5 research outputs found
Early outcome of a 31-gene expression profile test in 86 AJCC stage IB-II melanoma patients. A prospective multicentre cohort study
Background: The clinical and pathological features of primary melanoma are not sufficiently sensitive to accurately predict which patients are at a greater risk of relapse. Recently, a 31-gene expression profile (DecisionDx-Melanoma) test has shown promising results.
Objectives: To evaluate the early prognostic performance of a genetic signature in a multicentre prospectively evaluated cohort.
Methods: Inclusion of patients with AJCC stages IB and II conducted between April 2015 and December 2016. All patients were followed up prospectively to assess their risk of relapse. Prognostic performance of this test was evaluated individually and later combined with the AJCC staging system. Prognostic accuracy of disease-free survival was determined using Kaplan-Meier curves and Cox regression analysis. Results of the gene expression profile test were designated as Class 1 (low risk) and Class 2 (high risk).
Results: Median follow-up time was 26 months (IQR 22-30). The gene expression profile test was performed with 86 patients; seven had developed metastasis (8.1%) and all of them were in the Class 2 group, representing 21.2% of this group. Gene expression profile was an independent prognostic factor for relapse as indicated by multivariate Cox regression analysis, adjusted for AJCC stages and age.
Conclusions: This prospective multicentre cohort study, performed in a Spanish Caucasian cohort, shows that this 31-gene expression profile test could correctly identify patients at early AJCC stages who are at greater risk of relapse. We believe that gene expression profile in combination with the AJCC staging system could well improve the detection of patients who need intensive surveillance and optimize follow-up strategies
Early outcome of a 31-gene expression profile test in 86 AJCC stage IB-II melanoma patients. A prospective multicentre cohort study
Background: The clinical and pathological features of primary melanoma are not sufficiently sensitive to accurately predict which patients are at a greater risk of relapse. Recently, a 31-gene expression profile (DecisionDx-Melanoma) test has shown promising results.
Objectives: To evaluate the early prognostic performance of a genetic signature in a multicentre prospectively evaluated cohort.
Methods: Inclusion of patients with AJCC stages IB and II conducted between April 2015 and December 2016. All patients were followed up prospectively to assess their risk of relapse. Prognostic performance of this test was evaluated individually and later combined with the AJCC staging system. Prognostic accuracy of disease-free survival was determined using Kaplan-Meier curves and Cox regression analysis. Results of the gene expression profile test were designated as Class 1 (low risk) and Class 2 (high risk).
Results: Median follow-up time was 26 months (IQR 22-30). The gene expression profile test was performed with 86 patients; seven had developed metastasis (8.1%) and all of them were in the Class 2 group, representing 21.2% of this group. Gene expression profile was an independent prognostic factor for relapse as indicated by multivariate Cox regression analysis, adjusted for AJCC stages and age.
Conclusions: This prospective multicentre cohort study, performed in a Spanish Caucasian cohort, shows that this 31-gene expression profile test could correctly identify patients at early AJCC stages who are at greater risk of relapse. We believe that gene expression profile in combination with the AJCC staging system could well improve the detection of patients who need intensive surveillance and optimize follow-up strategies
Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit
Aim The anastomosis technique used following right-sided colonic
resection is widely variable and may affect patient outcome. This study
aimed to assess the association between leak and anastomosis technique
(stapled vs handsewn).
Method This was a prospective, multicentre, international audit
including patients undergoing elective or emergency right hemicolectomy
or ileo-caecal resection operations over a 2-month period in early 2015.
The primary outcome measure was the presence of anastomotic leak within
30 days of surgery, determined using a prespecified definition. Mixed
effects logistic regression models were used to assess the association
between leak and anastomosis method, adjusting for patient, disease and
operative cofactors, with centre included as a random-effect variable.
Results This study included 3208 patients, of whom 78.4\% (n = 2515)
underwent surgery for malignancy and 11.7\% (n = 375) underwent surgery
for Crohn's disease. An anastomosis was performed in 94.8\% (n = 3041)
of patients, which was handsewn in 38.9\% (n = 1183) and stapled in
61.1\% (n = 1858). Patients undergoing hand-sewn anastomosis were more
likely to be emergency admissions (20.5\% handsewn vs 12.9\% stapled)
and to undergo open surgery (54.7\% handsewn vs 36.6\% stapled). The
overall anastomotic leak rate was 8.1\% (245/3041), which was similar
following handsewn (7.4\%) and stapled (8.5\%) techniques (P = 0.3).
After adjustment for cofactors, the odds of a leak were higher for
stapled anastomosis (adjusted OR = 1.43; 95\% CI: 1.04-1.95; P = 0.03).
Conclusion Despite being used in lower-risk patients, stapled
anastomosis was associated with an increased anastomotic leak rate in
this observational study. Further research is needed to define patient
groups in whom a stapled anastomosis is safe