3-and 5-year Survival Rates Research Articles

Radiation-induced sarcoma in patients with nasopharyngeal carcinoma: a single-institution retrospective study

Objective:To analyze the clinical features, treatment methods and prognosis of radiation-induced sarcoma（RIS） of the head and neck after radiotherapy for nasopharyngeal carcinoma（NPC）, and explore its treatment strategies. Methods:A retrospective analysis was conducted on RIS patients after radiotherapy for NPC in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2013 to October 2022. The time of onset, lesion location, pathological subtypes, imaging features and treatment outcomes were described, and the median survival time was statistically analyzed through follow-up. Results:This study included 10 patients with an interval of 2-27 years between NPC and RIS. The nasopharynx was the more common site of RIS, and osteosarcoma was the main pathological type. The median overall survival was 18 months. The median survival was 40 months in the surgery combined with the chemotherapy group, and 12 months in the surgery alone group. The 1-and 2-year cumulative survival rates were 48% and 36%, respectively. Prognostic analysis showed that gender, age of onset, time of sarcoma onset after radiotherapy and treatment methods might not be influencing factors for prognosis, and osteosarcomas presented a poorer prognosis than other pathological types. Conclusion:RIS is one of the most severe long-term adverse effects in patients with NPC. The prognosis of RIS is poor, and complete surgical resection of the tumor can improve patient survival rates. In cases where complete surgical resection is challenging, radiotherapy or chemotherapy may offer some improvement in tumor control.

Pancreatic resection for metastasis from renal cell carcinoma: A single institution experience and meta-analysis of survival outcomes

AimsTo evaluate short-term clinical and long-term survival outcomes of pancreatic resection for pancreatic metastasis from renal cell carcinoma (RCC). MethodsA retrospective evaluation of patients undergoing pancreatic resection for metastasis from RCC over a 12-years period was conducted. Furthermore, a systematic search of electronic data sources and bibliographic reference lists were conducted to identify studies investigating the same clinical question. Short-term clinical and long-term survival outcomes were evaluated. Kaplan-Meier survival plots were constructed for survival outcomes. Cox-proportional regression analysis was performed to determine factors associated with survival. Finally, meta-analysis of survival outcomes was conducted using random-effects modelling. ResultsEighteen patients underwent pancreatic resections for RCC pancreatic metastasis within the study period. The mean age of the included patients was 63.8 ± 8.0 years. There were 10(55.6 %) male and 8(44.4 %) female patients. Pancreatectomy was associated with 4(25.0 %) Clavien–Dindo (C-D) I, 5(31.3 %) C-D II, and 7(43.7 %) C-D III complications, 7(38.8 %) pancreatic fistula, 3(16.7 %) post-pancreatectomy acute pancreatitis, 1(5.6 %) delayed gastric emptying, and 1(5.6 %) chyle leak. The mean length of hospital stay was 18 ± 16.3 days. The median survival was 64 months (95 % CI 60–78). The 3-and 5-year disease-free survival rates were 83.3 % and 55.5 %, respectively. The 3-and 5-year survival rates were 100 % and 55.6 %, respectively. The pooled analyses of 553 patients demonstrated 3-and 5-year survival rates of 77.6 % and 60.7 %, respectively. ConclusionsPancreatectomy for RCC metastasis is associated with acceptable short-term clinical and promising long-term survival outcomes. Considering the rarity of the entity, escalation of level of evidence in this context is challenging.

Results of multicomponent treatment of patients with progression of primary brain glioma

The aim of this study was to determine the most effective approach to the treatment of patients with continuous growth of brain glioma.Material and Methods. The study included 200 patients with progression of primary brain glioma, who were treated at the Chelyabinsk Regional Center of Oncology and Nuclear Medicine in the period from 2001 to 2021. The average age of patients was 47.86 ± 11.47 years. The ratio of men to women was 1:1. The continuous growth of high-grade glioma was detected in 125 cases. The progression of lowgrade glioma was observed in 40 patients. Transformation of low-grade glioma into high-grade glioma was found in 35 patients. Re-surgery was performed in 92 patients. Repeated radiation therapy was given to 140 patients. Chemotherapy as the method of choice was administered to 60 patients.Results. The median overall survival (OS) time was 36 months. The 1and 2-year survival rates were 96.0 % and 59.4 %, respectively. The method-specific overall survival time was 15 months. There was a tendency towards an increase in OS in all subgroups of patients who underwent re-surgery. The highest method-specific overall survival rates were observed in patients who received stereotactic radiation therapy (STRT) and combined photon-neutron therapy (CPNT): 23 and 47 months in patients with high-grade glioma and 60 and 72 months in patients with continuous growth of low-grade glioma, respectively (p>0.05). In patients with the transformation of low-grade glioma into high-grade glioma, the method-specific OS was higher in patients who received combination of chemotherapy and radiation therapy compared to those who received chemotherapy or radiation therapy alone: 32, 12, and 24 months, respectively (p>0.05).Conclusion. Repeated surgery is the optimal treatment approach for patients with continuous growth of primary brain glioma. In cases with repeated radiotherapy courses, CPNT or STRT can be the methods of choice. Treatment of patients with transformation of low-grade gliomas into high-grade gliomas should include repeated course of chemoradiotherapy.

