Population-based assessment of the National Comprehensive Cancer Network recommendations for baseline imaging of rectal cancer

2019 ◽  
Vol 8 (14) ◽  
pp. 1167-1172
Author(s):  
Omar Abdel-Rahman ◽  
Winson Y Cheung
Keyword(s):  
Rectal Cancer ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Predictive Value ◽  
Lung Metastases ◽  
Early Stage ◽  
Abdominal Imaging ◽  
Performance Characteristics ◽  
Seer Database ◽  
Routine Imaging

Aim: To examine the performance characteristics of alternative criteria for baseline staging, in a cohort of contemporary rectal cancer patients from the Surveillance, Epidemiology and End Results (SEER) database. Methods: The SEER database (2010–2015) was accessed and patients with rectal cancer plus complete information on clinical T and N stages as well as metastatic sites were evaluated. We examined various performance characteristics of baseline imaging, including specificity, sensitivity, number needed to investigate (NNI), positive predictive value (PPV), negative predictive value and accuracy. Results: A total of 15,836 rectal cancer patients were included. Based on current guidelines that suggest cross-sectional chest and abdominal imaging for all cases of invasive rectal cancer, these recommendations would yield a PPV of 11.9% for the detection of liver metastases and 6.2% for the detection of lung metastases. This would translate to an NNI of 8.4 for liver metastases and an NNI of 16.1 for lung metastases. When patients with T1N0 were excluded from routine imaging, this resulted in a PPV of 6.4% and an NNI of 15.6 to identify one case of lung metastasis. Likewise, this resulted in a PPV of 12.3% and an NNI of 8.0 to detect one case of liver metastasis. Similarly, when patients with either T1N0 or T2N0 were excluded from routine imaging, the PPV and NNI for lung metastases improved to 6.6% and 15.1, respectively, and the PPV and NNI for liver metastases improved to 12.6 and 7.9%, respectively. Conclusion: Our study suggests that the specificity of the current imaging approach for rectal cancer staging is limited and that the omission of chest and abdominal imaging among selected early stage asymptomatic cases may be reasonable to consider.

scholarly journals Liver Metastases Pattern in Rectal Cancer: A Real-World Analysis in the SEER Database

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Yang X ◽  
◽  
Ren H ◽  
Yang X ◽  
Zhang X ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Cox Regression ◽  
Lung Metastases ◽  
Logistic Analysis ◽  
Kaplan Meier ◽  
N Classification ◽  
New Diagnosis ◽  
Surgical Treatments

Background: The liver is a common metastatic site of colorectal cancer. Rectal cancer patients with organ metastases are more liable to show poor prognosis. The hazard and forecast elements of liver metastases are need to be estimated in rectal cancer patients. Methods: The data of newly diagnosed patients of rectal cancer with liver metastases are evaluated according to Surveillance, Epidemiology, and End Results (SEER) program between 2010 and 2016. The Overall Survival (OS) for dierent subgroups are appraised by Kaplan-Meier analysis and log-rank tests. Univariate and multivariable logistic analysis and Cox regression are performed to evaluate predictors and elements of the presence of liver metastases in new diagnosis, respectively. Results: There are a total of 6,662 (11.1%) rectal cancer patients paired with liver metastases. Factors including age (below), gender (female), marital status (unmarried), race (black), advanced T or N classification, presence of bone or lung metastases, and the absence of surgical treatments are importantly related to the occurrence of liver metastases. The median survival for liver metastases rectal cancer patients was 16.0 months. Indicators referring to elder age, black race, unmarried status, presence of bone, brain or lung metastases, and the absence of surgical treatments all predicted worse survival. Conclusion: The data of our research provide corresponding risks and prognostic elements for liver metastases rectal cancer patients, which offer a way to predict the occurrence of rectal cancer and guide prophylactic treatment in clinical settings.

scholarly journals The Role of CEA and Liver Function Tests in the Detection of Hepatic Metastases From Colo-Rectal Cancer

HPB Surgery ◽  
1990 ◽  
Vol 3 (1) ◽  
pp. 29-37 ◽  
Author(s):  
G. Bonfanti ◽  
Luigia Bombelli ◽  
F. Bozzetti ◽  
R. Doci ◽  
L. Gennari ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Liver Function ◽  
Liver Metastases ◽  
Predictive Value ◽  
Imaging Technique ◽  
Hepatic Metastases ◽  
Liver Function Tests ◽  
Good Prediction ◽  
Gamma Glutamyl Transpeptidase ◽  
Function Tests

