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Ho Seok Seo Yoon Ju Jung Ji Hyun Kim Cho Hyun Park Han Hong Lee 《Journal of Geriatric Oncology》2018,9(2):115-119
Objectives
This study analyzed the effect of D2 lymph node (LN) dissection on complications and survival in older patients with gastric cancer.Materials and Methods
A total of 103 octogenarian patients who underwent curative gastrectomy for gastric cancer were divided into two groups (D2 and D1) according to the extent of LN dissection and analyzed retrospectively for complications and survival.Results
No differences were observed in short-term postoperative outcomes, including complication rates, between the two groups. In a survival analysis, D2 LN dissection did not improve overall survival (OS) in any patient, including advanced cases. A Cox regression analysis revealed that the independent risk factors for OS were history of coronary artery disease (hazard ratio [HR], 11.095), postoperative short-term complications (HR, 9.939), and TNM stage (HR, 6.299). The extent of LN dissection was not an independent risk factor for OS, and D2 or more LN dissection (odds ratio, 10.89) increased the risk independently.Conclusions
D2 or more LN dissection did not improve survival, but rather increased the risk of complications. Thus, LN dissection should be performed sparingly in octogenarian patients with gastric cancer. 相似文献2.
Chantal Quinten C. Kenis M. Hamaker A. Coolbrandt B. Brouwers L. Dal Lago P. Neven P. Vuylsteke G. Debrock H. Van Den Bulck A. Smeets P. Schöffski A. Bottomley U. Wedding H. Wildiers 《Journal of Geriatric Oncology》2018,9(2):152-162
Objectives
We aim to assess short and long term effects of chemotherapy on patient-reported quality of life (QOL) and patient versus clinician symptom reporting in older patients with breast cancer adjusted for tumour and aging parameters.Material and Methods
In this prospective, multicentre, non-interventional, observational study, women aged ≥ 70 years were enrolled after surgery and assigned to a TC chemotherapy (docetaxel and cyclophosphamide) group or a control group depending on their planned adjuvant treatment. Longitudinal multivariate models were used to assess the statistical and minimal clinically important difference (MCID) in the impact of TC chemotherapy over time on QOL and symptom burden adjusted for baseline aging and tumour parameters. Statistical significance was set at 5% and MCID at 10 points.Results
In total, 57 patients were enrolled in the chemotherapy and 52 patients in the control group. Within the chemotherapy group, clinical deterioration was reported at 3 months for Fatigue (17.73), Dyspnoea (17.05), Diarrhoea (12.06) and Appetite Loss (17.05) scores (all p < 0.001). However, the scores had returned to baseline (or even better for Role Functioning) at year 1. No clinical deterioration was reported in the control group. Symptom scores as reported by patients were significantly (p < 0.05) higher than those reported by the clinicians, even more so for Fatigue, Dyspnoea, and Pain.Conclusion
Our results show that symptom burden and diminished QOL in an older breast cancer population receiving adjuvant TC chemotherapy are short-lived and disappear after a while with no long-term differences compared to a similar population not receiving chemotherapy. 相似文献3.
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Presentation of The Case
A 61-year-old man undergoes a sigmoid colectomy for a T3N1 (two of 18 nodes) adenocarcinoma of the sigmoid colon. He recovers well and receives 6 months of adjuvant FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) uneventfully. At his first follow-up visit, the oncologist recommended every 3 month visits for a physical, liver function tests, and carcinoembryonic antigen (CEA) measurement; every 6 month chest, abdomen, and pelvic computed tomography (CT) scans for 3 years; and aspirin, vitamin D supplementation, and exercise. Is CT scanning appropriate in the follow-up of colon cancer patients? (This case was presented at Massachusetts General Hospital Cancer Center.) 2011 Feb; 16(2): 254–256. doi: 10.1634/theoncologist.2011-0014Pro
Richard M. GoldbergRichard M. Goldberg
