Overall Survival Rate In Group Research Articles

Outcomes of repeated endoscopic submucosal dissection for superficial Esophageal squamous cell carcinoma on endoscopic resection scar.

Endoscopic submucosal dissection (ESD) can be performed for superficial esophageal cancer. However, performing ESD for superficial esophageal cancer on a previous endoscopic resection scar may be difficult. We compared the outcomes between ESD for superficial esophageal cancers on previous endoscopic resection scar (group A) and that for naïve lesions (group B). The study included outcomes of ESD, cumulative incidence of local failure, and predictors of the occurrence of local failure in ESD patients with squamous cell carcinoma (SCC). The outcome variables evaluated were en bloc resection rates, procedure times, adverse events, and overall survival rates. Overall, 220 lesions were extracted (groups A and B: 23 and 197 lesions, respectively). In groups A and B, the complete resection rates were 60.9 and 92.9% (P < 0.001), and the mean procedure times were 79 and 68min (P = 0.15), respectively. The perforation rates in groups A and B were 4.3 and 1% (P = 0.28). The 1-year cumulative local failure rates were 22 and 1% (P < 0.001), respectively. In the multivariate Cox proportional hazards analysis, superficial esophageal SCC on a previous endoscopic resection scar was a strong predictor of local failure (hazard ratio = 21.95 [3.99-120.80], P < 0.001). The 3-year overall survival rates in groups A and B were 95 and 93% (P = 0.99), respectively. Repeated ESD on scar is an option for treating superficial esophageal SCC with an acceptable rate of adverse events. Because of the low complete resection rate and high local failure compared with conventional ESD, strict endoscopic follow-up is required after repeated esophageal ESD.

Advancing treatment for perihilar cholangiocarcinoma: role of hepatopancreaticoduodenectomy in small-volume centers.

Hepatopancreaticoduodenectomy (HPD) is a controversial surgical technique for the treatment of perihilar cholangiocarcinoma. This study aimed to clarify the mortality, morbidity, and survival outcomes in patients with perihilar cholangiocarcinoma who underwent HPD at a small-volume hepatobiliary-pancreatic center. This retrospective study included 78 patients with perihilar cholangiocarcinoma who underwent HPD (n = 18) or major liver resection with bile duct resection (n = 60) at our center between October 2013 and December 2022. The primary endpoints were the in-hospital morbidity and 90-day mortality rates. The secondary endpoints included the recurrence-free and overall survival rates in both groups. Major complications (Clavien-Dindo grade ≥3) were more common in the HPD group (Group 1, 61.1%) than in the major liver resection group (Group 2; 23.3%, p = 0.03). The 1-, 3- and 5-year overall survival rates for Groups 1 and 2 were 66.7%, 41.7%, and 27.8% and 79.9%, 44.5%, and 22.7%, respectively (p = 0.89). The 1-, 3-, and 5-year recurrence-free survival rates for Groups 1 and 2 were 64.2%, 53.5%, and 35.6% and 85.3%, 46.8%, and 25.0%, respectively (p = 0.41). Although morbidity and mortality after HPD are higher than those after other surgeries, our findings suggest that HPD is a feasible treatment option for perihilar cholangiocarcinoma, even in small-volume centers. However, meticulous pre- and perioperative evaluation of the patient's overall health status, quality of life, and prospective advantages are required.

Proper position of single and large (≥5 cm) hepatocellular carcinoma in Barcelona Clinic Liver Cancer classification.

The purpose of this study was to evaluate the proper position of single large hepatocellular carcinoma (HCC) in the Barcelona Clinic Liver Cancer (BCLC) staging system. The data were collected from the nationwide multicentre database of the Korean Liver Cancer Association. Patients with single large (≥5 cm) HCC were separated from BCLC stage A patients and designated as Group X. The remaining BCLC stage A and stage B patients were classified as Group A and Group B, respectively. The survival outcomes of propensity score-matched groups were compared. Among the 3965 randomly selected patients, the number of patients in Group X, Group A, and Group B was 414, 2787, and 760, respectively. TriMatch analysis allowed us to obtain 116 well-balanced triplets. The 1-, 3-, and 5-year overall survival rates in Group X were worse than in Group A (91%, 71%, and 48% vs 90%, 78%, and 64%, respectively; P < .000). However, the rates were not different compared with those in Group B (91%, 71%, and 48% vs 90%, 69%, and 48%, respectively; P < .09). In multivariate analysis, Group X, Group B, age over 60 years, prothrombin time-international normalized ratio, and creatinine level were independent predictors of worse overall survival. Our findings suggest that Group X should be relocated to BCLC stage B rather than BCLC stage A.