Carcinoembryonic antigen and some liver function tests (alkaline phosphatase, gamma-glutamyl-transpeptidase, lactic dehydrogenase and cholinesterase) were evaluated in patients with primary colorectal cancer in order to define their role in the pre-operative detection of liver metastases.The records of 278 consecutive patients admitted to the Istituto Nazionale Tumori of Milan between January 1982 and December 1983 who were suffering from primary invasive colo-rectal cancer and who underwent laparotomy were retrospectively analyzed.At laparotomy, liver metastases were found in 38 pts (13.7%). Considering single tests, CEA was the most sensitive (71%); no single test was found to be reliably predictive, when the result was abnormal. On the contrary, the normal value of each test was associated with a good prediction.When we considered all the five tests together in the single patient their predictive value, when abnormal, proved to be quite good only if four or five results were abnormal. On the other hand, liver metastases in the presence of all normal tests were found only in two patients, so giving a negative predictive value of about 97%.So we conclude that, in the lack of an infallable imaging technique for liver evaluation, in the presence of all normal tests any other investigation on the liver could be avoided. However, when liver tests are pathologic, some other imaging technique should be performed in order to supply the surgeon with information about the extent and the spread of the metastases.

Comparing practice patterns and outcomes for early-stage hormone receptor-positive and node-positive breast cancer patients with high-intermediate-risk Oncotype Dx scores in the National Cancer Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12520-e12520
Author(s):  
Keerthi Tamragouri ◽  
Ethan M. Ritz ◽  
Ruta D. Rao ◽  
Cristina O'Donoghue
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Predictive Value ◽  
Practice Patterns ◽  
Early Stage ◽  
Oncotype Dx ◽  
Breast Cancer Patients ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

e12520 Background: Oncotype Dx (ODX) is a commercial diagnostic test primarily used to predict the likely benefit from chemotherapy in ER+, HER2-, and node negative breast cancer. The prognostic value (recurrence risk) has also been demonstrated to apply to early stage lymph node positive (LN+) disease in a number of retrospective and prospective studies. The ongoing RxPONDER trial aims to clarify the predictive value of RS in LN+ population. In light of the initial results, we analyzed the practice patterns and outcomes for HR+/Her2 -/node positive breast cancer patients receiving ODX testing in the years from 2010-2017 with RS 14-25 in a retrospective observational study of the NCDB. Methods: Women with HR+/Her2 -/node positive breast cancer receiving ODX testing from 2010-2017 were identified in the NCDB using TAILORx and RxPONDER patients’ inclusion criteria: ages 18-75, 6-50mm invasive tumors, N1, M0, ER+/HER2 -. The impact of ODX results in the high-intermediate range (14-25) and other clinico-pathologic variables on the receipt of chemotherapy were compared. Additionally, we examined the impact of chemotherapy on overall survival (OS). Frequencies, Kaplain-Meier analysis, and changepoint analysis using the Contal and O’Quigley method were utilized. Results: There were 109,652 T1-2 and N1 patients of whom 32,506 (29.6%) received ODX testing. 13,461 (41.4%%) women had scores in the high-intermediate (14-25) range. The majority tended to have only 1 LN involved (1LN: 77.2%, 2LNs: 17.5%, 3LNs: 5.3%), had a mean age of 57.8y, were Caucasian (86.4%), and were preferentially tested at academic or comprehensive community cancer programs (79.2%). 6,610 (49.3%) patients were recommended chemotherapy, the median ODX score for all women who were recommended chemotherapy was 20 compared to 17 for those whom chemotherapy was not recommended. 5,068 (76.7%) women had documentation of receiving chemotherapy which correlated with improved OS regardless of age. Conclusions: In the group of women with HR+/Her2 -/node positive breast cancer, clinicians appear to utilize ODX testing in less than one-third of patients, possibly finding RS to be most useful in guiding adjuvant therapy recommendations when only 1LN is involved. Both the recommendation and receipt of chemotherapy correlated linearly with increasing RS, as expected based on the current NCCN guideline recommendations. We identified an OS benefit when chemotherapy was administered, regardless of patient age. Long-term follow-up in the RxPONDER trial will likely continue to clarify the predictive value of RS < 25 in the ER+/HER2-/node positive breast cancer population.

Can You Help Me Feel Less Exhausted All the Time?

