3.
I. Amblard F. Mercier D.L. Bartlett S.A. Ahrendt K.W. Lee H.J. Zeh E.A. Levine D. Baratti M. Deraco P. Piso D.L. Morris B. Rau A.A.K. Tentes J.-J. Tuech F. Quenet E. Akaishi M. Pocard Y. Yonemura H.J. Zeh 《European journal of surgical oncology》2018,44(9):1378-1383
Background
Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy.Objective
To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC.Material and methods
A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test.Results
Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3–26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively.Conclusion
Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy. 相似文献4.
Peter Paximadis Jennifer L. Beebe-Dimmer Julie George Anne G. Schwartz Antoinette Wozniak Shirish Gadgeel 《Clinical lung cancer》2018,19(5):e559-e565
Introduction
The diagnosis of stage I small-cell lung cancer (SCLC) is increasing in incidence with the advent of low-dose screening computed tomography. Surgery is considered the standard of care but there are very few data to guide clinical decision-making. The purpose of this study was to compare outcomes for patients receiving definitive surgery, stereotactic body radiation therapy (SBRT), or external beam radiation therapy (EBRT) for stage I SCLC.Patients and Methods
Patients with a primary diagnosis of stage I SCLC were identified in the National Cancer Database. Patients were defined as having a first course of treatment of either surgery, EBRT, or SBRT. Overall survival (OS) was determined using the Kaplan–Meier method and Cox proportional hazards regression methods were used to estimate risk of overall mortality.Results
A total of 2678 patients were included in the analysis. The 2- and 3-year OS for the whole cohort was 62% and 50%. Comparing treatment strategies in a multivariate model, surgical resection showed improved OS over EBRT (P < .001) and SBRT (P < .001), however, the OS benefit over SBRT did not persist for patients who underwent limited resection. When excluding patients who underwent surgery, SBRT showed improved OS compared with EBRT (P = .04). Additional use of chemotherapy with any treatment modality resulted in improved OS (P < .001).Conclusion
In this hospital-based registry study, definitive surgical resection and use of chemotherapy resulted in improved survival for patients with early stage SCLC. For patients who are not candidates for surgery, SBRT may offer a survival benefit compared with standard EBRT. 相似文献5.
Praveen Polamraju Waqar Haque Vivek Verma Lee Wiederhold Sandra Hatch E. Brian Butler Bin S. Teh 《Clinical colorectal cancer》2018,17(3):e519-e530
Introduction
Patients with cT1-2N0M0 rectal cancer are often treated with up-front surgical resection, with adjuvant treatment reserved for patients upstaged with pathologic node-positive (pN+) disease at surgery. This study evaluates practice patterns and clinical outcomes when comparing different forms of adjuvant treatment for this patient population.Methods
The National Cancer Data Base was queried for cT1-2N0M0 rectal cancer patients between 2004 and 2015 with postoperative pN+ disease treated without neoadjuvant treatment. Patients were divided into groups receiving observation, chemotherapy, or chemoradiotherapy (CRT). Multivariable logistic regression determined factors associated with receipt of adjuvant treatment. Kaplan-Meier curves compared overall survival (OS), and Cox regression determined patient factors associated with OS.Results
Altogether, 1466 patients met the inclusion criteria; 536 patients (36.6%) received adjuvant chemotherapy, 413 (28.2%) received adjuvant CRT, and 517 (35.3%) were observed postoperatively. Use of adjuvant treatment was associated with superior median OS (124.1 vs. 51.1 months, P < .001), persisting after propensity score matching (124.0 vs. 61.9 months, P < .001), but not between adjuvant CRT versus chemotherapy on subset analysis. Patients with positive surgical margins receiving adjuvant CRT showed a trend toward OS improvement compared to patients managed with chemotherapy (54.9 vs. 47.4 months, P = .10). Increased age, pN2 status, positive margin status, and observation were associated with poorer OS.Conclusion
Most patients found to have pN+ disease after up-front surgery for cT1-2N0 rectal cancer receive adjuvant treatment, which is associated with improved OS. Chemotherapy or CRT are appropriate options, although there was a trend toward higher OS for patients with positive surgical margins receiving CRT. 相似文献6.
