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Watanabe T, Ohno R, Kajitani R, Sahara K, Munechika T, Matsumoto Y, Aisu N, Kojima D, Yoshimatsu G, Hasegawa S. Comparison of changes in health-related quality of life between elderly and non-elderly patients undergoing elective surgery for colorectal cancer. Int J Colorectal Dis 2023; 38:149. [PMID: 37256438 DOI: 10.1007/s00384-023-04440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Elderly people are thought to be more likely than their non-elderly counterparts to experience a decline in activities of daily living (ADL) and quality of life (QOL) due to the onset and treatment of disease. In this study, we investigated whether there was an age-related difference in changes in health-related QOL indices after surgical resection of colorectal cancer (CRC). METHODS Patients who underwent elective surgery for primary CRC at our hospital between September 2017 and November 2021 were enrolled. Changes in QOL after surgery were evaluated after dividing the study population into a non-elderly (NE) group (younger than 75 years) and an elderly (E) group. A Short-Form 36-Item Health Survey was used as an index of QOL. The subscale and component summary scores before and 6 months after surgery were compared. RESULTS Forty-seven patients were included in the E group and 166 patients were the NE group. The E group had significantly worse preoperative performance and physical status than the NE group. However, indices of physical function were not worsened after surgery in either group. In the NE group, there were significant decreases in role physical and role component summary scores and significant increases in general health, mental health, and mental component summary scores. In the E group, there were no significant changes in the subscale or component summary scores after surgery. CONCLUSION Our study demonstrated elderly patient did not necessarily show a decline in QOL more than non-elderly patients after CRC surgery. Surgical resection for CRC should be considered even for elderly patients, while considering possible risk factors for worsening ADL and QOL.
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Affiliation(s)
- Toshifumi Watanabe
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan.
| | - Ryo Ohno
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Kurumi Sahara
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Taro Munechika
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Daibo Kojima
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, 7-45‑1 Nanakuma, Jonan‑ku, Fukuoka, 814-0180, Japan
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Wong JSM, Ng IAT, Juan WKD, Ong WS, Yang GM, Finkelstein EA, Gandhi M, Ong CAJ, Seo CJ, Zhu HY, Chia CS. Trajectories of Patient-Reported Outcomes After Palliative Gastrointestinal Surgery in Advanced Cancer: Is Good Quality of Life Sustainable? ANNALS OF SURGERY OPEN 2022; 3:e206. [PMID: 37600285 PMCID: PMC10406115 DOI: 10.1097/as9.0000000000000206] [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: 05/25/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022] Open
Abstract
To evaluate the trajectories and sustainability of health-related quality of life (HRQoL) outcomes after palliative gastrointestinal (GI) surgery and perioperative factors associated with HRQoL improvement postsurgery. Background Palliative patients face a wide range of physical, emotional, social, and functional challenges. In evaluating the efficacy of palliative surgical interventions, a major pitfall of traditional surgical outcome measures is that they fall short of measuring outcomes that are meaningful to patients during end-of-life. HRQoL tools may provide a more comprehensive assessment of the true value and impact of palliative surgery. Methods We prospectively recruit advanced cancer patients undergoing palliative GI surgery. The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was administered before and at regular intervals after surgery. HRQoL improvement was defined as ≥4-points increment in FACT-G total score over baseline. Duration of sustained HRQoL improvement above this threshold and factors associated with varying extents of HRQoL change were evaluated. Results Of the 65 patients, intestinal obstruction was the most common indication for surgery (70.8%). The mean baseline FACT-G total score was 70.7 (95% CI: 66.3-75.1). Forty-six (70.8%) patients experienced HRQoL improvement after surgery. This HRQoL improvement was sustained over a median duration of 3.5 months and was driven mainly by improvements in patients' physical and emotional well-being. Albumin was significantly associated with the extent of HRQoL improvements (P = 0.043). Conclusion A clinically significant and sustained improvement in HRQoL was observed after palliative GI surgery. Patients with higher preoperative albumin levels were more likely to experience HRQoL improvements.
