Long-term Recurrence Research Articles

Intrapulmonary schwannoma presenting as an asymptomatic lung mass: a case report

BackgroundSchwannomas are solitary well-circumscribed encapsulated benign tumors that exhibit Schwann cell differentiation, and arise directly from myelinated peripheral or central nerves. Although they are usually asymptomatic and found incidentally, schwannomas can cause symptoms due to compression of nearby structures which, depending on the location, can make clinical presentations widely variable. Despite their rarity, schwannomas have been documented in a number of locations including the limbs, cerebellopontine angle, posterior mediastinum, and, far more infrequently, the lungs.Case presentationIn this article, we report an incidental finding of an intrapulmonary schwannoma in a 59-year-old Pakistani woman who was grossly asymptomatic upon presentation to the cardiothoracic surgery clinic. An [18F]fluorodeoxyglucose positron emission tomography/computed tomography scan revealed a lobulated soft-tissue lesion measuring 23 mm × 23 mm in the lower lobe of the right lung. A computed tomography-guided core biopsy of the mass was performed, which revealed a benign spindle cell lesion based on histopathological examination and immunohistochemical staining. The mass was surgically resected via a right lower lobectomy, and subsequently confirmed to be an encapsulated neoplastic lesion composed of well-differentiated Schwann cells. There were no short- or long-term complications, morbidities, or recurrences based on 1-year follow-up.ConclusionThis report underscores the predominantly asymptomatic nature of schwannomas and reemphasizes the efficacy of surgical resection as a safe and curative procedure for a tumor of this nature. Albeit very rare, intrapulmonary schwannomas can be considered a differential diagnosis when encountering solitary asymptomatic pulmonary nodules or masses.

Radiological Analysis of the Syndesmosis Concept in Metatarsus Primus Varus and Hallux Valgus Deformities Recurrence Prevention

Hallux valgus (HV) is a common deformity of the foot. Its postoperative recurrence is not uncommon and is closely related to the recurrence of its underlying metatarsus primus varus (MPV) deformity. The syndesmosis procedure uses 1 to 2 intermetatarsal cerclage sutures to realign the first metatarsal and then induces a biological bonding between the 2 metatarsals to prevent the MPV deformity from recurring. This radiological study aimed to assess its effectiveness in long-term MPV and HV deformities recurrence prevention. Ninety-two feet of 51 consecutive patients had syndesmosis procedures that were prospectively followed up for more than 1 y and up to 14 y, averaging 100.5 (SD 45.2) months. Patients underwent X-ray examinations regularly at fixed intervals of their feet. We used Hardy's methods in measuring the intermetatarsal angle (IMA), hallux valgus angle (HVA), and medial sesamoid position from standing foot X-rays. More than 450 relevant X-ray and photo images were submitted as Supplementary Material for online viewing and reference. There was a significant final correction of IMA from 14.30° (SD 2.70) to 6.70° (SD 1.75) (p < .0001). There was no significant increase in IMA after the sixth postoperative month to their final follow-up endpoints, regardless of their lengths. There was a significant final correction of HVA from 31.95° (SD 7.45) to 19.1° (SD 7.45) (p < .0001). This study reconfirmed past findings that the MPV deformity could be corrected without osteotomies. Creating a syndesmosis-like intermetatarsal bonding was effective for long-term MPV recurrence prevention. Three feet had postoperative stress fracture of the second metatarsal. However, the HV deformity correction was less satisfactory, and the reasons were explained.

The impact of MicroRNA-155 on the effect of cryoablation in paroxysmal atrial fibrillation.

Elevated plasma MicroRNA-155 (miR-155) levels are strongly associated with cardiac fibrosis and chronic inflammation processes. However, the relationship between miR-155 and paroxysmal atrial fibrillation (PAF) recurrence following cryoablation remains poorly explored. We aimed to evaluate whether elevated miR-155 is related to long-term AF recurrence following cryoablation. Preoperative miR-155 levels were determined in PAF patients undergoing initial cryoablation. Multivariate-adjusted Cox models were constructed to determine the relationship between miR-155 levels and PAF recurrence. Multivariate logistic regression analyses were performed to determine predictors of PAF recurrence. Of the 66 enrolled patients, 13 patients (19.7%) had recurrence at the 12-month following-up. These patients had significantly higher baseline miR-155 levels than those without PAF recurrence ((AAA ± BBB) vs. (AAA ± BBB), P < 0.05). The study results showed that miR-155 expression levels were significantly higher in the experimental group than in the control group. Additionally, logistic regression analysis revealed that miR-155 expression was positively correlated with PAF recurrence after cryoablation. Elevated preoperative miR-155 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following cryoablation.

