1
|
Suzuki S, Taguchi Y, Kitabayashi T, Sato N, Kaya H, Abe T, Endo T, Suzuki H, Kawasaki Y, Yamada T. Serum Albumin as an Independent Predictor of Long-Term Survival in Patients with Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma Treated with Nivolumab. J Clin Med 2024; 13:2456. [PMID: 38730986 PMCID: PMC11084251 DOI: 10.3390/jcm13092456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Nivolumab has been shown to improve the overall survival (OS) of patients with recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, there is a need to identify factors associated with long-term survival (beyond 2 years) in these patients. This study investigated the relationship between pretreatment factors and long-term survival in patients with R/M HNSCC treated with nivolumab. Methods: Forty-nine patients with R/M HNSCC who were treated with nivolumab were retrospectively reviewed. Baseline characteristics, clinical data, and survival outcomes were evaluated. Univariate and multivariate analyses were performed to identify factors associated with long-term survival (OS ≥ 2 years). Results: The median OS in the overall cohort was 11.0 months, and the 2-year survival rate was 34.7%. Long-term survivors (OS ≥ 2 years) had significantly higher proportions of patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores of 0 or 1, serum albumin levels ≥ 3.5 g/dL, and neutrophil-to-eosinophil ratio (NER) < 32.0 compared to non-long-term survivors. On multivariate analysis, serum albumin levels ≥ 3.5 g/dL, in addition to ECOG-PS score of 0 or 1, were independent predictors of long-term survival. Conclusions: Pretreatment serum albumin levels may be useful for predicting long-term survival in R/M HNSCC patients treated with nivolumab.
Collapse
Affiliation(s)
- Shinsuke Suzuki
- Department of Otorhinolaryngology & Head and Neck Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Carson KR, Riedell P, Lynch R, Nabhan C, Wildes TM, Liu W, Ganti A, Roop R, Sanfilippo KM, O'Brian K, Liu J, Bartlett NL, Cashen A, Wagner-Johnston N, Fehniger TA, Colditz GA. Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma. J Geriatr Oncol 2015; 6:211-8. [PMID: 25614297 PMCID: PMC4605388 DOI: 10.1016/j.jgo.2015.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/03/2014] [Accepted: 01/05/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. MATERIALS AND METHODS We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphoma patients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. RESULTS Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95% confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95% CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥85% of expected was only 14%. Patients treated with anthracycline dose intensity <85% had better one year survival compared to those treated at ≥85% (70% vs. 59%, p=0.029). CONCLUSION These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphoma patients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients.
Collapse
Affiliation(s)
- Kenneth R Carson
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA; Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Peter Riedell
- Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Ryan Lynch
- Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Chadi Nabhan
- Division of Hematology/Oncology, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, USA
| | - Tanya M Wildes
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA; Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Weijian Liu
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Arun Ganti
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA
| | - Ryan Roop
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Kristen M Sanfilippo
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Katiuscia O'Brian
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Jingxia Liu
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Amanda Cashen
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Nina Wagner-Johnston
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Todd A Fehniger
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| |
Collapse
|
3
|
AlHilli MM, Tran CW, Langstraat CL, Martin JR, Weaver AL, McGree ME, Mariani A, Cliby WA, Bakkum-Gamez JN. Risk-scoring model for prediction of non-home discharge in epithelial ovarian cancer patients. J Am Coll Surg 2013; 217:507-15. [PMID: 23816386 DOI: 10.1016/j.jamcollsurg.2013.04.