Prognostic Understanding and Quality of Life in Patients With Advanced Lung Cancer: A Multicenter Study

IntroductionCommunication about the palliative setting remains a barrier for many physicians because they are afraid to harm the patient by giving bad news. We sought to determine whether this a valid concern; the influence of prognostic understanding on patients’ quality of life (QoL); and which factors influence this relationship.MethodsThe present multicenter, cross-sectional study used a questionnaire to measure patients’ prognostic understanding, QoL, mood, and coping strategy.ResultsWe surveyed 125 patients with advanced lung cancer. Prognostic understanding correlated significantly with emotional well-being (r = −0.20; P = .01) and pain (r = 0.43; P = .00) but not with anxiety (r = 0.12, P = .12) or depression (r = 0.05; P = .29). Patients with anxiety (r = −0.23; P = .01) and patients with depressive feelings (r = −0.63; P = .00) experienced poorer QoL. Four in 10 patients reported feelings of anxiety and/or depression. Positive reframing as a coping strategy was associated with a better QoL (r = 0.25; P = .00).ConclusionPrognostic understanding was related to poorer emotional well-being and more pain but does not affect mood. Four in 10 patients reported feelings of anxiety and/or depression, which were associated with a poorer QoL. A holistic approach seems necessary when physicians communicate about the palliative setting.     

Survival Rate and Prognostic Factors for Colorectal Cancer in Sabah,Borneo, Malaysia: A Retrospective Cohort of a Population-Based Study

Background: Colorectal cancer is a major public health problem with significant number of cases and death in the population. This study aimed to determine the 5-year overall survival rate and the prognostic factors for colorectal cancer patients in Sabah. Methods: This was a retrospective cohort study conducted using secondary data from Malaysian National Cancer Registry (MNCR) database. A 5-year overall survival and the median survival time were determined with Kaplan-Meier survival curve. Cox regression analysis was done to determine the prognostic factors on survival. Results: A total of 1,152 patients were included in this study. The majority of the patients had colon cancer and presented at late stage (stage III and IV) as compared to early stage (stage I and II). From the analysis, the 5-year overall survival for colorectal cancer was 23.2% (95% CI: 21.8, 24.6) and the median survival time was 16 months (95% CI: 14.3, 17.7).  Higher survivals are seen in males (23.6%, 95% CI: 20.4, 24.7), aged 50-74 years old (24.2%, 95% CI: 22.4, 26.0), Chinese (25.5%, 95% CI: 23.0, 28.0), lived in Keningau (25.6%, 95% CI: 20.8, 30.4), colon as primary tumor site (24.5%, 95% CI: 22.5, 26.4), diagnosed with stage I (55.6%, 95% CI: 48.7, 62.5) and received surgery with chemotherapy or radiotherapy (31.3%, 95% CI: 27.8, 34.8). The significant prognostic factor was the stage at diagnosis. Patients with stage IV colorectal cancer (HR: 11.18; 95% CI: 3.48, 35.93) had eleven times risk of dying as compared to stage I. Conclusion: The survival rate for colorectal cancer patients in Sabah was comparatively lower than other states in Malaysia and in some Asian countries. Those patients who presented at later stage had poorer survival. Health promotion and community-based screening program should be emphasized in addition to encouraging early diagnosis to improve survival.     

Treatment Outcomes and Survival Study of Gastric Cancer Patients: A Retrospective Analysis in an Endemic Region

Purpose: To present information about prognostic factors of gastric cancer patients treated in our Erzurumcenter including age, gender, tumour location, pathological grade, stage and the effect of treatment on survival.Materials and Methods: This retrospective study was performed on patients who applied to our clinic anddiagnosed as gastric cancer. Age and gender of the patients, primary location, histopathological characteristics,TNM stage of the gastric cancers (GCs), treatment applied, oncological treatment modalities and survivaloutcomes were studied. A univariate analysis of potential prognostic factors was performed with the log-ranktest for categorical factors and parameters with a p value < 0.05 at the univariate step were included in themultivariate regression. Results: A total of 228 patients with a confirmed diagnosis of gastric cancer wereincluded in the study with a male/female ratio of 1.47. Median follow-up period was estimated as 22.3 (range, 3to 96) months. When diagnosis of the patients at admission was analysed, stage III patients were most frequentlyencountered (n=147; 64.5%). One hundred and twenty-six (55.3%) underwent surgical treatment, while 117(51.3%) were given adjuvant chemotherapy. Median overall survival time was 18.0 (±1.19) months. Mean overallsurvival rates for 1, 2, 3 and 5 years were 68±0.031%, 36±0.033%, 24±0.031% and 15.5±0.036%, respectively.Univariate variables found to be significant for median OS in the multivariate analysis were evaluated with Coxregression analysis. A significant difference was found among TNM stage groups, location of the tumour andpostoperative adjuvant treatment receivers (p values were 0.011, 0.025 and 0.001, respectively). Conclusions: Thisstudy revealed that it is possible to achieve long-term survival of gastric cancer with early diagnosis. Besides, inlocally advanced GC patients, curative resection followed by adjuvant concomitant chemoradiotherapy basedon the McDonald regimen was an independent prognostic factor for survival.     

