Prognostic Factors For Locoregional Recurrence Research Articles

P088 The evaluation of the 21-gene Breast Recurrence Score assay as a prognostic factor for locoregional recurrence in early breast cancer treated by lumpectomy and intraoperative radiotherapy only

P088 The evaluation of the 21-gene Breast Recurrence Score assay as a prognostic factor for locoregional recurrence in early breast cancer treated by lumpectomy and intraoperative radiotherapy only

The definition of “R1” lymph node dissection status in patients undergoing curative-aim gastrectomy for gastric carcinoma: A proof of concept study

IntroductionThe aim of this study was to define and investigate the prognostic impact of “R1-Lymph-node dissection” during gastrectomy. MethodsThis was a retrospective study conducted with 499 patients undergoing curative-aim gastrectomy. We defined R1-Lymph dissection as an involvement of lymph node stations anatomically connected with lymph node stations outside the declared level of dissection (D1 to D2+). The primary outcomes were disease-free and disease-specific survival (DFS and DSS). ResultsAt multivariable analysis, the type of gastrectomy, pT and pN were associated with DFS, and the type of gastrectomy, R1-Margin status, R1-Lymph status, pT, pN and adjuvant therapy were associated with DSS. Moreover, pT and R1-Lymph status were the only factors associated with overall loco-regional recurrence. ConclusionsIn this study, we introduced the concept of R1-Lymph-node dissection, which was significantly associated with DSS and appeared to be a stronger prognostic factor for loco-regional recurrence than the R1 status on the resection margin.

Validation of a prognostic scoring system for postmastectomy locoregional recurrence in breast cancer

BackgroundTo date, it remains unclear which patients with breast cancer (BC) benefit from post-mastectomy radiotherapy (PMRT). Cheng et al. developed and validated a scoring system based on 4 prognostic factors for locoregional recurrence (LRR) to identify patients in need for PMRT. These factors include age, estrogen receptor status, lymphovascular status and number of affected axillary lymph nodes. PurposeTo validate the scoring system for LRR in BC developed by Cheng et al. by using an independent BC database. Methods and materialsWe retrospectively identified 1989 BC cases, treated with mastectomy (ME) with or without PMRT at the University Hospitals Leuven between 2000 and 2007. The primary endpoint was 5-year locoregional control rate with and without PMRT, according to the LRR score. ResultsMedian follow-up time was 11.4 years. After excluding patients with missing variables 1103 patients were classified using the LRR scoring system: 688 (62.38%) patients were at low risk of recurrence (LRR score 0–1), 335 (30.37%) patients were at intermediate risk of recurrence (LRR score 2–3) and 80 (7.25%) patients were at high risk of recurrence (LRR score ≥4). 5-year locoregional control rates with and without PMRT were 99.20% versus 99.21% (p = 0.43) in the low-risk group; 98.24% versus 85.74% (p < 0.0001) in the intermediate-risk group and 96.87% versus 85.71% (p = 0.10) in the high-risk group respectively. ConclusionOur validation of the LRR scoring system suggests it can be used to point out patients that would benefit from PMRT. We recommend further validation of this scoring system by other independent institutions before application in clinical practice.

Hemoglobin A1c level is a prognostic factor for locoregional recurrence in stage III non-small cell lung cancer patients treated with radiotherapy.

BackgroundThe level of hemoglobin A1c (HbA1c) might be associated with the severity of tumor hypoxia in patients with cancer. Here, we evaluated the association between the level of HbA1c and survival outcome in stage III non‐small cell lung cancer patients treated with radical radiotherapy.MethodsWe retrospectively analysed the clinical data of 104 patients with lung cancer treated with radiotherapy. The HbA1c levels of all patients were checked 1 week before the start of radiotherapy. Survival outcomes were analysed according to the HbA1c level.ResultsThe 1‐, 2‐, and 3‐year locoregional recurrence‐free survival rates were 88.3%, 68.8%, and 63.0%, respectively, in the patient group with HbA1c levels ≤6% and 75.5%, 54.4%, and 41.8%, respectively, in the patient group with HbA1c levels >6% (p = 0.015). The HbA1c level remained a significant prognostic factor for locoregional recurrence‐free survival on multivariable analysis (hazard ratio = 2.014, 95% confidence interval = 1.088–3.726, p = 0.026).ConclusionsPretreatment HbA1c level is a significant prognostic factor for locoregional recurrence‐free survival in patients with stage III non‐small cell lung cancer treated with radical radiotherapy. Routine monitoring of pretreatment HbA1c levels and aggressive glycemic control may be considered to prevent the development of locoregional recurrence in these patients.

