scholarly journals Surgical treatment strategy for esophagogastric junction cancers based on the tumor diameter

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Isamu Hoshino ◽  
Hisashi Gunji ◽  
Fumitaka Ishige ◽  
Yosuke Iwatate ◽  
Nobuhiro Takiguchi ◽  
...  
Keyword(s):  
Tumor Size ◽  
Esophagogastric Junction ◽  
Survival Rates ◽  
Tumor Diameter ◽  
Clinical Factors ◽  
Number Of Patients ◽  
Nodal Dissection ◽  
Esophageal Invasion ◽  
Upper Mediastinum ◽  
Average Tumor Size

Abstract Background The number of patients with esophagogastric junction (EGJ) cancers has tended to increase. However, no clear consensus on the optimum treatment policy has yet been reached. Methods This study included patients diagnosed with adenocarcinoma of Sievert type II in whom resection was performed in our hospital. We performed a clinicopathological examination, and patients were divided into two groups by the tumor size: L group, tumor size ≥4 cm; and S group, tumor size < 4 cm. The clinical factors, such as nodal dissection and recurrence pattern, were then analyzed. Results A total of 48 patients were diagnosed with ECJ cancers. The average tumor size was 55.1 mm, and 32 cases (66.7%) had tumors ≥4 cm. Metastasis to the mediastinum was noted in 4 cases (12.5%) in the L group but none in the S group. Recurrence in the upper or middle mediastinum lymph nodes was noted in 3 cases (9.4%) in the L group. The 5-year overall survival rates were 49.7 and 83.9% in the L and S groups, respectively. Conclusions As the tumor grows large, it is difficult to accurately judge EGJ on the image, and as a result it is difficult to understand the exact esophageal invasion distance of the tumor. Therefore, lymph node dissection including the upper mediastinum is considered vital, regardless of the degree of esophageal invasion.

FA04.02: JAPANESE MULTICENTER PROSPECTIVE STUDY FOR ESOPHAGOGASTRIC JUNCTION CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 8-8
Author(s):  
Shinji Mine ◽  
Yukinori Kurokawa ◽  
Hiroya Takeuchi ◽  
Takeshi Sano ◽  
Masanori Terashima ◽  
...  
Keyword(s):  
Lymph Node ◽  
Prospective Study ◽  
Renal Vein ◽  
Esophagogastric Junction ◽  
Left Renal Vein ◽  
The Other ◽  
Celiac Axis ◽  
Esophageal Invasion ◽  
Multicenter Prospective Study ◽  
Upper Mediastinum

Abstract Background Lymph node metastasis from esophagogastric junction (EGJ) cancer is multi-directional, and the previously reported incidences in each nodal station are heavily biased by different operative approaches. We conducted a multicenter prospective study using a standardized surgical protocol of lymphadenectomy. Methods This study is a single-arm, multi-institutional, prospective study. Patients with resectable cT2–4 EGJ cancer were eligible, regardless of neoadjuvant therapy. The primary endpoint was the metastasis rate of each lymph nodal station. The planned sample size was 360, and the entry period was 4 years. Protocol of surgical procedure: Patients diagnosed as having EGJ adenocarcinoma with esophageal invasion > 3 cm or with upper/middle mediastinal lymph node involvement, or those having EGJ squamous cell carcinoma, underwent an esophagectomy via right thoracotomy or thoracoscopy. The lymphadenectomy included the upper/middle/lower mediastinum, paracardiac region, around the celiac axis, and the left renal vein area (16a2lat). Patients with EGJ adenocarcinoma with esophageal invasion ≤ 3 cm underwent transhiatal lower esophagectomy and gastrectomy with lymphadenectomy of the lower mediastinum, paracardiac region, around the celiac axis, and 16a2lat. Results From April 2014 to September 2017, 371 patients were enrolled in this study from 42 institutions. As 8 patients were excluded due to protocol violations and later refusals, 363 patients were analyzed finally. Of 363 patients, 332 (91.4%) had adenocarcinoma and 31 (8.5%) had SCC. 86 patients (23.7%) had cT2 tumors and the other 277 (76.3%) had cT3–4 tumors. 134 patients (36.9%) had cN0 and the other 229 (63.1%) had cN + disease. Neo-adjuvant treatments (mostly chemotherapy) were given to only 121 patients (33.3%). Esophagectomies were performed in 121 patients (33.3%) and extended gastrectomies were performed in 236 (65.0%). Resection with R0 was achieved in 339 (93.4%). Based on histological examinations, the incidences of nodal involvements in each area were as follows: upper mediastinum (9/118, 7.6%); middle mediastinum (14/128, 10.9%); lower mediastinum (47/353, 13.3%); abdominal (240/358, 67.0%); the left renal vein area (16A2lat) (18/344, 5.2%). Conclusion For patients with EGJ cancers, the incidences of nodal involvements in the upper mediastinum and the left renal vein area (16A2lat) were lower than our expectations. Disclosure All authors have declared no conflicts of interest.

