Mean Recurrence-free Survival Research Articles

Preoperative tumor embolization prolongs time to recurrence of meningiomas: a retrospective propensity-matched analysis

BackgroundMeningiomas are often embolized preoperatively to reduce intraoperative blood loss and facilitate tumor resection. However, the procedure is controversial and its effects have not yet been reported. We evaluated preoperative...

Pathological and genetic markers improve recurrence prognostication with the University of California Los Angeles Integrated Staging System for patients with clear cell renal cell carcinoma

PurposeTo elucidate which patients with clear cell renal cell carcinoma have the highest risk for disease relapse after curative nephrectomy is challenging but is acutely relevant in the era of approved adjuvant therapies. Pathological and genetic markers were used to improve the University of California Los Angeles Integrated Staging System (UISS) for the risk stratification and prognostication of recurrence free survival (RFS). Patients and methodsNecrosis, sarcomatoid features, Rhabdoid features, chromosomal loss 9p, combined chromosomal loss 3p14q and microvascular invasion (MVI) were tested in univariable and multivariable analyses for their ability to improve the discriminatory ability of the UISS. ResultsIn the development cohort, during the median follow-up time of 43.4 months (±SD 54.1 months), 50/240 (21%) patients developed disease recurrence. MVI (HR: 2.22; p = 0.013) and the combined loss of chromosome 3p/14q (HR: 2.89; p = 0.004) demonstrated independent association with RFS and were used to improve the assignment to the UISS risk category. In the current UISS high-risk group, only 7/50 (14%) recurrence cases were correctly identified; while in the improved system, 23/50 (45%) were correctly prognosticated. The concordance index meaningfully improved from 0.55 to 0.68 to distinguish patients at intermediate risk versus high risk. Internal validation demonstrated a robust prognostication of RFS. In the external validation cohort, there was no case with disease recurrence in the low-risk group, and the mean RFS times were 13.2 (±1.8) and 8.2 (±0.8) years in the intermediate and high-risk groups, respectively. ConclusionsAdding MVI and combined chromosomal loss3p/14q to the UISS improves the ability to define the patient group with clear cell renal cell carcinomawho are at the highest risk for disease relapse after surgical treatment.

Minimally invasive surgery versus percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma: Results from a high-volume liver surgery center in East Asia

Background & aimsThe outcomes of minimally invasive surgery (MIS) vs. percutaneous radiofrequency ablation (RFA) in treating early-stage hepatocellular carcinoma (HCC) remain inconclusive. This study thus aimed to compare the outcomes of both treatments for early-stage HCCs. MethodsThis retrospective study consecutively enrolled patients with newly diagnosed early-stage HCCs treated with MIS or percutaneous RFA between 2011 and 2018. Outcomes were compared between the MIS and RFA groups both before and after 1:1 propensity score matching (PSM). ResultsA total of 119 and 481 patients underwent MIS and percutaneous RFA, respectively. Patients undergoing percutaneous RFA exhibited older age (p = 0.007) and higher rates of Child–Pugh class B (p < 0.001) and multifocal disease (p < 0.001). The median overall survival (OS) was 73.7 months in the MIS group, which was significantly higher than that for the RFA group of 65.1 months (p = 0.003). 50% HCC recurrence after MIS was not reached. The mean recurrence-free survival (RFS) was 49.6 months for the MIS group, which was significantly higher than the RFA group of 41.3 months (p < 0.001). On multivariate analysis, age ≥65 (HR: 1.61; 95% CI: 1.13–2.31, p = 0.009), RFA (HR: 2.21; 95% CI: 1.14–4.29, p = 0.019), and Child–Pugh class B (HR: 2.03; 95% CI: 1.29–3.21, p = 0.002) remained risk factors for OS, and RFA (HR: 2.18; 95% CI: 1.42–3.35; p < 0.001) remained a risk factor for RFS. After PSM, 103 patients were included in each group. No significant difference in OS was identified (p = 0.198), but RFS was higher in the MIS group than the RFA group (p = 0.003). Severe postoperative complications occurred at the same rate (1%) in both groups (p > 0.99). ConclusionAfter PSM, severe postoperative complication and OS rates were found to be comparable between the MIS and RFA groups, but RFS was higher in the MIS group than the RFA group, suggesting that MIS may have better outcomes for patients with early-stage HCC.

Ki67 Index Is the Most Powerful Factor for Predicting the Recurrence in Atypical Meningioma : Retrospective Analysis of 99 Patients in Two Institutes.

