-
Matteo Fassan,
Marco Pizzi,
Stefano Realdon,
Mariangela Balistreri,
Vincenza Guzzardo,
Vittorina Zagonel, Carlo Castoro,
Luca Mastracci,
Fabio Farinati,
Donato Nitti,
Giovanni Zaninotto,
Massimo Rugge
[show abstract]
[hide abstract]
ABSTRACT: A subset of gastric (intestinal-type) and esophageal (Barrett) adenocarcinoma features HER2 protein overexpression. Consistent evidence demonstrates that microRNAs have a major role in HER2 (dys)regulation. MiR-125a-5p and miR125b expressions were tested in the spectrum of lesions in the gastroesophageal carcinogenic cascade, also correlating miR-125a-5p/125b levels with HER2 status. MiR-125a-5p and miR-125b expression (quantitative reverse transcriptase polymerase chain reaction [qRT-PCR]) and HER2 status (immunohistochemistry [IHC] and chromogenic in situ hybridization [CISH]) were assessed in a series of 90 biopsy samples spanning the whole histologic spectrum of gastric and esophageal carcinogenesis. To support the obtained results, the qRT-PCR levels of microRNAs and their expression (in situ hybridization) were tested in an adjunctive series of gastric and esophageal adenocarcinoma, including (IHC/CISH validated) HER2-negative and HER2-positive cases. Both miR-125a-5p and miR-125b levels were significantly down-regulated throughout the gastric and esophageal carcinogenic cascade. HER2 status (IHC and CISH) correlated inversely with miR-125 expression (qRT-PCR and in situ hybridization). Dysregulation of miR-125a-5p/125b and HER2 is an early event in the gastric (intestinal-type) and esophageal (Barrett) oncogenesis. In both oncogenetic cascades, miR-125 expression correlates inversely with HER2 status. MiR-125a-5p/125b can be considered among the therapeutic targets in HER2-positive esophageal and gastric adenocarcinoma.
Human pathology 04/2013; · 3.03 Impact Factor
-
Marco Scarpa,
Loretta Di Cristofaro,
Matteo Cortinovis,
Eleonora Pinto,
Maurizio Massa,
Rita Alfieri,
Matteo Cagol,
Luca Saadeh,
Aurelio Costa, Carlo Castoro,
Nicolò Bassi,
Cesare Ruffolo
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The purpose of this multicentric prospective study was to evaluate postoperative HRQL and satisfaction with care after laparoscopic colonic resection for colorectal cancer in elderly patients. METHODS: A total of 116 patients were enrolled in this study: 33 patients older than age 70 years had laparoscopic colectomy, whereas 24 had open colectomy; 44 patients younger than age 70 years had laparoscopic colectomy and 15 of them had open colectomy. The patients answered to three questionnaires about generic (EORTC QLQ C30) and disease-specific quality of life (EORTC CR29) and about treatment satisfaction (EORTC IN-PATSAT32). Nonparametric tests and forward stepwise multiple regression analysis were used for statistical analysis. RESULTS: One month after surgery, global quality of life (QL2 item) was significantly impaired in elderly patients who had laparoscopic colectomy compared with younger patients who had the same operation (p = 0.003). Similarly, role function (RF), physical function (PF), emotional function (EF), cognitive function (CF), and social function (SF) were impaired in elderly patients who had laparoscopic colectomy compared with younger patients (p < 0.001, p < 0.001, p = 0.013, p < 0.001, p = 0.01, respectively). Fatigue (FA), sleep disturbances (SL), appetite loss (AP), and dyspnea (DY) affected the quality of life of these patients more than younger patients (p < 0.001, p = 0.055, p = 0.051, and p = 0.003, respectively). CONCLUSIONS: Elderly patients undergoing laparoscopic colectomy for cancer experience less postoperative local complications than elderly patients undergoing open colectomy. Nevertheless, in the first postoperative month, these patients experience a worse global quality of life than younger patients undergoing the same operation with impairment of all the functions and the presence of fatigue, sleep disturbances, appetite loss, and dyspnea.
