The Relationship between Nutritional Status and Body Composition with Clinical Parameters,Tumor Stage,CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors

Recent studies have obtained inadequate data on the association between nutritional status, body composition, clinical parameters and tumor stage in patients withpancreatic and periampullary tumors. The purpose of this study was to assess the relationship between nutritional status (NS), body composition (BC) and selected clinical parameters in patients with pancreatic and periampullary cancer, as well as describe the differences between resection and non-resection groups. This is a prospective study of 76 patients with pancreatic and periampullary tumors. We evaluated NS, BMI, body mass loss (BML) and albumin, total protein, CRP, CEA, CA19-9, lipase, amylase, tumor stage, and BC using bioelectrical impedance (BIA). All subjects were divided into resection (n = 59) and non-resection (n = 17) groups. The non-resection group had a worse NS, as well as increased amylase and WBC, compared to the resection. The selected parameters of BC corresponded to BML albumin, TP, NS, age, BMI, Karnofsky, RBC, HCT and HGB. No associations were found between BC with tumor size, CRP, CA19-9, and CEA. We recorded the relationship between metastasis and NRS, as well as tumor size with SGA. The percentage of BML was positively correlated with age and CRP but negatively correlated with RBC, HGB, HCT and anthropometric measurements. We found many statistical correlations with NS and selected parameters, as well as differences between the resection and non-resection group. The detection of early prognostic factors of nutritional impairments would improve the quality of life and reduce the rate of postoperative complications.     

Impact of Nutritional Status on the Quality of Life of Advanced Cancer Patients in Hospice Home Care

Background: Cancer patients frequently experience malnutrition and this is an important factor in impairedquality of life. Objective: This cross-sectional study examined the association between global quality of life andits various subscales with nutritional status among 61 (33 females and 28 males) advanced cancer patients caredfor by selected hospices in peninsular Malaysia. Methods: The Patient Generated-Subjective Global Assessment(PG-SGA) and the Hospice Quality of Life Index (HQLI) were used to assess nutritional status and quality oflife, respectively. Results: Nine (14.7%) patients were well-nourished, 32 (52.5%) were moderately or suspectedof being malnourished while 20 (32.8%) of them were severely malnourished. The total HQLI mean score forthese patients was 189.9±51.7, with possible scores ranging from 0 to 280. The most problem areas in thesepatients were in the domain of functional well-being and the least problems were found in the social/spiritualdomain. PG-SGA scores significantly correlated with total quality of life scores (r2= 0.38, p<0.05),psychophysiological well-being (r2= 0.37, p<0.05), functional well-being (r2= 0.42, p<0.05) and social/ spiritualwell-being (r2= 0.07, p<0.05). Thus, patients with a higher PG-SGA score or poorer nutritional status exhibiteda lower quality of life. Conclusion: Advanced cancer patients with poor nutritional status have a diminishedquality of life. These findings suggest that there is a need for a comprehensive nutritional intervention forimproving nutritional status and quality of life in terminally ill cancer patients under hospice care.     

Survival After Induction Chemotherapy and Chemoradiation Versus Chemoradiation and Adjuvant Chemotherapy for Locally Advanced Rectal Cancer

BackgroundTotal neoadjuvant therapy (TNT) improves tumor response in locally advanced rectal cancer (LARC) patients compared to neoadjuvant chemoradiotherapy alone. The effect of TNT on patient survival has not been fully investigated.Materials and MethodsThis was a retrospective case series of patients with LARC at a comprehensive cancer center. Three hundred and eleven patients received chemoradiotherapy (chemoRT) as the sole neoadjuvant treatment and planned adjuvant chemotherapy, and 313 received TNT (induction fluorouracil and oxaliplatin-based chemotherapy followed by chemoradiotherapy in the neoadjuvant setting). These patients then underwent total mesorectal excision or were entered in a watch-and-wait protocol. The proportion of patients with complete response (CR) after neoadjuvant therapy (defined as pathological CR or clinical CR sustained for 2 years) was compared by the χ² test. Disease-free survival (DFS), local recurrence-free survival, distant metastasis-free survival, and overall survival were assessed by Kaplan-Meier analysis and log-rank test. Cox regression models were used to further evaluate DFS.ResultsThe rate of CR was 20% for chemoRT and 27% for TNT (P=.05). DFS, local recurrence-free survival, metastasis-free survival, and overall survival were no different. Disease-free survival was not associated with the type of neoadjuvant treatment (hazard ratio [HR] 1.3; 95% confidence interval [CI] 0.93-1.80; P = .12).ConclusionsAlthough TNT does not prolong survival than neoadjuvant chemoradiotherapy plus intended postoperative chemotherapy, the higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.     

