Outcomes of patients with de novo oligometastatic breast cancer treated with curative intent at a single institution.

Background: De novo oligometastatic breast cancer (OMBC) is often defined as limited disease with up to five distant lesions in two or fewer organs at initial presentation. Studies have suggested overall favorable outcomes for OMBC patients, making curative intent treatment appealing. Trials have attempted to address primary surgery in all de novo MBC (not OMBC) and, separately, ablative metastasis-directed therapy in OMBC (not all de novo) without survival benefits. However, no trial has addressed the cumulative benefits of removing the primary tumor, ablating all detectable distant metastatic lesions, and optimal systemic therapy with molecular subtype-specific multidrug systemic therapy in de novo OMBC. Management of de novo OMBC remains controversial. We analyzed outcomes of patients with de novo OMBC treated with curative intent. Methods: We analyzed data for patients with de novo OMBC who were treated with physician-expressed curative intent at a single institution between 1/2000 – 12/2020. We identified patients by performing a simple keyword search within institutional electronic medical records that included physician-entered terms “oligometastases” AND “breast cancer” AND “curative intent” or “curative hope” and had at least one visit in clinic. Term variants such as “oligometastatic” for “oligometastases” were also included. All resulting charts were then manually reviewed for inclusion criteria. We more strictly defined OMBC as one organ (including bone) involved with metastatic lesions and 4 or fewer lesions per metastasized organ. All patients were required to have had definitive breast surgery for inclusion into the analytic cohort. Recurrence-free survival (RFS) and overall survival (OS), beginning at time of surgery, were evaluated using Kaplan-Meier methods. Results: A total of 39 patients were identified: 12 hormone-receptor (HR) positive (+)/HER2+, 2 HR negative (-)/HER2-, 21 HR+/HER2-, 4 HR-/HER2+. Most patients (33, 84.6%) had 1 oligometastatic lesion at diagnosis, 3 (7.7%) had 2 lesions, 2 (5.1%) had 3 lesions, and 1 (2.6%) had 4 lesions. 100% of patients underwent breast surgery; 15 (38.5%) underwent lumpectomy and 24 (61.5%) underwent mastectomy. Median age at time of surgery was 47 (range 28-69). Most patients (29, 74.4%) also underwent radiation therapy (RT) to the breast. Two-thirds of patients (26, 66.7%) underwent metastasis-directed therapy (MDT). The most common MDT type was RT (22/29, 75.9%). With median follow-up of 5.8 years (y), 27/39 (69%) patients had not recurred. Of 12 recurrences, 100% were new distant metastases. Median RFS was 7.1y (95% CI 4.87-not reached). Five-year RFS was 62% (95% CI 46-84%). Median RFS was 7.1y (95% CI 2.01-not reached) among HER2+ patients and 6.98y (95% CI 4.62-not reached) among HR+/HER2- patients. Landmark RFS was not impacted by whether a patient received MDT. Median OS was not reached (95% CI 7.42-not reached) and five-year OS was 77% (95% CI 61-95%). Conclusions: The use of curative intent treatment in OMBC at a single institution was most common in patients with a single metastasis in one organ. Survival outcomes were favorable among this highly select cohort of patients, with nearly two-thirds of patients free of relapse at 5y and similar RFS among the HER2+ and HR+/HER2- cohorts. Validation of these findings in prospective series and further studies evaluating optimal treatment strategies in this setting are needed. The benefits of primary surgery and MDT in this population remain unknown. Citation Format: Emily L. Chen, Hillary Heiling, Tianyu Li, Jennifer Bellon, Faina Nakhlis, Heather Parsons, Alyssa R. Martin, Harold Burstein, Sara M. Tolaney, Melissa Hughes, Nabihah Tayob, Nancy U. Lin, Sarah Sammons. Treatment outcomes of patients with de novo oligometastatic breast cancer treated with “curative intent” at a single institution [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-12-29.

