Long-term Recurrence-free Survival Research Articles

The addition of paclitaxel to doxorubicin and cisplatin and volume-directed radiation does not improve overall survival (OS) or long-term recurrence-free survival (RFS) in advanced endometrial cancer (EC): A randomized phase III NRG/Gynecologic Oncology Group (GOG) study

ObjectivesTo determine if the addition of paclitaxel (P) to cisplatin and doxorubicin (CD) following surgical debulking and volume-directed radiation therapy improved long-term, recurrence-free survival (RFS) and overall survival (OS) in patients with advanced-stage endometrial cancer (EC). MethodsProspective, randomized GOG trial comparing (CD) (50 mg/m2)/(45 mg/m2) +/− (P) (160 mg/m2) following volume-directed radiation and surgery in advanced EC. A Kaplan-Meier (KM) analysis characterized the relationship between treatment arms and the OS outcome, a log-rank test assessed the independence of treatment with the OS outcome, and the treatment effect on estimated OS was determined using a Cox proportional hazards (PH) model stratified by stage. The PH assumption was assessed using a test of interaction between treatment variable and the natural logarithm of survival time. Adverse events, regardless of attribution, were graded. ResultsSince initial publication, 60 deaths occurred, leaving 311 patients alive with 290 (93.8%) recurrence- free. There was no significant decrease in the risk of recurrence or death associated with the CDP treatment regimen stratified for stage (p = 0.14, one-tail). The exploratory analysis for OS and the corresponding homogeneity tests for different effects across subgroups revealed only EFRT and EFRT & GRD status to have significantly different treatment effects (p = 0.027 and p = 0.017, respectively). Second primary malignancies were identified in 17/253 (6.4%) and 19/263 (7.0%) of patients treated with CD and CDP respectively. Breast (2.4%) followed by colon (1%) were the two cancers most frequently diagnosed in this setting. ConclusionNo significant difference between treatment arms was identified. Subgroup analysis both in the initial and current reports demonstrated a trend towards improved RFS and OS in patients treated with CDP and EFRT. This long-term analysis of outcomes also identified the necessity of providing on-going cancer screening to patients enrolled in trials.

The effect of adjuvant chemotherapy on survival in patients with FIGO stage I high-grade serous ovarian cancer

ObjectiveThe benefit of adjuvant chemotherapy for FIGO stage I, high-grade serous ovarian cancer (HGSOC) after optimal staging is a matter of debate. We investigated the effect of adjuvant chemotherapy on recurrence-free survival (RFS) and overall survival (OS) in a population-based cohort study. MethodsAll patients diagnosed in the Netherlands between 2002 and 2014 with FIGO stage I HGSOC who underwent surgical staging were included. Data on clinical characteristics, histopathology, completeness of staging and survival were collected from the Netherlands Cancer Registry and Dutch Pathology Registry. Recurrence data was collected from hospital files. We used Kaplan-Meier methods to estimate RFS and OS and Cox-proportional hazard analyses to control for differences in baseline characteristics between patients who did or did not receive chemotherapy. ResultsWe identified 223 patients who underwent optimal staging procedures including lymph node sampling. Events of disease recurrence occurred in 21 of the 101 patients (21%) who received adjuvant chemotherapy and in 46 of the 122 patients (38%) who did not (multivariable hazard ratio (HR), 0.37; 95%CI 0.22–0.64; p < 0.01). Five-year RFS was 81% after staging plus chemotherapy and 59% after staging only. At a median follow-up of 105 months, 21 patients (21%) in the chemotherapy group and 38 patients (31%) in the no-chemotherapy group had died (multivariable HR 0.50; 95%CI 0.28–0.89; p = 0.02). Ten-year OS was 78% with chemotherapy and 62% without chemotherapy. ConclusionsAdjuvant chemotherapy improves long-term RFS and OS in patients with FIGO stage I HGSOC after optimal staging.

