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Nagpal C, Ganguly S, Sasi A, Kumar V, Biswas B, Pushpam D, Kumar A, Agarwala S, Jain V, Dhua A, Yadav DK, Khan SA, Barwad A, Mirdha AR, Biswas A, Thulkar S, Bakhshi S. Ewing sarcoma among children 5 years of age or younger: Is it a different disease? Pediatr Blood Cancer 2024; 71:e31268. [PMID: 39138616 DOI: 10.1002/pbc.31268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 07/19/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Children ≤5 years of age with Ewing's sarcoma (ES) possibly have a distinct disease biology, data on which are scarce. We evaluated clinical features, outcomes, and prognostic factors of ES among children with age ≤5 years. METHODS Children with ES registered between 2003 and 2019 were included. Baseline clinical and treatment details were retrieved from medical records. Prognostic factors were identified using multivariable Cox regression. Clinical features and outcomes of children ≤5 years were compared with those greater than 5 years by chi-square and log-rank tests. Propensity score-matched (PSM) analysis was done to evaluate the impact of age on survival in the metastatic and localized subgroups. RESULTS Out of the 859 patients, 86 (10%) were ≤5 years of age (median age 4 years, 60 males [69.8%]). The most common location was the extremities (37.2%), followed by thorax (27.9%) and head and neck (H&N) (22.1%); baseline metastases were seen in 25 patients (29.8%). The median event-free-survival (EFS) and overall survival (OS) were 25.6 and 68.7 months, respectively. Metastatic disease predicted inferior OS (hazard ratio [HR] = 2.54, p = .018) and EFS (HR = 2.47, p = .007], symptom duration ≤3 months predicted an inferior OS (HR = 2.17, p = .048). Compared to age greater than 5 years, younger children had more H&N and less pelvic primaries (p < .001) and lesser baseline metastases (p = .037). PSM analysis did not reveal any significant impact of age on OS in the metastatic (HR = 1.59, p = .29) or localized cohort (HR = 1.77, p = .09). CONCLUSIONS Children with ES ≤5 years of age have a distinct favorable clinical presentation. However, age is not an independent prognostic factor for survival outcomes when adjusted for confounders.
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Affiliation(s)
- Chitrakshi Nagpal
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Kumar
- Division of Neonatology, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Apollo Multispecialty Hospital, Kolkata, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devender Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mirdha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi, India
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Rikhari H, Baidya Kayal E, Ganguly S, Sasi A, Sharma S, Antony A, Rangarajan K, Bakhshi S, Kandasamy D, Mehndiratta A. Improving lung nodule segmentation in thoracic CT scans through the ensemble of 3D U-Net models. Int J Comput Assist Radiol Surg 2024; 19:2089-2099. [PMID: 39044036 DOI: 10.1007/s11548-024-03222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE The current study explores the application of 3D U-Net architectures combined with Inception and ResNet modules for precise lung nodule detection through deep learning-based segmentation technique. This investigation is motivated by the objective of developing a Computer-Aided Diagnosis (CAD) system for effective diagnosis and prognostication of lung nodules in clinical settings. METHODS The proposed method trained four different 3D U-Net models on the retrospective dataset obtained from AIIMS Delhi. To augment the training dataset, affine transformations and intensity transforms were utilized. Preprocessing steps included CT scan voxel resampling, intensity normalization, and lung parenchyma segmentation. Model optimization utilized a hybrid loss function that combined Dice Loss and Focal Loss. The model performance of all four 3D U-Nets was evaluated patient-wise using dice coefficient and Jaccard coefficient, then averaged to obtain the average volumetric dice coefficient (DSCavg) and average Jaccard coefficient (IoUavg) on a test dataset comprising 53 CT scans. Additionally, an ensemble approach (Model-V) was utilized featuring 3D U-Net (Model-I), ResNet (Model-II), and Inception (Model-III) 3D U-Net architectures, combined with two distinct patch sizes for further investigation. RESULTS The ensemble of models obtained the highest DSCavg of 0.84 ± 0.05 and IoUavg of 0.74 ± 0.06 on the test dataset, compared against individual models. It mitigated false positives, overestimations, and underestimations observed in individual U-Net models. Moreover, the ensemble of models reduced average false positives per scan in the test dataset (1.57 nodules/scan) compared to individual models (2.69-3.39 nodules/scan). CONCLUSIONS The suggested ensemble approach presents a strong and effective strategy for automatically detecting and delineating lung nodules, potentially aiding CAD systems in clinical settings. This approach could assist radiologists in laborious and meticulous lung nodule detection tasks in CT scans, improving lung cancer diagnosis and treatment planning.
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Affiliation(s)
- Himanshu Rikhari
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Shuvadeep Ganguly
- Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Archana Sasi
- Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Swetambri Sharma
- Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Ajith Antony
- All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Krithika Rangarajan
- Dr. B.R.A. IRCH, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Sameer Bakhshi
- Medical Oncology, Dr. B.R.A. IRCH, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India.
- Department of Biomedical Engineering, All India Institute of Medical Sciences New Delhi, New Delhi, India.
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Sasi A, Chitikela S, Ganguly S, Biswas B, Pushpam D, Kumar A, Khan SA, Kumar VS, Kale SS, Biswas A, Barwad A, Mridha AR, Thulkar S, Bakhshi S. Treatment outcomes in patients with Ewing sarcoma of the spine in a resource-challenged setting: 17-year experience from a single center in India. Pediatr Hematol Oncol 2024; 41:211-223. [PMID: 38189167 DOI: 10.1080/08880018.2023.2296949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Ewing sarcoma (ES) of the spine is a rare childhood cancer with sparse literature on treatment outcomes. We aimed to describe survival outcomes and prognostic factors in patients with spinal ES treated at a single institute in a resource-challenged setting. We conducted a retrospective analysis of patients with spinal ES registered at a tertiary care oncology center between 2003-2019. Clinical patient data was retrieved from hospital records. Cox regression analysis was used to identify the association of baseline clinical parameters with event free survival (EFS) and overall survival (OS). A cohort of 85 patients was analyzed including 38 (45%) patients with metastatic disease. The median age was 15 years with 73% being male. Local therapy was administered in 62 (72.9%) patients with surgery alone in 8 (9.4%), radiotherapy alone in 36 (42.4%) and both in 18 (21.2%) patients. A higher proportion of males received local therapy than females (80.3% versus 59.1%; p = 0.049). The median EFS and OS were 20.1 and 28.6 months, respectively. On univariable analysis, age ≤ 15 years, female sex, serum albumin ≤3.5 g/dL and hemoglobin ≤11 g/dL were associated with inferior EFS while younger age, female sex, hypoalbuminemia and metastatic disease were associated with inferior OS. On multivariable analysis, only hypoalbuminemia was predictive for inferior EFS (HR:2.41; p = 0.005) while hypoalbuminemia (HR:2.06;p = 0.033) and female sex (HR:1.83; p = 0.046) were associated with inferior OS. We concluded that hypoalbuminemia confers poor prognosis in ES spine. Survival outcomes are poorer in females treated in our setting, possibly due to prevailing sex-based biases.
