Use Of Postoperative Adjuvant Chemotherapy Research Articles

Postoperative adjuvant chemotherapy is important for improving long-term survival in patients with colorectal cancer liver metastases undergoing simultaneous resection.

A growing number of studies have demonstrated that neoadjuvant chemotherapy can improve the prognosis of patients with resectable colorectal liver metastases (CRLM). However, the routine use of postoperative adjuvant chemotherapy (POAC) for patients with CRLM after simultaneous resection remains controversial. This retrospective study investigated the impact of POAC on outcomes in patients with CRLM who underwent simultaneous resection of colorectal cancer tumors and liver metastases using propensity score matching (PSM) analysis. From January 2009 to November 2020, patients with CRLM who underwent simultaneous resection were retrospectively enrolled. The confounding factors and selection bias were adjusted by 2:1 PSM. Patients were stratified into the POAC and non-POAC groups. Kaplan-Meier curves were utilized to compare overall survival (OS) and progression-free survival (PFS) between the groups. Univariate and multivariate Cox regression analyses were used to identify independent clinicopathological factors before and after PSM analysis. The utility of the model was evaluated using receiver operating characteristic (ROC) and calibration curves after PSM analysis. In total, 478 patients with resectable CRLM were enrolled and assigned to the POAC (n=212, 60.9%) or non-POAC group (n=136, 39.1%). After 2:1 PSM, there was no significant bias between the groups. Kaplan-Meier survival analysis revealed a significant effect of POAC on OS (P<0.001) but not PFS. Multivariate Cox regression analysis identified T stage (T3-T4), lymph node metastasis, radiofrequency ablation during surgery, operative time ≥325min, and the receipt of postoperative adjuvant chemotherapy (hazard ratio=0.447, 95% confidence interval=0.312-0.638, P<0.001) as independent prognostic factors for OS. The areas under the ROC curves for the nomogram model for predicting 1-, 3-, and 5-year survival were 0.653, 0.628, and 0.678, respectively. Subgroups analysis suggested that POAC can enhance OS in patients with resectable CRLM with either low (1-2, P<0.001) or high clinical risk scores (3-5, P=0.020). Overall, this study identified POAC as a prognostic factor to predict OS in patients with CRLM undergoing simultaneous resection.

Prognostic factors in patients with high-risk stage II colon cancer after curative resection: a post hoc analysis of the JFMC46-1201 trial

PurposeThe goal of the current study was to identify prognostic factors for disease-free survival (DFS) and overall survival (OS) in high-risk stage II colon cancer.MethodsThe subjects were patients with histologically confirmed stage II colon cancer undergoing R0 resection who met at least one of the following criteria: T4, perforation/penetration, poorly differentiated adenocarcinoma, mucinous carcinoma, and < 12 examined lymph nodes. Patients self-selected surgery alone or a 6-month oral uracil and tegafur plus leucovorin (UFT/LV) regimen. Serum CEA mRNA at ≥ 24 h after surgery and < 2 weeks after registration was also examined as a potential prognostic factor for stage II colon cancer. This study is registered with UMIN-CTR (protocol ID: UMIN000007783).Results1880 were included in the analysis to identify prognostic factors for DFS and OS in patients with high-risk stage II colon cancer. In multivariate analyses, gender, depth of tumor invasion, extent of lymph node dissection, number of examined lymph nodes, and postoperative adjuvant chemotherapy (POAC) emerged as significant independent prognostic factors for DFS. Similarly, multivariate analysis showed that age, gender, depth of tumor invasion, perforation/penetration, extent of lymph node dissection, number of examined lymph nodes, and POAC were significant independent prognostic factors for OS. Univariate analyses showed no significant difference in DFS or OS for CEA mRNA-positive and mRNA-negative cases.ConclusionThis study showed that gender, depth of tumor invasion, extent of lymph node dissection, number of examined lymph nodes, and lack of use of POAC were significant independent prognostic factors in stage II colon cancer.

