Prognostic Factors for Survival among Patients with Small Bowel Neuroendocrine Tumours Associated with Mesenteric Desmoplasia

2018 ◽  
Vol 106 (4) ◽  
pp. 366-380 ◽  
Author(s):  
Faidon Marios Laskaratos ◽  
Leonidas Diamantopoulos ◽  
Martin Walker ◽  
Henry Walton ◽  
Mohamed Khalifa ◽  
...  
Keyword(s):  
Small Bowel ◽  
Neuroendocrine Tumours ◽  
Univariate Analysis ◽  
Epidemiological Data ◽  
Carcinoid Heart Disease ◽  
Factors Affecting ◽  
Upper Limit ◽  
Hydroxyindoleacetic Acid ◽  
Small Bowel Neoplasms

Background: Small intestinal neuroendocrine tumours (SI NETs) represent 30–50% of small bowel neoplasms and are often associated with diverse fibrotic complications. Mesenteric fibrosis is a hallmark of SI NETs which may cause substantial morbidity and is considered an adverse feature. However, survival analyses in this group of patients are lacking. Methods: The aim of this retrospective study was to determine the overall survival (OS) and factors affecting prognosis in a large cohort of 147 patients with SI NETs and radiological evidence of mesenteric desmoplasia from our centre. The severity of desmoplasia was graded radiologically and its effect on OS and long-term complications was assessed. The median follow-up period was 82 months. Results: The median OS was 8.7 years (95% CI 6.8–9.9) with an overall 5-year survival of 71%. The univariate analysis demonstrated that an age >65 years, a liver tumour burden >50% of the hepatic parenchyma, carcinoid heart disease, chromogranin A levels >10 times the upper limit of normal, and urinary 5-hydroxyindoleacetic acid (5-HIAA) levels >5 times the upper limit of normal were poor prognosticators, while primary resection was associated with a longer OS. However, only an age >65 years and urinary 5-HIAA levels >10 times the upper limit of normal remained statistically significant after multivariate analysis. The severity of mesenteric desmoplasia did not seem to demonstrate a statistically significant relationship to OS or long-term outcomes. Conclusion: This study is the first comprehensive survival analysis of patients with SI NETs associated with mesenteric desmoplasia and has provided important and clinically relevant epidemiological data for this group of patients.

Evaluation of Clinical Prognostic Factors and Further Delineation of the Effect of Mesenteric Fibrosis on Survival in Advanced Midgut Neuroendocrine Tumours

2018 ◽  
Vol 107 (3) ◽  
pp. 292-304 ◽  
Author(s):  
Faidon-Marios Laskaratos ◽  
Martin Walker ◽  
Dominic Wilkins ◽  
Alexander Tuck ◽  
Shashank Ramakrishnan ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Large Scale ◽  
Neuroendocrine Tumours ◽  
Primary Tumour ◽  
Stage Iv ◽  
Epidemiological Data ◽  
Tumour Resection ◽  
Carcinoid Heart Disease ◽  
Factors Affecting ◽  
Stage Iv Disease

Background: Small intestinal neuroendocrine tumours (SI NETs) represent 30–50% of small bowel neoplasms and often present at an advanced stage. To date, there is relatively limited literature regarding prognostic factors affecting overall survival (OS) in stage IV disease. In addition, the prevalence of mesenteric fibrosis (MF) in SI NETs and its effect on OS have not been sufficiently explored in the literature. Aim: The primary aim of this study was to perform a large-scale survival analysis in an institutional cohort of 387 patients with metastatic (stage IV) SI NETs. The secondary aim was to provide epidemiological information regarding the prevalence of MF and to evaluate its effect on OS. Results: The median OS was 101 months (95% CI 84, 118). Age > 65 years, mesenteric metastases with and without desmoplasia, liver metastases, carcinoid heart disease (CHD) and bone metastases were associated with a significantly shorter OS, while primary tumour resection was predictive of a longer OS. The benefit of surgical resection was limited to symptomatic patients. MF was present in approximately 50% of patients with mesenteric lymphadenopathy. Elevated urinary 5-HIAA levels correlated strongly with the presence of CHD (p < 0.001) and to a lesser extent (p = 0.02) with MF. MF and CHD did not usually co-exist, suggesting that different mechanisms are likely to be involved in the development of these fibrotic complications. Conclusions: This study has identified specific prognostic factors in a large cohort of 387 patients with advanced SI NETs and has provided useful epidemiological data regarding carcinoid-related fibrotic complications.

