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Barbaro A, Bunjo Z, Asokan G, Kanhere A, Kuan LL, Trochsler M, Kanhere H, Maddern GJ. Impact of surgical specialization on emergency upper gastrointestinal surgery outcomes: A systematic review and meta-analysis. World J Surg 2024; 48:1941-1949. [PMID: 38956401 DOI: 10.1002/wjs.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Emergency presentations make up a large proportion of a general surgeon's workload. Patients who have emergency surgery carry a higher rate of mortality and complications. We aim to review the impact of surgical subspecialization on patients following upper gastrointestinal (UGI) emergency surgery. METHODS A systematic search of Ovid Embase, Ovid MEDLINE, and Cochrane databases using a predefined search strategy was completed reviewing studies published from 1st of January 1990 to August 27, 2023. The study was prospectively registered with PROSPERO (CRD42022359326). Studies were reviewed for the following outcomes: 30-day mortality, in-hospital mortality, conversion to open, length of stay, return to theater, and readmission. RESULTS Of 5181 studies, 24 articles were selected for full text review. Of these, seven were eligible and included in this study. There was a statistically significant improvement in 30-day mortality favoring UGI specialists (OR 0.71 [95% CI 0.55-0.92 and p = 0.009]) and in-hospital mortality (OR 0.29 [95% CI 0.14-0.60 and p = 0009]). There was a high degree of study heterogeneity in 30-day mortality; however, a low degree of heterogeneity within in-hospital mortality. There was no statistical significance when considering conversion to open and insufficient data to allow meta-analysis for return to theater or readmission rates. CONCLUSION In emergency UGI surgery, there was improved 30-day and in-hospital mortality for UGI specialists. Therefore, surgeons should consider early involvement of a subspecialist team to improve patient outcomes.
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Affiliation(s)
- Antonio Barbaro
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Zachary Bunjo
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Gayatri Asokan
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Akshay Kanhere
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Li Lian Kuan
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Markus Trochsler
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Division of Upper Gastrointestinal Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Harsh Kanhere
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
- Division of Upper Gastrointestinal Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guy J Maddern
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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2
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Lv Y, Zheng P, Mao Y, Xu Y, Chang W, Lin Q, Ji M, Ye L, Tang W, Xu J. Intratumor APOL3 delineates a distinctive immunogenic ferroptosis subset with prognosis prediction in colorectal cancer. Cancer Sci 2024; 115:257-269. [PMID: 37986654 PMCID: PMC10823281 DOI: 10.1111/cas.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
With the essential role of lipid transporting signaling in cancer-related immunity, apolipoprotein L3 (APOL3), a member of the apolipoprotein L gene family, demonstrated significant modulation ability in immunity. However, the expression profile and critical role of APOL3 in colorectal cancer (CRC) remain unclear. This study aimed to investigate the prognostic significance of APOL3 expression and its biological predictive value in CRC. The study enrolled multiple cohorts, consisting of 911 tumor microarray specimens of CRC patients from Zhongshan Hospital, 412 transcriptional data from The Cancer Genome Atlas, and 30 single-cell RNA sequencing (scRNA-seq) from internal and external CRC patients. APOL3 mRNA expression was directly acquired from public datasets, and APOL3 protein expression was detected using immunohistochemistry. Finally, the associations of APOL3 expression with clinical outcomes, immune context, and genomic and ferroptotic features were analyzed. Low APOL3 expression predicted poor prognosis and inferior responsiveness to 5-fluorouracil-based adjuvant chemotherapy (ACT) and targeted therapy. APOL3 fosters an immune-active microenvironment characterized by the promotion of ferroptosis, downregulation of macrophages, and upregulation of CD8+ T cell infiltration. Moreover, the expression of APOL3 in CD8+ T cells is intrinsically linked to ferroptosis and immune activation in CRC. In summary, APOL3 serves as an independent prognosticator and predictive biomarker for immunogenic ferroptosis, ACT, and targeted therapy in CRC. Furthermore, the APOL3 signaling activator could be a novel agent alone or in combination with current therapeutic strategies for CRC.
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Affiliation(s)
- Yang Lv
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Peng Zheng
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Yihao Mao
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Yuqiu Xu
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Wenju Chang
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Qi Lin
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Meiling Ji
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Lechi Ye
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Wentao Tang
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Jianmin Xu
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
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3
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Liang LA, Tseng YJ, Tanaka LF, Klug SJ. Second primary cancer among 217702 colorectal cancer survivors: An analysis of national German cancer registry data. Int J Cancer 2023; 153:1459-1471. [PMID: 37392091 DOI: 10.1002/ijc.34638] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
With improvements in survival after colorectal cancer (CRC), more survivors are at risk of developing a second cancer, particularly in younger populations where CRC incidence is increasing. We estimated the incidence of second primary cancer (SPC) in CRC survivors and its potential risk factors. We identified CRC cases diagnosed between 1990 and 2011 and SPCs until 2013 from nine German cancer registries. Standardized incidence ratios (SIR) and absolute excess risk (AER) per 10 000 person-years were calculated and were stratified by index site: colon cancer (CC) and rectal cancer (RC), age and sex. Cox regression assessed potential SPC risk factors, including primary tumor-related therapy considering death as a competing risk. We included 217 202 primary CRC cases. SPC occurred in 18 751 CRC survivors (8.6%; median age: 69 years). Risk of cancer was significantly higher in CRC survivors than in the general population (SIR males 1.14, 95% confidence interval [CI] 1.12-1.17, AER = 24.7; SIR females 1.20, 95% CI 1.17-1.23, AER = 22.8). Increased risks of SPCs were observed for the digestive system, urinary system and female and male reproductive organs. CRC incidence increased in younger persons (<50 years) and SPC incidence was 4-fold in this group (SIR males 4.51, 95% CI 4.04-5.01, AER = 64.2; SIR females 4.03, 95% CI 3.62-4.48, AER = 77.0). Primary tumor-related factors associated with SPC risk were right-sided cancer and smaller primary tumor size. Treatment and risk of SPC differed for CC (no effect) and RC (lower risk after chemotherapy). CRC survivors have excess risk of developing SPC, with particular characteristics that could guide targeted surveillance.
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Affiliation(s)
- Linda A Liang
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Ying-Ju Tseng
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Luana F Tanaka
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Silva TH, Sillos André JC, Orlando Correa Schilithz A, Borges Murad L, Arantes Ferreira Peres W. Prediction of survival of preoperative colorectal patients: A new tool to assess the interaction of nutritional status and inflammation. Clin Nutr ESPEN 2023; 56:230-236. [PMID: 37344078 DOI: 10.1016/j.clnesp.2023.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is responsible for the second leading cause of cancer death worldwide. Thus, the aim of this study was to investigate the application of a new nutritional status and inflammatory tool to predict overall survival (OS) in patients with CRC in the preoperative period. METHODS Retrospective cohort study with CRC patients of both sexes treated at a hospital unit, aged ≥20 years. Data were extracted between 2007 and 2015. Multivariate Cox's models were employed to predict OS utilizing a new grade classification system (body mass index vs. percentage weight loss - BMI/%WL), inflammatory markers and clinical data. RESULTS We evaluated 361 patients. BMI/%WL grade 3-4 (HR: 2.01; p = 0.001; 95% CI: 1.34-3.02) were independent predictors of poor OS. Moreover, BMI/%WL grade 3-4 + neutrophil-to-lymphocyte ratio (NLR) ≥2.4 (HR: 2.79; p = 0.001; 95% CI: 1.54-5.03) increased the death risk in 5-years. However, low NLR (<2.4) altered the OS prognostic ability of the BMI/%WL (HR: 1.72; p = 0.099; 95% CI: 0.90-3.28). CONCLUSION BMI/%WL was independent predictors of poor OS and the interaction with NLR produced an adjustment effect. These associated tools may be useful in the clinical management of preoperative patients with CRC.
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Affiliation(s)
| | - Julio Cezar Sillos André
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil; National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
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Qu A, Wang Q, Chang Q, Liu J, Yang Y, Zhang X, Zhang Y, Zhang X, Wang H, Zhang Y. Prognostic and predictive value of a lncRNA signature in patients with stage II colon cancer. Sci Rep 2023; 13:1350. [PMID: 36693876 PMCID: PMC9873786 DOI: 10.1038/s41598-022-25852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/06/2022] [Indexed: 01/26/2023] Open
Abstract
The current staging method is inadequate to identify high-risk recurrence patients with stage II colon cancer (CC). Using a systematic and comprehensive-biomarker discovery and validation method, we aimed to construct a lncRNA-based signature to improve the prognostic prediction of stage II CC. We identified 1,377 differently expressed lncRNAs by analyzing 16 paired stage II CC tumor tissue and adjacent normal mucosal tissue from the TCGA dataset. Subsequently, using a univariable and step multivariable Cox regression model, we trained an 11-lncRNA signature in the training cohort (n = 141), which could divide patients into high-risk and low-risk groups (AUC at 3 years = 0.801, 95% CI: 0.724-0.877; AUC at 5 years = 0.801, 95% CI: 0.718-0.885). Significantly, patients in the high-risk group had poorer recurrence-free survival (RFS) compared with the low-risk group (log-rank test, P < 0.001 in the training cohort). This lncRNA-based signature was further confirmed in the validation cohort (P < 0.001). Multivariate Cox regression and stratified survival analyses showed that the prognostic value of this signature was independent of other clinicopathological risk factors (CEA, T stage, and chemotherapy). Time-dependent receiver operating characteristic (ROC) analysis demonstrated that this signature had better prognostic ability than any other clinical risk factors or single lncRNAs (all P < 0.05). A nomogram was constructed for clinical use, which integrated both the lncRNA-based signature and clinical risk factors (CEA and T stage) and performed well in the calibration plots. Altogether, our lncRNA-based signature was an independent prognostic factor and possessed a stronger predictive power compared with the currently used clinicopathological risk factors when predicting the recurrence of patients with stage II CC. Collectively, this lncRNA-based signature might facilitate individualized treatment decisions and postoperative counseling, ultimately contributing to improved survival.
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Affiliation(s)
- Ailin Qu
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China
| | - Qian Wang
- Department of Gastroenterology, Central Hospital, Shandong First Medical University, Jinan, 250011, Shandong Province, People's Republic of China
| | - Qing Chang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China
| | - Jingkang Liu
- Department of Gynecology, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Yongmei Yang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China
| | - Xin Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China
| | - Yanli Zhang
- Department of Clinical Laboratory, Shandong Provincial Third Hospital, Jinan, 250031, Shandong Province, People's Republic of China
| | - Xiaoshi Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China
| | - Hongchun Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China.
| | - Yi Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Wenhua Xi Road, Jinan, 250012, Shandong Province, People's Republic of China.
