5-year Locoregional Recurrence-free Survival Rates Research Articles

Long-term follow-up and prognostic analysis of parotid tumors in children and adolescents.

The objective of this study is to summarize the clinical characteristics, treatment, and prognosis of parotid tumors in children and adolescents. Fifty-three children and adolescents diagnosed with parotid gland tumors were included. Survival was evaluated using the Kaplan-Meier method. Log-rank test and multivariate analysis were used to analyze the association between clinical factors and recurrence. Of the 53 patients, 30 cases were benign and 23 cases were malignant. All patients underwent surgery. Patients with malignant tumors with high-risk factors received radiotherapy or chemotherapy. The median follow-up time was 61 months. Of these, 1 patient with benign tumor and 5 patients with malignant tumors recurred. Of the patients with malignant tumors, 2 developed distant metastases and 2 died. The 5-year overall survival (OS) and 5-year locoregional recurrence-free survival (LRFS) rates for benign tumors were 100.0% and 92.9%, respectively, whereas the 5-year OS and 5-year LRFS rates for malignant tumors were 94.4% and 72.5%, respectively. The log-rank univariate test showed that tumor size >3.5 cm (p = .056), distant metastasis (p = .056), and stage III and IV (p = .032) were associated with recurrence. However, multivariate analysis did not show the above factors to be independent prognostic factors for LRFS. Surgery for benign tumors depends on the location and size. Surgery for malignant parotid tumors depends mainly on the stage, grade, pathological type, and recurrence. Prophylactic lymph node dissection is required for high-grade tumors. Radiotherapy or chemotherapy for children needs more research. Both benign and malignant tumors have high survival rates after active treatment. Level 2.

Is postmastectomy radiotherapy necessary for breast cancer patients with clinically node-positive downstaging to ypN0 after neoadjuvant chemotherapy?

The significance of postmastectomy radiotherapy (PMRT) in breast cancer patients who initially have clinically node-positive (cN +) status but achieve downstaging to ypN0 following neoadjuvant chemotherapy (NAC) remains uncertain. This study aims to assess the impact of PMRT in this patient subset. Patients were enrolled from West China Hospital, Sichuan University from 2008 to 2019. Overall survival (OS), Locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and breast cancer-specific survival (BCSS) were estimated using the Kaplan-Meier method and assessed with the log-rank test. The impact of PMRT was further analyzed by the Cox proportional hazards model. Propensity score matching (PSM) was performed to reduce the selection bias. Of the 333 eligible patients, 189 (56.8%) received PMRT, and 144 (43.2%) did not. At a median follow-up period of 71months, the five-year LRFS, DMFS, BCSS, and OS rates were 99.1%, 93.4%, 96.4%, and 94.3% for the entire cohort, respectively. Additionally, the 5-year LRFS, DMFS, BCSS, and OS rates were 98.9%, 93.8%, 96.7%, and 94.5% with PMRT and 99.2%, 91.3%, 94.9%, and 92.0% without PMRT, respectively (all p-values not statistically significant). After multivariate analysis, PMRT was not a significant risk factor for any of the endpoints. When further stratified by stage, PMRT did not show any survival benefit for patients with stage II-III diseases. In the context of comprehensive treatments, PMRT might be exempted in ypN0 breast cancer patients. Further large-scale, randomized controlled studies are required to investigate the significance of PMRT in this patient subset.

Pretreatment Circulating HPV16 DNA Viral Load Predicts Risk of Distant Metastasis in Patients with HPV16-Positive Oropharyngeal Cancer.

There are definite reasons to implement molecular diagnostics based on the measurement of human papillomavirus (HPV) DNA in liquid biopsy into clinical practice. It is a quick, repeatable, and health-safe test for cancer biomarkers in the blood. In this study, we investigated whether the circulating tumor-related HPV16 (ctHPV16) viral load (VL) in patients with oropharyngeal squamous cell carcinoma (OPSCC) was important for determining the risk of locoregional recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). This study included 91 patients with ctHPV16-positive OPSCC who had been treated with radical radiotherapy and chemotherapy. The VL was measured using quantitative PCR (qPCR) and a probe specific for HPV16. Based on 10 years of follow-up, the 2-, 3-, 5-, and 9-year LRFS, MFS, and OS were estimated. The 5-year actuarial LRFS, MFS, and OS rates of patients with ctHPV16-positive/OPSCC were 88%, 90%, and 81%, respectively. The VL was significantly higher in patients who subsequently developed distant metastases (DM) than in those who did not (VL 4.09 vs. 3.25; p = 0.009). In a Cox proportional hazards regression model for MFS, a higher ctHPV16 VL appeared to be a significant independent prognostic factor for the occurrence of DM (HR 2.22, p = 0.015). The ROC curve revealed a cutoff value of 3.556 for VL (p = 0.00001). A high VL before treatment indicates patients with a significant risk of DM, and should be used in OPSCC treatment stratification.

