Recurrence-free Rates Research Articles

Analysis of Treatment Outcomes According to Treatment Modalities for Patients with Stage IB-IIA Cervical Cancer

The most optimal primary treatment for early stage cervical cancer remains unclear because both radiotherapy (RT) and surgery are feasible therapeutic approaches. Since the only randomized study was performed many years ago and retrospective studies report diverse results, our aim in this study was to analyze the treatment outcomes and toxicity in FIGO IB-IIA stage cervical cancer patients depending on the primary treatment they received. Furthermore, we wanted to investigate whether there would be a subgroup in the low risk group in need of adjuvant treatment after surgery. A total of 334 patients diagnosed with histologically proven FIGO stage IB to IIA cervical cancer who were treated with a curative aim between September 2001 and June 2013 were analyzed. Patients were divided into three groups according to the treatment modality received: RT group (n = 88), surgery group (n = 129), and surgery + RT group (n = 117). Treatment outcomes and late toxicity were retrospectively analyzed. The median follow-up period was 77.5 months (range, 3.1 – 188.1 months). In the RT group, patients were older, had more medical comorbidities and had more tumors larger than 4cm. The surgery group consisted mostly of patients with stage IB disease and no lymph node metastasis. The 5-year overall survival rates were 82.8%, 96.9%, and 86.0%, for RT, surgery, and surgery + RT groups, respectively. For recurrence-free rates, including all local, regional, and distant failures, there were no differences between the three groups. The most frequent patterns of failure were distant failure for the RT and surgery + RT groups and local and regional failures for the surgery group. Among those who received surgery, low risk patients who did not meet the Sedlis criteria were further analyzed and patients with 0 risk factors showed excellent results whereas patients with one or two risk factors showed locoregional failures. Severe late toxicity rates were 6.8%, 6.2% and 6.0% for RT group, surgery group and surgery + RT group, respectively. Despite the drawback from retrospective analysis, this study demonstrated that RT improved locoregional control in both definitive and adjuvant settings compared with surgery alone. Further meticulous risk stratification is needed to select the patients who could benefit from adjuvant RT.

Gross tumor volume in sinonasal tract cancer as a predictor of local recurrence after chemoradiotherapy.

This study investigated whether gross tumor volume of the primary tumor before treatment was a predictor for local recurrence in patients with resectable sinonasal tract squamous cell carcinoma who were treated by chemoradiotherapy. A total of 24 patients were enrolled. Pretreatment gross tumor volume of primary tumor was assessed by palpitation, perception and imaging. The cut-off value of the gross tumor volume for local recurrence was determined by receiver-operating curve analysis. A log-rank test and Cox's proportional hazards model were used for univariate and multivariate analyses with adjustment for the clinical T category (cT1-T4a/cT4b), respectively. In the univariate analysis, patients with the gross tumor volume ≥83.7 ml were significantly associated with shorter local recurrence-free rate (P = 0.0023) and disease-free survival (P = 0.0064) than those with gross tumor volume <83.7 ml. In the multivariate analysis, gross tumor volume ≥83.7 ml were significantly associated with shorter local recurrence-free rate (P = 0.041). Pretreatment gross tumor volume of primary tumor ≥83.7 ml was significantly associated with local recurrence-free rate in resectable sinonasal tract squamous cell carcinoma.

Improvement in ejection fraction after cryoballoon pulmonary vein isolation for atrial fibrillation in individuals with systolic dysfunction.

Cryoballoon pulmonary vein isolation (PVI) is commonly used for rhythm control of atrial fibrillation (AF). Data are limited examining the outcomes of cryoballoon PVI in patients with systolic dysfunction. We evaluate the impact of cryoballoon PVI in patients with systolic dysfunction. We evaluated a single-center prospective registry of patients undergoing cryoballoon PVI between 8/2011 and 6/2016. Patients with systolic dysfunction (EF < 55%) between the time of AF diagnosis and their cryoballoon PVI procedure were assessed for AF recurrence at 6months and 1year post-procedure, with a 3-month blanking period. Final analysis included 66 patients with systolic dysfunction undergoing cryoballoon PVI. An AF diagnosis for ≥ 1year prior to PVI was present in 62.1% (n = 41), and 53.0% (n = 35) had systolic dysfunction for ≥ 1year pre-procedure. The proportion of AF-free patients at 1year was 51.5%. Of patients with echocardiograms performed at 1year (n = 43), a greater proportion of individuals without AF recurrence had an improvement in EF of ≥ 10% than in those with AF recurrence (54.2% vs. 25.0%, p = 0.039). Of the patients who had systolic dysfunction at the time of the ablation (EF < 55%), there was a significant increase in EF post-procedure (36.5% pre-procedure vs. 48.3% post-procedure, mean change 11.8%, p < 0.001). In patients with systolic dysfunction, cryoballoon PVI provides an acceptable AF recurrence-free rate at 1year. AF recurrence-free individuals were more likely to have improvement in EF. Further evaluation is needed to determine the potential role of early cryoballoon PVI in patients with a new diagnosis of systolic dysfunction and AF.