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6
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Lv Y, Feng Q, Zhang Z, Zheng P, Zhu D, Lin Q, Chen S, Mao Y, Xu Y, Ji M, Xu J, He G. Low ferroptosis score predicts chemotherapy responsiveness and immune-activation in colorectal cancer. Cancer Med 2022; 12:2033-2045. [PMID: 35855531 PMCID: PMC9883409 DOI: 10.1002/cam4.4956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Existing studies for ferroptosis and prognosis in colorectal cancer (CRC) were limited. In this study, we aim to investigate the prognostic role of ferroptosis markers in patients with CRC and exploration of its micro-environmental distributions. METHODS Immunohistochemical staining was performed for CRC patients' tissue microarray. Selection and prognostic validation of markers were based on mRNA data from the cancer genome atlas (TCGA) database. Gene Set Enrichment Analysis (GSEA) was performed to indicate relative immune landmarks and hallmarks. Ferroptosis and immune contexture were examined by CIBERSORT. Survival outcomes were analyzed by Kaplan-Meier analysis and cox analysis. RESULTS A panel of 42 genes was selected. Through mRNA expression difference and prognosis analysis, GPX4, NOX1 and ACSL4 were selected as candidate markers. By IHC, increased GPX4, decreased NOX1 and decreased FACL4 indicate poor prognosis and worse clinical characteristics. Ferroptosis score based on GPX4, NOX1 and ACSL4 was constructed and validated with high C-index. Low ferroptosis score can also demonstrate the better progression free survival and better adjuvant chemotherapy (ACT) responsiveness. Moreover, tumor with low ferroptosis score tend to be infiltrated with more CD4+ T cells, CD8+ T cells and less M1 macrophage. Finally, we found that IFN-γ was potentially the central molecule at the crossroad between ferroptosis and onco-immune response. CONCLUSION Ferroptosis plays important role on CRC tumor progression, ACT response and prognosis. Ferroptosis contributes to immune-supportive responses and IFN-γ was the central molecule for this process.
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Affiliation(s)
- Yang Lv
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Qing‐Yang Feng
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Zhi‐Yuan Zhang
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Peng Zheng
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - De‐xiang Zhu
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Qi Lin
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Si‐min Chen
- Department of PathologyAffiliated Hospital of Nanjing University of Chinese MedicineNanjingJiangsuChina
| | - Yi‐Hao Mao
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yu‐Qiu Xu
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Mei‐ling Ji
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Jian‐Min Xu
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Guo‐dong He
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
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7
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Yang L, WenTao T, ZhiYuan Z, Qi L, YuXiang L, Peng Z, Ke L, XiaoNa J, YuZhi P, MeiLing J, QingYang F, GuoDong H, YueXiang W, JianMin X. Cullin-9/p53 mediates HNRNPC degradation to inhibit erastin-induced ferroptosis and is blocked by MDM2 inhibition in colorectal cancer. Oncogene 2022; 41:3210-3221. [PMID: 35505093 DOI: 10.1038/s41388-022-02284-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 02/27/2022] [Accepted: 03/17/2022] [Indexed: 01/05/2023]
Abstract
Colorectal cancer (CRC) is the leading cause of cancer associated death worldwide. Ferroptosis is a newly defined form of regulated cell death characterized by the accumulation of lipid hydroperoxides and exerts an increased attention for cancer treatment. However, little is known about ferroptosis in CRC. In this study, through whole genome sequencing and external differential differentiated expression analysis, we identify CUL9 as a novel important modulator for ferroptosis in CRC. Here we demonstrated that CUL9 can binds p53 to ubiquitylate heterogeneous nuclear ribonucleoprotein C for degradation. Overexpression of CUL9 increases resistance to erastin-induced ferroptosis. Then, we discovered this resistance was mediated by CUL9-HNRNPC-MATE1 negative loop, which can provide us with a novel target to overcome drug resistance to ferroptosis activators. Finally, we found that targeting MDM2 was developed as an effective strategy to destroy precious drug-resistant CRC cells.
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Affiliation(s)
- Lv Yang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tang WenTao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - Zhang ZhiYuan
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - Lin Qi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - Luo YuXiang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Zheng Peng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - Li Ke
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Jia XiaoNa
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Pang YuZhi
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Ji MeiLing
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - Feng QingYang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - He GuoDong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China
| | - Wang YueXiang
- CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Xu JianMin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. .,Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China. .,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Surgery, Shanghai, China.
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8
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Chioreso C, Gao X, Gribovskaja-Rupp I, Lin C, Ward MM, Schroeder MC, Lynch CF, Chrischilles EA, Charlton ME. Hospital and Surgeon Selection for Medicare Beneficiaries With Stage II/III Rectal Cancer: The Role of Rurality, Distance to Care, and Colonoscopy Provider. Ann Surg 2021; 274:e336-e344. [PMID: 31714306 PMCID: PMC7176526 DOI: 10.1097/sla.0000000000003673] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine factors associated with rectal cancer surgery performed at high-volume hospitals (HVHs) and by high-volume surgeons (HVSs), including the roles of rurality and diagnostic colonoscopy provider characteristics. SUMMARY OF BACKGROUND DATA Although higher-volume hospitals/surgeons often achieve superior surgical outcomes, many rectal cancer resections are performed by lower-volume hospitals/surgeons, especially among rural populations. METHODS Patients age 66+ diagnosed from 2007 to 2011 with stage II/III primary rectal adenocarcinoma were selected from surveillance, epidemiology, and end results-medicare data. Patient ZIP codes were used to classify rural status. Hierarchical logistic regression was used to determine factors associated with surgery by HVH and HVS. RESULTS Of 1601 patients, 22% were rural and 78% were urban. Fewer rural patients received surgery at a HVH compared to urban patients (44% vs 65%; P < 0.0001). Compared to urban patients, rural patients more often had colonoscopies performed by general surgeons (and less often from gastroenterologists or colorectal surgeons), and lived substantially further from HVHs; these factors were both associated with lower odds of surgery at a HVH or by a HVS. In addition, whereas over half of both rural and urban patients received their colonoscopy and surgery at the same hospital, rural patients who stayed at the same hospital were significantly less likely to receive surgery at a HVH or by a HVS compared to urban patients. CONCLUSIONS Rural rectal cancer patients are less likely to receive surgery from a HVH/HVS. The role of the colonoscopy provider has important implications for referral patterns and initiatives seeking to increase centralization.
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Affiliation(s)
- Catherine Chioreso
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Xiang Gao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Marcia M. Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA
| | - Mary C. Schroeder
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Charles F. Lynch
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA
| | | | - Mary E. Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, IA
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9
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Koëter T, de Nes LCF, Wasowicz DK, Zimmerman DDE, Verhoeven RHA, Elferink MA, de Wilt JHW. Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands. BJS Open 2021; 5:6325344. [PMID: 34291288 PMCID: PMC8295312 DOI: 10.1093/bjsopen/zrab065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/28/2021] [Indexed: 01/18/2023] Open
Abstract
Background This study aimed to examine the sphincter-preservation rate variations in rectal cancer surgery. The influence of hospital volume on sphincter-preservation rates and short-term outcomes (anastomotic leakage (AL), positive circumferential resection margin (CRM), 30- and 90-day mortality rates) were also analysed. Methods Non-metastasized rectal cancer patients treated between 2009 and 2016 were selected from the Netherlands Cancer Registry. Surgical procedures were divided into sphincter-preserving surgery and an end colostomy group. Multivariable logistic regression models were generated to estimate the probability of undergoing sphincter-preserving surgery according to the hospital of surgery and tumour height (low, 5 cm or less, mid, more than 5 cm to 10 cm, and high, more than 10 cm). The influence of annual hospital volume (less than 20, 20–39, more than 40 resections) on sphincter-preservation rate and short-term outcomes was also examined. Results A total of 20 959 patients were included (11 611 sphincter preservation and 8079 end colostomy) and the observed median sphincter-preservation rate in low, mid and high rectal cancer was 29.3, 75.6 and 87.9 per cent respectively. After case-mix adjustment, hospital of surgery was a significant factor for patients’ likelihood for sphincter preservation in all three subgroups (P < 0.001). In mid rectal cancer, borderline higher rates of sphincter preservation were associated with low-volume hospitals (odds ratio 1.20, 95 per cent c.i. 1.01 to 1.43). No significant association between annual hospital volume and sphincter-preservation rate in low and high rectal cancer nor short-term outcomes (AL, positive CRM rate and 30- and 90-day mortality rates) was identified. Conclusion This population-based study showed a significant hospital variation in sphincter-preservation rates in rectal surgery. The annual hospital volume, however, was not associated with sphincter-preservation rates in low, and high rectal cancer nor with other short-term outcomes.
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Affiliation(s)
- T Koëter
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L C F de Nes
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Surgery, Maasziekenhuis Pantein, Boxmeer, The Netherlands
| | - D K Wasowicz
- Department of Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - D D E Zimmerman
- Department of Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - M A Elferink
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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10
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Huijts DD, Dekker JWT, van Bodegom-Vos L, van Groningen JT, Bastiaannet E, Marang-van de Mheen PJ. Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery. Int J Qual Health Care 2021; 33:6156887. [PMID: 33677517 PMCID: PMC7948387 DOI: 10.1093/intqhc/mzab038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background Emergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed. Objective To explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery. Methods An observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix. Results Patients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]). Conclusion This study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.
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Affiliation(s)
- Daniëlle D Huijts
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier de Graaf Group, Reinier de Graafweg 5, Delft 2600 GA, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Julia T van Groningen
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden 2333 ZA, The Netherlands.,Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands
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11
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Wu Y, Guo T, Xu Z, Liu F, Cai S, Wang L, Xu Y. Risk scoring system for recurrence after simultaneous resection of colorectal cancer liver metastasis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:966. [PMID: 34277766 PMCID: PMC8267263 DOI: 10.21037/atm-21-2595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/11/2021] [Indexed: 12/30/2022]
Abstract
Background The simultaneous resection of synchronous colorectal cancer liver metastasis (SCRLM) has been widely applied. It is necessary to establish a risk scoring system to predict post-operative recurrence, especially in patients with neoadjuvant treatment. Methods The medical records of 221 patients undergoing simultaneous resection of CRLM were assessed in this study with a further 128 patients allocated to a validation group. All patients in the study group were classified according to their history of neoadjuvant treatment and univariate and multivariate analyses were applied to study independent risk factors. A score model was then generated according to the factors included. Our data set were also applied to validate three other existing scoring models [Fong clinical recurrence score (CRS), Konopke, and Zakaria disease-free survival (DFS) score], and the concordance index was calculated for comparison among these models. Results CRLM involving more than three nodes positive for a primary tumor was considered an independent risk factor for progression in patients without neoadjuvant treatment and all score models could discretely stratify patients according to disease free survival. In patients receiving neoadjuvant treatment, CRLM involving more than one node and transfusion invasion were major determinants in patients after treatment. However, only our scoring system and Fong’s CRS score could discretely discriminate patients. In the validation group, patients were significantly classified with the score system. Conclusions Existing score models had better values for determining prognosis in patients with SCRLM, especially in those undertaking neoadjuvant treatment. Larger cohorts, along with more detailed clinical features and multicenter validation should be undertaken before utilization.
