Persistent lymphopenia after chemotherapy and/or radiotherapy predicted unfavorable outcome in breast cancer patients - a retrospective cohort study
Minjun DongWenying ZhuoLiang LuoLixi LuoJianguo ShenHaitao YuYi LuDanzhi ChenWenjun ChenWenhe ZhaoLinbo WangZhongyu Wu
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Abstract Background: Lymphopenia was often observed during follow-up for cancer patients, this study aimed to evaluate the prognostic value of prolonged lymphopenia for breast cancer patients. Methods: This was a retrospective cohort analysis of 296 patients with clinical stage I-III operable breast cancer, who had received chemotherapy and/or radiotherapy. Absolute lymphocyte count lower than 1.1×10^3/ul was defined as lymphopenia. Lymphopenia around the 6 th month after chemo-radiotherapy was defined as cohort L, while normal Absolute lymphocyte count was defined as cohort N. Predictors of lymphopenia were assessed using univariate and multivariate logistic regression analyses. Kaplan–Meier and Cox regression analyses were used to evaluate the relationship between the two cohorts. Results: The baseline characteristics analysis: comparing to cohort N, cohort L had more Stage III(47.4% vs. 25.5%) and less Stage I cancer(12.3% vs. 20.1%)(p=0.005), more patients experienced combined chemotherapy regimen(86.0% vs. 69.5%, p=0.012), more patients experienced radiotherapy(78.9% vs. 64.9%, p=0.041), and less patients experienced endocrine therapy(54.4% vs. 68.2%, p=0.049). Multivariate logistic regression analysis revealed two negative independent factors associated with DFS: pTNM staging (stage II vs. I: HR=5.346, 95% CI: 2.286-12.504, p<0.001; stage III vs. II: HR=3.089, 95% CI:1.739-5.487, p<0.001), and ALC status 6 months after chemo- and/or radiotherapy (HR=2.445, 95% CI: 1.577-3.788, p<0.001). Cohort L had significantly shorter DFS (log rank: p< 0.001), as well as significantly shorter OS (log rank: p< 0.001). Conclusion: Persistent lymphopenia after chemotherapy and/or radiotherapy was an independent predictor for breast cancer relapse and unfavorable survival.Keywords:
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Breast-conserving surgery
Distant metastasis
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To study the clinical effect of surgery combined with chemotherapy and radiotherapy in children with central primitive neuroectodermal tumor (cPNET), as well as the risks factors for poor prognosis.A retrospective analysis was performed for the clinical data of 42 children who were diagnosed with cPNET from June 2012 to September 2018.The 42 children had a median overall survival (OS) time of 2.0 years and a median event-free survival (EFS) time of 1.3 years; the 1-, 3-, and 5-year OS rates were 76.2%±6.6%, 41.4%±8.7%, 37.3%±8.8% respectively, and the 1-, 3-, and 5-year EFS rates were 64.3%±7.4%, 32.7%±8.0%, 28.0%±8.1% respectively. The univariate analysis showed that there were significant differences in the OS and EFS rates among the children with different patterns of surgical resection, chemotherapy cycles, and risk grades (P<0.05), and there was also a significant difference in the OS rate between the children receiving radiotherapy and those not receiving radiotherapy (P<0.05). The multivariate Cox regression analysis showed that chemotherapy cycles and risk grade were independent influencing factors for EFS and OS rates (P<0.05). The EFS and OS rates increased with the increase in chemotherapy cycles and the reduction in risk grade.Multimodality therapy with surgery, chemotherapy, and radiotherapy is an effective method for the treatment of cPNET in children. Early diagnosis and treatment and adherence to chemotherapy for as long as possible may improve EFS and OS rates.
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Object: Hodgkin lymphoma (HL) is one of the pediatric and adult cancers, with treatment of chemotherapy alone or combined with radiotherapy (RT). Considering the complications of RT, we aimed to evaluate the consequences and outcomes of the treatment with and without RT in a retrospective study. Method: We carried a cross-sectional retrospective study by referring and review of records for all patients admitted in Motahari hospital with HL diagnosis from 1995 to 2016. The staging of disease was classified by the Ann Arbor staging system. Results: 35 patients enrolled in our study that 54.3% were female and 45.7% were male patients. The mean age of patients was 10.08±6.38 years. 10 (28.6%) cases classified in stage 1, 13 (37.1%) case in stage 2, 9 (25.7%) cases in stage 3, and 3 (8.6%) cases in stage 4. 30 patients (85.7%) were treated by chemotherapy and 5 (14.3%) patients with chemotherapy and radiation combination. In our study, the overall survival was 97.1% of patients who treated with chemotherapy alone and one patient died due to drug side effects. That is comparable with the result of other studies that treated patients with chemotherapy and radiotherapy. Conclusion: According to our findings chemotherapy without radiotherapy as initial treatment in Hodgkin lymphoma would have similar results of concomitant radiotherapy and chemotherapy, so with consideration of cost and harms of radiation therapy, we suggest a limitation of radiation therapy to patients with resistant disease that do not respond to chemotherapy solo-protocols.