Demographic Characteristics,Survival and Prognostic Factors of Early Breast Cancer Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cohort Study

Objective: With increasing prevalence of type 2 diabetes mellitus and breast cancer in Iran, we aimed to search hospital registries of breast cancer patients to investigate type 2 diabetes mellitus association with survival outcomes of early breast cancer after adjustment of confounding factors. Methods: In a retrospective cohort study conducted from July 2003 to Feb 2014 and followed up until death or December 2016, female patients with early breast cancer who have been treated for the first time at the Cancer Institute of Iran, were divided to diabetic and non-diabetic groups. Primary and secondary outcomes were relapse free survival (RFS) and overall survival (OS). SPSS version 23 was used for analysis of data. Other variables included age, tumor stage, hormone receptor status, tumor subtype, and patient’s body mass index (BMI). Result: From a total of 1021 patients, 218 (21.4%) had type 2 diabetes mellitus. Diabetic patients had a higher mean age (53.31 vs 47.00), higher mean BMI (31.13 vs 29.15), lower HER2 expression (20.8% vs 32.1%) and higher frequency of luminal A subtype (61.1% vs 51.0). Overall, after adjustment of other variables, diabetes status did not affect RFS or OS independently. However, in luminal A subgroup, patients with diabetes mellitus had significantly lower survival outcomes of OS (135.277 vs 154.701) and RFS (114.107 vs 133.612) as well as OS higher hazard ratio of 1.830 and RFS hazard ratio of 1.663 compared to non-diabetic patients. BMI, hormone receptor status and tumor stage significantly affected the survival of the patients. Conclusion: In the present study, in addition to known breast cancer risk factors, BMI and type 2 diabetes mellitus had an independent impact on survival of the patients, highlighting the importance of health issues such as obesity and diabetes suboptimal performance in the treatment outcomes of early breast cancer patients in Iran.     

Site-Specific Evaluation of Prognostic Factors on Survival in Iranian Colorectal Cancer Patients: A Competing Risks Survival Analysis

Background: Colorectal cancer (CRC) is one of the most malignant cancers, but prognosis varies in differentparts of the world. Knowing the prognostic factors of the cancer is clinically important for prognosis and treatmentapplication objectives. However, evaluation of these factors overall does not provide thorough understanding ofthe cancer. Therefore, this study aimed to evaluate prognostic factors of colon and rectal cancers site-specifically,via a competing risks survival analysis with colon and rectum as competing causes of death. Methods: A total of1,219 patients with CRC diagnosis according to the pathology reports of our cancer registry, from 1 January2002 to 1 October 2007, were entered into the study. Demographic and clinicopathological factors with regard tosurvival of patients were analyzed using univariate and multivariate competing risks survival analysis, utilizingSTATA statistical software. Results: The results of univariate analysis showed that gender, body mass index(BMI), alcohol history, inflammatory bowel disease (IBD), tumor size, tumor grade and pathologic stage weresignificantly associated with colon cancer and BMI, personal history of cancer, pathologic stage and the kind offirst treatment used were significantly related to rectal cancer. In the multivariate analysis, BMI, IBD, tumorgrade and pathologic stage of the cancer were significant prognostic factors for colon cancer and BMI and thekind of first treatment used were significant prognostic factors of rectal cancer. Also 1, 2, 3, 4 and 5 year andoverall adjusted survival of patients with rectal cancer was better than those of colon cancer. Conclusion: Basedon our findings, CRC is not a single entity and its sub-sites should be evaluated separately to reveal hiddenassociations which may not be revealed under general modeling.     

Determination of Prognostic Factors in Japanese Patients With Advanced Gastric Cancer Using the Data From a Randomized Controlled Trial,Japan Clinical Oncology Group 9912

Background.

