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Bong JW, Na Y, Ju Y, Cheong C, Kang S, Lee SI, Min BW. Nomogram for predicting the overall survival of underweight patients with colorectal cancer: a clinical study. BMC Gastroenterol 2023; 23:39. [PMID: 36782150 PMCID: PMC9923908 DOI: 10.1186/s12876-023-02669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND An underweight individual is defined as one whose Body Mass Index (BMI) is < 18.5 kg/m2. Currently, the prognosis in patients with colorectal cancer (CRC) who are also underweight is unclear. METHODS Information on South Korean patients who underwent curative resection for CRC without distant metastasis was collected from health insurance registry data between January 2014 and December 2016. We compared the overall survival (OS) of underweight and non-underweight (BMI ≥ 18.5 kg/m2) patients after adjusting for confounders using propensity score matching. A nomogram to predict OS in the underweight group was constructed using the significant risk factors identified in multivariate analysis. The predictive and discriminative capabilities of the nomogram for predicting 3- and 5-year OS in the underweight group were validated and compared with those of the tumor, node, and metastasis (TNM) staging system in the training and validation sets. RESULTS A total of 23,803 (93.6%) and 1,644 (6.4%) patients were assigned to the non-underweight and underweight groups, respectively. OS was significantly worse in the underweight group than in the non-underweight group for each pathological stage (non-underweight vs. underweight: stage I, 90.1% vs. 77.1%; stage IIA, 85.3% vs. 67.3%; stage IIB/C, 74.9% vs. 52.1%; and stage III, 73.2% vs. 59.4%, P < 0.001). The calibration plots demonstrated that the nomogram exhibited satisfactory consistency with the actual results. The concordance index (C-index) and area under the receiver operating characteristic curve (AUC) of the nomogram exhibited better discriminatory capability than those of the TNM staging system (C-index, nomogram versus TNM staging system: training set, 0.713 versus 0.564, P < 0.001; validation set, 0.691 versus 0.548, P < 0.001; AUC for 3- and 5- year OS, nomogram versus TNM staging system: training set, 0.748 and 0.741 versus 0.610 and 0.601; validation set, 0.715 and 0.753 versus 0.586 and 0.579, respectively). CONCLUSIONS Underweight patients had worse OS than non-underweight patients for all stages of CRC. Our nomogram can guide prognostic predictions and the treatment plan for underweight patients with CRC.
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Affiliation(s)
- Jun Woo Bong
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Younghyun Na
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Yeonuk Ju
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Chinock Cheong
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Sanghee Kang
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Sun Il Lee
- grid.411134.20000 0004 0474 0479Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308 Republic of Korea
| | - Byung Wook Min
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
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Hosokawa K, Nishida T, Hayashi D, Kitazawa M, Masuda H, Tono K, Katanosaka Y, Sakamoto N, Fujii Y, Sugimoto A, Nakamatsu D, Matsumoto K, Yamamoto M, Fukui K. Impact of Initial Body Weight Loss on Prognosis in Advanced Pancreatic Cancer: Insights From a Single-Center Retrospective Study. Cancer Control 2023; 30:10732748231204719. [PMID: 37749874 PMCID: PMC10521268 DOI: 10.1177/10732748231204719] [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: 06/23/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Pancreatic cancer (PC) has a poor prognosis, with body weight loss commonly observed at diagnosis. However, the impact on PC prognosis of weight loss at the time of diagnosis on PC prognosis is unknown. METHODS This retrospective, single-center study enrolled consecutively patients diagnosed with metastatic or locally advanced PC or resectable PC who were intolerant of or refused surgery. Patients who had lost more than 5% of their body weight or more than 2% and had a body mass index (BMI) of less than 20 kg/m2 at diagnosis were classified as experiencing body weight loss. Patients were subclassified into 2 groups: patients with and without weight loss. The study evaluated patient-related and PC-related factors affecting prognosis. Cox proportional hazards models were used to assess factors affecting prognosis. The primary endpoint was overall survival. Additionally, 1:1 propensity score matching was performed to reduce bias. RESULTS In total, 220 patients were included in the study. The median age of the patients was 74 years, and 49.1% were male. Weight loss at diagnosis was observed in 43.2% of patients. There were no significant differences in clinical factors, except for anthropometric parameters, between the groups. The median survival time did not differ between the weight loss and no weight loss groups (149 and 173 days, respectively, P = .669). After matching, no significant differences in survival times were observed between the 2 groups. CONCLUSIONS This study found no association between weight loss at diagnosis and prognosis in patients with advanced PC treated with best supportive care or chemotherapy.
