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Francini E, Ou FS, Lazzi S, Petrioli R, Multari AG, Pesola G, Messuti L, Colombo E, Livellara V, Bazzurri S, Cherri S, Miano ST, Wolfe EG, Alberts SR, Hubbard JM, Yoon HH, Francini G. The prognostic value of CD3+ tumor-infiltrating lymphocytes for stage II colon cancer according to use of adjuvant chemotherapy: A large single-institution cohort study. Transl Oncol 2020; 14:100973. [PMID: 33338878 PMCID: PMC7750416 DOI: 10.1016/j.tranon.2020.100973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/02/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022] Open
Abstract
Low CD3+ TILs rate was associated with shorter OS in those with stage II colon cancer who did not receive adjuvant therapy. CD3+ TILs rate was not prognostic for patients with stage II colon cancer who had adjuvant therapy. Low CD3+ TILs rate may be an additional risk factor for stage II colon cancer patients who did not have adjuvant therapy yet.
Background High tumor infiltrating lymphocytes (TILs) density was previously shown to be associated with favorable prognosis for patients with colon cancer (CC). However, the impact of TILs on overall survival (OS) of stage II CC patients who received adjuvant chemotherapy (ADJ) or not (no-ADJ) is unknown. We assessed the prognostic value of CD3+ TILs in stage II CC patients according to whether they had ADJ or not. Methods Patients treated with curative surgery for stage II CC (2002–2013) were selected from the Santa Maria alle Scotte Hospital registry. TILs at the invasive front, center of tumor, and stroma were determined by immunohistochemistry and manually quantified as the rate of TILs/total tissue areas. High TILs (H-TILs) was defined as >20%. Patients were categorized as high or low TILs (L-TILs) and ADJ or no-ADJ. Results Of the 678 patients included, 137 (20%) received ADJ and 541 (80%) did not. The distribution of the 4 groups were: 16% (L-TIL/ADJ), 64% (L-TIL/no-ADJ), 5% (H-TIL/ADJ), 15% (H-TIL/no-ADJ). Compared to H-TILs/no-ADJ, ADJ patients showed a significantly increased OS (P<.01) regardless of the TILs rate whereas L-TILs/no-ADJ had significantly decreased OS and higher risk of death (HR=1.41; 95% CI, 1.06–1.88; P<.0001). On multivariable analysis, the unfavorable prognostic value of L-TILs (vs. H-TILs) for no-ADJ patients was confirmed (HR=1.36; 95% CI 1.02, 1.82; P=.0373). Conclusion Low CD3+ TILs rate was associated with shorter OS in those with stage II colon cancer who did not receive adjuvant therapy. Low CD3+ TILs could be considered an additional risk factor for still ADJ-untreated stage II CC patients, which could facilitate clinical decision making.
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Affiliation(s)
- Edoardo Francini
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy.
| | | | - Stefano Lazzi
- Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | | | | | | | | | | | | | | | - Sara Cherri
- Santa Maria Alle Scotte Hospital, Siena, Italy
| | | | | | | | | | | | - Guido Francini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
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Francini E, Ou FS, Lazzi S, Petrioli R, Multari AG, Pesola G, Messuti L, Colombo E, Livellara V, Bazzurri S, Cherri S, Salvatora M, Wolfe E, Alberts SR, Hubbard JM, Yoon HH, Francini G. CD3+ tumor-infiltrating lymphocytes (TILs) as prognostic in patients (pts) with stage II colon cancer (CC) not treated with adjuvant chemotherapy (ADJ). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
167 Background: Previous studies have reported high TILs are a favorable prognostic factor in stage II CC. However, whether the impact of TILs on overall survival (OS) differs among pts who did or did not receive ADJ is still to be determined. We assessed the prognostic value of CD3+ TILs in pts with stage II CC according to whether they received ADJ or not (no-ADJ). Methods: Pts treated with curative surgery for stage II CC (2002-2013) were identified through the Santa Maria alle Scotte Hospital database. CD3+ TILs at the invasive front, center of tumor, and stroma, were determined by immunohistochemistry and manually quantified as the rate of TILs/total tissue areas. High TILs (H-TILs) was defined as > 20%. Pts were classified as high or low TILs (L-TILs) and ADJ or no-ADJ. Cox models were used to assess OS with hazard ratio estimates (95% CI). Results: Of the 678 pts included (356 deaths), 137 (20%) received ADJ while 541 (80%) did not. ADJ comprised fluoropyrimidine +/- oxaliplatin. Median follow-up was 8.5 years. The distributions of the 4 groups were: 16% (L-TIL/ADJ), 64% (L-TIL/no-ADJ), 5% (H-TIL/ADJ), 15% (H-TIL/no-ADJ). Compared to H-TILs/no-ADJ, ADJ pts had a significantly longer OS (P < .0001) regardless of the TILS rate while L-TILs/no ADJ had significantly shorter OS and higher risk of death (HR = 1.41; 95% CI, 1.06-1.88; P < .0001) [See table]. On multivariable analysis, adjusting for perforation, obstruction, T-stage, grade, < 12 lymph nodes resected, lymphovascular and perineural invasion, the adverse prognostic impact of L-TILs (vs H-TILs) in no-ADJ pts was confirmed (HR = 1.36; 95% CI 1.02, 1.82; P = .0373). Conclusions: Low CD3+ TILs rate was independently associated with shorter OS in stage II CC pts who did not receive ADJ, but was not prognostic among pts who had ADJ. These data suggest a potentially different impact of TILs in chemo-treated vs -untreated stage II CC which could affect clinical decision making. [Table: see text]
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Affiliation(s)
| | | | - Stefano Lazzi
- Pathological Anatomy Department, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Roberto Petrioli
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Guido Pesola
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Luciana Messuti
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Elena Colombo
