Prognostic Factors For Local Recurrence Research Articles

Deep transfer learning based on magnetic resonance imaging can improve the diagnosis of lymph node metastasis in patients with rectal cancer.

Lymph node (LN) metastasis is the main prognostic factor for local recurrence and overall survival of patients with rectal cancer. The accurate evaluation of LN status in rectal cancer patients is associated with improved treatment and prognosis. This study aimed to apply deep transfer learning to classify LN status in patients with rectal cancer to improve N staging accuracy. The study included 129 patients with 325 rectal cancer screenshots of LN T2-weighted (T2W) images from April 2018 to March 2019. Deep learning was applied through a pre-trained model, Inception-v3, for recognition and detection of LN status. The results were compared to manual identification by experienced radiologists. Two radiologists reviewed images and independently identified their status using various criteria with or without short axial (SA) diameter measurements. The accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were calculated. When the same radiologist performed the analysis, the AUC was not significantly different in the presence or absence of LN diameter measurements (P>0.05). In the deep transfer learning method, the PPV, NPV, sensitivity, and specificity were 95.2%, 95.3%, 95.3%, and 95.2%, respectively, and the AUC and accuracy were 0.994 and 95.7%, respectively. These results were all higher than that achieved with manual diagnosis by the radiologists. The internal details of LNs should be used as the main criteria for positive diagnosis when using MRI. Deep transfer learning can improve the MRI diagnosis of positive LN metastasis in patients with rectal cancer.

Does adjuvant chemoradiation benefit patients with lymph node-positive biliary tract cancer? A secondary analysis of SWOG S0809.

4104 Background: Biliary tract cancers are rare tumors with a median overall survival (OS) of 16 months for node-positive (N+) and 37 months for node-negative (N0) disease despite resection. Lymph node status is a known strong prognostic factor for local recurrence with an average estimated 2-year disease-free survival (DFS): 65.5% for N0 and 29.7% for N+ tumors. The Phase II Intergroup Trial S0809 showed that adjuvant capecitabine and gemcitabine followed by radiotherapy and concurrent capecitabine improved OS in patients with extrahepatic cholangiocarcinoma (EHCC) and gallbladder cancer (GBC) compared to historical controls. We hypothesized that nodal status is a prognostic factor for local recurrence in this patient population who received adjuvant therapy. Methods: This analysis included patients with stage pT2-4, N+ or positive margin EHCC or GBC. Treatment included four cycles of gemcitabine (1,000 mg/m2 intravenously on days 1 and 8) and capecitabine (1,500 mg/m2 per day on days 1 to 14) every 21 days followed by concurrent capecitabine (1,330 mg/m2 per day) and radiotherapy (45 Gy to regional lymphatics; 52.5 to 59.4 Gy to tumor bed). S0809 patients who did not receive radiotherapy were excluded from analysis. Correlations between nodal status, resection margin, and other clinicopathological factors, patterns of recurrence and survival were analyzed, and Cox regression models were used to estimate the prognostic significance of nodal status. A Z-test was used to compare DFS rates between these patients and historical data. Results: A total of 69 patients [EHCC n = 46 (66%); GBCA n = 23 (33%)] were evaluated with a median age of 61.7 (26.1-80.6). The majority of N0 patients were female (17/24, 70.8%), whereas most N+ patients were male (25/45, 55.6%; p < 0.04). Distribution of R0 (66.7%) and R1 (33.3%) resections was similar in the N0 and N+ groups. Thirty-four patients with EHCC had N+ disease (73.9%) compared with 11 patients with GBCA (47.8%, p = 0.03). Nodal status did not significantly impact OS (HR = 2.03, 95% CI 0.92-4.49, p = 0.08) or DFS (HR = 1.75, 95% CI 0.85-3.59, p = 0.13). Two-year OS was 70.6% for N0 and 60.9% for N+ disease (p = 0.11). Nodal status was not significantly associated with 2-year DFS: 62.5% for N0 and 49.8% for N+ (p = 0.20). N+ vs N0 tumors showed higher rates of distant failure (51.1% vs 25.0%, p < 0.04), but similar local recurrence (17.8% vs 12.5%, p = 0.88). The observed 2-year DFS in patients with N+ tumors was significantly longer compared to the historical rate of 29.7% (p = 0.004). Conclusions: This combination adjuvant treatment regimen following curative resection for EHCC and GBCA provides favorable outcomes regardless of nodal status. These data suggest that adjuvant chemoradiation may positively impact local control in N+ patients. These findings need to be validated in future clinical trials. Clinical trial information: NCT00789958.

P099. Where angels fear to tread: Does surgical margin re-excision following breast conserving surgery increase the rate of local recurrence?