Gastrointestinal stromal tumors (GISTs) with remarkable cystic change: a specific subtype of GISTs with relatively indolent behaviors and favorable prognoses

PurposeGastrointestinal stromal tumors (GISTs) are typically solid neoplasms with small cystic change detected occasionally but in rare instances may present predominantly as cystic lesions. The histopathologic features and prognoses of cystic GISTs (cGISTs) are poorly understood.MethodsWe herein reviewed 20 cGISTs resected or consulted in our institution from January 1, 2003 to December 31, 2014.ResultsOf the 20 patients included, the mean age was 61 years and the male-to-female ratio was 9:11. The original locations were the stomach (n = 10, 50%), the small intestine (n = 9, 45%) and the omentum (n = 1, 5%). Indistinct diagnosis or misdiagnosis was established in 15 cases based only on preoperative radiology. Grossly, the cystic component made up the bulk of masses and was filled by dark bloody fluid and necrotic debris in 18 cases. Microscopically, cyst wall was composed of neoplastic spindle (n = 14, 70%)/epithelioid cells (n = 6, 30%) and collagenous fiber, with necrotic debris and granulation tissue lining on the inner surface. cGISTs resembled their solid counterparts in terms of morphology and immunohistology but demonstrated fewer malignant parameters. c-kit or PDGFRα mutations were detected in eleven cases with the remaining being wild type for these two mutations. Although classified as intermediate or high (3 and 17, respectively) risk of recurrence according to modified National Institute of Health criterion, most patients with cGISTs experienced long-term recurrence-free survival without adjuvant imatinib.ConclusionsCystic GISTs is a relatively indolent subset of GISTs with favorable prognoses and adjuvant imatinib should be a prudent consideration.

P091 STAPLED END-TO-SIDE VS. SIDE-TO-SIDE ANASTOMOSIS AFTER ILEOCECECTOMY FOR CROHN’S DISEASE: A PROPENSITY SCORE-MATCHED ANALYSIS

Ileocolic resection (ICR) is the most common surgical procedure for Crohn’s disease (CD). Anastomotic construction is most commonly achieved with stapled side-to-side (SSTS) or hand-sewn end-to-end anastomosis (ETE), with the decision often made by tissue quality, surgeon experience, and surgeon preference. Another option that combines advantages of both SSTS and ETE, and which is extensively used at our institution, is the Stapled End-to-Side anastomosis (SETS). SETS recapitulates the normal anatomy with the ileum entering the colon at a right angle, and facilitates reconstruction in the face of a lumen size discrepancy between colon and ileum. However, results after SETS have not previously been reported. Therefore, we aimed to compare short-term septic complications and long-term recurrence-free survival of CD between patients who underwent SETS vs. SSTS. This study was a retrospective analysis of a prospectively maintained database over a 5-year period. All patients who underwent resection and anastomosis for terminal ileal CD from 01/2012–12/2016 were included. Patients who had a stoma, or other type of anastomosis were excluded. Surgeries were done for 27 surgeons. The two groups were compared with univariate analysis. Recurrence (Rutgeerts>=i2 or active disease on CT/MRI) rates were assessed using Kaplan-Meier curves and a log-rank test. Cox-proportional hazard and linear regression models with propensity score inverse probability of treatment weighting were used to further evaluate postoperative outcomes and recurrence of CD. Numbers represent median or proportion as noted. A total of 383 patients were analyzed:181 underwent SETS and 202 underwent SSTS. There were no differences between the groups regarding demographics and disease characteristics, except SETS patients had less weight loss (8% vs.15%, p=0.04) and fewer phlegmons (5% vs. 10%, p=0.05). SETS operations were shorter (120 vs.133 min., p=0.02), and fewer were performed laparoscopically (46% vs. 65%, p=0.001). Patients who underwent SETS compared to STSS had surgeons with more years of experience, 23 vs.11 years, p<0.001, respectively. There was no significant difference in any short-term outcome between the two groups on univariate analysis (Fig.1). The Kaplan-Meier analysis (Fig.2) for recurrence showed no difference in recurrence rates. After inverse probability of treatment weighting using the propensity score and number of postoperative medications, there was no significant difference in any of the outcomes between the two groups. At our center, SETS and SSTS anastomoses in patients undergoing ICR for CD, after rigorous adjustment for confounders, were comparable with respect to short-term complications and long-term recurrence rates. Therefore SETS remains a viable method for reconstruction, especially in the case of bowel lumen size mismatch.