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Affiliation(s)
- Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Centre, Kolkata, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, Jhajjar, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Olmez OF, Bilici A, Gursoy P, Cubukcu E, Sakin A, Korkmaz T, Cil I, Cakar B, Menekse S, Demir T, Acikgoz O, Hamdard J. Impact of systemic inflammatory markers in patients with ALK-positive non-small cell lung cancer treated with crizotinib. Pulmonology 2023; 29:478-485. [PMID: 36564237 DOI: 10.1016/j.pulmoe.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the prognostic utility of inflammation-based prognostic scores in patients with ALK-positive metastatic or non-resectable non-small-cell lung cancer (NSCLC) treated with crizotinib. PATIENTS AND METHODS A total of 82 patients with ALK-positive metastatic or non-resectable NSCLC who received ALK TKI crizotinib were included. Pre-treatment modified Glasgow prognostic score (mGPS), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI, and SII on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). RESULTS The ORR was 77.2%, while 1-year OS and PFS rates were 95.0% and 93.5%, respectively. The univariate analysis revealed significantly higher 1-year PFS (89.4 vs. 64.4%, p=0.043) and OS (92.0 vs. 83.3%, p=0.01) rates in patients with low (<934.7) vs. high (≥934.7) SII scores. Multivariate analysis revealed that PNI ≥0.09 was a significant determinant of poorer 1-year OS rates (hazard ratio [HR]: 2.46, 95% confidence interval [CI] 0.88-4.85, p=0.035). No significant difference was observed in survival rates according to gender, age, smoking status, prior lines of therapy, or mGPS scores, while higher mGPS scores (odds ratio [OR]: 0.1, 95%CI 0.16-1.04; p=0.009) and higher PNI scores (OR: 0.16, 95% CI 0.02-0.55; p=0.035) were associated with poorer ORR. CONCLUSION Our findings indicate the prognostic significance of PNI and SII in terms of survival outcome and the impact of mGPS and PNI on treatment response in patients with ALK-positive NSCLC treated with crizotinib.
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Affiliation(s)
- O F Olmez
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - A Bilici
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - P Gursoy
- Ege University Faculty of Medicine, Izmir, Turkey
| | - E Cubukcu
- Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Sakin
- University of Health Sciences Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - T Korkmaz
- Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - I Cil
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - B Cakar
- Ege University Faculty of Medicine, Izmir, Turkey
| | - S Menekse
- Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - T Demir
- Bezmialem University Faculty of Medicine, Istanbul; Turkey
| | - O Acikgoz
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - J Hamdard
- Department of Medical Oncology, Medipol University Faculty of Medicine, Istanbul, Turkey.
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Baidya Kayal E, Ganguly S, Sasi A, Sharma S, DS D, Saini M, Rangarajan K, Kandasamy D, Bakhshi S, Mehndiratta A. A proposed methodology for detecting the malignant potential of pulmonary nodules in sarcoma using computed tomographic imaging and artificial intelligence-based models. Front Oncol 2023; 13:1212526. [PMID: 37671060 PMCID: PMC10476362 DOI: 10.3389/fonc.2023.1212526] [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: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
The presence of lung metastases in patients with primary malignancies is an important criterion for treatment management and prognostication. Computed tomography (CT) of the chest is the preferred method to detect lung metastasis. However, CT has limited efficacy in differentiating metastatic nodules from benign nodules (e.g., granulomas due to tuberculosis) especially at early stages (<5 mm). There is also a significant subjectivity associated in making this distinction, leading to frequent CT follow-ups and additional radiation exposure along with financial and emotional burden to the patients and family. Even 18F-fluoro-deoxyglucose positron emission technology-computed tomography (18F-FDG PET-CT) is not always confirmatory for this clinical problem. While pathological biopsy is the gold standard to demonstrate malignancy, invasive sampling of small lung nodules is often not clinically feasible. Currently, there is no non-invasive imaging technique that can reliably characterize lung metastases. The lung is one of the favored sites of metastasis in sarcomas. Hence, patients with sarcomas, especially from tuberculosis prevalent developing countries, can provide an ideal platform to develop a model to differentiate lung metastases from benign nodules. To overcome the lack of optimal specificity of CT scan in detecting pulmonary metastasis, a novel artificial intelligence (AI)-based protocol is proposed utilizing a combination of radiological and clinical biomarkers to identify lung nodules and characterize it as benign or metastasis. This protocol includes a retrospective cohort of nearly 2,000-2,250 sample nodules (from at least 450 patients) for training and testing and an ambispective cohort of nearly 500 nodules (from 100 patients; 50 patients each from the retrospective and prospective cohort) for validation. Ground-truth annotation of lung nodules will be performed using an in-house-built segmentation tool. Ground-truth labeling of lung nodules (metastatic/benign) will be performed based on histopathological results or baseline and/or follow-up radiological findings along with clinical outcome of the patient. Optimal methods for data handling and statistical analysis are included to develop a robust protocol for early detection and classification of pulmonary metastasis at baseline and at follow-up and identification of associated potential clinical and radiological markers.
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Affiliation(s)
- Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Shuvadeep Ganguly
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Archana Sasi
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Swetambri Sharma
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dheeksha DS
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manish Saini
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Krithika Rangarajan
- Radiodiagnosis, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Sameer Bakhshi
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Sasi A, Ganguly S, Biswas B, Pushpam D, Kumar A, Agarwala S, Khan SA, Kumar VS, Deo S, Sharma DN, Bakhshi S. Determinants and impact of diagnostic interval in bone sarcomas: A retrospective cohort study. Pediatr Blood Cancer 2023; 70:e30135. [PMID: 36524611 DOI: 10.1002/pbc.30135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/30/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnostic delays in cancers are frequent in developing countries due to poor health infrastructure. Existing literature from developed countries suggests that diagnostic interval in bone sarcomas is primarily dictated by tumour biology with no impact on survival. This study evaluates the social and biological determinants of the diagnostic interval in bone sarcomas in a resource-challenged setting and assesses its impact on treatment outcomes. METHODS A retrospective single-institutional study was conducted on patients with high-grade bone sarcomas recorded in the sarcoma clinic database between 2003 and 2018. Baseline clinical characteristics and treatment outcomes were recorded. Logistic regression was performed to assess the impact of baseline clinical and social characteristics (distance from treating centre and rural vs. urban residence) on the diagnostic interval. Further, the impact of diagnostic interval on histologic response to neoadjuvant chemotherapy, amputation requirement in extremity sarcomas and survival was evaluated. RESULTS A total of 1227 patients were included for analysis. The median diagnostic interval was 4 months (3-7 months). Age above 18 years, Ewing sarcoma (ES) diagnosis, absence of fever at presentation and tumour size above 7.5 cm were predictors of a longer diagnostic interval (>4 months). The length of the diagnostic interval did not impact amputation requirement or survival outcomes. However, the proportion of patients with good necrosis post-neoadjuvant chemotherapy was lower among patients with longer diagnostic intervals (25% vs. 34·16%; p-value = .04). CONCLUSION Tumour characteristics rather than social factors determined the diagnostic interval. Diagnostic interval did not impact survival outcomes even in a resource-constrained setting.