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Affiliation(s)
- Yuchen Wu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tianan Guo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhenhong Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lu Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Tong X, Zhuang Z, Wang X, Yang X, Bai L, Su L, Wei P, Su X. ACBP suppresses the proliferation, migration, and invasion of colorectal cancer via targeting Wnt/beta-catenin signaling pathway. Biomed Pharmacother 2021; 137:111209. [PMID: 33581651 DOI: 10.1016/j.biopha.2020.111209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/14/2020] [Accepted: 12/26/2020] [Indexed: 01/24/2023] Open
Abstract
Anticancer bioactive peptide (ACBP), a novel bioactive peptide isolated from spleens of goats immunized with tumor extracts in our lab, can inhibit the proliferation of CRC in vitro and vivo. However, it remains unclear how the proliferation of CRC is inhibited by ACBP at the molecular level. Here, we provide evidences showing that ACBP significantly inhibits the expression of Wnt/β-catenin related genes (cyclin D1, met and c-myc) through pharmacotranscriptomic and qRT-PCR analysis in CRCs. Active β-catenin, a key protein within Wnt pathway, was compromised remarkably by ACBP in three CRCs, including HCT116, RKO and HT29. Thus nuclear accumulation of active β-catenin was retarded and finally lead to the decreased expression of oncogenes cyclin D1, met, and c-myc. In addition, we proved that active β-catenin reduction was mainly due to the inhibition of phospho-LRP6 and stimulation of phospho-β-catenin by ACBP. Based on the detection of Met and C-Myc in CRC tumor tissue without prior radiotherapy or chemotherapy, our results demonstrated that ACBP can act as a promising anticancer agent for CRC by targeting Wnt/β-catenin pathway, especially active β-catenin.
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Affiliation(s)
- Xin Tong
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China; NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Tian Tan Xi Li, Beijing 100050, China
| | - Zhuochen Zhuang
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Tian Tan Xi Li, Beijing 100050, China
| | - Xianjue Wang
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China
| | - Xiaoyu Yang
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China
| | - Liping Bai
- NHC Key Laboratory of Biotechnology of Antibiotics, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Tian Tan Xi Li, Beijing 100050, China
| | - Liya Su
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China.
| | - Ping Wei
- Department of Medical Immunology, Basic Medical College, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian 271000, China.
| | - Xiulan Su
- Clinical Medical Research Center of the Affiliated Hospital, Inner Mongolia Medical University, Inner Mongolia Key Laboratory of Medical Cell Biology, 1 Tong Dao Street, Hohhot 010050, Inner Mongolia, China.
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13
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Contrast-Enhanced CT-based Textural Parameters as Potential Prognostic Factors of Survival for Colorectal Cancer Patients Receiving Targeted Therapy. Mol Imaging Biol 2020; 23:427-435. [PMID: 33108800 DOI: 10.1007/s11307-020-01552-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to estimate the clinical significance of the contrast-enhanced computed tomography (CT) textural features for prediction of survival in colorectal cancer (CRC) patients receiving targeted therapy (bevacizumab and cetuximab). PROCEDURES The LifeX software was used to extract the textural parameters of the tumor lesions in the contrast-enhanced CT. We used the least absolute shrinkage and selection operator (LASSO) Cox regression and random forest method to screen the non-redundant radiomic features and constructed the CT imaging score. Univariate and multivariate analyses through the Cox proportional hazards model were performed to assess the prognostic clinical factor. Based on the result of multivariate analysis and CT imaging score, combined nomogram model was constructed to predict the overall survival (OS) of patients. Decision curves analysis was employed to evaluate the performance of the combined model and clinical model. RESULTS After comparative analysis of the area under curve of the receiver operating characteristic (ROC) curve, we chose the result of random forest model as CT imaging score. Considering the clinical practice and the result of analysis, age, surgery, and lactate dehydrogenase (LDH) level have been introduced into clinical model. Based on the result of analysis and the CT imaging score, we constructed the nomogram combined model. C-index and calibration curve verified the goodness of fit and discrimination of the combined model. Decision curve analysis (DCA) demonstrated that the combined model showed the better net benefit for a 3-year OS than clinical model. CONCLUSIONS In conclusion, the study provides preliminary evidences that several radiomic parameters of tumor lesions derived from CT images were prognostic factors and predictive markers for CRC patients who are candidates for targeted therapy (bevacizumab and cetuximab).
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14
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Li Y, Yao Q, Zhang L, Mo S, Cai S, Huang D, Peng J. Immunohistochemistry-Based Consensus Molecular Subtypes as a Prognostic and Predictive Biomarker for Adjuvant Chemotherapy in Patients with Stage II Colorectal Cancer. Oncologist 2020; 25:e1968-e1979. [PMID: 32926498 PMCID: PMC8186407 DOI: 10.1002/onco.13521] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 08/25/2020] [Indexed: 01/19/2023] Open
Abstract
Background For stage II colorectal cancer (CRC), the efficacy of adjuvant chemotherapy remains controversial. Consensus molecular subtype (CMS) has been validated to be a prognostic tool for CRCs. In this study, CMS status was investigated as a prognostic biomarker for the efficacy of adjuvant chemotherapy for stage II colorectal cancer. Materials and Methods The tissue microarray was retrospectively constructed of 165 nonconsecutive, primary, and sporadic stage II CRCs. CMS status was determined by immunohistochemistry staining of CDX2, HTR2B, FRMD6, and ZEB1, combining with microsatellite instability testing. The prognostic for adjuvant chemotherapy efficacy of CMS status was calculated by Kaplan‐Meier curves and Cox regression analysis. Subgroup analyses were conducted according to tumor location. Results Kaplan‐Meier curves indicated that CMS was associated with overall survival (OS) and disease‐free survival for stage II CRCs. Cox regression analysis showed that CMS was an independent risk factor for OS. Among high‐risk clinicopathological factors, patients with CMS2/3 (hazard ratio [HR]: 0.445, 95% confidence interval [CI]: 0.227–0.875), left‐sided tumors (HR: 0.488, 95% CI: 0.247–0.968), or fewer than 12 lymph nodes examined (HR: 0.307, 95% CI: 0.097–0.974) had survival benefit from adjuvant chemotherapy. Subgroup analysis showed that adjuvant chemotherapy only improved OS for patients with left‐sided tumors of CMS2/3 subtype. Regardless of CMS, right‐sided tumors had no benefit from adjuvant chemotherapy. Conclusion CMS is a better prognostic factor for adjuvant chemotherapy for stage II CRCs. Together with tumor location, CMS classification will aid in personalized treatment for stage II CRCs. Implications for Practice For stage II colorectal cancer (CRC), the efficacy of adjuvant chemotherapy remains controversial, in that its minimal benefit (no more than 5% on average) is considered not worth the toxic effects of the drugs. There are still no effective prognostic and predictive biomarkers. This study showed that consensus molecular subtype (CMS) status is a predictive marker for adjuvant chemotherapy efficacy. Patients with left‐sided tumors of CMS2/3 subtype have survival benefit by receiving adjuvant chemotherapy, which will aid in personalized treatment for stage II CRCs. Moreover, this test of CMS based on immunohistochemistry is cheap, not time consuming, and easily conducted in the laboratories of most hospitals. Currently, no clinical evidence exists for the ability of consensus molecular subtype status to predict the efficacy of adjuvant chemotherapy for stage II colorectal cancer. This article reports results of a study that adopted an immunohistochemical‐based classifier to validate the feasibility of this approach, assessing the prognostic and predictive accuracy of consensus molecular subtype status as a biomarker for adjuvant chemotherapy compared with traditional clinicopathological high‐risk factors.
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Affiliation(s)
- Yaqi Li
- Department of Colorectal Surgery, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qianlan Yao
- Department of Pathology, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Long Zhang
- Department of Colorectal Surgery, Fudan University, Shanghai, People's Republic of China.,Cancer Institute, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Shaobo Mo
- Department of Colorectal Surgery, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Dan Huang
- Department of Pathology, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Junjie Peng
- Department of Colorectal Surgery, Fudan University, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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15
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Beck C, Weber K, Brunner M, Agaimy A, Semrau S, Grützmann R, Schellerer V, Merkel S. The influence of postoperative complications on long-term prognosis in patients with colorectal carcinoma. Int J Colorectal Dis 2020; 35:1055-1066. [PMID: 32172320 PMCID: PMC7245593 DOI: 10.1007/s00384-020-03557-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The impact of postoperative complications (POCs) on the long-term prognosis of patients with colorectal carcinoma was analysed with respect to their severity according to the Clavien-Dindo classification (CDC). METHODS The prospectively collected data of 2158 patients who underwent curative resection of a colorectal carcinoma (1168 rectal carcinomas, 990 colon carcinomas) without distant metastases from 1995 to 2014 were analysed. The POCs were documented in a standardized form and graded with the CDC. Patients who died postoperatively (CDC grade V, 1.7%) were excluded. RESULTS In total, 467 patients (21.6%) had POCs: CDC I, 141 (6.5%); CDC II, 162 (7.5%); CDC III, 112 (5.2%); and CDC IV, 52 (2.4%). More POCs and higher CDC grades were found in men, ASA III-IV patients, rectal carcinoma patients, and patients who underwent abdominoperineal excisions or multivisceral resections. The 5-year locoregional recurrence rate was 5.3% in patients without POCs and 6.6% in patients with POCs. It was highest in CDC III patients (12.9%), which was confirmed in multivariate analysis (HR 2.2; p = 0.005). The 5-year distant metastasis rate was 15.9% in CDC 0 patients and 19.5% in CDC I-IV patients. In multivariate analysis, distant metastasis was highest in CDC III patients (HR 1.7; p = 0.020). The 5-year overall survival rate was 83.5% in patients without POCs and 73.5% in patients with POCs. It was worst in CDC IV patients (63.1%), which was confirmed by multivariate analysis (HR 1.9; p = 0.001). CONCLUSION Patients with POCs after colorectal surgery have a poor long-term prognosis. As the CDC grade increases, survival deteriorates.
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Affiliation(s)
- Clemens Beck
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klaus Weber
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Brunner
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Vera Schellerer
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Merkel
- Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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16
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Biondo S, Gálvez A, Ramírez E, Frago R, Kreisler E. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol 2019; 23:1141-1161. [DOI: 10.1007/s10151-019-02110-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/02/2019] [Indexed: 02/07/2023]
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17
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Uppal A, Smieliauskas F, Sharma MR, Maron SB, Polite BN, Posner MC, Turaga K. Facilities that service economically advantaged neighborhoods perform surgical metastasectomy more often for patients with colorectal liver metastases. Cancer 2019; 126:281-292. [PMID: 31639217 DOI: 10.1002/cncr.32529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/13/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Metastasectomy of isolated colorectal liver metastases (CRLM) requires significant clinical expertise and may not be readily available or offered. The authors hypothesized that hospitals that treat a greater percentage of patients from higher income catchment areas are more likely to perform metastasectomies regardless of patient or tumor characteristics. METHODS Using the National Cancer Data Base, the authors classified facilities into facility income quartiles (FIQs) based on the percentage of patients from the wealthiest neighborhoods (by zip code). Quartile 1 included facilities with <2.1% of the patients residing within the highest income zip codes, quartile 2 included facilities with 2.2% to 15.6% of patients residing within the highest income zip codes, quartile 3 included facilities with 15.7% to 40.2% of patients residing within the highest income zip codes, and quartile 4 included facilities with 40.3% to 90.5% of patients residing within the highest income ZIP codes. Patient, tumor, and facility characteristics were analyzed using a multivariate logistic regression to identify associations between metastasectomy and FIQ. RESULTS Patients with CRLM were more likely to undergo metastasectomy at facilities in the highest FIQ compared with the lowest FIQ (18% vs 11% in FIQ4; P = .001). This trend was not observed in the resection of primary tumors for nonmetastatic CRLM (rates of 95% vs 93%; P = .94). After adjusting for individual insurance status, distance traveled, zip code-level individual income, tumor, and host, patients who were treated at the highest FIQ facilities were found to be more likely to undergo metastasectomy (odds ratio, 1.29; 95% CI, 1.02-1.72 [P = .03]). CONCLUSIONS Metastasectomy for CRLM is more likely to occur at facilities that serve a greater percentage of patients from high-income catchment areas, regardless of individual patient characteristics. This disparity uniquely affects those patients with advanced cancers for which specialized expertise for therapy is necessary.