Uterine Carcinosarcoma: A Plan for Treatment

Background: Uterine carcinosarcomas are very aggressive tumors in the womb that are associated with poor prognosis. They represent only less than 5% of uterine tumors and the incidence rate is less than 2 per 100,000 women per year. Objective: We reviewed diagnosis and treatment of women with uterine carcinosarcoma. To determine if lymphadenectomy, chemotherapy and radiotherapy are associated with decreased recurrence and increased survival. To prove that multimodality therapy including surgery, chemotherapy and radiotherapy are the ideal treatment for this malignancy. Patients and Methods: The rarity of the tumor made us depend on thirty cases done over 5 years mainly stage 1, 2 and 3 in University of Aswan between 2014 and 2018. We abstracted: histopathology results, survival outcomes from archived medical reports for the qualifying cases and patient demographics. Patient age at surgery and preoperative CA-125 for patient demographics. Histopathological results: cancer stage, depth of myometrial invasion, grade. Treatment data: Surgical details and use of postoperative adjuvant chemotherapy or radiotherapy or both. Results: Most uterine carcinosarcoma (UCS) patients are candidates for adjuvant chemotherapy combination therapy, but in-depth testing has not been widely used. The high rate of recurrence and poor overall survival indicate an ongoing need for clinical trials specifically. Hazard of death and recurrence decreased with chemotherapy multiagent and vaginal brachytherapy with five years of higher survival and disease free survival. Also lymphadenectomy decreased recurrence and rate of death associated with. Conclusion: Adjuvant chemotherapy with vaginal brachytherapy with lymphadenectomy were associated with increased survival and decreased recurrence of women with UCS.

507 NEOADJUVANT AND ADJUVANT CHEMOTHERAPIES FOR PATIENTS WHO UNDERWENT RESECTION FOR SQUAMOUS CELL CARCINOMA CF THE THORACIC ESOPHAGUS

Abstract The efficacy of neo-adjuvant chenmotherapy (NCT) and adjuvant chemotherapy (ACT) for squamous cell carcinoma (SCC) of the esophagus has not been fully expounded. This study analyzed the prognostic factors of patients who underwent esophagectomy for SCC of the thoracic esophagus, specially focused on NCT and ACT. Methods From January 2008 to January 2016, 1075 consecutive patients underwent esophgagectomy for stage T3-T4 SCC of the thoracic esophagus. Propensity-score matching (PSM) analyses were conducted in patients who underwent NCT, surgery alone (SA) and ACT. After PSM, there were 83 patients in NCT, 249 patients in SA and 249 patients in ACT group. Postoperative outcomes and prognostic factors of patients in the three groups were analyzed. Univariate analysis was performed using the Kaplan–Meier method and multivariate analysis using the Cox proportional hazard model. Differences were considered to be statistically significant when P &amp;lt; 0.05. Results The incidence of main postoperative complications was 9.6% (8/83) in NCT group compared to 6.8% (34/498) in SA and ACT groups (P = 0.834). In NCT group, 20 patients (24.1%) were downstaged by NCT and 63 patients (75.9%) remained stable. The 3-year survival rate of the entire group was 51.0%, and the 5-year survival rate was 33.4%. The 5-year survival rate was 32.2% in NCT group, 50.9% in ACT, and 19.5% in SA patients. In univariate analysis, both NCT and ACT were associated with long-term survival. In multivariate analysis, however, ACT rather than NCT was independent prognostic factor. Conclusion This study supports the use of postoperative ACT for patients with stage T3 or T4 SCC of the thoracic esophagus, but the effect of NCT needs further study.

Juvenile granulosa cell tumor: An interim report from the international ovarian and testicular stromal tumor (OTST) registry.