Association between ABCB1 Immunohistochemical Expression and Overall Survival in Gastric Cancer Patients

Gastric cancer (GC) is one of the most common malignancies worldwide. The ABCB1 protein, a member of the ATP-binding cassette (ABC) transporter family, encoded by the ABCB1 gene, considerably influences the distribution of drugs across cell membranes as well as multidrug resistance (MDR) of antineoplastic drugs. In contrast to the extensive knowledge on the pharmacological action of ABCB1 protein, the correlation between the clinical-pathological data and ABCB1 protein expression in patients with GC remains unclear. The aim was to investigate association between ABCB1 expression and overall survival in GC patients. Human tumor fragments from 57 GC patients were examined by immunohistochemistry assay. We observed lower survival rate of patients with GC who were positive for ABCB1 expression (p=0.030). Based on these observations, we conclude that GC patients with positive ABCB1 protein immunohistochemical expression in their tumors suffer shorter overall survival.     

Neutrophil Count and the Inflammation-based Glasgow Prognostic Score Predict Survival in Patients with Advanced Gastric Cancer Receiving First-line Chemotherapy

Purpose: To explore the value of systemic inflammatory markers as independent prognostic factors andthe extent these markers improve prognostic classification for patients with inoperable advanced or metastaticgastric cancer (GC) receiving palliative chemotherapy. Methods: We studied the prognostic value of systemicinflammatory factors such as circulating white blood cell count and its components as well as that combined toform inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio(NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy. Univariateand multivariate analyses were performed to examine the impact of inflammatory markers on overall survival(OS). Results: Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count,a decreased lymphocyte count, a low serum albumin concentration, and high CRP concentration, as well aselevated NLR/PLR , GPS, PI, PNI were significant predictors of shorter OS. Multivariate analysis demonstratedthat only elevated neutrophil count (HR 3.696, p=0.003) and higher GPS (HR 1.621, p=0.01) were independentpredictors of poor OS. Conclusion: This study demonstrated elevated pretreatment neutrophil count and highGPS to be independent predictors of shorter OS in inoperable advanced or metastatic GC patients treated withfirst-line chemotherapy. Upon validation of these data in independent studies, stratification of patients usingthese markers in future clinical trials is recommended.     

Staging with PET-CT in Patients with Locally Advanced Non Small Cell Lung Cancer is Superior to Conventional Staging Methods in Terms of Survival

Background: Of patients with non small cell lung cancer (NSCLC), around one third are locally advancedat the time of diagnosis. Because only a proprotion of stage III patients can be cured by surgery, in order toimprove the outcomes , sequential or concurrent chemoradiation, or concurrent chemoradiation with induction orconsolidation is offered to the patients with locally advanced NSCLC. Today, PET combined with computerizedtomography (PET-CT) is accepted as the most sensitive technique for detecting mediastinal lymph node andextracranial metastases from NSCLC. We aimed to compare PET-CT and conventional staging proceduresfor decisions regarding curative treatment of locally advanced NSCLC. Materials and Methods: A total of 168consecutive patients were included from Acibadem Kayseri Hospital, Acibadem Adana Hospital and KayseriResearch and Training Hospital in this study. Results: While the median PFS was 13.0±1.9 months in the PET-CTgroup, it was only 6.0±0.9 in the others (p<0.001). The median OS values were 20.5±15.6 and 11.5±1.5 months,respectively (p<0.001). Discussion: As a result, we found that staging with PET CT has better results in termsof survival staging. This superiority leads to survival advantage in patients with locally advanced NSCLC.     