Adult head and neck rhabdomyosarcoma: radiotherapy- based treatment, outcomes, and predictors of survival

BackgroundAdult head and neck rhabdomyosarcoma (HNRMS) is an exceptionally rare malignancy, and there is a paucity of data and research dedicated to understanding its characteristics and management in adult populations. This study aimed to assess the outcomes and identify survival predictors in adult HNRMS.MethodsWe retrospectively evaluated 42 adult patients (> 16 years) with HNRMS who received radiotherapy (RT)-based treatment at our institute between 2008 and 2022. We analysed the clinical characteristics and prognosis of these patients, including the locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS), using the Kaplan–Meier method. The chi-square and Fisher’s exact tests were used to analyse differences between groups for dichotomous and categorical variables, respectively. Survival rates were calculated using the Kaplan–Meier method. Prognostic variables were assessed through univariate Cox analyses.ResultsThe median patient age was 28 years (range, 16–82 years). Alveolar RMS was the most common histological type, observed in 21 patients (50.0%), followed by embryonal in 16 patients (38.1%). The anatomic sites of origin were orbital in one (2.4%), parameningeal in 26 (61.9%), and non-orbital/non-parameningeal in 15 (35.7%) patients. Nineteen patients (45.2%) had regional lymph node metastasis, and five patients (11.9%) presented with distant metastatic disease. Distant metastasis (n = 17) was the primary cause of treatment failure. At a median follow-up of 47.0 months, the 5-year LRFS, PFS, and OS rates were 69.0%, 39.7%, and 41.0%, respectively. Univariate analysis revealed that tumour size, lymph node involvement, and the local treatment pattern (surgery and RT vs. RT alone) were significant predictors of survival.ConclusionsThe main failure pattern in patients with HNRMS receiving RT-based treatment was distant metastasis. Tumour size > 5 cm and lymph node involvement were predictors of worse LRFS. Multimodality local treatment, combining surgery and RT, is effective and provides survival benefits.

Impact of Microscopically Positive (≤1 mm) Distal Margins on Disease Recurrence in Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy

The adequate distal resection margin is still controversial in rectal cancer treated by neoadjuvant chemoradiotherapy (nCRT). The aim of this study was to assess the impact of a distal margin of ≤1 mm on locoregional recurrence-free survival (LRRFS). Among 255 patients treated with nCRT and surgery at the National Cancer Institute of Milan, 83 (32.5%) had a distal margin of ≤1 mm and 172 (67.5%) had a distal margin of >1 mm. Survival analyses were performed to assess the impact of distal margin on 5-year LRRFS, as well as Cox survival analysis. The role of distal margin on survival was analyzed according to different tumor regression grades (TRGs). The overall 5-year LRRFS rate was 77.6% with a distal margin of ≤1 mm vs. 88.3% with a distal margin of >1 mm (Log-rank p = 0.09). Only stage ypT4 was an independent predictor of worse LRRFS (HR 15.14, p = 0.026). The 5-year LRRFS was significantly lower in TRG3-5 patients with a distal margin of ≤1 mm compared to those with a distal margin of >1 mm (68.5% vs. 84.2%, p = 0.027), while no difference was observed in case of TRG1-2 (p = 0.77). Low-responder rectal cancers after nCRT still require a distal margin of >1 mm to reduce the high likelihood of local relapse.

High-Risk pT1-2N0 Breast Cancer may Benefit from Postmastectomy Radiotherapy: A Risk Stratification Analysis Based on Nomogram

