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Bazzal AA, Hoteit BH, Chokor M, Safawi A, Zibara Z, Rizk F, Kawssan A, Danaf N, Msheik L, Hamdar H. Potential therapeutic applications of medical gases in cancer treatment. Med Gas Res 2025; 15:309-317. [PMID: 39829166 PMCID: PMC11918469 DOI: 10.4103/mgr.medgasres-d-24-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 09/27/2024] [Accepted: 12/05/2024] [Indexed: 01/22/2025] Open
Abstract
Medical gases were primarily used for respiratory therapy and anesthesia, which showed promising potential in the cancer therapy. Several physiological and pathological processes were affected by the key gases, such as oxygen, carbon dioxide, nitric oxide, hydrogen sulfide, and carbon monoxide. Oxygen targets shrinking the tumor via hyperbaric oxygen therapy, and once combined with radiation therapy it enhances its effect. Nitric oxide has both anti- and pro-tumor effects depending on its level; at high doses, it triggers cell death while at low doses it supports cancer growth. The same concept is applied to hydrogen sulfide which promotes cancer growth by enhancing mitochondrial bioenergetics and supporting angiogenesis at low concentrations, while at high concentrations it induces cancer cell death while sparing normal cells. Furthermore, carbon dioxide helps induce apoptosis and improve oxygenation for cancer treatments by increasing the release of oxygen from hemoglobin. Moreover, high-dose carbon monoxide gas therapy has demonstrated significant tumor reductions in vivo and is supported by nanomedicine and specialized medicines to boost its delivery to tumor cells and the availability of hydrogen peroxide. Despite the promising potentials of these gases, several challenges remain. Gas concentrations should be regulated to balance pro-tumor and anti-tumor effects for gases such as nitric oxide and hydrogen sulfide. Furthermore, effective delivery systems, such as nanoparticles, should be developed for targeted therapy.
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Affiliation(s)
- Abbas Al Bazzal
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Bassel H. Hoteit
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Mariam Chokor
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Abdallah Safawi
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Zahraa Zibara
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Fatima Rizk
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Aya Kawssan
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Naseeb Danaf
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Layal Msheik
- Faculty of Medical Science, Lebanese University, Hadath, Beirut, Lebanon
| | - Hiba Hamdar
- Research Department, Plovdiv Medical University, Plovdiv, Bulgaria
- Research Department, Medical Learning Skills Academy, Beirut, Lebanon
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Harun A, Bendele N, Khalil MI, Vasquez I, Djuanda J, Posey R, Rashid MH, Christopher GF, Bickel U, Gruev V, Tropp J, Egan PF, Srivastava I. 3D Tumor-Mimicking Phantom Models for Assessing NIR I/II Nanoparticles in Fluorescence-Guided Surgical Interventions. ACS NANO 2025. [PMID: 40378397 DOI: 10.1021/acsnano.5c01919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2025]
Abstract
Fluorescence image-guided surgery (FIGS) offers high spatial resolution and real-time feedback but is limited by shallow tissue penetration and autofluorescence from current clinically approved fluorophores. The near-infrared (NIR) spectrum, specifically the NIR-I (700-900 nm) and NIR-II (950-1700 nm), addresses these limitations with deeper tissue penetration and improved signal-to-noise ratios. However, biological barriers and suboptimal optical performance under surgical conditions have hindered the clinical translation of NIR-I/II nanoprobes. In vivo mouse models have shown promise, but these models do not replicate the complex optical scenarios encountered during real-world surgeries. Existing tissue-mimicking phantoms used to evaluate NIR-I/II imaging systems are useful but fall short when assessing nanoprobes in surgical environments. These phantoms often fail to replicate the tumor microenvironment, limiting their predictive assessment. To overcome these challenges, we propose developing tumor-mimicking phantom models (TMPs) that integrate key tumor features, such as tunable tumor cell densities, in vivo-like nanoparticle concentrations, biologically relevant factors (pH, enzymes), replicate light absorption components (hemoglobin), and light scattering components (intralipid). These TMPs enable more clinically relevant assessments of NIR-I/II nanoprobes, including optical tissue penetration profiling, tumor margin delineation, and ex vivo thoracic surgery on porcine lungs. The components of TMPs can be further modulated to closely match the optical profiles of in vivo and ex vivo tumors. Additionally, 3D bioprinting technology facilitates a high-throughput platform for screening nanoprobes under realistic conditions. This approach will identify high-performing NIR-I/II probes with superior surgical utility, bridging the gap between preclinical findings and clinical applications, and ensuring results extend beyond traditional in vivo mouse studies.
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Affiliation(s)
- Asma Harun
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
- Texas Center for Comparative Cancer Research (TC3R), Amarillo, Texas 79106, United States
| | - Nathaniel Bendele
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
- Department of Chemistry & Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Mohammad Ibrahim Khalil
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
| | - Isabella Vasquez
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
- Department of Chemistry & Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
- Texas Center for Comparative Cancer Research (TC3R), Amarillo, Texas 79106, United States
| | - Jonathan Djuanda
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
- Department of Chemistry & Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Robert Posey
- Department of Chemistry & Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
| | - Md Hasnat Rashid
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
| | - Gordon F Christopher
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
| | - Ulrich Bickel
- Texas Center for Comparative Cancer Research (TC3R), Amarillo, Texas 79106, United States
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Science Center, Amarillo, Texas 79106, United States
| | - Viktor Gruev
- Department of Electrical and Computer Engineering and Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Joshua Tropp
- Department of Chemistry & Biochemistry, Texas Tech University, Lubbock, Texas 79409, United States
- Texas Center for Comparative Cancer Research (TC3R), Amarillo, Texas 79106, United States
| | - Paul F Egan
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
| | - Indrajit Srivastava
- Department of Mechanical Engineering, Edward E. Whitacre Jr. College of Engineering, Texas Tech University, Lubbock, Texas 79409, United States
- Texas Center for Comparative Cancer Research (TC3R), Amarillo, Texas 79106, United States
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Lv Q, Rao SQ, Xiang Z. Preoperative hemoglobin to albumin ratio as a prognostic predictor for patients with colorectal cancer surgery. Updates Surg 2025:10.1007/s13304-025-02061-z. [PMID: 39792231 DOI: 10.1007/s13304-025-02061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 01/07/2025] [Indexed: 01/12/2025]
Abstract
The purpose of this study was to identify whether the preoperative hemoglobin to albumin ratio (HAR) could predict the prognosis of patients who underwent colorectal cancer (CRC) radical resection. This study enrolled 4018 consecutive CRC patients, calculating HAR as the hemoglobin count divided by albumin count. Patients were divided into the high and low HAR groups based on a cut-off value (0.36). Baseline information and short-term outcomes were compared between the two groups. Logistic and Cox regression analyses were conducted to determine whether HAR was an independent risk factor for CRC. A total of 4018 patients were divided into the high HAR group (3295) and the low HAR group (723). It was found that the high HAR group had more females (P < 0.01), less BMI (P = 0.027), less smoking (P < 0.01), less drinking (P < 0.01), less T2DM (P = 0.027), lower albumin (P < 0.01), higher hemoglobin (P < 0.01) and more rectal cancer (P = 0.026). We found that HAR was an independent risk factor for overall complications (P = 0.012, OR = 1.279, 95% CI 1.055-1.550). Moreover, we found that HAR was an independent risk factor for overall survival (OS) (P = 0.012, HR = 1.300, 95% CI 1.059-1.597) and disease-free survival (DFS) (P = 0.030, HR = 1.231, 95% CI 1.021-1.484). We found that the low HAR group had worse OS in stage III (P = 0.012) CRC than the high HAR group. In terms of DFS, the low HAR group also had worse DFS in stage III (P = 0.01) CRC than the high HAR group. HAR was an independent predictive factor for the prognosis of CRC. Therefore, surgeons should pay attention to hemoglobin and albumin values before surgery.
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Affiliation(s)
- Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Si-Qi Rao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zheng Xiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Chongqing Key Laboratory of Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Ahmad R, Barcellini A, Baumann K, Benje M, Bender T, Bragado P, Charalampopoulou A, Chowdhury R, Davis AJ, Ebner DK, Eley J, Kloeber JA, Mutter RW, Friedrich T, Gutierrez-Uzquiza A, Helm A, Ibáñez-Moragues M, Iturri L, Jansen J, Morcillo MÁ, Puerta D, Kokko AP, Sánchez-Parcerisa D, Scifoni E, Shimokawa T, Sokol O, Story MD, Thariat J, Tinganelli W, Tommasino F, Vandevoorde C, von Neubeck C. Particle Beam Radiobiology Status and Challenges: A PTCOG Radiobiology Subcommittee Report. Int J Part Ther 2024; 13:100626. [PMID: 39258166 PMCID: PMC11386331 DOI: 10.1016/j.ijpt.2024.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/02/2024] [Indexed: 09/12/2024] Open
Abstract
Particle therapy (PT) represents a significant advancement in cancer treatment, precisely targeting tumor cells while sparing surrounding healthy tissues thanks to the unique depth-dose profiles of the charged particles. Furthermore, their linear energy transfer and relative biological effectiveness enhance their capability to treat radioresistant tumors, including hypoxic ones. Over the years, extensive research has paved the way for PT's clinical application, and current efforts aim to refine its efficacy and precision, minimizing the toxicities. In this regard, radiobiology research is evolving toward integrating biotechnology to advance drug discovery and radiation therapy optimization. This shift from basic radiobiology to understanding the molecular mechanisms of PT aims to expand the therapeutic window through innovative dose delivery regimens and combined therapy approaches. This review, written by over 30 contributors from various countries, provides a comprehensive look at key research areas and new developments in PT radiobiology, emphasizing the innovations and techniques transforming the field, ranging from the radiobiology of new irradiation modalities to multimodal radiation therapy and modeling efforts. We highlight both advancements and knowledge gaps, with the aim of improving the understanding and application of PT in oncology.
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Affiliation(s)
- Reem Ahmad
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Amelia Barcellini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Clinical Department Radiation Oncology Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Kilian Baumann
- Institute of Medical Physics and Radiation Protection, University of Applied Sciences Giessen, Giessen, Germany
- Marburg Ion-Beam Therapy Center, Marburg, Germany
| | - Malte Benje
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Tamara Bender
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Paloma Bragado
- Biochemistry and Molecular Biology Department, Complutense University of Madrid, Madrid, Spain
| | - Alexandra Charalampopoulou
- University School for Advanced Studies (IUSS), Pavia, Italy
- Radiobiology Unit, Development and Research Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Reema Chowdhury
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Anthony J. Davis
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel K. Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - John Eley
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jake A. Kloeber
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas Friedrich
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - Alexander Helm
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Marta Ibáñez-Moragues
- Medical Applications of Ionizing Radiation Unit, Technology Department, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Lorea Iturri
- Institut Curie, Université PSL, CNRS UMR3347, Inserm U1021, Signalisation Radiobiologie et Cancer, Orsay, France
| | - Jeannette Jansen
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Miguel Ángel Morcillo
- Medical Applications of Ionizing Radiation Unit, Technology Department, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Daniel Puerta
- Departamento de Física Atómica, Molecular y Nuclear, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Complejo Hospitalario Universitario de Granada/Universidad de Granada, Granada, Spain
| | | | | | - Emanuele Scifoni
- TIFPA-INFN - Trento Institute for Fundamental Physics and Applications, Trento, Italy
| | - Takashi Shimokawa
- National Institutes for Quantum Science and Technology (QST), Chiba, Japan
| | - Olga Sokol
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | | | - Juliette Thariat
- Centre François Baclesse, Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, Caen, France
| | - Walter Tinganelli
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Francesco Tommasino
- TIFPA-INFN - Trento Institute for Fundamental Physics and Applications, Trento, Italy
- Department of Physics, University of Trento, Trento, Italy
| | - Charlot Vandevoorde
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany
| | - Cläre von Neubeck
- Department of Particle Therapy, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
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Wei C, Ai H, Mo D, Wang P, Wei L, Liu Z, Li P, Huang T, Liu M. A nomogram based on inflammation and nutritional biomarkers for predicting the survival of breast cancer patients. Front Endocrinol (Lausanne) 2024; 15:1388861. [PMID: 39170737 PMCID: PMC11335604 DOI: 10.3389/fendo.2024.1388861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024] Open
Abstract
Background We aim to develop a new prognostic model that incorporates inflammation, nutritional parameters and clinical-pathological features to predict overall survival (OS) and disease free survival (DFS) of breast cancer (BC) patients. Methods The study included clinicopathological and follow-up data from a total of 2857 BC patients between 2013 and 2021. Data were randomly divided into two cohorts: training (n=2001) and validation (n=856) cohorts. A nomogram was established based on the results of a multivariate Cox regression analysis from the training cohorts. The predictive accuracy and discriminative ability of the nomogram were evaluated by the concordance index (C-index) and calibration curve. Furthermore, decision curve analysis (DCA) was performed to assess the clinical value of the nomogram. Results A nomogram was developed for BC, incorporating lymphocyte, platelet count, hemoglobin levels, albumin-to-globulin ratio, prealbumin level and other key variables: subtype and TNM staging. In the prediction of OS and DFS, the concordance index (C-index) of the nomogram is statistically greater than the C-index values obtained using TNM staging alone. Moreover, the time-dependent AUC, exceeding the threshold of 0.7, demonstrated the nomogram's satisfactory discriminative performance over different periods. DCA revealed that the nomogram offered a greater overall net benefit than the TNM staging system. Conclusion The nomogram incorporating inflammation, nutritional and clinicopathological variables exhibited excellent discrimination. This nomogram is a promising instrument for predicting outcomes and defining personalized treatment strategies for patients with BC.
