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DE Rosa M, Pasculli A, Rondelli F, Mariani L, Avenia S, Ceccarelli G, Testini M, Avenia N, Bugiantella W. Could diagnostic and therapeutic delay affect the prognosis of gastrointestinal primary malignancies in the COVID-19 pandemic era? A literature review. Minerva Surg 2021; 76:467-476. [PMID: 33890444 DOI: 10.23736/s2724-5691.21.08736-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emergency situations, as the Covid-19 pandemic that is striking the world nowadays, stress the national health systems which are forced to rapidly reorganizing their sources. Therefore, many elective diagnostic and surgical procedures are being suspended or significantly delayed. Moreover, patients might find it difficult to refer to physicians and delay the diagnostic and even the therapeutic procedures because of emotional or logistic problems. The effect of diagnostic and therapeutic delay on survival in patients affected by gastrointestinal malignancies is still unclear. METHODS We carried out a review of the available literature, in order to determine whether the delay in performing diagnosis and curative-intent surgical procedures affects the oncological outcomes in patients with oesophageal, gastric, colorectal cancers, and colorectal liver metastasis. RESULTS The findings indicate that for oesophageal, gastric and colon cancers delaying surgery up to 2 months after the end of the staging process does not worsen the oncological outcomes. Oesophageal cancer should undergo surgery within 7-8 weeks after the end of neoadjuvant chemoradiation. Rectal cancers should undergo surgery within 31 days after the diagnostic process and within 12 weeks after neoadjuvant therapy. Adjuvant therapy should start within 4 weeks after surgery, especially in gastric cancer; a delay up to 42 days may be allowed for oesophageal cancer undergoing adjuvant radiotherapy. CONCLUSIONS Gastrointestinal malignancies can be safely managed taking into account that reasonable delays of planned treatments appear a generally safe approach, not having a significant impact on long-term oncological outcome.
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Affiliation(s)
- Michele DE Rosa
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, University A. Moro of Bari, Polyclinic of Bari, Bari, Italy
| | - Fabio Rondelli
- General and Specialized Surgery, Santa Maria Hospital, Terni, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Lorenzo Mariani
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Stefano Avenia
- Postgraduate School of General Surgery, University of Perugia, Perugia, Italy
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, University A. Moro of Bari, Polyclinic of Bari, Bari, Italy
| | - Nicola Avenia
- General and Specialized Surgery, Santa Maria Hospital, Terni, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Walter Bugiantella
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy -
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2
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Hisanaga K, Uchino H, Kakisu N, Miyagi M, Yoshikawa F, Sato G, Isobe K, Kishi K, Homma S, Hirose T. Pre-Existing Diabetes Limits Survival Rate After Immune Checkpoint Inhibitor Treatment for Advanced Lung Cancer: A Retrospective Study in Japan. Diabetes Metab Syndr Obes 2021; 14:773-781. [PMID: 33654416 PMCID: PMC7910101 DOI: 10.2147/dmso.s289446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although immune checkpoint inhibitors (ICIs) are promising in the treatment of advanced cancer, their use is associated with immune-related adverse events (irAEs) that affect endocrine organ systems. Although development of irAEs was associated with improved cancer-specific survival, the risk of irAEs is unclear. We investigated the association of pre-ICI comorbidities-including diabetes-with irAEs, overall survival (OS), and progression-free survival (PFS) in advanced lung cancer. METHODS Patients with lung cancer who were treated with ICIs during the period from September 1, 2015 through July 31, 2018 were retrospectively enrolled. All data were collected from the NEPTUNE database of university patients. Hazard ratios were estimated by using Cox regression weighted for propensity scores. Odds ratios were calculated by logistic regression and adjusted for unbalanced variables. The Kaplan-Meier method was used to compare OS, and the generalized Wilcoxon test was used to compare median survival. RESULTS Among the 88 patients identified, 22 (25.0%) had diabetes (DM) before ICI treatment and 57 (75.0%) did not (non-DM); irAEs developed in 12.2% of patients with DM and in 9.1% of patients in non-DM (p=0.87). Diabetes status was not associated with irAE risk in relation to baseline characteristics (age, sex, TNM staging, thyroid and renal function) or in propensity score-matched analysis (age, TNM staging). During a mean follow-up of 30 months, OS and cancer-specific PFS were significantly higher in patients who developed irAEs (Kaplan-Meier estimates, p=0·04 and 0·03, respectively). In propensity score-matched analysis, diabetes was significantly associated with lower OS (multivariate hazard ratio, 0·36; 95% CI, 0·13-0·98) unrelated to irAEs. Irrespective of irAEs, PFS was also lower among patients with DM than among non-DM patients (Kaplan-Meier estimate, p=0·04). CONCLUSION Pre-existing diabetes was associated with higher mortality in advanced lung cancer, regardless of irAE development during treatment with ICI.
