1
|
Cortes-Mejia NA, Lillemoe HA, Cata JP. Return to Intended Oncological Therapy: State of the Art and Perspectives. Curr Oncol Rep 2024; 26:1420-1430. [PMID: 39320576 DOI: 10.1007/s11912-024-01594-7] [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] [Accepted: 08/06/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE OF THE REVIEW Despite advances in surgical procedures, cancer recurrence still affects a substantial proportion of patients for whom surgery is considered a curative therapy. This review aims to provide a comprehensive overview of RIOT, addressing its definition, influencing factors, and clinical implications. FINDINGS RIOT can be defined as a continuous variable as the time from surgery to initiation of adjuvant therapies or categorically as whether patients can successfully receive adjuvant therapies or not. Factors influencing RIOT are age, sex, socioeconomic status, access to healthcare, physical performance and comorbidities, and quality of anesthesia and surgical care. Adjuvant therapies such as chemotherapy, radiotherapy, and immunotherapy are often administered to reduce the risk of recurrence after surgery and improve survival. Return to intended oncologic therapy (RIOT) has emerged as a promising outcome metric reflecting patients' functional recovery after surgery and their ability to receive adjuvant therapies.
Collapse
Affiliation(s)
- Nicolas A Cortes-Mejia
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Heather A Lillemoe
- Department of Breast Surgical Oncology, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
- Department of Surgical Oncology, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
- Department of Pain Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
2
|
Hurwitz LM, Bailey-Whyte M, Daneshvar MA, Vocke CD, Custer J, Ryan BM, Ambs S, Pinto PA, Rossi EL. Methylation-based immune deconvolution in prostate cancer patients before and after radical prostatectomy. Cancer Causes Control 2024:10.1007/s10552-024-01924-x. [PMID: 39390262 DOI: 10.1007/s10552-024-01924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 09/27/2024] [Indexed: 10/12/2024]
Abstract
PURPOSE Surgery, an established short-term immunosuppressive event, may spur dissemination of circulating tumor cells and promote the growth of micrometastases. Whether surgical treatment for prostate cancer (i.e., radical prostatectomy) leads to long-term immune changes is unknown. METHODS We characterized intra-individual changes in circulating immune cell subsets across a six-month period using serial blood samples from prostate cancer patients pre- and post-radical prostatectomy (n = 11), and from a comparison group managed with active surveillance (n = 8). Immune cell subsets for each patient at each time point were deconvoluted using genome-wide methylation data. RESULTS There were no statistically significant intra-individual changes in immune cell proportions from pre- to six months post-radical prostatectomy. There were also no intra-individual changes in immune cell proportions in the active surveillance group, and no differences between treatment groups in immune cell changes over time. CONCLUSION We observed no meaningful changes in circulating immune cell subsets six months after radical prostatectomy, suggesting that surgery-induced immune changes may not be long-lasting.
Collapse
Affiliation(s)
- Lauren M Hurwitz
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Maeve Bailey-Whyte
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
- School of Medicine, University of Limerick, Limerick, V94XD21, Ireland.
| | - Michael A Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cathy D Vocke
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Julian Custer
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bríd M Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Emily L Rossi
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
3
|
Potter GM, Siripurapu R, Herwadkar A, Abdulla S, Ikotun O, Broadhurst P, Woodward M, Bhalla RK, Glancz LJ, Hammerbeck-Ward CL, Rutherford SA, Pathmanaban ON, Roncaroli F, Colaco RJ, Pan S, Whitfield GA. Skull Base Chordoma and Chondrosarcoma: Neuroradiologist's Guide to Diagnosis, Surgical Management, and Proton Beam Therapy. Radiographics 2024; 44:e240036. [PMID: 39298353 DOI: 10.1148/rg.240036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
Skull base chordomas and chondrosarcomas are distinct types of rare, locally aggressive mesenchymal tumors that share key principles of imaging investigation and multidisciplinary care. Maximal safe surgical resection is the treatment choice for each, often via an expanded endoscopic endonasal approach, with or without multilayer skull base repair. Postoperative adjuvant radiation therapy is frequently administered, usually with particle therapy such as proton beam therapy (PBT). Compared with photon therapy, PBT enables dose escalation while limiting damage to dose-limiting neurologic structures, particularly the brainstem and optic apparatus, due to energy deposition being delivered at a high maximum with a rapid decrease at the end of the penetration range (Bragg peak phenomenon). Essential requirements for PBT following gross total or maximal safe resection are tissue diagnosis, minimal residual tumor after resection, and adequate clearance from PBT dose-limiting structures. The radiologist should understand surgical approaches and surgical techniques, including multilayer skull base repair, and be aware of evolution of postsurgical imaging appearances over time. Accurate radiologic review of all relevant preoperative imaging examinations and of intraoperative and postoperative MRI examinations plays a key role in management. The radiology report should reflect what the skull base surgeon and radiation oncologist need to know, including distance between the tumor and PBT dose-limiting structures, tumor sites that may be difficult to access via the endoscopic endonasal route, the relationship between intradural tumor and neurovascular structures, and tumor sites with implications for postresection stability. ©RSNA, 2024 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Gillian M Potter
