Body composition measurements and overall survival in patients with resectable pancreatic adenocarcinoma receiving neoadjuvant chemotherapy: Analysis from SWOG S1505.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4131-4131
Author(s):  
Davendra Sohal ◽  
Mai T. Duong ◽  
Robert Boutin ◽  
Leon Lenchik ◽  
Jiyoon Kim ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Body Composition ◽  
Adipose Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Prospective Trial ◽  
Sarcopenic Obesity ◽  
Significant Difference ◽  
Tissue Area ◽  
The Impact

4131 Background: Sarcopenia and sarcopenic obesity have been associated with overall survival (OS) in patients (pts) with borderline resectable and advanced pancreatic ductal adenocarcinoma (PDA), but little is known about the effect of body composition on OS in pts with resectable PDA. We examined the relationship between skeletal muscle and adipose tissue measurements on baseline computed tomography (CT) and OS of pts with resectable PDA in a secondary analysis of SWOG S1505 (NCT02562716). Methods: SWOG S1505 enrolled pts with resectable PDA who were randomized to receive neoadjuvant FOLFIRINOX or gemcitabine-nab paclitaxel, followed by surgical resection. Baseline axial CT images at the L3 level were analyzed with externally validated software and measurements were recorded for skeletal muscle area (SMA), density (SMD) and index (SMI); visceral adipose tissue area (VATA) and density (VATD); and subcutaneous adipose tissue area (SATA) and density (SATD). Sarcopenia was defined as SMI < 52 cm2/m2 for men and < 39 cm2/m2 for women; sarcopenic obesity was defined as sarcopenia and a body mass index (BMI) >30 kg/m2. The relationships between CT metrics and OS were analyzed using Cox regression models, with 95% CI. Statistical significance was defined as p < 0.05. Results: Of 98 pts with available baseline abdominal CT, 8 were excluded for scan quality, resulting in 90 evaluable cases: 51 men (57%), 39 women (43%); mean age, 63.2 years, SD 8.5; mean BMI, 29.3 kg/m2, SD 6.4; 80 (89%) White, 6 (7%) Black, and 4 (4%) unknown. Sarcopenia was present in 32 (36%) and sarcopenic obesity in 10 (11%) patients. Univariable analyses for the variables of interest indicated VATA (HR 1.24; 0.97-1.60; p = 0.09) and SMD (HR 0.75; 0.57-0.98; p = 0.04) were associated with OS. Analyses adjusted for sex, race, age, BMI, performance score, contrast use, sarcopenia, and sarcopenic obesity showed VATA was associated with OS (HR 1.58; 1.0-2.51; p = 0.05). No significant difference in median OS was observed between pts with vs. without sarcopenia (OS 23.6 [19.3-NA] vs. 27.9 months [18.6-NA], respectively). Pts with vs. without sarcopenic obesity had lower median OS: 18.6 (14.7-NA) vs. 25.1 (10.5-46.0) months, respectively, but this difference was not statistically significant (HR 1.90, 95%CI 0.81-4.47, p = 0.14). Conclusions: This is one of the first studies to systematically evaluate body composition parameters in a prospective trial of patients with resectable PDA who received neoadjuvant chemotherapy. We found that visceral fat (VATA) is a prognostic marker in this population, but that sarcopenia may not be predictive in early PDA. Further studies to define the impact of longitudinal changes in body composition on individual outcomes may provide greater precision in predicting OS for subsets of pts with pancreatic cancer. Clinical trial information: NCT02562716.

P7 THE IMPACT OF PREHABILITATION ON PARAMETERS OF BODY COMPOSITION IN PATIENTS UNDERGOING MULTIMODAL THERAPY FOR OESOPHAGO-GASTRIC (OG) CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Doganay Emre ◽  
R Boshier Piers ◽  
J Halliday Laura ◽  
Thomas Rob ◽  
E Low Donald ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Neoadjuvant Therapy ◽  
Physical Performance ◽  
Skeletal Muscle Index ◽  
Significant Difference ◽  
Axial Ct ◽  
Gastric Cancer Patients ◽  
Subcutaneous Adipose ◽  
The Impact