Clinical Implication of Left Atrial Appendage Emptying Velocity in Thoracoscopic Ablation of Atrial Fibrillation.

There are limited data about predictors of atrial fibrillation (AF) recurrence after totally thoracoscopic ablation (TTA). This study investigated the clinical implication of left atrial appendage emptying velocity (LAAV) in patients undergoing TTA.Methods and Results: Patients who underwent TTA between 2012 and 2015 at a tertiary hospital were prospectively enrolled in this study. LAAV was measured and averaged over five heart beats from preoperative transesophageal echocardiography. The primary outcome was a freedom from recurrent AF or atrial flutter (AFL) detected on 24-h Holter monitoring or an electrocardiogram over a 3-year period after TTA. In all, 129 patients were eligible for analysis in this study. The mean (±SD) patient age was 54.4±8.8 years, and 95.3% were male. During the 3 years after TTA, the overall event-free survival rate was 65.3%. LAAV was an independent predictor of recurrent AF/AFL during the 3-year period after TTA (per 1-cm/s increase, adjusted hazard ratio [aHR] 0.95; 95% confidence interval [CI] 0.91-0.99; P=0.016). Event-free survival was significantly lower among patients with a low LAAV (<20 cm/s; n=21) compared with those with a normal (≥40 cm/s; n=38; aHR 6.11; 95% CI 1.42-26.15; P=0.015) or intermediate (LAAV ≥20 and <40 cm/s; n=70; aHR 2.74, 95% CI 1.29-5.83; P=0.009) LAAV. In patients with AF, LAAV was significantly associated with the risk of long-term recurrence of AF after TTA.

Predictive value of remnant-like particle cholesterol in the prediction of long-term AF recurrence after radiofrequency catheter ablation

Predictive value of remnant-like particle cholesterol in the prediction of long-term AF recurrence after radiofrequency catheter ablation

Chronic Hand Eczema Treated with an Individualised Homoeopathic Ultradilution—A Case Report

AbstractEczema is a skin disease characterised by itching, redness, scaling and can be seen anywhere on the body, and the intensity of the complaints may vary individually. Hand eczema in the acute stage presents with macules, papules, vesicles and oedema; crusting, scaling, hyperkeratosis and fissure are the leading symptoms in the chronic stage if the complaints persist, lasting longer than 3 months or relapsing two or more times per year. However, it can also impact the patient's psychological health, as seen in the current case. Conventional treatment includes topical application and even steroids which can have long-term adverse effects and recurrence. A 48-year-old female presented with eczema on the palm, which had previously been treated by the conventional method. Petroleum 200c was prescribed after case taking and repertorisation, followed by Sulphur 200c as an antipsoric to prevent the recurrence of complaints. This case was followed up for 2 years with no recurrence of the complaints. It shows that the individualised medicine followed by miasmatic prescription will cure the disease. The relationship between treatment and clinical outcome is reaffirmed based on the Modified Naranjo Criteria for Homeopathy score 9, improvement in Dermatology Quality of Life Index and photographic evidence.

Empirical Marshall vein ethanol infusion as the first-line strategy in patients with persistent atrial fibrillation undergoing mitral isthmus ablation

