Estimation of Physiological Ability and Surgical Stress Score Is a Useful Prognostic Indicator for Elderly Patients with Colorectal Cancer

2019 ◽  
Vol 37 (2) ◽  
pp. 145-153 ◽  
Author(s):  
Manabu Yamamoto ◽  
Hiroaki Saito ◽  
Chihiro Uejima ◽  
Akimitsu Tanio ◽  
Yoichiro Tada ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Surgical Stress ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Prognostic Indicator ◽  
Histopathological Diagnosis ◽  
Characteristic Analysis ◽  
Curative Surgery ◽  
The Difference

Background: The incidence of colorectal cancer (CRC) among the elderly has been increasing. Therefore, determining postoperative prognosis factors in elderly CRC patients has clinical importance. This study retrospectively investigated the prognostic significance of the estimation of physiological ability and surgical stress (E-PASS) in elderly CRC patients. Methods: This study enrolled 166 elderly patients aged 75 or more with a histopathological diagnosis of colorectal adenocarcinoma who underwent curative surgery. Results: According to the results of receiver operating characteristic analysis, the patients were divided into the following 2 groups based on the comprehensive risk score (CRS): CRS of ≥0.05 (CRSHigh) and CRS of < 0.05 (CRSLow). The 5-year overall survival rates of CRSHigh group and CRSLow group were 51.1 and 89.6%, respectively, and the difference was statistically significant (p < 0.001). Furthermore, 5-year disease-specific survival rates of CRSHigh group and CRSLow group were 81.4 and 96.3%, respectively, and the difference was statistically significant (p = 0.017). Also, multivariate analysis indicated that CRS was an independent prognostic indicator in elderly CRC patients. With regard to the cause of death, both recurrence and cancer-unrelated deaths were observed significantly more in the CRSHigh group than in the CRSLow group. Conclusions: E-PASS was a useful prognostic indicator in elderly CRC patients.

Prognostic Significance of Pre- and Postoperative Lymphocyte Counts in Patients with Gastric Cancer

2018 ◽  
Vol 36 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Hiroaki Saito ◽  
Yusuke Kono ◽  
Yuki Murakami ◽  
Yuji Shishido ◽  
Hirohiko Kuroda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Elderly Patients ◽  
Lymphocyte Count ◽  
Operating Characteristic ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Venous Invasion ◽  
Prognostic Indicator ◽  
Characteristic Analysis ◽  
Patient Prognosis

Background: Although preoperative lymphopenia is reportedly a prognostic factor in cancer patients, the association between postoperative lymphopenia and patient prognosis has not been widely studied. Methods: We enrolled 352 patients who underwent surgery for gastric cancer (GC) between January 2005 and April 2013 to analyze correlations among pre- and postoperative lymphocyte counts (LCs) and prognosis in GC patients. Results: Pre- and postoperative (obtained 1 day after surgery) LCs were significantly correlated (r = 0.496, p < 0.0001). Pre- and postoperative LCs of elderly patients were significantly lower than those of non-elderly patients. Postoperative lymphocyte count was significantly lower in patients with a differentiated tumor than in those with an undifferentiated tumor. Based on the results of receiver operating characteristic analysis, patients were classified into subgroups as: preoperative LC ≥1,676 (pre-LCHigh), preoperative LC <1,676 (pre-LCLow); and as postoperative LC ≥855 (post-LCHigh), and postoperative LC <855 (post-LCLow). Five-year overall survival rates significantly differed between pre-LCHigh (82.5%) and pre-LCLow (71.6%) groups (p = 0.023); and also between the post-LCHigh (81.5%) and post-LCLow (69.5%) groups (p = 0.0072). The 5-year disease specific survival rates were 91.3 and 82.4% in patients with post-LCHigh and those with post-LCLow, respectively, and differences were statistically significant (p = 0.015). Multivariate analysis indicated that postoperative lymphocyte count was an independent prognostic indicator, along with age, gender, tumor size, lymph node metastasis, and venous invasion. Conclusions: Postoperative lymphocyte count is a useful predictive factor for prognosis in GC patients.

