Kaplan-Meier Survivals Research Articles

The prevalence and natural history of mitral annulus calcification

Abstract Background There is a paucity of data about the prevalence and natural history of mitral annular calcification (MAC). Purposes In a large cohort of patients undergoing clinically-indicated echocardiography, we aimed to evaluate the prevalence and the natural history of MAC, and the frequency of associated mitral valve dysfunction (MVD). Methods Retrospective review of all patients who underwent echocardiographic evaluation at our institution between January 1st and December 31st 2015. The patients were stratified into 3 groups: MAC with MVD, MAC without MVD, no MAC. MVD was defined as moderate or greater mitral regurgitation (MR) or stenosis (MS). The 3 groups were compared for baseline clinical and echocardiographic characteristics and all-cause mortality during follow-up. Results Of 24,415 evaluated patients, 5478 (22%) had MAC. Patients with MAC were older (75±10 vs. 60±16 years, p<0.01) and more often female (46% vs. 43%, p<0.01). MVD was more frequently observed in patients with MAC (16% vs. 7%, p<0.01); moderate or greater MR was found in 10% of patients with MAC vs. 6% without MAC (p<0.01) and MS in 7% vs. 0.5% (p<0.01). In patients with MAC, those with MVD were more often female and more frequently had creatinine ≥2mg/dl and moderate or greater aortic stenosis (AS) than those without MVD (Fig. A). Kaplan-Meier survivals at 1 year were 75% in patients with MAC and MVD, 87% in those with MAC without MVD, and 92% in those without MAC (Fig B). Adjusted for age, sex, diabetes, creatinine ≥2 mg/dl, coronary artery disease, left ventricular ejection fraction <50%, and AS, MAC was associated with higher all-cause mortality (adjusted hazard ratio1.4, 95% confidence interval: 1.3–1.5, p<0.01); combined MAC and MVD was associated with the highest mortality during follow-up of 2.5±1.8 years. Conclusion In a large cohort of patients undergoing echocardiographic evaluation, the prevalence of MAC was 22%. MV dysfunction was more than twice as prevalent in patients with MAC as without. Patients with MAC had higher all-cause mortality than patients without MAC. Among patients with MAC and mitral valvular dysfunction, adjusted mortality was two-fold higher compared to those without MAC. Funding Acknowledgement Type of funding source: None

Comparison of fecal calprotectin and serum C-reactive protein in early prediction of outcome to infliximab induction therapy

Background: Fecal calprotectin (FC) and serum C-reactive protein (CRP) are biomarkers of disease activity in Crohn’s disease (CD) and ulcerative colitis (UC). We assessed FC, CRP, Harvey–Bradshaw index (HBi), partial Mayo Clinic Scoring (pMCS) and a cytokine panel during infliximab induction to predict therapy outcome.Methods: FC, CRP and clinical indices were evaluated in 123 (76 CD, 47 UC) patients before infliximab induction and after 12 weeks. Responders were monitored 48 weeks for an ‘incident’ (dosage increase, shortened dosage interval, surgery). Cutoff values for FC and CRP were obtained using receiver-operating characteristics (ROC). Disease progression was analyzed with Kaplan–Meier survivals, log-rank test and logistic regression for combined biomarkers. Cytokines were analyzed with Luminex multiplexing system.Results: Following infliximab, FC and CRP declined (p < .0001) along with HBi for CD and pMCS for UC. Simultaneously, IL-6 and TNF-α decreased, while IL-10 increased. Optimal FC ROC cutoff was 221 µg/g (sensitivity 66%, specificity 67%, AUC 0.71) and CRP ROC cutoff 2.1 mg/L (sensitivity 54%, specificity 60%, AUC 0.58). In CD, FC > 221 µg/g (p < .0001), but not CRP > 2.1 mg/L predicted an ‘incident’. However, combined FC and CRP also predicted an ‘incident’ (p < .042). In UC, both FC > 221 µg/g (p < .0005) and CRP > 2.1 mg/L (p = .0334) predicted ‘incident’, as did combined biomarkers (p < .005).Conclusions: Clinical disease activity is reduced by treatment with infliximab. In CD, persistently high FC, but not CRP, predict a treatment ‘incident’, whereas in UC both high FC and high CRP predict ‘incident’. Combined FC and CRP values also predict an ‘incident’.

