Impact of comorbidities and use of common medications on cancer and non-cancer specific survival in esophageal carcinoma.

BACKGROUND: Chronic comorbidities and some of the commonly-used medications are thought to affect cancer patients' outcomes, but their relative impact on esophageal carcinoma (EC) has not been well studied. The purpose of the study was to identify the chronic comorbidities and/or commonly-used medications that impact EC patient survival. METHODS: A total of 1174 EC patients treated with chemoradiotherapy (CRT) with or without surgery in one institution from 1998 to 2012 were retrospectively included. Seven kinds of frequently occurring chronic comorbidities and 18 types of regularly-taken medications were obtained from medical records. Since it is expected prognostic factors have different effects between surgery patients and non-surgery patients, the impact value of all variables and the corresponding interactions with surgery on survival were evaluated in Cox proportional hazards regression model. Overall mortality, EC-specific mortality and non EC-specific mortality were endpoints. RESULTS: We found that atrial fibrillation was the only comorbidity that showed a significant impact on non-EC specific survival for all patients (HR 1.72, P = 0.03), whereas hypothyroidism was the only comorbidity that was evaluated as an independent predictive factor for overall survival (OS) (HR 0.59, P = 0.02) and EC-specific survival (HR 0.62, P = 0.05), but this association was seen only in the non-surgical patients. No other medications were found to have a significant impact for OS, EC-specific survival or non-EC specific survival in multivariable analysis. CONCLUSIONS: Our data indicate that certain comorbidities rather than medication use affect EC-specific survival or non EC-specific survival in EC patients treated with CRT with or without surgery. Comorbidity information may better guide individual treatment in EC.

Risk Prediction for Locoregional Recurrence in Epidermal Growth Factor Receptor-Mutant Stage III-pN2 Lung Adenocarcinoma after Complete Resection: A Multi-center Retrospective Study.

Background: This study aimed to develop a predictive model based on the risk of locoregional recurrence (LRR) in epidermal growth factor receptor (EGFR)-mutant stage III-pN2 lung adenocarcinoma after complete resection. Methods: A total of 11,020 patients with lung surgery were screened to determine completely resected EGFR-mutant stage III-pN2 lung adenocarcinoma. Patients were excluded if they received preoperative therapy or postoperative radiation therapy (PORT). The time from surgery to LRR was recorded. Clinicopathological variables with statistical significance predicting LRR in the multivariate Cox regression were incorporated into the competing risk nomogram. Patients were then sub-grouped based on different recurrence risk as a result of the nomogram. Results: Two hundred and eighty-eight patients were enrolled, including 191 (66.3%) with unforeseen N2 (IIIA1-2), 75 (26.0%) with minimal/single station N2 (IIIA3), and 22 (7.6%) with bulky and/or multilevel N2 (IIIA4). The 2-year overall cumulative incidence of LRR was 27.2% (confidence interval [CI], 16.3%-38.0%). IIIA4 disease (hazard ratio, 2.65; CI, 1.15-6.07; P=0.022) and extranodal extension (hazard ratio, 3.33; CI, 1.76-6.30; P<0.001) were independent risk factors for LRR and were incorporated into the nomogram. Based on the nomogram, patients who did not have any risk factor (low-risk) had a significantly lower predicted 2-year incidence of LRR than those with any of the risk factors (high-risk; 4.6% vs 21.9%, P<0.001). Conclusions: Pre-treatment bulky/multilevel N2 and pathological extranodal extension are risk factors for locoregional recurrence in EGFR-mutant stage III-pN2 lung adenocarcinoma. Intensive adjuvant therapies and active follow-up should be considered in patients with any of the risk factors.

Primary early-stage intestinal and colonic non-Hodgkin's lymphoma: clinical features, management, and outcome of 37 patients.

