scholarly journals Long-Term Outcomes of Colon Cancer Patients Undergoing Standardized Technique Operation With Curative Intent

2015 ◽  
Vol 100 (11-12) ◽  
pp. 1382-1395
Author(s):  
Erhan Akgun ◽  
Cemil Caliskan ◽  
Tayfun Yoldas ◽  
Can Karaca ◽  
Bulent Karabulut ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
R0 Resection ◽  
Cancer Specific Survival ◽  
Curative Intent ◽  
Lymph Node Count

There is no defined standard surgical technique accepted worldwide for colon cancer, especially on the extent of resection and lymphadenectomy, resulting in technical variations among surgeons. Nearly all analyses employ more than one surgeon, thus giving heterogeneous results on surgical treatment. This study aims to evaluate long-term follow-up results of colon cancer patients who were operated on by a single senior colorectal surgeon using a standardized technique with curative intent, and to compare these results with the literature. A total of 269 consecutive patients who were operated on with standardized technique between January 2003 and June 2013 were enrolled in this study. Standardized technique means separation of the mesocolic fascia from the parietal plane with sharp dissection and ligation of the supplying vessels closely to their roots. Patients were assessed in terms of postoperative morbidity, mortality, disease recurrence, and survival. Operations were carried out with a 99.3% R0 resection rate and mean lymph node count of 17.7 nodes per patient. Surviving patients were followed up for a mean period of 57.8 months, and a total of 19.7% disease recurrence was recorded. Mean survival was 113.9 months. The 5- and 10-year survival rates were 78% and 75.8% for disease-free survival, 82.6% and 72.9% for overall survival, and 87.5% and 82.9% for cancer-specific survival, respectively. R1 resection and pathologic characteristics of the tumor were found to be the most important prognostic factors according to univariate and Cox regression analyses. Standardization of surgical therapy and a dedicated team are thought to make significant contributions to the improvement of prognosis.

Patterns of failure after definitive treatment for T4a larynx cancer in the Veterans Affairs Health System.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18006-e18006
Author(s):  
Rohith S. Voora ◽  
Bharat Panuganti ◽  
Mitchell Flagg ◽  
Abhishek Kumar ◽  
Nikhil V. Kotha ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Disease Recurrence ◽  
Distant Recurrence ◽  
Larynx Cancer ◽  
Definitive Treatment ◽  
Lower Probability ◽  
Cancer Specific Survival ◽  
Curative Intent

e18006 Background: Both chemoradiotherapy (CRT) and total laryngectomy (TL) with adjuvant therapy are curative-intent treatment options for patients with T4a larynx cancer. Disease recurrence is a known negative prognosicator, but differences in recurrence patterns and the subsequent survival associations are not well characterized. To address this knowledge gap, we present long-term recurrence and survival outcomes from a novel longitudinal data source. Methods: Retrospective study of non-metastatic T4a larynx cancer patients diagnosed between 2000-2017 who underwent curative-intent treatment (TL with adjuvant therapy or primary CRT) from the VA Informatics and Computing Infrastructure database. Adjuvant therapy consisted of either postoperative radiotherapy (RT) or CRT. Fine-Gray and Cox models were used to evaluate primary outcomes – time to locoregional recurrence and distant recurrence. Secondary outcomes included overall survival (OS), cancer-specific survival (CSS), non-cancer specific survival (NCSS), and disease-free survival (DFS). These multivariable models accounted for age, race, alcohol history, smoking status, education and income, Charlson-Deyo score, N-classification, and tumor subsite. Results: The study included 1,114 patients with a median follow-up time of 63.3 months among those alive at last follow up. In the TL group, adjuvant RT was used in 69% and adjuvant CRT was used in 31%. Median time to first recurrence was 24.4 months with overall incidence of 28.5% locoregional and 9.5% distant recurrence. Primary CRT patients had higher rates of locoregional (37.2 vs. 22.9%) and distant recurrence (13.3 vs. 7.0%) (p < 0.0001). Median OS was 27.3 months for CRT (95% CI: 23.6-32.4 months) and 47.5 months (95% CI: 39.6-52.1 months) for TL. Median DFS was 14.1 months for CRT (95% CI:12.5-17.2 months) and 37.9 months (95% CI 31.2-47.5 months) for TL. On multivariable analysis compared to CRT, TL was associated with longer time to locoregional (HR 0.50, 95% CI:0.40-0.61) and distant recurrence (HR 0.50, 95% CI:0.34-0.73). Having N+ disease increased risk of distant recurrence (HR 2.20, 95% CI:1.42-3.41). TL was associated with improved OS (HR 0.78, 95% CI:0.67 – 0.91), CSS (HR 0.73, 95% CI:0.59 – 0.89), and DFS (HR 0.58, 95% CI 0.49-0.69) compared to CRT; NCSS was equivalent between groups (HR 1.09, 95% CI:0.88-1.35). Of the CRT patients with locoregional failures, 67/163 (41.1%) were salvaged with surgery. Conclusions: In this cohort of T4a larynx cancer patients, surgical management demonstrated favorable recurrence and survival results. TL with adjuvant therapy was associated with significantly lower incidence of both locoregional and distant recurrence and increased OS, CSS and DFS compared to CRT. Lower probability of disease recurrence, in addition to a survival advantage, should be considered as an important advantage to up-front surgery.