Randomized study of intravesical pirarubicin chemotherapy with low and intermediate-risk nonmuscle-invasive bladder cancer in Japan: Comparison of a single immediate postoperative intravesical instillation with short-term adjuvant intravesical instillations after transurethral resection.

Purpose:The objective of this study was to evaluate the efficacy, defined by the 3-year tumor recurrence-free survival rate, of intravesical chemotherapy using pirarubicin (THP) in patients with low or intermediate-risk nonmuscle-invasive bladder cancer (NMIBC).Patients and methods:Between October 2010 and January 2015, 206 patients were enrolled, and finally 113 were randomized to receive either a single immediate postoperative intravesical instillation of THP (30 mg) (Group A), or 8 additional weekly intravesical instillations of THP (30 mg) after a single postoperative instillation (Group B). The patients were examined by performing cystoscopy and urine cytology every 3 months after transurethral resection to determine bladder tumor recurrence. The primary endpoint was 3-year-recurrence-free survival rate.Results:All 113 patients were bacillus Calmette–Guérin (BCG)-naïve. The 3-year recurrence free survival rate was 63.7% for Group A and 85.3% for Group B (log-rank test, P = .0070). In patients with intermediate recurrence risk, the 3-year recurrence-free survival rate was 63.4% in Group A and 86.1% in Group B (log-rank test, P = .0036). Cox regression analysis revealed that only additional instillation of THP was a significant independent factor for recurrence-free rate in patients with intermediate risk. No patient with progression was noted during this period. Frequent adverse effects (AEs) were frequent urination and micturition pain, and no severe AEs (Grade 3 or more) occurred.Conclusion:Additional instillation of THP (30 mg) weekly for 8 weeks reduced the risk of tumor recurrence without severe AEs in BCG-naïve NMIBC patients with intermediate risk.

Unusual Presentation of a Rare Hepatic Tumor

Soft tissue sarcomas are comprised of gastrointestinal stromal tissue (GIST), rhabdomyosarcoma, desmoid, extremity/superficial trunk and retroperitoneal/abdominal tumors such as liposarcomas. As of 2013, thirteen cases of primary hepatic liposarcomas had been presented in the literature. Here we present a unique case of a recurrent hepatic tumor. A 58-year-old female underwent resection for an incidental large (30 x 21 x 8 cm) left lobe abdominal mass, which revealed a hepatic angiomyolipoma. Ten years later she represented after computed tech for a pre-urologic evaluation showing a 12cm left lobe intrahepatic lipoma. She was completely asymptomatic at both times with no evidence of abdominal pain or jaundice on physical exam. Given the size of her liver lesion, it was opted for surgical resection. Surgical pathology from left lobectomy revealed 17 x 17 x 5.5cm tumor Grade 1 focally involved well-differentiated liposarcoma (pT1). This case is interesting as hepatic liposarcomas are rare. Moreover, this patient not only presented with an extremely rare tumor, but it was her second tumor years after a prior resection of an other uncommon liver tumor—angiomyolipoma. Liposarcomas are most commonly treated with surgical resection and sometimes postoperative radiation. Yet, other alternatives such as medical therapy, if unable to undergo resection, are being presented such as Palbociclib. Liposarcomas are S100, caltretinin positive on histology stains, and are well-demarcated cytoplasmic lipid tumors with characteristic scalloping of the nuclear membrane. Fortunately, patients with low-grade disease such as our patient have a 95% metastasis-free survival and a 87% 10 year local recurrence-free rate.

BOXIT—A Randomised Phase III Placebo-controlled Trial Evaluating the Addition of Celecoxib to Standard Treatment of Transitional Cell Carcinoma of the Bladder (CRUK/07/004)

