Frequent Site Of Recurrence Research Articles

Use of semiquantitative analysis in local recurrence of colorectal carcinoma with 18F-FDG PET/CT: A myth or a truth?

ObjectiveRecurrence of colorectal cancer is mostly seen within the first 2 years after surgery. The most frequent site of recurrence is the postsurgical areas and its surroundings. The purpose of this study was to evaluate the usefulness of semiquantitative analysis of 18Fluorine fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in determining recurrence of colorectal carcinoma in the operation site. Materials and methodsFiles of 35 patients with colorectal carcinoma (25 men, 10 women, mean age: 59.25±2.82 years, range: 27–80 years) who were treated with surgery and underwent FDG PET/CT scanning for restaging of colorectal carcinoma and showing increased FDG uptake in the postsurgical area, were retrospectively analysed. Besides calculating SUVmax of the areas showing FDG uptake, SUVmax of physiological colonic activity was also obtained and SUVmax of lesion/SUVmax of colonic wall (RSUVmax), was calculated. Characteristics of FDG uptake were classified according to histological analysis or clinical and imaging follow-up. ResultsIn 17 of 35 patients (49%) the standard of reference for the final diagnosis was histologic analysis and in 18 (51%), final diagnosis was based on imaging and clinical follow-up. In 15 of 35 patients (43%) the etiology of increased FDG uptake was recurrence and in 20 (57%), FDG accumulation was observed due to benign etiology. The difference between the mean of the results of SUVmax in patients with recurrent disease and with no evidence of recurrence was statistically significant (p=0.030). For SUVmax, a cut-off value for recurrence was calculated as 9.51 with a sensitivity of 80% and a specificity of 70%. In terms of RSUVmax results, a statistically significant difference was also observed between mean values in patients with recurrent disease and in those without (p=0.002). ROC analysis demonstrated that the best predictive value of RSUVmax for recurrence was 1.75 with a sensitivity of 67% and specificity of 95%. ConclusionsSemiquantitative analysis of FDG PET/CT may be used in detecting recurrent disease of patients with colorectal carcinoma. Eliminating interfering physiological colonic activity in analysis may have an incremental effect on the success of this technique, by means of increasing the specificity.

Abstract 5011: Tumor associated macrophages promote malignant phenotypes of disseminated human gastric cancer cells in intraperitoneal cancer immune microenvironment

Abstract Gastric cancer is the third leading cause of cancer-related death, and peritoneal dissemination is one of the most frequent site of recurrence. Although the role of tumor microenvironment is recognized, it is still unclear how intraperitoneal cancer-immune microenvironment contributes to peritoneal metastasis. Thus, we investigated the interaction between intraperitoneal cancer and immune cells, especially focusing on tumor-associated macrophages (TAM) in the peritoneal cavity. The peritoneal wash from gastric cancer patients was subjected to conventional cytology, flow cytometry, and immuno-fluorescent assay using antibodies against CD45 (leukocytes), CD14 (monocytes), CD80/163 (M1/M2 macrophages, respectively), in combination with genetically engineered cancer-imaging viral agent ‘TelomeScan’ which specifically expresses GFP in telomerase-positive cells. In cytology-positive samples, CD163-positive macrophages could be detected in approximately 70% of intraperitoneal macrophages with TelomeScan-positive cancer cells, while cytology negative samples contained few CD163-positive macrophages. In addition, peripheral blood mononuclear cells (PBMCs) from healthy volunteers were induced to differentiate into CD163-positive M2 macrophages (TAM-like macrophages), and co-cultured with gastric cancer cells to examine the effect on their malignant phenotype such as migration and invasion. We found that PBMCs-derived CD163-positive M2 macrophages significantly potentiated the ability of migration and invasion in gastric cancer cells. In case of existence of free cancer cells in peritoneal cavity, intraperitoneal macrophages appeared to differentiate into TAM and they potentially accelerate malignant phenotypes of gastric cancer cells. These results suggested that intraperitoneal cancer-immune microenvironment may play an important role to promote peritoneal disseminations in gastric cancer. Citation Format: Shuichi Sakamoto, Shunsuke Kagawa, Kazuya Kuwada, Atene Ito, Tetsuya Kagawa, Satoru Kikuchi, Shinji Kuroda, Ryuichi Yoshida, Hiroshi Tazawa, Toshiyoshi Fujiwara. Tumor associated macrophages promote malignant phenotypes of disseminated human gastric cancer cells in intraperitoneal cancer immune microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5011. doi:10.1158/1538-7445.AM2017-5011

