Recurrence-free Survival In Patients Research Articles

RADIATION THERAPY OF CERVICAL CANCER PATIENTS: VIEW OF RADIOBIOLOGISTS

Summary. Despite the positive results achieved in recent years in the treatment of cervical cancer (CC), the overall and recurrence-free survival of patients with this pathology leaves much to be desired. This is connected with a number of problems. The main ones are late diagnosis, which leads to the neglect of the tumor process, insufficient effectiveness of conservative treatment methods, which depends on relatively low sensitivity to the drugs used, and low specificity of the radiation therapy (RT) used. Based on the analysis of data from the literature and our own research, the way to determine among the main radiobiological indicators, which take into account the mechanisms and stages of the formation of radiation lesions, predictors of complications due to RT in CC patients. This will make it possible to single out a group at increased risk of developing negative effects of RT, to develop effective means of pathogenetic therapy for tissue damage from around the tumor, and thus to reduce the frequency, nature and degree of severity of remote side complications of RT in this category of patients, which will contribute to improving the quality of life of patients.

Long-term prognosis in patients with thymoma combined with myasthenia gravis: a propensity score-matching analysis.

We aimed to assess the impact of myasthenia gravis (MG) on the long-term prognosis in patients with thymoma after surgery and identify related prognostic factors or predictors. This retrospective observational study included 509 patients with thymoma (thymoma combined with MG [MG group] and thymoma alone [non-MG group]). Propensity score matching was performed to obtain comparable subsets of 96 patients in each group. A comparative analysis was conducted on various parameters. Before matching, the 10-year survival and recurrence-free survival rates in both groups were 93.8 and 98.4%, and 85.9 and 93.4%, respectively, with no statistically significant difference observed in the survival curves between the groups (p > 0.05). After propensity score matching, 96 matched pairs of patients from both groups were created. The 10-year survival and recurrence-free survival rates in these matched pairs were 96.9 and 97.7%, and 86.9 and 91.1%, respectively, with no statistical significance in the survival curves between the groups (p > 0.05). Univariate analysis of patients with thymoma postoperatively revealed that the World Health Organization histopathological classification, Masaoka-Koga stage, Tumor Node Metastasis stage, resection status, and postoperative adjuvant therapy were potentially associated with tumor recurrence after thymoma surgery. Multivariate analysis demonstrated that the Masaoka-Koga stage and postoperative adjuvant therapy independently predicted the risk of recurrence in patients with thymoma after surgery. There was no difference in prognosis in patients with thymoma with or without MG. The Masaoka-Koga stage has emerged as an independent prognostic factor affecting recurrence-free survival in patients with thymoma, while postoperative adjuvant therapy represents a poor prognostic factor.

Evaluating Recurrence Risk in Patients Undergoing Breast-conserving Surgery Using E-cadherin Staining as a Biomarker.

Following the National Comprehensive Cancer Network guidelines, radiotherapy is administered after breast-conserving surgery (BCS) in patients with more than four positive lymph nodes. Four positive lymph nodes are typically considered an indicator to assess disease spread and patient prognosis. However, the subjective counting of positive axillary lymph nodes underscores the need for biomarkers to improve diagnostic precision and reduce the risk of unnecessary treatments. Loss of E-cadherin expression is associated with cancer metastasis, but its potential as a predictive marker for cancer treatment remains uncertain. This study aimed to investigate the validity of E-cadherin as a reference for adjuvant radiotherapy in breast cancer patients with positive lymph nodes post-mastectomy. Immunohistochemistry was performed on 60 clinical tissue specimens to assess these implications. Although no significant result was found in a single E-cadherin subgroup (low, medium, and high subgroups according to the X-tile algorithm), the proposed multivariate model, including the E-cadherin category, breast cancer subtype, and tumor size, yielded satisfactory recurrence risk estimation results for patients undergoing BCS. Patients with a low E-cadherin category, triple-negative breast cancers, and tumor size over 5 cm could have an increased risk of recurrence. Our study proposed a multivariate model that serves as a candidate prognostic factor for recurrence-free survival in patients undergoing BCS and radiotherapy. Utilizing this model for patient stratification in high-risk diseases and as a standard for assessing postoperative intensified therapy can potentially improve patient outcomes.

Risk factors that impact long-term outcomes in sigmoid colon cancer with urinary bladder involvement.