Evaluation of the Estimation of Physiologic Ability and Surgical Stress Score as a Prognostic Indicator for Older Patients with Gastric Cancer

2019 ◽  
Vol 37 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Yuki Murakami ◽  
Hiroaki Saito ◽  
Shota Shimizu ◽  
Yusuke Kono ◽  
Yuji Shishido ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Risk Score ◽  
Surgical Stress ◽  
Survival Rates ◽  
Prognostic Significance ◽  
Prognostic Indicator ◽  
Histopathological Diagnosis ◽  
Receiver Operating Characteristic Curves ◽  
Auc Value ◽  
Stress Score

Background: The incidence of gastric cancer (GC) among the older adults is increasing. Therefore, determining postoperative age-associated prognostic factors is clinically important. This present study retrospectively investigated the prognostic significance of the estimation of physiologic ability and surgical stress (E-PASS) of such patients with GC. Methods: We enrolled 136 patients aged ≥75 years with a histopathological diagnosis of gastric adenocarcinoma who underwent gastrectomy. Results: Receiver operating characteristic curves were generated to evaluate survival, and AUC values were compared to assess the discriminatory ability of carcinoembryonic antigen, the perioperative risk score, the surgical stress score, and the comprehensive risk score (CRS) of E-PASS. The AUC value of CRS was of the highest AUC value as a function of overall survival (OS) and disease-specific survival. The 5-year OS rates of CRSHigh and CRSLow groups were 50.6 and 76.9% (p = 0.0007) respectively. The 5-year DSS rates of the CRSHigh and CRSLow groups were 78.8 and 95.2% (p = 0.028) respectively. Further, the 5-year survival rates unrelated to cancer of the CRSHigh and CRSLow groups were 64.2 and 80.9% (p = 0.0096) respectively. Multivariate analysis identified that CRS was an independent prognostic indicator. Conclusions: E-PASS was a useful prognostic indicator for older GC patients.

Combined Pre- and Postoperative Lymphocyte Count Accurately Predicts Outcomes of Patients with Colorectal Cancer

2018 ◽  
Vol 36 (6) ◽  
pp. 487-494 ◽  
Author(s):  
Manabu Yamamoto ◽  
Hiroaki Saito ◽  
Chihiro Uejima ◽  
Akimitsu Tanio ◽  
Seigo Takaya ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
Survival Rates ◽  
Prognostic Indicator ◽  
Disease Specific Survival ◽  
Characteristic Analysis ◽  
Patient Prognosis ◽  
Disease Specific

Background: Although preoperative lymphopenia is reportedly a prognostic factor in cancer patients, the association between postoperative lymphopenia and patient prognosis has not been widely studied. Methods: We enrolled 379 patients who underwent surgery for colorectal cancer (CRC) to analyze correlations among pre- and postoperative lymphocyte counts (LCs) and prognosis in patients with CRC. Results: Pre- and postoperative LCs were significantly correlated (r = 0.615, p < 0.0001). Based on results of receiver operating characteristic analysis, patients were subgrouped as preoperative LC ≥1,280 (pre-LCHigh, n = 234), preoperative LC < 1,280 (pre-LCLow, n = 145); and as postoperative LC ≥680 (post-LCHigh, n = 246), and postoperative LC < 680 (post-LCLow, n = 133). Five-year disease-specific survival rates significantly differed between pre-LCHigh (88.6%) and pre-LCLow (72.5%) groups (p < 0.0001); and also between the post-LCHigh (88.5%) and post-LCLow (71.1%) groups (p < 0.0001). Five-year disease-specific survival rates of patients who were both pre-LCLow and post-LCLow was significantly lower than those for patients who were either pre-LCHigh or post-LCHigh or pre-LCHigh/post-LCHigh (p = 0.0003). Multivariate analysis indicated that the combination of pre- and postoperative LC was an independent prognostic indicator. Conclusions: The combination of pre- and postoperative LC is a predictive factor for prognosis in CRC patients.

scholarly journals Lymphopenia associated with adjuvant chemotherapy after potentially curative surgery for colorectal cancer correlates with recurrence

2016 ◽  
Author(s):  
Masatsune Shibutani ◽  
Kiyoshi Maeda ◽  
Hisashi Nagahara ◽  
Hiroshi Ohtani ◽  
Tetsuro Ikeya ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Lymphocyte Count ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Free Survival ◽  
Background Data ◽  
Disease Free

