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Hounchonou HF, Bajgora G, Esmaeilzadeh M, Hartmann C, Krauss JK. Surgical site infections after glioblastoma surgery: boon or bane? J Cancer Res Clin Oncol 2024; 150:36. [PMID: 38279060 PMCID: PMC10817840 DOI: 10.1007/s00432-023-05528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/13/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Surgical site infections (SSIs) are among the most common postoperative complications. Glioblastoma multiforme is the most frequent malignant brain tumor with a dismal prognosis despite combined treatment. The effect of SSIs on the course of glioblastoma patients has not been fully clarified since available data are limited and partially contradictory. The aim of this study is to investigate the impact of SSIs on the course of patients with glioblastoma. METHODS The medical records of all patients undergoing surgery for glioblastoma between 2010 and 2020 in our institution were scanned and those with surgical site infections after glioblastoma resection were identified and compared to an age-matched control group. Overall survival and progression-free survival were the primary endpoints followed by the number of hospitalizations and the length of stay in hospital. RESULTS Out of 305 patients undergoing surgery for glioblastoma, 38 patients with postoperative surgical site infection after resection were identified and 15 (5 men and 10 women aged between 9 and 72) were included in this study. 23 patients were excluded. The control group consisted of 30 age-matched patients without SSI (18 men and 12 women). There were no significant differences in median overall survival. Progression-free survival was higher in the SSI group. The number of hospitalizations and the length of stay were significantly higher in the SSI group. CONCLUSION Our data suggest that SSIs might reduce early recurrences without affecting overall survival. Furthermore, they might decrease health-related quality of life by doubling the total length of hospital stay.
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Affiliation(s)
- Harold F Hounchonou
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Genis Bajgora
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Majid Esmaeilzadeh
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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González Bonet LG, Piqueras-Sánchez C, Roselló-Sastre E, Broseta-Torres R, de las Peñas R. Glioblastomas de larga supervivencia: un análisis sistemático de la literatura a propósito de un caso. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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3
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González Bonet LG, Piqueras-Sánchez C, Roselló-Sastre E, Broseta-Torres R, de Las Peñas R. Long-term survival of glioblastoma: A systematic analysis of literature about a case. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:227-236. [PMID: 34802981 DOI: 10.1016/j.neucie.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In spite of the changes for the treatment of glioblastoma since 2005, we have not seen differences between long-survival patients of more than 10 years showing a value minor than 1%. MATERIAL AND METHOD We realize a systematic analysis and identify important factors for long survivor patients. We also show an own case with more of 20 years of survival. We make a new pathological study of the old paraffin block of this patient. RESULTS The most important variable associated with long-survival between all multivariant studies is the age. When we try to find genetic and molecular alterations in glioblastoma associated with prolongated survival, the MGMT promoter methylation play the most important role. We find a correct diagnosis in the current analysis of our patient's sample with very long survival. CONCLUSIONS Multiple variables are found that affect long survival of glioblastoma series but analyzed studies are very heterogeneous and it is very difficult comparation between them. Most articles we review are obtained from databases of different countries with hundreds of patients. It would be very interesting to promote the use of a single database in Spain that allows us to study these long-term glioblastoma survivors.
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Affiliation(s)
- Luis Germán González Bonet
- Servicio de Neurocirugía, Hospital General Universitario de Castellón, Castellón, Spain; Facultad de Ciencias de la Salud, Universidad Jaume I de Castellón, Castellón, Spain.
