Difference In Local Recurrence Research Articles

Evaluation of Two Different Approaches for Selecting Patients for Postoperative Radiotherapy in Deep-Seated High-Grade Soft Tissue Sarcomas in the Extremities and Trunk Wall.

Two national sarcoma centers have had different approaches for selecting patients with grade 2-3 deep-seated soft tissue sarcomas (STS) for postoperative radiotherapy (RT). We evaluated potential differences in local recurrence in patients treated at the two centers. At Sarcoma Center 1 (SC1), RT was the standard treatment for all tumors except certain small tumors excised with a margin wider than 1 cm. Sarcoma Center 2 (SC2) avoided RT for tumors regardless of tumor size if removed with a margin wider than 1 cm and/or a solid barrier. We included 386 patients (SC1/SC2 = 196/190) over 18 years of age diagnosed with a non-metastatic grade 2-3, deep-seated STS of the extremities or trunk wall, who underwent primary surgical treatment (only tumors excised with a negative margin) from 1 January 2000, to 31 December 2016. Kaplan-Meier survival analysis, competing risk analysis, and cause-specific Cox regression were applied. A total of 284 patients received primary RT, 163 (83%) at SC1 and 121 (64%) at SC2 (p < 0.001). The cumulative incidence of local recurrence at five years was 15% (95% CI: 10-19%) at SC1 and 14% (95% CI: 9-19%) at SC2. Multivariate analysis showed no significant differences in local recurrence between the centers. We concluded that when entering all available patients into the analysis using an intention-to-treat principle, a more selective approach to postoperative RT in patients with grade 2-3 deep-seated STS did not lead to a higher local recurrence rate. However, with this study design, we cannot rule out if the local recurrence rate could have been lower if RT was administered to all tumors removed with a margin wider than 1 cm and/or a solid barrier.

Oncological outcome following Hartmann's procedure compared with anterior resection and abdominoperineal resection for rectal cancer-The type of procedure does not influence local recurrence or distant metastasis: A population-based study.

The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery. We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I-III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease-free survival and overall survival at 5 years as well as risk factors for local recurrence. A total of 4741 patients were included in the study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease-free survival. Overall survival was higher following AR (OR 0.62, CI 0.54-0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33-4.40), a pT4 tumour (OR 1.93, CI 1.11-3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28-9.61). This nationwide study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR.

Treatment of retroperitoneal sarcoma results in improved outcomes.

To report the clinical characteristics, treatments, and outcomes in a cohort of dogs with histologically confirmed retroperitoneal sarcoma (RPS) and to identify potential variables of prognostic significance. 46 client-owned dogs from 10 clinics with histopathologic diagnosis of a sarcoma originating from the retroperitoneal space. Medical records were retrospectively reviewed to obtain information regarding clinical characteristics, treatments, and outcomes. Recorded variables were analyzed to report descriptive data for all cases and overall survival time. Multivariate analysis was utilized to evaluate prognostic factors for overall survival. Hemangiosarcoma was the most common histologic subtype diagnosed (76.1%). Cytoreductive and curative intent surgical excision of the RPS was attempted in 12 and 22 dogs, respectively; 12 dogs underwent no surgery or had an exploratory laparotomy with incisional biopsy only. Nineteen dogs received adjuvant chemotherapy, either injectable or metronomic, and 1 dog received adjuvant radiation therapy. Fourteen of the 34 (41.2%) surgically treated dogs developed evidence of local recurrence, but there was no difference in local recurrence when comparing dogs categorized as curative intent versus cytoreductive surgery. The median overall survival time was 238 days. On multivariable analysis, treatment approach was associated with survival with surgical excision (vs palliative treatment) and adjuvant chemotherapy following surgery being protective against death. A diagnosis of hemangiosarcoma was associated with a greater hazard of death. This study demonstrates a substantially greater survival time than previously published and suggests a survival benefit from surgical excision and adjuvant chemotherapy.

Abstract PO3-17-09: Outcome after the introduction of personalized treatment for axilla in patients with clinically node-negative early breast cancer

