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Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study
Andrea Imperatori, Giovanni Mariscalco, Giuditta Riganti, Nicola Rotolo, Valentina Conti, Lorenzo Dominioni
Journal of Cardiothoracic Surgery , 2012, DOI: 10.1186/1749-8090-7-4
Abstract: From 1996 to June 2009, 454 consecutive patients undergoing lobectomy for lung cancer were enrolled and followed-up until death or study end (October 2010). Patients with postoperative AF were identified; AF was investigated with reference to its predictors and to short- and long-term survival (> 5 years).Hospital mortality accounted for 7 patients (1.5%), while postoperative AF occurred in 45 (9.9%). Independent AF predictors were: preoperative paroxysmal AF (odds ratio [OR] 5.91; 95%CI 2.07 to 16.88), postoperative blood transfusion (OR 3.61; 95%CI 1.67 to 7.82) and postoperative fibro-bronchoscopy (OR 3.39; 95%CI 1.48 to 7.79). Patients with AF experienced higher hospital mortality (6.7% vs. 1.0%, p = 0.024), longer hospitalization (15.3 ± 10.1 vs. 12.2 ± 5.2 days, p = 0.001) and higher intensive care unit admission rate (13.3% vs. 3.9%, p = 0.015). The median follow-up was 36 months (maximum: 179 months). Among the 445 discharged subjects with complete follow-up, postoperative AF was not an independent predictor of mortality; however, among the 151 5-year survivors, postoperative AF independently predicted poorer long-term survival (HR 3.75; 95%CI 1.44 to 9.08).AF after pulmonary lobectomy for lung cancer, in addition to causing higher hospital morbidity and mortality, predicts poorer long-term outcome in 5-year survivors.Atrial fibrillation (AF) remains the most common medical complication after thoracic surgery, with an incidence ranging from 10% to 20% after pulmonary lobectomy, and as much as 40% after pneumonectomy [1-7]. Postoperative AF has been shown to predict worse prognosis, being correlated with higher hospital morbidity and mortality and with a considerable increase of hospital stay and cost [1-6]. However, the prognostic implications of this arrhythmia after pulmonary lobectomy for lung cancer remain controversial. None of the studies examining the consequences of postoperative AF has managed to present compelling data supporting an independent ass
Atrial fibrillation - An unusual presentation of metastatic lung cancer
Shameem Mohd,Bhargava Rakesh,Ahmed Z,Haque Faisal
Lung India , 2005,
Abstract: Cardiac rhythm disturbances are common concern among patients with neoplastic diseases. Arrhythmias may occur due to the effect of the tumor itself, treatment of the neoplastic process, or metabolic abnormalities. Dysrhythmia in cancer patients is morphologically and functionally identical to dysrhythmia seen in other patients. Atrial fibrillation may occur due to structural diseases of the heart like myxoma and rarely tumors from lung extending to myocardium. We report two cases of metastatic lung cancer, invading atrial cavity and presenting with atrial fibrillation.
Esophageal cancer presenting with atrial fibrillation: A case report
Ulas Bayraktar, Alix Dufresne, Soley Bayraktar, Roland Purcell, Ofem Ajah
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-292
Abstract: We present a 58-year-old man who developed atrial fibrillation with rapid ventricular rate in the emergency room while being evaluated for dysphagia and weight loss. Atrial fibrillation lasted less than 12 hours and did not recur. Echocardiogram did not reveal any structural heart disease. A 10-cm, ulcerated mid-esophageal mass was seen during esophagogastroscopy. Microscopic examination showed squamous cell carcinoma. Computed tomography of the chest revealed esophageal thickening compressing the left atrium.External compression of the left atrium was previously reported to provoke atrial fibrillation. Similarly, esophageal cancer may precipitate atrial fibrillation by mechanical compression of the left atrium or pulmonary veins, triggering ectopic beats in susceptible patients.Atrial fibrillation (AF) is a common arrhythmia and its prevalence increases with age. It is usually associated with underlying heart disease, of almost any cause, complicated by heart failure and atrial enlargement. Most common underlying disorders are hypertensive heart disease, coronary artery disease, valvular heart disease, hyperthyroidism, and alcoholism. The majority of AF episodes were found to be triggered by atrial ectopic beats from muscle fibers extending from the left atrium into the pulmonary veins [1]. Hence, radiofrequency catheter ablation of the pulmonary veins is effective for curing atrial fibrillation in selected cases, which may be complicated with atrioesophageal fistulas due to the proximity of the esophagus to the left atrium [2].Esophageal cancer (EC) is a relatively rare malignancy in the United States with a poor prognosis. The majority of ECs are squamous cell carcinoma (SCC) and adenocarcinoma (AC). Dysphagia and weight loss are the two most common presenting symptoms. The majority of SCCs are located in the midportion of the esophagus where it is closely related to the posterior wall of the left atrium.AF was previously reported in patients with EC as a complic
Geographic disparities in colorectal cancer survival