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | | | - Serena Bazzurri
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Sara Cherri
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Miano Salvatora
- Medical Oncology Unit, Santa Maria alle Scotte Hospital, Siena, Italy
| | | | | | | | | | - Guido Francini
- Medical Oncology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Petrioli R, Chirra M, Messuti L, Fiaschi AI, Savelli V, Martellucci I, Francini E. Efficacy and Safety of Regorafenib With 2/1 Schedule for Patients ≥ 75 Years With Metastatic Colorectal Cancer (mCRC) After Failure of 2 Lines of Chemotherapy. Clin Colorectal Cancer 2018; 17:307-312. [PMID: 29548772 DOI: 10.1016/j.clcc.2018.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 11/25/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the CORRECT (patients with metastatic COloRectal Cancer treated with REgorafenib or plaCebo after failure of standard Therapy) trial, regorafenib was proven to extend survival of patients with metastatic colorectal cancer (mCRC) that progressed after all available therapies. Grade 3 to 4 toxicity occurred in 54% of patients, and data on the activity and tolerability of regorafenib in elderly patients were scarce. The aim of this study was to evaluate the efficacy and safety of an alternative schedule, 2-week-on treatment and 1 week-off (2/1 schedule), of regorafenib for elderly patients with mCRC. PATIENTS AND METHODS Patients ≥ 75 years with mCRC who progressed after oxaliplatin- and irinotecan-based chemotherapy received regorafenib on a 2/1 schedule. Potentially frail subjects were identified by G8 screening tool and excluded. The 2-month disease-control rate was the primary endpoint, and the secondary endpoints included safety, progression-free survival (PFS), overall survival (OS), and objective response rate. RESULTS Between February 2014 and May 2017, 23 patients with mCRC were recruited at our institution. No partial or complete responses were observed, and the stable disease and disease-control rate were 52.2%. The median PFS was 4.8 months (95% confidence interval, 3.8-6.3 months), and the median OS was 8.9 months (95% confidence interval, 6.9-10.6 months). Adverse events were uncommon, and the most frequent grade 3 toxicity adverse events were hand-foot skin reaction (9%) and fatigue (9%). Toxicity-related dose reductions and discontinuations occurred in 5 and 2 patients, respectively. CONCLUSION Regorafenib administered with a modified 2/1 schedule to patients who were aged ≥ 75 years and non-frail with treatment-refractory mCRC seems to be tolerable and achieve encouraging results in terms of PFS and OS.
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Affiliation(s)
- Roberto Petrioli
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Martina Chirra
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luciana Messuti
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Ida Fiaschi
- Pharmacology Unit, Department of Medicine, University of Siena, Siena, Italy
| | - Vinno Savelli
- Department of Surgery and Bioengineering, Section of Surgery, University of Siena, Siena, Italy
| | - Ignazio Martellucci
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Messuti L, Zoli A, Marino G, Petricca L, Nowik M, Gigante M, Varriano V, Gremese E, Tolusso B, Ferraccioli G. SAT0406 Lupus Arthropathy: the Different forms of Deforming Arthropathy. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5877] [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: 11/03/2022]
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Simone D, Canestri S, Nowik M, Messuti L, Miceli M, Privitera R, Gremese E, Di Mario C, Tolusso B, Ferraccioli G. AB0657 Genetic and Clinical Predictors of Response to Tnf-Alpha Therapy in an Italian Axial-Spa Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Miceli M, Messuti L, Barini A, Canestri S, Gigante M, Barini A, Tolusso B, Gremese E, Ferraccioli G. AB0904 Anti-Mullerian Hormone in A Cohort of Young Adult Women with Juvenile Idiopathic Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5009] [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: 11/03/2022]
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De Luca G, Gremese E, Messuti L, Bosello SL, Fedele AL, Gigante MR, Berardi G, Alivernini S, Rucco M, Carbonella A, Ferraccioli G. THU0532 Distribution of Body Mass Index and Metabolic Syndrome in Patients with Inflammatory Autoimmune Diseases from a Single Italian Centre. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Messuti L, Gremese E, Petricca L, Gigante MR, Marino G, Nowik M, Ferraccioli G. THU0313 Antineutrophil Cytoplasmic Autoantibodies (ANCA) Positivity as a Red Flag of Severe Disease in Lupus Nephritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.841] [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: 11/03/2022]
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Scaramuzzo L, Messuti L, Manicone PF, Raffaelli L, Rossi B, Gallenzi P, Berardi D, Maccauro G. Clinical and histological modifications in osteopetrotic bone: a review. J BIOL REG HOMEOS AG 2009; 23:59-63. [PMID: 19589285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Osteopetrosis is one cause of diffuse osteosclerosis and bone fragility due to abnormal remodelling rate and balance. It may cause some serious skeletal abnormalities, with particular respect to long bones, and oral complications such as osteomyelitis and exposed necrotic bone. Orthopaedists and dentists should be aware of patients with the disease because of its effect on osteoclast function, which results in impaired wound healing. The purpose of this paper is to review the aetiology, pathogenesis and bone remodelling of osteopetrosis leading to some guidance for orthopaedic surgeons and dentists on the management of patients with osteopetrosis, with particular attention to fractures.
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