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1.
Andrew D. Lynch Faiz Gani Christian F. Meyer Carol D. Morris Nita Ahuja Fabian M. Johnston 《Surgical oncology》2018,27(3):373-379
Background and Objectives
A lack of consensus exists on the prognosis of extraskeletal Ewing sarcoma (EES) relative to its skeletal (ES) counterpart in adults. This study sought to characterize outcome differences between the two diagnoses.Methods
From 2004 to 2014, the NCDB identified 2,660 Ewing Sarcoma patients. Cox proportional hazards regression analysis was used to identify risk factors for overall survival (OS).Results
EES patients were older, more likely to be female, and have smaller tumors. Among patients with ES, 4.0% received no treatment, 2.5% received local therapy only (surgery and/or radiation), 16.8% received chemotherapy only, while 52.2% received combination therapy (local and chemotherapy), and 17.0% recieived triple therapy (surgery, radiation and chemotherapy). Among patients with EES, 4.3% recived no treatment, 5.6% received local therapy only, 15.6% received chemotherapy only, while 47.0% received combination therapy, and 21.6% received triple therapy. No difference in OS was observed between the two groups (P?=?0.816). Factors independently associated with OS for ES included age (HR?=?1.26, P?=?0.01), Charlson-Deyo Score (CDS) ≥2 (HR?=?3.66, P?<?0.001), combination therapy (HR?=?0.39, P?<?0.001) and triple therapy (HR?=?0.34, P?<?0.001). For EES, factors for OS were age (HR?=?1.52, P?<?0.001), CDS ≥2 (HR?=?1.90, P?=?0.02), combination therapy (HR?=?0.44, P?<?0.001), triple therapy (HR?=?0.34, P?<?0.001) and PNET histology (HR?=?1.33, P?=?0.02).Conclusions
Demographic, histological, and treatment characteristics differ between adult patients diagnosed with ES and ESS. However, survival and independent predictors of survival are consistent between the two diagnoses. 相似文献2.
Maria Novella Ringressi Luca Boni Giancarlo Freschi Stefano Scaringi Gianpiero Indennitate Ilenia Bartolini Paolo Bechi Antonio Taddei 《Surgical oncology》2018,27(2):115-122
Background
Although the short-term advantages of laparoscopy for colon cancer (CC) over open surgery have been clearly demonstrated, there is little evidence available concerning the long-term outcomes. This study aimed to compare the long-term results of laparoscopic surgery versus open surgery in a cohort of CC patients from a single center.Methods
A series of 443 patients consecutively operated on for stage I to III CC between January 2006 and December 2013 were followed up. Patients were divided into two groups according to the surgical technique and were compared for disease-free survival (DFS) and overall survival (OS) before and after 1:1 propensity score matching.Results
Due to exclusions and drop-outs, the statistical analysis of the study is based on 398 patients. Open surgery was performed in 133 patients, and laparoscopic surgery was performed in 265. After propensity score matching, two comparable groups of 89 patients each were obtained. The 5-year DFS was 64.3% and 78.2% for patients in the open and laparoscopic resection groups, respectively [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.33–1.19; P?=?0.148]. A 5-year OS of 72.1% and 86.8% was observed in the open and laparoscopic resection groups, respectively (HR 0.43, 95%CI 0.20–0.94; P?=?0.026). The multivariate survival analysis demonstrated better results of laparoscopy compared with open surgery for both DFS (HR 0.43, 95%CI 0.23–0.78; P?=?0.004) and OS (HR 0.28, 95%CI 0.14–0.59; P?<?0.001).Conclusions
Despite the limitations of a retrospective analysis, our study confirms better results for laparoscopic surgery in terms of DFS and OS compared with open surgery in CC treatment. 相似文献3.