In advanced gastric cancer (AGC), no globally accepted prognostic scoring system has been developed. Therefore, we explored baseline prognostic factors in Japanese AGC patients using the data from a randomized controlled trial, Japan Clinical Oncology Group (JCOG) 9912, which investigated the efficacy of systemic chemotherapy as a first-line treatment.

Patients and Methods.

Prognostic factors and prognostic indices for overall survival were screened and evaluated in patients enrolled in JCOG9912 using the Cox proportional hazard model. The Royal Marsden Hospital prognostic model was also applied to the JCOG9912 trial.

Results.

A total of 650 (92.3%) of the 704 patients randomized in the JCOG9912 trial, for whom complete data were available for multivariate analyses, was included in the present study (5-fluorouracil arm, n = 215; irinotecan plus cisplatin arm, n = 216; S-1 arm, n = 219). The median survival time (MST) for all patients was 11.8 months. To construct a prognostic index, we selected four risk factors by multivariate analysis: performance status ≥ 1, number of metastatic sites ≥ 2, no prior gastrectomy, and elevated alkaline phosphatase. MSTs were 17.0 months for patients categorized into the low-risk group, who had zero or one risk factor (n = 225); 10.4 months for patients in the moderate-risk group, who had two or three risk factors (n = 368); and 5.0 months for patients in the high-risk group, who had all four risk factors (n = 57).

Conclusion.

In the present study, we propose a new prognostic index for patients with AGC. This can be used for more appropriate patient stratification in future clinical trials.     

Factors Affecting Survival in Patients with Colorectal Cancer in Shiraz,Iran

Background: Colorectal cancer (CRC) is the third most common cancer in the world, and the fourth in Iran in both genders. The aim of this study was to find predictive factors for CRC survival. Materials and Methods: Medical records of 570 patients referred to the radiotherapy oncology department of Shiraz Namazi hospital from 2005 to 2010 were retrospectively analysed. Data were collected by reviewing medical records, and by telephone interviews with patients. Survival analysis was performed using the Cox’s regression model with survival probability estimated with Kaplan-Meier curve. The log-rank test was used to compare survival between strata. Data was analyzed with Stata 12. Results: The five-year survival rate and the mean survival time after cancer diagnosis were 58.5% and 67±1.4 months. On multivariate analysis, age of diagnosis, disease stage and primary tumor site‚ lymphovascular invasion and type of treatment (in colon cancer) were significant factors for survival. Conclusions: Age of diagnosis and type of treatment (adjuvant therapy in patients with colon cancer) were two modifiable factors related to survival of CRC patients. Therefore earlier diagnosis might help increase survival.     

The Effect of Treatment Sequence on Overall Survival for Men With Metastatic Castration-resistant Prostate Cancer: A Multicenter Retrospective Study

IntroductionWe aimed to evaluate the treatment sequence for patients with metastatic castration-resistant prostate cancer (mCRPC) in real-world practice and compare overall survival in each sequential therapy.Patients and MethodsWe retrospectively evaluated 146 patients with mCRPC who were initially treated with androgen deprivation therapy as metastatic hormone-naive prostate cancer in 14 hospitals between January 2010 and March 2019. The agents for the sequential therapy included new androgen receptor-targeted agents (ART: abiraterone acetate or enzalutamide), docetaxel, and/or cabazitaxel. We evaluated the treatment sequence for mCRPC and the effect of sequence patterns on overall survival.ResultsThe median age was 71 years. A total of 35 patients received ART-ART, 33 received ART-docetaxel, 68 received docetaxel-ART, and 10 received docetaxel-cabazitaxel sequences. The most prescribed treatment sequence was docetaxel-ART (47%), followed by ART-ART (24%). Overall survival calculated from the initial diagnosis reached 83, 57, 79, and 37 months in the ART-ART, ART-docetaxel, docetaxel-ART, and docetaxel-cabazitaxel, respectively. Multivariate Cox regression analyses showed no significant difference in overall survival between the first-line ART (n = 68) and first-line docetaxel (n = 78) therapies (hazard ratio [HR], 0.84; P = .530), between the ART-ART (n = 35) and docetaxel-mixed (n = 111) sequences (HR, 0.82; P = .650), and between the first-line abiraterone (n = 32) and first-line enzalutamide (n = 36) sequences (HR, 1.58; P = .384).ConclusionThe most prescribed treatment sequence was docetaxel followed by ART. No significant difference was observed in overall survival among the treatment sequences in real-world practice.     

