Long-term hematopoietic transfer of the anti-cancer and lifespan-extending capabilities of a genetically engineered blood system by transplantation of bone marrow mononuclear cells.

A causal relationship exists among the aging process, organ decay and disfunction, and the occurrence of various diseases including cancer. A genetically engineered mouse model, termed Klf1K74R/K74R or Klf1(K74R), carrying mutation on the well-conserved sumoylation site of the hematopoietic transcription factor KLF1/EKLF has been generated that possesses extended lifespan and healthy characteristics, including cancer resistance. We show that the healthy longevity characteristics of the Klf1(K74R) mice, as exemplified by their higher anti-cancer capability, are likely gender-, age-, and genetic background-independent. Significantly, the anti-cancer capability, in particular that against melanoma as well as hepatocellular carcinoma, and lifespan-extending property of Klf1(K74R) mice, could be transferred to wild-type mice via transplantation of their bone marrow mononuclear cells at a young age of the latter. Furthermore, NK(K74R) cells carry higher in vitro cancer cell-killing ability than wild-type NK cells. Targeted/global gene expression profiling analysis has identified changes in the expression of specific proteins, including the immune checkpoint factors PDCD and CD274, and cellular pathways in the leukocytes of the Klf1(K74R) that are in the directions of anti-cancer and/or anti-aging. This study demonstrates the feasibility of developing a transferable hematopoietic/blood system for long-term anti-cancer and, potentially, for anti-aging.

A virtual reality intervention to improve formal caregivers' understanding of community-dwelling people with dementia: a pilot study.

BACKGROUND: The optimum approach to enhance the understanding toward dementia is to experience how patients feel as they experience the manifestations of the disease. The application of virtual reality (VR) and relevant innovative technologies for developing caregiver training programs allows caregivers to better understand dementia and empathize with patients. OBJECTIVES: To develop a VR-based experiential training course on individualized care for the behavioral and psychological symptoms of dementia (BPSD). METHODS: The participants were caregivers of patients with dementia. They assessed the usability of the VR product after the intervention and the VR experience as a preliminary measure of the effectiveness of the intervention using a usability scale and a self-reported appraisal scale, respectively. RESULTS AND CONCLUSION: Ten in-service and in-home caregivers completed the VR training course. The course yielded a usability score of 74.06 points, indicating excellent usability. The content validity index (CVI) of the self-reported VR experience appraisal scale ranged from 0.8-1, scale-level CVI was 0.81, and reliability (Cronbach's α) was 0.929. The mean score of the overall scale was 4.67 ± 0.33. These findings suggest that the VR-based experiential training course enabled the home caregivers to deepen their understanding of the BPSD shown by community-dwelling patients and, therefore, to provide better care services. The course developed in this study is the first VR course directed toward dementia care in Taiwan. Given its excellent usability, as well as the effectiveness of the VR experience appraisal scale for deepening the caregivers' skills in managing patients' BPSD symptoms, the course can be promoted and applied in caregiver training programs for dementia in the future.

Socially Assistive Robots for People Living with Dementia in Long-Term Facilities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND OBJECTIVE: The purpose of our study was to explore the immediate and long-term effects of socially assistive robots (SARs) on neuropsychiatric symptoms (NPSs), behavioral and psychological symptoms of dementia (BPSD), positive emotional experiences, and social interaction in older people living with dementia. METHODS: We set keywords and used Boolean operators to search the CINAHL, Cochrane Library, EMBASE, IEEE Digital Library, MEDLINE, PsycINFO, PubMed, Web of Science, Scopus, and Chinese Electronic Periodical Service from inception to February 2022 for randomized controlled trials. The Cochrane Collaboration bias assessment tool was used to assess article quality, and RevMan 5.4.1 software was used to conduct the meta-analysis. RESULTS: A total of 14 studies were included in the meta-analysis. SARs can help people living with dementia reduce their NPS of depression and anxiety, provide happiness from positive emotional experiences, and improve their social interaction through conversation. However, there was no significant improvement in agitation behavior, overall BPSD, or quality of life in people living with dementia. In follow-up, it was found that the effect of SRT was limited. CONCLUSION: SARs can reduce depression and increase positive emotions in people living with dementia. They may also reduce the burden on healthcare workers during the COVID-19 pandemic. This research was registered on PROSPERO CRD42020169340.

