Evaluation of Clinical Prognostic Factors and Further Delineation of the Effect of Mesenteric Fibrosis on Survival in Advanced Midgut Neuroendocrine Tumours

2018 ◽  
Vol 107 (3) ◽  
pp. 292-304 ◽  
Author(s):  
Faidon-Marios Laskaratos ◽  
Martin Walker ◽  
Dominic Wilkins ◽  
Alexander Tuck ◽  
Shashank Ramakrishnan ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Large Scale ◽  
Neuroendocrine Tumours ◽  
Primary Tumour ◽  
Stage Iv ◽  
Epidemiological Data ◽  
Tumour Resection ◽  
Carcinoid Heart Disease ◽  
Factors Affecting ◽  
Stage Iv Disease

Background: Small intestinal neuroendocrine tumours (SI NETs) represent 30–50% of small bowel neoplasms and often present at an advanced stage. To date, there is relatively limited literature regarding prognostic factors affecting overall survival (OS) in stage IV disease. In addition, the prevalence of mesenteric fibrosis (MF) in SI NETs and its effect on OS have not been sufficiently explored in the literature. Aim: The primary aim of this study was to perform a large-scale survival analysis in an institutional cohort of 387 patients with metastatic (stage IV) SI NETs. The secondary aim was to provide epidemiological information regarding the prevalence of MF and to evaluate its effect on OS. Results: The median OS was 101 months (95% CI 84, 118). Age > 65 years, mesenteric metastases with and without desmoplasia, liver metastases, carcinoid heart disease (CHD) and bone metastases were associated with a significantly shorter OS, while primary tumour resection was predictive of a longer OS. The benefit of surgical resection was limited to symptomatic patients. MF was present in approximately 50% of patients with mesenteric lymphadenopathy. Elevated urinary 5-HIAA levels correlated strongly with the presence of CHD (p < 0.001) and to a lesser extent (p = 0.02) with MF. MF and CHD did not usually co-exist, suggesting that different mechanisms are likely to be involved in the development of these fibrotic complications. Conclusions: This study has identified specific prognostic factors in a large cohort of 387 patients with advanced SI NETs and has provided useful epidemiological data regarding carcinoid-related fibrotic complications.

scholarly journals ENETS TNM Staging Predicts Prognosis in Small Bowel Neuroendocrine Tumours

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Rajaventhan Srirajaskanthan ◽  
A. Ahmed ◽  
A. Prachialias ◽  
P. Srinivasan ◽  
N. Heaton ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Neuroendocrine Tumours ◽  
Primary Tumour ◽  
Staging System ◽  
Tnm Staging ◽  
Tumour Resection ◽  
Carcinoid Heart Disease ◽  
Tnm Staging System ◽  
Primary Tumour Resection

Introduction. Small bowel neuroendocrine tumours (NETs) are the most common type of gastrointestinal neuroendocrine tumours. The incidence and prevalence of these tumours are on the rise. The aims of this study were to determine prognostic clinicopathological features and whether the ENETS TNM staging system predicts prognosis and also. Method. Clinical data was collected retrospectively from 138 patients with histologically proven small bowel NETs managed at King’s College Hospital. Histology was reviewed and small bowels tumours, were staged according to the ENETS TNM staging system. Results. Median age was 65 years (range 29–87). The 5-year survival was 79.5% and the 10-year survival was 48.5%. Resection of the primary tumour was associated with improved survival (120 versus 56 months, P<0.05). On multivariate analysis prognostic factors were primary tumour resection and not having a carcinoid heart disease. TNM staging significantly separated survival of stage 2 and stage 3 from stage 4 NETs. Conclusion. Small bowel primary tumour resection and not having carcinoid heart disease are prognostic factors. The ENETS TNM staging and grading system appears to be of prognostic relevance to small bowel NETs.

