Predictor Of Postoperative Recurrence Research Articles

Impact of MAFLD criteria on postoperative recurrence of non-B, non-C HCC.

This study aimed to clarify the population in whom the presence of metabolic dysfunction-associated fatty liver disease (MAFLD) especially contributes to recurrence after liver resection for non-B, non-C hepatocellular carcinoma (NBNC-HCC). Of the 199 patients who underwent liver resection for NBNC-HCC, those who exceeded Milan criteria and with pathologically proven vascular invasion, intrahepatic metastasis, and positive resection margins were excluded, and the remaining 94 were eligible for this study. We explored factors contributing to postoperative recurrence in populations with and without advanced liver fibrosis. Independent factors contributing to postoperative recurrence in the study population were male sex ( P = 0.023) and presence of type 2 diabetes (DM) ( P = 0.006) and advanced liver fibrosis ( P < 0.001). Factors in cases with advanced liver fibrosis (n = 43) were non-overweight ( P = 0.02), type 2 DM ( P = 0.006), and preoperative alpha-fetoprotein level of 8.2 ng/ml or higher ( P = 0.021). In cases without advanced liver fibrosis (n = 51), only presence of all three MAFLD criteria was related to recurrence. Liver fibrosis is a strong factor contributing to postoperative recurrence of NBNC-HCC, as previously reported. In patients with advanced liver fibrosis, presence of type 2 DM was the only factor associated with recurrence among MAFLD criteria. On the other hand, in patients without advanced liver fibrosis, the combination of all MAFLD criteria, rather than a specific criterion alone, contributed to recurrence. MAFLD criteria were found to have utility as predictors of postoperative recurrence in NBNC-HCC.

Intraoperative Blood Loss Impacts Recurrence and Survival in Patients With Locally Advanced Esophageal Cancer.

Intraoperative blood loss (IBL) has been reported to decrease survival after surgical resection of some malignancies; however, there are few reports on the effects of IBL on recurrence and survival in locally advanced esophageal cancer. Therefore, we investigated the relationship between IBL and postoperative recurrence and overall survival in patients who underwent surgery for esophageal cancer. One hundred and ninety-eight patients with locally advanced esophageal cancer who underwent preoperative adjuvant chemotherapy and curative resection as standard treatment were included in this study. Based on a defined cut-off value for IBL, 27 and 171 patients were classified into the high and low IBL groups, respectively. The relationship between each group and clinicopathological factors, postoperative recurrence, and overall survival were investigated. In terms of the relationship between IBL and clinicopathological factors, the high IBL group had significantly more patients with pathological T4, longer operative time, and higher incidence of postoperative complications than the low IBL group. Both recurrence-free and overall survival were significantly worse in the high IBL group than in the low IBL group. Furthermore, multivariate analysis identified high IBL as an independent factor for predicting poor reference free survival and overall survival. Heavy IBL in patients with locally advanced esophageal cancer may be a useful predictor of postoperative recurrence and overall survival.

Predictive Factors of Liver Hydatid Cyst Recurrence in Children

BackgroundLiver hydatid cyst affects approximately 95% of the world's echinococcosis cases. Despite advances in treatment, the recurrence rate remains high and is influenced by several factors that are yet to be determined. The objective of this study was to identify the predictive factors of liver hydatid cyst recurrence following surgery in children and to establish a treatment regimen aimed at preventing this postoperative morbidity. MethodsA bi-centric retrospective descriptive and analytic study was conducted involving 122 children who underwent surgery for liver hydatid cysts between January 1st, 2009, and December 31st, 2017. All factors that could potentially contribute to recurrence were thoroughly investigated. The data was processed using SPSS.v21, and a significant level of p-value 0.05 was applied. ResultsOut of the 122 children, 20 patients experienced cyst recurrence (16.39%). Among them, there were nine girls and eleven boys. The median time of recurrence was 16.5 months. Abdominal ultrasonography demonstrated efficacy in detecting recurrence. Several factors were identified as predictors of postoperative recurrence, including intimate contact of the hydatid cyst with the large vessels (p = 0.031), intraperitoneal effusion (p = 0.042), bile duct dilation (p = 0.032), and postoperative spontaneous discontinuation of medical treatment (p = 0.010). Among these factors, two independent risk factors for recurrence were identified: intimate contact of the hydatid cyst with the large vessels (p = 0.011) and the presence of an intraperitoneal effusion (p = 0.018). ConclusionOur study has identified several predictors of postoperative recurrence, including two previously undocumented risk factors in the literature. Awareness of these risk factors can assist surgeons in implementing preventive measures to avoid the recurrence of hydatid cysts. Level of EvidencePrognosis study Level II.

