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Background
Immune-related adverse events (irAEs) are commonly encountered, when using programmed death-1/programmed death-ligand-1 (anti-PD-1/PD-L1) therapy and are often managed with corticosteroids. The effect of irAEs, particularly when steroids are required, on patient survival is not well established.Methods
In this retrospective analysis, data for 157 patients with various tumor types treated with anti-PD-1/PD-L1 therapy were obtained. Kaplan–Meier and Cox regression analyses were used to assess the effect of irAEs and corticosteroids on progression-free survival (PFS).Results
A total of 45 irAEs were recorded for 157 patients. Twenty-one patients received systemic corticosteroids. Patients who developed irAEs, as well as those who received systemic corticosteroids, had improved PFS by Kaplan–Meier estimate. Multivariate Cox regression showed that irAEs were associated with improved PFS (hazard ratio of 0.33, P <0.001) which persisted even with use of systemic corticosteroids (hazard ratio of 0.38, P?=?0.03).Conclusions
irAEs are associated with improved PFS in patients receiving anti-PD-1/PD-L1 therapy. This association does not appear to be altered by the use of systemic corticosteroids. 相似文献3.
Zarnie Lwin Alex Broom David Sibbritt Kay Francis Christos S Karapetis Deme Karikios Rosemary Harrup 《Seminars in oncology》2018,45(5-6):284-290
Background
The aim of this study was to understand the current and future challenges for the Australian medical oncologist workforce.Methods
Utilising an on-line self-administered questionnaire, this cross-sectional study collected data from members of the Medical Oncology Group of Australia on workforce-related issues. Participants consisted of medical oncology specialist advanced trainees, early-career oncologists (ECOs), and medical oncology consultants.Findings
Of the 633 members, 354 completed the questionnaire, representing a 55.9% response rate. Based on Medical Oncology Group of Australia membership, the number of medical oncologists has increased since the previous workforce study in 2009, with an uncertainty among junior medical oncologists regarding their future career prospects. The majority of participants worked in capital cities and metropolitan areas within the three most populous Australian states. Almost half (45%) of ECOs and consultants are undertaking or have completed a higher degree. A large number of advanced trainees (93%) and half of ECOs in this study were concerned about their future career prospects. For these participants, most were satisfied with the supervision they received (60% trainees and 69% ECOs) but only half of these participants (47% trainees and 52% ECOs) received any mentoring in their current or previous role. Compared to trainees and ECOs, consultants reported spending significantly more hours on administration per week; trainees 5.3 hours, ECOs 5.8 hours, consultants 7.5 hours (P < .031) and see a significantly greater number of patients per week; trainees 34 patients, ECOs 34 patients and consultants 49 patients (P < .001).Interpretation
Workforce challenges were unique across different career stages in oncology; trainees, ECOs and consultants. Work intensity, mentorship and career prospects were amongst the emergent issues highlighted in this study. 相似文献4.
Baoan Hong Lin Cai Jiangyi Wang Shengjie Liu Jingcheng Zhou Kaifang Ma Jiufeng Zhang Bowen Zhou Xiang Peng Ning Zhang Kan Gong 《Clinical genitourinary cancer》2019,17(2):97-104.e1
Background
Programmed death ligand-1 (PD-L1) is a potential predictive biomarker for immunotherapy in several malignancies. However, the expression level and clinical significance of PD-L1 in von Hippel–Lindau (VHL)-associated hereditary clear-cell renal cell carcinoma (ccRCC) remain unclear.Patients and Methods
Surgical specimens were recruited from 129 patients with sporadic ccRCC and 26 patients with VHL-associated hereditary ccRCC. The PD-L1 expression level was assessed using immunohistochemistry. Correlations between PD-L1 expression and clinicopathological features were analyzed.Results
In sporadic ccRCC, the positive expression rate of PD-L1 was 47.3% (61/129). Positive PD-L1 expression was correlated with advanced tumor T stage (P = .011), higher Fuhrman nuclear grade (P = .022), poor disease-free survival (P = .037), and sex (P = .025). In the VHL-associated hereditary ccRCC, positive PD-L1 expression rate was 34.6% (9/26), lower than that in sporadic ccRCC. Positive PD-L1 was correlated with higher Fuhrman nuclear grade (P = .008), but not with sex, age, tumor stage, or the onset age of VHL-associated tumors.Conclusion
Positive PD-L1 expression was correlated with the aggressive clinicopathological features in sporadic and VHL-associated hereditary ccRCC. Whether PD-L1 expression level in ccRCC is related to the effectiveness of programmed death-1/PD-L1 checkpoint inhibitor immunotherapy needs to be further investigated. 相似文献5.
