Five-year Disease-free Survival Research Articles

Outcomes of Cytoreduction and Oxaliplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Patients With Peritoneal Carcinomatosis From Colorectal Cancer.

Among patients with metastatic colorectal cancer, 25% have isolated peritoneal carcinomatosis. We performed a systematic review and meta-analysis to assess the disease-free survival (DFS) and overall survival (OS) of patients undergoing hyperthermic intraperitoneal chemotherapy with oxaliplatin. Eleven studies were included in the final assessment. Pooled three- and five-year OS rates were 58.60% and 42.19%, respectively. The estimated pooled three- and five-year DFS rates were 23.47% and 14.26%, respectively.

Clinical outcome of neoadjuvant chemoradiation in rectal cancer treatment.

To determine the clinical and pathological outcome of locally advanced rectal cancer patients treated with neoadjuvant chemoradiation (chemoradiotherapy [CRT]) followed by curative surgery and to identify predictive factors of pathological complete response (pCR).Locally advanced rectal cancer patients undergoing CRT followed by curative surgery from January 2012 to December 2017 were included. Patient's demographic data, pretreatment tumor characteristics, type of CRT regimens, type of surgery, postoperative complications, pathological reports and follow up records were analyzed. Univariate and multivariate analyses were applied to identify predictive factors for pCR. Five-year disease free and overall survival were estimated by Kaplan–Meier method and compared between pCR and non-pCR groups.A total of 85 patients were analyzed. Eighteen patients (21.1%) achieved pCR. The sphincter-saving surgery rate was 57.6%. After univariate analyses, tumor length >4 cm (P = .007) and positive lymph nodes (P = .040) were significantly associated with decreased rate of pCR. Complete clinical response was significantly associated with higher rate of pCR (P = .015). Multivariate analyses demonstrated that tumor length >4 cm (P = .010) was significantly associated with decreased rate of pCR. After a median follow-up of 65 months (IQR 34–79), the calculated 5-year overall survival and disease-free survival rates were 81.4% and 69.7%, respectively. Patients who achieved pCR tend to had longer 5-year disease-free survival (P = .355) and overall survival (P = .361) than those who did not.Tumor length >4 cm was associated with decreased rate of pCR in locally advanced rectal cancer who had CRT followed by surgery. Longer waiting time or more intense adjuvant treatment may be considered to improved pCR and oncological outcomes.

Prevalence, treatment patterns, and prognosis of low estrogen receptor-positive (1% to 10%) breast cancer: a single institution's experience in Korea.

To determine prevalence, clinicopathological characteristics, initial treatments, and outcomes associated with low estrogen receptor (ER)-expressing invasive breast cancer. This retrospective, non-interventional database study included patients undergoing surgery with curative intent for invasive ductal or lobular breast cancer. Patients were treated between January 2003-December 2012. Demographics, clinicopathological characteristics, initial treatments, and outcomes were abstracted from patient records. Patients were categorized using immunohistochemistry to determine ER, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) levels. ER-positive patients were subclassified as ER-low (1% to 10%) and ER-high (> 10%) according to the Allred Proportion Score. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared among groups by log-rank test. 5930 patients were included (median follow-up, 80.9months). Of all patients included, 117 (2.0%) had ER-low tumors: 63 (53.8%) of whom had HER2- tumors and 54 (46.2%) HER2+ tumors. Five-year DFS and OS were highest in the ER-high/HER2- cohort (94.0% and 98.6%, respectively) and lowest in the triple-negative breast cancer (TNBC; 81.3% and 90.1%) and ER-low/HER2- (85.7% and 92.1%) cohorts. Menopausal status, elevated Ki-67, higher nuclear grade, higher tumor stage, presence of lymphovascular invasion, greater regional lymph node involvement, and larger tumor size were all potential prognostic factors for shorter DFS and OS. Patients with ER-low/HER2- breast cancer had similar clinicopathological characteristics, treatments, and outcomes as patients with TNBC irrespective of disease setting. Further research is needed to understand predictive and prognostic factors associated with ER-low/HER2- disease.

