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Magnin J, Fournel I, Doussot A, Régimbeau JM, Zerbib P, Piessen G, Beyer-Berjot L, Deguelte S, Lakkis Z, Schwarz L, Orry D, Ayav A, Muscari F, Mauvais F, Passot G, Trelles N, Venara A, Benoist S, Messager M, Fuks D, Borraccino B, Trésallet C, Valverde A, Souche FR, Herrero A, Gaujoux S, Lefevre J, Bourredjem A, Cransac A, Ortega-Deballon P. Benefit of a flash dose of corticosteroids in digestive surgical oncology: a multicenter, randomized, double blind, placebo-controlled trial (CORTIFRENCH). BMC Cancer 2022; 22:913. [PMID: 35999521 PMCID: PMC9400297 DOI: 10.1186/s12885-022-09998-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 11/12/2022] Open
Abstract
Background The modulation of perioperative inflammation seems crucial to improve postoperative morbidity and cancer-related outcomes in patients undergoing oncological surgery. Data from the literature suggest that perioperative corticosteroids decrease inflammatory markers and might be associated with fewer complications in esophageal, liver, pancreatic and colorectal surgery. Their benefit on cancer-related outcomes has not been assessed. Methods The CORTIFRENCH trial is a phase III multicenter randomized double-blind placebo-controlled trial to assess the impact of a flash dose of preoperative corticosteroids versus placebo on postoperative morbidity and cancer-related outcomes after elective curative-intent surgery for digestive cancer. The primary endpoint is the frequency of patients with postoperative major complications occurring within 30 days after surgery (defined as all complications with Clavien-Dindo grade > 2). The secondary endpoints are the overall survival at 3 years, the disease-free survival at 3 years, the frequency of patients with intraabdominal infections and postoperative infections within 30 days after surgery and the hospital length of stay. We hypothesize a reduced risk of major complications and a better disease-survival at 3 years in the experimental group. Allowing for 5% of drop-out, 1 200 patients (600 per arm) should be included. Discussion This will be the first trial focusing on the impact of perioperative corticosteroids on cancer related outcomes. If significant, it might be a strong improvement on oncological outcomes for patients undergoing surgery for digestive cancers. Trial registration ClinicalTrials.gov, NCT03875690, Registered on March 15, 2019, URL: https://clinicaltrials.gov/ct2/show/NCT03875690. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09998-z.
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Affiliation(s)
- Joséphine Magnin
- Service de Chirurgie Digestive et Cancérologique, CHU François Mitterrand, 14 rue Paul Gaffarel, 21000 , Dijon, France. .,Department of Digestive Surgical Oncology, University Hospital of Dijon, INSERM 1432, University of Bourgogne, Dijon, France.
| | - Isabelle Fournel
- Department of Clinical Epidemiology, University Hospital of Dijon, INSERM CIC 1432, University of Bourgogne, Dijon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Jean-Marc Régimbeau
- Department of Digestive Surgical Oncology, University Hospital of Amiens, Amiens, France
| | - Philippe Zerbib
- Department of Digestive Surgical Oncology and Liver Transplantation, Claude Huriez University Hospital, Chu Lille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Chu Lille, France
| | - Laura Beyer-Berjot
- Department of Digestive Surgical Oncology, North University Hospital, Marseille, France
| | - Sophie Deguelte
- Department of Digestive Surgical Oncology, University Hospital of Reims, Reims, France
| | - Zaher Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Lilian Schwarz
- Department of Digestive Surgical Oncology, University Hospital of Rouen, Rouen, France
| | - David Orry
- Department of Surgical Oncology, Georges François Leclerc Cancer Center, Dijon, France
| | - Ahmet Ayav
- Department of Digestive Surgical Oncology, University Hospital of Nancy, Nancy, France
| | - Fabrice Muscari
- Department of Digestive Surgical Oncology, Rangueil University Hospital, Toulouse, France
| | - François Mauvais
- Department of Digestive Surgery, Simone Veil Hospital, Beauvais, France
| | - Guillaume Passot
- Department of Digestive Surgical Oncology, Pierre Bénite University Hospital, Lyon, France
| | - Nelson Trelles
- Department of Digestive Surgery, René-Dubos Hospital, Cergy-Pontoise, France
