Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience

2020 ◽  
Author(s):  
Jérémy Tricard ◽  
Daniel Milad ◽  
Anaëlle Chermat ◽  
Serge Simard ◽  
Yves Lacasse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Free Survival ◽  
Cardiac Procedure ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

Abstract OBJECTIVES The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management. METHODS From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection. RESULTS Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P < 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031). CONCLUSIONS When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure.

Impact on overall survival and disease-free survival of adjuvant chemotherapy after neoadjuvant chemoradiotherapy for rectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14173-e14173
Author(s):  
Rafael amaral de Castro ◽  
Carlos Eduardo Paiva ◽  
Rogerio Saad-Hossne ◽  
Odair Carlito Michelin ◽  
Cristiano de padua Souza
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

e14173 Background: Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of adjuvant chemotherapy after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5-FU 350mg/m2, D1-D5 (50% of cases) or 5-FU 425mg/m2, D1-D3 (43%) with LV 20mg/m2 bolus in the 1st and 5th week of the 25 sessions of radiotherapy in linear accelerator (total 45 - 50 Gy). When performed, Adjuvant chemotherapy (ADJC) consisted of 5-FU 425mg/m2, LV 20mg/m2, both on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve in SPSS version 13.0 Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum and 66% were ECOG 1. Pathologic Complete Response (PCR) was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (HR: 2.594, 95% CI: 1134-5938, p = 0.024) and OS (HR: 2.615, 95% CI: 1005-6807, p = 0.0488) were higher in patients with PCR independent of the use of ADJC. On the other hand, patient treated with ADJC vs without ADJC, independent of presence of PCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In PCR patients, ADJC do not interfere in the outcome (DFS, p = 0.76; SG, p = 0.73). In group 2 (patients without PCR), the subgroup with ADJC, there was a trend towards better SLD (p = 0.06) and OS (p = 0.06). Those who did not receive ADJC in group 2 had worse SLD (p = 0.011) and OS (p = 0.028) compared with group-1. Conclusions: Adjuvant treatment after NCRT did not increase OS or DFS. Patients without PRC had worse results without ADJC, compared to those with PCR. The first, probably, the subgroup of patients who benefited most from the use of ADJC. PCR improves OS and DFS regardless of ADJC, being perhaps the group that does not deserve ADJC.

Neuroendocrine tumors of uterine cervix in Mexican women.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15569-e15569
Author(s):  
Lucia Edith Flores ◽  
Dan Green ◽  
Daniela Morales-Espinosa ◽  
Lucely Cetina
Keyword(s):  
Overall Survival ◽  
Neuroendocrine Tumors ◽  
Uterine Cervix ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Group 3 ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

e15569 Background: Neuroendocrine tumors of the uterine cervix are rare, aggressive, and carry a poor prognosis. Most are small cell (SCNEC) and large cell (LCNEC). The limited knowledge of this neoplasm is based on small series due to the rarity of the diagnosis.There is a lack of information about NEC in Latin America. We describe both demographic and clinical characteristic of Mexican patients; and their multidisciplinary management in a reference center. Methods: We studied retrospectively clinical and histopathological variables of 33 women treated at the National Cancer Institute of Mexico from 1991 to 2010 with NEC. Patients were allocated into groups according to staging (Group 1 FIGO stages IB1 and IB2; Group 2 IIA-IVA, and Group 3 IVB). Results: Mean age at diagnosis was 50 y.o.; mean tumour size was 4.9 cm. There were 59.4% SCNEC and 40.6% LCNEC. Stage at diagnosis: IB1 15% (n=5), IB2 3% (n=1), IIA 18.2% (n=6), IIB 27.3% (n=9), IIIA 6% (n=2), IVB 27.3% (n=9). Common sites of metastases were lung and liver. The most common presenting symptom was transvaginal bleeding. In Group 1, 6/7 patients received multimodal management with surgery, chemoradiotherapy and induction or adjuvant chemotherapy. In Group 2, 12/17 patients received three modalities, 3/17 received only 2, due to comorbidty. In Group 3, 8/9 received 2 modalities. Patients with one treatment modality were those with disease progression. Cisplatin was used concurrently with radiotherapy; paclitaxel and carboplatin or etoposide and cisplatin were used for either induction or adjuvant settings. Disease free survival in months was: 50.3 (group 1); 23.1 (group 2), and 3.5 (group 3). Overall survival was: 68.5, 46.3, and 17.2 months, respectively. Main sites of recurrence were pelvis, mediastinum, lung, liver, central nervous system, pancreas, adrenal gland, bone and soft tissue. Conclusions: TheNational Cancer Institute of Mexico offers multidisciplinary treatment emphasizing local control after systemic therapy in both early and locally advanced disease; providing the most favourable disease-free survival and overall survival described. To our knowledge, this is the first report of NEC in the Mexican population, where carcinoma of uterine cervix represents yet an important public health issue.

