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Stretton B, Kovoor J, Gupta A, Hains L, Bacchi S, Wong B, O'Callaghan PG, Barreto S, Hugh TJ, Murphy E, Trochsler M, Padbury R, Boyd M, Maddern G. Get out what you put in: optimising electronic medical record data. ANZ J Surg 2023; 93:2056-2058. [PMID: 37303276 DOI: 10.1111/ans.18559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Brandon Stretton
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
| | - Joshua Kovoor
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
| | - Aashray Gupta
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
- Cardiothoracic Surgery Department, Gold Coast University Hospital, Queensland, Southport, Australia
| | - Lewis Hains
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
| | - Stephen Bacchi
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
- Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Bianca Wong
- Department of Medicine, Lyell McEwin Hospital, Northern Adelaide Local Health Network, South Australia, Adelaide, Australia
| | - Patrick G O'Callaghan
- Royal Adelaide Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, Australia
| | - Savio Barreto
- Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia
| | - Elizabeth Murphy
- Department of Medicine, Lyell McEwin Hospital, Northern Adelaide Local Health Network, South Australia, Adelaide, Australia
| | - Markus Trochsler
- Royal Adelaide Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, Australia
| | - Robert Padbury
- Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Mark Boyd
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
- Department of Medicine, Lyell McEwin Hospital, Northern Adelaide Local Health Network, South Australia, Adelaide, Australia
| | - Guy Maddern
- Adelaide Medical School, University of Adelaide, South Australia, Adelaide, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, South Australia, Adelaide, Australia
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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Stretton B, Kovoor J, Bacchi S, Gupta A, Hugh T, Dobbins C, Trochsler M, Hewett P, Chan WO, Barreto SG, Rayner C, Bruening M, Padbury R, Talley NJ, Anthony A, Horowitz M, Maddern G, Boyd M. Like a Surgeon? A letter commenting on Grosse and Thomas's 'Selection into training will always be an inexact process: a survey of Directors of Physician Education on selection into Basic Physician Training in Australia and New Zealand'. Intern Med J 2023; 53:1724-1725. [PMID: 37743243 DOI: 10.1111/imj.16214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Brandon Stretton
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray Gupta
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Thomas Hugh
- Surgical Education Research and Training, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Christopher Dobbins
- Department of Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Markus Trochsler
- Department of Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Peter Hewett
- Department of Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Weng O Chan
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Savio G Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Hepatobiliary and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Christopher Rayner
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Martin Bruening
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Robert Padbury
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Adrian Anthony
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Michael Horowitz
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy Maddern
- Department of Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mark Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Shepherdson M, Kilburn D, Ullah S, Price T, Karapetis CS, Nguyen P, Townsend A, Padbury R, Piantadosi C, Maddern G, Carruthers S, Roder D, Sorich M, Roy AC. Survival outcomes for patients with colorectal cancer with synchronous liver only metastasis. ANZ J Surg 2023; 93:1847-1853. [PMID: 37079715 DOI: 10.1111/ans.18482] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Colorectal cancer with synchronous liver-only metastasis is managed with a multimodal approach, however, optimal sequencing of modalities remains unclear. METHODS A retrospective review of all consecutive rectal or colon cancer cases with synchronous liver-only metastasis was conducted from the South Australian Colorectal Cancer Registry from 2006 to 2021. This study aimed to investigate how order and type of treatment modality affects overall survival. RESULTS Data of over 5000 cases were analysed (n = 5244), 1420 cases had liver-only metastasis. There were a greater number of colon than rectal primaries (N = 1056 versus 364). Colonic resection was the preferred initial treatment for the colon cohort (60%). In the rectal cohort, 30% had upfront resection followed by 27% that had chemo-radiotherapy as 1st line therapy. For the colon cohort, there was an improved 5-year survival with surgical resection as initial treatment compared to chemotherapy (25% versus 9%, P < 0.001). In the rectal cohort, chemo-radiotherapy as the initial treatment was associated with an improved 5-year survival compared to surgery or chemotherapy (40% versus 26% versus 19%, P = 0.0015). Patients who were able to have liver resection had improved survival, with 50% surviving over 5 years compared to 12 months in the non-resected group (P < 0.001). Primary rectal KRAS wildtype patients who underwent liver resection and received Cetuximab had significantly worse outcomes compared to KRAS wildtype patients who did not (P = 0.0007). CONCLUSIONS Where surgery is possible, resection of liver metastasis and primary tumour improved overall survival. Further research is required on the use of targeted treatments in patients undergoing liver resection.
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Affiliation(s)
- Mia Shepherdson
- Department of Surgery and Perioperative Medicine, Flinders Medical Center, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Daniel Kilburn
- Department of Surgery and Perioperative Medicine, Flinders Medical Center, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Timothy Price
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Peter Nguyen
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Amanda Townsend
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Padbury
- Department of Surgery and Perioperative Medicine, Flinders Medical Center, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Cynthia Piantadosi
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Guy Maddern
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Scott Carruthers
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Roder
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Amitesh C Roy
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Adelaide, South Australia, Australia
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Price T, Karapetis C, Geerinckx B, Roy A, D. Roder, Padbury R, Townsend A. 403P First-line anti-EGFR therapy, patient characteristics and survival: Results from South Australian (SA) metastatic colorectal registry (mCRCR). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Price TJ, Piantadosi C, Karapetis CS, Roy AC, Padbury R, Roder D, Geerinckx B, Townsend AR. Patterns of care and survival of first line anti-EGFR therapy; results from South Australian (SA) metastatic colorectal (mCRC) registry. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15577 Background: Treatment of mCRC has changed dramatically over the last decade with therapy guided by clinical and molecular features which include side of primary, RAS, BRAF and MMR status. For left sided RAS WT mCRC survival is optimized by using first line anti-EGFR anti-bodies combined with chemotherapy. This is reflected in modern guidelines. Methods: We aim to assess the uptake of first line anti-EGFR/chemotherapy combinations in patients with mCRC and assess for difference between cetuximab (C) and panitumumab (P) use from the SAmCRCR. The real word registry has collected data from all patients diagnosed with mCRC in SA prospectively since 2/2006. We compared RAS WT patients treated with chemo/bevacizumab (CB). Survival was analysed using the Kaplan Meier method. Results: Of the 5537 patients currently entered onto the registry, only 97 had RAS status recorded and had received first line anti-EGFR/chemotherapy (FaEC). 102 patients were RAS WT and received CB. Table summarises patient characteristics and median OS for FaEC (C or P) and CB. There was no statistical difference in survival for C v P (p = 0.055). Conclusions: When comparing C & P choice in first line therapy, C was more often combined with irinotecan/chemo. C patients had higher rate of left sided primary. There were lower rates of liver resection in patients treated with C which may explain the numerically lower median overall survival. An updated cohort analysis will be included to assess changes in practice over time.[Table: see text]
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Affiliation(s)
- Timothy Jay Price
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | | | | | | | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
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Marchegiani G, Barreto SG, Bannone E, Sarr M, Vollmer CM, Connor S, Falconi M, Besselink MG, Salvia R, Wolfgang CL, Zyromski NJ, Yeo CJ, Adham M, Siriwardena AK, Takaori K, Hilal MA, Loos M, Probst P, Hackert T, Strobel O, Busch ORC, Lillemoe KD, Miao Y, Halloran CM, Werner J, Friess H, Izbicki JR, Bockhorn M, Vashist YK, Conlon K, Passas I, Gianotti L, Del Chiaro M, Schulick RD, Montorsi M, Oláh A, Fusai GK, Serrablo A, Zerbi A, Fingerhut A, Andersson R, Padbury R, Dervenis C, Neoptolemos JP, Bassi C, Büchler MW, Shrikhande SV. Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS). Ann Surg 2022; 275:663-672. [PMID: 34596077 DOI: 10.1097/sla.0000000000005226] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison. BACKGROUND PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking. METHODS The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021. RESULTS We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications. DISCUSSIONS The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.
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Affiliation(s)
- Giovanni Marchegiani
- Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Savio George Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Elisa Bannone
- Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Michael Sarr
- Mayo Clinic Department of General Surgery, Rochester, NY
| | - Charles M Vollmer
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Saxon Connor
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roberto Salvia
- Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy
| | | | - Nicholas J Zyromski
- Indiana University School of Medicine, Indiana University Health, Indianapolis, IN
| | - Charles J Yeo
- Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Mustapha Adham
- Digestive Surgery Department, Lyon Civil Hospital, Lyon, France
| | | | - Kyoichi Takaori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Oliver Strobel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Olivier R C Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, PR China
| | - Christopher M Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians-University, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Yogesh K Vashist
- Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland
| | - Kevin Conlon
- Department of Surgery, AGIA OLGA Hospital, Athens, Greece
| | - Ioannis Passas
- School of Medicine and Surgery, Milano - Bicocca University, and Department of Surgery, San Gerardo Hospital, Monza, Italy
| | - Luca Gianotti
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Marco Del Chiaro
- Department of Surgery, Humanitas University and Research Hospital IRCCS, Milan, Italy
| | | | - Marco Montorsi
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Attila Oláh
- Department of Surgery, Miguel Servet University Hospital, Paseo Isabel la Catolica, Zaragoza, Spain
| | | | - Alejandro Serrablo
- Department of Surgery, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alessandro Zerbi
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Abe Fingerhut
- Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Robert Padbury
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | | | - John P Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Claudio Bassi
- Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Shailesh V Shrikhande
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
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Hibbert PD, Basedow M, Braithwaite J, Wiles LK, Clay-Williams R, Padbury R. How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis. BMC Health Serv Res 2021; 21:588. [PMID: 34144717 PMCID: PMC8212075 DOI: 10.1186/s12913-021-06598-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background A key characteristic of healthcare systems that deliver high quality and cost performance in a sustainable way is a systematic approach to capacity and capability building for quality improvement. The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these. Methods Between July 2018 and February 2020, the Southern Adelaide Local Health Network (SALHN), a network of health services in Adelaide, South Australia, conducted three capability-oriented capacity building programs that incorporated 82 longstanding individual quality improvement projects. Qualitative analysis of data collected from interviews of 19 project participants and four SALHN Improvement Faculty members and ethnographic observations of seven project team meetings were conducted. Results We found four interacting components that lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter. A strong safety culture is not necessarily a pre-requisite for quality improvement gains to be made; indeed, undertaking quality improvement activities can contribute to an improved safety culture. For most project participants in the program, the time commitment for projects was significant and, at times, maintaining momentum was a challenge. Conclusions Healthcare systems that wish to deliver high quality and cost performance in a sustainable way should consider embedding the four identified components into their quality improvement capacity and capability building strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06598-8.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia. .,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Martin Basedow
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, New South Wales, Australia
| | - Robert Padbury
- Department of Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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8
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Prasanna T, Wong R, Price T, Shapiro J, Tie J, Wong HL, Nott L, Roder D, Lee M, Kosmider S, Jalali A, Burge M, Padbury R, Maddern G, Carruthers S, Moore J, Sorich M, Karapetis CS, Gibbs P, Yip D. Metastasectomy and BRAF mutation; an analysis of survival outcome in metastatic colorectal cancer. Curr Probl Cancer 2020; 45:100637. [PMID: 32826083 DOI: 10.1016/j.currproblcancer.2020.100637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether the benefit is consistent for BRAF V600E mutant (MT) and wild type (WT) mCRC. This retrospective analysis explores the influence of BRAF MT on survival after metastasectomy. METHODS Overall survival (OS) and recurrence-free survival (RFS) for BRAF MT and WT mCRC were evaluated. Survival was also analyzed in the cohort of BRAF MT with or without metastasectomy. RESULTS Five hundred and thirteen patients who had undergone metastasectomy were identified, 6% were BRAF-MT. Median age 63. Median OS in BRAF MT vs WT: 25.7 vs 48.5 months (hazard ratio [HR] 1.95; 1.18-3.22). However, difference was not significant in a multivariate model. Right primary tumor, intact primary, >1 metastatic site, non-R0 resection, peritoneal metastasis, and synchronous metastasis were independent predictors of worse OS. Among 364 patients with RFS data there was no difference between BRAF MT and WT (16 vs 19 months, p=0.09). In another cohort of 158 BRAF-MT patients, OS was significantly better after metastasectomy compared to "no metastasectomy" (HR 0.34; 0.18-0.65, P= 0.001). Proficient mismatch repair status showed a trend toward worse survival after metastasectomy in BRAF MT (HR 1.71, P = 0.08). CONCLUSION OS did not differ after metastasectomy between BRAF MT and WT in a multivariate model. Median OS was >2 years in this study after metastasectomy among BRAFV600E MT patients suggesting a survival benefit of metastasectomy in this group where systemic therapeutic options are limited. Metastasectomy may be considered in carefully selected BRAF-MT patients.
