scholarly journals Evaluation of Four Lymph Node Classifications for the Prediction of Survival in Hilar Cholangiocarcinoma

2022 ◽  
Author(s):  
Zhi-Peng Liu ◽  
Qing-Yi Zhang ◽  
Wei-Yue Chen ◽  
Yu-Yan Huang ◽  
Yan-Qi Zhang ◽  
...  
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Curative Resection ◽  
Staging System ◽  
Prognostic Indicator ◽  
Patient Death ◽  
Predictive Capacity ◽  
Factors Affecting ◽  
Post Surgery ◽  
Staging Systems ◽  
The Impact

Abstract Background An important prognostic indicator of hilar cholangiocarcinoma (HCCA) in patients after surgery is metastasis of lymph nodes (LN). However, there are many types of LN staging systems to the issue of a better determination of the prognosis of patients through the lymphatic staging system which needs research. Based on the above, we tried to re-evaluate the staging system of HCCA LNs. We compared the American Joint Committee on Cancer (AJCC), number of metastatic LNs (MLN), ratio of LN (LNR), and log odds of MLNs (LODDS) in individuals undergoing curative resection to determine the best LN staging system. Methods In the current study, we retrospectively analyzed 229 patients undergoing curative resection. We evaluated the impact of the stage of AJCC pN, LNR, LODDS, and MLN on OS (overall survival) and RFS (recurrence-free survival). According to the curve of receiver operating characteristic (ROC), we compared the predictive capacity of different staging systems of LN for survival and recurrence. Results Multivariate analysis results revealed that LODDS >  − 0.45 (95% CI = 1.115–2.709, P = 0.015; 95% CI = 1.187–2.780, P = 0.006) are independent risk factors affecting OS and RFS, respectively. Compared with LN status, AJCC pN stage, MLN, and LNR, the variable having the highest area under the ROC curve (AUC) was LODDS when predicting 1-year, 3-year, and 5-year OS and RFS. Conclusion This study shows that metastasis of LNs is a key indicator for predicting patient death and recurrence. Among them, LODDS is the best LN staging system for the prognostic evaluation of HCCA patients after surgery. Clinicians can incorporate LODDS into HCCA patient lymphatic staging system for a more accurate prognosis of HCCA patients post-surgery.

Perioperative proADM-change is associated with the development of acute respiratory distress syndrome in critically ill cardiac surgery patients: a prospective cohort study

2019 ◽  
Vol 13 (13) ◽  
pp. 1081-1091
Author(s):  
Judith van Paassen ◽  
Jaap T van Dissel ◽  
Pieter S Hiemstra ◽  
Jaap Jan Zwaginga ◽  
Christa M Cobbaert ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Mixed Models ◽  
Distress Syndrome ◽  
Predictive Capacity ◽  
Post Surgery ◽  
Definition Of ◽  
The Impact

Aim: Biomarkers of acute respiratory distress syndrome (ARDS) after cardiac-surgery may help risk-stratification and management. Preoperative single-value proADM increases predictive capacity of scoring-system EuroSCORE. To include the impact of surgery, we aim to assess the predictive value of the perioperative proADM-change on development of ARDS in 40 cardiac-surgery patients. Materials & methods: ProADM was measured in nine sequential blood samples. The Berlin definition of ARDS was used. For data-analyses, a multivariate model of EuroSCORE and perioperative proADM-change, linear mixed models and logistic regression were used. Results: Perioperative proADM-change was associated with ARDS after cardiac-surgery, and it was superior to EuroSCORE. A perioperative proADM-change >1.5 nmol/l could predict ARDS. Conclusion: Predicting post-surgery ARDS with perioperative proADM-change enables clinicians to intensify lung-protective interventions and individualized fluid therapy to minimize secondary injury.

