Five-year Disease-specific Survival For Patients Research Articles

Prognostic capacity of the weighted lymph node ratio in head and neck squamous cell carcinoma patients treated with salvage neck dissection.

The aim of the study was to assess the prognostic capacity of the recently described weighted lymph node ratio (WLNR) in patients with head and neck squamous cell carcinoma (HNSCC) who undergo salvage neck dissection for regional recurrence. We retrospectively studied 197 adult patients with head and neck squamous cell carcinoma treated with salvage neck dissection from 1990 to 2017. The mean value for the WLNR for all patients was 26.2%. We established a classification based on the WLNR values taking 10.8% as the cut-off point. Five-year disease-specific survival for patients with WLNR ≤ 10.8% (n = 89, 45.2%) was 39.9% (IC 95% 29.4-50.4%), and for patients with WLNR ≥ 10.8% (n = 108, 54.8%) it was 20.5% (IC 95% 12.3-28.7%) (p = 0.007). The multivariate analysis showed the WLNR had a significant prognostic capacity. As a variable that integrates data related to the number of metastatic nodes with extracapsular spread to the LNR, the WLNR has a prognostic value in the pathological assessment of HNSCC patients with regional recurrence treated with salvage neck dissection.

Salvage surgery in head and neck cancer: External validation of predictors of disease-specific survival.

Salvage surgery in recurrent head and neck squamous cell carcinoma (HNSCC) is associated with poor outcomes. There is great interest to better identify suitable surgical patients. This study aimed to validate the proposal of Hamoir et al. to use three items to predict the outcomes of salvage surgery. Single-center analysis of 577 patients undergoing salvage surgery for recurrent HNSCC during the period 1985-2016, with a minimal follow-up of 2 years. Patients were classified according to the prediction modeling proposed by Hamoir et al. This prediction modeling is based on three predictors: the tumor site (larynx vs non-larynx), initial staging (stage I-II vs stage III-IV), and site of recurrence (local or regional vs locoregional). Five-year disease-specific survival after salvage surgery was 54.0% (95% CI: 49.6-58.4%). Applying the prediction modeling tested, a total of 212 patients (36.7%) patients had no predictors of poor prognosis, 185 (32.1%) had one predictor, 146 (25.3%) two predictors, and 34 (5.9%) three predictors. Five-year disease-specific survival for patients with none, one, two and three predictors were 82.2%, 47.2%, 29.5% and 20.2% respectively (P = 0.0001). We have validated the prediction modeling based on the location of the tumor, initial staging and locoregional recurrence proposed by Hamoir et al. This prediction model is easy to apply and provides good information about the possibilities of success of salvage surgery.

Prognostic Significance of Extranodal Extension in Head and Neck Squamous Cell Carcinoma cN0 Patients With Occult Metastatic Neck Nodes

Introduction and objectivesExtranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease. Material and methodsWe retrospectively analysed data from 348 head and neck squamous cell carcinoma patients without any previous treatment and lacking clinical or radiological evidence of neck node metastases during the initial workup, treated with an elective neck dissection between 1992 and 2014. The incidence of occult metastatic neck nodes with extranodal extension and the impact of extranodal extension in survival were evaluated. ResultsThe proportion of patients with occult neck node metastases was 33%. Of these, 23.5% had at least one metastatic neck node with extranodal extension. There were significant differences in the disease-specific survival rate according to neck node status. Five-year disease-specific survival for patients without histopathological metastases was 90%, for patients with occult neck node metastases without extranodal extension it was 71.2%, and for patients with occult neck node metastases with extranodal extension it was 25.9% (P=.0001). The multivariate analysis revealed that the presence of occult node metastases with extranodal extension was the factor with strongest impact on survival. The inclusion of the extranodal extension as a criterion of histopathological evaluation in the 8th TNM classification edition improves the prognostic capacity compared to previous TNM editions. ConclusionsAppearance of metastatic neck nodes with extranodal extension is an adverse prognostic factor in head and neck squamous cell carcinoma patients without clinical evidence of regional disease during the initial workup of the tumour.