Abstract Background Marshall vein ethanol infusion (MVEI) as an additional therapy to conventional catheter ablation (CA) has been proved to be efficacious in patients with persistent atrial fibrillation (PeAF). However, whether empirical MVEI could be the first-line strategy in mitral isthmus (MI) ablation has seldomly been investigated. Objective To compare the efficacy, safety and long-term outcomes between provisional and empirical MVEI in PeAF patients undergoing their index MI ablation. Methods We enrolled 133 propensity-score matched patients with PeAF at a ratio of 1:2.5 either into the provisional group (n=38, MVEI was performed when conventional endocardial and/or epicardial ablations were inadequate to achieve bidirectional MI block) or the empirical group (n=95, MVEI was applied empirically before MI CA). Baseline characteristics, procedure results and long-term outcomes were compared between groups. Results All of the baseline characteristics were comparable. Less spontaneous or inducible atrial tachycardias (ATs) including MI-dependent ones were encountered in the empirical group (P&amp;lt;0.001). More epicardial ablations were applied (26.3% vs 9.5%, P=0.016) and higher incidence of CA-facilitated restoration of sinus rhythm was recorded (86.8% vs 11.7%, P&amp;lt;0.001) in the provisional group. Although more fluoroscopy time (6.4[4.2, 9.3] vs 9.5[5.9, 11.6] min, P=0.019) and radiation exposure (69.0[25.3, 160.2] vs 122.0[62.5, 234.1] mGy, P=0.010) were documented in the empirical group with comparable procedure time, less time was consumed to achieve bidirectional MI block during endocardial ablation in the empirical group (455.9±192.2 vs 366.5±161.3 sec, P=0.038). Incidences of procedure-related complications were similar between groups. During a 16.5±4.4-month follow-up, the empirical group showed significantly higher freedom from AT recurrence (81.6% vs 95.8%, log-rank P=0.003), while the freedoms from AF recurrence were similar. Both univariate (HR 0.19, 95%CI 0.05-0.64, P=0.008) and multivariate (HR 0.25, 95%CI 0.07-0.92, P=0.037) Cox regression analyses indicated that empirical MVEI was independently associated with lower long-term AT recurrence. Conclusion Among patients with PeAF underwent their index MI ablations, empirical MVEI could reduce the endocardial MI ablation time and improve the long-term freedom from AT recurrence.Flowchart of the study.Freedoms from AF and AT recurrence

Long-term recurrence of new-onset post-operative AF in cardiac surgery patients as detected by an implantable loop recorder: a systematic review and individual participant data meta-analysis

Abstract Introduction New-onset atrial fibrillation (AF) occurs in 25-50% of patients after cardiac surgery. For some patients, post-operative AF (POAF) is thought to be a transient entity, while in others it represents a first presentation of paroxysmal or persistent AF. The long-term rate of AF recurrence in patients with POAF is not well defined. Objective To estimate the recurrence of AF in patients who had new-onset POAF following cardiac surgery as evaluated with an implantable loop recorder (ILR). Methods We searched MEDLINE, Embase and Cochrane CENTRAL to August 18, 2022 for studies of adult patients without a history of AF, who had POAF detected following cardiac surgery and received an ILR. We defined AF occurring in the first 30 days after surgery as POAF. We defined AF occurring beyond 30 days after surgery as AF recurrence. We contacted authors of eligible studies with a request to contribute individual participant time-to-event data on AF recurrence and participant demographics at the study level. When individual data were not available, we estimated events from figures in published study records. We constructed a Kaplan-Meier curve illustrating the time to first AF recurrence, with 95% confidence intervals (CIs). Results From 8111 screened records, we identified 8 eligible studies (Table 1). All studies were single-centre cohorts from 7 countries including the United States of America (2), Canada, Denmark, Israel, The Netherlands, Russia and Sweden. Two studies defined AF recurrence as lasting 30 seconds, four defined AF recurrence as lasting at least 2 minutes, one defined AF recurrence as lasting at least 5 minutes and one defined AF recurrence as lasting at least 6 minutes. We received data for 6 studies and estimated events for one study; data were not available from one study. We pooled data from a total of 186 participants, with a median follow-up of 1.7 (interquartile range (IQR): 1.3 – 2.8) years. Overall, 19.7% of participants were female, 79.8% of participants had isolated CABG, and the median (IQR) CHA2DS2-VASc was 3 (1 – 6). Rates of AF recurrence beginning after the 30-day post-operative period were: 15.1% (95% CI 10.5% – 21.2%) at 3 months, 23.9% (95% CI 18.1% – 31.0%) at 6 months, 30.7% (95% CI 24.1% – 38.1%) at 12 months and 39.2% (95% CI 32.0% – 47.0%) at 18 months (Figure 1, wherein the shaded area indicates the 95% CI). Conclusions For patients with new-onset POAF following cardiac surgery, AF recurrence, as detected by an ILR, is common, with approximately 1 in 3 experiencing recurrence in the first year after surgery. The optimal strategy for monitoring for AF recurrence and its clinical sequelae in this population remains uncertain.Figure 1:Incidence of AF RecurrenceTable 1:Study Characteristics Table