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Affiliation(s)
- Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Kumar
- Department of Medical Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Suryanarayana Deo
- Department of Surgical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Ganguly S, Sasi A, Khan SA, Kumar VS, Kapoor L, Sharma MC, Mridha A, Barwad A, Thulkar S, Pushpam D, Bakhshi S. Formulation and validation of a baseline prognostic score for osteosarcoma treated uniformly with a non-high dose methotrexate-based protocol from a low middle income healthcare setting: a single centre analysis of 594 patients. Front Oncol 2023; 13:1148480. [PMID: 37188186 PMCID: PMC10175811 DOI: 10.3389/fonc.2023.1148480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction The outcomes of osteosarcoma in low middle income countries (LMICs) are different due to patients presenting in advanced stages, resource constraints and the use of non-high-dose-methotrexate (HDMTX)-based regimens. This study derived and validated a prognostic score for osteosarcoma that integrates biologic and social factors and is tailored for patients from an LMIC setting using a non-HDMTX-based protocol. Materials and methods A retrospective study including osteosarcoma patients enrolled for treatment at a single tertiary care centre in India between 2003-19 was conducted. Baseline biologic and social characteristics were extracted from medical records and survival outcomes were noted. The cohort was randomised into a derivation and validation cohort. Multivariable Cox regression was used to identify baseline characteristics that were independently prognostic for survival outcomes in the derivation cohort. A score was derived from the prognostic factors identified in the derivation cohort and further validated in the validation cohort with estimation of its predictive ability. Results 594 patients with osteosarcoma were eligible for inclusion in the study. Around one-third of the cohort had metastatic disease with 59% of the patients residing in rural areas. The presence of metastases at baseline (HR 3.39; p<0.001; score=3), elevated serum alkaline phosphatase (SAP) >450 IU/L (HR 1.57; p=0.001; score=1) and baseline tumour size > 10 cm (HR 1.68; p<0.001; score=1) were identified to be independent factors predicting inferior event free survival (EFS) and were included in development of the prognostic score. Patients were categorized as low risk (score 0), intermediate risk (score 1-3) and high risk (4-5). Harrell's c-indices for the score were 0.682, 0.608 and 0.657 respectively for EFS in the derivation, validation and whole cohort respectively. The timed AUC of ROC was 0.67 for predicting 18-month EFS in the derivation, validation and whole cohorts while that for 36-month EFS were 0.68, 0.66 and 0.68 respectively. Conclusions The study describes the outcomes among osteosarcoma patients from an LMIC treated uniformly with a non-HDMTX-based protocol. Tumor size, baseline metastases and SAP were prognostic factors used to derive a score with good predictive value for survival outcomes. Social factors did not emerge as determinants of survival.
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Affiliation(s)
- Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Love Kapoor
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
- *Correspondence: Sameer Bakhshi,
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Bahçeci A, Kötek Sedef A, Işik D. The prognostic values of prognostic nutritional index in extensive-stage small-cell lung cancer. Anticancer Drugs 2022; 33:e534-e540. [PMID: 34407045 DOI: 10.1097/cad.0000000000001169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We aimed to assess the prognostic and predictive significance of pretreatment Prognostic Nutritional Index (PNI) in extensive-stage small-cell lung cancer (ES-SCLC) patients treated with first-line chemotherapy. We designed this study to evaluate the prognostic role of PNI in 147 ES-SCLC patients treated with platinum-based combination regimen between 2011 and 2018. Kaplan-Meier survival analyses and Cox proportional hazard models were used to examine the effects of basal PNI on overall survival (OS). The median age of the patients was 61 (range 38-81). The cutoff value for PNI was determined for whole group and patients were dichotomized into high (≥49.17) and low (<49.17). Seventy-eight (53.1%) patients had low PNI score and 69 (46.9%) patients had high PNI score. Patients with the high PNI score had better OS than those with low PNI (13 versus 12 months, respectively, and P = 0.03). The relationship between PNI score and OS was more prominent in patients over 65 years of age (13 versus 10 months, respectively, and P = 0.03). Progression-free survival of patients with complete response to first-line treatment was statistically significantly better than the other patients (8 versus 7 months, respectively, and P = 0.02). Similarly, OS was statistically significantly better than the other patients (15 versus 8 months, respectively, and P = 0.001). The results of our study show that PNI score is useful in evaluating the OS of patients with ES-SCLC. PNI is a cost-effective prognostic marker and should therefore be included in routine clinical practice.
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Affiliation(s)
| | - Ayşe Kötek Sedef
- Department of Radiation Oncology, Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
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Kataria B, Sharma A, Biswas B, Bakhshi S, Pushpam D. Pazopanib in rare histologies of metastatic soft tissue sarcoma. Ecancermedicalscience 2021; 15:1281. [PMID: 34824604 PMCID: PMC8580588 DOI: 10.3332/ecancer.2021.1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Indexed: 01/20/2023] Open
Abstract
Background Uncommon histopathological subtypes account for less than 5% cases of soft tissue sarcoma (STS) and unclassified STSs comprise another 16%, these are often chemotherapy-resistant, with a dismal outcome in unresectable/metastatic disease. Prospective studies on the use of pazopanib in this cohort of patients are lacking in the literature. Here, we describe the safety and efficacy of pazopanib in rare histologies of advanced STS. Materials and methods We conducted a retrospective study at two tertiary cancer centres in India, evaluating 33 cases of rare subtypes of STS, who received pazopanib as per institutional protocol between January 2013 and December 2019. Patients who received pazopanib for unresectable/metastatic disease were enrolled in this study for clinicopathologic features, treatment outcome and evaluation of prognostic factors. Results Out of 33 patients, there were seven cases of undifferentiated pleomorphic sarcoma, four cases each of myxofibrosarcoma, epithelioid sarcoma and malignant peripheral nerve sheath tumour, three cases each of haemangiopericytoma and spindle cell sarcoma, two cases of haemangioendothelioma and a case each of clear cell sarcoma, retroperitoneal sarcoma, angiosarcoma and pleomorphic rhabdomyosarcoma-adult type. The objective response rate was 27%. Most of the patients (67%) received pazopanib in second or subsequent lines of therapy. The majority (70%) were started at a lower dose of 400/600 mg and only 43% of these (10/23) could be escalated to a full dose of 800 mg based on tolerance. On univariate analysis, pazopanib’s starting dose didn’t predict progression-free survival (PFS)/overall survival (OS)/response rate. At a median duration of follow-up of 18.8 months (range 1.9–150.4 months), the median PFS and median OS were 10.3 months (95% confidence interval (CI): 5.9–14.8) and 17.8 months (95% CI: 10.7–29.3), respectively. 27% of the patients experienced grade ¾ toxicities, 12% required dose modification of pazopanib and 21% needed permanent discontinuation due to toxicity. Conclusion Our study shows that pazopanib is active in rare subtypes of STS.
