The optimal time-interval to re-resection for incidentally discovered gallbladder cancer: A multi-institution analysis from the US Extrahepatic Biliary Malignancy Consortium.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 201-201
Author(s):  
Cecilia Grace Ethun ◽  
Lauren McLendon Postlewait ◽  
Timothy M. Pawlik ◽  
Stefan Buettner ◽  
George A. Poultsides ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Cox Regression ◽  
Residual Disease ◽  
Optimal Time ◽  
Time Interval ◽  
Current Recommendation ◽  
Term Survival ◽  
Interval Time ◽  
T Stage ◽  
Group A

201 Background: Current recommendation is to perform re-resection for select patients with incidentally discovered gallbladder cancer. The interval time to re-resection that optimizes both patient selection and long-term survival is not known. Methods: All patients with incidentally discovered gallbladder cancer who underwent re-resection at 10 institutions from 01/2000-05/2015 were included. The interval time to re-resection was analyzed. Primary outcome was overall survival (OS). Results: Of 449pts with gallbladder cancer, 233 (52%) were discovered incidentally and underwent attempted re-resection at 3 different time-intervals from the date of original cholecystectomy: Group A: 0-4wks (49pts, 21%); B: 4-8wks (91pts, 39%); C: > 8wks (93pts, 40%). All 3 groups were similar with regards to T-stage, LN involvement, grade, and post-operative complications. Group A tended to have distant disease found less frequently at the time of re-resection (11% vs 20% vs 19%; p = 0.38) and was least likely to have residual disease on pathologic analysis (29% vs 47% vs 49%; p = 0.048). Despite these findings, patients who underwent attempted re-resection between 4-8 weeks had the longest median OS (Group B: 40.4mo) compared to those who underwent early (Group A: 18.1mo) or late (Group C: 23.6mo) re-exploration (p = 0.015). A 4-8 week time interval to re-resection, presence of residual disease, advanced T-stage, LN involvement, high grade, and positive margin were associated with decreased OS on UV Cox regression (all p < 0.05). Only a 4-8 week time interval to re-resection (HR 0.43, 95%CI 0.21-0.90; p = 0.02), advanced T-stage (HR 2.65, 95%CI 1.16-6.09; p = 0.02), and margin positivity (HR 2.46, 95%CI 1.16-5.22; p = 0.02) persisted on MV analysis. Conclusions: The optimal time-interval for attempted re-resection for incidentally discovered gallbladder cancer appears to be between 4-8 weeks after the date of the original cholecystectomy.

A novel pathology-based preoperative risk score to predict distant and locoregional residual disease and survival for incidentally discovered gallbladder cancer: A 10-institution study from the US Extrahepatic Biliary Malignancy Consortium.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 202-202
Author(s):  
Cecilia Grace Ethun ◽  
Lauren McLendon Postlewait ◽  
Timothy M. Pawlik ◽  
Stefan Buettner ◽  
George A. Poultsides ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Risk Score ◽  
Residual Disease ◽  
Risk Groups ◽  
Term Survival ◽  
T Stage ◽  
Increased Risk ◽  
The Us ◽  
Pathologic Characteristic ◽  
Predictive Risk

202 Background: T-stage alone is currently used to guide treatment for incidentally discovered gallbladder cancer. We aimed to develop a more robust predictive model for discovering distant or locoregional residual disease at the time of re-resection. Methods: All patients with incidentally discovered gallbladder cancer who underwent re-resection at 10 institutions from 2000-2015 were included. We utilized routine pathology data from initial cholecystectomy to create a gallbladder cancer predictive risk score (GBRS) for finding distant or locoregional residual disease at re-resection and predicting overall survival (OS). Results: Of 449pts with gallbladder cancer, 262 (58%) were incidentally discovered and underwent attempted re-resection. Advanced T-stage, grade, and lymphovascular (LVI) and perineural (PNI) invasion were all associated with increased rates of distant and locoregional residual disease, and decreased OS. Each pathologic characteristic was assigned a value (T1a: 0, T1b: 1, T2: 2, T3/4: 3; well diff: 1, mod diff: 2, poor diff: 3; LVI neg: 1, LVI pos: 2; PNI neg: 1, PNI pos: 2), which were added for a total GBRS score ranging from 3-10. The scores were then separated into 3 risk groups (Low: 3-4; Intermediate: 5-7; High: 8-10). Each progressive GBRS group was associated with an increased risk of finding distant and isolated locoregional residual disease at the time of re-resection, and was associated with reduced median OS (Table). Conclusions: By accounting for pathologic variations within each T-stage, this novel predictive risk-score redistributes T1b, T2, and T3 disease across separate risk-groups and more accurately identifies patients with incidentally discovered gallbladder cancer at risk for distant and locoregional residual disease, and decreased long-term survival. This score may help to better optimize treatment strategy for patients with incidentally discovered gallbladder cancer. [Table: see text]

