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Barry B, Dolivet G, Clatot F, Huguet F, Abdeddaim C, Baujat B, Blanchard N, Calais G, Carrat X, Chatellier A, Coste F, Cupissol D, Cuvelier P, De Mones Del Pujol E, Deneuve S, Duffas O, Dupret-Bories A, Even C, Evrard C, Evrard D, Faivre S, Fakhry N, Garrel R, Gorphe P, Houliat T, Kaminsky MC, Krebs L, Lapeyre M, Lindas P, Malard O, Mirghani H, Mondina M, Moriniere S, Mouawad F, Pestre-Munier J, Pham Dang N, Picard A, Ramin L, Renard S, Salvan D, Schernberg A, Sire C, Thariat J, Vanbockstael J, Vo Tan D, Wojcik T, Klein I, Block V, Baumann-Bouscaud L, De Raucourt D. [French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]. Bull Cancer 2024; 111:393-415. [PMID: 38418334 DOI: 10.1016/j.bulcan.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVES The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations. METHODOLOGY To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS). RESULTS The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey. CONCLUSION All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.
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Affiliation(s)
- Béatrix Barry
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, ORL et CCF, Nancy (54), France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Duffas
- Centre hospitalier de Libourne, ORL et CMF, Libourne, France
| | | | | | | | - Diane Evrard
- AP-HP, hôpital Bichat-Claude-Bernard, ORL et CCF, Paris (75), France
| | | | - Nicolas Fakhry
- Assistance publique-Hôpitaux de Marseille, ORL et CCF, Marseille, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didier Salvan
- Centre hospitalier Sud Francilien, ORL et CCF, Corbeil-Essonnes, France
| | | | | | | | | | | | | | - Isabelle Klein
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
| | - Véronique Block
- Dispositif Spécifique Régional du Cancer Grand Est - NEON, Nancy (54), France
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Bojaxhiu B, Templeton AJ, Elicin O, Shelan M, Zaugg K, Walser M, Giger R, Aebersold DM, Dal Pra A. Relation of baseline neutrophil-to-lymphocyte ratio to survival and toxicity in head and neck cancer patients treated with (chemo-) radiation. Radiat Oncol 2018; 13:216. [PMID: 30400969 PMCID: PMC6219022 DOI: 10.1186/s13014-018-1159-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background A high neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and together with the platelet-to-lymphocyte ratio (PLR) is associated with worse outcomes in several solid tumors. We investigated the prognostic value of NLR and PLR in patients with head and neck squamous cell carcinoma (HNSCC) treated with primary or adjuvant (chemo)radiotherapy ((C)RT). Methods A retrospective chart review of consecutive patients with HNSCC was performed. Neutrophil-to-lymphocyte ratio and PLR were computed using complete blood counts (CBCs) performed within 10 days before treatment start. The prognostic role of NLR and PLR was evaluated with univariable and multivariable Cox regression analyses adjusting for disease-specific prognostic factors. NLR and PLR were assessed as log-transformed continuous variables (log NLR and log PLR). Endpoints of interest were overall survival (OS), locoregional recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and acute toxicity. Results We analyzed 186 patients treated from 2007 to 2010. Primary sites were oropharynx (45%), oral cavity (28%), hypopharynx (14%), and larynx (13%). Median follow-up was 49 months. Higher NLR was associated with OS (adjusted HR per 1 unit higher log NLR = 1.81 (1.16–2.81), p = 0.012), whereas no association could be shown with LRFS (HR = 1.49 (0,83-2,68), p = 0.182), DRFS (HR = 1.38 (0.65–3.22), p = 0.4), or acute toxicity grade ≥ 2. PLR was not associated with outcome, nor with toxicity. Conclusion Our data suggest that in HNSCC patients treated with primary or adjuvant (C)RT, NLR is an independent predictor of mortality, but not disease-specific outcomes or toxicity. Neutrophil-to-lymphocyte ratio is a readily available biomarker that could improve pre-treatment prognostication and may be used for risk-stratification.
