Five-year Disease-free Survival Research Articles

Adult-Type Ovarian Granulosa Cell Tumour: Treatment Outcomes From a Single-Institution Experience.

Ovarian granulosa cell tumour is rare. This study aims to report the clinical characteristics and long-term outcomes of adult-type ovarian granulosa cell tumour (AOGCT) at King Faisal Specialist Hospital and Research Centre (KFSH&RC) and to determine the prognostic factors affecting relapse and survival. We retrospectively reviewed patients with AOGCT, from 1988 to 2014, who were treated at our institution. Baseline characteristics, pathological findings, and outcomes were analysed and reported. Sixty-one patients with AOGCT were identified with a median age of 49 years. Median follow-up was 5.0 years (range 2.1-8.2 years). 74% of patients were FIGO (InternationalFederationofGynecologyandObstetrics) stage I, whereas 7% were stage II, 5% were stage III, and unknown in 14% of the cases.The most common presenting symptoms included abdominal pain (43%) and vaginal bleeding (43%). The majority of patients (38 patients, 62%) were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy.Five (8%) patients received adjuvant chemotherapy. Sixteen patients (26%) relapsed with a median time to relapse of 5.5 years (0.7-8.1 years). Half of the recurrences (eight patients, 50%) occurred after five years of diagnosis. Five-year overall survival and disease-free survival (DFS) were 93% and 84%, respectively. Factors associated with a high risk of recurrence were the presence of ascites (p=0.000) and elevated preoperative CA 125 level (p=0.048). The overall survival was significantly influenced by the menopausal status (premenopausal 100% vs. postmenopausal 84%; p=0.02), preoperative CA 125 (normal 100% vs. elevated 64%; p=0.005), ascites (present 33% vs. absent 100%; p=0.000), and age (<55 years 100% vs. ≥ 55 years 77%; p= 0.002). This study confirms a good outcome for patients with AOGCT.They require long-term follow-up as late recurrences can occur many years post definitive therapy.The presence of ascites and elevated preoperative CA 125 levels were associated with a higher risk of recurrence and poor prognosis. Outcomes appear unaffected by fertility-sparing surgery or adjuvant chemotherapy.

58 (PB-058) Poster - Breast cancer in elderly patients in a Venezuelan breast center. How we manage the axilla

Objective: Axillary management in elderly patients with early breast cancer and clinically negative axillary nodes is controversial. This study aimed to evaluate clinico-histopathological and survival data in breast cancer patients aged 80 years or older with a negative axillary clinical and ultrasound examination not undergoing axillary lymph node investigation Patients and Method: A retrospective study of 36 patients who met the following inclusion criteria: aged 80 years or more, with a diagnosis of early breast cancer and clinically and ultrasound node negative breast cancer, and in a state of complete physical, mental well-being. The patients were treated surgically without axillary dissection. Clinico-histopathological, treatment and survival characteristics were evaluated. Results: A total of 36 patients were studied with an average age of 83.5 years (range, 80–91 years), and a median follow-up of 39.7 months (range: 0.5–168 months). Of these, 1 patient had bilateral breast cancer. Most patients were treated with partial mastectomy (64.9%). Almost all of the patients received adjuvant hormonal therapy (91.7%), almost one third received adjuvant radiotherapy (30.6%). Infiltrating ductal carcinoma represented 62% of the total. Average tumor size of 17.5 mm (range, 2– 50 mm). The most frequent molecular subtype was luminal A (54.1%). 8.3% of the patients had a relapse, none in axilla. Disease free survival was found to be a mean of 141.7 months, while five-year disease-free survival rate was 80.9%. The overall survival average time was 95.5months, while the five-year overall survival rate was 57%.Table 1:Clinical and Histopathological characteristicsAge (years) N = 36 (1 bilateral)80–8424 (66.7)85–9112 (33.3)Media (STD)83.5 (0.49)Tumor characteristicsTumor size (mm) N = 37≤2029 (78.4)<20 ≤ 508 (21.6)Media (STD) (range)17.5(1.52) (5–50)Histological type N = 37IDC23 (62.2)ILC4 (10.8)Others10 (27)Molecular Subtypes N = 37Luminal A20 (54.1)Luminal B10 (27)Luminal B-H5 (13.5)HER21 (2.7)Triple negative1 (2.7)Type of Surgery N = 37BCS24 (64.9)TM£1 patient with bilateral mastectomy13 (35.1)Treatment N = 36Adjuvant Hormonotherapy33 (91.7)Adjuvant Radiotherapy11 (30.6)Neoadjuvant Hormonotherapy9 (25)IDC: infiltrating ductal carcinoma, ILC: infiltrating lobullar carcinoma, Others: muninous carcinoma, papillary carcinoma, cribiform carcinoma, ductal carcinoma in situ. BCS: breast conservative surgery. TM: Total mastectomy.£ 1 patient with bilateral mastectomy Open table in a new tab IDC: infiltrating ductal carcinoma, ILC: infiltrating lobullar carcinoma, Others: muninous carcinoma, papillary carcinoma, cribiform carcinoma, ductal carcinoma in situ. BCS: breast conservative surgery. TM: Total mastectomy. Conclusion: Results from the present investigation suggest that axillary lymph node biopsy could be omitted in women 80 years or older with clinically node negative breast cancer treated with breast surgery and adjuvant therapy. No conflict of interest.