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Affiliation(s)
- Abhineet Uppal
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Fabrice Smieliauskas
- Department of Economics, Wayne State University, Detroit, Michigan.,Department of Pharmacy Practice, Wayne State University, Detroit, Michigan
| | - Manish R Sharma
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Steven B Maron
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Blase N Polite
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Kiran Turaga
- Department of Surgery, University of Chicago, Chicago, Illinois
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18
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van Groningen JT, Marang-van de Mheen PJ, Henneman D, Beets GL, Wouters MWJM. Surgeon perceived most important factors to achieve the best hospital performance on colorectal cancer surgery: a Dutch modified Delphi method. BMJ Open 2019; 9:e025304. [PMID: 31551369 PMCID: PMC6773321 DOI: 10.1136/bmjopen-2018-025304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Hospital variation in risk-adjusted outcomes after colorectal cancer surgery has been shown. However, explanatory factors are not sufficiently clear. The objective of this study was to identify factors perceived by gastrointestinal surgeons as important to achieve excellent casemix-adjusted outcomes after colorectal cancer surgery. DESIGN Based on literature and experts' opinion, 86 factors associated with serious complications, failure to rescue and mortality were listed. These were presented to gastrointestinal surgeons through two web-based surveys and an expert meeting. Participants were asked to choose their top 10 of most important factors. PARTICIPANTS Dutch gastrointestinal surgeons (n=52) of different hospitals and different hospital types (general/teaching/academic). RESULTS Of 31 invited experts for the first survey and meeting, 71% responded. Of 130 invited surgeons, 34 responded to the second survey. Factors deemed important were: procedural hospital volume (46% in top 10), specialised surgeons performing surgery, (elective 87%, emergency 60% and reoperations 62% in top 10), accessibility of, and daily ward rounds by specialised surgeons (41% and 38% in top 10), preoperative screening for malnutrition (57% in top 10), a protocol for recognition of anastomotic leakage and rapid reintervention (54% and 49% in top 10). CONCLUSION Procedural hospital volume, specialisation of surgeons, screening for malnutrition, early recognition of complications followed by rapid action were perceived as most important factors to achieve good outcomes by gastrointestinal surgeons.
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Affiliation(s)
- Julia Tessa van Groningen
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Daniel Henneman
- Department of Surgery, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Geerard L Beets
- Department of Surgical Oncology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | - Michel W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgical Oncology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
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Lu Y, Xin D, Wang F. Predictive Significance Of Preoperative Systemic Immune-Inflammation Index Determination In Postoperative Liver Metastasis Of Colorectal Cancer. Onco Targets Ther 2019; 12:7791-7799. [PMID: 31571929 PMCID: PMC6759789 DOI: 10.2147/ott.s223419] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Systemic inflammation and immune dysfunction have been proved to be significantly associated with cancer progression and metastasis in colorectal cancer (CRC). The aim of this retrospective study was to investigate the association between preoperative systemic immune-inflammation index (SII) and postoperative liver metastasis in CRC. Patients and methods This retrospective study evaluated 182 patients with CRC who underwent surgical resection. The inflammation-based prognostic factors, including SII, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI), were calculated based on preoperative laboratory data. The univariate and multivariate logistic regression analysis was performed to identify the risk factors correlated with postoperative liver metastasis in CRC. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were respectively used to assess the predictive ability and clinical usefulness of SII for postoperative liver metastasis in CRC. Results The univariate and multivariable analysis confirmed SII was independently correlated with postoperative liver metastasis in CRC (p<0.001), and the ROC and DCA analysis demonstrated SII was superior to other inflammation-based factors in terms of predictive ability. Conclusion SII is an independent predictive indicator of postoperative liver metastasis for patients with colorectal cancer.
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Affiliation(s)
- Yao Lu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Dao Xin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
| | - Feng Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, People's Republic of China
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20
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Feng Q, Chang W, Mao Y, He G, Zheng P, Tang W, Wei Y, Ren L, Zhu D, Ji M, Tu Y, Qin X, Xu J. Tumor-associated Macrophages as Prognostic and Predictive Biomarkers for Postoperative Adjuvant Chemotherapy in Patients with Stage II Colon Cancer. Clin Cancer Res 2019; 25:3896-3907. [PMID: 30988081 DOI: 10.1158/1078-0432.ccr-18-2076] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/06/2018] [Accepted: 04/09/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE For stage II colon cancer, the efficacy of postoperative adjuvant chemotherapy remains controversial. It is well known that tumor-associated macrophages (TAMs) are important in tumor progression. In this study, TAMs were investigated as prognostic and predictive biomarkers for the efficacy of adjuvant chemotherapy for stage II colon cancer after radical resection. EXPERIMENTAL DESIGN This study enrolled two independent cohorts of consecutive patients from one medical center with pathologic stage II colon cancer after radical resections. Macrophages were detected using IHC staining of CD68 and CD206. Infiltration densities of CD68+ TAMs, CD206+ TAMs, and ratio of CD206+ TAMs/CD68+ TAMs (CD206/CD68 ratio) were calculated as prognostic and predictive biomarkers. RESULTS The primary and validation cohorts consisted of 521 and 314 patients, respectively. In both cohorts, high CD206/CD68 ratio was significantly associated with poor disease-free survival (DFS) and overall survival (OS). As an independent risk factor, CD206/CD68 ratio also had significantly better prognostic efficacy than CD68+ TAM density, CD206+ TAM density, and traditional clinicopathologic high-risk factors. Moreover, adjuvant chemotherapy significantly improved DFS and OS for patients with high CD206/CD68 ratio but not for those with low CD206/CD68 ratio. The interaction analyses were also significant for DFS. In subgroup analysis, CD206/CD68 ratio was still a significant predictor for adjuvant chemotherapy for patients in traditional high-risk group of recurrence (significant interaction for DFS). CONCLUSIONS For stage II colon cancer, CD206/CD68 ratio is a better prognostic and predictive biomarker for postoperative adjuvant chemotherapy. Together with clinicopathologic high-risk factors, it will aid in precision treatment.
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Affiliation(s)
- Qingyang Feng
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Wenju Chang
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Yihao Mao
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Guodong He
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Peng Zheng
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Wentao Tang
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Ye Wei
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Li Ren
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Dexiang Zhu
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Meiling Ji
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Yongjiu Tu
- The 174th Hospital of PLA, Xiamen, Fujian Province, China
| | - Xinyu Qin
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China. .,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Jianmin Xu
- General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China. .,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
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21
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Lee CHA, Kong JCH, Heriot AG, Warrier S, Zalcberg J, Sitzler P. Short-term outcome of emergency colorectal cancer surgery: results from Bi-National Colorectal Cancer Audit. Int J Colorectal Dis 2019; 34:63-69. [PMID: 30269226 DOI: 10.1007/s00384-018-3169-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUNDS A significant number of patients with colorectal cancer will have an emergency presentation requiring surgery. This study aims to evaluate short-term outcomes for patients undergoing emergency colorectal cancer surgery in Australasia. METHODS All consecutive CRC from the Bi-National Colorectal Cancer Audit Database was interrogated from 2007 to 2016. Short-term outcomes including length of stay, complication rate and mortality rate were compared between the emergency and elective groups. Logistic regression analysis was performed to identify independent predictors for inpatient mortality. A predictive model for inpatient mortality was constructed using these variables, and its accuracy was then validated by the Bootstrap re-sampling method. RESULTS Of 15,676 colorectal cancer cases identified, 13.6% were emergency cases. The emergency group had a higher rate of surgical and medical complications (26.7% vs 22.6%, p < 0.001; 22.8 vs 13.8%, p < 0.001, respectively). Higher inpatient mortality rate was also observed in the emergency group (3.4% vs 2.6%, p = 0.023). Independent predictors for inpatient survival included age, American Society Anaesthesiologists score, emergency surgery and tumour stage. In addition, postoperative complications such as anastomotic leak (odds ratio [OR] 3.78, p < 0.001), sepsis (OR 2.85, p < 0.001) and medical complications (OR 13.88, p < 0.001) had a significant impact in survival in the emergency group. Receiver operating characteristics curve for inpatient mortality was 0.913. CONCLUSION Emergency colorectal cancer surgery carries significant morbidity and mortality. Recognition of the increasing rate of postoperative complications may help minimise the detrimental impact of this event on overall outcomes.
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Affiliation(s)
- Chun Hin Angus Lee
- Epworth Healthcare, Melbourne, VIC, 3121, Australia. .,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.
| | | | - Alexander G Heriot
- Epworth Healthcare, Melbourne, VIC, 3121, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Satish Warrier
- Epworth Healthcare, Melbourne, VIC, 3121, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - John Zalcberg
- Cancer Research Program, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Monash, Melbourne, VIC, 3004, Australia
| | - Paul Sitzler
- Epworth Healthcare, Melbourne, VIC, 3121, Australia
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Abstract
BACKGROUND Relationships between high-volume surgeons and improved postoperative outcomes have been well documented. Colorectal procedures are often performed by general surgeons, particularly in emergent settings, and may form a large component of their practice. The influence of subspecialized training on outcomes after emergent colon surgery, however, is not well described. OBJECTIVE The purpose of this study was to determine whether subspecialty training in colorectal surgery is associated with differences in postoperative outcomes after emergency colectomy. DESIGN This was a retrospective cohort study. SETTINGS Three tertiary care hospitals participating in the National Surgical Quality Improvement Project were included. PATIENTS Patients undergoing emergent colon resections were identified at each institution and stratified by involvement of either a colorectal surgeon or a general or acute care surgeon. MAIN OUTCOME MEASURES Propensity score matching was used to isolate the effect of surgeon specialty on the primary outcomes, including postoperative morbidity, mortality, length of stay, and the need for unplanned major reoperation, in comparable cohorts of patients. RESULTS A total of 889 cases were identified, including 592 by colorectal and 297 by general/acute care surgeons. After propensity score matching, cases performed by colorectal surgeons were associated with significantly lower rates of 30-day mortality (6.7% vs 16.4%; p = 0.001), postoperative morbidity (45.0% vs 56.7%; p = 0.009), and unplanned major reoperation (9.7% vs 16.4%; p = 0.04). In addition, length of stay was ≈4.4 days longer among patients undergoing surgery by general/acute care surgeons (p < 0.001). LIMITATIONS This study was limited by its retrospective design, with potential selection bias attributed to referral patterns. CONCLUSIONS After controlling for underlying disease states and illness severity, emergent colon resections performed by colorectal surgeons were associated with significantly lower rates of postoperative morbidity and mortality when compared with noncolorectal surgeons. These findings may have implications for referral patterns for institutions. See Video Abstract at http://links.lww.com/DCR/A767.
