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Joseph EA, Bowers KD, Marcus R, Aryal B, Schiffman SC, Wagner PL, Chalikonda S, Bartlett DL, Allen CJ. Assessing the long-term priorities of pancreaticoduodenectomy survivors. HPB (Oxford) 2024; 26:703-710. [PMID: 38443235 DOI: 10.1016/j.hpb.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study assessed the long-term quality of life (QOL) and priorities of pancreaticoduodenectomy (PD) survivors. METHODS Survivors were surveyed via internet-based support groups. The relative importance of longevity, experience, costs, and QOL were assessed. RESULTS The PD cohort (n = 247, 35%) was 60 ± 12 years, 71% female, and 93% white. With moderate agreement, patients ranked survival most important, followed by functional and emotional well-being; costs and experience were least important (W = 35.7%, p < 0.001). Well-being improved throughout survivorship (P-QOL: 39 ± 12 at ≤3 mo vs 43 ± 12 at >10 y, p = 0.170; M-QOL: 38 ± 13 at ≤3 mo vs 44 ± 16 at >10 y; p = 0.015) but remained below the general population (p < 0.001). PD patients with benign diagnoses ranked functional independence as most important (2.00 ± 1.13 vs 2.63 ± 1.19, p < 0.001, W = 41.1%); PD patients with malignant diagnoses regarded overall survival most important (2.10 ± 1.20 vs 1.82 ± 1.22, p < 0.16, W = 35.1%). The mean rank order of priorities remained concordant between short-term (<1 year) and long-term (>5 years) survivors. CONCLUSION PD survivors experience long-term mental and physical health impairments, underscoring the importance of functional and emotional support. Survivors place paramount importance on overall survival, functional independence, and emotional well-being. Cancer survivors prioritize longevity, while survivors of chronic benign conditions prioritize functional independence.
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Affiliation(s)
- Edward A Joseph
- Allegheny Health Network Singer Research Institute, Pittsburgh, PA, USA
| | - Kara D Bowers
- Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Rebecca Marcus
- Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Bibek Aryal
- Allegheny Health Network Singer Research Institute, Pittsburgh, PA, USA
| | - Suzanne C Schiffman
- Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Patrick L Wagner
- Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Sricharan Chalikonda
- Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - David L Bartlett
- Cancer Institute, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Casey J Allen
- Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA.
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Wagner PL, Knotts CM, Donneberg VS, Dadgar N, Pico CC, Xiao K, Zaidi A, Schiffman SC, Allen CJ, Donnenberg AD, Bartlett DL. ASO Visual Abstract: Characterizing the Immune Environment in Peritoneal Carcinomatosis-Insights for Novel Immunotherapy Strategies. Ann Surg Oncol 2024; 31:2332-2333. [PMID: 38265616 DOI: 10.1245/s10434-023-14739-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Patrick L Wagner
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Chelsea M Knotts
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Vera S Donneberg
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Neda Dadgar
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christian Cruz Pico
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kunhong Xiao
- Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ali Zaidi
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Suzanne C Schiffman
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Casey J Allen
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Albert D Donnenberg
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David L Bartlett
- Department of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
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3
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Wagner PL, Knotts CM, Donneberg VS, Dadgar N, Pico CC, Xiao K, Zaidi A, Schiffman SC, Allen CJ, Donnenberg AD, Bartlett DL. Characterizing the Immune Environment in Peritoneal Carcinomatosis: Insights for Novel Immunotherapy Strategies. Ann Surg Oncol 2024; 31:2069-2077. [PMID: 37996643 DOI: 10.1245/s10434-023-14553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND OR PURPOSE Carcinomatosis, a distinct pattern of metastatic cancer in the peritoneal cavity, poses challenges for treatment and has limited therapeutic options. Understanding the immune environment of peritoneal surface malignancies is crucial for developing effective immunotherapeutic approaches. This study characterizes soluble immune mediators in the peritoneal fluid of patients with and without carcinomatosis to identify targets for novel treatment strategies. PATIENTS AND METHODS Serum and peritoneal fluid samples were collected from surgical patients, and a multianalyte analysis was performed using the Luminex platform. Patient characteristics, tumor sites, and sample collection details were recorded. Soluble immune mediator levels were measured and compared between peritoneal fluid and serum samples and among clinical subgroups. Statistical analysis was conducted to assess differences in analyte concentrations and correlations between samples. RESULTS There were 39 patients included in the study, with varying surgical indications. Significant differences were observed in soluble immune mediator levels between peritoneal fluid and serum, with peritoneal fluid exhibiting lower concentrations. Carcinomatosis was associated with elevated levels of proinflammatory mediators, including IL-6 and IL-8, while adaptive immune response markers were low in peritoneal fluid. CONCLUSIONS The peritoneal immune microenvironment in carcinomatosis favors innate immunity, presenting a challenging environment for effective antitumor response. High levels of proinflammatory mediators suggest potential targets for intervention, such as the IL-6 axis, FGF2, IL-8, and CCL2; these could be explored as potential mitigators of malignant ascites and enhance anti-tumor immune responses. These findings provide valuable insights for developing immunotherapy strategies and improving outcomes in patients with peritoneal carcinomatosis.