Tumor Volume Is a Better Prognostic Factor than Greatest Tumor Diameter in Operated Stage I-III Non–Small-Cell Lung Cancer

IntroductionThe aim of this study was to investigate the prognostic impact of tumor volume (TV, recorded from surgical specimens) on patients with stage I-III non–small-cell lung cancer (NSCLC) after complete resection. Materials and MethodsA total of 129 patients with stage I-III NSCLC diagnosed and underwent curative resection from 2007 to 2014 in our center were included in the study. Their clinico-pathological factors were retrospectively reviewed. Overall survival (OS) and disease-free survival (DFS) analyses were performed with the Kaplan-Meier method and Cox's hazard model. According to the ROC analysis, patients were divided into 2 groups (Group 1: 58 patients <30.3 cm3 and Group 2: 71 patients ≥30.3 cm3) and the OS and DFS values were compared. ResultsMedian TVs and greatest tumor diameter were 12 cm3 (0.1-30) / 3 cm (0.4-6.5) in Group 1 and 98 cm3 (30.6-1521) / 6 cm (3.5-21) in Group 2. Median OS was 53 (5-177) months in Group 1 and 38 (2-200) months in Group 2 (P < .001). DFS was similar in both group (28 [1-140] vs. 24 [1-155] months, Introduction P = .489). Kaplan-Meier curves showed significantly higher OS rates in Group 1 than Group 2 (P = .04). In multivariable analysis (TV, tumor T stage, tumor N stage, receiving adjuvant radiotherapy) showed that TV (HR: 0.293, 95% CI: 0.121-0.707, P = .006) and tumor N stage (HR: 0.013, 95% CI: 0.001-0.191, P = .02) were independent factors associated with OS. ConclusionTumor volume, not considered in the routine TNM classification, may improve prediction accuracy of overall OS in operated Stage I-III NSCLC.

Comparative study on the clinical effect of preparing neobladder with different lengths of ileum.

To investigate the relationship between orthotopic U-shaped ileal neobladder volume and bladder function. To investigate the correlation between the volume of the radical cystectomy and the U-shaped ileal neobladder in situ and the function of the bladder. The clinical data of patients undergoing in orthotopic U-shaped neobladder in our hospital were retrospectively analyzed. They were divided into two groups according to the length of the retained ileum. Group 1: The length of the ileum was 25-35cm (including 35cm), and the second group: the length of the ileum was 35-45cm. The basic information, cushion usage, urodynamic examination and complications of the two groups were obtained. A total of 88 patients were included in the study, including 33 in the first group and 55 in the second group. There was no statistical difference in general data, lymph node collection, lymph node positive rate, positive margin rate, postoperative pathological stage, pathological grade, pathological type, intraoperative blood loss, blood transfusion, postoperative hospital stay, and complications between the two groups of patients. significance. Although the usage of urine pads in group 1 was more than that in group 2 in the short term after operation (P<0.05), it started from the third year after operation. Patients in group 1 used less cushion than group 2 (P<0.05). Urodynamic examination was performed on the patients, and the bladder function of group 1 maintained satisfactory time longer than that of group 2. The total number of deaths in the two groups was 12 and 23, respectively. The 5-year overall survival (OS) rate of group 1 was 53.60%, and the 5-year overall survival rate of group 2 was 52.9%. A new bladder formed by cutting the ileum with a length of 25-35 cm (including 35cm) has a longer time to maintain good bladder function than cutting the ileum with a length of 35-45 cm to produce a new bladder.

Annular-shaped stenosis in the ureter: Caution should be taken.

