Cholestyramine contributed to a more rapid and complete decline in thyroid hormone levels in patients with Graves' hyperthyroidism. It was thus proved to be an effective and well-tolerated adjunctive therapy.

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We investigated whether the combination of primary tumor and nodal 18F-FDG PET parameters predict survival outcomes in patients with nodal metastatic non-small cell lung cancer (NSCLC) without distant metastasis. We retrospectively extracted pre-treatment 18F-FDG PET parameters from 89 nodal-positive NSCLC patients (stage IIB–IIIC). The Cox proportional hazard model was used to identify independent prognosticators of overall survival (OS) and progression-free survival (PFS). We devised survival stratification models based on the independent prognosticators and compared the model to the American Joint Committee on Cancer (AJCC) staging system using Harrell’s concordance index (c-index). Our results demonstrated that total TLG (the combination of primary tumor and nodal total lesion glycolysis) and age were independent risk factors for unfavorable OS (p < 0.001 and p = 0.001) and PFS (both p < 0.001), while the Eastern Cooperative Oncology Group scale independently predicted poor OS (p = 0.022). Our models based on the independent prognosticators outperformed the AJCC staging system (c-index = 0.732 versus 0.544 for OS and c-index = 0.672 versus 0.521 for PFS, both p < 0.001). Our results indicate that incorporating total TLG with clinical factors may refine risk stratification in nodal metastatic NSCLC patients and may facilitate tailored therapeutic strategies in this patient group.

Nonmetastatic esophageal cancer can demonstrate a high local recurrence rate even under the standard treatment. We evaluated platelet counts before and after concurrent chemoradiotherapy (CCRT), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio for predicting esophageal cancer prognosis under CCRT. Newly diagnosed patients with esophageal cancer (stages IA–IIIC) who underwent CCRT during January 2013–December 2017 were enrolled. The data were collected retrospectively. Overall survival (OS), time to progressive disease (TPD), and time to metastasis (TM) were recorded for indicating prognosis. Kaplan–Meier curves were plotted and univariate and multivariate analyses were performed. In total, 105 patients were enrolled. The stages of esophageal cancer and surgery were associated with prognosis (i.e., OS, TPD, and TM). Based on TPD and TM, women had better prognosis than men. In the univariate analysis, high pre- and post-CCRT platelet counts (>300,000/μL), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) as well as low lymphocyte percentage were significantly associated with poor prognosis. However, in the multivariate analysis, only post-CCRT high platelet count (>300,000/μL) remained significantly associated with poor prognosis (P = .041, .045, and .023 for OS, TPD, and TM, respectively). Poor prognosis was observed in patients with high platelet counts, PLR, NLR, and low lymphocyte percentage. Surgery was an independent factor predicting better prognosis. Our findings may have clinical significance with regard to therapeutic decision-making.

