1
|
Sun Y, Zhang P, Zhang D. Impact of treatment delays on future survival outcomes in non-surgical patients with esophageal cancer in Shandong Province, China. Front Oncol 2024; 14:1445267. [PMID: 39099688 PMCID: PMC11294235 DOI: 10.3389/fonc.2024.1445267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
The treatment process of tumors in surgical patients is typically prompt and efficient, whereas non-surgical patients are more prone to treatment delay due to various factors. However, the relationship between treatment delay and survival outcomes in non-surgical Esophageal cancer (EC) patients has received limited study. This study aims to evaluate the impact of waiting time from diagnose to treatment on survival outcomes among non-surgical EC patients in Shandong Province, China. Over a 20-year follow-up period, a total of 12,911 patients diagnosed with EC and not receiving surgical intervention were identified from 2000 to 2020. The Kaplan-Meier methodology was employed to determine overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate Cox regression analyses were performed to evaluate the impact of treatment delays on future outcomes. The nonlinear association between waiting time and survival outcomes was investigated using restricted cubic spline (RCS) functions. The average delay in initiating EC treatment from the initial medical consultation for symptoms of EC was 1.18 months (95%CI=1.16-1.20). Patients with a long delay (≥3 months) in treatment demonstrated significantly lower rates of 1-, 3-, and 5-year OS and CSS compared to those with a brief delay in treatment initiation. A long delay in EC treatment independently associated with an increased risk of mortality from all causes and cancer. The association between waiting time and both all-cause and cause-specific mortality illustrated a pronounced J-shaped pattern. The prolong delay in treatment initiation significantly impacts the OS and CSS outcomes for non-surgical EC patients. Timely administration of treatment has the potential to enhance survival outcomes in patients with EC who are ineligible for surgery, including those in advanced stages without surgical options available.
Collapse
Affiliation(s)
- Yindi Sun
- Oncology Department, Zibo Central Hospital, Zibo, China
| | - Pei Zhang
- Oncology Department, Zibo Central Hospital, Zibo, China
| | - Dongqian Zhang
- The Sixth Department of Oncology, The Fourth People’s Hospital of Zibo, Zibo, China
| |
Collapse
|
2
|
Troester AM, Gaertner WB. Contemporary management of rectal cancer. Surg Open Sci 2024; 18:17-22. [PMID: 38312301 PMCID: PMC10832461 DOI: 10.1016/j.sopen.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
The management of rectal cancer has undergone significant changes over the past 50 years, and this has been associated with major improvements in overall outcomes and quality of life. From standardization of total mesorectal excision to refinements in radiation delivery and shifting of chemoradiotherapy treatment to favor a neoadjuvant approach, as well as the development of targeted chemotherapeutics, these management strategies have continually aimed to achieve locoregional and systemic control while limiting adverse effects and enhance overall survival. This article highlights evolving aspects of rectal cancer therapy including improved staging modalities, total neoadjuvant therapy, the role of short-course and more selective radiotherapy strategies, as well as organ preservation. We also discuss the evolving role of minimally invasive surgery and comment on lateral pelvic lymph node dissection. Key message Rectal cancer management is constantly evolving through refinements in radiation timing and delivery, modification of chemoradiotherapy treatment schedules, and increasing utilization of minimally invasive surgical techniques and organ preservation strategies. This manuscript aims to provide a synopsis of recent changes in the management of rectal cancer, highlighting contemporary modifications in neoadjuvant approaches and surgical management to enhance the knowledge of surgeons who care for this challenging population.
Collapse
Affiliation(s)
- Alexander M. Troester
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Wolfgang B. Gaertner
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
- Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
| |
Collapse
|
3
|
Jiang SJ, Diaconescu AC, McEwen DP, McEwen LN, Chang AC, Lin J, Reddy RM, Lynch WR, Bonner S, Lagisetty KH. Factors affecting timing of surgery following neoadjuvant chemoradiation for esophageal cancer. Heliyon 2023; 9:e23212. [PMID: 38144324 PMCID: PMC10746453 DOI: 10.1016/j.heliyon.2023.e23212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/26/2023] Open
Abstract
Background Neoadjuvant chemoradiation with esophagectomy is standard management for locally advanced esophageal cancer. Studies have shown that surgical timing following chemoradiation is important for minimizing postoperative complications, however in practice timing is often variable and delayed. Although postoperative impact of surgical timing has been studied, less is known about factors associated with delays. Materials and methods A retrospective review was performed for 96 patients with esophageal cancer who underwent chemoradiation then esophagectomy between 2018 and 2020 at a single institution. Univariable and stepwise multivariable analyses were used to assess association between social (demographics, insurance) and clinical variables (pre-operative weight, comorbidities, prior cardiothoracic surgery, smoking history, disease staging) with time to surgery (≤8 weeks "on-time" vs. >8 weeks "delayed"). Results Fifty-one patients underwent esophagectomy within 8 weeks of chemoradiation; 45 had a delayed operation. Univariate analysis showed the following characteristics were significantly different between on-time and delayed groups: weight loss within 3 months of surgery (3.9 ± 5.1 kg vs. 1.5 ± 3.6 kg; P = 0.009), prior cardiovascular disease (29% vs. 49%; P = 0.05), prior cardiothoracic surgery (4% vs. 22%; P = 0.01), history of ever smoked (69% vs. 87%; P = 0.04), absent nodal metastasis on pathology (57% vs. 82%; P = 0.008). Multivariate analysis demonstrated that prior cardiothoracic surgery (OR 8.924, 95%CI 1.67-47.60; P = 0.01) and absent nodal metastasis (OR 4.186, 95%CI 1.50-11.72; P = 0.006) were associated with delayed surgery. Conclusions Delayed esophagectomy following chemoradiotherapy is associated with prior cardiothoracic surgery and absent nodal metastasis. Further investigations should focus on understanding how these factors contribute to delays to guide treatment planning and mitigate sources of outcome disparities.
Collapse
Affiliation(s)
- Shannon J. Jiang
- Washington University in St. Louis, Department of Medicine, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Andrada C. Diaconescu
- University of Alabama at Birmingham, Department of Surgery, 1720 University Blvd, Birmingham, AL, 35294, USA
| | - Dyke P. McEwen
- University of Michigan, Department of Pharmacology, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Laura N. McEwen
- University of Michigan, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Andrew C. Chang
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Jules Lin
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Rishindra M. Reddy
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - William R. Lynch
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Sidra Bonner
- University of Michigan, Department of Surgery, Section of General Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kiran H. Lagisetty
- University of Michigan, Department of Surgery, Section of Thoracic Surgery, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| |
Collapse
|
4
|
Okui J, Shigeta K, Kato Y, Mizuno S, Sugiura K, Seo Y, Nakadai J, Baba H, Kikuchi H, Hirata A, Makino A, Kondo T, Matsui S, Seishima R, Okabayashi K, Obara H, Sato Y, Kitagawa Y. Delayed-Onset Organ/Space Surgical Site Infection Worsens Prognosis in High-Risk Stage II and III Colorectal Cancer. J Gastrointest Surg 2023; 27:2515-2525. [PMID: 37740145 DOI: 10.1007/s11605-023-05836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND It is unclear how early- and delayed-onset organ/space surgical site infections (SSIs) affect the long-term prognosis of patients with colorectal cancer, who are potential candidates for adjuvant chemotherapy. This study aimed to investigate the association between the timing of SSI onset and clinical outcome. METHODS This retrospective, multicenter cohort study evaluated patients who were diagnosed with high-risk stage II or III colorectal cancer and underwent elective surgery between 2010 and 2020. Five-year recurrence-free survival (RFS) was the primary endpoint and was compared between early SSI, delayed SSI (divided based on the median date of SSI onset), and non-SSI groups. RESULTS A total of 2,065 patients were included. Organ/space SSI was diagnosed in 91 patients (4.4%), with a median onset of 6 days after surgery. The early-onset SSI group had a higher proportion of patients with Clavien-Dindo grade ≥IIIb SSI than the delayed-onset SSI. Patients who received adjuvant chemotherapy (AC) had earlier organ/space SSI onset than those who did not. The adjusted hazard ratio of 5-year RFS in the delayed-onset SSI was 2.58 (95% confidence interval: 1.43-4.65; p = 0.002): higher than that in the early-onset SSI, with the non-SSI as the reference. CONCLUSIONS Delayed-onset organ/space SSI worsened long-term prognosis compared to early-onset, and this may be due to delayed initiation of AC. Patients who are clinically suspected of having lymph node metastasis might need additional intervention to prevent delays in commencing AC due to the delayed SSI.
Collapse
Affiliation(s)
- Jun Okui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yujin Kato
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shodai Mizuno
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyoaki Sugiura
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Yuki Seo
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Jumpei Nakadai
- Department of Gastrointestinal Surgery, Saitama City Hospital, Saitama, Japan
| | - Hideo Baba
- Department of Gastrointestinal Surgery, Saitama City Hospital, Saitama, Japan
| | - Hiroto Kikuchi
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Akitsugu Makino
- Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Takayuki Kondo
- Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Li S, Ji L, Huang J, Wang Y, Liu P, Zhang W, Lou Z. The impact of primary tumor resection for asymptomatic colorectal cancer patients with unresectable metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:214. [PMID: 37581775 DOI: 10.1007/s00384-023-04500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Whether patients with asymptomatic primary tumors and unresectable metastases of colorectal cancer (CRC) should undergo primary tumor resection (PTR) remains controversial. This study aims to determine the appropriateness of PTR for these individuals by evaluating a number of outcome measures. METHODS A systematic literature search was performed. Outcome measures included overall survival, emergency surgery rates, incidence of postoperative complications, time to initiate chemotherapy, conversion rates, and chemotherapy-related toxicities. RESULTS Patients who received PTR in addition to chemotherapy had a better overall survival rate than those who only received chemotherapy (HR = 0.62, 95%CI, 0.50-0.78, I2 = 84%, p < 0.00001). In the RCT subgroup, there were no significant differences with a HR of 0.72 (95%CI, 0.45-1.13, I2 = 17%, p = 0.15). More patients in the chemotherapy alone group could be converted to resectable status (OR = 0.47, 95%CI, 0.27-0.82, I2 = 0%, p = 0.008), but the incidence of emergency surgery was 23% (95%CI, 17-29%, I2 = 14%). The risk of chemotherapy-related toxicity was not significantly higher in the PTR group (OR = 1.5, 95%CI, 0.94-2.43, p = 0.09, I2 = 0%), with a 7% incidence of postoperative complications (95%CI, 0-14%, p = 0.05, I2 = 0%). The time to initiate chemotherapy after PTR was approximately 33.06 days (95%CI, 25.55-40.58, I2 = 0%). CONCLUSION PTR plus chemotherapy may be associated with improved survival in asymptomatic CRC patients with unresectable metastases. However, PTR did not provide a significant survival benefit in the subgroup of RCTs. Additionally, PTR did not result in a significantly increased risk of chemotherapy-related toxicity, with a postoperative complication rate of approximately 7%, and chemotherapy could be initiated at approximately 33.06 days after PTR. Compared with the PTR plus chemotherapy, chemotherapy alone could result in a significantly higher conversion rate. However, about 23% of patients receiving chemotherapy alone required emergency surgery for primary tumor-related symptoms. The above results needed to be validated in future larger prospective randomized trials.