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Affiliation(s)
- Caibiao Wei
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Huaying Ai
- Department of Injection Room, The People’s Hospital of Yingtan, Yingtan, Jiangxi, China
| | - Dan Mo
- Department of Breast, Guangxi Zhuang Autonomous Region Maternal and Child Health Care Hospital, Nanning, China
| | - Peidong Wang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Liling Wei
- Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhimin Liu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Peizhang Li
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Taijun Huang
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Miaofeng Liu
- Department of Clinical Laboratory, Guangxi Medical University Cancer Hospital, Nanning, China
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Valero C, León X, Quer M. Host-related indexes in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2024; 32:113-117. [PMID: 38116851 DOI: 10.1097/moo.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Peripheral blood host-related indexes have been widely studied in cancer patients. Several authors have shown the prognostic capacity of these indexes in head and neck cancer. Therefore, there has been an increasing interest in this topic recently. RECENT FINDINGS The main variables analyzed and used to create these host-related indexes are peripheral blood leukocytes - including neutrophils, monocytes and lymphocytes - albumin and hemoglobin levels. Other factors with proven prognostic capacity in some studies are: platelets, C-reactive protein, and BMI. Among all the combined indexes, the neutrophil-to-lymphocyte ratio has been the most accepted and used worldwide. Nonetheless, there are other indexes which group multiple of these factors that have shown better prognostic capacity, and are promising in the near future. SUMMARY Host-related indexes are ideal biomarkers to be used on our daily-basis. There is enough evidence to start considering them when assessing patients with head and neck cancer.
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Affiliation(s)
- Cristina Valero
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona
| | - Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid
- UVIC. Universitat Central de Catalunya, Vic, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid
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Costa S, Fang Q, Farrell T, Dao E, Farquharson M. Time-resolved fluorescence and diffuse reflectance for lung squamous carcinoma margin detection. Lasers Surg Med 2024; 56:279-287. [PMID: 38357847 DOI: 10.1002/lsm.23761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/26/2023] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES A major challenge in non-small cell lung cancer surgery is the occurrence of positive tumor margins. This may lead to the need for additional surgeries and has been linked to poor patient prognosis. This study aims to develop an in vivo surgical tool that can differentiate cancerous from noncancerous lung tissue at the margin. METHODS A time-resolved fluorescence and diffuse reflectance bimodal device was used to measure the lifetime, spectra, and intensities of endogenous fluorophores as well as optical properties of lung tissue. The tumor and fibrotic tissue data, each containing 36 samples, was obtained from patients who underwent surgical removal of lung tissue after being diagnosed with squamous carcinoma but before any other treatment was administered. The normal lung tissue data were obtained from nine normal tissue samples. RESULTS The results show a statistically significant difference between cancerous and noncancerous tissue. The results also show a difference in metabolic related optical properties between fibrotic and normal lung tissue samples. CONCLUSIONS This work demonstrates the feasibility of a device that can differentiate cancerous and noncancerous lung tissue for patients diagnosed with squamous cell carcinoma.
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Affiliation(s)
- Sarah Costa
- Department of Physics, McMaster University, Ontario, Hamilton, Canada
| | - Qiyin Fang
- Department of Engineering Physics, Faculty of Engineering, McMaster University, Ontario, Hamilton, Canada
| | - Thomas Farrell
- Radiation Physics Program, Juravinski Cancer Centre, Ontario, Hamilton, Canada
| | - Erica Dao
- Department of Physics, McMaster University, Ontario, Hamilton, Canada
| | - Michael Farquharson
- Department of Interdisciplinary Science, McMaster University, Ontario, Hamilton, Canada
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Shenoy G, Slagle-Webb B, Khunsriraksakul C, Pandya Shesh B, Luo J, Khristov V, Smith N, Mansouri A, Zacharia BE, Holder S, Lathia JD, Barnholtz-Sloan JS, Connor JR. Analysis of anemia and iron supplementation among glioblastoma patients reveals sex-biased association between anemia and survival. Sci Rep 2024; 14:2389. [PMID: 38287054 PMCID: PMC10825121 DOI: 10.1038/s41598-024-52492-8] [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: 03/25/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
The association between anemia and outcomes in glioblastoma patients is unclear. We analyzed data from 1346 histologically confirmed adult glioblastoma patients in the TriNetX Research Network. Median hemoglobin and hematocrit levels were quantified for 6 months following diagnosis and used to classify patients as anemic or non-anemic. Associations of anemia and iron supplementation of anemic patients with median overall survival (median-OS) were then studied. Among 1346 glioblastoma patients, 35.9% of male and 40.5% of female patients were classified as anemic using hemoglobin-based WHO guidelines. Among males, anemia was associated with reduced median-OS compared to matched non-anemic males using hemoglobin (HR 1.24; 95% CI 1.00-1.53) or hematocrit-based cutoffs (HR 1.28; 95% CI 1.03-1.59). Among females, anemia was not associated with median-OS using hemoglobin (HR 1.00; 95% CI 0.78-1.27) or hematocrit-based cutoffs (HR: 1.10; 95% CI 0.85-1.41). Iron supplementation of anemic females trended toward increased median-OS (HR 0.61; 95% CI 0.32-1.19) although failing to reach statistical significance whereas no significant association was found in anemic males (HR 0.85; 95% CI 0.41-1.75). Functional transferrin-binding assays confirmed sexually dimorphic binding in resected patient samples indicating underlying differences in iron biology. Anemia among glioblastoma patients exhibits a sex-specific association with survival.
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Affiliation(s)
- Ganesh Shenoy
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Becky Slagle-Webb
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery and Siteman Cancer Center Biostatistics Shared Resource, Washington University School of Medicine, St. Louis, MO, USA
| | - Vladimir Khristov
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Nataliya Smith
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Brad E Zacharia
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Sheldon Holder
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
| | - Justin D Lathia
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jill S Barnholtz-Sloan
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD, USA
| | - James R Connor
- Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA.
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Low JM, Rodriguez-Berriguete G, Higgins GS. Repurposing radiosensitising medicines for radiotherapy: an overview. BMJ ONCOLOGY 2024; 3:e000192. [PMID: 39886153 PMCID: PMC11235008 DOI: 10.1136/bmjonc-2023-000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/06/2023] [Indexed: 02/01/2025]
Abstract
Repurposing established non-cancer drugs for the treatment of cancer offers potential benefits such as speed of clinical translation and financial efficiencies. In this study, we assess the landscape of repurposing drugs for combined use with radiotherapy (RT) based on their capacity to increase tumour radiosensitivity. Using a literature-based approach, we identified 42 radiosensitising drugs with varied non-cancer indications and mechanisms of action, that have entered or completed clinical trials in combination with RT or with chemoradiotherapy. Two compounds, nicotinamide and nimorazole, have entered routine but limited clinical use in combination with radiotherapy. We provide an overview on these successfully repurposed drugs, and highlight some examples of unsuccessful repurposing efforts and drug candidates with an uncertain prospect of success. Upon reviewing the trials, we identified some common themes behind the unsuccessful efforts, including poor trial reporting, absence of biomarkers and patient selection, sub-optimal pharmacological properties, inappropriate trial design, lack or inadequate consideration of pre-clinical and clinical data, and limited funding support. We point out future directions to mitigate these issues and increase the likelihood of success in repurposing drug treatments for radiotherapy.
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Affiliation(s)
- Jie Man Low
- Department of Oncology, Oxford University Hospitals NHS Trust, Oxford, UK
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10
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Arnhold J. Inflammation-Associated Cytotoxic Agents in Tumorigenesis. Cancers (Basel) 2023; 16:81. [PMID: 38201509 PMCID: PMC10778456 DOI: 10.3390/cancers16010081] [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: 12/03/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Chronic inflammatory processes are related to all stages of tumorigenesis. As inflammation is closely associated with the activation and release of different cytotoxic agents, the interplay between cytotoxic agents and antagonizing principles is highlighted in this review to address the question of how tumor cells overcome the enhanced values of cytotoxic agents in tumors. In tumor cells, the enhanced formation of mitochondrial-derived reactive species and elevated values of iron ions and free heme are antagonized by an overexpression of enzymes and proteins, contributing to the antioxidative defense and maintenance of redox homeostasis. Through these mechanisms, tumor cells can even survive additional stress caused by radio- and chemotherapy. Through the secretion of active agents from tumor cells, immune cells are suppressed in the tumor microenvironment and an enhanced formation of extracellular matrix components is induced. Different oxidant- and protease-based cytotoxic agents are involved in tumor-mediated immunosuppression, tumor growth, tumor cell invasion, and metastasis. Considering the special metabolic conditions in tumors, the main focus here was directed on the disturbed balance between the cytotoxic agents and protective mechanisms in late-stage tumors. This knowledge is mandatory for the implementation of novel anti-cancerous therapeutic approaches.
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Affiliation(s)
- Jürgen Arnhold
- Institute of Medical Physics and Biophysics, Medical Faculty, Leipzig University, Härtelstr. 16-18, 04107 Leipzig, Germany
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11
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Sarfraz M, Arafat M, Zaidi SHH, Eltaib L, Siddique MI, Kamal M, Ali A, Asdaq SMB, Khan A, Aaghaz S, Alshammari MS, Imran M. Resveratrol-Laden Nano-Systems in the Cancer Environment: Views and Reviews. Cancers (Basel) 2023; 15:4499. [PMID: 37760469 PMCID: PMC10526844 DOI: 10.3390/cancers15184499] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The genesis of cancer is a precisely organized process in which normal cells undergo genetic alterations that cause the cells to multiply abnormally, colonize, and metastasize to other organs such as the liver, lungs, colon, and brain. Potential drugs that could modify these carcinogenic pathways are the ones that will be used in clinical trials as anti-cancer drugs. Resveratrol (RES) is a polyphenolic natural antitoxin that has been utilized for the treatment of several diseases, owing to its ability to scavenge free radicals, control the expression and activity of antioxidant enzymes, and have effects on inflammation, cancer, aging, diabetes, and cardioprotection. Although RES has a variety of pharmacological uses and shows promising applications in natural medicine, its unpredictable pharmacokinetics compromise its therapeutic efficacy and prevent its use in clinical settings. RES has been encapsulated into various nanocarriers, such as liposomes, polymeric nanoparticles, lipidic nanocarriers, and inorganic nanoparticles, to address these issues. These nanocarriers can modulate drug release, increase bioavailability, and reach therapeutically relevant plasma concentrations. Studies on resveratrol-rich nano-formulations in various cancer types are compiled in the current article. Studies relating to enhanced drug stability, increased therapeutic potential in terms of pharmacokinetics and pharmacodynamics, and reduced toxicity to cells and tissues are the main topics of this research. To keep the readers informed about the current state of resveratrol nano-formulations from an industrial perspective, some recent and significant patent literature has also been provided. Here, the prospects for nano-formulations are briefly discussed, along with machine learning and pharmacometrics methods for resolving resveratrol's pharmacokinetic concerns.
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Affiliation(s)
- Muhammad Sarfraz
- College of Pharmacy, Al Ain University, Al Ain Campus, Al Ain P.O. Box 64141, United Arab Emirates
| | - Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain Campus, Al Ain P.O. Box 64141, United Arab Emirates
| | - Syeda Huma H. Zaidi
- Department of Chemistry, Faculty of Science, Northern Border University, Arar 91431, Saudi Arabia
| | - Lina Eltaib
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
| | - Muhammad Irfan Siddique
- Department of Pharmaceutics, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
| | - Mehnaz Kamal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Abuzer Ali
- Department of Pharmacognosy, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | | | - Abida Khan
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia (M.I.)
| | - Shams Aaghaz
- Department of Pharmacy, School of Medical & Allied Sciences, Galgotias University, Greater Noida 203201, India
| | - Mohammed Sanad Alshammari
- Department of Computer Science, Faculty of Computing and Information Technology, Northern Border University, Rafha 91911, Saudi Arabia
| | - Mohd Imran
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia (M.I.)
