The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

Primary duodenal adenocarcinomas (PDAC) are uncommon tumors characterized by non-specific symptoms and late diagnosis, and treatments of PDAC have some controversies.

Method

To investigate the early diagnosis and outcomes of surgical treatment of PDAC, 32 patients who were treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy, including 18 patients (56.3%) with pancreaticoduodenectomy (PD), six patients (18.7%) with segmental resection (SR), and eight patients with bypass procedures. And, R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25 of 29), 48.3% (14 of 29), and 20.7% (six of 29), respectively. Moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19 of 19), 73.7% (14 of 19), and 31.6% (six of 19), which were significantly higher than those (50.0%?=?5/10, 0% and 0%) in patients with palliative operation (P?<?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (five of 18) in pancreaticoduodenectomy patients and 16.7% (one of six) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for the tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.     

The Surgical Treatment and Outcome for Primary Duodenal Adenocarcinoma

Background

To investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose.

Method

Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively.

Results

All 32 patients underwent laparotomy including 18 (56.3%) pancreaticoduodenectomy (PD), six (18.7%) segmental resection (SR), and eight bypass procedures. And R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 78.1% (25/32), 43.8% (14/32), and 18.8% (6/32), respectively; moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (20/20), 70.0% (14/20), and 30.0% (6/20), which were significantly higher than those (41.7%?=?5/12, 0%, and 0%) in patients with palliative operation (P?<?0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P?>?0.05).

Conclusion

PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients especially for tumors of the distal duodenum.     

Utility of Serum CA19-9 Levels in the Diagnosis of Pancreatic Ductal Adenocarcinoma in an Endoscopic Ultrasound Referral Population

Purpose

Recent data suggest the use of carbohydrate antigen (CA) 19-9 as a potential marker in the early detection of pancreatic ductal adenocarcinoma (PDAC) when used in the appropriate clinical setting. Here, we assess the utility of CA19-9 in PDAC detection in a select population of pancreatic endoscopic ultrasound (EUS) referrals.

Methods

Retrospective review of an institutional EUS Pancreas Registry containing cases referred from November 2002 to November 2011 was completed for categorical analyses with CA19-9 level. A separate case–control study for the subset of non-elevated CA19-9 PDAC population was also performed to characterize the clinical features in this unique group of patients.

Results

Two hundred eighty-three patients had available CA19-9 data in the registry and were included in the study. Compared to the typical PDAC distribution, the proportion of patients with stage I disease was significantly higher in our registry population (P?<?0.0001). Elevated CA19-9 levels most often reflected a diagnosis of PDAC relative to other pancreaticobiliary diagnoses. However, we observed that 15 % of patients with PDAC had normal CA19-9 levels. Clinical characteristics for this false-negative PDAC group compared to the true-positive group demonstrated a predilection for detection of cancer in the body/tail of the pancreas (P?=?0.03), increased likelihood of lymph node metastases (P?=?0.03), and initial presentation with vague abdominal pain or pancreatic mass as an incidental finding on imaging studies (P?=?0.01).

Conclusions

Elevated CA19-9 demonstrated a greater likelihood of PDAC diagnosis relative to benign pancreatic pathology, and higher levels of CA19-9 were in line with worse PDAC stage. Patients with normal CA19-9 PDAC may represent a unique subclass of patients, presenting with atypical clinical features, and possibly more advanced stage disease at the time of diagnosis. These patients may benefit from more diligent EUS examination or perhaps closer follow-up management.     

Multivariate analysis of immunohistochemical evaluation of protein expression in pancreatic ductal adenocarcinoma reveals prognostic significance for persistent Smad4 expression only

Background

Pancreatic ductal adenocarcinoma (PDAC) has a dismal prognosis with a 5-year survival rate of <5% and an average survival of only 6?months. Although advances have been made in understanding the pathogenesis of PDAC in the last decades, overall survival has not changed. Various clinicopathological and immunohistological variables have been associated with survival time but the exact role that these variables play in relation to survival is not clear.

