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1.
Ariella M. Altman Schelomo Marmor Todd M. Tuttle Jane Yuet Ching Hui 《Clinical breast cancer》2019,19(2):126-130
Introduction
The 21-gene recurrence score (RS) has been extensively studied and validated in patients with estrogen receptor-positive (ER+), human epidermal growth factor 2 (HER2)-negative breast cancer; however, RS testing is not routinely performed in patients with HER2-positive (HER2+) disease. We sought to determine patterns of RS testing, to characterize RS distributions, and to determine the impact of RS results on clinical decision-making for patients with ER+, HER2+ breast cancer.Materials and Methods
Using the Surveillance and Epidemiology End Results program database, we identified women with ER+, HER2+ breast cancer. We stratified patients using TAILORx RS cutoffs and evaluated treatment characteristics across patients. Multivariable logistic regression was performed to determine factors associated with RS testing and receipt of a high-risk RS.Results
Overall, 5% of patients with ER+, HER2+, early stage breast cancer underwent RS testing. The distribution of RS testing by TAILORx cutoffs were: high-risk, 17%; intermediate-risk, 49%; and low-risk, 34%. Chemotherapy utilization among those not tested was 66%. Among those tested, utilization was significantly associated with RS results: 67% of high-risk, 30% of intermediate-risk, and 19% of low-risk patients received chemotherapy. Progesterone receptor-negative status, larger tumor size, and high tumor grade were significantly associated with high-risk RS.Conclusions
RS testing is used sparingly among patients with HER2+ early-stage breast cancer; however, test results appear to impact clinician’s decision-making on chemotherapy use. 相似文献2.
Robin W.M. Vernooij Inge van Oort Theo M. de Reijke Katja K.H. Aben 《Journal of Geriatric Oncology》2019,10(2):252-258
Objectives
To examine the clinical features, applied treatments, and survival of older patients with prostate cancer compared with younger patients.Material and Methods
All patients diagnosed with prostate cancer between 2005 and 2015 in the Netherlands were identified from the nationwide population-based Netherlands Cancer Registry (NCR). Patient and tumour characteristics, as well as applied treatments, were described by age groups and prognostic risk groups. Relative survival rates were determined, including multivariable relative survival regression analyses. Additionally, to assess if age was associated with receiving curative treatment, a multivariable logistic regression analysis was performed.Results
In total, 48% of all patients were 70?years of age or older. Older patients had a higher prostate specific antigen (PSA) level, a higher Gleason score, as well as a higher disease stage at diagnosis. The 10-year relative survival decreased with increasing age, and after adjustment for disease stage, Gleason score, PSA level, and comorbidities, older patients had a worse survival rate. Older patients with intermediate- or high-risk disease appeared to be treated less often with curative intent compared with younger patients after adjustment for tumour stage, Gleason score, PSA level, and comorbidities. Older patients with intermediate/high risk prostate cancer treated with curative intent showed a 10-year relative survival rate similar to younger patients.Conclusion
The survival of older patients was worse than younger patients. This might be due to suboptimal treatment, as older patients were less often treated with curative intent. Although the increased risk of treatment complications should be considered, age alone should not be a decisive factor when offering a treatment. 相似文献3.
Jan J. Jobsen Judith G. Middelburg Job van der Palen Sietske Riemersma Ester Siemerink Henk Struikmans Sabine Siesling 《Journal of Geriatric Oncology》2019,10(2):330-336
Background
The aim of this study was to analyze the distant metastases-free survival (DMFS), and disease-specific survival (DSS) after breast-conserving therapy (BCT) in older patients with breast cancer in a large, population-based, single-center cohort study with long-term follow-up.Material and Methods
Analyses were based on 1,425 women aged 65?years and older with breast cancer treated with BCT. Patients were divided in three age categories: 65 – 70?years, 71 – 75?years, and >75?years. The study period extended over 30 years, divided in three decades. Multivariate survival analysis was carried out using Cox regression analysis.Results
The two youngest age categories showed significant improvements over time in 12-year DMFS and DSS. For women aged 65 – 70?years, this improvement was noted in stage I and stage II disease, while for women aged 71 – 75?years this was mainly in stage II tumors. Women >75 years of age did not show any improvement over time, regardless of stage.Conclusion
Among older Dutch women with breast cancer, outcomes with regard to DMFS and DSS after BCT differ between various age categories, showing the least gain in the very old. 相似文献4.