To draw the attention of clinicians and avoid the misdiagnosis, we investigate the relationship between annular-shaped stenosis under ureteroscopy and the clinicopathological features and prognosis in patients with primary urothelial carcinoma of the ureter that have been treated by radical nephroureterectomy. We reviewed the records of patients with primary urothelial carcinoma of the ureter who had received radical nephroureterectomy in our hospital between January 2014 and June 2020. Based on the luminal morphology of the ureteral lesion, patients were divided into two groups: Group A for annular stenosis and Group B for non-annular stenosis. The logistic regression and Cox proportional-hazards models were used to explore the relationship between annular stenosis and clinicopathological findings. We investigated a total of 147 patients in this study, including 30 patients (20.4%) in Group A and 117 (79.6%) patients in Group B. The proportion of patients with diabetes mellitus was significantly higher in group A than in group B (66.6% vs. 38.5%, P = 0.006), and the percentage of patients undergoing ureteroscopy with biopsy was also significantly higher in group A than in group B (100% vs. 35.9%, P < 0.001). Besides, the logistic regression model revealed that annular-shaped stenosis was correlated to advanced T-stage (P = 0.002) and worse tumour grade (P < 0.001). During a median follow-up of 35 months (range: 6-73), 45 (30.6%) patients died, including 35 (23.8%) who died of ureteral carcinoma. The 5-year overall survival rate in Group A was significantly lower than in Group B (33.7% vs. 56.1%, P = 0.004). Similarly, the 5-year cancer-specific survival rate in Group A was also considerably lower than Group B (36.7% vs. 64.8%, P = 0.009). According to the multivariate Cox regression analysis that included only preoperative parameters, annular-shaped stenosis was an independent risk factor for both overall survival and cancer-specific survival (P = 0.006, P = 0.012, respectively). Annular-shaped stenosis indicates high carcinoma invasiveness and poor prognosis for patients with primary transitional cell carcinoma of the ureter. This condition can be easily misidentified, so clinicians should pay more attention when making diagnoses. Additionally, we discovered that diabetes mellitus may contribute to the development of annular stenosis.

A twice-daily or a three-times-daily tegafur-uracil and leucovorin calcium regimen as adjuvant therapy in patients with resected colorectal cancer: A phase III study.

38 Background: Tegafur-uracil (UFT)/leucovorin calcium (LV) is an adjuvant chemotherapy treatment for colorectal cancer. We conducted a multicenter randomized trial to assess the noninferiority of a twice-daily compared with a three-times-daily UFT/LV regimen for stage II/III colorectal cancer in an adjuvant setting. Methods: Patients were randomly assigned to group A (three doses of UFT [300 mg/m2 per day]/LV [75 mg per day]) or B (two doses of UFT [300 mg/m2 per day]/LV [50 mg per day]). The schedule of 28-day oral administration followed by a 7-day rest period was repeated. Five 35-day cycles were repeated. The primary endpoint was 3-year disease-free survival. The secondary endpoints included 5-year overall survival and toxicity. Results: In total, 386 patients were enrolled between July 28, 2011, and September 27, 2013. The 3-year disease-free survival rates of group A (n = 194) and B (n = 192) were 79.4% and 81.4% (95% confidence interval, 72.6-84.4-74.5-85.9), respectively. The 5-year overall survival rates of group A and B were 89.7% and 91.0% (95% confidence interval, 83.3-92.8-84.8-93.8), respectively. The most common grade 3/4 adverse events in group A and B were diarrhea (3.9% vs. 7.3%), neutropenia (2.9% vs. 1.6%), increase in aspartate aminotransferase (4.0% vs. 3.9%), increase in alanine aminotransferase (6.2% vs. 6.8%), nausea (1.7% vs. 3.4%), and fatigue (1.1% vs. 2.3%). Conclusions: Group B outcomes were not inferior to group A outcomes, and adverse events did not increase. Clinical trial information: UMIN000005594.

First-line or second-line PD-1 inhibition in advanced oesophageal squamous cell carcinoma: A prospective, multicentre, registry study.

First-line and second-line immunotherapy with programmed death-1 (PD-1) inhibitors both improve overall survival in patients with advanced oesophageal squamous cell cancer (ESCC). This study explored survival differences between first-line and second-line PD-1 inhibition in advanced ESCC. This registry study included 167 patients with advanced ESCC who were exposed to PD-1 inhibitors in either a first-line or a second-line setting between 15January 2019 and 31 October 2020. The primary endpoint was overall survival, and secondary endpoints included overall tumour response, progression-free survival (PFS) and PFS2. A propensity score-matching (PSM) analysis was performed using the nearest-neighbour method. Sixty-one patients started first-line treatment with chemotherapy and a PD-1 inhibitor (Group 1), while 106started chemotherapy as the first-line choice and received a PD-1 inhibitor as the second-line choice (Group 2). The median PFS was 7.1months in Group 1 and 4.1months in Group 2 (log-rank p=0.001). The median PFS2 was 7.1months in Group 1 and 7.4months in Group 2 (log-rank p=0.4). Before PSM, the median overall survival was 13.5months in Group 1 and 14.1months in Group 2 (log-rank p=0.9), and the sensitivity analysis showed consistent results (14.0 vs. 14.1months). After PSM, the median overall survival rates for Group 1 (n=61) and Group 2 (n=61) were 13.5 and 13.1months (log-rank p=0.7) respectively. In this study, patients with advanced ESCC who received first-line or second-line PD-1 inhibitors seemed to have comparable overall survival.

