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Bancewicz J, Calman KC, Macpherson SG, McArdle CS, McVie JG, Soukop M. Adjuvant Chemotherapy and Immunotherapy for Colorectal Cancer: Preliminary Communication. J R Soc Med 2018; 73:197-9. [PMID: 7014886 PMCID: PMC1437544 DOI: 10.1177/014107688007300308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Following surgical resection of Dukes’ B or C colorectal cancers 72 patients have been randomly allocated to receive: 5-fluorouracil; or 5-fluorouracil and levamisole; or no treatment. Adjuvant treatment was continued for one year. 66 patients remain evaluable for up to 24 months. Preliminary results show no significant differences in survival or recurrence rates. Two patients receiving 5-fluorouracil and levamisole developed severe, but reversible, neutropenia. Other side effects were uncommon.
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2
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Harten J, Hay A, McMillan DC, McArdle CS, O'Reilly DSJ, Kinsella J. Postoperative serum urea is associated with 30-day mortality in patients undergoing emergency abdominal surgery. Ann Clin Biochem 2016; 43:295-9. [PMID: 16824280 DOI: 10.1258/000456306777695717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Emergency abdominal surgery carries considerable postoperative morbidity and mortality. Hypovolaemia is considered to be a cause of renal hypoperfusion, which is associated with a decreased clearance of serum urea and creatinine. This study examines whether the perioperative serum urea and creatinine concentrations are predictors of mortality in patients undergoing emergency abdominal surgery. Methods: Consecutive patients ( n=300) who underwent emergency abdominal surgery were studied. Age- and sex-specific reference intervals were used for the data analysis. Patients with incomplete biochemical ( n=51) or mortality data ( n=31) or with pre-existing renal failure ( n=9) were excluded from the analysis. Results: 209 patients were analysed, of whom 162 (78%) remained alive and 47 (22%) died following surgery. The non-survivors were older ( P<0.05), had undergone more extensive surgery ( P<0.001) and were more likely to have been admitted to the intensive care unit ( P<0.001). The serum urea concentration was higher preoperatively ( P<0.05) and on day one postoperatively ( P<0.001) in the non-survivors. On multivariate logistic regression analysis, age (odds ratio [OR] 3.27, 95% confidence interval [CI] 1.43-7.47, P<0.005), severity of surgery (OR 2.21, 95% CI 1.14-4.29, P<0.019), admission to intensive care (OR 0.54, 95% CI 0.11-0.54, P<0.001), seniority of anaesthetist (OR 0.50, 95% CI 0.27-0.90, P<0.022) and day one urea (OR 3.33, 95% CI 1.39-7.99, P<0.007) were independently associated with 30-day mortality. Conclusions: These results indicate that an increased serum urea concentration, but not serum creatinine concentration, in the postoperative period is associated with an increase in 30-day mortality in patients undergoing emergency abdominal surgery.
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Affiliation(s)
- J Harten
- Department of Anaesthesia, Gartnavel General Hospital, 30 Shelley Court, Glasgow G12 OYN, UK.
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Anderson JH, Geraghty JG, Wilson YT, Murray GD, McArdle CS, Anderson JR. Paroven and Graduated Compression Hosiery for Superficial Venous Insufficiency. Phlebology 2016. [DOI: 10.1177/026835559000500408] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effects of Sigvaris graduated compression hosiery and Paroven on symptoms of superficial venous insufficiency were assessed in a prospective, randomized, crossover study. Seventy-two patients awaiting surgery for non-cosmetic symptoms associated with varicose veins received 4-week treatments in random order, namely; placebo, Paroven alone, Sigvaris graduated compression hosiery and placebo, Sigvaris graduated compression hosiery and Paroven. Symptoms were assessed before and after each treatment using linear analogue scales. No statistically significant effects were observed, but there was a consistent trend for both Paroven alone and hosiery alone to produce modest improvements in symptoms. The relief of symptoms associated with a combination of Paroven and Sigvaris graduated compression hosiery was greater than that produced by either treatment on its own.
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Affiliation(s)
- J. H. Anderson
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31, UK
| | - J. G. Geraghty
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31, UK
| | - Y. T. Wilson
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31, UK
| | - G. D. Murray
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31, UK
| | - C. S. McArdle
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31, UK
| | - J. R. Anderson
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31, UK
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Eley JG, Whateley TL, Kerr DJ, McArdle CS, Goldberg JA, Anderson J, Kato T. Microencapsulation of Mitomycin-C with Ethylcellulose. Dissolution Studies and Pharmacokinetics in Patients with Liver Metastases. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1990.tb14420.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J G Eley
- Department of Pharmacy, University of Strathclyde, Glasgow G1 1XW
| | - T L Whateley
- Department of Pharmacy, University of Strathclyde, Glasgow G1 1XW
| | - D J Kerr
- University Department of Surgery, Royal Infirmary, Glasgow
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow
| | - J A Goldberg
- University Department of Surgery, Royal Infirmary, Glasgow
| | - J Anderson
- University Department of Surgery, Royal Infirmary, Glasgow
| | - T Kato
- University School of Medicine, Akita, Japan
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McMillan DC, McArdle CS. The impact of young age on cancer-specific and non-cancer-related survival after surgery for colorectal cancer: 10-year follow-up. Br J Cancer 2009; 101:557-60. [PMID: 19672260 PMCID: PMC2736824 DOI: 10.1038/sj.bjc.6605222] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: It has been reported that although young patients present with more advanced disease, when adjusted for stage, cancer-specific survival is not different after surgery for colorectal cancer. However, few studies have examined non-cancer survival in young patients and 10-year survival has rarely been reported. Moreover, the largest study included patients of old age as a comparator. The aim of this study was to compare cancer-specific and non-cancer-related survival at 10 years in a young age cohort and a middle age cohort in patients undergoing surgery for colorectal cancer. Methods: Two thousand and seventy seven patients who underwent surgery for colorectal cancer between 1991 and 1994 in 11 hospitals in Scotland were included in the study. Ten-year cancer-specific and non-cancer-related survival and the hazard ratios (HR) were calculated according to age groups (<45/45–54/55–64/65–74 years). Results: On follow-up, 1066 patients died of their cancer and 369 died of non-cancer-related causes. At 10 years, overall survival was 32%, cancer-specific was 45%, and non-cancer-related survival was 72%. On multivariate analysis of all factors, sex (HR 0.77, 95% CI 0.68–0.88, P<0.001), mode of presentation (HR 1.64, 95% CI 1.44–1.87, P<0.01), Dukes’ stage (HR 2.69, 95% CI 2.49–2.90, P<0.001), and specialisation (HR 1.24, 95% CI 1.04–1.44, P<0.01) were independently associated with cancer-specific survival. On multivariate analysis of all factors, age (HR 2.46, 2.04–2.97, P<0.001), sex (HR 0.56, 0.45–0.70, P<0.001), and deprivation (HR 1.16, 1.10–1.24, P<0.001) were independently associated with non-cancer-related survival. Conclusion: The results of this study confirm that young age does not have a negative impact on cancer-specific survival. Moreover, they show that, with 10-year follow-up, young age does not have a negative impact on non-cancer-related survival.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK.