scholarly journals Prognostic significance of advanced lung cancer inflammation index (ALI) in multiple myeloma patients – a retrospective study

2021 ◽  
Author(s):  
Junxia Huang ◽  
Juanjuan Hu ◽  
Yan Gao ◽  
Fanjun Meng ◽  
Tianlan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Multiple Myeloma ◽  
Overall Survival ◽  
Progression Free Survival ◽  
Advanced Lung Cancer ◽  
Free Survival ◽  
Factors Influencing ◽  
Independent Risk Factors ◽  
Cancer Inflammation

Abstract Background: Advanced lung cancer inflammation index (ALI) is known to predict the overall survival of patients having some solid tumors or B-cell lymphoma. The study investigates the predictive value of ALI in multiple myeloma (MM) patients and the correlation between ALI and prognosis.Methods: A database of 269 MM consecutive patients who underwent chemotherapy between December 2011 and June 2019 in the Affiliated Hospital of Qingdao University was reviewed. ALI cut-off value calculated before the initial chemotherapy and post 4 courses treatment were identified according to the receiver operating characteristic (ROC) curve, and its association with clinical characteristics, treatment response, overall survival (OS), and progression-free survival (PFS) were assessed.Results: Patients in the low ALI group (n=147) had higher risk of β2 microglobulin elevation, more advanced ISS (International Classification System stage), and TP53 gene mutation, with significantly lower median overall survival (OS; 36.29 vs. 57.92 months, P = 0.010) and progression-free survival (PFS; 30.94 vs. 35.67 months, P = 0.013). Independent risk factors influencing the OS of MM patients were ALI (P = 0.007), extramedullary infiltration (P = 0.001), TP53 (P = 0.020), Plt (P = 0.005), and bone destruction (P = 0.024). ALI (P = 0.005), extramedullary infiltration (P = 0.004), TP53 (P = <0.001), Plt (P = 0.017), and complex chromosome karyotype (P = 0.010) were independent risk factors influencing the PFS of MM patients.Conclusions: ALI is a potential independent risk factor predicting the prognosis of newly diagnosed MM patients.

scholarly journals Determination of prognostic factors of surgically treated pathological Stage IIIA non-small cell lung cancer

2020 ◽  
Vol 28 (3) ◽  
pp. 496-504
Author(s):  
Muhammet Sayan
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Disease Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Disease Free