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Affiliation(s)
- Patrick L Wagner
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Chelsea M Knotts
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Vera S Donneberg
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Neda Dadgar
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christian Cruz Pico
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kunhong Xiao
- Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ali Zaidi
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Suzanne C Schiffman
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Casey J Allen
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Albert D Donnenberg
- Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David L Bartlett
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA
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Falls SJ, Maxwell CM, Kaye DJ, Dighe SG, Schiffman SC, Bartlett DL, Wagner PL, Allen CJ. Minimally Invasive Hepatopancreatobiliary Surgery at a Large Regional Health System: Assessing the Safety of Program Expansion. Am Surg 2024; 90:85-91. [PMID: 37578387 DOI: 10.1177/00031348231192073] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Complex, minimally invasive hepatopancreatobiliary surgery (MIS HPB) is safe at high-volume centers, yet outcomes during early implementation are unknown. We describe our experience during period of rapid growth in an MIS HPB program at a large regional health system. METHODS During an increase in MIS HPB (60% greater from preceding year), hospital records of patients who underwent HPB surgery between 1/1/2019 and 12/31/2020 were reviewed. Operative time, estimated blood loss (EBL), conversion rates, length of stay (LOS), and perioperative outcomes were assessed. RESULTS 267 patients' cases were reviewed. The population was 62 ± 13 years, 50% female, 90% white. MIS was more frequently performed for hepatic than pancreatic resections (59% vs 21%, P < .001). Open cases were more frequently performed for invasive malignancy in both pancreatic (70% vs 40%, P < .018) and hepatic (87% vs 70%, P = .046) resections. There was no difference in operative time between MIS and open surgery (293[218-355]min vs 296[199-399]min, P = .893). When compared to open, there was a shorter LOS (4[2-6]d vs 7[6-10]d, P < .001) and lower readmission rate (21% vs 37%, P = .005) following MIS. Estimated blood loss was lower in MIS liver resections, particularly when performed for benign disease (200[63-500]mL vs 600[200-1200]mL, P = .041). Overall 30-day mortality was similar between MIS and open surgery (1.0% vs 1.8%, P = 1.000). DISCUSSION During a surgical expansion phase within our regional health system, MIS HPB offered improved perioperative outcomes when compared to open surgery. These data support the safety of implementation even during intervals of rapid programmatic growth.