Video-Assisted Thoracic Surgery Thymectomy Versus Sternotomy Thymectomy in Patients With Thymoma

This study was designed to evaluate the feasibility of video-assisted thoracoscopic surgery (VATS) and to compare the oncologic outcomes of VATS with those of sternotomy in patients with thymoma. The clinical outcomes of 2,835 patients with thymic epithelial tumors treated between 1991 and 2010 in 32 Japanese institutions were collected retrospectively. The study compared postoperative complications, positive surgical margins, location of recurrence, and survival in 140 of 142 VATS-treated patients (VATS group) matched with 140 of 1,294 sternotomy-treated patients (ST group) by using propensity scores. Postoperative complications were observed in 8 patients in the VATS group. The morbidity rate in the VATS group was not different from that of the ST group (p= 0.25). Positive surgical margins were noted in 4 patients (3 in the VATS group; 1 in the ST group). There was no statistically significant difference in the recurrence rate between groups (median follow-up period: 3.7 years in the VATS group; 5.2 years in the ST group). In total the most frequent site of recurrence was pleural dissemination. In the VATS group, the 5-year recurrence-free survival rate was 93.8%, and the 5-year overall survival rate was 97.9%. There was no difference in the recurrence-free survival and overall survival rates between the VATS group and the ST group (p= 0.91 and p= 0.74, respectively). VATS thymectomy was feasible and comparable to sternotomy for the treatment of patients with thymoma with regard to morbidity, incomplete resection rate, and prognosis. However, additional follow-up is required to evaluate long-term outcomes.

The Effectiveness of Prophylactic Modified Neck Dissection for Reducing the Development of Lymph Node Recurrence of Papillary Thyroid Carcinoma

AimThe most frequent recurrence site of papillary thyroid carcinoma (PTC) is the cervical lymph nodes. The introduction of an electric linear probe for use with ultrasonography in 1996 improved preoperative lateral neck evaluations. Before 2006, however, our hospital routinely performed prophylactic modified neck dissection (p-MND) for N0 or N1a PTCs >1 cm to prevent node recurrence. In 2006, we changed our policy and the indications for p-MND to PTCs >3 cm and/or with significant extrathyroid extension. Here, we retrospectively compared lymph node recurrence-free survival between PTCs with/without p-MND.MethodsWe examined the cases of N0 or N1 and M0 PTC patients who underwent initial surgery in 1992–2012. To compare lymph node recurrence-free survival between patients who did/did not undergo p-MND, we divided these patients into three groups (excluding those whose surgery was in 2006): the 2045 patients whose surgery was performed in 1992–1996 (Group 1), the 2989 with surgery between 1997 (post-introduction of ultrasound electric linear probes) and 2005 (Group 2), and the 5332 operated on in 2007–2012 (Group 3).ResultsThe p-MND performance rate of Group 3 (9%) was much lower than that of Group 1 (80%), but the lymph node recurrence-free survival of the former was significantly better, probably due to differences in clinical features and neck evaluations by ultrasound between the two groups. Our analysis of the patients aged <75 years with 1.1–4-cm PTCs in Groups 2 and 3 showed that p-MND did not improve lymph node recurrence-free survival. p-MND did significantly improve lymph node recurrence-free survival for the extrathyroid extension-positive 3.1–4-cm PTCs, but not for the other subsets.ConclusionsAbolishing routine p-MND for PTCs in 2006 did not decrease lymph node recurrence-free survival, probably due to improved ultrasound preoperative neck evaluations and clinical feature changes. Selective p-MND for high-risk cases improved lymph node recurrence-free survival.

