Extent of lymphadenectomy and survival in stomach cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17008-17008
Author(s):  
S. L. Wong ◽  
H. Ji ◽  
J. D. Birkmeyer
Keyword(s):  
Lymph Node ◽  
Stomach Cancer ◽  
Quality Indicator ◽  
Survival Rates ◽  
Median Number ◽  
Population Based ◽  
Extensive Lymphadenectomy ◽  
Provider Characteristics ◽  
Risk Patients ◽  
Total Lymph Node

17008 Background: Based on population-based studies, some investigators have posited that patients undergoing more extensive lymphadenectomy as part of their resection for stomach cancer had improved late survival rates. Such findings have prompted calls for the use of total lymph node counts as a quality indicator for hospitals. However, apparent relationships between number of lymph nodes resected and survival may be confounded by patient selection bias and provider factors. It is not clear that hospitals with higher lymph node counts have better outcomes than other hospitals. The purpose of this study is to examine relationships between total lymph node counts and survival for stomach cancer. Methods: Using the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1992–2002), we first identified all patients undergoing major resections for gastric cancer (n=3,049). Hospitals at which the procedures were performed were categorized into 3 groups (terciles) according to the median number of nodes examined. We then assessed 5-year survival rates for each hospital group, adjusting for potentially confounding patient and hospital characteristics. Results: Hospitals with the highest median lymph node counts had slightly higher 5-year survival rates than those with the lowest node counts (31% vs. 28%; unadjusted HR for mortality 0.90, 95% CI 0.81–1.00). Hospitals with higher lymph node counts tended to treat lower risk patients and had lower procedure volumes. Adjusting for these confounding patient and provider characteristics further weakened the apparent relationship between survival and lymph node counts by hospital (adjusted HR, high vs. low hospital tercile, 0.96; 95% CI 0.85–1.09). Conclusions: Apparent relationships between total lymph node counts by hospital and 5-year survival rates after resection for stomach cancer are relatively weak and explained in large part by confounding patient and provider factors. Stronger evidence should be required before moving forward with this metric as a hospital quality indicator. No significant financial relationships to disclose.

scholarly journals Days at Home in the Last 6 Months of Life: A Patient-Determined Quality Indicator for Cancer Care

2019 ◽  
Vol 15 (4) ◽  
pp. e308-e315 ◽  
Author(s):  
Sarah K. Andersen ◽  
Ruth Croxford ◽  
Craig C. Earle ◽  
Simron Singh ◽  
Matthew C. Cheung
Keyword(s):  
Administrative Data ◽  
Quality Indicator ◽  
Large Population ◽  
Median Number ◽  
Population Based ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Comorbidity Burden ◽  
Future Policy ◽  
At Home

PURPOSE: Quality end-of-life care (EoLC) is a key aspect of oncology. Days at home in the last 6 months of life represents a novel, patient-driven quality indicator of EoLC. We measured days at home in a large population of patients with cancer in Ontario, Canada. Trends over time and predictors of more or less time at home were also determined. METHODS: We conducted a population-based retrospective study using health administrative data linked by unique, encoded identifiers and analyzed at the ICES. Quantile regression was used to determine significant predictors of more or less time at home. RESULTS: Of 72,987 patients who died of cancer in Ontario, Canada and met our inclusion criteria, the median number of days spent at home in the last 6 months of life was 164 (interquartile range [IQR], 144 to 175 days) of a possible 180 days. Patients with hematologic cancers spent significantly fewer days at home (156; IQR, 134 to 170 days). The strongest predictors of more time at home were male sex (+2.87 days relative to female sex; CI, 2.43 to 3.31 days) and receipt of palliative care before the last 6 months of life (+2.38 days; CI, 1.95 to 2.08 days). Additional predictors included income, age, cancer type, comorbidity burden, and health region. The majority of patients (69.7%) did not die at home. CONCLUSION: Days at home in the last 6 months of life, obtained from administrative data, can be used as a measure of quality EoLC. Predictors of days at home may prove valuable targets for future policy intervention.

scholarly journals Second Malignant Neoplasms in Patients with Rhabdomyosarcoma: A US Population-Based Analysis