scholarly journals ENETS TNM Staging Predicts Prognosis in Small Bowel Neuroendocrine Tumours

ISRN Oncology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Rajaventhan Srirajaskanthan ◽  
A. Ahmed ◽  
A. Prachialias ◽  
P. Srinivasan ◽  
N. Heaton ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Small Bowel ◽  
Neuroendocrine Tumours ◽  
Primary Tumour ◽  
Staging System ◽  
Tnm Staging ◽  
Tumour Resection ◽  
Carcinoid Heart Disease ◽  
Tnm Staging System ◽  
Primary Tumour Resection

Introduction. Small bowel neuroendocrine tumours (NETs) are the most common type of gastrointestinal neuroendocrine tumours. The incidence and prevalence of these tumours are on the rise. The aims of this study were to determine prognostic clinicopathological features and whether the ENETS TNM staging system predicts prognosis and also. Method. Clinical data was collected retrospectively from 138 patients with histologically proven small bowel NETs managed at King’s College Hospital. Histology was reviewed and small bowels tumours, were staged according to the ENETS TNM staging system. Results. Median age was 65 years (range 29–87). The 5-year survival was 79.5% and the 10-year survival was 48.5%. Resection of the primary tumour was associated with improved survival (120 versus 56 months, P<0.05). On multivariate analysis prognostic factors were primary tumour resection and not having a carcinoid heart disease. TNM staging significantly separated survival of stage 2 and stage 3 from stage 4 NETs. Conclusion. Small bowel primary tumour resection and not having carcinoid heart disease are prognostic factors. The ENETS TNM staging and grading system appears to be of prognostic relevance to small bowel NETs.

Factors affecting duration of gastrostomy tube retention in survivors following treatment for head and neck cancer

2014 ◽  
Vol 128 (3) ◽  
pp. 263-267 ◽  
Author(s):  
H Blanchford ◽  
D Hamilton ◽  
I Bowe ◽  
S Welch ◽  
R Kumar ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Univariate Analysis ◽  
Gastrostomy Tube ◽  
Data Sets ◽  
Relevant Research ◽  
Factors Affecting ◽  
Co Morbidity

AbstractBackground:Many patients treated for head and neck cancer require nutritional support, which is often delivered using a gastrostomy tube. It is difficult to predict which patients will retain their gastrostomy tube in the long term. This study aimed to identify the factors which affect the duration of gastrostomy tube retention.Method:In this retrospective study, 151 consecutive patients from one centre were audited. All patients had a mucosal tumour of the head and neck, and underwent gastrostomy tube insertion between 2003 and 2007.Results:There were near-complete data sets for 132 patients. The gastrostomy tube was retained in survivors (n = 66) for a mean of 21.3 months and in non-survivors (n = 66) for 11.9 months. Univariate analysis showed that co-morbidity was the only factor which significantly increased duration of gastrostomy tube retention in survivors (p = 0.041).Conclusion:Co-morbidity alone was associated with a significant increase in gastrostomy tube retention. It is suggested that co-morbidity be included as a variable in future relevant research. Co-morbidity should also be considered when counselling patients about their long-term function following cancer treatment. Gastrostomy tube retention is likely to be affected by many factors, with few single variables having importance independently.

scholarly journals The importance of cancers prophylaxis among women

2020 ◽  
Vol 19 (2) ◽  
pp. 110-121
Author(s):  
Małgorzata Pabiś ◽  
Kinga Augustowska-Kruszyńska ◽  
Weronika Kozicka ◽  
Kamila Kułaczkowska ◽  
Diana Kuzioła
Keyword(s):  
Cervical Cancer ◽  
Negative Impact ◽  
Epidemiological Data ◽  
Sexual Life ◽  
State Budget ◽  
Factors Affecting ◽  
Breast And Cervical Cancer ◽  
Central Statistical ◽  
Central Statistical Office