Long-term survival outcomes of intravenous versus intraperitoneal chemotherapy in the treatment of advanced ovarian cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 6046-6046 ◽  
Author(s):  
Rachel Soyoun Kim ◽  
Manjula Maganti ◽  
Marcus Bernardini ◽  
Stephane Laframboise ◽  
Sarah E. Ferguson ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cox Regression ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis

6046 Background: The role of intraperitoneal (IP) chemotherapy in the management of advanced ovarian cancer has been questioned given emerging evidence showing lack of survival benefits. The objective of this study was to compare the long-term survival associated with IP chemotherapy at a tertiary cancer center. Methods: We reviewed the long-term survival records of 271 women with stage IIIC or IV high-grade serous ovarian cancer treated with primary cytoreductive surgery (PCS) followed by IP or intravenous (IV) chemotherapy between 2001-2015 with a minimum follow-up of 4 years. 5-year progression free (PFS) and overall survival (OS) rates were compared using Kaplan-Meier survival analysis and covariates were evaluated using Cox regression analysis. Results: Women who received IP chemotherapy after PCS (n = 91) were more likely to have undergone aggressive surgery (p < 0.001), longer surgery (p < 0.001), and had no residual disease (p < 0.001) compared to the IV arm (n = 180). Median follow-up was 51.6 months. Five-year PFS was 19% vs. 18% (p = 0.63) and OS was 73% vs. 44% (p = 0.00016) in the IP vs. IV arms, respectively. After controlling for covariates in a multivariable model, the use of IP was no longer a significant predictor of OS in the entire cohort (p = 0.12). In patients with 0mm residual disease, PFS was 28% vs. 26% (p = 0.67) and OS was 81% vs. 60% (p = 0.059) in IP (n = 61) vs. IV (n = 69), respectively. In patients with residual of 1-9mm, PFS was 30% vs. 48% (p = 0.076) and OS was 60% vs. 43% (p = 0.74) in IP (n = 29) vs. IV (n = 31), respectively. Conclusions: IP chemotherapy showed a trend towards improved survival over conventional IV chemotherapy, especially in patients with no residual disease. Given the retrospective nature and small numbers in this study, prospective non-randomized cohort studies are warranted to evaluate the role of IP chemotherapy in advanced ovarian cancer.

scholarly journals Extensive Dissection at No. 12 Station During D2 Lymphadenectomy Improves Survival for Advanced Lower-Third Gastric Cancer: A Retrospective Study From a Single Center in Southern China

2022 ◽  
Vol 11 ◽  
Author(s):  
Weigang Dai ◽  
Er-Tao Zhai ◽  
Jianhui Chen ◽  
Zhihui Chen ◽  
Risheng Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cox Regression ◽  
Southern China ◽  
Progression Free Survival ◽  
Control Group ◽  
D2 Lymphadenectomy ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Group A

BackgroundD2 lymphadenectomy including No. 12a dissection has been accepted as a standard surgical management of advanced lower-third gastric cancer (GC). The necessity of extensive No. 12 nodes (No. 12a, 12b, and 12p) dissection remains controversial. This study aims to explore its impact on long-term survival for resectable GC.MethodsFrom 2009 to 2016, 353 advanced lower-third GC patients undergoing at least D2 lymphadenectomy during a radical surgery were included, with 179 patients receiving No. 12a, 12b, and 12p dissection as study group. A total of 174 patients with No. 12a dissection were employed as control group. Surgical and long-term outcomes including 90-day complications incidence, therapeutic value index (TVI), 3-year progression-free survival (PFS), and 5-year overall survival (OS) were compared between both groups.ResultsNo. 12 lymph node metastasis was observed in 20 (5.7%) patients, with 10 cases in each group (5.6% vs. 5.7%, p = 0.948). The metastatic rates at No. 12a, 12b, and 12p were 5.7%, 2.2%, and 1.7%, respectively. The incidence of 90-day complications was identical between both groups. Extensive No. 12 dissection was associated with increased TVI at No. 12 station (3.9 vs. 0.6), prolonged 3-year PFS rate (67.0% vs. 55.9%, p = 0.045) and 5-year OS rate (66.2% vs. 54.0%, p = 0.027). The further Cox-regression analysis showed that the 12abp dissection was an independent prognostic factor of improved survival (p = 0.026).ConclusionAdding No. 12b and 12p lymph nodes to D2 lymphadenectomy might be effective in surgical treatment of advanced lower-third GC and improve oncological outcomes compared with No. 12a-based D2 lymphadenectomy.

