Long-term Recurrence-free Survival Research Articles

Prognostic Value of the Number of Retrieved Lymph Nodes in Pathological Nx or N0 Classical Papillary Thyroid Carcinoma.

This study evaluated the clinical implications of the number of retrieved central lymph nodes (LN) for the recurrence and recurrence-free survival (RFS) outcomes in patients with pathological Nx (pNx) or N0 classical papillary thyroid carcinoma (PTC). In total, 464 patients were enrolled following total thyroidectomy with central LN dissection. The risk factors related to recurrence and RFS were evaluated and compared between these groups. Age, primary tumor size, and number of retrieved central LNs were independent risk factors for recurrence according to multivariate analysis (p<0.05). The cut-off value for the number of retrieved central LNs related to recurrence was 4.5. Group 2 (pN0; ≥5 nodes) demonstrated a significantly higher proportion of patients with an ablation-stimulated thyroglobulin (sTg) level <2.0ng/mL (84.9 vs 61.1%; p<0.050) and control sTg level <1.0ng/mL (92.1 vs 79.6%; p<0.050) in comparison with patients in group 1 (pNx or pN0; 1-4 nodes). Perioperative complication rates were comparable between groups. The number of retrieved central LNs is an independent risk factor for recurrence, even among patients with pNx or pN0 classical PTC. A thorough central LN dissection may therefore improve the long-term RFS rate.

Controversies in criteria for liver transplantation in hepatocellular carcinoma

For patients with hepatic decompensation and hepatocellular carcinoma (HCC) within Milan criteria, liver transplantation provides the best long-term recurrence-free survival. However, there is controversy about the role of liver transplantation in other subgroups, including those with compensated cirrhosis, United Network for Organ Sharing (UNOS) T1 lesions, or HCC exceeding Milan criteria. For patients with compensated cirrhosis, surgical resection provides similar recurrence-free survival as liver transplantation and is the most cost-effective approach. Although a 'Wait and not Ablate' approach can facilitate priority listing in most patients with UNOS T1 lesions, nearly 10% will have rapid tumor growth beyond transplant criteria, thereby missing an opportunity for curative therapy. Patients exceeding Milan criteria have higher posttransplant recurrence rates and worse survival than those within Milan criteria, and any potential benefit of liver transplantation to these patients must be weighed against harms to others on the waiting list, particularly in areas with limited donor availability. Although downstaging may help select a subgroup of patients beyond Milan with good tumor biology and better prognosis, limitations of the current literature preclude rigorous evaluation. Until higher quality data become available that demonstrate transplant benefit in expanded criteria patients, liver transplantation should be reserved for patients within Milan criteria.

Surgical Resection Versus Radiofrequency Ablation for Single Hepatocellular Carcinoma ≤ 2 cm in a Propensity Score Model

To evaluate the efficacy of surgical resection (SR) and radiofrequency ablation (RFA) for single hepatocellular carcinoma (HCC) 2 cm or less. The optimal management for Barcelona Clínic Liver Cancer (BCLC) very early-stage HCC is undetermined. Between 2002 and 2013, a total of 237 (SR, 109; RFA, 128) patients with BCLC very early-stage HCC were enrolled. Their overall survival (OS) and recurrence-free survival (RFS) were compared. Propensity score matching analysis identified 79 matched pairs of patients to compare outcomes. At baseline, patients with SR were younger and had larger tumors (both P < 0.05). The 5-year OS rates were 81% versus 76% (P = 0.136), whereas 5-year RFS rates were 49% versus 24% (P < 0.001) for SR and RFA groups, respectively. In the propensity model, the baseline variables were well balanced between 2 groups. Surgical resection was significantly associated with better OS and RFS compared with RFA; the 5-year OS rates were 80% versus 66% (P = 0.034), and 5-year RFS rates were 48% versus 18% (P < 0.001) for SR and RFA groups, respectively. The Cox proportional hazards model identified RFA as an independent predictor for mortality and tumor recurrence in the propensity model (hazard ratio, 2.120 and 2.421, respectively; both P < 0.05). Patients with recurrent HCC had inferior prognosis compared with patients without recurrence (P = 0.001). However, the survival after recurrence was similar between patients initially treated with SR or RFA (P = 0.415). Surgical resection provides better long-term OS and RFS compared with RFA in patients with BCLC very early-stage HCC. Surgical resection should be considered as the first-line treatment for these patients.