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McMillan DC, Hole DJ, McArdle CS. The impact of old age on cancer-specific and non-cancer-related survival following elective potentially curative surgery for Dukes A/B colorectal cancer. Br J Cancer 2008; 99:1046-9. [PMID: 18797465 PMCID: PMC2567073 DOI: 10.1038/sj.bjc.6604669] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Previous studies have suggested that survival following surgery for colorectal cancer is poorer in the elderly. However, the findings were inconsistent and none of the studies adjusted for case mix. The aim of this study was to establish whether there were age-related differences in cancer (colorectal)-specific and non-cancer (colorectal)-related survival in patients undergoing elective potentially curative resection for Dukes stage A/B colorectal cancer. One thousand and forty three patients who underwent elective potentially curative resection for Dukes’ A/B colorectal cancer between 1991 and 1994 in 11 hospitals in Scotland were included in the study. Ten year cancer-specific and non-cancer-related survival and the hazard ratios were calculated according to age groups (<64; 65–74/>74 years). On follow-up 273 patients died of their cancer and 328 died of non-cancer-related causes. At 10 years, overall survival was 45%, cancer specific was 70% and non-cancer-related survival was 64%. On multivariate analysis of all factors, age (HR 1.38, 95% CI 1.18–1.62, P<0.001), sex (HR 1.74, 95% CI 1.36–2.23, P<0.001), site (HR 1.42, 95% CI 1.11–1.81, P<0.01) and Dukes’ stage (HR 1.71, 1.19–2.47, P<0.01) were independently associated with cancer-specific survival. On multivariate analysis of all factors, age (HR 2.14, 1.84–2.49, P<0.001), sex (HR 1.43, 1.15–1.79, P<0.01) and deprivation (HR 1.30, 1.09–1.55, P<0.01) were independently associated with non-cancer-related survival. The results of this study show that increasing age impacts negatively both on cancer-specific and non-cancer-related survival following elective potentially curative resection for node-negative colorectal cancer. However, the effect of increasing age is greater on the non-cancer-related survival. These results suggest that cancer-specific and non-cancer-related mortality should be considered separately in survival analysis of these cancer patients.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
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Canna K, Hilmy M, McMillan DC, Smith GW, McKee RF, McArdle CS, McNicol AM. The relationship between tumour proliferative activity, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Colorectal Dis 2008; 10:663-7. [PMID: 18005189 DOI: 10.1111/j.1463-1318.2007.01416.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of the present study was to examine the relationship between Ki-67, C-reactive protein and cancer-specific survival in patients undergoing resection for colorectal cancer. METHOD One hundred and forty-seven patients undergoing potentially curative resection for colorectal cancer had preoperative C-reactive protein concentrations and tumour Ki-67 labelling index measured. RESULTS On univariate analysis, age (P < 0.001), Dukes stage (P < 0.001), C-reactive protein (P < 0.001) and expression of Ki-67 (< 0.01) were associated with poorer cancer-specific survival. Ki-67 labelling index and C-reactive protein were correlated (r(s) = 0.172, P = 0.037). On multivariate analysis, age (HR 1.96, 95% CI 1.26-3.04, P = 0.003), Dukes stage (HR 4.38, 95% CI 2.11-9.09, P < 0.001) and C-reactive protein (HR 4.09, 95% CI 2.04-8.24, P < 0.001) retained significance. CONCLUSION Increased tumour proliferation is associated with a systemic inflammatory response and poor cancer-specific survival in patients undergoing potentially curative surgery for colorectal cancer.
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Affiliation(s)
- K Canna
- University Department of Surgery, Royal Infirmary, Glasgow, UK
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Harten J, Crozier JEM, McCreath B, Hay A, McMillan DC, McArdle CS, Kinsella J. Effect of intraoperative fluid optimisation on renal function in patients undergoing emergency abdominal surgery: a randomised controlled pilot study (ISRCTN 11799696). Int J Surg 2008; 6:197-204. [PMID: 18424200 DOI: 10.1016/j.ijsu.2008.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 03/04/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Emergency abdominal surgery carries a high risk of postoperative morbidity and mortality. Goal directed therapy has been advocated to improve outcome in high-risk surgery. The aim of the present pilot study was to examine the effect of goal directed therapy using fluid alone on postoperative renal function and organ failure score in patients undergoing emergency abdominal surgery. METHODS This prospective randomised pilot study included patients over the age of 50 undergoing emergency abdominal surgery. In the intervention group pulse pressure variation measurements were used to guide fluid boluses of 6% Hydroxyethylstarch 130/0.4. The control group received standard care. Serum urea, creatinine and cystatin C levels were measured prior to and at the end of surgery and postoperatively on day 1, day 3 and day 5. RESULTS Thirty patients were recruited. One patient died prior to surgery and was excluded from the analysis. The intervention group received a median of 750 ml of hydroxyethylstarch. The peak values of postoperative urea were 6.9 (2.7-31.8) vs. 6.4 (3.5-11.5)mmol/l (p=0.425), creatinine 100 (60-300) vs. 85 (65-150) micromol/l (p=0.085) and cystatin C 1.09 (0.66-4.94) vs. 1.01 (0.33-2.29)mg/dl (p=0.352) in the control and intervention group, respectively. CONCLUSIONS In the present pilot study replacing the identified fluid deficit was not associated with a change in renal function. These results do not preclude that goal directed therapy using fluid alone may have an effect on renal function but they would suggest that the effect size of fluid optimisation alone on renal function is small.
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Affiliation(s)
- J Harten
- Department of Anaesthesia, Gartnavel General Hospital, Glasgow G12 0YN, UK.
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9
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Crozier JEM, McKee RF, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, McMillan DC. Preoperative but not postoperative systemic inflammatory response correlates with survival in colorectal cancer. Br J Surg 2007; 94:1028-32. [PMID: 17437250 DOI: 10.1002/bjs.5706] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the relationship between the preoperative and postoperative systemic inflammatory response and survival in patients undergoing potentially curative resection for colorectal cancer. METHODS One hundred and eighty patients with colorectal cancer were studied. Circulating concentrations of C-reactive protein (CRP) were measured before surgery and in the immediate postoperative period. RESULTS The peak in CRP concentration occurred on day 2 (P < 0.001). During the course of the study 59 patients died, 30 from cancer and 29 from intercurrent disease. Day 2 CRP concentrations were dichotomized. In univariable analysis, advanced tumour node metastasis stage (P = 0.002), a raised preoperative CRP level (P < 0.001) and the presence of hypoalbuminaemia (P = 0.043) were associated with poorer cancer-specific survival. CONCLUSION Preoperative but not postoperative CRP concentrations are associated with poor tumour-specific survival in patients undergoing potentially curative resection for colorectal cancer.
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Affiliation(s)
- J E M Crozier
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
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Al Murri AM, Wilson C, Lannigan A, Doughty JC, Angerson WJ, McArdle CS, McMillan DC. Evaluation of the relationship between the systemic inflammatory response and cancer-specific survival in patients with primary operable breast cancer. Br J Cancer 2007; 96:891-5. [PMID: 17375036 PMCID: PMC2360103 DOI: 10.1038/sj.bjc.6603682] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The relationship between the systemic inflammatory response (as evidenced by elevated C-reactive protein and lowered albumin concentrations), clinico-pathologic status and relapse-free, cancer-specific and overall survival was examined in patients with invasive primary operable breast cancer (n=300). The median follow-up of the survivors was 46 months. During this period, 37 patients relapsed and 25 died of their cancer. On multivariate analysis, only tumour size (P<0.05), albumin (P<0.01) and systemic treatment (P<0.0001) were significant independent predictors of relapse-free, cancer-specific and overall survival. Lower serum albumin concentrations (<or=43 g l(-1)) were associated with deprivation (P<0.05), hormonal receptor negative tumours (P<0.01) and significantly poorer 3-year relapse-free (85 vs 93%, P=0.001) cancer-specific (87 vs 97%, P<0.0001) and overall survival (84 vs 94%, P=0.001) rates. The results of the present study suggest that lower preoperative albumin concentrations, but not elevated C-reactive protein concentrations, predict relapse-free, cancer-specific and overall survival, independent of clinico-pathologic status and treatment in patients undergoing potentially curative surgery for primary operable breast cancer.
