Margin distance as an independent predictor of survival after R0 resection for pancreatic adenocarcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 321-321
Author(s):  
George Van Buren ◽  
Herbert Zeh ◽  
Alyssa M Krasinskas ◽  
William E. Gooding ◽  
Jennifer Steve ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Vascular Invasion ◽  
Perineural Invasion ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Ajcc Stage ◽  
The Impact

321 Background: Microscopic tumor at the surgical margin is a predictor of recurrence and poor survival for pancreatic ductal adenocarcinoma (PDA). However, the impact of distance between the surgical margin and microscopic tumor on survival remains controversial. We hypothesized that margin distance (MD) would correlate with disease free survival (DFS) and overall survival (OS) in R0 resected PDA. Methods: Retrospective analysis of 191 resections for PDA. Margin distance was measured (0-1, 1-2, 2-4, 4-10, and > 10 mm) and categorized by location. Parameters including age, gender, BMI, TNM, AJCC stage, lymph node (LN) ratio, vascular and perineural invasion, vein resection, and adjuvant therapy were analyzed. Primary endpoints were DFS and disease specific OS. Univariate analysis was used to estimate factors associated with outcomes. The log rank test was applied to selected group comparisons. Results: 149 (78%) R0 outcomes were analyzed. 118 (79%) patients received adjuvant chemotherapy, 31 of whom also received XRT. Univariate analysis demonstrated reduced DFS (HR = 1.65, 95% CI = 1.13 – 2.48, p = .009) and OS (HR = 1.52 95% CI =.98 – 2.35, p = .059) among patients with margins ≤ 2mm compared to margins > 2mm. In addition LN status, LN ratio, tumor size, AJCC stage, vascular invasion, perineural invasion and adjuvant chemotherapy were found to influence OS on univariate analysis. Adjuvant XRT had no measurable effect on DFS or OS. Following adjustment for covariates in a multivariate model, margin distance >2mm did not correlate with DFS (HR = 1.14, 95%CI = .73 – 1.78, p = .57) or OS (HR = 1.13 95% CI = .69 – 1.85, p = .63), whereas adjuvant chemotherapy and presence of vascular invasion significantly affected OS (P=0.0006 and P=0.008 respectively). The retroperitoneal margin was the margin most commonly in close proximity to tumor (43% of Whipple), although there was no correlation between the closest margin and DFS (p=0.94) or OS (p=0.94). Conclusions: Margin distance is not an independent predictor of DFS or OS after R0 resection for PDA. Irrespective of margin distance, adjuvant chemotherapy, but not XRT, was associated with improved OS.

scholarly journals Outcomes of adult medulloblastoma treated with a multimodality approach: A tertiary cancer center experience

2015 ◽  
Vol 04 (04) ◽  
pp. 174-178 ◽  
Author(s):  
Supriya Mallick ◽  
Ajeet Kumar Gandhi ◽  
Rony Benson ◽  
Daya Nand Sharma ◽  
Kunhi Parambath Haresh ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Survival Data ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Disease Free Survival ◽  
Central Nervous System Tumor ◽  
Female Ratio ◽  
Adult Medulloblastoma ◽  
Multimodality Approach ◽  
The Impact

Abstract Objectives: Adult medulloblastoma (AMB) is a rare central nervous system tumor. We aimed to analyze the treatment outcomes of AMB treated at our institute with surgery followed by craniospinal irradiation (CSI) and adjuvant chemotherapy. Methods: We retrospectively evaluated the treatment charts of 31 patients of AMB treated from 2003-2011. The patient demography, treatment details and survival data were collected in a predesigned proforma. Kaplan Meier method was used to analyze disease free survival (DFS) and the impact of prognostic factors was determined by univariate analysis (log rank test). Results: Male: Female ratio was 21:10. Cerebrospinal fluid dissemination was noted in 16% cases. CSI (36 Gray at 1.8 Gray/fraction to entire neuraxis and 20 Gray at 2 Gray/fraction boost to posterior fossa) was used in all cases. 26 patients received adjuvant chemotherapy (carboplatin plus etoposide). Median follows up was 26.85 months (9.47-119.73 months). The estimated 3 and 5 years DFS was found to be 84.9% and 50.7% respectively. On univariate analysis, tumor located laterally had a trend towards better DFS (HR 3.04; 95%CI 0.722 to 12.812; P = 0.07) compared to midline tumors. Other factors like adjuvant chemotherapy, age, gender, surgical extent had no statistically significant impact on survival. Conclusion: The results of our study (largest series from India) show that the regimen of surgery, adjuvant CSI and chemotherapy is feasible and confers descent survival. AMB patients should be treated with a multimodality approach in a tertiary care centre.