Factors influencing locoregional recurrence and distant metastasis in Asian patients with cutaneous melanoma after surgery: A retrospective analysis in a tertiary hospital in Taiwan.

The goal of this study was to investigate the prognostic factors for locoregional recurrence and metastasis in patients with cutaneous melanoma (CM) who underwent surgery, especially in the acral lentiginous melanoma (ALM) subtype. This study was a retrospective review of patients who underwent surgery for CM at Taipei Veterans General Hospital between 2000 and 2018. We investigated the risk factors for locoregional and distant metastases. The association between clinicopathological factors and locoregional recurrence and distant metastasis of the CM and ALM subtypes was analyzed. In addition, the outcomes between the ALM and non-ALM groups were compared. A total of 161 patients were included in the analysis. The most common histological subtype was ALM. The overall locoregional recurrence rate of CM was 13.0% and the distant metastasis rate was 42.9%, whereas that of the ALM subtype was 12.5% and 45.5%, respectively. In patients with CM, male sex, tumor with lymphovascular invasion, and positive lymph node status were the prognostic factors for both locoregional recurrence and distant metastasis. Among the patients with ALM, positive lymph node status was significantly associated with both locoregional recurrence and distant metastasis. In this cohort, factors influencing locoregional recurrence and distant metastasis were similar between the ALM and non-ALM groups. The above-recommended surgical margin did not show any benefit in either the CM or the ALM subtype. ALM can be handled using the same surgical strategy as CM in the Asian population.

Risk factors for locoregional recurrence in patients with pathologic T3N0 rectal cancer with negative resection margin treated by surgery alone.

PurposeThis study aimed to identify prognostic factors for locoregional recurrence (LRR) in pT3N0 rectal cancer patients who were treated with surgery alone and had negative resection margin including circumferential resection margin (CRM) for optimal indication of adjuvant radiotherapy.Materials and MethodsWe reviewed patients with pT3N0 rectal cancer who were treated via upfront surgery and had no other adjuvant treatment from January 2003 to December 2012. In total, 122 patients who had negative resection margin including negative CRM were included in the analysis.ResultsThe median follow-up period after surgery was 60 months (range, 3 to 161 months). During this time, 6 patients (4.9%) experienced LRR at the anastomotic site (4 patients), and regional lymphatic area (2 patients). The estimated 5-year rates of overall survival, recurrence-free survival, and LRR-free survival were 96.7%, 84.6%, and 94.0%, respectively. Multivariate analysis showed that level of tumor ≤5 cm was a significant prognostic factor for LRR-free survival (LRRFS) (p = 0.04; hazard ratio = 7.08; 95% confidence interval, 1.06–47.30). Patients with level of tumor ≤5 cm had an estimated 5-year LRRFS of 66.8%, which was much higher than 2.3% in patients with level of tumor >5 cm. There was no significant factor for recurrence-free survival or overall survival.ConclusionIn T3N0 rectal cancer, adjuvant chemoradiotherapy should be recommended in patients with level of tumor ≤5 cm for better local control. However, in patients with pT3N0 disease, negative resection margin, and level of tumor >5 cm, adjuvant chemoradiotherapy should be carefully suggested.

Abstract B05: Pathologic complete response is an independent prognostic factor for locoregional recurrence in locally advanced breast cancer patients after neoadjuvant chemotherapy