| | | | - Esther Roselló-Sastre
- Facultad de Ciencias de la Salud, Universidad Jaume I de Castellón, Castellón, Spain; Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Ramón de Las Peñas
- Servicio de Oncología Médica, Hospital Provincial de Castellón, Castellón, Spain
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Beiriger J, Habib A, Jovanovich N, Kodavali CV, Edwards L, Amankulor N, Zinn PO. The Subventricular Zone in Glioblastoma: Genesis, Maintenance, and Modeling. Front Oncol 2022; 12:790976. [PMID: 35359410 PMCID: PMC8960165 DOI: 10.3389/fonc.2022.790976] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma (GBM) is a malignant tumor with a median survival rate of 15-16 months with standard care; however, cases of successful treatment offer hope that an enhanced understanding of the pathology will improve the prognosis. The cell of origin in GBM remains controversial. Recent evidence has implicated stem cells as cells of origin in many cancers. Neural stem/precursor cells (NSCs) are being evaluated as potential initiators of GBM tumorigenesis. The NSCs in the subventricular zone (SVZ) have demonstrated similar molecular profiles and share several distinctive characteristics to proliferative glioblastoma stem cells (GSCs) in GBM. Genomic and proteomic studies comparing the SVZ and GBM support the hypothesis that the tumor cells and SVZ cells are related. Animal models corroborate this connection, demonstrating migratory patterns from the SVZ to the tumor. Along with laboratory and animal research, clinical studies have demonstrated improved progression-free survival in patients with GBM after radiation to the ipsilateral SVZ. Additionally, key genetic mutations in GBM for the most part carry regulatory roles in the SVZ as well. An exciting avenue towards SVZ modeling and determining its role in gliomagenesis in the human context is human brain organoids. Here we comprehensively discuss and review the role of the SVZ in GBM genesis, maintenance, and modeling.
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Affiliation(s)
- Jamison Beiriger
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Ahmed Habib
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Nicolina Jovanovich
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Chowdari V Kodavali
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Lincoln Edwards
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Nduka Amankulor
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Pascal O Zinn
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
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Owens MR, Nguyen S, Karsy M. Utility of Administrative Databases and Big Data on Understanding Glioma Treatment—A Systematic Review. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1742333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background Gliomas are a heterogeneous group of tumors where large multicenter clinical and genetic studies have become increasingly popular in their understanding. We reviewed and analyzed the findings from large databases in gliomas, seeking to understand clinically relevant information.
Methods A systematic review was performed for gliomas studied using large administrative databases up to January 2020 (e.g., National Inpatient Sample [NIS], National Surgical Quality Improvement Program [NSQIP], and Surveillance, Epidemiology, and End Results Program [SEER], National Cancer Database [NCDB], and others).
Results Out of 390 screened studies, 122 were analyzed. Studies included a wide range of gliomas including low- and high-grade gliomas. The SEER database (n = 83) was the most used database followed by NCDB (n = 28). The most common pathologies included glioblastoma multiforme (GBM) (n = 67), with the next category including mixes of grades II to IV glioma (n = 31). Common study themes involved evaluation of descriptive epidemiological trends, prognostic factors, comparison of different pathologies, and evaluation of outcome trends over time. Persistent health care disparities in patient outcomes were frequently seen depending on race, marital status, insurance status, hospital volume, and location, which did not change over time. Most studies showed improvement in survival because of advances in surgical and adjuvant treatments.
Conclusions This study helps summarize the use of clinical administrative databases in gliomas research, informing on socioeconomic issues, surgical outcomes, and adjuvant treatments over time on a national level. Large databases allow for some study questions that would not be possible with single institution data; however, limitations remain in data curation, analysis, and reporting methods.
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Affiliation(s)
- Monica-Rae Owens
- Department of Neurosurgery, University of Utah, Utah, United States
| | - Sarah Nguyen
- Department of Neurosurgery, University of Utah, Utah, United States
| | - Michael Karsy
- University of Utah Health Care, University of Utah Health Hospitals and Clinics, Utah, United States
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Jovčevska I. Genetic secrets of long-term glioblastoma survivors. Bosn J Basic Med Sci 2019; 19:116-124. [PMID: 30114377 DOI: 10.17305/bjbms.2018.3717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022] Open
Abstract
Glioblastomas are the most aggressive and lethal primary astrocytic tumors of the central nervous system. They account for 60% to 70% of all gliomas and the majority are diagnosed in Caucasian male patients at advanced age. Genetic analyses of glioblastoma show a great intra- and inter-tumor heterogeneity, which opens up a debate about its cellular origin. Different types of brain cells, including astrocytes, neural stem cells, oligodendrocyte precursor cells and glioblastoma stem cells are proposed to have a role in tumor initiation and spreading; however, data is still inconclusive. Due to short life expectancy, long-term glioblastoma survivors are defined as patients who live longer than two years post-diagnosis. Extreme survivors, living 10 years or more after diagnosis, comprise less than 1% of all patients. Molecular testing indicates genetic differences between short- and long-term survivors with glioblastoma. The most informative are IDH1/2 gene mutations and MGMT promoter methylation, which are associated with a better response to standard clinical care. Moreover, a decreased expression of the CHI3L1, FBLN4, EMP3, IGFBP2, IGFBP3, LGALS3, MAOB, PDPN, SERPING1 and TIMP1 genes has been associated with prolonged survival. In addition, emerging evidence suggests the role of different microRNAs in predicting patient survival. Other factors that may affect the survival of glioblastoma patients include clinical/demographic characteristics such as seizures at presentation, age at diagnosis, and the extent of surgical resection. Because of the small number of long-term survivors with glioblastoma, comparative studies on genetic differences between short- and long-term survivors are challenging. To improve patient management and clinical outcomes, a thorough "omics" approach is necessary for identifying differences between short- and long-term survivors with glioblastoma.
