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Volume 51(4); October 2019
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Original Articles
Subdivision of Nasopharyngeal Carcinoma Patients with Bone-Only Metastasis at Diagnosis for Prediction of Survival and Treatment Guidance
Xue-Song Sun, Yu-Jing Liang, Sai-Lan Liu, Qiu-Yan Chen, Shan-Shan Guo, Yue-Feng Wen, Li-Ting Liu, Hao-Jun Xie, Qing-Nan Tang, Xiao-Yun Li, Jin-Jie Yan, Lin-Quan Tang, Hai-Qiang Mai
Cancer Res Treat. 2019;51(4):1259-1268.   Published online January 4, 2019
DOI: https://doi.org/10.4143/crt.2018.652
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to subdivide M1 stage nasopharyngeal carcinoma (NPC) patients with bone-only metastases for prognosis prediction while identifying the treatment effect of locoregional radiotherapy (LRRT) and metastasis radiotherapy (MRT) among patients with different risk.
Materials and Methods
From November 2006 to October 2016, a total of 226 patients with bone-only metastasic NPC were retrospectively enrolled. All patients developed distant lesions before receiving treatment. All potential prognostic factors were considered and the correlation of the M1 subdivisions with overall survival (OS) was determined by Cox regression hazards model. Kaplan–Meier curves were used to appraise survival condition and log-rank testing was used to compare the differences.
Results
The median follow-up time was 33.9 months (range, 3 to 126 months). According to multivariate Cox proportional hazard analysis, the number of metastatic lesions and Epstein-Barr virus (EBV) DNA status after palliative chemotherapy (PCT) were independent prognostic factors for OS. Thus, we subdivided patients into three risk groups according to these two factors. Systemic chemotherapy combined with LRRT may benefit patients in low- and intermediate-risk groups but not in the high-risk group. Further aggressive MRT based on systemic chemotherapy showed no survival benefit in any risk group.
Conclusion
The stratification of NPC patients with bone-only metastasis based on EBV DNA after PCT and the number of metastatic lesions provided promising prognostic value and could aid clinicians in person-specific treatment.

Citations

Citations to this article as recorded by  
  • Treatment of primary tumor in metastatic head and neck Carcinoma: A systematic review and Meta-Analysis
    Fausto Petrelli, Luigi Lorini, Alberto Paderno, Daniela Carioli, Francesca Trevisan, Vincenzo Capriotti, Massimiliano Nardone, Cristina Gurizzan, Carlo Resteghini, Paolo Bossi
    Oral Oncology.2025; 163: 107248.     CrossRef
  • Efficacy of metastatic lesion radiotherapy in patients with metastatic nasopharyngeal carcinoma: A multicenter retrospective study
    Yang Liu, Jie Ma, Xiao-Yi Zeng, Zhi-Chao Zuo, Rui-Zhong Chen, Xiao-Yu Li, Zhong-Guo Liang, Kai-Hua Chen, Xin-Bin Pan, Su Pei, Bin-Bin Yu, Ling Li, Song Qu, Yun-Li Yang, Xiao-Dong Zhu
    Radiotherapy and Oncology.2024; 196: 110311.     CrossRef
  • Ninth Version of the AJCC and UICC Nasopharyngeal Cancer TNM Staging Classification
    Jian-Ji Pan, Hai-Qiang Mai, Wai Tong Ng, Chao-Su Hu, Jin-Gao Li, Xiao-Zhong Chen, James C. H. Chow, Edwin Wong, Victor Lee, Ling-Yu Ma, Qiao-Juan Guo, Qin Liu, Li-Zhi Liu, Ting-Ting Xu, Xiao-Chang Gong, Meng-Yun Qiang, Kwok-Hung Au, Tsz-Chim Liu, Chi Leun
    JAMA Oncology.2024; 10(12): 1627.     CrossRef
  • Whether Primary Bone‐Only Oligometastatic Nasopharyngeal Carcinoma Patients Benefit From Radiotherapy to the Bones on the Basis of Palliative Chemotherapy Plus Locoregional Radiotherapy?—A Large‐Cohort Retrospective Study
    Wan‐Ping Guo, Guo‐Dong Jia, Si‐Yi Xie, Xuan Yu, Xiao‐Han Meng, Lin‐Quan Tang, Xiao‐Yun Li, Dong‐Hua Luo
    Cancer Medicine.2024;[Epub]     CrossRef
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  • Clinical characteristics and prognostic factors affecting survival after radical radiotherapy for early and late post-treatment metastatic nasopharyngeal carcinoma
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    BMC Cancer.2023;[Epub]     CrossRef
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    Yuting Fang, Shoucong Chen, Yuanfan Xu, Mengyun Qiang, Changjuan Tao, Shuang Huang, Lei Wang, Xiaozhong Chen, Caineng Cao
    Nuclear Medicine Communications.2023; 44(6): 457.     CrossRef
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    Dong‐Hua Luo, Jia‐Xin Li, Wan‐Ping Guo, Chen‐Guang Guo, Xiao‐Han Meng, Pei‐Jun Xie, Jie‐Yi Lin, Hao‐Yuan Mo, Qun Zhang, Yong Chen, Guo‐Ping Shen
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    Honggen Liu, Peiying Yang, Yingjie Jia
    European Archives of Oto-Rhino-Laryngology.2022; 279(2): 567.     CrossRef
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    Cheng Lin, Sheng Lin, Lili Zhu, Shaojun Lin, Jianji Pan, Yun Xu
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    Cancer.2020; 126(10): 2163.     CrossRef
  • Oral Maintenance Chemotherapy Using S-1/Capecitabine in Metastatic Nasopharyngeal Carcinoma Patients After Systemic Chemotherapy: A Single-Institution Experience


    Qiaojuan Guo, Mengwei Chen, Hanchuan Xu, Tianzhu Lu, Han Zhou, Yanyan Chen, Jingfeng Zong, Yun Xu, Bijuan Chen, Bingyi Wang, Lili Zhu, Jianji Pan, Shaojun Lin
    Cancer Management and Research.2020; Volume 12: 1387.     CrossRef
  • Metastatic disease in head & neck oncology
    Paolo Pisani, Mario Airoldi, Anastasia Allais, Paolo Aluffi Valletti, Mariapina Battista, Marco Benazzo, Roberto Briatore, Salvatore Cacciola, Salvatore Cocuzza, Andrea Colombo, Bice Conti, Alberto Costanzo, Laura della Vecchia, Nerina Denaro, Cesare Fant
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    BioMed Research International.2020;[Epub]     CrossRef
  • Synchronous Metastatic Nasopharyngeal Carcinoma: Characteristics and Survival of Patients Adding Definitive Nasopharyngeal-Neck Radiotherapy to Systematic Chemotherapy


    Wenjun Liao, Jinlan He, Qiheng Gou, Baofeng Duan, Lei Liu, Ping Ai, Yanchu Li, Kexing Ren, Nianyong Chen
    Cancer Management and Research.2020; Volume 12: 10211.     CrossRef
  • 8,556 View
  • 338 Download
  • 24 Web of Science
  • 19 Crossref
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Atezolizumab in Patients with Pretreated Urothelial Cancer: a Korean Single-Center, Retrospective Study
Joon Young Hur, Youjin Kim, Ghee-Young Kwon, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Hyun Moo Lee, Su Jin Lee, Se Hoon Park
Cancer Res Treat. 2019;51(4):1269-1274.   Published online January 9, 2019
DOI: https://doi.org/10.4143/crt.2018.604
AbstractAbstract PDFPubReaderePub
Purpose
Treatment targeting immune checkpoint with programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors has demonstrated efficacy and tolerability in the treatment of metastatic urothelial carcinoma (mUC). We investigated the efficacy and safety of atezolizumab in mUC patients who failed platinum-based chemotherapy.
Materials and Methods
A retrospective study using the Samsung Medical Center cancer chemotherapy registry was performed on 50 consecutive patients with mUC treated with atezolizumab, regardless of their PD-L1(SP142) status, as salvage therapy after chemotherapy failure between May 2017 and June 2018. Endpoints included overall response rate (RR), progression-free survival (PFS), and safety.
Results
Among 50 patients, men constituted 76% and the median age was 68 years (range, 46 to 82 years). Twenty-three patients (46%) received atezolizumab as second-line therapy. PD-L1 (SP142) status IC0/1 and IC2/3 were found in 21 (42%) and 21 (42%) of patients, respectively; in eight patients (16%), PD-L1 (SP142) expression was not available. Atezolizumab was generally well tolerated, with pruritus and fatigue being the most commonly observed toxicities. As a result, partial response was noted in 20 patients (40%), with 12 (24%) stable diseases. RRwas higherin IC2/3 (62%) than in IC0/1 patients (24%, p=0.013). The median PFS was 7.4 months (95% confidence interval, 3.4 to 11.4 months). As expected, PFS also was significantly longer in IC2/3 patients than in IC0/1 (median, 12.7 vs. 2.1 months; p=0.005). PFS was not significantly influenced by age, sex, performance status, number of previous chemotherapy, site of metastases, or any of the baseline laboratory parameters.
Conclusion
In this retrospective study, atezolizumab demonstrated clinically efficacy and tolerability in unselected mUC patients who failed platinum-based chemotherapy.