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Affiliation(s)
- Kana Hosokawa
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Daichi Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Miharu Kitazawa
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Haruka Masuda
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Katsuharu Tono
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yuhiko Katanosaka
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Naohiro Sakamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yoshifumi Fujii
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Aya Sugimoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Koji Fukui
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
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3
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Davis M, Vanenkevort E, Varun S, Young A, Correa Ordonez I, Brown J, Wojtowicz M. Is Weight Loss During Chemotherapy for Pancreatic Cancer Prognostic? Am J Hosp Palliat Care 2022:10499091221123049. [PMID: 36062722 DOI: 10.1177/10499091221123049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Predicting poor survival outcomes early in palliative chemotherapy is important to the timing of palliative care. Weight loss during chemotherapy if prognostic would lead to early palliative care. METHOD We collected demographics, stage, chemotherapy, chemotherapy cycles, weight, healthcare utilization, comorbidities (Charleson Comorbid Index), tumor markers, and weight changes over 60 days. We defined 3 groups of patients: 1. Weight gain to <.5% weight loss, 2. Weight loss< 2% and 3. Weight loss of >2%. A Chi-square test assessed differences in weight during treatment. Time-to-event analysis was expressed in a Kaplan Meier curve. RESULTS 93 individuals died of pancreatic cancer in 2018 and 2019. The median age was 71.2 years. Forty-three had stage I and II, 40 stages III and IV cancers, and 10 had unknown stages. Most received FOLFIRINOX and gemcitabine/nab-paclitaxel chemotherapy. Thirty-six gained to lost < .5% during chemotherapy,8 lost < 2% and 49 patients lost > 2% of their weight. Mortality was available in 55 of 93 patients. Median survival was 16.6 months in those with weight gain to < .5% weight loss, 17.28 months for those with < 2% weight loss, and 20.5 months for those with > 2% weight loss (P = .42). DISCUSSION Weight loss over 60 days did not predict a poor prognosis in this small retrospective study; larger prospective studies may clarify the prognostic importance of weight loss during chemotherapy. CONCLUSION In this small retrospective study, weight loss over 60 days did not predict poor survival.
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Affiliation(s)
- Mellar Davis
- 21599Geisinger Medical Center, Danville, PA, USA
| | | | - Samji Varun
- 21599Geisinger Medical Center, Danville, PA, USA
| | - Amanda Young
- 21599Geisinger Medical Center, Danville, PA, USA
| | | | - Jason Brown
- 21599Geisinger Medical Center, Danville, PA, USA
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Sahlström E, Bereza-Carlson P, Nilsson J, Tingstedt B, Andersson B. Risk factors and outcomes for patients with pancreatic cancer undergoing surgical exploration without resection due to metastatic disease: A national cohort study. Hepatobiliary Pancreat Dis Int 2022; 21:279-284. [PMID: 35248479 DOI: 10.1016/j.hbpd.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/08/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Unresectable disease is sometimes diagnosed during surgery in patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to identify preoperative risk factors for metastatic disease diagnosed at surgical exploration and to investigate and compare survival in resected and non-resected patients. METHODS Patients were identified from the Swedish National Pancreatic and Periampullary Cancer Registry 2010-2018. Predictors of metastatic disease were evaluated with a multivariable logistic regression model, and survival was evaluated with Kaplan-Meier estimates and log-rank tests. RESULTS In total, 1938 patients with PDAC were scheduled for surgery. An unresectable situation was diagnosed intraoperatively in 399 patients (20.6%), including 234 (12.1%) with metastasized disease. Independent risk factors for metastasis were involuntary weight loss (OR = 1.72; 95% CI: 1.27-2.33) and elevated carbohydrate antigen 19-9 (CA19-9) (35-599 U/mL, OR = 1.79, 95% CI: 1.11-2.89; ≥ 600 U/mL, OR = 3.24, 95% CI: 2.04-5.17). Overall survival was lower among patients with metastasized disease than that among patients with a resectable tumor (P < 0.001). CONCLUSIONS Involuntary weight loss and an elevation of CA19-9 are preoperative risk factors for diagnosing metastasized disease during surgical exploration.