The effect of chemotherapy type and timing among the other factors on patency of totally implantable vascular access devices in colorectal carcinoma

2021 ◽  
pp. 112972982110592
Author(s):  
Bilgin Kadri Aribas ◽  
Fatih Yildiz ◽  
Tugba Uylar ◽  
Ramazan Tiken ◽  
Hale Aydin ◽  
...  
Keyword(s):  
Colorectal Carcinoma ◽  
Vascular Access ◽  
Cox Regression ◽  
The Other ◽  
Time Interval ◽  
Initiation Time ◽  
Vascular Access Devices ◽  
Catheter Patency ◽  
Group A ◽  
Group B

Purpose: Catheter-related complications are observed in infusion of chemotherapy, and these were encountered with targeted therapies. Our principle is to study non-mechanical effects of type and initiation time of chemotherapy among the other factors on patency of totally implantable vascular access devices (TIVAD) inserted in patients with colorectal carcinoma. Methods: This is a one-center retrospective cohort study. We analyzed TIVAD related complications in 624 patients with colorectal carcinoma. The patients were categorized by chemotherapy type (non-target-directed chemotherapy agents (Group A), bevacizumab (Group B), and cetuximab (Group C)). Additionally, we divided the patients into groups by the time interval between TIVAD insertion and chemotherapy initiation. According to our study, a 3-day period was optimal. Therefore, we named the groups as within 3 days and beyond 3 days, and called this process 3 days cut-off. Age, gender, jugular-subclavian access, platelet count, INR, the types of chemotherapy, and the initiation time of chemotherapy were investigated by survival tests. We compared chemotherapy type groups both one-by-one and combined into one group. Results: The TIVADs were removed due to the complications in 11 patients of Group A, 6 patients of Group B, and 3 patients of Group C. Only chemotherapy type was significant ( p = 0.011) in Cox regression test. A clear difference ( p = 0.010) was detected between the catheter patency of Group A and combination of Groups B and C, because of skin necrosis and thrombosis. Within 3 days of their first chemotherapy day, an important difference between Group A and Group C ( p = 0.013) was observed in the TIVAD patency. The same observation was made between Group A and Group B ( p = 0.007). Beyond this period, no major difference was detected ( p = 0.341). Conclusion: A major effect on catheter patency was detected by using the target-directed chemotherapy agent within 3 days, which should be considered in target-directed chemotherapy.

scholarly journals Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival

JAMA Surgery ◽  
2017 ◽  
Vol 152 (2) ◽  
pp. 143 ◽  
Author(s):  
Cecilia G. Ethun ◽  
Lauren M. Postlewait ◽  
Nina Le ◽  
Timothy M. Pawlik ◽  
Stefan Buettner ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gallbladder Cancer ◽  
Optimal Time ◽  
Time Interval ◽  
Incidental Gallbladder Cancer

Implications of prolonged time to pancreaticoduodenectomy after neoadjuvant chemoradiation: Analysis of the National Cancer Database.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 473-473 ◽  
Author(s):  
Annabelle Teng ◽  
Trang Nguyen ◽  
Anton Bilchik ◽  
Victoria O'Connor ◽  
David Y Lee
Keyword(s):  
Surgical Resection ◽  
Clinical Stage ◽  
Neoadjuvant Chemoradiation ◽  
Whipple Procedure ◽  
Optimal Time ◽  
Time Interval ◽  
National Cancer Database ◽  
Short Term ◽  
Term Survival ◽  
The Impact

