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1.
Anticancer Res ; 41(11): 5539-5547, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732424

RESUMO

BACKGROUND/AIM: We aimed to investigate the prognosis of patients who received radiofrequency ablation (RFA) for liver metastases of unresectable colorectal cancer (CRC). PATIENTS AND METHODS: We retrospectively compared 147 patients treated for CRC liver metastases, who underwent RFA (n=26), resection (n=92), and chemotherapy (n=29) between 2001 and 2021. RESULTS: RFA and chemotherapy were performed for unresectable or non-operable cases, and resection was performed for suitable cases. The median overall survival (OS) was 44.9, 49.5, and 11.6 months for patients who underwent RFA, resection, and chemotherapy, respectively. RFA led to a significantly shorter OS compared to resection (p=0.027) but to a longer OS compared to chemotherapy (p=0.003). The 5-year survival rates were 34.6% and 42.4% for patients who underwent RFA and resection, respectively (p=0.508). CONCLUSION: RFA has the potential to achieve long-term survival or radical cure, even for unresectable or non-operable cases of CRC with liver metastasis.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Neoplasias Colorretais/mortalidade , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Estudos Retrospectivos , Fatores de Tempo
2.
Anticancer Res ; 41(11): 5821-5825, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732457

RESUMO

AIM: Anastomotic leakage (AL) in left-sided colorectal cancer is a serious complication, with an incidence rate of 6-18%. We developed a novel predictive model for AL in colorectal surgery with double-stapling technique (DST) anastomosis using auto-artificial intelligence (AI). PATIENTS AND METHODS: A total of 256 patients who underwent curative surgery for left-sided colorectal cancer between 2017 and 2021 were included. In addition to conventional clinicopathological factors, we included the type of circular stapler using DST, conventional double-row circular stapler (DCS) or EEA™ circular stapler with Tri-Staple™ technology, 28 mm Medium/Thick (Covidien, New Haven, CT, USA) which had triple-row circular stapler (TCS) as a covariate. Auto-AI software Prediction One (Sony Network Communications Inc.) was used to predict AL with 5-fold cross validation. Predictive accuracy was assessed using the area under the receiver operating characteristic curve. Prediction One also evaluated the 'importance of variables' (IOV) using a method based on permutation feature importance. RESULTS: The area under the curve of the AI model was 0.766. The type of circular stapler used was the most influential factor contributing to AL (IOV=0.551). CONCLUSION: This auto-AI predictive model demonstrated an improvement in accuracy compared to the conventional model. It was suggested that use of a TCS may contribute to a reduction in the AL rate.


Assuntos
Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Neoplasias Colorretais/cirurgia , Técnicas de Apoio para a Decisão , Aprendizado de Máquina , Grampeamento Cirúrgico/efeitos adversos , Idoso , Fístula Anastomótica/diagnóstico , Bases de Dados Factuais , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/instrumentação , Fatores de Tempo , Resultado do Tratamento
3.
Indian J Surg Oncol ; 12(3): 498-506, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34658577

RESUMO

Lymphocyte-to-monocyte ratio (LMR) has been reported as a biomarker for predicting the prognosis of colorectal cancer. However, the clinical usefulness of LMR requires detailed research, which can contribute to better therapeutic strategies. A cohort of 554 patients with resectable advanced colon cancer in our institution was analyzed retrospectively. An analysis of stages II and III resectable advanced colon cancer was performed. LMR was useful for predicting overall survival (OS) and relapse-free survival (RFS). The ROC curve revealed an LMR value of 2.77 as a cutoff for OS. A high LMR was an independent prognostic factor and was associated with a high hazard ratio (HR) in all cases for OS (HR = 0.530, 95% confidence interval (CI) = 0.334-0.842, p = 0.007). A high LMR was not an independent prognostic factor in stage II cases but was a predictor with the strongest association with prognosis in patients with stage III cases for OS (HR = 0.383, 95% CI = 0.160-0.915, p = 0.031). LMR is a strong predictor of prognosis in patients with stage III colon cancer and may be useful in postoperative treatment options.

