284 research outputs found
2020 M&A Monitor: Shedding light on M&A in Belgium
No full textThe Belgian mergers and acquisitions market experienced a good and stable year in 2019, with slight growth in the smaller transactions segment. However, as a result of the Covid-19 pandemic, merger and acquisition activities are expected to decline by more than 30% in 2020. In addition, 60% of Belgian experts also expect a price drop of more than 10%. Liquidity problems in many companies could also cause the balance of power to shift, mainly putting buyers in a strong bargaining position. Finally, for the first time a question was asked about the expected impact of an acquisition on future employment. This impact appears to be positive across the board. These are the main conclusions of the seventh edition of the M&A Monitor, an annual survey of around 110 Belgian merger and acquisition specialists including corporate finance advisers, private equity investors, brokers, bankers and lawyers. The survey asks about their experiences in the M&A market and the deals they were involved in during 2019 on the one hand, and their expectations for 2020 on the other. In order to estimate these expectations correctly, an additional survey was sent out in the second half of March which specifically asked about the expected impact of the Covid-19 pandemic. The study was conducted by professor Mathieu Luypaert and researcher Gianni Spolverato of the Centre for Mergers, Acquisitions & Buyouts at Vlerick Business School in collaboration with Bank J.Van Breda & Co., BDO, NautaDutilh and Sowaccess
Belgian mergers and acquisitions market peaks, but future is uncertain. Results of the 2022 M&A Monitor
No full textIn line with the international M&A market, Belgian acquisition activity recovered strongly in 2021, especially for large transactions and acquisitions by private equity players. The average price paid for a transaction is once again reaching a record high. ESG measures do not yet play a significant role in Belgium with regard to pricing or deal structure. And the high level of geopolitical uncertainty combined with inflation and disrupted supply chains make predictions for 2022 difficult. These are the main conclusions of the ninth edition of the M&A Monitor, an annual survey of just under 200 Belgian merger and acquisition specialists including corporate finance advisers, private equity investors, strategic advisers, bankers and lawyers. They represent all industries and transaction sizes. The survey asks about their experiences of the deals they were involved in during 2021 on the one hand, and their expectations for 2022 on the other. The study was conducted by Professor Mathieu Luypaert and researcher Gianni Spolverato of the Centre for Mergers, Acquisitions & Buyouts at Vlerick Business School in collaboration with Bank J.Van Breda & Co., BDO, Van Olmen & Wynant, and Sowalfin Transmission.Bank J.Van Breda & Co., BDO, Van Olmen & Wynant, and Sowalfin Transmission
IMMUNOREACT 0: Biopsy-based immune biomarkers as predictors of response to neoadjuvant therapy for rectal cancer—A systematic review and meta-analysis
No full textBackground: The main therapy for rectal cancer patients is neoadjuvant therapy (NT) followed by surgery. Immune biomarkers are emerging as potential predictors of the response to NT. We performed a meta-analysis to estimate their predictive significance. Methods: A systematic literature search of PubMed, Ovid MEDLINE and EMBASE databases was performed to identify eligible studies. Studies on patients with rectal cancer undergoing NT in which the predictive significance of at least one of the immunological markers of interest was assessed by immunohistochemistry (IHC) in pretreatment biopsies were included. Results: Seventeen studies reporting sufficient data met the inclusion criteria for meta-analysis. High levels of total CD3+, CD4+ and CD8+ tumor infiltrating lymphocytes (TILs), as well as stromal and intraepithelial CD8+ compartments, significantly predicted good pathological response to NT. Moreover, high levels of total (tumoral and immune cell expression) PD-L1 resulted associated to a good pathological response. On the contrary, high levels of intraepithelial CD4+ TILs were correlated with poor pathological response. FoxP3+ TILs, tumoral PD-L1 and CTLA-4 were not correlated to the treatment response. Conclusion: This meta-analysis indicated that high-density TILs might be predictive biomarkers of pathological response in patients that underwent NT for rectal cancer
Win Statistics in Observational Cancer Research: Integrating Clinical and Quality-of-Life Outcomes