6064 Background: Juvenile granulosa cell tumors (JGCT) are rare sex cord-stromal tumors which occur primarily in children and adolescents. Methods: All individuals or proxy caregivers provided informed consent/assent for participation in the International OTST Registry. Clinical data was collected. When available, pathology was centrally reviewed. Staging was evaluated using the International Federation of Gynecology and Obstetrics (FIGO) classification. Kaplan-Meier survival analyses and exact permutation tests were performed. Results: Forty-two individuals with ovarian JGCT were enrolled. Median age at diagnosis was 9 years (range 0-27). Most individuals had Stage I disease (Stage Ia=16; Stage Ib=1; Stage Ic=16). Seven individuals presented with higher stage (Stage II=2; Stage III=5). Stage was unknown for 2 individuals. Three-year overall survival (OS) was 88% (CI 77%, 100%) and event-free survival (EFS) was 69% (CI 54%, 88%). At median follow-up time of 25 months (range 0-416), 9 patients (Stage Ia=1, Stage Ic=5, Stage III=3) had recurrent disease. Use of post-operative adjuvant chemotherapy varied by stage and timing of rupture. Of those with Stage Ic JGCT, 2/7 with preoperative rupture and 3/9 with intraoperative rupture recurred. Among individuals with recurrence, median time to recurrence was 11.5 months (range 3-19). Four of 9 individuals with recurrence survived (no evidence of disease n=2; alive with disease n=2). All individuals who died presented with extrapelvic recurrence. Median time from recurrence to death was 10 months (range 2-53). In individuals with recurrence, advanced stage at diagnosis (HR 5.1; p-value 0.087) and recurrence outside the tumor bed (HR Infinity; p-value 0.048) were associated with inferior OS. Three-year OS for individuals with recurrence was 57% (CI 30%, 100%). Conclusions: Low stage JGCT is associated with a favorable prognosis, however, recurrence is associated with lower survival rate. Within this series, recurrences presented within 2 years of diagnosis. Novel strategies are needed to address recurrent and extrapelvic disease.

How equitable is access to treatment for lung cancer patients? A population-based review of treatment practices in Ontario.

Aim:Guideline concordance is one of the metrics used by the Cancer Quality Council of Ontario and Cancer Care Ontario to assess the quality of cancer care and to drive quality improvement.Materials & Methods:The rates for lung cancer surgical resection and concordance with the Cancer Care Ontario postoperative adjuvant chemotherapy (AC) guideline were assessed by health region during two time periods (2010–2011 and 2012–2013) according to five equity measures (age, sex, neighborhood income, location of residence and size of immigrant population).Results:Of the patients with stage I/II NSCLC, 52.2% to 63.0% underwent surgical resection in the province of Ontario, Canada; for patients with stage IIIA disease, the rate was 26.4%. The probability of a surgical resection decreased substantially with age; only 26.9% of those with potentially resectable (stage I–IIIA) disease over 80 years underwent surgery. The use of postoperative AC increased modestly over the time of the study but the rate of use varied widely by health region (34.6 to 84.6%). Patients in rural areas were as likely to receive AC as urban dwellers; however, older aged patients (≥65 years) and those from the lowest income neighborhoods were significantly less likely to receive AC.Conclusion:Surgical rates and the use of AC vary by health region in Ontario and by age and level of neighborhood income despite universal access in a publicly funded health care system. The reasons for this variance are unclear but warrant further study.Presented in part at the 15th World Conference on Lung Cancer, Sydney, Australia, 27–30 October 2013

Abstract 5254: Postoperative adjuvant chemotherapy improves survival in stage II colon cancer? A propensity score matching analysis