Methods and results

To examine how the variables affected survival independently, multivariate analysis was conducted in a study group of 78 pancreatic ductal adenocarcinomas. The analysis included clinicopathological parameters and protein expression examined by immunohistochemistry of p53, Smad4, Axl, ALDH, MSH2, MSH6, MLH1 and PMS2. Lymph node ratio <0.2 (p?=?0.004), tumor free resection margins (p?=?0.044) and Smad4 expression (p?=?0.004) were the only independent prognostic variables in the multivariate analysis. Expression of the other proteins examined was not significantly related to survival.

Conclusions

Discrepancies with other studies in this regard are likely due to differences in quantification of immunohistochemical staining and the lack of multivariate analysis. It underscores the importance to standardize the methods used for the application of immunohistochemistry in prognostic studies.     

Radical surgery of oligometastatic pancreatic cancer

Background

In metastatic disease (M1), chemotherapy (expected survival: 6–10 months) is considered the only treatment option. The aim of this study was to evaluate the outcome of curative M1 PDAC resections.

Analysis of Super-low Anterior Resection for Rectal Cancer from a Single Center

Purpose

The purpose of this study was to evaluate the outcome and genitourinary complications of super-low anterior resection (SLAR) followed by adjuvant radiochemotherapy in the management of patients with low rectal cancer.

Method

One hundred and six low rectal cancer patients managed with SLAR were analyzed retrospectively.

Results

There were seven patients who failed to follow up, and the 5-year survival rate was 65.7% (65/99). There were 35 patients (35.4%) who developed distant metastases, and 12 (12.1%) had local recurrence. The local recurrence rates were 21.1% (4/19), 7.1% (2/28), 5.9% (1/17), and 0% (0/2) in the patients with tumor distance of less than or equal to 2 cm, ranging from 2.1 to 3.0, from 3.1 to 4.0, from 4.1 to 5.0, and more than 5 cm, respectively. This implied local recurrence rate increased against the distance between the lower margin of tumor and resection line. Ninety-eight of 106 rectal patients had complete data of questionnaire: 58 scored 1, 32 scored 2, 7 scored 3, and 1 score 4. This revealed that the fecal function of most patients (91.8%, 90/98) was normal or nearly normal. Twenty-four of 37 males suffered from sexual dysfunction, and among them, eight were impotent (all older than 70 years), and 29 had retrograde ejaculation. Meanwhile, seven of 35 females suffered from sexual problem, 1 had dyspareunia, seven had decreased lubrication, and one had inability to achieve orgasm.

Conclusions

SLAR followed by adjuvant radiochemotherapy can effectively control local–regional disease and can be one choice of avoiding the functional morbidity of abdominoperineal resection.     

The surgical prognosis of pIIIA/N2 non-small-cell lung cancers

Objective

The aim of the study was to identify prognostic factors in non-small-cell lung cancer (NSCLC) with N2 nodal involvement.

Methods

A retrospective analysis of disease free survival and 5-year survival for NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy were performed. Between January 1998 and May 2004, 133 patients were enrolled. Several factors such as age, sex, skip metastasis, number of N2 lymph node stations, type of resection, histology, adjuvant therapy etc., were recorded and analyzed. SPSS 16.0 software was used.

Results

Overall 5-year survival for 133 patients was 32.33%, 5-year survival for single N2 station and multiple N2 stations sub-groups were 39.62% and 27.50% respectively, and 5-year survival for cN0?C1 and cN2 sub-groups were 37.78% and 20.93% respectively. COX regression analysis revealed that number of N2 station (P = 0.013, OR: 0.490, 95% CI: 0.427?C0.781) and cN status (P = 0.009, OR: 0.607, 95% CI: 0.372?C0.992) were two favorable prognostic factors of survival.

Conclusion

Number of N2 station and cN status were two favorable prognostic factors of survival. In restrict enrolled circumstances, after combined therapy made up of surgery and postoperative adjuvant therapy have been performed, satisfied survival could be achieved.     

Docetaxel-Based Preoperative Chemoradiation in Localized Gastric Cancer: Impact of Pathological Complete Response on Patient Outcome

Purpose

This study was conducted to evaluate the feasibility, efficacy, and toxicities of docetaxel-based induction chemotherapy and chemoradiotherapy in patients with localized gastric or gastroesophageal adenocarcinoma.

