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Zhang YF, Wang GD, Huang MG, Qiu ZQ, Si J, Xu MY. Association between the Khorana risk score and all-cause mortality in Japanese patients with gastric and colorectal cancer: A retrospective cohort study. World J Gastrointest Oncol 2023; 15:1784-1795. [PMID: 37969412 PMCID: PMC10631431 DOI: 10.4251/wjgo.v15.i10.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/21/2023] [Accepted: 09/18/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The Khorana risk score (KRS) has poor predictive value for cancer-associated thrombosis in a single tumor type but is associated with early all-cause mortality from cancer. Evidence for the association between KRS and all-cause mortality in Japanese patients with gastric and colorectal cancer is limited. AIM To investigate whether KRS was independently related to all-cause mortality in Japanese patients with gastric and colorectal cancer after adjusting for other covariates and to shed light on its temporal validity. METHODS Data from Dryad database were used in this study. Patients in the Gastroenterology Department of Sapporo General Hospital, Sapporo, Japan, were enrolled. The starting and ending dates of the enrollment were January 1, 2008 and January 5, 2015, respectively. The cutoff date for follow-up was May 31, 2016. The independent and dependent (target) variables were the baseline measured using the KRS and final all-cause mortality, respectively. The KRS was categorized into three groups: Low-risk group (= 0 score), intermediate-risk group (1-2 score), and high-risk group (≥ 3 score). RESULTS Men and patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 2 displayed a higher 2-year risk of death than women and those with ECOG PS 0-1 in the intermediate/high risk group for KRS. The higher the score, the higher the risk of early death; however, the relevance of this independent prediction decreased with longer survival. The overall survival of each patient was recorded via real-world follow-up and retrospective observations, and this study yielded the overall relationship between KRS and all-cause mortality. CONCLUSION The prechemotherapy baseline of KRS was independently associated with all-cause mortality within 2 years; however, this independent predictive relationship weakened as survival time increased.
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Affiliation(s)
- Yu-Feng Zhang
- Department of Oncology Radiotherapy, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
| | - Guo-Dong Wang
- Department of Oncology Radiotherapy, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
| | - Min-Guang Huang
- Department of Oncology Radiotherapy, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
| | - Zhao-Qi Qiu
- Department of Oncology Radiotherapy, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
| | - Jia Si
- Department of Electrocardiography, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji 311800, Zhejiang Province, China
| | - Mao-Yi Xu
- Department of Oncology, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), Jiaxing 314000, Zhejiang Province, China
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2
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Xia S, Wu W, Yu L, Ma L, Chen S, Wang H. Thrombocytosis predicts poor prognosis of Asian patients with colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30275. [PMID: 36107503 PMCID: PMC9439792 DOI: 10.1097/md.0000000000030275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no study analyzing and evaluating the prognostic role of thrombocytosis in Asian patients with colorectal cancer (CRC). METHODS A systematic search of articles (PubMed, Embase, and the Cochrane Library) was performed to identify studies using the terms Platelet count, Thrombocytosis, Thrombocytoses, Thrombocythemia or Thrombocythemias with colon, colonic, rectal, rectum, colorectal and prognostic, prognosis, survival or outcome. RESULTS Thirteen eligible studies with 3964 patients were included. Thrombocytosis was associated with a poorer overall survival (HR of 1.88 [95% CI: 1.24-2.85; P = .003] with univariate analyses, HR of 2.07 [95% CI: 1.2-3.56; P = .008] with multivariate analyses), disease-free survival (HR of 2.58 [95% CI: 1.87-3.57; P < .00001] with multivariate analyses) and cancer specific survival (HR of 2.55 [95% CI: 1.68-3.85; P < .00001]) in Asian patients with CRC. Thrombocytosis had a significant association with female gender, tumor location in the colon, higher pathological T-stage, pathological positive N-stage, but not with lymphatic involvement and venous involvement. CONCLUSION The present meta-analysis demonstrates that thrombocytosis is a potentially useful tool for predicting poor survival in Asian patients with CRC, especially for overall survival.
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Affiliation(s)
- Shijun Xia
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Wenjiang Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
- *Correspondence: Wenjiang Wu, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen 518000, China (e-mail: )
| | - Linchong Yu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lijuan Ma
- Shenzhen Traditional Chinese Medicine Anorectal Hospital, Shenzhen, China
| | - Shiwei Chen
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hao Wang
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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3
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Tamini N, Gianotti L, Darwish S, Petitto S, Bernasconi D, Oldani M, Uggeri F, Braga M, Nespoli L. Do Preoperative Transfusions Impact Prognosis in Moderate to Severe Anaemic Surgical Patients with Colon Cancer? Curr Oncol 2021; 28:4634-4644. [PMID: 34898556 PMCID: PMC8628678 DOI: 10.3390/curroncol28060391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/10/2023] Open
Abstract
(1) Background: Anaemia is a common finding in patients with colon cancer and is commonly corrected by blood transfusion prior to surgery. However, the prognostic role of perioperative transfusions is still debated. The aim of the present study was to investigate the role of preoperative anaemia and preoperative blood transfusion in influencing the prognosis in colon cancer. (2) Patients and Methods: Patients undergoing elective surgery for colon cancer at a tertiary referral university hospital between January 2010 and December 2018 were included in a retrospective review of a prospectively collected database. Univariate and regression analyses were performed to identify the prognostic role of preoperative anaemia and preoperative transfusions in this homogeneous cohort of patients. (3) Results: A total of 780 patients were included in the final analysis. The estimated five-year overall survival rate was significantly worse in the anaemic group (83.8% in non-anaemic patients, 60.6% in mild anaemic patients, 61.3% in moderate anaemic patients and 58.4% in severe anaemic patients; log-rank < 0.001 vs. non-anaemic patients). Anaemic status was found to be an independent adverse prognostic factor (hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.02-2.07) during multivariate analysis. Among moderate to severe anaemic patients, no significant association was found between preoperative transfusions and the risk of mortality or recurrence. (4) Conclusions: Preoperative anaemia, regardless of its severity, and not preoperative blood transfusion, was independently associated with a worse prognosis after surgery in patients with colonic cancer.
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Affiliation(s)
- Nicolò Tamini
- Department of Surgery, ASST Monza-San Gerardo Hospital, 20900 Monza, Italy;
| | - Luca Gianotti
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (L.G.); (S.D.); (S.P.); (F.U.); (M.B.); (L.N.)
| | - Shadya Darwish
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (L.G.); (S.D.); (S.P.); (F.U.); (M.B.); (L.N.)
| | - Salvatore Petitto
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (L.G.); (S.D.); (S.P.); (F.U.); (M.B.); (L.N.)
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
| | - Massimo Oldani
- Department of Surgery, ASST Monza-San Gerardo Hospital, 20900 Monza, Italy;
| | - Fabio Uggeri
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (L.G.); (S.D.); (S.P.); (F.U.); (M.B.); (L.N.)
| | - Marco Braga
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (L.G.); (S.D.); (S.P.); (F.U.); (M.B.); (L.N.)
| | - Luca Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (L.G.); (S.D.); (S.P.); (F.U.); (M.B.); (L.N.)
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4
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Tampellini M, Bironzo P, Di Maio M, Scagliotti GV. Thymidine phosphorylase: the unforeseen driver in colorectal cancer treatment? Future Oncol 2018; 14:1223-1231. [PMID: 29701074 DOI: 10.2217/fon-2017-0627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
5-Fluorouracil- and leucovorin-based chemotherapy regimens are the backbone of colorectal cancer treatment. The addition of oxaliplatin, irinotecan and monoclonal antibodies to this backbone has largely improved clinical outcomes, but has also led to new questions, with conflicting data frequently reported in studies. Thymidine phosphorylase (TP) is a nucleoside-metabolizing enzyme involved in 5-fluorouracil pharmacokinetics, as well as inflammatory responses, neoangiogenesis and apoptosis. TP expression is regulated by hypoxia, inflammatory cytokines and antitumoral agents. We hypothesize that TP could be the unforeseen driver in the conflicting data observed with different regimens commonly used in colorectal cancer treatment. Greater comprehension of the role of this enzyme in tumor progression and pyrimidine metabolism may lead to more accurate, patient-tailored therapy.
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Affiliation(s)
- Marco Tampellini
- Department of Oncology, AOU San Luigi di Orbassano, University of Torino, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - Paolo Bironzo
- Department of Oncology, AOU San Luigi di Orbassano, University of Torino, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - Massimo Di Maio
- Department of Oncology, AOU San Luigi di Orbassano, University of Torino, Regione Gonzole, 10, 10043 Orbassano, Italy
| | - Giorgio V Scagliotti
- Department of Oncology, AOU San Luigi di Orbassano, University of Torino, Regione Gonzole, 10, 10043 Orbassano, Italy
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5
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Long Y, Wang T, Gao Q, Zhou C. Prognostic significance of pretreatment elevated platelet count in patients with colorectal cancer: a meta-analysis. Oncotarget 2018; 7:81849-81861. [PMID: 27833087 PMCID: PMC5348435 DOI: 10.18632/oncotarget.13248] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
Background The prognostic effect of pretreatment elevated platelet count remains controversial in colorectal cancer patients. We conducted this meta-analysis to evaluate the prognostic impact of it in these patients. Methods PubMed, EMBASE and Cochrane Library were searched and studies on the prognostic significance of pretreatment elevated platelet count in colorectal patients were identified. We performed the meta-analysis, using overall survival and disease-free survival as outcomes and presenting data with hazard ratio and its 95% confidence interval. Heterogeneity among studies and publication bias were also evaluated. Results Thirty studies were included in the meta-analysis. Compared with normal platelet count, pretreatment elevated platelet count was associated with poorer overall survival (Hazard ratio = 1.837, 95% confidence interval, 1.497 to 2.255, p = 0.000) and poorer disease-free survival (Hazard ratio = 1.635, 95% confidence interval, 1.237 to 2.160, p = 0.001) in patients with colorectal cancer. In subgroup analyses, pretreatment elevated platelet count was also associated with poorer overall survival and disease-free survival in most subgroups. Conclusion Pretreatment elevated platelet count was an independent prognostic factor of overall survival and disease-free survival in colorectal cancer patients. Large-scale prospective studies and a validation study are warranted.
