Prognostic Significance Of Tumor Location Research Articles

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-analysis

Background: T2 GBC is subdivided into T2a and T2b by AJCC 8th edition staging system. However, there is a lack of evidence on the prognostic significance of tumor location. The aim of the present study was to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer(GBC) and to evaluate the optimal surgical extent according to tumor location.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis.

(1) Background: The AJCC Cancer Staging Manual, Eighth Edition, subdivided T2 GBC into T2a and T2b. However, there still exist a lack of evidence on the prognostic significance of tumor location. The aim of the present study was to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. (2) Methods: We searched for relevant literature published in the electronic databases PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase before September 2020 using search terms related to gallbladder, cancer, and stage. Data were weighted and pooled using random-effects modeling. (3) Results: Seven studies were deemed eligible for inclusion, representing a cohort of 1789 cases of resected T2 GBC. The overall survival for T2b tumor was significantly worse than that for T2a tumor (HR, 2.141; 95% confidence interval (CI), 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in the T2a group (26.6%) than in the T2b group (36.6%) (OR, 2.164; 95% CI, 1.309 to 3.575). There was no evidence of a survival difference between the patients who underwent extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042) and T2b GBC (OR, 0.820; 95% CI, 0.620 to 1.083). (4) Conclusions: Hepatic side tumor was a significant poor prognostic factor in T2 GBC. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC, and additional large-scale prospective studies are warranted to establish evidence-based treatment guidelines for T2 GBC.

Prognostic significance of tumor location in T2 gallbladder: A systematic review and meta-analysis

The purpose of this study is to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. Eligible studies examining the association between tumor location of T2 GBC and survival were sought using the Medline, Cochrane, and EMBASE databases to September 2020. The primary endpoint was overall survival according to tumor location. All statistical analyses were performed using Comprehensive Meta-Analysis version 2.0. Seven studies were deemed eligible for inclusion representing a cohort of 1,789 case of resected T2 GBC. The overall survival for T2a tumor was significantly better than that for T2b tumor (hazard ratio [HR], 2.141; 95% confidence interval [CI], 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in T2a group compared with that in T2b group (odd ratio [OR], 2.164; 95% CI, 1.309 to 3.575; number needed to benefit [NNTB], 3.6; 95% CI, NNTB 3.1 to NNTB 4.3). There was no evidence of a survival difference between extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042; I2 = 0.0%; Pchi2 = 0.928) and T2b GBC (OR, 0.816; 95% CI, 0.622 to 1.070; I2 = 0.0%; Pchi2 = 0.512). Tumor location was significantly associated with the prognosis of T2 GBC patients. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System-BiliaryPancreas (KOTUS-BP) Database Analysis

Objective: The aims of this study were to investigate the clinical features and clinical outcomes of T2 gallbladder cancer (GBC) according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy for T2 GBC. Methods: Using Korea tumor registry system- biliarypancreas (KOTUS-BP) database, between 2000 and 2014, a total 707 patients with T2 GBC who underwent curative resection were enrolled. Results: 309 patients were T2a, and 398 patients were T2b. The incidence of lymph node metastasis in T2b tumor group was 37.5% and significantly higher than that of T2a tumor group (29.5%). After a median follow-up period of 43 (range 3-189) months, the 5-year disease-specific survival (76% vs. 69%, p=0.019) and disease-free survival of the T2a group were better than those of the T2b group (69% vs. 57%, p=0.002). However, there was no significant difference in survival between Stage IIa (T2aN0) and Stage IIb (T2bN0) (83% vs.74%, p=0.149). There were no significant survival differences between T2a and T2b groups according to whether hepatic resection was performed or not. Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (hazard ratio 2.966, 95% confidence interval 1.960-4.489, p < 0.001). Conclusion: In T2 GBC, simple cholecystectomy and lymph node dissection for staging work-up could be recommended irrespective of tumor location. Postoperative adjuvant therapy should be considered, because lymph node metastasis was a significant poor prognostic factor, systemic recurrence was more common, and recurrence occurred more frequently among patients with lymph node metastasis.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) Database Analysis.

