Lower Probability Of Recurrence Research Articles

Uveitic Macular Edema: Clinical Outcomes in Real-World Practice

ABSTRACT Purpose To examine the real-world management and outcomes of uveitic cystoid macular oedema (CME). Design Retrospective study. Methods Patients with uveitic CME were identified from the Inflammatory Eye Disease database. 248 eyes of 218 patients with uveitic CME were identified. Main Outcome Measures: Time to resolution, time to recurrence and vision loss. Results Median age at time of CME was 51.7 years [IQR 37.3–63.9]. Overall likelihood of resolution was 209/248 eyes (85.3%). Resolution occurred in 34.1% with topical therapy, 69.2% treated with oral prednisone (72.9% if prednisone dose ≥ 60 mg/day), 73.5% treated with orbital floor steroid, and 86.7% treated with intravitreal steroid. On multivariate analysis, ERM was associated with decreased resolution of CME (HR 0.735 p = 0.045). Additionally, infectious aetiology approached significance (HR 0.635 p = 0.059) for CME resolution. Recurrence occurred in 85 eyes (36.5%). Predictors of increased likelihood of recurrence were current smoking status (HR 1.818 p = 0.042) and subretinal fluid at diagnosis (HR 1.577 p = 0.043). Eyes with infectious aetiology had lower chance of CME resolution, but those that did resolve had lower probability of recurrence (HR 0.891 p = 0.019). Moderate vision loss (20/50–20/200) occurred in 24 eyes (9/7%) and severe vision loss (≤20/200) in 17 eyes (6.9%). Conclusions Management of CME is challenging given the heterogeneous aetiologies, severity of the macular edema as well as response to the therapy. A high rate of resolution was observed, given sufficient time, but recurrence occurs in one-third. Current smoking status plays an important role in the risk of recurrence of CME and patients should be encouraged to stop smoking.

Performance of artificial intelligence-based algorithms to predict prolonged length of stay after head and neck cancer surgery

BackgroundMedical resource management can be improved by assessing the likelihood of prolonged length of stay (LOS) for head and neck cancer surgery patients. The objective of this study was to develop predictive models that could be used to determine whether a patient's LOS after cancer surgery falls within the normal range of the cohort. MethodsWe conducted a retrospective analysis of a dataset consisting of 300 consecutive patients who underwent head and neck cancer surgery between 2017 and 2022 at a single university medical center. Prolonged LOS was defined as LOS exceeding the 75th percentile of the cohort. Feature importance analysis was performed to evaluate the most important predictors for prolonged LOS. We then constructed 7 machine learning and deep learning algorithms for the prediction modeling of prolonged LOS. ResultsThe algorithms reached accuracy values of 75.40 (radial basis function neural network) to 97.92 (Random Trees) for the training set and 64.90 (multilayer perceptron neural network) to 84.14 (Random Trees) for the testing set. The leading parameters predicting prolonged LOS were operation time, ischemia time, the graft used, the ASA score, the intensive care stay, and the pathological stages. The results revealed that patients who had a higher number of harvested lymph nodes (LN) had a lower probability of recurrence but also a greater LOS. However, patients with prolonged LOS were also at greater risk of recurrence, particularly when fewer (LN) were extracted. Further, LOS was more strongly correlated with the overall number of extracted lymph nodes than with the number of positive lymph nodes or the ratio of positive to overall extracted lymph nodes, indicating that particularly unnecessary lymph node extraction might be associated with prolonged LOS. ConclusionsThe results emphasize the need for a closer follow-up of patients who experience prolonged LOS. Prospective trials are warranted to validate the present results.

Ultra-radical surgery for advanced ovarian cancer: a retrospective cohort study in a tertiary referral cancer center in the UK.