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Affiliation(s)
- Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | - Arnoud J Templeton
- Department of Medical Oncology, St. Claraspital Basel and Faculty of Medicine, University of Basel, Basel, Switzerland. .,Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Stadtspital Triemli, Zürich, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Basel, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Graupp M, Schaffer K, Wolf A, Vasicek S, Weiland T, Pondorfer P, Holzmeister C, Moser U, Thurnher D. C-reactive protein is an independent prognostic marker in patients with tongue carcinoma - A retrospective study. Clin Otolaryngol 2018; 43:1050-1056. [PMID: 29575651 DOI: 10.1111/coa.13102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Reliable prognostic markers are lacking for tongue carcinoma. C-reactive protein (CRP) and a ratio from neutrophils/lymphocytes (NLR) are biomarkers, associated with prognosis in solid cancers. Aim of this work was to investigate the role of CRP and NLR in prognosis of patients with tongue carcinoma. DESIGN Retrospective cohort study. SETTING We retrospectively analysed data of patients treated for tongue carcinoma at our institution. Levels of CRP, Neutrophils and Lymphocytes were measured pretherapeutic. PARTICIPANTS 197 patients treated for squamous cell carcinoma of the tongue between 2002 and 2015. MAIN OUTCOME MEASURES Overall survival, disease-free survival. RESULTS Elevated CRP was significantly associated with shorter overall survival in our cohort in uni- and multivariate analysis. NLR was not associated with prognosis. CONCLUSION In the present study we could confirm the role of CRP as an independent prognostic marker in patients with tongue carcinoma. Incorporating this marker in prognostication could represent a valuable and moreover inexpensive tool for improved decisions making concerning therapy in the future.
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Affiliation(s)
- M Graupp
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - K Schaffer
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - A Wolf
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - S Vasicek
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - T Weiland
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - P Pondorfer
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - C Holzmeister
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - U Moser
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
| | - D Thurnher
- Department of Otorhinolaryngology, Head and Neck surgery, Medical University of Graz, Graz, Austria
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Blatt S, Schön H, Sagheb K, Kämmerer PW, Al-Nawas B, Schiegnitz E. Hemoglobin, C-reactive protein and ferritin in patients with oral carcinoma and their clinical significance – A prospective clinical study. J Craniomaxillofac Surg 2018; 46:207-212. [DOI: 10.1016/j.jcms.2017.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/28/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
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Acharya S, Kale J, Hallikeri K, Anehosur V, Arnold D. Clinical significance of preoperative serum C-reactive protein in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2018; 47:16-23. [DOI: 10.1016/j.ijom.2017.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/25/2017] [Accepted: 06/23/2017] [Indexed: 12/21/2022]
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Tai SF, Chien HT, Young CK, Tsao CK, de Pablo A, Fan KH, Liao CT, Wang HM, Kang CJ, Chang JTC, Huang SF. Roles of preoperative C-reactive protein are more relevant in buccal cancer than other subsites. World J Surg Oncol 2017; 15:47. [PMID: 28209200 PMCID: PMC5314474 DOI: 10.1186/s12957-017-1116-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/01/2017] [Indexed: 02/06/2023] Open
Abstract
Background C-reactive protein (CRP) is an early marker for inflammation, and a relationship between serum CRP levels and survival in oral cancer has been demonstrated previously. In this study, we investigated the roles of CRP in different oral cancer subsites. Methods Three hundred and forty-three oral squamous cell carcinoma patients between June 1999 and March 2015 were retrospectively reviewed. Serum CRP levels were measured preoperatively. Results The elevation of CRP levels (≥5.0 mg/L) was significantly correlated with pathologic tumor status, pathologic nodal status, nodal extracapsular spread, tumor stage, skin invasion, tumor depth (≥10 mm), and bone invasion. The correlation between elevation of CRP and clinicopathologic factors was more evident in the buccal cancer compared to other tumor subsites. The disease-free survival and overall survival correlation was significant in buccal cancer (p = 0.003 and p < 0.001) but not in tongue cancer (p = 0.119 and p = 0.341) or other oral cancer subsites (p = 0.246 and p = 0.696). Conclusions Preoperative serum CRP level was a prognosticator in oral squamous cell carcinoma, and its effect was more prominent in buccal cancer that occurs more frequently in areca-quid (AQ) endemic regions. Electronic supplementary material The online version of this article (doi:10.1186/s12957-017-1116-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiao Fwu Tai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Huei-Tzu Chien
- Department of Public Health, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chi-Kuang Young
- Department of Otolaryngology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Chung-Kang Tsao
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Alba de Pablo
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chun-Ta Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chung-Jan Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Shiang-Fu Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Public Health, Chang Gung University, Taoyuan, Taiwan, Republic of China.