Ozlem Ercelep Nuriye Ozdemir Nedim Turan Turkan Ozturk Topcu Mukremin Uysal Ozgur Tanriverdi Umut Demirci Burcu Yapar Taskoylu Zuhat Urakcı Ayse Ocak Duran Asude Aksoy Serkan Menekse Melike Ozcelik Mahmut Gumus 《Current problems in cancer》2019,43(1):27-32
Purpose
Solid pseudopapillary neoplasm (SPN) is a rare, low-grade neoplasm with excellent prognosis. In this study, we evaluated clinicopathological characteristics of patients diagnosed with SPN retrospectively.Methods
This is a retrospective study intended to characterize patients with the diagnosis of SPN between 2005 and 2015. Clinicopathological features, recurrence rate, and overall survival of 28 patients were recorded. Malignant SPN criteria were defined as the presence of distant metastasis (developed at diagnosis or during follow up) or lymph node involvement.Results
The mean age at diagnosis was 42 (range: 17-41). Among patients, 82% (n?=?23) were female and 17.9% (n?=?5) were male. The mean size of tumor was 5.81 cm (range: 2-15). The mean follow up period was 55.6 months, 1-year survival was 96.5% and 5-year survival rate was 88%. A total of 25 patients were alive at the end of follow-up period and 3 of the patients became exitus due to disease. Two patients had a metastatic presentation in livers at the diagnosis and metastasis developed in 3 patients during follow-up (liver of 1 patient, peritoneum in 1 patient and liver and peritoneum in 1 patient). The reason of admission was headache in 68% patients. The type of operation was frequently subtotal pancreatectomy (n?=?11, 39.3%) and distal pancreatectomy (n?=?10, 35.7%). Tumors were located frequently in body and tail regions (n?=?18, 64.3%) and the number of patients with malignant criteria was 6 (21.4%). Although the mean age of malignant patients was significantly higher than benign patients (P?=?0.046), there was no significant difference between 2 groups in terms of gender, tumor size, capsule invasion, perineural invasion, vascular invasion, and margin status.Conclusion
SPN is a rarely seen tumor with low malignity potential. Surgical resection provides long-term survival rate even in local invasion or metastasis conditions. 相似文献6.
Madeline Grade Julie Koenig Yushen Qian Navjot Sandhu Yufei Liu Brandon Turner Rie von Eyben Susan Knox Sara Dudley 《Practical radiation oncology》2019,9(2):e203-e209
Purpose
Emergent palliative radiation therapy (PRT) of symptomatic metastases can significantly increase the quality of life of patients with cancer. In some contexts, this treatment may be underused, but in others PRT may represent an excessively aggressive intervention. The characterization of the current use of emergent PRT is warranted for optimized value and patient-centered care.Methods and Materials
This study is a cross-sectional retrospective analysis of all emergent PRT courses at a single academic tertiary institution across 1 year.Results
A total of 214 patients received a total of 238 treatment courses. The most common indications were bone (39%) and brain (14%) metastases. Compared with outpatients, inpatients had lower mean survival rates (2 months vs 6 months; P < .001), higher rates of stopping treatment early (19.1% vs 9.0%; P = .034), and greater involvement of palliative care (44.8% vs 24.1%; P < .001), but the same mean planned fractions (9.10 vs 9.40 fractions; P = .669). In a multiple predictor survival analysis, palliative care involvement (P = .025), male sex (P = .001), ending treatment early (P = .011), and having 1 of 3 serious indications (airway compromise, leptomeningeal disease, and superior/inferior vena cava involvement; P = .007) were significantly associated with worse overall survival.Conclusions
Survival is particularly poor in patients who receive emergent PRT, and patient characteristics such as functional status and indication should be considered when determining fractionation schedule and dosing. A multi-institutional study of practice patterns and outcomes is warranted. 相似文献7.
