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1.
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2.
In-Seob Lee Hyo Jeong Kang Young-Soo Park Min-Hee Ryu Jeong-Hwan Yook Yoon-Koo Kang Byung-Sik Kim 《Surgical oncology》2018,27(2):299-305
Background
In addition to the TNM stage, an additional prognostic factor is needed to assess the prognosis of gastric cancer. Moreover, there is no consensus on high-risk group of recurrence and adjuvant strategy in stage 1B gastric cancers. We aimed to investigate the prognostic significance of extranodal extension (ENE) in stage 1B gastric carcinomas and assess whether ENE can indicate the need for adjuvant treatment.Methods
The clinicopathological characteristics of 1588 patients who underwent curative gastrectomy with more than D1 plus lymphadenectomy for stage 1B gastric cancer from 2003 to 2010 were reviewed. A propensity score matching analysis was performed.Results
Age over 65 years and the presence of ENE were found to be poor prognostic factors for both overall survival (OS) and disease-free survival (DFS). Adjuvant chemotherapy was related to an increased overall survival. The 5 year OS and DFS rates were 88.7% and 86.2%, respectively. When divided into 3 groups (early gastric cancer with ENE [T1N1 ENE(+)], early cancer without ENE [T1N1 ENE(?)], and advanced tumor without nodal metastasis [T2N0]), the OS and DFS rates of the T1N1 ENE(+) group were significantly worse than those of the other groups (5 year OS rate of 72.7% vs. 88.4% vs. 91.9%, respectively, P?<?0.001 and 5 year DFS rate of 67.2% vs. 85.2% vs. 91.5%, respectively, P?<?0.001).Conclusion
ENE is an independent prognostic factor that predicted poor outcomes for stage 1B gastric cancers and it could be an indicator of the need for adjuvant treatment. 相似文献3.
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4.
Vivek Verma Christopher A. Ahern Christopher G. Berlind William D. Lindsay Jacob Shabason Sonam Sharma Melissa J. Culligan Surbhi Grover Joseph S. Friedberg Charles B. Simone 《Clinical lung cancer》2018,19(6):e901-e912
Introduction
For the 3 histologic subtypes of malignant pleural mesothelioma (MPM)—epithelioid, sarcomatoid, and biphasic—the magnitude of benefit with surgical management remains underdefined.Materials and Methods
The National Cancer Data Base was queried for newly diagnosed nonmetastatic MPM with known histology. Patients in each histologic group were dichotomized into those receiving gross macroscopic resection versus lack thereof/no surgery. Kaplan-Meier analysis evaluated overall survival (OS) between cohorts; multivariable Cox proportional hazards modeling assessed factors associated with OS. After propensity matching, survival was evaluated for each histologic subtype with and without surgery.Results
Overall, 4207 patients (68% epithelioid, 18% sarcomatoid, 13% biphasic) met the study criteria. Before propensity matching, patients with epithelioid disease experienced the highest median OS (14.4 months), followed by biphasic (9.5 months) and sarcomatoid (5.3 months) disease; this also persisted after propensity matching (P < .001). After propensity matching, surgery was associated with significantly improved OS for epithelioid (20.9 vs. 14.7 months, P < .001) and biphasic (14.5 vs. 8.8 months, P = .013) but not sarcomatoid (11.2 vs. 6.5 months, P = .140) disease. On multivariable analysis, factors predictive of poorer OS included advanced age, male gender, uninsured status, urban residence, treatment at community centers, and T4/N2 disease (all P < .05). Chemotherapy and surgery were independently associated with improved OS, as was histology (all P < .001).Conclusion
This large investigation evaluated surgical practice patterns and survival by histology for MPM and found that histology independently affects survival. Gross macroscopic resection is associated with significantly increased survival in epithelioid and biphasic, but not sarcomatoid, disease. However, the decision to perform surgery should continue to be individualized in light of available randomized data. 相似文献5.
