Cheng-Hsu Wang

Pretreatment serum interleukin‐1β, interleukin‐6, and tumor necrosis factor‐α levels predict the progression of colorectal cancer

The correlations of pretreatment serum concentrations of proinflammatory cytokines such as interleukin (IL)‐1β, IL‐6, and tumor necrosis factor‐α (TNFα) with the clinicopathologic features and progression of colorectal cancer (CRC) were investigated. The pretreatment serum levels of IL‐1β, IL‐6, and TNFα were measured in 164 CRC patients before treatment. The relationships between changes in proinflammatory cytokine and C‐reactive protein (CRP) levels and both clinicopathologic variables and disease progression were examined by univariate and multivariate analysis. Advanced tumor stage was associated with a poorer histologic differentiation, higher CRP level, lower albumin level, and inferior progression‐free survival rate (PFSR). Furthermore, high levels of CRP (>5 mg/L) were associated with proinflammatory cytokine intensity, defined according to the number of proinflammatory cytokines with levels above the median level (IL‐1β ≥10 pg/mL; IL‐6 ≥ 10 pg/mL; and TNFα ≥55 pg/mL). Under different inflammation states, proinflammatory cytokine intensity, in addition to tumor stage, independently predicted PFSR in patients with CRP <5 mg/L, whereas tumor stage was the only independent predictor of PFSR in patients with CRP ≥5 mg/L. Proinflammatory cytokine intensity and the CRP level are clinically relevant for CRC progression. Measurement of IL‐1β, IL‐6, and TNFα serum levels may help identify early cancer progression among patients with CRP <5 mg/L in routine practice.

To Operate or Not: Prediction of 3-Month Postoperative Mortality in Geriatric Cancer Patients.

Context: Appropriate selection of aging patient who fit for cancer surgery is an art-of-state. Objectives: This study aimed to identify predictive factors pertinent to 3-month postoperative mortality in geriatric cancer patients. Methods: A total of 8,425 patients over 70 years old with solid cancer received radical surgery between 2007 and 2012 at four affiliated hospitals of the Chang Gung Memorial Hospital were included. The clinical variables of patients who died within 3 months post-surgery were analyzed retrospectively. Recursive partitioning analysis (RPA) was performed by randomly selecting 50% of the patients (testing set) to identify specific groups of patients with the lowest and highest probability of 3-month postoperative mortality. The remaining 50% were used as validation set of the model. Results: Patients gender, Eastern Cooperative Oncology Group performance (ECOG scale), Charlson comorbidity index (CCI), American Society of Anesthesiologist physical status, age, tumor staging, and mode of admission were independent variables that predicted 3-month postoperative mortality. The RPA model identified patients with an ECOG scale of 0-2, localized tumor stage, and a CCI of 0-2 as having the lowest probability of 3-month postoperative mortality (1.1% and 1.3% in the testing set and validation set, respectively). Conversely, an ECOG scale of 3-4 and a CCI >2 were associated with the highest probability of 3-month postoperative mortality (55.2% and 47.8% in the testing set and validation set, respectively). Conclusion: We identified ECOG scale and CCI score were the two most influencing factors that determined 3-month postoperative mortality in geriatric cancer patients.

A simple risk stratification model that predicts 1-year postoperative mortality rate in patients with solid-organ cancer.

This study aimed to construct a scoring system developed exclusively from the preoperative data that predicts 1‐year postoperative mortality in patients with solid cancers. A total of 20,632 patients who had a curative resection for solid‐organ cancers between 2007 and 2012 at Chang Gung Memorial Hospital Linkou Medical Center were included in the derivation cohort. Multivariate logistic regression analysis was performed to develop a risk model that predicts 1‐year postoperative mortality. Patients were then stratified into four risk groups (low‐, intermediate‐, high‐, and very high‐risk) according to the total score (0–43) form mortality risk analysis. An independent cohort of 16,656 patients who underwent curative cancer surgeries at three other hospitals during the same study period (validation cohort) was enrolled to verify the risk model. Age, gender, cancer site, history of previous cancer, tumor stage, Charlson comorbidity index, American Society of Anesthesiologist score, admission type, and Eastern Cooperative Oncology Group performance status were independently predictive of 1‐year postoperative mortality. The 1‐year postoperative mortality rates were 0.5%, 3.8%, 14.6%, and 33.8%, respectively, among the four risk groups in the derivation cohort (c‐statistic, 0.80), compared with 0.9%, 4.2%, 14.6%, and 32.6%, respectively, in the validation cohort (c‐statistic, 0.78). The risk stratification model also demonstrated good discrimination of long‐term survival outcome of the four‐tier risk groups (P < 0.01 for both cohorts). The risk stratification model not only predicts 1‐year postoperative mortality but also differentiates long‐term survival outcome between the risk groups.

Impact of the pretreatment Glasgow prognostic score on treatment tolerance, toxicities, and survival in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy

The purpose of this study was to evaluate the impact of the pretreatment Glasgow prognostic score on treatment‐related toxicities, tolerance, and survival in patients with advanced head and neck cancers undergoing concurrent chemoradiotherapy (CRT).

Complementary role of the Memorial Sloan Kettering Cancer Center nomogram to the American Joint Committee on Cancer system for the prediction of relapse of major salivary gland carcinoma after surgery

The purpose of this study was to test the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram in predicting recurrence risk of major salivary gland carcinoma in an Asian cohort.

Glasgow prognostic score after concurrent chemoradiotherapy is a prognostic factor in advanced head and neck cancer

Objective This study aims to evaluate the impact and potential prognostic roles of the pre- and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy (CCRT). Methods We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre- and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival. Results The GPS changed in 72 (51.8%) patients, with worse scores observed post-CCRT in 65 (90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage. Conclusions After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.

Analysis of First Year Mortality in Stage III Esophageal Cancer Patients Treated with Concurrent Chemoradiotherapy

Medical practitioners currently have several management options to treat locally advanced esophageal cancer, including surgery, radiation therapy, and chemotherapy. However, most patients had multidisciplinary treatment. In Taiwan, the one-year survival rate of esophageal cancer was less than 50%. This phenomenon may be due to patient mortality before therapy, during therapy, or early after the completion of therapy. Because of this elevated mortality rate, it is important to illustrate the cause of mortality in the first year. We analyzed 47 locally advanced stage III esophageal cancer patients who had received concurrent chemoradiotherapy (CCRT) in our hospital. Eighteen of them died in the first year after diagnosis. Ten patients (56%) had tumor progression (primarily distant metastasis), 13 patients (72%) died directly from infection, 1 patient (6%) died from main artery esophageal fistula, 1 patient (6%) died from esophageal mediastinal fistula, 1 patient (6%) died solely from disease progression, 1 patient (6%) died from some kind of social event, and 1 patient (6%) died from ischemic stroke. Timely research to analyze the complications and mortality early after CCRT is relevant to improving treatment outcomes.

Bilateral Reactive Pleural Effusion as a Complication of Picibanil Pleurodesis

OK-432 (picibanil) is a potent immunostimulant which has demonstrated benefit in the treatment of several types of malignancies, malignant ascites, and pleural effusion. We report a female patient with premenopausal breast cancer presenting with refractory malignant right pleural effusion. Shortly after OK-432 pleurodesis, bilateral reactive pleural effusion developed, soon followed by dyspnea. The pleural effusion was improved by bilateral pigtail catheter replacement, and no more massive pleural effusion was noted in the following 4 months. This complication was possibly related to immune response, but further experience and investigation is needed to prove it.