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Affiliation(s)
- Yu Long
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ting Wang
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Gao
- Oncology Department, Du Jiang Yan Medical Center, Chengdu, Sichuan, China
| | - Chengya Zhou
- Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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6
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Liu X, Qiu H, Huang Y, Xu D, Li W, Li Y, Chen Y, Zhou Z, Sun X. Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single-institution retrospective analysis of 2163 Chinese patients. Cancer Med 2018; 7:360-369. [PMID: 29341506 PMCID: PMC5806112 DOI: 10.1002/cam4.1309] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022] Open
Abstract
We sought to evaluate whether preoperative anemia was an important determinant of survival in gastric cancer (GC). A single institution cohort of 2163 GC patients who underwent curative resection were retrospectively analyzed. Anemia was defined as a preoperative hemoglobin level <120 g/L in males and <110 g/L in females. Overall survival (OS) was analyzed using the Kaplan-Meier method, and a multivariate Cox proportional hazards model was performed to identify the independent prognostic factor. Anemic patients had a poorer OS compared with nonanemic patients after resection for tumor-nodes-metastasis (TNM) stage III tumors (5-year OS rate: 32.2% vs. 45.7%, P < 0.001) but not stage I (P = 0.480) or stage II (P = 0.917) tumors. Multivariate analysis revealed that preoperative anemia was an independent prognostic factor in TNM stage III (hazard ratio [HR], 1.771; 95% CI, 1.040-3.015; P = 0.035). In a stage-stratified analysis, preoperative anemia was still independently associated with OS in TNM stages IIIa through IIIc (P < 0.001, P = 0.075, and P = 0.012, respectively), though the association was only marginal in stage IIIb. Of note, preoperative mild anemia had a similar prognostic value in TNM stage III GC. Furthermore, preoperative anemia was significantly associated with more perioperative transfusions, postoperative complications and several nutritional-based indices, including the prognostic nutritional index (PNI), preoperative weight loss and performance status (all P < 0.05). Preoperative anemia, even mild anemia, was an important predictor of postoperative survival for TNM stage III GC.
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Affiliation(s)
- Xuechao Liu
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Haibo Qiu
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yuying Huang
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Dazhi Xu
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wei Li
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yuanfang Li
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yingbo Chen
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Zhiwei Zhou
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xiaowei Sun
- Sun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou510060China
- Department of Gastric SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
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7
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Sohal DPS, Kuderer NM, Shepherd FA, Pabinger I, Agnelli G, Liebman HA, Meyer G, Kalady MF, McCrae K, Lyman GH, Khorana AA. Clinical Predictors of Early Mortality in Colorectal Cancer Patients Undergoing Chemotherapy: Results From a Global Prospective Cohort Study. JNCI Cancer Spectr 2017; 1:pkx009. [PMID: 31360835 PMCID: PMC6649852 DOI: 10.1093/jncics/pkx009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023] Open
Abstract
Background Early mortality is a major problem in colorectal cancer (CRC). We have shown that Khorana Score is predictive of early mortality in other cancers. Here, we evaluated the value of this score and other prognostic variables in predicting early mortality in CRC. Methods CANTARISK was a prospective, noninterventional, global cohort study in patients with CRC initiating a new chemotherapy regimen. Data were collected at zero, two, four, and six months. Early mortality was defined as death within six months of enrollment. All data were compiled centrally and analyzed after the study closed. Statistically significant univariate associations were tested in multivariable models; adjusted odds ratios (ORs) are presented. Statistical tests were two-sided. Results From 2011 to 2012, 1789 CRC patients were enrolled. The median age was 62 years; 71% were Caucasian. One-third (35%) had a rectal primary, and 65% had metastatic disease. There were 184 (10.3%) patients who died during their first six months in the study. For low, intermediate, and high Khorana Score, there were 8.1%, 11.2% and 32.5% deaths, respectively. In multivariable analyses, Khorana Score was an independent predictor of early death (OR for high/intermediate vs low score = 1.70, P = .0027), in addition to age (OR for each incremental year = 1.03, P = .0014), presence of metastatic disease (OR = 3.28, P < .0001), and Easter Cooperative Oncology Group Performance Status Score of 2 or higher (OR = 3.85, P < .0001). Conclusions This study demonstrates that Khorana Score is predictive of early mortality in CRC patients. Intermediate- or high-risk patients, as defined by this score, may benefit from additional interventions aimed at reducing early mortality.
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Affiliation(s)
- Davendra P S Sohal
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Nicole M Kuderer
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Frances A Shepherd
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Ingrid Pabinger
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Giancarlo Agnelli
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Howard A Liebman
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Guy Meyer
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Matthew F Kalady
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Keith McCrae
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Gary H Lyman
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
| | - Alok A Khorana
- Hematology/Oncology, Cleveland Clinic, Cleveland, OH (DPSS, MFK, KM, AAK); Hematology/Oncology, University of Washington, Seattle, WA (NMK, GHL); Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada (FAS); Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria (IP); Stroke Unit, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy (GA); Jane Anne Nohl Devision of Hematology, University of Southern California, Los Angeles, CA (HAL); Respiratory and Intensive Care Medicine, Universite Paris Descartes, Paris, France (GM)
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8
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Martin D, Rödel F, Winkelmann R, Balermpas P, Rödel C, Fokas E. Peripheral Leukocytosis Is Inversely Correlated with Intratumoral CD8+ T-Cell Infiltration and Associated with Worse Outcome after Chemoradiotherapy in Anal Cancer. Front Immunol 2017; 8:1225. [PMID: 29085358 PMCID: PMC5649213 DOI: 10.3389/fimmu.2017.01225] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022] Open
Abstract
Peripheral blood leukocytosis has been implicated in promoting tumor progression leading to worse survival, but the mechanisms behind this phenomenon remain unexplored. Here, we examined the prognostic role of pretreatment white blood cell (WBC) count and clinicopathologic parameters in the context of CD8+ tumor-infiltrating lymphocytes (TIL) and myeloperoxidase+ tumor-associated neutrophils (TANs) in patients with anal squamous cell carcinoma (ASCC) treated with definitive chemoradiotherapy (CRT). After a median follow-up of 26 months, leukocytosis correlated with advanced T-stage (p < 0.001) and N-stage (p < 0.001), and predicted for worse distant-metastasis-free survival (p = 0.006), disease-free-survival (DFS, p = 0.029), and overall survival (p = 0.013). Importantly, leukocytosis was associated with a lower intraepithelial CD8+ TIL density (p = 0.014), whereas low CD8+ TIL expression in the intraepithelial compartment was associated with worse DFS (p = 0.028). Additionally, high TAN expression in the peritumoral compartment was associated with a significantly lower density of CD8+ TIL (p = 0.039), albeit, TAN expression lacked prognostic value. In conclusion, leukocytosis constitutes an important prognostic marker in ASCC patients treated with CRT. In conjunction with intratumoral TIL and TAN, these data provide for the first time important insight on the correlation of peripheral blood leukocytosis with the intratumoral immune contexture and could be relevant for future patient stratification using immunotherapies in ASCC.
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Affiliation(s)
- Daniel Martin
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt, Germany
| | - Ria Winkelmann
- Senckenberg Institute for Pathology, Goethe University Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt, Germany
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9
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Tridente A, Bion J, Mills GH, Gordon AC, Clarke GM, Walden A, Hutton P, Holloway PAH, Chiche JD, Stuber F, Garrard C, Hinds C, On behalf of the GenOSept and GAinS Investigators. Derivation and validation of a prognostic model for postoperative risk stratification of critically ill patients with faecal peritonitis. Ann Intensive Care 2017; 7:96. [PMID: 28900902 PMCID: PMC5595707 DOI: 10.1186/s13613-017-0314-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 08/18/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prognostic scores and models of illness severity are useful both clinically and for research. The aim of this study was to develop two prognostic models for the prediction of long-term (6 months) and 28-day mortality of postoperative critically ill patients with faecal peritonitis (FP). METHODS Patients admitted to intensive care units with faecal peritonitis and recruited to the European GenOSept study were divided into a derivation and a geographical validation subset; patients subsequently recruited to the UK GAinS study were used for temporal validation. Using all 50 clinical and laboratory variables available on day 1 of critical care admission, Cox proportional hazards regression was fitted to select variables for inclusion in two prognostic models, using stepwise selection and nonparametric bootstrapping sampling techniques. Using Area under the receiver operating characteristic curve (AuROC) analysis, the performance of the models was compared to SOFA and APACHE II. RESULTS Five variables (age, SOFA score, lowest temperature, highest heart rate, haematocrit) were entered into the prognostic models. The discriminatory performance of the 6-month prognostic model yielded an AuROC 0.81 (95% CI 0.76-0.86), 0.73 (95% CI 0.69-0.78) and 0.76 (95% CI 0.69-0.83) for the derivation, geographic and temporal external validation cohorts, respectively. The 28-day prognostic tool yielded an AuROC 0.82 (95% CI 0.77-0.88), 0.75 (95% CI 0.69-0.80) and 0.79 (95% CI 0.71-0.87) for the same cohorts. These AuROCs appeared consistently superior to those obtained with the SOFA and APACHE II scores alone. CONCLUSIONS The two prognostic models developed for 6-month and 28-day mortality prediction in critically ill septic patients with FP, in the postoperative phase, enhanced the day one SOFA score's predictive utility by adding a few key variables: age, lowest recorded temperature, highest recorded heart rate and haematocrit. External validation of their predictive capability in larger cohorts is needed, before introduction of the proposed scores into clinical practice to inform decision making and the design of clinical trials.