Kevin A Henry, Xiaoling Niu, Francis P Boscoe
International Journal of Health Geographics , 2009, DOI: 10.1186/1476-072x-8-48
Abstract: Using data from a population-based, statewide cancer registry, we examined a cohort of 25,040 men and women from New Jersey who were newly diagnosed with local or regional stage colorectal cancer from 1996 through 2003 and followed to the end of 2006. Survival times were adjusted for significant prognostic factors (sex, age, stage at diagnosis, race/ethnicity and census tract socioeconomic deprivation) and evaluated using a spatial scan statistic to identify places where CRC survival was significantly longer or shorter than the statewide experience.Age, sex and stage adjusted survival times revealed several areas in the northern part of the state where CRC survival was significantly different than expected. The shortest and longest survival areas had an adjusted 5-year survival rate of 73.1% (95% CI 71.5, 74.9) and 88.3% (95% CI 85.4, 91.3) respectively, compared with the state average of 80.0% (95% CI 79.4, 80.5). Analysis of survival times adjusted for age, sex and stage as well as race/ethnicity and area socioeconomic deprivation attenuated the risk of death from CRC in several areas, but survival disparities persisted.The results suggest that in areas where additional adjustments for race/ethnicity and area socioeconomic deprivation changed the geographic survival patterns and reduced the risk of death from CRC, the adjustment factors may be contributing causes of the disparities. Further studies should focus on specific and modifiable individual and neighborhood factors in the high risk areas that may affect a person's chance of surviving cancer.In the past several years, there has been significant progress in reducing colorectal cancer (CRC) incidence and mortality rates in most US population groups [1]. Despite this progress, an unequal cancer burden is borne by blacks, relative to whites, and by individuals of lower socioeconomic position. These groups have higher incidence and mortality rates, lower survival rates, and greater percentages diagnosed at advan
An overview of colorectal cancer survival rates and prognosis in Asia  [cached]
Bijan Moghimi-Dehkordi,Azadeh Safaee
World Journal of Gastrointestinal Oncology , 2012, DOI: 10.4251/wjgo.v4.i4.71
Abstract: Colorectal cancer is a rapidly rising trend in Asia. The incidence in many Asian countries is on par with the West. Several studies have provided data regarding the survival of patients with colorectal cancer. In Asia, the overall cure rate of colorectal cancer has not improved dramatically in the last decade, 5-year survival remaining at approximately 60%. Colorectal cancer survival time has increased in recent years, but mortality rate remains high. Although studies have determined a number of factors that can predict survival of patients after diagnosis, life expectancy has not been increased dramatically. It seems that among the prognostic factors explored so far, the most important are those that relate to early diagnosis of cancer. Primary detection is feasible since efficient screening modalities are available. Colonoscopic surveillance is needed, especially in subjects at higher risk.
Comparison of colorectal and gastric cancer: Survival and prognostic factors  [cached]
Moghimi-Dehkordi Bijan,Safaee Azadeh,Zali Mohammad
Saudi Journal of Gastroenterology , 2009,
Abstract: Background/Aims: Gastric and colorectal cancers are the most common gastrointestinal malignancies in Iran. We aim to compare the survival rates and prognostic factors between these two cancers. Methods: We studied 1873 patients with either gastric or colorectal cancer who were registered in one referral cancer registry center in Tehran, Iran. All patients were followed from their time of diagnosis until December 2006 (as failure time). Survival curves were calculated according to the Kaplan-Meier Method and compared by the Log-rank test. Multivariate analysis of prognostic factors was carried out using the Cox proportional hazard model. Results: Of 1873 patients, there were 746 with gastric cancer and 1138 with colorectal cancer. According to the Kaplan-Meier method 1, 3, 5, and 7-year survival rates were 71.2, 37.8, 25.3, and 19.5%, respectively, in gastric cancer patients and 91.1, 73.1, 61, and 54.9%, respectively, in patients with colorectal cancer. Also, univariate analysis showed that age at diagnosis, sex, grade of tumor, and distant metastasis were of prognostic significance in both cancers ( P < 0.0001). However, in multivariate analysis, only distant metastasis in colorectal cancer and age at diagnosis, grade of tumor, and distant metastasis in colorectal cancer were identified as independent prognostic factors influencing survival. Conclusions: According to our findings, survival is significantly related to histological differentiation of tumor and distant metastasis in colorectal cancer patients and only to distant metastasis in gastric cancer patients.
Atrial Fibrillation and Heart Failure
William G. Stevenson,Usha B. Tedrow,Jens Seiler
Journal of Atrial Fibrillation , 2008, DOI: 10.4022/jafib.v1i1.401
Abstract: Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.
