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1.
Y. Sun Z. Xu H. Lin X. Lu Y. Huang S. Huang X. Wang P. Chi 《European journal of surgical oncology》2017,43(10):1828-1834
Aim
To determine the effect of obesity, measured by body mass index (BMI), on tumor response and surgical outcome in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT) and radical surgery.Method
LARC patients undergoing nCRT and radical surgery from 2008 to 2014 were included and divided into three groups: non-obese (BMI < 25.0 kg/m2), obese I (BMI 25.0–29.9 kg/m2), and obese II (BMI ≥ 30.0 kg/m2). Tumor response, surgical and oncological outcome were compared between groups. Multivariate analyses were performed to identify risk factors for local recurrence.Results
A total of 522 LARC patients were analyzed (407 non-obese, 93 obese I, 22 obese II). Post-operative complications did not differ between groups. Increased BMI was associated with poorer T downstaging and Rectal Cancer Regression Grade (P = 0.116, P = 0.036). With a mean follow-up of 57 months, the 5-year overall survival and distant metastasis rates did not differ between groups (P = 0.861, P = 0.116). The 5-year local recurrence rate in obese II patients was 14.6%, higher than that in non-obese and obese I groups (P = 0.015). Cox regression analysis demonstrated that BMI ≥30 kg/m2 (HR = 6.187, P = 0.010) was significantly associated with increased risk for local recurrence.Conclusion
Obesity was associated with poorer T downstaging and Rectal Cancer Regression Grade, and thus poor local control in LARC following nCRT in Asian patients. More effective treatment strategies to improve treatment outcome for obese patients with LARC are warranted. 相似文献2.
Won Kyung Cho Doo Ho Choi Won Park Hyejung Cha Seok Jin Nam Seok Won Kim Jeong Eon Lee Jonghan Yu Young-Hyuck Im Jin Seok Ahn Yeon Hee Park Ji-Yeon Kim Soohyun Ahn 《Clinical breast cancer》2018,18(5):e1141-e1147
Purpose
To investigate the effect of body mass index (BMI) on survival in patients with breast cancer according to tumor subtype, metabolic syndrome, and systemic treatment.Patients and Methods
We identified 5668 patients who underwent curative surgery for breast cancer between 1996 and 2013 from the clinical data of a single institution. Disease-free survival (DFS) and overall survival (OS) were calculated and compared between the patients with BMI ≥ 25 kg/m2 and < 25 kg/m2 in all patients and in specific subgroups, including tumor subtype, metabolic syndrome, and systemic treatment.Results
In all patients, BMI ≥ 25 kg/m2 was an unfavorable factor for OS (P = .030) but not for DFS. In the HR+/HER2? subgroup, DFS and OS were longer in patients with BMI < 25 kg/m2 than ≥ 25 kg/m2 (P = .012 and .005, respectively). In patients with more than one metabolic syndrome, BMI was an unfavorable factor for OS (hazard ratio, 2.669; P < .001)Conclusion
BMI ≥ 25 kg/m2 was an unfavorable survival factor, particularly in patients with HR+/HER2? breast cancer. 相似文献3.
Bochao Zhao Jingting Zhang Di Mei Rui Luo Huiwen Lu Huimian Xu Baojun Huang 《European journal of surgical oncology》2018,44(12)
Background
Whether high body mass index (BMI) was associated with increased postoperative complications and unfavorable prognosis of gastric cancer (GC) patients remain controversial. In the present study, we performed a systematic review and meta-analysis to evaluate the impact of high BMI on surgical outcome, postoperative complications and long-term survival of GC patients.Methods
The related studies were identified by searching PubMed and Embase databases. According to the BMI, all GC patients were classified into BMI ≥25?kg/m2 group and BMI <25?kg/m2 group. The relevant data was extracted and pooled effect size was assessed using a fixed effect model or random effect model.Results
A total of 36 relevant studies involving 30,642?GC patients were included in this meta-analysis. The results indicated that high BMI patients had longer operation time, fewer number of retrieved lymph nodes and larger amount of intraoperative blood loss than other patients, regardless of open gastrectomy or laparoscopic gastrectomy. In addition, the risk of postoperative complications was significantly higher in the patients with BMI ≥25?kg/m2 than in those with BMI <25?kg/m2, especially for infectious complications. However, high BMI had no negative impact on postoperative mortality and long-term survival of GC patients.Conclusion
Despite the increased surgical difficulty and postoperative complications, high BMI was not associated with the prognosis of GC patients. To reduce the risk of postoperative complications, more meticulous operation technique and improved perioperative management should be necessary for high BMI patients. 相似文献4.