Yamila Goenaga Vázquez Fernando Cabanillas Joel Rivera Concepción Olga L. Díaz Miranda 《Clinical Lymphoma, Myeloma & Leukemia》2019,19(3):e153-e158
Background
Although most cases of herpes zoster (HZ) are self-limited, lymphoma patients are at greater risk for recurrences and more serious and atypical complications that can delay scheduled anti-lymphoma treatment or prevent its continuation.Patients and Methods
This is a cohort study with a retrospective chart review of 415 patients diagnosed with lymphoma to determine the incidence and risk factors for developing HZ among this population. Data collected included date of diagnosis, patient’s age, last follow-up or death, stage and presentation of lymphoma, treatment type, baseline laboratory tests, and comorbidities. Patients with a diagnosis of HZ at any time during their course of illness were identified. Patients were divided into various subgroups to analyze their risk of developing HZ individually. The frequencies of each categorical variable were compared with χ2 tests. Relative risks were calculated using 95% confidence intervals (CIs).Results
During a median follow-up of 8.9 years, 46 cases of HZ were identified, with an overall incidence density of 11.1%. Higher rates of HZ were associated with lymphocytopenia (P = .038), presentation (P = .030), stage (P = .034), autologous stem cell transplant (P = .019), multiple courses of chemotherapy (P = .035), and fludarabine therapy (P = .002). Those who received what we labeled as ‘highly immunosuppressive chemotherapy’ had 2.9 times the risk to develop HZ than those who did not receive this therapy (95% CI, 1.47-5.623; P < .001).Conclusions
Receiving highly immunosuppressive chemotherapy is an independent risk factor for developing HZ. Patients with the risk factors described here might benefit from antiviral prophylaxis against HZ. 相似文献8.
T. Bathily I. Borget E. Rivin del Campo S. Rivera C. Bourgier 《Cancer radiothérapie》2019,23(2):83-91
Purpose
Since accelerated partial breast irradiation has demonstrated non-inferiority to whole breast irradiation regarding recurrence rate in patients with early stage breast cancer, our objective was to compare its impact on short-term adverse events, patient satisfaction and costs.Materials and methods
Patients with early stage breast cancer treated by breast-conserving surgery between 2007 and 2012 were included: 48 women who received three-dimensional conformal accelerated partial breast irradiation in a multicentre phase-II trial were paired with 48 patients prospectively treated with whole breast irradiation. Adverse events, and patients’ opinions concerning cosmesis, satisfaction and pain, were gathered 1 month after treatment. Direct and indirect costs were collected from the French National Health Insurance System perspective until the end of radiotherapy.Results
When comparing its impact, skin reactions occurred in 37% of patients receiving three-dimensional conformal accelerated partial breast radiotherapy and 60% of patients receiving whole breast irradiation (P = 0.07); 98% were very satisfied in the group three-dimensional conformal accelerated partial breast radiotherapy versus 46% in the group treated with whole breast irradiation (P < 0.001); direct costs were significantly lower in the group treated with partial breast irradiation (mean cost: 2510 € versus 5479 €/patient), due to less radiation sessions.Conclusion
In patients with early-stage breast cancer, partial irradiation offered a good alternative to whole breast irradiation, as it was less expensive and satisfactory. These, and the clinical safety and tolerance results, need to be confirmed by long-term accelerated partial breast irradiation results in on-going phase III trials. 相似文献9.
Elio Mazzone Felix Preisser Sebastiano Nazzani Zhe Tian Nicola Fossati Giorgio Gandaglia Andrea Gallina Denis Soulieres Derya Tilki Francesco Montorsi Shahrokh F. Shariat Fred Saad Alberto Briganti Pierre I. Karakiewicz 《Clinical genitourinary cancer》2019,17(2):105-113.e2
Background
Radical cystectomy (RC) may occasionally be performed in individuals with metastatic urothelial carcinoma of the bladder (mUCB). However, the role of lymph node dissection (LND) for such cases is unknown. Thus, we tested the effect of RC on cancer-specific mortality (CSM) and overall mortality in mUCB patients and the effect of LND and its extent on CSM.Patients and Methods
Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2013), we identified patients with mUCB who underwent RC with or without LND or non-RC management. Kaplan-Meier analyses and multivariable Cox regression models (CRMs) were used, after propensity score matching. The number of removed nodes best predicting CSM was identified using cubic splines and then was tested in multivariable CRMs.Results
Of 2314 patients, 319 (13.8%) underwent RC. After 2:1 propensity score matching, CSM-free survival was 14 versus 8 months (P < .001), and overall mortality–free survival was 12 versus 7 months (P < .001) for, respectively, RC and non-RC patients. In multivariable CRMs, lower CSM (hazard ratio = 0.48; P < .001) and lower overall mortality (hazard ratio = 0.49; P < .001) rates were recorded in RC patients. LND status did not affect CSM-free survival (13 vs. 10 months; P = .1). Cubic splines-derived cutoff of ≥ 13 number of removed nodes showed better CSM-free survival (20 vs. 11 months; P = .02) and reduced CSM in CRMs (hazard ratio = 0.67; P = .02).Conclusion
Our study validates the survival benefit of RC in mUCB and highlights the importance of more extensive LND. These findings may corroborate the hypothesis of potential cytoreductive effect of surgery in the context of metastatic disease. 相似文献10.
