Zobrazení zdroje stránky Blochellegaard8858

BACKGROUND A watch-and-wait strategy is a nonoperative alternative to sphincter-preserving surgery for patients with locally advanced rectal cancer who achieve a clinical complete response after neoadjuvant therapy. There are limited data about bowel function for patients undergoing this organ-preservation approach. [https://www.selleckchem.com/Proteasome.html Proteasomal inhibitors] OBJECTIVE To compare bowel function in patients with rectal cancer managed with a watch-and-wait approach to bowel function in patients who underwent sphincter-preserving surgery (total mesorectal excision). DESIGN Retrospective case-control study employing patient-reported outcomes. SETTING Comprehensive cancer center. PATIENTS Twenty-one patients underwent a watch-and-wait approach and were matched 11 with 21 patients from a pool of 190 patients who underwent sphincter-preserving surgery, based on age, gender, and tumor distance from the anal verge. MAIN OUTCOME MEASURES Bowel function using the Memorial Sloan Kettering Cancer Center Bowel Function Instrument. RESULTS Patients in the watch-and-wait arm had better bowel function on the overall scale (median total score, 76 vs 55; p less then 0.001) and on all subscales, with the greatest difference on the urgency/soilage subscale (median score, 20 vs 12; p less then 0.001). LIMITATIONS Retrospective design, small sample size, and temporal variability between surgery and time of questionnaire completion. CONCLUSIONS A watch-and-wait strategy correlated with overall better bowel function when compared to sphincter-preserving surgery using a comprehensive validated bowel dysfunction tool. See Video Abstract at http//links.lww.com/DCR/B218.OBJECTIVES To report long-term outcomes of nonmelanoma skin cancer (NMSC) in immunosuppressed cardiac and liver transplant recipients (CLTR). MATERIALS AND METHODS The authors reviewed CLTR at the Mayo Clinic in Arizona from 1986 to 2013. Patient and tumor characteristics were recorded. Survival rates were calculated using the Kaplan-Meier method. Patient-specific and lesion-specific analyses were performed. Univariate and multivariate cox regressions were performed for comparisons. RESULTS Seven-hundred and forty-seven patients underwent cardiac (138) or liver (609) transplantation and of these, 97 patients (13%) developed 382 invasive NMSC. The median follow-up was 11 (range, 3 to 27) years for surviving patients. Primary treatment was mainly surgery alone. At 10 years, the local recurrence (LR) rate was 20% (95% confidence interval, 15%-28%), and 14% of patients had multiple LRs. At 10 years, LR rates were higher for T3/T4 tumors when compared with T1/T2 tumors (32.5% vs. 20%, P=0.05). At 10 years, overall survival was 79% (95% confidence interval, 64%-88%). On multivariate analysis, age 61 years and more demonstrated inferior overall survival (P less then 0.01). CONCLUSIONS This is the first study describing the AJCC 8th edition stage-based patterns of recurrence and long-term outcomes of surgically managed NMSC in a large cohort of immunosuppressed CLTRs. T3 and T4 tumors recur more often than early stage tumors. Further study is required to identify factors related to recurrence and guide upfront treatment intensification in this high-risk population.OBJECTIVE The objective of this study was to perform a meta-analysis of the diagnostic test accuracy of Glasgow Prognostic Score (GPS) as a prognostic factor for renal cell carcinoma (RCC). MATERIALS AND METHODS Studies were retrieved from PubMed, Cochrane, and Embase databases, and we performed comprehensive searches to identify studies that evaluated the prognostic impact of pretreatment GPS in RCC patients. We assessed sensitivity, specificity, summary receiver operating characteristic curve, and area under the curve (AUC). RESULTS Totally, studies were searched under the prespecified criteria, and 8 studies with a total of 1191 patients were included to evaluate the prognostic impact of GPS in RCC finally. They indicated a pooled sensitivity of 0.785 (95% confidence interval [CI] 0.705-0.848), specificity of 0.782 (95% CI 0.656-0.871), diagnostic odds ratio of 13.089 (95% CI 7.168-23.899), and AUC of 0.83 (95% CI 0.79-0.86). Heterogeneity was significant, and meta-regression revealed that the presence of metastasis might be the potential source of heterogeneity. Subgroup analysis also demonstrated that the presence of metastasis might be the source of heterogeneity. CONCLUSION GPS demonstrated a good diagnostic accuracy as a prognostic factor for RCC and especially in the case of nonmetastatic RCC.OBJECTIVES The brain is a rare site for sarcoma metastases. Sarcoma's radioresistance also makes standard whole-brain radiotherapy less appealing. We hypothesize that stereotactic radiation techniques (stereotactic radiosurgery [SRS]/stereotactic fractionated radiotherapy [FSRT]) may provide effective local control. MATERIALS AND METHODS This single-institution retrospective analysis evaluated our experience with linear acceleator-based SRS/FSRT for sarcoma brain metastases. Time to event analysis was estimated via Kaplan-Meier. Univariable/multivariable Cox regression analyses followed to assess the impact of patient and disease characteristics on outcomes. RESULTS Between 2003 and 2018, 24 patients were treated with 34 courses of SRS/FSRT to 58 discrete lesions. The median age at first treatment was 57 years (range 25 to 87 y). Majority of patients had concurrent lung metastases (n=21; 88%), diagnosed spindle cell sarcoma (n=15; 25%) or leiomyosarcoma (n=12; 21%) histology, and were treated with either SRS (n=43; median dose=19 Gy, range 15 to 24 Gy) or FSRT (n=17; 3/5 fractions, median dose=25 Gy, range 25 to 35 Gy). With a median follow-up after brain metastasis of 7.3 months, the 6 month/12 month local control, distant brain control, and overall survival of 89%/89%, 59%/34%, and 50%/38%, respectively. All local failures were of primary spindle cell histology (P less then 0.001), which was associated with poorer distant control (hazard ratio=25.8, 95% confidence interval 3.1-536.4; P=0.003) on univariable analysis, and OS (hazard ratio=7.1, 95% confidence interval 2.0-26.1; P=0.003) on multivariable analysis. CONCLUSIONS This is the largest patient cohort with sarcoma brain metastases treated with SRS/FSRT, it provides durable local control, despite a reputation for radioresistance. Further prospective evidence is required to determine the impact of primary histology on control and survival following brain metastasis diagnosis.