1058 Background: Some recommend curative treatment for oligometastatic breast cancer (OMBC). To date, no randomized clinical trial has demonstrated the benefits of such a strategy. We present the largest retrospective series of patients treated consecutively for ER and/or PR positive (HR+) OMBC in a single institution. The objective was to describe the clinical and biological characteristics and prognostic factors of HR+ OMBC. Methods: We retrospectively reviewed all patients treated consecutively from 2014 to 2018 at our institution for synchronous or metachronous metastatic breast cancer (MBC). HR+ OMBC was defined as MBC with up to five metastases at diagnosis, positive hormone receptor status, and no other inclusion criteria. Clinical and biological characteristics, treatment modalities - intent-to-cure vs palliative - and outcomes were recorded. Progression-free survival (PFS) and overall survival (OS) were calculated. Log rank test and Cox regression models were used for survival analyses including time-dependent variable. Results: Of 998 patients treated for MBC within our institution between 2014 and 2018, 11.3% (N=113/998) met inclusion criteria. 62.5% of them had SBR grade I/II HR+ OMBC and 80.5% had HR+/HER2- OMBC. 89.3% patients had only one organ involved. None had more than two; 89.3% patients had 1-3 metastases at diagnosis. Among these 113 patients, 63.7% had bone metastases, 54.9% had bone only metastases, 19.5% had visceral metastases, 17.7% had lymph node metastases, 7.1% had brain metastases, and 3.5% had other metastases. Forty-one patients (36.3%) were treated in a curative intent with systemic treatment plus ablative focal treatment of primary tumor – or local relapse – and all distant metastases. Median follow up was 67.2 months (95%CI= [63.1-75.4]). For the entire series, five-year PFS and OS were respectively 35.2% (95%CI= [25.6-44.6]) and 67.0% (95%CI= [56.7-75.3]) respectively. In univariable analysis, liver metastases was associated with worse OS (HR=3.13, 95%CI=[1.43-6.87], p=0.003). In multivariable analysis, HER2 positive status (HR=0.43, 95%CI= [0.21-0.90], p=0.024), bone only metastases (HR=0.46, 95%CI= [0.27-0.78], p=0.004), and intent-to-cure treatment (HR=0.53, 95%CI= [0.30-0.93], p=0.027) were significantly associated with longer PFS. In multivariate analysis, only intent-to-cure strategy was associated with better OS (HR=0.24, 95%CI= [0.09-0.60], p=0.002). Conclusions: This is the largest retrospective series of patients treated consecutively for HR+ OMBC to date. 71.5 % of OMBC and 11.3 % of all MBC are HR+ OMBC. Most had only one invaded organ and 1-3 metastases. Among our cohort, intent-to-cure treatment improve drastically HR+ OMBC PFS and OS. A multimodal intent-to-cure strategy should be routinely discussed for patients with HR+ metastatic breast cancer with one to five metastases at diagnosis.

There is no consensus whether primary surgery followed by either adjuvant radiotherapy (RT) or adjuvant chemoradiation (CRT) or definitive CRT should be the standard treatment approach to advanced-stage hypopharyngeal squamous cell carcinoma (HP SCC). To determine survival outcomes for patients with advanced-stage HP SCC treated at a single institution with either primary surgery plus RT or CRT or definitive CRT. We conducted a retrospective analysis of prospectively collected medical records in an institutional database for patients with HP SCC newly diagnosed between January 1999 and April 2013. Overall survival (OS) and recurrence-free survival (RFS) were calculated and compared between treatment groups using the Kaplan-Meier method, with multivariate Cox regression analysis used to control for demographic and clinicopathologic features. We identified 166 consecutively treated patients, 90 of whom did not meet study criteria. Of the 76 included patients, 48 (63%) had undergone definitive CRT, and 28 (37%) had undergone primary surgery with adjuvant RT or CRT. The groups were well balanced by age, smoking history, and alcohol use. Five-year OS and RFS for patients treated surgically were 66.3% and 53.6%, respectively; for patients treated with definitive CRT, OS and RFS were 41.3% and 34.5%, respectively. Multivariate Cox regression analysis showed that surgical management was associated with clinically improved OS (hazard ratio [HR], 4.78; 95% CI, 0.91-25.03; P = .06) and RFS (HR, 2.97; 95% CI, 0.76-11.53; P = .12), although the difference was not statistically significant. Patients with advanced-stage HP SCC treated surgically with adjuvant RT or CRT showed a trend toward clinically improved OS and RFS compared with patients treated with definitive CRT. However, the difference was not statistically significant, and further investigation with larger controlled trials using modern approaches should be undertaken to optimize the initial management of advanced-stage HP SCC.