Ovarian cancer is the leading cause of death from gynecological cancer in the UK. The standard of care is a combination of surgery and chemotherapy. The aim of the treatment is the resection of all macroscopic disease. In selected cases of advanced ovarian cancer this is achieved with ultra-radical surgery. However, NICE encourages further research due to low quality evidence on the safety and efficacy of this extensive surgery. The aim of this study was to examine the morbidity and survival rates of ultra-radical surgery for advanced ovarian cancer performed in our unit and compare our findings with the current literature. This is a retrospective study of 39 patients diagnosed with stage IIIA-IV ovarian and primary peritoneal cancer who underwent surgery in our unit between 2012 and 2020. The main outcome measures were the perioperative complications, the disease-free survival, the overall survival rate and the recurrence rate. The study enrolled 39 patients with stages IIIA-IV who were treated in our unit between 2012 and 2020. 21 patients were at stage III (53.8%) whereas 18 (46.1%) at stage IV. 14 patients underwent primary and 25 secondary debulking surgery. Major and minor complications occurred 17.9% and 56.4% of the patients, respectively. Complete cytoreduction following surgery was achieved in 24 cases (61.5%). The mean and the median survival time were 4.8 years and 5 years, respectively. The mean disease-free survival time was 2.9 years while median disease-free survival time was 2 years. Age (P=0.028) and complete cytoreduction (p=0.048) were found to be significantly associated with survival. Primary debulking surgery was significantly associated with lower probability of recurrence (P=0.049). Although the number of patients is relatively small, our study indicates that ultra-radical surgery in centers with high expertise may result in excellent survival rates with an acceptable rate of major complications. All patients in our cohort were operated by an accredited gynecological oncologist and a hepatobiliary general surgeon with a special interest in ovarian cancer. A few cases required input from a colorectal and a thoracic surgeon. We believe that the careful selection of the patients that can benefit from ultra-radical surgery and our model of joint surgery can explain our excellent results. Further research is essential to establish that ultra- radical surgery has an acceptable rate of morbidity for patients with advanced ovarian cancer.

Increasing Amount of Hair Reduction using Laser Correlates with Lower Probability of Recurrence in Patients with Pilonidal Disease

BackgroundHair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. MethodsPD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. Results198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8–6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. ConclusionPatients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. Level of EvidenceLevel IV.

Personalized neurosurgical tactics in the treatment of intervertebral hernias of the lumbar spine

Objective. Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk. Methods. A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018. The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery. Results. The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion. Conclusion. Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early post-operative activation of the patient. A personalized approach in the treatment of lumbar disc herniation is based on the competent selection of patients and the clarification of a number of factors in determining.

Role of ultrasound-guided technique in the treatment of gynecologic diseases: A systematic review and meta-analysis.

The efficacy and safety of ultrasound-guided interventional procedures for gynecologic diseases have not been evaluated comprehensively. Therefore, we aimed to provide an evidence-based medical reference for clinical treatment in this meta-analysis. The literature searches were conducted in databases of PubMed, Embase, and Web of Science for eligible studies published from 2002 to May 2022. All literature was searched, screened, and reviewed by 2 researchers separately. RevMan 5.3.0 was used to analyze the relevant data. A total of 12 articles consisting of 2854 patients were included. Compared with the control group, meta-analysis showed that ultrasound-guided technique in the experimental group was associated with a higher effective rate [risk ratio = 0.84, 95% confidence interval (CI) (0.84, 0.84)], a lower probability of recurrence [odds ratio = 0.13, 95% CI (0.13, 0.13), P < .00001], and a greater effective reintervention rate [odds ratio = 3.39, 95% CI (1.29, 8.86), P = .01]. However, it was not significantly associated with fewer adverse reactions. Ultrasound-guided technique in treating gynecologic diseases exerted a positive effect and had fewer adverse reactions, which could be popularized and applied in clinical practice.

Postoperative Concurrent Chemoradiotherapy for Locally Advanced Thoracic Esophageal Squamous Cell Carcinoma: A Phase II Clinical Trial.