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Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Australia; University of Canberra, ACT, Australia.
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia; Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Jeanne Tie
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Hui-Li Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia; Menzies Research institute, Hobart, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Australia; University of South Australia, Adelaide, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Suzanne Kosmider
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
| | - Azim Jalali
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia
| | - Matthew Burge
- Department of Medical Oncology, Royal Brisbane Hospital, Brisbane, Australia
| | - Robert Padbury
- Flinders University, Bedford Park, Australia; Department of Surgery, Flinders Medical Centre, Australia
| | - Guy Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Scott Carruthers
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - James Moore
- Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Christos S Karapetis
- Flinders University, Bedford Park, Australia; Department of Medical Oncology, Flinders Medical Centre, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia; Department of Medical Oncology, Western Hospital, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia; ANU Medical School, Australian National University, Australia
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9
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Roder D, Karapetis CS, Olver I, Keefe D, Padbury R, Moore J, Joshi R, Wattchow D, Worthley DL, Miller CL, Holden C, Buckley E, Powell K, Buranyi-Trevarton D, Fusco K, Price T. Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival. BMJ Open 2019; 9:e031421. [PMID: 31575579 PMCID: PMC6797269 DOI: 10.1136/bmjopen-2019-031421] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Some early studies indicated lower survival with longer time from diagnosis to cancer treatment, but others showed the reverse. We investigated time to treatment of colorectal cancer and associations with survival. SETTING AND PARTICIPANTS Clinical registry data for colorectal cancer cases diagnosed in 2000-2010 at four major public hospitals in South Australia and treated by surgery (n=1675), radiotherapy (n=616) and/or systemic therapy (n=1556). DESIGN A historic cohort design, with rank-order tests for ordinal clinical and sociodemographic predictors and multiple logistic regression for comparing time from diagnosis to treatment. Unadjusted Kaplan-Meier estimates and adjusted Cox proportional hazards regression were used to investigate disease-specific survival by time to treatment. OUTCOME MEASURES Time to treatment and survival from diagnosis to death from colorectal cancer. RESULTS Treatment (any type) commenced for 87% of surgical cases <60 days of diagnosis, with 80% having surgery within this period. Of those receiving radiotherapy, 59% began this treatment <60 days, and of those receiving systemic therapy, the corresponding proportion was 56%. Adjusted analyses showed treatment delay >60 days was more likely for rectal cancers, 2006-2010 diagnoses, residents of northern than other metropolitan regions and for surgery, younger ages <50 years and unexpectedly, those residing closer to metropolitan services. Adjusting for clinical and sociodemographic factors, and diagnostic year, better survival occurred in <2 years from diagnosis for time to treatment >30 days. Survival in the 3-10 years postdiagnosis generally did not differ by time to treatment, except for lower survival for any treatment >90 days for surgical cases. CONCLUSIONS The lower survival <2 years from diagnosis for treatment <30 days of diagnosis is consistent with other studies attributed to preferencing more complicated cases for earlier care. Lower 3-10 years survival for surgical cases first treated >90 days from diagnosis is consistent with previously reported U-shaped relationships.
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Affiliation(s)
- David Roder
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | | | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothy Keefe
- South Australian Cancer Service, South Australia Department of Health, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Padbury
- Medical Oncology, Flinders University, Adelaide, South Australia, Australia
- Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - James Moore
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rohit Joshi
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Cancer Research and Clinical Trials, Adelaide Oncology and Haematology, North Adelaide, South Australlia, Australia
| | - David Wattchow
- Medical Oncology, Flinders University, Adelaide, South Australia, Australia
- Surgery and Perioperative Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Dan L Worthley
- Gastrointestinal Cancer Biology, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Caroline Louise Miller
- Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carol Holden
- Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Elizabeth Buckley
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Powell
- Population Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Dianne Buranyi-Trevarton
- South Australian Cancer Service, South Australia Department of Health, Adelaide, South Australia, Australia
| | - Kellie Fusco
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Timothy Price
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Clinical Cancer Research, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Prasanna T, Wong R, Price TJ, Shapiro JD, Tie J, Wong HL, Nott LM, Roder D, Lee M, Kosmider S, Jalali A, Burge ME, Padbury R, Maddern G, Moore J, Carruthers S, Sorich M, Karapetis CS, Gibbs P, Yip D. Metastasectomy and BRAF mutation: An analysis of survival outcome in metastatic colorectal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3531 Background: Surgical resection of oligometastases improves survival in metastatic colorectal cancer (mCRC). It is unclear whether such benefit is consistently observed for BRAF V600E mutant (MT) and wild type (WT) mCRC. We conducted a retrospective analysis to explore the influence of BRAF mutation status on survival outcomes after metastasectomy. Methods: Data collected from two large prospective population databases in Australia (Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) and South Australian cancer registry). Overall survival (OS) and recurrence free survival (RFS) for BRAF MT and WT mCRC were evaluated by Kaplan-Meier method and compared by log-rank test. Results: 513 patients who had undergone metastasectomy were identified, 6% were BRAF MT. Median age 63. Metastasectomy rate was lower in BRAF MT (13 v 27%). In BRAF WT, 4% underwent resection of metastases (mets) in >1 organ at diagnosis and 5% had 3 or 4 metastasectomies versus none in BRAF MT. Median OS in BRAF MT v WT: 25.7 v 48.5 months (HR 1.95; 1.18-3.22). In a multivariate model adjusting for variables which were significant on univariate analysis, OS differences were not statistically significant. Right primary tumor, intact primary, >1 metastatic sites at diagnosis, non R0 resection, peritoneal mets and synchronous mets were independent predictors of worse OS. Among 364 patients with RFS data there was no difference between BRAF MT and WT (16 v 19 months, p=0.09). Rate of downsizing was higher with triplet chemo than doublet +/- bevacizumab or doublet/EGFR in BRAF WT (50 v 30%) as well as MT (33 v 11%). Conclusions: Median OS was > 2 years in BRAF MT V600E after metastasectomy in this study consistent with an OS benefit. OS did not differ after metastasectomy between BRAF MT and WT in a multivariate model. Presence of BRAF MT should not impact patient selection for metastasectomy.[Table: see text]
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Affiliation(s)
| | - Rachel Wong
- Eastern Health, Monash University, Melbourne, Australia
| | - Timothy Jay Price
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | | | - Jeanne Tie
- Department of Medical Oncology, Western Health, Melbourne, Australia
| | - Hui-Li Wong
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Margaret Lee
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Azim Jalali
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Guy Maddern
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | | | | - Peter Gibbs
- Royal Melbourne Hospital, Melbourne, Australia
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11
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Ghaneh P, Kleeff J, Halloran CM, Raraty M, Jackson R, Melling J, Jones O, Palmer DH, Cox TF, Smith CJ, O'Reilly DA, Izbicki JR, Scarfe AG, Valle JW, McDonald AC, Carter R, Tebbutt NC, Goldstein D, Padbury R, Shannon J, Dervenis C, Glimelius B, Deakin M, Anthoney A, Lerch MM, Mayerle J, Oláh A, Rawcliffe CL, Campbell F, Strobel O, Büchler MW, Neoptolemos JP. The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma. Ann Surg 2019; 269:520-529. [PMID: 29068800 DOI: 10.1097/sla.0000000000002557] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE AND BACKGROUND Local and distant disease recurrence are frequently observed following pancreatic cancer resection, but an improved understanding of resection margin assessment is required to aid tailored therapies. METHODS Analyses were carried out to assess the association between clinical characteristics and margin involvement as well as the effects of individual margin involvement on site of recurrence and overall and recurrence-free survival using individual patient data from the European Study Group for Pancreatic Cancer (ESPAC)-3 randomized controlled trial. RESULTS There were 1151 patients, of whom 505 (43.9%) had an R1 resection. The median and 95% confidence interval (CI) overall survival was 24.9 (22.9-27.2) months for 646 (56.1%) patients with resection margin negative (R0 >1 mm) tumors, 25.4 (21.6-30.4) months for 146 (12.7%) patients with R1<1 mm positive resection margins, and 18.7 (17.2-21.1) months for 359 (31.2%) patients with R1-direct positive margins (P < 0.001). In multivariable analysis, overall R1-direct tumor margins, poor tumor differentiation, positive lymph node status, WHO performance status ≥1, maximum tumor size, and R1-direct posterior resection margin were all independently significantly associated with reduced overall and recurrence-free survival. Competing risks analysis showed that overall R1-direct positive resection margin status, positive lymph node status, WHO performance status 1, and R1-direct positive superior mesenteric/medial margin resection status were all significantly associated with local recurrence. CONCLUSIONS R1-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.