Background: T2 gallbladder cancer (GBC) is subdivided into T2a and T2b by the American Joint Committee on Cancer (AJCC) 8th edition. However; there is a lack of evidence for the prognostic significance of tumor location and validation with large-scale studies is needed. The aims of this study were to investigate the clinical features and clinical outcomes of T2 GBC according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy. Methods: Between 2000 and 2014 the Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) database was used to identify and enroll a total 707 patients with pathologically diagnosed T2 GBC who underwent curative resection. Clinicopathological findings and long-term follow-up results were analyzed. Results: The incidence of lymph node metastasis in T2b was significantly higher than that of T2a tumors (37.9% vs. 29.5%, p = 0.032). The 5-year disease-specific survival of T2a was better than that of T2b tumors (74.8% vs. 65.4%, p = 0.019). There was no significant survival difference in T2a between extended cholecystectomy and simple cholecystectomy with lymph node dissection (81.8% vs. 73.7%, p = 0.361). However; there was a better survival trend for T2b tumor after extended cholecystectomy (71.7% vs. 59.3%, p = 0.057). Adjuvant chemotherapy was associated with improved survival for patients with lymph node metastasis in T2a (72.1% vs. 56.9; p = 0.022) and in T2b (68.2 vs. 48.5; p < 0.001). Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (Hazard ratio 3.222; 95% confidential interval 1.960–4.489; p < 0.001). Conclusions: For T2 GBC; tumor location was not an independent prognostic factor. Lymph node metastasis was a significant poor prognostic factor and adjuvant chemotherapy should be considered for the patients with lymph node metastasis.

Prognostic significance of the primary tumor site and immune indexes in patients with estrogen receptor-positive, human epidermal growth factor receptor-2-negative breast cancer.

The ability to predict high risk factors for recurrence after neoadjuvant chemotherapy (NAC) is controversial. The purpose of the present study was to investigate the prognostic significance of tumor location, tumor-infiltrating lymphocyte (TIL) level, and pretreatment lymphocyte-to-monocyte ratio (LMR) in determining the survival of patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor-2 (HER2)-negative breast cancer after treatment with NAC. The clinical data of 285 ER-positive, HER2-negative patients with clinical stage II-III breast cancer were analyzed from January 2009 to January 2015. To explore the prognostic factors for ER-positive, HER2-negative patients, we combined the conventional clinicopathological prognostic factors with tumor location, pretreatment LMR, and TIL. In addition, samples from 79 patients, who did not achieve pathological complete response (pCR) testing after NAC, were selected for hematoxylin-eosin (HE) staining to analyze the effect of TIL on prognosis. An LMR >5.2 was correlated with better 5-year disease-free survival (DFS) and overall survival (OS; P<0.001 and P<0.001, respectively). Patients with lower-inner/central quadrant tumors had lower 5-year DFS and OS than patients with tumors in the other quadrants (P=0.012 and P=0.048). Patients with a lower TIL level (≤10%) had better 5-year DFS than patients with a higher TIL level (P=0.010). According to the results of the multivariate analyses, tumor location was an independent prognostic factor for 5-year DFS (P=0.021). Pretreatment LMR was associated with both 5-year DFS and OS (P<0.001 and P<0.001, respectively). In the subgroup analysis stratified by TIL level, the TIL level and the initial clinical stage were associated with 5-year DFS (P=0.027 and P<0.001, respectively). We explored the prognostic significance of the tumor site, TIL level, and pretreatment LMR level for ER-positive, HER2-negative patients. We concluded that the lower-inner/central quadrant tumors, TIL >10%, and pretreatment LMR level ≤5.2 were correlated with a poor prognosis. More aggressive NAC and/or endocrine therapy with internal mammary node radiotherapy (IMN-RT) should be administered to address the relatively poor prognosis of patients with breast carcinoma presenting the aforementioned adverse factors.

The poor prognosis of lower-inner quadrant breast cancer in patients who received neoadjuvant chemotherapy.