Foley balloons' tamponade is an effective method for controlling massive pelvic bleeding during colorectal surgery.

PURPOSE: Hemostasis can be achieved by various methods, but it can be difficult to stop active bleeding in the pelvis. An effective method is described to stop massive active bleeding in the pelvis during colorectal surgery. METHODS: When there were massive bleedings in the pelvis, 3 to 5 Foley catheters were inserted through stab wounds on the abdomen. The tips of catheters were placed in the pelvis. Each balloon was inflated with 40 mL of sterile water. The water inside each balloon was removed gradually from the third postoperative day. If there is no further bleeding, all catheters were removed on the 7th postoperative day. RESULTS: There were 8 patients (4 males and 4 females) with massive pelvic bleeding encountered from January 1998 to December 2018. Four patients underwent low anterior resection for primary rectal cancer, 2 patients for colon cancer with pelvic recurrence, 1 patient for ovary cancer with pelvic recurrence, and 1 patient for presacral parachordoma with a bleeding tendency. All of the patients survived without further bleeding after surgery. CONCLUSION: The technique is a simple method to control massive pelvic bleeding during colorectal surgery. It is also inexpensive and effective even in patients with a bleeding tendency.

Real-world evidence of the safety and effectiveness of regorafenib in Taiwanese patients with metastatic colorectal cancer: CORRELATE Taiwan.

BACKGROUND/PURPOSE: This analysis reports safety and effectiveness data from the Taiwanese cohort of the CORRELATE study. METHODS: CORRELATE was a prospective, observational study to assess the safety and effectiveness of regorafenib for the treatment of metastatic colorectal cancer (CRC) in real-world clinical practice that was conducted in 13 different countries in Asia, Europe and Latin America. The primary endpoint of the study was incidence of all treatment-emergent AEs (TEAEs), and secondary endpoints included overall survival (OS), progression-free survival (PFS), and disease control rate (DCR). RESULTS: The global study population (N = 1037) included 128 Taiwanese patients with a median age of 64 years, median weight of 62.02 kg and 66.41% were male. Reduced initiating doses of regorafenib and dose interruptions were common in Taiwanese patients (71.87% and 50.00%, respectively). The safety profile of regorafenib was consistent with that seen in Asian patients in the clinical development trials, including the CORRECT and CONCUR studies, with hand-foot-skin reactions (HFSR) of any grade occurring in 33.59% of patients. Median OS was 11.64 months in the Taiwanese patients (95% confidence interval [CI], 8.36-13.82) and median PFS was 2.17 months (95% CI, 1.97-2.89). CONCLUSION: The safety and effectiveness of regorafenib in this real-world study was generally consistent with the known efficacy and safety profile in Asian patients in clinical trials. TRIAL REGISTRATION: NCT02042144.

Effectiveness of sigmoidoscopy for assessing ulcerative colitis disease activity and therapeutic response.

Ulcerative colitis (UC) typically begins in the rectum and progresses proximally in a contiguous fashion without skip lesions. Post-treatment inflammation distribution can change over time. Colonoscopy is unpleasant for the patient and clinical trials often use sigmoidoscopy for evaluation of disease severity. The aim of this study is to evaluate whether sigmoidoscopy is adequate to assess disease activity and therapeutic response as colonoscopy.We retrospectively reviewed patients who underwent colonoscopy for the initial diagnosis and follow-up by evaluating their mucosal inflammation in our hospital from January 2012 and December 2017.A total of 69 patients were analyzed. During follow up, the inflamed segment changed post-treatment in 62% (43/69). Extensive UC was common in the changed disease extent group (P < .01). Patients treated with oral mesalazine had a higher rate of changed disease extent (P < .01). The sigmoid segment was the most commonly involved segment, and the rectum was the severely inflamed segment during initial diagnosis and follow-up. According to Mayo endoscopic subscore (MES) in the most severely inflamed colonic and rectosigmoid segment, there were high degrees of correlation in the initial UC diagnosis (r = .90, P < .01) and follow-up (r = .74, P < .01).Our findings suggest that sigmoidoscopy is effective as colonoscopy for detecting disease activity and evaluating therapeutic response in UC patients during follow-up.