scholarly journals Prognostic Nomogram for Patients With Pancreatic Ductal Adenocarcinoma of Pancreatic Head After Pancreaticoduodenectomy

2021 ◽  
Vol 15 ◽  
pp. 117955492110241
Author(s):  
Hongkai Zhuang ◽  
Zixuan Zhou ◽  
Zuyi Ma ◽  
Shanzhou Huang ◽  
Yuanfeng Gong ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Perineural Invasion ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Pancreatic Head ◽  
Ductal Adenocarcinoma ◽  
R0 Resection ◽  
Cox Regression Analysis ◽  
Ajcc Stage

Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) of pancreatic head remains poor, even after potentially curative R0 resection. The aim of this study was to develop an accurate model to predict patients’ prognosis for PDAC of pancreatic head following pancreaticoduodenectomy. Methods: We retrospectively reviewed 112 patients with PDAC of pancreatic head after pancreaticoduodenectomy in Guangdong Provincial People’s Hospital between 2014 and 2018. Results: Five prognostic factors were identified using univariate Cox regression analysis, including age, histologic grade, American Joint Committee on Cancer (AJCC) Stage 8th, total bilirubin (TBIL), CA19-9. Using all subset analysis and multivariate Cox regression analysis, we developed a nomogram consisted of age, AJCC Stage 8th, perineural invasion, TBIL, and CA19-9, which had higher C-indexes for OS (0.73) and RFS (0.69) compared with AJCC Stage 8th alone (OS: 0.66; RFS: 0.67). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the nomogram for OS and RFS were significantly higher than other single parameter, which are AJCC Stage 8th, age, perineural invasion, TBIL, and CA19-9. Importantly, our nomogram displayed higher C-index for OS than previous reported models, indicating a better predictive value of our model. Conclusions: A simple and practical nomogram for patient prognosis in PDAC of pancreatic head following pancreaticoduodenectomy was established, which shows satisfactory predictive efficacy and deserves further evaluation in the future.

scholarly journals Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021341
Author(s):  
Cheng-I Hsieh ◽  
Raymond Nien-Chen Kuo ◽  
Chun-Chieh Liang ◽  
Hsin-Yun Tsai ◽  
Kuo-Piao Chung
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cox Regression ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Disease Stage ◽  
Multiple Primary Cancers ◽  
Positive Surgical Margin ◽  
Recurrence Rates ◽  
Significant Difference

ObjectivesOne feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes.SettingData from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009.Participants and methodsPostoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts.ResultsWe examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not.ConclusionsThe discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.

scholarly journals Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yiding Feng ◽  
Youhua Jiang ◽  
Qiang Zhao ◽  
Jinshi Liu ◽  
Hangyu Zhang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Tumor Size ◽  
Esophagogastric Junction ◽  
Perineural Invasion ◽  
Univariate Analysis ◽  
Rank Test ◽  
Duration Of Hospital Stay

