Surgical Outcomes and Risk Analysis of Primary Pulmonary Sarcoma

2019 ◽  
Author(s):  
Yoshito Yamada ◽  
Tevfik Kaplan ◽  
Alex Soltermann ◽  
Isabelle Schmitt-Opitz ◽  
Didier Schneiter ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Tumor Size ◽  
Lung Neoplasm ◽  
Incomplete Resection ◽  
Pathological Grade ◽  
Pathological Stage ◽  
Term Survival ◽  
Advanced Pathological Stage ◽  
Pulmonary Sarcoma

Background Primary pulmonary sarcoma (PPS) is a rare malignant lung neoplasm, and there is very little medical evidence about treatment of PPS. The aim of this study is to clarify the clinical characteristics and therapeutic outcome of patients who underwent surgical resection for PPS. Methods We retrospectively reviewed the records of patients who underwent surgical resection for PPS in our institution between 1995 and 2014. Cases who only underwent biopsy were excluded. Results A total of 24 patients (18 males, 6 females), with a median age of 60 (interquartile range: 44–67) years, were analyzed. The surgical procedures performed in these patients were pneumonectomy (n = 10), lobectomy (n = 11), and wedge resection (n = 3). Complete resection was achieved in 16 patients. The pathological stages (tumor, node, metastases lung cancer classification, 8th edition) of the patients were I (n = 4), II (n = 12), III (n = 2), and IV (n = 5), and there were four cases of lymph node metastasis. The 5-year overall survival rate of the patients was 50% (95% confidence interval [CI]: 29–72). Adverse prognostic factors for overall survival were incomplete resection (hazard ratio [HR]: 4.4, 95% CI: 2.1–42), advanced pathological stage (HR 14, 95% CI: 2.8–66), higher pathological grade (HR 4.5, 95% CI: 1.2–17), and tumor size ≥ 7 cm (HR 4.7, 95% CI: 1.1–21). Conclusions Our series of PPS revealed that incomplete resection, advanced pathological stage, higher pathological grade, and tumor size were unfavorable factors for long-term survival.

Thymic carcinoma: A cohort study of prognostic factors after surgical resection from the European Society of Thoracic Surgeons database.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7602-7602
Author(s):  
Enrico Ruffini ◽  
Frank C. Detterbeck ◽  
Dirk Van Raemdonck ◽  
Gaetano Rocco ◽  
Pascal Alexandre Thomas ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adjuvant Therapy ◽  
Surgical Resection ◽  
European Society ◽  
Tumor Size ◽  
Cumulative Incidence ◽  
Multidisciplinary Approach ◽  
Incomplete Resection ◽  
Rare Tumors ◽  
Thymic Carcinomas

7602 Background: Thymic carcinomas are rare tumors which have recently been separated from thymomas due to their different histologic/clinical characteristics. Most of the current literature is composed of small series spanned over extended time periods Methods: The European Society of Thoracic Surgeons (ESTS) developed a retrospective database collecting data on patients with thymic tumors submitted to surgery (1990-2011). Out of 2,265 incident cases, there were 229 thymic carcinomas. Clinical-pathologic characteristics were analyzed including age, gender, stage (Masaoka), histologic subtypes (squamous cell/others), type of resection (complete/incomplete), tumor size, induction and adjuvant therapy (chemotherapy-ChT/radiotherapy-RT), recurrence. Primary outcome was overall survival (OS); secondary outcomes were disease-free survival (DFS) and the cumulative incidence of recurrence. Survival analysis was performed using univariate and multivariate (Cox-shared frailty) competing-risk models. Missing data were analysed using multiple-imputation techniques Results: A multidisciplinary approach (surgery, ChT and RT) was used in most patients. Induction therapy was employed in 78 patients (ChT, 53; ChT/RT 23; RT, 2). Adjuvant therapy was employed in 150 patients (ChT, 19; ChT/RT, 72; RT, 59). Complete resection (R0) was achieved in 71% of the patients. Five and 10-year OS were 60% and 35%. Five and 10-year DFS were 62% and 43%. Cumulative incidence of recurrence was 0.25, 0.32 and 0.40 at 3, 5, and 10 years. Independent OS predictors (multivariate analysis) were young age (p=0.006), stage I/II (vs. III/IV, p=0.02), R0 resection (p<0.001), adjuvant therapy (ChT, RT or both) (p=0.02). Independent predictor of recurrence (univariate analysis) was tumor size (p=0.05). Conclusions: In thymic carcinomas submitted to surgical resection, increased age,Masaoka stages III-IV and incomplete resection had a significant impact in worsening survival. Larger tumors had an increased risk of recurrence. The administration of adjuvant ChT or RT was associated with improved overall survival. A multidisciplinary approach to these rare tumors remains essential.