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Affiliation(s)
- Ivana Jovčevska
- Medical Center for Molecular Biology, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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7
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Tykocki T, Eltayeb M. Ten-year survival in glioblastoma. A systematic review. J Clin Neurosci 2018; 54:7-13. [PMID: 29801989 DOI: 10.1016/j.jocn.2018.05.002] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 02/07/2023]
Abstract
Glioblastoma (GBM) is among the most deadly neoplasms associated with one of the worst 5-year overall survival (OS) rates among all human cancers. The aim of this systematic review is to present all cases with OS of a decade or more and to perform a descriptive analysis of the group. This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search for relevant articles was performed on PubMed, Embase and Google Scholar for a period until June 10, 2016, using the following search words: glioblastoma multiforme, glioblastoma, GBM, long-term survival/survivors. Reports containing cases with the long-term survival of 10 years or longer were included in the review. The search produced 36 studies with 162 cases published in the years 1950-2014. The rate of long survivors in the cohort studied was established 0.76%. Mean age at diagnosis, OS and PFS were 31.1 ± 11.1, 15.9 ± 6.3, 11.9 ± 5.6 years respectively. Total and subtotal resections were found in 82 and 58 patients respectively. Nine cases received a biopsy alone. No statistical differences were found in a comparison of PFS, OS and age between total and subtotal resection groups. A regression analysis showed a significant correlation between PFS and OS, with an inverse relationship stated between age at diagnosis and OS. The 10-year survival rate in the cohort studied with GBM was estimated 0.71%. OS was positively correlated with the length of PFS and inversely related with age at diagnosis.
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Affiliation(s)
- Tomasz Tykocki
- Department of Neurosurgery, Western Hospital in Grodzisk Mazowiecki, Poland.
| | - Mohamed Eltayeb
- Royal Victoria Infirmary, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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8
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Is radical surgery always curative in pancreatic neuroendocrine tumors? A cure model survival analysis. Pancreatology 2018; 18:313-317. [PMID: 29487026 DOI: 10.1016/j.pan.2018.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 01/17/2018] [Accepted: 02/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adjuvant therapy after curative surgery for sporadic pancreatic neuroendocrine tumor (pNETs) is not currently recommended, assuming that all patients could be cured by a radical resection. The aim of our study is to establish how many and which kind of patients remained uncured after radical resection of pNET. METHODS Retrospective study involving 143 resected sporadic pNETs. The survival analysis was carried out using the cure model, describing the cure fraction and the excess of risk recurrence. Multivariate analyses were made in order to evaluate the non negligible effect of demographics, clinical and pathological factors on survival parameters. The results were reported as percentages, fractions, ORs and HRs with 95% confidence interval (95 CI %). RESULTS The cure fraction and the excess of hazard rate of the whole population were 57.1% (37.4-74.6, 95% CI) and 0.06 (0.03-0.07, 95% CI), respectively. Two independent factors were related to the cure fraction: TNM stage (OR 0.27 ± 0.17; P = 0.002) and grading (OR 0.11 ± 0.18; P = 0.004). Considering the excess of hazard rate, only two independent factors were related to an increased risk of recurrence: TNM stage (HR 3.49 ± 1.12; P = 0.004) and grading (HR 4.93 ± 1.82; P < 0.001). CONCLUSION The radical surgery has a high probability of cure in stages I-II or in grading 1 while, in stages III-IV or in grading 3 tumors, surgery alone failed to achieve a "cure". A multimodal treatment should be employed in order to avoid a recurrence of the disease.