Abstract Background The incidence rate of adenocarcinoma of the esophagogastric junction (AEG) has significantly increased over the past two decades. Surgery remains the only curative treatment. However, there are currently few studies on Chinese AEG patients. The purpose of this study was to retrospectively analyze the survival and prognostic factors of AEG patients in our center. Methods Between January 2008 and September 2014, 249 AEG patients who underwent radical resection were enrolled in this retrospective study, including 196 males and 53 females, with a median age of 64 (range 31–82). Prognostic factors were assessed with the log-rank test and Cox univariate and multivariate analyses. Results The 5-year survival rate of all patients was 49%. The median survival time of all enrolled patients was 70.1 months. Pathological type, intraoperative blood transfusion, tumor size, adjuvant chemotherapy, duration of hospital stay, serum CA199, CA125, CA242 and CEA, pTNM stage, lymphovascular or perineural invasion, and the ratio of positive to negative lymph nodes (PNLNR) were significantly associated with overall survival when analyzed in univariate analysis. Conclusions Our study found that adjuvant chemotherapy, PNLNR, intraoperative blood transfusion, tumor size, perineural invasion, serum CEA, and duration of hospital stay after surgery had significance in multivariate analysis and were independent risk factors for survival.

Multi-modality management of extraosseous Ewing sarcoma: 10-year experience from a tertiary care centre

2020 ◽  
pp. 1-7
Author(s):  
Arvind Sathyamurthy ◽  
Ashish Singh ◽  
Tarun Jose ◽  
Patricia Sebastian ◽  
Rajesh Balakrishnan ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Disease Free Survival ◽  
Molecular Techniques ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
The Impact ◽  
Extraosseous Ewing Sarcoma ◽  
Disease Free

Abstract Aim: To analyse the presentation, diagnosis and patterns of care of extraosseous Ewing sarcoma treated at our institution between 2008 and 2018. Methods: Electronic medical records of extraosseous Ewing sarcoma patients treated at our institution between January 2008 and April 2018 were reviewed. Kaplan–Meier curves were plotted to assess the overall and disease-free survival with 95% confidence intervals. A univariate analysis was carried out to assess the impact of variables such as surgical excision, completeness of surgery, completeness of chemotherapy and addition of radiation therapy on the survivorship. Results: The records of 65 patients treated at our institution were available for review. The mean age was 26·4 years. The most frequent sites of extraosseous Ewing tumour were kidney—9/65 (13·8%) and brain—10/65 (15·4%). Sixteen (24·6%) patients presented with inoperable/metastatic disease at diagnosis. The other 49 (75·4%) had localised disease at presentation. The median overall survival of the 49 non-metastatic patients was 46 months, and the disease-free survival was 45 months. Conclusion: Extraosseous Ewing sarcoma is a rare and aggressive tumour diagnosed by molecular techniques. Multi-modality treatment including surgical resection with wide margins, adjuvant radiation when indicated and completion of systemic chemotherapy results in optimum outcomes.

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

2018 ◽  
Vol 36 (3) ◽  
pp. 241-250 ◽  
Author(s):  
Marco Vito Marino ◽  
Galyna Shabat ◽  
Domenico Guarrasi ◽  
Gaspare Gulotta ◽  
Andrzej Lech Komorowski
Keyword(s):  
Surgical Margin ◽  
Disease Free Survival ◽  
Laparoscopic Group ◽  
Postoperative Hemorrhage ◽  
Robotic Arm ◽  
R0 Resection ◽  
Right Hepatectomy ◽  
Conversion To Open Surgery ◽  
Young Surgeon ◽  
Estimated Blood Loss

Background: Despite potential benefits of robotic liver surgery, it is still considered a “development in progress” technique. Methods: The outcomes of 14 patients undergoing robotic right hepatectomy were analyzed and compared with the results of 20 laparoscopic right hepatectomies consecutively performed by the same young surgeon. Results: The overall mean operative time was less in robotic arm (425 ± 139 vs. 565.18 ± 183.73, p = 0.022) and the estimated blood loss was similar (335.15 ± 139.8 vs. 423.95 ± 205.15, p = 0.17); no blood transfusion was required. Two patients in robotic group and 5 in laparoscopic group (p = 0.454) underwent conversion to open surgery; the overall morbidity was 21.4 and 15% in studied arms, respectively (p = 0.634). Pathology reports showed a mean surgical margin of 26.02 ± 3.9 in robotic arm, 28.76 ± 4.6 for laparoscopic, (p = 0.079) and we achieved a R0 resection rate of 91.66 and 85%, respectively. Reoperation and 90-days mortality rate were both null in robotic arm. One patient in laparoscopic group was reoperated due to postoperative hemorrhage. One-year overall and disease free-survival rate were 92.3 and 84.6%, respectively in robotic arm and 90 and 85% in laparoscopic arm. Conclusions: Robotic right hepatectomy is a safe and feasible technique providing promising short-term outcomes and oncological results also in the initial phase of learning curve.