Adrenalectomy for Metastatic Melanoma: Current Role in the Age of Nonsurgical Treatments

2015 ◽  
Vol 81 (10) ◽  
pp. 1005-1009 ◽  
Author(s):  
Devin C. Flaherty ◽  
Gary B. Deutsch ◽  
Daniel D. Kirchoff ◽  
Jihey Lee ◽  
Kelly T. Huynh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Metastatic Melanoma ◽  
Surgical Resection ◽  
Stage Iv ◽  
Nonoperative Treatment ◽  
Unknown Primary ◽  
Adrenal Metastases ◽  
Term Survival ◽  
Relative Value ◽  
Resection Of Metastases

Surgical resection of metastases to the adrenal gland can improve overall survival of patients with stage IV melanoma, but its relative value with respect to current nonsurgical therapies is unknown. We hypothesized that surgery remains an optimal first-line treatment approach for resectable adrenal metastases. A search of our institution's prospectively collected melanoma database identified stage IV patients treated for adrenal metastases between January 1, 2000, and August 11, 2014. The 91 study patients had a mean age of 60.3 years at diagnosis of adrenal metastasis and 24 had undergone adrenalectomy. Improved survival was associated with an unknown primary lesion, surgical resection, and nonsurgical therapies. Median overall survival from diagnosis of adrenal metastases was 29.2 months with adrenalectomy versus 9.4 months with nonoperative treatment. Adrenalectomy, either as complete metastasectomy or targeted to lesions resistant to systemic therapy, is associated with improved long-term survival in metastatic melanoma.

Overall survival modeling and association with serum biomarkers in durvalumab-treated patients with head and neck cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6549-6549
Author(s):  
Vadryn Pierre ◽  
Xiang Guo ◽  
Ignacio Gonzalez-Garcia ◽  
Nassim Morsli ◽  
Alejandro Javier Yovine ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck ◽  
Tumor Size ◽  
Tumor Burden ◽  
P Value ◽  
Plasminogen Activator Inhibitor 1 ◽  
Term Survival ◽  
Baseline Serum ◽  
Neutrophil Lymphocyte Ratio ◽  
Pai 1

6549 Background: Optimal patient selection for immunotherapy remains a challenge as most patients fail to respond. We aim to assess baseline factors for association with long-term survival from durvalumab treatment in patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC)1,2. Methods: Pooled longitudinal tumor size, survival, and dropout data from four trials (1108: NCT01693562, CONDOR: NCT02319044 , HAWK: NCT02207530, and EAGLE: NCT02369874) involving 467 HNSCC patients were used to develop tumor size-driven hazard models. A panel of 66 serum protein biomarkers at baseline and 4 relevant clinical markers from 346 out of 413 patients treated with durvalumab (all studies except 1108) were initially screened to select a pool of 21 candidate covariates. The criteria for dimensionality reduction comprised correlation strength between biomarkers and pharmacological hypotheses pertaining to a prior analysis3 (inflammation, immunomodulation, tumor burden and angiogenesis). Results: The final tumor model highlighted that high tumor burden, elevated LDH and neutrophil-lymphocyte ratio were associated with faster tumor growth while patients with lower baseline tumor burden had an increase in net tumor shrinkage. For overall survival, the model suggested that high levels of immunomodulators (IL23, Osteocalcin), low inflammation (IL6, NLR), low tumor burden, and low angiogenesis factors (von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1)) were associated with survival benefits for patients treated with durvalumab. Specifically, these patients had baseline serum IL23 > 2.1 pg/mL and Osteocalcin > 32 pg/mL or serum PAI-1 < 229 pg/mL and serum IL6 < 5.4 pg/mL which corresponded to a hazard ratio estimate (HR and 95%CI) of 0.36 (0.27- 0.47), logrank p-value: 2.3x10−14. The median (n, 95%CI) overall survival time for the patients with favorable biomarker profile was 14.6 months (n = 129, 11.2-21.4) vs. 4.4 months (n = 217, 3.6-5.3). Conclusions: Our results corroborate the prior hypothesis highlighting the prognostic value of inflammation, disease burden, tumor angiogenesis, and immunomodulatory factors on the clinical outcomes of HNSCC patients treated with durvalumab3. Collectively, we identified a serum biomarker profile of HNSCC patients with median survival times exceeding 1 year which may potentially be used for patient enrichment following further validation in prospective studies. References: 1Yanan CPT 2017, 2Baverel, 2018 ENA, 3Guo, X, 2019 Asco P6048 Clinical trial information: NCT01693562, NCT02319044, NCT02207530, NCT02369874 .