Long-term efficacy of no-touch radiofrequency ablation in the treatment of single small hepatocellular carcinoma: A single center long-term follow-up study.

To evaluate the long-term efficacy of no-touch radiofrequency ablation (NT-RFA) for treating single hepatocellular carcinoma (HCC) less than 3cm. A total of 331 patients with HCC less than 3cm undergoing RFA in Southwest Hospital from 2015 to 2020 were analyzed retrospectively. All patients were divided into NT-RFA group (n=113) and conventional RFA (C-RFA) group (n=218). The survival rate, local tumor progression (LTP) and intrahepatic distant recurrence (IDR) of the two groups were calculated and compared. A significant difference was observed in ablation range (p=0.000) and safety margin (p=0.000) between the two groups. The 1-, 2-, 3-, 4-and 5-year overall survival (OS) rates in NT-RFA and C-RFA group were 99.12%, 93.73%, 76.18%, 57.00%, 45.17% and 99.08%, 89.91%, 71.26%, 54.28%, 41.77%, respectively. There was no significant difference between the two groups (p=0.281). The 1-, 2-, 3-, 4-and 5-year recurrence-free survival (RFS) rates in NT-RFA and C-RFA group were 78.51%, 52.59%, 41.02%, 34.36%, 30.92% and 68.81%, 44.95%, 30.88%, 23.73%, 22.88%, respectively. The two groups differed significantly (p=0.044). The 1-, 3-and 5-year LTP-free survival rates in NT-RFA and C-RFA group were 87.12%, 74.99%, 72.32% and 75.75%, 65.52%, 65.52%, respectively. The two groups also differed significantly (p=0.024). Furthermore, the RFS rates of D ≤ 2cm subgroups in NT-RFA and C-RFA groups differed significantly (p=0.037), while the RFS rates of 2cm < D ≤ 3cm subgroups in two groups showed no significant difference (p=0.578). The RFS rates of single HCC less than 3cm treated by NT-RFA was significantly higher than that of C-RFA. Due to a larger ablation range and safety margin, NT-RFA could significantly reduce LTP and improve RFS. Dual-electrode NT-RFA can significantly improve the RFS rate of patients with HCC less than 2cm, but there is no obvious advantage compared with C-RFA in the treatment of HCC over 2cm.

Efficacy of free anterolateral thigh flap and free jejunum in reconstruction for hypopharyngeal and cervical esophagus.

Because of its peculiar anatomical location, most patients with hypopharyngeal and cervical esophageal cancer are at advanced stage when they visit the hospital. At present, the treatment for hypopharyngeal and cervical esophageal cancer is primarily surgical resection and radiotherapy. However, due to the wide range of surgical resection, it can often lead to a large range of annular defects. Therefore, the upper digestive tract reconstruction after tumor resection is very important. We use the free anterolateral thigh flap (ALT) and free jejunum (FJ) transfer to reconstruct the hypopharyngeal and cervical esophagus, and to investigate the effect of both reconstruction methods on upper gastrointestinal tract defects. A retrospective analysis was conducted to investigate the clinical data of 42 patients with hypopharyngeal and cervical esophageal cancer (Clinical Stage IV) from Jan. 2004 to Jan. 2016 in the Second Xiangya Hospital of Central South University. All patients underwent total laryngopharyngectomy and cervical esophageal resection. The hypopharyngeal circumferential and cervical esophageal defects were reconstructed with free ALT (n=22) or FJ (n=20). Four patients who underwent radiotherapy and chemotherapy before surgery did not receive radiotherapy or chemotherapy after surgery. The remaining 38 patients underwent postoperative radiotherapy and chemotherapy. All patients were followed up by telephone or outpatient review, with a follow-up deadline in Jan. 2021. We compared the differences between the 2 groups in postoperative complications, radiotherapy complications, and survival rate. The differences in individual characteristics between 2 groups were analyzed using Fisher test. The differences in postoperative and radiotherapy complications between two groups were analyzed using χ² test. The 3- and 5-year overall survival rates were calculated using Kaplan-Meier survival curve method. In the ALT group, the postoperative complications mainly included anastomotic fistula, chylous fistula and subcutaneous hematoma of the donor site. The radiotherapy complication was anastomotic stenosis. However, in the FJ group, the postoperative complications mainly included chylous fistula, intestinal obstruction, and intestinal fistula. The radiotherapy complications mainly contained anastomotic fistula and tissue flap necrosis. The cases of postoperative complications in the ALT group and the FJ group were 7 and 5, respectively (P=0.625), and the cases of radiotherapy complications were 3 and 4, respectively (P=0.563). The 3-year overall survival rates in the ALT group and the FJ group were 52.9% and 46.7%, respectively, and the 5-year total survival rates were 35.1% and 31.9%, respectively (P=0.53). The cases of anastomotic stenosis after radiotherapy in the ALT group were more than those in the FJ group (P=0.097). However, the cases of jejunal necrosis and anastomotic fistula after radiotherapy in the FJ group were more than those in the ALT group (P=0.066). There are no significant differences in postoperative and radiotherapy complications and 3-and 5-year survival rates between the ALT group and the FJ group. The reconstruction with ALT is prone to develop anastomotic stricture. The reconstruction with FJ cannot withstand high-dose radiotherapy. The ALT and FJ are effective methods in the reconstruction of hypopharynx and cervical esophagus. The treatment protocol should be carefully chosen based on its advantages and disadvantages of these 2 methods.