MP42-10 ONCOLOGIC OUTCOMES FOLLOWING PARTIAL NEPHRECTOMY VERSUS PERCUTANEOUS CRYOABLATION: A PROPENSITY SCORE MATCHED ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-10 ONCOLOGIC OUTCOMES FOLLOWING PARTIAL NEPHRECTOMY VERSUS PERCUTANEOUS CRYOABLATION: A PROPENSITY SCORE MATCHED ANALYSIS Nicholas Pickersgill, Joshua Palka, Joel Vetter, Grant Henning, Eric Kim, Helen Kim, Ramakrishna Venkatesh, and Robert Figenshau Nicholas PickersgillNicholas Pickersgill More articles by this author , Joshua PalkaJoshua Palka More articles by this author , Joel VetterJoel Vetter More articles by this author , Grant HenningGrant Henning More articles by this author , Eric KimEric Kim More articles by this author , Helen KimHelen Kim More articles by this author , Ramakrishna VenkateshRamakrishna Venkatesh More articles by this author , and Robert FigenshauRobert Figenshau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While partial nephrectomy (PN) is the preferred treatment modality for small renal masses, percutaneous cryoablation (PCA) has emerged as an acceptable alternative with favorable outcomes. However, there is a deficit of long-term, high-quality data comparing the two techniques. We reviewed long-term oncologic outcomes following PN and PCA for renal masses utilizing a propensity score matching method. METHODS: A total of 940 patients with renal masses treated with PCA or PN between 2005 and 2016 were identified within our prospectively maintained institutional database. Demographic and clinical variables and oncologic outcomes were assessed. Two hundred and thirty-three patients who underwent PN were propensity-score matched 1:1 to 233 patients who underwent PCA. Patients were matched based on demographics, Charlson Comorbidity Index (CCI), and tumor characteristics, with exact matching performed for nephrometry score. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: There were no statistically significant differences in sex, body mass index, tumor size, or nephrometry score between the cohorts. Mean patient age was 65.3±9.5 years in the PN and 68.1±10.5 years in the PCA cohort (p=0.002). Twelve percent of patients undergoing PN and 20.6% of patients undergoing PCA had CCI ≥4 (p=0.045). Median follow-up was 48.0 months for PN and 47.9 months for PCA. Five-year DFS was 96.7% and 78.5% for PN and PCA, respectively. CONCLUSIONS: We report one of the largest propensity score matched analyses to date comparing long-term oncologic outcomes of PN and PCA. In our institutional experience, PCA has acceptable oncologic outcomes compared with PN when accounting for patient and tumor characteristics. A shared decision-making approach should be taken when choosing a treatment strategy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e775-e775 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Pickersgill More articles by this author Joshua Palka More articles by this author Joel Vetter More articles by this author Grant Henning More articles by this author Eric Kim More articles by this author Helen Kim More articles by this author Ramakrishna Venkatesh More articles by this author Robert Figenshau More articles by this author Expand All Advertisement PDF DownloadLoading ...

Five-Fraction Prone Accelerated Partial Breast Irradiation: Long-Term Oncologic, Dosimetric, and Cosmetic Outcome

PurposeRandomized data support accelerated partial breast irradiation (APBI) for early-stage breast cancer with variable techniques and cosmesis outcomes. We have treated patients with 5-fraction prone external beam APBI for over a decade and herein report acute and late outcomes. Methods and MaterialsPatients receiving APBI 600 cGy × 5 between 2010 and 2019 were included. APBI was primarily delivered prone, with opposed tangents targeting the tumor bed expanded by 1.5 cm (cropped 6 mm from skin). Ipsilateral breast was constrained to V50% < 60% and V100% < 35%. Survival was estimated with Kaplan-Meier. Late toxicities and clinician- and patient-rated cosmesis were evaluated for patients with >6 months follow-up (FU). ResultsOf 345 patients meeting criteria, 14 were excluded due to APBI given for ipsilateral breast tumor recurrence (IBTR; n = 3), palliation (n = 9), and incomplete radiation therapy course (n = 2). Of the 331 remaining, median age was 70, 7.2% had ductal carcinoma in situ, and 94.3% were treated prone, with 32% treated every other day and 68% on consecutive days. Mean heart dose was 23.8 cGy for left-sided and 12.7 cGy for right-sided cancers. Ipsilateral lung V30% was 0.4%. At 5-year median FU, there were 7 (2.1%) IBTR, 9 (2.7%) contralateral recurrences, and 1 (0.3%) distant metastasis. Five-year local recurrence-free, disease-free, and overall survival was 99.5%, 96.7%, and 98.1%, respectively. When comparing patients with IBTR versus without, a higher proportion did not receive hormone therapy (71.4% vs. 26.2%, P = .018). Rates of acute grade 1 to 2 dermatitis, fatigue, and pain were 35.4%, 21.8%, and 9.4%, respectively, with no grade 3 toxicity. The rate of good-excellent physician- and patient-rated cosmesis (n = 199, median FU 2.8 years) was 92.5% and 89.4%, respectively. Patients experienced low rates of telangiectasia, fibrosis, and retraction/atrophy. ConclusionsWe report excellent dosimetric, oncologic, cosmetic, and late toxicity outcomes for patients treated with 5-fraction APBI. To our knowledge this is the largest series of women treated with prone APBI.

