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1.
Anticancer Res ; 41(10): 5097-5106, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593460

RESUMO

AIM: D3 lymph node dissection (LND) for stage II and III colon cancer has been shown to improve prognosis, however, it generally increases surgical stress. Studies have reported that the C-reactive protein/albumin ratio (CAR) may be a useful inflammatory-nutritional biomarker to predict postoperative complications and poor prognosis for with various types of cancer. Our purposes were to assess the short- and long-term outcomes of D3 LND in patients with a high preoperative CAR (≥ 0.04). PATIENTS AND METHODS: This was a retrospective cohort analysis reviewing a prospectively collected database of Yokohama City University and three affiliated hospitals. A total of 449 patients with stage II or III colon cancer with high CAR who underwent primary resection with D2 or D3 LND were identified between 2008 and 2020. The primary and secondary outcomes of interests were the 3-year recurrence-free survival and postoperative complication rates. RESULTS: After propensity matching, 230 patients were evaluated. There was no significant difference between the D3 and D2 groups in the rate of postoperative complications overall (14.8% versus 11.3%, p=0.558), however, the incidence of anastomotic leakage tended to be greater in the D3 group (9.6% versus 2.6%, p=0.050). The long-term findings showed that there was no significant difference between the two groups (3-year recurrence-free survival rate: 77.2% versus 77.2%, p=0.880). CONCLUSION: D3 LND did not improve survival outcomes for patients with colon cancer with a poor CAR in this study. D2 LND may be a treatment option for patients with stage II-III colon cancer with a high preoperative CAR.


Assuntos
Albuminas/metabolismo , Biomarcadores Tumorais/metabolismo , Proteína C-Reativa/metabolismo , Neoplasias do Colo/mortalidade , Excisão de Linfonodo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/metabolismo , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida
2.
In Vivo ; 35(6): 3555-3561, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697194

RESUMO

AIM: Recent studies have reported that the albumin-to-globulin ratio (AGR) may be a useful inflammatory-nutritional biomarker to predict postoperative complications and poor prognosis in various types of patients with cancer. However, its prognostic value in patients with esophageal cancer is still unclear. We aimed to examine the utility of the AGR for predicting the short- and long-term outcomes in patients with esophageal cancer who underwent curative resection. PATIENTS AND METHODS: This was a retrospective cohort analysis reviewing the medical records of consecutive patients who underwent esophagectomy for clinical stage I to III esophageal cancer at Yokohama City University. A total of 105 patients were identified between 2005 and 2018. The overall survival (OS), recurrence-free survival (RFS), and postoperative complication rates were compared between patients with high AGR (>1.48) and those with low AGR (≤1.48) group. RESULTS: A total of 57 and 48 patients were classified into the high and low AGR groups, respectively. There was no significant difference between the two groups in the rate of overall postoperative complications of more than Clavien-Dindo grade 3 (50.9% vs. 54.2%, p=0.85). The long-term findings showed that 5-year OS and RFS rates were significantly better for the group with a high AGR (67.2% vs. 33.8%, p<0.001 and 51.6% vs. 28.5%, p=0.003, respectively). CONCLUSION: This study suggests that a low preoperative AGR is a risk factor for poor RFS and OS in patients who are planning to undergo curative surgery for esophageal cancer. AGR may be a useful biomarker for establishing treatment strategies to improve patients' survival.


Assuntos
Neoplasias Esofágicas , Globulinas , Biomarcadores , Neoplasias Esofágicas/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Albumina Sérica
3.
In Vivo ; 34(5): 2783-2790, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32871815

RESUMO

BACKGROUND/AIM: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on esophageal cancer survival and recurrence after curative treatment. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: An ACCI of 5 was regarded as the optimal critical point of classification considering the survival rates. The OS rates at 3 and 5 years after surgery were 64.2% and 54.4% in the low-ACCI group, respectively, and 42.3% and 29.2% in high-ACCI group, respectively (p=0.035). The RFS rates at 3 and 5 years after surgery were 50.2% and 43.6% in the low-ACCI group, respectively, and 28.5% and 21.3% in high-ACCI group, respectively (p=0.021). A multivariate analysis demonstrated that ACCI was a significant independent risk factor for both the OS and RFS. CONCLUSION: ACCI is a risk factor for survival in patients who undergo curative treatment for esophageal cancer. An effective plan for the perioperative care and surgical strategy should be developed according to ACCI.


