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C S McArdle

Publications and source records attributed to C S McArdle.

At least 19 recordsLinked to original sources
PubMed2002

Outcome following surgery for colorectal cancer: analysis by hospital after adjustment for case-mix and deprivation.

Outcome, adjusted for case-mix and deprivation, in 3200 patients undergoing resection for colorectal cancer in 11 hospitals in Central Scotland between 1991 and 1994 was studied. There were significant differences among individual hospitals in the proportion of elderly (P<0.001) and deprived (P<0.0001) patients, the mode (P=0.007) and stage (P<0.0001) at presentation, and the proportion of patients who underwent apparently curative resection (P<0.001). There were no significant differences in postoperative mortality. Cancer-specific survival at 5 years following apparently curative resection varied from 59 to 76%; cancer-specific survival at 2 years following palliative resection varied from 22 to 44%. The corresponding hazard ratios, adjusted for the above prognostic factors, for patients undergoing apparently curative resection varied among hospitals from 0.58 to 1.32; and the ratios for palliative resection varied from 0.73 to 1.26. This study demonstrates that, after adjustment for variations in case-mix and deprivation, significant differences in outcome among hospitals following resection for colorectal cancer persist.

Aged↗
PubMed2001

Longitudinal study of resting energy expenditure, body cell mass and the inflammatory response in male patients with non-small cell lung cancer.

The aim of this study was to examine the inter-relationship between the inflammatory response and resting energy expenditure in patients with non-small cell lung cancer (NSCLC) before and after the onset of weight loss. Healthy subjects (n=7) and patients with NSCLC without weight loss (n=12) were studied. Resting energy expenditure adjusted for metabolically active tissue, as measured by total body potassium, was approximately 15% higher in the NSCLC group (P<0.01). Moreover, the resting energy expenditure, correlated with the magnitude of the inflammatory response (r=0.753, P<0.01). Six cancer patients subsequently lost weight and the relationship between resting energy expenditure and the inflammatory response was maintained. These results highlight the impact of the inflammatory response on the increase in the resting energy expenditure which precedes the onset of weight loss in patients with NSCLC.

Adult↗
PubMed2001

Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss.

The association between hypoalbuminemia and poor prognosis in patients with cancer is well recognized. However, the factors that contribute to the fall in albumin concentrations are not well understood. In the present study, we examined the relationship between circulating albumin concentrations, weight loss, the body cell mass (measured using total body potassium), and the presence of an inflammatory response (measured using C-reactive protein) in male patients (n = 40) with advanced lung or gastrointestinal cancer. Albumin concentrations were significantly correlated with the percent ideal body weight (r = 0.390, p < 0.05), extent of reported weight loss (r = -0.492, p < 0.01), percent predicted total body potassium (adjusted for age, height, and weight, r = 0.686, p < 0.001), and log10 C-reactive protein concentrations (r = -0.545, p < 0.001). On multiple regression analysis, the percent predicted total body potassium and log10 C-reactive protein concentrations accounted for 63% of the variation in albumin concentrations (r2 = 0.626, p < 0.001). The interrelationship between albumin, body cell mass, and the inflammatory response is consistent with the concept that the presence of an ongoing inflammatory response contributes to the progressive loss of these vital protein components of the body and the subsequent death of patients with advanced cancer.

Aged↗
PubMed2000

Potential role of doppler perfusion index in selection of patients with colorectal cancer for adjuvant chemotherapy.

BACKGROUND: As yet there is no established method of accurately identifying patients with colorectal cancer who, despite undergoing apparently curative resection, are at high risk of recurrence. We assessed whether the doppler perfusion index (DPI; ratio of hepatic arterial to total liver blood flow) could be used to select patients who should receive adjuvant chemotherapy. METHODS: We studied 120 patients undergoing curative surgery for colorectal cancer. DPI was measured before surgery with colour duplex doppler ultrasonography. A DPI value of at least 0.3 was defined as abnormal. All patients were followed up until death or for at least 5 years. RESULTS: At 5 years, patients with Dukes' stage A or B tumours (n=61) had recurrence-free survival of 57% and overall survival of 64%, compared with 39% and 42% for patients with Dukes' stage C tumours (n=59; p=0.016 and p=0.008, respectively). 47 patients had normal DPI values and 73 patients had abnormal values. Patients with normal DPI had recurrence-free survival of 89% and overall survival of 91%, compared with 22% and 29% for those with abnormal DPI values (both p<0.0001). CONCLUSIONS: DPI can be used to identify patients with colorectal cancer at high risk of recurrence who are in need of adjuvant treatment. However, further studies with larger numbers of patients are needed to confirm these findings.