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Affiliation(s)
- Babita Kataria
- Department of Medical Oncology, National Cancer Institute, Badsa, Jhajjar, Haryana, 124105, India
| | - Aparna Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India.,Equally contributed to this work
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, DH Block(Newtown),Action area I, Kolkata, West Bengal, 700160, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Deepam Pushpam
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
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10
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Gulia A, Arora RS, Panda PK, Raja A, Tiwari A, Bakhshi S, Salins N, Goel V, Janu A. Adapting Management of Sarcomas in COVID-19: An Evidence-Based Review. Indian J Orthop 2021; 55:1-13. [PMID: 32836361 PMCID: PMC7261215 DOI: 10.1007/s43465-020-00143-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 02/04/2023]
Abstract
With the novel coronavirus disease (COVID-19) being declared a global pandemic by the World Health Organization, the Indian healthcare sector is at the forefront to deliver optimal care. Patients with cancer especially are at serious risk for increased chances of morbidity and mortality due to their immunocompromised state. Currently there is a paucity of definitive guidelines for the management of sarcomas during the pandemic in a resource-constrained and diverse population setting like India. Health care professionals from various specialties involved in the management of sarcomas have collaborated to discuss various aspects of evidence-based sarcoma management during the COVID-19 pandemic. This article provides structured recommendations for HCP to adapt to the situation, optimize treatment protocols with judicious use of all resources while providing evidence-based treatment for sarcoma patients.
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Affiliation(s)
- Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institure (HBNI), Mumbai, India
| | | | - Pankaj Kumar Panda
- Department of Clinical Research, Apollo Proton Cancer Centre, Chennai, India
| | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | - Akshay Tiwari
- Musculoskeletal Oncology, Max Institute of Cancer Care, Saket, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, MAHE, Manipal, India
| | - Vineeta Goel
- Radiation Oncology, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
| | - Amit Janu
- Department of Radiology, Tata Memorial Hospital, and Homi Bhabha National Institure (HBNI), Mumbai, India
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11
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Liu J, Li S, Zhang S, Yang C, Zhang L, Zhang B, Cheng Y, Wang C. Pretreatment prognostic nutritional index is a prognostic marker for extensive-stage small cell lung cancer patients treated with anlotinib. J Thorac Dis 2020; 12:5765-5773. [PMID: 33209408 PMCID: PMC7656377 DOI: 10.21037/jtd-20-755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Anlotinib is a multi-targeted tyrosine kinase inhibitor that inhibits tumor angiogenesis which has shown activity in several malignancies and approved for the treatment of small cell lung cancer (SCLC) in China. However, there are no markers can predict the clinical outcomes of anlotinib. We aimed to evaluate the efficacy of anlotinib in extensive stage SCLC (ES-SCLC) patients who failed at least two regimens treatment and to explore potential factors related to its survival benefit. Methods Patients with ES-SCLC treated with anlotinib monotherapy were screened between March 2017 and May 2019, prognostic nutritional index (PNI) before treatment were collected. Progression free survival (PFS) and overall survival (OS) were calculated and compared using the Kaplan–Meier method and the log-rank test. The prognostic values of each variable were evaluated with univariate and multivariate Cox proportional hazard regression (PHR) analyses. Results A total of 41 patients with ES-SCLC were received anlotinib treatment, the median age was 57 (range, 33–76). Median OS was significantly longer in the PNI high arm compared with the low arm [8.4 months (95% CI, 5.1–9.6 months) vs. 4.7 months (95% CI, 2.1–6.3 months); hazard ratio (HR) 0.42 (95% CI, 0.21–0.85); P=0.01]. The median PFS of two arms were 4.1 months (95% CI, 2.1–8.2 months) and 2.6 months (95% CI, 0.7–3.9 months), respectively (HR =0.53, 95% CI, 0.27–1.02, P=0.05). Multivariate analysis confirmed that PNI (P<0.01) and LDH (P<0.01) were significant independent biomarkers for OS. Conclusions The present study demonstrated that pretreatment PNI can be used as a novel and convenient biomarker to predict the prognosis in ES-SCLC patients treated with anlotinib.
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Affiliation(s)
- Jingjing Liu
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Tianjin, China
| | - Shuang Li
- Department of Thoracic Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Shuang Zhang
- Department of Thoracic Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Changliang Yang
- Department of Thoracic Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Liang Zhang
- Department of Thoracic Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Bin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Tianjin, China
| | - Ying Cheng
- Department of Thoracic Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Changli Wang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Tianjin, China
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12
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Pushpam D, Garg V, Ganguly S, Biswas B. Management of Refractory Pediatric Sarcoma: Current Challenges and Future Prospects. Onco Targets Ther 2020; 13:5093-5112. [PMID: 32606731 PMCID: PMC7293381 DOI: 10.2147/ott.s193363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Paediatric sarcomas are a heterogeneous group of disorders constituting bone sarcoma and various soft tissue sarcomas. Almost one-third of these presents with metastasis at baseline and another one-third recur after initial curative treatment. There is a huge unmet need in this cohort in terms of curative options and/or prolongation of survival. In this review, we have discussed the current treatment options, challenges and future strategies of managing relapsed/refractory paediatric sarcomas. Upfront risk-adapted treatment with multidisciplinary management remains the main strategy to prevent future recurrence or relapse of the disease. In the case of limited local and/or systemic relapse or late relapse, initial multimodality management can be administered. In treatment-refractory cases or where cure is not feasible, the treatment options are limited to novel therapeutics, immunotherapeutic approach, targeted therapies, and metronomic therapies. A better understanding of disease biology, mechanism of treatment refractoriness, identifications of driver mutation, the discovery of novel targeted therapies, cellular vaccine and adapted therapies should be explored in relapsed/refractory cases. Close national and international collaboration for translation research is needed to fulfil the unmet need.
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Affiliation(s)
| | - Vikas Garg
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
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13
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Elghazawy H, Nasr A, Zaky I, Zamzam M, Elgammal A, Farid N, Zaghloul MS. Whole lung irradiation for completely responding pulmonary metastases in pediatric Ewing sarcoma. Future Oncol 2020; 16:1043-1051. [PMID: 32250164 DOI: 10.2217/fon-2020-0066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Scarce data assessing the real value of whole lung irradiation (WLI) in Ewing's sarcoma (ES) with lung-only metastasis, with published conflicting results. We studied the impact of WLI in a homogenous pediatric population. Materials & methods: Retrospective study evaluating the survival outcomes of WLI in these patients. Results: Out of 163 metastatic ES; 41 patients were eligible for WLI. 30 patients (73.1%) received WLI (+ve) while 11 patients (26.8%) did not receive WLI (-ve). Five-year event-free survival was statistically significant in WLI (+ve). Five-year pulmonary relapse-free survival showed trend for improvement with WLI (+ve), while 5-year overall survival was not statistically significant between the two arms. Conclusion: WLI added significantly to the long term clinical outcome of metastatic ES patients, with no irreversible toxicity.
