The Assessment of Risk Factors for Long-term Survival Outcome in ypN0 Patients With Rectal Cancer After Neoadjuvant Therapy and Radical Anterior Resection

2021 ◽  
Author(s):  
Marcin Zeman ◽  
Marek Czarnecki ◽  
Ewa Chmielik ◽  
Adam Idasiak ◽  
Władysław Skałba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Negative Impact ◽  
Oncologic Outcomes ◽  
Clinicopathological Factors ◽  
Significant Negative Impact ◽  
The Impact

Abstract Background: The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, perineural invasion, the mucinous component of the tumor and poor differentiation. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior rectal resection.Methods: A retrospective survival analysis was performed on a group of 195 patients treated between 2008 and 2016. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL).Results: In the univariate analysis, AL and CCI> 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI> 3 was a significant adverse risk factor for DFS (HR:5.78, 95%CI:2.15-15.51, p<0.001), DSS (HR:7.25, 95%CI:2.25-23.39, p<0.001), and OS (HR:3.9, 95%CI:1.72-8.85, p=0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR:5.05, 95%CI:1.97-12.93, p<0.001), DSS (HR:10.84, 95%CI:3.44-34.18, p<0.001) and OS (HR:4.3, 95%CI:1.94-9.53, p<0.001).Conclusions: Late AL and CCI> 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.

scholarly journals The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marcin Zeman ◽  
Marek Czarnecki ◽  
Ewa Chmielik ◽  
Adam Idasiak ◽  
Władysław Skałba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Anterior Resection ◽  
Negative Impact ◽  
Oncologic Outcomes ◽  
Clinicopathological Factors ◽  
Significant Negative Impact

Abstract Background The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, and perineural invasion. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior resection. Methods A retrospective survival analysis was performed on a group of 195 patients. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL). Results In the univariate analysis, AL and CCI > 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI > 3 was a significant adverse risk factor for DFS (HR 5.78, 95% CI 2.15–15.51, p < 0.001), DSS (HR 7.25, 95% CI 2.25–23.39, p < 0.001), and OS (HR 3.9, 95% CI 1.72–8.85, p = 0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR 5.05, 95% CI 1.97–12.93, p < 0.001), DSS (HR 10.84, 95% CI 3.44–34.18, p < 0.001), and OS (HR 4.3, 95% CI 1.94–9.53, p < 0.001). Conclusions Late AL and CCI > 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.

scholarly journals Oncologic outcomes after resection of para-aortic lymph node metastasis in left-sided colon and rectal cancer

2020 ◽  
Author(s):  
Junichi Sakamoto ◽  
Heita Ozawa ◽  
Hiroki Nakanishi ◽  
Shin Fujita
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Management Strategy ◽  
Clinicopathological Characteristics ◽  
Oncologic Outcomes ◽  
Free Survival ◽  
Colon And Rectal Cancer ◽  
Aortic Lymph Node ◽  
Synchronous Resection

Abstract Background The optimal surgical management strategy for para-aortic lymph node (PALN) metastasis has not attracted as much attention as surgery for liver or lung metastasis. The purpose of this retrospective study was to evaluate the oncologic outcomes after synchronous resection of PALN metastasis in left-sided colon and rectal cancer.Methods Between January 1986 and August 2016, 29 patients with pathologically positive PALN metastasis who underwent curative resection at our hospital were retrospectively reviewed. We examined clinicopathological characteristics, long-term oncologic outcomes, and factors related to favorable prognosis in patients with PALN metastasis.Results The 3-year overall survival and recurrence-free survival (RFS) rates were 50.5% and 17.2%, respectively. Six (20.7%) patients experienced no recurrence in the three years after surgery. Postoperative complications were seen in nine (31.0%) patients. The three-year RFS rate was significantly better in the pM1a group than in the pM1b/pM1c group (26.3% and 0.0%, respectively, p = 0.032).Conclusions PALN dissection for left-sided colon or rectal cancer with synchronous PALN metastasis can be a feasible treatment option in selected patients.

scholarly journals Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients With Resectable Rectal Cancer: A Meta-Analysis