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Affiliation(s)
- Emil Sahlström
- Department of Clinical Sciences Lund, Surgery, Lund University, Sweden
| | - Paulina Bereza-Carlson
- Department of Clinical Sciences Lund, Surgery, Lund University, Sweden; Department of Surgery, Central Hospital Kristianstad, Sweden
| | - Johan Nilsson
- Department of Translational Medicine, Cardiothoracic surgery and bioinformatics, Lund University, Sweden; Department of Thoracic and vascular surgery, Skåne University hospital, Lund, Sweden
| | - Bobby Tingstedt
- Department of Clinical Sciences Lund, Surgery, Lund University, Sweden; Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Bodil Andersson
- Department of Clinical Sciences Lund, Surgery, Lund University, Sweden; Department of Surgery, Skåne University Hospital, Lund, Sweden.
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Steindorf K, Clauss D, Rötzer I, Tjaden C, Hackert T, Wiskemann J. Nutrition Intake and Nutrition Status of Pancreatic Cancer Patients: Cross-Sectional and Longitudinal Analysis of a Randomized Controlled Exercise Intervention Study. Nutr Cancer 2022; 74:3492-3500. [PMID: 35608567 DOI: 10.1080/01635581.2022.2077382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pancreatic cancer patients often present with an inadequate nutritional intake. At the same time, there are no standardized recommendations for nutrition intake during and after cancer treatment. In a prospective analysis of a randomized controlled trial analyzing the effects of a 6-month resistance training in pancreatic cancer patients, we assessed the nutritional intake and the impact of a 6-month supervised resistance training or home-based resistance training vs. usual care control on the nutritional intake of the patients. Nutritional intake was assessed by 24-h recall before and after the 6-month resistance training period. At baseline low protein intake (<1 g/kg body weight) was found in 33.9% of the 59 patients and low energy intake (<25 kcal/kg body weight) was found in 39.0% of the patients. In all, 35.6% of the patients were classified with a risk of malnutrition (NRS ≥ 3). In the total of 46 patients who finished the 6-month intervention period, there was no difference in nutritional intake over time between resistance training and usual care control. In conclusion, it appears that the majority of our study population had an adequate protein and energy intake. A resistance training seems to have no influence on the nutritional intake of the patients.
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Affiliation(s)
- Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, Germany
| | - Dorothea Clauss
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, Germany.,Department of Molecular and Cellular Sport Medicine, German Sport University, Cologne, Germany
| | - Ingeborg Rötzer
- Division of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Christine Tjaden
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
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Topkan E, Selek U, Pehlivan B, Kucuk A, Haksoyler V, Kilic Durankus N, Sezen D, Bolukbasi Y. The Prognostic Significance of Novel Pancreas Cancer Prognostic Index in Unresectable Locally Advanced Pancreas Cancers Treated with Definitive Concurrent Chemoradiotherapy. J Inflamm Res 2021; 14:4433-4444. [PMID: 34511977 PMCID: PMC8427684 DOI: 10.2147/jir.s329611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose We evaluated the prognostic quality of the novel pancreas cancer prognostic index (PCPI), a combination of CA 19-9 and systemic inflammation response index (SIRI), on the outcomes of locally advanced pancreas adenocarcinoma (LAPAC) patients who received concurrent chemoradiotherapy (C-CRT). Methods This retrospective analysis covered 152 unresectable LAPAC patients treated from 2007 to 2019. Receiver operating characteristic (ROC) curve analysis was used to define ideal cutoff thresholds for the pretreatment CA 19-9 and SIRI measurements, individually. The associations between the PCPI groups and progression-free- (PFS) and overall survival (OS) comprised the respective primary and secondary endpoints. Results The ROC curve analysis distinguished the respective rounded optimal cutoffs at 91 U/m/L (< versus ≥90) and 1.8 (< versus ≥1.8) for CA 19-9 and SIRI, arranging the study cohort into two significantly different survival groups for each, with resultant four likely groups: Group-1: CA 19-9<90 U/m/L and SIRI<1.8, Group-2: CA 19-9<90 U/m/L but SIRI≥1.8, Group-3: CA 19-9≥90 U/m/L but SIRI<1.8, and