Efficacy of High-Intensity Local Treatment for Metastatic Urothelial Carcinoma of the Bladder: A Propensity Score–Weighted Analysis From the National Cancer Data Base

2016 ◽  
Vol 34 (29) ◽  
pp. 3529-3536 ◽  
Author(s):  
Thomas Seisen ◽  
Maxine Sun ◽  
Jeffrey J. Leow ◽  
Mark A. Preston ◽  
Alexander P. Cole ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Urothelial Carcinoma ◽  
High Intensity ◽  
Cox Regression ◽  
Local Treatment ◽  
National Cancer Data Base ◽  
Cancer Data ◽  
Kaplan Meier ◽  
Metastatic Urothelial Carcinoma ◽  
Carcinoma Of The Bladder

Purpose Evidence from studies of other malignancies has indicated that aggressive local treatment (LT), even in the presence of metastatic disease, is beneficial. Against a backdrop of stagnant mortality rates for metastatic urothelial carcinoma of the bladder (mUCB) at presentation, we hypothesized that high-intensity LT of primary tumor burden, defined as the receipt of radical cystectomy or ≥ 50 Gy of radiation therapy delivered to the bladder, affects overall survival (OS). Patients and Methods We identified 3,753 patients within the National Cancer Data Base who received multiagent systemic chemotherapy combined with high-intensity versus conservative LT for primary mUCB. Patients who received no LT, transurethral resection of the bladder tumor alone, or < 50 Gy of radiation therapy delivered to the bladder were included in the conservative LT group. Inverse probability of treatment weighting (IPTW) –adjusted Kaplan-Meier curves and Cox regression analyses were used to compare OS of patients who received high-intensity versus conservative LT. Results Overall, 297 (7.91%) and 3,456 (92.09%) patients with mUCB received high-intensity and conservative LT, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer in the high-intensity LT group than in the conservative LT group (14.92 [interquartile range, 9.82 to 30.72] v 9.95 [interquartile range, 5.29 to 17.08] months, respectively; P < .001). Furthermore, in IPTW-adjusted Cox regression analysis, high-intensity LT was associated with a significant OS benefit (hazard ratio, 0.56; 95% CI, 0.48 to 0.65; P < .001). Conclusion We report an OS benefit for individuals with mUCB treated with high-intensity versus conservative LT. Although the findings are subject to the usual biases related to the observational study design, these preliminary data warrant further consideration in randomized controlled trials, particularly given the poor prognosis associated with mUCB.

scholarly journals Combined high-intensity local treatment and systemic therapy in metastatic head and neck squamous cell carcinoma: An analysis of the National Cancer Data Base

Cancer ◽  
2017 ◽  
Vol 123 (23) ◽  
pp. 4583-4593 ◽  
Author(s):  
Zachary S. Zumsteg ◽  
Michael Luu ◽  
Emi J. Yoshida ◽  
Sungjin Kim ◽  
Mourad Tighiouart ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Data Base ◽  
Squamous Cell ◽  
Systemic Therapy ◽  
High Intensity ◽  
Local Treatment ◽  
National Cancer Data Base ◽  
Cancer Data

Use of Adjuvant Chemotherapy, Radiation Therapy, or Combined Modality Therapy and the Impact on Survival for Uterine Carcinosarcoma Limited to the Pelvis

2017 ◽  
Vol 27 (6) ◽  
pp. 1171-1177 ◽  
Author(s):  
Andrew T. Wong ◽  
Yi-Chun Lee ◽  
David Schwartz ◽  
Anna Lee ◽  
Meng Shao ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Regression Analysis ◽  
Confidence Interval ◽  
Cox Regression ◽  
National Cancer Data Base ◽  
Uterine Carcinosarcoma ◽  
Cox Regression Analysis ◽  
Cancer Data ◽  
Impact On Survival ◽  
The Impact