Background: This study aims to identify the prognostic factors in Stage IIIA non-small cell lung cancer and to investigate whether there was a significant difference in terms of overall survival and disease-free survival among the subgroups belonging to this disease stage. Methods: Between January 2010 and December 2018, a total of 144 patients (125 males, 19 females; median age 60 years; range, 41 to 80 years) who were operated for non-small cell lung cancer in our clinic and whose pathological stage was reported as IIIA were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, histopathological diagnosis, the standardized uptake value of the mass on positron emission tomography-computed tomography, tumor diameter, type of surgery, lymph node metastasis status, visceral pleural invasion, and overall and disease-free survival rates were recorded. Results: The median survival was 39 (range, 27.8 to 46.1) months and the five-year overall survival rate was 28%. The mean tumor diameter was 4.3±2.7 cm. The median disease-free survival was 37 (range, 28.1 to 48.6) months and the five-year disease-free survival rate was 26.9%. In the multivariate analysis, overall survival and disease-free survival in T2N2M0 subgroup were significantly worse than the other subgroups. The other poor prognostic factors of survival were the standardized uptake value of the tumor, pneumonectomy, and histopathological subtypes other than squamous cell carcinoma and adenocarcinoma. Parietal pleural invasion was significantly associated with worse disease-free survival rates. Conclusion: Our results showed that there may be significant survival differences between subgroups created by tumor histopathology, lymph node invasion and the type of surgery in a heterogeneous lung cancer stage.

Correlation between outcomes and tumor size in >7 cm T4 non-small cell lung cancer patients: A tumor size-based comparison study

2021 ◽  
Vol 29 (8) ◽  
pp. 784-791
Author(s):  
Volkan Erdoğu ◽  
Necati Çitak ◽  
Celal B Sezen ◽  
Levent Cansever ◽  
Cemal Aker ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Lung Cancer Patients ◽  
Disease Free

Background We investigated whether all size-based pathological T4N0–N1 non-small cell lung cancer patients with tumors at any size >7 cm had the same outcomes. Methods We reviewed non-small cell lung cancer patients with tumors >7 cm who underwent anatomical lung resection between 2010 and 2016. A total of 251 size-based T4N0–N1 patients were divided into two groups based on tumor size. Group S ( n = 192) included patients with tumors of 7.1–9.9 cm and Group L ( n = 59) as tumor size ≥10 cm. Results The mean tumor size was 8.83 ± 1.7 cm (Group S: 8.06 ± 0.6 cm, Group L: 11.3 ± 1.6 cm). There were 146 patients with pathological N0 and 105 patients with pathological N1 disease. Mean overall survival and disease-free survival were 64.2 and 51.4 months, respectively. The five-year overall survival and disease-free survival rates were 51.2% and 43.5% (five-year OS; pT4N0:52.7%, pT4N1:47.9%, DFS; pT4N0:44.3%, pT4N1: 42.3%). No significant differences were observed between T4N0 and T4N1 patients in terms of five-year OS or DFS ( p = 0.325, p = 0.505 respectively). The five-year overall survival and disease-free survival rates were 52% and 44.6% in Group S, and 48.5% and 38.9% in Group L. No significant difference was observed between the groups in terms of five-year overall survival or disease-free survival ( p = 0.699, p = 0.608, respectively). Conclusions Above 7 cm, any further increase in tumor size in non-small cell lung cancer patients had no significant effect on survival, confirming it is not necessary to further discriminate among patients with tumors in that size class.

scholarly journals Modern radiopharmaceuticals for lung cancer imaging with positron emission tomography/computed tomography scan: A systematic review

2020 ◽  
Vol 8 ◽  
pp. 205031212096159
Author(s):  
Athanasios S Theodoropoulos ◽  
Ioannis Gkiozos ◽  
Georgios Kontopyrgias ◽  
Adrianni Charpidou ◽  
Elias Kotteas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Positron Emission Tomography ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Standard Uptake Value ◽  
Emission Tomography ◽  
Free Survival ◽  
Positron Emission ◽  
Disease Free