This study aimed to identify the risk factors impacting long-term outcomes in patients diagnosed with sigmoid colon cancer with urinary bladder involvement. A comprehensive analysis was conducted on a retrospective cohort of 118 patients who underwent multivisceral resection for sigmoid colon cancer with urinary bladder involvement between June 2002 and May 2017. Univariate and multivariate analyses were employed to identify risk factors associated with long-term outcomes. Among the included patients, 10 (8.5%) experienced grade III-IV complications according to Clavien-Dindo classification, with 4 (3.4%) presenting anastomotic leaks. The postoperative mortality was 0.8%. R0 resection was achieved in 108 (91.6%) patients. Adjuvant chemotherapy was administrated to only 31 patient (26.3%). Local recurrence was observed in 8 (6.8%) cases. Risk factors for local recurrence-free survival and disease-free survival were CCI>3, grade III-IV postoperative complications according to Clavien-Dindo classification, positive resection margins, stage III of the disease, additional resected organs (excluding colon and bladder) and the absence of adjuvant chemotherapy. The same risk factors, with the exception of CCI, were associated with overall survival. This study highlights that negative resection margins, a postoperative period without grade III-IV complications, and the implementation of adjuvant chemotherapy are crucial factors contributing to improve overall, disease-free and local recurrence-free survival in patients with sigmoid colon cancer with urinary bladder involvement.

FEATURES OF COL1A1 EXPRESSION IN BREAST CANCER TISSUE OF YOUNG PATIENTS.

In the last decades, the incidence of breast cancer (BCa) in young women has been increasing steadily. The quantitative indicators of expression of collagen, which play important role in stromal microenvironment, and their association with the age and survival rates of BCa patients have not been yet definitively clarified. To investigate the relationship between the COL1A1 gene expression at the mRNA and protein levels in BCa tissue and the clinicopatological features and survival rates of BCa patients of different age groups. The study was conducted on the clinical material of 50 patients with stage I-III BCa. COL1A1 gene expression at the mRNA and protein levels in BCa tissue were studied using the real-time PCR and immunohistochemical methods, as well as the bioinformatic analysis (UALCAN and Kaplan - Meier Plotter databases). The bioinformatic analysis showed that BCa tissue is characterized by 6.0 times (p < 0.05) higher level of COL1A1 mRNA compared to normal breast tissue. The correlation of COL1A1 expression at the mRNA and protein levels with the molecular subtype of neoplasms was demonstrated. According to Kaplan - Meier Plotter database, a low level of expression of COL1A1 protein level in BCa tissue is associated with lower rates of relapse-free survival of patients. The ex vivo study of the clinical material revealed a decrease in COL1A1 protein expression in tumor tissue of young patients with BCa of T3 category (p < 0.0374), low differentiation grade (p < 0.0163) and basal molecular subtype (p < 0.0001). A correlation between the expression of COL1A1 at the mRNA and protein levels and the expression status of estrogen receptors (p < 0.0001) and progesterone receptors (p < 0.0040) was established. The relapse-free 3-year survival rate of young BCa patients is significantly lower in the presence of a low COL1A1 optical density index in the tumor tissue. The identified relationship between COL1A1 expression and such indicators of BCa malignancy as tumor size, differentiation grade, molecular subtype, receptor status, and the recurrencefree survival of patients indicates the prospects of its use to predict the aggressiveness of the BCa course in young patients.

High-Intensity Focused Ultrasound Ablation of Prostate Cancer: 15 Years of Follow-up

Introduction. Prostate cancer (PC) is considered to be one of the most common malignancies in men. In recent years, conventional PC treatments have been supplemented with highly effective minimally invasive therapies such as highintensity focused ultrasound ablation (HIFU). Only a few studies have been published on the long-term oncological effectiveness of HIFU therapy for prostate cancer. Aim. To evaluate the oncological efficacy of HIFU in the treatment of prostate cancer in a long-term follow-up. Materials and methods. The retrospective analysis included the treatment outcomes of 171 patients with prostate cancer who underwent HIFU therapy at the Samara Clinical Oncology Dispensary in 2007–2009. The mean age of the patients was 69.7 years. Of these, 48 had a low risk of progression according to D’Amico, 57 patients — intermediate risk and 66 — high risk of progression. The follow-up period comprised 13–15 years (median 14.3 years). Positive histological findings, elevated PSA and/or the appearance of local or distant metastases were interpreted as recurrence. The Kaplan-Meier method was used to graphically represent survival curves. A multiparameter Cox proportional hazards regression analysis was performed to assess the prognostic significance of various clinical data in overall, cancer-specific and recurrence-free survival. All values of p&lt;0.05 were considered statistically significant. Results and discussion. The overall fifteen-year survival for patients in the low-risk, intermediate-risk, and high-risk groups accounted for 52.1, 56.1, and 37.9%, respectively. Fifteen-year PC-specific survival was determined in 90.1% of patients. Fifteen-year recurrence-free survival for patients in the low-risk, intermediate-risk, and high-risk groups comprised 95.4, 80.7 and 69.7%, respectively. A significant risk factor for recurrence was the distribution according to the D’Amico progression risk scale. Conclusion. HIFU therapy demonstrated good long-term oncologic results in the treatment of patients with prostate cancer.