The impact of time to adjuvant chemotherapy (AC) on survival in colorectal cancer (CRC): A systematic review and meta-analysis.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 364-364 ◽  
Author(s):  
J. J. Biagi ◽  
M. Raphael ◽  
W. D. King ◽  
W. Kong ◽  
W. J. Mackillop ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Publication Bias ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Significant Heterogeneity ◽  
Risk Of Death ◽  
The Impact ◽  
The Relationship

364 Background: The optimal timing from CRC surgery to initiation of AC is unknown. We report a systematic review and meta-analysis to determine the relationship between time to adjuvant chemotherapy (TTAC) and survival. Methods: A systematic review of literature was done to identify studies that described the relationship between TTAC and survival. Studies were only included if the distribution of relevant prognostic factors was adequately described, and either comparative groups were balanced or results adjusted for the prognostic factors. Hazard ratio (HR) and TTAC for overall survival (OS) and disease free survival (DFS) from each study were converted to a regression coefficient (β) and standard error (SE) corresponding to a continuous representation per 4 weeks of TTAC. The adjusted β from individual studies were combined using a fixed-effect model. Inverse-variance (1/SE2) was used to weight individual studies. The possible effect of publication bias was investigated using the trim and fill approach. Results: We identified 9 eligible studies involving 14,357 patients (4 published articles, 5 abstracts). Two studies were randomized trials and 7 were cohort studies. Six studies reported TTAC as a binary variable and 3 reported TTAC as ≥3 categories. An estimate of HR for OS was derived from all 9 studies and estimate for DFS was derived from 5 studies. Meta-analysis demonstrated that a 4-week increase in TTAC was associated with a significant decrease in both OS (HR = 1.12, 95% CI 1.09-1.15), and DFS (HR = 1.15, 95% CI 1.11-1.20). The analysis showed no significant heterogeneity among studies. These TTAC associations remained significant after analysis for potential publication bias, and when the analysis was repeated excluding the two studies of largest weight. Conclusions: This study demonstrates a 12% increase in the risk of death for each 4 week of delay in the start of AC for CRC. These findings indicate the need for clinicians and health systems managers to take the steps necessary to keep TTAC as short as reasonably achievable. In addition, our results suggest there may be some benefit to AC after a 3-month TTAC delay. No significant financial relationships to disclose.

Rectal adenocarcinoma: Outcomes of adjuvant chemotherapy after neoajuvant chemoradiotherapy in a retrospective cohort.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 790-790
Author(s):  
Vanessa Pachón Olmos ◽  
Pablo Reguera Puertas ◽  
Reyes Ferreiro Monteagudo ◽  
FEDERICO LONGO ◽  
Mercedes Rodríguez Garrote ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Rectal Adenocarcinoma ◽  
Disease Free Survival ◽  
Complete Response ◽  
Local Relapse ◽  
Stage Ii ◽  
Systemic Relapse ◽  
The Impact