Judith Stift Alexandra Graf Christoph Schwarz Dietmar Tamandl Patrick Starlinger Merima Herac Andrea Beer Friedrich Wrba Martin Bodingbauer Klaus Kaczirek Stefan Stremitzer 《European journal of surgical oncology》2018,44(1):139-147
Background
The value of microscopic biliary and perineural invasion as prognostic biomarkers in patients with resectable colorectal liver metastases (CLM) who undergo neoadjuvant chemotherapy and liver resection is still unclear. This retrospective study was performed to elucidate this issue.Methods
Histologic slides of resected CLM of patients who underwent neoadjuvant bevacizumab-based chemotherapy and liver resection were investigated with respect to biliary and perineural invasion. Presence of invasion was correlated with radiologic and histologic response, recurrence-free survival (RFS) and overall survival (OS).Results
One hundred forty-one patients were enrolled. There was a significant association between biliary and perineural invasion, respectively (P = 0.001). Moreover, both biliary and perineural invasion were associated with bilobar metastatic spread and higher number of metastases, while perineural invasion was also associated with a higher Fong score. No significant association was found with response. In univariable analysis, biliary and perineural invasion were associated with shorter RFS (median 10.1 vs. 13.5 months, HR 2.09, P = 0.010 and 7.6 vs. 14.0, HR 2.23, P = 0.001, respectively). Biliary invasion was also associated with shorter OS (median 32.8 months vs. not reached, HR 2.78, P = 0.010), however these results did not remain significant in multivariable analysis.Conclusions
In patients with resectable colorectal liver metastases undergoing neoadjuvant bevacizumab-based chemotherapy and liver resection, biliary and perineural invasion are associated with higher tumor load but may not be prognostic biomarkers. 相似文献7.
William P. Parker Elizabeth B. Habermann Courtney N. Day Harras B. Zaid Igor Frank R. Houston Thompson Matthew K. Tollefson Stephen A. Boorjian Lance C. Pagliaro R. Jeffrey Karnes 《Clinical genitourinary cancer》2018,16(1):64-71.e5
Background
The current guidelines do not recommend adjuvant chemotherapy (AC) for patients with adverse pathologic findings after neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for bladder cancer. We sought to evaluate the association of AC with overall survival (OS) in these patients.Materials and Methods
The National Cancer Database was used to identify patients with adverse pathologic findings (ypT3N0, ypT4N0, or ypTanyN1-N3) after NAC and RC for bladder cancer from 2006 to 2012. The clinicopathologic variables were abstracted, and the patients were stratified according to the receipt of AC. OS was estimated using the Kaplan-Meier method and log-rank test. Associations between AC and OS were evaluated in multivariable Cox proportional hazards regression models among all patients and stratified by pathologic classification.Results
A total of 1361 patients were identified: 444 (32.6%) with ypT3N0, 162 (11.9%) with ypT4N0, and 755 (55.5%) with ypTanyN1-N3. The median OS for the entire cohort was 22.9 months, which differed by pathologic classification: 34.6 months with ypT3N0, 21.4 months with ypT4N0, and 19.3 months with ypTanyN1-N3 (P < .01). AC was used in 328 patients (24.1%), and no difference in OS was observed by receipt of AC (24.6 months with AC vs. 22.0 months without; P = .18). On multivariable analysis, AC was not independently associated with OS (hazard ratio, 0.86; 95% confidence interval, 0.74-1.01; P = .06).Conclusion
Patients with adverse pathologic findings at RC after previous NAC have a median OS of approximately 2 years, which was not significantly improved with AC. Clinical trials with newer systemic agents are warranted for patients in this setting to guide future therapy. 相似文献8.
