Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

Background: The aim of this study is to evaluate the prognostic factors at medical ICU admittance predicting intensive care unit (ICU) mortality in cancer patients.Methods: Retrospectively data of adult patients admitted to medical ICU of a 1200-bed university hospital during January 2012-December 2013 interval were analysed. The patients were divided into three groups; patients with solid tumor, patients with hematologic malignancy and patients without cancer. The study end point was ICU mortality.Results: 512 patients were identified; 374 patients without cancer, 89 patients with solid tumor and 49 patients with hematologic malignancy. Overall mortality rate in intensive care unit was 46% (n=236). The ICU mortality rate of patients with hematologic malignancy was significantly higher than patients with solid tumors (68.6% vs 53%; p<0.001) and patients without cancer (68.6% vs 39.8%; p<0.001). Logistic regression analysis showed high APACHE II score and the requirement for invasive mechanical ventilation (odds ratio [OR], 5.52; 95% confidence interval [CI], 2.10-14.53; p<0.001) at the time of intensive care unit admittance as independent risk factors for increased mortality. In addition, the requirement of renal replacement therapy(OR, 2.34; [CI: 1.44-3.80]; p<0.002) and vasopressors(OR, 1.67; [CI: 1.10-2.54]; p<0.02)  at the time of intensive care unit admittance were detected as independent risk factors for increased mortality in cancer free group.Conclusions: In critically ill cancer patients; high APACHE II score and the requirement of invasive mechanical ventilation should be evaluated at the time of intensive care unit admittance, for these are strong predictors of increased mortality

The impact of adjuvant oxaliplatin and tumor sidedness on the overall survival of stage IIB colon cancer patients: A multicentre study

The aim of this multicentre retrospective study was to compare the efficacy of adjuvant chemotherapy regimens both with and without oxaliplatin and tumor sidedness in stage IIB (pT4aN0) colon cancer patients. This study included patients with stage IIB colon cancer who underwent curative surgery and received adjuvant chemotherapy. The patients were divided into two groups (one with and one without oxaliplatin) to compare the overall survival (OS) in right- and left-sided tumors. The study population included 298 patients with stage IIB colon cancer (median age: 57) of whom 69.1% were male. Forty-four per cent of these patients (n = 131) were diagnosed with right-sided colon cancer. The median follow-up duration was 35.9 months. In the entire population, a median OS was not reached, and the five-year OS was 83%. The median disease-free survival (DFS) was 12 months. There was no significant difference in terms of the five-year OS between right- (82%) and left-sided (84%) colon tumors (p = 0.67). In addition, the five-year OS of patients treated with and without oxaliplatin were 76% and 89%, respectively, and there was no statistically significant difference (p = 0.23). The five-year OS of the patients treated with and without oxaliplatin were 83% and 96.5%, respectively, (p = 0.8) in right-sided colon tumors, while it was 75% and 93% (p = 0.06), respectively, in left-sided colon tumors. Tumor sidedness and the addition of oxaliplatin to adjuvant chemotherapy were not found to be associated with the OS in stage IIB colon cancer patients in our study. Further large prospective studies that also include MSI, RAS and BRAF status data are warranted in colon cancer patients

Nivolumab in metastatic renal cell carcinoma: results from the Turkish Oncology Group Kidney Cancer Consortium database

Lay abstract Nivolumab is an immune checkpoint inhibitor (ICI) that blocks the communication between T cells and cancer cells and instead activates T cells to fight against cancer. Metastatic renal cell carcinoma (mRCC) is one of the most susceptible tumors to ICIs. The Checkmate 025 trial showed the efficacy of nivolumab in patients with previously treated mRCC. In this real-world study, 173 patients with mRCC were treated with nivolumab in the second line and beyond. Nivolumab was effective in the real-world setting without additional safety concerns. Aim: The authors present real-world data on the efficacy and safety of nivolumab in patients with metastatic renal cell carcinoma (mRCC). Methods: The Turkish Oncology Group Kidney Cancer Consortium (TKCC) database includes patients with mRCC from 13 cancer centers in Turkey. Patients with mRCC treated with nivolumab in the second line and beyond were extracted from the TKCC database. Results: A total of 173 patients were included. The rates of patients treated with nivolumab in the second, third, fourth and fifth lines were 47.4%, 32.4%, 14.5% and 5.7%, respectively. The median overall survival and progression-free survival were 24.2 months and 9.6 months, respectively. Nivolumab was discontinued owing to adverse events in 11 (6.4%) patients. Conclusion: Nivolumab was effective in patients with mRCC and no new safety signal was observed