Introduction
In recent years, the incidence of thyroid cancer and obesity has increased rapidly worldwide. Many studies have been conducted on the relationship between thyroid cancer and obesity; however, the potential mechanisms are not well understood, and few studies have been performed in Asia. This study aimed to identify the relationship between the risk of thyroid cancer and obesity in the Korean population based on a large cohort of data.Method
We analyzed clinical data from a total of 351,402 individuals (males: 181,709, females: 169,693) aged over 20 years who received medical examinations arranged by the national insurance program from 2003 to 2008. Newly diagnosed thyroid cancer was identified using insurance claims data. The median follow-up duration was 7.01 years.Results
The mean body mass index (BMI) of the subjects was 23.6?±?3.2?kg/m2 (males, 24?±?3; females, 23.1?±?3.3). A total of 3308 individuals (0.94%) developed thyroid cancer during the study period. The risk of thyroid cancer was higher with increasing BMI in both men and women. Hazard ratios (95% confidence interval) for obese (25–29.9?kg/m2) and extremely obese (≥30?kg/m2) groups were 1.23 (1.13–1.34) and 1.26 (1.02–1.50), respectively, compared to the normal group (18.5–22.9?kg/m2). In particular, the association between the risk of thyroid cancer and BMI was more remarkable in the male group than female group.Conclusion
Our findings show that higher BMI is positively associated with the risk of thyroid cancer. Furthermore, this study supports the positive association between obesity and the increased incidence of thyroid cancer. 相似文献5.
Seok-Soo Byun Eu Chang Hwang Seok Ho Kang Sung-Hoo Hong Jinsoo Chung Tae Gyun Kwon Hyeon Hoe Kim Cheol Kwak Yong-June Kim Won Ki Lee 《Clinical genitourinary cancer》2018,16(1):e173-e179
Introduction
We assessed the prognostic significance of obesity in relation to sex in patients with nonmetastatic clear-cell renal-cell carcinoma (nm-cRCC) in a large multicenter setting in Korea.Patients and Methods
A total of 2097 patients with nm-cRCC who underwent surgery with curative intent were enrolled from 6 institutions in Korea between April 2000 and February 2014. Obesity was determined by body mass index (BMI) before surgery. BMI was used as a continuous variable and was categorized as normal (≥ 18.5 to < 25.0 kg/m2, normal BMI) and overweight or obese (≥ 25 kg/m2, high BMI). The relationships between BMI, sex, recurrence-free survival (RFS), and cancer-specific survival (CSS) were evaluated.Results
Male patients had a greater high BMI ratio than female patients (P = .030). In men, the 5-year RFS and CSS rates in the high BMI group were greater than those in the normal BMI group (P = .003 and .006, respectively). Multivariate analyses revealed that in men, a high BMI was associated with greater RFS or CSS rates (hazard ratio: RFS, 0.901, P = .001; CSS, 0.822, P < .001). In women, there were no significant differences in the 5-year RFS and CSS rates according to BMI (P = .531 and .323, respectively), and high BMI was not associated with RFS or CSS (P = .250 and .180, respectively).Conclusion
In patients with nm-cRCC, obesity was a favorable prognosticator in male but not female patients. Therefore, the association between obesity and nm-cRCC prognosis might differ by sex. 相似文献6.
