A multivariate model to define risk groups among patients with curatively resected stage I and II colon carcinoma: Final report of a retrospective cohort study

696

Background: Patients with stage I or II colon carcinoma (CC) have a 10 or 20% risk, respectively, of presenting recurrent disease after a potentially curative surgical resection and adjuvant chemotherapy have not improved survival in this setting. In this study, we present a multivariate model to define risk groups. Methods: Consecutive cases with stage I and II CC treated at a single cancer center in Mexico City, from January 1992 to December 2016, were included in this 25-year cohort. Clinical history and biochemical data were registered, and colon resection was performed with curative intention with standard lymphadenectomy. Standard hematoxylin-eosin slides and CDX2 immunohistochemistry (IHC) slides were analyzed by two independent pathologists. The Kaplan-Meier method and Cox model were used to analyze the association of prognostic factors and overall survival (OS). Results: 3,301 cases of colorectal cancer were treated during this study, but only 556 patients with stage I and II CC were included in the database: 266 women (47.8%) and 290 males (52.2%) (mean age 57.9 years); 52 (9.4%), 431 (77.5%), 36 (6.5%) and 37 (6.7%) were pTNM stages I, IIa, IIb, and IIc, respectively. R0 resection was performed in 548 patients (98.6) and R1 in 8 (1.4%). Location in the left colon (HR 1.63), hemoglobin (HR 0.93), serum albumin (HR 2.45), prognostic nutritional index 0.915), platelet count (HR 0.998), body mass index (HR 0.94), basal carcinoembryonic antigen (HR 1.0), TNM stage [stage I reference category, IIa (HR 5.46), IIb (HR 4.42), IIc (HR 9.28)], R1 residual disease (HR 2.8), negative CDX2 IHC (HR 2.1), and use of adjuvant chemotherapy (HR 0.629) were included in the final model as independent predictors of OS (model p < 0.0001).Predicted survival functions using this model defined three distinct risk groups. Conclusions: This multivariate model adds significant prognostic value to the pTNM classification. This model can be useful for stratifying prognosis in patients with CC and will aid in the design of randomized clinical trials evaluating the usefulness of adjuvant chemotherapy in this subgroup of patients with CC.

Validation of the Mexican-Spanish version of the EORTC QLQ-INFO25 instrument in patients with gastrointestinal cancers

818

Background: Information received by the cancer patient is a main component of an evaluation of quality of care. The most frequently used instrument to do so is the EORTC QLQ-INFO25, and our aim is to validate its Mexican-Spanish version in patients with gastrointestinal cancer. Methods: This is a prospective study including patients who responded the QLQ-INFO25 instrument at a cancer referral center. Reliability and validity tests were performed, and the association of scale scores with clinical variables is shown. Results: One hundred thirty six patients were included, 70 female and 66 males. Mean age was 56.2 years; 111 corresponded to colorectal and 25 to gastroesophageal cancer. Questionnaire compliance rates were high and both instruments were well accepted; no missing values were found. Convergent item correlation in the QLQ-C30 ranged from 0.223 to 0.822 and in the QLQ-INFO25 from 0.008 to 0.768, respectively. Divergent item correlation ranged from 0.011 to 0.674 and from 0.014 to 0.662, respectively. Cronbach’s α coefficients of eight of nine multi-item scales of the QLQ-C30 and all four multi-item scales of the QLQ-INFO25 instruments were > 0.7 (range, 0.655–0.905). Selected scales of both instruments distinguished among esophagogastric or colorectal cancer. Conclusions: The Mexican-Spanish version of the QLQ-INFO25 questionnaire provides domains not covered by the generic instrument, it is reliable and valid to be used in clinical trials assessing patients’ appraisal on the received information by the health personnel.

Clinical differences and prognostic factors in right and left colon cancer

846

Background: Clinical-Pathological and genomic differences between Right-colon cancer (RCC) and Left-colon cancer (LCC) have been reported, but there is not available information from Latin American countries. Methods: A retrospective cohort study was carried out in patients with RCC and LCC treated from January 1989 to December 2016, in a cancer referral center at Mexico City. Patients were assigned into groups according to the location of the neoplasm defined by colonoscopy. Comparison between groups was performed regarding demographic, clinical, histopathology or survival data, using the Student’s T or Squared chi tests, as appropriate. Multivariate analysis was performed employing the logistic regression model. Survival analysis was addressed using the Kaplan-Meier method, and results were compared using the Log rank test. Results: 1,619 patients were included in this analysis; 806 were women (49.8%) and 813 men (50.2%); mean age was 58.1 years old. RCC was registered in 871 cases (53.8%) and LCC in 748 (46.2%). RCC was significantly associated with low socioeconomic status, low body mass index (BMI), low hemoglobin, low serum albumin, and lower lymphocyte count than LCC. Distribution of TNM stages was similar between groups, as well as gender, age of presentation, comorbidities, surgical morbidity and mortality; 72.3% of RCC and 83.2% of LCC were well or moderately differentiated ( p< 0.0001). Mean lymph node retrieval was 19.3 (SD 14.6) for RCC and 15.7 (SD 13.1) for LCC ( p< 0.0001). Mean metastatic lymph node ratio was 0.19 for RCC and 0.21 for LCC ( p= 0.54). Median Overall survival (OS) was 5.55 years (95% CI 4.3–6.8) for RCC, and 3.28 years (95% CI 2.1–4.45) for LCC ( p= 0.052). Conclusions: Striking differences between RCC and LCC were found, mainly represented by anemia and immunonutritional variables. Moreover, OS is substantially better for RCC.

