Outcomes of metastatic colorectal cancer over fifteen years from an Indian tertiary care center: A retrospective analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15050-e15050
Author(s):  
Vinod Sharma ◽  
Atul Sharma ◽  
Sushmita Pathy ◽  
Nootan Kumar Shukla ◽  
S V Suryanarayana Deo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Cox Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Location ◽  
P Value ◽  
Female Ratio ◽  
Retrospective Data Analysis ◽  
Ecog Ps

e15050 Background: Management of metastatic colorectal cancer (CRC) has revolutionised over the past 2 decades and a number of drugs are part of active disease management including biologicals. Published large database on metastatic CRC outcome has been lacking from India. Methods: A retrospective data analysis of metastatic CRC from prospectively based database was performed from the year, 2001-2015. All patients who have received at least 1 cycle of chemotherapy were enrolled. Kaplan Meier analysis was done for overall survival (OS). Cox-regression model was done to determine prognostic factors of OS. Results: A total of 288 patients including upfront metastatic (n = 197, 68%) and relapsed (n = 91, 32%) with male to female ratio of 1.4:1 and median age of 46 years were studied. CEA was high in 78% with median level of 20 ng/ml. Most common site of primary tumor location was rectum (47%). Proportions of left side, right side and transverse colon was 75%, 20% and 4.2%. Mucinous and signet histologies were seen in 24% and 9.2% of patients. Most common sites of metastases being liver (43%), peritoneum (31%) and lung (18%). Oxaliplatin based therapy was used 71% of patients as 1st line. Median chemotherapy cycles for both 1st and 2nd line regimen was 6. Biologicals were part of 1st line regimen in only 12.5% of patients. Median OS of our cohort was 18.5 months. Predictors of poor OS were ECOG PS > 1 (HR 2, CI: 1.3-3.3, p value = 0.003), high CEA ( > 5ng/ml, HR 2.5, CI: 1.3-4.6, p value = 0.004), low albumin (< 3.5 g/dl, HR 1.7, CI: 1.03-2.9, p value = 0.045), < 2 lines of chemotherapy received (HR 2, CI: 1.3-3.3, p value = 0.001). Conclusions: Outcomes of metastatic CRC in our cohort with use of doublet chemotherapy (small proportion with biologicals) is comparable to published literature worldwide. We have higher proportion of younger population, rectum cancer, signet and mucinous histology and higher incidence of peritoneal involvement.

GASTRIC CANCER: A 5 YEAR RETROSPECTIVE ANALYSIS OF CLINICAL, PATHOLOGICAL AND TREATMENT ASPECTS FROM A TERTIARY CARE CENTER IN SOUTH INDIA.

2021 ◽  
pp. 129-132
Author(s):  
B. Ramkumar ◽  
J. Kannan ◽  
Ingersal. N ◽  
Srigopal mohanty ◽  
Amit saklani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Tumor Location ◽  
Advanced Stage ◽  
Tertiary Care Center ◽  
Nodal Disease ◽  
Female Ratio

Context: Gastric cancer(GC) is fth most common cancer worldwide. Mostly presents with advanced stage and poor overall survival. Methods: Retrospective study on clinical, pathological, pattern of distant metastasis(DM) , treatment aspect of GC treated between January 2014 to December 2018 in a tertiary care center in south India. Statistical analysis : Chi square test and multivariate analysis (MVA) were used for analysis. P <0.05 was considered signicant. Results: Median age at diagnosis is 57 years. Higher male : female ratio. Most common presentation was abdominal pain followed vomiting. Malignant Gastric outlet obstruction(MGOO) was present in 22.7%. Histologically , all patients had adenocarcinoma with predominantly moderate differentiation (51.1%). Liver (19.1%)was most common site of metastasis . Curative surgery was done in 35.5% of patients. D2 lymph node dissection was performed in 12.4% of patient. Patients were given perioperative /preoperative/ adjuvant / palliative chemotherapy. MVA revealed history of tobacco use, body of stomach tumor location, nodal disease were risk factors for DM. Conclusion : The present analysis revealed use of tobacco, alcohol intake were main risk factors for GC. Most of the patients present in advanced stage , so prevention by avoiding risk factors and early detection by signs , symptoms and endoscopy are necessary. Use of tobacco,site of tumor location, nodal disease were factors associated with DM. Aggressive management with both surgery and chemotherapy is warranted for locally advanced disease.

scholarly journals Clinico-pathological and radiological correlation of sino-nasal masses in a tertiary care center