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Affiliation(s)
- Hagar Elghazawy
- Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.,Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Azza Nasr
- Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.,Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Zaky
- Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.,Department of Radiodiagnosis, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Manal Zamzam
- Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Elgammal
- Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.,Department of Pediatric Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nesma Farid
- Department of Research, Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt
| | - Mohamed S Zaghloul
- Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.,Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo, Egypt
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14
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Ganguly S, Kinsey S, Bakhshi S. Childhood cancer in India. Cancer Epidemiol 2020; 71:101679. [PMID: 32033883 DOI: 10.1016/j.canep.2020.101679] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/20/2022]
Abstract
India has made significant improvement in childhood cancer services in last few decades. However, the outcome still remains modest as compared to global standards due to significant barriers in recognition, diagnosis and cure. Data regarding comprehensive childhood cancer burden in country is lacking due to low and urban predominant coverage of population-based cancer registry programs. The available data shows lower incidence of childhood cancer incidence especially in leukaemia and CNS tumours which may suggest poor awareness of caregivers and delayed diagnosis with many "missed cases". Incidence data are also skewed towards male preponderance which suggests gender bias in seeking healthcare. The childhood cancer services in India are predominantly restricted to few tertiary care centres in major cities. The outcome in major groups of cancer is complicated by delayed and more advanced stage of presentation and poor supportive care during intensive treatment. Treatment refusal and abandonment remains major hurdles. Last few decades saw development of dedicated paediatric oncology services and training programs in the country. The development of InPOG (Indian Paediatric Oncology group) for conducting collaborative trials will lead to adoption of uniform treatment protocols suited for the country. Financial support through the government promoted health insurance and holistic support through philanthropic organizations have improved treatment adherence and outcome. Moving forward, the focus should be on strengthening the cancer registries for capturing nationwide data, improving awareness of childhood cancer among caregivers and healthcare workers for early recognition and improving accessibility of childhood cancer care services beyond major cities.
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Affiliation(s)
| | - Sally Kinsey
- Department of Paediatric Haematology, University of Leeds, Honorary Consultant Paediatric Haematologist, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Sameer Bakhshi
- Department of Medical Oncology, IRCH, AIIMS, New Delhi, India.
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15
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McLean TW, Stewart RM, Curley TP, Dewsnup MY, Thomas SG, Russell TB, Tooze JA. Hypoalbuminemia in children with cancer treated with chemotherapy. Pediatr Blood Cancer 2020; 67:e28065. [PMID: 31736232 PMCID: PMC6939630 DOI: 10.1002/pbc.28065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/19/2019] [Accepted: 10/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hypoalbuminemia is a well-recognized finding associated with cancer, but its prevalence and prognostic significance have not been well studied in children with cancer. OBJECTIVE To determine the prevalence of hypoalbuminemia prior to starting chemotherapy in children with cancer and its association with relapse-free survival (RFS) and overall survival (OS). DESIGN/METHOD We performed a single institution, IRB-approved, retrospective review of pediatric oncology patients diagnosed between 1998 and 2012. Five-year survival was estimated using the Kaplan-Meier method; groups were compared using Cox regression. RESULTS We identified 659 pediatric patients with a first diagnosis of cancer and a serum albumin level prior to starting chemotherapy. Mean age was 8.6 years (SD = 5.8); 62% were male and 92% were non-Hispanic. Hypoalbuminemia prior to starting chemotherapy was present at least once in 302 (45.8%). The five-year RFS and OS of those with hypoalbuminemia and without hypoalbuminemia were not significantly different. However, patients with severe hypoalbuminemia (defined as a value 10% or more below the lower limit of normal) had inferior RFS and OS for patients with hematologic/lymphatic malignancies, and inferior RFS for patients with metstatic Ewing sarcoma. CONCLUSION Hypoalbuminemia prior to starting chemotherapy in pediatric oncology patients is common (nearly half in this cohort). Severe hypoalbuminemia was associated with inferior 5-year RFS in some subgroups.
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Affiliation(s)
- Thomas Williams McLean
- Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ryan Michael Stewart
- Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Thomas Patrick Curley
- Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mark Young Dewsnup
- Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Sydney Gillian Thomas
- Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Thomas Bennett Russell
- Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Janet Austin Tooze
- Departments of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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16
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Zhou T, Zhao Y, Zhao S, Yang Y, Huang Y, Hou X, Zhao H, Zhang L. Comparison of the Prognostic Value of Systemic Inflammation Response Markers in Small Cell Lung Cancer Patients. J Cancer 2019; 10:1685-1692. [PMID: 31205524 PMCID: PMC6547997 DOI: 10.7150/jca.29319] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023] Open
Abstract
Increasing evidences support that systemic inflammation-based prognostic scores, modified Glasgow Prognostic Score (mGPS), C-reactive Protein/Albumin (CRP/ALB), Albumin/Globulin (AGR), Prognostic Nutritional Index (PNI) and Advanced Lung cancer Inflammation index (ALI), are key determinants of patients' outcome in solid tumors. However, in small cell lung cancer (SCLC), there have been no direct comparisons of them. Thus, the aim of this study was to compare the prognostic value of these markers in SCLC, and select a most appropriative one. The patients with confirmed SCLC were screened between 2006 and 2011, and inflammation-based prognostic factors (mGPS, CRP/ALB, AGR, PNI, ALI) were examined. Kaplan-Meier and Cox regression analysis were performed to assess these inflammation-based prognostic scores associated with overall survival (OS). Subsequently, we compared the prognostic value of these inflammation-based prognostic scores using the area under the curve (AUC). In 451 patients, on univariate analysis, mGPS (P<0.001), CRP/ALB (P<0.001), AGR (P<0.001), PNI (P<0.001) and ALI (P<0.001) were the strongest predictors of OS. Further multivariate analysis confirmed mGPS (P<0.001), CRP/ALB (P=0.007), AGR (P=0.034) and PNI (P=0.026) as independent markers associated with OS. Further subgroup analysis revealed CRP/ALB was able to predict outcome in both limited (P=0.005) and extensive disease (P=0.013). The CRP/ALB had higher AUC values compared with other inflammation-based prognostic socres (0.566). The CRP/ALB was characterized as best, in comparison to other systemic inflammation-based prognostic scores, for its predictive power of SCLC patients' survival, and had the potential to be hierarchical factor in future clinical trials.
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Affiliation(s)
- Ting Zhou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yuanyang Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shen Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xue Hou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Hongyun Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative innovation Center for Cancer Medicine, Guangzhou 510060, China
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17
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Miyake K, Kiyuna T, Li S, Han Q, Tan Y, Zhao M, Oshiro H, Kawaguchi K, Higuchi T, Zhang Z, Razmjooei S, Barangi M, Wangsiricharoen S, Murakami T, Singh AS, Li Y, Nelson SD, Eilber FC, Bouvet M, Hiroshima Y, Chishima T, Matsuyama R, Singh SR, Endo I, Hoffman RM. Combining Tumor-Selective Bacterial Therapy with Salmonella typhimurium A1-R and Cancer Metabolism Targeting with Oral Recombinant Methioninase Regressed an Ewing's Sarcoma in a Patient-Derived Orthotopic Xenograft Model. Chemotherapy 2019; 63:278-283. [PMID: 30673664 DOI: 10.1159/000495574] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ewing's sarcoma (ES) is a recalcitrant disease in need of transformative therapeutics. OBJECTIVES The aim of this study was to investigate the efficacy of tumor-selective Salmonella typhimurium A1-R combined with tumor metabolism targeting with oral administration of recombinant methioninase (o-rMETase), on an ES patient-derived orthotopic xenograft (PDOX) model. METHODS The ES PDOX models were previously established in the right chest wall. The ES PDOX models were randomized into 5 groups when the tumor volume reached 80 mm3: G1: untreated control; G2: doxorubicin; G3: S. typhimurium A1-R; G4: o-rMETase; G5: S. typhimurium A1-R combined with o-rMETase. All mice were sacrificed on day 15. Body weight and tumor volume were assessed twice a week. RESULTS S. typhimurium A1-R and o-rMETase respectively suppressed tumor growth as monotherapies (p = 0.050 and p = 0.032). S. typhimurium A1-R combined with o-rMETase regressed tumor growth significantly compared to untreated group on day 15 (p < 0.032). S. typhimurium A1-R combined with o-rMETase group was significantly more effective than S. typhimurium A1-R or o-rMETase monotherapy (p = 0.032, p = 0.032). CONCLUSIONS The present results suggest that the combination of S. typhimurium A1-R and o-rMETase has promise to be a transformative therapy for ES.
