Independent Risk Factors For Recurrence Research Articles

Treatment of cytomegalovirus anterior segment infection with intravitreal injection of ganciclovir in adjunction with or without oral valganciclovir: a long-term results

We evaluated the therapeutic outcome of intravitreal injection (IVI) of ganciclovir with/without oral valganciclovir for cytomegalovirus (CMV) anterior segment infection. We enrolled 61 patients (61 eyes) with PCR-proven CMV anterior segment infection. IVI of ganciclovir (2 mg/0.05 mL) was given as a loading dose; subsequent use of oral valganciclovir (900 mg twice daily) was determined according to the severity of anterior chamber inflammation after injection. All eyes had IVI of ganciclovir, and 53 patients received oral valganciclovir as adjunctive therapy with a mean duration of 1.9 months to achieve disease remission. Repeated diagnostic aqueous taps were performed in 37 eyes with suspected recurrence, and CMV DNA was positive in 24 eyes. This therapeutic strategy afforded a median 50% recurrence-free survival time of 47.0 ± 8.12 months. The patients’ mean best corrected visual acuity, intraocular pressure and corneal endothelial cell counts stabilized or improved. Corneal transplantation before CMV infection diagnosis was identified as an independent risk factor for recurrence (hazard ratio 6.81, 95% confidence interval 1.21–38.23, P = 0.029). In patients with CMV anterior segment infection, the relative short-term therapeutic strategy, IVI of ganciclovir in adjunction with/without oral valganciclovir, effectively achieved a median recurrence-free survival time of nearly 4 years.

Irbesartan inhibits metastasis by interrupting the adherence of tumor cell to endothelial cell induced by angiotensin II in hepatocellular carcinoma.

BackgroundThe use of angiotensin II inhibitors is associated with a low risk of recurrence and metastasis in hepatocellular carcinoma (HCC) patients. Vascular cell adhesion molecule-1 (VCAM-1) is a key factor in tumor metastasis.MethodsThe effects of angiotensin II and irbesartan (an angiotensin II inhibitor) on HCC were explored with a xenograft model, microarray analysis and cell adhesion experiments. The relationship between the expression of VCAM-1 in HCC tissues and prognosis was analyzed with public and our institutional clinical databases. The effects of angiotensin II, irbesartan and VCAM-1 on adhesion and metastasis in HCC were explored with a xenograft model and cell adhesion experiments. The regulatory mechanisms were analyzed by Western blot analysis.ResultsAngiotensin II type 1 receptor and VCAM-1 were expressed in HCC tissues. Irbesartan inhibited HCC growth and metastasis in vivo and weakened the adhesion of HCC cells to endothelial cells, an effect that was enhanced by angiotensin II. VCAM-1 was found to be an independent risk factor for recurrence and survival in HCC patients with microvascular invasion. Angiotensin II upregulated VCAM-1 expression, and this upregulation was inhibited by irbesartan. Angiotensin II enhanced adhesion mainly by promoting the expression of VCAM-1 in HCC cells. Irbesartan inhibited the expression of VCAM-1 by reducing p38/MAPK phosphorylation activated by angiotensin II in HCC cells.ConclusionsIrbesartan attenuates metastasis by inhibiting angiotensin II-activated VCAM-1 via the p38/MAPK pathway in HCC.

A Multicenter Analysis of Wide Excision and Reconstruction for Severe Anogenital Hidradenitis Suppurativa.