Clinical Pattern of Recurrent Disease during the Follow-Up of Rectal Carcinoma

Background/Aims: Several initiatives have started to transfer colorectal cancer follow-up (FU) from secondary to primary care. For this purpose, it is important to assess when and how recurrences of rectal carcinoma are detected after treatment with curative intent. Methods: Retrospective multicentre cohort study. Patients participating in an FU programme after curative intended treatment for rectal cancer stages I-III between 2007 and 2014. Results: Of the 378 patients, 64 (17%) developed recurrent disease (RD). Most were detected during scheduled FU consultations (n = 55) by (a combination of) radiological examinations and carcinoembryonic antigen levels, and were asymptomatic (n = 53); outside scheduled FU consultations, RD was detected during the treatment of postoperative complications or ostomy reversal (n = 5), or due to symptoms (n = 4). Most frequent sites of recurrence were liver (50%), lung (44%), multiple (22%) or locoregional (16%). Treatment of RD with curative intent was performed more frequently when detected during scheduled FU (60 vs. 22%). The only predictive factor for developing RD was stage III disease on initial presentation. Conclusions: The majority of rectal cancer patients are diagnosed with RD at an asymptomatic stage during scheduled FU consultations. Only a few patients presented with RD outside the FU programme. Arguably, general practitioners could order these same diagnostic tests during FU.

The role of para-aortic lymphadenectomy in stage IIIC endometrial cancer: A single-institute study

The therapeutic value of para-aortic lymphadenectomy (PAL) in women with endometrial cancer (EC) remains uncertain. We retrospectively analysed 25 patients with stage IIIc EC (17 stage IIIC1; 8 IIIC2) who were treated in our institution. All subjects had undergone pelvic lymphadenectomies in which para-aortic nodes were sampled, or removed only when these nodes were enlarged. Sampling of para-aortic nodes or PAL was performed in all patients with stage IIIC2 disease and one of 17 with stage IIIC1 disease. Para-aortic lymph nodes were the most frequent site of recurrence in stage IIIC1 patients, but no such recurrences occurred in stage IIIC2 patients. Overall survival tended to be shorter in stage IIIC1 patients than stage IIIC2 patients. Our findings indicate that PAL improves the outcomes of patients with EC and high risk of para-aortic lymph node metastasis, such as those with positive pelvic lymph nodes or enlargement of para-aortic lymph nodes.Impact statementPara-aortic lymph node (PALN) metastases are important prognostic factors in endometrial cancer.Overall survival of patients with stage IIIC1 disease is generally longer than for those with stage IIIC2 disease.Retrospective studies – but no prospective studies – have suggested that para-aortic lymphadenectomy (PAL) provides a survival benefit.In our institution, we had performed PAL or para-aortic sampling for patients with enlarged PALNs; therefore, as most IIIC1 patients had no enlarged PALNs, they underwent pelvic lymphadenectomy only, whereas all IIIC2 patients had enlarged PALNs and underwent pelvic lymphadenectomy and PAL or PALN sampling in addition to pelvic lymphadenectomy. However, under this policy, survival of stage IIIC1 patients was not better than for stage IIIC2 patients. Our retrospective study indicates a survival benefit for PAL in patients with pelvic node-positive or enlarged PALN. PAL warrants a prospective randomised trial to see whether it should be a standard treatment in these patients.

Current Status of Uterine Leiomyosarcoma in the Tohoku Region: Results of the Tohoku Translational Center Development Network Survey.

To prepare for a future clinical trial for improving the long-term prognosis of patients with uterine leiomyosarcoma (ULMS), we conducted a multi-institutional survey in the Tohoku region of Japan. We conducted a retrospective cohort study between 2011 and 2014 in member institutions of the Tohoku Translational Research Center Development Network. A total of 53 patients with ULMS were registered in 31 institutions for the present survey. The median patient age was 56years, 67.9% of the patients were postmenopausal, 88.7% had a performance status of 0 or 1, and only 6 patients (11.3%) showed preoperative evidence of malignancy. Although retroperitoneal lymphadenectomy was performed in only 26.4% of patients, 64.2% patients were identified as having FIGO stage 1 disease; 73.6% were eligible to undergo complete surgery. Among 36 patients who were treated with postoperative chemotherapy, 28 (77.8%) received docetaxel and gemcitabine combination therapy. The most frequent recurrence site was the lungs, and the median progression-free survival of all enrolled patients was 11.7months. However, the median progression-free survival and the median overall survival in patients with stages III and IV disease were 3.4 and 11.4months, respectively. Although ULMS was associated with a high rate of complete or optimal surgery, the long-term prognosis was poor. Effective postoperative therapy should be developed to improve the long-term prognosis of patients with ULMS.