Abstract Background : After the results of ACOSOG Z0011 and AMAROS trials were reported, axillary treatment has been promoted to de-escalation. For clinically negative cases of axillary lymph node metastasis (cN0), axillary dissection (Ax) has been the standard treatment when sentinel lymph node (SN) metastasis is positive. In our hospital, for patients with cN0, if SN macro metastasis is positive, Ax or irradiation (RT) is selected after sufficient explanation to the patients. Five years have passed since the introduction of treatment selection for the axilla, we examined treatment outcomes retrospectively. Methods : The subjects were 1376 patients who underwent SN biopsy for primary breast cancer with cN0 at our hospital from October 2004 to December 2018 (median observation period 79 months). Cases who underwent preoperative chemotherapy were excluded. We have introduced the treatment choice system since December 2015, and compared prognosis (local recurrence, distant recurrence and breast cancer specific death) before and after introduction using the log-rank test. Results : There were 947 cases before introduction of treatment choice system (pre group) and 429 cases after introduction (post group). The median observation period for each group was 91 months and 41 months. The maximum observation period post group was 67 months, then we compared the number of events in patients with observation period less than 67 months in pre group. There was no significant difference between two groups (Pre/Post) in terms of age (p=0.52), menopausal status (p=0.90), invasion of primary lesion (p=0.19), biology and SN metastasis status (p=0.41). There were 54 patients (12.6%) in pre group and 135 (14.3%) patients in post group had positive sentinel lymph nodes. In post group, 33 patient (61.1%) were macrometastasis of SN, 28 of whom underwent Ax and 5 underwent RT. Local recurrence was 4 cases (1.7%) in pre group, 9 cases (2.1%) in post group (p=0.84), distant recurrence was 13 cases (5.6%) and 5 cases (1.2%) (p=0.0002), and breast cancer specific death was 8 cases (0.8%) and 1 case (0.2%) (p=0.0003), respectively. Discussion : There was no significant difference in local recurrence rate within 67 months, but were poor prognosis in pre introduction group for distant metastasis and breast cancer specific survival. In the results of this study, there was no significant difference in local recurrence, but the prognosis for distant recurrence and breast cancer-specific death was poor in the before introduction group. The median observation period in the post introduction group was 47 months, and late recurrence of ER-positive breast cancer occurs later. It is necessary to continue the study by extending period and accumulation cases. Conclusion : For cN0 cases, if the case is suitable, we introduced the treatment choice system that allows omitting Ax by performing radiotherapy in SN macrometastasis positive patients. After introduction, there was no increase in the relapse rate after introduction in the short term. Appropriate case selection allowed the safety introduction of individualizes treatment for axilla. Citation Format: Mai Tomiguchi, Kaori Hidaka, Lisa Goto-Yamaguchi, Ayako Kajiwara, Kanako Nishikido, Toko Inao, Yutaka Yamamoto. Outcome after the introduction of personalized treatment for axilla in patients with clinically node-negative early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-17-09.

Abstract PO3-22-04: PMRT Decision with low prediction of genomic test score in pT3N0M0 luminal breast cancer: Protocol MF22-02: International multicenter real-world data

Abstract Background: In current guidelines, there is no definite recommendation regarding postmastectomy radiation therapy (PMRT) in patients with luminal pT3N0M0 breast cancer (BC). The goal of this study is to determine whether PMRT could be safely omitted for a specific subgroup of those patients. Methods and Materials: There were 202 women from 16 centers with pT3N0M0 hormone receptor (HR) positive, Her2 neu (-) BC who underwent mastectomy, were analyzed retrospectively. None of the patients received neoadjuvant chemotherapy. Three patients were excluded because of positive surgical margins. The patients were divided into two groups, PMRT (+) (n=130) and PMRT (-) (n=69). Groups were compared in terms of overall survival, loco-regional recurrence rate, and distant metastases regarding Magee score (MS) (&amp;lt; 18 are considered low risk) (https://path.upmc.edu/onlineTools/mageeequations.html), menopausal status, axillary surgery, pathology, lymphovascular invasion (LVI), adjuvant chemotherapy, and adjuvant endocrine therapy. Results: The majority of the patients had invasive ductal carcinoma (49%, n=98). There was no significant difference regarding tumor size, axillary surgery, and adjuvant endocrine therapy between the two groups (p=0.82, p=0.28, p=0.12, respectively). LVI was 49% (n=98) and it was greater in PMRT (+) group (25% vs. 10%; p=0.01). PMRT (+) patients received more chemotherap(66% vs. 30%; p&amp;lt; 0.001), had more grade 3 tumors (28% vs. 9%, p=0.005), and more premenopausal (49% vs. 22%; p=0.0001). At a median follow-up of 51.3 months for the PMRT (-) group and 65.9 months for the PMRT (+) group (p=0.041), 9% (n=6) of patients from the PMRT (-) group and 2% (n=3) from the PMRT (+) group developed locoregional recurrence (LRR) (p=0.047). There was no difference in local recurrence (1% in PMRT (-) group vs. 2% in PMRT (+); p=0.7) and distant recurrence (7% in PMRT (-) group vs. 3% in PMRT (+); p=0.16) between patients who received PMRT and not had PMRT. Further comparison of the LRR in the PMRT (-) and PMRT (+) groups in patients with an MS &amp;lt; 18 did not show a significant difference (3% vs. 4%; p=0.64). However, among patients with a Magee score ≥18, the PMRT (-) group had a higher LRR rate compared to the PMRT (+) group (11% vs. 2%; p=0.01). In patients with an MS≥18, the administration of PMRT correlates with statistically significantly better LRR-free survival (HR 0.19; 95%CI 0.05 – 0.79; p=0.02). Conclusions: Our findings imply that when considering PMRT for BC with pT3N0M0, HR (+), and Her2 neu (-), clinicians can benefit from a combination of pathological risk factors and recurrence prediction models. Patients with MS&amp;lt; 18 receiving PMRT or not appear to experience a comparable rate of recurrence. Citation Format: Atilla Soran, Caleb King, Parul N. Barry, Rohit Bhargava, Hasan Karanlik, Melis Gultekin, Ferah Yiıdız, Aykut Soyder, Berk Goktepe, Kazim Senol, Caglar Guzel, Ebru Sen Oran, Levent Yeniay, Ahmet Dağ, Selman Emiroglu, Didem Can Trabulus, Alper Coskun, Neslihan Cabioglu, Hagigat Veliyeva, N. Zafer Utkan, Berkay Demirors, Efe Sezgin, John A. Vargo. PMRT Decision with low prediction of genomic test score in pT3N0M0 luminal breast cancer: Protocol MF22-02: International multicenter real-world data [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-04.