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Affiliation(s)
- Paula Ghaneh
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jorg Kleeff
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Christopher M Halloran
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Michael Raraty
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Richard Jackson
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
| | - James Melling
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Owain Jones
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Daniel H Palmer
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
| | - Trevor F Cox
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
| | - Chloe J Smith
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
| | - Derek A O'Reilly
- Department of Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Jakob R Izbicki
- Department of Surgery, University of Hamburg Medical institutions UKE, Hamburg, Germany
| | - Andrew G Scarfe
- Department of Oncology Division of Medical Oncology 2228 Cross Cancer Institute and University of Alberta, Canada
| | - Juan W Valle
- Department of Medical Oncology , The Christie, Manchester, UK
| | - Alexander C McDonald
- Department of Medical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - Ross Carter
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Niall C Tebbutt
- Department of Medical Oncology, Austin Health, Melbourne, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales hospital and Clinical School University of New South Wales, Australia
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre, Adelaide, South Australia
| | - Jennifer Shannon
- Department of Medical Oncology, Nepean Cancer Centre and University of Sydney, Australia
| | | | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Mark Deakin
- Department of Surgery, University Hospital, North Staffordshire, UK
| | - Alan Anthoney
- Division of Oncology at the University of Leeds, St James's University Hospital, Leeds, UK
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Attila Oláh
- Department of Surgery, The Petz Aladar Hospital, Gyor, Hungary
| | - Charlotte L Rawcliffe
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
| | - Fiona Campbell
- Department of Pathology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Oliver Strobel
- The Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- The Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - John P Neoptolemos
- Liverpool Cancer Research U.K. Cancer Trials Unit, University of Liverpool, Liverpool, United Kingdom University of Liverpool, Liverpool, UK
- The Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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12
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Afroz F, Jonkman E, Hua J, Kist A, Zhou Y, Sokoya EM, Padbury R, Nieuwenhuijs V, Barritt G. Evidence that decreased expression of sinusoidal bile acid transporters accounts for the inhibition by rapamycin of bile flow recovery following liver ischemia. Eur J Pharmacol 2018; 838:91-106. [PMID: 30179613 DOI: 10.1016/j.ejphar.2018.08.043] [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: 05/23/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/16/2022]
Abstract
Rapamycin is employed as an immunosuppressant following organ transplant and, in patients with hepatocellular carcinoma, to inhibit cancer cell regrowth following liver surgery. Preconditioning the liver with rapamycin to induce the expression of antioxidant enzymes is a potential strategy to reduce ischemia reperfusion (IR) injury. However, pre-treatment with rapamycin inhibits bile flow, especially following ischemia. The aim was to investigate the mechanisms involved in this inhibition. In a rat model of segmental hepatic ischemia and reperfusion, acute administration of rapamycin by intravenous injection did not inhibit the basal rate of bile flow. Pre-treatment of rats with rapamycin for 24 h by intraperitoneal injection inhibited the expression of mRNA encoding the sinusoidal influx transporters Ntcp, Oatp1 and 2 and the canalicular efflux transporter Bsep, and increased expression of canalicular Mrp2. Dose-response curves for the actions of rapamycin on the expression of Bsep and Ntcp in cultured rat hepatocytes were biphasic, and monophasic for effects on Oatp1. In cultured tumorigenic H4IIE liver cells, several bile acid transporters were not expressed, or were expressed at very low levels compared to hepatocytes. In H4IIE cells, rapamycin increased expression of Ntcp, Oatp1 and Mrp2, but decreased expression of Oatp2. It is concluded that the inhibition of bile flow recovery following ischemia observed in rapamycin-treated livers is principally due to inhibition of the expression of sinusoidal bile acid transporters. Moreover, in tumorigenic liver tissue the contribution of tumorigenic hepatocytes to total liver bile flow is likely to be small and is unlikely to be greatly affected by rapamycin.
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Affiliation(s)
- Farhana Afroz
- Department of Medical Biochemistry, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Els Jonkman
- Department of Medical Biochemistry, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Jin Hua
- Department of Medical Biochemistry, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Alwyn Kist
- Department of Medical Biochemistry, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Yabin Zhou
- Department of Medical Biochemistry, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Elke M Sokoya
- Department of Human Physiology, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Robert Padbury
- The HPB and Liver Transplant Unit, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | | | - Greg Barritt
- Department of Medical Biochemistry, Flinders Medical Centre and School of Medicine, Flinders University, Adelaide, South Australia, Australia.
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Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncol 2018. [DOI: 10.1080/0284186x.2018.1487581 10.1080/0284186x.2018.1487581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
| | - Christos S. Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert Padbury
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia
- Menzies Research Institute, Hobart, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Yu Jo Chua
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | - Paul Craft
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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14
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Prasanna T, Karapetis CS, Roder D, Tie J, Padbury R, Price T, Wong R, Shapiro J, Nott L, Lee M, Chua YJ, Craft P, Piantadosi C, Sorich M, Gibbs P, Yip D. The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern. Acta Oncol 2018; 57:1438-1444. [PMID: 30035653 DOI: 10.1080/0284186x.2018.1487581] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. METHODS Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel-Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. RESULTS Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p < .001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p < .001) with lower incidence of lung (RR = 0.3, p = .004) and liver (RR = 0.7, p = .005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p = .007). Left colon tumors were associated with bone (RR = 1.6, p < .001) and lung-only metastases (RR = 2.3, p = .001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p < .001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p = .002, 1.7; p < .001, 2.0; p < .001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p = .01). CONCLUSION Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.
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Affiliation(s)
- Thiru Prasanna
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
| | - Christos S. Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Bedford Park, Australia
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
| | - David Roder
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Robert Padbury
- Flinders Clinical and Molecular Medicine, Surgery, Flinders University, Bedford Park, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Timothy Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - Rachel Wong
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Australia
| | - Louise Nott
- Department of Medical Oncology, Royal Hobart Hospital, Tasmania, Australia
- Menzies Research Institute, Hobart, Australia
| | - Margaret Lee
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Oncology, Eastern Health, Melbourne, Australia
| | - Yu Jo Chua
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | - Paul Craft
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
| | | | - Michael Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Hospital, Melbourne, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Desmond Yip
- Department of Medical Oncology, The Canberra Hospital, Garran, Canberra, Australia
- ANU Medical School, Australian National University, Canberra, Australia
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15
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Afroz F, Kist A, Hua J, Zhou Y, Sokoya EM, Padbury R, Nieuwenhuijs V, Barritt G. Rapamycin induces the expression of heme oxygenase-1 and peroxyredoxin-1 in normal hepatocytes but not in tumorigenic liver cells. Exp Mol Pathol 2018; 105:334-344. [PMID: 30290159 DOI: 10.1016/j.yexmp.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/27/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Abstract
Rapamycin (sirolimus) is employed as an immunosuppressant following liver transplant, to inhibit the re-growth of cancer cells following liver resection for hepatocellular carcinoma (HCC), and for the treatment of advanced HCC. Rapamycin also induces the expression of antioxidant enzymes in the liver, suggesting that pretreatment with the drug could provide a potential strategy to reduce ischemia reperfusion injury following liver surgery. The aim of this study was to further investigate the actions of rapamycin in inducing expression of the antioxidant enzymes heme oxygenase-1 (HO-1) and peroxiredoxin-1 (Prx-1) in normal liver and in tumorigenic liver cells. A rat model of segmental hepatic ischemia and reperfusion, cultured freshly-isolated rat hepatocytes, and tumorigenic H4IIE rat liver cells in culture were employed. Expression of HO-1 and Prx-1 was measured using quantitative PCR and western blot. Rapamycin pre-treatment of normal liver in vivo or normal hepatocytes in vitro led to a substantial induction of mRNA encoding HO-1 and Prx-1. The dose-response curve for the action of rapamycin on mRNA expression was biphasic, showing an increase in expression at 0 - 0.1 μM rapamycin but a decrease from maximum at concentrations greater than 0.1 μM. By contrast, in H4IIE cells, rapamycin inhibited the expression of HO-1 and Prx-1 mRNA. Oltipraz, an established activator of transcription factor Nrf2, caused a large induction of HO-1 and Prx-1 mRNA. The dose response curve for the inhibition by rapamycin of HO-1 and Prx-4 mRNA expression, determined in the presence of oltipraz, was monophasic with half maximal inhibition at about 0.01 μM. It is concluded that, at concentrations comparable to those used clinically, pre-treatment of the liver with rapamycin induces the expression of HO-1 and Prx-1. However, the actions of rapamycin on the expression of these two antioxidant enzymes in normal hepatocytes are complex and, in tumorigenic liver cells, differ from those in normal hepatocytes. Further studies are warranted to evaluate preconditioning the livers of patients subject to liver resection or liver transplant with rapamycin as a viable strategy to reduce IR injury following liver surgery.
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Affiliation(s)
- Farhana Afroz
- Discipline of Medical Biochemistry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alwyn Kist
- Discipline of Medical Biochemistry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jin Hua
- Discipline of Medical Biochemistry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Yabin Zhou
- Discipline of Medical Biochemistry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Elke M Sokoya
- Discipline of Human Physiology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert Padbury
- The HPB and Liver Transplant Unit, Flinders Medical Centre and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Greg Barritt
- Discipline of Medical Biochemistry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
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Sultana A, Brooke-Smith M, Ullah S, Figueras J, Rees M, Vauthey JN, Conrad C, Hugh TJ, Garden OJ, Fan ST, Crawford M, Makuuchi M, Yokoyama Y, Büchler M, Padbury R. Prospective evaluation of the International Study Group for Liver Surgery definition of post hepatectomy liver failure after liver resection: an international multicentre study. HPB (Oxford) 2018; 20:462-469. [PMID: 29287736 DOI: 10.1016/j.hpb.2017.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The International Study Group for Liver Surgery (ISGLS) definition of post hepatectomy liver failure (PHLF) was developed to be consistent, widely applicable, and to include severity stratification. This international multicentre collaborative study aimed to prospectively validate the ISGLS definition of PHLF. METHODS 11 HPB centres from 7 countries developed a standardised reporting form. Prospectively acquired anonymised data on liver resections performed between 01 July 2010 and 30 June 2011 was collected. A multivariate analysis was undertaken of clinically important variables. RESULTS Of the 949 patients included, 86 (9%) met PHLF requirements. On multivariate analyses, age ≥70 years, pre-operative chemotherapy, steatosis, resection of >3 segments, vascular reconstruction and intraoperative blood loss >300 ml significantly increased the risk of PHLF. Receiver operator curve (ROC) analysis of INR and serum bilirubin relationship with PHLF demonstrated post-operative day 3 and 5 INR performed equally in predicting PHLF, and day 5 bilirubin was the strongest predictor of PHLF. Combining ISGLS grades B and C groups resulted in a high sensitivity for predicting mortality compared to the 50-50 rule and Peak bilirubin >7 mg/dl. CONCLUSIONS The ISGLS definition performed well in this prospective validation study, and may be the optimal definition for PHLF in future research to allow for comparability of data.
