Long-term Treatment Outcomes In Patients Research Articles

Controversies in minimally invasive surgery for invasive cervical cancer

Background. Determination of the feasibility of performing minimally invasive surgery for invasive cervical cancer and identification of criteria for optimal surgical access that ensures safety, effectiveness, and satisfactory immediate and long-term results remain challenging in gynecological oncology. The aim of the study was to evaluate the immediate and long-term treatment outcomes in patients with invasive cervical cancer who underwent radical hysterectomy via laparotomy compared to those who underwent minimally invasive surgery. Material and methods. Treatment outcomes of 91 patients with invasive carvical cancer were analyzed. The assessment of the objective tumor response to neoadjuvant chemotherapy using the RECIST scale (Response Evaluation Criteria in Solid Tumors) was confirmed by clinical, ultrasound and CT/ MRI findings. The Kaplan-Maier curves and the log-rank criterion were used to compare the time of relapse-free and overall survivals. Statistical analysis and visualization of the analysis results were performed using prism 9.5.1 (GraphPad, USA). Results. The presence of parametrial lymphovascular space invasion and the frequency of lymphadenopathy were comparable for both groups of patients. there were no statistically significant differences in the number of the resected lymph nodes, but there was a statistically significant difference in volume of blood loss and the duration of surgery between the groups (p=0.0001). Every third patient was diagnosed with stage IIIC after surgery (pelvic lymph node lesion). Intraoperative complications were significantly lower in the laparoscopy group than in the laparotomy group (6.7 % vs 13 %). No significant differences in the proportion of relapses of the disease between the groups were found (9.6 % in the laparotomy group vs 11.7 % in the laparoscopy group). There were no significant differences in overall and relapse-free survival between the groups. Conclusion. Minimally invasive surgery is a promising and adequate surgical technique for the treatment of cervical cancer. However, additional studies are needed to determine the indications for these surgeries.

Adult Central Neurocytomas: Clinical Features and Long-Term Treatment Outcomes in Different Age Groups

Central neurocytomas (CNs) usually occur in young adults, and the clinical characteristics and surgical outcomes of patients in different age groups may be different. This study was undertaken to compare the clinical and long-term treatment outcomes of patients with CNs in younger and older adult age groups. Eighty consecutive adults with CNs were included, with a mean presentation age of 28.4 ± 7.6 years (range: 19-66 years). Thirty (37.5%) patients were <27 years old, and they tended to manifest with multiple symptoms (p=0.002), increased intracranial pressure (ICP) symptoms (p=0.036), an acute clinical course (p=0.037), worse preoperative neurological function (p=0.023), and a larger lesion size and volume (p=0.004 and 0.007, respectively) than their older age counterparts (≧27 years). An older onset age (p=0.005) or age ≧27 years (p=0.014) and worsened Karnofsky Performance Status (KPS) scale (p=0.040) immediately after microsurgery were associated with unimproved long-term outcomes. CNs in younger adult patients behave differently from those in the older age group. Surgery can halt neurological deterioration and ensure satisfactory outcomes.

Combination of urinary biomarkers and machine-learning models provided a higher predictive accuracy to predict long-term treatment outcomes of patients with interstitial cystitis/bladder pain syndrome.

To identify predictive factors for satisfactory treatment outcome of the patients with IC/BPS using urine biomarkers and machine-learning models. The IC/BPS patients were prospectively enrolled and provide urine samples. The targeted analytes included inflammatory cytokines, neurotrophins, and oxidative stress biomarkers. The patients with overall subjective symptom improvement of ≥ 50% were considered to have satisfactory results. Binary logistic regression, receiver-operating characteristic (ROC) curve, machine-learning decision tree, and random forest models were used to analyze urinary biomarkers to predict satisfactory results. Altogether, 57.4% of the 291 IC/BPS patients obtained satisfactory results. The patients with satisfactory results had lower levels of baseline urinary inflammatory cytokines and oxidative biomarkers than patients without satisfying results, including interleukin-6, monocyte chemoattractant protein-1 (MCP-1), C-X-C motif chemokine 10 (CXCL10), oxidative stress biomarkers 8-hydroxy-2'-deoxyguanosine (8-OHDG), 8-isoprostane, and total antioxidant capacity (TAC). Logistic regression and multivariable analysis revealed that lower levels of urinary CXCL10, MCP-1, 8-OHDG, and 8-isoprostane were independent factors. The ROC curve revealed that MCP-1 level had best area under curve (AUC: 0.797). In machine-learning decision tree model, combination of urinary C-C motif chemokine 5, 8-isoprostane, TAC, MCP-1, and 8-OHDG could predict satisfactory results (accuracy: 0.81). The random forest model revealed that urinary 8-isoprostance, MCP-1, and 8-OHDG levels had the most important influence on accuracy. Machine learning decision tree model provided a higher accuracy for predicting treatment outcome of patients with IC/BPS than logistic regression, and levels of 8-isoprostance, MCP-1, and 8-OHDG had the most important influence on accuracy.

