Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death: A Systematic Review and Meta-analysis.

A 66-year-old gentleman presented with gradual onset, painful, right eye visual loss with right maxillary paraesthesia on a background of previous Basal Cell Carcinoma (BCC) excision and mild cognitive impairment.Neurological...

The long-term outcome after local excision of T1 colorectal cancer (CRC) remains unknown. The aim of this study was to examine clinical and histopathological risk factors for recurrence in patients with T1 CRC undergoing endoscopic resection. This was a retrospective registry-based population study on prospectively collected data of all patients with nonpedunculated T1 CRC undergoing only local excision (no salvage surgery) in Sweden between 2009 and 2018. Potential risk factors for recurrence, including age, sex, tumor location, resection margins, lymphovascular, perineural, and submucosal invasion, grade of differentiation, and mucinous subtype, were analyzed using univariate and multivariate cox regression. Median follow-up time was 60 months, and 28 /602 patients (4.7 %) had a recurrence (13 local and 18 distant). Recurrence rate stratified by submucosal invasion was: Sm1 3.5 % (14 /397), Sm2 6.0 % (8 /133), and Sm3 8.3 % (6 /72), with no significant differences. Resection margins, lymphovascular and perineural invasion, grade of differentiation, mucinous subtype, and age were not significant risk factors for recurrence. In contrast, rectal location was found to be a significant risk factor for tumor recurrence in multivariate analysis (hazard ratio 3.08, P = 0.006). The 3- and 5-year disease-free survival was 96.2 % and 91.1 %, respectively, in T1 CRC patients undergoing endoscopic resection. Tumor recurrence was rare (4.7 %) in this large population-based study on recurrence after local excision of nonpedunculated T1 CRC. Rectal location was an independent risk factor for recurrence, suggesting the need for strict surveillance after endoscopic resection of early rectal cancer.

BackgroundPancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, and surgical resection is the only potentially curative approach. However, the rate of recurrence remains high, particularly within the first 6 months, and is associated with a poor prognosis. The present study evaluated the clinical characteristics and risk factors for early recurrence in pancreatic ductal adenocarcinoma (PDAC) patients who underwent curative resection, regardless of the use of neoadjuvant chemotherapy, to identify predictive factors associated with early recurrence and poor outcomes as well as to determine the optimal treatment strategy for patients at high risk of early recurrence after surgical resection.MethodsPatients who underwent pancreatic resection for PDAC at our institution from 2013 to 2021 were included in this study. We investigated the clinicopathological features of patients in groups: those with recurrence within 6 months, recurrence between 6 and 12 months, and recurrence beyond 12 months or no recurrence. A logistic regression analysis identified covariates associated with early recurrence at 6 and 12 months.ResultsThe study included 403 patients with a median follow-up of 25.7 months. Recurrence was observed in 279 patients, with 14.6% recurring within 6 months, 23.3% within 6–12 months, and 62% after 12 months or not at all. The preoperative CA19-9 level, modified Glasgow prognostic score (mGPS), and positive peritoneal cytology were significant risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant risk factors for recurrence within 12 months. For patients who received preoperative chemotherapy or chemoradiotherapy, the preoperative CA19-9 level, mGPS, and positive peritoneal cytology were significant independent risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant independent risk factors for recurrence within 12 months. The study concluded that the overall survival after surgical resection for potentially resectable PDAC worsened according to the number of risk factors present in the patient.ConclusionsWe clarified that preoperative CA19-9, positive peritoneal cytology, and the lack of adjuvant chemotherapy were consistent predictors for early recurrence within 6 and 12 months. In addition, an increased number of risk factors affecting the patient was associated with a poorer overall survival after potentially curable resection. Calculating the number of risk factors for early recurrence may be an essential predictive factor when considering treatment strategies.

Perineural Invasion Is Not an Independent Risk Factor for Recurrence and Lateral Neck Metastasis in Thyroid Cancer: A Propensity Score Matching Analysis.

Patterns of incidental perineural invasion and prognosis in cutaneous squamous cell carcinoma: A multicenter, retrospective cohort study

Recurrent squamous cell carcinoma with intracranial invasion of the dura mater after Mohs surgery

Influence of Somatic and Germline Gene Variants on the Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Hematological Malignancies

Risk Factors for Tumor Recurrence in Patients With Early-Stage (Stage I and II) Non-small Cell Lung Cancer: Patient Selection Criteria for Adjuvant Chemotherapy According to the Seventh Edition TNM Classification