ObjectiveThe primary objective of this study was to identify predicting factors for local control (LC) of atypical meningioma, and we validated them with comparing the predicting factors for recurrence-free survival (RFS). We also examined the rate of LC after surgical resection with or without adjuvant treatment and RFS. MethodsClinical and radiological records of patients with atypical meningiomas diagnosed at two institutes from January 2000 to December 2018 were reviewed retrospectively. Histopathological features were also reviewed using formalin-fixed paraffin embedded samples from pathological archives. ResultsOf the 99 atypical meningiomas eligible for analysis, 36 (36.4%) recurred during the follow-up period (mean, 83.3 months; range, 12–232 months). The rate of 3-year LC and 5-year LC was 80.8% and 74.7%, respectively. The mean time-to-recurrence was 49.4 months (range, 12–150). The mean RFS was 149.3 months (95% confidence interval, 128.8–169.8 months) during the mean follow-up duration of 83.3 months (range, 12–232 months). Multivariate analysis using Cox proportional-hazard regression model showed that the extent of resection (hazard ratio [HR], 4.761; p=0.013), Ki67 index (HR, 8.541; p=0.004), mitotic index (HR, 3.275; p=0.044), and tumor size (HR, 3.228; p=0.041) were independently associated with LC. These factors were also statistically associated with RFS. In terms of radiotherapy after surgical resection, the recurrence was not prevented by immediate radiotherapy because of the strong effect of proliferative index on recurrence. ConclusionThe present study suggests that the extent of resection, proliferative index (according to Ki67 expression) and mitotic index, and tumor size are associated with recurrence of atypical meningiomas. However, our results should be further validated through prospective and randomized clinical trials to overcome the inborn bias of retrospective nature of the study design.

Diffusive Ki67 and vimentin are associated with worse recurrence-free survival of upper tract urothelial carcinoma: A retrospective cohort study from bench to bedside.

This study aimed to determine the prognostic values of Ki67 and vimentin in upper tract urothelial carcinoma (UTUC) after extirpative surgery. Between 2014 and 2019, patients diagnosed with UTUC and receiving radical nephroureterectomy were included retrospectively. Nuclear MIB-1 clones and cytoplasmic VIM 3B4 clones were used to assess Ki67 and vimentin levels, respectively. A unified reading protocol was applied, and the expression level was read by a single pathologist. Receiver operating characteristic curves were utilized to determine the best threshold for Ki67 and vimentin regarding recurrence, and this level was set as the diffusive level. The outcome of recurrence-free survival (RFS) was analyzed via a Cox regression model with univariable and multivariable approaches. Survival outcomes were analyzed via Kaplan-Meier (KM) curves. A total of 247 patients were included, and the mean follow-up was 29.90 ± 6.80 months. Diffusive thresholds were 17.5% for both Ki67 and vimentin. Under multivariable Cox regression, diffusive Ki67 (hazard ratio: 4.20 [2.39-7.37], P < 0.001) and diffusive vimentin (hazard ratio: 5.34 [3.10-9.22], P < 0.001) were significant prognostic indicators of worse RFS. Diffusive Ki67 was accompanied by diffusive vimentin (chi square with Yates' correction, P = 0.015), and vice versa. In the KM curve, there was no difference between diffusive Ki67/nondiffusive vimentin and nondiffusive Ki67/diffusive vimentin (log-rank test, P = 0.073). Significant differences (log-rank test, P < 0.001) were seen in different combinations of diffusive Ki67/vimentin (Mean RFS: 19.76 [18.56-20.96] months), only one diffusive in Ki67 or vimentin (Mean RFS: 22.94 [21.88-24.00] months), and nondiffusive Ki67/vimentin (Mean RFS: 32.96 [32.43-33.50] months). Diffusive Ki67 and vimentin were related to each other, and they exerted equivalent and synergic effects on predicting worse RFS in UTUC.

Ultrasound-Guided Radiofrequency Ablation of Locally Recurrent Thyroid Carcinoma.