BackgroundThis study aims to investigate the efficacy and safety of postoperative intensity-modulated radiotherapy (IMRT) covering partial regional lymph node areas combined with chemotherapy for locally advanced thoracic esophageal squamous cell carcinoma patients.MethodsThis was a single-center, single-arm phase II clinical trial that began in 2014. Patients who underwent radical transthoracic resection within 3 months and were histologically confirmed esophageal squamous cell carcinoma (pT3-4 or N+, M0 determined according to AJCC Guidelines, Edition 7) were recruited. Postoperative radiotherapy was performed with a total dose of 50.4Gy in 28 fractions using IMRT. Clinical target volumes (CTVs) included tumor bed, anastomosis, bilateral supraclavicular region, and superior mediastinal lymph nodes. Synchronous chemotherapy for 2 cycles (paclitaxel 150mg/m2, day1; Cisplatin 25mg/m2, day1-3; every 4 weeks), followed by 2 cycles of consolidation chemotherapy with the same regimen. The primary endpoint was the 2-year local control rate, and the secondary endpoints were overall survival (OS) and adverse events (AEs).ResultsA total of 75 eligible patients were included from 2014 to 2017. The 2-year LRFS rate, as the primary endpoint, was 73.3%. The 1-year and 3-year OS rates were 88.0% and 68.0%, respectively. Local recurrence occurred in 13/75 (17.4%) patients, of which 2.7% (2/75) were extra-target lymph nodes. Grade 4 adverse events reported in this study included 10 cases (13.3%) of neutropenia, 1 case (1.3%) of anemia, and 2 cases (2.7%) of thrombocytopenia, without toxic-related deaths. Almost all (96%) patients completed the entire postoperative radiotherapy course, and 62 (82.7%) patients completed at least 2 cycles of chemotherapy.ConclusionPostoperative IMRT (clinical target volume including tumor bed, anastomosis, bilateral supraclavicular region, and superior mediastinal lymph nodes) combined with synchronous chemotherapy in patients with locally advanced thoracic esophageal squamous cell carcinoma was well tolerated, with a high local control rate and a low probability of recurrence outside the irradiation field.Clinical Trial Registration https://clinicaltrials.gov/ChiCTR1900022689.

Malignant Melanoma of Anorectal: A Report of Two Cases

Introduction and importance: Occurring in only 1% of cases of anorectal malignancy, malignant melanoma generally appears in the fifth and sixth decades of life, with complaints of anorectal bleeding or pain. The prognosis is generally poor. Although anorectal melanoma currently lacks a recommended treatment, surgery alone remains the primary modality treatment, the role of adjuvant therapy is generally minimal, and survival rate improves with early diagnosis. Presentation of case : Here, we report two cases of a rare malignant melanoma in the rectum treated with abdominoperineal resection and local excision. The first case is a 60-year-old man with a history of defecating bloody stool and the appearance of a lump on the anal opening. The abdominoperineal resection was performed followed by adjuvant chemoradiotherapy. The second case is a 51-year-old woman with a similar complaint and clinical finding with the first case. The second case was treated with a tumor excision procedure followed by adjuvant chemoradiotherapy. However, the lump was recurrence after 7 months of prior tumor excision. Discussion: Surgical resection of anorectal melanoma is debatable. While surgical resection is still the most common treatment option, there is no agreement on whether abdominoperineal resection or local excision is the best option. Conclusions: The abdominoperineal resection may offer a lower recurrence probability than that of tumor excision alone. However, further study is required to provide evidence-based surgical treatment

Fertility-Sparing Treatment for Endometrial Cancer or Atypical Endometrial Hyperplasia Patients With Obesity.

