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The Journal of Thoracic and... Oct 2021The purpose of this study was to recognize clinically meaningful differences in lung transplant outcomes based on local or distant lung procurement. This could identify...
OBJECTIVE
The purpose of this study was to recognize clinically meaningful differences in lung transplant outcomes based on local or distant lung procurement. This could identify if the lung allocation policy change would influence patient outcomes.
METHODS
This single-center retrospective cohort study analyzed adult patients who underwent lung transplant from 2006 to 2017. Donor and recipient data were abstracted from a collaborative, prospective registry shared by our local organ procurement organization, and tertiary medical center. Short-term outcomes, 1-year survival, and hospitalization costs were compared between local and distant lung transplants defined by donor service area.
RESULTS
Of the 722 lung transplants performed, 392 (54%) had local donors and 330 (46%) had distant donors. Donors were similar in age and cause of death. Recipients were significantly different in diagnosis and local recipients had lower median lung allocation scores (local, 37.3 and distant, 44.9; P < .01). Distant lung transplants had longer total ischemic times (local, 231 ± 52 minutes and distant, 313 ± 48 minutes; P < .01). The rate of major complications, length of hospital stay, and 1-year survival were similar between groups. Distant lung transplants were associated with higher median overall cost (local, $183,542 and distant, $229,871; P < .01). Local lung transplants were more likely to be performed during daytime (local, 333 out of 392 [85%] and distant, 291 out of 330 [61%]; P < .01).
CONCLUSIONS
Local lung transplants are associated with shorter ischemic times, lower cost, and greater likelihood of daytime surgery. Short- and intermediate-term outcomes are similar for lung transplants from local and distant donors. The new lung allocation policy, with higher proportion of distant lung transplants, is likely to incur greater costs but provide similar outcomes.
Topics: Adult; Cold Ischemia; Female; Graft Survival; Humans; Lung; Lung Transplantation; Male; Outcome Assessment, Health Care; Policy Making; Postoperative Complications; Registries; Resource Allocation; Retrospective Studies; Tertiary Care Centers; Tissue Donors; Tissue and Organ Procurement; Topography, Medical; Transplants; United States
PubMed: 32977961
DOI: 10.1016/j.jtcvs.2020.07.115 -
Journal of Gastrointestinal Oncology Apr 2023To evaluate the effect of magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) and tumor deposits (TDs) on distant metastasis and long-term...
Effects of magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) and tumor deposits (TDs) on distant metastasis and long-term survival after surgery for stage III rectal cancer: a retrospective study grouped based on the relationship between the bottom of the tumor and...
BACKGROUND
To evaluate the effect of magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) and tumor deposits (TDs) on distant metastasis and long-term survival after surgery for stage III rectal cancer based on the relationship between the bottom of the tumor and peritoneal reflection.
METHODS
A retrospective study was performed on 694 patients who underwent radical resection for rectal cancer at the Harbin Medical University Tumor Hospital from October 2016 to October 2021. According to the surgical records, a new group was established based on the relationship between the lower end of the tumor and peritoneal reflection. On the peritoneal reflection group: the tumors are all located on the peritoneal reflection. Across the peritoneal reflection group: the tumors recurred across the peritoneal reflection. Under the peritoneal reflection group: the tumors are all located under the peritoneal reflection. We evaluated the effects of mrEMVI and TDs on postoperative distant metastasis and long-term survival of stage III rectal cancer by combining mrEMVI with TDs.
RESULTS
In the whole study population, neoadjuvant therapy (P=0.003) was negatively correlated with distant metastasis after rectal cancer surgery. Also, mesorectal fascia (MRF) (P=0.024), postoperative distant metastasis (P<0.001), and TDs (P<0.001) were independent risk factors for long-term survival after rectal cancer surgery. Lymph node metastasis (P<0.001) and neoadjuvant therapy (P=0.023) were independent risk factors for the presence or absence of TDs of rectal cancer. In the non-neoassisted subgroup, postoperative distant metastasis (P<0.001) was considered to be an independent risk factor for long-term survival after rectal cancer surgery.