Timothy H.M. To Wee Kheng Soo Heather Lane Adnan Khattak Christopher Steer Bianca Devitt Haryana M. Dhillon Anne Booms Jane Phillips 《Journal of Geriatric Oncology》2019,10(2):216-221
Introduction
Geriatric assessment (GA) is a multidimensional health assessment of the older person to evaluate their physical and cognitive function, comorbidities, nutrition, medications, psychological state, and social supports. GA may help oncologists optimise care for older patients with cancer. The aim of this study was to explore the views of Australian medical oncologists regarding the incorporation of geriatric screening tools, GA and collaboration with geriatricians into routine clinical practice.Methods
Members of the Medical Oncology Group of Australia were invited to complete an online survey that evaluated respondent demographics, practice characteristics, treatment decision-making factors, use of GA, and access to geriatricians.Results
Sixty-nine respondents identified comorbidities, polypharmacy, and poor functional status as the most frequent challenges in caring for older patients with cancer. Physical function, social supports and nutrition were the most frequent factors influencing treatment decision-making. The majority of respondents perceived value in GA and geriatrician review, although access was a barrier for referral. Such services would need to be responsive, providing reports within two weeks for the majority of respondents.Conclusion
Despite an emerging evidence base for the potential benefits of GA and collaboration with geriatricians, medical oncologists reported a lack of access but a desire to engage with these services. 相似文献5.
Magnus Harneshaug Lene Kirkhus Jūratė Šaltytė Benth Bjørn Henning Grønberg Sverre Bergh Jon Elling Whist Siri Rostoft Marit S. Jordhøy 《Journal of Geriatric Oncology》2019,10(2):272-278
Introduction
As frailty is associated with inflammation, biomarkers of inflammation may represent objective measures that could facilitate the identification of frailty. Glasgow prognostic score (GPS), combines C-reactive protein (CRP) and albumin, and is scored from 0 to 2 points. Higher score indicates a higher degree of inflammation.Objectives
To investigate whether (1) GPS is associated with frailty, (2) GPS could be used to screen for frailty, (3) IL-6 and TNF-α add to the accuracy of GPS as a screening tool, and (4) GPS adds prognostic information in frail older patients with cancer.Methods
Prospective, observational study of 255 patients ≥70?years with solid malignant tumours referred for medical cancer treatment. At baseline, frail patients were identified by a modified Geriatric Assessment (mGA), and blood samples were collected.Results
Mean age was 76.7?years, 49.8% were frail, and 56.1% had distant metastases. The proportion of frail patients increased with higher GPS (GPS zero: 43.2%, GPS one: 52.7%, GPS two: 94.7%). GPS two was significantly associated with frailty (OR 18.5), independent of cancer type, stage, BMI and the use of anti-inflammatory drugs. The specificity of GPS was high (99%), but the sensitivity was low (14%). Frail patients with GPS two had poorer survival than patients with GPS zero-one. TNF-α and IL-6 did not improve the accuracy of GPS when screening for frailty.Conclusion
Frailty and GPS two are strongly associated, and GPS two is a significant prognostic factor in frail, older patients with cancer. The inflammatory biomarkers investigated are not suitable screening tools for frailty. 相似文献6.
Maite Antonio Carlota Gudiol Cristina Royo-Cebrecos Sara Grillo Carmen Ardanuy Jordi Carratalà 《Journal of Geriatric Oncology》2019,10(2):246-251
Purpose
To assess the etiology, clinical features and outcomes of bacteremia in older patients with solid tumors.Methods
All episodes of bacteremia in hospitalized patients with solid tumors were prospectively collected. Patients aged ≥70?years were compared to patients aged <70?years. Risk factors for case-fatality rates in older patients were identified.Results
We compared 217 episodes of bacteremia involving older patients and 525 occurring in younger patients. Older patients had more frequently other comorbidities, but were less commonly neutropenic and carried less frequently central venous catheters. Bacteremia from an abdominal source was more common in patients ≥70, whereas an endogenous source and catheter-related infection were less frequently observed. Streptococcus bovis group (3.7% vs. 0.8%, p?=?.01) and Listeria monocytogenes (4.6% vs. 1.9%, p?=?.04) were more common in older patients, whereas coagulase-negative staphylococci were less frequently found (1.4% vs. 5.3% p?=?.01). Infection due to multi-drug resistant (MDR) strains was significantly higher in older patients (17.1% vs. 10.9%, p?=?.02), who in addition, presented higher overall mortality (35.4% vs 27.7%, p?=?.04). In older patients, lung tumor, neutropenia, and low grade fever were associated with early mortality, whereas comorbidities, corticosteroids, septic shock and inadequate empirical antibiotic therapy were associated with overall mortality.Conclusions
We identified remarkable differences in the etiology and sources of bacteremia between older and younger cancer patients with bacteremia. Older patients had more frequent infection due to MDR organisms and presented a higher overall mortality. Corticosteroids and inadequate empirical antibiotic therapy are modifiable factors associated with mortality. 相似文献7.