No full textBackground: Quality-of-life metrics are increasingly important for oncological patients alongside traditional endpoints like mortality and disease progression. Statistical tools such as Win Ratio, Win Odds, and Net Benefit prioritize clinically significant outcomes using composite endpoints. In randomized trials, Win Statistics provide fair comparisons between treatment and control groups. However, their use in observational studies is complicated by confounding variables. Propensity score (PS) matching mitigates confounding variables but may reduce the sample size, affecting the power of win statistics analyses. Alternatively, PS matching can stratify samples, preserving the sample size. This study aims to assess the long-term impact of these methods on decision making, particularly in colorectal cancer patients. Methods: A motivating example involves a cohort of patients from the ReSARCh observational study (2016–2021) with locally advanced adenocarcinoma of the rectum, situated up to 12 cm from the anal verge. These patients underwent either a watch-and-wait approach (WW) or trans-anal local excision (LE). Win statistics compared the effects of WW and LE on a composite outcome (overall survival, recurrence, presence of ostomy, and rectum excision). For matched win statistics, we used robust inference techniques proposed by Matsouaka et al. (2022), and for stratified win statistics, we applied the method proposed by Dong et al. (2018). A simulation study assessed the coverage probability of matched and stratified win statistics in balanced and unbalanced groups, calculating how often the confidence intervals included the true values of WR, NB, and WO across 1000 simulations. Results: The results suggest a better efficacy of the LE approach when considering efficacy outcomes alone (WR: 0.47 (0.01 to 1.14); NB: −0.16 (−0.34 to 0.02); and WO: 0.73 (0.5 to 1.05)). However, when QoL outcomes are included in the analyses, the estimates are closer to 1 (WR: 0.87 (0.06 to 2.06); WO: 0.93 (0.61 to 1.4)) and to 0 (NB: −0.04 (−0.25 to 0.17)), indicating a negative impact of the treatment effect of LE regarding the presence of ostomy and the excision of the rectum. Moreover, based on the simulation study, our findings underscore the superior performance of matched compared to stratified win statistics in terms of coverage probability (matched WR: 97% vs. stratified WR: 33.3% in a high-imbalance setting; matched WR: 98% vs. stratified WR: 34.4% in a medium-imbalance setting; and matched WR: 99.2% vs. stratified WR: 37.4% in a low-imbalance setting). Conclusions: In conclusion, our study sheds light on the interpretation of the results of win statistics in terms of statistical significance, providing insights into the application of pairwise comparison in observational settings, promoting its use to improve outcomes for cancer patients
Liver transplantation in patients with liver metastases from neuroendocrine tumors
No full textThe prevalence of metastatic disease in neuroendocrine tumors (NETs) is very high (60-80%) and cancer-related death among these patients is generally due to metastatic disease. Numerous treatment options for cure and disease control have been investigated for patients with neuroendocrine liver metastases (NELM). Despite the success of liver directed therapy on slowing tumor progression and palliating symptoms, the chance of being cured by liver resection is 40-50% and only roughly 20% of patients have potentially resectable disease. As such, there has been interest in liver transplantation (LT) as a potentially curative option for patients with unresectable disease. Several criteria have been proposed in order to balance long-term outcomes of patients with NELM and the problem of organ shortage including the Milan-NET criteria, the UNOS criteria and the ENETS guidelines. In the most representative studies, recurrence rate after LT has ranged from 30% to 60% with a 5-year OS ranging from 50% to 97%. This large variability is due to the retrospective nature of the studies available, which used different inclusion criteria. As such, outcomes and the prognostic factors associated with LT for NELM warrant further investigation
Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis
No full textWe sought to estimate the cost-effectiveness of hepatic resection (HR) (strategy A) relative to surveillance plus 6 months of additional systemic chemotherapy (sCT) (strategy B) for patients with colorectal disappearing liver metastases (DLM).
A Markov model was developed using data from a systematic literature review. Three base cases were evaluated: (1) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized carcinoembryonic antigen (CEA), and was diagnosed with DLM through a computed tomography (CT) scan; (2) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized CEA, and was diagnosed with DLM through a magnetic resonance imaging (MRI) scan; and (3) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT plus hepatic artery infusion (HAI), had normalized CEA, and was diagnosed with DLM through a MRI scan. The outcomes evaluated were quality-adjusted life months (QALMs), incremental cost-effectiveness ratio (ICER), and net health benefit (NHB).
The NHB of strategy A versus strategy B was positive in base case 1 (7.7 QALMs, ICER 43,948/QALY). In contrast it was negative (-0.2 QALMs, ICER $72,474/QALY) for base case 3. Monte Carlo simulation showed that strategy B is acceptable only in old patients (> 60 years) with normalized CEA and MRI-based diagnosis. In younger patients, strategy B may reach cost-effectiveness only after sCT plus HAI.