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Affiliation(s)
- Jolene S. M. Wong
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Irene A. T. Ng
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Wen Kai D. Juan
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Grace M. Yang
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore
| | | | - Mihir Gandhi
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Chin-Ann J. Ong
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore
| | - Chin Jin Seo
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Hong-Yuan Zhu
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
| | - Claramae S. Chia
- From the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Treatment outcome of laparoscopic surgery after self-expandable metallic stent insertion for obstructive colorectal cancer. Int J Clin Oncol 2021; 26:2029-2036. [PMID: 34319530 DOI: 10.1007/s10147-021-01990-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND We assessed the technical and oncological safety of self-expandable metallic stent (SEMS) insertion followed by laparoscopic colorectal surgery as a bridge to surgery (BTS) for obstructive colorectal cancer (CRC). METHODS A retrospective, single-center study analyzed the short- and long-term outcomes of SEMS insertion followed by laparoscopic colorectal surgery in patients with stage II/III/IV obstructive CRC from 2012 to 2020 at Cancer Institute Hospital. RESULTS In 66 patients, including 28 stage IV patients, the clinical success rates of SEMS insertion were 97%. In laparoscopic surgery, primary anastomosis was performed in 61 patients (92%), and open conversion was required in 2 patients (3%). Postoperative complications were seen in 9 patients (13%); however, there was no anastomotic leakage or mortality. Curative resection was achieved in all 38 stage II/III patients and 15 of 28 (54%) stage IV patients. Stage IV patients had a longer operation time and greater blood loss than stage II/III patients; however, the open conversion and postoperative complication rates were similar between the groups. In stage II/III patients, 3-year disease-free survival and 3-year overall survival [OS] were 87.1 and 89.5%, respectively. The median OS of stage IV patients was 34.9 months, and stage IV patients who underwent R0 resection showed a significantly better OS (P = 0.0011) than those with R2 resection. CONCLUSION SEMS insertion followed by laparoscopic surgery is a feasible treatment strategy that achieves a high-primary anastomosis rate without severe postoperative complication in not only stage II/III but also stage IV obstructive CRC patients.
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Badic B, Oguer M, Cariou M, Kermarrec T, Bouzeloc S, Nousbaum JB, Robaszkiewicz M, Quénéhervé L. Ostomy prevalence and survival in elderly patients with stage III and IV rectal cancer. Geriatr Gerontol Int 2021; 21:670-675. [PMID: 34189871 DOI: 10.1111/ggi.14225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/02/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
AIM Oncological strategies in the elderly population are often debated. The objective of this study was to investigate the survival rates and prevalence of ostomy in elderly patients operated on for stage III and IV rectal cancers. METHODS This retrospective multicentric population-based study included 151 patients aged ≥75 years with stage III and IV rectal adenocarcinoma who underwent surgery between 2007 and 2014. Multivariable logistic regression was used to assess the impact of different prognostic factors. RESULTS The median age of the patients was 81 years (range: 75-97 years) with 40 patients >85 years of age. Age was significantly correlated with overall survival (OS) in both stage III and IV cancers (P < 0.001). For patients ≥80 years the presence of comorbid conditions was associated with a lower chance of survival (P = 0.02). A digestive stoma was created in 67 (76.1%) patients with stage III cancer and 26 (29.54%) had a stoma reversal. A palliative derivative stoma was performed in half of patients with stage IV cancer. Adjuvant chemotherapy was independently associated with improved 5-year OS (P < 0.001). CONCLUSIONS Age, comorbidities and adjuvant chemotherapy were independent predictors for OS. Resection of rectal tumors in fit elderly patients should be promoted; however, patients should be aware of the high risk of stoma. Geriatr Gerontol Int 2021; 21: 670-675.