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Affiliation(s)
- A M Al Murri
- Royal Infirmary, University Department of Surgery, Glasgow, UK
| | - C Wilson
- Western Infirmary, University Department of Surgery, Glasgow, UK
| | - A Lannigan
- Department of Surgery, Wishaw General Hospital, Lanarkshire, UK
| | - J C Doughty
- Western Infirmary, University Department of Surgery, Glasgow, UK
| | - W J Angerson
- Royal Infirmary, University Department of Surgery, Glasgow, UK
| | - C S McArdle
- Royal Infirmary, University Department of Surgery, Glasgow, UK
| | - D C McMillan
- Royal Infirmary, University Department of Surgery, Glasgow, UK
- E-mail:
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Crozier JEM, McKee RF, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, McMillan DC. The presence of a systemic inflammatory response predicts poorer survival in patients receiving adjuvant 5-FU chemotherapy following potentially curative resection for colorectal cancer. Br J Cancer 2006; 94:1833-6. [PMID: 16721360 PMCID: PMC2361334 DOI: 10.1038/sj.bjc.6603185] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
There is increasing evidence that the presence of a systemic inflammatory response plays an important role in survival following curative resection for colorectal cancer. The present study evaluated the relationship between C-reactive protein concentrations and survival in a cohort of patients receiving adjuvant 5-fluorouracil (5-FU) chemotherapy following potentially curative resection for colorectal cancer. In all, 222 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 50 patients received adjuvant 5-FU-based chemotherapy. Circulating concentrations of C-reactive protein were measured prior to surgery. The minimum follow-up was 15 months; the median follow-up of the survivors was 38 months. During this period 61 patients died, 32 patients of their cancer and 29 of intercurrent disease. In those patients who did not receive adjuvant chemotherapy, age (P < 0.001), Dukes stage (P < 0.05) and an elevated C-reactive protein (P < 0.01) were significantly associated with survival. In those patients who did receive adjuvant chemotherapy, an elevated C-reactive protein concentration (P < 0.01) was significantly associated with survival. The presence of a systemic inflammatory response is an independent predictor of poor outcome in patients receiving adjuvant 5-FU-based chemotherapy following potentially curative resection for colorectal cancer.
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Affiliation(s)
- J E M Crozier
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- E-mail:
| | - R F McKee
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - W J Angerson
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - J H Anderson
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - P G Horgan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
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McArdle CS, McMillan DC, Hole DJ. The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 2006; 93:483-8. [PMID: 16555262 DOI: 10.1002/bjs.5269] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have drawn attention to the high postoperative mortality and poor survival of patients who present as an emergency with colon cancer. However, these patients are a heterogeneous group. The aim of the present study was to establish, having adjusted for case mix, the size of the differences in postoperative mortality and 5-year survival between patients presenting as an emergency with evidence of blood loss, obstruction and perforation. METHODS The study included 2068 patients who presented with colon cancer between 1991 and 1994 in Scotland. Five-year survival rates and the adjusted hazard ratios were calculated. RESULTS Thirty-day postoperative mortality following potentially curative resection was consistently higher in patients who presented with evidence of blood loss, obstruction or perforation (all P < 0.005) than in elective patients. Following potentially curative surgery, cancer-specific survival at 5 years was 74.6 per cent compared with 60.9, 51.6 and 46.5 per cent in those who presented with blood loss, obstruction and perforation respectively (all P < 0.001). The corresponding adjusted hazard ratios (95 per cent confidence interval) for cancer-specific survival, relative to elective patients, were 1.62 (1.22 to 2.15), 2.22 (1.78 to 2.75) and 2.93 (1.82 to 4.70) for patients presenting with evidence of blood loss, obstruction or perforation (all P < 0.001). CONCLUSION Compared with patients who undergo elective surgery for colon cancer, those who present as an emergency with evidence of blood loss, obstruction or perforation have higher postoperative mortality rates and poorer cancer-specific survival.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow, UK
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13
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Forrest LM, McMillan DC, McArdle CS, Dunlop DJ. An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer 2005; 93:977-8. [PMID: 16234818 PMCID: PMC2361678 DOI: 10.1038/sj.bjc.6602825] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Treatment and survival of patients with inoperable Non-small-cell lung cancer in 1997 (n=117) and 2001 (n=126), before and after the introduction of a multidisciplinary team, was examined in a single centre. There were no differences in age, sex and extent of deprivation between the two years. However, in 2001, 23% of patients received chemotherapy treatment compared with 7% in 1997 (P<0.001). Median survival in 2001 was 6.6 months compared with 3.2 months in 1997 (P<0.001).
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Affiliation(s)
- L M Forrest
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D J Dunlop
- Department of Medical Oncology, Royal Infirmary, Glasgow G31 2ER, UK
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McArdle CS. A colour atlas of gastric revision operations: Single surgical procedures 33. J. Alexander-Williams. 260 × 195 mm. Pp. 64. Illustrated. 1986. London: Wolfe Medical Publications Ltd. £14.00. Br J Surg 2005. [DOI: 10.1002/bjs.1800731247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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15
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Cunningham D, Soukop M, McArdle CS, Carter DC, Smyth JF, Allan SG, Kaye SB, Sangster G, Calman KC, Hutcheon AW. Advanced gastric cancer: Experience in Scotland using 5-fluorouracil, adriamycin and mitomycin-C. Br J Surg 2005; 71:673-6. [PMID: 6548166 DOI: 10.1002/bjs.1800710909] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Eighty-four patients with advanced gastric cancer treated in four centres in Scotland between June 1980 and December 1982 were reviewed following treatment with 5-fluorouracil, adriamycin and mitomycin-C (FAM). Eighty-one patients were evaluable. Twenty-eight patients (35 per cent) responded (four complete) with a median duration of response of 10·5 months and median survival of 17 months. Ten are still alive. Response was associated with an improvement in performance status. Eight patients (10 per cent) had stable disease with a median survival of 10 months. Forty-five (55 per cent) had progressive disease with a median survival of 4·5 months; one patient remains alive. Analysis of prognostic variables indicated that the presence of hepatic metastases had a negative influence on response to FAM (P <0·001). Treatment was well tolerated on an outpatient basis. FAM offers good palliative therapy in a proportion of patients with this disease, especially those without overt liver metastases.