| | - Aurélien Venara
- Department of Digestive Surgical Oncology, University Hospital of Angers, Angers, France
| | - Stéphane Benoist
- Department of Digestive Surgical Oncology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Mathieu Messager
- Department of Digestive Surgery, Gustave Dron Hospital, Tourcoing, France
| | - David Fuks
- Department of Digestive Surgical Oncology, Cochin University Hospital, Paris, France
| | | | - Christophe Trésallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - Alain Valverde
- Department of Digestive Surgery, La Croix Saint Simon Hospital, Paris, France
| | - François-Régis Souche
- Department of Digestive Surgical Oncology, University Hospital of Montpellier, Montpellier, France
| | - Astrid Herrero
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Montpellier, Montpellier, France
| | - Sébastien Gaujoux
- Department of Digestive Surgical Oncology, Pitié Salpêtrière University Hospital, Paris, France
| | - Jérémie Lefevre
- Department of Digestive Surgical Oncology, Saint-Antoine University Hospital, Paris, France
| | - Abderrahmane Bourredjem
- Department of Clinical Epidemiology, University Hospital of Dijon, INSERM CIC 1432, University of Bourgogne, Dijon, France
| | - Amélie Cransac
- Department of Pharmacy, University Hospital of Dijon, Dijon, France
| | - Pablo Ortega-Deballon
- Service de Chirurgie Digestive et Cancérologique, CHU François Mitterrand, 14 rue Paul Gaffarel, 21000 , Dijon, France.,Department of Digestive Surgical Oncology, University Hospital of Dijon, INSERM 1432, University of Bourgogne, Dijon, France
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Abdalla TSA, Almanfalouti V, Effenberger K, Uzunoglu FG, Ghadban T, Dupreé A, Izbicki JR, Pantel K, Reeh M. Evaluation of the Hamburg-Glasgow Classification in Pancreatic Cancer: Preoperative Staging by Combining Disseminated Tumor Load and Systemic Inflammation. Cancers (Basel) 2021; 13:cancers13235942. [PMID: 34885052 PMCID: PMC8657182 DOI: 10.3390/cancers13235942] [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: 10/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 01/11/2023] Open
Abstract
This study aims to compare the Hamburg Glasgow Classification (HGC) to Union for International Cancer Control (UICC) classification in patients with pancreatic ductal adenocarcinoma (PDAC). As adequate tumor classification is only possible after tumor resection and histological evaluation, only 20% of patients with PDAC receive accurate tumor staging. Thus, an accurate preoperative staging system is still missing but urgently needed. Systemic inflammation and tumor dissemination are important factors regarding the oncological outcome. HGC integrates both into a preoperative staging system, by combining C-reactive protein (CRP), albumin, and disseminated tumor cells (DTC) in the bone marrow. In this prospective study, 109 patients underwent surgical exploration for suspected PDAC. All patients underwent a preoperative bone marrow aspiration for DTC detection. HGC showed significant preoperative risk stratification for overall survival (OS) (p-value < 0.001) and progression-free survival (PFS) (p-value < 0.001). These results were comparable to the UICC survival stratification for OS and PFS (p-value = 0.001 and 0.006). Additionally, in non-metastatic PDAC, HGC III-IV was associated with shorter OS and PFS (p-value < 0.001, respectively) when compared to HGC I-II. Therefore, the HGC is a promising preoperative prognostic staging classification for accurate and simple outcome stratification in patients with PDAC.
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Affiliation(s)
- Thaer S. A. Abdalla
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
| | - Valeria Almanfalouti
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
| | - Katharina Effenberger
- Department of Tumor Biology, University Cancer Center Hamburg, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (K.E.); (K.P.)
| | - Faik G. Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
| | - Anna Dupreé
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
| | - Jakob R. Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
| | - Klaus Pantel
- Department of Tumor Biology, University Cancer Center Hamburg, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (K.E.); (K.P.)
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (T.S.A.A.); (V.A.); (F.G.U.); (T.G.); (A.D.); (J.R.I.)