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Spolverato G, Vitale A, Cucchetti A, Popescu I, Marques HP, Aldrighetti L, Gamblin TC, Maithel SK, Sandroussi C, Bauer TW, Shen F, Poultsides GA, Marsh JW, Pawlik TM. Can hepatic resection provide a long-term cure for patients with intrahepatic cholangiocarcinoma? Cancer 2015; 121:3998-4006. [PMID: 26264223 DOI: 10.1002/cncr.29619] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND A patient can be considered statistically cured from a specific disease when their mortality rate returns to the same level as that of the general population. In the current study, the authors sought to assess the probability of being statistically cured from intrahepatic cholangiocarcinoma (ICC) by hepatic resection. METHODS A total of 584 patients who underwent surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. A nonmixture cure model was adopted to compare mortality after hepatic resection with the mortality expected for the general population matched by sex and age. RESULTS The median, 1-year, 3-year, and 5-year disease-free survival was 10 months, 44%, 18%, and 11%, respectively; the corresponding overall survival was 27 months, 75%, 37%, and 22%, respectively. The probability of being cured of ICC was 9.7% (95% confidence interval, 6.1%-13.4%). The mortality of patients undergoing surgery for ICC was higher than that of the general population until year 10, at which time patients alive without tumor recurrence can be considered cured with 99% certainty. Multivariate analysis demonstrated that cure probabilities ranged from 25.8% (time to cure, 9.8 years) in patients with a single, well-differentiated ICC measuring ≤5 cm that was without vascular/periductal invasion and lymph nodes metastases versus <0.1% (time to cure, 12.6 years) among patients with all 6 of these risk factors. A model with which to calculate cure fraction and time to cure was developed. CONCLUSIONS The cure model indicated that statistical cure was possible in patients undergoing hepatic resection for ICC. The overall probability of cure was approximately 10% and varied based on several tumor-specific factors. Cancer 2015;121:3998-4006. © 2015 American Cancer Society.
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Affiliation(s)
- Gaya Spolverato
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alessandro Vitale
- Unit of Hepatobiliary Surgery and Liver Transplantation, University of Padua Medical Center, Padua, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Irinel Popescu
- Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Hugo P Marques
- Hepato-Biliary- Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon, Portugal
| | | | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Charbel Sandroussi
- Department of Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - Todd W Bauer
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Feng Shen
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | - J Wallis Marsh
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Qureshi AI, Chaudhry SA, Qureshi MH, Suri MFK. Rates and predictors of 5-year survival in a national cohort of asymptomatic elderly patients undergoing carotid revascularization. Neurosurgery 2015; 76:34-40; discussion 40-1. [PMID: 25525692 DOI: 10.1227/neu.0000000000000551] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Current American Heart Association guidelines recommend carotid revascularization for asymptomatic patients on the basis of life expectancy. OBJECTIVE To determine the rates and predictors of 5-year survival in elderly patients with asymptomatic carotid artery stenosis who underwent either carotid artery stent placement (CAS) or carotid endarterectomy (CEA). METHODS The rates of 5-year survival were determined by use of Kaplan-Meier survival methods in a representative sample of fee-for-service Medicare beneficiaries ≥65 years of age who underwent CAS or CEA for asymptomatic carotid artery stenosis with postprocedural follow-up of 3.4 ± 1.7 years. Cox proportional hazards analysis was used to assess the relative risk of all-cause mortality for patients in the presence of selected comorbidities, including ischemic heart disease, chronic renal failure, and atrial fibrillation, after adjustment for potential confounders such as age, sex, race/ethnicity, and procedure type. RESULTS A total of 22,177 patients with asymptomatic carotid artery stenosis were treated with either CAS (n = 2144) or CEA (n = 20,033). The overall estimated 5-year survival rate (±SE) was 95.3 ± 0.00149; it was 95.5% and 93.8% in patients treated with CEA and CAS, respectively. After adjustment for potential confounders, relative risk of all-cause 5-year mortality was significantly higher among patients with atrial fibrillation (relative risk, 1.8; 95% confidence interval, 1.5-2.1) and those with chronic renal failure (relative risk, 2.1; 95% confidence interval, 1.7-2.6). CONCLUSION Risks and benefits must be carefully weighed before carotid revascularization in elderly patients with asymptomatic carotid artery stenosis who have concurrent atrial fibrillation or chronic renal failure.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Cerebrovascular Diseases, CentraCare Health, St. Cloud, Minnesota