Abstract 6596: Genomic and proteome analysis using preoperative cell free DNA and extracellular vesicles of lung cancer patients

Abstract Background: The detection of circulating cell free DNA (cfDNA) has been examined as a predictor of postoperative recurrence and survival in lung cancer patients. Extracellular vesicles (EVs) have potent for searching a new target to cancers. Objective: To analyze the association between cfDNA/EVs and prognosis after lung cancer surgery. Methods: We retrospectively examined patient background, disease-free survival, overall survival, and preoperative cfDNA in lung cancer patients who underwent surgery at Kanazawa University Hospital between January 2017 and May 2020, in whom preoperative chemotherapy was not administered. We extracted cfDNA from 4 ml plasma within 7 days before surgery and measured its concentration. EVs were extracted from 500 μl serum via Tim4 protein. Proteins included in EVs were analyzed by mass spectrometry. Results: 285 patients were included, 179 males and 106 females, median age 71(36-88) years, and 8 patients had SCLC. EGFRm- positive lung cancer was included in 93 cases (32.6%). The pStage0/l/ll/lll/lV of NSCLC was 7/187/42/36/6 respectively, and the pStagel/ll/lll of SCLC was 4/1/3 respectively. The mDFS of NSCLC was 14.6 (7.8-29.7)/21.5 (8.5-NA) months in pStage lll/lV, respectively. mOS was 53.3 (28.7-NA) months in pStage lll and was not achieved in other stages. The mDFS of SCLC was 19.8 (1.9-NA)/NA/5.7 (1.9-NA) months in pStage l/ll/lll, respectively. mOS was NA/NA/9.3 (9.3-NA) months, respectively. cfDNA was detected in 283 (99.2%) patients, with a concentration of 4.7 (0-60.0) ng/μl. The correlation coefficient between cfDNA concentration and DFS/OS in NSCLC was -0.023 (P=0.70)/-0.014 (P=0.81). The correlation coefficient between cfDNA concentration and DFS/OS for SCLC was -0.86 (P=0.024)/-0.89 (P=0.012). No recurrence was observed in patients in whom cfDNA was not detected.EVs were detectable from pre-operative serum samples, and the proteins included in these were different, whether disease was recurrent or not. Conclusion: The cfDNA concentration did not correlate with DFS/OS in post-operative NSCLC, whereas it correlated negatively with DFS/OS in SCLC. In the presentation, we will further discuss about the concrete genetic alterations and protein expression, based on the cfDNA sequencing and proteomics analysis. Citation Format: Hayato Koba, Hideharu Kimura, Seiji Yano. Genomic and proteome analysis using preoperative cell free DNA and extracellular vesicles of lung cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6596.

Solid Pseudopapillary Neoplasms of the Pancreas Across Races Demonstrate Disparities with Comparably Good Prognosis.