P086 HANDSEWN ANASTOMOSIS AFTER ILEOCOLIC RESECTION FOR CROHN’S DISEASE: A LOST ART?

Ileocolic resection (ICR) is the most common surgical procedure for Crohn’s disease (CD). Reconstruction is most commonly achieved with stapled side-to-side (SSTS) or hand-sewn (HS) ileocolic anastomosis (ICA), depending on tissue quality, surgeon experience, and surgeon preference. We aimed to compare short-term complications and long-term recurrence-free survival of CD between patients who underwent SSTS vs.HS anastomoses in our institution. This study was a retrospective analysis of a prospectively maintained database over a 5-year period. All patients who underwent ICR and ICA for terminal ileal CD from 01/2012–12/2016 were included. HS group included 53 end-to-end, 5 side-to-side, and 1 end-to-side cases. Surgeries were done for 26 surgeons. Patients who had a stoma or other types of anastomoses were excluded. The two groups were compared in a univariate analysis. Recurrence (Rutgeerts≥i2 or active disease on CT/MRI) rates were assessed using Kaplan-Meier curves and a log-rank test. Cox-proportional hazard and linear regression models with propensity score inverse probability of treatment weighting were used to further evaluate postoperative outcomes and recurrence of CD. Numbers represent median or proportion as noted. 261 patients were analyzed: 59 in the HS group and 202 in the SSTS group. Patients in the HS group had a longer course of disease (16 vs.9 years, p=0.005), were more likely to have previous surgeries (59 vs.42%, p=0.02), perianal disease (39 vs.23%, p=0.02) and redo ICA (56 vs.33%, p=0.001). There was no difference between the groups in preoperative or postoperative use of medications. More HS patients were ASA class 3 (65 vs.40%, p=0.004), and HS operations were longer (157 vs.133min., p<0.001), with more blood loss (150 vs.50ml, p<0.001), and fewer were laparoscopic (41 vs.65%, p<0.001). Patients who underwent HS compared to STSS had surgeons with more years of experience, 16 vs.11 years, p<0.001, respectively. For postoperative outcomes, HS patients had longer lengths of stay (6 vs.5 days, p=0.02). The Kaplan-Meier analysis for recurrence showed no difference in recurrence rates. After propensity score weighting and adjustment for covariates, HS patients had less than 1/3 of the odds of Clavien-Dindo≥3 complication compared to SSTS group (OR0.29 [0.09-0.92], p=0.03). At our center after ICR for CD, HS anastomoses, compared to SSTS anastomoses, were independently associated with a lower rate of major postoperative complications, despite being performed in more complex patients. In addition, no difference in recurrence rates between groups was observed. Thus, colorectal surgeons should be facile and confident in performing HS procedures, especially in difficult situations (advanced or recurrent disease, previous surgeries, and high morbidity patients), lest HS become a lost art.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

P091 STAPLED END-TO-SIDE VS. SIDE-TO-SIDE ANASTOMOSIS AFTER ILEOCECECTOMY FOR CROHN’S DISEASE: A PROPENSITY SCORE-MATCHED ANALYSIS

