scholarly journals Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 336
Author(s):  
Eleonora Terzi ◽  
Alice Giamperoli ◽  
Massimo Iavarone ◽  
Simona Leoni ◽  
Ludovico De Bonis ◽  
...  
Keyword(s):  
Early Stage ◽  
Univariate Analysis ◽  
Definitive Diagnosis ◽  
Liver Imaging ◽  
Histological Techniques ◽  
Free Survival ◽  
Median Size ◽  
Indeterminate Nodules ◽  
Better Than ◽  
Diagnostic Investigations

The American College of Radiology (ACR) released the Liver Imaging Report and Data System (LI-RADS) scheme, which categorizes hepatic nodules in risk classes from LR-1 to LR-5 (according to the degree of risk to be HCC) and LR-M (probable malignancy not specific for HCC). The aim of this study was to test whether HCC with different LR patterns on CEUS have different overall survival (OS) and recurrence-free survival (RFS). We retrospectively enrolled 167 patients with the first definitive diagnosis of single HCC (by using CT/MRI or histological techniques if CT/MRI were inconclusive) for whom CEUS examination was available. The median size of HCC lesions was 2.2 cm (range 1.0–7.2 cm). According to CEUS LI-RADS classification, 28 patients were in LR-3, 48 in LR-4, 83 in LR-5, and 8 in LR-M. Patient liver function and nodule characteristics were not statistically different between CEUS LI-RADS classes. Using univariate analysis, CEUS LI-RADS class was not found to be a predictor of survival (p = 0.347). In conclusion, HCC showing the CEUS LI-RADS classes LR-3 and LR-4 have no better clinical outcome than typical HCC. Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated.

Fifteen-year experience of all patients (pts) with small bowel adenocarcinoma (SBA), treated in a specialized gastrointestinal (GI) oncology unit: Royal Marsden (RM) experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 316-316
Author(s):  
Khurum Hayat Khan ◽  
Clare Peckitt ◽  
Francesco Sclafani ◽  
Sachin Trivedi ◽  
Vikram Kumar Jain ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Advanced Disease ◽  
Early Stage ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Small Bowel Adenocarcinoma ◽  
Early Stage Disease ◽  
Free Survival ◽  
Resectable Disease

316 Background: Small bowel adenocarcinoma (SBA) is a rare tumour with poor prognosis. There is paucity of published literature due to rarity of disease; we conducted this retrospective study to determine the clinical course and outcome along with prognostic factors in both early and later stage SBA. Methods: Clinical characteristics and outcomes of all pts treated consecutively in the GI Unit RM, 1996-2011 were recorded. The study endpoints were relapse free survival (RFS), progression free survival (PFS), and overall survival (OS), in early stage pts (G1) and in pts with advanced disease (presentation or relapse with un-resectable disease=G2). In G2 response rate (RR) to chemotherapy was determined. In both groups association to baseline prognostic factors were sought by performing Cox regression univariate analysis (UVA). Results: Eighty four pts with SBA were treated 1996-2011. A total of 48 presented with early stage disease (G1). In G1 (58.3% males; mean age, 57 years), 44/48 pts underwent R0 resection; 21 received adjuvant chemotherapy. RFS, PFS and OS in this group were 29.6 [95% confidence interval (CI) 3.3-55.9], 31.1 (CI=8.0-54.3) and 42.9 (CI=0-94.9) months (m), with median follow up of 76.4 m. Poor histological differentiation (p=0.025), abnormal CEA at presentation (P=0.082), and lymphovascular invasion (p=0.003) were prognostic of OS. G2 comprised of 36 pts with un-resectable disease along with 23 from G1 who subsequently relapsed [G2 (n=59); 52.5% males; mean age, 59 years]; 54 pts with metastatic and 5 with locally advanced disease; 78% received first-line chemotherapy. Overall RR of pts who received chemotherapy was 50%. OS and PFS were 12.8 (CI =8.4-17.2) and 8.8 (CI=5.5-12.3) m respectively; 1-year survival was 60.9% vs. 27.3% (no chemotherapy) (p=0.042). Abnormal albumin (0.041), platelet count (p=0.007) and CEA (p=0.025) were prognostic of OS in the chemotherapy group; doublet (18/41) versus triplet (23/41) chemotherapy were not prognostic (p=0.185). Conclusions: Pts with SBA and metastatic disease may derive benefit from systemic chemotherapy; prospective clinical trials are required to evaluate this further.

