Factors For Recurrence In Patients Research Articles

Impact of Postoperative Complications on Recurrence in Patients With Stage II/III Gastric Cancer Who Received Adjuvant Chemotherapy With S-1.

This study aimed to investigate the impact of postoperative complications (PCs) in patients with pathological stage (pStage) II or III gastric cancer (GC) who received adjuvant chemotherapy with S-1 after curative surgery. Altogether, data for 226 patients were examined retrospectively. The relationship between PCs and clinicopathological features and survival were examined. Recurrence-free survival was significantly worse in the group with PCs than in the PC-negative group. On multivariate analysis, having PCs of grade 2 or more was an independent risk factor for recurrence (hazard ratio=1.721; 95% confidence intervaI=1.014-2.920; p=0.044). In addition, for each pStage analysis, having PCs of grade 2 or more was a risk factor for recurrence even in patients with pStage II GC. PC of grade 2 or more was an independent risk factor for recurrence in patients with pStage II GC who received adjuvant chemotherapy with S-1 after curative gastrectomy. Thus, for patients with PCs, even for those with pStage II GC, more effective adjuvant chemotherapy, such as S-1 plus docetaxel, may be needed.

Tailoring neoadjuvant chemotherapy for patients with breast cancer who have achieved pathologic complete response.

BackgroundWe retrospectively examined whether different cycles of chemotherapy affected the prognosis of patients who achieved a pathologic complete response (pCR).MethodsWe reviewed data from patients who achieved pCR after neoadjuvant chemotherapy (NACT) between 2008 and 2018. In total, 286 patients were divided into three groups: group one (n=148, 52%) completed standard chemotherapy cycles before surgery, group two (n=81, 28%) did not complete standard chemotherapy cycles before surgery or received chemotherapy after surgery, and group three (n=57, 20%) did not complete standard chemotherapy cycles before surgery but completed them after surgery. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method, and differences between groups were evaluated by the log-rank test. Cox proportional hazards regression analysis was adjusted for different NACT groups, age, Ki-67 levels, and clinical stages.ResultsAfter a median follow-up of 26 months, there were no significant differences in RFS among the NACT groups (P=0.14). Multivariate analysis showed that Ki-67 ≥40% (P=0.03) and clinical stage (IIIB + IIIC) (P=0.002) might be risk factors for recurrence in patients with pCR. There were no significant differences in survival among subgroups according to Ki-67 levels and clinical stages.ConclusionsOur study suggests that, even with pCR, patients with baseline stage IIIB or IIIC or Ki-67 levels ≥40% may have an increased risk of recurrence. The RFS of patients with pCR was not associated with the completion of standard chemotherapy cycles, even in high-risk patients. Therefore, the prevention of excessive chemotherapeutic treatment by de-escalation is necessary for patients with pCR.

HER-2 overexpression is a negative predictive factor for recurrence in patients with non-muscle-invasive bladder cancer on intravesical therapy

ObjectiveHER-2 is overexpressed in a variety of human malignant tumors and has been widely used in the prognosis and treatment of breast cancer. In urothelial cell carcinoma of the bladder, some reports have shown an association between HER-2 overexpression and worse outcomes. The aim of this study was to examine the association between HER-2 expression and other clinicopathologic parameters in 48 patients treated for primary non-muscle-invasive transitional cell carcinoma of the bladder.MethodsThe initial expression of HER-2 in tumor specimens and its expression upon disease recurrence following instillation therapy (BCG, Mitomycin, or Epirubicin) were studied.ResultsHER-2 expression was significantly increased between these two timepoints. In multivariate analysis, HER-2 expression at the time of diagnosis was found to be the only independent factor and was associated with reduced recurrence free survival.ConclusionsHER-2 status could be an additional biomarker for predicting the outcome of non-muscle-invasive bladder cancer, which could help identify high-risk patients for recurrence and possible progression who require close observation and perhaps radical treatment, such as early cystectomy.