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Standardized pretreatment inflammatory laboratory markers and calculated ratios in patients with oral squamous cell carcinoma. Eur Arch Otorhinolaryngol 2016; 273:3371-84. [DOI: 10.1007/s00405-016-3950-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/22/2016] [Indexed: 12/18/2022]
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Monitoring carcinogenesis in a case of oral squamous cell carcinoma using a panel of new metabolic blood biomarkers as liquid biopsies. Oral Maxillofac Surg 2016; 20:295-302. [PMID: 26875085 DOI: 10.1007/s10006-016-0549-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/08/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION One of the common malignant tumors of the head and neck worldwide with generally unfavorable prognosis is squamous cell carcinoma (OSCC) of the oral cavity. Early detection of primary, secondary, or recurrent OSCC by liquid biopsy tools is much needed. CASE PRESENTATION Twelve blood biomarkers were used for monitoring a case of OSCC suffering from precancerous oral lichen ruber planus mucosae (OLP). After curative R0 tumor resection of primary OSCC (buccal mucosa), elevated epitope detection in monocytes (EDIM)-Apo10, EDIM-transketolase-like-1 (TKTL1), squamous cell carcinoma antigen (SCC-Ag), total serum lactate dehydrogenase (LDH), and its anaerobic isoforms (LDH-4, LDH-5) decreased to normal levels. Three and six months after surgery, transformation of suspicious mucosal lesions has been accompanied with an increase of EDIM scores, total serum LDH values, and a metabolic shift from aerobic (decrease of LDH-1, LDH-2) to anaerobic (increase of LDH-4, LDH-5) conditions. Two months later, secondary OSCC was histopathologically analyzed after tissue biopsy. Cytokeratin fraction 21-1 (CYFRA 21-1), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were not affected during the clinical course of carcinogenesis. CONCLUSIONS A combination strategy using a standardized panel of established (metabolic) blood biomarkers (TKTL1, LDH, LDH isoenzymes) is worth and can be recommended among others (apoptosis resistance-related Apo10, SCC-Ag) for early detection and diagnosis of primary, secondary, and recurrent OSCC. A tandem strategy utilizing (metabolic pronounced) routine liquid biopsies with imaging techniques may enhance diagnosis of OSCC in the future. Although we demonstrated the diagnostic utility of separated liquid biopsies in our previous study cohorts, further investigations in a larger patient cohort are necessary to recommend this combination strategy (EDIM blood test, LDH value, metabolic shift of LDH isoenzymes, and others, e.g., SCC-Ag or immunophenotyping) as a diagnostic tool for the addition to the OSCC staging system and as a routine procedure in the aftercare.
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Shrotriya S, Walsh D, Bennani-Baiti N, Thomas S, Lorton C. C-Reactive Protein Is an Important Biomarker for Prognosis Tumor Recurrence and Treatment Response in Adult Solid Tumors: A Systematic Review. PLoS One 2015; 10:e0143080. [PMID: 26717416 PMCID: PMC4705106 DOI: 10.1371/journal.pone.0143080] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/30/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A systematic literature review was done to determine the relationship between elevated CRP and prognosis in people with solid tumors. C-reactive protein (CRP) is a serum acute phase reactant and a well-established inflammatory marker. We also examined the role of CRP to predict treatment response and tumor recurrence. METHODS MeSH (Medical Subject Heading) terms were used to search multiple electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, EBM-Cochrane). Two independent reviewers selected research papers. We also included a quality Assessment (QA) score. Reports with QA scores <50% were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology was utilized for this review (S1 PRISMA Checklist). RESULTS 271 articles were identified for final review. There were 45% prospective studies and 52% retrospective. 264 had intermediate QA score (≥50% but <80%); Seven were adequate (80% -100%); A high CRP was predictive of prognosis in 90% (245/271) of studies-80% of the 245 studies by multivariate analysis, 20% by univariate analysis. Many (52%) of the articles were about gastrointestinal malignancies (GI) or kidney malignancies. A high CRP was prognostic in 90% (127 of 141) of the reports in those groups of tumors. CRP was also prognostic in most reports in other solid tumors primary sites. CONCLUSIONS A high CRP was associated with higher mortality in 90% of reports in people with solid tumors primary sites. This was particularly notable in GI malignancies and kidney malignancies. In other solid tumors (lung, pancreas, hepatocellular cancer, and bladder) an elevated CRP also predicted prognosis. In addition there is also evidence to support the use of CRP to help decide treatment response and identify tumor recurrence. Better designed large scale studies should be conducted to examine these issues more comprehensively.