Abstract Background: Neoadjuvant chemotherapy (NAC) has been the standard approach for downstaging in locally advanced breast cancer and can improve breast conservation rates. Pathologic complete response (pCR) after NAC has been reported to have favorable long-term outcome. However, there is still high locoregional recurrence (LRR) rate after NAC. The aim of this study is to analyze the relationship of pCR and LRR. Method: A retrospective study was analyzed from 2002 to 2011, and a total of 263 invasive breast cancer patients had NAC and, following mastectomy or breast conserving surgery (BCS) at Linkou Chang Gung Memorial Hospital, were enrolled. Concurrent weekly epirubicin and docetaxel was standard NAC regimen and adjuvant therapy including hormone therapy, radiotherapy, and target therapy was started postoperatively according to the pathologic characters. Result: The median age was 48 years old (range 18-75). The mean tumor size at diagnosis was 6.0 cm (range 2.0-22.0). The median follow-up time was 54.6 months (range 9.2-126.9). After neoadjuvant chemotherapy, 200 (76%) patients underwent mastectomy and 63 (24%) patients underwent BCS. 29 (11%) patients achieved pCR in this study. In univariate analysis, age&amp;lt;50, negative ER, negative PR, positive HER2, luminal B (HER2 positive) and HER2 overexpression, triple-negative subtype were factors to predict pCR. In multivariate analysis, age &amp;lt;50, luminal B (HER2 positive), HER2 overexpression, and triple-negative subtype were factors to predict pCR. No patients in pCR group developed LRR compared with 31 (13.2%) patients with LRR in non-pCR group. In multivariate analysis, pCR and age &amp;lt;50 were independent prognostic factors for LRR. Conclusion: Our findings suggested that pCR and younger age are independent prognostic factors for LRR in breast cancer patients after NAC with concurrent eprubicin and docetaxel. Citation Format: Hsu-Huan Chou, Shin-Che Chen. Pathologic complete response is an independent prognostic factor for locoregional recurrence in locally advanced breast cancer patients after neoadjuvant chemotherapy [abstract]. In: Proceedings of the AACR Special Conference: Advances in Breast Cancer Research; 2017 Oct 7-10; Hollywood, CA. Philadelphia (PA): AACR; Mol Cancer Res 2018;16(8_Suppl):Abstract nr B05.

Patterns of failure after resection of extrahepatic bile duct cancer: implications for adjuvant radiotherapy indication and treatment volumes

BackgroundThe role of adjuvant radiotherapy (RT) and setting proper RT target volumes have not been clearly demonstrated for extrahepatic bile duct (EHBD) cancer, due to the rarity of the disease and the lack of randomized trials. This study was conducted to evaluate the indication and treatment volume for adjuvant RT in EHBD cancer patients by identifying the prognostic factors for loco-regional (LR) failure, and analyze the patterns of LR failure.MethodsNinety-three patients with EHBD cancer, who underwent resection without adjuvant RT, at 2 medical centers, between 2001 and 2016, were analyzed retrospectively. Univariable and multivariable analyses were performed to find the prognostic factors for LR recurrence. The initial patterns of failure were recorded, especially those of LR recurrence, and categorized according to the Japanese classification.ResultsThe median follow-up duration was 30 months, and 38 (40.9%) patients experienced LR recurrence during this period. With regards to LR recurrence, close or positive resection margin (RM) status (p < 0.001) remained statistically significant in the multivariable analysis. The most common LR recurrence sites were the tumor bed (18.3%), and lymph node (LN) stations No. 8 (14.1%), No. 9 (12.7%), No. 12 (12.7%), No. 13 (5.6%), No. 14 (21.1%), No. 16 (14.1%), and No. 17 (1.4%).ConclusionsA close or positive RM status may be suggestive of high LR recurrence rates. In such cases, adjuvant RT may improve outcomes. When adjuvant RT is performed, the treatment volume should be well-designed so as to encompass the tumor bed, as well as LN stations No. 8, No. 9, No. 12, No. 14, and No. 16.

Prognostic Factors for Locoregional Recurrence in Neuroendocrine Tumors of the Rectum.

Optimal management of rectal neuroendocrine tumors is not yet well defined. Various pathologic factors, particularly tumor size, have been proposed as prognostic markers. We characterized sequential patients diagnosed with rectal neuroendocrine tumors in a population-based setting to determine whether tumor size and other pathologic markers could be useful in guiding locoregional management. This study is a retrospective analysis of data from the British Columbia provincial cancer registry. The study was conducted at a tertiary care center. Sequential patients diagnosed with rectal neuroendocrine tumors between 1999 and 2011 were identified. Neuroendocrine tumors were classified as G1 and G2 tumors with a Ki-67 ≤20% and/or mitotic count ≤20 per high-power field. Baseline clinicopathologic data including TNM staging, depth of invasion, tumor size, treatment modalities, and outcomes including survival data were measured. Of 91 rectal neuroendocrine tumors, the median patient age was 58 years, and 35 were men. Median tumor size was 6 mm. Median length of follow-up was 58.1 months, with 3 patients presenting with stage IV disease. Treatment included local ablation (n = 5), local excision (n = 79), surgical resection (n = 4), and pelvic radiation (n = 1; T3N1 tumor). Final margin status was positive in 17 cases. Local relapse occurred in 8 cases and 1 relapse to bone 13 months after T3N1 tumor resection. Univariate analysis demonstrated an association between local relapse and Ki-67, mitotic count, grade, and lymphovascular invasion (p < 0.01). Larger tumor size was associated with decreased disease-free survival. Sample size was 91 patients in the whole provincial population over a 13-year time period because of the low incidence of rectal neuroendocrine tumors. In this population-based cohort, rectal neuroendocrine tumors generally presented with small, early tumors and were treated with local excision or surgical resection without pelvic radiation. Pathologic markers play a role in risk stratification and prognostication. See Video Abstract at http://links.lww.com/DCR/A514.