Introduction: Breast-conserving surgery (BCS) is the gold standard surgical treatment for early stage breast cancer. The margin status of the resection is an important prognostic factor for local recurrence after BCS. Surgical re-excision of margins as a second procedure can be an inexact science. The aim of our audit was to compare local recurrence rates following re-excision of margins with local recurrence rates following BCS only.

Five‐year oncological outcomes for rectal cancer treated by upfront laparoscopic total mesorectal excision

AbstractAimThe study aimed to evaluate the long‐term recurrence rates and survival following upfront laparoscopic total mesorectal excision (TME) for rectal adenocarcinoma.Patient and MethodsThis was a retrospective cohort of 94 patients with rectal adenocarcinoma undergoing upfront radical resection in New Territories West Cluster between 2010 and 2015. Tumours with safe circumferential resection margin (>1 mm) on magnetic resonance imaging (MRI) staging were selected for upfront surgery. Demographic data, tumour characteristics, operative details, and histopathological and postoperative outcomes were collected from patients' records. The primary outcome was local recurrence. Secondary outcomes were distant recurrence and overall (OS) and disease‐free survival (DFS).ResultsA total of 224 patients were diagnosed with rectal adenocarcinoma, of which 94 received upfront surgery after a multidisciplinary team discussion by surgeons and oncologists. The median follow‐up period after surgery was 60 months (range 4.7‐60.9 months), with four patients lost to follow‐up. Six patients (6.3%) developed local recurrence (two with isolated local recurrence and four with local and distant recurrence). Twelve patients (12.8%) experienced distant recurrence. The 5‐year OS and DFS rates were 84.3% and 76.2%, respectively. Possible prognostic factors for local recurrence (including distal tumour level ≤ 5 cm, clinical nodal stage, clinical threatened margin, pathological stage, harvested lymph nodes <12, distal margin <1 cm, positive extramural venous invasion, and circumferential resection margin) were evaluated by multivariable logistic regression, and were shown to be insignificant.ConclusionUpfront laparoscopic TME for MRI‐selected rectal cancer patients can achieve favourable oncological outcomes in our centre. Routine neoadjuvant treatment for all T3 or nodal positive disease is not necessary.

Prognostic importance of circumferential resection margin in the era of evolving surgical and multidisciplinary treatment of rectal cancer: A systematic review and meta-analysis

BackgroundCircumferential resection margin is considered an important prognostic parameter after rectal cancer surgery, but its impact might have changed because of improved surgical quality and tailored multimodality treatment. The aim of this systematic review was to determine the prognostic importance of circumferential resection margin involvement based on the most recent literature. MethodsA systematic literature search of MEDLINE, Embase, and the Cochrane Library was performed for studies published between January 2006 and May 2019. Studies were included if 3- or 5-year oncological outcomes were reported depending on circumferential resection margin status. Outcome parameters were local recurrence, overall survival, disease-free survival, and distant metastasis rate. The Newcastle Ottawa Scale and Jadad score were used for quality assessment of the studies. Meta-analysis was performed using a random effects model and reported as a pooled odds ratio or hazard ratio with 95% confidence interval. ResultsSeventy-five studies were included, comprising a total of 85,048 rectal cancer patients. Significant associations between circumferential resection margin involvement and all long-term outcome parameters were uniformly found, with varying odds ratios and hazard ratios depending on circumferential resection margin definition (<1 mm, ≤1 mm, otherwise), neoadjuvant treatment, study period, and geographical origin of the studies. ConclusionCircumferential resection margin involvement has remained an independent, poor prognostic factor for local recurrence and survival in most recent literature, indicating that circumferential resection margin status can still be used as a short-term surrogate endpoint.

The Debatable Benefit of Gross-Total Resection of Brain Metastases in a Comprehensive Treatment Setting.