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Affiliation(s)
- Kaori Hisanaga
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
- Correspondence: Hiroshi Uchino Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, JapanTel +81-3-3762-4151Fax +81-3-3765-6488 Email
| | - Naoko Kakisu
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Masahiko Miyagi
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Fukumi Yoshikawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Genki Sato
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazutoshi Isobe
- Department of Respiratory Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Sakae Homma
- Department of Advanced and Integrated Interstitial Lung Disease Research, School of Medicine, Toho University, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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3
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Wang Y, Wang F. Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy. Cancer Manag Res 2020; 12:13023-13032. [PMID: 33376396 PMCID: PMC7755334 DOI: 10.2147/cmar.s286074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
Multidisciplinary therapies can improve the survival of patients with locally advanced esophageal carcinoma. However, the determination of the optimal modality is still a controversial subject. Many randomized controlled trials in the late 20th century showed that there was no survival benefit when postoperative radiotherapy was added to surgery for esophageal carcinoma. As a result, the treatment modality shifted thereafter to neoadjuvant therapies. Even so, these trials are criticized for many limitations and an increasing number of studies (mainly nonrandomized controlled trials) has indicated that postoperative radiotherapy/chemoradiotherapy can improve the survival of patients with a poor prognosis after R0 esophagectomy. Additionally, a large number of patients with locally advanced esophageal carcinoma still choose upfront surgery in the clinical practice due to many reasons. Therefore, postoperative radiotherapy seems to be a feasible treatment for these patients with a poor prognosis, particularly in the new era of conformal radiotherapy. Here, we review published studies on postoperative radiotherapy/chemoradiotherapy, and we discuss the clinical issues related to postoperative radiotherapy, such as the indication, target volume, total radiation dosage, time interval and complications of postoperative radiotherapy with or without chemotherapy, to make recommendations of postoperative radiotherapy for both current practice and future research in esophageal carcinoma.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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4
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Lin MQ, Li JL, Zhang ZK, Chen XH, Ma JY, Dai YQ, Huang SY, Hu YB, Li JC. Delayed postoperative radiotherapy might improve the long-term prognosis of locally advanced esophageal squamous cell carcinoma. Transl Oncol 2020; 14:100956. [PMID: 33227662 PMCID: PMC7689552 DOI: 10.1016/j.tranon.2020.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Postoperative radiotherapy timing for esophageal cancer remains to be determined. Delayed postoperative radiotherapy (>48 days) provides better survival benefit. Postoperative radiotherapy following 2–4 chemotherapy cycles achieved best survival.