Single-incision laparoscopic surgery transabdominal preperitoneal approach for recurrent inguinal hernia: A case series of long-term follow-up

Introduction and importanceLaparoscopic surgery is recommended to treat recurrent inguinal hernia (IH). Single-incision laparoscopic surgery transabdominal pre-peritoneal (SILS-TAPP) has been an option for IH repair but few studies on the application of this method for recurrent IH was conducted. We aimed to report our experience of SILS-TAPP for recurrent IH and the long-term outcomes of this technique. Case presentationTen patients of recurrent IH, including three multiple recurrences, were successfully treated with SILS-TAPP. Previous surgeries were Bassini and Lichtenstein's procedures. No perioperative complications were observed; neither additional trocar nor conversion to open surgery was needed. Median operation time was 65 (range: 45–95) minutes. Post-operative pain lasted for two to three days. Neither long-term complications nor recurrence was seen until the median follow-up time of 37 (range: 16–53) months. Clinical discussionAlthough the surgical procedure of hernia repair of SILS-TAPP was the same as conventional TAPP, the manipulation of the instrument was technically challenging. This surgical method should be done by an SILS expert with application of several surgical tips to overcome difficulties adhering to single-port surgery. Also, meticulous and patient dissection of the inguinal site is suggested. ConclusionSILS-TAPP is safe and feasible to repair recurrent inguinal hernia. However, it should be done by experienced surgeons.

Epigenetic signature discriminates lymphatic metastasis in BRAF wild-type thyroid carcinoma: methylation role of GRIK2.

Aim: Conservative treatment approaches for thyroid carcinoma (TC) patients with wild-type B-type Raf kinase (BRAF) pose risks of long-term recurrence. The association of DNA methylation with TC metastasis is unclear. Patients & methods: Here we analyzed data from 179 BRAF wild-type TC patients in the The Cancer Genome Atlasdatabase, identifying significant metastasis-associated CpGs. A logistic regression model was developed and validated for discriminating lymphatic metastasis in BRAF wild-type TC. Results: The model showed high accuracy (AUC: 0.924 training set; 0.812 and 0.773 external cohorts). TAGLN, MRPL4, CLDN10 and GRIK2 emerged as diagnostic markers. GRIK2, downregulated due to promoter hypermethylation, acted as a TC suppressor. Conclusion: Our 5-CpG epigenetic signature effectively discriminates lymphatic metastasis in BRAF wild-type TC, highlighting GRIK2's tumor-suppressive role influenced by promoter hypermethylation.

Decision-making for recurrent atrial fibrillation after catheter ablation

Catheter ablation for atrial fibrillation (AF), especially pulmonary vein (PV) isolation, is widely used for rhythm control. However, AF recurrence remains a challenge, affecting 20% to 50% of cases. This review focuses on AF recurrence after catheter ablation. AF recurrence can be categorized into early recurrence (ER) within 3 months after index procedure, late recurrence (LR) within 1 year, and very LR (VLR) occurring beyond 1 year. ER has emerged as a significant predictor of LR, contrary to the traditional understanding. LR is primarily caused by PV reconnection, while VLR more involves non-PV triggers or substrates. Managing AF recurrence includes antiarrhythmic drugs, steroids, colchicine, and repeat ablation. Antiarrhythmic drugs reduce ER but have a limited impact on LR. Steroids have been shown to reduce ER, but not long-term recurrence. Colchicine, an anti-inflammatory agent, shows promise in reducing both ER and LR, although further research is necessary. Whether to perform early repeat ablation after ER remains uncertain, as not all patients require immediate intervention. In conclusion, AF recurrence after ablation remains a complex issue. Understanding the underlying mechanisms is essential for personalized management. Tailored approaches, considering individual characteristics, are crucial for long-term success. Future research should focus on improving therapeutic strategies for AF recurrence.