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McArdle CS. Antibiotic prophylaxis in surgery. J. E. Conte Jr, L. S. Jacob and H. C. Polk Jr. 235 × 155 mm. Pp. 196 + ix. Illustrated. 1985. London: Harper & Row Ltd. £24.75. Br J Surg 2005. [DOI: 10.1002/bjs.1800730435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Parr NJ, Cuschieri RJ, Morran CG, McArdle CS. Postoperative pain and pulmonary complications. Br J Surg 2005. [DOI: 10.1002/bjs.1800730133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- N J Parr
- Department of Surgery, University of Liverpool, UK
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Hunt TK, Foster M, Morran CH, McArdle CS. Cefuroime in prevention of wound infection after cholecystectomy: C. G. Morran et al. Br J Surg 2005. [DOI: 10.1002/bjs.1800711137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- T K Hunt
- Department of Surgery, Bristol Royal Infirmary, Bristol BS9 8HW
| | - M Foster
- Department of Surgery, Bristol Royal Infirmary, Bristol BS9 8HW
| | - C H Morran
- Department of Surgery, Royal Infirmary, Glasgow G4 OSF
| | - C S McArdle
- Department of Surgery, Royal Infirmary, Glasgow G4 OSF
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Affiliation(s)
| | - L P Le Quesne
- Department of Surgical Studies, The Middlesex Hospital, London W1N 8AA
| | - J D N Nabarro
- Department of Surgical Studies, The Middlesex Hospital, London W1N 8AA
| | - P R Daggett
- Department of Surgical Studies, The Middlesex Hospital, London W1N 8AA
| | - S Pedrazzoli
- Istituto Di Clinica Chirurgica Generale, E Terapia Chirurgica, Universita Degli Studi Di Padova, 35100 Padova, Italy
| | | | - C Morran
- Department of Surgery, Royal Infirmary, Glasgow G4 0SF
| | - C S McArdle
- Department of Surgery, Royal Infirmary, Glasgow G4 0SF
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20
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Dykes EH, Stewart I, McArdle CS. Authors' response: Reply from Miss E. H. Dykes et al. Br J Surg 2005. [DOI: 10.1002/bjs.1800720237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - I Stewart
- Department of Surgery, Royal Infimary, Glasgow G4 0SF
| | - C S McArdle
- Department of Surgery, Royal Infimary, Glasgow G4 0SF
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21
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McArdle CS. A colour atlas of mucosal proctectomy and ileal reservoir formation. Single surgical procedures 36. T. Vincent Taylor. 260 × 195 mm. Pp. 64. Illustrated. 1986. London: Wolfe Medical Publications Ltd. £14.00. Br J Surg 2005. [DOI: 10.1002/bjs.1800731241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 2005; 92:1150-4. [PMID: 16035134 DOI: 10.1002/bjs.5054] [Citation(s) in RCA: 333] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
The impact of anastomotic leakage on immediate postoperative mortality in patients undergoing potentially curative resection for colorectal cancer is well recognized. Its impact on long-term survival is less clear. The aim of the present study was to evaluate the relationship between anastomotic leakage and long-term survival in patients undergoing potentially curative resection for colorectal cancer.
Methods
A total of 2235 patients who underwent potentially curative resection for colorectal cancer between 1991 and 1994 in Scotland were included in the study. Five-year survival rates and adjusted hazard ratios were calculated.
Results
Fourteen (16 per cent) of the 86 patients with an anastomotic leak died within 30 days of surgery compared with 83 (3·9 per cent) of 2149 without a leak. The 5-year cancer-specific survival rate, including postoperative deaths, was 42 per cent in patients with an anastomotic leak compared with 66·9 per cent in those with no leak (P < 0·001). Excluding postoperative deaths, respective values were 50 and 68·0 per cent (P < 0·001). The adjusted relative hazard ratios, for patients with an anastomotic leak compared with those without a leak, and excluding 30-day mortality, were 1·61 (95 per cent confidence interval (c.i.) 1·19 to 2·16; P = 0·002) for overall survival and 1·99 (95 per cent c.i. 1·42 to 2·79; P < 0·001) for cancer-specific survival.
Conclusion
Development of an anastomotic leak is associated with worse long-term survival after potentially curative resection for colorectal cancer.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow, UK.
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Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dagg K, Scott HR. A prospective longitudinal study of performance status, an inflammation-based score (GPS) and survival in patients with inoperable non-small-cell lung cancer. Br J Cancer 2005; 92:1834-6. [PMID: 15870712 PMCID: PMC2361776 DOI: 10.1038/sj.bjc.6602591] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The value of an inflammation-based prognostic score (Glasgow Prognostic score, GPS) was compared with performance status (ECOG-ps) in a longitudinal study of patients (n=101) with inoperable non-small-cell lung cancer (NSCLC). At diagnosis, stratified for treatment, only the GPS (HR 2.32, 95% CI 1.52–3.54, P<0.001) was a significant predictor of survival. In contrast, neither the GPS nor ECOG-ps measured at 3–6 months follow-up were significant predictors of residual survival. This study confirms the prognostic value of the GPS, at diagnosis, in patients with inoperable NSCLC. However, the role of the GPS and ECOG-ps during follow-up has not been established.
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Affiliation(s)
- L M Forrest
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - W J Angerson
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - K Dagg
- Department of Respiratory Medicine, Wishaw General Hospital, Lanarkshire ML2 0DP, UK
| | - H R Scott
- Department of Respiratory Medicine, Wishaw General Hospital, Lanarkshire ML2 0DP, UK
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Abstract
Abstract
Background
Recent reports based on registry data have shown that survival after surgery for colorectal cancer is improving in the UK. It is not clear whether these improvements are due to earlier presentation or more effective treatment.
Methods
Outcome for 645 patients with colorectal cancer admitted to Glasgow Royal Infirmary between 1974 and 1979 was compared with that for 354 patients admitted between 1991 and 1994.
Results
More patients in the later period had Dukes' A or B tumours and fewer had evidence of metastatic spread (P < 0·001); more underwent potentially curative resection (57·6 versus 49·9 per cent; P < 0·001) and fewer underwent palliative diversion. The overall postoperative mortality rate fell from 14·1 to 8·5 per cent (P = 0·017). Overall and cancer-specific 5-year survival after potentially curative resection increased from 40·1 to 60·5 per cent and from 47·3 to 71·7 per cent respectively (both P < 0·001). Compared with the earlier period, the adjusted hazard ratio for cancer-specific survival following potentially curative resection was 0·452 (95 per cent confidence interval 0·329 to 0·622; P < 0·001).
Conclusion
The observed improvement in survival was mainly due to improvements in the quality of surgery and in perioperative care rather than earlier presentation.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, University of Glasgow, Glasgow, UK.
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Canna K, McArdle PA, McMillan DC, McNicol AM, Smith GW, McKee RF, McArdle CS. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer 2005; 92:651-4. [PMID: 15700032 PMCID: PMC2361875 DOI: 10.1038/sj.bjc.6602419] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is increasing evidence that both local and systemic inflammatory responses play an important role in the progression of a variety of common solid tumours. The aim of the present study was to examine the relationship between tumour T-lymphocyte subset infiltration, the systemic inflammatory response and cancer-specific survival in patients with colorectal cancer. In all, 147 patients undergoing potentially curative resection for colorectal cancer were studied. Circulating concentrations of C-reactive protein were measured prior to surgery. CD4+ and CD8+ T-lymphocyte infiltration of the tumour was assessed using immunohistochemistry and a point counting technique. When patients were grouped according to the percentage tumour volume of CD4+ T-lymphocytes, there was no difference in terms of age, sex, tumour site, stage and tumour characteristics. However, there was an inverse relationship between percentage tumour CD4+ T-lymphocytes and C-reactive protein (P<0.01). On univariate analysis, both C-reactive protein concentrations (P<0.001) and percentage tumour volume of CD4+ (P<0.05) T-lymphocytes were associated with cancer-specific survival. The results of the present study show that low tumour CD4+ T-lymphocyte infiltration is associated with elevated C-reactive protein concentrations and both predict poor cancer-specific survival.