Erin B. Moth Belinda E. Kiely Natalie Stefanic Vasikaran Naganathan Andrew Martin Peter Grimison Martin R. Stockler Philip Beale Prunella Blinman 《Journal of Geriatric Oncology》2019,10(2):202-209
Aim
The Cancer and Aging Research Group's (CARG) Toxicity Score was designed to predict grade ≥3 chemotherapy-related toxicity in adults aged ≥65?yrs. commencing chemotherapy for a solid organ cancer. We aimed to evaluate the CARG Score and compare it to oncologists' estimates for predicting severe chemotherapy toxicity in older adults.Methods
Patients aged ≥65?yrs. starting chemotherapy for a solid organ cancer had their CARG Score (range 0–23) calculated. Their treating oncologist, blinded to these results, independently estimated each patient's risk of severe chemotherapy toxicity (0–100%). Toxicities were captured prospectively. The predictive value of the CARG Score and oncologists' estimates was estimated using logistic regression and in terms of Area Under the Receiver Operating Characteristic curve (AU-ROC).Results
126 patients from ten oncologists at two sites participated. The median age was 72?yrs. (range 65–84). The median CARG Score was 7 (range 0–17); the median oncologist estimate of risk was 30% (range 3–80%), and these measures were not correlated (r?=??0.01). 64 patients (52%) experienced grade?≥?3 toxicity. Rates of severe toxicity in low-, intermediate-, and high-risk groups by CARG Score were 58%, 47%, and 58% respectively, and 63%, 44%, and 67% by oncologist estimate. Severe chemotherapy toxicity was not predicted by the CARG Score (OR 1.04, 95%CI 0.92–1.18, p?=?.54, AU-ROC 0.52), or oncologists' estimates (OR 1.00, 95%CI 0.98–1.02, p?=?.82, AU-ROC 0.52).Conclusion
Neither the CARG Score, nor oncologists' estimates based on clinical judgement, predicted severe chemotherapy-related toxicity in our population of older adults with cancer. Methods to improve risk prediction are needed. 相似文献11.
Joo Hwan Lee Mina Yu Sung Hwan Kim Jong Hoon Lee Soo-Yoon Sung Bae Kwon Jeong Songmi Jeong Taek Keun Nam Jae Uk Jeong Hong Seok Jang 《Clinical colorectal cancer》2019,18(1):e130-e139
Background
In the Surveillance, Epidemiology, and End Results population-based data, the survival curves reversed between T4N0 (stages IIB or IIC) and T1-2N1 (stage IIIA) in rectal cancer. However, T4N0 had a higher stage than T1-2N1 in the current colorectal staging system.Patients and Methods
We analyzed 1804 patients with rectal cancer who were treated with preoperative chemoradiotherapy and curative surgery. We grouped patients by pathologic stage, and recurrence-free survival (RFS) and overall survival rates were calculated and compared for each stage. We evaluated prognostic factors that influenced recurrence and survival.Results
In the recurrence and survival analysis, 3-year RFS rates were 95.9% for ypStage 0, 94.0% for ypStage I, 78.9% for ypStage IIA, 55.8% for ypStage IIB/C, 80.2% for ypStage IIIA, 64.6% for ypStage IIIB, and 44.9% for ypStage IIIC. Patients with ypStage IIB/C showed significantly worse RFS (P = .004) than did those with ypStage IIIA. The ypStage IIB/C group showed significantly higher rates of both locoregional recurrence (24.3% vs. 5.5%; P = .02) and distant metastasis (31.6% vs. 17.1%; P = .048) than did the ypStage IIIA group. Compared with ypStage IIIA, ypStage IIB/C showed significantly higher pre-chemoradiotherapy carcinoembryonic antigen (P = .004), circumferential radial margin involvement (P = .001), and positive perineural invasion (P = .014).Conclusion
Patients with rectal cancer staged ypT4N0 were associated with higher locoregional recurrence and distant metastasis rates than those staged ypT1-2N1 in the current staging system. 相似文献12.