Giammauro Berardi Marc De Man Stéphanie Laurent Peter Smeets Federico Tomassini Riccardo Ariotti Anne Hoorens Jo van Dorpe Oswald Varin Karen Geboes Roberto I. Troisi 《European journal of surgical oncology》2018,44(7):1069-1077
Purpose
To investigate the short- and long-term outcomes of liver first approach (LFA) in patients with synchronous colorectal liver metastases (CRLM), evaluating the predictive factors of survival.Methods
Sixty-two out of 301 patients presenting with synchronous CRLM underwent LFA between 2007 and 2016. All patients underwent neoadjuvant chemotherapy. After neoadjuvant treatment patients were re-evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST). Liver resection was scheduled after 4–6 weeks. Changes in non-tumoral parenchyma and the tumor response according to the Tumor Regression Grade score (TRG) were assessed on surgical specimens. Primary tumor resection was scheduled 4–8 weeks following hepatectomy.Results
Five patients out of 62 (8.1%) showed “Progressive Disease” at re-evaluation after neoadjuvant chemotherapy, 22 (35.5%) showed “Stable Disease” and 35 (56.5%) “Partial Response”; of these latter, 29 (82%) showed histopathologic downstaging. The 5-year survival (OS) rate was 55%, while the 5-year disease-free survival (DFS) rate was 16%. RECIST criteria, T-stage, N-stage and TRG were independently associated with OS. Bilobar presentation of disease, RECIST criteria, R1 margin and TRG were independently associated with DFS. Patients with response to neoadjuvant chemotherapy had better survival than those with stable or progressive disease (radiological response 5-y OS: 65% vs. 50%; 5-y DFS: 20% vs. 10%; pathological response 5-y OS: 75% vs. 56%; 5-y DFS: 45% vs. 11%).Conclusions
LFA is an oncologically safe strategy. Selection is a critical point, and the best results in terms of OS and DFS are observed in patients having radiological and pathological response to neoadjuvant chemotherapy. 相似文献4.
Zhaolun Cai Yuan Yin Chaoyong Shen Jian Wang Xiaonan Yin Zhixin Chen Ye Zhou Bo Zhang 《Surgical oncology》2018,27(3):563-574
Background
Different preoperative, postoperative or perioperative treatment strategies, including chemotherapy or chemoradiotherapy, are available for patients with gastric cancer, but conventional meta-analyses that assess two alternative treatments are unable to compare differences in overall survival. Thus, we performed a network meta-analysis to identify the best treatment strategy.Methods
We systematically searched and assessed studies for eligibility and extracted data. We then pooled the data and conducted a Bayesian network meta-analysis to combine direct comparisons with indirect evidence. The node-splitting method was used to assess the inconsistency. Rank probabilities were assessed by the probability of treatment rankings.Results
Thirty-three eligible randomized controlled trials were included in the network meta-analysis. Four treatments that had significantly improved prognoses when compared with surgery only were postoperative chemotherapy [HR?=?0.80 with 95% CrI: (0.73, 0.88)], postoperative chemoradiotherapy [HR?=?0.73 with 95% CrI: (0.61, 0.87)], preoperative chemoradiotherapy [HR?=?0.77 with 95% CrI: (0.62, 0.98)] and perioperative chemotherapy [HR?=?0.69 with 95% CrI: (0.55, 0.84)]. Preoperative chemotherapy, however, did not significantly improve survival when compared with surgery alone [HR?=?0.94 with 95% CrI: (0.71, 1.2)]. There was no statistically significant difference between postoperative chemotherapy, postoperative chemoradiotherapy, preoperative chemoradiotherapy and perioperative chemotherapy in terms of overall survival. Chemoradiotherapy after D2 lymphadenectomy did not significantly improve OS when compared with postoperative chemotherapy [HR?=?0.95 with 95% CrI: (0.73, 1.3)].Conclusion
Among patients with operable gastric cancer, perioperative chemotherapy had the highest probability of being the best treatment. Further clinical resources may be required to assess the efficacy and safety of perioperative chemotherapy for patients with gastric cancer. 相似文献5.
Judith Stift Alexandra Graf Christoph Schwarz Dietmar Tamandl Patrick Starlinger Merima Herac Andrea Beer Friedrich Wrba Martin Bodingbauer Klaus Kaczirek Stefan Stremitzer 《European journal of surgical oncology》2018,44(1):139-147
Background
The value of microscopic biliary and perineural invasion as prognostic biomarkers in patients with resectable colorectal liver metastases (CLM) who undergo neoadjuvant chemotherapy and liver resection is still unclear. This retrospective study was performed to elucidate this issue.Methods
Histologic slides of resected CLM of patients who underwent neoadjuvant bevacizumab-based chemotherapy and liver resection were investigated with respect to biliary and perineural invasion. Presence of invasion was correlated with radiologic and histologic response, recurrence-free survival (RFS) and overall survival (OS).Results
One hundred forty-one patients were enrolled. There was a significant association between biliary and perineural invasion, respectively (P = 0.001). Moreover, both biliary and perineural invasion were associated with bilobar metastatic spread and higher number of metastases, while perineural invasion was also associated with a higher Fong score. No significant association was found with response. In univariable analysis, biliary and perineural invasion were associated with shorter RFS (median 10.1 vs. 13.5 months, HR 2.09, P = 0.010 and 7.6 vs. 14.0, HR 2.23, P = 0.001, respectively). Biliary invasion was also associated with shorter OS (median 32.8 months vs. not reached, HR 2.78, P = 0.010), however these results did not remain significant in multivariable analysis.Conclusions
In patients with resectable colorectal liver metastases undergoing neoadjuvant bevacizumab-based chemotherapy and liver resection, biliary and perineural invasion are associated with higher tumor load but may not be prognostic biomarkers. 相似文献6.