BackgroundNon–muscle-invasive bladder cancer (NMIBC) has a significant risk of recurrence despite adjuvant intravesical therapy. ObjectiveTo determine whether celecoxib, a cyclo-oxygenase 2 inhibitor, reduces the risk of recurrence in NMIBC patients receiving standard treatment. Design, setting, and participantsBOXIT (CRUK/07/004, ISRCTN84681538) is a double-blinded, phase III, randomised controlled trial. Patients aged ≥18 yr with intermediate- or high-risk NMIBC were accrued across 51 UK centres between 1 November 2007 and 23 July 2012. InterventionPatients were randomised (1:1) to celecoxib 200mg twice daily or placebo for 2 yr. Patients with intermediate-risk NMIBC were recommended to receive six weekly mitomycin C instillations; high-risk NMIBC cases received six weekly bacillus Calmette-Guérin and maintenance therapy. Outcome measurements and statistical analysisThe primary endpoint was time to disease recurrence. Analysis was by intention to treat. Results and limitationsA total of 472 patients were randomised (236:236). With median follow-up of 44 mo (interquartile range: 36–57), 3-yr recurrence-free rate (95% confidence interval) was as follows: celecoxib 68% (61–74%) versus placebo 64% (57–70%; hazard ratio [HR] 0.82 [0.60–1.12], p=0.2). There was no difference in high-risk (HR 0.77 [0.52–1.15], p=0.2) or intermediate-risk (HR 0.90 [0.55–1.48], p=0.7) NMIBC. Subgroup analysis suggested that time to recurrence was longer in pT1 NMIBC patients treated with celecoxib compared with those receiving placebo (HR 0.53 [0.30–0.94], interaction test p=0.04). The 3-yr progression rates in high-risk patients were low: 10% (6.5–17%) and 9.7% (6.0–15%) in celecoxib and placebo arms, respectively. Incidence of serious cardiovascular events was higher in celecoxib (5.2%) than in placebo (1.7%) group (difference +3.4% [–0.3% to 7.2%], p=0.07). ConclusionsBOXIT did not show that celecoxib reduces the risk of recurrence in intermediate- or high-risk NMIBC, although celecoxib was associated with delayed time to recurrence in pT1 NMIBC patients. The increased risk of cardiovascular events does not support the use of celecoxib. Patient summaryCelecoxib was not shown to reduce the risk of recurrence in intermediate- or high-risk non–muscle-invasive bladder cancer (NMIBC), although celecoxib was associated with delayed time to recurrence in pT1 NMIBC patients. The increased risk of cardiovascular events does not support the use of celecoxib.

Predictors of Early Recurrence Prior to Planned Postoperative Radiation Therapy for Oral Cavity Squamous Cell Carcinoma and Outcomes Following Salvage Intensified Radiation Therapy

To determine predictors and outcomes for oral squamous cell carcinoma (OSCC) patients who had early recurrence before commencement of postoperative radiation therapy (PORT). Retrospective review was performed for patients with OSCC treated with PORT between 2003 and 2015 after curative-intent surgery. Early recurrence was defined as tumor recurrence after surgical resection and before initiating planned PORT. Patients were classified into the following groups: (1) adjuvant PORT group (no early recurrence), (2) salvage PORT group (locoregional early recurrence), and (3) palliative PORT group (locoregional and distant early recurrence). For the whole cohort, multivariable analysis (MVA) was applied to identify predictors of early recurrence. In the salvage group, the post-PORT recurrence-free rate was estimated, and MVA was used to identify predictors of recurrence-free rate, disease-free survival, and overall survival (OS). Six hundred and one patients were identified, of whom 513 (85%) were treated with adjuvant PORT. Eighty-eight patients (15%) had early recurrence (28 of 88; 32% were biopsy proven) before PORT (70 in the salvage group and 18 in the palliative group). On MVA, oral tongue subsite, microscopic positive resection margin, pT3-4, and pN2-3 were associated with the development of early recurrence (P<.05 for all). The 3-year OS rates for patients with OSCC treated with adjuvant and salvage PORT were 71% (95% confidence interval [CI], 67%-75%) and 41% (95% CI, 30%-56%), respectively (P<.001; median follow-up was 3.4 and 2.9years, respectively). After salvage PORT, the 3-year recurrence-free rate was 36% (95% CI, 23%-47%). On MVA, extranodal extension and volume of early recurrent gross disease were associated with poor recurrence-free rate, disease-free survival, and OS (P<.05 for all). Early recurrences are not uncommon in patients with high-risk features, Further study is required to improve prediction and outcomes of this very high-risk group.

238 A case series of patients underwent laparoscopic extra-peritoneal radical prostatectomy with simultaneous implant of penile prosthesis: focus on penile length preservation

There are many grey zones in the field of penile rehabilitation after radical prostatectomy. One of the most important aspect for improve the patient’s compliance to the treatment is the preservation of the full dimensions of the penis after surgery. We show the first cases series of patients treated by laparoscopic extra-peritoneal radical prostatectomy (RP) and simultaneous penile prostheses implantation (PPI), in order to preserve the full length of the penis and improve patients' satisfaction. From June 2013 to June 2014, 10 patients underwent simultaneous PPI (AMS “inibizone”), how shown in Figure 1 and RP by the same surgeon at the same Centre. Patients were evaluated with urological visits, dedicated questionnaires and instrumentation before surgery, at the hospital discharge and on day 21-28, each 3 months for the first year and each 6 months after. The main outcome measures were oncological (biochemical recurrence free rate), functional (penile length) and QoL.

