Obstruction predicts worse long-term outcomes in stage III colon cancer: A secondary analysis of the N0147 trial.

Abstract:

BACKGROUND:Patients with colon cancer often present with obstruction. Large series have reported obstruction among the high-risk features, yet prospective data on its specific prognostic influence are lacking. We hypothesized that obstruction is an independent risk factor for poor prognosis in patients with stage III colon cancer. METHODS:N0147 was a trial conducted between 2004 and 2009 that randomly assigned patients with stage III colon cancer to adjuvant regimens of folinic acid (leucovorin calcium), fluorouracil, and oxaliplatin or fluorouracil, leucovorin, and irinotecan, with or without cetuximab. Patient-level data from the control chemotherapy-only arms were obtained. Patient, tumor, and treatment characteristics were abstracted. Disease-free survival and overall survival were estimated by the Kaplan-Meier method. Proportions were compared by χ2 and Fisher exact tests. Univariable and multivariable survival analyses were performed using Cox proportional hazards models. RESULTS:Of 1,543 patients with stage III colon cancer, 250 (16.2%) presented with obstruction. Patients with obstruction were equally likely to complete 12 cycles of adjuvant chemotherapy (75.9% vs 77.1%, P = .6). With median follow-up time of 30.9 months among survivors, five-year overall survival and disease-free survival were worse among patients with obstruction (overall survival 67.7% vs 78.0%, P < .001; disease-free survival 53.9% vs 67.0%, P < .0001). On multivariable analysis, obstruction remained significantly associated with worse survival after adjusting for T stage, N stage, performance status, age, sex, histologic grade, and body mass index (overall survival hazard ratio 1.57, 95% confidence interval 1.12-2.20, P = .001; disease-free survival 1.52, 95% confidence interval 1.18-1.95, P < .001). CONCLUSION:In this prospectively followed cohort of patients with stage III colon cancer treated with adjuvant chemotherapy, obstruction was associated with recurrence and worse survival. Moreover, this effect was independent of T and N stage and histologic grade. These results suggest that obstruction should be incorporated into novel risk-stratification models.

journal_name

Surgery

journal_title

Surgery

authors

Dahdaleh FS,Sherman SK,Poli EC,Vigneswaran J,Polite BN,Sharma MR,Catenacci DV,Maron SB,Turaga KK

doi

10.1016/j.surg.2018.06.044

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

1223-1229

issue

6

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(18)30391-X

journal_volume

164

pub_type

杂志文章,随机对照试验

相关文献

SURGERY文献大全
  • Plasma amino acid patterns in experimental acute hepatic failure: comparison between hepatectomy and liver devascularization in pigs.

    abstract::To clarify the physiopathologic mechanism leading to a marked increase in aromatic amino acids (AAA) in acute hepatic failure (AHF), we compared two experimental models of AHF. Ten pigs were submitted to one-stage hepatic devascularization (group A); in eight other pigs total hepatectomy was performed (group B). The a...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Mazziotti A,Bernardi M,Antonini L,Dioguardi FS,Bellusci R,Papa V,Tacconi C,Gasbarrini G,Cavallari A,Possati L

    更新日期:1981-09-01 00:00:00

  • Influence of failed vascular bypass procedures on conversion of below-knee to above-knee amputation levels.

    abstract::From 1975 to 1980, 79 major limb amputations were performed from a group of 552 lower extremity vascular reconstructions with glutaraldehyde-stabilized umbilical vein grafts. All amputations were performed in instances in which limb salvage had been the indication for the attempted bypass (n = 520)--an incidence of 15...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Dardik H,Kahn M,Dardik I,Sussman B,Ibrahim IM

    更新日期:1982-01-01 00:00:00

  • Impact of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) on growth of colorectal liver metastases.

    abstract:BACKGROUND:Associating liver partition and portal vein ligation for staged hepatectomy induces an unprecedented liver hypertrophy and enables resection of otherwise unresectable liver tumors. The effect of associating liver partition and portal vein ligation for staged hepatectomy on tumor proliferation, however, remai...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2017.10.036

    authors: Kambakamba P,Linecker M,Schneider M,Reiner CS,Nguyen-Kim TDL,Limani P,Romic I,Figueras J,Petrowsky H,Clavien PA,Lesurtel M

    更新日期:2018-02-01 00:00:00

  • Motor function of the esophagus after repair of esophageal atresia and tracheoesophageal fistula.

    abstract::Eleven patients with previous esophageal atresia repair (TEF) underwent esophageal motility studies and were compared to 10 normal patients. The upper sphincters (UES) in the two groups did not differ in resting pressure, contraction pressure, or coordination. UES relaxation, was 100% in normal patients and 83+/-8% in...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Duranceau A,Fisher SR,Flye M,Jones RS,Postlethwait RW,Sealy WC