Neglected prognostic importance of ileal resection in patients with peritoneal metastasis

We aimed to determine the prognostic role of ileal resection on postoperative complications and the final oncological results of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) treatment in patients with peritoneal metastasis (PM). Patients with PM who underwent CRS and HIPEC between 2007 and 2020 were analyzed retrospectively. Ileal resection was defined as the resection of the ileum at 100 cm or below. Patients were divided into ileal-resection and non-ileal resection groups. Besides clinico-pathological variables, peritoneal cancer index (PCI), completeness of cytoreduction (CC-0-1-2), (neo)adjuvant chemotherapy, operative time, need for surgical intensive care unit, and usage of blood products were all evaluated. The data of 664 patients was analyzed. Ileal resection was performed in 346(52.1%) patients. The median follow-up period was 27 months. The ileal resection group had significantly lower 3-and 5-year survival rates (55% and 43% vs. 69% and 52, p = .005, respectively). High PCI score (p < .001), more CC-1-2 cytoreductions (p < .001), more anastomoses (p < .001), prolonged operative time (p < .001), more ostomy creation (p = .001), increased morbidity (p < .001), and more infectious complications (p < .001) were all significantly associated with ileal resection. The loss of ileal function has a potential prognostic role in increased post-operative complications and worsened overall survival in patients with PMs.

Evaluation of the perioperative period and long-term outcomes of minimally invasive LTE and minimally invasive CTLE esophagectomy for stage Ⅰ-Ⅲ cervical esophageal carcinoma based on propensity score matching analysis

Objective: To evaluate the perioperative period and long-term effects of minimally invasive gasless laparoscopic transhiatal esophagectomy (LTE) and minimally invasive combined thoracoscopic and laparoscopic esophagectomy (CTLE) for stageⅠ-Ⅲ cervical esophageal cancer. Methods: The clinical data of 158 consecutive patients with cervical esophageal cancer stageⅠto Ⅲ who underwent minimally invasive CTLE or LTE esophagectomy in the Department of Thoracic Surgery, Beijing Tongren Hospital from January 2008 to December 2019 were retrospectively analyzed. A total of 40 pairs of cases were matched (40 cases of CTLE and 40 cases of LTE surgery) after using the propensity score matching analysis which aimed to balance the influence of confounding factors between groups, including 43 males and 37 females, aged 51 to 81 (62.5±7.0) years old. The perioperative variables and long-term outcomes of the two groups were compared. Results: The operation time ((148.0±31.3) min vs (201.3±48.3) min), intraoperative blood loss ((192.6±77.9) ml vs (387.8±112.4) ml), ICU monitoring time (0 day vs 1 day), and the complication rates of postoperative pneumonia (0 vs 15%) and arrhythmia (2.5% vs 20%) were lower in the LTE group than that of in the CTLE group(all P<0.05). The number of lymph node dissections in the CTLE group was higher than that of in the LTE group (21.2±6.1 vs 12.9±4.3, P<0.001). The 3-and 5-year overall survival (OS) rate and disease-free survival (DFS) rate in the LTE group (OS: 53.53% and 34.27%, DFS: 43.62% and 24.89%, respectively) and the CTLE group (OS: 59.48% and 37.29%, DFS: 49.12% and 28.82%, respectively) had no statistical differences (all P>0.05). Conclusion: The LTE group has advantages in reducing operation time, intraoperative bleeding, ICU monitoring time, postoperative incidence of pneumonia and arrhythmia, and its long-term prognosis is comparable to that of the CTLE group.

Revision Total Hip Arthroplasty with Primary Stem or Full-Porous-Coated Long Stem for Aseptic Femoral Component Loosening: A Matched-Pair Study.