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12
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Li Y, Wang H, Zhao Z, Yang Y, Meng Z, Qin L. Effects of the interactions between platelets with other cells in tumor growth and progression. Front Immunol 2023; 14:1165989. [PMID: 37153586 PMCID: PMC10158495 DOI: 10.3389/fimmu.2023.1165989] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
It has been confirmed that platelets play a key role in tumorigenesis. Tumor-activated platelets can recruit blood cells and immune cells to migrate, establish an inflammatory tumor microenvironment at the sites of primary and metastatic tumors. On the other hand, they can also promote the differentiation of mesenchymal cells, which can accelerate the proliferation, genesis and migration of blood vessels. The role of platelets in tumors has been well studied. However, a growing number of studies suggest that interactions between platelets and immune cells (e.g., dendritic cells, natural killer cells, monocytes, and red blood cells) also play an important role in tumorigenesis and tumor development. In this review, we summarize the major cells that are closely associated with platelets and discuss the essential role of the interaction between platelets with these cells in tumorigenesis and tumor development.
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13
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Barcellini A, Fontana G, Filippini DM, Ronchi S, Bonora M, Vischioni B, Ingargiola R, Camarda AM, Loap P, Facchinetti N, Licitra L, Baroni G, Orlandi E. Exploring the role of neutrophil-to-lymphocyte ratio and blood chemistry in head and neck adenoid cystic carcinomas treated with carbon ion radiotherapy. Radiother Oncol 2022; 177:143-151. [PMID: 36328091 DOI: 10.1016/j.radonc.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/26/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE In recent years, there is an emerging interest in the prognostic role of chemistry blood biomarkers in oncological patients but their role in adenoid cystic carcinomas (ACCs) is still unknown. This study aims to assess the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) and blood chemistry in a series of head and neck ACC patients treated with carbon ion radiotherapy (CIRT). MATERIAL AND METHODS We retrospectively retrieved the data of 49 consecutive head and neck ACC patients treated with CIRT. Univariable and multivariable Cox proportional hazard regression (Cox-ph) analyses were performed to look for a potential association of NLR, and other blood biomarker values, with disease-free survival (DFS), Local Control (LC), Metastasis Free Survival (MFS) and overall survival (OS). RESULTS No significant association between NLR > 2,5 and DFS, LC, MFS and OS was found with univariable analysis although a trend was reported for DFS (Hazard ratio [HR]: 2,10, 95 % CI: 0,85 - 5,08, p-value = 0,11). Patients with hemoglobin (hb) ≤ 14 g/dL showed significantly better DFS, MFS and OS. Multivariable regression Cox-ph analysis for DFS, adjusted for margin status, clinical target volume and Absolute Number of Monocytes, reported the following statistically significant HRs, for both NLR > 2,5 and hb > 14 g/dL respectively: 4,850 (95 % CI = 1,408 - 16,701, p = 0,012) and 3,032 (95 % CI = 1,095 - 8,393, p = 0,033). Moreover, hb > 14 with HR = 3,69 (95 % CI: 1,23 - 11,07, p-value = 0,02), was a negative independent prognostic predictor for MFS. CONCLUSIONS Pre-treatment NLR and hb values seem to be independent prognostic predictor for clinical outcomes in head and neck ACC patients. If their role will be validated in a larger prospective cohort, they might be worthwhile for a pre-treatment risk stratification in patients treated with CIRT.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Fontana
- Clinical Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Daria Maria Filippini
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Sara Ronchi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Nadia Facchinetti
- Scientific Direction, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lisa Licitra
- Scientific Direction, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Head and Neck Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Guido Baroni
- Clinical Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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14
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Influence of radiation treatment technique (IMRT vs. 3D-RT) on acute toxicity and prognostic factors for survival for anal cancer. Sci Rep 2022; 12:19914. [PMID: 36402828 PMCID: PMC9675840 DOI: 10.1038/s41598-022-24362-8] [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: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
We compared our institutional experience with intensity-modulated radiotherapy (IMRT) and 3D-conformal radiotherapy (3D-RT) for definitive treatment of primary anal cancer. We performed a single-institution retrospective review of all patients with anal squamous cell carcinoma treated with definitive (chemo) radiotherapy with curative intent from 2004 through 2018. We assessed several prognostic factors in respect to relevant survival endpoints. In addition, acute toxicities were determined and compared between IMRT and 3D-RT patients. This study included 94 patients (58 IMRT, 36 3D-RT). Mean follow up for all patients, for IMRT and 3D-RT patients was 61 months (range 6-176), 46 months (range 6-118), and 85 months (range 6-176), respectively. 5-year overall survival (OS) was 86%, disease-free survival (DFS) was 72%, and colostomy-free survival (CFS) was 75% in the IMRT cohort. In the 3D-RT cohort, OS was 87%, DFS was 71%, and CFS was 81% (all p > 0.05). Male gender and Karnofsky Index (KI) were revealed as independent prognostic factors for 5-year OS (p = 0.017; p = 0.023). UICC stage was an independent prognostic factor for DFS and CFS (p = 0.023; p = 0.042). In addition, the pre-treatment leukocyte count was an independent prognostic factor for CFS (p = 0.042). Acute grade ≥ 3 toxicity was not significantly different between IMRT and 3D-RT patients, but the IMRT cohort had favorable outcomes. This study confirmed IMRT as the primary definitive treatment of anal cancer. With similar survival rates, IMRT had the potential to reduce acute toxicity by sparing organs at risk. Promising prognostic factors such as BMI, KI, and leucocyte and hemoglobin levels should be further investigated.
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15
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Value of Cytokine Expression in Early Diagnosis and Prognosis of Tumor Metastasis. JOURNAL OF ONCOLOGY 2022; 2022:8112190. [PMID: 36157224 PMCID: PMC9507706 DOI: 10.1155/2022/8112190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the association of the plasma level of cytokines and blood routine indexes with clinical characteristics in patients with cancer. Methods We analyzed plasma samples derived from 134 cancer patients. Interleukins (IL) 1β, 2, 4, 5, 6, 8, 10, 12p70, 17, IFN-γ, IFN-α, and TNF-α, and blood routine indexes were measured. The associations of the levels of cytokine and blood routine indexes with demographic and clinical characteristics of cancer patients were analyzed. Partial least-squares discriminant analysis was employed to identify cancer metastasis using these plasma cytokine metrics as input. We compared the predictive effectiveness of numeric machine learning algorithms using these indexes and showed a promising model implemented with random forest. Results Plasma levels of IL-6 and IL-8 in cancer patients with metastases were higher than those without metastases (P < 0.05). Cancer patients without metastases had significantly higher levels of plasma IL-12p70 and percentage of lymphocytes as compared with those with metastases (P < 0.05). Our random forest model showed the highest prediction performance (upper quantile AUC, 0.885) among the six machine learning algorithms we evaluated. Conclusion Our findings suggest that plasma levels of IL-6, IL-8, and IL-12p70 and the percentage of lymphocytes could predict the recurrence, metastasis, and progression of cancer. Our findings will provide guidance for tumor monitoring and treatment.
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16
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Kong M, Lim YJ. Chronic hyperglycemia is an adverse prognostic factor for locoregional recurrence-free survival in small cell lung cancer patients treated with radical radiotherapy. Thorac Cancer 2022; 13:2633-2640. [PMID: 36106347 PMCID: PMC9475228 DOI: 10.1111/1759-7714.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Plasma glucose levels might be associated with the severity of tumor hypoxia in patients with cancer. In our previous study, we found that chronic hyperglycemia significantly increased the risk of locoregional recurrence in patients with non-small cell lung cancer treated with radical radiotherapy (RT). Here, we evaluated the association between plasma glucose levels in terms of hemoglobin A1c (HbA1c) and locoregional recurrence-free survival in patients with limited-stage small cell lung cancer treated with radical RT. METHODS We retrospectively analyzed the clinical data of 59 patients with small cell lung cancer. HbA1c levels were measured 1 week before the start of RT. Survival outcomes were analyzed according to HbA1c levels. Multivariable analysis was conducted to identify whether HbA1c level was a significant prognostic factor for survival. RESULTS The 1-, 2-, and 3-year locoregional recurrence-free survival rates were 90.9, 86.1, and 78.9%, respectively, in the low HbA1c group, and 45.1, 27.1, and 20.3%, respectively, in the high HbA1c group (p < 0.001). The 1-, 2-, and 3-year distant metastasis-free survival rates were 67.2, 57, and 57%, respectively, in the low HbA1c group, while it was 56.6, 24.9, and 24.9%, respectively, in the high HbA1c group (p = 0.024). HbA1c level remained a significant prognostic factor for locoregional recurrence-free survival in the multivariable analysis (p = 0.010). CONCLUSIONS Chronic hyperglycemia is a significant prognostic factor for locoregional recurrence-free survival in patients with limited-stage small cell lung cancer treated with radical RT. Routine monitoring of plasma glucose levels and aggressive glycemic control should be conducted to prevent locoregional recurrence.
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Affiliation(s)
- Moonkyoo Kong
- Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Lim
- Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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17
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Fletcher T, Thompson AJ, Ashrafian H, Darzi A. The measurement and modification of hypoxia in colorectal cancer: overlooked but not forgotten. Gastroenterol Rep (Oxf) 2022; 10:goac042. [PMID: 36032656 PMCID: PMC9406947 DOI: 10.1093/gastro/goac042] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022] Open
Abstract
Tumour hypoxia is the inevitable consequence of a tumour's rapid growth and disorganized, inefficient vasculature. The compensatory mechanisms employed by tumours, and indeed the absence of oxygen itself, hinder the ability of all treatment modalities. The clinical consequence is poorer overall survival, disease-free survival, and locoregional control. Recognizing this, clinicians have been attenuating the effect of hypoxia, primarily with hypoxic modification or with hypoxia-activated pro-drugs, and notable success has been demonstrated. However, in the case of colorectal cancer (CRC), there is a general paucity of knowledge and evidence surrounding the measurement and modification of hypoxia, and this is possibly due to the comparative inaccessibility of such tumours. We specifically review the role of hypoxia in CRC and focus on the current evidence for the existence of hypoxia in CRC, the majority of which originates from indirect positron emission topography imaging with hypoxia selective radiotracers; the evidence correlating CRC hypoxia with poorer oncological outcome, which is largely based on the measurement of hypoxia inducible factor in correlation with clinical outcome; the evidence of hypoxic modification in CRC, of which no direct evidence exists, but is reflected in a number of indirect markers; the prognostic and monitoring implications of accurate CRC hypoxia quantification and its potential in the field of precision oncology; and the present and future imaging tools and technologies being developed for the measurement of CRC hypoxia, including the use of blood-oxygen-level-dependent magnetic resonance imaging and diffuse reflectance spectroscopy.
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Affiliation(s)
- Teddy Fletcher
- Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing, St Mary’s Hospital, Imperial College London, London, UK
| | - Alex J Thompson
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing, St Mary’s Hospital, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing, St Mary’s Hospital, Imperial College London, London, UK
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18
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Hu CG, Hu BE, Zhu JF, Zhu ZM, Huang C. Prognostic significance of the preoperative hemoglobin to albumin ratio for the short-term survival of gastric cancer patients. World J Gastrointest Surg 2022; 14:580-593. [PMID: 35979426 PMCID: PMC9258240 DOI: 10.4240/wjgs.v14.i6.580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/20/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemoglobin and albumin are associated with the prognosis of gastric cancer (GC) patients. However, the prognostic value of the hemoglobin to albumin ratio (HAR) for the short-term survival of GC patients with D2 radical resection has not been studied. AIM To investigate the significance of the HAR in evaluating the short-term survival of GC patients after D2 radical resection and to construct a nomogram to predict the prognosis in GC patients after surgery, thus providing a reference for the development of postoperative individualized treatment and follow-up plans. METHODS Cox regression and Kaplan-Meier analysis was used for prognostic analysis. Logistic regression was used to analyze the relationships between HAR and the clinicopathological characteristics of the GC patients. A prognostic nomogram model for the short-term survival of GC patients was constructed by R software. RESULTS HAR was an independent risk factor for the short-term survival of GC patients. GC patients with a low HAR had a poor prognosis (P < 0.001). Low HAR was markedly related to high stage [odds ratio (OR) = 0.45 for II vs I; OR = 0.48 for III vs I], T classification (OR = 0.52 for T4 vs T1) and large tumor size (OR = 0.51 for ≥ 4 cm vs < 4 cm) (all P < 0.05). The nomogram model was based on HAR, age, CA19-9, CA125 and stage, and the C-index was 0.820. CONCLUSION Preoperative low HAR was associated with short-term survival in GC patients. The prognostic nomogram model can accurately predict the short-term survival of GC patients with D2 radical resection.