Ricard Ramos Ernest Nadal Inma Peiró Cristina Masuet-Aumatell Ivan Macia Francisco Rivas Gabriela Rosado Pau Rodriguez Anna Ureña Susana Padrones Samantha Aso Carlos Deniz Arturo Navarro Ignacio Escobar 《European journal of surgical oncology》2018,44(9):1419-1424
Background
As nutritional status plays an important role in outcomes after surgery, this study evaluated the association between preoperative nutritional status (NS) and postoperative outcomes after major resection for lung cancer.Methods
We identified 219 patients with a diagnosis of cancer who underwent pulmonary resection from 2010 to 2012. Preoperative NS was assessed by anthropometric and biological parameters, body mass index (BMI), and the Nutritional Risk Index (NRI). We stratified this population into 4 BMI groups: underweight, normal weight, overweight and obese and 4 NRI groups: well-nourished; mildly malnourished; moderately malnourished and severely malnourished. The outcomes measured were postoperative complications; 30-day postoperative mortality; hospital length of stay (LOS), overall survival (OS) and disease-free survival (DFS). We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables.Results
Mean BMI and NRI were, respectively, 26.5 ± 4.3 and 112.4 ± 3.3. There were no significant differences between BMI categories and resection type, pathological stage, or overall postoperative complications. By contrast, significant differences (p < 0.05) in postoperative complications were observed among the NRI groups. LOS was longer in underweight and/or malnourished patients. In terms of OS, we found no significant differences according to NRI and BMI; however, patients with underweight had significantly shorter DFS compared with patients with overweight and obesity (log-rank p-value = 0.001).Conclusion
NS as measured by the NRI is an independent predictor of the risk of postsurgical complications, regardless of clinicopathologic characteristics. NRI might therefore be an useful tool for identifying early-stage lung cancer patients at risk for postoperative complications. 相似文献7.
Giacomo Corrado Enrico Vizza Vito Cela Liliana Mereu Stefano Bogliolo Francesco Legge Francesca Ciccarone Emanuela Mancini Valerio Gallotta Ermelinda Baiocco Giorgia Monterossi Maria Teresa Perri Ashanti Zampa Tina Pasciuto Giovanni Scambia 《European journal of surgical oncology》2018,44(12)
Objective
The aim of this study was to evaluate the surgical and oncological outcome of robotic surgical staging with hysterectomy (RH) plus or less pelvic and aortic lymphadenectomy, compared to the same procedures performed by laparoscopic surgery (LH) in obese patients (BMI≥30?kg/m2) with endometrial cancer.Material and methods
From October 2001 to April 2017, obese patients (BMI?>?30?kg/m2) with primary, histologically confirmed endometrial carcinoma who underwent LH or RH using the Da Vinci Si or Xi Surgical System® (Intuitive Surgical Inc®, 1266 Kifer Road, Building 101 Sunnyvale, CA) were eligible for the study.Results
We identified 655 women with endometrial cancer and BMI >30?kg/m2. Out of 655 patients, 249 (38%) underwent RH and 406 (62%) underwent LH plus or less pelvic and aortic lymphadenectomy. Our study showed that, compared to the 406 patients treated in LPS, 249 patients treated in robotics have a statistically significant difference in terms of increased operating time and a decreased conversion rate. In addition, the rate of pelvic lymphadenectomies in robotic surgeries is twice the one reported in LPS surgeries. Furthermore, a reduction in hospital stay was observed in the robotic group. We observed that the oncological outcomes do not vary according to the surgical approach and BMI variation.Conclusions: robotic surgery in severely obese women with endometrial cancer is feasible, safe, and reproducible and could be a valid alternative to laparoscopy in the treatment of these patients. Prospective studies could confirm our results. 相似文献8.
Muhammad Bilal Abid Sanjay De Mel Muhammad Abbas Abid Eng Soo Yap Sathish Kumar Gopalakrishnan Yunxin Chen Yi Ching Yuen Hung Chew Wong Adeline Lin Li Mei Poon Liang Piu Koh Wee Joo Chng Lip Kun Tan 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(3):174-179
Background
The current standard of care for transplant-eligible myeloma patients is novel agent-based induction, followed by high-dose chemotherapy and autologous stem cell rescue. Chemo-mobilization of peripheral blood CD34+ stem cells (PBSCs) with pegylated filgrastim (pegfilgrastim), a sustained-duration formulation of filgrastim, has been used as an alternative to filgrastim in several studies involving heterogeneous cohorts of lymphoma and multiple myeloma (MM) patients and shown to be equivalent in PBSC yield and cost-effectiveness. The present study focused on the efficacy of pegfilgrastim in PBSC mobilization compared with filgrastim exclusively after novel agent-based induction in a homogeneous group of MM patients.Patients and Methods
We analyzed the data from 89 patients with MM treated at 2 transplant centers in Singapore who had received novel agent-based induction chemotherapy, PBSC mobilization with vinorelbine/cyclophosphamide, high-dose melphalan conditioning, and autologous stem cell rescue. Of the 89 patients, 61 were included in the pegfilgrastim group and 28 in the filgrastim group, with a similar median age and disease characteristics. PBSC harvesting was performed at a similar median time of 9.51 ± 0.84 days for both, and the peak peripheral blood CD34+ stem cell count was 19.90 × 106/kg for pegfilgrastim and 32.50 × 106/kg for filgrastim (95% confidence interval, ?4.36 to 0.70 × 106/kg).Results
No significant difference was found in the median PBSC collection between the 2 groups (pegfilgrastim, 7.90 × 106/kg vs. filgrastim, 10.10 × 106/kg; P = .16).Conclusion
The present study has demonstrated that a single dose of pegfilgrastim is comparable to filgrastim in terms of the timing and efficacy of PBSC harvest and could potentially spare the patient 6 days of filgrastim injections. In addition, ours is the first study to compare these growth factors using vinorelbine/cyclophosphamide as mobilization chemotherapy. 相似文献9.