Solid pseudopapillary neoplasms (SPNs) of the pancreas are rare with low-grade malignancy and unclarified clinicopathological features. This study aimed to examine their characteristics and re-evaluate current treatments. Databases from three sources were screened for patients with SPNs. We compared the perioperative variables, clinical data, overall survival (OS), and prognostic factors for recurrence among the three corresponding cohorts. We identified 286 patients diagnosed with SPNs between 1988 and 2020. Patients were mostly women (81%; median age: 38years), and peak incidence was observed in women of 20-29years of age. SPNs had a peak incidence in Asian men at 50-59years of age (p = 0.002) and a delayed peak incidence in Asian women at 30-39years of age (p < 0.001). Treatment strategies differed significantly across the institutions and included variations in the number of harvested lymph nodes and rates of vascular resection. Lymph node positivity was the only predictor of postoperative recurrence (odds ratio, 2.2; 95% confidence interval, 1.38-2.99; p = 0.007). Higher rates of lymphovascular invasion (p = 0.02), perineural invasion (p < 0.001), and R1 margin involvement (p < 0.001), as seen in one institution, did not result in poorer long-term survival in terms of the overall (p = 0.43), SPN-specific (p = 0.69), and recurrence-free survivals (p = 0.067). In contrast to previous findings that SPNs are prevalent in young women, a racial predilection for middle-aged Asian men and a delayed female peak incidence were noted. Parenchyma-preserving pancreatectomy may be an acceptable treatment. Non-radical surgery may be appropriate in patients with multiple comorbidities.

Elevated preoperative controlling nutritional status (CONUT) scores as a predictor of postoperative recurrence in gastrointestinal stromal tumors.

The controlling nutritional status (CONUT) score is associated with the postoperative outcomes in various types of tumors, and its prognostic role in gastrointestinal stromal tumors (GISTs) needs to be clarified. Patients with completely resected primary GISTs in the absence of imatinib adjuvant therapy were included. Recurrence-free survival(RFS) was estimated with the Kaplan-Meier method and compared using log-rank test. Prognostic factors were compared using Cox proportional hazards model. A total of 455 patients were included. The median follow-up time was 132.0 months (range: 7.0-253.0). Recurrence/metastasis developed in 92 (20.2%) patients. Patients were assigned to three groups: 219 (48.1%) were in normal nutrition group (CONUT = 0-1), 196 (43.1%) were in mild malnutrition group (CONUT = 2-4) and 40 (8.8%) were in moderate-severe malnutrition group (CONUT ≥ 5). Nongastric primary tumor site, large tumor size, high mitotic index, tumor rupture and high CONUT score were independent prognostic factors for shorter RFS using multivariate analysis (p < 0.05). Elevated preoperative CONUT score was a predictor of recurrence for patients with resected GIST. The clinical application of the CONUT score is simple and feasible, and might contribute to the individualized treatment of GIST patients.

Large sized gastrointestinal stromal tumors

Background: large gastrointestinal stromal tumors (GISTs) represent a surgical challenge for complete en block resection, which is the mainstay strategy for management. This study was done to determine long term oncological outcomes following resection of GISTs &gt;10 cm. Material and methods: This retrospective study included 52 patients who underwent surgical resection for GIST &gt;10 cm. Our main outcome is to determine the overall survival along with the predictors of post-operative recurrence after large GISTs resection. Results: The stomach was the most commonly affected organ (55.8%). Mass size was larger than 20 cm in 36.5% of our patients and the rest of them ranged between 10 – 20 cm. Anatomical/formal resection was performed in 63.5%of patients, and the remaining ones received a limited resection. After follow-up (median 57 months), disease-free and overall survival had mean values of 80.97 and 100.56 months, respectively. Recurrence was encountered in 36.5%, while the total mortality rate was 26.9%. Multivariate analysis revealed that tumor rupture and CD 34 positive tumors were strong predictors of recurrence. Conclusion: surgical resection of GISTs is the mainstay therapy, but it is associated with relatively high rate of recurrence even with adjuvant tyrosine kinase inhibitor therapy (TKIs).

Neutrophil-to-Lymphocyte Ratio as a Predictor of Postoperative Recurrence and Prognosis in Oesophageal Squamous Cell Carcinoma

