Francesca Cardella - Academia.edu (original) (raw)

Papers by Francesca Cardella

Cancers

Background: Microsatellite instability (MSI) is a predictive biomarker for immune checkpoint inhi... more Background: Microsatellite instability (MSI) is a predictive biomarker for immune checkpoint inhibitors. The main goal was to investigate the discordance between IHC and PCR/NGS for MSI testing in gastrointestinal cancers. Methods: Two series were analyzed through IHC for mismatch-repair-system proteins (MMRP) and PCR, with one series of 444 colorectal cancers (CRC) and the other of 176 gastric cancers (GC). All cases with discordant results between IHC and PCR were analyzed by NGS. IHC staining was evaluated as follows: proficient MMR (pMMR), with all MMR positive; deficient MMR (dMMR), with the loss of one heterodimer; and cases with the loss/patchy expression of one MMR (lo-paMMR). Cases with instability in at least two markers by PCR were MSI-high (MSI-H) and with instability in one marker, MSI-low (MSI-L). Cases without instability were evaluated as microsatellite-stable (MSS). Results: In the CRC cohort, 15 out of 444 cases were dMMR and 46 lo-paMMR. Among the 15 dMMR, 13 were...

Journal of Clinical Medicine

Background Coronavirus disease 2019 (COVID-19) can be complicated by interstitial pneumonia, poss... more Background Coronavirus disease 2019 (COVID-19) can be complicated by interstitial pneumonia, possibly leading to severe acute respiratory failure and death. Because of variable evolution ranging from asymptomatic cases to the need for invasive ventilation, COVID-19 outcomes cannot be precisely predicted on admission. The aim of this study was to provide a simple tool able to predict the outcome of COVID-19 pneumonia on admission to a low-intensity ward in order to better plan management strategies for these patients. Methods The clinical records of 123 eligible patients were reviewed. The following variables were analyzed on admission: chest computed tomography severity score (CTSS), PaO2/FiO2 ratio, lactate dehydrogenase (LDH), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio, C-reactive protein (CRP), fibrinogen, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, and albumin. The main outcome was the intensity of respirator...

Annali italiani di chirurgia, 2019

PURPOSE Oncological outcome depends not only on tumor behaviour but also on nutritional and immun... more PURPOSE Oncological outcome depends not only on tumor behaviour but also on nutritional and immune-inflammatory host status. Data in gastric cancer are limited. The main aim of this study was to prospectively assess Naples prognostic score (NPS) in gastric cancer patients. NPS was also compared with prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and systemic inflammation score (SIS). METHODS Overall survival (OS) and complication rates of 415 patients undergoing gastric cancer surgery from January 2000 to December 2015 were calculated. Disease-free survival (DFS) rates were assessed in 307 radically resected patients. MaxStat analysis was used to identify the best cut-off values. NPS scores were divided into 3 groups (NPS 0-3). The receiver-operating-characteristic (ROC) curve for censored survival data was used to compare the prognostic performance of scoring systems. RESULTS NPS positively correlated with current scoring systems (p<0.001) and a...

Background: The treatment of simultaneous oncological diseases in patients with other severe como... more Background: The treatment of simultaneous oncological diseases in patients with other severe comorbidities may be challenging. Multimodality treatment including percutaneous ablation and surgical resection may represent a valid option. Case Presentation: We report a singular case of a 71-year-old woman with diabetes, hypertensive heart disease, and HCV-related liver cirrhosis showing synchronous retroperitoneal liposarcoma and recurrent hepatocarcinoma. The patients have been treated, two years and one year before, with ablative therapy for hepatocarcinomas grown in the IV-V and IV-VIII hepatic segments, respectively. On November 2015, the patient was admitted at our Department for a large retroperitoneal liposarcoma in the left abdomen and preoperative imaging discovered a recurrent HCC at the site of the previous ablation. In order to offer a chance of cure to the patient, a multimodal approach was performed. It made up of two surgical phases, a thermoablative phase followed by a ...