The recurrence rate of meningioma after surgery is high, and progression is often observed. The risk factors for recurrence and progression are not clear. We evaluated the risk factors for recurrence and progression in meningioma using (11)C-methionine (MET) positron emission tomography (PET). Thirty-seven patients (mean follow-up, 80 months) with an intracranial meningioma were enrolled. MET PET was performed before treatment between 1995 and 2010, and patients were followed up in an out-patient clinic. Surgery was performed in 33 patients, and a wait-and-see approach was taken in four patients. We evaluated the extent of tumor resection, location, WHO grade, Ki-67 labeling index, and lesion to normal ratio (LN ratio) of MET uptake. Six of the surgical cases had a recurrence, and two of the observation-only patients had tumor progression. A high LN ratio of MET uptake was a significant risk factor for recurrence and progression with univariate analysis. The area under the curve of receiver operating characteristic curve for the LN ratio of MET uptake was 0.754, and the optimal cutoff value was 3.18 (sensitivity 63 %, specificity 79 %). With multivariate analysis, a high LN ratio of MET uptake, non-gross total resection, and a high WHO grade were significant risk factors for progression and recurrence. A high LN ratio of MET uptake was a risk factor for tumor progression and recurrence. The advantage of MET PET is that it is not invasive and can easily be used to evaluate the whole tumor.

Little is known about the variability of the dermoscopic criteria of squamous cell carcinoma (SCC) according to the histopathological differentiation grade. To evaluate whether specific dermoscopic criteria can predict the diagnosis of poorly differentiated SCC compared with well- and moderately differentiated SCC. Clinical and dermoscopic images of SCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver-operator characteristic curves. Of 143 SCCs included, 48 (33·5%) were well differentiated, 45 (31·5%) were moderately differentiated and 50 (35·0%) were poorly differentiated. Flat tumours had a fourfold increased probability of being poorly differentiated. Dermoscopically, the presence of a predominantly red colour posed a 13-fold possibility of poor differentiation, whereas a predominantly white and white-yellow colour decreased the odds of poorly differentiated SCC by 97% each. The presence of vessels in more than 50% of the tumour's surface, a diffuse distribution of vessels and bleeding were significantly associated with poor differentiation, while scale/keratin was a potent predictor of well- or moderately differentiated tumours. Dermoscopy may be regarded as a reliable preoperative tool to distinguish poorly from well- and moderately differentiated SCC. Given that poor differentiation of SCC represents an independent risk factor for recurrence, metastasis and disease-specific death, identifying poorly differentiated tumours in vivo may enhance their appropriate management.

Cutaneous squamous cell cancer (cSCC) is one of the most rapidly increasing cancers in the USA, striking 200,000 Americans annually. cSCC is most often observed in the sun-exposed areas such as the head and neck region. Although most patients have an improved prognosis after surgical treatment, a subset carries an increased risk of local recurrence, nodal metastasis, and disease-specific death. CXCL17 (C-X-C Motif Chemokine Ligand 17) is the latest chemokine family member, and our preliminary studies identified a causative role of CXCL17 in skin tumorigenesis. Accordingly, we aimed to investigate the correlation between CXCL17 and clinicopathological factors associated with recurrence, metastasis, and disease-specific death in cSCC. A retrospective chart review was conducted to identify patients with cSCC at Louisiana State University Health Sciences Center Shreveport (LSUHSC-S) and Overton Brooks Veterans Affairs Medical Center. Tissue samples were immunostained for human CXCL17/VCC-1. Risk factors such as the depth of invasion, perineural invasion, tumor diameter, location, and differentiation were obtained from chart review/clinical databases and correlated with the expression of CXCL17. Among 42 subjects included in the analysis, the Histo-score of CXCL17 expression in cytoplasm and nucleus was higher in the malignant group compared to the normal skin group (p=0.01 and p=0.03, respectively). Interestingly, the Histo-score of CXCL17 expression was associated with perineural invasion (p=0.01) suggesting a role for CXCL17 in disease aggressiveness. Our results indicate a positive correlation between CXCL17 and cSCC aggressiveness. Increased expression of CXCL17 was associated with perineural invasion, a principal risk factor for recurrence, metastasis, and disease-specific death in cSCC patients. These results suggest that CXCL17 plays a role as a prognostic marker and warrants further exploration as a potential target for treatment in aggressive cSCC. Citation Format: Janmaris Marin Fermin, Maksudul MD Alam, Xin Gu, Ameya Asarkar, Cherie-Ann Nathan, Alok R. Khandelwal. CXCL17 as a prognostic biomarker for aggressive cutaneous squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 647.

Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone

Postoperative adjuvant therapy strategies are generally determined based on pathological risk stratification in oral cancer. However, the efficacy of postoperative adjuvant therapy in patients with intermediate-risk factors for recurrence of oral cancer such as close surgical margins, pT3-T4 classification, pN2-N3 nodal status, perineural invasion, vascular invasion, lymphatic invasion and pattern of invasion remains unclear, and no standardized treatment guidelines or consensus have been established to date. Therefore, this study retrospectively analyzed the clinical significance of risk factors for pathological recurrence in patients with advanced oral cancer and evaluated the impact of postoperative adjuvant therapy on patient prognosis. This retrospective clinical study included 130 patients who underwent initial radical surgical resection for advanced oral squamous cell carcinoma (OSCC) at our institution between January 2010 and December 2023. The postoperative recurrence risk factors included ENE of the cervical lymph nodes, positive surgical margins, close surgical margins, pathological T classification (pT3 or pT4), pathological N classification (pN2 or pN3), metastasis to level IV or V lymph nodes, perineural invasion, vascular invasion, and lymphatic invasion. We analyzed the relationships among the presence of these risk factors, administration of postoperative adjuvant therapy (RT or CRT), occurrence of recurrence or metastasis, and patient prognosis (DFS). Patients with lymphatic invasion had a significantly lower survival rate than those without lymphatic invasion (66.7% vs. 82.8%, p < 0.05). Although pT4, pN2-N3, perineural invasion-positive and vascular invasion-positive did not reach statistical significance, a trend toward reduced survival was observed in each case. The perineural invasion-positive group had significantly higher recurrence and metastasis rates than the perineural invasion-negative group (51.9% vs. 23.6%, p < 0.05). Multivariate analysis using logistic regression also confirmed the presence of perineural invasion as an independent prognostic factor (HR = 4.496, p = 0.019). This study demonstrated that perineural invasion is a significant risk factor for recurrence and that lymphatic invasion is a poor prognostic factor in oral cancer. Postoperative adjuvant therapy in patients with perineural or lymphatic invasion-positive disease contributed to reduced recurrence rates and prolonged survival. These findings suggest that the pathological evaluation of perineural and lymphatic invasions is an important indicator in determining the appropriateness of postoperative adjuvant therapy.

The human papillomavirus (HPV) has been identified as a causative factor in 20% to 25% of all head and neck squamous cell carcinomas (HNSCC). Ongoing research suggests that the presence of HPV DNA in HNSCC predicts a positive prognosis with respect to disease-free and overall survival. However, most studies have been limited by the heterogeneity in treatment regimens and/or anatomic subsites of tumor origin. In this study, we correlate clinical outcomes with HPV status for patients with oropharyngeal carcinomas who were uniformly treated with a concurrent chemoradiation treatment protocol. Retrospective study. Demographic and clinicopathologic parameters, including age at diagnosis, gender, race, smoking and alcohol history, tumor stage and grade, locoregional recurrence, metastatic spread, recurrence-free survival, overall survival and disease-specific death, were obtained from medical charts and established databases. These parameters were correlated with HPV status of the tumors established by in situ hybridization analysis. HPV positivity correlated with improved clinical outcomes regarding locoregional control (P = .042), recurrence-free survival (P = .009), overall survival (P = .017), and disease-specific death (P = .09). Advanced T stage was a significant risk factor for recurrence and death independent of HPV status. In patients with oropharyngeal carcinoma uniformly treated with chemoradiation, the presence of HPV is a favorable prognostic indicator with respect to recurrence and overall survival. However, advanced T stage was an independent risk factor for recurrence and death that can to some degree offset this benefit.

Simple SummarySome researchers have found that preoperative pyuria is a risk factor for the recurrence of high-risk non-muscle invasive bladder cancer. However, no one has determined the risks of pyuria in relation to bacille Calmette-Guerin (BCG) treatment status. We defined pyuria as ≥10 white blood cells per high-power field. We analyzed recurrence-free rates in 424 patients with high-risk non-muscle invasive bladder cancer who had and had not undergone BCG treatment. We identified no risk factors for recurrence in the BCG-treated group (n = 179). However, in the non-BCG treated group (n = 245), pyuria was associated with being female and having T1 cancer. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. No significant difference in the severity of pyuria was found between BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk non-muscle invasive bladder cancer and pyuria.Some researchers have found that preoperative pyuria is a risk factor for recurrence after transurethral resection of high-risk non-muscle invasive bladder cancer. However, to our knowledge, none have clarified the risks associated with pyuria according to bacille Calmette-Guerin (BCG) treatment status. We retrospectively selected patients with high-risk non-muscle invasive bladder cancer according to Japanese Urological Association guidelines. Pyuria was defined as ≥10 white blood cells per high-powered field. We analyzed recurrence-free rates (RFS) in 424 patients who had and had not undergone BCG treatment. The median duration of follow-up was 45.2 months. According to multivariate analysis, postoperative intravesical BCG induction and preoperative pyuria were independent risk factors for intravesical recurrence in the whole study cohort. We found no significant risk factors for recurrence in the BCG-treated group (n = 179). In the non-BCG-treated group (n = 245), patients with pyuria were much more frequently female and more often had T1 disease than patients without pyuria. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. There was no significant difference in the severity of pyuria between the BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk NMIBC and pyuria.