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1.
Yoshimasa Miyagawa Kazuhiro Araki Ayako Bun Hiromi Ozawa Yukie Fujimoto Tomoko Higuchi Arisa Nishimukai Ayako Kira Michiko Imamura Yuichi Takatsuka Yasuo Miyoshi 《Clinical breast cancer》2018,18(5):400-409
Introduction
Although eribulin and nab-paclitaxel are chemotherapy agents widely used for locally advanced or metastatic breast cancer (MBC), their predictive factors remain unknown. Because the absolute neutrophil-to-lymphocyte ratio (NLR) is a significant prognostic factor for early-stage breast cancer, we investigated its usefulness in terms of the eribulin or nab-paclitaxel treatment efficacy for MBC.Patients and Methods
A total of 85 patients with MBC treated with eribulin (n = 59) or nab-paclitaxel (n = 26) were recruited. NLR values were collected at baseline, after 1 cycle, after 2 cycles, and at the end of treatment. The NLR cutoff value was set at 3.Results
The progression-free survival (PFS) of patients with an NLR < 3 at baseline (median, 242 days; n = 24) was significantly better than that of patients with an NLR of ≥ 3 (median, 98 days; n = 35; hazard ratio, 0.37, 95% confidence interval, 0.18-0.71; P = .0032). Similarly, the overall survival was marginally significantly better in patients with an NLR < 3 who were treated with eribulin (P = .058). However, the NLR was not significantly associated with PFS or overall survival for patients treated with nab-paclitaxel. No significant association was found between the NLR during treatment and PFS in the eribulin group. The significance of the NLR for the efficacy of eribulin was consistent, irrespective of estrogen receptor status, previous anthracycline or endocrine use, and the number of previous chemotherapy regimens.Conclusion
A low NLR at baseline was significantly associated with improved PFS in patients treated with eribulin but not in those treated with nab-paclitaxel. Therefore, the baseline NLR might be clinically useful for selecting patients who would benefit from eribulin. 相似文献2.
Introduction
The introduction of active new agents, such as small molecules and checkpoint inhibitors, for the treatment of metastatic renal-cell cancer (mRCC) is associated with a relevant increase in costs, and it is therefore important to strike a balance between the costs of treatment and the added value represented by the improvement of the clinical parameters of interest such as progression-free survival (PFS) and overall survival (OS).Methods
This analysis was conducted to assess the pharmacologic costs of second-line treatments for mRCC and was restricted to pivotal phase 3 randomized controlled trials (RCTs) used as second-line therapy.Results
Our analysis evaluated 4 phase 3 RCTs including a total of 2454 patients. The European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) reached high scores (grade 5) for the CheckMate 025 trial, medium scores (grade 3) for the RECORD-1 and AXIS trials, and low scores (grade 2) for the INTORSECT trial. When we combined the costs of therapy with the measure of efficacy represented by the PFS and OS, we found that the most relevant increase of costs was associated with the use of nivolumab but that it differed according to the difference in costs in terms of life gained, with the highest costs per week of PFS gained (€11,960) but the lowest cost for month of OS gain (€1772).Conclusion
When pharmacologic costs of drugs are combined with the measure of efficacy represented by the OS, nivolumab is a cost-effective second-line treatment for patients with mRCC. 相似文献3.
Brian I. Rini Thomas E. Hutson Robert A. Figlin Maria Josè Lechuga Olga Valota Lucile Serfass Brad Rosbrook Robert J. Motzer 《Clinical genitourinary cancer》2018,16(4):298-304
Background
Sunitinib malate, a targeted tyrosine kinase inhibitor, is standard of care for metastatic renal cell carcinoma (mRCC) and serves as the active comparator in several ongoing mRCC clinical trials. In this analysis we report benchmarks for clinical outcomes on the basis of International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk groups for patients treated with sunitinib for mRCC in a first-line setting.Materials and Methods
A retrospective analysis was performed on data from sunitinib-treated patients (n = 375) in the pivotal phase III trial of sunitinib versus interferon-α as first-line treatment for mRCC. Objective response rates (ORRs) were determined from independently reviewed radiologic assessments. The Kaplan–Meier method was used to estimate median progression-free survival (PFS) and median overall survival (OS) according to patient risk group.Results
Median PFS (95% confidence interval [CI]) was 14.1 (13.4-17.1), 10.7 (10.5-12.5), 2.4 (1.1-4.7), and 10.6 (8.1-10.9) months in sunitinib-treated patients in the IMDC favorable (n = 134), intermediate (n = 205), poor (n = 34), and intermediate + poor (n = 239) risk groups, respectively. Median OS (95% CI) was 23.0 (19.8-27.8), 5.1 (4.3-9.9), and 20.3 (16.8-23.0) months in sunitinib-treated patients in IMDC intermediate, poor, and intermediate + poor risk groups, respectively, and was not reached in the favorable risk group (>50% of patients were alive at data cutoff). ORRs (95% CI) was 53.0% (44.2%-61.7%), 33.7% (27.2%-40.6%), 11.8% (3.3%-27.5%), and 30.5% (24.8%-36.8%) in sunitinib-treated patients in IMDC favorable, intermediate, poor, and intermediate + poor risk groups, respectively.Conclusion
Results of this retrospective analysis show differences in patient outcomes for PFS, OS, and ORR on the basis of IMDC prognostic risk group assignment for patients with mRCC. 相似文献4.
