Angiotensin converting enzyme inhibitor and angiotensin receptor blocker use and outcomes in patients with colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 544-544 ◽  
Author(s):  
Sherilyn Alvaran Tuazon ◽  
Gentry Teng King ◽  
Joanna Paula Pingol Sta. Cruz ◽  
Jean B. Ong Kian Koc ◽  
Young Kwang Chae ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Receptor Blockers ◽  
Disease Free Survival ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

544 Background: Increasing evidence implicates angiotensin in the pathophysiology of carcinogenesis. Both Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) have shown in-vitro activity in Colorectal Cancer (CRC) via inhibition of both VEGF and IGF-1 and present a novel therapeutic strategy. This study aimed to investigate the association of these agents in outcomes of patients with CRC. Methods: We reviewed the medical records of patients with stage I-III CRC from 2004-2008. ACEI and ARB use was defined as consumption for at least 3 months in patients with no evidence of disease after initial diagnosis and treatment. Outcomes were Disease Free Survival (DFS) and Overall Survival (OS). Kaplan-Meier and Cox proportional hazards regression were used. Results: A total of 222 patients were included, with a median follow up of 39 months. A total of 105 (47%) were identified as users of ACEI/ARBs. Multivariate analysis, adjusted to age, sex, race, stage, grade, tumor location, adjuvant chemotherapy, radiotherapy, statin and ASA use showed significantly improved DFS among users of ACEI and/or ARBs compared to non-users (HR = 0.44, p = 0.003). Considered separately, users of ACEIs only and users of ARBs only had better DFS than non-users (HR = 0.43 and 0.53, respectively). Compared directly, users of ACEIs did not have significantly different DFS than users of ARBs (HR = 0.81, p = 0.678). With regards to OS, multivariate analysis showed that, compared to non-users, patients with ACEI or ARB use had better OS, although non-significantly (HR = 0.59, p = 0.219). However, the magnitude of the impact on OS was comparable to that seen for DFS. Conclusions: The use of ACEIs and/or ARBs is associated with improved disease-free survival in CRC patients. There was a statistically insignificant trend toward improved OS, which may be related to the low power to the study. This observation warrants further exploration.

scholarly journals Influence of Individual Surgeon Volume on Oncological Outcome of Colorectal Cancer Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Marleen Buurma ◽  
Hidde M. Kroon ◽  
Marlies S. Reimers ◽  
Peter A. Neijenhuis
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Disease Free Survival ◽  
High Volume ◽  
Free Survival ◽  
Significant Difference ◽  
Low Volume ◽  
The Impact ◽  
Disease Free

Background. Surgery performed by a high-volume surgeon improves short-term outcomes. However, not much is known about long-term effects. Therefore we performed the current study to evaluate the impact of high-volume colorectal surgeons on survival.Methods. We conducted a retrospective analysis of our prospectively collected colorectal cancer database between 2004 and 2011. Patients were divided into two groups: operated on by a high-volume surgeon (>25 cases/year) or by a low-volume surgeon (<25 cases/year). Perioperative data were collected as well as follow-up, recurrence rates, and survival data.Results. 774 patients underwent resection for colorectal malignancies. Thirteen low-volume surgeons operated on 453 patients and 4 high-volume surgeons operated on 321 patients. Groups showed an equal distribution for preoperative characteristics, except a higher ASA-classification in the low-volume group. A high-volume surgeon proved to be an independent prognostic factor for disease-free survival in the multivariate analysisP=0.04. Although overall survival did show a significant difference in the univariate analysisP<0.001it failed to reach statistical significance in the multivariate analysisP=0.09.Conclusions. In our study, a higher number of colorectal cases performed per surgeon were associated with longer disease-free survival. Implementing high-volume surgery results in improved long-term outcome following colorectal cancer.

scholarly journals Lymphopenia associated with adjuvant chemotherapy after potentially curative surgery for colorectal cancer correlates with recurrence

2016 ◽  
Author(s):  
Masatsune Shibutani ◽  
Kiyoshi Maeda ◽  
Hisashi Nagahara ◽  
Hiroshi Ohtani ◽  
Tetsuro Ikeya ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Lymphocyte Count ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Free Survival ◽  
Background Data ◽  
Disease Free

Abstract Objective: The aim of this retrospective study was to evaluate the prognostic significance of lymphopenia associated with chemotherapy in patients with colorectal cancer who received adjuvant chemotherapy after undergoing potentially curative surgery. Summary of background data: Lymphocyte plays an important role in anti-tumor immunity. Lymphopenia is sometimes induced during the period of adjuvant chemotherapy after potentially curative surgery for colorectal cancer. However, the prognostic significance of lymphopenia associated with chemotherapy is unknown. Methods: One hundred and fifteen patients who received adjuvant chemotherapy after potentially curative surgery for stage II/III colorectal cancer were enrolled in this study. All patients were classified into two groups, the lymphopenia group and the normal group, according to minimum lymphocyte count during the period of adjuvant chemotherapy. Lymphopenia was defined as a lymphocyte count of less than 1,000/Ã&#x8e;¼l. Lymphopenia associated with chemotherapy was found in 17 of the 115 patients (14.8%). Results: Lymphopenia was associated with a worse disease-free survival (p=0.018). Moreover, in a multivariate analysis, lymphopenia associated with chemotherapy was identified to be an independent prognostic factor.