Methods

Patients with localized, operable gastric or gastroesophageal adenocarcinoma received two cycles of induction chemotherapy of fluorouracil, docetaxel, and cisplatin (TPF) followed by 45 Gy of radiation and concurrent fluorouracil plus docetaxel then surgery for nonmetastatic patients.

Results

Forty-one patients were included. Pretreatment T3 was encountered in 56 % of patients while 61 % had N1 disease. A pathologic complete response (CR) was noted in 24 % of patients. Pathologic response was significantly associated with baseline T stage (P?<?0.001) and N stage (P?=?0.002). The 3-year overall survival (OS) and disease-free survival were 47.3 and 42.1 %, respectively. OS was significantly correlated with R0 resection (P?=?0.027), pathological response (P?=?0.01), dissected pathologically positive lymph node (P?=?0.037), and postsurgery (T) stage (P?=?0.02). Toxicities were manageable and there were no treatment-related deaths.

Conclusion

Docetaxel-based chemoradiotherapy in localized gastric adenocarcinoma patients resulted in 24 % path CR and was not associated with a higher percentage of postoperative complications. A well-designed randomized controlled trial is mandatory to further endorse this evolving approach.     

Two-year adjuvant imatinib mesylate after complete resection of localized, high-risk GIST with KIT exon 11 mutation

Purpose

To evaluate the efficacy and safety of 2-year adjuvant imatinib for patients at high risk of recurrence after complete resection of localized gastrointestinal stromal tumor with KIT exon 11 mutation.

Methods

Imatinib 400 mg/d was administered until disease recurrence, intolerable toxicities, or for 2 years. The primary end point was recurrence-free survival.

Results

Patients (n = 47) from 4 centers in Korea were enrolled. Treatment was well tolerated. Grade 3–4 toxicities included neutropenia (27.7 %), skin rash (8.5 %), anorexia (4.3 %), and constipation (2.1 %). At a median follow-up of 56.7 months, 19 patients had recurrences. Median recurrence-free survival was 58.9 months, which was significantly longer than 22.7 months from historical data of 27 patients in the pre-imatinib era (P < 0.0001). Imatinib was rechallenged for 15 patients with recurrence after completion of adjuvant imatinib. Thirteen patients had partial response, and two had stable disease. There was only one death so far.

Conclusions

Postoperative adjuvant imatinib for 2 years was safe and could prolong the recurrence-free survival in patients with a high risk of recurrence after complete resection of localized KIT exon 11 mutated gastrointestinal stromal tumor. Reintroduction of imatinib after recurrence appears to be effective if the recurrence develops after completion of adjuvant imatinib.     

Comparison of ILK and ERP29 expressions in benign and malignant pancreatic lesions and their clinicopathological significances in pancreatic ductal adenocarcinomas

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor of the pancreas with poor prognosis. The lack of understanding of the molecular mechanisms of PDAC and biomarkers for early diagnosis might be two of the reasons for the poor prognosis of PDAC.

Materials and methods

ILK and ERP29 protein expressions in PDAC, peritumoral tissues, benign pancreatic lesions, and normal pancreatic tissues were measured by immunohistochemistry and the clinical and pathological significances of ILK and ERP29 in PDAC were analyzed.

Results

The percentages of positive ILK and negative ERP29 expressions were significantly higher in PDAC tumors than in peritumoral tissues, benign pancreatic tissues, and normal pancreatic tissues (P < 0.01). Benign pancreatic lesions with positive ILK and negative ERP29 expressions exhibited dysplasia or intraepithelial neoplasia. The percentage of cases with positive ILK and negative ERP29 expressions was significantly lower in PDAC patients without lymph node metastasis and invasion, and having TNM stage I/II disease than in patients with lymph node metastasis, invasion, and TNM stage III/IV disease (P < 0.05 or P < 0.01). Kaplan–Meier survival analysis showed that positive ILK and negative ERP29 expressions were significantly associated with survival in PDAC patients (P < 0.001). Cox multivariate analysis revealed that positive ILK and negative ERP29 expressions were independent poor prognosis factors in PDAC patients.

Conclusions

Positive ILK and negative ERP29 expressions are associated with the progression of PDAC and poor prognosis in patients with PDAC.