An appropriate reconstruction strategy after wide excision for severe cases of anogenital hidradenitis suppurativa (aHS) is important to optimize outcomes, but there is no consensus on which reconstruction strategy should be preferred. Evaluate which reconstruction strategy after wide excision in patients with severe aHS is associated with the best outcomes in terms of recurrence rate, complications and patient-reported outcomes on range of motion, pain, appearance, sexual health and satisfaction. Multicenter retrospective analysis between 2009 and 2019 of wide excision and reconstruction by primary closure, secondary intention healing, split-thickness skin grafts or fasciocutaneous flaps (FCF). The recurrence rate was the primary endpoint of multivariable logistic regressions to determine variables with an independent effect on recurrence. A total of 93 patients were included. The overall recurrence rate was 62% after a median follow-up of 43 months, without statistical significance between reconstruction strategies (P = 0.737). The number of interventions during follow-up was an independent risk factor for recurrence (odds ratio, 2.55; confidence interval, 1.24-5.25; P = 0.011). Complications (37%) were more severe after FCF (P = 0.007). The mean score regarding patient-reported outcomes was 14.9 ± 2.8, of 24, with best appearance after FCF (P = 0.042). These long-term follow-up data on severe aHS demonstrate a high recurrence rate after wide excision and reconstruction. Patients should be informed that treatment consists of long-term medicinal and surgical interventions with high recurrence rates, and surgeons may choose their own preferred reconstruction methods. Furthermore, more attention should be paid to the sexual health of patients with aHS.

The relationship between premature atrial complexes and recurrence of atrial fibrillation: a meta-analysis

Objective: To explore the relationship between premature atrial complexes (PACs) and recurrence of atrial fibrillation (AF). Methods: Published literature was searched in PubMed, Embase, Web of Science, Cochrane, Weipu, China national knowledge infrastructure, Wanfang and China Biology Medicine disc up to 25 March 2020. RevMan5.3 software was used to analyzed the data and publication bias was performed by Stata 15.1. Results: A total of 8 studies were identified, including 1 252 AF patients with a mean age of 61.67 years, and male patients accounted for 70.6%. During follow-up, AF recurred in 425 cases. Meta-analysis showed that frequent PACs was an independent risk factor for recurrence of AF (HR=2.64, 95%CI:1.40-4.97). Subgroup analyses showed that PACs not only increasedthe risk of recurrence of AF after electrical cardioversion (HR=2.38, 95%CI:1.25-4.51), but also significantly increased the risk of recurrence of AF after catheter ablation cardioversion (HR=2.90, 95%CI:1.11-7.60). Conclusions: PACs is significantly associated with AF recurrence.

Predicting survival time of Korean hepatocellular carcinoma patients using the Cox proportional hazards model: a retrospective study based on big data analysis.

To predict survival time of Korean hepatocellular carcinoma (HCC) patients by analyzing big data using Cox proportional hazards model. Big data of the patients who underwent treatment for HCC from 2008 to 2015, provided by Korea Central Cancer Registry, National Cancer Center, and Ministry of Health and Welfare, were analyzed. A total of 10 742 patients with HCC were divided into two groups, with Group I (3021 patients) confirmed on biopsy and Group II (5563 patients) diagnosed as HCC according to HCC diagnostic criteria as outlined in Korean Liver Cancer Association guidelines. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors of recurrence after treatment and survival status. A total of 3021 patients in Group I and 5563 patients in Group II were included in the study and the difference in survival time between the two groups was statistically significant (P < 0.05). Recurrence was only included in intrahepatic cases, and the rates were 21.2 and 19.8% while the periods from the first treatment to recurrence were 15.57 and 14.19 months, respectively. Age, diabetes, BMI, platelet, alpha-fetoprotein, histologic tumor maximum size, imaging T stage, presence of recurrence, and duration of recurrence were included in multivariate analysis. By using nationwide, multicenter big data, it is possible to predict recurrence rate and survival time which can provide the basis for treatment response to develop a predictive program.

Ultrasound-guided hydrodilatation for adhesive capsulitis of the hip is a safe and effective treatment

PurposeAdhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients’ prognosis.MethodsWe enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position.ResultsOn MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified.ConclusionBased on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment.

Malignant Progression Contributes to the Failure of Combination Therapy for Atypical Meningiomas.

