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1.
D. Zhang Y. Zheng Z. Wang Q. Huang X. Cao F. Wang S. Liu 《European journal of surgical oncology》2017,43(10):1949-1955
Background
Recently, the 8th edition of the TNM classification of esophageal cancer has come up. The present study aims to compare the 7th and the proposed 8th edition of the AJCC/UICC TNM staging system for esophageal squamous cell carcinoma (ESCC).Methods
A total of 1872 ESCC patients who underwent radical surgery with curative intent were analyzed retrospectively. Survival was analyzed using the Kaplan–Meier method, and values were compared using the log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. The Akaike information criterion (AIC) and the concordance index (c-index) were applied to compare the two prognostic systems.Results
On univariate analysis, the 7th staging system, the proposed 8th staging system, gender, age as well as adjuvant treatment were found to have significant association with overall survival (OS). In both the current staging system and the modified version, age and gender were independent prognostic factors in a multivariate analysis. The AIC value for the proposed 8th version was smaller than that for the 7th staging system; the c-index value for the proposed 8th version was larger than that for the 7th staging system. Subgroup analysis in patients with/without nodal metastasis obtained consistent results.Conclusion
Based on the data from our single center, the proposed 8th AJCC staging system seems to be superior to the 7th AJCC staging system in terms of OS for patients with thoracic ESCC who underwent radical surgery. 相似文献2.
Kaiguo Li Ruyue Wang Shiting Huang Xinbin Pan Hongmin Chen Lei Zhou Junbao Wei Chunhua Wu Xiaodong Zhu Shixiong Liang Song Qu 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(12):e537-e543
Background
Extranodal natural killer/T-cell lymphoma (ENKTL) is a rare lymphoid malignancy with diverse clinical features and prognoses. The aims of this study were to explore the pretreatment prognostic factors of ENKTL and develop a new individual prognostic model.Patients and Methods
We retrospectively enrolled 81 ENKTL patients with newly diagnosed disease between June 2006 and August 2017 at the Affiliated Cancer Hospital of Guangxi Medical University. Survival analysis was used to assess the prognostic value of various factors. A nomogram was developed to predict overall survival (OS) based on the Cox proportional hazards model.Results
The median survival time of the patients was 48 months, and the 5-year OS rate was 47.5%. Cox regression analysis showed that the prognostic factors of OS for ENKTL patients included Eastern Cooperative Oncology Group performance status, Ann Arbor stage, pretreatment albumin-to-globulin ratio, and platelet count. A prognostic nomogram was developed to predict the OS rate for ENKTL patients based on these factors. The calibration curve showed that the nomogram was able to predict OS accurately. The concordance index of the nomogram for OS prediction was 0.807.Conclusion
Our proposed nomogram based on Eastern Cooperative Oncology Group performance status, Ann Arbor stage, albumin-to-globulin ratio, and platelet count provides an individualized risk estimate of OS in patients with ENKTL. 相似文献3.
Yang Yantong Liu Shan Chu Zhijie Zheng Youwei 《European journal of surgical oncology》2018,44(10):1595-1602
Background and Objectives
The prognostic prediction for centrally located hepatocellular carcinoma (CL-HCC) after hepatectomy has not been well established. We aimed to develop prognostic nomograms for patients undergoing hepatectomy for CL-HCC.Methods
A cohort of 380 patients who underwent curative hepatectomy for CL-HCC at our hospital between 2009 and 2015 were retrospectively studied. We randomly divided the subjects into training (n = 210) and validation (n = 170) groups. Univariate and multivariate survival analysis were used to identify prognostic factors. Visually orientated nomograms were constructed using Cox proportional hazards models. The performance of the nomogram was evaluated by the area under the ROC curve (AUC), calibration curve and compared with the conventional staging systems.Results
The statistical nomogram for OS built on the basis of ALBI grade, tumor number, tumor size, classification, hepatectomy methods, capsule formation and microvascular invasion (MVI) had good calibration and discriminatory abilities, with AUC of 0.746 (65-month survival). The nomogram for DFS was based on tumor number, tumor size, classification, HBV-DNA load, capsule formation and MVI, with AUC of 0.733 (65-month survival). These nomograms showed satisfactory performance in the validation cohort (AUC, 0.733 for 65-month OS; and 0.702 for 65-month DFS). The AUC of our nomograms were greater than those of conventional staging systems in the validation cohort.Conclusion
The established nomograms might be useful for estimating survival for patients with CL-HCC after liver resection. 相似文献4.