BackgroundRevision total hip arthroplasty (RTHA) for loosening the femoral stem is a technical challenge. Distally fixed, full-porous-coated long stems are widely accepted as the standard selection for these revisions. However, the success of primary stems in RTHA is not well known.MethodsThis study enrolled 24 patients with aseptic loosening of the femoral stem who underwent RTHA using primary stems. Another 72 patients with aseptic loosening who underwent RTHA using full-porous-coated long stems were matched in terms of operation date, proximal femoral bone stock (Paprosky classification), sex, and age. The primary and secondary outcomes of failure were the need for revision for any reason and the radiographic change in the stem respectively.ResultsIn the primary stem group, one patient had a periprosthetic fracture and received a second RTHA 2 years after the previous one. The primary outcome’s 5-and 10-year survival rates were both 95.8%. For the matched comparison group, one patient had an immediate periprosthetic fracture of the femoral shaft requiring further open reduction internal fixation surgery. Another patient had a full-porous-coated long stem breakage 6 years postoperatively, which required a second RTHA. The primary outcome’s 5-and 10-year survival rates were 98.6% and 97.2%, respectively.ConclusionPrimary stems can achieve non-inferior clinical success compared to a full-porous-coated long stem for aseptic stem loosening RTHA in patients with adequate proximal femoral bone stock.

LOBE-SPECIFIC METASTASIS IN NON-SMALL CELL LUNG CANCER

Aim: to identify the pathways of lymph node metastases in non-small cell lung cancer (NSCLC).Material and Methods. The frequency of mediastinal lymph node metastases and treatment outcomes were analyzed in 327 patients with stage I–III non-small cell lung carcinoma (NSCLC), who underwent lung resection with systematic lymph node dissection (SLND) between 2007 and 2011.Results. In cases with tumor location in any lobe of the right lung, metastasis occurred in the superior and inferior mediastinal lymph nodes. In left-side tumors, the main pathways of lymphatic spread of tumors were superior and inferior mediastinal nodes as well as aortic lymph nodes. Left lower lobe tumors metastasized most often to inferior mediastinal lymph nodes. Skip metastases were observed at any location of the tumor. Routine examination of all ipsilateral mediastinal lymph nodes overstaged NSCLC in 19.5 % of cases. The overall 5-and 10-year survival rates in patients with stage I–III NSCLC with SND were 61.5 % and 49.2 %, respectively. The median survival time was 103 months.Conclusion. Despite typical metastatic patterns of mediastinal lymph nodes in patients with NSCLC, non-specific metastasis was observed at any location of the tumor, which required mandatory systematic nodal dissection.

Development and validation of a novel nomogram for predicting survival rate in pancreatic neuroendocrine neoplasms

Background Over the past decades, the incidence and prevalence of pancreatic neuroendocrine neoplasms (pNENs) have steadily increased. However, accurate prediction of the prognosis and treatment of this condition are currently challenging. This study aims to develop and validate a personalized nomogram to predict the survival of patients with pNENs. Materials and methods A total of 9739 patients with pNENs were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Subsequently, the patients were randomly assigned to a derivation cohort (n = 6874) and a validation cohort (n = 2865). The survival of patients was assessed using the Cox proportional hazards (PHs) regression analysis. Then, the nomogram that predicted 3-and 5-year survival rates were developed in the derivation cohort. Further, the predictive performance of the nomogram was evaluated through discrimination and calibration. Results The Cox regression analysis revealed that age, differentiation, the extent of tumor, M staging, and surgery were independent prognostic predictors for pNENs. The nomogram showed superior discrimination capability than AJCC staging in both derived and validation cohorts (C-index: 0.874 versus 0.721 and 0.833 versus 0.721). The calibration curves showed that the practical and predicted survival rates effectively coincided, specifically for the 3-year survival rate. Conclusion Our nomogram is a valuable tool for the prediction of the survival rate for patients with pNENs; this may promote individualized prognostic evaluation and treatment.

The prognostic value of uveal melanoma cell type

To determine the prognostic value of a uveal melanoma (UM) cell type for the development of metastases (MTS). The investigation enrolled 96 patients (96 eyes) with UM after enucleation. Forty-one patients without signs of MTS were included in this group, who were followed up for more than 36 months (mean, 70.5 months (36 to 105 months)), 55 patients with MTS who were followed up for an average of 21 months (2 to 44 months). The MTS and non-MTS groups were statistically homogeneous in age, gender, tumor size, location, and ciliary body involvement in the process, as well as in extrabulbar growth. There were spindle cell, mixed cell, and epithelioid cell UMs in 44, 35, and 21% of patents, respectively. The tumors in patients without MTS were noted to be significantly more likely to have spindle cell-type UM (p<0.0001). Mixed cell and epithelioid cell UMs were more frequently detected in patients with MTS (p<0.0001), which was believed to be due to the presence of epithelioid cells in both cell types. A survival analysis showed that the 3- and 5-year survival rates for patients with spindle cell UM were significantly higher than that for those with epithelioid cell or mixed cell UM (p<0.001); the 3-and 5-year survival rates for spindle cell UM were 78 and 70%, respectively; those for mixed cell UM were 37 and 24%; and those for epithelioid cell UM were 50 and 31%. The similar survival rates for patients with mixed cell or epithelioid cell type UM could conclude that it is advisable to use the binary principle - the presence or absence of epithelioid cells in the tumor, when assessing a UM cell type as a prognostic factor.