AbstractIntroduction. Late detected breast and cervical cancer are two of the most dangerous cancers due to the therapeutic possibilities and high mortality rate of women. Conducted scientific research, prevention programs and social campaigns do not contribute to changes in the attitudes of Polish women who, do not report for examinations and thus, preclude the possibility of early diagnosis.Aim. The aim of the study is to analyze epidemiological data on the occurrence of cancer in women in Poland and to draw attention to the importance of prevention in this area.Material and methods. For epidemiological analyzes, data from the National Cancer Registry, the Central Statistical Office and the Supreme Medical Chamber from the years 2014-2018 were prepared using descriptive methods.Discussion. Every year the number of cancer deaths increases (SAO, 2018). Prevention, despite financing from the state budget, did not bring the intended goal. More than half of the surveyed men claimed that women after mastectomy lose their attractiveness and those men would not start a new relationship with such women. Despite the fact that permanent, long-term partners accept the appearance of their partner after mastectomy, women are ashamed of their sexuality, what has its consequence in problems in the relationship or even the end of this relationship.Conclusions. 1) Insufficient number of specialists in the field of oncology results in the fact that not every patient has a chance to be early diagnosed and to early start the treatment. 2) Regular examinations may contribute to a decrease in deaths caused by two most dangerous female cancers. 3) Diagnosis of breast cancer, cervical cancer and its effects have a negative impact on the psyche of women, especially on the perception of their femininity. In relationships in which there was a strong emotional bond before the woman’s disease, an improvement in sexual life was noted. Important factors affecting such relationship are: self-acceptance of a woman and her sense of attractiveness. 4) Large financial expenditures on preventive programs do not guarantee an increase in the detection of tumors nor a decrease in the number of deaths.

Long-term survival and clinical efficacy in patients with advanced pancreatic and small bowel metastatic neuroendocrine tumors (GEP-NET) after I.V. 90Y DOTATATE.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15045-e15045
Author(s):  
Wojciech Rogowski ◽  
Ewa Wachula ◽  
Jolanta Zok ◽  
Anna Lewczuk ◽  
Jaroslaw Cwikla ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Small Bowel ◽  
Neuroendocrine Tumour ◽  
Somatostatin Receptor ◽  
Univariate Analysis ◽  
Female Gender ◽  
Term Survival ◽  
Long Term Outcome ◽  
The Mean

e15045 Background: Current therapeutic options for patients with progressive metastatic gastroenteropancreatic neuroendocrine tumour/neoplasm (GEP-NET/NEN) are limited. Treatment with SST analogues is method of choice, due to good symptoms control. [DOTA0, D-Phe1,Tyr3] octreotate[DOTATATE] has a higher affinity for SST2 receptors and thus is able to achieve longer disease control. The aim of this study was to evaluate long term radiological and clinical therapeutic effect of 90Y-DOTATATE in patients with progressive somatostatin receptor–positive small bowel and pancreatic neuroendocrine tumour/neoplasm (GEP-NET/NEN).The primary end point was assessing OS and PFS in long term follow-up. Methods: 67 patients progressing after treatment with SST analogues were inlcuded in the study. The mean treatment activity was 3.8GBq. The mean interval between therapies was 7 weeks (range 6 -9 weeks). Patients were treated up to mean a cumulative activity of 11.2 GBq. Due to pure beta emission (90Y) internal dosimetry was evaluated. Results: Median overall survival (OS) and progression-free survival (PFS) are shown in the Table. In univariate analysis Ki-67 (p=0.048) was the only significant factor influencing OS in pancreatic tumors. That was not confirmed in multivariate analysis. In small bowel tumors we defined three factors influencing survival in univariate analysis. These were: female gender (p=0.023), performance status at the beginning of therapy (p=0.031) and presence of liver metastases (p=0.026). Female gender (HR=0.30, 95% CI 0.11-0.81; p=0.018) was confirmed as positive prognostic factor in multivariate analysis. Factos influencing PFS were also assessed and will be presented as well. Conclusions: 90Y DOTATATE PRRT is effective in long term outcome (OS and PFS) in patient with advances progressive pancreatic and small bowel GEP-NET. This therapy is relatively safe as initial systemic therapy and after previous treatment with chemotherapy or somatostatine analogues as well. [Table: see text]

Prognostic factors that mandate long term follow up following surgery for appendix neuroendocrine tumours (aNETs)