No Superiority of Stents vs Balloon Dilatation for Dominant Strictures in Patients With Primary Sclerosing Cholangitis

Dominant strictures occur in approximately 50% of patients with primary sclerosing cholangitis (PSC). Short-term stents have been reported to produce longer resolution of dominant strictures than single-balloon dilatation. We performed a prospective study to compare the efficacy and safety of balloon dilatation vs short-term stents in patients with non-end-stage PSC. We performed an open-label trial of patients with PSC undergoing therapeutic endoscopic retrograde cholangiopancreatography (ERCP) at 9 tertiary-care centers in Europe, from July 2011 through April 2016. Patients found to have a dominant stricture during ERCP were randomly assigned to groups that underwent balloon dilatation (n= 31) or stent placement for a maximum of 2 weeks (n= 34); patients were followed for 24 months. The primary outcome was the cumulative recurrence-free patency of the primary dominant strictures. Study recruitment was terminated after a planned interim analysis because of futility and differences in treatment-related serious adverse events (SAEs) between groups. The cumulative recurrence-free rate did not differ significantly between groups (0.34 for the stent group and 0.30 for the balloon dilatation group at 24 months; P = 1.0). Most patients in both groups had reductions in symptoms at 3 months after the procedure. There were 17 treatment-related SAEs: post-ERCP pancreatitis in 9 patients and bacterial cholangitis in 4 patients. SAEs occurred in 15 patients in the stent group (45%) and in only 2 patients in the balloon dilatation group (6.7%) (odds ratio, 11.7; 95% confidence interval, 2.4-57.2; P= .001). In a multicenter randomized trial of patients with PSC and a dominant stricture, short-term stents were not superior to balloon dilatation and were associated with a significantly higher occurrence of treatment-related SAEs. Balloon dilatation should be the initial treatment of choice for dominant strictures in patients with PSC. This may be particularly relevant to patients with an intact papilla. ClinicalTrials.gov no. NCT01398917.

Surgical management of large adrenal tumors: impact of different laparoscopic approaches and resection methods on perioperative and long-term outcomes

BackgroundThe indication of retroperitoneal laparoscopic adrenalectomy (RLA) was extended with the retroperitoneal approach and has been wildly accepted and technologically matured. However, the management of large adrenal tumors via this approach still remains controversial. The aim of this study was to perform a comprehensive analysis on the minimally invasive surgical management of larger adrenal tumors.MethodsA total of 78 patients with large adrenal tumors (> 5 cm) and 97 patients with smaller adrenal tumors (< 5 cm) were enrolled in this study. The patient characteristics were preferentially analyzed. The intra-operative and postoperative indicators were compared between those who underwent RLA and those who underwent transperitoneal laparoscopic adrenalectomy (TLA); the intra-operative and postoperative indicators were also compared between the large tumor group and smaller tumor group of those who underwent RLA. Furthermore, the analyses of partial RLA were focused on the perioperative indicators and follow-up results.ResultsRLA was superior to TLA in terms of operation time (98.71 ± 32.30 min vs. 124.36 ± 34.62 min, respectively, P = 0.001), hospitalization duration (7.43 ± 2.82 days vs. 8.91 ± 3.40 days, respectively, P = 0.04), duration of drain (4.83 ± 0.37 days vs. 3.94 ± 2.21 days, respectively, P = 0.02), first oral intake (2.82 ± 0.71 days vs. 1.90 ± 0.83 days, respectively, P < 0.001) and time to ambulation (3.89 ± 1.64 days vs. 2.61 ± 1.42 days, respectively, P < 0.001). Further analyses of the RLA patients demonstrated that the larger tumor (> 5 cm) group showed superior results for the intraoperative indicators than the smaller tumor (< 5 cm) group (P < 0.05), while the results for the postoperative indicators between the two tumor size groups were similar (P > 0.05). Data confirmed that the partial resection method was superior to the total resection method from the perspective of the hormone supplement (0% vs. 48.15%, P = 0.002). The 2-year recurrence-free rates were 92.60 and 92.86% for the total and partial RLA resection methods, respectively (P = 0.97). The partial RLA resection method had a similar complete remission rate as the total RLA resection method (96.30% vs. 100%, respectively, P = 0.47).ConclusionBoth RLA and TLA seem to provide similar effects for the surgical management of large adrenal tumors. However, partial RLA resection should be considered for the management of benign tumors to reduce the hormone supplement.