Collapse
Affiliation(s)
- Shuyuan Li
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Liqiang Ji
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Jie Huang
- The first affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ye Wang
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Peng Liu
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Wei Zhang
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Zheng Lou
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China.
| |
Collapse
|
6
|
Hashimoto S, Tominaga T, Nonaka T, Shiraishi T, To K, Takeshita H, Fukuoka H, Araki M, Tanaka K, Sawai T, Nagayasu T. Mid-term outcomes of laparoscopic vs open colectomy for pathological T4 and/or N2 colon cancer patients: Multicenter study using propensity score matched analysis. Asian J Endosc Surg 2023; 16:400-408. [PMID: 36799190 DOI: 10.1111/ases.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We aimed to assess mid-term outcomes after laparoscopic surgery (LAP) vs open surgery (OP) for pathological T4 (pT4) and/or N2 (pN2) colon cancer. METHODS We retrospectively reviewed 255 primary tumor resections for pT4 and/or pN2 colon cancer performed from 2015 to 2020 at six hospitals, divided into LAP (n = 204) and OP groups (n = 51). After propensity score matching to minimize selection bias, 47 matched patients per group were assessed. RESULTS Before matching, the rate of males (53.9% vs. 37.3%, P = .042), left sided colon cancer (53.9% vs 37.3%, P = .042), D3 lymph node dissection (90.7% vs 68.6%, P < .001) and body mass index (kg/m2 ) (22.3 vs 21.8, P = .039) were significantly greater in the LAP group. The rate of pT4b (7.8% vs 40.4%, P < .001) was lower and pN2 was higher (57.4% vs 37.3%, P = .012) in the LAP group. After matching, preoperative characteristics and pathologic status were equivalent between the groups. The LAP and OP groups showed comparable overall survival (OS) (2-year OS, 84.5% vs 76.8%, P = .055) and recurrence-free survival (RFS) (2-year RFS, 73.9% vs 52.8%, P = .359). In the patients with pT4, OS (2-year OS, 79.4% vs 75.7%, P = .359) and RFS (2-year RFS, 71.3% vs 58.7%) were comparable. In the patients with pN2, OS (2-year OS, 83.4% vs 76.3%) and RFS (2-year RFS, 69.6% vs 36.2%) were also comparable. CONCLUSIONS LAP for pT4 and/or pN2 colon cancer showed comparable mid-term outcomes compared with OP. LAP was an acceptable surgical approach in this cohort.
Collapse
Affiliation(s)
- Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuo To
- Department of Surgery, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ohmura, Japan
| | | | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
7
|
Li H, Zhou J, Chen R, Zhu J, Wang J, Wen R. The efficacy and timing of adjuvant chemotherapy in upper tract urothelial carcinoma. Urol Oncol 2023:S1078-1439(23)00143-6. [PMID: 37331821 DOI: 10.1016/j.urolonc.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/02/2023] [Accepted: 04/16/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND A recovery period between surgery and initiation of adjuvant chemotherapy (AC) is common in patients with upper tract urothelial carcinoma (UTUC), which can progress after a relatively long time. Therefore, the efficacy of AC initiated within 90 days after radical nephroureterectomy (RNU) was evaluated in UTUC patients at stage ≥pT2 (N0-3M0), in addition to the effect of delayed AC initiation on survival outcomes. METHODS Clinical data for 428 UTUC patients diagnosed with transitional cell carcinoma with postoperatively confirmed pathological stages, muscle-invasive or greater-stage (pT2-4) disease, any nodal status, and metastasis-free (M0) disease were retrospectively analyzed. All patients who received AC were treated within 90 days after RNU and underwent at least 4 cycles of the AC procedure. Then, patients receiving AC were divided into the "within 45 days" and "45 to 90 days" groups according to the time interval between RNU and AC initiation. Their clinicopathological characteristics were evaluated and the survival outcomes of the 2 groups were compared. Any adverse events that occurred during the AC process were also recorded. RESULTS A total of 428 patients were analyzed in the study, including 132 individuals who underwent the AC procedure with platinum in combination with gemcitabine within 90 days after RNU and 296 patients who failed to initiate AC within 90 days. The median age of all patients was 68 years (mean 67, range 28-90 years), and the median follow-up was 25 months (mean 36, range 1-129 months). There were no significant differences in age, sex, lymph node metastasis, tumor location, hydronephrosis status, hematuria status, cancer grade, or multifocality between the 2 groups. Individuals undergoing AC initiated within 90 days of RNU showed a significantly decreased mortality relative to those patients who did not receive AC. Shorter intervals between RNU and AC initiation within 45 days vs. 45-90 days did not improve patient OS and cancer-specific survival (CSS) and may have increased the incidence of adverse events. CONCLUSION The present study data supported the finding that a platinum-based combination with gemcitabine regimen initiated postoperatively significantly improved OS and CSS in patients with UTUC at stages ≥pT2 (N0-3M0). Furthermore, no survival benefit was evident in patients who started AC within 45 days after RNU compared to those who received AC within 45 to 90 days.
Collapse
Affiliation(s)
- Hailong Li
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Zhou
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Renfu Chen
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jiawei Zhu
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Junqi Wang
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rumin Wen
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| |
Collapse
|
8
|
Yang Y, Lu Y, Tan H, Bai M, Wang X, Ge S, Ning T, Zhang L, Duan J, Sun Y, Liu R, Li H, Ba Y, Deng T. The optimal time of starting adjuvant chemotherapy after curative surgery in patients with colorectal cancer. BMC Cancer 2023; 23:422. [PMID: 37161562 PMCID: PMC10170689 DOI: 10.1186/s12885-023-10863-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Postoperative adjuvant chemotherapy (AC) is now well-accepted as standard for high-risk stage II and stage III colorectal cancer (CRC) patients, however the optimal time to initiate AC remains elusive. METHODS A comprehensive literature search was performed using the PubMed and Embase databases. The Hazard ratio (HR) with the corresponding 95% confidence interval (CI) was used as an effect measure to evaluate primary endpoints. All analyses were conducted using Stata software version 12.0 with the Random-effects model. RESULTS A total of 30 studies were included in our study. Upon comparison on overall survival (OS), we identified that delaying the initiation of AC for > 8 weeks after operation was significantly associated with poor OS (HR: 1.37; 95% CI: 1.27-1.48; P < 0.01). The poor prognostic value of AC delay for > 8 weeks was not undermined by subgroup analysis based on region, tumor site, sample size and study quality. No obvious differences were observed in survival between AC within 5-8 weeks and ≤ 4 weeks (HR: 1.03; 95% CI: 0.96 -1.10; P = 0.46). Moreover, two studies both highlighted that the survival benefit of AC was still statistically significant when AC was applied 5-6 months after surgery compared with the non-chemotherapy group. CONCLUSIONS Delaying the initiation of AC for > 8 weeks after surgery was significantly associated with poor OS. AC started within 8 weeks after surgery brought more benefits to CRC patients. There were no obvious differences in survival benefits between AC within 5-8 weeks and ≤ 4 weeks. Compared to patients not receiving AC after surgery, a delay of approximately 5-6 months was still useful to improve prognosis.
Collapse
Affiliation(s)
- Yuchong Yang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Yao Lu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Hui Tan
- Department of Surgical Oncology and General Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ming Bai
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Xia Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Shaohua Ge
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Tao Ning
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Le Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Jingjing Duan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Yansha Sun
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Rui Liu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Hongli Li
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China
| | - Yi Ba
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China.
- Department of Cancer Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Ting Deng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi District, Tianjin, 300060, China.
| |
Collapse
|
9
|
Emland F, Taflin H, Carlsson G, Ljungman D, Lindskog EB. Prolonged postoperative length of stay may be a valuable marker for susceptibility to relapse beyond established risk factors in patients with stage III colon cancer. World J Surg Oncol 2022; 20:277. [PMID: 36056361 PMCID: PMC9438186 DOI: 10.1186/s12957-022-02742-8] [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: 06/10/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Delay from surgery to adjuvant chemotherapy causes impaired survival among patients undergoing radical resection for stage III colon cancer, and the underlying mechanism for this is incompletely clarified. It is established that prolonged postoperative hospital length of stay (LOS) is associated with delayed initiation of the adjuvant treatment driving the assumption that prolonged LOS is prognostically unfavorable due to this fact and case mix factors. We hypothesize that prolonged LOS after surgery is a valuable marker for susceptibility to relapse that is not detected in established prognostic factors and, alone, associated with a shorter disease-free survival (DFS). Materials and methods A total of 690 consecutive patients undergoing elective radical resection for stage III colon cancer in 2000–2015 were identified in a prospective detailed facility database. Univariate and multivariate analyses were performed using Cox proportional hazards model in the evaluation of LOS as an independent prognostic factor. Results Short postoperative LOS, low comorbidity, and few complications were associated with longer DFS (p < 0.01). Fewer patients in the short and intermediate LOS groups had a relapse in their disease (28% and 33%, respectively), compared to the patients with longer LOS (40%, p < 0.05). LOS was a prognostic factor for DFS in the unadjusted univariate model (HR 1.04 per unit change) and remained statistically significant in the adjusted multivariate analysis, with a HR of 1.03 per hospital day (p < 0.01). Conclusions Postoperative LOS independently correlates with the risk of recurrence and DFS, regardless of if adjuvant chemotherapy is given, along with the factors such as age, comorbidity, complications, and tumor features. We propose a further investigation into the causal mechanisms based on tumor and host biology linking LOS to DFS beyond established risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02742-8.
Collapse
Affiliation(s)
- Frans Emland
- Sahlgrenska Academy at University of Gothenburg, Box 400, 405 30, Gothenburg, Sweden
| | - Helena Taflin
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital/Transplant Centre, University of Gothenburg, Gothenburg, Sweden
| | - Göran Carlsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden
| | - Elinor Bexe Lindskog
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.
| |
Collapse
|
10
|
Hao S, Parikh AA, Snyder RA. Racial Disparities in the Management of Locoregional Colorectal Cancer. Surg Oncol Clin N Am 2021; 31:65-79. [PMID: 34776065 DOI: 10.1016/j.soc.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Racial disparities pervade nearly all aspects of management of locoregional colorectal cancer, including time to treatment, receipt of resection, adequacy of resection, postoperative complications, and receipt of neoadjuvant and adjuvant multimodality therapies. Disparate gaps in treatment translate into enduring effects on survivorship, recurrence, and mortality. Efforts to reduce these gaps in care must be undertaken on a multilevel basis and focus on modifiable factors that underlie racial disparity.
Collapse
Affiliation(s)
- Scarlett Hao
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA
| | - Rebecca A Snyder
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Surgical Oncology Suite, 4S-24, Greenville, NC 27834, USA.
| |
Collapse
|
11
|
Tron L, Fauvernier M, Bouvier AM, Robaszkiewicz M, Bouvier V, Cariou M, Jooste V, Dejardin O, Remontet L, Alves A, Molinié F, Launoy G. Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study. Cancers (Basel) 2021; 13:cancers13205156. [PMID: 34680305 PMCID: PMC8533795 DOI: 10.3390/cancers13205156] [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: 07/22/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022] Open
Abstract
Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.