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23
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Wu Y, Liu F, Song W, Liang F, Wang L, Xu Y. Safety evaluation of simultaneous resection of colorectal primary tumor and liver metastasis after neoadjuvant therapy: A propensity score matching analysis. Am J Surg 2018; 218:894-898. [PMID: 30268420 DOI: 10.1016/j.amjsurg.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Considering the surgical safety and perioperative complications, simultaneous resection after neoadjuvant therapy is not commonly recommended. METHODS A total of 253 patients were included in study. Comparison of the short-term outcomes was performed after propensity score adjustment in Group A (n = 96) and Group B (neoadjuvant therapy, n = 96). RESULTS There was no postoperative mortality. After matching, the differences from surgical confounders were well-balanced. Morbidity (15.6% vs. 15.6%, p = 0.981), and Clavien-Dindo grade of complications (p = 0.710) were similar. No difference was found when the complications were divided according to the origin (general, colorectal and hepatic). Length of the hospital stays also did not differ between the groups (p = 0.482). More importantly, there was no increase in the number of patients with delayed adjuvant treatment after surgery in Group B. CONCLUSIONS Neoadjuvant treatment did not increase morbidity, length of hospital stays and influence adjuvant treatment after simultaneous resection.
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Affiliation(s)
- Yuchen Wu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China
| | - Fangqi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China
| | - Wang Song
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China
| | - Fei Liang
- Clinical Statistical Center, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China
| | - Lu Wang
- Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China.
| | - Ye Xu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, No. 130, Dong An Road, Shanghai, 200032, China.
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24
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The significant value of predicting prognosis in patients with colorectal cancer using 18F-FDG PET metabolic parameters of primary tumors and hematological parameters. Ann Nucl Med 2018; 33:32-38. [PMID: 30218280 DOI: 10.1007/s12149-018-1299-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/09/2018] [Indexed: 02/08/2023]
Abstract
OBJECTS The purpose was to evaluate the correlation of the pre-treatment hematological parameters with metabolic parameters of primary tumor in baseline 18F-FDG PET/CT in patients with colorectal cancer (CRC) and estimate the prognostic value of both. METHODS We retrospectively investigated 231 patients with CRC who underwent baseline 18F-FDG PET/CT. Routine blood sampling was tested in the same term. PET parameters in term of hematological parameters and pathological characteristics of primary tumor were compared. Kaplan-Meier survival analysis was performed in the patients without distant metastasis. The differences of disease-free survival between groups were compared by log-rank tests. RESULTS Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were significantly correlated with all the metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG). The patients with NLR > 3 had higher MTV (24.82 ± 18.16 vs 19.06 ± 13.30, P = 0.039) and TLG (219.04 ± 186.94 vs 166.45 ± 146.39, P = 0.047) than those whose NLR ≤ 3. NLR in those patients with distant metastasis was significantly higher than those without distant metastasis (P = 0.018) while LMR in those patients with distant metastasis was significantly lower than those without distant metastasis (P = 0.032). Survival analysis showed that those patients with low MTV (P = 0.015), low NLR (P = 0.008) and high LMR (P = 0.027) revealed significant survival benefit. CONCLUSIONS There was a significant association between the pre-treatment hematological parameters and metabolic parameters of baseline 18F-FDG PET/CT in the patients with CRC. It might be helpful in those patients with high NLR and low LMR to undergo 18F-FDG PET/CT to detect distant metastasis and predict prognosis.
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25
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Campbell A, Macdonald A, Oliphant R, Russell D, Fogg QA. Neurovasculature of high and low tie ligation of the inferior mesenteric artery. Surg Radiol Anat 2018; 40:1343-1348. [PMID: 30173375 PMCID: PMC6244984 DOI: 10.1007/s00276-018-2092-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/10/2018] [Indexed: 11/06/2022]
Abstract
Purpose Controversy exists as to whether a high or low tie ligation of the inferior mesenteric artery (IMA) is the preferred technique in surgeries of the left colon and rectum. This study aims to contribute to the discussion as to which is the more beneficial technique by investigating the neurovasculature at each site. Methods Ten embalmed cadaveric donors underwent division of the inferior mesenteric artery at the level of the low tie. The artery was subsequently ligated at the root to render a section of tissue for histological analysis of the proximal (high tie), mid and distal (low tie) segments. Results Ganglia observed in the proximal end of seven specimens in the sample imply that there would be disruption to the innervation in a high tie procedure. Conclusion This study suggests that a high tie should be avoided if the low tie is oncologically viable.
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Affiliation(s)
- Amy Campbell
- Laboratory of Human Anatomy, School of Life Sciences, University of Glasgow, Glasgow, UK. .,University of Dundee, School of Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
| | - Angus Macdonald
- Department of Surgery, Monklands District General Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - Raymond Oliphant
- Department of Surgery, Monklands District General Hospital, Monkscourt Avenue, Airdrie, North Lanarkshire, ML6 0JS, UK
| | - David Russell
- Laboratory of Human Anatomy, School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Quentin A Fogg
- Laboratory of Human Anatomy, School of Life Sciences, University of Glasgow, Glasgow, UK
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de Neree Tot Babberich MPM, Detering R, Dekker JWT, Elferink MA, Tollenaar RAEM, Wouters MWJM, Tanis PJ. Achievements in colorectal cancer care during 8 years of auditing in The Netherlands. Eur J Surg Oncol 2018; 44:1361-1370. [PMID: 29937415 DOI: 10.1016/j.ejso.2018.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/03/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The efficacy of auditing is still a subject of debate and concerns exist whether auditing promotes risk averse behaviour of physicians. This study evaluates the achievements made in colorectal cancer surgery since the start of a national clinical audit and assesses potential signs of risk averse behaviour. METHODS Data were extracted from the Dutch ColoRectal Audit (2009-2016). Trends in outcomes were evaluated by uni and multivariable analyses. Patients were stratified according to operative risks and changes in outcomes were expressed as absolute (ARR) and relative risk reduction (RRR). To assess signs of risk averse behaviour, trends in stoma construction in rectal cancer were analysed. RESULTS Postoperative mortality decreased from 3.4% to 1.8% in colon cancer and from 2.3% to 1% in rectal cancer. Surgical and non-surgical complications increased, but with less reintervention. For colon cancer, the high-risk elderly patients had the largest ARR for complicated postoperative course (6.4%) and mortality (5.9%). The proportion of patients receiving a diverting stoma or end colostomy after a (L)AR decreased 11% and 7%, respectively. In low rectal cancer, patients increasingly received a non-diverted primary anastomosis (5.4% in 2011 and 14.4% in 2016). CONCLUSIONS No signs of risk averse behaviour was found since the start of the audit. Especially the high-risk elderly patients seem to have benefitted from improvements made in colon cancer treatment in the past 8 years. For rectal cancer, trends towards the construction of more primary anastomoses are seen. Future quality improvement measures should focus on reducing surgical and non-surgical complications.
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Affiliation(s)
- Michael P M de Neree Tot Babberich
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Robin Detering
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Marloes A Elferink
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Michel W J M Wouters
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery. Br J Surg 2018; 105:959-970. [DOI: 10.1002/bjs.10848] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 01/12/2023]
Abstract
Abstract
Background
Socioeconomic deprivation is a potentially important factor influencing surgical outcomes. This systematic review aimed to summarize the evidence for any association between socioeconomic group and mortality after colorectal surgery, and to report the definitions of deprivation used and the approaches taken to adjust for co-morbidity in this patient population.
Methods
MEDLINE, Embase, the Cochrane Library and Web of Science were searched for studies up to November 2016 on adult patients undergoing major colorectal surgery, which reported on mortality according to socioeconomic group. Risk of bias and study quality were assessed by extracting data relating to study size, and variations in inclusion and exclusion criteria. Quality was assessed using a modification of a previously described assessment tool.
Results
The literature search identified 59 studies published between 1993 and 2016, reporting on 2 698 403 patients from eight countries. Overall findings showed evidence for higher mortality in more deprived socioeconomic groups, both in the perioperative period and in the longer term. Studies differed in how they defined socioeconomic groups, but the most common approach was to use one of a selection of multifactorial indices based on small geographical areas. There was no consistent approach to adjusting for co-morbidity but, where this was considered, the Charlson Co-morbidity Index was most frequently used.
Conclusion
This systematic review suggests that socioeconomic deprivation influences mortality after colorectal surgery.
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Staging the tumor and staging the host: A two centre, two country comparison of systemic inflammatory responses of patients undergoing resection of primary operable colorectal cancer. Am J Surg 2017; 216:458-464. [PMID: 28967380 DOI: 10.1016/j.amjsurg.2017.08.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND How systemic inflammation-based prognostic scores such as the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR) differ across populations of patients with colorectal cancer (CRC) remains unknown. The present study examined the mGPS and NLR in patients from United Kingdom (UK) and Japan. METHODS Patients undergoing resection of TNM I-III CRC in two centres in the UK and Japan were included. Differences in clinicopathological characteristics and mGPS (0-CRP≤10 mg/L, 1-CRP>10 mg/L, 2-CRP>10 mg/L, albumin<35 g/L) and NLR (≤5/>5) were examined. RESULTS Patients from UK (n = 581) were more likely to be female, high ASA and BMI, present as an emergency (all P < 0.01) and have higher T stage compared to those from Japan (n = 559). After controlling for differences in tumor and host characteristics, patients from Japan were less likely to be systemically inflamed (OR: mGPS: 0.37, 95%CI 0.27-0.50, P < 0.001; NLR: 0.53, 95%CI 0.35-0.79, P = 0.002). CONCLUSION Systemic inflammatory responses differ between populations with colorectal cancer. Given their prognostic value, reporting of systemic inflammation-based scores should be incorporated into future studies reporting patient outcomes.
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Keller DS, Qiu J, Senagore AJ. Predicting opportunities to increase utilization of laparoscopy for rectal cancer. Surg Endosc 2017; 32:1556-1563. [PMID: 28917020 DOI: 10.1007/s00464-017-5844-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite proven safety and efficacy, rates of laparoscopy for rectal cancer in the US are low. With reports of inferiority with laparoscopy compared to open surgery, and movements to develop accredited centers, investigating utilization and predictors of laparoscopy are warranted. Our goal was to evaluate current utilization and identify factors impacting use of laparoscopic surgery for rectal cancer. METHODS The Premier™ Hospital Database was reviewed for elective inpatient rectal cancer resections (1/1/2010-6/30/2015). Patients were identified by ICD-9-CM diagnosis codes, and then stratified into open or laparoscopic approaches by ICD-9-CM procedure codes or billing charge. Logistic multivariable regression identified variables predictive of laparoscopy. The Cochran-Armitage test assessed trend analysis. The main outcome measures were trends in utilization and factors independently associated with use of laparoscopy. RESULTS 3336 patients were included-43.8% laparoscopic (n = 1464) and 56.2% open (n = 1872). Use of laparoscopy increased from 37.6 to 55.3% during the study period (p < 0.0001). General surgeons performed the majority of all resections, but colorectal surgeons were more likely to approach rectal cancer laparoscopically (41.31 vs. 36.65%, OR 1.082, 95% CI [0.92, 1.27], p < 0.3363). Higher volume surgeons were more likely to use laparoscopy than low-volume surgeons (OR 3.72, 95% CI [2.64, 5.25], p < 0.0001). Younger patients (OR 1.49, 95% CI [1.03, 2.17], p = 0.036) with minor (OR 2.13, 95% CI [1.45, 3.12], p < 0.0001) or moderate illness severity (OR 1.582, 95% CI [1.08, 2.31], p < 0.0174) were more likely to receive a laparoscopic resection. Teaching hospitals (OR 0.842, 95% CI [0.710, 0.997], p = 0.0463) and hospitals in the Midwest (OR 0.69, 95% CI [0.54, 0.89], p = 0.0044) were less likely to use laparoscopy. Insurance status and hospital size did not impact use. CONCLUSIONS Laparoscopy for rectal cancer steadily increased over the years examined. Patient, provider, and regional variables exist, with hospital status, geographic location, and colorectal specialization impacting the likelihood. However, surgeon volume had the greatest influence. These results emphasize training and surgeon-specific outcomes to increase utilization and quality in appropriate cases.