Audrey Rambeau Bérengère Beauplet Heidi Laviec Idlir Licaj Alexandra Leconte Claire Chatel Priscille Le Bon Julie Denhaerynck Bénédicte Clarisse Nicole Frenkiel Marie Lange Florence Joly 《Journal of Geriatric Oncology》2019,10(2):235-240
Introduction
Among the various instruments recommended by the International Society of Geriatric Oncology, the Mini Mental State Examination (MMSE) is the most commonly used cognitive screening test before oncological treatment. Although the Montreal Cognitive Assessment (MoCA) has been shown to be more sensitive than the MMSE in several pathologies, no specific data exist for older patients with cancer. We aimed to compare the proportions of older patients with cancer who had screened positive for cognitive impairment according to the MMSE and MoCA scores obtained during a pretherapeutic geriatric assessment (GA) in oncology.Patients and methods
This prospective study was conducted among 66 patients older than 70?years who were candidates for a first-line treatment for either a solid tumor or hematological malignancy. Patients with brain tumor or previously known dementia were ineligible. During GA, cognitive function was assessed using both the MoCA and the MMSE tests administered in a random order.Results
Median age was 78?years. Most patients (n?=?43, 65.2%) had a solid tumor. The median scores were 26 [11–30] for MMSE and 24 [8–30] for MoCA. Thirteen (19.7%) and 44 (66.7%) patients were screened positive for cognitive impairment according to MMSE and MoCA scores, respectively. Overall, 55 (66.7%) patients were screened positive: 12 (21.8%) on both scores, 32 (70.5%) with the MoCA only, and one patient with MMSE only (p?<?0.0001).Conclusion
The MoCA test seems to be most relevant to screen for cognitive impairment in older patients with cancer. 相似文献8.
Joyita Banerjee Sujata Satapathy Ashish Dutt Upadhyay Sada Nand Dwivedi Prasun Chatterjee Lalit Kumar Goura Kishor Rath Aparajit Ballav Dey 《Journal of Geriatric Oncology》2019,10(2):222-228
Introduction
With rise in incidence and prevalence of cancers in the ageing population, the need for an age sensitive comprehensive assessment measure has been felt. Comprehensive Geriatric Assessment (CGA) is often difficult to implement due to time and logistic constraints. A brief assessment tool encompassing the specific domains of the CGA would be a better way to assess older adults with cancer. These tools exist but have not necessarily been culturally adapted. The main aim of the study was to develop a culturally relevant short geriatric assessment tool and explore its psychometric properties.Methodology
An initial item pool was formed after review of the literature and study of the existing scales. This draft tool was then pre and pilot tested to finalize the items and check the feasibility of application. The final tool was validated by exploratory factor analysis on a sample of 100 older patients with cancer.Results
After pre and pilot study on fifteen and thirty older patients with cancer respectively, this tool consisting of a total of 38 items spread over eight domains was developed and validated on a sample of 100 subjects. Due to co-linearity, three items were deleted after exploratory factor analysis, bringing the final item number to35. The Cronbach's alpha was 0.93 and the intra-class correlation co-efficient (ICC) was 0.94. Thus, the final tool had 13 questions with sub-parts (35 items in total). The time taken to administer the tool was around 25?min.Conclusion
The tool developed is valid and reliable and can be used for the initial assessment and further care planning of older Indian patients with cancer. 相似文献9.