Background
Progression-free survival (PFS) and time to progression (TTP) have been reported to correlate with overall survival (OS) in several cancer types. To our knowledge, however, the correlation between them is unclear.Methods
A literature-based meta-analysis was performed to assess whether PFS and TTP can be considered reliable surrogate end points for OS in a phase 3 clinical trial of advanced breast cancer (ABC). The median hazard ratios of PFS/TTP and OS were analyzed by determining their nonparametric Spearman rank correlation coefficients (Rs).Results
A total of 37 trials with 38 treatment arms and 14,966 patients were selected for analysis. The Rs between the median PFS/TTP and OS was 0.405 (95% confidence interval [CI], 0.191-0.582; P = .003), and the correlation coefficient between the hazard ratios of PFS/TTP and OS was 0.555 (95% CI, 0.277-0.748; P = .003). PFS/TTP was closely correlated with OS in the trials of targeted therapy-based treatment (Rs = 0.872; 95% CI, 0.619-0.962; P = .0001) and of PFS/TTP or OS benefit (Rs = 0.753 and Rs = 0.821, respectively) for ABC.Conclusions
Both PFS and TTP can be considered valid surrogate end points for OS in the trials of targeted therapy-based treatments and clinical benefits for ABC. Further research is necessary to clarify the surrogacy of PFS/TTP for OS in other trials of targeted therapy-based treatments for ABC. 相似文献5.
Nils Kroeger Haoran Li Guillermo De Velasco Frede Donskov Hao-Wen Sim Viktoria Stühler J. Connor Wells Igor Stukalin Johannes Heide Jens Bedke Neeraj Agarwal Hiral Parekh Brian I. Rini Jennifer J. Knox Allan Pantuck Toni K. Choueiri Daniel Yick Chin Heng 《Clinical genitourinary cancer》2019,17(1):65-71
Background
Smoking increases the risk of developing renal cell carcinoma (RCC) but the effect of tobacco consumption on survival outcome of patients with metastatic RCC (mRCC) treated with targeted therapies has not been well characterized.Patients and Methods
The primary outcome was overall survival (OS) and secondary outcome was progression-free survival (PFS). Patients with mRCC were categorized as current, former, and nonsmokers at the time of starting targeted therapy. Smoking data from 1980 patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium (IMDC) from 12 international cancer centers.Results
Although former and nonsmokers had comparable OS times (23.8 vs. 23.4 months; P = .898), current smokers had significantly shorter OS (16.1 months; P < .001) than nonsmokers. Current but not former smoking status was an independent poor prognosis factor (hazard ratio [HR], 1.3; P = .002) when adjusted for the IMDC risk criteria. Each pack-year increased the risk of death by 1% (HR, 1.01; P = .036). The duration of first-line therapy response was not different and was 7.7 months versus 7.5 months versus 6.4 months in never, former (P = .609), and current smokers (P = .839), respectively.Conclusion
Active smoking is associated with diminished OS in mRCC patients treated with targeted therapy agents. However, patients who quit smoking returned to a similar risk of death from RCC compared with patients who never smoked. Smoking cessation should be a counseling priority among mRCC patients receiving targeted agents and smoking should be considered as a confounding factor in major clinical trials. 相似文献6.