A meta-analysis of total thyroidectomy and lobectomy outcomes in papillary thyroid microcarcinoma.

Current research on the most effective surgical method for papillary thyroid microcarcinoma is in dispute. Specifically, whether a total thyroidectomy (TT) is superior to a thyroid lobectomy (LT) in terms of recurrence rate, postoperative complications, and recurrence-free survival is an issue to be addressed. The objective of this study was to compare TT with LT in terms of recurrence, postoperative complications, and recurrence-free survival. In accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses standards, the PubMed, Embase, web of science and the Cochrane Library database were searched for relevant studies comparing TT versus LT. By pooling the relative risks (RR) of the 2 surgical procedures, perioperative results of the 2 group can be estimated. Recurrence-free survival was calculated from hazard ratios between the 2 surgical group. This meta-analysis included 8 studies involving 16,208 patients. In the TT group, there were fewer recurrences than in the LT group. (RR = 0.68; 95% confidence interval [CI], 0.39 to 1.18; P = .001). In subgroup analyses based on country and sample size, there were no significant differences between the 2 groups for the recurrence rates. We found that patients that underwent LT had lower total complication rates (RR = 15.12; 95% CI, 8.89 to 25.73; P = .009), wound recurrent laryngeal nerve injury and hypocalcemia. In terms of survival, TT can provide better recurrence-free survival than LT, with a hazard ratios of 0.57 (95% CI 0.36 to 0.90; P = .003). Comparing TT with LT, no statistical difference was found in recurrence rates between the 2 groups. In addition, the analysis showed a slight improvement in long-term recurrence-free survival for patients who underwent TT than for those who underwent LT, a finding with potential clinical implications for management decisions on papillary thyroid microcarcinoma treatment.

Long term outcomes beyond 5 years after pulmonary resection for non-small-cell lung cancer.

We investigated the incidence of late recurrence beyond 5years after pulmonary resection and aimed to identify candidates for long-term surveillance. We retrospectively reviewed the medical records of 978 non-small-cell lung cancer patients who underwent pulmonary resection between 2002 and 2015 and survived without recurrence for 5years. Clinicopathological factors associated with recurrence-free survival beyond 5years after surgery were investigated using univariate and multivariate analyses. The development of late metachronous malignancies was also investigated. The median follow-up period from 5years post-surgery was 27months in the whole cohort. Late recurrence occurred in 37 (3.8%) patients. Late metachronous malignancies were diagnosed in 116 patients (11.9%), including 57 (5.8%) with lung cancer. One-, three-, and five-year recurrence-free survival rates beyond 5years after surgery were 97.6%, 94.7%, and 94.7%, respectively. The recurrence-free survival of patients with pN1-2 was significantly poorer than that of patients with pN0 disease. Multivariate analysis revealed that adenocarcinoma and pN1-2 status were significantly associated with poor recurrence-free survival beyond 5years post-surgery (P = 0.009 and 0.007, respectively). Non-adenocarcinoma histology and pN0 status were significant favorable factors for recurrence-free survival beyond 5years post-surgery. The efficacies of long-term surveillance for the detection of late recurrence were considered limited for these populations. Twelve percent of the patients experienced late metachronous malignancies after pulmonary resection.

Recurrence-Free Survival in Patients With Surgically Resected Non-Small Cell Lung Cancer: A Systematic Literature Review and Meta-Analysis

