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Amezcua-Hernandez V, Jimenez-Rosales R, Martinez-Cara JG, Garcia-Garcia J, Valverde Lopez F, Redondo-Cerezo E. Preoperative EUS vs. PET-CT Evaluation of Response to Neoadjuvant Therapy for Esophagogastric Cancer and Its Correlation with Survival. Cancers (Basel) 2023; 15:cancers15112941. [PMID: 37296903 DOI: 10.3390/cancers15112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The objective of our study was to investigate whether Endoscopic Ultrasonography (EUS) and Positron Emission Tomography-Computed Tomography (PET-CT) restaging can predict survival in upper gastrointestinal tract adenocarcinomas and to assess their accuracy when compared to pathology. METHODS We conducted a retrospective study on all patients who underwent EUS for staging of gastric or esophago-gastric junction adenocarcinoma between 2010 and 2021. EUS and PET-CT were performed, and preoperative TNM restaging was conducted using both procedures within 21 days prior to surgery. Disease-free survival (DFS) and overall survival (OS) were evaluated. RESULTS A total of 185 patients (74.7% male) were included in the study. The accuracy of EUS for distinguishing between T1-T2 and T3-T4 tumors after neoadjuvant therapy was 66.7% (95% CI: 50.3-77.8%), and for N staging, the accuracy was 70.8% (95% CI: 51.8-81.8%). Regarding PET-CT, the accuracy for N positivity was 60.4% (95% CI: 46.3-73%). Kaplan-Meier analysis revealed a significant correlation between positive lymph nodes on restaging EUS and PET-CT with DFS. Multivariate COX regression analysis identified N restaging with EUS and PET-CT, as well as the Charlson comorbidity index, as correlated factors with DFS. Positive lymph nodes on EUS and PET-CT were predictors of OS. In multivariate Cox regression analysis, the independent risk factors for OS were found to be the Charlson comorbidity index, T response by EUS, and male sex. CONCLUSION Both EUS and PET-CT are valuable tools for determining the preoperative stage of esophago-gastric cancer. Both techniques can predict survival, with preoperative N staging and response to neoadjuvant therapy assessed by EUS being the main predictors.
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Affiliation(s)
| | - Rita Jimenez-Rosales
- Department of Gastroenterology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
| | | | - Javier Garcia-Garcia
- Department of Oncology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
| | - Francisco Valverde Lopez
- Department of Gastroenterology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
| | - Eduardo Redondo-Cerezo
- Department of Gastroenterology, "Virgen de las Nieves" University Hospital, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
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Jimenez-Rosales R, Lopez-Tobaruela JM, Lopez-Vico M, Ortega-Suazo EJ, Martinez-Cara JG, Redondo-Cerezo E. Performance of the New ABC and MAP(ASH) Scores in the Prediction of Relevant Outcomes in Upper Gastrointestinal Bleeding. J Clin Med 2023; 12:jcm12031085. [PMID: 36769733 PMCID: PMC9917936 DOI: 10.3390/jcm12031085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Background & Aims: Several risk scores have been proposed for risk-stratification of patients with upper gastrointestinal bleeding. ABC score was found more accurate predicting mortality than AIMS65. MAP(ASH) is a simple, pre-endoscopy score with a great ability to predict intervention and mortality. The aim of this study was to compare ABC and MAP(ASH) discriminative ability for the prediction of mortality and intervention in UGIB. As a secondary aim we compared both scores with Glasgow-Blatchford score and AIMS65. Methods: Our study included patients admitted to the emergency room of Virgen de las Nieves University Hospital with UGIB (2017-2020). Information regarding clinical, biochemical tests and procedures was collected. Main outcomes were in-hospital mortality and a composite endpoint for intervention. Results: MAP(ASH) and ABC had similar AUROCs for mortality (0.79 vs. 0.80). For intervention, MAP(ASH) (AUROC = 0.75) and ABC (AUROC = 0.72) were also similar. Regarding rebleeding, AUROCs of MAP(ASH) and ABC were 0.67 and 0.61 respectively. No statistically differences were found in these outcomes. With a low threshold for MAP(ASH) ≤ 2, ABC and MAP(ASH) classified a similar proportion of patients as being at low risk of death (42% vs. 45.2%), with virtually no mortality under these thresholds. Conclusions: MAP(ASH) and ABC were similar for the prediction of relevant outcomes for UGIB, such as intervention, rebleeding and in-hospital mortality, with an accurate selection of low-risk patients. MAP(ASH) has the advantage of being easier to calculate even without the aid of electronic tools.