     

Depressive symptoms are a risk factor for all-cause mortality: results from a prospective population-based study among 3,080 cancer survivors from the PROFILES registry

Background

The goal of this large prospective population-based study was to examine the association between depressive symptoms and all-cause mortality among cancer survivors up to 10 years post-diagnosis.

Methods

All currently alive individuals diagnosed with endometrial or colorectal cancer (CRC) between 1998 and 2007 or with lymphoma or multiple myeloma between 1999 and 2008, as registered in the Eindhoven Cancer Registry, received a questionnaire on depressive symptoms (Hospital Anxiety and Depression Scale (HADS)) in 2008 or 2009, respectively; 69 % (n?=?3,080) responded. Survival status was obtained from the Central Bureau for Genealogy.

Results

Clinically elevated levels of depressive symptoms (HADS cutoff value ≥8) were more prevalent in those who died compared to those who survived (38 vs. 19 %, respectively; p?<?0.0001). This was also evident across different types of cancer. After adjustment for independent predictors of all-cause mortality, 1–10-year survivors with depressive symptoms had an increased risk of death (hazard ratio (HR) 2.07; 95 % confidence interval (CI) 1.56–2.74; p?<?0.0001), and this was also found among 1–2-year survivors (HR, 2.20; 95 % CI, 1.41–3.43; p?<?0.001). Sub-analyses among CRC survivors gave the opportunity to adjust for metastasis and showed that depressive symptoms among 1–10-year CRC survivors and 1–2-year CRC survivors increased the risk of death (HR, 1.88; 95 % CI, 1.24–2.83; p?<?0.01 and HR, 2.55; 95 % CI, 1.44–4.51; p?<?0.001, respectively).

Conclusions

This study showed that patients with depressive symptoms had twofold risk for all-cause mortality, even after adjustment for major clinical predictors.

Implications for Cancer Survivors

Paying more attention to the recognition and treatment of depressive symptoms seems warranted since depressive symptoms are often underdiagnosed and undertreated in cancer patients.     

Phase II trial of induction irinotecan-cisplatin followed by concurrent irinotecan-cisplatin and radiotherapy for unresectable, locally advanced gastric and oesophageal-gastric junction adenocarcinoma

Purpose

The prognosis of patients with unresectable M0 gastric cancer remains very poor. We performed a phase II trial to explore the efficacy and toxicity of induction irinotecan-cisplatin (IC) followed by concurrent irinotecan-cisplatin and radiotherapy (IC/RT) in this setting.

Methods and materials

Patients with unresectable M0 gastric (GC) or oesophageal-gastric junction (EGJC) adenocarcinomas were treated with two courses of IC (irinotecan, 65?mg/m²; cisplatin, 30?mg/m² on days 1 and 8 every 21?days) followed by IC/RT (daily radiotherapy??45?Gy??with concurrent IC: irinotecan, 65?mg/m², and cisplatin, 30?mg/m², on days 1, 8, 15, and 22). Resectability was reassessed after this treatment, and surgical resection was performed if feasible. The primary endpoint was the R0 resection rate after induction treatment.

Results

Seventeen patients were included in the study (EGJC: 6; GC: 11). An R0 resection was achieved in only 5 patients (29%), and according to the design of the trial (Simon??s optimal two-stage) accrual of patients was terminated after the first stage. No patient died during IC, whereas 3 patients (24%) died during IC/RT and one of 5 resected patients (20%) died during the first 30?days after resection. The median survival was 10.5?months, and the actuarial 2-year survival rate was 27%.

Conclusions

Induction IC followed by IC/RT showed poor efficacy and significant toxicity in patients with unresectable GC/EGJC.     

Evaluation of CA 242 as a Tumor Marker in Gallbladder Cancer

Purpose

Gallbladder and pancreas share common embryological origin, and malignancies of these organs may share common tumor antigens. CA 242 is a tumor marker for pancreatic cancer, but has not been studied in gallbladder cancer (GBC). We measured serum CA 242 levels in patients with GBC and compared it with those in patients with gallstones (GS) and healthy volunteers.