Abstract PO4-16-10: Overall survival in sentinel node biopsy and axillary dissection: a real-world data

Abstract Background: Information about the status of the axilla (presence or absence of lymph node disease) is important for breast cancer (BC) treatment decision-making. Axillary dissection (AD) has been gradually substituted by sentinel node biopsy (SLNB) in clinical node negative patients and intraoperative evaluation became a routine. Most of the patients with a positive node in an intraoperative evaluation were submitted to AD, and when a negative intraoperative evaluation but a positive paraffin evaluation was found a new axillary surgery was a routine. Both approaches were gradually abandoned with the publication of the ACOSOG Z011 study showing no difference in local recurrence or overall survival (OS). Objective: To evaluate the number of patients with BC who meet the criteria of Z011 trial and could be spared of AD and compare the outcomes of the SLNB only and those that had AD. Methods: Patients with BC that were submitted to upfront surgery and had at least one positive node in SLNB were included in these retrospective analyses at Pérola Byington Hospital database, diagnosed between 1992 and 2019. Clinical and pathological characteristics were extracted from the database and patient medical records. T-test or chi-square test was used to individually analyze the association of each variable between the groups. Multivariate analysis was used to calculate odds ratio (OR) and 95% confidence intervals (CI) for independent variables correlated with positive AD. Cox regression was used for survival analysis, and survival curves were plotted using the Kaplan-Meier method, analyzing the difference between curves using the Log-rank test. R software version 4.1.1 was used for all analyses, with a p-value &amp;lt; 0.05 considered statistically significant. Results: A total of 729 patients were analyzed, with a mean age of 54.1 (±11.6) years at diagnosis. Most patients (n=633, 86.8%) underwent AD after a positive SLNB and 40,3% of the patients that were submitted to AD the only positive node was the sentinel node. After AD, 63,3% of these patients had 1 or 2 lymph nodes positive and met the Z011 criteria trial. The mean number of lymph node in AD was 12.2. Most patients (72.7%) were diagnosed at clinical stage II, 62% had nuclear grade 2 tumors, 52.9% had Luminal B subtype, and 63% were postmenopausal. Furthermore, 58.5% of patients underwent breast-conserving surgery, and 5.2% of patients experienced recurrence. The chance of AD was observed 2,2 times for the luminal B (OR 2.163, 95% CI 1.104-4.239, p=0.025), 2,1 times HER2-positive with receptor positive (OR 2.125, 95% CI 1.160-3.893, p=0.015), and 2,8 times for triple-negative (OR 2.806, 95% CI 1.013-7.757, p=0.047) compared to Luminal A. Patients that were submitted to AD had worse outcome when compared to SLNB, the overall survival showed a 94.4% higher risk of death with a median survival of 11 years (HR 1.944, 95% CI 1.20-3.14, p=0.006). Conclusion: These retrospective analyses showed 63,3% of the patients that had a positive node in a SLNB could be spared from AD (based on Z011 trial). Patients submitted to AD had worse outcome and these findings needs to be clarified. Citation Format: Renata Pares, Andre Mattar, Juliana de Lima, Marcelo Antonini, Francisco Pimentel Cavalcante, Luiz Henrique Gebrim. Overall survival in sentinel node biopsy and axillary dissection: a real-world data [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-16-10.

Abstract PO3-08-12: Oncologic Safety and Preventive Impact of Nipple-Sparing Mastectomy in BRCA1/2 Mutation Carriers: A Multicenter Retrospective Study of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG)