Cost minimization comparison of oral UFT/leucovorin versus 5-fluorouracil/leucovorin as adjuvant therapy for colorectal cancer in Taiwan.

AIM: Oral uracil-tegafur/leucovorin (UFT/LV) and intravenous 5-fluorouracil (FU)/LV are common adjuvant therapies for Stages II and III colorectal cancer. This study aims to determine the most cost-effective treatment alternative between UFT/LV and 5-FU/LV in Stages II and III colorectal cancer from Taiwan's National Health Insurance perspective. PATIENTS & METHODS: The costs were referenced directly from the National Health Insurance reimbursement price. Chemotherapy regimen considered for the cost analysis calculation was adapted from NSABP-C-06 study, and, a time saving calculation was also included. In addition, we compare the treatment outcome. RESULT: A total cost saving of US$3620.80-$3709.16 per patient per treatment was achieved with the UFT/LV treatment. UFT/LV provides the comparable outcome to 5-FU/LV. CONCLUSION: UFT/LV was the more cost-effective treatment as adjuvant chemotherapy.

Genome-Wide Scan for Copy Number Alteration Association with Relapse-Free Survival in Colorectal Cancer with Liver Metastasis Patients.

Predicting a patient's risk of recurrence after the resection of liver metastases from colorectal cancer is critical for evaluating and selecting therapeutic approaches. Clinical and pathologic parameters have shown limited accuracy thus far. Therefore, we combined the clinical status with a genomic approach to stratify relapse-free survival in colorectal cancer liver metastases patients. To identify new molecular and genetic signatures specific to colorectal cancer with liver metastasis (CRCLM) patients, we conducted DNA copy number profiling on a cohort of 21 Taiwanese CRCLM patients using a comparative genomic hybridization (CGH) array. We identified a three-gene signature based on differential copy number alteration between patients with different statuses of (1) recurrence and (2) synchronous metastasis. In relapse hotspot regions, only three genes (S100PBP, CSMD2, and TGFBI) were significantly associated with the synchronous liver metastasis factor. A final set of three genes-S100PBP, CSMD2, TGFBI-significantly predicted relapse-free survival in our cohort (p = 0.04) and another CRCLM cohort (p = 0.02). This three-gene signature is the first genomic signature validated for relapse-free survival in post-hepatectomy CRCLM patients. Our three-gene signature was developed using a whole-genome CGH array and has a good prognostic position for the relapse-free survival of CRCLM patients after hepatectomy.

Presence of colon carcinoma cells at the resection line may cause recurrence following stapling anastomosis.

BACKGROUND/OBJECTIVE: The presence of carcinoma cells in the suture line may result in local recurrence. The purpose of this study was to assess whether carcinoma cells were present along the resection line where the distal clamp was applied. METHODS: During surgery, the rectum was clamped at least 3 cm distal to the palpable margin of the tumor mass. The rectum was divided distal and proximal to the clamp. The tissue inside the clamp was rinsed with normal saline, and the irrigation solution was sent for cytologic examination. RESULTS: In 134 patients with carcinoma of the rectosigmoid colon or rectum, we found four (3.0%) cases of positive cytology, and five cases (3.7%) with cytology indicting the presence of atypical cells highly suspicious for malignancy. It was postulated that the trapping of cancer cells in a double-staple anastomosis line may have resulted in local recurrence. CONCLUSION: This study indicates that double staple-line recurrence is related to the shedding of cancer cells during dissection and clamping.

Challenges in the diagnosis of ulcerative colitis with concomitant bacterial infections and chronic infectious colitis.

Ulcerative colitis (UC) is a chronic inflammation of the large bowel characterized by diarrhea and a negative stool culture. However, several enteropathogens have been implicated as causative agents in UC. The differentiation between chronic infectious colitis (IC) and UC with concurrent infection is difficult owing to their similar clinical presentations. The study aimed to explore the presentations and diagnostic clues that enable differentiation between UC with concomitant infections and chronic IC. The study included 17 UC patients with a bacterial infection and 46 with chronic IC. The UC patients (47 ± 19 years) were younger than the chronic IC patients (58 ± 20 years) (P = 0.022). Bloody diarrhea was more common in UC than in chronic IC (58.8% vs 10.9%, P < 0.001). Previous antibiotic usage was a risk factor for chronic IC (5.9% vs 32.6%, P = 0.031). Malignancy was a common comorbidity of chronic IC (5.9% vs 34.8%, P = 0.022). UC patients had lower antibiotic response rates than chronic IC patients (60.0% vs 87.2%, P = 0.026). Aeromonas species and Clostridium difficile were common in both groups. Histological features of cryptitis and crypt abscess were useful in the diagnosis of UC (P = 0.052 and P = 0.016, respectively). Bloody diarrhea in a young adult, decreased response to antibiotic treatment, and results of endoscopy with biopsy are important features in the diagnosis of UC with bacterial infection.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