The elevated risk for recurrence in breast cancer patients after receiving neoadjuvant chemotherapy (NAC) is still controversial. The purpose of this paper was to investigate the prognostic significance of tumor location concerning the survival of patients with breast cancer treated with NAC. The clinical information of 676 patients with stage II-III breast carcinoma who were being treated with NAC between March 2009 and 2014 was investigated. The primary tumor sites were categorized into three groups: outer quadrant, upper-inner quadrant, and lower-inner/central quadrant. According to the results of multivariate analyses, the number of tumor locations, nuclear grade, and the initial clinical stage was associated with disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS). When stratified into subgroups, tumors in the lower-inner/central quadrant were associated with a significantly worse prognosis in patients not treated with postmastectomy radiation therapy (PMRT) and in patients in the human epidermal growth factor receptor 2 (HER-2)-enriched and triple-negative subgroups. The primary tumor site is likely to be a critical feature that affects the prognosis of breast cancer tumors treated with NAC. To address the poor prognosis related to inner-quadrant participation in breast carcinoma, more aggressive NAC with internal mammary node radiotherapy (IMN-RT) should be conducted.

NIMG-64. IMPACT OF TUMOR LOCATION ON IMAGE-DERIVED VOLUME, PROLIFERATION RATE AND GROWTH VELOCITY IN GLIOBLASTOMA PATIENTS

Abstract INTRODUCTION Glioblastoma (GBM) is the most common malignant primary brain tumor in adults with a median overall survival (OS) of 15months. Despite advancements in treatments, prognosis is dismal and the prognostic significance of tumor location is not entirely understood. METHODOLOGY: In our study, we investigated sex-specific volumetric, tumor growth kinetics, and outcome differences among GBMs in various brain locations. Primary GBM patients with pretreatment magnetic resonance imaging (MRI) data (N=289, 173 males, 116 females) were selected from our brain tumor repository. Tumor abnormality was segmented on T1-weighted post-gadolinium contrast agent (T1Gd) MRIs. We utilized the Harvard-Oxford brain atlases to determine the location of GBMs. RESULTS Overall, our study found smaller tumors in the left hemisphere. This may be expected as left-hemispheric GBM symptoms could present earlier, leading to earlier diagnosis and treatment. However, when the cohort was split by sex, we found this observation significant for females only in the parietal lobe (p &lt; 0.0001). Further, female GBMs demonstrated smaller necrotic volume in the left hemisphere (p = 0.030). Sex-specific differences in incidence were noted in the temporal and occipital lobes (2M:1F). Comparing tumor growth kinetics in different brain locations and hemispheres, females had significantly lower tumor proliferation rates in the left hemisphere (p = 0.009) and lower tumor proliferation rates in the left frontal lobe (p = 0.031). Controlling for treatment, patients with frontal lobe tumors had significantly longer OS compared to those with GBMs in the temporal lobe (p = 0.046, 312 days). Differences in growth velocities were noted between frontal and parietal lobe with frontal GBMs having lower velocities in comparison to parietal lobe GBMs. CONCLUSION Together, our results demonstrate that tumor growth and proliferation rates may vary based on location and sex. Additional research is needed to further explore the clinical significance of tumor location.

1146P - Impact of tumour site and adjuvant radiotherapy on survival in adenoid cystic carcinoma: A SEER database analysis

