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Aboukheir Aboukheir A, Villanueva EQ, Garrett JR, Moodie CC, Tew JR, Toloza EM, Fontaine JP, Baldonado JJAR. Association between the Preoperative Standard Uptake Value (SUV) and Survival Outcomes after Robotic-Assisted Segmentectomy for Resectable Non-Small Cell Lung Cancer (NSCLC). Cancers (Basel) 2023; 15:5379. [PMID: 38001639 PMCID: PMC10670906 DOI: 10.3390/cancers15225379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Lung-sparing procedures, specifically segmentectomies and wedge resections, have increased over the years to treat early-stage non-small cell lung cancer (NSCLC). We investigate here the perioperative and long-term outcomes of patients who underwent robotic-assisted segmentectomy (RAS) at an NCI-designated cancer center and aim to show associations between the preoperative standard update value (SUV) to tumor stage, recurrence patterns, and overall survival. METHODS A retrospective analysis was performed on 166 consecutive patients who underwent RAS at a single institution from 2010 to 2021. Of this number, 121 robotic-assisted segmentectomies were performed for primary NSCLC, and a total of 101 patients were evaluated with a PET-CT scan. The SUV from the primary tumor was determined from the PET-CT. The clinical, surgical, and pathologic profiles and perioperative outcomes were summarized via descriptive statistics. Numerical variables were described as the median and interquartile range because all numerical variables were not normally distributed as assessed by the Shapiro-Wilk test of normality. Categorical variables were described as the count and proportion. Chi-square or Fisher's exact test was used for association. The main outcomes were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier (KM) curves were constructed to visualize the OS and RFS, which were also stratified according to tumor histology, the pathologic stage, and standard uptake value. A log-rank test for the equality of survival curves was performed to determine significant differences between groups. RESULTS The most common postoperative complications were atrial fibrillation (8.8%, 9/102), persistent air leak (7.84%, 8/102), and pneumonia (4.9%, 5/102). The median operative duration was 168.5 min (IQR 59), while the median estimated blood loss was 50 mL (IQR 125). The conversion rate to thoracotomy in this cohort was 3.9% (4/102). Intraoperative complications occurred in 2.9% (3/102). The median hospital length of stay was 3 days (IQR 3). The median chest tube duration was 3 days (IQR 2), but 4.9% (5/102) of patients were sent home with a chest tube. The recurrence for this cohort was 28.4% (29/102). The time to recurrence was 353 days (IQR 504), while the time to mortality was 505 days (IQR 761). The NSCLC patients were divided into the following two groups: low SUV (<5, n = 55) and high SUV (≥5, n = 47). Statistically significant associations were noted between SUV and the tumor histology (p = 0.019), tumor grade (p = 0.002), lymph-vascular invasion (p = 0.029), viscera-pleural invasion (p = 0.008), recurrence (p < 0.001) and the site of recurrence (p = 0.047). KM survival analysis showed significant differences in the curves for OS (log-rank p-value 0.0204) and RFS (log-rank p-value 0.0034) between the SUV groups. CONCLUSION Robotic-assisted segmentectomy for NSCLC has reasonable perioperative and oncologic outcomes. Furthermore, we demonstrate here the prognostic implication of preoperative SUV to pathologic outcomes, recurrence-free survival, and overall survival.
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Affiliation(s)
- Aihab Aboukheir Aboukheir
- Department of General Surgery, Saint Luke Episcopal Medical Center, General Surgery Residency, Ponce Health Sciences University, Ponce, PR 00716, USA;
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
| | - Emilio Q. Villanueva
- Department of Pathology, University of the Philippines College of Medicine, Manila City 1000, Philippines;
- Expanded Hospital Research Office, UP–Philippine General Hospital, Manila City 1000, Philippines
| | - Joseph R. Garrett
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
| | - Carla C. Moodie
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
| | - Jenna R. Tew
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
| | - Eric M. Toloza
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
| | - Jacques P. Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
| | - Jobelle J. A. R. Baldonado
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA; (J.R.G.); (C.C.M.); (J.R.T.); (E.M.T.); (J.P.F.)
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Jamora RDG, Albay AB, Ditching MBDF, Sy MCC, Villanueva EQ, Espiritu AI, Anlacan VMM. Clinical Outcomes of COVID-19 Infection among Patients with Chronic Obstructive Pulmonary Disease: Findings from the Philippine CORONA Study. Clin Pract 2023; 13:1383-1392. [PMID: 37987425 PMCID: PMC10660839 DOI: 10.3390/clinpract13060124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The global pandemic caused by the coronavirus disease 2019 (COVID-19) resulted in many deaths from fulminant respiratory failure. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide. There has been great concern regarding the impact of COPD on the COVID-19 illness. METHODS Data from the Philippine CORONA study were analyzed to determine the association of COPD and COVID-19 in terms of mortality, disease severity, respiratory failure, mechanical ventilation, and lengths of stay in the intensive care unit (ICU) and hospital. RESULTS A total of 10,881 patients were included in this study, and 156 (1.4%) patients had been diagnosed with COPD. A majority of COVID-19 patients with COPD had other existing comorbidities: hypertension, diabetes mellitus, chronic cardiac disease, and chronic kidney disease. COPD patients were 2.0× more likely to present with severe to critical COVID-19 disease. COVID-19 patients with COPD in our study have a 1.7× increased mortality, 1.6× increased respiratory failure, and 2.0× increased risk for ICU admission. Smokers with COVID-19 were 1.8× more likely to present with more severe disease and have a 1.9× increased mortality. CONCLUSION Our study supports the growing evidence that COPD among COVID-19 patients is a risk factor for higher mortality, more severe form of COVID-19, higher ICU admission, and higher respiratory failure needing ventilatory support.