Patterns of initial failure after resection for gallbladder cancer: implications for adjuvant radiotherapy.

PurposeThis study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer.Materials and MethodsRecords for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.ResultsMedian follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8. Independent prognostic factors for locoregional recurrence were ≥pT2 disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260–24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378–20.491; p < 0.001).ConclusionPatients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.

518 - Prognostic Analysis of Uterine Cervical Cancer of Positive or Negative Vaginal Resection Margin: Importance of Intraoperative Frozen Pathology

Study Objective: To analyze prognostic factors for locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) in cervical cancer patients who underwent radical hysterectomy with positive or negative vaginal resection margin, and evaluate quality of life followed by postoperative radiotherapy (PORT).

Factors Associated With a High Risk of Locoregional Failure in Well-Differentiated Thyroid Carcinoma

While adjuvant external beam radiotherapy is a standard for locoregionally advanced squamous carcinomas of the head and neck, its’ utility in locoregionally advanced well-differentiated thyroid cancers is less clear. Current standard of care for well-differentiated thyroid cancer with cervical adenopathy includes total thyroidectomy and neck dissection followed by radioactive iodine. We sought to determine the risk of locoregional failure and potential prognostic factors in this group of patients. After approval by the institutional review board (IRB), records of patients with well-differentiated thyroid cancer with cervical adenopathy between 1998 and 2012 were retrospectively reviewed. Patients with medullary, poorly differentiated, or anaplastic histology, N0-N1a, or distant metastases at presentation, or those who received external beam radiation were excluded. Locoregional control (LRC) was assessed via Kaplan-Meier analysis. Potential predictors were compared via log-rank test. Variables with prognostic potential on univariate analysis were subjected to multivariate analysis with Cox proportional hazards regression. After exclusions, 152 patients remained for analysis. Median follow up of the entire cohort was 38 months (range 0 – 197) for LRC, and 67.5 months for overall survival (range 0-197). The LRC rate for the entire cohort at 3 years was 77.3%. Patients with 1-5 positive lymph nodes (LN) had a significantly higher rate of LRC at 3 years versus patients with ≥6 LN (92.1% vs 65.9%; p=0.001). Similarly, LRC at 3 years was also higher in patients with T0-1 stage patients versus those with T2-4 (97.5% vs 67.9% vs; p<0.001). The presence of extracapsular extension (70.9% vs 84.2%; p=0.026) and histology (papillary 76.8% vs follicular 0%; p=0.036) were also associated with a lower rate of LRC at 3 years. On multivariate analysis, T stage (hazard ratio [HR] = 0.176; 95% confidence interval [CI], 0.053-0.582; p =0.004) and the number of positive lymph nodes (HR = 0.464; 95% [CI], 0.218-0.986; p =0.046) remained significant for LRC at 3 years. Patients with T2-4 N1b tumors with 6 or more nodes had a 3 year rate of LRC of 60%. In addition, those patients with locoregional recurrence were found to have a significantly higher risk of distant metastasis, 1% vs 15.7% at 5 years (p < 0.001). Our findings indicate that both T stage and the number of lymph nodes are the independent prognostic factors for locoregional recurrence for patients with well differentiated thyroid cancer. Despite treatment with RAI after surgical resection, patients with T2-T4 disease and those with ≥ 6 positive lymph nodes are at a high risk of locoregional recurrence. This cohort of patients may benefit from adjuvant radiotherapy, which will need to be tested in a prospective clinical trial.

Adjuvant Therapy for a Microscopically Incomplete Resection Margin after an Esophagectomy for Esophageal Squamous Cell Carcinoma.

