Analysis of clinical prognostic factors for survival and time to progression in patients with metastatic colorectal cancer treated with 5-fluorouracil-based chemotherapy

Colorectal cancer (CRC) is one of the most common malignant tumors in adults. Twenty-five percent of patients are not amenable to surgical resection because they have locally advanced or metastatic disease. For these patients, median survival time is between 4 and 13 months, and chemotherapy is used mainly with palliative intent. We conducted this study to evaluate potential prognostic factors for time to progression and survival. A retrospective review of 91 patients with metastatic CRC treated with bolus 5-fluorouracil-based chemotherapy (Mayo Clinic schedule) was performed. Univariate and multivariate analyses of clinical prognostic factors were carried out. Median follow-up time was 53 months (range, 17-107 months). Median time to disease progression was 9.6 months, and median survival time was 15.4 months. Actuarial 5-year survival was 17%. In the univariate analyses, factors predictive of time to progression were visceral metastases, elevated alkaline phosphatase (AP) levels, performance status (PS), and elevated carcinoembryonic antigen (CEA) and CA 19-9 levels. Multivariate analyses confirmed the independent prognostic value of PS and AP levels. In the univariate analyses for survival, significant prognostic factors were visceral metastases, hypoalbuminemia, elevated lactate dehydrogenase levels, elevated AP levels, PS, and elevated CEA and CA 19-9 levels. In the multivariate analyses, only PS, elevated CEA and CA 19-9 levels, and liver involvement retained prognostic significance. This study confirms the prognostic value of PS for both time to progression and survival. AP levels are significantly related to time to progression. Additional factors influencing survival time are elevated tumor marker levels and the existence of liver metastases.     

Predictors of short-term survival and progression to chemotherapy in patients with advanced colorectal cancer treated with 5-fluorouracil-based regimens

The aim of this study was to assess in patients with advanced colorectal cancer which factors were associated with short-term survival (6 months or less) and progression to first-line 5-fluorouracil (5-FU) chemotherapy. Three hundred twenty-one consecutive nonselected patients with advanced colorectal cancer were treated with conventional 5-FU-based regimens as first-line treatment from 1988 to 1999. Factors related to patient, tumor, or treatment were analyzed by univariate and multivariate logistic regression analysis by comparing short survivors (SS, those who survived or= 2) (p = 0.015), elevated (>or=5 microg/l) serum carcinoembryonic antigen (CEA) (p = 0.015), and more than one site of metastatic disease (p < 0.001). Progression to first-line chemotherapy (p < 0.001) was also a strong factor associated with short survival in multivariate analysis; factors predictive of progression were elevated CEA (p = 0.027) and diffuse metastatic disease (p = 0.029). Our data indicate the relevance of some clinical prognostic factors (younger age, poor performance status, elevated CEA, site of primary, number of metastatic sites, resistance to chemotherapy) as independent factors associated with poor survival and progression to first-line chemotherapy in patients with metastatic colorectal cancer treated with conventional 5-FU regimens. Patients identified by these factors as having a poor prognosis and low probability of response to treatment should be considered either for more aggressive regimens or supportive care only: conventional 5-FU treatments do not impact on response or survival.     

A prognostic model to identify patients with advanced pancreas adenocarcinoma who could benefit from second-line chemotherapy

AimsThe role of salvage chemotherapy after first-line therapy in advanced pancreatic cancer has not yet been established. We intended to identify prognostic factors for long-term survival of advanced pancreatic adenocarcinoma patients with second-line chemotherapy and to devise a prognostic model of clinical parameters.Patients and methodsWe analysed 90 patients who had received second-line chemotherapy after the failure of first-line therapy in recurrent or metastatic pancreatic adenocarcinoma between August 2003 and December 2008.ResultsThe median age at the time of second-line chemotherapy was 61.9 years (range 39.8–74.9) and the median Eastern Cooperative Oncology Group (ECOG) performance status was 1 (0–2). Median progression-free survival and overall survival for second-line chemotherapy were 2.1 and 4.5 months, respectively, with an overall response rate of 10%. In multivariate analysis, an ECOG performance status of 2 or more, non-responder for first-line chemotherapy and albumin level of <3.5 mg/dl were independent prognostic factors for decreased overall survival for all 90 patients. Overall survival was estimated based on the number of adverse prognostic factors: zero or one (good prognostic group), two (intermediate group) or three (poor prognostic group). The median overall survival for good (n = 50), intermediate (n = 24) and poor (n = 16) prognostic groups was 5.5, 3.3 and 2.1 months, respectively (P < 0.001).ConclusionOur result suggests that second-line chemotherapy may be beneficial for overall survival in patients with ECOG performance status 0–1, albumin level ≥3.5 mg/dl and response to first-line chemotherapy.     

