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Karaoğlan BB, Yekedüz E, Yazgan SC, Mocan EE, Köksoy EB, Yaşar HA, Şenler FÇ, Utkan G, Demirkazık A, Akbulut H, Ürün Y. Impact of low sodium values on survival outcomes of patients with cancer receiving immune checkpoint inhibitors. Immunotherapy 2024; 16:821-828. [PMID: 39016058 PMCID: PMC11457628 DOI: 10.1080/1750743x.2024.2370231] [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: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
Background: Low serum sodium affects cancer prognosis, but its impact on immunotherapy is unclear.Objective: Assessing the association of pre- and post-ICI treatment sodium levels with survival.Methods: We retrospectively analyzed patients receiving ICI in January 2012-December 2023, collecting serum sodium levels at treatment initiation and 4 weeks post-ICI, with overall survival (OS) as the primary outcome.Results: Low sodium was observed in 125 and 119 patients pre-and post-treatment respectively. Pre-ICI and post-ICI low sodium correlated with decreased OS [10.6 vs. 22.9 months (p = 0.001) and 11.6 vs. 27.2 months (p = 0.009)]. Multivariate analysis identified pre-ICI low sodium [HR: 1.685; 95% CI: 1.050-2.705; p = 0.031] as an independent risk factor for worse OS.Conclusion: Low baseline serum sodium was an independent risk factor for poor OS in patients treated with ICIs.
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Affiliation(s)
- Beliz Bahar Karaoğlan
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Emre Yekedüz
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA02215, USA
| | - Satı Coşkun Yazgan
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Eda Eylemer Mocan
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Elif Berna Köksoy
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Hatime Arzu Yaşar
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Filiz Çay Şenler
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Güngör Utkan
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Ahmet Demirkazık
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Hakan Akbulut
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
| | - Yüksel Ürün
- Ankara University Faculty of Medicine, Department of Medical Oncology, Ankara, TÜRKİYE
- Ankara University, Cancer Research Institute, Ankara06620, TÜRKİYE
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Falhammar H, Stenman A, Juhlin CC, Kistner A. Adrenal tumors in patients with neuroendocrine neoplasms. Endocrine 2024; 85:356-362. [PMID: 38581593 PMCID: PMC11246291 DOI: 10.1007/s12020-024-03810-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE To study the prevalence of primary adrenal tumors and adrenal metastases in patients with neuroendocrine neoplasms (NENs) and describe these in detail. NENs can be further divided into neuroendocrine tumor (NET) and neuroendocrine carcinoma (NEC). METHODS A review of medical files was conducted for all patients who underwent a 68Gallium-DOTATOC-PET/CT during 2010-2023 or adrenalectomy during 1999-2023 at the Karolinska University Hospital. RESULTS In total, 68Gallium-DOTATOC-PET/CT was performed on 1750 individuals with NEN, among whom 12 (0.69%) had adrenal tumors. Of these, 9 (0.51%) were NEN metastases. Out of 1072 adrenalectomies, 4 (0.37%) showed evidence of NEN metastases. Thus, 16 patients with NEN exhibited adrenal tumors. The adrenal tumors were found on average 5 years after the NEN diagnosis and 19% of the adrenal tumors with simultaneous NEN were benign. Few had all adrenal hormones measured. None had an adrenal insufficiency nor an adrenal biopsy. Another synchronous metastasis was found in 69% at the time of the adrenal tumor discovery. During the median 2-year follow-up, 38% of the subjects had deceased (with the exclusion of individuals presenting supposedly benign adrenal tumors 31%) all due to tumor complications. A comparison between individuals identified through 68Gallium-DOTATOC-PET/CT and those who underwent adrenalectomy revealed a higher prevalence of NETs in the former group and NECs in the latter group. CONCLUSION Adrenal primary tumors and adrenal metastases are infrequent occurrences in patients with NEN. Most cases involved the presence of NEN metastasis upon the initial discovery of adrenal tumors. The overall prognosis was found to be favorable.
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Affiliation(s)
- Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, 171 77, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Adam Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, 171 77, Stockholm, Sweden
| | - Anna Kistner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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Paganetti C, Heigl A, Rosenberg R, Vetter M, Haslbauer J, Steuerwald M. Case report: 65-year-old man with metachronous left sided adrenal metastasis of hepatocellular carcinoma. Int J Surg Case Rep 2024; 119:109683. [PMID: 38688153 PMCID: PMC11067464 DOI: 10.1016/j.ijscr.2024.109683] [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: 02/13/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Due to therapeutic advances and improvements in follow-up care, the diagnosis and treatment of extrahepatic metastases of hepatocellular carcinoma [HCC] have gained clinical significance. However, adrenal gland metastases of HCC remain a rare clinical encounter. Several systemic and local treatment options are discussed in current literature. Adrenalectomy in cases of isolated adrenal metastases with well-controlled intrahepatic lesions has been shown to benefit patients in case series. PRESENTATION OF THE CASE This 65-year-old patient presented with suspected metachronous left sided adrenal metastasis seven years after bisegmentectomy for HCC and after undergoing trans-arterial chemoembolization [TACE] for multifocal intrahepatic recurrences while being listed for liver transplantation "beyond Milan criteria". Adrenalectomy was suggested for histopathological confirmation of the suspected metastasis and re-consideration for liver transplant. The resection was performed laparoscopically and metastasis of HCC was confirmed in histopathological analysis. Postoperatively, the patient recovered quickly. However, the patient decided against re-listing for liver transplantation. CLINICAL DISCUSSION Current literature suggests, that minimally-invasive adrenalectomy should be considered in patients with no more than two extrahepatic lesions, a Child-Pugh-Score of less than A5, low alpha-fetoprotein [AFP] levels <100 ng/ml and size <3 cm. The oncological goal should be to achieve a tumor free extrahepatic situation with a potential oncological benefit. CONCLUSION Our patient presented as an ideal candidate for resection of the adrenal gland metastasis and could have been re-assessed postoperatively for liver transplantation. Still, more research is needed to improve patient-selection for metastasectomy in HCC.