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Which Metrics Are Appropriate to Describe the Value of New Cancer Therapies? BIOMED RESEARCH INTERNATIONAL 2015; 2015:865101. [PMID: 26161418 PMCID: PMC4486603 DOI: 10.1155/2015/865101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/31/2014] [Indexed: 12/15/2022]
Abstract
Patients with certain cancers are treated with curative intent, but for others the results are less favorable and different therapeutic approaches are needed. Early data suggest that new therapies, which modulate immune responses to cancers, may have potential for long-term survival in a proportion of cases. Therefore, it is timely to consider whether metrics generally used to describe the medical value of therapies for patients with common solid tumors remain appropriate for therapies with curative potential. Literature reviews were conducted to define how various stakeholders describe cure in oncology and to identify the endpoints used in clinical trials for selected solid tumors. The results showed that “cure” is described using various terms that can be divided broadly into lack of disease progression, eradication of cancerous cells, and survival. The review of trial endpoints showed frequent use of median overall survival (OS) and progression- and response-related endpoints. Because these endpoints were mainly described in the context of chemotherapies that are not generally curative, they may not adequately capture outcomes of new therapeutic modalities with potential for long-term survival. More appropriate endpoints may include mean OS, cure fraction, and OS rate at landmark time points.
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Schatlo B, Fandino J, Smoll NR, Wetzel O, Remonda L, Marbacher S, Perrig W, Landolt H, Fathi AR. Outcomes after combined use of intraoperative MRI and 5-aminolevulinic acid in high-grade glioma surgery. Neuro Oncol 2015; 17:1560-7. [PMID: 25858636 PMCID: PMC4633924 DOI: 10.1093/neuonc/nov049] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/03/2015] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies have shown the individual benefits of 5-aminolevulinic acid (5-ALA) and intraoperative (i)MRI in enhancing survival for patients with high-grade glioma. In this retrospective study, we compare rates of progression-free and overall survival between patients who underwent surgical resection with the combination of 5-ALA and iMRI and a control group without iMRI. Methods In 200 consecutive patients with high-grade gliomas, we recorded age, sex, World Health Organization tumor grade, and pre- and postoperative Karnofsky performance status (good ≥80 and poor <80). A 0.15-Tesla magnet was used for iMRI; all patients operated on with iMRI received 5-ALA. Overall and progression-free survival rates were compared using multivariable regression analysis. Results Median overall survival was 13.8 months in the non-iMRI group and 17.9 months in the iMRI group (P = .043). However, on identifying confounding variables (ie, KPS and resection status) in this univariate analysis, we then adjusted for these confounders in multivariate analysis and eliminated this distinction in overall survival (hazard ratio: 1.23, P = .34, 95% CI: 0.81, 1.86). Although 5-ALA enhanced the achievement of gross total resection (odds ratio: 3.19, P = .01, 95% CI: 1.28, 7.93), it offered no effect on overall or progression-free survival when adjusted for resection status. Conclusions Gross total resection is the key surgical variable that influences progression and survival in patients with high-grade glioma and more likely when surgical adjuncts, such as iMRI in combination with 5-ALA, are used to enhance resection.
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Affiliation(s)
- Bawarjan Schatlo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Nicolas R Smoll
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Oliver Wetzel
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Luca Remonda
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Wolfgang Perrig
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Hans Landolt
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
| | - Ali-Reza Fathi
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland (B.S., J.F., O.W., S.M., W.P., H.L., A.-R.F.); Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland (L.R.); Department of Surgery, Frankston Hospital, Frankston, Australia (N.R.S.)