Guru Sonpavde Gregory Russell Pond Jonathan E. Rosenberg Toni K. Choueiri Joaquim Bellmunt Ashley Marie Regazzi Stephanie A. Mullane Andrea Necchi Daniele Raggi Jae-Lyun Lee Soonil Lee Joe Simpson Christina Louise Derleth Shih-Wen Lin Dean F. Bajorin 《Clinical genitourinary cancer》2018,16(4):e961-e967
Introduction
Optimal end points in phase 2 trials evaluating salvage therapy for metastatic urothelial carcinoma are necessary to identify promising drugs, particularly immunotherapeutics, where response and progression-free survival may be unreliable. We developed a nomogram using data from phase 2 trials of historical agents to estimate the 12-month overall survival (OS) for patients to which observed survival of nonrandomized data sets receiving immunotherapies could be compared.Patients and Methods
Survival and data for major prognostic factors were obtained from phase 2 trials: hemoglobin, performance status, liver metastasis, treatment-free interval, and albumin. A nomogram was developed to estimate 12-month OS. Patients were randomly allotted to discovery:validation data sets in a 2:1 ratio. Calibration plots were constructed in the validation data set and data bootstrapped to assess performance. The nomogram was tested on external nonrandomized cohorts of patients receiving pemetrexed and atezolizumab.Results
Data were available from 340 patients receiving sunitinib, everolimus, docetaxel + vandetanib, docetaxel + placebo, pazopanib, paclitaxel, or docetaxel. Calibration and prognostic ability were acceptable (c index = 0.634; 95% confidence interval [CI], 0.596-0.652). Observed 12-month survival for patients receiving pemetrexed (n = 127, 23.5%; 95% CI, 16.2-31.7) was similar to nomogram-predicted survival (19%; 95% CI, 16.5-21.5; P > .05), while observed results with atezolizumab (n = 403, 39.0%; 95% CI, 34.1-43.9) exceeded predicted results (24.6%; 95% CI, 23.4-25.8; P < .001).Conclusion
This nomogram may be a useful tool to interpret results of nonrandomized phase 2 trials of salvage therapy for metastatic urothelial carcinoma by assessing the OS contributions of drug intervention independent of prognostic variables. 相似文献5.
Chan Kim Woo Ram Kim Ki-Yeol Kim Hong Jae Chon Seung Hoon Beom Hyojoong Kim Minkyu Jung Sang Joon Shin Nam Kyu Kim Joong Bae Ahn 《Clinical colorectal cancer》2018,17(3):e513-e518
Background
Patients with stage I colorectal cancer (CRC) have excellent prognosis after curative surgery. However, approximately 5% to 10% of patients experience recurrence and have a poor prognosis. Because the incidence of stage I CRC is increasing with active screening programs worldwide, a more accurate and easy-to-use predictive tool for recurrence is becoming more important. This study aimed to develop a predictive nomogram for recurrence in stage I CRC.Patients and Methods
A total of 1538 patients who underwent curative surgery for stage I CRC were enrolled. Predictive factors for recurrence were determined by multivariate Cox regression model and were used to develop a predictive nomogram. This model was internally validated, and performance was evaluated through calibration plots.Results
The cumulative recurrence rate at 5 years after surgery for stage I CRC was 5.3%. In multivariate Cox analysis, independent predictors of recurrence were tumor location at rectum, pT2 stage, and presence of lymphovascular invasion. The 5-year recurrence rate was significantly different depending on the number of risk factors (0.7% for 0, 5.8% for 1, and 9.7% for ≥ 2 risk factors). On this basis, a nomogram for recurrence-free survival was developed and internally validated. The concordance index of the nomogram was 0.71, and the performance was acceptable.Conclusion
We developed and internally validated a nomogram that can predict postoperative recurrence in stage I CRC patients. This nomogram may be used to more accurately stratify the risk of recurrence and to perform personalized postoperative surveillance in stage I CRC patients. 相似文献6.
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7.