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Affiliation(s)
- Ce-Gui Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Bai-E Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jin-Feng Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zheng-Ming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Chao Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Meixner E, Hoeltgen L, Hoegen P, König L, Arians N, Michel LL, Smetanay K, Fremd C, Schneeweiss A, Debus J, Hörner-Rieber J. Age-Dependent Hematologic Toxicity Profiles and Prognostic Serologic Markers in Postoperative Radiochemotherapy Treatment for Uterine Cervical Cancer. Technol Cancer Res Treat 2022; 21:15330338221118188. [PMID: 35950239 PMCID: PMC9379804 DOI: 10.1177/15330338221118188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: In the adjuvant setting for cervical cancer, classical
risk factors for postoperative radiochemotherapy have been established. However,
data on laboratory changes during therapy and the prognostic value of
serological markers are limited and further knowledge is needed to optimize the
toxic trimodal regimen. Methods: We retrospectively identified 69
women who underwent weekly postoperative radiochemotherapy with
40 mg/m2 of cisplatin for cervical cancer between 2010 and 2021
at a single center. Laboratory parameters were recorded before, at each cycle
and after radiochemotherapy. Kaplan-Meier and log-rank analyses were used to
calculate and compare survival, groups were compared using the Mann–Whitney
U, χ2, and variance tests. Results:
With a median follow-up of 17.7 months, the 1- and 5-year local control rates
were 94.0% and 73.7%, respectively, with significantly better rates for more
chemotherapy cycles and negative resection margins. Only 68.1% of patients
completed all cycles. The most common reasons for early discontinuation were
persistent asymptomatic leukopenia in women aged ≤ 50 years, and limiting
infections in women aged > 50 years. Leukopenia was more likely to occur
after the third cycle. Significantly worse survival was observed for
post-radiochemotherapy elevated C-reactive-protein and lactate dehydrogenase
levels, low pre-radiochemotherapy nutritional index, and raised
C-reactive-protein-levels; the latter were also predictable for local control.
The Glasgow prognostic score did not reliably predict survival.
Conclusion: Incomplete application of simultaneous chemotherapy
leads to inferior local control, and age-dependent limiting factors should be
identified at an early stage. In addition to classical risk factors, serological
markers (C-reactive-protein, lactate dehydrogenase, nutritional index) show
prognostic significance.
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Affiliation(s)
- Eva Meixner
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Line Hoeltgen
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Laura L Michel
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Smetanay
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Carlo Fremd
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Department of Gynecology and Obstetrics, 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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20
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Valero C, Zanoni DK, Pillai A, Ganly I, Morris LGT, Shah JP, Wong RJ, Patel SG. Host Factors Independently Associated With Prognosis in Patients With Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:699-707. [PMID: 32525545 DOI: 10.1001/jamaoto.2020.1019] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance The association and interaction of host characteristics with prognosis in patients with oral cavity squamous cell carcinoma (OSCC) are poorly understood. There is increasing evidence that host characteristics are associated with treatment outcomes of many cancers. Objectives To examine the host factors associated with prognosis in patients with OSCC and their interactions to create a numerical index that quantifies the prognostic capacity of these host characteristics. Design, Setting, and Participants This retrospective cohort study included patients with OSCC treated surgically at a tertiary care center from January 1, 1998, to December 31, 2015. From a departmental OSCC database of 1377 previously untreated patients, 68 patients with missing data on any host variable of interest within a month before the start of treatment were excluded, leaving 1309 patients. Data analysis was performed from October 21, 2019, to December 10, 2019. Exposure Primary surgery for OSCC. Main Outcomes and Measures Overall survival (OS) was the primary end point, and disease-specific survival (DSS) was the secondary end point. Optimal cutoffs for each variable were identified using recursive-partitioning analysis with the classification and regression tree method using OS as the dependent variable. Body mass index (BMI) and pretreatment peripheral blood leukocyte count, platelet count, hemoglobin level, and albumin level were analyzed. A host index (H-index) was developed using independent factors associated with OS. Results A total of 1309 patients (731 [55.8%] male; mean [SD] age, 62 [14.3] years) participated in the study. When including all the host-related factors in a multivariable analysis, all except BMI (hazard ratio [HR], 1.14; 95% CI, 0.80-1.63) were independently associated with outcomes. For example, compared with a hemoglobin level of 14.1 g/dL or greater, the HR for a level of 12.9 to 14.0 g/dL was 1.42 (95% CI, 1.13-1.77) and for a level of 12.8 g/dL or less was 1.51 (95% CI, 1.18-1.94), and compared with an albumin level of 4.3 g/dL or greater, the HR for a level of 3.7 to 4.2 g/dL was 1.18 (95% CI, 0.95-1.45) and for a level of 3.6 g/dL or less was 3.64 (95% CI, 2.37-5.58). An H-index of 1.4 or less was associated with a 74% 5-year OS, an H-index of 1.5 to 3.5 with a 65% 5-year OS, and an H-index of 3.6 or higher with a 38% 5-year OS; for DSS, the 5-year survival was 84%, 80%, and 64%, respectively. Compared with patients with an H-index score of 1.4 or less, patients with H-index scores of 1.5 to 3.5 (hazard ratio, 1.474; 95% CI, 1.208-1.798) and 3.6 or higher (hazard ratio, 3.221; 95% CI, 2.557-4.058) had a higher risk of death. Conclusions and Relevance The findings suggest that pretreatment values of neutrophils, monocytes, lymphocytes, hemoglobin, and albumin are independently associated with prognosis in patients with OSCC. The interactions between these host factors were incorporated into a novel H-index that quantified the prognostic capacity of host characteristics associated with OSCC.
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Affiliation(s)
- Cristina Valero
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniella K Zanoni
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anjali Pillai
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal G Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Zayed S, Nguyen TK, Lin C, Boldt G, Beriwal S, Creutzberg CL, Kamrava M, Mendez LC, Velker V, Doll C, Taggar A, Leung E, D’Souza DP. Red Blood Cell Transfusion Practices for Patients With Cervical Cancer Undergoing Radiotherapy. JAMA Netw Open 2021; 4:e213531. [PMID: 33818620 PMCID: PMC8022218 DOI: 10.1001/jamanetworkopen.2021.3531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Packed red blood cell (PRBC) transfusions are used to treat anemia in patients with cervical cancer undergoing radiotherapy (RT) owing to concerns of hypoxia-induced radioresistance. In the absence of high-quality evidence informing transfusion practices for patients receiving external beam RT (EBRT) and brachytherapy, various arbitrary hemoglobin target levels are used worldwide. OBJECTIVE To develop consensus statements to guide PRBC transfusion practices in patients with cervical cancer receiving curative-intent RT with EBRT and brachytherapy. DESIGN, SETTING, AND PARTICIPANTS This international Delphi consensus study was completed between November 1, 2019, and July 31, 2020. A total of 63 international clinical experts in gynecologic radiation oncology were invited; 39 (62%) accepted and consented to participate. Consensus building was achieved using a 3-round anonymous Delphi consensus method. Participants rated their agreement or disagreement with statements using a 5-point Likert scale. An a priori threshold of 75% or more was required for consensus. MAIN OUTCOMES AND MEASURES The preplanned primary outcome of this study was to assess hemoglobin transfusion thresholds and targets for both EBRT and brachytherapy by expert consensus. RESULTS Response rates of 100% (39 of 39), 92% (36 of 39), and 97% (35 of 36) were achieved for the first, second, and third rounds of surveys, respectively. Twenty-three experts (59%) practiced in Canada, 11 (28%) in the United States, 3 (8%) in South America, 1 (3%) in Europe, and 1 (3%) in Asia. Consensus was reached for 44 of 103 statements (43%), which were combined to form the final 27-statement consensus guideline. No specific hemoglobin transfusion threshold was agreed on by consensus for EBRT or brachytherapy. By consensus (89% [31 of 35]), a hemoglobin transfusion target for patients who receive a PRBC transfusion should be 9 g/dL or more and less than 12 g/dL. CONCLUSIONS AND RELEVANCE This study presents the first international expert consensus guideline informing PRBC transfusion practices for patients with cervical cancer undergoing EBRT and brachytherapy. A minimum hemoglobin transfusion target of 9 g/dL was endorsed to balance tumor radiosensitivity with appropriate use of a scarce resource. Randomized clinical trials are required to evaluate the optimal transfusion threshold and target that maximize clinical benefit in this patient population.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Timothy K. Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Cindy Lin
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Sushil Beriwal
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Carien L. Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lucas C. Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Corinne Doll
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Amandeep Taggar
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David P. D’Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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22
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Açikgoz Y, Gurler F, Inci BK, Ergun Y, Ucar G, Dirikoc M, Esen SA, Tekin BO, Bal O, Dogan M, Uncu D. The prognostic value of tumor/lymph node standardized uptake value max ratio and correlation with hematologic parameters in stage III nonsmall cell lung cancer. Medicine (Baltimore) 2020; 99:e23168. [PMID: 33235077 PMCID: PMC7710171 DOI: 10.1097/md.0000000000023168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022] Open
Abstract
Stage III non-small cell lung cancer (NSCLC) is a highly heterogeneous subtype of lung cancer. There are still no widely accepted prognostic parameters for stage III NSCLC. In this study, we evaluated the prognostic value of the standardized uptake value (SUV) max ratio of primary tumor to lymph node (T/N SUV max) and its correlation with various hematological parameters.Patient data were reviewed from the hospital database retrospectively. The T/N SUV max ratio was calculated by dividing the SUV max of the primary tumor by the maximal SUV max of the lymph node. The cut-off value for T/N SUV max ratio was determined by receiver operating characteristic analysis. Survival analysis was performed by Kaplan-Meier method with the Long-rank test. P value < .05 was considered statistically significant.A total of 52 patients were included in this study. The optimal cut-off value for T/N SUV max was 1.96 (area under the curve: 0.74; 72.7% sensitivity and 73.7% specificity). Patients with T/N SUV max ≤1.96 were defined as high risk patients and those with >1.96 were defined as low risk patients. The median event (recurrence or progression) free survival was 24.3 months (95% confidence interval: 12.0-36.6) for low risk patients, and 9.2 months (95% confidence interval: 6.1-12.4) for high risk patients (P = .0015). There was an inverse correlation between T/N SUV max and hemoglobin concentration and mean corpuscular volume (rho: -0.349, P = .011; rho: -0.312, P = .025, respectively).Low risk patients had a more favorable prognosis compared to high risk patients. We demonstrated that T/N SUV max can be of prognostic value in stage III NSCLC. T/N SUV max correlated only with hemoglobin and mean corpuscular volume.
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Affiliation(s)
- Yusuf Açikgoz
- Department of Medical Oncology, Health Science University, Ankara City Hospital
| | - Fatih Gurler
- Department of Medical Oncology, Gazi University Medicine Faculty
| | - Bediz Kurt Inci
- Department of Medical Oncology, Gazi University Medicine Faculty
| | - Yakup Ergun
- Department of Medical Oncology, Health Science University, Ankara City Hospital
| | - Gokhan Ucar
- Department of Medical Oncology, Health Science University, Ankara City Hospital
| | - Merve Dirikoc
- Department of Medical Oncology, Health Science University, Ankara City Hospital
| | - Selin Akturk Esen
- Department of Medical Oncology, Health Science University, Ankara City Hospital
| | - Berna Okudan Tekin
- Department of Nuclear Medicine, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - Oznur Bal
- Department of Medical Oncology, Health Science University, Ankara City Hospital
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Dr AY Oncology Training and Research Hospital
| | - Dogan Uncu
- Department of Medical Oncology, Health Science University, Ankara City Hospital
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23
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Liang WF, Li H, Wu JY, Liu CH, Wu MF, Li J. Identification of Ovarian Cancer Patients Most Likely to Achieve Chemotherapy Response Score 3 Following Neoadjuvant Chemotherapy: Development of a Predictive Nomogram. Front Oncol 2020; 10:560888. [PMID: 33123471 PMCID: PMC7571668 DOI: 10.3389/fonc.2020.560888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/31/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The chemotherapy response score (CRS) system is a reproducible prognostic tool for patients receiving neoadjuvant chemotherapy (NACT) for tubo-ovarian high-grade serous carcinoma (HGSC). Achieving CRS 3 following NACT can be used as a surrogate for progression-free survival (PFS) and overall survival (OS). This study aimed to identify predictors of CRS 3 and develop a predictive nomogram. Methods: Data were extracted from 106 HGSC patients receiving NACT. Logistic regression was used to identify independent predictors for CRS 3. A nomogram was established based on the multivariate regression model. Results: All patients received three cycles of NACT, and CRS 3 was observed in 24 (22.6%) patients. Compared with patients in the CRS 1–2 group, patients in the CRS 3 groups had significantly improved PFS (log-rank test P < 0.0001). The multivariate regression analysis identified post-NACT CA125, percent decrease in CA125, post-NACT human epididymis protein 4 (HE4), and post-NACT hemoglobin level as independent predictors of CRS 3. The Hosmer-Lemeshow test showed goodness-of-fit of this regression model (P = 0.272). The nomogram including these factors presented good discrimination (area under the curve = 0.82), good calibration (mean absolute error = 0.039), and a net benefit within the threshold probabilities of CRS 3 > 5%. Conclusions: We validated the prognostic role of the CRS system and developed a nomogram that predicts the possibility of CRS 3 following NACT. The nomogram helps to identify patients who would benefit the most from NACT. More studies are warranted to validate this model.