Group-4: CA 19-9≥90 U/m/L and SIRI≥1.8. Since the PFS (P=0.79) and OS (P=0.86) estimates of the groups 2 and 3 were statistically indistinct, we merged them as one group and created the novel three-tiered PCPI: PCPI-1: CA 19-9<90 U/m/L and SIRI<1.8, PCPI-2: CA 19-9<90 U/m/L but SIRI≥1.8 or CA 19-9≥90 U/m/L but SIRI<1.8, and PCPI-3: CA 19-9≥90 U/m/L and SIRI≥1.8, respectively. Comparative analyses unveiled that the PCPI-1 and PCPI-3 groups had the respective best and worst PFS (17.0 versus 7.5 versus 4.4 months; P<0.001) and OS (26.1 versus 15.1 versus 7.4 months; P<0.001) outcomes, while the PCPI-2 group posed in between. The multivariate analysis outcomes confirmed the novel three tired PCPI’s independent prognostic significance on either of the PFS [HR: 5.38 (95% confidence interval (CI): 4.96-5.80); P<0.001)] and OS [HR: 5.67 (95% CI: 5.19-6.15); P<0.001] endpoints, separately. Conclusion The new PCPI introduced here can be used as an independent and reliable prognostic indicator to divide LAPAC patients into three subgroups with discrete survival results.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, Koc University Faculty of Medicine, Istanbul, Turkey.,Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Berrin Pehlivan
- Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey
| | - Ahmet Kucuk
- Radiation Oncology Clinics, Mersin City Hospital, Mersin, Turkey
| | | | | | - Duygu Sezen
- Department of Radiation Oncology, Koc University Faculty of Medicine, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, Koc University Faculty of Medicine, Istanbul, Turkey.,Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
OPINION STATEMENT Despite extensive research that has identified new risk factors, genetic mutations, and therapeutic options, pancreatic ductal adenocarcinoma continues to be a leading cause of cancer related death. Patients with pancreatic cancer, along with their clinicians, must balance realistic hope alongside a life-threatening diagnosis. As the search for treatments to reduce the morbidity and mortality continues, symptom management and quality of life remain the focus of our efforts. In addition to side effects of cancer-directed therapy, patients are at risk for malnutrition, pain, and fatigue. These factors are often overlooked in practice, so a multidisciplinary team is critical in optimizing the care of patients.
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Low Systemic Inflammation Response Index Predicts Good Prognosis in Locally Advanced Pancreatic Carcinoma Patients Treated with Concurrent Chemoradiotherapy. Gastroenterol Res Pract 2020; 2020:5701949. [PMID: 32802045 PMCID: PMC7414371 DOI: 10.1155/2020/5701949] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/15/2020] [Indexed: 12/19/2022] Open
Abstract
Background We investigated the prognostic significance of pretreatment systemic inflammation response index (SIRI) in locally advanced pancreatic carcinoma (LAPC) patients treated with concurrent chemoradiotherapy (CRT). Methods Present retrospective cohort analysis investigated consecutive 154 LAPC patients who received radical CRT. The SIRI was defined as: SIRI = neutrophil × monocyte/lymphocyte counts. Ideal SIRI cutoff(s) influencing overall survival (OS) and progression-free survival (PFS) results were sought by using receiver operating characteristic (ROC) curve analysis. The primary endpoint was the interaction between the SIRI and OS results. Results The median follow-up, PFS, and OS durations were 14.3 (range: 2.9-74.6), 7.9 [%95 confidence interval (CI): 5.7-10.1), and 14.7 months (%95 CI: 11.4-18.0) for the entire cohort, respectively. ROC curve analyses determined the ideal SIRI cutoff that exhibiting a significant link with OS and PFS outcomes at the rounded 1.6 point (AUC: 74.3%; sensitivity: 73.8%; specificity: 70.1%).The SIRI <1.6 patients (N = 58) had significantly superior median PFS (13.8 versus 6.7 months; P < 0.001) and OS (28.6 versus 12.6 months; P < 0.001) lengths than SIRI ≥1.6 patients (N = 96), respectively. Although the N0 (versus N1; P < 0.05) and CA 19-9 ≤90 U/mL (versus >90 U/mL) appeared as the other significant associates of better OS and PFS in univariate analyses, yet the results of multivariate analyses confirmed the SIRI <1.6 as the independent indicator of superior OS and PFS (P < 0.001 for each). Conclusion Pretreatment SIRI is a novel independent prognosticator that may further enhance the conventional tumor-node-metastases staging system in a more precise prediction of the OS and PFS outcomes of LAPC patients after radical CRT.