1875 Introduction: The aim of this study is to validate the clinical utility of a flow cytometric scoring system (FCSS) (1)in the diagnosis and prognosis of MDS by quantifying myeloid and monocytic dyspoiesis and correlating the accumulation of abnormalities to clinical outcome. Methods: The BM samples were characterized by the FCSS from 56 consecutive, newly diagnosed MDS patients who were morphologically classified as RA (n=3), MDS-U (n=1), RCMD/RCMD-RS (n=32), RAEB-1 (n=12) and RAEB-2 (n=8) from January 2005 to December 2009. Three-color FCM was performed on total nonerythroid BM cells with a standardized panel of monoclonal antibodies (Table 1). The final FCSS was based on the independent analysis of data by 2 investigators (S.C.C., T.F.W.,) who were blinded to MDS/non-MDS category and clinical outcomes. The FCSS were categorized as normal/mild (0 or 1 point), moderate (2 or 3 points), or severe (4 or more points). The results of FCSS were compared with findings in 27 non-MDS cytopenic patients as the control, including diagnosis of aplastic anemia (n=7), iron deficiency anemia (n=3), folic acid or vitamin B12 deficiency anemia (n=6) and idiopathic thrombocytopenia purpura (n=11). FCSS scores were retrospectively compared with marrow blast counts, cytogenetics, hematologic parameters, IPSS and WHO categorization to assess the utility in diagnosis and prognosis of MDS. Follow-up of patients continued until May 2010, with mortality observed in 30 (54%) patients. The patient characteristics are summarized in Table 2. Nearly all MDS patients underwent supportive care rather than hypomethylation agents(n=3), chemotherapy(n=4) or haematopoietic stem cell transplantation(n=0). Results: The FCSS scores were significantly higher in patients with MDS than those in the non-MDS control (3 vs. 0, P < .0001). A flow score of 2 or more allowed for a specificity of 100% with 75% sensitivity in diagnosing MDS. The FCSS scores correlated directly with IPSS scores (n=40, R=.5327, P =.0004) and WHO classification (n= 56, R=.5163, P<.0001) but did not correlated with IPSS cytogenetic risk categories (n=40, P= .7738). The median survival were 6 months, 19 months and not reach for MDS patients with severe, moderate and mild FCSS scores, respectively (n=56, P = .0018)(Figure 1). The Multivariate analyses using Cox proportional hazard model in a stepwise manner demonstrated the FCSS risk categories was an independent prognostic factor (P=.0020) after adjusting for sex, age (above 70 year-old or not) and IPSS risk categories. Furthermore, among 32 patients classified as RCMD/RCMD-RS, the median survival were 2 months, 13 months and not reach for patients with severe, moderate and mild FCSS scores, respectively (n=32, P = .0045) (Figure 2). Conclusion: These results demonstrate that quantifying aberrancies in myelomonocytic lineage by FCSS is very useful in MDS diagnosis. As shown in a bone marrow transplant study the FCSS also predicts outcome in conventionally treated patients and may give a more accurate prognosis especially among patients classified as RCMD subgroup. Reference: (1) Wells, DA et Myeloid and monocytic dyspoiesis as determined by flow cytometric scoring in myelodysplastic syndrome correlates with the IPSS and with outcome after hematopoietic stem cell transplantation Blood 102: 394–403, 2003. Disclosures: No relevant conflicts of interest to declare.

Background/Aim: This study aimed to evaluate the association of sarcopenia and Clinical Outcomes with esophageal cancer under neoadjuvant chemoradiotherapy (CRT). Patients and Methods: A retrospective study assessing patients with esophageal cancer who underwent CRT between 2001 and 2014 was conducted in the medical center. Hospital patients' records on sarcopenia and treatment outcomes were statistically analyzed. Results: The sarcopenia group had significantly lower body mass index than the non-sarcopenia group. CRT-related severe adverse events with mucositis, fever, and neutropenic fever were greater in the sarcopenia group. Overall survival and disease-free survival were significantly better in the nonsarcopenia group. Sarcopenic patients who received nutritional support with enteral access had less severe mucositis. There was no difference in mortality of sarcopenia patients with nutritional support via enteral access or without. Moreover, sarcopenia and advanced tumor stage were independent factors for mortality outcome. Conclusion: Sarcopenia before CRT may be associated with increased toxicities and worse overall survival/ disease-free survival in esophageal cancer patients.

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Background To investigate the survival prognostic value of the radiomic features of 18F-FDG PET in patients who had EGFR (epidermal growth factor receptor) mutated lung adenocarcinoma and received targeted TKI (tyrosine kinase inhibitor) treatment. Methods Fifty-one patients with stage III-IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI were retrospectively analyzed. All patients underwent pretreatment 18F-FDG PET/CT, and we calculated the PET-derived radiomic features. Cox proportional hazard model was used to examine the association between the radiomic features and the survival outcomes, including progression-free survival (PFS) and overall survival (OS). A score model was established according to the independent prognostic predictors and we compared this model to the TNM staging system using Harrell's concordance index (c-index). Results Forty-eight patients (94.1%) experienced disease progression and 41 patients (80.4%) died. Primary tumor SUV entropy > 5.36, and presence of pleural effusion were independently associated with worse OS (both p < 0.001) and PFS (p = 0.001, and 0.003, respectively). We used these two survival predictors to devise a scoring system (score 0–2). Patients with a score of 1 or 2 had a worse survival than those with a score of 0 (HR for OS: 3.6, p = 0.006 for score 1, and HR: 21.8, p < 0.001 for score 2; HR for PFS: 2.2, p = 0.027 for score 1 and HR: 8.8, p < 0.001 for score 2). Our scoring system surpassed the TNM staging system (c-index = 0.691 versus 0.574, p = 0.013 for OS, and c-index = 0.649 versus 0.517, p = 0.004 for PFS). Conclusions In this preliminary study, combining PET radiomics with clinical risk factors may improve survival stratification in stage III-IV lung adenocarcinoma with actionable EFGR mutation. Our proposed scoring system may assist with optimization of individualized treatment strategies in these patients.