ObjectiveTo evaluate the efficacy and prognosis of fertility-sparing treatment on endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) patients with BMI ≥ 30 kg/m2.MethodsA total of 102 EC or AEH patients with obesity who received fertility-preserving therapy in the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital were included in our study. All patients were followed up regularly. Clinical characteristics, treatment outcomes, adverse events, and reproductive outcomes were collected and analyzed.ResultsA total of 88 (86.3%) patients achieved complete response (CR), 92.5% in AEH and 82.3% in EC, with 6 months (3–12 months) median CR time. High remission rates were found in patients who received gonadotropin-releasing hormone agonist (GnRHa)-based regimen, were younger than 35 years old, and lost more than 10% of their weight. Fifteen (17.0%) women had developed recurrence with a median recurrence time of 26 (8–52) months. Patients who received GnRHa regimen, lost more than 10% weight, received maintenance therapy, or conceived during the follow-up period had a low probability of recurrence. Of the patients with CR, 57 women attempted to get pregnant and 16 (28.1%) patients became pregnant, 7 (12.3%) of them successfully delivered and 4 (7.0%) were in pregnancy, while 5 (8.8%) of them miscarried.ConclusionFor obese patients with EC and AEH, fertility-preserving treatment can still achieve a promising response. Weight loss of more than 10% has a positive influence on response, recurrence, as well as pregnancy rates. GnRHa could be an option for obese women due to less effect on weight gain compared to progestin therapy.

Huaier granule prevents the recurrence of early-stage hepatocellular carcinoma after thermal ablation: A cohort study

Ethnopharmacological relevanceClinical trials have demonstrated that Trametes robinophila Murr (Huaier granule) can inhibit recurrence and metastasis after hepatocellular carcinoma (HCC) resection, but its efficacy as an adjuvant therapy after thermal ablation of early HCC is unknown. Aim of the studyTo analyze the prognostic value and side effects of Huaier granules in HCC patients undergoing thermal ablation. Materials and methodsClinical information from 340 eligible subjects with early-stage HCC who were admitted to our department from September 1, 2008 to January 1, 2019 was extracted from the electronic medical record database. They were divided into the thermal ablation + TCM group and the thermal ablation group. Differences in their overall survival (OS), progression-free survival (PFS), extrahepatic metastatic rate (EMR), and therapeutic side effects (TSEs) between the two groups were compared. Beneficiaries of the integrated treatment and adequate treatment length were predicted. ResultsThe median follow-up was 32.5 months (range 2–122 months). The 1-year, 3-year and 5-year OS rates in the integrated treatment group and the control group were 93.2% vs. 92.6%, 54.5% vs. 51.4%, 23.5% vs. 19.7% (p = 0.110, HR 0.76(0.54–1.07)). The 1-year, 3-year and 5-year PFS rates were 78.8% vs. 69.4%, 50.6% vs. 40.6%, 35.3% vs. 26.5%, respectively (p = 0.020, HR 0.67(0.48–0.94)). The median OS (35 vs. 31 months) and PFS (24 vs. 12.5 months) were longer in the integrated treatment group. The EMR in the integrated treatment group was significantly lower than that in the control group (p = 0.018, HR 0.49 (0.27–0.89)). Patients with any two of the following three factors might be predicted to be beneficiaries of the integrated treatment, including younger than 65 years (p =0.039, HR 0.70 (0.50–0.98)), single tumor (p = 0.035, HR 0.70 (0.50–0.98), and tumor size ≤3 cm (p = 0.029, HR 0.69 (0.50–0.96). Patients with continuous oral administration of TCM following ablation had a lower probability of recurrence and metastasis within 2 years (p = 0.015, HR 0.67 (0.49–0.93)). Although the integrated treatment group reported a higher incidence of nausea and emesis, there were no significant differences between the two groups. ConclusionTCM following ablation may prolong PFS and suppress recurrence in patients with HCC, with continuous oral administration for more than 2 years maybe experience a greater benefit. The TSEs of the treatment are mild and can be tolerated.

Surgical treatment of extensive peripheral osteoma in the mandibular ramus: Case report