Disease-free and overall survival in nonmetastatic esophageal or gastroesophageal junctional cancer after treatment with curative intent: A nationwide population-based study.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 246-246
Author(s):  
Marieke Pape ◽  
Pauline A.J. Vissers ◽  
Laurens Beerepoot ◽  
Mark I. Van Berge Henegouwen ◽  
Sjoerd Lagarde ◽  
...  
Keyword(s):  
Overall Survival ◽  
Performance Status ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Rank Test ◽  
R0 Resection ◽  
Real World Data ◽  
Curative Intent ◽  
Netherlands Cancer Registry ◽  
Disease Free

246 Background: Among patients with potentially curable esophageal cancer (EC) or gastroesophageal junctional cancer (GEJC) treated with curative intent, survival remains poor and around half of these patients have disease recurrence within a few years. This study addresses the need for real-world data on disease-free survival (DFS) and overall survival (OS) in patients with EC or GEJC who underwent potentially curative treatment. Methods: Patients selected from the nationwide Netherlands cancer registry (NCR) had received a primary diagnosis of non-metastatic EC or GEJC (excluding patients with T4b tumors) in 2015 or 2016 and received treatment with curative intent. Curative intent was defined as receiving resection (with or without [neo]adjuvant therapy) or definitive chemoradiotherapy (dCRT) without surgery. DFS and OS were analysed using Kaplan-Meier curves with Log-Rank test from resection date or end of dCRT. A sub-analysis was performed for NCR patients selected to align with the population of the CheckMate-577 phase 3 study of adjuvant nivolumab, i.e. patients with non-cervical stage II/III disease, R0 resection and residual pathological disease after neoadjuvant CRT (nCRT) and surgery. Results: We identified 1916 patients of median age of 67 years and predominantly male (76%). The majority (79%) received surgery and 21% of patients received dCRT. In resected patients, 83% received nCRT, 10% neoadjuvant chemotherapy (with or without adjuvant CRT) and 7% received no (neo)adjuvant treatment. Compared to the resected group, the population receiving dCRT had significantly fewer males (65% vs 78%), a higher median age (72 vs 65 years) and worse performance status. Patients receiving dCRT significantly shorter median DFS (14.2 months) and OS (20.9 months) compared to resected patients (DFS: 26.4 months, p < 0.001; OS: 40.5 months, p < 0.001). The 1- and 3-year DFS probabilities were 68% and 44%, respectively, in resected patients, and 56% and 24%, respectively, in patients receiving dCRT. In patients receiving nCRT followed by surgery, the median DFS and OS were 25.2 and 38.0 months, respectively, and 1- and 3-year DFS probabilities were 67% and 43%, respectively. In the sub-analysis (n = 725) the median DFS and OS were 19.2 and 29.4 months, respectively, and the 1- and 3-year DFS rates were 62% and 36%, respectively. Conclusions: Although patients are treated with curative intent, a considerable amount of patients with non-metastatic EC or GEJC experienced recurrence within two years. Resected patients had a higher DFS and OS compared to patients receiving dCRT.

scholarly journals Preoperative Sarcopenia is Associated with Poorer Compliance Rate of Adjuvant Chemotherapy and Worse Disease-free Survival of Patients with Stage Ⅲ Colon Cancer

2021 ◽  
Author(s):  
Liang Yu ◽  
Guangliang Chen ◽  
Zongbin Xu ◽  
Pan Chi ◽  
Zhifen Chen
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Perioperative Complications ◽  
Compliance Rate ◽  
Disease Free Survival ◽  
Perioperative Outcomes ◽  
Significant Prognostic Factor ◽  
Important Indicator