CONCLUSIONS
In the under the peritoneal reflection group, the combination of mrEMVI and TDs seems to play a certain guiding role in predicting distant metastasis and long-term survival after rectal cancer surgery.
PubMed: 37201089
DOI: 10.21037/jgo-23-222 -
Journal of Gastrointestinal Oncology Aug 2021Although the current treatment for esophageal cancer has great technological progress, the 5-year survival rate of patients is not optimistic. About 70% of patients with...
Construction and evaluation of prognostic models for esophageal cancer patients with distant and non-distant metastases: providing a reference process for clinical diagnosis and treatment.
BACKGROUND
Although the current treatment for esophageal cancer has great technological progress, the 5-year survival rate of patients is not optimistic. About 70% of patients with esophageal cancer are at an advanced stage at first diagnosis. These patients are prone to distant metastasis, and the prognosis is poor. Therefore, understanding the risk factors for distant metastasis in patients with esophageal cancer, combined with the prognosis of the patient, can aid in choosing the optimal diagnosis and treatment plan. Ultimately, it will improve the patient's survival time and quality of life. This research aims to construct a model for the risk assessment of distant metastasis in patients with esophageal cancer and prognostic models for patients with distant and non-distant metastases.
METHODS
The Surveillance Epidemiology and End Results (SEER) database was used to select patients with esophageal cancer from 2010 to 2015. The optimal cutoff point was selected for the age and tumor size variables using X-tile. The nomogram was constructed using R software (The R Foundation for Statistical Computing).
RESULTS
Gender, grade, T stage, N stage, and tumor size were independent risk factors associated with distant metastasis in patients with esophageal cancer. The concordance index (C-index) of the nomogram prediction model for whether the patient will have distant metastasis was 0.609. Age, grade, T stage, N stage, and tumor size were independent risk factors affecting the prognosis without distant metastasis. The C-index of the nomogram prediction model for patients with distant metastases was 0.590. Age and T stage were independent risk factors affecting the prognosis of patients with distant metastases. The C-index of the nomogram prediction model was 0.543. The combination of radiotherapy, chemotherapy, and primary surgery yielded the best overall survival for both patients with distant metastases and patients with non-distant metastases.
CONCLUSIONS
A comprehensive assessment of the risk of distant metastasis in patients with esophageal cancer, combined with prognosis prediction, is necessary to provide patients with a reasonable treatment plan.
PubMed: 34532084
DOI: 10.21037/jgo-21-429 -
Scientific Reports Jun 2024Patients with distant metastasis of head and neck squamous cell carcinoma (HNSCC) often have a poor prognosis. However, early diagnosis of distant metastasis is...
Patients with distant metastasis of head and neck squamous cell carcinoma (HNSCC) often have a poor prognosis. However, early diagnosis of distant metastasis is challenging in clinical practice, and distant metastasis is often only detected in the late stages of tumor metastasis through imaging techniques. In this study, we utilized data from HNSCC patients collected from the TCGA database. Patients were divided into distant metastasis and nonmetastasis groups based on the tumor-node-metastasis (TNM) stage. We analyzed the differentially expressed genes between the two groups (DM/non-M DEGs) and their associated lncRNAs and generated a predictive model based on 23 lncRNAs that were significantly associated with the occurrence of distant metastasis in HNSCC patients. On this basis, we built a nomogram to predict the distant metastasis of HNSCC patients. Moreover, through WGCNA and Cytoscape software analysis of DM/non-M DEGs, we identified the gene most closely related to HNSCC distant metastasis: EIF5A. Our findings were validated using GEO data; EIF5A expression was significantly increased in the tumor tissues of HNSCC patients with distant metastasis. We then predicted miRNAs that can directly bind to EIF5A via the TargetScan and miRWalk websites, intersected them with differentially expressed miRNAs in the two groups from the TCGA cohort, and identified the only overlapping miRNA, miR-424; we predicted the direct binding site of EIF5A and miR-424 via the miRWalk website. Immunohistochemistry further revealed high expression of EIF5A in the primary tumor tissue of HNSCC patients with distant metastasis. These results provide a new perspective for the early diagnosis of distant metastasis in HNSCC patients and the study of the mechanisms underlying HNSCC distant metastasis.