BackgroundStandard treatment for early-stage or locoregionally-advanced non-small cell lung cancer (NSCLC) includes surgical resection. Recurrence after surgery is commonly reported, but a summary estimate for post-surgical recurrence-free survival (RFS) in NSCLC patients is lacking. Research QuestionWhat is the RFS following surgery in stage I-III NSCLC patients at different timepoints and what factors are associated with RFS? Study Design and MethodsA systematic search was performed in MEDLINE, EMBASE and Cochrane databases between January 2011-June 2021. The primary outcome was RFS at 1-, 2-, 3-, and 5-years post-resection. Single-arm, random-effects meta-analyses calculated effect estimates and 95% confidence intervals (CI). Analyses were stratified by stage/sub-stage per the American Joint Committee on Cancer Staging Manual, and RFS was estimated 1) after pooling studies using 7th or 8th edition staging criteria and 2) among studies using only 8th edition. Meta-regressions were performed to assess associations between RFS and patient demographic/clinical characteristics of interest. ResultsData from 471 studies comprising 1,060 surgical study arms were extracted. RFS estimates from 60,695 patients staged with 7th or 8th edition were analyzed. RFS ranged from 96% at 1-year post-resection to 82% at 5 years for stage I, and from 68% at 1-year to 34% at 5 years for stage III. Estimates for patients staged using only 8th edition criteria were slightly higher. Older age, higher percentage of males, advancing stage, larger tumor size, and geographical region (North America/Europe vs. Asia) were significantly associated with worse RFS. InterpretationThis study presents a comprehensive assessment of reported RFS from published clinical literature, offering estimates at multiple post-surgical time points and by geographical region. Findings can inform treatment decisions, clinical trial design, and future research to improve outcomes among NSCLC patients. RegistrationProtocol was not registered, but study was conducted based on a pre-specified protocol.

Clinicopathological and computed tomography features associated with recurrence-free survival of patients with small-sized peripheral invasive lung adenocarcinoma after sublobectomy.

Sublobar resection is gradually becoming a standard treatment for small-sized (≤2 cm) peripheral non-small cell lung cancer (NSCLC), with lung adenocarcinoma (LADC) being the most frequent histologic subtype. However, the prognostic predictors for preoperatively determining whether sublobectomy is feasible for patients with early LADC have not yet been well identified. Therefore, this study aimed to investigate the clinicopathological and computed tomography (CT) features associated with the recurrence-free survival (RFS) of patients with small-sized invasive LADC (SILADC) after sublobar resection. This retrospective cohort study analyzed 107 patients with SILADC who underwent preoperative chest CT scan and sublobar resection from December 2012 to March 2019. The Kaplan-Meier survival was used to analyze the relationship between clinicopathological characteristics, preoperative chest CT findings, and RFS. The Cox proportional hazards regression was used to identify independent prognostic factors of poor RFS. For clinicopathological characteristics, RFS was shorter in patients aged ≥70 years, smokers, and those with micropapillary/solid-predominant adenocarcinomas (all P values <0.05). For preoperative CT features, RFS was shorter in patients with tumor size ≥1.4 cm, solid component size ≥1.1 cm, proportion of solid component ≥72%, solid density, spiculation, vascular convergence sign, peripheral fibrosis, and type II pleural tag (all P values <0.05). Multivariate analysis showed proportion of solid component ≥72% [hazard ratio (HR): 5.920; P=0.006; 95% confidence interval (CI): 1.686-20.794], spiculation (HR: 5.026; P=0.001; 95% CI: 2.008-12.581), and type II pleural tag (HR: 4.638; P=0.002; 95% CI: 1.773-12.136) were independent risk factors for poor prognosis in patients with SILADC after sub-lobectomy. Clinicopathological and CT characteristics are helpful for predicting the RFS of patients with SILADC after sublobar resection and can be used as an auxiliary tool for thoracic surgeons to choose the best surgical mode.

Development and validation of a nomogram for predicting recurrence-free survival in endometrial cancer: a multicenter study

Recurrence is the main cause of death in patients with endometrial cancer (EC). This study aimed to construct and validate a nomogram to predict the recurrence-free survival of patients with EC. This was a multicenter retrospective study. A total of 812 patients from Wuhan Tongji Hospital were divided into training and validation cohorts, and 347 and 580 patients from People’s Hospital of Peking University and Qilu Hospital of Shandong, respectively, were used for validation. Univariate and multivariate Cox regression analyses were used to construct a nomogram for predicting recurrence-free survival of EC. Calibration curves, receiver operating characteristic (ROC) curves, and consistency indexes (C-indexes) were used to estimate the performance of the model. Decision curve analysis (DCA) curves were used to assess the clinical utility of the model. Age (P = 0.013), cancer antigen 125 level (P = 0.014), lymphovascular space invasion (P = 0.004), International Federation of Gynecology and Obstetrics stage (P = 0.034), and P53 (P < 0.001) were independently associated with recurrence, and we constructed a nomogram based on these variables. The C-indexes of the validation cohorts were 0.880, 0.835, and 0.875, respectively. The calibration, ROC, and DCA curves revealed that this model had excellent performance and clinical utility. Combining clinical data, clinicopathological factors, serological indicators, and immunohistochemical marks, a multicenter externally verified nomogram with robust performance was constructed to predict the recurrence of patients with EC.

