Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients

2021 ◽  
Author(s):  
Wojciech Dudek ◽  
Waldemar Schreiner ◽  
Mohamed Haj Khalaf ◽  
Horia Sirbu
Keyword(s):  
Primary Tumor ◽  
Multivariable Analysis ◽  
Pulmonary Metastasectomy ◽  
Incomplete Resection ◽  
Continuous Variables ◽  
Characteristic Analysis ◽  
Term Survival ◽  
Primary Tumors ◽  
Wide Range ◽  
The Impact

Abstract Background Despite weak evidence, pulmonary metastasectomy (PM) is widely performed with intent to improve patient survival. Our single-institution analysis aims to evaluate outcomes and to identify factors influencing survival of patients undergoing PM for metastases from wide range of primary tumors. Materials and Methods All patients undergoing curative-intent PM between 2008 and 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on overall survival (OS) was evaluated using univariable and multivariable Cox proportional hazard models. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. Results In this study, 281 patients (178 male, median age 61 years) underwent PM. Two (0.7%) perioperative deaths and 23 (8.2%) major complications occurred. Median interval between the treatment of primary tumor and PM was 21 months. Median size of largest metastasis was 1.4 cm. After the median follow-up of 29 months, 134 patients (47.7%) had died. Five-year OS rate after first PM was 47.1%. Complete resection was achieved in 274 (97.5%) patients. Multivariable analysis identified genitourinary origin (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.15–0.60, p = 0.0008) as independent positive survival prognosticator; incomplete resection (HR: 3.53, 95% CI: 1.40–8.91, p = 0.0077) and age at PM of ≥66 years (HR: 1.97, 95% CI: 1.36–2.85, p = 0.0003) were negative prognosticators. Conclusion The use of PM as a part of multimodal treatment is in selected population justified. Our analysis identified age, primary tumor origin, and completeness of resection as independent survival prognosticators.

Survival and Prognostic Analysis after Pulmonary Metastasectomy for Head and Neck Cancer

2020 ◽  
Author(s):  
Wojciech Dudek ◽  
Emad AlMoussa ◽  
Waldemar Schreiner ◽  
Konstantinos Mantsopoulos ◽  
Horia Sirbu
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Primary Tumor ◽  
Lung Metastases ◽  
Therapeutic Option ◽  
Pulmonary Metastasectomy ◽  
Continuous Variables ◽  
Characteristic Analysis ◽  
The Impact

Abstract Background There is no consensus on the value of pulmonary metastasectomy (PM) for head and neck cancer (HNC). The aim of our single-institution study was to evaluate outcomes and to examine factors influencing 5-year survival of patients undergoing resections for HNC lung metastases. Methods All HNC patients undergoing curative-intent PM between January 2008 and December 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on patient survival was evaluated using the univariable Cox proportional hazard model. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. Results In total, 44 patients (32 males and 12 females, with a median age of 65 years) underwent PM for metastatic HNC. There was one perioperative death, and major complications occurred in 2 (4.5%) patients. The median interval between the treatment of primary tumor and PM was 19.4 months (range: 0–151 months). Median size of the largest resected pulmonary lesion was 1.3 cm (range: 0.3–6.9 cm). Mean follow-up was 21 months (range: 0–123 months), and 5-year overall survival (OS) rate after the first PM was 41%. Resection was complete (R0) in all patients. Larger size of pulmonary metastasis (≥1.4 cm; hazard ratio: 4.49; 95% confidence interval: 1.79–11.27) was a significantly negative prognostic factor. Conclusion Despite the lack of randomized controlled trials, PM for HNC is a reasonable therapeutic option with favorable survival in a selected population. In patients with larger pulmonary lesions, shorter OS after PM is to be expected.

Impact of M1a and M1b staging in patients (pts) with metastatic colorectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3590-3590 ◽  
Author(s):  
Hagen F. Kennecke ◽  
Jason Yu ◽  
Sharlene Gill ◽  
Winson Y. Cheung ◽  
Charles Davic Blanke ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
Primary Tumors ◽  
7Th Edition ◽  
The Impact

