Impact of the post/preoperative serum CEA ratio on the survival of patients with rectal cancer

Purpose

This study demonstrated the usefulness of the post/preoperative serum carcinoembryonic antigen (CEA) ratio as a predictor of survival after surgery for stage III rectal cancer patients.

Methods

One hundred and four patients with stage III rectal cancer who underwent surgery between 1991 and 2000 were enrolled. The ratio of the postoperative serum CEA value divided by the preoperative serum CEA value was defined as post/preoperative serum CEA ratio, and the patients were separated into two groups: post/preoperative serum CEA ratio ≤1 (n = 86) and >1 (n = 18).

Results

The multivariate analyses demonstrated that the intraoperative blood loss, lack of a sphincter-saving procedure and a post/preoperative serum CEA ratio >1 were independent factors predicting a poor prognosis for the overall and disease-free survival. The overall and disease-free survival rates among patients with a high preoperative serum CEA level (>5 ng/ml) or patients with a high postoperative serum CEA (>5 ng/ml) were longer in patients with a post/preoperative serum CEA ratio ≤1, in comparison to those with a post/preoperative serum CEA ratio >1. Liver metastasis was observed more frequently in patients with a post/preoperative serum CEA ratio >1.

Conclusions

The post/preoperative serum CEA ratio may be a predictor of the prognosis after surgery for stage III rectal cancer patients.     

Significance of the Inflammation-Based Glasgow Prognostic Score for Short- and Long-Term Outcomes After Curative Resection of Gastric Cancer

Background

The Glasgow prognostic score (GPS) is a patient-related measure to determine long-term outcomes in cancer patients. This study examined the impact of GPS on outcomes including postoperative complications after curative resection of gastric cancer.

Methods

The systemic inflammatory response was assessed by GPS, and the severity of postoperative complications was evaluated according to the Clavien?CDindo classification. Survival analysis was performed by the Kaplan?CMeier method and the log rank test. Multivariate analysis was performed to determine significant associations with complications by a logistic regression model and the independent prognostic values by Cox??s proportional hazards model.

Results

Study patients (n?=?1017) were allocated as follows: 904 (88.9?%) to GPS 0, 92 (9.0?%) to GPS 1, and 21 (2.1?%) to GPS 2. One hundred sixty-three patients (16.0?%) had postoperative complications of ?? grade 2. Multivariate logistic analysis identified gender, body mass index, tumor location, tumor depth, blood transfusion, and comorbidity as significantly correlated with postoperative complications. However, GPS was not associated with the incidence of complication. On the other hand, multivariate analysis for overall survival identified GPS as an independent prognostic factor.

Conclusions

GPS is a significant predictor of long-term survival in curable gastric cancer surgery but not of short-term outcomes.     

Video-Assisted Thoracoscopic Pulmonary Metastasectomy in Patients with Colorectal Cancer: A Recent 10-Year Single-Institution Experience

Introduction

The purpose of this study was to identify independent unfavorable prognostic factors for patients who underwent video-assisted thoracoscopic surgery for resection of pulmonary metastases from colorectal cancer (CRC).

Methods

Between January 2004 and December 2013, 131 patients with pulmonary metastases from CRC underwent the aforementioned procedure for the first time at our institution. Kaplan–Meier survival curves and log-rank tests were used to analyze the survival rates. Multivariate analyses were performed using the Cox proportional hazards regression model.

Results

The 5-year disease-free survival (DFS) rate of these 131 patients was 34 %. Multivariate analyses showed two variables to be independent significant unfavorable prognostic factors for DFS: preoperative high serum carcinoembryonic antigen (CEA) level and a greater number of pulmonary metastases. According to subgroup analyses that combined these two risk factors, the 5-year DFS rates were 58, 25, and 12 % for patients with 0, 1, or 2 risk factors, respectively.

Conclusion

In patients who underwent video-assisted thoracoscopic surgery for pulmonary metastases from CRC, we identified two independent unfavorable prognostic factors for DFS: a high CEA level before metastasectomy and a greater number of pulmonary metastases. These factors can be used to identify higher- and lower-risk subgroups, which may help with selecting patients who would benefit the most from video-assisted thoracoscopic pulmonary metastasectomy.

     

Concurrent Chemoradiotherapy Followed by Metastasectomy Converts to Survival Benefit in Stage IV Rectum Cancer

Background

To investigate the impact of concurrent chemoradiotherapy (CCRT) on stage IV rectum cancer.