High density of CXCL12-positive immune cell infiltration predicts chemosensitivity and recurrence-free survival in ovarian carcinoma

BackgroundOvarian carcinoma is the most lethal gynecologic malignancy because of its late diagnosis, extremely high recurrence rate, and limited curative treatment options. In clinical practice, high-grade serous carcinoma (HGSC) predominates due to its frequency, high aggressiveness, and rapid development of drug resistance. Recent evidence suggests that CXCL12 is an important immunological factor in ovarian cancer progression. Therefore, we investigated the predictive and prognostic significance of the expression of this chemokine in tumor and immune cells in patients with HGSC.MethodsWe studied a cohort of 47 primary high-grade serous ovarian carcinomas and their associated recurrences. A tissue microarray was constructed to evaluate the CXCL12 immunostained tumor tissue. CXCL12 expression was evaluated and statistically analyzed to correlate clinicopathologic data, overall survival, and recurrence-free survival.ResultsA high proportion of CXCL12 + positive immune cells in primary ovarian serous carcinoma correlated significantly with chemosensitivity (p = 0.005), overall survival (p = 0.021), and longer recurrence-free survival (p = 0.038). In recurrent disease, high expression of CXCL12 was also correlated with better overall survival (p = 0.040). Univariate and multivariate analysis revealed that high CXCL12 + tumor-infiltrating immune cells (TICs) (HR 0.99, p = 0.042, HR 0.99, p = 0.023, respectively) and combined CXCL12 + /CD66b + infiltration (HR 0.15, p = 0.001, HR 0.13, p = 0.001, respectively) are independent favorable predictive markers for recurrence-free survival.ConclusionA high density of CXCL12 + TICs predicts a good response to chemotherapy, leading to a better overall survival and a longer recurrence-free interval. Moreover, with concomitant high CXCL12/CD66b TIC density, it is an independent favorable predictor of recurrence-free survival in patients with ovarian carcinoma.

Clinical retrospective analysis with a predictive model for diffused-tenosynovial giant cell tumors of the temporomandibular joint

BackgroundThis study aimed to find out the characteristics in relation to tumor recurrence in diffused-tenosynovial giant cell tumor of temporomandibular joint and to develop and validate the prognostic model for personalized prediction.MethodsFrom April 2009 to January 2021, patients with diffused-tenosynovial giant cell tumor of temporomandibular joint at a single center were included in this study. The clinical features and local recurrence-free survival were assessed through the expression of the Ki-67 index and colony-stimulating factor 1 receptor expression. Both univariate and multivariate analyses were performed on the prognostic factors for local recurrence-free survival. An independent predictor nomogram and pertinent tumor characteristics were included.ResultsThe retrospective study enrolling seventy eligible patients at the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. During the follow-up time, eleven patients suffered tumor recurrence. Age was an independent risk factor for local recurrence-free survival (P = 0.032). The Ki-67 index varied significantly in different sites (P = 0.034) and tumor volume (P = 0.017). Multivariate logistic regression was used to develop the prediction model using both statistical significance and prognostic indicators. The C-index of the nomogram based on age, site, Ki-67, and colony-stimulating factor 1 receptor was 0.833. These variates provided good predicted accuracy for a nomogram on local recurrence-free survival. Diffused-tenosynovial giant cell tumor from the temporomandibular joint is extremely uncommon, and certain clinical traits are linked to the tumor proliferation index.ConclusionsWe identified the risk indicators and developed a nomogram in this study to forecast the likelihood of local recurrence-free survival in patients with diffused-tenosynovial giant cell tumor from temporomandibular joint.

Relationship between transcriptional expression of pyruvate dehydrogenase and local control of disease in patients with oral cavity carcinomas