T. Chapelle B. Op de Beeck A. Driessen G. Roeyen B. Bracke V. Hartman I. Huyghe S. Morrison D. Ysebaert S. Francque 《European journal of surgical oncology》2017,43(12):2277-2284
Introduction
Recently, there has been increasing interest in the preoperative prediction and prevention of post-hepatectomy liver failure (PHLF). This is a particular concern in colorectal liver metastases (CRLM), when surgery follows potentially hepatotoxic chemotherapy. Platelet-based liver scores (PBLS) such as APRI and FIB-4 are predictive of chemotherapy-associated liver injury (CALI) and PHLF. Estimation of the future liver remnant function (eFLRF) by combining 99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBSBSA) with future liver remnant volume ratio (FLRV%), is predictive of PHLF and related mortality. We hypothesized that a HBSBSA based formula was a better predictor for PHLF than PBLS in chemotherapy-pretreated CRLM.Methods
Between 2012 and 2016, 140 patients underwent liver resection for CRLM following systemic therapy. HBSBSA, FLRV%, eFLRF and PBLS were calculated and compared for their value in predicting PHLF.Results
eFLRF and FLRV% had a better predictive value for PHLF than HBSBSA alone and APRI and FIB-4 (AUC = 0.800, 0.843 versus 0.652, 0.635 and 0.658 respectively). In a subgroup analysis (Oxaliplatin all, Oxaliplatin ≥ 6 cycles, Irinotecan all and Irinotecan ≥ 6 cycles), eFLRF was the only factor predictive for PHLF in all subgroups (all: p ≤ 0.05). Prediction of HBSBSA for chemotherapy associated steato-hepatitis (CASH) reached almost significance (p = 0.06). FIB-4 was predictive for sinusoidal obstruction syndrome (SOS) (p = 0.011). Only weak correlation was found between HBSBSA and PBLS.Conclusion
eFLRF is a better predictor of PHLF than PBLS or HBSBSA alone. PBLS seem to measure other aspects of liver function or damage than HBSBSA. 相似文献10.
Bianca van Veggel Adrianus J. de Langen Sayed M.S. Hashemi Kim Monkhorst Daniëlle A.M. Heideman Erik Thunnissen Egbert F. Smit 《Journal of thoracic oncology》2018,13(8):1222-1226
Introduction
EGFR exon 20 insertions comprise 4% to 9% of EGFR mutated NSCLC. Despite being an oncogenic driver, they are associated with primary resistance to EGFR tyrosine kinase inhibitors (TKIs). We hypothesized that dual EGFR blockade with afatinib, an irreversible EGFR TKI, and cetuximab, a monoclonal antibody against EGFR, could induce tumor responses.Methods
Four patients with EGFR exon 20 insertion–positive NSCLC were treated with afatinib 40 mg once daily and cetuximab 250 mg/m2 to 500 mg/m2 every 2 weeks.Results
All patients had stage IV adenocarcinoma of the lung harboring an EGFR exon 20 insertion mutation. Previous lines of treatment consisted of platinum doublet chemotherapy (n = 4) and EGFR TKI (n = 2). Three of four patients showed a partial response according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1). Median progression-free survival was 5.4 months (95% confidence interval: 0.0 – 14.2 months; range 2.7 months – 17.6 months). Toxicity was manageable with appropriate skin management and dose reduction being required in two patients.Conclusions
Dual EGFR blockade with afatinib and cetuximab may induce tumor responses in patients with EGFR exon 20 insertion–positive NSCLC. 相似文献11.