Selection of a patient subgroup with advanced esophageal squamous carcinoma who could benefit from second-line chemotherapy

Despite first-line therapy, most patients with advanced esophageal squamous cell carcinoma (ESCC) experience disease progression and may become eligible for second-line chemotherapy. Although commonly used, the role of salvage chemotherapy in patients with recurrent or metastatic ESCC has not yet been established. We analyzed 53 patients who had received second-line chemotherapy after the failure of cisplatin-based combination chemotherapy with or without radiotherapy as first-line therapy in ESCC between March 2000 and June 2008. Median progression-free survival (PFS) and overall survival (OS) for second-line chemotherapy were 2.4 and 5.2 months, respectively, with an overall response rate of 18.9%. In multivariate analysis, Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 2 or more and PFS under first-line therapy <4 months were independent prognostic factors for decreased OS. OS was estimated based on the number of adverse prognostic factors: 0 = good; 1 = intermediate, and 2 = poor. The median OS for the good, intermediate, and poor prognostic groups were 11.2, 4.5 and 4.3 months, respectively (p < 0.001). The good prognostic group showed better OS than the intermediate or poor groups (p < 0.001). Second-line chemotherapy may be beneficial for OS in ESCC patients with ECOG PS 0-1 and PFS under first-line therapy ≥4 months.     

Secondary treatment and predictive factors for second-line chemotherapy after first-line oxaliplatin-based therapy in metastatic colorectal cancer

Two consecutive studies have evaluated the efficacy of oxaliplatin combined with the Nordic bolus schedule of 5-fluorouracil and folinic acid as first-line treatment in metastatic non-resectable colorectal cancer. One hundred and twelve patients were followed after end of first-line treatment and any secondary therapy registered. Fifty-three patients (47%) did not receive second-line irinotecan-based chemotherapy. The main reason was too poor performance status (59%). These patients had a median survival of only 1.7 months after progression of first-line therapy. The best predictive factors at start of first-line chemotherapy for receiving later second-line chemotherapy were performance status and alkaline phosphatase level. Fifty-nine patients (53%) received irinotecan-based second-line therapy. Four (7%) patients had a partial response, and 28 (52%) had stable disease. Median progression-free survival after second-line chemotherapy was 4.1 months and median survival 9.5 months. Median survival after first-line chemotherapy and secondary liver surgery was 34 months and five-year disease-free survival 8%. Survival among patients receiving both first- and second-line chemotherapy was 20.8 months, but only 8.9 months in patients not receiving second-line irinotecan-based chemotherapy. Poor performance status or elevated alkaline phosphatase level at start of first-line chemotherapy predicts whether second-line chemotherapy will be given or not.     

Long term survivors with metastatic pancreatic cancer treated with gemcitabine alone or plus cisplatin: a retrospective analysis of an Anatolian Society of Medical Oncology multicenter study