Abstract Objective: The aim of this retrospective study was to evaluate the prognostic significance of lymphopenia associated with chemotherapy in patients with colorectal cancer who received adjuvant chemotherapy after undergoing potentially curative surgery. Summary of background data: Lymphocyte plays an important role in anti-tumor immunity. Lymphopenia is sometimes induced during the period of adjuvant chemotherapy after potentially curative surgery for colorectal cancer. However, the prognostic significance of lymphopenia associated with chemotherapy is unknown. Methods: One hundred and fifteen patients who received adjuvant chemotherapy after potentially curative surgery for stage II/III colorectal cancer were enrolled in this study. All patients were classified into two groups, the lymphopenia group and the normal group, according to minimum lymphocyte count during the period of adjuvant chemotherapy. Lymphopenia was defined as a lymphocyte count of less than 1,000/Ã&#x8e;¼l. Lymphopenia associated with chemotherapy was found in 17 of the 115 patients (14.8%). Results: Lymphopenia was associated with a worse disease-free survival (p=0.018). Moreover, in a multivariate analysis, lymphopenia associated with chemotherapy was identified to be an independent prognostic factor.

Correlation between the number of positive nodes, number of dissected nodes and survival of patiens with colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13585-13585
Author(s):  
J. C. Marin Marmolejo ◽  
C. R. Villegas Mejia ◽  
J. P. Cardona Arcila ◽  
E. Mulett Vasquez ◽  
M. Osorio Chica ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Medical Records ◽  
Tnm Classification ◽  
Prognostic Indicator ◽  
Absolute Number ◽  
Colon And Rectal Cancer ◽  
Nodal Dissection ◽  
The Difference

13585 Background: According to the TNM classification, the prognosis of patients suffering from colon and rectal cancer has been defined taking into account the number of nodes reported positively. Objective: This work is intending to establish a relation between the number of positive nodes and the number of dissected nodes, relating it with the overall survival. Methods: 5500 medical records of patients were reviewed. 771 out of these corresponded to gastrointestinal cancer (14%) from which 351(6.38%) corresponded to colorectal cancer. From this group, 291 patients (82.9%) underwent a surgery. A relation between the number of positive nodes and the number of dissected nodes was established and called proportion of positivity (positive nodes/ dissected nodes × 100) and this was in turn related to a five year overall survival. Two groups were analyzed: proportion of positivity > than 50% and proportion of positivity < than 50%. Results: A report of 209 patients showing nodes was obtained (59.5%), with a means of 10.4 (rank 0–31) of dissected nodes per patient and a means of positive nodes of 2.4 (rank 0–22). Comparing the two groups the statistic significance starts to be obvious from the 18 months and the difference between the two groups continues increasing until the five years. The survival to five years for the group with the proportion > than 50% was 39% (IC 95%:13.4–64.5) compared to the survival for the group with a proportion < than 50% that was 75.7% (IC 95%:67.6–83.7) p<0.05. Conclusions: The proposal shows that not only is the absolute number of positive dissected nodes as only prognostic indicator (TNM) but also that before nodes dissections with low number of them, it is possible to establish a reliable prognostic relationship by calculating the proportion of positivity. The above said does not consider that the nodal dissection can be less than recommended, on the contrary obtaining the biggest number of nodes will mean bigger equivalence of the proposal and a bigger possibility to detect positive nodes. No significant financial relationships to disclose.

Feasibility of the combination chemotherapy with 5-fluorouracil and oxaliplatin in metastatic gastric or colorectal cancer patients more than age of 80.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 136-136
Author(s):  
Kyu-Hyoung Lim ◽  
Hui-Young Lee ◽  
Sung Bae Park ◽  
Seo-Young Song
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Combination Chemotherapy ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Salvage Chemotherapy ◽  
Significant Difference ◽  
Colorectal Cancer Patients