Ileocolic resection (ICR) is the most common surgical procedure for Crohn’s disease (CD). Anastomotic construction is most commonly achieved with stapled side-to-side (SSTS) or hand-sewn end-to-end anastomosis (ETE), with the decision often made by tissue quality, surgeon experience, and surgeon preference. Another option that combines advantages of both SSTS and ETE, and which is extensively used at our institution, is the Stapled End-to-Side anastomosis (SETS). SETS recapitulates the normal anatomy with the ileum entering the colon at a right angle, and facilitates reconstruction in the face of a lumen size discrepancy between colon and ileum. However, results after SETS have not previously been reported. Therefore, we aimed to compare short-term septic complications and long-term recurrence-free survival of CD between patients who underwent SETS vs. SSTS. This study was a retrospective analysis of a prospectively maintained database over a 5-year period. All patients who underwent resection and anastomosis for terminal ileal CD from 01/2012–12/2016 were included. Patients who had a stoma, or other type of anastomosis were excluded. Surgeries were done for 27 surgeons. The two groups were compared with univariate analysis. Recurrence (Rutgeerts>=i2 or active disease on CT/MRI) rates were assessed using Kaplan-Meier curves and a log-rank test. Cox-proportional hazard and linear regression models with propensity score inverse probability of treatment weighting were used to further evaluate postoperative outcomes and recurrence of CD. Numbers represent median or proportion as noted. A total of 383 patients were analyzed:181 underwent SETS and 202 underwent SSTS. There were no differences between the groups regarding demographics and disease characteristics, except SETS patients had less weight loss (8% vs.15%, p=0.04) and fewer phlegmons (5% vs. 10%, p=0.05). SETS operations were shorter (120 vs.133 min., p=0.02), and fewer were performed laparoscopically (46% vs. 65%, p=0.001). Patients who underwent SETS compared to STSS had surgeons with more years of experience, 23 vs.11 years, p<0.001, respectively. There was no significant difference in any short-term outcome between the two groups on univariate analysis (Fig.1). The Kaplan-Meier analysis (Fig.2) for recurrence showed no difference in recurrence rates. After inverse probability of treatment weighting using the propensity score and number of postoperative medications, there was no significant difference in any of the outcomes between the two groups. At our center, SETS and SSTS anastomoses in patients undergoing ICR for CD, after rigorous adjustment for confounders, were comparable with respect to short-term complications and long-term recurrence rates. Therefore SETS remains a viable method for reconstruction, especially in the case of bowel lumen size mismatch.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis.

The recommended therapy for type I FIGO IB endometrial cancer (EC) is hysterectomy and adnexectomy, but the therapeutic benefits of additional pelvic and paraaortic lymph node dissection (LND) are still under discussion. In this study, we retrospectively evaluated overall survival (OAS) and recurrence-free survival (RFS) among patients with type I FIGO IB EC who did undergo systematic or elective lymphadenectomy or none at all. We selected 299 individuals from the database of the German Tumor Centre Regensburg who were diagnosed between 1998 and 2015 with endometrial adenocarcinoma of the uterus type I FIGO IB. We applied multivariable Cox regression to the selected patient data and estimated hazard ratios for OAS and RFS against the performed intervention. Further, we carried out risk adjustments with respect to clinicopathological parameters, and performed model selection using conditional stepwise forward selection. We observed significant benefits of LND in the unadjusted survival analysis; however, we did not confirm this effect in multivariable regression analysis upon risk adjustment. In this case, hazard ratio (HR) for OAS in patients without LND versus patients with LND is reduced to 1.214 (95% CI 0.771-1.911; p = 0.402), HR for RFS is 1.059 (95% CI 0.689-1.626; p = 0.795). Similarly, we were also able to eliminate the statistical benefit of systematic versus elective LND by risk adjustment. In contrast to previous observations in high-grade EC, our study provides compelling evidence that LND, in particular systematic lymphadenectomy, is not beneficial for patients with type I FIGO IB EC in terms of long-term OAS and RFS.

Surgical Outcomes, Complications, and Management Strategies for Foramen Magnum Meningiomas.

Objectives Foramen magnum meningiomas (FMM) are complex lesions because of their proximity to the brain stem and posterior cerebrovasculature. The objective of this study is to report surgical outcomes and complications after resection of FMM. Methods A retrospective chart review was conducted on patients with FMM from 1998 to 2015. Univariate logistic regression and recursive partitioning analysis were used to identify risk factors associated with complications and extent of resection (EOR). Results We identified 28 patients with FMM. Median follow-up was 5.9 years. Tumors were World Health Organization grade I (92.9%) or grade II (7.1%). The vertebral artery was completely encased (25%), partially encased (11%), or not encased (64%). Median size was 11.9 cm 3 . EOR was gross total (39%) and subtotal (61%). The observed recurrence rate was 4% ( n = 1). There were 38 complications in 12 patients (43%), and 6 patients (21%) had complications requiring additional surgery. Complications included cerebrospinal fluid leak/hydrocephalus ( n = 7, 25%), weakness ( n = 4, 14%), numbness ( n = 4, 14%), and cranial nerve deficits: IX, X ( n = 4, 14%), XI ( n = 2, 7%), XII ( n = 5, 18%). Medical complications included pneumonia ( n = 1, 4%) and meningitis ( n = 1, 4%). Tumor volume greater than 14 cm 3 (odds ratio [OR] = 21.7, p = 0.0010), any vertebral artery encasement (OR 6.1, p = 0.0386), and subtotal resection (OR 6.4, p = 0.0398) were significantly associated with complications. Tumor volume greater than 14 cm 3 was also significantly associated with subtotal resection (OR 8.3, p = 0.0201). Conclusions Resection of FMM carries perioperative morbidity that increases with larger tumor size. Despite the morbidity, long-term recurrence-free survival is achievable with maximal safe resection and adjuvant radiation.