Citations

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  • Real-world data of atezolizumab in patients with previously treated locally advanced or metastatic urothelial bladder cancer
    Rocío Díaz Acedo, Mercedes Galvan Banqueri, Silvia Artacho Criado, Eva María Fernández Parra, Rocío Jiménez Galán, Ana Isabel Gago Sánchez, Juan Francisco Marín Pozo, María José Martínez Bautista
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    The Korean Journal of Internal Medicine.2020; 35(4): 834.     CrossRef
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Nomogram Development and External Validation for Predicting the Risk of Lymph Node Metastasis in T1 Colorectal Cancer
Jung Ryul Oh, Boram Park, Seongdae Lee, Kyung Su Han, Eui-Gon Youk, Doo-Han Lee, Do-Sun Kim, Doo-Seok Lee, Chang Won Hong, Byung Chang Kim, Bun Kim, Min Jung Kim, Sung Chan Park, Dae Kyung Sohn, Hee Jin Chang, Jae Hwan Oh
Cancer Res Treat. 2019;51(4):1275-1284.   Published online January 17, 2019
DOI: https://doi.org/10.4143/crt.2018.569
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Predicting lymph node metastasis (LNM) risk is crucial in determining further treatment strategies following endoscopic resection of T1 colorectal cancer (CRC). This study aimed to establish a new prediction model for the risk of LNM in T1 CRC patients.
Materials and Methods
The development set included 833 patients with T1 CRC who had undergone endoscopic (n=154) or surgical (n=679) resection at the National Cancer Center. The validation set included 722 T1 CRC patients who had undergone endoscopic (n=249) or surgical (n=473) resection at Daehang Hospital. A logistic regression model was used to construct the prediction model. To assess the performance of prediction model, discrimination was evaluated using the receiver operating characteristic (ROC) curves with area under the ROC curve (AUC), and calibration was assessed using the Hosmer-Lemeshow (HL) goodness-of-fit test.
Results
Five independent risk factors were determined in the multivariable model, including vascular invasion, high-grade histology, submucosal invasion, budding, and background adenoma. In final prediction model, the performance of the model was good that the AUC was 0.812 (95% confidence interval [CI], 0.770 to 0.855) and the HL chi-squared test statistic was 1.266 (p=0.737). In external validation, the performance was still good that the AUC was 0.771 (95% CI, 0.708 to 0.834) and the p-value of the HL chi-squared test was 0.040. We constructed the nomogram with the final prediction model.
Conclusion
We presented an externally validated new prediction model for LNM risk in T1 CRC patients, guiding decision making in determining whether additional surgery is required after endoscopic resection of T1 CRC.

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    Adriana Vaz Safatle-Ribeiro
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  • 10,515 View
  • 386 Download
  • 44 Web of Science
  • 42 Crossref
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Development of Protocol for Korean Lung Cancer Screening Project (K-LUCAS) to Evaluate Effectiveness and Feasibility to Implement National Cancer Screening Program
Jaeho Lee, Juntae Lim, Yeol Kim, Hyae Young Kim, Jin Mo Goo, Choon-Taek Lee, Seung Hun Jang, Won-Chul Lee, Chan Wha Lee, Jin Young An, Ki Dong Ko, Min Ki Lee, Kui Son Choi, Boyoung Park, Duk Hyoung Lee
Cancer Res Treat. 2019;51(4):1285-1294.   Published online February 19, 2019
DOI: https://doi.org/10.4143/crt.2018.464
AbstractAbstract PDFPubReaderePub
Purpose
To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea.
Materials and Methods
Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS.
Results
In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer.
Conclusion
The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.

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Prevalence of Women with Dense Breasts in Korea: Results from a Nationwide Cross-sectional Study
Hye-Mi Jo, Eun Hye Lee, Kyungran Ko, Bong Joo Kang, Joo Hee Cha, Ann Yi, Hae Kyoung Jung, Jae Kwan Jun, on behalf of the Alliance for Breast Cancer Screening in Korea (ABCS-K)
Cancer Res Treat. 2019;51(4):1295-1301.   Published online January 29, 2019
DOI: https://doi.org/10.4143/crt.2018.297
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Women with dense breast are known to be at high risk for breast cancer, but their prevalence and number of Korean women are unknown. The current study was to investigate the distribution of mammographic breast density by age of women undergoing screening mammography, and to estimate the prevalence of Korean women with dense breasts, quantitatively.
Materials and Methods
For obtaining a nationwide representative sample, 6,481 mammograms were collected from 86 screening units participated in the National Cancer Screening Program for breast cancer. Based on the American College of Radiology Breast Imaging Reporting and Data System classification, breast density was evaluated by six breast radiologists, qualitatively. We applied these breast density distributions to age-specific counts of the Korean women population derived to mid-year 2017 to estimate the number of Korean women with dense breasts.
Results
Overall, 54.4% (95% confidence interval [CI], 52.9% to 55.8%) of women 40 to 69 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age. Based on the age distribution of Korean women, we estimated that 6,083,000 women (95% CI, 5,919,600 to 6,245,600) age 40-69 years in Korean have dense breasts. Women aged 40-49 years (n=3,450,000) accounted for 56.7% of this group.
Conclusion
More than half of Korean women aged 40 and over have dense breasts. To prevent breast cancer effectively and efficiently, it is necessary to develop a new personalized prevention strategy considering her status of breast density.

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Body Cavity–Based Lymphoma in a Country with Low Human Immunodeficiency Virus Prevalence: A Series of 17 Cases from the Consortium for Improving Survival of Lymphoma
Junghoon Shin, Young Hyeh Ko, Sung Yong Oh, Dok Hyun Yoon, Jeong-Ok Lee, Jin Seok Kim, Yong Park, Ho Jin Shin, Seok Jin Kim, Jong Ho Won, Sung-Soo Yoon, Won Seog Kim, Youngil Koh, On behalf of the Consortium for Improving Survival of Lymphoma investigators
Cancer Res Treat. 2019;51(4):1302-1312.   Published online February 14, 2019
DOI: https://doi.org/10.4143/crt.2018.555
AbstractAbstract PDFPubReaderePub
Purpose
Primary effusion lymphoma (PEL) is a type of body cavity–based lymphoma (BCBL). Most patients with PEL are severely immunocompromised and seropositive for human immunodeficiency virus (HIV). We investigated the distinctive clinicopathologic characteristics of BCBL in a country with low HIV burden.
Materials and Methods
We retrospectively collected data on the clinicopathologic characteristics, treatments, and outcomes of 17 consecutive patients with BCBL at nine institutions in Korea.
Results
Latency-associated nuclear antigen 1 (LANA1) immunostaining indicated that six patients had PEL, six patients had human herpesvirus 8 (HHV8)-unrelated BCBL, and five patients had HHV8-unknown BCBL. The patients with PEL exhibited no evidence of immunodeficiency except for one who was HIV positive. One (20%) and four (80%) patients with PEL and six (100%) and zero (0%) patients with HHV8-unrelated BCBL were positive for CD20 and CD30 expression, respectively. The two patients with PEL (one HIV-positive and one HIV-negative patient) with the lowest proliferation activity as assessed by the Ki-67 labeling index survived for > 1 and > 4 years without chemotherapy, respectively, in contrast to the PEL cases in the literature, which mostly showed a high proliferation index and poor survival.
Conclusion
PEL mostly occurred in ostensibly immunocompetent individuals and had a favorable outcome in Korea. A watchful waiting approach may be applicable for managing HIV-seronegative patients with PEL with a low Ki-67 labeling index. A possible trend was detected among LANA1, CD20, and CD30 expression in BCBL.

