Longer Recurrence-free Interval Research Articles

Updated Outcomes of Surgical Treatment for Recurrent Thymic Tumor: A Report from the Japanese Nationwide Database.

This study aimed to analyze the surgical outcomes for recurrent thymic epithelial tumors and identify the factors associated with post-recurrence survival, using an updated Japanese nationwide database. The cohort that developed recurrence after the initial resection was extracted from an updated database of patients whose thymic epithelial tumors were treated surgically between 1991 and 2010. Furthermore, we reviewed clinicopathological and prognostic factors of re-resected cases. Post-recurrence survival outcomes and cause-specific deaths in non-re-resected cases were also reviewed. We enrolled 191 patients who underwent re-resection and 259 patients who did not. In the surgery group, more patients with early-stage disease, less aggressive World Health Organization (WHO) histological classification, initial complete resection, and shorter recurrence-free intervals were included. Non-thymic carcinoma, absence of preoperative treatment, longer recurrent-free interval, single-site recurrence, and R0-1 re-resection were all significantly favourable prognostic factors for post-recurrence survival in the surgery group, according to univariable analyses. Non-thymic carcinoma histology, longer recurrence-free interval, and R0-1 re-resection were identified as independent prognostic factors according to multivariable analysis. The post-recurrence survival of the entire cohort with R2 re-resection was significantly better than that of the non-surgery group, although it was not demonstrated that patients with thymoma who underwent R2 re-resection had significantly better post-recurrence and lower cause-specific death. R0-1 re-resection was newly identified as a prognostic factor after re-resection, in addition to non-thymic carcinoma histological classification and longer recurrence-free intervals, as documented in the initial report.

Therapeutic results and prognostic factors of stage III NSCLC: a population-based study in Tunisia.

Prognostic factors are crucial to guide patient's selection through therapeutic decisions and outcome prediction. To investigate prognostic factors associated with improved survival in stage III non-small cell lung cancer. We retrospectively reviewed clinical data of 88stage III non-small cell lung cancer patients treated between 2010-2017. Multidisciplinary evaluation prior to therapy onset was mandatory. Univariate analyses and multivariate logistic regression were performed to identify factors associated with survival. Median follow-up was 28months, 56% of patients experienced recurrence. Median overall survival (OS) was 19months. On univariable analysis, improved OS correlated with younger age (p=0.011), better performance score (ECOG PS<2) (p<0.01), absence of weight loss (p=0.019) and smaller tumor size (≤7cm) (p=0.005). OS was improved in patients receiving therapy planned by multidisciplinary meeting compared with those who did not (p<0.01), in those with resected tumors (p=0.001), responding to therapy (neoadjuvant chemotherapy (p=0.034) and concurrent chemoradiation (p=0.001), as well as those with lower neutrophil-lymphocyte ratio (p=0.026) and lower platelet-lymphocyte ratio (p=0.003). Postoperative adjuvant therapy increased OS (64vs 24, p=0.025). Longer recurrence-free interval, locoregional failure and better perfomance status at recurrence were good prognostic factors for OS. Multivariate analysis showed that only upfront surgery followed by adjuvant therapy (hazard ratio (HR)=0.61; 95% confidence interval (CI) 0.38-0.96; p=0.034), adherence to multidisciplinary team decision (HR=0.26; 95% CI 0.15-0.47; p<0.01) and tumor size>7 cm (HR=2.31; 95% CI 1.29-4.13; p=0.005) were independent prognostic factors affecting OS. Optimal therapeutic strategy and adherence to the decision provided by the multidisciplinary evaluation of patients played an important role in stage III non-small cell lung cancer outcome.

Aromatase inhibitor maintenance therapy in high grade advanced ovarian cancer to delay first recurrence.

5515 Background: Ovarian cancer (OC) is mostly diagnosed as G3 serous advanced stage disease with survival of only 20% in 5 years. Maintenance therapy after 1st line chemotherapy is increasingly used, particularly with Bevacizumab or PARP inhibitors. However, the effect of antihormonal treatment in breast cancer but also in relapsed gynecological cancers has been shown. Also in low grade OC, data are highly supportive of antihormonal treatment. In a previous study of ours, also high grade serous cancers express high amounts of estrogen receptor (ER). The aim of this study was to analyze whether a maintenance antihormonal therapy in advanced OC adds a benefit in relation to the time of recurrence. Methods: All newly diagnosed G3 FIGO III/IV OC cases at our Hospital were assessed prospectively for ER expression. Patients with positive ER status (&gt; 10%) were treated as maintenance therapy with Letrozol 2.5mg 1x/d or not. Progression free survival was recorded and analyzed according to Kaplan-Meier. Patients with macroscopic residual disease post surgery receiving Bevacizumab maintenance treatment were also included. Results: We identified 51 patients with G3 serous OC FIGO III/IV expressing ER. Hereby, 24 patients received and 27 patients did not receive Letrozol after adjuvant chemotherapy. Time to progression ranged from 4 to 121 months. The use of Letrozol was associated with a significant prolonged progression free interval. After 12 months, only 65% of women in the control group vs 84% in the Letrozol group were progression-free. After 24 months, the effect was even stronger (46% in the control group vs 74% with Letrozol (p= 0.02)). Within the subgroup of patients with residual disease treated with Bevacizumab a similar effect was seen with 41% of patients progression free after 12 months vs 89% when taking Letrozol in addition to Bevacizumab. Conclusions: The use of Letrozol as a maintenance therapy after the 1st line treatment in G3 advanced stage serous OC patients was associated with a longer recurrence free interval in our cohort. These findings warrant a randomized controlled trial comparing all existing maintenance regimen as this might have a major influence on cost development in OC treatment.