Updates in Surgery, 2021

Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted ... more Background The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic. Methods The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March–May 2020), II (June–September 2020), and III (October–December 2020). Results Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative pati...

Background: Surgical treatment of breast cancer, the most frequent cancer in women, is deeply cha... more Background: Surgical treatment of breast cancer, the most frequent cancer in women, is deeply changed in the last years turning towards a progressive minimally invasion, both in extend of demolition and in axillary dissection completeness. This is due to the flexibility of the concept of radicality that today is taylored on the patient, rather than on the disease; If oncologic radicality is preserved, a less invasive operation on the breast is mandatory. In the era of mini-invasive surgery, a patient may ask for an aesthetic care without any additional health risk.Methods: In this article, we compared two groups of 75 consecutive patients undergoing conservative surgery for early stage breast cancer; the two groups were randomized for standard quadrantectomy and totally subcutaneous quadrantectomy. Statistical analysis was carried out for comparing data.Results: No difference in oncologic outcome was found with the different surgical procedures; the length of hospital stay and the i...

Cancers, 2021

Despite recent progresses, locally advanced gastric cancer remains a daunting challenge to embrac... more Despite recent progresses, locally advanced gastric cancer remains a daunting challenge to embrace. Perioperative chemotherapy and D2-gastrectomy depict multimodal treatment of gastric cancer in Europe, shows better results than curative surgery alone in terms of downstaging, micrometastases elimination, and improved long-term survival. Unfortunately, preoperative chemotherapy is useless in about 50% of cases of non-responder patients, in which no effect is registered. Tumor regression grade (TRG) is directly related to chemotherapy effectiveness, but its understanding is achieved only after surgical operation; accordingly, preoperative chemotherapy is given indiscriminately. Conversely, Naples Prognostic Score (NPS), related to patient immune-nutritional status and easily obtained before taking any therapeutic decision, appeared an independent prognostic variable of TRG. NPS was calculated in 59 consecutive surgically treated gastric cancer patients after neoadjuvant FLOT4-based ch...

Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging, 2020

Peritoneal carcinomatosis (PC) is a severe oncological condition originating from the mesothelium... more Peritoneal carcinomatosis (PC) is a severe oncological condition originating from the mesothelium or, more frequently, from gastrointestinal or gynecological tumors. The PC is believed to be a terminal phase of the oncological disease and, if left untreated, has a median survival of approximately 6 months after diagnosis. PC originating from colorectal cancer is often a metachronous disease, and only 10–15% of patients with colorectal cancer show PC at the time of primary diagnosis. However, the peritoneum is involved up to 50% of cases in patients with colorectal cancer who develop tumor recurrence after potentially curative surgery of the primary tumor; and in 10–35% of cases it is the only site of tumor recurrence. The only potentially curative treatment in primary and metastatic peritoneal carcinomatosis is cytoreductive surgery associated with intraperitoneal hyperthermic chemotherapy (HIPEC) with a 5-year survival rate of 30–48%, in selected cases. One of the most critical problems in PC treatment is represented by the correct diagnosis of the peritoneal nodules and identification of smaller lesions. In recent years, new technologies have allowed surgeons to cope better with these limits. Intraoperative fluoroscopy (FI) is a recently revised imaging modality that could improve PC detection. Indocyanine green (ICG), a near-infrared contrast agent that may become fluorescent, has been shown to selectively accumulate in the tumor tissue, thus increasing diagnostic detection of PC.