Surgical Endoscopy 03/2013; · 4.01 Impact Factor
-
The Journal of thoracic and cardiovascular surgery 03/2013; 145(3):895-6. · 3.41 Impact Factor
-
World Journal of Surgery 02/2013; · 2.36 Impact Factor
-
Journal of Cancer Research and Therapeutics 01/2013; 8(4):619-625. · 0.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The main outcome parameters in oesophageal surgery have traditionally been morbidity and mortality, but quality of life (QL) has become an important consideration in view of the severity and persistence of postoperative symptoms. The aim of this study was to analyse QL before and after oesophagectomy for oesophageal cancer and to explore possible association with patient's and disease characteristics. PATIENTS AND METHODS: One hundred twenty-six consecutive patients presenting with oesophageal cancer to the Oncological Surgery Unit of the Veneto Institute of Oncology between 2009 and 2011 were enrolled in this prospective study. The patients were asked to answer three QL questionnaires (the Italian versions of the QLQ-C30, the QLQ-OES18, and the IN-PATSAT32 modules developed by the European Organization for Research and Treatment of Cancer) at the time of disease diagnosis, after neoadjuvant therapy, immediately after surgery and at 1, 3, 6 and 12 months postoperatively. RESULTS: Global quality of life (QL2 item) seemed to improve after neoadjuvant therapy but it dropped markedly after surgery. It then rose to a value in between the one registered after neoadjuvant therapy and the one at diagnosis. Emotional function and dysphagia were associated to QL2 at diagnosis. After neoadjuvant therapy, age, oesophageal stenosis, emotional function and dysphagia were associated to good quality of life at that stage. After surgery, pain was associated to quality of life at that stage. During the early follow-up phase (1-3 months after surgery), role function and postoperative urinary complications were associated to QL2. In the long-term follow-up (6-12 months), adjuvant therapy, eating disorders and postoperative complications were associated to poor quality of life. CONCLUSIONS: Postoperative complications are associated to long-term emotional and physical function impairment which can lead to a significantly impaired global quality of life. Postoperative pain relief plays a key role in achieving a good postoperative quality of life. Finally, HRQL after oesophagectomy seems to be a function of therapeutic efficacy rather than of the specific surgical procedure used.
Journal of Gastrointestinal Surgery 01/2013; · 2.83 Impact Factor
-
Current Oncology 12/2012; 19(6):e501. · 2.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The nonparametric combination of dependent permutation tests method is a useful general tool when a testing problem can be broken down into a set of different k > 1 partial tests. These partial tests, after adjustment of p-values to control for multiplicity, can be marginally analyzed, but jointly considered they can provide information on an overall hypothesis, which might represent the true goal of the testing problem. On the one hand, independence among the partial tests is usually an unrealistic assumption; on the other, even when the underlying dependence relations are known quite often they are difficult to cope with properly. Therefore this combination must be achieved nonparametrically, by implicitly taking into account the dependence structure of tests without explicitly describing it. An important property of the tests based on nonparametric combination methodology, when the number of response variables is high compared to the sample sizes, consists in the finite sample consistency. A practical problem involves choosing the most suitable combining function for each specific testing problem given that the final result can be affected by this crucial choice. The purpose of this article is to present an nonparametric combination solution based on the iterated combination of partial tests, evaluate its power behavior using a Monte Carlo simulation study and apply it to a real medical problem, namely the evaluation of the effects of chemotherapy on the shape of esophageal tumors. R code has been implemented to carry out the analyses.
Statistical Methods in Medical Research 10/2012; · 2.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aims: The aim of this study was to assess the diagnostic value of positron emission tomography/computed tomography (PET/CT) in staging of esophageal cancer and to evaluate the prognostic role of metabolic parameters before and after neo-adjuvant treatment. Settings and Design: Mono-institutional retrospective study. Materials and Methods: We retrospectively evaluated 29 patients who underwent PET/CT at initial staging and after neo-adjuvant therapy. Metabolic parameters were calculated: mean, average, maximum standardized uptake value (SUVmax), and total lesion glycolysis (TLG). Diagnostic advantages of PET/CT over conventional imaging (CI) were determined. The relationships between baseline and after-therapy SUVmax and TLG, change in SUV and TLG (reported as ∆) for the primary tumor and prognosis were assessed. Statistical Analysis Used: Non-parametric statistic (e.g. Wilcoxon test and chi-square test). Results: Twenty-nine patients were eligible for the initial staging. Thirteen patients were incorrectly staged based on CI; PET/CT was able to identify distant lymph nodes in seven patients (59%) and distant metastases in four (31%). The median SUVmax before and after neoadjuvant therapy was 10.38 and 3.53 (P = 0.0005), respectively. Only few semi-quantitative parameters obtained by PET/CT after neoadjuvant therapy seemed to have a prognostic value. TLG and ∆TLG were significantly different between disease-free and died patients (0.49 versus 15.51 and 100% versus 94%, respectively; all P = <0.05). Conclusions: PET/CT is confirmed as being able to detect distant metastases and to avoid unnecessary surgery. Although not routinely reported, post-neoadjuvant TLG and ∆TLG might be considered as useful prognostic parameters and should be further evaluated prospectively.