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Affiliation(s)
- Samantha J Falls
- Surgical Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Conor M Maxwell
- Surgical Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Dylan J Kaye
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Shruti G Dighe
- Surgical Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | - Suzanne C Schiffman
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - David L Bartlett
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Patrick L Wagner
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Casey J Allen
- Division of Surgical Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
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5
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Ambani RN, Uemura T, Schiffman SC. Paradoxical Portal Anatomy in a Young Gentleman with Hepatocellular Carcinoma. Am Surg 2018; 84:455-457. [PMID: 29559065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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6
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Ambani RN, Uemura T, Schiffman SC. Paradoxical Portal Anatomy in a Young Gentleman with Hepatocellular Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400334] [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: 11/15/2022]
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7
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Cleveland NC, Hartman MS, Miller SB, Schiffman SC. Richter Transformation: An Unexpected Diffuse Large B-Cell Lymphoma Within a Fatty Mesenteric Mass in a Patient With Refractory Chronic Lymphocytic Leukemia. Curr Probl Diagn Radiol 2017; 47:353-356. [PMID: 28684057 DOI: 10.1067/j.cpradiol.2017.06.004] [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] [Received: 05/25/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022]
Abstract
Richter transformation is the development of a high-grade lymphoma from chronic lymphocytic leukemia. This rare disease manifestation is difficult to predict and carries a poor prognosis. We describe the case of a 75-year-old man with refractory chronic lymphocytic leukemia who presented with multiple growing fatty abdominal masses on computed tomography and vague abdominal distension. The patient underwent exploratory laparotomy with mass resection due to the nonspecific imaging findings. A mesenteric mass was found to contain nodules of diffuse large B-cell lymphoma. This case highlights the importance of radiologists to consider the prospect tumor transformation in the differential diagnosis of enlarging abdominal masses.
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Affiliation(s)
| | | | - Stacey B Miller
- Department of Pathology, Allegheny Health Network, Pittsburgh, PA
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8
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Schiffman SC, Abberbock S, Winters S, Valko C, Steve J, Zureikat AH, Zeh HJ, Hogg ME. A pancreatic cancer multidisciplinary clinic: insights and outcomes. J Surg Res 2016; 202:246-52. [DOI: 10.1016/j.jss.2016.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/25/2022]
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9
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Schiffman SC, Kim KH, Tsung A, Marsh JW, Geller DA. Laparoscopic versus open liver resection for metastatic colorectal cancer: a metaanalysis of 610 patients. Surgery 2014; 157:211-22. [PMID: 25282529 DOI: 10.1016/j.surg.2014.08.036] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 08/13/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) for metastatic colorectal cancer (mCRC) remains controversial. The objective of this manuscript was to perform a metaanalysis comparing outcomes of LLR with open liver resection (OLR) in patients with hepatic mCRC, and to identify which patients were suitable candidates for LLR. STUDY DESIGN A PubMed search identified 2,122 articles. When filtered for case-matched articles comparing LLR with OLR for mCRC, 8 articles were identified consisting of 610 patients (242 LLR, 368 OLR). A random effects metaanalysis was performed. RESULTS The 2 groups were well-matched for age, sex, American Society of Anesthesiologists score, tumor size, number of metastases, extent of major hepatectomy, and use of neoadjuvant/adjuvant chemotherapy. The mean number of metastases in the LLR and OLR groups were 1.4 and 1.5, respectively (P = .14). Estimated blood loss was less in LLR group (262 vs 385 mL; P = .049). Transfusion rate was significantly less in LLR group (9.9 vs 19.8%; P = .004). There was no difference in operative time (248.7 vs 262.8 min; P = .85). Length of stay (LOS) was less in the LLR group (6.5 vs 8.8 days; P = .007). The overall complication rate was less in LLR group (20.3% vs 33.2%; P = .03). Importantly, there was no difference in the 1-, 3-, and 5-year disease-free survival (DFS) or overall survival (OS) rates. CONCLUSION In carefully selected patients with limited mCRC (1 or 2 tumors), LLR provides marked perioperative benefits without compromising oncologic outcomes or long-term survival. Specifically, LLR offers decreased blood loss, LOS, and overall complication rates with comparable 5-year OS and DFS.