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Affiliation(s)
- Kentaro Miyake
- AntiCancer Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA.,Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tasuku Kiyuna
- AntiCancer Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Shukuan Li
- AntiCancer Inc., San Diego, California, USA
| | | | - Yuying Tan
- AntiCancer Inc., San Diego, California, USA
| | - Ming Zhao
- AntiCancer Inc., San Diego, California, USA
| | - Hiromichi Oshiro
- AntiCancer Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Kei Kawaguchi
- AntiCancer Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Takashi Higuchi
- AntiCancer Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | - Zhiying Zhang
- AntiCancer Inc., San Diego, California, USA.,Department of Surgery, University of California, San Diego, California, USA
| | | | | | | | - Takashi Murakami
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Arun S Singh
- Division of Hematology-Oncology, University of California, Los Angeles, California, USA
| | - Yunfeng Li
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Scott D Nelson
- Department of Pathology, University of California, Los Angeles, California, USA
| | - Fritz C Eilber
- Division of Surgical Oncology, University of California, Los Angeles, California, USA
| | - Michael Bouvet
- Department of Surgery, University of California, San Diego, California, USA
| | - Yukihiko Hiroshima
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Chishima
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shree Ram Singh
- Basic Research Laboratory, National Cancer Institute, Frederick, Maryland, USA
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Robert M Hoffman
- AntiCancer Inc., San Diego, California, USA, .,Department of Surgery, University of California, San Diego, California, USA,
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18
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Bosma SE, van Driel PB, Hogendoorn PC, Dijkstra PS, Sier CF. Introducing fluorescence guided surgery into orthopedic oncology: A systematic review of candidate protein targets for Ewing sarcoma. J Surg Oncol 2018; 118:906-914. [PMID: 30212597 PMCID: PMC6220824 DOI: 10.1002/jso.25224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 01/11/2023]
Abstract
Ewing sarcoma (ES), an aggressive bone and soft‐tissue tumor, is treated with chemotherapy, radiotherapy, and surgery. Intra‐operative distinction between healthy and tumorous tissue is of paramount importance but challenging, especially after chemotherapy and at complex anatomical locations. Near infrared (NIR) fluorescence‐guided surgery (FGS) is able to facilitate the determination of tumor boundaries intra‐operatively, improving complete resection and therefore survival. This review evaluates potential ES‐specific proteins from the literature as targets for NIR FGS.
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Affiliation(s)
- Sarah E Bosma
- Department of Orthopedics, Leiden University Medical Center, The Netherlands
| | | | | | - Pd Sander Dijkstra
- Department of Orthopedics, Leiden University Medical Center, The Netherlands
| | - Cornelis Fm Sier
- Department of Surgery, Leiden University Medical Center, The Netherlands
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19
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Willegger M, Posch F, Schieder S, Funovics PT, Scharrer A, Brodowicz T, Ay C, Windhager R, Panotopoulos J. Serum creatinine and albumin predict sarcoma-specific survival in patients with myofibroblastic and fibroblastic sarcomas. J Orthop Res 2017; 35:2815-2824. [PMID: 28485477 DOI: 10.1002/jor.23598] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/03/2017] [Indexed: 02/04/2023]
Abstract
Recent evidence suggests that common prognostic factors predicting disease progression and survival in soft tissue sarcomas (STS) are not applicable to all STS entities, indicating the need for histotype specific evaluation of new prognosticators. This study aimed at evaluating preoperative serum creatinine, albumin, and the albumin-creatinine ratio (ACR) as markers for survival in patients with malignant fibroblastic and myofibroblastic sarcomas. One hundred and thirty-two patients who underwent sarcoma resection have been included. Statistical analysis comprised uni- and multivariable Cox proportional hazard models, competing risk analysis and Kaplan-Meier estimates. The 5-year overall survival (OS) was estimated at 64.1% (95%CI: 53.7-72.8) and the 5-year sarcoma-specific mortality was 19.9% (95%CI: 12.8-28.1). Elevated serum creatinine levels were significantly associated with an impaired sarcoma-specific survival (SSS) adjusted for tumor stage (subdistribution hazard ratio (SHR) per 1 mg/dl increase: 3.27; 95%CI: 1.87-5.73; p < 0.0001). Low serum albumin levels were associated with a shorter recurrence-free survival (RFS) experience (HR per 10 g/L increase: 0.62; 95%CI: 0.41-0.94; p = 0.024). The ACR emerged as an AJCC-stage-independent prognosticator of SSS (SHR per 1 unit increase: 0.94; 95%CI: 0.90-0.98; p = 0.003). In conclusion, serum albumin and creatinine have been confirmed as predictive biomarkers for disease-specific outcomes in myofibroblastic and fibroblastic sarcomas. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2815-2824, 2017.
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Affiliation(s)
- Madeleine Willegger
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Florian Posch
- Clinical Division of Medical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Clinical Division of Haematology & Haemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sophie Schieder
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Philipp Theodor Funovics
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Anke Scharrer
- Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Thomas Brodowicz
- Clinical Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Clinical Division of Haematology & Haemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Joannis Panotopoulos
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Phase II study of doxorubicin and thalidomide in patients with refractory aggressive fibromatosis. Invest New Drugs 2017; 36:114-120. [PMID: 29170886 DOI: 10.1007/s10637-017-0542-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
Background To evaluate the efficacy and safety of doxorubicin (ADM) combined with thalidomide (THA) as a first-line treatment for patients with refractory aggressive fibromatosis (AF). Patients and Methods Eligible patients were treated with ADM 30 mg/m2 on days 1-2 and THA 200 mg nightly on days 1-21 every 3 weeks for a maximum of six cycles. THA was then continued for a total of 1 year. The primary end point was response rate (RR). Results Fifteen patients were enrolled in the study. No patient had a complete response, but five patients had partial responses, resulting in a RR of 33%. Eight patients (53%) had stable disease and two patients (13%) had progressive disease, and the disease control rate was 87%. The median progression free survival (mPFS) was 20.6 months (95% confidence interval, 14.5-26.7 months). Patients with below normal baseline serum albumin levels had significantly inferior mPFS compared with those with normal baseline serum albumin (1.4 months versus 23.7 months, P = 0.045). Grade 3/4 toxicities included leukopenia (33%), neutropenia (60%), febrile neutropenia (7%), nausea (7%), and vomiting (6.6%). Conclusions ADM plus THA was well-tolerated and effective as a first-line treatment for patients with refractory AF. However, patients with hypoalbuminemia at baseline had inferior clinical outcomes, and further studies are needed to investigate this issue.