Abstract Purpose: Nipple-sparing mastectomy (NSM) is known for its excellent cosmetic results and acceptable oncologic safety. However, evidence supporting NSM in breast cancer (BC) patients carrying pathogenic variant (PV) or likely pathogenic variant (LPV) in BRCA1/2 genes is still limited. This study aims to evaluate the oncologic safety of NSM in BC patients and examine its preventive effect in unaffected individuals with BRCA1/2 PV/LPV. Methods: In this multicenter, retrospective study was conducted by the Korea Robot-Endoscopic minimal access Breast Surgery study Group (KoREa-BSG). We evaluated data from women who underwent NSM and BRCA1/2 genetic testing across 19 South Korean institutions. This study included BC patients aged between 20 and 80 years who had NSM and BRCA1/2 genetic testing between January 2008 and December 2018. Patients with distant metastasis at the initial diagnosis were excluded. Results: A total of 786 women, encompassing 906 NSM cases, were included. This population comprised 120 patients who underwent bilateral NSM, 666 with unilateral NSM for unilateral BC. Among them, 214 who received neoadjuvant chemotherapy. The median follow-up period was 62 months, with an age range of 26-74 years (median 44). Sentinel lymph node biopsy was carried out in 74.7% of cases. In the bilateral NSM cohort (n=120), 36 were bilateral BC patients, 41 were unaffected carriers of BRCA1/2 PV/LPV who underwent bilateral risk-reducing NSM (RRNSM), and 33 presented with unilateral BC with BRCA1/2 PV/LPV. In the subset of 33 patients who underwent contralateral RRNSM for unilateral BC, incidental ductal carcinoma in situ (DCIS) was discovered in two cases. In comparing NSM outcomes according to BRCA status, we found no significant difference in local recurrence (LR) between BC patients with BRCA1/2 PV/LPV (n=172) and those without BRCA1/2 PV/LPV (n=592) (LR rates: 11 in BRCA1/2 PV/LPV vs. 45 in non-carriers; p = 0.7965). Of the 172 BRCA1/2 PV/LPV carriers who did not undergo RRNSM, contralateral BC occurred in 11 patients (6.4%), while no recurrence was recorded in the RRNSM group. Conclusions: NSM appears to be a feasible option in BC patients with BRCA1/2 PV/LPV. While the long-term impact of NSM on breast cancer prevention in BRCA1/2 PV/LPV carriers requires further investigation, current evidence suggests that NSM could serve as an effective risk-reducing strategy. Citation Format: Hong-Kyu Kim, Sung Yoon Jang, Soong June Bae, Eun Young Kim, Chihwan Cha, Hyung Seok Park, Jeeyeon Lee, Jun-Hee Lee, Eun-Shin Lee, Jung Eun Choi, Soo Youn Bae, Hee-Chul Shin, Dongwon Kim, Moo Hyun Lee, Yong-Yeup Kim, Sang-Ah Han, Janghee Lee, Youngwoo Chang, Junwon Min, Sanghwa Kim, Hee Jun Choi, Young-Joon Kang, Sae Byul Lee, Jai Min Ryu. Oncologic Safety and Preventive Impact of Nipple-Sparing Mastectomy in BRCA1/2 Mutation Carriers: A Multicenter Retrospective Study of the Korea Robot-Endoscopy Minimal Access Breast Surgery Study Group (KoREa-BSG) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-08-12.

Prognostic Outcomes of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Retrospective Comparative Cohort Study.

Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous neoplasm, and its incidence is on the rise. While most cSCCs have an excellent prognosis, certain risk factors, especially immunosuppression, have been associated with higher rates of local recurrence (LR), metastasis, and poor prognosis. This study aims to assess the risk factors for LR and metastasis development in cSCC among solid organ transplant recipients (SOTRs) and compare these rates with those in immunocompetent patients. A retrospective observational study included cSCC cases from the University Hospital Reina Sofía in Córdoba, Spain, between 2002 and 2019. Demographic, clinical, and histopathological data were collected. Local recurrence and metastasis rates were analyzed, along with progression-free survival. Univariate analyses were performed to identify prognostic factors in SOTRs. Among 849 cSCC cases, we found higher rates of local recurrence and metastasis in tumors developed by SOTRs compared to those in immunocompetent individuals. However, no significant differences in local recurrence, metastasis, or progression-free survival were observed between the two groups. Risk factors for adverse outcomes in SOTRs included tumor size > 2 cm, depth > 4 mm, and a higher Clark level. A total of 34.4% of SOTRs developed a second primary cSCC during the follow-up. In our study, cSCCs in SOTRs did not exhibit statistically significant differences in the rates of adverse outcomes compared to immunocompetent patients. The prognosis of cSCCs in SOTRs may be more related to other tumor-dependent risk factors than to the immunosuppression status itself. Future studies are needed to refine risk stratification and follow-up protocols to ensure the optimal management of high-risk cSCC cases, particularly among immunosuppressed patients.

Complete mesocolic excision for right colon cancer: Is D3 lymphadenectomy necessary?