Abstract Aims This study characterises changes in body composition and physical performance during neoadjuvant therapy in the context of prehabilitation before oesophago-gastric resection. Background & Methods Neoadjuvant therapy has deleterious effects on functional capacity and may lead to a decline in physical fitness and skeletal muscle mass. This is a retrospective review of oesophago-gastric cancer patients undergoing prehabilitation. Assessment of body composition (skeletal muscle, visceral and subcutaneous adipose tissue) was performed from L3 axial CT images acquired at the time of diagnosis and after neoadjuvant therapy. Results 42 patients (33M, 65.7±11.1) met the inclusion criteria. Patients body weight (81.8±21.3 kg vs. 81.3±21 kg, p=0.668) and BMI (27.9±7.2 kg/m2 vs. 27.8±7.0 kg/m2, p=0.648) did not change significantly between the study time points. There was no significant difference between estimated lean body mass (39.2±13.2 vs. 38.3±10.1; 95%CI -2.5 to 4.3 p=0.592) and fat mass (30.6±15.4 vs. 28.6±14.0; 95%CI -1.7 to 5.7, p=0.284). Skeletal muscle index significantly decreased (46.5±9.9 to 43.1±9.8; 95%CI 2.1 to 4.6, p<0.001). Patients who were adherent to the prehabilitation programme had a significantly higher skeletal muscle index compared to noncompliant patients (47.4±10.4 vs. 40.2±8.9; 95%CI 1.5 to 13.5, p=0.016). Patients who achieved a higher MET-minutes were less likely to be sarcopenic (F(1,40 = 6.1, p = 0.018)).There was no decline in physical performance (Median IQR; VO2max ml kg−1min−1) during neoadjuvant therapy (17.5 [14-19.3] vs. 17.5 [13.3-19.3]; p=0.164). Conclusion this is the first study to report variations in parameters of body composition in patients undergoing a prehabilitation programme. Findings suggest that prehabilitation may be a useful adjunct in limiting the extent of sarcopenia and patient deconditioning during neoadjuvant therapy.

Associations between baseline body composition and cancer-specific mortality following neoadjuvant chemotherapy and radical cystectomy for bladder cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17015-e17015
Author(s):  
Leonidas Nikolaos Diamantopoulos ◽  
Steven Ngo ◽  
Reno Maldonado ◽  
Ryan Blair O'Malley ◽  
Grace Laidlaw ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Bladder Cancer ◽  
Body Composition ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Cross Sectional ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Total Body ◽  
The Impact

e17015 Background: Sarcopenia is a modifiable risk factor independently associated with cancer-specific mortality (CSM) in bladder cancer (BC). Sarcopenic obesity, where obesity is measured by fat mass index [FMI, total body fat (kg)/height(m)2], has been proposed as an additive insult. To date, studies have overwhelmingly been performed in patients treated without neoadjuvant chemotherapy (NAC). Herein, we evaluate associations between baseline skeletal muscle index (SMI), FMI, and CSM in patients treated with NAC and radical cystectomy (RC). Methods: Lumbar SMI (cross sectional area of skeletal muscle/height2, cm2/m2) was measured on a computed tomography (CT) image at the level of the third lumbar vertebral body, within 60 days prior to NAC. Total body FMI was calculated from visceral and subcutaneous fat cross-sectional areas. Patients were classified as being sarcopenic, according to sex-specific consensus definitions: Male: SMI < 55, Female: SMI < 39, and as obese if Male: FMI > 9, Female: > 13. Cancer-specific survival (CSS) was estimated using the Kaplan Meier method. Associations with CSM were summarized with multivariable Cox proportional hazards models. Results: 143 patients had CT scans of sufficient quality (2005-18). There were no significant differences in clinicopathologic characteristics between the study cohort and patients without available imaging (N = 261). Cisplatin-based NAC was given to 125 patients (87%), and 18 (13%) received other regimens. In total, 86 (60%) patients were sarcopenic, 52 (36%) obese, and 25 (17%) both sarcopenic and obese, while 48 (34%) were sarcopenic with normal FMI. Median follow-up was 2.7 years (IQR 1.2-6.2), and 43 patients died from BC. Three-year CSS was 61% (sarcopenic) vs. 77% (p < 0.05). Sarcopenic patients with normal FMI had the worst 3-year CSS (55%) compared to those with sarcopenia and FMI-obesity (79%), normal SMI with FMI-obesity (69%), and normal body composition (88%, p = 0.03). On multivariable analysis, neither FMI (HR: 0.77, 95% CI: 0.47-1.3, p = 0.3) nor SMI was independently associated with CSM (HR: 0.98, 95% CI: 0.96-1, p = 0.07) after adjustment for ASA score, pathologic tumor, and nodal stage. Conclusions: In patients treated with NAC+RC, pretreatment SMI trended towards independently predicting risk of CSM. Patients with sarcopenia and normal fat demonstrated the worst CSS. Further study is warranted on the impact of NAC on body composition and the role of the latter in risk stratification of this high-risk patient population.