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The Prognostic Value of Albumin-to-Alkaline Phosphatase Ratio before Radical Radiotherapy in Patients with Non-metastatic Nasopharyngeal Carcinoma: A Propensity Score Matching Analysis
Jae Sik Kim, Bhumsuk Keam, Dae Seog Heo, Doo Hee Han, Chae-Seo Rhee, Ji-hoon Kim, Kyeong Cheon Jung, Hong-Gyun Wu
Cancer Res Treat. 2019;51(4):1313-1323.   Published online January 29, 2019
DOI: https://doi.org/10.4143/crt.2018.503
AbstractAbstract PDFPubReaderePub
Purpose
We first analyzed the prognostic power of albumin-to-alkaline phosphatase ratio (AAPR) before radical radiotherapy (RT) in non-metastatic nasopharyngeal carcinoma (NPC) patients.
Materials and Methods
The records of 170 patients with biopsy-proven, non-metastatic NPC treated by radical RT between 1998 and 2016 at our institution were retrospectively reviewed. Median follow-up duration was 50.6 months. All patients received intensity-modulated RT and cisplatin based chemotherapy before, during, or after RT. The major treatment of patients was based on concurrent chemoradiotherapy (92.4%). The AAPR was calculated by the last value of both albumin and alkaline phosphatase within 1 month immediately preceding RT. The optimal cut-off level of AAPR was determined by using Cutoff Finder, a web-based system. Propensity score matching (PSM) analysis was performed.
Results
The optimal cut-off level of AAPR was 0.4876. After PSM analysis of whole cohort, an AAPR was not related to survival outcomes. In PSM analysis for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC), an AAPR ≥ 0.4876 was related to better overall survival (OS), progression-free survival (PFS), and locoregional relapse–free survival (LRRFS) (OS: hazard ratio [HR], 0.341; 95% confidence interval [CI], 0.144 to 0.805; p=0.014; PFS: HR, 0.416; 95% CI, 0.189 to 0.914; p=0.029; and LRRFS: HR, 0.243; 95% CI, 0.077 to 0.769; p=0.016, respectively).
Conclusion
The AAPR, inexpensive and readily derived from a routine blood test, could be an independent prognostic factor for patients with LA-NPC. And it might help physicians determine treatment plans by identifying the patient's current status. Future prospective clinical trials to validate its prognostic value are needed.

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The Feasibility of Spinal Stereotactic Radiosurgery for Spinal Metastasis with Epidural Cord Compression
Yi-Jun Kim, Jin Ho Kim, Kyubo Kim, Hak Jae Kim, Eui Kyu Chie, Kyung Hwan Shin, Hong-Gyun Wu, Il Han Kim
Cancer Res Treat. 2019;51(4):1324-1335.   Published online January 29, 2019
DOI: https://doi.org/10.4143/crt.2018.653
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to investigate the effectiveness and safety of spinal stereotactic radiosurgery (SRS) in treating spinal metastasis with epidural spinal cord compression (ESCC).
Materials and Methods
During 2013-2016, 149 regions of spinal metastasis in 105 patients treated with singlefraction (12-24 Gy) spinal SRS were reviewed. Cord compression of Bilsky grade 2 (with visible cerebrospinal fluid [CSF]) or 3 (no visible CSF) was defined as ESCC. Local progression (LP) and vertebral compression fracture (VCF) rates after SRS were evaluated using multivariate competing-risk regression analysis.
Results
The 1-year cumulative incidences of LP for Bilsky grades 0 (n=80), 1 (n=39), 2 (n=21), and 3 (n=9) were 3.0%, 8.4%, 0%, and 24.9%, respectively. Bilsky grade 2 ESCC did not significantly increase the LP rate (no LP for grade 2). The 1-year cumulative incidences of VCF for Bilsky grades 0, 1, 2, and 3 were 6.6%, 5.2%, 17.1%, and 12.1%, respectively. ESCC may increase VCF risk (subhazard ratio [SHR] for grade 2, 5.368; p=0.035; SHR for grade 3, 2.215; p=0.460). Complete or partial pain response rates after SRS were 79%, 78%, 53%, and 63% for Bilsky grades 0, 1, 2, and 3, respectively (p=0.008). No neurotoxicity of grade ≥ 3 was observed.
Conclusion
Spinal SRS for spinal metastasis with Bilsky grade 2 ESCC did not increase the LP rate, was not associated with severe neurotoxicity, and showed moderate VCF and pain response rates. Bilsky grade 3 had a high LP rate.

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Changes of Tumor Infiltrating Lymphocytes after Core Needle Biopsy and the Prognostic Implications in Early Stage Breast Cancer: A Retrospective Study
Jiahui Huang, Xiaosong Chen, Xiaochun Fei, Ou Huang, Jiayi Wu, Li Zhu, Jianrong He, Weiguo Chen, Yafen Li, Kunwei Shen
Cancer Res Treat. 2019;51(4):1336-1346.   Published online February 12, 2019
DOI: https://doi.org/10.4143/crt.2018.504
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to investigate the changes of tumor infiltrating lymphocytes (TILs) between core needle biopsy (CNB) and surgery removed sample (SRS) in early stage breast cancer patients and to identify the correlating factors and prognostic significance of TILs changes.
Materials and Methods
A retrospective study was carried out on 255 patients who received CNB and underwent surgical resection for invasive breast cancer. Stromal TILs levels of CNB and SRS were evaluated respectively. Tumors with ≥50% stromal TILs were defined as lymphocyte-predominant breast cancer (LPBC). Clinicopathological variables were analyzed to determine whether there were factors associated with TILs changes. Log-rank tests and Cox proportional hazards models were used to analyze the influences of TILs and TILs changes on survival.
Results
SRS-TILs (median, 10.0%) were significant higher than CNB-TILs (median, 5.0%; p<0.001). Younger age (<60 years, p=0.016) and long surgery time interval (STI, ≥4 days; p=0.003) were independent factors correlating with higher TILs changes. CNB-LPBC patients showed better breast cancer-free interval (BCFI, p=0.021) than CNB-non-LPBC (CNB-nLPBC) patients. Patients were categorized into four groups according to the LPBC change pattern from CNB to SRS: LPBC→LPBC, LPBC→nLPBC, nLPBC→LPBC, and nLPBC→nLPBC, with estimated 5-year BCFI 100%, 100%, 69.7%, and 86.0% (p=0.016). nLPBC→LPBC pattern was an independent prognostic factor of worse BCFI (hazard ratio, 2.19; 95% confidence interval, 1.06 to 4.53; p=0.035) compared with other patterns.
Conclusion
TILs were significantly higher in SRS than in CNB. Higher TILs changes were associated with younger age and long STI. Changing from nLPBC to LPBC after CNB indicated a worse BCFI, which needs further validation.

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Conditional Survival Estimates Improve Over Time for Patients with Hepatocellular Carcinoma: An Analysis for Nationwide Korea Cancer Registry Database
Jae Seung Lee, In Rae Cho, Hye Won Lee, Mi Young Jeon, Tae Seop Lim, Oidov Baatarkhuu, Do Young Kim, Kwang-Hyub Han, Jun Yong Park
Cancer Res Treat. 2019;51(4):1347-1356.   Published online February 12, 2019
DOI: https://doi.org/10.4143/crt.2018.477
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Conditional survival estimates (CSE) can provide additional useful prognostic information on the period of survival after diagnosis, which helps in counseling patients with cancer on their individual prognoses. This study aimed to analyze conditional survival (CS) for hepatocellular carcinoma (HCC) using a Korean national registry.
Materials and Methods
Patients with HCC, registered in the Korean cancer registry database, were retrospectively reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method. The 1-year CS at X year or month after diagnosis were calculated as CS1=OS(X+1)/OS(X). CS calculations were performed in each Barcelona Clinic Liver Cancer stage, after which patients at stage 0, A, and B underwent subgroup analysis using initial treatment methods.
Results
A total of 4,063 patients diagnosed with HCC from January 2008 to December 2010, and 2,721 who were diagnosed from January 2011 to December 2012, were separately reviewed. In 2008-2010, the 1-year CS of 1, 2, 3, 4, and 5-year survivors was 82.9%, 85.1%, 88.3%, 88.0%, and 88.6%, respectively. Patients demonstrated an increase in CSE over time in subgroup analysis, especially in the advanced stages. In 2011-2012, the 1-year CS of 6, 12, 18, 24, 30, and 36 months was 81.5%, 83.8%, 85.3%, 85.5%, 86.5%, and 88.8%, respectively. The subgroup analysis showed the same tendency towards increased CSE in the advanced stages.
Conclusion
Overall, the CS improved with each additional year after diagnosis in both groups. CSE may therefore provide a more accurate prognosis and hopeful message to patients who are surviving with or after treatment.

