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Morelli D, Cantarutti A, Valsecchi C, Sabia F, Rolli L, Leuzzi G, Bogani G, Pastorino U. Routine perioperative blood tests predict survival of resectable lung cancer. Sci Rep 2023; 13:17072. [PMID: 37816885 PMCID: PMC10564956 DOI: 10.1038/s41598-023-44308-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/06/2023] [Indexed: 10/12/2023] Open
Abstract
There is growing evidence that inflammatory, immunologic, and metabolic status is associated with cancer patients survival. Here, we built a simple algorithm to predict lung cancer outcome. Perioperative routine blood tests (RBT) of a cohort of patients with resectable primary lung cancer (LC) were analysed. Inflammatory, immunologic, and metabolic profiles were used to create a single algorithm (RBT index) predicting LC survival. A concurrent cohort of patients with resectable lung metastases (LM) was used to validate the RBT index. Charts of 2088 consecutive LC and 1129 LM patients undergoing lung resection were evaluated. Among RBT parameters, C-reactive protein (CRP), lymphocytes, neutrophils, hemoglobin, albumin and glycemia independently correlated with survival, and were used to build the RBT index. Patients with a high RBT index had a higher 5-year mortality than low RBT patients (adjusted HR 1.93, 95% CI 1.62-2.31). High RBT patients also showed a fourfold higher risk of 30-day postoperative mortality (2.3% vs. 0.5%, p 0.0019). The LM analysis validated the results of the LC cohort. We developed a simple and easily available multifunctional tool predicting short-term and long-term survival of curatively resected LC and LM. Prospective external validation of RBT index is warranted.
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Affiliation(s)
- Daniele Morelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Camilla Valsecchi
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Federica Sabia
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Luigi Rolli
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Giovanni Leuzzi
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
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Evaluation of Simplified Diet Scores Related to C-Reactive Protein in Heavy Smokers Undergoing Lung Cancer Screening. Nutrients 2022; 14:nu14204312. [PMID: 36296996 PMCID: PMC9610125 DOI: 10.3390/nu14204312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to assess the relationship between adherence to a healthy diet, such as the Mediterranean diet (MedDiet), and C-reactive protein (CRP) in Italian heavy smokers undergoing an LDCT screening program (bioMILD trial), using scores calculated by simple questionnaires. Simple formats of food frequency questionnaires were administered to a sample of 2438 volunteers, and the adherence to a healthy diet was measured by the validated 14-point MEDAS and by two adaptations proposed by us: 17-item revised-MEDAS and 18-item revised-MEDAS. The OR of CRP ≥ 2 mg/L for 1-point increase in 14-point MEDAS score was 0.95 (95% CI 0.91–0.99), for 17-point score was 0.94 (95% CI 0.91–0.98), and for 18-point score was 0.92 (95% CI 0.88–0.97). These inverse associations remained statistically significant also after further adjustment for body mass index. These results showed the efficacy of simplified scores and their relationship with lower levels of CRP in a population of heavy smokers. This suggests that a targeted nutritional intervention might achieve a substantial reduction in CRP levels. The findings will be prospectively tested in a new randomized study on primary prevention during lung cancer screening.