Long Term Clinical Outcomes of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Single Center Study

Objectives: Few studies have reported long-term follow-up after treatment of gastric mucosaassociated lymphoid tissue (MALT) lymphoma. In this single-center study, we investigated longterm treatment outcomes in patients diagnosed with gastric MALT lymphoma.Methods: The study included 80 patients diagnosed with gastric MALT lymphoma, who were followed up at a single center between January 2005 and December 2019 after &lt;i&gt;Helicobacter pylori&lt;/i&gt; eradication therapy, radiotherapy, or chemotherapy. We evaluated complete remission, improvement, or recurrence of the lesion. Follow-up over &gt;60 months was classified as long-term follow-up, and the progression-free survival rate was recorded.Results: Following &lt;i&gt;H. pylori&lt;/i&gt; eradication treatment, complete remission occurred in 85.9% (55/64) of &lt;i&gt;H. pylori&lt;/i&gt;-positive and 50.0% (3/6) of &lt;i&gt;H. pylori&lt;/i&gt;-negative patients. All patients with gastric MALT lymphoma who did not respond to &lt;i&gt;H. pylori&lt;/i&gt; eradication therapy (100.0% [6/6]) achieved complete remission following administration of local radiotherapy. We observed no deaths on long-term follow-up (&gt;60 months), and the progression-free survival was 101 months.Conclusions: In this study, patients with gastric MALT lymphoma showed excellent survival rates, progression-free survival, and prognosis on long-term follow-up. Prospective studies are warranted to determine the long-term prognosis of gastric MALT lymphoma after treatment.

Stereotactic Puncture Surgery for the Treatment of Moderate Volume of Thalamus-Internal Capsule Area Hemorrhage: An Analysis of Real-World Data

The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies. One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching (PSM) method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the two groups of patients was analyzed by logistic regression analysis and model comparison. The primary outcome of this study was to assess Assessment of daily living(ADL) scores after 6 months of treatment.Based on the analysis of this study,the ADL of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P< 0.001), and the difference was statistically significant. The amount of residual haematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days and 2 weeks after the onset of the disease (P< 0.001), and the complication rate was lower than the conservative treatment group (P< 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (OR-0.27, 95% CI: 0.08-0.86, P< 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% CI: 0.09-0.96, P< 0.05) after adjusting for all covariates. For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery.

Adjuvant oxaliplatin-based chemotherapy comparing observation alone after radical resection of metachronous metastases of colorectal cancer: interim analysis

Introduction. Despite the registered standard treatment option for patients who underwent radical resection for metachronous metastases of colorectal cancer (CRC), the feasibility of adjuvant chemotherapy (ACT) for all patients seems controversial. Due to studies demonstrating improved disease-free survival rates with postoperative chemotherapy vs observation, it would seem that there is reasonable expectation of improved overall survival (OS) rates, which, however, were not statistically different between groups. This article presents the interim results of our own study.Aim. To analyse the efficacy of ACT vs dynamic observation in patients who underwent surgery for metachronous metastases of colorectal cancer.Materials and methods. It was a prospective-retrospective, non-randomized, non-inferiority study. A total of 120 patients were recruited between June 2008 and September 2022. The ACT group included 71 patients. All patients received only oxaliplatin-based chemotherapy regimens; the dynamic observation group included 49 patients.Results. The interim analysis showed that the median disease-free survival (mDFS) in the ACT group (n = 71) was 20.9 months (13.7–28.3) vs 24.4 months in the dynamic observation group (n = 49) (11.1–37.7), HR: 0.76 (95% CI: 0.45–1.29), p = 0.29. Two-year disease-free survival (DFS) rates were 46.6% in the post-surgery chemotherapy (CT) group (n = 50) and 55.5% in the experimental group (n = 31), HR: 0.69 (95% CI: 0.39–1.2), p = 0.21.Conclusion. ACT has not improved the long-term treatment outcomes in patients who underwent radical resection for metachronous metastases of CRC.