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Rekha Siripurapu
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Amit Herwadkar
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Sarah Abdulla
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Oluwaseun Ikotun
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Philip Broadhurst
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Mark Woodward
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Rajiv K Bhalla
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Laurence J Glancz
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Charlotte L Hammerbeck-Ward
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Scott A Rutherford
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Omar N Pathmanaban
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Federico Roncaroli
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Rovel J Colaco
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Shermaine Pan
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| | - Gillian A Whitfield
- From the Department of Radiology (G.M.P., P.B., M.W.) and ENT Surgery (R.K.B.), Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL; Department of Neuroradiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (R.S.); Department of Radiology, Salford Royal Hospital, Salford, United Kingdom (A.H., S.A.); Department of Neurosurgery, Salford Royal Hospital, Salford, United Kingdom (S.A.R., O.N.P.); University Hospital Lewisham, London, United Kingdom (O.I.); Department of Neurosurgery, Queen's Medical Centre, Nottinghamshire, United Kingdom and University of Nottingham, Nottingham, United Kingdom (L.J.G.); Department of Neurosurgery, Royal Sussex County Hospital Brighton, United Kingdom (C.L.H-W.); Division of Neuroscience (F.R.) and Division of Cancer Sciences (G.A.W.), University of Manchester, Manchester, United Kingdom; and Department of Clinical Oncology, Christie Hospital, Manchester, United Kingdom (R.J.C., S.P., G.A.W.)
| |
Collapse
|
4
|
Gao C, Tong YX, Zhu L, Dan Zeng CD, Zhang S. Short-term prognostic role of peripheral lymphocyte subsets in patients with gastric cancer. Int Immunopharmacol 2023; 115:109641. [PMID: 36584574 DOI: 10.1016/j.intimp.2022.109641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Immune function is associated with clinical outcomes in patients with gastric cancer. This study aimed to explore the prognostic role of peripheral lymphocyte subsets in patients with gastric cancer after curative surgery. METHODS This retrospective study was conducted at a single tertiary referral hospital. We included patients diagnosed with gastric cancer who had undergone surgery and met the inclusion criteria. Clinicopathological characteristics and preoperative peripheral lymphocyte subset data were collected for the analysis. Recurrence-free survival (RFS) and overall survival were analyzed using the Kaplan-Meier curve and Cox hazard regression model. We used the Whitney test and Spearman test to analyze the correlation between lymphocyte subsets and clinicopathological characteristics. RESULTS This study included 171 patients with gastric cancer who underwent curative surgery. Multivariate analysis revealed that carcinoembryonic antigen (p < 0.01), carbohydrate antigen 19-9 (p < 0.001), lymph node metastases (p < 0.001), total T-cell count (p = 0.02), B-cell count (p < 0.01), and regulatory T-cell percentage (p < 0.01) were independent predictive factors associated with RFS. CONCLUSIONS Impaired immune function may lead to early recurrence following curative surgery. Our study showed that the characteristics of peripheral lymphocyte subsets (T, B, and Treg cells) were independent predictive factors for recurrence in patients with gastric cancer after surgery.
Collapse
Affiliation(s)
- Chun Gao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Xin Tong
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Li Zhu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ci Dian Dan Zeng
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| |
Collapse
|
5
|
Mansouri S, Daniel L, Amhis N, Leveille M, Boudreau JE, Alkayyal AA, Collin Y, Tai LH. Perioperative oncolytic virotherapy to counteract surgery-induced immunosuppression and improve outcomes in pancreatic ductal adenocarcinoma. Front Oncol 2023; 13:1071751. [PMID: 36874130 PMCID: PMC9978493 DOI: 10.3389/fonc.2023.1071751] [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: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a high fatality cancer with one of the worst prognoses in solid tumors. Most patients present with late stage, metastatic disease and are not eligible for potentially curative surgery. Despite complete resection, the majority of surgical patients will recur within the first two years following surgery. Postoperative immunosuppression has been described in different digestive cancers. While the underlying mechanism is not fully understood, there is compelling evidence to link surgery with disease progression and cancer metastasis in the postoperative period. However, the idea of surgery-induced immunosuppression as a facilitator of recurrence and metastatic spread has not been explored in the context of pancreatic cancer. By surveying the existing literature on surgical stress in mostly digestive cancers, we propose a novel practice-changing paradigm: alleviate surgery-induced immunosuppression and improve oncological outcome in PDAC surgical patients by administering oncolytic virotherapy in the perioperative period.