Adult↗
PubMed2000

Changes in micronutrient concentrations following anti-inflammatory treatment in patients with gastrointestinal cancer.

Circulating concentrations of vitamin antioxidants (retinol, alpha-tocopherol, lutein, lycopene, alpha- and beta-carotene) and trace elements (zinc, copper, iron and selenium) plus carrier proteins (albumin, transferrin, caeruloplasmin) in gastrointestinal cancer patients (n = 12) with an inflammatory response (as demonstrated by an elevated C-reactive protein concentration) were compared with a control group (n = 12). Further, the effect of moderating the inflammatory response, using the anti-inflammatory agent ibuprofen, on these measurements was examined in the cancer group. The control and cancer groups were similar in terms of age, sex, and body mass index. However, the cancer group had significantly higher C-reactive protein concentrations (P < 0.001). Concentrations of vitamin antioxidants and trace elements (and carrier proteins) were significantly lower (P < 0.001), except copper (ceruloplasmin) which was significantly higher (P < 0.05). After anti-inflammatory treatment, there were small but significant increases in lutein, lycopene, and beta-carotene (P < 0.05) and in iron and selenium (P < 0.05), whereas ceruloplasmin decreased (P < 0. 05). The micronutrient concentrations in the cancer patients remained different from those in the control subjects. These results support the concept that the magnitude of inflammation plays an important role in the regulation of circulating concentrations of vitamin antioxidants and trace elements in patients with gastrointestinal cancer.

Adrenal Cortex Hormones↗
PubMed2000

Improved characterisation of focal liver tumours: dynamic power Doppler imaging using NC100100 echo-enhancer.

OBJECTIVE: To assess the vascularisation of focal hepatic tumours using NC100100, enhanced power Doppler imaging. METHODS: Twenty-two patients with focal liver tumours (12 metastases and ten hemangiomas) were studied. Using standardised settings, power Doppler imaging with ATL HDI3000 was performed before and after intravenous administration of NC100100 contrast agent. The video-recorded examinations were digitised for off-line analysis on a personal computer. Regions of interest were defined over the entire tumour and a neighbouring area of the normal liver parenchyma. The temporal changes of the mean power Doppler signal intensity (PDSI) was quantified to provide contrast agent wash-in (PDSI-time) curves for the initial 40 s. RESULTS: Liver metastases were characterised by a rapid increase in PDSI, while the PDSI-time curves within hemangiomas were flat. The PDSI within the tumour increased significantly in ten subjects with liver metastases and only one subject with hemangioma. An enhanced rim around hemangiomas was seen in four subjects. There was no clear relationship between the contrast agent dose and the peak PDSI within metastases. CONCLUSIONS: Power Doppler imaging with NC100100 contrast agent enhances tumour visualisation and may aid differential diagnosis of focal liver lesions.

Adult↗
PubMed2000

The effect of resecting the primary tumour on the Doppler Perfusion Index in patients with colorectal cancer.

AIM: In patients undergoing apparently curative resection for colorectal cancer, an elevated Doppler Perfusion Index (DPI; ratio of hepatic arterial to total liver blood flow) before surgery is associated with a high risk of recurrence. The role of the primary tumour in inducing and sustaining these blood flow changes is unknown. The aim of this study was to assess the impact of removing the primary tumour on the DPI. MATERIALS AND METHODS: Using duplex/colour Doppler sonography, the DPI was measured both before and after surgery (median, 9 months) in 14 patients undergoing apparently curative resection for colorectal cancer. RESULTS: In the five patients with a normal pre-operative DPI (< 0.30), there was no significant change following surgery. In the nine patients with an abnormal pre-operative DPI, there was a small but significant fall from 0.38 (SEM 0.02) to 0.33 (0.02) following surgery (P = 0.04). However, DPI values remained abnormally elevated in seven of these nine patients. CONCLUSION: These results suggest that the primary tumour plays a relatively minor role in inducing an abnormally elevated DPI in patients undergoing apparently curative resection for colorectal cancer.Oppo, K. (2000). Clinical Radiology55, 791-793.