473 Background: For patients with pancreatic adenocarcinoma (PA), the optimal time interval between neoadjuvant chemoradiation (CR) to surgical resection has not been well established. The National Cancer Database (NCDB) was used to evaluate the impact of radiation-surgery (RS) interval on outcomes. Methods: The NCDB from 2006-2014 was queried for patients ≥18 years old diagnosed with PA who received CR prior to surgery. Survival and short-term outcomes were compared between patients who had a Whipple procedure performed ≤12 weeks and > 12 weeks after completion of CR therapy. Results: 1610 patients met selection criteria. Average RS interval was 58.2 ± 39.5 days. 1419 patients had RS interval ≤12 weeks (mean 47.4 days) and 191 had RS interval > 12 weeks (mean 138.8 days). Age, race, gender, income, type of treatment facility, CA 19-9 levels, types of chemotherapy and radiation dosage administered were similar between the two groups. Mean tumor size was 32.2 mm in the ≤12 week group and 34.9 mm in the > 12 week group (p = 0.021). There was a higher proportion of patients with clinical stage III cancers in the > 12 weeks group than in the ≤12 weeks group (33.5% vs 14%). Short-term morbidity and mortality was not significantly different between the two groups in terms of length of stay, readmission within 30 days, 30-day and 90-day mortality. However, a long-term survival benefit was observed in the > 12 week group (median 25.8 months in ≤12 weeks vs 30.2 months in > 12 weeks, p = 0.049) that appears to persist. An interval > 12 weeks was associated with significantly prolonged survival on multivariate analysis (HR 0.80 (0.65-0.99 95% CI, p = 0.042)). Higher clinical stage and positive surgical margins were independently associated with worse survival. Conclusions: Surgical resection beyond 12 weeks after CR for PA did not worsen surgical outcomes. Waiting may contribute to better patient selection, especially those with larger tumors and higher clinical stage. In the absence of progressive disease, patients need to be continuously evaluated for surgical resection after CR.

scholarly journals Social Influences on Clinical Outcomes of Patients With Ovarian Cancer

2012 ◽  
Vol 30 (23) ◽  
pp. 2885-2890 ◽  
Author(s):  
Susan K. Lutgendorf ◽  
Koen De Geest ◽  
David Bender ◽  
Amina Ahmed ◽  
Michael J. Goodheart ◽  
...  
Keyword(s):  
Social Support ◽  
Ovarian Cancer ◽  
Cox Regression ◽  
Residual Disease ◽  
Clinical Information ◽  
Clinic Visit ◽  
Disease Stage ◽  
Term Survival ◽  
Social Attachment ◽  
Instrumental Social Support

Purpose Previous research has demonstrated relationships of social support with disease-related biomarkers in patients with ovarian cancer. However, the clinical relevance of these findings to patient outcomes has not been established. This prospective study examined how social support relates to long-term survival among consecutive patients with ovarian cancer. We focused on two types of social support: social attachment, a type of emotional social support reflecting connections with others, and instrumental social support reflecting the availability of tangible assistance. Patients and Methods Patients were prospectively recruited during a presurgical clinic visit and completed surveys before surgery. One hundred sixty-eight patients with histologically confirmed epithelial ovarian cancer were observed from the date of surgery until death or December 2010. Clinical information was obtained from medical records. Results In a Cox regression model, adjusting for disease stage, grade, histology, residual disease, and age, greater social attachment was associated with a lower likelihood of death (hazard ratio [HR], 0.87; 95% CI, 0.77 to 0.98; P = .018). The median survival time for patients with low social attachment categorized on a median split of 15 was 3.35 years (95% CI, 2.56 to 4.15 years). In contrast, by study completion, 59% of patients with high social attachment were still alive after 4.70 years. No significant association was found between instrumental social support and survival, even after adjustment for covariates. Conclusion Social attachment is associated with a survival advantage for patients with ovarian cancer. Clinical implications include the importance of screening for deficits in the social environment and consideration of support activities during adjuvant treatment.

scholarly journals Optimal Time Interval for Revision Surgery in Incidental Gallbladder Cancer(iGBC)

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S366
Author(s):  
S. Patel ◽  
S. Patkar ◽  
A. Gupta ◽  
A. Parray ◽  
M. Goel
Keyword(s):  
Gallbladder Cancer ◽  
Revision Surgery ◽  
Optimal Time ◽  
Time Interval ◽  
Incidental Gallbladder Cancer