Postoperative long-term survival of non-small cell lung cancer patients with skip-N2 metastases

ObjectiveRadical lymphadenectomy is crucial in operations for non-small cell lung cancer (NSCLC). Usually pN1 and pN2 lymph nodes are affected consecutively (N1N2). Nevertheless, pN2 metastases may also occur in the absence of pN1 as skip-N2 metastases (N0N2). Here we compare the long-term survival of N1N2- and N0N2 patients. Materials and methods464 patients underwent surgery for NSCLC at our institution between 2012 and 2017. We retrospectively reviewed data of pN2 stage patients (n = 68). Patients with N1N2 (n = 39) were compared to N0N2 (n = 29) patients. 1-, 3-and 5-year survival rates were measured. Survival was assessed by Kaplan-Meier curves and the cox proportional hazards model was used to identify prognostic factors for overall survival. All patients received adjuvant chemoradiation therapy according to European guidelines. ResultsThe baseline characteristics did not differ between groups. We observed no differences in the histology, localization, or gender in our cohort. N0N2 patients showed significantly better 1- (N1N2: 82.4% vs. N0N2 100%; p = 0.001), 3- (14.7% vs. 63.6%; p=<0.001) and 5-year (9.4% vs. 43.8%; p = 0.001) survival rates. Tumor size (Hazard ratio (HR) 1.46, Confidence interval (CI 95%) 1.03–2.04; p = 0.03) and the occurrence of N1N2 (HR 4.26, CI 2.04–8.91; p < 0.0001) were independent prognostic factors for worse long-term survival. The Kaplan-Meier curves showed a reduced overall survival for N1N2 patients (log-rank N1N2, N0N2 p < 0.0001). ConclusionN1N2 patients have a significantly worse prognosis compared to N0N2 patients. This will aid to classify the heterogeneous pN2-NSCLC patient population more precisely. Further, multimodal therapy should be considered for N1N2 patients.

The clinical characteristics of patients with primary plasma cell leukemia and the efficacy of novel agents and hematopoietic stem cell transplantation

Objective: To analyze the immunophenotype and cytogenetic characteristics of primary plasma cell leukemia (pPCL), and to evaluate the efficacy of bortezomib and hematopoietic stem cell transplantation as main treatment. Methods: A retrospective cohort study was conducted including 42 pPCL patients admitted to Peking University People's Hospital from January 1998 to March 2019. All patients were followed up until December 31, 2019. The immunophenotype and cytogenetic characteristics were compared with historical data of multiple myeloma (MM). Thirty-nine patients were divided into bortezomib-based group (29 cases) and non-bortezomib group (10 cases). All patients were also divided into hematopoietic stem cell transplantation (HSCT) group (15 cases) and non-HSCT group (24 cases).Chi-square test was used for efficacy comparison, and Kaplan-Meier method was used for univariate prognostic analysis. Cox proportional hazards model was used for multi-variant analysis. Results: pPCL accounted for 2.6% of the total patients with plasma cell diseases during the same period. There were 22 males and 20 females, with a median age of 50 (30-77) years old at diagnosis. In immunophenotype analysis, tumor cells in pPCL patients also expressed CD38, CD138, CD45, which was similar as patients with MM. However the expression of CXCR4 were more frequently seen in pPCL(73.1% vs. 34.7%, P= 0.000), while intensity of CD9 and CD200 was lower (40.7% vs. 62.5%, P =0.028, 33.3% vs. 58.0%, P=0.021).Overall response rate of bortezomib-based therapy was superior to non-bortezomib therapy (69.0% vs.50.0%). The median survival was 18.2 (0.2-95.7)months, and the 1-and 2-year survival rates were 61.9% and 37.4%, respectively. Multivariate prognostic analysis suggested that age (P= 0.027) and efficacy(P= 0.035)were significantly correlated with survival.HSCT resulted in superior survival compared with chemotherapy alone(26.8 vs. 8.1 months, P=0.021). Conclusions: Immunophenotypes and cytogenetic abnormalities in patients with pPCL are different from those with multiple myeloma. Bortezomib based regimens improve response rate and survival of pPCL. Hematopoietic stem cell transplantation also predicts survival benefits.