We aimed to evaluate the effectiveness and safety of radiofrequency ablation (RFA) for non-surgical treatment of locally recurrent thyroid cancers, in both well-differentiated and medullary thyroid carcinomas (DTC and MTC) that are not amenable to traditional treatments. We conducted a retrospective review of 48 patients with 103 recurrent tumors (81 DTC, 22 MTC) who underwent ultrasound-guided RFA. Patients were followed for 12-37months to observe the outcomes and complications. 64 tumors (62.1%) completely disappeared at the last follow-up visit with 61 (59.2%) being resolved within 12months. Technical success (volume reduction ratio (VRR) > 50%) was 96% (n = 99) in all tumors. The mean largest diameter of treated tumors decreased from 11.2 ± 5.3 to 2.4 ± 3.4mm (p value < 0.001), and the mean volume decreased from 501.0 ± 807.0 to 41.6 ± 97.1mm3 at the last follow-up (mean VRR = 91%). Our patients had a 77.1% recurrence-free survival rate (11 recurrences, 7 DTC, 4 MTC), with an overall mean recurrence-free survival time of 34.6months (95% confidence interval, 30.0-39.1). We observed 3 cases with complications (voice changes in DTC patients) that completely resolved during follow-ups. RFA is a safe and effective alternative to repetitive surgeries in recurrent loco-regional DTCs as well as MTCs. Level 3, Non-randomized controlled cohort/follow-up study.

Influence of tumor size in the progression of venous tumor thrombus in renal cell carcinoma: A 7-year single-center experience.

Objective:The objective of the study is to describe the perioperative outcomes, disease-specific, and overall survival status in patients diagnosed with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus.Patients and Methods:We did a retrospective analysis of all patients who underwent radical nephrectomy along with IVC thrombectomy from the year 2013 to 2020. Mayo’s classification was used to stratify the level of IVC thrombus. Demographic, perioperative, histopathology data, complications, and survival status were analyzed.Results:Total number of patients included in the study was 39, (Male: Female = 84.6%: 15.4%). Median age of patients was 58 (interquartile range [IQR] 50–63) years. Median size of renal tumor (in cms) was 9.5 (IQR 7.5–12), 8 (IQR 7–11.5), 8.5 (IQR 7–11.75), and 11 (IQR 9.5–11) (P = 0.998) in level 1,2,3, and 4 tumors, respectively. Clear cell variant was seen in 32 patients (82%) with R0 resection in 17 patients. Twelve patients (30.7%) had systemic metastasis on presentation. The overall mean survival time was 66.4 months with 95% confidence interval (CI) (52.4–80.5 months). Mean recurrence-free survival is 76 months with (63–90) CI of 95%. Mean survival in patients who presented with metastasis is 47 months with 95% CI (52.4–80.5). Perioperative mortality rate was 5.12% in this study.Conclusion:The tumor size does not have an influence on the progression of tumor thrombus into IVC. Significant difference in survival was observed between different levels of thrombus with high mortality in level four tumors.

Prognostic value of the endothelial activation and stress index in patients with upper tract urothelial cancer undergoing radical nephroureterectomy.

The relationship with endothelial activation and stress index (EASIX), which represents the degree of endothelial dysfunction, is unwell known in upper tract urothelial carcinoma (UTUC). The present study aims to assess the prognostic value of the EASIX for recurrence-free survival (RFS) and overall survival (OS) in patients with UTUC who underwent radical nephroureterectomy (RNU). We retrospectively reviewed the clinical data of 627 patients with UTUC who underwent RNU without neoadjuvant chemotherapy at three hospitals between 2002 and 2019. EASIX scores were calculated using the formula "serum lactate dehydrogenase (U/L)×creatinine (mg/dL)/platelet count (109/L)" and evaluated based on log2-transformed values. We divided the patients according to the EASIX score (>1.27 vs. ≤1.27). Among 627 patients, 380 were finally analyzed. Using maximally selected log-rank statistics, the optimal EASIX cutoff value was 1.27 on the log2 scale. The baseline characteristics were similar between the two groups except for age. The high EASIX score group had worse RFS and OS than the low EASIX score group (log-rank p=0.001 and p=0.006, respectively). At 5 years, the mean RFS and OS difference between the low and high EASIX score groups was 11.1 and 7.35 months, respectively. High EASIX score remained a key prognosticator of RFS and OS after RNU in multivariable analysis. EASIX score may represent endothelial dysfunction in patients with UTUC and may serve as a readily available prognostic factor for oncologic outcomes.

Optimal Serum Thyrotropin Level for Patients with Papillary Thyroid Carcinoma After Lobectomy.