Prognostic Role of Lymphovascular Invasion in Patients with Early Breast Cancer.

In this study, our aim was to evaluate the role of lymphovascular invasion (LVI) in the prognosis of patients with early stage breast cancer. The medical records of more than 7000 patients who suffered from invasive breast cancer and had undergone surgical treatment since December 1994 till December 2019, retrospectively. Patient's history, physical examination and the clinicopathological features, histopathology characteristics, immunohistochemical findings, adjuvant systemic therapy, recurrence rate, metastasis-free survival (MFS), disease-free survival (DFS), and overall survival (OS) were reviewed. A total of 5425 eligible patients were categorized into two groups based on the presence of LVI; 3031 (55.9%) patients had no LVI (group 1) and LVI was present in 2394 (44.1%) patients (group 2), then divided into LN-positive and -negative groups. Presence of LVI was significantly associated with patient age ≤ 40years (p = 0.048), high histological grade (grades II and III, p < 0.001), tumor size between 2-5cm and > 5cm (p < 0.001), number of involved LN ≥ 4 (p < 0.001), and negative ER (p = 0.042) tumors. Five-year OS, MFS, and DFS were 93%, 88.9%, and 76.1% and 85.2%, 84.7%, and 73.6 in groups 1 and 2, respectively (P < 0.001). On multivariate analysis, LVI was an independent prognostic factor for DFS in all patients. Furthermore, histological grade II, histological grade III, and a higher number of involved LNs (≥ 4) were independent predictors in all patients. Thus, the presence of LVI can be considered as an independent prognostic factor for patients with operable breast cancer, irrespective of the LN status.

Correlation between outcomes and tumor size in >7 cm T4 non-small cell lung cancer patients: A tumor size-based comparison study.

We investigated whether all size-based pathological T4N0-N1 non-small cell lung cancer patients with tumors at any size >7 cm had the same outcomes. We reviewed non-small cell lung cancer patients with tumors >7 cm who underwent anatomical lung resection between 2010 and 2016. A total of 251 size-based T4N0-N1 patients were divided into two groups based on tumor size. Group S (n = 192) included patients with tumors of 7.1-9.9 cm and Group L (n = 59) as tumor size ≥10 cm. The mean tumor size was 8.83 ± 1.7 cm (Group S: 8.06 ± 0.6 cm, Group L: 11.3 ± 1.6 cm). There were 146 patients with pathological N0 and 105 patients with pathological N1 disease. Mean overall survival and disease-free survival were 64.2 and 51.4 months, respectively. The five-year overall survival and disease-free survival rates were 51.2% and 43.5% (five-year OS; pT4N0:52.7%, pT4N1:47.9%, DFS; pT4N0:44.3%, pT4N1: 42.3%). No significant differences were observed between T4N0 and T4N1 patients in terms of five-year OS or DFS (p = 0.325, p = 0.505 respectively). The five-year overall survival and disease-free survival rates were 52% and 44.6% in Group S, and 48.5% and 38.9% in Group L. No significant difference was observed between the groups in terms of five-year overall survival or disease-free survival (p = 0.699, p = 0.608, respectively). Above 7 cm, any further increase in tumor size in non-small cell lung cancer patients had no significant effect on survival, confirming it is not necessary to further discriminate among patients with tumors in that size class.

