Progression of coronary artery calcification and thoracic aorta calcification in kidney transplant recipients

BACKGROUND: Vascular calcification independently predicts cardiovascular disease, the major cause of death in kidney transplant recipients (KTRs). Longitudinal studies of vascular calcification in KTRs are few and small and have short follow-up. We assessed the evolution of coronary artery (CAC) and thoracic aorta calcification and their determinants in a cohort of prevalent KTRs. STUDY DESIGN: Longitudinal. SETTING & PARTICIPANTS: The Agatston score of coronary arteries and thoracic aorta was measured by 16-slice spiral computed tomography in 281 KTRs. PREDICTORS: Demographic, clinical, and biochemical parameters were recorded simultaneously. OUTCOMES & MEASUREMENTS: The Agatston score was measured again 3.5 or more years later. RESULTS: Repeated analyzable computed tomographic scans were available for 197 (70%) KTRs after 4.40 ± 0.28 years; they were not available for the rest of patients because of death (n = 40), atrial fibrillation (n = 1), other arrhythmias (n = 4), refusal (n = 35), or technical problems precluding confident calcium scoring (n = 4). CAC and aorta calcification scores increased significantly (by a median of 11% and 4% per year, respectively) during follow-up. By multivariable linear regression, higher baseline CAC score, history of cardiovascular event, use of a statin, and lower 25-hydroxyvitamin D(3) level were independent determinants of CAC progression. Independent determinants of aorta calcification progression were higher baseline aorta calcification score, higher pulse pressure, use of a statin, older age, higher serum phosphate level, use of aspirin, and male sex. Significant regression of CAC or aorta calcification was not observed in this cohort. LIMITATIONS: Cohort of prevalent KTRs with potential survival bias; few patients with diabetes and nonwhites, limiting the generalizability of results. CONCLUSION: In contrast to previous small short-term studies, we show that vascular calcification progression is substantial within 4 years in prevalent KTRs and is associated with several traditional and nontraditional cardiovascular risk factors, some of which are modifiable

Peritoneal carcinomatosis and prostatic cancer: a rare manifestation of the disease with an impact on management

As it has been recently noted in two papers published in the JBRTBR (1, 2), prostate cancer is the second cause of male-cancer related death. The role of radiologists is crucial at the early stage of the disease, for local and distant staging, and during the follow up of the patient. We would like to take the opportunity to report on an uncommon case of peritoneal carcinomatosis observed during the long term follow up of a patient having prostate cancer. Based on these findings, there was a need for change of therapy, with a positive impact on the outcome

Long term oncological results and quality of life after HIPEC for carcinomatosis of colorectal origin

Introduction : Peritoneal carcinomatosis (PC) of colorectal origin remains the most advanced form of colorectal cancer and is still associated with poor outcome. Cytoreducive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) has deeply modified patients’ prognosis. Aim : This study aims to review our results of CRS and HIPEC based on Oxaliplatin and using a closed abdomen technique as treatment of peritonela carcinomatosis of colorectal origin. Beside oncologic outcome, this study examines the long term quality of life (QoL) of patients treated by CRS and HIPEC. Methods : This is a retrospective monocentric study based on consecutive patients presenting colorectal cancer with perioneal carcinomatosis and treated by CRS and HIPEC. Demographic, operative, post-operative and pathological data have been collected. Long term oncological results have been computed and quality of life has been evaluated using the EORTC QLQ C-30 and GIQLI questionnaires. Results : Between October 2007 and December 2015, 82 patients have undergone 92 HIPEC, of which 70 patients underwent 75 CS with Oxaliplatin HIPEC using a closed abdomen technique. Among the 38 patients alive at the time of the study, 34 had not benefited from a redo-HIPEC after December 31, 2015.Of the 82 patients operated between October 2007 and December 2015, 10 (10.9%) received prophylactic HIPEC. There were 44 women and 38 men with a median age of 60 (18-77). Twenty-one patients (32.6%) had synchronous resecable liver metastases. The median level of carcinoembryonic antigen was 2,7 ng / mL. The CC-0 and CC-1 resection scores were obtained for 75 (87.2%) and 10 (11.6%) procedures, respectively. The median index of peritoneal carcinomatosis (PCI) was 6 (0 to 30). Twenty-two patients (23.9%) had a Dindo-Clavien complication> 2 and the postoperative mortality was 1,6%. The median follow-up time is 35 months. Twenty-seven patients (29.3%) received neoadjuvant chemotherapy and 48 (53.3%) received adjuvant chemotherapy. Twelve patients (13.0%) had isolated recurrence of CP and 35 patients (38.0%) presented distant metastases. Overall survival (OS) and 5-year survival without recurrence (DFS) were 45.7% and 8.7%, respectively. The deterioration of the quality of life in the long term is related to the presence of an invasion and to the occurrence of distal recurrences. The EORTC and GIQLI questionnaires showed a high incidence and intensity of diarrhea. Conclusions : HIPEC with Oxaliplatin using a closed abdomen technique to treat CP of colorectal origin offers acceptable oncological results. This treatment strategy should therefore be considered for all patients with peritoneal carcinomatosis, while ensuring that patients live not only longer but also enjoy a good quality of life

Lymph node ratio and surgical quality are strong prognostic factors of rectal cancer: results from a single referral centre.

AIM: Nodal stage is a strong prognostic factor of oncological outcome of rectal cancer. To compensate for the variation in total number of harvested nodes, calculation of the lymph node ratio (LNR) has been advocated. The aim of the study was to compare the impact, on the long-term oncological outcome, of the LNR with other predictive factors, including the quality of total mesorectal excision (TME) and the state of the circumferential resection margin. METHOD: Consecutive patients having elective surgery for nonmetastatic rectal cancer were extracted from a prospectively maintained database. Retrospective uni- and multivariate analyses were performed based on patient-, surgical- and tumour-related factors. The prognostic value of the LNR on overall survival (OS) and on overall recurrence-free survival (ORFS) was assessed and a cut-off value was determined. RESULTS: From 1998 to 2013, out of 456 patients, 357 with nonmetastatic disease were operated on for rectal cancer. Neoadjuvant radiochemotherapy was administered to 66.7% of the patients. The mean number of lymph nodes retrieved was 12.8 ± 8.78 per surgical specimen. A lower lymph node yield was obtained in patients who received neoadjuvant chemoradiotherapy (11.8 vs 14.2; P = 0.014). The 5-year ORFS was 71.8% and the 5-year OS was 80.1%. Multivariate analysis confirmed LNR, the quality of TME and age to be independent prognostic factors of OS. LNR, age and perineural infiltration were independently associated with ORFS. Low- and high-risk patients could be discriminated using an LNR cut-off value of 0.2. CONCLUSION: LNR is an independent prognostic factor of OS and ORFS. In line with the principles of optimal surgical management, the quality of TME and lymph node yield are essential technical requirements