Background: The majority of patients with pancreatic cancer present with advanced disease. Systemicchemotherapy has limited impact on overall survival (OS) so that eligible patients should be selected carefully. Theaim of this study was to analyze prognostic factors for survival in Turkish advanced pancreatic cancer patients whosurvived more than one year from the diagnosis of recurrent and/or metastatic disease and receiving gemcitabine(Gem) alone or gemcitabine plus cisplatin (GemCis). Methods: This retrospective evaluation was performed forpatients who survived more than one year from the diagnosis of recurrent and/or metastatic disease and whoreceived gemcitabine between December 2005 and August 2011. Twenty-seven potential prognostic variableswere chosen for univariate and multivariate analyses to identify prognostic factors associated with survival.Results: Among the 27 variables in univariate analysis, three were identified to have prognostic significance:sex (p = 0.04), peritoneal dissemination (p =0.02) and serum creatinine level (p=0.05). Multivariate analysis byCox proportional hazard model showed only peritoneal dissemination to be an independent prognostic factorfor survival. Conclusion: In conclusion, peritoneal metastasis was identified as an important prognostic factorin metastatic pancreatic cancer patients who survived more than one year from the diagnosis of recurrent and/or metastatic disease and receiving Gem or GemCis. The findings should facilitate pretreatment prediction ofsurvival and can be used for selecting patients for treatment.     

Does maintenance of Bevacizumab after treatment failure have a role in metastatic colon cancer？

Objective: To study the timing of Bevacizumab (BVC) in the overall treatment strategy of advanced metastatic colorectal cancer - early use (first-line) or later use. Methods: 41 patients with progressive metastatic colorectal carcinoma were included. Patients were randomized to receive chemotherapy with or without BVC. Primary end point was objective response. Secondary end points were median survival, time to tumor progression, and toxicity. Results: Partial response with second-line BVC group constituted 25% and 18.8% in patients with first-line chemotherapy and BVC-based regimen respectively, compared to 11.8% and 5.9% with second-line chemotherapy. Median time to progression was 3.1 vs. 2.3 months for cases with first-line chemotherapy and BVC-based regimens respectively. Median survival was 8.2 vs. 4 months in both groups respectively (P = 0.019). Conclusion: Second-line chemotherapy combined BVC had higher disease control rate (partial response and stable disease), median time to progression and median survival in BVC-naive patients compared to patients with first-line BVC-based therapy. BVC should be maintained in the second- and third-line settings, as cases with BVC discontinuation had significantly lower median time to disease progression and median survival. Selection of patients for use of BVC was recommended with taking into consideration the cost-benefit value and that the discontinuation of BVC would increase tumor progression.     

影响晚期肺鳞癌一线化疗疗效的临床因素分析

目的:分析影响铂二联方案一线治疗晚期肺鳞癌的临床因素,为一线治疗提供临床依据。方法:回顾性分析2008年6月至2012年12月109例经病理及影像学检查确诊、一线应用铂二联方案化疗的IV期肺鳞癌患者的临床因素,包括:性别、年龄、是否吸烟、是否存在远处转移、一线化疗方案、一线方案的疗效及周期数、是否接受局部放疗及二线治疗;分析这些临床因素对一线方案近期及远期疗效的影响。近期疗效用客观有效率代表,远期疗效用中位生存期代表。结果:109例患者中,部分缓解者35例,疾病稳定者34例,疾病进展者40例,客观有效率 32.1%,疾病控制率 63.3%。中位生存期为12.00个月（95%CI:11.05~12.95个月）,一线治疗中位至疾病进展时间为5.0个月（95%CI:4.26~5.74个月）。单因素分析表明患者性别、年龄、是否吸烟、是否存在远处转移、一线方案对一线化疗疗效的影响不具有统计学意义。Kaplan-Meier分析及COX回归分析均表明:性别、年龄、是否吸烟、治疗前是否存在远处转移以及一线方案对患者生存期的影响不具有统计学意义;而一线化疗疗效、一线化疗周期数、是否接受局部放疗及二线治疗则对患者生存期的影响具有统计学意义。结论:一线化疗的疗效及周期数、是否接受二线治疗及局部放疗是影响晚期肺鳞癌患者预后的独立因素。     

Efficacy of First-line Chemotherapy Affects the Second-Line Setting Response in Patients with Advanced Non-Small Cell Lung Cancer