Value of European Organisation for Research and Treatment of Cancer score system for predication of immediate postoperative intravesical instillation of pirarubicin after transurethral resection of non-muscle invasive bladder cancer

Objective: To assess value of immediate postoperative intravesical instillation of pirarubicin after transurethral resection (TURBT)of non-muscle invasive bladder cancer. Methods: 484 patients diagnosed with non-muscle-invasive bladder cancer admitted to the Second Affiliated Hospital of Kunming Medical University were divided into two groups after transurethral resection of bladder tumor. 285 patients received postoperative intravesical instillation of pirarubicin within 6 hours after the surgery, 199 patients received first instillation of pirarubicin at 10 days after the surgery, after that, all the patients received routine bladder perfusion chemotherapy. Patients who received intravesical instillation of pirarubicin within 6 hours were defined as immediate intravesical instillation group and the other patients as the control group. Based on the European Organisation for Research and Treatment of Cancer risk tables, scores of recurrence and progression of patients were calculated and then stratified into risk groups accordingly. Recurrence and progression rates of the immediate intravesical instillation group were analyzed and then compared with the corresponding reference of the risk tables. Results: The 1-year and 5-year recurrence rate of patients with EORTC table scoring 0 in the immediate intravesical instillation group were significantly lower than that of the EORTC reference group (5.3% and 14.0% vs 15.0% and 31.0%, P<0.05). 1-year recurrence free rate between the immediate intravesical instillation group and the control group in patients scoring 1-4 was significantly different (81.3% vs 76.7%, P=0.014). However, 1-year recurrence free rate of the immediate intravesical instillation group was comparable with that of the control group in patients scoring 5-9, 10-17(P>0.05), which is quite close to the EORTC reference. The probability rates of 1-year and 5-year progression of the 285 patients who received immediate intravesical instillation group did not show significant difference with the EORTC reference. On multivariate analysis, previous recurrence, tumor grade G2-3, tumor multiplicity, delay of immediate intravesical instillation were independent risk factors of recurrence(P<0.05). Conclusions: With the help of EORTC recurrence risk table stratifying the patients into different risk groups, our study showed that delay of immediate postoperative intravesical instillation of chemotherapy after TURBT was an independent risk factor of post-surgery recurrence of tumor. Moreover, patients with EORTC scoring 1-4 might obtain greatest benefits.

Comparative analysis of clinical efficacy between stereotactic ablative radiotherapy and surgery for early-stage non-small cell lung cancer

Objective To compare the clinical efficacy and safety between stereotactic ablative radiotherapy (SABR) and surgery in the treatment of early-stage non-small cell lung cancer (NSCLC). Methods A total of 227 patients who were initially diagnosed with early-stage NSCLC and with complete clinical data admitted to Henan Cancer Hospital between June 2012 and December 2016 were recruited and assigned into the SABR (n=73) and surgery groups (n=154). Kaplan-Meier method was used to calculate survival rate and survival comparison was performed using the log-rank test. Chi-square test was adopted to compare the baseline data between two groups. Results All patients completed corresponding treatment. The samples of SABR group and operation group were 74 and 155 cases respectively. The 1-year and 3-year overall survival (OS) rates in the SABR and surgery groups were 97.2%, 81.9% and 96.5%, 78.2%(P=0.603), respectively. The 1-year and 3-year progression-free survival (PFS) rates in the SABR and surgery groups were 90.1%, 66.9% and 89.2%, 66.9%(P=0.565), respectively. The 1-year and 3-year locoregional recurrence-free survival rates in the SABR and surgery groups were 92.8%, 84.0% and 96.5%, 90.8%(P=0.133), respectively. The 1-year and 3-year distant metastasis-free survival rates in the SABR and surgery groups were 97.2%, 75.4% and 89.2%, 69.8%(P=0.095), respectively. Conclusions SABR and surgery yield similar OS, PFS, locoregional recurrence-free and distant metastasis-free survival rates in the treatment of early-stage NSCLC. Therefore, SABR is an alternative treatment for patients with early-stage NSCLC. Key words: Carcinoma, non-small cell lung/radiotherapy; Radiotherapy, stereotactic ablative; Prognosis

Low heart deceleration capacity imply higher atrial fibrillation-free rate after ablation

How deceleration capacity (DC) and acceleration capacity (AC) of heart rate associated with atrial fibrillation (AF) and ablation is still not clear. The dynamic changes of AC, DC and conventional heart rate variability (HRV) parameters were characterized in 154 subjects before circumferential pulmonary veins isolation (CPVI) and three days, 3 months and 6 months after CPVI. The DCs of the recurrent group decreased significantly at each time point after CPVI; the DCs of the recurrence-free group before CPVI and three days, 3 months and 6 months after CPVI were 7.06 ± 1.77, 3.79 ± 1.18, 4.22 ± 1.96 and 3.97 ± 0.98 ms respectively, which also decreased significantly at each time point and were significantly lower than these of recurrent group. Conversely, the AC of recurrent and recurrence-free groups increased significantly at each time point after CPVI; the ACs of recurrence-fee group were significantly higher than these of recurrent group at each time point. No stable difference trend of HRV parameters was found between two groups. Further Kaplan–Meier analysis showed that DC < 4.8 ms or AC ≥ −5.1 ms displayed significant higher recurrence-free rates. In conclusion, high AC and low DC imply higher AF-free rate after ablation.