University of North Carolina at Chapel HillFind articles by Richard M. GoldbergAuthor information Copyright and License information DisclaimerUniversity of North Carolina at Chapel HillCopyright notice Open in a separate windowRichard M. Goldberg, M.D.Just recently, I reorganized my talking points about management of metastatic colorectal cancer. Now I focus those conversations, whether they occur in a lecture hall or a clinic exam room, around an AJCC (American Joint Committee on Cancer) unsanctioned but pragmatic new staging system, which I will call “UNC.” With multidisciplinary input at the University of North Carolina (also, by coincidence, UNC), we sort patients into those “unlikely (U)” to undergo resection because of the extent of their metastatic disease or their comorbid conditions that make the risk of surgery prohibitive, those who can undergo resection “now (N),” and, those who “could (C)” after a response to medical treatment potentially undergo resection. We formulate management strategies that differ according to those categories. Currently, multidisciplinary teams can realistically offer the possibility of long-term disease-free survival to a subset of patients who fit into the N or C subcategories. How do we segregate patients into those categories? We book them an appointment for a CT scan because they seldom have symptoms or physical findings that reliably tell us how extensive their disease is [1].After patients with stage II or III disease complete their initial therapy, it is common practice to do interval CT scans, CEAs, and colonoscopies aimed at early detection of recurrent disease and new primary tumors. Guidelines issued by the American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), and the Cochrane Collaboration reinforce this practice [2–4]. Are we fooling ourselves and our patients about the value of this approach in terms of lives saved or prolonged and money spent? My fiscally conservative crimson (Harvard''s colors) friend and colleague Dr. Ryan suggests that we are and, from my vantage point on the opposite side of the color wheel (UNC''s team color is sky blue), I disagree. Is there evidence on which to base a CT scan-based surveillance protocol?The natural history of colorectal cancer stands out among solid tumors. Cohen and colleagues studied circulating tumor cells (CTCs) in patients with metastatic disease, proving that with current technology they could readily identify CTCs in a 10-ml aliquot of blood [5]. Yet in many patients, most of these potential seeds never grow and scans detect one or a few metastatic lesions. In patients with pancreatic cancer, resection of metastases is not curative. In many series, resection of limited hepatic and pulmonary metastases in colorectal cancer patients leads to a 30%–60% likelihood of long-term disease-free survival and to a substantial 5-year survival rate, even when surgery and drug therapy prove not to be curative [6]. Unfortunately, a substantial number of patients will subsequently relapse, some rapidly, and we need to discover molecular/genetic profiles that can help predict who among the patients with a single or small number of scan-identified lesions will likely benefit from curative resection and who will not. We hopefully can spare patients the pain and society the expense of fruitless surgeries once those data are available.An expert multidisciplinary committee that included several individuals whose prior published work included recommendations against routine surveillance CT scanning (Loprinzi, Virgo) wrote the most recent 2005 ASCO guidelines that endorse follow-up CT scan screening for patients with stage II and III colorectal cancer [2]. An exhaustive review of the literature available at that time convinced the panel of the value of scans. The review included three meta-analyses, all of which they classified as “highest quality” using the metrics defined by the Oxmann-Guyatt Overview Quality Questionnaire. These three meta-analyses reported a 20%–33% reduction in the risk of death from all causes in the groups of patients who had scans as a routine part of follow-up [4, 7, 8]. Interestingly, this reduction in the odds of death is nearly identical to that reported by Moertel and colleagues for adjuvant therapy of stage III colon cancer [9]. The data on the benefit of adding oxaliplatin to fluorouracil-based therapy provides a lesser incremental benefit [10]. Presumably, Dr. Ryan does offer adjuvant therapy with FOLFOX to his patients with stage III colon cancer after resection. Finally, I am having a hard time with the validity of the cost estimates that Dr. Ryan offers. In summary, I believe the data support CT scan surveillance for patients with stage II or III colorectal cancer and the management of those patients found to have recurrent disease using the “UNC” approach. 相似文献17.
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8月29日为29届奥委会接旗日,象征和平、团结、友谊的五环旗帜将从雅典传到北京,来到神州大地,这预示着2008年北京奥运会周期的开始.为了铭记这一历史时刻,在中华人民共和国卫生部、首都精神文明建设委员会办公室、国家中医药管理局、白求恩医科大学北京校友会支持下;由中华慈善总会、中国抗癌协会癌症康复会主办的<九九方元迎奥运癌症患者及社会各界万人健康长走--手拉手迈向2008工程启动仪式>在京隆重举行. 相似文献
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疾病面前,人人平等。但当面对疾病,选择怎样的治疗态度以及人生道路,却各有不同。有很多人面对癌症时,选择了勇敢面对、积极治疗,并努力将它对自己生活、工作的影响降低到最低。这些人中,有广大平凡的患者,也有一些头顶光环、举足轻重的"大人物",譬如说,他们的身份是总统。 相似文献