Follow-Up Study of Survival of Patients with Advanced Cancer in a Hospice Setting

Objective: This study was to present the survival of advanced cancer patients and explore the influence ofvarious factors on survival time as well as survival rate. The results provide guidelines for clinical practice ofcancer treatment. Methods: Follow-up of 674 advanced cancer patients was performed in a hospice. The mediansurvival time and survival rate were calculated, and survival analysis was carried out. Results: The mediansurvival time of all patients dying from cancer was 12.0 months and the average survival time was 25.1 months.The 1-year cumulative survival rate was 0.518±0.020 and the 5-year cumulative survival rate was 0.088±0.012.The following factors showed significant impacts on survival rate: gender, age, primary diagnosis, surgery andthe time when pain appeared. Conclusions: The survival time of patients with advanced cancer was relativelyshort. Major approaches to extend the survival time include early detection, early diagnosis, effective surgicaltreatment, pain control, reasonable supply of nutrients and multiple interventions.     

Eight Year Survival Analysis of Patients with Triple Negative Breast Cancer in India

Background: Triple-negative breast cancer (TNBC) often presents as an interval cancer with short survival upon metastasis and thus represents an important clinical challenge. The present study investigated the clinicopathologic characteristics and long term survival outcome of early and locally advanced TNBC. Materials and Methods: Medical records were reviewed retrospectively for 148 consecutive confirmed cases of TNBC treated in a single unit at our centre. Demographic profile, tumor type, histopathology details, treatment and follow-up information was recorded and immunohistochemistry was performed. Results: Age group >50 years was associated with tumors of clinical stage 3 (53.8%), pathological stage 3 (46.2%), pathological grade 3 (45.7%), presence of extracapsular extension (ECE, 48.5%) and lymphovascular invasion (LVI, 64.9%). Locally advanced breast cancers (LABCs) were characterized by pathological stage 3 (96.2%), presence of ECE (100%) and absence of LVI (46.7%) as compared to early breast cancers (EBCs) which had higher incidence of lower stage tumors (100%), absence of ECE (82%) and presence of LVI (91.9%; p-value Conclusions: TNBCs are aggressive tumors which show poor long term survival. Patients with TNBC benefit from chemotherapy, thus better and less toxic treatment options are needed. Identification of newer targets and development of targeted therapies are the need of the hour.     

头颈部肿瘤患者营养综合状况与急性放射毒性反应的关系

[目的]分析头颈部肿瘤患者放疗前的营养综合状况和急性放射毒性反应的关系。[方法]调查130例头颈部肿瘤患者放疗前的营养状况,分别在放疗前和放疗2周末、4周末、放疗结束时评价放射毒性反应。采用因子分析,建立营养评价综合模型;采用广义加性模型分析患者营养综合状况和急性放射毒性的关系。[结果]根据营养综合指标判断,入院时营养不良88例（67.7%）,其中轻度47例（36.2%）、中度32例（24.6%）、重度9例（6.9%）。患者营养状况与放射性皮炎（t=-4.65,P〈0.001）,口腔干燥（t=-5.67,P〈0.001）,咽/咽喉炎（t=-2.67,P=0.008）,疲劳（t=-4.01,P〈0.001）,厌食（t=-3.13,P=0.002）间存在线性关系,与吞咽困难（χ2=16.80,P〈0.001）,黏膜炎（χ2=3.65,P=0.037）存在某种曲线关系。[结论]头颈部肿瘤患者的营养综合状况与急性放射毒性反应之间存在着一定的相关性,营养不良的患者在放疗前应给予营养支持。     