Systematic use of half normal saline during ablation of ventricular tachycardia in structural heart disease.

Efficiency and safety of ablation using half normal saline (HNS) has been shown in refractory ventricular tachycardia (VT), but no evaluation in unselected larger populations has been made. To evaluate the efficiency and safety of systematic HNS ablation in VT ablation. All successive VT ablations in patients with structural heart disease from 2018 to 2021 used HNS in our center and were retrospectively included. One hundred seventy-seven successive VT ablation procedures using HNS have been performed in 148 patients (91% males, mean 64±12 years, ischemic cardiomyopathy 64%, left ventricular ejection fraction 38±13%). A mean of 19±7.5 min of RF was delivered, with a mean power of 44±7W. Relevant complications happened in 9% (strokes 2%, tamponades 3%, atrioventricular block during septal ablations 5%). Over a mean follow-up of 15±9 months, VT recurred in 46%. Final recurrence rate after one or several procedures was 36% (18 months follow-up). Number of VT episodes decreased from 14±35 before to 2.5±10 after ablation (p<.0001) and number of ICD shocks decreased from 4.8±6.8 to 1.5±0.8 (p=.027). Systematic use of HNS during VT ablations in patients with structural heart disease leads to long-term recurrences rates and complications in the range of what is reported using normal saline. Although controlled studies are needed for demonstrating the superiority of such attitude, the use of HNS in every scar-related VT ablation seems safe for standard cases and may be furthermore useful in case of refractory arrhythmias due to difficult-to-ablate substrates.

Association of plaque characteristics with long-term stroke recurrence in patients with intracranial atherosclerotic disease: a 3D high-resolution MRI-based cohort study

ObjectivesTo evaluate the predictive ability of plaque characteristics for long-term stroke recurrence among patients with symptomatic intracranial atherosclerotic disease (ICAD).MethodsThis cohort study included 132 patients with acute ischemic stroke (AIS) attributed to ICAD who were recruited between July 2017 and December 2020 and followed until stroke recurrence or December 2021. Plaque surface irregularity, degree of stenosis, plaque burden, remodeling ratio, enhancement ratio, and intraplaque hemorrhage were assessed with 3-dimensional high-resolution magnetic resonance vessel wall imaging (3D HR-MRI). Data were analyzed using Cox models, receiver operating characteristic (ROC) curves, and Kaplan–Meier survival analysis.ResultsOf the 132 patients, during a median follow-up of 2.8 years, stroke recurrence occurred in 35 patients. The multivariable-adjusted hazard ratio (95% confidence interval) of stroke recurrence was 3.15 (1.34–7.42) per 10% increase in plaque burden and 2.17 (1.27–3.70) for enhancement ratio. The area under the curve (AUC) to predict stroke recurrence was 0.725 (95% CI 0.629–0.822) for plaque burden, 0.692 (95% CI 0.593–0.792) for enhancement ratio, and only 0.595 (95% CI 0.492–0.699) for the Essen stroke risk score. The Kaplan–Meier survival analysis further demonstrated significant differences in survival of free recurrent stroke between patients with plaque burden or enhancement ratio below and above the optimum cut-offs (both p < 0.001).ConclusionHigher plaque burden and enhancement ratio are independent risk factors for long-term stroke recurrence among patients with symptomatic ICAD, and valuable imaging markers for predicting and stratifying risk of stroke recurrence.Clinical relevance statementIn patients with symptomatic ICAD, the results of this high-resolution magnetic resonance vessel wall imaging study have potential implications for optimal management of intracranial plaques and secondary prevention of stroke recurrence based on plaque burden and enhancement ratio.Key Points• Identification of intracranial plaque characteristics responsible for stroke recurrence is essential to preventing stroke recurrence in patients with symptomatic intracranial atherosclerotic disease.• Higher plaque burden and enhancement ratio are independent risk factors for stroke recurrence.• Plaque burden and enhancement ratio are valuable imaging markers in the prediction and stratification of the risk of stroke recurrence.

Addition of Mechanical Lithotripsy to Endoscopic Papillary Large Balloon Dilation in Patients with Difficult Common Bile Duct Stones: A Retrospective Single-Center Study.

