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Değerli E, Oruç K, Şentürk Öztaş N, Alkan Şen G, Bedir Ş, Demirci NS, Demirelli HF. Prognostic factors in Kaposi sarcoma, single centre experience. Australas J Dermatol 2024. [PMID: 38760927 DOI: 10.1111/ajd.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Kaposi sarcoma (KS) is a multicentric vascular and lymphatic neoplasm caused by human herpesvirus 8 (HHV-8). It generally concerns the elderly and immunosuppressed population. Four major clinical types of KS have been described. The most common subtype is Classical KS (CKS). OBJECTIVES Our retrospective study aimed to better define prognostic subgroups among patients with CKS, which is the most common in our country. METHOD Between 2014 and 2020, 43 patients with CKS were treated with local excision, radiotherapy and chemotherapy. Reviewed information included demographics, clinical features, laboratory findings, treatment responses and overall survival. RESULTS During the follow-up, eight patients (18.6%) died of CKS. The complete response rate was 46.5%, partial response and stable disease 51.2%, and progressive disease 2.3% of all patients. Gender, haemoglobin level at diagnosis, and disseminated involvement were prognostic factors affecting survival in all patients. CONCLUSION We confirmed that male gender, low haemoglobin levels, and disseminated involvement are associated with poor prognosis in CKS patients. It is the only Turkish study in which prognostic analysis was performed for this rare cancer.
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Affiliation(s)
- Ezgi Değerli
- Department of Medical Oncology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kerem Oruç
- Department of Medical Oncology, Yozgat City Hospital, Yozgat, Turkey
| | - Nihan Şentürk Öztaş
- Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gülin Alkan Şen
- Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Şahin Bedir
- Department of Medical Oncology, Bağcılar Training and Research Hospital, Istanbul, Turkey
| | - Nebi Serkan Demirci
- Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hulusi Fuat Demirelli
- Department of Medical Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Peng D, Li ZW, Liu F, Liu XR, Wang CY. Predictive value of red blood cell distribution width and hematocrit for short-term outcomes and prognosis in colorectal cancer patients undergoing radical surgery. World J Gastroenterol 2024; 30:1714-1726. [PMID: 38617745 PMCID: PMC11008369 DOI: 10.3748/wjg.v30.i12.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/26/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Previous studies have reported that low hematocrit levels indicate poor survival in patients with ovarian cancer and cervical cancer, the prognostic value of hematocrit for colorectal cancer (CRC) patients has not been determined. The prognostic value of red blood cell distribution width (RDW) for CRC patients was controversial. AIM To investigate the impact of RDW and hematocrit on the short-term outcomes and long-term prognosis of CRC patients who underwent radical surgery. METHODS Patients who were diagnosed with CRC and underwent radical CRC resection between January 2011 and January 2020 at a single clinical center were included. The short-term outcomes, overall survival (OS) and disease-free survival (DFS) were compared among the different groups. Cox analysis was also conducted to identify independent risk factors for OS and DFS. RESULTS There were 4258 CRC patients who underwent radical surgery included in our study. A total of 1573 patients were in the lower RDW group and 2685 patients were in the higher RDW group. There were 2166 and 2092 patients in the higher hematocrit group and lower hematocrit group, respectively. Patients in the higher RDW group had more intraoperative blood loss (P < 0.01) and more overall complications (P < 0.01) than did those in the lower RDW group. Similarly, patients in the lower hematocrit group had more intraoperative blood loss (P = 0.012), longer hospital stay (P = 0.016) and overall complications (P < 0.01) than did those in the higher hematocrit group. The higher RDW group had a worse OS and DFS than did the lower RDW group for tumor node metastasis (TNM) stage I (OS, P < 0.05; DFS, P = 0.001) and stage II (OS, P = 0.004; DFS, P = 0.01) than the lower RDW group; the lower hematocrit group had worse OS and DFS for TNM stage II (OS, P < 0.05; DFS, P = 0.001) and stage III (OS, P = 0.001; DFS, P = 0.001) than did the higher hematocrit group. Preoperative hematocrit was an independent risk factor for OS [P = 0.017, hazard ratio (HR) = 1.256, 95% confidence interval (CI): 1.041-1.515] and DFS (P = 0.035, HR = 1.194, 95%CI: 1.013-1.408). CONCLUSION A higher preoperative RDW and lower hematocrit were associated with more postoperative complications. However, only hematocrit was an independent risk factor for OS and DFS in CRC patients who underwent radical surgery, while RDW was not.
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Affiliation(s)
- Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Chun-Yi Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Rendón-Barrón MJ, Pérez-Arteaga E, Delgado-Waldo I, Coronel-Hernández J, Pérez-Plasencia C, Rodríguez-Izquierdo F, Linares R, González-Esquinca AR, Álvarez-González I, Madrigal-Bujaidar E, Jacobo-Herrera NJ. Laherradurin Inhibits Tumor Growth in an Azoxymethane/Dextran Sulfate Sodium Colorectal Cancer Model In Vivo. Cancers (Basel) 2024; 16:573. [PMID: 38339324 PMCID: PMC10854818 DOI: 10.3390/cancers16030573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common neoplasia in the world. Its mortality rate is high due to the lack of specific and effective treatments, metastasis, and resistance to chemotherapy, among other factors. The natural products in cancer are a primary source of bioactive molecules. In this research, we evaluated the antitumor activity of an acetogenin (ACG), laherradurin (LH), isolated from the Mexican medicinal plant Annona macroprophyllata Donn.Sm. in a CRC murine model. The CRC was induced by azoxymethane-dextran sulfate sodium (AOM/DSS) in Balb/c mice and treated for 21 days with LH or cisplatin. This study shows for the first time the antitumor activity of LH in an AOM/DSS CRC model. The acetogenin diminished the number and size of tumors compared with cisplatin; the histologic studies revealed a recovery of the colon tissue, and the blood toxicity data pointed to less damage in animals treated with LH. The TUNEL assay indicated cell death by apoptosis, and the in vitro studies exhibited that LH inhibited cell migration in HCT116 cells. Our study provides strong evidence of a possible anticancer agent for CRC.
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Affiliation(s)
- Michael Joshue Rendón-Barrón
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Av. Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México 14080, Mexico; (M.J.R.-B.); (E.P.-A.); (I.D.-W.)
- Unidad Profesional Adolfo López Mateos, Laboratorio de Genética, Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas, Zacatenco, Av. Wilfrido Massieu Esq Cda. Miguel Stampa S/N, Alcaldía Gustavo A. Madero, Ciudad de México 07738, Mexico; (I.Á.-G.); (E.M.-B.)
| | - Eduardo Pérez-Arteaga
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Av. Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México 14080, Mexico; (M.J.R.-B.); (E.P.-A.); (I.D.-W.)
| | - Izamary Delgado-Waldo
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Av. Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México 14080, Mexico; (M.J.R.-B.); (E.P.-A.); (I.D.-W.)
| | - Jossimar Coronel-Hernández
- Unidad de Investigación Biomédica en Cancer, Instituto Nacional Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Ciudad de México 14080, Mexico; (J.C.-H.); (C.P.-P.); (F.R.-I.)
| | - Carlos Pérez-Plasencia
- Unidad de Investigación Biomédica en Cancer, Instituto Nacional Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Ciudad de México 14080, Mexico; (J.C.-H.); (C.P.-P.); (F.R.-I.)
- Unidad de Investigación en Biomedicina, Laboratorio de Genómica, Facultad de Estudios Superiores Iztacala, Av. De los Barrios 1, Los Reyes Ixtacala, Tlalnepantla 54090, Mexico
| | - Frida Rodríguez-Izquierdo
- Unidad de Investigación Biomédica en Cancer, Instituto Nacional Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc 16, Tlalpan, Ciudad de México 14080, Mexico; (J.C.-H.); (C.P.-P.); (F.R.-I.)
| | - Rosa Linares
- Unidad de Investigación en Biología de la Reproducción, Laboratorio de Endocrinología, Facultad de Estudios Superiores Zaragoza, Batalla 5 de Mayo S/N, Ejército de Oriente Zona Peñon, Iztapalapa, Ciudad de México 09230, Mexico;
| | - Alma Rosa González-Esquinca
- Laboratorio de Fisiología y Química Vegetal, Instituto de Ciencias Biológicas, Universidad de Ciencias y Artes de Chiapas, Libramiento Norte Poniente 1150, Lajas Maciel, Tuxtla Gutiérrez 29039, Mexico;
| | - Isela Álvarez-González
- Unidad Profesional Adolfo López Mateos, Laboratorio de Genética, Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas, Zacatenco, Av. Wilfrido Massieu Esq Cda. Miguel Stampa S/N, Alcaldía Gustavo A. Madero, Ciudad de México 07738, Mexico; (I.Á.-G.); (E.M.-B.)
| | - Eduardo Madrigal-Bujaidar
- Unidad Profesional Adolfo López Mateos, Laboratorio de Genética, Instituto Politécnico Nacional, Escuela Nacional de Ciencias Biológicas, Zacatenco, Av. Wilfrido Massieu Esq Cda. Miguel Stampa S/N, Alcaldía Gustavo A. Madero, Ciudad de México 07738, Mexico; (I.Á.-G.); (E.M.-B.)
| | - Nadia Judith Jacobo-Herrera
- Unidad de Bioquímica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Av. Vasco de Quiroga 15, Col. Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México 14080, Mexico; (M.J.R.-B.); (E.P.-A.); (I.D.-W.)
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Sonal S, Schneider D, Boudreau C, Kunitake H, Goldstone RN, Bordeianou LG, Cauley CE, Francone TD, Ricciardi R, Berger DL. Patient Factors Affecting Inpatient Mortality Following Colorectal Cancer Resection. Am Surg 2023; 89:5806-5812. [PMID: 37178013 DOI: 10.1177/00031348231175141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Our objective is to identify factors for inpatient death in patients undergoing resection for colorectal cancer (CRC). STUDY DESIGN Unmatched 1:3 case-control study of surgically resected CRC at a tertiary care institution between 2004 and 2018. Variables for multivariate analysis were selected using tetrachoric correlation followed by a least absolute shrinkage and selection operator (LASSO) penalized regression model. RESULTS A total of 140 patients were included (N = 35 patients who died inpatient, N = 105 patients who did not die). Patients who died were older, had higher Charlson Comorbidity Index (CCI), higher rates of preoperative anemia, hypoalbuminemia, emergency surgeries, blood transfusion, postoperative vasopressor requirement, anastomotic leak, and postoperative ICU admission than patients who underwent surgical resection without inpatient mortality. Anemia (aOR = 8.62, 1.44-91.58), emergency admission (aOR = 5.71, 1.46-24.36), and ICU admission (aOR 45.51, 8.31-448.4) significantly predicted inpatient mortality when controlled for CCI and hypoalbuminemia. CONCLUSIONS Surprisingly, it appears that pre-existing anemia and perioperative factors are more important in predicting inpatient mortality of patients undergoing CRC surgery than baseline comorbidity or nutritional status.
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Affiliation(s)
- Swati Sonal
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Derek Schneider
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chloe Boudreau
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Robert N Goldstone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Todd D Francone
- Department of Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
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Juszczyk K, Afzal MZ, Ganguly T, Kelly TL, Zeelie R, Murphy EMA. Evaluating whether KRAS/BRAF mutation status, anaemia and obstruction are associated with recurrence and mortality in non-metastatic colorectal cancer. ANZ J Surg 2023; 93:2457-2463. [PMID: 37088911 DOI: 10.1111/ans.18470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND KRAS and BRAF testing is currently recommended in metastatic colorectal cancer. There is evidence that KRAS and BRAF mutation status may act as a prognostic biomarker in patients with non-metastatic colorectal cancer. Data is limited on whether KRAS and BRAF mutation status impacts recurrence and mortality in patients with non-metastatic colorectal cancer. METHODS A retrospective cohort study was conducted in a tertiary hospital examining outcomes in patients who had KRAS and BRAF testing for colorectal cancer in 2017. Primary outcomes were all-cause mortality and recurrence. Multivariable analysis for both outcomes, used cause specific Cox proportional hazards models with KRAS/BRAF status as exposure. For time to recurrence, a sensitivity analysis was performed with a weighted Fine-Grey model with death as a competing risk. RESULTS KRAS mutation status was not associated with all-cause mortality (average Hazard Ratio (aHR) = 0.78, 95% CI 0.28-2.21) or recurrence (aHR = 0.96, 95% CI 0.32-2.86). BRAF mutation status was not associated with time to all-cause mortality (aHR = 3.06, 95% CI 0.79-11.8) or recurrence (aHR = 0.94, 95% CI 0.13-6.57). Increased risk of recurrence was significantly associated with large bowel obstruction (aHR = 2.73, 95% CI 1.16-6.45) and anaemia (aHR = 3.39, 95% CI 1.06-10.8) at time of surgery. CONCLUSION This study did not demonstrate an association between KRAS and BRAF mutations and all-cause mortality or recurrence. A significantly increased risk of cancer recurrence was found in patients with large bowel obstruction and in patients with anaemia at time of surgery. Anaemia should be promptly investigated and corrected prior to colorectal cancer surgery.