Journal of cancer research and therapeutics 10/2012; 8(4):619-25. · 0.83 Impact Factor
-
World Journal of Surgery 09/2012; · 2.36 Impact Factor
-
Marco Scarpa,
Matteo Cagol,
Silvia Bettini,
Rita Alfieri,
Amedeo Carraro,
Francesco Cavallin,
Elisabetta Trevellin,
Luca M Saadeh,
Alberto Ruol,
Roberto Vettor,
Ermanno Ancona, Carlo Castoro
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Esophageal adenocarcinoma is often associated with obesity, and a 5 Kg m(-2) increase in body mass index (BMI) has, in fact, been found to be strongly associated with the risk of this type of cancer (RR, 1.52; p < 0.0001). Esophagectomy with lymphoadenectomy is the mainstay of therapy for these patients. The aim of this study was to assess and compare the surgical and oncological outcomes as well as the survival rates of underweight, normal weight, overweight, and obese patients following esophagectomy for esophageal cancer. PATIENTS AND METHODS: Data relative to 1,127 patients with esophageal adenocarcinoma presenting at a specialized tertiary hospital (the Center of Esophageal Diseases for the Veneto Region) between 2000 and 2008 were prospectively collected. The 278 subjects whose BMI values before disease onset were available and underwent esophagectomy were enrolled in the study. Sixty-one of the 278 patients were classified as obese (BMI >30), 121 were classified as overweight (BMI, 25-29.9), 81 were classified as normal weight (BMI <24.9), and 15 ones as underweight (BMI <20). The outcome and survival of the four groups were compared. Frequency and survival analyses were carried out. RESULTS: The rate of R0 esophagectomy and the incidence of toxicity during neoadjuvant chemotherapy were similar in the four groups. Respiratory complications after R0 esophagectomy seemed to be more frequent in the underweight and normal-weight patients group (p < 0.01). Moreover, underweight patients had a significantly higher rate of septic, cardiovascular, and metabolic postoperative complications. The 121 overweight patients had a better overall survival rate compared to normal weight and obese patients (p = 0.05). This difference was not significant if patients were stratified in stages I or II or stages III or IV. CONCLUSION: Overweight patients seem to respond better to esophageal cancer and esophagectomy with respect to normal-weight ones. This data seem to suggest that in spite of several unfavorable features, a moderate increase of weight may be helpful to survive after esophagectomy for cancer.
Journal of Gastrointestinal Surgery 09/2012; · 2.83 Impact Factor
-
Marco Scarpa,
Romilda Cardin,
Marina Bortolami,
Andromachi Kotsafti,
Maria Cristina Scarpa,
Anna Pozza,
Giorgia Maran,
Marika Picciocchi,
Cesare Ruffolo,
Renata D'Incà,
Giacomo C Sturniolo,
Ignazio Castagliuolo, Carlo Castoro,
Imerio Angriman
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: CD80 has been thought to play an active role in immunosurveillance as it has been found to be up-regulated in ulcerative colitis (UC) patients with dysplasia. The aim of the present study was to analyse early events in UC-related and non-inflammatory carcinogenesis with reference to CD80 expression to clarify what stimuli are involved in its up-regulation in these patients. PATIENTS AND METHODS: Sixty-two patients affected with UC, UC with dysplasia, UC and cancer, colonic adenoma, or colonic cancer and 11 healthy subjects were enroled in our study. Tissue samples were taken from surgical specimens during colonic resection or during colonoscopy. Mucosal mRNA expression of Toll-like receptor-4 (TLR4) and nuclear factor-kappaB (NF-κB) was quantified with Real Time RT-PCR. TLR4, β-catenin and p53 expressions were analysed by immunohistochemistry. Mucosal levels of activated NF-κB were measured with immunometric assays while 8-Hydroxydeoxyguanosine (8-OHdG) levels were quantified by high-performance liquid chromatography with electrochemical detection (HPLC-ED). Non-parametric tests were used for statistical analysis. RESULTS: 8-OHdG mucosal levels were higher in the patients with UC + dysplasia with respect to those in the patients with UC only (p=0.03). CD80 mRNA mucosal levels were directly correlated with 8-OHdG mucosal levels (τ=0.26, p=0.04), TLR4 protein expression (τ=0.45, p<0.01) and NF-κB mRNA expression and activity (τ=0.24, p=0.02; τ=0.34, p=0.02, respectively). CD80 protein expression, instead, was directly correlated with 8-OHdG mucosal levels (τ=0.19, p=0.05) and inversely correlated with TLR4 mRNA expression (τ=-0.25, p=0.03). CONCLUSION: Oxidative DNA damage peaked in UC-related dysplasia and was found to be directly correlated to CD80 expression. The direct correlation between TLR4 protein expression and CD80 mRNA and the indirect correlation between CD80 protein and TLR4 mRNA expressions give substance to the hypothesis that they play a role in immunosurveillance. No significant correlations between CD80 expression and p53 and β-catenin accumulation during oncogenesis were, instead, observed.