e13054 Background: In recent years, thanks to large, consecutive and retrospective series, knowledge of oligometastatic breast cancer (OMBC) has improved. However, the underlying pathophysiological mechanisms and patterns of progression of OMBC remain largely unknown. The aim of this study is to determine whether the limited capacity of OMBC to metastasize persisted in patients receiving first-line systemic treatment at the OMBC stage. To obtain a biologically homogeneous cohort, the analysis focused on hormone receptor positive (HR+) OMBC. Methods: We retrospectively reviewed all patients consecutively diagnosed and treated from 2012 to 2020 at our institution for synchronous and metachronous HR+ OMBC. Included were HR+ MBC patients with up to five metastases at diagnosis with no other criteria. Clinical and biological characteristics at diagnosis of first metastases, types of treatment (local ablative treatment of all sites (LAT) vs palliative treatment), outcomes and patterns of progression after a first line systemic treatment at the oligometastatic stage were recorded. Progression-free survival (PFS) and overall survival (OS) rates with a 95% confidence interval were estimated using the Kaplan Meier method. Results: Out of 1,686 patients treated for MBC at our institution between 2012 and 2020, 11.0% (186/1,686) met inclusion criteria. Among these 186 HR+ OMBC patients, 62.2% had SBR grade I/II HR+, and 19.3% had HER2+ OMBC. 93.5% patients had only one organ invaded, and 88.2% patients had one to three metastases at diagnosis. 66.7% had bone metastases, 60.2% had bone-only metastases, 18.3% had visceral (lung or liver) metastases, 14.5% had lymph node metastases and 6.5% had brain metastases. 35.5% of patients were treated with a curative intent including systemic treatment plus LAT. After a median follow-up of 73.4 months (95%CI= [69.3-76.8]), median PFS and OS were respectively 31.6 months (95%CI= [23.7-37.4]) and 90.9 months (95%CI= [70.0-109.9]). Five years PFS and OS were respectively 32.6 % (95%CI= [25.5-39.9]) and 66.3% (95%CI= [58.4-73.1]). During this period, 64.0% (119/186) of HR+ OMBC patients presented disease progression. Among the latter, 74.1% showed spread with no more than five metastases (oligoprogression), and 82.6% in only one organ. 27.7% (33/119) of patients were able to benefit from LAT. Conclusions: HR+ OMBC incidence is 11%. Among patients with progressive HR+ OMBC following first-line systemic treatment at the oligometastatic stage, a large majority presented oligoprogression and a substantial proportion were able to be treated by local ablative therapy with a curative intent at the time of this progression. The limited capacity of HR+ OMBC to metastasize thus persisted after a first-line systemic treatment. This could be an argument in favor of physiopathological mechanisms specific to oligometastatic disease.

398 Background: There have been conflicting results about whether KRAS mutation influences outcome in patients (pts) with colorectal cancer. In pts who underwent liver resection, Karagkounis reported a worse recurrence and survival in KRAS mutated (MUT) patients (ASCO 2012, abs 3616). Methods: In 105 pts who underwent liver resection and received adjuvant (adj) hepatic arterial infusion and systemic chemotherapy and in whom KRAS data was available, we evaluated recurrence patterns and survival. Correlation between KRAS and clinical factors such as prior chemotherapy, post operative CEA, clinical risk score, and stage at diagnosis was evaluated using Fisher’s exact test and the Wilcoxon rank sum test. Kaplan-Meier methods were used to estimate median overall recurrence free survival (RFS) and overall survival (OS) at 4 years. Log-rank test was used to determine whether survival functions differed by KRAS mutation status. Cumulative incidence function was used to estimate the probability of time from adj therapy to bone, brain, lung and liver metastases separately. Results: Of 105 patients, 76 were KRAS wildtype (WT), and 29 were KRAS MUT (26-G12 and 3-G13). The median RFS was 26 months for KRAS WT pts and 15 months for KRAS MUT pts (p=0.08). OS at 4 years was 88% [95% CI: 78%-94%] for KRAS WT and 78% [95% CI: 57%-90%] for KRAS MUT pts (p= 0.15). Cumulative incidence of developing bone, brain, lung, and liver metastases by 2 years is presented in the Table. The cumulative incidence of bone and brain metastases at 2 years was 0% and 0% in KRAS WT pts versus 16.4% [95% CI: 1.1%-31.7%] and 4.7% [95% CI: 0%-14.1%] in KRAS MUT pts (Table). There was no association between clinical factors and KRAS status. Conclusions: KRAS MUT pts appeared to have worse OS and RFS, although we were unable to show a significant difference between KRAS WT and MUT for OS and RFS. In addition, cumulative incidence of bone and brain metastases at 2 years appeared to be higher for KRAS MUT pts as compared to WT pts. Results are based on small sample size and further investigation is needed. [Table: see text]