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Affiliation(s)
- Bogdan Badic
- CHRU Brest, Service de Chirurgie Viscérale, Brest, France.,INSERM, UMR 1101, LaTIM, Brest, France
| | - Maude Oguer
- CHRU Brest, Service de Chirurgie Viscérale, Brest, France.,INSERM, UMR 1101, LaTIM, Brest, France
| | - Melanie Cariou
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Tiphaine Kermarrec
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Servane Bouzeloc
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France
| | - Jean-Baptiste Nousbaum
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,CHRU Brest, Service d'Hépato-gastro-entérologie, Brest, France
| | - Michel Robaszkiewicz
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,CHRU Brest, Service d'Hépato-gastro-entérologie, Brest, France
| | - Lucille Quénéhervé
- Registre des Cancers Digestifs du Finistère, Brest, France.,EA7479 SPURBO, Université de Bretagne Occidentale, Brest, France.,CHRU Brest, Service d'Hépato-gastro-entérologie, Brest, France
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5
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Henbrey R. Stoma formation as a palliative procedure: the role of the clinical nurse specialist in maintaining quality of life. ACTA ACUST UNITED AC 2021; 30:S4-S10. [PMID: 33769878 DOI: 10.12968/bjon.2021.30.6.s4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
More than half of patients diagnosed with colon cancer present at an advanced stage, and palliative treatment may involve stoma formation. A literature review was undertaken to determine the potential effects of stoma formation as a palliative procedure on a patient's quality of life, and to examine the role of the clinical nurse specialist in this situation. Limited literature was found on this specific subject, so established evidence surrounding stoma formation and quality of life was examined in relation to palliative care. The clinical nurse specialist provides expert knowledge that can help to limit stoma complications and is also able to conduct assessments that identify holistic concerns affecting quality of life. However, access to a clinical nurse specialist may be limited, particularly when surgery is performed as an emergency. There is the potential for research surrounding patient experiences that may improve service provision for this client group.
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Affiliation(s)
- Rachel Henbrey
- Colorectal Clinical Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust
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6
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Chok AY, Lim HJ, Lye WK, Samarakoon LB, Guo J, Tang CL, Mathew R. Stenting as a bridge to surgery for obstructed stage IV colorectal cancers - long-term outcomes of a 10-year study. Asian J Endosc Surg 2020; 13:343-350. [PMID: 31436381 DOI: 10.1111/ases.12747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/22/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Successful stenting of an obstructing colorectal tumor can avert upfront emergency surgery in malnourished obstructed patients with metastatic disease and poor physiological condition. This study aims to evaluate the outcomes of stenting followed by primary colorectal tumor resection among patients with obstructed stage IV colorectal cancer at presentation, over a 10-year period. METHODS From 2007 to 2016, a cohort comprising 25 consecutive patients were retrospectively reviewed from a prospectively collected database. The durability of palliation of bowel obstruction, oncological outcomes and factors influencing overall survival were analyzed. RESULTS No re-interventions were required for bowel obstruction during the study period. The overall perioperative morbidity rate was 16%, with no postoperative 90-day mortality. Laparoscopic resection rate was 52% and stoma formation rate was 8%. The median overall survival was 24 months for the entire cohort, and the 1-, 3- and 5-year survival rates were 80%, 35% and 23.33% respectively. More than one site of distant metastases, peritoneal involvement, and elevated carcinoembryonic antigen levels were significantly associated with poorer survival outcomes. Patients with peritoneal-only metastasis had worse outcomes, with a median survival of 7 months and no patients surviving beyond 18 months. CONCLUSION Stenting followed by resection of the primary obstructing colorectal cancer provides durable palliation among patients with stage IV disease, with low perioperative morbidity and stoma formation rates. Superior survival was observed among patients with single-site, non-peritoneal distant metastases.
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Affiliation(s)
- Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hui Jun Lim
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Weng Kit Lye
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Lasitha B Samarakoon
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jiwei Guo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Choong Leong Tang
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ronnie Mathew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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7
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Harji DP, Vallance A, Selgimann J, Bach S, Mohamed F, Brown J, Fearnhead N. A systematic analysis highlighting deficiencies in reported outcomes for patients with stage IV colorectal cancer undergoing palliative resection of the primary tumour. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1469-1478. [PMID: 30007475 DOI: 10.1016/j.ejso.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/24/2018] [Accepted: 06/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of the primary tumour in the presence of unresectable metastatic colorectal cancer (mCRC) is controversial. The role of primary tumour resection (PTR) has been investigated by a number of retrospective cohort studies, with a number on going randomised controlled trials. The aim of this study was to identify the clinical and patient-reported outcomes currently reported in studies that evaluate the role of PTR in mCRC. METHODS Literature searches were performed in MEDLINE (via OvidSP) (1966-June 2017), EMBASE (via OvidSP) and the Cochrane Library using terms related to colorectal cancer and primary tumour resection. All studies documenting outcomes following palliative PTR were included. Eligible articles were assessed using the Risk of Bias In Non-Randomised Studies of Intervention (ROBINS-I) tool. RESULTS Of 11,209 studies screened, 59 non-randomised studies reporting outcomes on 331,157 patients were included. Patient characteristics regarding performance status and co-morbidity were recorded in 26 (44.1%) and 17 (28.8%) studies. The chemotherapy regime used was reported in 27 (45.8%) studies. The operative setting and the operative approach was reported in 42 (71%) and 14 (23.7%) studies. Post-operative mortality and morbidity were reported in 33 (55.9%) and 35 (59.3%) studies. Overall survival was reported in 49 (83.1%) studies, with 5 different definitions identified. Quality of life was only reported in 1 (1.7%) study. CONCLUSION This study demonstrates significant heterogeneity in the selection and definition of outcomes reported following PTR in mCRC. There is significant heterogeneity with a significant under-reporting of important outcomes such as treatment related adverse events and patient reported outcomes.