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Yao Y, Hua Q, Liu S, Yang Z, Shen H, Gao W. Efficacy of multi-groove silicone drains in single-port video-assisted thoracoscopic lung cancer surgery and their effect on C-reactive protein: a single-center experience. J Thorac Dis 2022; 13:6885-6896. [PMID: 35070373 PMCID: PMC8743409 DOI: 10.21037/jtd-21-1801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022]
Abstract
Background The purpose of this study was to systematically evaluate the effectiveness and safety of a multi-groove silicone drain in single-port video-assisted thoracoscopic lung cancer surgery and its effect on postoperative serum C-reactive protein (CRP) levels. Methods We retrospectively analyzed 122 surgical cases who underwent standard lobectomy and lymph node dissection for primary lung cancer between May 2020 and December 2020. A total of 62 patients received 19-F multi-groove silicone drains (experimental group) and 60 patients received 24-F conventional chest drains (control group). According to the different thoracic drainage approaches, the clinical efficacy in the perioperative period, postoperative complications, and postoperative serum CRP levels were compared between the 2 groups. Results In this study, thoracic drainage volume, the average visual analog scale (VAS) pain scores in incisions, the rate of primary healing at the site of incisions, and the pulmonary infection rate in the multi-groove silicone drain group were significantly lower than those in the conventional chest drain group (P<0.05), but there was no significant difference in the average hospital stay time, arrhythmia rates, and chest tube removal time between the 2 groups. At postoperative day 1, the levels of serum CRP in the 2 groups were further increased (P>0.05), and the comparison between the 2 groups showed that the levels of serum CRP in the multi-groove silicone drain group at 72 h after the operation were significantly lower than those in the conventional drain group (P<0.05). Conclusions Our results showed that a multi-groove silicone drain is feasible and relatively safe in single-port video-assisted thoracoscopic lung cancer surgery for most patients. However we should take cautious in those patients with higher susceptibility of postoperative active bleeding. In patients undergoing lung cancer surgery in the clinical treatment process, the use of a multi-groove silicone drain can improve the quality of life of patients. Due to a small number of included studies and unclear bias, the above results should be verified by high-quality, large-sample randomized controlled studies. Keywords Video-assisted thoracoscopic lung cancer surgery; multi-groove silicone drains; conventional chest drains
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Affiliation(s)
- Yuanshan Yao
- Department of Thoracic Oncology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Qingwang Hua
- Department of Thoracic Oncology, Ningbo No. 2 Hospital, Ningbo, China
| | - Suyue Liu
- Department of Thoracic Oncology, Ningbo No. 2 Hospital, Ningbo, China
| | - Zhenhua Yang
- Department of Thoracic Oncology, Ningbo No. 2 Hospital, Ningbo, China
| | - Haibo Shen
- Department of Thoracic Oncology, Ningbo No. 2 Hospital, Ningbo, China
| | - Wen Gao
- Department of Thoracic Oncology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Ishibashi Y, Kobayashi H, Sawada R, Okuma T, Okajima K, Zhang L, Hirai T, Ohki T, Ikegami M, Shinoda Y, Akiyama T, Goto T, Tanaka S. Pretreatment serum C-reactive protein is a significant prognostic factor in patients with soft tissue metastases. J Orthop Sci 2021; 26:478-482. [PMID: 32563544 DOI: 10.1016/j.jos.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Soft tissue metastasis is rarer than bone metastasis. Patients with soft tissue metastasis generally have a dismal prognosis. The treatment for metastatic lesions is sometimes difficult, because the prognostic factors of patients with soft tissue metastasis remain unelucidated. Therefore, this study aimed to identify these prognostic factors. METHODS Thirty-one patients with soft tissue metastasis were included in the study. We evaluated associations of overall survival with clinical parameters and inflammatory markers using Kaplan-Meier curves and Cox proportional hazards models. RESULTS Twelve patients received surgery for soft tissue metastasis, while radiation therapy was performed in six cases. The median overall survival after the detection of soft tissue metastasis was 11 months. Univariate analysis revealed that detection of soft tissue metastasis after the multidisciplinary treatment (P = 0.01); solitary metastasis (P = 0.0003); and pretreatment C-reactive protein (CRP) level < 0.4 mg/dL (P < 0.0001), white blood cell count < 8500 × 103/μL (P = 0.0003), and neutrophil-to-lymphocyte ratio < 5 (P = 0.02) were significant good prognostic factors. Multivariate analysis revealed that a CRP value < 0.4 mg/dL (P = 0.07) and solitary metastasis (P = 0.09) were possible significant predictors of survival. Furthermore, in case of CRP levels <0.4 mg/dL and metastatic tumor resection, patients had a good prognosis; however, when the CRP levels increased to 0.4 mg/dL and above, patients had a poor prognosis, irrespective of tumor resection. CONCLUSIONS CRP is potentially useful for determining the indication of radical metastasectomy in soft tissue metastasis.
