The relationship between aortoiliac calcification and long-term outcome in rectal cancer resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 705-705
Author(s):  
Katrina Knight ◽  
Kate Boland ◽  
Donald C McMillan ◽  
Paul G. Horgan ◽  
Campbell SD Roxburgh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Tnm Stage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Iliac Arteries ◽  
Cancer Resection ◽  
Rectal Cancer Resection ◽  
The Relationship

705 Background: The interaction between host and tumour factors is an important determinant of long-term outcome following rectal cancer resection. At cellular level, hypoxia within the tumour microenvironment stimulates neovascularisation, alters tumour metabolism and is implicated in dissemination and metastases. At host level, restricted blood flow to the tumour may play a role in tumour hypoxia. Significant calcification of the distal aortic and iliac arteries could result in impaired rectal perfusion. We aimed to investigate the relationship between aortoiliac calcification (AC) and long-term outcome following rectal cancer resection. Methods: Patients were identified from a prospectively maintained database. Recurrence and survival data were abstracted. On staging CT images, the sum of calcified quadrants of the distal aorta and iliac arteries at the level of the bifurcation was calculated. ROC analysis was used to identify the optimum threshold for determining significant calcification. Results: Between 2008-2016, 181 patients with available CT scans underwent surgery for rectal cancer. Most were male (60%), aged over 65 (53%) and TNM stage II/III (72%). Median follow-up was 63 months. Significant AC was identified in 44 patients (24%). Recurrence occurred in 42 patients: local in 16 (9%) and systemic in 26 (14%) patients. Recurrence was associated with significant AC (p = 0.017), TNM stage (p = 0.002) and venous invasion (p = 0.006). When considering those with and without significant AC, there were differences in the rates of local (11% vs. 8%) and systemic (25% vs. 11%) recurrence respectively (p = 0.043). On univariate Cox regression analysis, overall survival was related to age (p = 0.012), ASA grade (p = 0.042) and significant AC (p = 0.001). On multivariate analysis, significant AC (p = 0.011) was the only independent predictor of overall survival. Conclusions: The burden of aortoiliac calcification appears to play an important role in influencing long-term outcome following rectal cancer resection, independent of traditional determinants such as TNM stage and ASA grade. While validation is required, further investigation of the mechanism underlying this relationship is warranted.

Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older

2000 ◽  
Vol 43 (12) ◽  
pp. 1704-1709 ◽  
Author(s):  
J. Puig-La Calle ◽  
J. Quayle ◽  
H. T. Thaler ◽  
W. Shi ◽  
P. B. Paty ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cancer Resection ◽  
Rectal Cancer Resection

scholarly journals Influence of Body Mass Index on Long-Term Outcome in Patients with Rectal Cancer—A Single Centre Experience

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 609 ◽  
Author(s):  
Kalb ◽  
Langheinrich ◽  
Merkel ◽  
Krautz ◽  
Brunner ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Local Recurrence ◽  
Distant Metastasis ◽  
Hazard Ratio ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Obesity Class

Background: Excess bodyweight is known to influence the risk of colorectal cancer; however, little evidence exists for the influence of the body mass index (BMI) on the long-term outcome of patients with rectal cancer. Methods: We assessed the impact of the BMI on the risk of local recurrence, distant metastasis and overall—survival in 612 patients between 2003 and 2010 after rectal cancer diagnosis and treatment at the University Hospital Erlangen. A Cox-regression model was used to estimate the hazard ratio and multivariate risk of mortality and distant-metastasis. Median follow up-time was 58 months. Results: Patients with obesity class II or higher (BMI ≥ 35 kg/m2, n = 25) and patients with underweight (BMI < 18.5 kg/m2, n = 5) had reduced overall survival (hazard ratio (HR) = 1.6; 95% confidence interval (CI) 0.9–2.7) as well as higher rates of distant metastases (hazard ratio HR = 1.7; 95% CI 0.9–3.3) as compared to patients with normal bodyweight (18.5 ≤ BMI < 25 kg/m2, n = 209), overweight (25 ≤ BMI <30 kg/m2, n = 257) or obesity class I (30 ≤ BMI <35 kg/m2, n = 102). There were no significant differences for local recurrence. Conclusions: Underweight and excess bodyweight are associated with lower overall survival and higher rates of distant metastasis in patients with rectal cancer.