A. Krishnamurthy J. Kankesan X. Wei S. Nanji J.J. Biagi C.M. Booth 《European journal of surgical oncology》2017,43(2):364-371
Background
International guidelines recommend peri-operative chemotherapy for patients with resectable colorectal cancer liver metastases (CRCLM). Chemotherapy delivery in routine practice is not well described.Methods
All cases of CRC who underwent resection of LM in 2002–2009 were identified using the population-based Ontario Cancer Registry. Electronic treatment records identified chemotherapy delivered within 16 weeks before or after hepatectomy. All pathology reports were reviewed to describe extent of LM. Modified Poisson regression was used to evaluate factors associated with chemotherapy delivery. Cox proportional hazards model and propensity score analysis were used to explore the association between post-operative chemotherapy and cancer-specific (CSS) and overall (OS) survival.Results
We identified 1310 patients. Sixty-two percent of cases (815/1310) received peri-operative chemotherapy; 25% (200/815) pre-operative, 45% (366/815) post-operative, and 31% (249/815) pre- and post-operative. Utilization of chemotherapy increased over time from 51% in 2002 (57/112) to 73% in 2009 (157/216, p < 0.001). Fifty-four percent of patients received FOLFOX, 41% FOLFIRI, and 10% 5-FU monotherapy. Factors that were independently associated with greater utilization of post-operative chemotherapy included younger age (p < 0.001), female sex (p = 0.050), shorter disease-free interval (p = 0.006), and no prior adjuvant chemotherapy (p < 0.001). Utilization of chemotherapy varied substantially across geographic regions (from 24% to 71%, p = 0.001). Post-operative chemotherapy was associated with improved CSS (HR 0.58, 95%CI 0.44–0.76) and OS (HR 0.49, 95%CI 0.38–0.61); results were consistent in propensity score analysis.Conclusion
Utilization of chemotherapy for resected CRCLM in routine practice has evolved with emerging evidence. Post-operative chemotherapy is associated with improved survival in the general population. 相似文献7.
Kiyohiko Omichi Takashi Mizuno Masayuki Okuno Ching-Wei D. Tzeng Claudius Conrad Yun Shin Chun Thomas A. Aloia Jean-Nicolas Vauthey 《European journal of surgical oncology》2017,43(11):2129-2134
Background
Squamous cell carcinoma (SCC) liver metastases still remains a difficult challenge and the effectiveness of resection for SCC liver metastases is unclear. The aim of this study was to analyze long-term outcomes of surgically treated patients with SCC liver metastases.Methods
The clinicopathological characteristics, overall survival (OS), and recurrence free survival (RFS) of all patients with SCC liver metastases resected between 1998 and 2015, were analyzed.Results
Among 28 patients who met inclusion criteria, there were 19 patients with anal cancer metastases (68%), 2 (7%) with cervix cancer metastases, 2 (7%) with tonsil cancer metastases, 2 (7%) with lung cancer metastases, 2 (7%) with primary unknown cancer metastases and 1 (4%) with vulvar cancer metastases. Four (14%) patients underwent major hepatectomy. There were no liver insufficiency cases or 90-day mortality. Cumulative 3- and 5-year OS rates were 52% and 47%. Cumulative 1- and 3-year RFS rates were 50% and 25%.Conclusions
Long-term outcomes after resection of SCC liver metastases compare favorably with those of colorectal or neuroendocrine liver metastases. Liver resection can be an effective treatment option for SCC liver metastases in appropriately selected patients after systemic therapy. 相似文献8.
