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Tan D, Fu Y, Tong W, Li F. Prognostic significance of lymphocyte to monocyte ratio in colorectal cancer: A meta-analysis. Int J Surg 2018; 55:128-138. [PMID: 29807167 DOI: 10.1016/j.ijsu.2018.05.030] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The lymphocyte to monocyte ratio, an inflammation-based score, has been used to predict the biological behavior of malignant tumors. However, the relationship between the lymphocyte to monocyte ratio and clinical outcomes in patients with colorectal cancer remains controversial. We conducted a meta-analysis to identify the association between the lymphocyte to monocyte ratio and the prognosis of patients with colorectal cancer. METHODS Data were retrieved from PubMed, Embase, and Web of science, the hazard ratio and odds ratios with 95% confidence intervals were used to assess the prognostic value of the lymphocyte to monocyte ratio. Outcomes of interest included prognosis, such as overall survival, disease-free survival, and cancer-specific survival in patients with colorectal cancer. RESULTS fifteen retrospective, observational, cohort studies involving 11,783 patients were identified. A high lymphocyte to monocyte ratio (LMR) was a significant predictor of better overall survival (hazard ratio = 0.57, 95% confidence interval: 0.52-0.62, P < 0.001), disease-free survival (hazard ratio = 0.77, 95% confidence interval: 0.70-0.84, P < 0.001), and cancer-specific survival (hazard ratio = 0.55, 95% confidence interval: 0.32-0.95, P = 0.031). Increased LMR is also significantly associated with the tumor invasion depth (OR: 0.77, 95% CI: 0.61-0.97) and tumor size (OR: 0.74, 95% CI: 0.61-0.89). CONCLUSIONS Our study indicated that a high lymphocyte to monocyte ratio might be a useful marker for colorectal cancer prognosis. As most of these findings were from retrospective studies, further studies are needed to verify the significance of the lymphocyte to monocyte ratio in clinical practice.
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Affiliation(s)
- Dewen Tan
- Department of General Surgery, Colorectal Division, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400000, People's Republic of China
| | - Yan Fu
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, People's Republic of China
| | - Weidong Tong
- Department of General Surgery, Colorectal Division, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400000, People's Republic of China
| | - Fan Li
- Department of General Surgery, Colorectal Division, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400000, People's Republic of China.
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Mohme M, Riethdorf S, Dreimann M, Werner S, Maire CL, Joosse SA, Bludau F, Mueller V, Neves RPL, Stoecklein NH, Lamszus K, Westphal M, Pantel K, Wikman H, Eicker SO. Circulating Tumour Cell Release after Cement Augmentation of Vertebral Metastases. Sci Rep 2017; 7:7196. [PMID: 28775319 PMCID: PMC5543076 DOI: 10.1038/s41598-017-07649-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/28/2017] [Indexed: 12/21/2022] Open
Abstract
Cement augmentation via percutaneous vertebroplasty or kyphoplasty for treatment of spinal metastasis is a well-established treatment option. We assessed whether elevated intrametastatic pressure during cement augmentation results in an increased dissemination of tumour cells into the vascular circulation. We prospectively collected blood from patients with osteolytic spinal column metastases and analysed the prevalence of circulating tumour cells (CTCs) at three time-points: preoperatively, 20 minutes after cement augmentation, and 3–5 days postoperatively. Enrolling 21 patients, including 13 breast- (61.9%), 5 lung- (23.8%), and one (4.8%) colorectal-, renal-, and prostate-carcinoma patient each, we demonstrate a significant 1.8-fold increase of EpCAM+/K+ CTCs in samples taken 20 minutes post-cement augmentation (P < 0.0001). Despite increased mechanical CTC dissemination due to cement augmentation, follow-up blood draws demonstrated that no long-term increase of CTCs was present. Array-CGH analysis revealed a specific profile of the CTC collected 20 minutes after cement augmentation. This is the first study to report that peripheral CTCs are temporarily increased due to vertebral cement augmentation procedures. Our findings provide a rationale for the development of new prophylactic strategies to reduce the increased release of CTC after cement augmentation of osteolytic spinal metastases.