Methods

Between 2000 and 2011, 297 consecutive patients diagnosed with stage IV rectum cancer (synchronous metastasis) were enrolled. Cox proportional hazard analyses were used for prognostic factors determination, and the Kaplan?CMeier method was used for survival analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matched patients for validation studies.

Results

In total, 63 patients received CCRT and 234 did not. The patients in the CCRT group were younger, had more low-lying lesions, and had more T4 lesions, lung metastases, metastasectomies, and oxaliplatin-based upfront chemotherapy. Before propensity-score matching, a younger age (HR?=?0.662, P?=?0.016), lower carcinoembryonic antigen (CEA) level (??20?ng/ml) (HR?=?0.531, P?=?0.001), no metastasectomy (HR?=?3.214, P?<?0.001), and no CCRT (HR?=?1.844, P?=?0.019) were independent prognostic factors after controlling for other confounding factors. After matching, only CEA and metastasectomy, but not CCRT, were independent prognostic factors. The survival benefit of CCRT was restricted to patients who undergo subsequent metastasectomy.

Conclusions

Upfront CCRT only provided a survival benefit in patients with stage IV rectum cancer who undergo subsequent metastasectomy.     

Prognostic factors for peritoneal carcinomatosis originating from colorectal cancer: an analysis of 921 patients from a multi-institutional database

Purpose

The purpose of this study was to clarify the factors affecting R0 resection and the prognosis of patients with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) in the Japanese population.

Methods

A multi-institutional retrospective analysis of 921 patients who underwent surgery between 1991 and 2007 for CRC with PC was conducted. Clinicopathological variables were analyzed for prognostic significance. A multivariate analysis using a Cox regression modeling was performed to assess the prognostic value of the variables.

Results

The median survival time of all patients was 14.3 months (range 0–209 months) and the 5-year overall survival rate was 9.7 %. The multivariate analysis revealed that a lymph node status of pN0/1, the absence of blood-born metastasis, R0 resection and adjuvant chemotherapy favorably affected the survival. Furthermore, the completion of R0 resection was significantly affected by the preoperative serum CEA level, the presence of blood-born metastasis and the grade of PC. The 5-year overall survival and median survival time of the patients with four favorable prognostic factors, namely pN0/1, the absence of blood-born metastasis, R0 resection and adjuvant chemotherapy, were significantly better than those of the remaining patients (37.1 vs. 7.2 % and 37.0 vs. 13.3 months, respectively; p < 0.0001).

Conclusions

Although few patients with PC from CRC survive for more than 5 years, performing R0 resection with curative intent in association with postoperative adjuvant chemotherapy should be considered in appropriately selected patients.     

Usefulness of serum p53 antibody measurement in colorectal cancer: an examination of 1384 primary colorectal cancer patients

Purposes

Recently, the serum p53 antibody (S-p53Ab) has been used widely in clinical practice as a tumor marker for colorectal cancer (CRC). However, no large-scale studies have examined the usefulness of serial measurements of S-p53Ab or have established the relationship of this parameter with the clinicopathological factors of CRC.

Methods

An ELISA for S-p53Ab was performed for 1384 primary CRC patients, and the results were categorized by the clinicopathological factors.

Results

The S-p53Ab positivity rate was 24.1 %, and was significantly higher in Stage III–IV than in Stage 0–II cases. However, no relationship was seen with the serum carcinoembryonic antigen (CEA) or carbohydrate antigen 19-9 (CA19-9) levels. The addition of the S-p53Ab assay to the CEA and CA19-9 measurements increased the overall diagnostic sensitivity to 50.9 % (CEA and/or CA19-9: 37.3 %). In patients who had undergone complete resection, S-p53Ab positivity was associated with a decrease in the relapse-free survival (p = 0.012), but it was not independent prognostic indicator. S-p53Ab positivity had no influence on the cancer-specific survival.

Conclusions

The S-p53Ab positivity rate was higher than the positivity rates for CEA and/or CA19-9 in Stage 0–I CRC patients. Combining the use of the three tumor marker tests is a potentially effective method for detecting even early-stage CRC.     

Clinical features and prognostic factors of bone metastases from colorectal cancer

Purpose

To investigate the clinical features and prognoses of patients with diagnosed bone metastases from colorectal cancer (CRC).

Methods

This was a 16-year retrospective study of 32 patients with bone metastases secondary to CRC, who were seen at National Kokura Hospital between 1993 and 2008. The influence of clinical and pathologic variables on survival was assessed by univariate and multivariate analyses.