Introduction: In this study, we evaluated the use and the contribution of radiopharmaceuticals to the field of lung neoplasms imaging using positron emission tomography/computed tomography. Methods: We conducted review of the current literature at PubMed/MEDLINE until February 2020. The search language was English. Results: The most widely used radiopharmaceuticals are the following: Experimental/pre-clinical approaches: (18)F-Misonidazole (18F-MISO) under clinical development, D(18)F-Fluoro-Methyl-Tyrosine (18F-FMT), 18F-FAMT (L-[3-18F] (18)F-Fluorothymidine (18F-FLT)), (18)F-Fluoro-Azomycin-Arabinoside (18F-FAZA), (68)Ga-Neomannosylated-Human-Serum-Albumin (68Ga-MSA) (23), (68)Ga-Tetraazacyclododecane (68Ga-DOTA) (as theranostic agent), (11)C-Methionine (11C-MET), 18F-FPDOPA, ανβ3 integrin, 68Ga-RGD2, 64Cu-DOTA-RGD, 18F-Alfatide, Folate Radio tracers, and immuno-positron emission tomography radiopharmaceutical agents. Clinically approved procedures/radiopharmaceuticals agents: (18)F-Fluoro-Deoxy-Glucose (18F-FDG), (18)F-sodium fluoride (18F-NaF) (bone metastases), and (68)Ga-Tetraazacyclododecane (68Ga-DOTA). The quantitative determination and the change in radiopharmaceutical uptake parameters such as standard uptake value, metabolic tumor volume, total lesion glycolysis, FAZA tumor to muscle ratio, standard uptake value tumor to liver ratio, standard uptake value tumor to spleen ratio, standard uptake value maximum ratio, and the degree of hypoxia have prognostic and predictive (concerning the therapeutic outcome) value. They have been associated with the assessment of overall survival and disease free survival. With the positron emission tomography/computed tomography radiopharmaceuticals, the sensitivity and the specificity of the method have increased. Conclusion: In terms of lung cancer, positron emission tomography/computed tomography may have clinical application and utility (a) in personalizing treatment, (b) as a biomarker for the estimation of overall survival, disease free survival, and (c) apply a cost-effective patient approach because it reveals focuses of the disease, which are not found with the other imaging methods.

scholarly journals Prognostic Value of the Preoperative Lymphocyte-to-monocyte Ratio for Survival After Lung Cancer Surgery

2020 ◽  
Author(s):  
Ricard Ramos ◽  
Iván Macía ◽  
Arturo Navarro-Martín ◽  
Carlos Déniz ◽  
Francisco Rivas ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Inflammatory Marker ◽  
Lung Cancer Surgery ◽  
Disease Free Survival ◽  
Free Survival ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio ◽  
Disease Free

Abstract Background: The aim of this study was to assess the effect of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with lung cancer treated with radical surgery on overall survival (OS), and disease-free survival (DFS).Methods: We performed a retrospective review of patients with lung cancer who prospectively underwent radical resection between 2004 and 2012. Prior to surgery, blood samples were taken as part of preoperative workup. The inflammatory markers studied were absolute values of lymphocytes, monocytes, neutrophils and platelets, with subsequent calculation of the ratios. Median follow-up was 52 months. Results: 268 patients underwent surgery, of whom 218 (81.3%) were men. Mean age was 62.9 ± 8.7 years. A lymphocyte-to-monocyte ratio ≥ 2.5 was independently associated with longer disease-free survival (hazard ratio [HR] 0.476 (0.307–0.738), p=0.001) and longer overall survival (HR, 0.546; 95% CI: 0.352-0.846; p=0.007), in models adjusted by age, sex, stage, and type of resection. No other systemic inflammatory marker showed a significant association. Conclusion: Preoperative lymphocyte-to-monocyte ratio is an independent prognostic factor in terms of overall survival and recurrence-free survival in patients with surgically resected early stage lung cancer.

scholarly journals Protein Kinase D1 Is Increased in Tumor Tissue, Correlates With Advanced Tumor Features and Worse Prognosis of Non-Small Cell Lung Cancer

2020 ◽  
Vol 19 ◽  
pp. 153303382093412
Author(s):  
Jing Yao ◽  
Yan Jiang ◽  
Shuang Geng ◽  
Li Sun
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Protein Kinase ◽  
Small Cell Lung Cancer ◽  
Disease Free Survival ◽  
Small Cell ◽  
Small Cell Lung ◽  
Free Survival ◽  
Protein Kinase D1 ◽  
Disease Free