Gérard Lorimier Valérie Seegers Marie Coudert Denis Dupoiron Emilie Thibaudeau Luc Pouplin Nathalie Lebrec Pierre Yves Dubois Frédéric Dumont Véronique Guérin-Meyer Olivier Capitain Mario Campone Romuald Wernert 《European journal of surgical oncology》2018,44(11):1824-1831
Objective
To assess the effectiveness of prolonged perioperative thoracic epidural analgesia (PEA) on long term survival of patients who underwent a complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM).Background
Grade III-IV morbidity affects long term outcomes after CRS and HIPEC. As compared with opioid administered via patient-controlled analgesia (PCA), PEA reduces morbidity.Method
From 2005 to 2016, 150 patients underwent CRS plus HIPEC with or without prolonged PEA. Clinical data and outcomes collected from prospective database were analyzed. Survival was assessed in terms of analgesic method using Kaplan-Meier plots and a propensity score.Results
Patients ‘characteristics of 59 patients in PCA group were comparable to those of 91 patients in PEA group, except for age, ASA score and fluid requirements, significantly more important in PEA group. Grade III-IV morbidity was 62.7% in PCA group compared with 36.3% in PEA group (p = 0.0015). Median overall survival (OS) of PEA group was 54.7 months compared to 39.5 months in PCA group (p = 0.0078). When adjusted on the covariates, using the propensity score, the PEA significantly improves OS [HR 0.40 (95% CI: 0.28–0.56)] (p < 0.0001) and disease free survival (DFS) [HR 0.61 (95% CI: 0.45–0.81] (p < 0.0007)Conclusions
In this retrospective study of patients who underwent a complete CRS and HIPEC for colorectal peritoneal metastases, the perioperative thoracic epidural analgesia prolonged for over 72 h reduced significantly the grade III-IV morbidity and may improve OS and DFS. 相似文献6.
M.J. Wilson J.W.T. Dekker S. Buettner J.J. Harlaar J. Jeekel M. Schipperus J.J. Zwaginga 《Surgical oncology》2018,27(2):192-199
Introduction
Intravenous iron therapy has been shown to be advantageous in treating anaemia and reducing the need for blood transfusions. Iron treatment, however, may also be hazardous by supporting cancer growth. Present clinical study explores, for the first time, the effect of preoperative intravenous iron therapy on tumour prognosis in anaemic colorectal cancer patients.Methods
A retrospective cohort study was performed on consecutive patients who underwent surgery for colorectal cancer between 2010 and 2016 in a single teaching hospital. The primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Survival estimates were calculated using the Kaplan-Meier method and patients were matched based on propensity score.Results
320 (41.0%) of all eligible patients were anaemic, of whom 102 patients received preoperative intravenous iron treatment (31.9%). After propensity score matching 83 patients were included in both intravenous and non-intravenous iron group. The estimated 1-, 3-, and 5-year OS (91.6%, 73.1%, 64.3%, respectively) and DFS (94.5%, 86.7%, 83.4%, respectively) in the intravenous iron group were comparable with the non-intravenous iron group (p?=?0.456 and p?=?0.240, respectively). In comparing patients with an event (death or recurrence) and no event in the intravenous iron group, a distinct trend was found for decreased transferrin in the event group (median 2.53??g/L vs 2.83??g/L, p?=?0.052).Conclusion
The present study illustrates that a dose of 1000–2000?mg preoperative intravenous iron therapy does not have a profound effect on long-term overall and disease-free survival in anaemic colorectal cancer patients. Future randomised trials with sufficient power are required to draw definite conclusions on the safety of intravenous iron therapy. 相似文献7.