康莱特注射液治疗晚期胰腺癌的效果及对患者免疫功能的影响

目的 探讨康莱特注射液治疗晚期胰腺癌的效果及对患者免疫功能的影响.方法 采用回顾性研究方法,选择晚期胰腺癌患者72例作为研究对象,根据随机平行数字信封法分为观察组与对照组,各36例.对照组给予常规放化疗治疗,观察组在对照组治疗的基础上给予康莱特注射液治疗.2组都治疗观察2个疗程,记录预后与免疫指标变化情况.结果 治疗后观察组与对照组的总有效率分别为77.8%和44.4%,观察组的总有效率明显高于对照组(P<0.05).观察组与对照组治疗期间的血像反应与消化道反应情况对比,无明显差异(P>0.05).治疗后观察组与对照组的CA19-9与CEA值明显低于治疗前(P<0.05),同时治疗后观察组的CA19-9与CEA值也低于对照组(P<0.05).治疗后观察组的CD3+值明显上升,而CD4+值明显降低,较治疗前差异均明显(P<0.05),而对照组治疗前后的CD3+、CD4+值差异无统计学意义(P>0.05).结论 康莱特注射液治疗晚期胰腺癌能提高治疗效果,降低肿瘤标志物的表达,且不会增加不良反应,其作用机制与提高免疫力有关.     

Influence of Perineural Invasion on Survival and Recurrence in Patients with Resected Pancreatic Cancer

Background: Perineural invasion (PNI) has been reported as one of the sources of locoregional recurrence inresected pancreatic cancer (PC). However the impact of PNI in resected pancreatic cancer remains controversial.The purpose of this study was to determine the association between PNI status and clinical outcomes. Methods:Publications were identified which assessed prognostic significance of PNI status in resected pancreatic cancerup to February 2013. A meta-analysis was performed to clarify the association between PNI status and clinicaloutcomes. Results: A total of 21 studies met the inclusion criteria, covering 4,459 cases. Analysis of these datashowed that intrapancreatic PNI was correlated with reduced overall survival only in resected pancreaticductal adenocarcinoma (PDAC) patients (HR=1.982, 95%CI: 1.526-2.574, p=0.000). Extrapancreatic PNI wascorrelated with reduced overall survival in all resected pancreatic cancer patients (HR=1.748, 95%CI: 1.372-2.228, p=0.000). Moreover, intrapancreatic PNI status may be associated with tumor recurrence in all resectedpancreatic cancer patients (HR=2.714, 95%CI: 1.885-3.906, p=0.000). Conclusion: PNI was an independent andpoor prognostic factor in resected PDAC patients. Moreover, intrapancreatic PNI status may be associated withtumor recurrence.     

Prognostic Factors for Overall Survival in Patients with Hormone Receptor-Positive Advanced Breast Cancer: Analyses From PALOMA-3

Background

This analysis investigated whether baseline characteristics affect the survival benefit derived from palbociclib-fulvestrant and the optimal timing of cyclin-dependent kinase 4/6 inhibitor therapy for advanced breast cancer (ABC) in patients from PALOMA-3.

Patients and Methods

In total, 521 patients were randomized 2:1 to receive palbociclib (125 mg/day, 3/1 schedule)–fulvestrant (500 mg, intramuscular injection, on days 1 and 15 of cycle 1, and then day 1 of each subsequent cycle) or matching placebo-fulvestrant. Median overall survival (OS) and progression-free survival were estimated using the Kaplan-Meier method.

Results

Multivariable analysis identified endocrine sensitivity, nonvisceral disease, no prior chemotherapy for ABC, and Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 as significant prognostic factors for OS. Patients without chemotherapy for ABC had fewer prior lines of treatment in any setting and in the ABC setting versus patients with prior chemotherapy for ABC (two or fewer prior systemic therapies: 69% vs. 42%; no more than one prior line for ABC: 82% vs. 33%, respectively). Median OS was prolonged with palbociclib-fulvestrant in patients without prior chemotherapy for ABC (39.7 vs. 29.5 months; hazard ratio, 0.75; 95% confidence interval [CI]: 0.56–1.01) and was similar in patients with prior chemotherapy for ABC (25.6 vs. 26.2 months; hazard ratio, 0.91 [95% CI: 0.63–1.32]) versus placebo-fulvestrant.