BackgroundThe altered cellular metabolism is one of the hallmarks of the cancer cells, favoring the process of aerobic glycolysis, known as the Warburg effect. The pyruvate dehydrogenase (PDH) complex is one of the elements involved in this metabolic process. The present study aims to evaluate the relationship between the transcriptional expression of PDHB and the risk of local recurrence in patients with oral cavity carcinomas. MethodsWe determined the transcriptional expression of PDHB in biopsies from 41 patients with oral cavity carcinomas treated with surgery. The PDHB expression was categorized according to the local control of the disease with a recursive partitioning analysis. ResultsDuring the follow-up period 13 patients (31.7%) had a local recurrence of the tumor. Considering local disease control as the dependent variable, the recursive partitioning analysis classified the patients in two categories according to high (n=16, 39.0%) or low (n=25, 61.0%) PDHB expression. Five-year local recurrence-free survival for patients with high PDHB expression was 84.8% (95% CI: 65.2-100%), and for patients with low expression it was 54.3% (95% CI: 34.3–74.2 %) (P=0.034). The results of multivariate analysis showed that patients with a low PDHB expression had a 4.90 times higher risk of local recurrence of the tumor (95% CI: 1.02–22.68, P=0.042). ConclusionThere is a relationship between the metabolic characteristics of the tumor and its aggressiveness. According to our results, patients with oral cavity carcinomas with low transcriptional expression levels of PDHB have a significantly higher risk of local tumor recurrence.

SuPARnostic: an advanced predictive tool for detecting recurrence in renal cell carcinoma

BackgroundPlasma soluble urokinase-type Plasminogen Activator Receptor (suPAR) predicts disease aggressiveness in renal cell carcinoma (ccRCC), but its prognostic accuracy has not been investigated. To investigate the prognostic accuracy of preoperative plasma suPAR in patients who received curative treatment for initially localized ccRCC.MethodsWe retrospectively analyzed plasma samples stored in the Danish National Biobank between 2010 and 2015 from 235 patients with ccRCC at any stage. Relationships with outcome analyzed using univariate and multiple logistic Cox regression analysis.ResultsThere were 235 patients with ccRCC. The median follow-up period was 7.7 years. In univariate analysis suPAR ≥ 6 ng/mL was significantly associated with overall survival (OS) and recurrence-free survival (RFS). Patients with elevated suPAR were more likely to recur, with a Hazard Ratio (HR) of 2.3 for RFS. In multiple logistic regression, suPAR ≥ 6 ng/mL remained a negative predictor of OS and RFS. Limitations include retrospective study design, wide confidence intervals, and tumor subtype heterogeneity bias.ConclusionsccRCC patients with high plasma suPAR concentrations are at an elevated risk of disease recurrence and see lower OS. suPAR is a promising surveillance tool to more precisely follow up with ccRCC patients and detect future recurrences.Patient SummaryIn this study, we showed that new type of liquid marker in blood plasma, called suPAR, is associated to a higher risk of kidney cancer recurrence when elevated above 6ng/mL. We also showed suPAR to independently be able to predict patients overall and recurrence free survival in patient with any stage of kidney cancer.

Effectiveness of perioperative chemotherapy and radical cystectomy in treating bladder cancer

BackgroundDespite abundant evidence supporting the use of perioperative chemotherapy from clinical trials, no study to date has comprehensively evaluated its use in the treatment of muscle-invasive bladder cancer (MIBC) in the real-world setting. Little is known regarding the impact of pretreatment disease stage and real-world factors such as patient comorbidities preventing timely completion of therapy on its effectiveness. This study aims to assess the usage of perioperative chemotherapy and examines its impact on pathologic downstaging rates and recurrence free survival in patients undergoing radical cystectomy. MethodsA retrospective review was conducted in 805 patients with muscle invasive bladder cancer undergoing radical cystectomy with no perioperative chemotherapy, 761 with presurgical chemotherapy followed by radical cystectomy, and 134 radical cystectomy followed by adjuvant chemotherapy. Relevant clinicopathologic features were reviewed. Recurrence-free survival and Overall Survival probability estimates were calculated using the Kaplan–Meier method and compared using the Log-rank or Gehan-Breslow tests. The prognostic effects of presurgical chemotherapy and adjuvant chemotherapy regimens were evaluated by estimating hazard ratio and 95% confidence interval from an adjusted Cox proportional hazards model. Statistical tests were 2-sided, and significance was defined as P-value < 0.05. ResultsIn this contemporary, real-world cohort, 5-yr RFS was found to be 65.6% in pT0, 59.1%in <pT2, 35.4% in pT2, 15.3% in >pT2, and 10.8% in pN+ patients. Presurgical chemotherapy increased pathologic downstaging rates from 27.5% to 41.1% in patients with ≥cT2 BCa. Stratified by clinical T-stage, only cT2 patients derived recurrence-free survival (Median 45.3 months vs. 29.0 months, P < 0.01) and overall survival (Median 62.3 months vs. 41.9 months, P < 0.001) benefits. In patients with adverse pathologic features (≥pT3 or pN+), adjuvant chemotherapy improved recurrence-free survival (Median 22.8 months vs. 10.0 months, P < 0.0001) and overall survival (Median OS 32.4 months vs. 16.3 months, P < 0.0001). ConclusionsWe report real-world outcomes from a large cohort of muscle-invasive bladder cancer patients undergoing surgical treatment with/out perioperative chemotherapy. Pathologic response rates to pre-surgical chemotherapy were modest and led to clinical benefit only in cT2 patients. Adjuvant chemotherapy provided survival benefit for pathologically advanced MIBC patients irrespective of pT/N staging.