2016 ◽  
Author(s):  
Edward Alabraba ◽  
Heman Joshi ◽  
Andrea Tufo ◽  
Hassan Malik ◽  
Melissa Banks ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Neuroendocrine Tumours ◽  
Long Term Follow Up

INFORMATION SUPPORT FOR MAKING MANAGEMENT DECISIONS IN THE FIELD OF PREVENTION OF EYE DISEASES AT STUDENTS BASED ON MULTI-VARIANT SIMULATION AND FORECASTING

2020 ◽  
pp. 147-153
Author(s):  
Юлия Владимировна Татаркова ◽  
Татьяна Николаевна Петрова ◽  
Олег Валериевич Судаков ◽  
Александр Юрьевич Гончаров ◽  
Ольга Николаевна Крюкова
Keyword(s):  
Preventive Measures ◽  
Influential Factors ◽  
Eye Diseases ◽  
Information Support ◽  
Factor Space ◽  
Factors Affecting ◽  
Eye Fatigue ◽  
Modeling And Forecasting ◽  
Medical Examinations

В настоящей статье представлен обзор основных решений, доступных сегодня для формирования как краткосрочных, так и долгосрочных проекций заболеваемости болезней глаза и его придаточного аппарата в студенческой среде. С другой стороны, существует ряд проблем, связанных с многообразием факторов, влияющих на заболеваемость, статистической необоснованностью и противоречивостью имеющихся результатов анализа данных. Представлены результаты математического моделирования зависимости показателя заболеваемости от наиболее влиятельных факторов образовательной и социальной среды. Перечислены важнейшие направления разработки математических моделей распространения заболеваемости. С помощью разработанного программного комплекса проведена серия вычислительных экспериментов по оценке и прогнозированию заболеваемости обучающихся в вузах разного профиля. Показана эффективность применения методики многовариантного моделирования и прогнозирования, указаны их ограничения и возможности практического применения. По расположению обобщенной области благоприятного прогноза в факторном пространстве можно определить время воздействия неблагоприятных для зрения факторов, которое должно составлять не более 10 ... 11 часов в сутки, количество профилактических мероприятий должно составлять не менее 3 ... 4. При этом риск развития миопии составит не более 0,4, вероятность усталости глаз за компьютером составит не более 0,4, вероятность дискомфорта глаз на занятиях составит не более 0,15. Исходя из характера прогноза, определяется длительность диспансерного наблюдения, а также потребность профилактических мероприятий по устранению или ослаблению действия неблагоприятно влияющих социально-гигиенических и медико-биологических факторов конкретного больного. Использование прогностической матрицы в практическом здравоохранении позволяет существенно улучшить работу по профилактике офтальмологической заболеваемости и является одним из эффективных мероприятий диспансеризации студенческой молодежи, так как дает возможность выделить из числа обучающихся группу с высоким риском неблагоприятного исхода заболевания This article provides an overview of the main solutions available today for the formation of both short-term and long-term projections of the incidence of eye diseases and its adnexa in the student environment. On the other hand, there are a number of problems associated with a variety of factors affecting the incidence, statistical unreasonability and inconsistency of the available data analysis results. The results of mathematical modeling of the dependence of the incidence rate on the most influential factors of the educational and social environment are presented. The most important areas of developing mathematical models for the spread of morbidity are listed. With the help of the developed software package, a series of computational experiments was carried out to assess and predict the incidence of students in universities of various profiles. The effectiveness of the application of multivariate modeling and forecasting methods is shown, their limitations and practical application possibilities are indicated. By the location of the generalized region of favorable prognosis in the factor space, it is possible to determine the exposure time of factors unfavorable for vision, which should be no more than 10 ... 11 hours a day, the number of preventive measures should be at least 3 ... 4. At the same time, the risk of development myopia will be no more than 0.4, the probability of eye fatigue at the computer will be no more than 0.4, the likelihood of eye discomfort in the classroom will be no more than 0.15. Based on the nature of the forecast, the duration of the follow-up observation is determined, as well as the need for preventive measures to eliminate or weaken the action of adverse social, hygienic and biomedical factors of a particular patient. The use of the prognostic matrix in practical health care can significantly improve the work on the prevention of ophthalmic morbidity and is one of the effective medical examinations for students, since it makes it possible to distinguish among the students a group with a high risk of an unfavorable outcome of the disease

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