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    Jie Kong, Tingfeng Huang, Jianxi Zhang, Shichuan Tang, Hongzhi Liu, Jingfeng Liu, Yongyi Zeng
    HPB.2023; 25(2): 179.     CrossRef
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    Hye Won Lee, Kyung Joo Cho, Jun Yong Park
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    Lingjun Yan, Fa Chen, Lin Chen, Jing Lin, Qing Chen, Xiaodan Bao, Yu Qiu, Lisong Lin, Xiaoyan Zheng, Lizhen Pan, Jing Wang, Zhijian Hu, Fengqiong Liu, Baochang He, Bin Shi
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    Jaewoong Kim, Jin Won Chang, Jun Yong Park
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    Cancers.2019; 11(4): 509.     CrossRef
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Surveillance Rate and its Impact on Survival of Hepatocellular Carcinoma Patients in South Korea: A Cohort Study
Sanghyuk Im, Eun Sun Jang, Ju Hyun Lee, Chung Seop Lee, Beom Hee Kim, Jung Wha Chung, Jin-Wook Kim, Sook-Hyang Jeong
Cancer Res Treat. 2019;51(4):1357-1369.   Published online February 12, 2019
DOI: https://doi.org/10.4143/crt.2018.430
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Though regular surveillance of hepatocellular carcinoma (HCC) for high-risk patients is widely recommended, its rate and effectiveness are not clear. The aim of this study is to investigate the actual rate of HCC surveillance and its related factors and to clarify its impact on survival in a Korean HCC cohort.
Materials and Methods
From 2012 to 2015, 319 newly diagnosed HCC patients were prospectively enrolled at a tertiary hospital. Patient interviews based on a structured questionnaire survey were conducted. Surveillance was defined as liver imaging test ≥ 2 times with at least 3-month interval within 2 years prior to HCC diagnosis.
Results
Surveillance rate was 39.8%. Of the HCC patients with high-risk factors, only 182 (57.1%) had knowledge for the need for regular surveillance, and 141 (44.2%) had the accurate information about the method (ultrasound-based study). Surveillance group showed a higher proportion of early HCC (p < 0.001) and a longer overall survival (p < 0.001) compared to non-surveillance group. The multivariable Cox regression analysis indicated Child-Pugh class A, history of anti-viral therapy, low serum α-fetoprotein level, non-advanced Barcelona Clinic Liver Cancer stage as independent predictors of overall survival, while regular surveillance was not (p=0.436).
Conclusion
Less than half of the newly diagnosed Korean HCC patients were under surveillance and the accurate perception for the need of HCC surveillance was insufficient. Of those under surveillance, most patients were diagnosed with early stage HCC, which led to the improved survival. Comprehensive efforts to optimize the surveillance program for the target population are warranted.

Citations

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    Mayur Brahmania, Stephen Congly, Yashasavi Sachar, Kelly W. Burak, Brendan Lethebe, Jessie Hart Szostakiwskyj, David Lautner, Alexandra Medellin, Deepak Bhayana, Jason Wong, Henry Nguyen, Matthew D. Sadler, Meredith Borman, Alexander I. Aspinall, Carla S.
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  • Factors associated with the survival outcomes of patients with untreated hepatocellular carcinoma: An analysis of nationwide data
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Korean First Prospective Phase II Study, Feasibility of Prone Position in Postoperative Whole Breast Radiotherapy: A Dosimetric Comparison
Yoonsun Chung, Jeong Il Yu, Won Park, Doo Ho Choi
Cancer Res Treat. 2019;51(4):1370-1379.   Published online February 18, 2019
DOI: https://doi.org/10.4143/crt.2018.423
AbstractAbstract PDFPubReaderePub
Purpose
This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions.
Materials and Methods
Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images.
Results
In total 50 patients, 32 cases were decided as prone-position–beneficial group and 18 cases as supine-position–beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position–beneficial group but was comparable between two positions for supine-position–beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position–beneficial group. However, prone position for supine-position–beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position.
Conclusion
Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.

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    Pierre Loap, Abdelkarim Uakkas, Sofiane Allali, Jihane Bouziane, Alain Fourquet, Youlia Kirova
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    Odile Fargier-Bochaton, Xinzhuo Wang, Giovanna Dipasquale, Mohamed Laouiti, Melpomeni Kountouri, Olena Gorobets, Nam P. Nguyen, Raymond Miralbell, Vincent Vinh-Hung
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    Yi Gao, Li Wang, Han Bai, Xiang Pan, Lan Li, Li Chang, Yaoxiong Xia, Wenhui Li, Yu Hou
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    Junming Lai, Fangyan Zhong, Jianxiong Deng, Shuang Hu, Ruoyan Shen, Hui Luo, Yongbiao Luo
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    Tianhui Wei, Yufeng Cheng
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    Sager Omer, Beyzadeoglu Murat, Dincoglan Ferrat, Demiral Selcuk, Uysal Bora, Gamsiz Hakan, Ozcan Fatih, Colak Onurhan, Dirican Bahar
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Characteristics and Treatment Patterns of Patients with Advanced Soft Tissue Sarcoma in Korea
Hyo Song Kim, Chung Mo Nam, Suk-Yong Jang, Sun Kyu Choi, Minkyung Han, Seonmin Kim, Maria Victoria Moneta, Sae Young Lee, Jae Min Cho, Diego Novick, Sun Young Rha
Cancer Res Treat. 2019;51(4):1380-1391.   Published online February 18, 2019
DOI: https://doi.org/10.4143/crt.2018.476
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
A soft tissue sarcoma (STS) is a rare type of cancer, accounting for 1% of adult solid cancers. The aim of the present study is to determine the incidence of localized and advanced STS in Korean patients, their treatment patterns, and the survival of patients by disease status.
Materials and Methods
The STS patient cohort was defined using National Health Insurance Service medical data from 2002 to 2015. Incidence, distribution, anatomical location of tumors, survival rates (Kaplan-Meyer survival function) and treatment patterns were analyzed by applying different algorithms to the STS cohort containing localized and advanced STS cases.
Results
A total of 7,813 patients were diagnosed with STS from 2007 to 2014, 4,307 were localized STS and 3,506 advanced STS cases. The total incidence of STS was 2.49 per 100,000 person- years: 1.37 per 100,000 person-years for localized STS and 1.12 per 100,000 person-years for advanced STS. The 5-year survival rate after diagnosis was 56.4% for all STS, 82.4% for localized, and 27.2% for advanced STS. Half of the advanced STS patients (49.98%) received anthracycline-containing chemotherapy as initial treatment after diagnosis.
Conclusion
This study provides insights into localized and advanced STS epidemiology, treatment patterns and outcomes in Korea, which could be used as fundamental data in improving clinical outcomes of STS patients in the future.

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Active and Passive Smoking, BRAFV600E Mutation Status, and the Risk of Papillary Thyroid Cancer: A Large-Scale Case-Control and Case-Only Study
Kyoung-Nam Kim, Yunji Hwang, Kyungsik Kim, Kyu Eun Lee, Young Joo Park, June Young Choi, Do Joon Park, BeLong Cho, Daehee Kang, Sue K. Park
Cancer Res Treat. 2019;51(4):1392-1399.   Published online February 20, 2019
DOI: https://doi.org/10.4143/crt.2018.612
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The association between tobacco smoking and thyroid cancer remains uncertain. We evaluated the associations of active and passive smokingwith the risk of papillary thyroid cancer (PTC), the most common type of thyroid cancer, and with the BRAFV600E mutation, the most common oncogenic mutation in PTC related to poor prognosis.
Materials and Methods
We conducted this study with newly diagnosed PTC patients (n=2,142) and community controls (n=21,420) individually matched to cases for age and sex. Information on active and passive smoking and potential confounders were obtained from structured questionnaires, anthropometric measurements, and medical records. BRAFV600E mutation status was assessed in PTC patients. We evaluated the associations of active and passive smoking with PTC and BRAFV600E mutation risk using conditional and unconditional logistic regression models, respectively.
Results
We did not find associations between exposure indices of active and passive smoking and PTC risk in both men and women, except for the association between current smoking and lower PTC risk. Cumulative smoking ≥ 20 pack-years was associated with lower BRAFV600E mutation risk in male PTC patients (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.30 to 1.00). The CI for the association was wider in female PTC patients (OR, 0.23; 95% CI, 0.02 to 2.62), possibly owing to a smaller sample size in this stratum.
Conclusion
We did not find consistent associations between active and passive smoking and PTC risk. Cumulative smoking ≥ 20 pack-years was associated with lower BRAFV600E mutation risk in male PTC patients.