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Identification of preoperative factors predictive of non-home discharge after surgery for epithelial ovarian cancer (EOC) may aid counseling and optimize discharge planning. We aimed to determine the association between preoperative risk factors and non-home discharge. STUDY DESIGN Patients who underwent primary surgery for EOC at Mayo Clinic between January 2, 2003 and December 29, 2008 were included. Demographic, preoperative, and intraoperative factors were retrospectively abstracted. Logistic regression models were fit to identify preoperative factors associated with non-home discharge. Multivariable models were developed using stepwise and backward variable selection. A risk-scoring system was developed for use in preoperative counseling. RESULTS Within our cohort of 587 EOC patients, 12.8% were not discharged home (61 went to a skilled nursing facility, 1 to a rehabilitation facility, 1 to hospice, and there were 12 in-hospital deaths). Median length of stay was 7 days (interquartile range [IQR] 5, 10 days) for patients dismissed home compared with 11 days (IQR 7, 17 days) for those with non-home dismissals (p < 0.001). In multivariable analyses, patients with advanced age (odds ratio [OR] 3.75 95% CI [2.57, 5.48], p < 0.001), worse Eastern Cooperative Oncology Group (ECOG) performance status (OR 0.92 [95% CI 0.43, 1.97] for ECOG performance status 1 vs 0 and OR 5.40 (95% CI 2.42, 12.03) for score of 2+ vs 0; p < 0.001), greater American Society of Anesthesiologists (ASA) score (OR 2.03 [95% CI 1.02, 4.04] for score ≥3 vs < 3, p = 0.04), and higher CA-125 (OR 1.28 [95% CI 1.12, 1.46], p < 0.001) were less likely to be discharged home. The unbiased estimate of the c-index was excellent at 0.88, and the model had excellent calibration. CONCLUSIONS Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.
Collapse
Affiliation(s)
- Mariam M AlHilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Sengeløv L, Frølich S, Kamby C, Jensen NH, Steven K. The functional and psychosocial status of patients with disseminated bladder cancer. Urol Oncol 2012; 5:20-4. [PMID: 21227281 DOI: 10.1016/s1078-1439(98)00039-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/1998] [Indexed: 11/12/2022]
Abstract
This study describes self-reported functional and psychological status of patients using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and relates this to the prognosis. Patients with incurable locally advanced or metastatic transitional cell cancer of the urothelial tract were prospectively included in a study of self-reported functional and psychosocial status. The study included 25 patients; 19 patients completed one or more Quality of Life Questionnaires. The median survival was 5.2 months, and there was a significant relation between functional, emotional, and social status and survival. The self-assessment of functional status was a better prognostic factor for survival than performance status evaluated by the clinician. The value of the global quality of life scale did not relate to survival after recurrence. Functional, emotional, and quality of life scales declined during the progression of the disease. The study suggests that evaluation with self-reporting questionnaires may provide the physician with useful information, and it may aid in making treatment decisions in patients with metastatic bladder cancer.
Collapse
Affiliation(s)
- L Sengeløv
- Department of Oncology, Herlev University Hospital, DK-2730 Herlev, Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
5
|
Lindegaard JC, Thranov IR, Engelholm SA. Radiotherapy in the management of cervical cancer in elderly patients. Radiother Oncol 2000; 56:9-15. [PMID: 10869749 DOI: 10.1016/s0167-8140(00)00168-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report treatment results and complications experienced by elderly patients treated with curatively intended radiotherapy for cancer of the uterine cervix. PATIENTS AND METHODS One hundred and fourteen elderly patients (median 75.5 years, range 70.0-85.9) consecutively referred for curative radiotherapy in the period 1987-1996 were prospectively followed with regard to tumour control and complications. The importance of age, stage (FIGO), tumour size, histology, tumour fixation, haemoglobin, concurrent disease, performance status (WHO) and type of radiotherapy were assessed using univariate and multivariate analyses. RESULTS Treatment was completed as planned in 68%, delayed in 29% and stopped prematurely in 3%. The frequency of grade 3 late complications was 11% and the actuarial probability at 5 years was 20%. Overall 5-year survival according to FIGO was 61% (I), 34% (II) and 25% (III). Cox multivariate analysis identified tumour size as independent prognostic factor for tumour control, disease-free survival and overall survival. FIGO stage was predictive for late grade 2 complications. We were unable to identify significant factors with respect to grade 3 complications. Age was not a significant parameter for any of the investigated endpoints. CONCLUSION Elderly patients in good performance status with advanced cancer of the uterine may tolerate radical radiotherapy with acceptable morbidity and reasonable survival. Radiotherapy may also be a good alternative in early stage disease for surgically unfit elderly patients.