- Correspondence:
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3
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Lorton CM, Higgins L, O'Donoghue N, Donohoe C, O'Connell J, Mockler D, Reynolds JV, Walsh D, Lysaght J. C-Reactive Protein and C-Reactive Protein-Based Scores to Predict Survival in Esophageal and Junctional Adenocarcinoma: Systematic Review and Meta-Analysis. Ann Surg Oncol 2021; 29:1853-1865. [PMID: 34773194 DOI: 10.1245/s10434-021-10988-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Esophageal adenocarcinoma (EAC) has a poor prognosis; predictive markers of prognosis would facilitate advances in personalized therapy. C-reactive protein (CRP) and CRP-based scores are increasingly recommended across oncology; however, their role and value in EAC is unclear. This systematic review and meta-analysis examined CRP cut-point and scores and how they may best be applied in predicting survival in EAC. METHODS A systematic literature search was conducted in EMBASE, Medline, Web of Science, Cochrane, Scopus and CINAHL databases, from inception to 1st October 2020. Studies reporting data from adults with EAC including adenocarcinoma of the gastro-esophageal junction (AEG), pre-treatment CRP or CRP-based score and Hazard Ratio (HR) for survival were included. QUIPS tool assessed risk of bias. Meta-analysis was undertaken. RESULTS A total of 819 records were screened. Eight papers were included, with data for 1475 people. CRP cut-points ranged from 2.8 to 10 mg/L. The Glasgow Prognostic Score (GPS) and modified GPS were the most commonly reported scores. On meta-analysis, elevated preoperative GPS/mGPS was significantly associated with worse overall survival (hazards ratio [HR] 1.81, 95% confidence interval [CI] 1.25-2.62, p = 0.002); results were similar in subgroup analyses of multimodal treatment, M0 disease, and R0 resection. CONCLUSIONS This is the first review to evaluate comprehensively the evidence for CRP and CRP-based scores in EAC. Meta-analysis demonstrated that elevated preoperative GPS or mGPS was significantly associated with reduced overall survival in EAC, including AEG. There is insufficient evidence to support use of CRP alone. Future studies should examine GPS/mGPS in EAC prospectively, alone and combined with other prognostic markers.
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Affiliation(s)
- Cliona M Lorton
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland. .,School of Medicine, Trinity College Dublin, Dublin, Ireland. .,Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute, Trinity St. James's Cancer Institute, Trinity College Dublin and St. James's Hospital, Dublin, Ireland.
| | | | | | - Claire Donohoe
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Gastro-intestinal Medicine and Surgery, St. James's Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| | - Jim O'Connell
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Gastro-intestinal Medicine and Surgery, St. James's Hospital, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity Centre for the Health Sciences, St James's Hospital, Dublin, Ireland
| | - John V Reynolds
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Gastro-intestinal Medicine and Surgery, St. James's Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, St James's Hospital, Dublin, Ireland
| | - Declan Walsh
- Department of Supportive Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - Joanne Lysaght
- School of Medicine, Trinity College Dublin, Dublin, Ireland.,Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity Translational Medicine Institute, Trinity St. James's Cancer Institute, Trinity College Dublin and St. James's Hospital, Dublin, Ireland
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Sui K, Okabayashi T, Umeda Y, Oishi M, Kojima T, Sato D, Endo Y, Ota T, Hioki K, Inagaki M, Matsuda T, Hirai R, Kimura M, Yagi T, Fujiwara T. Prognostic Utility of the Glasgow Prognostic Score for the Long-Term Outcomes After Liver Resection for Intrahepatic Cholangiocarcinoma: A Multi-institutional Study. World J Surg 2020; 45:279-290. [PMID: 32989578 DOI: 10.1007/s00268-020-05797-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The usefulness of the modified Glasgow prognostic score (GPS) as a prognostic tool remains unclear for patients undergoing curative surgery for intrahepatic cholangiocarcinoma (ICC). Therefore, this study investigated the prognostic usefulness of the GPS for patients who underwent ICC surgery. METHOD All ICC patients who had a curative-intent hepatectomy at 17 institutions between 2000 and 2016 were included. The correlation was assessed between the preoperative GPS and the baseline characteristics of the patients, histopathological parameters, surgical parameters, and the postresection overall survival (OS). RESULT There were 273 patients who met the eligibility criteria between the years 2000 and 2016. The postoperative OS rates at 1, 3, and 5 years were 83.8%, 56.3%, and 41.5%, respectively (median OS, 47.7 months). A multivariate analysis revealed the factors that were associated with a worse OS, which included an increased GPS (hazard ratio = 1.62; 95% confidence interval [CI]: 1.01-2.53; P = 0.03), an elevated carcinoembryonic antigen level (hazard ratio = 1.60; 95% CI: 1.06-2.41; P = 0.02), an elevated carbohydrate antigen 19-9 level (hazard ratio = 1.55; 95% CI: 1.05-2.30; P = 0.03), undifferentiated carcinoma (hazard ratio = 2.41; 95% CI: 1.56-3.67; P < 0.01), and positive metastasis to the lymph nodes (hazard ratio = 2.54; 95% CI: 1.76-3.67; P < 0.01). In ICC patients after a hepatectomy, an elevated GPS was associated with poorer OS, even if the tumour factors that affected GPS were eliminated by propensity-score matching. CONCLUSION Preoperative GPS can be useful to predict the postoperative outcomes of ICC patients. Therefore, this relatively simple and inexpensive scoring system can be utilized to further refine patient stratification as well as to predict survival.