Allogeneic Transplantation to Treat Therapy-Related Myelodysplastic Syndrome and Acute Myelogenous Leukemia in Adults

Patients who develop therapy-related myeloid neoplasm, either myelodysplastic syndrome (t-MDS) or acute myelogenous leukemia (t-AML), have a poor prognosis. An earlier Center for International Blood and Marrow Transplant Research (CIBMTR) analysis of 868 allogeneic hematopoietic cell transplantations (allo-HCTs) performed between 1990 and 2004 showed a 5-year overall survival (OS) and disease-free survival (DFS) of 22% and 21%, respectively. Modern supportive care, graft-versus-host disease prophylaxis, and reduced-intensity conditioning (RIC) regimens have led to improved outcomes. Therefore, the CIBMTR analyzed 1531 allo-HCTs performed in adults with t-MDS (n=759) or t-AML (n=772) between and 2000 and 2014. The median age was 59 years (range, 18 to 74 years) for the patients with t-MDS and 52 years (range, 18 to 77 years) for those with t-AML. Twenty-four percent of patients with t-MDS and 11% of those with t-AML had undergone a previous autologous (auto-) HCT. A myeloablative conditioning (MAC) regimen was used in 49% of patients with t-MDS and 61% of patients with t-AML. Nonrelapse mortality at 5 years was 34% (95% confidence interval [CI], 30% to 37%) for patients with t-MDS and 34% (95% CI, 30% to 37%) for those with t-AML. Relapse rates at 5 years in the 2 groups were 46% (95% CI, 43% to 50%) and 43% (95% CI, 40% to 47%). Five-year OS and DFS were 27% (95% CI, 23% to 31%) and 19% (95% CI, 16% to 23%), respectively, for patients with t-MDS and 25% (95% CI, 22% to 28%) and 23% (95% CI, 20% to 26%), respectively, for those with t-AML. In multivariate analysis, OS and DFS were significantly better in young patients with low-risk t-MDS and those with t-AML undergoing HCT with MAC while in first complete remission, but worse for those with previous auto-HCT, higher-risk cytogenetics or Revised International Prognostic Scoring System score, and a partially matched unrelated donor. Relapse remains the major cause of treatment failure, with little improvement seen over the past 2 decades. These data mandate caution when recommending allo-HCT in these conditions and indicate the need for more effective antineoplastic approaches before and after allo-HCT.

Toxicity and Efficacy After Adjuvant Vaginal Brachytherapy Using 30 Gy in 6 Fractions for Stages I and II Endometrial Cancer

PurposeThis study aimed to evaluate outcomes and toxicity in patients with endometrial cancer per our institutional adjuvant vaginal cuff brachytherapy (VBT) fractionation scheme. Methods and MaterialsWe identified women with International Federation of Gynecology and Oncology stages I and II endometrial cancer who underwent surgical staging and adjuvant high-dose-rate VBT without external beam radiation. All patients received 30 Gy in 6 fractions to the upper one-third of the vagina, prescribed to a depth of 5 mm and delivered twice weekly. Toxicities were prospectively elicited at each follow up, and rates of recurrence and survival were retrospectively assessed. ResultsWe identified 247 eligible patients treated between 1992 and 2018 with a median follow up of 5.8 years (range, 0.1-24.7 years). Most patients had stage I disease (52% stage IA; 37% stage IB), and 11% of patients were stage II. Deep myometrial invasion was predictive of local recurrence (P = .002). The 5-year rates of local recurrence, regional recurrence, and distant metastases were 5%, 5%, and 7%, respectively. Five-year overall and disease-free survival were 91% and 83%, respectively. The most common grade 1 toxicities were acute fatigue (11% crude rate), urinary frequency (11%), chronic (>6 months) urinary frequency (13%), urinary incontinence (13%), and vaginal stenosis (21%). There were few grade 2 toxicities (all <5%) and no grade 3 to 5 toxicities. ConclusionsThe adjuvant VBT fractionation scheme of 30 Gy in 6 fractions results in low rates of toxicity, with no grade ≥3 adverse events, and local control rates comparable with those from other published series using different fractionation schemes.

Merkel Cell Carcinoma of the Head and Neck.

Merkel cell carcinoma (MCC) of the head and neck is a rare and aggressive non-melanoma skin cancer. The objective of this study was to assess the oncological outcome of MCC by retrospective review of electronic and paper records of a population-based cohort of 17 consecutive cases of the head and neck MCC without distant metastasis, diagnosed in Manitoba between 2004 and 2016. The average age of the patients at initial presentation was 74.1 ± 14.4 years with 6 patients presenting with stage I, 4 with stage II, and 7 with stage III disease. Both surgery or radiotherapy alone were the primary treatment modalities in 4 patients each and the remaining 9 patients had a combination of surgery with adjuvant radiotherapy. During the median follow-up of 52 months, 8 patients had recurrent/residual disease and 7 eventually died of it (P = .001). Metastatic spread of disease to the regional lymph nodes was observed in 11 patients either at presentation or during the follow-up and to the distant sites in 3 patients. At the time of the last contact on November 30, 2020, 4 patients were alive and disease-free, 7 had died of disease, and 6 had died of other causes. The case fatality rate was 41.2%. Five-year disease-free and disease-specific survivals were 51.8% and 59.7%, respectively. The 5-year disease-specific survival was 75% for early stage MCC (stage I and II) and 35.7% for stage III MCC. Early diagnosis and intervention are crucial for disease control and improving survival.