Abstract 672: Baseline serum albumin as a prognostic factor in patients with stage I and II colon adenocarcinoma

Background: Patients with stage I or II colon carcinoma (CC) have a significant risk of recurrence after adequately performed curative resection. Adjuvant chemotherapy has not improved recurrence or survival in such patients. In this study, a prognostic model in patients with stage I or II CC is presented.

Methods: Consecutive cases with CC treated at a cancer center in Mexico City from January 2008 to December 2014, with diagnosis of adenocarcinoma by colonoscopy and biopsy were included in this cohort. Patients were treated according to standard guidelines. Follow-up continued until June 2016; the Kaplan-Meier method and the Cox model were used to analyze the association of prognostic factors and overall survival (OS).

Results: 1,259 cases of CC were treated; only 496 patients have stage I and II CC and were included in the database: 234 women (47.2%) and 262 males (52.8%) and their mean age was 59.9 years (SD 14.9); 96, 339, 31 and 30 cases were pTNM stages I, IIa, IIb and IIc, respectively. Multivariate analysis of prognostic factors is depicted below. Predicted survival functions using this model, defined 4 risk groups that showed better prognostic value than simple TNM stages I-IIc.

Conlusion: BSA is an independent, significant, simple, cheap and widely available prognostic factor in patients with CC. BSA and other clinical factors add significant prognostic information to TNM classification. Feasibly, it can be used to develop multivariate prognostic models with clinical impact defining the use of adjuvant chemotherapy. The use of histopathological and immunohistochemical markers could improve the prognostic information of this model.

Multivariate análisis of prognostic factorsBetaSEpHR95% CIMale gender0.3550.1660.0321.4261.031-1.973Hemoglobin-0.0880.0380.020.9160.85-0.986Platelet count-0.0020.0010.0010.9980.996-0.999Neutrophil count0.0820.0280.0041.0851.027-1.147Albumin0.7820.2280.0012.1851.397-3.417Albumin/Globulin-1.6240.4880.0010.1970.076-0.513BMI-0.0420.0220.0510.9580.918-1.0TNM 0/I0.0541TNM IIa0.5540.2550.031.741.056-2.869TNM Iib0.7340.4040.0692.0830.944-4.597TNM IIc0.950.3670.012.5861.26-5.305Chemotherapy-0.7650.2&lt;0.00010.4650.315-0.688R0&lt;0.00011R10.2670.4750.5741.3060.515-3.311R20.9360.3480.0072.5511.29-5.044No Resection1.9360.288&lt;0.00016.9323.944-12.18Platelet/Lymphocute ratio0.0010.0010.081.0011.0-1.002

Citation Format: Luis F. Onate-Ocana. Baseline serum albumin as a prognostic factor in patients with stage I and II colon adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 672. doi:10.1158/1538-7445.AM2017-672

Abstract B26: Baseline serum albumin as a prognostic actor in patients with stage I and II colon adenocarcinoma

Background: Patients with stage I or II Colon carcinoma (CC) have a significant risk of recurrence after adequately performed curative resection. Adjuvant chemotherapy has not improved recurrence or survival in such patients. In this study, a prognostic model in patients with stage I or II CC, based on Baseline serum albumin (BSA) and other common clinical markers is presented.

Methods: Consecutive cases with CC treated at a single cancer center in Mexico City from January 1998 to December 2014, with diagnosis of adenocarcinoma by colonoscopy and biopsy were included in this cohort. Clinical history and chemistry data were registered, and patients were treated according to standard guidelines. Follow-up continued until June 2016; the Kaplan-Meier method and the Cox model were used to analyze the association of prognostic factors and overall survival (OS), and Hazard ratios (HR) were calculated.

