Effect of preoperative neutrophil�Clymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy

Background and aims

Selection of appropriate stage II colon cancer patients for adjuvant chemotherapy is critical for improving survival outcome. With the aim of identifying more high risk factors for stage II colon cancer, this study aimed to determine whether the neutrophil?Clymphocyte ratio (NLR) is a predictor of surgical outcomes in patients with stage II colon cancer who do not receive adjuvant chemotherapy.

Materials and methods

We enrolled 1,040 stage II colon cancer patients who had undergone colectomy at a single institution between January 1995 and December 2005 and did not receive adjuvant chemotherapy.

Results

Of these 1,040 patients, 785 (75.5%) patients had a normal NLR and 255 (24.5%) had an elevated NLR. Those with an elevated NLR included patients ??65?years, T4b cancer, carcinoembryonic antigen ??5?ng/mL, and tumor obstruction or perforation. Patients with an elevated NLR had a significantly worse overall survival (OS) and worse disease-free survival (DFS) than did patients with a normal NLR. Cox regression analysis revealed that elevated NLR was an independent predictor of OS (P=0.012) but not DFS (P=0.255).

Conclusion

An elevated NLR is an independent predictor of OS but not DFS in stage II colon cancer patients who did not receive adjuvant chemotherapy. Preoperative NLR measurement in stage II colon cancer patients may be a simple method for identifying patients with a poor prognosis who can be enrolled in further trials of adjuvant chemotherapy.     

Postoperative Fever and Survival in Patients after Open Resection for Colorectal Cancer: A Long-Term Follow-Up Study of 2,311 Prospectively Enrolled Patients

Purpose  Two reports on the impact of postoperative fever on survival after surgery in patients with colorectal cancer yielded contradictory results. Our study examined possible associations between postoperative fever and long-term survival of patients who underwent resection of colorectal cancer. Methods  We investigated 2,311 consecutive patients who underwent elective open colorectal resection for primary colorectal cancer at a single institution between 1995 and 1998. The primary end points were cancer-specific and overall survival. Multiple covariate impact of risk factors on survival rates was assessed by Cox regression analysis. Results  A total of 252 patients (12.2 percent) developed postoperative fever. The most important independent risk factor for postoperative fever was postoperative morbidity (odds ratio, 4.9; 95 percent confidence interval, 3.7–6.6) followed by blood transfusion (1.7; 1.2–2.2), Stage IV disease (1.6; 1.1–2.2), male gender (1.4; 1.0–1.9), and rectal cancer (1.4; 1.0–1.8). Cox regression modeling indicated that stage, histology, tumor location, and blood transfusion were statistically significant covariate predictors for cancer-specific survival. Postoperative fever was not independently associated with cancer-specific or overall survival. Conclusions  This study did not support the hypothesis that postoperative fever is an independent prognostic factor after colorectal resection for primary colorectal cancer.     

Hepatitis B virus genotype B results in better immediate, late and sustained responses to peginterferon-alfa in hepatitis-B-e-antigen-positive patients

Background and Aims: This study investigated outcome predictors in hepatitis‐B‐e‐antigen (HBeAg)‐positive chronic hepatitis B patients treated with peginterferon alfa‐2a. Methods: A total of 88 HBeAg‐positive patients receiving peginterferon alfa‐2a for 6 months and followed up for at least 24 weeks were prospectively analyzed. Precore and core promoter genes of hepatitis B virus (HBV) were sequenced from the serial serum samples of 88 patients. Results: After 24 weeks of follow up, 38.6% and 28.4% of patients achieved HBeAg clearance and combined response, respectively. Multivariate analysis disclosed that pretreatment HBeAg sample to cut‐off (S/Co) ratio ≤ 200, alanine aminotransferase > 200 IU/mL, HBV genotype B and T1846 were independent factors for HBeAg clearance, and HBeAg S/Co ratio ≤ 200 and HBV genotype B were major determinants for combined response. HBeAg S/Co ratio ≤ 10 at week 12 of therapy was the useful factor for treatment response and had a greater power (P = 0.012) to predict HBeAg clearance than HBV DNA. Patients with HBeAg clearance had a higher frequency of A1896 mutation at baseline and during therapy than those without HBeAg clearance, and the frequency of A1896 decreased during treatment. During follow up, delayed HBeAg seroconversion and reactivation of HBV after HBeAg clearance were observed in eight non‐responders and 20 patients with HBeAg clearance, respectively. HBV genotype B was a significant factor to predict both responses. Conclusions: Pretreatment HBeAg S/Co ratio ≤ 200 and HBV genotype B were major determinants for treatment response to peginterferon. Genotype‐B‐infected patients had higher probability of delayed HBeAg clearance and sustained response. Rapid decrease of HBeAg titer was useful on treatment predictor.     