Collapse
Affiliation(s)
- Laure Tron
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Correspondence:
| | - Mathieu Fauvernier
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Michel Robaszkiewicz
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Véronique Bouvier
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Cancer Registry of Calvados, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Mélanie Cariou
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Valérie Jooste
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Olivier Dejardin
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Laurent Remontet
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Arnaud Alves
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
- Department of Digestive Surgery, University Hospital of Caen, 14000 Caen, France
| | | | - Florence Molinié
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Loire-Atlantique/Vendée Cancer Registry, 44000 Nantes, France
- CERPOP, Université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - Guy Launoy
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| |
Collapse
|
12
|
Davis RE, Trickey AW, Abrahamse P, Kato I, Ward K, Morris AM. Association of Cumulative Social Risk and Social Support With Receipt of Chemotherapy Among Patients With Advanced Colorectal Cancer. JAMA Netw Open 2021; 4:e2113533. [PMID: 34106262 PMCID: PMC8190628 DOI: 10.1001/jamanetworkopen.2021.13533] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Approximately 38% of patients with advanced colorectal cancer do not receive chemotherapy. OBJECTIVE To determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer and whether social support would moderate this association. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, population-based, mailed survey study was conducted from 2012 to 2014. Participants were recruited between 2011 and 2014 from all adults within 1 year after diagnosis of stage III colorectal cancer in the Detroit, Michigan, and State of Georgia Surveillance, Epidemiology, End-Results cancer registries. Patients were eligible if they were aged 18 years or older, had undergone surgery 4 or more months ago, did not have stage IV cancer, and resided in the registry catchment areas. Data analyses were conducted from March 2017 to April 2021. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of chemotherapy. Cumulative social risk represented a sum of 8 risk factors with the potential to drain resources from participants' cancer treatment (marital status, employment, annual income, health insurance, comorbidities, health literacy, adult caregiving, and perceived discrimination). Social support was operationalized as emotional support related to colorectal cancer diagnosis. RESULTS Surveys were mailed to 1909 eligible patients; 1301 completed the survey (response rate, 68%). A total of 1087 participants with complete data for key variables were included in the sample (503 women [46%]; mean [SD] age, 64 [13] years). Participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors (3 factors, odds ratio [OR], 0.48 [95% CI, 0.26-0.87]; 4 factors, OR, 0.41 [95% CI, 0.21-0.78]; 5 factors, OR, 0.42 [95% CI, 0.20-0.87]; ≥6 factors, OR, 0.22 [95% CI, 0.09-0.55]). Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support (2 sources, OR, 3.05 [95% CI, 1.36-6.85]; 3 sources, OR, 3.24 [95% CI, 1.48-7.08]; 4 sources, OR, 3.69 [95% CI, 1.71-7.97]; 5 sources, OR, 4.40 [95% CI, 1.98-9.75]; ≥6 sources, OR 5.95 [95% CI, 2.58-13.74]). Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased. CONCLUSIONS AND RELEVANCE Cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with colorectal cancer who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support.
Collapse
Affiliation(s)
- Rachel E. Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Paul Abrahamse
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Ikuko Kato
- Department of Pathology, Karmanos Cancer Institute, Wayne State University, Michigan
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arden M. Morris
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
13
|
Patel SH, Battaglia MA, Shanker BA, Cleary RK. A Single Institution Propensity Score Weighted Analysis of Time to Chemotherapy After Minimally Invasive Versus Open Colorectal Surgery. Am Surg 2021; 88:2877-2885. [PMID: 33856932 DOI: 10.1177/00031348211011137] [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: 11/15/2022]
Abstract
BACKGROUND Oncologic outcomes for colon cancer are optimal when chemotherapy is started within 6 to 8 weeks after surgery. The study objective was to investigate the impact of operative modality and urgency on the time interval from surgery to adjuvant chemotherapy. METHODS This is a retrospective institutional tumor registry cohort study of open and laparoscopic/robotic colorectal resections for stage II-IV cancer between April 2010 and January 2018. Primary outcome was time from surgery to chemotherapy. Predictor variables were adjusted for imbalances by propensity score weighting. RESULTS A total of 220 patients met inclusion criteria: 171 elective (108 laparoscopic/robotic and 63 open) and 49 urgent colectomies. After propensity score weighting, there was no significant difference in time to chemotherapy between elective minimally invasive and open surgical approaches (48 days vs. 58 days, P = .187). Only 68.9% of minimally invasive and 50.8% of open colectomy patients started chemotherapy within 8 weeks of surgery. There was a significant difference (P = .037) among surgical sites with rectal resections having the longest (55 days), and right colectomies having the shortest (46 days), time to chemotherapy. Patients who had urgent operations had significantly longer hospital length of stay (P < .001) and higher post-discharge emergency department visit rates (P < .001) than the elective operation group. However, there was no significant difference in time to chemotherapy. DISCUSSION Neither operative modality nor operative urgency resulted in a significant difference in postoperative time to initiating chemotherapy. Future efforts should be focused on identifying postoperative recovery criteria and optimum multidisciplinary communication methods that allow recovered patients to start chemotherapy sooner.
Collapse
Affiliation(s)
- Samik H Patel
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Michael A Battaglia
- Biostatistics and Epidemiology Methods Consulting, BEMC, LLC, Ann Arbor, MI, USA
| | - Beth-Ann Shanker
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Robert K Cleary
- Department of Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| |
Collapse
|
14
|
Konradsen AA, Lund CM, Vistisen KK, Albieri V, Dalton SO, Nielsen DL. The influence of socioeconomic position on adjuvant treatment of stage III colon cancer: a systematic review and meta-analysis. Acta Oncol 2020; 59:1291-1299. [PMID: 32525420 DOI: 10.1080/0284186x.2020.1772501] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with colon cancer (CC) with low socioeconomic position (SEP) have a worse survival than patients with high SEP. We investigated the association between different socioeconomic indicators and the steps in the treatment trajectory leading to initiation of adjuvant chemotherapy (ACT) for patients with stage III CC. MATERIALS AND METHODS A systematic review and meta-analyses were conducted in accordance with the MOOSE checklist. MEDLINE and EMBASE were searched for eligible studies. Meta-analyses were performed on the separate socioeconomic indicators with the random-effects model. The heterogeneity across studies was assessed by the Q and the I 2 statistic. RESULTS In total, 27 observational studies were included. SEP was measured by insurance, income, poverty, employment, education, or an index on an area or individual level. SEP, regardless of indicator, was negatively associated with the steps in the treatment trajectory leading to initiation of ACT among patients with resected stage III CC. The meta-analyses showed that patients with low SEP had a significantly lower odds of receiving ACT and increased odds of delayed treatment start, whereas SEP had no impact on the choice of therapy: combination or single-agent therapy. CONCLUSION SEP was associated with less initiation of and higher risk for delayed initiation of ACT. Our findings suggest there is a social disparity in receipt of ACT in patients with stage III CC.
Collapse
Affiliation(s)
- A. A. Konradsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - C. M. Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Copenage, Copenhagen Center for Clinical Age Research, University of Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| | - K. K. Vistisen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - V. Albieri
- Statistics and Data Analysis Department, Danish Cancer Society, Research Center, Copenhagen, Denmark
| | - S. O. Dalton
- Department of Clinical Oncology & Palliative Services, Zealand University Hospital, Naestved, Denmark
- Suvivorship and Inequality in Cancer, Danish Cancer Society, Research Center, Copenhagen, Denmark
| | - D. L. Nielsen
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Denmark
| |
Collapse
|
15
|
Zhu L, Tong YX, Xu XS, Xiao AT, Zhang YJ, Zhang S. High level of unmet needs and anxiety are associated with delayed initiation of adjuvant chemotherapy for colorectal cancer patients. Support Care Cancer 2020; 28:5299-5306. [PMID: 32112352 PMCID: PMC7547036 DOI: 10.1007/s00520-020-05333-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/21/2022]
Abstract
AIMS Adjuvant chemotherapy is recommended for patients with curatively resected colorectal cancer. The aim of this study is to evaluate the impact of unmet supportive care needs and anxiety on the initiation of postoperative adjuvant chemotherapy in colorectal cancer patients. METHODS This is a retrospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included. The Hospital Anxiety and Depression Scale (HADS) and modified 34-item Supportive Care Needs Survey (SCNS-SF34) were applied to assess patient's anxiety level and unmet needs. The time intervals between initiation of adjuvant chemotherapy and operation were recorded. Factors associated with delayed initiation of chemotherapy were investigated in univariate and multivariate analysis. RESULTS A total of 135 patients with colorectal cancer were included. In total, 16.3% (22/135) and 5.2% (7/135) reported symptoms of anxiety and depression. In multivariate analysis, low to moderate income status, postoperative complications, anxiety, and high level of unmet needs are independent risk factors for late initiation of chemotherapy. CONCLUSIONS Our findings showed that psychological problems such as anxiety and high unmet supportive needs are correlated with delayed initiation of adjuvant chemotherapy in colorectal cancer patients.
Collapse
Affiliation(s)
- Li Zhu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, No, Wuhan, 1095 China
| | - Yi Xin Tong
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, No, Wuhan, 1095 China
| | - Xiang Shang Xu
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, No, Wuhan, 1095 China
| | - Ai Tang Xiao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, No, Wuhan, 1095 China
| | - Yu Jie Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, No, Wuhan, 1095 China
| | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Ave, No, Wuhan, 1095 China
| |
Collapse
|
16
|
Kwon J, Park SY, Park Y, Jun E, Lee W, Song KB, Lee JH, Hwang DW, Kim SC. A comparison of minimally invasive vs open distal pancreatectomy for resectable pancreatic ductal adenocarcinoma: Propensity score matching analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:967-982. [PMID: 33091208 DOI: 10.1002/jhbp.853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Owing to concerns regarding adequate oncological outcomes and perioperative complications, minimally invasive distal pancreatectomy (MIDP) for pancreatic ductal adenocarcinoma (PDAC) has limited generalizability. The aim of this study was to assess the perioperative and oncologic outcomes of MIDP compared with open distal pancreatectomy (ODP) for resectable PDAC after propensity score matching (PSM). METHODS The patients who underwent MIDP and ODP for PDAC between January 2010 and December 2017 were retrospectively reviewed. Demographics, perioperative outcomes, pathological outcomes, and overall and disease-free survival data were collected to compare MIDP and ODP. After PSM, perioperative and oncologic outcomes were analyzed. RESULTS A total of 156 MIDP patients were compared with 156 ODP patients for resectable PDAC after PSM. Tumor size, TNM stage, differentiation, harvested lymph nodes, and positive lymph nodes were not different except for R1 resection and lymphovascular invasion between the MIDP and ODP groups. Operation times, overall complications, POPF, and adjuvant treatment were also not different between the two groups. The MIDP group had shorter hospital stays (10.0 vs 13.4 days, P < 0.001) and shorter interval times from surgery to adjuvant treatment (37.6 days vs 46.0 days, P = 0.002) than the ODP group. The MIDP group had better overall survival (34.9 vs 24.5 months, P = 0.012) and disease-free survival (16.2 vs 10.3 months, P = 0.001). CONCLUSION Minimally invasive distal pancreatectomy has advantages with respect to postoperative hospital stay, interval between surgery, and adjuvant treatment. MIDP is associated with the possibility of improved survival rate for resectable PDAC.
Collapse
Affiliation(s)
- Jaewoo Kwon
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yejong Park
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| | - Eunsung Jun
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea.,Convergence Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woohyung Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| | - Ki Byung Song
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| | - Dae Wook Hwang
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| | - Song Cheol Kim
- Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan college of Medicine, Seoul, South Korea
| |
Collapse
|
17
|
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum 2020; 63:1191-1222. [PMID: 33216491 DOI: 10.1097/dcr.0000000000001762] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
18
|
Chakrabarti S, Peterson CY, Sriram D, Mahipal A. Early stage colon cancer: Current treatment standards, evolving paradigms, and future directions. World J Gastrointest Oncol 2020; 12:808-832. [PMID: 32879661 PMCID: PMC7443846 DOI: 10.4251/wjgo.v12.i8.808] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/16/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
Colon cancer continues to be one of the leading causes of mortality and morbidity throughout the world despite the availability of reliable screening tools and effective therapies. The majority of patients with colon cancer are diagnosed at an early stage (stages I to III), which provides an opportunity for cure. The current treatment paradigm of early stage colon cancer consists of surgery followed by adjuvant chemotherapy in a select group of patients, which is directed at the eradication of minimal residual disease to achieve a cure. Surgery alone is curative for the vast majority of colon cancer patients. Currently, surgery and adjuvant chemotherapy can achieve long term survival in about two-thirds of colon cancer patients with nodal involvement. Adjuvant chemotherapy is recommended for all patients with stage III colon cancer, while the benefit in stage II patients is not unequivocally established despite several large clinical trials. Contemporary research in early stage colon cancer is focused on minimally invasive surgical techniques, strategies to limit treatment-related toxicities, precise patient selection for adjuvant therapy, utilization of molecular and clinicopathologic information to personalize therapy and exploration of new therapies exploiting the evolving knowledge of tumor biology. In this review, we will discuss the current standard treatment, evolving treatment paradigms, and the emerging biomarkers, that will likely help improve patient selection and personalization of therapy leading to superior outcomes.