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Affiliation(s)
- Malte Mohme
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Sabine Riethdorf
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Dreimann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Cecile L Maire
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Simon A Joosse
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Frederic Bludau
- Department for Trauma Surgery, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Centre Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Rui P L Neves
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Dusseldorf, Dusseldorf, Germany
| | - Nikolas H Stoecklein
- Department of General, Visceral and Pediatric Surgery, University Hospital and Medical Faculty of the Heinrich-Heine University Dusseldorf, Dusseldorf, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Pantel
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Harriet Wikman
- Department of Tumour Biology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sven O Eicker
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Yan FH, Lou Z, Liu XS, Wang Z, Xu XD, Gao YJY, He J, Wang H, Fu CG, Zhang W, He HY, Cai BL, Yu ED. Long-Term Oncological Outcomes of Endoscopic Stenting as a Bridge to Surgery Versus Emergency Surgery for Malignant Colorectal Obstruction: A Comparative Study. J Laparoendosc Adv Surg Tech A 2017; 27:611-617. [PMID: 28092477 DOI: 10.1089/lap.2016.0529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM With consideration of the theoretical link between the stent insertion and the increased risk of tumor cells spillaged, which may lead to distant metastases, there is a concern about long-term clinical outcomes after the usage of self-expanding metallic stents (SEMS) as a "bridge to surgery" in the malignant colorectal obstruction (MCO) treatment. This cohort study aimed to compare the long-term oncological outcomes of SEMS as a bridge to surgery (SEMS group) with those of emergency surgery (ES group) for MCO. METHODS Twenty-seven patients who underwent semielective curative resection after endoscopic SEMS insertion were included from October 2007 to December 2012 in the SEMS group were compared with 33 patients who underwent emergency curative surgery for MCO during the same period in the ES group. The clinical pathologic characteristics and the overall survival (OS) rate were compared between the two groups. RESULTS There were no significant differences in demographics, tumor stage, location, and histology between the SEMS and ES groups. The median OS times were 37 months for the SEMS group and 23 months for the ES group. The proportions of patients who received postoperative adjuvant chemotherapy were comparable (SEMS group versus ES group, 70.4% versus 45.5%; P = .138). There were no significant differences in terms of the long-term oncological outcome between two groups in the 3-year OS rate (55.6% versus 39.4%; P = .2119) and the 5-year OS rate (48.1% versus 36.4%; P = .3570). CONCLUSIONS Long-term oncological outcomes of the SEMS group were comparable to those of the ES group.
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Affiliation(s)
- Fei-Hu Yan
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China .,2 Department of General Surgery, 413 Hospital , Zhoushan, China
| | - Zheng Lou
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiao-Shuang Liu
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhen Wang
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiao-Dong Xu
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yong-Jun-Yi Gao
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jian He
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hao Wang
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Chuan-Gang Fu
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Wei Zhang
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hai-Yan He
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Bei-Li Cai
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - En-da Yu
- 1 Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Martin OA, Anderson RL, Narayan K, MacManus MP. Does the mobilization of circulating tumour cells during cancer therapy cause metastasis? Nat Rev Clin Oncol 2016; 14:32-44. [PMID: 27550857 DOI: 10.1038/nrclinonc.2016.128] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite progressive improvements in the management of patients with locoregionally confined, advanced-stage solid tumours, distant metastasis remains a very common - and usually fatal - mode of failure after attempted curative treatment. Surgery and radiotherapy are the primary curative modalities for these patients, often combined with each other and/or with chemotherapy. Distant metastasis occurring after treatment can arise from previously undetected micrometastases or, alternatively, from persistent locoregional disease. Another possibility is that treatment itself might sometimes cause or promote metastasis. Surgical interventions in patients with cancer, including biopsies, are commonly associated with increased concentrations of circulating tumour cells (CTCs). High CTC numbers are associated with an unfavourable prognosis in many cancers. Radiotherapy and systemic antitumour therapies might also mobilize CTCs. We review the preclinical and clinical data concerning cancer treatments, CTC mobilization and other factors that might promote metastasis. Contemporary treatment regimens represent the best available curative options for patients who might otherwise die from locally confined, advanced-stage cancers; however, if such treatments can promote metastasis, this process must be understood and addressed therapeutically to improve patient survival.