4.
Anticancer Res ; 41(9): 4471-4478, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475071

RESUMO

AIM: This study aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in elderly patients with Stage I-III colon cancer for long-term oncologic outcomes. PATIENTS AND METHODS: We retrospectively reviewed 175 patients aged >75 years who underwent radical surgery for Stage I-III colon cancer between 2000 and 2015 at our institute. Overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) were evaluated according to NLR values using propensity score analysis. Patients were allocated to the higher NLR (H-NLR) or the lower NLR (L-NLR) group with a cut-off value of 2.3, based on receiver operating characteristic curve. RESULTS: Before case matching, there were significant differences between the two groups for CSS (p=0.023) and RFS (p<0.001), but not for OS (p=0.069). Similar results were obtained after case matching, with significant differences observed for CSS (p=0.003) and RFS (p=0.027), but not for OS (p=0.145). CONCLUSION: NLR may be a prognostic factor in elderly patients with colon cancer.


Assuntos
Neoplasias do Colo/sangue , Neoplasias do Colo/cirurgia , Neutrófilos/metabolismo , Pontuação de Propensão , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Procedimentos Cirúrgicos do Sistema Digestório , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos , Masculino , Estadiamento de Neoplasias , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
5.
Anticancer Res ; 41(9): 4629-4636, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475091

RESUMO

BACKGROUND/AIM: We aimed to develop a novel recurrence prediction model for stage II-III colon cancer using simple auto-artificial intelligence (AI) with improved accuracy compared to conventional statistical models. PATIENTS AND METHODS: A total of 787 patients who had undergone curative surgery for stage II-III colon cancer between 2000 and 2018 were included. Binomial logistic regression analysis was used to calculate the effect of variables on recurrence. The auto-AI software 'Prediction One' (Sony Network Communications Inc.) was used to predict recurrence with the same dataset used for the conventional statical model. Predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS: The AUC of the multivariate model was 0.719 (95%CI=0.655-0.784), whereas that of the AI model was 0.815, showing a significant improvement. CONCLUSION: This auto-AI prediction model demonstrates improved accuracy compared to the conventional model. It could be constructed by clinical surgeons who are not familiar with AI.


Assuntos
Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Inteligência Artificial , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Curva ROC , Medição de Risco , Resultado do Tratamento , Adulto Jovem
6.
Clin Exp Metastasis ; 38(5): 459-466, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34406563

RESUMO

This study aimed to examine the risk factors for surgical site infection (SSI) and the association of that with recurrence in JCOG0212. The results for secondary endpoints showed that compared with the mesorectal excision (ME) alone group, ME with lateral lymph node dissection (LLND) group showed significantly longer operative time and significantly higher blood loss. These results suggested that LLND was a risk factor for SSI. All 701 patients registered in JCOG0212 were analyzed in this study. Wound infection was defined as incisional/deep SSI, and pelvic abscess and anastomotic leakage were defined as organ/space SSI. The risk factors for the incidence of SSI and the effect of SSI on relapse-free survival (RFS) were investigated. Multivariable odds ratio of Grade 2 or higher all SSI was 0.58 [95% Confidence interval: 0.36-0.93] for female (vs. male) and that of Grade 2 or higher incisional/deep SSI was 2.24 [1.03-4.86] for blood infusion. For RFS, patients with Grade 3 or higher all SSI showed poor prognosis (multivariable hazard ratio: 1.66 [1.03-2.68]). LLND is not significant factor for the incidence of all SSI. Male sex might be a risk factor of Grade 2 or higher SSI, and blood transfusion is a possible risk factor of Grade 2 or higher incisional/deep SSI. Grade 3 or higher all SSI might be a significant worse prognostic factor for lower rectal cancer.


Assuntos
Neoplasias Retais/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Modelos Logísticos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia
7.
J Chromatogr A ; 1652: 462355, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34233246

RESUMO

Polyamine metabolites provide pathophysiological information on disease or therapeutic efficacy, yet rapid screening methods for these biomarkers are lacking. Here, we developed high-throughput polyamine metabolite profiling based on multisegment injection capillary electrophoresis triple quadrupole tandem mass spectrometry (MSI-CE-MS/MS), which allows sequential 40-sample injection followed by electrophoretic separation and specific mass detection. To achieve consecutive analysis of polyamine samples, 1 M formic acid was used as the background electrolyte (BGE). The BGE spacer volume had an apparent effect on peak resolution among samples, and 20 nL was selected as the optimal volume. The use of polyamine isotopomers as the internal standard enabled the correction of matrix effects in MS detection. This method is sensitive, selective and quantitative, and its utility was demonstrated by screening polyamines in 359 salivary samples within 360 min, resulting in discrimination of colorectal cancer patients from noncancer controls.