Collapse
Affiliation(s)
- Sakti Chakrabarti
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Carrie Y Peterson
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Deepika Sriram
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Amit Mahipal
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, United States
| |
Collapse
|
19
|
Bergin RJ, Thomas RJS, Whitfield K, White V. Concordance between Optimal Care Pathways and colorectal cancer care: Identifying opportunities to improve quality and reduce disparities. J Eval Clin Pract 2020; 26:918-926. [PMID: 31287616 DOI: 10.1111/jep.13231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Care pathway policies for cancer aim to reduce variation and improve the quality of patient care, and there is increasing evidence that adherence to such pathways is associated with improved survival and lower health care costs. Australia is implementing Optimal Care Pathways (OCPs) for several cancers, including colorectal cancer, but studies evaluating how well care conforms to OCP recommendations are rare. This study examined concordance between OCP recommendations and colorectal cancer care prior to policy rollout and disparities for vulnerable populations. METHOD Cross-sectional survey (2012-2014) of cancer registry-identified colorectal cancer patients aged ≥40 approached within 6 months of diagnosis (n = 433), their general practitioner (GP, n = 290), and specialist (n = 144) in Victoria, Australia. We measured concordance with 10 OCP recommendations and variation by geography, socio-economic, and health insurance status using age- and sex-adjusted logistic regression models. RESULTS Use of recommended GP investigations varied from 66% for colonoscopy to 13% for digital rectal exam. Recommended waiting times to receive a colonoscopy, see a specialist after referral, and begin adjuvant chemotherapy were exceeded for around a third of patients. Twenty-eight percent of specialists reported a pretreatment multidisciplinary meeting. Most patients received surgery in a hospital with an intensive care unit (92%) and chemotherapy for high risk disease (84%). In general, care was similar across sociodemographic groups. However, receipt of GP investigations tended to be higher and waiting times longer for rural, low socio-economic, and non-privately insured patients. For example, receiving a colonoscopy within 4 weeks was significantly less likely for rural (51%) than urban (78%) patients (odds ratio = 0.30; 95% confidence interval, 0.11-0.79). CONCLUSION Prior to implementation, a significant proportion of colorectal cancer patients received care that did not meet OCP recommendations. Low concordance and inequities for rural and disadvantaged populations highlight components of the pathway to target during policy implementation.
Collapse
Affiliation(s)
- Rebecca J Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Robert J S Thomas
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kathryn Whitfield
- Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia
| | - Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.,School of Psychology, Deakin University, Melbourne, Australia
| |
Collapse
|
20
|
Jansen L, Behrens G, Finke I, Maier W, Gerken M, Pritzkuleit R, Holleczek B, Brenner H. Area-Based Socioeconomic Inequalities in Colorectal Cancer Survival in Germany: Investigation Based on Population-Based Clinical Cancer Registration. Front Oncol 2020; 10:857. [PMID: 32670870 PMCID: PMC7326086 DOI: 10.3389/fonc.2020.00857] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Socioeconomic inequalities in colorectal cancer survival have been observed in many countries. To overcome these inequalities, the underlying reasons must be disclosed. Methods: Using data from three population-based clinical cancer registries in Germany, we investigated whether associations between area-based socioeconomic deprivation and survival after colorectal cancer depended on patient-, tumor- or treatment-related factors. Patients with a diagnosis of colorectal cancer in 2000–2015 were assigned to one of five deprivation groups according to the municipality of the place of residence using the German Index of Multiple Deprivation. Cox proportional hazards regression models with various levels of adjustment and stratifications were applied. Results: Among 38,130 patients, overall 5-year survival was 4.8% units lower in the most compared to the least deprived areas. Survival disparities were strongest in younger patients, in rectal cancer patients, in stage I cancer, in the latest period, and with longer follow-up. Disparities persisted after adjustment for stage, utilization of surgery and screening colonoscopy uptake rates. They were mostly still present when restricting to patients receiving treatment according to guidelines. Conclusion: We observed socioeconomic inequalities in colorectal cancer survival in Germany. Further studies accounting for potential differences in non-cancer mortality and exploring treatment patterns in detail are needed.
Collapse
Affiliation(s)
- Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Werner Maier
- Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Michael Gerken
- Tumor Center-Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany
| | | |
Collapse
|
21
|
Zhao B, Lv W, Lin J. Delaying adjuvant chemotherapy in advanced gastric cancer patients: Risk factors and its impact on survival outcome. Curr Probl Cancer 2020; 44:100577. [PMID: 32418615 DOI: 10.1016/j.currproblcancer.2020.100577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/19/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Abstract
Adjuvant chemotherapy following the curative resection could improve the survival outcome of advanced gastric cancer (GC) patients. However, it is unclear whether delayed initiation of adjuvant chemotherapy had a negative impact on survival outcome in GC patients. The purpose of this study was to review current published literature about the impact of delaying adjuvant chemotherapy on survival outcome and summarize risk factors for delaying adjuvant chemotherapy. Delayed initiation of adjuvant chemotherapy was quite frequent in GC patients who underwent gastrectomy due to postoperative complications, poor nutritional status, comorbid diseases and socioeconomic status. Therefore, it is important for these patients to have a sufficient and smooth transition from surgery to initiation of adjuvant chemotherapy. Based on current available evidence, there is no specific timing interval for the initiation of adjuvant chemotherapy in GC patients. Earlier initiation of adjuvant chemotherapy (<4 weeks) may not be mandatory for GC patients who underwent curative resection. However, the patients should be recommended to receive adjuvant chemotherapy within 6-8 weeks if their performance status and nutritional status were deemed to be appropriate. Minimizing postoperative complications and providing requisite nutritional advice may be helpful for timely initiation of adjuvant chemotherapy.
Collapse
Affiliation(s)
- Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, PR China.
| | - Wu Lv
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, PR China
| | - Jie Lin
- Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, PR China.
| |
Collapse
|
22
|
Is Early Initiation of Adjuvant Chemotherapy Beneficial for Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy and Radical Surgery? World J Surg 2020; 44:3149-3157. [PMID: 32415467 DOI: 10.1007/s00268-020-05573-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM This study aimed to evaluate whether earlier initiation (< 4 weeks) of adjuvant chemotherapy (ACT) confer any oncological benefits for locally advanced rectal cancer (LARC) patients undergoing neoadjuvant chemoradiotherapy (nCRT) and radical surgery. METHOD Clinicopathological and survival outcomes were compared. Propensity score matching (PSM) was performed to adjust for differences between groups. Cox regression analysis was performed to evaluate the impact of earlier ACT initiation on overall survival (OS) and disease-free survival (DFS). RESULTS Totally, 443 eligible patients were included. More laparoscopic surgeries, less postoperative complications, and more ACT completion were observed in patients whose ACT was initiated within 4 weeks after surgery (all P < 0.001). With a mean follow-up of 59 months, the 5-year OS and DFS rate was 89.8% and 82.0% in the early group, significantly higher than 81.6% and 73.1% in the late group (P = 0.007, and P = 0.022, respectively). After PSM, the 5-year OS and DFS rate was 90.9% and 84.4% in the early group, significantly higher than 83.4% and 68.8% in the late group (P = 0.047, and P = 0.017, respectively). Cox regression analysis demonstrated that time to ACT initiation (early vs. late, HR = 0.486, P = 0.008) was independently associated with OS. CONCLUSION Early initiation of ACT (<4 weeks) confers a survival benefit, and is an independent prognostic factor of OS in LARC patients following nCRT. Further investigations are needed to define the role of earlier initiation of ACT in patients with LARC after nCRT.
Collapse
|
23
|
Xiao AT, Tong YX, Xu XS, Zhou Y, Zhang S. Preoperative Nutritional Status Contributes to the Development of Neutropenia Event in Patients With Gastric Cancer Receiving CAPEOX Adjuvant Chemotherapy. Front Oncol 2020; 10:692. [PMID: 32426291 PMCID: PMC7204396 DOI: 10.3389/fonc.2020.00692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of this study is to evaluate the risk factors for ≥ grade 3 neutropenia in gastric cancer patients receiving postoperative adjuvant chemotherapy. Methods: This is a retrospective study from a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in this study. Baseline and clinicopathological characteristics of the patients were collected. Patients were followed-up for 12 months and the incidence of neutropenia were recorded. Factors associated with neutropenia of chemotherapy in cycle 1 were investigated. Results: A total of 202 patients with gastric cancer were included. All patients received oxaliplatin plus oral capecitabine (CAPEOX) as the adjuvant chemotherapy. The incidence of ≥ grade 3 neutropenia is 11.9% (24/202) in cycle 1 among all patients. In multivariate analysis, independent risk factors for ≥ grade 3 neutropenia were serum prealbumin level (p = 0.041), prognostic nutritional index (PNI) (p = 0.049) and pre-cycle neutrophil count (p = 0.007). Conclusions: Our findings for the first time showed that nutritional parameter as prealbumin level and PNI are independent risk factors for neutropenia in gastric cancer patients receiving adjuvant chemotherapy. This may provide evidence for further investigation on prophylaxis use of granulocyte colony-stimulating factor in selected high-risk patients to prevent sever neutropenia in cycle 1 of adjuvant chemotherapy.
Collapse
Affiliation(s)
| | | | | | | | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
24
|
Kwon J, Song KB, Park SY, Shin D, Hong S, Park Y, Lee W, Lee JH, Hwang DW, Kim SC. Comparison of Minimally Invasive Versus Open Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Propensity Score Matching Analysis. Cancers (Basel) 2020; 12:cancers12040982. [PMID: 32326595 PMCID: PMC7226374 DOI: 10.3390/cancers12040982] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Few studies have compared perioperative and oncological outcomes between minimally invasive pancreatoduodenectomy (MIPD) and open pancreatoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective review of patients undergoing MIPD and OPD for PDAC from January 2011 to December 2017 was performed. Perioperative, oncological, and survival outcomes were analyzed before and after propensity score matching (PSM). Results: Data from 1048 patients were evaluated (76 MIPD, 972 OPD). After PSM, 73 patients undergoing MIPD were matched with 219 patients undergoing OPD. Operation times were longer for MIPD than OPD (392 vs. 327 min, p < 0.001). Postoperative hospital stays were shorter for MIPD patients than OPD patients (12.4 vs. 14.2 days, p = 0.040). The rate of overall complications and postoperative pancreatic fistula did not differ between the two groups. Adjuvant treatment rates were higher following MIPD (80.8% vs. 59.8%, p = 0.002). With the exception of perineural invasion, no differences were seen between the two groups in pathological outcomes. The median overall survival and disease-free survival rates did not differ between the groups. Conclusions: MIPD showed shorter postoperative hospital stays and comparable perioperative and oncological outcomes to OPD for selected PDAC patients. Future randomized studies will be required to validate these findings.
Collapse
Affiliation(s)
- Jaewoo Kwon
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Ki Byung Song
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea;
| | - Dakyum Shin
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Sarang Hong
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Yejong Park
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Woohyung Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul 05505, Korea; (J.K.); (K.B.S.); (D.S.); (S.H.); (Y.P.); (W.L.); (J.H.L.); (D.W.H.)