2013 ◽  
Vol 31 (25) ◽  
pp. 3056-3060 ◽  
Author(s):  
Pleun J. de Raaf ◽  
Carin C.D. van der Rijt
Keyword(s):  
Rectal Cancer ◽  
Liver Metastases ◽  
Low Anterior Resection ◽  
Preoperative Radiotherapy ◽  
Lung Metastases ◽  
Primary Treatment ◽  
Cancer Center ◽  
Her Family ◽  
Mentally Disabled ◽  
Upper Abdomen

A 64-year-old woman with metastatic rectal cancer is admitted to the acute palliative care unit of our cancer center because of debilitating fatigue. She had been diagnosed with metastatic disease in 2009, when liver metastases were found 1 year after the primary treatment of her rectal cancer with preoperative radiotherapy and low anterior resection. Since then, she had been treated with resection of liver metastases in 2009 and 2010, palliative combination chemotherapy (oxaliplatin plus capecitabine) after the diagnosis of new liver and lung metastases in 2010, irinotecan in 2011, and then cetuximab until progression. She declined participation in a phase I clinical trial because she was afraid of experiencing adverse effects; she felt relatively well at the time. She had functioned without hindering symptoms until 2 weeks before admission. Her condition had deteriorated markedly since then. At admission, she is bedridden because of progressive fatigue. Furthermore, she complains of dyspnea and nausea and vomits approximately twice per day. She also suffers from pain in the upper abdomen, especially when rising from the bed. She is no longer able to care for her 84-year-old husband or her 40-year-old mentally disabled son, who lives with them. She is aware of her poor prognosis but is not able to share her sorrows with her family.

scholarly journals Clinicopathologic and outcome characteristics of breast cancer with liver metastases (BCLM): a population study of the SEER database and a registry analysis of 1728 women

2020 ◽  
Author(s):  
zhonghua wang ◽  
Lei ji ◽  
Lei Cheng ◽  
Xiuzhi Zhu ◽  
Yu Gao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Targeted Therapy ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Triple Negative ◽  
Cancer Center ◽  
Seer Database ◽  
Breast Cancer Patients ◽  
Death Risk ◽  
Increased Risk

Abstract Background Breast cancer patients generally have a worse prognosis in presence of liver metastasis. The purpose of this study was to evaluate the risk factors and prognosis of breast cancer patients with liver metastases (BCLM). Methods Data on 311,573 breast cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed 2010 to 2016 and 1728 BCLM patients from Fudan University Shanghai Cancer Center (FUSCC) were analyzed for further exploration. We extracted the clinicopathological characteristics for analysis by two independent authors. Logistic regression was used to identify factors associated with the risk of liver metastases. Survival analysis was completed using Cox proportional hazards regression model and Kaplan-Meier analysis. Results Young age, invasive ductal carcinoma, higher pathological grade, and subtype of triple-negative and human epidermal growth factor receptor 2 positive (HER2+), were associated with increased risk of the liver metastases. The median overall survival (OS) after BCLM diagnosis was 20.0 months in the SEER database and 27.3 months in the FUSCC dataset. We observed that hormone receptor-positive (HR+)/HER2+ patients had the longest median OS 38.0 for SEER vs. 34.0months for FUSCC), whereas triple-negative breast cancer had the poorest OS (9.0 vs. 15.6 months) in both SEER and FUSCC. According to the results from the FUSCC, the subtype of HR+/HER2+ (hazard ratio (HR)=2.62; 95% confidence interval (CI)= 1.88-3.66; P<0.001) and HR-/HER2+ (HR=3.43; 95% CI=2.28-5.15; P<0.001) were associated with a significantly increased death risk in comparison with subtype of HR+/HER2-, if the patients did not receive HER2-targeted therapy. For BCLM patients who had received HER2-targeted therapy, however, HR+/HER2+ was an indicator for decreased death risk in comparison of the subtype of HR+/HER2- (HR=0.74; 95% CI=0.58-0.95; P<0.001). Conclusions BCLM is associated with poor survival, depending on HR/HER2-defined subtypes. Patients with HR+/HER2+ subtype displayed the longest median survival than HR+/HER2- and triple-negative BCLM patients. HER2-targeted therapy should be recommended for HER2+ BCLM patients.

scholarly journals NEOADJUVANT RADIATION THERAPY FOR RECTAL CANCER WITH SYNCHRONOUS LIVER METASTASES (LITERATURE REVIEW)

2021 ◽  
Vol 20 (5) ◽  
pp. 123-137
Author(s):  
T. P. Pochuev ◽  
A. A. Nevolskikh ◽  
L. O. Petrov ◽  
L. N. Titova ◽  
A. A. Karpov
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Distant Metastases ◽  
Point Of View ◽  
Surgical Approaches ◽  
Primary Tumors ◽  
Synchronous Liver Metastases ◽  
Number Of Patients