Feasibility and Safety of Endoscopic Procedure in Burr-Hole Surgery for Chronic Subdural Hematoma in Patients of Very Advanced Age

The usefulness of endoscopic procedures for chronic subdural hematoma (CSDH) has been described, but the indications in patients of very advanced age have not been analyzed. The aim of this study was to evaluate the feasibility, safety, and usefulness of introduction of an endoscopic procedure for such patients. We retrospectively analyzed the data of 540 CSDHs treated by burr-hole surgery with endoscopic examination. The safety of the endoscopic procedure was assessed according to postoperative complications, morbidity, and mortality. The outcome was evaluated by statistical comparison among 4 different age-groups, and the recurrence rate and risk factors for recurrence was investigated in patients of very advanced age. Postoperative complications occurred in 7 cases (1.5%). The 6-month morbidity and mortality were 13.5% and 4.5%. No complications, morbidity, or mortality associated with the additional endoscopic procedure occurred even in patients of very advanced age. The endoscopic features of trabecular structures and residual septa separating the cavity were also risk factors for recurrence in patients of very advanced age. Releasing of the septa showed the possibility of decreasing the risk of recurrence to 6.6% in patients aged ≥85 years as well as in younger patients. There were some inevitable problems such as prolongation of the surgical time and inadequate endoscopic surgical skill. An endoscopic procedure for CSDH can be safely indicated and useful even in patients aged ≥85 years. However, clinicians should carefully select the patients based on clinical information associated with risk factors for recurrence.

Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors.

The aim of this study was to analyze the incidence, patterns and prognostic factors of recurrence in patients with complicated colon cancer who had emergency surgery within 24h of admission. A retrospective observational study was performed on patients with obstructing or perforated colon cancer having resection with curative intent between 1996 and 2014 at a single center. Data were obtained from a prospectively maintained database. Patients who had rectal cancer, iatrogenic endoscopic perforation, stage IV disease, palliative surgery, a colonic stent or decompressive colostomy were excluded. The study included 393 patients. Obstruction was observed in 320 patients (81.4%) and perforation in 73 (18.6%). Hartmann's procedure was more frequently performed by general surgeons (7.5% vs 23.3%; p = 0.023). 30-day postoperative mortality was 13.5% (53/393), including 47 (14.7%) obstructed and 6 (8.2%) perforated patients. Postoperative complications (Clavien-Dindo III-IV) occurred in 87 patients (22.1%), including 68 (21.2%) of obstructed and 19 (26.0%) of perforated patients. Anastomotic dehiscence was diagnosed in 52 of 329 (15.8%) patients with primary anastomosis and was higher in the obstructing group than in the perforated group (17.4% vs 7.6%). There was a significantly higher anastomotic dehiscence rate after procedures performed by general surgeons when compared with those performed by colorectal surgeons (10.3% vs 21.3%; p = 0.005; OR 2.81, 95% CI 1.4-5.9). With a median follow-up of 6years, the recurrence rate was 30.1% (67.4% distant, 22.8% local, 9.8% both). Overall and cancer-related survivals were 68.7% and 77.8%, respectively. The presence of positive nodes, male gender, anastomotic dehiscence and diffuse peritonitis were independent predictors for local recurrence while type of surgeon (general) was an independent factor for distant recurrence. Male gender, diffuse peritonitis, positive lymph nodes, type of surgeon and postoperative anastomotic dehiscence significantly influence recurrence ofcolorectal cancer in thisseries.

546P - Differential of the nutritional index before and after neoadjuvant chemoradiotherapy as a prognostic factor of recurrence in patients with locally advanced adenocarcinoma of the rectum

