Showing papers by "Paula Ghaneh published in 2014"
University of Manchester1, National Institute for Health Research2, University of Liverpool3, University of Verona4, University of Birmingham5, The Royal Marsden NHS Foundation Trust6, University of Alberta7, Pierre-and-Marie-Curie University8, University of Hamburg9, University of Greifswald10, Karolinska Institutet11, University of Oxford12, Leeds Teaching Hospitals NHS Trust13, Freeman Hospital14, Glasgow Royal Infirmary15, Heidelberg University16
TL;DR: Completion of all six cycles of planned adjuvant chemotherapy rather than early initiation was an independent prognostic factor after resection for pancreatic adenocarcinoma and there seems to be no difference in outcome if chemotherapy is delayed up to 12 weeks, thus allowing adequate time for postoperative recovery.
Abstract: Purpose Adjuvant chemotherapy improves patient survival rates after resection for pancreatic adenocarcinoma, but the optimal duration and time to initiate chemotherapy is unknown. Patients and Methods Patients with pancreatic ductal adenocarcinoma treated within the international, phase III, European Study Group for Pancreatic Cancer–3 (version 2) study were included if they had been randomly assigned to chemotherapy. Overall survival analysis was performed on an intention-to-treat basis, retaining patients in their randomized groups, and adjusting the overall treatment effect by known prognostic variables as well as the start time of chemotherapy. Results There were 985 patients, of whom 486 (49%) received gemcitabine and 499 (51%) received fluorouracil; 675 patients (68%) completed all six cycles of chemotherapy (full course) and 293 patients (30%) completed one to five cycles. Lymph node involvement, resection margins status, tumor differentiation, and completion of therapy were all shown by multivaria...
326 citations
University of Liverpool1, University Hospitals Birmingham NHS Foundation Trust2, Uppsala University3, University of Alberta4, Princess Margaret Cancer Centre5, University of Manchester6, Beatson West of Scotland Cancer Centre7, University of Paris8, Glasgow Royal Infirmary9, University of Melbourne10, University of New South Wales11, University of Sydney12, Freeman Hospital13, University of Oxford14, St James's University Hospital15, Greifswald University Hospital16, Semmelweis University17, University of Verona18, Heidelberg University19
TL;DR: Subject to prospective validation, gemcitabine should not be used for patients with low tumor hENT1 expression.
Abstract: Background Human equilibrative nucleoside transporter 1 (hENT1) levels in pancreatic adenocarcinoma may predict survival in patients who receive adjuvant gemcitabine after resection. Methods Microarrays from 434 patients randomized to chemotherapy in the ESPAC-3 trial (plus controls from ESPAC-1/3) were stained with the 10D7G2 anti-hENT1 antibody. Patients were classified as having high hENT1 expression if the mean H score for their cores was above the overall median H score (48). High and low hENT1-expressing groups were compared using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. All statistical tests were two-sided. Results Three hundred eighty patients (87.6%) and 1808 cores were suitable and included in the final analysis. Median overall survival for gemcitabine-treated patients (n = 176) was 23.4 (95% confidence interval [CI] = 18.3 to 26.0) months vs 23.5 (95% CI = 19.8 to 27.3) months for 176 patients treated with 5-fluorouracil/folinic acid (months vs 23.5 (95% CI = 19.8 to 27.3) months for 176 patients treated with 5-fluorouracil/folinic acid (chi(2)(1)=0.24; P = .62). Median survival for patients treated with gemcitabine was 17.1 (95% CI = 14.3 to 23.8) months for those with low hENT1 expression vs 26.2 (95% CI = 21.2 to 31.4) months for those with high hENT1 expression (chi(2)(1)=9.87; P = .002). For the 5-fluorouracil group, median survival was 25.6 (95% CI = 20.1 to 27.9) and 21.9 (95% CI = 16.0 to 28.3) months for those with low and high hENT1 expression, respectively (chi(2)(1) = 0.83; P = .36). hENT1 levels were not predictive of survival for the 28 patients of the observation group (chi(2)(1) = 0.37; P = .54). Multivariable analysis confirmed hENT1 expression as a predictive marker in gemcitabine-treated (Wald chi(2)(1) = 9.16; P = .003) but not 5-fluorouracil-treated (Wald chi(2)(1) = 1.22; P = .27) patients. Conclusions Subject to prospective validation, gemcitabine should not be used for patients with low tumor hENT1 expression.