- Correspondence: ; Tel.: +82-2-3010-3936; Fax: +82-2-474-9027
| |
Collapse
|
25
|
Shah M, Parmar A, Chan KKW. Socioeconomic disparity trends in diagnostic imaging, treatments, and survival for non-small cell lung cancer 2007-2016. Cancer Med 2020; 9:3407-3416. [PMID: 32196964 PMCID: PMC7221447 DOI: 10.1002/cam4.2978] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/30/2019] [Accepted: 02/19/2020] [Indexed: 12/25/2022] Open
Abstract
Socioeconomic status (SES) has led to treatment and survival disparities; however, limited data exist for non‐small cell lung cancer (NSCLC). This study investigates the impact of SES on NSCLC diagnostic imaging, treatment, and overall survival (OS), and describes temporal disparity trends. The Ontario Cancer Registry was used to identify NSCLC patients diagnosed between 2007 and 2016. Through linkage to administrative datasets, patients’ demographics, imaging, treatment, and survival were obtained. Based on median household neighborhood income, the Ontario population was divided into five income quintiles (Q1‐Q5; Q1 = lowest income). Multivariable regressions assessed SES association with OS, imaging, treatment receipt, and treatment delay, and their interaction with year of diagnosis to understand temporal trends. Endpoints were adjusted for demographics, stage and comorbidities, along with treatments and imaging for OS. A total of 50 542 patients were identified. Higher SES patients (Q5 vs. Q1) showed improved 5‐year OS (hazard ratio, 0.89; 95% confidence interval [CI], 0.87‐0.92; P < .0001) and underwent greater magnetic resonance imaging head (stages IA‐IV; odds ratio [OR], 1.24; 95% CI, 1.16‐1.32; P < .0001), lung resection (IA‐IIIA; OR, 1.58; 95% CI, 1.43‐1.74; P < .0001), platinum‐based vinorelbine adjuvant chemotherapy (IB‐IIIA; OR, 1.63; 95% CI, 1.39‐1.92; P < .0001), palliative radiation (IV; OR, 1.14; 95% CI, 1.05‐1.25; P = .023), and intravenous chemotherapy (IV; OR, 1.45; 95% CI, 1.32‐1.60; P < .0001). Lower SES patients underwent greater thoracic radiation (IA‐IIIB; OR, 0.86; 95% CI, 0.79‐0.94; P = .0003). Across 2007‐2016, socioeconomic disparities remain largely unchanged (interaction P > .05) despite widening income inequality.
Collapse
Affiliation(s)
- Monica Shah
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ambica Parmar
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelvin K W Chan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.,Cancer Care Ontario, Toronto, ON, Canada
| |
Collapse
|
26
|
Laparoscopic-assisted Versus Open D2 Gastrectomy for Advanced Gastric Cancer in Highly Selective Patients: Short-term Surgical and Chemotherapy Outcomes of a Prospective Cohort Study. Am J Clin Oncol 2020; 42:459-465. [PMID: 30883390 DOI: 10.1097/coc.0000000000000534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The feasibility and efficacy of laparoscopic-assisted D2 gastrectomy (LAD2G) for advanced gastric cancer (AGC) remain controversial. We conducted a prospective cohort study to provide a comprehensive comparison of LAD2G and open D2 gastrectomy (OD2G) for AGC. MATERIALS AND METHODS Between April 2016 and December 2017, patients with clinical stage T2-4aN0-3M0 gastric cancer were enrolled and assigned to either LAD2G or OD2G group. The primary endpoint was short-term surgical and chemotherapy outcomes. The postoperative pain and perioperative anxiety were compared as the secondary endpoint to indicate perioperative life quality. RESULTS A total of 110 patients in LAD2G group and 238 patients in OD2G group were included. The 2 groups showed similar number of retrieved lymph nodes (29.85±6.52 vs. 30.60±5.37, P=0.069) and postoperative morbidity (21.01% vs. 21.82%, P=0.888). A total of 84.4% of patients in LAD2G group and 75.6% in OD2G group received adjuvant chemotherapy (AC) (P=0.069). The mean time interval to AC was shorter in LAD2G group (34±13.74 vs. 40.78±18.78 d, P<0.001). Furthermore, LAD2G was superior to OD2G in terms of earlier postoperative recovery, faster relief of postoperative pain, and lower postoperative anxiety. CONCLUSIONS LAD2G is feasible for AGC in experienced centers. Patients after LAD2G tended to have earlier initiate of AC. LAD2G could provide more rapid postoperative recovery and relief of postoperative pain, along with lower postoperative anxiety.
Collapse
|
27
|
Lu H, Zhao B, Zhang J, Huang R, Wang Z, Xu H, Huang B. Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 46:1103-1110. [PMID: 31948838 DOI: 10.1016/j.ejso.2020.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/23/2019] [Accepted: 01/07/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy(AC) following the curative resection could improve the survival outcome of advanced gastric cancer(GC) patients. However, there is no specific timing interval from radical surgery to initiation of AC. Whether delayed initiation of AC could affect the survival outcome of these patients remains unclear. In this study, we performed a systematic review and meta-analysis to evaluate the relationship between delaying AC and the survival outcome of GC patients. METHODS PubMed, Embase and Cochrane Library databases were systematically searched for eligible studies that evaluated the relationship between time to AC and survival outcome. Survival data for HR and 95% CI were extracted and converted to a regression coefficient(β) corresponding to a continuous representation per 4-week delay of AC. Individual adjusted β were combined using a fixed-effects or random-effects model. Heterogeneity was assessed by I2 statistic and publication bias was detected using standard error-based funnel plots. RESULTS A total of 11 eligible studies involving 6,017 patients were included in this meta-analysis. Eight studies evaluated the impact of delaying AC on overall survival(OS) and five evaluated the impact of delaying AC on disease-free survival(DFS). The pooled results demonstrated that the initiation of AC per 4-week delay was associated with a significant decrease in OS(HR:1.05, 95% CI: 1.03-1.08, P < 0.001; I2 = 18.5%) and DFS (HR:1.06, 95% CI: 1.02-1.10, P = 0.001; I2 = 40.6%). CONCLUSION The initiation of AC per 4-week delay was associated with worse survival outcomes in GC patients. If physical status and postoperative recovery were appropriated, GC patients should be recommended to receive adjuvant chemotherapy timely.
Collapse
Affiliation(s)
- Huiwen Lu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Jiale Zhang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Rui Huang
- Department of Clinical Medicine of year 2017, Dalian Medical University, PR China
| | - Zhenning Wang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Baojun Huang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
| |
Collapse
|
28
|
Luo P, Zhou JG, Jin SH, Qing MS, Ma H. Influence of marital status on overall survival in patients with ovarian serous carcinoma: finding from the surveillance epidemiology and end results (SEER) database. J Ovarian Res 2019; 12:126. [PMID: 31888704 PMCID: PMC6937688 DOI: 10.1186/s13048-019-0600-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022] Open
Abstract
Objective This study is to investigate the relationship between marital status and prognosis of patients with ovarian serous carcinoma. Results We performed data analysis from 19,276 patients identified from the SEER database of the National Cancer Center of the United States. 57.8% of the patients were married, 13.0% unmarried, and 29.2% separated/ divorced/widowed (SDW). The median overall survival time ofthe unmarried group and the married group are 48 months and 52 months respectively. Univariate Cox regression analysis showed that the patients with serous ovarian cancer in the unmarried group resulted in a hazard ratio (HR) of 1.14 (95% CI: 1.08–1.19%; P < 0.001), comparing to SDW group with a HR of 1.02 (95% CI: 0.98–1.19%; P = 0.26). However, the SDW group was not statistically significantly different from the married group. (median 32 vs 52 months). Multivariate Cox regression analysis presented the unmarried group leading to a HR of 1.05 (95% CI: 1.00–1.11%; P = 0.05), and the SDW group was not significant with a HR of 0.99 (95% CI: 0.95–1.03%; P = 0.57). Conclusion Unmarried patients with ovarian serous carcinoma have higherHRof overall survival. After controlling age, race, grade, radiation and year of diagnosis, unmarried patients were found to have a significantly higher risk of OS. Consequently, these patients are suggested to obtain more focused healthcare for the management of ovarian serous carcinoma.
Collapse
Affiliation(s)
- Pei Luo
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Jian-Guo Zhou
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China. .,Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, 91054, Germany.
| | - Su-Han Jin
- Department of Orthodontics, Affiliated Stomatology Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Ming-Song Qing
- Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
| |
Collapse
|
29
|
Jue JS, Koru-Sengul T, Miao F, Kroeger ZA, Moore KJ, Alameddine M, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Timing of adjuvant chemotherapy and overall survival following radical cystectomy. Urol Oncol 2019; 38:75.e15-75.e22. [PMID: 31864939 DOI: 10.1016/j.urolonc.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND We investigated the relationship between timing of adjuvant chemotherapy on overall survival following radical cystectomy. METHODS We retrospectively reviewed the National Cancer Data Base for patients with newly diagnosed pT2-T4, N0, M0 urothelial cell carcinoma who received no treatment prior to radical cystectomy. Patients who received no adjuvant chemotherapy or who received adjuvant chemotherapy more than 45 days after radical cystectomy were propensity matched to patients receiving adjuvant chemotherapy within 45 days of radical cystectomy. Selection bias was assessed by comparing the length of stay, readmission rate, and surgical approach between groups. Median survival was calculated using Kaplan-Meier analysis. Adjusted hazard ratios and 95% confidence intervals were calculated from a multivariable Cox regression model to examine factors affecting overall survival. RESULTS From 2004 to 2014, 284 patients with muscle-invasive bladder cancer met inclusion criteria. Patients receiving chemotherapy within 45 days had the best 5-year overall survival (47.0%, 95%CI: 40.6%-53.2%) compared to those receiving chemotherapy after 45 days (37.5%, 95%CI: 31.4%-43.7%). Chemotherapy after 45 days and no adjuvant chemotherapy were significant predictors of worse overall survival compared to chemotherapy within 45 days (1.27, 1.02-1.59, P = 0.033 and 1.41, 1.12-1.78, P = 0.003). Receiving no adjuvant chemotherapy was not significantly different than chemotherapy after 45 days (1.11, 0.89-1.38, P = 0.348). Significant predictors of poorer overall survival were female sex (1.37, 1.04-1.81, P = 0.028), Medicare (1.37, 1.06-1.76, P = 0.016), pT3 stage (1.79, 1.35-2.38, P < 0.001), and pT4 stage (3.00, 2.20-4.01, P < 0.001). Significantly more patients with length of stay ≤7 days following RC received chemotherapy within 45 days (53.2%) compared to those who received adjuvant chemotherapy after 45 days after RC (44.0%) or no adjuvant chemotherapy (43.0%; P = 0.0369). CONCLUSIONS Initiation of adjuvant chemotherapy within 45 days of radical cystectomy for patients with pT2-4 bladder cancer was associated with an overall survival benefit compared to patients who received adjuvant chemotherapy after 45 days or no adjuvant chemotherapy.
Collapse
Affiliation(s)
- Joshua S Jue
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL.