Prognostic Factors for Survival among Patients with Small Bowel Neuroendocrine Tumours Associated with Mesenteric Desmoplasia

2018 ◽  
Vol 106 (4) ◽  
pp. 366-380 ◽  
Author(s):  
Faidon Marios Laskaratos ◽  
Leonidas Diamantopoulos ◽  
Martin Walker ◽  
Henry Walton ◽  
Mohamed Khalifa ◽  
...  
Keyword(s):  
Small Bowel ◽  
Neuroendocrine Tumours ◽  
Univariate Analysis ◽  
Epidemiological Data ◽  
Carcinoid Heart Disease ◽  
Factors Affecting ◽  
Upper Limit ◽  
Hydroxyindoleacetic Acid ◽  
Small Bowel Neoplasms

Background: Small intestinal neuroendocrine tumours (SI NETs) represent 30–50% of small bowel neoplasms and are often associated with diverse fibrotic complications. Mesenteric fibrosis is a hallmark of SI NETs which may cause substantial morbidity and is considered an adverse feature. However, survival analyses in this group of patients are lacking. Methods: The aim of this retrospective study was to determine the overall survival (OS) and factors affecting prognosis in a large cohort of 147 patients with SI NETs and radiological evidence of mesenteric desmoplasia from our centre. The severity of desmoplasia was graded radiologically and its effect on OS and long-term complications was assessed. The median follow-up period was 82 months. Results: The median OS was 8.7 years (95% CI 6.8–9.9) with an overall 5-year survival of 71%. The univariate analysis demonstrated that an age >65 years, a liver tumour burden >50% of the hepatic parenchyma, carcinoid heart disease, chromogranin A levels >10 times the upper limit of normal, and urinary 5-hydroxyindoleacetic acid (5-HIAA) levels >5 times the upper limit of normal were poor prognosticators, while primary resection was associated with a longer OS. However, only an age >65 years and urinary 5-HIAA levels >10 times the upper limit of normal remained statistically significant after multivariate analysis. The severity of mesenteric desmoplasia did not seem to demonstrate a statistically significant relationship to OS or long-term outcomes. Conclusion: This study is the first comprehensive survival analysis of patients with SI NETs associated with mesenteric desmoplasia and has provided important and clinically relevant epidemiological data for this group of patients.

scholarly journals Size of metastatic deposits affects prognosis in patients undergoing pulmonary metastectomy for colorectal cancer

2014 ◽  
Vol 96 (1) ◽  
pp. 32-36 ◽  
Author(s):  
MA Javed ◽  
ARG Sheel ◽  
AA Sheikh ◽  
RD Page ◽  
PS Rooney
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Pulmonary Metastases ◽  
Primary Tumour ◽  
Hepatic Metastases ◽  
Lymph Node Involvement ◽  
R0 Resection ◽  
Hilar Lymph Node ◽  
Poor Prognostic Factor ◽  
Factors Affecting

INTRODUCTION Pulmonary metastectomy for colorectal cancer (CRC) is a well accepted procedure although data regarding indications and prognostic outcomes are inconsistent. This study aimed to analyse our experience with resection of pulmonary CRC metastases to evaluate clinically relevant prognostic factors affecting survival. METHODS A retrospective analysis was undertaken of the records of all patients with pulmonary metastases from CRC who underwent a thoracotomy between 2004 and 2010 at a single surgical centre. RESULTS Sixty-six patients with pulmonary metastases from the colon (n=34) and the rectum (n=32) were identified. The 30-day hospital mortality rate was 0%, with 63 patients undergoing a R0 resection and 3 having a R1 resection. The median survival was 45 months and the cumulative 3-year survival rate was 61%. Size of pulmonary metastasis and ASA (American Society of Anesthesiologists) grade were statistically significant prognostic factors (p=0.047 and p=0.009 respectively) with lesions over 20mm associated with a worse prognosis. Sex, age, site, disease free interval (cut-off 36 months), primary tumour stage, hepatic metastases, number of metastases (solitary vs multiple), type of operation (wedge vs lobe resection), hilar lymph node involvement and administration of adjuvant chemotherapy were not found to be statistically significant prognostic factors. CONCLUSIONS Pulmonary metastectomy has a potential survival benefit for patients with metastatic CRC. Improved survival even in the presence of hepatic metastases or multiple pulmonary lesions justifies aggressive surgical management in carefully selected patients. In our cohort, size of metastatic deposit was a statistically significant poor prognostic factor.