Abnormal grey matter structural changes in patients with end-stage kidney disease and mild cognitive impairment: correlations with clinical features

End-stage kidney disease and mild cognitive impairment (ESKD-MCI) affect the quality of life and long-term treatment outcomes of patients affected by these diseases. Clarifying the morphological changes from brain injuries in ESKD-MCI and their relationship with clinical features is helpful for the early identification and intervention of MCI before it progresses to irreversible dementia. This study gathered data from 23 patients with ESKD-MCI, 24 patients with ESKD and non-cognitive impairment (NCI), and 27 health controls (HCs). Structural magnetic resonance studies, cognitive assessments, and general clinical data were collected from all participants. Voxel-based morphometry analysis was performed to compare grey matter (GM) volume differences between the groups. The patients’ GM maps and clinical features were subjected to univariate regression to check for possible correlations. Patients with ESKD-MCI displayed significantly more impairments in multiple cognitive domains, including global cognition, visuospatial and executive function, and memory, compared to patients with ESKD-NCI. Using a more liberal threshold (P < 0.001, uncorrected), we found that compared to patients with ESKD-NCI, patients with ESKD-MCI exhibited clusters of regions with lower GM volumes, including the right hippocampus (HIP), parahippocampal gyrus (PHG), Rolandic operculum, and supramarginal gyrus. The volumes of the right HIP and PHG were negatively correlated with serum calcium levels. ESKD-MCI was associated with a subtle volume reduction of GM in several brain areas known to be involved in memory, language, and auditory information processing. We speculate that these slight morphometric impairments may be associated with disturbed calcium metabolism.

Effect of Scar Deformation on Long-Term Outcomes of Suturing Perforated Pylorobulbar Ulcers

Despite the use of modern anti-ulcer therapy, the percentage of unsatisfactory results after suturing perforated ulcers ranges from 4.8 to 57% [1, 2, 3]. It is necessary to search for reasons explaining such significantly different values in the long-term treatment outcomes of patients with perforated ulcers. Cicatricial changes in the pylorobulbar area leading to a violation of the motor-evacuation function and, as a consequence, ulcer recurrence may be one of the causes.The aim of the study was to investigate the effect of a suture row and a type of suture material on the long-term outcomes in suturing perforated ulcer. Materials and methods. The study involved results of suturing perforated ulcers in 280 patients. When suturing, a single-row and double-row sutures, absorbable and non-absorbable suture materials were used. In the immediate postoperative period, the main attention was paid to the suture failure. In the long-term period, the results were evaluated in 106 patients, which accounted for 37.8% of the operated patients. The results were analysed according to the Visick score modified by M.Y. Pantsyrev [4]. Fibrogastroduodenoscopy findings in the long-term period were also analyzed in 56 patients; 31 of them were performed suturing with a single-row suture technique using absorbable threads, 25 patients were performed suturing with a double-row suture technique using dacron or silk threads. The severity of cicatricial deformation of the pylorobular area was evaluated based on B.P. Dergachev classification (1982) [5].Results. Evaluating the immediate results of suturing, no significant increase in the percentage of suture failure was registered when using a single-row suture technique and absorbable suture material (p=0.2). In the long-term postoperative period, the number of patients with excellent results according to the Visick score was significantly higher in the group where a single-row suture was performed (p=0.023). Analyzing endoscopic examination findings, the authors obtained the following results: no pronounced scar deformation was detected under fibrogastroduodenoscopy in patients who were performed a single-row suturing. In three cases (9.7%), no signs of scarring were found. Endoscopic signs of scar deformation were detected in all cases in patients of the second group, who were performed a double-row suturing. Of these, 6 (24.0%) patients had pronounced scar deformity. After performing a double-row suturing with non-absorbable suture material, an ulcerative defect with the ligature at the bottom was detected in the duodenum under fibrogastroduodenoscopy in two cases.Conclusion. Application of a single-row suture and absorbable suture materials is a reliable option to close perforation without increased suture failures; it results in improved long-term treatment outcomes. The use of a double-row suture and non-absorbable suture materials results in a more severe deformation of the suturing area and is one of the risk factors for ulcer recurrence.