Leigha Rowbottom Allison Loucks Rana Jin Henriette Breunis Ali Taqi Syed Sarah Watt Narhari Timilshina Martine Puts Daniel Yokom Arielle Berger Shabbir M.H. Alibhai 《Journal of Geriatric Oncology》2019,10(2):229-234
Purpose
Geriatric assessment (GA) is recommended for older adults?≥?70?years with cancer to guide treatment selection. Screening tools such as the Vulnerable Elders Survey (VES-13) and G6 have been used to identify patients at highest need of GA. Whether either tool predicts a change in oncologic treatment following GA is unclear.Methods
Patients attending a geriatric oncology clinic between July 2015 and June 2017 who completed a VES-13 and underwent subsequent GA were included. Clinical information was extracted from a prospectively maintained database. G6 scores were assigned retrospectively. Patients were stratified into those who were “VES-13 positive” (score?≥?3) and “VES-13 negative” (score?<?3). Logistic regression was used to explore the relationship between VES-13 score, G6 score, and treatment modification.Results
Ninety-nine patients were seen prior to initiating cancer treatment. The median VES-13 score was 7; with 81.8% of patients scoring ≥3. The treatment plan was modified in 47.5% of patients after GA. VES-13 score was predictive of treatment plan modification (63.0% among VES-13 positive versus 16.7% among VES-13 negative patients; p?=?0.001). G6 performed similarly to the VES-13. The only statistically significant predictor of treatment change in multivariable analysis was performance status.Conclusion
VES-13 positive patients are more likely to undergo treatment modification to reduce treatment intensity or supportive care only. The VES-13 may provide oncologists with a rapid, reliable way of identifying vulnerability in older adults with cancer who may need further GA prior to commencing cancer treatment. 相似文献10.
Caleb Miller Syed J. Raza Facundo Davaro Allison May Sameer Siddiqui Zachary A. Hamilton 《Journal of Geriatric Oncology》2019,10(2):285-291
Objective
Treatment of renal cell carcinoma has evolved with emphasis on nephron preservation for small renal masses. Our objective was to evaluate the proportions of treatment types for octogenarians with clinical stage 1 renal cell carcinoma.Materials and Methods
The National Cancer Database was analyzed from 2004 to 2015. Patients with clinical stage 1, tumor size?≤?7?cm, and age 80–89?years old were compared to a younger control arm of patients?≤?70?years old. Treatment modality was categorized as radical nephrectomy (RN), partial nephrectomy (PN), percutaneous ablative therapy (PAT), and no treatment (NT). Primary outcome was treatment utilization over time using estimated annual percentage change (EAPC). Secondary outcomes included logistic regression for 30?day readmission after treatment and any definitive tumor treatment choice.Results
18,903 octogenarians were identified and compared to a control of 142,179 patients?≤?70?years old. Overall, NT (36%) was the most common modality for octogenarians while PN (44.8%) was most common for the control arm. Using EAPC for octogenarians, we found increases for PAT (7.1%), PN (2.8%), and NT (1.6%) but a decrease for RN (?4.6%). EAPC for the younger cohort noted increases for PAT (6.8%), PN (5.4%), and NT (4.4%) but a decrease for RN (?5.5%).Conclusion
For octogenarians with stage 1 renal cell carcinoma, minimally invasive treatments are increasingly utilized, while RN is decreasing. Compared to a younger cohort, a greater proportion of octogenarians are receiving NT. These findings remain encouraging for appropriate treatment of localized disease in patients with advanced age. 相似文献11.
Francisco J. Tarazona-Santabalbina Jorge Llabata-Broseta Ángel Belenguer-Varea David Álvarez-Martínez David Cuesta-Peredo Juan A. Avellana-Zaragoza 《Journal of Geriatric Oncology》2019,10(2):298-303
Objectives
Comprehensive geriatric assessment (CGA) has shown to benefit older patients undergoing urological and orthopedic surgery. However, this approach has been scarcely assessed in patients elected for colorectal surgery.Materials and Methods
Retrospective cohort of patients aged ≥70?years admitted for elective colorectal cancer surgery to a single hospital between 2008 and 2012. Upon admission, patients were assigned to a usual care (UC) plan or a CGA-based care (GS) plan conducted by a multidisciplinary team, according to standard clinical criteria.Analyzed outcomes included the incidence of delirium and other geriatric syndromes during hospital stay, mortality, readmissions, andnumber of perioperative complications.Results
The cohort included 310 patients, 203 assigned to the GS group and 107 to the UC group. Patients in the GS group had significantly lower Barthel and Lawton scores, higher prevalence of dementia and heart failure, and higher comorbidity burden. Fifty-four (17.5%) patientsexperienced delirium (23 [11.3%] and 31 [29.2%] in the GS and UC groups, respectively; p?<?.001), and 49 (15.8%) patient experienced other geriatric syndromes (21 [10.3%] and 28 [26.2%] in the GS and UC groups, respectively; p?<?.001). Serious complications were more frequent in the GS group: 154 (75.9%) vs 60 (56.1%) in the UC group; p?<?.001. No significant differences were observed between groups regarding readmissions, and in-hospital and post-discharge (1?year follow-up) mortality.Conclusions
Despite the poorer clinical condition of patients in the GS group, the CGA-based intervention resulted in a lower incidence of delirium and other geriatric syndromes compared with the UC group. 相似文献12.