Prognosis of Hepatocellular Carcinoma Patients Who Achieved Long-Term Recurrence-Free Survival After Curative Therapy: Impact of the ALBI Grade

Background/AimsSome patients experience very late recurrence of HCC more than 5 years after initial therapy. We aimed to clarify the predictive factors for very late recurrence of HCC in such cases. MethodsAmong 807 HCC patients undergoing surgical resection or ablative therapy with curative intent, the patients who survived for 5 years without any recurrence were reviewed. The prognosis and possible predictive factors for late recurrence were analyzed retrospectively. ResultsA total of 184 patients survived for more than 5 years without recurrence. Among them, 61 patients experienced recurrence, at a median of 6 years after initial therapy. In univariate analysis, the pre-treatment aspartate aminotransferase, alanine aminotransferase, Child-Pugh class, and ALBI grade were not related to recurrence, but those at 5 years after treatment were significantly related to recurrence. By multivariate analysis, an ALBI grade of 2–3 at 5 years was an independent risk factor for recurrence (P<0.0001). Moreover, variation of the ALBI grade over the 5 years after the initial treatment was significantly related to recurrence-free survival. ConclusionsThe ALBI grade is an effective index of the variation in liver function after curative therapy and may be a useful prognostic factor for the long-term recurrence-free survival of HCC patients.

Correlation between the expression of androgen receptor mRNA and the long-term tumor-specific and recurrence-free survival rate in patients with T1 bladder cancer

Objective To investigate the predictive value of androge receptors in stage pT1 non-muscle-invasive bladder cancer. Methods A total of 196 patients with stage pT1 non-muscle-invasive bladder cancer who underwent a transurethral resection of the bladder in Baoji People′s Hospital from February 2003 to June 2012 were recruited to carry a retrospective analysis. The mRNA expression of the androge receptors transcript variants 1 (AR1) and 2 (AR2) was measured by quantitative real-time PCR. Spearman′s correlation coefficient was used to analysis the correlation of androge receptors mRNA level to KRT5 and KRT20 mRNA. Results Kaplan-Meier analysis indicated that the recurrence-free survival, progression-free survival and cancer specific survival of patients with high AR1 mRNA expression (≥35.47) were significant better than patients with low AR1 mRNA expression (P<0.05). Multivariate COX regression analysis revealed that high AR1 mRNA expression was an independent prognostic marker for recurrence-free survival and cancer specific survival (P<0.05). Spearman rank correlation revealed a significant positive association between mRNA expression of AR1 and KRT5 (rs=0.3171, P<0.001) as well as a negative association with multifocal tumors (rs=0.1478, P<0.05). Conclusion Androge receptors mRNA expression can predict recurrence-free survival and cancer specific survival in patients with stage T1 non-muscle-invasive bladder cancer. Further studies on the levels of androge receptors mRNA tend to be particularly important. Key words: Receptors, androge; Urinary bladder neoplasms; RNA, messenger; Survival