Prognostic Factors after Curative Resection for Single-Lesion Hepatocellular Carcinoma in Patients with Normal Liver Function: A Historical Cohort Study

Background: Hepatic resection for hepatocellular carcinoma (HCC) is now established as the treatment most likely to yield the best outcome. We aimed to clarify the risk factors for HCC recurrence after curative resection of single HCC in patients with normal liver function (NLF). Methods: The clinical records of 105 patients with NFL and a single HCC less than 5 cm in diameter who had undergone curative liver resection between April 2000 and January 2013 were investigated. We analyzed risk factors for recurrence of HCC. Results: Forty of the 105 patients suffered recurrence of HCC, and median recurrence-free survival (RFS) was 22.0 (5.1-148.5) months after surgery, and the liver was the most frequent site of recurrence. Univariate analysis showed that limited resection (LR; p = 0.002), the indocyanine green retention rate at 15 min (p = 0.023), C-reactive protein value (p = 0.001), bilirubin value (p = 0.042), neutrophil to lymphocyte ratio (p = 0.042), operation time (p = 0.018), and amount of bleeding (p = 0.011) were associated with RFS. Multivariate analysis showed that LR (p = 0.007) was a significant risk factor associated with RFS. Conclusion: LR is a risk factor for HCC recurrence in patients with single-lesion HCC and NLF.

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas.

Background:Juvenile nasal angiofibromas (JNA) is a benign lesion with high vascularity and propensity of bone erosion leading to skull base invasion and intracranial extension. It is known to involve multiple compartments, which are often surgically difficult to access. With evolution in surgical expertise and technical innovations, endoscopic and endoscopic-assisted management has become the preferred choice of surgical management. Over the last four decades, various staging systems have been proposed, which are largely based on the extent of nasal angiofibroma. However, no clear guidelines exist for the stage-appropriate surgical management. In this study, we aim to formulate a novel staging system based on the analysis of high quality preoperative imaging and propose detailed surgical guidelines related to disease stages as observed in 242 primary cases of JNA.Methods:A retrospective analysis of the case records of 242 primary JNA cases was performed at our center. Patients were staged according to various existing staging systems as well as our own new staging system, and outcome variables were compared with respect to intraoperative blood loss, multiple staged operations, and tumor recurrences. Operative records were studied and precise endoscopic surgical guidelines were formulated for each stage.Results:Comparing the intraoperative blood loss seen in stages of various classifications, it was found that intraoperative blood loss correlated best and statistically significantly with stages in the newly proposed Janakiram staging system when compared to the existing staging systems. Staged operations were performed in a total of 7/242 patients, and there was a significant association between the requirement of a staged operation and tumor extent (Fischer's exact test, P < 0.001). Tumor recurrence was seen in 22 cases and the pterygoid wedge was found to be the most frequent site of recurrence initially. As the extent of resection improved with better surgical technique over time, recurrences were only found in superior orbital fissure, around the internal carotid artery, and in the middle cranial fossa.Conclusion:This new Janakiram staging system is based on preoperative imaging data from one of the largest JNA case series reported thus far. Respective guidelines reliably stratify patients into treatment groups with definite surgical approaches and predicts outcome. Improved surgical approaches in the modern endoscopic era have redefined JNA management with improved outcome. This study shows the importance of precise presurgical imaging and the choice of the most suitable surgical approach in reducing morbidity and mortality in JNA surgery.

Adjuvant intraperitoneal chemotherapy for the treatment of gastric cancer at risk for peritoneal carcinomatosis: A systematic review.