3590 Background: In 2009, pts with M1 colorectal cancer were divided into two subsets for the American Joint Committee on Cancer (AJCC) 7th edition. Pts with metastases (mets) confined to one organ or site at initial diagnosis became stage M1a while multiple sites or peritoneal mets became M1b. The objectives of the study are to evaluate the impact of site of mets and M1a/b staging among pts with M1 colorectal cancer. Methods: All pts referred to the BC Cancer Agency from 1999-2007 with newly diagnosed M1 colon or rectal cancer were included. Demographic, treatment, and outcome data were prospectively collected. The prognostic impact of individual sites of mets was assessed by hazard ratio estimates from univariate Cox models. Multivariable Cox proportional-hazards models were used to determine variables associated with overall survival in the entire cohort and in those undergoing resection of their primary tumor. Results: 2,049 pts with M1 disease were included. Median age was 66 years; 71% had colonic origin; 70% had their primary tumor resected; and 69% received chemotherapy. In univariate analysis, solitary mets were associated with improved survival. In multivariable analysis, M1a/b status still had significant prognostic effect. The effect remained significant in the subgroup analysis of pts with resected primary tumors when histology, T and N stage were included. Conclusions: Pts with solitary mets, including peritoneum, have superior overall survival as compared to those with multiple sites of mets. AJCC 7th edition staging that includes M1a/b provides significant prognostic information and should be considered in clinical practice and trials of pts with M1 disease who otherwise have few prognostic factors. [Table: see text]

scholarly journals Discordance of KRAS Mutational Status between Primary Tumors and Liver Metastases in Colorectal Cancer: Impact on Long-Term Survival Following Radical Resection

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2148
Author(s):  
Francesco Ardito ◽  
Francesco Razionale ◽  
Lisa Salvatore ◽  
Tonia Cenci ◽  
Maria Vellone ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Kras Mutation ◽  
Colorectal Tumor ◽  
Term Survival ◽  
Primary Tumors ◽  
Mutation Status ◽  
Primary Colorectal Tumor ◽  
Kras Mutation Status

If KRAS mutation status of primary colorectal tumor is representative of corresponding colorectal liver metastases (CRLM) mutational pattern, is controversial. Several studies have reported different rates of KRAS discordance, ranging from 4 to 32%. Aim of this study is to assess the incidence of discordance and its impact on overall survival (OS) in a homogenous group of patients. KRAS mutation status was evaluated in 107 patients resected for both primary colorectal tumor and corresponding CRLM at the same institution, between 2007 and 2018. Discordance rate was 15.9%. Its incidence varied according to the time interval between the two mutation analyses (p = 0.025; Pearson correlation = 0.2) and it was significantly higher during the first 6 months from the time of primary tumor evaluation. On multivariable analysis, type of discordance (wild-type in primary tumor, mutation in CRLM) was the strongest predictor of poor OS (p < 0.001). At multivariable logistic regression analysis, the number of CRLM >3 was an independent risk factor for the risk of KRAS discordance associated with the worst prognosis (OR = 4.600; p = 0.047). Results of our study suggested that, in the era of precision medicine, possibility of KRAS discordance should be taken into account within multidisciplinary management of patients with metastatic colorectal cancer.

scholarly journals SURG-13. EVALUATION OF 5-ALA FLUORESCENCE IN BRAIN METASTASES OF VARIOUS PRIMARY TUMORS: A MULTICENTER STUDY WITH EXPERIENCE IN 157 CASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i33-i33
Author(s):  
Petra Andreea Mercea ◽  
Franz Marhold ◽  
Florian Scheichel ◽  
Barbara Kiesel ◽  
Mario Mischkulnig ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Primary Tumor ◽  
Aminolevulinic Acid ◽  
World Health ◽  
Incomplete Resection ◽  
Strong Fluorescence ◽  
Primary Tumors ◽  
Fluorescence Pattern ◽  
Fluorescence Characteristics ◽  
Intraoperative Visualization

Abstract INTRODUCTION: Local recurrence of brain metastases following incomplete resection is not uncommon. One reason is insufficient intraoperative visualization of tumor tissue. Recently, visible intraoperative 5-aminolevulinic acid (5-ALA) fluorescence was reported in the first brain metastases series. Thus, the aim of this study was to investigate intraoperative 5-ALA fluorescence in brain metastases at two specialized centers in the largest patient cohort up to date. METHODS: 5-ALA was administered prior to resection of 157 brain metastases in 154 patients. Intraoperatively, the fluorescence quality (strong, vague or none) and fluorescence homogeneity (homogeneous or heterogeneous) of each brain metastasis was investigated. These 5-ALA fluorescence characteristics were correlated with primary tumor and histopathological subtype according to the current World Health Organization (WHO) 2016 criteria. RESULTS: Visible 5-ALA fluorescence was observed in 104 brain metastases (66%), whereas fluorescence was absent in the remaining 53 cases (34%).53/104 (51%) brain metastases showed strong fluorescence and 51/104 (49%) vague fluorescence. The majority of brain metastases (84%) demonstrated a heterogeneous fluorescence pattern. In context of primary tumor, visible fluorescence was less frequent in brain metastases of melanomas compared to all other tumors (p=0.037). Moreover, visible fluorescence was more common for ductal breast cancer subtype than other subtypes (p=0.008). CONCLUSION: Our data indicate that 5-ALA fluorescence is a valuable for intraoperative visualization of brain metastases to improve the extent of resection and thus patient prognosis. However, the frequent heterogeneous 5-ALA fluorescence pattern and lack of strong fluorescence limits the use of 5-ALA in brain metastases, claiming for further technical refinement.