Tumor-infiltrating lymphocytes as easily accessible prognostic tool in adenocarcinoma of the colon

To determine the prognostic value of tumor-infiltrating lymphocytes (TILs) in colon adenocarcinomas. The study was performed on 180paraffin blocks of operation material from patients diagnosed with adenocarcinoma of the colon, treated at the Kyiv City Oncology Center in 2013-2018. TILs were counted on histological slides stained with hematoxylin-eosin. By TILs count percentage in tumor slides, the samples were divided into three groups: 0-9% TILs (n=65); 10-39% TILs (n=79); and > 40% TILs (n=36). Kaplan - Meyer estimate showed that the difference in overall survival between groups was significant (p=0.001). Multivariate Cox's proportional hazard regression model analysis evidenced on significantly better overall survival rates in groups with moderate TILs percentage (hazard ratio 0.54, 95% CI 0.30-0.97, p=0.042) and high TILs percentage (hazard ratio 0.36, 95% CI 0.13-0.99, p=0.049), respectively, as compared with low TILs percentage group. TILs content can be considered as an independent prognostic factor for colon adenocarcinoma and used as an additional tool in routine practice of pathologists.

Clinical and Therapeutic Factors Vary by Prognosis in Patients with Pathological Complete Response After Neoadjuvant Therapy for Breast Cancer.

PurposeTo determine clinical predictors of recurrence and metastasis in patients with pathological complete response (pCR) after neoadjuvant chemotherapy (NCT).MethodsPatients treated with NCT who achieved pCR (n=285) were classified into three groups according to pre-NCT clinical stage (cStage): group I (IIa–IIb), group II (IIIa), and group III (IIIb–IIIc). Survival was analysed using the Kaplan–Meier method. The relationships between clinicopathological factors and recurrence were determined using Cox regression analysis.ResultsThe median follow-up was 31 months. The 3-year disease-free survival and overall survival rates in groups I, II, and III were 92.7%, 87.8%, and 66.7% (P < 0.01) and 98.6%, 98.3%, and 90.6% (P=0.370), respectively. Lymph node status and tumour size were independent risk factors for recurrence and metastasis after NCT. In the human epidermal growth factor receptor 2-positive subgroup, advanced cStage and lymph node metastasis were associated with recurrence (P < 0.01). In the hormone receptor-positive subgroup, disease-free survival rates differed for cStages I–II compared to cStage III (P=0.049) and clinical node status 0–2 compared to clinical node status 3 (P=0.037).ConclusionPre-NCT cStage predicted the prognosis of pCR for different breast cancer subtypes. Patients with advanced cStage, lymph node metastasis, and large tumour sizes had a higher risk of recurrence or metastasis.

311 PATHOLOGIC COMPLETE LYMPH NODE REGRESSION AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Pathologic complete lymph node regression, which is defined as lymph nodes with evidence of neoadjuvant treatment effect but without viable residual cancer cells, are sometimes observed following neoadjuvant treatments and has been shown to be prognostic, yet with conflicting results. We aim to study its clinicopathological correlation and prognostic impact. Methods Patients who received neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy for esophageal squamous cell carcinoma (ESCC) in a single institute are retrospectively reviewed. Lymph nodes retrieved at post-nCRT esophagectomy are re-examined by a dedicated pathologist. Patients are classified as (1) lymph node-negative with no evidence of tumor involvement or regression (true negative; plausible cN0, ypN0; group 1); (2) lymph node-negative with evidence of complete regression (e.g. fibrosis; plausible cN+ ypN0; group 2); and (3) lymph node-positive (ypN+; group 3). Kaplan–Meier curve and log-rank test, and cumulative incidence of recurrence (CIR) are used for outcome analysis. Results A total of 136 patients, including 73, 25, and 38 in group 1, 2, and 3, respectively, are included. Group 2 is significantly associated with lower risk for lymphovascular invasion (0%, p &amp;lt; 0.001) and perineural invasion (4%, p = 0.038), and higher rate of pathologic complete response in primary tumor (76%, p &amp;lt; 0.001). The 5-year overall survival rates in group 1, 2, and 3 are 42.1%, 52.8%, and 8.0%, respectively. There is no survival difference between group 1 and 2 (p = 0.454). The CIR at 24 months are 46% and 41% in group 1 and 2 (HR: 0.84, 95% CI: 0.432–1.623, p = 0.601, figure 1). Conclusion Pathologic complete lymph node regression correlates with treatment response in primary tumor. The outcome of patients with pathologic complete lymph node regression is comparable to that of those with true negative lymph node involvement. Pathologic complete lymph node regression could be a surrogate for chemoradiotherapy sensitivity and regarded as a good prognostic factor in patients with ESCC.