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Affiliation(s)
- Wei-Feng Liang
- Department of Gynecology and Obstetrics, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.,Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Li
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie-Ying Wu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chang-Hao Liu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Miao-Fang Wu
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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24
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Huang C, Hu C, Zhu J, Zhang W, Huang J, Zhu Z. Establishment of Decision Rules and Risk Assessment Model for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer. Front Oncol 2020; 10:1638. [PMID: 32984033 PMCID: PMC7492596 DOI: 10.3389/fonc.2020.01638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Preoperative accurate prediction of lymph node status is especially important for the formulation of treatment plans for patients with gastric cancer (GC). The purpose of this study was to establish decision rules and a risk assessment model for lymph node metastasis (LNM) in GC using preoperative indicators. Methods: The clinical data of 554 patients who underwent gastrectomy with D2 lymphadenectomy were collected. A 1:1 propensity score matching (PSM) system was used, and the clinical data of the matched 466 patients were further analyzed. The important risk factors for LNM were extracted by the random forest algorithm, and decision rules and nomogram models for LNM were constructed with a classification tree and the "rms" package of R software, respectively. Results: Tumor size (OR: 2.058; P = 0.000), computed tomography (CT) findings (OR: 1.969; P = 0.001), grade (OR: 0.479; P = 0.000), hemoglobin (Hb) (OR: 1.211; P = 0.005), CEA (OR: 1.111; P = 0.017), and CA19-9 (OR: 1.040; P = 0.033) were independent risk factors for LNM in GC. Tumor size did rank first in the ranking of important factors for LNM in GC and was the first-level segmentation of the two initial branches of the classification tree. The accuracy, sensitivity, specificity, and positive predictive value of the decision rules in diagnosing preoperative LNM in GC were 75.6, 85.7, 73.9, 73.5, and 79.3%, respectively. The accuracy, sensitivity, and specificity of the risk assessment model in predicting preoperative LNM in GC were 79.3, 80.3, and 79.4%, respectively. Conclusion: Tumor size was the most important factor for evaluating LNM in GC. This decision rules and nomogram model constructed to take into account tumor size, CT findings, grade, hemoglobin, CEA, and CA19-9 effectively predicted the incidence of LNM in preoperative GC.
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Affiliation(s)
| | | | | | | | | | - Zhengming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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25
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Mahyudin F, Edward M, Basuki MH, Basrewan Y, Hernugrahanto KD, Wahyudiputra AG. Analysis of prognostic factors in soft tissue sarcoma: Cancer registry from a single tertiary hospital in Indonesia. A retrospective cohort study. Ann Med Surg (Lond) 2020; 57:257-263. [PMID: 32884743 PMCID: PMC7453062 DOI: 10.1016/j.amsu.2020.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Soft tissue sarcoma is one cause of mortality in adult malignancies. This tumor is rare, persistent, and highly-recurrent. Many patients are came in late stage. It is important to identify a prognostic tool that is reliable, easily obtainable, and widely applicable. The aim of this study is to investigate and analyze the prognostic value of clinicopathological and biomarker factors in patients with soft tissue sarcoma. METHODS This retrospective study extracts data from the musculoskeletal tumor registry from January 2012 to December 2018 in a single tertiary hospital. Eighty patients with diagnosis of soft tissue sarcoma were included. Preoperative modified Glasgow Prognostic Score, Neutrophils/Lymphocytes Ratio, Hemoglobin, serum lactate dehydrogenase data were analyzed along with demographic, clinical, radiological and histopathological data. The relationship between variables on overall survival, distant metastasis, and local recurrence were evaluated using univariate and multivariate Cox regression. RESULTS On univariate analysis, there was significant relationship between hemoglobin, Neutrophils/Lymphocytes Ratio and modified Glasgow Prognostic Score with overall survival (p = 0.031, HR = 1.99; p = 0.04, HR = 1.129; and p = 0.044, HR = 3.89). A significant relationship was found between age and soft tissue sarcoma stage with distant metastasis (p = 0.046, HR = 1.95; and p = 0.00, HR = 3.22). In addition, we also found significant relationship between surgical margin with local recurrence (p = 0.018, OR = 3.44). However, on multivariate analysis the independent prognostic factor for overall survival was only modified Glasgow Prognostic Score (HR = 2.138; p = 0.011). Stage IIIA (HR = 5.32; p = 0.005) and IIIB (HR = 13.48; p = 0.00) were independent prognostic for distant metastasis. Surgical margin was independently associated with local recurrence (HR = 14.84; p = 0.001). CONCLUSION Modified Glasgow Prognostic Score can be used as prognostic tool of overall survival in soft tissue sarcoma patients. Moreover, stage of STS and surgical margin can be used as a prognostic factor for distant metastasis and local recurrence of soft tissue sarcoma respectively.
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Affiliation(s)
- Ferdiansyah Mahyudin
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Mouli Edward
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Muhammad Hardian Basuki
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Yunus Basrewan
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Kukuh Dwiputra Hernugrahanto
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Adhinanda Gema Wahyudiputra
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
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26
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Melo-Alvim C, Miguel-Semedo P, Paiva RS, Lobo-Martins S, Luna-Pais H, Costa AL, Santos AR, Florindo A, Vasconcelos AL, Abrunhosa-Branquinho AN, Palmela P, Fernandes L, Presa DL, Costa L, Ribeiro L. Pretreatment hemoglobin level as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma. Rep Pract Oncol Radiother 2020; 25:768-774. [PMID: 32802001 DOI: 10.1016/j.rpor.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/30/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
Aim Evaluate pretreatment hemoglobin values as a prognostic factor in patients with locally advanced head and neck squamous cell carcinoma treated with concurrent chemoradiotherapy. Background Anemia is one of the most prevalent laboratory abnormalities in oncological disease. It leads to a decrease in cellular oxygen supply, altering radiosensitivity of tumor cells and compromising therapeutic outcomes. Materials and Methods Retrospective evaluation of patients with HNSCC treated with cCRT. Primary and secondary endpoint was to evaluate the correlation of Hb levels (≥12.5 g/dL or <12.5 g/dL) at the beginning of cCRT with overall survival (OS) and progression-free survival (PFS), respectively. Results A total of 108 patients were identified. With a median follow-up of 16.10 months median OS was 59.70 months for Hb ≥12.5 g/dL vs. 14.13 months for Hb <12.5 g/dL (p = 0.004). PFS was 12.29 months for Hb ≥12.5 g/dL and 1.68 months for Hb <12.5 g/dL (p = 0.016). Conclusions In this analysis, Hb ≥12.5 g/dL correlated with significantly better OS and PFS. Further studies are needed to validate these findings.
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Affiliation(s)
- Cecília Melo-Alvim
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Patrícia Miguel-Semedo
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Rita Silva Paiva
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Soraia Lobo-Martins
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Helena Luna-Pais
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Ana Lúcia Costa
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Ana Rita Santos
- Otorhinolaryngology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - André Florindo
- Radiology Oncology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Ana Luísa Vasconcelos
- Radiology Oncology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - André N Abrunhosa-Branquinho
- Radiology Oncology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Paulo Palmela
- Stomatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Leonor Fernandes
- Imaging Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Dolores Lopez Presa
- Pathology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
| | - Luís Costa
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal.,Luís Costa Lab, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Leonor Ribeiro
- Medical Oncology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-035, Portugal
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27
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Kaisman-Elbaz T, Elbaz Y, Merkin V, Dym L, Noy A, Atar-Vardi M, Bari R, Turiel S, Alt A, Zamed T, Eskira Y, Lavrenkov K, Kezerle Y, Dyomin V, Melamed I. Hemoglobin Levels and Red Blood Cells Distribution Width Highlights Glioblastoma Patients Subgroup With Improved Median Overall Survival. Front Oncol 2020; 10:432. [PMID: 32426265 PMCID: PMC7212453 DOI: 10.3389/fonc.2020.00432] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma multiforme (GBM) is known for its dismal prognosis, though its dependence on patients' readily available RBCs parameters is not fully established. In this work, 170 GBM patients, diagnosed and treated in Soroka University Medical Center (SUMC) over the last 12 years were retrospectively inspected for their survival dependency on pre-operative RBCs parameters. Besides KPS and tumor resection supplemented by oncological treatment, age under 70 (HR = 0.4, 95% CI 0.24–0.65, p = 0.00073), low hemoglobin level (HR = 1.79, 95% CI 1.06–2.99, p = 0.031), and Red Cell Distribution Width (RDW) < 14% (HR = 0.57, 95% CI 0.37–0.88, p = 0.018) were found to be prognostic of patients' overall survival in multivariate analysis, accounting for a false discovery rate of < 5% due to multiple hypothesis testing. According to these results, a stratification tree was made, from which a favorable route highlighted a subgroup of nearly 30% of the cohorts' patients whose median overall survival was 21.1 months (95% CI 16.2–27.2)—higher than the established chemo-radiation standard first-line treatment regimen overall median survival average of about 15 months. The beneficial or detrimental effect of RBCs parameters on GBM prognosis and its possible causes is discussed.
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Affiliation(s)
- Tehila Kaisman-Elbaz
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yonatan Elbaz
- Physics Department, Nuclear Research Center - Negev, Be'er Sheva, Israel
| | - Vladimir Merkin
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Lianne Dym
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ariel Noy
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Maya Atar-Vardi
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
| | - Romi Bari
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
| | - Sivan Turiel
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel
| | - Adi Alt
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel
| | - Tali Zamed
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yael Eskira
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Konstantin Lavrenkov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Institute of Oncology, Soroka University Medical Center, Be'er Sheva, Israel
| | - Yarden Kezerle
- Institute of Pathology, Soroka University Medical Center, Be'er Sheva, Israel
| | - Victor Dyomin
- Institute of Pathology, Soroka University Medical Center, Be'er Sheva, Israel
| | - Israel Melamed
- Department of Neurosurgery, Soroka University Medical Center, Be'er Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Resveratrol and Its Nanoformulation Attenuate Growth and the Angiogenesis of Xenograft and Orthotopic Colon Cancer Models. Molecules 2020; 25:molecules25061412. [PMID: 32244860 PMCID: PMC7144556 DOI: 10.3390/molecules25061412] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
Cancer is a multifactorial disorder that induces mortality worldwide, and the colorectal type is the third most common cancer globally. Resveratrol (RSV) is a natural compound with an effective anticancer effect, especially against colorectal cancer, and therefore numerous studies recommended its use in colorectal cancer prevention and treatment. The current study investigated the effect of either RSV or its nanoformulation (NP-RSV) on the growth and vascularity of xenograft and orthotopic mice models in colon cancer (COLO205-luc). Both RSV and NP-RSV induced significant reductions in tumor growth and the hemoglobin percentages of the tumor mass, but NP-RSV showed greater bioavailability and efficacy than RSV. Generally, we recommend using NP-RSV as a therapeutic to control colon cancer.