Waqar Haque Vivek Verma E.Brian Butler Bin S. Teh 《Clinical genitourinary cancer》2018,16(4):e935-e943
Background
Because renal cell carcinoma (RCC) has been traditionally considered a “radioresistant” histology, it may be advantageous to treat brain metastases (BMs) with ablative dosing by means of stereotactic radiosurgery (SRS). This is the first known analysis evaluating utilization of SRS for RCC BMs in the United States.Methods
The National Cancer Data Base was queried (2005-2014) for metastatic RCC and delivery of intracranial radiotherapy. Patients were stratified into groups receiving either SRS or non-SRS treatment. Multivariable logistic regression ascertained factors associated with SRS administration. Secondary exploratory Kaplan-Meier overall survival (OS) analysis without and with propensity matching, along with Cox proportional hazards modeling evaluated predictors of OS.Results
Of 2312 patients, 813 (35%) received SRS, whereas 1499 (65%) received non-SRS radiotherapy. Use of SRS increased from 27% in 2005 to 44% in 2014. Patients receiving SRS tended to reside farther from the treating facility, received therapy at academic centers, and underwent chemotherapy and/or nephrectomy (P < .05). SRS was less often given to persons with lower income and who were uninsured/had Medicaid (P < .05). Higher OS was observed in the SRS cohort both before and following propensity matching; on subset analysis, differences persisted when stratifying for nephrectomy and lack thereof (P < .001 for all). Treatment at an academic center independently predicted for higher OS.Conclusions
SRS for RCC BMs is rising; this is driven by multiple socioeconomic disparities, which needs to be better addressed to ensure high-quality care for all patients. Treatment with SRS was associated with higher survival; further prospective studies are warranted to confirm these findings. 相似文献8.
G. Lorimier B. Linot N. Paillocher D. Dupoiron V. Verrièle R. Wernert A. Hamy O. Capitain 《European journal of surgical oncology》2017,43(1):150-158
Objectives
This study describes the outcomes of patients with colorectal peritoneal carcinomatosis (PC) with or without liver metastases (LMs) after curative surgery combined with hyperthermic intraperitoneal chemotherapy, in order to assess prognostic factors.Background
Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) increases overall survival (OS) in patients with PC. The optimal treatment both for PC and for LMs within one surgical operation remains controversial.Methods
Patients with PC who underwent CRS followed by HIPEC were evaluated from a prospective database. Overall survival and disease free survival (DFS) rates in patients with PC and with or without LMs were compared. Univariate and multivariate analyses were performed to evaluate predictive variables for survival.Results
From 1999 to 2011, 22 patients with PC and synchronous LMs (PCLM group), were compared to 36 patients with PC alone (PC group). No significant difference was found between the two groups. The median OS were 36 months [range, 20–113] for the PCLM group and 25 months [14–82] for the PC group (p > 0.05) with 5-year OS rates of 38% and 40% respectively (p > 0.05). The median DFS were 9 months [9–20] and 11.8 months [6.5–23] respectively (p = 0.04). The grade III–IV morbidity and cytoreduction score (CCS) >0 (p < 0.05) were identified as independent factors for poor OS. Resections of LMs and CCS >0 impair significantly DFS.Conclusions
Synchronous complete CRS of PC and LMs from a colorectal origin plus HIPEC is a feasible therapeutic option. The improvement in OS is similar to that provided for patients with PC alone. 相似文献9.
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10.
Chang Il Choi Minyong Kang Hyun Hwan Sung Hwang Gyun Jeon Byong Chang Jeong Seong Soo Jeon Hyun Moo Lee Seong I.L. Seo 《Clinical genitourinary cancer》2018,16(6):e1189-e1199
Purpose
To evaluate the prognostic role of cytoreductive nephrectomy (CN) in patients with synchronous metastatic renal-cell carcinoma (mRCC).Patients and Methods
We analyzed the electronic medical records of 294 patients with synchronous mRCC treated at Samsung Medical Center from January 2005 to December 2015. Primary and secondary end points were overall survival (OS) and cancer-specific survival (CSS), respectively. OS and CSS were estimated by the Kaplan-Meier method and compared between patients with and without CN, particularly by performing 1:1 propensity score matching. Multivariate Cox regression analysis was used to identify independent predictors of survival outcomes.Results
Among the overall population of synchronous mRCC patients, 189 patients (64.3%) underwent CN. Compared to mRCC patients without CN, those who underwent CN have a higher proportion of single metastasis (63.0% vs. 32.4%) and clear-cell histology (87.8% vs. 72.4%). In the matched cohort, the patients who underwent CN had better OS and CSS outcomes compared to those who did not undergo CN (median OS, 23.0 months vs. 11.0 months; P < .001; median CSS, 34.0 months vs. 14.0 months; P < .001). On multivariable analysis, undergoing CN, body mass index, and Heng risk score were found as significant predictive factors of both OS and CSS. In subgroup analyses stratified by Heng risk criteria, the patients who received CN had better OS and CSS in all risk groups.Conclusion
CN significantly improved survival outcomes in synchronous mRCC patients treated with targeted therapies and independently associated with prolonged survival, regardless of Heng risk criteria. 相似文献11.