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Affiliation(s)
- K Canna
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - P A McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
| | - A-M McNicol
- Department of Pathology, Royal Infirmary, Glasgow G31 2ER, UK
| | - G W Smith
- Department of Pathology, Royal Infirmary, Glasgow G31 2ER, UK
| | - R F McKee
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
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Al Murri AM, Doughty JC, Lannigan A, Wilson C, McArdle CS, McMillan DC. The relationship between deprivation, tumour stage and the systemic inflammatory response in patients with primary operable breast cancer. Br J Cancer 2004; 91:1063-5. [PMID: 15305191 PMCID: PMC2747685 DOI: 10.1038/sj.bjc.6602096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The extent of deprivation (Carstairs deprivation index) was directly associated with the magnitude of the systemic inflammatory response (reduced albumin and elevated C-reactive protein, P<0.01) in patients with primary operable breast cancer (n=314). Deprivation was not associated with age, tumour size, tumour type, grade, and the proportion of patients with involved lymph nodes and oestrogen receptor status.
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Affiliation(s)
- A M Al Murri
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - J C Doughty
- University Department of Surgery, Western Infirmary, Glasgow, UK
| | - A Lannigan
- Department of Surgery, Wishaw General Hospital, Lanarkshire, UK
| | - C Wilson
- University Department of Surgery, Western Infirmary, Glasgow, UK
| | - C S McArdle
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
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Al-Shaiba R, McMillan DC, Angerson WJ, Leen E, McArdle CS, Horgan P. The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases. Br J Cancer 2004; 91:205-7. [PMID: 15213726 PMCID: PMC2409827 DOI: 10.1038/sj.bjc.6601886] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The relationship between hypoalbuminaemia, tumour volume and C-reactive protein was examined in patients with colorectal liver metastases (n=57). On multiple regression analysis, albumin concentrations were independently associated with C-reactive protein (r=0.56, P<0.001) but not percentage hepatic replacement (P=0.34). These results show that hypoalbuminaemia is associated with the presence of a systemic inflammatory response rather than tumour volume in patients with colorectal liver metastases.
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Affiliation(s)
- R Al-Shaiba
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
| | - W J Angerson
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - E Leen
- Department of Radiology, Royal Infirmary, Glasgow G31 2ER, UK
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - P Horgan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
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Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. Br J Cancer 2004; 90:1704-6. [PMID: 15150622 PMCID: PMC2409737 DOI: 10.1038/sj.bjc.6601789] [Citation(s) in RCA: 265] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The value of an inflammation-based prognostic score (GPS) was compared with performance status (ECOG) in patients (n=109) receiving platinum-based chemotherapy for inoperable non-small-cell lung cancer. On multivariate analysis with ECOG, white cell count and the GPS entered as covariates, only the GPS was a significant independent predictor of survival (HR 1.88, 95% CI 1.25–2.84, P=0.002).
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Affiliation(s)
- L M Forrest
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - W J Angerson
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D J Dunlop
- Department of Medical Oncology, Royal Infirmary, Glasgow G31 2ER, UK
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29
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Canna K, McMillan DC, McKee RF, McNicol AM, Horgan PG, McArdle CS. Evaluation of a cumulative prognostic score based on the systemic inflammatory response in patients undergoing potentially curative surgery for colorectal cancer. Br J Cancer 2004; 90:1707-9. [PMID: 15150596 PMCID: PMC2409754 DOI: 10.1038/sj.bjc.6601757] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The value of combining Dukes' stage and C-reactive protein to form a cumulative prognostic score was assessed in 147 patients undergoing potentially curative resection for colorectal cancer. The cancer-specific survival rates at 3 years for patients with a cumulative prognostic score of 0, 1 and 2 were 100, 77 and 40%, respectively (HR 4.76, 2.78-8.15, P<0.001).
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Affiliation(s)
- K Canna
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK. E-mail:
| | - R F McKee
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - A-M McNicol
- University Department of Pathology, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - P G Horgan
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - C S McArdle
- University Department of Surgery, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
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Ali AA, McMillan DC, Matalka II, McNicol AM, McArdle CS. Tumour T-lymphocyte subset infiltration and tumour recurrence following curative resection for colorectal cancer. Eur J Surg Oncol 2004; 30:292-5. [PMID: 15028311 DOI: 10.1016/j.ejso.2003.11.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2003] [Indexed: 12/27/2022] Open
Abstract
AIM The relationship of tumour T-lymphocytic subset infiltration and recurrence in patients undergoing potentially curative resection for colorectal cancer has not been clearly defined. METHODS Tumour sections from patients who had undergone potentially curative resection for colorectal cancer were stained and counted for CD4+ and CD8+ T-lymphocytes. RESULTS Twenty-three patients developed recurrence during the follow-up period. Patients were grouped according to whether or not they developed recurrence. The groups were similar in age, sex, site of tumour, Dukes stage and the numbers of patients receiving adjuvant therapy. The total percentage volume of labelled CD4+ T-lymphocytes in the tumour was significantly lower in the patients who recurred (p<0.05). CONCLUSIONS The results of the present pilot study suggest that a reduction in tumour T-lymphocyte infiltration, in particular CD4+ T-lymphocyte infiltration, is associated with recurrence in patients following potentially curative resection for colorectal cancer.
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Affiliation(s)
- A A Ali
- University Department of Surgery, Royal Infirmary, Glasgow, Scotland G31 2ER, UK
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Abstract
Abstract
Background
Previous studies have reported that emergency presentation of colorectal cancer is associated with poor outcome. Many of these studies were small and most were not adjusted for case mix. The aim of this study was to establish, after adjusting for case mix, the magnitude of the differences in postoperative mortality and survival between patients undergoing elective surgery and those presenting as an emergency.
Methods
Three thousand two hundred patients who underwent surgery for colorectal cancer between 1991 and 1994 in Scotland were studied. Five-year survival rates and adjusted hazard ratios were calculated.
Results
Some 1603 (72·4 per cent) of 2214 elective patients had a potentially curative resection compared with 632 (64·1 per cent) of 986 patients who presented as an emergency (P < 0·001). Following curative resection, the postoperative mortality rate was 2·8 per cent after elective and 8·2 per cent after emergency operation (P < 0·001). Overall survival at 5 years was 57·5 per cent after elective and 39·1 per cent after emergency curative surgery (P < 0·001); cancer-specific survival at 5 years was 70·9 and 52·9 per cent respectively (P < 0·001). The adjusted hazard ratio for overall survival after emergency relative to elective surgery was 1·68 (95 per cent confidence interval (c.i.) 1·49 to 1·90; P < 0·001) and that for cancer-specific survival was 1·90 (95 per cent c.i. 1·62 to 2·22; P < 0·001).
Conclusion
Following apparently curative resection for colorectal cancer, there was an excess of both cancer-related and intercurrent deaths in patients who presented as an emergency.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, University of Glasgow, Glasgow, UK
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Abstract
Abstract
Background
Previous studies have shown that significant surgeon-related differences in survival exist following surgery for colorectal cancer. It is not clear whether these differences were due to differences in caseload or degree of specialization.
Methods
Outcome in 3200 patients who underwent resection for colorectal cancer between 1991 and 1994 was analysed on the basis of caseload and degree of specialization of individual surgeons. Five-year survival rates, and the corresponding hazard ratios adjusted for case mix, were calculated.