ObjectiveTo investigate the independent risk factors for recurrence in intracranial atypical meningiomas (AMs) treated with gross total resection (GTR) and early external beam radiotherapy (EBRT).MethodsClinical, radiological, and pathological data of intracranial AMs treated with GTR-plus-early-EBRT between January 2008 and July 2016 were reviewed. Immunohistochemical staining for Ki-67 was performed. Kaplan–Meier curves and univariate and multivariate Cox proportional hazards regression analyses were used to explore independent predictors of tumor recurrence. Chi square test was performed to compare variables between subgroups.ResultsForty-six patients with intracranial AMs underwent GTR and early EBRT. Ten (21.7%) recurred and three (6.5%) died during a median follow-up of 76.00 months. Univariate and multivariate Cox analyses revealed that malignant progression (MP) (P = 0.009) was the only independent predictor for recurrence, while Ki-67 was of minor value in this aspect (P = 0.362). MP-AMs had a significantly higher recurrence rate (P = 0.008), a higher proportion of irregularly shaped tumors (P = 0.013) and significantly lower preoperative Karnofsky Performance Scale (KPS) scores (P = 0.040) than primary (Pri) AMs. No significant difference in Ki-67 expression was detected between these subgroups (P = 0.713).ConclusionsMP was significantly correlated with an increased incidence of recurrence in GTR-plus-early-EBRT-treated intracranial AMs. Significantly higher frequencies of tumor relapse and irregularly shaped tumors and lower preoperative KPS scores were observed in MP-AMs compared with Pri-AMs. Ki-67 expression is of minor value in predicting tumor recurrence or distinguishing tumor origins in AMs.

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort.

We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE). French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation. A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2-6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20-2.62, p < 0.01), whether PE was provoked by a major transient risk factor or not. A threshold at 41% was identified as the best value associated with the risk of recurrence 6 months after stopping anticoagulation (area under curve = 0.64). PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.

Cribriform carcinoma in the lymph nodes is associated with distant metastasis, recurrence, and survival among patients with node-positive colorectal cancer.

Cribriform lymph node pattern is an independent risk factor for metachronous or synchronous distant metastasis in patients with stage III and IV node-positive colorectal cancer. Multivariable analysis in patients with stage III disease indicated that the cribriform pattern of carcinoma in the lymph nodes was an independent risk factor for recurrence and survival. Kaplan–Meier analysis demonstrated that the group with stage III cribriform-type lymph node carcinoma had shorter recurrence-free and overall survival times than the stage III group with the tubular type (P &amp;lt; 0.001).

Preoperative detection of KRAS mutated circulating tumor DNA is an independent risk factor for recurrence in colorectal cancer

Preoperative ctDNA status in relation to recurrence in cases of CRC remains unclear. We examined preoperative ctDNA detection by targeting KRAS gene mutations as a predictive marker for recurrence after CRC surgery. We measured the preoperative KRAS mutated ctDNA status and analyzed the correlation with clinicopathologic features of 180 patients that underwent surgery for CRC. We studied the association between preoperative KRAS mutated ctDNA and postoperative recurrence in patients (n = 150) that underwent radical surgery. KRAS mutated ctDNA was detected in 59 patients (32.8%). Median mutant allele frequency of KRAS in ctDNA was 0.20%. KRAS status in ctDNA and lymph node metastasis and distant metastasis were not significantly different. Among patients that underwent radical resection, recurrence occurred in 21 (14.0%, median follow-up 24 months). In Kaplan–Meier analysis, preoperative detection of KRAS mutated ctDNA was associated with inferior recurrence-free interval (RFI) (p = 0.002) and recurrence-free survival (RFS) (p = 0.025). In a multivariate Cox proportional hazards model, preoperative detection of KRAS mutated ctDNA was an independent factor related to both RFI (HR = 3.08; p = 0.012) and RFS (HR = 2.18; p = 0.044). Preoperative measurement of KRAS mutated ctDNA could be useful to decide postoperative treatment.

