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Expert Review of Gastroenterology &... Jun 2020The effect of distant metastasis on prognosis in patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) remains elusive.
BACKGROUND
The effect of distant metastasis on prognosis in patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) remains elusive.
METHODS
Patients diagnosed as metastatic Siewert type II AEG were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival analysis and a Cox proportional hazards analysis were performed to assess the effect of distant metastases sites.
RESULTS
We analyzed 1616 eligible patients. Liver was the most frequent metastatic site. For patients with isolated distant metastasis, the median survival time was 8, 7, 8, 10, and 11 months for patients with liver, bone, brain, lung, and distant lymph nodal metastasis, respectively ( = 0.011). The number of metastatic sites and the site of distant metastasis were independent prognostic factors for cancer-specific survival (CSS). In patients with isolated distant metastasis, using bone metastasis as reference, lung ( = 0.011) or distant lymph node metastasis ( = 0.030) was associated with better CSS, while patients with liver ( = 0.051) or brain ( = 0.488) metastasis had similar CSS compared to patients with bone metastasis.
CONCLUSION
CSS in metastatic Siewert type II AEG is dependent on the metastatic site and the number of metastatic sites.
Topics: Adenocarcinoma; Esophagogastric Junction; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Metastasis; Prognosis; Proportional Hazards Models; Retrospective Studies; SEER Program; Stomach Neoplasms; United States
PubMed: 32324423
DOI: 10.1080/17474124.2020.1760839 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Jun 2017To investigate clinical features of distant metastases from malignant salivary gland carcinomas after treated by I internal brachy therapy alone.
OBJECTIVE
To investigate clinical features of distant metastases from malignant salivary gland carcinomas after treated by I internal brachy therapy alone.
METHODS
Between 2002 and 2010, 43 patients with locally advanced unresectable or recurrent malignant salivary gland carcinomas were treated by I internal brachy therapy alone at Peking University School and Hospital of Stomatology. All of them had been follow-up at least 2 years. The primary sites of malignant salivary gland carcinomas were the parotid for 12 patients, infratemporal fossa for 9 patients, tongue for 7 patients, maxilla for 6 patients, parapharyngeal for 4 patients, floor of months for 3 patients, submandibular gland for 1 patient, and lip for 1 patient. The overall survival rate, local control rate, and distant metastases were retrospectively reviewed.
RESULTS
Distant metastases occurred in 23 of the 43 patients (53.5%). Distant metastases developed from 5 to 96 months, with an average interval of (27.0±23.7) months from the time of initial diagnosis, the mean interval was 21 months. The commonest site of distant metastases overall was the lung 69.6%(16/23). The most common pathological types of distant metastases were adenoid cystic carcinoma (14/23, 60.9%) and nonspecific adenocarcinoma (7/23, 30.4%). At the time of the last follow-up, 26 patients died, and 18 of them due to distant metastases (69.2%, 18/26). In the study, 27 patients got complete remission(CR), 12 got partial remission(PR) more than 50%, 2 less than 50%, and 2 patients were invalid. The effective rate (CR+ PR) was 90.7%. The 3 year loco-regional control rate and survival rate were 60.1%, 82.6%, respectively, and the 5 year's 53.4% and 56.0%.
CONCLUSION
The I brachy therapy is a feasible and effective modality for the treatment of locally advanced unresectable or recurrent malignant salivary gland carcinomas. However, further studies are needed with larger numbers of patients and for a longer follow-up assessment. Distant metastasis was the main cause of treatment failure, and the lung was the most common site of distant metastases.
Topics: Adenocarcinoma; Carcinoma, Adenoid Cystic; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Neoplasm Recurrence, Local; Retrospective Studies; Salivary Gland Neoplasms; Salivary Glands; Survival Rate
PubMed: 28628162
DOI: No ID Found -
Identifying Breast Cancer Distant Recurrences from Electronic Health Records Using Machine Learning.Journal of Healthcare Informatics... 2019Accurately identifying distant recurrences in breast cancer from the Electronic Health Records (EHR) is important for both clinical care and secondary analysis. Although...