Conclusion

Prognostic factors for OS included endocrine sensitivity, nonvisceral disease, ECOG PS of 0, and no prior chemotherapy for ABC. Exploratory analyses suggest improved OS with palbociclib-fulvestrant versus placebo-fulvestrant in patients with no prior chemotherapy for ABC, prior endocrine sensitivity, and fewer prior regimens of systemic therapy. (Clinical trial identification number: NCT01942135).

Implications for Practice

Prognostic factors for overall survival in HR+/HER2− advanced breast cancer (ABC) include the absence of prior chemotherapy in the advanced setting, endocrine sensitivity, nonvisceral disease, and an ECOG performance status of 0. Improved overall survival benefit was observed with palbociclib-fulvestrant versus placebo-fulvestrant in patients (regardless of menopausal status or visceral involvement) with no prior chemotherapy for ABC, with prior endocrine sensitivity, and fewer prior regimens of systemic therapy. Progression-free survival was prolonged with palbociclib across subgroups (regardless of chemotherapy exposure in ABC). These exploratory findings suggest that patients may receive greater clinical benefit from palbociclib-fulvestrant if they receive the combination before chemotherapy in the advanced setting.

     

Factors Associated with Suicide Risk in Advanced Cancer Patients: A Cross-Sectional Study

The study aimed to find out to what degree suicidal thoughts and associated factors affect the suicide risk of advanced cancer patients. The frequency of suicidal thoughts among patients with cancer, especially in the advanced stages, is about 3 times greater than the adult average in South Korea. We recruited 457 participants with four types of cancers (colon, breast, cervical, and lung) using stratified sampling. Data collection was carried out through one-on-one interviews by trained nurses using a structured questionnaire. Advanced cancer patients with high, vs. low, levels of anxiety and pain had a higher suicide risk. In contrast, having one’s spouse as the primary care provider was associated with a low suicide risk. Overall, the three factors of anxiety, pain, and the primary caregiver being one’s spouse explained 17.2% of the variance in suicide risk. In conclusion, we derived influencing factors of suicide risk using a sample of patients with various types of advanced cancer. The results provide systematic baseline data for preparing nurse-led interventions to prevent suicidal thoughts and suicide attempts among advanced cancer patients.     

Response to Neoadjuvant Chemotherapy in Patients with Advanced Breast Cancer: A Local Hospital Experience

A large proportion of women present with advanced breast cancer in the developing countries with limitedresources. Many of these patients have ulcerated, bleeding lesions or visually obvious masses in the breast.Neoadjuvant chemotherapy is well established as the standard of care and initial management of choice forthese patients. Tumor shrinkage achieved with neoadjuvant chemotherapy has the advantage of converting aninoperable disease to an operable condition, with the option of breast conservation surgery where mastectomyis the only initial option for loco-regional control. Neoadjuvant chemotherapy also provides the earliest possibletreatment of micrometastases and thus improves survival. In the present study, 165 advanced breast cancerfemale patients registered at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, between 1st July2005 and 30th June 2007 were evaluated for response to neoadjuvant chemotherapy. Tumor measurements weremade and recorded prior to the first cycle of chemotherapy and 3 weeks after the third cycle. A clinical completeresponse was seen in 7.3%, a partial response in 60%, stable disease in 24% and progressive disease in 9%. Acomplete pathological response was only seen in 3.6% of evaluable patients. We conclude that breast cancer inpatients presenting for neoadjuvant chemotherapy at our facility is more aggressive, generally presents as moreadvanced and bulky local disease, affects a younger population and features a low and unpredictable responseto neoadjuvant chemotherapy.     