ObjectiveClinical outcomes for patients with uterine carcinosarcoma are poor after surgical management alone. Adjuvant therapies including chemotherapy (CT) and/or radiation therapy (RT) have been previously investigated, but the optimal management of this disease remains controversial. The purposes of this study were to analyze the patterns of use of adjuvant CT and RT and to assess the impact on survival of each of these treatment regimens using the National Cancer Data Base.Methods/MaterialsThe National Cancer Data Base was queried for patients given a diagnosis of uterine carcinosarcoma confined to the pelvis who underwent total hysterectomy/bilateral salpingo-oophorectomy between 2004 and 2011. Patients were excluded if they survived less than 4 months after diagnosis. Data regarding CT and RT use were collected. Overall survival (OS) was analyzed using the Kaplan-Meier method. Multivariable Cox regression analysis was performed to evaluate the effect of covariates on OS.ResultsA total of 4906 patients were included in this study. Median age was 67 years (interquartile range, 60–75 years). Median follow-up was 28.9 months (interquartile range, 15.4–52.9 months). There were 1777 patients (36.2%) who received no adjuvant treatment, 971 (19.8%) who received CT alone, 1060 (21.6%) who received RT alone, and 1098 (22.4%) who received both RT and CT. The 5-year OS for patients receiving no adjuvant therapy, adjuvant RT alone, adjuvant CT alone, and combined CT and RT were 44.9%, 47.1%, 47.5%, and 62.9%, respectively. On pairwise analysis, combined CT and RT was associated with improved survival compared with all other subgroups (P < 0.001). On multivariable Cox regression analysis, combined CT and RT (hazard ratio, 0.50; 95% confidence interval, 0.44–0.57; P < 0.001) and CT alone (hazard ratio, 0.78; 95% confidence interval, 0.69–0.88; P < 0.001) were significantly associated with improved OS, whereas RT alone was not.ConclusionsCombination therapy with CT and RT was associated with significantly improved 5-year OS compared with no further therapy, RT alone, or CT alone.

scholarly journals Clinical Significance of Squamous Differentiation in Urothelial Carcinoma of the Bladder

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481880026 ◽  
Author(s):  
Akinori Minato ◽  
Hirotsugu Noguchi ◽  
Ikko Tomisaki ◽  
Atsushi Fukuda ◽  
Tatsuhiko Kubo ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Clinical Significance ◽  
Cox Regression ◽  
Squamous Differentiation ◽  
Muscle Invasive Bladder Cancer ◽  
Free Survival ◽  
Kaplan Meier ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive

The prognostic value of squamous differentiation (SD) in urothelial carcinoma (UC) of the bladder is unclear. The aim of this study was to identify the clinical significance of SD in UC in terms of oncological outcomes in patients undergoing radical cystectomy (RC). We evaluated consecutive patients with muscle-invasive bladder cancer (MIBC; clinical T2-4aN0M0) treated with RC at our institution from March 2003 to March 2017. We enrolled 20 and 81 patients with UC with SD (UCSD) and pure UC, respectively. Postoperative survival outcomes were compared between the patients with UCSD and pure UC using the Kaplan-Meier method. Pre- and postcystectomy factors that influenced the overall survival (OS) and recurrence-free survival (RFS) were investigated in these patients. Multivariate Cox regression models were used to identify the predictors of OS and RFS. With a median follow-up time of 31 months, the 5-year OS rate of the UCSD and pure UC groups was 41.1% and 69.7% ( P = .002) and the 5-year RFS rate was 51.8% and 59.5% ( P = .027), respectively. The shape of the Kaplan-Meier curves for UCSD suggested a more rapid course of the disease within the first 2 years than observed in pure UC. Multivariate analyses suggested that SD in UC was significantly associated with OS (hazard ratio [HR]: 4.22; 95% confidence interval [CI]: 1.20-14.8; P = .024) and close to significance for a lower RFS (HR: 2.13, 95% CI: 0.74-6.15, P = .064). Our results indicate that SD may be an independent predictor of OS and RFS in UC of MIBC in patients undergoing RC.

Radiation therapy for malignant phyllodes tumors: An analysis of over 3,100 patients from 1998 to 2009.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 183-183
Author(s):  
Richelle T. Williams ◽  
Jennifer Lynn Gnerlich ◽  
Katharine Yao ◽  
Nora T. Jaskowiak ◽  
Swati Kulkarni
Keyword(s):  
Cox Regression ◽  
Treatment Guidelines ◽  
Disease Free Survival ◽  
National Cancer Data Base ◽  
Adjuvant Radiation ◽  
Cancer Data ◽  
Phyllodes Tumors ◽  
Kaplan Meier ◽  
Standard Treatment Guidelines ◽  
Main Determinants