136 Background: The combination chemotherapy of 5-fluorouracil (5-FU) and Oxaliplatin is usually used in gastric cancer (GC) and colorectal cancer (CRC). The safety and efficacy of the combination chemotherapy in patients over 80-years old has not been established yet. The purpose of this study was to assess the clinical outcomes and tolerability in the combination with 5-FU, leucovorin and oxaliplatin as first-line treatment in extremely elderly patients with GC or CRC. Methods: Eligibility included: 1) more than 80-years old, 2) metastatic gastric or colorectal cancer 3) chemotherapy-naive, 4) ECOG PS 0-1, 5) adequate organ function. Patients received the combination chemotherapy of 5-FU, leucovorin and oxaliplatin. Response evaluation was done every 8 weeks with RECIST criteria and toxicity was evaluated with NCI-CTCAE. Results: Between Sep 2008 and Nov 2014, 28 patients were reviewed and composed of equal numbers of GC and CRC. The median age was 82.2 years (80.0-85.6yrs) in GC and 81.1 years (80.0-89.3) in CRC, respectively. Total administrated cycles were 89 with median cycles of 5 in GC and 112 with median cycles of 11 in CRC. The median progression-free survival (PFS) and overall survival (OS) in GC were 5.4 months and 6.6 months, as compared with 7.3 months and 8.1 months, respectively. There were no significant difference in PFS (p = 0.94) and OS (p = 0.28) between GC and CRC. Overall survival rates at 1 year were 35.7% and 42.9%, respectively. After disease progression, salvage chemotherapy in GC and CRC was administrated in 1 and 7 patients, respectively. Common grade 3/4 hematology toxicities in both group were neutropenia, anemia. Frequent non-hematological toxicities were anorexia (60%), neuropathy (40%) and mucositis (25%), which were grade 1/2. Conclusions: The combination chemotherapy of 5-fluorouracil (5-FU) and Oxaliplatin has limited effect on improvement of OS in metastatic gastric or colorectal cancer patients more than age of 80. Further studies on the role of chemotherapy in these extremely elderly patients are needed.

Urgent Need for a New Staging System in Advanced Colorectal Cancer

2008 ◽  
Vol 26 (29) ◽  
pp. 4828-4833 ◽  
Author(s):  
Graeme J. Poston ◽  
Joan Figueras ◽  
Felice Giuliante ◽  
Gennaro Nuzzo ◽  
Alberto F. Sobrero ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Stage Iv ◽  
Staging System ◽  
Sequential Therapy ◽  
Rapid Expansion ◽  
Curative Surgery ◽  
The Impact

Despite recent advances in the medical treatment of metastatic colorectal cancer (mCRC), which include irinotecan- and oxaliplatin-based first-line regimens, the concept of planned sequential therapy involving three active agents during the course of a patient's treatment and the increasing use of targeted monoclonal antibodies, 5-year survival rates for patients with advanced CRC remain unacceptably low. For patients with CRC liver metastases, liver resection remains the only chance of cure, with 5-year survival rates ranging from 25% to 40%. However, 80% to 85% of patients with stage IV CRC have liver disease which is considered unresectable at presentation. The rapid expansion in the use of improved combination chemotherapy regimens plus or minus biologics, to render initially unresectable metastases resectable has increased the percentage of patients eligible for potentially curative surgery. However, the current staging criteria for CRC patients with metastatic disease do not reflect these recent changes or the fact that there is also a large variation in the survival of patients with stage IV CRC. For example the survival for a patient with a solitary, resectable liver metastasis is better than that for a patient with stage III disease. A new staging system is therefore needed that acknowledges both the improvements that have been made in surgical techniques for resectable metastases and the impact of modern chemotherapy on rendering initially unresectable CRC liver metastases resectable, while at the same time distinguishing between patients with a chance of cure at presentation and those for whom only palliative treatment is possible.

scholarly journals LRIG1 Expression and Colorectal Cancer Prognosis

2020 ◽  
Author(s):  
Maryam Bakherad ◽  
Mahdieh Salimi ◽  
Seyed Abdolhamid Angaji ◽  
Frouzandeh Mahjoubi ◽  
Tayebeh Majidizadeh
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Significance ◽  
Prognostic Indicator ◽  
Cancer Prognosis ◽  
Protein Levels ◽  
Tumor Tissues ◽  
The Right ◽  
Colorectal Cancer Patients ◽  
Leucine Rich Repeats ◽  
And Control

Abstract BackgroundTo make the right treatment decisions about colorectal cancer (CRC) patients reliable predictive and prognostic data are needed. However, in many cases this data is not enough. Some studies suggest that LRIG1 gene (leucine-rich repeats and immunoglobulin-like domains1) has prognostic implications in different kinds of cancers. MethodsOne hundred and two patients with colorectal cancer were retrospectively analyzed for LRIG1 expression at both mRNA and protein levels. SYBR Green Real-Time RT-PCR technique was used for mRNA expression analyses and Glyceraldehyde-3-Phosphate Dehydrogenase gene (GAPDH) was considered as a reference gene for data normalization. LRIG1 protein expression was analyzed using Immunohistochemistry (IHC). Additionally, appropriate statistic analyses were used to assess the expression of LRIG1 in test and control groups. The prognostic significance of LRIG1 expression was analyzed using the univariate and multivariate analyses.ResultsThe data revealed that the expression of LRIG1 in both mRNA and protein levels was down regulated in colorectal tumor tissues (P<0.01) but is not clinically relevant prognostic indicator in CRC. ConclusionsTherefore, it is suggested that LRIG1 expression analyses may not be considered as an important issue when making informed and individualized clinical decisions regarding the management of colorectal cancer patients.

