Development of a Prognostic Model for Early Breast Cancer Integrating Neutrophil to Lymphocyte Ratio and Clinical-Pathological Characteristics

BACKGROUND

Breast cancer-related inflammation is critical in tumorigenesis, cancer progression, and patient prognosis. Several inflammatory markers derived from peripheral blood cells count, such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) are considered as prognostic markers in several types of malignancy.

METHODS

We investigate and validate a prognostic model in early patients with breast cancer to predict disease-free survival (DFS) based on readily available baseline clinicopathological prognostic factors and preoperative peripheral blood-derived indexes.

RESULTS

We analyzed a training cohort of 710 patients and 2 external validation cohorts of 980 and 157 patients with breast cancer, respectively, with different demographic origins. An elevated preoperative NLR is a better DFS predictor than others scores. The prognostic model generated in this study was able to classify patients into 3 groups with different risks of relapse based on ECOG-PS, presence of comorbidities, T and N stage, PgR status, and NLR.

CONCLUSION

Prognostic models derived from the combination of clinicopathological features and peripheral blood indices, such as NLR, represent attractive markers mainly because they are easily detectable and applicable in daily clinical practice. More comprehensive prospective studies are needed to unveil their actual effectiveness.

Factors influencing COVID-19 mortality among cancer patients: A Brazilian multi-institutional study

PURPOSE

This study aimed to describe the demographic and clinical characteristics of cancer patients with COVID-19, exploring factors associated with adverse outcomes.

PATIENTS AND METHODS

This retrospective cohort study methodically extracted and curated data from electronic medical records (EMRs) of numerous healthcare institutions on cancer patients diagnosed with a confirmed SARS-CoV-2 infection between May 2020 and August 2021, to identify risk factors linked to extended hospitalization and mortality. The retrieved information encompassed the patients' demographic and clinical characteristics, including the incidence of prolonged hospitalization, acute complications, and COVID-19-related mortality.

RESULTS

A total of 1446 cancer patients with COVID-19 were identified (mean [Standard deviation] age, 59.2 [14.3] years). Most patients were female (913 [63.1%]), non-white (646 [44.7%]), with non-metastatic (818 [56.6%]) solid tumors (1318 [91.1%]), and undergoing chemotherapy (647 [44.7%]). The rate of extended hospitalization due to COVID-19 was 46% (n = 665), which was significantly impacted by age (p = 0.012), sex (p = 0.003), race and ethnicity (p = 0.049), the presence of two or more comorbidities (p = 0.006), hematologic malignancies (p = 0.013), metastatic disease (p = 0.002), and a performance status ≥ 2 (p = 0.001). The COVID-19-related mortality rate was 18.9% (n = 273), and metastatic disease (<0.001), performance status ≥2 (<0.001), extended hospitalization (p = 0.028), renal failure (p = 0.029), respiratory failure (p < 0.001), sepsis (p = 0.004), and shock (p = 0.040) significantly and negatively influenced survival.

CONCLUSION

The rate of extended hospitalization and COVID-19-specific death in cancer patients was notably high and could be influenced by comorbidities, cancer treatment status, and clinical fragility. These observations may aid in developing risk counseling strategies regarding COVID-19 in individuals diagnosed with cancer.

EGFR Mutation Detection in Brazilian Patients With Non-Small-Cell Lung Cancer: Lessons From Real-World Data Scenario of Molecular Testing

PURPOSE

There is a paucity of consistent data concerning genetic mutations in Brazilian patients with lung cancer. The aim of this study was to retrospectively analyze epidermal growth factor receptor (EGFR) mutations detected in a real-world scenario using a large cohort of Brazilian patients with non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

This was a cross-sectional, observational, descriptive study on the basis of a database of EGFR molecular analysis from tumor samples of patients with a confirmatory histopathological diagnosis of primary lung cancer. Specimens were collected from 2013 to 2017 and were tested using cobas, next-generation sequencing, and Sanger sequencing platforms.