scholarly journals Impact of body composition on outcomes from anti-PD1 +/− anti-CTLA-4 treatment in melanoma

2020 ◽  
Vol 8 (2) ◽  
pp. e000821
Author(s):  
Arissa C Young ◽  
Henry T Quach ◽  
Haocan Song ◽  
Elizabeth J Davis ◽  
Javid J Moslehi ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Checkpoint Inhibitors ◽  
Lumbar Vertebrae ◽  
Composition Analysis ◽  
Muscle Area ◽  
Skeletal Muscle Index ◽  
Body Composition Analysis ◽  
Tissue Area

BackgroundImmune checkpoint inhibitors (ICIs) have transformed treatment for melanoma, but identifying reliable biomarkers of response and effective modifiable lifestyle factors has been challenging. Obesity has been correlated with improved responses to ICI, although the association of body composition measures (muscle, fat, etc) with outcomes remains unknown.MethodsWe performed body composition analysis using Slice-o-matic software on pretreatment CT scans to quantify skeletal muscle index (SMI=skeletal muscle area/height2), skeletal muscle density (SMD), skeletal muscle gauge (SMG=SMI × SMD), and total adipose tissue index (TATI=subcutaneous adipose tissue area + visceral adipose tissue area/height2) of each patient at the third lumbar vertebrae. We then correlated these measures to response, progression-free survival (PFS), overall survival (OS), and toxicity.ResultsAmong 287 patients treated with ICI, body mass index was not associated with clinical benefit or toxicity. In univariable analyses, patients with sarcopenic obesity had inferior PFS (HR 1.4, p=0.04). On multivariable analyses, high TATI was associated with inferior PFS (HR 1.7, p=0.04), which was particularly strong in women (HR 2.1, p=0.03). Patients with intermediate TATI and high SMG had the best outcomes, whereas those with low SMG/high TATI had inferior PFS and OS (p=0.02 for both PFS and OS).ConclusionsBody composition analysis identified several features that correlated with improved clinical outcomes, although the associations were modest. As with other studies, we identified sex-specific associations that warrant further study.

scholarly journals Two years later – changes in abdominal organs: First observations from the UK Biobank longitudinal imaging study

2021 ◽  
Author(s):  
Brandon Whitcher ◽  
Marjola Thanaj ◽  
Madeleine Cule ◽  
Yi Liu ◽  
Nicolas Basty ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Waist Circumference ◽  
Imaging Study ◽  
Iliopsoas Muscle ◽  
Uk Biobank ◽  
Short Period ◽  
The Uk ◽  
The Impact

Longitudinal studies provide unique insights into the impact of environmental factors and lifespan issues on health and disease. Here we investigate changes in body composition in 3,088 free-living participants, part of the UK Biobank in-depth imaging study. All participants underwent neck-to-knee MRI scans at baseline and after approximately two years (re-imaging). Image-derived phenotypes for each participant were extracted using a fully-automated image processing pipeline, including volumes of several tissues and organs: liver, pancreas, spleen, kidneys, total skeletal muscle, iliopsoas muscle, visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), as well as fat and iron content in liver, pancreas and spleen. Overall, no significant changes were observed in BMI, body weight, or waist circumference over the scanning interval, despite some large individual changes. A significant decrease in grip strength was observed, coupled to small, but statistically significant, decrease in all skeletal muscle measurements. Significant increases in VAT and intermuscular fat in the thighs were also detected in the absence of changes in BMI, waist circumference and ectopic-fat deposition. Adjusting for disease status at baseline did not have an additional impact on the changes observed. In summary, we show that even after a relatively short period of time significant changes in body composition can take place, probably reflecting the obesogenic environment currently inhabited by most of the general population in the United Kingdom.