Abstract Purpose: Preoperative sarcopenia has been proved to be associated with worse postoperative outcomes in cancer patients. This study aimed to evaluate whether preoperative sarcopenia affects the perioperative outcomes, adjuvant chemotherapy, and long-term outcomes of patients with stage Ⅲ colon cancer.Methods: Total 218 patients who underwent curative resection for stage Ⅲ colon cancer in our department from January, 2015 and December, 2018 were retrospectively analyzed. Sarcopenia was assessed by total psoas index, which measured the total area the level of L3 vertebral body and normalized according to patients’ height. Perioperative complications, postoperative adjuvant chemotherapy, and long-term prognosis were retrospectively analyzed.Results: Of 218 patients, 100(45.9%) patients were diagnosed with sarcopenia. Sarcopenia did not add the risk of perioperative complications (20.0% vs 15.3%, P=0.357), but it increased hospital stays (7.6±3.9 vs 6.7±2.2 days, P=0.042). Patients with sarcopenia had a lower rate of receiving adjuvant chemotherapy (70.0% vs 82.2%, p=0.033) and less likely to receive adequate adjuvant chemotherapy (58.6% vs 70.1, P=0.08). Patients with adequate adjuvant chemotherapy had significantly better 3-year OS (89.8% vs 79.5, P=0.005) and a tendency of better 3-year DFS (76.4% vs 63.6%, P=0.055) than those with inadequate adjuvant chemotherapy and Non-adjuvant chemotherapy. Compared with the patients without sarcopenia, patients with sarcopenia had significantly worse 3-year DFS (76.9% vs 62.8%, P=0.026).Conclusion: Preoperative sarcopenia was an important indicator to predict the compliance of AC in stage Ⅲ colon cancer patients, and it is also a significant prognostic factor of worse 3-year DFS.

Adjuvant treatment for resected rectal cancer: Effect of postoperative oxaliplatin added to 5-FU in the neoadjuvant era.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 672-672
Author(s):  
Benjamin Garlipp ◽  
Patrick Stuebs ◽  
Hans Lippert ◽  
Karsten Ridwelski ◽  
Henry Ptok ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Adjuvant Treatment ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Data Set ◽  
Cox Regression Analysis ◽  
The Impact

672 Background: Oxaliplatin (Ox) added to postoperative 5-fluorouracil (5FU) based adjuvant treatment has shown a survival benefit in colon cancer. For rectal cancer, the impact of Ox on survival has almost exclusively been tested in studies using 5FU +/- Ox both as a component of preoperative chemoradiotherapy (CRT) and as adjuvant treatment. Only one study (NCT00807911) investigated adjuvant 5FU +/- Ox in patients undergoing preop 5FU based CRT without Ox. Thus, the evidence for the benefit of adding Ox to adjuvant 5FU in patients treated with preop 5FU based CRT is limited. Methods: Data from the prospective German multicenter Quality Assurance in Rectal Cancer observational trial involving more than 300 hospitals of all levels of care throughout Germany were retrospectively analyzed. Patients undergoing R0 total mesorectal excision (TME) for rectal cancer following neoadjuvant 5FU based treatment without oxaliplatin between 01/01/2008 and 12/31/2010 were included. Disease-free survival (DFS) in patients receiving adjuvant treatment with or without Ox was compared using the Kaplan Meier method. The impact of adjuvant treatment with 5FU with or without Ox on DFS was investigated in a Cox regression analysis including open vs. laparoscopic approach, pT stage, pN stage, tumor grading, TME quality grade, and presence of anastomotic leakage as potential confounding factors. Results: The entire data set included 1,861 patients. Data for all variables investigated were available for 599 patients of whom 512 (85%) and 89 (15%) received 5FU based adjuvant treatment without and with Ox, respectively. Mean DFS was not different in patients receiving 5FU only vs. 5FU with Ox (p=0.103). Cox regression analysis revealed no significant impact of adding Ox to adjuvant 5FU on DFS. Of all factors analyzed, only pN2 (vs. pN0) status had an independent adverse effect on DFS (Hazard ratio 4.22, p<0.001). Conclusions: These data indicate that adjuvant Ox added to 5FU does not provide a DFS benefit in rectal cancer patients treated with preoperative 5FU based CRT under routine care conditions. Rectal cancer patients may be different from patients with colon cancer with respect to benefit from adjuvant Ox.

scholarly journals Impact of examined lymph node count on long-term survival of T1-2N0M0 double primary NSCLC patients after surgery: a SEER study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8692 ◽  
Author(s):  
Kan Jiang ◽  
Xiaohui Zhi ◽  
Yue Shen ◽  
Yuanyuan Ma ◽  
Xinyu Su ◽  
...  
Keyword(s):  
Cox Regression ◽  
Early Stage ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Cutoff Value ◽  
Long Term Survival ◽  
Lymph Node Count ◽  
Primary Nsclc ◽  
Nsclc Patients