The comparison of thrombocytosis and platelet-lymphocyte ratio as potential prognostic markers in colorectal cancer

2014 ◽  
Vol 111 (03) ◽  
pp. 483-490 ◽  
Author(s):  
Valéria Jósa ◽  
Kristóf Dede ◽  
Emese Ágoston ◽  
Marcell Szász ◽  
Dániel Sinkó ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Platelet Count ◽  
Prognostic Factor ◽  
Prognostic Markers ◽  
Disease Free Survival ◽  
Free Survival ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio ◽  
Disease Free

SummaryThe aim of the present study was to analyse the preoperative platelet count and the platelet-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC) of different stages and with hepatic metastasis of CRC (mCRC) and to compare these factors as potential prognostic markers. Clinicopathological data of 10 years were collected retrospectively from 336 patients with CRC and 118 patients with mCRC. Both in the CRC and the mCRC group overall survival (OS) was significantly worse in patients who had elevated platelet count (hazard ratio [HR] = 2.2, p < 0.001 and HR = 2.9, p = 0.018, respectively). Multivariate analysis indicated that elevated platelet count was an independent prognostic factor of CRC (HR = 1.7, p = 0.035) and mCRC (HR = 3.1, p = 0.017). Disease-free survival (DFS) was significantly worse in patients with elevated platelet count in the CRC group (HR = 2.0, p = 0.011). In the multivariate analysis the PLR was not a prognostic factor in either of the two cohorts (HR = 0.92, p < 0.001 and HR = 0.89, p = 0.789, respectively). The platelet count is a valuable prognostic marker for the survival in patients both with CRC and mCRC while the PLR is not prognostic in either group.

scholarly journals Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer

2009 ◽  
Vol 27 (31) ◽  
pp. 5131-5137 ◽  
Author(s):  
Catherine Liebig ◽  
Gustavo Ayala ◽  
Jonathan Wilks ◽  
Gordana Verstovsek ◽  
Hao Liu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Survival Rate ◽  
Perineural Invasion ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Negative ◽  
Disease Free Survival Rate ◽  
Disease Free

Purpose Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients. Patients and Methods We identified 269 consecutive patients who had CRC resected at our institution. Tumors were rereviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test. Results PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P < .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival. Conclusion PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.

scholarly journals Does delaying curative surgery for colorectal cancer influence long-term disease-free survival? A cohort study

2021 ◽  
Author(s):  
Stephanie Garcia-Botello ◽  
J. Martín-Arevalo ◽  
C. Cozar-Lozano ◽  
A. Benitez-Riesco ◽  
D. Moro-Valdezate ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Disease Free Survival ◽  
Time Interval ◽  
Wait List ◽  
Free Survival ◽  
Ajcc Stage ◽  
Definitive Surgery ◽  
The Impact ◽  
Disease Free

Abstract Background Surgical wait list time is a major problem in many health-care systems and its influence on survival is unclear. The aim of this study is to assess the impact of wait list time on long-term disease-free survival in patients scheduled for colorectal cancer resection. Materials and methods A prospective study was carried out in patients with colorectal cancer scheduled for surgery at a tertiary care center. Wait list time was defined as the time from completion of diagnostic workup to definitive surgery and divided into 2-week intervals from 0 to 6 weeks. The outcome variables were 2-year and 5-year disease-free survival. Results A total of 602 patients, 364 (60.5%) male, median age 73 years (range = 71) were defined. The median wait list time was 28 days (range = 99). Two and 5-year disease-free survival rates were 521 (86.5%) and 500 (83.1%) respectively. There were no differences in 2-year or 5-year disease-free survival for the whole cohort or by tumor stage between wait list time intervals except for AJCC stage II tumors which showed a higher 5-year disease-free survival for the 2–4 and 4–6-week wait list time interval (p = 0.021). Conclusions Time from diagnosis to definitive surgery up to 6 weeks is not associated with a decrease in 2-year or 5-year disease-free survival (DFS) in AJCC stage I through III colorectal cancer patients. These are important findings in the light of the COVID-19 pandemic and offer a window of opportunity for preoperative optimization and prehabilitation.