Significado pronóstico de la extensión extranodal en pacientes con carcinomas escamosos de cabeza y cuello cN0 con metástasis ganglionares ocultas

Introduction and objectivesExtranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease. Material and methodsWe retrospectively analysed data from 348 head and neck squamous cell carcinoma patients without any previous treatment and lacking clinical or radiological evidence of neck node metastases during the initial workup, treated with an elective neck dissection between 1992-2014. The incidence of occult metastatic neck nodes with extranodal extension and the impact of extranodal extension in survival were evaluated. ResultsThe proportion of patients with occult neck node metastases was 33%. Of these, 23.5% had at least one metastatic neck node with extranodal extension. There were significant differences in the disease-specific survival rate according to neck node status. Five-year disease-specific survival for patients without histopathological metastases was 90%, for patients with occult neck node metastases without extranodal extension it was 71.2%, and for patients with occult neck node metastases with extranodal extension it was 25.9% (P=.0001). The multivariate analysis revealed that the presence of occult node metastases with extranodal extension was the factor with strongest impact on survival. The inclusion of the extranodal extension as a criterion of histopathological evaluation in the 8th TNM classification edition improves the prognostic capacity compared to previous TNM editions. ConclusionsAppearance of metastatic neck nodes with extranodal extension is an adverse prognostic factor in head and neck squamous cell carcinoma patients without clinical evidence of regional disease during the initial workup of the tumour.

Identification of Patients with High-Risk Stage II Colon Cancer for Adjuvant Therapy

Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features. The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage II colon cancer to identify high-risk patients. We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to 2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative resection alone, without postoperative chemotherapy. With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1-6.2; P = 0.02), preoperative carcinoembryonic antigen > 5 ng/ml (HR, 2.1; 95 percent CI, 1.1-4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1-4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent; five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year disease-specific survival for patients with > or = 2 poor prognostic features was 57 percent. Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy and/or enrollment in investigational trials.

New evidence for geographic variation in the role of human papillomavirus in tonsillar carcinogenesis

Our previous studies of tonsillar cancers from New South Wales, Australia, and Jilin Province in the north-east of China, provided evidence that the proportion of these cancers attributable to human papillomavirus (HPV) varies geographically. This study provides the first data on HPV in tonsillar cancers from Hong Kong. A total of 49 Hong Kong tonsillar cancers were analysed for HPV DNA by PCR/sequencing and for p16(INK4A), retinoblastoma (pRb) protein, cyclin D1 and p53 expression by semiquantitative immunohistochemistry as evidence of virus causality. Results were compared with those from New South Wales and Jilin Province. Of the 31 Hong Kong cancers with amplifiable DNA, nine (29%) were HPV positive by PCR compared with 46% from New South Wales and 0% from Jilin Province. HPV positivity correlated with female gender, young age, over-expression of p16(INK4A) and loss of pRb and cyclin D1. Five-year disease-specific survival for patients with HPV positive and HPV negative cancers was 82 and 42%, respectively. Relationships between HPV status and cell protein expression in Hong Kong cancers were consistent with those from New South Wales and Jilin Province. The proportion of HPV-associated cancers reflected the relative incidence of oropharyngeal cancer in these regions. HPV is responsible for a small proportion of tonsillar cancers in Hong Kong patients. Differences in the proportions of tumours attributable to HPV in Hong Kong, New South Wales and Jilin Province may be due to environmental, cultural or genetic factors in the different populations.

Multimodal therapy including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) for stage IIB to IV cervical cancer

Objective: The purpose of this study was to determine the survival rates and toxicity levels that are associated with multimodal therapy (including neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin [MVAC]) in patients with stage IIB to IVB cervical cancer. Study Design: We retrospectively reviewed the cases of 49 patients who were treated between 1989 and 1997 with neoadjuvant MVAC for advanced cervical cancer. Results: The clinical response rate was 90% (27 partial responders, 17 complete responders). Grade 3 or greater toxicity was mostly limited to neutropenia; no deaths were attributed to MVAC. Combined therapy after MVAC included operation in 34 patients (69%) and radiation in 41 patients (84%). Twenty-one patients (43%) had <2 cm residual tumor at histologic evaluation. Pelvic control was achieved in 86% of patients. Five-year disease-specific survival for patients with stage III disease was 60%. Conclusion: For patients with advanced cervical cancer, neoadjuvant MVAC had a high response rate (90%) and an acceptable toxicity level. Compared with historic control subjects, multimodal treatment may be associated with improved rates of pelvic control. (Am J Obstet Gynecol 2002;186:1167-73.)