2021 ◽  
Author(s):  
HONGNAN ZHEN ◽  
ZHIKAI LIU ◽  
HUI GUAN ◽  
JIABIN MA ◽  
WENHUI WANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Soft Tissues ◽  
Survival Rates ◽  
Malignant Neoplasm ◽  
The United States ◽  
Population Based ◽  
Malignant Neoplasms ◽  
Second Malignant Neoplasm ◽  
Second Malignant Neoplasms ◽  
Risk Patients

Abstract Objective Rhabdomyosarcoma (RMS) is a rare malignant tumor. The main treatment modality is comprehensive with chemotherapy, radiation therapy, and surgery. With the advancement in recent decades, patient survival has been prolonged, and long-term complications are attracting increasing attention among both physicians and patients. This study aimed to present the survival of patients with RMS and analyze the risk factors for the development of a second malignant neoplasm (SMN). Methods The Surveillance, Epidemiology, and End Results (SEER) Program 18 registry database from 1973 to 2015 of the National Cancer Institute of the United States was used for the survival analyses, and the SEER 9 for the SMN analysis. Results The 5-, 10-, and 20-year overall survival rates of the patients with RMS were 45%, 43%, and 33%, respectively. The risk of SMN was significantly higher in patients with RMS compared to the general population (SIR = 1.95, 95% CI: 1.44–2.57, p < 0.001). The risk of developing SMN was increased in multiple locations, including the bones and joint (SIR = 35.25) and soft tissues including the heart (SIR = 22.5), breasts (SIR = 2.10), male genital organs (SIR = 118.14), urinary system (SIR = 2.36), brain (SIR = 9.21), and brain and other nervous system organs (SIR = 8.59). The multivariate analysis indicated that RMS in the limbs and earlier diagnosis time were independent risk factors for the development of SMN. Patients with head and neck (OR = 0.546, 95% CI: 0.313–0.952, p = 0.033) and trunk RMS (OR = 0.322, 95% CI: 0.184–0.564. p < 0.001) and a later diagnosis time were less likely to develop SMN (OR = 0.496, 95% CI: 0.421–0.585, p < 0.001). Conclusion This study describes the risk factors associated with the development of SMN in patients with RMS, which is helpful for the personalized screening of high-risk patients with RMS.

Retreatment with Alemtuzumab after a First, Successful Alemtuzumab Treatment in B-CLL.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4714-4714 ◽  
Author(s):  
Michael Fiegl ◽  
Florian Falkner ◽  
Andreas Falkner ◽  
Niklas Zojer ◽  
Michael Fridrik ◽  
...  
Keyword(s):  
Survival Rates ◽  
Normal Karyotype ◽  
Early Death ◽  
Complete Response ◽  
Median Number ◽  
Time Interval ◽  
Heavily Pretreated ◽  
Trisomy 12 ◽  
Risk Patients ◽  
Cytogenetic Profile

Abstract Alemtuzumab is the standard therapy for treatment of patients with relapsed/refractory B-CLL, and significant responses have also been documented in the front-line CLL setting. We and others have demonstrated, in controlled studies and retrospective surveys, that heavily pretreated patients who achieve a complete response (CR) or partial response (PR), or even stable disease (SD), as defined by the National Cancer Institute (NCI) criteria, benefit in terms of quality of life and prolonged overall survival (OS). This is probably due to the fact that response is of long duration and that, in many cases, effective re-treatment is feasible. We analysed which treatments were used following a first course of alemtuzumab in CLL (Fiegl et al. Cancer2006;107:2408–16), and found that alemtuzumab, alone or in combination, was the most frequently used drug for re-treatment. Here we present updated data in 26 CLL patients re-treated with alemtuzumab. Seventeen patients were male (65%), had B-CLL (n=23), B-CLL with more than 15% prolymphocytes (n=2), or CLL with Richter’s transformation (n=1). The median number of previous therapies including the first course of alemtuzumab was 4 (range, 2–12), and 15 cases (58%) were fludarabine-refractory. At the start of re-treatment, the majority of patients had Rai stage 4 disease. Fluorescence in situ hybridization (FISH) cytogenetics according to Dohner’s classification were available in 13 patients, and 5 patients had a high risk anomaly (17p deletion). The median time interval between last dose of alemtuzumab and start of alemtuzumab re-treatment was 10.2 months (1.7–28.3 months). Response evaluation according to NCI criteria was available in 17 patients. Alemtuzumab re-treated patients had PR, SD, and progressive disease (PD) rates of 53%, 18%, and 18%, respectively. In 12% response could not be evaluated because of early death. Survival rates were available for all 26 patients. The median OS since start of alemtuzumab re-treatment was 16.7 months. This favourable survival time underscores the fact that patients receiving alemtuzumab re-treatment are selected because they benefited from the previous course of alemtuzumab. There was a dramatic difference in outcome depending on whether alemtuzumab re-treatment was necessary earlier or later: median OS was 8.4 months in patients who had to be re-treated within 10.3 months after last dose of initial course of alemtuzumab, whereas median OS was not reached in patients retreated after a longer interval (P=0.001). OS was inferior in cytogenetically poor risk patients (17.8 months in 17p-deleted patients vs. “not reached” in patients with 13q deletion, trisomy 12, or normal karyotype; P=0.01). There was no difference in OS in fludarabine-refractory patients. Re-treatment was well tolerated, with moderate toxicity. In conclusion, we hereby demonstrate that B-CLL patients who have been treated successfully with alemtuzumab may benefit profoundly from a second course of alemtuzumab, especially if there is a prolonged interval between the treatments, and a favourable cytogenetic profile is present.