Kimiharu Takamatsu Ryuichi Mizuno Minami Omura Shinya Morita Kazuhiro Matsumoto Kazunobu Shinoda Takeo Kosaka Toshikazu Takeda Toshiaki Shinojima Eiji Kikuchi Hiroshi Asanuma Masafumi Oyama Shuji Mikami Mototsugu Oya 《Clinical genitourinary cancer》2018,16(4):e927-e933
Background
Almost half of patients with metastatic renal-cell carcinoma (mRCC) are classified as intermediate risk by the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model. The aim of this study was to evaluate whether baseline C-reactive protein (CRP) levels predict overall survival (OS) in intermediate-risk group mRCC patients.Patients and Methods
Data from 107 intermediate-risk group mRCC patients receiving first-line targeted therapy were retrospectively reviewed. We evaluated the correlation between baseline CRP levels as well as other indices and OS.Results
Of the 107 patients with intermediate-risk disease, 46 patients (43%) were classified as having elevated CRP levels. The elevation of pretreatment serum CRP levels was the independent prognostic factor of OS in patients with intermediate risk (hazard ratio, 4.609; P = .001). The 1- and 3-year survival rates of patients with intermediate–nonelevated CRP were 90.0% and 64.7% compared to the favorable-risk group, at 92.1% and 68.5%, respectively. In contrast, the 1- and 3-year survival rates of patients with intermediate–elevated CRP were 80.5% and 37.4% compared to the poor-risk group, at 65.2% and 24.2%, respectively.Conclusion
Baseline CRP levels could divide mRCC patients in the intermediate-risk group into 2 prognostic subgroups. 相似文献7.
Nizar M. Tannir Robert A. Figlin Martin E. Gore M. Dror Michaelson Robert J. Motzer Camillo Porta Brian I. Rini Caroline Hoang Xun Lin Bernard Escudier 《Clinical genitourinary cancer》2018,16(1):6-12.e4
Background
We characterized clinical outcomes of patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib who were long-term responders (LTRs), defined as patients having progression-free survival (PFS) > 18 months.Patients and Methods
A retrospective analysis of data from 5714 patients with mRCC treated with sunitinib in 8 phase II/III clinical trials and the expanded access program. Duration on-study and objective response rate (ORR) were compared between LTRs and patients with PFS ≤ 18 months (“others”). PFS and overall survival (OS) were summarized using Kaplan–Meier methodology.Results
Overall, 898 (15.7%) patients achieved a long-term response and 4816 (84.3%) patients did not achieve long-term response. The median (range) duration on-study was 28.6 (16.8-70.7) months in LTRs and 5.5 (0-68.8) months in others. ORR was 51% in LTRs versus 14% in others (P < .0001). Median PFS in LTRs was 32.11 months and median OS was not reached. LTRs had higher percentage of early tumor shrinkage ≥ 10% at the first scan (67.1% vs. 51.2%; P = .0018) and greater median maximum on-study tumor shrinkage from baseline (?56.9 vs. ?27.1; P < .0001) versus others. White race, Eastern Cooperative Oncology Group performance status 0, time from diagnosis to treatment ≥ 1 year, clear cell histology, no liver metastasis, lactate dehydrogenase ≤ 1.5 upper limit of normal (ULN), corrected calcium ≤ 10 mg/dL, hemoglobin greater than the lower limit of normal, platelets less than or equal to ULN, body mass index ≥ 25 kg/m2, and low neutrophil-to-lymphocyte ratio were associated with LTR.Conclusion
A subset of patients with mRCC treated with sunitinib achieved long-term response. LTRs had improved ORR, PFS, and OS. 相似文献8.
Wungki Park Deukwoo Kwon Diana Saravia Amrita Desai Fernando Vargas Mohamed El Dinali Jessica Warsch Roy Elias Young Kwang Chae Dae Won Kim Sean Warsch Adrian Ishkanian Chukwuemeka Ikpeazu Raja Mudad Gilberto Lopes Mohammad Jahanzeb 《Clinical lung cancer》2018,19(3):280-288.e4
Introduction
Despite significant improvement of clinical outcomes of advanced non–small-cell lung cancer (NSCLC) patients treated with immunotherapy, our knowledge of optimal biomarkers is still limited.Patients and Methods
We retrospectively evaluated 159 advanced NSCLC patients in our institution treated with nivolumab after disease progression during platinum-based chemotherapy. We correlated several variables with progression-free survival (PFS) to develop the immunotherapy, Sex, Eastern Cooperative Oncology Group performance status, Neutrophil-to-lymphocyte ratio (NLR), and Delta NLR (iSEND) model. We categorized patients into iSEND good, intermediate, and poor risk groups and evaluated their clinical outcomes. Performance of iSEND at 3, 6, 9, and 12 months was evaluated according to receiver operating characteristic (ROC) curves and internally validated using bootstrapping. The association of iSEND risk groups with clinical benefit was evaluated using logistic regression.Results
Median follow-up was 11.5 months (95% confidence interval [CI], 9.4-13.1). There were 50 deaths and 43 with disease progression without death. PFS rates at 3, 6, 9, and 12 months were 78.4%, 63.7%, 55.3%, and 52.2% in iSEND good; 79.4%, 44.3%, 25.9%, and 19.2% in iSEND intermediate; and 65%, 25.9%, 22.8%, and 17.8% in iSEND poor. Time-dependent area under ROC curves of iSEND for PFS at 3, 6, 9, and 12 months were 0.718, 0.74, 0.746, and 0.774. The iSEND poor group was significantly associated with progressive disease at 12 ± 2 weeks (odds ratio, 9.59; 95% CI, 3.8-26.9; P < .0001).Conclusion
The iSEND model is an algorithmic model that can characterize clinical outcomes of advanced NSCLC patients receiving nivolumab into good, intermediate, or poor risk groups and might be useful as a predictive model if validated independently. 相似文献9.