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Affiliation(s)
- Asma Sultana
- Flinders Medical Centre and Flinders University of South Australia, Australia
| | - Mark Brooke-Smith
- Flinders Medical Centre and Flinders University of South Australia, Australia.
| | - Shahid Ullah
- Flinders Medical Centre and Flinders University of South Australia, Australia; South Australian Health and Medical Research Institute, Australia
| | | | | | | | | | - Thomas J Hugh
- Royal North Shore Hospital and University of Sydney, Australia
| | | | | | | | | | | | | | - Robert Padbury
- Flinders Medical Centre and Flinders University of South Australia, Australia
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17
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Cho JY, Baron TH, Carr-Locke DL, Chapman WC, Costamagna G, de Santibanes E, Dominguez Rosado I, Garden OJ, Gouma D, Lillemoe KD, Angel Mercado M, Mullady DK, Padbury R, Picus D, Pitt HA, Sherman S, Shlansky-Goldberg R, Tornqvist B, Strasberg SM. Proposed standards for reporting outcomes of treating biliary injuries. HPB (Oxford) 2018; 20:370-378. [PMID: 29397335 DOI: 10.1016/j.hpb.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/06/2017] [Accepted: 10/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is no standard nor widely accepted way of reporting outcomes of treatment of biliary injuries. This hinders comparison of results among approaches and among centers. This paper presents a proposal to standardize terminology and reporting of results of treating biliary injuries. METHODS The proposal was developed by an international group of surgeons, biliary endoscopists and interventional radiologists. The method is based on the concept of "patency" and is similar to the approach used to create reporting standards for arteriovenous hemodialysis access. RESULTS The group considered definitions and gradings under the following headings: Definition of Patency, Definition of Index Treatment Periods, Grading of Severity of Biliary Injury, Grading of Patency, Metrics, Comparison of Surgical to Non Surgical Treatments and Presentation of Case Series. CONCLUSIONS A standard procedure for reporting outcomes of treating biliary injuries has been produced. It is applicable to presenting results of treatment by surgery, endoscopy, and interventional radiology.
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Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University, Bundang Hospital, Seoul National University College of Medicine, Seongnam, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 13620, Republic of Korea
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, 130 Mason Farm Road CB 7080, Chapel Hill, NC 27599, USA
| | - David L Carr-Locke
- The Center for Advanced Digestive Care, Weill Cornell Medicine, New York Presbyterian Hospital, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - William C Chapman
- Section of Transplantation, Department of Surgery, Washington University in St Louis, 1 Barnes Hospital Plaza, St Louis, MO 63110, USA
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University of the Sacred Heart, Gemelli Hospital, Largo Agostino Gemelli, 8, Roma, RM 00168, Italy
| | - Eduardo de Santibanes
- Department of Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH CABA, Buenos Aires, Argentina
| | - Ismael Dominguez Rosado
- Department of Surgery, National Institute of Medical Sciences and Nutrition, Vasco de Quiroga 15 Col. Seccion XVI, Tlalpan C.P. 14000, Mexico City, Mexico
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - Dirk Gouma
- Department of Surgery, Faculty of Medicine AMC, University of Amsterdam, Sweelincklaan 15, 1217 CK, Hilversum, The Netherlands
| | - Keith D Lillemoe
- Department of Surgery, White 506, 55 Fruit Street, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Miguel Angel Mercado
- Department of Surgery, National Institute of Medical Sciences and Nutrition, Vasco de Quiroga 15 Col. Seccion XVI, Tlalpan C.P. 14000, Mexico City, Mexico
| | - Daniel K Mullady
- Washington University in St Louis, Department of Medicine, Division of Gastroenterology, Campus Box 8124 660 S Euclid Ave, St Louis, MO 63110, USA
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Flinders Dr, Bedford Park SA 5042, Australia
| | - Daniel Picus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd, St Louis, MO 63110, USA
| | - Henry A Pitt
- Department of Surgery, Lewis Katz School of Medicine at Temple University, 3509 N. Broad Street, Boyer Pavilion, E 938, Philadelphia, PA 19140, USA
| | - Stuart Sherman
- Department of Medicine, Division of Digestive and Liver Disorders, Indiana University Health-University Hospital, 550 North University Blvd, Suite 1634, Indianapolis, IN 46202, USA
| | - Richard Shlansky-Goldberg
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, Silverstein 1st floor, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Bjorn Tornqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Steven M Strasberg
- Section of HPB Surgery, Washington University in St Louis, 1 Barnes Hospital Plaza, St Louis, MO 63110, USA.
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18
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Sultana A, Meng R, Piantadosi C, Brooke-Smith M, Chen J, Dolan P, Maddern G, Price T, Padbury R. Liver resection for colorectal cancer metastases: a comparison of outcomes over time in South Australia. HPB (Oxford) 2018; 20:340-346. [PMID: 29187305 DOI: 10.1016/j.hpb.2017.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/08/2017] [Accepted: 10/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the current study was to assess outcomes following liver resection in metastatic CRC (mCRC) in South Australia across two study periods (pre-2006 versus post-2006). METHODS The South Australian (SA) Clinical Registry for mCRC maintains data prospectively on all patients in SA with mCRC diagnosed from 01 February 2006. This data was linked with a prospectively collated database on liver resections for mCRC from 01/01/1992 to 01/02/2006. The primary end point was overall survival. RESULTS 757 patients underwent liver resection for mCRC. Liver resection was performed on 286 patients pre-2006 and 471 patients post-2006. The median age of the study population was 62 years, and this was similar across both eras. Overall survival was significantly better in the post-2006 era (hazard ratio HR = 0.45, p = 0.001). Complications (59% pre-2006 versus 23% post-2006) and transfusion rates (34% pre-2006 versus 2% post-2006) were significantly higher in the pre-2006 era. Repeat liver resection rates were significantly higher in the post-2006 era (1% pre-2006 versus 10% post-2006). CONCLUSIONS Outcomes following liver resection for mCRC have improved over time, with significantly better overall survival in the post-2006 era compared to pre-2006.
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Affiliation(s)
- Asma Sultana
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia
| | - Rosie Meng
- Centre for Epidemiology and Biostatistics, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - Cynthia Piantadosi
- South Australian Metastatic Colorectal Cancer Registry, Flinders Centre for Innovation in Cancer, Bedford Park SA 5049, Australia
| | - Mark Brooke-Smith
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia
| | - John Chen
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia
| | - Paul Dolan
- Department of HPB Surgery, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia
| | - Guy Maddern
- Department of HPB Surgery, Queen Elizabeth Hospital, Woodville, SA 5011, Australia; Discipline of Surgery, University of Adelaide, Adelaide, SA 5005, Australia
| | - Timothy Price
- Department of Medical Oncology, Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Robert Padbury
- Department of HPB Surgery, Flinders Medical Centre, Bedford Park, SA 5045, Australia; Department of Surgery, Faculty of Medicine, Flinders University, Adelaide, SA 5001, Australia.
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19
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Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D, Pitt HA, Yoshida M, Gomi H, Miura F, Garden OJ, Kiriyama S, Yokoe M, Endo I, Asbun HJ, Iwashita Y, Hibi T, Umezawa A, Suzuki K, Itoi T, Hata J, Han HS, Hwang TL, Dervenis C, Asai K, Mori Y, Huang WSW, Belli G, Mukai S, Jagannath P, Cherqui D, Kozaka K, Baron TH, de Santibañes E, Higuchi R, Wada K, Gouma DJ, Deziel DJ, Liau KH, Wakabayashi G, Padbury R, Jonas E, Supe AN, Singh H, Gabata T, Chan ACW, Lau WY, Fan ST, Chen MF, Ker CG, Yoon YS, Choi IS, Kim MH, Yoon DS, Kitano S, Inomata M, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2017; 25:96-100. [PMID: 29090868 DOI: 10.1002/jhbp.519] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Schlossberg
- Professor of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.,Medical Director, TB Control Program, Philadelphia, PA, USA.,Department of Public Health, Philadelphia, PA, USA
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.,Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | - Harumi Gomi
- Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Horacio J Asbun
- Department of Surgery, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Jiro Hata
- Department of Endoscopy and Ultrasound, Kawasaki Medical School, Okayama, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, NC, USA
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kui-Hin Liau
- Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama, Japan
| | - Robert Padbury
- Division of Surgical and Specialty Services, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Harjit Singh
- Department of Hepato-Pancreato-Biliary Surgery, Hospital Selayang, Selangor, Malaysia
| | | | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sheung Tat Fan
- Director, Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Myung-Hwan Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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20
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Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, Ukai T, Shikata S, Noguchi Y, Teoh AYB, Kim MH, Asbun HJ, Endo I, Yokoe M, Miura F, Okamoto K, Suzuki K, Umezawa A, Iwashita Y, Hibi T, Wakabayashi G, Han HS, Yoon YS, Choi IS, Hwang TL, Chen MF, Garden OJ, Singh H, Liau KH, Huang WSW, Gouma DJ, Belli G, Dervenis C, de Santibañes E, Giménez ME, Windsor JA, Lau WY, Cherqui D, Jagannath P, Supe AN, Liu KH, Su CH, Deziel DJ, Chen XP, Fan ST, Ker CG, Jonas E, Padbury R, Mukai S, Honda G, Sugioka A, Asai K, Higuchi R, Wada K, Yoshida M, Mayumi T, Hirata K, Sumiyama Y, Inui K, Yamamoto M. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 2017; 25:87-95. [PMID: 28888080 DOI: 10.1002/jhbp.504] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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21
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Price T, Hardingham J, Karapetis C, Smith E, Padbury R, Roy A, Roder D, Burge M, Townsend A. Bevacizumab first line and impact on subsequent anti-EGFR activity. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Price TJ, Karapetis CS, Padbury R, Burge ME, Roy AC, Maddern G, Roder D, Piantadosi C, Townsend AR. Bevacizumab and its impact on survival for patients receiving subsequent anti-EGFR therapy: Updated results from the SA metastatic CRC registry. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.3569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3569 Background: Debate exists as to whether first line bevacizumab effects subsequent sensitivity to anti-EGFR therapy. Authors hypothesize that initial anti-VEGF therapy may induce biological changes that then increase the risk of acquired resistance to subsequent EGFR inhibitors. Methods: A retrospective cohort study was performed to compare the characteristics and survival of patients who were treated with an anti-EGFR therapy 2nd line and beyond by two groups defined by the first line therapy; 1. chemotherapy (chemo) plus bevacizumab (bev) and 2. chemo alone. Survival for this analysis is from the time of commencing first line chemotherapy and secondly from anti-EGFR therapy. Pearson chi test analysis was performed to determine whether receiving first line bev was associated with worse overall survival (OS). Results: 348 mCRC patients who received chemo with or without bev and then an anti-EGFR therapy were studied. Patient characteristics are summarised in the table below. The significant differences between group 1. Vs. 2. were as follows; median age 63.8 years v 67.9 years (p = 0.005), lower use of single agent FU 6.4% v 19.2%, KRAS status not tested (reflecting the practice changes over time) 19.3% v 39.2%, KRAS MT 2% v 4%, and where BRAF MT status was known (11%); BRAF MT rate 23% v 0. Median OS for the 2 groups was 34.2 months, and 28.2 months respectively (p = 0.12) from first line therapy. Median OS for patients who underwent single agent anti-EGFR as subsequent therapy was also not significantly different, 31.1 months group 1 (n = 60) versus 27.7 months group 2 (n = 85), p = 0.52. Results based on commencement of anti-EGFR therapy are under way. Conclusions: Survival was not significantly different between the two groups, and the trend was towards higher OS with chemo plus bev suggesting that in our registry population, bev administration in first line therapy with chemo did not lead to a worse outcome overall for those patients subsequently receiving anti-EGFR therapy, either with chemotherapy or as a single agent. Updated results from commencement of anti-EGFR therapy will give further insights and will be presented at the meeting.