Sarcopenia and Adipopenia Are Independent Prognostic Factors in Patients with Acute Myeloid Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4953-4953
Author(s):  
Nobuhiko Nakamura ◽  
Yuhei Shibata ◽  
Takuro Matsumoto ◽  
Hiroshi Nakamura ◽  
Junichi Kitagawa ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Adipose Tissue ◽  
Prognostic Factors ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
Ct Images ◽  
The Impact ◽  
Acute Myeloid

Abstract Background: The response to treatment and overall survival of patients with acute myeloid leukemia (AML) are heterogeneous. A number of prognostic factors related to patient and tumor characteristics have been described for AML, including age, performance status, and karyotype. The depletion of skeletal muscle (sarcopenia) and adipose tissue (adipopenia) are known to be associated with unfavorable prognosis in patients with some malignant diseases including lymphoma. Here, we studied the impact of sarcopenia and adipopenia on clinical outcomes of adult AML. Patients and Methods: We retrospectively analyzed 70 patients with adult AML (age ≥ 18 years) who received chemotherapy at Gifu University Hospital between December 2004 and September 2014. Skeletal muscle and adipose tissue were measured by the analysis of CT images at the L3 level before treatment. CT images were analyzed using SliceOMatic version 4.3 software (TomoVision, Montreal, QB, Canada), which enables specific tissue demarcation using previously reported Hounsfield unit (HU) thresholds. The CT HU thresholds were -29 to 150 for skeletal muscles and -190 to -30 and -50 to -150 for subcutaneous and visceral adipose tissue, respectively. These values were normalized for stature in order to calculate skeletal muscle index (SMI, cm2/m2) and adipose tissue index (ATI, cm2/m2). Results: Median age at diagnosis was 57 years (18-84 years), with 37 males and 33 females. SMI was significantly higher in male than female patients (P &lt; 0.001). ATI was significantly higher in patients aged 60 years and over than in those under 60 years (P &lt; 0.05). The sex-specific cut-offs for the SMI and ATI were determined by ROC curve analysis. Thirty-five (50%) and 31 (44%) patients were defined as sarcopenia and adipopenia, respectively. Sarcopenia and adipopenia did not significantly differ among various FAB subtypes or cytogenetic risk profiles. The rate of patients with poor performance status (ECOG ≥ 2) was significantly higher in the sarcopenic group (80% vs 45%, P &lt; 0.05), whereas not in the adipopenic group (40% vs 47%). With a median follow-up of 33.5 months, the 3-year overall survival (OS) in the sarcopeniac group was 34% compared with 74% in the non-sarcopenic group (P &lt; 0.001, Figure 1A) and 32% in the adipopenic group compared with 72% in the non-adipopenic group (P &lt; 0.005, Figure 1B). In a multivariate analysis, sarcopenia (HR = 2.84, CI = 1.08-8.08, P &lt; 0.05) and adipopenia (HR = 2.85, CI = 1.19-7.24, P &lt; 0.05) remained predictive of OS. Conclusion: Sarcopenia and adipopenia are independent prognostic factors in patients with AML. Evaluation of skeletal muscle and adipose tissue depletion by CT imaging is a useful objective tool to predict patient outcomes, but a larger prospective study is needed to confirm this effect. Figure 1. Overall survival according to sarcopenic (A) and adipopenic (B) status. Figure 1. Overall survival according to sarcopenic (A) and adipopenic (B) status. Disclosures No relevant conflicts of interest to declare.