Retrospective Analysis of Proton Beam Therapy for Postoperative Locally Recurrent Rectal Cancer

<h3>Purpose/Objective(s)</h3> The outcomes of postoperative locally recurrent rectal cancer (PLRRC) are unsatisfactory in the multimodal treatment era. We retrospectively analyzed the outcomes of proton beam therapy (PBT) for PLRRC at our institution. <h3>Materials/Methods</h3> We included 79 PBT-treated PLRRC patients between December 2008 to December 2019. We excluded patients with prior history of salvage surgery, radiotherapy, or distant metastasis before PBT, and those treated with postoperative adjuvant PBT. We included patients who had history of chemotherapy. We estimated the overall survival (OS), disease-free survival (DFS), and local control (LC) using the Kaplan–Meier method. The prognostic factor for each outcome was verified using a Cox proportional hazards model. <h3>Results</h3> We enrolled 23 patients. The median follow-up time was 36.8 months. The median age was 64 (range, 34–83) years. The median time from surgery to recurrence was 18.1 months. Twenty patients (87%) had adenocarcinoma, two had carcinoid, and one had neuroendocrine carcinoma. The postoperative recurrent sites were presacral (12 patients), pelvic side wall (seven patients), and anastomoses (four patients). The median recurrent tumor size was 37 (range, 16–130) mm. The median maximum standardized uptake value (SUV_max) of Fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (18^F-FDG-PET/CT) before PBT was 7.4. Twenty-one patients (91%) received PBT alone. The median total dose was 72.6 (range, 60–87) Gy relative biological effectiveness. The treatment response was stratified by initial imaging (median, two months) after PBT. Of 23 patients, 16 (70%) received 18^F-FDG-PET/CT for initial imaging modality. Eleven patients had complete response (CR), eight had partial response, two had stable disease, and two had progressive disease. Eleven patients (48%) had lumbar or anal pain before PBT and had symptomatic pain improvement after PBT. Three- and five-year OS, DFS, and LC were 71.5%/43.3%, 37.3%/37.3%, and 54.5%/46.7%, respectively. The SUV_max of 18^F-FDG-PET/CT before PBT (cut-off value:10) showed significant difference for OS (<i>P</i>=0.0135), DFS (<i>P</i>=0.047), and LC (<i>P</i>=0.0239). The patients who achieved CR after PBT had significantly better LC compared with those with non-CR (HR 4.71, 95% CI 1.18–18.65, <i>P</i>=0.0177). Elderly patients (≧65 years) had significantly better LC and DFS. The patients with pain before PBT and larger tumor (≧30 mm) also had significantly lower DFS. Of 23 patients, 12 (52%) had further local recurrence after PBT. One patient developed grade 2 acute radiation dermatitis. Grade 4 late gastrointestinal toxicity (perforation) was recorded in three patients, two of which were associated with reirradiation for further local recurrence after PBT. <h3>Conclusion</h3> The outcomes of PBT for PLRRC are better than those of conventional photon therapy, and are comparable with those of surgery. 18^F-FDG-PET/CT before/after PBT correctly reflected the treatment effect and prognosis.

The Impact of Colon Cancer Sites on Survival Rates after Curative Resection and Adjuvant Chemotherapy: A SingleCenter Study

