Colorectal cancer in the young: a possible role for immune surveillance?

Background: Younger patients with colorectal cancer (CRC) generally have better survival in spite of worse clinical and pathological features. Methods: Twenty-six patients under 50 years operated for primary CRC were enrolled and matched 1:2:2 according to stage, tumor site and gender with 52 patients from 50 to 70 years and 52 patients over 70 years old. Results: Patients under 50 years had a significantly longer overall, cancer specific and disease free survival (p\u2009=\u2009.001, p\u2009=\u2009.007 and p\u2009=\u2009.05, respectively). However, they had more frequently lymphovascular invasion (p\u2009=\u2009.006) and they more frequently developed metachronous CRC at follow-up (p\u2009=\u2009.03). Nevertheless, preoperative lymphocytes blood count/white blood count (LBC/WBC) ratio inversely correlated with age at operation (rho\u2009=\u2009 12.21, p\u2009=\u2009.04) and it predicted CRC recurrence with an accuracy of 70%, p\u2009<\u2009.001 (threshold value LBC/WBC =\u20090.21%) and better overall, cancer specific and disease free survival (p\u2009<\u2009.0001 for all). At multivariate analysis, stage and LBC/WBC ratio resulted independent predictors of disease free survival (p\u2009=\u2009.0001 and p\u2009=\u2009.01, respectively). Conclusions: Patients under 50 years had a significantly longer survival with a higher LBC/WBC ratio. These results could suggest a possible role of immunosurveillance in neoplastic control. \ua9 2017 The Royal Belgian Society for Surger

Sex-Related Differences and Factors Associated with Peri-Procedural and 1 Year Mortality in Chronic Limb-Threatening Ischemia Patients from the CLIMATE Italian Registry

Background: Identifying sex-related differences/variables associated with 30 day/1 year mortality in patients with chronic limb-threatening ischemia (CLTI). Methods: Multicenter/retrospective/observational study. A database was sent to all the Italian vascular surgeries to collect all the patients operated on for CLTI in 2019. Acute lower-limb ischemia and neuropathic-diabetic foot are not included. Follow-up: One year. Data on demographics/comorbidities, treatments/outcomes, and 30 day/1 year mortality were investigated. Results: Information on 2399 cases (69.8% men) from 36/143 (25.2%) centers. Median (IQR) age: 73 (66-80) and 79 (71-85) years for men/women, respectively (p &lt; 0.0001). Women were more likely to be over 75 (63.2% vs. 40.1%, p = 0.0001). More men smokers (73.7% vs. 42.2%, p &lt; 0.0001), are on hemodialysis (10.1% vs. 6.7%, p = 0.006), affected by diabetes (61.9% vs. 52.8%, p &lt; 0.0001), dyslipidemia (69.3% vs. 61.3%, p &lt; 0.0001), hypertension (91.8% vs. 88.5%, p = 0.011), coronaropathy (43.9% vs. 29.4%, p &lt; 0.0001), bronchopneumopathy (37.1% vs. 25.6%, p &lt; 0.0001), underwent more open/hybrid surgeries (37.9% vs. 28.8%, p &lt; 0.0001), and minor amputations (22% vs. 13.7%, p &lt; 0.0001). More women underwent endovascular revascularizations (61.6% vs. 55.2%, p = 0.004), major amputations (9.6% vs. 6.9%, p = 0.024), and obtained limb-salvage if with limited gangrene (50.8% vs. 44.9%, p = 0.017). Age &gt; 75 (HR = 3.63, p = 0.003) is associated with 30 day mortality. Age &gt; 75 (HR = 2.14, p &lt; 0.0001), nephropathy (HR = 1.54, p &lt; 0.0001), coronaropathy (HR = 1.26, p = 0.036), and infection/necrosis of the foot (dry, HR = 1.42, p = 0.040; wet, HR = 2.04, p &lt; 0.0001) are associated with 1 year mortality. No sex-linked difference in mortality statistics. Conclusion: Women exhibit fewer comorbidities but are struck by CLTI when over 75, a factor associated with short- and mid-term mortality, explaining why mortality does not statistically differ between the sexes