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Zachary A Kroeger
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Kevin J Moore
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Mahmoud Alameddine
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
30
|
Pisarska M, Torbicz G, Gajewska N, Rubinkiewicz M, Wierdak M, Major P, Budzyński A, Ljungqvist O, Pędziwiatr M. Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer. World J Surg 2019; 43:2552-2560. [PMID: 31286185 DOI: 10.1007/s00268-019-05073-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results. OBJECTIVE The aim of the study was to determine the association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. MATERIAL AND METHODOLOGY Between 2013 and 2016, 350 patients underwent laparoscopic colorectal cancer resection in the 2nd Department of General Surgery, Jagiellonian University Medical College, and were enrolled for further analysis. The relationship between the rate of compliance with the ERAS protocol and 3-year survival was analyzed according to the Kaplan-Meier method with log-rank tests. Patients were divided into two groups according to their degree of adherence to the ERAS interventions: Group 1 (109 patients), < 80% adherence, and Group 2 (241 patients), ≥ 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters. RESULTS The groups were similar in terms of demographics and surgical parameters. The median compliance to ERAS interventions was 85.2%. The Cox proportional model showed that AJCC III (HR 3.28, 95% CI 1.61-6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19-5.52, p = 0.0161), and compliance with ERAS protocol < 80% (HR 3.38, 95% CI 2.23-5.21, p = 0.0102) were independent predictors for poor prognosis. Additionally, analysis revealed that adherence to the ERAS protocol in Group 2 with ≥ 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p < 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p < 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p < 0.0001) and mobilization (77.7% vs. 96.1%, p < 0.0001) on the first postoperative day. CONCLUSIONS AND RELEVANCE This study reports an association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. Lower adherence to the protocol, independent from stage of cancer and postoperative complications, was an independent risk factors for poorer survival rates.
Collapse
Affiliation(s)
- Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
| |
Collapse
|
31
|
Vimawala S, Topf MC, Savard C, Zhan T, Keane W, Luginbuhl A, Goldman R, Cognetti DM, Curry JM. Risk factors for unplanned readmission in total laryngectomy patients. Laryngoscope 2019; 130:1725-1732. [DOI: 10.1002/lary.28255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Swar Vimawala
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | | | - Corey Savard
- Sidney Kimmel Medical CollegeThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - William Keane
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Adam Luginbuhl
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Richard Goldman
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - David M. Cognetti
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Joseph M. Curry
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| |
Collapse
|
32
|
Abstract
OBJECTIVES To conceptualize the pathways and assess current evidence for the relationship between caregiver well-being and the quality of the cancer patient's care. DATA SOURCES Qualitative, quantitative, and theoretical literature and official reports. CONCLUSION Caregiver well-being has both direct and indirect effects on the quality of cancer care, including care received from the health care team, from the caregiver themselves, and in relation to patients' own self-management. IMPLICATIONS FOR NURSING PRACTICE Supporting caregivers has tangible consequences with regard to the quality of cancer care on multiple levels, with direct implications for patient outcomes. Nurses have a key role in providing psychosocial care to patients and their caregivers, and in supporting system-level change.
Collapse
|
33
|
Kang J, Chong SW, Park EJ, Baik SH, Lee KY. Safety and feasibility of in-hospital early chemotherapy initiation after surgery in patients with stage II-IV colon cancer. Medicine (Baltimore) 2019; 98:e15371. [PMID: 31045781 PMCID: PMC6504305 DOI: 10.1097/md.0000000000015371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Although it is recommended to initiate postoperative chemotherapy for colon cancer within 8 weeks after surgery, the feasibility and impact of initiating chemotherapy before discharge after surgical resection has not been investigated.Patients with stage II-IV colon cancer who received postoperative chemotherapy were dichotomized into early (chemotherapy initiation before discharge) and control (chemotherapy initiation after discharge) groups. A multivariable logistic regression model was used to determine factors associated with delayed chemotherapy, defined as more than 6 or 8 weeks after surgery.From January 2004 to December 2012, of 729 patients with stage II-IV colon adenocarcinoma, 555 patients (76.1%) underwent postoperative chemotherapy. Of them, 181 (32.6%) patients were included in the early group. Time to initiation of chemotherapy was significantly shorter in the early group than in the control group (14.9 days vs 31.5 days, P < . 001). Multivariate analysis revealed that tumor stage and chemotherapy initiation strategy (odds ratio 8.4; 95% confidence interval, 1-66, P = .041) were independent predictors of delayed initiation of chemotherapy at more than 8 weeks. There was no difference in the completion rate of planned chemotherapy cycles between the 2 groups (P > .05).The strategy of initiating chemotherapy before discharge after surgery is safe and feasible and might reduce the potential delay in chemotherapy initiation in patients with colon cancer.
Collapse
Affiliation(s)
- Jeonghyun Kang
- Department of Surgery, Yonsei University College of Medicine
| | - Su-Weon Chong
- Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Jung Park
- Department of Surgery, Yonsei University College of Medicine
| | - Seung Hyuk Baik
- Department of Surgery, Yonsei University College of Medicine
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine
| |
Collapse
|
34
|
Bennedsen ALB, Eriksen JR, Gögenur I. Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery. Colorectal Dis 2018; 20:1097-1108. [PMID: 30307103 DOI: 10.1111/codi.14446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/02/2018] [Indexed: 02/08/2023]
Abstract
AIM The present database study aimed to identify patients with a longer postoperative length of stay (LOS) or patients readmitted and to characterize both groups based on perioperative factors. METHOD A retrospective review of the Danish Colorectal Cancer Group database and a local database was performed of all patients undergoing elective resection for colorectal cancer in a 25-month period. The primary outcome was the number of patients with a prolonged hospital stay (LOS ≥ 10 days after the primary operation) and readmissions within 30 days after discharge. RESULTS A total of 372 patients with colon resection and 215 patients with rectal resection were included. Patients undergoing colonic resection had a rate of prolonged hospital stay of 10.6% and a readmission rate of 13.7%; prolonged hospital stay was significantly associated with age ≥ 76 years and those who underwent a conversion from a laparoscopic procedure. Patients undergoing rectal cancer resection had a rate of prolonged hospital stay of 17.7% and a readmission rate of 14.0%; Charlson comorbidity score (CCS) ≥ 2, total mesorectal excision (TME) and laparoscopic conversion were significantly associated with prolonged hospital stay, and American Society of Anesthesiologists (ASA) score ≥ 3, TME and a duration of surgery ≥ 300 min were significantly associated with readmission. CONCLUSION In patients with colon cancer, older age and conversion to open surgery were associated with prolonged hospital stay. In patients with rectal cancer, CCS ≥ 2, TME and conversion were associated with prolonged hospital stay, and a preoperative ASA score ≥ 3, TME and a duration of surgery ≥ 300 min were associated with readmission.
Collapse
Affiliation(s)
- A L B Bennedsen
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - J R Eriksen
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| | - I Gögenur
- Department of Surgery, Zealand University Hospital, Roskilde, Denmark
| |
Collapse
|
35
|
Chen JS, Hung CY, Liu KH, Tsai CY, Kuo YC, Hsu JT, Chou WC. Factors related to patient propensity to receive adjuvant chemotherapy and outcomes in stage III gastric cancer cases after D2 surgery. Asian J Surg 2018; 42:604-612. [PMID: 30249414 DOI: 10.1016/j.asjsur.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radical gastrectomy and extended lymph node (D2) dissection followed by adjuvant chemotherapy is the optimal treatment for patients with stage III gastric cancer in Asian population. The clinical factors associated with patient propensity to receive adjuvant chemotherapy and outcomes were analyzed. METHODS In total, 509 patients with stage III gastric cancer who had undergone D2 surgery between 2007 and 2017 at a single medical center in Taiwan were analyzed. The patients' preoperative clinical characteristics relevant to adjuvant chemotherapy adherence were analyzed using multivariate regression. Significant variables were analyzed using recursive partitioning analysis (RPA) for identifying specific patient groups with the lowest and highest probabilities of adjuvant chemotherapy adherence. RESULTS After surgery, 361 (70.9%) patients in the cohort had received adjuvant chemotherapy. All patients were categorized into five probability groups with adherence to adjuvant chemotherapy according to age, Eastern Cooperative Oncology Group (ECOG) performance status grade, and American Society of Anesthesiologists (ASA) class, which were discovered to be independent factors in the RPA-based probability prediction. In general, adjuvant chemotherapy improved survival across broad categories of stage III gastric cancer patients (overall survival hazard ratio: 0.53-0.75 and disease-free survival hazard ratio: 0.47-0.76). CONCLUSIONS Our study identified that age, ECOG grade, and ASA class were independent clinical factors associated with patient propensity to receive adjuvant chemotherapy in stage III gastric cancer. Knowledge of the clinical factors of patients may help clinicians identify and encourage specific patients to receive the adjuvant chemotherapy.
Collapse
Affiliation(s)
- Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Hematoloy-Oncology, Division of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Keng-Hao Liu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chia Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
36
|
Abstract
BACKGROUND The prognosis of tumor deposits in stage III colon adenocarcinoma is poorly described. OBJECTIVE The purpose of this study was to determine the impact of tumor deposits on oncologic outcomes in patients with stage III colon cancer. DESIGN This was a multicenter retrospective cohort study. SETTINGS The 2010 to 2014 National Cancer Database was queried for patients with resected stage III colon adenocarcinoma on final pathology. PATIENTS Patients were divided into 3 groups: lymph nodes+tumor deposits-, lymph nodes+tumor deposits+, and lymph nodes-tumor deposits+. MAIN OUTCOME MEASURES The main outcome was 5-year overall survival. RESULTS Of 74,577 patients, there were 55,800 patients with lymph nodes+tumor deposits-, 13,740 patients with lymph nodes+tumor deposits+, and 5037 patients with lymph nodes-tumor deposits+. The groups had similar patient and facility characteristics, but patients with lymph nodes+tumor deposits+ had more advanced tumor characteristics. Patients with lymph nodes-tumor deposits+ were less likely to receive adjuvant systemic therapy (52% vs 74% lymph nodes+tumor deposits- and 75% lymph nodes+tumor deposits+, p < 0.001) and had a longer delay to initiation of adjuvant treatment (>8 weeks; 43% vs 33% lymph nodes+tumor deposits- and 33% lymph nodes+tumor deposits+, p < 0.001). Patients with lymph nodes+tumor deposits+ had the lowest 5-year overall survival (46.0% vs 63.4% lymph nodes+tumor deposits- vs 61.9% lymph nodes-tumor deposits+, p < 0.001). On multivariate analysis, patients with lymph nodes-tumor deposits+ had similar 5-year overall survival compared with patients with lymph nodes+tumor deposits- with ≤3 positive lymph nodes (HR, 0.93; 95% CI, 0.87-1.01). Patients with lymph nodes+tumor deposits+ had worse prognosis regardless of the number of involved lymph nodes (≤3 +lymph nodes: HR, 1.37; 95% CI, 1.28-1.47 and ≥4 +lymph nodes: HR, 1.30; 95% CI, 1.22-1.38). Of those not receiving adjuvant treatment, patients with lymph nodes-tumor deposits+ were younger and had more adverse tumor features than lymph node+ disease. Lymph nodes-tumor deposits+ was independently associated with less delivery of adjuvant systemic therapy (OR, 0.81; 95% CI, 0.80-0.82). LIMITATIONS This study was limited by its retrospective analysis of a prospective database. CONCLUSIONS The prognosis of patients with N1c disease is similar to nodal involvement without tumor deposits, yet these patients were less likely to receive adjuvant systemic therapy. Improvement in the delivery of appropriate care in these patients may increase survival and should be a target of future quality initiatives. See Video Abstract at http://links.lww.com/DCR/A666.