Collapse
Affiliation(s)
- Sarah Mansouri
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lauren Daniel
- Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nawal Amhis
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Maxime Leveille
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jeanette E Boudreau
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | - Almohanad A Alkayyal
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia.,Immunology Research Program, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yves Collin
- Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| | - Lee-Hwa Tai
- Department of Immunology and Cell Biology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
| |
Collapse
|
6
|
Schlanger D, Popa C, Pașca S, Seicean A, Al Hajjar N. The role of systemic immuno-inflammatory factors in resectable pancreatic adenocarcinoma: a cohort retrospective study. World J Surg Oncol 2022; 20:144. [PMID: 35513845 PMCID: PMC9074307 DOI: 10.1186/s12957-022-02606-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic cancer is an aggressive malignancy, surgery being the only potentially curative treatment. The systemic inflammatory response is an important factor in the development of cancer. There is still controversy regarding its role in pancreatic cancer. METHODS Our study is a retrospective observational cohort study. We included patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), who underwent surgical resection in our hospital, between January 2012 and December 2019. We gathered information from preoperative and postoperative blood tests. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were determined. RESULTS We included 312 patients. All the immune-inflammatory scores assessed significantly changed after the surgery. The impact on overall survival of these markers showed that only some of the postoperative scores predicted survival: high PLR had a negative prognostic impact, while high lymphocyte and PNI values had a positive effect on overall survival. DISCUSSION The circulating immune cells and their values integrated in the assessed prognostic scores suffer statistically significant changes after curative pancreatic surgery. Only the postoperative values of lymphocyte count, PLR, and PNI seem to influence the overall survival in PDAC. TRIAL REGISTRATION ClinicalTrials.gov-identifier NCT05025371 .
Collapse
Affiliation(s)
- D. Schlanger
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - C. Popa
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - S. Pașca
- Department of Haematology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400012 Cluj-Napoca, Romania
| | - A. Seicean
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162 Cluj-Napoca, Romania
| | - N. Al Hajjar
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| |
Collapse
|
7
|
Wang Z, Ke N, Wang X, Wang X, Chen Y, Chen H, Liu J, He D, Tian B, Li A, Hu W, Li K, Liu X. Optimal extent of lymphadenectomy for radical surgery of pancreatic head adenocarcinoma: 2-year survival rate results of single-center, prospective, randomized controlled study. Medicine (Baltimore) 2021; 100:e26918. [PMID: 34477122 PMCID: PMC8415937 DOI: 10.1097/md.0000000000026918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Radical pancreaticoduodenectomy is the only possible cure for pancreatic head adenocarcinoma, and although several RCT studies have suggested the extent of lymph node dissection, this issue remains controversial. This article wanted to evaluate the survival benefit of different lymph node dissection extent for radical surgical treatment of pancreatic head adenocarcinoma. METHODS A total of 240 patients were assessed for eligibility in the study, 212 of whom were randomly divided into standard lymphadenectomy group (SG) or extended lymphadenectomy group (EG), there were 97 patients in SG and 95 patients in EG receiving the radical pancreaticoduodenectomy. RESULT The demography, histopathology and clinical characteristics were similar between the 2 groups. The 2-year overall survival rate in the SG was higher than the EG (39.5% vs 25.3%; P = .034). The 2-year overall survival rate in the SG who received postoperative adjuvant chemotherapy was higher than the EG (60.7% vs 37.1%; P = .021). There was no significant difference in the overall incidence of complications between the 2 groups (P = .502). The overall recurrence rate in the SG and EG (70.7% vs 77.5%; P = .349), and the patterns of recurrence between 2 groups were no significant differences. CONCLUSION In multimodality therapy system, the efficacy of chemotherapy should be based on the appropriate lymphadenectomy extent, and the standard extent of lymphadenectomy is optimal for resectable pancreatic head adenocarcinoma. The postoperative slowing of peripheral blood lymphocyte recovery might be 1 of the reasons why extended lymphadenectomy did not result in survival benefits. CLINICAL TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov (NCT02928081) in October 7, 2016. https://clinicaltrials.gov/.