Citations

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  • The Correlation Between Biological Markers and Prognosis in Thyroid Cancer
    Rami Hajjar, Ciprian Duta, Ionut Flaviu Faur, Catalin Prodan-Barbulescu, Hadi Alhajjar, Stelian Pantea
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  • 6,769 View
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Report of the Korean Association of Lung Cancer Registry (KALC-R), 2014
Chang-Min Choi, Ho Cheol Kim, Chi Young Jung, Deog Gon Cho, Jae Hyun Jeon, Jeong Eun Lee, Jin Seok Ahn, Seung Joon Kim, Yeongdae Kim, Yoo-Duk Choi, Yang-Gun Suh, Jung-Eun Kim, Boram Lee, Young-Joo Won, Young-Chul Kim
Cancer Res Treat. 2019;51(4):1400-1410.   Published online February 25, 2019
DOI: https://doi.org/10.4143/crt.2018.704
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The aim of this study was to investigate epidemiology, clinical characteristics and sex differences of patients with lung cancer using nationwide registry in Korea.
Materials and Methods
The Korean Association for Lung Cancer developed a registry in cooperation with the Korean Central Cancer Registry, and surveyed about 10% of lung cancer cases. For this first survey of cases diagnosed in 2014, cases were selected through a systematic sampling method.
Results
Total 2,621 lung cancer patients were surveyed, and the median patient age was 70 years. During the study period, adenocarcinoma was the most frequent histologic type, the proportion of female patients was 28.4%, and women had a better prognosis (median survival, not reached vs. 13 months; p<0.001) than did men for non-small cell lung cancer. The proportion of never-smokers was 36.4%, and never-smoking was more prevalent in women than in men (87.5 vs. 16.0%, p<0.001). Epidermal growth factor receptor (EGFR) mutations were found in 36.8% of stage IV adenocarcinoma patients, and higher in female compared to male patients (51.2 vs. 26.6%, p<0.001). In addition, patients with EGFR mutation showed better survival (median survival, 18 vs. 8 months; p<0.001) than patients without EGFR mutation in these patients.
Conclusion
This is the first survey to gather unbiased nationwide lung cancer statistics in Korea. More than one-third of lung cancer patients had no smoking history. Female had a high proportion of non-smoker, more adenocarcinoma with EGFR mutation and generally better prognosis than male.

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    Minh-Thao Tu, Thi-Ngoc Tran, Hoejun Kwon, Yoon-Jung Choi, Youngjoo Lee, Hyunsoon Cho
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The Use of CD44 Variant 9 and Ki-67 Combination Can Predicts Prognosis Better Than Their Single Use in Early Gastric Cancer
Se-Il Go, Gyung Hyuck Ko, Won Sup Lee, Jeong-Hee Lee, Sang-Ho Jeong, Young-Joon Lee, Soon Chan Hong, Woo Song Ha
Cancer Res Treat. 2019;51(4):1411-1419.   Published online February 25, 2019
DOI: https://doi.org/10.4143/crt.2018.663
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We previously demonstrated that CD44v9 and Ki-67 played an important role in predicting poor prognosis of early gastric cancer (EGC). However, little is known about combined use of both biomarkers as prognostic biomarker. The present study was performed to investigate the significance of CD44v9 and Ki-67 expression as a combination biomarker for EGC.
Materials and Methods
With tissue microarray for 158 EGC tissues, we performed immunohistochemical staining for CD44v9 and Ki-67. The whole patients were divided into three groups (group A, CD44v9- negative/Ki-67–low; group B, neither group A or C; and group C, CD44v9-positive/Ki-67– high). Its clinical significance was re-analyzed with adjustment via propensity score matching (PSM). For validation, we performed bootstrap resampling.
Results
The median follow-up duration was 90.4 months (range, 3.7 to 120.4 months). In the comparison according to CD44v9/Ki-67 expression, the combined use of the two biomarker clearly separated the three groups by 5-year survival rates (5-YSR, 96.3%, 89.8%, and 76.8% in group A, B, and C, respectively; p=0.009). After PSM, 5-YSR were 97.7% and 76.8% in group A+B and group C, respectively (p=0.002). Multivariable analysis demonstrated that group C had independently poor prognosis (hazard ratio, 9.137; 95% confidence interval, 1.187 to 70.366; p=0.034) compared with group A. Bootstrap resampling internally validated this result (p=0.016).
Conclusion
This study suggests that both positive CD44v9 and high Ki-67 expression are associated with poor prognosis in EGC, and the combined use of these markers provides better prognostic stratification than the single use of them.

Citations

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MiR-1246 Promotes Metastasis and Invasion of A549 cells by Targeting GSK-3β‒Mediated Wnt/β-Catenin Pathway
Fan Yang, Hairong Xiong, Li Duan, Qian Li, Xin Li, Yongqin Zhou
Cancer Res Treat. 2019;51(4):1420-1429.   Published online March 4, 2019
DOI: https://doi.org/10.4143/crt.2018.638
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
MicroRNAs (miRNAs) are a group of small non-coding RNAs involved in different cancers, including lung cancer. Here, we aim to investigate the expression profiles of circulating miRNAs and their roles contributed to the progress of lung cancer.
Materials and Methods
The levels of circulating miRNA in lung cancer patients were investigated by miRNAs assay. Then we predicted the target genes of aberrantly expressing miRNAs by searching genetic databases. Based on the A549 cells transfected with miR-1246 mimics or miR-1246 inhibitor,we further measured the roles of miR-1246 involving in the epithelial-mesenchymal transition (EMT), migration and invasion capacities of lung cancer cells in vitro. Finally, we detected the effects of miR-1246 on glycogen synthase kinase-3β (GSK-3β)/β-catenin pathway by immunofluorescence and Western blot, respectively.
Results
We identified that 14 miRNAs were aberrantly expressed in the serum of lung cancer patients. Among them, miR-1246 was the most up-regulated. The cell assays indicated that miR-1246 significantly increased the migration and invasion capabilities of A549 lung cancer cells. Meanwhile, immunofluorescence analysis revealed that miR-1246 promoted EMT process of A549 cells accompanying with decreasing E-cadherin expression, while increasing vimentin and transforming growth factor β (TGF-β) expression. Furthermore, an online tool predicated that miR-1246 might bind to 3′-untranslated region of GSK-3β, which was confirmed by overexpression and knockdown of miR-1246 assays.
Conclusion
Taken together, the study illustrates that miR-1246 regulates Wnt/β-catenin pathway through targeting GSK-3β/β-catenin, which partly contributing to tumor metastasis. MiR-1246 may play an essential role in the diagnosis and therapeutic of lung cancer.

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Changes in the Diagnostic Efficiency of Thyroid Fine-Needle Aspiration Biopsy during the Era of Increased Thyroid Cancer Screening in Korea
Young Ki Lee, Kyeong Hye Park, Young Duk Song, Taemi Youk, Joo Young Nam, Sun Ok Song, Dong Yeob Shin, Eun Jig Lee
Cancer Res Treat. 2019;51(4):1430-1436.   Published online February 26, 2019
DOI: https://doi.org/10.4143/crt.2018.534
AbstractAbstract PDFPubReaderePub
Purpose
The volume of thyroid cancer screening and subsequent thyroid fine-needle aspiration (FNA) have rapidly increased in South Korea. We analyzed the thyroid cancer diagnoses/thyroid FNA ratio according to the annual number of FNA to evaluate changes in the diagnostic efficiency of FNA.
Materials and Methods
This was a nationwide population-based retrospective cohort study. The overall thyroid cancer diagnoses/thyroid FNA ratio and annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratio were indirectly calculated using data obtained from the Korea Central Cancer Registry database and the Korean National Health Insurance Service claims database from 2004 to 2012. Pearson correlation analyses were performed to evaluate the strength of linear associations between variables.
Results
The number of thyroid FNA increased from 28,596 to 177,805 (6.2-fold increase) from 2004 to 2012. The overall thyroid cancer diagnoses/thyroid FNA ratio decreased from 36.5% in 2004 to 25.1% in 2012 and was negatively correlated to the number of FNA (R=‒0.977, p < 0.001). The annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratios (range, 15.3% to 30.7%) were always lower than the overall thyroid cancer diagnoses/thyroid FNA ratio in each year and also worsened according to the increase in the number of FNA (R=‒0.853, p=0.007).
Conclusion
The diagnostic performance of both overall and annual incremental thyroid FNA worsened, whereas the number of thyroid FNA procedures increased. More sophisticated indications for FNA are required to improve its diagnostic efficiency, considering the increased burden of screening-detected thyroid nodules.