Simple SummaryIn this monocentric retrospective analysis, the extent of resection of singular/solitary brain metastases has no impact on local recurrence and overall survival rates in patients receiving multidisciplinary adjuvant treatment. Since systemic disease progression is the leading cause of death, and an uncontrolled systemic disease status, along with adjuvant treatment, present independent predictors of overall survival, a comprehensive, multidisciplinary treatment concept is essential for patients with brain metastases.Background and Purpose: The value of gross-total surgical resection remains debatable in patients with brain metastases (BMs) as most patients succumb to systemic disease progression. In this study, we evaluated the impact of the extent of resection of singular/solitary BM on in-brain recurrence (iBR), focusing on local recurrence (LR) and overall survival (OS) in an interdisciplinary adjuvant treatment setting. Patients and Methods: In this monocentric retrospective analysis, we included patients receiving surgery of one BM and subsequent adjuvant treatment. A radiologist and a neurosurgeon determined in consensus the extent of resection based on magnetic resonance imaging. The OS was calculated using Kaplan–Meier estimates; prognostic factors for LR and OS were analysed by Log rank test and Cox proportional hazards. Results: We analyzed 197 patients. Gross-total resection was achieved in 123 (62.4%) patients. All patients were treated with adjuvant radiotherapy, and 130 (66.0%) received systemic treatment. Ninety-six (48.7%) patients showed iBR with an LR rate of 23.4%. LR was not significantly influenced by the extent of resection (p = 0.139) or any other parameter. The median OS after surgery was 18 (95%CI 12.5–23.5) months. In univariate analysis, the extent of resection did not influence OS (p = 0.6759), as opposed to adjuvant systemic treatment (p < 0.0001) and controlled systemic disease (p = 0.039). Systemic treatment and controlled disease status remained independent factors for OS (p < 0.0001 and p = 0.009, respectively). Conclusions: In this study, the extent of resection of BMs neither influenced the LR nor the OS of patients receiving interdisciplinary adjuvant treatment.

Mortalité et facteurs pronostiques du myxofibrosarcome — analyse rétrospective de 109 patients

BackgroundMyxofibrosarcoma (MFS) is one of the most common sarcoma subtype in elderly patients. They are reported to recur locally independently of the tumour grade in 30–40% of cases and metastases are reported to develop in high-grade tumours in 20–35% cases. As MFS is a rare diagnosis, data investigating specific survival and independent risk factors are lacking and have mostly been limited to single orthopaedic oncology centre studies so far. Thus we set up a pathology-based retrospective study and analyzed all MFS diagnosed in our institution with the following aims: (1) analysis of independent risk factors for overall survival, disease specific survival, local recurrence-free survival and distant metastasis free survival following resection of MFS and (2) analysis of resection margin status. HypothesisHigh-grade MFS have a low survival distant metastasis free survival and local recurrence-free survival is dependent on surgical margin status. Patients and methodsWe retrospectively analysed 109 patients (median 66 years [range, 21–96]) diagnosed with MFS and a median follow-up of 42 months at one centre between 1990 and 2014. Tumor-associated survival, including competing risk analysis, and prognostic factors for local recurrence, metastatic disease and death from disease were investigated and included in a multivariate analysis. ResultsOverall survival was 79% [95% CI: 71.9–87.5] at 3 years and 76% [95% CI: 67.4–84.6] at 5 years. Disease specific survival was 85% [95% CI: 78.4–92.2] at 3 years and 80% [95% CI: 72.2–88.2] at 5 years. There were local recurrences in 11/109 patients (10%). Local recurrence-free survival (LRFS) was 95% [95% CI: 92.0–99.8] at 3 and 88% [95% CI: 84.3–96.4] at 5 years. Metastatic disease (n=25; 23%) occurred after a median follow-up of 10 months. Distant metastasis free survival was 78% [95% CI: 69.9–85.9] at 3 and 77% [95% CI: 68.4–84.8] at 5 years. R1 status at primary resection was an independent risk factor for decreased local recurrence-free survival (OR: 8.5, 95% CI: 1.59–49.79 [p=0.01]). Grading was an independent risk factor for decreased disease specific survival (OR 13.4, 95% CI: 1.65–1734.84 [p=0.01]) and distant metastasis free survival (OR 16.2, 95% CI: 2.0–2110.5 [p=0.004]). Primary resection achieved R0 margins in 63 (58%) of 109 patients. Margins were adequate significantly more often (p<0.001) in patients treated primarily at a sarcoma centre (R0=58/68, 85%) than in those treated primarily at non-sarcoma centres (R0=5/41, 12%), whereby the latter significantly more often treated superficial tumours (p=0.001) with a size of less than 5cm (p<0.001). DiscussionPatients with high-grade MFS had a poorer prognosis with respect to Disease specific survival/Distant metastasis free survival than low-grade MFS. Local recurrence did not significantly affect disease specific survival. Level of evidenceIV.