Abstract Objective : Stage II colon cancer with high-risk features have been traditionally considered more likely to benefit from postoperative adjuvant chemotherapy (POAC). National Comprehensive Cancer Network (NCCN) guidelines do not recommend routine administration of adjuvant chemotherapy for Stage II patients, except for those with high risk features, such as poorly-differentiated tumors, T4 disease, perforated tumors and those with inadequate lymph node sampling. However, the use of POAC after surgery for patients with Stage II colon cancer remains controversial. The current study was conducted to investigate the effectiveness of POAC using propensity score (PS) matching analysis, which can reduce or minimize the confounding that is seen frequently in observational studies of the effect of treatment on outcomes, based on prognostic factors. Materials : Two hundred and nineteen patients with Stage II colon cancer who underwent surgery with curative intent between 1995 and 2005 were enrolled. The decision regarding the use of POAC was made for each case based on individual patient/physician discussions. All patients were required to provide informed consent. During the present study period, patients received 5-FU drugs orally, starting 4~8 weeks after surgery. The median observation period was 73.4 months (range: 2.2 - 184.2 months). Methods : PS matching analysis was used to adjust for differences in clinicopathological severity between the patients with and without POAC. Recurrence-free and cancer-specific survival were calculated using the Kaplan-Meier method and univariate analyses were performed using the log-rank test. The Cox proportional-hazard model was used to determine Hazard ratios and 95% confidence intervals. Results : One hundred and nineteen patients (54.3%) underwent POAC. In univariate analysis, there were significant differences in age, invasion depth, lymphatic invasion and venous invasion between the patients with and without POAC. After PS matching analysis, in univariate analysis, there were no significant differences with respect to the clinicopathological factors between the patients with and without POAC. Before PS matching analysis significant survival benefits from POAC were not recognized for recurrence-free survival (Hazard ratio= 0.76, 95% CI 0.40-1.45, P=0.41) or cancer-specific survival (Hazard ratio= 0.52, 95% CI 0.22-1.19, P=0.12). After PS matching analysis significant survival benefits from POAC were not recognized for recurrence-free survival (Hazard ratio= 0.55, 95% CI 0.23-1.23, P=0.15) or cancer-specific survival (Hazard ratio= 0.46, 95% CI 0.16-1.18, P=0.11). Conclusions : The one-to-one pair PS matching successfully balanced the clinicopathological factors between the patients with and without POAC. The PS matching analysis demonstrated no significant difference in survival in the patients with Stage II colon cancer. Citation Format: Ryoichi Tsukamoto, Kiichi Sugimoto, Shingo Kawano, Koichiro Niwa, Shun Ishiyama, Hirohiko Kamiyama, Hiromitsu Komiyama, Makoto Takahashi, Yutaka Kojima, Michitoshi Goto, Yuichi Tomiki, Kazuhiro Sakamoto. Postoperative adjuvant chemotherapy improves survival in stage II colon cancer? A propensity score matching analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5254. doi:10.1158/1538-7445.AM2017-5254

Is there randomized controlled trial evidence to support the use of postoperative adjuvant chemotherapy in people with rectal cancer operated for cure?

Is there randomized controlled trial evidence to support the use of postoperative adjuvant chemotherapy in people with rectal cancer operated for cure?

Overall Survival of Stage III Colon Cancer with Only One Lymph Node Metastasis Is Independently Predicted by Preoperative Carcinoembryonic Antigen Level and Lymph Node Sampling Status.

BackgroundThis study identified predictors of favorable overall survival (OS) for stage III colon cancer patients who had only one lymph node (LN) metastasis (N1a).MethodsVariables, including preoperative carcinoembryonic antigen (CEA) level, LN sampling status, and the choices of postoperative adjuvant chemotherapy, were recorded. Prognostic significance was determined using the log-rank test and multivariate Cox regression analysis.ResultsThe median 42-month follow-up period included 363 eligible patients. Among them, 230 (63.3%) received only 5-flurouracil (5-FU) adjuvant chemotherapy; 76 (20.9%) underwent oxaliplatin-based regimens; and 57 (15.7%) chose surgery alone. The 5-year survival rate of these evaluated patients was 75%, 63%, and 77%, respectively (P = 0.823). Multivariate analysis revealed that normal preoperative CEA level (≦5 ng/mL) and adequate LN sampling (LN ≧ 12) were significant predictors for higher 5-year OS (P < 0.001; P = 0.007, respectively). However, the use of postoperative adjuvant chemotherapy in these N1a colon cancer patients did not significantly affect their 5-year OS.ConclusionsA preoperative CEA level of less than or equal to 5 ng/mL, and curative surgery with an adequate lymphadenectomy determined a favorable OS outcome in stage III colon cancer with only one LN metastasis.

Is pancreatic fistula associated with worse overall survival in patients with pancreatic carcinoma?