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Affiliation(s)
- Rita Jimenez-Rosales
- Department of Gastroenterology, “Virgen de las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - Jose Maria Lopez-Tobaruela
- Department of Gastroenterology, “Virgen de las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
- University of Granada, 18010 Granada, Spain
- Correspondence:
| | - Manuel Lopez-Vico
- Department of Gastroenterology, “Virgen de las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - Eva Julissa Ortega-Suazo
- Department of Gastroenterology, “Virgen de las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - Juan Gabriel Martinez-Cara
- Department of Gastroenterology, “Virgen de las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - Eduardo Redondo-Cerezo
- Department of Gastroenterology, “Virgen de las Nieves” University Hospital, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
- Department of Medicine, School of Medicine, University of Granada, 18016 Granada, Spain
- Biosanitary Institute of Granada (ibs.GRANADA), 18014 Granada, Spain
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Redondo-Cerezo E, Heredia-Carrasco C, Alegría-Motte C, Caballero-Mateos A, Vadillo-Calles F, Ortega-Suazo EJ, Martos-Ruiz V, Ariza-Fernández JL, López-González E, Martínez-Cara JG, Valverde-Lopez F, de Hierro ML, Sánchez-Capilla D, López-Hidalgo JL, Jimenez-Rosales R. Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study). Surg Endosc 2022; 36:5356-5365. [PMID: 34988735 DOI: 10.1007/s00464-021-08917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Polyps histology and diameter up to 1 cm determine whether a patient needs a colonoscopy after 3 years or less, or far ahead. Endoscopists' and pathologists' size estimations can be imprecise. Our aim was to assess endoscopist ability to correctly recommend surveillance colonoscopies for patients with polyps around the 10 mm threshold, based on its endoscopic sizing and optical diagnosis by NBI. METHODS NBI-assisted diagnosis and endoscopist estimation of polyp size were compared with reference standard, considering this as the post resection polyp measurements by the nurse assistant and the pathologic results, in a prospective, multicenter, real life study, that recruited adults undergoing colonoscopy in five hospitals. By comparing the endoscopic and pathologist size estimation, with polyps' measurement after resection, and optical and histological diagnoses in patients with polyps between 5 and 15 mm, sensitivity was assessed at the patient level by means of two characteristics: the presence of adenoma, and the surveillance interval. Surveillance intervals were established by the endoscopist, based on optical diagnosis, and by another gastroenterologist, grounded on the pathologic report. Determinants of accuracy were explored at the polyp level. RESULTS 532 polyps were resected in 451 patients. Size estimation was more precise for the endoscopist. Endoscopist sensitivity for the presence of adenoma or carcinoma was 98.7%. Considering the presence of high-grade dysplasia or cancer, sensitivity was 82.6% for the endoscopic optical diagnosis. Sensitivity for a correct 3-year surveillance interval was 91.5%, specificity 82.3%, with a PPV of 93.2% and NPV of 78.5% for the endoscopist. 6.51% of patients would have had their follow-up colonoscopy delayed, whereas 22 (4.8%) would have it been performed earlier, had endoscopist recommendations been followed. CONCLUSION Our study observes that NBI optical diagnosis can be recommended in routine practice to establish surveillance intervals for polyps between 5 and 15 mm. CLINICAL TRIALS REGISTRATION NUMBER NCT04232176.
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Affiliation(s)
- Eduardo Redondo-Cerezo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain.
| | - Clara Heredia-Carrasco
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | | | | | - Eva Julissa Ortega-Suazo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | | | | | - Juan Gabriel Martínez-Cara
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Francisco Valverde-Lopez
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Mercedes López de Hierro
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | - Damián Sánchez-Capilla
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
| | | | - Rita Jimenez-Rosales
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Avenida de las Fuerzas Armadas 2, 18014, Granada, Spain
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Redondo-Cerezo E, Ortega-Suazo EJ, Vadillo-Calles F, Valverde-Lopez F, Martínez-Cara JG, Jimenez-Rosales R. Upper gastrointestinal bleeding in patients 80 years old and over. A comparison with younger patients and risk factors analysis for in-hospital and delayed mortality. Int J Clin Pract 2021; 75:e14806. [PMID: 34487386 DOI: 10.1111/ijcp.14806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Outcomes in old patients with upper gastrointestinal bleeding (UGIB) have been scarcely studied. Our aim was to compare very old individuals (>80 years old) with younger patients with UGIB, and to identify risk factors for the main outcomes. METHODS A single-centre prospectively collected database was analysed. Descriptive, inferential and multivariate logistic regression models were performed. Main clinical outcomes were in-hospital and delayed 6-month mortality. RESULTS 698 patients were included, 143 very old and 555 aged <80. Old patients differed from younger ones in comorbidities (85.9% vs. 62%, P < .0001), oral anticoagulants (32.3% vs. 12.7%; P < .0001), and antiplatelets intake (32.3% vs. 21.2%; P < .007). No differences were found in the need for endoscopic interventions, blood unit transfusions, hospital stay, in-hospital rebleeding and mortality. Among very old patients, creatinine levels were higher in those who died compared with the ones who survived (1.92 ± 1.46 vs. 1.25 ± 0.59 mg/dL; P = .002), they had lower haemoglobin levels (8.1 ± 1.4 vs. 9.1 ± 2.4 g/dL; P = .04) and longer hospital stays (17.75 ± 15.5 vs. 8.1 ± 8.4 days; P < .0001). Logistic regression showed creatinine levels (OR: 2.42; 95% CI: 1.24-4.74; P = .01), cirrhosis (OR: 2.88, 95% CI: 1.88-17.34; P = .04) and being an impatient (OR: 3.90; 95% CI: 1.11-20; P = .035) were independent risk factors for mortality in older patients. They had an increased delayed 6-month mortality compared with younger patients (17.5% vs. 8%, P = .001). CONCLUSIONS Creatinine levels, cirrhosis or the onset of UGIB while being an inpatient were independent risk factors for mortality in very old patients. Delayed mortality was higher among them, mostly caused by cardiovascular events and neoplasms, but not in-hospital mortality.
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Affiliation(s)
- Eduardo Redondo-Cerezo
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Eva Julissa Ortega-Suazo
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Francisco Vadillo-Calles
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Francisco Valverde-Lopez
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Juan Gabriel Martínez-Cara
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Rita Jimenez-Rosales
- Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain
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