2020 ◽  
Vol 6 (7) ◽  
pp. 1342
Author(s):  
Dimple Sahni ◽  
Gagandeep Kaur ◽  
Peeyush Verma ◽  
Rajwant Kaur ◽  
Harpal Singh
Keyword(s):  
Histopathological Examination ◽  
Care Center ◽  
Tertiary Care ◽  
Inflammatory Lesion ◽  
P Value ◽  
Radiological Investigation ◽  
Female Ratio ◽  
Histopathological Correlation ◽  
Neoplastic Lesion ◽  
Neoplastic Lesions

<p class="abstract"><strong>Background:</strong> The nasal masses are most commonly encountered condition in outpatient department of otorhinolaryngology. The purpose of this study was to show the clinical, radiological and histopathological correlation of sino nasal masses.</p><p class="abstract"><strong>Methods:</strong> This study was conducted on 100 cases with sino nasal masses over a period of 2 years. A provisional diagnosis was made after clinical and radiological investigation which was confirmed with histopathological examination and the findings were correlated.  </p><p class="abstract"><strong>Results:</strong> The number of non-neoplastic lesions were more than neoplastic lesions (75% vs 25%). Incidence was highest in the age group of 31-40 year (21%) with male to female ratio of 1.5:1. In our study among non-neoplastic lesion, inflammatory lesion had highest frequency (75%). We found clinical and histopathological correlation in 94.6% cases (p value 0.04). 93.33% cases correlated radiologically and histopathologically (p value 0.04).    </p><p class="abstract"><strong>Conclusions:</strong> We concluded that for proper evaluation of sino nasal masses, clinical, radiological, histopathological evaluation should be carried out conjointly. Histopathologic evaluation remains the gold standard.</p>

scholarly journals Histopathology of Polyps and Cancer of Colorectum: A ten years study from a tertiary care center

2021 ◽  
Vol 14 (2) ◽  
pp. 100-106
Author(s):  
Binita Goyal
Keyword(s):  
Colorectal Cancer ◽  
Care Center ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
Older Age ◽  
Histologic Grade ◽  
Age Group ◽  
Female Ratio ◽  
Pathologic Stage ◽  
Male Female Ratio

Introduction and objectives: Polyps and colorectal cancer have overlapping clinical presentation and may be difficult to diagnose on clinical grounds alone and close clinicopathological correlation is required for correct diagnosis and management. This study was aimed to see the spectrum of polyps and cancer in colorectum, see the percentage of colorectal cancer in younger individuals, see association between histologic grade and pathologic stage at presentation and compare site of tumor and pathologic stage at presentation in younger and older age group. Methods: This study was carried out on 138 consecutive cases of polyps and malignant lesions of colorectum during a time period of 10 years from January 2011 to December 2020. Results: Age of the patients ranged from 2 – 90 years with mean 45.1 years and a male female ratio 2:1. There were 58 (42.0%) cases of polyps and 80 (58.0%) cases of malignancies. 37 (46.3%) malignancy cases were seen in individuals ≤ 50 years of age. Most common site of involvement was rectum in 80 (58.0%) cases. Most common non-neoplastic polyp was retention polyp comprising 25 (67.6%) and most common neoplastic polyp was adenoma comprising of 18 (85.7%) cases. Most common malignancy was adenocarcinoma comprising 75 (93.8%) cases. Conclusion: Significant number of malignancies is seen in younger individuals stressing the need for suspicion and surveillance in this age group. Histologic grade is an important prognostic parameter and there is no difference in site of tumor and stage at presentation between younger and older age group.

A randomized phase III trial of S-1/oxaliplatin (SOX) plus bevacizumab versus 5-FU/l-LV/oxaliplatin (mFOLFOX6) plus bevacizmab in patients with metastatic colorectal cancer: The SOFT study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3519-3519 ◽  
Author(s):  
Daisuke Takahari ◽  
Yasuhide Yamada ◽  
Hiroshi Matsumoto ◽  
Hideo Baba ◽  
Kazuhiro Yoshida ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Progression Free Survival ◽  
Phase Iii ◽  
P Value ◽  
Open Label ◽  
Phase Iii Trial ◽  
Open Label Phase ◽  
Grade 3 ◽  
Ecog Ps