Role of Surgery in the Treatment of Patients With Stage 4 Neuroblastoma Age 18 Months or Older at Diagnosis

2013 ◽  
Vol 31 (6) ◽  
pp. 752-758 ◽  
Author(s):  
Thorsten Simon ◽  
Beate Häberle ◽  
Barbara Hero ◽  
Dietrich von Schweinitz ◽  
Frank Berthold
Keyword(s):  
Local Control ◽  
Primary Tumor ◽  
Tumor Resection ◽  
Local Control Rate ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Primary Tumor Site ◽  
Free Survival ◽  
Stage 4 ◽  
The Impact

Purpose Although intensive multimodal treatment has improved the prognosis of patients with metastatic neuroblastoma, the impact of primary tumor resection on outcome is a matter of medical debate. Patients and Methods Patients from the German prospective clinical trial NB97 with stage 4 neuroblastoma and age 18 months or older at diagnosis were included. Operation notes and imaging reports were reviewed by two independent experienced physicians. Finally, the extent of tumor resections was correlated with local control rate and outcome. Results A total of 278 patients were included in this study. Image-defined risk factors present at diagnosis were found to be predictive for the extent of tumor resection at first (P < .001) and best (P < .001) operation. No patient died from surgery. Before chemotherapy, complete resection, incomplete resection, and biopsy or no surgery were performed in 6.1%, 5.0%, and 88.5% of patients, respectively. The extent of first operation had no impact on event-free survival (EFS; P = .207), local progression–free survival (LPFS; P = .195), and overall survival (OS; P = .351). After induction chemotherapy, 54.7% of patients underwent complete resection of the primary tumor, 30.6% underwent incomplete resection, and 13.3% had only biopsy or no surgery of the primary tumor. The extent of best operation also had no impact on EFS (P = .877), LPFS (P = .299), and OS (P = .778). Moreover, multivariate analyses showed that surgery did not affect EFS, LPFS, and OS. Conclusion In intensively treated patients with stage 4 neuroblastoma age 18 months or older at diagnosis, surgery of the primary tumor site has no impact on local control rate and outcome.

Contrast enhanced CT (CE-CT) changes and nephrometry down-scoring of unresectable primary renal cell carcinoma (RCC) tumors in patients (Pts) treated with neoadjuvant sunitinib.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 299-299 ◽  
Author(s):  
M. Salem ◽  
S. N. Shah ◽  
L. S. Wood ◽  
P. Elson ◽  
A. Medsinge ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Objective Response ◽  
Sign Test ◽  
Rank Test ◽  
Primary Tumors ◽  
Venous Thrombus ◽  
Nephrometry Score ◽  
Primary Renal Cell Carcinoma ◽  
Contrast Enhanced Ct ◽  
The Impact

299 Background: The impact of neoadjuvant sunitinib on CE-CT parameters and nephrometry score of primary RCC tumors remains unknown. Methods: Retrospective review of baseline and prenephrectomy CE-CT from a prospective phase II trial of neoadjuvant sunitinib (50 mg sunitinib continuous dosing) in unresectable primary RCC tumors with or without metastatic disease. CE-CT parameters and R.E.N.A.L. nephrometry score for each lesion were determined in pts who underwent subsequent surgery. RECIST and MASS criteria were used to assess primary tumor radiographic response. CT changes were analyzed using the sign test and Wilcoxon signed rank test. Results: Twenty nine pts were enrolled, of which 13 pts (85%M; median age 63y) underwent post-sunitinib resection of 16 primary tumors (3 pts had multifocal RCC). Post-therapy, 88% of tumors had decreased long diameter (median 32% decrease, p<0.001 vs. baseline), 88% decreased attenuation (median 30 HU reduction, p=0.006) and 69% increased necrosis (p=0.001). 56% of tumors had a decrease in nephrometry score (median 1 point decrease; 10 to 9, p=004). At baseline, 81% of tumors were highly complex by nephrometry score; following therapy 46% of the highly complex tumors became moderately complex. At baseline 13 tumors abutted renal hilar vital structures, whereas following treatment 4 tumors demonstrated abutment. Adenopathy decreased (range, 23%-83%) in 4/4 patients with enlarged baseline lymph nodes, with complete resolution in 1 patient. RECIST objective response was seen in 38% and SD in 56% of primary tumors; 1 tumor had PD based on size despite > 95% necrosis. MASS criteria response was favorable 38%, intermediate 62%. Two of four pts had reduction in extent of venous thrombus (1 pt from level 0 to resolved and 1 pt from level IV to II). Conclusions: Neoadjuvant sunitinib resulted in decreased size/attenuation, increased necrosis of the primary tumor and reduction in lymphadenopathy and venous thrombus in pts who underwent subsequent surgery. Sunitinib reduced the RENAL nephrometry score and facilitated nephrectomy, notably due to impact on tumor proximity to vital structures in the renal hilum. [Table: see text]