Prognostic value of pet/ct determined sarcopenia inpatients with resected ampullary carcinoma

Objectives: Our aim is to investigate the prognostic value and effect on chemotherapy toxicity of pre-treatment sarcopenia determined with positron emission tomography/computerized tomography(PET/CT) in patients with ampullary carcinoma. Methods: Characteristics of patients retrieved retrospectively. Skeletal muscle area(SMA) measurement of the muscle at L3 vertebra level was evaluated for each patient from their PET/CT scan taken at the time of diagnosis. The sex-specific cut-off levels for determining sarcopenia were <38.5 cm2/m2 for females and <52.4 cm2/m2 for males. Association between oncological and radiological data was analyzed. Results: A total of 90 patients included in the study. Median age at diagnosis was 62(range: 44-77). Half of the patients were sarcopenic. Pre-treatment sarcopenia was determined as an independent variable predicting survival for both disease-free-survival(DFS) and overall survival(OS). Sarcopenic patients had statistically significant shorter OS(67.2 months for non-sarcopenic patients vs 53.2 months for sarcopenic patients, 95%CI:63.6-70.9, p<0.001), and a trend for shorter DFS(48 months for non-sarcopenic patients vs 36.8 months for sarcopenic patients, 95%CI:20.3-53.4, p=0.95) was also determined. On the other hand, chemotherapy related toxicity has also seen more in sarcopenic patients. Conclusion: Detecting the presence of pre-treatment sarcopenia may enable clinicians to predict the patient group with low survival and high probability of treatment toxicity. In order to protect this group of patients from toxicity, pretreatment sarcopenia measurement should be applied in routine practice and should guide treatment plan

Impact of factors at admittance predicting intensive care unit mortality in critically ill cancer patients

Background: The aim of this study is to evaluate the prognostic factors at medical ICU admittance predicting intensive care unit (ICU) mortality in cancer patients.Methods: Retrospectively data of adult patients admitted to medical ICU of a 1200-bed university hospital during January 2012-December 2013 interval were analysed. The patients were divided into three groups; patients with solid tumor, patients with hematologic malignancy and patients without cancer. The study end point was ICU mortality.Results: 512 patients were identified; 374 patients without cancer, 89 patients with solid tumor and 49 patients with hematologic malignancy. Overall mortality rate in intensive care unit was 46% (n=236). The ICU mortality rate of patients with hematologic malignancy was significantly higher than patients with solid tumors (68.6% vs 53%; p&lt;0.001) and patients without cancer (68.6% vs 39.8%; p&lt;0.001). Logistic regression analysis showed high APACHE II score and the requirement for invasive mechanical ventilation (odds ratio [OR], 5.52; 95% confidence interval [CI], 2.10-14.53; p&lt;0.001) at the time of intensive care unit admittance as independent risk factors for increased mortality. In addition, the requirement of renal replacement therapy(OR, 2.34; [CI: 1.44-3.80]; p&lt;0.002) and vasopressors(OR, 1.67; [CI: 1.10-2.54]; p&lt;0.02)  at the time of intensive care unit admittance were detected as independent risk factors for increased mortality in cancer free group.Conclusions: In critically ill cancer patients; high APACHE II score and the requirement of invasive mechanical ventilation should be evaluated at the time of intensive care unit admittance, for these are strong predictors of increased mortality

A rare case of primary rectal choriocarcinoma and review of the literature

Introduction Primary choriocarcinoma of the colon is an extremely rare neoplasm which has a poor prognosis. Only 18 cases have been previously reported in English medical literature. Here we present a case of primary rectal choriocarcinoma with a good response to chemotherapy and review the literature on this uncommon tumor. Case report A 36-year-old woman presented with abdominal pain and vaginal bleeding. Abdominal magnetic resonance imaging revealed 6.9 x 5.3 x 6.4 cm hypervascular mass posterior to uterus very close to rectum. Beta-human chorionic gonadotropin (beta-hCG) level was markedly elevated. Low anterior resection of the rectum with lymph node dissection and total abdominal hysterectomy with bilateral salpingo-oophorectomy were performed. Pathologic diagnosis was reported as colonic choriocarcinoma with a focal component of adenocarcinoma. Post-operative magnetic resonance imaging detected multiple metastatic lesions throughout the liver. The patient was treated with systemic chemotherapy using bleomycin, etoposide and cisplatin (BEP protocol). After three cycles, beta-hCG level decreased to normal and magnetic resonance imaging showed regression of liver metastasis. However, the patient died of respiratory failure due to bleomycin toxicity and pneumonia accompanied by rapid disease progression. Discussion This is an extremely rare case of primary rectal choriocarcinoma. Due to poor prognosis of the disease, it seems very important to start prompt treatment to improve patient's survival