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Affiliation(s)
- Deena P Harji
- Newcastle Centre of Bowel Disease, Royal Victoria Infirmary, Newcastle upon Tyne, UK; Clinical Trials Research Unit, University of Leeds, UK.
| | - Abigail Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Jenny Selgimann
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Simon Bach
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Faheez Mohamed
- Peritoneal Malignancy Institute, North Hampshire Hospital, Hampshire Hospital Foundation Trust, Basingstoke, UK
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, UK
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Addenbrooke's Hospital, Cambridge, UK
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8
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Lau JW, Chang HS, Lee KY, Gwee YX, Lee WQ, Chong CS. Survival outcomes following primary tumor resection for patients with incurable metastatic colorectal carcinoma: Experience from a single institution. J Dig Dis 2018; 19:550-560. [PMID: 30117288 DOI: 10.1111/1751-2980.12657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Palliative primary tumor resection (PTR) has been used for preventing and treating tumor-related complications. We aimed to determine whether PTR can increase overall survival (OS) in patients with unresectable metastatic colorectal cancer (CRC). METHODS A retrospective review of a prospectively collected database in a single center was performed. Patients diagnosed with metastatic CRC from January 2004 to December 2014 were included. Patients who had attained curative resection or had disease recurrence were excluded. All patients were discussed at a multidisciplinary tumor board where subsequent treatment decisions were made. RESULTS Altogether 408 patients were analyzed. Of these 145 received PTR with palliative chemotherapy (PC; group A), 110 received PC only (group B), 52 received PTR only (group C), while 101 received neither PTR nor PC (group D). Undergoing PTR led to statistically significant improvement in OS (22.7 months vs 12.1 months vs 6.9 months vs 2.7 months, P < 0.001). We performed subgroup analyses to control for potential confounders and found that the influence of PTR on OS persisted. With multivariate analysis, the predictors of poor OS were no PTR (hazards ratio [HR] 2.32, 95% confidence interval [CI] 1.82-2.96, P < 0.001), no PC (HR 4.25, 95% CI 3.27-5.33, P < 0.001) and the presence of peritoneal metastases (HR 1.37, 95% CI 1.06-1.78, P = 0.018). Diversion surgery did not lead to a statistical difference in OS. CONCLUSIONS The absences of PTR and PC, and peritoneal metastases are independently associated with decreased OS in patients with unresectable metastatic CRC. Randomized controlled trials are needed to verify this observation.