scholarly journals Intrathoracic Anastomosis or Cervical Anastomosis for Esophagogastric Junction Cancer Surgery: A Retrospective Cohort Study

2020 ◽  
Vol 104 (3-4) ◽  
pp. 123-130
Author(s):  
Kei Hosoda ◽  
Keishi Yamashita ◽  
Hiromitsu Moriya ◽  
Hiroaki Mieno ◽  
Masahiko Watanabe
Keyword(s):  
Reflux Esophagitis ◽  
Esophagogastric Junction ◽  
Survival Rates ◽  
Cervical Anastomosis ◽  
Ivor Lewis ◽  
Esophagogastric Junction Cancer ◽  
Study Population ◽  
Esophageal Invasion ◽  
Mckeown Esophagectomy ◽  
Esophagogastric Junction Carcinoma

Aims: This study aimed to determine the degree of reflux esophagitis after either intrathoracic or cervical esophagogastrostomy in patients with esophagogastric junction carcinoma. Patients and Methods: The study population consisted of 10 and 15 consecutive patients who underwent esophagectomy with gastric conduit reconstruction via intrathoracic (Ivor Lewis) or cervical (McKeown) esophagogastrostomy, respectively. Reflux esophagitis was evaluated annually after surgery and scored on a 0- to 4-point scale corresponding to grades N/M, A, B, C, and D, respectively. The reflux esophagitis score of each patient, defined as the average of scores at 1, 2, and 3 years after surgery, was compared between the groups. Results: Of the 30 planned annual endoscopic follow-ups (3 years in 10 patients) in the Ivor Lewis group and 45 planned follow-ups (3 years in 15 patients) in the McKeown group, 24 and 29 such follow-ups were performed in the Ivor Lewis and McKeown groups, respectively. The reflux esophagitis score was significantly better in the McKeown group than in the Ivor Lewis group (0.51 ± 0.24 versus 1.46 ± 0.29, P = 0.019). Overall survival did not significantly differ between the Ivor Lewis and McKeown groups (respective 5-year survival rates, 64% versus 57%, P = 0.75). Conclusions: The degree of reflux esophagitis may be greater in patients with esophagogastric junction cancer treated by Ivor Lewis esophagectomy than in those treated by McKeown esophagectomy. McKeown esophagectomy might be a more suitable method for the treatment of esophagogastric junction cancer with extended esophageal invasion.

Results of the Brazilian Osteosarcoma Treatment Group Studies III and IV: Prognostic Factors and Impact on Survival

2006 ◽  
Vol 24 (7) ◽  
pp. 1161-1168 ◽  
Author(s):  
A. Sérgio Petrilli ◽  
Beatriz de Camargo ◽  
Vicente Odone Filho ◽  
Paula Bruniera ◽  
Algemir L. Brunetto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Treatment Group ◽  
Tumor Size ◽  
Survival Rates ◽  
Large Tumor ◽  
Free Survival ◽  
Number Of Patients ◽  
Impact On Survival ◽  
The Impact