ABVD Versus VEPEMB in Elderly Hodgkin’s Lymphoma Patients.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2322-2322 ◽  
Author(s):  
Alessandro Levis ◽  
Francesco Merli ◽  
Stefania Tamiazzo ◽  
Annalisa Arcari ◽  
Monica Bellei ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Daily Living ◽  
Early Stage ◽  
Survival Rates ◽  
Advanced Stage ◽  
Multi Centre Study ◽  
Free Survival ◽  
Grade 3 ◽  
Reduced Intensity ◽  
Better Than

Abstract BACKGROUND. In advanced age the prognosis of Hodgkin Lymphoma (HL) is poor. Aggressive regimens such as BEACOPP are toxic and difficult to apply in the elderly (Engert et al JCO23, 5052, 2005). Moreover it is not clear if low intensive chemotherapy regimens are better than ABVD. The reduced intensity VEPEMB schedule showed good results in terms of efficacy and tolerance in a phase II multi-centre study (Levis et al Ann Oncol15, 123, 2004). AIM OF THE WORK. To compare in HL elderly patients the reduced intensity VEBEMP schedule to the ABVD conventional one. PATIENTS AND METHODS. From June 2002 to December 2006, 54 HL patients older than 65 years entered the study. Frail patients were excluded. Patients were defined frail when present one or more of the following conditions: a) age higher than 80; b) three or more grade 3 comorbidities and/or one or more grade 4 co-morbidities according to the CIRS scale; c) activities of daily living (ADL) score less than 6; d) geriatric syndrome. Early stage (IA-IIA) patients were randomized between 3 courses of ABVD and 3 courses of VEPEMB, both of them followed by IF radiotherapy. Advanced stage (IIB-IV) patients were randomized between 6 courses of ABVD and 6 courses of VEPEMB, with radiotherapy limited to the areas of residual masses or of previous bulky disease. The VEPEMB regimen was as follows: vinblastine 6 mg/sqm i.v. on day 1, cyclophosphamide 500 mg/sqm on day 1, procarbazine 100 mg/sqm p.o. days 1 through 5, prednisone 30 mg/sqm p.o. days 1 through 5, etoposide 60 mg/sqm p.o. days 15 through 19, mitoxantrone 6 mg/sqm i.v. on day 15, bleomycin 10 mg/sqm i.v. on day 15. The regimen was scheduled every 28 days. ABVD was scheduled as usual. Growth factors (G-CSF and erythropoietin) were regularly considered for both regimens. RESULTS. Mean age was 72 (range 66–80). Seventeen patients (31%) were in early stage and the remaining 37 ones (69%) in advanced stage. One or more comorbidities were present in 26 cases (48%). Twenty six patients were allocated to ABVD and twenty eight to VEPEMB. Significant differences at diagnosis were not seen in terms of sex, mean age, stage, histology, co-morbidity and instrumental activity of daily living (IADL) score between the two arms. Significant differences in grade 3 or 4 toxicities were not seen between ABVD and VEPEMB arms: leucopenia 76% vs 82%; anemia 40% vs. 31%; mucositis 27% vs 19%; neurological toxicity 31% vs. 19%; infections 7% vs 23%. Toxic deaths were not observed. Treatment violations or interruptions were more frequent in the ABVD than in the VEPEMB arm, but this difference was not statistically significant (26% vs. 12%, p=ns). On an intention to treat analysis the final CR rate was slightly better in the ABVD than in the VEPEMB arm, even if this difference was not statistically significant: 86% vs. 77%. The 3-year relapse free survival rates were 57% and 50% (p=ns) for the ABVD and VEPEMB arm respectively. The 3-year overall survival and the event free survival rates for ABVD and VEPEMB were 79% vs. 60% (p=ns) and 52% vs. 24% (p=0.08) respectively. CONCLUSIONS. The prognosis of this group of elderly HL patients has been confirmed inferior to that observed in younger patients. ABVD is feasible with modest toxic cost in non-frail elderly patients and its results are at least equal, if not better, than those observed with the low intensive VEPEMB regimen.