CD73 expression in primary and metastatic renal cell carcinoma (RCC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 643-643 ◽  
Author(s):  
Abhishek Tripathi ◽  
Sarah E Johnston ◽  
Yan D Zhao ◽  
Oudai Hassan ◽  
Linda F Thompson ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Checkpoint Inhibitors ◽  
Statistical Significance ◽  
Method Comparison ◽  
Rank Test ◽  
Primary Tumors ◽  
Metastatic Tissue ◽  
Pathologic Features ◽  
Cd73 Expression ◽  
The Impact

643 Background: Agents targeting the PD-1 pathway have improved outcomes in RCC. CD73 may be an additional mechanism which tumors can exploit for immune evasion. It is regulated by hypoxia inducible factor (HIF) and converts AMP to adenosine. The resulting increase in extracellular adenosine can inhibit T-cell effector function. We evaluated CD73 expression in primary and metastatic tumor samples in patients with RCC. Methods: A commercial TMA (US Biomax) consisting of 31 primary clear cell RCC samples (2 with sarcomatoid features) with 8 matched and 1 unmatched metastases was used to assess CD73 expression. A genitourinary pathologist (OH) confirmed pathology and grade. Immunohistochemistry (IHC) was performed using a monoclonal anti-CD73 antibody (Cell Signaling; D7F9A). A combined score (CS: % of cells positive x intensity) was employed to quantify CD73 expression. Expression levels between matched primary and metastatic tissue was compared using Wilcoxon signed-rank test. Correlation of CD73 expression (CS > 0) in primary tumor with baseline clinical and pathologic characteristics was assessed using Kruskal-Wallis and Fisher's exact tests. Overall survival (OS) was estimated using the Kaplan-Meier method. Comparison between CD73 expression groups used log rank test. Results: CD73 expression was seen in 19% (n = 6) of primary and 66.7% (n = 6) of metastatic samples. Among matched primary and metastatic samples (n = 8 each), median CS was 25 (Q1-Q3:0-105) in metastatic samples while none of the corresponding primary samples demonstrated CD73 expression (median CS = 0, p = 0.062). CD73 expression in primary tumor samples did not correlate with baseline clinical or pathologic features. Five-year OS was 50% in patients who expressed CD73 in primary tumors compared to 84% in those who did not (p = 0.26). Conclusions: We observed a numerical increase in CD73 expression in metastatic tissue compared to primary RCC samples and worse 5 year OS. The small number of samples has limited statistical significance. Further studies are needed to examine the impact of CD73 expression on outcomes in RCC patients treated with currently approved checkpoint inhibitors and the investigational CD73 antagonists that are in early phases of development.

scholarly journals Impact of Mitral Annular Dilation on Edge-to-Edge Therapy With MitraClip-XTR

2021 ◽  
Author(s):  
Felix Kreidel ◽  
Syed Zaid ◽  
Alexander R. Tamm ◽  
Tobias F. Ruf ◽  
Andres Beiras-Fernandez ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Left Atrial Volume ◽  
Characteristic Analysis ◽  
Vena Contracta ◽  
3 Dimensional ◽  
Suboptimal Outcome ◽  
Annular Dilation ◽  
The Impact