Systematic Analysis Identifies a Specific RNA-Binding Protein-Related Gene Model for Prognostication and Risk-Adjustment in HBV-Related Hepatocellular Carcinoma.

ObjectiveIncreasing evidence shows that dysregulated RNA binding proteins (RBPs) modulate the progression of several malignancies. Nevertheless, their clinical implications of RBPs in HBV-related hepatocellular carcinoma (HCC) remain largely undefined. Here, this study systematically analyzed the associations of RBPs with HBV-related HCC prognosis.MethodsBased on differentially expressed RBPs between HBV-related HCC and control specimens, prognosis-related RBPs were screened by univariate analyses. A LASSO model was then created. Kaplan-Meier curves, ROCs, multivariate analyses, subgroup analyses and external verification were separately applied to assess the efficacy of this model in predicting prognosis and recurrence of patients. A nomogram was created by incorporating the model and clinical indicators, which was verified by ROCs, calibration curves and decision curve analyses. By CIBERSORT algorithm, the association between the risk score and immune cell infiltrations was evaluated.ResultsTotally, 54 RBPs were distinctly correlated to prognosis of HBV-related HCC. An 11-RBP model was created, containing POLR2L, MRPS12, DYNLL1, ZFP36, PPIH, RARS, SRP14, DDX41, EIF2B4, and NOL12. This risk score sensitively and accurately predicted one-, three- and five-year overall survival, disease-free survival, and progression-free interval. Compared to other clinical parameters, this risk score had the best predictive efficacy. Also, the clinical generalizability of the model was externally verified in the GSE14520 dataset. The nomogram may predict patients’ survival probabilities. Also, the risk score was related to the components in the immune microenvironment.ConclusionCollectively, RBPs may act as critical elements in the malignant progression of HBV-related HCC and possess potential implications on prognostication and therapy decision.

Prognostic significance of occult lymph node metastases in breast cancer: a meta-analysis

BackgroundOccult metastases in axillary lymph nodes have been reported to be associated with poor prognosis in patients with breast cancer. However, studies on the prognostic value of occult metastases have shown controversial results. This meta-analysis aimed to evaluate the prognostic significance of occult lymph node metastases in breast cancer.MethodsStudies published until May, 2020, which retrospectively examined negative lymph nodes by stepsectioning and/or immunohistochemistry, were retrieved from MEDLINE, EMBASE, CNKI, and Cochrane Library databases. The pooled Relative Risk (RR) with 95% confidence interval (95% CI) for overall survival (OS) and disease-free survival (DFS) were calculated to examine the associations between occult metastases and prognosis.ResultsPatients with occult metastases in axillary lymph nodes had poorer five-year DFS (RR = 0.930; 95% CI = 0.907–0.954) and OS (RR = 0.972; 95% CI = 0.954–0.990). Furthermore, the DFS (RR = 0.887; 95% CI = 0.810–0.972) and OS (RR = 0.896; 95% CI = 0.856–0.939) of patients with occult metastases were significantly lower after a ten-year follow-up.ConclusionsOccult metastases in the axillary lymph nodes are associated with poorer DFS andOS of patients with breast cancer. Occult metastases might serve as a predictive factor of survival outcomes in patients with breast cancer.

Malignant salivary gland tumours: Single-centre experience of 108 patients.

●A functioning facial nerve is a critical structure that limits the margin of resection in parotid malignancies. There was no difference in disease-free survival with close or negative resection margins. ●Microscopic positive (R1) resection margins were associated with poorer disease free survival, but this was not statistically significant, implying that more functional and less radical surgery may be acceptable when followed by adjuvant therapy. ●Perineural invasion was found in 37% of tumours ●Five-year overall and disease-free survival were 82% and 71%. ●Age >50, pT classification 3-4, higher tumour grade, perineural invasion, and advanced TNM stage were all associated with worse overall and disease-free survival.