Trimodal therapy is frequently used for patients with locally advanced, resectable oesophageal cancer. However, it does not provide a satisfactory prognosis. The neutrophil-to-lymphocyte ratio (NLR) is an important indicator of patients' inflammatory and immune statuses. We investigated the prognostic role of NLR values obtained at different treatment stages in patients with oesophageal squamous cell carcinoma. We evaluated the correlation between NLR values or their change and prognosis at each treatment point (before chemoradiotherapy; before surgery; and at 14 days, and 1 and 2 months postoperatively) in 163 patients with oesophageal squamous cell carcinoma who underwent oesophagectomy after neoadjuvant chemoradiotherapy from April 2003 to August 2018. The outcomes studied were overall (OS) and relapse-free (RFS) survival. The NLR at 1 month postoperatively showed the strongest correlation with prognosis, with an optimal cut-off value of 4.5 (area under the curve=0.7878; 95% confidence interval=0.70-0.85; p<0.0001). Univariate and multivariate analyses showed that NLR ≥4.5 was a significant factor for both RFS (hazard ratio=4.44, 95% confidence interval=2.69-7.34) and OS (hazard ratio=3.88, 95% confidence interval=2.38-6.32). Furthermore, NLR significantly stratified patients for the RFS and OS regardless of the pathological response (complete/non-complete response) and postoperative complications (Clavien-Dindo grade <IIIa/≥ IIIa). NLR measurement at 1 month postoperatively correlated with prognosis and was also a useful predictor of recurrence. Patients with high NLRs need more rigorous follow-up as they constitute a high-risk group. Postoperative adjuvant therapy may also be considered for such patients.

Predictors of postoperative recurrence in a cohort of Tunisian patients with Crohn's disease.

Background:The aim of our study was to evaluate the frequency and risk factors of clinical postoperative recurrence in Tunisian patients with Crohn’s disease (CD).Methods:Clinical data of 86 patients with CD who underwent ileocolonic resection at University Hospital of Sahloul in Tunisia were retrospectively reviewed. Continuous data are expressed as median (interquartile range), and categorical data as frequencies and percentages. Multivariate Cox proportional hazard regression analysis was conducted to identify the risk factors of postoperative clinical recurrence.Results:A total of 86 patients with CD were included in this study. During follow-up, 21 patients (24.4%) had clinical recurrence. The cumulative clinical recurrence rate was 9.3% at 1 year and 20.9% at 5 years. In univariate analysis, predictive factors of postoperative clinical recurrence were active preoperative smoking (p = 0.008), ileal location of the disease (p = 0.01), active CD [Crohn’s Disease Activity Index (CDAI) > 150] (p = 0.04), duration of disease before first surgery <9.5 months (p = 0.027), and limited resection margins (<2 cm) from macroscopically diseased bowel (p = 0.005). In multivariate analysis, only smoking (p = 0.012), duration of disease before first surgery <9.5 months (p = 0.048), and limited resection margins (<2 cm) from macroscopically diseased bowel (p = 0.046) were confirmed to be independent factors of clinical relapse.Conclusion:Smoking, duration of disease before first surgery <9.5 months, and limited resection margins (<2 cm) from macroscopically diseased bowel were independent risk factors for clinical recurrence. Based on these factors, patients could be stratified in order to guide postoperative therapeutic options.

PD-L1 expression as a predictor of postoperative recurrence and the association between the PD-L1 expression and EGFR mutations in NSCLC

Although information on the PD-L1 expression and EGFR mutations in non-small cell lung cancer (NSCLC) is important for therapeutic strategies, the effect of these factors on postoperative recurrence and the association between each factor have remained unclear. We retrospectively assessed the PD-L1 expression and EGFR mutations in 280 NSCLC patients, and analyzed the associations by multivariate analyses. The hazard ratio (HR) of postoperative recurrence in cases with high (≥ 50%) PD-L1 expression regarding negative expression was 4.83 (95% confidence interval [CI] 1.51–15.5). The HR for the PD-L1 expression, considered a continuous variable, was 1.016 (95% CI 1.01–1.03). The HRs in cases with EGFR major and minor mutations were 0.42 (95% CI 0.14–1.25) and 0.63 (95% CI 0.18–2.15), respectively. The high PD-L1 (≥ 50%) expression was significantly associated with exon 21 L858R mutation (Ex21) of EGFR (odds ratio, 0.10; 95% CI 0.01–0.87). The risk of postoperative recurrence increased 1.016-fold for every 1% increase in the PD-L1 expression, and a marked increase in risk was observed for expression levels of ≥ 50%. Whereas EGFR mutations were not an independent risk factor. The high PD-L1 (≥ 50%) expression was negatively associated with Ex21. These findings may help identify NSCLC patients with an increased risk of postoperative recurrence.