Ola S. Ali Marwa I. Shabayek Mae M. Seleem Heba G. Abdellateif Dalia O. Makhlouf 《Clinical breast cancer》2018,18(6):e1373-e1379
Introduction
Breast cancer (BC) is the most common malignancy among women; supporting the need for identification of novel prognostic biomarkers, circulating microRNAs (miRNAs) could serve as such in various cancers. The aim of this study was to explore the association between miRNAs 182 and 375 with BC stages and its receptors, based on their expression using real time PCR.Materials and Methods
Detailed medical history was taken and blood samples were withdrawn from 80 female subjects divided over the studied groups. Patients ranged in age from 24 to 80 years and were classified as follows: group I included 10 noncancerous postmenopausal control subjects; group II included 32 postmenopausal patients with BC; group III included 10 noncancerous premenopausal control subjects; group IV included 24 premenopausal patients with BC; and group V included 6 patients with benign breast tumors.Results
miRNA 182 expression was significantly higher in group II, group IV, and group V (3.36 ± 0.14, 2.52 ± 0.34, and 4.93 ± 0.3,9 respectively); miRNA 375 expression was significantly higher in group II, group IV, and group V (4.41 ± 0.40, 3.12 ± 0.35, and 11.28 ± 2.37, respectively) (P < .05). Both miRNAs were significantly associated with each other and with receptors used for the prognosis of BC even after multiple regression analysis.Conclusion
Accordingly, miRNAs 182 and 375 could be potential noninvasive markers used for the follow up of BC patients. 相似文献12.
D. Badrudin L. Sideris F.A. Leblond V. Pichette A.S. Cloutier P. Drolet P. Dubé 《Surgical oncology》2018,27(2):275-279
Background
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (OX) is the standard of care for selected patients with peritoneal carcinomatosis of colorectal origin. Because 5-FU is mandatory to improve efficacy of OX when used by systemic route, several teams now empirically combine intravenous (IV) 5-FU with HIPEC OX, but this practice has yet to be supported by preclinical data. Using a murine model, we studied the impact of IV 5-FU on peritoneal absorption of HIPEC OX.Methods
Under general anesthesia, 24 Sprague-Dawley rats were submitted to 4 different doses of IV 5-FU (0, 100, 400 and 800?mg/m2) and a fixed dose of HIPEC OX (460?mg/m2) perfused at 40?°C during 25?min. At 25?min, samples in different compartments were harvested (peritoneum, portal vein and systemic blood) and the concentrations of 5-FU and OX were measured by high performance liquid chromatography.Results
Peritoneal absorption of OX was significantly higher (17.0, 20.1, 34.9 and 38.1?nmol/g, p?<?0.0001) with increasing doses of 5-FU (0, 100, 400 and 800?mg/m2, respectively). Peritoneal absorption of OX reached a plateau between 400 and 800?mg/m2 of IV 5-FU.Conclusion
IV 5-FU enhances peritoneal absorption of HIPEC OX. The most efficient dose of IV 5-FU to be used in combination with HIPEC OX seems to be 400?mg/m2. 相似文献13.
Eman A. Elghoroury Hesham G. ElDine Solaf A. Kamel Amany H. Abdelrahman Asmaa Mohammed Mahmoud M. Kamel Mona H. Ibrahim 《Clinical breast cancer》2018,18(4):e721-e726
Background
Breast cancer remains one of the top threats to women’s health. The current lack of tumor markers with desirable sensitivity and specificity is a major obstacle toward the future management of breast cancer. Many studies are directed to reveal the diagnostic and prognostic potentials of circulating miRNAs in breast cancer. In this study, we attempt to evaluate the feasibility and clinical utility of circulating miRNA-21 and let-7 as prognostic biomarkers for breast cancer.Methods
Real-time quantitative polymerase chain reaction technique was used. Levels of miRNA-21 and let-7 expression were determined in sera from 125 participants representing 3 different groups. With fold-change analysis, the expression of miRNA-21 and let-7 in the decided groups were assessed.Results
Patients with breast cancer showed significantly higher expression of miRNA-21 compared with controls and other participants with benign breast lesions (P < .001). The mean expression levels of serum miRNA-21 was 3.27 ± 2.10-fold in patients with breast cancer. The expression of miRNA let-7 was significantly decreased in patients with breast cancer (2.45 ± 2.20-fold) than the control group and the benign breast lesions group (5.27 ± 3.30-fold and 6.22 ± 4.90-fold, respectively; P < .001). Levels of miRNA let-7 expression negatively correlated with development of metastases in patients with breast cancer (P < .001).Conclusions
Our study establishes the association between altered levels of miRNA let-7 and metastases risk in patients with breast cancer, implying a role of miRNA let-7 in disease progression and prognosis. 相似文献14.