Risk factors for recurrence after coil embolization for internal carotid artery-posterior communicating artery aneurysms

BackgroundUse of coil embolization for internal carotid artery-posterior communicating artery aneurysms (IC-PC ANs) has been increasing. However, the recurrence rate after embolization is rather high compared to that after surgery. The aim of this study was to evaluate the factors related to recurrence after coil embolization for IC-PC ANs. MethodsA total of 69 patients with IC-PC ANs treated with coil embolization between 2013 and 2019 were retrospectively enrolled, and we evaluated whether the aneurysms recurred after embolization. The patients were divided into two groups (no-recurrence group and recurrence group), and the relationships of several patient or aneurysm characteristics and treatment-related information with aneurysm recurrence were examined. ResultsTwenty patients (29%) developed aneurysm recurrence. There were significant differences in dome size (5.19 mm/6.48 mm, p = 0.01), neck width (3.25 mm/4.23 mm p = 0.009), aneurysm volume (47.5 mm3/120 mm3, p = 0.003), and Pcom diameter (1.11 mm/1.96 mm p = 0.005) between the two groups. Pcom diameter was the independent risk factor for recurrence (odds ratio: 3.52, 95%CI 1.43–8.69, p = 0.006). The cutoff for Pcom diameter as the factor related to recurrence was 1.79 mm, with sensitivity of 60% and specificity of 83.7%. ConclusionIn this study, dome size, neck width, aneurysm volume, and Pcom diameter were associated with recurrence after coil embolization for IC-PC ANs. In particular, Pcom diameter could be an independent risk factor for recurrence.

Differences in initial versus recurrent diabetic foot ulcers at a specialized tertiary diabetic foot care center in China.

ObjectiveTo investigate the characteristics of diabetic foot ulcer (DFU) recurrence.MethodsA total of 573 patients with DFUs were recruited and divided into an initial group (395 patients) and a recurrence group (178 patients). The factors related to recurrence were analyzed using multivariate regression.ResultsThe recurrence group had longer diabetes duration (odds ratio [OR] 192; 95% confidence interval 120, 252 vs. 156; 96, 240); lower glycated hemoglobin levels (OR 8.1; 95% CI 6.8, 9.6 vs. 9.1; 7.4, 10.5), and higher rates than the initial group of amputation (37.5% vs. 2.0%), history of vascular intervention (21.3% vs. 3.9%), retinopathy (77.7% vs. 64.7%), callus (44.4% vs. 20.8%), foot deformity (51.2% vs. 24.6%), and outdoor sports shoe wearing (34.0% vs. 21.2%). Multiple factor logistic regression analysis showed that diabetes duration (OR 1.004), callus (OR 2.769), vascular intervention (OR 2.824) and amputation (OR 22.256) were independent risk factors for DFU recurrence.ConclusionDiabetes duration, callus, history of vascular intervention, and amputation were independent risk factors for recurrent DFUs in a cohort of Chinese patients with active DFU. The prevention and treatment of DFUs, especially callus treatment, foot care, and blood glucose control, should be improved in China.

Analysis of Factors Influencing Relapse and Pregnancy in Patients with Borderline Ovarian Tumors.

Objective: This retrospective study analyzed the factors affecting recurrence in patients after surgery with borderline ovarian tumors and postoperative recurrence and pregnancy after fertility-sparing surgery (FSS), to provide guidance for clinical treatment of borderline ovarian tumors and propose a therapeutic strategy for fertility protection.Methods: A total of 415 patients with borderline ovarian tumors were initially operated on in the gynecology ward of Shengjing Hospital Affiliated with China Medical University from September 1, 2013, to September 1, 2019. Central pathology review and prospective follow-up were carried out. The clinical and pathological data were consulted through the medical record query system of our hospital. The recurrence and pregnancy of the patients were investigated through telephone follow-up and outpatient and inpatient medical records. The influence of clinical and pathological variables on recurrence and pregnancy were evaluated using univariate/multivariate analyses.Results: In this study, 415 patients were collected, of which 21 lost follow-up, and a total of 394 eligible patients were included in the analysis. Among these patients, 25 patients relapsed with a recurrence rate of 6.3% and there were 196 patients with fertility-sparing surgery, of the 63 patients attempting to conceive, 35 were able to attain pregnancy with a pregnancy rate of 55.6%. All patients survived until the follow-up deadline. In univariate and multivariate analyses, FSS, FIGO stage, and micropapillary pattern were independent risk factors for recurrence of BOTs. FIGO stage, micropapillary pattern were independent risk factors for recurrence of BOTs with FSS. The risk of recurrence was not related to omentectomy nor postoperative chemotherapy. While omentectomy and chemotherapy had an impact on the pregnancy rate (P <0.05) and the pregnancy rate of patients without omentectomy or chemotherapy was higher.Conclusion: Omentectomy did not affect recurrence and it is not recommended as a routine operation. Adjuvant chemotherapy does not reduce the recurrence rate. While omentectomy and chemotherapy had an impact on the pregnancy rate, and both of them should be carried out more carefully in patients with fertility requirements.