Background: Chemotherapy is the mainstay of treatment for the majority of patients with advanced nonsmall cell lung cancer (NSCLC) without driver mutations and many receive therapies beyond first-line. Secondline chemotherapy has been disappointing both in terms of response rate and survival and we know relatively little about the prognostic factors. Materials and Methods: One thousand and eight patients with advanced NSCLC who received second-line chemotherapy after progression were reviewed in Shanghai PulmonaryHospital, China, from September 2005 to July 2010. We analyzed the effects of potential prognostic factors on the outcomes of second-line chemotherapy (overall response rate, ORR; progression free survival, PFS; overall survival, OS). Results: The response and progression free survival of first-line chemotherapy affects the ORR, PFS and OS of second-line chemotherapy (ORR: CR/PR 15.4%, SD 10.1%, PD2.3%, p<0.001; PFS: CR/PR 3.80 months, SD 2.77 months, PD 2.03 months, p<0.001; OS: CR/PR 11.60 months, SD 10.33 months, PD 6.57 months, p=0.578, p<0.001, p<0.001, respectively). On multivariate analysis, better response to first-line therapy (CR/PR: HR=0.751, p=0.002; SD: HR=0.781, p=0.021) and progression within 3-6 months (HR=0.626, p<0.001), together with adenocarcinoma (HR=0.815, p=0.017), without liver metastasis (HR=0.541, p=0.001), never-smoker(HR=0.772, p=0.001), and ECOG PS 0-1 (HR=0.745, p=0.021) were predictors for good OS following secondline chemotherapy. Conclusions: Patients who responded to first-line chemotherapy had a better outcome after second-line therapy for advanced NSCLC, and the efficacy of first-line chemotherapy, period of progression, histology, liver metastasis, smoking status and ECOG PS were independent prognostic factors for OS.     

含铂方案联合西乐葆一线治疗晚期非小细胞肺癌的Ⅱ期临床研究

背景与目的目前铂类联合第三代化疗药物的方案为晚期非小细胞肺癌的一线治疗方案,但其对中位生存期及1年生存率的改善已达平台期。本研究的目的是探讨含铂方案联合西乐葆一线治疗晚期非小细胞肺癌的疗效、影响因素及不良反应。方法选择免疫组化证实为COX-2阳性的初治晚期非小细胞肺癌患者接受铂类为基础的二联化疗方案(GP方案:吉西他滨1250mg/m2,d1、8 顺铂80mg/m2,分d1、d2给药;NP方案:长春瑞滨25mg/m2,d1、8 顺铂80mg/m2,分d1、d2给药;TP方案:多西紫杉醇75mg/m2,d1 顺铂80mg/m2,分d1、d2给药),同时在化疗开始前5-7天开始口服西乐葆400mg,Bid,直至病情进展或出现不可耐受的副反应。不良反应采用NCI-CTC标准。采用Kaplan-Meier法估计生存,Cox模型分析影响因素。评价终点:中位生存期、1年生存率、无疾病进展生存期、有效率及不良反应。结果2005年2月至2007年3月入组患者可评价者共44例,有效率为45%,疾病控制率为59%。中位无疾病进展生存期为6个月(95%CI:4-8个月),中位生存期为18个月(95%CI:9-27个月),1年生存率为68%。一线周期数和总体评效是影响PFS的预测因素,未发现明确影响生存期的预测因素。白细胞减少和恶心/呕吐为最常见的不良反应,发生率分别为59%和50%,Ⅲ/Ⅳ度不良反应占15%。结论西乐葆联合铂类为基础的化疗作为COX-2筛选阳性的晚期非小细胞肺癌患者一线治疗是有效的,而且毒副反应可以接受。     

Treatment results of peritoneal dissemination from gastric cancer by neoadjuvant intraperitoneal-systemic chemotherapy