Accurately identifying distant recurrences in breast cancer from the Electronic Health Records (EHR) is important for both clinical care and secondary analysis. Although multiple applications have been developed for computational phenotyping in breast cancer, distant recurrence identification still relies heavily on manual chart review. In this study, we aim to develop a model that identifies distant recurrences in breast cancer using clinical narratives and structured data from EHR. We applied MetaMap to extract features from clinical narratives and also retrieved structured clinical data from EHR. Using these features, we trained a support vector machine model to identify distant recurrences in breast cancer patients. We trained the model using 1,396 double-annotated subjects and validated the model using 599 double-annotated subjects. In addition, we validated the model on a set of 4,904 single-annotated subjects as a generalization test. In the held-out test and generalization test, we obtained F-measure scores of 0.78 and 0.74, area under curve (AUC) scores of 0.95 and 0.93, respectively. To explore the representation learning utility of deep neural networks, we designed multiple convolutional neural networks and multilayer neural networks to identify distant recurrences. Using the same test set and generalizability test set, we obtained F-measure scores of 0.79 ± 0.02 and 0.74 ± 0.004, AUC scores of 0.95 ± 0.002 and 0.95 ± 0.01, respectively. Our model can accurately and efficiently identify distant recurrences in breast cancer by combining features extracted from unstructured clinical narratives and structured clinical data.
PubMed: 33225204
DOI: 10.1007/s41666-019-00046-3 -
Gynecologic Oncology May 2014The aim of this study is to investigate patterns of distant relapse after primary radiochemotherapy in cervical cancer patients. (Observational Study)
Observational Study
OBJECTIVE
The aim of this study is to investigate patterns of distant relapse after primary radiochemotherapy in cervical cancer patients.
METHODS
All patients with cervical cancer treated in curative intent with external beam radiotherapy +/- chemotherapy and image-guided adaptive brachytherapy between January 1998 and June 2009 at the Medical University of Vienna were included in this retrospective analysis. Patients with locoregional recurrences were excluded from this study. Presence, site of and time to distant metastases were recorded. For identifying prognostic factors, uni- and multivariate analyses using Cox regression analysis were performed. Based on the result from the multivariate analysis, patients were stratified into a high and a low risk group. The Kaplan-Meier method was used to estimate distant-metastasis-free-survival in the overall cohort, in the risk groups and for analysing the impact of chemotherapy within the risk groups.
RESULTS
A total number of 189 patients were included in this study. After a median follow-up of 54 months, 49 patients developed distant metastases. Overall, distant-metastasis-free-survival 5 years after treatment was 73%. FIGO stage, lymph node status and the extent of tumour regression during treatment were significant predictors for distant metastasis. Distant-metastasis-free-survival 5 years after treatment was 91% and 60% in the low and high risk groups, respectively. The number of the cycles of chemotherapy had a significant impact on the occurrence of distant metastasis in high risk patients, but not in low risk patients.
CONCLUSION
Patients with high risk factors have a 40% probability of developing distant metastasis within 5 years. In these patients, decreasing the number of cycles of cisplatin may increase their probability of developing distant metastasis.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Brachytherapy; Chemotherapy, Adjuvant; Cisplatin; Combined Modality Therapy; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Multivariate Analysis; Neoplasm Metastasis; Prognosis; Proportional Hazards Models; Radiotherapy, Image-Guided; Retrospective Studies; Risk Factors; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 24517875
DOI: 10.1016/j.ygyno.2014.02.004 -
Gynecologic Oncology Sep 2018To assess the association between patterns of distant metastases and overall survival in metastatic ovarian cancer and identify prognostic factors for site-specific...
OBJECTIVE
To assess the association between patterns of distant metastases and overall survival in metastatic ovarian cancer and identify prognostic factors for site-specific distant metastases.
METHODS
Data was obtained from the SEER database between 2010 and 2014. Univariate and multivariate Cox proportional hazard models were used to identify variables associated with overall survival. Survival times between different groups were compared using Kaplan-Meier analysis and log-rank tests.
RESULTS
We analyzed 1481 patients. The most common distant metastatic site was liver, followed by distant lymph nodes, lung, bone, and brain. The site of distant metastases was an independent prognostic factor for overall survival. Using liver metastases as reference, overall survival was lower for lung metastases (p = 0.0297) and higher for distant lymph node metastases (p = 0.0006). Using distant lymph nodes as reference, distant metastases to the liver (p = 0.0006), lung (p < 0.0001), brain (p = 0.0455), and bone (p = 0.0138) were all associated with worse overall survival. The number of metastatic sites did not affect overall survival. We also found that surgery and chemotherapy affected overall survival for patients with distant lymph node metastases only; age, histological subtype, surgery, and chemotherapy affected overall survival for patients with liver metastases only, while histological subtype and chemotherapy affected overall survival for patients with lung metastases only.
CONCLUSIONS
The site of distant metastases affected overall survival in metastatic ovarian cancer. Patients with specific distant metastatic sites should receive special treatment and management. The identified prognostic factors can help clinician evaluate the prognosis for ovarian cancer patients with distant metastases.