Tomoyuki Abe Hironobu Amano Tsuyoshi Kobayashi Keiji Hanada Masahiro Nakahara Hideki Ohdan Toshio Noriyuki 《European journal of surgical oncology》2018,44(10):1573-1579
Background
The neutrophil-to-lymphocyte ratio (NLR), which reflects the cancer-induced systemic inflammation response, has been proposed as a risk factor for poor long-term prognosis in cancer. We investigated the prognostic role of the NLR and the relationship between the NLR and TNM stage in pancreatic ductal adenocarcinoma (PDAC) patients following curative resection.Methods
One-hundred thirty-eight consecutive patients with resected PDAC were enrolled between 2004 and 2014. Univariate and multivariate analyses identified variables associated with overall survival (OS) and recurrence-free survival (RFS). Patients were stratified according to the NLR, with an NLR cut-off value of 2.2 being estimated by receiver operating characteristic curve.Results
Compared to patients with a low NLR (≤2.2), those with a high preoperative NLR (>2.2) had worse OS and RFS (P = 0.017, P = 0.029, respectively). For early-stage tumors, tumor size ≥20 mm and a high NLR were independent risk factors for poor OS (hazard ratio (HR): 3.255, 95% confidence interval (CI): 1.082–9.789, P = 0.036; HR: 3.690, 95% CI: 1.026–13.272, P = 0.046, respectively) and RFS (HR: 3.575, 95% CI: 1.174–10.892, P = 0.025; HR: 5.380, 95% CI: 1.587–18.234, P = 0.007, respectively). The NLR was not correlated with prognosis in patients with advanced stages.Conclusions
An elevated preoperative NLR was an important prognosticator for early TNM stage PDAC. The NLR, which is calculated using inexpensive and readily available biomarkers, could be a novel tool for predicting long-term survival in patients, especially those with early stage PDAC. 相似文献10.
Kenji Tsuchihashi Mamoru Ito Toshikazu Moriwaki Shota Fukuoka Hiroya Taniguchi Atsuo Takashima Yosuke Kumekawa Takeshi Kajiwara Kentaro Yamazaki Taito Esaki Akitaka Makiyama Tadamichi Denda Hironaga Satake Takeshi Suto Naotoshi Sugimoto Kenji Katsumata Toshiaki Ishikawa Tomomi Kashiwada Eishi Baba 《Clinical colorectal cancer》2018,17(4):e687-e697
Background
Assessment of patient factors is essential for selecting later-line chemotherapy in patients with metastatic colorectal cancer (mCRC). The efficacy, prognosis, and safety of each treatment regimen according to nutritional and inflammatory status still remain to be elucidated.Patients and Methods
A total of 550 patients with mCRC who were registered in the REGOTAS study (Regorafenib versus TAS-102 as Salvage-line in patients with colorectal cancer refractory to standard chemotherapies: a multicenter observational study, UMIN 000020416) and treated with trifluridine/tipiracil (TFTD) or regorafenib as a later-line therapy were retrospectively stratified according to the modified Glasgow Prognostic Score (mGPS), which divided patients into mGPS 0 to 2 by serum albumin and C-reactive protein, and compared.Results
The median overall survival (OS) of patients with mGPS 0, 1, and 2 was 10.0 months (95% confidence interval [CI], 9.2-11.6 months), 6.5 months (95% CI, 5.3-7.1 months), and 3.9 months (95% CI, 3.3-4.9 months), respectively. The median progression-free survival (PFS) with mGPS 0, 1, and 2 was 2.5 months (95% CI, 2.1-3.0 months), 2.0 months (95% CI, 1.9-2.3 months), and 1.7 months (95% CI, 1.4-1.9 months), respectively. There were significant differences by mGPS in both OS and PFS (all P < .001). No significant differences in OS and PFS were observed between the patient groups treated with TFTD and regorafenib in each mGPS group. In patients aged ≥ 65 years with mGPS 2, the OS and PFS were worse with regorafenib than with TFTD (OS: hazard ratio, 1.45; 95% CI, 0.93-2.25; P = .097; PFS: hazard ratio, 1.57, 95% CI, 1.01-2.44; P = .047), but there were no consistent trends observed as mGPS increased. The frequency of grade 3 and more adverse events was generally similar in each mGPS group. The multivariate analyses showed that mGPS was the strongest predictive factor for OS.Conclusions
The mGPS before later-line chemotherapy is strongly correlated with survival in patients with mCRC. 相似文献11.