Clinical analysis of mediastinal lymph node dissection through sternotomy approach in the treatment of papillary thyroid carcinoma with mediastinal lymph node metastasis

Objective: To investigate the rule of mediastinal lymph node metastasis of papillary thyroid carcinoma and the application of therapeutic mediastinal lymph node dissection through the sternotomy approach in the treatment of mediastinal lymph node metastasis of papillary thyroid carcinoma. Methods: All cases of papillary thyroid carcinoma with mediastinal lymph node metastasis treated through sternotomy cooperated by thoracic surgeons and head and neck surgeons from January 2006 to January 2017 in Cancer Hospital of Chinese Academy of Medical Sciences were included in this study. The distribution, metastasis rate, metastasis degree, surgical method, surgical complications and postoperative survival of patients with mediastinal lymph node metastasis were retrospectively analyzed. Results: A total of 31 patients (16 males and 15 females) with papillary thyroid cancer with mediastinal lymph node metastasis, with a median age of 46 (19-65) years, were enrolled in the group. Partial upper sternotomy was used in 28 cases, and total sternotomy was used in 3 cases. The mediastinal lymph nodes of papillary thyroid carcinoma metastasized farthest to the station 6, and the lymph node metastasis rate of each group from high to low was: 2R (61%), 1R (39%), 3A (39%), 1L (16%), 2L (10%), 4R (10%), 5 (3%) and 6 (3%). No metastasis was observed in station 3P, 4L and 7. In addition, the degree of lymph node metastasis at station 2R was the highest, reaching 35% (77/219). Extra-nodal invasion of mediastinal metastatic lymph nodes in thyroid papillary carcinoma is common (23%), easily fuses into masses (23%) and invades peripheral vascular nerves (26%). Up to 29% of blood transfusions are required during or after surgery due to oozing or bleeding (9/31). The 1-, 3-, 5-and 10-year survival rates of patients undergoing surgical treatment were 94%, 94%, 87% and 81%, respectively. Conclusion: Papillary thyroid carcinoma can metastasize to almost all mediastinal lymph nodes except station 3P, 4L and 7. Radical mediastinal lymph node dissection through sternotomy is an effective method for the treatment of mediastinal lymph node metastasis of thyroid papillary carcinoma.

Preliminary analysis of efficacy and safety of intensity-modulated radiotherapy for stage IVA thymoma

Objective To preliminarily evaluate the efficacy and safety of intensity-modulated radiotherapy (IMRT) in the treatment of inoperable stage ⅣA thymoma. Methods A retrospective analysis of 15 patients with inoperable stage ⅣA thymoma receiving IMRT from January 2010 to December 2017 was performed. Among them, 9 patients were male and 6 female, aged 31-83 years with a medianof 59 years. The dose of radiotherapy was 50Gy/60Gy/70Gy/15-20 fractions for PTV/CTV/GTV. The short-term efficacy, overall survival rate and adverse reactions were analyzed. Results The follow-up rate was 100%. The median follow-up time was 48 months. The short-term partial remission rate was 93%(14/15). The 1-, 3-and 5-year overall survival rates were 100%, 75% and 75%, respectively. One patient presented with grade 3 hematological reaction. Four patients died of tumors. Conclusion Preliminary findings demonstrate that IMRT is an efficacious and safe treatment of stageⅣA thymoma, which can be applied for patients with unresectable thymoma. Key words: Thymoma/intensity-modulated radiotherapy; Treatment outcome; Safety

Effect of locoregional risk factors on long-term prognosis of patients with N0 stage esophageal cancer receiving intensity-modulated radiotherapy