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Affiliation(s)
- Timothy Jay Price
- Queen Elizabeth Hospital and Lyell McEwin Hospital, Adelaide, Australia
| | | | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | | | | | - Guy Maddern
- Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Division of Health Sciences, Sansom Institute for Health Research, Adelaide, Australia
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23
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Su YL, Woodman RJ, Silva MF, Muller K, Libby J, Chen JW, Padbury R, Wigg AJ. Good outcomes of liver transplantation for hepatitis C at a low volume centre. Ann Hepatol 2017; 15:207-14. [PMID: 26845598 DOI: 10.5604/16652681.1193713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Concerns exist about outcomes of liver transplantation (LT) from low volume centres, especially for hepatitis C (HCV) patients. The aim of the study was to assess patient outcomes as well as their predictors post LT for HCV in a small volume Australian unit (< 25 LTs/year), comparing these with the average outcomes obtained from national and international transplant registries. Patients transplanted for HCV at the South Australian Liver Transplant Unit between 1992 and 2012 were studied. Outcomes assessed were patient and graft survival at 1,3, and 5 years. Factors independently associated with the outcomes were assessed using Cox regression model. RESULTS 1, 3, and 5-year patient survival for HCV patients was 95.2, 82.9, and 78.2%, graft survival were 93.7, 80.1, and 75.5% respectively. The total follow-up time observed was 299.9 years amongst 61 patients in which there were 16 deaths. The expected number of deaths was 40.4 and the standardized mortality ratio 0.40 (95% CI = 0.24, 0.65). These results compared favourably to those obtained from the SRTR registry. Variables independently associated with lower patient survival: donor age (HR = 1.06, 95% CI 1.02 - 1.11; P = 0.003), and post LT cytomegalovirus (CMV) disease requiring treatment (HR = 4.03, 95% CI 1.48 - 10.92;P = 0.06). CONCLUSION In conclusion, high rates of patient and graft survival for HCV liver transplantation can be obtained in a small volume unit. Young donor age and lack of CMV disease post-transplant were associated with better outcomes. Institutional factors may be influential determinants of outcomes.
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Affiliation(s)
- Yin Lau Su
- Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia; The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University of South Australia, Adelaide, South Australia
| | - Mauricio F Silva
- The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia; LiverTransplant Unit, Irmandade Santa Casa de Misericordiade Porto Alegre, Brazil
| | - Kate Muller
- Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia; The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia
| | - John Libby
- The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia
| | - John W Chen
- The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia
| | - Robert Padbury
- The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia
| | - Alan J Wigg
- Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, South Australia; The South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia
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24
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Price TJ, Karapetis CS, Roy AC, Padbury R, Maddern G, Roder D, Piantadosi C, Burge ME, Townsend AR. Bevacizumab and its impact on survival for patients receiving subsequent anti-EGFR therapy: Results from the South Australian metastatic colorectal cancer registry. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
754 Background: Questions over the impact of 1st line bevacizumab on subsequent sensitivity to anti-EGFR therapy have been raised with authors hypothesizing that up-front anti-VEGF agent’s use influences biological changes that increase the risk of acquired resistance to subsequent EGFR inhibitors. Methods: Aretrospective cohort study was performed to compare the characteristics and survival of patients who were treated with an anti-EGFR therapy 2nd line and beyond by two groups defined by the 1st line therapy; 1. chemotherapy (chemo) plus bevacizumab (bev) and 2. chemo alone. Pearson chi test analysis was performed to determine whether receiving 1st line bev was associated with worse OS. Results: 348 mCRC patients who received chemo with or without bev and then an anti-EGFR therapy were studied. Patient characteristics are summarised in table. The significant differences between group 1. Vs. 2. were as follows; median age, lower use of single agent FU, KRAS status not tested, and where BRAF MT status was known (11%); BRAF MT rate. Median OS for the 2 groups was 34.2 mths, and 28.2 mths respectively (p = 0.12). Conclusions: Survival was not significantly different between the two groups, and the trend was towards higher OS with chemo plus bev suggesting that in our registry population, bev administration in first line therapy with chemo did not lead to a worse outcome for those patients subsequently receiving anti-EGFR therapy. [Table: see text]
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Affiliation(s)
- Timothy Jay Price
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Christos Stelios Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | | | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Guy Maddern
- Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Division of Health Sciences, Sansom Institute for Health Research, Adelaide, Australia
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Price TJ, Karapetis CS, Piantadosi C, Padbury R, Roy AC, Maddern G, Gonzalo TR, Moore J, Roder D, Townsend AR. Nonagenarian patients with metastatic colorectal cancer: Results from the South Australian metastatic colorectal cancer registry. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
752 Background: With improved healthcare we now face an ageing population worldwide. More patients with metastatic colorectal cancer (mCRC) will present at advanced age. Patients with mCRC now have the potential of living longer due to surgery, chemotherapeutic agents and monoclonal antibodies. Australian data (2011) indicated 1.3% of the population are aged over 90 years*. Medical oncologists are now being referred patients in their 90’s and the optimal management for this group is unknown. Methods: The population based South Australian Clinical Registry for mCRC includes all patients with metastatic CRC diagnosed since the 1st February 2006. We examined cancer characteristics, treatments administered and outcomes for patients aged > 90 years. Results: 130 patients of 4199 (3%) were aged 90 years or older. The median age was 92.1 years (range 90-104.8 years). 61% were female, 70% presented with synchronous disease. Organ involvement was as follows; 58% liver, 32% lung, 8% peritoneal and 7% bone. Primary site was: right 46%, left 28%, rectum 20%, unknown 6%. Only 4 patients had KRAS testing (all WT). 44.6% overall have had no surgery for their CRC primary. 24% of those with synchronous disease at diagnosis had resection of primary lesion and 3% had stoma formed for palliation. One patient had lung resection for metastasis. Only 4 patients received systemic therapy (age range 90-93). Lines of therapy delivered; one in 2 patients, two lines in one and 4 lines in one. Aside single agent 5FU, combination therapy (oxaliplatin/FU+/- bevacizumab) was given to two patients and cetuximab single agent in 2 (WT one, unknown one). The median survival overall was 3 months (95% CI 1.4-4.6 months). Two year survival was 10%. Conclusions: This analysis gives us some insight into the management of the very old. Female sex and right sided cancers are more frequent. Systemic therapy is rarely offered and the outlook is poor. Further research to understand whether active therapy is possible or warranted in this age group should be considered. *http://www.abs.gov.au/ausstats/abs@.nsf
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Affiliation(s)
- Timothy Jay Price
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Christos Stelios Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | | | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | | | - Guy Maddern
- Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia
| | | | - James Moore
- Royal Adelaide Hospital, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Division of Health Sciences, Sansom Institute for Health Research, Adelaide, Australia
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Price TJ, Beeke C, Townsend AR, Lo L, Amitesh R, Padbury R, Roder D, Maddern G, Moore J, Karapetis C. BRAF Mutation Testing and Metastatic Colorectal Cancer in the Community Setting: Is There an Urgent Need for More Education? Mol Diagn Ther 2016; 20:75-82. [PMID: 26714964 DOI: 10.1007/s40291-015-0179-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with metastatic colorectal cancer (mCRC) with BRAF mutation (BRAF MT) generally have a poorer prognosis. BRAF MT may also have implications for treatment strategy. Despite this, inclusion of BRAF in routine molecular testing varies. Here we report the frequency of BRAF reporting in the South Australian (SA) mCRC registry reflecting community practice, together with the survival outcomes based on mutation status. METHODS The SA population-based mCRC registry was analysed to assess the number of patients where a BRAF MT result was available. The patient characteristics are reported and overall survival was analysed using the Kaplan-Meier method. RESULTS Of the 3639 patients who have been entered in the registry, only 6.2% (227) have BRAF MT results available. Of the patients tested, the BRAF MT rate is 12.7%. The mutation rate was highest in rightsided primary; right colon 23 versus left colon 8.9% and rectum 7%. There was no significant difference in median age or male/female proportion. The median overall survival (mOS) for BRAF MT versus wild-type (WT) patients is 14.0 versus 32.9 months (p = 0.003). For patients who have chemotherapy (plus or minus surgery) the mOS is 14.6 months BRAF MT versus 36.1 months (p ≤ 0.001) WT. Liver or lung resection was performed on only 8% of the BRAF MT group versus 26.5% of the WT group. CONCLUSION Results in a population setting confirm our understanding that BRAF MT is more frequently right sided and of lower frequency in rectal cancer. Survival is lower for patients with mCRC that have BRAF MT, regardless of the therapy. BRAF testing is currently performed infrequently in an Australian setting despite its importance as a significant prognostic factor, and the implications for alternate therapeutic approaches.
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Affiliation(s)
- Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.