2021 ◽  
Author(s):  
Xinlong Li ◽  
Xiangyuan Li ◽  
Rongrong Fu ◽  
Derry Minyao Ng ◽  
Tong Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Term Survival ◽  
Resectable Rectal Cancer ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background: The impact of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer is controversial. This study aimed to explore the effect of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer. Methods: Four major databases (PubMed, Web of Science, Embase, Cochrane library) were searched to find relevant articles published between January 2000 and July 2020. The main outcome indicators were the 5-year overall survival (OS) and disease-free survival (DFS). Results: Compared with upfront surgery, our meta-analysis showed that 5-year OS (HR: 0.84, 95% Cl: 0.78-0.91) and DFS (HR: 0.91, 95% Cl: 0.87-0.95) were prolonged for patients with resectable rectal cancer after receiving neoadjuvant therapy. The results of subgroup analysis suggested that both neoadjuvant short-course radiotherapy (SCRT) and neoadjuvant chemo-radiotherapy (CRT) could improve the 5-year OS and DFS. The 5-year OS and DFS of patients with stage Ⅱ-Ⅲ rectal cancer increased significantly and the improvement of 5-year OS and DFS could also be observed in mid/low rectal cancer.Conclusion: Neoadjuvant therapy could improve the long-term survival of patients with mid/low rectal cancer in stage Ⅱ-Ⅲ. For the treatment, neoadjuvant SCRT and neoadjuvant CRT were recommended.

scholarly journals Impact of Capital Structure on Firm’s Performance: Focusing on Non-financial Listed Egyptian Firms

2019 ◽  
Vol 10 (6) ◽  
pp. 78 ◽  
Author(s):  
Ahmed Sakr ◽  
Amina Bedeir
Keyword(s):  
Capital Structure ◽  
Negative Impact ◽  
Short Term ◽  
Total Debt ◽  
Significant Negative Impact ◽  
Two Measures ◽  
Independent Variable ◽  
Measure Of Performance ◽  
The Impact

The purpose of this paper is to investigate the impact of capital structure decisions on the performance of the firm. The investigation has been performed using a data of 62 listed non-financial Egyptian firms over a period of fourteen years from 2003-2016. This study used two measures for performance the dependent variable which are ROA and ROE, the most common used measures agreed upon on the majority of previous studies. Whereas, for the independent variable “the capital structure, the study uses the three measures of capital structure which are total debt to total assets (TD), total short-term debt to total assets (STD), and total long-term debt to total assets (LTD). The results showed when using ROA as a measure of performance, a significant negative impact of capital structure (TD, STD, and LTD) exists; while in case of using ROE as a measure of performance, there’s a significant negative impact of capital structure only when using STD, otherwise a positive significant impact of capital structure exist.

Risk factors related to lymph node metastases after neoadjuvant therapy for locally advanced rectal cancer

2009 ◽  
Vol 28 (9) ◽  
pp. 923-927
Author(s):  
Zhi-Fan Zeng ◽  
Pei-Rong Ding ◽  
Zhi-Zhong Pan ◽  
Jun-Zhong Lin ◽  
Li-Ren Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Lymph Node Metastases ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Node Metastases

scholarly journals Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients with Resectable Rectal Cancer: a Meta-Analysis

2021 ◽  
Author(s):  
Xinlong Li ◽  
Xiangyuan Li ◽  
Rongrong Fu ◽  
Derry Minyao Ng ◽  
Tong Yang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Meta Analysis ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Term Survival ◽  
Resectable Rectal Cancer ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background: The impact of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer is controversial. This study aimed to explore the effect of neoadjuvant therapy on the long-term prognosis of patients with resectable rectal cancer. Methods: Four major databases (PubMed, Web of Science, Embase, Cochrane library) were searched to find relevant articles published between January 2000 and July 2020. The main outcome indicators were the 5-year overall survival (OS) and disease-free survival (DFS). Results: Compared with upfront surgery, our meta-analysis showed that 5-year OS (HR: 0.84, 95% Cl: 0.78-0.91) and DFS (HR: 0.91, 95% Cl: 0.87-0.95) were prolonged for patients with resectable rectal cancer after receiving neoadjuvant therapy. The results of subgroup analysis suggested that both neoadjuvant short-course radiotherapy (SCRT) and neoadjuvant chemo-radiotherapy (CRT) could improve the 5-year OS and DFS. The 5-year OS and DFS of patients with stage Ⅱ-Ⅲ rectal cancer increased significantly and the improvement of 5-year OS and DFS could also be observed in mid/low rectal cancer.Conclusion: Neoadjuvant therapy could improve the long-term survival of patients with mid/low rectal cancer in stage Ⅱ-Ⅲ. For the treatment, neoadjuvant SCRT and neoadjuvant CRT were recommended.

scholarly journals Worse outcomes after conversion of thoracoscopic lobectomy for lung cancer

2020 ◽  
Author(s):  
Piotr Gabryel ◽  
Cezary Piwkowski ◽  
Mariusz Kasprzyk ◽  
Paweł Zieliński ◽  
Magdalena Roszak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Long Term Outcomes ◽  
Short Term ◽  
Thoracoscopic Lobectomy ◽  
Node Metastases ◽  
The Impact