BackgroundThe Nutritional Prognostic Index (INP) is a nutritional and immunological marker. The difference between concomitant pre and post chemoradiotherapy INP and its impact as a prognostic factor for recurrence in patients with locally advanced rectal adenocarcinoma remains unclear. With the aim of providing greater evidence of the recurrent prognostic role of the differential of the pre and post INP in patients with locally advanced rectal adenocarcinoma we carried out the present study. MethodsOf the total of 206 patients, 74 patients were excluded. The analysis included 132 patients. INP formula: 10 * serum albumin (g / dL) + 0.005 * total lymphocyte count (per mm3). The INP values were determined in 2 points: before QT/RTneoadjuvant (preQT/RT INP ) and after the neoadjuvant QT/RT termination, (postQT/RT PNI). The difference in INP (dINP) was calculated with the formula: preQT/RT INP - postQT/RT INP. ResultsTable546P Univariate and multivariate analysisTableUnivariateMultivariateFactorPHRIC 95%PGender0.3761.4090.657 – 3.020.378Age0.0370.9690.940 – 0.9980.039body mass index0.0750.6340.382 – 1.0520.078Degree Differentiation0.3561.1790.697 – 2.020.550ypT0.1521.10.646 – 1.920.697ypN0.1021.280.947 – 1.750.106Diferencial INP0.1211.420.906 – 2.230.126ECOG0.0083.41.26 – 9.60.016In the Kaplan and meier analysis, recurrence free survival (SLR) was P=0.03. Independent factors for recurrence were age and ECOG (95% CI 0.940 – 0.998¸ P=0.037, HR 3.4 95% IC 1.26 – 9.6, P=0.016). Our findings showed a better SLR in the low dINP subgroup, so we took it as a cutoff 5. Patients who presented a dINP less than 5, have a better SLR in relation to those who have a dINP > 5. P=0.013. ConclusionsThe difference less than 5 between the nutritional index before and after neoadjuvant chemoradiotherapy in patients with locally advanced adenocarcinoma of the rectum is associated with an increase in SLR as an independent predictor of recurrence. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

P1.17-35 Solid Predominant Subtype Is an Independent Risk Factor for Recurrence in Patients with Pathologic Stage I Adenocarcinoma

P1.17-35 Solid Predominant Subtype Is an Independent Risk Factor for Recurrence in Patients with Pathologic Stage I Adenocarcinoma

Investigation of Recurrence Factors in Patients Who Received Radiotherapy for Ependymoma: A Retrospective Multicenter Analysis Conducted by the Japan Children’s Cancer Group

Investigation of Recurrence Factors in Patients Who Received Radiotherapy for Ependymoma: A Retrospective Multicenter Analysis Conducted by the Japan Children’s Cancer Group

Endoscopic Balloon Dilation for Benign Bilioenteric Stricture: Outcomes and Factors Affecting Recurrence.

Balloon dilation (BD) is a simple, effective procedure for postoperative benign bilioenteric strictures (BBESs). Factors associated with BBES recurrence after endoscopic BD have not been studied adequately. This study examined the outcomes and 1-year recurrence factors in patients with BBES who underwent endoscopic BD. Patients who underwent endoscopic BD as an initial treatment between April 2008 and March 2017 were retrospectively assessed. The median time to recurrence of BBES (RBBES) and recurrence factors were evaluated. The study group comprised 55 patients (median age 72years). The rate of RBBES was 52.7% (29/55), and the median time to RBBES was 2.78years (95% confidence interval [CI] 1.17-4.40). RBBES was observed in 32.7% (18/55) within 1year after endoscopic BD. The significant factors associated with recurrence within 1year, revealed by multivariate analysis, were: postoperative bile leak (p = 0.001; hazard ratio [HR] 10.94; 95% CI 2.47-48.39); BBES onset within 6months, postoperatively (p = 0.013; HR 6.18; 95% CI 1.46-26.21); no intrahepatic stones (p = 0.049; HR 3.05; 95% CI 1.01-9.22); and remaining balloon waist (p = 0.005; HR 5.71; 95% CI 1.69-19.31). The median time to RBBES was significantly shorter in patients with these recurrence factors (0.88years vs. not reached, p = 0.004). Patients exhibiting at least two recurrence factors were significantly more likely to experience recurrence (p < 0.001). Endoscopic BD is effective for BBES, especially for patients with no recurrence factors. Consideration of endoscopic BD and additional treatment may be necessary for patients with recurrence factors.

Predictive Factors of Recurrence in Patients with Differentiated Thyroid Carcinoma: A Retrospective Analysis on 579 Patients.