183 Background: Malignant phyllodes tumors of the breast are uncommon. Currently, there are no standard treatment guidelines for adjuvant therapy. We hypothesized that there has been a trend towards increased use of radiation despite its uncertain effect on outcomes. Methods: Using the National Cancer Data Base, treatment trends and predictors of radiation utilization were examined for women with malignant phyllodes from 1998 to 2009. Kaplan-Meier and Cox regression were used to determine the effect of radiation on local recurrence (LR), disease-free survival (DFS), and overall survival (OS). Results: Of 3,153 patients, 57.4% underwent lumpectomy and 42.6% underwent mastectomy. Overall, 14.2% received radiation, with utilization doubling over the study period (9.2% in 1998 vs. 19.8% in 2009, p<0.001). Women were significantly more likely to receive radiation if they were diagnosed later in the study (OR 2.25, 95% CI 1.26-4.03), were age 50-59 (OR 1.64, 95% CI 1.13-2.39), had tumors >10cm (OR 2.28, 95% CI 1.55-3.35), or had nodes removed (OR 2.04, 95% CI 1.56-2.69). Race/ethnicity, socioeconomic factors, hospital characteristics, type of surgery, and margin status were not independent predictors of radiation. Of 1,758 patients with known recurrence status, overall recurrence was 13.8% and LR was 5.9%. With 50 months median follow-up and controlling for potential confounders, radiation reduced LR (aHR 0.41, 95% CI 0.18-0.92) but had no impact on DFS or OS. Conclusions: Use of adjuvant radiation for malignant phyllodes doubled from 1998 to 2009. Tumor factors and time were the main determinants of utilization. Radiation decreased LR but had no effect on DFS or OS.

Radiation therapy sequencing for resected pancreatic adenocarcinoma in the National Cancer Data Base: A multi-institutional comparative analysis.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 305-305
Author(s):  
Lauren E Colbert ◽  
William A Hall ◽  
Dana Nickleach ◽  
Yuan Liu ◽  
Jeffrey M Switchenko ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Data Base ◽  
Pancreatic Adenocarcinoma ◽  
National Cancer Data Base ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Preoperative Radiation ◽  
Cancer Data ◽  
Kaplan Meier ◽  
Significant Difference

305 Background: Pancreatic adenocarcinoma (PAC) remains a devastating malignancy and the role for preoperative radiation therapy (prRT) remains uncertain. This analysis used the National Cancer Data Base (NCDB) to report outcomes for the largest known retrospective cohort of patients treated with prRT for resectable PAC to date. Methods: NCDB data were obtained for all patients who underwent resection and RT for PAC from 1998-2002. Patients with metastatic (M1) disease, combined prRT and poRT, missing OS or missing RT variables were excluded. The difference in patients’ characteristics was assessed by a Chi-square test and ANOVA. The Kaplan-Meier method was used to estimate overall survival (OS); survival differences were assessed using a log-rank test. A Cox proportional hazards model was used for unadjusted and multivariable (MV) survival analysis. Two MV logistic regression models also were used to assess for differences in margin status and lymph node (LN) status across treatment groups. Results: 5,414 analyzable patients were identified. 5.1% (277/5,414) received prRT and 94.9% (5,137/5,414) received poRT. All patients underwent resection and prRT or poRT +/- chemotherapy; 92.9% chemo. 793 patients were AJCC 5th edition stage I, 1,002 stage II, 2,990 were stage III, and 522 were stage IVa; 107 patients were M0 with unknown overall stage. There was no significant difference in OS between the two groups on unadjusted Kaplan-Meier analysis. In covariate-adjusted analysis, there was no significant difference in OS in the prRT (HR, 1.20 [95% CI .98-1.48]; p = 0.08) compared with poRT; prRT was associated with lower rates of LN positivity (OR, 0.45 [95% CI 0.31-0.65]; p < 0.001) and higher rates of negative margins (OR 1.71 [95% CI 1.17-2.52]; p = 0.006). Conclusions: In the largest published series of prRT patients to date, prRT was associated with negative margins and LN negativity at resection. There was no significant difference in OS between the groups. Limitations of this study include its retrospective nature, a small prRT cohort and lack of comorbidity data. These data may be useful in generating future prospective studies of prRT for PAC.

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