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Affiliation(s)
- Karolina Juszczyk
- Division of Surgical Specialities and Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Mohamed Zaafer Afzal
- Division of Surgical Specialities and Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Timothy Ganguly
- Division of Surgical Specialities and Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Thu-Lan Kelly
- Quality Use of Medicines Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Robyn Zeelie
- Division of Surgical Specialities and Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Elizabeth Mary Ann Murphy
- Division of Surgical Specialities and Anaesthesia, Northern Adelaide Local Health Network, Lyell McEwin Hospital, Adelaide, South Australia, Australia
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Yan T, Lei S, Zhou B, Huang Y, Li X, Zhang J, Huang Q, Zhang L. Association between preoperative anemia and postoperative short-term outcomes in patients undergoing colorectal cancer surgery - a propensity score matched retrospective cohort study. BMC Anesthesiol 2023; 23:307. [PMID: 37697231 PMCID: PMC10494383 DOI: 10.1186/s12871-023-02270-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Based on previous studies which failed to analyze important confounding variables, the association between preoperative anemia and outcomes of patients who underwent colorectal cancer (CRC) surgery has not been clearly demonstrated. This study aimed to investigate the relationship between preoperative anemia and short-term outcomes in patients with CRC. METHODS Data from a retrospective collective database of patients who underwent CRC surgery at our hospital between September 1, 2019 and September 30, 2021 were retrieved and analyzed, and the short-term postoperative outcomes of anemic (hemoglobin < 120 g dL- 1 for female, hemoglobin < 130 g dL- 1 for male) and non-anemic patients were analyzed, using a 1:1 propensity score matching (PSM) analysis. RESULTS After excluding some cases, the remaining 1894 patients had complete data available for analysis. The incidence of preoperative anemia was 39.8% (754/1894). Before PSM, preoperative anemia patients had a higher risk of major morbidity than non-anemia patients (27.2% vs. 23.1%, odds ratio [OR] 1.245, 95% confidence interval [CI] 1.008-1.538, P = 0.042). After PSM was performed in the cohort, 609 patients remained in the anemic and non-anemic groups. The incidence of major morbidity (25.8% vs. 24.0%, OR 1.102, 95% CI 0.849-1.429, P = 0.446) between anemic and non-anemic patients was comparable. No significant difference was found between the anemic and non-anemic groups in postoperative length of stay (8.0 [6.0-12.0] vs. 8.0 [7.0-11.0], P = 0.311). The sensitivity analysis results were in accordance with the primary outcome. Furthermore, we did not ascertain any discernible correlation between the extent of anemia and significant major morbidity. CONCLUSIONS Compared with preoperative non-anemia, anemia status does not seem to be associated with major morbidity in patients with CRC surgery. It is noteworthy that, anemia is insufficient as a solitary risk factor and may be a better marker of poor health resulting from multiple factors. TRIAL REGISTRATION Registration Authority: Chinese Clinical Trial Registry; Registration number and date: ChiCTR2100049696, 08/08/2021; Principal investigator: Ting Yan; Link to trial registry: http://www.chictr.org.cn/showproj.aspx?proj=131698 ; .
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Affiliation(s)
- Ting Yan
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Shaohui Lei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bingbing Zhou
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Yaqi Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Xiaoting Li
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Jiaqi Zhang
- Department of Information Systems and Management Engineering, Southern Science and Technology University, Shenzhen, China
| | - Qijian Huang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China
| | - Liangcheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xin-Quan Road, Fuzhou, 350001, China.
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Monti M, Prochowski Iamurri A, Bianchini D, Gallio C, Esposito L, Montanari D, Ruscelli S, Molinari C, Foca F, Passardi A, Vittimberga G, Morgagni P, Frassineti GL. Association between Pre-Treatment Biological Indicators and Compliance to Neoadjuvant/Perioperative Chemotherapy in Operable Gastric Cancer. Nutrients 2023; 15:3604. [PMID: 37630794 PMCID: PMC10458231 DOI: 10.3390/nu15163604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Perioperative treatment is currently the gold standard approach in Europe for locally advanced gastric cancer (GC). Unfortunately, the phenomenon of patients dropping out of treatment has been frequently observed. The primary aims of this study were to verify if routine blood parameters, inflammatory response markers, sarcopenia, and the depletion of adipose tissues were associated with compliance to neoadjuvant/perioperative chemotherapy. METHODS AND STUDY DESIGN Blood samples were considered before the first and second cycles of chemotherapy. Sarcopenia and adipose indices were calculated with a CT scan before starting chemotherapy and before surgery. Odds ratios (OR) from univariable and multivariable models were calculated with a 95% confidence interval (95% CI). RESULTS A total of 84 patients with locally advanced GC were identified between September 2010 and January 2021. Forty-four patients (52.4%) did not complete the treatment according to the number of cycles planned/performed. Eight patients (9.5%) decided to suspend chemotherapy, seven patients (8.3%) discontinued because of clinical decisions, fourteen patients (16.7%) discontinued because of toxicity and fifteen patients (17.9%) discontinued for miscellaneous causes. Seventy-nine (94%) out of eighty-four patients underwent gastrectomy, with four patients having surgical complications, which led to a suspension of treatment. Sarcopenia was present in 38 patients (50.7%) before chemotherapy began, while it was present in 47 patients (60%) at the CT scan before the gastrectomy. At the univariable analysis, patients with basal platelet to lymphocyte ratio (PLR) ≥ 152 (p = 0.017) and a second value of PLR ≥ 131 (p = 0.007) were more frequently associated with an interruption of chemotherapy. Patients with increased PLR (p = 0.034) compared to the cut-off were associated with an interruption of chemotherapy, while patients with increased monocytes between the first and second cycles were associated with a lower risk of treatment interruption (p = 0.006); patients who underwent 5-fluorouracil plus cisplatin or oxaliplatin had a higher risk of interruption (p = 0.016) compared to patients who underwent a 5-fluorouracil plus leucovorin, oxaliplatin and docetaxel (FLOT) regimen. The multivariable analysis showed a higher risk of interruption for patients who had higher values of PLR compared to the identified cut-off both at pretreatment and second-cycle evaluation (OR: 5.03; 95% CI: 1.34-18.89; p = 0.017) as well as for patients who had a lower PLR than the identified cut-off at pretreatment evaluation and had a higher PLR value than the cut-off at the second cycle (OR: 4.64; 95% CI: 1.02-21.02; p = 0.047). Becker regression was neither affected by a decrease of sarcopenia ≥ 5% (p = 0.867) nor by incomplete compliance with chemotherapy (p = 0.281). CONCLUSIONS Changes in PLR values which tend to increase more than the cut-off seem to be an immediate indicator of incomplete compliance with neoadjuvant/perioperative treatment. Fat loss and sarcopenia do not appear to be related to compliance. More information is needed to reduce the causes of interruption.
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Affiliation(s)
- Manlio Monti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Andrea Prochowski Iamurri
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - David Bianchini
- Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Chiara Gallio
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Luca Esposito
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Daniela Montanari
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Silvia Ruscelli
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Chiara Molinari
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Giovanni Vittimberga
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy
| | - Paolo Morgagni
- General and Oncologic Surgery, “Morgagni-Pierantoni” Hospital, 47121 Forlì, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
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Lynch KT, Hassinger TE. Preoperative Identification and Management of Anemia in the Colorectal Surgery Patient. Clin Colon Rectal Surg 2023; 36:161-166. [PMID: 37113284 PMCID: PMC10125282 DOI: 10.1055/s-0043-1760868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Preoperative anemia is a common finding in patients undergoing colorectal surgery, particularly those with cancer. While often multifactorial, iron deficiency anemia remains the most common cause of anemia in this patient population. Although seemingly innocuous, preoperative anemia is associated with an increased risk of perioperative complications and need for allogenic blood transfusions, both of which may worsen cancer-specific survival. Preoperative correction of anemia and iron deficiency is thus necessary to diminish these risks. Current literature supports preoperative screening for anemia and iron deficiency in patients slated to undergo colorectal surgery for malignancy or for benign conditions with associated patient- or procedure-related risk factors. Accepted treatment regimens include iron supplementation-either oral or intravenous-as well as erythropoietin therapy. Autologous blood transfusion should not be utilized as a treatment for preoperative anemia when there is time to implement other corrective strategies. Additional study is still needed to better standardize preoperative screening and optimize treatment regimens.
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Affiliation(s)
- Kevin T. Lynch
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Taryn E. Hassinger
- Division of Colon and Rectal Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania
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Deng Y, Weng M, Zhang J. Preoperative anemia and long-term survival in patients undergoing colorectal cancer surgery: a retrospective cohort study. World J Surg Oncol 2023; 21:122. [PMID: 37013545 PMCID: PMC10071685 DOI: 10.1186/s12957-023-03005-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The impact of preoperative anemia on a survival outcome and the importance of correcting preoperative anemia in patients with colorectal cancer (CRC) remain controversial. This study aimed to explore how preoperative anemia affects the long-term survival of patients undergoing colorectal cancer surgery. METHODS This was a retrospective cohort study in which adult patients underwent surgical resection for colorectal cancer between January 1, 2008, and December 31, 2014, at a large tertiary cancer center. A total of 7436 patients were enrolled in this study. Anemia was defined according to the diagnostic criteria of China (hemoglobin level < 110 g/L for women and < 120 g/L for men). The median follow-up time was 120.5 months (10.0 years). Inverse probability of treatment weighting (IPTW) using the propensity score was used to reduce selection bias. Overall survival (OS) and disease-free survival (DFS) were compared between patients with and without preoperative anemia using the Kaplan-Meier estimator and the weighted log-rank test based on IPTW. Univariate and multivariate Cox proportional hazards models were used to assess factors associated with OS and DFS. Multivariable Cox regression was also used to assess red blood cell (RBC) transfusion associations between preoperative anemia and outcomes. RESULTS After IPTW adjustment, clinical profiles were similar, except that tumor location and TNM stage remained imbalanced between the preoperative anemia and preoperative non-anemia groups (p < 0.001). IPTW analysis showed that the 5-year OS rate (71.3 vs. 78.6%, p < 0.001) and the 5-year DFS rate (63.9 vs. 70.9%, p < 0.001) were significantly lower in the preoperative anemia group. Multivariate analysis showed that preoperative anemia was associated with poorer OS and DFS, while RBC transfusion may improve OS (hazard ratio [HR] 0.54, p = 0.054) and DFS (HR 0.50, p = 0.020) in CRC patients with preoperative anemia. CONCLUSIONS Preoperative anemia is an independent risk factor for survival in patients undergoing colorectal surgery. Strategies to reduce preoperative anemia in patients with CRC should be considered.
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Affiliation(s)
- Yixu Deng
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Meilin Weng
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Xuhui District, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
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Wiklund E, Carlander J, Wagner P, Engdahl M, Chabok A, Nikberg M. Lower need for allogeneic blood transfusion after robotic low anterior resection compared with open low anterior resection: a propensity score-matched analysis. J Robot Surg 2023:10.1007/s11701-023-01571-5. [PMID: 36976475 PMCID: PMC10374684 DOI: 10.1007/s11701-023-01571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
Robotic low anterior resection (R-LAR) for rectal cancer may decrease estimated blood loss compared with open low anterior resection (O-LAR). The aim of this study was to compare estimated blood loss and blood transfusion within 30 days after O-LAR and R-LAR. This was a retrospective matched cohort study based on prospectively registered data from Västmanland Hospital, Sweden. The first 52 patients operated on using R-LAR for rectal cancer at Västmanland Hospital were propensity score-matched 1:2 with patients who underwent O-LAR for age, sex, ASA (American Society of Anesthesiology physical classification system), and tumor distance from the anal verge. In total, 52 patients in the R-LAR group and 104 patients in the O-LAR group were included. Estimated blood loss was significantly higher in the O-LAR group compared with R-LAR: 582.7 ml (SD ± 489.2) vs. 86.1 ml (SD ± 67.7); p < 0.001. Within 30 days after surgery, 43.3% of patients who received O-LAR and 11.5% who received R-LAR were treated with blood transfusion (p < 0.001). As a secondary post hoc finding, multivariable analysis identified O-LAR and lower pre-operative hemoglobin level as risk factors for the need of blood transfusion within 30 days after surgery. Patients who underwent R-LAR had significantly lower estimated blood loss and a need for peri- and post-operative blood transfusion compared with O-LAR. Open surgery was shown to be associated with an increased need for blood transfusion within 30 days after low anterior resection for rectal cancer.
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Affiliation(s)
- Erik Wiklund
- Colorectal Unit, Department of Surgery, Västmanland Hospital Västerås, 72189, Västerås, Sweden
| | - Johan Carlander
- Colorectal Unit, Department of Surgery, Västmanland Hospital Västerås, 72189, Västerås, Sweden
| | - Philippe Wagner
- Colorectal Unit, Department of Surgery, Centre for Clinical Research of Uppsala University, Västmanland Hospital Västerås, Västerås, Sweden
| | - Malin Engdahl
- Colorectal Unit, Department of Surgery, Västmanland Hospital Västerås, 72189, Västerås, Sweden
| | - Abbas Chabok
- Colorectal Unit, Department of Surgery, Västmanland Hospital Västerås, 72189, Västerås, Sweden
- Colorectal Unit, Department of Surgery, Centre for Clinical Research of Uppsala University, Västmanland Hospital Västerås, Västerås, Sweden
| | - Maziar Nikberg
- Colorectal Unit, Department of Surgery, Västmanland Hospital Västerås, 72189, Västerås, Sweden.
- Colorectal Unit, Department of Surgery, Centre for Clinical Research of Uppsala University, Västmanland Hospital Västerås, Västerås, Sweden.
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Ren W, Xu Y, Yang C, Cheng L, Yao P, Fu S, Han J, Zhuo D. Development and validation of a predictive model for diagnosing prostate cancer after transperineal prostate biopsy. Front Oncol 2022; 12:1038177. [DOI: 10.3389/fonc.2022.1038177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
ObjectiveThis study aimed to develop and validate a nomogram to predict the probability of prostate cancer (PCa) after transperineal prostate biopsy by combining patient clinical information and biomarkers.MethodsFirst, we retrospectively collected the clinicopathologic data from 475 patients who underwent prostate biopsy at our hospital between January 2019 to August 2021. Univariate and multivariate logistic regression analyses were used to select risk factors. Then, we established the nomogram prediction model based on the risk factors. The model performance was assessed by receiver operating characteristic (ROC) curves, calibration plots and the Hosmer–Lemeshow test. Decision curve analysis (DCA) was used to evaluate the net benefit of the model at different threshold probabilities. The model was validated in an independent cohort of 197 patients between September 2021 and June 2022.ResultsThe univariate and multivariate logistic regression analyses based on the development cohort indicated that the model should include the following factors: age (OR = 1.056, p = 0.001), NEUT (OR = 0.787, p = 0.008), HPR (OR = 0.139, p < 0.001), free/total (f/T) PSA (OR = 0.013, p = 0.015), and PI-RADS (OR = 3.356, p < 0.001). The calibration curve revealed great agreement. The internal nomogram validation showed that the C-index was 0.851 (95% CI 0.809-0.894). Additionally, the AUC was 0.851 (95% CI 0.809-0.894), and the Hosmer–Lemeshow test result presented p = 0.143 > 0.05. Finally, according to decision curve analysis, the model was clinically beneficial.ConclusionHerein, we provided a nomogram combining patients’ clinical data with biomarkers to help diagnose prostate cancers.
