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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.
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
Objective
Sarcopenia is associated with poor outcomes in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). However, few studies have assessed changes in sarcopenia during multimodality therapy or its effect on overall survival (OS).Methods
Computed tomography (CT) total psoas area index (TPAI) and weighted average Hounsfield units (HU) were measured at each treatment interval in patients with resectable PDAC. Four cohorts were compared: 1. Neoadjuvant chemotherapy plus surgery plus adjuvant chemotherapy (“NSA”; n?=?20); 2. surgery plus adjuvant chemotherapy (“SA”; n?=?20); 3. neoadjuvant chemotherapy with intent to perform surgery (“Chemotherapy”; n?=?24); and 4. treated with palliative intent (“Palliative”; n?=?21).Results
Fifty-nine deaths were identified. Median OS was 15.7?months (95% Confidence Interval (CI) 12.7–20.2). Patients who underwent surgery had a higher OS (p?<?0.001), with the SA group having a longer OS than the NSA group. Cox regression models identified baseline TPAI (Hazard Ratio (HR)?=?0.82; p?=?0.04), but not psoas HU, as a significant predictor of OS. The mean decrease in TPAI following neoadjuvant chemotherapy was 0.6?cm2/m2 (p?<?0.001; 95% CI ?0.8–?0.3) and the mean decrease in HU was 2.7 (p?=?0.04, 95% CI ?5.4–?0.1). For patients who underwent surgery (NSA and SA cohorts), a decrease in TPAI was associated with worse OS (HR 0.52; p?=?0.05). In contrast, decreased HU was associated with worse OS in patients who did not undergo surgery (HR 0.93; p?=?0.01).Conclusions
In patients who received neoadjuvant chemotherapy, there was a significant decrease in TPAI and HU during treatment. Prospective studies are warranted to assess the impact of TPAI loss and HU changes on clinical outcomes to better individualize treatment pathways based on a patient's fitness. 相似文献3.
Lawrence Lee Arman Erkan Noura Alhassan Justin J. Kelly George J. Nassif Matthew R. Albert John RT Monson 《Surgical oncology》2018,27(3):449-455
Introduction
Tumour location may affect oncologic outcomes for colon adenocarcinoma due to different levels of vascular ligation and nodal harvest, but the data are equivocal. The objective of this study is to determine the effect of tumor location and lymph node yield on overall survival(OS) in stage I-III colon adenocarcinoma.Methods
The 2004–2014 National Cancer Database was queried for colectomies for non-metastatic colon adenocarcinoma, excluding transverse colon and rectal cancer. Patients were grouped based on left/right tumor location. Main outcome measure was 5-year OS. Propensity score matching created balanced cohorts. Multilevel survival analysis determined the independent effect of tumor location and nodal harvest on OS.Results
There were 504,958 patients (273,198 right; 231,760 left) in the entire cohort: 26.4% stage-I, 37.3% stage-II, and 36.3% stage-III (equal distribution left/right). After 1:1 matching(n?=?297,080), right cancers were associated with worse 5-year overall survival for stage-II (66% vs. 70%, p?<?0.001) and -III (56% vs. 60%, p?<?0.001) despite similar nodal harvest and proportion receiving systemic therapy. On multivariate analysis, right-sided cancers (HR 1.12, 95%CI 1.06–1.19) had worse OS, independent of stage and nodal harvest. Nodal harvest ≥22 nodes had the highest OS (HR 0.71, 95%CI 0.68–0.75). There was an interaction between right-sided cancer and >22 lymph node harvest towards increased survival (HR 0.86, 95%CI 0.80–0.92).Conclusions
Right-sided cancers are associated with worse oncologic outcomes compared to left-sided tumors but a higher lymph node yield improves survival. These data provide indirect evidence for a higher lymphatic harvest to improve survival. 相似文献4.