P.B. Olthof J. Huiskens N.R. Schulte D.A. Wicherts M.G. Besselink O.R.C. Busch P.J. Tanis T.M. van Gulik 《European journal of surgical oncology》2017,43(1):100-106
Background
Hepatic vascular inflow occlusion (VIO) can be applied during resection of colorectal liver metastases (CRLM) to control intra-operative blood loss, but has been linked to accelerated growth of micrometastases in experimental models. This study aimed to investigate the effects of hepatic VIO on disease-free and overall survival (DFS and OS) in patients following resection for CRLM.Methods
All patients who underwent liver resection for CRLM between January 2006 and September 2015 at our center were analyzed. Hepatic VIO was performed if deemed indicated by the operating surgeon and severe ischemia was defined as ≥20 min continuous or ≥45 min cumulative intermittent VIO. Cox regression analysis was performed to identify predictive factors for DFS and OS.Results
A total of 208 patients underwent liver resection for CRLM. VIO was performed in 64 procedures (31%), and fulfilled the definition of severe ischemia in 40 patients. Patients with severe ischemia had inferior DFS (5-year DFS 32% vs. 11%, P < 0.01), and inferior OS (5-year OS 37% vs. 64%, P < 0.01). At multivariate analysis, a high clinical risk score (Hazard ratio (HR) 1.60 (1.08–2.36)) and severe ischemia (HR 1.89 (1.21–2.97)) were independent predictors of worse DFS. Severe ischemia was not an independent predictor of OS.Conclusion
The present cohort study suggests that prolonged hepatic VIO during liver resection for CRLM was associated with reduced DFS. A patient-tailored approach seems advisable although larger studies should confirm these findings. 相似文献9.
Background
While the indications for surgery among patients with colorectal cancer liver metastases (CRCLM) are expanding, the role of surgery in patients with hepatic lymph node involvement remains controversial. We report management and outcomes in a population-based cohort of patients undergoing hepatectomy with concomitant hepatic lymphadenectomy for CRCLM.Methods
All cases of hepatectomy for CRCLM in the Canadian Province of Ontario from 2002 to 2009 were identified using the population-based Ontario Cancer Registry and linked electronic records of treatment. Pathology reports were used to identify concomitant lymphadenectomy with liver resection as well as extent of disease and surgical procedure.Results
Among 1310 patients who underwent resection for CRCLM, 103 (8%) underwent simultaneous regional lymphadenectomy. Seventy-one percent of cases with lymphadenectomy (70/103) had a major liver resection (≥3 segments). Of the 103 lymphadenectomy cases, 80 (78%) were hepatic pedicle, 16 (16%) were celiac and 7 (7%) were para-aortic. The mean number of nodes removed was 2.2 (range 1–15). Ninety-day mortality was 6%. Twenty-nine percent (30/103) of cases had positive nodes. Unadjusted overall survival at 5 years for positive vs negative nodes was 21% vs 42% (p = 0.003); cancer-specific survival was 10% vs 43% (p < 0.001). In adjusted analyses, hepatic node involvement was associated with inferior OS (HR 2.19, p = 0.010) and CSS (HR 3.07, p = 0.002).Conclusions
Patients with resected CRC liver metastases with regional lymph node involvement have inferior survival compared to patients with negative nodes. Despite this poor prognostic factor, a small proportion of cases with involved nodes will achieve long-term survival. 相似文献10.
Diamantis I. Tsilimigras Ioannis Ntanasis-Stathopoulos Fabio Bagante Demetrios Moris Jordan Cloyd Eleftherios Spartalis Timothy M. Pawlik 《Surgical oncology》2018,27(2):280-288
Background
Hepatic resection is considered the optimal potentially curative treatment for colorectal liver metastases (CRLM). Following resection, up to two-thirds of patients will develop recurrence within 5-years. Genetic mutation analysis of CRLM, especially KRAS status, has been proposed as a means to guide treatment, as well as identifying patients who can derive the most survival benefit from hepatic resection.Methods
A systematic review of the literature was conducted the PubMed, Embase and Cochrane library through February 8th, 2018. The following algorithm was applied: “(colorectal OR rectal OR colon OR colonic) AND (liver OR hepatic) AND (metastasis OR metastases) AND (gene OR mutation OR KRAS OR BRAF OR SMAD4 OR RAS OR TP53 OR P53 OR APC OR PI3K OR MSI OR EGFR OR MACC1 OR microsatellite).”Results
From the 2404 records retrieved, 78 studies were finally deemed eligible; 47 studies reported mutational data on patients with resectable CRLM, whereas 31 studies reported on patients with unresectable CRLM. Mutational analyses were mostly performed on the CRLM specimen rather than the primary CRC. The vast majority of studies reported on the KRAS mutational status (88.5%, n?=?69/78). Prevalence of KRAS mutations ranged from 25% to 52%. Most studies reported that RAS mutation was a negative prognostic factor for overall (OS) (n?=?24) and recurrence-free (RFS) (n?=?9) survival; a few reports noted no effect of RAS mutational status on OS (n?=?4) or RFS (n?=?6). Twelve studies reported on BRAF mutations with a prevalence of BRAF mutation ranging from 0 to 9.1% in resected CRLM specimens. BRAF mutation was strongly associated with a worse prognosis. TP53 and PIK3CA gene mutations did not affect long-term outcomes.Conclusions
The biological status of each tumor provides the basis for individualized cancer therapeutics. Data on the mutational status on CRLM should be a part of multidisciplinary discussions to help inform the therapeutic approach, type of chemotherapy, as well as timing and approach of surgical resection. 相似文献11.