Assuntos
Neoplasias Colorretais/diagnóstico , Eletroforese Capilar/métodos , Poliaminas/análise , Saliva/química , Espectrometria de Massas em Tandem/métodos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/isolamento & purificação , Neoplasias Colorretais/química , Humanos , Poliaminas/isolamento & purificação
8.
Front Oncol ; 11: 688709, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34211856

RESUMO

Background: Primary tumor location (PTL) is an important prognostic and predictive factor in the first-line treatment of metastatic colorectal cancer (mCRC). Although regorafenib (REG) and trifluridine/tipiracil (FTD/TPI) have been introduced recently, the clinical impact of PTL in these treatments is not well understood. Materials and Methods: We retrospectively evaluated patients with mCRC who were registered in a multicenter observational study (the REGOTAS study). The main inclusion criteria were Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-2, refractory or intolerant to fluoropyrimidines, oxaliplatin, irinotecan, angiogenesis inhibitors, anti-epidermal growth factor receptor therapy (if RAS wild-type), and no prior use of REG and FTD/TPI. The impact of PTL on overall survival (OS) was evaluated using Cox proportional hazard models based on baseline characteristics. Results: A total of 550 patients (223 patients in the REG group and 327 patients in the FTD/TPI group) were included in this study, with 122 patients with right-sided tumors and 428 patients with left-sided tumors. Although the right-sided patients had significantly shorter OS compared with the left-sided patients by univariate analysis (p = 0.041), a multivariate analysis revealed that PTL was not an independent prognostic factor (hazard ratio, 0.95; p = 0.64). In a subgroup analysis, the OS was comparable between the REG and FTD/TPI groups regardless of PTL (p for interactions = 0.60). Conclusions: In the present study, PTL is not a prognostic and predictive factor in patients with mCRC under later-line REG or FTD/TPI therapy.

9.
Anticancer Res ; 41(4): 2157-2163, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813427

RESUMO

BACKGROUND: This study assessed the efficacy and safety of biweekly trifluridine and tipiracil hydrochloride (TAS-102) with bevacizumab combination therapy for patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS: We included 19 patients with mCRC who received TAS-102 and bevacizumab combination therapy biweekly as third-line chemotherapy. The primary endpoint was progression-free survival. RESULTS: Patients had a median age of 73 years and most (73.4%) were men. The median progression-free and overall survival were 5.6 and 11.5 months, respectively. Five (26.3%) patients achieved a response and the disease control rate was 12/19 (63.1%). One patient (5.2%) experienced neutropenia grade 3 or more. The median time from baseline performance status 0/1 to worsening to 2 or more was 10.3 months. CONCLUSION: Biweekly TAS-102 plus bevacizumab facilitates tumor shrinkage by reducing the incidence of grade 3 or more neutropenia, improving survival, and maintaining performance status. This combination may represent a treatment option for patients with late-stage mCRC receiving third- or later-line therapy.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab/administração & dosagem , Neoplasias Colorretais/tratamento farmacológico , Pirrolidinas/administração & dosagem , Timina/administração & dosagem , Trifluridina/administração & dosagem , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/efeitos adversos , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Neutropenia Febril Induzida por Quimioterapia/etiologia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Pirrolidinas/efeitos adversos , Análise de Sobrevida , Timina/efeitos adversos , Resultado do Tratamento , Trifluridina/efeitos adversos
10.
Front Oncol ; 11: 576036, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33763345