Differentiated thyroid carcinoma (DTC) is usually associated with a favorable prognosis. Nevertheless, up to 30% of patients present a local or distant recurrence. The aim of this study was to assess the incidence of recurrence after surgery for DTC and to identify predictive factors of recurrence. We included in this retrospective study 579 consecutive patients who underwent thyroidectomy for DTC from 2011 to 2016 at our institution. We observed biochemical or structural recurrent disease in 36 (6.2%) patients; five-year disease-free survival was 94.1%. On univariate analysis, male sex, histotype, lymph node yield, lymph node metastasis, extrathyroidal invasion and multicentricity were associated with significantly higher risk of recurrence, while microcarcinoma was correlated with significantly lower risk of recurrence. On multivariate analysis, only lymph node metastases (OR 4.724, p = 0.012) and microcarcinoma (OR 0.328, p = 0.034) were detected as independent predictive factors of recurrence. Postoperative management should be individualized and commensurate with the risk of recurrence: Patients with high-risk carcinoma should undergo strict follow-up and aggressive treatment. Furthermore, assessment of the risk should be repeated over time, considering individual response to therapy.

P-170 - Nutritional index differential as a prognostic factor for recurrence in patients with locally advanced rectal cancer

P-170 - Nutritional index differential as a prognostic factor for recurrence in patients with locally advanced rectal cancer

Circulating tumor cell-related transcripts in blood as prognostic biomarkers of early recurrence after liver resection for colorectal metastases.

Several prognostic factors were proposed to improve early detection of recurrence after liver resection of metastases of colorectal cancer. Circulating tumor cell-related transcripts were evaluated in colorectal cancer patients with conflicting results. The aim of this study was to investigate usefulness of carcinoembryonic antigen CAM5, epidermal growth factor receptor, and ERCC1 transcripts in the bloodstream as predictive factors of recurrence in patients who underwent liver resection for metastases of colorectal cancer. Peripheral blood was collected from 29 patients at the time of the colorectal cancer liver metastasis resection, and from 25 normal controls. Follow-up draws (FUDs) were also performed at 30 days, and 3 and 12 months since surgery. On each sample, carcinoembryonic antigen CAM5, ERCC1, and GAPDH mRNAs were examined by quantitative reverse transcription (qRT). Carcinoembryonic antigen transcript levels were linearly correlated to the number of spiked cells (qRT analytical limit = five cells). Among 29 patients (20 M/9 F; mean age 63 years (range 32-79), highly significant levels of carcinoembryonic antigen, if compared to the baseline, were detected in those relapsing after surgery (P <0.05). The main differences were between the 1st- and 12th-month FUDs. Significantly higher levels of carcinoembryonic antigen were also detected in patients who died from disease progression during the follow-up (as evaluated at 30 days and 90 days FUDs). Blood carcinoembryonic antigen-mRNA absolute copy number overtime variation can represent a valid early predictor of relapse after liver resection in colorectal liver metastases patients. Prospective studies, in the context of large clinical trials, will provide further data to also qualify ERCC1 as a predictive biomarker for decisions on therapeutic strategies.

The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones

BackgroundThe removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound.MethodsWe enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group (n = 31), EPLBD group (n = 96), and limited EST-EPLBD group (n = 58). The primary outcome variables were the success rate of complete stone removal and complications.ResultsThe limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12–61) min vs. 23.5 (17–68) min vs. 25.0 (14–60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group.ConclusionsLimited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.

Prognostic Factors in Stage IIB Non-Small Cell Lung Cancer according to the 8th Edition of TNM Staging System.

BackgroundThe purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease.MethodsPatients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients.ResultsOf 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC.ConclusionThe stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

Evaluation of prognostic factors after esophagectomy in which preoperative chemotherapy was successful.