Background In 2013, transoral robotic surgery (TORS) was implemented as a protocolled treatment alternative to the traditional radiotherapy (RT) in Denmark for oropharyngeal squamous cell carcinoma (OPSCC). In 2017, we published our first prospective feasibility study, showing that TORS with concurrent neck dissection successfully achieved negative margins in 29 out of 30 patients (97%) with early-stage OPSCC. Aims/objectives This follow-up study aims to evaluate the five-year overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS). Methods Retrospective follow-up study including 30 patients treated with TORS for early-stage OPSCC (T1–T2, N0–N1, M0, UICC 7th edition) from September 2014 to January 2016 at a single head and neck cancer centre in Denmark. The five-year OS, DSS and RFS, including a detailed analysis of the recurrences, were addressed. Results The five-year OS, DSS and RFS was 90%, 93% and 87%, respectively. Median follow-up was 54.5 months. Four patients developed a recurrence, with one regional, one distant metastatic (M) and two locoregional recurrences. The median time to recurrence was 24 months (range 3–42 months). Conclusions and significance This follow-up study demonstrates good five-year OS, DSS and RFS in a prospective cohort of patients undergoing TORS and neck dissection for early-stage OPSCC.

Purpose: The role of resection of the primary tumour in management of patients with OMBC is controversial. Loco-regional treatment (LRT) with curative intent could be discussed considered for OMBC patients, who experience good response to systemic therapy. We retrospectively studied the impact of resection of the primary tumour on overall survival (OS) for de novo OMBC treated at Oscar Lambret Center in Lille.Patients and methods: Between 2005 and 2017, all consecutive patients were selected. De novo OMBC was defined by 1 to 5 metastases in 1 or 2 organs, diagnosed within three months after primary tumor. Clinical data, tumor characteristics, metastatic sites, locoregional treatment, systemic first line treatment were recorded retrospectively. We set up 2 groups according to therapeutic strategy. Group 1 patients were managed with a prior planned curative intent surgery and systemic treatments and group 2 included patients with systemic therapy alone, without plan of surgery.Results: 116 patients were included in our analysis; 78 patients in group 1 and 38 patients in group 2. Median age was 54,9 years (25,2-86,2) with no difference between both groups (p=0,08). TNM stage, cancer histologies were comparable in both groups, excluding that there were more HER2+ tumour in Group 2 (p=0.003). 81 patients underwent LRT, 69 patients in group 1 and 12 patients in group 2. 59% of them had radical mastectomy and 89% had axillary surgery. For 29% of them, surgery was performed before knowledge of metastatic disease. The other main indications of breast surgery included stable disease (50%), local progression (9%), palliation (5%), single metastasis (5%) and complete metastatic response after chemotherapy (2%). 59 of 81 patients had adjuvant radiotherapy. Regarding systemic first line treatment, patients in group 1 received more chemotherapy (63% vs 86%, p=0.01), anti-HER2 treatment was appropriate except for 6 patients because of heart disease and 69% of patients had hormone therapy with no difference in both groups. Regarding metastases at diagnosis, the mean number of metastases was 2,1 (SD=1,2), 103 patients (89%) had one metastatic site, and 13 patients (11%) had two metastatic sites, with no difference between both groups. Secondary bone involvement was most prevalent site (69%). There was no difference between both groups in metastasis distribution. Median OS was 70,2 months in our cohort. LRT did not improve OS (HR 1,23; 95% CI [0,75-2,00] p=0,41), even after adjustment on age and HER2 status. Median progression free survival (PFS) was 30,2 months in our cohort. LRT did not improve PFS in comparison with systemic treatment alone (HR 1,38; 95% CI [0,91- 2,11] p=0,13).Conclusion: We found that LRT did not improve outcome (PFS or OS) in OMBC patients. This is in line with recently issued large randomized phase III trial. LRT is not a standard of care in OMBC, nevertheless, further clinical studies are needed to better identify the subgroup of OMBC patients that could benefit from LRT, at least in term of quality of life. Citation Format: Charlotte Debuquoy, Claudia Regis, Jennifer Wallet, David Pasquier, Nicolas Penel, Marie-Cecile Le Deley, Marie-Pierre Chauvet, Emilie Kaczmarek. The role of resection of the primary tumour in patients with de novo oligometastatic breast cancer (OMBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-58.