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Affiliation(s)
- Ascanio Tridente
- Whiston Hospital Prescot, Merseyside and Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK
| | - Julian Bion
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | | | | | | | - Andrew Walden
- Intensive Care Unit, Royal Berkshire Hospital, Reading, UK
| | - Paula Hutton
- Intensive Care Unit, John Radcliffe Hospital, Oxford, UK
| | | | | | - Frank Stuber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Charles Hinds
- Barts and the London Queen Mary School of Medicine, London, UK
| | - On behalf of the GenOSept and GAinS Investigators
- Whiston Hospital Prescot, Merseyside and Department of Infection, Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- University of Sheffield, Sheffield, UK
- Imperial College, London, UK
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Intensive Care Unit, Royal Berkshire Hospital, Reading, UK
- Intensive Care Unit, John Radcliffe Hospital, Oxford, UK
- Hospital Cochin, Paris, France
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
- Barts and the London Queen Mary School of Medicine, London, UK
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10
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Zhang J, Zhang HY, Li J, Shao XY, Zhang CX. The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Oncotarget 2017; 8:68837-68846. [PMID: 28978160 PMCID: PMC5620300 DOI: 10.18632/oncotarget.18575] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/05/2017] [Indexed: 12/28/2022] Open
Abstract
Recently, several studies have reported that inflammatory response and elevated platelet counts may be associated with the poor prognosis of colorectal cancer. This meta-analysis was designed to analyze and evaluate the prognostic role of elevated preoperative or pretreatment neutrophils-to-lymphocytes ratio, platelet-to-lymphocytes ratio or platelet counts in patients with colorectal cancer. We searched PubMed, EMBASE, Cochrane Library and Web of Science to April, 2016. A total of 23 studies (N = 11762 participants) were included for this meta-analysis. Elevated neutrophils-to-lymphocytes ratio have a close relationship with the poor Overall Survival of colorectal cancer with the pooled HR being 1.92 [95% CI 1.57–2.34; P < 0.00001]. This meta-analysis indicated that elevated neutrophils-to-lymphocytes ratio, platelet-to-lymphocytes ratio or platelet counts may be a cost-effective and noninvasive serum biomarker for poor prognosis for patients with colorectal cancer.
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Affiliation(s)
- Jie Zhang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Hong-Ying Zhang
- Department of Pathology and Forensic Medicine, College of Basic Medical Sciences, Dalian Medical University, Dalian 116044, China
| | - Jia Li
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xin-Yu Shao
- Medical Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
| | - Chun-Xia Zhang
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
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11
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Wilson MJ, van Haaren M, Harlaar JJ, Park HC, Bonjer HJ, Jeekel J, Zwaginga JJ, Schipperus M. Long-term prognostic value of preoperative anemia in patients with colorectal cancer: A systematic review and meta-analysis. Surg Oncol 2017; 26:96-104. [PMID: 28317592 DOI: 10.1016/j.suronc.2017.01.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/12/2017] [Accepted: 01/31/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the long-term prognostic factor of preoperative anemia in colorectal cancer patients. BACKGROUND Anemia is frequently observed in colorectal cancer patients, with a case incidence of 30 to 67 percent. Besides an indicator of tumor-induced blood loss and inflammation, anemia in cancer is also suggested to be a cause of inferior outcome, possibly via worsening of tumor hypoxia. As surgery is likely to enhance anemia, the long-term prognostic value of preoperative anemia seems most interesting. METHODS Comprehensive searches were carried out in all relevant databases, including MEDLINE, Embase and Web-of-Science. To include studies addressing overall survival, follow-up had to be at least 24 months or till death. For pooling of survival results, a mixed-linear (fixed-effects) model was fit to the reported hazard ratios (HRs) to calculate a pooled estimate and confidence interval. RESULTS We included 12 studies comprising 3588 patients to estimate the association between preoperative anemia and overall survival (OS) and disease-free survival (DFS). In a fixed-effects meta-analysis of eight studies, including both colon and rectal cancer, preoperative anemia was significantly associated with poor OS (HR 1.56; 95% CI 1.30 to 1.88; p < 0.001). A meta-analysis of seven studies also showed that preoperative anemia was significantly associated with poor DFS (HR 1.34; 95% CI 1.11 to 1.61; p = 0.002). Restricted to studies exclusively on colon cancer or rectal cancer, HRs for OS were 1.25 (95% CI 1.00 to 1.55; p = 0.05) and 2.59 (95% CI 1.68 to 4.01; p < 0.001), respectively, while HRs for DFS were 1.21 (95% CI 0.96 to 1.52; p = 0.11) and 1.61 (95% CI 1.18 to 2.21; p = 0.003). CONCLUSION The present meta-analysis reveals that preoperative anemia is significantly associated with decreased long-term OS and DFS in rectal cancer, but not in colon cancer patients, although this meta-analysis is mainly based on retrospective studies with high heterogeneity. These results justify raised awareness about the impact of preoperative anemia on long-term survival.
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Affiliation(s)
- M J Wilson
- TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands; Erasmus University Medical Center Rotterdam, Department of Surgery, The Netherlands.
| | - M van Haaren
- OLVG Amsterdam, Department of Internal Medicine, The Netherlands
| | - J J Harlaar
- Westfriesgasthuis Hoorn, Department of Surgery, The Netherlands; VU Medical Center Amsterdam, Department of Surgery, The Netherlands
| | - Hee Chul Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiation Oncology, Seoul, South Korea
| | - H J Bonjer
- VU Medical Center Amsterdam, Department of Surgery, The Netherlands
| | - J Jeekel
- Erasmus University Medical Center Rotterdam, Department of Neuroscience, The Netherlands
| | - J J Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands; Leiden University Medical Center, Department of Immunohematology and Blood Transfusion, The Netherlands
| | - M Schipperus
- Haga Ziekenhuis Den Haag, Department of Hematology, The Netherlands; TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands
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12
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Wang YH, Deng SJ, Yang YD, Yao N, Zhao JM, Min GT, Wang J, Xu TF, Zhao PY, Wang HP, Chen W. The pretreatment thrombocytosis may predict prognosis of patients with colorectal cancer: a systematic review and meta-analysis. Biomark Med 2017; 11:195-210. [PMID: 28097884 DOI: 10.2217/bmm-2016-0214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AIM Recently, several studies have reported that thrombocytosis may be associated with the poor prognosis of colorectal cancer (CRC). Nevertheless, their conclusions were still controversial. Results & methodology: We searched PubMed, Embase, Cochrane Library and Web of Science up to April 2016. A total of 30 studies including 9129 patients were included in this meta-analysis. Thrombocytosis had a close relationship with the poor overall survival of CRC compared with normal platelet counts, with the pooled hazard ratios being 1.89 (95% CI: 1.45-2.47; p < 0.00001) and 1.83 (95% CI: 1.33-2.53; p = 0.0002), with univariate and multivariate analyses, respectively. DISCUSSION & CONCLUSION This meta-analysis indicated that thrombocytosis may be a cost-effective and noninvasive indicator for poor prognosis of patients with CRC, especially for overall survival.
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Affiliation(s)
- Yong-Hong Wang
- Department of General Surgery, The First People's Hospital of Xi'ning City, Xi'ning 810000, Qinghai Province, PR China.,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Shao-Jun Deng
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, PR China.,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Yong-Dong Yang
- Department of General Surgery, The First People's Hospital of Xi'ning City, Xi'ning 810000, Qinghai Province, PR China
| | - Nan Yao
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Jian-Meng Zhao
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Guang-Tao Min
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, PR China.,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Jun Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Teng-Fei Xu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Peng-Ying Zhao
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Hong-Peng Wang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
| | - Wei Chen
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, Gansu Province, PR China
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13
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Moschini M, Soria F, Abufaraj M, Foerster B, D'Andrea D, Damiano R, Klatte T, Montorsi F, Briganti A, Colombo R, Gallina A, Shariat SF. Impact of Intra- and Postoperative Blood Transfusion on the Incidence, Timing, and Pattern of Disease Recurrence After Radical Cystectomy. Clin Genitourin Cancer 2017; 15:e681-e688. [PMID: 28162943 DOI: 10.1016/j.clgc.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/24/2016] [Accepted: 01/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The administration of blood transfusion (BT) has been associated with a decrease in survival expectancies in patients treated with radical cystectomy (RC), as a consequence of the immunosuppressive effect mediated by BT. We sought therefore to evaluate if the usage of BT may influence the risk and pattern location of distant recurrences after RC, which may be influenced by this effect. METHODS Data from 2 independent cohorts of consecutive patients with bladder cancer treated with RC were analyzed. Distant recurrence included all recurrence locations outside of the true pelvis, such as lung, liver, bone, extra pelvic lymph nodes, peritoneal, or brain recurrences. Cox regression analyses evaluating the risk of developing distant recurrence after RC were built. RESULTS In the testing cohort, composed of 1081 patients, 41.2% received a perioperative BT. Within a median follow-up of 52 months (interquartile range, 44-61 months), 277 (25.6%) patients experienced a distant recurrence. In the validation cohort, composed of 433 patients, 42.3% received perioperative BT within a median follow-up of 83 months, and 127 (28.3%) patients experienced distant recurrence. On multivariable analyses predicting distant recurrences, BT was not associated with the risk of distant recurrence stratified by location and time (within first year or later after RC; all P ≥ .2) in both cohorts. CONCLUSIONS BT administration was not associated with a different pattern, timing, or rate of distant recurrences in patients when compared with those who did not receive BT. New data are needed to investigate the mechanisms behind the association between BT and survival in RC patients.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria; Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy.