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Abdel-Razeq H, Hashem H. Recent update in the pathogenesis and treatment of chemotherapy and cancer induced anemia. Crit Rev Oncol Hematol 2019; 145:102837. [PMID: 31830663 DOI: 10.1016/j.critrevonc.2019.102837] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Cancer and chemotherapy-induced anemia (CIA) is commonly encountered among patients undergoing active chemotherapy with or without radiation therapy. Its pathogenesis is complex and is often difficult to identify. Symptoms related to CIA may have a negative impact on quality of life and may influence treatment efficacy, disease progression and even survival. The recent major setback of erythropoietin-stimulating agents (ESAs) and the reluctance to transfuse cancer patients with mild and even moderate anemia, had resulted in significant under-treatment of CIA. The discovery of hepcidin and its role in iron homeostasis has revolutionized our understanding of the pathogenesis of iron deficiency and iron overload states. In the present review we examine the multifactorial pathogenesis of CIA, addressing the main mechanisms by which the tumor and immune system affect anemia. Additionally, we discuss the treatment options with more focus on the utilization of the new intravenous iron formulations for this indication.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Departments of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
| | - Hasan Hashem
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
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30
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Leś D, Saduś-Wojciechowska M, Rutkowski T, Wygoda A, Składowski K. The endogenous erythropoietin in correlation with other erythrocytic parameters in patients with head and neck squamous cell carcinoma treated with platinum-based induction chemotherapy. Contemp Oncol (Pozn) 2019; 23:178-182. [PMID: 31798335 PMCID: PMC6883964 DOI: 10.5114/wo.2019.89247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/21/2019] [Indexed: 12/27/2022] Open
Abstract
Between January 2017 and July 2018 103 patients were included in a prospective study of erythropoietin (EPO) monitoring. The group consisted of 33% patients with oropharynx, 29% with oral cavity, 13% with nasopharynx, 6% with larynx, 6% with hypopharynx, 8% with unknown primary cancer, 4% with nasal cavity, and 1% with salivary gland cancer. Clinic stage: T4 - 50, T3 - 21, T2 - 14, T1 - 10, T0 - 8, and N3 - 19, N2 - 61, N1 - 10, N0 - 13. All patients received from one to four cycles of induction chemotherapy. EPO was measured in blood serum by enzyme-labelled chemiluminescent immunometric assay, using an Immulite 2000XPi analyser before the administration and on day 11 of each chemotherapy cycle. During induction chemotherapy the EPO level was elevated in all patients, which is expressed by means of medians: 10.7 (p = 0.000001) in the middle of cycle 1; 10.9 (p = 0.66) before cycle 2; 14.35 (p = 0.000177) in the middle of cycle 2; 14.95 (p = 0.39) before cycle 3, 17.00 (p = 0.00078) in the middle of cycle 3, and 20.9 after cycle 3 (p = 0.41). The correlation analysis conducted indicates that the administration of one chemotherapy dose results in higher EPO release (two-fold increase in EPO concentration) which intensifies reticulocytes (REC) production but without haemoglobin concentration in reticulocytes (HGB-REC) growth. In consequence, it leads to a decrease in RBC and HGB concentration (29-32 cases). The administration of two and three chemotherapy doses results in the subsequent higher release of EPO, which does not intensify REC production. In consequence, anaemia increases (35 cases).
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Affiliation(s)
- Dominika Leś
- I Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Maria Saduś-Wojciechowska
- Department of Bone Marrow Transplantation and Haematology-Oncology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Tomasz Rutkowski
- I Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Andrzej Wygoda
- I Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Krzysztof Składowski
- I Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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31
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Li Z, Xu Z, Huang Y, Zhao R, Cui Y, Zhou Y, Wu X. Prognostic values of preoperative platelet-to-lymphocyte ratio, albumin and hemoglobin in patients with non-metastatic colon cancer. Cancer Manag Res 2019; 11:3265-3274. [PMID: 31114364 PMCID: PMC6489677 DOI: 10.2147/cmar.s191432] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/12/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose: Preoperative platelet-to-monocyte ratio (PLR), albumin and hemoglobin are suggested prognostic indicators in various malignancies. However, the prognostic values of PLR, albumin and hemoglobin remain elusive. The objective of the present study was to evaluate the prognostic values of PLR, albumin and hemoglobin in stage I-III colon cancer. Patients and methods: A total of 312 patients with non-metastatic colon cancer undergoing curative resection were enrolled in this study. The prognostic values of PLR, albumin and hemoglobin were identified by receiver operating characteristics, and univariate and multivariate analyses. Results: Univariate analysis revealed that preoperative PLR, albumin and hemoglobin were significantly associated with overall survival (OS) and that preoperative PLR and albumin were significantly associated with progression-free survival (PFS). Multivariate analysis revealed that preoperative PLR was significantly associated with OS. Conclusion: Reduced preoperative PLR was significantly associated with better OS in patients with stage I-III colon cancer. Preoperative PLR was an independent prognostic indictor for OS in patients with colon cancer undergoing curative resection.
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Affiliation(s)
- Zhigui Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Zhaofen Xu
- Department of Pathology, The Second People's Hospital, Neijiang, Sichuan 641000, People's Republic of China
| | - Yuqian Huang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Rui Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yaping Cui
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yong Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Xiaoting Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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32
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Topkan E, Ekici NY, Ozdemir Y, Besen AA, Yildirim BA, Mertsoylu H, Sezen D, Selek U. Baseline hemoglobin <11.0 g/dL has stronger prognostic value than anemia status in nasopharynx cancers treated with chemoradiotherapy. Int J Biol Markers 2019; 34:139-147. [PMID: 30864463 DOI: 10.1177/1724600818821688] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND To retrospectively investigate the influence of pretreatment anemia and hemoglobin levels on the survival of nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy (C-CRT). METHODS A total of 149 nasopharyngeal carcinoma patients who received C-CRT were included. All patients had received 70 Gy to the primary tumor plus the involved lymph nodes, and 59.4 Gy and 54 Gy to the intermediate- and low-risk neck regions concurrent with 1-3 cycles of cisplatin. Patients were dichotomized into non-anemic and anemic (hemoglobin <12 g/dL (women) or <13 g/dL (men)) groups according to their pre-treatment hemoglobin measures. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of a pre-treatment hemoglobin cut-off that impacts outcomes. Potential interactions between baseline anemia status and hemoglobin measures and overall survival, locoregional progression-free survival (LRPFS), and progression-free survival were assessed. RESULTS Anemia was evident in 36 patients (24.1%), which was related to significantly shorter overall survival (P=0.007), LRPFS (P<0.021), and progression-free survival (P=0.003) times; all three endpoints retained significance in multivariate analyses (P<0.05, for each). A baseline hemoglobin value of 11.0 g/dL exhibited significant association with outcomes in ROC curve analysis: hemoglobin <11.0 g/dL (N=26) was linked with shorter median overall survival (P<0.001), LRPFS (P=0.004), and progression-free survival (P<0.001) times, which also retained significance for all three endpoints in multivariate analyses and suggested a stronger prognostic worth for the hemoglobin <11.0 g/dL cut-off value than the anemia status. CONCLUSION Pre-C-CRT hemoglobin <11.0 g/dL has a stronger prognostic worth than the anemia status with regard to LRPFS, progression-free survival, and overall survival for nasopharyngeal carcinoma patients.
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Affiliation(s)
- Erkan Topkan
- 1 Baskent University Medical Faculty, Department of Radiation Oncology, Adana, Turkey.,2 Nicosia Dr. Burhan Nalbantoglu Goverment Hospital, Radiation Oncology Clinics, Nicosia, Turkish Republic of Northern Cyprus
| | - Nur Yücel Ekici
- 3 Adana City Hospital, Clinics of Otolaryngology, Adana, Turkey
| | - Yurday Ozdemir
- 1 Baskent University Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Ali Ayberk Besen
- 4 Baskent University Medical Faculty, Department of Medical Oncology, Adana, Turkey
| | - Berna Akkus Yildirim
- 1 Baskent University Medical Faculty, Department of Radiation Oncology, Adana, Turkey
| | - Hüseyin Mertsoylu
- 4 Baskent University Medical Faculty, Department of Medical Oncology, Adana, Turkey
| | - Duygu Sezen
- 5 Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey
| | - Ugur Selek
- 5 Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey.,6 The University of Texas, MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX, USA
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Shell JR, LaRochelle EP, Bruza P, Gunn JR, Jarvis LA, Gladstone DJ, Pogue BW. Comparison of phosphorescent agents for noninvasive sensing of tumor oxygenation via Cherenkov-excited luminescence imaging. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-8. [PMID: 30834723 PMCID: PMC6397946 DOI: 10.1117/1.jbo.24.3.036001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/01/2019] [Indexed: 05/20/2023]
Abstract
Cherenkov emission generated in tissue during radiotherapy can be harnessed for the imaging biochemistry of tissue microenvironments. Cherenkov-excited luminescence scanned imaging (CELSI) provides a way to optically and noninvasively map oxygen-related signals, which is known to correlate to outcomes in radiotherapy. Four candidate phosphorescent reagents PtG4, MM2, Ir(btb)2 ( acac ) , and MitoID were studied for oxygen sensing, testing in a progressive series of (a) in solution, (b) in vitro, and (c) in subcutaneous tumors. In each test, the signal strength and response to oxygen were assessed by phosphorescence intensity and decay lifetime measurement. MM2 showed the most robust response to oxygen changes in solution, followed by PtG4, Ir(btb)2 ( acac ) , and MitoID. However, in PANC-1 cells, their oxygen responses differed with Ir(btb)2 ( acac ) exhibiting the largest phosphorescent intensity change in response to changes in oxygenation, followed by PtG4, MM2, and MitoID. In vivo, it was only possible to utilize Ir(btb)2 ( acac ) and PtG4, with each being used at nanomole levels, to determine signal strength, lifetime, and pO2. Oxygen sensing with CELSI during radiotherapy is feasible and can estimate values from 1 mm regions of tissue when used in the configuration of this study. PtG4 was the most amenable to in vivo sensing on the timescale of external beam LINAC x-rays.
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Affiliation(s)
- Jennifer R. Shell
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Address all correspondence to Jennifer R. Shell, E-mail:
| | - Ethan P. LaRochelle
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Petr Bruza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Jason R. Gunn
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Lesley A. Jarvis
- Dartmouth College, Geisel School of Medicine, Hanover, New Hampshire, United States
| | - David J. Gladstone
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
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Jia MJ, Bruza P, Jarvis LA, Gladstone DJ, Pogue BW. Multi-beam scan analysis with a clinical LINAC for high resolution Cherenkov-excited molecular luminescence imaging in tissue. BIOMEDICAL OPTICS EXPRESS 2018; 9:4217-4234. [PMID: 30615721 PMCID: PMC6157777 DOI: 10.1364/boe.9.004217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/16/2018] [Accepted: 08/06/2018] [Indexed: 05/22/2023]
Abstract
Cherenkov-excited luminescence scanned imaging (CELSI) is achieved with external beam radiotherapy to map out molecular luminescence intensity or lifetime in tissue. Just as in fluorescence microscopy, the choice of excitation geometry can affect the imaging time, spatial resolution and contrast recovered. In this study, the use of spatially patterned illumination was systematically studied comparing scan shapes, starting with line scan and block patterns and increasing from single beams to multiple parallel beams and then to clinically used treatment plans for radiation therapy. The image recovery was improved by a spatial-temporal modulation-demodulation method, which used the ability to capture simultaneous images of the excitation Cherenkov beam shape to deconvolve the CELSI images. Experimental studies used the multi-leaf collimator on a clinical linear accelerator (LINAC) to create the scanning patterns, and image resolution and contrast recovery were tested at different depths of tissue phantom material. As hypothesized, the smallest illumination squares achieved optimal resolution, but at the cost of lower signal and slower imaging time. Having larger excitation blocks provided superior signal but at the cost of increased radiation dose and lower resolution. Increasing the scan beams to multiple block patterns improved the performance in terms of image fidelity, lower radiation dose and faster acquisition. The spatial resolution was mostly dependent upon pixel area with an optimized side length near 38mm and a beam scan pitch of P = 0.33, and the achievable imaging depth was increased from 14mm to 18mm with sufficient resolving power for 1mm sized test objects. As a proof-of-concept, in-vivo tumor mouse imaging was performed to show 3D rendering and quantification of tissue pO2 with values of 5.6mmHg in a tumor and 77mmHg in normal tissue.