Impact of the T and N stage in the American Joint Committee on Cancer (AJCC) 8th edition staging system for pancreatic cancer with curative resection.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 261-261
Author(s):  
Akiko Todaka ◽  
Akira Fukutomi ◽  
Mitsuhiro Furuta ◽  
Hiromichi Shirasu ◽  
Masahiro Kawahira ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Treatment ◽  
Tumor Size ◽  
Curative Resection ◽  
Staging System ◽  
Median Number ◽  
New Classification ◽  
N Classification ◽  
N Stage ◽  
The Impact

261 Background: The 8th edition of the AJCC staging system for pancreatic cancer contains several changes. T and N classification incorporate tumor size and number of positive lymph node (LN). The aim of this study was to evaluate the impact on the outcomes of the new classification for the patients who underwent curative resection and received adjuvant treatment with S-1. Methods: We retrospectively reviewed 96 patients who underwent curative resection for pancreatic ductal adenocarcinoma and received adjuvant treatment with S-1 (40, 50, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14-day rest, every 6 weeks [one cycle], for up to four cycles) at our institution between January 2007 and December 2015. Inclusion criteria were as follows: PS0/1, adequate-organ functions, no critical complication, start of adjuvant therapy within 10 weeks after resection, and no active concomitant malignancy. Results: 66 patients were satisfied with these criteria. Patients characteristics were as follows: median age 67 years (range, 43-83), male 40 (61%), Pancreatoduodenectomy / Distal / Total pancreatectomy 50/14/2, combined portal vein or superior mesenteric vein resection 25 (38%), no postoperative complication 25 (38%), Well/Moderately/Poorly differentiated type 23/41/2, the median tumor size 30mm (range, 13-130), the median number of dissected LN 25 (range, 10-60), the median number of positive LN 2 (range, 0-8), and the resection margin status (R0/1) 62/4. The distribution in the 8th edition (1A/1B/2A/2B/3) was 6(9%) / 10(15%) / 5(8%) / 36(54%) / 9(14%), respectively. 2-year overall survival (OS) and relapse-free survival (RFS) were 70% and 52%. In the 8th edition staging system (1A/1B/2A/2B/3), 2-year OS and RFS were 100/90/80/66/40% and 83/70/53/49/22%, respectively. 2-year OS and RFS by T classification according to AJCC 8th edition were 100/68/56% and 90/39/56% (T1/2/3), while those by N classification were 90/66/40% and 70/49/22% (N0/1/2), respectively. Conclusions: The survival was poor with progress of the stage in the new classification. Especially at N stage, it might be suggested an association with prognosis.

A randomized phase II trial of adjuvant chemotherapy with cisplatin, epirubicin, 5-fluorouracil, gemcitabine (PEFG regimen) or gemcitabine alone after curative resection for pancreatic cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4608-4608
Author(s):  
M. Reni ◽  
S. Cereda ◽  
G. Aprile ◽  
M. C. Tronconi ◽  
C. Milandri ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Curative Resection ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Single Agent ◽  
R1 Resection ◽  
Post Surgery ◽  
Grade 3 ◽  
Intent To Treat ◽  
The Impact

4608 Background: The PEFG regimen yielded a statistically relevant outcome advantage as compared with gemcitabine (G) in patients with advanced pancreatic adenocarcinoma (PA). The current trial assessed the impact upon disease control of PEFG regimen and single agent G after curative resection for PA. At time of trial design, both arms were experimental since the role of adjuvant therapy in PA was debated. Methods: After R0 or R1 resection for PA, patients with stage IB-III disease, aged 18–70 years, Karnofsky performance status (PS) >60 were randomized within 8 weeks from surgery to receive either G 1 g/m2/weekly Q3 every 4 weeks (Arm A), or PEFG (cisplatin and epirubicin at 40 mg/m2 each on day one, gemcitabine at 600 mg/m2 on days 1 and 8 and 5-FU at 200 mg/m2/day on days 1 to 28) every 4 weeks (Arm B). In both treatment arms chemotherapy was administered for 3 months and followed by radiotherapy (54–60 Gy in 27–30 fractions) with concurrent 5-FU 250 mg/m2/day. A CT scan was performed every three months. The primary endpoint was the probability of being disease-free at 1 year (DFS1y) from surgery. The Fleming design was used to calculate the sample size. Assuming P0=35% and P1=55%, α .05 and β.10, the study was to enroll 51 patients per arm. The treatment arm had to be considered of interest with > 23 patients being DFS1y. Results: Between August 2003 and August 2008, 102 patients were enrolled, stratified by center and resection margin and randomized (51 per arm). All patients were eligible. One patient in arm A and 2 in arm B refused the assigned treatment. An intent-to-treat analysis was performed. Patients’ characteristics were (A/B): median age 61/60, median PS 90/90, stage IIA 19/12%; stage IIB 73/81%; stage III 8/7%; grade 3 30/46; R1 36/30; pre- and post-surgery surgery CA19.9 > upper limit of laboratory normal 68/80% and 29/33%, tumor size > 2.9 cm 41/43%. To date, 41 patients per arm are assessable for the primary endpoint: 19 (46%) and 28 (68%) patients were DFS1. Main G3–4 toxicity was: neutropenia in 21/85% and thrombocytopenia in 0/23% of patients. Conclusions: With a mature follow-up for 80% of patients, PEFG reached the primary endpoint of the trial and warrants further study while G not yet. No significant financial relationships to disclose.

