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P. Ubiali
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Poster Display Session (ID 63)
- Event: ELCC 2017
- Type: Poster Display Session
- Track:
- Presentations: 4
- Moderators:
- Coordinates: 5/07/2017, 12:30 - 13:00, Hall 1
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152P - Relationship between overall survival and preoperative parameters in patients with colorectal cancer and synchronous liver and lung metastases (ID 451)
12:30 - 13:00 | Author(s): P. Ubiali
- Abstract
Background:
The overall survival (OS) of patients with synchronous colorectal cancer (CRC) and pulmonary metastases (PMs) is significantly shorter, but the optimal surgical strategy, including simultaneous colorectal and liver resection vs. delayed liver metastasectomy, has not been defined. The aim of this retrospective study was to evaluate the relationship between OS and preoperative parameters, including age, number and median size of metastases, in patients with PMs from CRC and synchronous or metachronous liver metastases (LMs).
Methods:
The medical charts of a group of 20 patients (9 man, 11 women, median age 60 years, range 31-75) who underwent curative surgery for CRC and developed both PMs and synchronous or metachronous LMs were reviewed. Eleven patients aged <65 years, whilst 9 patients aged 65 years or older. Written informed consent was obtained from all the participants. The Pearson correlation coefficient (R) and the linear regression equation calculation was obtained. Because the data were not normally distributed, the Mann-Whitney U-test was used to evaluate statistical significance of correlations.
Results:
The median OS was 12.0 months (range 1-58 months) and the overall disease-free interval (DFI) was 2.7±1.9 months. The OS showed a difference in favor of the older (≥65 years) patients (43.3±21.3 vs. 20.1±23.3, p = 0.036). As expected, a strong direct linear relationship between OS and DFI (R = 0.8469, p < 0.000001) was found. There was no significant correlation between OS and both median size (R=−0.3976, p = 0.8256, regression line equation: mm = 21.820349609352-0.20184496105481OS) and number of metastases (R=−0.2975, p = 0.2025, regression line equation: Number=3.294978403666-0.039208413596717OS). Surprisingly, a direct strong relationship between OS and the age of the patients (R = 0.6098, p = 0.0043, regression line equation: age=52.147836178944 + 0.46213761830125OS) was found.
Conclusions:
Our results suggest that patients with both PMs and LMs from CRC aged ≥65 years should undergo metastasectomy (in lack of contraindication to surgery) regardless of other parameters, including number and size of metastases, because OS directly correlates with age.
Clinical trial identification:
Legal entity responsible for the study:
Università degli Studi di Padova
Funding:
Università degli Studi di Padova
Disclosure:
All authors have declared no conflicts of interest.
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153P - Predictive markers of survival in patients with pulmonary metastases and malignant pleural effusion (ID 404)
12:30 - 13:00 | Author(s): P. Ubiali
- Abstract
Background:
Lung metastases (LMs) can be identified in up to 30-50% of all cancer patients, and represent the result of metastatic spread to the lungs from the several cancers. The presence of LMs seriously affects overall survival (OS), and the onset of pleural effusion further reduces the life expectancy of the patients. The aim of this retrospective study was to evaluate the usefulness of carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), and C-reactive protein (CRP) measurement in the pleural fluid of patients with LMs and malignant pleural effusion (MPE).
Methods:
The medical records of 22 patients (median age 68 years, range 46-86) with LMs (mainly from breast, urinary tract, and colorectal cancers) and MPE were analyzed. There were 13 (59.1%) males and 9 (40.9%) females. All patients underwent video-assisted thoracoscopic (VAT)-assisted thoracentesis and subsequent pleural fluid examination, including CEA, LDH, and CRP, which were measured using a chemiluminescent (CLIA) immunoassay (sandwich CLIA with native CEA coated to magnetic microbeads), a spectrophotometric assay (L-lactate as substrate), and an immunonephelometric assay (polystyrene particles coated with anti-human CRP monoclonal antibodies), respectively.
Results:
The OS was 6.7±5.2 months (range 1-23 months), and the levels of pleural markers were 10.4±21.6 ng/mL (CEA), 418.4±342.9 U/L (LDH), and 6.2±9.1 mg/L (CRP). No relationship was found between OS and the age of the patients (R = 0.14, p = 0.542), LDH (R=-0.31, p = 0.169) or CRP (R=-0.33, p = 0.136). There was a significant direct correlation between OS and CEA (R = 0.66, p = 0.0007). The relative regression line equations are reported in the table.rnTable: 153Prnrn
rnrn rnrnParameter rnRegression line equation rnrn rnAge of the patients rnOS = 63.323797651973 + 0.23725477330884 age rnrn rnCEA rnOS = 2.0616207417742-4.4634344843623 CEA rnrn rnLDH rnOS = 470.3738751303-20.900941750959 LDH rnrn rnrnCRP rnOS = 12.210673177537-0.84687826996861 rn
Conclusions:
In patients with MPE and LMs, only CEA pleural levels significantly related to OS, and can be considered a useful predictive factor. Further studies will eventually confirm our results.
Clinical trial identification:
Legal entity responsible for the study:
Università degli Studi di Padova
Funding:
Università degli Studi di Padova
Disclosure:
All authors have declared no conflicts of interest.
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154P - Analysis of factors affecting survival in patients with simultaneous liver and pulmonary metastases from colorectal cancer (ID 450)
12:30 - 13:00 | Author(s): P. Ubiali
- Abstract
Background:
In patients with colorectal cancer (CRC) the presence of simultaneous liver (LMs) and pulmonary metastases (PMs) is uncommon, but may significantly affect overall survival (OS). The aim of this study was to identify the prognostic factors (PFs) influencing OS in such a group of patients.