Pancreatic fistula (PF) is one of the leading complications after pancreatic resection for pancreatic carcinoma. The aim of this study was to determine whether PF was associated with deterioration of long-term outcomes in patients with pancreatic carcinoma after surgical resection. Medical records of 210 patients with pancreatic carcinoma who underwent tumor resection were reviewed retrospectively. PF was defined as grade B or C PF according to the criteria of the International Study Group on Pancreatic Fistula. Clinicopathological factors including overall survival were compared between patients with and without PF by univariate and multivariate analyses. Thirty-one patients (15 %) developed postoperative PF, and 179 (85 %) did not. The 31 cases of PF consisted of 27 grade B PF and 4 grade C PF. There were no differences in the use of adjuvant chemotherapy, tumor differentiation, lymph node status, surgical margin status, or UICC stage between groups. Overall 5-year survival rates for patients with and without PF were 25 and 27 %, respectively. There was no significant difference in overall survival between the two groups (P = 0.743). Multivariate analysis demonstrated that the use of postoperative adjuvant chemotherapy (P < 0.001), tumor differentiation (P = 0.005), and lymph node metastasis (p < 0.001) were factors independently associated with overall survival. These results suggested that PF was not associated with deterioration of long-term outcomes in patients with pancreatic carcinoma. However, further analyses on larger number of patients are needed to determine a negative effect of grade C PF on long-term survival.

Biological predictors of survival in stage II colorectal cancer

The routine use of postoperative adjuvant chemotherapy in patients with stage II colorectal cancer is not recommended. However, the incidence of tumor recurrence or distant metastasis in these patients is reported to be 25–35%. The identification of high-risk patients with stage II colorectal cancer remains difficult. Therefore, the aim of this study was to determine the risk factors that may help identify stage II colorectal cancer patients with unfavorable prognosis. Paraffin-embedded tissue samples from 109 patients with stage II colorectal cancer following curative operation were analyzed. Thirteen clinicopathological variables and 5 biological markers were assessed using immunohistochemistry, including p53 (tumor suppressor gene), CD10 (tumor invasion marker), CD34 (angiogenic marker), Ki-67 (cell proliferation index) and CAM 5.2 (marker of lymph node micrometastasis) and investigated for associations with disease-specific survival. Univariate analysis revealed bowel obstruction, lymph node micrometastasis and lymphatic invasion (P<0.01) to be highly significant factors for determining the 5-year disease-specific survival. By contrast, the multivariate analysis revealed lymph node micrometastasis and lymphatic invasion to be independent prognostic factors. Stage II colorectal cancer patients with lymph node micrometastasis and lymphatic invasion may therefore be suitable candidates for adjuvant chemotherapy to improve prognosis.

Hepatic resection for colorectal cancer metastasis: A retrospective review of the Ottawa Hospital Cancer Centre over 7 years.

e14154 Background: The timing of chemotherapy (adjuvant vs neoadjuvant) for patients undergoing potentially curative hepatic resection of metastasis from colorectal cancer origin is controversial. Methods: We performed a retrospective review of all patients at TOHCC who underwent successful surgical resection of hepatic metastasis from CRC between 2002-2009. Patients receiving intra-operative radiofrequency ablation (RFA) as part of their management were included. Factors associated with overall survival were evaluated. Results: 168 patients had median age 62 years (31-84), 57/43% male/female. Median pre-op CEA was 5.5 ng/ml (0.3 - 529.2). Primary tumor location included 40% left, 35% rectum, 20% right, 5% transverse. 61.5% patients were node positive. Following hepatectomy 10.2% had positive resection margins. Intra-operative RFA was used in 26 (15.4%) patients. Chemotherapy was administered in a neo-adjuvant (47.6%), adjuvant (58.4%) or “perioperative” (both neoadjuvant and adjuvant; 36.1% ) setting. Use of intraoperative RFA vs. no RFA was not associated with overall survival (HR: 0.94 [95%CI: 0.49-1.80],p=0.85). In both univariate and multivariate analysis, the only adverse factor found associated with survival was R1 status (HR 2.38 [95% CI 1.49-5.0], p=0.0198). Other baseline variables (age, gender, node status, histologic grade, primary tumour site, timing of metastatic diagnosis [metachronous vs. synchronous]) did not reach statistical significance. Conclusions: While statistical significance was not achieved, ability to demonstrate benefit of chemotherapy may have been limited by sample size. Hazard ratios suggest trend to greatest benefit with use of post-operative adjuvant chemotherapy. 3y and 5y survival data is encouraging. Use of RFA where required as an adjunct to hepatic resection appeared as effective as resection of all disease in this series. Recurrence and morbidity data will be presented. [Table: see text]