European journal of cancer (Oxford, England: 1990) 06/2012; · 4.12 Impact Factor
-
World Journal of Surgery 04/2012; 36(9):2263; author reply 2264. · 2.36 Impact Factor
-
Matteo Fassan,
Kathrin Ludwig,
Marco Pizzi, Carlo Castoro,
Vincenza Guzzardo,
Mariangela Balistreri,
Giovanni Zaninotto,
Alberto Ruol,
Luciano Giacomelli,
Ermanno Ancona,
Massimo Rugge
[show abstract]
[hide abstract]
ABSTRACT: Differences in human epithelial growth factor receptor 2 dysregulation in primary solid tumors and metastases may (at least partially) explain human epithelial growth factor receptor 2-targeted therapeutic inconsistencies. Human epithelial growth factor receptor 2 status was tested in a series of 47 radically treated consecutive esophagogastric junction adenocarcinomas (male/female, 38/9; mean age, 67.9 years) in both primary cancers and paired synchronous nodal metastases. None of the patients received neoadjuvant therapy. For each case, 2 nonadjacent tissue samples from primary esophagogastric junction adenocarcinoma and 2 different metastatic nodes were considered (188 tissue samples in all). Human epithelial growth factor receptor 2 status was assessed by immunohistochemistry (PATHWAY-HER2/neu [4B5]; Ventana Medical Systems, Milan, Italy) and dual chromogenic in situ hybridization (duoCISH; DAKO, Glostrup, Denmark). Immunohistochemistry staining scores were nil in 22 tumors (47%), 1 (21%) in 10, 2 (13%) in 6, and 3 (19%) in 9. Human epithelial growth factor receptor 2 gene amplification (25.5%) was associated with more differentiated phenotype (Fisher exact test, P = .039) and advanced tumor stage (Fisher exact test, P = .015). Significant agreement was observed between human epithelial growth factor receptor 2 protein expression (immunohistochemistry) and human epithelial growth factor receptor 2 gene's amplification (chromogenic in situ hybridization) (κ = 0.84, P < .001). Both immunohistochemistry and chromogenic in situ hybridization documented an excellent intratumor agreement in human epithelial growth factor receptor 2 status (κ = 0.75, P < .001; κ = 0.88, P < .001, respectively). Human epithelial growth factor receptor 2 status was comparable in primary versus metastatic nodal cancers by both immunohistochemistry and chromogenic in situ hybridization (Cohen Φ, both P < .001). In esophagogastric junction adenocarcinomas, human epithelial growth factor receptor 2 status (as assessed by immunohistochemistry and/or chromogenic in situ hybridization) is virtually unaffected by intratumor variability; it is consistent with findings in nodal metastases, and it reliably identifies patients with esophagogastric junction adenocarcinoma eligible for anti-human epithelial growth factor receptor 2 therapy.
