Nationwide comprehensive gastro-intestinal cancer cohorts: the 3P initiative.

BACKGROUND: The increasing sub-classification of cancer patients due to more detailed molecular classification of tumors, and limitations of current trial designs, require innovative research designs. We present the design, governance and current standing of three comprehensive nationwide cohorts including pancreatic, esophageal/gastric, and colorectal cancer patients (NCT02070146). Multidisciplinary collection of clinical data, tumor tissue, blood samples, and patient-reported outcome (PRO) measures with a nationwide coverage, provides the infrastructure for future and novel trial designs and facilitates research to improve outcomes of gastrointestinal cancer patients. MATERIAL AND METHODS: All patients aged ≥18 years with pancreatic, esophageal/gastric or colorectal cancer are eligible. Patients provide informed consent for: (1) reuse of clinical data; (2) biobanking of primary tumor tissue; (3) collection of blood samples; (4) to be informed about relevant newly identified genomic aberrations; (5) collection of longitudinal PROs; and (6) to receive information on new interventional studies and possible participation in cohort multiple randomized controlled trials (cmRCT) in the future. RESULTS: In 2015, clinical data of 21,758 newly diagnosed patients were collected in the Netherlands Cancer Registry. Additional clinical data on the surgical procedures were registered in surgical audits for 13,845 patients. Within the first two years, tumor tissue and blood samples were obtained from 1507 patients; during this period, 1180 patients were included in the PRO registry. Response rate for PROs was 90%. The consent rate to receive information on new interventional studies and possible participation in cmRCTs in the future was >85%. The number of hospitals participating in the cohorts is steadily increasing. CONCLUSION: A comprehensive nationwide multidisciplinary gastrointestinal cancer cohort is feasible and surpasses the limitations of classical study designs. With this initiative, novel and innovative studies can be performed in an efficient, safe, and comprehensive setting.

Transfused stored platelets have the same haemostatic function as circulating native platelets.

BACKGROUND AND OBJECTIVES: As thrombelastography (TEG) measures haemostasis in whole blood, we used this instrument to study whether transfused platelets (PLTs) have the same haemostatic function compared to native circulating PLTs. Further, we studied the effect of storage time on the haemostatic potential of platelet concentrates (PCs). MATERIALS AND METHODS: During the decrease in PLT count after chemotherapy, TEG parameters were measured serially until the transfusion trigger was reached in 92 patients. TEG parameters for different ranges of native circulating PLTs could be assessed, which were compared to ranges obtained in the thrombocytopenic period in which the patient received PLT transfusions. Finally, we compared the haemostatic potential of fresh PCs (1-3 days) with PCs with longer storage time (4-5 days). RESULTS: No differences could be found in haemostatic potential between native PLTs and transfused stored PLTs (all P-values > or = 0.1). The transfusion of fresh PLTs demonstrated better haemostatic effects than longer stored PLTs, measured 1 h after transfusion. Both the time until a fixed level of clot firmness was reached (K-time) and the rate of clot growth (alpha angle) were superior for fresh PCs. CONCLUSION: TEG is able to monitor the haemostatic effects of PLT transfusion, with comparable haemostatic properties of native circulating and transfused stored-PLTs. Further, our data suggest that limited storage time is associated with a better haemostatic capacity. However, before TEG can be applied as a qualitative test in PLT transfusion, further research is needed with focus on clinical outcomes like bleeding episodes.

Renal failure after treatment with interferon alpha 2b.

Although there has been considerable experience with interferons in the treatment of malignancy and viral illnesses, acute renal failure as a side-effect of interferon treatment has rarely been reported. We present the case of a patient who developed acute on chronic renal failure 16 months after the initiation of interferon alpha 2b for a metastatic carcinoid tumor.

[Acute acalculous cholecystitis: not only in the intensive care department]. / Acute acalculeuze cholecystitis; ook buiten de intensive care.

In two men aged 65 and 40 years with abdominal pain, the diagnosis 'acute acalculous cholecystitis' (AAC) could be reached only after exploratory laparotomy. The first patient was initially admitted to the coronary-care department because of known atherosclerotic vascular disease; he died a few days after the operation due to sepsis. The second patient recovered satisfactorily after admission to intensive care because of haemodynamic instability. AAC is an illness with a non-specific clinical presentation and incomplete radiologic imaging. AAC is more frequently seen in outpatients than in acutely ill inpatients, especially in older male patients who have atherosclerotic vascular disease. Diagnostic and therapeutic delay leads to gangrene, empyema and perforation, resulting in a high mortality. To improve the outcome, a high and early index of suspicion is needed. Hepatobiliary scintigraphy should be included in the diagnostic pathway.