Aged↗
PubMed2000

Prognostic factors in advanced gastrointestinal cancer patients with weight loss.

There are few reports on factors that determine survival in advanced gastrointestinal cancer with weight loss. In these patients (n = 91, median weight loss 16.6%), we prospectively examined the importance of metastatic spread, anthropometry, blood parameters, Karnofsky performance status, appetite, and the acute-phase response as predictors of survival. Survival was calculated from date of assessment to the most recent clinic attendance (> or = 30 mo) or until death. On multivariate analysis, metastatic spread (p < 0.05), Karnofsky performance status (p < 0.01), and C-reactive protein concentration (p < 0.001) had independent prognostic value. In locally advanced disease (n = 64), Karnofsky performance status and C-reactive protein concentration remained significant. There was a significantly lower survival in patients with an acute-phase response (median 136 days) than in patients with no response (median 466 days; p < 0.01). Performance status and the acute-phase response are associated, independent of weight loss, with survival duration in advanced gastrointestinal cancer patients.

Acute-Phase Reaction↗
PubMed1999

A prospective randomized study of megestrol acetate and ibuprofen in gastrointestinal cancer patients with weight loss.

The use of megestrol acetate in the treatment of weight loss in gastrointestinal cancer patients has been disappointing. The aim of the present study was to compare the combination of megestrol acetate and placebo with megestrol acetate and ibuprofen in the treatment of weight loss in such patients. At baseline, 4-6 weeks and 12 weeks, patients underwent measurements of anthropometry, concentrations of albumin and C-reactive protein and assessment of appetite, performance status and quality of life using EuroQol-EQ-5D and EORTC QLQ-C30. Thirty-eight and 35 patients (median weight loss 18%) were randomized to megestrol acetate/placebo or megestrol acetate/ibuprofen, respectively, for 12 weeks. Forty-six (63%) of patients failed to complete the 12-week assessment. Of those evaluable at 12 weeks, there was a decrease in weight (median 2.8 kg) in the megestrol acetate/placebo group compared with an increase (median 2.3 kg) in the megestrol acetate/ibuprofen group (P<0.001). There was also an improvement in the EuroQol-EQ-5D quality of life scores of the latter group (P<0.05). The combination of megestrol acetate/ibuprofen appeared to reverse weight loss and appeared to improve quality of life in patients with advanced gastrointestinal cancer. Further trials of this novel regimen in weight-losing patients with hormone-insensitive cancers are warranted.

Aged↗
PubMed1999

Intra-arterial 5-fluorouracil and intravenous folinic acid in the treatment of liver metastases from colorectal cancer.

OBJECTIVE: To compare two regimens of intra-arterial chemotherapy for the treatment of hepatic metastases from colorectal cancer. DESIGN: Open study. SETTING: Teaching hospital, UK SUBJECT: 57 patients with unresectable metastases confined to the liver, and an indwelling catheter in the hepatic artery. INTERVENTIONS: The first 33 patients had a 24-hour intra-arterial infusion of 5-fluorouracil (5-FU) 1500 mg/m2, together with folinic acid 200 mg/m2 intravenously for the first and last two hours of the 5-FU infusion. This was repeated at weekly intervals for six weeks followed by a two-week gap before the next cycle. The remaining 24 patients had a two-weekly regimen in which folinic acid 200 mg/m2 was infused intravenously over 2 hours followed by an intra-arterial loading dose of 5-FU 400 mg/m2 over 15 minutes; 5-FU 1600 mg/m2 was then given by intra-arterial infusion over 22 hours. This was repeated on day 2 and then at two-weekly intervals. MAIN OUTCOME MEASURES: Response rate and toxicity. RESULTS: Median follow-up was 21 months, and estimated median survival 19 months. 29 patients (51%) have responded, 5 completely. There are no significant differences between the groups. Sites of progression were liver alone 26 (53%), lung alone 9 (18%), liver and lung 3 (6%), and the remainder in local or regional nodes (n = 7) or bone (n = 4). Six patients experienced WHO grade 3 or 4 toxicity. CONCLUSION: The two regimens have high response rates and cause little systemic toxicity. Intra-arterial chemotherapy for hepatic metastases from colorectal cancer is currently being compared with conventional systemic chemotherapy in a randomised controlled trial.