RESUMO

Background: The survival benefits of regorafenib (REG) and trifluridine/tipiracil hydrochloride (TFTD) have been demonstrated in chemorefractory patients with metastatic colorectal cancer (mCRC). However, the effects of crossover administration of REG and TFTD on patient survival remain unclear. The present study evaluated the association between exposure to REG and TFTD and overall survival (OS) in patients with mCRC using data from the REGOTAS study. Patients and Methods: We analyzed patients registered in the REGOTAS study, which retrospectively compared the efficacy and safety of use of REG or TFTD as later-line chemotherapy for chemorefractory mCRC patients. We compared the survival outcomes of cohort A (treated using both REG and TFTD) and cohort B (treated using either REG or TFTD). Results: A total of 550 patients (cohort A, n = 252; cohort B, n = 298) met the inclusion criteria. The median OS was significantly increased in cohort A compared with cohort B [9.6 months (95% confidence interval (CI), 8.9-10.9 months) vs. 5.2 months (95% CI, 4.4-6.0 months), P < 0.001]. Multivariate analysis revealed that cohort A was independently associated with a significant increase in OS [A vs. B: Hazard ratios (HR), 0.58; 95% CI, 0.47-0.72; P < 0.001]. Subgroup analysis adjusted using multivariate Cox model revealed a consistently better trend in most subgroups for cohort A compared with cohort B. Conclusions: Our study revealed prolonged survival in patients treated with REG and TFTD. Therefore, all active agents, including REG and TFTD, should be made available to mCRC patients.

12.
Surg Endosc ; 35(5): 2386-2388, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33409595

RESUMO

BACKGROUND: Complete mesocolic excision (CME) has been demonstrated to be a useful surgical procedure for advanced colon cancer. We previously reported on laparoscopic (Lap) CME with true central vascular ligation (CVL) for advanced right-sided colon cancer. Lap CME with true CVL is highly plausible from the perspective of surgical oncology. However, true CVL of the middle colic artery (MCA) may require extensive resection of the transverse colon. The Japanese Classification of Colorectal Cancer defines D3 as main lymph node dissection around the superior mesenteric artery (SMA), and true CVL is not listed as a required condition. Our institution has been performing a Lap procedure (Lap D3/modified CME) that consists of the dissection of main lymph nodes around the root of the MCA (#223LNs) while preserving the left branch of the MCA. Two videos of a Lap D3/modified CME are presented, and the short-term outcome is reported. METHODS: Lap D3/modified CME was defined as Lap ligation surgery at the root of the right branch of the MCA that preserves the MCA with #223LNs on the resection side. The present study retrospectively examined 11 cases of Lap D3/modified CME performed at the Tokyo Medical University Hospital between 2015 and 2020. When the SMA is difficult to visualize in Type V/A cases, the SMV is pulled using some silicone string, and the surrounding lymph nodes are dissected while visualizing the SMA. RESULTS: The median operating time was 289 min, and the median blood loss was 57 ml. The median total number of dissected lymph nodes was 38, and the median number of dissected #223LNs was three. No metastasis was found in the dissected #223LNs. CONCLUSION: Although this surgery can be performed safely, we believe that this surgery needs to be performed for suitable cases by a highly experienced and skilled surgical team.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Artérias Mesentéricas/cirurgia , Colo Transverso/irrigação sanguínea , Colo Transverso/cirurgia , Neoplasias do Colo/patologia , Humanos , Ligadura , Linfonodos/patologia , Linfonodos/cirurgia , Mesocolo/cirurgia , Duração da Cirurgia , Estudos Retrospectivos
13.
BMC Cancer ; 21(1): 23, 2021 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-33402130

RESUMO

BACKGROUND: Preoperative chemoradiotherapy (CRT), the current standard of care for locally advanced rectal cancer (LARC), is associated with many radiotherapy (RT)-related side effects. We aimed to evaluate whether S-1 and oxaliplatin (SOX) or folinic acid, 5-FU, and oxaliplatin (mFOLFOX6) can be as effective as neoadjuvant chemotherapy (NAC) regimens for LARC without RT. METHODS: Patients with untreated resectable LARC were randomly assigned to receive SOX or mFOLFOX6. The NAC protocol period was 3 months. The primary endpoint was 3-year disease-free survival (DFS), and the secondary endpoints included pathological effects, surgical completion rate, 3-year survival, and safety. RESULTS: From September 2013 to October 2015, 56 and 54 patients were enrolled in the SOX and mFOLFOX6 arms, respectively. The 3-year DFS rates were 69.4% (95% confidence interval [CI] 54.9-83.6) and 73.4% (95% CI 58.7-83.6) in the SOX and mFOLFOX6 arms, respectively; no significant differences were found between the arms (log-rank test; P = 0.5315, hazard ratio: 0.808, 95% CI 0.414-1.578). The 3-year survival rates were 92.3 and 91.8% in the SOX and mFOLFOX6 arms, respectively. The surgical completion rate was 98.1% overall, 100% in the SOX arm, and 96.0% in the mFOLFOX6 arm. The incidences of pathological response rates ≥grade 1b were 41.5 and 43.8% in the SOX and mFOLFOX6 arms, respectively. Both treatments were manageable and tolerable. CONCLUSION: We demonstrated the effectiveness and safety of SOX and mFOLFOX6, both of which may be new neoadjuvant treatment candidates in previously untreated LARC cases. TRIAL REGISTRATION: Date of enrolment of the first participant to the trial: 3rd Oct 2013; This study was registered in the UMIN clinical trials registry on 14th Aug, 2013. (Prospectively registered, UMIN-CTR number UMIN000011486). https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&recptno=R000013441&language=J.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante/mortalidade , Terapia Neoadjuvante/mortalidade , Neoplasias Retais/tratamento farmacológico , Adenocarcinoma/patologia , Adulto , Idoso , Combinação de Medicamentos , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Oxaliplatina/administração & dosagem , Ácido Oxônico/administração & dosagem , Prognóstico , Neoplasias Retais/patologia , Taxa de Sobrevida , Tegafur/administração & dosagem
14.
Am Surg ; 87(3): 341-346, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32972197