e15568 Background: Current standard treatment for Stage IB/II/III Japanese squamous cell carcinoma of the esophagus is esophagectomy after two courses preoperative chemotherapy with 5-FU/CDDP. Prognosis of cases in which preoperative chemotherapy was successful is usually good, but some cases were recurrence. On the other hand, some reports showed that the negative survival impact of infectious complications after esophagectomy is canceled out by succeeding preoperative chemotherapy. So we evaluate of prognostic factors after esophagectomy in which preoperative chemotherapy was successful. Methods: Between 2011 and 2015, 122 cases were performed esophagectomy after two courses of preoperative chemotherapy using 5-FU/CDDP for stage IB / II / III esophageal cancer, and 46 cases were achieved Grade 2 histopathological effect(2/3 or more disappearance of tumor). We examined 3-year survival rate and 3-year RFS in this 46 cases and examined what could be a prognostic factor. PS, ASA, sex, operation time, volume of bleeding , postoperative complications(C-D classification≧G2), pT, pN, tumor wall retentivity, preoperative nutritional status(Albumin, CRP, Prealbumin, RBP), nutritional indicators at discharge (weight change rate, fat mass change rate, muscle mass change rate) were evaluated as recurrence prediction factor. Results: 3-year OS of histological Grade2 cases were 84.5%, and 3 -year RFS were 88.8%. In 46 cases, relapse was found in 12 cases, and univariate analysis showed pT, pN as a risk of relapse, and multivariate analysis showed only pT as a risk of relapse. There were 5 cases of recurrence within 1 year after esophagectomy, and there was a significantly poor prognosis compared with recurrent cases later than 1 year after esophagectomy. Conclusions: The risk factor of recurrence in patients with squamous cell carcinoma after preoperative chemotherapy followed by esophagectomy was pathological T factor, and recurrent case within 1 year after esophagectomy was significantly poor prognosis.

Sa1205 – Predicting Factors of Recurrence in Patients of Gastroesophageal Reflux Disease: A Prospective Follow-Up Analysis

Sa1205 – Predicting Factors of Recurrence in Patients of Gastroesophageal Reflux Disease: A Prospective Follow-Up Analysis

SUN-452 Predictive Factors of Recurrence in Cushing's Disease after Successful Transsphenoidal Surgery

Introduction: Successful long-term management in Cushing’s disease (CD) is challenging. Transsphenoidal surgery (TS) is the treatment of choice. Recurrence rates vary from 15–66% within 5-10 years of initially successful surgery. Objective: To evaluate the predictive factors for recurrence in patients with CD submitted to TS. Methods: Retrospective study of 44 patients with CD submitted to TS between 2005 and 2016 in a single tertiary center. Patients were divided into two groups, based on the outcome after TS (remission vs recurrence/persistence of disease), for comparison. Immediate postoperative remission (IPR) was defined as cortisol < 2ug/dL and ACTH <5 pg/mL within 7 days of tumor resection. Recurrence is defined by CD relapse after an initial remission after TS. Different variables were analyzed: age at diagnosis, gender, preoperative basal and dynamic hormonal tests and pituitary MRI, immediate postoperative hormonal tests, histological findings, postoperative hypopituitarism, time to recurrence, and time to recovery of hypothalamo-pituitary-adrenal (HPA) axis. Statistical analysis was performed with SPSS software, version 20. Statistical significance: p < 0.05. Results: From a total of 44 patients, 42 were eligible for the analysis and 2 were excluded due to unknown outcome after TS. The mean age was 40.6 ± 15 years and 90.5% were female. Based on immediate postoperative biochemical evaluation, performed in 35 individuals, only 18 (51,4%) would be considered in remission. Later clinical and biochemical evolution enabled considering 39 patients (92.9%) in remission. At a median follow-up of 6 years (1-21), 23 patients (59%) were still in remission whereas the remaining 41% relapsed; median time to recurrence – 3 years (0.25-17). Recurrence was significantly more frequent in: patients who needed glucocorticoid replacement therapy during less than 6 months after TS (19% vs 77.8%, p=0.004) and patients without histological evidence of adenoma/hyperplasia (75% vs 31%, p=0.04). There were no statistically significant differences between groups concerning the remaining variables studied. Conclusions: Absence of IPR criteria does not allow for conclusion of disease persistence. On the other hand, IPR is not a guarantee of life long remission. In this study, 41% of the patients who achieved surgical remission after TS recurred during long term follow-up making surveillance essential. Rapid recovery of HPA axis and negative histology were predictive factors of recurrence.

Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis.