Chang Il Choi Minyong Kang Hyun Hwan Sung Hwang Gyun Jeon Byong Chang Jeong Seong Soo Jeon Hyun Moo Lee Seong I.L. Seo 《Clinical genitourinary cancer》2018,16(6):e1189-e1199
Purpose
To evaluate the prognostic role of cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal-cell carcinoma (mRCC).Patients and Methods
We analyzed the electronic medical records of 294 patients with synchronous mRCC treated at Samsung Medical Center from January 2005 to December 2015. Primary and secondary end points were overall survival (OS) and cancer-specific survival (CSS), respectively. OS and CSS were estimated by the Kaplan-Meier method and compared between patients with and without CN, particularly by performing 1:1 propensity score matching. Multivariate Cox regression analysis was used to identify independent predictors of survival outcomes.Results
Among the overall population of synchronous mRCC patients, 189 patients (64.3%) underwent CN. Compared to mRCC patients without CN, those who underwent CN have a higher proportion of single metastasis (63.0% vs. 32.4%) and clear-cell histology (87.8% vs. 72.4%). In the matched cohort, the patients who underwent CN had better OS and CSS outcomes compared to those who did not undergo CN (median OS, 23.0 months vs. 11.0 months; P < .001; median CSS, 34.0 months vs. 14.0 months; P < .001). On multivariable analysis, undergoing CN, body mass index, and Heng risk score were found as significant predictive factors of both OS and CSS. In subgroup analyses stratified by Heng risk criteria, the patients who received CN had better OS and CSS in all risk groups.Conclusion
CN significantly improved survival outcomes in synchronous mRCC patients treated with targeted therapies and independently associated with prolonged survival, regardless of Heng risk criteria. 相似文献12.
Roberto Mina Maria Teresa Petrucci Paolo Corradini Stefano Spada Francesca Patriarca Chiara Cerrato Lorenzo De Paoli Norbert Pescosta Roberto Ria Alessandra Malfitano Pellegrino Musto Luca Baldini Tommasina Guglielmelli Barbara Gamberi Donato Mannina Giulia Benevolo Renato Zambello Antonietta Pia Falcone Sara Bringhen 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(8):533-540
Background
High-dose therapy with autologous stem cell transplantation (HDT-ASCT) and maintenance treatment with novel agents are the best options for patients with newly diagnosed multiple myeloma, increasing the rate of complete response (CR) and prolonging progression-free survival (PFS) and overall survival (OS). Indeed, the achievement of a CR is a predictor of long-term survival among transplant-eligible patients. However, it is unclear whether patients reaching a CR after induction treatment could receive less intense consolidation or avoid maintenance therapy.Patients and Methods
We analyzed CR patients treated in 2 phase III trials, GIMEMA-RV-MM-PI-209 and RV-MM-EMN-441, to compare HDT-ASCT with an R-Alk (lenalidomide, alkylator) regimen as consolidation, and lenalidomide (R) maintenance with no maintenance. The primary endpoints were PFS, second PFS (PFS2), and OS from consolidation and maintenance (_m).Results
Overall, the data from 166 patients in CR were analyzed, 95 in the HDT-ASCT group and 71 in the R-Alk group. The CR patients who received HDT-ASCT had a better PFS (hazard ratio [HR], 0.55; P = .01), PFS2 (HR, 0.46; P = .02), and OS (HR, 0.42; P = .03) compared with patients randomized to R-Alk. The survival benefit with HDT-ASCT was confirmed among all the subgroups, according to age, International Staging System (ISS stage, cytogenetic profile, and receipt of maintenance therapy. CR patients who received lenalidomide maintenance had a better PFS_m (4 years: 54% vs. 19%; HR, 0.43; P = .02) compared with those who received no maintenance. However, no difference was observed in terms of PFS2_m (4 years: 72% vs. 58%; HR, 0.83; P = .67) and OS_m (4 years: 79% vs. 72%; HR, 0.82; P = .73) with maintenance therapy.Conclusion
Even in CR patients, outcomes were improved by an intensified approach with HDT-ASCT consolidation and lenalidomide-based maintenance therapy. 相似文献13.