Ten-Year Outcomes of Stereotactic Body Radiotherapy for Oligometastatic Breast Cancer: Does Synchronous Oligometastatic Breast Cancer Benefit?

Background The current definition, prognosis, and optimal treatment (tx) for oligometastatic breast cancer (OMBC) are not fully known. With advances in multimodality breast cancer (BC) tx and overall improvement in patient (pt) outcomes, it is important to identify baseline pt factors that confer better prognosis in OMBC and assess the impact of local/regional tx and metastasis (mets)-directed tx on survival outcomes. Methods We reviewed 105 Mayo Clinic pts with OMBC (up to 5 mets) from 2003 to 2021. Pts were excluded from analysis if they were misidentified as having OMBC (n=6), did not have a primary breast mass (n=1), developed de novo BC during tx (n=1), or were lost to follow up (n=2). Categorical variables were summarized as counts. Continuous variables were reported as medians. Kaplan-Meier method was used to estimate survival and the time from diagnosis to next tx at 1, 3, and 5 years. Log-rank test was used to compare survival rates between baseline factors. Univariate Cox proportional hazards models were performed on both baseline and time-dependent factors. All tests were two-sided with p-value < 0.05 considered statistically significant. Results Total pts included were 95. Median age was 49 (range, 26-86), most (93.6%) pts were White, and 46.8% were postmenopausal. Invasive ductal carcinoma (89.5%) was the most common BC type. Median survival was 10.8 years; 1-, 3-, and 5-year survival rates were 98.9%, 87.7%, and 81%, respectively. 58 pts (61.1%) required a change in tx due to disease progression. No significant survival difference was observed in pre- vs. postmenopausal pts (p=0.71) or in groups based on hormone receptor and/or human epidermal growth factor receptor 2 status. 47 pts (49.5%) received local/regional tx; no significant difference in survival (HR 0.57, 95% CI 0.23-1.40; p=0.217) or time to next tx (HR 0.67, 95% CI 0.39-1.15; p=0.144) was seen in this subgroup. Of these pts, 36 (76.6%) received neoadjuvant chemotherapy and/or immunotherapy, 5 of whom (10.6%) also started endocrine tx preoperatively. Overall, 11/47 pts (23.4%) received neoadjuvant endocrine tx. 20 pts received systemic tx without eventual surgery, and 5 pts got palliative radiation (RT). Biopsy-confirmed mets were noted in 76 pts (80%), with bone-only mets in 50%, 30 pts (31.6%) with viscera-only mets and 7 pts (7.4%) with both bone and visceral mets. 18 pts had suspected mets on imaging but did not undergo biopsy. The hazard of death was 6.34 times higher in pts with both bone and visceral mets than those with bone-only mets (p=0.008). Pts with viscera-only mets had higher survival at 2 and 3 years than pts with bone-only or both bone and visceral mets (p=0.093). Pts with 3 mets (7/76, 7.4%) had decreased survival at 1, 2, and 3 years compared to pts with 1-2 (65/76, 85.5%) mets (p=0.6). 67 pts (70.5%) received mets-directed tx; RT alone was the most common modality (52/67, 77.6%), followed by surgery (6/67, 9%), RT plus surgery (5/67, 7.5%), and ablation alone (3/67, 4.5%). There was no significant difference in survival (HR 1.27, 95% CI (0.53, 3.07), p=0.589) or time to next tx (HR 0.95, 95% CI (0.56, 1.63), p=0.856) in pts who received mets-directed tx. Multivariate analysis was not performed because most findings were not statistically significant in univariate analysis. Conclusions We did not find any significant differences in survival based on characteristics like menopausal status or site or number of mets in pts with OMBC. There was a trend toward improved survival in pts with viscera-only mets, but this finding requires validation. Local/regional and mets-directed tx did not improve survival; however, survival at 1, 3, and 5 years was excellent in this OMBC pt population. Our study was limited by low pt numbers and heterogeneity in the pt population. Findings need validation in larger studies. Citation Format: Tanmayi Pai, Raza Zarrar, Zhongwei Peng, Zhuo Li, Lauren Cornell, Kostandinos Sideras, Rohit Rao, Alvaro Moreno-Aspitia, Saranya Chumsri, Sarah McLaughlin, James Jakub, Emmanuel gabriel, Sanjay Bagaria, Laura Vallow, Santo Maimone, Pooja Advani. Clinical Features and Survival Outcomes of Oligometastatic Breast Cancer Patients: The Mayo Clinic Experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-06-04.