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9
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Sahlström E, Nilsson J, Tingstedt B, Bergenfeldt M, Andersson R, Andersson B. Surgical exploration without resection in pancreatic and periampullary tumors: Report from a national database. Scand J Surg 2020; 110:344-350. [PMID: 32299289 PMCID: PMC8551431 DOI: 10.1177/1457496920913669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background and objective: Pancreatic and periampullary cancers are sometimes found to have a too advanced disease during surgery to allow resection. The aim was to describe characteristics, treatment, outcome, and time trends for patients that were planned for pancreatic surgery but found unresectable during surgery. Methods: Data from the Swedish National Pancreatic and Periampullary Cancer Registry were used. All patients registered between January 2010 and August 2018 were included. The patient cohort was divided in two halves based on year of diagnosis. Results: In total, 12,377 patients were included in the registry and finally 4568 patients were scheduled for surgery. During surgical exploration, 3879 (84.9%) patients underwent pancreatic resection, 658 (14.4%) patients were found unresectable, and 31 (0.7%) had no pancreatic resection due to other reasons (e.g. benign lesion, comorbidity). More patients underwent surgical exploration and resection during the second time period, but exploration without resection was unchanged (15.7% vs 13.7%; p = 0.062). Survival rates were lower among the unresectable patients with pancreatic and periampullary tumors compared to the resectable patients, including 30-day mortality (n = 17 (3.5%) vs n = 39 (1.6%), p = 0.004) and 90-day mortality (n = 72 (15.0%) vs n = 70 (2.8%), p < 0.001). Palliative surgery became less common during the second half of the time period (p < 0.001). Conclusions: Unresectability is associated with an unfavorable prognosis. The frequency did not decrease during the study period, but palliative surgical procedures became less common.
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Affiliation(s)
- Emil Sahlström
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Johan Nilsson
- Department of Clinical Sciences, Lund, Cardiothoracic Surgery Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bobby Tingstedt
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Bergenfeldt
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Roland Andersson
- Department of Clinical Sciences, Lund, Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bodil Andersson
- Department of Surgery, Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, SE-221 85, Sweden
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10
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Topkan E, Mertsoylu H, Ozdemir Y, Sezer A, Kucuk A, Besen AA, Ozyilkan O, Selek U. Prognostic Usefulness Of Advanced Lung Cancer Inflammation Index In Locally-Advanced Pancreatic Carcinoma Patients Treated With Radical Chemoradiotherapy. Cancer Manag Res 2019; 11:8807-8815. [PMID: 31632140 PMCID: PMC6789411 DOI: 10.2147/cmar.s222297] [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: 07/07/2019] [Accepted: 09/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Previously advanced lung cancer inflammation index (ALI) has been demonstrated to have prognostic utility in the stratification of patients into distinctive survival groups, but the prognostic value of ALI has never been explored in the setting of locally advanced pancreatic carcinomas (LAPC) treated with concurrent chemoradiotherapy (CCRT). Hence, we aimed to investigate the prognostic value of pre-treatment ALI in LAPC patients who underwent radical CCRT. Methods Present retrospective cohort analysis incorporated 141 LAPC patients who received radical CCRT. Accessibility of baseline ALI cutoff(s) impacting survival outcomes was sought by receiver operating characteristic (ROC) curve analysis. Interaction between the ALI and overall- (OS) and progression-free survival (PFS) comprised our primary and secondary endpoints, respectively. Results At a median follow-up of 14.4 months (range: 3.2–74.2), the median PFS and OS were 7.5 (%95 CI: 5.9–9.1) and 14.6 months (%95 CI: 11.6–17.6), respectively. ROC curve analyses set the ideal ALI cutoff value at 25.3 (AUC: 75.6%; sensitivity: 72.7%; specificity: 70.3%) that exhibited significant associations with both the OS and PFS results. Patient stratification into two groups per ALI [≤25.3 (N=75) versus>25.3 (N=66)] showed that the ALI>25.3 group had significantly superior median OS (25.8 versus 11.4 months; P<0.001) and PFS (15.9 versus 6.0 months; P<0.001) durations than its ALI≤25.3 counterpart. Other factors exhibiting significantly better OS and PFS rates were N0 stage (versus N1; P<0.05 for each endpoint) and CA 19-9 ≤90 U/mL (versus >90 U/mL; P<0.05 for each endpoint), respectively. These three factors were additionally asserted to be independent indicators of longer OS (P<0.05 for each) and PFS (P<0.05 for each) in multivariate analyses. Conclusion Results of this hypothesis-generating research proposed the pre-CCRT ALI as a novel robust associate of OS and PFS outcomes for LAPC patients undergoing CCRT.