Osteomas are benign osteogenic tumors, which clinically manifest as well-defined and asymptomatic lesions. This article aims to report a case of extensive osteoma in the mandibular branch, addressing the main tools used for diagnosis and treatment modalities. Patient L.M.S, 55 years old, male, sought the service of Maxillofacial Surgery, reporting the appearance of a nodule on the face with evolution of 2 years. On physical examination, a significant volumetric increase was observed in the pre-auricular region on the left side, asymptomatic on palpation and non-bleeding. Computed tomography was requested, which showed a hyperdense bone lesion in the mandibular ramus region. The planned surgical proposal was for extra-oral access in the pre-auricular region on the left side, excision of the lesion by osteotomy followed by osteoplasty for the regularization of the remaining bone tissue and suture by planes. Subsequently, the piece was sent for histopathological analysis that identified the lesion as a compact osteoma. The patient was followed up for 1 and a half years, through clinical and radiographic evaluation, through which an excellent bone repair was observed, with no signs of recurrence. Carrying out the clink exam is essential for the diagnosis of osteoma, as it is an asymptomatic pathology. Due to the fact that it has a low probability of recurrence and does not present malignancy, a conservative approach can be performed with the appropriate postoperative follow-up. Therefore, it is concluded that the performance of a thorough clinical examination associated with the imaging and microscopic information are essential for a good clinical management of this pathology.

Percutaneous endoscopic transforaminal and interlaminar lumbar discectomy for cranially migrated disc hernia

Objective. To evaluate clinical outcomes, safety, and technical peculiarities of percutaneous endoscopic transforaminal and interlaminar removal of the lumber spine cranially migrated disc hernias. Material and Methods. In 2015–2018, percutaneous endoscopic transforaminal and interlaminar removal of cranially migrated hernias of the lumbar spine was performed in 53 patients (23 men and 30 women): 2 (3.8 %) at L2–L3 level, 13 (24.5 %) at L3–L4, 18 (34.0 %) at L4–L5, and 20 (37.7 %) at L5–S1. The age of patients ranged from 25 to 76 years and averaged 43.4 ± 11.6 years. Transforaminal approach was performed at the L4–L5 level and higher (62.3 % of cases), and interlaminar approach – at the L5–S1 level (37.7 %). Based on MRI, hernias with cranial migration were divided into zones: zone I – hernias with migration to the lower edge of the superjacent vertebra pedicle – 21 (39.6 %) patients; and zone II – hernias with migration above this border – 32 (60.4 %). Results were evaluated using ODI, VAS, and the McNab scale. Statistical analysis of VAS indicators (leg and back pain) and ODI scores before and after surgery was performed using the R and Microsoft Excel 2007 software. Results. Data collection was carried out using patient questionnaires at in-person examination, telephone interviews and electronic communications. Follow-up data of different terms were monitored in all patients. In one case (when mastering this technology), at the second stage, microdiscectomy was performed at the L4–L5 level for a residual hernia fragment in migration zone II, and in another case, a conversion into microdiscectomy was performed at L3–L4 level with a hernia in zone II due to lack of venous bleeding control in a patient receiving anticoagulants. In other patients, the mean VAS scores of preoperative radicular and axial pain decreased from 7.5 ± 1.4 and 3.8 ± 1.2 to 1.4 ± 1.2 and 3.5 ± 1.3, respectively, on the next day, to 1.7 ± 1.4 and 3.2 ± 1.1 in 1 month, to 1.5 ± 1.3 and 2.8 ± 1.4 in 6 months, to 1.6 ± 1.2 and 2.0 ± 1.3 in 12 months, and to 1.6 ± 1.2 and 2.0 ± 1.3 in 24 months after surgery. In the long-term follow-up period, no radicular leg pain was observed in any patient. According to the McNab scale, up to 6 months treatment results were assessed as excellent by 19 (35.8 %) patients, and as good – by 32 (60.3 %). In the case of lumbar pain in the long term period, blockade of facet joints and radiofrequency ablation of the medial nerve branch were performed. Relapse of hernias and instability of the operated spinal segment were not revealed. The average ODI score improved from 66.4 ± 7.2 to 20.5 ± 3.2 in 1 month, to 13.6 ± 2.1 in 6 months, to 12.4 ± 2.3 in 12 months, and to 12.4 ± 2.3 in 24 months after surgery. Conclusion. Percutaneous endoscopic transforaminal and interlaminar discectomy for cranially migrated lumbar disc hernia, while adhering the surgical technique target and exclusion criteria, is a safe and effective method, avoids excessive resection of the bone-ligamentous structures of the spine, can prevent iatrogenic instability of the spinal motion segment, and promotes early postoperative activation and recovery of the patient. Cranially migrated disc henias have a low probability of recurrence.