298 citations
TL;DR: To determine the outcome of patients that underwent liver resection for metastases from uveal melanoma, a large number of patients were diagnosed with at least some form of liver cancer.
Abstract: Aim
To determine the outcome of patients that underwent liver resection for metastases from uveal melanoma.
Methods
Over a 9-year period, patients referred with uveal melanoma metastases were included. Following treatment of primary uveal melanoma, high-risk patients were offered to be enrolled into a 6-monthly non-contrast liver magnetic resonance imaging (MRI) surveillance. Following detection of liver metastases, patients were staged with a contrast-enhanced (Primovist®) liver MRI, computer tomography (CT) of the thorax and staging laparoscopy.
Results
155 patients were referred with uveal melanoma liver metastases, of which 17 (11.0%) patients had liver resection and one patient was treated with percutaneous radio-frequency ablation. The majority of patients undergoing liver resection were treated with multiple metastectomies (n = 8) and three patients had major liver resections. The overall median survival for patients treated with surgery/ablation was 27 (14–90) months, and this was significantly better compared to patients treated palliatively [median = 8(1–30) months, P < 0.001]. Following surgery, 11 patients had recurrent disease [median = 13(6–36) months]. Patients who had undergone a major liver resection had a significantly poorer disease-free survival (P = 0.037).
Conclusions
Patients who can undergo surgical resection for metastatic uveal melanoma have a more favorable survival compared to those who do not. J. Surg. Oncol. 2014 109:542–547. © 2013 Wiley Periodicals, Inc.
61 citations
Leiden University Medical Center1, Université Bordeaux Segalen2, Uppsala University3, Katholieke Universiteit Leuven4, University of Verona5, Pierre-and-Marie-Curie University6, Institut Gustave Roussy7, Liverpool Hospital8, Beaujon Hospital9, French Institute of Health and Medical Research10, Caritas Hospital11, Hebron University12, European Organisation for Research and Treatment of Cancer13, Curie Institute14, Royal Liverpool University Hospital15, University of Strasbourg16
TL;DR: The formal consensus approach reached the elaboration of guidelines for standardised definitions of time-to-event end-points allowing cross-comparison of RCTs in pancreatic cancer.
60 citations
TL;DR: The recently described 2012 Revised Atlanta Classification and the Determinant Classification both provide a more accurate description of edematous and necrotizing pancreatitis and local complications.
Abstract: Acute pancreatitis has a mortality rate of 5-10%. Early deaths are mainly due to multiorgan failure and late deaths are due to septic complications from pancreatic necrosis. The recently described 2012 Revised Atlanta Classification and the Determinant Classification both provide a more accurate description of edematous and necrotizing pancreatitis and local complications. The 2012 Revised Atlanta Classification uses the modified Marshall scoring system for assessing organ dysfunction. The Determinant Classification uses the sepsis-related organ failure assessment scoring system for organ dysfunction and, unlike the 2012 Revised Atlanta Classification, includes infected necrosis as a criterion of severity. These scoring systems are used to assess systemic complications requiring intensive therapy unit support and intra-abdominal complications requiring minimally invasive interventions. Numerous prognostic systems and markers have been evaluated but only the Glasgow system and serum CRP levels provide pragmatic prognostic accuracy early on. Novel concepts using genetic, transcriptomic and proteomic profiling and also functional imaging for the identification of specific disease patterns are now required.
49 citations
01 Jan 2014
TL;DR: The recently described 2012 Revised Atlanta Classification and the Determinant Classification both provide a more accurate description of edematous and necrotizing pancreatitis and local complications.
Abstract: Acute pancreatitis has a mortality rate of 5–10%. Early deaths are mainly due to multiorgan failure and late deaths are due to septic complications from pancreatic necrosis. The recently described 2012 Revised Atlanta Classification and the Determinant Classification both provide a more accurate description of edematous and necrotizing pancreatitis and local complications. The 2012 Revised Atlanta Classification uses the modified Marshall scoring system for assessing organ dysfunction. The Determinant Classification uses the sepsis-related organ failure assessment scoring system for organ dysfunction and, unlike the 2012 Revised Atlanta Classification, includes infected necrosis as a criterion of severity. These scoring systems are used to assess systemic complications requiring intensive therapy unit support and intra-abdominal complications requiring minimally invasive interventions. Numerous prognostic systems and markers have been evaluated but only the Glasgow system and serum CRP levels provide pragmatic prognostic accuracy early on. Novel concepts using genetic, transcriptomic and proteomic profiling and also functional imaging for the identification of specific disease patterns are now required.
2 citations