BackgroundAdenoid cystic carcinoma (ACC) is a rare salivary gland tumor, comprising less than 1% of head and neck neoplasms. Adjuvant radiotherapy (aRT) is suggested for late-stage disease (stage III or IV); however, recent evidence suggests that it may be associated with improved survival even for early-stage disease. Moreover, the prognostic significance of tumor location on overall (OS) and ACC-specific (ACC-S) survival is unclear. We sought to address these knowledge gaps via analyses of the Surveillance, Epidemiology and End Results (SEER) database. MethodsIntraoral minor (m) and major (M) ACCs from the SEER database (1973-2015) were selected for analysis. Information on age, sex, race, site, stage, treatment and survival was retrieved. The associations of tumor site and aRT with OS and ACC-S were estimated using hazard ratios (HR) and corresponding 95% confidence intervals (CI) obtained via Cox regression models adjusted for covariates as appropriate. Analyses were done using Stata 15.1 (StataCorp LP, College Station, TX). ResultsThere were 635 minor and 1,064 major (parotid: n=547, submandibular: n=470, sublingual: n=47) ACC cases included in the analyses. Late-stage patients (49% of total) were significantly more likely to have received aRT (76% vs. 66%; P<0.01) compared to those with early-stage disease. Submandibular was the only tumour site that demonstrated statistically significant survival differences compared to the other sites; i.e., worse OS (HR=1.4; 95% CI=1.1-1.8) and ACC-S (HR=1.7; 95% CI=1.2-2.3) compared to minor ACCs. This difference was only evident for late-stage tumours: stage IV submandibular cases had worse OS (HR=2.1; 95% CI=1.5-2.8) and ACC-S (HR=2.4; 95% CI=1.7-3.4) compared to stage IV minor ACCs. Overall, aRT was associated with better OS (HR=0.7; 95% CI=0.6-0.9) and ACC-S (HR=0.8; 95% CI=0.6-1.1). This beneficial effect was more pronounced and statistically confirmed only in stage IV disease. ConclusionsThese results, based on SEER data, suggest that aRT is associated with favorable survival only in late-stage ACC and that, among these late-stage tumors, submandibular gland ACCs have substantially worse prognosis than other sites, irrespective of aRT. Legal entity responsible for the studyThe authors. FundingAcademy of Athens PhD Scholarship to Jason Tasoulas; UNC Lineberger Tier 3 Developmental Award funds and the University Cancer Research Fund to A.L. Amelio. DisclosureAll authors have declared no conflicts of interest.

Does tumor location affect prostate cancer prognosis?

45 Background: Does tumor location affect prostate cancer prognosis? To clarify this question we conducted a retrospective study to characterize the incidence and prognostic significance of tumor location of prostate cancer. Methods: From 2000 to 2017, radical prostatectomy with no neoadjuvant therapy was performed in 916 cases in our hospital. Serial whole mount sections were reviewed to determine the incidence, clinicopathological features and prognostic significance of tumor location in the prostate gland. For the tumor location, we defined the subzones, which were made from subdivision of the McNeal’s zonal anatomy, are shown in Table 1 in detail. The peripheral zone (PZ) is composed of 8 subzones including A1, A2, A3 , M1, M2, M3, M4, M5. The transition zone (TZ) is composed of 5 subzones including T1, T2, T3, T4 and B1. The central zone (CZ) is composed of 3 subzones including M6, B2 and B3. Results: The median age was 67 and PSA was 8.6 ng/ml. The subzonal tumor incidence divided by all cases was the highest in A2, followed by M4, A1, M3, T2 in that order, while the lowest in B3, followed by M6, T4, T3, B1 in that order. The median follow-up time was 67 months. A 5-year PSA failure rate (5Y-PSAFR) was 23%. Among the subzones, the highest 5Y-PSAFR was seen in B3, followed by M6, B2, T4, A3, and the lowest was seen in M4, A2, T2, A1 in that order. A multivariate analysis for PSAF risk among subzones showed that B3 (HR 8.6, p &lt;0.0001) and M6 (HR 3.3, p = 0.03) were the independent high risk subzones. Conclusions: We demonstrated that the cancer incidence and prognosis varies according to the location within the prostate gland. The B3 and M6 around the ejaculatory duct showed the lowest incidence, while these locations also had the highest recurrence risk. [Table: see text]

Prognostic Significance of Tumor Location for Liver Cancer Radiotherapy.