Role of Hormone Therapy After Primary Surgery for Endometrioma: A Multicenter Retrospective Cohort Study.

Endometriosis is a major cause of disability in women, and 40% to 50% of patients experience disease recurrence by 5 years after surgery. This multicenter retrospective cohort study (N = 588) determined the rate and risk factors for recurrent endometrioma after primary surgery and examined the role of postoperative hormone therapy. When recurrence was defined by sonographic identification of the endometrioma (≥20 mm in size), 61 (10.4%) patients experienced disease recurrence. The cumulative recurrence rates at 1, 2, 3, and 5 years after surgery were 2.2%, 4.9%, 6.9%, and 9.8%, respectively. To determine the risk factors for recurrence, the clinical factors of patients with and without recurrence were compared. There was a significantly increased risk of recurrence with posterior cul-de-sac (PCDS) obliteration (P = .031) and higher serum cancer antigen 125 (CA125) level (P = .005). A longer postoperative hormonal therapy duration (P < .01), absence of PCDS obliteration (P = .036), and lower serum CA125 level (P = .014) were associated with longer recurrence-free interval on multivariate analysis using the Cox regression model. Postoperative hormone therapy prolonged the interval from the time of surgery to the first recurrence. However, it did not prolong the interval from the end of treatment to the first recurrence. Our results indicate that although long-term postoperative hormone therapy might maintain minimal disease status, it does not control residual disease. Therefore, persistent hormone suppression should be used to prevent disease recurrence.

Su1750 Crohn's Disease Recurrence After Ileocolonic Resection: Higher BDNF Levels in Healthy Ileum Is Associated to a Longer Recurrence-Free Interval

Su1750 Crohn's Disease Recurrence After Ileocolonic Resection: Higher BDNF Levels in Healthy Ileum Is Associated to a Longer Recurrence-Free Interval

Prognostic factors for post-recurrence survival in patients with completely resected Stage I non-small-cell lung cancer

The clinical course from recurrence to cancer-related death after curative resection has not been clearly elucidated in non-small-cell lung cancer (NSCLC). This study examined the clinical outcomes after postoperative recurrence in patients with completely resected Stage I NSCLC. This study included patients who had recurrence after complete resection for pathological Stage I NSCLC between 2003 and 2009. Clinical data evaluated in this study included the diagnostic process of recurrence, recurrence pattern, treatment process and prognosis. A number of clinicopathological factors were analysed for post-recurrence survival by univariate and multivariate analyses. Seventy-two patients experienced recurrence during a median follow-up period of 37.5 months. Thirteen patients (18%) presented symptoms at the initial recurrence. Tumour markers, computed tomography (CT) and positron emission tomography/CT were chosen as the initial diagnostic tools and detected recurrences in 1 (1%), 51 (71%) and 7 (10%) patients, respectively. The mean recurrence-free interval (RFI) was 15.4 months (≤12 months in 34, >12 months in 38 patients). The patterns of recurrence were presented as loco-regional recurrence in 36 (50%) and distant metastasis in 36 patients (50%). Types of the initial treatment included operations in 28 (39%), chemotherapy and/or radiotherapy in 38 (53%) and radiofrequency ablation in 2 patients (3%). Four patients (6%) rejected treatment. Forty-three patients (62%) presented a good response to the initial treatment. Thirty-seven patients (51%) died, and the cause of death in all of these patients was cancer-related. The median survival duration after recurrence was 43.6 (1-136) months. Univariate analysis identified no recurrence of symptoms, a good response to treatment and a longer RFI as good prognostic factors, while a good response to treatment and a longer RFI were independent prognostic factors in multivariate analysis. Most postoperative recurrences were detected in an asymptomatic condition during the routine follow-up period, and a good response to initial treatment and a longer RFI were significant predictors of better post-recurrence survival in patients with completely resected Stage I NSCLC.