Роль ендоваскулярних методик ремоделювання печінки в хірургічній гепатології

Objective — to study the results of surgical treatment of patients with liver tumors who underwent embolization of the portal vein branches (PVE) as a remodeling of the planned hepatic remnant. Materials and methods. PVE was performed in 485 patients in the period from 2003 to 2018. For all patients the calculation of the volume of the planned hepatic balance was performed before PVE and before liver resection. The level of postoperative morbidity and mortality, as well as long-term overall and recurrence-free survival was investigated comparing a group of patients who were not treated with PVE before resection of the liver. Results. In all patients after the portal vein embolization, an increase in the residual volume of the liver was observed on average by 58.6 %. The degree of hypertrophy was found to depend on the extention of embolization performed. Radical resection of the liver was performed in 397 (81.9 %) patients. In the main group of patients, a decrease in the incidence of acute postoperative liver failure from 9.3 % to 2.3% was observed and the decrease in postoperative mortality from 8.8 % to 4.6 %. Compared to the group of patients, were the endovascular remodeling techniques before liver resection had not been used. Distant total 3-year and 5-year postoperative survival in these groups is not significantly different. Conclusions. Embolization of the portal vein branches is a necessary method of preparing patients with a small estimated hepatic remnant for expanded liver resection and allows to reduce postoperative morbidity and mortality in this group of patients.

Résultats oncologiques à long terme des patients ayant un cancer de la prostate traité par prostatectomie totale et curage ganglionnaire avec atteinte métastatique ganglionnaire infraclinique

The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection. This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS. Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. 4.

Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: Percutaneous biliary drainage has no adverse effects on survival.

The objective of the current study was to define long-term survival of patients with resectable hilar cholangiocarcinoma (HCCA) after preoperative percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD). Between 2000 and 2014, 240 patients who underwent curative-intent resection for HCCA were identified at 10 major hepatobiliary centers. Postoperative morbidity and mortality, as well as disease-specific survival (DSS) and recurrence-free survival (RFS) were analyzed among patients. The median decrease in total bilirubin levels after biliary drainage was similar comparing PTBD (n = 104) versus EBD (n = 92) (mg/dL, 4.9 vs 4.9, P = 0.589) before surgery. There was no difference in baseline demographic characteristics, type of surgical procedure performed, final AJCC tumor stage or postoperative morbidity among patients who underwent EBD only versus PTBD (all P > 0.05). Patients who underwent PTBD versus EBD had a comparable long-term DSS (median, 43.7 vs 36.9 months, P = 0.802) and RFS (median, 26.7 vs 24.0 months, P = 0.571). The overall pattern of recurrence relative to regional or distant disease was also the same among patients undergoing PTBD and EBD (P = 0.669) CONCLUSIONS: Oncologic outcomes including DSS and RFS were similar among patients who underwent PTBD versus EBD with no difference in tumor recurrence location.

Neuroendoscopic Treatment of Cystic Craniopharyngiomas: A Case Series with Systematic Review of the Literature.

Total removal of craniopharyngiomas is burdened by high morbidity. In cases of a cystic or mixed craniopharyngioma, when the symptoms are caused by the cystic component of the tumor, a less invasive surgical approach aiming at cyst drainage may be recommended. Here, we report our experience with intraventricular neuroendoscopy, describe our clear-cut surgical technique, and analyze results in the context of literature data. We reviewed the clinical data of 8 consecutive adult patients affected by cystic or mixed craniopharyngioma who were treated with intraventricular neuroendoscopy at our institution in the last decade. At surgery, wide opening and emptying of the cyst was performed; a ventricular catheter with adjunctive holes was then placed to maintain a continuous cerebrospinal fluid (CSF) washout. A systematic review of the pertinent literature was performed and a pooled analysis of individual data from selected studies was made. Ten neuroendoscopic procedures were performed. The treatment determined immediate neurologic and radiologic improvement without significant complications in all patients. No chemical meningitis was observed. Recurrence rate was 20%, in line with literature data. Median progression-free survival was 57 months. The systematic review of the literature showed that neuroendoscopy carries a lower recurrence rate than stereotaxy (P= 0.0390). Moreover, the creation of a cyst-CSF communication is a protective factor against recurrences. Finally, adjuvant radiotherapy determined no significant differences in terms of cyst recurrence rate. We describe a neuroendoscopic treatment of cystic craniopharyngiomas that, without adjuvant radiotherapy, is safe and effective and ensures long-term recurrence-free survival.