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13.
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):210-215
Background
The use of geriatric assessment (GA) and the Cancer and Aging Research Group (CARG) Toxicity Score by Australian oncologists is low. We sought oncologists' views about the value of GA and the CARG Score when making decisions about chemotherapy for their older patients.Methods
Patients aged ≥65?yrs. with a plan to start chemotherapy for a solid organ cancer underwent a GA and had their CARG Score calculated. Results of the GA and CARG Score were provided to treating oncologists who then completed a questionnaire on the value of these measures for each patient.Results
We enrolled 30 patients from eight oncologists. Patients had a median age of 76?years and most (77%) were ECOG performance status 0 or 1. Risk category for severe chemotherapy toxicity by CARG Score was low in 7 patients (23%), intermediate in 18 (60%), and high in 5 (17%). The GA provided oncologists new information for 12 patients (40%), most frequently in the domains of function and nutrition. Knowledge of the GA prompted supportive interventions for 7 patients (23%). Oncologists considered modifications to recommended chemotherapy based on the CARG Score for 2 patients (7%) (one more intensive and one less intensive), and based on GA for no patients. Oncologists judged the GA and CARG Score as useful in 26 (87%) and 25 (83%) patients, respectively.Conclusion
Although oncologists valued the GA and CARG Score, they rarely used them to modify chemotherapy. The GA provided new information that prompted supportive interventions in one quarter of patients. 相似文献14.
Lorenzo Dottorini Laura Catena Italo Sarno Giandomenico Di Menna Annamaria Marte Eugenio Novelli Carmen Rusca Emilio Bajetta 《Journal of Geriatric Oncology》2019,10(2):356-358
Background
Endocrine therapy is the main treatment in hormonosensitive breast cancer; the most frequent side effects are arthralgia, osteoporosis, depression, dyslipidemia and hypertension. G8 is a simple test developed to identify older patients who could benefit from a comprehensive geriatric assessment (CGA). The aim of this study is to evaluate the possible role of G8 in predicting side effects from treatment with aromatase inhibitor in women ≥65?years old.Matherial and method
Women ≥65?years old affected by breast cancer about to start a therapy with an aromatase inhibitor, in the adjuvant setting, were evaluated with the G8 tool. Patients were classified as “fit” with G8 score?>?14 or “vulnerable” with G8 score?≤?14; they then started treatment and clinical-instrumentalfollow-up.Results
From April 2016 to February 2018, 50 consecutive patients were screened. Median age was 75.1 (range 65–86). G8 identified 30 patients (60%) as “fit” (score?>?14) and 20 (40%) as “vulnerable” (score?≤?14). The grade of concordance between G8 score and the appearance/absence of adverse events were statistically significant (41/50 patients, 82%, p?=?0.0002); sensitivity resulted in 78% and specificity was 81%; positive predictive value was 70% and negative predictive value was 87%. The most frequent adverse event was arthromyalgia.Conclusion
The G8 screening tool has a potential role in predicting side effects during a treatment with aromatase inhibitor. G8 could be very useful in everyday clinical practice for this population. 相似文献15.
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16.