Background: The optimal serum thyrotropin (TSH) level for postlobectomy papillary thyroid carcinoma (PTC) patients is unclear. The objective of this study was to examine the association of TSH and recurrence in postlobectomy patients. Methods: Patients who underwent lobectomy for PTC in a single tertiary hospital from January 2000 to December 2014 were enrolled. The mean TSH of a patient was calculated based on each serum TSH value during follow-up. The reference range of serum TSH was 0.5-4.0 mU/L. Univariate and multivariable analyses were performed with Cox proportional hazards models. Restricted cubic spline (RCS) functions were used to model relationships between mean TSH and recurrence-free survival (RFS). Results: A total of 2297 patients (median age 42 years; 1750 (76.2%) female) were analyzed. Mean TSH below (≤0.5mU/L), in the lower half (0.6-2 mU/L), in the upper half (2.1-4 mU/L), and above (>4 mU/L) the reference range were observed in 668 (29.1%), 1162 (50.6%), 345 (15.0%), and 122 (5.3%) patients, respectively. According to the Cox model and RCS, no association was observed between mean TSH and RFS in the whole cohort, low-risk group and intermediate- to high-risk groups (adjusted p = 0.4737, 0.9314, 0.1859, adjusted p for nonlinear = 0.4589, 0.8622, 0.3010). The only RFS difference observed in the stratified univariate analysis was between patients with mean TSH in the lower half (0.6-2 mU/L, n = 659) and above the reference range (>4 mU/L, n = 68) in the intermediate- to high-risk group (10-year RFS by Kaplan-Meier 84.4% vs. 69.4%, log rank p = 0.011). Conclusions: Mean serum TSH levels are not associated with recurrence. A normal TSH reference range is recommended for postlobectomy PTC patients.

Photodynamic therapy for primary tracheobronchial malignancy in Northwestern China

BackgroundPhotodynamic therapy (PDT) has been routinely performed to treat tracheobronchial malignancy. However, the experience in tracheobronchial adenoid cystic carcinoma (ACC) and peripheral lung cancer is still insufficient. This study aimed to share the experience of PDT for patients with primary tracheobronchial malignancy, especially the adenoid cystic carcinoma and peripheral lung cancer, and evaluated the efficacy and safety of PDT in Northwestern Chinese patients. MethodsThis study retrospectively analyzed the clinical data of 23 patients with primary tracheobronchial malignancy receiving PDT in our center. The short-term effect was evaluated by the objective tumor response and the clinical response. The long-term effect was estimated by recurrence-free survival (RFS). ResultsOf 23 patients, SR was achieved in 18 patients and MR in 3 patients. The clinical symptoms and the quality of life were significantly improved after PDT (P<0.05). And the mean RFS was 8.9 ± 1.9 months. SR for 6 cases of ACC were achieved with significant improvement of clinical symptoms and quality of life. No procedure-related complications appeared. And PDT was successfully performed for the peripheral lung cancer with the guidance of electromagnetic navigation bronchoscopy (ENB). ConclusionsThis study demonstrated that PDT achieved satisfactory efficacy and safety for Northwestern Chinese patients with primary tracheobronchial malignancy. Patients with ACC can benefit from PDT. And ENB-guided PDT is a novel and available option for the peripheral lung cancer. In short, this study accumulated valuable experience for the application of PDT in Chinese patients with primary tracheobronchial malignancy.

Bi-segmentectomy versus wedge hepatic resection in extended cholecystectomy for T2 and T3 gallbladder cancer: A matched case-control study.

Backgrounds/AimsExtended cholecystectomy (EC) is the mainstay of treatment in most patients with potentially curable gallbladder cancer (GBC). The optimum extent of hepatic resection in EC is debatable.MethodsThis retrospective study was conducted on patients with GBC who received EC from May 2009 to February 2019. Based on the extent of hepatic resection, patients were divided into ECB (EC involving bi-segmentectomy s4b&5) and ECW (EC involving wedge hepatic resection) groups. Patients with T1 GBC, T4 GBC, and benign diseases were excluded. Post-exclusion, both groups were matched for T and N stage. Matched groups were then compared.ResultsOut of a total of 161 patients who received EC, 86 patients had ECB and 75 patients had ECW. After exclusion and matching, both ECB and ECW groups had 35 patients. Their demographic and clinical profiles were comparable. Surgical blood loss (p = 0.005) and postoperative complication rate (p = 0.035) were significantly less in the ECB group. For ECB vs. ECW, mean recurrence-free survival (RFS) was 58.2 months vs. 42.3 months (p = 0.264) and overall survival (OS) was 61.5 months vs. 43.4 months (p = 0.161). On univariate analysis, higher T and N stages were associated with poor prognosis. On multivariate analysis, higher T stage, N stage, and American Society of Anaesthesiologists grade were associated with poor RFS and OS.ConclusionsThe survival after ECB for T2 and T3 GBC was not significantly superior to that after ECW. However, surgical blood loss and postoperative complications were lower following ECB.

