In-hospital mortality after stomach cancer surgery in Spain and relationship with hospital volume of interventions

<p>Abstract</p> <p>Background</p> <p>There is no consensus about the possible relation between in-hospital mortality in surgery for gastric cancer and the hospital annual volume of interventions. The objectives were to identify factors associated to greater in-hospital mortality for surgery in gastric cancer and to analyze the possible independent relation between hospital annual volume and in-hospital mortality.</p> <p>Methods</p> <p>We performed a retrospective cohort study of all patients discharged after surgery for stomach cancer during 2001–2002 in four regions of Spain using the Minimum Basic Data Set for Hospital Discharges. The overall and specific in-hospital mortality rates were estimated according to patient and hospital characteristics. We adjusted a logistic regression model in order to calculate the in-hospital mortality according to hospital volume.</p> <p>Results</p> <p>There were 3241 discharges in 144 hospitals. In-hospital mortality was 10.3% (95% CI 9.3–11.4). A statistically significant relation was observed among age, type of admission, volume, and mortality, as well as diverse secondary diagnoses or the type of intervention. Hospital annual volume was associated to Charlson score, type of admission, region, length of stay and number of secondary diagnoses registered at discharge. In the adjusted model, increased age and urgent admission were associated to increased in-hospital mortality. Likewise, partial gastrectomy (Billroth I and II) and simple excision of lymphatic structure were associated with a lower probability of in-hospital mortality. No independent association was found between hospital volume and in-hospital mortality</p> <p>Conclusion</p> <p>Despite the limitations of our study, our results corroborate the existence of patient, clinical, and intervention factors associated to greater hospital mortality, although we found no clear association between the volume of cases treated at a centre and hospital mortality.</p

Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer

Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) is recognized to be an accurate, non-invasive imaging modality for the diagnosis and staging of many malignancies, including breast cancer. Studies performed on different cancers have shown that hypermetabolic tumours usually have a poorer prognosis than hypometabolic tumours1. Oshida and colleagues2 have reported that a high uptake of FDG in tumour tissue can serve as a risk factor for recurrence in women with breast cancer. There are various prognostic factors related to breast cancer. Some provide important information that can affect management, such as axillary lymph node status, presence of metastases, and oestrogen and progesterone receptor status. Others such as p53 immunoreactivity are relevant clinically, but are still not used routinely for risk stratification. Most factors can be assessed only after surgery1. Preoperative prediction of patient prognosis is becoming more important because an increasing number of women with breast cancer have neoadjuvant chemotherapy with the aim of downstaging their disease, and increasing the feasibility of breast-conserving surgery. It may also be possible to evaluate the chemosensitivity of the breast tumour; FDG–PET seems to be promising for this purpose3. FDG–PET before surgery may provide important information about tumour metabolism and its proliferation rate which could be of prognostic significance. Calculating FDGuptake bymeans of a simple method, the standardized uptake value (SUV), can be done before surgery, andmight be associated with the biological aggressiveness of breast cancer. The aim of this study was to determine the possible correlation between FDG uptake and well established prognostic markers in women with breast cancer

Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer

Positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) is recognized to be an accurate, non-invasive imaging modality for the diagnosis and staging of many malignancies, including breast cancer. Studies performed on different cancers have shown that hypermetabolic tumours usually have a poorer prognosis than hypometabolic tumours1. Oshida and colleagues2 have reported that a high uptake of FDG in tumour tissue can serve as a risk factor for recurrence in women with breast cancer. There are various prognostic factors related to breast cancer. Some provide important information that can affect management, such as axillary lymph node status, presence of metastases, and oestrogen and progesterone receptor status. Others such as p53 immunoreactivity are relevant clinically, but are still not used routinely for risk stratification. Most factors can be assessed only after surgery1. Preoperative prediction of patient prognosis is becoming more important because an increasing number of women with breast cancer have neoadjuvant chemotherapy with the aim of downstaging their disease, and increasing the feasibility of breast-conserving surgery. It may also be possible to evaluate the chemosensitivity of the breast tumour; FDG–PET seems to be promising for this purpose3. FDG–PET before surgery may provide important information about tumour metabolism and its proliferation rate which could be of prognostic significance. Calculating FDGuptake bymeans of a simple method, the standardized uptake value (SUV), can be done before surgery, andmight be associated with the biological aggressiveness of breast cancer. The aim of this study was to determine the possible correlation between FDG uptake and well established prognostic markers in women with breast cancer