Purpose To evaluate the impact of chemotherapy and surgery on the outcome of osteosarcoma (OS) of the extremities and to identify prognostic factors in Brazilian patients. Patients and Methods A total of 225 patients with metastatic and nonmetastatic OS of the extremities were enrolled and assessed in two consecutive studies designed and implemented by the Brazilian Osteosarcoma Treatment Group. Results The 5-year survival and event-free survival rates for the 209 assessable patients were 50.1% and 39%, respectively; for the 178 patients with nonmetastatic disease at diagnosis, the rates were 60.5% and 45.5%, respectively. The multivariate analysis showed that the following variables were associated with a shorter survival: metastases at diagnosis (P < .001), necrosis grades 1 and 2 (P = .046), and tumor size (P = .0071). Conclusion The overall 5- and 10-year survival rates were lower than the rates reported in North American and European trials. A pattern of advanced disease at diagnosis was often present, with a high proportion of patients having metastases (20.8%) and large tumor size (42.9%). However, these features were not necessarily associated with longer duration of prediagnostic symptoms. These findings were considered in the strategic planning of the current Brazilian cooperative study, with the aim of improving survival and quality of life of a large number of patients with OS.

scholarly journals EPEN-24. SIOP EPENDYMOMA II: CENTRAL EPENDYMOMA MANAGEMENT ADVISORY GROUP – THE UK EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii312-iii312
Author(s):  
Donald C Macarthur ◽  
Conor Mallucci ◽  
Ian Kamaly-Asl ◽  
John Goodden ◽  
Lisa C D Storer ◽  
...  
Keyword(s):  
Survival Rates ◽  
Target Volume ◽  
Advisory Group ◽  
Subtotal Resection ◽  
Str Analysis ◽  
Oncological Treatment ◽  
Beneficial Effects ◽  
Number Of Patients ◽  
Pathological Review ◽  
The Uk

Abstract Paediatric Ependymoma is the second most common malignant brain tumour of childhood with approximately 50% of cases recurring. It has been described as a “surgical” disease since patients who have undergone a gross total surgical resection (GTR) have a better prognosis than those who have a subtotal resection (STR). Analysis of the UKCCSG/SIOP 1992 04 clinical trial has shown that only 49% of cases had a GTR, with 5-year survival rates for STR of 22–47% and GTR of 67–80%. As part of the SIOP II Ependymoma trial the UK established a panel of experts in the treatment of Ependymoma from Neuro-oncology, Neuro-radiology and Neuro-surgery. Meeting weekly, cases are discussed to provide a consensus on radiological review, ensuring central pathological review, trial stratification and whether further surgery should be advocated on any particular case. Evaluation of the first 68 UK patients has shown a GTR in 47/68 (69%) of patients and STR in 21/68 (31%) of patients. Following discussion at EMAG it was felt that 9/21 (43%) STR patients could be offered early second look surgery. Following this 2nd look surgery the number of cases with a GTR increased to 56/68 (82%). There has been a clear increase in the number of patients for whom a GTR has been achieved following discussion at EMAG and prior to them moving forwards with their oncological treatment. This can only have beneficial effects in decreasing their risk of tumour recurrence or CSF dissemination and also in reducing the target volume for radiotherapy.

scholarly journals Validation of the T Descriptor (TNM-8) in T3N0 Non-Small-Cell Lung Cancer Patients; a Bicentric Cohort Analysis with Arguments for Redefinition

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1812
Author(s):  
Philip Baum ◽  
Samantha Taber ◽  
Stella Erdmann ◽  
Thomas Muley ◽  
Mark Kriegsmann ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Tumor Size ◽  
Cohort Analysis ◽  
Lung Cancer Surgery ◽  
Tnm Staging ◽  
Parietal Pleura ◽  
Tumor Diameter ◽  
Lung Cancer Patients ◽  
Multiple Nodules

The current pT3N0 category represents a heterogeneous subgroup involving tumor size, separate tumor nodes in one lobe, and locoregional growth pattern. We aim to validate outcomes according to the eighth edition of the TNM staging classification. A total of 281 patients who had undergone curative lung cancer surgery staged with TNM-7 in two German centers were retrospectively analyzed. The subtypes tumor size >7 cm and multiple nodules were grouped as T3a, and the subtypes parietal pleura invasion and mixed were grouped as T3b. We stratified survival by subtype and investigated the relative benefit of adjuvant chemotherapy according to subtype. The 5-year overall survival (OS) rates differed between the different subtypes tumor diameter >7 cm (71.5%), multiple nodules in one lobe (71.0%) (grouped as T3a), parietal pleura invasion (59.%), and mixed subtype (5-year OS 50.3%) (grouped as T3b), respectively. The cohort as a whole did not gain significant OS benefit from adjuvant chemotherapy. In contrast, adjuvant chemotherapy significantly improved OS in the T3b subgroup (logrank p = 0.03). This multicenter cohort analysis of pT3N0 patients identifies a new prognostic mixed subtype. Tumors >7 cm should not be moved to pT4. Patients with T3b tumors have significantly worse survival than patients with T3a tumors.