High-intensity focused ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: Predictors of disease response.

135 Background: Some patients with localized radio-recurrent prostate cancer (PCa) may have long-term recurrence-free (RFS) survival with salvage high-intensity focused ultrasound (HIFU). In this study, we describe our previously unreported oncologic outcomes and predictors of disease response after salvage HIFU. Methods: Participants were prospectively enrolled in this study from January 2005 to December 2014 if they had localized radio-recurrent prostate cancer. Participants had to meet both biochemical (PSA nadir+ 2ng/ml) and histologic (positive biopsy) definitions of recurrence. Study exclusion criteria included the receipt of prior salvage therapy, presence of metastastatic disease, and receipt of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the Ablatherm device (EDAP, France). The primary endpoint of this study was RFS, defined as a composite endpoint of PSA progression (PSA nadir + 2 ng/ml), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to determine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (undetectable PSA nadir, low TRUS biopsy grade, &gt;3 TRUS biopsy cores positive, pre-HIFU PSA&lt;4ng/ml, receipt of prior ADT and presence of pre-HIFU palpable disease). Survival analysis was performed on participants with a minimum of 1-year follow-up. Results: Twenty-four participants were eligible for study inclusion with a median follow-up of 31.0 months. Median PSA at study entry was 4.02 ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04 ng/ml. 2-year and 5-year RFS were 66.3% and 51.6% respectively. An undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P&lt;0.001). No participants developed a rectourethral fistula. Conclusions: Salvage HIFU allows for disease control in select patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response.

Optimum Biyolojik Doz Tespiti için ROC Eğrisi Altında Zamana Bağlı Alan

Copyright © 2016 by Turkiye Klinikleri ABSTRACT Objective: In Metronomic Chemotherapy (MC) performance of specific surrogate markers plays an important role to obtain the effective treatment. It is very difficult to detect the initial threshold value of surrogate markers to get an idea about optimum dose level of MC for long-term effective treatment. The long-term effective treatment can be obtained through controlling the surrogate markers on continues measured value into a specific range. The long-term effective treatment is defined as long-term recurrence-free survival. During the treatment initiation, many surrogate markers value changes rapidly and those values are time-dependent measurements. The specification of surrogate markers threshold value can only be obtained through the application of ROC curve (AUC), Sensitivity, and Specificity analysis. Material and Methods: The application of ROC curve to detect the timedependent continuous measurement becomes complicated. In this paper, a straightforward Survival Analysis estimator through MCMC iteration for each possible time point measurement is adopted to detect the possible threshold value of surrogate markers. Results: The surrogate markers levels on angiogenesis in Head and Neck Cancer (HNC) patients are considered. Conclusion: The threshold value of the surrogate markers is detected through the formation of ROC curve.

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Brachytherapy: state‐of‐the‐art radiotherapy in prostate cancer

Investigating molecular alterations to profile short- and long-term recurrence-free survival in patients with primary glioblastoma.

Glioblastoma (GB) is the most aggressive type of primary brain tumor. Despite the progress in recent years regarding the diagnosis and treatment of GB, the recurrence rate remains high, due to the infiltrative and dispersive nature of the tumor, which typically results in poor patient prognosis. In the present study, 19 formalin-fixed, paraffin-embedded GB samples were selected from patients with GB tumors. The samples were classified into a short or long recurrence-free survival (RFS) group, based on the time of first recurrence of the disease in the patients. The 19 samples were molecularly characterized for mutations in the isocitrate dehydrogenase 1 (IDH1) gene, amplification of the epidermal growth factor receptor (EGFR) gene, presence of the EGFR variant III, and methylation of the promoter region of the O6-methylguanine-DNA methyltransferase (MGMT) gene. Then, the expression of 84 genes involved in cell-cell and cell-matrix interactions, and that of 84 microRNAs (miRNAs) associated with brain cancer, was profiled. In addition, a copy number variation analysis of 23 genes reported to undergo frequent genomic alterations in human glioma was also performed. Differences in the expression levels of a number of genes were detected across the short and long RFS groups. Among these genes, 5 in particular were selected, and a 5-genes combination approach was developed, which was able to differentiate between patients with short and long RFS outcome. The high levels of sensitivity and precision displayed by this 5-genes combination approach, which were confirmed with a cross-validation method, provide a strong foundation for further validation of the involvement of the aforementioned genes in GB in a larger patient population. In conclusion, the present study has demonstrated how the expression pattern of miRNAs and mRNAs in patients with GB defines a particular molecular hallmark that may increase or reduce the aggressive behavior of GB tumors, thus influencing the survival rates of patients with GB, their response to therapy and their tendency to suffer a relapse.

Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

Objective: The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. Subjects and Methods: A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrence-free survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow-up of up to 20 years after primary PSD surgery. Results: Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20-year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. Conclusion: The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures.

P0388 : Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤2cm in a propensity score model

Objectives: To evaluate the efficacy of surgical resection (SR) and radiofre- quency ablation (RFA) for single hepatocellular carcinoma (HCC) 2 cm or less. Background: The optimal management for Barcelona ClLiver Cancer (BCLC) very early-stage HCC is undetermined. Methods: Between 2002 and 2013, a total of 237 (SR, 109; RFA, 128) patients with BCLC very early-stage HCC were enrolled. Their overall survival (OS) and recurrence-free survival (RFS) were compared. Propensity score matching analysis identified 79 matched pairs of patients to compare outcomes. Results: At baseline, patients with SR were younger and had larger tumors (both P < 0.05). The 5-year OS rates were 81% versus 76% (P = 0.136), whereas 5-year RFS rates were 49% versus 24% (P < 0.001) for SR and RFA groups, respectively. In the propensity model, the baseline variables were well balanced between 2 groups. Surgical resection was significantly associated with better OS and RFS compared with RFA; the 5-year OS rates were 80% versus 66% (P = 0.034), and 5-year RFS rates were 48% versus 18% (P < 0.001) for SR and RFA groups, respectively. The Cox proportional hazards model identified RFA as an independent predictor for mortality and tumor recurrence in the propensity model (hazard ratio, 2.120 and 2.421, respec- tively; both P < 0.05). Patients with recurrent HCC had inferior prognosis compared with patients without recurrence (P = 0.001). However, the survival after recurrence was similar between patients initially treated with SR or RFA (P = 0.415). Conclusions: Surgical resection provides better long-term OS and RFS com- pared with RFA in patients with BCLC very early-stage HCC. Surgical resec- tion should be considered as the first-line treatment for these patients.

Unknown primary of the head and neck: A long-term follow-up

BackgroundA diagnosis of squamous cell carcinoma of an unknown primary (CUP) is a major burden for patients. Because the location of the primary tumor is unclear, patients remain fearful of recurrence, which aggravates the uncertain prognosis of the disease. This study evaluates factors associated with long-term recurrence-free and overall survival of patients with CUP of the head and neck. Additionally, patient survival rates are compared with those of patients with head and neck squamous cell carcinoma (HNSCC). MethodsA total of 293 consecutive patients operated on between January 1999 and December 2009 with at least a 5-year follow-up (survival permitting), were evaluated retrospectively. ResultsTwenty-six patients with a CUP of the head and neck were identified. Patients with CUP had a low overall survival rate, comparable with that of patients with pN + HNSCC, and recurrent disease occurred with a similar likelihood as in patients with pN + HNSCC. The median recurrence-free survival in the CUP group was 28.5 months compared with 48 months in the whole of the HNSCC group. The median overall survival of the CUP group was 56 months versus 65 months for the HNSCC group. Extracapsular spread was the only independent prognostic factor for overall survival for CUP patients. ConclusionPatients diagnosed with CUP syndrome have a poorer prognosis for overall survival compared with other HNSCC patients. Postoperative radiotherapy diminished disease recurrence and improved overall survival. Omission of postoperative radiotherapy resulted in a very high recurrence rate (75%) for CUP patients. Based on these results we suggest postoperative radiotherapy including the oral mucosa for all patients, regardless of histopathological results, possible favorable nodal disease, or favorable lymph node ratios.

