Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann’s operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features ( p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication ( p = 0.012, p = 0.044) and mortality ( p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication ( p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.
In the diagnosis of SAIS, MNT is a reliable and highly accurate maneuver and seems useful to distinguish this syndrome from frozen shoulder.
Background: Stage IV breast cancer was considered to be an incurable disease with a poor survival outcome. Among them, patients with de novo stage IV breast cancer (BC) account for approximately 25%. Systemic therapy has remained the cornerstone of treatment, and the role of local therapy (Surgical resection of the primary tumor and/or radiotherapy) for de novo stage IV BC remains controversial. Aim: This study was conducted to examine the clinical and pathological profile and survival outcomes of patients with de novo stage IV BC treated with local therapy at our institutions. Settings and design: The study was conducted at two Chinese tertiary hospitals and was retrospective in nature. Methods and patients: All de novo stage IV BC patients (all female) treated with local therapy and systemic therapy alone at our hospitals between March 2007 and November 2016 were enrolled in the study. Data were retrospectively extracted from the patients’ case records. Data were analyzed according the clinicopathological features and treatment outcomes. Overall survival was used as the primary study outcome. Univariable and multivariable Cox regression analysis were used to assess the association between local therapy and overall survival. Further stratified survival analysis was used to assess the effect of surgical resection of the primary tumor before or after systemic therapy on survival outcomes. Kaplan-Meier method was used for survival analysis and the outcome variables were compared using the log-rank test. Results: A total of 138 cases of de novo stage IV BC patients admitted to our institutions were included, of whom 80 underwent local treatment. There was no significant difference in age, primary tumor N-stage, Ki-67 index, ER/PR status, and HER-2 expression between local treatment group and systemic therapy group. But there were differences in tumor size and metastatic site between the two groups. Surgical resection of the primary tumor was performed in 71/138 (51.4%) patients and 26 cases of the patients had combined radiotherapy. The median duration of follow-up was 31±20.6 months. Median survival time of all patients was 32.1 months, and the 3-year and 5-year survival rates were 36.2% and 12.3%, respectively. The median survival time of local treatment group and systemic therapy group were 38.0 and 19.0 months (HR 0.50; 95% CI 0.34-0.73; p<0.0001), and the 3-year and 5-year survival rates were 53.5% versus 20.9% and 16.9% versus 7.5%, respectively. Similarly, patients who had surgery were found to have a better survival outcome than the patients with non-surgery therapy (HR 0.53; 95% CI 0.36-0.77; p<0.0001). While receipt of radiotherapy alone to either the primary and/or metastatic sites had no impact on overall survival (p=0.24). Interestingly, surgical resection of the primary tumor, whether before or after systemic therapy (p=0.0004; p=0.0005), was independently associated with improved overall survival when compared to systemic therapy alone. Conclusions: Our data support that local therapy mainly based on surgical resection of the primary tumor can improve overall survival in patients with de novo stage IV BC, but fail to demonstrate the survival benefit from radiotherapy alone. However, prospective evidence from phase-3 randomized controlled trials on the feasibility of local therapy in de novo stage IV BC is required before its routine use can be recommended. Key words: De novo stage IV breast cancer; Local therapy; Surgical resection of the primary tumor; Survival outcomes Research protocol number: 2017-AF29-058 Citation Format: Ren Chongxi, Sun Jianna, Kong Lingjun, Liu Hong. Local therapy and its association on survival outcomes in patients with de novo stage IV breast cancer: Results from a retrospective cohort study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-19.
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BackgroundSchwannomas are benign, encapsulated, peripheral nerve tumours that arise from the Schwann cell. Approximately 25%–45% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck. However, schwannoma of the supraglottic oropharynx is rare.Case presentationWe report on a 35-year-old female who complained of progressive dysphagia, from whom a large schwannoma in the supraglottic oropharynx was excised through a transoral approach. No recurrence was seen after one year follow-up.ConclusionAlthough rare, schwannomas do occasionally occur in the supraglottic oropharynx. When dysphagia is present, a thorough diagnostic procedure should be performed to evaluate the morphology and function of the upper aerodigestive tract. MRI is sensitive and specific in the diagnosis of schwannoma. And the best treatment of choice is complete excision with preservation of functions.
Treatment of human metastatic colorectal cancer (mCRC) has changed remarkably in the past two decades. The use of novel therapies and more complex treatment strategies have contributed to progressively increase the median life expectancy of patients up to approximately 30 months. Although traditional cytotoxic chemotherapy and newer targeted therapy are now available for use in treating patients with mCRC, the optimal treatment strategy remains unknown. In recent years, there has been a treatment paradigm shift for mCRC patients with the emergence of the concept of ‘continuum of care’ as the optimal palliative therapy strategy. It is based on the concept whereby patients are exposed throughout the course of their disease to different active drugs; the therapy is personalized according to the need for rapid response, the burden of disease and molecular subtype status, such as RAS, BRAF, MMR and HER2. Drugs are often reintroduced if they demonstrated activity in a previous line of therapy, and most importantly, maintenance chemotherapy and/or intermittent therapy are considered. This review details available data for the use of the continuum of care strategy in mCRC, in which the strategy has provided significant clinical benefit in clinical studies. As our understanding advances, optimal treatment strategy for the patients with mCRC should still be individualized.