Although complete mesocolic excision (CME) for colon cancer is oncologically sound, to date, there has been no consensus on the extent of lymphadenectomy in radical right colectomy. This study essentially compared the perioperative and survival outcomes of CME with two templates of lymphadenectomy for right colon cancer. This was a propensity matched, retrospective analysis of a single centre, prospectively maintained database of all patients undergoing elective right colectomy for nonmetastatic, biopsy-proven adenocarcinoma from November 2013 to October 2018. CME + D3 was adopted selectively, documented prospectively, and compared with patients undergoing CME + central vascular ligation (CVL). The only technical difference between the groups was the excision of the surgical trunk of Gillot in the CME + D3 group. Postoperative, long-term outcomes and patterns of recurrence were compared between the groups. Of the 244 eligible patients, 88 (36.1%) and 156 (63.9%) underwent CME + D3 and CME + CVL, respectively. Matched groups (72 [CME + D3] vs. 108 [CME + CVL]) showed no difference in histology, tumour grade, postoperative complications, mortality, and hospital stay. CME + D3 was preferentially performed laparoscopically (35.2% vs. 9%), was associated with lower blood loss (215 mL vs. 297 mL, p = 0.001), higher nodal yield (31 vs. 25 nodes, p = 0.003) and a higher incidence of chyle leak (4 vs. 0, p = 0.013). At a median follow-up of more than 57 months, there was no significant difference in local recurrence, disease-free or overall survival. In this retrospective study, lymphadenectomy along the superior mesenteric vein, as a component of CME for right colon cancer, offered a higher nodal yield with no improvement in oncological outcome. Dissection of the SMV, over and above a D2 dissection, could therefore be restricted to specialized colorectal units until further studies establish the incremental oncological benefit of this extended lymphadenectomy or define a patient group in whom it is beneficial.

Treatment of Internal Mammary Nodes is Associated With Improved Overall Survival in Breast Cancer: A Meta-Analysis.

The role of internal mammary nodal irradiation (IMNI) as a component of regional nodal radiotherapy is a controversial issue in breast radiation oncology with conflicting results presented in recent landmark trials. We thus created a meta-analysis of available data to better ascertain the potential benefit of IMNI. We hypothesize that with the increased power available within a meta-analysis, IMNI will prove to improve overall survival (OS) in breast cancer. Literature search was conducted for prospective studies comparing IMNI to no IMNI. Primary endpoint was OS and secondary endpoints included local recurrence, regional recurrence, disease-free survival (DFS), breast cancer mortality (BCM), distant metastasis-free survival (DMFS), grade 2+ skin toxicity, cardiac events, and pneumonitis events. Subgroup analyses were performed for tumor location (medial/central vs. lateral), and nodal status (pN+ vs. pN0). Fixed-effect model was used if there was no heterogeneity, random-effects model otherwise. Four studies with a total of 5258 patients (IMNI: n=2592; control: n=2666) were included in the study. Pooled results showed IMNI significantly improved OS for all-comers (hazard ratio [HR]=0.89; 95% CI 0.81-0.97; P =0.008), as well as subgroups of pN+ with medial/central tumor location (HR=0.84; 95% CI 0.73-0.96; P =0.01) and pN+ with lateral tumor location (HR=0.87; 95% CI 0.77-0.99; P =0.04). There was no significant difference in OS for subgroups of pN0 and medial/central tumor location. There was no difference in local recurrence, but regional recurrence was significantly improved ( P =0.04). Endpoints of DFS (HR 0.91, 95% CI 0.84-0.99 P =0.03), BCM (HR 0.87, 95% CI 0.77-0.98, P =0.03), and DMFS (HR=0.87; 95% CI, 0.78-0.98; P =0.02) were all improved with IMNI. Grade 2+ skin toxicity, cardiac events and pneumonitis events were not significantly different between patient in the IMNI and no IMNI groups. Inclusion of IMN irradiation improves OS, DFS, BCM, and DMFS in breast cancer. Largest effect on OS was noted in the subgroup of patients with pN+ and medial/central tumor location.

Extensive intraductal component as a factor determining local recurrence of breast cancer: a systematic review and meta-analysis.

Breast-conserving surgery and mastectomy are standard surgical options for breast cancer. However, some patients experience a local recurrence after the operation. Many factors have been identified as a risk of local recurrence. Extensive intraductal component (EIC) was found as one of the major risks of the recurrence. Nevertheless, there were neither any systematic reviews nor controlled trials focused on EIC. This study aims to identify the impact of EIC on the local recurrence of breast cancer. We searched all relevant studies published between the inception to December 2020. All electronic data from PubMed and Scopus databases were extracted for evaluation of EIC as a factor of the recurrence. Local recurrence was a primary outcome between EIC-positive group and EIC-negative group. Margin status and adjuvant radiation were focused as a subgroup analysis. The Newcastle Ottawa Scale was applied for quality assessment of included studies and RevMan 5.3 program was used to estimate the effect of the results. The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A total of 32 studies, comprising 4,290 and 15,143 patients in the EIC-positive and EIC-negative groups respectively, were retrieved and met selection criteria. All included studies were at low to intermediate risk of bias. There was a statistically significant difference in local recurrence between EIC-positive patients and EIC-negative patients (OR =2.73; 95% CI: 2.42-3.07; P<0.00001). However, there was not any significant difference in patients who had negative margin (OR =1.97; 95% CI: 0.92-4.19; P=0.36) or received any adjuvant irradiation (OR =1.58; 95% CI: 0.55-4.54; P=0.24). EIC increases the risk of local recurrence, especially in breast-conserving surgery patients. However, there are a limited number of populations to analyze in subgroup analysis, the rate of local recurrence between two groups is not different in patients who had negative margin or received postoperative irradiation.

Effect of high-dose radiation therapy on positive margins after breast-conserving surgery for invasive breast cancer.