scholarly journals Clinicopathological characteristics and survival of lymphoepithelial carcinoma of the oral cavity and pharynx: a population-based study

2019 ◽  
Author(s):  
Jinbo Bai ◽  
Fen Zhao ◽  
Shuang Pan
Keyword(s):  
Lymph Node ◽  
Oral Cavity ◽  
Survival Time ◽  
Old Age ◽  
Survival Rates ◽  
Distant Metastases ◽  
Population Based ◽  
Clinicopathological Characteristics ◽  
Lymphoepithelial Carcinoma ◽  
Population Based Study

AbstractLymphoepithelial carcinoma (LEC) of the oral cavity and pharynx is uncommon, and the characteristics and survival remains unclear. The present study aims to describe the clinicopathological characteristics and determine the factors associated with survival of this uncommon cancer. A population-based study was carried out to investigate clinical characteristics and prognosis of LEC of the oral cavity and pharynx using the data from Surveillance, Epidemiology and End Results (SEER) database between 1988 and 2013. The propensity-matched analysis was conducted for prognostic analysis, and a prognostic nomogram was also constructed. Totally, 1025 patients with LEC of the oral cavity and pharynx were identified, including 769 nasopharyngeal LEC patients and 256 non-nasopharyngeal LEC patients. The median OS of all LEC patients was 232.0m (95% CI 169.0-258.0). The 1-, 5-, 10- and 20-year survival rates were 92.9%, 72.9%, 59.3%, and 46.8%, respectively. Surgery could significantly prolong the survival time of LEC patients (P<0.01, mOS: 190m vs. 255m). Radiotherapy, as well as radiotherapy after surgery, could prolong the mOS (P<0.01 for both). The survival analysis demonstrated that old age (>60 years), lymph node (N3) and distant metastases were independent factors for poor survival, whereas radiotherapy and surgery were independent factors for favorable survival. No significant differences in survival time between nasopharyngeal LEC and non-nasopharyngeal LEC patients were observed. The prognostic nomogram was established base on five independent prognostic factors (C-index=0.70; 95% CI 0.66-0.74). In conclusion, LEC of the oral cavity and pharynx is a rare disease, and old age, lymph node and distant metastases, surgery and radiotherapy were significantly associated with prognosis. The prognostic nomogram could be used to make individual predictions of OS.

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

BIOPSY OF THE SIGNALING LYMPH NODES IN GASTRIC CANCER - CURRENT STATUS OF THE PROBLEM AND PROSPECTS

2018 ◽  
Vol 64 (3) ◽  
pp. 335-344
Author(s):  
Aleksey Karachun ◽  
Yuriy Pelipas ◽  
Oleg Tkachenko ◽  
D. Asadchaya
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Nodes ◽  
Stomach Cancer ◽  
Current Status ◽  
Regional Lymph Nodes ◽  
Systematic Analysis ◽  
Tumor Spread ◽  
Special Value

The concept of biopsy of sentinel lymph node as the first lymph node in the pathway of lymphogenous tumor spread has been actively discussed over the past decades and has already taken its rightful place in breast and melanoma surgery. The goal of this method is to exclude vain lymphadenectomy in patients without solid tumor metastases in regional lymph nodes. In the era of minimally invasive and organ-saving operations interventions it seems obvious an idea to introduce a biopsy of sentinel lymph node in surgery of early gastric cancer. Meanwhile the complexity of lymphatic system of the stomach and the presence of so-called skip metastases are factors limiting the introduction of a biopsy of sentinel lymph node in stomach cancer. This article presents a systematic analysis of biopsy technology of signaling lymph node as well as its safety and oncological adequacy. Based on literature data it seems to us that the special value of biopsy of sentinel lymph nodes in the future will be in the selection of personalized surgical tactics for stomach cancer.