Collapse
Affiliation(s)
- J C Lindegaard
- Department of Oncology, Building 5, Aarhus University Hospital, DK-8000, Aarhus, Denmark
| | | | | |
Collapse
|
7
|
Abstract
In the present review, we have evaluated the outcome of radiotherapy in patients with bladder cancer. The exact value of radical radiotherapy is difficult to establish because changes in treatment techniques and selection of patients have biased the results. The 5-year survival rates are reported to be 35-71% in T1 tumors, 27-59% in T2 tumors, 10-38% in T3 tumors and 0-16% in T4 tumors. Several other factors, like performance status and hemoglobin level, are important for the outcome. Morbidity of radical radiotherapy depends on several treatment and patient related factors, but 50-75% experience acute intestinal or urological symptoms and 10-20% may develop severe late toxicity, depending on the kind of registration. The importance of field size or overall treatment time cannot be established from available data. Hyperfractionation with dose escalation has proven effective in one study. Preoperative radiotherapy with cystectomy has not proven better than cystectomy alone or better than radiotherapy alone. The addition of systemic chemotherapy has increased disease-free survival, but has not significantly reduced the rate of distant metastases or improved overall survival. Presently, the standard radiation regimen is a conventional dose and fractionation schedule to a total dose of 60-66 Gy with a three- or four-field technique covering the bladder and tumor. The efficacy of additional irradiation of regional lymph nodes is questionable. New treatment possibilities with advanced techniques of radiotherapy, hyperfractionation and dose escalation and/or the addition of systemic chemotherapy may improve outcome. These options should be further explored in clinical trials.
Collapse
Affiliation(s)
- L Sengeløv
- Department of Oncology, Herlev University Hospital, Copenhagen, Denmark
| | | |
Collapse
|
8
|
Sengeløv L, Klintorp S, Havsteen H, Kamby C, Hansen SL, von der Maase H. Treatment outcome following radiotherapy in elderly patients with bladder cancer. Radiother Oncol 1997; 44:53-8. [PMID: 9288858 DOI: 10.1016/s0167-8140(97)00069-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The optimal treatment of elderly patients with bladder cancer is not established. This study aimed to evaluate prognostic variables for survival and morbidity, which may be important for treatment strategy. MATERIAL AND METHODS The medical records of 94 patients aged > or = 75 years receiving curatively intended radiotherapy for bladder cancer were reviewed retrospectively. RESULTS Median age was 78 years (range 75-93 years). Fifty patients had T1-2 tumors, and 42 patients had T3-4 tumors. The total planned dose was 57.6-62.6 Gy in 24-30 fractions in 6 weeks. In 76 patients, a 2 week rest period was planned after 16 fractions (split course). Half of the patients were hospitalized during or after the treatment because of gastrointestinal or urogenital side effects. Median survival was 13.9 months (range 0.6-150.0 + months), 29% survived for 2 years and 7% survived for 5 years. Patients aged > 78 years survived for a shorter period than patients aged 75-78 years (13.4 versus 16.1 months). Univariate survival analysis revealed that low stage (T1-2), good performance status (PS < or = 1), split course treatment, no treatment interruption due to side effects, and no hospitalization during treatment were associated with long survival. In multivariate analyses, T-stage, split course treatment, and performance status were independent prognostic factors. CONCLUSION The results confirm that curative intended radiotherapy is feasible in elderly patients, but patients with stage T3-4 and PS > 1 have a short survival. These patients should be offered palliative treatment.
Collapse
Affiliation(s)
- L Sengeløv
- Department of Oncology, Herlev University Hospital, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|