Objective To evaluate the effect of locoregional risk factors of esophageal cancer on the recurrence of gross tumor volume (GTV) in patients with N0 esophageal squamous cell carcinoma after radical intensity-modulated radiotherapy (IMRT) and to evaluate its effect on the 10-year survival of patients. Methods Clinical data of 374 patients with clinical N0 esophageal squamous cell carcinoma who underwent radical IMRT in the Fourth Hospital of Hebei Medical University from 2005 to 2010 were retrospectively analyzed. Involved-field irradiation was performed in 284 patients and selective lymph node irradiation was given in 90 patients. Concurrent radiochemotherapy was conducted in 69l patients and sequential radiochemotherapy was performed in 38 patients. The survival analysis was carried out by Kaplan-Meier method. The prognosis analysis was performed by multivariate Cox’s regression model. Results A total of 143 patients (38.2%) had recurrence in GTV. The maximum transverse diameter (GTV-D), GTV volume (GTV-V) and GTV volume/length (GTV-V/L) of GTV patients were significantly longer than those without recurrence in GTV (P=0.008, 0.043, 0.001). ROC curve analysis showed that the optimal diagnostic thresholds for GTV-D, GTV-L, GTV-V and GTV-V/L for GTV recurrence were 3.5 cm, 5.5 cm, 24.0 cm3 and 4.6 cm2, respectively (P=0.000, 0.003, 0.000 and 0.000), and the ratio of recurrence within GTV in the patient group was significantly greater than that in the smaller group (P=0.000, 0.002, 0.001 and 0.000). GTV-L and GTV-V/L were the independent risk factors of recurrence in GTV (P=0.021 and 0.009). The 3-, 5-and 10-year survival rates of all patients in the whole group were 42.9%, 23.2% and 7.9%, respectively. Multivariate analysis demonstrated that age, T stage, concurrent radiochemotherapy, GTV-D and GTV-V/L were the independent risk factors of survival (P=0.027, 0.000, 0.018, 0.009 and 0.034). The main cause of death in patients with a survival time of more than 5 years was still associated with cancer. Conclusions The locoregional risk factors of esophageal cancer exert significant effect on the recurrence of GTV in patients with N0 esophageal squamous cell carcinoma undergoing radical radiochemotherapy, which can be utilized as the predicting markers. Both GTV-D and GTV-V/L are significantly correlated the 10-year survival of patients. Key words: Esophageal neoplasm/radiochemotherapy; Recurrence of primary tumor bed; Prognosis

Comparison of survival between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy followed by surgery for esophageal squamous cell carcinoma

Objective To compare the effect of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT) on the survival of patients with esophageal cancer. Methods Clinical data of 275 cases of thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were analyzed retrospectively. The data of treatment and follow-up were complete and analyzable. There were 70 cases in the NCRT group and 205 cases in the NCT group. The survival rate was calculated by Kaplan-Meier method and statistically compared by log-rank test, and multivariate analysis was performed by Cox regression model. Results The median follow-up time was 32(3-84) months. The median survival time and recurrence-free survival time was 42(3-84) months and 30(3-84) months, respectively. The overall 3-and 5-year survival rates were 56.8% and 45.9%, respectively, and the 3-and 5-year recurrence-free survival rates were 45.1% and 38.9%, respectively. The median survival time in the NCRT and NCT groups was 46(7-84) and 40(4-74) months, and the median recurrence-free survival time was 31(3-84) and 28(3-69) months, respectively. The 3-and 5-year overall survival of the two groups were 59.1%, 47.1% and 56.3%, 47.5%(P=0.515), and the 3-and 5-year recurrence-free survival were 44.5%, 40.1% and 47%, 39%, respectively. There was no significant difference in the survival between two neoadjuvant therapy modes (P=0.554). Multivariate analysis showed that postoperative pathological TNM staging was an independent factor affecting the prognosis of patients with esophageal cancer (P=0.001). Conclusions The survival results of NCRT are similar to those of NCT. Postoperative pathological staging is an independent survival factor. Key words: Esophageal neoplasm/neoadjuvant radiotherapy; Esophageal neoplasm/neoadjuvant chemotherapy; Prognosis

Systemic Immune Inflammation Index, Lowest Total Lymphocyte Count and Hemoglobin Level Are Prognostic Factors in Patients with Postoperative Recurrence of Esophageal Carcinoma Treated with Salvage Radiotherapy and Chemotherapy

To analyze the effects of clinical features, chemoradiotherapy related factors, hematological different nutritional indexes, and inflammatory indexes on the survival of postoperative recurrence of esophageal carcinoma treated with salvage chemoradiotherapy, and to explore the predictive factors of treatment-related toxic and side effects. A total of 242 postoperative esophageal carcinoma patients with local/regional recurrence during January 2008 to December 2016 treated with chemoradiotherapy were analyzed. Recurrence included anastomotic recurrence and regional lymph node metastasis (supraclavicular, mediastinal, and abdominal lymph node metastasis involved). The clinical features (sex, age, tumor location, T stage, N stage, TNM stage, regional recurrence site, number of recurrence areas, postoperative recurrence time), chemoradiotherapy related factors (post-recurrence treatment, radiotherapy target area, radiotherapy dose, chemotherapy regimen, chemotherapy cycle), hematological inflammation related indicators, including the absolute monocyte count (AMC), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation score (SIS), and hematological nutrition-related indicators, including total lymphocyte count (TLC), hemoglobin (HB), albumin (ALB), prognostic nutritional index (PNI)，body mass index (BMI) on survival, toxic and side effects were analyzed. The median survival time was 16.6 months, and the 1-, 2-, 3-and 5-year survival rates were 65.6%, 36.7%, 25.5% and 11.5%, respectively. Univariate analysis showed that T stage, N stage, TNM stage, chemotherapy cycle, NLR level, PLR level, LMR level, SII level, HB level, PNI level before chemoradiotherapy, and the minimum level of TLC during chemoradiotherapy were the influencing factors of OS. Multivariate analysis showed that the minimum level of TLC during chemoradiotherapy, SII and HB level before chemoradiotherapy were independent influencing factors of OS (P=0.001; P=0.009; P=0.009, respectively). AMC level, HB level and TLC minimum level were the main factors affecting hematological toxicity. The incidence of grade 2 hematological toxicity in the high AMC group was similar to that in the low AMC group, and the incidence of the non-anemia group and the G0-2 group in the lowest TLC was even lower than that in the corresponding group. No factors affecting hematological toxicity and radiation pneumonia were found in hematology. The minimum level of TLC during chemoradiotherapy, the level of SII and HB before chemoradiotherapy were the independent prognostic factors for postoperative esophageal carcinoma patients treated with salvage chemoradiotherapy.