Isolating the entire pulmonary venous component versus isolating the pulmonary veins for persistent atrial fibrillation: A propensity-matched analysis.

The outcomes of pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) are suboptimal. The entire pulmonary venous component (PV-Comp), consisting of the pulmonary veins, their antra, and the area between the antra, provides triggers and substrate for AF. PV-Comp isolation is an alternative strategy for persistent AF ablation. Among 328 patients with persistent AF who underwent a first radiofrequency ablation procedure, 200 patients (PVI, n=100; PV-Comp isolation, n=100) were selected by propensity score matching. Both groups were followed up for 1 year. At 6- and 12-month follow-up, atrial tachyarrhythmia (AF/atrial tachycardia) recurred in 41 and 61 patients in PVI group and 22 (P=.006) and 33 patients (P<.001) in PV-Comp isolation group, respectively. PV-Comp isolation was associated with longer mean time to recurrence (PVI: 8 months, PV-Comp isolation: 10 months, log-rank P<.001) and a lower probability of recurrence (odds ratio [OR]=0.32; 95% confidence of interval [CI]=0.18-0.56, P<.001), with no increase in procedural complications (PVI: 5 of 100, PV-Comp isolation: 6 of 100, P=.76). Procedure duration was longer in PV-Comp isolation group (PVI: 186 ± 42min, PV-Comp isolation: 238 ± 44min, P<.001), as well as fluoroscopy time (PVI: 22 ± 16min, PV-Comp isolation: 31 ± 21min, P=.001). PV-Comp isolation for persistent AF reduced atrial tachyarrhythmia recurrence up to 1 year compared with PVI alone. While procedure and fluoroscopy time increased, there was no difference in procedural complications.

Risk Communication on Floodings: Insights Into the Risk Awareness of Migrants in Rural Communities in Austria

The Alpine region is expected to be considerably affected by climate change and an increase of settlement area exposed to natural hazards. To respond to emerging challenges due to climate change, land-use changes, and sociodemographic and migration issues, an integrated management of natural hazards is needed, including appropriate approaches to risk communication. This study—which included a quantitative street survey, semistructured interviews (Leitfadeninterview), and focus group discussions carried out in 9 Austrian municipalities prone to flooding—found that residents with foreign-born parents and foreign-born residents were underrepresented in local governments and in voluntary organizations related to disaster risk management and therefore often do not participate in decision-making. Nonetheless, ethnicity was often not the prevailing factor that determined vulnerability and modes of coping. Instead, social networks and ownership structures had an important influence on people's ability to recover from past events and prepare for future events. Study participants who had not recently been affected by natural hazards, including floods, generally perceived them as having a low probability of recurrence and ranked them lower than other (daily) risks and struggles. This article aims to contribute to a better understanding of efficient communication as well as target-group–oriented communication channels and contents that foster risk awareness and private adaptation capacity among migrants in rural Austria.

Expression of PD-1/PD-L1 in head and neck squamous cell carcinoma and its clinical significance.

To investigate the role of programmed death-1 (PD-1), programmed death-ligand 1 (PD-L1), and P16 in patients with head and neck squamous cell carcinoma (HNSCC). A total of 95 paraffin-embedded samples of tumorous tissue of HNSCC were collected. Expression levels of PD-1, PD-L1, and P16 were determined by immunohistochemistry. A significantly higher proportion of PD-1 among patients infected with the human papillomavirus was found. PD-L1 expression is closely associated with the primary site of the tumor, postoperative recurrence, survival, PD-1 expression and P16 expression. Univariable analysis indicated that T stage, N stage, tumor node metastasis stage, tumor differentiation, and PD-L1 expression were all shown to be prognostic variables for overall survival in patients with HNSCC. In the multivariate analysis, only N stage (P = 0.010) and PD-L1 expression (P = 0.001) were found to be independent prognostic variables for overall survival. In addition, for disease recurrence, multivariate analysis showed that only PD-L1 expression was the associated independent risk factor. For the patients with negative PD-L1 expression, Kaplan-Meier analysis revealed that they had significantly worse outcomes in terms of overall survival (P = 0.001). Similarly, compared with the patients with positive PD-L1 expression, those with negative PD-L1 expression had a higher probability of recurrence (P = 0.026). The expression of PD-L1, PD-1, and P16 in HNSCC is significantly correlated. Human papillomavirus infection (P16 positive) is negatively related to postoperative recurrence. HNSCC patients with positive PD-L1/PD-1 expression tend to have better overall survival outcomes and lower probability of recurrence, providing more evidence for the PD-l-targeted immunotherapy of HNSCC.

A concise review of angiofibroma of soft tissue: A rare newly described entity that can be encountered by dermatopathologists.

Angiofibroma of soft tissue (AFST) is a newly described, rare mesenchymal neoplasm with fibroblastic and vascular components; it can be seen in both sexes and in a broad age range. It presents as a slowly enlarging mass, most often in the deep tissues of the upper and lower extremities, but occasionally in a superficial location where it may be encountered by dermatopathologists. It has a benign clinical course with a very low probability of recurrence after complete excision. This lesion has a prominent vasculature and may have an infiltrative growth pattern. These features could lead to a misdiagnosis, such as malignant vascular tumor, by an unwary dermatopathologist. The diagnosis of AFST initially relied solely on morphology and immunohistochemistry but, more recently, molecular studies have begun to play a role. Because of the potential for misdiagnosis, we present this review to raise awareness.

Salvage treatment for recurrences after first resection of colorectal liver metastases: the impact of histopathological growth patterns

The majority of patients recur after resection of colorectal liver metastases (CRLM). Patients with CRLM displaying a desmoplastic histopathological growth pattern (dHGP) have a better prognosis and lower probability of recurrence than patients with non-dHGP CRLM. The current study evaluates the impact of HGP type on the pattern and treatment of recurrences after first resection of CRLM. A retrospective cohort study was performed, including patients with known HGP type after complete resection of CRLM. All patients were treated between 2000 and 2015. The HGP was determined on the CRLM resected at first partial hepatectomy. The prognostic value of HGPs, in terms of survival outcome, in the current patient cohort were previously published. In total 690 patients were included, of which 492 (71%) developed recurrent disease. CRLM displaying dHGP were observed in 103 patients (21%). Amongst patients with dHGP CRLM diagnosed with recurrent disease, more liver-limited recurrences were seen (43% vs. 31%, p = 0.030), whereas patients with non-dHGP more often recurred at multiple locations (34% vs. 19%, p = 0.005). Patients with dHGP CRLM were more likely to undergo curatively intended local treatment for recurrent disease (adjusted odds ratio: 2.37; 95% confidence interval (CI) [1.46–3.84]; p < 0.001) compared to patients with non-dHGP. The present study demonstrates that liver-limited disease recurrence after complete resection of CRLM is more often seen in patients with dHGP, whereas patients with non-dHGP more frequently experience multi-organ recurrence. Recurrences in patients with dHGP at first CRLM resection are more likely to be salvageable by local treatment modalities, but no prognostic impact of HGPs after salvage therapy for recurrent disease was found.

Incidence and timing of recurrence of optic neuritis.

To describe the incidence and timing of recurrence in patients with optic neuritis (ON). Medical documents of adult patients with ON were retrospectively reviewed. The incidence and timing of recurrence of an ON episode were analyzed. One hundred eleven patients with ON were included in this study. Their mean follow-up duration was 4.1 ± 3.1years. Seven relapses occurred after intravenous methylprednisolone treatment. The estimated cumulative incidence of recurrence in either eye was 26% at 1year, 33% at 3years, 37% at 5years, and 50% at 10years after the first episode of ON. If there was no recurrence until 6months after the first episode of ON, the next 5-year recurrence-free survival probability was 67%. If there was no recurrence until 1year, the next 5-year survival probability was 72%. If there was no recurrence until 2years, the next 5-year survival probability was 81%. Relapse within 1month and the presence of neuromyelitis optica-immunoglobulin G were factors that increased the recurrence rate over time. We evaluated the incidence and timing of the recurrence in patients with ON after the first episode. Lower probability of recurrence was observed in patients with longer recurrence-free follow-up period. However, monitoring for recurrence is needed even in patients with a single episode of ON due to the increasing tendency of the estimated cumulative incidence of recurrence over many years.