Characterization of Crohn's disease patients in Egypt: Risk factors for postoperative recurrence (A cohort study)

BackgroundThe aim of study to identify the characterizations of Crohn's disease in Egyptian patients and to determine its predictors for postoperative recurrence. MethodsWe conducted a retrospective observational cohort study on 15 patients diagnosed as Crohn's disease with surgical interventions. Different characteristics of studied patients were analyzed to determine the risk factors for postoperative recurrence such as age at diagnosis, gender, smoking, main presenting symptom, Montreal classification, perianal disease, laboratory findings and protocol of management including surgical characteristics like age at operation, surgical indication, preoperative medication, surgical approach, and operative findings. ResultsNine of the studied patients (60%) suffered from clinical postoperative recurrence with mean duration of 23.5 ± 40.6 months. In comparison the demographic, clinical, operative, and medical treatment data between patients with postoperative recurrence of Crohn's disease and those without recurrence, age at diagnosis (mean age 42.9 years) and age at operation (mean 44.7 years) were found statistically significant in postoperative recurrence group (p-value = 0.001). According to Montreal classification of Crohn's disease, patients >40 years were significantly found in postoperative recurrence group, while patients between 17 and 40 years were significantly found in postoperative non-recurrence group (p-value=0.007) and ileal location of Crohn's disease was found significantly in postoperative recurrent group (p-value=0.044). Postoperative biological therapy significantly decreased the incidence of postoperative recurrence in the current study (p-value= 0.041). ConclusionsAge at diagnosis, age at operation, ileal location of Crohn's disease can significantly predict postoperative recurrence. Also, postoperative biological therapy can significantly decrease the incidence of postoperative recurrence.

Predictors of postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma.

To analyze the effect of patterns of extrarenal tumor extension with other pathological factors on postoperative recurrence in patients with non-metastatic pT3a renal cell carcinoma. We retrospectively reviewed 587 non-metastatic renal cell carcinoma patients who underwent radical surgery between 2006 and 2017 at Kansai Medical University Hospital, Hirakata, Osaka, Japan. We extracted a subset of 114 patients with pT3a of predominant histological types: 93 with clear cell renal cell carcinoma (81.6%), 13 with unclassified renal cell carcinoma (11.4%), six with chromophobe renal cell carcinoma (5.3%) and two with papillary renal cell carcinoma. The primary end-point was recurrence-free survival. The Kaplan-Meier method and Cox proportional hazards model were used for statistical analysis. Of the 114 patients with pT3a renal cell carcinoma, 42 patients (36.8%) experienced recurrence. Multivariate analysis showed that perinephric fat invasion (hazard ratio 2.36, P=0.009), sarcomatoid or rhabdoid component (hazard ratio 2.88, P=0.022) and necrosis (hazard ratio 2.34, P=0.030) were independent factors for recurrence-free survival. The high-risk pT3a group, which had more than two independent predictors, had poor prognosis. Recurrence-free survival of the high-risk pT3a group and the pT3b or greater group were similar (median recurrence-free survival 23.0 and 10.8months, respectively). Perinephric fat invasion, sarcomatoid or rhabdoid component and necrosis are independent predictors of recurrence-free survival in patients with pT3a-predominant renal cell carcinoma. Patients with more than two of these predictors have poor oncological outcomes. These findings will aid in risk stratification for predicting recurrence and provide prognostic information for patient counseling.

A novel classification of portal venous tumor invasion to predict residual tumor status after surgery in patients with pancreatic neuroendocrine neoplasms.