Prospects for predicting long-term treatment outcomes in patients with combat ocular trauma

Introduction. The analysis of experience in changing approaches to organizing medical care for combat eye injuries, changing treatment tactics for such patients during armed conflicts in the 20th and 21st centuries, domestic experience in providing medical care for eye and its adnexal injuries, highlights the search for informative methods of predicting long-term outcomes of the applied treatment methods. The aim of the study was to determine the informativeness of constructing a forecast of functional changes of the visual analyzer based on the results of treatment of patients with eye injuries during dynamic retrospective observation. Materials and Methods: The primary material for the study was medical documentation of combat eye injury patients (data from medical histories, outpatient cards, and discharge summaries) for the period of 2014-2015, who were treated at the National Military Medical Clinical Center "Main Military Clinical Hospital" (NMMCC "MMCH"). Indicators of the functional state of the visual analyzer were evaluated upon admission to the NMMCC "MMCH" and after 180 days following the injury. The study used the proposed F. Kuhn and colleagues' scale for evaluating long-term treatment outcomes (OTS-Ocular Trauma Score). Results. It was found that overall, the results of treatment for combat eye injuries and their adnexa at the NMMCC "MMCH" during the study period of 2014-2015 showed a high correlation with the calculated values of the probability of preserving visual functions according to the OTS scale. Almost all patients with a case of blindness remained blind in the injured eye six months later. In the group with light projection and movement of the hand near the face, an improvement in visual function in most cases (65%) was noted, while, according to the OTS scale, these patients in most cases remain in this group or move to the group with blindness. Cases with visual acuity of 0.005-0.1 after 6 months improve visual acuity with the transition in most cases to 0.1 and above. The same trend, but, as expected, with a higher probability in groups with visual acuity of 0.1-0.4 and above 0.5. The identified discrepancies justify the need for adaptation of the OTS scale for predicting functional changes in combat eye injuries, as it has been developed for use in eye injuries during peacetime. Conclusion: Considering the large number of wounded soldiers with severe eye injuries during the war with rf, scientific research on the implementation of a system for predicting long-term functional outcomes of the treatment of combat eye trauma based on clinical data at the time of initial examination remains relevant. The results obtained with the OTS (Ocular Trauma Score) assessment scale in most cases correspond to the results of the treatment of injured patients in the ophthalmology clinic of the NMMCC "MMCH" in 2014-2015. Further development of the existing OTS system and its adaptation to domestic conditions and the realities of providing ophthalmic care for combat eye trauma is promising for further study.

Long-term treatment outcomes in patients with multidrug-resistant tuberculosis

ObjectivesTo describe long-term treatment outcomes in patients with multi-drug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) and validate established outcome definitions for MDR/RR-TB treatment. MethodsAmong patients with MDR/RR-TB admitted to a German MDR/RR-TB referral centre from 1 September 2002 to 29 February 2020, we compared long-term treatment outcomes derived from individual patient follow-up with treatment outcomes defined by WHO-2013, WHO-2021 and the Tuberculosis Network European Trials Group-2016. ResultsIn a total of 163 patients (mean age, 35 years; standard deviation, 13 years; 14/163 [8.6%] living with HIV; 109/163 [66.9%] men, 149/163 [91.4%] migrating to Germany within 5 years), the treatment of culture-confirmed MDR/RR-TB was initiated. Additional drug resistance to a fluoroquinolone or a second-line injectable agent was present in 15 of the 163 (9.2%) Mycobacterium tuberculosis strains; resistance against both the drug classes was present in 29 of the 163 (17.8%) strains. The median duration of MDR/RR-TB treatment was 20 months (interquartile range, 19.3–21.6 months), with a medium of five active drugs included. The median follow-up time was 4 years (47.7 months; interquartile range, 21.7–65.8 months). Among the 163 patients, cure was achieved in 25 (15.3%), 82 (50.3%) and 95 (58.3%) patients according to the outcome definitions of WHO-2013, WHO-2021, and the Tuberculosis Network European Trials Group-2016, respectively. The lost to follow-up rate was 17 of 163 (10.4%). Death was more likely in patients living with HIV (hazard ratio, 4.28; 95% confidence interval, 1.26–12.86) and older patients (hazard ratio, 1.08; 95% confidence interval, 1.05–1.12; increment of 1 year). Overall, 101/163 (62.0%) patients experienced long-term, relapse-free cure; of those, 101/122 (82.8%) patients with a known status (not lost to-follow-up or transferred out) at follow-up. ConclusionUnder optimal management conditions leveraging individualized treatment regimens, long-term, relapse-free cure from MDR/RR-TB is substantially higher than cure rates defined by current treatment outcome definitions.