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Affiliation(s)
- Deborah S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, 3500 Gaston Street, R-1013, Dallas, TX, 75246, USA.
| | - Jiejing Qiu
- Healthcare Economics and Outcomes Research, Medtronic, Mansfield, MA, USA
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Skyrud KD, Myklebust TÅ, Bray F, Eriksen MT, de Lange T, Larsen IK, Møller B. How Many Deaths from Colorectal Cancer Can Be Prevented by 2030? A Scenario-Based Quantification of Risk Factor Modification, Screening, and Treatment in Norway. Cancer Epidemiol Biomarkers Prev 2017; 26:1420-1426. [PMID: 28626069 DOI: 10.1158/1055-9965.epi-17-0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/24/2017] [Accepted: 06/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Colorectal cancer mortality can be reduced through risk factor modification (adherence to lifestyle recommendations), screening, and improved treatment. This study estimated the potential of these three strategies to modify colorectal cancer mortality rates in Norway.Methods: The potential reduction in colorectal cancer mortality due to risk factor modification was estimated using the software Prevent, assuming that 50% of the population in Norway-who do not adhere to the various recommendations concerning prevention of smoking, physical activity, body weight, and intake of alcohol, red/processed meat, and fiber-started to follow the recommendations. The impact of screening was quantified assuming implementation of national flexible sigmoidoscopy screening with 50% attendance. The reduction in colorectal cancer mortality due to improved treatment was calculated assuming that 50% of the linear (positive) trend in colorectal cancer survival would continue to persist in future years.Results: Risk factor modification would decrease colorectal cancer mortality by 11% (corresponding to 227 prevented deaths: 142 men, 85 women) by 2030. Screening and improved treatment in Norway would reduce colorectal cancer mortality by 7% (149 prevented deaths) and 12% (268 prevented deaths), respectively, by 2030. Overall, the combined effect of all three strategies would reduce colorectal cancer mortality by 27% (604 prevented deaths) by 2030.Conclusions: Risk factor modification, screening, and treatment all have considerable potential to reduce colorectal cancer mortality by 2030, with the largest potential reduction observed for improved treatment and risk factor modification.Impact: The estimation of these health impact measures provides useful information that can be applied in public health decision-making. Cancer Epidemiol Biomarkers Prev; 26(9); 1420-6. ©2017 AACR.
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Affiliation(s)
- Katrine Damgaard Skyrud
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway.
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Morten Tandberg Eriksen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas de Lange
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Inger Kristin Larsen
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo, Norway
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Wu Y, Li C, Zhao J, Yang L, Liu F, Zheng H, Wang Z, Xu Y. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict chemotherapy outcomes and prognosis in patients with colorectal cancer and synchronous liver metastasis. World J Surg Oncol 2016; 14:289. [PMID: 27852294 PMCID: PMC5112720 DOI: 10.1186/s12957-016-1044-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/07/2016] [Indexed: 12/30/2022] Open
Abstract
Background Recent evidence indicates that inflammatory parameters could be useful to predict metastasis from colorectal cancer. However, their roles in predicting chemotherapy response and prognosis in patients with synchronous colorectal liver metastasis (CLM) are unknown. Methods The clinical data and baseline laboratory parameters of 55 patients with synchronous CLM were retrospectively reviewed. All patients underwent palliative resection of the primary tumor and oxaliplatin-based chemotherapy. Two indices of systemic inflammation were reviewed—neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)—preoperatively and before the second cycle of chemotherapy. Associations between prognostic variables and tumor response, progression, and survival were investigated. Results NLR < 4 and PLR < 150 were correlated with better disease control (p = 0.024 and 0.026, respectively). In univariate analysis, elevated NLR and PLR were significant prognostic factors for poor overall survival (OS) and progression-free survival (PFS). In multivariate analysis, PLR (p = 0.027), age (p = 0.018), resection of liver metastases (p = 0.017), and lactate dehydrogenase level (p = 0.011) were independent predictors of PFS, while resection of liver metastases was the only independent predictor of OS (p = 0.002). In addition, when patients were divided into groups according to changes in NLR and/or PLR, reduced NLR and PLR were associated with improved disease control (p = 0.038 and 0.025, respectively). Normalization of NLR also was associated with improved PFS. Conclusions NLR and PLR are potentially useful clinical biomarkers to predict chemotherapy response in patients with synchronous CLM. PLR also may be useful to predict PFS in these patients. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-1044-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuchen Wu
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Cong Li
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Jiang Zhao
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Li Yang
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Fangqi Liu
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Hongtu Zheng
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Zhimin Wang
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center and Shanghai Industrial Technology Institute (SITI), Shanghai, 201203, China.
| | - Ye Xu
- Department of Oncology, Shanghai Medical College, Shanghai, 200032, China. .,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
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Watt DG, McSorley ST, Park JH, Horgan PG, McMillan DC. A Postoperative Systemic Inflammation Score Predicts Short- and Long-Term Outcomes in Patients Undergoing Surgery for Colorectal Cancer. Ann Surg Oncol 2016; 24:1100-1109. [PMID: 27822634 DOI: 10.1245/s10434-016-5659-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Following surgery, a significant proportion of patients develop postoperative complications that are associated with poorer long-term survival. Stereotypical markers of the systemic inflammatory response (SIR) have been shown to identify patients at increased risk of developing such complications. The aim of the present study was to examine the prognostic value of a postoperative systemic inflammation-based score in patients undergoing potentially curative surgery for colorectal cancer. METHODS Patients with histologically proven colorectal cancer undergoing resection between 1999 and 2013 (n = 813) were grouped into two cohorts-a retrospective test cohort (n = 402) and a prospective validation cohort (n = 411). Patients were assessed for postoperative complications and had routine blood samples taken daily. The relationship between markers of the postoperative SIR and survival was examined using Cox regression analysis. RESULTS In the test cohort, 87 patients developed an infective complication, while in the validation cohort, 106 patients developed an infective complication. In both cohorts, the postoperative SIR (C-reactive protein and albumin thresholds of >150 mg/L and <25 g/L, respectively) were associated with the development of infective complications (all p < 0.01). Using these thresholds, a scoring system [postoperative Glasgow prognostic score (poGPS)] was created, and on days 3 and 4 was associated with an incremental increase in the infective complication rate (all p < 0.001) and complication severity (p < 0.001). In the overall cohort, there were 175 cancer and 139 non-cancer deaths. The poGPS was also significantly associated with overall survival (p < 0.05). CONCLUSIONS The postoperative SIR, evidenced by the poGPS, was associated with increased complication rates and severity and a reduction in survival.
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Affiliation(s)
- David G Watt
- Academic Unit of Surgery, R2.06, School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK.
| | - Stephen T McSorley
- Academic Unit of Surgery, R2.06, School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
| | - James H Park
- Academic Unit of Surgery, R2.06, School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
| | - Paul G Horgan
- Academic Unit of Surgery, R2.06, School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
| | - Donald C McMillan
- Academic Unit of Surgery, R2.06, School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK
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Wu QB, Wang M, Hu T, He WB, Wang ZQ. Prognostic role of the lymphocyte-to-monocyte ratio in patients undergoing resection for nonmetastatic rectal cancer. Medicine (Baltimore) 2016; 95:e4945. [PMID: 27858839 PMCID: PMC5591087 DOI: 10.1097/md.0000000000004945] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Lymphocyte-to-monocyte ratio (LMR) was associated with survival benefit in some types of cancer. The relationship between LMR and rectal cancer has not been investigated. We conducted a retrospective cohort study to assess the prognostic significance of LMR in patients with nonmetastatic rectal cancer. Patients with rectal cancer who underwent potentially curative resection between January 2009 and December 2013 were enrolled. The LMR was calculated from preoperative blood test by dividing the absolute lymphocyte counts by the absolute monocyte counts. The optimal cut-off value for LMR was calculated as the median value. On the basis of the cut-off value, patients were divided into 2 groups: low group and high group. A total of 543 patients with rectal cancer were eligible for this study. The median follow-up time for all patients was 55 months (range 6-85 months). The cut-off value of LMR was 5.13 and patients were divided into 2 groups: low group (LMR < 5.13) and high group (LMR ≥ 5.13). In the univariate and multivariate analysis, the LMR was not significantly associated with overall survival (OS) [hazard ratio (HR): 1.034, 95% confidence intervals (CIs): 0.682-1.566, P = 0.876]. When disease-free survival (DFS) was compared, univariate and multivariate analysis also indicated that the LMR was not significantly associated with DFS (HR: 0.988, 95% CI: 0.671-1.453, P = 0.950). In addition, in the subgroup analysis by tumor-node-metastasis stage, there existed no significance between LMR and OS and DFS. Although as an easy access and highly efficient laboratorial inflammatory marker, LMR cannot predict the prognosis of nonmetastatic rectal cancer patients.
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Affiliation(s)
- Qing-Bin Wu
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Wang
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wan-Bin He
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zi-Qiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang No. 37, Chengdu 610041, China (e-mail: )
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Murage P, Crawford SM, Bachmann M, Jones A. Geographical disparities in access to cancer management and treatment services in England. Health Place 2016; 42:11-18. [PMID: 27614062 DOI: 10.1016/j.healthplace.2016.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/01/2016] [Accepted: 08/25/2016] [Indexed: 11/19/2022]
Abstract
This study seeks to examine the extent to which cancer services are geographically located according to cancer incidence, and assess the association with cancer survival. We identified hospital sites serving English PCTs (Primary Care Trusts) with the management and treatment of breast, lung and colorectal cancer. Geographical access was estimated as travel time in minutes from LSOAs (Lower Super Output Areas) to the nearest hospital site and aggregated to PCT level. Correlations between PCT level mean travel times and cancer cases were estimated using Spearman's rank correlation. Associations between PCT level mean travel times and cancer relative survival rates were estimated using linear regression with adjustment for area deprivation and for a PCT level measure of the reported ease of obtaining a doctor's appointment. We found that cancer services tended to be located farther from areas with more cancer cases, and longer average travel times are associated with worse survival after adjustment for age, sex, year and area deprivation. This suggests that geographical access to cancer services remains a concern in England.