Introduction: This study aimed to compare the treatment outcomes of endoscopic papillary large-balloon dilation (EPLBD) with and without mechanical lithotripsy (ML) in removing difficult common bile duct stones. Methods: Patients with difficult common bile duct stones treated with EPLBD, with or without ML, at the Eastern Chiba Medical Center between April 2014 and March 2020, were retrospectively evaluated. The rates of cumulative recurrence and complications were compared between the two groups. Results: Overall, 122 patients (n = 44, EPLBD + ML and n = 78, EPLBD) treated by 12 gastroenterologists were included. Patients in the EPLBD + ML group were older (85 years versus 81.5 years) and had larger maximum stone diameter (15 mm versus 12.5 mm) than those in the EPLBD group. Compared with the EPLBD group, the EPLBD + ML group required more endoscopic retrograde cholangiopancreatography (ERCP) procedures (≥2) (86% versus 67%) and longer total ERCP time after reaching the papilla (78.5 minutes versus 25 minutes). Complication rates were not significantly different (9.1% versus 12.8%); however, the cumulative recurrence rates were higher in the EPLBD + ML group than in the EPLBD group (69.4% versus 23.5% at 4 years). Conclusion: Although there were no differences in complication rates, the long-term recurrence rate was higher in the EPLBD + ML group than in the EPLBD group. This study emphasizes the added burden imposed by performing ML during ERCP and suggests that by appropriate case selection, it is possible to treat cases of difficult biliary stones using EPLBD without ML.

Individualized curative treatment for malignant diseases through liver transplantation

For patients with primary and secondary liver tumors that are functionally or technically nonresectable, liver transplantation remains the sole curative treatment option. Over the years the benefits of transplantation have also been validated for conditions other than hepatocellular carcinoma. Currently, amidst aperiod of organ shortage the broadening of transplantation indications is atopic of ongoing debate. Although recent studies have confirmed the long-term success of transplantation within multimodal treatment regimens, this approach has yet to become the standard treatment for many conditions. This article explores the potential of liver transplantation in individualized multimodal oncological treatment strategies. Liver transplantation has become an integral component of the treatment regimen for hepatocellular carcinoma. In Germany there is aprioritized organ allocation facilitated by the granting of astandard exception for cases with asmaller tumor burden. Over the years numerous studies have demonstrated comparable long-term results using different listing criteria. Both intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma can be curatively treated with transplantation in Germany, although this is typically within the context of clinical studies. The neoadjuvant therapy and patient selection, based on tumor burden and the response to preliminary treatment, play acrucial role in influencing long-term survival and recurrence rates. The success of transplantation for liver metastases from neuroendocrine malignancies or colorectal carcinomas, which cannot be removed by partial resection, also significantly hinges on the patient selection. The role of living donor liver transplantation is becoming increasingly more pivotal in this context.

Epigenetic regulation of TP53 is involved in prostate cancer radioresistance and DNA damage response signaling

External beam radiotherapy (RT) is a leading first-line therapy for prostate cancer (PCa), and, in recent years, significant advances have been accomplished. However, RT resistance can arise and result in long-term recurrence or disease progression in the worst-case scenario. Thus, making crucial the discovery of new targets for PCa radiosensitization. Herein, we generated a radioresistant PCa cell line, and found p53 to be highly expressed in radioresistant PCa cells, as well as in PCa patients with recurrent/disease progression submitted to RT. Mechanism dissection revealed that RT could promote p53 expression via epigenetic modulation. Specifically, a decrease of H3K27me3 occupancy at TP53 gene promoter, due to increased KDM6B activity, was observed in radioresistant PCa cells. Furthermore, p53 is essential for efficient DNA damage signaling response and cell recovery upon stress induction by prolonged fractionated irradiation. Remarkably, KDM6B inhibition by GSK-J4 significantly decreased p53 expression, consequently attenuating the radioresistant phenotype of PCa cells and hampering in vivo 3D tumor formation. Overall, this work contributes to improve the understanding of p53 as a mediator of signaling transduction in DNA damage repair, as well as the impact of epigenetic targeting for PCa radiosensitization.