Objective There is no consensus on the optimal timing of postoperative radiotherapy (PORT) for locally advanced esophageal squamous cell carcinoma (ESCC). We aimed to determine whether the timing of PORT affects the long-term prognosis of ESCC, and plotted nomograms to predict survival. Methods We retrospectively analyzed 351 ESCC patients who underwent radical surgery and PORT. Receiver operating characteristic curves were used to estimate the optimal cutoff point of the time interval between surgery and PORT. Cox proportional hazards regression was used to identify prognostic predictors. Overall survival (OS) and progression-free survival (PFS) were predicted using nomograms. Results The median follow-up was 53 months (range: 3–179 months). Compared to early PORT, PORT at >48 days after surgery was associated with better OS (adjusted hazard ratio [HR]: 1.406, p = 0.037) and PFS (adjusted HR: 1.475, p = 0.018). In the chemotherapy subgroup, incorporation of chemotherapy timing into the analysis suggested that 2–4 chemotherapy cycles followed by PORT was the optimal treatment schedule as compared to 0–1 chemotherapy cycle followed by PORT and concurrent chemoradiotherapy (5-year PFS: 65.9% vs. 51.0% vs. 50.1%; p = 0.049). The nomograms for OS and PFS were superior to the TNM classification (concordance indices: 0.721 vs. 0.626 and 0.716 vs. 0.610, respectively). Conclusions Delayed PORT (>48 days) provides better survival benefit than early PORT among ESCC patients. PORT following 2–4 chemotherapy cycles might lead to the best survival rate. The nomogram plotted in this study effectively predicted survival and may help guide treatment.
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Affiliation(s)
- Ming-Qiang Lin
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jin-Luan Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Zong-Kai Zhang
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen 361003, China.
| | - Xiao-Hui Chen
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jia-Yu Ma
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Ya-Qing Dai
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen 361003, China.
| | - Shu-Yun Huang
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Yi-Bin Hu
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jian-Cheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
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5
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Wang Y, Xing Q, Chen X, Wang J, Guan S, Chen X, Sun P, Wang M, Cheng Y. The Clinical Prognostic Value of LRG1 in Esophageal Squamous Cell Carcinoma. Curr Cancer Drug Targets 2020; 19:756-763. [PMID: 30714525 DOI: 10.2174/1568009619666190204095942] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/22/2018] [Accepted: 01/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Leucine-rich-alpha-2-glycoprotein1 (LRG1) is a new oncogene-related gene, which has been proven important for the development and poor prognosis of human cancers. However, whether it participates in esophageal squamous cell carcinoma (ESCC) progression remains unclear. OBJECTIVE To investigate the expression level and functional influence of LRG1 in ESCC. METHODS The expression of LRG1 was evaluated on the mRNA and protein level in ESCC patients. Then, correlation of LRG1 expression with clinicpathological variables was analyzed in ESCC. Besides, to clarify the biological function of LRG1, Eca109 and KYSE150 cells were transfected with LRG1 shRNA, the cell viability, clonal efficiency, apoptosis and invasion assays in vitro were performed. RESULTS LRG1 was significantly over-expressed in ESCC and related to deeper invasion depth (T stage) and distal metastasis (M stage). Kaplan-Meier analysis indicated that LRG1 up-regulation in ESCC was closely correlated to worse clinical survival (overall survival and progression-free survival), all P<0.001. LRG1 was confirmed to be an independent poor premonitory indicator for clinical outcomes in ESCC through the univariate and multivariate analyses. Down-regulation of LRG1 in ESCC cells markedly suppressed cell proliferation and invasion, stimulated apoptosis (all p <0.01). CONCLUSION LRG1 might play a significant role in the progression of ESCC, and could be served as a promising prognostic prediction for ESCC patients.
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Affiliation(s)
- Yuanyuan Wang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China.,Department of Oncology, Linyi People's Hospital, Dezhou, Shandong, China
| | - Qian Xing
- Department of Oncology, Linyi People's Hospital, Dezhou, Shandong, China
| | - Xue Chen
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianbo Wang
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shanghui Guan
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xuan Chen
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Peng Sun
- Thoracic Surgery, Linyi People's Hospital, Dezhou, Shandong, China
| | - Mingxia Wang
- Pathology, Linyi People's Hospital, Dezhou, Shandong, China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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