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Objective To analyze the prognostic factors affecting long-term results in the elderly patients with nasopharyngeal carcinoma(NPC) . Methods From Jaunary 2004 to Jaunary 2007,134 newly diagnosed patients with NPC aged 61-76 years old were treated in our hospital. The prognostic factors were investigated by univariate and multivariate analysis. Results The 3-year and 5-year overall survival rate and cancer specific survival rate of the 134 elderly patients with NPC was 66. 7% ,41. 7% and 72. 5% ,53. 1% ,respectively. The clinical stage,T stage,N stage,radiotherapy interruption,local tumor and regional neck lymph nodes response,anaemia,combined chemotherapy were significant prognostic factors of survival rates by single factor analysis(P 0. 05) . Multivariate analysis showed that clinical stage,radiotherapy interruption,regional neck lymph nodes response,anaemia were independent risk factors. Conclusions Radiotherapy is an effective way to treat aged patients with NPC. Clinical stage,radiotherapy interruption,anaemia and regional neck lymph nodes response can affect the prognosis of aged patients with NPC.
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Background and purpose:Non-small cell lung cancer (NSCLC) is the most frequent histological type of the lung cancer. There are significant differences of prognoses among the patients with advanced NSCLC patients after chemotherapy. The purpose of this study was to explore the prognostic factors of advanced NSCLC patients after chemotherapy. Methods:204 advanced NSCLC patients after chemotherapy were enrolled in the Oncology Center of Shandong Provincial Hospital from Feb.1998 to Jul.2006. Kaplan-Meier method and Log-rank time series analysis for the univariate analysis and Cox proportional hazard model for the multivariate analysis were used. Results:The median survival time was 12 .2 months, 1 year survival rate was 54.9%. The univariate analysis suggested that TNM staging (P=0.0075), KPS scoring (P=0.0151), chemotherapy regiman (P=0.0325), the chemotherapy cycles (P=0.0298) and the status of patients’ immediate response to the treatment (P=0.0061) significantly influenced survival of NSCLC. Multivariate analysis suggested that KPS scoring (P=0.019), TNM staging (P=0.011), and the status of patients’ immediate response to the treatment (P=0.009) were the independent factors of survival. Conclusion:KPS scoring, TNM staging and the status of patients’ immediate response to the treatment are the independent prognostic factors for advanced NSCLC patients after chemotherapy.
Univariate analysis
Univariate
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Introduction: Hodgkin lymphoma (HL) is one of the pediatric and adult cancers, with the treatment of chemotherapy alone or combined with radiotherapy. Objectives: We aimed to evaluate the consequences and outcomes of the treatment with or without radiotherapy in a retrospective study. Patients and Methods: We carried out a cross-sectional retrospective study by referring and reviewing records for all patients admitted to Motahari hospital with HL diagnosis from 1995 to 2016. The Ann Arbor staging system classified the staging of disease. Results: Totally, 35 patients enrolled in our study that 54.3% were female, and 45.7% were male patients. The mean age of patients was 10.08±6.38 years. 10 (28.6%) cases classified in stage 1, 13 (37.1%) case in stage 2, 9 (25.7%) cases in stage 3, and 3 (8.6%) cases in stage 4. 30 patients (85.7%) were treated by chemotherapy and 5 (14.3%) patients with chemotherapy and radiation combination. In our study, the overall survival was 97.1% of patients treated with chemotherapy alone, and one patient died due to drug side effects. That is comparable with other studies that treated patients with chemotherapy and radiotherapy. Conclusion: According to our findings, chemotherapy without radiotherapy as initial treatment in HL would have similar results to concomitant radiotherapy and chemotherapy, so considering the cost and harms of radiotherapy, we suggest a limitation of radiotherapy to patients with resistant diseases that do not respond to chemotherapy solo-protocols.
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Objective To investigate the effect of PR expression on the sensitivity of chemotherapy with TC regimen in locally advanced breast cancer patients.Methods The expression of PR was detected by EnVision immunohistochemistry in breast cancer tissues before neoadjuvant chemotherapy with TC regimen in corresponding patients,and the correlation of PR expression with the sensitivity of chemotherapy were studied in 57 PR negative or positive patients.Results The sensitivity was 81.48%(22/27)in PR negative breast tumours,and was 53.33%(16/30) in PR positive breast tumours with TC regimen in locally advanced breast cancer patients,and there was significant difference of sensitivity between breast cancer patients with PR negative and positive tumours(P0.05).Conclusion PR negative breast cancer patients were more sensitive to neoadjuvant chemotherapy.PR negative may serve as one of good markers for prediction of sensitivity of neoadjuvant chemotherapy with TC regimen in locally advanced breast cancer patients.
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Chemotherapy regimen
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A survival benefit of patients with inoperable non-small cell lung cancer has been reported since a development of new therapeutic agents in the 1990's. However, multivariate analyses of patients have not been evaluated. The aim of this study is to identify prognostic factors in the long-term survivors who had been treated with chemotherapy using these new agents and/or radiotherapy. A retrospective study and clinical analysis of 121 inoperable nonsmall cell lung cancer patients were conducted. Fifteen cases (male: 9, female: 6) with a survival of more than 2 years were revealed. Regarding clinical variables between the 15 cases and others, an early nodal (N) status, a high serum protein level, a good performance status (PS) and those having first-line chemotherapy or radiotherapy were all identified as significant prognostic factors for the long-term survivors. Multivariate analyses also revealed that an early N status, a good PS, female gender and chemotherapy and/or radiotherapy were associated with the long-term survivors. These results suggest that patients with inoperable non-small cell lung cancer should be considered for appropriate treatments including new chemotherapeutic agents.
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Univariate analysis
External beam radiotherapy
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