The peritoneal surface is a frequent site of recurrence following surgery for gastric cancer. A systematic review and random effect analysis was undertaken to analyze current literature regarding the role of adjuvant intraperitoneal chemotherapy in gastric cancer. While pooled analysis supports the use of adjuvant IP chemotherapy in resectable gastric cancer, maximal benefit occured with intra-operative delivery, and possibly the use of MMC. J. Surg. Oncol. 2017;115:192-201. © 2016 Wiley Periodicals, Inc.

Omental Biopsy for Surgical Staging of Uterine Serous Carcinoma.

The aims of this study were to determine the role of omental sampling in staging of uterine serous carcinoma (USC) and to evaluate its impact on patient outcomes. A retrospective study of 106 women with USC who underwent primary surgery between 2005 and 2014 was done. Overall survival, disease-free survival, and progression and recurrence patterns were studied in 84 patients with follow-up over 1 year. Diagnostic characteristics were evaluated for preoperative imaging and operative findings. Univariate and multivariate analyses were performed to evaluate risk factors for omental metastasis. Survival curves were used to compare omental sampling status and the presence of omental metastasis. Of the 106 patients, 66 underwent surgical staging with omental biopsy (54; 82%) or omentectomy (12, 18%). Eight (12%) patients had metastatic disease in the omental samplings. All 6 patients with macrometastasis had visible lesions or palpable nodules and preoperative computed tomography (CT) was suspicious in 3. In 2 (3%) patients, omentum was not suspicious on CT or intraoperatively but had micrometastases. The negative predictive value regarding the staging CT scan was 92% and of the operative findings was 97%. On multivariate analysis, no variable was associated with omental involvement. Disease progressed or recurred in 40 (48%) patients. The most frequent sites of recurrence or progression were the omentum (23; 27%), peritoneum (26; 31%), pelvis (15, 18%), lung (15, 18%), and liver (12, 14%). Comparing the groups with or without omental assessment, no significant difference was found regarding progression and recurrence patterns, overall survival, and disease-free survival. Omental involvement in USC upstages patients to stage IV disease and traditional risk factors fail to predict extrauterine disease. Although omental sampling does not influence disease progression or survival, a comprehensive intraoperative evaluation of the omentum is advised as most cases have grossly visible lesions.

The characteristics of the serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels in gastric cancer cases.

Although carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 are the most commonly used tumor markers in gastric cancer, the differences in the characteristics of these two markers remain unclear, because most previous studies have included many patients who were positive for both markers. We analyzed the available data on 1050 patients with gastric cancer who underwent R0 resection. The background characteristics and recurrence-free survivals (RFS) were compared between the single-positive patients for CEA or CA 19-9 and double-negative patients. Among these 1050 patients, 86 patients (8.2%) were positive for CEA only, 77 patients (7.3%) were positive for CA 19-9 only, and 867 patients (82.6%) were double negative for both markers. Patients who were elderly, male and had a differentiated histology were more commonly observed in the CEA-positive group than in the double-negative group (P=0.004, P=0.009, and P=0.001). The patients who were positive for either CEA or CA 19-9 had a significantly worse RFS than the patients who were negative for both (P<0.001 and P<0.001). The most frequent site of recurrence was the liver (9.3%) in the CEA-positive group and the peritoneum (11.7%) in the CA 19-9-positive group. Age, sex, and histological type were thus found to be associated with CEA positivity. CEA is, therefore, considered to be a sensitive marker for liver recurrence, while CA 19-9 is a sensitive marker for peritoneal recurrence.

Limited significance of curative surgery in Borrmann type IV gastric cancer.

Borrmann type IV advanced gastric cancer has a poor prognosis. Although surgical resection remains the only hope for a cure, the role of curative surgery is questionable in this type of cancer. This study defined the role of curative surgery in the prognosis of type IV gastric cancer. We analyzed 168 patients with Borrmann type IV undergoing surgery at Seoul St. Mary's Hospital from 1989 to 2010. We categorized the patients into curative (R0) and non-curative (R1, R2, and non-resection) groups. The curative and non-curative groups comprised 88 and 80 patients, respectively. The preoperative predictive value of Borrmann type IV was 50.5, and 8.9% of the patients had microscopic resection margin involvement. The 3- to 5-year overall survival (OS) of patients in the curative group was significantly higher than that of in the non-curative group (p<0.001). However, in a multivariate analysis, curability was not a significant predictor of survival (p=0.187). In the curative group, the most frequent recurrence site was the peritoneum (85.7%). Most recurrences occurred within 2years. The role of surgery for Borrmann type IV is quite limited. Such cases have a poor prognosis even after curative surgery. In addition, microscopic resection margin involvement is frequent in type IV cancer because it is difficult to diagnose preoperatively. Therefore, multimodal diagnostic tools and treatment strategies should be developed for Borrmann type IV gastric cancer.