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12
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Dahmen AS, Phuoc VH, Cohen JB, Sexton WJ, Patel SY. Bloodless surgery in urologic oncology: A review of hematologic, anesthetic, and surgical considerations. Urol Oncol 2022; 41:192-203. [PMID: 36470804 DOI: 10.1016/j.urolonc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
The urologic oncology patient who refuses blood transfusion can present unique challenges in perioperative blood management. Since blood loss and associated transfusion can be expected in many complex urologic oncology surgeries, a multidisciplinary approach may be required for optimal outcomes. Through collaboration with the hematologist, anesthesiologist, and urologist, various techniques can be employed in the perioperative phases to minimize blood loss and the need for transfusion. We review the risks and benefits of these techniques and offer recommendations specific to the urologic oncology patient.
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Affiliation(s)
- Aaron S Dahmen
- Department of Urology, University of Chicago, Chicago, IL
| | - Vania H Phuoc
- Department of Medical Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jonathan B Cohen
- Department of Anesthesiology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Wade J Sexton
- Department of Genitourinary Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Sephalie Y Patel
- Department of Anesthesiology, Moffitt Cancer Center and Research Institute, Tampa, FL.
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Calderillo Ruiz G, Lopez Basave H, Vazquez Renteria RS, Castillo Morales A, Guijosa A, Castillo Morales C, Herrera M, Diaz C, Vazquez Cortes E, Ruiz-Garcia E, Munoz Montano WR. The Prognostic Significance of HALP Index for Colon Cancer Patients in a Hispanic-Based Population. JOURNAL OF ONCOLOGY 2022; 2022:4324635. [PMID: 36467502 PMCID: PMC9711950 DOI: 10.1155/2022/4324635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 10/04/2023]
Abstract
BACKGROUND Survival and recurrence rates following locoregional colon cancer surgical resection are highly variable. Currently used tools to assess patient risk are still imperfect. In the present work, we evaluate, for the first time, the prognostic value of the recently developed HALP (hemoglobin, albumin, lymphocyte, and platelet) index in Hispanic colon cancer patients. Patients and Methods. We conducted a retrospective cohort study in Mexican patients with a nonmetastatic colon cancer diagnosis who underwent surgical resection. We determined the preoperative HALP score optimal cut-off value by using the X-tile software. We plotted survival curves using the Kaplan-Meier method and performed a multivariate Cox regression analysis to explore the association of preoperative HALP score with two primary endpoints: overall survival (OS) and disease-free survival (DFS). RESULTS We included 640 patients (49.8% female). The optimal HALP cut-off value was 15.0. A low HALP index was statistically significantly associated with a higher TNM stage. Low HALP score was statistically significantly associated with shorter median OS in the Kaplan-Meier analysis (73.5 vs. 84.8 months) and in the multivariate Cox regression analysis (HR = 1.942, 95% CI = 1.647-2.875). There was no significant association between the HALP score and DFS. CONCLUSIONS Our findings show that the HALP index is an independent factor associated with survival in Hispanic patients, despite recurrence. It seems to reflect both the anatomical extent of the disease and traditionally unaccounted nutritional and inflammatory factors that are significant for prognosis.
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Affiliation(s)
| | - Horacio Lopez Basave
- Gastrointestinal Oncology Unit, Instituto Nacional de Cancerologia, Mexico, Mexico
| | | | | | - Alberto Guijosa
- School of Medicine, Universidad Panamericana, Mexico, Mexico
| | | | - Marytere Herrera
- Gastrointestinal Oncology Unit, Instituto Nacional de Cancerologia, Mexico, Mexico
| | - Consuelo Diaz
- Gastrointestinal Oncology Unit, Instituto Nacional de Cancerologia, Mexico, Mexico
| | | | - Erika Ruiz-Garcia
- Gastrointestinal Oncology Unit, Instituto Nacional de Cancerologia, Mexico, Mexico
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Müller SD, Both CP, Sponholz C, Voelker MT, Christiansen H, Niggli F, Schmitz A, Weiss M, Thomas J, Stehr SN, Piegeler T. Association between Intraoperative Blood Transfusion, Regional Anesthesia and Outcome after Pediatric Tumor Surgery for Nephroblastoma. Cancers (Basel) 2022; 14:cancers14225585. [PMID: 36428673 PMCID: PMC9688304 DOI: 10.3390/cancers14225585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent data suggest that anesthesiologic interventions-e.g., the choice of the anesthetic regimen or the administration of blood products-might play a major role in determining outcome after tumor surgery. In contrast to adult patients, only limited data are available regarding the potential association of anesthesia and outcome in pediatric cancer patients. METHODS A retrospective multicenter study assessing data from pediatric patients (0-18 years of age) undergoing surgery for nephroblastoma between 2004 and 2018 was conducted at three academic centers in Europe. Overall and recurrence-free survival were the primary outcomes of the study and were evaluated for a potential impact of intraoperative administration of erythrocyte concentrates, the use of regional anesthesia and the choice of the anesthetic regimen. The length of stay on the intensive care unit, the time to hospital discharge after surgery and blood neutrophil-to-lymphocyte ratio were defined as secondary outcomes. RESULTS In total, data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival (hazard ratio (HR) 7.59, 95% confidence interval (CI) 1.36-42.2, p = 0.004), whereas overall survival (HR 5.37, 95% CI 0.42-68.4, p = 0.124) was not affected. The use of regional anesthesia and the choice of anesthetic used for maintenance of anesthesia did not demonstrate an effect on the primary outcomes. It was, however, associated with fewer ICU transfers, a shortened time to discharge and a decreased postoperative neutrophil-to-lymphocyte ratio. CONCLUSIONS The current study provides the first evidence for a possible association between blood transfusion as well as anesthesiologic interventions and outcome after pediatric cancer surgery.
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Affiliation(s)
- Sarah D. Müller
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
| | - Christian P. Both
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Christoph Sponholz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, 07740 Jena, Germany
| | - Maria Theresa Voelker
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
| | - Holger Christiansen
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Achim Schmitz
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Jörg Thomas
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Sebastian N. Stehr
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
| | - Tobias Piegeler
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
- EuroPeriscope: The ESA-IC Onco-Anaesthesiology Research Group
- Correspondence: ; Tel.: +49-341-97-17700; Fax: +49-341-97-17709
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Fletcher T, Thompson AJ, Ashrafian H, Darzi A. The measurement and modification of hypoxia in colorectal cancer: overlooked but not forgotten. Gastroenterol Rep (Oxf) 2022; 10:goac042. [PMID: 36032656 PMCID: PMC9406947 DOI: 10.1093/gastro/goac042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022] Open
Abstract
Tumour hypoxia is the inevitable consequence of a tumour's rapid growth and disorganized, inefficient vasculature. The compensatory mechanisms employed by tumours, and indeed the absence of oxygen itself, hinder the ability of all treatment modalities. The clinical consequence is poorer overall survival, disease-free survival, and locoregional control. Recognizing this, clinicians have been attenuating the effect of hypoxia, primarily with hypoxic modification or with hypoxia-activated pro-drugs, and notable success has been demonstrated. However, in the case of colorectal cancer (CRC), there is a general paucity of knowledge and evidence surrounding the measurement and modification of hypoxia, and this is possibly due to the comparative inaccessibility of such tumours. We specifically review the role of hypoxia in CRC and focus on the current evidence for the existence of hypoxia in CRC, the majority of which originates from indirect positron emission topography imaging with hypoxia selective radiotracers; the evidence correlating CRC hypoxia with poorer oncological outcome, which is largely based on the measurement of hypoxia inducible factor in correlation with clinical outcome; the evidence of hypoxic modification in CRC, of which no direct evidence exists, but is reflected in a number of indirect markers; the prognostic and monitoring implications of accurate CRC hypoxia quantification and its potential in the field of precision oncology; and the present and future imaging tools and technologies being developed for the measurement of CRC hypoxia, including the use of blood-oxygen-level-dependent magnetic resonance imaging and diffuse reflectance spectroscopy.
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Affiliation(s)
- Teddy Fletcher
- Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing, St Mary’s Hospital, Imperial College London, London, UK
| | - Alex J Thompson
- The Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing, St Mary’s Hospital, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Queen Elizabeth the Queen Mother Wing, St Mary’s Hospital, Imperial College London, London, UK
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Weng M, Guo M, Li T, Zhou C, Sun C, Yue Y, Liao Q, Cai S, Lu X, Zhou D, Miao C. Anemia tolerance versus blood transfusion on long-term outcomes after colorectal cancer surgery: A retrospective propensity-score-matched analysis. Front Oncol 2022; 12:940428. [PMID: 36046042 PMCID: PMC9421070 DOI: 10.3389/fonc.2022.940428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background Perioperative anemia and transfusion are intertwined with each other, and both have adverse impacts on the survival of colorectal cancer (CRC) patients. But the treatment of anemia still relies on transfusion in several countries, which leads us to question the effects of anemia tolerance and transfusion on the long-term outcomes of CRC patients. We investigated the combined effect of preoperative anemia and postoperative anemia and of preoperative anemia and blood transfusion, which imposes a greater risk to survival, to compare the effects of anemia tolerance and transfusion on overall survival (OS) and disease-free survival (DFS) in patients undergoing CRC surgery. Methods A retrospective propensity-score-matched analysis included patients with CRC undergoing elective surgery between January 1, 2008, and December 31, 2014. After propensity-score matching, Kaplan–Meier survival analysis and univariable and multivariable Cox proportional hazards models were used to study the prognostic factors for survivals. In univariate and multivariate Cox regression analysis, two novel models were built. Results Of the 8,121 patients with CRC, 1,975 (24.3%) and 6,146 (75.7%) patients presented with and without preoperative anemia, respectively. After matching, 1,690 patients remained in each group. In the preoperative anemia and postoperative anemia model, preoperative anemia and postoperative anemia was independent risk factor for OS (HR, 1.202; 95% CI, 1.043–1.385; P=0.011) and DFS (HR, 1.210; 95% CI, 1.050–1.395; P=0.008). In the preoperative anemia and transfusion model, preoperative anemia and transfused was the most dangerous independent prognostic factor for OS (HR, 1.791; 95% CI, 1.339–2.397; P<0.001) and DFS (HR, 1.857; 95% CI, 1.389–2.483; P<0.001). In patients with preoperative anemia, the OS and DFS of patients with transfusion were worse than those of patients without transfusion (P=0.026 in OS; P=0.037 in DFS). Conclusions Preoperative anemia and blood transfusion imposed a greater risk to OS and DFS in patients undergoing CRC surgery, indicating that the harm associated with blood transfusion was greater than that associated with postoperative anemia. These findings should encourage clinicians to be vigilant for the timely prevention and treatment of anemia, by appropriately promoting toleration of anemia and restricting the use of blood transfusion in patients with CRC.
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Affiliation(s)
- Meilin Weng
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Anesthesiology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Miaomiao Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ting Li
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
| | - Changming Zhou
- Department of Cancer Prevention, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Caihong Sun
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
| | - Ying Yue
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
| | - Qingwu Liao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Xihua Lu
- Department of Anesthesiology, Affiliated Cancer Hospital of Zhengzhou University, Henan, China
- *Correspondence: Changhong Miao, ; Di Zhou, ; Xihua Lu,
| | - Di Zhou
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
- *Correspondence: Changhong Miao, ; Di Zhou, ; Xihua Lu,
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Zhongshan Hospital Fudan University, Shanghai, China
- *Correspondence: Changhong Miao, ; Di Zhou, ; Xihua Lu,
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Impact of preoperative anemia, iron-deficiency and inflammation on survival after colorectal surgery—A retrospective cohort study. PLoS One 2022; 17:e0269309. [PMID: 35895618 PMCID: PMC9328530 DOI: 10.1371/journal.pone.0269309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Anemia is present in up to two-thirds of patients undergoing colorectal surgery mainly caused by iron deficiency and inflammation. As anemia is associated with increased risk of perioperative death, diagnosis and treatment of preoperative anemia according to etiology have been recommended. Objective The aim of the present study was to assess if the association between anemia and survival in patients undergoing colorectal surgery was determined by the severity of anemia alone or also by anemia etiology. Methods To determine the prevalence of anemia and etiology, preoperative hematological parameters, C-reactive protein, ferritin and transferrin saturation were retrospectively assessed and correlated with outcome in a cohort of patients undergoing colorectal surgery between 2005 and 2019 at the University Hospital of Innsbruck. Anemia was defined as hemoglobin <120 g/L in females and <130 g/L in males. The etiology of anemia was classified on the basis of serum iron parameters, as iron deficiency anemia, anemia of inflammation or other anemia etiologies. Results Preoperative anemia was present in 54% (1316/2458) of all patients. Anemia was associated with iron deficiency in 45% (134/299) and classified as anemia of inflammation in 32% (97/299) of patients with available serum iron parameters. The etiology of anemia was a strong and independent predictor of survival, where iron deficiency and anemia of inflammation were associated with better postoperative survival than other anemia etiologies. One year survival rates were 84.3%, 77.3% and 69.1% for patients with iron deficiency anemia, anemia of inflammation and other anemia types. Inflammation indicated by high C-reactive protein is a strong negative predictor of overall survival. Conclusions Anemia has a high prevalence among patients undergoing colorectal surgery and rational treatment requires early assessment of serum iron parameters and C-reactive protein.
