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Early Chest Imaging Can Benefit Colorectal Cancer Patients

By MedImaging International staff writers
Posted on 18 Oct 2022

Despite improved survival rates, colorectal cancer is the third leading cause of cancer-related deaths in the U.S. Though rates of colorectal cancer have declined among people 65 and older, largely thanks to increased screening efforts, rates among younger adults are rising. When the cancer is caught early, many patients can remain disease-free for the rest of their lives after surgical treatment, but colorectal cancer can spread (metastasize) in up to 50% of patients. One of the most common areas colorectal cancer spreads to is the lungs, affecting up to 18% of patients with colorectal cancer. Detecting cancerous nodules in the lung early provides patients with the best outcomes, but there are no evidence-based standards for when and how often to screen colorectal cancer patients with chest CT or PET scans. Now, a new study has found that colorectal cancer patients with certain clinical characteristics may benefit from more frequent chest imaging to help identify and target cancer that has spread to the lungs. These findings have the potential to improve long-term outcomes of patients with metastatic colorectal cancer.

The study by researchers at the MD Anderson Cancer Center (Houston, TX, USA) investigated optimal timing intervals and key clinical factors, including genetic factors and tumor characteristics, that may reveal which patients are at risk for developing lung metastases. To identify which colorectal cancer patients may benefit from early chest imaging and at what time intervals, an interdisciplinary team of researchers – including cardiothoracic surgeons, colorectal cancer surgeons, and gastrointestinal oncologists – collaborated to investigate evidence-based surveillance guidelines for colorectal patients who are at risk of developing lung metastases.

Using two MD Anderson cancer databases that included both colorectal cancer patients and thoracic cancer patients, the study team retrospectively reviewed data from patients with colorectal cancer who did and did not develop lung metastases. Patients were grouped according to the development of lung metastases and the timing of their diagnosis. The team used statistical methods to investigate which clinical characteristics, such as age or genetic factors, correlated most with the risk of developing lung metastases. The findings of the study revealed that out of 1,600 patients with colorectal cancer, 233 (14.6%) developed pulmonary (lung) metastases, with a median time of 15.4 months following colorectal surgery. The team identified age, neoadjuvant or adjuvant systemic therapy (such as chemotherapy or immunotherapy), lymph node ratio, lymphovascular and perineural invasion (high-risk tumor characteristics observed under a microscope), and presence of KRAS genetic mutations as risk factors for developing lung metastases.

Further data analysis revealed that patients who required systemic therapy around the time of their surgical operation for colorectal cancer, who had an elevated lymph node ratio, and a KRAS mutation, were at risk of developing lung metastases within three months of surgery. The authors concluded that these patients may benefit from more frequent surveillance with chest CT or PET scans. The researchers noted that while these risk factors are not necessarily surprising from a clinical perspective, they highlight the need to adequately screen certain colorectal cancer patients after surgical treatment. In some cases, removing cancerous lung nodules surgically early on can significantly improve outcomes. In future research, the team plans to validate findings in a separate group of patients, with the hope of formalizing chest surveillance protocols for widespread clinical adoption. The researchers have noted that as colorectal cancer research evolves, sensitive blood tests to detect cancer or advanced radiographic screening methods using artificial intelligence may also play an important role in monitoring patients.

“After patients are diagnosed with colorectal cancer, many of them want to better understand what their cancer diagnosis entails in terms of their surveillance and survivorship for the rest of their life, but we currently lack data and uniform guidelines to support how often these patients should be screened with chest imaging,” said co-author Mara Antonoff, MD, FACS, associate professor, thoracic and cardiovascular surgery, UT MD Anderson Cancer Center. “With this study, we sought to develop a strategy that is evidence-based to determine how frequently, at what intervals, and for how long patients at risk of developing lung metastases should undergo imaging of their chest.”

“A concrete clinical application of this research, following validation, is to build evidence-based guidelines affecting chest surveillance in patients with resected colorectal cancer,” said Nathaniel Deboever, MD, general surgery resident, UTHealth Houston McGovern Medical School, and the lead author of the study. “These guidelines will hopefully allow high-risk patients to undergo radiographic screening in a timely manner, permitting the early diagnosis of pulmonary disease.”

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60 (54.121017456055): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

61 (427.9613494873): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

62 (!!!!! 1447.9160308838): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

63 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

64 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

65 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

66 (65.088272094727): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

67 (495.91064453125): SELECT fid FROM jos_deeppockets WHERE id=294794979 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794979 AND published='1' LIMIT 1

68 (50.067901611328): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

69 (51.021575927734): select jos_twitters.link from jos_twitters where cat=10

70 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

71 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

72 (56.028366088867): select jos_linkedin.link from jos_linkedin where cat=10

73 (38.862228393555): SELECT fid FROM jos_deeppockets WHERE id=294794979 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294794979 AND published='1' LIMIT 1

74 (32.186508178711): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

75 (346.89903259277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (359.05838012695): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

77 (45.061111450195): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

78 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (44.822692871094): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (33.140182495117): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

94 (31.948089599609): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

95 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

109 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

110 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

111 (56.028366088867): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

114 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

115 (44.822692871094): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (510.93101501465): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

117 (619.88830566406): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (336.1701965332): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

119 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

120 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

122 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

123 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

124 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

125 (317.09671020508): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 20689.010620117): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

127 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

128 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

129 (494.00329589844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794979 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794979 AND type='deeppockets_item' AND published='1' LIMIT 1

130 (!!!!! 600692.98744202): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (82.015991210938): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

132 (89.883804321289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

134 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (37.193298339844): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

136 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (35.04753112793): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

138 (544.07119750977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (972.98622131348): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (55.789947509766): SELECT name FROM jos_deeppockets WHERE id=215

141 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=215

142 (627.04086303711): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (530.00450134277): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

144 (446.08116149902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

145 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

146 (!!!!! 17692.089080811): TRUNCATE TABLE jos_trademed_module

147 (87.02278137207): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (56.982040405273): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294794979 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (512.83836364746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

152 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

153 (!!!!! 1508.9511871338): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

154 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

155 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

156 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294794979 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294794979 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (44.822692871094): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

158 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

159 (61.03515625): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (968.93310546875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

161 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294794979 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294794979 AND published='1' LIMIT 1

162 (53.167343139648): select jos_twitters.link from jos_twitters where cat=10

163 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

164 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

165 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

166 (359.05838012695): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

167 (!!!!! 1433.1340789795): insert into jos_banners_delta values (14615,'2025-04-29 21:59:08','18.219.74.193','view'),(14202,'2025-04-29 21:59:08','18.219.74.193','view'),(14203,'2025-04-29 21:59:08','18.219.74.193','view')

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