Clinical characteristics of patients in their forties who underwent surgical resection for colorectal cancer in Korea

BACKGROUNDThe proportion of young patients with colorectal cancer (CRC), especially in their 40s, is increasing worldwide. AIMTo confirm the clinical characteristics of such patients, we planned a study comparing them to patients in their 30s and 50s.METHODSPatients undergoing primary resection for CRC, patients in their 30s, 40s and 50s were included in the study. Patient and tumor characteristics, and perioperative and oncologic outcomes were compared. RESULTSMost clinical characteristics of 451 (10.5%) patients in their 40s were more similar to those of patients in their 30s than those in their 50s. On pathology data, there were more metastatic lesions (30s vs 40s vs 50s; 17.5% vs 21.1% vs 14.9%, P = 0.012) in patients in their 40s. There was a trend toward less frequent K-ras mutations among patients in their 40s (48.5% vs 33.3% vs 44.5%, P = 0.064). The proportion of patients receiving postoperative chemotherapy was also significantly greater among patients in their 40s (58.3% vs 63.9% vs 56.3%, P = 0.032). Five-year overall survival (OS) and disease-free survival (DFS) did not differ between the three groups (5-year OS, 92.2% vs 89.8% vs 92.2%, P = 0.804; 5-year total DFS, 98.6% vs 95.7% vs 96.1%, P = 0.754; 5-year local DFS, 98.6% vs 94.3% vs 94.9%, P = 0.579; 5-year systemic DFS, 86.4% vs 87.9 % vs 86.4%, P = 0.908).CONCLUSIONPatients with CRC in their 40s showed significantly more numerous metastatic lesions. The oncologic outcome of stage 1-3 patients in their 40s was not inferior compared to that of those in their 30s and 50s.

P-208 Pancreatic neuroendocrine neoplasia: Experience of a comprehensive cancer center

Pancreatic neuroendocrine neoplasia (Pan-NEN) are rare tumors in which therapeutic options have been increasing over the last decade. However, the effect of implementing these therapies in the real world is poorly understood. We aim to characterize the clinical features and therapeutic strategies of patients with Pan-NEN within a 12-year period in a cohort of patients followed at IPOFG-Porto. We performed a retrospective cohort study of patients diagnosed with Pan-NEN between 2006 and 2017 at the largest NEN reference Portuguese Center. Progression-free (PFS) and overall survival (OS) time estimates were calculated by Kaplan-Meier method. To assess the impact of baseline clinicopathological characteristics on survival, we used univariate and multivariate Cox proportional hazard models. Ninety-seven patients were included. Mean patient age was 59.5±13.55 years-old, with 55 (56.7%) being male. Forty-five patients (48.5%) had an Adjusted Charlson Comorbidity Index >3. Most patients were symptomatic at diagnosis, mainly due to tumor location-related symptoms (n=55, 69.6%), and 12 (15.0%) hormone secretion-related symptoms. Most tumors were well differentiated neuroendocrine tumors (NET) (n=77, 79.9%) according with WHO 2010 classification. NET G1 and NET G2 constituted the majority of cases (n=72, 75.8%). Predominant pancreatic topography was body and tail (n=43, 44.3%) followed by head (n=28, 28.9%). Fifty-two (53.6%) had localized/locoregional disease while 46.4% (n=45) had metastatic disease. Liver was the most frequent site of synchronous metastasis at diagnosis (n=42, 93.3%), followed by non-regional nodal (n=11, 24.4%) and bone (n=11, 24.4%). Globally, 60 (61.9%) surgical procedures were performed, 22 (22.9%) transarterial embolization, 5 (5.2%) other locoregional therapies, 56 (57.7%) somatostatin analogues, 23 (23.7%) Peptide Receptor Radionuclide Therapy, 11 (11.3%) everolimus and 32 (33.0%) chemotherapy. Forty-six patients (47.4%) had potentially curative disease, of which 43 (93.5%) had surgery as primary treatment. Eighteen patients (45.0%) had disease recurrence after surgery. Five-year Disease-free Survival was 61.9%. Seventy-two patients received antineoplastic palliative treatments (51 patients with metastatic/irresectable disease at diagnosis, 18 with disease recurrence and 3 refused curative intention therapy). Of those, twenty-six (36.1%) received 2 lines and 20 (27.8%) ≥3 lines of treatment. Median PFS after first line treatment was 25.0 months (95%CI 18.0-32.0) and median OS was 58 months (95%CI 30.0-86.0). Patients with localized/locoregional disease had a median OS of 160 months and patients with metastatic disease of 29 months, HR 4.55 (95%CI 2.58-8.02), p On univariate analysis, the risk of death was increased in those patients with NEC, metastatic disease at diagnosis, and primary location of the tumor not in the pancreatic body or tail. On multivariate analysis, NEC (HR 2.46 95%CI 1.28-4.73) and metastatic disease (HR 3.44 95%CI 1.85-6.37) were independent prognostic factors. Patients with PAN-NENs analyzed in this study present similar characteristics to other cohorts described in the literature. Therapeutic strategies in PAN-NENs are highly diversified and adapted to histological differentiation, stage, hormone hypersecretory-related symptoms and patients characteristics and preferences. NEC and metastatic disease were associated with a significant increase risk of death.