Background: Most recent studies indicate that right-sided colon cancer is associated with a significantly higher mortality rate. Multivariate analyses showed that the patient’s age, sex, mode of presentation, co-morbidity, and the stage had significantly influenced their survival. Although the primary tumor location has an impact on the overall survival in metastatic settings, the laterality of early-stage colon cancer might also affect the disease-free survival and determine the duration of adjuvant chemotherapy for each side. This study aimed to compare overall survival and disease-free survival between left-sided and right-sided high-risk stage II and stage III colon cancer in patients from a single institute. Methods: This retrospective cohort study was conducted between January 2004 and December 2017. Data on 153 patients who underwent curative resection and adjuvant chemotherapy for colon cancer were retrieved from an existing database. Results: We found that the five-year disease-free survival rates were 63.20% for left-sided colon cancer and 51.11% for right-sided colon cancer (P-value &lt; 0.05). The five-year overall survival rates were 66.98% for left-sided colon cancer and 57.77% for right-sided colon cancer (P-value 0.063). The right-sided primary tumor location was associated with a significantly higher mortality rate (HR: 2.28; 95%CI 1.38–5.8; P-value: 0.004). Conclusion: The results of this study confirmed that patients with high-risk stage II and stage III colon cancer who had right-sided tumors were significantly more likely to have decreased disease-free survival and overall survival. Further prospective studies should focus on tumor genetics and proper durations of adjuvant chemotherapy to maximize the benefit of treatment with acceptable toxicity.

Tumor Load Matters - the Peritoneal Cancer Index in Patients With High-grade Serous Ovarian Cancer.

The aim of this study was to analyze the predictive and prognostic value of the peritoneal cancer index (PCI) with regard to complete cytoreduction and clinical outcomes in patients with high-grade serous ovarian cancer. In a cohort comprising 188 patients with high-grade serous ovarian cancer, the PCI was retrospectively assessed. Clinical factors and perioperative complications were analyzed according to different PCI groups. Five-year disease-free survival (DFS) and overall survival (OS) were calculated based on the Kaplan-Meier Log rank analysis. Receiver operating characteristic (ROC) analysis was applied to detect associations of PCI and complete cytoreduction. Multivariate survival analysis was performed by Cox proportional hazards model. In our study, the PCI was predictive of complete cytoreduction (ROC analysis; AUC 0.8227). In patients with optimal cytoreduction, higher PCI scores were associated with poorer 5-year OS (p<0.001) and 5-year DFS (p<0.001). Complications (G1-G5) were significantly more frequent in patients with PCI scores >9 (p=0.0023). Five-year OS was reduced in patients with severe complications compared to patients with none or mild complications (30.88% versus 51.01%; p=0.001). There were significant OS (p<0.001) and DFS (p<0.001) differences between patients with none or mild versus severe complications following complete cytoreduction within the PCI subgroups (PCI: 9-11, PCI: 12-18, PCI >18). The PCI score showed high predictability for complete cytoreduction and was associated with clinical outcomes. In presence of severe complications, higher PCI scores were associated with poorer survival. Hence, in patients with high tumor load, the prevention of severe perioperative complications is of utmost importance in all cases where complete cytoreduction is deemed to be feasible.

Prognosis of Liposarcoma Patients in Modern ERA: Single-Center Experience.

Objective Liposarcomas are relatively rare tumors. Prognostic and predictive factors and treatment options are limited. We herein presented our 10-year experience with liposarcomas. Materials and Methods Adult patients with liposarcoma treated between 2005 and 2015 in our center were included. Demographic and clinicopathologic features of patients were retrieved from patient files. Statistical Analyses Outcomes in terms of disease-free survival (DFS) and overall survival (OS) were assessed along with potential prognostic factors using Kaplan-Meier analyses. Results A total of 88 patients were included. The median age was 52. Rates of well-differentiated (WDLS), dedifferentiated (DDLS), myxoid (MLS), and pleomorphic liposarcomas (PLS) were 42, 9.1, 37.5, and 4.5%, respectively. Only 10% of patients had high-grade tumors and 93% had localized disease. Ninety-six percent of patients ( n = 84) underwent surgery. Adjuvant chemotherapy was delivered to 16 patients. The most common regimen was ifosfamide-doxorubicin. Recurrences were observed in 30 patients, 21 had local, and 9 had distant metastasis. Five-year DFS of patients with the localized disease was 68%. All patients with PLS had relapses and those had the highest distant relapse rates among all subtypes. Multivariate analysis showed T stage and grade were associated with DFS. Five-year OS of the entire population was 68%. Five-year OS was 79, 76, 50, and 0% in WDLS, MLS, DDLS, and PLS, respectively ( p = 0.002). Conclusion Management of liposarcomas is still challenging. Surgery is the mainstay of treatment. Novel effective therapies are needed, particularly in advanced disease settings.

Impact of substage and histologic type in stage I ovarian carcinoma survival: a multicenter retrospective observational study

ObjectiveThis international study aimed to investigate the impact of substage, histological type and other prognostic factors on long-term survival for stage I ovarian carcinoma.MethodsOur study was a retrospective multicenter cohort...

