327 IS LOCAL ENDOSCOPIC RESECTION A VIABLE THERAPEUTIC OPTION FOR EARLY CLINICAL STAGE T1A AND T1B OESOPHAGEAL ADENOCARCINOMA? A PROPENSITY-MATCHED ANALYSIS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
S Kamarajah ◽  
A Phillips ◽  
G Hanna ◽  
D Low ◽  
S Markar
Keyword(s):  
Endoscopic Resection ◽  
Therapeutic Option ◽  
Clinical Stage ◽  
Nodal Metastasis ◽  
Oesophageal Adenocarcinoma ◽  
Future Research ◽  
Significant Difference ◽  
Node Positive Disease ◽  
Similar Survival ◽  
Early Clinical Stage

Abstract   The role of endoscopic resection (ER) in the management of subsets of clinical T1N0 oesophageal adenocarcinoma is controversial. The aim of this study was to evaluate the outcome of ER versus oesophagectomy in node negative cT1a and cT1b oesophageal adenocarcinoma. Methods Data from the National Cancer Database (2010-2015), was used to identify patients with clinical T1aN0 (n = 2,545) and T1bN0 (n = 1,281) oesophageal adenocarcinoma that received either ER (cT1a, n = 1,581; cT1b, n = 335) or oesophagectomy (cT1a, n = 964; cT1b, n = 946). Propensity score matching (PSM) and Cox multivariable analyses were used to account for treatment selection bias. Results ER for cT1a and cT1b disease was performed more commonly over time. The rates of node-positive disease in patients with cT1a and cT1b oesophageal adenocarcinoma were 4% and 15%, respectively. In the matched cohort for cT1a cancers, ER had similar survival to oesophagectomy (HR: 0.85, 95% CI: 0.70-1.04, p = 0.1). The corresponding 5-year survival for ER and oesophagectomy were 70% and 74% (p = 0.1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR: 0.87, 95% CI: 0.66-1.14, p = 0.3). The corresponding 5-year survival for ER and oesophagectomy were 53% vs. 61% (p = 0.3), respectively. Conclusion This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 oesophageal adenocarcinoma. However, 15% of patients with cT1b oesophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from oesophagectomy with lymphadenectomy.

Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma?

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Alexander W. Phillips ◽  
George B. Hanna ◽  
Donald E. Low ◽  
Sheraz R. Markar
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Endoscopic Resection ◽  
Therapeutic Option ◽  
Clinical Stage ◽  
Early Clinical Stage

scholarly journals Cancer-associated thromboembolism: could direct-acting oral anticoagulants be a promising therapeutic option? Literature review

2020 ◽  
Vol 11 (1) ◽  
pp. 22-28
Author(s):  
Paraskevi Savvari
Keyword(s):  
Therapeutic Option ◽  
Oral Anticoagulants ◽  
Primary Prophylaxis ◽  
Future Research ◽  
Patients With Cancer ◽  
Significant Difference ◽  
Venous Thromboembolic Events ◽  
Prevention And Treatment ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

AbstractBackgroundCancer-associated thromboembolism (CAT) is usually managed with low-molecular-weight heparins (LMWHs) or vitamin K antagonists (VKAs). The recent data suggest that direct-acting oral anticoagulants (DOACs) might have a role in the management of CAT both in terms of prevention and treatment. The aim of this article is to review the current literature regarding the use of DOACs in patients with cancer.MethodsPUBMED and ClinicalTrials.gov were searched to identify prospective trials on patients with cancer managed with DOACs as either primary prophylaxis or treatment of venous thromboembolic events.ResultsIn terms of primary prophylaxis, five studies (CASSINI, ADVOCATE, MYELAXAT, NCT02958969, and AVERT) have been identified. When considered together, CASSINI and AVERT showed a significant benefit of rivaroxaban and apixaban, respectively, versus placebo for the prevention of venous thromboembolism (VTE), with a low incidence of major bleeding and no significant difference in mortality. ADVOCATE, MYELAXAT, and NCT02958969 showed that apixaban was well tolerated in patients with metastases receiving chemotherapy or those with multiple myeloma receiving immunomodulatory imide drugs. With respect to VTE treatment, 3 studies (HOKUSAI-VTE, SELECT-D, and ADAM-VTE) were identified. These studies demonstrated significantly lower rates of VTE recurrences in patients treated with edoxaban, rivaroxaban, or apixaban, without compromise on safety.ConclusionsDOACs seem a promising therapeutic option in CAT. As cancer is a heterogeneous disease, future research will clarify the role of these newer anticoagulant agents in both prevention and treatment of cancer-related VTE.