scholarly journals Colorectal Cancer in Octogenarian and Nonagenarian Patients: Clinicopathological Features and Survivals

2020 ◽  
Vol 36 (5) ◽  
pp. 323-329 ◽  
Author(s):  
Soo Min Lee ◽  
Jun Sang Shin
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Survival Rates ◽  
The Elderly ◽  
Clinicopathological Parameters ◽  
Female Ratio ◽  
Significant Difference ◽  
Differentiation Stage ◽  
Male To Female

Purpose: Elderly population will comprise a substantial proportion of colorectal cancer (CRC) patients. We examined patients older than 80 years according to their clinical and pathological characteristics to fully understand the elderly patients.Methods: CRC patients, 60 years or older at diagnosis, admitted between 2009 and 2014 at our hospital were enrolled. The patients were divided into 2 groups: elderly (aged > 80 years, n = 133), and controls (aged 60 to 79 years, n = 596). Patient’s demographics, risk factors for prognosis of CRC, Clinicopathological parameters, treatment, and survival rates were compared.Results: The mean ages were 83.9 and 64.8 years, respectively. Male-to-female ratio and tumor sidedness were comparable in both groups. Prognostic factors found in univariate analysis; differentiation, stage, lymphovascular invasion, and carcinoembryonic antigen showed no statistical difference. The microsatellite instability status and number of retrieved lymph nodes were also similar (17.2 vs 21.6, P = 0.505). A significant difference was found in the treatment approach for chemotherapy as the elderly patients with stage III and IV tend to have omitted adjuvant (43.6% vs. 92.8%, P < 0.001) or palliative (35.8% vs. 89.4%, P = 0.016) chemotherapy. Except in stage I, elderly patients showed significantly lower overall survival rates.Conclusion: Current study shows far-elderly patients with CRC were less likely to receive standard treatments, which might have resulted in an inferior outcome. As the number of elderly patients with CRC increase, our results provide a basis for further clinical and molecular investigations of elderly CRC patients.

scholarly journals Complete Response of Pulmonary Metastases from Rectal Cancer to Tegafur-Uracil/Leucovorin plus Bevacizumab in an Elderly Patient: A Case Report

2018 ◽  
Vol 11 (2) ◽  
pp. 461-466
Author(s):  
Masatsune Shibutani ◽  
Kiyoshi Maeda ◽  
Hisashi Nagahara ◽  
Tatsunari Fukuoka ◽  
Yasuhito Iseki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patient ◽  
Rectal Cancer ◽  
Elderly Patients ◽  
Metastatic Colorectal Cancer ◽  
Treatment Cycle ◽  
Pulmonary Metastases ◽  
Intensive Therapy ◽  
Complete Response ◽  
Curative Surgery

As a result of recent major advances in chemotherapy for metastatic colorectal cancer, the prognosis for patients with metastatic colorectal cancer has improved. However, elderly patients often cannot receive intensive therapy. There are still many problems to solve regarding treatment for elderly patients with metastatic colorectal cancer. We herein report a case of complete response of pulmonary metastases from rectal cancer to tegafur-uracil (UFT)/leucovorin (LV) + bevacizumab (Bmab) in an elderly patient. An 80-year-old woman who had undergone curative surgery for rectal cancer 5 years ago was diagnosed with pulmonary metastases. Taking into account her advanced age and low renal function (creatinine clearance: 41.2 mL/min), UFT/LV + Bmab therapy was selected. The patient received UFT (300 mg/m2/day) and LV (75 mg/day) on days 1–5, 8–12, and 15–19 and Bmab (7.5 mg/kg) on day 1. The treatment cycle was repeated every 21 days. Following 17 courses of treatment without adverse events, a complete response was observed. Furthermore, there was no recurrence within 6 months after the final course of therapy. This case indicates that UFT/LV + Bmab is suitable for the treatment of elderly patients with metastatic colorectal cancer.

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