Recurrence of Early Stage Cervical Cancer After Laparoscopic Versus Open Radical Surgery

The aim of the study was to compare site and time to recurrence in patients affected by early stage cervical cancer (CC) treated with laparoscopy radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH). This retrospective study was conducted in a university teaching, tertiary referral center hospital. We included patients undergoing either LRH or open ARH to treat CC. One hundred fifty patients were included, 82 submitted to LRH and 68 submitted to ARH. Baseline characteristics of the 2 groups were comparable, except for body mass index higher in ARH group. Patients undergoing LRH experienced less blood loss (100 vs 400 mL, P < 0.0001), less lymph nodes removed (20 vs 31, P = 0.001), and shorter recovery (4 vs 8 days, P = 0.0005) in comparison with the ARH group. No significant differences were found regarding recurrence rate (9 vs 13, P = 0.17) and time to recurrence (8 vs 17 months, P = 0.066) between LRH and ARH group.Sites of recurrence were also comparable between the 2 groups: 2/9 versus 2/13 (P = 1) local recurrence, 4/9 versus 8/13 (P = 0.66) pelvic recurrence, 4/9 versus 7/13 (P = 1) distant recurrence in LRH and ARH groups, respectively. The most frequent sites of recurrence were pelvic and distant (44.4%) in LRH group and pelvic (61.5%) in ARH group. Our data demonstrate that early stage CC can be treated with LRH with similar recurrence rates and patterns in comparison with ARH, reassuring its continuing clinical use.

Details of recurrence sites after definitive radiation therapy for cervical cancer.

ObjectiveThis is a retrospective study aimed at clarifying the details of recurrence patterns and sites in patients with cervical cancer treated with definitive radiation therapy (RT).MethodsData were analyzed from consecutive patients, admitted to the University of Tokyo Hospital (Tokyo, Japan) between 2001 and 2013, who had received definitive RT, with or without chemotherapy, for International Federation of Gynecology and Obstetrics stages IB–IVA cervical cancer.ResultsOne hundred and thirty-seven patients formed the patient cohort. The median follow-up period for surviving patients was 57.0 months. A complete response was achieved in 121 patients (88%). Of these, 36 (30%) developed a cancer recurrence during follow-up. The first sites of recurrence were located in intra-RT fields in nine, outside RT fields in 20, and both in seven patients. In the intra-RT field group, all patients showed a local recurrence, while no one experienced an isolated pelvic lymph node (PLN) recurrence. In the outside RT field group, the most frequent site of recurrence was lung (60%), and three-quarters of patients were free from intra-RT field recurrence until the last follow-up. Of the entire cohort, including 48 PLN-positive patients, only seven patients (5.1%) developed PLN persistence or recurrence, all in the common iliac, internal iliac, and/or obturator nodes, and all with another synchronous relapse.ConclusionLocal disease was a major type of intra-RT field recurrence, while PLN control was favorable even in initially PLN-positive patients. The predominance of outside RT field recurrence alone highlights issues concerning distant control, including the intensity enhancement of systematic therapy.