Andrea Sitlinger Rebecca A. Shelby Alyssa N. Van Denburg Heidi White Sarah N. Edmond Paul K. Marcom Hayden B. Bosworth Francis J. Keefe Gretchen G. Kimmick 《Journal of Geriatric Oncology》2019,10(2):317-321
Objective
To explore the impact of symptoms on physical function in women on adjuvant endocrine therapy for breast cancer.Methods
Eligible women were postmenopausal, had hormone receptor positive, stage I-IIIA breast cancer, completed surgery, chemotherapy, radiation, and on adjuvant endocrine therapy. At a routine follow-up visit, women (N?=?107) completed standardized symptom measures: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy Neurotoxicity scales. Two performance measures assessed function: grip strength (Jamar dynamometer; n?=?71) and timed get-up-and-go (TUG; n?=?103). Analyses were performed with an overall symptom composite score. Correlations and multiple linear regression analyses were performed to test adverse effects on physical function.Results
The mean age was 64?years (range 45–84), 81% white, 84% on an aromatase inhibitor, and on endocrine therapy for mean 35?months (range 1–130?months). Dominant hand grip strength was inversely correlated with symptom composite scores (r?=??0.29, p?=?.02). Slower TUG was positively correlated with higher Charlson comorbidity level (r?=?0.36, p?<?.001) and higher symptom composite scores (r?=?0.24, p?=?.01). In multivariate analyses, weaker dominant and non-dominant hand grip strength were significantly associated with greater symptom composite scores (β?=??0.27, t?=?2.43, p?=?.02 and β?=??0.36, t?=?3.15, p?=?.003, respectively) and slower TUG was associated with higher symptom composite scores (β?=?0.18, t?=?1.97, p?=?.05).Conclusions
Higher symptom burden is associated with worse physical function, as measured by hand grip strength and TUG. Further study to determine the impact of endocrine therapy and its side effects on function is warranted. 相似文献13.
Omar Abdel-Rahman Yuan Xu Shiying Kong Joseph Dort May Lynn Quan Safiya Karim Antoine Bouchard-Fortier HyoKeun Cho Winson Y. Cheung 《Clinical breast cancer》2019,19(2):e297-e305
Introduction
The aim of this study was to characterize treatment trends and outcomes of women who have preexisting cardiovascular disease (CVD) prior to the diagnosis of breast cancer.Patients and Methods
This represented a retrospective, population-based cohort study that analyzed pooled data from the provincial cancer registry, physician billing claims, hospital discharge abstracts, ambulatory care, and the 2011 census in a large Canadian province. Multivariable logistic regression was performed to identify the associations of CVD with breast cancer treatment and outcomes. Kaplan-Meier analyses were conducted and survival was compared between CVD and non-CVD groups. Cox regression models were constructed to determine the effect of CVD on overall and cancer-specific survival.Results
A total of 25,594 women with breast cancer were eligible and included in the current analysis. Preexisting CVD was associated with a lower likelihood of receiving chemotherapy (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.48-0.66; P < .0001) and radiotherapy (OR, 0.75; 95% CI, 0.67-0.83; P < .0001), but a higher probability of undergoing mastectomy (OR, 1.13; 95% CI, 1.03-1.25; P = .011). Unadjusted Kaplan-Meier analyses showed that individuals with preexisting CVD experienced worse median overall and cancer-specific survival when compared with those without CVD (87 vs. 150 months and 106 vs. 131 months, respectively; both P < .0001). Adjusting for measured confounders, the presence of preexisting CVD continued to predict for worse overall survival (hazard ratio, 1.55; 95% CI, 1.43-1.67; P < .0001), but not cancer-specific survival (hazard ratio, 1.11; 95% CI, 0.98-1.27; P = .099).Conclusions
Patients with breast cancer with preexisting CVD are less likely to receive recommended treatment for their cancer and more likely to exhibit worse overall survival. 相似文献14.