RESUMO

BACKGROUND: No previous study has compared the risk of surgical site infection (SSI) between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) related to intra-abdominal infection in laparoscopic right hemicolectomy. Therefore, this study aimed to compare the risk of SSI in IA and EA in this context. METHODS: From July 2014 to March 2018, 101 consecutive (median age, 73 years; male, 54) patients underwent laparoscopic right hemicolectomy for colon cancer. The IA and EA groups consisted of 51 and 50 cases, respectively. After either IA or EA, lavage was performed with 100 mL of saline in the area surrounding the anastomosis, and a sample was collected for bacterial culture. The product of the virulence score and dose of bacterial contamination score called the risk of SSI score was evaluated in both groups, and short-term outcomes in both groups were analyzed retrospectively. RESULTS: No significant difference was found in patient characteristics between the 2 groups. The frequency of organ/space SSI in the IA group was significantly higher than that in the EA group (7.8% vs 0%, P = .04). The risk of SSI score was significantly higher in the IA group than in the EA group (median, 9 vs 1, P < .01). CONCLUSIONS: Compared with EA, IA in laparoscopic right hemicolectomy increased organ/space SSI rates, signifying intra-abdominal infection. We strongly recommend prevention of intra-abdominal infection when performing an IA.


Assuntos
Infecções Bacterianas/etiologia , Colectomia/métodos , Colo/cirurgia , Neoplasias do Colo/cirurgia , Infecções Intra-Abdominais/etiologia , Laparoscopia/métodos , Infecção da Ferida Cirúrgica/etiologia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Feminino , Humanos , Infecções Intra-Abdominais/epidemiologia , Infecções Intra-Abdominais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
15.
J Laparoendosc Adv Surg Tech A ; 31(4): 433-442, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32865445

RESUMO

Background: Noninferiority of the laparoscopic approach compared with open surgery for colon cancer treatment has remained controversial. In this study, we aimed to evaluate the long-term outcomes of laparoscopic surgery (LS) versus open surgery (OPS). Methods: A total of 418 patients with Stage I-III colon cancer, who received radical surgery at the Tokyo Medical University Hospital from 2000 to 2014 were included. Propensity score analysis with overall survival (OS) and relapse-free survival (RFS) as the primary endpoints was performed retrospectively to reduce the effects of confounding factors between groups, including age, sex, body mass index, tumor size, clinical T stage, and clinical N stage. Results: After case matching, the 5-year OS rate was 87.8% in the OPS group (n = 97) and 90.1% in the LS group (n = 97; P = .59), indicating no significant difference. The 5-year RFS rate was 79.0% in the OPS group (n = 97) and 84.1% in the LS group (n = 97; P = .29), indicating no significant difference. Five-year cumulative local recurrence (LR) rates were 7.6% and 0% in the OPS group and the LS group, respectively, indicating a significant difference (P = .007). Five-year cumulative distant metastasis rates were 9.2% and 12.7% in the OPS group and the LS group, respectively (P = .49). Conclusion: Laparoscopic surgery appears to be a reasonable option with similar long-term outcomes and to have low LR rate to open surgery in colon cancer patients.