Nationwide trends in the incidence of orbital lymphoma from 1999 to 2016 in South Korea

2020 ◽  
pp. bjophthalmol-2020-316796
Author(s):  
Su Kyung Jung ◽  
Jiwon Lim ◽  
Suk Woo Yang ◽  
Young-Joo Won
Keyword(s):  
South Korea ◽  
B Cell ◽  
Incidence Rate ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Percent Change ◽  
Orbital Lymphoma

Background/AimsLymphomas are the most frequent neoplasm of the orbit. However, the epidemiology of orbital lymphomas is not well reported. This study aimed to provide a population-based report on the epidemiology of orbital lymphomas and measure the trends in the incidence of orbital lymphoma cancer in South Korea.MethodsNationwide cancer incidence data from 1999 to 2016 were obtained from the Korea Central Cancer Registry. Age-standardised incidence rates and annual percent changes were calculated according to sex and histological types. The analysis according to the Surveillance, Epidemiology, and End Results summary stage classifications was performed from 2006 to 2016. Survival rates were estimated for cases diagnosed from 1999 to 2016.ResultsA total of 630 patients (median age: 54 years) with orbital lymphoma in the orbital soft tissue were included in this study. The age-standardised incidence rates increased from 0.03 to 0.08 per 100 000 individuals between 1999 and 2016, with an annual percent change of 6.61%. The most common histopathological type of orbital lymphoma was extra marginal zone B cell lymphoma, accounting for 82.2% of all orbital lymphomas during 1999–2016, followed by diffuse large B cell lymphoma (9.2%). Five-year, 10-year and 15-year overall survival (OS) of orbital lymphoma was 90.8%, 83.8% and 75.8%, respectively. OS showed a significant decrease as age increased and no significant differences between men and women.ConclusionThe incidence rate of orbital lymphoma is very low in South Korea. However, the incidence rate has increased over the past years. Orbital lymphomas have a worse prognosis as age increases.

Back-Table Modified Stent-Graft for Endovascular Repair of Ascending Aorta

2021 ◽  
pp. 152660282110282
Author(s):  
Juan Shi ◽  
Ligang Liu ◽  
Xiang Wei ◽  
Mingjia Ma
Keyword(s):  
Endovascular Repair ◽  
Survival Rates ◽  
Ascending Aorta ◽  
Cerebellar Infarction ◽  
Type Ia ◽  
Risk Patients ◽  
Aorta Replacement ◽  
Aortic Dissections ◽  
Event Rates

Objectives To investigate the effectiveness of modified stent-grafts (SGs) for the management of ascending aortic pathologies. Materials and Methods From January 2015 to December 2019, 31 individuals were treated by ascending aortic endovascular repair with a back-table modified SG for acute (n=4) or chronic (n=1) type A aortic dissections, penetrating aortic ulcers (n=18), pseudoaneurysms (n=2), anastomotic fistula (n=1), and endoleaks after thoracic endovascular aortic repair (TEVAR) (n=5). The commercially available thoracic aortic SGs were modified with a fenestration or truncation technique on the back-table according to aortography during the operation. Results The 30-day mortality and aorta-related mortality rates were 12.9% and 6.5%, respectively. There were 2 strokes, 3 respiratory insufficiencies, and 6 endoleaks during hospitalization. During a mean follow-up of 28.8±16.6 months, the overall survival rates at 1 year and 3 years were both 80.6%. Free from adverse event rates at 1 year and 3 years were 88.9% and 84.7%, respectively. There were 2 deaths during follow-up: One patient died of cachexia 1 month after discharge, and the other patient died of acute myocardial infarction 3 months after discharge. One patient with a pseudoaneurysm underwent open ascending aorta replacement 3 months after discharge for a type Ia endoleak. Another patient suffered from cerebellar infarction 17 months after discharge. Conclusion The modified SG for endovascular repair of the ascending aorta is a practicable alternative and presents acceptable outcomes in high-risk patients.

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