Collapse
|
37
|
Lee L, Wong-Chong N, Kelly JJ, Nassif GJ, Albert MR, Monson JRT. Minimally invasive surgery for stage III colon adenocarcinoma is associated with less delay to initiation of adjuvant systemic therapy and improved survival. Surg Endosc 2018; 33:460-470. [PMID: 29967992 DOI: 10.1007/s00464-018-6319-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/29/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) may improve surgical recovery and reduce time to adjuvant systemic therapy after colon cancer resection. The objective of this study was to determine the effect of MIS on the initiation of adjuvant systemic therapy and survival in patients with stage III colon cancer. METHODS The 2010-2014 National Cancer Database was queried for patients with resected stage III colon adenocarcinoma, and divided into MIS, which included laparoscopic and robotic approaches, and open surgery. Propensity-score matching was used to balanced open and MIS groups. The main outcome measures were delayed initiation of adjuvant systemic therapy (defined as > 8 weeks after surgery) and 5-year overall survival (OS). Multiple Cox regression was performed to identify independent predictors for 5-year OS, including an interaction between delayed systemic therapy and MIS, and adjusted for clustering at the hospital level. RESULTS There were 86,680 patients that were included in this study. Overall, 45% (38,713) underwent MIS colectomy, of which 93% underwent laparoscopic and 7% robotic surgery. After matching, 33,183 open patients were balanced to 33,183 MIS patients. Patient, tumor, and facility characteristics were similar in the matched cohort. More patients in the MIS group received adjuvant therapy within 8 weeks of surgery (49% vs. 42%, p < 0.001), and fewer MIS patients did not receive any systemic therapy (30% vs. 35%, p < 0.001). Delayed initiation of systemic therapy > 8 weeks was associated with worse 5-year OS (HR 1.27, 95%CI 1.19-1.36). MIS was independently associated with improved survival (HR 0.92, 95%CI 0.86-0.97). This relationship remained even if 90-day mortality was excluded. CONCLUSIONS MIS approaches are associated with less delay to the initiation of adjuvant systemic therapy and improved survival in patients with stage III colon adenocarcinoma. Surgeons should favor MIS approaches for the treatment of stage III colon adenocarcinoma whenever possible.
Collapse
Affiliation(s)
- Lawrence Lee
- Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA. .,Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. .,Colon and Rectal Surgery, McGill University Health Centre, 1001 Decarie Blvd, DS1-3310, Montreal, QC, H4A 3J1, Canada.
| | - Nathalie Wong-Chong
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.,Colon and Rectal Surgery, McGill University Health Centre, 1001 Decarie Blvd, DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - Justin J Kelly
- Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA
| | - George J Nassif
- Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA
| | - Matthew R Albert
- Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA
| | - John R T Monson
- Center for Colon and Rectal Surgery, Florida Hospital, Orlando, FL, USA
| |
Collapse
|
38
|
Hospital variation and the impact of postoperative complications on the use of perioperative chemo(radio)therapy in resectable gastric cancer. Results from the Dutch Upper GI Cancer Audit. Eur J Surg Oncol 2018; 44:532-538. [DOI: 10.1016/j.ejso.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 10/07/2017] [Accepted: 01/05/2018] [Indexed: 01/13/2023] Open
|
39
|
Lee Y, Min SH, Park KB, Park YS, Kim JW, Ahn SH, Kim JW, Park DJ, Lee KW, Kim HH. Effect of Early Adjuvant Chemotherapy on Survival of Advanced Gastric Cancer Patients: a Propensity Score-matched Analysis. J Gastric Cancer 2018; 18:58-68. [PMID: 29629221 PMCID: PMC5881011 DOI: 10.5230/jgc.2018.18.e5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose Generally, adjuvant chemotherapy (AC) should be initiated as soon as possible after surgery to eradicate microscopic cancer cells. In this study, we investigated the effect of early AC on the survival of stage II/III gastric cancer patients. Materials and Methods Four hundred sixty patients who received AC (S-1 or XELOX) for pathologic stage II/III gastric cancer at Seoul National University Bundang Hospital between January 2008 and December 2014 were included. Patients were divided into 2 groups: early AC administration (within 4 weeks) and late AC administration (more than 4 weeks). Patients in the early AC group (n=174) were matched 1:1 with patients in the late AC group (n=174) by propensity scoring to adjust for clinical differences. Three-year relapse-free survival (RFS) was evaluated according to the timing of AC. Results Three-year RFS was 98.1% in stage IIA (n=109), 85.0% in stage IIB (n=83), 87.4% in stage IIIA (n=96), 83.5% in stage IIIB (n=91), and 62.5% in stage IIIC (n=81). After propensity score matching, RFS was similar between early and late AC groups (hazard ratio [HR],1.04; 95% confidence interval [CI], 0.62–1.74; P=0.889). Pathologic stage and histological type were independent prognostic factors of RFS (HR, 2.05; 95% CI, 1.06–3.96; P=0.033 and HR, 2.61; 95% CI, 1.42–4.80; P=0.002, respectively). Conclusions Early initiation of AC within 4 weeks does not affect survival rates in stage II/III gastric cancer.
Collapse
Affiliation(s)
- Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sa-Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki Bum Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
40
|
Duraes LC, Stocchi L, Steele SR, Kalady MF, Church JM, Gorgun E, Liska D, Kessler H, Lavryk OA, Delaney CP. The Relationship Between Clavien-Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection. Ann Surg Oncol 2017; 25:188-196. [PMID: 29116488 DOI: 10.1245/s10434-017-6142-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes. METHODS Patients with pathological stages I-III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database. The severity of POCs was determined using the Clavien-Dindo classification, and oncologic outcomes were assessed. RESULTS Of 2266 patients, 669 (30%) had at least one POC. POCs were not associated with pathologic stage (p = 0.58) or use of adjuvant therapy (p = 0.19). With a mean follow-up of 5.3 years, POCs were associated with decreased 5-year overall survival (OS) (60% vs. 77%, p < 0.001), disease-free survival (DFS) (53% vs. 70%, p < 0.001), cancer-specific survival (CSS) (81% vs. 87%, p < 0.001), and increased overall recurrence rates (19% vs. 15%, p = 0.008). Increasing Clavien-Dindo scores from I to IV was significantly associated with progressively decreasing OS (71, 64, 60, 22%, p < 0.001), DFS (65, 58, 51, 19%, p < 0.001), CSS (88, 77, 79, 74%, p < 0.001), and increasing recurrence rates (12, 20, 26, 18%, p = 0.002). Multivariate analysis confirmed POCs as an independent factor associated with decreased OS [hazard ratio (HR) 0.63, 95% CI 0.52-0.76], DFS (HR 0.64, 95% CI 0.54-0.76), CSS (HR 0.73, 95% CI 0.56-0.97), and increased recurrence rates (HR 1.36, 95% CI 1.02-1.80). CONCLUSIONS POCs are associated with adverse oncologic outcomes, with increasing effect with higher Clavien-Dindo score. Efforts to reduce both the incidence and severity of complications should result in improved oncologic outcomes.
Collapse
Affiliation(s)
- Leonardo C Duraes
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew F Kalady
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James M Church
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Olga A Lavryk
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Conor P Delaney
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
41
|
Haviland J, Sodergren S, Calman L, Corner J, Din A, Fenlon D, Grimmett C, Richardson A, Smith PW, Winter J, Foster C. Social support following diagnosis and treatment for colorectal cancer and associations with health-related quality of life: Results from the UK ColoREctal Wellbeing (CREW) cohort study. Psychooncology 2017; 26:2276-2284. [PMID: 29094430 PMCID: PMC6220760 DOI: 10.1002/pon.4556] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/11/2017] [Accepted: 09/09/2017] [Indexed: 01/09/2023]
Abstract
Objective Social support is acknowledged as important in cancer survivorship, but little is known about change in support after cancer diagnosis and factors associated with this, particularly in colorectal cancer. The CREW cohort study investigated social support up to 2 years following curative intent surgery for colorectal cancer. Methods A total of 871 adults recruited pre‐treatment from 29 UK centres 2010 to 2012 consented to follow‐up. Questionnaires at baseline, 3, 9, 15, and 24 months post‐surgery included assessments of social support (Medical Outcomes Study‐Social Support Survey, MOS‐SSS) and health‐related quality of life (HRQoL). Socio‐demographic, clinical and treatment details were collected. Longitudinal analyses assessed social support over follow‐up, associations with participant characteristics, and HRQoL. Results Around 20% were living alone and 30% without a partner. Perceived social support declined in around 29% of participants, with 8% of these reporting very low levels overall from baseline to 2 years (mean MOS‐SSS overall score < 40 on a scale from 0 to 100). Older age, female gender, greater neighbourhood deprivation, presence of co‐morbidities, and rectal cancer site were significantly associated with reductions in perceived support. Poorer HRQoL outcomes (generic health/QoL, reduced wellbeing, anxiety, and depression) were significantly associated with lower levels of social support. Conclusions Levels of social support decline following colorectal cancer diagnosis and treatment in nearly a third of patients and are an important risk factor for recovery of HRQoL. Assessment of support early on and throughout follow‐up would enable targeted interventions to improve recovery, particularly in the more vulnerable patient groups at risk of poorer social support.
Collapse
Affiliation(s)
- Joanne Haviland
- Institute of Cancer Research Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Samantha Sodergren
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jessica Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - Amy Din
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Deborah Fenlon
- College of Health and Human Sciences, Swansea University, Swansea, Wales, UK
| | - Chloe Grimmett
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter W Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - Jane Winter
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Claire Foster
- Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
42
|
Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study. Surg Endosc 2017; 32:1478-1485. [DOI: 10.1007/s00464-017-5835-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
|
43
|
Marhic A, Tremblay JF, Kaci R, André T, Eveno C, Pocard M. Molecular analysis of sentinel lymph node in colon carcinomas by one-step nucleic acid amplification (OSNA) reduces time to adjuvant chemotherapy interval. Dig Liver Dis 2017; 49:924-928. [PMID: 28668271 DOI: 10.1016/j.dld.2017.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/01/2017] [Accepted: 05/17/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The interval between surgery and adjuvant chemotherapy (AC) is a predictive factor of survival in high-risk colon cancer (CC). This study aimed to evaluate the impact of intraoperative sentinel lymph node (SLN) analysis using the one-step nucleic acid amplification (OSNA) technique on the time interval between surgery and AC. METHODS We performed a prospective study analyzing 56 consecutive patients who had surgery for CC between July 2012 and October 2014, including 20 patients needing AC. SLN status was determined intraoperatively in 17 patients in the OSNA group; when positive, a portacath (PAC) was placed during the procedure for upcoming AC. In the remaining patients, we proceeded without SLN status determination and the PAC was installed after definitive histopathological analysis of the specimen if needed. RESULTS There was no difference between the groups regarding cancer staging, duration of hospitalization (7.5days in the OSNA group and 10days in the control group, p=0.43) and major complications (20% vs 30% respectively, p=0.55). The time interval between surgery and adjuvant chemotherapy was significantly shorter in the OSNA group at 35 (±8) days vs 67 (±36) days (p=0.021). CONCLUSION SLN status determination by the OSNA technique is safe, feasible and could significantly reduce time between surgery and adjuvant chemotherapy in a pilot study.