Results: 1,259 cases of CC were treated, but only 496 patients have stage I and II CC and were included in the database: 234 women (47.2%) and 262 males (52.8%) and their mean age was 59.9 years (SD 14.9); 96, 339, 31 and 30 cases were pTNM stages I, IIa, IIb and IIc, respectively. BSA (HR 2.185), male gender (HR 1.43), baseline hemoglobin (HR 0.916), baseline platelet count (HR 0.998), baseline neutrophil count (HR 1.085), albumin/globulin ratio (HR 0.197), baseline platelet/lymphocyte ratio (HR 1.001), body mass index (HR 0.958), TNM stages (IIa HR 1.74, IIb HR 2.08, IIc HR 2.59; Stage I is the reference category), use of adjuvant chemotherapy (HR 0.465) and R classification (R1 HR 1.306, R2 HR 2.55, no resection HR 6.93; R0 is the reference category). Predicted survival functions using this model, defined 4 risk groups that showed better prognostic value than simple TNM stages I-IIc.

Conclusion: BSA is an independent, significant, simple, cheap and widely available prognostic factor in patients with CC. BSA and other clinical factors add significant prognostic information to TNM classification. Feasibly, it can be used to develop multivariate prognostic models with clinical impact defining the use of adjuvant chemotherapy. The use of histopathological and immunohistochemical markers could improve the prognostic information of this model.

Citation Format: Sagrario Gonzalez-Trejo, Jose F. Carrillo, Doris Carmona-Herrera, Roberto Herrera-Goepfert, Francisco J. Ochoa-Carrillo, Vincenzo Aiello-Crocifoglio, Dolores Gallardo-Rincon, Luis F. Onate-Ocana. Baseline serum albumin as a prognostic actor in patients with stage I and II colon adenocarcinoma. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr B26.

Blood serum albumin as prognostic factor in patients with colorectal carcinoma

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Background: During the las decades, Colorectal carcinoma (CRC) has become the commonest gastrointestinal neoplasm in Mexico, being stages III and IV the most frequent, reaching thus,, diagnosed by colonoscopy and biopsyand a dismal prognosis. Basal blood serum albumin has been reported as significant prognostic factor in several diseases and in several cancers. Therefore, our aim is to define the role of the basal measurement of blood serum albumin at diagnosis as prognostic factor. Methods: Consecutive cases with CRC diagnosed by colonoscopy and biopsy and treated at a single cancer center in Mexico City from January 2010 to December 2014, were included in this cohort. Clinical history and laboratory data were registered, and patients were treated according to standard guidelines. Follow-up continued until September 2015; the Kaplan-Meier method and the Cox model were used to analyze the association of prognostic factors and overall survival (OS). Results: There were 567 patients with CRC: 258 women (45.5%) and 309 males (55.5%); mean age was 60.04 years (SD 15.6). Fifty-seven, 155, 113 and 242 were stages I, II, III and IV, respectively; 132 were located in right colon, 33 in transverse, 35 in left, 114 in sigmoid, 239 in rectum and 14 in anal canal. Neither gender, age, blood hemoglobin, lymphocyte count, albumin-lymphocyte interaction, nor Nutritional prognostic index were significantly associated with OS. Serum albumin was associated to OS, by bivariate and by multivariate analysis. This association remainded significant after adjustment for TNM stages, locations, and other clinically relevant factors. Conclusions: Serum albumin at diagnosis is an independent, significant, simple, cheap and widely available prognostic factor in patients with CRC in Mexico, adding significant prognostic information to TNM classification. Feasibly, it can be used to develop multivariate prognostic models with clinical impact.

Association between ERCC1 and XPA expression and polymorphisms and the response to cisplatin in patients with non-seminomatous testicular germ cell tumors