To elucidate whether portal venous tumor invasion (PVTI) is a prognostic factor for patients with pancreatic neuroendocrine neoplasms (Pan-NENs). From 2002 to 2019, 240 patients with Pan-NEN were included to examine prognostic factors. PVTI based on computed tomography (CT) images are classified into four types: no PVTI (Vp0/1), PVTI not invading the superior mesenteric vein (Vp2), PVTI invading the superior mesenteric vein or portal vein (Vp3), and PVTI invading the portal bifurcation (Vp4). Simultaneous liver metastases (SLM) determined the overall survival (OS) in 240 patients. The 5-year OS rates with and without SLM were 46% and 92%, respectively (P < 0.001). PVTIs were observed in 56 of the 240 patients (23%). Among such patients, 39, 11, and 6 had Vp2, Vp3, and Vp4, respectively. The 5-year OS rates with and without PVTI were 62% and 82%, respectively (P < 0.001). Severity of PVTI did not decide PFS and OS after R0/1 resection. There was significant difference in the prognoses between Vp0/1 and Vp2-4. In 161 patients without SLM, 21 had PVTI (13%). According to a multivariate analysis, PVTI and Ki-67 index were independent prognostic factors for progression-free survival (PFS) in patients without SLM. The 5-year PFS rates with and without PVTI were 18% and 77%, respectively (P < 0.001). The 5-year OS rates with and without PVTI were 76% and 95%, respectively (P = 0.02). PVTI was associated with tumor functionality, high serum NSE, and high Ki-67 index. PVTI may be a predictor for postoperative recurrence.

MET-08 Air in cistern or ventricle after brain metastasis surgery is a predictor of early postoperative intracranial recurrence

INTRODUCTION: The operations of brain metastasis are on the increase as a result of more routine diagnostic imaging and improved extracranial systemic treatment strategies. Opening of the cistern or ventricle during tumor resection may promote local recurrence and cerebrospinal fluid dissemination. We investigated whether the air found in the cistern/ventricle on postoperative Computed tomography (CT) was a predictor of postoperative recurrence.METHODS: Between 2012 and 2019, 27 patients with single brain metastasis were treated with gross total resection at our hospital. The patients in which air was found in the cistern or ventricle of the head CT on the day after surgery was designated as air(+) group, and the patients without air was designated as air(-) group. The primary outcome was the local recurrence, as diagnosed with neuroimaging. The death due to other than brain metastasis was defined as competing risk.RESULTS: CT air(+) group was 17 patients, whereas CT air(-) group was 10 patients. There was no significant difference between the two groups, such as age and sex. Estimated 1-year brain tumor recurrence rate was 70% in the air(+) group and 5.9% in the air(-) group. (p = 0.004). On the other hand, no significant difference was observed in estimated 1-year competing risk between in the air(+) group (10%) and in the air(-) group (2.4%).CONCLUSION: En bloc resection of brain metastasis is effective, but there was no report on the risk of opening the cistern or ventricle. Our results indicate that postoperative air presence in the cistern or ventricle could be a predictor of early postoperative recurrence. In metastatic brain tumor removal, the cistern and ventricle should not be opened, and close follow-up should be done if air in the cistern or ventricle is detected on postoperative CT.

Preoperative AminoIndex Cancer Screening (AICS) abnormalities predict postoperative recurrence in patients undergoing curative resection for non-small cell lung cancer

BackgroundAminoIndex™ Cancer Screening (AICS (lung)) was developed as a screening test for lung cancer using a multivariate analysis of plasma-free amino acid (PFAA) profiles. According to the developed index composed of PFAA, the probability of lung cancer was categorized into AICS (lung) ranks A, B, and C in order of increasing risk. The aim of the present study was to investigate the relationship between the preoperative AICS (lung) rank and surgical outcomes in patients who underwent curative resection for non-small cell lung cancer (NSCLC).MethodsPreoperative blood samples were collected from 297 patients who underwent curative resection for NSCLC between 2006 and 2015. PFAA concentrations were measured. The relationship between the preoperative AICS (lung) rank and clinicopathological factors was examined. The effects of the preoperative AICS (lung) rank on postoperative outcomes were also analyzed.ResultsThe AICS (lung) rank was A in 93 patients (31.3%), B in 82 (27.6%), and C in 122 (41.1%). The AICS (lung) rank did not correlate with any clinicopathological factors, except for age. Based on follow-up data (median follow-up period of 6 years), postoperative recurrence was observed in 22 rank A patients (23.7%), 15 rank B (18.3%) and 49 rank C (40.2%). In the univariate analysis, preoperative AICS (lung) rank C was a worse factor of recurrence-free survival (p = 0.0002). The multivariate analysis identified preoperative AICS (lung) rank C (HR: 2.17, p = 0.0005) as a significant predictor of postoperative recurrence, particularly in patients with early-stage disease or adenocarcinoma.ConclusionPreoperative AICS (lung) rank C is a high-risk predictor of postoperative recurrence in patients undergoing curative resection for NSCLC.