Perioperative oral nutritional support for patients diagnosed with primary colon adenocarcinoma undergoing radical surgical procedures -Peri-Nutri Trial: study protocol for a randomized controlled trial

BackgroundColon cancer is one of the most common cancers in Finland and worldwide. Cancer-related malnutrition is a well-known risk factor for increased morbidity and mortality after surgery, and it is associated with complications and longer hospitalizations. There are no established recommendations on how to improve the nutritional status of colon cancer patients´ during the perioperative phase. Administration of simple oral nutritional supplements has been suggested to reduce complication rates, but evidence to support this practice is scarce.MethodsThe Peri-Nutri trial is a prospective, multicenter, randomized, controlled trial. Its primary endpoint is to evaluate whether perioperative oral nutritional support (ONS) decreases the number of complications during the 30-day follow-up after surgery. Secondary endpoints are to study the effect of ONS on quality of life after surgery, length of stay in institutional care, 90-day mortality rate, five-year disease-free survival and overall survival. The patients with a Nutritional risk screening 2002 (NRS-2002) questionnaire result between 2 and 5 (≥ 3 are classified at risk of malnutrition) will be randomized (1:1 ratio) into either the intervention or control group. The intervention group will receive preoperative ONS two weeks before the operation, and nutritional support will continue 10 days after the operation. The control group will not receive ONS. A total of 318 patients will be randomized into two groups and patients are followed five years.DiscussionPeri-Nutri study evaluate the impact of ONS to short-term and long-term postoperative morbidity and mortality rates of colon cancer patients undergoing curative surgery. If ONS will decrease patients´ morbidity and mortality, that has a huge impact on patients´ quality of life and also to financial cost.Trial registrationClinicalTrials.gov, NCT03863236, Registered 25 February 2019.

Extent of Extranodal Extension in Oral Cavity Squamous Cell Carcinoma is Not Independently Associated With Overall or Disease-Free Survival at a 2.0-mm Threshold

The presence of extranodal extension (ENE) conveys a poor prognosis in oral cavity squamous cell carcinoma (OSCC); however, there is no consensus regarding whether the histopathologic extent of ENE (e-ENE) may be a more discriminating prognostic indicator. The purpose of this study was to assess the impact of minor ENE (<2.0mm) versus major ENE (≥ 2.0mm) on overall survival (OS) and disease-free survival (DFS) in OSCC. A single-institution, retrospective cohort study was designed using an electronic medical record review. Inclusion criteria included patients with OSCC and cervical node metastasis. All subjects were treated between the years 2009 and 2017 in the Michigan Medicine Department of Oral and Maxillofacial Surgery (Ann Arbor, Michigan). The primary predictor variable was e-ENE, measured as the maximum distance of tumor invasion into extranodal tissue from the outer aspect of the nodal capsule. Primary outcome variables were OS and DFS. Other covariates included demographic data, tumor staging, and histopathologic data. Descriptive statistics were performed. Kaplan-Meier survival plots for OS and DFS were performed. The data were mined for an alternative threshold at which e-ENE may impact survival using Cox proportional hazards models. One hundred sixty eight subjects were included (91 ENE-negative, 48 minor ENE, and 29 major ENE). Most subjects were male (62%) and the mean age was 62.9years. Mean follow-up time was 2.97+/- 2.76years. There was no statistically significant difference in OS or DFS between minor and major ENE. Five-year OS for minor ENE was 30.4% versus 20.7% for major ENE (P=.28). Five-year DFS for minor ENE was 26.7% versus 18.1% for major ENE (P=.30). Five-year OS and DFS was worse for subjects with ENE-positive disease versus ENE-negative disease (OS: 26.9% vs 63.1%, hazard ratio [HR]: 2.70, 95% confidence interval [CI]: [1.77, 4.10], P<.001; DFS: 23.7% vs 59.7%, HR=2.55, 95% CI [1.71, 3.79], P<.001). At an alternative threshold of 0.9mm e-ENE, there was greater DFS in subjects with e-ENE 0.1-0.9mm versus e-ENE > 0.9 (40.6% vs 18.9%, respectively) (HR=0.49, 95% CI [0.24, 0.99], P=.047). There was no independent association between survival and e-ENE at a 2.0-mm threshold.

Efficacy of S-1 or Capecitabine Plus Oxaliplatin Adjuvant Chemotherapy for Stage II or III Gastric Cancer after Curative Gastrectomy: A Systematic Review and Meta-Analysis.