Background: In an earlier analysis of this cohort study, local therapy based on surgical resection of the primary tumor might confer a survival benefit in women with de novo metastatic breast cancer (dnMBC). Here we report the survival outcomes of locoregional treatment (LRT), focusing on the association of surgical timings and surgical margins with survival in these patients. Methods: The retrospective study included patients with dnMBC in two Chinese tertiary hospitals, between March 1, 2007, and December 31, 2017. Overall survival (OS) was evaluated by means of a stratified log-rank test and summarized with the use of Kaplan–Meier methods. Results: A total of 153 patients were included, of whom 87 underwent LRT and 66 systemic therapy alone (STA). LRT showed a significant OS benefit over STA (HR, 0.47; 95% CI, 0.33 to 0.69; p<.0001). Median OS of LRT group and STA group were 42 months (95% CI, 35.0 to 48.9 months) and 21 months (95% CI, 16.1 to 25.9 months), respectively. The benefit was consistent across most subgroups. The OS of patients undergoing surgery was better than that of patients without surgery (HR, 0.48; 95% CI, 0.33 to 0.70; p=.0001), and there was difference in survival improvement at different surgical timings (surgery before chemotherapy, during chemotherapy and after chemotherapy) (HR, 0.79; 95% CI, 0.65 to 0.95; p=.013). The survival benefit of surgery after chemotherapy was the most, followed by surgery during chemotherapy (Median 56 months, 95% CI, 40.8 to 71.2 months). Moreover, compared with patients with positive margins, the OS of patients with negative margins was significantly improved (HR, 2.35; 95% CI, 1.65 to 3.35; p<.0001), with a median OS of 56 months (95% CI, 45.9 to 66.1 months). Conclusions: Our results suggest that LRT is associated with improved OS in women with dnMBC, and patients who had surgery after or during systemic chemotherapy with negative surgical margins, are expected to benefit more.
e20505 Background: Lung ground-glass opacity (GGO), a hazy increased opacity on computed tomography with preservation of bronchial and vascular margins, has been shown to be associated with early-stage lung cancer. With the increasing prevalence of ground-glass opacity-type lung cancer (GGO-LC), more researches have focused on the diagnosis and treatment of this early stage lung cancer; however, the clinical characteristics and survival outcomes of this disease has not yet been fully elucidated. Aim: To analyze and review the clinicopathological characteristics for GGO-LC and to identify the optimal treatment strategies in this select population. A systematic review and meta-analysis of the literature were carried out. The study was registered (CRD42021228774). Methods: We did a systematic review and meta-analysis of observational studies published from database inception to June 30, 2020, which reported on clinicopathological characteristics, management and survival outcomes in patients with GGO-LC. Studies were identified by searches in PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and by hand searching of previous publications. We extracted the general information to perform the meta-analysis, mainly focusing on age, gender, and smoking status. We also extracted treatment and prognosis information to assess the effect of treatment strategies on overall survival (OS). Robustness of pooled estimates from random-effects models was considered with sensitivity analyses, meta-regression, and subgroup analyses. All statistical analyses were performed with Stata 16.0. Results: Data on 9444 patients in 27 observational studies were included. GGO-type lung cancer was typically characterized as non-invasively or minimally invasively low-grade adenocarcinomas. Therapeutic intervention for these early stage lung cancers was an important opportunity for decreasing overall mortality of lung cancer. The final pooled analysis showed that the average age at diagnosis, female proportion and non-smoking proportion of patients with GGO-LC was 57.7 (95% CI, 53.9-61.5, P < 0.001, I2 = 92.9%), 0.591 (95% CI, 0.563-0.619, P < 0.001, I2 = 86.7%), and 0.631 (95% CI, 0.556-0.706, P < 0.001, I2 = 98.3%), respectively. The pooled overall survival rate was 96.2% (95% CI, 0.954 to 0.970, P < 0.001, I2 = 78.9%). The results showed that the majority of GGO-LC patients had good survival outcomes, presenting a significant proportion of young, female and non-or light smokers. Conclusions: From our analysis, it demonstrates that the patients with GGO-LC may be relatively young females and non-or light smoking history, and had better prognosis. However, there are some limitations in the present study, and more evidence is necessary to wait for more results from RCT to draw a valid conclusion.
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