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Affiliation(s)
| | | | - Max Bachmann
- Norwich Medical School, University of East Anglia, UK
| | - Andy Jones
- Norwich Medical School, University of East Anglia, UK
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35
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Low anterior resection syndrome: a survey of the members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP). Int J Colorectal Dis 2016; 31:813-23. [PMID: 26825055 DOI: 10.1007/s00384-016-2511-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is frequent following sphincter-sparing procedures for rectal cancer. OBJECTIVE This study aims to assess surgeons' awareness of LARS. DESIGN This was a survey study. SETTINGS Members of the American Society of Colon and Rectal Surgeons (ASCRS), the Spanish Association of Surgeons (AEC), and the Spanish Society of Coloproctology (AECP). PARTICIPANTS Three hundred thirty-four surgeons from the ASCRS and 150 from the Spanish Societies completed a 23-item electronic questionnaire. MAIN OUTCOME MEASURES Surgeons' opinions regarding different aspects of LARS. RESULTS The proportion of rectal cancer patients undergoing sphincter-sparing operations ranged between 71 and 90 %. Low anterior resection with end-to-end anastomosis was the most frequently cited procedure after mesorectal excision. More than 80 % of participants were recognized to be moderately or extremely aware of the condition, but regarding the method used to assess LARS, the majority relied on clinical manifestations. Around 35 % of surgeons considered that severe LARS developed in less than 40 % of patients. The most important factor related to defecatory function impairment in the surgeons' opinion was the distance from the anal margin to anastomosis. Other factors thought to be involved were anastomotic leakage, preoperative radiation therapy, age, and postoperative radiotherapy, with similar percentages in the two groups of surgeons. Lifestyle changes and dietary measures associated with or without drug treatment was the modality of choice. The experience with transanal irrigation or sacral nerve stimulation was limited. It was considered that <30 % of patients chronically suffer from severe LARS with significant quality of life impairment. LIMITATIONS The limitations of this study are the international mix and expert status of the specialists. CONCLUSIONS The probability of patients suffering from LARS was underestimated despite reporting good knowledge of the syndrome. Validated methods for the assessment of LARS were rarely used. Deficient awareness regarding risk factors for LARS was documented. Knowledge of therapeutic options was also limited.
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36
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Hall GM, Shanmugan S, Bleier JIS, Jeganathan AN, Epstein AJ, Paulson EC. Colorectal specialization and survival in colorectal cancer. Colorectal Dis 2016; 18:O51-60. [PMID: 26708838 DOI: 10.1111/codi.13246] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/16/2015] [Indexed: 12/12/2022]
Abstract
AIM It is recognized that higher surgeon volume is associated with improved survival in colorectal cancer. However, there is a paucity of national studies that have evaluated the relationship between surgical specialization and survival. METHOD We used the Surveillance, Epidemiology, and End Results Medicare cancer registry to examine the association between colorectal specialization (CRS) and disease-specific survival (DSS) between 2001 and 2009. A total of 21,432 colon cancer and 5893 rectal cancer patients who underwent elective surgical resection between 2001 and 2009 were evaluated. Univariate and multivariate Cox survival analysis was used to identify the association between surgical specialization and cancer-specific survival. RESULTS Colorectal specialists performed 16.3% of the colon and 27% of the rectal resections. On univariate analysis, specialization was associated with improved survival in Stage II and Stage III colon cancer and Stage II rectal cancer. In multivariate analysis, however, CRS was associated with significantly improved DSS only in Stage II rectal cancer [hazard ratio (HR) 0.70, P = 0.03]. CRS was not significantly associated with DSS in either Stage I (colon HR 1.14, P = 0.39; rectal HR 0.1.26, P = 0.23) or Stage III (colon HR 1.06, P = 0.52; rectal HR 1.08, P = 0.55) disease. When analysis was limited to high volume surgeons only, the relationship between CRS and DSS was unchanged. CONCLUSIONS CRS is associated with improved DSS following resection of Stage II rectal cancer. A combination of factors may contribute to long-term survival in these patients, including appropriate surgical technique, multidisciplinary treatment decisions and guideline-adherent surveillance. CRS probably contributes positively to these factors resulting in improved survival.
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Affiliation(s)
- G M Hall
- Division of Colon and Rectal Surgery, Department of General Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S Shanmugan
- Division of Colon and Rectal Surgery, Department of General Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J I S Bleier
- Division of Colon and Rectal Surgery, Department of General Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A N Jeganathan
- Department of General Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A J Epstein
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - E C Paulson
- Division of Colon and Rectal Surgery, Department of General Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of General Surgery, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
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Anticancer bioactive peptides suppress human colorectal tumor cell growth and induce apoptosis via modulating the PARP-p53-Mcl-1 signaling pathway. Acta Pharmacol Sin 2015; 36:1514-9. [PMID: 26592508 DOI: 10.1038/aps.2015.80] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/12/2015] [Indexed: 02/06/2023] Open
Abstract
AIM We have reported novel anticancer bioactive peptides (ACBPs) that show tumor-suppressive activities in human gastric cancer, leukemia, nasopharyngeal cancer, and gallbladder cancer. In this study, we investigated the effects of ACBPs on human colorectal cancer and the underlying mechanisms. METHODS Cell growth and apoptosis of human colorectal tumor cell line HCT116 were measured using cell proliferation assay and flow cytometry, respectively. The expression levels of PARP, p53 and Mcl1A were assessed with Western blotting and immunohistochemistry. For evaluation of the in vivo antitumor activity of ACBPs, HCT116 xenograft nude mice were treated with ACBPs (35 μg/mL, ip) for 10 days. RESULTS Treatment of HCT116 cells with ACBPs (35 μg/mL) for 4-6 days significantly inhibited the cell growth. Furthermore, treatment of HCT116 cells with ACBPs (35 μg/mL) for 6-12 h significantly enhanced UV-induced apoptosis, increased the expression of PARP and p53, and decreased the expression of Mcl-1. Administration of ACBPs did not change the body weight of HCT116 xenograft nude mice, but decreased the tumor growth by approximately 43%, and increased the expression of PARP and p53, and decreased the expression of Mcl-1 in xenograft mouse tumor tissues. CONCLUSION Administration of ACBPs inhibits human colorectal tumor cell growth and induces apoptosis in vitro and in vivo through modulating the PARP-p53-Mcl-1 signaling pathway.
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38
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Watt DG, Proctor MJ, Park JH, Horgan PG, McMillan DC. The Neutrophil-Platelet Score (NPS) Predicts Survival in Primary Operable Colorectal Cancer and a Variety of Common Cancers. PLoS One 2015; 10:e0142159. [PMID: 26544968 PMCID: PMC4636235 DOI: 10.1371/journal.pone.0142159] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Recent in-vitro studies have suggested that a critical checkpoint early in the inflammatory process involves the interaction between neutrophils and platelets. This confirms the importance of the innate immune system in the elaboration of the systemic inflammatory response. The aim of the present study was to examine whether a combination of the neutrophil and platelet counts were predictive of survival in patients with cancer. METHODS Patients with histologically proven colorectal cancer who underwent potentially curative resection at a single centre between March 1999 and May 2013 (n = 796) and patients with cancer from the Glasgow Inflammation Outcome Study, who had a blood sample taken between January 2000 and December 2007 (n = 9649) were included in the analysis. RESULTS In the colorectal cancer cohort, there were 173 cancer and 135 non-cancer deaths. In patients undergoing elective surgery, cancer-specific survival (CSS) at 5 years ranged from 97% in patients with TNM I disease and NPS = 0 to 57% in patients with TNM III disease and NPS = 2 (p = 0.019) and in patients undergoing elective surgery for node-negative colon cancer from 98% (TNM I, NPS = 0) to 65% (TNM II, NPS = 2) (p = 0.004). In those with a variety of common cancers there were 5218 cancer and 929 non-cancer deaths. On multivariate analysis, adjusting for age and sex and stratified by tumour site, incremental increase in the NPS was significantly associated with poorer CSS (p<0.001). CONCLUSION The neutrophil-platelet score predicted survival in a variety of common cancers and highlights the importance of the innate immune system in patients with cancer.
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Affiliation(s)
- David G. Watt
- Academic Unit of Surgery, School of Medicine–University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
- * E-mail:
| | - Michael J. Proctor
- Academic Unit of Surgery, School of Medicine–University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - James H. Park
- Academic Unit of Surgery, School of Medicine–University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Paul G. Horgan
- Academic Unit of Surgery, School of Medicine–University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Donald C. McMillan
- Academic Unit of Surgery, School of Medicine–University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Long-Term Outcomes of Colon Cancer Patients Undergoing Standardized Technique Operation With Curative Intent. Int Surg 2015. [DOI: 10.9738/intsurg-d-15-00135.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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40
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Ait Ouakrim D, Pizot C, Boniol M, Malvezzi M, Boniol M, Negri E, Bota M, Jenkins MA, Bleiberg H, Autier P. Trends in colorectal cancer mortality in Europe: retrospective analysis of the WHO mortality database. BMJ 2015; 351:h4970. [PMID: 26442928 PMCID: PMC4595561 DOI: 10.1136/bmj.h4970] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine changes in colorectal cancer mortality in 34 European countries between 1970 and 2011. DESIGN Retrospective trend analysis. DATA SOURCE World Health Organization mortality database. POPULATION Deaths from colorectal cancer between 1970 and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of colorectal cancer mortality in the subsequent period. MAIN OUTCOMES MEASURES Time trends in rates of colorectal cancer mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population. RESULTS From 1989 to 2011, colorectal cancer mortality increased by a median of 6.0% for men and decreased by a median of 14.7% for women in the 34 European countries. Reductions in colorectal cancer mortality of more than 25% in men and 30% in women occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for men. In countries with decreasing mortality, reductions were more important for women of all ages and men younger than 65 years. In the 27 European Union member states, colorectal cancer mortality fell by 13.0% in men and 27.0% in women, compared with corresponding reductions of 39.8% and 38.8% in the United States. CONCLUSION Over the past 40 years, there has been considerable disparity in the level of colorectal cancer mortality between European countries, as well as between men and women and age categories. Countries with the largest reductions in colorectal cancer mortality are characterised by better accessibility to screening services, especially endoscopic screening, and specialised care.