Simple SummaryAdjuvant chemotherapy regimens tegafur/gimeracil/oteracil (S-1) and capecitabine plus oxaliplatin (CAPOX) have predominated, owing to evidence of their remarkable oncologic outcomes, however, there has been a lack of studies on the difference in efficacy between the two regimens. We conducted pairwise meta-analyses comparing the efficacy of S-1 and CAPOX regimens for overall survival (OS) and disease-free survival (DFS) in stage II or III gastric cancer patients. In all stages (stages II and III), the five-year OS was not different between the two regimens (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.78–1.17; p = 0.56). Additionally, the five-year DFS was not different at any stage (HR 1.00, 95% CI 0.85–1.18; p = 0.21). The present meta-analysis showed that five-year OS and DFS for stage II or III gastric cancer patients were comparable between the S-1 and CAPOX adjuvant chemotherapy regimens.Background: Adjuvant chemotherapy (AC) regimens tegafur/gimeracil/oteracil (S-1) and capecitabine plus oxaliplatin (CAPOX) have predominated, however, there has been a lack of studies on their differences in efficacy. Methods: We conducted pairwise meta-analyses comparing the efficacy of S-1 and CAPOX regimens for overall survival (OS) and disease-free survival (DFS) in stage II or III GC patients. Results: Three studies were enrolled and analyzed using a forest plot for meta-analysis. Two of them were propensity score matching studies, and the remaining one was a retrospective observational study. In all stages, the five-year OS was not different between the two regimens (HR 0.96, 95% CI 0.78–1.17; p = 0.56). Additionally, the 5-year DFS was not different at any stage (HR 1.00, 95% CI 0.85–1.18; p = 0.21). After omitting the retrospective observational study, the five-year OS (HR 1.40, 95% CI 0.53–3.73) and DFS (HR 1.41, 95% CI 0.57–3.44) of S-1 tended to be better in stage II, and the five-year OS (HR 0.81, 95% CI 0.56–1.16) and DFS (HR 0.85, 95% CI 0.63–1.13) of CAPOX tended to be better in stage III, without statistical significance. Conclusions: In the present meta-analysis, the five-year OS and DFS for stage II or III GC patients were comparable between S-1 and CAPOX regimens as AC.

Influence of molecular genetic factors on the prognosis of localized and locally advanced adrenocortical cancer in children

Materials and methods. The study included 18 samples of patients with ACC stages I–III who received treatment from 2003 to 2021. Samples from 6 (33 %) patients with stage I, 5 (28 %) patients with stage II, and 7 (39 %) patients with stage III ACC were analyzed. The average age of patients is 61.6 (12–216) months. Four subgroups of patients were identified: with an isolated mutation in the TP-53 gene, with an isolated mutation in the IGF-2 gene, with simultaneous mutations in the TP-53 and IGF-2 genes and no mutations in the studied genes.Results. In 12 out of 18 (67 %) of the studied samples, mutations in the TP-53 and IGF-2 genes and their combination were detected. A mutation in the TP-53 gene was present in 8 patients, in the IGF-2 gene in 8 patients, and a combination of TP-53 + IGF-2 in 4 patients. The five-year OS and DFS in the groups of patients with mutations in TP-53 and/or IGF-2 were 45.5 % and 41.6 % versus 83.3 % and 83.3 % in the group without mutations (p = 0.15 and p = 0.18, respectively). The five-year overall (OS) and disease-free (DFS) survival in the TP-53 group compared with the group without the mutation was 50 % and 50 % versus 62.2 % and 66.7 % (p = 0.6 and p = 0.5, respectively). The five-year OS and DFS in the IGF-2 group compared with the group without mutation was 14.3 % and 0 % versus 90 % and 90 % (p = 0.001 and p = 0.0009, respectively). The five-year OS and DFS in the group in which the combination of mutations in the TP-53 + IGF-2 genes was present compared with patients without the combination of these mutations was 0 % vs. 75.2 % and 76.9 % (p = 0.002 and p = 0.003, respectively).Conclusion. The presence of a mutated IGF-2 gene is combined with a high Ki-67 index and is a factor in poor prognosis in children with localized forms of ACC. The simultaneous presence of mutations in the TP-53 and IGF-2 genes in the tumor also significantly negatively affects survival rates. Further prospective studies are needed to confirm the data and develop tactics for this group of patients.

Prognostic capacity of the transcriptional expression of lactate dehydrogenase A in patients with head and neck squamous cell carcinoma.

To analyze the relationship between the transcriptional expression of lactate dehydrogenase A (LDHA) and the disease control in patients with a head and squamous cell carcinoma (HNSCC). We determined the transcriptional expression of LDHA in 110 HNSCC patients treated with surgery. Five-year disease-free survival for patients with a high transcriptional expression of LDHA (n= 51) was 39.2% (95% confidence interval [CI]: 25.3%-53.1%), and for patients with a low expression (n= 59), it was 63.6% (95% CI: 51.1%-76.1%) (p= 0.004). According to the results of a multivariate analysis, patients with a high transcriptional expression of LDHA had a 3.4-fold increased risk of tumor recurrence. Patients with a high transcriptional expression of LDHA tended to show a higher intensity of immunohistochemical expression of LDHA at the tumor cells (p= 0.086). In HNSCC patients treated with surgery, a high transcriptional expression of LDHA was associated with a significant decrease in disease-free survival.