4555

Background: Cisplatin-based chemotherapy cures over 80% of testicular germ cell tumors (TGCTs); nucleotide-excision repair (NER) modifies the sensitivity to cisplatin. In this work we explored the association between NER-proteins and their polymorphisms (SNPs) with cisplatin-sensitivity (CPS) and overall survival (OS) of patients with advanced non-seminomatous (ns)-TGCTs treated with bleomycin-etoposide-cisplatin (BEP). Methods: ERCC1, XPA-expression and gammaH2AX-presence, were tested in cisplatin-treated cancer cell lines. ERCC1 and XPA-expression were also analyzed in ns-TGCTs by qPCR. Immunohistochemistry was performed to detect ERCC1 protein in ns-TGCTs specimens. The SNPs were genotyped by PCR-RFLPs technique. Results: High basal ERCC1-expression was observed in non-CPS cancer cell lines; ERCC1-expression augmented further, as well as gammaH2AX, after cisplatin-treatment. Basal ERCC1 expression increases in the non-CPS patients in Mexican and Peruvian populations compared to CPS patients (p<0.001; p=0.002). XPAexpression levels weren’t different. These polymorphisms weren’t associated with CPS or OS. ERCC1-positive immunostaining was observed in 30/108 patients (27.8%). From 76 patients that were CPS, 59 (77.6%) were ERCC1-negative, compared with 17 (22.4%) that were ERCC1-positive (p=0.05). 5-year OS probability was smaller for those patients ERCC1-positive and non-CPS (15.38%) than tumor ERCC1-negative and CPS (89.3%) (p<0.001). Using the Cox Model, adjusted on the prognosis groups, the hazard ratio (HR) of death in patients with ERCC1-negative and non-CPS was >14.43 and in patients ERCC1-positive and non-CPS the HR was >11.86 (p<0.001). Conclusions: High-levels of ERCC1-expression and ERCC1-protein are associated with non-CPS, suggesting the use of ERCC1 as a potential indicator of response to cisplatin-based chemotherapy and the prognosis in patients with ns-TGCTs. Moreover, it’s important to identify patients potentially non-CPS in order to diminish the toxicity of cisplatin and improved quality of life avoiding adverse effects due to this agent. Work supported by CONACYT 83959 and PAPIIT IN213311-3.

Prospective study on the association of depression and anxiety on quality of life, treatment adherence and prognosis in patients with advanced non small cell lung cancer

e19618

Background: Symptoms of depression and anxiety are common in patients with lung cancer and could produce impact on health-related quality of life (HRQL) and survival. The aim of the present study is to evaluate the association of depression and anxiety on HRQL, treatment adherence and prognosis in patients with non-small cell lung cancer (NSCLC). Methods: This is a prospective study of consecutive patients with stages IIIB-IV NSCLC. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale (HADS) and the International Psychiatric Interview (MINI), and HRQL with the EORTC QLQ-C30 and QLQ-LC13 questionnaires.All instruments were applied before treatment; at three and six months. Lack of adherence to treatment was considered in patients who stopped attending consultation. Overall survival (OS) was calculated with the Kaplan-Meier and Cox methods. Results: Eighty-two patients were included, mean age 58.9 years. Depression and anxiety were found in 32.9 and 34.1% - respectively - at the initial evaluation. Factors associated with depression were: female gender (p=0.034) and poor performance status (p=0.048). Depression showed association to HRQL; particularly Global health status/QoL and functional scales (i.e: Physical, Role, Emotional, cognitive and Social); Anxiety also showed association to HRQL; particularly Global health status/QoL and functional scales (all p≤0.05).Patients with depression presented a median OS of 6.8 months (95% CI 2.4-11.1) whilst non-depressed patients: 14 (10.3-17.6). Anxiety was not associated to OS. By multivariate analysis, depression has a hazard ratio of 1.9 (95% CI 1.03-3.7, p=0.042). Forty-four percent of the patients with depression had poor treatment adherence versus 14% of the non-depressed (p<0.05). Conclusions: One third of patients with advanced NSCLC presented depression and anxiety. Both were associated to decreased HRQL functional scales of QLQ-C30 and treatment adherence. Depression was independently associated to poor prognosis.

Factors associated with surgical resection for pancreatic and periampullary carcinomas in a cancer center in Mexico City

191

Background: Medical information regarding periampullary neoplasms is scarce in Mexico. Therefore, our aim is to report our experience with pancreatic and periampullary neoplasms, with attention to factors associated to surgical resection in a Cancer Center.

Methods: A retrospective analysis of medical records of all patients with malignant neoplasms located at periampullary region demonstrated by biopsy from January 2005 to December 2010. Factors associated to resectability or survival were calculated employing logistic regression or Cox models.

Results: A total of 464 patients with neoplasms of the periampullary region were identified, 249 women and 215 males (mean age 60.2 years). Pancreatic cancer was reported in 269 cases (58%), ampullary in 91 (19.6%), duodenal in 63 (13.6%), intrapancreatic bile duct in 15 (3.2%), neuroendocrine neoplasms in 13 (2.8%) and other types in 13 (2.8%). Sixty-two pancreatoduodenectomies were performed in this 6-year period (13.4% resectability). Sixty-one patients were stages I or II, and 403 stages III or IV. Age (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.96-0.99) and ampullary carcinoma (OR 6.09; 95% CI 3.4-10.8) were the only factors associated to resectability (p<0.0001). Median overall survival of the cohort was 2.9 months (95% CI 2.4-3.4). Factors associated to overall survival with their estimators of the Cox model (p<0.00001) are shown in the Table.

Conclusions: Resectability is low and advanced stages are frequent. Young age and location in the ampulla defines increased probability of resection. Overall survival is associated to younger age, being female, ampullary carcinoma, neuroendocrine carcinoma and surgical resection.

[Table: see text]