Methods

We enrolled consecutive patients with GBC (cases), GS (disease controls), and healthy volunteers (healthy controls). Serum CA 242, CEA, and CA 19?C9 levels were measured using ELISA. Receiver operator curve was plotted for all the three markers.

Results

We studied 117 patients with GBC, 58 with GS, and 10 healthy volunteers. Among patients with GBC, 81 (69%) also had GB calculi. Patients with GBC more often had elevated CA 242 levels (64%) compared to those with GS (17%; p?<?0.001) and healthy controls (0%; p?<?0.001). The median levels of CA 242 was higher in the GBC group (59 [199] U/ml) compared to the GS group (10 [13] U/ml; p?<?0.001) and the control group (3 [14.5] U/ml; p?<?0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive values of CA 242 for diagnosis of GBC were 64%, 83%, 88%, and 53%, respectively. At a cutoff of 45?U/ml, the specificity and PPV increased to 100%. CA 242 had higher AOC (0.759) compared to CEA (0.528) and CA 19?C9 (0.430).

Conclusions

CA 242 is a promising tumor marker for GBC and performs better than CEA and CA 19-9.     

Successful treatment of infants with localized neuroblastoma based on their MYCN status

Background

The aim of this study was to evaluate the effectiveness of post-surgical chemotherapy for infants with localized neuroblastoma without MYCN amplification (MNA), and determine whether risk classification using MNA is reasonable.

Methods

Four hundred and fourteen eligible patients were registered between 1998 and 2004. Resectable patients in stage 1 and 2A/2B were treated by surgical resection only. Unresectable patients in stage 3 without MNA received either 6 cycles of regimen A or 3 cycles of regimen A plus 3 cycles of regimen C2; regimen A consisted of low doses of cyclophosphamide and vincristine and regimen C consisted of cyclophosphamide, vincristine and pirarubicin before surgical resection. The resectable and unresectable patients were randomly selected to receive post-surgical chemotherapy. The patients with MNA received intensive chemotherapy regimen D2, consisting of cyclophosphamide, vincristine, pirarubicin and cisplatin, and some of them received high-dose chemotherapy with stem cell transplantation.

Results

The 5-year event-free survival (5-EFS) rates of stage 1 and 2A/2B patients without MNA were 97.2 and 89.0% respectively (p = 0.02). A total of 31 patients in stage 3 without MNA received post-surgical chemotherapy, and 30 patients did not. The 5-EFS rates of these two groups (96.0 and 96.2%, respectively) were not significantly different (p = 0.869). The 5-EFS rate for localized patients with MNA (n = 6) was 50.0%, and that of patients without MNA was 95.0% (p < 0.001).

Conclusion

Post-surgical chemotherapy was therefore unnecessary for localized patients without MNA. This treatment strategy using MNA is considered to be appropriate in infants.     

Development of treatment and clinical results in childhood AML in Austria (1993–2013)

Background

Since the early 1990s, three consecutive pediatric acute myeloid leukemia (AML) trials have been performed in Austria (AML-Berlin-Frankfurt-Münster (BFM) 93, AML-BFM 98, and AML-BFM 2004) in close cooperation with the international BFM study center. Herein, we review the pertinent patient characteristics, therapy, and outcome data.

Patients and methods

From January 1993 to April 2013, 249 children and adolescents (193 protocol patients) diagnosed with AML were enrolled in the three BFM studies. Patients were mainly treated in one of five pediatric hematology/oncology centers distributed over Austria.

Results

Many characteristics and outcome parameters were not statistically different between the three trials. Almost similar proportions of patients were stratified into two risk groups: standard risk (SR) (approximately 37?% overall) and high-risk (HR) (61?%). MLL rearrangements were found in 23?% of patients overall as the most frequent genetic aberration subtype. Complete remission (CR) was achieved by 84–95?% of patients. The most important type of event was leukemic relapse (5-year cumulative incidence 40?±?8?%, 21?±?5?%, and 39?±?6?%; p?=?0.058), with a trend to a higher rate specifically in SR patients of study AML-BFM 2004 compared with AML-BFM 98. Importantly, the frequency of death from causes other than relapse sequelae declined over the years (AML-BFM 93: 5/42 12?%, AML-BFM 98: 5/57 9?%, and AML-BFM 2004: 5/94 5?%). Altogether, event-free survival at 5 years varied insignificantly (48?±?8?%, 61?±?7?%, and 50?±?6?%; p?=?0.406). Nevertheless, survival (pSU) apparently improved from BFM 93 to subsequent studies, both overall (57?±?8?%, 75?±?6?%, and 62?±?6?%; p?=?0.046) and regarding the HR group (5-year-probability of survival (pSU) 40?±?10?%, 66?±?8?%, and 52?±?8?%; p?=?0.039).