IJU this issue

Recurrence after radical nephrectomy for localized renal cancer could occur even after a very long latency, and the duration of follow up is a matter of interest. Antonelli et al. (Brescia, Italy) evaluated the features and the predictors of “very late” recurrences after surgery for localized renal cell carcinoma. The risk of a “very late” recurrence is approximately 5%, and depends on the pathological stage. Interestingly enough, the contralateral kidney was the most frequent site of recurrence in pT1 disease, but multiple sites were more frequently observed in pT3. The authors recommended a long follow-up schedule based on the initial pathological stage of primary tumor. Although ejaculatory dysfunction is a common adverse effect after benign prostatic hyperplasia surgery, no clear evidence is present to counsel men seeking to preserve ejaculation. Marra et al. (Turin, Italy) carried out a systematic review on ejaculatory dysfunction in relation to benign prostatic hyperplasia surgery. First of all, the definition of ejaculatory dysfunction is not standardized. Most of the studies reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery used poor methodology to investigate this complication. The authors mentioned the need for further study to formulate clear hypotheses with the aim to both reduce ejaculatory dysfunction and to safely address men seeking to preserve ejaculation in the choice of the most appropriate surgical strategy. Active surveillance (AS) is one of the major treatment options for low-risk prostate cancer, as AS could minimize overtreatment and impairment of quality of life in patients. Currently, several AS criteria are clinically used for predicting clinically insignificant prostate cancer. Yamada et al. (Chiba, Japan) evaluated the ability of contemporary AS protocols to predict pathologically insignificant prostate cancer among Asian men undergoing radical prostatectomy. Predictive rates for insignificant cancer in Asian men were lower than USA and Western European men. Because of the higher probability of containing significant cancer missed at biopsy, the authors suggested that AS should be carefully carried out considering the clinical characteristics of prostate cancers depending on ethnicity in Asian men. Recently, the application of low-intensity shock wave therapy (LI-SWT) has been introduced as a novel effective treatment for erectile dysfunction (ED). Hisasue et al. (Tokyo, Japan) reported the initial outcome of LI-SWT for ED in Japan, and the predictors for its generalized efficacy on ED. LI-SWT was a safe and effective treatment for ED. The authors reported the possible future indication of LI-SWT for ED patients including first-line therapy and salvage therapy for phosphodiesterase type-5 inhibitor refractory patients. None declared.

Clinicopathologic factors associated with recurrence in low- and high-grade parotid cancers.

The purpose of this study was to determine clinicopathological correlates of outcome among patients with parotid gland cancer. The medical records of 126 patients treated by surgery for localized parotid cancer were retrospectively reviewed to identify the clinicopathologic correlates of recurrence-free survival (RFS) according to histologic grade. Multivariate analysis revealed that age and lymphovascular invasion were significant factors for recurrence in patients with low-grade cancer (p = .049 and p = .019, respectively), whereas perineural invasion was the only significant factor in patients with high-grade cancer (p = .001). The most frequent recurrence site tends to be different according to histologic grade: local recurrence at low-grade cancer (8.3%) and distant at high-grade cancer (13.6%). The duration of RFS was significantly longer in low-grade cancer than high-grade cancer in regional and distant recurrence (p = .044 and p = .016, respectively). Consideration of different factors may be required for individual low-grade and high-grade parotid cancers when predicting the risk of recurrence. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1788-E1793, 2016.

Surgical Outcomes of Patients With Stage III Thymoma in the Japanese Nationwide Database

To investigate the clinical characteristics and therapeutic outcomes of patients who underwent surgery for stage III thymoma in Japan. Using the Japanese nationwide database, which contains the records of 2,835 patients with thymic epithelial tumors who underwent treatment between 1991 and 2010, we extracted and analyzed the records of those who underwent surgery for stage III thymoma. A total of 310 patients (170 males, 140 females; median age, 58 years) were analyzed. Involved sites were the lung in 194 (62.6%), the pericardium in 151 (48.7%), the great vessels in 126 (40.6%), the phrenic nerve in 84 (27.1%), and the chest wall in 7 (2.3%). Complete resection (R0) was achieved in 247 (79.7%) cases. Induction therapies were administered to 42 (13.5%) patients, and postoperative therapies were administered to 147 (47.4%). In R0 cases, 68 (27.5%) experienced recurrence. The pleural space was the most frequent site of recurrence (46; 18.6%). The 10-year overall and disease-free (in R0) survival rates were 80.2% and 51.6%, respectively. Multivariate analyses revealed that age (p= 0.002), male sex (p= 0.017), induction therapy (p < 0.001), and type B histology (p= 0.037) were independent adverse predictors for overall survival. Chest wall invasion was the only independent adverse predictor for disease-free survival, although the factor analysis was marginal for overall survival. The outcomes of surgery for patients with stage III thymoma were favorable unless chest wall invasion was present; however, the role of complete resection and appropriate multimodal treatment plan require further investigation.

