Search

We retrospectively evaluated clinical data from patients with advanced non-small-cell lung cancer (NSCLC) treated with third-generation chemotherapy agents prior to treatment, to determine a reliable method for predicting prognosis in such patients. We analyzed 100 patients who received third-generation agents (paclitaxel, docetaxel, gemcitabine, irinotecan, and vinorelbine) for the treatment of advanced NSCLC. Factors significantly related to prognosis were evaluated using the Cox regression model, and the prognostic index (PI) was determined by combining these factors. The mean follow-up duration was 12.6 months (0.2-67.0 months). Multivariate analysis identified pleural effusion, absolute neutrophil count (ANC), and C-reactive protein (CRP) level as significant factors that independently contribute to prognosis in patients with advanced NSCLC treated with third-generation agents (p < 0.05). The PI was calculated using these 3 factors, according to the following formula: PI = 0.581 × pleural effusion + 0.125 × ANC + 0.105 × CRP. The death rate in the group with the highest PI scores was significantly higher than in the group with the lowest scores (p < 0.001). Pleural effusion, ANC, and CRP level were the most important factors that contributed to prognosis following chemotherapy with third-generation agents in patients with advanced NSCLC. The PI is suggested to be an appropriate index to predict the prognosis of patients with NSCLC., (© 2017 S. Karger AG, Basel.)

Objective: To assess the cost-effectiveness of chemotherapy for patients with non-resectable pancreatic cancer, we compared two regimens containing either gemcitabine (GEM) or S-1., Methods: We developed a decision tree that showed the clinical processes of non-resectable pancreatic cancer patients. We calculated the probabilities of endpoint and life months gained (LMG) based on previously reported articles. To estimate the costs, we analyzed medical records of 44 inpatients with non-resectable pancreatic cancer treated with GEM(n=34)or S-1(n=10). Sensitivity analysis was used to check the robustness of the results., Results: In the GEM group and S-1 group, costs were 1,636,393 and 985,042 yen, and LMG was 6. 0 and 9. 0 months, respectively. Thus, the cost-effectiveness ratio(CER)was calculated to be 272,732 and 109,449 yen/LMG, respectively, and the incremental cost effectiveness ratio (ICER) was -217,117 yen/LMG. The sensitivity analysis showed that the result was definitely robust., Conclusion: Our findings suggest that the markedly cost-effective S-1 regimen could prolong LMG with less cost than the GEM regimen.

We have retrospectively evaluated clinical data before therapy to enable reliable prediction of the response of esophageal cancer to chemoradiotherapy (CRT). We analyzed 108 patients who received 5-fluorouracil and platinum combined with 60 Gy radiation for esophageal cancer. Factors significantly related to response were extracted by use of logistic regression analysis, and a response score (RS) was prepared by combining these factors. By multivariate analysis, nutritional status, T stage, M stage, and alkaline phosphatase were selected as significant factors that contributed independently to the response of esophageal cancer to CRT (P < 0.05). The odds ratios of the four selected factors was approximated and scored. The group with a high RS was found to include patients with complete response with a significantly higher frequency than the group with a low score (72.7% vs. 14.8%, P < 0.001). The RS is suggested to be an appropriate scoring system with which to predict response for these patients.

Objective: To assess the cost-effectiveness of chemoradiotherapy (CRT) regimens for patients with esophageal cancer, we compared two regimens consisting of 5-fluorouracil (5-FU) and cisplatin (CDDP) or 5-FU and nedaplatin (CDGP) with radiotherapy., Methods: Medical records of 108 patients with esophageal cancer who received CRT of 5-FU+CDDP (CDDP group) or 5-FU+CDGP (CDGP group) were analyzed. In both groups, most of the patients were men with a pathological diagnosis of squamous cell carcinoma. A Markov model was used to show the clinical courses of esophageal cancer after the CRT therapy. An outcome used for economic evaluation was life year gained (LYG). We calculated the cost per-effectiveness ratio (CER) and incremental cost effectiveness ratio (ICER). Clinical effectiveness and costs in this model were investigated retrospectively, and the costs were estimated from the perspective of the medical institution. Sensitivity analysis was used to check the robustness of this model., Results: In CDDP and CDGP group, LYG was 18.23 and 16.31 years and CER was 270,373 and 406,264 yen/LYG, respectively. As a result, ICER was .883,999 yen/LYG. The sensitivity analysis showed that this model was definitely robust., Conclusion: Our results suggested that CDDP could prolong LYG with less cost than CDGP and that CRT of 5-FU and CDDP was markedly cost effective treatment.