Purpose
Chemoradiation allows for organ preservation in patients with anal cancer, but patients with large tumors (>?5 cm) have elevated rates of locoregional recurrence. With conformal radiation techniques, there is interest in dose escalation to decrease local recurrence in patients with large tumor size.Methods/patients
The National Cancer Database (NCDB) was used to identify patients with anal cancer from 2004 to 2013 with tumors?>?5 cm. Adult patients who received definitive chemoradiation were included. Patients with prior resection were excluded. High dose was defined as greater than or equal to 5940 cGy. Statistical analyses were performed using logistic regression, Kaplan–Meier, and Cox proportional hazards for overall survival (OS).Results
In total, 1349 patients were analyzed with 412 (30.5%) receiving high-dose radiation therapy (RT). 5-year OS was 58 and 60% for high and standard dose RT, respectively (p?=?0.9887). On univariate analysis, high-dose RT was not associated with improved OS (HR?=?0.998, CI 0.805–1.239, p?=?0.9887). On multivariate analysis, high-dose RT (HR?=?0.948, CI 0.757–1.187, p?=?0.6420) was not associated with improved OS but older age (HR?=?1.535, CI 1.233–1.911, p?=?0.0001), male sex (HR?=?1.695, CI 1.382–2.080, p?<?0.0001), comorbidities (HR?=?1.389, CI 1.097–1.759, p?=?0.0064), and long RT (HR?=?1.299, CI 1.047–1.611, p?=?0.0173) were significantly associated with decreased OS.Conclusions
There was no observed difference in OS for dose escalation of anal cancers?>?5 cm in this population-based analysis. Differences in local control and salvage therapy cannot be assessed through the NCDB. Whether dose escalation of large tumors may improve local control and colostomy-free survival remains an important question and is the subject of ongoing trials.5.
Winesh Ramphal Jeske R.E. Boeding Paul D. Gobardhan Harm J.T. Rutten Leandra J.M. Boonman de Winter Rogier M.P.H. Crolla Jennifer M.J. Schreinemakers 《Surgical oncology》2018,27(4):730-736
Introduction
Anastomotic leakage is one of the most severe early complications after colorectal surgery, and it is associated with a high reoperation rate-, and increased in short-term morbidity and mortality rates. It remains unclear whether anastomotic leakage is associated with poor oncologic outcomes. The aim of this study was to determine the impacts of anastomotic leakage on long-term oncologic outcomes, disease-free survival and overall mortality in patients who underwent curative surgery for colorectal cancer.Methods
This single-centre, retrospective, observational cohort study included patients who underwent curative surgery for colorectal cancer between 2005 and 2015 and who had a primary anastomosis. Survival- and multivariate cox regression analyses were performed to adjust for confounding.Results
A total of 1984 patients had a primary anastomosis after surgery. The overall incidence of anastomotic leakage was 7.5%; 19 patients were excluded because they were lost to follow-up. Of the remaining 1965 patients, 41 (2.1%) developed local recurrence associated with anastomotic leakage [adjusted hazard ratio (HR)?=?2.25; 95% confidence interval (CI) 1.14–5.29; P?=?0.03]. Distant recurrence developed in 291(14.8%) patients with no association with anastomotic leakage [adjusted HR?=?1.30 (95% CI: 0.85–1.97) P?=?0.23]. Anastomotic leakage was associated with increased long-term mortality [adjusted HR?=?1.69 (95% CI 1.32–2.18) P?<?0.01]. Five year disease-free survival was significantly decreased in patients with anastomotic leakage, (log rank test P?<?0.01).Conclusion
Anastomotic leakage was significantly associated with increased rates of local recurrence, disease free-survival and overall mortality. Associations of anastomotic leakage with distant recurrence was not found. 相似文献6.
Liang Chen Qiang Zhang Feng-Yuan Li Li Yang Dian-Cai Zhang Lin-Jun Wang Wei-Zhi Wang Zheng Li Jiang-Hao Xu Zhong-Yuan He Kang-Jing Xu Ming Chen Hao Xu Ze-Kuan Xu 《Surgical oncology》2018,27(4):737-742
Background
Complete surgical resection remains the predominant treatment modality for primary gastrointestinal stromal tumors (GISTs). No therapeutic consensus exists for 2–5?cm gastric GISTs. We compared the efficacy, safety, and prognosis of laparoscopic and endoscopic surgeries in the treatment of relatively small (2–5?cm) intraluminal gastric GISTs.Methods
We collected 101 patients with relatively small intraluminal gastric GISTs who had integrated clinicopathological data and underwent laparoscopic or endoscopic resection (laparoscopic group n?=?66; endoscopic group n?=?35). Clinicopathological characteristics, perioperative data, and long-term oncological outcomes were retrospectively analyzed. Comparative analysis of clinicopathological data in the two groups was performed by using a chi-square test, Fisher's exact test, and Student's t-test. Recurrence-free survival (RFS) was analyzed by the log-rank test.Results
All clinicopathological characteristics had no significant difference between the two groups. Patients in the endoscopic group had shorter operation time (P?<?0.001), postoperative hospital stay (P?<?0.001), time to a liquid diet (P?<?0.01), and time to a semi-liquid diet (P?<?0.01), and lower hospital charges (P?<?0.001), compared to those in the laparoscopic group. Four patients (6.1%) in the laparoscopic group and one patient (2.9%) in the endoscopic group had perioperative complications, but with no significant difference. Recurrence occurred in 6 patients (9.1%) and 2 patients (5.7%) in the laparoscopic and endoscopic groups, respectively. There was no significant difference in RFS between the two groups.Conclusion
Endoscopic resection is a feasible and safe treatment modality for patients with relatively small (2–5?cm) intraluminal gastric GISTs. Due to faster recovery and lower cost, endoscopic resection is more suitable for elderly and weak patients, or patients with a poor financial situation. 相似文献7.