scholarly journals Prognostic Impact of Preoperative Imaging Parameters on Resectability of Hilar Cholangiocarcinoma

HPB Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Anthony T. Ruys ◽  
Olivier R. Busch ◽  
Erik A. Rauws ◽  
Dirk J. Gouma ◽  
Thomas M. van Gulik
Keyword(s):  
Hepatic Artery ◽  
Hilar Cholangiocarcinoma ◽  
Diagnostic Laparoscopy ◽  
Staging System ◽  
Preoperative Imaging ◽  
R0 Resection ◽  
Prognostic Impact ◽  
Cross Sectional ◽  
Staging Systems ◽  
Cross Sectional Imaging

Objectives. To evaluate, in hilar cholangiocarcinoma (HCCA), the prognostic impact of specific preoperative radiologic parameters on resectability, metastases, and yield of laparoscopy, and to evaluate the currently used staging systems. Methods. Consecutive patients with HCCA presenting in our center from January 2003 through August 2010 were evaluated. Suspicion on lymph node metastasis, portal vein and hepatic artery involvement, lobar atrophy, and proximal extent of ductal invasion was scored. The prognostic value of these parameters for predicting resectability, yield of diagnostic laparoscopy, likelihood of metastatic disease, R0 resection, and survival was assessed. The Bismuth-Corlette classification and MSKCC staging system were evaluated. Results. Of all 289 evaluated patients, 158 patients (55%) had unresectable disease based on cross-sectional imaging studies or diagnostic laparoscopy; 131 patients (45%) underwent exploration. 83 patients (64%) underwent resection, of whom 67 (87%) had a radical (R0) resection. Suspicious lymph nodes and involvement of the hepatic artery were important prognostic factors for resectability. Predictive power of the evaluated staging systems was limited. Conclusions. Current staging systems predict resectability, but there is room for improvement. Hepatic artery involvement and nodal status might be important factors for prediction of resectability and should be considered in future staging systems.

Incorporating Biology Into Breast Cancer Staging: American Joint Committee on Cancer, Eighth Edition, Revisions and Beyond

2018 ◽  
pp. 38-46 ◽  
Author(s):  
Elizabeth A. Mittendorf ◽  
John M. S. Bartlett ◽  
Daphne L. Lichtensztajn ◽  
Sarat Chandarlapaty
Keyword(s):  
Breast Cancer ◽  
Tumor Biology ◽  
Staging System ◽  
Cancer Staging ◽  
Her2 Status ◽  
Breast Cancer Staging ◽  
Pathologic Evaluation ◽  
Staging Systems ◽  
Eighth Edition ◽  
The Impact

Higher-quality imaging, refined surgical procedures, enhanced pathologic evaluation, and improved understanding of the impact of tumor biology on treatment and prognosis have necessitated revisions of the AJCC breast cancer staging system. The eighth edition includes clinical and pathologic prognostic stages that incorporate biologic variables—grade, estrogen and progesterone receptor status, HER2 status, and multigene panels—with the anatomic extent of disease defined by tumor, node, and metastasis categories. The prognostic staging systems facilitate more refined stratification with respect to survival than anatomic stage alone. Because the prognostic staging systems are dependent on biologic factors, accuracy is dependent on rigorous pathologic evaluation of tumors and on administration of treatment dictated by tumor biology. It is anticipated that technological advances will facilitate even more refined determination of underlying biology within tumors and in the peripheral blood, which increasingly is being evaluated as a compartment that reflects the primary tumor and sites of distant metastases. Diseases should be staged according to the eighth edition staging system to accurately reflect prognosis and to allow standardized data collection. Such standardization will facilitate assessment of the impact of advances in diagnosis and treatment of patients with breast cancer.