Mihai Dorin Vartolomei Matteo Ferro Francesco Cantiello Giuseppe Lucarelli Savino Di Stasi Rodolfo Hurle Giorgio Guazzoni Gian Maria Busetto Ettore De Berardinis Rocco Damiano Sisto Perdona Paolo Verze Roberto La Rocca Marco Borghesi Riccardo Schiavina Eugenio Brunocilla Gilberto L. Almeida Pierluigi Bove Shahrokh F. Shariat 《Clinical genitourinary cancer》2018,16(6):445-452
Introduction
The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non–muscle-invasive bladder cancer (NMIBC).Patients and Methods
The study period was from January 2002 through December 2012. A total of 1046 patients with primary T1 HG/G3 who had NMIBC on re-transurethral bladder resection (TURB) who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance from 13 academic institutions were included. Endpoints were time to disease, and recurrence-free (RFS), progression-free (PFS), overall (OS), and cancer-specific survival (CSS).Results
A total of 512 (48.9%) of patients had NLR ≥ 3 prior to TURB. High pretreatment NLR was associated with female gender and residual T1HG/G3 on re-TURB. The 5-year RFS estimates were 9.4% (95% confidence interval [CI], 6.8%-12.4%) in patients with NLR ≥ 3 compared with 58.8% (95% CI, 54%-63.2%) in patients with NLR < 3; the 5-year PFS estimates were 57.1% (95% CI, 51.5%-62.2%) versus 79.2% (95% CI, 74.7%-83%; P < .0001); the 10-year OS estimates were 63.6% (95% CI, 55%-71%) versus 66.5% (95% CI, 56.8%-74.5%; P = .03); the 10-year CSS estimates were 77.4% (95% CI, 68.4%-84.2%) versus 84.3% (95% CI, 76.6%-89.7%; P = .004). NLR was independently associated with disease recurrence (hazard ratio [HR], 3.34; 95% CI, 2.82-3.95; P < .001), progression (HR, 2.18; 95% CI, 1.71-2.78; P < .001) and CSS (HR, 1.65; 95% CI, 1.02-2.66; P = .03). The addition of NLR to a multivariable model that included established features increased its discrimination for predicting of RFS (+6.9%), PFS (+1.8%), and CSS (+1.7%).Conclusions
Pretreatment NLR ≥ 3 was a strong predictor for RFS, PFS, and CSS in patients with primary T1 HG/G3 NMIBC. It could help in the decision-making regarding intensity of therapy and follow-up. 相似文献14.
Everett E. Vokes Ramaswamy Govindan Neill Iscoe Anwar M. Hossain Belen San Antonio Nadia Chouaki Marianna Koczywas Suresh Senan 《Journal of thoracic oncology》2018,13(8):1183-1188
Introduction
We investigated the potential impact of stage migration because of positron-emission tomography (PET) scan staging on survival in the locally advanced (stage IIIA/B) NSCLC setting.Methods
In PROCLAIM, 598 patients with stage IIIA/B nonsquamous NSCLC (intent-to-treat population) were randomized to either pemetrexed plus cisplatin and concurrent thoracic radiotherapy for 3 cycles followed by 4 cycles of pemetrexed consolidation or etoposide plus cisplatin and concurrent thoracic radiotherapy for 2 cycles followed by a consolidation platinum-based doublet regimen for up to 2 cycles. Baseline PET scan (PET Yes versus No) was one of the stratification factors. Subgroup analyses (PET Yes versus No) of overall survival (OS) and progression-free survival (PFS) were conducted on the intent-to-treat population regardless of treatment, as the study did not show superior efficacy for either arm.Results
Majority (491 of 598; 82.1%) of patients had a baseline PET scan staging performed. A longer median OS (PET Yes versus No: 27.2 versus 20.8; hazard ratio = 0.81, p = 0.130) and an improved median PFS (PET Yes versus No: 11.3 versus 9.2; hazard ratio = 0.73, p = 0.012) were observed for patients with PET scans compared to those with conventional staging in both treatment arms.Conclusions
Both a significantly improved PFS and a numerically longer OS in the PET Yes subgroup, compared to patients with conventional staging, are consistent with improved survival due to stage migration. The magnitude of differences in OS and PFS based on PET scan is a reminder of the potential for factors other than the therapeutic intervention to affect outcomes. 相似文献15.