Purpose: To investigate the prognosis of esophageal squamous cell carcinoma with a microscopically incomplete (R1) resection margin following an esophagectomy, as well as the impact of adjuvant treatment on survival.Methods: Data obtained from 124 patients with R1-resected ESCC were reviewed. The impact of clinicopathological factors and adjuvant treatment on the overall survival, locoregional recurrence, and distant recurrence were explored.Results: For a median follow-up time of 16.8 months, the median overall survival of 124 patients was 25.6 months. The 1, 3, and 5-year overall survival rates were 75.6%±4.0%, 35.9%±5.1%, and 23.2%±5.0%, respectively. Adjuvant therapy was administered in 78 patients. In the univariate analyses, patients with a pN0 stage (log rank, p=0.028) and adjuvant chemotherapy (log rank, p=0.032) exhibited more favorable overall survival. In the multivariate analyses, the pN stage (HR=2.192, p=0.004) and adjuvant chemotherapy (HR=0.032, p=0.004) were independent prognostic factors for overall survival. Locoregional recurrence was the main failure pattern after R1 resection. The pN stage (HR=2.567, p=0.009) and adjuvant radiotherapy (HR=0.278, p=0.000) were independent prognostic factors for locoregional recurrence.Conclusion: In R1-resected esophageal squamous cell carcinoma, adjuvant radiotherapy reduced locoregional recurrence; however, it did not improve overall survival. Adjuvant chemotherapy demonstrated benefits for overall survival. The pN stage was an independent prognostic factor for locoregional recurrence and overall survival.

Prognostic Factors in Malignant Sublingual Salivary Gland Tumors

The present study identified the prognostic factors and outcomes for malignant sublingual salivary gland tumors, which are rare. A retrospective cohort study of patients treated for malignant sublingual salivary gland tumors from 1997 to 2011 was performed. The predictor variables, including age, gender, tumor stage, nodal stage, perineural invasion, margin status, and lymphovascular invasion, were analyzed. The Cox regression model was used to determine the prognostic factors for locoregional recurrence, distant metastasis, and survival. Of the 38 patients, 16 (42.1%) were men. Their mean age was 53years (range 36 to 75). A total of 11 patients (28.9%) had T3-T4 tumors, and 6 (15.8%) had positive neck lymph nodes. The recurrence rate at 5years was 18.4%. The distant metastasis rate at 5years was 23.7%. Multivariable analysis confirmed the independent prognostic importance of patient age, N stage, and limited tongue mobility in locoregional recurrence and mortality at 5years. Our results suggest that patient age, N stage, and limited tongue mobility are useful as independent predictors of locoregional recurrence and mortality in patients with malignant sublingual salivary gland tumors.

Factors influencing survival and recurrence and potential significance of postoperative radiotherapy and adjuvant chemotherapy for stage ⅢA-N2 non-small cell lung cancer

Objective: To investigate the survival, recurrence patterns and risk factors in patients with stage ⅢA-N2 NSCLC treated with curative surgery and adjuvant chemotherapy and to explore the significance of postoperative radiation therapy. Methods: The clinical data of 290 patients with pathologically diagnosed stage ⅢA-N2 NSCLC after curative resection and adjuvant chemotherapy from January 2010 to December 2014 at our department were retrospectively analyzed. The survival and recurrence patterns were observed, and the factors affecting locoregional recurrence were analyzed. Results: The median survival time was 31.5 months. The 1-, 3-and 5-year survival rates were 88.3%, 46.0% and 33.2%, respectively. The median locoregional control time was 38.5 months. The 1-, 3-and 5-year locoregional control rates were 78.6%, 55.2% and 41.0%, respectively. The median distant metastasis-free survival was 26.8 months. The 1-, 3-and 5-year distant metastasis-free survival rates were 76.4%, 45.5% and 39.5%, respectively. The median progression-free survival was 19.1 months. The 1-, 3-and 5-year progression-free survival rates were 64.1%, 32.5% and 23.8%, respectively. Univariate analysis showed that clinical N status, histological type, pathological T stage, operation mode, the number of positive N2 lymph nodes and the number of positive N2 lymph node stations had a significant influence on overall survival; clinical N status, histological type, the number of positive N2 lymph nodes and the number of positive N2 lymph node stations had a significant influence on locoregional control. Multivariate analysis demonstrated that the number of N2 positive lymph nodes (P= 0.017) was an independent factor for overall survival of stage ⅢA-N2 patients; the number of N2 positive lymph nodes (P=0.009) and histological type (P=0.005) were independent factors for locoregional recurrence. For left-sided lung cancer, the lymph node station failure sites were mostly in 2R, 4R, 5, 6 and 7, and the contralateral mediastinum was frequently involved. For right-sided lung cancer, the lymph node station failure sites were mostly in 2R, 4R, 7, 10R and surgical stump. Conclusions: Clinical N2, squamous cell carcinoma, positive N2 nodes of more than 3 and multiple positive N2 stations are poor prognostic factors for locoregional recurrence. Locoregional recurrence of left lung cancer frequently involves the contralateral mediastinum, while that of the right lung cancer usually locates in the ipsilateral mediastinum.