Conclusion

Treatment of pediatric AML in Austria renders survival rates in the range of international best practice. However, unambiguous statistical comparison of treatment periods is eventually hampered by small numbers and inequalities of recruitment. Hence, only internationally collaborative trials will allow developing treatment further to achieve higher cure rates with fewer events.     

Long-Term Results and Prognostic Factors in Resected Pancreatic Body and Tail Adenocarcinomas

Background

Adenocarcinoma of the body and tail of the pancreas are more often than not inoperable to begin with. Factors predicting the prognosis in the resected tumors of pancreatic body and tail were analyzed.

Methods

Between 1989 and 2006, 43 patients with adenocarcinoma of the body and tail of the pancreas underwent resection at Chang Gung Memorial Hospital, Taoyuan, Taiwan. Univariate and multivariate analysis of clinicopathological factors affecting the prognosis were analyzed.

Results

Totally, 32 patients were available for the analysis. The median follow-up was 13.6 months (1.5–87.5 months). The median survival time was 14.2 months and the 1-, 3-, and 5-year survival rates were 58.1, 25.8, and 6.5 %, respectively. On univariate analysis, the factors which influenced the survival were tumor size >4 cm (p?=?0.004), lymphatic invasion (p?=?0.001), and positive resection margin (p?=?0.030). On multivariate analysis, only the tumor size and the lymphatic invasion were independent prognostic factors.

Conclusion

Even after macroscopic curative resection, the prognosis remains poor for pancreatic body and tail adenocarcinoma. Early diagnosis is the key to achieving long-term survival. Newer effective adjuvant treatment after curative resection is needed to improve the survival     

Effect of adjuvant chemoradiotherapy on overall survival of gastric cancer patients submitted to D2 lymphadenectomy

Background

Adjuvant chemoradiotherapy (CRT) is the standard treatment in Western countries for gastric cancer patients submitted to curative resection. However, the role of adjuvant CRT in gastric cancer treated with D2 lymphadenectomy has not been well defined.

Methods

We conducted a retrospective study in patients with stage II to IV gastric adenocarcinoma with no distant metastases, who underwent curative resection with D2 lymphadenectomy between January 2002 and December 2007. The present study compared the 3-year overall survival of two treatments (adjuvant CRT according to the INT 0116 trial versus resection alone). Survival curves were estimated by the Kaplan–Meier method and compared with a log-rank test. Multivariate analysis of prognostic factors was performed by the Cox proportional hazards model.

Results

A total of 185 patients were included, 104 patients (56 %) received adjuvant CRT and 81 received resection alone. The 3-year overall survival was 64.4 % in the CRT group and 61.7 % in the resection-alone group (p: 0.415). However, according to the Cox proportional hazards model, adjuvant CRT was a prognostic factor for 3-year overall survival (hazard ratio [HR] 0.46, 95 % confidence interval [CI] 0.26–0.82, p: 0.008).

Conclusions

In the present study, adjuvant CRT was associated with a lower risk of death over a 3-year period in gastric cancer patients treated with D2 lymphadenectomy.     

Comparison of Two Diverse Populations, British Columbia, Canada, and Ardabil, Iran, Indicates Several Variables Associated with Gastric and Esophageal Cancer Survival

Background

Geographic variation and temporal trends in the epidemiology of esophageal and gastric cancers vary according to both tumor morphology and organ subsite. This study compares 1-year survival of gastric and esophageal cancers between two distinct populations: British Columbia (BC), Canada, and Ardabil, Iran.

