Postoperative hyperglycemia in patients undergoing cytoreductive surgery and HIPEC: A cohort study.

BACKGROUND: Hyperglycemia following elective or emergency surgery is generally associated with an increased risk of complications. The impact of hyperglycemia following surgery for peritoneal surface malignancy remains unclear. MATERIALS AND METHODS: Records of patients undergoing cytoreduction and HIPEC for peritoneal surface malignancy were reviewed at two institutions. Postoperative hyperglycemia was defined as serum glucose >140 mg/dl at the first measurement after surgery. Lengths of stay and 30-day complication rates were recorded. RESULTS: There were 115 total patients included, 65 from Institution A (A) and 50 from Institution B (B). Perioperative steroids were given to 55% (A) and 100% (B) of patients, with postoperative hyperglycemia present in 39% and 86% of patients respectively. Complication rates were not significantly different in patients with hyperglycemia versus patients who were normoglycemic at each site [56% vs. 53%, p = 0.8 at (A); 47% vs. 43%, p = 1.0 at (B)]. Infection rates were also similar between groups [16% vs. 13%, p = 0.72 at (A); 14% vs. 29%, p = 0.31 at (B)]. CONCLUSIONS: Rates of hyperglycemia in patients undergoing cytoreduction and HIPEC are high. This likely represents a stress response but does not seem to have the same adverse impact as seen in other abdominal surgical patient populations.

Loss of miR-155 upregulates WEE1 in metastatic melanoma.

Significant advances have been made in the treatment of melanoma by targeting key cellular pathways, but additional targets are needed as many patients do not respond or relapse with resistant disease. MicroRNA-155 (MiR-155) has previously been shown to regulate melanoma cell growth and acts as a tumor suppressor. We tested a clinical population of melanoma tumors for miR-155 expression, and find that expression is low in most patients, although not predictive of outcome. We identified the protein kinase WEE1 as a novel target of miR-155. A mouse model of experimental metastasis finds that both increased expression of miR-155 and silencing of WEE1 lead to decreased metastases. Loss of miR-155 and increased expression of WEE1 may contribute to the metastatic phenotype in patients with melanoma.

Pregnancy after a melanoma diagnosis in women in the United States.

BACKGROUND: Melanoma is the third most common cancer in women aged 18-39 years. Medical literature recommends that women wait for at least 2 years before becoming pregnant, yet few studies have examined pregnancy after melanoma. Our aims were to investigate the pregnancy rate after a melanoma diagnosis and the relationship between melanoma treatment and subsequent pregnancy. METHODS: We studied women with a melanoma diagnosis in the Truven Health MarketScan database. Women with a melanoma diagnosis were matched 1:1 to women with no melanoma diagnosis to compare pregnancy rates between groups. For women with melanoma, Cox models were fitted for rates of pregnancy overall, pregnancy if postsurgical treatment was received, and for treatment after pregnancy. RESULTS: The sample included 11,801 women aged 18-40 years with melanoma, who were not pregnant on the index date. These women had a higher rate of pregnancy within 2 years compared to matched controls (15.8% versus 13.6%, P < 0.001). For 0-9 months after diagnosis, women who received postsurgical treatment had a 74% lower probability of becoming pregnant (hazard ratio = 0.26, P = 0.003). Rates of treatment received after pregnancy were not significantly different (hazard ratio = 0.68, P = 0.23). CONCLUSIONS: Our study is the largest review of postmelanoma pregnancy in the United States. After a melanoma diagnosis, women had a slightly higher rate of pregnancy than matched controls, indicating that women are not delaying pregnancy. However, women who received advanced treatment for melanoma had a lower rate of pregnancy than untreated women. Women who became pregnant after a melanoma diagnosis did not have an increased risk of requiring subsequent treatment for melanoma.