Human pathology 01/2012; 43(8):1206-12. · 3.03 Impact Factor
-
Marco Scarpa,
Alessia Grillo,
Melania Scarpa,
Paola Brun, Carlo Castoro,
Anna Pozza,
Donatella Cavallo,
Diego Faggian,
Cesare Ruffolo,
Renata D'Incà,
Romeo Bardini,
Ignazio Castagliuolo,
Imerio Angriman
[show abstract]
[hide abstract]
ABSTRACT: Defensins are small cationic peptides with antibacterial activity expressed in Paneth cells (α-defensins) or generally in intestinal epithelial cells (β-defensins) that have a profound effect on gut microbiota. Chronic pouchitis, which occurs in 5% of patients after restorative proctocolectomy and can cause pouch failure, is associated to a significant increase of Clostridiaceae spp. The aim of this study was to gain further insight in the pathogenesis of pouch dysbiosis by exploring defensin expression. Thirty-two consecutive patients coming for follow-up endoscopy were recruited. On pouch biopsies, we cultured bacteria adherent to the mucosa and determined α- and β-defensins and toll-like receptor-4 and -2 mRNA by quantitative real-time RT-PCR. Serum and mucosal levels of IL-1β, IL-6 and TNF-α were measured with immunometric assays. Faecal lactoferrin was analysed by quantitative ELISA. After a median follow-up of 23 (IQR 20-24) months, the patients were contacted for a reassessment of current and past disease activity. During the follow-up, chronic/relapsing pouchitis was diagnosed in six patients. The mucosal level of α-5 and α-6 defensins correlated with chronic/relapsing pouchitis onset (τ = 0.30, p = 0.034 and τ = 0.28, p = 0.053, respectively). High levels of α-5 defensin resulted to be predictive of chronic/relapsing pouchitis [AUC = 74% (95% CI = 53-89%), p = 0.052]. Patients with high levels of α-5 and α-6 defensins had earlier pouchitis relapses (p = 0.009 and p = 0.034, respectively). High levels of α-5 defensin were associated to a significant risk of chronic/relapsing pouchitis [OR = 10.6 (95% CI = 1.2-97.6), p = 0.027]. At multivariate analysis, the mucosal levels of α-5 defensin and the number of CFU of mucosa-associated Clostridiaceae spp resulted to be independent predictors of chronic/relapsing pouchitis [β = 0.46 (0.18), p = 0.024 and β = 0.44 (0.18), p = 0.027, respectively]. In conclusion, chronic/relapsing pouchitis is associated to increased expression of mucosal HD-5 and to increased antimicrobial activity against Escherichia coli. In patients with chronic/relapsing pouchitis, HD-5 and TLR-4 over-expression is likely to create a hostile environment against Enterobacteriaceae, thus favouring Clostridiaceae spp by decreasing competing bacteria families.
Journal of Gastrointestinal Surgery 01/2012; 16(1):188-201; discussion 201-2. · 2.83 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study is aimed to assess the long-term health-related quality of life (HRQL) of patients after esophagectomy for esophageal cancer in comparison with established norms, and to evaluate changes in HRQL during the different stages of follow-up after esophageal resection. A systematic review was performed by searching medical databases (Medline, Embase and the Cochrane Library) for potentially relevant studies that appeared between January 1975 and March 2011. Studies were included if they addressed the question of HRQL after esophageal resection for esophageal cancer. Two researchers independently performed the study selection, data extraction and analysis processes. Twenty-one observational studies were included with a total of 1282 (12-355) patients. Five studies were performed with short form-36 (SF-36) and 16 with European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 (14 of them also utilized the disease-specific OES18 or its previous version OES24). The analysis of long-term generic HRQL with SF-36 showed pooled scores for physical, role and social function after esophagectomy similar to United States norms, but lower pooled scores for physical function, vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 global scale during a 6-mo follow-up showed that global scale and physical function were better at the baseline. The symptom scales indicated worsened fatigue, dyspnea and diarrhea 6 mo after esophagectomy. In contrast, however, emotional function had significantly improved after 6 mo. In conclusion, short- and long-term HRQL is deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-term consequence of esophagectomy involving either the respiratory system or the alimentary tract. The short- and long-term improvement in the emotional function of patients who have undergone successful operations may be attributed to the impression that they have survived a near-death experience.
World Journal of Gastroenterology 11/2011; 17(42):4660-74. · 2.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Neoadjuvant chemoradiotherapy (CT-RT) before esophagectomy seems to affect the number of nodal metastasis and to alter the distribution of those that remain. The aim of this study was to define how neoadjuvant chemoradiotherapy changes nodal metastasis patterns in locally advanced esophageal cancer.
A total of 402 consecutive patients with cancer of the esophagus or esophagogastric junction (181 adenocarcinoma [AC] and 221 squamous cell carcinoma [SCC]) (evaluated at clinical stage T1N1, T2N1, T3N0, or T3N1 and pathological stage M0) presenting in our Department between 1992 and 2007 and who underwent complete resection (R0) were included in this retrospective study on a prospectively collected database. All dissected lymph nodes were retrieved and microscopically analyzed. Nodal metastasis patterns in patients who underwent chemotherapy (CT) or chemoradiotherapy (CT-RT) neoadjuvant therapy were compared with those in patients who underwent surgery alone.