Y.-K. Chao W.-Y. Chuang H.-K. Chang C.-K. Tseng C.-J. Yeh Y.-H. Liu 《European journal of surgical oncology》2017,43(1):234-239
Background
The purpose of this study was to investigate the prognosis and its predictors in patients with esophageal squamous cell carcinoma (ESCC) who achieve major histopathological response (MaHR) after neoadjuvant chemoradiotherapy (nCRT).Methods
We examined a total of 187 ESCC patients who achieved MaHR following nCRT and survived the perioperative period. MaHR was defined as either absence or <10% vital residual tumor cells (VRTC) in the resected esophagus without nodal involvement. Univariate and multivariate analyses were used to identify factors significantly associated with overall survival (OS).Results
At the time of analysis, 113 patients (60.4%) were dead (5-year OS = 48%; median survival time = 54.8 months). The amount of VRTC (1–10% versus 0% VRTC; hazard ratio [HR] = 1.9, P < 0.001) and the thoroughness of histopathological examination (standard [≤ 4 tumor blocks] versus thorough [> 4 tumor blocks], HR = 1.57; P = 0.013) were independent predictors of OS in multivariate analysis. A stepwise increase in OS was observed in the following groups: patients with 1–10% VRTC identified by the standard protocol, patients with 1–10% VRTC identified by the thorough protocol, patients with 0% VRTC identified by the standard protocol, and patients with 0% VRTC identified by the thorough protocol (5-year OS rates = 20%, 40%, 50%, and 62%, respectively, P < 0.001).Conclusions
In ESCC patients who achieve MaHR after nCRT, the presence of microscopical residual disease and the thoroughness of histopathological examination are associated with survival. 相似文献8.
Wei Song Chang-guang Lv Dong-liu Miao Zhi-gang Zhu Qiong Wu Yong-gang Wang Lei Chen 《European journal of surgical oncology》2018,44(10):1657-1665
Background
This study aimed to develop and validate nomograms for predicting long-term overall survival (OS) and cancer-specific survival (CSS) in gastrointestinal stromal tumours (GISTs).Methods
Patients diagnosed with GISTs between 2004 and 2015 were selected for the study from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly separated into the training set and the validation set. Multivariate analysis was used on the training set to obtain independent prognostic factors to build nomograms for predicting 3- and 5-year OS and CSS. The discrimination and calibration plots were used to evaluate the predictive accuracy of the nomograms.Results
Data for a total of 5622 patients with GISTs were collected from the SEER database. Nomograms were established based on variables that were significantly associated with OS and CSS identified by the Cox regression model. The nomograms for predicting OS and CSS displayed better discrimination power than did the SEER stage and Tumour-Node-Metastasis (TNM) staging systems (7th edition) in the training set and validation set. Calibration plots of the nomograms indicated that OS and CSS closely corresponded to actual observation.Conclusions
The nomograms were able to more accurately predict 3- and 5-year OS and CSS of patients with GISTs than were existing models. 相似文献9.
Huaqiang Zhou Yaxiong Zhang Zeting Qiu Gang Chen Shaodong Hong Xi Chen Zhonghan Zhang Yan Huang Li Zhang 《Clinical lung cancer》2018,19(2):e195-e203
Background
The objective of this study was to evaluate the probability of cause-specific death and other causes of death in patients with stage I non–small-cell lung cancer (NSCLC) who underwent surgery. We also built competing risk nomograms to predict the prognosis of patients with NSCLC.Patients and Methods
Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We identified patients who underwent surgery with stage I NSCLC between 2004 and 2013. We estimated the cumulative incidence function (CIF) for cause-specific death and other causes of death, and tested the differences using Gray’s test. The Fine and Gray proportional subdistribution hazard approach was applied to model CIF. We also built competing risk nomograms on the basis of Fine and Gray’s model.Results
We identified 20,850 stage I NSCLC patients from 2004 to 2013 in the SEER database. The 5-year cumulative incidence of cause-specific death for stage I NSCLC was 21.9% and 14.2% for other causes of death. Variables associated with cause-specific mortality included age, sex, marital status, histological grade, TNM stage, and surgery. The nomograms were well calibrated, and had good discriminative ability, with a c-index of 0.64 for the cancer-specific mortality model and 0.66 for the competing mortality model.Conclusion
We evaluated the CIF of cause-specific death and competing risk death in patients with surgically resected stage I NSCLC using the SEER database. We also built proportional subdistribution models and the first competing risk nomogram to predict prognosis. Our nomograms show a relatively good performance and can be a convenient individualized predictive tool for prognosis. 相似文献10.