Liver Transplantation as a New Standard of Care in Patients With Perihilar Cholangiocarcinoma? Results From an International Benchmark Study.

To define benchmark values for liver transplantation (LT) in patients with perihilar cholangiocarcinoma (PHC) enabling unbiased comparisons. Transplantation for PHC is used with reluctance in many centers and even contraindicated in several countries. Although benchmark values for LT are available, there is a lack of specific data on LT performed for PHC. PHC patients considered for LT after Mayo-like protocol were analyzed in 17 reference centers in 2 continents over the recent 5-year period (2014-2018). The minimum follow-up was 1 year. Benchmark patients were defined as operated at high-volume centers (≥50 overall LT/year) after neoadjuvant chemoradiotherapy, with a tumor diameter <3cm, negative lymph nodes, and with the absence of relevant comorbidities. Benchmark cutoff values were derived from the 75th to 25th percentiles of the median values of all benchmark centers. One hundred thirty-four consecutive patients underwent LT after completion of the neoadjuvant treatment. Of those, 89.6% qualified as benchmark cases. Benchmark cutoffs were 90-day mortality ≤5.2%; comprehensive complication index at 1 year of ≤33.7; grade ≥3 complication rates ≤66.7%. These values were better than benchmark values for other indications of LT. Five-year disease-free survival was largely superior compared with a matched group of nodal negative patients undergoing curative liver resection (n=106) (62% vs 32%, P <0.001). This multicenter benchmark study demonstrates that LT offers excellent outcomes with superior oncological results in early stage PHC patients, even in candidates for surgery. This provocative observation should lead to a change in available therapeutic algorithms for PHC.

Validation of a Nomogram to Predict Recurrence in Patients with Mucinous Neoplasms of the Appendix with Peritoneal Dissemination After Cytoreductive Surgery and HIPEC.

Survival of patients affected by mucinous appendiceal neoplasms with peritoneal dissemination (PD) is mainly related to histopathological features. However, prognostic stratification is still a concern, as the clinical course of the disease is often unpredictable. The aim of this study is to construct and externally validate a nomogram predicting disease-free survival (DFS) in mucinous appendiceal neoplasms with PD treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Patients treated in two referral centers were included: Hospital General Universitario Gregorio Marañón, Madrid, Spain (derivation cohort) and Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (validation cohort). Cox regression analysis identified factors associated with shorter DFS in the derivation cohort. The nomogram performance was externally evaluated in the validation cohort using concordance index and calibration plots. Histology was classified according to the Peritoneal Surface Oncology Group International (PSOGI). The derivation cohort included 95 patients, and the validation cohort 348. Five-year DFS rates were 51.5 and 62%, respectively. Cox regression analysis (derivation cohort) identified PSOGI histology of the peritoneal components, number of preoperative elevated tumor marker, and peritoneal disease extent, as assessed by peritoneal carcinomatosis index, to be predictors of DFS. The model's predictive capacity was higher than that of PSOGI classification alone, with respective concordance indexes of 0.702 ± 0.023 and 0.610 ± 0.018 (validation cohort). The nomogram approximated the perfect model in the calibration plots at 3- and 5-year DFS. An easy-to-use model that provides better prognostic stratification than histopathological features has been constructed. This nomogram may help clinicians in individualized survival predictions and informed clinical decision-making.

Outcomes of Papillary Thyroid Microcarcinoma Presenting with Palpable Lateral Lymphadenopathy.