Revision Transoral Robotic Surgery for Early Stage HPV Positive Oropharyngeal Squamous Cell Carcinoma, it's Timing and Margins: Past and Present- a Prospective Single Centre Observational Study.

To review cohort of patients with HPV positive early stage oropharyngeal cancer that underwent revision trans oral robotic surgery for positive or close margin for evidence of residual disease, its impact on survival and discussion about clear margin. This is a prospective observational study. Our TORS revision rate was 20.6%. 91.7% did not need radiotherapy to primary site; mean recurrence free survival is 31months and no mortality in this cohort due to the primary disease. There is no consensus on what is clear margin. The surgical margins are a surrogate marker for later recurrences or long-term survival and this is what guides our treatment but equally attempts should be made to preserve their function and not increase the morbidity.

Analysis of pregnancy-associated factors after fertility-sparing therapy in young women with early stage endometrial cancer or atypical endometrial hyperplasia

BackgroundFertility-sparing therapy is an alternative conservative treatment for patients with early stage endometrioid cancer or atypical endometrial hyperplasia. In this study, we investigated pregnancy outcomes and pregnancy-associated factors in young patients receiving hormonal therapy.MethodsWe retrospectively analyzed 68 patients who attempted to conceive after fertility-sparing therapy and achieving complete remission (CR). They were divided into a pregnancy group and a non-pregnancy group. A Cox proportional hazard regression model was applied for univariate and multivariate analysis to determine factors associated with pregnancy. Kaplan–Meier analysis, combined with the log-rank test, was used to calculate a patient’s pregnancy probability and the distribution of recurrence-free survival (RFS).ResultsA total of 36 patients became pregnant with 47 pregnancies. Univariate and multivariate Cox analysis revealed that several factors were associated with pregnancy, including BMI at the time of pregnancy permission, the time to CR, prolonged treatment time, the number of hysteroscopy procedures, the endometrium thickness after CR, and relapse before pregnancy. The mean RFS of patients who achieved pregnancy, and those who did not, was 27.6 months and 14.8 months, respectively (P = 0.002). No significant difference was detected in terms of cumulative RFS when compared between assisted reproductive technology (ART) cases and those involving natural conception (NC) (P = 0.707).ConclusionsNormal BMI, a shorter time to CR, a prolonged three-month treatment, fewer hysteroscopy procedures, and a thicker endometrium may be positive indicators for successful pregnancies, while relapse before pregnancy may have a negative effect on conception. Moreover, a successful pregnancy protects the endometrium while ART does not increase the risk of recurrence.

Recurrence free survival and overall survival in women with stage 1A uterine serous carcinoma

Objectives: National Comprehensive Cancer Network Treatment guidelines for stage 1A uterine serous carcinoma (USC) outline four options for adjuvant management: systemic therapy + vaginal brachytherapy, external beam radiotherapy ± vaginal brachytherapy, vaginal brachytherapy in select cases of non-invasive disease, or observation. We evaluated the patterns of recurrence free survival (RFS), and overall survival (OS) in women with stage 1A USC based on the type of adjuvant therapy. Methods: After IRB approval, we identified all women with stage 1A USC between January 2011 and September 2019 treated at our institution. Demographics and outcome measures were abstracted from the medical records. Cox proportional hazard models, log-rank tests, and comparisons of means were used to calculate significance (p Results: Sixty-three patients were eligible. Median age at diagnosis was 67 years (range 54-86). Median body mass index (BMI) was 30.6 (range 18.6-47.3). The majority (68%) underwent MIS staging. Nineteen (30%) patients did not have adjuvant therapy, 13 (21%) had adjuvant chemotherapy (CT) only, 3 (5%) had adjuvant radiotherapy (RT) only (100% had vaginal brachytherapy). 28 patients (44%) had chemotherapy and radiotherapy (CT+RT). The mean overall survival (OS) was 60.8 months (range 1-105 months). Thirteen (21%) patients had recurrent disease. Mean RFS was 35.1 months (range: 3-82). Highest rate of recurrence in the RT only (33%). Five (38%) patients had vaginal cuff or pelvic recurrence, 3 (23%) in abdomen and pelvis, 3 (23%) in the abdomen only, and 2 (15%) in the lungs. Eleven (17.4%) patients had positive peritoneal cytology. Eight (73%) had adjuvant therapy with CT±RT. Six (55%) patients with positive cytology had disease recurrence. Mean RFS and OS for patients with positive cytology was 40.3 and 48.7 months, respectively. Positive cytology showed a 5.18-fold increase in developing recurrence compared to those with negative cytology (p=0.015). This was independent of age, race, smoking status, BMI, surgical approach, tumor size, and adjuvant therapyThere was no significant difference between the observation and any and all the adjuvant therapy groups with respect to OS (p=0.62) and RFS (p=0.95). There was no significant difference in OS and RFS between CT only and CT+RT groups (p>0.05). A significant difference in RFS occurred in patients with positive cytology (p=0.002) but there was no difference in OS. Download : Download high-res image (84KB) Download : Download full-size image Conclusions: Our data suggest that there is no difference in RFS and OS between observation versus any form of adjuvant therapy. There was a higher rate of recurrence in patients with positive pelvic cytology. Use of peritoneal cytology in the staging of high-grade uterine cancers may be important in deciding optimal adjuvant therapy for stage 1A USC. Multi-institutional randomized controlled trials are needed to determine the optimal treatment for early stage USC.

Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience.

Simple SummaryGiant pituitary adenomas are highly invasive tumors whose treatment is challenging. Surgery is their management mainstay. However, there is no consensus about the type of approach. Open transcranial, microscopic, and endoscopic trans-sphenoidal approaches have all been employed, alone or in combination. Extended endoscopic endonasal techniques may represent a versatile and safe one-stage approach. Our research aimed at evaluating prospectively their applicability, effectiveness, and safety in a multicenter series, to acquire further evidence toward its use in the treatment of those challenging lesions. Ninety-six patients were recruited and followed-up for 52.4 months on average. Most of them (81.2%) presented with visual deficits and >50% had various degrees of adenohypophysis insufficiency. Resection of at least 75% of initial volume was achieved in all cases, with 98.7% visual improvement, >50% endocrine deficit recovery and a permanent complication rate of 4.2%, indicating extended endoscopic endonasal approaches as a valuable treatment option.Purpose: To evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs). Methods: We recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed. Results: Of 1169 patients treated for pituitary adenoma, 96 (8.2%) had GPAs. Seventy-eight (81.2%) patients had visual impairment, 12 (12.5%) had headaches, 3 (3.1%) had drowsiness due to hydrocephalus, and 53 (55.2%) had anterior pituitary insufficiency. EoR was gross or near-total in 46 (47.9%) and subtotal in 50 (52.1%) patients. Incomplete resection was associated with lateral suprasellar, intraventricular and/or cavernous sinus extension and with firm/fibrous consistence. At the last follow-up, all but one patient (77, 98.7%) with visual deficits improved. Headache improved in 8 (88.9%) and anterior pituitary function recovered in 27 (50.9%) patients. Recurrence rate was 16.7%, with 32 months mean recurrence-free survival. Conclusions: EEA-TTP is a valid option for GPAs and seems to provide better outcomes, lower rate of complications and higher EoR compared to one- or multi-stage microscopic, non-extended endoscopic transsphenoidal, and transcranial resections.

Study of pre-operative neutrophil-lymphocyte ratio in urothelial carcinoma.

Neutrophil-lymphocyte ratio (NLR), as an indicator of heightened systemic inflammatory response, predicts increased disease burden and poor oncological outcomes in urothelial carcinoma (UC). The study was undertaken with an aim to evaluate the association of NLR with clinicopathological variables and survival outcomes. A total of 80 patients of UC were enrolled in the current retrospective study. Pre-operative NLR (within one month prior to the procedure), patient age, sex, tumour grade, pathological stage, recurrence free survival (RFS), progression free survival (PFS) and cancer specific survival (CSS) were recorded. We chose a cut-off value of 2.7 for NLR and patients were divide into two groups (NLR <2.7 and≥2.7). NLR≥2.7 was significantly associated with advanced tumour stage (p=0.001), but not with tumour grade (p=0.116). Progression (p=0.032) and death rates (p=0.026) were high in patients with NLR≥2.7. Mean RFS (p=0.03), PFS (p=0.04) and CSS (p=0.04) were reduced in patients with NLR≥2.7. On univariate analysis, NLR≥2.7 predicted worse RFS (HR=2.928, p=0.007), PFS (HR=3.180, p=0.006) and CSS (HR=3.109, p=0.016). However, it was not an independent predictor of outcomes on multivariate analysis. Tumour stage and grade are the only independent predictors of RFS, PFS and CSS. High NLR at a cut-off value of≥2.7 is associated with advanced pathological stage, but does not have an independent predictive value for RFS, PFS and CSS.

Preservation of Organ Function in Locally Advanced Non-Metastatic Gastrointestinal Stromal Tumors (GIST) of the Stomach by Neoadjuvant Imatinib Therapy.