RESULTS

A total of 7,413 tumor specimens were tested. The patients were predominantly women with a median age of 67.0 years. Patients with at least one mutation represented 24.2% of the total sample. Among the positive patients, the majority had just one mutation, but two or more simultaneous mutations were observed in 1.52% of patients. Exon 19 deletion was the most prevalent alteration in the sample (12.8%), followed by exon 21 L858R (6.9%) and exon 20 insertion (1.6%). All others were considered uncommon mutations and were observed in 18.5% of all mutated patients and 4.0% of the total sample (2.3%-18.7% depending on the sequencing method).

CONCLUSION

This study examined the prevalence of EGFR mutations in Brazilian patients with NSCLC using different technologies, suggesting that the type of method used, directed or nondirected against specific mutations, influences the analysis, particularly for uncommon mutations, which will be missed by mutation-specific approaches such as cobas testing. Our estimates are the largest in Latin America and are consistent with previous reports from other parts of the world. Besides the variability in methods described here as technology incorporation advances in a nonhomogeneous manner, it is probably like the real-world clinical setting Brazilian oncologists face in their daily practice.

Paradoxical interaction between cancer and long-term postsepsis disorder: impairment of de novo carcinogenesis versus favoring the growth of established tumors

Background

Previous data have reported that the growth of established tumors may be facilitated by postsepsis disorder through changes in the microenvironment and immune dysfunction. However, the influence of postsepsis disorder in initial carcinogenesis remains elusive.

Methods

In the present work, the effect of postsepsis on inflammation-induced early carcinogenesis was evaluated in an experimental model of colitis-associated colorectal cancer (CAC). We also analyzed the frequency and role of intestinal T regulatory cells (Treg) in CAC carcinogenesis.

Results

The colitis grade and the tumor development rate were evaluated postmortem or in vivo through serial colonoscopies. Sepsis-surviving mice (SSM) presented with a lower colonic DNA damage, polyp incidence, reduced tumor load, and milder colitis than their sham-operated counterparts. Ablating Treg led to restoration of the ability to develop colitis and tumor polyps in the SSM, in a similar fashion to that in the sham-operated mice. On the other hand, the growth of subcutaneously inoculated MC38luc colorectal cancer cells or previously established chemical CAC tumors was increased in SSM.

Conclusion

Our results provide evidence that postsepsis disorder has a dual effect in cancer development, inhibiting inflammation-induced early carcinogenesis in a Treg-dependent manner, while increasing the growth of previously established tumors.

Abstract PS6-25: Cts5 tested in a Brazilian population: A tool that can predict global survival in early breast cancer ER+/HER2-, as well as the response to extended endocrine therapy

Background: Breast cancer (BC) accounts for 30% of female cancer, is the most commonly diagnosed cancer worldwide and the second most common cause of cancer-related deaths among females. The majority (79%) of breast cancers express the estrogen receptor (ER+) and 91% of them are diagnosed at an early stage. But it is also known that late recurrence (5 years or more after diagnosis) represents about 50% of all recurrences of ER+ BC. Identify those patients who are at greatest risk for late recurrence and develop strategies to prevent it has emerged as a major unmet need in ER+ BC. In an attempt to reduce late recurrences, several studies have recently proposed that endocrine therapy (ET) prolonged beyond five years would achieve this goal. Conversely, extended ET increases the rates of side-effects, compared to conventional ET. Therefore, selecting patients who would really benefit from extended ET is crucial, as this would spare low-risk patients from potentially greater side effects and impacts in quality of life, restricting the treatment only for those who really could take advantage of this approach. That is why, currently, the subject late recurrence is being studied so much. CTS 5 (Clinical Treatment Score after 5 years) is a simple clinical-pathological tool developed to estimate the residual risk of distant recurrence after 5 years of ET.

Objective: To assess the prognostic and predictive impact of CTS5 in overall survival (OS) of ER+BC patients treated with conventional or extended ET in a Brazilian Cancer Center.

Study design and statistical analysis: A retrospective cohort study was conducted, selecting, through administrative databases of AC Camargo Cancer Center, 1085 ER+ BC patients with at least 5 years of adjuvant ET. Patients who missed follow-up before completing ET were excluded, but we kept those who presented any event related to illness or treatment. Statistical analysis includes a Kaplan-Meier analysis and the Log Rank test. Prognostic factors were assessed using univariate and multivariate Cox analysis.

