David D Smith

Publications (2)5.19 Total impact

• Article: Trends in local therapy for hepatocellular carcinoma and survival outcomes in the US population.

  Roderich E Schwarz, David D Smith
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  ABSTRACT: Hepatocellular cancer (HCC) frequently presents with limitations to resection. We investigated survival outcomes after various local HCC therapies in US patients. Relationships between local HCC therapy modality and overall survival (OS) were analyzed from the Surveillance, Epidemiology and End Results (SEER) 1973-2003 database. Of 46,065 patients with primary hepatobiliary malignancy, 5,317 individuals with HCC had sufficient surgical data. The median age was 65 (range 0-105), and 73% of patients were male. The median tumor size was 6 cm (.2-30). There were single lesions (52%), multiple lesions (28%), and extrahepatic disease (20%). Mortality at 30 days was 8.4% (resection), 3.3% (transplantation), 3.2% (ablation), or 31% (no local therapy, P <.0001). Actuarial 5-year survival was 67% after transplantation, 35% after resection, 20% after ablation, and 3% for no or incomplete local therapy (P <.0001). Multivariate prognosticators were surgical modality, disease extent, grade (all at P <.0001), tumor size (P = .01), vascular invasion (P = .02), and age (P = .045). Compared to resection, risk ratios were .56 (transplantation) and 1.53 (ablation). Long-term HCC survival can be observed after all 3 treatment approaches but is best after transplantation and resection, although likely biased through confounding patient selection variables. Preferred HCC treatment should be individualized based on morbidity and long-term OS prospects.
  American journal of surgery 06/2008; 195(6):829-36. · 2.36 Impact Factor
• Article: Clinical impact of lymphadenectomy extent in resectable esophageal cancer.

  Roderich E Schwarz, David D Smith
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  ABSTRACT: Esophageal cancer (EC) frequently presents with advanced stages and is associated with high recurrence rates after esophagectomy. The value of an extended lymph node dissection (ELND) remains unclear in this setting. An EC data set was created from the Surveillance, Epidemiology, and End-Results 1973-2003 database. Relationships between the number of lymph nodes (LNs) examined and overall survival (OS) were analyzed. From a cohort of 40,129 EC patients, 5,620 individuals were selected. The median age was 65 (range: 11-102), and 75% were men. The median tumor size was 5.0 cm (0.1-30). On multivariate analysis, total LN count (or negative LN count, respectively) was an independent prognostic variable, aside from age, race, resection status, radiation, T category, N category (all at p < 0.0001), and M category (p = 0.0003). Higher total LN count (>30) and negative LN count (>15) categories were associated with best OS and lowest 90-day mortality (p < 0.0001). The numeric LN effect on OS was independent from nodal status or histology. Greater total and negative LN counts are associated with longer EC survival. Although the mechanism remains uncertain, it does not appear to be limited to stage migration. ELND during potentially curative esophagectomy for EC can be supported by the data.
  Journal of Gastrointestinal Surgery 12/2007; 11(11):1384-93; discussion 1393-4. · 2.83 Impact Factor