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Evaluating compliance with National Comprehensive Cancer Network guidelines in management of colorectal, liver and thyroid cancer
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Scientific Poster Presentations: 2014 Clinical Congress
CONCLUSIONS: VDR expression, seen for the first time in OC was decreased compared to controls and patients with lower expression had advanced disease. OVDS showed improved QOL on all the scales. Evaluating compliance with National Comprehensive Cancer Network guidelines in management of colorectal, liver and thyroid cancer Michelle Estrada, Sean Y McGill, BA, Subhasis Misra, MD, MBBS, FACS Texas Tech University School of Medicine, Lubbock, TX INTRODUCTION: Cancer biomarkers have demonstrated diagnostic, prognostic and predictive utilities. However their clinical adoption has been variable. This study evaluates compliance to National Comprehensive Cancer Network (NCCN) guidelines. METHODS: Biomarker baseline levels for 109 patients diagnosed with colorectal adenocarcinoma (CRC), hepatocellular carcinoma (HCC), papillary/follicular thyroid cancer from January 2011 to December 2013 in a Commission of Cancer designated hospital were compared with current NCCN Guidelines. Surveillance levels for 81 of the109 patients were also analyzed. Surveillance excluded patients who expired, transferred facilities, CRC staged T1 or unknown stage before the first recommended follow-up level. CRC baseline adherence was met if carcinoembryonic antigen (CEA) was obtained upon diagnosis. If the cancer was staged T2-T4, CEA levels were gathered every 3-6 months for 2 years and every 6 months for 3 years. HCC compliance was met if baseline alpha-fetoprotein (AFP) level was obtained upon diagnosis, every 3-6 months for 2 years, then every 6-12 months thereafter. Thyroid cancer recommendations were met if baseline thyroglobulin (TG) was obtained upon diagnosis, after 6 and 12 months, and annually thereafter. RESULTS: NCCN recommendations for baseline values of CEA, AFP and TG were observed in 69%, 94% and 16% patients respectively. Adherence to surveillance values of CEA, AFP and TG were observed in 12%, 8% and 21% patients respectively. CONCLUSIONS: Recommendations for baseline biomarker levels were met by AFP testing. CEA and TG observations fell below guideline standards. Adherence to surveillance guidelines of CEA, AFP, and TG were below the recommendations. Compliance to NCCN guidelines may be significant for appropriate cancer care and management. Clinical utility of endoscopic ultrasound in the preoperative evaluation of gastric adenocarcinoma: a sonographic validation study Oscar K Serrano, MD, Kevin Huang, BA, Nicole Ng, PharmD, Patricia Friedmann, MS, Steven K Libutti, MD, FACS, Timothy J Kennedy, MD, FACS Albert Einstein College of Medicine, Bronx, NY INTRODUCTION: Neoadjuvant chemotherapy in the treatment of gastric adenocarcinoma has been proven effective. Endoscopic
J Am Coll Surg
ultrasonographic (EUS) staging has been proposed as a useful adjunct in this setting. METHODS: We performed a retrospective review of patients treated at our institution for gastric adenocarcinoma between 2005 and 2013. We identified patients referred for EUS before surgery as part of a prospective treatment plan. Histopathologic staging was compared to EUS staging. Agreement between the two modalities was examined using Kappa Statistics. Survival distributions were estimated using the KaplaneMeier method. RESULTS: We identified 614 patients with biopsy-proven gastric adenocarcinoma; 146 underwent curative-intent surgery. Surgical pathology and EUS results were available from 70 patients. The accuracy of EUS for the evaluation of T- and N-stage was 37.3% and 51.0%, respectively. EUS demonstrated greater concordance with histopathology at evaluating T-stage (kappa ¼ 0.3081) than Nstage (kappa ¼ 0.2801). EUS underestimated T- and N-stage in 54.9% and 39.2% of patients, respectively. Patients with EUSdiagnosed T-exclusive disease demonstrated a 3- and 5-year survival of 57.0% and 34.2%, respectively; whereas patients with pathology-diagnosed T-exclusive disease demonstrated a 3- and 5-year survival of 63.2% and 42.5%, respectively. Patients with EUSdiagnosed N-disease demonstrated a 3- and 5-year survival of 61.4% and 40.9%, respectively; whereas patients with pathologydiagnosed N-disease demonstrated a 3- and 5-year survival of 45.3% and 20.1%, respectively. CONCLUSIONS: EUS seems to correlate poorly with pathology in the pre-operative staging of gastric adenocarcinoma. In the majority of inaccurate cases, EUS underestimates both T- and N-stage, limiting its utility in the neoadjuvant setting. Sentinel node biopsy under local anesthesia: the European Institute of Oncology experience Francesco Verrecchia, Alessandro Testori, MD, Antonio Intelisano, Elisabetta Pennacchioli Istituto Europeo di Oncologia, Milan, Italy INTRODUCTION: We decided to evaluate feasibility, safety and satisfaction of patients and surgeons about sentinel node biopsy performed under local anesthesia and with single-day hospitalization. METHODS: Since 1999 at the European Institute of Oncology (EIO) Melanoma division a questionnaire about SNB performed under local anesthesia has been submitted to patients and surgeons. The local anesthesia approach was proposed only on patients with a single site sentinel node localization, excluding neck and poplyt sentinel nodes. We recorded data about the preoperative medical information given to patients about the procedure, any symptomatology of pain during the procedure through a scale from 0 to 10, patient’s satisfaction, hospitalization setting, drugs used and drugs dosage, availability of anesthetist during the procedure in the event of a patient requiring a sedation and duration of surgery.
