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( Yeonjung Ha ),( Mohamed A. Mohamed Ali ),( Molly M. Petersen ),( William S. Harmsen ),( Terry M. Therneau ),( Han Chu Lee ),( Baek-yeol Ryoo ),( Sally Bampoh ),( Kenneth A. Valles ),( Mohamad Mady ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: The ability of the pretreatment lymphocyte to monocyte ratio (LMR) to predict outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib is not conclusively determined. Methods: We retrospectively studied patients treated with sorafenib for HCC in two tertiary referral centres in Asia and North America. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Predictive factors for the outcomes were determined by Cox proportional hazards models. A risk-assessment tool was developed. Results: Compared to the North America cohort, the Asia cohort was more heavily pretreated (72.1% vs. 35.2%; P<0.001), had higher hepatitis B virus infection (87.6% vs. 5.6%; P<0.001), and more distant metastases (83.2% vs. 25.4%; P<0.001). Lower monocyte count in the Asia cohort (median, 462.7 vs. 600.0/μL; P=0.023) resulted in a higher LMR (median, 2.6 vs. 1.8; P<0.001). High LMR was associated with a significantly higher OS (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.81-0.97; P=0.007). This was confirmed in a sensitivity analysis including patients treated in Asia only (HR, 0.89; 95% CI, 0.81-0.97; P=0.010). An OS nomogram was constructed with following variables selected in the multivariate Cox model: LMR, treatment location, previous treatment, performance status, AFP, lymph node metastasis, and Child-Pugh score. The concordance score was 0.71 (95% CI, 0.69-0.73). LMR did not predict PFS. Conclusions: Pretreatment LMR predicts OS in HCC patients treated with sorafenib. Our OS nomogram, incorporating LMR, can be offered to clinicians to improve their ability to assess prognosis, strengthen the prognosis-based decision making, and inform patients in the clinic.
Gabriella F. Bulman,Ronik S. Bhangoo,Todd A. DeWees,Molly M. Petersen,Cameron S. Thorpe,William W. Wong,Jean Claude M. Rwigema,Thomas B. Daniels,Sameer R. Keole,Steven E. Schild,Carlos E. Vargas 대한방사선종양학회 2021 Radiation Oncology Journal Vol.39 No.2
Purpose: To analyze rectal dose and changes in quality of life (QOL) measured with the Expanded Prostate and Cancer Index Composite (EPIC) bowel domain in patients being treated for prostate cancer with curative-intent proton beam therapy (PBT) within a large single-institution prospective registry. Materials and Methods: Data was collected from 243 patients with localized prostate cancer treated with PBT from 2016 to 2018. The EPIC survey was administered at baseline, end-of-treatment, 3, 6, and 12 months, then annually. Dose-volume histogram (DVH) parameters for the rectum were computed, and rectal dose was analyzed using BED (α/β = 3), EQD2Gy, and total dose. Repeated measures mixed models were implemented to determine the effect of patient, clinical, and treatment factors (including DVH) on patient-reported bowel symptom burden (EPIC-Bowel). Results: Treatment overall resulted in changes in EPIC-Bowel scores (baseline score = 93.7), most notably at end-of-treatment (90.6) and 12 months (89.7). However, they returned to baseline at 36 months (92.9). On multivariate modeling, rectal BED D25 (Gy) ≥23% was significantly associated with decline in QOL scores measuring bother (p < 0.01; 4.06 points different). Conclusion: Rectal doses, specifically BED D25 (Gy) ≥23%, are significantly associated with decline in bowel bother-related QOL in patients undergoing definitive radiotherapy for localized prostate cancer. This study demonstrates BED as an independent predictor of bowel QOL across dose fractionations of PBT.