Efficacy analysis of neoadjuvant chemotherapy for resectable locally advanced adenocarcinoma of the esophageal-gastric junction

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy (oxaliplatin + capecitabine, XELOX) for the resectable locally advanced adenocarcinoma of esophageal-gastric junction (AEG). Methods The prospective study was conducted. The clinicopathological data of 106 locally advanced AEG patients who were admitted to the Cancer Hospital of Shantou University Medical College from January 2011 to December 2014 were collected. All the patients were divided into the treatment group and control group by single blind, randomized, controlled random number table. Patients underwent preoperative neoadjuvant chemotherapy (XELOX) + surgery + postoperative adjuvant chemotherapy (XELOX) in the treatment group and surgery + postoperative adjuvant chemotherapy (XELOX) in the control group. Total gastrectomy + Roux-en-Y esophagojejunostomy + D2 lymphadenectomy were applied to patients by the same team of doctors. Observation indicators: (1) treatment situations; (2) results of postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination was performed to detect the postoperative tumor recurrence or metastasis and patients′ survival up to February 2017. Measurement data with normal distribution were represented as ±s, and comparisons between groups were evaluated with the t test. Measurement data with skewed distribution were described as M (range) and analyzed by the nonparametric test. Comparisons of count data were analyzed using the chi-square test. The ordinal data were compared using the nonparametric test. Survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method and survivals were compared using the Long-rank method. Results One hundred and six patients were screened for eligibility, including 54 in the treatment group and 52 in the control group. (1) Treatment situations: ① preoperative neoadjuvant chemotherapy: 54 in the treatment group received 2-4 cycle neoadjuvant chemotherapy. During the chemotherapy, gastrointestinal reaction, grade 1-2 granulocytopenia, elevated alanine transaminase (ALT) and grade 3 granulocytopenia were detected in 21, 17, 8, 1 patients, and 7 patients had no adverse reaction. The complete response(CR), partial response (PR), stable disease (SD) and progressive disease (PD) of neoadjuvant chemotherapy in the treatment group were detected in 4, 27, 20 and 3 patients, respectively. Of 54 patients in the treatment group, 4, 13, 25 and 12 were in grade 0, 1, 2 and 3 of response to preoperative chemotherapy, respectively. ② Surgical situations: preoperative carcinoembryonic antigen (CEA) in the treatment and control groups were respectively 4.71 μg/L (range, 0.20-36.19 μg/L) and 14.09 μg/L (range, 0.71-178.20 μg/L), with a statistically significant difference between groups (Z=-1.92, P 0.05). ③ Postoperative adjuvant chemotherapy: all the patients completed the postoperative adjuvant chemotherapy. The granulocytopenia, elevated ALT and gastrointestinal reaction occurred in 25, 5, 28 patients in the treatment group and 21, 7, 30 patients in the control group, respectively, with no statistically significant difference between groups (χ2=0.38, 0.47, 0.36, P>0.05). Some of the patients were merged with multiple adverse reactions. (2) Results of postoperative pathological examination: maximum tumor dimension, cases with lymphovascular invasion, perineural invasion, T0, T2, T3, T4 (T stage), stage 0, Ⅰ, Ⅱ and Ⅲ (TNM stage) were respectively (3.6±1.4)cm, 5, 10, 4, 10, 20, 20, 4, 7, 15, 28 in the treatment group and (4.5±1.7)cm, 24, 30, 0, 2, 13, 37, 0, 1, 12, 39 in the control group, with statistically significant differences between groups (t=-2.88, χ2=18.14, 17.30, Z=14.74, 8.13, P 0.05). There was a statistically significant difference in cases with local recurrence between groups (χ2=4.41, P<0.05) The tumor-free survival time and overall survival time in the treatment group were respectively 29 months (range, 8-72 months), 38 months (range, 10-72 months) in 31 patients with CR and PR and 11 months (range, 3-68 months), 18 months (range, 4-68 months) in 23 patients with SD and PD, showing statistically significant differences in tumor-free and overall survival times (χ2=5.27, 7.72, P<0.05). Conclusion Neoadjuvant chemotherapy with oxaliplatin and capecitabine is safe and effective for patients with the resectable locally advanced AEG, it can also decrease tumor stage and reduce local recurrence, but fail to demonstrate a survival benefit. Key words: Adenocarcinoma of esophagogastric junction; Locally advanced; Neoadjuvant chemotherapy

Adjuvant radiotherapy is not supported in patients with verrucous carcinoma of the oral cavity

To analyze the impact of adjuvant radiation therapy (RT) on overall survival (OS) and disease-specific survival (DSS) in patients with verrucous carcinoma (VC) as compared to squamous cell carcinoma (SCC) of the oral cavity. Cross-sectional population analysis. Cases of nonmetastatic VC/SCC of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (1988-2013). Kaplan-Meier survivals, stratified according to T stage, were compared between VC and SCC for treatment with or without adjuvant RT. A total of 18,819 VC/SCC cases were identified. There were 581 (3.1%) VC (mean age 69.6 years, 48.9% female) versus 18,238 (97.0%) SCC (mean age, 65.3, 37.1% female) patients. Verrucous carcinoma patients receiving surgery alone (N = 539) demonstrated a trend toward improved OS versus VC patients receiving surgery and RT (N = 40) (117.0 vs. 71.4 months, respectively, P = 0.119). There was a statistically significant improvement in DSS in VC patients receiving surgery alone (217.2 vs. 110.9 months, P = 0.05). Verrucous carcinoma patients treated with adjuvant RT demonstrated a trend toward a worse OS (71.4 vs. 93.0 months, P = 0.992) and DSS (110.9 vs. 162.3 months, P = 0.275) compared to SCC treated with adjuvant RT, suggesting a different biology and radiosensitivity between VC and SCC. Verrucous carcinoma treated with adjuvant RT had a worse OS and DSS compared to both VC treated with surgery alone and SCC treated with surgery and adjuvant RT. Consideration should be given to surgical re-section rather than adjuvant RT in patients with positive margins or local recurrence. 2C. Laryngoscope, 127:1334-1338, 2017.

Comparison of tumor response assessment methods in patients with metastatic colorectal cancer after locoregional therapy.

We evaluated the performance of the Response Evaluation Criteria in Solid Tumor (RECIST), modified RECIST, and the European Association for the Study of Liver (EASL) guidelines and correlated them with survival in patients with metastatic colorectal cancer (mCRC) treated with locoregional therapy (LRT). Our LRT registry was evaluated from 2008 to 2013. 228 mCRC patients were treated with LRT (91% drug-eluting beads, 9% radioembolization) were evaluated. Cox regression and Kaplan-Meier (KM) statistics were utilized for survival analysis. Excellent inter-rater agreement between EASL/mRECIST (κ = 905) was seen. Correlations between RECIST/mRECIST (κ = 0.638) and EASL/RECIST were weaker (κ = 0.638 and 0.598, respectively). There were significant differences in KM and Cox regression survivals between responders and nonresponders with all three methods (all P < 0.0001). Multivariate analysis identified RECIST response, tumor extent, performance status, concomitant chemotherapy, and prior surgery/ablation as independent prognostic factors. EASL response and mRECIST response were not found to be independent prognostic factors. Imaging biomarkers are not efficient and do not represent ideal surrogates for survival; however, they all display prognostic significance. RECIST is superior to mRECIST/EASL given its ability to stratify survival benefit according to response category and demonstrate independent prognostic significance. J. Surg. Oncol. 2016;113:443-448. © 2016 Wiley Periodicals, Inc.

Pleomorphic Lobular Carcinoma of the Breast: A Review of 35 Cases at a Single Institution

Objectives: Pleomorphic lobular carcinoma (PL) is an aggressive subtype of invasive lobular carcinoma. There are few case series reporting on this aggressive form of breast cancer. This report features a descriptive and survivorship comparison of a large case series of PL reviewed by a single breast pathologist. Methods: From 1993-2010 we retrospectively reviewed 198 cases of invasive lobular carcinomas, 35 cases (34 patients with one patient presenting with 2 independent cancers) of PL and 163 cases of non-pleomorphic invasive lobular carcinoma (NPL). The pathology was reviewed by a single breast pathologist and classified as either PL or NPL according to WHO classification. Kaplan-Meier survivals were computed and compared with a log rank test using SPSS 18. Overall survival (OS) was computed from date of diagnosis. Progression free survival (PFS) until either local or metastatic failure was computed. Results: Median follow-up was 59.5 months and 73 months, for NPL and PL respectively. Median age of diagnosis was 55 and 58.67 for PL and NPL groups. Of the NPL group, 75.5% were post-menopausal opposed to 67.6% in PL group. PL cases were ER positive 87.1% vs. 90.1% of the NPL cases. Her-2/neu status was known in nearly 50% of cases with 17 positive NPL and 5 positive PL. Clinical stage at presentation was stage IIB or less in 67.6% of the PL and 80.1% of the NPL. Six presented (17.6%) with metastatic disease in the PL group and 12 (7.7%) in the NPL group. None of the descriptive comparisons were significantly different by c2 analyses. PFS at 5 years was 30% and 21% in PL and NPL, respectively (p=0.73). OS at 5 years was 68.5% for PL and 83.9% for NPL (p=0.031). Conclusions: PL patients showed a statistically significant decreased OS, but no significant difference in PFS, at 5 years from diagnosis.

Pleomorphic lobular breast carcinoma: A review of 35 cases at a single institution.

175 Background: Pleomorphic lobular carcinoma (PL) is an aggressive subtype of invasive lobular carcinoma. A previous report of 52 patients showed an increase in development of metastases for pleomorphic lobular carcinoma patients. There are relatively few case series reporting on this aggressive form of breast cancer. This report features a descriptive and survivorship comparison of a large case series of PL reviewed by a single breast pathologist. Methods: From 1993-2010 we retrospectively reviewed 198 cases of invasive lobular carcinomas, 35 cases (34 patients with one patient presenting with 2 independent cancers) of PL and 163 cases of non-pleomorphic invasive lobular carcinoma (NPL). The pathology was reviewed by a single breast pathologist and classified as either PL or NPL according to WHO classification. Kaplan-Meier survivals were computed and compared with a log rank test using SPSS 18. Overall survival (OS) was computed from date of diagnosis to date of last update (02/01/11). Progression free survival (PFS) until either local or metastatic failure was also computed. Results: The median follow-up was 59.5 months and 73 months, for NPL and PL patients respectively. The median age of diagnosis was 55 (range 40-80) and 58.67 (range 36-89) for PL and NPL groups. Of the NPL group, 75.5% were post-menopausal as opposed to 67.6% in the PL group. PL cases were ER positive 87.1% vs. 90.1% of the NPL cases. Her-2/neu status was known in nearly 50% of cases with 17 positive NPL cases and 5 positive PL cases. Clinical stage at presentation was stage IIB or less in 67.6% of the PL patients and 80.1% of the NPL patients. Six patients presented (17.6%) with metastatic disease in the PL group and 12 patients (7.7%) in the NPL group. None of the descriptive comparisons above were significantly different by χ2 analysis. PFS at 5 years was 30% and 21% in PL and NPL patients, respectively (p=0.73). OS at 5 years was 68.5% for PL patients and 83.9% for NPL patients (p=0.031). Conclusions: In this large case series of PL cases reviewed by a single breast pathologist, PL patients showed a statistically significant decreased OS, but no significant difference in PFS, at 5 years from diagnosis.

Survival in oral cavity minor salivary gland carcinoma

Objective To describe the epidemiology and comparative survival for minor salivary gland cancer of the oral cavity. Study Design Historical cohort study. Setting Academic medical center. Subjects and Methods Cases of minor salivary gland cancer of the oral cavity were extracted from the Surveillance, Epidemiology, and End Results database (1988-2005) and staged. Kaplan-Meier survivals were compared according to histology as well as T stage and N stage. A Cox proportional hazards model incorporating histology, T stage, N stage, age, and sex was analyzed. Results A total of 639 salivary gland cancers of the oral cavity (55% female; mean age, 56 years) were identified with complete staging information, consisting of 318 mucoepidermoid, 169 adenoid cystic, 139 adenocarcinoma, and 14 acinic cell cancers. The hard palate and gums were the most common subsites involved (87.6%), followed by lip (7.2%) and tongue (5.2%). At presentation, T1 and T4 tumors predominated (42.6% and 35.2%, respectively); 93.4 percent were N0. Overall mean survival (months) was 157.9 and was similar across histologic subtypes: mucoepidermoid (172.4), adenoid cystic (141.4), acinic cell (138.7), and adenocarcinoma (147.2). Survival for low- and intermediate-grade mucoepidermoid carcinoma (171.0 and 182.3, respectively) was better than survival for high-grade mucoepidermoid carcinoma (50.3, P < 0.001). On multivariate analysis, N stage ( P < 0.001) was the most powerful predictor of survival, along with T stage ( P = 0.013), age ( P < 0.001), and sex ( P < 0.001). Conclusion T stage and N stage are the most powerful predictors of survival in minor salivary gland carcinoma of the oral cavity. With the exception of high-grade mucoepidermoid carcinoma, survival for these lesions is generally favorable.