IntroductionAccording to the Surveillance, Epidemiology and End Results (SEER) data, cancerous involvement of the liver is on an increase over the last three decades. It occurs worldwide in all races and carries a poor prognosis. Currently, considerable progress has been made in patient selection, staging, surgery, chemotherapy agents, and stereotactic radiotherapy in both primary and metastatic liver cancers with improved outcomes. While there is evidence of the prognostic factors of liver function, the involvement of the portal vein, inferior vena cava thrombosis, lesion size, radiation dose, number of fractions, and SBRT techniques, there is no study evaluating outcomes with the location of the lesion. Our aim in this retrospective study was to explore the correlation of tumor location from the portal vein bifurcation (vascular wall) and the radiotherapy outcome (survival) in hepatocellular cancer.MethodsContrast-enhanced computed tomography (CT) studies in 86 patients with liver cancer were retrospectively reviewed in an institutional review board (IRB)-approved database to determine the distance to the bifurcation point of the portal vein from tumor’s centre of mass (distance tumor bifurcation: DTB) and from the edge point of the planning target volume closest to the bifurcation (distance edge bifurcation: DEB). The mean dose to the sphere of 1 cm diameter around the bifurcation point (mean dose at bifurcation: MDB) was calculated. These parameters were tested as predictors of patient outcomes using univariate and multivariate analysis as two groups of patients.ResultsOnly the DEB correlation with survival for hepatocellular carcinoma (HCC) was found to be significant (P = 0.028). A larger MDB is caused by a smaller DTB and a smaller DEB. The hazard ratio for DTB, DEB, and MDB were 0.48, 0.41, and 1.05, respectively. The DEB was found to be a better predictor of outcomes (overall survival) compared to the DTB and MDB parameters. The close proximity of the tumor to the blood supply vessels was a decisive factor. The DTB parameter is also dependent on the size of the tumor and this factor weakens the correlation of this parameter on survival data. The inclusion of the dosimetric and geometric location, as well as distance parameters in predictive models for liver cancer patients, was shown to benefit the pre-selection of treatment options for liver cancer patients treated with radiotherapy.ConclusionFor hepatocellular cancer patients, the distance between the edge point of the planning treatment volume (PTV) to the portal vein bifurcation (DEB) of more than 2 cm was found to be a predictor of survival.

Prognostic implication of the primary tumor location in early-stage breast cancer: focus on lower inner zone

The aim of this study was to investigate the prognostic significance of tumor location of lower inner zone (LIZ) on the survival of patients with early-stage breast cancer. We retrospectively identified 961 breast cancer patients from Jan 2000 to Apr 2016 from hospital database. We evaluated overall survival (OS) and disease-free survival (DFS) in patients with tumors in and outside LIZ. Subgroup analyses were performed according to clinicopathological characteristics and treatment strategies. A total of 838 cases were finally included. Patients with tumor location of LIZ showed significantly lower survival rates than tumors in other sites in terms of DFS (p=0.028) but not OS (p=0.106). When stratified into subgroups, tumors in LIZ retained a significant worse prognosis in DFS in patients with HER-2-negative, high ki-67 expression breast cancers, those who received neoadjuvant chemotherapy, axillary nodal negative patients, and patients with lymphovascular invasion. Univariate and multivariate analyses suggested that tumor location of LIZ was an independent prognostic factor for DFS (p=0.022). Our results suggested that tumor location of LIZ was an independent adverse prognostic factor for DFS in patients with early-stage breast cancer. Multicenter studies with larger sample size are needed to confirm the conclusion and anatomical experiments are desired to elaborate the mechanism.

Effect of tumor location on survival in urinary bladder adenocarcinoma: A population-based analysis