Clinicopathological Assessment of Patients with Locally Advanced Breast Cancer with 10 or More Lymph Node Metastases

Background and Objective: Prognosis is generally very poor in patients with breast cancer with 10 or more axillary node metastases, but long-term recurrence-free survival is observed. We assess the clinicopathological features of these patients with and without recurrent disease and review the literature. Patients and Methods: We retrospectively examined the background, clinicopathological features, and prognoses of 29 patients who underwent surgery at our hospital for primary breast cancer with 10 or more axillary lymph node metastases between April 2003 and March 2015 and compared findings between those with and without disease recurrence. Metastases were identified based on hematoxylin and eosin staining. Results: The mean number of lymph node metastases was 19 and of dissected lymph nodes, 26. The cumulative disease-free survival plateaued at 59% 3 years after treatment, and the cumulative overall survival rate was 68.4% at 5 years and plateaued at 61% at 6 years. The mean disease-free survival was significantly shorter in those whose disease recurred (13.6 months) than those without recurrence (62.2 months). The expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) differed significantly between the 2 groups. Conclusion: Prognosis is generally very poor in patients with breast cancer with 10 or more axillary node metastases if tumors recur within 3 years. Furthermore, findings of all five patients with recurrent disease demonstrating a triple-negative subtype and all 14 patients without recurrence demonstrating luminal A intrinsic subtype suggest the use of these subtypes as prognostic factors.

Long-term analysis of oncological outcomes after laparoscopic radical cystectomy in Europe: results from a multicentre study by the European Association of Urology (EAU) section of Uro-technology.

To report long-term outcomes of laparoscopic radical cystectomy (LRC) in a multicentre European cohort, and explore feasibility and safety of LRC. This study was coordinated by European Association of Urology (EAU)-section of Uro-technology (ESUT) with nine centres enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analysed. Descriptive statistics were used to explore peri- and postoperative characteristics of th ecohort. Kaplan-Meier curves were constructed to evaluate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, lymph node (LN) involvement and surgical margin status. Minor complications (Clavien I-II) occurred in 39% and major (IIIa-IVb) in 17%. In all, 10 (2%) postoperative deaths were recorded. The median (interquartile, IQR) LN retrieval was 14 (9-17) and positive surgical margins were detected in 29 (5.8%) patients. The median (mean, IQR) follow-up was 50 (60, 19-90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5 years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, LN involvement and margin status (log-rank P < 0.001). On multivariate Cox analysis, T stage and LN involvement (both P < 0.001) were significant predictors of RFS, CSS and OS. Positive margins were significant predictors of RFS (P = 0.016) and CSS (P = 0.043). In this European LRC multicentre study, the largest to date, long-term RFS, CSS and OS rates after LRC appear comparable to those reported in current open RC series. Further randomised controlled trials are necessary to assess the global impact of LRC.

Clinical Characteristics and Outcomes for Patients With Thymic Carcinoma: Evaluation of Masaoka Staging

Thymic carcinomas are rare cancers with limited data regarding outcomes, particularly for those patients with advanced disease. We identified patients with thymic carcinomas diagnosed between 1993 and 2012. Patient characteristics, recurrence-free survival (RFS), and overall survival (OS) were analyzed. One hundred twenty-one patients with thymic carcinomas were identified. Higher Masaoka stage was associated with worse OS and RFS (5-year OS of 100%, 81%, 51%, 24%, and 17% for stage I, II, III, IVa, and IVb respectively, p < 0.001 and 5-year RFS of 80%, 28%, and 7% for stage I/II, III, and IV respectively, p < 0.001). Patients with stage IVb lymph node (LN) only disease had a better 5-year OS as compared with patients with distant metastasis (24% versus 7%, p = 0.025). Of the 61 patients with stage IVb disease, 22 of 29 patients (76%) with LN-only disease underwent curative intent resection versus 3 of 32 patients (9%) with distant metastasis. Twenty-two patients with LN involvement were treated with multimodality therapy. Three (14%) remain free of disease with long-term follow-up (range, 3.4+ years- to 6.8+ years). We describe the clinical features of a large series of patients with thymic carcinoma in North America. The Masaoka staging system effectively prognosticated OS and RFS. Patients with stage IVb LN-only disease had significantly better OS as compared with patients with distant metastasis with a subset of patients sustaining long-term RFS with multimodality therapy. If validated, these data would support a revised staging system with subclassification of stage IVb disease into two groups.

En bloc resection of primary malignant bone tumors of the cervical spine.

Due to the poor response of primary malignant bone tumors to adjuvant therapies, surgical resection performed in an en bloc fashion with free margins remains the best option for long-term recurrence-free survival of patients harboring such lesions. In this article the authors provide a stepwise review of the technical details involved in the performance of en bloc resections of tumoral lesions in the cervical spine. Due to the anatomical peculiarities of the cervical spine related to the presence of functional nerve roots as well as the vertebral arteries, en bloc resections in this region remains a challenging surgical procedure.