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Affiliation(s)
| | - Kevin H Kim
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - J Wallis Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
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10
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Schiffman SC, Boyd TG, Wrightson WR. Intercostal Herniation of the Gallbladder after Thoracotomy with Right Lower Lobe Lung Resection. Am Surg 2013. [DOI: 10.1177/000313481307901107] [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: 11/15/2022]
Affiliation(s)
| | - Travis G. Boyd
- Department of Surgery Veterans Affairs Medical Center Louisville, Kentucky
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11
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Schiffman SC, Boyd TG, Wrightson WR. Intercostal herniation of the gallbladder after thoracotomy with right lower lobe lung resection. Am Surg 2013; 79:E329-E330. [PMID: 24165239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Suzanne C Schiffman
- Department of Surgery, Veterans Affairs Medical Center, Louisville, Kentucky, USA
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12
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Schiffman SC, Nowacki MR, Spencer L, McMasters KM, Scoggins CR, Martin RC. Molecular factors associated with recurrence and survival following hepatectomy in patients with intrahepatic cholangiocarcinoma: A guide to adjuvant clinical trials. J Surg Oncol 2013; 109:98-103. [DOI: 10.1002/jso.23459] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/03/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Suzanne C. Schiffman
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
| | | | - Lena Spencer
- Norton Hospital Department of Pathology; Louisville Kentucky
| | - Kelly M. McMasters
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
| | - Charles R. Scoggins
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
| | - Robert C.G. Martin
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
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13
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Schiffman SC, Li Y, Martin RCG. The association of manganese superoxide dismutase expression in Barrett's esophageal progression with MnTBAP and curcumin oil therapy. J Surg Res 2011; 176:535-41. [PMID: 22316666 DOI: 10.1016/j.jss.2011.11.1013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 10/15/2011] [Accepted: 11/18/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between reflux induced bile insult and MnSOD expression, as well as to examine therapies to preserve MnSOD expression. Additionally, we sought to examine the relationship between MnSOD protein expression and MnSOD enzymatic activity. METHODS MnSOD protein expression was determined by Western blot assay and enzymatic activity was determined by SOD assay. The enzymatic activity of the Het-1A and Bar-T cells were compared both before and after treatments. RESULTS MnSOD expression in Het-1A cells was decreased after bile salt exposure. The cells that received MnTBAP or curcumin oil pretreatment showed increased MnSOD expression compared with control untreated cells. The Bar-T cells showed an increase in MnSOD expression after treatment with bile salts. The cells that were pretreated with MnTBAP displayed a larger increase in MnSOD expression compared with the cells that were not pretreated prior to bile salt exposure. The MnSOD activity was significantly different between the untreated cell lines (P = 0.01) and after treatment with bile salt (P = 0.03). Additionally, Bar-T cells had significantly less MnSOD activity than Het-1A cells after each of the pretreatments. CONCLUSIONS We demonstrated preservation of MnSOD expression in Het-1A cells that were pretreated with antioxidants including MnTBAP, curcumin oil, and certain berry extracts. Additionally, we demonstrated that Bar-T cells have significantly less MnSOD activity than Het-1A cells. These finding have important implications for future studies regarding chemoprevention and the treatment of esophageal cancer.
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Affiliation(s)
- Suzanne C Schiffman
- Department of Surgical Oncology, Division of Surgical Oncology, University of Louisville, Louisville, Kentucky 40202, USA
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Aiyer HS, Li Y, Losso JN, Gao C, Schiffman SC, Slone SP, Martin RCG. Effect of freeze-dried berries on the development of reflux-induced esophageal adenocarcinoma. Nutr Cancer 2011; 63:1256-62. [PMID: 22043833 DOI: 10.1080/01635581.2011.609307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The incidence of esophageal adenocarcinoma in humans is increasing more rapidly than any other malignancy in the United States. Animal studies have demonstrated the efficacy of freeze-dried berry supplementation on carcinogen-induced esophageal squamous cell carcinoma in rats; however, no such studies have been done in esophagoduodenal anastomosis (EDA), an animal model for reflux-induced esophageal adenocarcinoma (EAC) development. Eight-week-old male Sprague-Dawley rats were randomized into 3 groups: EDA + control diet (EDA-CD; n = 10); EDA + 2.5% black raspberry diet (EDA-BRB; n = 11) and EDA + 2.5% blueberry diet (EDA-BB; n = 12). After 2 wk of feeding the respective diets, the rats underwent EDA surgery to induce gastroesophageal reflux and then continued the diet. Measurement of feed intake suggested that all EDA-operated animals had lower feed intake starting at 10 wk after surgery and this was significant close to termination at 24 wk. There were no significant differences in either reflux esophagitis (RE), intestinal metaplasia (IM) (70% in CD, 64% in BRB, and 66% in BB; P = 0.1) or EAC incidence (30% for CD, 34% for BRB, and 25% for BB; P = 0.2) with supplementation. Berry diets did not alter COX-2 levels, but BB diet significantly reduced MnSOD levels (1.23 ± 0.2) compared to control diet (2.05 ± 0.14; P < 0.05). We conclude that a dietary supplementation of freeze-dried BRB and BB at 2.5% (w/w) was not effective in the prevention of reflux-induced esophageal adenocarcinoma in this EDA animal model.