Abstract P3-07-09: The preoperative systemic inflammatory response as a strong prognostic factor in breast cancer patients

Abstract Background: Recent reports show that the preoperative systemic inflammatory response status correlate with the survival rate in cancer patients. The Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) score are used as screening tools for immunonutritional status and reported to be a predictor of postoperative recurrence in patients with various gastrointestinal cancers. However, the clinical importance of these scoring in breast cancer has not been fully elucidated. The aim of this study is to investigate the clinical impact of preoperative systemic inflammatory response on long-term survival of breast cancer patients. Patients and Methods: We retrospectively analyzed 653 consecutive stage I-III breast cancer patients who were treated from January 2002 to December 2013. The PNI score was calculated as 10 x serum albumin (g/dl) + 0.005 x total lymphocyte count (per mm3). The CONUT score is calculated from three parameters, serum albumin, cholesterol, and total lymphocytes count. The patients were divided into two groups according to each value. The uni- and multivariate Cox regression analyses were performed to evaluate the prognositic value of the systemic inflammatory response in breast cancer. Results: The malnutritional or high SIR status was observed in 170 (26%),131 (20%), 119 (18%) and 226 (35%) patients as low-PNI, high-CONUT, elevated NLR and PLR, respectively. The relapse-free survival (RFS) and overall survival (OS) rates were significantly lower in the low-PNI group (RFS: p&amp;lt;0.0001, OS: p&amp;lt;0.0001) and high-CONUT group (RFS: p=0.0009, OS: p=0.0018). No significant association was found between NLR, PLR and prognosis. In the multivariate analysis, low-PNI was the independent prognostic factors for OS (HR4.71, p=0.0023). In the subset analysis, the low-PNI group showed poor prognosis especially in the postmenopausal, hormone receptor negative patients. The low-PNI also had poorer prognosis in post-recurrence survival. Conclusions: The preoperative systemic inflammatory response, especially PNI, is a strong independent predictor of long-term survival among breast cancer patients. Citation Format: Nami Yamashita, Sayuri Akiyoshi, Eiki Sano, Tomoko Shigechi, Yuichi Hisamatsu, Eriko Tokunaga, Eiji Oki, Masaki Mori. The preoperative systemic inflammatory response as a strong prognostic factor in breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-07-09.

Local and systemic recurrence patterns of urothelial cancer after radical cystectomy and their prognostic factors

Objective To assess the local recurrence rate and distant metastasis rate of bladder urothelial carcinoma after radical cystectomy, and to determine the related factors of local recurrence and distant metastasis. Methods From 2001 to 2011, 200 patients diagnosed with bladder urothelial carcinoma who underwent radical cystectomy were enrolled. The patients were followed up (average 33.5 months) and the corresponding clinical data were collected. Results One hundred and twenty-three patients had recurrence in all patients enrolled in the standard. Of these, 45 (24.5%) had local recurrence and 78 (39.0%) had distant metastases. There was statisrtical significance between two groups for LND level(<10% vs.≥10%, P=0.006) The TTR of local recurrence and distant recurrence was (14.78±12.43)months and (14.23±13.26)months, respectively. Analysis of different predictors showed that clinical stage (HR=2.035/3.567, P<0.001)and lymph node involvement(HR=3.560, P<0.001)were the most important predictors of postoperative recurrence. Conclusions Recurrence after radical cystectomy is the main obstacle to the surgical treatment of bladder cancer. Clinical stage and lymph node involvement are important prognostic factors for local recurrence and distant metastasis. Adjuvant therapy for prognostic factors can improve patient survival. Key words: Urinary Bladder Neoplasms; Cystectomy; Neoplasm Recurrence, Local; Neoplasm Metastasis

The clinical impact of the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score on breast cancer patients survival.