Surveillance of DLM after sCT was more beneficial and cost-effective among patients > 60 years with multiple factors predictive of true complete pathological response, such as normalization of CEA, HAI therapy, BMI a parts per thousand currency sign30 kg/m(2), and diagnosis of DLM made through M
ASO Author Reflections: Local Excision Following Neoadjuvant Therapy for Rectal Cancer: A Compromise Between TME and Watch-and-Wait in Patients with Major Response
No full textCognitive load in 3d and 2d minimally invasive colorectal surgery
No full textBackground: Three-dimensional (3d) laparoscopy has been introduced to enhance depth perception and facilitate surgical operations. The aim of this study was to compare cognitive load during 3d and 2d laparoscopic procedures. Methods: Two subjective questionnaires (the Simulator Sickness Questionnaire and the NASA task load index) were used to prospectively collect data regarding cognitive load in surgeons performing 2d and 3d laparoscopic colorectal resections. Moreover, the perioperative results of 3d and 2d laparoscopic operations were analyzed. Results: A total of 313 patients were included: 82 in the 2d group and 231 in the 3d group. The NASA TLX results did not reveal significantly major cognitive load differences in the 3d group compared with the 2d group; the SSQ results were better in the 3d group than in the 2d group in terms of general discomfort, whereas difficulty concentrating, difficulty focusing, and fatigue were more frequent in 3d operations than in 2d operations (p = 0.001–0.038). The results of age, sex, and ASA score were comparable between the two groups (p = 0.299–0.374). The median operative time showed no statistically significant difference between the 3d and 2d groups (median, IQR, 2d 150 min [120–180]—3d 160 min [130–190] p = 0.611). There was no statistically significant difference in the risk of severe complications between patients in the 3d group and in the 2d group (2d 7 [8.54%] vs 3d 21 [9.1%], p = 0.271). The median hospitalization time and the reoperation rate showed no difference between the 2d and 3d operations (p = 0.417–0.843). Conclusion: The NASA TLX did not reveal a significant difference in cognitive load between the 2d and 3d groups, whereas data reported by the SSQ showed a mild risk of cognitive load in the 3d group. Furthermore, 3d laparoscopic surgery revealed the same postoperative results as 2d standard laparoscopy
Assessing prognosis in cholangiocarcinoma: a review of promising genetic markers and imaging approaches
No full textIntroduction: Despite the progress in the treatment of liver cancer, the prognosis of CCA remains poor and the surgical resection remains the only treatment with a potentially curative intent to date. Areas covered: Advances in the knowledge of cholangiocarcinoma regarding the mutational status and radiological of the tumor have been reviewed searching the most updated papers using MEDLINE and EMBASE databases. Recent studies have investigated the mutational status and the imaging features of CCA patients in order to identify new factors correlated with the prognosis in CCA patients who underwent surgical resection. Moreover, the discovery of some gene mutations has led to the development of personalized therapy in CCA patients. Investigation of the mutational profile of CCA patients has been characterized by analysis of the incidence of single-gene mutations, patterns of gene mutations as well as the role of ncRNa alterations. Two innovative radiological sectors (radiomics and radiogenomics), investigating the associations between the imaging features and the molecular profiles, have contributed to knowledge of CCA biology. Expert opinion: The analysis of the mutational profile and application of radiogenomics/radiomics represent promising fields in the identification of new targets toward a more personalized treatment approach for CCA patients
Effects of the Exposure of Human Non-Tumour Cells to Sera of Pancreatic Cancer Patients
No full textPancreatic ductal adenocarcinoma (PDAC) has high metastatic potential. The “genometastasis” theory proposes that the blood of some cancer patients contains elements able to transform healthy cells by transferring oncogenes. Since findings on genometastasis in PDAC are still scarce, we sought supporting evidence by treating non-tumour HEK293T and hTERT-HPNE human cell lines with sera of PDAC patients. Here, we showed that HEK293T cells have undergone malignant transformation, increased the migration and invasion abilities, and acquired a partial chemoresistance, whereas hTERT-HPNE cells were almost refractory to transformation by patients’ sera. Next-generation sequencing showed that transformed HEK293T cells gained and lost several genomic regions, harbouring genes involved in many cancer-associated processes. Our results support the genometastasis theory, but further studies are needed for the identification of the circulating transforming elements. Such elements could also be useful biomarkers in liquid biopsy assays
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