Assuntos
Neoplasias Esofágicas , Recidiva Local de Neoplasia , Fatores Etários , Comorbidade , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/terapia , Humanos , Estudos Retrospectivos
4.
In Vivo ; 34(4): 2021-2027, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606176

RESUMO

BACKGROUND/AIM: The aim of the present study was to evaluate the optimal number of harvested LNs (LNs) in patients who were LN metastasis-negative after curative esophagectomy for esophageal cancer. PATIENTS AND METHODS: Sixty-one patients who underwent curative surgery for esophageal cancer between 2005 and 2017 and diagnosed as lymph node metastasis-negative were included in this study. RESULTS: The 5-year overall survival rates were 27.8% for 0-20 harvested LNs, 35.7% for 21-30 harvested LNs, 79.4% for 31-40 harvested LNs, and 85.2% for ≥41 harvested LNs. Thirty harvested LNs was regarded as the optimal critical point of classification, considering the 5-year OS rate. The number of harvested LNs was selected as a significant prognostic factor in both univariate and multivariate analyses. The respective 3- and 5-year OS rates were 50.3% and 36.7% for <30 harvested LNs and 82.4% and 82.4% for ≥30 harvested LNs (p=0.003). CONCLUSION: Thirty or more harvested LNs was a significant prognostic factor in patients with metastasis-negative LNs after curative esophagectomy for esophageal cancer. Therefore, the number of harvested LNs might be useful for predicting the LN metastasis status in esophageal cancer.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
5.
In Vivo ; 34(4): 2087-2093, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606187

RESUMO

BACKGROUND/AIM: We investigated the clinical impact of the lymph node ratio (LNR) on overall survival (OS) and recurrence-free survival (RFS) in esophageal cancer patients who underwent curative surgery. PATIENTS AND METHODS: One hundred twenty patients who underwent curative surgery for esophageal cancer between 2005 and 2017 were included in this study. The LNR was defined as the ratio of the number of metastatic lymph nodes (LNs) to the total number of harvested LNs. RESULTS: A lymph node ratio of 10% was regarded as the optimal critical point for classification based on the overall survival rate. The 3-year and 5-year OS rates were 65.5% and 57.0%, respectively, in the LNR<10% group, and 11.8% and 0% in the LNR≥10% group; the difference was statistically significant (p<0.001). The 3-year and 5-year RFS rates were 52.6% and 44.6%, respectively, in the LNR<10% group, and 0% and 0% in the LNR>10% group; the difference was also statistically significant (p<0.001). When comparing the sites of first relapse, the incidence of distant lymph node metastasis in the LNR>10% group was significantly higher than that in the LNR<10% group. CONCLUSION: The LNR was a risk factor for both OS and RFS in patients who underwent curative surgery for esophageal cancer.


Assuntos
Neoplasias Esofágicas , Razão entre Linfonodos , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos
6.
Anticancer Res ; 40(4): 2359-2364, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234938