| | - Carol Beeke
- Department of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Amanda Rose Townsend
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Louisa Lo
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia
| | - Roy Amitesh
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - David Roder
- School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Guy Maddern
- Department of Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - James Moore
- Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christos Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
- Flinders University, Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia
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Price T, Karapetis C, Piantadosi C, Rico GT, Padbury R, Maddern G, Moore J, Carruthers S, Roder D, Townsend A. Brain metastasis in advanced colorectal cancer: Results from the South Australian metastatic colorectal cancer (SAmCRC) registry. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ayoola A, Vantandoust S, Roy A, Price T, Kitchener M, Roder D, Quinn S, Kichenadasse G, Piantadosi C, Padbury R, Karapetis C. Selective internal radiation therapy (SIRT) in metastatic colorectal cancer (mCRC): Safety, efficacy and survival outcomes from the South Australian registry. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vatandoust S, Price TJ, Ullah S, Roy AC, Beeke C, Young JP, Townsend A, Padbury R, Roder D, Karapetis CS. Metastatic Colorectal Cancer in Young Adults: A Study From the South Australian Population-Based Registry. Clin Colorectal Cancer 2016; 15:32-6. [PMID: 26341410 DOI: 10.1016/j.clcc.2015.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
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Price T, Townsend A, Beeke C, Roder D, Padbury R, Maddern G, Roy A, Patel D, Moore J, Karapetis C. 2163 BRAF testing in the community setting; are we testing enough given the importance of BRAF mutation and the clinical implications? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Patel GS, Ullah S, Beeke C, Hakendorf P, Padbury R, Price TJ, Karapetis CS. Association of BMI with overall survival in patients with mCRC who received chemotherapy versus EGFR and VEGF-targeted therapies. Cancer Med 2015. [PMID: 26211512 PMCID: PMC4618617 DOI: 10.1002/cam4.490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although a raised body mass index (BMI) is associated with increased risk of colorectal cancer (CRC) and recurrence after adjuvant treatment, data in the metastatic setting is limited. We compared overall survival (OS) across BMI groups for metastatic CRC, and specifically examined the effect of BMI within the group of patients treated with targeted therapies (TT). Retrospective data were obtained from the South Australian Registry for mCRC from February 2006 to October 2012. The BMI at first treatment was grouped as underweight <18.5 kg/m2, Normal = 18.5 to <25 kg/m2, Overweight = 25 to <30 kg/m2, Obese I = 30 to <35 kg/m2, Obese II ≥35 kg/m2. Of 1174 patients, 42 were underweight, 462 overweight, 175 Obese I, and 77 Obese II. The OS was shorter for patients who were underweight and overweight compared to normal (OS 13.7 and 22.3 vs. 24.1 months, respectively, hazard ratio [HR] 2.21 and 1.23). The adjusted median OS was longer for normal versus overweight or obese I patients receiving chemotherapy + targeted therapy (35.7 vs 25.1 or 22.8 months, HR 1.59 and 1.63, respectively) with no difference in OS for chemotherapy alone. On breakdown by type of targeted therapy, overweight and obese I patients had a poorer outcome with Bevacizumab. The BMI is predictive of a poorer outcome for underweight and overweight patients in the whole population. Of those receiving chemotherapy and targeted therapy, BMI is an independent predictor for OS for overweight and obese I patients, specifically for those treated with Bevacizumab. Patients who are overweight or obese (group I) may be a target group for lifestyle and nutrition advice to improve OS with TT.
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Affiliation(s)
- Gargi S Patel
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Shahid Ullah
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Carol Beeke
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Robert Padbury
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
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Price TJ, Tomita Y, Beeke C, Padbury R, Townsend AR, Maddern G, Roy A, Roder D, Karapetis CS. Survival for patients with resectable lung metastatic colorectal cancer (mCRC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
708 Background: Hepatic resection for CRC metastasis is now considered a standard of care and perioperative chemotherapy may improve outcomes. Resection of metastasis isolated to lung is also considered potentially curable, although there is still some variation in recommendations and no evidence for perioperative or adjuvant chemotherapy. Here, we explore patient characteristics and outcomes for patients undergoing lung resection for mCRC, with the liver resection group as the comparator. Methods: SA mCRC registry data were analysed to assess patient characteristics and survival outcomes between patients suitable for lung or liver resection. K-M survival analysis was used to assess OS. Results: 3,241 patient are registered on the database. 102 (3.1%) patients were able to undergo a lung resection compared to 420 (12.9%) a liver resection. Of the lung resection patients, 21% initially presented with liver only disease, 11% both lung and liver, and 7% brain or pelvic disease. 62 (61%) presented with lung only disease. Of these patients, 79% went straight to surgery and 34% had lung resection as the only intervention. When comparing the groups, they were balanced for age and sex, liver v lung; 67.7 years v 69.5 years, 63.6% v 57.8% male. There was no difference in pathological grade or KRAS MT rate when tested (36% liver v 32% lung). Compared to patients undergoing liver resection, those having lung resection were more likely to be metachronous (75.5% v 44%, p=<0.0001) and have a rectal primary (43.1% v 30.7%, p=0.017). Chemotherapy for metastatic disease was given more often in liver resection patients (76.9% v 53.9%, p=0.17). Median overall survival is not reached for both arms and the lower hazard rate for lung than liver resection does not approach statistical significance (HR 0.82, 95% CI 0.54-1.24, p=0.33). The 3 and 5 year survival liver v lung as follows; 77% v 81% and 62% v 70%. Conclusions: Lung resection occurs less frequently than liver resection for metastatic disease as expected. There was no statistical difference in overall survival in patients suitable for lung or liver resection. These data support the potential for long term survival with resection of both lung and liver metastasis in mCRC.
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Affiliation(s)
- Timothy Jay Price
- Queen Elizabeth Hospital, University of Adelaide, Woodville, Australia
| | - Yoko Tomita
- Queen Elizabeth Hospital, Adelaide, Australia
| | - Carol Beeke
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | | | - Guy Maddern
- Queen Elizabeth Hospital, Adelaide, Australia
| | - Amitesh Roy
- Flinders Medical Centre, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Division of Health Sciences, Sansom Institute for Health Research, Adelaide, Australia
| | - Christos Stelios Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
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Hocking C, Broadbridge VT, Karapetis C, Beeke C, Padbury R, Maddern GJ, Roder DM, Price TJ. Equivalence of outcomes for rural and metropolitan patients with metastatic colorectal cancer in South Australia. Med J Aust 2015; 201:462-6. [PMID: 25332033 DOI: 10.5694/mja14.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the management and outcome of rural and metropolitan patients with metastatic colorectal cancer (mCRC) in South Australia. DESIGN, SETTING AND PATIENTS Retrospective cohort study of patients with mCRC submitted to the South Australian mCRC registry between 2 February 2006 and a cut-off date of 28 May 2012. MAIN OUTCOME MEASURES Differences in oncological and surgical management and overall survival (calculated using the Kaplan-Meier method) between city and rural patients. RESULTS Of 2289 patients, 624 (27.3%) were rural. There was a higher proportion of male patients in the rural cohort, but other patient characteristics did not significantly differ between the cohorts. Equivalent rates of chemotherapy administration between city and rural patients were observed across each line of treatment (first line: 56.0% v 58.3%, P = 0.32; second line: 23.3% v 22.5%, P = 0.78; and third line: 10.1% v 9.3%, P = 0.69). A higher proportion of city patients received combination chemotherapy in the first-line setting (67.4% v 59.9%; P = 0.01). When an oxaliplatin combination was prescribed, oral capecitabine was used more frequently in rural patients (22.9% v 8.4%; P < 0.001). No significant difference was seen in rates of hepatic resection or other non-chemotherapy treatments between cohorts. Median overall survival was equivalent between city and rural patients (14.6 v 14.9 months, P = 0.18). CONCLUSION Patterns of chemotherapy and surgical management of rural patients with mCRC in SA are equivalent to their metropolitan counterparts and lead to comparable overall survival. The centralised model of oncological care in SA may ensure rural patients gain access to optimal care.
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Affiliation(s)
| | | | - Christos Karapetis
- Flinders Cancer Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Carol Beeke
- Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Robert Padbury
- Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - David M Roder
- School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Timothy J Price
- Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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Brooke-Smith M, Figueras J, Ullah S, Rees M, Vauthey JN, Hugh TJ, Garden OJ, Fan ST, Crawford M, Makuuchi M, Yokoyama Y, Büchler M, Weitz J, Padbury R. Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study. HPB (Oxford) 2015; 17:46-51. [PMID: 25059275 PMCID: PMC4266440 DOI: 10.1111/hpb.12322] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition. METHODS Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally. RESULTS Bile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5-15 times greater risk of intervention required in this group (P < 0.001). CONCLUSION The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.
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Affiliation(s)
- Mark Brooke-Smith
- Flinders Medical CentreBedford Park, SA, Australia,Flinders University of South AustraliaBedford Park, SA, Australia,Correspondence, Mark Brooke-Smith, Department of Surgery and Specialty Services, Flinders Medical Centre, Bedford Park, SA 5065, Australia. Tel: +61 8 8204 4253. Fax: +61 8 8204 5843. E-mail:
| | | | - Shahid Ullah
- Flinders Medical CentreBedford Park, SA, Australia,Flinders University of South AustraliaBedford Park, SA, Australia
| | | | | | | | | | | | | | | | | | - Marcus Büchler
- Department of Surgery, Technische Universität DresdenDresden, Germany
| | - Juergen Weitz
- Department of Surgery, Technische Universität DresdenDresden, Germany
| | - Robert Padbury
- Flinders Medical CentreBedford Park, SA, Australia,Flinders University of South AustraliaBedford Park, SA, Australia
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Price TJ, Beeke C, Ullah S, Padbury R, Maddern G, Roder D, Townsend AR, Moore J, Roy A, Tomita Y, Karapetis C. Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease? Cancer 2014; 121:830-5. [PMID: 25377235 DOI: 10.1002/cncr.29129] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [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: 07/14/2014] [Revised: 09/07/2014] [Accepted: 09/23/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous reports have described differences in biology and outcome for colorectal cancer based on whether the primary is right or left sided. Further division by right, left, and rectum or even exact primary site has also been explored. Possible differences in response to biological agents have also been reported based on side of primary lesion. METHODS We explored the South Australian registry for metastatic colorectal cancer to assess if there were any differences in patient characteristics, prognostic markers, and treatment received and outcomes based on whether the primary was right or left sided. We also explored if differences exist based on left colon and rectum and by exact primary site. RESULTS Two thousand nine hundred seventy-two patients were analyzed. Thirty-five percent had a right-sided primary. The median overall survival for the entire group right versus left was 9.6 versus 20.3 months (P < .001). Multivariate analysis confirmed side of primary as an independent prognostic factor. For the group that had active therapy, defined as chemotherapy (± metastasis resection), median overall survival was right, 18.2 months; and left, 29.4 months (P < .001). Importantly, we found no suggestion of major differences if left side was divided by left colon and rectum, and trends by individual site still supported a left and right division. CONCLUSIONS Patients with a right-sided primary have more negative prognostic factors and indeed have inferior outcomes compared with those with a left-sided primary. Our data with further breakdown by exact site still favor a simple left-versus-right division moving forward for metastatic colorectal cancer.