    更新日期:1977-07-01 00:00:00

  • Renal transplantation following previous heart, liver, and lung transplantation: an 8-year single-center experience.

    abstract:BACKGROUND:Long-term follow-up of heart, liver, and lung transplantation has led to an increased recognition of secondary end-stage renal failure (ESRF) in transplant recipients. This study examines our center's experience with renal transplantation following previous solid organ transplantation. METHODS:From January ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1067/msy.2001.115834

    authors: Coopersmith CM,Brennan DC,Miller B,Wang C,Hmiel P,Shenoy S,Ramachandran V,Jendrisak MD,Ceriotti CS,Mohanakumar T,Lowell JA

    更新日期:2001-09-01 00:00:00

  • Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis.

    abstract::The optimal stimulus which produced the maximum increase in blood velocity in the femoral vein during compression of the lower limb with a sequential compression device (six chambers) was determined using Doppler ultrasound in 10 normal limbs. Pressures of 35, 30, and 20 mm Hg at the ankle, calf, and thigh, respective...

    journal_title:Surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Nicolaides AN,Fernandes e Fernandes J,Pollock AV

    更新日期:1980-01-01 00:00:00

  • Nitric oxide regulates insulin secretion in the isolated perfused human pancreas via a cholinergic mechanism.

    abstract:BACKGROUND:The purpose of this study was to determine whether nitric oxide regulates insulin secretion in the isolated perfused human pancreas. METHODS:Single-pass perfusion was performed in four pancreata with a modified Krebs medium. Sequential 10-minute infusions (separated by 10-minute basal periods) of (1) 25 nmo...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/s0039-6060(96)80305-9

    authors: Atiya A,Cohen G,Ignarro L,Brunicardi FC

    更新日期:1996-08-01 00:00:00

  • Effects of steroid withdrawal on long-term renal allograft recipients with posttransplantation diabetes mellitus.

    abstract:BACKGROUND:Posttransplantation diabetes mellitus (PTDM), a common complication of current immunosuppressive regimens, has been attributed to the diabetogenic effects of prednisone and cyclosporine. We report our experience with steroid withdrawal (SW) in renal allograft recipients with PTDM. METHODS:SW was attempted o...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Fabrega AJ,Cohan J,Meslar P,Pollak R

    更新日期:1994-10-01 00:00:00

  • Evaluating cumulative and annual surgeon volume in laparoscopic cholecystectomy.

    abstract:BACKGROUND:Although there is a large body of published data demonstrating improved outcomes for complex operations when performed by high-volume surgeons at high-volume hospitals, the literature is mixed regarding whether this same relationship applies in less complex and more common surgeries such as laparoscopic chol...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2016.08.027

    authors: Abelson JS,Spiegel JD,Afaneh C,Mao J,Sedrakyan A,Yeo HL

    更新日期:2017-03-01 00:00:00

  • Quantitative photoplethysmography in chronic venous insufficiency: a new method of noninvasive estimation of ambulatory venous pressure.

    abstract::We estimated ambulatory venous pressure (AVP) noninvasively with a new technique of quantitative photoplethysmography (PPG). Postural changes of hydrostatic pressure permitted in vivo calibration of the PPG. We recorded quantitative PPG and AVP in 14 normal subjects and 14 patients with postthrombotic chronic venous i...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Norris CS,Beyrau A,Barnes RW

    更新日期:1983-11-01 00:00:00

  • Intrahepatic portosystemic vascular stents: a bridge to hepatic transplantation.

    abstract::Refractory esophageal variceal hemorrhage (EVH) remains a formidable problem in patients awaiting liver transplantations. Transjugular intrahepatic portosystemic shunts (TIPS) have provided an alternative approach for managing EVH that may obviate the need for portosystemic shunt surgery. Experience with TIPS placemen...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Woodle ES,Darcy M,White HM,Perdrizet GA,Vesely TM,Picus D,Hicks M,So SK,Jendrisak MD,McCullough CS

    更新日期:1993-03-01 00:00:00

  • Peritoneal inflammatory cells in acute pancreatitis: Relationship of infiltration dynamics and cytokine production with severity of illness.

    abstract:BACKGROUND:The purpose of this study was to clarify the still poorly understood dynamics of peritoneal inflammatory cells (PICs) in acute pancreatitis. METHODS:Acute pancreatitis of 3 different degrees of severity was induced in male Wistar rats. Peritoneal lavage was performed at 1, 6, 12, and 24 hours after the indu...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1067/msy.2002.125171

    authors: Mikami Y,Takeda K,Shibuya K,Qiu-Feng H,Egawa S,Sunamura M,Matsuno S

    更新日期:2002-07-01 00:00:00

  • Continuous monitoring and control of plasma glucose during operation for removal of insulinomas.