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Affiliation(s)
- Harini S Aiyer
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
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15
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Schiffman SC, Reuter NP, McMasters KM, Scoggins CR, Martin RCG. Overall survival peri-hilar cholangiocarcinoma: R1 resection with curative intent compared to primary endoscopic therapy. J Surg Oncol 2011; 105:91-6. [PMID: 21815152 DOI: 10.1002/jso.22054] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 07/13/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with peri-hilar cholangiocarcinoma who undergo R1 resection with curative intent will have an improved survival compared to patients who were not resected. METHODS Review of a prospective hepatobiliary database identified 130 patients. Survival was compared using the log-rank test. RESULTS Seventy-nine patients (61%) were resected while 51 (49%) patients were not. Forty-two patients (54%) had an R0 resection. There was no difference in mean age (69 vs. 67; P = 0.8), BMI (27.8 vs. 27.9; P = 1.0), gender (73% vs. 43% male; P = 0.1), presence of jaundice (77% vs. 64%; P = 0.5), vascular involvement on pre operative imaging (77% vs. 64%; P = 0.5), stent (73.1% vs. 64.3%; P = 0.72), and lobar atrophy (27% vs. 7%, P = 0.2) in the resected versus non-resected patients. All patients underwent chemotherapy and/or radiation therapy. After a median follow up of 35.6 months the median OSl for all peri-hilar patients was 16.2 months (95% CI = 11.2-23.4). The median OS for resected patients was 18.9 months (95% CI = 12.5-24.7) versus 5.0 months (95% CI = 0-6.9) for patients not resected (P < 0.001). The only pre-operative predictor of OS was resection (P = 0.041). Vascular invasion, lobar atrophy, and stent placement were not statistically significant predictors. CONCLUSION Overall survival is improved in patients undergoing R1 resection and multi-modality therapy compared to patients not resected.
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Affiliation(s)
- Suzanne C Schiffman
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
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16
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Schiffman SC, McMasters KM, Scoggins CR, Martin RC, Chagpar AB. Lymph Node Ratio: A Proposed Refinement of Current Axillary Staging in Breast Cancer Patients. J Am Coll Surg 2011; 213:45-52; discussion 52-3. [DOI: 10.1016/j.jamcollsurg.2011.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 04/25/2011] [Accepted: 04/25/2011] [Indexed: 11/26/2022]
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17
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Schiffman SC, Chu CK, Park J, Russell M, Keilin S, Kooby DA, Scoggins CR, McMasters KM, Martin RC. Is prior cholecystectomy associated with decreased survival in patients with resectable pancreatic adenocarcinoma following pancreaticoduodenectomy? Am J Surg 2011; 201:519-24. [DOI: 10.1016/j.amjsurg.2010.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/04/2010] [Indexed: 01/23/2023]
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18
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Schiffman SC, Metzger T, Dubel G, Andrasina T, Kralj I, Tatum C, McMasters KM, Scoggins CR, Martin RCG. Precision hepatic arterial irinotecan therapy in the treatment of unresectable intrahepatic cholangiocellular carcinoma: optimal tolerance and prolonged overall survival. Ann Surg Oncol 2010; 18:431-8. [PMID: 20862554 DOI: 10.1245/s10434-010-1333-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Unresectable intrahepatic cholangiocellular carcinoma (ICC) carries a poor prognosis, and there are few chemotherapeutic treatments to prolong survival. The purpose of this study was to assess the efficacy of drug-eluting bead (DEB) therapy by transarterial infusion for unresectable ICC. METHODS A prospective multicenter study of ICC patients who received hepatic arterial DEB therapy. RESULTS Twenty-four patients with unresectable ICC were treated with DEB. Ten patients (41.6%) had recurrent ICC after prior radiofrequency ablation (n = 3) or hepatectomy (n = 7). Twenty patients (80%) had received prior chemotherapy, mostly of gemcitabine (n = 8) or Eloxatin (n = 6). The percent of overall liver involvement was < 25% (n = 8), 26% to 50% (n = 11), and > 50% (n = 4). Ten patients (40%) had sites of extrahepatic disease located at lymph nodes (n = 5), bone (n = 2), peritoneum (n = 1), lung (n = 1), and mouth (n = 1). A total of 42 DEB treatments were administered. Eight were administered in combination with systemic chemotherapy of FOLFOX (n = 4) or Gemzar (n = 4). Twelve patients (48%) received a second treatment, and 4 patients (16%) received a third treatment. The median length of stay was 23 h (23-72 h). Eleven adverse reactions (26.2%) were reported. Of these, 7 (63.6%) were minor (less than grade 3). One patient died from hepatorenal syndrome. The disease of one patient was downstaged to resection. After a median follow-up of 13.6 months, the median overall survival of a multitherapeutic regimen with DEB therapy was significantly greater than chemotherapy alone (17.5 vs. 7.4 months; P = 0.02). CONCLUSIONS Bead therapy is safe and effective in patients with unresectable ICC. There is a marked survival benefit when DEB therapy is used as adjunctive therapy.