Soft tissue metastasis in p16-positive oropharynx carcinoma: Prevalence and association with distant metastasis

Ungraded extracapsular spread (ECS) has been found non-prognostic in p16-positive, surgically-treated oropharynx squamous cell carcinoma (OPSCC). However, soft tissue metastasis (STM), the highest ECS grade, is reported prognostic. Our study's objective is to explore STM relative to distant metastasis (DM), the most frequent recurrence site in surgically-treated p16-positive OPSCC. Primary p16-positive OPSCC patients undergoing transoral surgery (TOS) and neck dissections were identified from a prospectively-assembled database. DM and regional recurrence (RR) rates, and DM-free survival (DMFS) were compared in pN+patients without STM (group I) and with STM (group II). Of 222 patients, 202 had pN+disease: 147 (73%) in group I and 55 (27%) in group II. The DM rate was 6.7% (n=15/222) overall. The DM rates were 4% (n=6/147) vs. 16.4% (n=9/55), RR rates were 2% (n=3) vs. 5% (n=3), and 5-year DMFS rates were 94.8% vs. 82.4%, in groups I and II respectively. STM was significantly associated with poorer DMFS (HR=4.6, 95% CI: 1.65, 13.03, p=0.004), an observation driven by its effect in the T3-T4 and not the T1-T2 subset. Amongst patients receiving adjuvant therapy, STM's association with poorer DMFS was lost in multivariable analysis; high T-classification, however, remained significant (HR=5.16, 95% CI: 1.43, 18.52, p=0.012). Five-year DMFS for STM patients was 82.2% in chemoradiation (37% T3-T4) vs. 85.6% in radiation (35% T3-T4) group. STM was significantly associated with DM and DMFS, but only in the T3-T4, not T1-T2 subset; no significant association was seen with RR. In patients receiving adjuvant therapy, only high T-classification was associated with DMFS, not STM. Chemoradiation used as adjuvant therapy was not associated with better DMFS in STM patients for any T-classification.

Para-aortic lymph node metastases in locally advanced cervical cancer: Comparison between surgical staging and imaging

ObjectiveCompare surgical staging with imaging (PET-CT, PET or CT) of the para-aortic lymph nodes (PAOLN) in locally advanced cervical cancer (LACC). MethodsMonocentric retrospective study of 336 patients with cervical cancer FIGO stage IB2-IVA. All patients underwent staging of the PAOLN using imaging by PET-CT, PET or CT. Two hundred and four patients with normal or not overtly malignant PAOLN on imaging underwent surgical PAOLN staging up to the inferior mesenteric artery (189 endoscopy and 15 laparotomy). ResultsThe patients were divided into 4 groups: 16 with positive surgical staging and negative PAOLN imaging (sPAOLN+), 172 negative surgical staging (sPAOLN−), 20 positive imaging without surgical staging (iPAOLN+) and 128 negative imaging without surgical staging (iPAOLN−). Median operative time of staging was 70 (40–160) min and median number of removed PAOLN was 5 (0–24). Operative complications were 10 peroperative bleedings, 2 ureteral traumas, 1 carbon dioxide retention and 1 retroperitoneal abscess. The median follow-up was 31 (1–218) months. Overall survival at 2years was for sPAOLN+, sPAOLN−, iPAOLN+, and iPAOLN− 40%, 83%, 58%, and 69%, respectively (p<0.001 for sPAOLN+ and iPAOLN+ versus sPAOLN− and iPAOLN−). The most frequent site of recurrence was distant LN metastases (outside the pelvic and PAO area) (36%) for sPAOLN+. For sPAOLN−, iPAOLN+, and iPAOLN− the most frequent site of recurrence was the cervix (27%, 66% and 26%, respectively). ConclusionDespite negative imaging, PAOLN metastases were present in 8% at surgical staging. Overall survival is significantly influenced by the presence of PAOLN metastases.