Repair of Functional Tricuspid Regurgitation: Comparison Between Suture Annuloplasty and Rings Annuloplasty

The purpose of this study was to review our experience with modified De Vega tricuspid annuloplasty versus ring annuloplasty for treating functional tricuspid regurgitation (TR). In all, 448 consecutive patients undergoing tricuspid annuloplasty with concomitant procedures between 2000 and 2012 were included. Modified De Vega annuloplasty was performed in 216 patients (group 1) and ring annuloplasty in 232 patients (group 2). Clinical and echocardiographic follow-up results were used to assess TR grade. Recurrent TR was defined as grade 2 or greater at echocardiography. Preoperative clinical and echocardiographic characteristics were comparable in the two groups. Early mortality was similar (group 1, 0.9%, versus group 2, 1.3%; p<0.67). Follow-up was available for 97%; New York Heart Association class and symptoms of right-side heart failure were significantly improved. Survival rates at 1 and 5 years were comparable (97% and 84% for group 1, and 96% and 82% for group 2, respectively). Postoperative echocardiography showed significant improvement in tricuspid valve function, with reduction in TR grade from 3.4 to 0.6, and no differences between groups. However, recurrence-free survival was better for group 2 than for group 1 (78.8% versus 74.5%; p<0.62). Risk factors for recurrent TR included severity of preoperative TR, atrial fibrillation, and pulmonary hypertension. The modified De Vega tricuspid annuloplasty is acceptable for repair of functional TR and improvements in clinical and echocardiographic status on a long-term basis, although the long-term recurrence-free survival appeared to be lower than that for ring annuloplasty.

Long-Term Recurrence-Free Survival After Metachronous Surgery of the Stomach and Liver for Gastric Adenocarcinoma and Multiple, Synchronous Liver Metastases: A Case Report and Review of Literature

This report describes a 58-year-old woman with gastric adenocarcinoma and liver metastases, who survives for more than 18 years after diagnosis. At diagnosis and first surgery, a moderately differentiated gastric adenocarcinoma with subserosal invasion was detected, along with 2 regional lymph node metastases and 2 liver metastases. She underwent gastrectomy and regional lymph node dissection but did not undergo liver operation then. After gastrectomy, she received adjuvant chemotherapy for 1 month but discontinued it due to severe diarrhea. Another metastasis in another area of the liver was detected, for which she underwent excision of the right lobe of the liver (subsegments 5, 6, and 7) about 30 months later. No signs of recurrence have been detected for 18 years (as of March 2012). This patient represents a rare case of long-term survival of gastric adenocarcinoma without recurrence after surgical treatment, despite multiple, synchronous, liver and regional lymph node metastases.

Should Local Therapy for Invasive Breast Cancer Be Customized on the Basis of Subtype?

Microarray analyses have identified intrinsic breast cancer subtypes with distinct gene expression profiles. These subtypes can be approximated by immunohistochemical analysis of markers routinely available in pathology reports, in particular hormone receptors (HR) and HER2. These approximated subtypes can be used to stratify patients with regard to long-term recurrence-free and breast cancer-specific survival, and local-regional recurrence (LRR)-free survival. Patients who are HR−/HER2− have the highest risk of LRR; however, there are no data supporting more aggressive local-regional treatment with surgery or radiation to reduce that risk for this group. It is possible that local-regional therapy could be limited for patients with more favorable subtypes (HR+/HER2−); however, more data are needed to support this strategy.

PD-0004 Perioperative Chemotherapy Including Bevacizumab in Potentially Curable Metastatic Colorectal Cancer; A Multicenter, Single Arm Phase I/II Trial: Asso Lm1