Impact of Coexisting Uterine Adenomyosis on the Survival Outcome of Patients with Endometrial Cancer: A Retrospective Cohort Study

Objective: To determine the effects of uterine adenomyosis on endometrial cancerrecurrence rates. Methods: Thisretrospective cohort study reviewed all consecutive patients diagnosed with endometrial cancerwho underwent totalhysterectomy-based surgical staging at Srinagarind Hospital between January, 2010 and January, 2016. The patientsweredivided into two groups:a uterine adenomyosisgroup and a non-adenomyosis group. Patient demographics, type ofsurgery, histopathology, stage of endometrial cancer, adjuvant treatment, and survival outcomes were compared.Results: A total 350 patients were enrolled, with 132 (37.71%) in the adenomyosis group and 218 (62.29%) in the nonadenomyosis group. Deep myometrial invasion and lymphovascular space invasion (LVSI) were more commonly foundamong patients who had no adenomyosis compared to those with adenomyosis(52.8% vs 39.4%, P=0.02 and 53.2%vs. 38.6%, P=0.01). There were no significant differences in terms of five-year recurrence-free survival (HR=1.47;95%CI 0.88-2.44) and five-year overall survival (HR=0.81; 95%CI 0.43-1.53) between the two comparison groups.Conclusion: Coexisting uterine adenomyosis in endometrial cancer wasassociated withdeep myometrial invasion andLVSI but did not have significant impact on survival.     

Mortality Determinants in Colorectal Cancer Patients at Different Grades: a Prospective,Cohort Study in Iran

Background: Colorectal cancer (CRC) is an important cause of mortality and morbidity in many communitiesworldwide. This population based study was conducted to assess determinants of colorectal mortality in Iranianpatients. Materials and Methods: A cohort of 1,127 cases of confirmed colorectal cancer registered in a populationbased registry covering 10 referral hospital in Tehran, Iran, were followed for five years. Information about tumorcharacteristics, smoking status and family history were collected at base line and survival status were followedevery six months by contacting patient or next of kin (if patients died during the follow-up). The cause of deathfor each case was validated by verbal autopsy and referring to patient medical records at the time of death. Thedata were analyzed by Stata software using univariate and multivariate analysis (Cox regression). In building themodel a p value of less than 5% was considered as significant. Results: The age at diagnosis was 53.5±14 years.Sixty one percent were male. Colorectal mortality among the patients was 96.9 person-years among men and 83person-years among women. Seventy five percent of patients lived for 2.72 years, 50% for 5.83, and 25% for 13years after the diagnosis of colorectal cancer. The age at diagnosis was significantly different between men andwomen (p<0.03). Higher tumor grade predicted higher death rate; the adjusted hazard ratios were 1.79 (95%CI,0.88-3.61), 2.16 (95%CI, 1.07-4.37), and 3.1 (95%CI, 1.51-6.34) for grades II, III, and IV respectively when theywere compared with grade I as reference. Ethnicity, marital status, family history of cancer, and smoking wererelated to survival with different degrees of magnitude. Conclusions: Among many factors related to survivalamong the colorectal patients, tumor grade and smoking showed the highest magnitudes of association.     

Long-Term Overall Survival From KEYNOTE-021 Cohort G: Pemetrexed and Carboplatin With or Without Pembrolizumab as First-Line Therapy for Advanced Nonsquamous NSCLC