Network meta-analysis of adjuvant chemotherapy in early breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12071-e12071
Author(s):  
Preethi John ◽  
Raveendhara R Bannuru ◽  
Joshua T. Cohen ◽  
Rachel J. Buchsbaum ◽  
John Kalil Erban
Keyword(s):  
Breast Cancer ◽  
Randomized Clinical Trials ◽  
Early Stage ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Survival Outcomes ◽  
Free Survival ◽  
Dose Dense ◽  
Optimal Regimen ◽  
Better Than

e12071 Background: The NCCN recommends several adjuvant regimens for early stage breast cancer (ESBC) that have not been directly compared in randomized clinical trials (RCTs) making the optimal regimen unclear. Regimens of interest include dose dense doxorubicin/cyclophosphamide followed by paclitaxel (DDAC-T), doxorubicin/cyclophosphamide followed by weekly paclitaxel (ACwkT), docetaxel/doxorubicin/cyclophosphamide (TAC), and docetaxel/cyclophosphamide (TC) x 4 cycles. This is the first network meta-analysis (NMA) to compare the effectiveness of these regimens. Methods: A systematic literature review was performed to identify RCTs that included the above regimens. To complete the network, doxorubicin/cyclophosphamide (AC), doxorubicin/cyclophosphamide followed by paclitaxel (AC-T) every 3 wks, and doxorubicin/cyclophosphamide followed by docetaxel (AC-D) every 3 wks were included. Primary outcomes were progression free survival (PFS) and overall survival (OS) estimated as odds ratios (OR). OR > 1 indicates better survival. Bayesian random effects model with non-informative priors was used. Results: 5 RCTs involving 12,579 females with mainly node positive, Her2- ESBC were analyzed. Although there were no statistically significant differences in PFS or OS among these regimens, AC-D, ACwkT, DDAC-T, TAC, and TC demonstrated better survival outcomes compared to AC and AC-T (not shown). Survival outcomes among DDAC-T, ACwkT, TAC, and TC were comparable. DDAC-T survival outcomes were marginally better than the other regimens. Conclusions: DDAC-T, ACwkT, TC, and TAC were similar in efficacy. Final results with at least one additional RCT will be presented. Although NMA is not a substitute for direct comparison RCTs, it allows indirect comparisons to aid in decision making. Future results from ongoing RCTs will refine estimates of anthracycline vs non anthracycline efficacy and toxicity. [Table: see text]

scholarly journals SURG-22. CUSHING’S DISEASE: A DIFFICULT TO TREAT NEURO-ONCOLOGICAL CONDITION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi244-vi244
Author(s):  
Santanu Bora ◽  
Ashish Suri
Keyword(s):  
Cortisol Level ◽  
Remission Rate ◽  
Univariate Analysis ◽  
Clinical Manifestations ◽  
Plasma Cortisol Level ◽  
Cushing Disease ◽  
Factors Affecting ◽  
Microscopic Surgery ◽  
Acth Secreting ◽  
Better Than