Locoregional recurrence patterns in women with breast cancer who have not undergone post-mastectomy radiotherapy

BackgroundTo analyze the patterns of locoregional recurrence in breast cancer patients after mastectomy.MethodsThe retrospective study included 7073 women with breast cancer without post-mastectomy radiotherapy: 4604 (65.1%) had pT1–2 N0 disease (low risk); 2042 (28.9%), pT1–2 N1 (intermediate risk); and 427 (6.0%), pT3–4 and/or pN2–3, or pT1–2 N1 after neoadjuvant chemotherapy (high risk). The distribution of cumulative locoregional recurrence was analyzed. The local recurrence and regional recurrence rates were estimated by the Kaplan-Meier method, and differences were compared with the log-rank test. Multivariate analysis was performed using Cox logistic regression analysis.ResultsIn the median follow-up of 63.0 months, 469 patients had locoregional recurrence: chest wall recurrence in 238 (50.7%) cases, supraclavicular/infraclavicular nodes in 236 (50.3%) cases, axilla in 92 (19.6%), and internal mammary nodes in 50 (10.7%) cases. The 5-year local recurrence and regional recurrence rates were 2.5 and 4.4%, respectively. Subgroup analysis of the three risk groups and five molecular subtypes (luminal A, luminal B-Her2 negative, luminal B-Her2 positive, Her2-enriched, and triple negative) also showed that the chest wall and supraclavicular/infraclavicular nodes were the most common recurrence sites. Age, tumor location, T stage, N stage, and hormone receptor status were independent prognostic factors for both local recurrence and regional recurrence (p < 0.05).ConclusionsThe chest wall and supraclavicular/infraclavicular nodes are common sites of locoregional recurrence in breast cancer, irrespective of disease stage or molecular subtype, and the prognostic factors for local recurrence and regional recurrence are similar. Therefore, chest wall and supraclavicular/infraclavicular nodes irradiation should always be considered in post-mastectomy radiotherapy.

Tumor-associated mortality and prognostic factors in myxofibrosarcoma – A retrospective review of 109 patients

BackgroundMyxofibrosarcoma (MFS) is one of the most common sarcoma subtype in elderly patients. They are reported to recur locally independently of the tumour grade in 30-40% of cases and metastases are reported to develop in high-grade tumours in 20-35% cases. As MFS is a rare diagnosis, data investigating specific survival and independent risk factors are lacking and have mostly been limited to single orthopaedic oncology centre studies so far. Thus we set up a pathology-based retrospective study and analyzed all MFS diagnosed in our institution with the following aims: (1) analysis of independent risk factors for overall survival, disease specific survival, local recurrence-free survival and distant metastasis free survival following resection of MFS; (2) analysis of resection margin status. HypothesisHigh-grade MFS have a low survival distant metastasis free survival and local recurrence free survival is dependent on surgical margin status. Patients and MethodsWe retrospectively analysed 109 patients (median 66 years [range, 21–96]) diagnosed with MFS and a median follow-up of 42 months at one centre between 1990 and 2014. Tumor-associated survival, including competing risk analysis, and prognostic factors for local recurrence, metastatic disease and death from disease were investigated and included in a multivariate analysis. ResultsOverall survival was 79% [95%CI: 71.9–87.5] at 3 years and 76% [95%CI: 67.4–84.6] at 5 years. Disease specific survival was 85% [95%CI: 78.4–92.2] at 3 years and 80% [95%CI: 72.2–88.2] at 5 years. There were local recurrences in 11/109 patients (10%). Local recurrence free survival (LRFS) was 95% [95%CI: 92.0–99.8] at 3 and 88% [95%CI: 84.3–96.4] at 5 years. Metastatic disease (n=25; 23%) occurred after a median follow-up of 10 months. Distant metastasis free survival was 78% [95%CI: 69.9–85.9] at 3 and 77% [95%CI: 68.4–84.8] at 5 years. R1 status at primary resection was an independent risk factor for decreased Local Recurrence-free survival (OR: 8.5, 95%CI: 1.59–49.79 [p=0.01]). Grading was an independent risk factor for decreased Disease specific survival (OR 13.4, 95%CI: 1.65–1734.84 [p=0.01]) and Distant metastasis free survival (OR 16.2, 95%CI: 2.0–2110.5 [p=0.004]). Primary resection achieved R0 margins in 63 (58%) of 109 patients. Margins were adequate significantly more often (p<0.001) in patients treated primarily at a sarcoma centre (R0=58/68, 85%) than in those treated primarily at non-sarcoma centres (R0= 5/41, 12%), whereby the latter significantly more often treated superficial tumours (p=0.001) with a size of less than 5cm (p<0.001). DiscussionPatients with high-grade MFS had a poorer prognosis with respect to Disease specific survival/Distant metastasis free survival than low-grade MFS. Local recurrence did not significantly affect disease specific survival. Level of EvidenceIV.

Prognostic factors for local recurrence and survival and impact of local treatments on survival in lacrimal gland carcinoma

Background/aimsTo identify prognostic factors for local recurrence, distant metastasis and disease-specific survival (DSS) for lacrimal gland carcinoma.MethodsAll consecutive patients with lacrimal gland carcinoma treated from January 1998 through December 2018...