Collapse
Affiliation(s)
- Ziyao Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nengwen Ke
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xing Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yonghua Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyu Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jinheng Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Du He
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Bole Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ang Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weiming Hu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kezhou Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xubao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
8
|
Kim EY, Hong TH. Changes in natural killer cell activity after surgery and predictors of its recovery-failure. J Surg Oncol 2021; 124:1561-1568. [PMID: 34351633 DOI: 10.1002/jso.26636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the changes in natural killer cell activity (NKA) during the entire treatment period of patients with resectable biliopancreatic cancers and investigated the predictors of the failure of recovery of NKA after surgery. METHODS A total of 202 patients who underwent curative resection for biliopancreatic cancer were enrolled in the study. NKA levels were measured six times during the treatment period. We investigated whether there was any difference in postoperative NKA recovery according to the period-by-time NKA value. RESULTS NKA decreased after surgery (mean, 40 pg/ml) compared to the NKA value at admission (200.2 pg/ml), then began to increase from 3 weeks after surgery (139.7 pg/ml) and rose to normal NKA levels at 5 weeks (217.1 pg/ml). The pattern of NKA changes was distinct according to the NKA values at admission. In multivariate analysis, NKA values of less than 250 pg/ml at admission (odds ratio = 5.898, p = 0.044) were a predictor of NKA recovery failure 5 weeks after surgery. CONCLUSIONS NKA rapidly decreased after curative surgery for biliopancreatic cancer and recovered to normal levels about 5 weeks later. Clinicians should be aware and cautious that patients with low NKA at admission may fail to recover NKA postoperatively.
Collapse
Affiliation(s)
- Eun Y Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae H Hong
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
9
|
Mohindroo C, Hasanov M, Rogers JE, Dong W, Prakash LR, Baydogan S, Mizrahi JD, Overman MJ, Varadhachary GR, Wolff RA, Javle MM, Fogelman DR, Lotze MT, Kim MP, Katz MHG, Pant S, Tzeng CWD, McAllister F. Antibiotic use influences outcomes in advanced pancreatic adenocarcinoma patients. Cancer Med 2021; 10:5041-5050. [PMID: 34250759 PMCID: PMC8335807 DOI: 10.1002/cam4.3870] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 12/21/2022] Open
Abstract
Recent studies defined a potentially important role of the microbiome in modulating pancreatic ductal adenocarcinoma (PDAC) and responses to therapies. We hypothesized that antibiotic usage may predict outcomes in patients with PDAC. We retrospectively analyzed clinical data of patients with resectable or metastatic PDAC seen at MD Anderson Cancer from 2003 to 2017. Demographic, chemotherapy regimen and antibiotic use, duration, type, and reason for indication were recorded. A total of 580 patients with PDAC were studied, 342 resected and 238 metastatic patients, selected retrospectively from our database. Antibiotic use, for longer than 48 hrs, was detected in 209 resected patients (61%) and 195 metastatic ones (62%). On resectable patients, we did not find differences in overall survival (OS) or progression‐free survival (PFS), based on antibiotic intake. However, in the metastatic cohort, antibiotic consumption was associated with a significantly longer OS (13.3 months vs. 9.0 months, HR 0.48, 95% CI 0.34–0.7, p = 0.0001) and PFS (4.4 months vs. 2 months, HR 0.48, 95% CI 0.34–0.68, p = <0.0001). In multivariate analysis, the impact of ATB remained significant for PFS (HR 0.59, p = 0.005) and borderline statistically significant for OS (HR 0.69, p = 0.06). When we analyzed by chemotherapy regimen, we found that patients who received gemcitabine‐based chemotherapy as first‐line therapy (n = 118) had significantly prolonged OS (HR 0.4, p 0.0013) and PFS (HR 0.55, p 0.02) if they received antibiotics, while those receiving 5FU‐based chemotherapy (n = 98) had only prolonged PFS (HR 0.54, p = 0.03). Antibiotics‐associated modulation of the microbiome is associated with better outcomes in patients with metastatic PDAC. We have analyzed the effect of antibiotics’ intake on two cohorts of patients with pancreatic adenocarcinoma, resectable, and metastatic. We have found that on the metastatic cohort, antibiotics use was significantly associated with better outcomes, particularly, on patients that received gemcitabine based‐chemotherapy as the first line.