Purpose: Papillary thyroid microcarcinoma (PTMC) is typically indolent in nature, allowing management with active surveillance protocols. Occasionally, a more aggressive phenotype can present and may lead to poor outcomes such as patients presenting with clinically significant lateral lymphadenopathy (cN1b). Prior analysis of the outcomes of this cohort is largely from papillary thyroid cancer (PTC) (>1 cm) or from institutions where use of radioactive iodine (RAI) is limited. Hence, we aim to describe the outcomes of patients with PTMC who presented with palpable cN1b disease, treated with total thyroidectomy and RAI. Methodology: We performed a retrospective cohort study. Outcomes of patients with PTMC who presented with palpable lateral lymph node (LN) metastases (microPTC cN1b) treated between 1997 and 2020 at Royal North Shore Hospital were compared with two control groups' outcomes: patients with clinically detected PTMC without evidence of involved LNs (microPTC cN0) and with larger PTC (>10 mm) who presented with palpable lateral lymphadenopathy (larger PTC cN1b). We assessed clinicopathological variables, postoperative risk stratification, rates of disease recurrence, reoperative surgery, and structural disease-free survival (DFS). Results: In total, 1534 PTMCs were diagnosed following thyroid surgery in the study period; of these, 157 (10%) were clinically detected microPTC cN0 and 26 microPTC cN1b (1.7%). There were 138 patients in the larger PTC cN1b control group. All cN1b patients were treated with total thyroidectomy and adjuvant RAI. Mean size of the largest LN deposit was similar between the microPTC cN1b and larger PTC cN1b groups (23 vs. 27 mm, p = 0.11). Patients with microPTC cN1b were more likely to have biochemical or structural persistence or recurrence compared with microPTC cN0 (19%, 5/26 vs. 3.8%, 6/157, p = 0.002) but less likely than larger PTC cN1b patients (19%, 5/26 vs. 42%, 58/138, p = 0.04). All patients in the microPTC cN1b group who had an excellent response to initial therapy (85%, 22/26) were disease free at last follow-up. The rate of reoperation was similar for the microPTC cN1b and microPTC cN0 groups (4%, 1/26 vs. 2%, 3/157, p = 0.461) and significantly lower than the larger PTC cN1b group (4%, 1/26 vs. 26%, 36/138, p = 0.002). Five-year DFS estimates were significantly better for microPTC cN1b patients than for larger PTC cN1b patients (94% vs. 59%, p = 0.001). Conclusions: MicroPTC cN1b patients treated with thyroidectomy and adjuvant RAI have inferior clinical outcomes compared with microPTC cN0 patients but have better outcomes than their larger PTC cN1b counterparts with respect to disease persistence and recurrence. Response to initial therapy provides valuable prognostication in microPTC cN1b patients: if these patients had an excellent response to initial treatment, they achieved long-term DFS in this series.

JMJD3 suppresses tumor progression in oral tongue squamous cell carcinoma patients receiving surgical resection.

BackgroundJumonji domain-containing-3 (JMJD3) is reported to be a histone H3 lysine 27 (H3K27) demethylase and a tumor suppressor gene. The present study designed to investigate the crucial role of JMJD3 in oral tongue squamous cell carcinoma (OTSCC) patients who received surgical resection.MethodsWe enrolled a total of 156 OTSCC patients receiving surgical resection, including 73 patients (47%) with high expression of JMJD3 and 83 patients (53%) harboring low expression of JMJD3. Two OTSCC cell lines, SAS and Cal 27, were used to explore the modulation of cancer. GSK-J4, a potent inhibitor of JMJD3, was used to treat the two OTSCC cell lines. The Chi-square test was performed to examine between-group differences in categorical variables; the Kaplan–Meier method was used to investigate survival outcome in univariate analysis, and the Cox regression model was used for multivariate analysis.ResultsThe median follow-up period was 59.2 months and he five-year disease-free survival (DFS) and overall survival (OS) rates were 46.2% and 50.0%, respectively. Better five-year DFS (59% versus 35%) and five-year OS (63% versus 39%) were mentioned in patients with high expression of JMJD3 compared to those with low expression of JMJD3. High expression of JMJD3 was significantly associated with superior DFS and OS in the univariate and multivariate analyses. Following successful inhibition of JMJD3 by GSK-J4, western blotting analysis showed the decreased expression of Rb and p21.ConclusionOur study showed that high expression of JMJD3 is a good prognostic factor in OTSCC patients who underwent surgical resection.

Intraoperative calculus or hemorrhage in transurethral seminal vesiculoscopy as a risk factor for recurrent hemospermia

We have summarized our experience regarding transurethral seminal vesiculoscopy (TUSV) and analyzed both its recurrence status and the risk factors for recurrence. From January 2010 to December 2020, 48 patients with intractable hemospermia received successful TUSV at Taichung Invalids General Hospital. Upon analysis of the intraoperative findings, the five-year disease-free Survival rates (DFS) were 74.1% in the no calculus group compared to 37.1% in the calculus group with a significant difference (log-rank p = 0.015), 75.0% in the no hemorrhage or no blood clot group compared to 43.2% in the hemorrhage or blood clot group with significant difference (log-rank p = 0.032). Univariate analysis showed intraoperative calculus (p = 0.040; HR: 2.94, 95% CI: 1.05-8.21) to be significantly associated with recurrence (p < 0.05). Patients with intractable hemospermia who were diagnosed with stones or blood clots found during TUSV experienced a higher rate of hemospermia recurrence.