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Affiliation(s)
- Suzanne C Schiffman
- Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
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Abstract
We sought to determine differences in risk perception and use of genetic testing in these individuals compared with those with a family history of female breast cancer (FHxFBC) in a population-based cohort. Data from the 2005 National Health Interview Survey were used to assess risk perception and use of genetic counseling in individuals with a family history of male breast cancer (FHxMBC) versus those with a FHxFBC. Of the 2429 individuals with a first-degree relative with breast cancer surveyed, 21 (0.7%) had a FHxMBC, whereas 2408 (99.3%) had a FHxFBC. Women who had a FHxMBC perceived themselves as being at higher risk for developing breast cancer than those with a FHxFBC (61.5 vs 46.5%, P = 0.011). Fewer individuals with a FHxMBC had heard about genetic testing than those with a FHxFBC (38.4 vs 50.8%, P = 0.322). Of these, none of the individuals with a FHxMBC discussed this with their physician (vs 13% of individuals with a FHxFBC, P = 0.004) and none underwent genetic testing (vs 3% of individuals with a FHxFBC, P = 0.009). Women with a FHxMBC perceive this as being associated with increased cancer risk, but few discuss this with their physicians. Physicians should be proactive in discussing risk with these patients.
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Affiliation(s)
| | - Anees B. Chagpar
- Department of Surgery, University of Louisville, Louisville, Kentucky
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20
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Schiffman SC, Chagpar AB. Does a family history of male breast cancer influence risk perception and use of genetic testing? Am Surg 2010; 76:879-882. [PMID: 20726421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We sought to determine differences in risk perception and use of genetic testing in these individuals compared with those with a family history of female breast cancer (FHxFBC) in a population-based cohort. Data from the 2005 National Health Interview Survey were used to assess risk perception and use of genetic counseling in individuals with a family history of male breast cancer (FHxMBC) versus those with a FHxFBC. Of the 2429 individuals with a first-degree relative with breast cancer surveyed, 21 (0.7%) had a FHxMBC, whereas 2408 (99.3%) had a FHxFBC. Women who had a FHxMBC perceived themselves as being at higher risk for developing breast cancer than those with a FHxFBC (61.5 vs 46.5%, P = 0.011). Fewer individuals with a FHxMBC had heard about genetic testing than those with a FHxFBC (38.4 vs 50.8%, P = 0.322). Of these, none of the individuals with a FHxMBC discussed this with their physician (vs 13% of individuals with a FHxFBC, P = 0.004) and none underwent genetic testing (vs 3% of individuals with a FHxFBC, P = 0.009). Women with a FHxMBC perceive this as being associated with increased cancer risk, but few discuss this with their physicians. Physicians should be proactive in discussing risk with these patients.