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Affiliation(s)
- Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Cécile Pizot
- Department of Biostatistics, International Prevention Research Institute, Lyon, France
| | - Magali Boniol
- Department of Biostatistics, International Prevention Research Institute, Lyon, France
| | - Matteo Malvezzi
- Department of Clinical Sciences and Community Health, Universitá degli Studi di Milano, Milan, Italy
| | - Mathieu Boniol
- Department of Biostatistics, International Prevention Research Institute, Lyon, France University of Strathclyde Institute for Global Public Health at iPRI, Lyon, France
| | - Eva Negri
- Department of Epidemiology, IRCCS (Istituto di Ricerche Farmacologiche Mario Negri), Milan, Italy
| | - Maria Bota
- Department of Biostatistics, International Prevention Research Institute, Lyon, France University of Strathclyde Institute for Global Public Health at iPRI, Lyon, France
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Philippe Autier
- University of Strathclyde Institute for Global Public Health at iPRI, Lyon, France Department of Population Research, International Prevention Research Institute, 69006 Lyon Cedex 08, France
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Watt DG, Martin JC, Park JH, Horgan PG, McMillan DC. Neutrophil count is the most important prognostic component of the differential white cell count in patients undergoing elective surgery for colorectal cancer. Am J Surg 2015; 210:24-30. [PMID: 25842358 DOI: 10.1016/j.amjsurg.2014.12.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Systemic inflammatory scoring systems such as the NLR have been reported to have prognostic value in many solid organ cancers. The aim of this study was to examine the relationships between the components of the white cell count (WCC) and survival in patients undergoing elective surgery for colorectal cancer. METHODS Patients undergoing elective resection at a single center (1997 to 2008) were identified from a prospective database (n = 508). Patient demographics and preoperative laboratory measurements including the differential WCC and their association with cancer-specific survival (CSS) and overall survival were examined. RESULTS There were 172 cancer deaths and 120 noncancer deaths. On Kaplan-Meier analysis of the whole cohort, age, Tumor, Nodal, and Metastasis stage, venous invasion, margin involvement, peritoneal involvement and tumor perforation, and white cell and neutrophil count (all P < .05) were associated with CSS. In those with node-negative colon cancer (n = 226), on multivariate analysis, age, venous invasion, modified Glasgow Prognostic Score, and neutrophil count (all P < .05) were independently associated with CSS. CONCLUSION Of the components of a differential WCC, only the neutrophil count was independently associated with survival, particularly in node-negative colon cancer.
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Affiliation(s)
- David G Watt
- Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK.
| | - John C Martin
- Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK
| | - James H Park
- Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK
| | - Paul G Horgan
- Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine - University of Glasgow, Glasgow Royal Infirmary, G31 2ER, UK
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42
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Oliphant R, Horgan PG, Morrison DS, McMillan DC. Validation of a modified clinical risk score to predict cancer-specific survival for stage II colon cancer. Cancer Med 2014; 4:84-9. [PMID: 25487740 PMCID: PMC4312121 DOI: 10.1002/cam4.352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/12/2014] [Accepted: 08/20/2014] [Indexed: 01/20/2023] Open
Abstract
Many patients with stage II colon cancer will die of their disease despite curative surgery. Therefore, identification of patients at high risk of poor outcome after surgery for stage II colon cancer is desirable. This study aims to validate a clinical risk score to predict cancer-specific survival in patients undergoing surgery for stage II colon cancer. Patients undergoing surgery for stage II colon cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Overall and cancer-specific survival rates up to 5 years were calculated. A total of 871 patients were included. At 5 years, cancer-specific survival was 81.9% and overall survival was 65.6%. On multivariate analysis, age ≥75 years (hazard ratio (HR) 2.11, 95% confidence intervals (CI) 1.57–2.85; P<0.001) and emergency presentation (HR 1.97, 95% CI 1.43–2.70; P<0.001) were independently associated with cancer-specific survival. Age and mode of presentation HRs were added to form a clinical risk score of 0–2. The cancer-specific survival at 5 years for patients with a cumulative score 0 was 88.7%, 1 was 78.2% and 2 was 65.9%. These results validate a modified simple clinical risk score for patients undergoing surgery for stage II colon cancer. The combination of these two universally documented clinical factors provides a solid foundation for the examination of the impact of additional clinicopathological and treatment factors on overall and cancer-specific survival.
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Affiliation(s)
- Raymond Oliphant
- University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G4 0SF, U.K; West of Scotland Cancer Surveillance Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, U.K
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The impact of surgical specialisation on survival following elective colon cancer surgery. Int J Colorectal Dis 2014; 29:1143-50. [PMID: 25034593 DOI: 10.1007/s00384-014-1965-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Reorganisation of cancer services in the UK and across Europe has led to elective surgery for colon cancer being increasingly, but not exclusively, delivered by specialist colorectal surgeons. This study examines survival after elective colon cancer surgery performed by specialist compared to non-specialist surgeons. METHOD Patients undergoing elective surgery for colon cancer in 16 hospitals between 2001 and 2004 were identified from a prospectively maintained regional audit database. Post-operative mortality (<30 days) and 5-year relative survival in those receiving surgery under the care of a specialist or non-specialist surgeon were compared. RESULTS A total of 1,856 patients were included, of which, 1,367 (73.7%) were treated by a specialist and 489 (26.4%) by a non-specialist surgeon. Those treated by a specialist were more likely to be deprived, undergo surgery in a high volume unit and have higher lymph node yields than those treated by a non-specialist. Post-operative mortality was lower (4.5 versus 7.0%; P = 0.032) and 5-year relative survival was higher (72.2 versus 65.6%; P = 0.012) among those treated by a specialist surgeon. In multivariate analysis, surgery by non-specialists was independently associated with increased post-operative mortality (adjusted odds ratio (OR) 1.69; P < 0.001) and poorer 5-year relative survival (adjusted relative excess risk (RER) 1.17; P = 0.045). After exclusion of post-operative deaths, there was no difference in long-term survival (adjusted RER 1.08; P = 0.505). CONCLUSION Five-year relative survival after elective colon cancer surgery was higher among those treated by specialist colorectal surgeons due to increased post-operative mortality among those treated by non-specialists.
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Thomas M, Angele M, Stangl M, Rentsch M, Pratschke S, Andrassy J, Jauch KW, Guba M. Loss of liver transplant surgeons into alternate career paths. Transpl Int 2014; 27:1120-4. [DOI: 10.1111/tri.12390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/26/2014] [Accepted: 06/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Thomas
- Department of Surgery; University of Munich; Großhadern Germany
| | - Martin Angele
- Department of Surgery; University of Munich; Großhadern Germany
| | - Manfred Stangl
- Department of Surgery; University of Munich; Großhadern Germany
- Transplant Center; University of Munich; Großhadern Germany
| | - Markus Rentsch
- Department of Surgery; University of Munich; Großhadern Germany
| | | | - Joachim Andrassy
- Department of Surgery; University of Munich; Großhadern Germany
- Transplant Center; University of Munich; Großhadern Germany
| | | | - Markus Guba
- Department of Surgery; University of Munich; Großhadern Germany
- Transplant Center; University of Munich; Großhadern Germany
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Ismail SIMF. The increasing number of surgical procedures for female genital fistula in England: analysis of Hospital Episode Statistics (HES) data. J OBSTET GYNAECOL 2014; 35:57-9. [PMID: 25020114 DOI: 10.3109/01443615.2014.935714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to describe the number and trend of surgical procedures for female genital fistula in England. An online search of Hospital Episode Statistics (HES) data was carried out. Data were available for the 4-year period from 2002-03 until 2005-06. The total number of surgical procedures carried out for female genital fistula steadily increased by 28.7% from 616 in 2002-03 to 793 in 2005-06. The number of surgical procedures performed for rectovaginal fistula exceeded the total number of surgical procedures carried out for vesicovaginal and urethrovaginal fistula in each year of the study period. This pattern needs to be monitored and investigated further.
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Affiliation(s)
- S I M F Ismail
- Department of Obstetrics and Gynaecology, Royal Sussex County Hospital , East Sussex, England , UK
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Etzioni DA, Young-Fadok TM, Cima RR, Wasif N, Madoff RD, Naessens JM, Habermann EB. Patient survival after surgical treatment of rectal cancer: Impact of surgeon and hospital characteristics. Cancer 2014; 120:2472-81. [DOI: 10.1002/cncr.28746] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 12/24/2022]
Affiliation(s)
- David A. Etzioni
- Department of Surgery; Mayo Clinic College of Medicine; Phoenix Arizona
- Mayo Clinic Center for the Science of Healthcare Delivery; Rochester Minnesota
| | | | - Robert R. Cima
- Mayo Clinic Center for the Science of Healthcare Delivery; Rochester Minnesota
- Department of Surgery; Mayo Clinic College of Medicine; Rochester Minnesota
| | - Nabil Wasif
- Department of Surgery; Mayo Clinic College of Medicine; Phoenix Arizona
| | - Robert D. Madoff
- Department of Surgery; University of Minnesota; Minneapolis Minnesota
| | - James M. Naessens
- Mayo Clinic Center for the Science of Healthcare Delivery; Rochester Minnesota
| | - Elizabeth B. Habermann
- Mayo Clinic Center for the Science of Healthcare Delivery; Rochester Minnesota
- Department of Surgery; Mayo Clinic College of Medicine; Rochester Minnesota
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Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival. Int J Colorectal Dis 2014; 29:591-8. [PMID: 24651957 DOI: 10.1007/s00384-014-1847-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The majority of patients with node-negative colorectal cancer have excellent 5-year survival prospects, but up to a third relapse. Strategies to identify patients at higher risk of adverse outcomes are desirable to enable optimal treatment and follow-up. The aim of this study was to examine postoperative mortality and longer-term survival by mode of presentation for patients with node-negative colorectal cancer undergoing surgery with curative intent. METHODS Patients from 16 hospitals in the west of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Postoperative mortality and 5-year relative survival by mode of presentation were recorded. RESULTS Of 1,877 patients with node-negative disease, 251 (13.4%) presented as an emergency. Those presenting as an emergency were more likely to be older (P = 0.023), have colon rather than rectal cancer (P < 0.001), have pT4 stage disease (P < 0.001), have extramural vascular invasion (P = 0.001), and receive surgery under the care of a nonspecialist surgeon (P < 0.001) compared to those presenting electively. The postoperative mortality rate was 3.3% after elective and 12.8% after emergency presentation (P < 0.001). Five-year relative survival was 91.8% after elective and 66.8% after emergency presentation (P < 0.001). The adjusted relative excess risk ratio for 5-year relative survival after emergency relative to elective presentation was 2.59 (95% CI 1.67-4.01; P < 0.001) and 1.90 (95% CI 1.00-3.62; P = 0.049) after exclusion of postoperative deaths. CONCLUSIONS Emergency presentation of node-negative colorectal cancer treated with curative intent was independently associated with higher postoperative mortality and poorer 5-year relative survival compared to elective presentation.
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Xin C, Zhang H, Liu Z. miR-154 suppresses colorectal cancer cell growth and motility by targeting TLR2. Mol Cell Biochem 2013; 387:271-7. [PMID: 24242044 DOI: 10.1007/s11010-013-1892-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/05/2013] [Indexed: 02/07/2023]
Abstract
MicroRNAs play critical roles in the development and progression of colorectal cancer (CRC). miR-154 acts as a tumor suppressor in several tumors; however, its role in CRC is poorly understood. Herein, we found that miR-154 was decreased in CRC tissues and cell lines. Ectopic expression of miR-154 remarkably suppressed cell proliferation and colony formation, migration and invasion in CRC cells. The toll-like receptor 2 (TLR2) was found to be a direct target of miR-154 in CRC cells. Inhibition of TLR2 performed similar effects with miR-154 overexpression on CRC cells, and overexpression of TLR2 could significantly reverse the tumor suppressive effects of miR-154 on CRC cells. This study suggests an essential role for miR-154 in CRC.
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Affiliation(s)
- Chaoguang Xin
- Anus-Intestines Department, Daqing Oilfield General Hospital, Daqing, 163000, China
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