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The combination of temozolomide-irinotecan regresses a doxorubicin-resistant patient-derived orthotopic xenograft (PDOX) nude-mouse model of recurrent Ewing's sarcoma with a FUS-ERG fusion and CDKN2A deletion: Direction for third-line patient therapy. Oncotarget 2017; 8:103129-103136. [PMID: 29262551 PMCID: PMC5732717 DOI: 10.18632/oncotarget.20789] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/23/2017] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study was to determine the usefulness of a patient-derived orthotopic xenograft (PDOX) nude-mouse model of a doxorubicin-resistant metastatic Ewing’s sarcoma, with a unique combination of a FUS-ERG fusion and CDKN2A deletion, to identify effective drugs for third-line chemotherapy of the patient. Our previous study showed that cyclin-dependent kinase 4/6 (CDK4/6) and insulin-like growth factor-1 receptor (IGF-1R) inhibitors were effective on the Ewing’s sarcoma PDOX, but not doxorubicin, similar to the patient’s resistance to doxorubicin. The results of the previous PDOX study were successfully used for second-line therapy of the patiend. In the present study, the PDOX mice established with the Ewing’s sarcoma in the right chest wall were randomized into 5 groups when the tumor volume reached 60 mm3: untreated control; gemcitabine combined with docetaxel (intraperitoneal [i.p.] injection, weekly, for 2 weeks); irinotecan combined with temozolomide (irinotecan: i.p. injection; temozolomide: oral administration, daily, for 2 weeks); pazopanib (oral administration, daily, for 2 weeks); yondelis (intravenous injection, weekly, for 2 weeks). All mice were sacrificed on day 15. Body weight and tumor volume were assessed 2 times per week. Tumor weight was measured after sacrifice. Irinotecan combined with temozolomide was the most effective regimen compared to the untreated control group (p=0.022). Gemcitabine combined with docetaxel was also effective (p=0.026). Pazopanib and yondelis did not have significant efficacy compared to the untreated control (p=0.130, p=0.818). These results could be obtained within two months after the physician’s request and were used for third-line therapy of the patient.
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Lim WS, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Pretreatment albumin level predicts survival in head and neck squamous cell carcinoma. Laryngoscope 2017; 127:E437-E442. [PMID: 28561532 DOI: 10.1002/lary.26691] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/13/2017] [Accepted: 04/18/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Poor nutritional status in patients with head and neck squamous cell carcinoma (HNSCC) is associated with tumor progression and survival. This study examined the prognostic value of nutritional and hematological markers in patients with HNSCC who received definitive treatments. STUDY DESIGN A prospective observational cohort study. METHODS This study included 338 consecutive patients who underwent surgery and/or radiotherapy/chemoradiotherapy for treatment-naïve HNSCC. Body weight and nutritional and hematological parameters were regularly measured before and after treatment. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify factors associated with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS Body weight, serum total protein and albumin levels, and hematological variables significantly decreased after treatment. Univariate analyses illustrated that age, tumor site, T and N classifications, overall stage, pretreatment serum albumin (<3.5 g/dL) and hemoglobin (<12 g/dL) levels, and neutrophil-lymphocyte ratio were significantly associated with DFS, CSS, and OS (all P < .05). Multivariate analyses identified age, tumor site, N classification, and pretreatment albumin levels as independent predictors of DFS, CSS, and OS (all P < .05). Patients with low serum albumin levels prior to treatment experienced approximately sixfold increases in the risks of tumor progression and cancer-specific and overall mortality compared to the findings in their counterparts. CONCLUSIONS Our results suggest that pretreatment serum albumin levels predict DFS, CSS, and OS in patients who received definitive treatment for HNSCC. These findings might help to predict treatment outcome and guide nutritional intervention in patients with HNSCC. LEVEL OF EVIDENCE 2b. Laryngoscope, 127:E437-E442, 2017.
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Affiliation(s)
- Won Sub Lim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tsuda Y, Ogura K, Kobayashi E, Hiruma T, Iwata S, Asano N, Kawai A, Chuman H, Ishii T, Morioka H, Kobayashi H, Kawano H. Impact of geriatric factors on surgical and prognostic outcomes in elderly patients with soft-tissue sarcoma. Jpn J Clin Oncol 2017; 47:422-429. [DOI: 10.1093/jjco/hyx016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/07/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Yusuke Tsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Koichi Ogura
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Eisuke Kobayashi
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Toru Hiruma
- Division of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Kanagawa
| | - Shintaro Iwata
- Division of Orthopedic Surgery, Chiba Cancer Center, Chiba
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Hirokazu Chuman
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Takeshi Ishii
- Division of Orthopedic Surgery, Chiba Cancer Center, Chiba
| | - Hideo Morioka
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Teikyo, Tokyo, Japan
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Biswas B, Bakhshi S. Management of Ewing sarcoma family of tumors: Current scenario and unmet need. World J Orthop 2016; 7:527-538. [PMID: 27672565 PMCID: PMC5027007 DOI: 10.5312/wjo.v7.i9.527] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Ewing sarcoma family tumors (ESFT) are heterogeneous, aggressive group of disease with peak incidence in adolescent and young adults. The outcome has been improved dramatically from 10% with surgery and radiotherapy alone to 65%-70% now, in localized disease, with the introduction of chemotherapy. Chemotherapy regimen evolved from single agent to multiagent with effort of many cooperative clinical trials over decades. The usual treatment protocol include introduction of multi-agent chemotherapy in neoadjuvant setting to eradicate systemic disease with timely incorporation of surgery and/or radiotherapy as local treatment modality and further adjuvant chemotherapy to prevent recurrence. Risk adapted chemotherapy in neoadjuvant and adjuvant setting along with radiotherapy has been used in many international collaborative trials and has resulted in improved outcome, more so in patients with localized disease. The role of high dose chemotherapy with stem cell rescue is still debatable. The outcome of patients with metastatic disease is dismal with long term outcome ranges from 20%-40% depending on the sites of metastasis and intensity of treatment. There is a huge unmet need to improve outcome further, more so in metastatic setting. Novel therapy targeting the molecular pathways and pathogenesis of ESFT is very much required. Here we have discussed the current standard of management in patients with ESFT, investigational targeted or novel therapies along with future promises.
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Ramaswamy A, Rekhi B, Bakhshi S, Hingmire S, Agarwal M. Indian data on bone and soft tissue sarcomas: A summary of published study results. South Asian J Cancer 2016; 5:138-45. [PMID: 27606300 PMCID: PMC4991135 DOI: 10.4103/2278-330x.187587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bone sarcomas are rare tumors, approximating 0.2% of all cancers, with osteosarcoma (OGS), chondrosarcoma, and Ewing sarcoma being the most common cancers in this subset. The formation of disease management groups/clinics focused on sarcomas has resulted in better understanding and management of these uncommon tumors. Multiple large-scale retrospective data from Tata Memorial Hospital (TMH) and All India Institute of Medical Sciences have reported outcomes comparable to Western data in the field of OGS and Ewing sarcoma, with interesting prognostic factors identified for further evaluation. Soft tissue sarcomas are a rare heterogeneous group of tumors, more than 50 different tumor entities. The common subtypes identified in India include Ewing sarcoma and synovial sarcoma. Valuable work regarding brachytherapy has been done by radiation oncologists from the TMH, especially in pediatric patients.