Results: The demographic and clinical characteristics of patients are described in table 1. In this cohort, continuous CTS5 was a significant predictor for OS (HR = 4,49 [3.12-6.46], p&lt;0.001). In addition, in the high CTS5 group a significant benefit was observed with prolongation of adjuvant ET beyond 5 years (HR = 4,91 [3.41-7.06], p&lt;0.001), not observed for low and intermediate risks.

Conclusion: In this cohort, composed of real-life Brazilian women with ER+/ HER2- BC, irrespective of menopausal status, CTS5 proved to be an excellent predictor of OS. In addition, it was shown to be a predictor of response to extended ET. CTS5 score can identify a group of high-risk patients who benefits from extended ET.

We consider that it would be of great value to expand the study population and follow-up, especially to analyze whether this tool also has a predictive value in contraindicating extended ET in low- risk and intermediate-risk patients.

Table 1. Demographic and Clinical CharacteristicsCharacteristicNo. (%)Age, yearsMedian53IQR26-91&lt; 50 years446 (41.1)&gt;50 years639 (58.9)Tumor size, mm≤ 10285 (24.1)10-20458 (38.7)20-50378 (31.9)&gt;5060 (5.1)GradeWell142 (11,9)Intermediate385 (32,5)Poor654 (55,2)Nodal status (No. of positive nodes)0756 (64.0)1 -3305 (25.8)≥4120 (10.2)ChemotherapyAdjuvant592 (50.1)Neoadjuvant118 (10.0)Endocrine TerapyET 5 years1060 (89,7)ET extendend100 (8.4)ET for less than 5 years.21 (1,8)CTS5Low587 (49.6)Intermediate344 (29.1)High250 (21.1)RecurrenceDistant147 (12,4)Local 39 (3,3)

Citation Format: Lucas Vian, Ronaldo Souza, Vladmir Claudio Cordeiro de Lima, Daniella Yumi Tsuji Honda, Samara Theodoro Pacheco, Caio Dabbous de Liz, Luciana Beatriz Mendes Gomes, Bruno Cezar Mendonça Uchôa Júnior, Paula Tavares Guimarães, Celso Silva e Souza Filho, Andréa Paiva Guimarães, Maria Fernanda Evangelista Simões, Mauro Daniel Spina Donadio, Angelo Bezerra de Souza Fêde, Augusto Obuti Saito, Adriana Regina Gonçalves Ribeiro, Joyce Maria Lisboa Maia, Iara Karoline Freire Lustosa, Fabricio de Souza Castro, Monique Celeste Tavares, Marcelle Goldner Cesca, Marcelo Corassa, Noam Falbel Pondé, Solange Sanches. Cts5 tested in a Brazilian population: A tool that can predict global survival in early breast cancer ER+/HER2-, as well as the response to extended endocrine therapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-25.

PD-L1 expression by Tumor Proportion Score (TPS) and Combined Positive Score (CPS) are similar in non-small cell lung cancer (NSCLC)

BACKGROUND

For non-small cell lung cancer (NSCLC) the most used method for analysing programmed cell death ligand 1 (PD-L1) expression is the Tumor Proportion Score (TPS). Nevertheless, for other tumour types, the Combined Positive Score (CPS) has been the method of choice.

AIM

Evaluate and compare the predictive value of both CPS and TPS as predictors of immunotherapy response in NSCLC, and to evaluate the agreement intra-observer between both methods and inter-observer between two expert lung pathologists.

METHODS

56 NSCLC patients who were treated with anti-programmed cell death 1 (PD-1)/PD-L1 therapy were included. Two pathologists evaluated all cases independently, considering the sample's adequacy for analysis, and the PD-L1 expression by TPS and CPS.

RESULTS

The Kappa coefficient for adequacy was 0.82 (95% CI 0.67 to 0.97). There was a high agreement between TPS and CPS and a high agreement between pathologists concerning the two methods. The Kappa coefficient between TPS and CPS was 0.85 for both pathologists, and between pathologists was 0.94 and 0.93 for TPS and CPS, respectively.

CONCLUSIONS

Both methods proved to be equally predictive of response to anti-PD-1/PD-L1 therapy. There was both a high intra-observer agreement between the two methods and a high inter-observer agreement between pathologists. This study suggests that CPS could also be used in a routine setting for immunotherapy decision in NSCLC.