<h3>Purpose/Objective(s)</h3> Postmastectomy radiation therapy (PMRT) had heterogeneous effects on clinical outcome of patients with pT1-2N0 breast cancer. We aimed to develop nomograms for predicting locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS), and to explore the potential effect of PMRT in pT1-2N0 breast cancer. <h3>Materials/Methods</h3> Clinical data were collected from 840 patients with newly diagnosed pT1-2N0 breast cancer between January 2015 and December 2018. Nomograms predicting the LRRFS and DFS rates were developed based on the risk factors identified by Cox regression analysis in patients treated with mastectomy alone (n =671). Furthermore, the effect of PMRT was indirectly investigated by comparing patients treated with mastectomy alone with those treated with breast-conserving surgery (BCS) plus radiotherapy (n =169) in different risk subgroups stratified by the nomogram scores. The optimal cut-off points were identified by X-tile software. LRRFS and DFS were evaluated using the Kaplan-Meier method, and the differences were compared using the log-rank test. Propensity score matching analysis (PSM) was performed to balance the backgrounds of patients between the mastectomy alone and BCS plus radiotherapy sets. <h3>Results</h3> After a median follow-up duration of 62 months (range, 9–79 months) and 50 months (range, 10–79 months) in the mastectomy alone and BCS plus radiotherapy sets, respectively. The 5-year LRRFS rates (97.0% vs. 97.3%, P = 0.516) and the 5-year DFS rates (92.0% vs. 92.7%, P = 0.339) were similar between the mastectomy alone and BCS plus radiotherapy sets, respectively. Multivariate Cox regression showed that larger tumor size, high grade, and hormone receptor (HR)-negative status were independent poor prognostic factors for both LRRFS and DFS (P<0.05 for all), while premenopausal status was independently associated with worse LRRFS (P=0.019). Incorporation of these factors into the constructed nomograms showed high accuracy when predicting the 5-year LRRFS and DFS rates, with concordance indexes of 0.794 (95%CI: 0.704-0.884) and 0.726 (95%CI: 0.659-0.793), respectively, after internal validation. Based on nomogram scores, patients were classified into different risk groups. After PSM in subgroups, compared with mastectomy alone, BCS plus radiotherapy significantly improved the LRRFS (84.9% vs. 96.6%, p = 0.026) and DFS (71.8% vs. 100%, p = 0.033) in the high-risk group, but not in the low-risk or intermediate-risk group (P>0.05 for all). <h3>Conclusion</h3> The constructed nomograms can not only estimate the individualized 5-year LRRFS and DFS rates among patients with pT1-2N0 breast cancer after mastectomy but can also stratify patients into different risk subgroups, and thus, they can help identify high-risk patients who are more likely to benefit from PMRT.

Validation of the Role of Postoperative Radiotherapy in Improving Disease-Free Survival of Patients with Stage III ypN2 Non-Small Cell Lung Cancer after Neoadjuvant Therapy Followed by Complete Resection – A Propensity-Score Matching Study

<h3>Purpose/Objective(s)</h3> Although the Lung ART study, a phase III trial, showed that postoperative radiotherapy (PORT) could not significantly improve the disease-free survival (DFS) of patients with pN2 non-small cell lung cancer (NSCLC) after complete resection. However, its subgroup analysis showed that PORT did significantly improve the DFS of those with ypN2 NSCLC after neoadjuvant therapy and surgery. Our study aimed to validate the effect of PORT on the survival of patients with ypN2 NSCLC. <h3>Materials/Methods</h3> Patients was filtrated from our center from 2004 to 2021. The inclusion criteria of patients were as follows: 1) diagnosed with NSCLC; 2) accepted neoadjuvant systematic treatments including chemotherapy, tyrosine kinase inhibitors (EGFR, ALK), or immune checkpoint inhibitors; 3) received complete resection (R0 resection); 4) with stage III ypN2 disease (AJCC 8^th). We excluded patients with multiple primary malignant tumors and those who died within four months after surgery. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) was used to match the baseline characteristics between the PORT group and the non-PORT group. Kaplan-Meier method was used to estimate the endpoints. All data were analyzed using R 4.1.2. <h3>Results</h3> Totally 185 patients were included in the final analysis. There were 49 patients (26.5%) with PORT. After 1:1 PSM between the PORT group and the non-PORT group, 82 patients remained with 41 in each group. The baseline characteristics of majority in the matched cohort were as follows: male (75.6%), smoking history (79.3%), performances scores 0-1 (100%), adenocarcinoma (47.6%), grade 3-4 (58.5%), receiving neoadjuvant chemotherapy (91.5%), lobectomy (82.9%), ypT1-2 (78.9%), and ypN2b (51.2%). The median age of patients was 58. The median numbers of examined and positive lymph nodes were 20.5 and 6. The median follow-up time was 49.5 months. The median DFS of the PORT group and the non-PORT group were 25.5 months vs. 18.6 months, with the 5-year DFS rates of 43.4% vs. 24.8%, respectively (P=0.044). The median LRFS of the two groups were not reached vs. 56.8 months, with the 5-year LRFS rates of 89.1% vs. 39.8% (P<0.001). The median OS of the two groups were not reached vs. 67.7 months, with the 5-year OS rates of 76.7% vs. 34.8% (P=0.092). <h3>Conclusion</h3> For patients with stage III ypN2 NSCLC after neoadjuvant systematic therapy followed by complete resection, PORT can significantly improve the DFS and LRFS, but failed to improve OS. However, the results need to be clarified by prospective randomized clinical trials.

Adenoid Cystic Carcinoma of Lobar Bronchial Origin: 20-Year Experience at a Single Institution.