Cycles of cisplatin and etoposide affect treatment outcomes in patients with FIGO stage I-II small cell neuroendocrine carcinoma of the cervix.

This study sought to explore the outcomes and prognostic factors of patients with small cell neuroendocrine carcinoma of the cervix (SCNEC) and to determine the effects of adjuvant treatment on survival in patients with FIGO stage I-II SCNEC after radical surgery. A single-institution retrospective analysis was performed in 92 patients who underwent radical surgery for SCNEC. All clinicopathological variables and treatment strategies were reviewed. Kaplan-Meier and Cox regression methods were used for survival analyses. During a median follow-up period of 38months (23.6-52.4), 43 (46.7%) patients experienced disease recurrence, and distant metastases were documented in 35 (81.4%) patients. The 3-year recurrence-free survival (RFS) for the entire group was 50.1%. The median RFS was 39months. The multivariate analysis confirmed that lymph node metastasis, positive parametrial extension and cycles of etoposide plus platinum (EP) were independent prognostic factors for disease recurrence. Adjuvant chemotherapy for at least 5cycles of EP (EP 5+, n=39) was associated with improved 5-year RFS compared with other treatments (n=46) (67.6% vs. 20.9%, p<0.001). Additional radiotherapy or concurrent chemoradiation failed to validate further improved RFS in patients with EP 5+, and this finding was consistent in the subset of patients with high-risk factors (positive lymph nodes or positive parametrium). Half of stage I-II SCNEC patients experienced disease failure within 3years, and distant metastasis was an outstanding issue. EP regimen for at least 5cycles improved long-term RFS after radical surgery. Additional radiation might be unnecessary, even in patients with high-risk factors.

P12.18 A case of malignant meningioma with long-term recurrence free survival

P12.18 A case of malignant meningioma with long-term recurrence free survival

Long-term Recurrence-free Survival After Standard Endoscopic Resection Versus Surgical Resection of Submucosal Invasive Colorectal Cancer: A Population-based Study.

There is controversy over the optimal management for T1 colorectal cancer (T1 CRC). This study compared initial endoscopic resection with or without additional surgery, or initial surgery for T1 CRC, and assessed risk factors for lymph node metastases (LNMs) and long-term recurrence. We performed a registration study that included all patients diagnosed with T1 CRC from 1995 through 2011 in the southeast area of The Netherlands (n= 1315). High-risk histology (with regard to LNM) was defined as the presence of poor differentiation, lymphangio-invasion, and/or deep submucosal invasion. The primary outcome measure was the combined rate of local and distant CRC recurrence during a mean follow-up period of 6.6 years. Logistic regression and Cox proportional hazards regression analyses were performed to evaluate independent risk factors for LNM and CRC recurrence, respectively. Endoscopic resection was performed in 590 patients (44.9%); of these, 220 (16.7%) underwent additional surgery. Initial surgery was performed in 725 patients (55.1%). The risk of LNM was higher in T1 CRC with histologic risk factors (15.5% vs 7.1% without histologic risk factors; odds ratio, 2.21; 95% confidence interval, 1.33-3.70). Thirty-day mortality did not differ between patients who received additional surgery (0.9%) and those who underwent only endoscopic resection (1.4%; P= .631). Rates of CRC recurrence were 6.2% (9.8/1000 patient-years) after only endoscopic resection vs 6.4% (9.4/1000 patient-years) after additional surgery (P= .912), and 3.4% (5.2/1000 patient-years) after initial surgery (P= .031). In multivariate analysis, this difference was not significant. The only independent risk factor for long-term recurrence was a positive resection margin (hazard ratio, 6.88; 95% confidence interval, 2.27-20.87). Based on a population analysis of patients diagnosed with T1 CRC, additional surgery after endoscopic resection should be considered only for patients with high-risk histology or a positive resection margin.

Erratum to:Hepatic resection for predominantly large size hepatocellular carcinoma: Early and long-term results from a tertiary care center in India.