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Affiliation(s)
- Timothy J Price
- Department Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide, Adelaide, South Australia, Australia
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Price T, Beeke C, Padbury R, Roder D, Townsend A, Maddern G, Roy A, Karapetis C. Does Exact Primary Site Impact on Outcome for Metastatic Colorectal Cancer (Mcrc)? Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Charakidis M, Price TJ, Beeke C, Padbury R, Roder D, Townsend AR, Maddern G, Roy AC, Carruthers S, Karapetis CS. Survival improvements associated with access to biologic agents: Results from the South Australian (SA) Metastatic Colorectal (mCRC) Registry. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Timothy Jay Price
- The Queen Elizabeth Hospital and University of Adelaide, Woodville, Australia
| | - Carol Beeke
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Division of Health Sciences, Sansom Institute for Health Research, Adelaide, Australia
| | | | - Guy Maddern
- The Queen Elizabeth Hospital, Adelaide, Australia
| | | | | | - Christos Stelios Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
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Karapetis CS, Padman SJA, Beeke C, Padbury R, Kitchener M, Kirkwood I, Voyvodic F, Ayres O, Price TJ. The management of colorectal cancer (CRC) liver metastases with yttrium-90 microspheres (Y90): The south Australian (SA) experience. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
666 Background: Treatment of CRC liver metastases with Y90 may provide a survival benefit but remains under investigation. We report on the accumulated SA clinical experience of using Y90 in the treatment of patients with metastatic CRC. Methods: Data from the SA mCRC Database was used to analyse the baseline characteristics of patients treated with Y90 to determine patterns of care. Safety and adverse outcomes, tumour response, disease progression, and survival were also examined. Survival outcomes were analysed using Kaplan Meier estimates, and chi square testing used for comparisons. Results: 33 patients received Y90, with median age 67 (range 33-83), 25 male, 29 colon/4 rectal primary, 25 hepatic only metastatic disease. Systemic therapy pre Y90 was as follows; nil=4, 1 line=7, 2 lines=9, ≥3=11, unknown=2. There were no immediate Grade III/IV adverse events, though immediate toxicity occurred in 9 patients; liver capsule pain in 8, chest pain and vomiting in 1 patient. Following Y90 treatment, radiologist reported response showed: measurable reduction =3 (ORR 9%), SD=4, PD=20, and 1 patient unknown. Treatment beyond Y90; nil=16 patients, 1 line=7, 2 lines=7 and >3=2 patients. Data on hepatic progression free survival (PFS) and overall PFS is currently being analysed. Median survival from the time of Y90 treatment was 10.3 months. Conclusions: Our data show Y90 use in SA occurs most often after 2 lines of chemotherapy. No immediate grade 3/4 toxicity was encountered. Survival for this select group appears longer than expected. Data on mOS from delivery of Y90, hepatic PFS and overall PFS for subgroups will be reported.
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Affiliation(s)
| | | | - Carol Beeke
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Michael Kitchener
- Department of Nuclear Medicine, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Ian Kirkwood
- Department of Nuclear Medicine, Royal Adelaide Hospital, and The University of Adelaide, Adelaide, Australia
| | - Frank Voyvodic
- Department of Medical Imaging, Flinders Medical Centre and Flinders University, Bedford Park, Australia
| | - Oliver Ayres
- Department of Medical Imaging, Flinders Medical Centre, Bedford Park, Australia
| | - Timothy Jay Price
- The Queen Elizabeth Hospital and University of Adelaide, Woodville, Australia
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Price TJ, Beeke C, Padbury R, Maddern G, Roder D, Moore J, Townsend AR, Roy A, Hocking C, Karapetis CS. Right (R) or left (L) primary site of colorectal cancer and outcomes for metastatic colorectal cancer (mCRC): Results from the south Australian registry of mCRC. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
596 Background: Previous reports have described differences in biology and outcome based on whether the primary is R or L sided. Possible differences in response to biological agents have also been reported based on side of primary lesion (SY Brule et al., JCO31, 2013 (supp #3528). Methods: We explored the SA mCRC registry to assess if there were any differences in patient characteristics, treatment received and outcomes based on whether the primary was R (caecum to transverse colon) or L (splenic flexure to rectum) sided (JA Bufill, Ann Int Med. 113, 1990, 779-788). KM was used for survival outcomes and Cox proportional hazards regression modeling was used to assess defined prognostic markers. Results: 2,877 patients were analysed. 33% had R sided primary. Major differences between R and L respectively are as follows; Female 51.3% vs. 37.9% (p = <0.0001), Med age 75.8 yrs vs. 70.5yrs (p = <0.0001), poorly differentiated pathology 34.3% vs. 20.8% (p = <0.0001), KRAS mutation 48% vs. 37% (p = 0.023), and liver surgery 10.5% vs. 16.3% (p = <0.0001). Analysis of chemotherapy (defined as either cytotoxic and/or molecular-targeted) revealed similar rates of first-line therapy, but differences in rates of therapy beyond first-line R vs. L respectively; second-line 46% vs. 60.4%, third-line 17% vs. 30%, fourth-line 7% vs. 13%. There was however no difference in single agent vs. combination first-line therapy. The median overall survival (mOS) for the entire group R vs. L was 9.6 vs. 20.3 months (p <0.0001). For the group who had active therapy defined as chemotherapy (+/- metastasis resection), mOS was R 18.2 months vs. L 29.4 months (p <0.0001). For those (n = 123) who underwent liver resection (+/- chemotherapy) mOS was 6.2 years for both R and L (p = 0.32). Patients who were treated with only chemotherapy, the mOS was 10.7 mths vs. 15.3 mths for R v L (p = 0.0005). Conclusions: Patients with R sided primary have more negative prognostic factors and indeed have inferior outcomes when compared with those with a L sided primary. This did not appear to be the case for patients who were suitable for hepatic surgery.
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Affiliation(s)
- Timothy Jay Price
- The Queen Elizabeth Hospital and University of Adelaide, Woodville, Australia
| | - Carol Beeke
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Robert Padbury
- Department of Surgery, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Guy Maddern
- The Queen Elizabeth Hospital, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Division of Health Sciences, Sansom Institute for Health Research, Adelaide, Australia
| | - James Moore
- Royal Adelaide Hospital, Adelaide, Australia
| | | | - Amitesh Roy
- Flinders Medical Centre, Adelaide, Australia
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Padman S, Padbury R, Beeke C, Karapetis CS, Bishnoi S, Townsend AR, Maddern G, Price TJ. Liver only metastatic disease in patients with metastatic colorectal cancer: impact of surgery and chemotherapy. Acta Oncol 2013; 52:1699-706. [PMID: 24102180 DOI: 10.3109/0284186x.2013.831473] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Metastatectomy in colorectal cancer (CRC) is now a standard of care with improved survival reported. Conversion chemotherapy has increased the population who are suitable for surgery. Here we assess patterns of care and treatment outcome in liver only metastases in South Australia using the clinical registry for advanced CRC. METHODS We analysed the outcomes for patients with liver only metastatic involvement from the SA Metastatic CRC Database with the aim to investigate the role of chemotherapy on liver resection and outcome in comparison to liver resection only and chemotherapy without liver resection. Patients who had no therapy or non-surgical liver interventions were excluded for this analysis. RESULTS One thousand nine hundred and eight patients were available for analysis, 687 (36%) had liver only metastatic disease and 455 (24%) had active therapy as defined. In total 54.2% (247/455) had chemotherapy alone, 19.1% (87/455) had liver resection alone, and 26.6% (121/455) had combined treatment. The three-year survival for chemotherapy, resection and combined treatment subgroups is 19.5%, 73.8% and 73.7%, respectively. The addition of chemotherapy to surgery did not improve survival. Switching chemotherapy was associated with a poorer outcome; three-year overall survival for chemotherapy switch was 62.5%, compared with same regimen pre- and post-74%, and chemo post-resection 80%. CONCLUSION Liver only metastatic disease is common in CRC and patients undergoing liver resection have improved long-term survival. Survival for a combined approach of chemotherapy and hepatic resection is similar to surgery alone. Patients not suitable for surgery with liver only disease have a poorer prognosis highlighting the need for improved liver-directed therapies and attempts to covert non-resectable to resectable disease if possible.
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Affiliation(s)
- Sunita Padman
- Department of Medical Oncology, The Queen Elizabeth Hospital and University of Adelaide , South Australia , Australia
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Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Gomi H, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF, Dervenis C, Chan ACW, Supe AN, Liau KH, Kim MH, Kim SW. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013. [PMID: 23307001 DOI: 10.1007/s00534-012- 0561-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6 %) and high specificity (77.7 %). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis--hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia--have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
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Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Gomi H, Dervenis C, Windsor JA, Kim SW, de Santibanes E, Padbury R, Chen XP, Chan ACW, Fan ST, Jagannath P, Mayumi T, Yoshida M, Miura F, Tsuyuguchi T, Itoi T, Supe AN. TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 2013; 20:89-96. [PMID: 23307007 DOI: 10.1007/s00534-012-0567-x] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is now accepted as a surgical procedure for acute cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with acute cholecystitis. The updated Tokyo Guidelines 2013 (TG13) describe the surgical treatment for acute cholecystitis according to the grade of severity, the timing, and the procedure used for cholecystitis in a question-and-answer format using the evidence concerning surgical management of acute cholecystitis. METHODS AND MATERIALS Forty-eight publications were selected for a careful examination of their full texts, and the types of surgical management of acute cholecystitis were investigated using this evidence. The items concerning the surgical management of acute cholecystitis were the optimal surgical treatment for acute cholecystitis according to the grade of severity, optimal timing for the cholecystectomy, surgical procedure used for cholecystectomy, optimal timing of the conversion of cholecystectomy from laparoscopic to open surgery, and the complications of laparoscopic cholecystectomy. RESULTS There were eight RCTs and four meta-analyses concerning the optimal timing of the cholecystectomy. Consequently, it was found that cholecystectomy is preferable early after admission. There were three RCTs and two meta-analyses concerning the surgical procedure, which concluded that laparoscopic cholecystectomy is preferable to open procedures. Literature concerning the surgical treatment according to the grade of severity could not be quoted, because there have been no publications on this topic. Therefore, the treatment was determined based on the general opinions of professionals. CONCLUSION Surgical management of acute cholecystitis in the updated TG13 is fundamentally the same as in the Tokyo Guidelines 2007 (TG07), and the concept of a critical view of safety and the existence of extreme vasculobiliary injury are added in the text to call the surgeon's attention to the need to reduce the incidence of bile duct injury. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Gomi H, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF, Dervenis C, Chan ACW, Supe AN, Liau KH, Kim MH, Kim SW. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2013; 20:24-34. [PMID: 23307001 DOI: 10.1007/s00534-012-0561-3] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteria. The diagnostic criteria of TG07 do not have enough sensitivity and specificity, and its severity assessment criteria are unsuitable for clinical use. A working team for the revision of TG07 was organized in June, 2010, and these criteria have been updated through clinical implementation and its assessment by means of multi-center analysis. The diagnostic criteria of acute cholangitis have been revised as criteria to establish the diagnosis where cholestasis and inflammation demonstrated by clinical signs or blood test in addition to biliary manifestations demonstrated by imaging are present. The diagnostic criteria of the updated Tokyo Guidelines (TG13) have high sensitivity (87.6 %) and high specificity (77.7 %). TG13 has better diagnostic capacity than TG07. Severity assessment is classified as follows: Grade III: associated with organ failure; Grade II: early biliary drainage should be conducted; Grade1: others. As for the severity assessment criteria of TG07, separating Grade II and Grade I at the time of diagnosis was impossible, so they were unsuitable for clinical practice. Therefore, the severity assessment criteria of TG13 have been revised so as not to lose the timing of biliary drainage or treatment for etiology. Based on evidence, five predictive factors for poor prognosis in acute cholangitis--hyperbilirubinemia, high fever, leukocytosis, elderly patient and hypoalbuminemia--have been extracted. Grade II can be diagnosed if two of these five factors are present. Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, 503-8502, Japan.