FIGO stage IIIC endometrial carcinoma: Prognostic factors and outcomes

BackgroundIntrahepatic cholangiocarcinoma (ICC) poses a significant clinical challenge, demanding a thorough understanding of prognostic indicators for effective patient management. Despite reports suggesting the impact of perineural invasion (PNI) on the prognosis of early-stage ICC patients, there has been a dearth of comprehensive research specifically targeting this subgroup. This study seeks to investigate the influence of PNI on survival outcomes in early-stage ICC patients and aims to enhance the prognostic value of the American Joint Committee on Cancer (AJCC) T category.MethodsA cohort of 268 early-stage (T1-T2N0M0) ICC patients, who underwent curative-intent resection (R0) between 2011 and 2015 at the Eastern Hepatobiliary Surgery Hospital, were enrolled in this study. Lasso and Cox regression analyses were employed to explore differences in clinical and prognostic data. Kaplan-Meier curves were generated to illustrate the clinical significance of the combination of PNI and T category.ResultsAmong the 268 patients, 24.6% exhibited PNI. Patients with PNI demonstrated shorter recurrence-free survival (RFS) [median RFS: 16 months (interquartile range, 9.5–19 months)] and overall survival (OS) [median OS: 16.53 months (interquartile range, 10–25 months)]. PNI emerged as an independent risk factor for both RFS and OS in T1- and T2-stage patients (all P<0.05), whereas tumor size was only an independent risk factor for OS (P=0.004). PNI was associated with all prognostic markers for ICC patients, including gender, jaundice, cholangitis, hepatitis B virus (HBV) infection, cancer antigen 199 (CA199), preoperative serum albumin, and preoperative platelet count (all P<0.05). However, there was no significant difference in RFS (P=0.270) and OS (P=0.360) between T2 patients without PNI and T1 patients with PNI.ConclusionsThis study underscores PNI as a robust prognostic factor in early-stage ICC, emphasizing the necessity of incorporating PNI into the AJCC T category for precise risk stratification. Clinically, understanding the impact of PNI on survival outcomes can guide tailored treatment strategies for early ICC patients.

Squamous cell carcinoma of the soft palate (SCCSP) is uncommon. The aim of this study was to report our experience and identify factors predictive of outcome. Between 1976 and 2005, 186 patients with SCCSP were treated with curative intent. In all, 150 patients had primary surgery, of whom 112 patients (75%) had cT1/T2 tumors and 103 patients (69%) had cN0 necks. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan-Meier method and factors predictive of outcome were identified. Five-year OS, DSS, and RFS for surgical patients were, respectively, 52%, 71%, and 56%. DSS for cT1T2N0 and cT1T2N+ were 79% and 56%, respectively. For OS and DSS, multivariate analysis showed cN classification was predictive of outcome. For RFS and distant RFS, margin status was a significant predictor, whereas the cT classification was a significant predictor for local RFS. Outcomes of patients with early-stage SCCSP managed by surgery were excellent. These patients may be suitable for transoral robotic or endoscopic surgical procedures.