Paola Morelato Assunção Tamires Prates Lana Márcia Torresan Delamain Gislaine Oliveira Duarte Roberto Zulli Irene Lorand-Metze Carmino Antonio de Souza Erich Vinicius de Paula Katia Borgia Barbosa Pagnano 《Clinical Lymphoma, Myeloma & Leukemia》2019,19(3):162-166
Background
Cardiovascular events (CVEs) have been observed in patients with chronic myeloid leukemia treated with second-generation tyrosine kinase inhibitors.Patients and Methods
We retrospectively evaluated the incidence of CVEs on 233 consecutive patients with chronic myeloid leukemia, of which 116 were treated with imatinib, 75 with dasatinib, and 42 with nilotinib. The median follow-up was 2047, 1712, and 1773 days, respectively.Results
The cumulative incidence of CVEs was 4.29%. Three events occurred during dasatinib treatment, 6 during nilotinib treatment, and none during imatinib treatment (P ≤ .001). Arterial occlusive events occurred in 2 (2.6%) of 75 patients treated with dasatinib and in 6 (14.2%) of 42 patients treated with nilotinib (P ≤ .001). Furthermore, all of them occurred in patients with high-risk (n = 2) and very high-risk (n = 6) cardiovascular risk, contributing to 4.3% of mortality.Conclusion
CVEs were more frequent in patients treated with second-generation tyrosine kinase inhibitors. Arterial occlusive events were more frequent in patients treated with nilotinib, with high and very high cardiovascular risk. 相似文献15.
Dangui Chen Di Zhou Jingyan Xu Rongfu Zhou Jian Ouyang Bing Chen 《Clinical Lymphoma, Myeloma & Leukemia》2019,19(3):e159-e164
Background
Multiple myeloma (MM) is a heterogeneous disease characterized by chromosomal translocation, deletion, and amplification in plasma cells, resulting in a huge heterogeneity in its outcomes. In the era of novel agents such as bortezomib, thalidomide, and the cycles of treatment, risk stratification by chromosomal aberrations may enable a more rational risk-stratification selection of therapeutic approaches in patients with MM.Patients and Methods
We performed a retrospective study in 63 patients with MM; 29 (46.03%) with 1q21 gain and 34 (53.97%) without gain.Result
In all patients, we did not find that the patients with 1q21 gain had significantly better survival compared with patients without 1q21 gain (overall survival, P = .6916; progression-free survival, P = .8740). However, in 1q21 gain patients, we found that the bortezomib group had significantly better survival compared with the non-bortezomib group in terms of both the 3-year estimated overall survival (82.3% vs. 18.8%; P = .0154) and progression-free survival (62.8% vs. 8.75%; P = .0385).Conclusion
1q21 gain detected by fluorescence in situ hybridization is not as high risk for poor prognosis with regard to time for overall survival. And the clinical outcome of patients with 1q21 gain can be improved in those who received no less than 4 cycles of bortezomib-based therapy (bortezomib, thalidomide, and dexamethasone). 相似文献16.
Maxime Vanmechelen Diether Lambrechts Thomas Van Brussel Annelies Verbiest Gabrielle Couchy Patrick Schöffski Herlinde Dumez Philip R. Debruyne Evelyne Lerut Jean-Pascal Machiels Vincent Richard Maarten Albersen Vincent Verschaeve Stéphane Oudard Arnaud Méjean Pascal Wolter Jessica Zucman-Rossi Benoit Beuselinck 《Clinical genitourinary cancer》2019,17(2):e235-e246
Background
There are no validated markers that predict response or resistance in patients with metastatic clear-cell renal cell carcinoma (mccRCC) treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors such as sunitinib and pazopanib. Recently, single nucleotide polymorphism (SNP) rs2981582 in Fibroblast Growth Factor Receptor 2 (FGFR2) was found to be associated with clinical outcome in patients with mccRCC treated with pazopanib and sunitinib. We aimed to validate these findings in patients treated with sunitinib.Materials and Methods
Germline DNA was collected in patients with mccRCC starting first-line systemic therapy with sunitinib. SNP rs2981582 in FGFR2 C>T was genotyped. Association of the genotype with response rate, tumor shrinkage, median progression-free survival (mPFS), and median overall survival (mOS) was studied.Results
We collected clinical data from 154 patients with available germline DNA. Baseline prognostic markers were well-balanced between both subgroups. Patients with the TT genotype had a poorer outcome compared with patients with the CT/CC genotype. The median shrinkage of selected tumor target lesions during treatment with sunitinib was ?16% versus ?31% (P = .002), mPFS was 8 versus 15 months (P = .0007), and mOS was 22 versus 33 months (P = .04), respectively. On multivariate analysis, rs2981582 remained an independent predictor of PFS (hazard ratio, 2.858; 95% confidence interval, 1.659-4.923; P < .0001) and OS (hazard ratio, 1.795; 95% confidence interval, 1.003-3.212; P = .049).Conclusion
Polymorphism rs2981582 in FGFR2 is correlated to PFS and OS in patients with mccRCC treated with sunitinib. Prospective validation of the impact of this SNP is warranted. 相似文献17.
