This cohort study examines whether racial disparities exist in treatment received and in survival among patients undergoing surgical intervention with curative intent for gastrointestinal tract cancer.
Study Design:
Systematic review.
Objectives:
Sacral chordomas are rare, primary tumors of the spine, best treated with en bloc
resection. The purpose of this study was to assess the literature for resected sacral
chordoma and to quantify the prevalence of, risk factors for, and treatment outcomes of
local and distant recurrence therein.
Methods:
We searched 5 online databases from January 1980 to May 2016 to find articles that
report survival, recurrence outcomes, and/or prognostic factors for the resected sacral
chordoma patient population. Characteristics and clinical outcomes of the pooled cohort
are reported. Fisher exact tests, unpaired
t
tests, and one-way
analysis of variance were used to investigate patient- and treatment-associated
prognostic factors for local and distant recurrence. Survival analyses were performed
for time to local recurrence and death. The protocol’s PROSPERO ID is
CRD42015024384.
Results:
Fifty-seven studies, with 1235 unique sacral chordoma patients, were included in this
review. Local and distant recurrence occurred in 42.6% and 22.4% of patients with
adequate follow-up, respectively. Kaplan-Meier overall median survival for patients with
and without recurrence were 98 and 209 months after surgery, respectively. Wide surgical
margin was associated with a lower rate of local recurrence; and wide surgical margin,
female sex, and patient age ≥65 years were associated with lower rates of distant
recurrence.
Conclusions:
While surgical margin remains the most significant prognostic factor for local and
distant recurrence, combined surgical approach may be associated with local recurrence.
Male sex and age <65 years may be associated with distant recurrence. Patients with
risk factors for recurrence should undergo close monitoring to maximize survival.
Results Per-subject multivariate analyses showed associations of CD56 and MICA with age: CD56 was increased in older subjects (p = 0.03), while MICA was increased in younger subjects (p = 0.005). Per-lobule analyses showed that CD56 and MICA levels were both decreased in lobules with fibrocystic change, with median levels of CD56 and MICA staining, respectively, at 0.31 and 7.0% in fibrocystic lobules compared to 0.76 and 12.2% in lobules without fibrocystic change (p < 0.001 for each). Among fibrocystic lobules, proliferative/atypical lobules showed significantly lower expression compared to nonproliferative lobules for MICA (p = 0.02) but not for CD56 (p = 0.80). Conclusion Levels of CD56+ NK cells and activating ligand MICA were decreased in breast lobules with fibrocystic change, and MICA levels showed a significant stepwise decrease with increasing histopathologic abnormality. MICA levels were also significantly decreased in older subjects, who generally have higher risk of developing cancer. These findings advance a model in which MICA promotes cytotoxic activity in CD56+ NK cells to protect against tumorigenesis in breast lobules, and suggest further research is warranted.
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