Purpose The relationship between examined lymph nodes (ELN) and survival has been confirmed in several single early-stage malignancies. We studied the association between the ELN count and the long-term survival of T1-2N0M0 double primary non-small cell lung cancer (DP-NSCLC) patients after surgery, based on the Surveillance, Epidemiology and End Results (SEER) database. Methods A total of 948 patients were identified and their independent prognostic factors were analyzed. These factors included the ELN count, which related to overall survival (OS) and the cancer-specific survival (CSS) of synchronous (n = 426) and metachronous (n = 522) T1-2N0M0 DP-NSCLC patients after surgery. Results X-tile analysis indicated that the cutoff value for the sum of ELNs was 22 for both OS and CSS in the synchronous DP-NSCLC group. Patients with a sum of ELNs >22 were statistically more likely to survive than those with ≤22 ELNs. X-tile analysis revealed that the ELN count of the second lesion was related to both OS and CSS in the metachronous DP-NSCLC group. The optimal cutoff value was nine. These results were confirmed using univariate and multivariate Cox regression analyses. Conclusion Our findings indicate that ELN count was highly correlated with the long-term survival of T1-2N0M0 double primary NSCLC patients after surgery.

scholarly journals Exploration of a Modified Stage for pN0 Colon Cancer Patients

2021 ◽  
Author(s):  
Yunxiao Liu ◽  
Hao Zhang ◽  
Yuliuming Wang ◽  
Mingyu Zheng ◽  
Chunlin Wang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Validation Cohort ◽  
Predictive Accuracy ◽  
Model Fitting ◽  
Cancer Specific Survival ◽  
T Stage ◽  
N Stage ◽  
Medical University

Abstract Purpose: Exploring a modified stage (mStage) for pN0 colon cancer patients.Methods: 39637 pN0 colon cancer patients were collected from the SEER database (2010-2015) (development cohort) and 455 pN0 colon cancer patients from the Second Affiliated Hospital of Harbin Medical University (2011-2015) (validation cohort). The optimal lymph nodes examined (LNE) stratification for cancer-specific survival (CSS) was obtained by X-tile software. LNE is combined with conventional T stage to form the mStage.Results: The novel N stage was built based on the LNE (N0a: LNE ≥ 26, N0b: LNE = 10-25 and N0c: LNE < 10). The mStage include mStageA (T1N0a, T1N0b, T1N0c and T2N0a), mStageB (T2N0b, T2N0c and T3N0a), mStageC (T3N0b), mStageD (T3N0c, T4aN0a and T4bN0a), mStageE (T4aN0b and T4bN0b) and mStageF (T4aN0c and T4bN0c). Cox regression model showed that mStage was an independent prognostic factor. AUC showed that the predictive accuracy of mStage was better than the conventional T stage for 5-year CSS in the development (0.700 vs 0.678, P < 0.001) and validation cohort (0.649 vs 0.603, P = 0.018). The C-index also showed that mStage had a superior model-fitting.Conclusions: For pN0 colon cancer patients, mStage might be superior to conventional T stage in predicting the prognosis.

Effectiveness of capecitabine plus oxaliplatin for advanced colon cancer: A public hospital experience.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 570-570
Author(s):  
Carrie Luu ◽  
Johnathan Velasquez ◽  
Amy Kaji ◽  
Bruce E. Stabile ◽  
Beverley A Petrie ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Public Hospital ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Stage Ii ◽  
Stage Iii ◽  
Curative Intent ◽  
Advanced Colon Cancer

570 Background: Adjuvant chemotherapy has been shown to improve disease-free survival (DFS) and overall survival (OS) in advanced colon cancer (CC). 5-fluorouracil (5-FU)/leucovorin and oxaliplatin is the first line therapy for stage II and III CC. Due to systematic and financial constraints imposed by administering infusional 5-FU, this agent is not available at our institution. Capecitabine plus oxaliplatin (CAPOX) has been studied by others as a possible alternative. We report our experience with CAPOX in the adjuvant treatment of CC patients in a large, public hospital. Methods: A retrospective study of 142 patients with CC who received CAPOX from 2005 to 2011 was performed. Data on patient demographics, treatment, disease recurrence, and survival were analyzed. Survival was assessed by the Kaplan-Meier method. The Cox regression model was used for multivariate analysis. Results: There were 60 female and 82 male patients with a mean age of 54 years (range 21-80). 57 patients were diagnosed with stage II CC and 85 with stage III CC. All patients with stage II and stage III disease underwent curative-intent surgical resection, except for one patient, who refused surgery. 14/141 operations (10%) were performed emergently. Mean follow-up was 36 months (range 2-85 months). The 3-year OS rates were 91% and 81% for stages II and III, respectively. The 3-year DFS rate was 74% for stage II and 66% for stage III. By multivariate analysis, only cancer stage was predictive of overall survival. Conclusions: CAPOX is an effective treatment for stage II and III CC in the adjuvant setting. Our study supports recent evidence demonstrating the efficacy of CAPOX in CC. Ease of administration and improved utilization of resources make it an ideal regimen for public hospital facilities.