Collapse
Affiliation(s)
- Chirayu Mohindroo
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Merve Hasanov
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyda Baydogan
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan D Mizrahi
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gauri R Varadhachary
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David R Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael T Lotze
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shubham Pant
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Investigation Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Florencia McAllister
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
10
|
Changes in prognostic nutritional index during hospitalization and outcomes in patients with acute heart failure. Heart Vessels 2021; 37:61-68. [PMID: 34131778 DOI: 10.1007/s00380-021-01888-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Although the prognostic nutritional index (PNI) is reported as a prognosticator in patients with heart failure (HF), that is evaluated usually on one occasion, and any changes in PNI during hospitalization are not considered. This study aimed to assess between changes in the PNI during hospitalization and outcomes in patients with acute HF. We enrolled 141 patients (median age, 84 years, 75 male) admitted to our hospital for the treatment of acute HF. The PNI was calculated on admission and at discharge based on the original report. According to the PNI change during hospitalization, patients were classified as either improved (PNI at discharge ≥ PNI on admission) or deteriorated (PNI at discharge < PNI on admission). Primary outcomes were all-cause death or unplanned hospitalization due to HF within the first year. Forty-nine events occurred (19 deaths, 30 HF hospitalizations). The event-free survival rate determined by Kaplan-Meier analysis was significantly higher in patients in the improved group (log-rank test, P < 0.0001), regardless of the PNI value on admission. Multivariate analysis showed that younger age (HR 1.06, 95% CI 1.01-1.11, P = 0.016), higher body mass index (HR 0.90, 95% CI 0.82-0.98, P = 0.021) and the PNI in the improved group (HR 0.30, 95% CI 0.14-0.57, P = 0.0006) were independently associated with favorable outcomes. In conclusion, changes in nutritional status during hospitalization, evaluated using the PNI on admission and at discharge, were independently associated with 1-year outcomes in patients with acute HF.
Collapse
|
11
|
Wu M, Yang S, Feng X, Li C, Yu F, Dong J. Prognostic value of the postoperative neutrophil-lymphocyte ratio in solid tumors: A meta-analysis. PLoS One 2021; 16:e0250091. [PMID: 33872342 PMCID: PMC8055017 DOI: 10.1371/journal.pone.0250091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/30/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Numerous studies have demonstrated that a variety of systemic inflammatory markers were associated with the survival of different tumors. However, the association between elevated postoperative neutrophil-lymphocyte ratio (postNLR) and long-term outcomes, including overall survival (OS), disease-free survival (DFS), in patients with solid tumors remains controversial. A systematic review was conducted to explore the association between the postNLR and long-term outcomes in solid tumors. MATERIALS AND METHODS Relevant literature was identified using PubMed, Embase, Web of Science, and the Cochrane Library from the initiation of the databases to October 2020. Data were extracted from included studies reporting hazard ratio (HR) and 95% confidence intervals (CI), and were pooled using generic inverse-variance and random-effects modeling. 25 studies reporting on7539 patients were included in the analysis. RESULTS Elevated postNLR was associated with poor OS (HR 1.87, 95% CI = 1.53-2.28; P < 0.00001), and worse DFS (HR 1.69, 95% CI = 1.28-2.22; P = 0.0002). Subgroup analyses showed that the trend of the pooled HR for most of the subgroups was not changed, and the heterogeneity of the same tumor type was not obvious. However, there was no correlation between high postNLR obtained within 7days and poor DFS (n = 3, HR 1.25, 95CI% = 0.54-2.88; P = 0.60). CONCLUSIONS Elevated postNLR might be a readily available and inexpensive biomarker for long-term outcomes in solid tumors. Multicenter and prospective studies are needed to explore the impact of the postNLR on the prognosis of solid tumors.