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Affiliation(s)
- Roland Dominic G. Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines; (M.C.C.S.); (A.I.E.); (V.M.M.A.)
- Institute for Neurosciences, St. Luke’s Medical Center, Global City, Taguig 1634, Philippines
| | - Albert B. Albay
- Division of Pulmonary Medicine, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines; (A.B.A.J.); (M.B.D.F.D.)
| | - Mary Bianca Doreen F. Ditching
- Division of Pulmonary Medicine, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines; (A.B.A.J.); (M.B.D.F.D.)
| | - Marie Charmaine C. Sy
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines; (M.C.C.S.); (A.I.E.); (V.M.M.A.)
| | - Emilio Q. Villanueva
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines;
| | - Adrian I. Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines; (M.C.C.S.); (A.I.E.); (V.M.M.A.)
- Department of Clinical Epidemiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines
| | - Veeda Michelle M. Anlacan
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila 1000, Philippines; (M.C.C.S.); (A.I.E.); (V.M.M.A.)
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Espiritu AI, Larrazabal RB, Sy MCC, Villanueva EQ, Anlacan VMM, Jamora RDG. Outcomes and Risk Factors of Patients With COVID-19 and Cancer (ONCORONA): Findings from The Philippine CORONA Study. Front Oncol 2022; 12:857076. [PMID: 35494040 PMCID: PMC9044028 DOI: 10.3389/fonc.2022.857076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background A study conducted in China on patients with coronavirus disease 2019 (COVID-19) showed that cancer conferred a five times increased risk for needing intensive care admission and mortality; No data has yet been collected and published from the Philippines. Thus, the investigators conducted this substudy to determine the association of having a history of cancer with clinical outcomes among patients included in the Philippine CORONA Study. Methodology Multi-center, retrospective cohort design. Results A total of 244 patients had a history of cancer, out of 10,881 COVID-19 hospital admissions. After adjusting for different confounding variables of interest, having cancer was significantly associated with a 75% increased odds of having severe/critical COVID-19 at nadir (CI 95% 1.32, 2.33; p < 0.001). After adjusting for different confounding variables of interest, having cancer was significantly associated with the following time-to-event outcomes: 72% increase in hazard of in-hospital mortality (CI 95% 1.37, 2.16; p < 0.001), 65% increase in hazard of respiratory failure (CI 95% 1.31, 2.08; p < 0.001), and 57% increase in hazard of being admitted to ICU (CI 95% 1.24, 1.97; p < 0.001). Conclusion A history of cancer conferred poorer clinical outcomes on adult, hospitalized COVID-19 patients.
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Affiliation(s)
- Adrian I Espiritu
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.,Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Ramon B Larrazabal
- Division of Medical Oncology, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Marie Charmaine C Sy
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Emilio Q Villanueva
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Veeda Michelle M Anlacan
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G Jamora
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.,Institute for Neurosciences, St. Luke's Medical Center, Taguig, Philippines
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Saranza G, Villanueva EQ, Lang AE. Preferences for Communication About End-of-Life Care in Atypical Parkinsonism. Mov Disord 2021; 36:2116-2125. [PMID: 33913219 DOI: 10.1002/mds.28633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Studies on preferences regarding discussions on end-of-life care (EOLC), advance care planning (ACP), medical assistance in dying (MAiD), and brain donation have not yet been conducted in patients with atypical parkinsonism (AP). OBJECTIVE The aim of this study was to know the preferences of patients with AP regarding discussions on EOLC, ACP, MAiD, and brain donation. METHODS This cross-sectional study was conducted in patients clinically diagnosed with AP. An adapted questionnaire that assessed various potential factors that affect patients' preferences regarding EOLC and ACP was sent through postal mail to 278 patients. RESULTS A total of 90 completed questionnaires were returned. Most patients preferred to discuss at the time of diagnosis information about the disease, its natural course, treatment options, and prognosis. In contrast, they preferred that EOLC and ACP be discussed when the disease has progressed. No demographic or disease-related factors were found to be predictors of the patient's preferences. Notably, most patients (63.3%) had previous actual discussions on these issues. Less than a third of patients were open to discussions about MAiD and brain donation; older age and the importance of spirituality and religion decreased the odds of discussing these. CONCLUSIONS Our study demonstrates that patients with AP have preferences regarding the timing of the discussion of the different themes surrounding EOLC and ACP. A needs-based approach in initiating and conducting timely discussions on these difficult but essential issues is proposed. A thorough explanation and recognition of a patient's beliefs are recommended when initiating conversations about MAiD and brain donation. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gerard Saranza