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Affiliation(s)
- Mengyu Jeremy Jia
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
| | - Lesley A. Jarvis
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - David J. Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
- Norris Cotton Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
- Norris Cotton Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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Oei RW, Ye L, Huang J, Kong F, Xu T, Shen C, Wang X, He X, Kong L, Hu C, Ying H. Prognostic value of nutritional markers in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy: a propensity score matching study. Onco Targets Ther 2018; 11:4857-4868. [PMID: 30147337 PMCID: PMC6098427 DOI: 10.2147/ott.s165133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate the prognostic value of nutritional markers for survival in nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT), with or without chemotherapy. Patients and methods This retrospective study included 412 NPC patients who received IMRT-based treatment. Weight loss (WL) during treatment, hemoglobin level (Hb) and serum albumin level (Alb) before treatment were measured. The prognostic values of these markers for overall survival (OS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were analyzed using Kaplan-Meier method and Cox proportional hazards regression analysis. Propensity score matching was performed to reduce the effect of confounders. Results WL, Hb and Alb were significantly correlated with each other and inflammatory markers. Adjusted Cox regression analysis showed that critical weight loss (CWL) (WL≥5%) was an independent prognostic factor for OS (HR: 2.399, 95% CI: 1.267-4.540, P=0.007) and LRFS (HR: 2.041, 95% CI: 1.052-3.960, P=0.035), while low pretreatment Hb was independently associated with poor DMFS (HR: 2.031, 95% CI: 1.144-3.606, P=0.016). However, no significant correlation was found between Alb and survival in our study cohort. The prognostic value of these markers was further confirmed in the propensity-matched analysis. Conclusion CWL, Hb and Alb have a significant impact on survival in NPC patients undergoing IMRT. They can be utilized in combination with conventional staging system to predict the prognosis of NPC patients treated with IMRT.
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Affiliation(s)
- Ronald Wihal Oei
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Lulu Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Juan Huang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Fangfang Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Tingting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Chunying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Xiaoshen Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Lin Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
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Franco P, Montagnani F, Arcadipane F, Casadei C, Andrikou K, Martini S, Iorio GC, Scartozzi M, Mistrangelo M, Fornaro L, Cassoni P, Cascinu S, Ricardi U, Casadei Gardini A. The prognostic role of hemoglobin levels in patients undergoing concurrent chemo-radiation for anal cancer. Radiat Oncol 2018; 13:83. [PMID: 29720197 PMCID: PMC5930791 DOI: 10.1186/s13014-018-1035-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Concurrent chemo-radiation (CT-RT) is a standard therapy for squamous cell carcinoma of anal canal. Different clinical and biological factors may potentially affect outcome. We investigated the prognostic role of baseline hemoglobin (Hb) in a cohort of anal cancer patients submitted to CT-RT with 5-fluorouracil and mitomycin C. METHODS Up to 161 patients with clinical stage T1-T4/N0-N3/M0 were treated. Response was assessed at 6 weeks and thereafter at 3, 6 and 12 months. Two different approaches were used:a)simultaneous integrated boost following RTOG 05-29 indications;b)first sequence of 45Gy/25 fractions to the pelvis followed by 9-14.4 Gy/5-8 fractions to the macroscopic disease. Primary endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS On multivariate analysis, pre-treatment Hb level had a significant correlation to OS (HR:0.53;95% CI:0.33-0.87; p = 0.001), but not to PFS (HR:0.78;95% CI:0.53-1.15; p = 0.12) Patients with pre-treatment Hb ≥ 12 g/dl had 5-year PFS and OS of 82.2%, compared to 29.3% and 32.8% for those below the threshold. The likelihood to achieve a complete remission increased by 5.6% for every single-unit (g/dl) increase in baseline Hb level over 11 g/dl. On multivariate analysis, response to treatment had a significant correlation to PFS (incomplete vs complete response - HR:5.43;95% CI:2.75-10.7; p < 0.0001) and OS (HR: 6.96;95% CI:2.96-16.5; p < 0.0001). CONCLUSIONS We showed that baseline Hb level is a strong indicator for poor response to RT-CT in anal cancer patients. A close clinical monitoring for incomplete response to treatment should be advised in patients with low pre-treatment Hb. The hypothesis that the preservation of adequate Hb level during treatment may lead to a better outcome needs prospective evaluation.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin at AOU Citta' della Salute e della Scienza, Via Genova 3, 10126, Turin, Italy.
| | | | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Kalliopi Andrikou
- Modena Cancer Center, Department of Oncology/Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin at AOU Citta' della Salute e della Scienza, Via Genova 3, 10126, Turin, Italy
| | - Giuseppe Carlo Iorio
- Department of Oncology, Radiation Oncology, University of Turin at AOU Citta' della Salute e della Scienza, Via Genova 3, 10126, Turin, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | | | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paola Cassoni
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - Stefano Cascinu
- Modena Cancer Center, Department of Oncology/Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin at AOU Citta' della Salute e della Scienza, Via Genova 3, 10126, Turin, Italy
| | - Andrea Casadei Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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37
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Li J, Chen S, Peng S, Liu Y, Xing S, He X, Chen H. Prognostic nomogram for patients with Nasopharyngeal Carcinoma incorporating hematological biomarkers and clinical characteristics. Int J Biol Sci 2018; 14:549-556. [PMID: 29805306 PMCID: PMC5968847 DOI: 10.7150/ijbs.24374] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/16/2018] [Indexed: 12/27/2022] Open
Abstract
Predictive models for survival prediction in individual cancer patients following the tumor, node, and metastasis (TNM) staging system are limited. The survival rates of patients who share TNM stage diseases are diversified. Therefore, we established a nomogram in which hematological biomarkers and clinical characteristics for predicting the overall survival (OS) of nasopharyngeal carcinoma (NPC) patients were incorporated. The clinicopathological and follow-up data of 690 NPC patients who were histologically diagnosed histologically at the Sun Yat-sen University Cancer Center between July 2007 and December 2011 were retrospectively reviewed. Data was randomly divided into primary (n = 460) and validation groups (n = 230). Cox regression analysis was used to identify prognostic factors for building the nomogram in primary cohorts. The predictive accuracy and discriminative ability of the nomogram were measured by the concordance index (C-index) and decision curve, and were compared with the TNM staging system, Epstein-Barr virus DNA copy numbers (EBV DNA), or TMN stage plus EBV DNA. The results were internally validated by assessment of discrimination and calibration using the validation cohorts at the same institution. Independent factors selected into the nomogram for OS included age [hazard ratio (HR): 1.765; 95% confidence interval (CI): 1.008-3.090)], TNM stage (HR: 1.899; 95% CI: 1.023-3.525), EBV DNA (HR: 1.322; 95% CI: 1.087-1.607), lactate dehydrogenase level (LDH) (HR: 1.784; 95% CI: 1.032-3.086), high sensitivity C-reactive protein (hs-CRP) (HR: 1.840; 95% CI: 1.039-3.258), high-density lipoprotein cholesterol (HDL-C) (HR: 0.503; 95% CI: 0.282-0.896), hemoglobin (HGB) (HR: 0.539; 95% CI: 0.309-0.939) and lymphocyte to lymphocyte ratio (LMR) (HR:0.531; 95% CI: 0.293-0.962). The C-index in the primary cohort and validation cohort were 0.800 and 0.831, respectively, and were statistically higher when compared to C-index values for TNM stage (0.672 and 0. 716), EBV DNA (0.668 and 0.688), and TNM stage+ EBV DNA (0. 732 and 0. 760), P < 0.001 for all. Moreover, the decision curve analyses demonstrated that the nomogram model had a higher overall net benefit compared to the TNM staging system, EBV DNA and TNM stage+ EBV DNA. Next, patients were divided into three distinct risk groups for OS based on total points (TPs) of the nomogram: a low-risk group (TPs ≤ 19.0), an intermediate risk group (19.0 < TPs ≤ 25.5) and a high risk group (TPs > 25.5), respectively. The nomogram predicting prognosis generated for NPC patients had a higher predictive power compared to the TNM staging system, EBV DNA, and TNM stage+ EBV DNA.
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Affiliation(s)
- Jianpei Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Shulin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Songguo Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yijun Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Shan Xing
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xia He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hao Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Wei YS, Zhou YG, Wang GY, Liang ZH, Luo MR, Yang TA, Huang J. The impact of chemotherapy-associated hemoglobin on prognosis of colorectal cancer patients receiving adjuvant chemotherapy. Cancer Biomark 2017; 20:627-635. [PMID: 28800321 DOI: 10.3233/cbm-170601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The association of chemotherapy-associated hemoglobin and survival of colorectal cancer (CRC) receiving adjuvant chemotherapy is uncertain. We sought to explore the prognostic value of chemotherapy-associated hemoglobin in CRC receiving adjuvant chemotherapy and the best cut point affecting prognosis. METHODS Three hundred and twenty stage II and III CRC patients receiving adjuvant FOLFOX chemotherapy from March 2003 to March 2012 were enrolled. The associations between chemotherapy-associated hemoglobin (the absolute levels of post-chemotherapy) or chemotherapy-associated hemoglobin change (change between the pre- and post-chemotherapy hemoglobins) and disease free survival (DFS) or overall survival (OS) of CRC, and the best cut point were investigated. RESULTS Log rank test showed the best cut points for chemotherapy-associated hemoglobin and chemotherapy-associated hemoglobin change were respectively 90 g/L, 30 g/L. Cox regression model showed chemotherapy-associated hemoglobin < 90 g/L was the independent prognostic factor for DFS (HR, 2.221; 95% CI = 1.157-4.262), OS (HR, 2.058; 95% CI = 1.009-4.197), respectively, but no association of chemotherapy-associated hemoglobin change ⩾ 30g/L and DFS (HR, 2.063; 95% CI = 0.929-4.583), OS (HR, 1.386; 95% CI = 0.553-3.471) was found. CONCLUSIONS Chemotherapy-associated hemoglobin < 90 g/L has a significant prognostic value in CRC receiving adjuvant chemotherapy, which is a significant biomarker in the individualized management and may suggest the simple indication for the treatment of anemia in adjuvant chemotherapy in CRC.
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Affiliation(s)
- Yi-Sheng Wei
- Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
- Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou 511436, Guangdong, China
| | - Ya-Guang Zhou
- Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
| | - Guo-Ying Wang
- Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong, China
- Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
| | - Zhi-Hua Liang
- Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
| | - Min-Rui Luo
- Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
| | - Tian-Ai Yang
- Department of General Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
| | - Jun Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, China
- Department of Gastrointestinal Surgery, Lab of Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China
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Hierarchical clustering analysis identifies metastatic colorectal cancers patients with more aggressive phenotype. Oncotarget 2017; 8:87782-87794. [PMID: 29152120 PMCID: PMC5675672 DOI: 10.18632/oncotarget.21213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022] Open
Abstract
A large percentage of metastatic colorectal cancer (mCRC) patients presents metastasis at the time of diagnosis. In the last years, great efforts have been made in the treatment of these patients with the identification of different phenotypes playing a key role in the definition of new systemic therapies. Unsupervised hierarchical clustering analysis (HCA) was performed considering the clinicopathological characteristics of 51 mCRCs. Using immunohistochemistry on tissue microarrays, we assessed the expression of β-catenin, NHERF1, RASSF1A, TWIST1, HIF-1α proteins in tumors and paired liver metastases. We also analyzed RASSF1A methylation status on the samples of the same patients. HCA distinguished Group 1 and Group 2 characterized by different clinicopathological features. Group 1 was characterized by higher number of positive lymph nodes (p=0.0139), poorly differentiated grade (p<0.0001) and high extent of tumor spread (p=0.0053) showing a more aggressive phenotype compared to Group 2. In both Groups, we found a common "basal" condition with a higher level of nuclear TWIST1 (p<0.0001 and cytoplasmic β-catenin (p<0.0001) in tumors than in paired liver metastases. Furthermore, the Group 1 was also characterized by RASSF1A hypermethylation (p<0.0001) and nuclear HIF-1α overexpression (p=0.0354) in paired liver metastases than in tumors. In conclusion, HCA identifies mCRC patients with a more aggressive phenotype. Moroever, our results support the important contribution to the progression of the disease of RASSF1A methylation and the oncogenic role of HIF-1α in these patients. These evidences, should provide relevant information concerning the biology of this tumor and, as a consequence, potential new systemic therapeutic approaches.
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40
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Differences in outcome for cervical cancer patients treated with or without brachytherapy. Brachytherapy 2017; 16:133-140. [DOI: 10.1016/j.brachy.2016.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/09/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023]
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The effect of low hemoglobin levels on outcomes of radiotherapy following microscopically complete resection of locally advanced SCCHN: Implications for the future. J Craniomaxillofac Surg 2016; 44:1441-4. [DOI: 10.1016/j.jcms.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/27/2016] [Accepted: 07/01/2016] [Indexed: 12/27/2022] Open
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Li X, Heldermon CD, Yao L, Xi L, Jiang H. High resolution functional photoacoustic tomography of breast cancer. Med Phys 2016; 42:5321-8. [PMID: 26328981 DOI: 10.1118/1.4928598] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the feasibility of functional photoacoustic tomography (fPAT) for high resolution detection and characterization of breast cancer and to demonstrate for the first time quantitative hemoglobin concentration and oxygen saturation images of breasts that were formed with model-based reconstruction of tomographic photoacoustic data. METHODS The study was HIPAA compliant and was approved by the university institutional review board. Written informed consents were obtained from all the participants. Ten cases, including six cancer and four healthy (mean age = 50 yr; age range = 41-66 yr), were examined. Functional images of breast tissue including absolute total hemoglobin concentration (HbT) and oxygen saturation (StO2%) were obtained by fPAT and cross validated with magnetic resonance imaging (MRI) readings and/or histopathology. RESULTS HbT and StO2% maps from all six pathology-confirmed cancer cases (60%) show clear detection of tumor, while MR images indicate clear detection of tumor for five of six cancer cases; one small tumor was read as near-complete-resolution by MRI. The average HbT and StO2% value of suspicious lesion area for the cancer cases was 61.6 ± 18.9 μM/l and 67.5% ± 5.2% compared to 25.6 ± 7.4 μM/l and 65.2% ± 3.8% for background normal tissue. CONCLUSIONS fPAT has the potential to be a significant add-on in breast cancer detection and characterization as it provides submillimeter resolution functional images of breast lesions.