3519 Background: Several studies of oxaliplatin plus S-1 combination therapy (SOX) conducted in Asia have shown promising efficacy and safety for metastatic colorectal cancer (mCRC), suggesting the potential to replace mFOLFOX6. We performed a randomized phase III trial to determine whether SOX plus bevacizmab (SOX+Bev) is non-inferior to mFOLFOX6 plus bevacizmab (mFOLFOX6+Bev) in terms of progression-free survival (PFS). Methods: The SOFT study was a randomized, open-label, phase III trial. Chemotherapy-naïve patients (pts) with mCRC, an ECOG PS of 0-1, and adequate organ functions were randomized to receive either mFOLFOX6+Bev (5 mg/kg of bevacizumab, followed by 200 mg/m2 of l-leucovorin given simultaneously with 85 mg/m2 of oxaliplatin, followed by a 400 mg/m2 bolus of 5-FU on day 1 and then 2,400 mg/m2 of 5-FU over 46 h, every 2 weeks) or SOX+Bev (7.5 mg/kg of bevacizumab, 130 mg/m2 of oxaliplatin on day 1, and 40−60 mg of S-1 twice daily for 2 weeks, followed by a 1-week rest). The primary endpoint was PFS. A sample size of 225 pts per group was estimated to be necessary based on a median PFS of 10.0 months in each group and an 80% power to demonstrate non-inferiority of SOX+Bev with a 2.5-month margin (hazard ratio, HR = 1.33) and a 2-sided alpha of 0.05. Results: A total of 512 pts were enrolled from February 2009 to March 2011. Data were analyzed after confirming >388 events as planned. Demographic factors were well balanced. Pts received a median of 12 cycles (1 cycle = 2 weeks) of mFOLFOX6+Bev and 8 cycles (1 cycle = 3 weeks) of SOX+Bev (range: 1−16). Median PFS was 11.5 months (95% CI: 10.7−13.2) with mFOLFOX6+Bev and 11.7 months (95% CI: 10.7−12.9) with SOX+Bev. The adjusted HR for PFS was 1.043 (95% CI: 0.860−1.266), and the p value for non-inferiority was 0.0139. Response rate was 62.7% with mFOLFOX6+Bev and 61.5% with SOX+Bev. Grade 3/4 toxicities (%) with mFOLFOX6+Bev/SOX+Bev were leukopenia 8.4/2.4, neutropenia 33.7/8.8, anorexia 1.2/5.2, and diarrhea 2.8/9.2. Conclusions: SOX+Bev is non-inferior to mFOLFOX6+Bev with respect to PFS as 1st-line treatment for mCRC and thus can replace mFOLFOX6+Bev. Clinical trial information: JapicCTI-090699.

scholarly journals Study on demographic factors of discharge against medical advice in pediatric population

2020 ◽  
Vol 7 (2) ◽  
pp. 359
Author(s):  
Vidya B. U. ◽  
Anil Shetty K.
Keyword(s):  
Lumbar Puncture ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Medical Advice ◽  
P Value ◽  
Against Medical Advice ◽  
Female Ratio ◽  
Significant Difference ◽  
Discharge Against Medical Advice

Background: Discharge against medical advice (DAMA) is of serious concern among the pediatrics population. Parent(s)/guardians understanding about the disease and various other factors play role in their decision of DAMA. The aim of this study is to know the prevalence of DAMA in a tertiary care center and to observe the gender stratification in DAMA.Methods: A retrospective survey of medical records of children discharge against medical advice during the period January 2017 to January 2019. Demographic data, length of hospital stay, clinical diagnosis and procedure refused was collected.Results: Total 12977 were discharged during the study period of which, 387 children were DAMA, prevalence of DAMA was 2.9%, male to female ratio among DAMA patients is 1.2:1. The mean length of stay was 4.8 days. Among the DAMA patients’ newborns were predominant (61.6 %), p value = 0.0001, highly significant. No significant difference with respect to age and gender (p value = 0.535). Out of 370 DAMA patients, 211 patients who required further investigations and procedure was refused by parents/guardians (p value = 0.0001) highly significant. Phototherapy refusal was most common among newborn (59.7%), followed by neuroimaging and lumbar puncture in children (10.9%).Conclusions: DAMA was observed more among the newborns compared to infants, toddlers and children. Among newborns, phototherapy refusal was most common. In infants and children neuroimaging and lumbar puncture was the most commonly refused procedure. There was no gender bias.

scholarly journals Retrospective analysis of oral cancers in Shimla-Himachal Pradesh (2011-2018): a hospital-based study

2021 ◽  
Vol 8 (8) ◽  
pp. 3876
Author(s):  
Shailee Fotedar ◽  
Vikas Fotedar ◽  
Manish Gupta ◽  
Vinay Bhardwaj ◽  
Purnima Thakur ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Buccal Mucosa ◽  
Care Center ◽  
Tertiary Care ◽  
Cancer Control ◽  
Female Gender ◽  
P Value ◽  
Age Group ◽  
Female Ratio ◽  
Oral Cancers