PurposeTo investigate the prognostic significance of tumor location on survival outcomes in patients with urinary bladder adenocarcinoma (BAC). MethodsWe retrospectively analyzed cases of BAC with known tumor location from the Surveillance, Epidemiology, and End Results database from 1973 to 2012. Data regarding patient demographics, tumor characteristics, and oncological and survival outcomes were collected. Patients were subgrouped according to tumor location into urachal/dome (dome and urachus [UD]), lateral wall (anterior, posterior, and lateral bladder walls [LW]), and base (trigone, ureteral orifices, and bladder neck [BL]). ResultsA total of 1,361 cases of BAC with known tumor location were identified. More UD tumors were low grade (grade I and II; 51%) than LW (33%) and BL (43%) tumors (P<0.0001). UD lesions were the most likely to have metastatic spread (23% vs. 17% for LW and 15% for BL) (P<0.0001). The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 37.3% and 49.0%, respectively, for all BAC. Furthermore, the 5-year OS rates were 42.3%, 35.9%, and 28.4% for UD, LW, and BL lesions, respectively (P<0.0001), whereas the 5-year DSS rates were 50.2%, 51.7%, and 42.1% for UD, LW, and BL lesions, respectively (P = 0.0097). Multivariate Cox regression analysis controlling for tumor stage and grade demonstrated that both tumors of the LW (hazards ratio [HR] = 1.52 for OS and 1.30 for DSS) and BL (HR = 1.71 for OS and 1.57 for DSS) conferred a worse prognosis relative to those of the UD (P< 0.05). ConclusionsTumor location of BAC is an independent prognostic factor for disease outcome. Our results suggest that the urachal and dome locations are associated with relatively favorable survival and oncological outcomes, whereas basal location confers poorer outcomes.

Survival analysis for colon subsite and rectal cancers: Experience from a single surgeon

Purpose: The survival rates of patients with colorectal cancers have been well documented in many studies. Some studies have shown that proximal colon cancers have inferior survival rates when compared with distal colon cancers. However, the prognostic significance of tumor location with respect to survival remains controversial. By using data from a single physician, we analysed patient survival rates based on colon cancer subsite location, including rectal cancers. Methods: We retrospectively analysed 881 patients with colorectal cancers between 1987 and 2008. Colon subsite locations were defined as cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Subsite-specific survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards ratios. The median follow-up time was 93 months. Results: A total of 689 colorectal cancer cases were included in our analysis, of which 14 were cecum (2.0%), 95 were ascending colon (13.8%), 21 were transverse colon (3.0%), 25 were descending colon (3.6%), 129 were sigmoid colon (18.7%), and 405 were rectum (58.8%) cancers. The 5-year overall survival rates were 77.8% for all colorectal cancers, which consisted of 92.9% for cecal cancer, 69.5% for ascending colon cancer, 76.2% for transverse colon cancer, 84.0% for descending colon cancer, 82.2% for sigmoid colon cancer, and 77.5% for rectal cancer. Conclusion: Ascending colon cancer was associated with the poorest survival outcome, whereas descending colon cancer was associated with the best survival outcome except cecal cancer. Moreover, the survival rate associated with left colon cancer was better than the survival for right colon and rectal cancer.

Ureteral Involvement Is Associated with Poor Prognosis in Upper Urinary Tract Urothelial Carcinoma Patients Treated by Nephroureterectomy: A Multicenter Database Study

BackgroundThe prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis. ObjectiveTo investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU). Design, setting, and participantsIn this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17–77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both–regional (having both renal pelvic and ureteral tumors). The ureteral and both–regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact. InterventionAll patients underwent RNU. Outcome measurements and statistical analysisThe prognostic impact of tumor location on survival was analyzed. Results and limitationsThe renal pelvic, ureteral, and both–regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both–regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both–regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both–regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p=0.006) and PFS (HR: 1.35; p=0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design. ConclusionsThe presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis. Patient summaryWe demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy.

Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study.