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Rizzitelli A, Smoll NR, Chae MP, Rozen WM, Hunter-Smith DJ. Incidence and overall survival of malignant ameloblastoma. PLoS One 2015; 10:e0117789. [PMID: 25692490 PMCID: PMC4333213 DOI: 10.1371/journal.pone.0117789] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malignant ameloblastoma, comprising metastasizing ameloblastoma and ameloblastic carcinoma, represents 1.6-2.2% of all odontogenic tumors. Due to its rare nature, malignant ameloblastoma has only been reported in the literature in small case series or case reports. Using the Surveillance, Epidemiology and End-Results (SEER) database, we have performed a population-based study to determine the incidence rate and the absolute survival of malignant ameloblastoma. METHOD Using the International Classification of Diseases for Oncology (ICD-O) codes 9310/3 and 9270/3, data from the SEER database were used to calculate the incidence rate and absolute survival rate of population with malignant ameloblastoma. RESULTS The overall incidence rate of malignant ameloblastoma was 1.79 per 10 million person/year. The incidence rate was higher in males than females and also higher in black versus white population. The median overall survival was 17.6 years from the time of diagnosis and increasing age was associated with a statistically significant poorer survival. CONCLUSIONS To our best knowledge, we report the largest population-based series of malignant ameloblastoma. The incidence rate was 1.79 per 10 million person/year and the overall survival was 17.6 years.
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Affiliation(s)
- Alexandra Rizzitelli
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Nicolas R. Smoll
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
- Department of Surgery, Monash University, Level 5, E Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Michael P. Chae
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
- Department of Surgery, Monash University, Level 5, E Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Warren M. Rozen
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
- Department of Surgery, Monash University, Level 5, E Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
- Department of Surgery, School of Medicine and Dentistry, James Cook University Clinical School, Level 1, Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville Queensland 4814, Australia
- * E-mail:
| | - David J. Hunter-Smith
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
- Department of Surgery, Monash University, Level 5, E Block, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia
- Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
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Cucchetti A, Ferrero A, Cescon M, Donadon M, Russolillo N, Ercolani G, Stacchini G, Mazzotti F, Torzilli G, Pinna AD. Cure Model Survival Analysis After Hepatic Resection for Colorectal Liver Metastases. Ann Surg Oncol 2014; 22:1908-14. [DOI: 10.1245/s10434-014-4234-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Indexed: 12/11/2022]
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Qureshi AI, Chaudhry SA, Tekle WG, Suri MFK. Comparison of Long-term Outcomes Associated With Endovascular Treatment vs Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms. Neurosurgery 2014; 75:380-6; discussion 386-7. [DOI: 10.1227/neu.0000000000000450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
BACKGROUND:
Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date.
OBJECTIVE:
To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment.
METHODS:
The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for unruptured intracranial aneurysms with postprocedure follow-up of 4.7 (±3.0) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality, new intracranial hemorrhage, or second procedure for patients who underwent endovascular treatment compared with those who underwent surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups by using Kaplan-Meier survival methods.
RESULTS:
A total of 688 patients with unruptured intracranial aneurysms were treated with either endovascular (n = 398) or surgical treatment (n = 290). The rate of immediate postprocedural neurological complications (10.3% vs 3.5%, P = .001) was higher among patients treated with surgery than among those who underwent endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients who underwent surgical and endovascular treatments, respectively. After adjusting for age, sex, and race/ethnicity, the RRs of all-cause mortality (RR, 0.6; 95% confidence interval, 0.3-1.1) and new intracranial hemorrhage (RR, 0.4; 95% confidence interval, 0.2-0.8) were lower with endovascular treatment.
CONCLUSION:
In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.
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A DNA-based nano-immunoassay for the label-free detection of glial fibrillary acidic protein in multicell lysates. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 11:293-300. [PMID: 24780311 DOI: 10.1016/j.nano.2014.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/27/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022]
Abstract
UNLABELLED We have developed a quantitative approach to eventually enable precise and multiplexing protein analysis of very small systems, down to a single or a few cells. Through DNA-directed immobilization of DNA-protein conjugates we immobilized antibodies specific for a certain protein of interest, on a complementary DNA nanoarray fabricated by means of nanografting, a nanolithography technique based on atomic force microscopy (AFM). The proof of concept was realized for glial fibrillary acidic protein (GFAP), a biomarker crucial in cell's differentiation of astrocytes, and functional to grade classification of gliomas, the most common of primary malignant brain tumors. The efficiency of the nano-immuno sensing was tested by obtaining the immobilization of purified recombinant GFAP protein at different concentration in a standard solution then in a cellular lysate. A comparison of sensitivity between our technique and conventional ELISA assays is provided at the end of the paper. FROM THE CLINICAL EDITOR This team developed a quantitative approach to enable precise and multiplexing protein analysis of very small systems, down to a single or a few cells, demonstrating the utility of this DNA-based nano-immunoassay in the detection of GFAP.