Results

The bone most commonly involved was the spinal column. The mean disease-free interval was 17.6 months and mean survival from the diagnosis of bone metastases was 9.3 months. On univariate analysis, the serum CEA level at the time of diagnosis of bone metastases (p = 0.020) and history of pulmonary metastases (p = 0.013) were significant. On multivariate analysis, a history of bone metastases in the ribs (hazard ratio 3.669, p = 0.025) and a history of pulmonary metastases (hazard ratio 3.854, p = 0.022) significantly affected survival.

Conclusions

It is important to investigate for bone metastases in patients who complain of back pain and lumbago after CRC surgery.     

Natural History of Merkel Cell Carcinoma Following Locoregional Recurrence

Background

Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with an ill-defined natural history following locoregional recurrence.

Methods

This is a retrospective review of patients with MCC diagnosed at the Mayo Clinic from 1981 to 2008. For each outcome (subsequent locoregional recurrence, distant recurrence, and death) the survival-free of the outcome was estimated using the Kaplan?CMeier method. Associations of patient and clinical characteristics with the outcomes were assessed by fitting Cox proportional hazards regression models.

Results

Among the 240 patients diagnosed with MCC, 70 (29%) patients were identified who developed locoregional recurrence as the first site of recurrence. The median time from diagnosis to locoregional recurrence was 6?months. The pattern of first locoregional failure in this group includes 25 (10.4%) local, 18 (7.5%) in-transit, and 27 (11.3%) nodal recurrences. Recurrences were most commonly treated by surgery and radiation. At 3?years after the initial recurrence, locoregional recurrence-free survival was 75% and the distant recurrence-free survival was 56%. Locoregional recurrence is a poor prognostic sign associated with a 3-year overall survival of 39%. Nodal status at time of original surgery and time to first recurrence were important predictors of distant recurrence (P?P?Conclusions Locoregional recurrence is a substantial problem in patients with MCC and is a poor prognostic sign. In those patients who experience a locoregional recurrence, aggressive efforts to regain locoregional control appear warranted and may result in long-term survival.     

Sub-classification of Stage II colorectal cancer based on clinicopathological risk factors for recurrence

Purpose

To make a Stage II colorectal cancer (CRC) sub-classification based on clinicopathological factors.

Methods

The subjects of this study were 422 patients with Stage II CRC, who underwent curative surgery with dissection of more than 12 lymph nodes. We used the logistic regression analysis or model and Cox’s proportional hazard regression model for analysis.

Results

Preoperative carcinoembryonic antigen (CEA) level (p = 0.0057), macroscopic type (p = 0.0316), and depth of invasion (p = 0.0401) were extracted as independent risk factors for recurrence, whereas the preoperative CEA level (p = 0.0045) and depth of invasion (p = 0.0395) were extracted as independent predictors of 5-year disease-free survival. We defined depth of invasion (pT4) and the preoperative CEA level (abnormal) as risk factors for recurrence, and classified Grade A as a normal CEA level regardless of depth invasion, Grade B as depth of invasion to pT3 and an elevated CEA level, and Grade C as depth of invasion to pT4 and an elevated CEA level. There were significant differences in cumulative 5-year disease-free survival rates among each grade (Grade A vs. Grade B, p = 0.0474; Grade A vs. Grade C, p < 0.0001; Grade B vs. Grade C, p = 0.0134).

Conclusion

The sub-classification of Stage II CRC, according not only to depth of invasion but also to preoperative CEA level, is important for predicting the prognosis.     

Prognostic Role of Carcinoembryonic Antigen Level after Preoperative Chemoradiotherapy in Patients with Rectal Cancer

Background

The prognostic role of post-chemoradiotherapy (CRT) carcinoembryonic antigen (CEA) level is not clear. We evaluated the prognostic significance of post-CRT CEA level in patients with rectal cancer after preoperative CRT.

Methods

We reviewed 659 consecutive patients who underwent preoperative CRT and total mesorectal excision for non-metastatic rectal cancer. Patients were categorized into two groups according to post-CRT serum CEA level: low CEA (<?5 ng/mL) and high CEA (≥?5 ng/mL).