Adjuvant chemotherapy is an additional option for locally advanced gastric cancer after radical gastrectomy with D2 lymphadenectomy: a retrospective control study

BackgroundThis study compared the long-term efficacy of different durations of adjuvant chemotherapy for patients with gastric cancer after radical gastrectomy with D2 lymphadenectomy.MethodsWe retrospectively identified 428 patients with stage II–III gastric cancer who underwent D2 gastrectomy between 2009 and 2016. Patients were divided into four groups according to the duration of adjuvant chemotherapy, including 0 week (no adjuvant, group A), 20 to 24 weeks (completed 7–8 cycles every 3 weeks or 10–12 cycles every 2 weeks, group B), and 12 to18 weeks (completed 4–6 cycles every 3 weeks or 6–9 cycles every 2 weeks, group C), and less than 12 weeks (received up to 3 cycles every 3 weeks or 5 cycles every 2 weeks, group D). The chemotherapy regimens included XELOX, SOX, and FOLFOX. 5-year overall survival (OS) and disease-free survival (DFS) were analyzed.ResultsThe 5-year OS rates for groups A, B, C, and D were 52.3, 73.7, 72.0, and 53.3%, respectively, and the 5-year DFS rates were 50.0, 68.0, 65.4, and 50.0%, respectively. OS and DFS were higher in group B than in groups A and D. Similarly, patients in group C were more likely to have higher OS and DFS than those in groups A and D. Meanwhile, there were no significant differences in OS and DFS between groups B and C. The multivariate analysis confirmed with high statistical significance the efficacy of complete courses of adjuvant chemotherapy, and, among them, the similar impact of 4–6/6–9 and 7–8/10–12 cycles, resulting in similar HRs vs Group A (0.52 and 0.42, respectively).ConclusionsTo reduce toxicity and maintain efficacy, XELOX or SOX chemotherapy regimens administered for 4–6 cycles every 3 weeks or FOLFOX regimen for 6–9 cycles every 2 weeks might be a favorable option for patients with stage II–III gastric cancer after D2 gastrectomy. Prospective multicenter clinical trials with adequate sample sizes are necessary to verify these findings.

Geriatric nutritional risk index as a prognostic indicator in elderly patients with early colorectal cancer undergoing endoscopic submucosal dissection.

Data on the long-term outcomes of endoscopic submucosal dissection (ESD) performed in elderly patients with early colorectal cancer (CRC) are limited. We analyzed the prognosis of elderly CRC patients, not only from the viewpoint of treatment curability but also from the patients' baseline physical condition assessed by several indexes. A retrospective analysis of 729 patients aged ≥75 years who underwent ESD for Tis/T1 CRC in 16 institutions was conducted. The patients were classified into three groups based on curability: curative ESD (Group A, n = 582), non-curative ESD with additional surgery (Group B, n = 60), and non-curative ESD without additional surgery (Group C, n = 87). Overall survival (OS) was compared among the groups, and factors associated with reduced OS were investigated. The median follow-up periods in Groups A, B, and C were 41, 49, and 46 months, respectively (P = 0.62), during which 92 patients died. Two patients (0.3%) in Group A, none (0%) in Group B, and three (3.4%) in Group C died of CRC. Three-year OS rates in Groups A, B, and C were 93.9%, 96.1%, and 90.1%, respectively, without a significant difference (P = 0.07). Multivariate analysis indicated low (<96.3) geriatric nutritional risk index (GNRI) as the sole independent predictor for reduced OS (hazard ratio 3.37; 95% confidence interval 2.18-5.22; P < 0.0001). Low GNRI, but not the curability attained by ESD, was independently associated with reduced OS in patients with early CRC aged ≥75 years.

Development and Validation of a Prognostic Nomogram for Colorectal Cancer Patients With Synchronous Peritoneal Metastasis.