Background: Mitral annular dilation has been shown to challenge successful edge-to-edge therapy with earlier MitraClip generations. Recently, third-generation MitraClip-XTR with extended clip arm length was introduced. We assessed the impact of annular dilation on residual mitral regurgitation (MR) after MitraClip-XTR repair and sought to identify cutoffs associated with suboptimal MR reduction. Methods: We included 107 patients (78.9±6.7 years; 40.2% female) with symptomatic severe MR (46.7% primary MR; 53.3% secondary MR) undergoing MitraClip-XTR repair. Annular dimensions were retrospectively assessed by 2-dimensional and 3-dimensional-transesophageal echocardiography including a semiautomated analysis. Impact of annular diameters and area on suboptimal reduction defined as ≥2+MR on transthoracic echocardiography at discharge was assessed and predictive cutoff values identified. Previously identified predictors of suboptimal outcome after MitraClip therapy were included in multivariable analysis. Results: Technical success was achieved in 93%, 1-year mortality was 23%. Suboptimal MR reduction was observed in 26% and associated with higher 1-year mortality (odds ratio, 4.5 [1.5–14.1]). End-systolic anteroposterior and intercommissural annular diameters, annular area and further vena-contracta width, effective regurgitant orifice area and left atrial volume were associated with suboptimal outcomes. Independent predictors of suboptimal reduction were end-systolic annular area (odds ratio, 1.36 [1.08–1.71] per cm 2 ) and vena-contracta width (odds ratio, 1.47 [1.04–2.09] per mm). On receiver operating characteristic analysis, 3-dimensional-transesophageal echocardiography end-systolic anteroposterior diameter >40.5 mm, intercommisural diameter >40.5 mm, and annular-area >12.50 cm 2 were the most predictive thresholds for suboptimal reduction. If all 3 annular measurements exceeded the determined threshold values, the risk for suboptimal reduction increased by 17-fold. Conclusions: Annular dilation was found to challenge successful edge-to-edge therapy also with extended-reach MitraClip-XTR. Our proposed thresholds for preprocedural annular dimensions may serve as guidance for improved patient selection in edge-to-edge repair.

scholarly journals Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

2020 ◽  
Author(s):  
Marius Kryzauskas ◽  
Augustinas Bausys ◽  
Austeja Elzbieta Degutyte ◽  
Vilius Abeciunas ◽  
Eligijus Poskus ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Rectal Resection ◽  
Multivariable Analysis ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Male Sex ◽  
The Impact

Abstract Background: Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer.Methods: Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified and long-term outcomes of patients with and without AL were compared.Results: AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III-IV; OR=10.54, p=0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR=2.40, p=0.004), CCI score >5 (OR=1.72, p=0.025) and T3/T4 stage tumors (OR=2.25, p=0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p=0.009 and p=0.001) and rectal (p=0.003 and p=0.014) surgery.Conclusion: ASA score of III-IV is an independent risk factor for AL after sigmoid surgery and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

scholarly journals Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique

2021 ◽  
Vol 12 ◽  
Author(s):  
Selena Alonso ◽  
Marta Vidal ◽  
Gemma Ruiz-Olalla ◽  
Raquel González ◽  
M. Nelia Manaca ◽  
...  
Keyword(s):  
Placental Transfer ◽  
Multivariable Analysis ◽  
Igg Subclasses ◽  
Sub Saharan Africa ◽  
Transplacental Transfer ◽  
Suspension Array ◽  
Wide Range ◽  
Vaccine Antigens ◽  
Antibody Levels ◽  
The Impact

Transplacental transfer of antibodies is essential for conferring protection in newborns against infectious diseases. We assessed the impact of different factors, including gestational age and maternal infections such as HIV and malaria, on the efficiency of cord blood levels and placental transfer of IgG subclasses. We measured total IgG and IgG subclasses by quantitative suspension array technology against 14 pathogens and vaccine antigens, including targets of maternal immunization, in 341 delivering HIV-uninfected and HIV-infected mother-infant pairs from southern Mozambique. We analyzed the association of maternal HIV infection, Plasmodium falciparum exposure, maternal variables and pregnancy outcomes on cord antibody levels and transplacental transfer. Our results show that maternal antibody levels were the main determinant of cord antibody levels. Univariable and multivariable analysis showed that HIV reduced the placental transfer and cord levels of IgG and IgG1 principally, but also IgG2 to half of the antigens tested. P. falciparum exposure and prematurity were negatively associated with cord antibody levels and placental transfer, but this was antigen-subclass dependent. Our findings suggest that lower maternally transferred antibodies may underlie increased susceptibility to infections of HIV-exposed infants. This could affect efficacy of maternal vaccination, especially in sub-Saharan Africa, where there is a high prevalence of HIV, malaria and unfavorable environmental factors.

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