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Affiliation(s)
- Olga A Martin
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,Molecular Radiation Biology Laboratory, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Robin L Anderson
- Metastasis Research Laboratory, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Kailash Narayan
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Michael P MacManus
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
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Jatana KR, Balasubramanian P, McMullen KP, Lang JC, Teknos TN, Chalmers JJ. Effect of surgical intervention on circulating tumor cells in patients with squamous cell carcinoma of the head and neck using a negative enrichment technology. Head Neck 2016; 38:1799-1803. [PMID: 27265898 DOI: 10.1002/hed.24519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/29/2016] [Accepted: 05/05/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the impact of surgical intervention on detection of circulating tumor cells (CTCs) in patients with squamous cell carcinoma of the head and neck (SCCHN.) METHODS: We utilized a negative depletion technique to identify cytokeratin (CK)-positive CTCs. The numbers of CTCs immediately before and after surgical resection were compared. RESULTS Seventy-six blood samples from 38 patients with SCCHN were examined. Seventy-nine percent of the patients had CTCs detected before and after surgery. A total of 7.89% had no CTCs before surgery, yet had CTCs identified after surgery. Overall, 60.5% of patients had an increased number of CTCs/mL after surgery with a mean increase of 6.63-fold. A statistically significant increase in CTCs was seen after surgery (p = .02). CONCLUSION The timing of sample collection in patients with SCCHN who have surgical intervention can potentially impact the number of CTCs identified. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1799-1803, 2016.
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Affiliation(s)
- Kris R Jatana
- Department of Pediatric Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio
- Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio
| | - Priya Balasubramanian
- William G. Lowrie Department of Chemical and Biomolecular Engineering, Ohio State University, Columbus, Ohio
| | - Kyle P McMullen
- Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio
| | - Jas C Lang
- Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio
| | - Theodoros N Teknos
- Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, Ohio
| | - Jeffrey J Chalmers
- William G. Lowrie Department of Chemical and Biomolecular Engineering, Ohio State University, Columbus, Ohio
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Bork U, Grützmann R, Rahbari NN, Schölch S, Distler M, Reissfelder C, Koch M, Weitz J. Prognostic relevance of minimal residual disease in colorectal cancer. World J Gastroenterol 2014; 20:10296-10304. [PMID: 25132746 PMCID: PMC4130837 DOI: 10.3748/wjg.v20.i30.10296] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/18/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Presence of occult minimal residual disease in patients with colorectal cancer (CRC) has a strong prognostic impact on survival. Minimal residual disease plays a major role in disease relapse and formation of metastases in CRC. Analysis of circulating tumor cells (CTC) in the blood is increasingly used in clinical practice for disease monitoring of CRC patients. In this review article the role of CTC, disseminated tumor cells (DTC) in the bone marrow and micrometastases and isolated tumor cells (ITC) in the lymph nodes will be discussed, including literature published until September 2013. Occult disease is a strong prognostic marker for patient survival in CRC and defined by the presence of CTC in the blood, DTC in the bone marrow and/or micrometastases and ITC in the lymph nodes. Minimal residual disease could be used in the future to identify patient groups at risk, who might benefit from individualized treatment options.
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7
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Akagi Y, Kinugasa T, Adachi Y, Shirouzu K. Prognostic significance of isolated tumor cells in patients with colorectal cancer in recent 10-year studies. Mol Clin Oncol 2013; 1:582-592. [PMID: 24649214 DOI: 10.3892/mco.2013.116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 04/18/2013] [Indexed: 12/14/2022] Open
Abstract
Circulating tumor cells (CTCs) that detach from the primary tumor and move into the circulation are detected in patients with metastatic cancer. The discovery of such cancer cells has been used as a predictor of recurrence and prognosis, although a consensus regarding such applications has not been reached. Peritoneal cytology may be used for identifying high risk of recurrence or mortality, whereas the intraoperative presence of tumor cells in drainage veins, bone marrow, or the liver is not always useful for evaluating the prognosis. The reported positive rate for tumor cells in the peripheral blood of patients with colorectal cancer, including metastasis, has varied from 10 to 80%; however, numerous studies have demonstrated significant differences in the recurrence and mortality rates between patients with and without isolated tumor cells (ITCs) in the peripheral blood. However, the clinical significance of CTCs as an absolute prognostic factor has not been elucidated, since the measurement methodologies and/or the number of cases differed between the studies. Future prospective studies including larger patient populations may elucidate the utility of routine detection of ITCs in daily practice.