Brendan G. Coutu Christopher T. Wilke Jianling Yuan Qing Cao Matthew R. Vernon Chung Lee Veronika Bachanova Kathryn E. Dusenbery 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(1):65-73
Introduction
We evaluated the role of consolidative radiotherapy (RT) for patients undergoing high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) for relapsed or refractory diffuse large B-cell lymphoma (DLBCL).Materials and Methods
We reviewed the medical records of 72 consecutive patients who had undergone ASCT for relapsed or refractory DLBCL at our institution from 2006 to 2014. Pretransplant conditioning consisted of HDC and total body irradiation. Of the 72 patients, 13 received post-transplant consolidative RT at the discretion of the consulted radiation oncologist.Results
Consolidative RT was associated with significantly improved 2-year locoregional control (LRC) (92% vs. 68%; P = .04). However, no difference was seen in either the 2-year progression-free survival (PFS) (69% vs. 54%; P = .25) or overall survival (OS) (85% vs. 59%; P = .44). Analysis of the subgroup of 19 patients with persistent residual masses ≥ 2 cm on post-transplant imaging demonstrated a significant improvement in LRC (100% vs. 36%; P < .01), PFS (88% vs. 27%; P = .01), and OS (100% vs. 45%; P = .02) with consolidative RT.Conclusion
The use of consolidative RT after HDC and ASCT for relapsed or refractory DLBCL appears to significantly improve LRC. For patients with masses ≥ 2 cm after ASCT, improved 2-year PFS and OS were seen. Prospective trials are needed to further identify the patients who would derive the most benefit from consolidative RT in the ASCT setting. 相似文献9.
Holly Lee Peter Duggan Ahsan Chaudhry Paola Neri Jason Tay Fariborz Rashid-Kolvear Nizar J. Bahlis Victor H. Jimenez-Zepeda 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(1):e69-e75
Introduction
Multiple myeloma is a heterogeneous disease with diverse clinical courses and patient outcomes. Although the introduction of novel agents has improved the overall survival (OS) of multiple myeloma patients, reports have highlighted that a subset of patients persists who experience early relapse (ER) and whose prognosis is significantly poorer than that of patients with a longer therapy response.Methods
The purpose of the present study was to understand the effect of ER on OS and identify other predictors of OS. We analyzed the outcomes of 257 patients who had undergone novel agent-based induction and single autologous stem cell therapy at our center from 2010 to 2016.Results
ER occurred in 35 patients (13.6%), and the group had a greater percentage of high-risk cytogenetics (48.5% vs. 23.3%; P = .0001), a lower percentage of a very good partial response or better (51.4% vs. 80.5%; P = .001), and a shorter median OS (17.8 months vs. not realized; P = .0001) compared with the non-ER group. Multivariate analysis showed that the presence of ER, high-risk cytogenetics, and lactate dehydrogenase > 350 UI/L are independent prognosticators for OS (P < .05).Conclusions
Our results have demonstrated that ER is an important clinical indicator of patients at high risk. As applications of novel agents evolve, further studies are required to tailor therapy for this patient group. 相似文献10.
Rahul Ladwa Timothy Kalas Shivanshan Pathmanathan Natasha Woodward David Wyld Jasotha Sanmugarajah 《Clinical breast cancer》2018,18(5):e1181-e1187
Introduction
Maintaining the relative dose intensity (RDI) of adjuvant chemotherapy at ≥ 85% has been associated with improved treatment outcomes in early-stage breast cancer (ESBC). Increasing evidence has suggested that patients aged ≥ 65 years can maintain the optimal RDI for standard chemotherapy regimens. The present study investigated the RDI of newer adjuvant chemotherapy regimens in this demographic.Patients and Methods
We retrospectively analyzed the data from 281 patients aged ≥ 65 years with a diagnosis of ESBC who had received adjuvant chemotherapy across 3 sites in Queensland, Australia from 2010 to 2015. The primary endpoint was the proportion of patients who had received an RDI of ≥ 85%.Results
The median age at diagnosis was 68 years (range, 65-85 years), with 36.3% aged > 70 years. The patient characteristics included tumor stage T3 or T4 in 17% and node-positive disease in 60%. The common chemotherapy regimens included docetaxel/cyclophosphamide (23%), 5-fluorouracil/epirubicin/cyclophosphamide plus docetaxel or paclitaxel (17%); Adriamycin/cyclophosphamide/weekly paclitaxel (38%); and docetaxel/carboplatin/trastuzumab (11%). Primary (15%) and secondary (54%) granulocyte colony-stimulating factor (G-CSF) was used. An RDI of ≥ 85% was achieved in 63% of the patients. Significant associations were noted between a reduced RDI and age ≥ 70 years (P < .001), Charlson comorbidity index ≥ 1 (P = .043), initial dose reductions (P = .01), secondary G-CSF use (P = .45), hospital admission (P < .001), and febrile neutropenia (P = .007). Treatment-related toxicities were the most common reason for noncompletion, with high rates of hospital admissions (46%) and febrile neutropenia (22%).Conclusion
Our findings suggest that patients aged ≥ 65 years with ESBC can maintain an optimal RDI with modern chemotherapy regimens. Appropriate geriatric assessment and the use of supportive measures such as G-CSF could better assist select groups to maintain an optimal dose intensity. 相似文献11.