Methods

Data for invasive primary esophageal and gastric cancer patients were obtained from the population-based cancer registries for BC and Ardabil. The relative survival rate was calculated using WHO Statistical Information System (WHOSIS) life-tables for each country. Chi-square and Fisher??s exact tests were used to compare survival differences between BC and Ardabil. T-tests, chi-square tests, and Fisher??s exact test were used to compare patient characteristics and tumor factors between the populations.

Results

The overall 1-year age-standardized relative survivals for gastric cancer were 48% and 21% in BC and Ardabil, respectively (p?p?Conclusion Findings of this study point to differences in disease characteristics and patient factors, not solely differences in healthcare systems, as being responsible for the survival difference in these populations.     

Impact of chemotherapy-related prognostic factors on long-term survival in patients with stage III colorectal cancer after curative resection

Background

This retrospective study evaluated the prognostic factors of chemotherapy in stage III colorectal cancer after curative resection.

Methods

From 1996 to 2001, 1,054 patients with primary single colorectal cancer underwent curative resection. Seven hundred sixteen patients received various 5-fluorouracil (FU)-based adjuvant chemotherapy regimens, including oral and intravenous treatments. The chemotherapy-related parameters examined included therapeutic duration, frequency, route of administration, composition of combination therapies, and postoperative time interval from the operation to the start of chemotherapy.

Results

The therapeutic duration and postoperative time interval of starting therapy were independent prognostic factors, in addition to clinicopathological factors. The 8-year cancer-specific/overall survival rates in patients who received chemotherapy for >4 months (63.0/58.6%) were significantly higher than the rates in patients who received no chemotherapy (56.7/37.7%, P < 0.01) and those who remained on chemotherapy for 1–4 months (49.4/41.9%, P < 0.05). The 8-year cancer-specific/overall survival rates in patients who waited 1–5 weeks after surgery to receive chemotherapy (62.9/58.5%) were significantly higher versus rates in those who did not receive chemotherapy (56.7/37.7%) and those who did not receive chemotherapy until >5 weeks after surgery (52.3/45.9%) (both P < 0.05). Survival rates did not differ between patients who did not undergo chemotherapy, those for whom chemotherapy lasted 1–4 months, and patients who did not receive chemotherapy until >5 weeks after surgery.

Conclusions

The appropriate duration of therapy and early chemotherapy after surgery were 2 of the most important factors in eradicating occult cancer and effecting long-term survival benefits in patients with stage III colorectal cancer.     

Comparative Effectiveness of Chemotherapy in Elderly Patients with Metastatic Colorectal Cancer

Purpose

Treatment advances have improved outcomes in clinical trials of patients with metastatic colorectal cancer (mCRC). Less is known about these effects for patients in real-world settings. This study evaluated treatment patterns and survival in older, demographically diverse patients with mCRC.

Methods

A retrospective cohort analysis was performed for 4,250 patients from January 1, 2000 to December 31, 2007 using linked Surveillance, Epidemiology, and End Results-Medicare database. Patients were ≥66 years, enrolled in Medicare parts A and B, and received first-line treatment with fluorouracil and leucovorin (5-FU/LV), capecitabine (CAP), 5-FU/LV plus oxaliplatin (FOLFOX), or CAP and oxaliplatin (CAPOX). Cox regression with backward elimination and propensity score-weighted Cox regression estimated relative risk of death. Date of last follow-up was December 2009. Statistical comparisons were made between 5-FU/LV vs. CAP and FOLFOX vs. CAPOX.

Results

Compared to 5-FU/LV, patients treated with CAP were older (mean age 78 vs. 76; P?< 0.0001) and more likely female (61 vs. 54 %; P?=?0.0017), while patients receiving CAPOX and FOLFOX were similar in age (mean age 74 vs. 73; P?=?0.0924). Complications requiring medical resource utilization following initiation of therapy were significantly higher among patients administered with 5-FU/LV (54 %) vs. CAP (17 %; P?<?0.0001) and FOLFOX (75 %) vs. CAPOX (57 %; P?<?0.0001). The multivariate analysis revealed no significant differences in survival between 5-FU/LV and CAP and between FOLFOX and CAPOX.

Conclusions

Overall survival was comparable between CAP and 5-FU/LV and between CAPOX and FOLFOX with fewer complications requiring medical resource utilization associated with CAP and CAPOX, thus confirming clinical trial results.