Topics: Female; Humans; Male; Middle Aged; Biomarkers, Tumor; Eukaryotic Translation Initiation Factor 5A; Gene Expression Profiling; Gene Expression Regulation, Neoplastic; Head and Neck Neoplasms; MicroRNAs; Neoplasm Metastasis; Nomograms; Peptide Initiation Factors; Prognosis; RNA, Long Noncoding; RNA-Binding Proteins; Squamous Cell Carcinoma of Head and Neck
PubMed: 38862693
DOI: 10.1038/s41598-024-64197-z -
Scientific Reports Oct 2021Risk factors of recurrence and distant metastasis of acral lentiginous melanoma (ALM) are of great interest for the high percentage of ALM in cutaneous melanoma in Asian...
Risk factors of recurrence and distant metastasis of acral lentiginous melanoma (ALM) are of great interest for the high percentage of ALM in cutaneous melanoma in Asian populations. This single-center retrospective cohort including 177 patients with localized melanoma diagnosed from 2004 to 2020 aims to identify adverse predictors in cutaneous melanoma in Taiwan, with a focus on ALM. The relationship between clinicopathological features and outcomes, including incidences of recurrence and distant metastasis in 5 years from diagnosis, was analyzed. This study included 124 patients (70.1%) with ALM and 53 (29.9%) with non-ALM melanoma. Regarding clinicopathological characteristics, ALM patients were diagnosed at an older age and received sentinel lymph node biopsies (SLNBs) more often, while adjacent melanocytic nevi were more prevalent in non-ALM patients. With respect to prognostic implications of clinicopathological features, in ALM, implementation of SLNB was associated with a lower 5-year distant metastasis rate. Thickness of melanoma lesions over 4 mm, ulceration, and neurotropism, were related to both higher 5-year recurrence and distant metastasis rates. With regard to non-ALM patients, diagnoses made at or over 65 years old was linked to a higher 5-year recurrence rate, whereas ulceration was associated with both higher 5-year recurrence and distant metastasis rates. In conclusion, several clinicopathological characteristics have been identified to be associated with poor prognosis of cutaneous melanoma, especially ALM.
Topics: Adult; Aged; Aged, 80 and over; Disease Management; Female; Humans; Male; Melanoma; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis; Prognosis; Proportional Hazards Models; Public Health Surveillance; Recurrence; Risk Assessment; Risk Factors; Skin Neoplasms; Taiwan; Young Adult; Melanoma, Cutaneous Malignant
PubMed: 34697327
DOI: 10.1038/s41598-021-00386-4 -
Journal of Gastrointestinal Oncology Apr 2021High neutrophil-lymphocyte ratio (NLR) is linked to poor overall survival (OS) in gastrointestinal tract cancers. This study explores the clinical value of NLR, in...
BACKGROUND
High neutrophil-lymphocyte ratio (NLR) is linked to poor overall survival (OS) in gastrointestinal tract cancers. This study explores the clinical value of NLR, in addition to absolute lymphocyte count (ALC) and other hematologic parameters in association with distant metastases and OS in primary gastric lymphoma (PGL) patients.
METHODS
Clinical data of 139 PGL patients who received treatment at King Hussein Cancer Center (KHCC), Amman-Jordan were retrospectively evaluated. Using data from complete blood count (CBC) tests, the following hematologic parameters: absolute neutrophil count (ANC), ALC, absolute eosinophil count (AEC), absolute monocyte count (AMC), NLR, platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) were assessed in association with the following clinical outcomes: presence or absence of baseline distant metastases and OS. We conducted univariate and multivariate analyses assessing the various hematologic parameters in association with distant metastases.