Surgical Innovation, 2018

Background. After surgery for liver tumors, recurrence rates remain high because of residual posi... more Background. After surgery for liver tumors, recurrence rates remain high because of residual positive margins or undiagnosed lesions. It has been suggested that detection of hepatic tumors can be obtained with near-infrared fluorescence imaging (FI). Indocyanine green (ICG) has been used with contrasting results. The aims of this study were to explore ICG-FI-guided surgery methodology and to assess its potential applications. Materials and Methods. Out of 14 patients with liver tumors, 5 were not operated on, and 9 patients (3 primary and 6 metastatic tumors) underwent surgery. ICG (0.5 mg/kg) was injected intravenously 24 hours before surgery. Fluorescence was investigated prior to resection to detect liver lesions, during hepatic transection to guide surgery, on both cross-section and benchtop to assess surgical margins, and for pathological evaluation. Results. All operations were successful and had a short duration. ICG-FI detected all already known lesions (n = 10), and identified 2 additional small tumors (1 hepatocarcinoma and 1 metastasis, diagnostic improvement = 20%). Two hepatocarcinomas were hyperfluorescent; the remaining one, with a central hypofluorescent area and a hyperfluorescent ring, was indeed a mixed cholangiohepatocarcinoma. All metastatic nodules were hypofluorescent with a hyperfluorescent rim. In all cases, in vivo and ex vivo fluorescence revealed clear liver margins. Postoperative pathological examination greatly benefited of liver fluorescence to assess radicality. Conclusion. ICG-FI-guided surgery was shown to be an effective tool to improve both intraoperative staging and radicality in the surgical treatment of primary and metastatic liver tumors.

Diseases of the colon and rectum, 2017

The existing scores reflecting the patient's nutritional and inflammatory status do not inclu... more The existing scores reflecting the patient's nutritional and inflammatory status do not include all biomarkers and have been poorly studied in colorectal cancers. The purpose of this study was to assess a new prognostic tool, the Naples prognostic score, comparing it with the prognostic nutritional index, controlling nutritional status score, and systemic inflammation score. This was an analysis of patients undergoing surgery for colorectal cancer. The study was conducted at a university hospital. A total of 562 patients who underwent surgery for colorectal cancer in July 2004 through June 2014 and 468 patients undergoing potentially curative surgery were included. MaxStat analysis dichotomized neutrophil:lymphocyte ratio, lymphocyte:monocyte ratio, prognostic nutritional index, and the controlling nutritional status score. The Naples prognostic scores were divided into 3 groups (group 0, 1, and 2). The receiver operating characteristic curve for censored survival data compared ...

World Journal of Surgery, 2017

Background Indocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferent... more Background Indocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferentially accumulates in cancer tissue. The aim of our study was to investigate the role of fluorescence imaging (FI) with ICG (ICG-FI) for detecting peritoneal carcinomatosis (PC) from colorectal cancer (CRC). Methods Four CRC patients with PC scheduled for cytoreductive surgery ? hyperthermic intraperitoneal chemotherapy were enrolled in this prospective study. At a median time of 50 min after 0.25 mg/kg ICG injected intravenously, intraoperative ICG-FI using Fluobeam Ò was performed in vivo and ex vivo on all specimens. The Peritoneal Cancer Index was used to estimate the likelihood of complete cytoreduction. Results No severe complications were recorded. ICG-FI took a median of 20 min (range 10-30, IQR 15-25). Sixtynine nodules were harvested. Fifty-two nodules had been diagnosed preoperatively by conventional imaging (n = 30; 43%) or intraoperatively by visual inspection/palpation (n = 22; 32%). With ICG-FI, 47 (90%) nodules were hyperfluorescent, and five hypofluorescent. Intraoperative ICG-FI identified 17 additional hyperfluorescent nodules. On histopathology, 16 were metastatic nodules. Sensitivity increased from 76.9%, with the conventional diagnostic procedures, to 96.9% with ICG-FI. The positive predictive value of ICG-FI was 98.4%, and test accuracy was 95.6%. Diagnostic performance of ICG-FI was significantly better than preoperative (p = 0.027) and intraoperative conventional procedures (p = 0.042). The median PCI score increased from 7 to 10 after ICG-FI (p \ 0.001). Conclusions Our results suggest that intraoperative ICG-FI can improve outcomes in patients undergoing CS for PC from CRC. Further studies are needed to determine the role of ICG-FI in this patient population.

