scholarly journals Gastric Endocrine Carcinoma: A New Look at a Rare Tumor From Cases in Japan

2020 ◽  
Vol 104 (3-4) ◽  
pp. 111-115
Author(s):  
Kenichi Iwasaki ◽  
Takeshi Suda ◽  
Hiroshi Yamaguchi ◽  
Kosuke Takahashi ◽  
Takafumi Watanabe ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Radical Resection ◽  
Middle Region ◽  
Relapse Free Survival ◽  
Standard Type ◽  
Free Survival ◽  
Future Studies ◽  
Factors Associated ◽  
Clinicopathologic Factors ◽  
The Mean

Objective: We evaluated the clinicopathologic factors associated with gastric neuroendocrine carcinoma (NEC) in patients who underwent surgical resection. Gastric NEC is rare, accounting for only about 0.6% of all malignant gastric tumors. Neither its pathogenesis nor its treatment has been fully established. Methods: We assessed 10 patients with gastric NEC who underwent surgical resection in our hospital between September 2007 and June 2019. Results: The patients consisted of 9 men and 1 woman, aged 63 to 78 years. The tumors were localized in the upper region (n = 5), middle region (n = 3), and lower region (n = 2). The macroscopic types were evaluated as 0-IIc (n = 3), 1 (n = 3), 2 (n = 1), 3 (n = 2), and 4 (n = 1). The stages were ascertained as IA (n = 3), IIB (n = 3), IIIA (n = 2), IIIB (n = 1), and IIIC (n = 1). Radical resection was performed in all the patients. After surgery, relapse-free survival was achieved in 6 patients. The mean postoperative survival time was 63.5 months. On immunostaining, 6 patients were positive for CD56, and all were positive synaptophysin and chromogranin A. Of the 10 patients, standard-type adenocarcinoma was concomitantly present in 6. Conclusions: Some patients with surgically resected gastric NEC survived over a long period, suggesting the usefulness of radical resection. In future studies, the pathogenesis of gastric NEC should be fully clarified, and therapeutic strategies must be further developed.

scholarly journals Factors Associated with the Platelet Graft in Hematopoietic Precursor Cell Transplant Patients in a Third Level Hospital in Mexico

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Cynthia Pelayo Mena ◽  
Luis Manuel Valero Saldaña ◽  
Brenda Lizeth Acosta-Maldonado ◽  
Dana Perez Camargo ◽  
Victor Itaí Urbalejo Ceniceros
Keyword(s):  
Statistical Significance ◽  
Allogeneic Transplantation ◽  
Cell Transplant ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Post Transplant ◽  
Factors Associated ◽  
Transplant Patients ◽  
Hematopoietic Precursor ◽  
The Mean