N.N.Y. Janssen R.F.D. van la Parra C.E. Loo E.J. Groen M.J. van den Berg H.S.A. Oldenburg J. Nijkamp M.T.F.D. Vrancken Peeters 《European journal of surgical oncology》2018,44(1):67-73
Background and objectives
Breast conserving surgery (BCS) can be challenging for large regions of ductal carcinoma in situ (DCIS), resulting in high rates of positive resection margins. Radioactive seed localization (RSL) using multiple radioactive iodine (125I) seeds can be used to bracket extensive DCIS (eDCIS). The goal of this study was to retrospectively compare the use of a single or multiple 125I seeds in RSL to enable BCS in patients with eDCIS.Methods
All patients with eDCIS (area of ≥3.0 cm) who underwent either single or multiple-seed RSL between January 2008 and December 2016 were included. Patient, tumor and surgery characteristics were compared between both groups. Primary outcome measures were positive resection margin and re-operation rates.Results
Respectively 48 and 58 patients with eDCIS underwent single- and multiple-seed RSL and subsequent BCS. The rate of positive resection margin (focal and more than focal) with single-seed RSL was 47.9%, compared to 29.3% with multiple-seed RSL (p = 0.06). The re-operation rate was 39.6% with single-seed RSL and 20.7% in the multiple-seed RSL group (p = 0.05).Conclusion
Multiple-seed RSL enables bracketing of large areas of DCIS, with the potential to decrease the high rate of positive resection margins in this patient group. 相似文献15.
Yutaro Kikuchi Yukihiko Hiroshima Kenichi Matsuo Takashi Murakami Daisuke Kawaguchi Kohei Kasahara Kuniya Tanaka 《European journal of surgical oncology》2018,44(1):130-138
Background
The impact of associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS) on tumor growth activity was investigated.Methods
A BALB/c mouse model (male, 8–10 weeks old) of liver metastasis labeled by red fluorescent protein was established. Changes in future liver remnant (FLR) volumes, tumor growth activity, and levels of cytokines and growth factors in liver tissues during the treatment period were compared among the models involving ALPPS, portal vein ligation (PVL), or sham operation.Results
The ratio of the FLR volume to body weight at 24 h after the procedure was greater for ALPPS (4.45 ± 0.12 × 10?2) than for PVL (3.79 ± 0.12 × 10?2; P = 0.003) and sham operation (3.18 ± 0.16 × 10?2; P < 0.001). No differences in tumor progression in the FLR were observed at any time point after the procedures. Within the deportalized liver (DL), although tumor progression was observed during a later period after ALPPS (9 days postoperative) and PVL (12 days postoperative), no acceleration of tumor growth after ALPPS was observed in an early period similar to PVL.Conclusion
ALPPS induces a rapid increase in FLR volume and avoids remnant tumor progression during the early postoperative period. 相似文献16.
Jose F. Falantes Francisco J. Márquez-Malaver Cristina Calderón-Cabrera Begoña Pedrote María L. Martino Jose González Ildefonso Espigado Jose A. Pérez-Simón 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(7):469-474.e1
Background
The prognosis of patients with lower-risk myelodysplastic syndrome (LR-MDS) is very heterogeneous. In addition to survival estimates, identification of factors related to the probability of leukemic progression might help prognosis assessment.Patients and Methods
The present study is a retrospective analysis of 409 patients with primary LR-MDS. The probability of leukemic progression was estimated in the competing risk framework by the cumulative incidence method considering death without acute myeloid leukemia (AML) as a competing event.Results
Sixty-six patients (16.1%) progressed to AML. The following covariates influenced the probability of leukemic progression in a multivariate competing risk regression model: intermediate karyotype versus diploid or chromosome 5 deletion, 5% to 9% bone marrow blast percentage, platelet count <50 × 10e9/L and age younger than 75 years.Conclusion
According to these, a predictive model is proposed, which categorizes patients with different probability of leukemic progression (P < .001). Validation of these results might help prognostic refinement of patients with LR-MDS. 相似文献17.