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Torino, Italy
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Rocco Damiano
- Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Renzo Colombo
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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14
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Mörner MEM, Edgren G, Martling A, Gunnarsson U, Egenvall M. Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study. Int J Colorectal Dis 2017; 32:223-232. [PMID: 27770250 PMCID: PMC5285411 DOI: 10.1007/s00384-016-2678-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The hypothesis in this study was that anaemia prior to surgery and perioperative red blood cell transfusion increases the risk for recurrence and overall mortality in patients with stages I-III colorectal cancer after abdominal resection with curative intent. METHODS This is a Swedish single centre retrospective cohort study. Data on 496 consecutive radical abdominal resections stages I-III colorectal cancer performed at the Karolinska University Hospital 2007-2010 were extracted from the Swedish Colorectal Cancer Registry. Data were linked to local laboratory and transfusion databases to identify preoperative anaemia and perioperative transfusion. Disease recurrence was validated by scrutiny of patient records. A total of 496 stages I-III colorectal cancer patients were included in the analysis. Multivariate Cox regression analysis adjusted for tumour and patient characteristics were performed to assess risk for recurrence and overall mortality. RESULTS Anaemia prior to surgery was associated with increased risk for overall mortality (HR 2.1, 95% CI 1.4-3.2). There was no association between anaemia and risk for recurrence (HR 1.6, 95% CI 0.97-2.6). Transfusion was not associated with increased risk of recurrence (HR 0.7, 95% CI 0.4-1.3) or overall mortality (HR 1.04, 95% CI 0.7-1.6). CONCLUSIONS Anaemia prior to colorectal cancer surgery was associated with increased risk for overall mortality while a no increased risk was seen for recurrence. Previous findings indicating an association between blood transfusion and increased risk for recurrence could not be confirmed.
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Affiliation(s)
- Malin E. M. Mörner
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ,Functional Area of Emergency Medicine Huddinge, C1:63, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
| | - Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,Center of Digestive Diseases, P9:03, Karolinska University Hospital, Solna, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå university, Umeå, Sweden
| | - Monika Egenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,Center of Digestive Diseases, P9:03, Karolinska University Hospital, Solna, Sweden
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15
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He Y, Xia T, Bian H, Zhuo Z, Lu H, Wang Z. Pretreatment thrombocytosis predicts survival in colorectal cancer. Clin Res Hepatol Gastroenterol 2016; 40:e59-e60. [PMID: 27255967 DOI: 10.1016/j.clinre.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Yazhou He
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Tianli Xia
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - He Bian
- Division of biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario M5T 3M7, Canada
| | - Zeguo Zhuo
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Haitao Lu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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16
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Kulik U, Schrem H, Bektas H, Klempnauer J, Lehner F. Prognostic relevance of hematological profile before resection for colorectal liver metastases. J Surg Res 2016; 206:498-506. [PMID: 27884348 DOI: 10.1016/j.jss.2016.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/06/2016] [Accepted: 08/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although alterations of hematological profile and especially elevated platelet counts were reported to influence survival in primary colorectal cancer, its prognostic relevance before the surgical treatment of colorectal liver metastases (CLM) is mainly unclear. Therefore, the aim of this study was to analyze the impact of these factors on overall survival following liver resection of CLM. MATERIALS AND METHODS The surgical treatment of primary CLM between 1994 and 2012 in 983 patients was retrospectively analyzed using univariable and multivariable Cox regression models. RESULTS In the multivariable analyses, a preoperative anemia was independently associated with inferior overall outcome (P = 0.005, hazard ratio: 1.355). However, with only 2.7% of all cases, an elevation of preoperative platelets was not a frequent finding and no independent impact on survival (P = 0.834). Furthermore, abnormal hemoglobin and platelet values had no impact on rate of surgical revisions due to bleeding complications (P = 0.962 and P = 0.671, respectively), but a potential interaction between abnormal hemoglobin and platelet values and the amount of transfused packed red blood cells (P = 0.004 and P < 0.001, respectively) was observed. CONCLUSIONS Preoperative anemia is statistically significantly associated with inferior overall survival following resection of CLM and might define a new prognostic marker. Preoperative elevated platelets were not a frequent finding and showed no influence on overall survival.
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Affiliation(s)
- Ulf Kulik
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
| | - Harald Schrem
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany; Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Hueseyin Bektas
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Juergen Klempnauer
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Lehner
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
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17
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Lee YS, Suh KW, Oh SY. Preoperative thrombocytosis predicts prognosis in stage II colorectal cancer patients. Ann Surg Treat Res 2016; 90:322-7. [PMID: 27274508 PMCID: PMC4891523 DOI: 10.4174/astr.2016.90.6.322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Thrombocytosis is known to be a poor prognostic factor in several types of solid tumors. The prognostic role of preoperative thrombocytosis in colorectal cancer remains limited. The aim of this study is to investigate the prognostic role of preoperative thrombocytosis in stage II colorectal cancer. Methods Two hundred eighty-four patients with stage II colorectal cancer who underwent surgical resection between December 2003 and December 2009 were retrospectively reviewed. Thrombocytosis was defined as platelet > 450 × 109/L. We compared patients with thrombocytosis and those without thrombocytosis in terms of survival. Results The 5-year disease-free survival (DFS) rates were lower in patients with thrombocytosis compared to those without thrombocytosis in stage II colorectal cancer (73.3% vs. 89.6%, P = 0.021). Cox multivariate analysis demonstrated that thrombocytosis (hazard ratio, 2.945; 95% confidence interval, 1.127–7.697; P = 0.028) was independently associated with DFS in patients with stage II colorectal cancer. Conclusion This study showed that thrombocytosis is a prognostic factor predicting DFS in stage II colorectal cancer patients.
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Affiliation(s)
- Yong Sun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Wook Suh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Yeop Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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18
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Kuderer NM, Culakova E, Lyman GH, Francis C, Falanga A, Khorana AA. A Validated Risk Score for Venous Thromboembolism Is Predictive of Cancer Progression and Mortality. Oncologist 2016; 21:861-7. [PMID: 27125754 DOI: 10.1634/theoncologist.2015-0361] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/01/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Retrospective studies have suggested an association between cancer-associated venous thromboembolism (VTE) and patient survival. We evaluated a previously validated VTE Clinical Risk Score in also predicting early mortality and cancer progression. METHODS A large, nationwide, prospective cohort study of adults with solid tumors or lymphoma initiating chemotherapy was conducted from 2002 to 2006 at 115 U.S. practice sites. Survival and cancer progression were estimated by the method of Kaplan and Meier. Multivariate analysis was based on Cox regression analysis adjusted for major prognostic factors including VTE itself. RESULTS Of 4,405 patients, 134 (3.0%) died and 330 (7.5%) experienced disease progression during the first 4 months of therapy (median follow-up 75 days). Patients deemed high risk (n = 540, 12.3%) by the Clinical Risk Score had a 120-day mortality rate of 12.7% (adjusted hazard ratio [aHR] 3.00, 95% confidence interval [CI] 1.4-6.3), and intermediate-risk patients (n = 2,665, 60.5%) had a mortality rate of 5.9% (aHR 2.3, 95% CI 1.2-4.4) compared with only 1.4% for low-risk patients (n = 1,200, 27.2%). At 120 days of follow-up, cancer progression occurred in 27.2% of high-risk patients (aHR 2.2, 95% CI 1.4-3.5) and 16.4% of intermediate-risk patients (aHR 1.9, 95% CI 1.3-2.7) compared with only 8.5% of low-risk patients (p < .0001). CONCLUSION The Clinical Risk Score, originally developed to predict the occurrence of VTE, is also predictive of early mortality and cancer progression during the first four cycles of outpatient chemotherapy, independent from other major prognostic factors including VTE itself. Ongoing and future studies will help determine the impact of VTE prophylaxis on survival. IMPLICATIONS FOR PRACTICE The risk of venous thromboembolism (VTE) is increased in patients receiving cancer chemotherapy. In this article, the authors demonstrate that a popular risk score for VTE in patients with cancer is also associated with the risk of early mortality in this setting. It is important that clinicians evaluate the risk of VTE in patients receiving cancer treatment and discuss the risk and associated symptoms of VTE with patients. Individuals at increased risk should be advised that VTE is a medical emergency and should be urgently diagnosed and appropriately treated to reduce the risk of serious and life-threatening complications.
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Affiliation(s)
| | - Eva Culakova
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Gary H Lyman
- University of Washington, Seattle, Washington, USA Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | | | - Alok A Khorana
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Moschini M, Bianchi M, Gandaglia G, Cucchiara V, Luzzago S, Pellucchi F, Damiano R, Serretta V, Briganti A, Montorsi F, Salonia A, Colombo R. The Impact of Perioperative Blood Transfusion on Survival of Bladder Cancer Patients Submitted to Radical Cystectomy: Role of Anemia Status. Eur Urol Focus 2016; 2:86-91. [DOI: 10.1016/j.euf.2015.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/16/2015] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
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20
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Moschini M, Dell' Oglio P, Capogrosso P, Cucchiara V, Luzzago S, Gandaglia G, Zattoni F, Briganti A, Damiano R, Montorsi F, Salonia A, Colombo R. Effect of Allogeneic Intraoperative Blood Transfusion on Survival in Patients Treated With Radical Cystectomy for Nonmetastatic Bladder Cancer: Results From a Single High-Volume Institution. Clin Genitourin Cancer 2015; 13:562-7. [DOI: 10.1016/j.clgc.2015.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 04/13/2015] [Accepted: 04/26/2015] [Indexed: 12/16/2022]
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Jósa V, Krzystanek M, Vass T, Lang T, Juhász V, Szilágyi K, Tihanyi B, Harsányi L, Szállási Z, Salamon F, Baranyai Z. Thrombocytosis of Liver Metastasis from Colorectal Cancer as Predictive Factor. Pathol Oncol Res 2015; 21:991-7. [PMID: 25761795 DOI: 10.1007/s12253-015-9925-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/24/2015] [Indexed: 01/17/2023]
Abstract
There is increasing evidence that thrombocytosis is associated with tumor invasion and metastasis formation. It was shown in several solid tumor types that thrombocytosis prognosticates cancer progression. The aim of this study was to evaluate preoperative thrombocytosis as a potential prognostic biomarker in isolated metastases, in patients with liver metastasis of colorectal cancer (mCRC). Clinicopathological data of 166 patients with mCRC who had surgical resection between 2001 and 2011 were collected retrospectively. All primary tumors have been already resected. The platelet count was evaluated based on the standard preoperative blood profile. The patients were followed-up on average for 28 months. Overall survival (OS) of patients with thrombocytosis was significantly worse both in univariate (HR = 3.00, p = 0.03) and in multivariate analysis (HR = 4.68, p = 0.056) when adjusted for gender, age, tumor size and surgical margin. Thrombocytosis was also a good prognosticator of disease-free survival (DFS) with HR = 2.7, p = 0.018 and nearly significant in multivariate setting (HR = 2.26, p = 0.073). The platelet count is a valuable prognostic marker for the survival in patients with mCRC.