RESULTS
Univariate and multivariate analyses indicated that patients with an elevated NLR (>3.14) displayed more baseline distant metastases compared to patients with a low NLR (≤3.14), (P value: 0.02 and 0.018, respectively). High baseline ALC (>1,819/µL) was associated with lower baseline distant metastases (P value: 0.04). In the OS analysis, high baseline ANC (>5,100/µL), NLR (>2.75), and PLR (>0.16) were associated with poor OS, (P value: 0.027, 0.016, and 0.011 respectively).
CONCLUSIONS
High NLR and ALC were associated with baseline distant metastases. High baseline ANC, NLR, and PLR were associated with poor OS. Hematologic parameters might be potentially helpful in assessing and correlating NLR with the response success to treatment in PGL.
PubMed: 34012632
DOI: 10.21037/jgo-20-383 -
Cancer Science Mar 2022Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe...
Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe treatment and survival in patients with advanced unresectable ESCC: patients with cT4b disease without metastases (cT4b), metastases limited to the supraclavicular lymph nodes (SCLNM) or distant metastatic ESCC at the population level. All patients with unresectable (cT4b) or synchronous metastatic ESCC at primary diagnosis (2015-2018) or patients with metachronous metastases after primary non-metastatic diagnosis in 2015-2016 were selected from the Netherlands Cancer Registry. Fifteen percent of patients had cT4b disease (n = 146), 12% SCLNM (n = 118) and 72% distant metastases (n = 681). Median overall survival (OS) time was 6.3, 11.2, and 4.4 months in patients with cT4b, SCLNM, and distant metastases, respectively (P < .001). Multivariable Cox regression showed that patients with cT4b (hazard ratio 1.44, 95% CI 1.04-1.99) and patients with distant metastases (hazard ratio 1.42, 95% CI 1.12-1.80) had a worse survival time compared with patients with SCLNM. Among patients who received chemoradiotherapy and/or underwent resection (primary tumor and/or metastases), median OS was 11.9, 16.1, and 14.0 months in patients with cT4b, SCLNM, and distant metastases, respectively (P = .76). Patients with SCLNM had a better survival time compared with patients with cT4b and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.
Topics: Aged; Chemoradiotherapy; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Female; Humans; Male; Middle Aged; Netherlands; Pneumonectomy; Registries; Retrospective Studies; Survival Rate
PubMed: 34986523
DOI: 10.1111/cas.15262 -
Revista Da Associacao Medica Brasileira... Jul 2017To evaluate the influence of functional capacity (FC) and how it affects quality of life (QoL) in breast cancer survivors.
OBJECTIVE
To evaluate the influence of functional capacity (FC) and how it affects quality of life (QoL) in breast cancer survivors.
METHOD
A total of 400 breast cancer survivors were studied - 118 without metastasis, 160 with locoregional metastasis and 122 with distant metastasis. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire--Core 30 (EORTC QLQ-C30), Breast Cancer-Specific (EORTC QLQ-BR23), and the Karnofsky Performance Scale (KPS) were used to evaluate FC and QoL.
RESULTS
Women with distant metastases presented lower KPS 75.3 (SD=12.5) (p<0.001). For QLQ-C30, the mean of the Functional Scale for patients with distant metastasis was 57 (SD=19) (p<0.001), and the mean of the Symptom Scale for patients with distant metastasis was 37 (SD=20) (p<0.001). Both the scales for pain and fatigue showed the highest mean in the groups. For the Global Health Scale, patients without metastasis scored a mean of 62 (SD=24) points, while those with locoregional metastases scored a mean of 63 (SD=21.4), and distant metastasis scored 51.3 (SD=24) points. In the group with distant metastases, 105 (87%) had pain, and the average KPS was 74 (SD=12.0) (p=0.001).
