38 research outputs found
The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study
AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease
The international staging system for multiple myeloma is applicable in symptomatic Waldenstrom's macroglobulinemia
Several studies have indicated that age, hemoglobin and serum albumin
are among the most important prognostic factors for survival of patients
with Waldenstrom’s macroglobulinemia (WM). Furthermore, recent data
indicate that serum b2-microglobulin may be also significant. The
recently proposed International Staging System (ISS) for multiple
myeloma is based on serum albumin and b2-microglobulin. We designed a
study to assess this model in patients with WM. Our analysis included 83
previously untreated patients with WM who required systemic treatment
and in whom pretreatment values for both serum albumin and
b2-microglobulin were available. Based on these variables the patients
were stratified into three ISS stages. Stage I: albumin greater than or
equal to3.5 g/dl and b2-microglobulin <3.5 mg/dl, stage II: albumin <3.5
g/dl and b2-microglobulin <3.5 mg/gl or b2-microglobulin 3.5 - 5.5 mg/dl
and stage III: b2-microglobulin >5.5 mg/dl. Low albumin (<3.5 g/dl) and
high b2-microglobulin (>= 3.5 mg/dl) were recorded in 45% and 52% of
patients respectively. The distribution of patients in the three ISS
stages was: stage I: 30%, stage II: 43% and stage III: 27%. The
median overall survival from the date of treatment initiation was 115
months. The median survival according to ISS was not reached for stage
I, 116 months for stage II and 54 months for stage III ( P = 0.02). Our
analysis indicated that the recently proposed ISS for multiple myeloma
could stratify the patients with WM into three distinct subgroups with
significantly different survival times. If this model is validated in
independent series, it could provide a new staging system for WM based
on readily available and reproducible variables
Treatment of Waldenstrom's macroglobulinemia with rituximab: Prognostic factors for response and progression
Recent data have suggested that rituximab is an active agent for the
treatment of Waldenstrom’s macroglobutinemia (WM). However, the patients
that are more likely to benefit have not been clearly defined. In order
to address this question we evaluated 52 patients who were treated with
single-agent rituximab in the context of prospective studies. Several
clinical and laboratory variables were assessed for their correlation
with response and time to progression. Twenty-three (44%) patients
achieved a partial response after treatment with rituximab. Previously
untreated and pretreated patients had the same probability for response.
Higher response rates were noted in patients with serum monoclonal
protein < 40 g/l, with serum albumin >= 35 g/l and with kappa light
chain. The median time to progression for all patients was 13.8 months.
A multivariate analysis indicated that elevated serum monoclonal protein
levels and low serum albumin were the dominant variables associated with
shorter progression. Presence of two, one or none of these adverse
prognostic factors was associated with time to progression of 3.6
months, 11 months and more than 40 months, respectively. We conclude
that rituximab is an effective treatment modality for patients with WM.
Patients with both low levels of monoclonal protein and normal albumin
are the best candidates for treatment with standard dose rituximab