Factors associated with allogeneic hematopoietic stem cell transplantation (HSCT) outcomes in patients (pts) with relapsed/refractory acute lymphoblastic leukemia (R/R ALL) treated with inotuzumab ozogamicin (InO) versus (v) conventional chemotherapy (C).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 7007-7007 ◽  
Author(s):  
Partow Kebriaei ◽  
Daniel J. DeAngelo ◽  
Matthias Stelljes ◽  
Nicola Gökbuget ◽  
Hagop M. Kantarjian ◽  
...  
Keyword(s):  
Cox Regression ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Term Survival ◽  
Hematopoietic Stem ◽  
Factors Associated ◽  
Significant Difference ◽  
Before And After ◽  
Conditioning Regimens ◽  
Previously Treated

7007 Background: InO therapy in R/R ALL resulted in superior complete remission (CR)/CR with incomplete hematologic recovery (CRi) rates v C in the Phase 3 INO-VATE trial (NCT01564784; Kantarjian NEJM 2016). More InO v C pts proceeded to HSCT (41% [45/109] v 11% [12/109]; P<0.001). Factors associated with outcomes after HSCT are described. Methods: Full details have been published. Multivariate analyses (MVA) using Cox regression modeling were conducted to determine predictors of non-relapse mortality (NRM) and overall survival (OS). Results: As of 3/8/16, 108/326 pts underwent allogeneic HSCT (InO n=77; C n=31). Baseline characteristics were generally similar, except baseline platelet values were lower in InO v C pts. More InO v C pts achieved minimal residual disease negativity (MRDneg [best status]; 71% v 26%; P<0.0001). Less InO v C pts received additional therapy before HSCT (14% v 55%, P<0.0001). NRM rates were higher in InO v C pts at 1 year (yr; 36% [95% CI 26–47] v 20% [8–36]) and 2 yrs (39% [27–51] v 31% [13–51]), but relapse rates were lower (1 yr, 23% [15–33] v 29% [13–48]; 2 yrs, 33% [22–44] v 46% [24–65]). No significant difference in post-HSCT survival was detected in InO v C pts; however, visual inspection of the curve suggested the survival probability varied before and after 15 months post-HSCT (1 yr, 44% [95% CI 33–55] v 65% [44–79]; 2 yr, 39% [28–50] v 34% [15–54]). Fatal veno-occlusive disease (VOD) was observed in 5 InO pts (all during the first 100 days from the date of HSCT) and no C pts. MVA showed that conditioning regimens without dual alkylators and thiotepa were associated (2-sided; P<0.05) with lower risk of NRM and post-HSCT survival, respectively. Conclusions: Compared with C, InO permitted more pts with R/R ALL to proceed to HSCT in CR/CRi with MRDneg (best status). Despite increased NRM and fatal VOD, long-term survival was attainable in InO pts. In pts previously treated with InO, interventions to reduce NRM and improve OS after HSCT include avoiding dual alkylator conditioning regimens, especially those containing thiotepa. Funding: Pfizer Clinical trial information: NCT01564784.

scholarly journals Prognostic Estimator of Survival for Patients with Localized and Extended Pancreatic Ductal Adenocarcinoma

2013 ◽  
Vol 12 ◽  
pp. CIN.S11496 ◽  
Author(s):  
Michael X. Gleason ◽  
Tengiz Mdzinarishvili ◽  
Chandrakanth Are ◽  
Aaron Sasson ◽  
Alexander Sherman ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Tumor Grade ◽  
Ductal Adenocarcinoma ◽  
Model Parameters ◽  
Web Based ◽  
T Stage ◽  
Kaplan Meier ◽  
Group A

The 18,352 pancreatic ductal adenocarcinoma (PDAC) cases from the Surveillance Epidemiology and End Results (SEER) database were analyzed using the Kaplan-Meier method for the following variables: race, gender, marital status, year of diagnosis, age at diagnosis, pancreatic subsite, T-stage, N-stage, M-stage, tumor size, tumor grade, performed surgery, and radiation therapy. Because the T-stage variable did not satisfy the proportional hazards assumption, the cases were divided into cases with T1- and T2-stages (localized tumor) and cases with T3- and T4-stages (extended tumor). For estimating survival and conditional survival probabilities in each group, a multivariate Cox regression model adjusted for the remaining covariates was developed. Testing the reproducibility of model parameters and generalizability of these models showed that the models are well calibrated and have concordance indexes equal to 0.702 and 0.712, respectively. Based on these models, a prognostic estimator of survival for patients diagnosed with PDAC was developed and implemented as a computerized web-based tool.

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