Andreas Andreou Sebastian Knitter Fritz Klein Thomas Malinka Moritz Schmelzle Benjamin Struecker Rosa B. Schmuck Alina Roxana Noltsch Daniela Lee Uwe Pelzer Timm Denecke Johann Pratschke Marcus Bahra 《Surgical oncology》2018,27(4):688-694
Background
The role of hepatectomy for patients with liver metastases from ductal adenocarcinoma of the pancreas (PLM) remains controversial. Therefore, the aim of our study was to examine the postoperative morbidity, mortality, and long-term survivals after liver resection for synchronous PLM.Methods
Clinicopathological data of patients who underwent hepatectomy for PLM between 1993 and 2015 were assessed. Major endpoint of this study was to identify predictors of overall survival (OS).Results
During the study period, 76 patients underwent resection for pancreatic cancer and concomitant hepatectomy for synchronous PLM. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 67%, 25%, and 8% of the patients, respectively. The median PLM size was 1 (1–13) cm and 36% of patients had multiple PLM. The majority of patients (96%) underwent a minor liver resection. After a median follow-up time of 130 months, 1-, 3-, and 5-year OS rates were 41%, 13%, and 7%, respectively. Postoperative morbidity and mortality rates were 50% and 5%, respectively. Preoperative and postoperative chemotherapy was administered to 5% and 72% of patients, respectively. In univariate analysis, type of pancreatic procedure (P?=?.020), resection and reconstruction of the superior mesenteric artery (P?=?.016), T4 stage (P?=?.086), R1 margin status at liver resection (P?=?.001), lymph node metastases (P?=?.016), poorly differentiated cancer (G3) (P?=?.037), no preoperative chemotherapy (P?=?.013), and no postoperative chemotherapy (P?=?.005) were significantly associated with worse OS. In the multivariate analysis, poorly differentiated cancer (G3) (hazard ratio [HR]?=?1.87; 95% confidence interval [CI]?=?1.08–3.24; P?=?.026), R1 margin status at liver resection (HR?=?4.97; 95% CI?=?1.46–16.86; P?=?.010), no preoperative chemotherapy (HR?=?4.07; 95% CI?=?1.40–11.83; P?=?.010), and no postoperative chemotherapy (HR?=?1.88; 95% CI?=?1.06–3.29; P?=?.030) independently predicted worse OS.Conclusions
Liver resection for PLM is feasible and safe and may be recommended within the framework of an individualized cancer therapy. Multimodal treatment strategy including perioperative chemotherapy and hepatectomy may provide prolonged survival in selected patients with metastatic pancreatic cancer. 相似文献8.
Erkan Topkan Ugur Selek Yurday Ozdemir Berna A. Yildirim Ozan C. Guler Fuat Ciner Huseyin Mertsoylu Kadir Tufan 《Journal of neuro-oncology》2018,139(2):411-419
Introduction
To evaluate the prognostic value of the Glasgow Prognostic Score (GPS), the combination of C-reactive protein (CRP) and albumin, in glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (GPS).Methods
Data of newly diagnosed GBM patients treated with partial brain RT and concurrent and adjuvant TMZ were retrospectively analyzed. The patients were grouped into three according to the GPS criteria: GPS-0: CRP?<?10 mg/L and albumin?>?35 g/L; GPS-1: CRP?<?10 mg/L and albumin?<?35 g/L or CRP?>?10 mg/L and albumin?>?35 g/L; and GPS-2: CRP?>?10 mg/L and albumin?<?35 g/L. Primary end-point was the association between the GPS groups and the overall survival (OS) outcomes.Results
A total of 142 patients were analyzed (median age: 58 years, 66.2% male). There were 64 (45.1%), 40 (28.2%), and 38 (26.7%) patients in GPS-0, GPS-1, and GPS-2 groups, respectively. At median 15.7 months follow-up, the respective median and 5-year OS rates for the whole cohort were 16.2 months (95% CI 12.7–19.7) and 9.5%. In multivariate analyses GPS grouping emerged independently associated with the median OS (P?<?0.001) in addition to the extent of surgery (P?=?0.032), Karnofsky performance status (P?=?0.009), and the Radiation Therapy Oncology Group recursive partitioning analysis (RTOG RPA) classification (P?<?0.001). The GPS grouping and the RTOG RPA classification were found to be strongly correlated in prognostic stratification of GBM patients (correlation coefficient: 0.42; P?<?0.001).Conclusions
The GPS appeared to be useful in prognostic stratification of GBM patients into three groups with significantly different survival durations resembling the RTOG RPA classification.9.