ABSTRACT Introduction Patients with colorectal cancer (CRC) and liver metastases may benefit from pre- and postoperative chemotherapy and disease resection. Best treatment sequence, length and combination still needs to be determined. We evaluated Bevacizumab and XELOX in a multicenter approach. Resectabilty was the primary endpoint, periOP morbidity, response rate, recurrence-free and overall survival the secondary end points. Methods Patients with liver metastases from CRC potentially curable by resection were eligible for this trial. Patients received Bevacizumab 5mg/kg (day 1), oxaliplatin 85mg/m2 (day 1) and Capecitabine 3000mg/m2/day (days 1–7) of a 2-week cycle for six cycles. The sixth cycle did not include Bevacizumab, resulting in 5 weeks between the last Bevacizumab dose and surgery. Therapy with Bevacizumab plus XELOX was restarted 5 weeks after surgery for another six cycles. Response rates were assessed by the PIs and after central review, pathological response was assessed centrally according to Rubbia-Brandt. Results 43 patients (pts) with a median age of 66 years (38-80) were enrolled into this multicenter trial. 78% of these pts had synchronous disease, 51% of these started treatment without primary tumor resection. The median number of metastases was 2 (1-10) and median Fong score was 3 (0-4). In total of 8 pts were ineligible for resection, 1 due to PD, 7 due to protocol violation or personal reason. Resectability of operated patients was 97% with 34 R0 resections and one R1 resection. Postoperative morbidity occurred in 22% of the pts, 3 operative revisions were related to the primary tumor resection. Efficacy results for response in 38 eligible patients confirm an ORR of 66%, 31% SD and 3% PD according to RECIST. Preoperative grade 3/4 adverse events were 17% diarrhea, 5% HFS, 2% neuropathy and 5% thromboembolic events. Histological assessment of resected metastases revealed a major histological response in 56%, a partial histological response in 28%, and no histological response in 16%. Recurrence-free (RFS) and overall survival (OS) significantly differed dependent upon the fulfillment of the adjuvant treatment cycles in curative resected patients (24 pts completed periOP CTx vs 10 pts neoCTx only): median RFS was 26.2 months in patients receiving postsurgical Bev + Xelox vs. 7.4 months in those without postOP therapy (p Conclusion These data demonstrate that Bevacizumab and XELOX provide substantial response rates with well-known adverse events in this potentially curative mCRC setting. In patients eligible for resection after 3 months of neoadjuvant therapy perioperative morbidity is not increased compared to studies without Bevacizumab. Long-term recurrence-free and overall survival was significantly prolonged in our study in patients receiving postoperative chemotherapy plus Bevacizumab.

術後7年無再発生存中の紡錘細胞型退形成性膵管癌の1例

症例は63歳男性で，心窩部痛と黄疸を主訴に発症した．膵鈎頭部に2.5 cm大の乏血性腫瘤を認め, 膵鈎頭部癌の診断で膵頭十二指腸切除術を施行．病理組織学的検査の結果，紡錘細胞型退形成性膵管癌（anaplastic ductal carcinoma of the pancreas；以下，ADCと略記）と診断された．補助化学療法は施行せず，術後7年無再発生存中である．ADCは浸潤性膵管癌の一亜型であり，まれで予後不良な腫瘍である．その細胞形態から紡錘細胞型を含め4型に分類されるが，これまでに紡錘細胞型における長期生存例の報告はない．ADC本邦報告例に自験例を加えた検討を行い，報告する．

Patients with non-[18F]fludeoxyglucose-avid advanced hepatocellular carcinoma on clinical staging may achieve long-term recurrence-free survival after liver transplantation

There is increasing evidence that a relevant number of patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria may benefit from liver transplantation (LT). We retrospectively analyzed the prognostic significance of [(18) F]fludeoxyglucose ([(18) F]FDG) positron emission tomography (PET) for identifying appropriate LT candidates with advanced HCC on clinical staging. Between 1995 and 2008, 111 patients with HCC were listed for LT. All underwent a pretransplant PET evaluation. LT was performed for 91 of these patients. The tumor recurrence rate after LT was 3.6% for patients with non-[(18) F]FDG-avid (PET(-) ) tumors, but it was 54.3% for patients with [(18) F]FDG-avid (PET(+) ) tumors (P < 0.001). The 5-year recurrence-free survival rates were comparable for patients with tumors meeting the Milan criteria (86.2%) and patients with PET(-) HCC exceeding the Milan criteria (81%) at LT, but these rates were significantly higher than the rate for liver recipients with [(18) F]FDG-avid advanced HCC (21%, P = 0.002). In a multivariate analysis, negative PET findings (odds ratio = 21.6, P < 0.001), an alpha-fetoprotein level <400 IU/mL (odds ratio = 3.3, P = 0.013), and a total tumor diameter <10 cm (odds ratio = 3.0, P = 0.022) were identified as pretransplant prognostic variables for recurrence-free survival. A PET(+) status was assessed as the only independent clinical predictor of tumor-related patient dropout from the waiting list (hazard ratio = 5.7, P = 0.01). Patients with non-[(18) F]FDG-avid HCC beyond the Milan criteria according to clinical staging may achieve excellent long-term recurrence-free survival after LT.