Long-term Outcome of Local Excision After Preoperative Chemoradiation for ypT0 Rectal Cancer

2014 ◽  
Vol 57 (11) ◽  
pp. 1245-1252 ◽  
Author(s):  
Francesco Stipa ◽  
Marcello Picchio ◽  
Antonio Burza ◽  
Emanuele Soricelli ◽  
Carlo Eugenio Vitelli
Keyword(s):  
Rectal Cancer ◽  
Local Excision ◽  
Preoperative Chemoradiation ◽  
Term Outcome ◽  
Long Term Outcome

Allogeneic Hematopoietic Stem-Cell Transplantation In AML and MDS Using Myeloablative Versus Reduced Intensity Conditioning: 10 Years Later

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4635-4635
Author(s):  
Avichai Shimoni ◽  
Noga Shem-Tov ◽  
Yulia Volchek ◽  
Ivetta Danylesko ◽  
Ronit Yerushalmi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Reduced Intensity Conditioning ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Relapse Rates ◽  
Active Disease ◽  
Reduced Intensity

Allogeneic stem cell transplantation (SCT) with both myeloablative (MAC) and reduced intensity conditioning (RIC) is effective therapy in AML and MDS. However, the relative merits of each may differ in different settings. There is paucity of data on the long-term outcome (beyond 10 years) following RIC due to the relative recent introduction of this approach. We have previously reported on the role of dose intensity in a group of 112 patients (pts) with AML/MDS given SCT with different regimens between 1999 and 2004 (ASH 2004, Leukemia 2005). We showed that overall survival (OS) was similar with MAC and RIC in pts given SCT in remission, but was inferior in pts given RIC in active disease due to high post SCT relapse rates. We have now updated SCT outcomes in the same cohort with a median follow up of 10 years (range, 8.5-12.5) in order to better predict long-term outcome and confirm whether late events may have changed the initial conclusions. The median age at SCT was 50 years (18–70). Eighty-five pts had AML and 17 had MDS (IPSS int2 or high). Fifty-eight had active disease at SCT (>10% marrow blasts) and 54 were in remission. The donor was HLA-matched sibling (n=58), 1-Ag mismatched related (n=6) or matched-unrelated (n=48). Twenty-nine pts (26%) had poor risk cytogenetics. Forty-five pts met eligibility criteria for standard MAC and were given intravenous-busulfan (ivBu, 12.8 mg/kg) and cyclophosphamide (BuCy). Sixty-seven pts were considered non-eligible for standard MAC due to advanced age, extensive prior therapy, organ dysfunction or poor performance status. These pts were given RIC with fludarabine and ivBu (6.4 mg/kg, FB2, n=41) or reduced toxicity conditioning (RTC) with fludarabine and myeloablative doses of ivBu (12.8 mg/kg, FB4, n=26). The median age of RIC/RTC and MAC recipients was 55 and 42 years, respectively (p=0.001) and a larger proportion of RIC/RTC recipients had unrelated donors (p=0.01). In all, 38 pts are alive and 74 have died, 48 relapse, 26 non-relapse mortality (NRM). Overall survival (OS) at 10 years was 44% and 31% after MAC and RIC/RTC, respectively (p=0.22). Active disease at SCT and poor-risk cytogenetics were the most significant factors predicting reduced OS in multivariable analysis, HR 2.0 (p=0.05) and 2.7 (p=0.003), respectively. Advanced age, secondary disease, donor and conditioning type had no prognostic significance. MAC and RIC/RTC had similar outcomes when leukemia was in remission at SCT; 10-year OS been 47%, 50% and 47% after BuCy, FB4, and FB2, respectively (p=0.97). OS rates of pts with active disease at SCT was 43%, 19% and 0%, respectively (p=0.01) suggesting an advantage for more intense regimens in this setting. Relapse rates were higher after RIC/RTC than MAC throughout the follow-up period. The rate was 30% and 18%, 1 year after SCT (p=0.03), 37% and 20% after 2 years (p=0.08), 49% and 27% after 5 years (p=0.02) and 51% and 29% after 10 years (p=0.02), respectively. NRM rates were higher after MAC than RIC/RTC in the initial 2 years after SCT but approached each other in the late post SCT course. NRM rate was 22% and 9%, 1 year after SCT (p=0.05), 22 and 10% after 2 years (p=0.08), 22% and 15% after 5 years (p=0.27), and 27% and 19% after 10 years (p=0.35), respectively. Thus, OS was similar within the first 2 years after SCT, 56% and 52% after MAC and RIC/RTC, respectively (p=0.86), but there was a trend for better OS after MAC later on, 51% and 36%, 5 years after SCT (p=0.26) and 44% and 31%, 10 years after SCT (p=0.22), respectively. Forty-seven pts were alive 5 years after SCT (42%). Nine of them died later on. Four of 24 RIC/RTC survivors at this point later died, 3 of second malignancies, 1 of relapse. Five of 23 MAC survivors at 5 years later died, 2 of relapse, 2 of chronic GVHD, 1 of MI. For pts surviving 5 years after SCT, the expected OS for the next 5 years was 86% and 87%, respectively (p=0.76). In conclusion, with a long-term follow-up of more than 10 years, RIC/RTC is an acceptable alternative to MAC in ineligible pts. NRM is lower after RIC/RTC in the early post SCT period, but late NRM negates this early advantage. Relapse rates are higher after RIC/RTC throughout the course. Due to these observations, it seems an advantage of MAC may become apparent 5-10 years after SCT. Pts who are alive 5 years after SCT can expect similarly good further OS with both approaches. Long-term follow-up studies (beyond 10 years) are of significant importance when assessing SCT outcomes in general and RTC SCT in particular. Disclosures: No relevant conflicts of interest to declare.

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