1560 Background: Recent reports show that the preoperative immunonutritional status correlate with the survival rate in cancer patients. The Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are used as screening tools for immunonutritional status and reported to be a predictor of postoperative recurrence in patients with various gastrointestinal cancers. However, the clinical importance of the PNI and CONUT in breast cancer has not been elucidated. The aim of this study is to investigate the clinical impact of preoperative PNI and CONUT on long-term survival of breast cancer patients. Methods: We retrospectively analyzed 653 consecutive stage I-III breast cancer patients who were treated from January 2002 to December 2013. The PNI score was calculated as 10 x serum albumin (g/dl) + 0.005 x total lymphocyte count (per mm3). The CONUT score is calculated from three parameters, serum albumin, cholesterol, and total lymphocytes count. The patients were divided into two groups according to the PNI and CONUT score. The uni- and multivariate Cox regression analyses were performed to evaluate the prognositic value of the PNI and CONUT in breast cancer. Results: The malnutritional status was observed in 170 (26%) and 131 (20%) patients as low-PNI and high-CONUT, respectively. The relapse-free survival (RFS) and overall survival (OS) rates were significantly lower in the low-PNI group (RFS: p &lt; 0.0001, OS: p &lt; 0.0001) and high-CONUT group (RFS: p = 0.0009, OS: p = 0.0018). In the multivariate analysis, low-PNI was independent prognostic factors for both RFS and OS (RFS: HR2.33, p = 0.032, OS: HR5.01, p = 0.0009). In the subset analysis, the low-PNI group showed poor prognosis especially in the postmenopausal, hormone receptor negative patients. The low-PNI also had poorer prognosis in post-recurrence survival. Conclusions: The preoperative PNI is a strong independent predictor of long-term survival among breast cancer patients.

Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn's disease.

AIMTo evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.METHODSData from all patients who underwent Crohn’s disease (CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperative recurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection.RESULTSOne hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery (OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender (OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior (OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization (OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.CONCLUSIONThe presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.

Predictive impact for postoperative recurrence using the preoperative prognostic nutritional index in pathological stage I non-small cell lung cancer

BackgroundThe most effective treatment for early-stage non-small cell lung cancer (NSCLC) is surgical resection. Nevertheless, up to 20% of patients, even those with stage I NSCLC, relapse after surgery and die. The prognostic nutritional index (PNI) is used to assess immunonutritional conditions or is a predictor of postoperative recurrence in patients with digestive malignancies. However, the usefulness of the PNI for lung cancer is still unknown. We retrospectively analyzed clinicopathological features of stage I NSCLC patients to identify predictors of recurrence and to investigate effects of preoperative PNI levels. MethodsWe selected 141 consecutive stage I NSCLC patients who were treated from August 2005 to August 2010. We measured their preoperative PNI levels in uni- and multivariate Cox regression analyses of recurrence-free survival. ResultsA low PNI was significantly associated with sex (P=0.0117), preoperative serum carcino embryonic antigen levels (P=0.0228), and postoperative recurrence (P<0.0001). In multivariate analysis, PNI (RR: 9.243; 95% CI: 3.662–25.823; P<0.0001), pleural invasion (RR: 8.664; 95% CI: 2.510–38.056; P=0.0005), and intratumoral blood vessel invasion (RR: 3.151; 95% CI: 1.259–7.681; P=0.0152) were independent prognostic factors. The low-PNI group had a significantly shorter recurrence-free survival than the high-PNI group, regardless of pathological T factors (T1a, P=0.0422; T1b, P<0.0001; T2a, P=0.0098). ConclusionsThe preoperative PNI level is a simple and novel predictor of recurrence in stage I NSCLC patients, and might help identify patients who will need multimodality therapy such as induction or adjuvant therapy.