Scientific Poster Presentations: 2014 Clinical Congress
CONCLUSIONS: VDR expression, seen for the first time in OC was decreased compared to controls and patients with lower expression had advanced disease. OVDS showed improved QOL on all the scales. Evaluating compliance with National Comprehensive Cancer Network guidelines in management of colorectal, liver and thyroid cancer Michelle Estrada, Sean Y McGill, BA, Subhasis Misra, MD, MBBS, FACS Texas Tech University School of Medicine, Lubbock, TX INTRODUCTION: Cancer biomarkers have demonstrated diagnostic, prognostic and predictive utilities. However their clinical adoption has been variable. This study evaluates compliance to National Comprehensive Cancer Network (NCCN) guidelines. METHODS: Biomarker baseline levels for 109 patients diagnosed with colorectal adenocarcinoma (CRC), hepatocellular carcinoma (HCC), papillary/follicular thyroid cancer from January 2011 to December 2013 in a Commission of Cancer designated hospital were compared with current NCCN Guidelines. Surveillance levels for 81 of the109 patients were also analyzed. Surveillance excluded patients who expired, transferred facilities, CRC staged T1 or unknown stage before the first recommended follow-up level. CRC baseline adherence was met if carcinoembryonic antigen (CEA) was obtained upon diagnosis. If the cancer was staged T2-T4, CEA levels were gathered every 3-6 months for 2 years and every 6 months for 3 years. HCC compliance was met if baseline alpha-fetoprotein (AFP) level was obtained upon diagnosis, every 3-6 months for 2 years, then every 6-12 months thereafter. Thyroid cancer recommendations were met if baseline thyroglobulin (TG) was obtained upon diagnosis, after 6 and 12 months, and annually thereafter. RESULTS: NCCN recommendations for baseline values of CEA, AFP and TG were observed in 69%, 94% and 16% patients respectively. Adherence to surveillance values of CEA, AFP and TG were observed in 12%, 8% and 21% patients respectively. CONCLUSIONS: Recommendations for baseline biomarker levels were met by AFP testing. CEA and TG observations fell below guideline standards. Adherence to surveillance guidelines of CEA, AFP, and TG were below the recommendations. Compliance to NCCN guidelines may be significant for appropriate cancer care and management. Clinical utility of endoscopic ultrasound in the preoperative evaluation of gastric adenocarcinoma: a sonographic validation study Oscar K Serrano, MD, Kevin Huang, BA, Nicole Ng, PharmD, Patricia Friedmann, MS, Steven K Libutti, MD, FACS, Timothy J Kennedy, MD, FACS Albert Einstein College of Medicine, Bronx, NY INTRODUCTION: Neoadjuvant chemotherapy in the treatment of gastric adenocarcinoma has been proven effective. Endoscopic
J Am Coll Surg
ultrasonographic (EUS) staging has been proposed as a useful adjunct in this setting. METHODS: We performed a retrospective review of patients treated at our institution for gastric adenocarcinoma between 2005 and 2013. We identified patients referred for EUS before surgery as part of a prospective treatment plan. Histopathologic staging was compared to EUS staging. Agreement between the two modalities was examined using Kappa Statistics. Survival distributions were estimated using the KaplaneMeier method. RESULTS: We identified 614 patients with biopsy-proven gastric adenocarcinoma; 146 underwent curative-intent surgery. Surgical pathology and EUS results were available from 70 patients. The accuracy of EUS for the evaluation of T- and N-stage was 37.3% and 51.0%, respectively. EUS demonstrated greater concordance with histopathology at evaluating T-stage (kappa ¼ 0.3081) than Nstage (kappa ¼ 0.2801). EUS underestimated T- and N-stage in 54.9% and 39.2% of patients, respectively. Patients with EUSdiagnosed T-exclusive disease demonstrated a 3- and 5-year survival of 57.0% and 34.2%, respectively; whereas patients with pathology-diagnosed T-exclusive disease demonstrated a 3- and 5-year survival of 63.2% and 42.5%, respectively. Patients with EUSdiagnosed N-disease demonstrated a 3- and 5-year survival of 61.4% and 40.9%, respectively; whereas patients with pathologydiagnosed N-disease demonstrated a 3- and 5-year survival of 45.3% and 20.1%, respectively. CONCLUSIONS: EUS seems to correlate poorly with pathology in the pre-operative staging of gastric adenocarcinoma. In the majority of inaccurate cases, EUS underestimates both T- and N-stage, limiting its utility in the neoadjuvant setting. Sentinel node biopsy under local anesthesia: the European Institute of Oncology experience Francesco Verrecchia, Alessandro Testori, MD, Antonio Intelisano, Elisabetta Pennacchioli Istituto Europeo di Oncologia, Milan, Italy INTRODUCTION: We decided to evaluate feasibility, safety and satisfaction of patients and surgeons about sentinel node biopsy performed under local anesthesia and with single-day hospitalization. METHODS: Since 1999 at the European Institute of Oncology (EIO) Melanoma division a questionnaire about SNB performed under local anesthesia has been submitted to patients and surgeons. The local anesthesia approach was proposed only on patients with a single site sentinel node localization, excluding neck and poplyt sentinel nodes. We recorded data about the preoperative medical information given to patients about the procedure, any symptomatology of pain during the procedure through a scale from 0 to 10, patient’s satisfaction, hospitalization setting, drugs used and drugs dosage, availability of anesthetist during the procedure in the event of a patient requiring a sedation and duration of surgery.