Results
Cancer-specific survival rate at 5 years following curative resection varied among surgeons from 53·4 to 84·6 per cent; the adjusted hazard ratios varied from 0·48 to 1·55. Cancer-specific survival rate at 5 years following curative resection was 70·2, 62·0 and 65·9 per cent for surgeons with a high, medium and low case volume respectively. There were no consistent differences in the adjusted hazard ratios by volume. Cancer-specific survival rate at 5 years following curative resection was 72·7 per cent for those treated by specialists and 63·8 per cent for those treated by non-specialists; the adjusted hazard ratio for non-specialists was 1·35 (95 per cent confidence interval 1·13 to 1·62; P = 0·001).
Conclusion
The differences in outcome following apparently curative resection for colorectal cancer among surgeons appear to reflect the degree of specialization rather than case volume. It is likely that increased specialization will lead to further improvements in survival.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow, UK.
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Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer 2003; 89:1028-30. [PMID: 12966420 PMCID: PMC2376960 DOI: 10.1038/sj.bjc.6601242] [Citation(s) in RCA: 547] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A score based on the combination of the systemic inflammatory response and albumin hazards ratio (HR) 1.70, 95% CI 1.23 - 2.35, P=0.001) was comparable in prognostic value to that based on stage and performance status (HR 1.48, 95% CI 1.12 - 1.95, P=0.006) in patients with inoperable non-small-cell lung cancer. The former is simple to measure and well standardised.
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Affiliation(s)
- L M Forrest
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK. E-mail:
| | - C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - W J Angerson
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK
| | - D J Dunlop
- Department of Medical Oncology, Royal Infirmary, Glasgow G31 2ER, UK
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34
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Abstract
The presence of a systemic inflammatory response predicted cancer-specific (HR 2.55, 95% CI 1.22-5.32, P<0.05) and overall survival (HR 2.12, 95% CI 1.17-3.87, P<0.05), independent of Dukes stage, in patients who had undergone apparently curative surgery for colorectal cancer (n=158). Deprivation predicted overall survival (HR 1.26, 95% CI 1.04-1.51, P<0.05) independent of Dukes stage.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 ZER, UK.
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35
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McMillan DC, McArdle CS. Author's reply: Systemic inflammatory response predicts survival following curative resection of colorectal cancer ( Br J Surg 2003; 90: 215–219). Br J Surg 2003. [DOI: 10.1002/bjs.4334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- D C McMillan
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - C S McArdle
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
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36
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Abstract
BACKGROUND Previous studies have suggested that survival following surgery for colorectal cancer is better in women than men. However, the findings were inconsistent and few studies adjusted for case-mix. The aim of the present study was to establish whether there were gender differences in survival following surgery for colorectal cancer after adjusting for case-mix. METHODS Some 3200 patients who underwent resection for colorectal cancer between 1991 and 1994 in 11 hospitals in Scotland were included in the study. Five-year survival rates, and the corresponding hazard ratios, adjusted for age, mode of presentation, site of tumour, the nature of surgery and Dukes stage, were calculated for men and women. RESULTS Overall survival at 5 years was higher in women than men, in those with colonic tumours, those who underwent elective surgery and those who underwent apparently curative resection (all P < 0.001). Cancer-specific survival at 5 years was also higher in women (P = 0.008) and those who underwent elective surgery (P < 0.001). The adjusted hazard ratios, for women relative to men following curative resection, were 0.76 (95 per cent confidence interval (c.i.) 0.68 to 0.85) (P < 0.001) for overall survival and 0.84 (95 per cent c.i. 0.73 to 0.98) (P = 0.021) for cancer-specific survival. CONCLUSION Following apparently curative resection for colorectal cancer and after adjusting for case-mix, there was an excess of both cancer-related and intercurrent deaths in men.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, University of Glasgow, Glasgow, UK.
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37
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Abstract
BACKGROUND Some studies have shown that the presence of a systemic inflammatory response, as evidenced by raised circulating concentrations of C-reactive protein (CRP), predicted recurrence and overall survival in patients with colorectal cancer. The aim of this study was to examine the relationship between the inflammatory response and overall and cancer-specific survival in patients undergoing potentially curative resection for colorectal cancer. METHODS A total of 174 patients considered to have undergone curative resection were studied. Circulating CRP concentrations were measured before and/or after operation. RESULTS The majority of patients were aged 65 years or more, had colonic tumours and Dukes' stage B lesions. During follow-up, 47 patients (27 per cent) developed recurrence and 59 (34 per cent) died. On univariate analysis, age (P < 0.01), Dukes' stage (P < 0.001), and CRP levels before (P < 0.01) and after (P < 0.01) operation were significantly associated with overall and cancer-specific survival. On multivariate analysis of patients in whom preoperative CRP concentration was measured, age (P < 0.01), Dukes' stage (P < 0.05) and CRP concentration (P < 0.01) were independently associated with both overall and cancer-specific survival. CONCLUSION In patients who have undergone potentially curative resection for colorectal cancer, the presence of a systemic inflammatory response predicts a poor outcome.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK.
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McMillan DC, Elahi MM, Sattar N, Angerson WJ, Johnstone J, McArdle CS. Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer 2002; 41:64-9. [PMID: 12094630 DOI: 10.1080/01635581.2001.9680613] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The assessment of prognosis in patients with advanced cancer remains problematical. The value of C-reactive protein concentration in this context has not been clearly defined. Patients with a diagnosis of colorectal (n = 182), gastric (n = 87), breast (n = 99), or bronchogenic (n = 404) cancer and who had measurements of C-reactive protein and albumin were identified. Median survival, from the time of sampling, ranged from 478 days in the colorectal cancer patients to 60 days in patients with bronchogenic cancer. On univariate analysis, there was, in each tumor type, a significant relationship between the duration of survival and both log10 C-reactive protein and albumin concentrations (P < or = 0.0002). On multivariate analysis, in each tumor type, log10 C-reactive protein remained a significant independent predictor of survival (P < or = 0.0002). When all four groups of cancer patients were analyzed (n = 772), the hazard ratio for a 10-fold increase in C-reactive protein concentration in cancer-specific survival was 2.21 (95% confidence interval = 1.92-2.56, P < 0.0001) and the corresponding hazard ratio for non-cancer survival was 5.48 (95% confidence interval = 3.55-8.46, P < 0.0001). The results of the present study indicate that in advanced cancer patients the presence of a systemic inflammatory response and the magnitude of that response predict the duration of cancer-specific and non-cancer survival.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK.
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Simpson HW, McArdle CS, George WD, Griffiths K, Turkes A, Pauson AW. Pregnancy postponement and childlessness leads to chronic hypervascularity of the breasts and cancer risk. Br J Cancer 2002; 87:1246-52. [PMID: 12439713 PMCID: PMC2408917 DOI: 10.1038/sj.bjc.6600600] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2002] [Revised: 08/18/2002] [Accepted: 08/22/2002] [Indexed: 12/03/2022] Open
Abstract
Epidemiologists have established that women with small families, and particularly nulliparae, are prone to develop breast cancer later in life. We report that physiological mammary hypervascularity may be an intermediate reason against the background that breast-core vascularity is normal in pregnancy but pathological in the vascularisation of cancer. We examined breast 'core' vascularity in nulliparae during their potential reproductive life and in parous women after their last birth but before their menopause. Fifty clinically normal pre-menopausal non-pregnant women (100 breasts) were studied daily for one 'luteal positive' menstrual cycle. Their parity history varied from zero to five babies. Under controlled domestic conditions each wore a special electronic thermometric bra to automatically record breast 'core' temperature changes as a measure of mammary tissue blood flow. In the nulliparae there was a rise of breast vascularity throughout reproductive life. In the parous women, a year or so after each birth, breast vascularity was reset at a lower level than before the pregnancy; thereafter, as in nulliparae, there was progressive increase in mammary vascularity until the menopause.