Factors associated with the platelet graft in hematopoietic precursor cell transplant patients in a third level hospital in Mexico Introduction The success of TCPH is affected by various factors such as graft versus host disease (GVHD), relapse, treatment-related toxicity, and infection, leading to increased morbidity and mortality. Thrombocytopenia is almost universal in the pre-graft period in patients sometimes on TCPH, delayed platelet recovery beyond the expected time occurs in 5% to 37% of patients sometimes on TCPH. Various studies have described a relationship between platelet graft delay and CD34 + cell dose, pre-transplant disease status, source of the graft, blood group, and even the development of platelet refractoriness. Male receptor gender and elevated serum hepcidin level have also been associated as risk factors for delayed platelet graft. Aims To assess the factors associated with late platelet grafting in the post-transplant patient of hematopoietic precursor cells. Methods Retrospective, cross-sectional, observational and descriptive study. From January 2018 to December 2019. Results 101 patients were included, 59.4% men and 40.6% women. The mean age was 37 years. Patients diagnosed with MM were 24.8%, ALL 22.8%, NHL 19.8%, HL 15.8%, AML 14.9%, CML 1%. 73.3% of the patients had a CR prior to transplantation and 26.7% had a PR. BUCY was used as a conditioning scheme in 27.7%, PEAM 27.7%, FLUBUCY 16.8%, BORMEL 11.9%, BUMEL 9.9%. 55.4% of the patients underwent autologous transplantation and 44.6% underwent allogeneic. During the peritransplantation period, 32.7% had some type of infection, 21.8% developed GVHD, and 12.9% had a relapse of the disease. Of the 101 patients, 85.1% were alive at the time of this study; 3 of these patients did not achieve a platelet graft, 2 of them required a thrombopoietic receptor agonist, 2 had a diagnosis of ALL and one had MM, the 3 patients died before the +100 day due to infectious complications. The mean platelet apheresis transfusion was 1.80. The mean recovery time for neutrophils was 11 days and for platelets 13 days. The mean follow-up was 25 months. The overall one-year survival is 70% in allogeneic post-transplant patients and 95% in autologous post-transplant patients Of the factors evaluated using the KM method to relate them to overall survival, statistical significance was found: relapse (p = 0.0001), GVHD (p = 0.002) and more than 5 x 106CD34 infused (p = 0.047). The recovery time for the platelet and neutrophil graft was not statistically significant, p=0.288 and p = 0.421 respectively. GVHD was the only factor associated with relapse-free survival. When performing a bivariate analysis, the factors with statistical significance (p= <0.05) related to the platelet graft were: allogeneic transplantation, the amount of CD34 infused, infections and GVHD. Discussion The mean time for neutrophil and platelet grafting was 11 and 13 days, respectively. According to the bivariate analysis performed, allogeneic transplantation confers 6.7 times more risk for the platelet graft to be greater than 13 days p= 0.0001. Begeman et al. have reported that there is an inverse relationship between the amount of CD34 infused and the time of platelet grafting. This observation was not reproducible in our population since we found that an amount greater than 5 x 106 CD34 conferred a 4.4-fold risk for the platelet graft to be greater than 13 days, with a p= 0.0001. This could suggest that it is probable that an amount greater than 5 x 106 could have an opposite effect and prolong the grafting time; this will have to be taken with reserve since in our multivariate a significant result was not confirmed. Overall survival and relapse-free survival were not affected by neutrophil or platelet graft time as described in some studies; probably due to the size of our sample and that in other series the follow-up time has been comparable. The median of relapse-free survival was reached at 5 months and it should be noted that relapse was the only factor that had a negative impact on the survival of our population, and was observed only in patients undergoing allogeneic transplantation; therefore, those patients who present a relapse of the disease have a poor prognosis, whose median was reached at 25 months, so perhaps it would be worthwhile to search for available rescue therapies in these patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Investigating the Relationship between CD34+and CD3+ Cell Doses, One-Year Graft-Versus-Relapse-Free-Survival, Graft-Versus-Host Disease, and Overall Survival in Haploidentical Hematopoietic Stem Cell Transplantation: A Single Center Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2051-2051 ◽  
Author(s):  
Mindy Hsiao ◽  
Anastasia Martynova ◽  
George Yaghmour ◽  
Chris Foss
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Acute Gvhd ◽  
Chronic Gvhd ◽  
Optimal Dose ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Improved Outcomes ◽  
The Mean ◽  
Related Mortality