Topics: Age Factors; Aged; Antineoplastic Agents; Bone Neoplasms; Brain Neoplasms; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Middle Aged; Ovarian Neoplasms; Proportional Hazards Models; SEER Program; Survival Rate; Tertiary Lymphoid Structures; United States
PubMed: 30001833
DOI: 10.1016/j.ygyno.2018.06.022 -
Journal of Otolaryngology - Head & Neck... Apr 2022Hypopharyngeal squamous cell carcinoma (HPSCC) has a high rate of distant metastasis, resulting in poor prognosis. The role of the maximum standardized uptake value...
BACKGROUND
Hypopharyngeal squamous cell carcinoma (HPSCC) has a high rate of distant metastasis, resulting in poor prognosis. The role of the maximum standardized uptake value (SUVmax), which was assessed via pretreatment 18-fluorodeoxyglucose positron emission tomography (FDG-PET), and computed tomography (CT) was examined, for predicting distant metastasis and survival.
METHODS
This study included 121 patients who underwent pretreatment FDG-PET/CT scanning and subsequent treatment for HPSCC. The SUVmax was measured via FDG-PET/CT. A receiver operating characteristic (ROC) curve analysis was used to determine whether the SUVmax was a predictor of distant metastasis and to select the best cutoff value. Univariate and multivariate Cox hazard regression analyses were used in identifying associations between the SUVmax and other clinicopathological factors with distant metastasis-free survival.
RESULTS
Distant metastases were identified in 33 patients during the median follow-up of 24 months after treatment. The ROC curve analysis determined that SUVmax was predictive of distant metastasis and identified a SUVmax of 13.9 as the best potential cutoff value. The univariate analysis showed that T and N classification, clinical stage, and SUVmax were significantly related to distant metastasis. However, in multivariate analysis, an SUVmax ≥ 13.9 was the only independent predictor of distant metastasis. Patients with high SUVmax values displayed significantly shorter distant metastasis-free survival and overall survival.
CONCLUSIONS
SUVmax determined via pretreatment FDG-PET/CT is useful for predicting distant metastasis, distant metastasis-free survival, and overall survival in patients with HPSCC.
Topics: Disease-Free Survival; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Positron Emission Tomography Computed Tomography; Prognosis; Squamous Cell Carcinoma of Head and Neck
PubMed: 35365214
DOI: 10.1186/s40463-022-00568-8 -
Journal of the Formosan Medical... Feb 2022This study was conducted to identify risk factors for distant interval metastases (IM) in patients with esophageal squamous cell carcinoma (ESCC) who underwent...
BACKGROUND
This study was conducted to identify risk factors for distant interval metastases (IM) in patients with esophageal squamous cell carcinoma (ESCC) who underwent chemoradiotherapy (CRT).
METHODS
We retrospectively reviewed the clinical records of 358 patients with ESCC treated with CRT between 2006 and 2017. Distant IM were defined as systemic metastases developing during or shortly after CRT and identified during the restaging work-up period. A risk prediction nomogram for distant IM was developed based on independent pretreatment risk factors identified using multivariable logistic regression analysis.
RESULTS
Distant IM occurred in 26 (7.3%) patients and had a significant adverse impact on survival (median survival: 8.7 months). The most common site of distant IM was the lung (n = 9), followed by non-regional lymph nodes (n = 8) and the bone (n = 8). Multivariable logistic regression analysis revealed that high baseline tumor SUVmax values were independently associated with an increased risk of distant IM (odds ratio [OR] = 1.059, p = 0.019), whereas older age was an independent protective factor (OR = 0.946, p = 0.032). A nomogram based on age, tumor SUVmax, tumor length, and the chemotherapy regimen showed a good predictive performance (c-statistic = 0.761), which was internally validated using 200 bias-corrected bootstrap replicates (c-statistic = 0.71).
CONCLUSION
Distant IM were identified in 7.3% of patients with ESCC undergoing CRT. The nomogram described in our study may prove useful to predict the risk of distant IM in this patient group.
Topics: Aged; Chemoradiotherapy; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Humans; Retrospective Studies; Risk Factors
PubMed: 34167877
DOI: 10.1016/j.jfma.2021.06.002 -
ANS. Advances in Nursing ScienceAn increasing number of individuals are reporting increased stress and anxiety associated with the COVID-19 pandemic. A feasibility, mixed-method design was conducted to...
An increasing number of individuals are reporting increased stress and anxiety associated with the COVID-19 pandemic. A feasibility, mixed-method design was conducted to investigate distant Reiki as a virtual healing modality within Rogers' framework of the Science of Unitary Human Beings. Data were collected using pre- and post-distant Reiki session interviews and 2 surveys. Study findings demonstrated changes in participant pattern manifestation and statistically significant reductions in perceived stress and anxiety (P < .001). The preliminary findings support the feasibility of distant Reiki and suggest that nurses, who are Reiki practitioners, may influence the human-environmental field to foster healing.