    abstract::A glucose-controlled insulin and glucose infusion system (Biostator system, Miles Laboratories Inc., Elkhart, Ind.) was used during operation for removal of four suspected insulinomas. In two patients the Biostator system continuously monitored plasma glucose levels and, through a computer-controlled feedback mechanis...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Schwartz SS,Horwitz DL,Zehfus B,Langer BG,Kaplan E

    更新日期:1979-06-01 00:00:00

  • Immunomodulators in the treatment of peritonitis in burned and malnourished animals.

    abstract::Deficiencies in the immune system that lead to increased morbidity and mortality from infectious complications have been well documented in patients suffering from trauma, malnutrition, sepsis, and thermal injuries. We investigated the potential benefit of immune stimulation for preventing infection in such conditions...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Waymack JP,Miskell P,Gonce SJ,Alexander JW

    更新日期:1984-08-01 00:00:00

  • Stenting does not decompress the pancreatic duct as effectively as surgery in experimental chronic pancreatitis.

    abstract:BACKGROUND:In humans with chronic pancreatitis (CP), pancreatic interstitial pressure (IP) is elevated and pancreatic blood flow (PBF) is reduced. The efficacy of surgical decompression (SD) of the pancreatic duct (ie, pancreaticojejunostomy) is believed to be due to its ability to decrease IP and pancreatic vascular r...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Reber PU,Patel AG,Lewis MP,Ashley SW,Reber HA

    更新日期:1998-09-01 00:00:00

  • Adenoviral transfer of the inducible nitric oxide synthase gene blocks endothelial cell apoptosis.

    abstract:BACKGROUND:We have previously reported that vascular inducible nitric oxide synthase (iNOS) gene transfer inhibits injury-induced intimal hyperplasia in vitro and in vivo. One mechanism by which NO may prevent intimal hyperplasia is by preserving the endothelium or promoting its regeneration. To study this possibility ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/s0039-6060(97)90016-7

    authors: Tzeng E,Kim YM,Pitt BR,Lizonova A,Kovesdi I,Billiar TR

    更新日期:1997-08-01 00:00:00

  • Defining service and education: the first step to developing the correct balance.

    abstract:BACKGROUND:Service and education activities have not been well defined or studied. The purpose of this study is to describe how attendings and residents categorize common resident activities on a service-education continuum. METHODS:A web-based survey was designed to categorize resident activities. A panel of resident...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2007.04.011

    authors: Reines HD,Robinson L,Nitzchke S,Rizzo A

    更新日期:2007-08-01 00:00:00

  • Sepsis and endotoxemia stimulate intestinal interleukin-6 production.

    abstract:BACKGROUND:Endotoxemia stimulates tumor necrosis factor (TNF) and interleukin-1 (IL-1) production in mucosa of the small intestine, but the effect on IL-6 production is not known. Intestinal IL-6 may be especially important, considering its role in the acute phase response. We tested the influence of endotoxemia and se...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/s0039-6060(05)80342-3

    authors: Meyer TA,Wang J,Tiao GM,Ogle CK,Fischer JE,Hasselgren PO

    更新日期:1995-08-01 00:00:00

  • Moesin expression is associated with the estrogen receptor-negative breast cancer phenotype.

    abstract:BACKGROUND:Estrogen receptor (ER)-positive breast carcinomas possess a less aggressive phenotype than ER-negative breast carcinomas. We hypothesize that a set of genes exists that is expressed only in ER-negative breast carcinomas, which account for the more malignant phenotypic characteristics of these tumors. METHOD...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Carmeci C,Thompson DA,Kuang WW,Lightdale N,Furthmayr H,Weigel RJ

    更新日期:1998-08-01 00:00:00

  • Duodenum-preserving pancreatic head resection: A retrospective analysis of the Hamburg Modification.

    abstract:BACKGROUND:Chronic pancreatitis remains a challenging inflammatory disease, causing progressive, irreversible fibrosis of the pancreatic parenchyma. Several surgical options for treatment have been established, but duodenum-preserving pancreatic head resections seem to be the most favorable option other than pancreatod...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2018.11.009

    authors: Bellon E,Roswora MD,Melling N,Grotelueschen R,Grupp K,Reeh M,Ghadban T,Izbicki JR,Bachmann K

    更新日期:2019-05-01 00:00:00

  • Umbilical vein bypass in patients with severe lower limb ischemia: a report of 121 consecutive cases.

    abstract::In 112 patients with severe ischemia of the lower limb and without a suitable saphenous vein, 99 femoropopliteal and 22 femorodistal bypass procedures were performed with the modified human umbilical vein (Biograft, Meadox Medicals Inc., Oakland, N.J.). Seventy-eight percent of the operations were performed for limb s...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Andersen LI,Nielsen OM,Buchardt Hansen HJ

    更新日期:1985-03-01 00:00:00

  • Radionuclide diagnosis of diaphragmatic rupture with hepatic herniation.