Evaluation of dynamic recurrence risk for locally advanced gastric cancer in the clinical setting of adjuvant chemotherapy: a real-world study with IPTW-based conditional recurrence analysis

BackgroundThe long-term dynamic recurrence hazard of locally advanced gastric cancer (LAGC) in the clinical setting of adjuvant chemotherapy (ACT) remains unclear.PurposeThis study aimed to investigate the dynamic recurrence risk of LAGC in patients who received ACT or not.MethodsThe study assessed data from patients with LAGC who underwent radical gastrectomy between January, 2010 and October, 2015. Inverse probability of treatment weighting (IPTW) was performed to reduce selection bias between the ACT and observational (OBS) groups. Conditional recurrence-free survival (cRFS) and restricted mean survival time (RMST) were used to assess the survival differences.ResultsIn total, 1,661 LAGC patients were included (ACT group, n = 1,236 and OBS group, n = 425). The recurrence hazard gradually declined; in contrast, cRFS increased with RFS already accrued. Following IPTW adjustment, the cRFS rates were higher in the ACT group than those in the OBS group for patients at baseline or with accrued RFS of 1 and 2 years (p˂0.05). However, the cRFS rates of the ACT group were comparable with those of the OBS group for patients with accrued RFS of 3 or more years (p > 0.05). Likewise, the 5-year △RMST between the ACT and OBS groups demonstrated a similar trend. Moreover, the hematological metastasis rate of the ACT group was significantly lower than that of the OBS group for patients at baseline or with accrued RFS of 1 and 2 years, respectively (p˂0.05).ConclusionsAlthough ACT could provide substantial benefits for patients with LAGC, the differences in recurrence hazard between the ACT and OBS groups may attenuate over time, which could help guide surveillance and alleviate patients’ anxiety. Further prospective large-scale studies are warranted.

Factores de mal pronóstico en 113 pacientes sometidos a duodenopancreatectomía cefálica por colangiocarcinoma distal

IntroductionDistal cholangiocarcinoma is a malignant epithelial neoplasia that affects the extrahepatic bile ducts, below the cystic duct. No relevant relationship between perioperative factors and worse long-term outcome has been proved. ObjectiveTo analyze the risk factors for mortality and long-term recurrence of distal cholangiocarcinoma in resected patients. Materials and methodsA single-center prospective database of patients operated on for distal cholangiocarcinoma between 1990 and 2021 was analyzed in order to investigate mortality and recurrence factors. ResultsOne hundred and thirteen patients have undergone surgery, with mean actuarial survival of 100.2 (76–124) months after resection. The bivariate study did not show differences between patients depending on age or preoperative variables studied. When multivariate analysis was performed, the presence of affected adenopathy was a risk factor for long-term mortality. The presence of affected lymph nodes, tumor recurrence, and biliary fistula during the postoperative period implied worse actuarial survival when comparing the Kaplan–Meier curves. ConclusionsThe presence of affected lymph nodes influence the prognosis of the disease. The occurrence of biliary fistula during postoperative cholangiocarcinoma distal could aggravate long-term outcomes, a finding that should be reaffirmed in future studies.

Clinical characteristics and long-term follow-up outcomes of myelin oligodendrocyte glycoprotein antibody-associated disease in Han Chinese participants.

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated inflammatory demyelinating disease of the central nervous system. This study aimed to delineate the clinical manifestations, imaging features, and long-term outcomes in Chinese patients with MOGAD and analyze the recurrence-associated factors. The phenotypic and neuroimaging characteristics of 15 Han Chinese patients with MOGAD were retrospectively analyzed. Demyelinating attacks, MOG antibodies in the cerebrospinal fluid/serum, response to immunotherapy, follow-up outcomes, and recurrence-associated factors were recorded. The median age at disease onset was 34 years (range, 4-65 years). The most common initial presentations included vision loss (10/15, 66.7%) and seizures (5/15, 33.3%). Serum MOG-Ab titers in 14/15 cases were higher than those in the cerebrospinal fluid and were detected in 3/6 relapsed patients. Brain magnetic resonance imaging during acute attacks showed lesions in 10/15 patients (66.7%), mostly in the cortex/subcortical white matter (5/15, 33.3%). Recurrence occurred in 6/15 patients (40.0%); in 4 patients, recurrence occurred shortly after immunotherapy discontinuation. Residual neurological deficits were present in 5/15 patients (33.3%), including visual impairment, incapacitation, cognitive impairment, and speech reduction. Optic neuritis was the most common clinical manifestation of MOGAD. magnetic resonance imaging findings were heterogeneous and the cerebral cortex/subcortical white matter was the most susceptible brain region. Although patients in the acute phase responded well to methylprednisolone pulse therapy, the long-term recurrence rate was high. Consistently detected serum MOG antibodies and inappropriate maintenance immunotherapy may be associated with recurrence, and residual neurological deficits should not be ignored.

