RFA was used as an adjunct to resection in patients with greater disease burden. Despite this, RFA was not significantly associated with a higher risk of local failure and was not associated with worse survival, when compared with liver resection alone.

To cite this article: Shah MA, Capanu M, Soff G, Asmis T, Kelsen DP. Risk factors for developing a new venous thromboembolism in ambulatory patients with non-hematologic malignancies and impact on survival for gastroesophageal malignancies. J Thromb Haemost 2010; 8: 1702-9.Summary. Background: Venous thromboembolism(VTE) is a significant, common comorbidity of cancer patients associated with increased mortality. We evaluated the incidence and risk factors for developing a new VTE in ambulatory cancer patients while they were receiving therapy for advanced cancer. We also examined the affect of developing a new VTE on survival for patients with gastroesophageal malignancies. Methods: All patients with non-hematologic malignancies who were treated using investigator-initiated therapeutic protocols at Memorial Sloan Kettering Cancer Center (MSKCC) from 2003 through to 2005 were identified for this cohort study. The occurrence of VTE was prospectively recorded in an actively managed clinical research database. Baseline laboratory parameters, treatment details and tumor type were correlated with VTE risk and patient survival. Results: 115 out of 2120 patients being treated for advanced malignancy developed a new VTE (12.8 VTEs/100 person-years). In multivariate analysis, a diagnosis of gastroesophageal cancer (hazard ratio (HR), 2.76 (1.41-5.38); P = 0.003), pancreatic cancer (HR, 2.26 (1.06-4.80); P = 0.05), use of white cell growth factors (HR 1.69(1.09-2.64); P = 0.02) and irinotecan therapy (HR, 1.89 (1.29-3.59); P = 0.05) were independently associated with VTE development. Hemoglobin > 10 g dL )1 (HR, 0.52 (0.3-0.91); P = 0.02) and albumin ‡ 4 g dL )1 (HR, 0.61 (0.39-0.94); P = 0.024) were associated with reduced VTE risk. The unadjusted HR for death among ambulatory gastroesophageal cancer patients with VTE is 0.89 (0.61-1.3), P = 0.53. After adjusting for confounding risk factors associated with survival, the HR for death associated with VTE is 0.78 (0.5-1.2), P = 0.25. Conclusion: Upper gastrointestinal malignancies are independently associated with the development of a new VTE, implicating tumor biology in VTE development. Even after adjusting for prognostic factors, we were unable to demonstrate an adverse impact on survival due to the new development of VTE amongst patients with active gastroesophageal malignancy receiving therapy.

ConclusionsCompared with patients who did not receive chemotherapy, those who received chemotherapy, regardless of timing, experienced improved overall survival and disease-free survival. Use of rfa where required as an adjunct to hepatic resection appears to be effective and is not associated with worse overall survival. KEY WORDSColorectal cancer, hepatic resection, timing of chemotherapy, radiofrequency ablation INTRODUCTIONOf the estimated 23,800 Canadians diagnosed with colorectal cancer (crc) annually, approximately 9200 (40%) will die from their disease, most with distant metastatic spread 1 . When feasible, hepatic resection offers the greatest probability of cure for patients with isolated liver metastases 2 . However, even for those with disease that is largely liver-limited, there are barriers to curative resection such as the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age 3 .The maldistribution of lesions within the liver, making complete excision of all disease impossible without the risk of subsequent liver insufficiency, is one barrier that has received considerable attention. Strategies include serial resection, portal vein embolization, and the adjuvant use of radiofrequency ablation (rfa). The rfa procedure uses heat derived from radiofrequency waves at the end of a probe inserted into a metastasis to induce tumour necrosis. The use of rfa as an adjunct to hepatic resection is gaining acceptance. However, its efficacy in comparison with resection is controversial because of high rates of recurrence at the ablation site in some studies 4 .Despite the increasing opportunity for potentially curative hepatic resection, recurrence in resected patients is the most frequent outcome. Chemotherapy, ABSTRACT BackgroundAlmost 40% of people diagnosed with colorectal cancer will die from their disease, most with metastatic spread. When feasible, hepatic resection offers the greatest probability of cure for isolated liver metastases, but there are barriers to curative resection. Those barriers include the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age. Chemotherapy is often administered before or after resection with the intention of improving disease-free and overall survival. The timing of chemotherapy (adjuvant vs. neoadjuvant vs. perioperative) for patients undergoing potentially curative hepatic resection of metastasis of colorectal cancer origin is controversial. MethodsColorectal cancer patients with liver metastases resected at The Ottawa Hospital between January 1, 2003, and December 31, 2009, were identified, and their clinical records were retrospectively reviewed. Patients receiving intraoperative radiofrequency ablation (rfa) as part of their management were included. Factors associated with overall and diseasefree survival were evaluated. ResultsThe 168 identified patients (57% men, 43% women) had a median age of 63 years (range: 31-84 years). After hepatectomy, 10% had positive resection margi...

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