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Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Huseyin Mertsoylu
- Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Yurday Ozdemir
- Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Ahmet Sezer
- Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Ahmet Kucuk
- Department of Radiation Oncology, Mersin City Hospital, Mersin, Turkey
| | - Ali Ayberk Besen
- Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Ozgur Ozyilkan
- Department of Medical Oncology, Baskent University Medical Faculty, Adana, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey.,Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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11
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Progressive Resistance Training to Impact Physical Fitness and Body Weight in Pancreatic Cancer Patients: A Randomized Controlled Trial. Pancreas 2019; 48:257-266. [PMID: 30589829 DOI: 10.1097/mpa.0000000000001221] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Maintaining or improving muscle mass and muscle strength is an important treatment goal in pancreatic cancer (PC) patients because of high risk of cachexia. Therefore, we assessed feasibility and effectivity of a 6-month progressive resistance training (RT) in PC patients within a randomized controlled trial. METHODS Sixty-five PC patients were randomly assigned to either supervised progressive RT (RT1), home-based RT (RT2), or usual care control group (CON). Both exercise groups performed training 2 times per week for 6 months. Muscle strength for knee, elbow, and hip extensors and flexors and cardiorespiratory fitness and body weight were assessed before and after the intervention period. RESULTS Of 65 patients, 43 patients were analyzed. Adherence rates were 64.1% (RT1) and 78.4% (RT2) of the prescribed training sessions. RT1 showed significant improvements in elbow flexor/extensor muscle strength and in maximal work load versus CON and RT2 (P < 0.05). Further, knee extensors were significantly improved for RT1 versus CON (P < 0.05). Body weight revealed no significant group differences over time. CONCLUSIONS Progressive RT was feasible in PC patients and improved muscle strength with significant results for some muscle groups. Supervised RT seemed to be more effective than home-based RT.
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Abstract
PURPOSE OF REVIEW Cancer-associated weight loss is a common comorbid condition best described among patients with advanced malignancy receiving systemic therapy, but its relationship to patients undergoing radiation treatment is less well described. We review the interaction between cancer-associated weight loss and radiation treatment as well as its prognostic significance. RECENT FINDINGS Multiple studies demonstrate a consistent detrimental effect of cancer-associated weight loss either existing prior to treatment or developing during radiotherapy. Emerging data suggest cancer-associated weight loss independently contributes to an aggressive malignant phenotype rather than simply reflecting a consequence of disease. Novel therapies are urgently needed to address the unmet burden of cancer-associated weight loss. SUMMARY Consideration of cancer-associated weight loss is important among patients receiving radiotherapy. Further study will further characterize the relationship and identify targetable biologic mechanisms of cancer cachexia.
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Cong Z, Wang D, Cao Y. The relationship between body mass index changes during chemotherapy and prognosis of patients with advanced colorectal cancer: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e10843. [PMID: 29851794 PMCID: PMC6392521 DOI: 10.1097/md.0000000000010843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We investigated the relationships between body mass index change (ΔBMI) and prognoses and clinical effects of patients with advanced colorectal cancer (CRC).From January 2008 to December 2012, 224patients with stage IV CRC were diagnosed in our hospital, and their clinical and pathological data were collected for this retrospective study. These patients were divided into lowΔ BMI group (ΔBMI ≤-0.45 kg/m) and high ΔBMI (ΔBMI >-0.45 kg/m) group.After 2 cycles of chemotherapy, there were no significant differences between prediagnosis BMI, ΔBMI, and clinical effects (P = .196; P = .59).There was also no significant difference in median progression-free survival of the high ΔBMI and low ΔBMI groups (P = .530). The overall survival (OS) time of the high ΔBMI group was significantly longer than that of the low ΔBMI group (P = .002). Family history (P = .041), eastern cooperative oncology group performance status (ECOG PS) score (P = .001), ΔBMI (P = .023), and carcinoembryonic antigen, (P = 0.02) were independent predictive factors of OS rates in patients with CRC. The relative risk was 0.72-fold for patients with CRC patients with high ΔBMI levels, relative to those with lower ΔBMI levels.Our results demonstrate that ΔBMI decreases predict poor prognoses for patients with advanced CRC, and elevated ΔBMI was a predictive factor for high survival rate. Thus, ΔBMI appears to be an independent predictive factor of CRC survival rates.