No standard treatment exists for peritoneal dissemination from gastric cancer. We reviewed our experience using a novel treatment consisting of peritonectomy and intraoperative chemo-hyperthermic peritoneal perfusion (CHPP). Records of all patients who underwent CHPP and cytoreductive surgery from 1992 to 2001 were reviewed. RESULTS: Data from 107 patients (average age, 52 years) were available. P3 dissemination was found in 72 patients, and 8 and 27 patients showed P1 or P2 dissemination, respectively. Peritoneal metastasis was synchronous in 75 and metachronous in 32 patients. All patients received CHPP after cytoreductive surgery. Peritonectomy was performed in 42 patients. Complete cytoreduction (CC-0) was achieved in 47 patients (44%). Peritonectomy, resulted in CC-0 in 69% (29/42), but CC-0 was achieved in 18 of 65 (28%) patients by ordinary surgical techniques. There were 23 postoperative complications (21%) after operation. The overall operative mortality was 2.8% (3/107). Median follow-up for the entire study group was 46 months. Seventeen patients (15%) were disease-free, and 90 patients were dead at the time of analysis. Eighty-seven deaths were related to progression of disease. The median survival of all patients was 16.2 months, with an actual 5-year survival of 6%. Median survival of CHPP plus ordinary cyoreduction was 12.0 months and that after CHPP and peritonectomy was 22.8 months. Completeness of cytoreduction and peritonectomy were significant prognostic factors on univariate analysis and 5-year survival rate was 27%. Lymph node status, grade of peritoneal dissemination (P1-2 vs P3), age (>60 years vs <60 years), tumor volume of dissemination (>2.5 cm vs <2.5 cm in diameter), and histologic type (differentiated vs. poorly differentiated type) did not affect survival. The cox proportional model demonstrated that completeness of cytoreduction was the strongest prognostic factor. Patients who had an incomplete resection had 2.8-fold higher risk of dying from disease than patients who underwent complete cytoreduction. The 5-year survival after complete cytoreduction was 12%, compared with 2% for incomplete resection. Four patients lived more than 5 years. Cytoreduction was incomplete in one 5-year survivor who showed complete response to CHPP. CONCLUSION: Complete cytoreduction using peritonectomy and CHPP may improve survival of patients with peritoneal dissemination from gastric cancer. This procedure is most appropriate for highly motivated patients who are committed to survive as long as possible.     

老年广泛期小细胞肺癌患者的预后分析

目的:分析老年广泛期小细胞肺癌患者的独立预后因素。方法:回顾性研究2010年6月至2015年6月在安阳市肿瘤医院治疗的60例老年广泛期小细胞肺癌患者的临床资料，所有患者均经细胞学或组织病理明确诊断。采用Kaplan-Meier法计算生存时间和生存率，采用Log-rank检验单因素分析，对有统计学意义的单因素采用Cox风险模型进行多因素分析。结果:60例老年广泛期小细胞肺癌患者1年、2年、3年生存率分别为38.3%、8.3%、3.3%，中位生存时间为10.0个月。单因素分析显示年龄、ECOG评分、一线化疗疗效、化疗周期数、肝转移情况和合并慢性疾病情况是影响患者预后的因素，P值小于0.05，具有统计学差异。Cox风险模型分析显示，年龄、ECOG评分、一线化疗疗效、化疗周期数和肝转移情况对患者的总生存时间具有显著影响。结论:患者年龄、ECOG评分、一线化疗疗效、化疗周期数和肝转移情况是影响老年广泛期小细胞肺癌的独立预后因素。     

Predictive factors of response to cisplatin-based chemotherapy and the relation of response to survival in patients with metastatic urothelial cancer

Purpose: To identify pretreatment variables predicting overall and complete response to cisplatin-based chemotherapy for metastatic urothelial cancer, and to study the relation between response and the duration of survival. Patients and methods: A total of 119 evaluable patients with recurrent locally advanced or metastatic urothelial cancer received cisplatin-based combination chemotherapy in four consecutive phase II studies from 1987 to 1997. The relationship of pretreatment variables and response was evaluated with logistic regression, and prognostic factors for survival were analyzed with Cox's multivariate model. Results: Response was achieved in 49% of the patients with a complete response rate of 15%. Good performance status and absence of bone metastases were independently predictive of overall response. Good performance status and normal hemoglobin were independently predictive of complete response. Median survival was 8.9 months. Performance status, alkaline phosphatase, s-creatinine, liver and bone metastases were independent prognostic factors for survival. Median survival was 12.4 months in responding patients and 6.3 in non-responding patients. Response to chemotherapy was included in the multivariate model and was the strongest prognostic factor for survival. Conclusion: The presence of bone metastases, low hemoglobin or poor performance status predicts decreased chance of response to chemotherapy. Response to chemotherapy is an independent prognostic factor for prolonged survival in patients with metastatic urothelial cancer. Received: 23 February 2000 / Accepted: 26 June 2000     