scholarly journals Bone marrow niche crosses paths with BMPs: a road to protection and persistence in CML

2019 ◽  
Vol 47 (5) ◽  
pp. 1307-1325 ◽  
Author(s):  
Caroline Busch ◽  
Helen Wheadon
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Bone Morphogenetic Proteins ◽  
Kinase Inhibitor ◽  
Survival Rates ◽  
High Survival ◽  
Bone Marrow Niche ◽  
Matrix Deposition ◽  
Bmp Receptors ◽  
Number Of Patients

Abstract Chronic myeloid leukaemia (CML) is a paradigm of precision medicine, being one of the first cancers to be treated with targeted therapy. This has revolutionised CML therapy and patient outcome, with high survival rates. However, this now means an ever-increasing number of patients are living with the disease on life-long tyrosine kinase inhibitor (TKI) therapy, with most patients anticipated to have near normal life expectancy. Unfortunately, in a significant number of patients, TKIs are not curative. This low-level disease persistence suggests that despite a molecularly targeted therapeutic approach, there are BCR-ABL1-independent mechanisms exploited to sustain the survival of a small cell population of leukaemic stem cells (LSCs). In CML, LSCs display many features akin to haemopoietic stem cells, namely quiescence, self-renewal and the ability to produce mature progeny, this all occurs through intrinsic and extrinsic signals within the specialised microenvironment of the bone marrow (BM) niche. One important avenue of investigation in CML is how the disease highjacks the BM, thereby remodelling this microenvironment to create a niche, which enables LSC persistence and resistance to TKI treatment. In this review, we explore how changes in growth factor levels, in particular, the bone morphogenetic proteins (BMPs) and pro-inflammatory cytokines, impact on cell behaviour, extracellular matrix deposition and bone remodelling in CML. We also discuss the challenges in targeting LSCs and the potential of dual targeting using combination therapies against BMP receptors and BCR-ABL1.

Initial Clinical Results of Stereotactic Radiotherapy for the Treatment of Craniopharyngiomas

2002 ◽  
Vol 1 (1) ◽  
pp. 51-59 ◽  
Author(s):  
Michael T. Selch ◽  
Antonio A.F. DeSalles ◽  
Maria Wade ◽  
Steve P. Lee ◽  
Timothy D. Solberg ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Survival Rates ◽  
Optic Chiasm ◽  
Clinical Results ◽  
Tumor Diameter ◽  
Actuarial Survival ◽  
Long Term Follow Up ◽  
Tissue Sparing ◽  
Single Isocenter

The efficacy and toxicity of stereotactic radiotherapy (SRT) for the treatment of craniopharyngioma has been retrospectively evaluated in 16 patients. The median tumor diameter was 2.8 cm (range 1.5–6.1) and the median tumor volume was 7.7 cc (range 0.7–62.8). SRT was delivered to a single isocenter using a dedicated 6 MV linear accelerator to patients immobilized with a relocatable stereotactic head frame. The three-year actuarial overall survival was 93% and the rate of survival free of any imaging evidence of progressive disease was 75%. The three-year actuarial survival rates free of solid tumor growth or cyst enlargement were 94% and 81% respectively. Our results suggest that SRT is a safe and effective treatment approach for patients with craniopharyngioma. Long-term follow-up is required to determine whether the normal tissue-sparing inherent with SRT results in reduction of the neurocognitive effects of conventional radiotherapy for craniopharyngioma. SRT can be delivered to craniopharyngioma that may be difficult to treat with stereotactic radiosurgery due to proximity of the optic chiasm. Further clinical experience is necessary to determine the clinical utility of beam shaping in the setting of SRT.