Impact of body composition on outcomes from anti-programmed death-1 (PD-1) treatment.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9516-9516 ◽  
Author(s):  
Arissa Young ◽  
Henry T. Quach ◽  
Elizabeth J. Davis ◽  
Javid Moslehi ◽  
Grant R. Williams ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Favorable Effect ◽  
High Fat ◽  
Muscle Area ◽  
Skeletal Muscle Index ◽  
Pre Treatment ◽  
Skeletal Muscle Area ◽  
The Impact

9516 Background: Obesity is associated with improved outcomes in melanoma patients (pts) treated with PD-1, whereas low muscle mass, known as sarcopenia, has been associated with poor outcomes in many cancers. We sought to assess the impact of body composition on PD-1 outcomes. Methods: We analyzed pre-treatment CT scans at the L3 slice using Slice-o-matic software (Tomovision V. 5.0) to determine skeletal muscle, visceral adipose, and subcutaneous adipose tissue parameters for 104 pts with metastatic melanoma who received PD-1 monotherapy. We assessed sarcopenia using skeletal muscle index (SMI=skeletal muscle area/m2). We also quantified total adipose tissue index (TATI), and skeletal muscle gauge (SMG = SMI x skeletal muscle density [SMD]). We stratified pts into high/low groups using previously published cutoffs and assessed toxicity (tox), progression-free and overall survival (PFS/OS), and response rate (RR) by group. Results: Sarcopenia (low SMI) was negatively associated with any tox (39% vs. 60%, p=0.04) but not OS, PFS, or RR. Adiposity (TATI) was not associated with outcomes. By contrast, SMG was significantly associated with OS (median 35.5 vs. 16.0m, p=0.01 for high vs. low SMG). Interestingly, when incorporating TATI with SMG, we found that high SMG/high TATI pts (high muscle/high fat) have superior clinical outcomes (Table). Notably, low SMG/high TATI pts (low muscle/high fat) had seemingly the worst outcomes. Conclusions: We found that high SMG, a measure incorporating muscle area and density, was associated with improved OS in PD1 treated pts. Further, pts with high adiposity and high SMG had superior outcomes, potentially identifying the population responsible for the favorable effect of obesity in these pts. Validation and combination treated cohorts will be presented. [Table: see text]

scholarly journals Computed Tomography–Based Body Composition in Patients With Ovarian Cancer: Association With Chemotoxicity and Prognosis

2021 ◽  
Vol 11 ◽  
Author(s):  
Maria Del Grande ◽  
Stefania Rizzo ◽  
Gabriele Maria Nicolino ◽  
Ilaria Colombo ◽  
Lorenzo Rossi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ovarian Cancer ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Dose Reduction ◽  
Wilcoxon Test ◽  
Early Discontinuation ◽  
Before And After

PurposeTo assess the association between computed tomography (CT)-derived quantitative measures of body composition profiling and chemotherapy-related complications, in terms of dose reduction, premature discontinuation of chemotherapy, and cycle delays in patients with ovarian cancer. Secondary purposes were to evaluate associations between sarcopenia and survival, and to evaluate differences in body composition profiling at baseline and after neoadjuvant chemotherapy.Materials and MethodsThe study population was retrospectively selected from a database of patients with newly diagnosed ovarian cancer (any stage) referred to our Institution between Feb 2011 and Mar 2020. Clinical data were recorded, and CT images at the level of the 3rd lumbar vertebra were stored. By using specific software, skeletal muscle area (SMA), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle density (SMD) were extracted. Skeletal muscle index (SMI) was then calculated. Statistical analysis was performed by logistic regression models to identify body composition features predictive of dose reduction, premature end of chemotherapy, and cycle delays. Kaplan-Meier analyses were performed to assess overall survival (OS) and progression-free survival (PFS). The log-rank test was used to determine differences in OS and PFS between sarcopenic and non-sarcopenic patients. Wilcoxon test was performed to compare body composition features before and after neoadjuvant chemotherapy (NACT).ResultsSixty-nine patients were included. A significant association was found between VAT and cycle delays (OR = 1.01, z = 2.01, 95% CI: 1.00–1.02, p &lt; 0.05), between SMA and early discontinuation of chemotherapy (OR = 1.03, z = 2.10, 95% CI: 1.00–1.05, p &lt; 0.05), and between mean SMD and cycle delays (OR = 0.92, z = −2.70, 95%CI: 0.87–0.98, p &lt; 0.01). No significant difference emerged for OS in sarcopenic and non-sarcopenic patients, nor in CT body composition features before and after NACT.ConclusionsIn ovarian cancer patients, CT-derived body composition profiling might predict the risk of chemotoxicity. In particular, VAT and SMD are associated with chemotherapy cycle delays, and SMA with early discontinuation of chemotherapy.