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Affiliation(s)
- Ch Paganetti
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland.
| | - A Heigl
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - R Rosenberg
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - M Vetter
- Department of Oncology, Cancer Center, Medical University Clinic, Cantonal Hospital Baselland, Liestal, Switzerland
| | - J Haslbauer
- Department of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - M Steuerwald
- Praxis für Gastroenterologie und Hepatologie, Liestal, Switzerland
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Green RL, Gao TP, Kuo LE. Perioperative Outcomes After Adrenalectomy for Secondary Adrenal Malignancy. J Surg Res 2024; 296:556-562. [PMID: 38340489 DOI: 10.1016/j.jss.2024.01.029] [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: 11/02/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION The risk of adverse outcomes after adrenal metastasectomy is not well defined. Knowledge of these risks is essential to guide patient counseling. METHODS The 2015-2020 National Surgical Quality Improvement Program datasets were combined. Patients who underwent adrenalectomy for secondary adrenal malignancy (SM) and benign nonfunctional (BNF) adrenal neoplasms were identified; BNF neoplasms were chosen as a comparison as functional neoplasms can contribute to comorbidity. Patients who had additional surgery at the time of adrenalectomy were excluded. Patient demographics, comorbidities, perioperative factors, and outcomes were compared between groups. Multivariable logistic regression analysis was performed. RESULTS Of 3496 adrenalectomy patients, 332 had SM and 3164 had BNF neoplasms. Patients with SM were older (65 versus 54 y) and more often had chronic obstructive pulmonary disease (7.5% versus 4.4%), chronic steroid use (10.5% versus 3.8%), and bleeding disorders (4.5% versus 2.2%) than patients with BNF, respectively (P < 0.01 for all). Laparoscopic adrenalectomy was the most common operative approach for both groups (74.7% versus 88.3%). Rates of mortality, morbidity, reoperation, readmission, and nonhome discharge did not differ significantly between groups. Patients with SM had higher rates of postoperative bleeding than patients with BNF (6.3% versus 2.6%, P < 0.001). This persisted on multivariable regression analysis that adjusted for demographics, comorbidities, and operative approach (odds ratio 2.34, 95% confidence interval 1.19-4.64). CONCLUSIONS Adrenalectomy for SM is associated with an increased risk of postoperative bleeding compared to adrenalectomy for BNF adrenal neoplasms. Patients with SM that meet criteria for adrenal metastasectomy should be counseled appropriately.
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Affiliation(s)
- Rebecca L Green
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
| | - Terry P Gao
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
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Ginzberg SP, Gasior JA, Kelz LR, Passman JE, Soegaard Ballester JM, Roses RE, Fraker DL, Wachtel H. Adrenalectomy approach and outcomes according to surgeon volume. Am J Surg 2024; 229:44-49. [PMID: 37940441 PMCID: PMC10922122 DOI: 10.1016/j.amjsurg.2023.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND This study assessed the relationship between surgeon volume, operative management, and resource utilization in adrenalectomy. METHODS Isolated adrenalectomies performed within our health system were identified (2016-2021). High-volume surgeons were defined as those performing ≥6 cases/year. Outcomes included indication for surgery, perioperative outcomes, and costs. RESULTS Of 476 adrenalectomies, high-volume surgeons (n = 3) performed 394, while low-volume surgeons (n = 12) performed 82. High-volume surgeons more frequently operated for pheochromocytoma (19% vs. 16%, p < 0.001) and less frequently for metastasis (6.4% vs. 23%, p < 0.001), more frequently used laparoscopy (95% vs. 80%, p < 0.001), and had lower operative supply costs ($1387 vs. $1,636, p = 0.037). Additionally, laparoscopic adrenalectomy was associated with shorter length of stay (-3.43 days, p < 0.001), lower hospitalization costs (-$72,417, p < 0.001), and increased likelihood of discharge to home (OR 17.03, p = 0.008). CONCLUSIONS High-volume surgeons more often resect primary adrenal pathology and utilize laparoscopy. Laparoscopic adrenalectomy is, in turn, associated with decreased healthcare resource utilization.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Julia A Gasior
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Jesse E Passman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robert E Roses
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Fraker
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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