A retrospective analysis of 20-year data of the surgical management of ulcerative colitis patients in Taiwan: a study of Taiwan Society of Inflammatory Bowel Disease.

BACKGROUND/AIMS: With the recent progress in medical treatment, surgery still plays a necessary and important role in treating ulcerative colitis (UC) patients. In this study, we analyzed the surgical results and outcomes of UC in Taiwan in the recent 20 years, via a multi-center study through the collaboration of Taiwan Society of IBD. METHODS: A retrospective analysis of surgery data of UC patients from January 1, 1995, through December 31, 2014, in 6 Taiwan major medical centers was conducted. The patients' demographic data, indications for surgery, and outcome details were recorded and analyzed. RESULTS: The data of 87 UC patients who received surgical treatment were recorded. The median post-operative follow-up duration was 51.1 months and ranged from 0.4 to 300 months. The mean age at UC diagnosis was 45.3±16.0 years and that at operation was 48.5±15.2 years. The 3 leading indications for surgical intervention were uncontrolled bleeding (16.1%), perforation (13.8%), and intractability (12.6%). In total, 27.6% of surgeries were performed in an emergency setting. Total or subtotal colectomy with rectal preservation (41.4%) was the most common operation. There were 6 mortalities, all due to sepsis. Emergency operation and low pre-operative albumin level were significantly associated with poor survival (P=0.013 and 0.034, respectively). CONCLUSIONS: In the past 20 years, there was no significant change in the indications for surgery in UC patients. Emergency surgeries and low pre-operative albumin level were associated with poor survival. Therefore, an optimal timing of elective surgery for people with poorly controlled UC is paramount.

TEGAFIRI is an effective alternative regimen for the management of recurrent or metastatic colorectal cancer.

At present, the global incidence of colorectal cancer is increasing, with numerous individuals succumbing to the disease. The standard treatment strategy for colorectal cancer is curative resection. However, a cure is rarely achieved for metastatic colorectal cancer. Currently, chemotherapy is the main treatment for metastatic and recurrent colorectal cancer. The majority of metastases or recurrences have been found to respond well to chemotherapy. The present study evaluated the response rates of recurrent or metastatic colorectal cancer patients treated with a combination chemotherapy of irinotecan and oral uracil-tegafur (UFUR). In the pilot study, 33 patients with metastatic or recurrent colorectal cancer were treated with different regimens of irinotecan and UFUR with or without leucovorin; however, irinotecan (150 mg/m2 every two weeks) with continuous UFUR and leucovorin without interruption resulted in improved survival compared with the other regimens evaluated and, thus, was employed for the present study of 113 patients. The patients that received irinotecan with UFUR and leucovorin without interruption exhibited similar efficacy in terms of overall survival and response rate to that of the pilot study. In addition, the incidences of diarrhea, alopecia and hematologic toxicity were acceptable, which was in agreement with the results of the pilot study. Therefore, combination chemotherapy with irinotecan, oral UFUR and leucovorin appears to be a satisfactory treatment strategy for recurrent or metastatic colorectal cancer.

Safety and Efficacy of Adalimumab for Patients With Moderate to Severe Crohn's Disease: The Taiwan Society of Inflammatory Bowel Disease (TSIBD) Study.