Risk factors of local recurrence after surgery in extraabdominal desmoid-type fibromatosis: A multicenter study in Japan.

This study was undertaken to clarify the risk factors, including the mutation status of CTNNB1, for the local recurrence after surgery of the rare disease desmoid‐type fibromatosis. It was designed as a multiinstitutional joint research project with 7 major centers in Japan participating. The committee members of 7 major medical centers specializing in bone and soft tissue tumors formed this study group to develop clinical care guidelines. Of 196 cases with specimens and medical records collected from the 7 institutions, 88 surgically treated ones were analyzed regarding clinicopathologic prognostic factors including CTNNB1 mutation status. Excluding R2 cases (n = 3), 5‐year local recurrence‐free survival (LRFS) was 52.9%. No case had received pre‐ or postoperative radiotherapy. Univariate analysis revealed that extremity location (P < .001) and larger size (8 cm or more, P = .036) were significant adverse risk factors for LRFS. Multivariate analysis indicated that extremity location (P < .001) was a significantly adverse factor in addition to recurrent tumor (P = .041), S45F mutation (P = .028), and R1 surgical margin (P = .039). Preoperative drug treatment, including nonsteroidal antiinflammatory drugs, did not reduce the incidence of local recurrence (P = .199). This is the first study to analyze the factors correlating with outcomes of surgical treatment, including CTNNB1 mutation status, in a relatively large number of cases from an Asian country. Tumor location was found to be the most influential prognostic factor for local recurrence, similar to the results from Europe and North America. The development of more sensitive method(s) for determination of CTNNB1 mutation is a priority for future study.

Correlating MRI and histological tumor thickness in the assessment of tongue cancer

Objective: Tumor thickness in tongue cancer is an important independent prognostic factor for local recurrence, nodal metastasis, and patient survival. An accurate preoperative assessment of tumor thickness is therefore essential for optimal treatment planning. The aim of our study was to evaluate the accuracy of MRI findings for the preoperative measurement of tumor thickness. Subjects and methods: Thirty six patients with oral tongue cancer underwent preoperative MRI of the tongue. After surgery, the glossectomy specimens were serially sectioned. The radiologic tumor thickness of contrast-enhanced T1-weighted and T2-weighted images was compared with the histologic tumor thickness using our proposed tumor thickness staging classifications. These included stage I (tumor ≤ 3 mm), stage II (> 3 mm but ≤ 9 mm) and stage III (> 9 mm).Results: The overall accuracy in assessment of proposed tumor thickness staging using contrast-enhanced T1-weighted and T2-weighted images was 83.33% and 61.11%, respectively. The radiologic tumor thickness as measured on contrast-enhanced T1-weighted and T2-weighted images had significant correlation with histologic tumor thickness (R = 0.980 and 0.985, respectively).Conclusion: MR images provide satisfactory accuracy for the measurement of tumor thickness and staging of tongue cancer. Preoperative MRI is recommended to assist in treatment planning for patients with this disease.

Quality of treatment and surgical approach for rectal gastrointestinal stromal tumour (GIST) in a large European cohort

BackgroundRectal gastrointestinal stromal tumours (GISTs) are rare tumours. Variability in the management may influence outcome, but there is a lack of understanding regarding contemporary variance in care. A multicenter, international, retrospective cohort study was performed to elucidate characteristics and outcomes of rectal GIST in European practice, with particular reference to surgical approach. MethodsAll rectal GIST patients diagnosed between 2009 and 2018 were identified from five European databases. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Possible confounders were identified using Cox regression analyses. ResultsFrom 210 patients, 155 patients had surgery. The three main types of surgery were local tumour resection (LTR, n = 46), low anterior resection (LAR, n = 31) and abdomino-perineal resection (APR, n = 32). Most patients received neoadjuvant (65%) and/or adjuvant imatinib therapy (66%). Local recurrence rate after surgery was 15% and overall recurrence rate 28%. No significant differences were found in terms of RFS nor OS between LTR, LAR and APR. However, locally resected tumours were smaller, while LAR and APR patients more often received perioperative imatinib. General hospitals treated smaller GISTs, offered imatinib less frequently, and had a higher tumour rupture rate. In the multivariate analysis in the group having LTR, APR or LAR, the only significant prognostic factor for local recurrence was higher age (HR 1.06, CI 1.00–1.12, p = 0.048). ConclusionsIn European clinical practice for rectal GIST, LTR, LAR and APR have comparable local control. Multimodal approach is higher and tumour rupture less frequent in specialist centres compared to general hospitals.