Retrospective comparison of response rates and survival with neoadjuvant docetaxel versus anthracycline-based chemotherapy for locally advanced breast cancer patients

e11564 Background: LABC is a major problem in our country comprising of ≥ 20% of all breast cancer patients. Neoadjuvant chemotherapy is now standard treatment for LABC but randomized trials have failed to show survival advantage. Methods: We retrospectively analyzed locally advanced breast cancer (stage III) patients who received neoadjuvant chemotherapy (NACT) from January 2000 to December 2008. Out of 3000 case records screened, 570 (19%) were LABC and 110/570 (19%) treatment-naïve patients started on NACT were analyzed. Ninety one (37 docetaxel [D], 54 anthracycline [A]) patients were eligible for response and survival analysis. Pathological CR (pCR) was defined as no evidence of malignancy in both breast and axilla. Survival curves generated using Kaplan-Meier method and survivals compared using log-rank test. Results: Median age of whole cohort was 45 years (range 25–68 years). Premenopausal were 42% and ER+ 49.5%. Most (90%) were T4 tumors and 70% were stage IIIB. Median number of preoperative cycles was 3 and 6 in D and A group. Overall clinical response rates for breast primary were 74.3% (CR 28.6%) and 53.7% (CR 16.7%, p=0.58) while for axilla ORR were 75.7% (51.4% CR) vs 54.8% (40.4% CR, p=0.77) respectively for D and A. Corresponding pCR rates were 19% vs 13% respectively. There was no significant difference in disease free (3 year 56.84% vs 61.16%, p=0.80) and overall survival (3 year 70% vs 78.5%, p=0.86) between two groups. Those who achieved pCR in both groups also had no survival advantage (p=0.34) over non achievers. There was no difference in pCR rates for ER+ vs ER- patients but ER+ patients had significantly higher DFS than ER- patients (p=0.05). Conclusions: Although pCR rates were higher with docetaxel based NACT, it did not translate into superior DFS/OS compared to anthracycline based chemotherapies. Achievement of pCR too, was not associated with any survival advantage. No significant financial relationships to disclose.

Keratoplasty for Treatment of Acanthamoeba Keratitis

To evaluate and compare the outcomes of therapeutic keratoplasty (TKP) and optical keratoplasty (OKP) in the management of medically unresponsive Acanthamoeba keratitis and post-keratitis scarring, respectively. Retrospective, nonrandomized, comparative, interventional case series. Thirty patients with Acanthamoeba keratitis treated at a single center. Retrospective review of all cases of penetrating keratoplasty (PKP) or lamellar keratoplasty (LKP) performed for Acanthamoeba keratitis at a single center between January 1, 1980, and December 31, 2007. Inclusion criteria included histopathologic confirmation of Acanthamoeba organisms in the surgical specimen and at least 6 months of postoperative follow-up. Postoperative complications, microbiological cure, graft survival, and visual acuity. Thirty-one eyes of 30 patients met the inclusion criteria. This included 22 eyes (22 patients) that were initially treated with TKP (20 PKP/2 LKP) and 9 eyes (8 patients) treated with OKP (8 OKP/1 LKP). Of the 22 eyes treated with TKP, multiple keratoplasties (range, 2-6) were performed in 12 eyes (55%), whereas repeat keratoplasty was performed in only 1 eye (11%) treated with OKP (P = 0.004). Recurrent Acanthamoeba keratitis, glaucoma, early and late persistent epithelial defects, and endophthalmitis were more likely to occur after TKP than after OKP. A microbiological cure was achieved in all surgical cases. Among eyes treated with TKP, this required 1 keratoplasty in 14 eyes, 2 keratoplasties in 6 eyes, and 3 keratoplasties in 2 eyes. After the initial keratoplasty, Kaplan-Meier survivals after TKP were 45.5%, 45.5%, and 37.5% at 1 year, 5 years, and 10 years, respectively, compared with 100%, 100%, and 66.7%, respectively, after OKP (P = 0.004). The median visual acuity was 20/40 after TKP and 20/25 after OKP. Eyes treated with TKP were less likely to obtain visual acuity of 20/40 or better and more likely to have vision of 20/200 or worse. Therapeutic keratoplasty can successfully treat medically unresponsive cases of Acanthamoeba keratitis, although multiple grafts may be required and the visual prognosis is guarded. Optical keratoplasty performed after resolution of active keratitis is associated with an excellent prognosis for both graft survival and visual outcome. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Staging and Survival Analysis for Nonsquamous Cell Carcinomas of the Larynx