Pulmonary adenoid cystic carcinoma (ACC) is a rare type of lung malignancy. The prevalence of ACC of lobar bronchial origin is lower than that of other lung malignancies, and studies investigating it are lacking. This study aimed to evaluate survival of patients with ACC of the lobar bronchus after surgical resection and to explore its prognostic factors. Between January 2000 and December 2019, 35 patients at the National Cancer Center/Cancer Hospital with a diagnosis of ACC of the lobar bronchus were included in the retrospective analysis. During a median follow-up period of 61 months (range, 10-194 months), the analysis showed a 5-year overall survival (OS) rate of 81.4%, a 5-year locoregional recurrence-free survival rate of 84.0%, and 5-year disease-free survival rate of 60.1%. The univariate analysis exclusively identified the surgical margin as a predictor of OS, and survival was significantly longer for the patients with negative surgical margins than for those with positive surgical margins (R0 vs. R1: 94.4% vs. 66.0%; p = 0.014). Adjuvant radiotherapy was administered to most of the patients with positive surgical margins, which might have contributed to prolonged OS (R0 vs. R1+RT: 94.4% vs. 66.7%, p = 0.173; R0 vs. R1+no RT: 94.4% vs. 62.5%, p = 0.007). For ACC of lobar bronchial origin, complete resection is the radical treatment, and the OS rate was significantly higher for the R0 patients than for the R1 patients. Adjuvant radiotherapy for patients with R1 may prolong survival.

Abstract P3-20-09: Surgery vs radiation therapy as the first stage treatment in patients with locally advanced breast cancer with incomplete clinical response

Abstract Objective: The management of patients with locally advanced breast cancer (LABC) with skin involvement continues to be one of the most controversial topics in mammology. Systemic therapy (chemotherapy and/or hormone therapy and biological agents) followed by local therapy (surgery and/or radiation therapy) are usually recommended. There are no generally accepted definitions of tumor resectability following systemic therapy (skin edema/erythema/thickening), and thus there are no specific guidelines for the priority of local treatment. Systematic well-conducted randomized trials of these patients are still rare. So the purpose of our analysis is to assess the long-term outcome in patients with incomplete clinical response to neoadjuvant systemic therapy followed by different priority of local treatment types.Materials and methods: We performed a retrospective analysis of 182 consecutive patients with N4bN0-3 non-metastatic breast cancer treated between 2010 and 2018 in N.N. Blokhin National Cancer Research Center. All patients were treated with neoadjuvant hormone- or chemotherapy and were considered as borderline for surgical resection because of partial skin edema. Ninety one (50%) received radiotherapy (RT) with (50 women, total dose 50 Gy) or without (41 women, total dose 62Gy) consecutive surgery after systemic treatment (first group) and 91 (50%) received surgery with consecutive radiotherapy (second group). The median age of the first and second group were 58,76±1,29 and 57,64±1,29 years, respectively (р = 0,539). Median follow-up time was 7,5 years. Results: The 3- and 5-​year disease-free survival (DFS) of the first group were 47% and 33,3%, of the second group were 61,4% and 54,1% respectively. DFS differed significantly between the two groups (р = 0,008). There was no difference in DFS regardless of the surgery in the first group (p = 0,931). Also, the risk of a local-regional recurrence was lower at the second group (the 3- and 5-year LRR-free survival rates were 87,7% and 85,6% vs 77,3% and 65,9%, р = 0,027). The 3- and 5-year overall survival (OS) of the first group were 75.2% and 57.9%, the 3- and 5-year overall survival (OS) of the second group were 77.1% and 57,9%, respectively. There wasn`t a statistically significant difference between the two groups (p=0,768 and p=0,619, respectively). A separate analysis, dividing the patients of the first group on with and without surgery, did not substantially alter the results of OS (p = 0,088 and p = 0,411). Mortality rate was 48,4% (CI: 38,8% - 58,0%) in the first group and 41,8% in the second group (CI:32,5% - 51,5%), р=0,228.Conclusion: Our study showed that local control and DFS in LABC patients with skin involvement after systemic treatment were better if surgery was performed as the first stage of the local treatment. Therefore, prospective randomized trials are needed to improve patient selection and optimization of the local treatment. Citation Format: Alexander Petrovsky, Victory Amosova, Oxana Trofimova, Mona Frolova. Surgery vs radiation therapy as the first stage treatment in patients with locally advanced breast cancer with incomplete clinical response [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-20-09.

Contemporary Outcomes After Multimodality Therapy in Patients With Breast Cancer Presenting With Ipsilateral Supraclavicular Node Involvement