Increse of newly - detected in situ cancers in non-palpable breast lesions

2006 ◽  
Vol 53 (1) ◽  
pp. 73-75
Author(s):  
N. Miletic ◽  
D. Stojiljkovic ◽  
M. Inic ◽  
M. Prekajski ◽  
A. Celebic ◽  
...  
Keyword(s):  
Breast Tissue ◽  
Malignant Disease ◽  
Clinical Stage ◽  
Diagnostic Procedures ◽  
Basal Membrane ◽  
Needle Aspiration ◽  
Screening Mammography ◽  
Significant Difference ◽  
Malignant Lesions

Great importance in detecting cancer in the phase of in situ lays in the fact that the epithelial layer is deprived of blood and lymph vessels, so metastases may develop only when basal membrane has been broken. This paper includes 46 operated women in whom it preoperatively had been verified suspect non-palpable lesion. The preoperative diagnostics included use of high- resolution mammography, aimed mammography, palpatory examination, as well as fine-needle aspiration (FNA), biopsy and cytologic analysis of the sample. The methodology of this work implies the use of stereotaxic marking, specimen mammography and ex-tempore pathohistology analysis. Out of 46 investigated patients in clinical stage T0N0M0, in whom there were no signs of malignant disease, and according to suspect lesion of initial screening mammography, malignant lesions of breast tissue were diagnosed in 19 patients (41%) intraoperatively. Three of these lesions (15,8%) were histopathologically verified as in situ. Comparing our results with data of the Institute of oncology and radiology of Serbia hospital registry (IORS) for the year 2001, from 1173 patients registered with malignant lesions, only 16 ones (1,4%) had in situ cancer, operated on the basis of the suspect mammography of clinical stage T0N0M0. Statistically significant difference was found related to the number of detected cancers in this early phase of the breast malignant disease. This limits surgical intervention to tumorectomy, with preservation of the remaining breast tissue, what brings to healing, justifying in that way, screening examinations and routine application of the most contemporary diagnostic procedures.

scholarly journals Management of anticoagulants in delayed bleeding after endoscopic resection: A systematic review and meta-analysis

2021 ◽  
Vol 09 (07) ◽  
pp. E1128-E1135
Author(s):  
Xianhong Zhao ◽  
Yangxue Huang ◽  
Jiarong Li ◽  
Aoqiang Zhou ◽  
Gengxin Chen ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Clinical Effect ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Delayed Bleeding ◽  
Best Management ◽  
Significant Difference ◽  
Meta Analyses ◽  
Bridge Therapy

Abstract Background and study aims Delayed bleeding and thrombotic events are uncontrolled adverse events that are hard to balance in patients receiving anticoagulants after endoscopic resection. The present study aims to assess the clinical effect of warfarin, when compared to direct oral anticoagulants (DOACs), in terms of delayed bleeding and thrombotic events. Methods A comprehensive electronic literature search was conducted for eligible literature. Pairwise meta-analyses were performed on outcomes of delayed bleeding and thrombotic events. Two networks within the Bayesian framework were established based on the management of anticoagulants and type of DOAC. Results Eight cohort studies with 2,046 patients were eligible for inclusion, including 1,176 patients treated with warfarin and 870 with DOACs. There was no significant difference between warfarin and DOACs, in terms of delayed bleeding (OR = 1.29, 95 % CI [0.99–1.69]) and thromboembolism (OR = 2.0, 95 % CI [0.32–12.39]). In the network meta-analyses for delayed bleeding, the rank probabilities revealed that the safest management was discontinuous warfarin without heparin bridge therapy (HBT). Rank probabilities for the types of DOACs demonstrated that the safest drug was dabigatran. Conclusions There was no significant difference in delayed bleeding and thromboembolism between warfarin and DOACs in patients receiving endoscopic treatment. In terms of delayed bleeding, discontinuous warfarin without HBT was suggested as the best management, and dabigatran was recommended as the best type of DOAC.