Zhaohui Jin Mindy L. Hartgers Cristobal T. Sanhueza Christopher R. Shubert Steven R. Alberts Mark J. Truty Prasuna Muppa David M. Nagorney Thomas C. Smyrk Mohamed Hassan Amit Mahipal 《European journal of surgical oncology》2018,44(5):677-683
Introduction
Ampullary adenocarcinoma is a rare entity with limited data on prognostic factors. The aim of this study is to identify prognostic factors and assess the benefit of adjuvant therapy in patients with ampullary adenocarcinoma who underwent pancreatoduodenectomy.Methods
A cohort of 121 consecutive patients underwent pancreatoduodenectomy for ampullary adenocarcinoma from 2006 to 2016 at Mayo Clinic in Rochester, MN. All patients were confirmed by independent pathologic review to have ampullary carcinoma. Patient survival and its correlation with patient and tumor variables were evaluated by univariate and multivariate analysis.Results
Fifty three patients (45%) received adjuvant therapy (34 patients had chemotherapy alone, while 19 patients received both chemotherapy and radiation therapy). Fifty seven percent of the patients were diagnosed with advanced stage disease (Stage IIB or higher). Nearly all patients (98.3%) had negative surgical margins. Median overall survival (OS) was 91.8 months (95% CI:52.6 months-not reached). In multivariate analysis, excellent performance status (ECOG: 0), adjuvant therapy, and advanced stage remained statistically significant. Adjuvant therapy was independently associated with improved disease free survival (Hazard ratio [HR]:0.52, P = 0.04) and overall survival (HR:0.45, P = 0.03) in patients with advanced disease.Conclusions
Adjuvant therapy was associated with improved survival in patients with resected ampullary cancer, especially with advanced stage disease. A multi-institutional randomized trial is needed to further assess the role of adjuvant therapy in ampullary adenocarcinoma. 相似文献12.
Karna Sura Inga S. Grills Charles C. Vu Craig W. Stevens Hong Ye Thomas M. Guerrero 《Clinical lung cancer》2018,19(2):e185-e194
Background
Currently, the ideal timing for postoperative radiotherapy (PORT) and chemotherapy is unknown. The present study evaluated their relative timing on overall survival (OS) using the National Cancer Database (NCDB).Materials and Methods
The NCDB was queried for patients from 2004 to 2012 with resected non–small-cell lung cancer (NSCLC), pathologically involved N2 (pN2) nodes, and negative margins. All patients underwent adjuvant chemotherapy and external beam radiotherapy. The time to radiation (TTR) was determined from the date of surgery to the start of PORT, with the exclusion of those receiving PORT < 4 weeks or > 24 weeks postoperatively. Early and late TTR was dichotomized at 8 weeks after receiver operating characteristic analysis. Multivariate Cox regression analysis was conducted to predict the variables significantly associated with survival.Results
A total of 1629 patients were eligible for analysis. Of the 1629 patients, 703 had received PORT < 8 weeks and 926 had received PORT ≥ 8 weeks postoperatively. The receipt of PORT after 8 weeks was associated with better OS (P = .0044). No significant differences were found in survival in the concurrent group comparing early and later TTR (P = .9119). However, a significant OS benefit was found for sequential chemotherapy with an increased TTR (P = .0045). Older age, male sex, shorter distance traveled, increased nodal positivity, larger tumor size, higher Charlson/Deyo comorbidity score, and early TTR were associated with inferior survival on multivariate analysis.Conclusion
A TTR of ≥ 8 weeks with sequential chemotherapy in the setting of PORT was associated with improved survival in patients with NSCLC with pN2 nodes. 相似文献13.