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Broadbridge VT, Karapetis CS, Beeke C, Woodman RJ, Padbury R, Maddern G, Kim SW, Roder D, Hakendorf P, Price TJ. Do metastatic colorectal cancer patients who present with late relapse after curative surgery have a better survival? Br J Cancer 2013; 109:1338-43. [PMID: 23860523 PMCID: PMC3778277 DOI: 10.1038/bjc.2013.388] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/17/2013] [Accepted: 06/24/2013] [Indexed: 12/12/2022] Open
Abstract
Background: Patients who relapse after potentially curative surgery for colorectal cancer tend to relapse within 5 years. There is, however, a group of patients who relapse beyond 5 years after resection and this late relapsing group may have a different behaviour and prognosis. Methods: We analysed data from a prospective population-based registry to compare the characteristics and survival of relapsed patients with metachronous mCRC. Patients were categorised into relapse at <2, 2–5 and >5 years following their initial surgery. Univariate log-rank tests and multivariate Cox regression was performed to determine whether time to relapse (TTR) and other factors were associated with overall survival (OS). Results: A total of 750 metachronous mCRC patients were identified. In all, 56% relapsed ⩽2 years, 32.4% at 2–5 years and 11.6% >5 years. Median survival time from the time of diagnosis of mCRC for the three groups was 17.6, 26.1 and 27.5 months, respectively. Short TTR (<2 years) was significantly associated with survival (HR=0.75, 95% confidence interval (CI)=0.60–0.93 and HR=0.73, 95% CI=0.53–1.01, respectively, for 2–5 and >5 years vs <2 years, P<0.05). However, there was no significant difference in survival between patients who relapsed at 5 years or later compared with those who relapsed between 2 and 5 years (HR=0.98, 95% CI=0.69–1.38, P=0.90). Conclusion: TTR within 2 years is an independent predictor of shorter survival time for mCRC patients who experience a relapse. These data do not support the hypothesis that patients who have late relapse late (>5 years) have a ‘better' biology or survival compared with patients with a TTR of 2–5 years.
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Affiliation(s)
- V T Broadbridge
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Price TJ, Broadbridge V, Beeke C, Padbury R, Maddern G, Roder D, Karapetis CS. Outcomes of rural patients with metastatic colorectal cancer treated in a centralized system compared with their metropolitan counterparts. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6598 Background: Significant geographical variation in survival after diagnosis of colorectal cancer (CRC) has been reported in Australia. Patients residing in rural locations have inferior survival time compared to metropolitan patients. Factors which have an impact on survival include local access to services (investigations, surgery and chemotherapy). Rural patients tend to present with more advanced disease. We analysed data from South Australia (SA) where cancer care has tended to be centralised to determine if rural patients in this setting have inferior outcomes to metropolitan patients. We examined survival of patients with stage 4 CRC. Methods: An analysis of the SA mCRC registry was performed to compare the oncological and surgical management and survival of city (metropolitan postcode) v rural (rest of state) patients. Overall Survival (OS) was calculated using the Kaplan-meier method. Results: Data from 2289 patient with mCRC since February 2006 were analysed. 27% of patients were rural. Patient characteristics did not differ between the 2 groups. There was no difference in chemotherapy use; City v rural, 1st, 2nd and 3rd line respectively-56%v58%, 23%v23%, 10%v9%. Choice of chemotherapy did not differ between city and rural; FU/Oxaliplatin 61%v60%, irinotecan+/-FU 9%v6%, FU alone 28%v31%. When an oxaliplatin doublet was chosen, oral capecitabine was used more frequently 32% in rural v 13% in city (P<0.001) Addition of bevacizumab/anti-EGFR to first line chemotherapy was equivalent: 19.7% v 14.3%/1.6% v 1.4%. Hepatic resection was also similar in 2 groups 14%v12%. Median OS did not differ; 23.4 months city v 23.5 months rural. These outcomes were similar for men and women. Conclusions: The patient characteristics, choice of chemotherapy (drug and single v doublet), hepatic resection rates and importantly, overall survival did not differ between city v rural patients. Oral chemotherapy used was higher in rural patients without affecting outcome.
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Affiliation(s)
| | | | - Carol Beeke
- Department of Surgery, Flinders Medical Centre, Adelaide, Australia
| | | | - Guy Maddern
- The Queen Elizabeth Hospital, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology, Sansom Institute for Health Research, Division of Health Sciences, Adelaide, Australia
| | - Christos Stelios Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
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Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci 2013; 19:578-85. [PMID: 22872303 PMCID: PMC3429769 DOI: 10.1007/s00534-012-0548-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were published in 2007 as the world’s first guidelines for acute cholangitis and cholecystitis. The diagnostic criteria and severity assessment of acute cholecystitis have since been widely used all over the world. A validation study of TG07 has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. In addition, considerable new evidence referring to acute cholecystitis as well as evaluations of TG07 have been published. Consequently, we organized the Tokyo Guidelines Revision Committee to evaluate TG07, recognize new evidence, and conduct a multi-center analysis to revise the guidelines (TG13). Methods and materials We retrospectively analyzed 451 patients with acute cholecystitis from multiple tertiary care centers in Japan. All 451 patients were first evaluated using the criteria in TG07. The “gold standard” for acute cholecystitis in this study was a diagnosis by pathology. The validity of TG07 diagnostic criteria was investigated by comparing clinical with pathological diagnosis. Results Of 451 patients evaluated, a total of 227 patients were given a diagnosis of acute cholecystitis by pathological examination (prevalence 50.3 %). TG07 criteria provided a definite diagnosis of acute cholecystitis in 224 patients. The sensitivity of TG07 diagnostic criteria for acute cholecystitis was 92.1 %, and the specificity was 93.3 %. Based on the preliminary results, new diagnostic criteria for acute cholecystitis were proposed. Using the new criteria, the sensitivity of definite diagnosis was 91.2 %, and the specificity was 96.9 %. The accuracy rate was improved from 92.7 to 94.0 %. In regard to severity grading among 227 patients, 111 patients were classified as Mild (Grade I), 104 as Moderate (Grade II), and 12 as Severe (Grade III). Conclusion The proposed new diagnostic criteria achieved better performance than the diagnostic criteria in TG07. Therefore, the proposed criteria have been adopted as new diagnostic criteria for acute cholecystitis and are referred to as the 2013 Tokyo Guidelines (TG13). Regarding severity assessment, no new evidence was found to suggest that the criteria in TG07 needed major adjustment. As a result, TG07 severity assessment criteria have been adopted in TG13 with minor changes.
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Affiliation(s)
- Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan.
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Khattak MA, Martin HL, Beeke C, Price T, Carruthers S, Kim S, Padbury R, Karapetis CS. Survival differences in patients with metastatic colorectal cancer and with single site metastatic disease at initial presentation: results from South Australian clinical registry for advanced colorectal cancer. Clin Colorectal Cancer 2012; 11:247-54. [PMID: 22763194 DOI: 10.1016/j.clcc.2012.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/09/2012] [Accepted: 06/02/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common cancer in Australia. The median overall survival for metastatic colorectal cancer is nearly 2 years. However, there may be survival differences based on site of metastatic disease. METHODS Data was collected from the South Australian Registry for Advanced Colorectal Cancer. A total of 1207 patients with single site metastatic disease at initial diagnosis were subclassified into 6 subgroups: liver only (n = 780), pelvic only (n = 148), lung only (n = 142), lymph node only (n = 95), bone only (n = 32), and brain only (n = 10). Univariate and multivariate parametric survival analyses were performed. RESULTS Median overall survival was 20.3 months for the whole group. The overall survival for lung-only metastases group was 41.1 months followed by liver- and pelvic-only disease groups (22.8 and 23.8 months, respectively). Patients with isolated bone-only and brain-only metastases had poor overall survival (5.1 and 5.7 months, respectively). On multivariate analysis, prognosis was superior for the lung-only group. CONCLUSIONS Lung only group had the longest median overall survival. Bone and brain sites had a poor outlook. Site of metastatic disease at initial presentation may be prognostic.
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Affiliation(s)
- Muhammad A Khattak
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.
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Bishnoi S, Price T, Beeke C, Karapetis C, Townsend A, Maddern G, Padbury R. 6040 POSTER Liver Only Metastatic Disease in Patients With Metastatic Colorectal Cancer (mCRC), Impact of Surgery and Chemotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rahbari NN, Garden OJ, Padbury R, Maddern G, Koch M, Hugh TJ, Fan ST, Nimura Y, Figueras J, Vauthey JN, Rees M, Adam R, DeMatteo RP, Greig P, Usatoff V, Banting S, Nagino M, Capussotti L, Yokoyama Y, Brooke-Smith M, Crawford M, Christophi C, Makuuchi M, Büchler MW, Weitz J. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB (Oxford) 2011; 13:528-35. [PMID: 21762295 PMCID: PMC3163274 DOI: 10.1111/j.1477-2574.2011.00319.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established. METHODS An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management. RESULTS The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level > 3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH. CONCLUSION The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications.
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Affiliation(s)
- Nuh N Rahbari
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| | - O James Garden
- Department of Clinical & Surgical Sciences, University of EdinburghEdinburgh
| | | | - Guy Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth HospitalWoodville
| | - Moritz Koch
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| | - Thomas J Hugh
- Department of Gastrointestinal Surgery, Royal North Shore HospitalHong Kong, China
| | - Sheung Tat Fan
- Department of Surgery, Queen Mary Hospital, University of Hong KongHong Kong, China
| | - Yuji Nimura
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of MedicineNagoya
| | - Joan Figueras
- Hepatobiliary and Pancreatic Division of Surgery, ‘Josep Trueta’ Hospital. IDiBGi. University of GironaSpain
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, TX
| | - Myrddin Rees
- Department of Hepatobiliary Surgery, North Hampshire HospitalBasingstoke, UK
| | - Rene Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-BiliaireVillejuif, France
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan-Kettering Cancer CenterNew York, NY, USA
| | - Paul Greig
- Department of Surgery, Toronto General Hospital, University of TorontoToronto, ON, Canada
| | - Val Usatoff
- Department of Surgery. Alfred HospitalCandiolo, Turin, Italy
| | - Simon Banting
- Hepatobiliary Surgery, St Vincent's HospitalCandiolo, Turin, Italy
| | - Masato Nagino
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of MedicineNagoya
| | - Lorenzo Capussotti
- Division of Surgical Oncology, Institute of Cancer Research and TreatmentCandiolo, Turin, Italy
| | - Yukihiro Yokoyama
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of MedicineNagoya
| | - Mark Brooke-Smith
- Hepatopancreatobiliary and Transplant Surgery, Flinders Medical CentreAdelaide
| | | | | | - Masatoshi Makuuchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of TokyoHeidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
| | - Jürgen Weitz
- Department of General, Visceral and Transplantation Surgery, University of HeidelbergGermany
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Jain K, Price TJ, Beeke C, Padbury R, Young GP, Roder D, Townsend AR, Bishnoi S, Karapetis CS. An analysis of the effect of stage at diagnosis of bowel cancer on survival: Findings from the South Australian Clinical Registry (SACR) for metastatic colorectal cancer (mCRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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