Results

Median post-CRT CEA level was 1.7 ng/mL (range, 0.1–207.0). A high post-CRT level was significantly associated with ypStage, ypT category, tumor regression grade, and pre-CRT CEA level. The 5-year overall survival rate of the 659 patients was 87.8% with a median follow-up period of 57.0 months (range, 1.4–176.4). When the post-CRT CEA groups were divided into groups according to pre-CRT CEA level, the 5-year overall survival rates were significantly different (P?<?0.001 and P?=?0.001, respectively). Post-CRT CEA level was an independent prognostic factor for overall survival. Multivariate analysis revealed that operation method, differentiation, perineural invasion, postoperative chemotherapy, tumor regression grade, and post-CRT CEA level were independent prognostic factors for overall survival.

Conclusion

The level of serum CEA after preoperative CRT was an independent prognostic factor for overall survival in patients with rectal cancer.

     

Management of obstructive colorectal cancer: evaluation of preoperative bowel decompression using ileus tube drainage

Purpose

This study evaluated a better treatment for patients with obstructive colorectal cancer (CRC) that have a poor prognosis.

Method

This study compared the outcomes of 138 patients with obstructive CRC, including 70 primary resections, 50 resections after bowel decompression using an ileus tube, and 18 delayed resections after colostomy.

Results

The ileus tube and delayed resection groups included more left-sided primary lesions. The physiologic POSSUM, types 3–4, tumor size, CEA, and hospital stay of the delayed resection group were different, in comparison to both the primary resection and ileus tube groups. The histopathological type and depth of invasion of the delayed resection group included less well types and more T4 than those of the ileus tube group. The operative blood loss of the delayed resection group was more than that of the ileus tube group. There were no differences in the overall and disease-free survival among the three groups.

Conclusion

Separately analyzing the data of the right-sided cancer group and the left-sided cancer group demonstrated that primary resection might be acceptable for right-sided obstructive CRC and delayed resection might be done for patients with poorer general conditions (high PPS) and poorer oncological prognostic factors such as more type3/type4 cases, a larger tumor size, a less well-differentiated histopathological type, more T4 cases, and a higher CEA level.     

Is There a Role for Unstimulated Thyroglobulin Velocity in Predicting Recurrence in Papillary Thyroid Carcinoma Patients with Detectable Thyroglobulin after Radioiodine Ablation?

Background

In the follow-up of papillary thyroid cancer (PTC) patients treated with curative thyroidectomy and radioiodine ablation, raised thyroglobulin (Tg) predicts recurrence with reasonable sensitivity and specificity. However, a proportion of patients present with raised Tg level but no other clinical evidence of disease. Only limited data on Tg kinetics have been reported to date. Here we aim to evaluate the prognostic and predictive significance of nonstimulated serum Tg velocity (TgV).

Methods

Consecutive PTC patients treated with curative thyroidectomy and radioiodine ablation between 2003 and 2010 were analyzed. Patients with at least one detectable Tg measurement (>0.2?ng/mL) were included. TgV was defined as the annualized rate of Tg change. Logistic regression analyses were performed to evaluate the role of TgV in the prediction of disease recurrence. The optimal TgV cutoff was assigned by receiver?Coperating characteristic curve analysis. Overall survival of patients above versus below the TgV cutoff were determined by the Kaplan?CMeier method and compared.

Results

Of a total of 501 patients, 87 had at least one Tg value >0.2?ng/mL; in these latter patients, 29 (33.3?%) developed recurrence. TgV was an independent predictor of the recurrence. TgV ??0.3?ng/mL per year predicted recurrence with a sensitivity of 83.3?% and specificity of 94.4?%. Patients with TgV below the cutoff had a significantly better overall survival (p?=?0.038).

Conclusions

TgV predicts recurrence with high sensitivity and specificity, and is a prognosticator of survival in postthyroidectomy and postablation PTC patients with raised Tg.     

Carcinoma of the Ampulla of Vater: Patterns of Failure Following Resection and Benefit of Chemoradiotherapy

Background

Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. We performed a single-institution outcomes analysis to define the role of concurrent chemoradiotherapy (CRT) in addition to surgery.

Methods

A retrospective analysis was performed of all patients undergoing potentially curative pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1976 and 2009. Time-to-event analysis was performed comparing all patients who underwent surgery alone to the cohort of patients receiving CRT in addition to surgery. Local control (LC), disease-free survival (DFS), overall survival (OS), and metastases-free survival (MFS) were estimated using the Kaplan?CMeier method.

Results

A total of 137 patients with ampullary carcinoma underwent Whipple procedure. Of these, 61 patients undergoing resection received adjuvant (n?=?43) or neoadjuvant (n?=?18) CRT. Patients receiving chemoradiotherapy were more likely to have poorly differentiated tumors (P?=?.03). Of 18 patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response (pCR). With a median follow-up of 8.8?years, 3-year local control was improved in patients receiving CRT (88% vs 55%, P?=?.001) with trend toward 3-year DFS (66% vs 48%, P?=?.09) and OS (62% vs 46%, P?=?.074) benefit in patients receiving CRT.