Surgical management of cancer of the stomach and gastroesophageal junction after neoadjuvant therapy: the experience of the MRRC and literature review

Itroduction. Gastric cancer incidence and mortality rates remain very high worldwide, including the Russian Federation. More than 50 % of gastric cancers are locally advanced at presentation [1]. Perioperative or adjuvant chemotherapy is a standard treatment for gastric cancer patients. The use of neoadjuvant chemoradiotherapy is considered very promising.Material and Methods. We present the analysis of the results of surgical treatment of cancer of the stomach and gastrooesophageal junction after various options of neoadjuvant therapy: chemotherapy, chemoradiotherapy, and their combinations. The experience of the Medical Radiological Research Centre (MRRC), including 5 clinical prospective studies and one randomized multicenter clinical trial, was analyzed. A total of 237 patients with histologically proven locally advanced cancer of the stomach and gastro-oesophageal junction were included into the study. Of these patients, 202 received neoadjuvant therapy. Our treatment outcomes were compared with those of randomized trials published over the last 15 years.Results. Of 202 patients who received neoadjuvant therapy, 190 (94 %) underwent surgery (R0 resection: 184 patients). In the early postoperative period, complications were observed in 62 patients (32.6 %). Re-surgery was performed in 11 (5.8 %) patients. Postoperative mortality was 1.6 % (3 patients). Multicenter randomized studies and meta-analyses, as well as the long-term experience of MRRC, have shown that neoadjuvant therapy does not increase the number of postoperative complications and mortality, increases the rate of R0 resections and improves long-term treatment outcomes in patients with resectable locally advanced cancer of the stomach and gastro-oesophageal junction.Conclusion. Analysis of long-term clinical studies conducted at the MRRC as well as the treatment results published by other authors show that in some cases neoadjuvant therapy can lead to soft tissue changes in a surgical area and may complicate surgical management; however, it does not have a negative impact on the rates of postoperative complications and mortality.

Justification of Chemotherapy Duration in Patients with Multiple and Pre-Extensive Drug Resistant Tuberculosis in the Russian Federation

The objective: to justify the optimal duration of chemotherapy with Lzd and Bdq by evaluating the long-term treatment outcomes in patients with multiple/pre-extensive drug resistant (MDR/preXDR) tuberculosis who interrupted treatment at different time points.Subjects and Methods. 800 patients with MDR/preXDR tuberculosis were enrolled in the study, they were from all regions of the Russian Federation and they started a course of chemotherapy with regimens containing Lzd and Bdq in 2017-2018. All patients who interrupted their chemotherapy (124) were divided at 4 groups. Group 1-43 patients who received less than 90 doses, Group 2-37 patients who received from 91 to 180 doses, Group 3-39 patients who received from 181 to 270 doses, and Group 4-5 patients who received from 271 to 360 doses of anti-tuberculosis drugs.Results. In Group 3, the effectiveness of reaching a favorable outcome during observation for 3-4 years made 53.8% in 21/39, which was comparable to the effectiveness of treatment with a 24-month course of chemotherapy (2017 – 58.0 and 2018 – 52.1%). The treatment duration of patients from Group 3 was additionally analyzed, the arithmetic mean of the number of administered doses makes 262 ± 15, which allowed recommending 9-month courses of chemotherapy.

Clinical features and long-term treatment outcome of posterior scleritis.