PurposePatients with breast cancer and ipsilateral supraclavicular (SCV) node involvement at the time of diagnosis (TNM cN3c) have historically had poor outcomes. Radiation therapy (RT) has an important role because SCV nodes are not routinely surgically dissected. However, optimal locoregional management, contemporary outcomes, and prognostic factors are not well defined. Methods and MaterialsWe reviewed the data of patients with cN3c breast cancer treated at our institution between 2014 and 2019 with curative intent, including neoadjuvant chemotherapy, surgery, and adjuvant RT. All patients received comprehensive regional RT, including to the SCV nodes. Institutional guidelines recommend a 10-Gy or 16-Gy boost to resolved and unresolved N3 nodes, respectively. Overall survival (OS), recurrence-free survival (RFS), locoregional recurrence-free survival (LRRFS), and supraclavicular recurrence-free survival (SCRFS) were analyzed. ResultsData from 173 consecutive patients were analyzed with a median follow-up time of 2.8 years. The median age was 54 years, 76 patients (44%) were estrogen receptor positive/human epidermal growth factor receptor 2 negative, 100 patients (58%) had T3/4 disease, and 10 patients (6%) underwent a neck dissection. In addition, 156 patients (90%) received a cumulative SCV dose of ≥60 Gy. The 5-year OS, SCRFS, LRRFS, and RFS rates were 73%, 95%, 86%, and 50%, respectively. The 5-year OS rate for a cumulative SCV dose of ≥60 Gy versus <60 Gy was 75% versus 39% (P = .04). In the multivariable analysis, a cumulative SCV dose of ≥60 Gy, extranodal extension, receptor status, and Eastern Cooperative Oncology Group performance status were associated with OS. The 5-year SCRFS rates with and without neck dissection were 100% versus 95% (P = .57). Among patients with a postchemotherapy SCV node size of ≥1 cm without neck dissection, the 5-year SCRFS rate was 83%. ConclusionsIn one of the largest series of patients with cN3c breast cancer, multimodality therapy using adjuvant RT with a SCV boost resulted in a 5-year LRRFS rate of 86%. There is a limited role for neck dissection as the 5-year SCRFS rate was 95% overall and 83% for residual SCV disease ≥1 cm after chemotherapy with RT alone. A cumulative SCV dose of ≥60 Gy was associated with improved OS, but not SCRFS, LRRFS, or RFS. A SCV boost should be considered in these patients as treatment was well-tolerated. Despite advances in systemic therapy, nearly half of patients developed distant metastases, highlighting the need for close observation after treatment.

Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma?

ObjectiveTo determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe.MethodsAdult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group.Results370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16–85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%.ConclusionPTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.

Significance of serum CA125 level in surgically resected cervical adenocarcinoma with adverse features.

ObjectiveUnlike cervical squamous cell carcinoma, there are no consensus criteria for serum tumor markers in cervical adenocarcinoma. This study aimed to identify the prognostic value of preoperative carbohydrate antigen 125 (CA125) levels in cervical adenocarcinoma patients with adverse pathologic features.MethodsA total of 105 patients who underwent radical hysterectomy followed by adjuvant radiotherapy (RT) or concurrent chemoradiation therapy were included. Locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were evaluated using the Cox proportional hazard regression model.ResultsUsing a cutoff value of 50 U/mL, 83 and 22 patients had low- and high-CA125, respectively. Patients with high-CA125 had a larger tumor size, more frequent parametrial extension, and more frequent lymph node metastasis than those with low-CA125. During a median follow-up of 59.3 (interquartile range, 32.7–97.8) months, patients with high-CA125 showed inferior 5-year LRFS, DMFS, and OS rates compared to those with low-CA125 (38.5% vs. 70.0%; 37.0% vs. 69.4%; 43.6% vs. 78.1%, respectively, all p<0.05). In multivariable analysis, the high-CA125 remained significant prognostic factor for LRFS, DMFS, and OS (all p<0.05). Furthermore, 12 patients with high-CA125 at recurrence exhibited lower 5-year OS rates than 21 patients with low-CA125 at recurrence (0.0% vs. 51.3%, p=0.003).ConclusionIn this retrospective analysis, the serum CA125 level at diagnosis and recurrence was related to the extent of disease and prognosis of cervical adenocarcinoma with adverse pathologic features. A CA125 level of ≥50 U/mL may be a prognostic surrogate marker for cervical adenocarcinoma in patients with the presence of adverse factors.

Survival analysis of postmastectomy radiotherapy for breast cancer staged in cT1-2N1M0 after neoadjuvant chemotherapy with 0-3 metastatic lymph nodes