OR32-06 Disease-related Outcomes In Patients With Thyroid Cancer On Long Term Follow-up: Analysis Of 1487 Patients

Abstract Disclosure: W.R. Doerfler: None. E. Morariu: None. S.E. Carty: None. M. Nikiforova: Other; Self; Thyroseq. Y.E. Nikiforov: Other; Self; Thyroseq. L. Yip: None. Introduction: Molecular genotype of differentiated thyroid cancer (DTC) has been shown to be associated with histology and disease-related outcomes including local recurrence and distant metastatic disease. In an updated analysis with long follow-up of a large cohort of thyroid cancer patients with prospective 7-gene molecular testing results, we aim to identify the risk of long-term recurrence and associated factors to guide optimal surveillance strategies. Methods: We reviewed a consecutive series of 1487 patients with DTC who had index thyroidectomy performed from 2007-2013 and routine molecular testing to detect alterations in 7 genes: BRAF, NRAS, HRAS, and KRAS genes, and RET/PTC1, RET/PTC3, and PAX8/PPARG fusions. We assessed for disease recurrence at latest follow-up which was defined as date of thyroglobulin measurement or neck ultrasound. Recurrence (occurring &amp;gt; 6 months after initial treatment) was defined per 2015 ATA guidelines as disease confirmed on histology, a rise in unstimulated thyroglobulin to &amp;gt;1 ng/mL without clear structural recurrence, or structural recurrence on imaging without confirmed biopsy. Results:98% of patients were diagnosed with papillary thyroid carcinoma (PTC). BRAFV600E was the most common mutation identified (43%). At least 5 years of follow-up occurred in 966 (64.9%) patients. Median follow up was 7.3 years ± 4.1 years. Of 1390 patients for whom recurrence could be assessed, 93 (6.4%) recurred including 55 (59%) recurrences &amp;lt; 2 years after surgery, 25 (27%) between 2-5 years, and 13 (14%) who were diagnosed &amp;gt;5 years. Of those who recurred between 2 to 5 years, 16 had BRAFV600E, 1 had NRAS, and 1 had RET/PTC1 cancer. Of those who recurred &amp;gt;5 years, 7 had BRAFV600E-positive DTC, 5 were 7-gene negative, and 1 had a complex BRAF mutation. Of the late recurrences (diagnosed &amp;gt;5 years), 9 were structural including 6 locoregional which were biopsy-confirmed, and 4 were biochemical. Metachronous distant metastatic disease occurred in 1 of 13 with late recurrence and was a patient with pulmonary metastasis whose tumor was positive for complex BRAF mutation. Disease-free survival at 5 years for patients with RAS, PAX8PPARG, and BRAFK601E positive cancer (99-100%)was higher than for patients with cancers positive for RET/PTC (87%) or BRAFV600E (88.7%)(p&amp;lt;0.001), and remained higher at 10 years (99-100% vs 87%, p&amp;lt;0.001). Conclusion: In this large cohort of consecutive DTC patients with prospective 7-gene molecular testing and long-term follow-up, 5- and 10-year DFS was higher in patients with RAS-like TC compared to those with BRAF-like TC. ∼60% of recurrences occurred in the first 2 years, while most recurrences &amp;gt;5 years were locoregional or biochemical and only one patient developed distant metastatic disease. Further analysis with additional comprehensive genetic variables is ongoing to better identify patients who are at risk for long-term recurrence. Presentation: Sunday, June 18, 2023