Citations

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    Larysa Soyka, Oksana Kovalchuk, Iryna Upatova
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    Raffaele Palladino, Ilaria Migliatico, Roberta Sgariglia, Mariantonia Nacchio, Antonino Iaccarino, Umberto Malapelle, Elena Vigliar, Domenico Salvatore, Giancarlo Troncone, Claudio Bellevicine
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    Özlem DEMİRCİOĞLU
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Impact of 21-Gene Recurrence Score on Chemotherapy Decision in Invasive Ductal Carcinoma of Breast with Nodal Micrometastases
Wei-Rong Chen, Jia-Peng Deng, Jun Wang, Jia-Yuan Sun, Zhen-Yu He, San-Gang Wu
Cancer Res Treat. 2019;51(4):1437-1448.   Published online March 4, 2019
DOI: https://doi.org/10.4143/crt.2018.611
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to investigate the effect of 21-gene recurrence score (RS) on predicting prognosis and chemotherapy decision in node micrometastases (N1mi) breast invasive ductal carcinoma (IDC).
Methods
Patients with stage T1-2N1mi and estrogen receptor-positive IDC diagnosed between 2004 and 2015 were included. The associations of 21-gene RS with breast cancer-specific survival (BCSS), chemotherapy decision, and benefit of chemotherapy were analyzed.
Results
We identified 4,758 patients including 1,403 patients (29.5%) treated with adjuvant chemotherapy. In the traditional RS cutoffs, 2,831 (59.5%), 1,634 (34.3%), and 293 (6.2%) patients were in the low-, intermediate-, and high-risk RS groups, respectively. In 3,853 patients with human epidermal growth factor receptor-2 (HER2) status available, most patients were HER2-negative disease (98.3%). A higher RS was independently related to chemotherapy receipt, and 14.0%, 47.7%, and 77.8% of patients in the low-, intermediate-, and high-risk RS groups received chemotherapy, respectively. The multivariate analysis indicated that a higher RS was related to worse BCSS (p < 0.001). The 5-year BCSS rates were 99.3%, 97.4%, and 91.9% in patients with low-, intermediate-, and high-risk RS groups, respectively (p < 0.001). However, chemotherapy receipt did not correlate with better BCSS in low-, intermediate-, or high-risk RS groups. There were similar trends using Trial Assigning Individualized Options for Treatment RS cutoffs.
Conclusion
The 21-gene RS does predict outcome and impact on chemotherapy decision of N1mi breast IDC. Large cohort and long-term outcomes studies are needed to identify the effects of chemotherapy in N1mi patients by different 21-gene RS groups.

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    Yahiya Y. Syed
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Patterns of Failure and Survival Trends in 3,808 Patients with Stage II Nasopharyngeal Carcinoma Diagnosed from 1990 to 2012: A Large-Scale Retrospective Cohort Study
Xue-Song Sun, Di-Han Liu, Sai-Lan Liu, Qiu-Yan Chen, Shan-Shan Guo, Yue-Feng Wen, Li-Ting Liu, Hao-Jun Xie, Qing-Nan Tang, Yu-Jing Liang, Xiao-Yun Li, Jin-Jie Yan, Ming-Huang Hong, Jun Ma, Lin-Quan Tang, Hai-Qiang Mai
Cancer Res Treat. 2019;51(4):1449-1463.   Published online March 7, 2019
DOI: https://doi.org/10.4143/crt.2018.688
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to investigate the survival trends and patterns of failure in patients with stage II nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT) and chemotherapy over the last 20 years.
Materials and Methods
Thirty-eight hundred and eight patients diagnosed with stage II NPC between January 1990 and December 2012 were involved in this retrospective cohort study. All patients were treated with RT. According to the main imaging techniques and RT technology, we categorized these patients into four calendar periods: 1990-1996, 1997-2002, 2003-2007, and 2008-2012. Overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), and distant metastasis–free survival (DMFS) were served as the clinical outcome.
Results
After a median follow-up period of 84.7 months, we observed increasing trends in survival and disease control. The 3- and 5-year OS rates increased from 87.1% and 78.7% in the first calendar period to 97.4% and 94.5% in the last calendar period, respectively (p<0.001). Additionally, significant increasing trends could be seen in the PFS and LRFS during the four calendar periods. In the subgroup analysis, the LRFS in patients older than 50 years at diagnosis showed greater improvement than younger patients. However, the rate of distant metastasis was stable and relatively low, as the 5-year DMFS ranged from 90.5% to 94.7% among the four calendar periods.
Conclusion
The survival rates in patients with stage II NPC showed increasing trends from 1990 to 2012. The advance of RT provided excellent locoregional control and enhanced OS.

Citations

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    Zhi-Hui Wang, Xiao-Feng Pei, Zhi-Quan Zhu, Zhong Lin, Yin-Yan Mao, Xiao-Lu Xu, You-Li Luo, Li Zhang, Pei-Jian Peng
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Novel Prognostic Nomograms Based on Inflammation-Related Markers for Patients with Hepatocellular Carcinoma Underwent Hepatectomy
Yifei Wang, Kaiyu Sun, Jingxian Shen, Bin Li, Ming Kuang, Qinghua Cao, Sui Peng
Cancer Res Treat. 2019;51(4):1464-1478.   Published online March 11, 2019
DOI: https://doi.org/10.4143/crt.2018.657
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy.
Materials and Methods
We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established, and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed, and compared with existed staging systems.
Results
Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumour number, tumour diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, α-fetoprotein, microvascular invasion, satellite lesions, tumour diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95% CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p<0.001).
Conclusion
The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.

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Prognostic Value of Baseline and Interim Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on 18F-FDG PET-CT in Patients with Follicular Lymphoma
Jin-Hua Liang, Yun-Ping Zhang, Jun Xia, Chong-Yang Ding, Wei Wu, Li Wang, Lei Cao, Hua-Yuan Zhu, Lei Fan, Tian-Nv Li, Jian-Yong Li, Wei Xu
Cancer Res Treat. 2019;51(4):1479-1487.   Published online March 12, 2019
DOI: https://doi.org/10.4143/crt.2018.649
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to investigate the prognostic significance of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in patients with follicular lymphoma (FL) at baseline and mid-treatment with 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans.
Methods
The study analyzed data from 48 patients with FL who were treated in Jiangsu Province Hospital and reviewed their baseline PET-CT scans. TMTV and TLG were computed by using the absolute value of 2.0, 2.5, and 3.0 thresholding method, respectively.
Results
Median age was 53 years, 75.0% of patients had stage III to IV disease, 43.8% had a Follicular Lymphoma International Prognostic Index 1 (FLIPI1) score of 3 to 5 and 20.8% had a FLIPI2 score of 3 to 5. Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off values for TMTV3.0 and TLG3.0 were 476.4 (sensitivity, 85.7%; specificity, 78.0%; area under the curve [AUC], 0.760; p=0.003) and 2,676.9 (sensitivity, 71.4%; specificity, 78.0%; AUC, 0.760; p=0.003). On multivariable analysis, TMTV3.0 and TLG3.0 were independent predictors of both progression-free survival (PFS) (hazard ratio [HR], 5.406; 95% confidence interval [CI], 1.326 to 22.040; p=0.019 and HR, 6.502; 95% CI, 1.079 to 39.182; p=0.042) and overall survival (OS) (HR, 4.111; 95% CI, 1.125 to 15.027; p=0.033 and HR, 5.885; 95% CI, 1.014 to 34.148; p=0.049). ROC curve analysis showed the optimal cut-off values for ΔTMTV3.0 and ΔTLG3.0 were 66.3% (sensitivity, 85.7%; specificity, 63.4%; AUC, 0.774; p < 0.001) and 64.5% (sensitivity, 85.7%; specificity, 65.9%; AUC, 0.777; p < 0.001).
Conclusion
Baseline TMTV and TLG are strong predictors of PFS and OS in FL. Furthermore, interim TMTV (ΔTMTV > 66.3%) and TLG (ΔTLG > 64.5%) reduction are valuable tools for early treatment response assessment in FL patients.