Objective To investigate the value of postoperative radiotherapy in patients with cT1-2N1M0 breast cancer after neoadjuvant chemotherapy and modified radical mastectomy which postoperative pathology showed that the number of axillary lymph node metastases was 0-3. Methods One hundred and twenty-eight patients diagnosed with cT1-2N1M0 breast cancer admitted to our hospital from January 1, 2000 to December 31, 2014 were retrospectively reviewed. All patients underwent neoadjuvant chemotherapy and modified radical mastectomy. The number of postoperative axillary lymph node metastases was 0-3. According to whether there was postoperative radiotherapy or not, the whole group of patients was divided into radiotherapy group (n=87) and non-radiotherapy group (n=41). In the two groups after operation, there were 43 and 11 patients with 1-3 axillary lymph node metastases (ypN1), while there were 44 and 30 patients without axillary lymph node metastases (ypN0) respectively. The 5-year locoregional recurrence-free survival (LRFS) rate, disease-free survival (DFS) rate and overall survival (OS) rate were calculated by Kaplan-Meier method, and the differences were compared by log-rank test. Univariate analysis was performed to analyze the effects of clinical features and treatment on prognosis. Results The 5-year LRFS rate, DFS rate and OS rate of 128 patients were 91.4%, 82.8% and 93.0% respectively. The 5-year LRFS rates of the patients in the radiotherapy group and the non-radiotherapy group were 94.3% and 85.4% respectively, and the difference was not statistically significant (χ2=3.055, P=0.080). As well as the 5-year DFS rates were 89.7% and 68.3% respectively, and the difference was statistically significant (χ2=9.312, P=0.005). The 5-year OS rates were 94.3% and 90.2% respectively, and the difference was not statistically significant (χ2=0.810, P=0.368). In the subgroup analysis, the 5-year LRFS rates of the patients who had achieved ypN1 in the radiotherapy group and the non-radiotherapy group were 93.0% and 72.7%, and the 5-year DFS rates were 88.4% and 63.6%, with statistically significant differences (χ2=4.248, P=0.039; χ2=4.525, P=0.033). The 5-year OS rates were 90.7% and 81.8% respectively, and the difference was not statistically significant (χ2=0.713, P=0.399). The 5-year LRFS rates of the patients who had achieved ypN0 in the radiotherapy group and the non-radiotherapy group were 95.5% and 90.0% respectively, with no statistically significant difference (χ2=0.872, P=0.350). The 5-year DFS rates were 90.9% and 70.0% respectively, with statistically significant difference (χ2=5.439, P=0.019). The 5-year OS rates were 97.7% and 93.3% respectively, with no statistically significant difference (χ2=0.876, P=0.349). The univariate analysis indicated that age (χ2=11.709, P=0.001) and blood vessel invasion (χ2=7.608, P=0.006) were significant influencing factors for 5-year LRFS rate. Postoperative radiotherapy (χ2=9.312, P=0.002) was a prognostic factor for 5-year DFS rate. Age (χ2=6.093, P=0.014) and hormone receptor status (χ2=3.974, P=0.046) were prognostic factors for OS. Conclusion For the cT1-2N1M0 breast cancer patients with 1-3 positive axillary lymph nodes after neoadjuvant chemotherapy, postmastectomy radiotherapy has local control benefit, and it can improve DFS. However, the benefit of postoperative radiotherapy needs to be further investigated in patients with pathological negative axillary lymph nodes after neoadjuvant chemotherapy. Key words: Breast neoplasms; Prognosis; Neoadjuvant chemotherapy; Radiotherapy

Preoperative Evaluation Of Serum CA-125 Levels Maybe A More Significantly Prognostic Factor In Low To Intermediate-risk Endometrial Carcinoma: A Multi-institutional Study

To evaluate the prognostic role of preoperative serum CA-125 levels in different ESMO-ESGO-ESTRO risk classification in early-stage endometrial carcinoma (EC) from long-term data of a multi-institutional analysis. The material for the current study was derived from a total of 1108 patients with early-stage EC from a multi-institutional analysis in China between 2000 and 2016. The eligibility criteria included the primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy, stage I and II disease (FIGO 2009 staging) with complete clinicopathologic and follow-up information, serum CA-125 levels were evaluated preoperatively. Risk classification according to ESMO-ESGO-ESTRO Consensus. Time to any event was measured from the day RT started. Overall survival (OS), cancer-specific survival (CSS), disease free survival (DFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were calculated using the Kaplan–Meier method, Cox proportional hazards regression model was used for multivariate analysis. The cut-off values of CA-125 were obtained using receiver operating characteristic curves (ROC). Statistical analyses were performed with statistical analysis software. A total of 447 patients were enrolled. The median follow-up time was 49 months. The median age was 56 years. Stage Ia/b disease represented 90.6% of the cohort, low to intermediate-risk group62.9%. Patients mainly received VBT alone (65.8%, n = 294). The 5-year OS, DFS, CSS, LRFS, and DMFS rates for all patients were 95.2%, 89.5%, 97.1%, 92.8%, and 90.7% respectively. Subgroup analysis revealed that age>60, preoperative serum CA-125>35U/ml, and grade were found to be significant prognostic factors for CSS in low to intermediate-risk group(p = 0.032, 0.002, and 0.031). The best cut-off values for preoperative serum CA-125 of low to intermediate-risk and high-intermediate to high-risk diseases were 20.35U/mL (AUC = 0.825, p = 0.013) and 17.21 U/mL(AUC = 0.681, p = 0.042), respectively. Preoperative serum CA-125 had no significant prognostic effect on OS and DFS. Preoperative evaluation of serum CA-125 level maybe a more significantly prognostic factor for CSS in low to intermediate-risk EC than high-intermediate to high-risk diseases, but it may not be useful for predicting OS and DFS.