Rajni Sethi Jyoti Mayadev Suresh Sethi Dominique Rash Lee-may Chen Rebecca Brooks Stefanie Ueda I-Chow Hsu 《Practical radiation oncology》2019,9(2):e180-e186
Purpose
We assessed the effect of elective extended field radiation (EFRT) and nodal dose escalation on locoregional control and survival in patients with node-positive cervical cancer treated with definitive chemoradiation at 2 academic institutions.Methods and Materials
Patients with cervical cancer with pelvic and/or paraortic lymph node (PALN) metastases treated with definitive chemoradiation between 2004 and 2011 were retrospectively reviewed. Patterns of failure were recorded. The impact of tumor and treatment on survival or recurrence were evaluated.Results
A total of 78 patients were included. Median follow-up in surviving patients was 34 months. The 3-year overall survival (OS) and disease-free survival (DFS) were 65% and 50%, respectively (all patients), 68% and 52% (pelvic lymph nodes), and 59% and 48% (PALN). OS or DFS in pelvic-only versus PALN-positive patients was not significantly different (log-rank P = .24). Recurrences were distant (n = 22), PALN (n = 6), central pelvis (n = 5), pelvic lymph node (n = 3), and suspended ovary (n = 1). Higher nodal prescribed dose (range, 45-60 Gy) and elective EFRT did not affect DFS or OS (Cox proportional hazards P > .05). There was a trend toward decreased regional recurrence with higher nodal dose (hazard ratio, 0.85 per Gy increase; Cox proportional hazards P = .08). Elective EFRT did not affect PALN failure rate, OS, or DFS (Cox proportional hazards P > .05).Conclusions
Survival of patients with PALN involvement was similar to those with pelvic-only nodes. Higher nodal dose may improve regional control but did not affect survival. Elective extended-field radiation did not affect outcomes in this cohort. Most failures were distant, emphasizing the potential role of systemic therapy to improve outcomes. 相似文献18.
Nanya Wang Yabing Dong Lingling Zhao Hengjun Zhao Wei Li Jiuwei Cui 《Current problems in cancer》2019,43(1):77-85
Purpose
To analyze clinical factors that were associated with inadequate pain control in cancer patients with metastatic malignancy and moderate to severe baseline pain.Patients
We retrospectively analyzed data from 260 advanced cancer patients who admitted to the First Hospital of Jilin University (Jilin, China) from January 2012-May 2013.Measurements
Statistical analysis was performed to assess the correlation between pain control and baseline characteristics including, gender, patient age, type of malignancy, presence of bone metastases, pain intensity, pain location, etiology of pain, type of pain, and presence of breakthrough pain.Main Results
A total of 75.4% of patients obtained satisfactory pain control (numerical rating scale ≤ 3) in 3 days. Baseline characteristics including gastrointestinal tumors (P = 0.032), severe pain (P < 0.001), and frequent breakthrough pain (P < 0.001) were independent risk factors of poor pain control in the 3-day treatment. These factors were also significantly associated with longer time needed to achieve stable pain control. Of the 185 patients treated with opioids, higher doses of analgesics were used in younger patients (<60 years old; P = 0.018), and in patients with severe pain (P < 0.001), neuropathic pain (P = 0.002), and frequent breakthrough pain (P = 0.015).Conclusions
Factors associated with more difficult pain control include gastrointestinal tumor, severe baseline pain, presence of breakthrough pain, and neuropathic etiology of pain. 相似文献19.
Fernando A. Angarita Sergio A. Acuna Nancy Down Chung Shan Leung Farahnaz Pirmoradi Fahima Osman 《Clinical breast cancer》2019,19(2):e364-e369