Background: Oral cancer ranks in the top three of all cancers in India, and oral cancer control is quickly becoming a global health priority. To analyse the epidemiological and clinical profile of oral cancer patients treated in Tertiary Care Center, IGMC, Shimla from 2011-2018.Methods: A retrospective study of patients with oral cancers treated from 2011-2018 at TCC, IGMC, Shimla was conducted. Demographic characteristics, tobacco use and oral cancer characteristics related to site, histology and stage at presentation were recorded from patient file records at TCC, Shimla. Data was analysed by Statistical package for social sciences (SPSS) version 16. Statistical test used was chi square test. A p value of 0.05 was considered to be statistically significant.Results: Oral cancer represents 1.53% of overall cancers. The total number of subjects were 246 out of which 205 were men and 41 were women thus making a male female ratio of 5:1. Peak age of occurrence is the 5th and 6th decade. The most common site involved was tongue (37.5%) followed by buccal mucosa (35.5%). Buccal mucosa was significantly associated with male gender, age group of less than 40 years. Lip was significantly associated with female gender, more than 60 years and with no habits. Floor of the mouth was significantly associated with males, 40-60 year age group and tobacco smoking.Conclusions: Strategies to overcome the present situation must be undertaken at state level by oral health programs for the early diagnosis and prevention and to support a tobacco free environment. 

The prognostic value of serum IL-6 and YKL-40 in patients with metastatic colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15060-e15060
Author(s):  
Benny Vittrup Jensen ◽  
Mathias Holsey Gramkow ◽  
Camilla Stedstrup Mosgaard ◽  
Christian Dehlendorff ◽  
Per Pfeiffer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Metastatic Colorectal Cancer ◽  
Prognostic Value ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Continuous Variables ◽  
Female Ratio ◽  
Cox Regression Analysis ◽  
L 14

e15060 Background: The prognostic value of serum IL-6, YKL-40 and CEA before first (1) and third line therapy (3LT) in metastatic colorectal cancer (mCRC) is lacking and was evaluated in this study. Methods: From 2004 to 2015 serum samples were collected from 160 and 255 patients with mCRC before 1LT and 3LT, respectively. Median age was 64 years (range 33-87) and male/female ratio 243(59%)/172(41%). Serum IL-6 (R&D, UK) and YKL-40 (Quidel, USA) were determined by ELISA. Progression-free (PFS) and overall survival (OS), crude and adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI) were estimated with Cox regression analysis. CEA, IL-6 and YKL-40 were included as log2-transformed continuous variables with mutual adjustment between CEA, IL-6 and YKL-40, primary tumor location, sex and age. Results: In 3LT IL-6, YKL-40 and CEA levels were higher (P < 0.001) than in 1LT (IL-6: 9.5 pg/ml [IQR4.2-18.5] vs. 4.6 [2.5-10.5]; YKL-40: 140 ng/ml [77-272] vs. 101 [62-172]; and CEA: 59 ug/l [14-288] vs. 23[5.8-153]). In 3LT univariate analysis showed that increased levels of IL-6, YKL-40 and CEA were associated with shorter PFS (IL-6: HR = 1.19, 95% CI 1.07-1.31, P < 0.01; YKL-40: HR = 1.13, 1.04-1.24, P = 0.01; CEA: HR = 1.05, 1.00-1.09, P = 0.04). In 1LT only high IL-6 was associated with shorter PFS (HR = 1.09, 1.01-1.17, P = 0.03). In a multivariate analysis only high IL-6 was significantly associated with shorter PFS in 3LT (HR = 1.15, 1.03-1.29, P < 0.01) and none of the biomarkers in 1LT. In 3LT univariate analysis showed that increased levels of all 3 biomarkers were associated with a shorter OS (IL-6: HR = 1.36, 1.23-1.51, P < 0.01; YKL-40: HR = 1.21, 1.10-1.33, P < 0.01; CEA: HR = 1.11, 1.06-1.16, P < 0.01). In 1LT high levels of IL-6 (HR = 1.17, 1.08-1.27, P < 0.01) and YKL-40 (HR = 1.18, 1.00-1.38, P = 0.05), but not CEA, were associated with short OS. In 3LT the multivariate analysis showed that both higher IL-6 (HR = 1.34, 1.20-1.50, P < 0.01) and CEA (HR = 1.09, 1.03-1.14, P < 0.01), but not YKL-40 were significantly associated with a shorter OS. In 1LT only higher IL-6 was associated with a shorter OS (HR = 1.19, 1.08-1.31, P < 0.01) Conclusions: Serum IL-6 and YKL-40 may be useful prognostic biomarkers in combination with CEA in patients with mCRC

scholarly journals Frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction: A single-center experience at a large tertiary care center in Lahore, Pakistan