scholarly journals Analysis of tumor size enhances predictive power of CA19-9 for overall survival following surgical resection in pancreatic adenocarcinoma

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S552-S553
Author(s):  
S. Said ◽  
B. Perlmutter ◽  
J. McMichael ◽  
C. Barrows ◽  
J. Scheman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Surgical Resection ◽  
Tumor Size ◽  
Predictive Power

Should all pancreatic neuroendocrine tumors (PNET) over 1 cm be resected?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4108-4108
Author(s):  
Diana Hsu ◽  
Sidney Le ◽  
Alex Chang ◽  
Austin Spitzer ◽  
George Kazantsev ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Metastatic Disease ◽  
Tumor Size ◽  
Cox Regression ◽  
Metastatic Spread ◽  
Rank Test ◽  
Pancreatic Neuroendocrine Tumors ◽  
Localized Disease

4108 Background: Pancreatic neuroendocrine tumors (PNET) are a heterogeneous group of tumors that represent 1-2% of all pancreatic neoplasms. Their biologic behaviors are unpredictable with high grade, nodal metastasis, or liver metastasis lending an unfavorable prognosis. Current guidelines recommend resection for functioning tumors and those 2 cm or larger but are less straightforward regarding tumors < 2 cm in size. Previous data show that observation for nonfunctioning tumors < 2 cm can be safe and feasible; however, a significant portion of these patients may have nodal involvement or metastatic disease. Methods: A retrospective review was undertaken to identify patients with pancreatic neuroendocrine tumors treated at Northern California Kaiser Permanente (KP-NCAL) between February 2010 and December 2018. Univariate and multivariate analyses were performed with the log-rank test and Cox regression. Chi-squared test of relevant clinicopathologic factors determined which factors were predictive for overall survival (OS). Results: Mean age was 61 years in our cohort of 354 patients, with 29% over the age of 70. Mean tumor size was 3.43 cm; 32% of tumors were 2 cm or smaller. 51% of the patients had localized disease; 32% of the patients presented with metastatic disease. The pancreatic tail was the most common tumor location (38%), followed by the head of the pancreas (24%). On multivariate survival analysis, stage, location of the tumor, and surgical resection were statistically significant in terms of overall survival ( p<.001). Mean OS for patients with localized and metastatic disease was 93 months versus 37 months ( p<.001). Surgery was utilized in 8.9% of patients with metastatic disease ( p<.001). All patients with PNET smaller than 1 cm in our study group had localized disease only. However, in patients with tumor size between 1 and 2 cm, 11% had nodal or metastatic spread. Conclusions: PNETs are indolent but have malignant potential at any size. In our retrospective study, all of the patients with tumor size < 1 cm had localized disease. For those with PNETs 1-2 cm in size, 11% had nodal or metastatic spread. Based on our findings, we suggest a more aggressive surgical resection size criteria of 1 cm.[Table: see text]

Does Surgical Resection Have a Role in the Treatment of Large or Multinodular Hepatocellular Carcinoma?