Mark Zaki Michael Dominello Gregory Dyson Shirish Gadgeel Antoinette Wozniak Steven Miller Peter Paximadis 《Clinical lung cancer》2017,18(1):e21-e26
Background
The objective of this study was to review our institution's experience among patients with locally advanced non–small-cell lung cancer (LA-NSCLC) treated with chemotherapy and radiation and to determine the prognostic significance of age.Patients and Methods
Patients were included if they underwent sequential or concurrent chemoradiotherapy from 2006 to 2014 for LA-NSCLC. Patients were stratified according to age ≤70 and >70 years. Kaplan–Meier and Cox regression methods were performed to evaluate overall survival (OS) and progression-free survival (PFS).Results
One hundred twenty-three patients were identified. Ninety-eight patients were 70 years of age or younger and 25 patients were older than 70 years of age. The median radiotherapy dose was 6660 cGy (range, 3780-7600 cGy). A greater percentage of elderly patients were men, 72% (18 patients) versus 39% (38 patients) (P = .006) and received carboplatin/paclitaxel-based chemotherapy, 60% (15 patients) versus 21% (20 patients) (P < .001). Median follow-up for OS was 25.9 (95% confidence interval [CI], 21.3-33.9) months. There was no difference in the PFS of older patients versus younger patients (hazard ratio [HR], 1.15; P = .64), adjusted for significant covariates. The 1-year PFS rate for patients 70 years of age or younger was 51% (95% CI, 42%-63%) versus 45% (95% CI, 28%-71%) in patients older than 70 years. After adjusting for significant covariates, there was no difference in the OS of older patients compared with younger patients (HR, 1.18; P = .65). The 1-year OS rate for patients 70 years of age or younger was 77% (95% CI, 68%-86%) versus 56% (95% CI, 39%-81%) in patients younger than 70 years.Conclusion
Chemoradiotherapy is an effective treatment in elderly patients with LA-NSCLC, with outcomes similar to that in younger patients. Appropriately selected elderly patients should be considered for chemoradiation. 相似文献14.
Jonathan M. Loree Sean K. Tan Laurence M. Lafond Caroline H. Speers Hagen F. Kennecke Winson Y. Cheung 《Clinical colorectal cancer》2018,17(1):65-72
Background
With improved survival and longer duration of treatment, clinicians managing metastatic colorectal cancer (mCRC) increasingly consider intermittent (IC) or maintenance chemotherapy (MC), but the effect of these treatment modifications on real-world outcomes is unclear.Patients and Methods
Using a population-based cohort of mCRC patients who received combination chemotherapy, we aimed to describe the use of IC/MC and their effect on overall survival (OS).Results
Among 617 patients, 120 (19%) had periods of IC, 67 (11%) had periods of MC, and 53 (9%) had periods of both. Most (85.5%) modifications occurred in the first-line setting. The receipt of IC (median OS [mOS], 37 vs. 21 months; P < .0001) or MC (mOS, 36 vs. 24 months; P = .0015) was associated with improved mOS compared with continuous combination therapy. In multivariate analysis adjusting for age, sex, and regimen used at the time of treatment modification, IC (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.42-0.65; P < .0001), MC (HR, 0.71; 95% CI, 0.58-0.88; P = .002), and the combination (HR, 0.45; 95% CI, 0.33-0.63; P < .0001) were all associated with improved mOS. Among patients receiving MC, individuals with (HR, 0.69; 95% CI, 0.53-0.90; P = .005) and without (HR, 0.74; 95% CI, 0.55-1.00; P = .048) re-escalation to their original cytotoxic regimen had improved mOS compared with continuous therapy. The use of IC was associated with an improved OS compared with MC (HR, 0.65; 95% CI, 0.47-0.90; P = .009).Conclusion
In patients with mCRC, IC and MC are reasonable options to maintain quality of life and do not appear to negatively affect OS in carefully selected patients. 相似文献15.