2021 ◽  
Vol 15 (2) ◽  
pp. 87-90
Author(s):  
Sarmad Zahoor ◽  
Hafiz Mudabbar Mahboob ◽  
Hafiz Muhammad Sajid Jehangir ◽  
Bilal Mehmood ◽  
Aleena Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vision Loss ◽  
Care Center ◽  
Tertiary Care ◽  
Retinal Hemorrhage ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Cross Sectional ◽  
Female Ratio ◽  
St Elevation

Background: Thrombolytic therapy with streptokinase is the mainstay of pharmacological treatment in acute myocardial infarction in Pakistan. Retinal hemorrhage is a common complication of streptokinase-induced thrombolysis and is often overlooked which can lead to permanent vision loss. Therefore, this study was carried out to determine the frequency of retinal hemorrhage after thrombolysis with streptokinase in patients presenting with ST-elevation myocardial infarction (STEMI). Patients and methods: It was an observational, cross-sectional study conducted at the Emergency Department of Mayo Hospital Lahore from 11-08-2015 to 10-02-2016. The patients underwent injection of streptokinase (1.5 million U) intravenously over 60 min and intravenous heparin 5,000 U bolus followed by 1,000 U/hour. Then patients were followed up for 24 hours followed by the ophthalmoscopy to confirm the presence of retinal hemorrhage. The data were entered and analyzed using SPSS version 20. Results: A total of 130 patients were included in this study. The mean age of patients was 62±9.86 years. The male to female ratio was 1.6:1. The retinal hemorrhage was present in 17 (13.08%) patients. About 80 (61.5%) were diabetics and 96 (73.8%) were hypertensive. Stratified variables like age, gender, hypertension, and diabetes were not found associated with retinal hemorrhage (p-value ≥0.05).   Conclusion: Retinal hemorrhage was found in 13.08% after streptokinase injection in patients presenting with STEMI. Although the association was statistically insignificant but still the proportion of retinal hemorrhage was substantially high in these patients. This higher percentage demands vigilant monitoring with the drug for timely diagnosis of this ignored complication which latter can be proved hazardous to the vision.  

scholarly journals A Serum Metabolomics Classifier Derived from Elderly Patients with Metastatic Colorectal Cancer Predicts Relapse in the Adjuvant Setting

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2762
Author(s):  
Samantha Di Donato ◽  
Alessia Vignoli ◽  
Chiara Biagioni ◽  
Luca Malorni ◽  
Elena Mori ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Metastatic Colorectal Cancer ◽  
Early Stage ◽  
Prospective Trial ◽  
Proton Nuclear Magnetic Resonance ◽  
P Value ◽  
Resonance Spectroscopy ◽  
Metabolomic Fingerprinting

Adjuvant treatment for patients with early stage colorectal cancer (eCRC) is currently based on suboptimal risk stratification, especially for elderly patients. Metabolomics may improve the identification of patients with residual micrometastases after surgery. In this retrospective study, we hypothesized that metabolomic fingerprinting could improve risk stratification in patients with eCRC. Serum samples obtained after surgery from 94 elderly patients with eCRC (65 relapse free and 29 relapsed, after 5-years median follow up), and from 75 elderly patients with metastatic colorectal cancer (mCRC) obtained before a new line of chemotherapy, were retrospectively analyzed via proton nuclear magnetic resonance spectroscopy. The prognostic role of metabolomics in patients with eCRC was assessed using Kaplan–Meier curves. PCA-CA-kNN could discriminate the metabolomic fingerprint of patients with relapse-free eCRC and mCRC (70.0% accuracy using NOESY spectra). This model was used to classify the samples of patients with relapsed eCRC: 69% of eCRC patients with relapse were predicted as metastatic. The metabolomic classification was strongly associated with prognosis (p-value 0.0005, HR 3.64), independently of tumor stage. In conclusion, metabolomics could be an innovative tool to refine risk stratification in elderly patients with eCRC. Based on these results, a prospective trial aimed at improving risk stratification by metabolomic fingerprinting (LIBIMET) is ongoing.

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