To analyze the clinical characteristics and long-term treatment outcomes of patients with posterior scleritis. This retrospective, observational case series analyzed medical records of 14 patients diagnosed with infectious or non-infectious posterior scleritis between May 2005 and March 2020 at Severance Hospital and Gangnam Severance Hospital. A total of 12 patients with non-infectious and two with infectious posterior scleritis were treated. Conjunctival injection (85.7%) was the most common symptom, followed by pain on eyeball movement (57.1%), and decreased visual acuity (42.9%). Anterior uveitis (64.3%) was the most common associated clinical finding. In five eyes (35.7%), immunosuppressive agents were administered in addition to corticosteroids to control the inflammation. Recurrence was noted in three eyes (21.4%), all of them showing non-infectious scleritis. The final visual acuity of the patients did not show significant change compared to that at the first visit (P=0.878). Most posterior scleritis patients were of non-infectious type and some needed additional immunosuppressive treatment. In patients with a history of ocular surgery or trauma, especially with the presence of pus-containing nodules, infectious posterior scleritis should always be considered. Since impaired vision does not improve significantly after treatment of posterior scleritis, prompt diagnosis and aggressive treatment are recommended.

Spleen-preserving D2 subtotal distal resection of the stomach and corpocaudal resection of the pancreas after neoadjuvant induction chemotherapy and chemoradiotherapy: case report and literature review

Background. Stomach cancer is one of the most common cancers worldwide. Long-term treatment outcomes in patients with locally advanced gastric cancer with invasion to adjacent structures are poor. In clinical recommendations of the Ministry of Health of the Russian Federation, it is recommended to treat these patients with perioperative chemotherapy according to the FLOT scheme. The effectiveness of neoadjuvant chemoradiotherapy is studied in many multicenter studies involving randomized clinical trials. Case description. We present a case of a successful treatment of a patient with locally advanced gastric cancer (сT4bN2M0 – IVA stage). The patient received neoadjuvant therapy (2 cycles according to the FLOT scheme) followed by chemoradiotherapy (total dose of 46 Gy with the concurrent chemotherapy with capecitabine and oxaliplatin). Neoadjuvant therapy was well tolerated (grade 1 gastrointestinal and hematological toxicity). The patient underwent distal subtotal resection of the stomach with D2 lymph node dissection and distal subtotal resection of the pancreas with preservation of the spleen. No postoperative complications were observed. Histological examination revealed complete pathological response of the primary tumor, including the area of earlier invasion into the pancreas; metastasis in one lymph node of the small omentum. The patient is alive with no evidence of disease 20 months after surgery. Conclusion. The feasibility of conducting safe multimodal neoadjuvant therapy followed by organ-preserving surgery in a patient with locally advanced gastric cancer (сT4bN2M0) was shown. The effective neoadjuvant therapy resulted in the achievement of complete pathologic response, which is a favorable prognostic factor.

1513P Impact of mutational status on long-term treatment outcomes in patients with advanced gastrointestinal stromal tumors (GIST) treated in the first line with imatinib

GISTs are driven by genetic aberrations, mostly observed within KIT and PDGFRA genes. Standard first-line therapy for inoperable/metastatic GIST includes imatinib. The presence of specific genetic alterations may impact imatinib efficacy and patients' survival. We aimed to analyze the impact of KIT and PDGFR mutation in patients with GIST treated in the first line with imatinib in two cohorts according to anatomical location.

Short-term and long-term treatment outcomes in patients with lower and middle rectal cancer with complete clinical and pathomorphological response after comprehensive treatment