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Antiangiogenic Drug-Induced Proteinuria as a Prognostic Factor in Metastatic Colorectal Cancer. Curr Oncol 2022; 29:3996-4011. [PMID: 35735428 PMCID: PMC9221669 DOI: 10.3390/curroncol29060319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 12/14/2022] Open
Abstract
Treatment with bevacizumab is known to cause adverse events such as proteinuria and hypertension, amongst others. However, while bevacizumab-induced hypertension has been linked to increased overall survival (OS), data on proteinuria are controversial. We performed a retrospective analysis to observe the influence of adverse events developed during treatment with bevacizumab and chemotherapy on the OS in patients with metastatic colorectal cancer (mCRC). Kaplan–Meier and log-rank analyses were used to assess differences in OS, and hazard ratios (HR) were estimated using Cox models. Out of the 3497 mCRC patients admitted to our center between 2014 and 2019, 150 met the criteria for inclusion in our analysis. Out of these, 50.7% experienced proteinuria and had reached a longer OS (40 versus 25 months, p = 0.015) and progression-free survival (15 versus 12 months, p = 0.039). The following groups were identified as having a lower risk of death: patients with proteinuria (HR 0.589; 95% CI 0.402–0.863; p = 0.007), one metastatic site (HR 0.533; 95% CI 0.363–0.783; p = 0.001), and non-metastatic stage at diagnosis (HR 0.459; 95% CI 0.293–0.720; p = 0.001). Patients with anemia and diabetes had an increased risk of death. Proteinuria emerges as a useful prognostic factor in mCRC patients undergoing bevacizumab-based systemic therapy, and it could be easily integrated into the decision-making process, thus allowing physicians to further individualize systemic treatments.
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Altintas MM, Kaya S, Kocaoglu AE, Mulkut F. Does preoperative anaemia have an effect on the perioperative period in colorectal cancer surgery? Niger J Clin Pract 2022; 25:1102-1106. [DOI: 10.4103/njcp.njcp_1664_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gvirtzman R, Livovsky DM, Tahover E, Goldin E, Koslowsky B. Anemia can predict the prognosis of colorectal cancer in the pre-operative stage: a retrospective analysis. World J Surg Oncol 2021; 19:341. [PMID: 34876136 PMCID: PMC8653538 DOI: 10.1186/s12957-021-02452-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) improves prognosis, yet many CRCs are diagnosed following symptoms. The aim of this study was to determine which CRC-related symptoms or signs can predict an advanced CRC in the pre-operative stage. METHODS Retrospective analysis of 300 patients who underwent surgery for CRC between the years 2008 and 2019. Patients' symptoms prior to CRC diagnosis were documented. Primary endpoint was the association of signs or/and symptoms with CRC diagnosis at TNM stages of 2-4 (i.e., highly advanced), compared to TNM score of 0-1 (i.e., locally advanced). RESULTS Three hundred patients, 91 with locally advanced and 209 with highly advanced CRC, were enrolled. There was a significant correlation between highly advanced CRC, compared to locally advanced, regarding tumor size (4.8 vs. 2.6 cm, p<0.001), presentation of any symptom prior to diagnosis (77% vs. 54%, p<0.001), anemia (46% vs. 29%, p=0.004), and severe anemia (17% vs. 4%, p=0.002). Mean hemoglobin was 12.2 ± 2.2 and 13.1 ± 1.8 in the highly advanced compared to locally advanced CRC, respectively, p<0.001. Anemia correlated with the T stage of the tumor: 21% of patients diagnosed at stages 0-1 had anemia, 39% at stage 2, 44% at stage 3, and 66% at stage 4 (p=0.001). CONCLUSIONS Anemia is the only finding that correlates with highly advanced CRC, in the pre-operative stage. When CRC has been diagnosed, the presence of anemia, at any level, may be considered in determining prognosis at the pre-operative stage. Physicians should be aware that when anemia is present, the risk for highly advanced CRC increases, and therefore should pursue with CRC detection.
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Affiliation(s)
- Rotem Gvirtzman
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Dan Meir Livovsky
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Esther Tahover
- Faculty of Medicine, Hebrew University of Jerusalem, Oncology Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eran Goldin
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Benjamin Koslowsky
- Faculty of Medicine, Hebrew University of Jerusalem, Digestive Diseases Institute, Shaare-Zedek Medical Center, Jerusalem, Israel.
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21
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Clavreul A, Lemée JM, Soulard G, Rousseau A, Menei P. A Simple Preoperative Blood Count to Stratify Prognosis in Isocitrate Dehydrogenase-Wildtype Glioblastoma Patients Treated with Radiotherapy plus Concomitant and Adjuvant Temozolomide. Cancers (Basel) 2021; 13:cancers13225778. [PMID: 34830935 PMCID: PMC8616081 DOI: 10.3390/cancers13225778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The survival times of glioblastoma (GB) patients after the standard therapy including safe maximal resection followed by radiotherapy plus concomitant and adjuvant temozolomide are heterogeneous. In order to define a simple, reliable method for predicting whether patients with isocitrate dehydrogenase (IDH)-wildtype GB treated with the standard therapy will be short- or long-term survivors, we analyzed the correlation of preoperative blood counts and their combined forms with progression-free survival (PFS) and overall survival (OS) in these patients. METHODS Eighty-five patients with primary IDH-wildtype GB treated with the standard therapy between 2012 and 2019 were analyzed retrospectively. Cox proportional hazards models and Kaplan-Meier analysis were used to investigate the survival function of preoperative hematological parameters. RESULTS Preoperative high neutrophil-to-lymphocyte ratio (NLR, >2.42), high platelet count (>236 × 109/L), and low red blood cell (RBC) count (≤4.59 × 1012/L) were independent prognostic factors for poorer OS (p = 0.030, p = 0.030, and p = 0.004, respectively). Moreover, a high NLR was an independent prognostic factor for shorter PFS (p = 0.010). We also found that, like NLR, preoperative high derived NLR (dNLR, >1.89) was of poor prognostic value for both PFS (p = 0.002) and OS (p = 0.033). A significant correlation was observed between NLR and dNLR (r = 0.88, p < 0.001), which had a similar prognostic power for OS (NLR: AUC = 0.58; 95% CI: [0.48; 0.68]; dNLR: AUC = 0.62; 95% CI: [0.51; 0.72]). Two scores, one based on preoperative platelet and RBC counts plus NLR and the other on preoperative platelet and RBC counts plus dNLR, were found to be independent prognostic factors for PFS (p = 0.006 and p = 0.002, respectively) and OS (p < 0.001 for both scores). CONCLUSION Cheap, routinely ordered, preoperative assessments of blood markers, such as NLR, dNLR, RBC, and platelet counts, can predict the survival outcomes of patients with IDH-wildtype GB treated with the standard therapy.
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Affiliation(s)
- Anne Clavreul
- Université d’Angers, CHU d’Angers, CRCINA, F-49000 Angers, France; (J.-M.L.); (A.R.); (P.M.)
- Département de Neurochirurgie, CHU Angers, F-49933 Angers, France;
- Correspondence: ; Tel.: +33-241-354822; Fax: +33-241-354508
| | - Jean-Michel Lemée
- Université d’Angers, CHU d’Angers, CRCINA, F-49000 Angers, France; (J.-M.L.); (A.R.); (P.M.)
- Département de Neurochirurgie, CHU Angers, F-49933 Angers, France;
| | | | - Audrey Rousseau
- Université d’Angers, CHU d’Angers, CRCINA, F-49000 Angers, France; (J.-M.L.); (A.R.); (P.M.)
- Département de Pathologie Cellulaire et Tissulaire, CHU Angers, F-49933 Angers, France
| | - Philippe Menei
- Université d’Angers, CHU d’Angers, CRCINA, F-49000 Angers, France; (J.-M.L.); (A.R.); (P.M.)
- Département de Neurochirurgie, CHU Angers, F-49933 Angers, France;
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22
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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;
- Correspondence:
| | - 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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23
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Bojesen RD, Eriksen JR, Vogelsang RP, Grube C, Forman JL, Gogenür I. The dynamic effects of preoperative intravenous iron in anaemic patients undergoing surgery for colorectal cancer. Colorectal Dis 2021; 23:2550-2558. [PMID: 34166572 DOI: 10.1111/codi.15789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/02/2021] [Accepted: 06/18/2021] [Indexed: 12/21/2022]
Abstract
AIM The aim of this study was to describe the dynamic changes in blood work following individual adjusted dosage of intravenously administered iron(III) isomaltoside in a 4-week period prior to surgery in patients with colorectal cancer. METHODS This was a single-centre, observational cohort study with prospectively collected data, including patients with colorectal cancer receiving preoperative treatment with iron(III) isomaltoside. Blood samples were taken at baseline, 1 week, 2 weeks and 4 weeks after initial treatment. Sixty-two patients were included in the study. RESULTS Sixty-two patients were included for final analysis. The mean increase in haemoglobin was 0.77 g/dl (95% CI 0.52-1.03 g/dl, P < 0.0001) at week 1, 1.5 g/dl (95% CI 1.21-1.80 g/dl, P < 0.0001) at week 2 and 2.13 g/dl (95% CI 1.71-2.55 g/dl, P < 0.0001) at week 4. Patients with severe anaemia (<9.02 g/dl) showed the largest increase in haemoglobin during the treatment course (2.92 g/dl, 95% CI 2.27-3.58 g/dl, P < 0.0001). Patients with mild anaemia (>10.31 g/dl) did not show a significant increase (0.66 g/dl, 95% CI -0.29-1.61 g/dl, P = 0.17). The mean of transferrin saturation after 4 weeks was 8% (95% CI 6%-10%, P < 0.0001). CONCLUSIONS After intravenously administered iron, patients with severe anaemia had the most substantial increase in haemoglobin, and the increase was largest after 4 weeks. Patients with mild anaemia did not have an increase in haemoglobin during the treatment course. The vast majority of patients still had iron deficiency at surgery 4 weeks after the initial treatment.
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Affiliation(s)
- Rasmus Dahlin Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | | | | | - Camilla Grube
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gogenür
- Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
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Taylor M, Abah U, Hayes T, Eadington T, Smith M, Shackcloth M, Granato F, Shah R, Booton R, Grant SW. Preoperative Anemia is Associated With Worse Long-Term Survival After Lung Cancer Resection: A Multicenter Cohort Study of 5,029 Patients. J Cardiothorac Vasc Anesth 2021; 36:1373-1379. [PMID: 34538557 DOI: 10.1053/j.jvca.2021.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although some evidence to suggest an association between preoperative anemia and reduced overall survival exists, contemporary studies investigating the impact of preoperative anemia on outcomes after resection for primary lung cancer are lacking. DESIGN A multicenter retrospective review. SETTING Two tertiary cardiothoracic surgery centers in the Northwest of England. PARTICIPANTS A total of 5,029 patients between 2012 and 2018. INTERVENTIONS All patients underwent lung resection for primary lung cancer. Patients were classified as anemic based on the World Health Organization definition. Men with hemoglobin <130 g/L and women with hemoglobin <120 g/L were considered to be anemic. MEASUREMENTS AND MAIN RESULTS Outcomes assessed included perioperative mortality, 90-day mortality, and overall survival. Multivariate logistic and Cox regression analyses were used to assess the impact of preoperative anemia on 90-day mortality and overall survival, respectively. Overall, preoperatively, 24.0% (n = 1207) of patients were anemic. The 90-day mortality for anemic and nonanemic patients was 5.6% and 3.1%, respectively (p < 0.001). After multivariate adjustment, preoperative anemia was not associated with increased 90-day mortality. However, a log-rank analysis demonstrated reduced overall survival for anemic patients (p < 0.001). After multivariate adjustment, preoperative anemia was found to be independently associated with reduced overall survival (hazard ratio 1.287, 95% confidence interval 1.141-1.451, p < 0.001). CONCLUSIONS Although anemia was not an independent predictor of short-term outcomes, it was independently associated with significantly reduced survival for patients undergoing resection for lung cancer. Further work is required to understand why anemia reduces long-term survival and whether pathways for anemic patients can be adapted to improve long-term outcomes.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Tim Hayes
- Department of Cardiothoracic Anaesthesia, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Thomas Eadington
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Richard Booton
- Department of Respiratory Medicine, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom
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Jokela EMK, Kauppila JH. Preoperative hemoglobin count and prognosis of esophageal cancer, a population-based nationwide study in Finland. Eur J Surg Oncol 2021; 48:548-552. [PMID: 34420826 DOI: 10.1016/j.ejso.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/26/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prognostic value of preoperative hemoglobin in patients undergoing esophagectomy is unknown. The aim of this study was to examine whether preoperative hemoglobin is associated with prognosis in patients undergoing esophagectomy for cancer. MATERIALS AND METHODS This was a population-based nationwide retrospective cohort study in Finland, using Finnish National Esophago-Gastric Cancer Cohort (FINEGO). Esophagectomy patients with available preoperative hemoglobin measurement were included. Multivariable cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for calendar period of surgery, age at surgery, sex, comorbidity (Charlson Comorbidity Index), tumor histology, tumor stage, neoadjuvant therapy, type of surgery (minimally invasive or open) and annual hospital volume. RESULTS Of the 1313 patients, 932 (71.0%) were men and 799 (60.9%) had esophageal adenocarcinoma. Overall all-cause mortality was significantly higher in the lowest hemoglobin count tertile (HR 1.26 (1.07-1.47)) compared to the highest tertile, but this association was attenuated after adjustment for confounding. No differences were found between the preoperative hemoglobin groups in the adjusted analyses of 90-day all-cause, 5-year all-cause, and 5-year cancer-specific mortality. CONCLUSION In this population-based nationwide study, preoperative hemoglobin count had no independent prognostic significance in esophageal cancer.