The aim of this study was to determine the predictors of seizure recurrence in surgery for focal cortical dysplasia (FCD) by conducting a meta-analysis. Publications that met the pre-stated inclusion criteria were selected from PubMed and CNKI databases. Two authors extracted data independently about prognostic factors, surgical outcome, and clinical characteristics of participants. A fixed-effects model was used to calculate the summary of odds ratio (OR) with 95% confidence interval (CI). Forty-eight studies were included in our meta-analysis. Three predictors of seizure recurrence (Engel class III/IV)-histological FCD type I, incomplete resection, and extratemporal location were determined; combined OR with 95% CI were 1.94 (95%CI 1.53-2.46), 12.06 (95%CI 7.32-19.88), and 1.91 (95%CI 1.06-3.44), respectively. Trial sequential analysis revealed that the outcomes had a sufficient sample size to reach firm conclusions. Furthermore, seizure location was not substantially modified by geographic region, while histological FCD type I and incomplete resection showed a significant association with seizure recurrence in different continents except Asia for incomplete resection. Sensitivity analyses restricted to studies for each variable yielded robust results. Little evidence of publication bias was observed. Meanwhile, the difference in the standard for outcome failed to influence the results for prognosis. Network meta-analysis including 13 trials comparing subtypes of FCD found the FCD IIb had the lowest seizure recurrence rate. This meta-analysis suggests that histological FCD type I, incomplete resection, and extratemporal location are recurrence factors in patients with epilepsy surgery for FCD. In addition, FCD IIb is associated with the highest rates of postoperative seizure control among the subtypes of FCD, type I and type II.

Predictive factors of recurrence in patients with early‐stage epithelial ovarian cancer

To identify predictive factors of recurrence and survival in patients with early-stage epithelial ovarian cancer (eEOC). We retrospectively searched the medical records of all women undergoing optimal surgical staging for eEOC (stage I-II) at the National Cancer Institute of Milan, Italy, between January 1, 1974, and December 31, 2014. During the study period, 429 patients underwent primary surgery followed by either adjuvant chemotherapy or observation alone for apparent eEOC. In multivariable analysis, International Federation for Gynecology and Obstetrics (FIGO) stage greater than 1 (hazard ratio [HR] 2.49, 95% CI 1.24-4.99) was the only prognostic factor for lower disease-free survival. Multivariate analysis showed that age at diagnosis (HR 1.68, 95% CI 1.14-2.47) and stage (HR 2.29, 95% CI 1.01-6.39) were independent predictive factors for poorer overall survival (OS). FIGO stage is the most important prognostic factor for recurrence and survival in patients with eEOC. Furthermore, age at diagnosis was identified as a factor that negatively influenced OS. Our data for oncologic outcomes are similar to those reported in previous studies.

Depth of invasion alone as a prognostic factor in low-risk early-stage oral cavity carcinoma.

To evaluate the significance of increasing depth of invasion (DOI) as the sole risk factor for recurrence in patients with low-risk early-stage oral cavity squamous cell carcinoma (OCSCC). We retrospectively reviewed 560 patients with OCSCC treated at our institution between 2003 and 2013. Patients were included if they had low-risk early-stage OCSCC treated with surgical resection ± neck dissection and no adjuvant therapy. Low risk was defined as absence of positive or close margins, lymphovascular invasion, perineural invasion, and positive lymph nodes. Patients with tumor (T)3-T4 disease were excluded. Pathology specimens were independently re-reviewed by two board-certified pathologists to confirm proper measurement of DOI. Kaplan-Meier and Cox proportional hazards regression analyses were performed to identify factors predictive for recurrence as well as progression-free survival (PFS) and overall survival (OS). A total of 126 patients with low-risk early-stage T1-2N0 OCSCC were included. Median follow-up time was 42.5 months and median DOI was 4 mm. There was no significant difference in incidence of local (P = 0.95), regional (P = 0.81), or distant recurrence (P = 0.96) among patients with DOI < 4 mm versus ≥4 mm. On multivariable analysis, DOI was significant for both PFS (P = 0.03) and OS (P = 0.002). In this study, we show that in the absence of other high-risk pathologic features, DOI ≥ 4 mm does not portend for increased incidence of local, regional, or distant relapse in patients treated with surgery alone; however, increasing DOI is a marker for worse PFS and OS in patients with low-risk, early-stage OCSCC. 4 Laryngoscope, 129:2082-2086, 2019.