Risk factors associated with atrial fibrillation in early period after operation of lung cancer  [cached]
Jing ZHANG,Baojian LUO,Fen HAN,Endong WU
Chinese Journal of Lung Cancer , 2008,
Abstract: Background and objective Atrial fibrillation (AF) is a common complication after operation of lung cancer. Atrial fibrillation is often associated with longer hospital stay time and higher hospital cost, as well as increased postoperative mortality. The aim of this study is to explore the risk factors of atrial fibrillation (AF) in early period after operation of lung cancer and analyze its impact on short-term mortality, hospital stay time and hospitalization cost.Methods From January 2006 to December 2007, 416 consecutive lung cancer patients underwent operation in our hospital were chosen. Postoperative ECG (electrocardiography) was used to diagnose AF. The cases were divided into two groups: AF group and control group (Non-AF group). Statistic χ2 test was used to compare numeration data and Logistic regression was performed to find risk factors of postoperative AF. Results In the 416 lung cancer patients, 52 cases (12.5%) were with AF and most occurred in the 1 to 3 days after operation. Multivariate analysis showed that the patients with age older than 65, preoperative pulmonary infection, low preoperative FEV1%pre, Intrapericardia operation and postoperative hypoxemia are prone to occur AF after operation. In AF group, the hospital stay time was longer, the hospitalization cost was higher. No obvious difference was observed with short-term mortality between the two groups. Conclusion The incidence of AF after operation with lung cancer is 12.5% (52/416). Patients with age older than 65, preoperative pulmonary infection, low FEV1%pre, intrapericardia operation and postoperative hypoxemia have a higher risk of AF following operation. Although postoperative AF has no obvious impact on short-term mortality, it is associated with longer impatient time and higher hospitalization cost.
Tumor infiltrating lymphocytes: an intriguing player in the survival of colorectal cancer patients
Vanessa Deschoolmeester, Marc Baay, Eric Van Marck, Joost Weyler, Peter Vermeulen, Filip Lardon, Jan B Vermorken
BMC Immunology , 2010, DOI: 10.1186/1471-2172-11-19
Abstract: Two-hundred-fifteen colorectal cancer cases, previously analyzed for microsatellite instability (MSI), were selected for immunohistochemical detection of CD3+, CD8+ infiltration and the expression of granzyme B. Prognostic relevance was assessed by survival analysis.Strong correlations were found between the infiltration of lymphocytes and several clinicopathological variables. Survival analysis revealed that intra-epithelial infiltration of CD3+ and CD8+ T lymphocytes and stromal infiltration of CD3+ lymphocytes had a major impact on the patients' overall survival in the univariate analysis, however independent of their association with MSI-status. In addition, it was also demonstrated that there was an important disease specific survival advantage for patients with microsatellite stable (MSS) tumors containing intraepithelial CD8+ tumor infiltrating lymphocytes. When samples were analyzed for colon cancer and rectal cancer separately, the results of the overall population were confirmed in colon cancer only. When entered into a multiple Cox regression analysis adjusting for other possible important confounding factors, the strong impact of lymphocyte infiltration on overall survival was not maintained. Only early stage and young age (borderline significant for overall population only) were associated with a better overall survival (early disease with disease-free survival also).In conclusion our results suggest a role for infiltrating CD3+ and CD8+ T lymphocytes in colorectal cancer whereby tumor infiltration could reflect a general principle of antitumor immunity, irrespective of the MSI-status.Colorectal cancer belongs to the most common malignancies in the Western World [1]. The treatment of choice remains surgical resection. For patients who undergo successful surgery for colorectal cancer, adjuvant chemotherapy and/or radiotherapy is recommended in cases of high risk stage II and III disease [2,3]. Although the introduction of new chemotherapeutic agents impr
Atrial fibrillation following cardiac surgery: risk analysis and long-term survival  [cached]
Helgadottir Solveig,Sigurdsson Martin I,Ingvarsdottir Inga L,Arnar David O
Journal of Cardiothoracic Surgery , 2012, DOI: 10.1186/1749-8090-7-87
Abstract: Background We studied potential risk factors for postoperative atrial fibrillation (POAF) in a large cohort of patients who underwent open-heart surgery, evaluating short- and long-term outcome, and we developed a risk-assessment model of POAF. Methods A retrospective study of 744 patients without prior history of AF who underwent CABG (n = 513), OPCAB (n = 207), and/or AVR (n = 156) at Landspitali Hospital in 2002–2006. Logistic regression analysis was used to study risk factors for POAF, comparing patients with and without POAF. Results The rate of POAF was 44%, and was higher following AVR (74%) than after CABG (44%) or OPCAB (35%). In general, patients with POAF were significantly older, were more often female, were less likely to be smokers, had a lower EF, and had a higher EuroSCORE. The use of antiarrythmics was similar in the groups but patients who experienced POAF were less likely to be taking statins. POAF patients also had longer hospital stay, higher rates of complications, and operative mortality (5% vs. 0.7%). In multivariate analysis, AVR (OR 4.4), a preoperative history of cardiac failure (OR 1.8), higher EuroSCORE (OR 1.1), and advanced age (OR 1.1) were independent prognostic factors for POAF. Overall five-year survival was 83% and 93% for patients with and without POAF (p <0.001). Conclusion POAF was detected in 44% of patients, which is high compared to other studies. In the future, our assessment score will hopefully be of use in identifying patients at high risk of POAF and lower complications related to POAF.
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