Adjuvant Gemcitabine Plus S-1 Chemotherapy Improves Survival After Aggressive Surgical Resection for Advanced Biliary Carcinoma

The aim of this study was to evaluate the efficacy of adjuvant gemcitabine plus S-1 chemotherapy after aggressive surgical resection for advanced biliary carcinoma. No effective adjuvant therapy for advanced biliary carcinoma has been reported although its prognosis is extremely poor. Medical records were reviewed for 103 patients with International Union Against Cancer (UICC) stage II biliary carcinoma who underwent aggressive surgical resection. About 50 patients received 10 cycles of adjuvant gemcitabine plus S-1 chemotherapy and 53 patients did not. Clinicopathological factors and patient survival were compared between the 2 groups using univariate and multivariate analysis. A cycle of chemotherapy consisted of intravenous gemcitabine 700 mg/m(2) on day 1 and oral S-1 50 mg/m(2) for 7 consecutive days, followed by a 1-week break from chemotherapy. Patient demographics, tumor characteristics, and surgical procedures did not differ between the 2 groups. Aggressive surgical procedures including major hepatectomy or pancreatoduodenectomy were performed for 94 of 103 patients. In the chemotherapy group, 37 patients (74%) were given the full number of 10 cycles. The use of postoperative adjuvant chemotherapy (P < 0.001) and surgical margin status (P = 0.003) were independently associated with long-term survival by multivariate analysis. Five-year survival rates of patients who did or did not receive postoperative adjuvant chemotherapy were 57% and 24%, respectively (P < 0.001). Toxicity during chemotherapy was mild. Adjuvant gemcitabine plus S-1 chemotherapy may be one of several factors contributing to improved outcomes after aggressive surgical resection of advanced biliary carcinoma in recent years.

Postoperative Adjuvant Chemotherapy Improves Survival after Surgical Resection for Pancreatic Carcinoma

Pancreatic carcinoma is one of the most aggressive types of gastrointestinal malignancy, and its prognosis remains extremely dismal. The aim of this study was to identify useful prognostic factors for patients undergoing surgical resection for pancreatic carcinoma. Medical records of 89 patients with pancreatic carcinoma who underwent surgical resection were retrospectively reviewed. Univariate and multivariate models were used to analyze the effect of various clinicopathological factors on long-term survival. There were no operative deaths. Overall 1-, 2-, and 5-year survival rates were 59, 28, and 7%, respectively (median survival time, 12.1 months). Univariate analysis revealed that postoperative adjuvant chemotherapy, portal vein invasion, lymph node metastasis, extrapancreatic nerve plexus invasion, surgical margin status, UICC pT factor, and UICC stage were significantly associated with long-term survival (P < 0.01). Furthermore, use of postoperative adjuvant chemotherapy and absence of extrapancreatic nerve plexus invasion were found to be significant independent predictors of a favorable prognosis using a Cox proportional hazard regression model (P < 0.05). These results suggest that postoperative adjuvant chemotherapy may improve survival after surgical resection for pancreatic carcinoma and that extrapancreatic nerve plexus invasion indicates a poor prognosis for long-term survival.

The effect of inadvertent tumor contamination of wounds during the surgical resection of musculoskeletal neoplasms.

The effect of inadvertent tumor violation with visually evident wound contamination during the surgical resection of musculoskeletal neoplasms is unknown. In an attempt to assess the significance of wound contamination by tumor tissue, the incidence of local recurrence in 28 cases of known wound contamination was determined. The influence of immediate lavage, re-excision, subsequent surgical margin, and the use of adjuvant chemotherapy and/or radiation therapy upon local recurrence was assessed. Achieving a wide surgical margin by immediate re-excision after contamination gave a significantly lower incidence of recurrence than those with lesser final margins (P less than 0.01). The use of postoperative adjuvant chemotherapy or irradiation resulted in a lower recurrence rate, but the difference between those with and without adjuvant treatment had statistically less significance than the surgical margin on the incidence of local recurrence (P less than 0.2). The risk of local recurrence after contamination was not influenced by the histologic grade of the tumor.