The role of primary tumour resection in patients with stage IV colorectal cancer

2007 ◽  
Vol 9 (5) ◽  
pp. 430-437 ◽  
Author(s):  
V. R. Konyalian ◽  
D. K. Rosing ◽  
J. S. Haukoos ◽  
M. R. Dixon ◽  
R. Sinow ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Tumour ◽  
Stage Iv ◽  
Tumour Resection ◽  
Stage Iv Colorectal Cancer ◽  
Primary Tumour Resection

scholarly journals Primary Melanoma Characteristics of Metastatic Disease: A Nationwide Cancer Registry Study

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4431
Author(s):  
Catherine Zhou ◽  
Marieke Louwman ◽  
Marlies Wakkee ◽  
Astrid van der Veldt ◽  
Dirk Grünhagen ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Metastatic Disease ◽  
Prediction Models ◽  
Primary Tumour ◽  
Stage Iv ◽  
Stage I ◽  
Stage Iii ◽  
Early Stage Disease ◽  
Stage Iv Disease ◽  
Tumour Characteristics

The characteristics and disease patterns of primary stage I and II cutaneous melanomas that progress to stage III or IV disease were investigated based on data from the Netherlands Cancer Registry (NCR). Data on stage III or IV melanomas at first diagnosis or during follow-up between 2017 and 2019 were retrieved. Patient and primary tumour characteristics were investigated in relation to time to disease progression and the number of organ sites with metastatic disease using regression models. In total, 2763 patients were included, of whom 1613 were diagnosed with stage IV disease. Among the patients with stage IV disease, 60% (n = 963) were initially diagnosed with stage I or II disease. The proportion of patients who received a sentinel lymph node biopsy increased after the introduction of adjuvant therapy in 2019 from 61% to 87%. Among all patients with stage III disease who were eligible for adjuvant systemic therapy (n = 453) after 2019, 37% were not treated with this therapy. Among patients with stage IV disease, lung metastases were most often detected as the first metastatic site and females presented with more metastatic sites than males. Most patient and primary tumour characteristics were not associated with the distant metastatic organ site, except melanoma localisation in the lower extremities and the head or neck. Our observation that most stage IV patients were initially diagnosed with early-stage disease highlights the need for more accurate risk prediction models.

Patient satisfaction with participation in phase II/III NCCTG clinical trials: Was it worth it? (N0392).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6133-6133 ◽  
Author(s):  
Cynthia Chauhan ◽  
Pamela J. Atherton ◽  
Daniel Satele ◽  
Amylou C. Dueck ◽  
Gamini S. Soori ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Phase Ii ◽  
Stage Iv ◽  
Treatment Decision ◽  
Factors Affecting ◽  
Treatment Decision Making ◽  
Phase Ii Studies ◽  
Trial Experience ◽  
Stage Iv Disease ◽  
Post Trial

6133 Background: Patient (pt) trial experience may give insight to quality of life (QOL) factors affecting accrual, retention and outcome. While pts are vital to clinical trial success, we know little about their post-trial opinions. This trial examined pt opinion of their trial and treatment decision making (TDM). Methods: Pts enrolled on designated North Central Cancer Treatment Group (NCCTG) phase II or III treatment trials completed the TDM Control Preferences Scale at baseline and the Was It Worth It (WIWI) satisfaction assessment at the ends of cycle 1 and active protocol treatment. The primary endpoint was the proportion of pts reporting worthwhile participation. Fisher Exact tests compared pt opinion across subgroups. Results: As of 01/15/2012, 264 pts were enrolled on 25 protocols and treated at 79 sites. 86% of pts were in phase II studies and 89% had stage IV disease. At the end of cycle 1, pts felt the trial was worthwhile (74%), would do it again (85%), and would recommend it to others (82%). 85% of pts reported undiminished QOL and only 7% rated the trial worse than expected. End of treatment responses were similar. Satisfaction rates varied by tumor site (p=0.04). 11% of pts having tumor response rated the trial as not worthwhile, and 66% of pts with progressive disease rated it worthwhile (see table). Pts with concordant preferred and actual TDM roles rated participation higher than pts with discordant TDM roles (see table). Conclusions: Most pts endorsed their clinical trial experience. Contrary to popular beliefs, treatment outcome did not have an overwhelming impact on pt satisfaction, and was just one of many factors such as TDM role discordance. Assessing pt satisfaction will inform future study design that can potentially improve pt accrual and retention. [Table: see text]