吉西他滨联合替吉奥胶囊治疗晚期胰腺癌的疗效观察

目的探讨吉西他滨联合替吉奥胶囊化疗方案与吉西他滨单药治疗进展期胰腺癌的疗效。方法对2008年1月至2011年1月收治的52例晚期胰腺癌患者的临床资料进行回顾性分析,其中28例采用吉西他滨联合替吉奥胶囊方案治疗(A组);24例采用吉西他滨单药治疗(B组)。采用Kaplan-Meier法分析患者的生存时间,并比较两组患者的客观缓解率、临床受益反应(CBR)、中位疾病进展时间、中位生存时间和不良反应。结果 A组有效率明显高于B组(32.1%vs.20.8%),差异有统计学意义(P=0.039)。A组疾病控制率(DCR)高于B组(67.9%vs.45.8%),但差异无统计学意义(P=0.230)。A组患者CBR缓解率高于B组(72.1%vs.46.9%),差异无统计学意义(P=0.41)。A组的中位生存时间为10.2个月(95%CI:8.0～11.8个月),高于B组的8.03个月(95%CI:3.8～10.9个月),差异有统计学意义(P=0.045);A、B两组的中位疾病进展时间分别为3.6个月和3.0个月(P=0.721)。A组的6个月生存率(72.7%)略高于B组(66.8%),但差异无统计学意义(P>0.05)。两组不良反应的发生率也相似(P>0.05)。结论吉西他滨联合替吉奥胶囊治疗方案与单药治疗晚期胰腺癌相比,在客观疗效、中位生存时间表现出一定优势,疾病控制率及临床受益反应也有所提高,且不良反应可耐受,是晚期胰腺癌的有效治疗方案。     

Clinical characteristics and prognosis of triple-negative breast cancer patients with postoperative initial visceral metastasis北大核心CSCD

Objective: To analyze and discuss the clinicopathologic characteristics of triple-negative breast cancer with initial visceral metastasis after surgery, as well as the efficacy of first-line chemotherapy and the prognostic factors. Methods: A retrospective analysis was performed using the clinical data of 107 triple-negative breast cancer patients with postoperative initial visceral metastasis, who were treated in Department of Medical Oncology, Fudan University Shanghai Cancer Center from January 1, 2011 to June 30, 2013. The analysis also included their first-line chemotherapy efficacy, survival situation and prognostic factors. Results: Among 107 patients, there were 101 patients (94.4%) with invasive ductal carcinoma and 6 patients (5.6%) with other pathological types or mixed patterns. The postoperative median disease-free interval was 14.4 months; the 1-, 2- and 3-year survival rates after visceral metastasis were 75.7%, 41.1% and 22.4%, respectively. The objective response rate of first-line platinum-based chemotherapy was 60.0%, and the median progressionfree survival time was 8.6 months; which were significantly higher or longer than that in the non-platinum chemotherapy group (36.2%, P = 0.014; 5.1 months, P = 0.023). However, there was no significant difference in the median survival time between the two groups (19.9 vs 20.9 months, P = 0.423). Univariate analysis showed that neoadjuvant chemotherapy, postoperative radiotherapy, lymph node metastasis status, clinical stage, disease-free interval, best curative effect of first-line chemotherapy, plurivisceral metastasis, and progression-free survival after first-line chemotherapy had significant effects on the overall survival (all P < 0.05). Additionally, multivariate analysis showed that neoadjuvant chemotherapy and disease-free interval had significant effects on overall survival (both P < 0.05). Conclusion: The triple-negative breast cancer patients with initial visceral metastasis have short disease-free interval time and low long-term survival rate. The first-line platinumbased chemotherapy is a good choice for these patients. The neoadjuvant chemotherapy and disease-free interval within one year may be the independent prognostic factors for their overall survival. Copyright © 2017 by TUMOR All rights reserved.     