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Affiliation(s)
- Xiaoqi Li
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611
| | - Coy D Heldermon
- Department of Medicine, University of Florida, Gainesville, Florida 32611
| | - Lei Yao
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611
| | - Lei Xi
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611
| | - Huabei Jiang
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611
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Horsman MR, Vaupel P. Pathophysiological Basis for the Formation of the Tumor Microenvironment. Front Oncol 2016; 6:66. [PMID: 27148472 PMCID: PMC4828447 DOI: 10.3389/fonc.2016.00066] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/07/2016] [Indexed: 12/27/2022] Open
Abstract
Poor microenvironmental conditions are a characteristic feature of solid tumors. Such conditions occur because the tumor vascular supply, which develops from the normal host vasculature by the process of angiogenesis, is generally inadequate in meeting the oxygen and nutrient demands of the growing tumor mass. Regions of low oxygenation (hypoxia) is believed to be the most critical deficiency, since it has been well documented to play a significant role in influencing the response to conventional radiation and chemotherapy treatments, as well as influencing malignant progression in terms of aggressive growth and recurrence of the primary tumor and its metastatic spread. As a result, significant emphasis has been placed on finding clinically applicable approaches to identify those tumors that contain hypoxia and realistic methods to target this hypoxia. However, most studies consider hypoxia as a single entity, yet we now know that it is multifactorial. Furthermore, hypoxia is often associated with other microenvironmental parameters, such as elevated interstitial fluid pressure, glycolysis, low pH, and reduced bioenergetic status, and these can also influence the effects of hypoxia. Here, we review the various aspects of hypoxia, but also discuss the role of the other microenvironmental parameters associated with hypoxia.
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Affiliation(s)
- Michael R Horsman
- Department of Experimental Clinical Oncology, Aarhus University Hospital , Aarhus , Denmark
| | - Peter Vaupel
- Department of Radiooncology and Radiotherapy, Klinikum rechts der Isar, Technische Universität München (TUM) , Munich , Germany
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3rd Mediterranean Multidisciplinary Course on Iron Anemia April, 17(th)-18(th) 2015, Rome, Italy. Expert Rev Hematol 2016; 8 Suppl 1:S1-S32. [PMID: 25991086 DOI: 10.1586/17474086.2015.1044965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Oblak I, Cesnjevar M, Anzic M, Hadzic JB, Ermenc AS, Anderluh F, Velenik V, Jeromen A, Korosec P. The impact of anaemia on treatment outcome in patients with squamous cell carcinoma of anal canal and anal margin. Radiol Oncol 2016; 50:113-20. [PMID: 27069457 PMCID: PMC4825341 DOI: 10.1515/raon-2015-0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/22/2014] [Indexed: 12/27/2022] Open
Abstract
Background Radiochemotherapy is the main treatment for patients with squamous cell carcinoma of the anal canal. Anaemia is reported to have adverse effect on survival in cancer patients. The aim of the study was to evaluate the influence of anaemia on radiochemotherapy treatment outcome in patients with squamous cell carcinoma of the anal canal. Patients and methods One hundred consecutive patients with histologically confirmed squamous cell carcinoma of the anal canal were treated radically with 3-dimensional conformal or intensity-modulated radiation therapy followed by brachytherapy or external beam radiotherapy boost and with concurrent mitomycin C and 5-fluorouracil. The influence on survival of pre-treatment, mean on-treatment and end-of-treatment haemoglobin (Hb) concentrations was studied. Results The 5-year locoregional control, disease free survival, disease specific survival and overall survival rates for all patients were 72%, 71%, 77% and 62%, respectively. In univariate analysis, patients with pre-treatment and end-of-treatment Hb > 120 g/L survived statistically significantly better compared to patients with Hb ≤ 120 g/L. Patients with mean on-treatment Hb > 120 g/L only had statistically significant better locoregional control and overall survival than patients with Hb ≤ 120 g/L. In multivariate analysis, independent prognostic factors were pre-treatment Hb (> 120 g/L vs. ≤ 120 g/L) for overall survival (hazard ratio [HR] = 0.419, 95% confidence interval [CI] = 0.190–0.927, p = 0.032) and stage (I & II vs. III) for disease specific (HR = 3.523, 95% CI = 1.375–9.026, p = 0.009) and overall survival (HR = 2.230, 95% CI = 1.167–4.264, p = 0.015). Conclusions The pre-treatment, mean on-treatment and end-of-treatment Hb concentration > 120 g/L carried better prognosis for patients for with squamous cell carcinoma of the anal canal treated with radiochemotherapy. The pre-treatment Hb > 120 g/L was an independent prognostic factor for overall survival of patients with anal canal cancer.
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Affiliation(s)
| | - Monika Cesnjevar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mitja Anzic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna But Hadzic
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ajra Secerov Ermenc
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Franc Anderluh
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Ana Jeromen
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Peter Korosec
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Clavo B, Santana-Rodríguez N, Llontop P. In Regard to Shenouda et al. Int J Radiat Oncol Biol Phys 2015; 93:939-40. [PMID: 26530770 DOI: 10.1016/j.ijrobp.2015.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Bernardino Clavo
- Radiation Oncology and Experimental Surgery-Research Unit, Dr Negrin University Hospital, Las Palmas, Spain; Canary Islands Institute for Cancer Research, Las Palmas, Spain; Grupo de Investigación Clínica en Oncología Radioterápica, Madrid, Spain
| | | | - Pedro Llontop
- Experimental Surgery-Research Unit, Dr Negrin University Hospital, Las Palmas, Spain
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47
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Pretreatment anemia and survival in nasopharyngeal carcinoma. Tumour Biol 2015; 37:2225-31. [PMID: 26358251 DOI: 10.1007/s13277-015-4042-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/02/2015] [Indexed: 12/27/2022] Open
Abstract
Due to the low incidence of pretreatment anemia in nasopharyngeal carcinoma (NPC), the true prognostic impact of pretreatment anemia may be underestimated before. We retrospectively analyzed the association of pretreatment anemia with disease-specific survival (DSS), distant-metastasis-free survival (DMFS), and locoregional-relapse-free survival (LRFS) by Cox regression in a cohort of 5830 patients, stratifying by midtreatment anemia, smoking, body mass index (BMI), etc. Pretreatment anemia was significantly associated with adverse DSS (hazard ratio (HR) = 2.15, 95 % confidence interval (CI) 1.62-2.85, P < 0.001) and DMFS (HR = 1.53, 95 % CI 1.08-2.17, P = 0.018), comparing to patients with normal hemoglobin, after adjusting for covariates. Moreover, the association with DSS remained unchanged regardless of smoking status and clinical stage, whereas it was limited in the subgroups of above 45 years, male sex, and BMI <25 kg/m(2). With restriction to midtreatment anemic patients, pretreatment anemia was still strongly correlated with inferior DSS and DMFS. This study, in the largest reported cohort, is the first to show the adverse prognostic impact of pretreatment anemia on DSS and DMFS in NPC.
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Thakur P, Seam RK, Gupta MK, Rastogi M, Gupta M, Bhattacharyya T, Sharma M, Revannasiddaiah S. Comparison of Effects of Hemoglobin Levels Upon Tumor Response among Cervical Carcinoma Patients Undergoing Accelerated Hyperfractionated Radiotherapy versus Cisplatin Chemoradiotherapy. Asian Pac J Cancer Prev 2015; 16:4285-9. [DOI: 10.7314/apjcp.2015.16.10.4285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Shenouda G, Zhang Q, Ang KK, Machtay M, Parliament MB, Hershock D, Suntharalingam M, Lin A, Rotman M, Nabid A, Hong S, Shehata S, Cmelak AJ, Sultanem K, Le QT. Long-term results of radiation therapy oncology group 9903: a randomized phase 3 trial to assess the effect of erythropoietin on local-regional control in anemic patients treated with radiation therapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2015; 91:907-15. [PMID: 25670542 DOI: 10.1016/j.ijrobp.2014.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/27/2014] [Accepted: 12/08/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE This paper reports long-term results of RTOG 9903, to determine whether the addition of erythropoietin (EPO) would improve the outcomes of radiation therapy (RT) in mildly to moderately anemic patients with head and neck squamous cell carcinoma (HNSCCa). METHODS AND MATERIALS The trial included HNSCCa patients treated with definitive RT. Patients with stage III or IV disease received concomitant chemoradiation therapy or accelerated fractionation. Pretreatment hemoglobin levels were required to be between 9.0 and 13.5 g/dL (12.5 g/dL for females). EPO, 40,000 U, was administered weekly starting 7 to 10 days before RT was initiated in the RT + EPO arm. RESULTS A total of 141 of 148 enrolled patients were evaluable. The baseline median hemoglobin level was 12.1 g/dL. In the RT + EPO arm, the mean hemoglobin level at 4 weeks increased by 1.66 g/dL, whereas it decreased by 0.24 g/dL in the RT arm. With a median follow-up of 7.95 years (range: 1.66-10.08 years) for surviving patients and 3.33 years for all patients (range: 0.03-10.08 years), the 5-year estimate of local-regional failure was 46.2% versus 39.4% (P=.42), local-regional progression-free survival was 31.5% versus 37.6% (P=.20), and overall survival was 36.9% versus 38.2% (P=.54) for the RT + EPO and RT arms, respectively. Late toxicity was not different between the 2 arms. CONCLUSIONS This long-term analysis confirmed that despite the ability of EPO to raise hemoglobin levels in anemic patients with HNSCCa, it did not improve outcomes when added to RT. The possibility of a detrimental effect of EPO could not be ruled out.
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Affiliation(s)
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center
| | - K Kian Ang
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Diane Hershock
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | | | - Alexander Lin
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Marvin Rotman
- Brooklyn Minority-based Community Clinical Oncology Program, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Abdenour Nabid
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke (Québec), Québec, Canada
| | | | - Sarwat Shehata
- Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada
| | | | | | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, California
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Zhang Y, Chen Y, Chen D, Jiang Y, Huang W, Ouyang H, Xing W, Zeng M, Xie X, Zeng W. Impact of preoperative anemia on relapse and survival in breast cancer patients. BMC Cancer 2014; 14:844. [PMID: 25406979 PMCID: PMC4242544 DOI: 10.1186/1471-2407-14-844] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/04/2014] [Indexed: 02/06/2023] Open
Abstract
Background Previous studies have shown that preoperative anemia is correlated with the
prognoses of various solid tumors. This study was performed to determine the
effect of preoperative anemia on relapse and survival in patients with breast
cancer. Methods A total of 2960 patients with breast cancer who underwent surgery between 2002
and 2008 at the Sun Yat-sen University Cancer Center (Guangzhou, PR China) were
evaluated in a retrospective analysis. A total of 2123 qualified patients were
divided into an anemic group [hemoglobin (Hb) < 12.0 g/dL, N = 535)] and a
nonanemic group (Hb ≥ 12.0 g/dL, N = 1588). The effects of anemia on local
relapse-free survival (LRFS), lymph node metastasis-free survival (LNMFS), distant
metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival
(OS) were assessed using Kaplan–Meier analysis. Independent prognostic factors
were identified in the final multivariate Cox proportional hazards regression
model. Results Among the 2123 women who qualified for the analysis, 535 (25.2%) had a Hb
level < 12.0 g/dL. The Kaplan–Meier curves showed that anemic patients had
worse LRFS, LNMFS, DMFS, RFS, and OS than nonanemic patients, even in the same
clinical stage of breast cancer. Cox proportional hazards regression model
indicated that preoperative anemia was an independent prognostic factor of LRFS,
LNMFS, DMFS, RFS, and OS for patients with breast cancer. Conclusions Preoperative anemia was independently associated with poor prognosis of
patients with breast cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Weian Zeng
- Anesthesiology Department, State Key Laboratory in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, PR China.
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