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Koumarianou A, Krivan S, Machairas N, Ntavatzikos A, Pantazis N, Schizas D, Martikos G, Kampoli K, Misiakos EP, Patapis P, Liakakos T. Ten-year survival outcomes of patients with potentially resectable gastric cancer: impact of clinicopathologic and treatment-related risk factors. Ann Gastroenterol 2019; 32:99-106. [PMID: 30598599 PMCID: PMC6302201 DOI: 10.20524/aog.2018.0320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/01/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite therapeutic advancements, gastric cancer (GC) remains a leading cause of death worldwide. METHODS This retrospective cohort study statistically analyzed the clinicopathologic characteristics, treatments and outcomes of patients with potentially resectable GC managed at our institution between 2006 and 2010. The STROBE checklist was applied. RESULTS Preoperative assessment of 164 GC patients (male: female ratio 1.87, median age 65 years) assigned 132 (80.5%) to total (56; 42.4%) or subtotal (76; 57.6%) gastrectomy. Resection margins were microscopically tumor-free (R0) in 100 (75.8%), microscopically infiltrated (R1) in 25 (18.9%) and macroscopically infiltrated (R2) in 7 (5.3%) patients. Nodal plane dissection was D0 in 34 (25.8%), D1 in 62 (47.0%) and D2 in 36 (27.3%) patients. Early GC was diagnosed in 19 patients (14.4%). Fluorouracil-based chemotherapy was administered in 69.7% and chemoradiation in 18.2% of patients. The 5- and 10-year survival rates of patients with R0 resection were 74% and 65.4%, respectively. The 2-year survival rates for R1 and R2 resection were 28.9% and 0% respectively. The 5- and 10-year survival rates according to nodal plane dissection were 55.6% and 41.4% for D2, and 53.2% and 49.7% for D1, respectively. On multivariate analysis, T4, N3 and R1/R2 remained independent negative prognostic factors for overall survival. Microscopic or macroscopic infiltration of surgical margins was the worst adverse prognostic factor for survival. CONCLUSION These results are equivalent to those from centers of excellence and indicate the urgent need for improvements in the field, particularly in the development of predictive models to guide personalized therapy.
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Affiliation(s)
- Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine (Anna Koumarianou, Katerina Kampoli)
- Correspondence to: Anna Koumarianou MD, PhD, Medical Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Rimini 1, 12462 Athens, Greece, e-mail:
| | - Sylvia Krivan
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
| | - Nikolaos Machairas
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
| | | | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics (Nikos Pantazis), Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
| | - George Martikos
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
| | - Katerina Kampoli
- Hematology Oncology Unit, Fourth Department of Internal Medicine (Anna Koumarianou, Katerina Kampoli)
| | - Evangelos P. Misiakos
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
| | - Pavlos Patapis
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
| | - Theodoros Liakakos
- Third Department of Surgery (Sylvia Krivan, Nikolaos Machairas, Dimitrios Schizas, George Martikos, Evangelos P. Misiakos, Pavlos Patapis, Theodoros Liakakos)
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Farrugia FA, Martikos G, Surgeon C, Tzanetis P, Misiakos E, Zavras N, Charalampopoulos A. Radiology of the adrenal incidentalomas. Review of the literature. Endocr Regul 2017; 51:35-51. [PMID: 28222025 DOI: 10.1515/enr-2017-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The term "adrenal incidentaloma" is a radiological term. Adrenal incidentalomas are adrenal tumors discovered in an imaging study that has been obtained for indications exclusive to adrenal conditions (Udelsman 2001; Linos 2003; Bulow et al. 2006; Anagnostis et al. 2009). This definition excludes patients undergoing imaging testing as part of staging and work-up for cancer (Grumbach et al. 2003; Anagnostis et al. 2009). Papierska et al. (2013) have added the prerequisite that the size of a tumor must be "greater than 1cm in diameter", in order to be called incidentaloma. Although in the most cases these masses are non-hypersecreting and benign, they still represent an important clinical concern because of the risk of malignancy or hormone hyperfunction (Barzon et al. 2003). Th e adrenal tumors belong to the commonest incidental findings having been discovered (Kanagarajah et al. 2012).
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Farrugia FA, Martikos G, Tzanetis P, Charalampopoulos A, Misiakos E, Zavras N, Sotiropoulos D. Pheochromocytoma, diagnosis and treatment: Review of the literature. Endocr Regul 2017; 51:168-181. [DOI: 10.1515/enr-2017-0018] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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] [Indexed: 02/01/2023] Open
Abstract
Abstract
Objective. We conducted an extensive review of the literature and tried to cite the most recent recommendations concerning the pheochromocytoma (PHEO).
Methods. Pub Med and Google Scholar databases were searched systematically for studies concerning pheochromocytomas (intra-adrenal paragangliomas) from 1980 until 2016. Bibliographies were searched to find additional articles.
Results. More than four times elevation of plasma fractionated metanephrines or elevated 24-h urinary fractionated metanephrines are keys to diagnosing pheochromocytoma. If the results are equivocal then we perform the clonidine test. If we have not done it already, we preferably do a CT scan and/or an MRI scan. The patient needs pre-treatment with α1-blockers at least 10–14 days before operation. Alternatives or sometimes adjuncts are Calcium Channels Blockers and/or β-Blockers. Several familial syndromes are associated with PHEO and genetic testing should be considered.