S. Knight E. Lambaudie L. Sabiani D. Mokart M. Provansal A. Tallet G. Houvenaeghel 《European journal of surgical oncology》2018,44(12):1929-1934
Introduction
The objective of this study was to report a 30-year experience of PE for gynecologic malignancies in a cancer center.Materials and methods
A retrospective study was conducted at Institut Paoli-Calmette including patients who underwent PE for gynecologic malignancies. Four periods were evaluated: P1 before 1992, P2 between 1993 and 1999, P3 between 2000 and 2006 and P4 after 2006. The study evaluated the number of PE performed during each period, the type of PE, its level, indication, location of the primary tumor, patient age, previous radiotherapy ≥45?Gy, the rate of “curative” PE and exenteration-related reconstructive techniques. 90-day post-operative mortality and morbidity using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) v 4.03 were reported.Results
277?PE were performed. The number of PE performed for recurrences rose during the study period (p?=?0.042), PE performed for central tumors increased during P3 (64.4%) and P4 (67.4%) (p?<?0.0001) and administration of radiotherapy ≥45?Gy was more frequent (p?<?0.0001). The rate of “curative” PE increased (p?<?0.0001). In multivariate analysis, “curative” PE were correlated with PE type, central locations and study period. Pelvic filling was progressively more frequently performed (p?=?0.002).90-day complication rate was 56.3%. In multivariate analysis there was a significant difference in distribution of CTCAE grade 3-4-5 morbidity depending on the period. Overall survival (OS) improved during the 2 last periods (p?=?0.008).Conclusion
A better selection of eligible patients for PE, namely through improvement in imaging techniques, has enabled to raise the rate of curative PE. 相似文献10.
Laetitia Gambotti Emilie Schwob Thomas Schouman Gregory Murcier Patrick Goudot Alain Mallet Chloé Bertolus 《Surgical oncology》2018,27(4):715-721
Objectives
There is no consensus for the specific management of elderly patients presenting with oral cavity squamous cell carcinomas (OC SCC). We report our findings in the treatment of primary OC SCC, for patients of 70 years of age or more, in a French university hospital center.Patients and methods
One hundred and twenty five patients diagnosed between 2000 and 2010, were included retrospectively. Independent risk factors of post-operative complications were identified using a logistic regression. The overall survival (OS) was estimated using the Kaplan Meier method. Independent factors of survival were calculated using a Cox model.Results
The patient's median age was 78. Women presented significantly more premalignant lesions, less alcohol intoxication, and less tobacco consumption. Half of the population sample was staged T4 in the TNM classification. Eighty eight percent of the patients received a curative treatment. The independent risk factors for post-operative complications were T3/T4 stages (OR 4.3 [1.3–14.4]), lymph node metastasis (OR 6.9 [2.1–22.7]), and alcohol abuse (OR 3.5 [1.1–11.0]). The median OS was 14.0 months. The independent negative prognostic factors for OS for patients treated curatively were: age >79 years (HR 1.9 [1.2–3.2]), stage T2/T3/T4 tumor vs. T1 (HR?=?3.0 [1.5–6.0], P?=?0.001) and substandard surgery (HR?=?1.8 [1.1–2.9], P?=?0.03).Conclusions
The management of OC SCC in elderly patients is complex and requires collaboration among gerontologists, surgeons and oncologists. The treatment choice is related to the disease extent and preoperative morbid conditions. 相似文献11.
Sung Il Kang Heung-Kwon Oh Jae Suk Yoo Soyeon Ahn Min Hyun Kim Myung Jo Kim Il Tae Son Duck-Woo Kim Sung-Bum Kang Young Soo Park Chang Jin Yoon Rumi Shin Seung Chul Heo In Taek Lee Eui Gon Youk Min Jung Kim Tae Young Chang Sung-Chan Park Kyu Joo Park 《Surgical oncology》2018,27(2):216-224
Background
Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer.Methods
A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias.Results
One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730–1.548; Log-rank, p?=?0.746) and the adjusted population (HR 0.122, 95% CI 0.920–1.987; Log-rank, p?=?0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568–1.334; Log-rank, p?=?0.526) and the adjusted population (HR 1.023, 95% CI 0.665–1.572; Log-rank, p?=?0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, p?<?0.001).Conclusion
The ‘bridge to surgery’ strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction. 相似文献12.