Outcomes of Patients with Stage I Germ Cell Tumour; Adjuvant Chemotherapy vs Surveillance; A Single Institutional Experience

Objective: To determine five-year survival and stratify risk factors for disease relapse in the clinical stage I germ cell tumour post orchiectomy.&#x0D; Study Design: Retrospective longitudinal study.&#x0D; Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore Pakistan, from 2008 to 2013.&#x0D; Methodology: We analyzed overall survival and disease-free survival in patients with stage 1 Germ cell tumours who either received chemotherapy or were kept on active surveillance after higher orchiectomy. In addition, risk factor stratification for recurrence was determined using the clinical, radiological and histopathological parameters.&#x0D; Results: Of 88 patients, 51 (58%) received chemotherapy, while 37 (42%) patients were kept on surveillance post orchiectomy for stage I germ cell tumours, including seminoma and non-seminoma histologies. Five-year overall survival and disease-free survivals were 99% and 92%, respectively, for all patients with stage 1 Germ cell tumours. Subgroup analysis showed that DFS was better in the adjuvant chemotherapy arm than the surveillance arm in both subtype histologies; however, five-year overall survival was comparable. Lymph vascular invasion and tumour size (T) was identified as risk factor for disease relapse.&#x0D; Conclusion: This institutional report suggests that while identifying risk factors, active surveillance post orchiectomy can be an effective treatment option for clinical stage I germ cell tumours and is comparable with adjuvant chemotherapy. Two important factors determining survival in our study were Lymph vascular invasion and T staging.

Prognostic values of clinical and molecular features in HER2 low-breast cancer with hormonal receptor overexpression: features of HER2-low breast cancer

BackgroundHuman epidermal growth factor receptor 2 (HER2) low breast cancer was considered as a distinct subtype different from HER2-zero breast cancer. Our study aimed to investigate the prognostic values of clinicopathological features and recurrence score (RS) in HER2-low and HER2-zero hormone receptor (HR)-positive breast cancer patients.MethodsA total of 2099 HR + primary female breast cancer patients diagnosed between Jan 2009 and Jan 2019 were collected. Tumors with immunohistochemistry 1 + /2 + and negative in situ hybridization results were defined as HER2-low. We compared the clinical and genetical features of HER2-low (n = 1732) and HER2-zero (n = 367) breast cancer and their prognostic values.ResultsEstrogen receptor (ER) high expression (> 90%) was more common in HER2-low breast cancer than HER2-zero breast cancer (78.2% vs 58.6%, p < 0.01). Five-year disease-free survival (DFS) was similar between HER2-zero and HER2-low subgroups (92.3% vs 93.3%, p = 0.83). The predictive value of RS was only significant in HER2-zero patients (p = 0.03). The proliferation-related genes performed well in predicting DFS in HER2-zero patients, but not in HER2-low patients (p for interaction < 0.01). The higher HER2 module score was correlated with worse DFS only in HER2-low patients (p = 0.04).ConclusionWe observed similar survival outcomes between HER2-low and HER2-zero HR + patients. HER2-low patients had a higher proportion of ER high expressed tumors than HER2-zero patients did. RS and its proliferation module might be less clinically meaningful to HER2-low patients.

Laparoscopic and Laparotomic Restaging in Patients With Apparent Stage I Epithelial Ovarian Cancer: A Comparison of Surgical and Oncological Outcomes.

ObjectiveTo assess the surgical and oncological outcomes of laparoscopic restaging compared with laparotomy for apparent early-stage epithelial ovarian cancer.MethodsA retrospective chart review was undertaken of patients who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) restaging at the Peking Union Medical College Hospital, China, between January 2012 and December 2017. All patients had apparent stage I epithelial ovarian cancer that was incompletely staged at the initial surgery.ResultsA total of 157 patients were included, with 50 in the laparoscopy group and 107 in the laparotomy group. Baseline characteristics were similar between the groups. No cases were converted from laparoscopy to laparotomy. The laparoscopy group had a significantly shorter operating time (p<0.001), less estimated blood loss (p<0.001), and a shorter postoperative hospitalization duration (p<0.001) than the laparotomy group. Transfusions were required in only eight laparotomy patients. No significant differences in postoperative complications were observed between the two groups (p=0.55). Eighteen (11.5%) patients were upstaged to stage II or stage III after surgery. A total of 123 (78.3%) patients received postoperative platinum-based chemotherapy. During the follow-up period, 15 (9.6%) patients experienced disease recurrence, and 3 patients died of disease progression. Five-year disease-free survival (p = 0.242, log-rank test) and overall survival (p = 0.236, log-rank test) were not affected by the surgical approach.ConclusionsLaparoscopic restaging showed more favorable operative outcomes than laparotomy. Surgical restaging via laparoscopy versus laparotomy was not associated with worse survival in women with apparent stage I epithelial ovarian cancer.