Is Nipple-Sparing Mastectomy Indicated after Previous Breast Surgery? A Series of 387 Institutional Cases.

Previous breast surgery does not represent an absolute contraindication for nipple-sparing mastectomy, although it may negatively interfere with surgical outcomes. The aim of the authors' study was to confirm the feasibility of nipple-sparing mastectomy after previous breast surgery, focusing on skin incisions and risk factors, complications, and oncologic outcomes. The authors retrospectively identified 368 patients who underwent 387 nipple-sparing mastectomies and reconstruction after previous surgery (quadrantectomy, breast resection, augmentation and reduction mammaplasty, mastopexy) at the European Institute of Oncology from January of 2003 to November of 2017. Patterns of skin incisions (i.e., radial, hemiperiareolar, periareolar, vertical pattern, inframammary fold, Wise-pattern, and round-block) for primary surgery and for mastectomy, type of reconstruction, and radiotherapy have been recorded. The authors collected data regarding early and late complications and further operations (implant change, fat grafting) performed within 2 years to improve cosmetic outcomes. Oncologic follow-up has been reported for in-breast recurrences. Complete and partial nipple-areola complex necrosis occurred, respectively, in 2.8 percent and in 5.4 percent of cases. The authors recorded 5.4 percent failures resulting in implant removal. The analysis of risk factors for complications or for the need for further operations showed no significant association with skin incision for first surgery and mastectomy, use of the same skin incision, previous radiotherapy, or type of primary surgery. Five-year overall survival and disease-free survival were 99.1 and 93.8 percent, respectively. No nipple recurrence was recorded. The authors' results confirm that nipple-sparing mastectomy can be a safe surgical procedure after previous breast surgery. Surgical planning should be tailored to each patient. Therapeutic, III.

Anorectal dose–effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial

Background and purposeThe phase III FLAME trial (NCT01168479) showed an increase in five-year biochemical disease-free survival, with no significant increase in toxicity when adding a focal boost to external beam radiotherapy (EBRT) for localized prostate cancer [Kerkmeijer et al. JCO 2021]. The aim of this study was to investigate the association between delivered radiation dose to the anorectum and gastrointestinal (GI) toxicity (grade ≥2). Material and methodsAll patients in the FLAME trial were analyzed, irrespective of treatment arm. The dose–effect relation of the anorectal dose parameters (D2cm3 and D50%) and GI toxicity grade ≥2 in four years of follow-up was assessed using a mixed model analysis for repeated measurements, adjusted for age, cardiovascular disease, diabetes mellitus, T-stage, baseline toxicity grade ≥1, hormonal therapy and institute. ResultsA dose–effect relation for D2cm3 and D50% was observed with adjusted odds ratios of 1.17 (95% CI 1.13–1.21, p < 0.0001) and 1.20 (95% CI 1.14–1.25, p < 0.0001) for GI toxicity, respectively. ConclusionAlthough there was no difference in toxicity between study arms, a higher radiation dose to the anorectum was associated with a statistically significant increase in GI toxicity following EBRT for prostate cancer. This dose–effect relation was present for both large and small anorectal volumes. Therefore, further increase in dose to the anorectum should be weighed against the benefit of focal dose escalation for prostate cancer.