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Mazzoni E, Gerosa M, Lupidi F, Corallini A, Taronna AP, D'Agostino A, Bovenzi M, Ruggeri G, Casali F, Rotondo JC, Rezza G, Barbanti-Brodano G, Tognon M, Martini F. Significant prevalence of antibodies reacting with simian virus 40 mimotopes in sera from patients affected by glioblastoma multiforme. Neuro Oncol 2013; 16:513-9. [PMID: 24305701 DOI: 10.1093/neuonc/not217] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is a rare tumor, which affects 1/100 000 individuals, but it represents 30% of central nervous system malignancies. GBM is a severe tumor responsible for 2% of all cancer-related deaths. Although characterized by genotypic and phenotypic heterogeneities, GBM invariably resists conventional chemo- and radiotherapies. Several chromosome alterations and gene mutations were detected in GBM. Simian virus 40 (SV40), a small DNA tumor virus, has been found in GBM specimens by some studies, while other investigations have not confirmed the association. METHODS An indirect enzyme-linked immunosorbent assay with 2 synthetic peptides mimicking SV40 antigens of viral capsid proteins 1-3 was employed to detect specific antibodies against SV40 in serum samples from GBM-affected patients, together with controls represented by patients affected by breast cancer and normal subjects of the same median age. RESULTS Our data indicate that in serum samples from GBM-affected patients (n = 44), the prevalence of antibodies against SV40 viral capsid protein antigens is statistically significantly higher (34%, P = .016 and P = .03) than in the control groups (15%), represented by healthy subjects (n = 101) and patients affected by breast cancer (n = 78), respectively. CONCLUSION Our data indicate that SV40, or a closely related yet undiscovered human polyomavirus, is associated with a subset of GBM and circulates in humans. Our study can be transferred to the clinical oncology application to discriminate different types of heterogeneous GBM, which in turn may address an innovative therapeutic approach to this fatal cancer.
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Affiliation(s)
- Elisa Mazzoni
- Section of Pathology, Oncology, and Experimental Biology, School of Medicine, University of Ferrara, Ferrara, Italy (E.M., J.C.R., M.T., F.M.); Department of Surgery, School of Medicine, University of Verona, Verona, Italy (M.G., F.L., A.D.); Department of Medical Sciences, University of Ferrara, Ferrara, Italy (A.C., A.P.T., G.B-B.); Department of Medical Sciences, University of Trieste, Trieste, Italy (M.B.); United Clinical Laboratories Analysis, City Hospitals, Brescia, Italy (G.R.); Clinical Laboratory Analysis, San Marino State Hospital, Republic of San Marino (F.C.); Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy (G.R.)
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Long-term survival of patients with glioblastoma multiforme (GBM). J Clin Neurosci 2013; 20:670-5. [PMID: 23352352 DOI: 10.1016/j.jocn.2012.05.040] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/06/2012] [Indexed: 12/29/2022]
Abstract
Long-term survival is an often used, yet poorly defined, concept in the study of glioblastoma multiforme (GBM). This study suggests a method to define a time-point for long-term survival in patients with GBM. Data for this study were obtained from the Surveillance, Epidemiology and End-Results database, which was limited to the most recent data using the period approach. Relative survival measures were used and modelled using piecewise constant hazards to describe the survival profile of long-term survivors of GBM. For patients with GBM, the first quarter of the second year (5th quarter) post-diagnosis is considered to be the peak incidence of mortality with an excess hazard ratio of 7.58 (95% confidence interval=6.54, 8.78) and the risk of death due to GBM decreases to half of its rate at 2.5 years post-diagnosis. The 2.5-year cumulative relative survival (CRS) for all patients is approximately 8%, with a CRS of approximately 2% at 10 years. Using the definition of long-term survival suggested here, the results indicate that long-term survivors are patients who survive at least 2.5 years post-diagnosis. The most likely time period for patients with GBM to die is the 5th quarter post-diagnosis.
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