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Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Re-biopsy in Previously Treated Lung Cancer
Joohae Kim, Hyo Jae Kang, Sung Ho Moon, Jong Mog Lee, Hyae Young Kim, Geon-Kook Lee, Jin Soo Lee, Bin Hwangbo
Cancer Res Treat. 2019;51(4):1488-1499.   Published online March 15, 2019
DOI: https://doi.org/10.4143/crt.2019.031
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for the diagnosis and staging of lung cancer. However, evidence of its usefulness for re-biopsy in treated lung cancer, especially according to the previous treatment, is limited. We evaluated the role of EBUS-TBNA for re-biopsy and its diagnostic values in patients with different treatment histories.
Materials and Methods
We reviewed the medical records of patients who underwent EBUS-TBNA for re-biopsy of suspicious recurrent or progressive lesions between January 2006 and December 2016 at the National Cancer Center in South Korea. Patients were categorized into three groups based on the previous treatment modalities: surgery, radiation, and palliation.
Results
Among the 367 patients (surgery, n=192; radiation, n=40; palliation, n=135) who underwent EBUS-TBNA for re-biopsy, the overall sensitivity, negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in detecting malignancy were 95.6%, 82.7%, and 96.3%, respectively. The sensitivity was lower in the radiation group (83.3%) when compared with the surgery (95.7%, p=0.042) and palliation (97.7%, p=0.012) groups. The NPV was lower in the palliation group (50.0%) than in the surgery group (88.5%, p=0.042). The sample adequacy of EBUS-TBNA specimens was lower in the radiation group (80.3%) than in the surgery (95.4%, p < 0.001) or palliation (97.8%, p < 0.001) groups. EGFR mutation analysis was feasible in 94.6% of the 92 cases, in which mutation analysis was requested. There were no major complications. Minor complications were reported in 12 patients (3.3%).
Conclusion
EBUS-TBNA showed high diagnostic values and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. The sensitivity was lower in the radiation group and NPV was lower in the palliation group. The complication rate was low.

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    Yangyang Wang, Yongyuan Zhang, Nana Ren, Fangting Li, Lin Lu, Xin Zhao, Zhigang Zhou, Mengyu Gao, Meng Wang
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Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14)
Kyubo Kim, Yuri Jeong, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Su Ssan Kim, Chang-Ok Suh, Yong Bae Kim, Doo Ho Choi, Won Park, Jihye Cha, Mison Chun, Dong Soo Lee, Sun Young Lee, Jin Hee Kim, Hae Jin Park, Wonguen Jung
Cancer Res Treat. 2019;51(4):1500-1508.   Published online March 15, 2019
DOI: https://doi.org/10.4143/crt.2018.575
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.
Materials and Methods
A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.
Results
The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients.
Conclusion
Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.

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    Xiaofang Wang, Xiaomeng Zhang, Li Zhang, Jin Meng, Wei Shi, Xingxing Chen, Zhaozhi Yang, Xin Mei, Xiaoli Yu, Zhen Zhang, Zhimin Shao, Xiaomao Guo, Jinli Ma
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    Jae Sik Kim, Kyubo Kim, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Su Ssan Kim, Yong Bae Kim, Jee Suk Chang, Doo Ho Choi, Won Park, Tae Hyun Kim, Mison Chun, Jihye Cha, Jin Hee Kim, Dong Soo Lee, Sun Young Lee, Hae Jin Park
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    Kyubo Kim, Su Ssan Kim, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Doo Ho Choi, Won Park, Sun Young Lee, Mison Chun, Jin Hee Kim, Yong Bae Kim, Jihye Cha, Hae Jin Park, Dong Soo Lee, Wonguen Jung
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    Tianyi Ma, Yan Mao, Haibo Wang
    Cancer Management and Research.2020; Volume 12: 11857.     CrossRef
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Television Viewing Time and Breast Cancer Incidence for Japanese Premenopausal and Postmenopausal Women: The JACC Study
Jinhong Cao, Ehab Salah Eshak, Keyang Liu, Isao Muraki, Renzhe Cui, Hiroyasu Iso, Akiko Tamakoshi, JACC Study Group
Cancer Res Treat. 2019;51(4):1509-1517.   Published online March 21, 2019
DOI: https://doi.org/10.4143/crt.2018.705
AbstractAbstract PDFPubReaderePub
Purpose
The evidence on effects of TV viewing time among premenopausal and postmenopausal women for breast cancer risk remains controversial and limited.
Materials and Methods
A prospective study encompassing 33,276 (17,568 premenopausal, and 15,708 postmenopausal) women aged 40-79 years in whom TV viewing time, menstrual, and reproductive histories were determined by a self-administered questionnaire. The follow-up was from 1988 to 2009 and hazard ratios (HRs) with 95% confidence intervals (CIs) of breast cancer incidence were calculated for longer TV viewing time in reference to shorter TV viewing time by Cox proportional hazard models.
Results
During 16.8-year median follow-up, we found positive associations between TV viewing time and breast cancer incidence with a borderline significant trend among total women and a significant trend among postmenopausal women. Among total women, the multivariable HRs (95% CIs) for risk of breast cancer in reference to < 1.5 hr/day of TV viewing time were 0.89 (0.59-1.34) for 1.5 to < 3.0 hr/day, 1.19 (0.82-1.74) for 3.0 to < 4.5 hr/day, and 1.45 (0.91-2.32) for ≥ 4.5 hr/day (p for trend=0.053) and among postmenopausal women, the corresponding risk estimates were 1.10 (0.42-2.88), 2.54 (1.11-5.80), and 2.37 (0.92-6.10) (p for trend=0.009), respectively.
Conclusion
Prolonged TV viewing time was associated with increased risk of breast cancer, especially among postmenopausal women.

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  • METTL3 regulates FAM83D m6A modification to accelerate tumorigenesis of triple-negative breast cancer via the Wnt/β-catenin pathway
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Loss of LKB1 Protein Expression Correlates with Increased Risk of Recurrence and Death in Patients with Resected, Stage II or III Colon Cancer
Maria Sfakianaki, Chara Papadaki, Maria Tzardi, Maria Trypaki, Sardar Alam, Eleni D. Lagoudaki, Ippokratis Messaritakis, Odysseas Zoras, Dimitris Mavroudis, Vassilis Georgoulias, John Souglakos
Cancer Res Treat. 2019;51(4):1518-1526.   Published online March 20, 2019
DOI: https://doi.org/10.4143/crt.2019.008
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to investigate the prognostic significance of liver kinase b1 (LKB1) loss in patients with operable colon cancer (CC).
Materials and Methods
Two hundred sixty-two specimens from consecutive patients with stage III or high-risk stage II CC, who underwent surgical resection with curative intent and received adjuvant chemotherapy with fluoropyrimidine and oxaliplatin, were analyzed for LKB1 protein expression loss, by immunohistochemistry as well as for KRAS exon 2 and BRAFV600E mutations by Sanger sequencing and TS, ERCC1, MYC, and NEDD9 mRNA expression by real-time quantitative reverse transcription polymerase chain reaction.
Results
LKB1 expression loss was observed in 117 patients (44.7%) patients and correlated with right-sided located primaries (p=0.032), and pericolic lymph nodes involvement (p=0.003), BRAFV600E mutations (p=0.024), and TS mRNA expression (p=0.041). Patients with LKB1 expression loss experienced significantly lower disease-free survival (DFS) (hazard ratio [HR], 1.287; 95% confidence interval [CI], 1.093 to 1.654; p=0.021) and overall survival (OS) (HR, 1.541; 95% CI, 1.197 to 1.932; p=0.002), compared to patients with LKB1 expressing expressing tumors. Multivariate analysis revealed LKB1 expression loss as independent prognostic factor for both decreased DFS (HR, 1.217; 95% CI, 1.074 to 1.812; p=0.034) and decreased OS (HR, 1.467; 95% CI, 1.226 to 2.122; p=0.019).
Conclusion
Loss of tumoral LKB1 protein expression, constitutes an adverse prognostic factor in patients with operable CC.