Tao Jiang Ruirui Cheng Guowei Zhang Chunxia Su Chao Zhao Xuefei Li Jie Zhang Fegnying Wu Xiaoxia Chen Guanghui Gao Wei Li Weijing Cai Fei Zhou Jing Zhao Anwen Xiong Shengxiang Ren Guojun Zhang Caicun Zhou Jun Zhang 《Clinical lung cancer》2017,18(6):631-639.e2
Background
The risk factors for liver metastasis (LM) in patients with non–small-cell lung cancer (NSCLC) remain unknown. Whether LM predicts for the effect of first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in patients with EGFR-mutant NSCLC needs to be explored.Patients and Methods
A total of 598 NSCLC patients from 3 centers underwent EGFR testing, and 293 had EGFR-mutant NSCLC. Of the 598 NSCLC patients, 99 had LM; 56 patients with EGFR-mutant NSCLC received EGFR-TKIs as first-line therapy.Results
EGFR mutation was not associated with LM in NSCLC patients (relative ratio, 1.305, P = .261). In the EGFR-mutant group that received first-line EGFR-TKIs, patients with LM had shorter progression-free survival (PFS; 7.5 vs. 11.8 months; P = .0003) and overall survival (OS; 20.8 vs. 30.6 months; P = .0190) than patients without LM. The significant difference in PFS was observed in both patients with EGFR exon 19 deletion (19del) and Leu858Arg mutation (L858R). However, patients with EGFR 19del and LM showed marginally significantly shorter OS (P = .0531) and patients with EGFR L858R and LM had OS similar to that of patients without LM (P = .1883). Regardless of EGFR status, patients with LM who received first-line chemotherapy had PFS and OS similar to those of patients without LM. Univariate analyses identified only never smoking (hazard ratio, 0.536; P = .012) was significantly associated with better OS for patients with NSCLC and LM.Conclusion
EGFR mutation is not an independent risk factor for LM in NSCLC patients. However, the presence of LM is a negative predictive factor for first-line EGFR-TKI therapy for patients with EGFR-mutant NSCLC. 相似文献16.
Sunil W. Dutta Clayton E. Alonso Taylor C. Jones Mark R. Waddle Einsley-Marie Janowski Daniel M. Trifiletti 《Clinical colorectal cancer》2018,17(4):297-306
Introduction
The purpose of this study was to compare the utilization, pathologic response, and overall survival (OS) between long-course neoadjuvant chemoradiation (LC-CRT) and short-course neoadjuvant radiation (SC-RT) in the treatment of non-metastatic rectal cancer.Methods and Materials
Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with clinical stage II or III (limited to T3, any N or T1-2, N1-2) rectal cancer between 2004 and 2014 (28,193 patients). Univariate and multivariate analyses were performed to investigate factors associated with receipt of SC-RT, pathologic complete response (pCR) rate, and OS. Patients were compared based on the neoadjuvant therapy they received prior to tumor resection. SC-RT was defined as 25 Gy given over 1 week prior to surgery (with or without chemotherapy as part of their treatment course). LC-CRT was defined as 45 to 60 Gy given over 5 to 6 weeks (with chemotherapy) prior to surgery.Results
A total of 27,988 (99%) of patients received LC-CRT, and 205 (1%) patients received SC-RT. Receipt of SC-RT was associated with older age, more comorbidities, and treatment at an academic facility (P < .001 for each). Additional days from radiation completion to surgery was associated with a higher pCR rate (P < .001 for both). LC-CRT did not lead to increased OS compared with SC-RT (P = .517).Conclusions
In this United States database study, there was no improvement in OS for patients receiving LC-CRT compared with SC-RT; however, a longer interval between radiation therapy and surgery led to a higher pCR rate. Academic facilities were more likely to utilize SC-RT compared with other facilities. 相似文献17.
Tao Jiang Hongcheng Liu Meng Qiao Xuefei Li Chao Zhao Chunxia Su Shengxiang Ren Caicun Zhou 《Clinical lung cancer》2018,19(2):e177-e184
Background
The current study aimed to comprehensively investigate the impact of various clinicopathologic features on the efficacy of programmed cell death-1 (PD-1) and ligand (PD-L1) inhibitors in patients with previously treated non–small-cell lung cancer (NSCLC).Patients and Methods
Randomized controlled trials that compared PD-1/PD-L1-inhibitor monotherapy with chemotherapy or placebo in patients with previously treated NSCLC were included.Results
Five trials were included (n = 3025). For all studies, PD-1/PD-L1 inhibitors significantly prolonged overall survival (OS) (hazard ratio [HR], 0.70; P < .001) and progression-free survival (PFS) versus chemotherapy (HR, 0.86; P = .020). Subgroup analysis showed that anti-PD-1/PD-L1 monotherapy could markedly improve OS in elderly patients (HR, 0.69; P < .001), female patients (HR, 0.70; P < .001), never-smoking patients (HR, 0.73; P = .001), and patients with a histology of squamous cell carcinoma (HR, 0.67; P < .001), but not PFS in the elderly and female patient groups. Notably, PD-1/PD-L1 inhibitors cannot prolong both OS (HR, 0.76; P = .390) and PFS (HR, 0.74; P = .210) in patients with central nervous system (CNS) metastasis, whereas patients without CNS metastasis could benefit from anti-PD-1/PD-L1 monotherapy on OS (HR, 0.71; P < .001).Conclusion
PD-1/PD-L1-inhibitor monotherapy could significantly prolong both OS and PFS in patients with previously treated NSCLC. Subgroup analyses showed that most patients including elderly, females, never-smokers, and patients with squamous cell carcinomas do benefit. However, whether patients with CNS metastasis could benefit from anti-PD-1/PD-L1 monotherapy requires further validation. 相似文献18.