Prognostic significance of lymphadenectomy in patients with esophageal cancer receiving neoadjuvant chemoradiation.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 87-87
Author(s):  
Charmi Vijapura ◽  
Ravi Shridhar ◽  
Jill M. Weber ◽  
Sarah E. Hoffe ◽  
Jeremiah Lee Deneve ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Multivariate Analysis ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Neoadjuvant Chemoradiation ◽  
Free Survival ◽  
Nodal Harvest ◽  
The Impact ◽  
Disease Free

87 Background: The optimal number of lymph nodes that should be harvested in esophageal cancer patients remains to be defined, particularly in patients that receive neoadjuvant therapies. We investigated the impact of nodal resection and survival in esophageal cancer patients treated with neoadjuvant chemoradiation (NT). Methods: Using our comprehensive esophageal cancer database we identified patients treated with NT followed by esophagectomy between 2000-2011. Clinical and pathologic data were compared using Fisher’s exact and chi-square while, Kaplan Meier estimates were used for survival analysis. Overall (OS) and disease-free survival (DFS) were compared with varying numbers of lymph nodes resected <10 and ≥10 (ST-1), <12 and ≥12 (ST-2), and <15 and ≥15 (ST-3). Multivariate analysis was analyzed by the Cox proportional hazard model. Results: We identified 358 patients treated with NT and esophagectomy with a median follow-up of 18.5 months (range, 0-116 months). There was no survival benefit demonstrated for patients with increased lymph nodes removed during their surgery (ST-1 OS p=0.400, DFS p=0.8727; ST-2 OS p=0.6833, DFS p=0.6092; ST-3 OS p=0.1798, DFS p=0.4028). Patients were further stratified by pathologic response to NT and nodal harvest. There were no differences in OS or DFS in patients with increased nodal harvest when analyzed by complete (pCR) (ST-1 OS p=0.7278, DFS p=0.3602; ST-2 OS p=0.6182, DFS p=0.3592; ST-3 OS p=0.4489, DFS p=0.6976), partial (pPR) (ST-1 OS p=0.3762, DFS p=0.5061; ST-2 OS p=0.8036, DFS p=0.6497; ST-3 OS p=0.0890, DFS p=0.3364), or non response (pNR) (ST-1 OS p=0.6825, DFS p=0.7161; ST-2 OS p=0.7084, DFS p=0.8351; ST-3 OS p=0.5002, DFS p=0.7314) to NT. Multivariate analysis demonstrated that age (p=0.028), t-stage (p=0.006), pPR (p=0.025), and pNR (p<0.0005) to NT were all independent predictors of mortality. Conclusions: In our experience, the number of lymph nodes resected was not predictive for overall or disease free survival in esophageal cancer patients treated with NT. In addition, extended lymph node resection did not improve survival for those with residual disease.

Clinicopathologic characteristics and survival outcomes in multifocal and multicentric breast cancer.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 41-41
Author(s):  
Atsushi Fushimi ◽  
Atsushi Yoshida ◽  
Osamu Takahashi ◽  
Naoki Hayashi ◽  
Hiroshi Yagata ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Survival Outcomes ◽  
Breast Cancers ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

41 Background: Although multifocal and multicentric (MF/MC) breast cancers are a common entity, their clinical behaviors are not well characterized. We evaluated the impact of MF/MC on the disease-free survival (DFS) and distant disease free survival (DDFS) of breast cancer patients and compared clinicopathological characteristics between MF/MC breast cancers and breast cancers with single lesion. Methods: We retrospectively analyzed 734 consecutive patients who had invasive breast carcinoma and underwent definitive surgery at the St Luke’s International Hospital from January 2004 to December 2006. MF or MC ware defined as more than one lesion in the same quadrant or in separate quadrants, respectively. DDFS and DFS ware calculated by The Kaplan–Meier method. Univariate analysis was performed using the log rank test and multivariate analysis by Cox proportional hazards models. Results: Of 734 patients, 136 (18.5%) had MF/MC disease. MF/MC disease was associated with smaller tumor size (P <0.001). Multivariate analysis shows that MF/MC disease did not have an independent impact on DDFS or DFS adjusting by age, ER status, tumor size, lymphovascular invasion, lymph node metastases and nuclear grade. Conclusions: MF/MC breast cancers were not associated with poor prognostic factors, and were not independent predictors of worse survival outcomes. Our findings support the current TNM staging system of using the diameter of the largest lesion to assign T stage.