Simple SummaryThis study reports a single-center analysis of 55 patients with primary, locally advanced gastric GIST treated with imatinib mesylate (IM) preoperatively for a median of 10 months. The therapy yielded shrinkage of median tumor size from 113 mm to 62 mm. This facilitated 50 patients to undergo significantly less-extensive surgical procedures and resulted in a stomach preservation rate of 96%. The rate of R0 resections was 94% and was followed by a mean recurrence-free-survival time of 132 months with the median not reached. The approach was successful even for patients starting IM during an episode of upper gastrointestinal bleeding. Neoadjuvant IM therapy for locally advanced, non-metastatic gastrointestinal stromal tumors (GIST) of the stomach may play an important role in preserving organ function which might be important for IM plasma levels in an adjuvant or metastatic setting.Background: Neoadjuvant imatinib mesylate (IM) for advanced, non-metastatic gastrointestinal stromal tumors (GIST) of stomach is recommended to downsize the tumor prompting less-extensive operations and preservation of organ function. Methods: We analyzed the clinical-histopathological profile and oncological outcome of 55 patients (median age 58.2 years; range, 30–86 years) with biopsy-proven, cM0, gastric GIST who underwent IM therapy followed by surgery with a median follow-up of 82 months. Results: Initial median tumor size was 113 mm (range, 65–330 mm) and 10 patients started with acute upper GI bleeding. After a median 10 months (range, 2–21 months) of treatment, tumor size had shrunk to 62 mm (range, 22–200 mm). According to Response Evaluation Criteria In Solid Tumors version 1.0 and version 1.1 (RECIST 1.1), 39 (75%) patients had partial response and 14 patients had stable disease, with no progressive disease. At plateau response, 50 patients underwent surgery with an R0 resection rate of 94% and pathological complete response in 24%. In 12 cases (24%), downstaging allowed laparoscopic resection. The mean recurrence-free survival (RFS) was 123 months (95%CI; 99–147) and the estimated 5-year RFS was 84%. Conclusions: Neoadjuvant IM allowed stomach preservation in 96% of our patients with excellent long-term RFS, even when starting treatment during an episode of upper GI bleeding. Preservation of the stomach provides the physiological basis for the use of oral IM in the adjuvant or metastatic setting.

RADIOFREQUENCY AND CRYOABLATION FOR MALIGNANT LUNG NODULES IN A COMMUNITY SETTING

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Localized ablative therapies such as radiofrequency ablation (RFA) and cryoablation (CA) are now accepted treatment modalities for malignant lung lesions, especially for those who are not candidates for surgery or radiotherapy. In this study, we present our experience in two community centers in utilizing ablative lung therapies. METHODS: A retrospective chart and image review was performed of patients treated with lung ablative therapies between November 2014 and September 2019. Outcomes were collected through February 2020. RFA utilized Boston Scientific LeVeen electrodes of sizes 3(13), 3.5(7) and 4 (1). CA was done using one (6) or two (11) Boston Scientific Galil probes. Our primary outcome was local recurrence free survival (RFS), defined as recurrence in the ablation zone or in the same segment. RESULTS: 25 (11 male) patients age 66 (SD 8) underwent ablation for 38 malignant nodules. 20 patients had 25 primary lung malignancies (16 adenocarcinoma, 9 squamous) and 5 patients had 13 metastatic nodules. The metastases were from colon (2), lung, leiomyosarcoma and nasopharyngeal carcinoma. 21 lesions (13 primary) were treated with RFA and 17 lesions (12 primary) were treated with CA. 10 procedures (26%) resulted in pneumothorax and 6 (15%) required chest tube placement. 31 patients (82%) were discharged same day or within 24 hours. Median follow-up was 25 months (range 6-63). The mean lesion size was 17mm (95% CI ± 2.9). Index lesion size was similar in RFA (16.3 ± 3.7) and CA (17.9 ± 4.5mm) groups. In the CA group there were 12% (2/17) local recurrences, whereas the RFA group had 29% (6/21) recurrences (p=0.26). Index lesion size for local recurrences was 16.3 ± 4.8mm in the RFA group and 21 ± 7.8mm in the CA group. There were 0 local recurrences with CA of primary tumors <2cm in diameter. There was no significant difference in local mean RFS time between RFA (33 ± 3.1 months) and CA groups (31.9 ± 2.7 months). Two-year local RFS rate was 79.5% in the RFA group vs 85.6% in the CA group (p=0.63). There were no deaths in the CA group, however the RFA group had 3 mortalities (p=0.1089). CONCLUSIONS: This study shows that ablative therapies can be utilized safely and effectively in a community center for stage I NSCLC and metastatic disease. Our outcomes are comparable to the Alliance trial in terms of local RFS and adverse events. This comprehensive evaluation of our experience with ablative procedures was not powered to detect differences in treatment groups between CA and RFA. However, CA tends to show a better outcome than RFA in our experience. Differences can be due to small sample size, low event rates, cofounders and selection bias. CLINICAL IMPLICATIONS: Our case series highlights the success and feasibility of local ablation for low-grade NSCLC and metastatic disease in a community setting. Further randomized control trials are required to prove superiority of one method over the other. DISCLOSURES: No relevant relationships by Gerard Berry, source=Web Response No relevant relationships by Francis Brahmakulam, source=Web Response No relevant relationships by Michael DiRico, source=Web Response No relevant relationships by shambo guha roy, source=Web Response