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Affiliation(s)
- Shiva Shrotriya
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Declan Walsh
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- * E-mail:
| | - Nabila Bennani-Baiti
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Shirley Thomas
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Cliona Lorton
- Our Lady’s Hospice & Care Services, Harold’s Cross, Dublin, Ireland
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Lin ZH, Li X, Hong YF, Ma XK, Wu DH, Huang M, Chen ZH, Chen J, Dong M, Wei L, Wang TT, Ruan DY, Lin ZX, Zhong X, Xing YF, Wen JY, Wu XY, Lin Q. Alanine aminotransferase to hemoglobin ratio is an indicator for disease progression for hepatocellular carcinoma patients receiving transcatheter arterial chemoembolization. Tumour Biol 2015; 37:2951-9. [DOI: 10.1007/s13277-015-4082-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022] Open
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Selzer E, Grah A, Heiduschka G, Kornek G, Thurnher D. Primary radiotherapy or postoperative radiotherapy in patients with head and neck cancer: Comparative analysis of inflammation-based prognostic scoring systems. Strahlenther Onkol 2015; 191:486-94. [PMID: 25583136 DOI: 10.1007/s00066-014-0803-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/18/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inflammation-based scoring systems have potential value in evaluating the prognosis of cancer patients; however, detailed comparative analyses in well-characterized head and neck cancer patient collectives are missing. METHODS We analyzed overall survival (OS) in locally advanced head and neck cancer patients who were treated with curative intent by primary radiotherapy (RT) alone, by RT in combination with cetuximab (RIT) or with cisplatin (RCHT), and by primary surgery followed by postoperative radiotherapy (PORT). The primary RT collective (N = 170) was analyzed separately from the surgery plus RT group (N = 148). OS was estimated using the Kaplan-Meyer method. Cox proportional-hazard regression models were applied to compare the risk of death among patients stratified according to risk factors and the inflammation-based Glasgow Prognostic Score (GPS), the modified GPS (mGPS), the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the prognostic index (PI). RESULTS A prognostic relevance of the scoring systems for OS was observed in the primarily irradiated, but not in the PORT collective. OS was 35.5, 18.8, and 15.4 months, respectively, according to GPS 0, 1, and 2. OS according to mGPS 0-2 was identical. The PLR scoring system was not of prognostic relevance, while OS was 27.3 months in the NLR 0 group and 17.3 months in the NLR 1 group. OS was 35.5 months in PI 0, 16.1 months in PI 1, and 22.6 months in PI 2. CONCLUSION GPS/mGPS scoring systems are able to discriminate between three risk groups in primarily, but not postoperatively irradiated locally advanced head and neck cancer patients.
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Affiliation(s)
- Edgar Selzer
- Department of Radiotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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Esquerdo Galiana G, Cervera JM, Barrajón E, Juárez A, Llorca C, Díaz N, López A, Peiró R. Association between serum levels of C-reactive protein and response to treatment of chemotherapy-induced anemia in patients with solid tumors: a multicenter, prospective, observational study. Med Oncol 2013; 30:417. [PMID: 23371041 DOI: 10.1007/s12032-012-0417-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 11/09/2012] [Indexed: 11/27/2022]
Abstract
Our objective was to determine the association between C-reactive protein (CRP) levels at initiation of anemia treatment and response in solid tumor patients with chemotherapy (CT)-induced anemia. This was a multicenter, prospective, observational study which included adult patients with solid tumor initiating treatment for CT-induced anemia. Data were collected up to 16 weeks, or until premature discontinuation. We included 98 patients (median age 62.5 years, 64 % males, 57 % with ECOG 0-1, 85.7 % at stages III-IV and 54.1 % undergoing palliative CT). Mean (SD) Hb levels at baseline were 10.3 (0.9) g/dL (85.7 % < 11 g/dL) and median (Q1; Q3) CRP was 16.4 mg/L (3.9; 77.8) (68 % ≥ 5 mg/L). A total of 96 % of patients initiated erythropoiesis-stimulating agents (ESA) and iron supplementation; 4 % initiated iron monotherapy. After a median of 85 days, 65 % of patients had Hb ≥ 11 g/dL (in absence of transfusion) (mean change: +0.86 g/dL, 95 % confidence interval (CI) 0.53-1.19). A total of 8 patients required transfusion. A significant correlation (r = -0.39, p = 0.003) was observed between baseline CRP and final Hb levels. In the multivariate linear regression analysis, the independent predictors of higher final Hb levels were a high baseline Hb (adjusted ß = +0.69 g/dL for each g/dL of baseline Hb, 95 % CI 0.17-1.21) and a low log baseline CRP (-0.62 for each log mg/L, 95 %CI -1.22 to -0.02). Our results suggest that, in patients with solid tumors and CT-induced anemia, high CRP levels at treatment initiation predict a poor response to treatment with ESA and iron, independently from anemia severity at therapy initiation and from other patient and disease characteristics.
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Affiliation(s)
- Gaspar Esquerdo Galiana
- Medical Oncology Service, Hospital Clínica Benidorm, Avda Alfonso Puchades 8, 03501 Benidorm, Alicante, Spain.
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