Morgan R.L. Lichtenstein Ryan D. Nipp Alona Muzikansky Kelly Goodwin Danyon Anderson Richard A. Newcomb Justin F. Gainor 《Journal of thoracic oncology》2019,14(3):547-552
Introduction
Immunotherapy has revolutionized the treatment of NSCLC, but little is known about the activity of programmed cell death 1 and programmed death ligand 1 blockade across age groups.Methods
We retrospectively evaluated patients with NSCLC who initiated programmed cell death 1 and programmed death ligand 1 inhibitors from January 2013 through July 2017. Medical records and radiographic imaging were reviewed to determine progression-free survival (PFS) and overall survival (OS). We also compared immunotherapy-related toxicities, steroid use, and hospitalizations by age.Results
Of the 245 patients, 26.1% were younger than 60 years, 31.4% were age 60 to 69 years, 31.0% were age 70 to 79 years, and 11.4% were age 80 years or older. The median PFS times by age group were as follows: younger than 60 years, 1.81 months; age 60 to 69 years, 2.53 months; age 70 to 79 years, 3.75 months; and age 80 years or older, 1.64 months (log-rank p value = 0.055). The median OS times by age group were as follows: younger than 60 years, 13.01 months; age 60 to 69 years, 14.56 months; age 70 to 79 years, 12.92 months; and age 80 years or older, 3.62 months (log-rank p value = 0.011). Rates of immunotherapy-related toxicities, steroid use, and hospitalizations did not differ by age.Conclusions
Although the OS and PFS benefits of immunotherapy differ by age, the rates of toxicity are similar regardless of age. 相似文献17.
K.A. Lee M.T.A. Sharabiani D. Tumino J. Wadsley V. Gill G. Gerrard R. Sindhu M.N. Gaze L. Moss K. Newbold 《Clinical oncology (Royal College of Radiologists (Great Britain))》2019,31(6):385-390
Aims
To obtain an overview of the management and outcomes of children aged 18 years or younger diagnosed with differentiated thyroid carcinoma of follicular cell origin across the UK, by collecting and analysing data from the limited number of centres treating these patients. This multicentre data might provide a more realistic perspective than single-institution series.Materials and methods
Six centres submitted data extracted from historical records on patients aged 18 years or younger, diagnosed between 1964 and 2017. The univariate and multivariable Cox proportional hazard model was used to identify potential predictors of progression-free survival, using national data as a control.Results
Data on 166 patients were available for analysis. Females (74%) were predominant, and the age ranged from 3 to 19 years at diagnosis, mean 14.1 years. Nodal metastases were present in 51%; 12% had distant metastases. After surgery, 95% received radioactive iodine (39% on more than one occasion) and 4% received external beam radiotherapy. With a median follow-up duration of 5 years, 69% are alive with no evidence of disease; 20% are alive with a raised thyroglobulin level as the only evidence of residual disease; 6% have residual structural disease detectable on imaging; 2% have died, from cerebral metastases.Conclusion
Despite most patients having advanced disease at presentation, outcomes are very good. A national prospective registry should allow systematic collection of good-quality data and may facilitate research to further improve outcomes. 相似文献18.
19.
Tomohiro F. Nishijima Allison M. Deal Jennifer L. Lund Kirsten A. Nyrop Hyman B. Muss Hanna K. Sanoff 《Journal of Geriatric Oncology》2019,10(2):279-284
Background
Our aim was to evaluate the prognostic impact of three inflammatory markers - neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) - on overall survival (OS) in older adults with cancer.Materials and Methods
Our sample includes 144 patients age?≥?65?years with solid tumor cancer who completed a cancer-specific Geriatric Assessment (GA) from 2010 to 2014 and had pretreatment CBC with differential. NLR was dichotomized a previously reported cut-off value of 3.5, while PLR and LMR were dichotomized at the median. Cox proportional hazards models evaluated whether NLR, PLR and LMR were predictive of OS independent of covariates including a recently developed 3-item GA-derived prognostic scale consisting of (1) “limitation in walking several blocks”, (2) “limitation in shopping”, and (3) “≥ 5% unintentional weight loss in 6 months”.Results
Median age was 72?years, 53% had breast cancer, 27% had stage 4 cancer, 14% had Karnofsky Performance Status (KPS)?<?80, 11% received less intensive than standard treatment for stage, and 39% had NLR?>?3.5. In univariable analysis, higher NLR and PLR and lower LMR were significantly associated with worse OS. NLR remained a significant predictor of OS (HR?=?2.16, 95% CI; 1.10–4.25, p?=?.025) after adjusting for cancer type, stage, age, KPS, treatment intensity, and the GA-derived prognostic scale.Conclusion
NLR?>?3.5 is predictive of poorer OS in older adults with cancer, independent of traditional prognostic factors and the GA-derived prognostic scale. 相似文献20.
Kerri M. Winters-Stone Mary E. Medysky Michael A. Savin 《Journal of Geriatric Oncology》2019,10(2):311-316