Association of T and N Categories of the American Joint Commission on Cancer, 8th Edition, With Metastasis and Survival in Patients With Orbital Sarcoma

No previous studies to date have validated the American Joint Committee on Cancer (AJCC) 8th edition of the TNM classification for orbital sarcoma. To determine the prognostic performance of the most recent TNM classification for orbital sarcoma and to identify other prognostic factors for local recurrence, lymph node metastasis, distant metastasis, and death due to disease. This single-center retrospective cohort study included 73 consecutive patients treated for orbital sarcoma from March 1, 2003, through June 30, 2018. Data were analyzed from November 1 to December 31, 2018. T and N categories at presentation and disease-related outcomes, including local recurrence, lymph node metastasis, distant metastasis (DM), and death due to disease (DD). The 73 participants included 43 men (59%), and the median age was 21 (range, 0-77) years. The common histologic types were rhabdomyosarcoma (RMS) (35 [48%]), solitary fibrous tumor/hemangiopericytoma (10 [14%]), and Ewing sarcoma (8 [11%]). The most common TNM designations were T2 N0 M0 (26 [36%]) and T4 N0 M0 (24 [33%]). T category was associated with the risk of all disease-related outcomes, including local recurrence (hazard ratio [HR] for T2 vs T4, 0.22 [95% CI, 0.06-0.81]; HR for T3 vs T4, 0.59 [95% CI, 0.13-2.65]; P = .03), lymph node metastasis by the last follow-up (T1, 1 [14%]; T2, 0; T3, 0; T4, 12 [35%]; P = .001), DM (HR for T2 vs T4, 0.29 [95% CI, 0.08-1.07]; P = .04), and DD (HR of T2 vs T4, 0.16 [95% CI, 0.04-0.73]; HR of T3 vs T4, 0.30 [95% CI, 0.04-2.34]; P = .02). Higher risk of DM and higher risk of DD were associated with disease category of at least T3 (HR for DM, 3.24 [95% CI, 0.89-11.72; P = .06]; HR for DD, 6.32 [95% CI, 1.43-27.95; P = .005]), N1 disease (HR for DM, 13.33 [95% CI, 4.07-43.65; P < .001]; HR for DD, 7.07 [95% CI, 2.45-20.44; P < .001]), tumor size larger than 3 cm (HR for DM, 2.72 [95% CI, 0.92-8.05; P = .06]; HR for DD, 5.79 [95% CI, 1.85-18.14; P < .001]), and age of patient with RMS younger than 1 year or 10 years or older (HR for DM, 6.85 [95% CI, 0.83-56.53; P = .04]; HR for DD, 7.03 [95% CI, 0.85-57.83; P = .04]). Higher risk of local recurrence was associated with disease category of at least T3 (HR for<T3 vs≥T3, 0.20 [95% CI, 0.06-0.71]; P < .01) and tumor size greater than 3 cm (HR for ≤3 cm vs >3 cm, 0.27 [95% CI, 0.09-0.77]; P = .009). Higher risk of lymph node metastasis was associated with disease category of at least T3 (odds ratio [OR], 13.33 [95% CI, 1.77-602.30]; P = .004), alveolar RMS (OR, 9.98 [95% CI, 2.13-51.55]; P = .001), and age of patient with RMS younger than 1 year or 10 years or older (OR, 9.20 [95% CI, 1.01-458.29] P = .03). In patients with orbital sarcoma, T and N categories at presentation (defined by the AJCC 8th edition classification) correlate with metastasis and survival. These findings appear to support consideration of strict surveillance testing for regional nodal and systemic metastases in patients with orbital sarcoma with disease category of at least T3 and/or N1 disease.

Uni-institutional analysis of patients diagnosed with breast ductal carcinoma in situ treated with breast-conserving surgery and adjuvant radiotherapy

Introduction: The treatment for Ductal Carcinoma in situ (DCIS) can be mastectomy, breast-conserving surgery with or without adjuvant Radiotherapy (RT). Regarding the conserving treatment, ipsilateral recurrence is the main reason of concern. Randomized studies show that RT reduces the risk of local recurrence (LR). Age, comedonecrosis, absence of endocrine therapy (ET) and positive margins are also prognostic factors. Objective: To assess the local relapse-free survival (LRFS) of patients with DCIS treated with breast-conserving surgery, followed by adjuvant RT, and to identify possible prognostic factors related to LR. Method: between March 2007 and December 2017, we identified 95 women diagnosed with DCIS and treated with breast-conserving surgery and adjuvant RT in Hospital São Paulo (HSP/UNIFESP). Regarding RT, we used the 3D technique with conventional fractionation (50/50.4 Gy and 2/1.8 Gy fraction per day), or hypofractionation (40 Gy and 2.67 Gy fraction per day). The data were submitted to descriptive analysis and evaluation of LR. Factors such as characteristics of the patients, the tumor and the treatment were correlated by using Fisher’s Exact Test and Kruskall-Wallis test. The log-rank test was used for the Kaplan-Meier comparison. The results were considered as statistically significant when p&lt;0.05. Results: 71.6% of the patients were 50 years old or older; margins were negative in 70.5% of the cases, and 78.9% of the patients presented with positive hormone receptors. Regarding RT, 89.5% of the patients were treated with conventional fractionation. The median follow-up of patients was 67 months (8-150 months). LRFS was 97.8% and 91.9% in 5 and 10 years, respectively. Among the assessed factors, negative hormone receptors (p&lt;0.001) and absence of ET (p=0.022) were prognostic factors for LR. The margin status was not associated with higher rates of LR. Conclusion: The LRFS of the patients diagnosed with DCIS who underwent a conserving treatment in HSP/UNIFESP is favorably compared to the results described in the literature. Negative hormone receptors and absence of ET had an influence on local control.