Risk factors for the local recurrence of giant cell tumours of the sacrum treated with nerve-sparing surgery.

There is a lack of evidence about the risk factors for local recurrence of a giant cell tumour (GCT) of the sacrum treated with nerve-sparing surgery, probably because of the rarity of the disease. This study aimed to answer two questions: first, what is the rate of local recurrence of sacral GCT treated with nerve-sparing surgery and second, what are the risk factors for its local recurrence? A total of 114 patients with a sacral GCT who underwent nerve-sparing surgery at our hospital between July 2005 and August 2017 were reviewed. The rate of local recurrence was determined, and Kaplan-Meier survival analysis carried out to evaluate the mean recurrence-free survival. Possible risks factors including demographics, tumour characteristics, adjuvant therapy, operation, and laboratory indices were analyzed using univariate analysis. Variables with p < 0.100 in the univariate analysis were further considered in a multivariate Cox regression analysis to identify the risk factors. The rate of local recurrence of sacral GCT treated with nerve-sparing surgery was 28.95% (33/114). Multivariate Cox regression analysis showed that large tumour size (> 8.80 cm) (hazard ratio (HR) 3.16; 95% confidence interval (CI) 1.27 to 7.87; p = 0.014), high neutrophil-to-lymphocyte ratio (NLR) (> 2.09) (HR 3.13; 95% CI 1.28 to 7.62; p = 0.012), involvement of a sacroiliac joint (HR 3.09; 95% CI 1.06 to 9.04; p = 0.039), and massive intraoperative blood loss (> 1,550 ml) (HR 2.47; 95% CI 1.14 to 5.36; p = 0.022) were independent risk factors for local recurrence. Patients with a sacral GCT who undergo nerve-sparing surgery have a local recurrence rate of 29%. Large tumour size, high NLR, involvement of a sacroiliac joint, and massive intraoperative blood loss are independent risk factors. Cite this article: Bone Joint J 2020;102-B(10):1392-1398.

Efficacy of whole-sellar gamma knife radiosurgery for magnetic resonance imaging-negative Cushing's disease.

Corticotroph adenoma delineation in Cushing's disease (CD) patients with previous surgery can be challenging. This study investigated the outcome of whole-sellar gamma knife radiosurgery (GKRS) in MRI-negative, but hormone-active CD patients with prior failed treatment attempts. We retrospectively analyzed data of nine CD cases who underwent whole-sellar GKRS between April 2008 and April 2020 at a single center. Remission was determined as normal morning serum cortisol, normal 24-hour urinary free cortisol (UFC) or extended postoperative requirement for hydrocortisone replacement. Median age was 35.0 years, and most of the cases were female (89%). All subjects had undergone previous surgery. The mean pre-GKRS morning serum cortisol and 24-hour UFC were 27.5 μg/dL and 408.0 μg, respectively. Target volume varied from 0.6 to 1.8 cc, and the median margin dose was 28 Gy. The median duration of endocrine follow-up was 105 months, and initial endocrine remission was achieved in eight subjects (89%) at a median time of 22 months. The actuarial initial remission was 44% at two years, 67% at four years, and 89% at six years. The mean recurrence-free survival was 128 months. Age and pre-GKRS morning serum cortisol was found to be predictors for initial and durable endocrine remissions. New-onset hypopituitarism was observed in two of five patients (40%). None of the patients developed new neurological deficits and had GKRS-related adverse events during the follow-up. Whole-sellar GKRS is a safe and efficient method to manage MRI-negative CD and provides similar GKRS outcome rates as in MRI-positive CD.