Adult↗
PubMed1999

Longitudinal study of weight, appetite, performance status, and inflammation in advanced gastrointestinal cancer.

There is increasing evidence that, in most patients with advanced cancer, weight loss is associated with an inflammatory response. To examine the temporal relationship between weight loss, appetite, performance status, and the inflammatory response, 50 patients with advanced gastrointestinal cancer with weight loss were observed for six weeks. Patients were grouped according to whether they had lost weight (> 3%, n = 16), were weight stable (< 3% change, n = 25), or gained weight (> 3%, n = 9). At baseline, the group that subsequently lost weight had lower albumin and higher C-reactive protein concentrations (p < 0.05). On follow-up, there was an increase in C-reactive protein concentration and reductions in triceps skinfold thickness and Karnofsky performance status in the weight-losing group (p < 0.05). In contrast, Karnofsky performance status was improved in the group that gained weight (p < 0.05). Over the six to eight weeks, there was a difference in the changes of triceps skinfold thickness (p < 0.05) and Karnofsky performance status (p < 0.01) between the two groups. These results suggest that loss or gain of > 2.5 kg over a six- to eight-week period is required to produce a significant alteration in performance status in weight-losing patients with gastrointestinal cancer. Moreover, the results suggest that the presence of an inflammatory response is associated with further weight loss and the deterioration of performance status.

Adult↗
PubMed1998

Oestrogen receptor status predicts local recurrence following breast conservation surgery for early breast cancer.

AIMS: To evaluate factors predicting locoregional recurrence in patients treated for early breast carcinoma by breast conservation surgery with or without radiotherapy. METHODS: A retrospective study of 256 patients was carried out, with special emphasis on the role of oestrogen receptor status. Other parameters studied included age, menopausal status, size of primary tumour, tumour type, axillary nodal status and adjuvant therapy. RESULTS: Multivariate analysis showed the following parameters to be independent predictors of locoregional recurrence. Radiotherapy (57% reduction in hazard, P = 0.004): expression of oestrogen receptors (52% reduction in hazard, P = 0.008); tamoxifen therapy (46% reduction in hazard, P = 0.023); tumour size (40% increase in hazard per cm, P<0.001). CONCLUSIONS: Within this study, lack of oestrogen receptor expression was a strong independent factor associated with a higher rate of locoregional recurrence. This may be of value in selecting a group of patients less suitable for breast conservation surgery.

Adult↗
PubMed1998

Prospective assessment of the hepatic perfusion index in patients with colorectal cancer.

BACKGROUND: This prospective study was designed to test the hypothesis that abnormal liver blood flow is related to poor prognosis in patients with colorectal cancer. METHODS: The hepatic perfusion index (HPI), measured by dynamic hepatic scintigraphy, was assessed in 202 patients with colorectal cancer. Assessment for overt hepatic metastasis included liver palpation at laparotomy and perioperative computed tomography (CT). Follow-up at a dedicated clinic included regular abdominal ultrasonography and CT. RESULTS: The HPI was abnormal (greater than 0.37) in 92 (88 per cent) of 105 patients with overt liver metastases. Of 89 patients with no evidence of overt metastases or residual tumour after primary resection, 52 had an abnormal and 37 a normal HPI. At a median follow-up of 39 (range 13-76) months, 25 of 38 patients with recurrence had an abnormal HPI. Some 31 of 45 patients who died had an abnormal HPI. The HPI predicted overall recurrence (P=0.04, log rank test). Multivariate analysis showed the HPI was independent of Dukes stage for predicting disease-free survival (P=0.04, relative risk 1.94 (95 per cent confidence interval (c.i.) 1.03-3.67)) but this just failed to attain significance for overall survival (P=0.055, relative hazard 1.88 (95 per cent c.i. 1.00-3.58)). CONCLUSION: The HPI predicts a poor outcome in patients with colorectal cancer and may be useful in patient selection for adjuvant chemotherapy.