Positive margins after breast-conserving surgery are associated with poor oncological outcomes and warrant additional surgery. This study aimed to evaluate the effectiveness of high-dose radiation therapy for positive margins by comparing local recurrence between patients with positive and negative margins. We retrospectively evaluated 550 patients treated with adjuvant radiation therapy after breast-conserving surgery for invasive breast cancer between 2013 and 2019. The total equivalent dose in 2Gy fractions (EQD2) to the tumor bed ranged from 65.81 to 66.25Gy for positive margins and 59.31-61.81Gy for negative margins. The differences in local recurrence between the positive and negative margin groups were analyzed. After a median follow-up of 58 months, the crude local recurrence rate was 7.3% in the positive margin group (n=55) and 2.4% in the negative margin group (n=495). Positive margins were associated with higher local recurrence without statistical significance in the entire cohort (p=0.062). Among patients aged <60 years, those with positive margins had a significantly lower 5-year local recurrence-free survival rate than those with negative margins (89.16% vs. 97.57%, respectively; p=0.005). In contrast, there was no significant difference in the 5-year local recurrence-free survival rate between patients with positive and negative margins among those aged ≥60 years (100.00% vs. 94.38%, respectively; p=0.426). In this study, positive margins were not associated with poor local control in older patients after a high-dose boosts. Further prospective studies are needed to verify our findings.

Comparative efficacy of intraoperative radiotherapy and external boost irradiation in early-stage breast cancer: a systematic review and meta-analysis.

External boost radiotherapy (EBRT) and intraoperative radiotherapy (IORT) are shown to be effective in patients with early-stage breast cancer. However, the difference between IORT and EBRT for patients' prognosis remains to be elucidated. The purpose of this meta-analysis is to investigate differences in local recurrence (LR), distant metastases, disease free survival (DFS), and overall survival (OS) between these two therapies. We searched the Cochrane Library, PubMed, Web of Science and Embase, from inception to Jan 10th, 2022. We used The Cochrane risk-of-bias assessment tool to assess the risk of bias of the included studies, and the STATA15.0 tool was used for the meta-analyses. Eight studies were ultimately included. Meta-analysis demonstrated that there was an inconsistent finding in the long-term risk of LR between the two radiotherapies, and there was no significant difference in short-term risk of LR, the metastasis rate, DFS, and OS IORT would be more convenient, less time-consuming, less costly, and more effective at reducing side effects and toxicity. However, these benefits must be balanced against the potential for increased risk of LR in the long term.

Clinical efficacy of Neoadjuvant Chemotherapy combined with Laparoscopic Surgery in patients with Middle and Low Rectal Cancer and its Effect on serum VEGF Levels and quality of life.

To observe the clinical efficacy of neoadjuvant chemotherapy combined with laparoscopic surgery in patients with middle and low rectal cancer and its effect on serum VEGF level and quality of life. Retrospective analysis was performed on 80 patients with middle and low rectal cancer admitted to Baoding No.1 Central Hospital from June 2018 to June 2020.They were randomly divided into two groups. Patients in the control group underwent laparoscopic radical rectal cancer surgery, while those in the experimental group underwent neoadjuvant chemotherapy before surgery. The differences of various surgical indicators between the two groups were compared. The incidence of surgical complications, the serum VEGF levels and the improvement of quality of life were compared. The differences in local recurrence, metastasis and overall survival with in two years after surgery were compared. The various surgical indicators of the experimental group were significantly better than the control group (p<0.05). After treatment, the VEGF levels in the experimental group were significantly lower than those in the control group (p=0.00), while the SF-36 score was significantly higher than that of the control group (p=0.00). The total incidence of surgical complications in experimental group was significantly lower (p=0.03), the local recurrence rate was significantly lower (p=0.02), and the overall survival rate was significantly higher than that in control group (p=0.04). Neoadjuvant chemotherapy combined with laparoscopic surgery is superior to direct surgery alone in the treatment of middle and low rectal cancer and it needs to be promoted.

Comparison of pre-operative and post-operative radiotherapy in patients with localized myxoid liposarcoma.

Myxoid liposarcoma is more radiosensitive than other soft tissue sarcomas, and radiotherapy has been reported to reduce tumour size. This study was performed to compare the rates of local recurrence, survival and wound complications between pre- and post-operative radiotherapy for localized myxoid liposarcoma. From the Japanese Nationwide Bone and Soft Tissue Tumor Registry database, 200 patients with localized myxoid liposarcoma who received pre- (range, 30-56Gy) or post-operative (range, 45-70Gy) radiotherapy and surgery were included in this retrospective study. Propensity score matching was used to adjust for background differences between patients who received pre- and post-operative radiotherapy. Local recurrence occurred in five (5.0%) and nine (9.0%) patients in the pre- and post-operative radiotherapy groups, respectively (both n=100). The median follow-up time from diagnosis was 40.5months (IQR, 26.3-74). Univariate analysis showed a similar risk of local recurrence between the pre- and post-operative radiotherapy groups (5-year local recurrence-free survival 94.9% [95% CI 87.0-98.1] vs. 89.0% [95% CI 79.6-94.3]; P=0.167). Disease-specific survival was similar between the pre- and post-operative radiotherapy groups (5-year disease-specific survival 88.1% [95% CI 75.5-94.6] vs. 88.4% [95% CI 77.3-94.5]; P=0.900). The incidence of wound complications was similar between the pre- and post-operative radiotherapy groups (7.0% vs. 12.0%; P=0.228). There was no difference in local recurrence, survival or incidence of wound complications between pre- and post-operative radiotherapy for localized myxoid liposarcoma. Therefore, pre-operative radiotherapy for myxoid liposarcoma provides clinical results equivalent to post-operative radiotherapy.