Abstract OBJECTIVES Conversion of thoracoscopic lobectomy for lung cancer to thoracotomy can adversely affect short-term outcomes, but the impact on long-term outcomes is unknown. This study aimed to identify the risk factors for conversion and to determine the influence of conversion on the outcomes of lung cancer treatment. METHODS This retrospective study included 1002 consecutive patients with lung cancer who underwent thoracoscopic lobectomy between 7 June 1999 and 17 July 2018. The groups of patients with and without conversion were compared in terms of possible risk factors and the short- and long-term outcomes. The survival of patients was analysed by the Kaplan–Meier method. RESULTS Conversion was done in 105 patients (10.5%). On multivariable logistic regression analysis, the independent risk factors for conversion were pleural adhesions (P &lt; 0.001) and mediastinal lymph node metastases (P &lt; 0.001). Compared with the non-conversion group, the conversion group had longer chest drainage time (4 vs 3 days, P &lt; 0.001) and hospital stay (8 vs 6 days, P &lt; 0.001); more frequent complications (38.1% vs 27.1%, P = 0.018), including red blood cell transfusion (10.5% vs 2%, P &lt; 0.001) and supraventricular arrhythmia (13.3% vs 7.5%, P = 0.037); and lower 5-year survival rate in patients with stage I lung cancer (70% vs 87%, P = 0.014). Conversion did not increase in-hospital mortality. CONCLUSIONS Pleural adhesions and lymph node metastases increased the probability of conversion to thoracotomy. Conversion adversely affected the short-term outcomes of thoracoscopic lobectomy. Long-term outcomes of treatment of non-small-cell lung cancer could be worse in patients after conversion, but definitive conclusions cannot be made in this regard because of the absence of control of selection bias.

Long-term oncologic outcomes following neoadjuvant therapy and transanal excision of T2 or T3 rectal cancer

2020 ◽  
Author(s):  
Sidrah Khan ◽  
Jesse Guardado ◽  
Brandon Mahler ◽  
Javier Salgado ◽  
James Celebrezze ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Transanal Excision ◽  
Oncologic Outcomes ◽  
T3 Rectal Cancer

scholarly journals Risk Factors For Long-Term Survival in Patients With ypN+M0 Rectal Cancer After Radical Anterior Resection

2021 ◽  
Author(s):  
Marcin Zeman ◽  
Władysław Skałba ◽  
Piotr Szymański ◽  
Grzegorz Hadasik ◽  
Dmytro Żaworonkow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Anterior Resection ◽  
Term Survival ◽  
Factors Affecting ◽  
Long Term Treatment ◽  
Multiple Factor

Abstract Background: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN+M0 patients.The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN+M0 patients after radical rectal anterior resection.Methods: 112 patients with ypN+M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.Results: In the multiple factor Cox analysis, adverse factors affecting OS were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (HR: 3.059, 95% CI: 1.349-6.934, p= 0.007) and past <=3 cycles of adjuvant chemotherapy (HR: 2.833, 95% CI: 1.289-6.229, p= 0.01). For DFS, significant adverse factors were: the use of ACEIs (HR: 3.11, 95%CI: 1.01-9.56, p= 0.047), presence of perineural invasion (HR: 7.27, 95% CI: 2.74-19.3, p< 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI: 2.09-22.11, p= 0.001), while a positive factor was the negative lymph node (NLN) count >7 (HR: 0.33, 95% CI: 0.12-0.88, p= 0.026). Conclusions: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN+M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.

scholarly journals Oncologic outcomes after resection of para-aortic lymph node metastasis in left-sided colon and rectal cancer

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241815
Author(s):  
Junichi Sakamoto ◽  
Heita Ozawa ◽  
Hiroki Nakanishi ◽  
Shin Fujita
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lung Metastasis ◽  
Clinicopathological Characteristics ◽  
Oncologic Outcomes ◽  
Free Survival ◽  
Colon And Rectal Cancer ◽  
Aortic Lymph Node ◽  
Synchronous Resection

Aim The optimal surgical management strategy for para-aortic lymph node (PALN) metastasis has not attracted as much attention as surgery for liver or lung metastasis. The purpose of this retrospective study was to evaluate the oncologic outcomes after synchronous resection of PALN metastasis in left-sided colon and rectal cancer. Methods Between January 1986 and August 2016, 29 patients with pathologically positive PALN metastases who underwent curative resection at our hospital were retrospectively reviewed. We examined clinicopathological characteristics, long-term oncologic outcomes, and factors related to favorable prognosis in these patients. Results The 3-year overall survival and recurrence-free survival (RFS) rates were 50.5% and 17.2%, respectively. In total, 6 (20.7%) patients experienced no recurrence in the 3 years after surgery, while postoperative complications were seen in 9 (31.0%) patients. The 3-year RFS rate was significantly better in the pM1a group than in the pM1b/pM1c group (26.3% and 0.0%, respectively, p = 0.032). Conclusion PALN dissection for patients without other organ metastases in left-sided colon or rectal cancer is a good indication as it is for liver and lung metastasis.

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