Methods:
We retrospectively reviewed the medical records of 36 patients (mean age 62.2±10.5 years) with CRC who underwent curative surgical resection and developed PMs during follow up requiring video-assisted thoracoscopic (VATS) metastasectomy. There were 21 (58.3%) males and 15 (41.7%) females. Twenty (55.6%) patients had already LMs at the time of VATS. Survival curves were estimated by Kaplan-Meyer method and compared with log rank testing. Cox proportional hazard model (HR) calculation (stepwise logistic regression) was used in the multivariate analysis, to identify the independent variables. A p-value of < 0.01 (two-tailed) was considered statistically significant.
Results:
The OS of the entire population ranged widely (30.6±25.1 months), according to patient age (p = 0.004), presence of involved mesenteric (p = 0.0003) or thoracic (p = 0.0001) lymph nodes, number of the involved nodes (p = 0.006), and simultaneous LMs and PMs (p = 0.0002). There was no relationship between gender (p = 0.67) or the mean size of metastases (p = 0.53) and OS. A tendency towards a correlation between age and the presence of lymph node involvement (p = 0.050) was also observed. The regression analysis showed that the number of LMs (HR = 1.37, 95% CI: 1.14-1.67, p = 0.0011), and the presence of node involvement, both thoracic (HR = 11.49, 95% CI: 1.49-88.58, p = 0.0191) and mesenteric (HR = 5.79, 95% CI: 1.27-26.30, p = 0.0230), were independent parameters affecting OS.
Conclusions:
In patients with CRC with both LMs and PMs only lymph node involvement and their number should be considered as negative PFs. In conclusion, the results of liver metastasectomy are independent of age, gender, and size of metastases, and thus this therapeutic approach should be suggested in all node-negative patients suitable for surgery, regardless of other PFs.
Clinical trial identification:
Legal entity responsible for the study:
Università degli Studi di Padova
Funding:
Università degli Studi di Padova
Disclosure:
All authors have declared no conflicts of interest.
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38P - Flow cytometry immunophenotyping of pleural fluid cytology in patients with diffuse large B-cell lymphoma (DLBCL) and malignant pleural effusion (ID 377)
12:30 - 13:00 | Author(s): P. Ubiali
- Abstract
Background:
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL and comprises up to 35% of cases. In patients with DLBCL the clinical presentation varies widely. Malignant pleural effusion (MPE) represents a common occurrence in cancer patients with either thoracic and extra-thoracic malignancies, often requiring invasive diagnostic procedures, including video-assisted thoracoscopic surgery (VATS)-guided biopsy. Approximately 20% of patients with DLBCL may develop MPE. The aim of this study was to demonstrate the usefulness of flow cytometry phenotyping (FCP) of pleural cytology (PC) in patients with MPE due to DLBCL.
Methods:
A retrospective chart review of 40 (15 (37.5%) males and 25 (62.5%) females, median age 69 tears, range 46-85 years) patients with histologically confirmed MPE was performed at a tertiary referral Medical Center. All patients underwent PC and FCP before VATS-guided biopsy. For the FCP, the FACSCanto II system and the FACSDiva software (BD Biosciences, Franklin Lakes, USA) were used. Compensation beads were obtained with single stains of each antibody to determine the compensation settings, and the settings were applied in FlowJo software (Tree Star, Ashland, USA) after data collection. Sample cells were stained with a panel of antibodies, including CD5, CD10, CD19, CD23, Kappa, Lambda, and CD45 (Dako, Glostrup, Denmark). In the presence of a T-cell population with aberrant phenotypes or a B-cell population with monotypic light chains, the diagnosis of DLBCL-related pleural effusion was made.
Results:
Final histology showed 5 (12.5%) patients with DLBCL and 35 (87.5%) with MPE from other malignancies (mainly breast cancer and lung cancer). The age (68.0±10.1 vs. 67.5±14.2 years; p = 0.94) and the male to female ratio (p = 0.64) did not differ between groups. The results are reported in the Table. The sensitivity and negative predictive value of FCP reached 100%, the specificity was the same as obtained with the PC alone, but the accuracy was superior (97.5% vs. 85%; p = 0.003).rnTable: 38PResults of flow cytometry phenotyping and pleural cytologyrnrn
rnrn rnrnResults rnFlow cytometry immunophenotyping rnPleural fluid cytology rnrn rnSensitivity rn100% rn0% rnrn rnSpecificity rn97.1% (95% CI: 91.6-100) rn97.1% (95% CI: 91.6-100) rnrn rnNegative predictive value rn100% rn97.2% rnrn rnClinical accuracy rn97.5% rn85.0% rnrn rnPrevalence rn12.5% rn12.5% rnrn rnFalse positive rate rn2.9% rn2.9% rnrn rnFalse negative rate rn0% rn14.3% rnrn rnLikelihood ratio positive rn35 rn0 rnrn rnrnLikelihood ratio negative rn0 rn1.3 rn
Conclusions:
FCP of PC has great value in confirming (or excluding) the relationship between pleural effusion and malignancy, including lymphoma, exhibiting a significantly higher accuracy that that of PC alone. FCP should be performed in all patients with a history of DLBCL who exhibit suspicious MPE.
Clinical trial identification:
Legal entity responsible for the study:
Università degli Studi di Padova
Funding:
Università degli Studi di Padova
Disclosure:
All authors have declared no conflicts of interest.