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Affiliation(s)
- Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tetsushi Kinugasa
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Yosuke Adachi
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Kazuo Shirouzu
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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Does stenting of left-sided colorectal cancer as a "bridge to surgery" adversely affect oncological outcomes? A comparison with non-obstructing elective left-sided colonic resections. Int J Colorectal Dis 2012; 27:1509-14. [PMID: 22684548 DOI: 10.1007/s00384-012-1513-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE With a theoretical link between stent insertion and increased risk of tumour seeding, there is concern about long-term survival after the use of self-expanding metallic stents (SEMS) as a "bridge to surgery" in the treatment of left-sided obstructing colorectal cancer. This cohort study aims to determine if preoperative stenting adversely affects long-term survival by comparing a group of patients having preoperative stenting (group A) with a group of patients having elective surgery (group B) in a single centre. METHODS The study is retrospective. Survival was calculated with Kaplan-Meier analysis and compared using the log-rank test. Other group characteristics were compared with Fisher's exact test. RESULTS From November 1998 to November 2008, 15 patients had preoperative SEMS and were entered in group A. This represented 11.5 % of a total of 130 patients undergoing SEMS insertion in the same period. Group B included 88 consecutive patients undergoing elective left-sided colonic resection for Dukes' B and C cancer excluding mid and low rectal tumours between January 2003 and December 2007. The 30-day mortality rate for groups A and B was 6.7 % (one patient) and 5.7 % (five patients), respectively. The 5-year survival rate was 60 % and 58 %, respectively, with a p value of 0.96. CONCLUSIONS In our own practice, patients undergoing SEMS as a "bridge to surgery" have the same long-term survival with those undergoing elective surgery. This finding needs to be confirmed in larger scale studies.
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9
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Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
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10
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Rahbari NN, Aigner M, Thorlund K, Mollberg N, Motschall E, Jensen K, Diener MK, Büchler MW, Koch M, Weitz J. Meta-analysis shows that detection of circulating tumor cells indicates poor prognosis in patients with colorectal cancer. Gastroenterology 2010; 138:1714-26. [PMID: 20100481 DOI: 10.1053/j.gastro.2010.01.008] [Citation(s) in RCA: 243] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 01/03/2010] [Accepted: 01/11/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS The prognostic significance of circulating (CTCs) and disseminated tumor cells in patients with colorectal cancer (CRC) is controversial. We performed a meta-analysis of available studies to assess whether the detection of tumor cells in the blood and bone marrow (BM) of patients diagnosed with primary CRC can be used as a prognostic factor. METHODS We searched the Medline, Biosis, Science Citation Index, and Embase databases and reference lists of relevant articles (including review articles) for studies that assessed the prognostic relevance of tumor cell detection in the peripheral blood (PB), mesenteric/portal blood (MPB), or BM of patients with CRC. Meta-analyses were performed using a random effects model, with hazard ratio (HR) and 95% confidence intervals (95% CIs) as effect measures. RESULTS A total of 36 studies, including 3094 patients, were eligible for final analyses. Pooled analyses that combined all sampling sites (PB, MPB, and BM) associated the detection of tumor cells with poor recurrence-free survival (RFS) (HR = 3.24 [95% CI: 2.06-5.10], n = 26, I(2) = 77%) and overall survival (OS) (2.28 [1.55-3.38], n = 21, I(2) = 66%). Stratification by sampling site showed that detection of tumor cells in the PB compartment was a statistically significant prognostic factor (RFS: 3.06 [1.74-5.38], n = 19, I(2) = 78%; OS: 2.70 [1.74-4.20], n = 16, I(2) = 59%) but not in the MPB (RFS: 4.12 [1.01-16.83], n = 8, I(2) = 75%; OS: 4.80 [0.81-28.32], n = 5, I(2) = 82%) or in the BM (RFS: 2.17 [0.94-5.03], n = 4, I(2) = 78%; OS: 1.50 [0.52-4.32], n = 3, I(2) = 84%). CONCLUSION Detection of CTCs in the PB indicates poor prognosis in patients with primary CRC.
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Affiliation(s)
- Nuh N Rahbari
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
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11
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Pavlidis TE, Marakis G, Ballas K, Rafailidis S, Psarras K, Pissas D, Sakantamis AK. Does emergency surgery affect resectability of colorectal cancer? Acta Chir Belg 2008; 108:219-225. [PMID: 18557147 DOI: 10.1080/00015458.2008.11680207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Emergency surgery for colorectal cancer is common in daily practice, and is mainly implied by bowel obstruction. It is related to increased morbidity and mortality. Its relation with the stage and respectability of the disease is uncertain. This study aims to further clarify these parameters. PATIENTS AND METHODS Over the past 24-year period 121 patients had an emergency operation (12%) from a total of 1009 patients with colorectal carcinoma. There were 59 men (48.8%) and 62 women (51.2%) with a mean age of 68 years (range 21-93); 61 patients (50.4%) were > or = 70-years-old. The data of all these patients were studied retrospectively in comparison with those who underwent elective surgery. Emergency cases were further divided into two age groups (> or = 70 and < 70 years) and compared. The tumour location was mainly in the left colon, whereas obstruction was the predominant reason for acute presentation. RESULTS On operation, absence of macroscopic spread was noted in 57.8% of emergency cases and 72% of elective cases (p < 0.05). The resectability rates were 75% and 90% respectively (p < 0.05), and were not significantly affected by the age factor. There were no differences in the grade of malignant cell differentiation or in the depth of microscopic invasion (p > 0.05) in either group. For emergency operations, the morbidity was 20% (24 patients) and the 30-day mortality rate was 5.8% (7 patients). Both parameters were higher in patients > or = 70-years-old. CONCLUSION Emergency surgery for colorectal carcinoma is related to lower resectability and to higher--but acceptable--postoperative morbidity and mortality rates, when compared with elective surgical management.