BACKGROUND/AIMS: Only moderate to severe Crohn's Disease (CD) patients without a satisfactory conventional therapy effect are eligible to get reimbursement from the National Health Insurance of Taiwan for using adalimumab. These are more stringent criteria than in many Western countries and Japan and Korea. We aim to explore the efficacy of using adalimumab in CD patients under such stringent criteria. METHODS: A retrospective analysis was conducted in nine medical centers in Taiwan and we collected the results of CD patients receiving adalimumab from Sep 2009 to Mar 2014. The clinical characteristics, response measured by CDAI (Crohn's Disease Activity Index), adverse events and survival status were recorded and analyzed. CR-70, CR-100, and CR-150 were defined as attaining a CDAI decrease of 70, 100 or 150 points compared with baseline. RESULTS: A total of 103 CD patient records were used in this study. Sixty percent of these patients received combination therapy of adalimumab together with immunomodulators. CR-70 was 68.7%, 74.5% and 88.4% after week 4, 8 and 12 of treatment, respectively. The steroid-free rate, complications and survival were 47.6%, 9.7% and 99% of patients, respectively. In considering the mucosal healing, only 25% patients achieve mucosal healing after treatment for 6 to 12 months. Surgery was still needed in 16.5% of patients. Combination treatment of adalimumab with immunomodulators further decreased the level of CDAI at week 8 when compared with the monotherapy. CONCLUSIONS: Even under the stringent criteria for using adalimumab, the response rate was comparable to those without stringent criteria.

An open-label safety study of first-line bevacizumab in combination with standard chemotherapy in Chinese patients with metastatic colorectal cancer treated in an expanded access program in Taiwan.

OBJECTIVE: An increased risk of serious adverse effects related to bevacizumab has been observed in many Western studies for metastatic colorectal cancer. To evaluate the safety of bevacizumab in Chinese patients, a safety study was conducted in Taiwan. METHODS: Bevacizumab was provided by the Expanded Access Program in combination with first-line chemotherapy per investigator's choice. The primary objective is the safety profile, particularly the targeted adverse events such as proteinuria, bowel perforation, hypertension, wound healing complication, thromboembolism and bleeding. The second objectives include time to disease progression and overall survival time. Patients with major surgical procedure performed within the 28 days of bevacizumab were excluded from this study. RESULTS: Forty patients were eligible for intent-to-treat analysis. The overall rate of objective response and disease control was 55.2 and 81.6%. The median time to disease progression and overall survival were 11.9 and 22.9 months. The actuarial 2-year survival was 46.6%. Regarding toxicity, 7 subjects (17.5%) had serious adverse effects related to study treatment. None of the patients in this cohort had arterial thrombotic events and bowel perforation. CONCLUSIONS: Bevacizumab demonstrates a similar activity and safety profile in Chinese patients. Life-threatening bowel complications were avoided in this study by excluding patients with major surgery within the first 28 days.

Abdominoperineal resection without an abdominal incision for rectal cancer has the advantage of no abdominal wound complication and easier stoma care.

Abdominoperineal resection has been used for years for the management of low rectal cancer. However, the abdominal incision is associated with many complications and causes interference of the stoma care. If the abdominal incision can be avoided, it would be beneficial to the patient. The aim of the study is to evaluate the possibility and safety of performing abdominoperineal resection and the oncology result without an abdominal incision. From September 2001 to May 2010, 40 patients with rectal malignancies received excision of the rectum, anus, and perineum through a perineal incision and a skin hole created for stomy. No harmonic scalpel or laser was used during surgery. No laparoscope or hand port was used in the procedure. There were 19 males and 21 females. Age ranged from 31 to 87 years old (average, 62.9 years). There were 39 adenocarcinomas and one malignant gastrointestinal stromal cell tumor. There was no operative mortality. Six patients had postoperative complications; three patients had intestinal obstructions; and one patient each had bleeding, urinary tract infection, and colostomy separation from the skin. The lymph nodes in the specimens ranged from 9 to 33 cm (average, 16.8 cm). The survival is similar to the traditional abdominoperineal resection. This limited experience suggests that an abdominal incision is not necessary for radical resection of the rectum, anus, and perineum in patients with low-lying rectal cancer. It also offers the patient easier care of stoma without interference of the abdominal incision.

A surgeon's help with the management of bowel problems related to gynecology is truly needed - comparison of two periods spanning 24 years.