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Kang J, Lee SH, Son JH, Lee JW, Choi YH, Choi JH, Paik WH, Ryu JK, Kim YT. Body mass index and weight change during initial period of chemotherapy affect survival outcome in advanced biliary tract cancer patients. PLoS One 2018; 13:e0195118. [PMID: 29608578 PMCID: PMC5880377 DOI: 10.1371/journal.pone.0195118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/17/2018] [Indexed: 01/10/2023] Open
Abstract
Background The impact of obesity on survival is known to vary in different cancers. Advanced biliary tract cancer was rarely analyzed about the relationship between obesity and prognosis. We performed this study to evaluate the BMI and body weight change as prognostic factors for advanced biliary tract cancer patients with palliative chemotherapy. Methods Between January 2005 and December 2016, two hundred and seventy-six patients who underwent chemotherapy for biliary tract cancer were retrospectively analyzed. The relationship between BMI (kg/m2) and clinical outcomes including overall and progression-free survival was assessed. Additionally the relationship between change in body composition and overall survival was evaluated. Results Median overall survival was 9.7 months for underweight patients, 10.1 months for normal patients, 15.8 months for overweight group, 13.1 months for obese patients, respectively. (p = 0.047) Univariate analysis showed that BMI, stage III, age less than 64 year-old, gallbladder cancer, operation, radiotherapy and ECOG performance were significantly associated with better survival. Compared with normal patients, overweight patients (BMI 23–24.9kg/m2) had a reduced risk of mortality in multivariate analysis (HR 0.632; 95% CI 0.436–0.918, p = 0.016). In the additional analysis for the effect of changes in body weight and BMI to the overall survival, decrease in body weight and BMI (HR 1.410, 95% CI 1.168–1.986, p = 0.046) was associated with a shorter in overall survival. Conclusion Overweight status and the maintenance of body weight during the initial period of chemotherapy are important and independent predictors of better overall survival in advanced biliary tract cancer patients.
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Affiliation(s)
- Jinwoo Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Gastroenterolgy and Hepatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- * E-mail:
| | - Jun Hyuk Son
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Woo Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Mediplex Sejong Hospital, Gyeyang-gu, Incheon, Korea
| | - Young Hoon Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Excessive Pretreatment Weight Loss Is a Risk Factor for the Survival Outcome of Esophageal Carcinoma Patients Undergoing Radical Surgery and Postoperative Adjuvant Chemotherapy. Can J Gastroenterol Hepatol 2018; 2018:6075207. [PMID: 29623265 PMCID: PMC5830280 DOI: 10.1155/2018/6075207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/04/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prognostic values of weight loss and body mass index (BMI) in esophageal carcinoma remain controversial. This study aimed to evaluate the impacts of weight loss on the survival of patients undergoing radical surgery and adjuvant chemotherapy. METHODS The medical records of 189 consecutive patients with nonmetastatic esophageal carcinoma treated in our hospital between January 2012 and December 2013 were reviewed, and 121 patients were included for analysis. RESULTS Kaplan-Meier analysis revealed that the 3-year overall survival rate was significantly higher in the low pretreatment weight loss (pre-LWL) group than in the high pretreatment weight loss (pre-HWL) group (P < 0.001). In addition, the 3-year overall survival rate of normal weight group was higher than that of overweight and underweight groups (P = 0.007). Multivariate Cox proportional hazards analysis showed that pre-LWL group had a significantly better 3-year overall survival than pre-HWL group (P = 0.027, HR = 1.89, and 95% CI = 1.07-3.32). pN stage and age were also the survival prognostic factors. CONCLUSIONS Our study showed that low pretreatment weight loss predicted a better survival outcome in the esophageal carcinoma patients with radical surgery and adjuvant chemotherapy. However, BMI and weight loss during treatment had no impact on the survival outcome.
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