Acute vitreomacular traction syndrome after uneventful phacoemulsification

We prospectively evaluated 59 eyes following uneventful phacoemulsification and intraocular lens implantation with optic coherence tomography at one and seven postoperative days (POD). Acute vitreomacular traction was observed in two eyes (3.3%) at the first POD. Spontaneous resolution occurred in both eyes within one week. The temporary visual loss associated with acute vitreomacular traction syndrome may go unnoticed as visual acuity rapidly improves

Predictive value of 18F-FDG PET/CT indices on extensive residual cancer burden in breast cancer patients treated with neoadjuvant chemotherapy [Valor predictivo de los índices 18F-FDG PET/TC sobre la carga tumoral residual en pacientes con cáncer de mama extenso tratadas con quimioterapia neoadyuvante]

Aim: We investigated the correlation between 18F-FDG PET/CT indices and pathological response in breast cancer treated with neoadjuvant chemotherapy (NACT) which was scored with Residual Cancer Burden (RCB) system after surgery. Our aim is to detect extensive residual cancer burden earlier by using PET/CT indices. Methods: Characteristics of patients were retrieved retrospectively. Baseline maximum Standart Uptake Value (SUVmax), Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) indices and reduction rate (RR) between baseline and interim evaluation were calculated with FDG PET/CT scan. All patients were evaluated according to RCB scores after surgery. Pathological responses and PET/CT measurement results were analyzed with demographic and clinical parameters. Results: A total of 95 patients were included in the study. According to pathological responses, the distribution of RCB-0, -1, -2, -3 were 13 (13.7%), 11 (11.6%), 30 (31.6%), 41 (43.2%), respectively. Disease-free survival was significantly lower in the RCB-3 group compared to the pathological responder group (P=.01). According to multivariate analysis, RR of SUVmax was determined as an independent variable predicting extensive residual cancer burden with an optimal cut-off value of 86% (P&lt;.05). Conclusions: We determined RR of SUVmax as an independent factor for predicting extensive residual tumor burden. We believe that RR of SUVmax is sufficient to predict pathological response in daily practice. In addition, MTV and TLG measurements do not contribute additionally to SUVmax alone and can cause unnecessary labor loss. © 202

Impact of the Charlson Comorbidity Index on dose-limiting toxicity and survival in locally advanced and metastatic renal cell carcinoma patients treated with first-line sunitinib or pazopanib

Background Anti-angiogenic tyrosine kinase inhibitors, sunitinib and pazopanib, have proven efficacy in advanced renal cell carcinoma, with specific adverse events occurring during treatment process. Comorbidities can reflect functional status and have prognostic value in oncology patients. We aimed to assess the association of the Charlson Comorbidity Index with severe toxicities and mortality in renal cell carcinoma cases treated with front-line sunitinib or pazopanib. Methods Files of locally advanced and metastatic renal cell carcinoma patients who received first-line sunitinib or pazopanib were retrospectively examined. Charlson Comorbidity Index of each patient was calculated. Patients were also stratified into Memorial Sloan-Kettering Cancer Center risk groups. Predictors of dose-limiting toxicity were evaluated with binomial logistic regression analysis. Univariate and multivariate Cox regression models were utilized to determine prognostic factors for survival. Results The study included 102 patients, 64 were treated with first-line sunitinib and 38 with pazopanib. In 42 patients (41.9%), Charlson Comorbidity Index was 9 or more. Dose-limiting toxicities were significantly more frequent in Charlson Comorbidity Index >= 9 group (69% vs. 40%, p = 0.004), and Charlson Comorbidity Index independently predicted dose-limiting toxicity (Hazard ratio (HR) = 4.30, p = 0.002). After adjusting for other variables, a Charlson Comorbidity Index of >= 9 is also a significant prognostic factor for progression-free (HR = 1.76, p = 0.02) and overall survival (HR = 1.75, p = 0.03). Conclusions Charlson Comorbidity Index may be a valuable method to estimate prognosis and optimize therapy in patients with advanced renal cell carcinoma receiving first-line sunitinib or pazopanib