Purpose: For breast cancer (BC) patients treated with adjuvant chemotherapy (CT), the optimal time to initiation of adjuvant radiotherapy (TTR) from definitive surgery is still controversial especially with modern systemic therapy, while the impact of TTR from completion of CT has not been reported to date. The current study aims to evaluate the impact of TTR from surgery and from completion of CT on survival outcomes in non-metastatic BC patients according to BC subtype. Methods and Materials: BC patients who were treated with definitive surgery followed by adjuvant CT and received adjuvant radiotherapy (RT) from January 2009 through December 2015 in a single institution were included in this study. Patients receiving neoadjuvant therapy were not enrolled. According to our clinical practice, if adjuvant treatments were well organized, RT could be initiated within 180 days following surgery and with completion of most up-to-date CT regimens. As a result, patients were categorized into two groups according to TTR from surgery as ≤180 and &amp;gt;180 days and according to TTR from CT as ≤12 and &amp;gt;12 weeks. The survival curves were estimated by the Kaplan-Meier method and compared by log-rank test. The independent effect of TTR from surgery and TTR from CT were separately tested using a Cox proportional hazards model for multivariate analysis after adjusting for these variables that were statistically significant on univariate analysis. Results: In total, 989 patients were enrolled. The number of patients with HR-positive, triple-negative (TN) and HER2-positive BC was 590, 196, and 203, respectively. The median follow-up was 43 (range: 4 to 117) months. The median TTR from surgery was 180 (range: 24 to 117) days and from completion of CT was 29 (range: 7 to 247) days. The 5-year recurrence-free survival (RFS), locoregional RFS (LRRFS), distant RFS (DRFS) and overall survival (OS) were 88.0%, 96.9%, 89.3% and 93.5%, respectively. The 5-year OS was 94.7%, 88.3% and 95.2% in patients with HR-positive, TN and HER-2 positive BC, respectively (P&amp;lt;0.01). Initiation of RT &amp;gt;12 weeks after completion of CT was associated with worse OS (5-year 94.0% vs 85.1%, p=0.006), &amp;gt;180 days after surgery was associated with worse DRFS (5-y 91.7% vs 86.9%, p=0.004) and worse RFS (5-y 90.7% vs 85.4%, p=0.003). In the multivariable analysis, TTR after completion of CT remained independent prognostic factor for OS (hazard ratio [HR], 2.81; 95% CI, 1.17 to 6.74; P=0.02) and TTR &amp;gt;180 days after surgery was also significantly associated with worse DRFS (HR, 1.79; 95% CI, 1.09 to 2.93; P=0.02) and RFS (HR, 1.71; 95% CI, 1.09 to 2.69; P=0.02). In patients with HR-positive BC, TTR &amp;gt;12 weeks after completion of CT was significantly associated with worse OS, while &amp;gt;180 days after surgery was with adverse DRFS (5-y 91.0% vs. 83.8%, p=0.004), RFS (5-y 89.8% vs. 82.8%, p=0.003), and OS (5-y96.6% vs 91.8%, p=0.026). However, these associations between TTRs and survival outcomes were not found in patients with HER2-positive BC or TNBC. Conclusion: In BC patients indicated for CT, delaying initiation of RT after definitive surgery or after completion of CT both adversely impact on survival outcomes. Efforts should be made to minimize delays in the initiation of RT in the above two TTR settings. Citation Format: Lu Cao, Jia-Yi Chen. Impact of delaying initiation of RT following definitive surgery or following adjuvant chemotherapy on survival outcomes in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-19.

Objective To explore prognostic factors of renal cell carcinoma and investigate the association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of renal cell carcinoma (RCC) in patients who received nephrectomy treatment. Methods We retrospectively reviewed the records of 1325 patients with renal cell carcinoma who underwent nephrectomy between January, 2008 and December, 2012. We retrospectively analyzed the clinicopathologic characteristics of patients. The optimal cutoff value for NLR was determined using receiver operating characteristic curve (ROC) analysis. We defined them as high NLR group when NLR ≥ 2.7 and low NLR group when NLR<2.7. Overall survival (OS) and recurrence free survival (RFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate models were used to analyze the association of NLR with clinicopathologic outcomes. Results By the end of the study, 1220 cases were followed up. The follow-up rate was 92.1%. Mean follow-up was 40 months (range 2 months to 87 months). The three-year and five-year overall survival rate were 91.3% and 86.9%, respectively. Meanwhile the three-year and five-year recurrence free survival rate were 88.2% and 85.8%, respectively. 2.7 was selected as the optimal cutoff value to differentiate between low NLR and high NLR. A NLR ≥2.7 was significantly associated with worse 5-year overall survival and worse 5-year recurrence free survival than a NLR 65, presentation mode with symptom, higher tumor stage, higher Fuhrman grade, histologic subtype, neutrophil count≥4.5, lymphocyte count<1.7, NLR ≥2.7 significantly correlated with poor OS on univariate analysis. Multivariate analysis revealed that higher tumor stage, preoperative NLR ≥2.7 at diagnosis were poor independent prognostic factors for OS of renal cell carcinoma. Conclusion High NLR was independent poor predictor of renal cell carcinoma. Key words: Carcinoma, renal cell; Neutrophil-to-lymphocyte ratio; Prognosis; Survival rate

Long-term Oncologic Outcomes Following Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium