Low-risk Carcinoma Research Articles

Two-year clinical outcomes of de-intensified chemoradiotherapy for low-risk HPV-associated oropharyngeal squamous cell carcinoma.

6044 Background: We here-in report 2 year cancer control outcomes from a prospective phase II clinical trial evaluating de-intensified chemoradiotherapy (CRT) for patients with favorable risk, HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Methods: The major inclusion criteria were: T0-T3, N0-N2c, M0, HPV or p16 positive, and minimal smoking history. Treatment was limited to 60 Gy intensity modulated radiotherapy with concurrent weekly intravenous cisplatin (30 mg/m2). Patients neither received induction chemotherapy nor definitive surgery. The primary study endpoint was pathologic complete response rate (pCR) based on required biopsy of the primary site and dissection of pretreatment positive lymph node regions, regardless of radiographic response. Secondary endpoint measures included 2 year local control (LC), regional control (RC), cause specific survival (CSS), distant metastasis free survival (DMFS), and overall survival (OS), and patient reported symptoms (PRO-CTCAE) and quality of life (EORTC QLQ-C30 & H&N35). Results: Forty-four patients enrolled and the median f/u was 36 months (range 5-53 months, 93% with > / = 1 year, 88% > / = 2 years). We have previously reported the pCR to be ~ 86%. Two year LC, RC, CSS, DMFS, and OS are the following: 100%, 100%, 100%, 100%, and 95%. All 6 patients who had pathological partial responses are alive with no evidence of disease with a median f/u of 34 months (range 9-48 months). Two patients have died (stroke and glioblastoma). Mean pre and 2-year post EORTC QOL scores were: Global 80/82 (lower worse), Swallowing 11/10 (higher worse), Dry Mouth 16/54, and Sticky Saliva 6/33. 39% of patients required a feeding tube (none permanent) for a median of 15 weeks (5 - 22 weeks). Mean pre and 2 year post PRO-CTCAE (1 to 4 scale, higher worse) scores were: Swallowing 0.4/0.8 and Dry mouth 0.4/1.8. There were no > / = Grade 3 late adverse events. Conclusions: The 2-year clinical outcomes with decreased intensity of therapy with 60 Gy of IMRT and weekly low-dose cisplatin are excellent in favorable risk OPSCC with evidence of better preservation of quality of life as compared to standard therapies. Clinical trial information: NCT01530997 .

Intravoxel incoherent motion diffusion-weighted MR imaging parameters predict pathological classification in thymic epithelial tumors.

We evaluated the performance of intravoxel incoherent motion (IVIM) parameters for preoperatively predicting the subtype and Masaoka stage of thymic epithelial tumors (TETs). Seventy-seven patients with pathologically confirmed TETs underwent a diffusion weighted imaging (DWI) sequence with 9 b values. Differences in the slow diffusion coefficient (D), fast perfusion coefficient (D), and perfusion fraction (f) IVIM parameters, as well as the multi b-value fitted apparent diffusion coefficient (ADCmb), were compared among patients with low-risk (LRT) and high-risk thymomas (HRT) and thymic carcinomas (TC), and between early stage (stages I and II) and advanced stage (stages III and IV) TET patients. ADCmb, D, and D values were higher in the LRT group than in the HRT or TC group, but did not differ between the HRT and TC groups. The mean ADCmb, D, and D values were higher in the early stage TETs group than the advanced stage TETs group. The f values did not differ among the groups. These results suggest that IVIM DWI could be used to preoperatively predict subtype and Masaoka stage in TET patients.

High concordance of findings obtained from transgluteal magnetic resonance imaging - and transrectal ultrasonography-guided biopsy as compared with prostatectomy specimens.

To determine the utility of our transgluteal magnetic resonance imaging (MRI)-guided prostate biopsy approach. A total of 960 biopsy series, taken within the period of 1 year, were evaluated, including 301 MRI-guided and 659 transrectal ultrasonography (TRUS)-guided biopsies. The positivity rate and proportion of high grade cancers were significantly higher in MRI-guided than in TRUS-guided biopsies. Of 301 MRI-guided biopsies, 65.4% contained cancer while 57.2% of 659 TRUS biopsies contained cancer (P = 0.016). Gleason grade 3 + 3 = 6 disease was observed in 16.8% of 197 MRI-guided and in 36.1% of 377 TRUS-guided biopsies (P < 0.001). There was also a markedly higher quantity of cancer tissue in MRI-guided biopsies. In all cancers, the mean cancer surface area was 64.8 ± 51.6 mm2 in MRI-guided biopsies as compared with 23.0 ± 31.4 mm2 in non-MRI-guided biopsies (P < 0.001). With respect to the tissue quantity, superiority of MRI-guided biopsy was highest in Gleason grade 3 + 3 = 6 cancers (20.9 ± 27.9 vs 5.1 ± 10.2 mm2 ; P < 0.001) and in Gleason grade 3 + 4 = 7 cancers (59.7 ± 38.0 vs 17.7 ± 18.4 mm2 ; P < 0.001). Comparison of biopsy Gleason grades with findings in prostatectomy specimens was possible in 80 patients with MRI-guided and in 170 patients with non-MRI-guided biopsies. This comparison showed a very high but almost identical concordance of TRUS- and MRI-guided biopsies with the prostatectomy specimen findings. With both approaches, undetected high-risk cancers were present in ~10% of patients with low-risk biopsy results. A significant difference was observed, however, in the proportion of patients who had clinically insignificant cancers and who underwent surgery. The proportion of patients with Gleason grade 3 + 3 = 6 carcinoma in their prostatectomy specimen was 11.2% in the post-TRUS biopsy cohort, but only 2.5% in the post-MRI biopsy cohort (P = 0.021). MRI-guided transgluteal prostate biopsy has a high detection rate for high-risk carcinomas, while the risk of detecting clinically insignificant carcinomas appears to be reduced. This may by itself lead to a reduction of unnecessary prostatectomies. Overtreatment may be further avoided by better applicability of molecular testing to MRI-guided biopsies because of the excessive amount of tissue available for analysis, especially in patients with potential low-risk carcinomas.

167P Predictive factors for central neck lymph node metastasis in patients with papillary thyroid microcarcinoma without suspicious metastasis by preoperative ultrasonography

Background Papillarymicrocarcinoma(PTMC) isasmallpapillarythyroidcarcinoma measuring 1cm or less in diameter. Recently, incidence of PTMC has been increased due to an increase in the detection of subclinical disease such as small and low-risk carcinomas with ultrasonography and fine needle aspiration cytology. However, there is central neck lymph node metastasis in patients with PTMC without clinical evidence of metastasis by preoperative ultrasonography. We performed analysis to determine the influencing factors for central lymph node metastasis in PTMC although there was no clinical evidence of metastasis by preoperative ultrasonography. Methods We analyzed retrospectively 625 patients with PTMC underwent thyroid surgery at Chosun University Hospital from January 2002 to December 2012. Finally, we included 575 patients who had no evidence of lymph node metastasis by preoperative ultrasonography. We reviewed medical records including clinical information and pathologic report. Results Central lymph node metastasis was found in 81 patients (14.1%) among total 575 patients. A lymph node metastasis occurred frequently according to univariate analysisin patients withfollowingfactors;morethan0.5cminlargesttumorsizeby preoperativesonographyandpathologicreports(p=0.048andp=0.001,respectively) andlymphovascularinvasion(p<0.001).Multivariateanalysisrevealedthatthegender (Female vs Male), pathologic tumor size (0.5 ~ 1cm vs < 0.5cm) and lymphovascular invasion(YesvsNo)weresignificantassociatedfactorsforlymphnodemetastasis [Odds ratio (OR)=0.498, 95% confidence interval (CI)=0.250-0.992, P = 0.047; OR = 2.450, 95% CI = 1.313-4.570, P = 0.005; and OR = 24.954, 95% CI = 2.430- 256.217,P=0.007,respectively]. Conclusions Male gender, larger tumor size (>0.5cm) and lymphovascularinvasion were found as the risk factors for central neck lymph node metastasis in patients with PTMC without suspicious clinical evidence of node metastasis. We concluded that prophylactic central neck lymph node dissection might be required in these cases of PTMC. Legalentity responsiblefor thestudy: N/A Funding N/A Disclosure All authors have declared no conflicts of interest.

L1CAM: amending the "low-risk" category in endometrial carcinoma.

Low- and intermediate-risk endometrial carcinomas have an excellent prognosis. Nonetheless, a small subgroup of such patients will experience unexpected relapse. Recently L1CAM was suggested to be a strong prognosticator in endometrial carcinoma. The focus of our study was on low- and intermediate-risk disease, where no or only limited adjuvant treatment is recommended according to current guidelines. Endometrial carcinomas of low, intermediate and high-intermediate risk according to published 2016 consensus guidelines were identified. The study was limited to cases with previous central pathology review focusing on histotype, depth of myometrial invasion, presence of lymphovascular space invasion (LVSI) and MELF pattern of invasion. Standard L1CAM immunohistochemistry was performed. Disease-specific uni- and multivariate survival analyses were calculated. A total of 344 cases were available for immunohistochemistry (low-risk: n=250; intermediate-risk: n=67; high-intermediate-risk: n=27). L1CAM positivity rates were: 29/344 (8.4%; all cases), 18/250 (7.2%; low-risk), 6/67 (9.0%; intermediate-risk) and 5/27 (18.5%; high-intermediate-risk). Expression of L1CAM was independent of LVSI and MELF. L1CAM was a significant independent prognosticator for disease-specific survival with a hazard ratio of 5.98 [CI 1.50-22.14, p=0.012]. Adverse prognostic significance of L1CAM positivity was maintained after low-risk subgroup analysis (5-year disease-specific survival rates 71.8 vs. 100%, p<0.0001). All four tumour-related deaths in the subgroup of low-risk disease occurred in patients with L1CAM-positive tumours. The current definition of "low-risk" in endometrial carcinoma should be amended. "Low-risk carcinomas" should be limited to L1CAM-negative tumours. L1CAM status will play a key role in future algorithms to tailor adjuvant treatment and patient follow-up strategies.

Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence.

To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm. Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients (40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo (mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis. Median size of the lesions was 30 mm (20-70 mm), 69.0% were localized in the right-sided (cecum, ascending and transverse) colon. Most of the lesions (85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique (78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216 (23.6%) lesions including 4 low risk carcinomas (pT1a, L0, V0, R0 - G1/G2). Histologically proven recurrence was observed in 33/216 patients (15.3%). Patient age > 65 years, polyp size > 30 mm, non-pedunculated morphology, localization in the right-sided colon, piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis, only localization in the right-sided colon (HR = 6.842/95%CI: 1.540-30.394; P = 0.011), tubular-villous histology (HR = 3.713/95%CI: 1.617-8.528; P = 0.002) and polyp size > 30 mm (HR = 2.563/95%CI: 1.179-5.570; P = 0.017) were significantly associated risk factors for adenoma recurrence. Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm, with tubular-villous histology.

The value of thyroperoxidase as a prognostic factor for differentiated thyroid cancer -- a long-term follow-up study.

BackgroundThyroperoxidase (TPO) is a membrane-bound protein essential for the production of thyroid hormones; because of this, TPO expression may be impaired in selected thyroid diseases. The goal of this study is to analyze TPO immune expression in differentiated thyroid cancer, and to determine whether TPO has any prognostic value.MethodsA total of 139 patients who required surgery due to a thyroid nodule with signs or symptoms suspicious for malignancy during their physical, ultrasound and/or cytology examination were consecutively selected for the study. A study of TPO immunohistochemical expression was carried out on these patients using the MoAb47 monoclonal antibody. In addition, cell proliferation marker Ki67 and tumor suppressor p53 were also measured for comparison.ResultsA total of 139 cases, 43 benign tumors, 42 papillary carcinomas, 38 follicular carcinomas, 8 undifferentiated carcinomas, and 8 sporadic medullary carcinomas were analyzed. The relationship between TPO expression and disease was statistically significant (p <0.001), and decreased with tumor dedifferentiation extent. Increased TPO expression in benign lesions as compared to decreased expression in papillary carcinomas and undifferentiated tumors is outstanding. Differences in TPO expression were observed in minimally invasive follicular carcinoma (MIFC) compared to widely invasive follicular carcinoma (WIFC). TPO expression decreases in undifferentiated malignancies in contrast with p53 and Ki67 expression, which increases in that setting. TPO, p53 and Ki67 expression was significantly related to TNM stage (p <0.001). Survival rate was 72 % after a 20-year follow-up, and 100 % for subjects with higher TPO expression.ConclusionsTPO may be useful in confirming or ruling out benign diseases from differentiated thyroid carcinoma, with the exception of low-risk carcinoma such as MIFC. It could be used as a prognostic factor for differentiated thyroid cancer and patient follow-up, together with other markers.

A prospective phase II trail of de-intensified chemoradiotherapy for low-risk HPV-associated oropharyngeal squamous cell carcinoma.

6004 Background: This is a prospective multi-institutional phase II study of a substantial decrease in chemoradiotherapy (CRT) intensity as concurrent primary treatment for favorable risk oropharyngeal squamous cell carcinoma. Methods: The major inclusion criteria were: 1) T0-T3, N0-N2c, M0, 2) HPV or p16 positive, and 3) ≤ 10 pack-years smoking history. Treatment was limited to 60 Gy Intensity Modulated Radiotherapy with concurrent weekly intravenous cisplatin (30 mg/m2). The primary study endpoint was pathologic complete response rate (pCR) based on required biopsy of the primary site and dissection of pretreatment positive lymph node regions, regardless of radiographic response. Power computations were performed for the null hypothesis that the pCR rate is 87% and N = 40 (type I error = 14.2%). Secondary endpoint measures included physician reported toxicity (CTCAE), patient reported symptoms (PRO-CTCAE), quality of life (EORTC QLQ-C30 & H&N35), and penetration aspiration scale (PAS) scores for modifie...

Multicenter study comparing two approaches to nodal assessment in patients with low-risk endometrial carcinoma: Contemporary sentinel lymph node mapping versus historical selective systematic surgical staging

Multicenter study comparing two approaches to nodal assessment in patients with low-risk endometrial carcinoma: Contemporary sentinel lymph node mapping versus historical selective systematic surgical staging

The satisfactory reproducibility of the Ki-67 index in breast carcinoma, and it′s correlation with the recurrence score

Objective: The clinical utility of Ki-67 in predicting response to neoadjuvant chemotherapy is limited by lack of an accepted validated method of assessment of Ki-67 and wide variations in the cut-offs. In this study, the interobserver variability in the estimation of Ki-67 proliferation index (PI) and its association with recurrence score (RS) was assessed. Materials and Methods: The interobserver variability was assessed between 3 pathologists in 27 invasive breast carcinomas that had also been analyzed for the RS (Oncotype DX). The guidelines proposed by International Breast Cancer Working Group (IBCWG) for analysis of Ki-67 were used. A Pearson correlation between the mean Ki-67 PI and the RS was calculated. Results: In the 27 tumors, the pathologists were in 89.1% agreement (intra-class correlation coefficient = 0.891, 95%, 0.806-0.945) for Ki-67 PI estimation. Furthermore, a strong positive correlation between Ki-67 and RS (r = 0.78464, P < 0.0001) was obtained. There were 10 cases with low risk (mean RS: 10.1; Ki-67 range: 3-33%); 13 with intermediate risk (mean RS: 21.4; Ki-67 range: 6-43%) and 3 with high risk (mean RS: 53; Ki-67 range: 55-91%). Conclusion: Conventional evaluation of Ki-67 index is reproducible using the method suggested by the IBCWG. The wide range of Ki-67 PI in low and intermediate risk groups and the unexpectedly high Ki-67 PI in some low risk carcinomas limit its use as a predictive measure.

Phase II study of de-intensification of radiation and chemotherapy for low-risk HPV-related oropharyngeal squamous cell carcinoma.

TPS6097 Background: The prognosis is excellent for low-risk human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC). Current standard chemoradiotherapy (CRT) regimens cure most patients but cause significant acute (mucositis) and long-term toxicities (xerostomia and dysphagia). Toxicity is primarily determined by the dose of radiotherapy and the intensity of chemotherapy. The aim of this study is to evaluate the pathological complete response (pCR) rate of low-risk HPV-associated OPSCC after de-intensified CRT. Methods: The major inclusion criteria are: 1) T0-T3, N0-N2c, M0, 2) HPV or p16 positive, and 3) &lt;/= 10 pack-years smoking history. Patients receive 60 Gy of intensity modulated radiotherapy (IMRT) with concurrent weekly intravenous cisplatinum (30 mg/m2). CT scans are obtained 4 to 8 weeks after completion of CRT to assess response. All patients have a surgical resection of any clinically apparent residual primary tumor or biopsy of the primary site if there is no evidence of residual tumor and a selective neck dissection to encompass at least those nodal level(s) that were positive pre-treatment, within 4 to 14 weeks after CRT. Longitudinal assessments of quality of life (EORTC QLQ-C30 &amp; H&amp;N35, NDII), patient reported outcomes (PRO-CTCAE, EAT-10), and swallowing evaluations (modified barium swallow) are obtained prior to, during, and after CRT. The primary endpoint of this study is the rate of pCR after CRT. The null hypothesis is that the pCR rate for de-intensified CRT is at least 87%, the historical rate (based on the reported 3-year local regional control rate of 87% in the RTOG 0129). Power computations were performed for N=40, with a type I error of 14.2% if the true pCR rate is 0.87. The study will be done in 3 stages with 15+15+10 patients with interim analyses at 15 and 30 patients. The trial will be stopped if the pCR rate is &lt;/= 9/15 and 21/30. The null hypothesis will be accepted if the pCR rate is &gt;/= 33/40. Clinical trial information: NCT01530997.

Phase III Multicenter Trial: Interstitial Brachytherapy Alone Versus External Beam Radiation Therapy after Breast Conserving Surgery for Low-Risk Invasive Carcinoma and Low-Risk Ductal Carcinoma In-Situ of the Female Breast – One-Year Toxicities

26% (220) high-risk. Biochemical failure occurred in 7.7% (66) of patients overall and 4.2% (9), 5.5% (23) and 15.5% (34) of low-, intermediate-, and high-risk group patients. PSA progression-free survival significantly differed according to risk group (log rank test, p!.0001). By 8 years, PSA progression-free survival was 95% for low-risk patients, 87% for intermediate-risk patients, and 63% for high-risk patients. On multivariate analysis, intermediate-risk patients had a 1.5-fold risk (95%CI 0.7-3.3, p50.3) and high-risk patients had a 4-fold increased risk (95%CI 1.9-8.6, p!.001) of PSA progression compared with low-risk patients.

Reply to Bertolaccini et al.

We thank Bertolaccini et al. [1] for their interest in our paper [2] and appreciate the opportunity to reply. To begin with, we would like to point out some misunderstandings with regard to our paper. In our analysis, we divided 58 patients with thymic epithelial tumours into three groups according to a simplified histological classification: low-risk thymomas (Types A, AB and B1, n = 23), high-risk thymomas (Types B2 and B3, n = 21) and thymic carcinomas (n = 14). The maximum standardized uptake value (SUVmax) of the thymic carcinomas was significantly higher than those of the low-risk and high-risk thymomas (P < 0.001, respectively). No significant differences were observed between the low-risk thymomas and the high-risk thymomas (P = 0.204). In addition, as shown in Figure 3 in our article, the SUVmax of the Stages III and IV thymomas showed a higher trend towards Stages I and II thymomas (P = 0.060). We excluded thymic carcinoma cases in this analysis because the majority of them were in advanced stages. Although no significant differences were observed between the low-risk and the high-risk thymomas, we suppose that significant differences might appear if the number of patients increases. We think that the large confidence interval in our box–whisker plot is due to the small number of cases. As often said, SUVmax is a very nonuniform value between institutions. It depends on the dose of radionucleotide that is given, the machine, the timing of scanning and the radiologist reading it and so on. Calculating the SUV tumour mediastinum (T/M) ratio is one of the methods to ensure the universality of SUVmax in [ F] fluoro-2-deoxy-D glucose positron emission tomography-computed tomography (F-FDG PET-CT) [1]. We cannot provide these data in our cohort, as they were not available in our previous cases. However, as other authors have demonstrated [3–5], there is little difference between the results of SUVmax T/M ratio and nonadjusted SUVmax. We believe that nonadjusted SUVmax in F-FDG PET-CT can play an important role in the differential diagnosis between thymomas and thymic carcinomas. The area under the curve in receiver-operating curve for the differential diagnosis between thymomas and thymic carcinomas was 0.951 in our cohort (data is not shown), a result that is considered to be quite good. We completely agree on the necessity of prospective studies with a larger number of patients, as thymic epithelial tumours are quite a rare disease. Discussions between not only thoracic surgeons, but also radiologists and pathologists are required to ensure the universality of radiological and pathological diagnoses.

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

BackgroundTransanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissue-sparing technique that protects the anal sphincter. The present retrospective analysis reports the course of observation after local excision of adenomas and T1 low-risk carcinomas using transanal endoscopic microsurgery.MethodsIn a retrospective analysis we examined data on 279 patients for local recurrence. A total of 144 patients had a rectal adenoma (n = 103) or a R0 resection of low-risk T1 carcinomas (n = 41). In this collective, we also examined parameters concerning perioperative management, complications, intraoperative blood loss and duration of hospital stay.ResultsPatients with adenoma were on average 64.9 (range 37 to 90) years old; 83.5% of the adenomas were located 3 to 11 cm from the anocutaneous line. In adenoma patients the recurrence rate was 2.9% for an observation period of 21.8 months. The postoperative course was without any complications in 98.1% of patients.Patients with T1 low-risk carcinoma were 64.6 (range 30 to 89) years old. In all cases, an R0 resection could be performed. The recurrence rate was 9.8% for an observation period of 34.4 months. In this group the postoperative course was free of complications in 97.6% of patients.ConclusionsThe high efficacy of transanal endoscopic microsurgery ensures minimally invasive treatment of adenomas and low-risk T1 carcinomas with low complication rates and a low rate of therapeutic failure.

Low-risk Breast Ductal Carcinoma In Situ (DCIS): Results From the Radiation Therapy Oncology Group 9804 Phase 3 Trial

Author Disclosure: A. Chakravarti: None. M. Wang: None. K. Aldape: B. Independent Contractor; Genetech, Bristol-Myers Squibb. E. Research Grant; Astra-Zenica. E. Sulman: F. Honoraria; Merck. M. Bredel: None. M. Hegi: E. Research Grant; MDxHealth. M. Gilbert: B. Independent Contractor; Merck, Abbott, Genetech. E. Research Grant; Merck, Genetech. F. Honoraria; Merck, Genetech. W. Curran: B. Independent Contractor; BMS. E. Research Grant; Abbott. M. Werner-Wasik: None. M. Mehta: B. Independent Contractor; Bayer, Elekta, Merck, Novartis, Quarck, Tomotherapy, Vertex, BMS, USOnc. F. Honoraria; Merck, Grace, MDM, Prine Onc, Strategic Edge, WebMD. L. Stock Options; Pharmacyclis, Colby, Accuracy, Procertus, Stemina.

Cost‐effective treatment of low‐risk carcinoma not invading bladder muscle

Study Type - Therapy (cost effectiveness analysis) Level of Evidence 2a What's known on the subject? and What does the study add? Bladder cancer is one of the costliest malignancies to treat throughout the life of a patient. The most cost-effective management for low-risk non-muscle-invasive bladder cancer is not known. The current study shows that employing cystoscopic office fulguration for low-risk appearing bladder cancer recurrences can materially impact the cost-effectiveness of therapy. In a follow-up protocol where office fulguration is routinely employed for low-risk bladder cancers, peri-operative intravesical chemotherapy may not provide any additional cost-effectiveness benefit. To examine the cost-effectiveness of fulguration vs transurethral resection of bladder tumour (TURBT) with and without perioperative intravesical chemotherapy (PIC) for managing low-risk carcinoma not invading bladder muscle (NMIBC). Low-risk NMIBC carries a low progression rate, lending support to the use of office-based fulguration for small recurrences rather than traditional TURBT. A Markov state transition model was created to simulate treatment of NMIBC with vs without PIC, with recurrence treated by formal TURBT vs treatment with fulguration. Costing data were obtained from the Medicare Resource Based Relative Value Scale. Data regarding the success of PIC were obtained from the peer-reviewed literature, as were corresponding utilities for bladder cancer-related procedures. Sensitivity analyses were performed. At 5-year follow-up, a strategy of fulguration without PIC was the most cost-effective (mean cost-effectiveness = US $654.8/quality-adjusted life year), despite a lower recurrence rate with PIC. Both fulguration strategies dominated each TURBT strategy. Sensitivity analysis showed that fulguration without PIC dominated all other strategies when the recurrence rate after PIC was increased to ≥14.2% per year. Similarly, the cost-effectiveness of TURBT becomes more competitive with fulguration when the total cost of TURBT declines < US $1175. The present study shows that fulguration without PIC was the most cost-effective strategy for treating low-risk NMIBC. The effectiveness of PIC and the cost of TURBT can materially impact the cost-effectiveness of the different management strategies. These results should be considered in treatment decisions in the context of preserving oncological control.

Molecular biomarkers involved in the tumor dedifferentiation process of thyroid carcinoma of epithelial origin: perspectives

Although papillary or follicular well-differentiated thyroid carcinoma usually has a good prognosis, a proportion of well-differentiated thyroid carcinomas show a more aggressive behavior with local recurrence and metastases, either at diagnosis (in less than 5% of cases) or over time. Although there are several scoring systems to assess prognosis of well-differentiated thyroid carcinoma, mainly based on clinical and pathological data, there is currently no valid criterion to define an adequate, differential treatment for patients with low risk carcinomas as compared to those with more aggressive tumors. Identification of patients with a high risk at the time of diagnosis would be essential to develop new therapeutic strategies and to improve follow-up, and molecular biomarkers could be a highly useful tool for this purpose.

Application of micro-RNA (miRNA) expression profiles for prognostication in low-risk endometrial carcinoma (LEC).

5032 Background: Reliably predicting which LEC patients are most likely to recur is a challenge for the clinician with implications on adjuvant therapy. MiRNAs have been exploited for diagnosis and prognostication in a number of malignancies. We hypothesize that miRNA expression profiles differ in tumors from patients with recurrence compared to those without recurrence. Methods: The inclusion criteria for this study are informed consent, stage 1 disease, grade 1 or 2 tumors and endometrioid histology. RNA was extracted from formalin-fixed paraffin-embedded tissues and miRNA profiling was done using Agilent Human miRNA. Differentially expressed miRNAs were identified using GeneSpring GX software and the two groups were compared using the student t-test. Results: The expression levels of 866 miRNAs were determined from LEC patients with recurrence (n=15) and without recurrence (n=16). The mean follow-up interval was 61.5 months. The average age of cancer diagnosis for patients with and without recurrence was 60.2 (range 42-75) and 59.7 (range 44-86), respectively (p=0.91). Three of 15 patients with recurrence and 6 of 16 patients without recurrence received adjuvant brachytherapy following their primary surgery (p=0.43). 17 miRNAs were identified which can distinguish between the tumors with recurrence and those without recurrence (p&lt;0.05). MiR-146a, miR-18a, miR-222, and miR-30a showed the highest fold change difference (&gt;5 fold) in the tumors with recurrence compared to that did not recur. A decision tree prediction model for recurrent LEC was developed where a miRNA cutoff was used as a branch in the decision tree. This model identified those patients who were most likely to recur based on the expression of 4 dysregulated miRNAs (miR-222, miR-361-3p, miR-181c and miR-125b). Conclusions: These preliminary results show the miRNA expression profile differs among LEC and can be used to distinguish an aggressive sub-group. Should future validation studies confirm this result, this information would be valuable in the design of a biomarker study to help decide which patients would benefit most from extended adjuvant treatment.

Stimulated Thyroglobulin and Neck Ultrasonography Facilitates Postsurgical Radioactive Iodine Remnant Ablation Selection in Patients with Low-Risk Well-Differentiated Thyroid Carcinoma

Stimulated Thyroglobulin and Neck Ultrasonography Facilitates Postsurgical Radioactive Iodine Remnant Ablation Selection in Patients with Low-Risk Well-Differentiated Thyroid Carcinoma

Biomarcadores moleculares implicados en el proceso de desdiferenciación tumoral del carcinoma de tiroides de origen epitelial: perspectivas

Although papillary or follicular well-differentiated thyroid carcinoma usually has a good prognosis, a proportion of well-differentiated thyroid carcinomasshow a more aggressive behavior with local recurrence and metastases, either at diagnosis (in less than 5% of cases) or over time. Although there are several scoring systems to assess prognosis of well-differentiated thyroid carcinoma, mainly based on clinical and pathological data, there is currently no valid criterion to define an adequate, differential treatment for patients with low risk carcinomas as compared to those with more aggressive tumors. Identification of patients with a high risk at the time of diagnosis would be essential to develop new therapeutic strategies and to improve follow-up, and molecular biomarkers could be a highly useful tool for this purpose.