Chung Ryul Oh Jeong Eun Kim Jihoon Kang Sun Young Kim Kyu-pyo Kim Yong Sang Hong Seok-Byung Lim Chang Sik Yu Jin Cheon Kim Jihun Kim Se Jin Jang Tae Won Kim 《Clinical colorectal cancer》2018,17(4):e679-e685
Background
We investigated whether the microsatellite instability (MSI) status affects the survival outcomes in patients with stage II/III rectal cancer who have undergone an upfront curative resection.Patients and Methods
A total of 1103 patients with curatively resected stage II/III rectal cancer who had available polymerase chain reaction-based MSI results were included in the final analysis.Results
Twenty-four (2.2%) patients in the total cohort were found to be MSI-high (MSI-H). In univariate analysis, neither disease-free survival (DFS) nor overall survival (OS) demonstrated significant differences between patients with MSI-H tumors and those with MSI-low (MSI-L) or microsatellite stable (MSS) tumors. The 5-year DFS rate was 78.0% in MSI-H patients and 69.9% in MSI-L/MSS patients (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.35-2.02; P = .689). The 5-year OS rates for MSI-H and MSI-L/MSS patients were 84.0% and 83.1%, respectively (HR, 0.86; 95% CI, 0.27-2.69; P = .790). By multivariate analysis, the MSI status did not affect either the DFS (HR, 1.00; 95% CI, 0.40-2.47; P = .994) or OS (HR, 0.85; 95% CI, 0.26-2.73; P = .778).Conclusions
MSI-H tumors are rarely observed in rectal adenocarcinoma, and the MSI status may not affect the survival outcome in patients with a resected rectal cancer. 相似文献12.
Peter R. Bucciarelli Kay See Tan Neel P. Chudgar Whitney Brandt Joseph Montecalvo Takashi Eguchi Yuan Liu Rania Aly William D. Travis Prasad S. Adusumilli David R. Jones 《Journal of thoracic oncology》2018,13(1):73-84
Introduction
Expression of breast cancer metastasis suppressor 1 gene (BRMS1) is decreased in NSCLC cells and tumors. We hypothesized that intratumoral breast cancer metastasis suppressor 1 (BRMS1) expression is associated with lung adenocarcinoma (LUAD) histologic subtypes and overall survival (OS) and disease-free survival (DFS) in patients undergoing resection for early-stage LUAD.Methods
Patients (N = 1030) who underwent complete resection for LUAD with tissue available for histologic evaluation were identified. Tissue microarrays were constructed, and immunostaining was performed and scored for intensity of BRMS1 expression. OS and DFS were estimated (by the Kaplan-Meier method) and compared between groups (by the log-rank test), stratified by stage. Hazard ratios (HRs) for hazard of death and recurrence were estimated using univariable and multivariable Cox proportional hazards models. OS and DFS nomograms were created, and model performance was examined.Results
Intratumoral BRMS1 expression was high in 632 patients (61%) and low in 398 (39%). Low BRMS1 expression was associated with higher pathologic T stage (p = 0.001), larger tumor size (p ≤ 0.0001), greater lymphatic (p = 0.032) and vascular (p = 0.001) invasion, LUAD histologic subtype (p = 0.001), and intermediate and high architectural tumor grade (p = 0.003). Low BRMS1 expression was an independent predictor of worse OS (HR = 1.35, 95% confidence interval: 1.10–1.65, p = 0.004) and DFS (HR = 1.27, 95% confidence interval: 1.05–1.54, p = 0.012). OS and DFS nomograms showed excellent predictive performance based on discrimination and calibration.Conclusions
Among patients with surgically resected LUAD, OS and DFS were significantly worse in cases with low intratumoral BRMS1 expression. Our findings suggest that BRMS1 is an independent biomarker with prognostic significance in surgically resected LUAD. 相似文献13.