Kimiharu Takamatsu Ryuichi Mizuno Minami Omura Shinya Morita Kazuhiro Matsumoto Kazunobu Shinoda Takeo Kosaka Toshikazu Takeda Toshiaki Shinojima Eiji Kikuchi Hiroshi Asanuma Masafumi Oyama Shuji Mikami Mototsugu Oya 《Clinical genitourinary cancer》2018,16(4):e927-e933
Background
Almost half of patients with metastatic renal-cell carcinoma (mRCC) are classified as intermediate risk by the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model. The aim of this study was to evaluate whether baseline C-reactive protein (CRP) levels predict overall survival (OS) in intermediate-risk group mRCC patients.Patients and Methods
Data from 107 intermediate-risk group mRCC patients receiving first-line targeted therapy were retrospectively reviewed. We evaluated the correlation between baseline CRP levels as well as other indices and OS.Results
Of the 107 patients with intermediate-risk disease, 46 patients (43%) were classified as having elevated CRP levels. The elevation of pretreatment serum CRP levels was the independent prognostic factor of OS in patients with intermediate risk (hazard ratio, 4.609; P = .001). The 1- and 3-year survival rates of patients with intermediate–nonelevated CRP were 90.0% and 64.7% compared to the favorable-risk group, at 92.1% and 68.5%, respectively. In contrast, the 1- and 3-year survival rates of patients with intermediate–elevated CRP were 80.5% and 37.4% compared to the poor-risk group, at 65.2% and 24.2%, respectively.Conclusion
Baseline CRP levels could divide mRCC patients in the intermediate-risk group into 2 prognostic subgroups. 相似文献11.
Weerapat Owattanapanich Eakkapol Utchariyaprasit Adisak Tantiworawit Ekarat Rattarittamrong Pimjai Niparuck Teeraya Puavilai Jakrawadee Julamanee Pirun Saelue Chantiya Chanswangphuwana Chantana Polprasert Wasithep Limvorapitak Nonglak Kanitsap Chinadol Wanitpongpun Chajchawan Nakhakes Chantarapa Sriswasdi Kannadit Prayongratana 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(12):e509-e514
Background
Elderly patients with acute myeloid leukemia (AML) have a poorer prognosis than younger ones. Several factors contribute to the poor outcomes for this patient group.Patients and Methods
This study investigated the epidemiology, clinical characteristics, treatment, and clinical outcomes of elderly Thai patients with AML. This 3-year, prospective, multicenter study was focused on Thai patients with AML aged over 60 years who were diagnosed between 2014 and 2016.Results
Of 680 patients with AML, 235 elderly patients with AML (34.6%) were identified, with a mean age of 70 ± 8 years. Using a 3-group cytogenetic risk classification (favorable, intermediate, and adverse risk), the proportions of patients in each category were 3.6%, 73.8%, and 22.6%, respectively. The median follow-up time for surviving patients was 846 days. The median overall survival (OS) of the patients was 128.2 days (range, 0-1205 days), with a 1-year OS of 13%. From a multivariate analysis, the significant factors associated with an improved long-term OS were patients with an Eastern Cooperative Oncology Group performance status 0 to 2 and those receiving intensive therapy.Conclusion
Our study confirms the high prevalence of AML in elderly patients with generally poor outcomes. Selected patients with a good performance status and those who received intensive induction treatment could have a long-term survival. 相似文献12.
Background
The purpose of this study was to investigate the impact of splenic node dissection on short-term outcomes and survival after esophagectomy in patients with thoracic esophageal squamous cell carcinoma (ESCC).Methods
We retrospectively analyzed the clinical data of 1282 consecutive patients with thoracic ESCC who underwent esophagectomy in the First Affiliated Hospital of Zhengzhou University from January 2005 to December 2013.Results
Of all 1282 patients, there were 964 without splenic node dissection and 318 with splenic node dissection. The average operative time in the splenic node nondissection group was significantly shorter than dissection group, and blood loss in the nondissection group was significantly less than dissection group (all p < 0.05). The comparison of overall survival curves between the splenic node nondissection group and dissection group showed no significant difference (p > 0.05). In the dissection group, there were 15 patients (4.7%) with confirmed splenic node metastasis by postoperative pathologic examination. Patients with splenic node metastasis had a worse cumulative survival compared with those without splenic node metastasis (p < 0.05). Compared with nondissection group, prophylactic splenic node dissection failed to improve the survival rate significantly (p > 0.05).Conclusion
The frequency of splenic node metastasis is low in thoracic ESCC. Splenic node metastasis indicates a worse prognosis for patients with thoracic ESCC. Splenic node dissection might be futile for patients with thoracic ESCC. 相似文献13.