IntroductionIn cohort G of KEYNOTE-021 (NCT02039674), first-line pembrolizumab plus pemetrexed-carboplatin significantly improved the objective response rate and progression-free survival versus chemotherapy alone with manageable toxicity in advanced nonsquamous NSCLC. We report the long-term outcomes from this study.MethodsPatients with previously untreated advanced nonsquamous NSCLC without sensitizing EGFR or ALK alterations were randomly assigned 1:1 to receive open-label pemetrexed 500 mg/m² plus carboplatin at area under the concentration-time curve of 5 mg/mL/min (four cycles) with or without pembrolizumab 200 mg (up to 2 years), with optional pemetrexed maintenance, each administered every 3 weeks. Eligible patients could crossover from the chemotherapy arm to pembrolizumab monotherapy after progression. Responses were assessed per the Response Evaluation Criteria in Solid Tumors version 1.1.ResultsAfter the median time of 49.4 months from randomization to data cutoff, objective response rate (58% versus 33%) and progression-free survival (median: 24.5 versus 9.9 mo; hazard ratio: 0.54; 95% confidence interval: 0.35?0.83) remained improved with pembrolizumab combination (n = 60) versus chemotherapy (n = 63), regardless of programmed death ligand 1 status. Median overall survival was 34.5 versus 21.1 months (hazard ratio: 0.71; 95% confidence interval: 0.45?1.12), despite a 70% crossover rate from chemotherapy alone to anti?programmed death (ligand) 1 therapy. Among the 12 patients who completed 2 years of pembrolizumab, 92% were alive at data cutoff; the estimated 3-year duration of response rate was 100%. Grade 3 to 5 treatment-related adverse events occurred in 39% of patients receiving pembrolizumab combination and 31% receiving chemotherapy.ConclusionsFirst-line pembrolizumab plus pemetrexed-carboplatin continued to show improved response and survival versus chemotherapy alone in advanced nonsquamous NSCLC, with durable clinical benefit in patients who completed 2 years of therapy. No new safety signals were observed with longer follow-up.     

Overall Survival Rate of Vietnamese Patients with Colorectal Cancer: A Hospital-Based Cohort Study in the Central Region of Vietnam

Background: This study investigated the overall survival (OS) at 1-year, 3-years, and 5-years after colorectal cancer (CRC) diagnosis and examined the prognostic factors of mortality among patients with CRC in Vietnam’s central region. Methods: This ambidirectional cohort study included patients newly diagnosed with CRC at a tertiary hospital in Vietnam’s central region between 2013 and 2019. Survival duration was calculated from the surgery date or the first day of CRC-specific treatment until the date of death or the study’s end date, July 31, 2020. Kaplan-Meier methods and log-rank test were used to estimate and compare the OS between the subgroups, respectively. The Cox proportional-hazards (PH) regression analysis was applied to estimate the magnitude of the effects between prognostic factors and outcome. Results: The median follow-up was 24 months (interquartile range: 13–43 months). The OS rate dropped significantly to 84.7%, 56.19%, and 45.01% at 1-year, 3-years, and 5-years after diagnosis, respectively. The median OS was 48.59 months (39.34 –57.93 months) for the rectum and colon cases. In the multivariate analysis, a higher mortality risk was observed in patients with an advanced-stage CRC (HRadj, 3.04; 95% confidence interval [CI], 1.79–5.18), who were underweight (<18.5 kg/m2; HRadj, 1.65; 95%CI, 1.03–2.65), and had elevated preoperative carcinoembryonic antigen (CEA) level (>5.0 ng/mL; HRadj, 1.63; 95%CI, 1.03–2.59). Additionally, younger patients (<50 years) had a poorer OS than the middle-aged group (60–69 years). Conclusion: Our findings indicate that <50% of Vietnamese patients with CRC survive until 5-years after diagnosis. Several individual factors that contribute to the poor OS of patients with CRC, including young age, underweight, and elevated preoperative CEA level, should be evaluated and managed. Early diagnoses through active routine examination of or screening programs for high-risk groups should be prioritized.     

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.     

Outcomes of Patients with Transformed Mycosis Fungoides: Analysis from a Prospective Multicenter US Cohort Study

IntroductionWe examined patient characteristics, treatments, and outcomes of patients with transformed mycosis fungoides (tMF) from COMPLETE: a large, multicenter, prospective cohort study of peripheral T-cell lymphoma patients in the United States.MethodsPatients with tMF were enrolled in COMPLETE at the time of transformation. For this analysis, we identified patients with tMF with completed baseline, treatment, and follow-up records. Median survival was assessed using Kaplan-Meier methodology.ResultsOf the 499 patients enrolled in COMPLETE, 17 had tMF. Median age was 61; 53% were male, 9 had elevated lactate dehydrogenase, and 9 had lymph node involvement. Approximately one-quarter of the patients were African American and 47% had CD30+ disease. Median time to transformation was 53 months. All patients received systemic therapy, with 19% receiving concomitant radiotherapy. Most patients (87%) received single agents, including liposomal doxorubicin, pralatrexate, and gemcitabine. Eight patients (50%) had reported responses to therapy. Median survival was 18 months. One- and 2-year survival rates were 56% and 44%, respectively.ConclusionstMF often expresses CD30 and presents with lymph node involvement. Responses have been seen with single agents, but survival remains poor. Novel treatment approaches are urgently needed to improve outcomes.