Xiu-Ping Zhang Kang Wang Nan Li Cheng-Qian Zhong Xu-Biao Wei Yu-Qiang Cheng Yu-Zhen Gao Han Wang Shu-Qun Cheng 《BMC cancer》2017,17(1):902
Background
No consensus treatment has been reached for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Hepatic resection (HR) and transarterial chemoembolization (TACE) have been recommended as effective options, but which is better remains unclear. This meta-analysis is to compare the effectiveness of HR and TACE for HCC with PVTT patients.Methods
The PubMed, EMBASE, Cochrane Library, VIP, Wan Fang, and Sino Med databases were systematically searched for comparing HR and TACE treating PVTT.Results
Twelve retrospective studies with 3129 patients were included. A meta-analysis of 11 studies suggested that the 1-, 2-, 3-, and 5-year overall survival (OS) rates (OR?=?0.48, 95% CI?=?0.41–0.57, I2 =?37%, P?<?0.00001; OR?=?0.21, 95% CI?=?0.12–0.38, I2 =?43%, P?<?0.00001; OR?=?0.35, 95% CI?=?0.28–0.44, I2 =?53%, P?<?0.00001; OR?=?0.28, 95% CI?=?0.14–0.54, I2 =?72%, P?=?0.0001, respectively) favored HR over TACE. In a subgroup analysis, HR had better 1-, 2-,3, 5-year OS for type I PVTT (OR?=?0.33, 95% CI?=?0.17–0.64, I2 =?20%, P?=?0.001; OR?=?0.32, 95% CI?=?0.16–0.63, I2?=?0%, P?=?0.001; OR?=?0.18, 95% CI?=?0.09–0.36, I2?=?0%, P?<?0.00001; OR?=?0.07, 95% CI?=?0.01–0.32, I2?=?0%, P?=?0.0006, respectively) and better 1-, 3-, and 5-year OS for type II PVTT (OR?=?0.37, 95% CI?=?0.20–0.70, I2 =?59%, P?=?0.002; OR?=?0.22, 95% CI?=?0.13–0.39, I2 =?0%, P?<?0.00001; OR?=?0.16; 95% CI?=?0.03–0.91; I2 =?51%, P?=?0.04, respectively). There was no difference in 1-, 3-, or 5-year OS between HR and TACE for type III PVTT (OR?=?0.86, 95% CI?=?0.61–1.21, I2 =?0%, P?=?0.39; OR?=?0.83, 95% CI?=?0.42–1.64, I2 =?0%, P?=?0.59; OR?=?0.59, 95% CI?=?0.06–-6.04, I2 =?65%, P?=?0.66, respectively).Conclusions
HR may lead to longer OS for some selected HCC patients with PVTT than TACE, especially for type I or II PVTT, with less difference being observed for type III or IV PVTT.13.
Florencio Quero-Valenzuela Inmaculada Piedra-Fernández Francisco Hernández-Escobar María Martínez-Ceres Pedro J. Romero-Palacios Antonio Cueto-Ladrón De Guevara Pablo Torné-Poyatos 《Surgical oncology》2018,27(4):630-634
Introduction
Mortality following surgery for lung cancer increases at 90 days. The objective of this study was to determine the rate, factors, time to death, hospital stay until discharge, time to death after discharge and causes of mortality at 90 days following surgery for lung cancer.Methods
A prospective follow-up study was performed in a cohort of 378 patients who underwent surgery for lung cancer between January 2012 and December 2016. Data on preoperative status, postoperative complications, and mortality were collected.Results
Rates of mortality were 1.6% vs. 3.2% at 30 and 90 days, respectively. Half of deaths occurred between 31 and 90 postoperative days following discharge.The variables found to be related to mortality at 90 days were a Charlson Index >3 (p?<?0.001), a history of stroke (p?=?0.036), postoperative pneumonia (p?=?0.001), postoperative pulmonary or lobar collapse (p?=?0.001), reintubation (p?<?0.001) and postoperative arrhythmia (p?=?0.0029). The risk of mortality was also observed to be associated with the type of surgical technique –being higher for thoracotomy as compared to video-assisted thoracoscopy (VATS) (p?=?0.011) –, and hospital readmission after discharge (p?<?0.001). Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Multivariate analysis revealed that a Charlson Index >3 (p?=?0.001) OR 2.0 (1.55,2.78), a history of stroke (p?=?0.018) OR 5.1 (1.81, 32.96) and postoperative pulmonary or lobar collapse (p?=?0.001) OR 8.5 (2.41,30.22) were independent prognostic factors of mortality.The most common causes of death were related to respiratory (58.3%) and cardiovascular (33.2%) complications.Conclusions
Mortality at 90 days following surgery for lung cancer doubles 30-day mortality, which is a relevant finding of which both, patients and healthcare should be aware.Half the deaths within 90 days after surgery for lung cancer occur after discharge.Specific outpatient follow-up programs should be designed for patients at a higher risk of 90-day mortality. 相似文献14.