Benefit of Adjuvant Chemoradiotherapy in Resected Gallbladder Carcinoma

To evaluate the benefit of adjuvant treatments, such as chemoradiotherapy (CRT) and chemotherapy (CTx), compared with no adjuvant treatment (No-AT) in resected gallbladder (GB) cancer patients, 151 patients were analyzed: 98 (64.9%) patients received adjuvant treatment with CRT (n = 59, 39.1%) or CTx (n = 39, 25.8%), and the remaining 53 (35.1%) did not (No-AT). The clinicopathological factors, patterns of failure, locoregional recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS) were compared among the three groups according to tumor stage. In patients with T2-3N0M0 stage disease, the incidences of locoregional recurrence and distant recurrence and 5-year LRFS, RFS and OS rates were not significantly different among the No-AT, CTx, and CRT groups (p > 0.05 each). In those with T2-3N1-2M0 stage disease, the incidences of locoregional recurrence (11.4%, 78.1%, and 68.4%, respectively) and distant recurrence (42.8%, 73.9% and 66.7%, respectively) in the CRT group were significantly lower than those in the No-AT and CTx groups (p < 0.05), and the CRT group had significantly higher 5-year LRFS (82,1%, 26.8%, and 19.0%), RFS (53.3%, 11.6% and 16.7%) and OS rates (64.0%, 22.7% and 4.3%) than the CTx and No-AT groups (p < 0.05 each). Therefore, adjuvant CRT may improve the LRFS and RFS and subsequently improve OS in lymph node-positive resected GB cancer.

The prolonged interval between induction chemotherapy and radiotherapy is associated with poor prognosis in patients with nasopharyngeal carcinoma

ObjectivesInduction chemotherapy (IC) now is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). The current study was conducted to examine the association between prognosis and the interval between IC and radiotherapy (RT) in NPC patients.MethodsPatients with newly diagnosed, non-metastatic NPC who were treated with IC followed by RT from 2009 to 2012 were identified from an inpatient database. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS) were compared between those with interval ≤ 30 and > 30 days by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis.ResultsA total of 668 patients met inclusion criteria with median follow-up of 64.4 months. Patients were categorized by interval: 608 patients with interval ≤ 30 days, and 60 with interval > 30 days. The 5-year OS, DFS, DMFS and LRFS rates were 86.6, 78.2, 88.0 and 89.8% for patients with interval ≤ 30 days, respectively, and 69.2, 64.5, 71.2 and 85.1% for patients with interval > 30 days, respectively. The prolonged interval was a risk factor for OS, DFS and DMFS with adjusted hazard ratios (95% confidence intervals) were 2.44 (1.48–4.01), 1.99 (1.27–3.11) and 2.62 (1.54–4.47), respectively.ConclusionsProlonged interval > 30 days was associated with a significantly higher risk of distant metastasis and death in NPC patients. Efforts should be made to avoid prolonged interval between IC and RT to minimize the risk of treatment failure.

Outcomes of stage II-IV upper-tract urothelial carcinoma and adjuvant chemotherapy for locally advanced cancer.

The present retrospective study aimed to examine the outcomes of stage II-IV upper-tract urothelial carcinoma (UTUC) and determine whether adjuvant chemotherapy is a beneficial treatment for patients with locally advanced UTUC (specifically, stage III-IV). The analysis included 126 patients with muscle-invasive UTUC who were treated between June 2003 and June 2012. All patients underwent laparoscopic or open nephroureterectomy and bladder cuff excision. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and locoregional recurrence-free survival (LRFS) were assessed. Outcomes were compared between groups of patients with stage II (high-stage localized) disease, stage III-IV (high-stage locally advanced) disease treated with chemotherapy, and stage III-IV disease not treated with chemotherapy. Among patients with high-stage locally advanced UTUC (stage III-IV), those who received adjuvant chemotherapy had significantly better rates of OS (67.1 vs. 33.7%; P=0.004), DFS (70.2 vs. 46.0%; P=0.030) and DMFS (86.3 vs. 65.2%; P=0.048) at 5-years compared with those who did not undergo adjuvant chemotherapy. However, there was no significant difference between the 5-year LRFS rates in these two groups (78.2 vs. 62.5%; P=0.525). Importantly, the survival curve of patients with high-stage UTUC who received adjuvant chemotherapy was similar to that of patients with low-stage UTUC who underwent surgery only. Multivariate analysis revealed that adjuvant chemotherapy was an independent risk factor for OS [without adjuvant chemotherapy vs. with adjuvant chemotherapy: Hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.129-0.654; P=0.003] and DFS (without adjuvant chemotherapy vs. with adjuvant chemotherapy: HR, 0.381; 95% CI, 0.168-0.865; P=0.021). In conclusion, adjuvant chemotherapy may improve the outcome for patients with high-stage locally advanced UTUC.