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Affiliation(s)
- T E Pavlidis
- Second Propedeutical Department of Surgery, Medical School, Aristotle. University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42, Thessaloniki, Greece.
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12
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Maruthachalam K, Lash GE, Shenton BK, Horgan AF. Tumour cell dissemination following endoscopic stent insertion. Br J Surg 2007; 94:1151-4. [PMID: 17541987 DOI: 10.1002/bjs.5790] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study examined whether colonoscopy or endoscopic stent insertion increases levels of carcinoembryonic antigen (CEA) and/or cytokeratin (CK) 20 mRNA expression in the peripheral circulation of patients with colorectal cancer. METHODS Peripheral venous blood samples were obtained before and after colonoscopy (38 patients) or colonic stent insertion (20). Twenty patients undergoing colonoscopy for benign conditions served as controls. Expression of mRNA was quantified using real-time reverse transcriptase-polymerase chain reaction. RESULTS Circulating CK20 mRNA was detected in 13 of 38 patients who had a colonoscopy and eight of 20 patients with stent insertion. CK20 mRNA expression was increased following stent insertion (P = 0.007) but not after staging colonoscopy (P = 0.454). CEA mRNA was detected in one patient who had colonoscopy and two who had a stent inserted. Neither CEA nor CK20 mRNA was found in blood samples from controls. CONCLUSION Endoscopic insertion of colonic stents but not staging colonoscopy results in increased levels of CK20 mRNA in the peripheral circulation.
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Affiliation(s)
- K Maruthachalam
- Department of Colorectal Surgery, Freeman Hospital, Newcastle upon Tyne, UK
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13
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Badger SA, Devlin PB, Neilly PJD, Gilliland R. Preoperative staging of rectal carcinoma by endorectal ultrasound: is there a learning curve? Int J Colorectal Dis 2007; 22:1261-8. [PMID: 17294198 DOI: 10.1007/s00384-007-0273-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Endorectal ultrasound (ERUS) is becoming an essential tool in the management of rectal cancer. However, accuracy in the assessment of disease staging may be dependent on operator experience. The aim of this study was to determine if a learning curve exists. MATERIALS AND METHODS From October 1999 to December 2004, all patients with rectal cancer had a pre-operative ERUS performed by a single radiologist. ERUS staging was compared with post-operative pathology findings using the tumour, node, metastases (TNM) classification. The accuracy of ERUS in tumour (T) and node (N) staging after each additional consecutive ten patients was calculated. RESULTS One hundred and thirty one patients were investigated by ERUS, of which 36 were excluded, leaving 95 patients in the study (60 men). Overall accuracy for T staging was 71.6%. No improvement with experience was noted (p > 0.05). With regard to T staging, ERUS tended to overstage more frequently than understage (24.2 versus 4.2%). The sensitivity, specificity, positive predictive value and negative predictive value of uT3 staging were 96.6, 33.3, 70.4 and 85.7%, respectively. Overall accuracy of uN staging was 68.8%. ERUS tended to overstage nodal disease more frequently than understage (16.1 versus 15.1%). Sensitivity, specificity, positive predictive value and negative predictive value were calculated for ultrasound-detected nodal disease (73.2, 62.2, 74.5 and 60.5%, respectively). Nodal staging accuracy improved from 50% after assessment of 10 cases to 77% after 30 cases were examined. CONCLUSIONS ERUS is an accurate method for staging rectal cancer pre-operatively. Accurate assessment of tumour stage can be achieved immediately by an experienced radiologist without specific training in ERUS. Nodal staging accuracy tends to improve with experience but reaches a plateau after 30 cases.
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Affiliation(s)
- S A Badger
- Department of Surgery, Altnagelvin Area Hospital, Glenshane Road, Northern Ireland, UK.
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