Atypical Histological Features as Risk Factors for Recurrence in Newly Diagnosed WHO Grade I Meningioma.

The significance of atypical histological features (AHF) as risk factors for recurrence in benign meningioma is not well understood. This study examined risk factors of World Health Organization (WHO) Grade I meningioma (GIM) recurrence, focusing on AHF. We investigated 150 consecutive newly diagnosed GIM patients who had more than one year of follow-up after resection in our hospital between January 2007 and March 2018. The following factors were reviewed retrospectively: age, sex, tumor location, extent of resection, MIB-1 index, mitotic figures, number and distribution of AHF, and recurrence. The patients were grouped according to the presence or absence of recurrence and comparatively examined. Recurrence was observed in 10 cases (6.7%). Univariate analysis showed that patients with recurrence had a significantly higher MIB-1 index (2.0 vs. 4.3; p = 0.006) and a significantly higher proportion of male patients (21.4% vs. 70.0%; p = 0.002) and patients with sheet-like growth (6.42% vs. 30.0%; p = 0.04). In multivariate analysis, skull base location (odds ratio [OR] 31.424; 95% confidence interval [CI] 1.74–569), gross total resection (OR 0.130; 95% CI 0.0189–0.897), and MIB-1 index (OR 1.939; 95% CI 1.19–3.15) were significantly associated with recurrence. Our study revealed that skull base location, subtotal resection, and high MIB-1 index were independent risk factors for recurrence. Only the presence of sheet-like growth had a significantly higher incidence in patients with recurrence in univariate analysis of AHF. Multivariate analysis found no significant association. Sheet-like growth may be involved in malignancy and recurrence of benign meningioma.

Supraclavicular lymph node metastasis in elderly patients undergoing esophageal squamous cell carcinoma radical surgery: construction of risk and prognostic predictive nomograms.

BackgroundSupraclavicular lymph node metastasis (SCLN) is an adverse prognostic determinant of esophageal cancer. However, lymphadenectomy for SCLN is a traumatic procedure, especially in elderly patients, which is associated with more postoperative complications. Currently, identification of risk factors of SCLN metastasis and avoidance of unnecessary lymphadenectomy for SCLN in esophageal squamous cell carcinoma (ESCC) patients has become an unmet clinical need.MethodsA total of 90 elderly patients with ESCC between January 2008 and December 2013 was eligible for this analysis. Logistic regression was performed to determine risk factors for SCLN metastasis after ESCC radical surgery in elderly patients. A nomogram was constructed to individually predict the risk for SCLN metastasis. The Kaplan-Meier survival curve and cumulative risk curve were further analyzed to evaluate the effect of SCLN metastasis after ESCC radical surgery on survival prognosis and cumulative risk assessment in elderly patients. Finally, the SCLN metastasis group and the independent risk factor group were fitted by drawing a decision curve to evaluate the net benefit of the model.ResultsSCLN developed in 38 patients (42.2%). Postoperative lymph node metastasis (P<0.05), tumor thrombus (P<0.05) and tumor infiltration (P<0.05) were independent risk factors for SCLN metastasis. The influence of SCLN metastasis on postoperative survival in elderly ESCC patients was statistically significant (P=0.028, P <0.05); with the passage of time, the cumulative risk of SCLN metastasis increased, the survival probability decreased, and the survival time was shortened.ConclusionsPostoperative lymph node metastasis, tumor thrombus and tumor infiltration are independent risk factors for recurrence and metastasis of SCLNs in elderly patients with esophageal squamous cell carcinoma. The nomogram model based on these factors provides a preliminary reference for individualized risk assessment, prognosis guidance and decision-making of SCLN metastasis in elderly patients with esophageal squamous cell carcinoma (ESCC).