scholarly journals L-Asparaginase, Doxorubicin, Vincristine, and Prednisolone (LHOP) Chemotherapy as a First-Line Treatment for Dogs with Multicentric Lymphoma

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2199
Author(s):  
Jih-Jong Lee ◽  
Albert Taiching Liao ◽  
Shang-Lin Wang
Keyword(s):  
Clinical Stage ◽  
Progression Free Survival ◽  
Cell Phenotype ◽  
Chop Chemotherapy ◽  
First Line ◽  
Canine Lymphoma ◽  
Free Survival ◽  
Significant Difference ◽  
Multicentric Lymphoma ◽  
First Line Treatment

Cyclophosphamide exhibits the weakest therapeutic effect compared with vincristine and doxorubicin in the CHOP (C, cyclophosphamide; H, doxorubicin; O, vincristine; and P, prednisolone) chemotherapeutic protocol for the treatment of canine lymphoma. Twenty dogs with multicentric lymphoma were treated using the LHOP protocol, which used l-asparaginase in place of cyclophosphamide, and the outcomes were historically compared with those of dogs that received CHOP chemotherapy in the same institution. No significant differences were found in age (p = 0.107), body weight (p = 0.051), sex (p = 0.453), clinical stage V (p = 1), substage b (p = 0.573), T-cell phenotype (p = 0.340), overall response (p = 1), and hypercalcaemia status (p = 1) between the LHOP and CHOP groups. The adverse effects of l-asparaginase were well tolerated and self-limiting. The median PFS (progression-free survival) and median ST (survival time) in the LHOP group were 344 days (range: 28–940 days) and 344 days (range: 70–940 days), respectively. The median PFS and median ST in the CHOP group were 234 days (range: 49–1822 days) and 314 days (range: 50–1822 days), respectively. The dogs that received LHOP chemotherapy had a significantly longer PFS than the dogs that received CHOP chemotherapy (p = 0.001). No significant difference was observed in ST between the LHOP and CHOP groups (p = 0.131). Our study findings thus indicate that the LHOP protocol can be used as a first-line chemotherapeutic protocol in canine multicentric lymphoma.

scholarly journals Stock Market Reaction to COVID-19: Evidence in Customer Goods Sector with the Implication for Open Innovation

2020 ◽  
Vol 6 (4) ◽  
pp. 99
Author(s):  
Zaky Machmuddah ◽  
St. Dwiarso Utomo ◽  
Entot Suhartono ◽  
Shujahat Ali ◽  
Wajahat Ali Ghulam
Keyword(s):  
Stock Prices ◽  
Stock Price ◽  
Practical Implication ◽  
Efficient Market Hypothesis ◽  
Future Research ◽  
Observation Data ◽  
Economic Sectors ◽  
Significant Difference ◽  
Before And After ◽  
Long Term Impact

The coronavirus pandemic has spread all over the world, affecting both the health and economic sectors. The aim of this research was to observe stock prices of customer goods before and after the COVID-19 pandemic using event study and the comparison test. The sample included data of daily closing stock prices and volume of stock trade during the three months before (−90 days) and after (+90 days) the occurrence of the COVID-19 pandemic ongoing, totaling 2670 observation data both before and after the COVID-19 pandemic, for a total of 5340. The research findings indicate a significant difference between the daily closing stock price and volume of stock trade before and after the COVID-19 pandemic. The current research has both theoretical and practical implications: the findings strengthen the efficient market hypothesis, which states that the more complete the provided information, the more efficient the market. The practical implication is that investors should be careful when choosing to invest. Investors should choose customer goods sector companies that provide products that are much needed by customers, for example, pharmacy, food, beverages, etc. Future research is needed to investigate the long-term impact of the pandemic on the economy.

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