PurposeSynchronous peritoneal metastasis (S-PM) is considered a poor prognostic factor for colorectal cancer (CRC) and there is no nomogram to predict the survival of these patients. In this study, we aimed to use a multicenter data to identify the factors associated with S-PM of CRC to construct a nomogram for predicting the overall survival (OS) of these patients.MethodsCRC patients with S-PM from two medical centers were enrolled between September 2007 and June 2017. Multivariate analysis was used to identify independent factors associated with OS for the nomogram to predict the 1-, 2-, and 3-year OS rates in the development group. The concordance index (C-index), calibration plot, relative operating characteristic (ROC) curve with area under the curve (AUC) were calculated to evaluate the performance of the nomogram in both the development and an external validation group.Results277 CRC patients with S-PM in the development group and 68 patients in the validation group were eligible for this study. In multivariate analysis of development group, age, carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and chemotherapy were independent variables for OS, based on which the nomogram was built. The C-index of the nomogram in the development and validation group was 0.701 (95% Cl, 0.666–0.736) and 0.716 (95% Cl, 0.622–0.810); demonstrating good discriminative ability. The calibration plots showed satisfactory consistency between actual observation and nomogram-predicted OS probabilities in the development and external validation group. The nomogram showed good predictive accuracy for 1-, 2-, and 3-year OS rates in both groups with AUC >0.70. An online dynamic webserver was also developed for increasing the ease of the nomogram.ConclusionsWe developed and validated a predictive nomogram with good discriminative and high accuracy to predict the OS in CRC patients with S-PM.

Real-world outcomes of esophagectomy versus chemoradiotherapy for clinical stage I esophageal squamous cell carcinoma.

178 Background: Recently, JCOG0502 trial have shown a comparable efficacy with chemoradiotherapy (CRT) and esophagectomy as standard treatment in patients with clinical stage (cStage) I esophageal squamous cell carcinoma (ESCC), showing the standard treatment option of CRT. However, there is few reports for comparison of clinical outcomes with these treatments in real-world. The aim of this study was to clarify the real-world outcomes in cStage I ESCC who performed with CRT or esophagectomy. Methods: This retrospective study included patients with clinical stage I ESCC who received thoracoscopic or open esophagectomy with three-field lymph node dissection or CRT mainly consisted of 5-fluorouracil and platinum with concurrent radiotherapy (50.4 Gy/28Fr or 60 Gy/30Fr) between 2009 and 2017 at National Cancer Center Hospital East. Survival outcomes were calculated using the Kaplan-Meier method, and the differences were evaluated using the log-rank test. Results: Among a total of 156 patients, 128 were male and median age was 68 years old. 120 and 36 patients underwent esophagectomy and CRT, respectively. ECOG performance status 0/1/2 were 138/12/6 patients. Tumor location was Ut/Mt/Lt in 16/87/53 patients. Clinical tumor depth (MM-SM1/SM2-SM3) were 33/123 patients. Patients’ characteristics were similar among treatment groups, except clinical tumor depth (SM2-3; 84.2% in esophagectomy group vs. 61.1% in CRT group, p = 0.005). All patients underwent radical surgery in esophagectomy group, while three patients (8.3%) in CRT group were received additional esophagectomy or endoscopic resection due to residual disease. With a median follow-up of 72 months, 5-year overall survival (OS) and progression-free survival rate were 81.5%/77.0% in esophagectomy group and 82.6/74.4% in CRT group (p = 0.89 and p = 0.48). In safety profile, grade 3 or higher stenosis was observed in 21.7% of esophagectomy group. There was no treatment-related death in both groups. In subgroup analysis for OS, elderly patients (75 years and older) tended to have better 5-year OS rate in CRT group (76.9% in esophagectomy group vs. 81.8% in CRT group), while younger patients ( &lt; 75 years) showed comparable 5-year OS rate in both groups (82.4% in esophagectomy group vs. 82.9% in CRT group). Conclusions: Real-world data reproduced the results of clinical trial, supporting CRT as one of the standard treatment options in patients with cStage I ESCC.

Mortality Rates of EUS-Guided Biliary Drainage (EUS-BD) in Malignant Biliary Obstruction Patients in EUS-BD Era versus Non-EUS-BD Era: A Retrospective Cohort Study