Collapse
Affiliation(s)
- Meilong Wu
- School of Clinical Medicine, Tsinghua University, Haidian District, Beijing, China
- Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Shizhong Yang
- School of Clinical Medicine, Tsinghua University, Haidian District, Beijing, China
- Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Xiaobin Feng
- School of Clinical Medicine, Tsinghua University, Haidian District, Beijing, China
- Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Chengquan Li
- School of Clinical Medicine, Tsinghua University, Haidian District, Beijing, China
- Institute for Precision Healthcare, Tsinghua University, Haidian District, Beijing, China
| | - Fei Yu
- School of Clinical Medicine, Tsinghua University, Haidian District, Beijing, China
- Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Jiahong Dong
- School of Clinical Medicine, Tsinghua University, Haidian District, Beijing, China
- Hepato-pancreato-biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
- Institute for Precision Healthcare, Tsinghua University, Haidian District, Beijing, China
- * E-mail:
| |
Collapse
|
12
|
MacLeod CS, McKay R, Barber D, McKinlay AW, Leeds JS. Predicting 30-day mortality following PEG insertion: External validation of the Sheffield Gastrostomy Score and analysis for additional predictors. Clin Nutr ESPEN 2021; 42:227-232. [PMID: 33745584 DOI: 10.1016/j.clnesp.2021.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND and study aims: The Sheffield Gastrostomy Score (SGS) was devised to stratify patients by calculating their risk of mortality at 30 days following PEG insertion. The aim was to externally validate the SGS and identify any further predictors of 30-day mortality. PATIENTS AND METHODS Retrospective review of all PEG insertions performed over a ten year period in our centre. All patients who had a new PEG inserted were identified and the SGS calculated. Additionally, demographic, indication for PEG insertion and other blood results were recorded. Receiver operating characteristic curves were calculated and subsequent univariate and multivariate analysis was performed to identify additional risk factors for 30 day mortality. RESULTS The PEG database comprised 1373 patients, of which 808 were suitable for analysis. For each increasing SGS gradation mortality rose, with 4% of those scoring 0 compared to 50% scoring 3. An area under the ROC curve of 0.69 (95% confidence interval 0.64-0.74) indicated good discriminative capacity. Multivariate analysis demonstrated that age ≥60 years (OR = 2.1 p = 0.016), serum albumin concentrations of 25-34 g/l (OR = 2.5 p = 0.001) or <25 g/l (OR = 6.8 p < 0.001), C-Reactive Protein ≥10 mg/l (OR = 2.7 p = 0.009) and lymphocyte count of <1.5 × 109/l (OR = 2.0 p = 0.004) increased the odds of 30-day mortality, whilst referral for PEG placement whilst an inpatient decreased the risk of death (OR = 0.53 p = 0.005). CONCLUSIONS The SGS displayed reasonable predictive ability but the area under the curve is not high enough for routine clinical use. Modelling of further predictors from a multicentre study could provide scope for updating the SGS potentially improving patient selection.
Collapse
Affiliation(s)
- Caitlin S MacLeod
- Department of Gastroenterology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK
| | - Rebecca McKay
- Department of Gastroenterology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK
| | - Dorothy Barber
- Department of Gastroenterology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK
| | - Alastair W McKinlay
- Department of Gastroenterology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK
| | - John S Leeds
- Department of Gastroenterology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN, UK.
| |
Collapse
|
13
|
Pereira-Neves A, Rocha-Neves J, Fragão-Marques M, Duarte-Gamas L, Jácome F, Coelho A, Cerqueira A, Andrade JP, Mansilha A. Red blood cell distribution width is associated with hypoperfusion in carotid endarterectomy under regional anesthesia. Surgery 2021; 169:1536-1543. [PMID: 33610341 DOI: 10.1016/j.surg.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A subset of patients submitted to carotid endarterectomy under regional anesthesia develop intraoperative neurologic deficit during carotid artery crossclamping related to critical cerebral perfusion, which may be owing to low flow or embolic phenomena. This subgroup is deemed prone to worse outcomes, which highlights its clinical relevance. The main aim of this study was to identify clinical and hematological predictors for intraoperative neurologic deficit. The secondary aim was to evaluate the perioperative prognostic value of postcarotid artery crossclamping manifestations of cerebral ischemia. METHODS Between January 2012 to January 2020, patients submitted to carotid endarterectomy under regional anesthesia in a tertiary referral center who presented intraoperative neurologic deficit were prospectively and consecutively included. This group constituted 8% of the total carotid endarterectomy performed in the center during this timeframe. The control group of patients was the subsequent patient submitted to carotid endarterectomy without intraoperative neurologic deficit in a 1:1 ratio. Blood samples were collected before surgery (<2 weeks). Propensity score matching was used to identify well-matched pairs of patients. RESULTS A total of 180 patients were included, with 90 (50% of the cohort and 8% of total carotid endarterectomies) presenting intraoperative neurologic deficit associated to clamping. Mean age was 71.4 ± 9.27 years in the study group and 68.8 ± 8.36 years in the control group. The clinical variables presenting significance after multivariate analysis include: age (adjusted odds ratio: 1.04, 5-95% confidence interval, [1.003-1.078]; P = .034), obesity (adjusted odds ratio: 3.537 [1.445-8.658]; P = .006), lower ipsilateral carotid stenosis grade (adjusted odds ratio: 0.725 [0.525-0.997]; P = .049), and higher contralateral carotid stenosis grade (adjusted odds ratio: 1.266 [1.057-1.516]; P = .010). Red cell distribution width coefficient of variation demonstrated statistical significance in predicting intraoperative neurologic deficit with an adjusted odds ratio of 1.394 (1.076-1.805); P = .012. The 30-day stroke rate was significantly higher in the intraoperative neurologic deficit group, with an adjusted odds ratio of 5.13 (5-95% confidence interval [1.058-24.87]; P = .042) after propensity score matching. Postoperative complications (Clavien-Dindo ≥2) were also associated with intraoperative neurologic deficit (after propensity score matching adjusted odds ratio of 2.748 [5-95% confidence interval, 0.976-7.741]; P = .051). CONCLUSION In this study, increased red cell distribution width coefficient of variation demonstrated value to predict intraoperative neurologic deficit. Additionally, age, obesity, a lower degree of ipsilateral carotid stenosis, and a higher degree of contralateral carotid stenosis also demonstrated ability to predict intraoperative neurologic deficit. Moreover, intraoperative neurologic deficit was an independent risk factor for 30-day stroke and postoperative complications Clavien-Dindo ≥2.
Collapse
Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R & D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Andreia Coelho
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José P Andrade
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Armando Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| |
Collapse
|
14
|
Sakamoto T, Yagyu T, Uchinaka E, Morimoto M, Hanaki T, Watanabe J, Yamamoto M, Matsunaga T, Tokuyasu N, Honjo S, Fujiwara Y. Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy. BMC Surg 2020; 20:178. [PMID: 32762748 PMCID: PMC7430815 DOI: 10.1186/s12893-020-00838-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 07/30/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the usefulness of the range of change in prognostic nutritional index (PNI) during the early postoperative period as a predictor of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. METHODS Data were retrospectively analyzed for 192 patients who underwent pancreaticoduodenectomy. Univariate and multivariate logistic regression analyses were used to evaluate perioperative variables. PNIP3-Pre ratio represented the range of change in PNI from before surgery to postoperative day (POD) 3, PNIP1-Pre ratio represented the range of change in PNI from before surgery to POD 1, and PNIP3-P1 ratio represented the range of change in PNI from POD 1 to POD 3. RESULTS The area under the curve (AUC) for PNIP3-P1 for prediction of POPF following pancreaticoduodenectomy was 0.683 (P < 0.001), which was highest among PNI ratios and higher than PNI on POD 3. The AUC for serum amylase level on POD 1 was 0.704 (P < 0.001), which was superior to the corresponding AUC on POD 3. The AUC for the combination of PNIP3-P1 ratio and serum amylase level on POD 1 for prediction of POPF was higher than the AUC of either indicator alone (0.743, P < 0.001). The combination of PNIP3-P1 ratio and serum amylase level on POD 1 was an independent predictor of POPF following pancreaticoduodenectomy (P = 0.018). CONCLUSIONS The combination of the range of change in PNI from POD 1 to POD 3 and serum amylase levels on POD 1 may be useful for prediction of POPF following pancreaticoduodenectomy.
Collapse
Affiliation(s)
- Teruhisa Sakamoto
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan.
| | - Takuki Yagyu
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Ei Uchinaka
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Masaki Morimoto
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Takehiko Hanaki
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Joji Watanabe
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Manabu Yamamoto
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Soichiro Honjo
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, 36-1 Nishi-cho, Yonago, 683-8504, Japan
| |
Collapse
|
15
|
Roulin D, Demartines N. Evidence for enhanced recovery in pancreatic cancer surgery. Langenbecks Arch Surg 2020; 405:595-602. [DOI: 10.1007/s00423-020-01921-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022]
|
16
|
Wang D, Guo D, Li A, Wang P, Teng F, Yu J. The post-treatment neutrophil-to-lymphocyte ratio and changes in this ratio predict survival after treatment of stage III non-small-cell lung cancer with conventionally fractionated radiotherapy. Future Oncol 2020; 16:439-449. [PMID: 32141321 DOI: 10.2217/fon-2019-0837] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To investigate the predictive potential of post-treatment neutrophil-to-lymphocyte ratio (NLR) and changes in this ratio (ΔNLR) for stage III non-small-cell lung cancer (NSCLC) patients who received conventionally fractionated radiotherapy (CFRT). Patients & methods: The data of 168 NSCLC patients treated at the Shandong Cancer Hospital were analyzed retrospectively. The relationship between progression-free survival (PFS), overall survival (OS) and post-treatment NLR and ΔNLR were analyzed using both Kaplan-Meier and Cox regression methods. Results: Kaplan-Meier survival analyses showed that post-treatment NLR and ΔNLR were associated with PFS (p < 0.001) and OS (p < 0.001) after CFRT. Multivariate analyses revealed that ΔNLR was an independent predictor of PFS (p = 0.001) and OS (p = 0.018). Post-treatment NLR can only be used as an independent predictor of PFS (p = 0.040). Conclusion: Our results demonstrated the prognostic value of the ΔNLR in predicting PFS and OS in stage III NSCLC patients undergoing CFRT. However, post-treatment NLR has predictive value only for PFS.