Spread Through Air Spaces Is a Prognostic Factor in Sublobar Resection of Non-Small Cell Lung Cancer

Spread through air spaces (STAS) identified in lung cancer is considered to be a risk factor for recurrence after surgery. The purpose of this study is to clarify the prognostic impact of STAS in sublobar resections. We studied 514 patients with clinical stage IA cancers: 329 underwent lobectomies and 185 underwent sublobar resections. We assessed the prognostic impact of STAS in the cases with a sublobar resection for stage IA lung cancer versus the cases with a lobectomy. STAS was found in 73 of 329 (22.2%) lobectomy cases and 31 of 185 (16.8%) sublobar resection cases. For overall survival, univariate analysis revealed that STAS was not a prognostic factor in the lobectomy group, but it was a significantly worse prognostic factor for the sublobar resection group in both univariate and multivariate analyses. For the recurrence-free rate, multivariate analysis showed STAS was not a risk factor in the lobectomy group, but it was a significant risk factor for the sublobar resection group in both univariate and multivariate analyses. Patients with STAS and sublobar resection had a significantly higher rate of pulmonary metastases than did patients with STAS and lobectomy (8 of 31 [25.8%] vs 6 of 73 [8.2%]). STAS is a prognostic factor of poor outcomes for sublobar resection in patients with lung cancer. The worse prognosis for sublobar resection would be associated with STAS.

MP53-13 IS THE CANCER OF THE PROSTATE RISK ASSESSMENT SCORE A VALID TOOL TO PREDICT BIOCHEMICAL RECURRENCE, METASTASIS AND DEATH AFTER RADICAL PROSTATECTOMY IN LATIN AMERICAN PATIENTS?