Introduction: Most of the Cholangiocarcinoma (CCA) patients are commonly found in an advanced stage and often presents with Malignant Biliary Obstruction (MBO). Palliative treatment using biliary drainage plays a major role in the treatment modalities. However, only a few studies with small number of subjects have reported their long term outcomes. Aim: To compare the mortality rates of MBO patients in Endoscopic Ultrasound-guided Biliary Drainage (EUS-BD) era versus non-EUS-BD era. Materials and Methods: The present study was a retrospective cohort study which enrolled 132 MBO patients who had received palliative treatment between January 2014 to August 2020 at Thabo Crown Prince Hospital, Nong Khai, Thailand. The patients were treated either with EUS-BD (group l, n=30) or non-EUS-BD (group ll, n=94). Due to imbalance of follow-up time between two groups, the Overall Survival (OS) rates were compared using parametric survival analysis with restricted mean difference at 12 months follow-up, adjusted by other covariates, and presented in term of Kaplan-Meier curve, Hazard Ratio (HR) and 95% confidence interval. Results: Most of the patients (99.19%) were having CCA. The clinical characteristics between the two groups showed no significant difference, except the mean follow-up time that group II was shorter than group I (2.43 vs. 7.12 months; p&lt;0.001). At 12 months after treatment, the OS rate of group I remained significantly higher than group II (mean difference=2.23; 95%CI: 0.54-3.92; p=0.010). The parametric-Cox proportional hazard model showed that the 1-year mortality of patients in group I were 63% less than those in group II, the parametric model between two groups showed statistical significance with p-value=0.043. Conclusion: From present study it can be concluded that EUS-BD in MBO patients achieves lower mortality rate at one year follow-up. For conclusive findings of the benefit of EUS-BD, a prospective long term study with larger numbers of subjects should be performed.

Effective Radiotherapy in Tracheobronchial Adenoid Cystic Carcinoma With Positive Surgical Margin

The study aimed to evaluate the role of postoperative radiotherapy (PORT) in the treatment of trachea and main bronchus adenoid cystic carcinoma (ACC) with a positive surgical margin. Patients with pathologically confirmed trachea or main bronchus ACC operated on at Shanghai Chest Hospital were enrolled. Survival, univariate, and multivariate analyses were performed. The χ2 test was applied to analyze the failure patterns among different groups (R0/0: negative margin resection without PORT; R1/0: positive margin resection without PORT; R1/1: positive margin resection with PORT). From January 2001 to December 2014, 77 patients were deemed eligible for the study. Pairwise comparisons showed that the overall survival rate of group R1/1 was comparable to that of group R0/0 (P=.438), and significantly longer than the rate of group R1/0 (P= .032). Additionally, the local disease-free survival rate of group R1/1 was much higher than that of group R0/0 (P= .023) and R1/0 (P= .001). Cox multivariate analysis identified the radiologic feature (P= .012) and PORT (P= .006) as significantly favorable prognostic factors for locoregional disease-free survival. By contrast, for overall survival, PORT (P= .032) was the only corresponding variable identified by univariate analysis. Furthermore, PORT significantly decreased the locoregional recurrence rate (P= .002) but not distant metastases (P > .999). PORT helped patients with tracheobronchial ACC and microscopic positive surgical margins to achieve a similar outcome as patients with complete resection. R0 resection may not be necessary for tracheobronchial ACC if it is difficult to be completely resected.

Drug-eluting beads transarterial chemoembolization sequentially combined with radiofrequency ablation in the treatment of untreated and recurrent hepatocellular carcinoma.

BACKGROUNDDrug-eluting beads transarterial chemoem-bolization (DEB-TACE) has the advantages of slow and steady release, high local concentration, and low incidence of adverse drug reactions compared to the traditional TACE. DEB-TACE combined with sequentially ultrasound-guided radiofrequency ablation (RFA) therapy has strong anti-cancer effects and little side effects, but there are fewer related long-term studies until now.AIMTo explore the outcome of DEB-TACE sequentially combined with RFA for patients with primary hepatocellular carcinoma (HCC).METHODSSeventy-six patients with primary HCC who underwent DEB-TACE sequentially combined with RFA were recruited. Forty patients with untreated HCC were included in Group A, and 36 patients with recurrent HCC were included in Group B. In addition, 40 patients with untreated HCC who were treated with hepatectomy were included in Group C. The serological examination, preoperative magnetic resonance imaging examination, and post-treatment computed tomography enhanced examination were performed for all patients. The efficacy was graded as complete remission (CR), partial remission (PR), stable disease and progressive disease at the 3rd, 6th, and 9th. All patients were followed up for 3 years and their overall survival (OS), disease-free survival (DFS) were assessed.RESULTSThe efficacy of Group A and Group C was similar (P > 0.05), but the alanine aminotransferase, aspartate aminotransferase and total bilirubin of Group A were lower than those of Group C (all P < 0.05). The proportions of CR (32.5%), PR (37.5%) were slightly higher than Group A (CR: 27.5%, PR: 35%), but the difference was not statistically significant (χ2 = 0.701, P = 0.873). No operational-related deaths occurred in Group A and Group C. The OS (97.5%, 84.7%, and 66.1%) and the DFS (75.0%, 51.7%, and 35.4%) of Group A at the 1st, 2nd, and 3rd year after treatment were similar with those of Group C (OS: 90.0%, 79.7%, and 63.8%; DFS: 80.0%, 59.7%, and 48.6%; P > 0.05). The OS rates in Group A and Group B (90%, 82.3%, and 66.4%) were similar (P > 0.05). The DFS rates in Group B (50%, 31.6%, and 17.2%) were lower than that of Group A (P = 0.013).CONCLUSIONThe efficacy of DEA-TACE combined with RFA for untreated HCC is similar with hepatectomy. Patients with recurrent HCC could get a longer survival time through the combined treatment.