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Affiliation(s)
- Ella M K Jokela
- Surgery Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Joonas H Kauppila
- Surgery Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Sawayama H, Miyamoto Y, Mima K, Kato R, Ogawa K, Hiyoshi Y, Shimokawa M, Akiyama T, Kiyozumi Y, Iwagami S, Iwatsuki M, Baba Y, Yoshida N, Baba H. Preoperative iron status is a prognosis factor for stage II and III colorectal cancer. Int J Clin Oncol 2021; 26:2037-2045. [PMID: 34302234 DOI: 10.1007/s10147-021-01995-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Iron deficiency anemia is represented in colorectal cancer (CRC) patients. Iron surplus load to increase non-transferrin bound iron (NTBI), and NTBI promotes cancer progression and influences microbiota. This study investigated whether preoperative serum iron status was associated with prognosis after CRC resection. METHODS We evaluated preoperative iron and transferrin saturation (TSAT), which was calculated as iron divided by total iron-binding capacity, in 327 patients who underwent surgery for Stage II-III CRC. Fe < 60 μg/dl and TSAT > 40% were defined as low and high iron, respectively. The associations between iron status and overall survival (OS) were evaluated in univariate and multivariate Cox proportional hazards analysis. RESULTS Of the 327 patients, 179 (54.7%), 124 (37.9%) and 24 (7.3%) had low, normal and high iron, respectively. In univariate analysis, low iron was associated with shorter OS (hazard ratio [HR] 2.821, 95% confidence interval [CI] 1.451-5.485, P = 0.002). High iron was also associated with shorter OS (HR 3.396, 95% CI 1.359-8.489, P = 0.009). In multivariate analysis, high age (P = 0.002), depth of invasion pT4 (P = 0.012), lymph-node metastasis presence (P = 0.035), low albumin (P = 0.011), low iron (HR 2.282, 95% CI 1.163-4.478, P = 0.016) and high iron (HR 3.757, 95% CI 1.486-9.494 P = 0.005) were independently associated with shorter OS. High iron was associated with the amount of intratumoral Fusobacterium nucleatum compared with normal iron. CONCLUSION Both low and high preoperative iron in Stage II-III CRC patients were associated with unfavorable OS in univariate and multivariate analyses.
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Affiliation(s)
- Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Rikako Kato
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Katsuhiro Ogawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Takahiko Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuki Kiyozumi
- Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Almilaji O, Parry SD, Docherty S, Snook J. Evidence for improved prognosis of colorectal cancer diagnosed following the detection of iron deficiency anaemia. Sci Rep 2021; 11:13055. [PMID: 34158616 PMCID: PMC8219720 DOI: 10.1038/s41598-021-92623-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/24/2021] [Indexed: 01/22/2023] Open
Abstract
Iron deficiency anaemia (IDA) is common in colorectal cancer (CRC), especially, in right-sided CRC which is known to have an overall worse prognosis. The associations between diagnostic pathway (Bowel Cancer Screening Programme (BCSP), IDA, symptomatic) and tumour side/stage was assessed using logistic regression models in 1138 CRC cases presenting during 2010-2016 at a single secondary-care centre in the UK. In the IDA sub-group, the relationship between CRC stage and the event of having a blood count prior to CRC diagnosis was examined using Bayesian parametric survival model. IDA was found as the only significant predictor of right-sided CRC (OR 10.61, 95% CI 7.02-16.52). Early-stage CRC was associated with both the IDA (OR 1.65, 95% CI 1.18-2.29) and BCSP pathway (OR 2.42, 95% CI 1.75-3.37). At any age, the risk of detecting CRC at late-stage was higher in those without a previous blood count check (hazard ratio 1.53, 95% credibility interval 1.08-2.14). The findings of this retrospective observational study suggest a benefit from diagnosing CRC through the detection of IDA, and warrant further research into the prognosis benefit of systematic approach to blood count monitoring of the at-risk population.
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Affiliation(s)
- Orouba Almilaji
- Gastroenterology Unit, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
- Department of Medical Science and Public Health, Bournemouth University, Bournemouth, UK.
| | - Sally D Parry
- Gastroenterology Unit, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Sharon Docherty
- Department of Medical Science and Public Health, Bournemouth University, Bournemouth, UK
| | - Jonathon Snook
- Gastroenterology Unit, University Hospitals Dorset NHS Foundation Trust, Poole, UK
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28
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Lin J, Wang C, Liu J, Yu Y, Wang S, Wen A, Wu J, Zhang L, Sun F, Guo X, Liu F, Li H, Li N, Wang H, Lv Y, Jia Z, Li X, Zhang J, Li Z, Liu S, Zhong S, Yang J, Ma S, Zhou L, Guan X, Ma C, Cheng S, Chen S, Xu Z, Li G, Wang D. Prevalence and intervention of preoperative anemia in Chinese adults: A retrospective cross-sectional study based on national preoperative anemia database. EClinicalMedicine 2021; 36:100894. [PMID: 34041460 PMCID: PMC8144738 DOI: 10.1016/j.eclinm.2021.100894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preoperative anemia is an important pillar of perioperative patient blood management. However, there was no literature comprehensively described the current situation of preoperative anemia in China. METHODS We conducted a national retrospective cross-sectional study to assess the prevalence and intervention of preoperative anemia in Chinese adults. Data were from the National Preoperative Anemia Database based on hospital administration data from January 1, 2013 to December 31, 2018. FINDINGS A total of 797,002 patients were included for analysis. Overall, 27.57% (95% CI 27.47-27.67) of patients had preoperative anemia, which varied by gender, age, regions, and type of operation. Patients who were female, age over 60 years old, from South China, from provinces with lower per capita GDP, underwent operations on the lymphatic and hematopoietic system, with laboratory abnormalities were more likely to have a high risk of preoperative anemia. Among patients with preoperative anemia, 5.16% (95% CI 5.07-5.26) received red blood cell transfusion, 7.79% (95% CI 7.67-7.91) received anemia-related medications such as iron, erythropoietin, folic acid or vitamin B12, and 12.25% (95% CI 12.10-12.40) received anemia-related therapy (red blood cell transfusion or anemia-related medications) before operation. The probability of preoperative RBC transfusion decreased by 54.92% (OR 0.46, 95% CI 0.46-0.47) as each 10-g/L increase in preoperative hemoglobin. Patients with preoperative hemoglobin less than 130 g/L was associated with longer hospital stay and more hospital costs. Patients with severe preoperative anemia given iron preoperatively had lower intra/post-operative RBC transfusion rate, shorter length of stay and less hospitalization costs, but no similar correlation was found in patients with mild and moderate preoperative anemia and patients given erythropoietin preoperatively. INTERPRETATION Our present study shows that preoperative anemia is currently a relatively prevalent problem that has not been fully appreciated in China. More researches will be required to optimize the treatment of preoperative anemia. FUNDING National Natural Science Foundation of China and the Logistics Support Department of the Central Military Commission.
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Affiliation(s)
- Jie Lin
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chao Wang
- Institute of Statistics and Information, Beijing Center for Diseases Control and Prevention, Beijing, China
| | - Junting Liu
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yang Yu
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Shufang Wang
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Aiqing Wen
- Department of Blood Transfusion, Daping Hospital, Army Medical University, Chongqing, China
| | - Jufeng Wu
- Department of Blood Transfusion, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Long Zhang
- Department of Blood Transfusion, Affiliated Hospital of Chifeng University, Inner Mongolia Autonomous Region, China
| | - Futing Sun
- Department of Blood Transfusion, Weifang People's Hospital, Shandong, China
| | - Xiaojun Guo
- Department of Blood Transfusion, The First Hospital of Shanxi Medical University, Shanxi, China
| | - Fenghua Liu
- Department of Blood Transfusion, The First Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Hailan Li
- Department of Blood Transfusion, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Zhuang Autonomous Region, China
| | - Na Li
- Department of Blood Transfusion, General Hospital of Easter Theater Command, Jiangsu, China
| | - Haibao Wang
- Department of Blood Transfusion, Hainan Hospital of PLA General Hospital, Hainan, China
| | - Yi Lv
- Clinical Laboratory Medicine Center, Zhengzhou Yihe Hospital Affiliated to Henan University, Henan, China
| | - Zhonghua Jia
- Department of Blood Transfusion, Gaoan People's Hospital, Jiangxi, China
| | - Xiaoyan Li
- Department of Blood Transfusion, Baoji Central Hospital, Shaanxi, China
| | - Jun Zhang
- Department of Blood Transfusion, The First Affiliated Hospital of Bengbu Medical College, Anhui, China
| | - Zunyan Li
- Department of Blood Transfusion, Affiliated Hospital of Beihua University, Jilin, China
| | - Shanshan Liu
- Department of Blood Transfusion, The First People's Hospital of GuiYang, Guizhou, China
| | - Shuhuai Zhong
- Department of Blood Transfusion, Guizhou Provincial People's Hospital, Guizhou, China
| | - Jun Yang
- Department of Blood Transfusion, Zigong Fourth People's Hospital, Sichuan, China
| | - Shuxuan Ma
- Department of Blood Transfusion, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lingling Zhou
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Xiaozhen Guan
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chunya Ma
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | | | | | - Zhenhua Xu
- HealSci Technology Co., Ltd, Beijing, China
| | - Gang Li
- Institute of Statistics and Information, Beijing Center for Diseases Control and Prevention, Beijing, China
| | - Deqing Wang
- Department of Transfusion Medicine, The First Medical Center of PLA General Hospital, Beijing, China
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Wang S, Zhou Z, Tian D, Huang S, Wang C, Gao Z, Ben X, Tang J, Xie L, Zhou H, Zhang D, Shi R, Deng C, Zhuang W, Ding Y, Qiao G. A validated nomogram integrating hematological indicators to predict response to neoadjuvant therapy in esophageal squamous cell carcinoma patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:703. [PMID: 33987401 PMCID: PMC8106100 DOI: 10.21037/atm-21-1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prognoses for advanced Esophageal squamous cell cancer (ESCC) was very poor. Neoadjuvant therapy was shown to improve overall survival of ESCC patients. However, there is still no effective indicator to predict the efficacy of neoadjuvant therapy. The present study intended to investigate the correlation between hematological parameters and the efficacy of neoadjuvant therapy so as to provide a reference for the prediction of cancer response to neoadjuvant therapy. METHODS This study included 197 ESCC patients in our center from January 2010 to December 2018. Response evaluation criteria in solid tumors (RECIST) criteria were used for the treatment evaluation. The results of univariate and multivariate logistic regression analysis were used to select independent factors for construction of the prediction model. The concordance index (C-index), receiver operating characteristic (ROC) curve, and calibration curve were used to evaluate the robustness of the model, while the bootstrap method was used for internal validation. RESULTS Among the 197 included ESCC patients, 94 patients achieved partial remission, 80 patients were in stable condition, and 23 patients had disease progression, 123 of whom underwent surgery. The comparisons of the dynamic hematological test results before and after treatment show that pre-PLT, pre-MONO%, post-Hb, △WBC, and the option of undergoing neoadjuvant chemoradiation were the potential predictors for the effectiveness of neoadjuvant therapy. The model in which the C-index was 0.803 (95% confidence interval: 0.742-0.864) showed good prediction performance, and still reach a C-index of 0.764 when internally validated. CONCLUSIONS For the neoadjuvant treatment of ESCC, hematological indexes are closely related to the efficacy of neoadjuvant therapy. The nomogram can be used to easily predict the efficacy of neoadjuvant therapy in patients.
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Affiliation(s)
- Sichao Wang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shujie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Ce Wang
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhen Gao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Xiaosong Ben
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiming Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liang Xie
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dongkun Zhang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruiqing Shi
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Deng
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weitao Zhuang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yu Ding
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second Clinical Medical School, Southern Medical University, Guangzhou, China
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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30
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Weiler S, Nairz M. TAM-ing the CIA-Tumor-Associated Macrophages and Their Potential Role in Unintended Side Effects of Therapeutics for Cancer-Induced Anemia. Front Oncol 2021; 11:627223. [PMID: 33842333 PMCID: PMC8027083 DOI: 10.3389/fonc.2021.627223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/01/2021] [Indexed: 12/21/2022] Open
Abstract
Cancer-induced anemia (CIA) is a common consequence of neoplasia and has a multifactorial pathophysiology. The immune response and tumor treatment, both intended to primarily target malignant cells, also affect erythropoiesis in the bone marrow. In parallel, immune activation inevitably induces the iron-regulatory hormone hepcidin to direct iron fluxes away from erythroid progenitors and into compartments of the mononuclear phagocyte system. Moreover, many inflammatory mediators inhibit the synthesis of erythropoietin, which is essential for stimulation and differentiation of erythroid progenitor cells to mature cells ready for release into the blood stream. These pathophysiological hallmarks of CIA imply that the bone marrow is not only deprived of iron as nutrient but also of erythropoietin as central growth factor for erythropoiesis. Tumor-associated macrophages (TAM) are present in the tumor microenvironment and display altered immune and iron phenotypes. On the one hand, their functions are altered by adjacent tumor cells so that they promote rather than inhibit the growth of malignant cells. As consequences, TAM may deliver iron to tumor cells and produce reduced amounts of cytotoxic mediators. Furthermore, their ability to stimulate adaptive anti-tumor immune responses is severely compromised. On the other hand, TAM are potential off-targets of therapeutic interventions against CIA. Red blood cell transfusions, intravenous iron preparations, erythropoiesis-stimulating agents and novel treatment options for CIA may interfere with TAM function and thus exhibit secondary effects on the underlying malignancy. In this Hypothesis and Theory, we summarize the pathophysiological hallmarks, clinical implications and treatment strategies for CIA. Focusing on TAM, we speculate on the potential intended and unintended effects that therapeutic options for CIA may have on the innate immune response and, consequently, on the course of the underlying malignancy.