OBJECTIVE: Colorectal surgeons are frequently on call to provide help to gynecologists who are managing bowel problems that occur either during or following gynecological surgery. This is a retrospective analysis of a single surgeon's experiences associated with such instances. The analysis focuses on whether there have been any changes in referral patterns, surgical techniques and/or results. MATERIALS AND METHODS: From July 1984 to June 2008, 282 patients were operated on by a single colorectal surgeon, for problems that were related to gynecology. These consisted of 137 patients operated on during the first 12-year period, from July 1984 to June 1996. During this first period, 85 patients were operated on for cervical cancer related problems, 39 patients were operated on for problems related to other gynecological malignancies and nine patients were operated on for iatrogenic bowel injury during surgery. During the second 12-year period, from July 1996 to June 2008, 145 patients were operated on. Of these, 85 patients were operated on for cervical cancer related problems, 44 patients were operated on for problems related to other gynecological malignancies and eight patients were operated on for iatrogenic bowel injury during surgery. RESULTS: During the first 12-year period, six operations were pelvic exenterations for primary gynecological malignancies or recurrences. One hundred and one patients received stomas during their first operation. Twenty-five patients encountered various complications. Postoperative death occurred in five patients. During the second 12-year period, 12 operations were pelvic exenterations for primary gynecological malignancies or recurrences. Eighty-seven patients received stomas during their first operation. Thirty-seven patients encountered various complications. Postoperative death occurred in six patients. CONCLUSION: Gynecological problems frequently involve the colon or rectum. Cervical cancer related problems remain the most common type necessitating help from a colorectal surgeon. In spite of advances in surgical management, stomas are still frequently unavoidable in order to cure a patient or improve the patient's quality of life. Appropriate management of problems by a colorectal surgeon in relation to gynecology is important and in the best interests of the patient.

Presacral parachordoma causing intestinal obstruction in a patient with renal failure: Report of a case.

Parachordoma is usually lobulated and pseudoencapsulated, grows slowly, and is only locally invasive. It rarely occurs in the retroperitoneal area. Differential diagnoses include chordoma, extraskeletal myxoid chondrosarcoma, and subcutaneous sacrococcygeal myxopapillary ependymoma. We herein report our experience with a huge presacral parachordoma causing intestinal obstruction. A 48-year-old woman was a hemodialysis-dependent patient with end-stage renal disease. She had been diagnosed with uterine myomas several years prior. The patient presented with signs of intestinal obstruction. A presacral tumor with severe compression on the rectum resulting in rectal stricture was found. A resection of the presacral tumor was difficult owing to its large size and the difficult location of the tumor, tendency for high blood loss, and the patient's poor physiological status secondary to uremia. Resection of the lesion was complicated by intraoperative bleeding and late occurrence of a pelvic abscess, which was successfully treated by computed tomography-guided drainage.

Pharmacoeconomic analysis of capecitabine versus 5-fluorouracil/leucovorin as adjuvant therapy for stage III colon cancer in Taiwan.

OBJECTIVES: To assess the cost-effectiveness of oral capecitabine compared with intravenous bolus 5-fluorouracil/leucovorin (5-FU/LV) in the adjuvant treatment of stage III colon cancer in Taiwan from payer (Bureau of National Health Insurance [BNHI]) perspectives. METHODS: A health state-transition model was developed to estimate the incremental costs and effectiveness of capecitabine versus 5-FU/LV. The time horizons studied were: treatment duration (24 weeks) plus 36 months, 48 months, 60 months, 120 months, and lifetime. Costs were expressed in Taiwanese new dollars (NT$). Clinical outcomes, medical resource use, and utilities were extracted from published sources. Unit costs were estimated from BNHI fee schedules, published sources, and local expert opinion. Outcomes and future costs were discounted at 3%. Cost-effectiveness was expressed as cost per quality-adjusted life-month (QALM). The effects of uncertainty were explored through a one-way sensitivity analysis. RESULTS: For the 24-week time period, drug acquisition costs were higher for capecitabine than 5-FU/LV (NT$114,405 vs. NT$4,904 per patient); however, these were offset by the higher administration costs of 5-FU/LV (NT$2,573 vs. NT$204,201 per patient). Overall direct costs for the 24-week treatment period were less with capecitabine than 5-FU/LV (NT$129,327 vs. NT$233,873 per patient). Cost savings with capecitabine were also evident when longer time horizons were considered. Over a lifetime, the projected survival benefit for capecitabine was 7 QALMs. CONCLUSIONS: From the perspectives of the BNHI and society in Taiwan, capecitabine not only saves costs but also improves health outcomes compared with 5-FU/LV in the adjuvant treatment of stage III colon cancer.