Prognostic Factors for Locoregional Recurrence in Patients with Thoracic Esophageal Squamous Cell Carcinoma Treated with Radical Two-Field Lymph Node Dissection: Results from Long-Term Follow-Up.

To aim of this study was to determine the clinical and biological prognostic factors for locoregional recurrence (LRR) in patients with thoracic esophageal squamous cell carcinoma (ESCC) undergoing radical two-field lymph node dissection (2FLD). A total of 462 patients diagnosed with thoracic ESCC underwent radical esophagectomy between March 2001 and May 2010 at Sun Yat-Sen University Cancer Center. Clinical characteristics, CD44 expression, and tumor-infiltrating lymphocyte (TIL) levels were evaluated in 198 patients who underwent R0 dissection with long-term follow-up. Partial Cox regression analysis with leave-one-out cross-validation was performed to validate the selected risk factors. With a median follow-up of 54months, the 5-year local failure-free survival (LFFS) rate of 198 patients was 62.5%. Multivariate analysis revealed that T stage (p=0.043), pathological positive tumor above the carina (p=0.000), CD44 expression level (p=0.045) and TIL level (p=0.007) were prognostic factors for LFFS, while the Cox model with risk scores had an area under the curve value of 83.6% for the prediction of 5-year LFFS. The best cut-off value (sum score=11.19) was used to determine the high- and low-risk groups, with patients at high risk having a significantly shorter 5-year LFFS than patients at low risk (p=0.000). The LRR pattern revealed significantly high incidences of recurrent disease at the supraclavicular and cervical sites, mediastinum (above the carina), and anastomosis. Our predictive model was able to distinguish between patients at high risk for LRR and patients at low risk for LRR. LRR primarily involved the upper thorax and this area must be considered in future study designs for radical trimodality treatment.

Clinical and Biological Prognostic Factors for Locoregional Recurrence in Patients With Thoracic Esophageal Squamous Cell Carcinoma Treated With Radical 2-field Lymph Node Dissection: Results From Long-term Follow-up

Clinical and Biological Prognostic Factors for Locoregional Recurrence in Patients With Thoracic Esophageal Squamous Cell Carcinoma Treated With Radical 2-field Lymph Node Dissection: Results From Long-term Follow-up

Infracentimetric cervical lymph node metastasis in head and neck squamous cell carcinoma: Incidence and prognostic value

ObjectivesSupracentimetric cervical lymph node metastasis is classically a poor prognostic factor for locoregional recurrence and survival in head and neck cancer. Causality, however, is more controversial for infracentimetric cervical lymph node metastases. The objective of this study was to evaluate the incidence and prognostic value of infracentimetric lymph node metastasis. Materials and methodsTwo hundred and forty-three neck dissections from 150 head and neck cancer patients were analyzed. A single pathologist exhaustively inventoried the number and size of all adenopathies in the surgical specimen. ResultsCervical lymph node metastases were infracentimetric in 38% of cases, with 72% extracapsular spread (versus 91% for supracentimetric adenopathies; P<0.01). Infracentimetric metastases were more often associated with other cervical lymph node metastases (mean 5.3 versus 3.9; P=0.14). Fifty three percent of specimens showed only supracentimetric metastases (versus 13% infracentimetric metastases; P<0.01). Disease-specific and failure-free survival were lower in case of infracentimetric metastasis, associated with supracentimetric metastasis or not, than in case of macrometastasis only. ConclusionInfracentimetric cervical lymph node metastasis is a factor of poor prognosis, and may represent a different, more aggressive lymphatic process. We suggest complete neck dissection by the surgeon and meticulous analysis by the pathologist, the results of which guide complementary therapy. Close surveillance of recurrence is also recommended.