MRI-based radiomics approach for the prediction of recurrence-free survival in triple-negative breast cancer after breast-conserving surgery or mastectomy.

To explore the value of a radiomics signature and develop a nomogram combined with a radiomics signature and clinical factors for predicting recurrence-free survival in triple-negative breast cancer patients. We enrolled 151 patients from the cancer imaging archive who underwent preoperative contrast-enhanced magnetic resonance imaging. They were assigned to training, validation and external validation cohorts. Image features with coefficients not equal to zero in the 10-fold cross-validation were selected to generate a radiomics signature. Based on the optimal cutoff value of the radiomics signature determined by maximally selected log-rank statistics, patients were stratified into high- and low-risk groups in the training and validation cohorts. Kaplan-Meier survival analysis was performed for both groups. Kaplan-Meier survival distributions in these groups were compared using log-rank tests. Univariate and multivariate Cox regression analyses were used to construct clinical and combined models. Concordance index was used to assess the predictive performance of the 3 models. Calibration of the combined model was assessed using calibration curves. Four image features were selected to generate the radiomics signature. The Kaplan-Meier survival distributions of patients in the 2 groups were significantly different in the training (P < .001) and validation cohorts (P = .001). The C-indices of the radiomics model, clinical model, and combined model in the training and validation cohorts were 0.772, 0.700, 0.878, and 0.744, 0.574, 0.777, respectively. The C-indices of the radiomics model, clinical model, and combined model in the external validation cohort were 0.778, 0.733, 0.822, respectively. The calibration curves of the combined model showed good calibration. The radiomics signature can predict recurrence-free survival of patients with triple-negative breast cancer and improve the predictive performance of the clinical model.

Correlation of Heavy Metal Content in the Blood of Patients with Ovarian Cancer by Place of Residence

Introduction. Malignant ovarian tumours are an urgent problem in oncology today. Ovarian cancer (OC) is in the top ten in terms of prevalence, ranking 7th, and in the top five in terms of mortality, ranking 4th. The asymptomatic course of the disease is explained by the progression of ovarian cancer mainly due to peritoneal dissemination; that is the reason why the disease is diagnosed at late stages. The prognosis of the disease depends on its stage, the degree of differentiation of the tumour, the recurrence-free period, the size of the residual tumour after surgical treatment. Taking into account the above factors, this disease is interesting for scientists in terms of finding new factors for predicting its course and trying to influence them. Purpose: increasing the effectiveness of treatment of patients with ovarian cancer by individualizing supportive therapy taking into account the level of heavy metal salts in the blood.&#x0D; Methods. The study is based on the results of observation of 127 patients with ovarian cancer of stages I-IV. The duration of recurrence-free survival was studied and evaluated depending on the place of residence of patients with ovarian cancer. Results. The analysis of the recurrence-free survival of patients by the territorial principle was carried out: higher rates of cumulative survival of patients are recorded in virtually all studied intervals in patients living in Ivano-Frankivsk and Kalush districts (where a higher content of Zn in the blood of patients is recorded). Cox regressions in correlation with Zn variables were constructed for them.&#x0D; The Cox regression was calculated in correlation with the variables of Zn in the blood of patients with OC living in the Ivano-Frankivsk and Kalush districts at minimal values of the metal content in the blood. For the Ivano-Frankivsk district, it is predicted that at the 16th month of observation, the recurrence-free survival rate will be 0%. For Kolomyia district, the projected recurrence-free survival rate is even lower, with no patients remaining at the 9th month of follow-up. The predicted recurrence-free survival in correlation with Zn variables in the blood of patients with OC living in Ivano-Frankivsk and Kalush districts at the maximum values of the metal in the blood was determined. For the Ivano-Frankivsk district, it is predicted that 97% of patients will remain under observation at month 36. For Kolomyia district, the predicted recurrence-free survival rate at the 36th month of observation is 99%. Conclusions. A correlation was found between the zinc content in the blood of patients with OC and the place of residence in Ivano-Frankivsk region; according to the analysis of the obtained data set, the strongest correlation of recurrence-free survival of patients is observed with this element. Increased levels of zinc and copper in the blood of patients resulted in a longer duration of disease-free survival, so patients from Kalush and Ivano-Frankivsk regions have a more favourable prognosis.&#x0D; For chromium and copper, the place of residence of patients doesn’t play any role.