Curative resection for hilar cholangiocarcinoma: Does adjuvant therapy impact overall survival? A multi-institution analysis from the U.S. Extrahepatic Biliary Malignancy Consortium.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 388-388
Author(s):  
Bradley Krasnick ◽  
Linda Jin ◽  
Jesse Davidson ◽  
Cecilia Grace Ethun ◽  
Timothy M. Pawlik ◽  
...  
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Adjuvant Therapy ◽  
Hilar Cholangiocarcinoma ◽  
Curative Resection ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Biliary Malignancy ◽  
The Impact ◽  
The U.S

388 Background: Surgical resection is the cornerstone of curative therapy for localized hilar cholangiocarcinoma. However, the effect of adjuvant therapy (AT) on survival is unclear. We analyzed the impact of AT on overall survival (OS) in those patients undergoing curative resection for hilar cholangiocarcinoma. Methods: We reviewed 294 patients who underwent curative resections for hilar cholangiocarcinoma between 1998 and 2015 from ten institutions participating in the U.S Extrahepatic Biliary Malignancy consortium. We analyzed the impact of AT on the primary outcome of OS. Probability of OS was calculated in the method of Kaplan and Meier and analyzed using multivariate Cox regression analysis. Statistical significance was set at p≤0.05. Results: Mean age was 65 years. OS at 5 years was 16%. A total of 146 patients (50%) received AT. Of these patients, 44 patients underwent solely chemotherapy, 5 underwent only radiation therapy (XRT), and 97 underwent combined therapy. On univariate analysis, patients who received AT and those who did not had similar demographic and preoperative features, with the major difference being in the rate of lymph node (LN) positive disease (50% AT group vs. 19% no AT group, p<0.01). In a multivariate Cox regression analysis, AT conferred a significant protective effect on OS (HR 0.578, p<0.01, 95% CI 0.38-0.86), even when adjusting for age, tumor size, R0 resection status, ASA classification, and LN positivity (Table). Conclusions: AT is associated with improved OS in resected hilar cholangiocarcinoma. This association remains even after adjusting for poor prognostic features. We acknowledge that there is an inherent selection bias when looking at those who underwent AT, and thus future prospective randomized trials are needed. [Table: see text]

scholarly journals Prognostic performance of different lymph node staging systems after curative resection for Siewert type II adenocarcinoma of the esophagogastric junction

2020 ◽  
Author(s):  
Weilin Zhang ◽  
Yong Li
Keyword(s):  
Lymph Node ◽  
Esophagogastric Junction ◽  
Curative Resection ◽  
Staging System ◽  
The Other ◽  
Type Ii ◽  
Siewert Type ◽  
Prognostic Performance ◽  
Siewert Type Ii ◽  
Staging Systems

Abstract Background: The tumor-node-metastasis (TNM) pN stage, which is based on the number of positive lymph nodes (LNs), is an important prognostic factor for patients with adenocarcinoma of the esophagogastric junction (AEG). The lymph node ratio (LNR) and log odds of metastatic lymph nodes (LODDS) staging systems are new effective indicators of prognosis. We aimed to evaluate their prognostic value in Siewert type II AEG.Methods: Patients diagnosed with Siewert type II AEG who underwent curative resection between 2004 and 2014 at Guangdong General Hospital were recruited. A Cox regression model was constructed, and prognostic performance was measured using Harrell’s concordance index (C-index) and the Akaike information criterion (AIC).Results: When LN status was modeled as a continuous variable, the LODDS system (C-index: 0.729; AIC: 940.483) outperformed the other staging systems, including the number of positive LNs (LNP) (C-index: 0.721; AIC: 946.935) and LNR (C-index: 0.725; AIC: 938.918).However,when assessed as categorical variables, the LNR staging system had a better prognostic performance (C-index: 0.752; AIC: 926.350) than the American Joint Committee on Cancer (AJCC) 8th edition TNM pN (C-index: 0.740; AIC: 934.349) and LODDS (C-index: 0.737; AIC: 939.087) staging systems. Each LNR stage is more evenly distributed than the other two staging systems. Moreover, the LODDS stage is more dependent on the TLNE.Conclusion: The LNR represented the best prognostic factor when assessed as a categorical variable and may serve as an alternative nodal staging system for AEG.