Stephan Schorn Ihsan Ekin Demir Bernhard Haller Florian Scheufele Carmen Mota Reyes Elke Tieftrunk Mine Sargut Ruediger Goess Helmut Friess Güralp Onur Ceyhan 《Surgical oncology》2017,26(1):105-115
Objectives
To assess the impact of neural invasion/NI on overall survival/OS and tumor recurrence in pancreatic ductal adenocarcinoma/PDAC.Summary background data
NI is a histopathological hallmark of PDAC. Although some studies suggested an important role for NI on OS, disease-free/DFS and progression-free survival/PFS in PDAC, there is still no consensus on the actual role of NI on survival and local recurrence in PDAC.Methods
Pubmed, Cochrane library, Ovid and Google Scholar were screened for the terms “pancreatic ductal adenocarcinoma”, “pancreatic cancer”, “survival”, “tumor recurrence” and “perineural invasion”. The Preferred–Reporting-Items-for-Systematic-review-and-Meta-Analysis/PRISMA-guidelines were used for systematic review and meta-analysis. Articles meeting predefined criteria were critically analysed on relevance, and meta-analyses were performed by pooling univariate and multivariate hazard ratios/HR.Results
A total number of 25 studies on the influence of NI on tumor recurrence, and 121 studies analysing the influence of NI on survival were identified by systematic review. The HR of the univariate (HR 1.88; 95%-CI 1.71–2.07; p < 0.00001) and multivariate meta-analysis (HR 1.68; 95%-CI 1.47–1.92; p < 0.00001) showed a major impact of NI on OS. Likewise, NI was associated with decreased DFS (HR 2.53; 95%-CI: 1.67–3.83; p = 0.0001) and PFS (HR 2.41; 95%-CI: 1.73–3.37: p < 0.00001) multivariate meta-analysis.Conclusions
Although the power of this study is limited by missing pathological procedures to assess the true incidence of NI, NI appears to be an independent prognostic factor for OS, DFS and PFS in PDAC. Therefore, NI should be increasingly considered in patient stratification and in the development of novel therapeutic algorithms. 相似文献14.
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15.
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16.
Praveen Polamraju Waqar Haque Vivek Verma Lee Wiederhold Sandra Hatch E. Brian Butler Bin S. Teh 《Clinical colorectal cancer》2018,17(3):e519-e530
Introduction
Patients with cT1-2N0M0 rectal cancer are often treated with up-front surgical resection, with adjuvant treatment reserved for patients upstaged with pathologic node-positive (pN+) disease at surgery. This study evaluates practice patterns and clinical outcomes when comparing different forms of adjuvant treatment for this patient population.Methods
The National Cancer Data Base was queried for cT1-2N0M0 rectal cancer patients between 2004 and 2015 with postoperative pN+ disease treated without neoadjuvant treatment. Patients were divided into groups receiving observation, chemotherapy, or chemoradiotherapy (CRT). Multivariable logistic regression determined factors associated with receipt of adjuvant treatment. Kaplan-Meier curves compared overall survival (OS), and Cox regression determined patient factors associated with OS.Results
Altogether, 1466 patients met the inclusion criteria; 536 patients (36.6%) received adjuvant chemotherapy, 413 (28.2%) received adjuvant CRT, and 517 (35.3%) were observed postoperatively. Use of adjuvant treatment was associated with superior median OS (124.1 vs. 51.1 months, P < .001), persisting after propensity score matching (124.0 vs. 61.9 months, P < .001), but not between adjuvant CRT versus chemotherapy on subset analysis. Patients with positive surgical margins receiving adjuvant CRT showed a trend toward OS improvement compared to patients managed with chemotherapy (54.9 vs. 47.4 months, P = .10). Increased age, pN2 status, positive margin status, and observation were associated with poorer OS.Conclusion
Most patients found to have pN+ disease after up-front surgery for cT1-2N0 rectal cancer receive adjuvant treatment, which is associated with improved OS. Chemotherapy or CRT are appropriate options, although there was a trend toward higher OS for patients with positive surgical margins receiving CRT. 相似文献17.