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Affiliation(s)
- Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Sameer Bakhshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Hingmire
- Department of Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Manish Agarwal
- Department of Orthopedic Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Kang HS, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Noncancer-Related Health Events and Mortality in Head and Neck Cancer Patients After Definitive Radiotherapy: A Prospective Study. Medicine (Baltimore) 2016; 95:e3403. [PMID: 27175640 PMCID: PMC4902482 DOI: 10.1097/md.0000000000003403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected not only by progression of the original cancer or occurrence of a second cancer but also by noncancer health event (NCHE). In this study, we evaluated the prognostic significance of early NCHEs in HNSCC patients after definitive radiotherapy (RT) or chemoradiotherapy (CRT).The prospective study cohort comprised 190 HNSCC patients who underwent definitive RT (n = 75) or CRT (n = 115). An early NCHE was defined as an event requiring hospital readmission of the patient within 12 months after treatment. Univariate and multivariate analyses were performed to identify clinicopathologic factors associated with early NCHEs, and competing and all-cause mortalities.Thirty-three patients suffered an NCHE (17.3%) and 8 succumbed to a competing cause of mortality (4.2%). Twenty-two (11.6%) patients had an early NCHE: respiratory (22.8%), cerebrovascular (13.7%), gastrointestinal (13.7%), and others (50.0%). In multivariate analysis, hypoalbuminemia (P = 0.022, hazard ratio [HR] = 3.66, 95% confidence interval [CI] = 1.21-11.1), chemotherapy (P = 0.047, HR = 3.02, 95% CI = 1.01-8.98), and tumor recurrence (P = 0.024, HR = 2.66, 95% CI = 1.14-6.22) were independent predictors of an early NCHE. Patients with early NCHEs were at high risk of competing mortality (P < 0.001, HR = 22.6, 95% CI = 4.21-121.00) and all-cause mortality (P = 0.002, HR = 4.44, 95% CI = 1.76-11.2).Early NCHEs are a major contributor to competing and all-cause mortality in HNSCC patients receiving RT or CRT. The risk factors identified could be used to predict early NCHEs.
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Affiliation(s)
- Ho-Seob Kang
- From the Departments of Otolaryngology (H-SK, J-LR, S-HC, SYN, SYK); Radiation Oncology; and Internal Medicine (Oncology) (S-BK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Panotopoulos J, Posch F, Funovics PT, Willegger M, Scharrer A, Lamm W, Brodowicz T, Windhager R, Ay C. Elevated serum creatinine and low albumin are associated with poor outcomes in patients with liposarcoma. J Orthop Res 2016. [PMID: 26222652 DOI: 10.1002/jor.23002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Low serum albumin levels and impaired kidney function have been associated with decreased survival in patients with a variety of cancer types. In a retrospective cohort study, we analyzed 84 patients with liposarcoma treated at from May 1994 to October 2011. Uni- and multivariable Cox proportional hazard models and competing risk analyses were performed to evaluate the association between putative biomarkers with disease-specific and overall survival. The median age of the study population was 51.7 (range 19.6-83.8) years. In multivariable analysis adjusted for AJCC tumor stage, serum creatinine was highly associated with disease-specific survival (Subdistribution Hazard ratio (SHR) per 1 mg/dl increase = 2.94; 95%CI 1.39-6.23; p = 0.005). High albumin was associated with improved overall and disease-specific survival (Hazard Ratio (HR) per 10 units increase = 0.50; 95%CI 0.26-0.95; p = 0.033 and SHR = 0.64; 95%CI 0.42-1.00; p = 0.049). The serum albumin-creatinine-ratio emerged to be associated with both overall and disease-specific survival after adjusting for AJCC tumor stage (HR = 0.95; 95%CI 0.92-0.99; p = 0.011 and SHR = 0.96; 95%CI 0.93-0.99; p = 0.08). Our study provides evidence for a tumor-stage-independent association between higher creatinine and lower albumin with worse disease-specific survival. Low albumin and a high albumin-creatinine-ratio independently predict poor overall survival. Our work identified novel prognostic biomarkers for prognosis of patients with liposarcoma.
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Affiliation(s)
| | - Florian Posch
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - Philipp T Funovics
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | | | - Anke Scharrer
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Lamm
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Thomas Brodowicz
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
| | - Cihan Ay
- Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
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Moon H, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Prognostic value of nutritional and hematologic markers in head and neck squamous cell carcinoma treated by chemoradiotherapy. Radiother Oncol 2015; 118:330-4. [PMID: 26653356 DOI: 10.1016/j.radonc.2015.10.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Malnutrition and systemic lymphopenia are common in many cancers and are associated with tumor progression. The purpose of this study was to investigate the prognostic values of nutritional and hematologic markers in patients with head and neck squamous cell carcinoma (HNSCC). METHODS This prospective study included 153 patients with treatment-naïve HNSCC who underwent definitive chemoradiotherapy. Body weight, serologic and hematologic parameters were measured at baseline and after 2 months of treatment. Univariate and multivariate analyses using Cox proportional hazards model were used to identify predictors of progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS Body weight, body mass index (BMI), serum albumin, total serum proteins, hemoglobin, and circulating neutrophil, lymphocyte, monocyte, and platelet counts significantly decreased, but neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) significantly increased after 2 months of treatment (P<0.05 each). Multivariate analyses showed that pretreatment hypoalbuminemia and high NLR were independent predictors of PFS (P<0.01 each). ECOG performance status, BMI<18.5 kg/m(2) and NLR were independent predictors of CSS and OS (P<0.01 each). CONCLUSIONS Our data support the evidence that several nutritional and hematologic markers are associated with the prognosis of HNSCC.
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Affiliation(s)
- Hyun Moon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hong S, Zhou T, Fang W, Xue C, Hu Z, Qin T, Tang Y, Chen Y, Ma Y, Yang Y, Hou X, Huang Y, Zhao H, Zhao Y, Zhang L. The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol 2014; 36:3389-97. [PMID: 25527156 DOI: 10.1007/s13277-014-2973-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/10/2014] [Indexed: 12/11/2022] Open
Abstract
Recent studies have shown the prognostic nutritional index (PNI) had prognostic value in some solid tumors. However, no studies have examined its prognostic role in small-cell lung cancer (SCLC) patients. In this retrospective study, 724 consecutive SCLC patients were included between 2006 and 2013. Demographic, clinical, and laboratory data were collected. The PNI was calculated as 10 × serum albumin value (g/dl) + .005 × peripheral lymphocyte count (per mm(3)). Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors. The optimal cut-off value of PNI for OS stratification was determined to be 52.48. A total of 464 and 260 patients were assigned to low and high PNI groups, respectively. Compared with low PNI, high PNI was associated with older age, advanced stage, and elevated lactate dehydrogenase (LDH). Median overall survival (OS) was worse in the low PNI group (low vs high, 15.90 vs 25.27 months; HR, 0.62; p < 0.001). In multivariate analysis, stage, performance status, LDH, and PNI were independent prognostic factors for OS. Subgroup analysis showed PNI was generally a significant prognostic factor in different clinical situations. The assessment of PNI could assist the identification of patients with poor prognosis and be a hierarchical factor in the future SCLC clinical trials.
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Affiliation(s)
- Shaodong Hong
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, 651# Dongfeng East Road, Guangzhou, China, 510060
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