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Section of Neurology, Department of Internal Medicine, Chong Hua Hospital, Cebu, Philippines
| | | | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Rossy Progressive Supranuclear Palsy Program, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
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Villanueva EQ, Li CC, Lin PY, Yang KL. HLA-A, -B, and -DRB1 genotyping and haplotype frequencies among Filipinos living in the National Capital Region of the Philippines. Hum Immunol 2020; 81:397-398. [PMID: 32571529 DOI: 10.1016/j.humimm.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
In this report, HLA polymorphisms (A, B, and DRB1 loci) were determined in 51 unrelated Filipinos. Molecular genotyping was carried out by sequence-based typing (Sanger sequencing). Data were analyzed by HLA-net GENE[RATE] tools. HLA-A, -B and -DRB1 genotype frequencies were at Hardy-Weinberg equilibrium. A*11, B*15, and DRB1*15 were the most frequent allele groups, while A*11-B*15-DRB1*15 was the most frequent HLA-A-B-DRB1 haplotype. HLA data are available in the Allele Frequencies Net Database (AFND: 3690) under the population name "Philippines National Capital Region".
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Affiliation(s)
- Emilio Q Villanueva
- Department of Pathology, College of Medicine, University of the Philippines, Manila, Philippines; Immunogenetics Laboratory, Buddhist Tzu Chi Stem Cells Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China
| | - Chi-Cheng Li
- Immunogenetics Laboratory, Buddhist Tzu Chi Stem Cells Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China
| | - Py-Yu Lin
- Immunogenetics Laboratory, Buddhist Tzu Chi Stem Cells Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China
| | - Kuo-Liang Yang
- Immunogenetics Laboratory, Buddhist Tzu Chi Stem Cells Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, Republic of China; Department of Laboratory Medicine and Biotechnology, Buddhist Tzu Chi University, Hualien, Taiwan, Republic of China.
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Villanueva EQ, Carnate JM. Glomangiopericytoma: The Sinonasal Mimic Of Soft Tissue Hemangiopericytoma. Philipp J Otolaryngol Head Neck Surg 2016. [DOI: 10.32412/pjohns.v31i1.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 42-year old Filipino male with a 10-month history of progressive left nasal obstruction and rhinorrhea and a clinical impression of nasal polyposis underwent endoscopic sinus surgery with partial ethmoidectomy and polypectomy.
We received several dark-brown, irregular, rubbery tissue fragments with an aggregate diameter of 3 cm. Histopathologic examination shows sheets of spindly tumor cells beneath the respiratory epithelial lining. These spindle cells are closely packed and arranged in short fascicles and storiform clusters surrounding hyalinized large vessels or thin-walled submucosal blood vessels. (Figures 1 and 2) There is no atypia or necrosis. Immunohistochemical studies show strong immunoreactivity to muscle specific actin, and focal reactivity to S-100. (Figure 3) Stains for CD34, caldesmon, cytokeratin, and desmin, are negative. (Figure 4) Based on these features, we diagnosed the case as glomangiopericytoma.
Glomangiopericytoma is a rare tumor arising from the pericytes surrounding capillaries, and accounts for less than 0.5% of all sinonasal tumors.1 It has a very slight female preponderance, with a peak incidence during the seventh decade of life. The most common symptom is nasal obstruction, or epistaxis, with accompanying difficulty breathing, sinusitis and headache. A mass, or polyp is the most common clinical finding.2
Hematoxylin–eosin staining shows a well-delineated but unencapsulated cellular tumor underneath the normal respiratory epithelium that effaces or surrounds adjacent normal structures.2 The tumor is composed of closely packed, uniform, oval to spindle-shaped cells, in short fascicles and in storiform, whorled or palisaded patterns. The cells surround numerous branching thin-walled, blood vessels, thus the morphologic resemblance to soft tissue hemangiopericytoma/solitary fibrous tumor. However, in contrast to hemangiopericytoma, glomangiopericytoma shows diffuse reactivity to muscle actins, and non-reactivity to CD34, while hemangiopericytoma shows the reverse reactions. Desmin and caldesmon are likewise non-reactive, distinguishing the tumor from leiomyomas or leiomyosarcomas of the upper aerodigestive tract. Cytokeratin non-reactivity distinguishes it from spindle cell carcinoma. S100, although typically negative, can be focally and weakly positive in a small percentage of tumor.3
Glomangiopericytoma is categorized as a borderline low malignancy tumor with an overall survival of >90% in 5 years but which tends to recur in up to 30% of cases. Strict follow-up is thus required, especially if complete resection is not achieved.1
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