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Schiffman SC, Li Y, Xiao D, Li X, Aiyer HS, Martin RCG. The resistance of esophageal adenocarcinoma to bile salt insult is associated with manganese superoxide dismutase expression. J Surg Res 2010; 171:623-30. [PMID: 20638682 DOI: 10.1016/j.jss.2010.04.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 03/30/2010] [Accepted: 04/17/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bile acids are implicated as etiologic agents in esophageal cancer. We sought to analyze the impact of bile acid exposure on esophageal epithelial cells, Barrett's metaplastic cells (BE), esophageal adenocarcinoma cells (EAC), and esophageal squamous carcinoma cell (ESC). We sought to determine if cellular resistance is related to manganese superoxide dismutase expression. METHODS Cells were exposed to sodium choleate (CA), sodium deoxycholate (DCA), sodium glycocholate (GCA), sodium taurocholate (TCA), or a 1:1 mixture (MIX) of reagents at concentrations in the range 0.2-0.8 mM. Cell viability was evaluated by MTT assay. Manganese superoxide dismutase (MnSOD) expression was analyzed by Western blot. Statistical analysis was performed using SPSS ver. 17.0, SPSS Inc., Chicago, IL. RESULTS Bile salt exposure inhibited cell viability in esophageal squamous cells in time- and growth-dependent manner. There was a 50% decrease in cell viability from 4 to 24 h. BE, EAC, and ESC cell lines were more resistant to bile insult. In untreated cell lines, MnSOD expression was significantly decreased in EAC and ESC cell lines compared with esophageal squamous epithelial cells and BE cells (P=0.002). Exposure of ESC cells to bile salt increased MnSOD expression. CONCLUSION The confirmation of the role of reactive oxygen species (ROS) and bile acids in esophageal carcinogenesis has interesting implications for chemoprevention in patients with reflux esophagitis and Barrett's esophagus. Further studies are necessary to assess the preventative role of antioxidant supplementation.
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Affiliation(s)
- Suzanne C Schiffman
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, Kentucky 40202, USA
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22
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Schiffman SC, Li Y, Dryden G, Li X, Martin RCG. Positive correlation of image analysis by mini-endoscopy with micro-PET scan and histology in rats after esophagoduodenal anastomosis. Surg Endosc 2010; 24:2835-41. [PMID: 20440518 DOI: 10.1007/s00464-010-1059-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 03/21/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND Visual inspection of induced carcinogenic transformation is of crucial interest when evaluating growth patterns and therapeutic effects. In previous studies we have used micro-PET scan to analyze the esophageal adenocarcinoma (EAC) transformation in an intact rat model of esophagoduodenal anastomosis (EDA), in which intestinal metaplasia and EAC were reproduced successfully. Our current study aimed to test the feasibility of evaluating the outcomes of our EDA model with a recently developed mini-endoscope. METHODS EDA was performed as described previously. Postoperative rats underwent evaluation with upper endoscopy with the mini-endoscope (±endoscopic biopsy) and a micro-PET scan with (18)F-FDG 3 months after the EDA procedure. Rats were euthanized and the esophagi were collected for histological observation, immunohistochemical staining, and TdT labeling assay. We compared the endoscopic images with the radiographic images of (18)F-FDG uptake by micro-PET scan and correlated the endoscopic images with the histological changes in the EDA rats. RESULTS The endoscope provided visualization of the entire esophageal tract and upper stomach, with the smallest detectable lesion being 0.5 mm in diameter. Mini-endoscopy was performed regularly and was tolerated without any significant procedure-related alterations in the esophageal tract. The visualized esophageal lesion correlated well with the micro-PET image and the histological changes in the EDA rats. CONCLUSIONS The new mini-endoscope constitutes a practical and reliable tool for diagnosis and regular follow-up of the esophagus in rats. Lesions identified by endoscopic observation were consistent with the changes found in the micro-PET scan, histopathology, and alteration of cellular and molecular events in esophageal mucosa. This instrument will allow for serial endoscopic evaluations, similar to endoscopic screening in humans, which will significantly enhance the preclinical development and evaluation of experimental intravesical antitumor therapies.