C. Lim A. Doussot M. Osseis F. Esposito C. Salloum J. Calderaro C. Tournigand D. Azoulay 《Clinical & translational oncology》2018,20(10):1274-1279
Background
Multimodal strategy including chemotherapy and hepatectomy is advocated for the management of colorectal liver metastases (CRLM). The aim of this study was to evaluate the impact of neoadjuvant Bevacizumab-based chemotherapy on survival in patients with resected stage IVA colorectal cancer and liver metastases.Methods
Data from 120 consecutive patients who received neoadjuvant chemotherapy and underwent curative-intent hepatectomy for synchronous CRLM were retrospectively reviewed. Overall survival (OS) was stratified according to administration of Bevacizumab before liver resection and surgical strategy, i.e., classical strategy (primary tumor resection first) versus reverse strategy (liver metastases resection first).Results
Patients who received Bevacizumab (n?=?37; 30%) had a higher number of CRLM (p?=?0.003) and underwent more often reverse strategy (p?=?0.005), as compared to those who did not (n?=?83; 70%). Bevacizumab was associated with an improved OS compared with conventional chemotherapy (p?=?0.04). After stratifying by the surgical strategy, Bevacizumab was associated with improved OS in patients who had classical strategy (p?=?0.03). In contrast, Bevacizumab had no impact on OS among patients who had liver metastases resection first (p?=?0.89).Conclusions
Neoadjuvant Bevacizumab-based chemotherapy was associated with improved OS in patients who underwent liver resection of synchronous CRLM, especially in those who underwent primary tumor resection first.12.
Jashodeep Datta Brett L. Ecker Madalyn G. Neuwirth Rula C. Geha Douglas L. Fraker Robert E. Roses Giorgos C. Karakousis 《Surgical oncology》2017,26(2):117-124
Background
While margin-negative resection remains the cornerstone of therapy for retroperitoneal sarcoma (RPS), the impact of adjuvant chemotherapy (AC) on overall survival (OS) remains poorly understood.Methods
The National Cancer Data Base was queried for patients undergoing curative-intent resection of primary non-metastatic RPS (2004–2013). Multivariable modeling identified factors associated with AC receipt. Cox regression identified covariates associated with OS, and AC and surgery alone (SA) cohorts were matched 1:1 by propensity scores based on these covariates. In the propensity-score matched cohort, OS was compared by Kaplan-Meier estimates. Results from this analysis were presented in the context of a review of the existing literature on the impact of AC in resected RPS.Results
Of 3892 resected RPS patients, 90.0% and 10.0% received SA and AC, respectively. Predictors of AC receipt included younger age, non-Caucasian race, hospital location, histologic grade, adjacent organ invasion, and histologic subtype. The propensity score-matched cohort comprised 767 patients (SA n = 377; AC n = 390); at a median follow-up of 59.2 (IQR 35.0–85.3) months, median OS of the propensity-matched cohort was 53.6 (IQR 22.4–119.5) months. Utilization of AC was associated with significantly worse long-term survival (median OS: 47.8 vs. 68.9 months, p = 0.017; HR 1.30, 95% CI 1.05–1.61). AC was not associated with improved OS in margin-positive (R1/R2) resection, high-grade (G2/G3) and larger (>10 cm) tumors, or in any histologic subtype. Albeit not statistically significant, there was a trend toward improved OS with AC in spindle cell (HR 0.37, 95% CI 0.10–1.38), giant cell (HR 0.82, 95% CI 0.32–2.13), and synovial (HR 0.26, 95% CI 0.05–1.33) sarcoma.Conclusions
Data from a large nationwide oncology database and review of the existing literature do not support adjuvant chemotherapy regimens following curative-intent resection of RPS, even in subgroups at high risk of failure (e.g., R1/R2 resection, high-grade or large tumors). The possible benefit of conventional adjuvant regimens in spindle cell, giant cell, and synovial sarcoma should be explored in prospective studies. 相似文献13.