scholarly journals Clinicopathological characteristics and prognostic factors of cervical adenocarcinoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Wang ◽  
Bo Yuan ◽  
Zhen-huan Zhou ◽  
Wei-wei Han
Keyword(s):  
Prognostic Factors ◽  
Tumor Size ◽  
Survival Rates ◽  
Tumor Grade ◽  
Figo Stage ◽  
Cervical Adenocarcinoma ◽  
Stage Ii ◽  
Prognostic Indicators ◽  
Rank Test ◽  
Cancer Specific Survival

AbstractWe aimed to assess the clinicopathological features and to determine the prognostic factors of cervical adenocarcinoma (AC). Relevant data were extracted from surveillance, epidemiology and end results database from 2004 to 2015. The log-rank test and Cox proportional hazard analysis were subsequently utilized to identify independent prognostic factors. A total of 3102 patients were identified. The enrolled patients were characterized by higher proportion of early FIGO stage (stage I: 65.9%; stage II: 14.1%), low pathological grade (grade I/II: 49.1%) and tumor size ≤ 4 cm (46.8%). The 5- and 10-year cancer-specific survival rates of these patients were 74.47% and 70.00%, respectively. Meanwhile, the 5- and 10-year overall survival (OS) rates were 71.52% and 65.17%, respectively. Multivariate analysis revealed that married status, surgery as well as chemotherapy were independent favorable prognostic indicators. Additionally, aged > 45, tumor grade III/IV, tumor size > 4 cm, advanced FIGO stage and pelvic lymph node metastasis (LNM) were unfavorable prognostic factors (all P < 0.01). Stratified analysis found that patients without surgery could significantly benefit from chemotherapy and radiotherapy. In addition, chemotherapy could significantly improve the survival in stage II–IV patients and radiotherapy could only improve the survival in stage III patients (all P < 0.01). Marital status, age, grade, tumor size, FIGO stage, surgery, pelvic LNM and chemotherapy were significantly associated with the prognosis of cervical AC.

Significance of Platelet and AFP Levels and Liver Function Parameters for HCC Size and Survival

2014 ◽  
Vol 29 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Edoardo G. Giannini ◽  
Fabio Farinati ◽  
Francesca Ciccarese ◽  
...  
Keyword(s):  
Tumor Size ◽  
Blood Platelet ◽  
Tumor Diameter ◽  
Proportional Hazard ◽  
Gamma Glutamyl Transpeptidase ◽  
Vein Thrombosis ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Maximum Tumor Diameter ◽  
Glutamyl Transpeptidase

Background Hepatocellular carcinoma (HCC) is a heterogeneous disease with both tumor and liver factors being involved. Aims To investigate HCC clinical phenotypes and factors related to HCC size. Methods Prospectively-collected HCC patients' data from a large Italian database were arranged according to the maximum tumor diameter (MTD) and divided into tumor size terciles, which were then compared in terms of several common clinical parameters and patients' survival. Results An higer MTD tercile was significantly associated with increased blood alpha-fetoprotein (AFP), gamma-glutamyl transpeptidase (GGTP), and platelet levels. Patients with higher platelet levels had larger tumors and higher GGTP levels, with lower bilirubin levels. However, patients with the highest AFP levels had larger tumors and higher bilirubin levels, reflecting an aggressive biology. AFP correlation analysis revealed the existence of 2 different groups of patients: those with higher and with lower AFP levels, each with different patient and tumor characteristics. The Cox proportional-hazard model showed that a higher risk of death was correlated with GGTP and bilirubin levels, tumor size and number, and portal vein thrombosis (PVT), but not with AFP or platelet levels. Conclusions An increased tumor size was associated with increased blood platelet counts, AFP and GGTP levels. Platelet and AFP levels were important indicators of tumor size, but not of survival.

scholarly journals Survival of COVID-19 with Multimorbidity Patients

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1423
Author(s):  
E. Bustos-Vázquez ◽  
E. Padilla-González ◽  
D. Reyes-Gómez ◽  
M. C. Carmona-Ramos ◽  
J. A. Monroy-Vargas ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Survival Rates ◽  
Hospitalized Patients ◽  
Sample Population ◽  
Mechanical Ventilators ◽  
Number Of Patients ◽  
Regression Test ◽  
Main Variable ◽  
Logistic Regression Test

Background: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.

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