790 Background: The role of adjuvant chemotherapy (AC) after chemoradiotherapy and surgery in stage II and III of rectal cancer is not well defined. Neither the regimen nor the duration is clear. Besides, guidelines from different expert groups are conflicting. Methods: 224 patients diagnosed from January 2003 to December 2013 with rectal adenocarcinoma T3/T4 and/or positive node staged by ultrasound or magnetic resonance imaging was collected retrospectively from the Pathology Department data base. Results: Of the 224 patients 61.6% were male, median of age at diagnosis 68.6 years (range 31.3-85.4). All of them received 50.4 Gy with different concomitant regimens (capecitabine, continuous infusion of fluoracil or bolus of fluoracil-leucovorin). 13.4% of patients achieved a pathological complete response. 76.8% of the cohort received adjuvant chemotherapy. The main reasons for not receiving chemotherapy were ECOG ≥ 2, surgery complications and a decision of the patient. 51.2% of patients received an oxaliplatin based regimen and the median time of chemotherapy duration was 4 months (range 1-6 months). Local relapse was diagnosed in 6.3% of patients while a systemic relapse was found in 22.3%. Patients without AC had a mean overall survival (OS) of 85.5 months (CI 95% 70.7-100.4) versus 119.8 monts (CI 95% 110.8-128.8) in the AC cohort (p 0.002) without reaching the median after 58 months (range 8-153.9) median follow-up. Disease free survival (DFS) was also better in the AC cohort with a mean DFS of 104 months (CI 95% 94.3-113.6) versus 71.4 months (CI 95% 55.4-87.4), p = 0.01. Conclusions: AC after chemoradiotherapy and surgery in stage II and III rectal cancer as a standard does not exist. In our cohort, AC showed a significant improve in OS and DFS, but the limitations of a retrospective study should be considered, as well as the impact of surgery on metastasis and salvage chemotherapies. Randomized studies are clearly needed.

Retrospective analysis of adjuvant treatment for localized, operable uterine leiomyosarcoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11072-11072
Author(s):  
Jomjit Chantharasamee ◽  
Karlton Wong ◽  
Pasathorn Potivongsajarn ◽  
Amir Aqorbani ◽  
Bartosz Chmielowski ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Mitotic Rate ◽  
Stage I ◽  
Uterine Leiomyosarcoma ◽  
Recurrence Rates ◽  
The Impact

11072 Background: Surgery is the standard of care for uterine leiomyosarcoma, but recurrence rates are high and outcomes are poor. Standard adjuvant treatment of localized uterine leiomyosarcoma(uLMS) has not yet been established as clinical trials to address this question have been small or hindered by slow accrual. Methods: We reviewed the medical records of patients with uLMS who underwent upfront surgery between 2000-2018. We evaluated the clinical characteristics and adjuvant therapy on outcomes. Patient characteristics and treatment outcomes were described using descriptive statistics. Kaplan-Meier survival analysis was used for DFS. Cox proportional hazard regression was used to compare difference between groups. Results: 59 patients with a median age of 52 years were analyzed and the median time from surgery to adjuvant treatment was 47 days. 48/59 (81.4%) underwent TAH-BSO. 64.4% were FIGO stage I, 16.9% were stage II and 6.7% were stage III. The median tumor size was 11 cm (range: 3-21cm) and the median mitotic rate was 13 mitoses/ 10 high-power fields (HPF), (range: 1-63). 34/59 (57.6%) of patients received adjuvant chemotherapy +/- radiation therapy and 25 patients (42.3%) did not receive adjuvant treatment. With a median follow-up time of 42.8 months, 42 patients (71.2%) had disease relapse and 15 (35.7%) had pulmonary metastases. The median disease-free survival (mDFS) for all patients was 23.1 months. Any adjuvant treatment (chemotherapy or radiation) had a trend toward longer mDFS than no adjuvant treatment (36.6 vs 13.6 months, p = 0.14). Patients who had adjuvant chemotherapy had a non-significant longer mDFS compared to who did not receive any adjuvant treatment (33.8 vs 13.6 months, p = 0.18). Patients with stage I disease had trend towards higher mDFS in the chemotherapy group, it was not statistically significant (29.7 vs 16.6 months, p = 0.59). Multivariate analysis found that the independent prognostic factors for worse DFS included tumor size larger than 10 cm, and mitotic rate over 10/ 10HPF. More morcellated specimens were found in non-adjuvant treatment arm (36%) compare to 8% in adjuvant arm. In the non-treatment arm, 14 patients had recurrences within 6 months. Conclusions: In a retrospective uLMS population, the mDFS was 23.1 months. Tumor size > 10cm and mitotic rate > 10/10 HPF were independent prognostic factors for lower DFS. The non-treatment group had a significantly higher number of patient with morcellization and relapsed within 6 months, confounding analyses of the impact of adjuvant chemotherapy.

Sign in / Sign up

Export Citation Format

Share Document