Clinical characteristics and prognosis of triple-negative breast cancer patients with postoperative initial visceral metastasis北大核心CSCD

Objective: To analyze and discuss the clinicopathologic characteristics of triple-negative breast cancer with initial visceral metastasis after surgery, as well as the efficacy of first-line chemotherapy and the prognostic factors. Methods: A retrospective analysis was performed using the clinical data of 107 triple-negative breast cancer patients with postoperative initial visceral metastasis, who were treated in Department of Medical Oncology, Fudan University Shanghai Cancer Center from January 1, 2011 to June 30, 2013. The analysis also included their first-line chemotherapy efficacy, survival situation and prognostic factors. Results: Among 107 patients, there were 101 patients (94.4%) with invasive ductal carcinoma and 6 patients (5.6%) with other pathological types or mixed patterns. The postoperative median disease-free interval was 14.4 months; the 1-, 2- and 3-year survival rates after visceral metastasis were 75.7%, 41.1% and 22.4%, respectively. The objective response rate of first-line platinum-based chemotherapy was 60.0%, and the median progressionfree survival time was 8.6 months; which were significantly higher or longer than that in the non-platinum chemotherapy group (36.2%, P = 0.014; 5.1 months, P = 0.023). However, there was no significant difference in the median survival time between the two groups (19.9 vs 20.9 months, P = 0.423). Univariate analysis showed that neoadjuvant chemotherapy, postoperative radiotherapy, lymph node metastasis status, clinical stage, disease-free interval, best curative effect of first-line chemotherapy, plurivisceral metastasis, and progression-free survival after first-line chemotherapy had significant effects on the overall survival (all P < 0.05). Additionally, multivariate analysis showed that neoadjuvant chemotherapy and disease-free interval had significant effects on overall survival (both P < 0.05). Conclusion: The triple-negative breast cancer patients with initial visceral metastasis have short disease-free interval time and low long-term survival rate. The first-line platinumbased chemotherapy is a good choice for these patients. The neoadjuvant chemotherapy and disease-free interval within one year may be the independent prognostic factors for their overall survival. Copyright © 2017 by TUMOR All rights reserved.     

Chemotherapy for patients with non-curative advanced or recurrent gastric cancer in our hospital

In our hospital, beginning in April 2005, chemotherapy for non-curative advanced or recurrent gastric cancer was integrated, and 9 regimens including 6 combination therapies were prepared. First-line chemotherapy mainly focusing on TS-1 plus docetaxel combination therapy(S-1+DOC)was done. Second-line and subsequent chemotherapy treatments were chosen by the doctor in charge. 78.6% of second-line chemotherapy was monotherapy. Median survival time(MST)since first-line chemotherapy was 15.6 months, and 1-year survival rate since first-line chemotherapy was 65.0%. MST since the start of first-line S-1+DOC was over 16.4 months, and 1-year survival rate since this therapy start was 69.0%. The good results were ascribed to following: 1. good response rate(30.4%), prolonged time to progression(TTP)(6.1 months), and good control against adverse events at first-line chemotherapy; 2. good shift rate of second-line chemotherapy from the first-line one(82.4%); and 3. good disease control rate(78.6%), prolonged TTP(7.0 months), and good control against adverse events at second-line chemotherapy. In patients with peritoneal metastasis, however, despite the prolonged TTP of 8.7 months by first-line chemotherapy, MST since first-line chemotherapy was poor at 11.1 months. Thus, improvement of second-line or subsequent chemotherapy is warranted.     

Prognostic factors in the palliation of pancreatic cancer.

AIM: Few patients with pancreatic cancer are eligible for resection. In the remainder, estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy.The aim is to evaluate the prognostic significance of clinical and laboratory variables in patients with unresectable pancreatic cancer. METHODS: Information was gathered retrospectively for 325 patients with unresectable pancreatic cancer who underwent palliative interventions, including surgical bypass, endoscopic or percutaneous stenting or who received supportive care only. RESULTS: Histological proof was obtained in 182 patients (56%). Median survival was 5.7 months. Absence of therapeutic intervention, leukocytosis (WCC> or =11 x 10(9)/l), gamma glutamyl transferase (gamma GT)>165U/L, prothrombin time ratio > or =1.1, and C-reactive protein (CRP) > or = 5mg/dL were associated with shorter survival on univariate analysis. Only absence of therapeutic intervention, leukocytosis, and gamma GT>165 U/L reached significance on multivariate analysis. In the 51 patients in whom serum CRP was available, CRP was the only significant predictor of survival on multivariate analysis. CONCLUSIONS: Leukocytosis, elevated gamma GT and raised CRP predict shorter survival and may help to guide the choice of palliative intervention for patients with unresectable pancreatic cancer.     