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Affiliation(s)
- Stefan Weiler
- National Poisons Information Centre, Tox Info Suisse, Associated Institute of the University of Zurich, Zurich, Switzerland.,Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, Eidgenossische Technische Hochschule Zurich, Zurich, Switzerland
| | - Manfred Nairz
- Department of Internal Medicine II, Infectious Diseases, Immunology, Rheumatology, Pneumology, Medical University of Innsbruck, Innsbruck, Austria
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Nanji S, Mir ZM, Karim S, Brennan KE, Patel SV, Merchant SJ, Booth CM. Perioperative blood transfusion and resection of colorectal cancer liver metastases: outcomes in routine clinical practice. HPB (Oxford) 2021; 23:404-412. [PMID: 32792307 DOI: 10.1016/j.hpb.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/13/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prior work has shown associations between blood transfusion (BT) and inferior outcomes during resection for colorectal cancer liver metastases (CRLM). Herein, we describe short and long-term outcomes relating to perioperative BT in routine clinical practice. METHODS All CRLM resections in Ontario, Canada from 2002 to 2009 were identified using the Ontario Cancer Registry. Log-binomial regression and Cox regression were used to explore factors associated with receipt of BT and the association of BT with 5-year cancer specific (CSS) and overall survival (OS), respectively. RESULTS The study included 1310 patients; 31% (403/1310) had perioperative BT. Transfused patients had longer median length of stay (9 vs. 7 days, p < 0.001), higher 90-day mortality (9% vs. 1%, p < 0.001), greater 90-day readmission (28% vs. 16%, p < 0.001), and inferior 5-year CSS (41% vs. 48%, p = <0.001) and OS (38% vs. 47%, p < 0.001). Transfusion was independently associated with inferior CSS (HR = 1.35, 95% CI: 1.11-1.63) and OS (HR = 1.30, 95% CI: 1.10-1.53), however, excluding 90-day postoperative deaths showed these associations were no longer significant. CONCLUSION Perioperative BT is common in patients undergoing resection of CRLM. While transfusion is associated with greater morbidity, mortality, and inferior survival, after excluding early postoperative deaths, BT does not appear to be independently associated with CSS or OS.
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Affiliation(s)
- Sulaiman Nanji
- Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada.
| | - Zuhaib M Mir
- Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Safiya Karim
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Kelly E Brennan
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Sunil V Patel
- Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Shaila J Merchant
- Department of Surgery, Queen's University, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
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Preoperative anemia predicts poor prognosis in patients with endometrial cancer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 258:382-390. [PMID: 33529973 DOI: 10.1016/j.ejogrb.2021.01.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/27/2022]
Abstract
AIM To systematically and meta-analytically pool the existing evidence regarding the prognostic impact of preoperative anemia (hemoglobin level <12 mg/dl) in patients with endometrial cancer. METHODS Four (PubMed, Embase, Scopus and Web of Science) databases were searched from inception to 20-August-2020. We assessed the risk of bias using the Newcastle-Ottawa Scale. We estimated the pooled prevalence of preoperative anemia in the included studies. We pooled odds ratios (ORs) and hazard ratios (HRs) with their 95 % confidence intervals (95 % CIs) to evaluate the correlation between preoperative anemia and its impact on clinicopathologic parameters and survival outcomes. Analyses were performed under random- or fixed-effects meta-analysis models depending on data heterogeneity. RESULTS Seven studies met the inclusion criteria comprising 1495 patients with endometrial cancer. Nearly all studies had low risk of bias. The pooled prevalence of preoperative anemia was 26.5 % (95 % CI: 18.6%-36.2%). Preoperative anemia significantly correlated with advanced FIGO stage III-IV (OR = 5.14, 95 % CI [3.36, 7.86], p < 0.00001), ≥50 % myometrial invasion (OR = 1.95, 95 % CI [1.36, 2.78], p = 0.0003), lymph node metastasis (OR = 4.46, 95 % CI [2.39, 8.30], p < 0.00001), non-endometrioid histology (OR = 3.25, 95 % CI [1.89, 5.60], p < 0.0001), adnexal involvement (OR = 5.88, 95 % CI [3.05, 10.23], p < 0.001), cervical involvement (OR = 2.91, 95 % CI [1.65, 5.11], p = 0.0002), positive peritoneal cytology (OR = 3.24, 95 % CI [1.41, 7.44], p = 0.006), preoperative thrombocytosis (OR = 6.66, 95 % CI [3.05, 14.52], p < 0.00001) and lymphovascular space invasion (OR = 3.50, 95 % CI [1.82, 6.74], p = 0.0002). High tumor grade II-III was increased in patients with preoperative anemia, yet this effect was not statistically significant (OR = 2.12, 95 % CI [0.97, 4.66], p = 0.06). Consistently, the five-year overall survival (OS) and disease-free survival (DFS) rates were significantly lower in patients with preoperative anemia when compared to those without preoperative anemia. Pooled HR showed that preoperative anemia was significantly associated with reduced DFS at univariate (HR = 3.22, 95 % CI [1.28, 8.11], p = 0.01) and multivariate (HR = 1.02, 95 % CI [1.00, 1.05], p = 0.03) analyses. CONCLUSION Preoperative anemia predicts poor clinicopathologic and survival outcomes in patients with endometrial cancer.
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Hubert M, Gabriel D, El Khouda S, Coster M, Routiaux C, Hans G, Nihant N, Joris J. Energy and Protein Intake After Return Home in Colorectal Surgery Patients With an Enhanced Recovery Program: A Prospective Observational Study. Nutr Clin Pract 2021; 36:639-647. [PMID: 33410538 DOI: 10.1002/ncp.10617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients scheduled for colorectal surgery with an enhanced recovery program (ERP), feeding after returning home has been insufficiently investigated. The aim of this study was to measure energy and protein intake during the first month at home. METHODS Seventy adult patients scheduled for colorectal surgery with ERP were included. Calorie and protein intakes were calculated, and body weight was measured preoperatively and 3, 7, 15, and 30 days after discharge home. Data are mean ± SD or median (interquartile range). RESULTS Patient characteristics were age 60.0 ± 15.0 years, BMI = 25.9 ± 5.5 kg/m2 , and colon/rectum of 56/14. The duration of hospitalization was 3 (2-5) days. Calorie and protein intakes (21.9 [17.7-28.6] kilocalorie per kilogram of ideal body weight [kcal/kg IBW] and 0.81 [0.61-1.14] g/kg IBW) were significantly reduced (P < .01) by 15% on day 3, compared with preoperative values, and then increased gradually to reach preoperative values after 1 month. Almost 50% of the patients failed to reach the calorie intake target of 25 kcal/kg IBW, and almost no patient reached the protein intake target of 1.5 g/kg IBW 30 days after discharge home. Weight loss after 30 days at home remained at -1.8 ± 2.7 kg. CONCLUSIONS Colorectal surgery, even in an ERP, is associated with energy and protein intake below the targets recommended for the rehabilitation phase and results in weight loss. Whether nutrition counseling and prolonged administration of protein-enriched oral supplements could accelerate weight gain needs to be explored.
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Affiliation(s)
- Mégane Hubert
- Department of Anesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Dominique Gabriel
- Dietary and Nutrition Services, CHU Liège, University of Liège, Liège, Belgium
| | - Soraya El Khouda
- Dietary and Nutrition Services, CHU Liège, University of Liège, Liège, Belgium
| | - Marine Coster
- Haute Ecole de la Province de Liège, Dietetics Section, Jemeppe, Belgium
| | - Clara Routiaux
- Haute Ecole de la Province de Liège, Dietetics Section, Jemeppe, Belgium
| | - Gregory Hans
- Department of Anesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Nicole Nihant
- Haute Ecole de la Province de Liège, Dietetics Section, Jemeppe, Belgium
| | - Jean Joris
- Department of Anesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium.,Groupe francophone de réhabilitation améliorée après chirurgie (GRACE; Francophone group for enhanced recovery after surgery), Beaumont, France
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A Comprehensive Evaluation of Associations Between Routinely Collected Staging Information and The Response to (Chemo)Radiotherapy in Rectal Cancer. Cancers (Basel) 2020; 13:cancers13010016. [PMID: 33375133 PMCID: PMC7792936 DOI: 10.3390/cancers13010016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Rectal cancer patients are often treated with radiotherapy, either alone or combined with chemotherapy, prior to surgery to enable radical surgery on a non-resectable tumor or to lower the recurrence risk. For some patients, the tumor disappears completely after preoperative treatment, while others experience little or no benefit. Accurate prediction of therapy response before treatment is of great importance for a personalized treatment approach and intentional organ preservation. We performed a comprehensive evaluation of the predictive capacity of all routinely collected staging information at diagnosis in a population-based, completely staged patient material of 383 patients representing a real-life clinical situation. Size or stage of the rectal tumor were independent predictors of excellent response irrespective of preoperative treatment, with small/early-stage tumors being significantly more likely to reach a complete response. Levels of the tumor marker carcinoembryonic antigen (CEA) above upper normal limit halved the chance of response. Abstract Radiotherapy (RT) or chemoradiotherapy (CRT) are frequently used in rectal cancer, sometimes resulting in complete tumor remission (CR). The predictive capacity of all clinical factors, laboratory values and magnetic resonance imaging parameters performed in routine staging was evaluated to understand what determines an excellent response to RT/CRT. A population-based cohort of 383 patients treated with short-course RT (5 × 5 Gy in one week, scRT), CRT, or scRT with chemotherapy (scRT+CT) and having either had a delay to surgery or been entered into a watch-and-wait program were included. Complete staging according to guidelines was performed and associations between investigated variables and CR rates were analyzed in univariate and multivariate analyses. In total, 17% achieved pathological or clinical CR, more often after scRT+CT and CRT than after scRT (27%, 18% and 8%, respectively, p < 0.001). Factors independently associated with CR included clinical tumor stage, small tumor size (<3 cm), tumor level, and low CEA-value (<3.8 μg/L). Size or stage of the rectal tumor were associated with excellent response in all therapy groups, with small or early stage tumors being significantly more likely to reach CR (p = 0.01 (scRT), p = 0.01 (CRT) and p = 0.02 (scRT+CT). Elevated level of carcinoembryonic antigen (CEA) halved the chance of response. Extramural vascular invasion (EMVI) and mucinous character may indicate less response to RT alone.
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Wu CT, Huang YC, Chen WC, Chen MF. The Significance of Neutrophil-to-Lymphocyte Ratio and Combined Chemoradiotherapy in Patients Undergoing Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer. Cancer Manag Res 2020; 12:13125-13135. [PMID: 33376404 PMCID: PMC7764706 DOI: 10.2147/cmar.s283954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background Bladder-sparing treatment has been developed with the aim of preserving bladder function. However, considerable controversy remains regarding the effectiveness of organ preservation strategies. Accordingly, we investigated factors influencing the prognosis of muscle-invasive bladder cancer (MIBC) patients who received bladder-sparing treatment. Materials and Methods In the study, we retrospectively reviewed 193 patients who were newly diagnosed with MIBC and received bladder-sparing treatment from 2006 to 2013 in our hospital. Results The 5-year overall survival, progression-free survival (PFS) and bladder-preservation survival rates after diagnosis were 64.7%, 52.1%, and 64%, respectively. The presence of hydronephrosis, advanced stage and not achieving complete response were associated with a marked reduction in PFS. Treatment with an adequate dose of combined chemoradiotherapy (CCRT) (chemotherapy ≥2 cycles combined with radiotherapy dose ≥56Gy) significantly improved the complete response (CR), 5-year bladder-preservation survival, and PFS rates, particularly for patients with good performance status. The 5-year bladder-preservation survival rates for CR and non-CR patients were 75%, and 21%, respectively. Furthermore, higher pre-treatment neutrophil-to-lymphocyte ratio (NLR) (≥3) and lower hemoglobin (≤12) were significantly associated with lower CR rate, increased risk of loco-regional recurrence and reduced bladder-preservation survival rate. Multivariable Cox regression analysis based on different co-variables showed that pretreatment NLR was an independent prognostic factor for PFS when MIBC patients were stratified by clinical stage and the doses of CCRT. Conclusion In MIBC patients with bladder-sparing treatment, adequate doses of CCRT and low NLR were found to be correlated with better PFS. We suggest the use of NLR as a clinical biomarker for the prognosis of MIBC and guidance of treatment decisions.
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Affiliation(s)
- Chun-Te Wu
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yun-Ching Huang
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Wen-Cheng Chen
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Miao-Fen Chen
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
- Correspondence: Miao-Fen Chen Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Taiwan Email
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Dickson EA, Keeler BD, Ng O, Kumar A, Brookes MJ, Acheson AG. Preoperative intravenous iron therapy and survival after colorectal cancer surgery: long-term results from the IVICA randomised controlled trial. Colorectal Dis 2020; 22:2018-2027. [PMID: 32871616 DOI: 10.1111/codi.15342] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
Abstract
AIM Preoperative iron is frequently used for the correction of anaemia in colorectal cancer surgery. However, enteral iron intake may promote tumour growth and progression which could influence cancer recurrence and patient survival. We explore the long-term outcomes of patients receiving either oral or intravenous iron replacement therapy as part of a previous randomized controlled trial. METHODS The IVICA trial randomized anaemic colorectal cancer patients to receive either oral (OI, control) or intravenous (IVI, treatment) iron prior to their elective operation. Follow-up analysis of all patients recruited to this multicentre trial who underwent surgical resection with curative intent was performed. Kaplan-Meier survival estimates and Cox proportional hazard models were used to compare groups. A pooled group multivariable analysis comparing patients who achieved resolution of anaemia preoperatively to those who did not was also undertaken. RESULTS In all, 110 of the 116 patients previously enrolled were eligible for analysis (OI n = 56, IVI n = 54). Median overall follow-up duration was 61 months (interquartile range 46-67). No significant difference in 5-year overall survival (hazard ratio (HR) 1.22, 95% CI 0.65-2.28, P = 0.522) or disease-free survival (HR 1.08, 95% CI 0.61-1.92, P = 0.79) was observed between OI and IVI. A pooled analysis of treatment groups found that preoperative resolution of anaemia led to improved 5-year overall survival on multivariable analysis (HR 3.38, 95% CI 1.07-11.56, P = 0.044). CONCLUSION We recommend IVI for the preoperative correction of anaemia. Route of iron therapy did not significantly influence survival. Preoperative anaemia correction may lead to an overall survival advantage following elective colorectal cancer surgery.