2010 ◽  
Vol 76 (11) ◽  
pp. 1189-1197 ◽  
Author(s):  
Giovanni Ramacciato ◽  
Paolo Mercantini ◽  
Niccolò Petrucciani ◽  
Matteo Ravaioli ◽  
Alessandro Cucchetti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Surgical Resection ◽  
Survival Rates ◽  
Treatment Modalities ◽  
Impaired Liver Function ◽  
Term Survival ◽  
Impaired Liver ◽  
Disease Free

Several effective treatments are available for patients with small solitary hepatocellular carcinomas (HCCs). Conversely, the management of patients with large or multinodular HCCs is controversial, and the role of surgical resection is not well defined. Between 2000 and 2006, 51 patients with large or multinodular HCC underwent liver resection. Clinicopathologic and follow-up data were prospectively collected and retrospectively reviewed. The perioperative and long-term outcomes were analyzed. Univariate and multivariate analysis of prognostic factors were conducted. Although 20 patients had multinodular HCCs, 31 had large solitary tumors. Perioperative mortality occurred in eight patients and complications in 15. In patients with large solitary tumors, 5-year disease-free and overall survival were 41.3 per cent and 56.1 per cent, respectively. Those with multinodular HCCs demonstrated 5-year disease-free and overall survival rates of 0 per cent and 33.6 per cent, respectively. Liver resection can result in long-term survival in select patients with large or multinodular HCCs, even in select patients with impaired liver function. Large solitary HCCs seem to have better prognoses than multinodular tumors, with lower recurrence and higher survival rates after surgery. Randomized controlled trials comparing resection to other treatment modalities are indicated to determine optimal patient management.

scholarly journals Factors Predictive of Improved Survival in Patients With Brain Metastases From Gynecologic Cancer: A Single Institution Retrospective Study of 47 Cases and Review of the Literature

2015 ◽  
Vol 25 (9) ◽  
pp. 1711-1716 ◽  
Author(s):  
Gregory M. Gressel ◽  
Lisbet S. Lundsberg ◽  
Gary Altwerger ◽  
Tasleem Katchi ◽  
Masoud Azodi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Survival Data ◽  
Gynecologic Cancer ◽  
Treatment Modalities ◽  
Single Institution ◽  
Term Survival ◽  
Free Data

ObjectiveThe reported incidence of brain metastasis from epithelial ovarian cancer (EOC), endometrial cancer (EC), and cervical cancer (CC) is exceedingly rare. As the long-term survival for patients with gynecologic cancer increases, there has been a corresponding increase in the number of diagnosed intracranial metastases. We seek to report our experience with managing brain metastatic disease (BMD) in patients with gynecologic cancer.MethodsA retrospective review of all patients with EOC, EC, and CC at our institution revealed 47 patients with concurrent BMD between 2000 and 2013. Demographic data, risk factors, treatment modalities, progression-free data, and overall survival data were collected.ResultsMedian survival time in patients with brain metastasis from EOC, EC, and CC was 9.0, 4.5, and 3.0 months, respectively. Two-year overall survival rates were 31.6%, 13.6%, and 0%, respectively. Patients received surgery, radiation therapy alone, palliative care, or radiation plus surgery. Radiation combined with surgical resection resulted in a significant hazards ratio of 0.36 (95% confidence interval, 0.15–0.86), compared with radiation alone.ConclusionsOur report provides a large single-institution experience of brain metastases from gynecologic cancer. Patients with BMD have poor prognoses; however, treatment with multimodal therapy including surgical resection and radiation may prolong overall survival.

scholarly journals Development and external validation of a nomogram for predicting the effect of tumor size on survival of patients with perihilar cholangiocarcinoma

2020 ◽  
Author(s):  
Yaodong Zhang ◽  
Zhengshan Wu ◽  
Xing Wang ◽  
Changxian Li ◽  
Jiang Chang ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Tumor Size ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
External Validation ◽  
Perihilar Cholangiocarcinoma ◽  
Optimal Cutoff ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Cutoff Value