Distant metastases in ovarian carcinoma

2003 ◽  
Vol 13 (2) ◽  
pp. 125-129 ◽  
Author(s):  
G. Cormio ◽  
C. Rossi ◽  
A. Cazzolla ◽  
L. Resta ◽  
G. Loverro ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Factors ◽  
Ovarian Carcinoma ◽  
Metastatic Disease ◽  
Stage Iv ◽  
Distant Metastases ◽  
Distant Disease ◽  
Distant Metastatic Disease ◽  
Interval Time ◽  
Stage Iv Disease

Distant metastases are unusual at presentation and during the course of ovarian carcinoma. The aim of the present study was to determine the incidence and prognostic factors of distant metastases consistent with stage IV disease in ovarian cancer patients. A retrospective chart review was conducted on 162 patients with epithelial ovarian carcinoma treated at our Unit between 1991 and 2000. Pertinent clinical information, pathologic data, treatment, and prognostic factors for survival following documentation of distant metastatic disease were collected. The significance of the association between metastatic status and various clinical variables was assessed using the standard chi-square test. Survival time was calculated from the time of diagnosis of ovarian cancer and from the time of diagnosis of the distant metastases. A logistic regression procedure was used to estimate the odds of metastatic status given the presence of certain clinical variables. A total of 67 metastatic sites were diagnosed in 50 patients. Thirteen patients (8%) had distant metastatic disease at the time of diagnosis, 37 patients (22%) had distant metastases at the time of recurrent of progressive disease. Site of metastases were: liver, 21; pleura, 11; lung, 8; central nervous system and skin, 7 each; extra-abdominal lymph nodes and spleen, 5 each; bone, 2; and breast, 1. Significant risk factors for the development of distant metastases were stage, grade, and lymph node involvement. Median interval time between diagnosis of ovarian cancer and documentation of metastatic disease was 44 months (range 3–105), and at the time of diagnosis of distant disease, 36 of 50 patients (72%) had other sites of disease (intra-abdominal or extra-abdominal). Median survival from diagnosis of distant disease was 12 months (range 1–58). In univariate analysis performance status (P = 0.03), the presence of other sites of disease (P = 0.04) and interval time between diagnosis of ovarian cancer and documentation of distant metases (P = 0.03) were the only factors significantly associated with survival. Long interval time remained significant for prognosis in multivariate analysis also (P = 0.04). Distant metastasis consistent with stage IV disease is a late complication that occurs in about one third of ovarian cancer patients. Prognosis after documentation of distant metastases is poor. We conclude the most important prognostic factor associated with survival is the interval time between diagnosis of ovarian cancer and documentation of distant metastases.

scholarly journals Nomogram for predicting overall survival in colorectal cancer with distant metastasis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zheng Liu ◽  
Yao Xu ◽  
Guijun Xu ◽  
Vladimir P. Baklaushev ◽  
Vladimir P. Chekhonin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Distant Metastasis ◽  
Primary Tumour ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Stage Iv Colorectal Cancer ◽  
Colorectal Cancer Patients

Abstract Background Colorectal cancer (CRC) is a major cancer burden, and prognosis is determined by many demographic and clinicopathologic factors. The present study aimed to construct a prognostic nomogram for colorectal cancer patients with distant metastasis. Methods Colorectal cancer patients with distant metastasis diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results database. Cox proportional hazards regression was used to identify independent prognostic factors. A nomogram was constructed to predict survival, and validation was performed. Results A total of 7099 stage IV colorectal cancer patients were enrolled in the construction cohort. The median overall survival was 20.0 (95% CI 19.3–20.7) months. Age at diagnosis, marital status, race, primary tumour site, tumour grade, CEA level, T stage, N stage, presence of bone, brain, liver and lung metastasis, surgery for primary site and performance of chemotherapy were independent prognostic factors. The nomogram was constructed and the calibration curve showed satisfactory agreement. The C-index was 0.742 (95% CI 0.726–0.758). In the validation cohort (7098 patients), the nomogram showed satisfactory discrimination and calibration with a C-index of 0.746 (95% CI 0.730–0.762). Conclusion A series of factors associated with the survival of CRC patients with distant metastasis were found. Based on the identified factors, a nomogram was generated to predict the survival of stage IV colorectal cancer patients. The predictive model showed satisfactory discrimination and calibration, which can provide a reference for survival estimation and individualized treatment decisions.

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