To determine the prognostic impact of tumor location in gallbladder cancer. Depth of tumor is a strong predictor of survival after curative resection of gallbladder cancer. However, the gallbladder has a unique anatomical relationship with the liver, and the clinical significance of tumor location remains unclear. For 437 patients with gallbladder cancer who underwent resection at 4 international institutions, clinicopathologic characteristics and their association with survival were analyzed. Tumor location was defined as "hepatic side" or "peritoneal side," and the prognostic significance of tumor location was evaluated. Among the 252 patients with T2 disease, patients with tumors on the hepatic side (T2h, n = 99) had higher rates of vascular invasion, neural invasion, and nodal metastasis than patients with tumors on the peritoneal side (T2p, n = 153) (51% vs 19%, 33% vs 8%, and 40% vs 17%, respectively; P < 0.01 for all). After a median follow-up of 58.9 months, 3-year and 5-year survival rates were 52.1% and 42.6%, respectively, for T2h tumors and 73.7% and 64.7%, respectively, for T2p tumors (P = 0.0006). No such differences were observed in T1 or T3 tumors. Multivariate analysis confirmed the independent association of hepatic-side location with survival in T2 tumors (hazard ratio, 2.7; 95% confidence interval, 1.7-4.2; P < 0.001). This subclassification of T2 tumors predicted recurrence in the liver (23% vs 3%; P = 0.003) and distant lymph nodes (16% vs 3%; P = 0.019) even after radical resection. After curative resection of T2 gallbladder cancer, tumor location predicts the pattern of recurrence and survival.

Pediatric supratentorial high-grade glioma: multicenter retrospective observational study of the Korean Society for Pediatric Neuro-Oncology.

We analyzed the prognostic factors of Korean pediatric patients with supratentorial high-grade glioma (HGG). Between 1997 and 2011, 62 patients with 34 glioblastomas and 28 anaplastic gliomas were surgically operated at nine institutions. The male-to-female ratio was 33 to 29 and the median age was 12 years (range 1-18). The prognostic significance of tumor location, extent of removal, pathologic grade, treatment method, and pattern of recurrence was analyzed. The median progression-free survival (PFS) and overall survival (OS) were 9.3 (± 0.8) and 17.8 (± 1.9) months, respectively. Glioblastoma and anaplastic glioma showed OSs of 15.9 (± 1.3) and 19.6 (± 2.4) months, respectively. Based on the univariate analysis, gross total removal (GTR) and initial combined chemoradiotherapy improved PFS (p = 0.012 and p = 0.003) and OS (p = 0.030 and p = 0.013), respectively. Cerebrospinal fluid (CSF) dissemination showed poor OS (p = 0.001). Based on the multivariate analysis, GTR and initial combined chemoradiotherapy resulted in an improved PFS [(hazard ratio 0.360; 95 % CI 0.177-0.733; p = 0.005) and (hazard ratio 0.458; 95 % CI 0.230-0.911; p = 0.026), respectively]. GTR, initial combined chemoradiotherapy, and no CSF seeding resulted in an improved OS [(hazard ratio 0.417; 95 % CI 0.201-0.861; p = 0.018), (hazard ratio 0.406; 95 % CI 0.206-0.800; p = 0.009), and (hazard ratio 0.288; 95 % CI 0.148-0.563; p = 0.000), respectively]. No significant difference in PFS and OS was observed between glioblastoma and anaplastic glioma. CSF dissemination was observed in 22 patients (35.5 %) during total follow-up. Pediatric anaplastic glioma showed poor survival, similarly to glioblastoma. GTR and initial combined chemoradiotherapy were associated with improved survival.

Hilar location is an independent prognostic factor for recurrence in T1 renal cell carcinoma after nephrectomy.

We investigated the prognostic significance of tumor location at the renal hilum near the sinus structure on the recurrence in T1 renal cell carcinoma (RCC). A total of 1,818 T1 RCC patients who underwent radical (RN) or partial nephrectomy (PN) from 1997 to 2011 were retrospectively reviewed. A hilar tumor was defined as a tumor abutting the main renal artery and/or vein or its segmental branches, without invasion. We compared the recurrence-free survival (RFS) rates between hilar and nonhilar T1 RCC and analyzed predictors of RFS after nephrectomy. Patients with hilar tumors showed a poorer 5-year RFS compared with nonhilar tumors both in T1a (89.7 vs. 98.5 %, p < 0.001) and T1b (81.6 vs. 95.1 %, p < 0.001) RCCs. Among patients who underwent RN and PN, hilar tumors were associated with lower 5-year RFS (87.6 vs. 97.2 % for RN, 78.1 vs. 98.2 % for PN, both p < 0.001). In T1a hilar tumor, PN was associated with poorer 5-year RFS than RN (79.5 vs. 93.0 %, p < 0.001). In multivariate analysis, a hilar location remained as an independent predictor of recurrence in both T1a and T1b tumors (both p = 0.001). Hilar tumors show a higher recurrence rate than nonhilar counterparts in T1 RCC. In T1a hilar tumors, PN demonstrated poorer RFS than RN. Potential intrinsic renal anatomical or lymphovascular structural differences as well as differences in cancer characteristics need further investigations.