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Affiliation(s)
- Yuki Ishibashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Ryoko Sawada
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koichi Okajima
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Liuzhe Zhang
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Toshihide Hirai
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Takahiro Ohki
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masachika Ikegami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Shinoda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Takahiro Goto
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Lu J, Xu BB, Xue Z, Xie JW, Zheng CH, Huang CM, Li P. Perioperative CRP: A novel inflammation-based classification in gastric cancer for recurrence and chemotherapy benefit. Cancer Med 2020; 10:34-44. [PMID: 33270989 PMCID: PMC7826470 DOI: 10.1002/cam4.3514] [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: 04/16/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Perioperative C‐reactive protein (CRP) levels have effects on the prognosis of cancer patients. We intended to determine the prognostic value of combining the two for gastric cancer (GC). Methods Data were extracted from a clinical trial. By calculating the area under the curve (AUC) and the C‐index, the predictive value of CRPs among different time points, including preoperative (pre‐CRP), postoperative days 1, 3, and 5 (post‐CRPs), and postoperative maximum CRP (post‐CRPmax), was derived. Multivariate analysis was performed to further explore the independent variates for recurrence‐free survival (RFS). Results Finally, 401 patients were available in the present study. For RFS, higher AUC (0.692) and concordance index (0.678) of pre‐CRP were observed when compared with those of post‐CRPs. Further, among post‐CRPs, post‐CRPmax had the highest predictive values (AUC: 0.591; concordance index: 0.585) among the other post‐CRPs. The threshold values in predicting RFS for pre‐CRP and post‐CRPmax were 3.1 mg/L and 77.1 mg/L. Multivariate analysis showed both pre‐CRP≥3.1 mg/L (high‐pre‐CRP) and post‐CRPmax≥77.1 mg/L (high‐post‐CRPmax) were risk factors for RFS. Postoperative chemotherapy benefit was further analyzed for patients with stage II/III GC and indicated that patients with pre‐CRP<3.1 mg/L had better prognosis without benefit from postoperative adjuvant chemotherapy (ACT), p = 0.557. In high‐pre‐CRP patients, only patients with post‐CRPmax≥77.1 mg/L but not post‐CRPmax<77.1 mg/L benefited from postoperative ACT (RFS: 33.2% vs 49.9% for non‐chemotherapy group and chemotherapy group, respectively, p = 0.037). Analyses for overall survival obtained the similar outcomes. Conclusions Both high‐pre‐CRP and high‐post‐CRPmax are associated with worse prognosis in GC. ACT seems to only improve the prognosis for stage II/III GC with pre‐CRP≥3.1 mg/L and post‐CRPmax≥77.1 mg/L after radical gastrectomy. Further studies are needed to confirm these findings and explore the potential mechanism.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
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Londero F, Grossi W, Parise O, Cinel J, Parise G, Masullo G, Tetta C, Micali LR, Mauro E, Morelli A, Maessen JG, Gelsomino S. The Impact of Preoperative Inflammatory Markers on the Prognosis of Patients Undergoing Surgical Resection of Pulmonary Oligometastases. J Clin Med 2020; 9:jcm9103378. [PMID: 33096884 PMCID: PMC7590166 DOI: 10.3390/jcm9103378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to assess the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in patients undergoing resection of pulmonary oligometastases. A retrospective analysis on 141 patients undergoing a first pulmonary metastasectomy in a single center was carried out. Two distinct analysis were performed subdividing patients according to their NLR ratio and CRP level. The main outcomes were survival and time to recurrence. At completion of follow-up 74 patients were still alive (52.5%). Subdividing patients according to their NLR yielded a significant difference in five-year progression-free survival (PFS, NLR < 4:32% vs. NLR ≥ 4:18%, p = 0.01). When subdivided by their CRP levels, patients with preoperative CRP < 5 mg/L demonstrated higher values of five-year overall survival (OS, 57% vs. 34%, p = 0.006) and five-year PFS (35% vs. 22%, p = 0.04). At multivariate analysis, level of neutrophils (p = 0.009) and lung comorbidities (p = 0.021) were independent predictors of death, whereas preoperative CRP (p = 0.002), multiple metastases (p = 0.003) and presence of lung comorbidities (p = 0.001) were independent predictors of recurrence. NLR and CRP are important predictors of prognostic outcome in patients undergoing pulmonary metastasectomy.
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Affiliation(s)
- Francesco Londero
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy; (F.L.); (W.G.); (J.C.); (G.M.); (A.M.)
| | - William Grossi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy; (F.L.); (W.G.); (J.C.); (G.M.); (A.M.)
| | - Orlando Parise
- Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (O.P.); (G.P.); (L.R.M.); (E.M.); (J.G.M.)
| | - Jacqueline Cinel
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy; (F.L.); (W.G.); (J.C.); (G.M.); (A.M.)
| | - Gianmarco Parise
- Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (O.P.); (G.P.); (L.R.M.); (E.M.); (J.G.M.)
| | - Gianluca Masullo
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy; (F.L.); (W.G.); (J.C.); (G.M.); (A.M.)
| | - Cecilia Tetta
- Radiology Department, Rizzoli Institute, 40136 Bologna, Italy;
| | - Linda Renata Micali
- Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (O.P.); (G.P.); (L.R.M.); (E.M.); (J.G.M.)
| | - Emanuela Mauro
- Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (O.P.); (G.P.); (L.R.M.); (E.M.); (J.G.M.)
| | - Angelo Morelli
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy; (F.L.); (W.G.); (J.C.); (G.M.); (A.M.)
| | - Jos G. Maessen
- Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (O.P.); (G.P.); (L.R.M.); (E.M.); (J.G.M.)
| | - Sandro Gelsomino
- Cardiovascular Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands; (O.P.); (G.P.); (L.R.M.); (E.M.); (J.G.M.)