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Affiliation(s)
- Suzanne C Schiffman
- Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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Li Y, Li X, Li Y, Brown RE, Schiffman SC, Martin RC. Abstract 2074: Association of MnSOD and microRNA-301a regulation with inhibition of pancreatic ductal adenocarcinoma. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-2074] [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: 11/16/2022]
Abstract
Abstract
Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Manganese superoxide dismutase (MnSOD) has been found to be low in human pancreatic ductal adenocarcinoma (PDAC). Overexpressing MnSOD in PDAC has decreased growth rate of cancer cells. microRNAs, short 20-25 nucleotide RNA molecules, can function as oncogenes or as tumour suppressors. It has been shown that microRNA-301a is specifically up-regulated in PDAC specimen and inhibition of microRNA-301a has a decreased growth rate of PDAC cells. Aim: This study is to determine the relationship between the level of MnSOD and microRNA-301a regulation regarding the growth inhibition of PDAC. Methods: we carried out two experiments. A total of 60 PDAC specimens, along with 20 normal pancreatic tissues were obtained for immunohistochemistry (IHC) and in situ hybridization (ISH) studies to evaluate MnSOD and microRNA-301a expression. All pathology findings for the specimens were scored by two pathologists who were both blinded to the subjects. We also established a xenograft PDAC mouse model to study the growth rate in vivo. Nude BALB/C mice, 6 weeks old, were injected subcutaneously with 5×106 human PDAC (PanC-1 cells transfected with micro-301a antisence and control). Tumor-bearing animals were maintained for 8 weeks. Tumor growth was followed and tumor volume (TV) was determined using the standard formula, TV = (L xW2)/2. Results: There were significant decreases of MnSOD expression in PDAC specimens (1.5±0.06) compared to normal controls (2.5±0.07; p < 0.05). microRNA-301a expression was significantly increased in PDAC specimens (0.85±0.046) compared to normal controls (0.1±0.05; p < 0.05). The animal study findings indicated that microRNA-301a antisence transfection can significantly decrease the growth rate of inoculated PDAC cells. The decrease the growth rate is associated with the increased MnSOD levels (Fig 1) and decreased NF-kappaB expression. Conclusions: 1) MnSOD levels are negatively associated microRNA-301a expression in PDAC tissues; 2) increased levels of MnSOD are associated with microRNA-301a down-regulation and inhibition of PDAC.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2074.
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Affiliation(s)
- Yan Li
- 1Univ. of Louisville, Louisville, KY
| | | | - Yong Li
- 1Univ. of Louisville, Louisville, KY
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Schiffman SC, Woodall CE, Kooby DA, Martin RCG, Staley CA, Egnatashvili V, McMasters KM, Scoggins CR. Factors associated with recurrence and survival following hepatectomy for large hepatocellular carcinoma: a multicenter analysis. J Surg Oncol 2010; 101:105-10. [PMID: 20035538 DOI: 10.1002/jso.21461] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Optimal management of large (>5 cm) hepatocellular carcinoma (HCC) remains controversial. We sought to determine the factors associated with recurrence and survival for patients with large HCC following hepatectomy. METHODS An analysis of a combined prospective database from two tertiary care centers was performed on consecutive patients who underwent hepatectomy for HCC > 5 cm. Univariate and multivariate analyses were performed to determine factors associated with recurrence, disease-free (DFS) and overall survival (OS). RESULTS Seventy-eight patients were identified: 32 (41%) had hepatic fibrosis. Forty-six patients (59%) underwent a major hepatectomy with a morbidity rate of 41% and a mortality rate of 13%. Fibrosis was associated with male gender (P = 0.045), hepatitis C (P = 0.003), higher Child-Pugh (P < 0.0001) and Okuda score (P = 0.002), smaller tumors (6.25 cm vs. 10.5 cm; P < 0.001), positive-margin resection (P = 0.01), and death (P = 0.047). Factors associated with recurrence include tumor multifocality (P = 0.03) and vascular invasion (P = 0.02). Predictors of OS include multifocal tumors (P = 0.05), margin status (P = 0.02), vascular invasion (P = 0.01), and treatment complications (P = 0.004). The median overall DFS and OS were 12 and 20 months, respectively. Fibrosis had no impact on DFS (P = 0.24) or OS (P = 0.20). CONCLUSIONS For patients with HCC larger than 5 cm, tumor-related factors predict outcomes and survival.
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Affiliation(s)
- Suzanne C Schiffman
- Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky 40202, USA
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