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Affiliation(s)
- Valéria Jósa
- Tumorgenetika Human Biospecimen Collection and Research, 1147, Budapest, Kerékgyártó u. 36., Hungary
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22
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Chen Y, Zhang L, Liu WX, Liu XY. Prognostic Significance of Preoperative Anemia, Leukocytosis and Thrombocytosis in Chinese Women with Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2015; 16:933-9. [DOI: 10.7314/apjcp.2015.16.3.933] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Ilhan-Mutlu A, Starlinger P, Perkmann T, Schoppmann SF, Preusser M, Birner P. Plasma fibrinogen and blood platelet counts are associated with response to neoadjuvant therapy in esophageal cancer. Biomark Med 2015; 9:327-35. [DOI: 10.2217/bmm.14.111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: To investigate coagulatory factors in predicting response to neoadjuvant therapy (NeoTr) in esophageal cancer (EC). Methods: We investigated the relevance of coagulatory factors in 84 EC patients (56 adenocarcinomas, 28 squamous cell cancer) who received NeoTr. Plasma fibrinogen (PFR), peripheral blood platelet counts (PBPC) and C-reactive protein (CRP) were determined before NeoTr. Response was classified as tumor regression grades. Results: Patients with good response to NeoTr had significantly higher PFR (p = 0.006), CRP (p = 0.002) and PBPC levels (p = 0.034) when compared with others. Only, PFR remained an independent factor influencing tumor regression (p = 0.0064, coefficient of regression: -0.003). No association with survival was observed. Conclusion: PFR and to a lesser extent PBPC and CRP might be considered as a predictive marker for the response to NeoTr in EC.
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Affiliation(s)
- Aysegül Ilhan-Mutlu
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Comprehensive Cancer Center Vienna, Gastroesophageal Tumors Unit, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Patrick Starlinger
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Sebastian F Schoppmann
- Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Comprehensive Cancer Center Vienna, Gastroesophageal Tumors Unit, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Comprehensive Cancer Center Vienna, Gastroesophageal Tumors Unit, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Peter Birner
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
- Comprehensive Cancer Center Vienna, Gastroesophageal Tumors Unit, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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24
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An MS, Yoo JH, Kim KH, Bae KB, Choi CS, Hwang JW, Kim JH, Kim BM, Kang MS, Oh MK, Hong KH. T4 stage and preoperative anemia as prognostic factors for the patients with colon cancer treated with adjuvant FOLFOX chemotherapy. World J Surg Oncol 2015; 13:64. [PMID: 25889520 PMCID: PMC4336700 DOI: 10.1186/s12957-015-0488-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 01/26/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND FOLFOX-based adjuvant chemotherapy is a benefit for high-risk stage II and stage III colon cancer after curative resection. But, the prognostic factor or predictive marker for the efficacy of FOLFOX remains unclear. This study was aimed to identify the prognostic value and cumulative impact of adjuvant FOLFOX on the stage II and III colon cancer patients. METHODS A total of 196 stage II and III colon cancer patients were retrospectively enrolled in prospectively collected data. They underwent curative resection followed by FOLFOX4 adjuvant chemotherapy. The oncological outcomes included the 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate. Cox-regression analysis was performed to identify the prognostic value, and its cumulative impact was analyzed. RESULTS The 5-year DFS rate of the patients was 71.94% and the 5-year OS rate was 81.5%. The prognostic values for the 5-year DFS rate and 5-year OS rate were T4 stage and preoperative anemia in a multivariate analysis. Each patient group who had no prognostic value, single, or both factors revealed 95.35%, 69.06%, and 28.57% in the 5-year DFS rate, respectively (p < 0.0001). The 5-year OS rate also showed the significant differences in each group who had no prognostic value, single, or both factors revealed 100%, 79.3%, and 45.92%, respectively (p < 0.0001). CONCLUSION Our results showed similar efficacy to MOSAIC study in stage II and stage III colon cancer patients treated with adjuvant FOLFOX chemotherapy after curative resection. Patients who had T4 stage and/or preoperative anemia showed worse prognosis than patients without any prognostic value. These findings suggest that FOLFOX could not be effective in the patients with T4 stage colon cancer accompanied by preoperative anemia.
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Affiliation(s)
- Min Sung An
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
| | - Jong Han Yoo
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
| | - Kwang Hee Kim
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
| | - Ki Beom Bae
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
| | - Chang Soo Choi
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
| | - Jin Won Hwang
- Internal medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 614-735, Korea.
| | - Ji Hyun Kim
- Internal medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 614-735, Korea.
| | - Bo Mi Kim
- Pathology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 614-735, Korea.
| | - Mi Seon Kang
- Pathology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 614-735, Korea.
| | - Min Kyung Oh
- Clinical Trial Center in Pharmacology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 614-735, Korea.
| | - Kwan Hee Hong
- Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 614-735, Korea.
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Sohal DPS, Shrotriya S, Glass KT, Pelley RJ, McNamara MJ, Estfan B, Shapiro M, Wey J, Chalikonda S, Morris-Stiff G, Walsh RM, Khorana AA. Predicting early mortality in resectable pancreatic adenocarcinoma: A cohort study. Cancer 2015; 121:1779-84. [PMID: 25676016 DOI: 10.1002/cncr.29298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/22/2015] [Accepted: 01/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Survival after surgical resection for pancreatic cancer remains poor. A subgroup of patients die early (<6 months), and understanding factors associated with early mortality may help to identify high-risk patients. The Khorana score has been shown to be associated with early mortality for patients with solid tumors. In the current study, the authors evaluated the role of this score and other prognostic variables in this setting. METHODS The current study was a cohort study of patients who underwent surgical resection for pancreatic cancer from January 2006 through June 2013. Baseline (diagnosis ±30 days) parameters were used to define patients as high risk (Khorana score ≥3). Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) were calculated. RESULTS The study population comprised 334 patients. The median age was 67 years, 50% of the study population was female, and 86% of the patients were white. The pancreatic head was the primary tumor site for 73% of patients; 67% of tumors were T3 and 63% were N1. The median Khorana score was 2; 152 patients (47%) were determined to be high risk. Adjunctive treatment included chemotherapy (70%) and radiotherapy (40%). The postoperative (30-day) mortality rate was 0.9%. The 6-month mortality rate for the entire cohort was 9.4%, with significantly higher rates observed for high-risk patients (13.4% vs 5.6%; P = .02). On multivariable analyses (examining a total of 326 patients), the Khorana score (HR for high risk, 2.31; P = .039) and elevated blood urea nitrogen (HR, 4.34; P<.001) were associated with early mortality. CONCLUSIONS Patients at high risk of early mortality after surgical resection of pancreatic adenocarcinoma can be identified using simple baseline clinical and laboratory parameters. Future studies should address preoperative interventions in these patients at high risk of early mortality.
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Affiliation(s)
- Davendra P S Sohal
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shiva Shrotriya
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kate Tullio Glass
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J Pelley
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael J McNamara
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bassam Estfan
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marc Shapiro
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jane Wey
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sricharan Chalikonda
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gareth Morris-Stiff
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - R Matthew Walsh
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Rambach L, Bertaut A, Vincent J, Lorgis V, Ladoire S, Ghiringhelli F. Prognostic value of chemotherapy-induced hematological toxicity in metastatic colorectal cancer patients. World J Gastroenterol 2014; 20:1565-1573. [PMID: 24587632 PMCID: PMC3925865 DOI: 10.3748/wjg.v20.i6.1565] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish whether chemotherapy-induced neutropenia is predictive of better outcome in patients with metastatic colorectal cancer (mCRC).
METHODS: Survival and patient characteristics from consecutive mCRC patients treated in the Centre Georges Francois Leclerc, Dijon, France between January 2001 and December 2011 were analyzed. Patient and tumor characteristics, hematological toxicity (neutropenia, anemia, and thrombocytopenia), and type of chemotherapy received were recorded.
RESULTS: We retrospectively analyzed data from 399 consecutive patients with mCRC who received at least one line of chemotherapy. Median follow up was 6.3 years. Eighty-eight percent of the patients received more than two lines of chemotherapy. By univariate analysis, whatever their grade, neutropenia and thrombocytopenia occurring during the first two lines of chemotherapy were significantly associated with better overall survival (HR = 0.55, 95%CI: 0.43-0.70, P < 0.0001 and HR = 0.70, 95%CI: 0.56-0.88, P = 0.025 respectively). In contrast, anemia during chemotherapy was significantly associated with poorer overall survival (HR = 1.9, 95%CI: 1.22-2.97, P = 0.005). Multivariate analysis revealed that both neutropenia and thrombocytopenia were significantly associated with better overall survival: HR = 0.43, 95%CI: 0.29-0.64, P < 0.0001 and HR = 0.69, 95%CI: 0.49-0.98, P = 0.036, respectively.
CONCLUSION: These data suggest that occurrence of neutropenia or thrombocytopenia during first- or second-line chemotherapy for mCRC is associated with better survival.