CONCLUSION
Breast cancer was associated with decreased FC, compromised QoL in women with locoregional and distant metastases compared to those without metastasis.
Topics: Breast Neoplasms; Female; Humans; Interviews as Topic; Karnofsky Performance Status; Neoplasm Metastasis; Pain Measurement; Quality of Life; Surveys and Questionnaires; Survivors
PubMed: 28977083
DOI: 10.1590/1806-9282.63.07.583 -
NPJ Precision Oncology Oct 2021Lymph nodes (LNs) and distant metastases can arise from independent subclones of the primary tumor. Herein, we characterized the molecular landscape and the differences...
Lymph nodes (LNs) and distant metastases can arise from independent subclones of the primary tumor. Herein, we characterized the molecular landscape and the differences between LNs, distant metastases and primary colorectal cancers (CRCs). Samples were analyzed using next generation sequencing (NGS, MiSeq on 47 genes, NextSeq on 592 genes) and immunohistochemistry. Tumor mutational burden (TMB) was calculated based on somatic nonsynonymous missense mutations, and microsatellite instability (MSI) was evaluated by NGS of known MSI loci. In total, 11,871 samples were examined, comprising primaries (N = 5862), distant (N = 5605) and LNs metastases (N = 404). The most frequently mutated genes in LNs were TP53 (72%), APC (61%), KRAS (39%), ARID1A (20%), PIK3CA (12%). LNs showed a higher mean TMB (13 mut/MB) vs distant metastases (9 mut/MB, p < 0.0001). TMB-high (≥17mut/MB) and MSI-H (8.8% and 6.9% vs 3.7%, p < 0.001 and p = 0.017, respectively) classifications were more frequent in primaries and LNs vs distant metastases (9.5% and 8.8% vs 4.2%, p < 0.001 and p = 0.001, respectively). TMB-high is significantly more common in LNs vs distant metastases and primaries (P < 0.0001), regardless MSI-H status. Overall, LNs showed significantly different rates of mutations in APC, KRAS, PI3KCA, KDM6A, and BRIP1 (p < 0.01) vs primaries, while presenting a distinct molecular profile compared to distant metastases. Our cohort of 30 paired samples confirmed the molecular heterogeneity between primaries, LNs, and distant metastases. Our data support the hypothesis that lymphatic and distant metastases harbor different mutational landscape. Our findings are hypothesis generating and need to be examined in prospective studies.
PubMed: 34707195
DOI: 10.1038/s41698-021-00230-y -
Veterinary World Mar 2021Wound healing is a dynamic and complex process that requires an appropriate environment to promote healing process. The healing of distant flaps in cats is determined by...
BACKGROUND AND AIM
Wound healing is a dynamic and complex process that requires an appropriate environment to promote healing process. The healing of distant flaps in cats is determined by vascularization, nutrient sufficiency for the cells, and stability of skin flaps. This study aims to evaluate the healing of distant flaps treated with moist wound dressing through subjective and objective observation in five cats with wounds in the forelimb and hindlimb area to determine the time to cut the skin flaps from the donor site.
MATERIALS AND METHODS
In this study, five Indonesian local cats with wounds of various sizes in the limb were brought to the Veterinary Teaching Hospital. The sterile wound treatment included the administration of anesthesia, wound debridement, and distant flap closure in the thoracic and abdominal area. The distant flap and time to cut the skin flaps from the donor site were evaluated through subjective and objective examinations.
RESULTS
The subjective observation on the color of the distant skin flaps showed redness and response to pain on day 3 after surgery, whereas the objective observation, which was based on drug absorption capability and drug effect showed good results. On day 7 after surgery, the skin flaps from the donor site were cut and showed good progress.
CONCLUSION
Overall, moist dressing helps in stabilizing the distant flap, allowing the distant flaps from the donor site to be cut on day 7 after surgery.
PubMed: 33935420
DOI: 10.14202/vetworld.2021.734-738