Background. In Russia, synchronous distant metastases are annually detected in approximately 6,200 patients and synchronous liver metastases in 4,000 patients. To plan treatment for rectal cancer with synchronous liver metastases, it is necessary to consider the location of the tumor, extent of the primary tumor involvement, tumor-related complications, and resectability of metastases.The purpose of this review was to analyze the results of studies aimed at finding the best regimens for treating rectal cancer patients with synchronous liver metastases.Material and Methods. The review includes both retrospective and prospective studies devoted to treatment of rectal cancer with synchronous liver metastases. Previous reviews and clinical recommendations were analyzed.Results. Most oncologists are in favor of preoperative radiotherapy, especially when rectal cancer is located in the lower-and middle-ampullary regions. However, there are no randomized trials with a representative number of patients to confirm or refute this point of view. Due to the increased life expectancy of patients and introduction of modern minimally invasive surgical approaches, there is an urgent need for radical treatment of rectal cancer patients. Thus, the approaches to the treatment of primary tumors with synchronous metastatic liver damage should be the same as in stage II–III of the disease, and neoadjuvant radiation therapy is an integral part of this strategy. 

Treatment of rectal cancer patients with synchronous liver metastases.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e15567-e15567
Author(s):  
Alexey Privalov ◽  
Andrey Antonov ◽  
Andrey Vazenin
Keyword(s):  
Rectal Cancer ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Synchronous Liver Metastases

A Risk Model for Chemotherapy-Induced Anemia (CIA) in Cancer Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 754-754
Author(s):  
Gary H. Lyman ◽  
Brandon McMahon ◽  
Nicole M. Kuderer ◽  
Jeffrey Crawford ◽  
Debra Wolff ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Likelihood Ratio ◽  
Test Performance ◽  
Predictive Value ◽  
Risk Model ◽  
Performance Status ◽  
Low Risk ◽  
Performance Characteristics ◽  
Hematological Toxicity ◽  
Predictive Test

Abstract Background: Anemia represents the most common hematological toxicity in cancer patients receiving systemic chemotherapy and is associated with considerable morbidity and cost (Lyman‚ Value in Health 2005). Current ASH/ASCO guidelines call for intervention at a hemoglobin (Hgb) &lt;10 gm/dl. Treatment options include transfusion or administration of an erythropoietic-stimulating protein (ESP). A recent meta-analysis demonstrated the clinical value of early versus late intervention with an ESP (Lyman‚ Cancer‚ 2005 in press). An accurate and valid risk model for CIA is needed to select patients for ESP treatment early in the course of chemotherapy when it can be most effective. Methods: More than 3‚000 patients with cancer of the breast‚ lung‚ colon and ovary or malignant lymphoma initiating a new chemotherapy regimen have been prospectively registered at 115 randomly selected U.S. practice sites. Data on at least one cycle of chemotherapy were available on 2‚842 patients. A logistic regression model for Hgb &lt;10 gm/dl based on pretreatment characteristics was developed and predictive test performance characteristics examined. Results: Over a median of three cycles of chemotherapy, Hgb &lt;10 gm/dl was reported one or more times in 817 (28.7%) patients. Significant independent predictive factors for Hgb &lt;10 gm/dl include: history of peptic ulcer (OR=1.90; P=.015), myocardial infarction (OR=1.94; P=.009), or congestive heart failure (OR=2.13; P=.017), increasing age (OR=1.02; P=.002), female gender (OR=2.40; P&lt;.001), ECOG performance status (OR=1.24; P=.002), Charlson Comorbidity Index (OR=1.06, P=.002), body surface area (OR=3.75, P&lt;.001), low baseline hemoglobin (OR=1.95, P&lt;.001), pretreatment hematocrit (OR=.85, P&lt;.001), and glomerular filtration rate (OR=0.99, P=.027), and regimens containing anthracyclines (OR=3.21, P&lt;.001), cisplatinum (OR=3.86, P&lt;.001) or carboplatinum (OR=2.71, P&lt;.001). Model fit was excellent (P&lt;.001), R2=0.455 and c-statistic = 0.775 [95% CL: .76–.79, P&lt;.0001]. Individual predicted risk of Hgb &lt;10 gm/dl based on the model ranged from 0 to 98% with mean and median probabilities of 0.28 and 0.22, respectively. Based on a risk cutpoint of 20%, 1,541 patients (55%) were classified as high risk and 1,282 as low risk. The average risks of Hgb &lt;10 gm/dl during chemotherapy in high and low risk subjects were 43% and 12%, respectively. Model test performance characteristics [±95% CL] included: sensitivity: 81% [78–84]; specificity: 56% [54–58]; likelihood ratio positive: 1.85 [1.74–1.96]; likelihood ratio negative: 0.34 [0.29–0.39]; positive predictive value: 43% [40–45]; negative predictive value: 88% [86–90] and diagnostic odds ratio: 5.47 [4.50–6.66]. Conclusions: This risk model identified cancer patients initiating chemotherapy who are at risk for clinically significant anemia using common clinical parameters. Validation of the model in a separate population of patients is in progress.

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