Adjuvant Chemotherapy in Uterine Leiomyosarcoma: Trends and Factors Impacting Usage.
Neoplasm Staging; Odds Ratio; Age Factors; Survival; Confidence Intervals; Neoplasm Metastasis; Human; Multiple Regression; Chemotherapy; Chemoradiotherapy; Cox Proportional Hazards Model; Kaplan-Meier Estimator; Uterine Neoplasms – Diagnosis; Lymph Nodes – Pathology; Adjuvant – Trends; Adjuvant – Utilization; Leiomyosarcoma – Diagnosis; Leiomyosarcoma – Prognosis; Leiomyosarcoma – Therapy; Uterine Neoplasms – Prognosis; Uterine Neoplasms – Therapy
Objectives. The benefit of adjuvant chemotherapy in patients with localized uterine leiomyosarcoma (LMS) remains unclear due to a lack of randomized studies and data only from small retrospective series to rely on. We sought to identify factors associated with the administration of chemotherapy and to determine the trends in the usage of adjuvant chemotherapy in patients with nonmetastatic uterine LMS. Methods. Patients diagnosed with nonmetastatic uterine LMS between 2004 and 2014 were identified from the National Cancer Database (NCDB). Multiple regression was used to determine factors with a significant impact on patient receipt of chemotherapy. Kaplan–Meier curves and the Cox model were used to determine the effect of adjuvant chemotherapy on overall survival (OS). Results. 2,732 uterine LMS patients were identified. Patients older than 65 were less likely to receive chemotherapy than their younger counterparts. Patients with stage I or stage II cancer were less likely to receive chemotherapy, whereas individuals with positive regional lymph nodes and those who had received radiation were more likely. In this cohort, adjuvant chemotherapy had no significant impact on OS (HR, 1.04; 95% CI, 0.90–1.22; P=0.5768). However, administration of chemotherapy significantly increased from 2004 to 2014 (P\textless0.0001). Conclusions. Expected tumor characteristics such as higher stage of tumor were associated with receipt of chemotherapy. Although adjuvant chemotherapy demonstrated no benefit over observation on OS in patients with nonmetastatic LMS, the number of patients being treated with chemotherapy continued to increase from 2004 to 2014.
Patel Dhara; Handorf Elizabeth; von Mehren Margaret; Martin Lainie; Movva Sujana
Sarcoma
2019
2019-02-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1155/2019/3561501" target="_blank" rel="noreferrer noopener">10.1155/2019/3561501</a>
The importance of extranodal extension in penile cancer: a meta-analysis.
Comparative Studies; Cox Proportional Hazards Model; Evaluation Research; Human; Humans; Lymph Nodes – Pathology; Lymph Nodes/pathology; Lymphatic Metastasis; Male; Meta Analysis; Multicenter Studies; Neoplasm Metastasis; Odds Ratio; Penile Neoplasms – Diagnosis; Penile Neoplasms – Mortality; Penile Neoplasms – Pathology; Penile Neoplasms/diagnosis/*mortality/*pathology; Prognosis; Proportional Hazards Models; Publication Bias; Validation Studies
BACKGROUND: The role of extranodal extension (ENE) in penile cancer is controversial and has not been well studied. The aim of this study was to investigate the importance of ENE in predicting prognosis and presence of pelvic lymph node metastasis (PLNM) in penile cancer patients. METHODS: We searched related studies in Medline, Embase, Cochrane Library, and Scopus database. Hazard ratio (HR) and odds ratio (OR) were directly extracted or indirectly estimated from the included studies. RESULTS: A total of ten studies with 1,142 patients were included in this meta-analysis. Patients with ENE showed a worse cancer-specific survival (CSS) (HR = 1.90, 95 % confidence interval [CI] = 1.35-2.67, P = 0.0002) and overall survival (HR = 4.04, 95 % CI = 1.02-16.1, P = 0.05) than those without ENE. Further subgroup analysis revealed that the predictive value of ENE for CSS in penile cancer patients was significant regardless of the study's country of origin, but not in the subgroup with shorter follow-up time (\textless36 months, P = 0.38). Patients with ENE also showed a higher incidence of presenting with PLNM (OR = 4.95, 95 % CI = 2.58-9.49, P \textless 0.001). A stratified analysis demonstrated that the predictive role of ENE for PLNM was only detected in studies with a larger sample size (\textgreater 100 cases). No significant publication bias was observed, as suggested by Begg's and Egger's tests. CONCLUSIONS: ENE is associated with worse prognosis and high risk of PLNM in penile cancer patients. Due to the limited number of studies included in this meta-analysis, a large-scale, well-designed study will be required to verify our results.
Zhang Zhi-Ling; Yu Chun-Ping; Liu Zhuo-Wei; Velet Liliya; Li Yong-Hong; Jiang Li-Juan; Zhou Fang-Jian
BMC cancer
2015
2015-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1186/s12885-015-1834-4" target="_blank" rel="noreferrer noopener">10.1186/s12885-015-1834-4</a>