Tumour length as an independent prognostic factor in resectable oesophageal carcinoma.

Oesophageal longitudinal tumour length has been investigated as a prognostic indicator for disease recurrence and overall survival in resectable oesophageal carcinoma. However, there is conflicting evidence regarding its use in clinical practice. This study aims to assess the prognostic significance of histological tumour length in potentially curative oesophageal resections for cancer. Patients with locally advanced oesophageal carcinoma (squamous or adenocarcinoma) were identified in a single centre between July 2000 and December 2016. Patient demographics, tumour characteristics and survival outcomes were assimilated. Unifactorial and multifactorial analysis was performed to assess tumour length correlation with oncological outcomes. A total of 281 patients were included; 226 (80.4%) male and 55 (19.6%) female, with a median age of 66 years; 39 patients (13.9%) developed local recurrence and 104 (37%) distant metastases. Disease progression rate was 44.8% with a median progression-free survival of 21 months and median overall survival of 30 months. Median tumour length was 3cm (interquartile range 2-4.5cm). Multivariate analysis demonstrated longer tumours to be significantly associated with a higher rate of local recurrence (p=0.028), metastases (p=0.016), disease progression (p=0.001) and shorter progression-free survival (p=0.001). This study demonstrates histological tumour length as an independent prognostic factor for local recurrence, metastases, disease progression and progression-free survival. Further larger multicentre studies are required to define the role of longitudinal tumour length as a marker to identify patients who are at higher risk of poor oncological outcomes following surgery.

Pretreatment ADC is not a prognostic factor for local recurrences in head and neck squamous cell carcinoma when clinical T-stage is known

ObjectivesPretreatment identification of radio-insensitive head and neck squamous cell carcinomas (HNSCC) would affect treatment modality selection. The apparent diffusion coefficient (ADC) of a tumor could be a predictor of local recurrence. However, little is known about its prognostic value next to known factors such as clinical T-stage. The aim of the present study is to determine the added value of pretreatment ADC to clinical T-stage as a prognostic factor for local recurrence.MethodsThis retrospective cohort study included 217 patients with HNSCC treated with (chemo)radiotherapy between April 2009 and December 2015. All patients underwent diffusion-weighted MRI prior to treatment. Median ADC values of all tumors were obtained using a semi-automatic delineation method. Univariate models containing ADC and T-stage were compared with a multivariable model containing both variables.ResultsFifty-eight patients experienced a local recurrence within 3 years. On average, the ADC value in the group of patients with a recurrence was 1.01 versus 1.00 (10−3 mm2/s) in the group without a recurrence. Univariate analysis showed no significant association between tumor ADC and local recurrence within 3 years after (chemo)radiotherapy (p = 0.09). Cox regression showed that clinical T-stage was an independent predictor of local recurrence and adding ADC to the model did not increase its performance.ConclusionPretreatment ADC has no added value as a prognostic factor for local recurrence to clinical T-stage.Key Points• Pretreatment identification of head and neck squamous cell carcinoma patients who do not benefit from (chemo)radiotherapy could improve personalized cancer care.• The apparent diffusion coefficient (ADC) obtained from diffusion-weighted MRI has been reported to be a prognostic factor for local recurrence.• In this study, ADC has no added value as a prognostic factor compared with clinical T-stage.