Assuntos
Neoplasias do Colo/cirurgia , Laparoscopia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Colectomia , Neoplasias do Colo/mortalidade , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Sci Rep ; 10(1): 21057, 2020 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-33273632

RESUMO

Colorectal cancer (CRC) has increasing global prevalence and poor prognostic outcomes, and the development of low- or less invasive screening tests is urgently required. Urine is an ideal biofluid that can be collected non-invasively and contains various metabolite biomarkers. To understand the metabolomic profiles of different stages of CRC, we conducted metabolomic profiling of urinary samples. Capillary electrophoresis-time-of-flight mass spectrometry was used to quantify hydrophilic metabolites in 247 subjects with stage 0 to IV CRC or polyps, and healthy controls. The 154 identified and quantified metabolites included metabolites of glycolysis, TCA cycle, amino acids, urea cycle, and polyamine pathways. The concentrations of these metabolites gradually increased with the stage, and samples of CRC stage IV especially showed a large difference compared to other stages. Polyps and CRC also showed different concentration patterns. We also assessed the differentiation ability of these metabolites. A multiple logistic regression model using three metabolites was developed with a randomly designated training dataset and validated using the remaining data to differentiate CRC and polys from healthy controls based on a panel of urinary metabolites. These data highlight the changes in metabolites from early to late stage of CRC and also the differences between CRC and polyps.


Assuntos
Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/urina , Eletroforese Capilar/métodos , Espectrometria de Massas/métodos , Metabolômica , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Metaboloma , Pessoa de Meia-Idade , Análise de Componente Principal
17.
BMC Cancer ; 20(1): 922, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977767

RESUMO

BACKGROUND: A large number of patients suffer recurrence after curative resection, and mortality from colon cancer remains high. The role of systemic inflammatory response, as reflected by neutrophil-to-lymphocyte ratio (NLR), in cancer recurrence and death has been increasingly recognized. This study aimed to analyze long-term oncologic outcomes of Stage II-III colon cancer to examine the prognostic value of NLR using a propensity score analysis. METHODS: A total of 375 patients with colon cancer underwent radical surgery between 2000 and 2014 at Tokyo Medical University Hospital. Long-term oncologic outcomes of these patients were evaluated according to NLR values. A cut-off NLR of 3.0 was used based on receiver operating characteristic curve analysis. Primary outcomes were overall survival (OS) and relapse-free survival (RFS). An analysis of outcomes according to tumor sidedness was also performed. RESULTS: Patients with lower NLR values ("lower NLR group") were more likely to have lymph node metastasis compared to those with higher NLR values ("higher NLR group") before case matching. After case matching, clinical outcomes were similar between the two groups. There were no significant differences in 5-year OS and 5-year RFS rates between the two groups before case matching based on propensity scores. After case matching, 5-year OS rates were 94.5% in the lower NLR group (n = 135) and 87.0% in the higher NLR group (n = 135), showing a significant difference (p = 0.042). Five-year RFS rates were 87.8% in the lower NLR group and 77.9% in the higher NLR group, also showing a significant difference (p = 0.032). Among patients with left-sided colon cancer in the matched cohort, 5-year OS and 5-year RFS rates were 95.2 and 87.3% in the lower NLR group (n = 88), respectively, and 86.4 and 79.2% in the higher NLR group (n = 71), respectively, showing significant differences (p = 0.014 and p = 0.047, respectively). CONCLUSIONS: The NLR is an important prognostic factor for advanced colon cancer, especially for left-sided colon cancer.


Assuntos
Neoplasias do Colo/sangue , Linfócitos/metabolismo , Neutrófilos/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão
18.
Surg Endosc ; 34(12): 5640-5641, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32813060