Metastatic Involvement of the Prostatic Anterior Fat Pad: Implications for the Pathologist.

There is little information regarding the utility of pathologic evaluation of the prostatic anterior fat pad (PAFP) in patients with a low preoperative probability of recurrence. Our study aimed to determine the utility of PAFP pathologic examination, especially for this group of patients. We analyzed a tertiary care academic center's radical prostatectomy (RP) specimens from 2009 to 2017. Of 602 RP specimens, 420(70%) included the PAFP; four of 420 (1%) had lymph node involvement (LNI) in the PAFP. In two of four cases with LNI in the PAFP, this was the only site of LNI. Of these two cases, one occurred in a patient with low probability of recurrence and involved a nonpalpable PAFP lymph node. Pathologic evaluation of the PAFP may be useful even in patients with low probability of recurrence because it may change staging by detecting metastatic involvement of small PAFP lymph nodes.

Abstract 4718: Filamin A interacting protein 1-like is a marker of prognosis, progression and chemosensitivity in ovarian cancer

Abstract Purpose: The WNT/β-catenin pathway and the resulting epithelial-to-mesenchymal transition (EMT) play a key role in ovarian cancer progression and chemoresistance. Filamin A interacting protein 1-like (FILIP1L) enhances β-catenin degradation, thereby inhibiting canonical WNT signaling and EMT. FILIP1L is a tumor suppressor whose expression is down-regulated by promoter hyper-methylation in ovarian cancer. FILIP1L down-regulation is inversely correlated with the invasive potential of ovarian cancer cells. However, the clinical relevance of FILIP1L down-regulation in ovarian cancer progression has yet to be addressed. Experimental design: To study the clinical implications of FILIP1L in regulating the WNT/β-catenin pathway and chemoresistance, the expression of FILIP1L, β-catenin, SNAIL and SLUG was analyzed by immunohistochemistry on tissue microarrays of 369 ovarian samples ranging from normal to metastatic. Their expression was evaluated with clinicopathological characteristics including FIGO stage and chemosensitivity, and correlated with overall and disease-free survival by Kaplan-Meier plots and Cox proportional hazards model. Results: We demonstrated that FILIP1L expression decreased with tumor progression, resulting in a significant difference between primary and metastatic ovarian cancer samples. In contrast, levels of β-catenin and SLUG increased with tumor progression. Furthermore, tumors that were resistant to platinum/paclitaxel combination therapy showed a significant reduction in FILIP1L expression when compared to sensitive tumors, contrary to SLUG expression, which was significantly higher. The expression of FILIP1L was negatively correlated with the expression of β-catenin and SLUG, whereas β-catenin expression was positively correlated with SLUG expression, suggesting a link between FILIP1L and the WNT/β-catenin pathway in ovarian cancer. Moreover, patients with low FILIP1L expression showed a median overall survival and disease-free survival of 60 and 19 months, respectively, whereas patients with high FILIP1L expression had not yet reached median overall and disease-free survival at their 120 month follow-up. Notably, low FILIP1L expression was independent negative prognostic factor with respect to overall and disease-free survival. Conclusions: Our study provides the first clinical relevance of FILIP1L in human cancer, and suggests that FILIP1L may be a novel biomarker for good prognosis and lower probability of recurrence in ovarian cancer patients. Citation Format: Mijung Kwon, Jae-Hoon Kim, Chel Hun Choi, Joon-Yong Chung, Stephen Hewitt, Steven Libutti. Filamin A interacting protein 1-like is a marker of prognosis, progression and chemosensitivity in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4718. doi:10.1158/1538-7445.AM2017-4718