W. Petz D. Ribero E. Bertani S. Borin G. Formisano S. Esposito G. Spinoglio P.P. Bianchi 《European journal of surgical oncology》2017,43(11):2060-2066
Introduction
Right-sided colon cancer has a worse prognosis than left-sided colon cancer. Complete mesocolic excision (CME) with central vessels ligation (CVL) reduces local recurrence, but is technically demanding, particularly with a laparoscopic approach.Aim of this study is to describe a new robotic approach to right colectomy with CME and CVL and to report oncologic safety and short term outcomes.Methods
Twenty consecutive patients were included. All patients had a right colon adenocarcinoma and underwent right colectomy with a suprapubic approach. Surgery was realized with the Da Vinci Xi® system and all trocars were placed along a horizontal line 3–6 cm above the pubis. CME with CVL was realized in all the patients.Data analysed were: duration of surgery, conversions to open surgery, intraoperative and postoperative complication by Clavien Dindo classification, margins of resections, length of specimen and number of lymph nodes retrieved.Results
Patients median age was 69 years, median body mass index was 27 kg/m2. Median operative time was 249 min, blood loss was negligible, no conversions to open or laparoscopic surgery occurred. Median hospital stay was six days; two postoperative grade IIIa Clavien–Dindo complications occurred, no 30-days postoperative death was registered. Resection margins were negative in all patients; median tumour diameter was 3.6 cm, median specimen length was 40 cm, median number of harvested lymph nodes was 40.Conclusions
Robotic right colectomy with CME using a suprapubic approach is a feasible and safe technique that allows for an extended lymphadenectomy and provides high quality surgical specimens. 相似文献18.
19.
Yi-Long Wu Lecia V. Sequist Eng-Huat Tan Sarayut L. Geater Sergey Orlov Li Zhang Ki Hyeong Lee Chun-Ming Tsai Terufumi Kato Carlos H. Barrios Martin Schuler Vera Hirsh Nobuyuki Yamamoto Kenneth O’Byrne Michael Boyer Tony Mok Barbara Peil Angela Märten Keunchil Park 《Clinical lung cancer》2018,19(4):e465-e479
Background
Afatinib is approved in the US, Europe, and several other regions for first-line treatment for epidermal growth factor receptor mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC).Patients and Methods
Treatment-naive patients with advanced EGFRm+ NSCLC were randomized to afatinib (40 mg/d) versus cisplatin/pemetrexed (LUX-Lung 3 [LL3]) or cisplatin/gemcitabine (LUX-Lung 6 [LL6]), or versus gefitinib (250 mg/d; LUX-Lung 7 [LL7]). We report subgroup analyses according to age, including 65 years or older versus younger than 65 years (preplanned; LL3/LL6) and additional cutoffs up to 75 years and older (exploratory; LL7). Progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were evaluated.Results
Among the 134 of 345 (39%) and 86 of 364 (24%) patients aged 65 years and older in LL3 and LL6, median PFS was improved with afatinib versus chemotherapy (LL3: hazard ratio [HR], 0.64 [95% confidence interval (CI), 0.39-1.03]; LL6: HR, 0.16 [95% CI, 0.07-0.39]). Afatinib significantly improved OS versus chemotherapy in elderly patients with Del19+ NSCLC in LL3 (HR, 0.39 [95% CI, 0.19-0.80]). Among the 40 of 319 patients (13%) aged 75 years or older in LL7, median PFS (HR, 0.69 [95% CI, 0.33-1.44]) favored afatinib, consistent with the overall population. Afatinib-associated AEs in older patients were consistent with the overall populations.Conclusions
Subgroup analyses of the LL3, LL6, and LL7 trials show that afatinib is an effective and tolerable treatment for patients with EGFRm+ NSCLC, independent of age. 相似文献20.
N. Lou C.-H. Chi X.-D. Chen C.-J. Zhou S.-L. Wang C.-L. Zhuang X. Shen 《European journal of surgical oncology》2017,43(1):188-195