Intra-arterial chemotherapy with gemcitabine (GEM) for unresectable pancreatic cancer

PURPOSE: Most patients with pancreatic cancer are unresectable because of local invasion and liver metastasis at the time of diagnosis. To date, no treatment has had a significant impact on this disease. To deliver a high concentration of drug to the cancer, intra-arterial chemotherapy with GEM was performed in two patients with unresectable advanced cancer. PATIENTS AND METHODS: One patient, a 70-year-old man with liver metastasis, was treated with arterial infusion of GEM 1,000 mg/body. Another patient, a 55-year-old woman with local invasion and distant metastatic lymphadenopathy, was given intra-arterial infusion of GEM 400 mg and intra-venous infusion of GEM 1,000 mg/body. The patients were given GEM weekly for 3 weeks followed by a week of rest. RESULTS: In the first patient, the pain went away and CEA was decreased for 6 months. After that, the patient died due to intra-abdominal dissemination within 4 months. In the other patient, the pain went away. Tumor markers, such as CEA and CA19-9, were normalized and primary pancreatic cancer was reduced locally. The patient currently has a metastatic liver tumor, but she has had a significant improvement in performance status. CONCLUSION: Intra-arterial chemotherapy with GEM may be tolerated in patients with unresectable pancreatic cancer.     

Comparison of high-dose therapy and autologous stem-cell transplantation with conventional therapy for Hodgkin's disease induction failure: a case-control study. Société Francaise de Greffe de Moelle.

PURPOSE: To determine the prognostic factors and outcome of first-line induction failure Hodgkin's disease patients who were treated with a salvage regimen of high-dose chemotherapy and autologous stem-cell transplantation, and to compare them with matched, conventionally treated patients. PATIENTS AND METHODS: We retrospectively analyzed data relating to 86 Hodgkin's disease patients who underwent autologous stem-cell transplantation after failure of the first chemotherapy regimen, either because they did not enter a complete remission and experienced progression of disease less than 3 months after the end of their first-line treatment or because they showed evidence of disease progression during first-line therapy. Graft patients were matched with 258 conventionally treated patients (three controls per case) for age, sex, clinical stage, B symptoms, and time at risk; patient data were obtained from international databases. RESULTS: Among the 86 graft patients, the median age at diagnosis was 29 years (range, 14 to 57 years). Thirty-nine percent of patients had stage II disease, 23% had stage III disease, and 38% had stage IV disease. Seventy percent of the patients received chemotherapy and 30% received combined modality therapy; 60% of the patients received a seven- or eight-drug regimen. After this first-line treatment, 91% had disease progression and 9% had a brief partial response. Eighty patients received a second-line treatment; pretransplantation status was as follows: 24% of patients had a complete remission, 38% had a partial remission (PR), 14% had stable disease, and disease progression occurred in 24%. With a median follow-up of 22 months (range, 4 to 105 months) from diagnosis, the 5-year event-free survival and overall survival rates from transplantation were 25% and 35% (95% confidence intervals, 15 to 36 and 23 to 49), respectively. In multivariate analysis, the pretransplantation disease status after salvage therapy was the only significant prognostic factor for survival (PR: relative risk = 2.8, P = .017; progressive disease: relative risk (RR) = 5.26, P < .001). From diagnosis, the 6-year overall survival rates of the graft patients and 258 matched conventionally treated patients were 38% and 29%, respectively (P = .058). CONCLUSION: Autologous stem-cell transplantation represents the best therapeutic option currently available for patients with primary induction failure and is associated with acceptable toxicity. Response to second-line treatment before high-dose chemotherapy is the only prognostic factor that can be correlated with survival.