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    Yuemei Feng, JiZhuo Yang, Yihan Wang, Xue Wang, Qian Ma, Yalin Li, Xuehui Zhang, Songmei Wang, Qiao Zhang, Fei Mi, Yanjiao Wang, Dubo Zhong, Jianzhong Yin
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    Ippokratis Messaritakis, Asimina Koulouridi, Eleni Boukla, Maria Sfakianaki, Konstantinos Vogiatzoglou, Michaela Karagianni, Nikolaos Gouvas, John Tsiaoussis, Evangelos Xynos, Elias Athanasakis, Dimitrios Mavroudis, Maria Tzardi, John Souglakos
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    Maria Sfakianaki, Chara Papadaki, Maria Tzardi, Maria Trypaki, Stavroula Manolakou, Ippokratis Messaritakis, Zenia Saridaki, Elias Athanasakis, Dimitrios Mavroudis, John Tsiaoussis, Nikolaos Gouvas, John Souglakos
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    Li-Yan Jin, Kui Zhao, Long-Jiang Xu, Rui-Xun Zhao, Kaitlin D. Werle, Yong Wang, Xiao-Long Liu, Qiu Chen, Zhuo-Jun Wu, Ke Zhang, Ying Zhao, Guo-Qin Jiang, Feng-Mei Cui, Zhi-Xiang Xu
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BioPATH: A Biomarker Study in Asian Patients with HER2+ Advanced Breast Cancer Treated with Lapatinib and Other Anti-HER2 Therapy
Sung-Bae Kim, In-Gu Do, Janice Tsang, Tae-You Kim, Yoon-Sim Yap, Gerardo Cornelio, Gyungyub Gong, Soonmyung Paik, Suee Lee, Ting-Ying Ng, Sarah Park, Ho-Suk Oh, Joanne Chiu, Joohyuk Sohn, Moonhee Lee, Young-Jin Choi, Eun Mi Lee, Kyong-Hwa Park, Christos Nathaniel, Jungsil Ro
Cancer Res Treat. 2019;51(4):1527-1539.   Published online June 4, 2019
DOI: https://doi.org/10.4143/crt.2018.598
AbstractAbstract PDFPubReaderePub
Purpose
BioPATH is a non-interventional study evaluating the relationship of molecular biomarkers (PTEN deletion/downregulation, PIK3CA mutation, truncated HER2 receptor [p95HER2], and tumor HER2 mRNA levels) to treatment responses in Asian patients with HER2+ advanced breast cancer treated with lapatinib and other HER2-targeted agents. Materials and Methods Female Asian HER2+ breast cancer patients (n=154) who were candidates for lapatinib-based treatment following metastasis and having an available primary tumor biopsy specimen were included. The primary endpoint was progression-free survival (PFS). Secondary endpoints were response rate, overall survival on lapatinib, correlation between biomarker status and PFS for any previous trastuzumab-based treatment, and conversion/conservation rates of the biomarker status between tissue samples collected at primary diagnosis and at recurrence/metastasis. Potential relationships between tumor mRNA levels of HER2 and response to lapatinib-based therapy were also explored.
Results
p95HER2, PTEN deletion/downregulation, and PIK3CA mutation did not demonstrate any significant co-occurrence pattern and were not predictive of clinical outcomes on either lapatinib-based treatment or any previous trastuzumab-based therapy in the metastatic setting. Proportions of tumors positive for p95HER2 expression, PIK3CA mutation, and PTEN deletion/down-regulation at primary diagnosis were 32%, 31.2%, and 56.2%, respectively. Despite limited availability of paired samples, biomarker status patterns were conserved in most samples. HER2 mRNA levels were not predictive of PFS on lapatinib.
Conclusion
The prevalence of p95HER2 expression, PIK3CA mutation, and PTEN deletion/downregulation at primary diagnosis were similar to previous reports. Importantly, no difference was observed in clinical outcome based on the status of these biomarkers, consistent with reports from other studies.

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  • PIK3CA Mutation is Associated with Poor Response to HER2-Targeted Therapy in Breast Cancer Patients
    Ju Won Kim, Ah Reum Lim, Ji Young You, Jung Hyun Lee, Sung Eun Song, Nam Kwon Lee, Seung Pil Jung, Kyu Ran Cho, Cheol Yong Kim, Kyong Hwa Park
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Clinical Significance of Pleural Attachment and Indentation of Subsolid Nodule Lung Cancer
Hyung-Jun Kim, Jun Yeun Cho, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jin-Haeng Chung, Sukki Cho, Kwhanmien Kim, Kyung Won Lee, Jae Ho Lee, Choon-Taek Lee
Cancer Res Treat. 2019;51(4):1540-1548.   Published online March 25, 2019
DOI: https://doi.org/10.4143/crt.2019.057
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of pleural attachment and/or indentation on visceral pleural invasion (VPI) and recurrence-free survival.
Materials and Methods
Patients who underwent curative resection of lung cancer as subsolid nodules from April 2007 to January 2016 were retrospectively evaluated. They were divided into four groups according to their relationship with the pleura. Clinical, radiographical, and pathological findings were analyzed.
Results
Among 404 patients with malignant subsolid nodule, 120 (29.7%) had neither pleural attachment nor indentation, 26 (6.4%) had attachment only, 117 (29.0%) had indentation only, and 141 (34.9%) had both. VPI was observed in nodules of 36 patients (8.9%), but absent in nonsolid nodules and in those without pleural attachment and/or indentation. Compared to subsolid nodules with concurrent pleural attachment and indentation, those with attachment only (odds ratio, 0.12; 95% confidence interval [CI], 0.02 to 0.98) and indentation only (odds ratio, 0.10; 95% CI, 0.03 to 0.31) revealed lower odds of VPI. On subgroup analysis, the size of the solid portion was associated with VPI among those with pleural attachment and indentation (p=0.021). Such high-risk features for VPI were associated with earlier lung cancer recurrence (adjusted hazard ratio, 3.31; 95% CI, 1.58 to 6.91).
Conclusion
Concurrent pleural attachment and indentation are risk factors for VPI, and the odds increase with larger solid portion in subsolid nodules. Considering the risk of recurrence, early surgical resection could be encouraged in these patients.

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Bevacizumab Plus Erlotinib Combination Therapy for Advanced Hereditary Leiomyomatosis and Renal Cell Carcinoma-Associated Renal Cell Carcinoma: A Multicenter Retrospective Analysis in Korean Patients
Yeonjoo Choi, Bhumsuk Keam, Miso Kim, Shinkyo Yoon, Dalyong Kim, Jong Gwon Choi, Ja Young Seo, Inkeun Park, Jae Lyun Lee
Cancer Res Treat. 2019;51(4):1549-1556.   Published online March 25, 2019
DOI: https://doi.org/10.4143/crt.2019.086
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) is a rare genetic syndrome resulting from germline mutations in fumarate hydratase. The combination of bevacizumab plus erlotinib showed promising interim results for HLRCC-associated RCC. Based on these results, we analyzed the outcome of bevacizumab plus erlotinib in Korean patients with HLRCC-associated RCC.
Materials and Methods
We retrospectively reviewed the efficacy and safety of bevacizumab plus erlotinib in patients with HLRCC-associated RCC who were confirmed to have germline mutations in fumarate hydratase. The primary endpoint was the objective response rate (ORR), while the secondary endpoints were progression-free survival (PFS) and overall survival (OS).
Result
We identified 10 patients with advanced HLRCC-associated RCC who received bevacizumab plus erlotinib. Median age at diagnosis was 41 years, and five of the patients had received the combination as first- or second-line treatments. The ORR was 50% and the median PFS and OS were 13.3 and 14.1 months, respectively. Most adverse events were predictable and manageable by conventional measures, except for one instance where a patient died of gastrointestinal bleeding.
Conclusion
This is the first real-world outcome of the treatment of advanced HLRCC-associated RCC. Bevacizumab plus erlotinib therapy showed promising activity with moderate toxicity. We should be increasingly aware of HLRCC-associated RCC and bevacizumab plus erlotinib should be a first-line treatment for this condition, unless other promising data are published.

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Characteristics, Prognostic Factors, and Survival of Patients with NK/T-Cell Lymphoma of Non-upper Aerodigestive Tract: A 17-Year Single-Center Experience
Ze-Long Liu, Xi-Wen Bi, Xue-Wen Zhang, De-Xin Lei, Pan-Pan Liu, Hang Yang, Yan Gao, Yuan-Xue Jiang, Wen-Qi Jiang, Yi Xia
Cancer Res Treat. 2019;51(4):1557-1567.   Published online April 1, 2019
DOI: https://doi.org/10.4143/crt.2018.681
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The extranodal natural killer (NK)/T-cell lymphoma (NKTCL) of non-upper aerodigestive tract (NUAT) was found to have clinical heterogeneity compared with NKTCL of the upper aerodigestive tract (UAT) in small scale studies. We conducted this study in a much larger cohort to analyze the clinical characteristics, prognostic factors, treatment modality, and clinical outcomes of patients with NUAT-NKTCL.
Materials and Methods
From January 2001 to December 2017, a total of 757 NKTCL patients were identified and included in this study, including 92 NUAT-NKTCL patients (12.2%) and 665 UAT-NKTCL patients (87.8%).
Results
NUAT-NKTCL patients had relatively poorer performance status, more unfavorable prognostic factors, and more advanced stage, compared with UAT-NKTCL patients. The 5-year overall survival (OS) was 34.7% for NUAT-NKTCL, which was significantly worse than UAT-NKTCL (64.2%, p<0.001). The median OS duration was 30.9 months for NUAT-NKTCL. Multivariate analysis showed that presence with B symptoms and elevated serum lactate dehydrogenase independently predicted worse OS. International prognostic index score and prognostic index of natural killer lymphoma score still had prognostic values in NUAT-NKTCL, while the Ann Arbor system could not accurately predict the OS.
Conclusion
NUAT-NKTCL is a distinctive subtype of NKTCL in many aspects. Patients with NUAT-NKTCL have relatively poorer performance status, more unfavorable prognostic factors, more advanced stage, and poorer prognosis.

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