Sebastian Zschaeck Peter Wust Reinhold Graf Martin Misch Julia Onken Pirus Ghadjar Harun Badakhshi Julian Florange Volker Budach David Kaul 《Radiation oncology (London, England)》2018,13(1):251
Background
The dismal overall survival (OS) prognosis of glioblastoma, even after trimodal therapy, can be attributed mainly to the frequent incidence of intracranial relapse (ICR), which tends to present as an in-field recurrence after a radiation dose of 60 Gray (Gy). In this study, molecular marker-based prognostic indices were used to compare the outcomes of radiation with a standard dose versus a moderate dose escalation.Methods
This retrospective analysis included 156 patients treated between 2009 and 2016. All patients were medically fit for postoperative chemoradiotherapy. In the dose-escalation cohort a simultaneous integrated boost of up to 66?Gy (66?Gy RT) within small high-risk volumes was applied. All other patients received daily radiation to a total dose of 60?Gy or twice daily to a total dose of 59.2?Gy (60?Gy RT).Results
A total of 133 patients received standard 60?Gy RT, while 23 received 66?Gy RT. Patients in the 66?Gy RT group were younger (p?<? 0.001), whereas concomitant temozolomide use was more frequent in the 60?Gy RT group (p?<? 0.001). Other intergroup differences in known prognostic factors were not observed. Notably, the median time to ICR was significantly prolonged in the 66?Gy RT arm versus the 60?Gy RT arm (12.2 versus 7.6?months, p?=?0.011), and this translated to an improved OS (18.8 versus 15.3?months, p?=?0.012). A multivariate analysis revealed a strong association of 66?Gy RT with a prolonged time to ICR (hazard ratio?=?0.498, p?=?0.01) and OS (hazard ratio?=?0.451, p?=?0.01). These differences remained significant after implementing molecular marker-based prognostic scores (ICR p?=?0.008, OS p?=?0.007) and propensity-scored matched pairing (ICR p?=?0.099, OS p?=?0.023).Conclusion
Radiation dose escalation was found to correlate with an improved time to ICR and OS in this cohort of glioblastoma patients. However, further prospective validation of these results is warranted.15.
Linda M. Youngwirth Kyle Freischlag Daniel P. Nussbaum Ehsan Benrashid Dan G. Blazer 《Surgical oncology》2018,27(4):676-680
Introduction
Primary sarcomas of the pancreas are rare, and the limited data regarding their presentation, oncologic profile, and survival have been derived from small case series.Methods
The National Cancer Data Base (1998–2012) was queried for patients with primary sarcomas of the pancreas. Demographic and clinical features at the time of diagnosis were evaluated for all patients. Subjects who underwent surgical resection were identified, and logistic regression was used to identify variables associated with resection. A Cox proportional hazards model was developed to identify factors associated with survival.Results
In total, 253 patients were identified. The mean age at diagnosis was 63 years, with tumors occurring more frequently in women (57.3%) and those of white race (79.8%). Tumors in the head of the pancreas were most common (63.3%). The mean size was 7.5?cm. Only 100 patients (39.5%) underwent resection, with younger age (OR?=?0.763, p?=?0.04) and smaller tumor size (OR?=?0.978, p?<?0.01) associated with resection. Chemotherapy and radiation therapy use were similar in patients who underwent resection and those who did not. Patients who underwent resection had a median survival of 17 months, compared to 6 months for patients who were not resected (p?<?0.01). Following adjustment, only older age (HR 1.257, p?=?0.03) and higher tumor grade (HR 1.997, p?=?0.01) were associated with an increased risk of death in resected patients.Conclusions
Primary pancreatic sarcomas are rare and the majority of patients do not undergo resection; thus, little is known about their oncologic profile or outcomes following pancreatectomy. Patients who undergo resection have markedly improved survival; older age and higher tumor grade are associated with decreased survival. 相似文献16.