Objective
To determine the efficacy of first-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in molecularly selected patients with advanced non-small cell lung cancer (NSCLC), we performed this pooled analysis.Method
Randomized trials of EGFR-TKIs as treatment for advanced NSCLC were included for this meta-analysis. We used published hazard ratios (HRs), if available, or derived treatment estimates from other survival data. Pooled estimates of treatment efficacy of EGFR-TKIs in the selected patients by EGFR-mutation status were calculated.Results
Out of 2134 retrieved articles, 30 randomized controlled trials (RCTs) enrolling more than 4053 patients with wild-type EGFR tumors and 1592 patients with mutant EGFR tumors were identified. For EGFR mutant patients, EGFR-TKIs treatment improved progression-free survival (PFS) compared with chemotherapy: the summary HRs were 0.41 (p?<?0.00001) for the first-line setting and 0.46 (p?=?0.02) for second/third-line setting, respectively. Also, the same superior trend was found with TKIs maintenance over placebo (HR?=?0.14, p?<?0.00001) and with TKIs combined with chemotherapy over chemotherapy (HR?=?0.49, p?=?.002) in both the first-line and maintenance therapy settings. For EGFR wild-type patients, EGFR-TKIs have fared worse than chemotherapy in the first-line setting (HR?=?1.65, p?=?.03) and in the second/third-line setting (HR?=?1.27, p?=?.005). However, EGFR-TKIs maintenance still produced a reduction of 19 % in the risk of progression over placebo (HR?=?0.81, p?=?.02). Furthermore, EGFR-TKIs added to chemotherapy as first-line treatment resulted in an improvement of PFS over chemotherapy alone in such wild-type EGFR patients (HR?=?0.82, p?=?.03). In overall survival (OS) analysis, only EGFR-TKIs single agent was inferior to chemotherapy in EGFR wild-type patients (HR?=?1.13, p?=?.02). No statistically significant difference in terms of OS was observed in any other subgroup analysis.Conclusions
For EGFR mutant patients, EGFR-TKIs therapy produced a prominent PFS benefit in all settings. Among EGFR wild-type patients, EGFR-TKIs were inferior to chemotherapy both for first-line treatment and for second/third-line treatment. However, EGFR-TKIs maintenance and addition of EGFR-TKIs to chemotherapy could provide additive benefit over chemotherapy alone in such EGFR wild-type patients.14.
Simone Famularo Stefano Di Sandro Alessandro Giani Andrea Lauterio Marta Sandini Riccardo De Carlis Vincenzo Buscemi Fabrizio Romano Luca Gianotti Luciano De Carlis 《European journal of surgical oncology》2018,44(10):1580-1587
Purpose
The extent of liver resection for the optimal treatment of hepatocellular carcinoma (HCC) is debated. The purpose of this study was to compare the impact of anatomic resection (AR) vs. parenchyma-sparing resection (PSR) on disease recurrence and patient survival.Methods
We retrospectively analyzed patients with HCC who underwent liver resection from January 2001 to August 2015. Patients receiving AR or PSR were compared by a propensity score analysis (PSA) (caliper = 0.1). The primary outcomes were disease-free survival (DFS) and overall survival (OS) rates, and assessed by the Kaplan-Meier method.Results
455 consecutive patients were evaluated. After PSA 354 patient were studied (177 pairs for each group). The median follow-up time was 28.2 months. The median OS was 47.5 months (95% CI: 30.0–65.9) for AR and 56.5 months (95% CI 33.2–79.6) for PSR (p = 0.169). The median DFS was 29.2 months (95% CI 17.6–40.8) for AR and 24.8 months (95% CI: 15.2–34.2) for PSR (p = 0.337). The multivariate regression model showed that cirrhosis (HR 2.85, 95% CI: 1.53–5.32; p = 0.001), BCLC grade B (HR 4.15, 95% CI: 1.33–12.95; p = 0.014), microvascular invasion (HR 1.55, 95% CI: 1.03–2.31; p = 0.033), presence of satellitosis (HR 1.94, 95% CI: 1.25–3.01; p = 0.003), severe complications (HR 6.09, 95% CI: 2.26–16.40; p > 0.001) were independently associated with poor long-term oncologic outcomes.Conclusions
The extent of resection did not significantly affect overall and disease-free survival while tumor characteristics and underlying liver function appeared significant determinants. 相似文献15.