Peripelvic/periureteral fat invasion is independently associated with worse prognosis in pT3 upper tract urothelial carcinoma

To elucidate the reasons for conflicting results regarding the prognostic significance of tumor location in upper tract urothelial carcinoma (UTUC), we analyzed the stage-specific impact of tumor location on oncological outcomes following radical nephroureterectomy (RNU). Data from 392 patients who underwent RNU with curative intent between 1991 and 2010 were reviewed. Prognostic impact of tumor location and various clinicopathological factors for recurrence-free survival (RFS) and cancer-specific survival (CSS) was evaluated using Kaplan-Meier and Cox regression analyses at each pathological stage. Tumor location was classified as renal pelvis or ureter, and pT3 tumors were further stratified as invading the renal parenchyma or peripelvic or periureteral fat. In stage-specific analysis, tumor location did not have prognostic significance in patients with ≤pT2 tumors, whereas RFS and CSS rates were significantly lower in patients with pT3 ureteral tumors than renal pelvic tumors. Subgroup analysis showed that RFS and CSS rates were significantly higher for pT3 tumors invading the renal parenchyma than the peripelvic or periureteral fat. On multivariate analysis in pT3 tumors adjusting other clinicopathological parameters, tumor location remained significant predictors for both RFS and CSS. Compared with tumors invading renal parenchyma, tumors invading peripelvic fat or periureteral fat were associated with about 3.5 times higher risk for cancer-specific mortality (p < 0.05). Location-dependent survival difference exists only in patients with pT3 UTUC. Conflicting institutional results regarding tumor location in UTUC may be due to difference in the proportions of parenchymal versus peripelvic fat invasion in pT3 pelvic tumors.

Prognostic significance of tumor location and superficial urothelial bladder carcinoma history in patients with ureteral urothelial carcinoma treated with radical nephroureterectomy

To investigate the significance of tumor location and superficial urothelial bladder carcinoma (UBC) history on oncological outcomes in patients treated with radical nephroureterectomy (RNU) for ureteral urothelial carcinoma (UC). One hundred and thirty-two patients treated with RNU for ureteral UC between January 1999 and July 2010 were retrospectively analyzed. Recurrence probabilities and survival rates were analyzed, stratified by tumor location and superficial UBC history. Comparison of patients with proximal, middle, and distal ureteral UC showed that percentage of bladder recurrence was 13.3, 14.7, and 25.0 %, respectively (P = 0.285); retroperitoneal (tumor bed or lymph node) recurrence was 26.7, 14.7, and 27.9 % (P = 0.319); and contralateral recurrence was 0, 2.9, and 0 % (P = 0.234). Comparison of patients with and without history of superficial UBC revealed that percentage of bladder recurrence was 15.4 and 20.2 %, respectively (P = 0.681); retroperitoneal recurrence was 15.4 and 25.2 % (P = 0.433); and contralateral recurrence was 0 and 0.84 % (P = 0.740). Using multivariable Cox regression analyses, there were no significant differences of recurrence-free survival (RFS) and cancer-specific survival (CSS) with regard to neither tumor location nor superficial UBC history (RFS: P = 0.282 and 0.762, CSS: P = 0.272 and 0.818, respectively). Tumor location and history of superficial UBC could not be used to predict oncological outcomes of patients who underwent RNU for ureteral UC. Therefore, operative strategies or postoperative surveillance should not be affected by tumor location or history of superficial UBC.