    abstract::Seven surgically proven cases of a traumatic rupture of the right hemidiaphragm with a hepatic herniation were preoperatively diagnosed by radionuclide liver-spleen imagings, and they were retrospectively analyzed. All injuries resulted from blunt traumatic injury including automobile accidents, and there were associa...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Kim EE,McConnell BJ,McConnell RW,Duke JH,Dillon M

    更新日期:1983-07-01 00:00:00

  • Proximal bile duct stricture disguised as malignant neoplasm.

    abstract:BACKGROUND:Discrimination of malignant proximal bile duct (PBD) stricture from a benign lesion is difficult with nonsurgical methods; indeed, 8% to 13% of PBD strictures prove to be benign after histologic examination of the surgically resected specimen. METHODS:In a 7-year period 178 patients with PBD stricture were ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Nakayama A,Imamura H,Shimada R,Miyagawa S,Makuuchi M,Kawasaki S

    更新日期:1999-05-01 00:00:00

  • Disturbance of basal and stimulated serum levels of intact parathyroid hormone in primary hyperparathyroidism.

    abstract::In patients with primary hyperparathyroidism, measurements were made of basal and stimulated levels of intact parathyroid hormone (PTH). The basal PTH values were elevated in all but six of 89 patients and provided clear separation towards normal individuals (n = 75) and patients with hypercalcemia of other origin (n ...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Ljunghall S,Larsson K,Lindh E,Lindqvist U,Rastad J,Akerström G,Wide L

    更新日期:1991-07-01 00:00:00

  • Physiologic response to cricopharyngeal myotomy and diverticulum suspension.

    abstract::Ten patients who had a cricopharyngeal myotomy and diverticulum suspension for pharyngoesophageal diverticulum have been studied clinically, radiologically, and manometrically. There were no deaths or morbidity and all patients have achieved marked improvement of their symptoms. Before operation all patients but one h...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Duranceau A,Rheault MJ,Jamieson GG

    更新日期:1983-10-01 00:00:00

  • Surgical strategy for carcinoma of the papilla of Vater on the basis of lymphatic spread and mode of recurrence.

    abstract:BACKGROUND:Nodal status is one of the most important prognostic factors for carcinoma of the papilla of Vater. The pattern of lymphatic spread and mode of recurrence were analyzed by determining the frequency of nodal involvement and antemortem and postmortem examination of patients with recurrent disease. METHODS:Fro...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/s0039-6060(97)90048-9

    authors: Kayahara M,Nagakawa T,Ohta T,Kitagawa H,Miyazaki I

    更新日期:1997-06-01 00:00:00

  • Transsternal operations in thyroid cancer.

    abstract::Large thyroid carcinomas extending into the anterior mediastinum were removed from six patients by a transsternal surgical approach (partial median sternotomy). Transcervical mediastinal dissection offers obscure exposure and therefore entails the risk of the operation not being radical. The transsternal procedure was...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Niederle B,Roka R,Fritsch A

    更新日期:1985-12-01 00:00:00

  • Nelson's syndrome after Cushing's disease in childhood: a continuing problem.

    abstract::Nelson's syndrome--progressive cutaneous hyperpigmentation with x-ray film evidence of an expanding pituitary tumor--is now a well-recognized sequela of bilateral adrenalectomy for Cushing's disease. It is estimated to occur in 8% to 38% of adults. Because Cushing's disease is rare in children, a higher incidence of N...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Thomas CG Jr,Smith AT,Benson M,Griffith J

    更新日期:1984-12-01 00:00:00

  • Pasireotide (SOM230) is effective for the treatment of pancreatic neuroendocrine tumors (PNETs) in a multiple endocrine neoplasia type 1 (MEN1) conditional knockout mouse model.

    abstract:BACKGROUND:Pasireotide (SOM230), a long-acting somatostatin analogue (LAR), has improved agonist activity at somatostatin receptors. We tested the effect of SOM230 on insulin secretion, serum glucose concentrations, tumor growth, and survival using an MEN1 transgenic mouse model. METHODS:Eight 12-month-old conditional...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:10.1016/j.surg.2012.08.021

    authors: Quinn TJ,Yuan Z,Adem A,Geha R,Vrikshajanani C,Koba W,Fine E,Hughes DT,Schmid HA,Libutti SK

    更新日期:2012-12-01 00:00:00

  • Correction of hypothermia by continuous pleural perfusion.

    abstract::Hypothermia to less than 30 degrees C is associated with significant harmful effects, including ventricular fibrillation. None of the currently used techniques for core rewarming is entirely satisfactory. Continuous perfusion of the pleural space with warm saline solution has been studied as a method of core rewarming...

    journal_title:Surgery

    pub_type: 杂志文章

    doi:

    authors: Barr GL,Halvorsen LO,Donovan AJ

    更新日期:1988-05-01 00:00:00