Andreas Andreou Benjamin Struecker Nathanael Raschzok Felix Krenzien Philipp Haber Simon Wabitsch Christoph Waldbaur Eva-Maria Touet Anne-Christine Eichelberg Georgi Atanasov Matthias Biebl Marcus Bahra Robert Öllinger Moritz Schmelzle Johann Pratschke 《Surgical oncology》2018,27(4):751-758
Background
Minimal-invasive hepatectomy (MIH) has been increasingly performed for benign and malignant liver lesions with most promising results. However, the role of MIH for the treatment of patients with hepatocellular carcinoma (HCC) needs further investigation.Methods
Clinicopathological data of patients who underwent liver resection for HCC between 2005 and 2016 were assessed. Postoperative outcomes und long-term survivals of patients following MIH were compared with those of patients undergoing conventional open hepatectomy (OH) after 1:1 propensity score matching.Results
During the study period, 407 patients underwent liver resection for HCC with curative intent. Fifty-six patients underwent MIH and were compared with a matched cohort of 56 patients who underwent OH. The rate of patients with fibrosis/cirrhosis (82% vs. 86%, p?=?0.959), multiple lesions (32% vs. 32%, p?=?1.00), tumor size >30?mm (61% vs. 55%, p?=?0.566), and major resection (16% vs. 16%, p?=?1.00) was comparable between the two groups (MIH vs. OH). MIH was associated with lower 90-day complication rate (32% vs. 54%, p?=?0.022), lower postoperative major complication rate (14% vs. 30%, p?=?0.041), lower liver failure rate (0% vs. 7%, p?=?0.042), lower 90-day mortality rate (0 vs. 7%, p?=?0.042), and shorter length of hospital stay (9 vs. 12 days, p?=?0.009) compared to OH. After a median follow-up time of 51 months, MIH and OH showed comparable 5-year overall survival (54% vs. 41%, p?=?0.151), and 5-year disease-free survival rates (50% vs. 38%, p?=?0.956).Conclusions
MIH for HCC is associated with lower postoperative morbidity and mortality and shorter length of hospital stay, resulting in oncologic outcomes similar to those achieved with the established OH. Our findings suggest that MIH should be considered as the preferred method for the treatment of curatively resectable HCC. 相似文献16.
Charlotte E.L. Klaver Karin A.T.G.M. Wasmann Marlies Verstegen Jarmila D.W. van der Bilt Iris D. Nagtegaal Bert van Ramshorst Pieter J. Tanis Albert M. Wolthuis Hjalmar C. van Santvoort Johannes H.W. de Wilt André D&#x;Hoore 《European journal of surgical oncology》2018,44(12)
Introduction
Patients with pT4 colon cancer are at risk of developing intra-abdominal recurrence. Infectious complications have shown to negatively influence disease free survival (DFS) and overall survival (OS) in stage I-III colon cancer. The aim of this study was to determine whether surgical site infections (SSIs) also increase the risk of intra-abdominal recurrence in pT4 colon cancer patients.Methods
All consecutive patients with pT4N0-2M0 colon cancer from four centres between January 2000 and December 2014 were included. Patients were categorized into 2 groups; with and without a postoperative (<30 days) SSIs. SSIs included both deep incisional as well as organ/space SSIs. The primary outcome was intra-abdominal recurrence (including local/incisional recurrence, peritoneal metastases) and was assessed using Kaplan-Meier and Cox regression analyses. Secondary outcome measures were DFS and OS.Results
Out of 420 patients, 62 (15%) developed a SSI. The 5-year intra-abdominal recurrence rates were 44% and 27% for patients with and without a SSI, respectively (p?=?0.011). After multivariate analysis, SSI was independently associated with intra-abdominal recurrence (HR 1.807 (1.091–2.992)), worse DFS (HR 1.788 (1.226–2.607)), and worse OS (HR 1.837 (1.135–2.973)). Other independent risk factors for intra-abdominal recurrence were a R1 resection (HR 2.616 (1.264–5.415)) and N2-stage (HR 2.096 (1.318–3.332)).Conclusion
SSIs after resection of a pT4N0-2M0 colon cancer are associated with an increased risk of intra-abdominal recurrence and worse survival. This finding supports the hypothesis that infection-based immunologic pathways play a role in colon cancer cell dissemination and outgrowth. 相似文献17.