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Affiliation(s)
- Joel Wl Lau
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Heidi Sy Chang
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Kai Y Lee
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Yong X Gwee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Q Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choon S Chong
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
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9
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Zhao H, Liu B, Li J. LIM and SH3 protein 1 knockdown suppresses proliferation and metastasis of colorectal carcinoma cells via inhibition of the mitogen-activated protein kinase signaling pathway. Oncol Lett 2018; 15:6839-6844. [PMID: 29731863 PMCID: PMC5920965 DOI: 10.3892/ol.2018.8222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/13/2017] [Indexed: 12/15/2022] Open
Abstract
LIM and SH3 protein 1 (Lasp-1), a focal adhesion protein, serves a critical role in the regulation of cell proliferation and migration. The role of Lasp-1, as well as the intracellular signaling pathways involved in metastasis and progression of colorectal carcinoma, remains unclear. In the present study, the regulatory effect of Lasp-1 and the underlying molecular mechanism involved in migration and invasion of colorectal carcinoma were investigated. RNA interference and overexpression in SW480 cells were performed to elucidate the role of Lasp-1. Reverse transcription-quantitative polymerase chain reaction, western blotting and immunofluorescence were conducted to determine the mRNA and protein levels of Lasp-1 and extracellular-signal-regulated kinase 1/2 (ERK1/2) in SW480 cells as well as tumor and adjacent normal tissues obtained from 20 patients with colorectal carcinoma. Furthermore, a cell proliferation assay, flow cytometric analysis, and cell migration and invasion assays were performed to examine the effect of Lasp-1 on cell growth. The results of the present study demonstrated that Lasp-1 and ERK1/2 were upregulated in tumor tissue compared with adjacent normal colorectal mucosa. Cell-based in vitro assays demonstrated that Lasp-1 knockdown suppressed the expression and activation of ERK1/2, whereas Lasp-1 overexpression resulted in ERK1/2 upregulation. Additionally, Lasp-1 knockdown inhibited cell proliferation, migration, and invasion and induced cellular apoptosis and G0/G1 cell-cycle arrest. The results of the present study indicate that Lasp-1 serves a critical role in the progression of colorectal carcinoma regulating the activation of the mitogen-activated protein kinase signaling pathway.
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Affiliation(s)
- Hongpeng Zhao
- Department of Gastrointestinal Surgery, Shandong Qianfoshan Hospital, Jinan, Shandong 250014, P.R. China
| | - Bo Liu
- Department of Gastrointestinal Surgery, Shandong Qianfoshan Hospital, Jinan, Shandong 250014, P.R. China
| | - Jie Li
- Department of Hepatobiliary Surgery, Shandong Qianfoshan Hospital, Jinan, Shandong 250014, P.R. China
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10
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Law JH, Koh FHX, Wang S, Tan KK. Curative treatment for metastatic colorectal cancer in the young population: is it worth it? J Gastrointest Oncol 2018; 10:61-67. [PMID: 30788160 DOI: 10.21037/jgo.2018.09.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background A significant proportion of patients with colorectal cancer (CRC) presents with metastatic disease. In younger patients, a more aggressive approach is often adopted in an attempt to achieve cure and improve survival. The aim of this paper is to review the management and outcomes of young patients with metastatic CRC. Methods All patients under 50 years diagnosed with CRC in a single institution from January 2007 to December 2015 were reviewed. Patient demographics, details of their treatments, progress and outcomes of treatment were collected for our review. Results There were 154 newly diagnosed CRC patients who were <50 years old during the study period. Thirty-three patients (21.4%) had stage IV disease on presentation. Seventeen (51.5%) of these 33 patients were treated with curative intent; 9 (52.9%) of whom underwent upfront surgical resection alone while the remaining 8 (47.1%) patients had neoadjuvant therapy followed by surgical resection. Among the 16 patients who were treated with palliative intent, 9 (56.3%) had surgery while 7 (43.7%) had definitive chemo- or radio-therapy. There was no significant difference in the median survival of patients treated with curative and palliative intent (29 vs. 24 months, P=0.140). Conclusions Young CRC patients with stage IV disease typically survive for 2 years upon diagnosis. Those who were treated and underwent surgery with curative intent have a slightly longer but not statistically significant median survival than those treated with palliative intent. The role of aggressive treatment in these young patients with metastatic patients merits further evaluation.
