Mo1481 The Impact of Impedance (MII) Testing on Patient Selection for Anti-Reflux Surgery in the Setting of a Normal 24-Hour pH Test

575 Background: Postoperative adjuvant chemotherapy (CTx) is a standardized treatment for patients with Stage III colorectal cancer (CRC). Since previous studies reported that the benefit of adjuvant CTx is estimated up to only 15% in Stage III patients, it is necessary to establish an appropriate patient selection for adjuvant CTx. Recently, systemic inflammation is reported to play a critical role in the progression of cancer and several studies demonstrate the impact of inflammation-based score, such as mGPS and SIS. There however is a lack of evidence for the influence of inflammation on patient requiring adjuvant CTx. The aim of this study is to evaluate the impact of SIS on patient selection of adjuvant CTx for Stage III CRC. Methods: Between 2004 and 2012 a total of 295 patients with Stage III CRC who underwent curative resection were included. The SIS was developed based on serum albumin and lymphocyte-to-monocyte ratio (LMR) levels (SIS = 0; albumin > 4.0 g/dl and LMR > 4.44, SIS = 1; albumin < 4.0 g/dl or LMR < 4.44, SIS = 2; albumin < 4.0 g/dl and LMR < 4.44). Primary endpoint was defined as disease free survival (DFS). DFS rates were compared using Kaplan-Meier curves and Prognostic factors were assessed by Cox proportional hazard model. Results: The median follow-up period was 5.99 years. 75.9% of patients received adjuvant CTx. The distribution of SIS was SIS = 0; 32.6 %, SIS = 1; 43.3 %, and SIS = 2; 24.1 %. In multivariate analysis for overall patients, SIS was not a significant prognostic factor. Subgroup analysis according to each SIS score demonstrated that adjuvant CTx significantly prevented postoperative recurrence just only in patients with SIS = 0 (5-year DFS rate; adjuvant CTx (+) 85.5 % vs. CTx (-) 33.7 %, p < 0.001 ). In Cox proportional hazard model, protective effect of adjuvant CTx decreased in proportion to the increase of SIS (HR of adjuvant CTx (95 % CI): SIS = 0; 0.187 (0.089-0.393), SIS = 1; 0.601 (0.311–1.162), SIS = 2; 0.747 (0.319–1.752)). Conclusions: The SIS can provide an appropriate patient selection for patients with stage III CRC who can benefit from adjuvant CTx. The results from this study might enhance precision medicine for adjuvant CTx for Stage III CRC.

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Technical Note: Investigating the impact of field size on patient selection for the 1.5T MR-Linac

Medical Physics ◽

10.1002/mp.12557 ◽

2017 ◽

Vol 44 (11) ◽

pp. 5667-5671 ◽

Cited By ~ 8

Author(s):

Robert W. Chuter ◽

Philip Whitehurst ◽

Ananya Choudhury ◽

Marcel van Herk ◽

Alan McWilliam

Keyword(s):

Patient Selection ◽

Technical Note ◽

Field Size ◽

Selection For ◽

The Impact

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Interaction between time, ASPECTS, and clinical mismatch

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015921 ◽

2020 ◽

Vol 12 (9) ◽

pp. 911-914 ◽

Cited By ~ 2

Author(s):

Shashvat M Desai ◽

Daniel A Tonetti ◽

Bradley J Molyneaux ◽

Kunakorn Atchaneeyasakul ◽

Marcelo Rocha ◽

...

Keyword(s):

Patient Selection ◽

Infarct Volume ◽

National Institutes Of Health ◽

Vessel Occlusion ◽

Flow Mri ◽

Selection For ◽

Automated Software ◽

The Impact ◽

Core Volume ◽

Over Time

BackgroundImaging-based patient selection for neurothrombectomy is reliant on the identification of irreversibly damaged brain tissue (core) and salvageable tissue (penumbra). The DAWN trial used the clinical-core mismatch (CCM) paradigm (clinical deficit out of proportion to infarct volume). We aim to determine the prevalence of CCM in large vessel occlusion (LVO) strokes and study the impact of time and the Alberta Stroke Program Early CT Score (ASPECTS) on the likelihood of mismatch.MethodsWe performed a retrospective observational analysis of internal carotid artery/middle cerebral artery M1 occlusions with available advanced imaging (relative cerebral blood flow/MRI). We used automated software for infarct volume analysis and ASPECTS determination. The prevalence of CCM and the impact of time and ASPECTS were analyzed.ResultOne hundred and eighty-five LVO strokes were included. Mean age was 71±15 years and median National Institutes of Health Stroke Scale score was 17 (range 12–21). Mean ischemic core volume was 50±69 mL. Within 0–24 hours, CCM was present in 53% and ranged from 63% in 0–3 hours to 25% at 21–24 hours (p=0.03). Prevalence of mismatch reduced 1.6% for every 1 hour increase in time to imaging. CCM prevalence by ASPECTS groups was: ASPECTS 9–10: 77%, ASPECTS 6–8: 65%, ASPECTS 0–5: 13% (p<0.01), with a 6.4% decrement for every 1 point decrease in ASPECTS. The prevalence of mismatch did not diminish over time among ASPECTS groups and higher ASPECTS was an independent predictor of CCM (OR 1.4 (95% CI 1.1 to 1.7), p<0.001).ConclusionsCCM is present in 57% and 50% of LVO strokes in the 0–6 and 6–24 hour window, respectively. The prevalence of mismatch declines with increasing time (1.6%/hour) and decreasing ASPECTS (6.4%/point). Among ASPECTS groups the prevalence of mismatch does not decline over time. These data support the use of an ASPECTS-based paradigm for late window patient selection.

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