Objective: to compare short-term and long-term treatment outcomes between patients with lower and middle rectal cancer with complete clinical and pathomorphological response after comprehensive treatment.Materials and methods. we performed retrospective analysis of treatment outcomes in patients with lower and middle rectal cancer. The experimental group included 27 patients with complete clinical response, whereas the control group comprised 31 patients with complete pathomorphological response (ypT0n0m0) who had undergone total mesorectal excision following neoadjuvant therapy. The main evaluated parameters included postoperative complications, proportion of R0 resections, proportion of sphincter-preserving surgeries, 2-year overall survival, and progression-free survival.Results. At a median follow-up time of 41 months (range: 25–114 months), 2 patients from the experimental group had progressive disease registered 18 and 19 months after treatment initiation; both patients underwent abdominoperineal extirpation of the rectum. The remaining 25 patients had sphincter sparing surgeries. At a median follow-up time of 48 months (range: 24–101 months), one patient was found to have liver metastasis 5 months following treatment initiation. He underwent simultaneous surgery that included low anterior resection of the rectum and liver resection and had no postoperative complications. In the group of surgical treatment, all patients underwent radical surgeries (R0), including those with permanent stoma formation (n = 11; 35.5 %) or preventive stoma formation (n = 20; 64.5 %) with subsequent bowel repair. The 2-year overall survival rate was 100 % in both groups. The 2-year progression-free survival rate was 92.6 % in the experimental group and 96.8 % in the control group (p = 0.473).Conclusion. The watch and wait strategy with active dynamic follow-up is a safe alternative to surgery in patients with complete clinical response after neoadjuvant therapy, since it ensures the results equivalent to those in patients with complete pathomorphological response.

Simultaneous Integrated Boost Volumetric Modulated Arc Therapy for Rectal Cancer: Long-Term Results after Protocol-Based Treatment.

Background Volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) is an advanced form of radiotherapy (RT) technology. The purpose of this study was to report long-term treatment outcomes in patients with locally advanced rectal cancer undergoing VMAT-SIB based concurrent chemoradiotherapy (CRT). Methods Between January 2016 and January 2018, a total of 22 patients with operable stage II-III rectal adenocarcinoma were recruited for the pre-designed VMAT-SIB RT protocol. All patients underwent standard diagnostic and staging work-up. The RT target volumes included the following areas: PTV1 = mesorectum that contained gross tumors and enlarged lymph node regions and PTV2 = mesorectum and regional lymphatics from L4-5/S1 to 3-4 cm below the tumor or levator ani muscle, excluding PTV1. The VMAT-SIB dose prescription was as follows: PTV1 = 52.5 Gy/daily 2.1 Gy/25 fractions, PTV2 = 45 Gy/daily 1.8 Gy/25 fractions. Results The mean age of the study population was 64 (range, 18-84) years, and 15 (68.2%) patients were male. Radical operation (total mesorectal excision) was performed by either low anterior resection, ultralow anterior resection, or abdominal perineal resection. All five (22.7%) of the patients with confirmed increasing serum carcinoembryonic antigen (CEA) level at diagnosis showed normalization of serum CEA level after the planned treatment. Among 20 patients who underwent preoperative CRT and surgery, tumor down staging in T- and N-stages was achieved in 10 patients (50%) and 13 patients (65%), respectively, with 20% of ypT0/Tis. With a median follow-up of 54.2 (range, 22.6-61.1) months, the 5-year disease-free survival, overall survival, and local control rates were 64.6%, 81.8%, and 84.4%, respectively. Five patients developed distant metastasis and one developed local recurrence as a first event. Two cases with anastomosis site leakage, three with adhesive ileus, and two with abscess formation were observed during postoperative periods. Conclusions The current VMAT-SIB-based CRT protocol provided acceptable treatment and toxicity outcomes.

Risk factors for long-term survival in patients with ypN+\u2009M0 rectal cancer after radical anterior resection

BackgroundRegional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection.Methods112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan–Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.ResultsIn the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01–9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74–19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09–22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12–0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44–12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082–0.586, p = 0.002).ConclusionsThe use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.

Bronchoplatic surgery in the treatment of patients with nonsmall cell lung cancer