Abstract BACKGROUND Cushing disease (CD) comprises a spectrum of clinical manifestations secondary to hypercortisolism due to ACTH-secreting pituitary adenoma. Transsphenoidal adenomectomy remains the standard treatment. Because of the significant rate of recurrence or persistence of CD, it is of interest to determine factors that may correlate with long-term outcomes following surgical intervention. OBJECTIVE The objective of our study is to determine the remission rate after surgery with special emphasis on factors affecting remission. METHODS Data of all patients undergoing surgery for CD from 2009 to 2017 was analyzed retrospectively. Transphenoidal resection was the preferred treatment with a recent trend in favor of endonasal endoscopic skull base approach. Post-operative cortisol level of < 2 μg/dL was taken as remission and value between 2 and 5 μg/dL as possible remission. RESULTS 104 patients operated primarily for CD were included for analysis. 47 patients underwent microscopic surgery, 55 endoscopic surgery and two were operated trans-cranially. Remission was achieved in 76.47% of patients. In univariate analysis, factors significantly associated with remission were (1) type of surgery (p=0.01); endoscopy (88.23% remission) better than microscopy (56.6% remission) (2) postoperative day-1 morning cortisol (p=0.004) and; (3) postoperative day-1 morning ACTH (p=0.015). In multivariate analysis, however only postoperative day-1 cortisol was found to be significant as predictor of remission (p=0.02). CONCLUSION Postoperative plasma cortisol level is a strong independent predictor of remission and value less than 10.7µgm/dl can be taken as cut off for predicting remission. Remission provided by endoscopy appears to be significantly better than microscopic approach.

scholarly journals Chemotherapy Delays Are Associated with Inferior Outcome in Acute Lymphoblastic Leukemia: A Retrospective Study from a Tertiary Cancer Center in South India

2021 ◽  
Vol 42 (01) ◽  
pp. 051-060
Author(s):  
Vineet Agrawal ◽  
Smita Kayal ◽  
Prasanth Ganesan ◽  
Biswajit Dubashi
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Univariate Analysis ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Separate Analysis ◽  
Term Survival ◽  
Free Survival ◽  
Intensive Phase ◽  
The Impact

Abstract Background Treatment protocols for acute lymphoblastic leukemia (ALL) have evolved over time to give excellent cure rates in children and moderate outcomes in adults; however, little is known how delays in chemotherapy affect long-term survival. Objectives To find the association of delays during different treatment phases on the survival outcomes. Materials and Methods Data from 149 ALL cases treated between 2009 and 2015 were retrospectively analyzed. Treatment course in commonly used protocols was divided into three phases—induction, consolidation (postremission), maintenance, and also a combined intensive phase (induction plus consolidation) for the purpose of analysis, and delay in each phase was defined based on clinically acceptable breaks. Analysis was done to find the impact of treatment delay in each phase on the survival outcomes. Results The median age was 12 years (range, 1–57). Multi-center Protocol-841 (MCP-841) was used for 72%, German Multicenter Study Group for Adult ALL (GMALL) for 19%, and Berlin, Frankfurt, Muenster, 95 protocol (BFM-95) for 9% of patients. Delay in induction was seen in 52%, consolidation in 66%, and during maintenance in 42% of patients. The median follow-up was 41 months, and 3-year survival outcomes for the entire cohort were event-free survival (EFS)—60%, relapse-free survival (RFS)—72%, and overall survival (OS)—68%. On univariate analysis, delay in induction adversely affected EFS (hazard ratio [HR] = 1.78, p = 0.04), while delay in intensive phase had significantly worse EFS and RFS (HR = 2.41 [p = 0.03] and HR = 2.57 [p = 0.03], respectively). On separate analysis of MCP-841 cohort, delay in intensive phase affected both EFS (HR = 3.85, p = 0.02) and RFS (HR = 3.42, p = 0.04), whereas delay in consolidation significantly affected OS with (HR = 4.74, p = 0.04) independently. Conclusion Treatment delays mostly in intensive phase are associated with worse survival in ALL; attempts should be made to maintain protocol-defined treatment intensity while adequately managing toxicities.

scholarly journals Clinicopathological features and prognostic significance of CTNNB1 mutation in low-grade, early-stage endometrial endometrioid carcinoma

2021 ◽  
Author(s):  
Ignacio Ruz-Caracuel ◽  
Álvaro López-Janeiro ◽  
Victoria Heredia-Soto ◽  
Jorge L. Ramón-Patino ◽  
Laura Yébenes ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Mismatch Repair ◽  
Predictive Value ◽  
Early Stage ◽  
Disease Free Survival ◽  
Low Grade ◽  
Beta Catenin ◽  
Free Survival ◽  
Disease Free ◽  
Risk Of Relapse