Association of tissue factor pathway inhibitor gene polymorphism -33T→C with disease-free survival in colorectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 395-395
Author(s):  
Amy K Bazzarelli ◽  
Adena S Scheer ◽  
Lee-Hwa Tai ◽  
Rashmi Seth ◽  
Christiano Tanese de Souza ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Tissue Factor ◽  
Tissue Factor Pathway Inhibitor ◽  
Disease Free Survival ◽  
Normal Colonic Mucosa ◽  
Colorectal Tumour ◽  
Free Survival ◽  
Tissue Factor Pathway ◽  
The Impact ◽  
Disease Free

395 Background: Tissue Factor Pathway Inhibitor (TFPI) is an anticoagulant protein exhibiting antimetastatic properties in preclinical models. The homozygous CC polymorphism on intron 7 of TFPI (-33T-->C) is associated with higher TFPI protein levels and a lower risk of venous thromboembolism (VTE). The present study is the first to evaluate the impact of the inherited TFPI polymorphism on disease-free survival (DFS) in cancer patients following curative resection. Methods: A prospectively maintained colorectal tumour bank with associated clinical data was used to identify patients who underwent curative surgery for colorectal cancer between 1994 and 2006. Germline DNA was extracted from formalin fixed, paraffin embedded normal colonic mucosa. Single nucleotide polymorphisms (SNPs) for Tissue Factor Pathway Inhibitor (TFPI, -33T-->C), Factor V Leiden (FVL, G1691A), and Prothrombin (PT, G20210A) were determined by polymerase chain reaction. DFS was described using the Kaplan-Meier method. Multivariable regression analysis, with known prognostic factors, was performed using the Cox Proportional Hazard model. Results: Of the 139 patients identified, the prevalence of the wildtype (TT) TFPI genotype was found in 57.3% of samples, the heterozygous genotype (TC) in 29.4%, and the homozygous genotype (CC) in 10.5%. The incidence of VTE was 21.6% in the TT/TC genotypes and 6.7% in the CC genotype (p=0.4). The CC genotype was associated with superior DFS (HR 0.38, [95%CI 0.17-0.88]; p=.02) with 5 year DFS 56.3% vs. 24.6% for CC vs. TT/TC respectively. In multivariate analysis female sex (HR=0.61, p=.02), chemotherapy (HR=0.66, p=.05), node negative (HR=0.47, p=.005) and TFPI CC polymorphism (HR=0.35, p=.01) were independently associated with improved DFS. The prevalence of FVL (0.7%) and PT (2.2%) polymorphisms was too low to detect any interaction with TFPI polymorphism and DFS. Conclusions: These findings indicate that the inherited anticoagulant homozygous -33T-->C TFPI polymorphism may protect against colon cancer recurrence, and suggest a causal role for the coagulation system in cancer outcomes.

scholarly journals Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis

2020 ◽  
Vol 18 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Daniel Boakye ◽  
Viola Walter ◽  
Lina Jansen ◽  
Uwe M. Martens ◽  
Jenny Chang-Claude ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Cancer Prognosis ◽  
Free Survival ◽  
Hazard Ratios ◽  
The Impact ◽  
Disease Free ◽  
Worse Prognosis

Background: Comorbidities and old age independently compromise prognosis of patients with colorectal cancer (CRC). The impact of comorbidities could thus be considered as conveying worse prognosis already at younger ages, but evidence is lacking on how much worsening of prognosis with age is advanced to younger ages in comorbid versus noncomorbid patients. We aimed to quantify, for the first time, the impact of comorbidities on CRC prognosis in “age advancement” of worse prognosis. Methods: A total of 4,602 patients aged ≥30 years who were diagnosed with CRC in 2003 through 2014 were recruited into a population-based study in the Rhine-Neckar region of Germany and observed over a median period of 5.1 years. Overall comorbidity was quantified using the Charlson comorbidity index (CCI). Hazard ratios and age advancement periods (AAPs) for comorbidities were calculated from multivariable Cox proportional hazards models for relevant survival outcomes. Results: Hazard ratios for CCI scores 1, 2, and ≥3 compared with CCI 0 were 1.25, 1.53, and 2.30 (P<.001) for overall survival and 1.20, 1.48, and 2.03 (P<.001) for disease-free survival, respectively. Corresponding AAP estimates for CCI scores 1, 2, and ≥3 were 5.0 (95% CI, 1.9–8.1), 9.7 (95% CI, 6.1–13.3), and 18.9 years (95% CI, 14.4–23.3) for overall survival and 5.5 (95% CI, 1.5–9.5), 11.7 (95% CI, 7.0–16.4), and 21.0 years (95% CI, 15.1–26.9) for disease-free survival. Particularly pronounced effects of comorbidity on CRC prognosis were observed in patients with stage I–III CRC. Conclusions: Comorbidities advance the commonly observed deterioration of prognosis with age by many years, meaning that at substantially younger ages, comorbid patients with CRC experience survival rates comparable to those of older patients without comorbidity. This first derivation of AAPs may enhance the empirical basis for treatment decisions in patients with comorbidities and highlight the need to incorporate comorbidities into prognostic nomograms for CRC.

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