Collapse
Affiliation(s)
- Duoying Wang
- Department of Clinical Medicine, Weifang Medical University, Weifang, PR China.,Department of Radiotherapy, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, PR China
| | - Dong Guo
- Department of Radiotherapy, Sunshine Union Hospital, Weifang, PR China
| | - Aijie Li
- Department of Clinical Medicine, Weifang Medical University, Weifang, PR China.,Department of Radiotherapy, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, PR China
| | - Peiliang Wang
- Department of Radiotherapy, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, PR China
| | - Feifei Teng
- Department of Radiotherapy, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, PR China
| | - Jinming Yu
- Department of Radiotherapy, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, PR China
| |
Collapse
|
17
|
Tang F, Tie Y, Tu C, Wei X. Surgical trauma-induced immunosuppression in cancer: Recent advances and the potential therapies. Clin Transl Med 2020; 10:199-223. [PMID: 32508035 PMCID: PMC7240866 DOI: 10.1002/ctm2.24] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 02/05/2023] Open
Abstract
Surgical resection remains the mainstay treatment for solid cancers, especially for localized disease. However, the postoperative immunosuppression provides a window for cancer cell proliferation and awakening dormant cancer cells, leading to rapid recurrences or metastases. This immunosuppressive status after surgery is associated with the severity of surgical trauma since immunosuppression induced by minimally invasive surgery is less than that of an extensive open surgery. The systemic response to tissue damages caused by surgical operations and the subsequent wound healing induced a cascade alteration in cellular immunity. After surgery, patients have a high level of circulating damage-associated molecular patterns (DAMPs), triggering a local and systemic inflammation. The inflammatory metrics in the immediate postoperative period was associated with the prognosis of cancer patients. Neutrophils provide the first response to surgical trauma, and the production of neutrophil extracellular traps (NETs) promotes cancer progression. Activated macrophage during wound healing presents a tumor-associated phenotype that cancers can exploit for their survival advantage. In addition, the amplification and activation of myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs) or the elevated programmed death ligand-1 and vascular endothelial growth factor expression under surgical trauma, exacerbate the immunosuppression and favor of the formation of the premetastatic niche. Therapeutic strategies to reduce the cellular immunity impairment after surgery include anti-DAMPs, anti-postoperative inflammation or inflammatory/pyroptosis signal, combined immunotherapy with surgery, antiangiogenesis and targeted therapies for neutrophils, macrophages, MDSCs, and Tregs. Further, the application of enhanced recovery after surgery also has a feasible outcome for postoperative immunity restoration. Overall, current therapies to improve the cellular immunity under the special condition after surgery are relatively lacking. Further understanding the underlying mechanisms of surgical trauma-related immunity dysfunction, phenotyping the immunosuppressive cells, and developing the related therapeutic intervention should be explored.
Collapse
Affiliation(s)
- Fan Tang
- State Key Laboratory of Biotherapy and Cancer CenterWest China HospitalSichuan UniversityChengduSichuanPeople's Republic of China
- Department of OrthopeadicsWest China HospitalSichuan UniversityChengduSichuanPeople's Republic of China
| | - Yan Tie
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of MedicineUniversity of Electronic Science and Technology of ChinaChengduSichuanPeople's Republic of China
| | - Chongqi Tu
- Department of OrthopeadicsWest China HospitalSichuan UniversityChengduSichuanPeople's Republic of China
| | - Xiawei Wei
- State Key Laboratory of Biotherapy and Cancer CenterWest China HospitalSichuan UniversityChengduSichuanPeople's Republic of China
| |
Collapse
|