AIM: To analyze the clinical features, management, and outcome of treatment of patients with primary intestinal and colonic non-Hodgkin's lymphoma (PICL). METHODS: A retrospective study was performed in 37 patients with early-stage PICL who were treated in our hospital from 1958 to 1998. Their clinical features, management, and outcome were assessed. Prognostic factors for survival were analyzed by univariate analysis using the Kaplan-Meier product-limit method and log-rank test. RESULTS: Twenty-five patients presented with Ann Arbor stage I PICL and 12 with Ann Arbor stage II PICL. Thirty-five patients underwent surgery (including 31 with complete resection), 22 received postoperative chemotherapy or radiotherapy or both. Two patients with rectal tumors underwent biopsy and chemotherapy with or without radiotherapy. The 5- and 10-year overall survival (OS) rates were 51.9% and 44.5%. The corresponding disease-free survival (DFS) rates were 42.4% and 37.7%. In univariate analysis, multiple-modality treatment was associated with a better DFS rate compared to single treatment (P = 0.001). While age, tumor size, tumor site, stage, histology, or extent of surgery were not associated with OS and DFS, use of adjuvant chemotherapy significantly improved DFS (P = 0.031) for the 31 patients who underwent complete resection. Additional radiotherapy combined with chemo-therapy led to a longer survival than chemotherapy alone in six patients with gross residual disease after surgery or biopsy. CONCLUSION: Combined surgery and chemotherapy is recommended for treatment of patients with PICL. Additional radiotherapy is needed to improve the outcome of patients who have gross residual disease after surgery.

Stereotactic body radiation therapy favors long-term overall survival in patients with lung metastases: five-year experience of a single-institution.

BACKGROUND: Metastatic lung cancer is one of the most common oncologic problems. This study aimed to evaluate the long-term clinical outcome of stereotactic body radiation therapy (SBRT) for metastatic lung tumors. METHODS: We retrospectively reviewed the 71 patients with lung metastases, who had 172 lesions treated with SBRT from January 2000 to December 2006. All patients were unfit or failed after surgery and/or chemotherapy. The median total dose was 48 Gy (range, 30 - 60) in 4 (range, 2 - 12) fractions. The median size of the irradiated lesions was 2.1 cm (range, 0.9 - 7.9 cm). RESULTS: All but two patients received follow up. The median follow-up time was 24.7 months (range, 2.9 - 114.4 months). The median follow-up time for living patients was 86.8 months (range, 58.1 - 114.4 months). The 1-, 3-, 5-year local control and overall survival rates were 88.8%, 75.4%, 75.4% and 78.9%, 40.8%, 25.2%. Multivariate analysis showed that the absence of extrapulmonary metastases (P = 0.024; hazard ratio (HR), 1.894; 95% confidence interval (CI), 1.086 - 3.303) and disease-free interval ≤ 12 months (P = 0.014; HR, 0.511; 95%CI, 0.299 - 0.873) were independent prognostic factors. No grade 3 or more acute and late toxicities occurred. Only one patient developed a non-symptomatic rib fracture. CONCLUSION: SBRT could be an alternative treatment to surgery for subsets of patients with lung metastases with favorable long-term survival and tolerable complications.

Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial.

AIM: To examine whether acupuncture can prevent prolonged postoperative ileus (PPOI) after intraperitoneal surgery for colon cancer. METHODS: Ninety patients were recruited from the Fudan University Cancer Hospital, Shanghai, China. After surgery, patients were randomized to receive acupuncture (once daily, starting on postoperative day 1, for up to six consecutive days) or usual care. PPOI was defined as an inability to pass flatus or have a bowel movement by 96 h after surgery. The main outcomes were time to first flatus, time to first bowel movement, and electrogastroenterography. Secondary outcomes were quality of life (QOL) measures, including pain, nausea, insomnia, abdominal distension/fullness, and sense of well-being. RESULTS: No significant differences in PPOI on day 4 (P = 0.71) or QOL measures were found between the groups. There were also no group differences when the data were analyzed by examining those whose PPOI had resolved by day 5 (P = 0.69) or day 6 (P = 0.88). No adverse events related to acupuncture were reported. CONCLUSION: Acupuncture did not prevent PPOI and was not useful for treating PPOI once it had developed in this population.