LONG-TERM OUTCOMES OF INTRAOPERATIVE RADIATION THERAPY FOR NON-SMALL CELL LUNG CANCER

The purpose of the study was to analyze long-term outcomes of intraoperative radiation therapy (IORT) in patients with stage III non-small cell lung cancer (NS CLC). Material and Methods. The study included 103 patients with stage III NS CLC treated at the Cancer Research Institute (Tomsk, Russia). All patients were divided into two groups. Group I consisted of 51 patients, who underwent radical surgery and IORT at a single dose of 15 Gy. Group II (control group) comprised 52 patients, who underwent radical surgery alone. There were 34 (33 %) pneumonectomies, 39 (37.9 %) lob-, bilobectomies, 9 (8.7 %) reconstructive surgeries and 21 (20.4 %) combined surgeries. A compact pulsed betatron MIB-6E with the average electron energy of 6 MeV, located directly in the operating unit, was used for performing IORT. The Kaplan-Meier method was used for survival analysis. The significance of differences in survival between groups was assessed using the log rank test. Results. Excluding the cases lost to follow-up and deaths from concomitant non-malignant diseases, treatment outcomes were followed up in 97 of 103 patients with NS CLC for 3, 5, and 10 years. The 3-year and disease-free survival rates were significantly higher in the IORT group than in the control group (p<0.05). The IORT reduced the frequency of locoregional recurrence from 28.6 % to 20.8 % and increased recurrence-free survival from 12 to 17.1 months. In patients with stage III NS CLC, who received combined modality treatment including IORT, the 5and 10-year disease-free survival rates were 18.7 % and 12.5 %, respectively. In the control group patients, the corresponding values were 14.3 % and 6.1 %, respectively (р<0.05). The 5and 10-year overall survival rates were 29.2 % and 18.7 % versus 20.4 % and 8.2 %, respectively (р<0.05). Conclusion. In patients with stage III NS CLC, combined modality treatment, including radical surgery and IORT, results in a better local control and higher long-term survival rates compared to surgery alone.

Lymph node ratio has impact on relapse and outcome in patients with stage III melanoma.

Even though both the involvement of regional lymph nodes and the number of metastatic lymph nodes are regarded as major determinants of survival in cutaneous melanoma, the extent of node dissection has been analyzed as an independent prognostic indicator in only a few studies. This study aims to determine how the lymph node ratio (NR) (ratio of positive nodes to total nodes removed) might predict the disease relapse and survival in node-positive melanoma. A total of 317 patients with stage III primary melanoma were included in the study and reviewed retrospectively. All patients had nodal staging (N) by radical lymph node dissection. Patients were divided into three groups based on NR1 ≤ 10%, NR2 10-25%, and NR3 > 25%. The median age was 50years (range 16-86) and men were predominant (59.3%). The majority of the patients had thicker Breslow depth (> 2mm) (83.3%), higher mitotic rate (> 2/mm2) (64.1%) and ulcerated lesions (69.4%). The median number of positive nodes was 1 (range 1-32). The largest group was N1 (52.4%), which was followed by N2 (29.6%) and N3 (18%). The ratios of patients were 37.5%, 35.3%, and 27.1% in NR1, NR2, and NR3, respectively. The median number of excised lymph nodes was 13 (range 1-73). For all patients the estimated 5-and 10-year relapse-free survival (RFS) rates were 41% and 39%, respectively; and the estimated 5-and 10-year overall survival (OS) rates were 51% and 42%, respectively. Nodular histopathology, ulcerated lesions, higher mitotic rates, and higher node substages were the independent variables that were inversely correlated with survival for all patients; and NR was one of the significant prognostic factors and strongest predictors of relapse and survival (p = 0.03 and p = 0.01, respectively). Our results suggest that, apart from the conventional nodal status, NR is an independent prognostic factor-regarding both RFS and OS in stage III cutaneous melanoma.