Keigo Kobayashi Ichiro Nakachi Katsuhiko Naoki Ryosuke Satomi Morio Nakamura Takashi Inoue Hiroki Tateno Fumio Sakamaki Koichi Sayama Takeshi Terashima Hidefumi Koh Takayuki Abe Makoto Nishino Daisuke Arai Hiroyuki Yasuda Ichiro Kawada Kenzo Soejima Tomoko Betsuyaku 《Clinical lung cancer》2018,19(3):e349-e358
Background
Nivolumab, an immune checkpoint inhibitor, is now a standard treatment for previously treated advanced non–small-cell lung cancer based on the results from phase III clinical trials. We evaluated the real-world efficacy and safety of nivolumab in a nonselected population and identified the clinical characteristics that influence efficacy.Materials and Methods
A total of 142 patients with advanced non–small-cell lung cancer who were administered nivolumab at Keio University and affiliated hospitals in Japan from January to July 2016 were enrolled. The treatment efficacy and adverse events were retrospectively reviewed, and the clinical characteristics associated with the nivolumab response were evaluated using univariate and stratified analyses and the Cochran-Mantel-Haenszel test.Results
The objective response rate was 17.0% (95% confidence interval [CI], 12.0%-24.0%), the median progression-free survival (PFS) was 58 days (95% CI, 50-67 days), and the proportion of patients with adverse events of any grade was 45.0%. EGFR/ALK mutation status was inversely associated with the treatment response (P < .05), and the difference in PFS for the mutation-positive versus mutation-negative patients was statistically significant (49 vs. 63 days; hazard ratio, 1.9; 95% CI, 1.1-5.2; P = .029). Previous radiotherapy also had a positive association with the treatment response (P = .012).Conclusion
The objective response rate, PFS, and adverse event profiles were comparable to those observed in previous clinical trials. EGFR/ALK mutation-negative status and previous radiotherapy might be key clinical characteristics associated with a positive treatment response. Our findings could aid in the efficient immunotherapeutic management of lung cancer. 相似文献16.
Hideaki Miyake Takayuki Sugiyama Ryota Aki Yuto Matsushita Keita Tamura Daisuke Motoyama Toshiki Ito Atsushi Otsuka 《Clinical genitourinary cancer》2018,16(3):219-225
Background
The objective of the present study was to assess the oncologic outcomes of patients receiving second-line therapy against metastatic castration-resistant prostate cancer (mCRPC).Patients and Methods
The present study included 222 consecutive mCRPC patients with progression during initial androgen receptor-axis-targeted agent (ARATA) therapy with either abiraterone acetate (AA) or enzalutamide (Enz). Of these 222 patients, 108 subsequently received an alternative ARATA (AA-to-Enz, n = 49; Enz-to-AA, n = 59) and 114 received docetaxel (DTX; AA-to-DTX, n = 54; Enz-to-DTX, n = 60).Results
The prostate-specific antigen (PSA) level in the 114 patients receiving DTX was significantly greater than that in the 108 patients receiving ARATA. However, no significant differences were found in the remaining parameters between the 2 groups. The PSA response rate, PSA progression-free survival (PFS), and overall survival (OS) during second-line therapy in the DTX group (n = 114) were significantly superior to those for the ARATA group (n = 108; PSA response rate, 42.1% vs. 21.3%; median PSA PFS, 7.2 vs. 4.2 months; median OS, 17.5 vs. 14.5 months). Similar trends were confirmed by comparing these outcomes among 4 therapy groups, with significant differences (PSA response rate, Enz-to-AA vs. AA-to-DTX and Enz-to-AA vs. Enz-to-DTX; PSA PFS, AA-to-Enz vs. Enz-to-AA, AA-to-Enz vs. AA-to-DTX, Enz-to-AA vs. AA-to-DTX, and Enz-to-AA vs. Enz-to-DTX; and OS, Enz-to-AA vs. AA-to-DTX and Enz-to-AA vs. Enz-to-DTX). Furthermore, the introduction of DTX was independently associated with improved PSA PFS, but not OS, on multivariate analysis.Conclusion
Favorable oncologic outcomes can be expected with DTX treatment, rather than with alternative ARATA, for mCRPC patients after failure of an initial ARATA. 相似文献17.
Andrew W. Hahn Camryn Froerer Sidney VanAlstine Nityam Rathi Erin B. Bailey David D. Stenehjem Neeraj Agarwal 《Clinical genitourinary cancer》2018,16(5):365-368
Background
Vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKIs) are a mainstay of treatment for metastatic renal-cell carcinoma. Stool microbiome composition is predictive of response to immunotherapy and cytotoxic chemotherapy. We sought to investigate whether antibiotics targeting Bacteroides species affect progression-free survival (PFS) while receiving first-line VEGF-TKI therapy.Patients and Methods
Using a retrospective cohort of intermediate- and poor-risk metastatic renal-cell carcinoma patients from the University of Utah, we categorized patients receiving first-line VEGF-TKIs by receipt of antibiotics (Bacteroides spp., non-Bacteroides spp., or none) and assessed PFS by Kaplan-Meier and Cox proportional hazard models.Results
Of 145 patients, 17 received antibiotics with Bacteroides spp. coverage and 32 patients received antibiotics without Bacteroides spp. coverage. When compared to patients not receiving antibiotics, improved PFS was seen with each additional day antibiotics were prescribed with Bacteroides spp. coverage (hazard ratio = 0.92; 95% confidence interval, 0.83-0.99; P = .04).Conclusion
Targeting stool Bacteroides spp. with antibiotics improves PFS in patients receiving first-line VEGF-TKIs in a duration-dependent manner. 相似文献18.
N. Hirahara T. Matsubara D. Kawahara S. Nakada S. Ishibashi Y. Tajima 《European journal of surgical oncology》2017,43(2):493-501
Background
Recent studies have revealed significant relationships between the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) and survival in various cancers. The purpose of this study was to confirm whether the LMR, NLR, and PLR have prognostic values, independent of clinicopathological criteria, in patients undergoing curative resection for esophageal cancer.Methods
The LMR, NLR and PLR were calculated in 147 consecutive patients who underwent curative esophagectomy between January 2006 and December 2014. Receiver operating characteristics (ROC) curve analysis was conducted to identify the optimal cutoff values of each biomarkers.Results
In multivariate analysis for cancer-specific survival (CSS), pTNM stage (p < 0.0001) and low LMR (p = 0.0081) were selected as independent prognostic factor. Similarly, pTNM stage(p < 0.0001) and low LMR (p = 0.0225) were found to be independent prognostic factor for overall survival (OS). There was no significant relationship between LMR, NLR and PLR and survival in patients with stage I or II, however, significant relationships between LMR and CSS or OS were observed in patients with stage III esophageal cancer.Conclusions
LMR can be used as a novel predictor of postoperative CSS and OS in patients with esophageal cancer and that it may be useful in identifying patients with a poor prognosis even after radical esophagectomy. 相似文献19.
Gwynivere A. Davies Sunita Ghosh Danielle H. Oh Mita Manna Anthea C. Peters Colin A. Stewart Douglas A. Stewart 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(12):829-835
Background
Patients with low tumor burden follicular lymphoma (FL) are commonly managed with watchful waiting (WW). The incidence of organ dysfunction and/or transformation at disease progression, and subsequent impact on outcomes is poorly understood.Patients and Methods
Patients managed with WW during 1994 to 2011 were identified through the Alberta Lymphoma Database. Individuals receiving immediate rituximab (R)-chemotherapy were identified as a comparator group to those on WW who received R-chemotherapy at progression. Endpoints included transformation, organ dysfunction, time to progression, time to next treatment, progression-free survival (PFS) after chemotherapy, and overall survival (OS).Results
We identified 238 patients managed with WW (28.9% of registry patients) during this 17-year period. The median follow up was 8.2 years. At a median of 29.9 months, 58 (24.4%) of these patients developed organ dysfunction and/or transformation. Of 169 (71%) patients who required therapy, 10-year OS was inferior for those with transformation (hazard ratio, 2.88; P = .002) and organ dysfunction (hazard ratio, 2.10; P = .028). PFS after R-chemotherapy and OS in patients without organ dysfunction and/or transformation was not affected by the initial WW period, compared with immediate R-chemotherapy. WW resulted in increased high risk FL International Prognostic Index scores at initiation of R-chemotherapy (45% vs. 20%), and more frequent transformation at progression (5-year risk, 17.8% vs. 3.5%; P < .001). Baseline characteristics did not predict organ dysfunction.Conclusion
Patients with FL accepting initial WW should be aware of the 1 in 4 risk of organ dysfunction and/or transformation, and subsequent inferior OS. Physicians should consider surveillance for progression to consider early therapy. 相似文献20.
Kriti Mittal Lisa Derosa Laurence Albiges Laura Wood Paul Elson Timothy Gilligan Jorge Garcia Robert Dreicer Bernard Escudier Brian Rini 《Clinical genitourinary cancer》2018,16(3):e663-e667