C.-Y. Tsai C.-J. Yeh Y.-K. Chao H.-K. Chang C.-K. Tseng Y.-H. Liu 《European journal of surgical oncology》2017,43(10):1970-1976
Background
The prognostic impact of perineural invasion (PNI) in patients with esophageal cancer who receive neoadjuvant chemoradiotherapy (nCRT) remains unclear.Methods
A thorough pathological review of PNI was performed on post-nCRT esophagectomy specimens obtained from non-ypT0 patients with esophageal squamous cell carcinoma (ESCC). When PNI was identified, it was classified according to the presence or absence of penetration through the nerve sheath (i.e., PNI surrounding the nerve sheath [PNI-SS] versus PNI penetrating through the nerve sheath [PNI-TS]). The impact of PNI on overall survival (OS) was assessed in combination with clinical and pathological risk factors.Results
A total of 177 eligible patients were identified between 1998 and 2008. PNI was identified in 43.5% (77/177) of participants. Of them, 33 and 44 had PNI-SS and PNI-TS, respectively. The 5-year OS rate of patients with PNI-TS was significantly lower (6.7%) than that observed in those without PNI (30.6%, P < 0.001). However, the 5-year OS observed in the latter group did not differ significantly from that of patients with PNI-SS (26%, P = 0.68). Multivariate analysis identified PNI-TS (hazard ratio [HR] = 1.965, P = 0.02), LVI (HR = 1.514, P = 0.048), and ypN2 stage (HR = 2.39, P = 0.007) as independent adverse prognostic factors for OS.Conclusions
The presence of PNI-TS after nCRT is associated with poor survival. A thorough assessment of distinct PNI patterns (i.e., PNI-TS versus PNI-SS) should be part of the routine post-nCRT histopathological work-up of ESCC patients. 相似文献14.
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15.
Weiye Deng Ting Xu Yujin Xu Yifan Wang Xiangyu Liu Yu Zhao Pei Yang Zhongxing Liao 《Journal of thoracic oncology》2018,13(12):1968-1974
Introduction
The positive-to-resected lymph node ratio (LNR) predicts survival in many cancers, but little information is available on its value for patients with N2 NSCLC who receive postoperative radiotherapy (PORT) after resection. We tested the applicability of prognostic scoring models and heat mapping to predict overall survival (OS) and cancer-specific survival (CSS) in patients with resected N2 NSCLC and PORT.Methods
Our test cohort comprised patients identified from the Surveillance, Epidemiology, and End Results database with N2 NSCLC who received resection and PORT in 2000–2014. Prognostic scoring models were developed to predict OS and CSS using Cox regression; heat maps were constructed with corresponding survival probabilities. Recursive partitioning analysis was applied to the Surveillance, Epidemiology, and End Results data to identify the optimal LNR cutoff point. Models and cutoff points were further tested in 183 similar patients treated at The University of Texas M. D. Anderson Cancer Center in 2000–2015.Results
Multivariate analyses revealed that low LNR independently predicted better OS and CSS in patients with resected N2 NSCLC who received PORT.Conclusions
LNR can be used to predict survival of patients with resected N2 NSCLC followed by PORT. This approach, which to our knowledge is the first application of heat mapping of positive and negative lymph nodes, was effective in estimating 3-, 5-, and 10-year OS probabilities. 相似文献16.