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Affiliation(s)
- E A Dickson
- National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - B D Keeler
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - O Ng
- Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - A Kumar
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - M J Brookes
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - A G Acheson
- National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Janssen TL, Steyerberg EW, van Gammeren AJ, Ho GH, Gobardhan PD, van der Laan L. Intravenous Iron in a Prehabilitation Program for Older Surgical Patients: Prospective Cohort Study. J Surg Res 2020; 257:32-41. [PMID: 32818782 DOI: 10.1016/j.jss.2020.07.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older patients often have iron deficiency anemia before surgery, which can be effectively treated with intravenous iron supplementation (IVIS). Anemia and blood transfusions are associated with an increased risk of delirium. The aim of this research was to assess the effectiveness and safety of using IVIS in a prehabilitation program. MATERIAL AND METHODS Patients ≥70 y who underwent abdominal surgery between November 2015 and June 2018 were included in this single-center prospective cohort study. All patients were prehabilitated; however, only anemic patients received a single dose of 1000 mg intravenous iron (ferric carboxymaltose) to increase preoperative hemoglobin levels (IVIS group). Nonanemic patients received standard care (SC). The hemoglobin levels (primary outcome) were assessed at the outpatient clinic visit, at admission, and at discharge. Secondary outcomes were postoperative delirium, postoperative anemia, blood transfusion, complications other than delirium, and length of hospital stay. All outcomes were compared between the IVIS group and SC group. RESULTS Of all patients (n = 248), 97 anemic patients received IVIS (39%). Of the anemic patients, 50 patients (52%) had iron deficiency. Initial differences in hemoglobin concentrations between the IVIS group and SC group at T1 and T2 (7.2 versus 8.8; P < 0.001 and 7.4 versus 8.6; P = 0.023, respectively) were no longer present at discharge (6.6 versus 7.2; P = 0.35). No statistically significant differences were observed for all secondary outcomes between the IVIS group and the SC group. No infusion-related adverse events occurred. CONCLUSIONS Adding IVIS to prehabilitation programs is safe and diminishes differences in these concentrations between preoperatively anemic and nonanemic patients. IVIS may be worthwhile as an additional component of prehabilitation programs. Results merit further investigation.
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Affiliation(s)
- Ties L Janssen
- Department of Surgery, Amphia Hospital, Breda, the Netherlands.
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adriaan J van Gammeren
- Department of Clinical Chemistry and Haematology, Amphia Hospital, Breda, the Netherlands
| | - Gwan H Ho
- Department of Surgery, Amphia Hospital, Breda, the Netherlands
| | | | - Lijckle van der Laan
- Department of Surgery, Amphia Hospital, Breda, the Netherlands; Department of Cardiovascular Science, University Hospital Leuven, Belgium
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Kwon YH, Lim HK, Kim MJ, Park JW, Ryoo SB, Jeong SY, Park KJ. Impacts of anemia and transfusion on oncologic outcomes in patients undergoing surgery for colorectal cancer. Int J Colorectal Dis 2020; 35:1311-1320. [PMID: 32363477 DOI: 10.1007/s00384-020-03601-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to evaluate the prevalence of preoperative anemia and impacts of anemia and transfusion on survival in patients undergoing surgery for colorectal cancer. METHODS This study included patients who underwent surgery for primary colorectal cancer between 2011 and 2012. The influence of preoperative anemia and postoperative transfusion on recurrence-free survival and overall survival were retrospectively investigated. Anemia was defined as hemoglobin level < 13 g/dL in males and < 12 g/dL in females. The primary outcome was the prevalence of preoperative anemia in patients with colorectal cancer. Secondary outcomes included preoperative anemia management, postoperative 30-day mortality and morbidity, tumor recurrence, and overall survival. RESULTS Among a total of 1899 patients, 823 patients (43.3%) were anemic preoperatively, and 264 patients (13.9%) received postoperative transfusions. Postoperative transfusion was associated with 30-day postoperative complications (OR = 1.514, 95% CI = 1.020 ~ 2.247) but not preoperative anemia (OR = 1.143, 95% CI, 0.811 ~ 1.611). Preoperative anemia (HR = 1.459, 95% CI = 1.104 ~ 1.929) and postoperative transfusion (HR = 1.566, 95% CI = 1.089 ~ 2.252) were significantly associated with worse recurrence-free survival in multivariable analysis. Preoperative anemia (HR = 1.572, 95% CI = 1.274 ~ 1.940) and postoperative transfusion (HR = 1.381, 95% CI = 1.076 ~ 1.773) were significant independent risk factors for worse overall survival. CONCLUSIONS Preoperative anemia and postoperative transfusion were associated with worse survival in patients undergoing surgery for colorectal cancer. An alternative therapy to treat anemia and reduce transfusions should be introduced to improve oncologic outcomes.
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Affiliation(s)
- Yoon-Hye Kwon
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Han-Ki Lim
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Min Jung Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ji Won Park
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Seung-Bum Ryoo
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Seung-Yong Jeong
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Kyu Joo Park
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Platelet and hemoglobin count at diagnosis are associated with survival in African American and Caucasian patients with colorectal cancer. Cancer Epidemiol 2020; 67:101746. [PMID: 32521488 DOI: 10.1016/j.canep.2020.101746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND African Americans (AAs) compared to Caucasian Americans (CAs) with colorectal cancer (CRC) have lower stage-specific survival. CRC patients often present with several hematopathologies (such as thrombocytosis, thrombocytopenia, anemia) at diagnosis, which is associated with poorer survival. However, whether these measures impact the racial disparity in survival is not known. METHODS The study population was composed of 581 histologically confirmed CRCs at the Medical University of South Carolina (393 CA, 188 AA) diagnosed between 01/01/2000 and 06/30/2013. We used Cox proportional hazards regression to estimate the association between thrombocytosis, thrombocytopenia, or anemia at diagnosis and risk of death by race. This analysis was adjusted for age, sex, stage and first-line treatment. RESULTS In all patients combined, thrombocytosis, thrombocytopenia, and anemia (vs. the normal ranges) were associated with significantly higher risks of death. In the race-specific analyses, AAs (HR 2.51 [95 % CI: 1.52-4.15]) vs. CAs (HR 1.15 [95 % CI: 0.75-1.75]) with thrombocytosis compared to normal had a higher risk of death (p for difference = 0.03). CONCLUSIONS Abnormal thrombocyte and hemoglobin levels at diagnosis were associated with poorer survival. AAs compared to CAs with elevated platelets at diagnosis had a higher risk of death. Our study is the first to examine the role of race, hematologic measures at diagnosis, and risk of death in colorectal cancer patients. These results suggest that the racial differences in the immune response may contribute to the racial disparity in survival.
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Li Y, Wu H, Xing C, Hu X, Zhang F, Peng Y, Li Z, Lu T. Prognostic evaluation of colorectal cancer using three new comprehensive indexes related to infection, anemia and coagulation derived from peripheral blood. J Cancer 2020; 11:3834-3845. [PMID: 32328188 PMCID: PMC7171501 DOI: 10.7150/jca.42409] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Many indicators of peripheral blood in routine blood test (BRT) results of colorectal cancer (CRC) patients are related to prognosis. Currently, indexes such as NLR (Neutrophil-to- Lymphocyte Ratio), PLR (Platelet-to-Lymphocyte Ratio) and LMR (Lymphocyte-to-Monocyte ratio) evaluate the survival risk of patients by assessing the inflammatory - immune status of CRCs. These indexes are more comprehensive and accurate than independent estimates. We hope to design more effective indexes through fully considering the correlation and significance between BRT indicators and prognosis, so as to play a guiding role in clinical malignant estimation of CRCs. Methods: 701 CRCs in training set and 256 CRCs in test set were included in the study samples, and their clinical data, tumor pathology results and peripheral blood routine results were collected. The prognosis, progression, and survival status of all patients were determined after follow-up. Above data were used for statistical analysis and designing new indexes. Results: It was found that high NE, MONO, RDW-CV/SD and PLT in peripheral blood indicated poor prognosis of DFS and OS. Conversely, CRCs with postoperative tumor progression or death had lower LY, EO, RBC, HGB, HCT, MCV, MCH, MCHC, PDW, and P-LCR. IRR, ARR and CRR related to infection, anemia and coagulation were designed respectively using the largest AUC indicators (P<0.05) selected by ROC curve. The formula: IRR= (NE*MONO)/(LY*EO); ARR= (HGB*MCHC)/RDW-CV; CRR=PLT/PDW. Results of Kaplan‑Meier survival analysis and multivariate COX proportional hazard analysis adjusted for age, gender, TNM stage, infiltration, adhesion showed IRR, ARR, CRR were all able to be used as the evaluation standard of survival of CRC. The result was also authenticated in the test set. Conclusion: We designed three different prognostic indexes of colorectal cancer, IRR, ARR and CRR, which could be used as risk indicators of CRC prognosis, tumor progression and survival.
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Affiliation(s)
- Yalun Li
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Huizhe Wu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Chengzhong Xing
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Xiaoyun Hu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Fangxiao Zhang
- Department of Intensive Care Unit, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yangjie Peng
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Zeyu Li
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Tingting Lu
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
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Prechemotherapy Hemoglobin Levels as a Predictive Factor of Ovarian Cancer Survival: A Systematic Review and Meta-Analysis. Am J Clin Oncol 2020; 42:725-731. [PMID: 31361606 DOI: 10.1097/coc.0000000000000570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The impact of anemia on cancer survival has been previously mentioned in various oncological fields. To date, however, it remains unknown whether prechemotherapy hemoglobin (Hgb) levels are predictive of ovarian cancer survival (OC). The purpose of the present systematic review is to accumulate evidence in this field. MATERIALS AND METHODS We used the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases in our primary search. The date of our last search was set for July 30, 2018. Statistical meta-analysis was performed with the RevMan 5.3 software. RESULTS Overall, 11 articles were included that recruited 1816 women with OC. Five articles that involved 856 OC patients were included in the meta-analysis. Compared with patients with anemia, patients with Hgb levels >12 g/dL had increased odds of overall survival (odds ratio, 1.72; 95% confidence interval: 1.41, 2.10). Similarly, the progression-free survival of patients was significantly affected, although the available data could not be accumulated in a meta-analysis because of the heterogeneity in outcome reporting measures. CONCLUSIONS Current evidence suggests that prechemotherapy Hgb levels below the threshold of 12 g/dL can potentially predict worse overall survival of OC patients. Future research is required in the field to elucidate whether several independent variables such as the stage and histology of disease and rates of optimal debulking affect the clinical significance of this association.
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Zhang J, Zhou X, Ding H, Wang L, Liu S, Liu Y, Chen Z. The prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer. BMC Urol 2020; 20:31. [PMID: 32192483 PMCID: PMC7082918 DOI: 10.1186/s12894-020-00602-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A routine blood examination is one of the most rapid, convenient and inexpensive clinical examinations that can reflect a patient's inflammatory status and other blood conditions, and the prognostic value of routine preoperative blood parameters in MIBC patients is still unclear, so we evaluated the prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC). METHODS Data on 202 patients with MIBC who underwent RC at our institution were retrospectively collected between October 2007 and August 2018. The median preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (HGB) values were used as cutoffs to form the low and high NLR, low and high PLR, and low and high HGB groups, respectively. The clinicopathologic characteristics of each group were compared by chi-square and t tests. Kaplan-Meier survival and multivariate Cox regression analyses were used to analyze prognosis. RESULTS The median NLR, PLR and HGB values were 2.42, 112 and 125 g/L, respectively. Kaplan-Meier results showed that the low HGB group had poor progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). A high NLR and high PLR groups correlated only with poor OS. Multivariate Cox analyses showed that pathological T3/4 stage, positive lymph node status and low HGB were independent risk factors for PFS, CSS and OS, and age was the only independent risk factor for OS. CONCLUSION Preoperative peripheral blood HGB is an independent risk factor for the prognosis of MIBC patients. These data suggest that HGB may be a useful prognostic marker for MIBC patients undergoing RC.
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Affiliation(s)
- Jingqi Zhang
- Institute of Urology, Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiaozhou Zhou
- Institute of Urology, Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Hua Ding
- Institute of Urology, Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Liwei Wang
- Institute of Urology, Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Sha Liu
- Department of Cell Biology, College of Basic Medical Sciences, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yuting Liu
- Institute of Urology, Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhiwen Chen
- Institute of Urology, Department of Urology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Kam PMH, Chu CWH, Chan EMY, Liu OL, Kwok KH. Use of intravenous iron therapy in colorectal cancer patient with iron deficiency anemia: a propensity-score matched study. Int J Colorectal Dis 2020; 35:521-527. [PMID: 31930457 DOI: 10.1007/s00384-020-03508-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Iron deficiency anemia is common in colorectal cancer patients and is related to poor surgical outcome. Increasing evidence supports preoperative use of intravenous iron (IVI) to correct anemia. Our study investigates effect of preoperative IVI on hemoglobin level. METHODS From August 2017 to March 2019, colorectal cancer patients with iron deficiency anemia received intravenous iron at least 2 weeks before their scheduled operations (IVI group). These patients' prospectively collected data were compared to a historic cohort of anemic patients who received elective colorectal surgery within 3 years before the study period (non-IVI). RESULTS Forty-six patients were included after receiving intravenous iron. After propensity score matching on 1:2 ratio, 38 patients in IVI group were matched with 62 patients from non-IVI group. There was no statistical difference for preoperative mean hemoglobin level between the two groups (8.43 g/dL in IVI, 8.79 g/dL in non-IVI, p = 0.117), but IVI group has significantly higher mean hemoglobin level on admission (10.63 g/dL in IVI, 9.46 g/dL in non-IVI, p = < 0.001). IVI group had higher median hemoglobin rise (1.9 in IVI, 0.6 in non-IVI, p = <0.001) and significantly less red cell transfusion (8 patients in IVI, 30 in non-IVI, p = 0.006). Subgroup analysis showed that less patients in IVI group required transfusions in preoperative period (1 in IVI group, 20 in non-IVI, p < 0.001). CONCLUSION Our data suggested that IVI can significantly increase hemoglobin level in iron deficiency anemic patients before colorectal surgery, with reduction in red cell transfusions.