AbstractLow-grade and early-stage endometrioid endometrial carcinomas (EECs) have an overall good prognosis but biomarkers identifying patients at risk of relapse are still lacking. Recently, CTNNB1 exon 3 mutation has been identified as a potential risk factor of recurrence in these patients. We evaluate the prognostic value of CTNNB1 mutation in a single-centre cohort of 218 low-grade, early-stage EECs, and the correlation with beta-catenin and LEF1 immunohistochemistry as candidate surrogate markers. CTNNB1 exon 3 hotspot mutations were evaluated by Sanger sequencing. Immunohistochemical staining of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6), p53, beta-catenin, and LEF1 was performed in representative tissue microarrays. Tumours were also reviewed for mucinous and squamous differentiation, and MELF pattern. Nineteen (8.7%) tumours harboured a mutation in CTNNB1 exon 3. Nuclear beta-catenin and LEF1 were significantly associated with CTNNB1 mutation, showing nuclear beta-catenin a better specificity and positive predictive value for CTNNB1 mutation. Tumours with CTNNB1 exon 3 mutation were associated with reduced disease-free survival (p = 0.010), but no impact on overall survival was found (p = 0.807). The risk of relapse in tumours with CTNNB1 exon 3 mutation was independent of FIGO stage, tumour grade, mismatch repair protein expression, or the presence of lymphovascular space invasion. CTNNB1 exon 3 mutation has a negative impact on disease-free survival in low-grade, early-stage EECs. Nuclear beta-catenin shows a higher positive predictive value than LEF1 for CTNNB1 exon 3 mutation in these tumours. Graphical abstract

scholarly journals 154 Disease-free survival in early-stage cervical cancer: comparison of laparoscopic versus open surgery in a tertiary centre

2020 ◽  
Author(s):  
Amanda Veiga-Fernández ◽  
María López-Altuna ◽  
Ignacio Romero-Martínez ◽  
Elsa Mendizábal Vicente ◽  
Patricia Rincon Olbes ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Open Surgery ◽  
Early Stage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Tertiary Centre ◽  
Early Stage Cervical Cancer ◽  
Disease Free

scholarly journals Comparison of the survival outcomes of laparoscopy versus laparotomy in treatment of early-stage ovarian cancer: a systematic review and meta-analysis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Qingduo Kong ◽  
Hongyi Wei ◽  
Jing Zhang ◽  
Yilin Li ◽  
Yongjun Wang
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Survival Outcomes ◽  
Free Survival ◽  
Review Manager ◽  
Early Stage Ovarian Cancer

Abstract Background Laparoscopy has been widely used for patients with early-stage epithelial ovarian cancer (eEOC). However, there is limited evidence regarding whether survival outcomes of laparoscopy are equivalent to those of laparotomy among patients with eEOC. The result of survival outcomes of laparoscopy is still controversial. The aim of this meta-analysis is to analyze the survival outcomes of laparoscopy versus laparotomy in the treatment of eEOC. Methods According to the keywords, Pubmed, Embase, Cochrane Library and Clinicaltrials.gov were searched for studies from January 1994 to January 2021. Studies comparing the efficacy and safety of laparoscopy versus laparotomy for patients with eEOC were assessed for eligibility. Only studies including outcomes of overall survival (OS) were enrolled. The meta-analysis was performed using Stata software (Version 12.0) and Review Manager (Version 5.2). Results A total of 6 retrospective non-random studies were included in this meta-analysis. The pooled results indicated that there was no difference between two approaches for patients with eEOC in OS (HR = 0.6, P = 0.446), progression-free survival (PFS) (HR = 0.6, P = 0.137) and upstaging rate (OR = 1.18, P = 0.54). But the recurrence rate of laparoscopic surgery was lower than that of laparotomic surgery (OR = 0.48, P = 0.008). Conclusions Laparoscopy and laparotomy appear to provide comparable overall survival and progression-free survival outcomes for patients with eEOC. Further high-quality studies are needed to enhance this statement.

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