Conclusions. The biggest problem for pheochromocytoma is to suspect it in the first place. Elevated metanephrines establish the diagnosis. With the proper preoperative preparation the risks during operation and the postoperative period are minimal. If there is a risk of the hereditable mutation, it is strongly suggested that all the patients with pheochromocytoma need clinical genetic testing.
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Affiliation(s)
- FA Farrugia
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
| | - G Martikos
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
| | - P Tzanetis
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
| | - A Charalampopoulos
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
| | - E Misiakos
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
| | - N Zavras
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
| | - D Sotiropoulos
- 3 University Department of Surgery, Attikon University Hospital , University of Athens, School of Medicine , Athens , Greece
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Koumarianou A, Economopoulou P, Katsaounis P, Laschos K, Arapantoni-Dadioti P, Martikos G, Rogdakis A, Tzanakis N, Boukovinas I. Gastrointestinal Stromal Tumors (GIST): A Prospective Analysis and an Update on Biomarkers and Current Treatment Concepts. Biomark Cancer 2015; 7:1-7. [PMID: 26056505 PMCID: PMC4454203 DOI: 10.4137/bic.s25045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/12/2015] [Accepted: 04/20/2015] [Indexed: 12/13/2022]
Abstract
Gastrointestinal stromal tumors (GIST) are the most common sarcomas of the gastrointestinal tract, with transformation typically driven by activating mutations of cKIT and less commonly platelet-derived growth factor receptor alpha (PDGFRA). Successful targeting of tyrosine-protein kinase Kit with imatinib, a tyrosine kinase inhibitor, has had a major impact in the survival of patients with GIST in both the adjuvant and metastatic setting. A recent modification of treatment guidelines for patients with localized, high-risk GIST extended the adjuvant treatment duration from 1 year to 3 years. In this paper, we review the clinical data of patients with GIST treated in the Oncology Outpatient Unit of "Attikon" University Hospital and aim to assess which patients are eligible for prolongation of adjuvant imatinib therapy as currently suggested by treatment recommendations.
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Affiliation(s)
- Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, "Attikon" University Hospital, Haidari, Athens, Greece
| | - Panagiota Economopoulou
- Department of Medical Oncology, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | | | | | | | - George Martikos
- Third Department of Surgery, "Attikon" University Hospital, Haidari, Greece
| | - Athanasios Rogdakis
- Second Department of Surgery, Pireus General Hospital "Ag. Panteleimon", Nikaia, Athens, Greece
| | - Nikolaos Tzanakis
- Department of Surgery, "Asklhpeion Voulas" General Hospital, Voula, Athens, Greece
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Koumarianou A, Krivan S, Patapis P, Missiakos E, Martikos G, Charalabopoulos A, Schizas D, Petropoulos K, Bakopoulos A, Katsaounis P, Xiros N, Kouloulias V, Peros G, Karatzas G, Macheras A, Liakakos T. A restrospective study of treatments and outcome in gastric cancer patients: A report from a single institution. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15089] [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)
- Anna Koumarianou
- Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Sylvia Krivan
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
| | - Pavlos Patapis
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
| | | | - George Martikos
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
| | | | - Dimitrios Schizas
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
| | | | - Aris Bakopoulos
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
| | - Panagiotis Katsaounis
- Second Department of Internal Medicine and Research Institute, Attikon University Hospital, Athens, Greece
| | - Nikolaos Xiros
- Medical Oncology Unit, Second Department of Internal Medicine Propaedeutic, Attikon University Hospital, Athens, Greece
| | | | - George Peros
- Fourth Department of Surgery, Attikon University Hospital, Athens, Greece
| | - Gabriel Karatzas
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
| | | | - Theodoros Liakakos
- Third Department of Surgery, Attikon University Hospital, ATHENS, Greece
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Suleiman SH, Salim OEH, Yousif DO, Eltahir MA, Elzaki K, Ibrahim SZ, Ahmed KM, Mudawi HM, Vini L, Silyvridou A, Kakana C, Janinis J, Diamantidou E, Navrozidou C, Boulogianni G, Hourmouzi D, Kopanakis K, Macheras A, Charalabopoulos A, Bistarakis D, Xylardistos P, Shizas D, Petropoulos K, Bakopoulos A, Liakakos T, Oikonomopoulos N, Martikos G, Patapis P, Misiakos E, Tsapralis D, Azas A, Charalobopoulos A, Liakakos L, Millo P, Allieta R, Nardi M, Brachet Contul R, Scozzari G, Alexandrou I, Lainakis N, Efstathiou E, Demetriadis D, Dolatzas T, Antypas S, Parini U, Persico F, Loffredo A, Lale Murix E, Fabozzi M, Roveroni M, Usai A, Da Broi J, Nardi MJ, Roustanis E, Benetatos N, Pappas-Gogos G, Tsimogiannis KE, Tsimoyiannis EC, Pramateftakis MG, Mantzoros I, Kanellos I, Demetriades H, Angelopoulos S, Despoudi K, Lazarides H, Tsachalis T, Sapidis N, Gouvas N, Tsiaoussis J, Pechlivanides G, Zervakis N, Xynos E. Abstracts Colorectal Games, Rethymnom, Crete, Greece, May 2008. Tech Coloproctol 2008. [DOI: 10.1007/s10151-008-0432-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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