Mudit Chowdhary Jeffrey M. Switchenko Robert H. Press Jaymin Jhaveri Zachary S. Buchwald Philip A. Blumenfeld Gaurav Marwaha Aidnag Diaz Dian Wang Ross A. Abrams Jeffrey J. Olson Hui-Kuo G. Shu Walter J. Curran Kirtesh R. Patel 《Journal of neuro-oncology》2018,139(3):689-697
Introduction
Neutrophil-to-lymphocyte ratio (NLR) is a surrogate for systemic inflammatory response and its elevation has been shown to be a poor prognostic factor in various malignancies. Stereotactic radiosurgery (SRS) can induce a leukocyte-predominant inflammatory response. This study investigates the prognostic impact of post-SRS NLR in patients with brain metastases (BM).Methods
BM patients treated with SRS from 2003 to 2015 were retrospectively identified. NLR was calculated from the most recent full blood counts post-SRS. Overall survival (OS) and intracranial outcomes were calculated using the Kaplan–Meier method and cumulative incidence with competing risk for death, respectively.Results
188 patients with 328 BM treated with SRS had calculable post-treatment NLR values. Of these, 51 (27.1%) had a NLR >?6. The overall median imaging follow-up was 13.2 (14.0 vs. 8.7 for NLR ≤?6.0 vs. >?6.0) months. Baseline patient and treatment characteristics were well balanced, except for lower rate of ECOG performance status 0 in the NLR?>?6 cohort (33.3 vs. 44.2%, p?=?0.026). NLR?>?6 was associated with worse 1- and 2-year OS: 59.9 vs. 72.9% and 24.6 vs. 43.8%, (p?=?0.028). On multivariable analysis, NLR?>?6 (HR: 1.53; 95% CI 1.03–2.26, p?=?0.036) and presence of extracranial metastases (HR: 1.90; 95% CI 1.30–2.78; p?<?0.001) were significant predictors for worse OS. No association was seen with NLR and intracranial outcomes.Conclusion
Post-treatment NLR, a potential marker for post-SRS inflammatory response, is inversely associated with OS in patients with BM. If prospectively validated, NLR is a simple, systemic marker that can be easily used to guide subsequent management.17.
Background
Stromal tumor-infiltrating lymphocytes (sTILs) have been identified as a predictive biomarker for response to neoadjuvant chemotherapy (NAC) and prognosis in human epidermal growth factor receptor 2 (HER2)-positive breast cancers. However, standardized scoring methods for use in clinical practice need to be established, and the optimal threshold of sTILs to predict pathological complete response (pCR) and prognosis in HER2+ breast cancers has not yet been defined.Objective
The predictive and prognostic values of sTILs in patients with HER2-positive breast cancer treated with NAC were evaluated, with the aim to explore the optimal thresholds of sTILs and to investigate the feasibility of scoring methods in clinical practice.Patients and Methods
A total of 143 core needle biopsy specimens of HER2-positive invasive breast cancers obtained from Chinese patients who had been treated with trastuzumab-based NAC followed by surgery between 2009 and 2015 were extracted from the pathology database of Fudan University Shanghai Cancer Center. sTIL levels in the pre-NAC core needle biopsy specimens were scored using methods recommended by the International TILs Working Group 2014. The associations between sTILs and pCR, disease-free survival (DFS), and overall survival (OS) were evaluated, and the optimal thresholds for predictive and prognostic values of sTILs were analyzed.Results
First, sTILs were associated with a higher pCR rate in HER2-positive breast cancers. Univariate (per 10% sTILs: odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, p?=?0.001) and multivariate regression analyses (per 10% sTILs: OR 1.04, 95% CI 1.00–1.07, p?=?0.034) indicated that sTILs as a continuous variable were a significant predictor of pCR in HER2-positive breast cancers. Receiver operating characteristics (ROC) curve analysis showed that a 20% threshold best distinguished the pCR subgroup from the non-pCR subgroup. The dichotomized sTILs with a threshold set at 20% was a strong predictor of pCR in the univariate (OR 0.25, 95% CI 0.12–0.52, p?<?0.001) and multivariate analyses (OR 0.35, 95% CI 0.14–0.87, p?=?0.024). Second, sTILs were associated with better prognosis in HER2-positive breast cancers. Univariate (DFS: hazard ratio [HR] 0.91, 95% CI 0.88–0.95, p?<?0.001; OS: HR 0.88, 95% CI 0.83–0.94, p?<?0.001), and multivariate analyses (DFS: HR 0.93, 95% CI 0.90–0.97, p?<?0.001; OS: HR 0.92, 95% CI 0.86–0.98, p?=?0.009) suggested that sTILs as a continuous variable had a strong predictive value for improved DFS and OS. As a binary variable with a threshold of 20%, univariate (DFS: HR 6.60, 95% CI 2.91–14.95, p?<?0.001; OS: HR 10.29, 95% CI 2.37–44.66, p?=?0.002) and multivariate analyses (DFS: HR 3.87, 95% CI 1.65–9.12, p?=?0.002; OS: HR 4.74, 95% CI 1.02–22.01, p?=?0.047) indicated that patients with ≥ 20% sTILs had a significantly better prognosis than the patients with < 20% sTILs.Conclusions
Our study indicates that baseline sTILs scored by methods recommended by the International TILs Working Group in pre-NAC core needle biopsy specimens are significantly correlated with pCR and prognosis in HER2-positive breast cancers. A 20% threshold for sTILs may be a feasible diagnostic marker to predict pCR to NAC and prognosis in patients with HER2-positive breast cancers.18.