Collapse
Affiliation(s)
- Alix Marhic
- Digestive and Surgical Oncology Department, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010, Paris, France
| | - Jean-François Tremblay
- Digestive and Surgical Oncology Department, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010, Paris, France
| | - Rachid Kaci
- Department of Pathology, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010, Paris, France
| | - Thierry André
- Department of Medical Oncology, Saint-Antoine Hospital, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; University Pierre et Marie Curie (UMPC), Paris VI,4 Place Jussieu, Paris 75005, France
| | - Clarisse Eveno
- Digestive and Surgical Oncology Department, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010, Paris, France; Paris Diderot University, USPC, Sorbonne Paris Cité, CART, INSERM U965, CART Carcinomatosis Angiogenesis and Translational Research F-74575 Paris, France
| | - Marc Pocard
- Digestive and Surgical Oncology Department, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010, Paris, France; Paris Diderot University, USPC, Sorbonne Paris Cité, CART, INSERM U965, CART Carcinomatosis Angiogenesis and Translational Research F-74575 Paris, France.
| |
Collapse
|
44
|
Kaito A, Kinoshita T, Shitara K, Shibasaki H, Nishida T. Timing of initiation of adjuvant chemotherapy for gastric cancer: A case-matched comparison study of laparoscopic vs. open surgery. Eur J Surg Oncol 2017; 43:801-807. [PMID: 28187877 DOI: 10.1016/j.ejso.2017.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/22/2016] [Accepted: 01/12/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) is reported to be associated with faster recovery than open gastrectomy (OG); however, the influence of the surgical approach on initiation timing of adjuvant chemotherapy (AC) remains unclear. METHODS This was a single-institutional retrospective observational study. Patients with pathological stage II/III gastric cancer undergoing LG with D2 lymphadenectomy (LG group: n = 74) were matched 1:1 with patients selected from 214 similar patients undergoing OG (OG group: n = 74), identically matching gender, age, pathological stage, and type of gastrectomy, and comparing AC initiation timing between the two groups. Factors associated with delayed initiation of AC were investigated in a multivariable analysis. RESULTS AC was performed in 86.5% (LG) and 83.8% (OG) of patients (p = 0.64). The median time interval before AC was significantly shorter in the LG vs. OG group (5.7 vs. 6.6 weeks, respectively, p < 0.001), and significantly more patients received AC within 6 weeks (60.8% vs. 27.0%, p < 0.001). Independent factors associated with delayed initiation of AC (>6 weeks) were: morbidity (≥grade 3a; odds ratio (OR): 16.1, 95% confidence interval (CI): 1.86-143), open surgery (OR: 5.17, 95% CI: 2.50-13.1), and postoperative weight loss ≥ 8% (OR: 2.47, 95% CI: 1.07-5.71). CONCLUSIONS LG may be associated with shorter intervals before AC. Postoperative morbidity should be reduced as much as possible.
Collapse
Affiliation(s)
- A Kaito
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
| | - T Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
| | - K Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - H Shibasaki
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
| | - T Nishida
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan.
| |
Collapse
|
45
|
Nachiappan S, Askari A, Mamidanna R, Munasinghe A, Currie A, Stebbing J, Faiz O. Initiation of adjuvant chemotherapy within 8 weeks of elective colorectal resection improves overall survival regardless of reoperation. Colorectal Dis 2016; 18:1041-1049. [PMID: 27807941 DOI: 10.1111/codi.13308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/08/2016] [Indexed: 02/08/2023]
Abstract
AIM Reoperation after elective colorectal resection may delay the start of adjuvant chemotherapy (AC). The study investigated the dual impact of a reoperation and AC delay on overall survival (OS). METHOD The Hospital Episode Statistics database was analysed between 1997 and 2012. Patients were divided into colon and rectal cancer cohorts and data were analysed based on whether there was delay in receiving AC beyond 8 weeks and whether a patient suffered reoperation within 30 days. Multivariate regression analysis was undertaken to investigate the relationship between delay in giving AC and reoperation and their combined effect on OS. RESULTS Logistic regression showed reoperation, amongst other things, to be an independent predictor of AC delay, in both colon and rectal cancer (colon, odds ratio 2.31, P < 0.001; rectal, odds ratio 2.19, P < 0.001). There was no significant difference in OS between patients who had no AC delay but suffered a reoperation and patients who had no AC delay and no reoperation. Patients who had AC delay but no reoperation, however, had significantly worse OS compared to those who had no AC delay and no reoperation [colon, hazard ratio (HR) 1.16, P < 0.001; rectal, HR 1.17, P < 0.001]. Individuals who had both AC delay and a reoperation also had worse OS compared with patients who had neither (colon, HR 1.33, P = 0.037; rectal, HR 1.38, P < 0.001). CONCLUSION Delayed receipt of AC beyond 8 weeks after surgery is associated with significantly reduced OS regardless of reoperation status in both colon and rectal cancer patients.
Collapse
Affiliation(s)
- S Nachiappan
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| | - A Askari
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - R Mamidanna
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Munasinghe
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Currie
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - J Stebbing
- Department of Surgery and Cancer, Imperial College London, London, UK.,Hammersmith Hospital, London, UK
| | - O Faiz
- Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital and Academic Institute, Watford Road, Harrow, Middlesex.,Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
46
|
Becerra AZ, Aquina CT, Mohile SG, Tejani MA, Schymura MJ, Boscoe FP, Xu Z, Justiniano CF, Boodry CI, Swanger AA, Noyes K, Monson JR, Fleming FJ. Variation in Delayed Time to Adjuvant Chemotherapy and Disease-Specific Survival in Stage III Colon Cancer Patients. Ann Surg Oncol 2016; 24:1610-1617. [DOI: 10.1245/s10434-016-5622-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Indexed: 11/18/2022]
|
47
|
Jung YB, Kang J, Park EJ, Baik SH, Lee KY. Time to Initiation of Adjuvant Chemotherapy in Colon Cancer: Comparison of Open, Laparoscopic, and Robotic Surgery. J Laparoendosc Adv Surg Tech A 2016; 26:799-805. [PMID: 27560660 DOI: 10.1089/lap.2016.0293] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The time to initiation of adjuvant chemotherapy (TIC) can be used as a recovery parameter after surgery. The effect of laparoscopic or robotic surgery on TIC has not been thoroughly studied. This study aimed to compare the impact of open, laparoscopic, and robot-assisted surgery on TIC after colon cancer surgery. MATERIALS AND METHODS Patients who underwent curative resection for stage II or III colon cancer between January 2007 and June 2013 and who received adjuvant chemotherapy from surgeons capable of performing open, laparoscopic, and robotic surgeries were included in this study. Patient demographics, clinicopathologic variables, and TIC were compared among the three groups. Univariate and multivariate analyses were performed to identify factors affecting TIC. RESULTS Of the 252 patients, 40, 161, and 51 patients underwent open, laparoscopic, and robotic colectomy, respectively. The postoperative complication rate was lower in the laparoscopic and robotic groups compared to the open group (P = .002). The length of hospital stay was shorter in the laparoscopic group compared with the open and robotic groups (P < .001). Multivariate analysis revealed that the operation method was the only factor affecting TIC, with laparoscopic and robotic surgery being favorable (regression coefficient -5.1, 95% confidence interval -7.6 to -2.6; P < .001). However, there was no difference in TIC between the laparoscopic and robotic group. CONCLUSIONS Laparoscopic and robotic surgeries were associated with shorter TIC. This study demonstrates another benefit of minimally invasive surgery with regard to early initiation of adjuvant chemotherapy.
Collapse
Affiliation(s)
- Yoon Bin Jung
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea
| | - Jeonghyun Kang
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea
| | - Eun Jung Park
- 2 Division of Colon and Rectal Surgery, Department of Surgery, Ajou University School of Medicine , Suwon, South Korea
| | - Seung Hyuk Baik
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea
| | - Kang Young Lee
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea
| |
Collapse
|
48
|
Popescu I, Schrag D, Ang A, Wong M. Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality: The Role of Physician-level Variations in Care. Med Care 2016; 54:780-8. [PMID: 27326547 PMCID: PMC6173517 DOI: 10.1097/mlr.0000000000000561] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite a large body of research showing racial/ethnic and socioeconomic disparities in cancer treatment quality, the relative role of physician-level variations in care is unclear. OBJECTIVE To examine the effect of physicians on disparities in breast and colorectal cancer care. SUBJECTS Linked SEER Medicare data were used to identify Medicare beneficiaries diagnosed with colorectal and breast cancer during 1995-2007 and their treating physicians. RESEARCH DESIGN We identified treating physicians from Medicare claims data. We measured the use of NIH guideline-recommended therapies from SEER and Medicare claims data, and used logistic models to examine the relationship between race/ethnicity, socioeconomic status, and cancer quality of care. We used physician fixed effects to account for between-physician variations in treatment. RESULTS Minority and low socioeconomic status beneficiaries with breast and colorectal cancer were less likely to receive any recommended treatments as compared with whites. Overall, between-physician variation explained <20% of the total variation in quality of care. After accounting for between-physician differences, median household income explained 14.3%, 18.4%, and 13.2% of the variation in use of breast-conserving surgery, chemotherapy, and radiation for breast cancer, and 13.7%, 12.9%, and 12.6% of the within-physician variation in use of colorectal surgery, chemotherapy, and radiation for colorectal cancer, whereas race and ethnicity explained <2% of the within-physician variation in cancer care. CONCLUSIONS Between-physician variations partially explain racial disparities in cancer care. Residual within-physician disparities may be due to differences in patient-provider communication, patient preferences and treatment adherence, or unmeasured clinical severity.
Collapse
Affiliation(s)
- Ioana Popescu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
| | - Deborah Schrag
- Division of Population Sciences, Dana Farber Cancer Institute and the Harvard Medical School, Boston, MA
| | - Alfonso Ang
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
| | - Mitchell Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
| |
Collapse
|
49
|
Kambakamba P, Linecker M, Alvarez FA, Samaras P, Reiner CS, Raptis DA, Kron P, de Santibanes E, Petrowsky H, Clavien PA, Lesurtel M. Short Chemotherapy-Free Interval Improves Oncological Outcome in Patients Undergoing Two-Stage Hepatectomy for Colorectal Liver Metastases. Ann Surg Oncol 2016; 23:3915-3923. [DOI: 10.1245/s10434-016-5419-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Indexed: 01/07/2023]
|
50
|
Chou WC, Chang PH, Lu CH, Liu KH, Hung YS, Hung CY, Liu CT, Yeh KY, Lin YC, Yeh TS. Effect of Comorbidity on Postoperative Survival Outcomes in Patients with Solid Cancers: A 6-Year Multicenter Study in Taiwan. J Cancer 2016; 7:854-61. [PMID: 27162545 PMCID: PMC4860803 DOI: 10.7150/jca.14777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/15/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose: Patients with comorbidities are more likely to experience treatment-related toxicities and death. Our aim was to examine the effect of comorbidity on postoperative survival outcomes in patients with solid cancers. Methods: In total, 37,288 patients who underwent potentially curative operations for solid cancers at four affiliated hospitals of the Chang Gung Memorial Hospital, between 2007 and 2012, were stratified according to the Charlson Comorbidity Index (CCI) for postoperative survival analysis. Multivariate Cox regression was used to adjust hazard ratios of survival outcomes among different CCI subgroups. Results: A significantly greater proportion of patients with comorbidities presented with poorer clinicopathological characteristics compared to those without. After cancer surgery, 26% of patients died after a median follow-up duration of 38.9 months. Overall mortality rates of patients with CCI scores of 0, 1, 2, 3, 4, and 5-8 were 22.9%, 29.5%, 38.2%, 43.2%, 50.2%, and 56.4%, respectively. After adjusting for other clinicopathological factors, patients with increasing CCI scores were associated with significantly reduced overall and noncancer-specific survival rates, while only patients with CCI scores of >2 were associated with higher cancer-specific mortality rates. Conclusions: Patients with increasing numbers of comorbidities were associated with reduced postoperative survival outcomes. Patients with multiple comorbidities were most vulnerable to both cancer- and noncancer-specific deaths in the first 6 months after cancer surgery. Our results suggest that for both the patient and clinician, it should be taken into consideration about cancer surgery when dealing with multiple comorbidities.
Collapse
Affiliation(s)
- Wen-Chi Chou
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan;; 2. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan
| | - Pei-Hung Chang
- 3. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Hsien Lu
- 4. Department of Medical Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Keng-Hao Liu
- 5. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Shin Hung
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Yen Hung
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chien-Ting Liu
- 6. Department of Medical Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kun-Yun Yeh
- 3. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Chang Lin
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ta-Sen Yeh
- 5. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| |
Collapse
|