Inter-observer variability of portal hemodynamics measured by Doppler ultrasound on three different locations of portal vein

Doppler ultrasound is a noninvasive modality for portal hemodynamic study. However, inter-observer variability has been observed. This study has investigated ways to produce less inter-observer variability. Doppler ultrasound portal vein hemodynamic studies were carried out by three well-trained specialists on 20 healthy hospital staff members. The intra-hepatic, first branch, right portal vein, the hilar portal vein, and the extra-hepatic portal vein were chosen for study. With respect to the diameter of portal veins, a significant inter-observer variability was found for the first branch right portal vein and the extra-hepatic portal vein, but not for the hilar portal vein. For maximal portal vein velocity studies, inter-observer variability was not found at any location. A significant failure rate was noted for the measurement of extra-hepatic portal vein velocity. Only 8 volunteers had complete data from all of the three investigators. A significant variability was also noted for the average velocity of extra-hepatic portal vein. We conclude that Doppler ultrasound hemodynamic studies of the hilar portal vein has the most acceptable inter-observer variability and thus should be used for longitudinal portal hemodynamic studies. © 1996 John Wiley & Sons, Inc.     

Mucin-producing cholangiocarcinoma: Clinical experience of 24 cases in 16 years

Objective Mucin-producing cholangiocarcinoma (MPCC) is an uncommon biliary tract malignancy. This retrospective study was designed to investigate the clinical presentations, associated diseases, the value of tumor markers, and treatment and prognosis of MPCC. Material and methods The study included 24 MPCC cases (7 M, 17 F) from 132 histopathology-proven cholangiocarcinoma patients seen between 1988 and 2003. MPCC and non-mucin-producing cholangiocarcinoma (non-MPCC) were compared. Results Common clinical symptoms and signs included epigastric or right upper quadrant pain, fever and chills, jaundice, and anemia. Seventeen patients had mucobilia in surgical, cholangiographic, or CT findings. Biliary stones were found in 71% of MPCC patients. In detecting MPCC, a serum CA-19-9 level >120 U/ml had 73% sensitivity, 41% specificity, 25% positive predictive value, 85% negative predictive value, and 48% accuracy in the 132 cholangiocarcinoma patients. The 1-, 2-, 3-, 4-, and 5-year survival rates were 44.3%, 33.8%, 28.1%, 21.1%, and 21.1%, respectively. Univariate analysis showed that tumor type (MPCC) was the only significant factor predicting survival when compared with non-MPCC patients in 5-year cumulative survival rates (21.1% versus 5.4%). MPCC patients receiving surgical resection had a prolonged median survival time (13 months versus 6 months) than those without resection. Conclusions MPCC clinical presentations were similar to non-MPCC in Taiwan except for more jaundice, fever and chills. The major factor predisposing to MPCC was biliary stones. Using serum CA19-9 levels greater than 120 U/ml was a diagnostic aid to detecting MPCC patients. MPCC patients had a better prognosis than non-MPCC patients. The recommended treatment for MPCC is surgical resection.     

A comparison of 4-year entecavir efficacy in nucleos(t)ide analog-naïve and -experienced adult Taiwanese chronic hepatitis B patients

Purpose

To compare the efficacy of entecavir (ETV) monotherapy up to 4 years in nucleos(t)ide analog (NA)-experienced and -naïve subjects.

Methods

One hundred sixty NA-experienced and 282 naïve chronic hepatitis B patients who were treated with ETV were enrolled. Of the 160 NA-experienced patients, 49 had prior lamivudine (LAM)-resistant mutants, 18 had resistant mutants to LAM followed by adefovir (ADV) after switching to ADV sequential therapy (LAM/ADV resistance), and 9 had prior ADV-resistant mutants. NA-resistant mutants were detected by line probe assay.

Results

Four years of ETV therapy resulted in virological response (VR, HBV DNA < 300 copies/ml), HBeAg seroconversion, and ETV-resistant mutants development in 98.2, 45.2, and <1 % of naïve patients, respectively. LAM- and ADV-experienced patients who never developed LAM-resistant mutants had similar VR and ETV-resistant mutant rates to NA-naïve patients. In contrast, prior LAM-resistant mutants were significantly associated with higher ETV-resistant mutants development and reduced VR rates. Patients with prior LAM-resistant mutants but not at baseline had a lower rate of ETV-resistant mutants compared to those with baseline LAM-resistant mutants [hazard ratio (HR): 0.58, 95 % confidence interval (CI): 0.35–0.95] and those who had LAM/ADV resistance (HR:0.16, 95 % CI:1.0.03–0.76). Early add-on ADV achieved VR in eight of nine patients with ETV-resistant mutants when HBV DNA was <2 × 10⁵ copies/ml.

Conclusions

Entecavir was highly efficacious and low resistance in NA-naïve, LAM-, or ADV-experienced patients without LAM-resistant mutants. Patients with prior LAM-resistant mutants but not at baseline had lower ETV-resistant mutant rates compared to those with baseline LAM-resistant mutants or LAM/ADV resistance.