Kun Wang Da Xu Xiao-Luan Yan Graeme Poston Bao-Cai Xing 《European journal of surgical oncology》2018,44(6):771-777
Background
Primary tumour location has long been debated as a prognostic factor in colorectal cancer patients with liver metastases (CRLM) undergoing liver resection. This retrospective study was conducted to clarify the prognostic value of tumour location after radical hepatectomy for CRLM and its underlying causes.Methods
We retrospectively analysed clinical data from 420 patients with CRLM whom underwent liver resection between January 2002 and December 2015. Right-sided (RS) tumours include tumours located in the cecum, ascending colon, and transverse colon, and left-sided (LS) tumours include those located in the splenic flexure, descending colon, sigmoid colon, and rectum.Results
Both overall survival (OS) and disease-free survival (DFS) were similar between patients with RS and LS primary tumours (5-year OS: 46.5% vs 38.3%, P = 0.699; 5-year DFS: 29.1% vs 22.4%, P = 0.536). Specifically, RAS mutation rate was significantly higher in patients with RS tumours (P = 0.007). Subgroup analysis showed that the RAS mutation on the LS and RS tumours have different prognostic impact for CRLM patients on long-term survival after hepatic resection (RS, OS: P = 0.437, DFS: P = 0.471; LS, OS: P < 0.001, DFS: P = 0.002). The multivariable analysis showed that RAS mutant is an independent factor influencing OS in patients with LS primary tumour only.Conclusions
The site of the primary tumour has no significant impact on the long-term survival in patients with CRLM undergoing radical surgery. However, prognostic value of RAS status differs depending on the site of the primary tumour. 相似文献18.
Joost Huiskens Pim B. Olthof Eric P. van der Stok Thomas Bais Krijn P. van Lienden Adriaan Moelker Jan Krumeich Rudi M. Roumen Dirk J. Grünhagen Cornelis J.A. Punt Martin van Amerongen Johannes H.W. de Wilt Cornelis Verhoef Thomas M. Van Gulik 《European journal of surgical oncology》2018,44(1):108-114
Introduction
There is an ongoing controversy surrounding portal vein embolization (PVE) regarding the short-term safety of PVE and long-term oncological benefit. This study aims to compare survival outcomes of patients subjected to major liver resection for colorectal liver metastases (CRLM) with or without PVE.Methods
All consecutive patients who underwent major liver resection for CRLM in four high volume liver centres between January 2000 and December 2015 were included. Major liver resection was defined as resection of at least three Couinaud liver segments. To reduce selection bias, propensity score matching was performed for PVE and non-PVE patients with overall and disease-free survival as primary endpoints. For matching, all patients who underwent PVE followed by a major liver resection were selected. Patients were matched to patients who had undergone major liver resection without PVE.Results
Of 745 patients undergoing major liver resection for CRLM, 53 patients (7%) underwent PVE before liver resection. In the overall cohorts, PVE patients had inferior DFS and a trend towards inferior OS. A total of 46 PVE patients were matched to 46 non-PVE patients to create comparable cohorts and between these two matched cohorts no differences in DFS (3-year DFS 16% vs 9%, p = 0.776) or OS (5-year OS 14% vs 14%, p = 0.866) were found.Conclusions
This retrospective, matched analysis does not suggest a negative impact of PVE on long-term outcomes after liver resection in patients with CRLM. 相似文献19.
Daniela Falcão Henrique Alexandrino Rui Caetano Oliveira João Martins Luís Ferreira Ricardo Martins Marco Serôdio Mónica Martins José Guilherme Tralhão Maria Augusta Cipriano Francisco Castro e Sousa 《European journal of surgical oncology》2018,44(8):1212-1219
Introduction
Liver resection combined with neoadjuvant chemotherapy (NAC) has reported notable results in patients with colorectal liver metastases (CRLM). Tumoral response to NAC is associated with specific histopathologic patterns with prognostic implications. The main objective of this study was to evaluate the influence of pathological findings on overall survival (OS), disease-free survival (DFS) and liver recurrence-free survival (LRFS).Patients and methods
Analysis of clinical and outcome data from 110 patients who underwent first CRLM resection between January 2010 and July 2013. Blinded pathological review of histological material of several parameters: resection margin, tumor regression grade (TRG), tumor thickness at the tumor-normal interface (TTNI) and the growth pattern (GP).Results
The median survival following hepatic resection was 52 months and 3- and 5- year Kaplan-Meier estimates were 69 and 48%, respectively. Seventy-four patients developed recurrent disease. Oxaliplatin-based chemotherapy was significantly associated with a pushing GP. A positive resection margin was an independent predictor of decreased DFS (p = 0.018) but not of decreased OS. LRFS was strongly reduced by the absence of histologic tumor response (p = 0.018). The pushing pattern had an adverse impact on both OS (p = 0.007) and DFS (p = 0.004) on multivariate analysis.Conclusion
The prognostic value of histopathological features in patients who underwent CRLM's resection is undeniable. The pushing GP was related with worse prognosis. Further studies are required to clarify the biological mechanisms underlying these findings in order to enhance a more personalized and efficient treatment of these patients. 相似文献20.
Andrew J. Benjamin Mary M. Buschmann Shuang Qin Zhang Kristen Wroblewski Hedy L. Kindler Kevin K. Roggin William Dale 《Journal of Geriatric Oncology》2018,9(4):367-372