Chest Wall and Supraclavicular/Infraclavicular Nodal Region are Common Sites of Locoregional Recurrence for Women with Breast Cancer after Mastectomy Irrespective of TN Stage or Molecular Subtypes

To analyze the failure patterns of locoregional recurrence (LRR) and identify the prognostic factors for local recurrence (LR) and regional recurrence (RR) in breast cancer patients after mastectomy. Between 1999 and 2014, 7207 women with breast cancer after mastectomy and axillary dissection were analyzed. All didn’t receive postmastectomy radiotherapy (PMRT). 4671 (64.8%) had pT1-2N0 disease (low-risk), 2078 (28.8%) had pT1-2N1 disease (intermediate-risk) and 458 (6.4%) were defined as high-risk, which included 360 with pT3-4 or pN2-3 disease and 98 pT1-2N1 after neoadjuvant chemotherapy. Among the 5427 patients who had sufficient information to construct molecular subtype, there were 2451 (45.2%) luminal A, 579 (10.7%) luminal B-Her2 negative, 814 (15.0%) luminal B-Her2 positive, 593 (10.9%) Her2 enriched, and 990 (18.2%) triple negative (TN). The distribution of accumulated LRR was analyzed. The LR and RR rates were estimated by the Kaplan-Meier method, and the differences were compared with Log-rank test. Multivariate analysis was performed using Cox logistic regression analysis. With a median follow-up of 62.9 months (6.0-194.6), 481 patients had LRR, including chest wall in 225 (46.8%), supraclavicular/infraclavicular nodes (SCN) in 242 (50.3%), axilla in 96 (20.0%) and internal mammary nodes (IMN) in 52 (10.8%) patients. For LRR patients with low, intermediate and high risk group, 93 (54.1%), 83 (44.9%), 69 (55.6%) had chest wall recurrence, 68 (39.5%), 110 (59.5%), 64 (51.6%) had SCN recurrence, 27 (15.7%), 37 (20.0%), 32 (25.8%) had axilla recurrence, and 28 (16.3%), 20 (10.8%), 4 (3.2%) had IMN recurrence. For LRR patients with luminal A, luminal B-Her2 negative, luminal B-Her2 positive, Her2-enriched, and TN tumors, 48 (45.3%), 23 (56.1%), 25 (43.1%), 25 (57.2%), 61 (58.1%) had chest wall recurrence, 51 (48.1%), 23 (56.1%), 32 (55.2%), 33 (62.3%), 51 (48.6%) had SCN recurrence, 21 (19.8%), 10 (24.4%), 13 (22.4%), 9 (17.0%), 22 (21.0%) had axilla recurrence, and 9 (8.5%), 7 (17.1%), 6 (10.3%), 7 (13.2%), 14 (13.3%) had IMN recurrence. The median interval to LR and RR was 51.6 and 29.2 months. In multivariate analysis, age (≤45 years vs. >45 years), tumor location (inner quadrant vs. other quadrants), T stage (T3-4 vs. T1-2), N stage (pN3 vs. pN2 vs. pN1 vs. pN0), hormone receptor status (negative vs. positive) were significant prognostic factors for both LR and RR (p < 0.05). In breast cancer after mastectomy without PMRT, both chest wall and supraclavicular/infraclavicular nodal region are common sites of LRR, irrespective of TN stage or molecular subtypes. The prognostic factors for LR and RR are similar, which indicates that chest wall and supraclavicular/infraclavicular nodal irradiation should be considered in all patients who planned to receive PMRT.

Investigating and Validating Metabolic Tumor Volume As a Prognostic Factor for Local Recurrence in Early Stage Lung Cancer

Investigating and Validating Metabolic Tumor Volume As a Prognostic Factor for Local Recurrence in Early Stage Lung Cancer

Absence of estrogen receptor is associated with worse oncologic outcome in patients who were received neoadjuvant chemotherapy for breast cancer

Neoadjuvant chemotherapy (NAC) is a standard treatment for locally advanced breast cancer, especially for HER2-positive or triple negative breast cancer which shows good response to chemotherapy. However, because a result of biomarkers is, occasionally, changed after NAC, the treatment strategy should be differently applied for patients with locally advanced breast cancer. We compared the results of biomarkers before and after NAC to evaluate the association with disease prognosis and oncologic results. Fifty-seven patients with locally advanced breast cancer underwent NAC and the immunohistochemical (IHC) staining results were compared between before and after NAC. And the association between oncologic outcomes and biomarkers was analyzed. Negative status of estrogen receptor (ER) was associated with locoregional recurrence and distant metastasis both before and after NAC (p=0.021, 0.019; p=0.018, 0.036). And the negative status of progesterone receptor (PR) and triple negative status before neoadjuvant chemotherapy were also associated with death and distant metastasis, respectively. However, the changes of biomarkers after NAC in breast cancer were not directly associated with any oncologic outcomes. The absence of ER in breast cancer before and after NAC would be a significant prognostic factor for local recurrence and distant metastasis. Therefore, the absence of ER should be considered as important factor in determining the treatment strategy.