RESUMO

BACKGROUND: Complete mesocolic excision (CME) is known to be effective for colon cancer. However, in right-sided colon cancer, central vascular ligation (CVL) is not easy to perform. In particular, in patients in whom the superior mesenteric vein (SMV) runs on the ventral side of the superior mesenteric artery (SMA) (Type V/A), laparoscopic ligation of the artery at its root is extremely difficult compared with this procedure in patients in whom the SMA runs on the ventral side of the SMV (Type A/V). METHODS: We started performing laparoscopic CME with true CVL for right-sided colon cancer using the SMA as a landmark in 2015, and by 2019, we had completed it for 60 patients. To start, the mesocolon is opened well to the caudal side of the ileocolic vessels. The mesentery is then fully detached from the retroperitoneal tissue, after which the ileocolic vessels are ligated at their roots. D3 lymph node dissection of the lymph nodes around the SMA and SMV on the resection side is also performed using the SMA as a landmark, and depending on the location of the tumor, the roots of the right and middle colic vessels are ligated and divided. This study was conducted with the approval of the Tokyo Medical University Ethics Committee. All patients provided informed consent. RESULTS: The tumor was located in the cecum in 21 cases, the ascending colon in 33, and the transverse colon in 6. The mean operating time was 229 min and the mean volume of hemorrhage was 67 ml. There was one Clavien-Dindo Grade 3 or worse postoperative complication (ileus). There were no surgery-related or in-hospital deaths. CONCLUSION: This procedure can be performed comparatively safely. However, since it requires some skill, we consider that it should only be performed in suitable cases by teams with sufficient experience.


Assuntos
Neoplasias do Colo/cirurgia , Laparoscopia , Ligadura , Mesocolo/cirurgia , Idoso , Feminino , Humanos , Laparoscopia/efeitos adversos , Linfonodos/patologia , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
19.
Gan To Kagaku Ryoho ; 47(1): 126-128, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-32381880

RESUMO

The patient was a 26-year-old female who had undergone conservative treatment for acute appendicitis at another clinic and was referred to our hospital for interval appendectomy. We performed a single-incision laparoscopic appendectomy, and the patient was diagnosed with goblet cell carcinoid(GCC)based on the postoperative pathological examination. Since GCC is considered a high-grade tumor, we performed a laparoscopic ileocolic resection with D3 lymphadenectomy. There was no residual disease or lymph node metastasis detected in the resected specimen. Patients with advanced GCC typically have poor prognosis, because GCC is characterized by peritoneal dissemination and lymph node metastasis. However, our findings suggested that an additional laparoscopic surgery could be one of the curative and safe treatment options for selected pa- tients with GCC.


Assuntos
Tumor Carcinoide , Adulto , Apendicectomia , Neoplasias do Apêndice , Apendicite , Colectomia , Feminino , Humanos
20.
Int J Clin Oncol ; 25(4): 614-621, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31838590

RESUMO

BACKGROUND: Although regorafenib or trifluridine/tipiracil (FTD/TPI) has been recognized as a later-line standard treatment in patients with metastatic colorectal cancer (mCRC), not all patients have beneficial outcomes. This study aimed to develop a prognostic scoring system for evaluating the overall survival (OS) benefit. METHODS: Patients included in the REGOTAS study, which comprised 489 patients (regorafenib group: 199; FTD/TPI group: 290 patients), were evaluated. OS was analyzed using multivariate Cox proportional model. The prognostic score was calculated using the worst four individual factors weighted by hazard ratio, and the total scores were categorized as low-, moderate-, and high-OS benefit. RESULTS: The worst four factors in the regorafenib group were AST > 40 IU/dL (point, + 3), CRP ≥ 1.0 mg/dL (+ 2), number of metastatic organ site ≥ 3 (+ 2), and duration from initiation of 1st-line chemotherapy < 18 months (+ 2), while they were AST (+ 2), CRP (+ 2), CA19-9 > 37.0 U/mL (+ 2), and ECOG PS ≥ 1 (+ 2) in the FTD/TPI group. These corresponded to a total prognostic score of > 5, 2-4, and 0 points in the regorafenib group and 8, 2-6, and 0 points in the FTD/TPI group. The median OS in the low, moderate, and high OS benefit group was 3.3 (95% CI 3.0-3.7), 8.1 (95% CI 6.4-9.7), and 12.6 months (95% CI 10.6-14.6) in the regorafenib group and 2.8 (95% CI 2.0-3.5), 7.5 (95% CI 6.6-8.3), and 15.4 months (95% CI 9.7-21.2) in the FTD/TPI group. CONCLUSION: These prognostic scores are useful for identifying patients with mCRC who will obtain survival benefits from these drugs.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/mortalidade , Compostos de Fenilureia/uso terapêutico , Piridinas/uso terapêutico , Pirrolidinas/uso terapêutico , Trifluridina/uso terapêutico , Uracila/análogos & derivados , Idoso , Neoplasias Colorretais/patologia , Combinação de Medicamentos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Timina , Resultado do Tratamento , Uracila/uso terapêutico
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