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2018MP53-13 IS THE CANCER OF THE PROSTATE RISK ASSESSMENT SCORE A VALID TOOL TO PREDICT BIOCHEMICAL RECURRENCE, METASTASIS AND DEATH AFTER RADICAL PROSTATECTOMY IN LATIN AMERICAN PATIENTS? Rubén Bengió, leandro Arribillaga, Hernán García Onto, Javier Epelde, Esteban Cordero, Verónica Bengió, and Ruben. H Bengió Rubén BengióRubén Bengió More articles by this author , leandro Arribillagaleandro Arribillaga More articles by this author , Hernán García OntoHernán García Onto More articles by this author , Javier EpeldeJavier Epelde More articles by this author , Esteban CorderoEsteban Cordero More articles by this author , Verónica BengióVerónica Bengió More articles by this author , and Ruben. H BengióRuben. H Bengió More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1684AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical prostatectomy is an effective modality of treatment of localized prostate cancer at all levels of risk. However, the recurrence of the disease has been described in more than 40% of the patients after radical prostatectomy. Therefore, to determine the risk of disease and thus trying to Stratify it is essential in these tumors. Thus, various tools for predicting postoperative evolution have been developed and subsequently validated in several studies. In 2011, the University of California, San Francisco proposed the Cancer of the Prostate Risk Assessment Score (CAPRA-S), which uses clinical and pathological information in order to predict progression of an easy and reasonable way. The aim of the present study is to perform external validation to determine whether the Cancer of the Prostate Risk Assessment score (CAPRA-S) predicts biochemical recurrence, metastasis and death for prostate cancer after radical prostatectomy in Latin American population. METHODS 216 patients were studied. Probability of score to predict biochemical recurrence after radical prostatectomy was analyzed by Cox proportional method. Biochemical recurrence, metastasis and cancer specific free survival was determinate by Kaplan method. Exactitude of CAPRA-S score to predict biochemical recurrence, metastasis and death by prostate cancer was made in accordance with Harrells concordance index. RESULTS median follow up was 74 months. Biochemical recurrence index increase proportionally with the increment of CAPRA-S score. In the stratification of patients in low, intermediate or high risk, biochemical recurrence free rate were 85%, 54% and 4% respectively. Concordance index (C-Index) to biochemical progression, metastasis and death by prostate cance were 0.85, 0.90 and 0.90 respectively. CONCLUSIONS CAPRA-S score is an easily applicable tool and had high predictive exactitude to determinate biochemical recurrence, metastasis and death by prostate cancer in our population. Concordance Index in these variables was higher than 0.85. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e708-e709 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Rubén Bengió More articles by this author leandro Arribillaga More articles by this author Hernán García Onto More articles by this author Javier Epelde More articles by this author Esteban Cordero More articles by this author Verónica Bengió More articles by this author Ruben. H Bengió More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD29-11 IMPACT OF BILATERAL NEUROVASCULAR BUNDLE PRESERVATION ON ONCOLOGICAL OUTCOMES IN NON-ORGAN CONFINED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV1 Apr 2018PD29-11 IMPACT OF BILATERAL NEUROVASCULAR BUNDLE PRESERVATION ON ONCOLOGICAL OUTCOMES IN NON-ORGAN CONFINED PROSTATE CANCER Felix Preisser, Gorgio Gandaglia, Pierre Karakiewicz, Marco Bandini, Raisa Pompe, Francesco Montorsi, Markus Graefen, Hartwig Huland, Alberto Briganti, and Derya Tilki Felix PreisserFelix Preisser More articles by this author , Gorgio GandagliaGorgio Gandaglia More articles by this author , Pierre KarakiewiczPierre Karakiewicz More articles by this author , Marco BandiniMarco Bandini More articles by this author , Raisa PompeRaisa Pompe More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Hartwig HulandHartwig Huland More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , and Derya TilkiDerya Tilki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1386AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preservation of the neurovascular bundles (NVB) at radical prostatectomy (RP) improves the functional outcome in patients with prostate cancer. The aim of this study was to test, if preservation of the NVBs is oncologically safe in patients with non-organ confined diseases. METHODS We relied on a two-institutional high-volume center database to identify patients who harbored pathologic T3 stage PCa at RP with bilateral or no NVB preservation, without lymph node invasion (N0) between 2000 and 2015. Only patients with a primary Gleason of 4 or 5 in the RP specimen were included. Univariable and multivariable Cox regression models and Kaplan-Meier analyses were used to test the effect of NVB preservation on biochemical recurrence (BCR) and clinical recurrence. RESULTS Overall, 1,663 patients were identified. Of those, 50.4 (838) vs. 49.6% (825) underwent bilateral or no NVB preservation, respectively. Patients with bilateral NVB preservation were significantly younger (median age: 65.3 vs. 67.7 years), had lower median PSA (8.7 vs. 9.8ng/ml) and less frequently a biopsy Gleason score ≥8 (25.2 vs. 46.3%). Moreover, these patients harbored better pathological tumor characteristic compared to patients without NVB preservation: more frequently they had pathologic Gleason score of 4+3/7 (77.6 vs. 54.3%), a lower rate of positive margins (34.0 vs. 45.7%) and less frequently pathologic T3b stage (35.7 vs. 49.0%). BCR-free rates were 50.6 and 47.1% at 72 months after RP and clinical recurrence-free rates were 81.1 vs. 76.5% at 96 months after RP for bilateral and no NVB preservation, respectively. After adjustment for pathologic characteristics multivariable Cox regression models revealed that preservation of the NVB was no independent risk factor for BCR (p=0.4) and clinical recurrence (p=0.9) CONCLUSIONS Preservation of the NVBs was not associated with worse oncological outcome in patients with adverse pathology and can be offered to selected patients who are at risk of harboring non-organ confined prostate cancer. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e572 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Felix Preisser More articles by this author Gorgio Gandaglia More articles by this author Pierre Karakiewicz More articles by this author Marco Bandini More articles by this author Raisa Pompe More articles by this author Francesco Montorsi More articles by this author Markus Graefen More articles by this author Hartwig Huland More articles by this author Alberto Briganti More articles by this author Derya Tilki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluación del riesgo clínico, no genómico y resultados de supervivencia en el carcinoma de mama hormonosensible, HER-2 negativo, con ganglios negativos

Background and objectivesIn endocrine-sensitive, HER-2 negative, node negative breast cancer, the presence of a low genomic risk allows treatment with adjuvant endocrine therapy alone, obtaining excellent survival rates. The justification for this study is to show that excellent survival rates are also obtained by treating with adjuvant hormone therapy alone, based on clinical risk assessment. Patients and methodsA descriptive, observational and retrospective study was performed between 2006 and 2016 with endocrine-sensitive, HER-2 negative, node negative breast cancer, greater than 1cm or between 0.6 and 1cm with unfavourable features. Retrospective review of health records. Mortality data of the National Registry of Deaths. ResultsA total of 203 patients were evaluable for survival. One hundred and twenty-three (60.50%) were treated with adjuvant endocrine therapy alone, 77 (37.90%) with chemotherapy and endocrine therapy, one (0.50%) with chemotherapy alone and 2 (1%) were not treated. The overall survival rate at 5 years was 97% (95% confidence interval [CI] 94-100). Distant recurrence-free interval was 94% (95% CI 90-98). In the subgroup of patients treated with endocrine therapy alone, overall survival and distant recurrence-free interval rates at 5 years were 98% (95% CI 95-100) and 97% (95% CI 93-100), respectively. ConclusionsPatients with endocrine-sensitive, HER-2-negative, node negative breast cancer treated with endocrine therapy alone according to their clinical risk have similar survival outcomes as those treated with endocrine therapy according to their genomic risk.