Conclusions

Long-term survival rates are low and local failure rates high following radical resection alone. Given patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered.     

Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study

Purpose

The aim of this retrospective study was to establish the prognostic factors for overall survival after pulmonary resection for lung metastases of colorectal carcinoma (CRC).

Methods

The baseline characteristics and outcomes of 266 CRC patients undergoing complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group. We used the Cox proportional hazard regression to identify independent prognostic factors for OS.

Results

The 5-year overall survival rate of patients undergoing complete resection of isolated pulmonary metastases was 56.5 %. The independent unfavorable prognostic factors after pulmonary resection included stage T4 (p = 0.0004) and N2 (p = 0.0082) as primary cancer-related factors, and more than three metastases (p = 0.0342), bilateral distribution (p = 0.0450), metastatic disease-free interval (DFI) of less than 2 years (p = 0.0257), and a preoperative carcinoembryonic antigen (CEA) level greater than 5.0 ng/mL (p = 0.0209) as pulmonary metastases-related factors.

Conclusions

This retrospective analysis suggested that the indications for pulmonary resection of CRC metastases should be decided not only by the status of lung metastases, but also by pulmonary-related factors such as the T and N stage of the primary lesion, preoperative CEA level, and the DFI.     

Unexpected Gallbladder Cancer after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Worrisome Picture

Objective

The objective of this study is to assess the prognosis of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy for acute cholecystitis.

Methods

Data of all patients treated for unexpected gallbladder cancer after laparoscopic cholecystectomy at a tertiary care surgical center between January 1998 and December 2009 were reviewed. Demographics and clinical and pathological data of patients submitted to adjunctive revisional surgery were analyzed. Survival was calculated by the Kaplan?CMeier method, and log-rank test was used to compare the survival curves. The Cox proportional hazard model was used to determine the effect on survival of urgent surgery for acute cholecystitis and of the other common factors such as age, gender, tumor grading, pT stage, nodal involvement, residual disease at re-exploration, and American Joint Committee on Cancer stage.

Results

In the considered period, 34 patients with pT1b, pT2, or pT3 unexpected gallbladder cancer underwent a second standard revisional procedure including resection of liver segments 4b and 5, lymphadenectomy, and port-sites excision. Thirteen patients had previously undergone urgent surgery for acute cholecystitis; 21 had undergone a routine operation. The 5-year overall survival was 63.3?%. At multivariate analysis, G3 tumor grading (hazard ratio, 12.261; p?=?0.002), residual disease at re-exploration [hazard ratios (HR)?=?7.760, p?=?0.004], and urgent surgery for acute cholecystitis (HR?=?5.436, p?=?0.012) were independent predictors of poor prognosis.

Conclusions

The prognosis of unexpected gallbladder cancer is worsened when laparoscopic cholecystectomy is performed for acute cholecystitits. The unfavorable impact of emergency surgery on prognosis might be related to intraoperative gallbladder emptying with bile spillage and cancer dissemination.     

Aggressive Management of Peritoneal Carcinomatosis from Mucinous Appendiceal Neoplasms

Background

Peritoneal carcinomatosis (PC) in the setting of mucinous appendiceal neoplasms is characterized by the intraperitoneal accumulation of mucinous ascites and mucin-secreting epithelial cells that leads to progressive compression of intra-abdominal organs, morbidity, and eventual death. We assessed postoperative and oncologic outcomes after aggressive surgical management by experienced surgeons.

Methods

We analyzed clinicopathologic, perioperative, and oncologic outcome data in 282 patients with PC from appendiceal adenocarcinomas between 2001 and 2010 from a prospective database. Kaplan?CMeier survival curves and multivariate Cox-regression models were used to identify prognostic factors affecting oncologic outcomes.