R. Valente P. Lykoudis D. Tamburrino M. Inama I. Passas C. Toumpanakis T.V. Luong B. Davidson C. Imber M. Malagò S.H. Rahman A. Shankar D. Sharma M. Caplin G. Fusai 《European journal of surgical oncology》2017,43(11):2119-2128
Background
The oncological impact of surgical complications has been studied in visceral and pancreatic cancer.Aim
To investigate the impact of complications on tumour recurrence after resections for pancreatic neuroendocrine tumours.Methods
We have retrospectively analysed 105 consecutive resections performed at the Royal Free London Hospital from 1998 to 2014, and studied the long-term outcome of nil-minor (<3) versus major (≥3) Clavien–Dindo complications (CD) on disease-free (DFS) and overall survival (OS).Results
The series accounted for 41 (39%) pancreaticoduodenectomies, two (1.9%) central, 48 (45.7%) distal pancreatectomies, eight (7.6%) enucleations, four (3.8%) total pancreatectomies. Sixteen (15.2%) were extended to adjacent organs, 13 (12.3%) to minor liver resections. Postoperative complications presented in 43 (40.1%) patients; CD grade 1 or 2 in 23 (21.9%), grades ≥3 in 20 (19%). Among 25 (23.8%) pancreatic fistulas, 14 (13.3%) were grades B or C. Thirty-four (32.4%) patients developed exocrine, and 31 (29.5%) endocrine insufficiency. Seven patients died during a median 27 (0–175) months follow up. Thirty-day mortality was 0.9%. OS was 94.1% at 5 years. Thirty tumours recurred within 11.7 (0.8–141.5) months. DFS was 44% at 5 years. At univariate analysis, high-grade complications were not associated with shorter DFS (p = 0.744). At multivariate analysis, no parameter was independent predictor for DFS or OS. The comparison of nil-minor versus major complications showed no DFS difference (p = 0.253).Conclusion
From our series, major complications after P-NETs resection are not associated to different disease recurrence; hence do not require different follow up or adjuvant regimens. 相似文献18.
Adil S. Akthar Matthew Koshy Mark K. Ferguson Septimiu Murgu D. Kyle Hogarth Daniel W. Golden Philip P. Connell Erik M. Davies Eric Kowalski Renuka Malik 《Clinical lung cancer》2018,19(2):e227-e233
Background
In this study we sought to determine if staging endoscopic bronchial ultrasound (EBUS) improves outcomes in stage I non–small-cell lung cancer (NSCLC) patients who received hypofractionated radiation therapy (HFRT).Patients and Methods
Patients with stage I NSCLC treated with HFRT from 2008 to 2015 were retrospectively identified from 3 affiliated institutions. All patients underwent positron emission tomography/computed tomography staging and a subset of patients received pretreatment EBUS. Patients with and without pre-radiation therapy EBUS were compared for baseline characteristics. The log rank test was used to compare Kaplan–Meier estimates. Univariate analysis (UVA) and multivariable analysis (MVA) were used to analyze the effect of factors on disease-free survival (DFS) and overall survival (OS).Results
Ninety-two patients met study criteria. Median follow-up for the entire cohort was 21 months. Two-year DFS and OS were 63% and 81%, respectively. Two-year freedom from local, regional, and distant failure were 93%, 87%, and 87%, respectively. Thirty-seven of 92 patients (40%) received pretreatment EBUS. There were no statistically significant differences in 2-year freedom from regional failure rates, DFS, or OS for EBUS-staged versus non–EBUS-staged patients. On UVA, smaller tumor size (P = .03) and higher performance status (P = .05) were associated with improved OS. On MVA, tumor size retained significance for improved OS (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.19-0.97; P = .04) and higher performance status showed a trend toward improved OS (HR, 0.51; 95% CI, 0.23-1.11; P = .09).Conclusion
In this retrospective series, we did not detect a difference in regional failure or survival outcomes among stage I NSCLC patients who received invasive staging with EBUS before HFRT. 相似文献19.
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20.
S. Kim S. Paget-Bailly M. Messager T. Nguyen P. Mathieu N. Lamfichekh F. Fein S. Fratté D. Cléau Z. Lakkis M. Jary N. Sakek M. Jacquin A. Foubert F. Bonnetain C. Mariette F. Fiteni C. Borg 《European journal of surgical oncology》2017,43(1):218-225