Topics: Humans; Therapeutic Touch; COVID-19; Pandemics; Anxiety; Surveys and Questionnaires
PubMed: 36308730
DOI: 10.1097/ANS.0000000000000441 -
Clinical Medicine Insights. Oncology 2024Distant metastasis is the leading cause of death in patients with rectal cancer. This study aims to comprehensively analyze the risk factors of distant metastasis in...
BACKGROUND
Distant metastasis is the leading cause of death in patients with rectal cancer. This study aims to comprehensively analyze the risk factors of distant metastasis in T3 T4 rectal cancer using magnetic resonance imaging (MRI), pathological features, and serum indicators.
METHODS
The clinicopathological data of 146 cases of T3 T4 rectal cancer after radical resection from January 2015 to March 2023 were retrospectively analyzed. Pre- and postoperative follow-up data of all cases were collected to screen for distant metastatic lesions. Univariate and multivariate Logistic regression methods were used to analyze the relationship between MRI features, pathological results, serum test indexes, and distant metastasis.
RESULTS
Of the 146 included patients, synchronous or metachronous distance metastasis was confirmed in 43 (29.4%) cases. The patients' baseline data and univariate analysis showed that mrEMVI, maximum tumor diameter, mr T Stage, pathological N stage, number of lymph node metastasis, cancer nodules, preoperative serum CEA, (Carcinoembryonic antigen) and CA199 were associated with distant metastasis. In the multiple logistic regression model, mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter, and preoperative serum CEA were identified as independent risk factors for distant metastasis: mrEMVI [odds ratio (OR) = 3.06], pathological N stage (OR = 6.52 for N1 vs N0; OR = 63.47 for N2 vs N0), preoperative serum CEA (OR = 0.27), tumor maximum diameter (OR = 1.03), number of lymph nodes metastasis (OR = 0.62). And, the receiver operating characteristic (ROC) curve was plotted and the area under the curve was calculated (area under the curve [AUC) = 0.817, 95% CI = 0.744-0.890, < .001].
CONCLUSIONS
mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter and preoperative serum CEA are the independent risk factors for distant metastasis in T3 T4 rectal cancer. A comprehensive analysis of the risk factors for distant metastasis in rectal cancer can provide a reliable basis for formulating individualized treatment strategies, follow-up plans, and evaluating prognosis.
PubMed: 38322665
DOI: 10.1177/11795549241227423 -
Clinical Lung Cancer Jan 2019The use of stereotactic body radiation therapy (SBRT) has emerged as an effective treatment modality for patients with early-stage non-small-cell lung cancer (NSCLC),...
PURPOSE
The use of stereotactic body radiation therapy (SBRT) has emerged as an effective treatment modality for patients with early-stage non-small-cell lung cancer (NSCLC), with excellent local control rates. Despite this, there is a predominant pattern of distant failure. We sought to identify factors that help predict which patients with stages I to IIA NSCLC treated with SBRT are at highest risk of distant failure, so that we may utilize these factors in the future to help determine which patients may benefit from the addition of systemic therapies.
PATIENTS AND METHODS
We retrospectively reviewed 292 patients treated with SBRT for early stage NSCLC from 2006 to 2016 at 2 institutions. Patients were classified by T stage, tumor size, location and histology, pretreatment positron emission tomography/computed tomography (PET/CT) standardized uptake value (SUV), smoking status, and age. The primary endpoint of the study was distant failure. We aimed to analyze if patient characteristics could be identified that predicted for distant failure through the use of competing risk analysis.
RESULTS
The median follow-up was 21.9 months. The median dose of radiation and fractionation delivered was 50 Gy (range, 45-65 Gy) in 5 fractions (range, 3-13 fractions). The median patient age was 72.8 years (interquartile range, 65.4-79.7 years). The 2-year distant failure was 22.0%, and overall survival at 2 years was found to be 61.0%. For every 1-year increase in patient age, the hazard of distant failure at any given time was 3% lower (hazard ratio, 0.97; 95% confidence interval, 0.94-0.99; P = .04). None of the remaining characteristics emerged as significant risk factors for distant failure on univariable or multivariable analysis.
CONCLUSIONS
Overall, our cohort had distant failure and survival rates comparable with what has been described in the literature. Although we were unable to identify factors outside of age that correlated to risk of distant failure, this topic warrants further investigation, as distant failure is the primary pattern of failure with SBRT when used as the primary management for early-stage NSCLC. Additional molecular studies are needed to further inform on the role of systemic therapy in patients with early-stage NSCLC to improve clinical outcomes.
Topics: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Neoplasm Staging; Prognosis; Radiosurgery; Retrospective Studies; Survival Analysis; Treatment Failure; Treatment Outcome
PubMed: 30279109
DOI: 10.1016/j.cllc.2018.09.002