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, Jan 27, 2017

Cancer outcome is considered to result from the interplay of several factors, among which host in... more Cancer outcome is considered to result from the interplay of several factors, among which host inflammatory and immune status are deemed to play a significant role. The neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR) have been profitably used as surrogate markers of host immunoinflammatory status and have also been shown to correlate with outcome in several human tumors. However, only a few studies on these biomarkers have been performed in gastric cancer patients, yielding conflicting results. Data were retrieved from a prospective institutional database. Overall survival (OS) of 401 patients undergoing surgery for gastric cancer between January 2000 and June 2015 as well as disease-free survival (DFS) rates in 297 radically resected patients were calculated. MaxStat analysis was used to select cutoff values for NLR and LMR. NLR and LMR did not significantly correlate with tumor stage. Patients with a high NLR and a low LMR experienced more tumor rec...

PloS one, 2017

In gastric cancer, the current AJCC numeric-based lymph node staging does not provide information... more In gastric cancer, the current AJCC numeric-based lymph node staging does not provide information on the anatomical extent of the disease and lymphadenectomy. A new anatomical location-based node staging, proposed by Choi, has shown better prognostic performance, thus soliciting Western world validation. Data from 284 gastric cancers undergoing radical surgery at the Second University of Naples from 2000 to 2014 were reviewed. The lymph nodes were reclassified into three groups (lesser and greater curvature, and extraperigastric nodes); presence of any metastatic lymph node in a given group was considered positive, prompting a new N and TNM stage classification. Receiver-operating-characteristic (ROC) curves for censored survival data and bootstrap methods were used to compare the capability of the two models to predict tumor recurrence. More than one third of node positive patients were reclassified into different N and TNM stages by the new system. Compared to the current staging ...

Surgery, Jan 24, 2015

Systemic inflammation and immune response play a crucial role in tumor growth, and the neutrophil... more Systemic inflammation and immune response play a crucial role in tumor growth, and the neutrophil to lymphocyte ratio (NLR) may be a simple way to assess the host inflammatory response. The NLR has been shown to be a prognostic indicator in many human tumors; in early colon cancers, it has been evaluated only in a few studies and its role remains controversial. We analyzed data from 503 colon cancer patients. The best cutoff value for NLR was defined by receiver operating characteristic curve analysis. We grouped 276 Dukes A/B colon cancers, not receiving adjuvant chemotherapy, into low (<2.36) and high (>2.36) NLR and subjected to further analyses related to disease-free survival (DFS). A propensity score-matched analysis and the inverse probability of treatment weighting (IPTW) were performed to avoid confounding bias. The NLR correlated with tumor stage and oncologic outcome. The best NLR cutoff value was identical in the whole cohort and in Dukes A/B patients. Low NLR pati...

Surgery, 2015

Although D2 lymphadenectomy has been shown to improve outcomes in gastric cancer, it may increase... more Although D2 lymphadenectomy has been shown to improve outcomes in gastric cancer, it may increase postoperative morbidity, mainly owing to splenopancreatic complications. In addition, the effects of nodal dissection along the proper hepatic artery have not been extensively elucidated. We hypothesized that modified D2 (ie, D1+) lymphadenectomy may decrease surgical risks without impairing oncologic adequacy. Patients with node-positive gastric cancer undergoing curative total gastrectomy were intraoperatively randomized to D1+ (group 1, 36 patients) or standard D2 lymphadenectomy (group 2, 37 patients), the latter including splenectomy and nodal group 12a. The index of estimated benefit was used to assess the efficacy of dissection of each nodal station. The primary endpoint for oncologic adequacy was the disease-free survival (DFS) rate. Surgical complications were significantly more common in group 2, which also included 2 postoperative deaths. Overall, 35 patients (49%) experienced tumor recurrence. The primary site of tumor relapse and the 5-year DFS rate were not different between the 2 groups. Involvement of the second nodal level was associated with a worse DFS rate; however, patients undergoing more extensive lymphadenectomy did not show a better DFS rate. The incidence of involvement of nodal stations 10, 11d, and 12a was 5%, and the 5-year DFS rate was zero. Consequently, the benefit to dissect such lymph nodes was null. These findings suggest that modified D2 lymphadenectomy confers the same oncologic adequacy as standard D2 lymphadenectomy, with a significant reduction of postoperative morbidity.