Nomograms based on clinicopathological factors and inflammatory indicators for prediction of early and late recurrence of hepatocellular carcinoma after surgical resection for patients with chronic hepatitis B.

BackgroundFew studies have focused on the prognostic values of inflammation-related factors for different phases of recurrence in hepatocellular carcinoma (HCC). We aimed to identify the different risk factors for overall, early, and late recurrence, and to establish nomograms based on inflammation-related parameters for predicting the risks of recurrence in a group of HCC patients undergoing hepatectomy.MethodsWe retrospectively enrolled 383 HCC patients with chronic hepatitis B (CHB) who underwent hepatectomy. Univariate and multivariate Cox analyses were conducted to identify independent risk factors for recurrence. Nomograms for overall, early, and late recurrence-free survival (RFS) were established. The discrimination and calibration abilities of the nomograms were evaluated by concordance indexes (C-index), calibration plots, and Kaplan-Meier curves. Finally, receiver operating characteristic (ROC) curves were used to compare the derived nomograms with other existing models.ResultsFibrinogen, lymphocyte-to-monocyte ratio, and S-index inflammation-related factors were independently related to overall and early RFS, but only the S-index correlated with late recurrence. Nomograms with tumor number, diameter, and pathological differentiation for overall and early RFS were established, while nomogram for late recurrence was constructed with tumor number and Child-Pugh grade. The C-indexes for overall, early, and late RFS were 0.679, 0.677, and 0.728, respectively. The calibration plots fit well. The nomograms showed superior discrimination capacities and better performance prediction with larger areas under the curve for recurrence.ConclusionsThe developed nomograms that integrated inflammation-related factors showed high predictive accuracy for overall, early, and late recurrence in HCC patients with CHB after hepatectomy.

Preoperative systemic immune-inflammation index predicts survival and recurrence in patients with resected primary pulmonary sarcomatoid carcinoma.

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a rare lung cancer subtype. Studies concerning PSC are limited and controversial; therefore, we analyzed the treatment and outcomes of PSC utilizing a relatively large single-institution database.MethodsFrom January 2003 to December 2018, 262 consecutive PSC patients treated at our institution were retrospectively reviewed. The clinical characteristics, treatments, and outcomes were analyzed.ResultsThe median survival time (MST) was 22.0 months, with 1-, 3-, and 5-year overall survival (OS) rates of 59.9%, 40.1%, and 36.1%, respectively. Patients who underwent surgery had a significantly better prognosis than patients who received nonsurgical treatment (MST, 23.0 vs. 11.0 months, P=0.016). The use of surgery followed by adjuvant therapy significantly prolonged survival in stage III patients (MST, 17.0 vs. 8.0 months, P=0.003) but not in stage I and II patients. Multivariate analysis showed that a systemic inflammation-immune index (SII) value >430.8, TNM stage and necrosis were independent prognostic predictors of OS and disease-free survival (DFS) in radically resected PSC patients (P<0.05). In addition, SII and necrosis were independent risk factors for recurrence after the radical resection of PSC (P<0.05).ConclusionsPSC is aggressive and has a poor prognosis. Surgery should be the mainstay treatment for operable cases, and adjuvant therapy is recommended for locally advanced disease. A novel potential biomarker, SII, which is an integrated parameter based on preoperative lymphocyte, neutrophil, and platelet counts, may be useful for prognostic prediction and the identification of resected PSC patients at high risk for recurrence.