Almost 30% of the adenocarcinoma patients and approximately 40% of the SCC patients showed effective tumor downstaging after neoadjuvant therapy. There were fewer paracardial node metastases (P = .002) in the AC patients who underwent CT-RT neoadjuvant therapy. There were, likewise, significantly fewer paraesophageal, paracardial, and subcarinal node metastases in the SCC patients in whom the perigastric nodes became the second-most frequent site of metastasis.
Not only was frequency of lymph node metastases decreased after neoadjuvant therapy, but nodal localization and pattern were also significantly modified.
Annals of Surgical Oncology 05/2011; 18(13):3743-54. · 4.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy, more than 50% of patients have incurable disease at the time of presentation. This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients. Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom, the optimum management is not established. Self-expanding metal stents (SEMS) are a well-established palliation modality for dysphagia in such patients. Health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic or palliative intervention. To date, only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation. The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC. All Medline articles regarding HRQoL in patients with advanced EC, particularly those related to SEMS, were reviewed. In most studies, relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy. SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia, recurrent dysphagia and better HRQoL, although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions.
World Journal of Gastroenterology 01/2011; 17(2):144-50. · 2.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this work was to assess the diagnostic yield of some clinical diagnostic procedures utilized to establish a diagnosis of midgut neuroendocrine tumors (NETs). Medical databases published between 1982 and 2007 were analyzed. Seventeen observational studies, including 629 patients, met the inclusion criteria. Urinary 5-HIAA is the first test to prescribe in patients with flushing or persistent, unexplained diarrhea. Abdominal CT scan and OctreoScan should be prescribed whenever NET is suspected.
Journal of Surgical Oncology 12/2010; 102(7):877-88. · 2.10 Impact Factor
-
Alberto Ruol,
Christian Rizzetto, Carlo Castoro,
Matteo Cagol,
Rita Alfieri,
Gianpietro Zanchettin,
Francesco Cavallin,
Silvia Michieletto,
Gianfranco Da Dalt,
Vanna Chiarion Sileni,
Luigi Corti,
Silvia Mantoan,
Giovanni Zaninotto,
Ermanno Ancona
[show abstract]
[hide abstract]
ABSTRACT: Aim of this study was to evaluate whether delayed surgery after neoadjuvant chemoradiotherapy (CRT) affects postoperative outcomes in patients with locally advanced squamous cell carcinoma (SCC) of the thoracic esophagus.
Esophagectomy is usually recommended within 4 to 6 weeks after completion of neoadjuvant CRT. However, the optimal timing of surgery is not clearly defined.
A total of 129 consecutive patients with locally advanced esophageal cancer, treated between 1998 and 2007, were retrospectively analyzed using prospectively collected data. Patients were divided into 3 groups on the basis of timing to surgery: group 1, ≤30 days (n = 17); group 2, 31 to 60 days (n = 83); and group 3, 61 to 90 days (n = 29). Subsequently, only 2-numerically more consistent-groups were studied, using the median value of timing intervals as a cutoff level: group A, ≤46 days (n = 66); and group B, >46 days (n = 63).
Groups were comparable in terms of patient and tumor characteristics, type of neoadjuvant regimen, toxicity, postoperative morbidity and mortality rates, tumor downstaging, and pathologic complete responses. The overall 5-year actuarial survival rate was 0% in group 1, 43.1% in group 2, and 35.9% in group 3 (P = 0.13). After R0 resection (n = 106), the 5-year actuarial survival rate was 0%, 51%, and 47.3%, respectively (P = 0.18). Tumor recurrence after R0 resection seemed to be inversely related, even if not significantly (P = 0.17), to the time interval between chemoradiation and surgery: 50% in group 1, 40.6% in group 2, and 21.7% in group 3. When considering only 2 groups, the overall 5-year survival was 33.1% in group A and 42.7% in group B (P = 0.64); after R0 resection, the 5-year survival was 37.8% and 56.3%, respectively (P = 0.18). The rate of tumor recurrence was significantly lower in group B (25%) than in group A (48.3%) (P = 0.02).
Delayed surgery after neoadjuvant chemoradiation does not compromise the outcomes of patients with locally advanced SCC of the esophagus. Delaying surgery up to 90 days offers relevant advantages in the clinical management of the patients, can reduce tumor recurrences, and may improve prognosis after complete R0 resection surgery.
Annals of surgery 11/2010; 252(5):788-96. · 7.90 Impact Factor
