e14653 Background: It is estimated that 142,820 people will be diagnosed and 50,830 will die from colon cancer in U.S. in 2013. The known risk factors include age (>50 years old), personal history of colon polyp(s) and Inflammatory bowel disease, family history of colon cancer, hereditary syndromes, Black race, type II Diabetes Mellitus, obesity, physical inactivity, smoking and alcohol use. In order to improve colon cancer survivorship, current study explores factors that affect it. Methods: Data of 524,613 colon cancer patients between 1973 and 2009 was obtained from the Surveillance Epidemiology and End Results (SEER) program. Factors evaluated in this study were age at diagnosis, gender, race, annual household income, education, unemployment, and smoking. Clinical factors evaluated include SEER historic stage and treatments received. The definition of these factors was based on the SEER data dictionary. Kaplan-Meier method and log rank test was used to estimate and compare survivals. Cox regressions were used to identify risk factors that affect survival. Results: Characteristics of this half millions colon cancer patients were 51.3% of males, 84.4% of whites, and 70% of adjusted household income <$50,000. Primary site: Sigmoid Colon (30.84%), Cecum (22.7%), Ascending Colon (9.42%), and others (9.42%). Stage: Localized (37%), Regional (36.26%), Distant (20.01%), and Unstaged (6.63%). In multivariate analysis, adjusting for other factors, age (≤49 vs. 60-69, HR=0.57), female gender (HR=0.87), stage (localized vs. distant stage, HR= 0.15) and race (Black HR=1.38, vs. Asian) are significant factors in colon cancer survival. People living in areas with a high percentage of smokers have increased risk by 8%. People living in areas of higher unemployment have 6% increased risk. Household income and education level have relatively less effect on colon cancer survival (40-55k vs. 0-40k, HR=1.02). Conclusions: We conclude that in a large database, age, race, stage, smoking, and unemployment have significant impact on colon cancer survival. Other factors such as insurance status, detailed treatments, screening effect, individual life styles and etc. need further investigation.
Purpose: To determine whether SUV max(Maximum Standardized Uptake Value) of primary lung tumor on FDGPET/CT scan (Fluorodeoxy Glucose -Positron Emission Tomography/Computed Tomography) at baseline has any role in predicting survival in patients with Stage IV NSCLC. Background: Lung Cancer is the leading cause of mortality in both sexes in United States and Worldwide. About 70% of patients with lung cancer present with locally advanced or metastatic disease at diagnosis. In general Stage IV Lung cancer has poor prognosis with 5-year survival of 2 percent. Limited numbers of factors are known to predict survival in Stage IV Lung cancer. Prognosis in Lung cancer is directly related to the stage at diagnosis, performance status, and genomic expression profile. Earlier studies have found SUV max of primary lung tumor on FDGPET/CT scan in early stage lung cancer correlates with tumor doubling time and survival. However prior studies performed in advanced stage lung cancer yielded conflicting data and most of the studies included StageIII/IVNSCLC patients. Hence we performed a retrospective review on patients with Stage IVNSCLC. Patients and Methods: Retrospective review identified 46 patients between September 2004- September 2011 that were diagnosed with stage IV NSCLC at our institution who underwent FDGPET/CT scan at diagnosis .Extensive clinical data including tumor histologic type, clinical stage at presentation, number of metastatic sites,performance status and treatment were recorded. SUVmax in primary tumor on FDG PET/CT scan was determined on the attenuated-corrected FDG PET images utilizing an automated program on a dedicated PET/CT workstation by a single nuclear medicine specialist. Cox regression analysis and Log rank test were used for data analysis. Results: Descriptive statistics showed Median age 61.6(43.8-77.8), Females 17(36%), African Americans 26(56%), Performance status(0-1)36(80%),number of metastatic sites(1-2)30(65%),Adenocarcinoma 32(70%),Chemotherapy 31(61%).The patient population was subdivided into two groups using the median SUVmax of 15.4. Median OS was 8.8months (95%CI, 5-13months). The median survival of patients having SUV max ≤15.4 and SUVmax > 15.4 was 10.5 months(95%CI, 3.5-15.8months) and 6.0 months (95%CI,4.1-12.6months)respectively(P =0.127) Multivariate analysis indicated that performance status (HR=3.1) and use of chemotherapy (HR=2.8) predicted survival. We did not find gender, race and histology to be a predictor of survival. We found SUV max>15.4 has increased risk of death by 70% (HR=1.7, P=0.12) Conclusion: Survival difference based on SUV max value of primary lung tumor on FDGPET/CT scan in patients with Stage IV NSCLC did not reach statistical significance but there was a trend towards improved survival in patients with SUVmax≤15.4. Future studies with a larger sample may be required to evaluate this trend. Citation Format: Manga Devi Kodali, Amol Takalkar, Runhua Shi, Syed H. Jafri. SUV max of primary lung tumor on FDGPET/CT scan at baseline as a potential prognostic factor in stage IV NSCLC: a retrospective review. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4697. doi:10.1158/1538-7445.AM2013-4697
e19070 Background: Lung cancer is the leading cause of mortality in United States and worldwide. Stage IV lung cancer has poor prognosis with 5-year survival of 2%. Limited numbers of factors are known to predict survival in stage IV NSCLC (Non Small Cell Lung Cancer) including stage at diagnosis, Performance Status (PS), genomic expression profile. Earlier studies have found SUV max (Maximum Standardized Uptake Value) of primary lung tumor on FDGPET/CT (Fluoro Deoxy Glucose –Positron Emission Tomography/Computed Tomography) correlates with tumor doubling time and survival. However prior studies included stage I-IV NSCLC patients and SUVmax of primary lung tumor. Hence we performed this study with only clinical stage IVNSCLC who underwent FDGPET/CT scan at baseline to determine whether SUVmax value of most intense lesion has any prognostic significance. Methods: Retrospective review identified 46 patients (September 2004- September 2011) that were diagnosed with stage IV NSCLC at our institution. SUVmax of most intense lesion on FDG PET/CT scan was determined utilizing an automated program on a dedicated PET/CT workstation by a single nuclear medicine specialist. Cox regression analysis and Log-rank test were used to analyze data. Results: Descriptive statistics: Median age 61.6 (43.8-77.8), Females 17 (36%), African Americans 26 (56%), Performance status 0-1=36 (80%), number of metastatic sites 1-2=30 (65%), Adenocarcinoma 32 (70%), Chemotherapy 31 (61%), SUV max- primary (65%), other sites (35%). The patient population was subdivided into two groups using the median SUVmax of 17.8. The median survival of patients having SUV max ≤17.8 and SUVmax > 17.8 was 13.4 months and 4.5 months respectively (P =0.0269). Multivariate analysis indicated PS (HR=2.8), any chemotherapy (HR=2.56) and SUV max ≤ 17.8 (HR=1.98, P=0.04) predicted survival. Conclusions: SUV max of the most intense lesion at the time of presentation predicts worse outcome in stage IVNSCLC and needs to be validated in a prospective study. PETCT may be able to predict the areas that harbor resistant clones of cells, described in previous studies as tumor heterogeneity, which may confer prognostic significance.
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