Long-term outcomes of thoracoscopic thymectomy for thymoma stage i-ii

To compare long-term outcomes of video-assisted thoracoscopic (VATS) and conventional open surgery in patients with early-stage (Masaoka stage I-II) thymic malignancies. Retrospective study included patients after VATS and open thymectomy for the period 2000-2019. Long-term outcomes were analyzed. VATS thymectomy was performed in 53 (54.1%) patients, open thymectomy - in 45 (45.9%) cases. Median follow-up period was 66.9 months. Overall 5-year survival was 89.8% and 97% in the Open and VATS groups, respectively (p=0.076). Disease-free survival rates were 79.6% and 86.6% (p=0.279), respectively. There was no significant difference in cumulative incidence of recurrence (13.3% vs 7.5%, p=0.505). Age <50 years and tumor size >5 cm were the independent risk factors of recurrence. VATS thymectomy is an effective approach ensuring similar long-term outcomes in patients with early stages of thymic malignancies.

Recurrence Factors following Curative-Intent Resection for Intrahepatic Cholangiocarcinoma

Background: Recurrence of intrahepatic cholangiocarcinoma (ICC) after curative resection is common and the prognosis of recurrent ICC is dismal. Objective: This study was designed to investigate the risk factors and prognosis after disease recurrence following curative-intent resection for ICC. Methods: Data of patients undergoing curative resection for ICC in a single institution were identified. Results: A total of 147 patients were included. With a median follow-up of 21 months, 101 patients (68.7%) experienced ICC recurrence. On multivariate analysis, rim-enhanced or hypovascular mass on late arterial phase of CT image (hazard ratio [HR] 3.893, 95% confidence interval [CI] 1.700-8.915; p = 0.0013 and HR 6.241, 95% CI 2.670-14.586, p < 0.001, respectively), macrovascular invasion (HR 0.518, 95% CI 0.280-0.960; p = 0.037), microvascular invasion (HR 1.813, 95% CI 1.134-2.900, p = 0.013), advanced T stage ( HR 1.801, 95% CI 1.105-2.934, p = 0.018), and Lymph node metastasis (HR 2.067, 95% CI 1.168-3.657, p = 0.013) were associated with recurrence of ICC following curative resection, independently. Median survival after recurrence was better among patients who tried any treatment modality (18.5 months) than patients who did not received treatment (5.0 months) [p < 0.001]. Conclusions: Several factors including preoperative vascularity of ICC on CT image are the independent risk factors for recurrence of ICC after curative resection. Proactive treatment for recurrent ICC can be helpful to prolong the survival length of patients with recurrent ICC.

Circulating Tumor Cells Expressing Krüppel-Like Factor 8 and Vimentin as Predictors of Poor Prognosis in Pancreatic Cancer Patients.

Background:Circulating tumor cells (CTCs) with an epithelial-mesenchymal transition phenotype in peripheral blood may be a useful marker of carcinomas with poor prognosis. The aim of this study was to determine the prognostic significance of CTCs expressing Krüppel-like factor 8 (KLF8) and vimentin in pancreatic cancer (PC).Methods:CTCs were isolated by immunomagnetic separation from the peripheral blood of 40 PC patients before undergoing surgical resection. Immunocytochemistry was performed to identify KLF8+ and vimentin+ CTCs. The associations between CTCs and time to recurrence (TTR), clinicopathologic factors, and survival were assessed. Univariate and multivariate analyzes were performed to identify risk factors.Results:Patients with CTCs (n = 30) had a higher relapse rate compared to those without (n = 10) (70.0% vs 20.0%; P < 0.01). The proportion of KLF8+/vimentin+ CTCs to total CTCs was inversely related to TTR (r = −0.646; P < 0.01); TTR was reduced in patients with > 50% of CTCs identified as KLF8+/vimentin+ (P < 0.01). Independent risk factors for recurrence were perineural invasion and > 50% KLF8+/vimentin+ CTCs (both P < 0.05).Conclusion:Poor prognosis can be predicted in PC patients when > 50% of CTCs are positive for KLF8 and vimentin.