- Correspondence:
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Primavesi F, Andreasi V, Hoogwater FJ, Partelli S, Wiese D, Heidsma C, Cardini B, Klieser E, Marsoner K, Fröschl U, Thalhammer S, Fischer I, Göbel G, Hauer A, Kiesslich T, Ellmerer P, Klug R, Neureiter D, Wundsam H, Sellner F, Kornprat P, Függer R, Öfner D, Nieveen van Dijkum EJ, Bartsch DK, de Kleine RH, Falconi M, Stättner S. A Preoperative Clinical Risk Score Including C-Reactive Protein Predicts Histological Tumor Characteristics and Patient Survival after Surgery for Sporadic Non-Functional Pancreatic Neuroendocrine Neoplasms: An International Multicenter Cohort Study. Cancers (Basel) 2020; 12:cancers12051235. [PMID: 32423000 PMCID: PMC7280962 DOI: 10.3390/cancers12051235] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Oncological survival after resection of pancreatic neuroendocrine neoplasms (panNEN) is highly variable depending on various factors. Risk stratification with preoperatively available parameters could guide decision-making in multidisciplinary treatment concepts. C-reactive Protein (CRP) is linked to inferior survival in several malignancies. This study assesses CRP within a novel risk score predicting histology and outcome after surgery for sporadic non-functional panNENs. Methods: A retrospective multicenter study with national exploration and international validation. CRP and other factors associated with overall survival (OS) were evaluated by multivariable cox-regression to create a clinical risk score (CRS). Predictive values regarding OS, disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by time-dependent receiver-operating characteristics. Results: Overall, 364 patients were included. Median CRP was significantly higher in patients >60 years, G3, and large tumors. In multivariable analysis, CRP was the strongest preoperative factor for OS in both cohorts. In the combined cohort, CRP (cut-off ≥0.2 mg/dL; hazard-ratio (HR):3.87), metastases (HR:2.80), and primary tumor size ≥3.0 cm (HR:1.83) showed a significant association with OS. A CRS incorporating these variables was associated with postoperative histological grading, T category, nodal positivity, and 90-day morbidity/mortality. Time-dependent area-under-the-curve at 60 months for OS, DSS, and RFS was 69%, 77%, and 67%, respectively (all p < 0.001), and the inclusion of grading further improved the predictive potential (75%, 84%, and 78%, respectively). Conclusions: CRP is a significant marker of unfavorable oncological characteristics in panNENs. The proposed internationally validated CRS predicts histological features and patient survival.
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Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (B.C.); (D.Ö.)
| | - Valentina Andreasi
- Pancreatic Surgery, Università Vita-Salute, IRCCS Hospital San Raffaele, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Frederik J.H. Hoogwater
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.J.H.H.); (R.H.J.d.K.)
| | - Stefano Partelli
- Pancreatic Surgery, Università Vita-Salute, IRCCS Hospital San Raffaele, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Dominik Wiese
- Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35043 Marburg, Germany; (D.W.); (D.K.B.)
| | - Charlotte Heidsma
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.H.); (E.J.M.N.v.D.)
| | - Benno Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (B.C.); (D.Ö.)
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University, 5020 Salzburg, Austria; (E.K.); (D.N.)
| | - Katharina Marsoner
- Department of Surgery, Medical University Graz, 8036 Graz, Austria; (K.M.); (P.K.)
| | - Uwe Fröschl
- Department of Surgery, Ordensklinikum, 4010 Linz, Austria; (U.F.); (I.F.); (H.W.); (R.F.)
| | - Sabine Thalhammer
- Department of Surgery, Kaiser Franz Josef Hospital, 1100 Vienna, Austria; (S.T.); (F.S.)
| | - Ines Fischer
- Department of Surgery, Ordensklinikum, 4010 Linz, Austria; (U.F.); (I.F.); (H.W.); (R.F.)