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Tridente A, Clarke GM, Walden A, McKechnie S, Hutton P, Mills GH, Gordon AC, Holloway PAH, Chiche JD, Bion J, Stuber F, Garrard C, Hinds CJ. Patients with faecal peritonitis admitted to European intensive care units: an epidemiological survey of the GenOSept cohort. Intensive Care Med 2013; 40:202-210. [PMID: 24306080 DOI: 10.1007/s00134-013-3158-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 11/07/2013] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Faecal peritonitis (FP) is a common cause of sepsis and admission to the intensive care unit (ICU). The Genetics of Sepsis and Septic Shock in Europe (GenOSept) project is investigating the influence of genetic variation on the host response and outcomes in a large cohort of patients with sepsis admitted to ICUs across Europe. Here we report an epidemiological survey of the subset of patients with FP. OBJECTIVES To define the clinical characteristics, outcomes and risk factors for mortality in patients with FP admitted to ICUs across Europe. METHODS Data was extracted from electronic case report forms. Phenotypic data was recorded using a detailed, quality-assured clinical database. The primary outcome measure was 6-month mortality. Patients were followed for 6 months. Kaplan-Meier analysis was used to determine mortality rates. Cox proportional hazards regression analysis was employed to identify independent risk factors for mortality. RESULTS Data for 977 FP patients admitted to 102 centres across 16 countries between 29 September 2005 and 5 January 2011 was extracted. The median age was 69.2 years (IQR 58.3-77.1), with a male preponderance (54.3%). The most common causes of FP were perforated diverticular disease (32.1%) and surgical anastomotic breakdown (31.1%). The ICU mortality rate at 28 days was 19.1%, increasing to 31.6% at 6 months. The cause of FP, pre-existing co-morbidities and time from estimated onset of symptoms to surgery did not impact on survival. The strongest independent risk factors associated with an increased rate of death at 6 months included age, higher APACHE II score, acute renal and cardiovascular dysfunction within 1 week of admission to ICU, hypothermia, lower haematocrit and bradycardia on day 1 of ICU stay. CONCLUSIONS In this large cohort of patients admitted to European ICUs with FP the 6 month mortality was 31.6%. The most consistent predictors of mortality across all time points were increased age, development of acute renal dysfunction during the first week of admission, lower haematocrit and hypothermia on day 1 of ICU admission.
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Affiliation(s)
- Ascanio Tridente
- Whiston Hospital, Prescot, Merseyside and Academic Unit of Medical Education, The Medical School, University of Sheffield, Sheffield, UK
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Baranyai Z, Krzystanek M, Jósa V, Dede K, Agoston E, Szász AM, Sinkó D, Szarvas V, Salamon F, Eklund AC, Szállási Z, Jakab F. The comparison of thrombocytosis and platelet-lymphocyte ratio as potential prognostic markers in colorectal cancer. Thromb Haemost 2013; 111:483-90. [PMID: 24285160 DOI: 10.1160/th13-08-0632] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/12/2013] [Indexed: 12/17/2022]
Abstract
The aim of the present study was to analyse the preoperative platelet count and the platelet-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC) of different stages and with hepatic metastasis of CRC (mCRC) and to compare these factors as potential prognostic markers. Clinicopathological data of 10 years were collected retrospectively from 336 patients with CRC and 118 patients with mCRC. Both in the CRC and the mCRC group overall survival (OS) was significantly worse in patients who had elevated platelet count (hazard ratio [HR] = 2.2, p < 0.001 and HR = 2.9, p = 0.018, respectively). Multivariate analysis indicated that elevated platelet count was an independent prognostic factor of CRC (HR = 1.7, p = 0.035) and mCRC (HR = 3.1, p = 0.017). Disease-free survival (DFS) was significantly worse in patients with elevated platelet count in the CRC group (HR = 2.0, p = 0.011). In the multivariate analysis the PLR was not a prognostic factor in either of the two cohorts (HR = 0.92, p < 0.001 and HR = 0.89, p = 0.789, respectively). The platelet count is a valuable prognostic marker for the survival in patients both with CRC and mCRC while the PLR is not prognostic in either group.
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Affiliation(s)
- Z Baranyai
- Dr. Zsolt Baranyai, Kerékgyártó utca 36-38, H-1147 Budapest, Hungary, Tel.: +36 30 4500388, Fax: +36 1 786 1859, E-mail:
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Ahmed S, Leis A, Fields A, Chandra-Kanthan S, Haider K, Alvi R, Reeder B, Pahwa P. Survival impact of surgical resection of primary tumor in patients with stage IV colorectal cancer: results from a large population-based cohort study. Cancer 2013; 120:683-91. [PMID: 24222180 DOI: 10.1002/cncr.28464] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently, there is very low-quality evidence available regarding benefit of surgical resection of the primary tumor (SRPT), in patients with stage IV colorectal cancer (CRC). In the absence of randomization, the reported benefit may reflect selection of younger and healthier patients with good performance status. A large population-based cohort study was undertaken to determine the survival benefit of SRPT in advanced CRC by eliminating various biases reported in the literature. METHODS A retrospective cohort study involving patients with stage IV CRC, diagnosed between 1992 and 2005, in the province of Saskatchewan, Canada. Survival was estimated by using the Kaplan-Meier method. Survival distribution was compared by log-rank test. Cox proportional multivariate regression analysis was performed to determine survival benefit of SRPT by controlling other prognostic variables. RESULTS A total of 1378 eligible patients were identified. Their median age was 70 years (range, 22-98 years) and male:female ratio was 1.3:1; 944 (68.5%) of them underwent SRPT. Among 1378 patients, 42.3% received chemotherapy and 19.1% received second-generation therapy. Patients who underwent SRPT and received chemotherapy had median overall survival of 18.3 months (95% confidence interval [CI] = 16.6-20 months) compared with 8.4 months (95% CI = 7.1-9.7 months) if they were treated with chemotherapy alone (P < .0001). Cox proportional analysis revealed that use of chemotherapy (hazard ratio [HR] = 0.47, 95% CI = 0.41-0.54), SRPT (HR = 0.49, 95% CI = 0.41-0.58), second-line chemotherapy (HR = 0.47, 95% CI = 0.45-0.64), and metastasectomy (HR = 0.54, 95% CI = 0.45-0.64) were correlated with superior survival. CONCLUSIONS SRPT improves survival in patients with stage IV CRC, independent of other prognostic variables including age, performance status, comorbid illness and chemotherapy.
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Affiliation(s)
- Shahid Ahmed
- Saskatchewan Cancer Agency, Regina, Canada; Department of Oncology, University of Saskatchewan, Saskatoon, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Preoperative anemia, leukocytosis and thrombocytosis identify aggressive endometrial carcinomas. Gynecol Oncol 2013; 131:410-5. [DOI: 10.1016/j.ygyno.2013.08.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/17/2022]
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The prognostic significance of pretreatment leukocytosis in patients with anal cancer treated with radical chemoradiotherapy or radiotherapy. Dis Colon Rectum 2013; 56:1036-42. [PMID: 23929012 DOI: 10.1097/dcr.0b013e31829ab0d4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are emerging data showing the prognostic significance of pretreatment leukocytosis in patients with cervical cancer; it is generally associated with adverse outcome. However, the prognostic impact of leukocytosis in patients with anal cancer has not been previously reported. OBJECTIVE The purpose of this study was to assess the relationship between pretreatment leukocytosis and clinical outcomes in patients with anal cancer treated with radical chemoradiotherapy or radiotherapy. DESIGN This is a retrospective cohort study. SETTING AND PATIENTS One hundred twenty-six patients with invasive anal canal cancer, treated with radical chemoradiotherapy or radiotherapy between 2000 and 2008 at 2 major tertiary cancer centers, were evaluated. MAIN OUTCOME MEASURES The primary outcomes were disease-free and overall survival. RESULTS Median follow-up was 24 months. Pretreatment leukocytosis (white blood cell count >10 × 10/L) was identified in 15.9% (20/126) of patients. After adjusting for sex, tumor size, and stage in a multivariate analysis, leukocytosis remained significantly associated with worse disease-free survival (HR, 2.2; 95% CI, 1.1-4.8; p = 0.045) and worse overall survival (HR, 2.9; 95% CI, 1.1-7.9; p = 0.036). Patients with both leukocytosis and anemia (pretreatment hemoglobin <125 g/L) had the worst prognosis: 2-year disease-free survival 42.1% versus 72.9% for patients without these factors (HR, 2.7; 95% CI, 1.1-6.8; p = 0.033); 2-year overall survival 60.9% versus 89.8% (HR, 4.5; 95% CI, 1.5-13.2; p = 0.006). LIMITATIONS The study was limited by its retrospective nature and lack of patients with multiple hematologic abnormalities (ie, both anemia and leukocytosis). HIV status was unable to be evaluated. CONCLUSIONS Pretreatment leukocytosis in patients with anal cancer is associated with significantly worse disease-free and overall survival, which appears to be exacerbated with the presence of pretreatment anemia.
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Ishizuka M, Kubota K. Clinical utility of inflammation-based prognostic systems in patients with colorectal cancer. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
SUMMARY This systematic review focuses on the clinical utility of three inflammation-based prognostic systems for patients with colorectal cancer (CRC): the Glasgow Prognostic Score (GPS) and its modified version – the modified GPS, neutrophil:lymphocyte ratio (NLR) and reactive thrombocytosis. The GPS/modified GPS had prognostic value in patients undergoing surgery, patients receiving chemo-/radiation therapy, patients with inoperable CRC, patients receiving nutritional evaluation and patients with perioperative complications. The NLR and reactive thrombocytosis also had prognostic value in patients undergoing surgery, patients receiving chemo-/radiation therapy and patients with inoperable CRC. The recommended cut-off value for the NLR is considered to be 5. Because thrombocytosis has been investigated in only seven studies, involving 1971 patients, and the recommended cut-off value is considered to be 300–400 × 109/l, further studies will be required to decide the ideal cut-off value for reactive thrombocytosis in patients with CRC.