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Affiliation(s)
- H W Simpson
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
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Scott HR, McMillan DC, Forrest LM, Brown DJF, McArdle CS, Milroy R. The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer 2002; 87:264-7. [PMID: 12177792 PMCID: PMC2364225 DOI: 10.1038/sj.bjc.6600466] [Citation(s) in RCA: 225] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2002] [Revised: 05/14/2002] [Accepted: 05/29/2002] [Indexed: 12/22/2022] Open
Abstract
The relationship between the magnitude of systemic inflammatory response and the nutritional/functional parameters in patients with inoperable non-small cell lung cancer were studied. The extent of weight loss, albumin, C-reactive protein, performance status and quality of life was measured in 106 patients with inoperable non-small cell lung cancer (stages III and IV). Survival analysis was performed using the Cox proportional hazard model. The majority of patients were male and almost 80% had elevated circulating C-reactive protein concentrations (>10 mg x l(-1)). On multivariate analysis, age (P=0.012), tumour type (0.002), weight loss (P=0.056), C-reactive protein (P=0.047), Karnofsky performance status (P=0.002) and fatigue (P=0.046) were independent predictors of survival. The patients were grouped according to the magnitude of the C-reactive protein concentrations (< or =10, 11-100 and >100 mg x l(-1)). An increase in the magnitude of the systemic inflammatory response was associated with increased weight loss (P=0.004), reduced albumin concentrations (P=0.001), reduced performance status (P=0.060), increased fatigue (P=0.011) and reduced survival (HR 1.936 95%CI 1.414-2.650, P<0.001). These results indicate that the majority of patients with inoperable non-small cell lung cancer have evidence of a systemic inflammatory response. Furthermore, an increase in the magnitude of the systemic inflammatory response resulted in greater weight loss, poorer performance status, more fatigue and poorer survival.
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Affiliation(s)
- H R Scott
- Department of Respiratory Medicine, Wishaw General Hospital, Lanarkshire ML 0DP, UK
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Abstract
BACKGROUND Previous studies have demonstrated that socioeconomic deprivation is associated with poorer survival in patients with colorectal cancer. These differences have been attributed to more advanced disease at presentation. METHODS A total of 2269 patients undergoing resection for colorectal cancer in hospitals in central Scotland between 1991 and 1994 were studied. Socioeconomic status was defined using the Carstairs deprivation index. The impact of deprivation on case mix, treatment and outcome was analysed. RESULTS There were no significant differences in mode of presentation, extent of disease at presentation, type of resection and postoperative mortality rate among the socioeconomic groups. Following curative resection, the overall survival rate at 5 years was 47.0 per cent in deprived patients, compared with 55.4 per cent in affluent patients (P = 0.05); the cancer-specific survival rate was 62.6 per cent in the deprived and 68.1 per cent in the affluent (P = 0.05). Compared with the affluent, the adjusted hazard ratios for the deprived were 1.36 (95 per cent confidence interval (c.i.) 1.09 to 1.69) for overall mortality and 1.26 (95 per cent c.i. 0.95 to 1.67) for cancer-specific mortality. Following palliative resection, there was no difference in survival between the affluent and deprived for either overall (P = 0.27) or cancer-specific (P = 0.89) mortality. CONCLUSION These findings confirm that the cancer-specific survival rate following surgery for colorectal cancer is lower in deprived patients. Stage of disease at presentation and type of operation did not account for this difference. The excess mortality was confined to patients undergoing apparently curative resection.
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Affiliation(s)
- D J Hole
- Departments of Public Health and Surgery, University of Glasgow, Glasgow, UK.
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McMillan DC, Watson WS, O'Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer 2002; 39:210-3. [PMID: 11759282 DOI: 10.1207/s15327914nc392_8] [Citation(s) in RCA: 320] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The association between hypoalbuminemia and poor prognosis in patients with cancer is well recognized. However, the factors that contribute to the fall in albumin concentrations are not well understood. In the present study, we examined the relationship between circulating albumin concentrations, weight loss, the body cell mass (measured using total body potassium), and the presence of an inflammatory response (measured using C-reactive protein) in male patients (n = 40) with advanced lung or gastrointestinal cancer. Albumin concentrations were significantly correlated with the percent ideal body weight (r = 0.390, p < 0.05), extent of reported weight loss (r = -0.492, p < 0.01), percent predicted total body potassium (adjusted for age, height, and weight, r = 0.686, p < 0.001), and log10 C-reactive protein concentrations (r = -0.545, p < 0.001). On multiple regression analysis, the percent predicted total body potassium and log10 C-reactive protein concentrations accounted for 63% of the variation in albumin concentrations (r2 = 0.626, p < 0.001). The interrelationship between albumin, body cell mass, and the inflammatory response is consistent with the concept that the presence of an ongoing inflammatory response contributes to the progressive loss of these vital protein components of the body and the subsequent death of patients with advanced cancer.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow G31 2ER, UK.
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Doughty JC, Kane E, Cooke TG, McArdle CS. Mitoxantrone and methotrexate chemotherapy with and without mitomycin C in the regional treatment of locally advanced breast cancer. Breast 2002; 11:97-9. [PMID: 14965654 DOI: 10.1054/brst.2001.0316] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/1997] [Revised: 04/18/2001] [Accepted: 04/20/2001] [Indexed: 11/18/2022] Open
Abstract
Fifty patients with locally advanced breast cancer received regional chemotherapy delivered angiographically via the internal mammary artery and varying vessels supplying the lateral aspect of the breast. Thirty three patients received mitomycin C, methotrexate and mitoxantrone, and 17 patients received methotrexate and mitoxantrone only. There was no significant difference in clinical response between the two groups. However, in patients who received mitomycin C, severe local skin toxicity occurred in nine patients resulting in delay of further therapy and considerable morbidity. Mitomycin C should not be administered regionally in patients with locally advanced breast cancer.
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Affiliation(s)
- J C Doughty
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
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McArdle CS, Hole DJ. Outcome following surgery for colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation. Br J Cancer 2002; 86:331-5. [PMID: 11875693 PMCID: PMC2375219 DOI: 10.1038/sj.bjc.6600120] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2001] [Revised: 11/19/2001] [Accepted: 12/05/2001] [Indexed: 12/18/2022] Open
Abstract
Outcome, adjusted for case-mix and deprivation, in 3200 patients undergoing resection for colorectal cancer in 11 hospitals in Central Scotland between 1991 and 1994 was studied. There were significant differences among individual hospitals in the proportion of elderly (P<0.001) and deprived (P<0.0001) patients, the mode (P=0.007) and stage (P<0.0001) at presentation, and the proportion of patients who underwent apparently curative resection (P<0.001). There were no significant differences in postoperative mortality. Cancer-specific survival at 5 years following apparently curative resection varied from 59 to 76%; cancer-specific survival at 2 years following palliative resection varied from 22 to 44%. The corresponding hazard ratios, adjusted for the above prognostic factors, for patients undergoing apparently curative resection varied among hospitals from 0.58 to 1.32; and the ratios for palliative resection varied from 0.73 to 1.26. This study demonstrates that, after adjustment for variations in case-mix and deprivation, significant differences in outcome among hospitals following resection for colorectal cancer persist.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK.
