Background
Anatomic location of primary tumors across the colon correlate with survival in the metastatic setting, whereas left‐sided tumors may exhibit superior survival compared with right‐sided ...tumors. The Oncotype Recurrence Score (RS) assay is a clinically validated predictor of recurrence risk in patients with stage II colorectal cancer (CRC). Previous studies had indicated that without adjuvant chemotherapy, CDX2‐negative stage II CRC tumors are associated with a lower rate of disease‐free survival than CDX2‐positive stage II CRC tumors. We aimed to evaluate whether these two validated prognostic biomarkers may correlate with primary tumor location, and whether tumor location may reflect differential prognosis in stage II CRC.
Materials and Methods
We retrospectively analyzed patients with T3 mismatch repair‐proficient (MMR‐P) stage II CRC for whom RS assay was performed. Pathological report was reviewed for exact primary tumor location and CDX2 immunostaining. RS and CDX2 expression were correlated with primary tumor location.
Results
The analysis included 1,147 patients with MMR‐P stage II CRC (median age 69 years range 29–93). Tumor distribution across the colon was as follows: 46% (n = 551) were right‐sided and 54% (n = 596) were left‐sided. RS was higher in right‐sided tumors (p = .01). The RS results gradually decreased across the colon (cecum, highest score; sigmoid, lowest score; p = .04). Right‐sided tumors exhibited more CDX2‐negative tumors (p = .07).
Conclusion
Our study indicates that right‐sided colorectal tumors may display worse prognosis compared with left‐sided tumors in MMR‐P stage II CRC. Primary tumor location may serve as a prognostic factor that should be taken into account for recurrence risk assessment and consideration of adjuvant treatment.
Implications for Practice
Sidedness matters, even in stage II colorectal cancer (CRC). Using two previously established prognostic tools, the Oncotype DX assay and CDX2 expression, this study found that right‐sided tumors may display worse prognosis compared with left‐sided tumors in mismatch repair‐proficient stage II CRC. Therefore, primary tumor location should be taken into account for recurrence risk assessment and consideration of adjuvant treatment.
摘要
背景。在转移性结直肠癌中，原发性肿瘤的解剖位置与存活率相关，而与右侧肿瘤相比，左侧肿瘤可能表现出更高的存活率。肿瘤基因复发评分 (RS) 测定是经过临床验证的 II 期结直肠癌 (CRC) 患者复发风险的预测因子。既往研究已表明，如果没有辅助化疗，CDX2 阴性的 II 期 CRC 肿瘤与 CDX2 阳性的 II 期 CRC 肿瘤相比具有更低的无病生存率。我们的目的是评估这两种经过验证的预后生物标记物是否与肿瘤的原发部位相关，以及肿瘤部位是否可能反映出 II 期 CRC 的预后差异。
材料和方法。我们回顾性分析了具有 T3 错配修复‐无缺失 (MMR‐P) 的 II 期 CRC 患者，对他们进行了 RS 测定。回顾了病理报告中的确切原发肿瘤部位 和 CDX2 免疫染色。RS 和 CDX2 表达与肿瘤的原发部位相关。
结果。该分析包括 1 147 名患有 MMR‐P 的 II 期 CRC 患者 中位年龄为 69 岁(年龄范围为 29‐93)。结肠的肿瘤分布如下:46%(n = 551) 位于右侧， 54%(n = 596)位于左侧。RS 在右侧肿瘤中更高(p = 0.01)。RS 评分在结肠分布中逐渐减少(盲肠，最高分；乙状结肠，最低分； p = 0.04)。右侧肿瘤较多表现为 CDX2 阴性肿瘤(p = 0.07)。
结论。我们的研究表明，与 MMR‐P II 期 CRC 中的左侧肿瘤相比，右侧结直肠肿瘤可能表现出更差的预后。肿瘤的原发部位可作为一个预后因素，在进行复发风险评估和考虑辅助治疗时应该予以考虑。
实践意义:即使在 II 期结直肠癌 (CRC) 中，位于左侧还是右侧也很重要。使用两个先前建立的预后工具 ‐ Oncotype DX 测定和 CDX2 表达，本研究发现，与错配修复‐ 无缺失的 II 期 CRC 中的左侧肿瘤相比，右侧肿瘤可能表现出更差的预后。因此，在进行复发风险评估和考虑辅助治疗时，应考虑肿瘤的原发部位。
This article evaluates prognostic biomarkers with a focus on primary tumor location in stage II colorectal cancer.
We report a 48-year-old woman with metastatic infiltrating lobular carcinoma of the breast. Though her metastatic disease remained stable, she was repeatedly admitted for symptomatic anaemia and ...treated by red blood cell and platelet transfusions with increasing frequency as time elapsed. Abdominal examination and ultrasound revealed splenomegaly (27 cm span). A bone marrow biopsy showed fibrosis and foci of metastatic carcinoma. Splenectomy ameliorated her transfusion-dependent anaemia and thrombocytopaenia. Histopathology revealed multiple foci of metastatic carcinoma and scattered foci of extramedullary haematopoiesis. Differential diagnosis of anaemia and thrombocytopaenia in patients with cancer include bone morrow involvement by cancer cells, iron-deficiency anaemia, microangiopathies and chemotherapy suppression of haematopoiesis. Splenic involvement with cancer is common in patients with multivisceral disease. Many may regard transfusion-dependent severe anaemia and thrombocytopaenia as an end-stage disease in these patients. Nevertheless, palliative splenectomy should be considered in patients with possible hypersplenism who will otherwise survive for a relatively prolonged period of time.