Feasibility of UTE-MRI-based radiomics model for prediction of histopathologic subtype of lung adenocarcinoma: in comparison with CT-based radiomics model.

To assess the feasibility of the UTE-MRI radiomic model in predicting the micropapillary and/or solid (MP/S) patterns of surgically resected lung adenocarcinoma. We prospectively enrolled 74 lesions from 71 patients who underwent UTE-MRI and CT before curative surgery for early lung adenocarcinoma. For conventional radiologic analysis, we analyzed the longest lesion diameter and lesion characteristics at both UTE-MRI and CT. Radiomic features were extracted from the volume of interest of the lesions and Rad-scores were generated using the least absolute shrinkage and selection operator with fivefold cross-validation. Six models were constructed by combining the conventional radiologic model, UTE-MRI Rad-score, and CT Rad-score. The areas under the curves (AUCs) of each model were compared using the DeLong method. Early recurrence after curative surgery was analyzed, and Kaplan-Meier survival analysis was performed. Twenty-four lesions were MP/S-positive, and 50 were MP/S-negative. The longitudinal size showed a small systematic difference between UTE-MRI and CT, with fair intermodality agreement of lesion characteristic (kappa = 0.535). The Rad-scores of the UTE-MRI and CT demonstrated AUCs of 0.84 and 0.841, respectively (p = 0.98). Among the six models, mixed conventional, UTE-MRI, and CT Rad-score model showed the highest diagnostic performance (AUC = 0.879). In the survival analysis, the high- and low-risk groups were successfully divided by the Rad-score in UTE-MRI (p = 0.01) and CT (p < 0.01). UTE-MRI radiomic model predicting MP/S positivity is feasible compared with the CT radiomic model. Also, it was associated with early recurrence in the survival analysis. A radiomic model utilizing UTE-MRI, which does not present a radiation hazard, was able to successfully predict the histopathologic subtype of lung adenocarcinoma, and it was associated with the patient's recurrence-free survival. • No studies have reported the ultrashort echo time (UTE)-MRI-based radiomic model for lung adenocarcinoma. • The UTE-MRI Rad-score showed comparable diagnostic performance with CT Rad-score for predicting micropapillary and/or solid histopathologic pattern. • UTE-MRI is feasible not only for conventional radiologic analysis, but also for radiomics analysis.

Predictive factors and oncological outcomes of pathological T3a upstaging in patients with clinical T1 renal cell carcinoma undergoing partial nephrectomy.

To investigate predictive factors and oncological outcomes of pathological T3a upstaging in renal cell carcinoma patients who were initially diagnosed as clinical T1 and treated with partial nephrectomy. The clinical records and survival data of 1617 patients, who had undergone partial nephrectomy for clinical T1 renal cell carcinoma at Tokyo Women's Medical University, Tokyo, Japan between January 2011 and December 2020, were analyzed retrospectively. Of 1617 clinical T1 renal cell carcinoma patients who underwent partial nephrectomy, 28 (1.73%) had pathological T3a upstaging. In the multivariable analysis for pathological T3a upstaging using logistic regression models, male sex and clinical T1b were significant factors associated with pathological T3a upstaging (male sex: odds ratio=5.07, 95% confidence interval: 1.18-21.8, clinical T1b: odds ratio=8.36, 95% confidence interval: 3.56-19.6). The Kaplan-Meier method of the recurrence-free survival showed shorter recurrence-free survival in patients with pathological T3a upstaging than in those with pathological T1 (P<0.0001). In the multivariable analysis using Cox proportional hazards regression models, pathological T3a upstaging was no longer significantly associated with recurrence-free survival after adjustment for other pathological factors (hazard ratio=1.59, 95% confidence interval: 0.58-4.36). In a sensitivity analysis that analyzed its components individually instead of whole pathological T3a, neither perinephric fat invasion, sinus fat invasion, nor renal vein invasion was associated with recurrence-free survival. Male sex and clinical T1b were significant predictors for pathological T3a upstaging after partial nephrectomy in clinical T1 renal cell carcinoma patients. Although patients with pathological T3a upstaging had worse recurrence-free survival compared with those without upstaging, multivariable analyses revealed that pathological T3a upstaging was not an independent predictor for poor recurrence-free survival.