Results

Adequate cytoreduction was achieved in 82% of patients (completeness of cytoreduction score (CC)-0: 49%; CC-1: 33%). Median simplified peritoneal cancer index (SPCI), operative time, and estimated blood loss were 14 (range, 0?C21), 483.5?min (range, 46?C1,402), and 800?ml (range, 0?C14,000), respectively. Pathology assessment demonstrated high-grade tumors in 36% of patients and lymph node involvement in 23% of patients. Major postoperative morbidity occurred in 70 (25%) patients. Median overall survival was 6.72?years (95% confidence interval (CI), 4.17?years not reached), with 5?year overall survival probability of 52.7% (95% CI, 42.4, 62%). In a multivariate Cox-regression model, tumor grade, age, preoperative SPCI and chemo-na?ve status at surgery were joint significant predictors of overall survival. Tumor grade, postoperative CC-score, prior chemotherapy, and preoperative SPCI were joint significant predictors of time to progression.

Conclusions

Aggressive management of PC from mucinous appendiceal neoplasms, by experienced surgeons, to achieve complete cytoreduction provides long-term survival with low major morbidity.     

Preoperative Carcinoembryonic Antigen Level Predicts Prognosis in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Background

Even though management of pseudomyxoma peritonei (PMP) was improved with cytoreductive surgery (CRS) and hyperthermic chemotherapy (HIPEC), several aspects of PMP still need to be optimized, including patient selection for surgery and prognostic factors. We assessed the role of preoperative carcinoembryonic antigen (CEA) levels in PMP patients treated with CRS and HIPEC.

Methods

A total of 449 PMP patients with documented preoperative CEA levels referred to our center between 2005 and 2011 underwent CRS and HIPEC. The association between CEA levels and characteristics of patients with PMP was assessed with χ ² test, linear correlation, and logistic regression analyses. Survival analysis was performed with Cox proportional hazard model.

Results

Median age was 55 (range 19–84) years. There were 245 (54.5 %) females and 204 (45.5 %) males. Preoperative CEA levels were elevated in 328 (73 %, sensitivity) patients with PMP. Preoperative CEA levels were also related to peritoneal cancer index (P < 0.0001), cytoreductive surgery scores (P < 0.0001), progress free survival (P < 0.001) and overall survival (P < 0.001) in patients with PMP.

Conclusions

Our results indicated that preoperative CEA levels are useful in predicting the extent of disease and surgical success as well as progress-free and overall survival in patients with PMP treated with cytoreductive surgery and HIPEC.     

Prognosis associated with surgery for non-small cell lung cancer and synchronous brain metastasis

Purpose

Several reports have described extended survival after aggressive surgical treatment for non-small cell lung cancer (NSCLC) and synchronous brain metastasis. This retrospective analysis assesses the prognostic factors in this population.

Methods

We reviewed retrospectively the medical records of 29 patients with synchronous brain metastasis from NSCLC, who underwent surgical treatment in our institution between 1980 and 2008. All patients underwent chest surgery to remove the primary lesion. The impact of several variables on survival was assessed.

Results

The median follow-up period was 9.6 months and the 5-year survival rate from the time of lung cancer resection was 20.6 %. Univariate analysis demonstrated that the carcinoembryonic antigen (CEA) level, primary tumor size, and the presence of lymph node involvement were predictive of overall survival (p < 0.05). Multivariate analysis also identified those factors to be independent favorable prognostic factors.

Conclusions

Although the survival of patients with brain metastasis from non-small cell lung cancer remains poor, surgical resection may benefit a select group of patients, particularly those with a normal CEA level, small tumor size, and node-negative status.     

Body Mass Index and Survival in Esophageal Adenocarcinoma Treated with Chemoradiotherapy Followed by Esophagectomy

Background

Body mass index (BMI) has been linked with inferior outcomes in gastrointestinal malignancies. The purpose of this study is to evaluate the effect of BMI on survival in patients with esophageal adenocarcinoma.

Methods

Medical records were analyzed for patients who underwent esophagectomy after neoadjuvant chemoradiotherapy (nCRT) for adenocarcinoma from 2000 to the present. Patients were grouped into BMI ??25, >25?C30, >30?C35, and BMI >35. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan?CMeier method. Multivariate analysis (MVA) was performed using Cox proportional hazard regression model.

Results

We identified 303 patients for the analysis. The only difference in patient characteristics between groups was gender. We found no difference in OS and DFS associated with BMI (p?=?0.3297 for OS; p?=?0.5950 for DFS). There were no differences in postoperative complications or mortality between BMI groups. MVA revealed that higher stage and less than a complete response to nCRT were prognostic for worse OS and DFS, while age, gender, type of surgery, year of diagnosis, and BMI were not prognostic.

Conclusions

BMI was neither associated with surgical complications nor survival in patients with esophageal adenocarcinoma treated with nCRT. BMI should not be considered a contraindication to surgical resection after nCRT.