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Affiliation(s)
- Philip Ming-Ho Kam
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
| | - Colin Wai-Ho Chu
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Emily Mei-Yi Chan
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - On-Lai Liu
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Kam-Hung Kwok
- Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
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Increased 30-Day Mortality Risk in Patients With Diabetes Mellitus After Colon Cancer Surgery: A Mediation Analysis. Dis Colon Rectum 2020; 63:290-299. [PMID: 31977584 PMCID: PMC8573828 DOI: 10.1097/dcr.0000000000001586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients with (versus without) diabetes mellitus who develop colon cancer are at increased risk of dying within 30 days after surgery. OBJECTIVE The purpose of this study was to identify potential mediators of the effect of diabetes mellitus on all-cause 30-day mortality risk after surgery for colon cancer. DESIGN A retrospective cohort study was conducted using the 2013-2015 National Surgical Quality Improvement Program data. SETTING The study was conducted at various hospitals across the United States (from 435 to 603 hospitals). PATIENTS Patients who underwent resection for colon cancer with or without obstruction based on the National Surgical Quality Improvement Program colectomy module were included. Patients who had ASA physical status classification V or metastatic disease and those who presented emergently were excluded. Patients were classified as "no diabetes," "diabetes not requiring insulin," or "diabetes requiring insulin." Potential reasons for increased risk of dying within 30 days were treatment related, comorbidity, health behaviors, surgical complications, and biomarkers of underlying disease. MAIN OUTCOME MEASURES We measured all-cause 30-day mortality. RESULTS Of 26,060 patients, 18.8% (n = 4905) had diabetes mellitus that was treated with insulin (n = 1595) or other antidiabetic agents (n = 3340). Patients with diabetes mellitus had a 1.57 (95% CI, 1.23-1.99) higher unadjusted odds of dying within 30 days versus patients without diabetes mellitus. In the multivariable model, 76.7% of the association between diabetes mellitus and 30-day mortality was explained; patients with diabetes mellitus were equally likely to die within 30 days versus those without diabetes mellitus (OR = 1.05 (95% CI, 0.81-1.35)). Anemia and sepsis explained 33.7% and 15.2% of the effect of diabetes mellitus on 30-day mortality (each p < 0.0001). Treatment-related variables, cardiovascular disease, surgical complications, and biomarkers played limited roles as mediators. LIMITATIONS The study was limited to larger hospitals, and limited information about duration and type of diabetes mellitus was available. CONCLUSIONS Better management and prevention of anemia and sepsis among patients with diabetes mellitus may reduce their increased risk of death after colon cancer resection. See Video Abstract at http://links.lww.com/DCR/B140. AUMENTO DEL RIESGO DE MORTALIDAD A 30 DÍAS EN PACIENTES DIABETICOS LUEGO DE CIRUGÍA DE CÁNCER DE COLON: ANÁLISIS DE MEDIACIÓN: Los pacientes con (y sin) diabetes que desarrollan cáncer de colon tienen un mayor riesgo de morir dentro de los 30 días posteriores a la cirugía.Identificar los posibles mediadores del efecto de la diabetes sobre el riesgo de mortalidad dentro los 30 días, por cualquier causa después de cirugía por cáncer de colon.Estudio de cohortes retrospectivo entre 2013-2015 utilizando los datos del Programa Nacional de Mejoría en Calidad Quirúrgica.Entre 435 a 603 hospitales en los Estados Unidos.Se incluyeron aquellos pacientes sometidos a resección por cáncer de colon con o sin obstrucción según el módulo de colectomía Programa Nacional de Mejoría en Calidad Quirúrgica. Se excluyeron los pacientes estadío V de la clasificación de la Sociedad Estadounidense de Anestesiólogos (ASA), aquellos con enfermedad metastásica y aquellos operados de urgencia. Los pacientes se clasificaron como "sin diabetes,' "con diabetes que no requiere insulina" o "con diabetes que requiere insulina.' Las posibles razones para un mayor riesgo de morir dentro de los 30 días estuvieron relacionadas con el tratamiento, la comorbilidad, los comportamientos de salud, las complicaciones quirúrgicas y los biomarcadores de enfermedad.Mortalidad de cualquier orígen dentro los 30 días depués de la cirugía.De 26'060 pacientes, 18.8% (n = 4,905) tenían diabetes tratada con insulina (n = 1,595) u otros agentes antidiabéticos (n = 3,340). Los pacientes con diabetes tenían 1.57 (IC 95%: 1.23-1.99) mayores probabilidades no ajustadas de morir dentro de los 30 días en comparación con los pacientes sin diabetes. En el modelo multivariable, se explicó que el 76,7% de la asociación entre diabetes y mortalidad a los 30 días; los pacientes con diabetes tenían la misma probabilidad de morir dentro de los 30 días que aquellos sin diabetes (OR: 1.05; IC 95%: 0.81-1.35). La anemia y la sepsis explicaron el 33,7% y el 15,2% del efecto de la diabetes en la mortandad a 30 días (p <0,0001). Las variables relacionadas con el tratamiento, las enfermedades cardiovasculares, las complicaciones quirúrgicas y los biomarcadores jugaron un papel limitado como mediadores.Estudio limitado a hospitales más grandes e información limitada sobre la duración y el tipo de diabetes.Una mejor prevención y manejo de la anemia y la sepsis en los pacientes con diabetes puede reducir el mayor riesgo de muerte después de la resección del cáncer de colon. Consulte Video Resumen en http://links.lww.com/DCR/B140.
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Abdel-Razeq H, Hashem H. Recent update in the pathogenesis and treatment of chemotherapy and cancer induced anemia. Crit Rev Oncol Hematol 2019; 145:102837. [PMID: 31830663 DOI: 10.1016/j.critrevonc.2019.102837] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Cancer and chemotherapy-induced anemia (CIA) is commonly encountered among patients undergoing active chemotherapy with or without radiation therapy. Its pathogenesis is complex and is often difficult to identify. Symptoms related to CIA may have a negative impact on quality of life and may influence treatment efficacy, disease progression and even survival. The recent major setback of erythropoietin-stimulating agents (ESAs) and the reluctance to transfuse cancer patients with mild and even moderate anemia, had resulted in significant under-treatment of CIA. The discovery of hepcidin and its role in iron homeostasis has revolutionized our understanding of the pathogenesis of iron deficiency and iron overload states. In the present review we examine the multifactorial pathogenesis of CIA, addressing the main mechanisms by which the tumor and immune system affect anemia. Additionally, we discuss the treatment options with more focus on the utilization of the new intravenous iron formulations for this indication.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Departments of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
| | - Hasan Hashem
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
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Tuomisto AE, Mäkinen MJ, Väyrynen JP. Systemic inflammation in colorectal cancer: Underlying factors, effects, and prognostic significance. World J Gastroenterol 2019; 25:4383-4404. [PMID: 31496619 PMCID: PMC6710177 DOI: 10.3748/wjg.v25.i31.4383] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/07/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Systemic inflammation is a marker of poor prognosis preoperatively present in around 20%-40% of colorectal cancer patients. The hallmarks of systemic inflammation include an increased production of proinflammatory cytokines and acute phase proteins that enter the circulation. While the low-level systemic inflammation is often clinically silent, its consequences are many and may ultimately lead to chronic cancer-associated wasting, cachexia. In this review, we discuss the pathogenesis of cancer-related systemic inflammation, explore the role of systemic inflammation in promoting cancer growth, escaping antitumor defense, and shifting metabolic pathways, and how these changes are related to less favorable outcome.
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Affiliation(s)
- Anne E Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90220, Finland
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90220, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90220, Finland
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90220, Finland
| | - Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90220, Finland
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90220, Finland
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, United States
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The Association of Preoperative Anemia and the Postoperative Course and Oncological Outcome in Patients Undergoing Rectal Cancer Surgery: A Multicenter Snapshot Study. Dis Colon Rectum 2019; 62:823-831. [PMID: 31188183 DOI: 10.1097/dcr.0000000000001360] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is still controversy about the relationship between preoperative anemia and outcomes after rectal cancer surgery. OBJECTIVE The aim of this study was to analyze the association between preoperative anemia and postoperative complications and the survival of patients undergoing surgery for rectal cancer in the era of laparoscopic surgery and modern perioperative care. DESIGN This was a cohort study. SETTINGS Data were gathered from 71 hospitals in The Netherlands. PATIENTS Patients who underwent resection for rectal cancer in 2011, for whom preoperative hemoglobin level was registered, were included. INTERVENTIONS(S) There were no interventions. MAIN OUTCOME MEASURES Short-term outcome parameters were any postoperative complication or mortality within 30 days postoperatively, and pelvic infectious complications defined as anastomotic leakage and presacral abscess. Long-term outcomes were chronic sinus diagnosed at any time during 3-year follow-up, 3-year local and distant recurrence rates, and 3-year overall survival. RESULTS Of 2095 patients, 1857 had a registered preoperative hemoglobin level; 576 (31%) of these patients anemic and 1281 (69%) were nonanemic. Preoperative anemia was not independently associated with postoperative complications (HR, 1.1; 95% CI, 0.9-1.4; p = 0·24) or 30-day mortality (HR, 1.4, 95% CI, 0.7-2.8; p = 0·29). Preoperative anemia was associated with 3-year overall survival (HR, 2.1; 95% CI, 1.7-2.5; p < 0.0001), after multivariable analysis (HR, 1.4; 95% CI, 1.1-1.8; p = 0·008), and with local recurrence rate (HR, 1.6; 95% CI, 1.1-2.4; p = 0.026), but not with distant recurrence rate (HR, 1.2; 95% CI, 1.0-1.5; p = 0.054). LIMITATIONS Preoperative anemia appeared to have only limited association with postoperative and disease-specific outcome after rectal cancer surgery in contrast to published meta-analysis of small historical series. CONCLUSIONS Anemia is associated with overall survival. It might be considered as one of the warning signs in identifying high-risk patients. See Video Abstract at http://links.lww.com/DCR/A913.
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Väyrynen JP, Väyrynen SA, Sirniö P, Minkkinen I, Klintrup K, Karhu T, Mäkelä J, Herzig KH, Karttunen TJ, Tuomisto A, Mäkinen MJ. Platelet count, aspirin use, and characteristics of host inflammatory responses in colorectal cancer. J Transl Med 2019; 17:199. [PMID: 31196200 PMCID: PMC6567577 DOI: 10.1186/s12967-019-1950-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/05/2019] [Indexed: 02/08/2023] Open
Abstract
Background Platelets not only contribute to hemostasis but also to the regulation of inflammatory reactions and cancer pathogenesis. We hypothesized that blood platelet count would be associated with systemic inflammation, the densities of tumor infiltrating immune cells, and survival in colorectal cancer (CRC), and these relationships could be altered by aspirin use. Methods We measured blood platelet count in a cohort of 356 CRC patients and analyzed its relationships with tumor and patient characteristics including aspirin use, markers of systemic inflammation (modified Glasgow Prognostic Score, mGPS; serum levels of CRP, albumin, and 13 cytokines), blood hemoglobin levels, five types of tumor infiltrating immune cells (CD3, CD8, FoxP3, Neutrophil elastase, mast cell tryptase), and survival. Results Platelet count inversely correlated with blood hemoglobin levels (p < 0.001) and positively correlated with serum levels of CRP and multiple cytokines including IL-1RA, IL-4, IL-6, IL-7, IL-8, IL-12, IFNγ, and PDGF-BB (p < 0.001 for all), while aspirin use was not associated with the levels of systemic inflammatory markers. High platelet count was also associated with high mGPS (p < 0.001) but did not show statistically significant multivariable adjusted associations with the densities of tumor infiltrating immune cells. Higher platelet counts were observed in higher tumor stage (p < 0.001), but platelet count or aspirin use were not associated with patient survival. Conclusions High platelet count is associated with systemic inflammation in CRC. This study could not demonstrate statistically significant associations between platelet count, aspirin use, and the densities of tumor infiltrating immune cells. Electronic supplementary material The online version of this article (10.1186/s12967-019-1950-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland. .,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland. .,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Sara A Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Päivi Sirniö
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Ilkka Minkkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Kai Klintrup
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Surgery, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Toni Karhu
- Research Unit of Biomedicine and Biocenter of Oulu, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Jyrki Mäkelä
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Surgery, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine and Biocenter of Oulu, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572, Poznan, Poland
| | - Tuomo J Karttunen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Anne Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
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Kwon HY, Kim BR, Kim YW. Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. ACTA ACUST UNITED AC 2019; 26:e357-e366. [PMID: 31285680 DOI: 10.3747/co.26.4983] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background We investigated whether preoperative anemia and perioperative blood transfusion (pbt) are associated with overall survival and recurrence-free survival in patients with nonmetastatic colorectal cancer. Methods From 1 January 2009 to 31 December 2014, 1003 patients with primary colorectal cancer were enrolled in the study. Perioperative clinical and oncologic outcomes were analyzed based on the presence of preoperative anemia and pbt. Results Preoperative anemia was found in 468 patients (46.7%). In the anemia and no-anemia groups, pbt was performed in 44% and 15% of patients respectively. Independent predictors for pbt were preoperative anemia, higher American Society of Anesthesiologists score, laparotomy, lengthy operative time, advanced TNM stage, T4 stage, and 30-day morbidity. The use of pbt, but not preoperative anemia, was found to be an independent adverse prognostic factor for overall survival. In terms of recurrence-free survival, the presence of preoperative anemia was similarly not a significant prognostic factor, but the use of pbt was an independent factor for an unfavourable prognosis. Conclusions The use of pbt, but not preoperative anemia, was independently associated with worse overall and recurrence-free survival in nonmetastatic colorectal cancer. For better oncologic outcomes, our findings indicate a need to reduce the use of blood transfusion during the perioperative period.
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Affiliation(s)
- H Y Kwon
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| | - B R Kim
- Health Promotion Center, Wonju Severance Christian Hospital, Wonju, R.O.K.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| | - Y W Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, R.O.K.,Big Data Research Group, Yonsei University Wonju College of Medicine, Wonju, R.O.K
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