Clinical outcomes of patients with histologic variants of urothelial carcinoma treated with tetra-modality bladder-sparing protocol incorporating consolidative partial cystectomy.

490 Background: Trimodality bladder-sparing therapy has become an accepted treatment for selected patients with muscle-invasive bladder cancer (MIBC). As some of the histologic variants of urothelial carcinoma (VUC) are more resistant to chemotherapy and radiotherapy compared with pure urothelial carcinoma (PUC), it is still controversial whether bladder-sparing therapy provides comparable disease control in VUC. We have developed a tetra-modality bladder-sparing therapy consisting of maximal transurethral resection (TUR), chemoradiotherapy (CRT), and consolidative partial cystectomy, which has theoretical advantage in locoregional control by surgically eliminating chemo- and radio-resistant cells (Koga et al, Urol Oncol 2013, BJU Int 2012). Methods: After maximal TUR and CRT (40Gy + cisplatin), treatment response was evaluated by cytology, imaging and tumor-site rebiopsy. Complete responders were candidate for consolidative partial cystectomy, while radical cystectomy was recommended for others. VUC identified in maximal TUR samples were categorized according to the 2004 World Health Organization Classification. Response rate to CRT, MIBC recurrence-free survival and cancer-specific survival (CSS) were compared between patients with PUC and VUC. Results: Between 1997 and 2016, 153 consecutive patients with cT2-3N0M0 bladder cancer (median age 69, female/male = 33/120, cT2/3 = 99/54) entered tetra-modality bladder-sparing protocol. VUC was identified in 37 (24%) of the patients, including glandular in 12 (8%), squamous in 11 (7%), micropapillary in 8 (5%), sarcomatoid in 2 (1%), microcystic in 2 (1%), and lymphoepithelioma-like in 1 (0.7%). There was no difference in the response rate to CRT between PUC and VUC (71% vs 84%, p = 0.13). Among the patients with PUC (n = 75) and VUC (n = 31) who underwent partial cystectomy, 5-yr MIBC recurrence-free rates were 92% and 100% (p = 0.21), and 5-yr CSS rates were 93% and 94% (p = 0.64), respectively. Conclusions: Tetra-modality bladder-sparing therapy incorporating partial cystectomy could provide favorable locoregional control and survival for patients with VUC.

Clinical Benefits of Transurethral Resection Under Narrow Band Imaging for Non-Muscle Invasive Bladder Cancer

The aim of this study was to reveal the clinical benefits of transurethral resection (TUR) under narrow band imaging (NBI-TUR) for non-muscle-invasive bladder cancer (NMIBC) compared with conventional white light imaging TUR (WLI-TUR). The subjects were 172 patients with NMIBC who were followed for more than 1 year after undergoing TUR with no additional postoperative treatment. In the WLI-TUR group (n=101), lesions that were detected as positive after systematic intravesical observation under WLI were resected completely under WLI. In the NBI-TUR group (n=71), similar observations under WLI were followed by systematic intravesical observation under NBI. After multiple site biopsy under NBI, TUR was performed for all lesions that were detected as positive under NBI. The sensitivity was calculated based on the results of cystoscopy and pathology of multiple site biopsy samples under WLI and NBI in the NBITUR group. The tumor recurrence rate was analyzed in both groups. Background factors did not differ significantly between the two groups, except for the observation period (63.3 months in the WLI-TUR group vs 42.0 months in the NBI-TUR group, p<0.01). The procedure under NBI had significantly higher sensitivity (94.6% vs 75.0%, p<0.01) compared with that under WLI. The recurrence-free rate in the NBITUR group was significantly higher than that in the WLI-TUR group (p=0.013). The tumor recurrencefree rate of NBI-TUR is higher than that of conventional WLI-TUR for patients with NMIBC.

Clinical outcomes of patients who undergo additional excision after unplanned excision surgery for soft tissue sarcoma

Surgeons who operate on benign soft tissue masses that are presumed to be benign often encounter malignancies that require wider excision, a procedure referred to as an ‘unplanned excision’. These patients then undergo additional excision after being diagnosed with malignancies. We aimed to investigate the outcomes of patients with soft tissue sarcomas who underwent unplanned excisions of their tumors followed by additional excisions at our institution. We examined 6 patients with soft tissue sarcomas, 3 men and 3 women, who underwent additional excisions after an unplanned excision between 2004 and 2015 at our hospital. Their mean age was 59.5 y, their mean primary tumor size was 9.0 cm, and 3 each had superficial and deep tumors, respectively. No residual tumor cells were observed in patient specimens following additional excision. None of the patients required plastic reconstructions. The 5-y survival rate was 100%, while the 5-y local recurrence-free rate was 83% after 1 patient experienced local recurrence and underwent a second additional resection. Our data suggest that patients who undergo unplanned excisions should also undergo additional excisions to avoid tumor recurrence.