Background: Haploidentical hematopoietic cell transplantation (haplo-HCT) has emerged as a popular alternative to traditional HLA-matched hematopoietic cell transplant. As the number of haplo-HCT's rises, investigating the factors that may affect outcomes is necessary in order to improve overall survival and reduce transplant-related mortality. The optimal dose of CD34+ cells used during haplo-HCT to ensure favorable outcomes using PTCy has not yet been reported though a range of 2 to 5.00x106 cells/kg is commonly used.Furthermore, the optimal dose of CD3+ cells is unknown however recent data has suggested less than 3.00x108 cells/kg may prevent the development of acute GVHD. The importance of studying the impact of CD34+/CD3+ cell dosing may help to improve outcomes in this setting. Methods: We retrospectively analyzed adult patients at USC Norris Cancer Hospital (age ≥ 21) who received haplo-HCT from 2014 to 2019. The primary end-point assessed was 1-year GVHD-free/relapse-free survival (GRFS) defined as grade 3-4 acute GVHD, systemic therapy-requiring chronic GVHD, relapse, or death in the first post-HCT year. Secondary end-points included 1-, 2-, and 3-year relapse-related mortality (RRM) and overall survival (OS) in addition to 1-year transplant related mortality (TRM) and incidence of both acute and chronic GVHD. Results: A total of 67 adult haplo-HCT recipients were reviewed. Of the patients evaluated, approximately 50% (n = 33) were male and 49% (n = 32) were female. The age range was 21-71 years old (median = 44), and the most common underlying hematologic disorders included AML (40%), ALL (38%), aplastic anemia (7.7%), and others (MDS, lymphoma, myelofibrosis, and HLH) (13.8%). 67% of patients received myeloablative conditioning regimens while 33% received reduced intensity regimens. 70% (n = 47) of patients received peripheral blood as a stem cell source with 30% (n = 20) receiving bone marrow. The mean CD34+ dose infused was 6.07x106 cells/kg and the mean CD3+ dose was 2.94x108 cells/kg. The mean time to recovery of platelets, neutrophils, and lymphocytes was 25, 18, and 37 days respectively. CD34+ stem cells ≥5.00x106 cells/kg was significantly associated with shorter time to lymphocyte recovery (p = 0.0265) though recovery less than 30 days was not significantly associated with OS (p = 0.5268). Incidence of 1-year GRFS was 71% (n= 46) and 1-, 2-, and 3-year RRM were 4.6%, 6%, and 7.7% respectively. 1-year TRM was 15.3% with 50% of deaths from acute GVHD. 1-, 2-, and 3-year OS were 80%, 78%, and 77% respectively. Factors significantly associated with increased mortality included use of RIC regimen (p = 0.004) and disease status at time of transplant (p = 0.04). Cumulative incidence of GVHD was 63% (n = 42) with 33% (n = 22) and 30% of patients (n = 20) with acute and chronic GVHD respectively. Lack of mild chronic GVHD was associated with increased mortality (p = 0.0029) and use of a myeloablative regimen (p = 0.0029) was significantly associated with GVHD. Subgroup analysis of those who received CD34+ dose ≥7.00x106 cells/kg (n = 24) and ≥10x106 cells/kg (n = 7) were found to have 1-year OS of 87.5% and 85.7% compared with 77% and 80% in those that received lower doses (p= 0.2229 and p = 1.00) respectively however this was not found to be significantly associated with increased incidence of GVHD, relapse, or mortality. Discussion: Our results demonstrate improved outcomes specifically 71% survived 1 year without experiencing at least 1 GRFS event compared with 24-35% reported by CIBMTR, Holtan et al 2015, and Solh et al 2016 with 3-year OS of 77% when compared with a previously reported 48%. The mean CD34+ cell dose of our population is higher than the standard range which may account for the improved outcomes however the dosing of CD34+/CD3+ cells were not significantly associated with our primary and secondary end-points. It was significantly associated, however, with shorter time to lymphocyte recovery, a factor that has been reported to be associated with decreased RRM and therefore improved OS. Furthermore, subgroup analysis of higher CD34+ dose did show a better 1-year OS though this was not statistically significant. Limitations of this study include small sample size and short follow-up period. Further research with a prospective study identifying the optimal CD34+/CD3+ cell dose in addition to comprehensive evaluation of immune recovery is warranted in order to improve haplo-HCT outcomes. Figure Disclosures Yaghmour: Jazz Pharmaceutical company: Consultancy, Speakers Bureau; Astella company: Speakers Bureau; Takeda: Speakers Bureau.

scholarly journals Estimate of long-term relapse-free survival (RFS) and analysis of baseline factors associated with RFS in the COMBI-AD trial

2018 ◽  
Vol 29 ◽  
pp. viii445
Author(s):  
R. Dummer ◽  
D. Schadendorf ◽  
A. Hauschild ◽  
M. Santinami ◽  
V.G. Atkinson ◽  
...  
Keyword(s):  
Relapse Free Survival ◽  
Free Survival ◽  
Factors Associated ◽  
Baseline Factors