Varices on computed tomography as predictor of survival after hepatic resection in patients with single hepatocellular carcinoma.

The aim of this study was to evaluate whether presence of varices on computed tomography (CT) could predict treatment outcome for hepatocellular carcinoma patients. We enrolled 241 patients with single hepatocellular carcinoma≤5cm treated by surgery. With the use of preoperative CT/endoscopy, patients were classified into the following: presence of standard clinically significant portal hypertension (CSPH) surrogate, defined as varices on esophagogastroduodenoscopy and/or thrombocytopenia with splenomegaly (group 1, n=47); varices on CT without standard CSPH surrogate (group 2, n=45); and none of both (group 3, n=149). Development of posthepatectomy liver failure and overall survival (OS) were evaluated for each patient group, and patients were re-classified into two groups according to presence of CT-enhanced CSPH surrogate, defined as standard surrogate and/or varices on CT. Predictive power of each survival model was compared using Harrell's C-index. Posthepatectomy liver failure rate in group 2 was similar to that in group 1 (53.3% [24/45] vs. 55.3% [26/47]; P=1.000) but significantly higher than that in group 3 (53.3% [24/45] vs. 28.2% [42/149], P=0.002). Seven-year OS rates in group 2 were similar to those in group 1 (55.6% vs. 60.8%, P=0.988) but significantly lower than those in group 3 (55.6% vs. 83.3%, P=0.001). Presence of standard CSPH surrogate (hazard ratio =1.89 [1.08-3.30], P=0.025) and CT-enhanced CSPH surrogate (hazard ratio=2.60 [1.56-4.39], P<0.001) were significant predicting factor for OS. However, CT-enhanced CSPH surrogate had significantly higher Harrell's C-index than standard surrogate (0.619 vs. 0.553, P=0.034). The presence of CT-enhanced CSPH surrogate including varices on CT was the significant predictive of poor OS, providing better predictive power than standard surrogate.

Pulmonary Hypertension Registry: a single-center experience in Egypt

Introduction Pulmonary hypertension is a life-threatening progressive disease that eventually leads to disability and death. Aim To establish the first single-center registry for pulmonary hypertension in Egypt, Kasr Al-Ainy Hospitals, Cairo University, to characterize the pattern of disease burden in terms of survival. Patients and methods Patient enrollment was performed over 2 years with a 5-year follow-up, and the following were recorded: demographic data, clinical presentation, hemodynamic changes, and the 1-, 3-, and 5-year survival rates in groups I and IV, who were potentially treatable. Results A total of 104 patients were enrolled, 65 patients completed the investigational panel, including right heart catheterization. A total of 54 (83.1%) patients belonged to group I, and 11 (16.9%) patients belonged to group IV. Idiopathic pulmonary arterial hypertension was present in 38.5% of the patients, bilharzial pulmonary arterial hypertension in 15.4%, and connective tissue diseases in 18.5%. The mean age was 37.8±12 years; the male : female ratio was 1 : 2.4. Of the patients, 85% presented with functional class II or III disease, and the mean 6-min walk distance was 256±98 m. The hemodynamic parameters were: mean pulmonary artery pressure: 47±10 mmHg; cardiac index: 2.29±0.5; pulmonary vascular resistance: 11±4; and mixed venous oxygen saturation: 59.6±7. Conclusion Idiopathic pulmonary arterial hypertension is the most common cause of pulmonary arterial hypertension in Egypt. Patients with connective tissue diseases have delayed referrals, leading to poor hemodynamic parameters and survival. Bilharziasis is not currently common. The 1-, 3-, and 5-year overall survival rates of group I were 90.9, 81.5, and 75.93%, respectively.