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Andreas Hauer
- Department of Surgery, General Hospital Horn, 3580 Horn, Austria; (A.H.); (R.K.)
| | - Tobias Kiesslich
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Philipp Ellmerer
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Reinhold Klug
- Department of Surgery, General Hospital Horn, 3580 Horn, Austria; (A.H.); (R.K.)
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, 5020 Salzburg, Austria; (E.K.); (D.N.)
| | - Helwig Wundsam
- Department of Surgery, Ordensklinikum, 4010 Linz, Austria; (U.F.); (I.F.); (H.W.); (R.F.)
| | - Franz Sellner
- Department of Surgery, Kaiser Franz Josef Hospital, 1100 Vienna, Austria; (S.T.); (F.S.)
| | - Peter Kornprat
- Department of Surgery, Medical University Graz, 8036 Graz, Austria; (K.M.); (P.K.)
| | - Reinhold Függer
- Department of Surgery, Ordensklinikum, 4010 Linz, Austria; (U.F.); (I.F.); (H.W.); (R.F.)
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (B.C.); (D.Ö.)
| | - Elisabeth J.M. Nieveen van Dijkum
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (C.H.); (E.J.M.N.v.D.)
| | - Detlef K. Bartsch
- Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Marburg, 35043 Marburg, Germany; (D.W.); (D.K.B.)
| | - Ruben H.J. de Kleine
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.J.H.H.); (R.H.J.d.K.)
| | - Massimo Falconi
- Pancreatic Surgery, Università Vita-Salute, IRCCS Hospital San Raffaele, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (F.P.); (B.C.); (D.Ö.)
- Correspondence: ; Tel.: +43-512-504-22601
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Stanzi A, Verzoni E, Ruggirello M, Rolli L, Pastorino U. Post-surgical Regression of Thoracic Metastases After Salvage Lobectomy for Recurrent Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 18:e284-e288. [PMID: 31879241 DOI: 10.1016/j.clgc.2019.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Alessia Stanzi
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Luigi Rolli
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Rolli L, Duranti L, Leuzzi G. Treatment of anaemia in the "ERAS" era: how far can we go? J Thorac Dis 2019; 11:3692-3695. [PMID: 31656640 DOI: 10.21037/jtd.2019.09.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Luigi Rolli
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Leonardo Duranti
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Giovanni Leuzzi
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
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Dudek W, Schreiner W, Mykoliuk I, Higaze M, Sirbu H. Pulmonary metastasectomy for sarcoma-survival and prognostic analysis. J Thorac Dis 2019; 11:3369-3376. [PMID: 31559040 DOI: 10.21037/jtd.2019.08.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pulmonary metastasectomy (PM) has commonly been performed in patients with controlled metastatic sarcoma. We reviewed our single-institution experience with pulmonary resections for sarcoma to analyse clinical outcome and to identify prognostic factors associated with patient survival. Methods All sarcoma patients undergoing curative intent PM between 2008 and 2014 were retrospectively analysed. Factors related to primary tumour, metastases, applied therapy, systematic inflammation and preoperative nutritional condition, associated with survival after PM were evaluated using the univariable Cox proportional hazard model. Cut-off values of continuous variables were determined by a receiver operating characteristic (ROC) analysis. Results In total, 33 patients (19 male and 14 female, median age 55 years) underwent PM for metastatic sarcoma. There were no perioperative deaths; major complications occurred in 5 (15.2%) patients. The median interval between the treatment of primary tumour and PM was 16 months (range, 0-171 months). The median size of the largest pulmonary lesion was 1.3 cm. Mean follow-up was 37 months (range, 1-100 months) and the 5-year overall survival (OS) rate after first PM was 40.4%. Resection was complete (R0) in 31 (93.9%) patients. In univariable analysis, a shorter interoperative interval [<30 months, hazard ratio (HR) 5.05, 95% confidence interval (CI): 1.15-22.19] and grade 3 (G3) sarcoma (HR 3.52, 95% CI: 1.01-12.25) were significant negative prognosticators. Conclusions Despite the lack of randomized controlled trials PM for sarcomatous disease is a reasonable therapeutic option with acceptable survival in a selected patient population. In sarcoma patients with a shorter interoperative interval and G3 tumour, shorter survival after PM can be expected.
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Affiliation(s)
- Wojciech Dudek
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Iurii Mykoliuk
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mostafa Higaze
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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