scholarly journals Deep Learning-Based Body Composition Analysis Predicts Outcome in Melanoma Patients Treated with Immune Checkpoint Inhibitors

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2314
Author(s):  
Anton Faron ◽  
Nikola S. Opheys ◽  
Sebastian Nowak ◽  
Alois M. Sprinkart ◽  
Alexander Isaak ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Deep Learning ◽  
Immune Checkpoint ◽  
Composition Analysis ◽  
Skeletal Muscle Index ◽  
Checkpoint Inhibitor Therapy ◽  
Tissue Compartments ◽  
The Impact

Previous studies suggest an impact of body composition on outcome in melanoma patients. We aimed to determine the prognostic value of CT-based body composition assessment in patients receiving immune checkpoint inhibitor therapy for treatment of metastatic disease using a deep learning approach. One hundred seven patients with staging CT examinations prior to initiation of checkpoint inhibition between January 2013 and August 2019 were retrospectively evaluated. Using an automated deep learning-based body composition analysis pipeline, parameters for estimation of skeletal muscle mass (skeletal muscle index, SMI) and adipose tissue compartments (visceral adipose tissue index, VAI; subcutaneous adipose tissue index, SAI) were derived from staging CT. The cohort was binarized according to gender-specific median cut-off values. Patients below the median were defined as having low SMI, VAI, or SAI, respectively. The impact on outcome was assessed using the Kaplan–Meier method with log-rank tests. A multivariable logistic regression model was built to test the impact of body composition parameters on 3-year mortality. Patients with low SMI displayed significantly increased 1-year (25% versus 9%, p = 0.035), 2-year (32% versus 13%, p = 0.017), and 3-year mortality (38% versus 19%, p = 0.016). No significant differences with regard to adipose tissue compartments were observed (3-year mortality: VAI, p = 0.448; SAI, p = 0.731). On multivariable analysis, low SMI (hazard ratio (HR), 2.245; 95% confidence interval (CI), 1.005–5.017; p = 0.049), neutrophil-to-lymphocyte ratio (HR, 1.170; 95% CI, 1.076–1.273; p < 0.001), and Karnofsky index (HR, 0.965; 95% CI, 0.945–0.985; p = 0.001) remained as significant predictors of 3-year mortality. Lowered skeletal muscle index as an indicator of sarcopenia was associated with worse outcome in patients with metastatic melanoma receiving immune checkpoint inhibitor therapy.

scholarly journals Impact of insurance status on overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

2020 ◽  
Vol 5 (3) ◽  
Author(s):  
Ravi J. Chokshi ◽  
Jin K. Kim ◽  
Jimmy Patel ◽  
Joseph B. Oliver ◽  
Omar Mahmoud
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Abdominal Wall ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Safety Net ◽  
Insurance Status ◽  
Gynecologic Malignancies ◽  
Safety Net Hospital ◽  
The Impact

AbstractObjectivesThe impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood.MethodsRetrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS).ResultsA total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group.ConclusionsIn this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.

scholarly journals Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

2021 ◽  
Vol 10 (2) ◽  
pp. 334
Author(s):  
Stephanie Seidler ◽  
Meriem Koual ◽  
Guillaume Achen ◽  
Enrica Bentivegna ◽  
Laure Fournier ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Lymph Node Dissection ◽  
Prospective Trial ◽  
Node Dissection ◽  
Advanced Epithelial Ovarian Cancer ◽  
The Impact ◽  
Systematic Lymph Node Dissection

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.

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