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Affiliation(s)
- C S McArdle
- University Department of Surgery, Royal Infirmary, Glasgow, UK
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46
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Abstract
There are few reports on factors that determine survival in advanced gastrointestinal cancer with weight loss. In these patients (n = 91, median weight loss 16.6%), we prospectively examined the importance of metastatic spread, anthropometry, blood parameters, Karnofsky performance status, appetite, and the acute-phase response as predictors of survival. Survival was calculated from date of assessment to the most recent clinic attendance (> or = 30 mo) or until death. On multivariate analysis, metastatic spread (p < 0.05), Karnofsky performance status (p < 0.01), and C-reactive protein concentration (p < 0.001) had independent prognostic value. In locally advanced disease (n = 64), Karnofsky performance status and C-reactive protein concentration remained significant. There was a significantly lower survival in patients with an acute-phase response (median 136 days) than in patients with no response (median 466 days; p < 0.01). Performance status and the acute-phase response are associated, independent of weight loss, with survival duration in advanced gastrointestinal cancer patients.
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Affiliation(s)
- P O'Gorman
- University Department of Surgery, Royal Infirmary, Glasgow, UK. patricia.o'
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Scott HR, McMillan DC, Watson WS, Milroy R, McArdle CS. Longitudinal study of resting energy expenditure, body cell mass and the inflammatory response in male patients with non-small cell lung cancer. Lung Cancer 2001; 32:307-12. [PMID: 11390012 DOI: 10.1016/s0169-5002(00)00244-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to examine the inter-relationship between the inflammatory response and resting energy expenditure in patients with non-small cell lung cancer (NSCLC) before and after the onset of weight loss. Healthy subjects (n=7) and patients with NSCLC without weight loss (n=12) were studied. Resting energy expenditure adjusted for metabolically active tissue, as measured by total body potassium, was approximately 15% higher in the NSCLC group (P<0.01). Moreover, the resting energy expenditure, correlated with the magnitude of the inflammatory response (r=0.753, P<0.01). Six cancer patients subsequently lost weight and the relationship between resting energy expenditure and the inflammatory response was maintained. These results highlight the impact of the inflammatory response on the increase in the resting energy expenditure which precedes the onset of weight loss in patients with NSCLC.
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Affiliation(s)
- H R Scott
- Department of Respiratory Medicine, Stobhill NHS Trust, G21 3UW, Glasgow, UK
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Oppo K, Leen E, Angerson WJ, McArdle CS. The effect of resecting the primary tumour on the Doppler Perfusion Index in patients with colorectal cancer. Clin Radiol 2000; 55:791-3. [PMID: 11052881 DOI: 10.1053/crad.2000.0522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM In patients undergoing apparently curative resection for colorectal cancer, an elevated Doppler Perfusion Index (DPI; ratio of hepatic arterial to total liver blood flow) before surgery is associated with a high risk of recurrence. The role of the primary tumour in inducing and sustaining these blood flow changes is unknown. The aim of this study was to assess the impact of removing the primary tumour on the DPI. MATERIALS AND METHODS Using duplex/colour Doppler sonography, the DPI was measured both before and after surgery (median, 9 months) in 14 patients undergoing apparently curative resection for colorectal cancer. RESULTS In the five patients with a normal pre-operative DPI (< 0.30), there was no significant change following surgery. In the nine patients with an abnormal pre-operative DPI, there was a small but significant fall from 0.38 (SEM 0.02) to 0.33 (0.02) following surgery (P = 0.04). However, DPI values remained abnormally elevated in seven of these nine patients. CONCLUSION These results suggest that the primary tumour plays a relatively minor role in inducing an abnormally elevated DPI in patients undergoing apparently curative resection for colorectal cancer.Oppo, K. (2000). Clinical Radiology55, 791-793.
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Affiliation(s)
- K Oppo
- University Department of Surgery, Royal Infirmary, Glasgow, UK
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McMillan DC, Sattar N, Talwar D, O'Reilly DS, McArdle CS. Changes in micronutrient concentrations following anti-inflammatory treatment in patients with gastrointestinal cancer. Nutrition 2000; 16:425-8. [PMID: 10869897 DOI: 10.1016/s0899-9007(00)00270-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Circulating concentrations of vitamin antioxidants (retinol, alpha-tocopherol, lutein, lycopene, alpha- and beta-carotene) and trace elements (zinc, copper, iron and selenium) plus carrier proteins (albumin, transferrin, caeruloplasmin) in gastrointestinal cancer patients (n = 12) with an inflammatory response (as demonstrated by an elevated C-reactive protein concentration) were compared with a control group (n = 12). Further, the effect of moderating the inflammatory response, using the anti-inflammatory agent ibuprofen, on these measurements was examined in the cancer group. The control and cancer groups were similar in terms of age, sex, and body mass index. However, the cancer group had significantly higher C-reactive protein concentrations (P < 0.001). Concentrations of vitamin antioxidants and trace elements (and carrier proteins) were significantly lower (P < 0.001), except copper (ceruloplasmin) which was significantly higher (P < 0.05). After anti-inflammatory treatment, there were small but significant increases in lutein, lycopene, and beta-carotene (P < 0.05) and in iron and selenium (P < 0.05), whereas ceruloplasmin decreased (P < 0. 05). The micronutrient concentrations in the cancer patients remained different from those in the control subjects. These results support the concept that the magnitude of inflammation plays an important role in the regulation of circulating concentrations of vitamin antioxidants and trace elements in patients with gastrointestinal cancer.
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Affiliation(s)
- D C McMillan
- University Department of Surgery, Royal Infirmary, Glasgow, UK.
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Ramnarine KV, Kyriakopoulou K, Gordon P, McDicken NW, McArdle CS, Leen E. Improved characterisation of focal liver tumours: dynamic power Doppler imaging using NC100100 echo-enhancer. Eur J Ultrasound 2000; 11:95-104. [PMID: 10781657 DOI: 10.1016/s0929-8266(00)00074-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the vascularisation of focal hepatic tumours using NC100100, enhanced power Doppler imaging. METHODS Twenty-two patients with focal liver tumours (12 metastases and ten hemangiomas) were studied. Using standardised settings, power Doppler imaging with ATL HDI3000 was performed before and after intravenous administration of NC100100 contrast agent. The video-recorded examinations were digitised for off-line analysis on a personal computer. Regions of interest were defined over the entire tumour and a neighbouring area of the normal liver parenchyma. The temporal changes of the mean power Doppler signal intensity (PDSI) was quantified to provide contrast agent wash-in (PDSI-time) curves for the initial 40 s. RESULTS Liver metastases were characterised by a rapid increase in PDSI, while the PDSI-time curves within hemangiomas were flat. The PDSI within the tumour increased significantly in ten subjects with liver metastases and only one subject with hemangioma. An enhanced rim around hemangiomas was seen in four subjects. There was no clear relationship between the contrast agent dose and the peak PDSI within metastases. CONCLUSIONS Power Doppler imaging with NC100100 contrast agent enhances tumour visualisation and may aid differential diagnosis of focal liver lesions.
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Affiliation(s)
- K V Ramnarine
- Department of Medical Physics and Medical Engineering, University of Edinburgh, Royal Infirmary, UK.
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