乳腺癌患者外周血T淋巴细胞AgNOR活性表达及其临床意义

目的:探讨乳腺癌患者外周血T淋巴细胞AgNOR的活性表达及其与临床病理因素的相关性.方法:利用KL型图像分析系统检测80例乳腺癌患者,40例乳腺纤维腺瘤患者,25例乳腺炎症患者和75例健康人外周血T淋巴细胞AgNOR的活性表达(T淋巴细胞核仁银染面积与细胞核面积比值,即I.S%),并与乳腺癌患者临床病理因素进行相关性分析.双抗体夹心法检测乳腺癌患者CA153和CEA.结果:发现乳腺癌患者外周血T淋巴细胞AgNOR的活性表达(5.88±6.05%)明显低于健康人(7.07±0.81%)、乳腺纤维腺瘤患者(6.58±0.72%)和乳腺炎症患者(9.58±0.68%)(P=0.000);乳腺炎症患者AgNOR的活性表达明显高于健康人、乳腺纤维腺瘤和乳腺癌患者(P=0.000);健康人与乳腺纤维腺瘤患者之间比较无显著性差异(P＞0.05).乳腺癌患者AgNOR阳性率(65.00%)明显优于CA153(17.50%)和CEA(12.50%)的阳性率(P=0.000).AgNOR表达与乳腺癌临床分期有关(P＜0.05),而与年龄、肿瘤大小、淋巴结转移状况无相关性(P＞0.05).结论:AgNOR阳性表达可作为评价乳腺癌发生、发展的客观生物学指标;在乳腺癌诊断、鉴别诊断和病情监测等方面有重要意义.     

Comparison of Radical Cystectomy and Chemoradiotherapy in Patients with Locally Advanced Bladder Cancer

The aim of this study was to evaluate the clinical outcomes of radical cystectomy (RC) and concurrent chemoradiotherapy (CRT) with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with locally advanced bladder cancer (BC). From December 2000 to February 2012, 72 patients with locally advanced BC (T3-4a, N0 or N+, M0) received either RC or CRT. RC with bilateral pelvic lymph node dissection including the common iliac region as the standard procedure. Patients in the CRT group received one cycle of MVAC followedby radiotherapy with a half dose of MVAC and then two more cycles of MVAC. Standard fractionation at a daily dose of 1.8-2.0 Gy was used, with a median total dose of 50 Gy (range, 45-60 Gy). The 3-year progression-free survival (PFS) rates in the RC and CRT groups were 56.2% and 25.6%, respectively (p=-0.015) and the 3-year overall survival (OS) rates were 63.5% and 48.1% (p=0.272). Multivariate Cox proportional hazards regression analysis with application of a propensity score indicated that RC was a significant predictor of PFS (p=0.033)but not of OS (p=0.291). Among patients with locally advanced BC, PFS was significantly prolonged in the RC group compared with the CRT group. However, RC was not a significant predictor of OS. Although the sample size in this study was small, the results suggest that patient background and postoperative quality of life should be considered when choosing treatment strategy for locally advanced BC.     

胃癌患者血清瘦素与营养状况的关系

目的:探讨肥胖基因表达产物瘦素与胃癌病人营养状况的关系。方法:采用放射免疫分析法测定147例胃癌病人血清瘦素含量,同时测定身高、体重、疾病分期、ECOG法一般状况分级。体质指数(BMI)=体重(kg)/犤身高(m)犦2。营养正常的BMI范围为18.5～25;BMI<18.5为营养不良;BMI>25为肥胖。结果:胃癌病人合并营养不良组的血清瘦素平均含量明显低于营养正常组或肥胖组。男性胃癌病人合并营养不良、营养正常及肥胖组血清瘦素水平分别为(2.41±1.59)μg/L、(4.80±3.21)μg/L、(9.16±2.81)μg/L;女性则分别为(5.53±3.06)μg/L、(8.94±4.78)μg/L、(20.58±9.48)μg/L。全组男性、女性胃癌病人的血清瘦素水平分别为(4.39±3.42)μg/L、(8.97±6.56)μg/L;女性均值高于男性1倍。胃癌病人的血清瘦素水平与BMI显著相关(男性r=0.538,P<0.05;女性r=0.785,P<0.05)。BMI正常的胃癌病人的血清瘦素与健康人无差异。结论:血清瘦素含量可以反映胃癌病人的BMI变化和营养状况,且可作为判断胃癌病人营养状况的指标。