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Affiliation(s)
- Jia Hao Law
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Frederick Hong Xiang Koh
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Shi Wang
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ker Kan Tan
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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A Novel Derivation Predicting Survival After Primary Tumor Resection in Stage IV Colorectal Cancer: Validation of a Prognostic Scoring Model and an Online Calculator to Provide Individualized Survival Estimation. Dis Colon Rectum 2017; 60:895-904. [PMID: 28796727 DOI: 10.1097/dcr.0000000000000821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A prognostic scoring model has been devised previously to predict survival following primary tumor resection in patients with metastatic colorectal cancer and unresectable metastases. This has yet to be validated. OBJECTIVE The main objectives of this study are to validate the proposed prognostic scoring model and create an interactive online calculator to estimate an individual's survival after primary tumor resection. DESIGN Clinical data and survival outcomes of patients were extracted from a prospectively maintained database. Patients were categorized into good, moderate, or poor survivor groups based on the previously proposed scoring algorithm. Discrimination was assessed and recalibration was performed, with the recalibrated model implemented as an interactive Web application to provide individualized survival probability. SETTINGS This study was conducted at a tertiary referral center. PATIENTS The study included 324 consecutive patients with metastatic colorectal carcinoma and unresectable metastases who underwent primary tumor resection between January 2008 and December 2013. MAIN OUTCOME MEASURES The primary outcome measured was overall survival. RESULTS Three hundred twenty-four patients were included in the study. Median survival in the good, moderate, and poor prognostic groups was 56.8, 25.7, and 19.9 months (log rank test, p = 0.003). The κ statistic was 0.638 and RD was 0.101. Significant differences in survival were found between the moderate and good prognostic groups (HR, 2.79; 95% CI, 1.51-5.15; p = 0.001) and between poor and good prognostic groups (HR, 4.12; 95% CI, 1.98-8.55; p < 0.001). The model was implemented as an interactive online calculator to provide individualized survival estimation after primary tumor resection (http://bit.ly/Stage4PrognosticScore). LIMITATIONS Selection bias and single-center data preclude the generalizability of the proposed model. Information regarding the severity or likelihood of developing symptoms from the primary tumor were also not accounted for in the prognostic scoring model proposed. CONCLUSIONS The prognostic scoring model provides good prognostic stratification of survival after primary tumor resection and may be a useful tool to predict survival after primary tumor resection. See Video Abstract at http://links.lww.com/DCR/A330.
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Laitinen I, Sand J, Peromaa P, Nordback I, Laukkarinen J. Quality of life in patients with pancreatic ductal adenocarcinoma undergoing pancreaticoduodenectomy. Pancreatology 2017; 17:445-450. [PMID: 28274687 DOI: 10.1016/j.pan.2017.02.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Survival for pancreatic ductal adenocarcinoma (PDAC) is relatively short even after complete resection. Pancreaticoduodenectomy (PD) carries a high risk for postoperative morbidity, and the effect on quality of life (QoL) is unclear. We aimed to study QoL in PDAC patients undergoing PD. PATIENTS AND METHODS Sixty patients with suspected PDAC and planned PD were asked to complete EORTC QoL questionnaires QLQ-C30 and QLQ-PAN26 preoperatively and at 3-6-12-18-24 months postoperatively. RESULTS 47 PDAC patients who underwent PD (66 (21-84) years, 53% men) were included. Follow-up was completed by 81% (6 months) and 45% (24 months) post-PD. Compared to preoperative level, QoL tended to improve or remained the same in 63% during the follow-up. At three months after PD patients had less hepatic symptoms (decreased by 100%; p < 0.001), pancreatic pain and sexuality symptoms tended to decrease by 33% and global and functional QoL tended to slightly improve. These parameters remained at the achieved level during the longer follow-up. A temporary rising tendency was seen in digestive symptoms at three months but this later reverted to the preoperative level. More altered bowel movements and sexuality symptoms tended to arise during the longer follow-up. A negative correlation was found between reported financial difficulties and length of survival. CONCLUSIONS PD does not worsen the QoL in most of the patients with PDAC. The potentially beneficial effect on QoL is apparent already at three months after surgery. This information may be helpful for the clinician and patient, when deciding on the treatment for PDAC.
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Affiliation(s)
- Ismo Laitinen
- Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Juhani Sand
- Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Pipsa Peromaa
- Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Isto Nordback
- Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Johanna Laukkarinen
- Dept of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
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Søreide K. Resection of asymptomatic primary tumour in unresectable stage IV colorectal cancer: time to move on from propensity matched scores to randomized controlled trials. Int J Cancer 2016; 139:1927-9. [PMID: 27400774 PMCID: PMC5095777 DOI: 10.1002/ijc.30244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Gastrointestinal Translational Research Unit, Laboratory for Molecular Biology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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