Clinical outcomes and prognostic factors in patients with stage II-III breast cancer treated with neoadjuvant chemotherapy followed by surgery and postmastectomy radiation therapy in the modern treatment era

PurposeThere are no randomized studies on the indication for postmastectomy radiation therapy (PMRT) in patients who receive neoadjuvant chemotherapy (NAC) followed by a mastectomy. The aim of this study was to determine clinical outcomes and identify reliable prognostic factors in patients with locally advanced breast cancer treated with NAC followed by a mastectomy and PMRT. Methods and materialsWe retrospectively evaluated the relationship between clinicopathological factors and outcomes in 351 patients with stage II or III breast cancer who underwent NAC followed by radical mastectomy and PMRT between March 2005 and December 2013. ResultsThe median follow-up duration was 81 months (Range, 12-156 months). For all patients, the 5-year locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 91.3 %, 69.8 %, and 83.4 %, respectively. On multivariate analysis, estrogen-receptor positivity, and complete response of cancer in axillary nodes (ypN0) were significant prognostic factors for better LRFS, while lympho-vascular invasion and clinical stage IIIC were independent prognostic factors for worse LRFS. The number of axillary node metastasesafter surgery was an independent prognostic factor of DMFS and OS. Patients with hormone receptor- and human epidermal growth factor receptor 2 positivity had significantly better 5-year LRFS rates. ConclusionsWe identified several prognostic factors in our study. In particular, the number of axillary node metastases is significantly related to OS.

Concurrent Chemoradiotherapy for Loco-regionally Advanced Nasopharyngeal Carcinoma: Treatment Outcomes and Prognostic Factors

Background:We conducted this study to contribute to resolving some controversial issues on management of nasopharyngeal carcinoma.Methods:Thirty-two patients with stage III-IVB nasopharyngeal carcinoma were included in this retrospective study. All patients received concurrent chemoradiotherapy with either 3D conformal radiotherapy or intensity-modulated radiotherapy. We retrospectively analyzed the survival outcome, prognostic factors for survival, and toxicity outcome.Results:The 2- and 5-year overall survival rates were 89.9% and 82.6%. The 2- and 5-year distant metastasis-free survival rates were 83.2% and 79.4%. The 2- and 5-year loco-regional recurrence-free survival rates were 83.3% and 79.5%. Addition of induction chemotherapy to concurrent chemoradiotherapy did not improve survival outcomes. The survival benefit of intensity-modulated radiotherapy over 3D conformal radiotherapy was not clear. Intensity-modulated radiotherapy significantly decreased the development of late toxicities compared with 3D conformal radiotherapy. Total RT dose was prognostic factor for overall, loco-regional recurrence-free, and distant metastasis-free survival. Temporary RT interruption was prognostic factor for overall survival. Daily RT dose was prognostic factor for distant metastasis-free survival.Conclusions:Concurrent chemoradiotherapy resulted in high survival rates with an acceptable level of toxicities in patients with loco-regionally advanced nasopharyngeal carcinoma. To confirm the results of this study, well-designed randomized prospective trials are warranted.

Clinical outcome of head and neck adenoid cystic carcinoma in the Taiwan population: a single institution experience

Background: Adenoid cystic carcinoma (ACC) is a rare malignant cell type in the head and neck region. Although most ACC are classified as low grade, clinical course and outcome may be very different depending on the tumor site. We aim to evaluate the clinical pattern and prognosis in our institution. Methods: Patients with head and neck ACC (HNACC) without distant metastasis at diagnosis and received curative-intent management at our institution were identified. Clinicopathologic features were collected and outcomes were analyzed. We used the Kaplan-Meier statistic method to estimate local control, disease-free survival (DFS) and overall survival (OS) in these patients. Results: In this retrospective study, we reviewed 53 patients who were diagnosed with HNACC between January 1995 and December 2014 in our institution. The mean patient age was 52.66 years (range, 23–92 years) and median follow-up time was 5.65 years (range, 1.89–19.48 years). Tumors originated from the salivary gland in 33 patients and from other sites in 20 patients. Fourteen locoregional recurrences and 17 distant metastatic events were noted. Between the salivary gland and non-salivary gland group, 5-year OS were 90.4% and 71.4% (P=0.248) respectively, and 5-year locoregional recurrence-free survival rates were 90.8% and 47.1% (P=0.002) respectively. In multivariate analysis, female gender, non-salivary gland site, nodal positive, close/positive margin, and adjuvant radiotherapy showed significant influence for locoregional recurrence-free survival. Conclusions: Non-salivary gland ACC had worse locoregional recurrence-free survival and radiotherapy showed benefit towards locoregional control. The most common failure was distant metastasis, especially to the lungs. Further research for systemic therapy is warranted.