A prognostic index for locoregional recurrence after neoadjuvant chemotherapy.

BackgroundThe appropriate selection criteria for breast-conserving surgery (BCS) or mastectomy after neoadjuvant chemotherapy (NAC) are poorly defined. The aim of this study is to analyse the incidence and prognostic factors for locoregional recurrence (LRR) in patients with breast cancer (BC) treated with NAC to develop a prognostic score to help with clinical decision-making.Materials and methodsUsing our retrospective maintained BC database, we identified 730 patients treated with NAC (327 patients treated with BCS and 403 patients treated with mastectomy) between 1998 and 2014. To identify variables associated with an increased LRR rate, we performed firstly Kaplan–Meier curves, with comparisons among groups using log-rank test, and then, significant variables were included in a multivariate analysis using Cox proportional hazards. The prognostic index was developed by assigning score 0 (favourable) or score 1 (unfavourable) for each significant variable of multivariate analysis and was created separately for patients with BCS and mastectomy.ResultsAt a median follow-up of 72 months, the 6-year cumulative incidence of LRR was 7.2% ( ± 3%) for BCS and 7.9% ( ± 3%) for mastectomy.By univariate analysis, variables associated with an increased LRR were for BCS: HER2 positive, grade III, ductal carcinoma in situ (DCIS), No-pCR (ypTis, ypN0), and age < 40 years; and for mastectomy, HER2-positive, DCIS, No-pCR, and LVI. By multivariate analysis, variables associated with an increased LRR were for BCS: HER2 positive (HR: 11.1, p = 0.001), DCIS (HR: 3.1, p = 0.005), and age < 40 years (HR: 2.8, p = 0.02); and for mastectomy: HER2 positive (HR: 9.5, p = 0.03), DCIS (HR: 2.7, p = 0.01), No-pCR (HR: 11.4, p = 0.01), and age < 40 years (HR: 2.8, p = 0.006).The score stratified patients into three subsets with statistically different levels of risk for LRR. For BCS, the six-year LRR rates were 3%, 13%, and 33% for the low (score 0, n = 120), intermediate (score 1, n = 95) and high (score 2–3, n = 27) risk groups, respectively (p = 0.001). For mastectomy, the six-year LRR rates were 0%, 8%, and 27% for the low (score 0, n = 20), intermediate (score 1–2, n 191), and high (score 3–4, n = 30) risk groups, respectively (p = 0.001). Of note, 21 patients that had a LRR event were HER2 positive, all of them had received trastuzumab.ConclusionsPatients with a score of 0, which made up to 19% of the study population, had very low risk of LRR. The score enabled the identification of a small group (7%) of patients with very high risk of LRR, and who may benefit from alternative treatment.

Quality management during development and implementation of complete mesocolic excision in colon carcinoma

In a prospective observational study, the implementation of complete mesocolic excision (CME) from 1978 through to 2014 was examined in light of process and outcome quality during ongoing developments in treatment for colon carcinoma. Data from 2019 patients with stage I–III colon carcinoma were analysed by comparing five time periods – 1978–1984 (pre-CME), 1985–1994 (CME development), 1995–2002 (CME implementation), 2003–2009 (CME) and 2010–2014 (CME) – with a special focus on indicators of process and outcome quality. Over the 37-year period, the patients became older, and right-sided carcinoma was more common and more likely to present at stage I, which is associated with a favourable prognosis. Fewer patients had regional lymph node metastases. The proportion of patients with histology-negative lymph nodes (pN0) with at least 12 examined regional lymph nodes increased significantly, to 100%, as did the curative (R0) resection rate, and the application of adjuvant chemotherapy in stage III colon carcinoma increased to 79%. The 5-year rate of locoregional recurrence decreased significantly, from 6.7% to 2.1% ( p =0.008). The cancer-related 5-year survival rate increased significantly, from 78.9% to 90.6% ( p <0.001). In multivariate analysis, the date of treatment in the series chronology was found to be an independent prognostic factor for locoregional recurrence ( p =0.018) and cancer-related survival ( p =0.001). In summary, the quality indicators of process and outcome quality improved with CME. Adjuvant chemotherapy at stage III and multidisciplinary approaches in patients with metachronous distant metastases also improved outcomes. Strict quality management is mandatory to accompany changes in treatment.