Curative Radiotherapy using Different Radiation Techniques for Isolated Lung Metastasis from Colorectal Cancer

2013 ◽  
Vol 99 (1) ◽  
pp. 68-75 ◽  
Author(s):  
Sunyoung Lee ◽  
Dae Yong Kim ◽  
Sun Young Kim ◽  
Woong Sub Koom ◽  
Sun Young Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Treatment Response ◽  
Surgical Resection ◽  
Lung Metastasis ◽  
Local Control ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Curative Radiotherapy ◽  
Isolated Lung

Aims and background Surgical resection remains the mainstay for the treatment of colorectal lung metastasis, but a group of patients who are medically inoperable or unsuitable for surgery are treated with radiotherapy. The purpose of this multi-institutional study was to evaluate the clinical outcome and investigate the prognostic factors affecting local control and survival in this subset of patients. Methods We retrospectively analyzed 30 patients with 43 lesions who underwent curative radiotherapy for isolated lung metastasis from colorectal cancer at nine institutions from 2003 and 2008. A total dose of 42–75 Gy at the peripheral planning target volume was administered in 3–35 fractions. The median biologically equivalent dose was 84 Gy (range, 58.5–180). Results Treatment response was complete in 10 (33.3%), partial in 13 (43.3%), stable in six (20.0%), and progressive in one patient (3.3%). The median follow-up period for all patients was 29.0 months (range, 5.0–93.8). Kaplan-Meier local control at 5 years was 44%. The median survival was 46.2 months, and the 5-year overall survival was 47%. Twenty-three patients (77%) experienced treatment failure, most of which were intrapulmonary failure. The intrapulmonary relapse-free survival and overall relapse-free survival at 5 years were 22% and 19%, respectively. Treatment response and pre-radiotherapy carcinoembryonic antigen level were significant prognostic factors for local control and survival. Grade 3–5 toxicity occurred in 7 patients. Three patients had grade 5 toxicity, including radiation pneumonitis, a tracheoesophageal fistula, and hemoptysis. Conclusions Curative radiotherapy for isolated lung metastasis from colorectal cancer in patients who are medially inoperable or unsuitable for surgery results in long-term survival, comparable to surgical resection. Curative radiotherapy could be an effective and noninvasive alternative if dose-limiting toxicity is carefully considered, particularly in patients with bilateral or central lesions.

scholarly journals Prognostic Impact of Cirrhosis in Patients with Intrahepatic Cholangiocarcinoma following Hepatic Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Seogsong Jeong ◽  
Lei Gao ◽  
Ying Tong ◽  
Lei Xia ◽  
Ning Xu ◽  
...  
Keyword(s):  
Hepatic Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Statistical Significance ◽  
Prognostic Impact ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Future Studies ◽  
B Virus ◽  
Cirrhotic Patients ◽  
The Impact

Background. Prognostic impact of cirrhosis in patients with intrahepatic cholangiocarcinoma (ICC) upon hepatic resection remains unclear due to lack of studies in the literature.Methods. A total of 106 resected patients with ICC were reviewed, including 25 patients (23.6%) with cirrhosis and 81 noncirrhotic patients (76.4%). Subgroups of cirrhotic patients with and without hepatitis B virus (HBV) infection were studied.Results. The impact of cirrhosis on the overall survival (OS) (hazard ratio [HR], 0.901; 95% confidence interval [CI], 0.510 to 1.592;P=0.720) and the relapse-free survival (RFS) (HR, 0.889; 95% CI, 0.509 to 1.552;P=0.678) revealed no statistical significance. Furthermore, HBV-associated cirrhotic patients and the other cirrhotic patients demonstrated no statistical difference on survival outcomes (1 yr OS, 60.0% versus 70.0%; 5 yr OS, 10.0% versus 0%;P=0.744; 1 yr RFS, 53.3% versus 30.0%; 5 yr RFS, 10.0% versus 0%;P=0.279). In patients with cirrhosis, tumor size larger than 5 cm was found to be the foremost factor that was independently associated with poor prognosis.Conclusion. The presence of liver cirrhosis did not significantly affect prognosis of patients with ICC after resection. Downstaging modality may be in need for patients with ICC underlying cirrhosis, which remains to be validated in future studies.