Introduction
Evidence supporting adjuvant therapy for resected pancreatic cancer is limited primarily to head tumors. We analyzed data from the National Cancer Database (NCDB) to evaluate the relationship of tumor site with benefit from adjunctive (adjuvant, neoadjuvant, perioperative) therapy (Rx).Methods
All NCDB patients with clinical stage I and II pancreatic cancer, diagnosed from 2003 to 2013, who underwent surgical resection and had data on site of primary were included. Overall survival (OS) analyses with hazard ratios (HR), 95% confidence intervals (CI), and two-sided p-values are presented.Results
A total of 27,930 patients met inclusion criteria; median age 66 years, 51% males, 86% white. Primary site was coded as head (74.4%), body (9.3%), or tail (16.3%). Pathologic stage was predominantly stage II (77%); 81% had negative margins. Perioperative Rx was used in 4%, neoadjuvant in 8%, adjuvant in 48%. Median OS for the cohort was 24 months; for head, body and tail tumors, it was 21.6, 34.5, and 42.5 months, respectively. In univariable analyses, adjunctive Rx was associated with improved OS in head tumors (HR, any Rx vs. no Rx: 0.87; 95% CI 0.84–0.91; p?<?0.0001) but not in body (1.82; 1.59–2.08; <0.0001) and tail (2.28; 2.05–2.53; <0.0001) tumors; multivariable models including statistically significant predictors (Charlson-Deyo comorbidity score, tumor grade and stage, positive resection margin) confirmed these results.Conclusions
Our study suggests that the benefit of adjunctive Rx is restricted to pancreatic head tumors; body and tail tumors have a much better prognosis. These results warrant further evaluation in prospective studies. 相似文献19.
Objective
To investigate the clinicopathologic prognostic factors in patients with malignant sex cord-stromal tumors (SCSTs) with lymph node dissection, and at the same time, to evaluate the influence of the log odds of positive lymph nodes (LODDS) on their survival.Methods
Patients diagnosed with malignant SCSTs who underwent lymph node dissection were extracted from the 1988–2013 Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were estimated by Kaplan-Meier curves. The Cox proportional hazards regression model was used to identify independent predictors of survival.Results
576 patients with malignant SCSTs and with lymphadenectomy were identified, including 468 (81.3%) patients with granulosa cell tumors (GCTs) and 80 (13.9%) patients with Sertoli-Leydig cell tumors (SLCTs). 399 (69.3%) patients and 118 (20.5%) patients were in the LODDS < ?1 group and ?1 ≤ LODDS < ?0.5 group, respectively. The 10-year OS rate was 80.9% and CSS was 87.2% in the LODDS < ?0.5 group, whereas the survival rates for other groups were 68.5% and 73.3%. On multivariate analysis, age 50 years or less (p < 0.001), tumor size of 10 cm or less (p < 0.001), early-stage disease (p < 0.001), and GCT histology (p ≤ 0.001) were the significant prognostic factors for improved survival. LODDS < ?0.5 was associated with a favorable prognosis (OS: p = 0.051; CSS:P = 0.055).Conclusions
Younger age, smaller tumor size, early stage, and GCT histologic type are independent prognostic factors for improved survival in patients with malignant SCST with lymphadenectomy. Stratified LODDS could be regarded as an effective value to assess the lymph node status, and to predict the survival status of patients. 相似文献20.
Giulia Cossu Louis-Marie Terrier Lotfi Benboubker Christophe Destrieux Stéphane Velut Patrick François Ilyess Zemmoura Aymeric Amelot 《Surgical oncology》2018,27(2):321-326