Objective: This study aimed to assess protein kinase D1 expression and its association with tumor characteristics as well as prognosis in patients with non-small cell lung cancer. Methods: Protein kinase D1 expression in tumor tissues and adjacent tissues from 172 patients with non-small cell lung cancer who underwent surgical resection were analyzed by immunohistochemical staining. Based on the total immunohistochemical score, protein kinase D1 expression was classified as protein kinase D1 high expression (further divided into protein kinase D1 high+++, protein kinase D1 high++, and protein kinase D1 high+ expressions) and protein kinase D1 low expression. Clinical characteristics of patients with non-small cell lung cancer were acquired from the database. Accumulating disease-free survival and overall survival were calculated based on patients’ relapse/survival status. Results: Protein kinase D1 expression was increased in tumor tissues compared to adjacent tissues ( P < .001). Tumor protein kinase D1 high expression correlated with poorer pathological differentiation ( P = .041), increased tumor size ( P = .003), the presence of lymph node metastasis ( P = .001), and elevated tumor, nodes and metastases stage ( P < .001). Besides, both accumulating disease-free survival and overall survival were decreased in patients with tumor protein kinase D1 high expression compared to patients with tumor protein kinase D1 low expression ( P = .010 for disease-free survival and P = 0.005 for overall survival). Moreover, they were lowest in patients with tumor protein kinase D1 high+++ expression, followed by patients with tumor protein kinase D1 high++ expression, then patients with tumor protein kinase D1 high+ expression, and highest in patients with tumor protein kinase D1 low expression ( P < .001 for disease-free survival and P = .001 for overall survival). Notably, higher tumor protein kinase D1 expression was an independent predictive factor for decreased disease-free survival ( P = .001) and overall survival ( P = .004). Conclusions: Protein kinase D1 might be a potential marker to identify patients with non-small cell lung cancer with worse tumor features and prognosis.

Conjunctival and uveal melanoma: Survival and risk factors following orbital exenteration

2021 ◽  
pp. 112067212199513
Author(s):  
Sven Holger Baum ◽  
Henrike Westekemper ◽  
Nikolaos Emmanouel Bechrakis ◽  
Christopher Mohr
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Uveal Melanoma ◽  
Disease Free Survival ◽  
Orbital Exenteration ◽  
Free Survival ◽  
The Mean ◽  
Disease Free ◽  
Worse Prognosis

Purpose: This study aims to analyse disease-free survival, overall survival and risk factors after orbital exenteration in patients with conjunctival and uveal melanoma. Methods: Patients who underwent orbital exenteration due to conjunctival and uveal melanoma were included in this retrospective study (March 2000 to March 2018). Results: A total of 76 patients were enrolled in this study: 60 patients had a conjunctival melanoma and 16 had a uveal melanoma. In conjunctival melanoma, the mean age was 68.4 years. The overall survival rate was 82% after 1 year and 52% after 5 years. Univariate analysis of overall survival found that the following parameters were predictive of a worse prognosis: gender, extent of the primary tumour, lymph node metastases, distant metastases, adjuvant chemotherapy or radiotherapy and relapse. In multivariate analysis, relapse and adjuvant radiotherapy appeared to contribute to a significantly worse prognosis. In uveal melanoma, the mean age was 63.6 years. Eleven patients died during follow-up (mean follow up 30.7 months). The overall survival and disease-free survival rates after 1 year were 62% and 57%, respectively. An analysis of risk factors was not possible due to the small number of cases. Conclusion: Orbital exenterations in conjunctival and uveal melanoma are rarely necessary, but can be performed as an ultima ratio treatment with curative intent. Disease-free survival and overall survival are significantly lower for both groups due to the advanced stage of the disease compared to patients treated without exenteration in the literature. If a recurrence occurs after exenteration, the prognosis is poor in both groups.

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