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

2010 ◽  
Vol 5 (1) ◽  
pp. 30-48 ◽  
Author(s):  
Robert E. Elliott ◽  
Kevin Hsieh ◽  
Tsivia Hochm ◽  
Ilana Belitskaya-Levy ◽  
Jessica Wisoff ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Tumor Size ◽  
Progression Free Survival ◽  
Radical Resection ◽  
Primary Tumors ◽  
Free Survival ◽  
Recurrent Tumors ◽  
The Mean

Object Optimal treatment of primary and recurrent craniopharyngiomas remains controversial. Radical resection and limited resection plus radiation therapy yield similar rates of disease control and overall survival. The data are much less clear for recurrent tumors. The authors report their experience with radical resection of both primary and recurrent craniopharyngiomas in children and compare the outcomes between the 2 groups. Methods A retrospective analysis was performed in 86 children younger than 21 years of age who underwent a total of 103 operations for craniopharyngioma between 1986 and 2008; these were performed by the senior author. The goal was resection with curative intent in all patients. Two patients were lost to follow-up and were excluded from analysis. The mean age at the time of surgery was 9.6 years, and the mean follow-up was 9.0 years. Results All 57 children with primary tumors underwent gross-total resection (GTR). A GTR was achieved in significantly fewer children with recurrent tumors (18 [62%] of 29). There were 3 perioperative deaths (3%). Tumor recurred after GTR in 14 (20%) of 71 patients. Overall survival and progression-free survival were significantly better in patients with primary tumors at time of presentation to the authors' institution. There were no significant differences in the neurological, endocrinological, visual, or functional outcomes between patients with primary and those with recurrent tumors. Factors negatively affecting overall survival and progression-free survival include subtotal resection (recurrent tumors only), tumor size ≥ 5 cm, or presence of hydrocephalus or a ventriculoperitoneal shunt. Prior radiation therapy and increasing tumor size were both risk factors for incomplete resection at reoperation. Conclusions In the hands of surgeons with experience with craniopharyngiomas, the authors believe that radical resection at presentation offers the best chance of disease control and potential cure with acceptable morbidity. While GTR does not preclude recurrence and is more difficult to achieve in recurrent tumors, especially large and previously irradiated tumors, radical resection is still possible in patients with recurrent craniopharyngiomas with morbidity similar to that of primary tumors.

scholarly journals The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qiao-xuan Wang ◽  
Rong Zhang ◽  
Wei-wei Xiao ◽  
Shu Zhang ◽  
Ming-biao Wei ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Surgical Resection ◽  
Neoadjuvant Chemoradiotherapy ◽  
Radical Resection ◽  
Complete Response ◽  
Sphincter Preservation ◽  
Watch And Wait ◽  
Free Survival ◽  
Clinical Complete Response

Abstract Background The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancer patients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection. Methods Stage II/III rectal adenocarcinoma patients who received neoadjuvant chemoradiotherapy and achieved a cCR were selected from the databases of three centers. cCR was evaluated by findings from digital rectal examination, colonoscopy, and radiographic images. Patients in whom the watch-and-wait strategy was adopted were matched with patients who underwent radical resection through 1:1 propensity score matching analyses. Survival was calculated and compared in the two groups using the Kaplan–Meier method with the log rank test. Results A total of 117 patients in whom the watch-and-wait strategy was adopted were matched with 354 patients who underwent radical resection. After matching, there were 94 patients in each group, and no significant differences in term of age, sex, T stage, N stage or tumor location were observed between the two groups. The median follow-up time was 38.2 months. Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable. Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group. Conclusion The watch-and-wait strategy was safe, with similar survival outcomes but a superior sphincter preservation rate as compared to surgery in rectal cancer patients achieving a cCR after neoadjuvant chemoradiotherapy, and could be offered as a promising conservative alternative to invasive radical surgery.

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