Determine staging and comparative survival for nonsquamous cell carcinoma (SCC) of the larynx. Cross-sectional population analysis. : Cases of non-SCC supraglottic, glottic, and subglottic cancers were extracted from the Surveillance, Epidemiology and End Results database (1988-2003) and the staging distribution computed. For each site, Kaplan-Meier survivals were compared according to histology, T-stage, and N-stage. Survival for non-SCC cancers for each site were compared among histologies, T-stage, and N-stage as well as with age/sex/stage-matched SCC cancers to determine differences in survival. One hundred forty supraglottic non-SCC cases were identified (67% male, mean age 62.0 yr) consisting of 25 neuroendocrine, 25 small cell, and 22 lymphomas (among others), with mean survivals of 44.8, 52.1, and 80.5 months, respectively. Survival was not significantly different according to histology (log-rank, P = .440) but was significantly different according to T-stage (P = .029) and N-stage (P < .001). Seventy-eight glottic non-SCC cases were identified (83% male, mean age 66.1 yr) consisting of 32 spindle cell, 13 sarcoma, and 10 small cell (among others), with mean survivals of 114.6, 89.8, and 39.2 months, respectively. Survival was not significantly different according to histology (P = .056) but was significantly different according to T-stage (P = .002) and N-stage (P = .022). Small numbers (26) precluded subglottic analysis. For both supraglottic and glottic sites including all histologies, survival was similar for matched non-SCC and SCC cases (P = .510 and P = .930, respectively). Non-SCCs are more common in the supraglottic larynx. T-stage and N-stage influence survival more than histology alone for these cancers.

What to expect after tricuspid valve replacement? Long-term results

Current knowledge in long-term results of tricuspid valve replacement is limited. Present study reviews our experience from a consecutive series. Forty-two patients (16 male, 26 female; mean age: 33+/-15) underwent tricuspid valve replacement between March 1987 and December 2004. The etiology was rheumatic in 64%, Ebstein's anomaly in 31%, and endocarditis in 5%. Nineteen patients were in New York Heart Association (NYHA) Class III functional capacity (45%), and 13 in class IV (31%). Twenty patients (48%) underwent isolated tricuspid valve replacement. The remaining underwent combined (mitral and/or aortic) valve replacements. Tricuspid replacement device was mechanical in 31% and bioimplant in 69%. Hospital mortality was 26%. Rheumatic etiology, reoperation and elevated pulmonary artery pressure were associated with higher early mortality. The patients with decreased functional capacity (NYHA Class III/IV), congestive symptoms and rheumatic origin were more prone to low cardiac output development. The Kaplan-Meier survivals were 37% at 10 years and 30% at 15 years. The 10-year event-free survival was 31%. Elevated pulmonary artery pressure and rheumatic etiology unfavorably affected the long-term results. The average functional capacity in survivors improved significantly after operation. Any tricuspid disease not amenable to repair thus necessitating replacement is an unfortunate situation since both the short and long-term results of valve replacement are suboptimal in regard to those of left-sided valve replacements, probably due to different structural and geometrical characteristics of right ventricle and the low-pressure venous system hemodynamics. Etiology, clinical presentation and pulmonary vascular hemodynamics are major determinants of the outcome.

Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries

Objective: This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great arteries after restoration of the morphologically left ventricle to the systemic circulation. Methods Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks–40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7%), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7%), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6%). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31%). Follow-up is complete (median 4.4 years). Results Early mortality was 5.6% (n = 3), with 2 late deaths. Kaplan-Meier survivals (± SEM) were 94.4% ± 3.1% at 1 year and 89.7% ± 4.4% at 9 years. Survivals at 7 years were 84.9% ± 7.1% in the double-switch group and 95.5% ± 4.4% in the Rastelli-Senning group ( P = .32). Of the 49 survivors, 46 (94%) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2% ± 3.3% and 77.5% ± 9.0%, with no significant difference between the groups ( P = .60). Conclusions Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.

Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema

Objective: Numerous reports have confirmed the early benefits of lung volume reduction surgery for selected patients with emphysema. This report documents the long-term survival and functional results after lung volume reduction surgery. Methods: Between January 1993 and June 2000, a total of 250 consecutive patients underwent bilateral lung volume reduction surgery through median sternotomy at our institution. All patients had disabling dyspnea, thoracic hyperinflation, and a heterogeneous pattern of emphysema with suitable target areas for resection. Preoperative pulmonary rehabilitation was required and post-rehabilitation data were used as the baseline for data analysis. Follow-up ranged from 1.8 to 9.1 years (median 4.4 years). Results: Prolonged air leaks (>7 days) were the most common complication (45.2%, n = 113). Reexploration rates for air leak and bleeding were 3.2% (n = 8) and 1.2% (n = 3), respectively. Eighteen patients (7.2%) required reintubation and mechanical ventilation. The in-hospital mortality in this series was 4.8% (n = 12). The median length of hospitalization was 9 days (range 4-168 days). Kaplan-Meier survivals after lung volume reduction surgery were 93.6%, 84.4%, and 67.7% at 1, 3, and 5 years, respectively. Eighteen patients (7.2%) have subsequently undergone lung transplantation after a median interval of 4.3 years (range 2.1-6.4 years). Spirometric values, lung volumes, and gas exchange parameters improved after surgery. The forced expiratory volume in 1 second and the residual volume showed statistically significant improvements between preoperative values and each time point of follow-up. Health-related quality of life showed significant postoperative improvement and with time correlated well with the improvement in forced expiratory volume in 1 second. Conclusions: Lung volume reduction surgery produces significant functional improvement for selected patients with emphysema. For most of these patients, benefits appear to last at least 5 years.J Thorac Cardiovasc Surg 2003;125:513-25

Induction chemotherapy in the treatment of patients with carcinoma of the esophagus

A prospective randomized phase III trial was carried out at Songklanagarind Hospital from August 1988 to December 1990. The objectives of the study were to evaluate the effect of chemotherapy regimen in squamous cell carcinoma of the esophagus and to determine whether induction chemotherapy improves symptom-free period and survival in these patients compared to surgical treatment alone. Twenty-four patients were randomized to receive 2 cycles of chemotherapy, cis-platinum 100 mg/m2 intravenously on day 1, bleomycin 10 mg/m2 loading dose on day 3, followed by 10 mg/m2/day continuous intravenous infusion on days 4 through 7, and vinblastine 3 mg/m2 given intravenously on days 1, 8, 15, 22. The cycle was repeated on day 29. Fifteen patients completed 2 courses of chemotherapy and among these, 2 patients had a complete clinical response (13%), 6 (40%) had a partial response, and 7 patients (47%) had no response. Four patients died during chemotherapy treatment. Grade 3 hematologic toxicity (ECOG criteria) was observed in 47% (7/15) of patients. Twenty-two patients were randomized to conventional treatment (surgery alone). Median survival time was 17 months in both groups. However, early survival appeared to be better in the control group. Kaplan-Meier survivals at 6 months were 69% and 89% and at 3 years were 31% and 36% for the induction chemotherapy group and control group, respectively. The survival time differences were not statistically significant (P = 0.186). These findings demonstrate that although this chemotherapy regimen had some effect on squamous cell carcinoma of esophagus, it did not improve survival. On the contrary, survival seems to be better in the control group. The 6-month survival discrepancy between both groups might be due to the poor nutritional status of our patients, who may better tolerate smaller dosages of chemotherapy.