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Affiliation(s)
- Mitsuru Ishizuka
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan.
| | - Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan
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Sejima T, Morizane S, Yao A, Isoyama T, Saito M, Amisaki T, Koumi T, Takenaka A. Prognostic impact of preoperative hematological disorders and a risk stratification model in bladder cancer patients treated with radical cystectomy. Int J Urol 2013; 21:52-7. [DOI: 10.1111/iju.12161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/10/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Takehiro Sejima
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Shuichi Morizane
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Akihisa Yao
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Tadahiro Isoyama
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
| | - Motoaki Saito
- Division of Molecular Pharmacology; Department of Pathophysiological and Therapeutic Science; Tottori University Faculty of Medicine; Yonago Japan
| | - Takashi Amisaki
- Department of Biological Regulation; Tottori University Faculty of Medicine; Yonago Japan
| | - Tsutomu Koumi
- Department of Urology; Matsue Red Cross Hospital; Matsue Japan
| | - Atsushi Takenaka
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Yonago Japan
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Abstract
Since the first report of the spontaneous appearance of venous thrombophlebitis as a sign of visceral cancer by Trousseau in 1865, many other studies have documented the existence of cancer-associated coagulation disorders. In this review, we describe the hypercoagulable state associated with colorectal cancer, from three perspectives: first, the incidence, risk factors and prevention of clinically symptomatic thromboembolic conditions associated with cancer, such as venous thromboembolism and arterial thrombosis; second, the association between hypercoagulable conditions, such as thrombocytosis, hyperfibrinogenemia, or D-dimer elevation, and the clinical progression and poor prognosis of cancer patients; third, the experimental approach to elucidate the role of various coagulation-related factors in the process of cancer progression, focusing specifically on the role of platelets and tissue factors.
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Budischak SA, Jolles AE, Ezenwa VO. Direct and indirect costs of co-infection in the wild: Linking gastrointestinal parasite communities, host hematology, and immune function. INTERNATIONAL JOURNAL FOR PARASITOLOGY-PARASITES AND WILDLIFE 2012; 1:2-12. [PMID: 24533308 PMCID: PMC3904086 DOI: 10.1016/j.ijppaw.2012.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 01/21/2023]
Abstract
Most animals are concurrently infected with multiple parasites, and interactions among these parasites may influence both disease dynamics and host fitness. However, the sublethal costs of parasite infections are difficult to measure and the effects of concomitant infections with multiple parasite species on individual physiology and fitness are poorly described for wild hosts. To understand the direct and indirect physiological costs of co-infection, we investigated the relationships among gastrointestinal parasite richness, species identity, and abundance and host hematological parameters, body condition, and investment in lymphocyte defenses. Using aggregate-scale parasite data from African buffalo (Syncerus caffer), we found few direct or indirect associations between infection and hematology in male hosts, and no significant associations were observed in female hosts or with respect to body condition in either sex. These results suggest that only strong physiological effects are detectable with aggregate-scale parasite data, and that hematological variables may be more sensitive to changes in condition than standard body fat condition indices. Analyses accounting for parasite species identity in female buffalo revealed that different parasites show distinct relationships with host hematology, body condition, and immune investment. However, four of six species-specific associations were obscured when parasites were considered in combination. Overall, fitness-related physiological mediators such as hematological indices may provide assessments of direct and indirect effects of parasite infection, particularly when parasite species identity and community composition are considered.
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Affiliation(s)
- Sarah A. Budischak
- Odum School of Ecology, 140 E. Green St., University of Georgia, Athens, GA 30602-2202, USA
- Corresponding author. Tel.: +1 706 542 7401; fax: +1 706 542 4819.
| | - Anna E. Jolles
- Department of Biomedical Sciences, 105 Dryden Hall, Oregon State University, Corvallis, OR 97331-4801, USA
- Department of Zoology, 3029 Cordley Hall, Oregon State University, Corvallis, OR 97331, USA
| | - Vanessa O. Ezenwa
- Odum School of Ecology, 140 E. Green St., University of Georgia, Athens, GA 30602-2202, USA
- Department of Infectious Diseases, College of Veterinary Medicine, 501 D.W. Brooks Drive, University of Georgia, Athens, GA 30602, USA
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Carruthers R, Tho LM, Brown J, Kakumanu S, McCartney E, McDonald AC. Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer. Colorectal Dis 2012; 14:e701-7. [PMID: 22731833 DOI: 10.1111/j.1463-1318.2012.03147.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM Current management of locally advanced rectal cancer includes neoadjuvant chemoradiation in selected patients to increase the chance of a tumour-free circumferential resection margin. There is uncertainty over the role of and selection criteria for additional systemic therapy in this group of patients. In this retrospective study we investigate the association between markers of systemic inflammatory response (SIR) and outcome from treatment. METHOD One hundred and fifteen patients with locally advanced rectal cancer undergoing preoperative chemoradiation had recording of full blood count parameters including neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR). Postoperative surgical margins (R status) and pathological stage were documented. Outcome measures were overall survival (OS), time to local recurrence (TTLR) and disease-free survival (DFS). Cox regression analysis was performed to identify predictors of outcome. RESULTS Only NLR and R status were significant predictors for all outcome measures on univariate and multivariate analysis. Elevated NLR (≥5) was associated with decreased OS, [hazard ratio (HR) and 95% CI, 7.0 (2.6-19.2)], decreased TTLR [HR 3.8 (1.3-11.2)] and shorter DFS [HR 4.1 (1.7-9.8)]. Median survival for patients with an elevated NLR was 18.8 months compared with 54.4 months without an elevated NLR (P<0.001). CONCLUSION In addition to postoperative R-status, an elevated NLR is also a valuable prognostic marker in patients undergoing chemoradiation for locally advanced rectal carcinoma. It is associated with worse OS, TTLR and DFS. An elevated NLR may be a useful additional tool in guiding the decision-making process for adjuvant or neoadjuvant therapies.
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Affiliation(s)
- R Carruthers
- Colorectal Cancer Team, Beatson West of Scotland Cancer Centre, Glasgow Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
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Impact of preoperative thrombocytosis on the survival of patients with primary colorectal cancer. World J Surg 2012; 36:192-200. [PMID: 22045447 DOI: 10.1007/s00268-011-1329-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although thrombocytosis has been reported in patients with various types of cancer, the association between thrombocytosis and the clinicopathological features of patients with colorectal cancer (CRC) has not been fully investigated. We evaluated the clinical features associated with thrombocytosis in CRC. MATERIALS AND METHODS The medical records of 636 consecutive CRC patients undergoing surgery in our department between January 2002 and July 2008 were retrospectively reviewed. The correlation between the clinicopathological variables and the preoperative platelet count was analyzed by univariate and multivariate analyses. The impact of thrombocytosis on the prognosis of these patients was assessed, in comparison with the other clinicopathological variables. RESULTS Platelet count showed significant correlation with gender, age, venous involvement, tumor size, depth of invasion, regional lymph node metastasis, distant metastasis in univariate analysis, and tumor size and depth of invasion were independent factors in multivariate analysis. The cancer-specific survival (CSS) of CRC patients with thrombocytosis was significantly shorter than that for those without thrombocytosis (P < 0.001), specifically in patients with stage III CRC (P < 0.001). Multivariate analysis indicated that thrombocytosis was an independent prognostic factor of CSS (hazard ratio = 2.96, 95% confidence interval [CI] = 1.72-5.00). Moreover, within stage II CRC, the univariate analysis revealed that disease-free survival (DFS) was associated with preoperative thrombocytosis, but not the other clinicopathological variables. CONCLUSIONS Preoperative thrombocytosis is not only an independent indicator of poor CSS in CRC patients but also an independent predictor of poor DFS in patients with stage II CRC.
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Hsu CL, Chen KY, Shih JY, Ho CC, Yang CH, Yu CJ, Yang PC. Advanced non-small cell lung cancer in patients aged 45 years or younger: outcomes and prognostic factors. BMC Cancer 2012; 12:241. [PMID: 22695392 PMCID: PMC3420246 DOI: 10.1186/1471-2407-12-241] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 06/13/2012] [Indexed: 01/16/2023] Open
Abstract
Background Lung cancer in young patients (less or equal to 45 years) is uncommon and has clinical characteristics different from that in older patients. We investigated the outcomes and prognostic factors of young patients with advanced non-small cell lung cancer (NSCLC). Methods From January 2000 to December 2009, we enrolled patients aged ≤45 years and diagnosed with stage IIIB or IV NSCLC. Their clinical data, including age, gender, performance status, histologic types, disease stages, laboratory data at diagnosis, treatment modalities, and survival were reviewed and analyzed. A Cox proportional hazard model was used to calculate the hazard ratio (HR) and its 95% confidence interval (CI). Results A total of 144 patients with advanced NSCLC were included. Female patients were more prevalent (n = 74, 51.4%). Adenocarcinoma was the most common histologic type (n = 119, 82.6%) in both genders (male, n = 54, 77.1%; female, n = 65, 87.8%). Epidermal growth factor receptor (EGFR) sequences were determined using tumor specimens from 58 patients, and 29 showed an EGFR mutation. No significant difference in median survival was found between patient groups with and without the EGFR mutation (798 vs. 708 days, p = 0.65). In multivariate analysis, male gender (HR, 1.70; 95% CI: 1.08-2.68), body mass index (BMI) less than 25 kg/m2 (HR, 2.72; 95% CI: 1.39-5.30), stage IV disease (HR, 2.62; 95% CI: 1.50-4.57), and anemia (HR, 2.08; 95% CI: 1.15-3.77) were associated with a short survival time. Conclusions Low BMI, stage IV disease, anemia at diagnosis, and male gender were the negative prognostic factors for young patients with advanced NSCLC.