Abstract Background: The effect of tumor size on account of the long-term survival results in perihilar cholangiocarcinoma (PCCA) patients has remained a controversial debate. It is urgent necessary to identify the optimal cutoff value of tumor size in PCCA and integrate tumor size with other prognostic factors into a nomogram to improve the predictive accuracy of the prognosis of patients with PCCA. Methods: 363 PCCA patients underwent surgical resection were extracted from the Surveillance, Epidemiology and End Results (SEER) database. X-tile program was used to identify the optimal cutoff value of tumor size. A nomogram including tumor size was established to predict 1-, 3- and 5-year cancer-specific survival (CSS) based on the independent risk factors chosen by Kaplan-Meier methods and multivariable cox regression models. The precision of the nomogram for predicting survival was validated internally and externally. Results: PCCA patients underwent surgical resection were classified into 1-19 mm, 20-33 mm and ³34 mm subgroup based on the optimal cutoff for tumor size in terms of CSS. And we noticed that more larger tumor size group had worse tumor grade, advanced T stage, more positive regional lymph nodes and more frequency vascular invasion. The nomogram according to the independent factors was well calibrated and displayed better discrimination power than 7 th Tumor-Node-Metastasis (TNM) stage systems. Conclusions: The results demonstrated that the larger the tumor size was, the worse the survival would be. The proposed nomogram, which outperforms the conventional TNM staging system, showed consistently reliability and clinically practicality for predicting the prognosis of PCCA patients.

Role of adjuvant chemotherapy in patients with pathological stage I NSCLC with high-risk features.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 9022-9022
Author(s):  
Lubina Arjyal ◽  
Dipesh Uprety ◽  
Susan M Frankki ◽  
Andrew J Borgert ◽  
David E. Marinier
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Tumor Size ◽  
Stage I ◽  
Median Income ◽  
Pathological Stage ◽  
Kaplan Meier

9022 Background: Lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC). There is a lack of prospective data on the benefit of adjuvant chemotherapy (CT) in patients with negative margins but with high-risk features: lympho-vascular invasion (LVI) or visceral pleural invasion (VPI). We aimed to investigate the benefit of adjuvant CT in patients with pathological stage I NSCLC with high-risk features. Methods: The 2016 National Cancer Database was queried to identify patients with pathological stage I NSCLC (8th edition AJCC staging) diagnosed from 2010-2015 who received lobectomy/pneumonectomy with clear surgical margins. Patients were stratified into high risk (tumor size ≥2 cm with LVI and/or VPI) or low risk group. Multivariate Cox proportional hazards regression and propensity score matched Kaplan-Meier survival analysis were used to compare overall survival between those who received adjuvant CT and those who did not. Results: 34,556 patients were identified with 1114 (3.2%) receiving adjuvant CT. On multivariate Cox regression analysis, high risk tumors (hazard ratio [95% confidence interval] = 1.31 [1.25-1.38]) and lack of adjuvant chemotherapy (1.25 [1.09-1.44]) were associated with worse overall survival (OS). Additionally, male sex, age ≥ 60 years, higher comorbidity burden, lack of insurance, low facility volume, low median income, non-squamous histology were associated with worse OS. After propensity score matching, Kaplan-Meier survival analysis of the high risk subgroup (n = 2923) showed a significant difference in overall survival (OS) between those who received adjuvant CT (n = 1032, 5 year OS, 74.7%; 95% CI, 70.9%-78.0%) and those who did not (n = 1891, 5 year OS, 66.9%; CI, 63.9%-69.6%; p = 0.0002). In patients with no high risk factors for recurrence (n = 384), OS was not significantly different between the patients who received adjuvant CT (n = 78, 5 year OS, 75.8%; CI, 61.3%-85.5%) and those who did not receive adjuvant CT (n = 306, 5 year OS, 77.1%; CI, 70.0%-82.7%; p = 0.3). Conclusions: Our study showed better survival with adjuvant CT in patients with pathological stage I NSCLC who have tumor size greater than 2 cm, LVI and/or VPI.

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