Waqar Haque Vivek Verma E. Brian Butler Bin S. Teh 《Clinical genitourinary cancer》2018,16(1):42-49.e1
Purpose
Management of cT4b bladder cancer is poorly defined; national guidelines recommend chemotherapy (CT) alone or chemoradiation (CRT). Using a large, contemporary dataset, we evaluated national practice patterns as well as associated outcomes, especially with respect to radical cystectomy (RC) and CRT versus CT alone.Methods
The National Cancer Data Base was queried (2004-2013) for patients diagnosed with cT4bN0-3M0 bladder cancer. Patients were divided into 5 treatment groups: CT alone, CRT, RC (with/without CT/radiotherapy [RT]), other treatment (subtherapeutic RT with/without CT), or no treatment. Statistics included multivariable logistic regression to determine factors predictive of observation, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS.Results
Of 896 total patients, 185 (20.6%) underwent CT alone, 80 (8.9%) CRT, 161 (18.9%) RC, 221 (24.7%) other treatments, and 249 (27.8%) observation. Differences in treatment paradigms were appreciated based on age, gender, nodal status, insurance, and facility-related parameters. Observation yielded a median OS of 3.7 months, lower than CT alone (P < .001). As compared with the latter, CRT was associated with higher OS (10.5 vs. 12.1 months, P = .004). RC-based treatment displayed the numerically highest OS (14.2 months) and was statistically similar to CRT (P = .676). Treatment with any modality independently predicted for superior OS over observation.Conclusions
In the largest study of its kind, a surprisingly high proportion of patients underwent observation. CRT is associated with higher survival over CT alone, and carefully selected patients undergoing RC may experience prolonged survival. 相似文献17.
Jun Lu Chao-hui Zheng Long-long Cao Ping Li Jian-wei Xie Jia-bin Wang Jian-xian Lin Qi-yue Chen Mi Lin Chang-ming Huang 《European journal of surgical oncology》2017,43(12):2349-2356
Background
The 8th edition of the AJCC TNM staging system for gastric cancer was released in 2016 and included major revisions, especially of stage III.Patients and Methods
Data from 3281 patients with GC who underwent R0 resection between December 2006 and November 2014 were reviewed. Of them, 1579 patients with stage III according to the seventh edition were analyzed and the 7th and 8th TNM classifications were compared.Results
The most important tumor stages change observed in stage III GC. For stage III patients, the median number of lymph nodes (LNs) resected in stage III patients was 33 (range 5–112), and the optimal cut-off value for the number of LNs resected was 30. Although the 7th edition classification had higher c-index, linear trend and likelihood ratio χ2 scores, and smaller AIC values compared with those for the 8th edition, which represented the optimum prognostic stratification, however, the differences between 7th and 8th edition seems to be not statistically significant, and AIC demonstrates similar trend as well. Further subgroup analysis found that the 8th staging system generated the marginally better prognostic stratification only when LNs removed ≥30.Conclusion
The 8th TNM classification may provide better accuracy than 7th edition in predicting the prognosis of stage III GC after R0 resection with LNs harvested ≥30. However, further research in an external validation setting is warranted. 相似文献18.
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
Background
Even though the perioperative chemotherapy improves the overall survival (OS) compared to surgery alone in patients with a resectable gastroesophageal adenocarcinoma (GEA), prognosis of these patients remains poor. Docetaxel (D), cisplatin (C), and 5-fluorouracil (F) regimen improves OS compared to CF among patients with advanced GEA. We evaluated the potential interest of a perioperative DCF regimen, compared to standard (S) regimens, in resectable GEA patients.Methods
We identified 459 patients treated with preoperative DCF or S regimens. The primary endpoint was OS. Propensity scores were estimated with a logistic regression model in which all baseline covariates were included. We then used two methods to take PS into account and thus make DCF and S patients comparable. OS analyses were performed with Kaplan–Meier and Cox models in propensity score matched samples, and inverse probability of treatment weighted (IPTW) samples.Results
In the propensity score matched sample, the p-value from the log rank test for OS was 0.0961, and the 3-year OS rate was 73% and 55% in DCF and S groups, respectively. The multivariate Cox regression underlined a Hazard Ratio of 0.55 (95% CI 0.27–1.13) for DCF patients compared to S patients. The results from IPTW analyses showed that DCF was significantly and independently associated with OS (HR = 0.52; 95% CI 0.40–0.69).Conclusions
In this retrospective multicenter, hypothesis-generating study, the propensity score analyses underlined encouraging results in favor of DCF compared to S regimens regarding OS. This promising result should be validated in a phase-3 trial. 相似文献19.
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20.
Jinning Ye Yufeng Ren Zhewei Wei Xun Hou Weigang Dai Shirong Cai Min Tan Yulong He Yujie Yuan 《Surgical oncology》2018,27(2):146-153