3 results on '"Hendifar AE"'
Search Results
2. Midgut Neuroendocrine Tumors with Liver-only Metastases: Benefit of Primary Tumor Resection.
- Author
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Gangi A, Manguso N, Gong J, Crystal JS, Paski SC, Hendifar AE, and Tuli R
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Humans, Middle Aged, Retrospective Studies, Survival Rate, Young Adult, Intestinal Neoplasms pathology, Intestinal Neoplasms surgery, Liver Neoplasms secondary, Liver Neoplasms surgery, Neuroendocrine Tumors pathology, Neuroendocrine Tumors surgery
- Abstract
Background: Management of metastatic midgut neuroendocrine tumors (MNET) remains controversial. The benefits of resecting the primary tumor are not clear and advocated only for select patients. This study aimed to determine whether resection of the primary MNET in patients with untreated liver-only metastases has an impact on survival., Methods: This retrospective study reviewed data of the National Cancer Database from 2004 to 2015 for patients with liver-only metastatic MNETs and compared those who received resection of their primary MNET with those who did not. Patient demographics, tumor characteristics, and clinical outcomes were compared between the groups. The primary outcome was overall survival (OS) after adjustment for patient, demographic, and tumor-related factors., Results: The study identified 1952 patients with a median age of 63 years (range, 18-90 years). The median primary tumor size was 2.4 cm (range, 0.1-20 cm). Of these patients, 1295 (66%) underwent resection of the primary tumor and 667 (34%) did not. The patients who underwent resection were younger (median age, 63 vs 65 years; p < 0.001) and had smaller primary tumors (median, 2.3 vs 3.0 cm; p < 0.001). The patients with clinical T1 or T2 tumors were significantly less likely to undergo resection than those with stage T3 or T4 tumors (58.5% vs 89.7%; p < 0.001). The median follow-up period was 43 months (range, 1-83 months). In the entire cohort, 483 deaths occurred, with a 5-year OS of 61%. The 5-year OS rate was 49% for the patients who underwent resection and 66% for those who did not (p < 0.001). When the patients were grouped according to T stage, no OS difference between resection and no resection for stages T1 (p = 0.07) and T2 (p = 0.40) was identified. However, the 5-year OS rate was significantly better for the resected patient cohort with T3 (67.5% vs 37.2%; p < 0.001) or T4 (59.8% vs 21.5%; p < 0.001) tumors., Conclusions: The patients with treatment-naïve liver-only metastatic MNET had improved OS when the primary tumor was resected, particularly those with clinical stage T3 or T4 tumors. These patients may benefit from surgical resection of their primary tumor.
- Published
- 2020
- Full Text
- View/download PDF
3. Redefining the Positive Margin in Pancreatic Cancer: Impact on Patterns of Failure, Long-Term Survival and Adjuvant Therapy.
- Author
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Osipov A, Nissen N, Rutgers J, Dhall D, Naziri J, Chopra S, Li Q, Hendifar AE, and Tuli R
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma surgery, Adenocarcinoma therapy, Aged, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal surgery, Carcinoma, Pancreatic Ductal therapy, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Neoplasm Recurrence, Local therapy, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Pancreatic Neoplasms therapy, Prognosis, Survival Rate, Adenocarcinoma mortality, Carcinoma, Pancreatic Ductal mortality, Chemoradiotherapy, Adjuvant mortality, Neoplasm Recurrence, Local mortality, Pancreatectomy mortality, Pancreatic Neoplasms mortality
- Abstract
Purpose: There is debate regarding the definition and clinical significance of margin clearance in pancreatic ductal adenocarcinoma (PDA). A comprehensive archival analysis of surgical resection margins was performed to determine the effect on locoregional recurrence and survival, and the impact of adjuvant therapy in PDA., Methods: We identified 105 patients with resected PDA. Pancreatic, anterior, bile duct, and posterior surgical resection margins (PM; posterior surface, uncinate and vascular groove) were identified. Three pathologists reviewed all archival surgical specimens and recategorized each margin as tumor at ink/transected, <0.5, 0.5-1, >1-2, or >2 mm from the inked surface. The impact of these and other clinical variables was assessed on local control, disease-free survival (DFS), and overall survival (OS)., Results: Among all margins, PM clearance up to 2 mm was prognostic of DFS (p = 0.01) and OS (p = 0.01). Dichotomizing the PM at 2 mm revealed it to be an independent predictor of local recurrence-free survival [hazard ratio HR] 0.20, 95% confidence interval [CI] 0.048-0.881, p = 0.033), DFS (HR 0.46, 95% CI 0.22-0.96, p = 0.03), and OS (HR 0.31, 95% CI 0.14-0.74, p = 0.008). A margin status of >2 mm was also prognostic of OS in patients who received adjuvant chemotherapy (HR 0.31, 95% CI 0.11-0.89, p = 0.03), however this difference was mitigated in patients receiving adjuvant chemoradiotherapy (HR 0.40, 95% CI 0.10-1.58, p = 0.19)., Conclusion: These data highlight the clinical significance of the PM and the lack of significance of other resection margins. Clearance in excess of 2 mm should be considered to improve long-term clinical outcomes. The use of adjuvant radiotherapy should be strongly considered in patients with PMs <2 mm.
- Published
- 2017
- Full Text
- View/download PDF
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