Effect of Delayed Oncoplastic Reduction Mammoplasty on Radiation Treatment Delay Following Breast-Conserving Surgery for Breast Cancer.

The purpose of this study was to evaluate the delay in initiating adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) in patients with early-stage breast cancer who underwent oncoplastic reduction mammoplasty (ORM) following BCS compared with a matched cohort of patients who did not undergo ORM between BCS and RT. Medical records of 112 women (56 ORMs and 56 matched non-ORMs) with carcinoma in situ or early-stage breast cancer treated with BCS were reviewed. ORM was performed in a delayed manner following BCS, allowing confirmation of negative surgical margins. Time to RT was defined as time from last oncologic surgery to start of RT. The median follow-up time was 6.8 years for the ORM cohort and 6.7 years for the control non-ORM cohort. Patients who underwent ORM following BCS experienced a significant delay in initiating RT (>8 weeks) than matched patients not undergoing ORM (66% vs. 34%; p<0.001). Wound complications occurred in 44.6% (n=25) of patients in the ORM cohort, which were mostly minor, including delayed wound healing and/or infection (39%). There was no significant difference in local recurrence between patients in the non-ORM and ORM cohorts (p=0.32). This study demonstrates that ORM following BCS has the potential to delay RT >8 weeks, largely as a result of increased risk of wound complications; however, this delay did not impact local control. ORM can be safely considered for appropriately selected patients with breast cancer.

Comparison of Ablation Volume Between Emprint® and Mimapro® Systems for Hepatocellular Carcinoma -A Preliminary Study.

Microwave ablation (MWA) is a standard percutaneous local therapy for hepatocellular carcinoma (HCC). Next-generation MWA is reported to create a more spherical ablation zone than radiofrequency ablation (RFA). We compared the ablation zone and aspect ratio of two 2.45 GHz MWA ablation probes; Emprint® (13G) and Mimapro® (17G). We compared the ablation zone to the applied energy after MWA in patients with hepatocellular carcinoma (HCC). Furthermore, we investigated local recurrence. We included 20 patients with HCC, with an average tumour diameter of 33.2 ± 12.2 mm, who underwent MWA using Emprint®, and 9 patients who underwent MWA using Mimapro® with an average tumour diameter of 31.1 ± 10.5 mm. Both groups underwent the same ablation protocol using the same power settings. The images obtained after MWA showed the treatment ablation zone and aspect ratio, which were measured and compared using three-dimensional image analysis software. The aspect ratios in the Emprint® and Mimapro® groups were 0.786 ± 0.105 and 0.808 ± 0.122, respectively, with no significant difference (p = 0.604). The ablation time was significantly shorter in the Mimapro® group than in the Emprint® group, and there was no significant difference in the frequency of popping or the ablation volume. There were no significant differences in local recurrence between the two groups. There was no significant difference in the aspect ratios of the ablation diameter, and the ablation zone was almost spherical in both cases. Mimapro® at 17G was less invasive than Emprint® at 13G.

Efficacy of modified thoraco-laparoscopic Ivor-Lewis versus traditional thoraco-laparoscopic Ivor-Lewis for esophageal cancer: Propensity score-matched analysis.

To compare the clinical results of the modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct and surrounding tissues, with the traditional Ivor-Lewis procedure, which removes these tissues, for treating esophageal squamous cell carcinoma, and evaluating whether the azygous vein, thoracic duct and surrounding tissues are required to be removed for the surgery of esophageal cancer. To retrospectively analyze the clinical data of patients suffering from esophageal cancer treated by thoracic-laparoscopic Ivor-Lewis procedure admitted to the Department of Thoracic Surgery of Gansu Provincial People's Hospital from September 2017 to September 2019. According to the surgical method, they were divided into the modified thoracolaparoscopic Ivor-Lewis (modified group) and the traditional thoracolaparoscopic Ivor-Lewis (traditional group). Propensity score matching analysis (PSM) was applied to reduce the selection bias of confounding factors. A total of 245 patients who suffered from esophageal cancer and underwent thoracic-laparoscopic Ivor-Lewis were enrolled in the study. There were 124 cases in the modified group and 121 cases in the traditional group. The discrepancies in the age and T-stage among patients in the traditional and modified groups were statistically significant. After PSM, the above-mentioned factors became statistically insignificant. There were 86 patients in each group after PSM. Compared with the traditional group, the modified group has shorter operative time (p=0.007), less intraoperative bleeding (p=0.003) and less postoperative 3 days chest drainage(p=0.001), with a statistically significant difference. No significant difference in local recurrence (p=0.721) and distant metastasis (p=0.742) after surgery were found in the two groups, and the difference was not statistically significant. There was also no statistically significant difference in the 3-year postoperative survival rate (44.2% vs. 41.9%, p=0.605) between the modified and traditional groups. The modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct, and surrounding tissue, reduces surgical trauma in esophageal cancer, has not increased postoperative recurrent metastases, while achieved the same long-term outcomes as expanded surgery.

