Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: A retrospective study of 5-year survivors.

BACKGROUND: Pancreaticoduodenectomy (PD) is the standard curative treatment for periampullary tumors. The aim of this study is to report the incidence and predictors of long-term survival (≥ 5 years) after PD. METHODS: This study included patients who underwent PD for pathologically proven periampullary adenocarcinomas. Patients were divided into 2 groups: group (I) patients who survived less than 5 years and group (II) patients who survived ≥ 5 years. RESULTS: There were 47 (20.6%) long-term survivors (≥ 5 years) among 228 patients underwent PD for periampullary adenocarcinoma. Patients with ampullary adenocarcinoma represented 31 (66.0%) of the long-term survivors. Primary analysis showed that favourable factors for long-term survival include age < 60 years old, serum CEA < 5 ng/mL, serum CA 19-9 < 37 U/mL, non-cirrhotic liver, tumor size < 2 cm, site of primary tumor, postoperative pancreatic fistula, R0 resection, postoperative chemotherapy, and no recurrence. Multivariate analysis demonstrated that CA 19-9 < 37 U/mL [OR (95% CI) = 1.712 (1.248-2.348), P = 0.001], smaller tumor size [OR (95% CI )= 1.335 (1.032-1.726), P = 0.028] and Ro resection [OR (95% CI) = 3.098 (2.095-4.582), P < 0.001] were independent factors for survival ≥ 5 years. The prognosis was best for ampullary adenocarcinoma, for which the median survival was 54 months and 5-year survival rate was 39.0%, and the poorest was pancreatic head adenocarcinoma, for which the median survival was 27 months and 5-year survival rate was 7%. CONCLUSIONS: The majority of long-term survivors after PD for periampullary adenocarcinoma are patients with ampullary tumor. CA 19-9 < 37 U/mL, smaller tumor size, and R0 resection were found to be independent factors for long-term survival ≥ 5 years.

Predictors of long term survival after hepatic resection for hilar cholangiocarcinoma: A retrospective study of 5-year survivors.

AIM: To determine predictors of long term survival after resection of hilar cholangiocarcinoma (HC) by comparing patients surviving > 5 years with those who survived < 5 years. METHODS: This is a retrospective study of patients with pathologically proven HC who underwent surgical resection at the Gastroenterology Surgical Center, Mansoura University, Egypt between January 2002 and April 2013. All data of the patients were collected from the medical records. Patients were divided into two groups according to their survival: Patients surviving less than 5 years and those who survived > 5 years. RESULTS: There were 34 (14%) long term survivors (5 year survivors) among the 243 patients. Five-year survivors were younger at diagnosis than those surviving less than 5 years (mean age, 50.47 ± 4.45 vs 54.59 ± 4.98, P = 0.001). Gender, clinical presentation, preoperative drainage, preoperative serum bilirubin, albumin and serum glutamic-pyruvic transaminase were similar between the two groups. The level of CA 19-9 was significantly higher in patients surviving < 5 years (395.71 ± 31.43 vs 254.06 ± 42.19, P = 0.0001). Univariate analysis demonstrated nine variables to be significantly associated with survival > 5 year, including young age (P = 0.001), serum CA19-9 (P = 0.0001), non-cirrhotic liver (P = 0.02), major hepatic resection (P = 0.001), caudate lobe resection (P = 0.006), well differentiated tumour (P = 0.03), lymph node status (0.008), R0 resection margin (P = 0.0001) and early postoperative liver cell failure (P = 0.02). CONCLUSION: Liver status, resection of caudate lobe, lymph node status, R0 resection and CA19-9 were demonstrated to be independent risk factors for long term survival.

Vitamin D receptor gene polymorphism and its association with 1,25-dihydroxyvitamin D3 in patients with Graves disease in an Egyptian population: a pilot study.

OBJECTIVE: To study the association of vitamin D receptor (VDR) gene polymorphisms (BsmI, ApaI, and TaqI) with susceptibility to Graves disease (GD) in Egyptian patients and their correlation with serum levels of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. METHODS: The current study consisted of 90 patients with GD (65 women and 25 men), with ages ranging from 25 to 55 years. A control group of 55 healthy euthyroid subjects (40 women and 15 men) with matched ages were included in the study. Genotyping was performed by restriction fragment length polymorphism analysis. Serum levels of 1,25(OH)2D3 were measured with use of radioimmunoassay in the patients and the control subjects. RESULTS: The distribution of genotype frequencies differed significantly between patients with GD and control subjects (BsmI: χ² = 10.627, P = .004; ApaI: χ² = 12.581, P = .001; TaqI: χ² = 9.591, P = .008). We found overexpression of the VDR BsmI "bb" (odds ratio, 2.360; 95% confidence interval [CI], 1.11 to 4.996), ApaI "aa" (odds ratio, 2.785; 95% CI, 1.116 to 6.933), and TaqI "TT" (odds ratio, 3.047; 95% CI, 1.478 to 6.283) genotypes in patients with GD in comparison with control subjects. In contrast, no correlation was observed with respect to the 1,25(OH)2D3 levels with BsmI, ApaI, and TaqI genotypes (P>.05) on the analysis of variance test. CONCLUSION: These data suggested that BsmI, ApaI, and TaqI polymorphisms in the VDR gene were associated with susceptibility to GD, whereas BsmI, ApaI, and TaqI polymorphisms were not associated with serum levels of 1,25(OH)2D3.