STAGE IB2–IIIB CERVICAL CANCER: NEOADJUVANT CHEMOTHERAPY, RADICAL SURGERY AND PATIENT SURVIVAL

The aim of the study was to evaluate the five-year survival rate in patients with stage ib2–iiib cervical cancer treated with neoadjuvant chemotherapy and radical surgery.Material and Methods. Long-term treatment outcomes were studied in 173 patients with histologically-verified stage ib2–iiib cervical squamous cell carcinoma. The patients underwent neoadjuvant chemotherapy using intravenous infusion of cytostatic drugs (n=106) and intra-arterial infusion of cytostatic drugs in combination with embolization of tumor-feeding arteries (n=67). Patients with resectable tumors underwent radical surgery. Disease-free survival was assessed.Results. The median follow-up time was 66 months, and the maximum follow-up period was 144 months. 160 (92.5 %) patients underwent radical surgery after chemotherapy. 55 (34.4 %) patients did not receive adjuvant radiation therapy. The five-year disease-free survival rate was 79.6 %.Conclusion. For the group of patients with locally advanced cervical cancer, who achieved respectability following neoadjuvant chemotherapy, radical surgery could be performed. Chemotherapy followed by radical surgery can improve disease-free survival rates in patients with stage ib2–iiib cervical cancer.

Utility of the CPS + EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy

BackgroundPathological complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with superior survival. This association is strongest in triple-negative breast cancer (TNBC). The CPS + EG system, based on pre-treatment clinical (CS) and post-treatment pathological stage (PS), oestrogen-receptor status (E) and grade (G), leads to a refined estimate of prognosis after NACT in all-comers and hormone receptor–positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Here, we investigate if CPS + EG scoring provides a superior estimate of prognosis in TNBC to select patients for postneoadjuvant therapy. MethodsWe calculated the CPS + EG score for 1795 patients with TNBC from 8 prospective German trials. Five-year disease-free survival (DFS) and overall survival estimates were calculated using the Kaplan-Meier method. ResultsIn TNBC, patients with pCR (ypT0/is ypN0, n = 822, 45.8%) had a 5-year DFS of 86%, whereas patients with residual American Joint Committee on Cancer stage I disease (n = 383; 21.3%) had a 5-year DFS of 77.5%.CPS + EG led to superior prognostic information compared with that provided by the clinical stage, but it was inferior to the prognostic information provided by the pathological stage (c-index statistics, p < 0.001). CPS + EG did not discriminate prognosis within the two best prognostic groups (score 1 and 2; n = 362; 37.2%). In contrast, pCR status added prognostic information beyond CPS + EG. Patients with a CPS + EG score of 3 had a 5-year DFS rate of 64% overall, but those with pCR had a 5-year DFS rate of 84%, and those without pCR had a 5-year DFS rate of only 49.7%. ConclusionsIn TNBC, CPS + EG scoring provided inferior prognostic information compared with the pathological stage and was unable to identify patients without pCR and with a sufficiently good prognosis, who could avoid postneoadjuvant therapy. pCR remains the strongest and most clinically useful prognostic factor after NACT. Other biologic factors beyond pCR are needed in TNBC.

Merkel cell carcinoma of the head and neck in the south-east of England

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy of the skin. Its incidence is increasing with half of cases involving the head and neck. To the best of our knowledge, few large studies have been published in the UK, and to date this is the largest reported series of head and neck MCC. We retrospectively reviewed the outcomes of patients with MCC in three hospitals in the south-east of England over a 12-year period (2008–2019). Diagnosis was based on histological data following biopsy. Overall survival and disease-specific survival were calculated using Kaplan–Meier and log-rank tests. Fifty-eight patients met the inclusion criteria (24 stage I, 22 stage II, 9 stage III, and 3 unclassified). Median disease-free survival was 36 months (95% CI 0 to 77.2) and median overall survival 50 months (95% CI 29.9 to 70). Overall five-year survival was 34.4% (95% CI 17% to 52%) with two-year survival at 62% (95% CI 48% to 76%). Five-year disease-free survival was 26.7% (95% CI 17 to 52%) with two-year disease-free survival at 54% (95% CI 40% to 68%). To date, this is the largest UK based study reporting overall and disease-free survival associated with MCC of the head and neck. Half the patients presented late, and surgery was the mainstay of treatment, augmented by adjuvant radiotherapy. There is a need to better stratify patients at risk of developing metastatic disease, with the use of sentinel lymph node biopsy and positron-emission tomography-computed tomography (PET-CT), as immunotherapy and targeted agents are now available to treat advanced disease.