Breast-Conserving Surgery in Triple-Negative Breast Cancer: A Retrospective Cohort Study.

The aim of the study is to evaluate the efficacy and prognosis of neoadjuvant chemotherapy (NAC) combined with breast-conserving surgery (BCS) in treating triple-negative breast cancer (TNBC) and analyze the influencing factors and predictors of the efficiency and prognosis of NAC. A retrospective cohort study was conducted by dividing patients into two groups according to two different therapy methods. With BCS as the exposure factor, 46 cases were assigned to the exposed group and 80 cases to the nonexposed group. We compare the difference in operation-related indicators, postoperative complications, local recurrence rate, distant metastasis rate, and overall survival (OS) rate between the two groups. The factors affecting the efficiency and prognosis of NAC were analyzed by binary logistic regression, and the optimal cutoff value was determined by the area under the ROC curve (AUC). The survival curve was plotted, and the univariate log-rank test was performed to analyze the difference in OS between the two groups. The influencing factors of OS were analyzed by the Cox risk regression model. NAC + BCS resulted in significantly less intraoperative blood loss, lower incidence of postoperative complications, and shorter operative time and length of hospital stay than that in NAC (P < 0.05). There was no significant difference in local recurrence, distant metastasis, or OS between the two groups (P > 0.05). Multivariate analysis showed that the clinical stage I and Ki-67 high expression were independent protective factors of the efficacy of NAC. The high expression of Ki-67 and nondecline expression of Ki-67 were independent risk factors of prognosis. Ki-67 high expression was an independent risk factor of OS (P < 0.05). The ROC curve showed that the AUC of Ki-67 for NAC efficacy, prognosis, and OS were 0.706, 0.820, and 0.687, respectively, with optimal cutoff values of 25.5%, 29.0%, and 32.5%, respectively. Survival analysis showed that the OS of patients with NAC + BCS was 73.9% and NAC + MRM was 70.0% (P > 0.05). In the low expression subgroup of Ki-67, the OS of the two groups were 100.0% and 77.8%, respectively (P=0.060). In the high expression subgroup of Ki-67, the OS of the two groups were 53.8% and 63.6%, respectively (P=0.419). NAC + BCS is a good method for treating TNBC, which has an obvious short-term effect and a good long-term prognosis. Clinical stage I and the high expression of Ki-67 are independent protective factors for the efficacy of NAC. The high expression of Ki-67 and nondecline expression of Ki-67 are independent risk factors of prognosis. Ki-67 is a potential predictor for the efficacy, prognosis, and OS of NAC in TNBC patients. The high expression of Ki-67 indicates better NAC efficacy, a poorer prognosis, and a lower OS.

Is palpable DCIS more aggressive than screen-detected DCIS?

BackgroundPalpable ductal carcinoma in-situ (pDCIS) is a subset of DCIS presenting with a clinical mass. We hypothesized pDCIS would have more aggressive clinical and pathological features, and higher rates of recurrence and upgrade to invasive disease compared to screen-detected DCIS. Materials and methodsWe performed a retrospective analysis of female patients (age 28–76) with DCIS on core-needle biopsy. pDCIS patients had a physician documented palpable mass prior to initial biopsy. Descriptive statistics were performed to compare groups. ResultsThis study included 83 patients, 26 had pDCIS and 57 had screen-detected DCIS. Mean duration of follow-up was 49.4 months. pDCIS patients had significantly larger lesions (p = 0.03) which were more frequently biopsied via ultrasound (p = 0.002). In multivariate analysis, pDCIS was associated with ultrasound guided core needle biopsy, size of DCIS >2 cm, and comedo pattern (p = 0.001, p = 0.007 and p = 0.022, respectively). 7.7 % of pDCIS cases versus 3.5 % of screen-detected cases were upgraded to invasive cancer (p = 0.59). There was no difference in local recurrence (p = 0.55) between groups. Neither group experienced regional or distant recurrence. ConclusionspDCIS was associated with some aggressive pathologic and clinical features and was more frequently diagnosed by ultrasound guided core-needle biopsy than screen-detected DCIS. However, there was no significant difference in rate of recurrence or upgrade to invasive disease between groups. Key messageAlthough pDCIS was associated with some aggressive pathologic and clinical features, there was no significant difference in rate of recurrence or upgrade to invasive disease compared to screen-detected DCIS.