Aim. To study the effect of organ-preserving bronchoplastic surgery on long-term treatment outcomes of patients with non-small cell lung cancer (NSCLC ).Material and Methods. The long-term results of surgical treatment of 740 patients with stage I–III NSCLC , who were treated in Ugra from 2002 to 2015, were analyzed. Lobectomy and bilobectomy were performed in 477 patients, and pneumonectomy was performed in 263 patients. Thirty-two patients underwent bronchoplastic lobectomy and bilobectomy. Intraoperative pathological frozen sections of lymph nodes (# 12) of the remaining lobe of the lung were examined in all patients. If metastases in these lymph nodes were not detected, we performed bronchoplastic lobectomy. If metastases in lymph nodes of the remaining lobe were detected, we performed pneumonectomy. The median age of the patients (only male patients) was 55.3 ± 9.9 years. In 19 (59.4 %) patients, sleeve resections were performed on the right side and in 13 (40.6 %) patients, these resections were performed on the left side. There were 15 bronchoplastic lobectomies of type A, 9 of type B, 4 of type C, and 4 of type D. Sleeve resection of the pulmonary artery was performed in 4 patients. In 16 cases (50.0 %), there were no regional metastases (pN0). In 10 (31.3 %) cases, there was pN1, in six – pN2 (18.7 %).Results. There were no cases of postoperative death. Late complications (asymptomatic bronchial stenosis) occurred in 3 (9.4 %) patients. Long-term treatment outcomes were better in patients who underwent organ-preserving bronchoplastic surgery than in patients who underwent pneumonectomy. Median survival was 66 months after bronchoplastic lobectomies and 34 months after pneumonectomies (p=0.01). The 5- and 10-year survival rates in patients who underwent bronchoplastic lobectomies were 52.9 % and 36.2 %, respectively. The corresponding values in patients who underwent pneumonectomies were 38.0 % and 31.9 %, respectively.Conclusion. Organ-preserving bronchoplastic surgery compared to pneumonectomy does not worsen long-term outcomes in patients with NSCLC .

Long-term treatment outcomes of patients with non-clear cell renal cell carcinoma

Objective: to analyze factors affecting relapse-free and overall survival of patients with non-metastatic non-clear cell renal cell carcinoma (nccRCC) after surgical treatment.Materials and methods. This study included 279 (13.62 %) nccRCC patients from the database containing information on 2049 patients with localized and locally advanced renal cell carcinoma (RCC) without distant metastases who underwent surgical treatment in the Department of Urologic Oncology, P.A. Herzen Moscow Oncology Research Institute between 2002 and 2018. Gender ratio was 1.36:1 (161 men (57.7 %) and 118 women (42.3 %)). Median follow-up time was 34.5 months (range: 1-141 months). Patients had undergone either radical nephrectomy (n = 117; 41.9 %) or kidney resection (n = 160; 57.4 %) or radiofrequency thermal ablation (n = 2; 0.7 %). Standard (open) transperitoneal approach was used in 135 patients (48.4 %) patients, whereas 144 (51.6 %) patients were operated on via laparoscopic approach. Postoperative histological examination demonstrated that 110 participants (39.4 %) had chromophobe RCC, while 79 (28.3 %) and 63 (22.6 %) individuals had type 1 and type 2 papillary RCC, respectively. Twenty-seven patients were found to have rare or mixed variants of nccRCC (they were excluded from the analysis due to their relatively small number). Patients were diagnosed with the following stages of cancer: рТ1а (n = 129; 46.2 %), pT1b (n = 72; 25.8 %), рТ2а (n = 18; 6.5 %), pT2b (n = 8; 2.9 %), рТ3а (n = 31; 11.1 %), pT3b (n = 4; 1.4 %), рТ4 (n = 1; 0,4 %), and pN+ (n = 16; 5.7 %).Results and conclusion. 13 patients (4.7 %) were diagnosed progressive disease; 9 patients (3.2 %) died due to nccRCC progression. The highest relapse-free and overall survival rates were registered in the patients with type 1 papillary RCC and chromophobe RCC.Spearman's correlation analysis showed a significant correlation between the risk of disease progression and tumor size (R = 0.23; p &lt;0.0001), pT stage (R = 0.24; p = 0.0001), vascular invasion (R = 0.36; p &lt;0.0001), pN+ stage (R = 0.4; p &lt;0.0001), surgical resection margin (R = 0.5; p &lt;0.0001), histological variant (R = 0.14; p = 0.02), and Furman differentiation grade (R = 0.16; p = 0.02). The following factors were found to have an impact on relapse-free survival according to multivariate Cox regression: presence of necrosis (p = 0.04), pT stage (p = 0.03), and vascular invasion (p = 0.08), although the last variable failed to reach statistical significance. Cancer-specific survival was significantly affected by pT stage (p = 0.01) and Furman differentiation grade (p = 0.04). None of the factors demonstrated significant associations with overall survival. Thus, the most significant prognostic factor affecting relapse-free, overall, and cancer-specific survival in nccRCC patients was the pT stage (p &lt;0.05).