Dataset Information

Post-Treatment/Pre-operative PET Response Is Not an Independent Predictor of Outcomes for Patients With Gastric and GEJ Adenocarcinoma.

ABSTRACT: OBJECTIVE:To determine whether changes in positron emission tomography (PET) avidity correlated with histologic response and were independently associated with outcome. BACKGROUND:The implications of metabolic response to neoadjuvant therapy as measured by repeat PET imaging remain ill-defined for patients with gastric and gastroesophageal junction (GEJ) cancers. METHODS:We identified patients with gastric and GEJ adenocarcinoma who were evaluated with PET imaging before and following neoadjuvant treatment, and subsequently underwent curative resections. Spearman rank correlation and Cox proportional hazards regression were used to evaluate standardized uptake value (SUV) and histologic response, pathologic parameters, and disease-specific survival (DSS). RESULTS:From 2002 to 2013, 192 patients met our inclusion criteria. The median SUVmax response was 57.3% (range: -110% to 100%) for patients with GEJ cancers, with a corresponding median pathologic treatment response of 80% (range: 0% to 100%). The median SUVmax response was 32.5% (-230% to 100%) for patients with gastric cancers, with a corresponding median pathologic treatment response of 35% (range: 0% to 100%). The Spearman correlation between SUVmax response and histologic response was significant for patients with GEJ (rho = 0.19, P = 0.04) and gastric (rho = 0.44, P < 0.0001) cancers. For patients with GEJ (P <0.0001 to 0.046) and gastric cancers (P = 0.0003 to 0.016), histopathologic response and tumor staging predicted DSS. SUVmax response failed to demonstrate a relationship with DSS when entered into multivariable models containing conventional pathologic variables. CONCLUSION:Following completion of neoadjuvant therapy for gastric and GEJ adenocarcinoma, histopathologic staging remains the best predictor of outcome. Repeat post-treatment/preoperative PET imaging for the purpose of prognostication is of limited value.

SUBMITTER: Hernandez JM

PROVIDER: S-EPMC5794647 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Post-Treatment/Pre-operative PET Response Is Not an Independent Predictor of Outcomes for Patients With Gastric and GEJ Adenocarcinoma.

Hernandez Jonathan M JM Beylergil Volkan V Goldman Debra A DA van Beek Elke E Gonen Mithat M Tang Laura L Downey Robert R Rizk Nabil N Shah Manish M Strong Vivian V Janjigian Yelena Y Schöder Heiko H Coit Daniel G DG

Annals of surgery 20180501 5

<h4>Objective</h4>To determine whether changes in positron emission tomography (PET) avidity correlated with histologic response and were independently associated with outcome.<h4>Background</h4>The implications of metabolic response to neoadjuvant therapy as measured by repeat PET imaging remain ill-defined for patients with gastric and gastroesophageal junction (GEJ) cancers.<h4>Methods</h4>We identified patients with gastric and GEJ adenocarcinoma who were evaluated with PET imaging before an ...[more]

PMID: 28767564

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Project description:Importance: Trichiasis surgery programs globally have faced high rates of poor surgical outcomes. Identifying correctable risk factors for improving long-term outcomes is essential for countries targeting elimination of trachoma as a public health problem.Objective: To determine whether the location of trichiatic eyelashes prior to surgery influences development of post-operative trichiasis (PTT) within two years after surgery.Design: Secondary data analysis of four randomized clinical trials evaluating methods to improve trichiasis surgery outcomes. These include the Surgery for Trichiasis, Antibiotics for Recurrence (STAR) trial, Partnership for Rapid Elimination of Trachoma (PRET-Surgery), absorbable versus silk sutures trial, and epilation versus surgery for minor trichiasis trial.Setting: Primary trials were conducted in rural areas of Ethiopia and Tanzania.Interventions or exposures: Trichiasis surgery performed with either the bilamellar tarsal rotation procedure or posterior lamellar rotation procedure.Main outcomes: Prevalence of PTT within two years after surgery, location of trichiatic eyelashes pre-operatively and post-operatively.Results: 6,747 eyelids that underwent first-time trichiasis surgery were included. PTT rates varied by study, ranging from 10-40%. PTT was less severe (based on number of trichiatic eyelashes) than initial trichiasis for 72% of those developing PTT, and only 2% of eyelids were worse at follow up than pre-operatively. Eyelids with central only-trichiasis pre-operatively had lower rates of PTT than eyelids with peripheral only trichiasis in each of the three trials that included severe TT cases. 10% of eyelids with peripheral trichiasis pre-operatively that develop PTT have central TT post-operatively.Conclusions and relevance: Pre-operative central trichiasis is less likely than peripheral trichiasis to be associated with subsequent PTT. Regardless of type of surgery, surgeon skill levels, or pre-operative trichiasis severity, the presence of peripheral trichiasis pre-operatively is associated with higher rates of PTT. Making an incision that extends the length of the eyelid and adequately rotating the nasal and temporal aspects of the eyelid when suturing may help to minimize the chance of developing peripheral PTT.Trial registration: ClinicalTrials.gov PRET: NCT00886015; Suture: NCT005228560; Epilation: NCT00522912.

Project description:BackgroundVenous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator.MethodsPatients who underwent colorectal cancer resection from 2012 to 2016 were identified from ACS NSQIP colectomy and proctectomy procedure-targeted modules. Multivariable logistic regression was used to identify factors associated with post-discharge VTE. Incorporating pre-operative, intra-operative, and post-operative variables, a post-discharge VTE risk calculator was constructed and validated.ResultsOf 51,139 patients, 387 (0.76%) developed post-discharge VTE. Pre-operative factors associated with post-discharge VTE included BMI (e.g., morbidly obese OR 2.27, 95% CI 1.65-3.12 vs. normal BMI), and thrombocytosis (OR 1.41, 95% CI 1.03-1.92). Intra-operative factors included operative time (4-6 h OR 1.56, 95% CI 1.12-2.17; > 6 h, OR 1.85, 95% CI 1.21-2.84, vs. < 2 h), and type of operation (e.g., open partial colectomy OR 1.67, 95% CI 1.30-2.16 vs. laparoscopic partial colectomy). Post-operative factors included anastomotic leak (OR 2.05, 95% CI 1.31-3.21) and post-operative ileus (OR 1.39, 95% CI 1.07-1.79). Using the risk calculator, the predicted probability of post-discharge VTE ranged from 0.04 to 10.29%. On a 10-fold cross validation, the calculator's mean C-Statistic was 0.65.ConclusionsPatient-specific factors are associated with varying rates of post-discharge VTE. We present the first post-discharge VTE risk calculator designed for use at the time of discharge following colorectal cancer resection.

Dataset Information

Post-Treatment/Pre-operative PET Response Is Not an Independent Predictor of Outcomes for Patients With Gastric and GEJ Adenocarcinoma.

Publications

Post-Treatment/Pre-operative PET Response Is Not an Independent Predictor of Outcomes for Patients With Gastric and GEJ Adenocarcinoma.

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