Adult↗
PubMed1998

Longitudinal study of body cell mass depletion and the inflammatory response in cancer patients.

There is recent evidence that the inflammatory response may be important in the disproportionate loss of body cell mass in cancer patients. To examine this further, 18 male patients with lung or gastrointestinal cancer were studied over a 12-week period. In addition to weight, anthropometry, C-reactive protein (marker of the inflammatory response), albumin, and total body potassium were measured at baseline and 12 weeks. When those patients who lost total body potassium were compared with those who had not, there was a significant increase in the baseline and 12-week C-reactive protein concentrations (p < 0.05). The reduction in total body potassium was also associated with a reduction in triceps skinfold thickness (p < 0.05). There were significant correlations between the mean C-reactive protein concentration and the relative (r = -0.846, p < 0.001) and absolute (r = -0.806, p < 0.001) change in total body potassium over the follow-up period. This study demonstrates the association of a chronic inflammatory response with the rate of loss of body cell mass observed in cancer patients.

Aged↗
PubMed1998

Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients.

The relationship between weight loss, appetite, the inflammatory response, and quality of life in patients with advanced gastrointestinal cancer was examined. Height, weight, and skinfold anthropometry were measured in 119 patients. Blood was taken for analysis of C-reactive protein and albumin. Appetite, performance status, and quality of life were assessed using EuroQol EQ-5D and EORTC QLQ-C30 questionnaires. Weight loss was > 5% (median 17.1%) of their preillness weight in 97 patients; the remaining 22 patients were weight stable. Anthropometric measurements and circulating albumin concentrations were significantly lower (p < 0.01) and circulating concentrations of C-reactive protein were significantly higher in the weight-losing than in the weight-stable group (p < 0.001). Appetite scores, performance status, and EuroQol EQ-5D and EORTC QLQ-C30 scores were also lower in the weight-losing group (p < 0.01). When the weight-losing cancer patients were divided on the basis of whether they had a marked inflammatory response, albumin concentrations, appetite, and Karnofsky performance status were significantly lower (p < 0.05) in the group with a marked inflammatory response. The results of the present study are consistent with weight loss, reduction of appetite, and an elevated inflammatory response being important related factors in lowering the quality of life of gastrointestinal cancer patients.

Aged↗
PubMed1998

Progesterone resistance in women who have had breast cancer.

OBJECTIVE: To investigate whether certain physiological responses to luteal progesterone are normal in women previously treated for breast cancer. DESIGN: Salivary progesterone concentrations, basal body temperatures, and breast blood flow changes (surface temperature method) were all recorded daily for one natural menstrual cycle. SETTING: Participants in the study made saliva collections and temperature measurements at home under semi-standardised conditions with supervisory visits by a project nurse. PARTICIPANTS: Twenty-five controls were compared with 30 women with previous breast cancer; all but three participants were parous and the average ages were 39 years (range 28-48) and 40 years (range 29-46), respectively. On average the women with previous breast cancer had had surgery 2.4 years previously; the operation was usually mastectomy, leaving the contralateral breast for study. RESULTS: Follicular phase (day 1-14) oral temperature averages were statistically indistinguishable between women in the control group and those with previous breast cancer. Luteal progesterone profiles were considered in the normal range for the controls and patients. However, the women with previous breast cancer, on average, exhibited a significantly smaller rise in the luteal phase basal body temperature. Follicular phase breast surface temperature was significantly higher in the breast cancer group (+0.30 degree C). This group showed a highly significant reduction of the luteal heat cycle in their breasts. CONCLUSIONS: Two progesterone-mediated physiological mechanisms have been found to be significantly less responsive in women with previous breast cancer than controls. The literature has been reviewed. Progesterone resistance could be a clinical entity and could be important in carcinogenesis.

Adult↗