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Affiliation(s)
- Chia-Lin Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, and College of Medicine, Taipei, Taiwan
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Todenhöfer T, Renninger M, Schwentner C, Stenzl A, Gakis G. A new prognostic model for cancer-specific survival after radical cystectomy including pretreatment thrombocytosis and standard pathological risk factors. BJU Int 2012; 110:E533-40. [PMID: 22578156 DOI: 10.1111/j.1464-410x.2012.11231.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Study Type - Prognosis (cohort series) Level of Evidence 2a What's known on the subject? and What does the study add? Preoperative thrombocytosis has been identified as a predictor of poor outcome in various cancer types. However, the prognostic role of platelet count in patients with invasive bladder cancer undergoing radical cystectomy is unknown. The present study demonstrates that preoperative thrombocytosis is an independent risk factor for decreased cancer-specific survival after radical treatment of invasive bladder cancer. We developed a new prognostic scoring model for cancer-specific outcomes after radical cystectomy including platelet count and established pathological risk factors. Consideration of platelet count in the final model increased its predictive accuracy significantly. Thrombocytosis may be a useful parameter to include within established international bladder cancer nomograms. OBJECTIVE • To investigate the oncological significance of preoperative thrombocytosis in patients with invasive bladder cancer undergoing radical cystectomy, as it has been reported as a marker for aggressive tumour biology in a variety of solid tumours. PATIENTS AND METHODS • The series comprised 258 patients undergoing radical cystectomy between 1999 and 2010 in whom different clinical and histopathological parameters were assessed. • Elevated platelet count was defined as >450 × 10(9) /L. • Based on regression estimates of significant parameters in multivariable analysis a new weighted scoring model was developed to predict cancer-specific outcomes. RESULTS • The median follow-up was 30 months (6-116). • Of the 258 patients, 26 (10.1%) had elevated and 232 (89.9%) had normal platelet count. The 3-year cancer-specific survival in patients with normal and elevated platelet count was 61.5% and 32.7%, respectively (P < 0.001). • In multivariable analysis, cancer-specific survival was significantly lower in patients with locally advanced disease (≥pT3a) (relative risk 2.91, 1.54-5.65; P= 0.001), positive soft tissue surgical margins (4.03, 1.99-7.92; P= 0.001) and thrombocytosis (2.68, 1.26-5.14; P= 0.011). • The 3-year cancer-specific survival in patients with a score 0 (low risk), 1-2 (intermediate risk) and 3-5 (high risk) was 81.0%, 54.8% and 8.2%, respectively (P < 0.001). • Consideration of preoperative platelet count in the final model increased its predictive accuracy by 1.8% with a concordance index of 0.745 (P= 0.040). CONCLUSIONS • The presence of thrombocytosis at radical cystectomy portends unfavourable prognosis. • We constructed a simple weighted prognostic model for cancer-specific outcomes after radical cystectomy based on pretreatment platelet count and established pathological risk factors. • These data warrant external validation and may allow for tailored monitoring and selection of appropriate patients for neoadjuvant and adjuvant trials.
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Worley MJ, Nitschmann CC, Shoni M, Vitonis AF, Rauh-Hain JA, Feltmate CM. The significance of preoperative leukocytosis in endometrial carcinoma. Gynecol Oncol 2012; 125:561-5. [PMID: 22465698 DOI: 10.1016/j.ygyno.2012.03.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/09/2012] [Accepted: 03/22/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of preoperative leukocytosis among patients with endometrial carcinoma. METHODS The medical records of all patients that underwent surgical treatment for endometrial carcinoma between January 2005 and December 2010 were retrospectively reviewed. Patients were separated into two groups based on the presence or absence of preoperative leukocytosis (WBC ≥ 10,000 cells per μl). The groups were then compared with respect to pathologic findings, progression-free survival and overall survival. RESULTS 1144 patients were identified, 156 (13.6%) with preoperative leukocytosis and 988 (86.4%) without leukocytosis. The leukocytosis group had a greater percentage of patients with stage 3 (15.4% vs. 9.8%, crude p=0.02) and 4 (7.1% vs. 3.0%, crude p=0.007) disease. Leukocytosis was associated with a greater mean tumor size (4.4 vs. 3.4 cm, p=0.0002) and a greater percentage of patients with cervical stromal involvement (14.8% vs. 8.7%, crude p=0.02), adnexal involvement (14.1% vs. 7.5%, crude p=0.007) and lymphvascular space invasion (24% vs. 16.3%, crude p=0.02). On multivariate analysis, mean tumor size (OR, 95% CI; 1.10, 1.02-1.18) remained significantly associated with preoperative leukocytosis. There was no difference between groups, with respect to time to recurrence. However, leukocytosis was independently associated with an increased risk of death (HR, 95% CI; 1.69, 1.07-2.68). CONCLUSIONS Preoperative leukocytosis, among endometrial cancer patients, was independently associated with increasing tumor size and independently imposed an increased risk of death.
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Affiliation(s)
- Michael J Worley
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Lu HJ, Chen KW, Tzeng CH, Liu JH, Chiou TJ, Yen CC, Chao TC, Teng HW, Chen MH, Liu CY, Wang WS, Chang PMH, Yang MH. Evaluation of Prognosis for Carcinoma of Unknown Origin in Elderly Patients. Oncology 2012; 83:24-30. [DOI: 10.1159/000337983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 03/05/2012] [Indexed: 01/07/2023]
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Clinico-pathological and biological prognostic variables in squamous cell carcinoma of the vulva. Crit Rev Oncol Hematol 2011; 83:71-83. [PMID: 22015047 DOI: 10.1016/j.critrevonc.2011.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/08/2011] [Accepted: 09/21/2011] [Indexed: 11/23/2022] Open
Abstract
Several clinical-pathological parameters have been related to survival of patients with invasive squamous cell carcinoma of the vulva, whereas few studies have investigated the ability of biological variables to predict the clinical outcome of these patients. The present paper reviews the literature data on the prognostic relevance of lymph node-related parameters, primary tumor-related parameters, FIGO stage, blood variables, and tissue biological variables. Regarding these latter, the paper takes into account the analysis of DNA content, cell cycle-regulatory proteins, apoptosis-related proteins, epidermal growth factor receptor [EGFR], and proteins that are involved in tumor invasiveness, metastasis and angiogenesis. At present, the lymph node status and FIGO stage according to the new 2009 classification system are the main predictors for vulvar squamous cell carcinoma, whereas biological variables do not have yet a clinical relevance and their role is still investigational.
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The prognostic value of hematological and systemic inflammatory disorders in invasive bladder cancer. Curr Opin Urol 2011; 21:428-33. [DOI: 10.1097/mou.0b013e32834966fa] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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An evaluation of the preoperative hemoglobin level as a prognostic factor for oral squamous cell carcinoma. HEAD & NECK ONCOLOGY 2011; 3:35. [PMID: 21843350 PMCID: PMC3199902 DOI: 10.1186/1758-3284-3-35] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/15/2011] [Indexed: 12/27/2022]
Abstract
Background Hypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and several immunohistochemical markers have been discussed in this regard. The aim of the present study was to evaluate preoperative hemoglobin levels as a prognostic factor for oral SCC. Materials and methods The files of 287 patients who had been treated for oral SCC between 1999 and 2008 were studied retrospectively. Hemoglobin levels between 1 and 5 days prior to surgical treatment were compared to Tumor (T)- and Nodal (N)- status, local recurrence, and lymph node metastases rate. The minimum follow-up period was 12 months. Results From a total of 287 patients with oral SCC, 205 (71.4%) were in the normal hemoglobin (Hb) group (female Hb≥12.0 g/dl; male Hb≥13.0 g/dl), 53 (18.5%) in the mild anemia (female Hb = 11.0-11.9 g/dl; male Hb = 11.0-12.9 g/dl), and 29 (10.1%) in the severe anemia group (female & male Hb<11.0 g/dl). Anemia was significant for the development of lymph node metastasis (p = 0.005) as well as for local recurrence (p = 0.001). No significant correlation was found to the initial T status (p = 0.183). Conclusion Our data suggests that an Hb of below 11 g/dl contributes to and is an indicator for a poor prognosis. Consequently, pre-treatment Hb corrections may significantly improve outcome, but further investigations, including blood transfusion/application of erythropoietin due to tumor anemia, independent of intraoperative blood-loss are necessary to ascertain their role in an improved survival.
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Qiu MZ, Xu RH, Ruan DY, Li ZH, Luo HY, Teng KY, Wang ZQ, Li YH, Jiang WQ. Incidence of anemia, leukocytosis, and thrombocytosis in patients with solid tumors in China. Tumour Biol 2010; 31:633-41. [PMID: 20652781 DOI: 10.1007/s13277-010-0079-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Accepted: 07/06/2010] [Indexed: 12/22/2022] Open
Abstract
Despite the fact that malignancies are associated with hematological abnormalities, some clinical studies have been unable to detect such a relation. The aim of our study was to detect the prevalence of pretreatment hematologic abnormalities in patients with common solid tumors and to determine if such a profile could be used for prognostic evaluations. We identified all patients in Cancer Center of Sun Yat-sen University who were diagnosed as solid tumors (breast carcinoma, hepatocellular carcinoma, nasopharyngeal carcinoma, esophageal carcinoma, gastric cancer, cervical carcinoma, endometrial cancer, renal cell carcinoma, and non-small cell lung cancer) between January 2000 and August 2009. All subjects were investigated regarding levels of white blood cells, platelets, and hemoglobin concentration. We identified 3,180 patients with solid tumors and 285 patients with benign diseases for the final analysis. The percentages of leukocytosis, anemia, and thrombocytosis in patients with solid tumors ranged from 4.0% to 25.6%, 3.3% to 29.2%, and 2.1% to 9.7%, respectively. The multivariate Cox analysis revealed that anemia was an independent prognostic factor in patients with breast cancer (P = 0.006), hepatocellular carcinoma (P = 0.002), nasopharyngeal carcinoma (P = 0.008), and esophageal carcinoma (P = 0.001). Leukocytosis was an independent prognostic factor in patients with cervical cancer (P = 0.007). The incidence of hematological abnormalities in Chinese patients with solid tumors was relatively lower than that of the counterparts in the Western countries. A pretreatment anemia or leukocytosis can serve as a useful marker to predict outcome of patients in some of the solid tumors.
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Affiliation(s)
- Miao-zhen Qiu
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
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