Thomas A. Ollila Adam J. Olszewski James N. Butera Matthew I. Quesenberry Peter J. Quesenberry John L. Reagan 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(3):204-209
Background
Induction chemotherapy for acute myeloid leukemia (AML) is based on the “7+3” cytarabine/anthracycline regimen. A nonhypocellular day 14 (D14) bone marrow sample with a blast count > 5% to 10% is suggestive of residual leukemia, for which a second course of induction chemotherapy has been recommended. Although the prognostic value of D14 bone marrow findings has been established, its use as a decision point is controversial because the benefit of repeat induction has been questioned.Patients and Methods
In the present single-center retrospective study of 113 patients with newly diagnosed AML, we evaluated the role of cellularity on the clinical outcomes of patients with residual morphologic leukemia (blasts ≥ 5%). Among 64 patients with D14 bone marrow samples, 31 had residual morphologic leukemia.Results
The complete remission (CR) rates were greater for the hypocellular (11 of 16) than for the nonhypocellular (4 of 15) patients (P = .03). The median overall survival (OS) for the hypocellular D14 patients was longer than that for the nonhypocellular patients (17 vs. 8 months; P = .02). No significant difference between the receipt of reinduction therapy and CR or OS was found on logistic or survival model analysis. The specificity for residual leukemia on D14 bone marrow samples was better for cellularity ≥ 20% and blasts ≥ 20% than for blasts ≥ 5%.Conclusion
The results of our study have shown that patients with < 20% cellularity and < 20% blasts on the D14 bone marrow assessment should continue observation until recovery rather than receive additional immediate therapy. 相似文献19.
Matthew P. Deek Sinae Kim Robert Beck Nikhil Yegya-Raman John Langenfeld Joyti Malhotra Omar Mahmoud Joseph Aisner Salma K. Jabbour 《Clinical lung cancer》2018,19(4):e381-e390
Background
We evaluated trends in administration of concurrent chemoradiation therapy (CRT) and how variations in start dates of chemotherapy and radiotherapy affected overall survival (OS) in patients with non–small cell lung cancer (NSCLC) undergoing a course of definitive CRT.Materials and Methods
Cases of NSCLC treated with definitive CRT were obtained from the National Cancer Database. A survival analysis was performed with Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching was conducted.Results
On a national level, only 48.6% of patients began concurrent CRT on the same day. In a propensity-matched population, starting CRT within 6 days was associated with improved OS (17.9 months) compared with starting 7 to 13 days apart (16.5 months; P = .04). Starting dual therapy within 6 days of each other was associated with a 7% reduction in the risk of death (hazard ratio, 0.93; P = .05). Furthermore, in a propensity-matched cohort, starting CRT within 3 days was associated with longer survival (18.7 months) compared with 4 to 6 days apart (17.5 months; P = .02). Starting treatment 4 to 6 days apart was associated with an 8% increased risk of death (hazard ratio, 1.08; P = .04).Conclusion
A large proportion (48.6%) of patients with unresectable NSCLC do not initiate CRT on the same day as is considered standard by national guidelines. In this population, nonsimultaneous initiation of CRT was associated with differences in OS. Further efforts to understand the mitigating factors and barriers that interfere with timely delivery of concurrent CRT are needed. 相似文献20.
Margaret M. Lee Andrew MacKinlay Christine Semira Christine Schieber Antonio Jose Jimeno Yepes Belinda Lee Rachel Wong Chathurika K.H. Hettiarachchige Natalie Gunn Jeanne Tie Hui-Li Wong Iain Skinner Ian T. Jones James Keck Suzanne Kosmider Ben Tran Kathryn Field Peter Gibbs 《Clinical colorectal cancer》2018,17(3):e569-e577