Timing of first surveillance colonoscopy in stage I colon cancer patients and the association with colon cancer-specific survival.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 618-618
Author(s):  
Robert Brooks Hines ◽  
Md Jibanul Haque Jiban ◽  
Adrian V. Specogna ◽  
Priya Vishnubhotla ◽  
Eunkyung Lee ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Stage I ◽  
Absolute Difference ◽  
Number Needed To Treat ◽  
Surveillance Colonoscopy ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Increased Risk

618 Background: Surveillance colonoscopy following curative surgery in stage I colon cancer patients is controversial. This study was conducted to assess the relationship between timing of first surveillance colonoscopy and 5-year colon cancer-specific survival. Methods: This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Stage I colon cancer patients (66-84 years of age) were categorized according to receipt of first colonoscopy following cancer-directed surgery as: Year 1, Year 2, Year 3, and No Colonoscopy within 3 years of surgery. Propensity score weighting was used to balance covariates. Cox regression was used to obtain hazard ratios for the relative risk of 5-year colon cancer-specific death, adjusted survival estimates, and the number needed to treat (NNT) with colonoscopy in Year 1 to prevent a colon cancer-specific death in the other groups. Results: There were 8,494 stage I colon cancer patients available for analysis. Regarding 5-year colon cancer-specific mortality, compared to Year 1 patients, the No Colonoscopy group experienced 2.2 times the risk of colon cancer-specific death (HR, 2.23; 95% CI, 1.38 to 3.61). Those who received ≥ 1 additional colonoscopies in the two years following their initial assessment experienced a significant 73% decreased risk of death (HR, 0.27; 95% CI, 0.16 to 0.45). Delaying colonoscopy (Years 2 & 3) did not result in a statistically significant increased risk of death. Although the absolute difference in 5-year adjusted survival was small, if all patients in the No Colonoscopy group received a colonoscopy in Year 1, 46.2% (n = 49.9) of the 108 colon cancer deaths that occurred in this group could have been prevented. Conclusions: Although stage I colon cancer patients have a good prognosis, patients who received colonoscopy within one year of cancer-directed surgery experienced significantly better survival than patients who did not receive colonoscopy within 3 years of surgery. The results of this study justify efforts to ensure that stage I colon cancer patients receive colonoscopic surveillance testing approximately 1 year following cancer-directed surgery.

scholarly journals Effects of marital status on overall and cancer-specific survival in laryngeal cancer patients: a population-based study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhao Ding ◽  
Deshun Yu ◽  
Hefeng Li ◽  
Yueming Ding
Keyword(s):  
Marital Status ◽  
Cancer Patients ◽  
Laryngeal Cancer ◽  
Cox Regression ◽  
Group Analysis ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Prognostic Effect ◽  
The Difference

AbstractMarital status has long been recognized as an important prognostic factor for many cancers, however its’ prognostic effect for patients with laryngeal cancer has not been fully examined. We retrospectively analyzed 8834 laryngeal cancer patients in the Surveillance Epidemiology and End Results database from 2004 to 2010. Patients were divided into four groups: married, widowed, single, and divorced/separated. The difference in overall survival (OS) and cancer-specific survival (CSS) of the various marital subgroups were calculated using the Kaplan–Meier curve. Multivariate Cox regression analysis screened for independent prognostic factors. Propensity score matching (PSM) was also conducted to minimize selection bias. We included 8834 eligible patients (4817 married, 894 widowed, 1732 single and 1391 divorced/separated) with laryngeal cancer. The 5-year OS and CSS of married, widowed, single, and separated/divorced patients were examined. Univariate and multivariate analyses found marital status to be an independent predictor of survival. Subgroup survival analysis showed that the OS and CSS rates in widowed patients were always the lowest in the various American Joint Committee on Cancer stages, irrespective of sex. Widowed patients demonstrated worse OS and CSS in the 1:1 matched group analysis. Among patients with laryngeal cancer, widowed patients represented the highest-risk group, with the lowest OS and CSS.

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