There are no large series on hepatic resection for hepatocellular carcinoma (HCC) from India. We present the results of consecutive patients of HCC treated with hepatic resection at a tertiary care center in India. The records of all patients who underwent hepatic resection for HCC in the Department of Gastrointestinal Surgery, All India Institute of Medical Sciences (New Delhi), were reviewed. The relevant perioperative and follow up data were extracted from a prospectively maintained database. Between January 1987 and December 2013, 81 patients [71 males; mean age: 49.2 ± 15.6 years] underwent hepatic resection for HCC. Of these, 23 (28 %) were cirrhotic and 36 (49 %) had hepatitis B. Hepatitis B was significantly more common in cirrhotic (77 % vs. 37 %; p = 0.001). Most patients had locally advanced disease at presentation [tumor size ≥10 cm in 61 (75 %); vascular tumor thrombus in 10 (12 %)]. Anatomical resection was done in 61 (75 %) including 56 major hepatic resections (≥3 segments). Overall in-hospital mortality was 13 (16 %) [cirrhotic 5 (22 %) vs. noncirrhotic 8 (14 %), p = 0.503]. Grade III–V complications (modified Clavien-Dindo classification) occurred in 25 (31 %) patients (cirrhotic 48 % vs. noncirrhotic 24 %; p = 0.037). Follow up information was available for 51 (75 %) patients. The median time to recurrence was 12 months, and most (86 %) occurred within 1 year. The recurrence-free survival at 1, 3, and 5 years was 48 %, 40 %, and 36 %, respectively. Positive resection margin and vascular invasion were significantly associated with very poor prognosis. Majority of Indian HCC patients present with locally advanced disease. Despite this, surgical resection provides a chance for long-term recurrence-free survival in a third of them.

Long-term recurrence-free survival after hepatic resection for metachronous gastric cancer liver metastases

: We present the case of a man who underwent total gastrectomy and splenectomy at the age of 60 for stage IIIa adenocarcinoma of the stomach. Twenty-two months after surgery abdominal CT scan showed two hepatic metastases in segments V and VI. Because of further progression under palliative chemotherapy and reduced tolerance for this treatment, partial hepatectomy of segments V-VI was performed. Currently 72 years old, he is completely symptom-free without evidence for tumor recurrence. This report shows that long-term recurrence-free survival after hepatic resection for gastric cancer liver metastases (GCLM) is possible even in the presence of several unfavorable prognostic factors.

Hepatic resection for predominantly large size hepatocellular carcinoma: Early and long-term results from a tertiary care center in India.

There are no large series on hepatic resection for hepatocellular carcinoma (HCC) from India. We present the results of consecutive patients of HCC treated with hepatic resection at a tertiary care center in India. The records of all patients who underwent hepatic resection for HCC in the Department of Gastrointestinal Surgery, All India Institute of Medical Sciences (New Delhi), were reviewed. The relevant perioperative and follow up data were extracted from a prospectively maintained database. Between January 1987 and December 2013, 81 patients [71 males; mean age: 49.2 ± 15.6years] underwent hepatic resection for HCC. Of these, 23 (28%) were cirrhotic and 36 (49%) had hepatitis B. Hepatitis B was significantly more common in cirrhotic (77 % vs. 37%; p = 0.001). Most patients had locally advanced disease at presentation [tumor size ≥10cm in 61 (75%); vascular tumor thrombus in 10 (12%)]. Anatomical resection was done in 61 (75%) including 56 major hepatic resections (≥3 segments). Overall in-hospital mortality was 13 (16%) [cirrhotic 5 (22%) vs. noncirrhotic 8 (14%), p = 0.503]. Grade III-V complications (modified Clavien-Dindo classification) occurred in 25 (31%) patients (cirrhotic 48% vs. noncirrhotic 24%; p = 0.037). Follow up information was available for 51 (75%) patients. The median time to recurrence was 12months, and most (86%) occurred within 1year. The recurrence-free survival at 1, 3, and 5years was 48 %, 40 %, and 36%, respectively. Positive resection margin and vascular invasion were significantly associated with very poor prognosis. Majority of Indian HCC patients present with locally advanced disease. Despite this, surgical resection provides a chance for long-term recurrence-free survival in a third of them.