DAMPAK KEBIJAKAN FISKAL TERHADAP KINERJA SEKTOR PERTANIAN DI SULAWESI TENGGARA

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
La Ode Jabuddin ◽  
Ayub M Padangaran ◽  
Azhar Bafadal Bafadal
Keyword(s):  
Fiscal Policy ◽  
Interest Rates ◽  
Agricultural Sector ◽  
Simultaneous Equations ◽  
Poor People ◽  
Land Area ◽  
Factors Affecting ◽  
Historical Simulation ◽  
The Impact ◽  
Direct Expenditure

This study aims to: (1) Knowing the dynamics of fiscal policy and the performance of the agricultural sector, (2) Analyze the factors that influence fiscal policy and the performance                   of the agricultural sector, and (3) Analyzing the impact of fiscal policy on the performance of the agricultural sector. The data used in this study were pooled 2005-2013 data in the aggregate. Econometric model the impact of fiscal policy on the performance of the agricultural sector is built in the form of simultaneous equations, consisting of 7 equations with 25 total variables in the model, 7 endogenous variables, 12 exogenous variables, and 6 variables lag. The model is estimated by 2SLS method SYSLIN procedures and historical simulation with SIMNLIN procedure.The results showed that: (1) The development of fiscal policy in Southeast Sulawesi from year to year tends to increase, (2) The performance of the agricultural sector from the aspect of GDP has decreased, from the aspect of labor is still consistent, in terms of investment to grow positively, and assign roles which means to decrease the number of poor people, (3) factors affecting fiscal policy is local revenues, equalization funds, other revenues, as well as the lag fiscal policy, (4) the factors that affect the performance of the agricultural sector from the aspect GDP is labor, direct expenditure and GDP lag; from the aspect of labor is the total labor force, investment, land area, direct expenditure, as well as the lag of labor; from the aspect of investment is influenced by GDP per capita, land area, interest rates and investment lag; as well as from the aspect of poor people, are affected by population, investments, direct expenditure and poverty lag, (5). Fiscal policy impact on the agricultural sector GDP increase, a decrease in the number of poor, declining agricultural laborers, and a decrease in the amount of investment in the agricultural sector.Keywords: Fiscal policy, the performance of the agricultural sector, the simultaneous equations

Structural Model of Service Quality Factors Affecting Loyalty Sustainability

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Eman Al-erqi ◽  
◽  
Mohd Lizam Mohd Diah ◽  
Najmaddin Abo Mosali ◽  
◽  
...  
Keyword(s):  
International Students ◽  
Service Quality ◽  
Goodness Of Fit ◽  
Structural Model ◽  
Quality Factors ◽  
Factors Affecting ◽  
Measurement Models ◽  
Confirmatory Factor ◽  
The University ◽  
The Impact

This study seeks to address the impact of service quality affecting international student's satisfaction towards loyalty tothe Universiti Tun Hussein Onn Malaysia(UTHM). The aim of thestudy is to develop relationship between service quality factor and loyalty to the university from the international students’ perspectives. The study adopted quantitative approach where data was collected through questionnaire survey and analysed statistically. A total of 246 responses were received and found to be valid. The model was developed and analysed using AMOS-SEM software. Confirmatory factor analysis (CFA) function of the software was to assessed the measurement models and found that all the models achieved goodness of fit. Then path analysis function was used to assessed structural model and found that service qualityfactors have a significant effect on the students’ satisfaction and thus affecting the loyaltyto the university. Hopefully the outcome form this study will benefit the university in providing services especially to the international students.

Influence of the ICCPR in Asia

2018 ◽  
Author(s):  
Yogesh Tyagi
Keyword(s):  
Human Rights ◽  
Political Rights ◽  
International Human Rights ◽  
Factors Affecting ◽  
Judicial Discourse ◽  
International Human ◽  
Golden Jubilee ◽  
Civil And Political Rights ◽  
The Impact

The golden jubilee of the International Covenant on Civil and Political Rights (ICCPR) coincides with the emergence of Asia as a centre of global attention. However, greater attention to Asia has been accompanied by some scepticism over its attitude towards human rights. The chapter provides an overall assessment of the impact of the ICCPR on the major Asian States, with an analysis of the factors affecting such influence. The chapter considers the involvement in, observance of, and compliance with the provisions of the ICCPR by these States. It further delves into the academic and judicial discourse on the ICCPR within these States, recording the domestic disposition towards judgments of foreign courts, the output of the Human Rights Committee, and the work of other international human rights bodies. It makes suggestions for developing mechanisms to improve the effectiveness of the ICCPR and for creating databases to perform further research in the area.

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