Harveshp D Mogal1, Edward A Levine2, Greg Russell3, Perry Shen2, John H Stewart2, Konstantinos I Votanopoulos4. 1. Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA. hmogal@wakehealth.edu. 2. Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA. 3. Department of Biostatistics, Wake Forest Baptist Health, Winston-Salem, NC, USA. 4. Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA. kvotanop@wakehealth.edu.
Abstract
INTRODUCTION: Survival of patients after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy for appendiceal neoplasms is projected by conventional overall survival (OS) curves that do not address the survival time a patient has already accrued. We sought to study the conditional survival (CS) after CRS, contingent on patients surviving a fixed duration of time after surgery. METHODS: A retrospective analysis of 493 appendiceal cancer patients from a prospective database was performed. OS was calculated for patients who achieved a complete CRS. CS was estimated based on Kaplan-Meier curves to determine what the patient's long-term survival (3-, 5-, 7-, or 10-year) would be if they were alive at 1, 2, or 3 years from surgery. RESULTS: OS at 5 and 10 years for 137 low-grade patients with complete resections was 83.3 and 74.2 %, respectively. For low-grade patients still alive at 3 years, 5- and 10-year CS was 93.4 and 83.2 %, respectively. For the 35 high-grade patients with complete CRS who survived to 3 years, CS at 10 years was 41.7 %, while their 10-year conventional OS was 24.6 %. CONCLUSIONS: Conventional analysis underestimates OS due to unpredictable variations in tumor biology. When adjusted for time already elapsed since surgery, improvements in survival estimates are more pronounced with high-grade tumors. CS outcomes can be used in determining the optimal frequency of long-term follow-up of these patients.
INTRODUCTION: Survival of patients after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy for appendiceal neoplasms is projected by conventional overall survival (OS) curves that do not address the survival time a patient has already accrued. We sought to study the conditional survival (CS) after CRS, contingent on patients surviving a fixed duration of time after surgery. METHODS: A retrospective analysis of 493 appendiceal cancerpatients from a prospective database was performed. OS was calculated for patients who achieved a complete CRS. CS was estimated based on Kaplan-Meier curves to determine what the patient's long-term survival (3-, 5-, 7-, or 10-year) would be if they were alive at 1, 2, or 3 years from surgery. RESULTS:OS at 5 and 10 years for 137 low-grade patients with complete resections was 83.3 and 74.2 %, respectively. For low-grade patients still alive at 3 years, 5- and 10-year CS was 93.4 and 83.2 %, respectively. For the 35 high-grade patients with complete CRS who survived to 3 years, CS at 10 years was 41.7 %, while their 10-year conventional OS was 24.6 %. CONCLUSIONS: Conventional analysis underestimates OS due to unpredictable variations in tumor biology. When adjusted for time already elapsed since surgery, improvements in survival estimates are more pronounced with high-grade tumors. CS outcomes can be used in determining the optimal frequency of long-term follow-up of these patients.
Authors: Joshua Winer; Mazen Zenati; Lekshmi Ramalingam; Heather Jones; Amer Zureikat; Matthew Holtzman; Kenneth Lee; Steven Ahrendt; James Pingpank; Herbert J Zeh; David L Bartlett; Haroon A Choudry Journal: Ann Surg Oncol Date: 2013-11-08 Impact factor: 5.344
Authors: Hatem El Halabi; Vadim Gushchin; Jennifer Francis; Nicholas Athas; Ryan Macdonald; Carol Nieroda; Kimberly Studeman; Armando Sardi Journal: Ann Surg Oncol Date: 2011-07-12 Impact factor: 5.344
Authors: Olivier Glehen; François N Gilly; Florent Boutitie; Jean M Bereder; François Quenet; Lucas Sideris; Baudouin Mansvelt; Gérard Lorimier; Simon Msika; Dominique Elias Journal: Cancer Date: 2010-08-24 Impact factor: 6.860
Authors: Terence C Chua; Brendan J Moran; Paul H Sugarbaker; Edward A Levine; Olivier Glehen; François N Gilly; Dario Baratti; Marcello Deraco; Dominique Elias; Armando Sardi; Winston Liauw; Tristan D Yan; Pedro Barrios; Alberto Gómez Portilla; Ignace H J T de Hingh; Wim P Ceelen; Joerg O Pelz; Pompiliu Piso; Santiago González-Moreno; Kurt Van Der Speeten; David L Morris Journal: J Clin Oncol Date: 2012-05-21 Impact factor: 44.544
Authors: D Elias; F Gilly; F Quenet; J M Bereder; L Sidéris; B Mansvelt; G Lorimier; O Glehen Journal: Eur J Surg Oncol Date: 2010-03-12 Impact factor: 4.424
Authors: Robert F Bradley; John H Stewart; Gregory B Russell; Edward A Levine; Kim R Geisinger Journal: Am J Surg Pathol Date: 2006-05 Impact factor: 6.394
Authors: Keli M Turner; Nader N Hanna; Yue Zhu; Ajay Jain; Susan B Kesmodel; Rebecca A Switzer; Latoya M Taylor; H Richard Alexander Journal: Ann Surg Oncol Date: 2013-03-02 Impact factor: 5.344
Authors: Edward A Levine; John H Stewart; Perry Shen; Gregory B Russell; Brian L Loggie; Konstantinos I Votanopoulos Journal: J Am Coll Surg Date: 2013-12-21 Impact factor: 6.113
Authors: Konstantinos I Votanopoulos; Naeem A Newman; Greg Russell; Chukwuemeka Ihemelandu; Perry Shen; John H Stewart; Edward A Levine Journal: Ann Surg Oncol Date: 2013-06-19 Impact factor: 5.344
Authors: Omeed Moaven; Konstantinos I Votanopoulos; Perry Shen; Paul Mansfield; David L Bartlett; Greg Russell; Richard McQuellon; John H Stewart; Edward A Levine Journal: Ann Surg Oncol Date: 2019-11-12 Impact factor: 5.344