RESUMO

BACKGROUND: The aim of the present study was to evaluate the clinical impact of the perioperative use of antiplatelet/anticoagulation therapy for postoperative bleeding after esophagectomy for esophageal cancer. PATIENTS AND METHODS: Patients were selected from the medical records of consecutive patients who were diagnosed with primary esophageal adenocarcinoma or squamous cell carcinoma and who underwent complete resection at Yokohama City University from January 2005 to September 2018. The patients were divided into the antiplatelet/anticoagulation treatment group and the non-treatment group. We compared the safety and feasibility of esophagectomy between two groups. RESULTS: One hundred and twenty-two patients underwent esophagectomy for esophageal cancer and were analyzed in the present study. Among them, 18 (14.8%) received anti-thrombotic therapy (anticoagulation group). The incidence of postoperative bleeding in patients overall was 8.2% (10/122). The incidence of postoperative bleeding in the anticoagulation group was 22.2% (4/18), while that in the non-anticoagulation group was 5.8% (6/104). Preoperative anticoagulation therapy was identified as a significant independent risk factor for postoperative bleeding (hazard ratio=4.673, 95% confidence interval=1.170-18.519; p=0.029). CONCLUSION: The perioperative use of anti-thrombotic therapy was a significant risk factor for postoperative bleeding after esophagectomy for esophageal cancer. Thus, when patients receive perioperative antiplatelet/anticoagulation treatment, careful attention is required after esophagectomy due to their increased risk of postoperative bleeding.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Complicações Pós-Operatórias/diagnóstico , Hemorragia Pós-Operatória/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Esofagectomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/etiologia , Fatores de Risco
7.
Anticancer Res ; 40(4): 2365-2371, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234939

RESUMO

BACKGROUND: Several immune-inflammatory markers are associated with cancer progression. The purpose of the present study was to clarify the influence of the preoperative C-reactive protein-to-albumin ratio (CRP/ALB ratio) on survival of patients with esophageal cancer and recurrence after curative resection. PATIENTS AND METHODS: The preoperative CRP/ALB ratio was evaluated in 122 patients who underwent radical resection for esophageal cancer from 2005 to 2018. The correlations between the CRP/ALB ratio and cancer-specific overall (OS), recurrence-free (RFS) survival and the clinicopathological status were analyzed. RESULTS: The optimal cut-off value of the CRP/ALB ratio determined using receiver operating characteristic curve analysis was 0.04. Patients were divided into two groups based on this cut-off value: the low CRP/ALB group (n=59) and the high CRP/ALB group (n=50). The OS rate at 5 years after surgery was significantly lower in the group with high CRP/ALB at 40.5% whilst it was 63.5% in the low CRP/ALB group (p=0.005). The corresponding RFS rates at 5 years after surgery were 32.5% and 48.3%, respectively, which was a statistically significant difference (p=0.007). A multivariate analysis showed that a high CRP/ALB ratio was a significant independent risk factor for poorer cancer-specific OS and RFS. CONCLUSION: The preoperative CRP/ALB ratio was a strong prognostic marker for patients with esophageal cancer. The surgical strategy, including procedure and perioperative care should be carefully planned for patients with a high CRP/ALB ratio.


Assuntos
Proteína C-Reativa/análise , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Albumina Sérica/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos
8.
In Vivo ; 34(2): 857-862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32111795

RESUMO

BACKGROUND/AIM: The present study aimed to identify risk factors for anastomosis leak (AL) after esophagectomy for esophageal cancer. PATIENTS AND METHODS: One-hundred twenty-two patients who underwent esophagectomy for esophageal cancer between 2008 and 2018 were included. The rate of AL was measured based on the definition of leak as adapted from the Surgical Infection Study Group. To identify the risk factors for AL, logistic regression analysis was used. RESULTS: AL was found in 44 of the 122 patients (36.1%). Among the factors examined, the lymph node dissection status (p=0.007) and preoperative serum albumin level (p=0.022) were significant independent risk factors for AL. The incidence of AL was 26.7% (20 of 75) among patients who received 2-field lymph node dissection and 51.1% (24 of 47) among those who received 3-field lymph node dissection. The incidence of AL was 29.9% (23 of 77) in the preoperative serum albumin levels ≥4.0 g/dl group and 46.7% (21 of 45) in the serum albumin levels <4.0 g/dl group. CONCLUSION: Lymph node dissection status and preoperative serum albumin levels were risk factors for AL in patients who received esophagectomy for esophageal cancer.