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Affiliation(s)
- Kenta Sui
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
| | - Masahiro Oishi
- Department of Surgery, Tottori Municipal Hospital, Tottori, Japan
| | - Toru Kojima
- Department of Gastroenterological Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Daisuke Sato
- Department of Surgery, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshikatsu Endo
- Department of Surgery, Himeji Red Cross Hospital, Himeji, Japan
| | - Tetsuya Ota
- Department of Surgery, National Okayama Medical Center, Okayama, Japan
| | | | - Masaru Inagaki
- Department of Surgery, National Fukuyama Medical Center, Fukuyama, Japan
| | - Tadakazu Matsuda
- Department of Surgery, Tenwakai Matsuda Hospital, Okayama, Japan
| | - Ryuji Hirai
- Department of Surgery, Himeji Saint Mary's Hospital, Himeji, Japan
| | - Masashi Kimura
- Department of Surgery, Matsuyama City Hospital, Matsuyama, Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan
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Chen S, Li X, Wen X, Peng S, Xue N, Xing S, Liu Y. Prognostic nomogram integrated baseline serum lipids for patients with non-esophageal squamous cell carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:548. [PMID: 31807530 PMCID: PMC6861798 DOI: 10.21037/atm.2019.09.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Serum lipids have been documented as prognostic biomarkers in several types of cancer, however the prognostic value of serum lipids in non-esophageal squamous cell carcinoma (non-ESCC) is not clear. The purpose of this study was to investigate the prognostic roles of serum lipids in non-ESCC and to establish a novel effective nomogram for overall survival (OS) and disease-free survival (DFS) in patients with non-ESCC. METHODS We retrospectively analyzed the prognostic values of pretreatment serum lipids, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoproteinA-I (ApoAI), and apolipoprotein B (ApoB) and three lipid derivatives: atherogenic index [AI: (TC-HDL-C)/HDL-C], THR (TG/HDL-C) and LHR (LDL-C/HDL-C) in non-ESCC patients. Prognostic factors predictive of OS and DFS were determined by univariate and cox hazards analysis, and prognostic nomograms were established. The predictive power of independent prognostic factors was compared adopting time-dependent ROC. Comparisons between the nomograms and traditional TNM staging systems were evaluated using the C-index and decision curve analysis. RESULTS A total of 180 non-ESCC patients were recruited in this prospective study between January 2006 and December 2016. Four (cancer type, TNM stage, TC, and TG) and five (cancer type, TNM stage, TC, TG, and LDL-C) independent prognostic factors were chosen to generate the nomogram for OS and DFS, respectively. Our results showed that the area under curves (AUCs) of cancer type and TG were higher than TNM stage for OS. For DFS, however, AUCs of cancer type, TG and LDL-C were higher than the TNM stage. The C-index of the nomogram for predicting the OS was 0.69, which was significantly higher than that of TNM stage (0.58, P=0.005). In addition, for DFS, the C-index of the nomogram was significantly higher than that of the TNM stage (0.70 vs. 0.60, P=0.001). Furthermore, decision curve analysis showed that the predictive accuracy of the prognostic nomogram for OS and DFS were both higher than the TNM stage. CONCLUSIONS Our study demonstrated that pretreatment of serum lipids based on the prognostic nomogram could be applied to predict the OS and DFS in non-ESCC patients.
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Affiliation(s)
- Shulin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaohui Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaoyan Wen
- Department of Urology, The First Municipal Hospital of Guangzhou, Guangzhou 510180, China
| | - Songguo Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ning Xue
- Department of Clinical Laboratory, Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou 450100, China
| | - Shan Xing
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yijun Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Sihvo E, Helminen O, Gunn J, Sipilä JO, Rautava P, Kytö V. Long-term outcomes following minimally invasive and open esophagectomy in Finland: A population-based study. Eur J Surg Oncol 2019; 45:1099-1104. [DOI: 10.1016/j.ejso.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/18/2018] [Accepted: 12/06/2018] [Indexed: 01/04/2023] Open
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