The increased susceptibility of cancer patients to coronavirus disease-2019 (COVID-19) infections and complications calls for special precautions while treating cancer patients during COVID-19 ...pandemics. Thus, oncology departments have had to implement a wide array of prevention measures.
To address issues associated with cancer care during the COVID-19 pandemic and to assess the implementation of measures aimed at containment of COVID-19 diffusion while allowing continuation of quality cancer care.
A national survey among oncology departments in Israel was conducted between 12 April 2020 and 14 April 2020. Eighteen heads of hospital-based oncology departments completed a self-report questionnaire regarding their institute's preparedness for treatment of cancer patients during the COVID-19 pandemic.
In this national survey, prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying in the departments. Most participants (78-89%) reported using a quick triage of patients and caregivers prior to their entrance to the oncology units, limiting the entrance of caregivers, and reducing unnecessary visits to the clinic. Switching to oral therapies rather than intravenous ones when possible was considered by 82% and shortage in personal protective equipment was reported by five (28%) heads of oncology departments. Some differences between large and small/medium sized medical centers were observed regarding issues related to COVID-19 containment measures and changes in treatment.
Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity.
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Background: Recent evidence indicate that the anatomic location of primary tumors across the colon correlate with survival in the metastatic setting, whereas left-sided tumors may ...exhibit superior survival compared with right-sided. The Oncotype DX, a 12-gene colon cancer assay, is a clinically validated predictor of recurrence risk in stage II colorectal cancer (CRC) patients. Previous studies had indicated that CDX2-negative colorectal tumors are often associated with several adverse prognostic variables. Recently, it has been shown that without adjuvant chemotherapy, CDX2-negative stage II CRC tumors were associated with a lower rate of disease-free survival than CDX2-positive stage II CRC tumors. We aimed to evaluate whether these validated two prognostic biomarkers may correlate with primary tumor location, and whether tumor location may reflect differential prognosis in stage II CRC. Methods: We retrospectively analyzed a cohort of patients with T3 mismatch repair proficient (MMR-P) stage II CRC for whom 12-gene assay was performed (between 1/2011-2/2016). Pathological report was reviewed for exact primary tumor location and CDX2 immunostaining. Recurrence score (RS) and CDX2 expression were correlated with primary tumor location. Results: The analysis included 1087 patients with MMR-P stage II CRC (median age 69 years (range 29-93)). Tumor distribution across the colon was as follows: 46% (n = 500) were right-sided (cecum, ascending colon, transverse colon) and 54% (n = 587) were left-sided (splenic flexure, descending colon, sigmoid colon and rectum). Recurrence score was higher in right-sided tumors compared with left-sided tumors (p = 0.01). The RS gradually decreased across the colon (cecum - highest score, sigmoid-lowest score, p = 0.04). Right-sided tumors exhibited more CDX2-negative tumors compared with left-sided tumors (p = 0.07). Conclusions: Our study indicate that right-sided colorectal tumors may display worse prognosis compared with left-sided tumors in MMR-P stage II CRC. Primary tumor location may serve as a prognostic factor that should be accounted for recurrence risk assessment and consideration of adjuvant treatment.
The purpose of this paper was to describe an unusual manifestation of a sarcoma of the spleen and to raise awareness for spontaneous rupture of the splenic vessels in patients with splenic tumors. A ...70-year-old man was admitted to our institution, suffering from left upper quadrant abdominal pain. Upon physical examination, a large and tender abdominal mass was palpated. Abdominal computed tomography showed a heterogenous enlarged spleen with active contrast extravasation from the splenic artery, free intraperitoneal fluid, and a retroperitoneal hematoma. The patient was treated with angioembolization of the splenic artery. Because of rebleeding, splenectomy was performed. Pathology revealed the spleen to be involved with an unclassified malignant spindle cell neoplasm. We concluded that in the case of spontaneous rupture of the splenic artery, accompanied with a radiologic appearance of an enlarged spleen, the diagnosis of sarcoma should be included in the differential diagnosis.
Background
Precision treatment of cancer uses biomarker-driven therapy to individualize and optimize patient care.
Objective
To evaluate real-life clinical experience with biomarker-driven therapy in ...metastatic gastric and esophageal cancer in Israel.
Patients and Methods
This multicenter retrospective cohort study included patients with metastatic gastric or esophageal cancer who were treated in the participating institutions and underwent biomarker-driven therapy. Treatment was considered to have a benefit if the ratio between the longest progression-free survival (PFS) post biomarker-driven therapy and the last PFS before the biomarker-driven therapy was ≥1.3. The null hypothesis was that ≤15% of patients gain such benefit.
Results
The analysis included 46 patients (61% men; median age, 58 years; 57% with poorly-differentiated tumors). At least one actionable (i.e., predictive of response to a specific therapy) biomarker was identified for each patient. Immunohistochemistry was performed on all samples and identified 1–8 (median: 3) biomarkers per patient (most commonly: low TS, high TOPO1, high TOP2A). Twenty-eight patients received therapy after the biomarker analysis (1–4 lines). In the 1st line after biomarker analysis, five patients (18%) achieved a partial response and five (18%) stable disease; the median (range) PFS was 129 (12–1155) days. Twenty-four patients were evaluable for PFS ratio analysis; in seven (29.2%), the ratio was ≥1.3. In a one-sided exact binomial test vs. the null hypothesis,
p
= 0.019; therefore, the null hypothesis was rejected.
Conclusions
Our findings demonstrated that implementing biomarker-driven analysis is feasible and could provide clinical benefit for a considerable proportion (~30%) of patients with metastatic gastric or esophageal cancer.
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