Assuntos
Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/epidemiologia , Esofagectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Fístula Anastomótica/diagnóstico , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
9.
Anticancer Res ; 40(2): 1087-1093, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014958

RESUMO

BACKGROUND: The short- and long-term outcomes of esophagectomy for esophageal cancer were fully evaluated in patients older than 75 years of age. PATIENTS AND METHODS: The present study selected patients who received esophagectomy for esophageal cancer. Patients were divided into non-elderly patients [age <75 years (non-elderly group)] and elderly patients [age ≥75 years (elderly group)]. The postoperative surgical morbidity, postoperative 30-days mortality, recurrence-free survival (RFS), and overall survival (OS) rates were evaluated between the non-elderly group and elderly group. RESULTS: One hundred twenty-two patients were evaluated in this study. Ninety-eight patients and 24 patients were classified into the non-elderly group and elderly group, respectively. The postoperative surgical complication rates in the non-elderly and elderly groups were 71.4% and 75.0%. There was not a statistically significant difference between the two groups (p=0.710). Mortality was observed in 1 patient in the elderly group (4.2%) due to cardiovascular disease. Significant differences were observed in the five-year OS and RFS rates of the elderly and non-elderly groups (55.4% vs. 29.7%, p=0.0017 and 42.2% vs. 21.2%, p=0.0334, respectively). CONCLUSION: Although the rate of postoperative surgical complications after esophagectomy for esophageal cancer was almost equal in the elderly and the non-elderly patients, significant differences were observed in the mortality and long-term outcomes of the two groups. Thus, the surgical strategy and perioperative care must be carefully planned for esophageal cancer patients older than 75 years of age.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/mortalidade , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Assistência Perioperatória , Complicações Pós-Operatórias/etiologia , Prognóstico , Resultado do Tratamento
10.
Anticancer Res ; 39(6): 2711-2714, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177105

RESUMO

Perioperative oral/dental care has been introduced to cancer surgery patients as perioperative management using a multimodal approach. Several approaches were tested for managing perioperative oral/dental health care in this population. However, while the clinical impact of perioperative oral/dental care on patients with various types of malignancies has been evaluated, most previous studies have used and evaluated data obtained from relatively small sample sizes of fewer than 200 patients from individual institutions. Therefore, the recommendation of perioperative oral/dental care is controversial. Recent studies have shown that perioperative oral/dental care affects the cancer surgery outcomes. In addition, perioperative oral/dental care by dentistry professionals and the number of oral/dental care sessions have been shown to be important for this beneficial effect, even when patients were temporarily intubated. Further studies are, therefore, necessary to establish the optimal perioperative dental/oral care regiment and verify the beneficial effect of perioperative oral/dental care on cancer surgery outcomes. This review summarizes the background, current status, and future perspectives of perioperative oral/dental care for cancer surgery.


Assuntos
Assistência Odontológica/métodos , Neoplasias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Feminino , Humanos , Masculino , Assistência Perioperatória , Tamanho da Amostra , Resultado do Tratamento
11.
Anticancer Res ; 39(5): 2671-2678, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092467

RESUMO

BACKGROUND/AIM: Postoperative pneumonia after esophageal cancer can lead to additional pain, prolonged hospital stay, and respiratory failure. These adverse events might lead to early recurrence and/or death. We investigated the influence of postoperative pneumonia on the esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into: i) those with postoperative pneumonia (pneumonia group) and ii) those without postoperative pneumonia (non-pneumonia group). The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. RESULTS: Postoperative complications were found in 34 of the 122 patients (27.9%). The OS rate at 5 years following surgery was 28.2% in the pneumonia group and 55.1% in the non-pneumonia group (p=0.006). The RFS rate at 5 years after surgery was 18.9% in the pneumonia group and 49.2% in the non-pneumonia group (p=0.061). A multivariate analysis showed that postoperative pneumonia was a significant independent risk factor for OS. CONCLUSION: The development of postoperative pneumonia was a risk factor for a decreased overall survival in patients who underwent curative surgery for esophageal cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned in order to avoid postoperative pneumonia.


Assuntos
Neoplasias Esofágicas/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Sobreviventes de Câncer , Intervalo Livre de Doença , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Pneumonia/etiologia , Pneumonia/patologia , Pneumonia/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco
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