Recurrence Time Research Articles

ThP2.4 - Unveiling the Odds: Identifying the Axillary Recurrence rates in Invasive Breast Cancer Surgery in a district general hospital - Seventeen years of Surgical Performance decoded

Abstract Introduction Axillary recurrence should be minimised by effective staging and treatment where appropriate Minimum standard <5% axillary recurrence at 5 years Target <3% axillary recurrence at 5 years according to UK ABS guidelines. Methods All patients with primary cancer diagnosed at our institution between January 2004 and December 2020 were identified from a prospectively maintained database of operations obtained from the medical coding department. Demographics of the patients, pre-operative investigations, MDT discussion outcomes, operative details (and complications), post-operative pathology, neo-adjuvant and adjuvant therapy regimens and follow-up data were recorded. All patients were followed up to the censoring date of December 2021 which gave a median follow-up of 18 months (range, 12- 204). Axillary recurrence and treatment regimens were recorded. Primary outcome measures were overall axillary recurrence and disease-free. IBM SPSS Statistics (Version 26.0 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis to determine patient and pre-operative pathological characteristics that were predictive of isolated axillary recurrence after completion of the primary treatment course. Significance was defined as P<0.05. Results There were 4024 women diagnosed with breast cancer in Midyorks trust between this period who were referred and had surgical intervention. Of these, 107 patients were identified with recurrences. 12 were found to have an isolated axillary recurrence (8 ANC 4 SLNB) Conclusion The 17-year isolated axillary recurrence rate of women treated was 0.3%. Multimodality management at the time of recurrence, including axillary surgery, radiation, and systemic therapy, significantly improved the morbidity

Pernicious anemia is a common cause of cobalamin deficiency-caused megaloblastic anemia in Hainan, China

ABSTRACT Background Pernicious anemia (PA) is believed to be highly prevalent in Western countries but has rarely been reported in China. The study explores whether PA, an autoimmune disease, is an uncommon cause of cobalamin (vitamin B12) deficiency anemia in China. Methods Clinical and hematological data were collected from 90 cobalamin deficiency-caused megaloblastic anemia (MA) patients between July 2014 and December 2021. Through anti-intrinsic factor antibody (IFA) and anti-parietal cell antibody (PCA) testing, PA was distinguished from other causes of cobalamin deficiency leading to MA. Meanwhile, 30 healthy controls (HCs) were included to estimate the positive rates of IFA and PCA. Results Of the 30 HCs, only one tested positive for IFA, and all 30 tested negative for PCA. Among the 90 patients with cobalamin deficiency-caused MA, 76.7% were positive for IFA, and 47.8% were positive for PCA; a total of 76 patients (84.4%) were diagnosed with PA. The mean follow-up time was 41.0 ± 16.3 months. During the follow-up period, no case relapsed among the continuous cobalamin-supply treatment patients, while 24.4% of patients relapsed due to the interruption of maintenance cobalamin-supplement therapy (the median recurrence time was 54.0 ± 17.7 months). Conclusions The proportion of PA in cobalamin deficiency-caused MA patients in Hainan province was higher than 80%, which was more common than expected. Therefore, screening for IFA, PCA, endoscopic biopsy, and thyroid-related parameters are recommended for all cobalamin deficiency-caused MA patients. Furthermore, maintenance cobalamin-supplement therapy is important for PA patients.

Interval to Recurrence Affects Survival in Recurrent Head and Neck Squamous Cell Carcinoma.

Approximately half of head and neck squamous cell carcinoma (HNSCC) cases recur, with most recurrences occurring within the first two years after treatment. Although it has been suggested that the interval to recurrence after radical treatment is associated with prognosis in patients with HNSCC, further investigation is needed. Patients diagnosed with HNSCC at Kyushu University Hospital were retrospectively analyzed (n=500). Early recurrence (ER) was defined as disease recurrence within six months of radical treatment, whereas late recurrence (LR) was defined as recurrence after more than six months. Continuous variables were assessed using the Mann-Whitney U-test and categorical variables were assessed using Fisher's exact test. A total of 234 patients experienced recurrence, with 110 and 124 patients experiencing ER (recurrence within two to six months) and LR (recurrence after six months), respectively. Multivariate analyses identified two independent risk factors for poor prognosis: ER [hazard ratio (HR)=3.200, 95% confidence interval (CI)=1.570-6.521, p=0.001] and absence of radiotherapy (HR=0.374, 95%CI=0.191-0.733, p=0.004). In patients with recurrent HNSCC, a short interval to recurrence is a risk factor for poor prognosis and survival. This study demonstrated the prognostic value of ER in these patients. The selection of treatment for patients with recurrent head and neck squamous cell carcinoma should consider the timing of recurrence, the initial treatment regimen, and the strategy for changing salvage therapy depending on the recurrence status.

Patterns of Locoregional Pancreatic Cancer Recurrence After Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes

PurposeThis study aimed to generate a map of local recurrences after neoadjuvant chemotherapy and radiation (total neoadjuvant therapy [TNT]) followed by surgical resection for pancreatic ductal adenocarcinoma (PDAC). Such recurrence patterns will serve to inform radiation treatment planning volumes that should be given in the neoadjuvant setting. Methods and MaterialsLocoregional recurrences after TNT followed by surgery treated between 2009 and 2022 were radiologically identified. Recurrences were individually segmented using MIM software and complied in a single base scan. All contour compilations were used to create a threshold contour encompassing 80% of recurrences among all patients, head only, and body/tail only. The distance between organs at risk and the threshold contour were measured to design an optimal clinical target volume contour for patients treated with TNT. Recurrence patterns were also compared with existing adjuvant guidelines to assess coverage. ResultsA database of 484 patients managed with TNT for PDAC was queried. While locoregional recurrences were rare in this cohort, we identified 80 patients with either isolated locoregional or simultaneous local and distant recurrences. Patients with diagnostic imaging at the time of recurrence were identified. The majority of recurrences were partially in the field of published contouring guidelines or volumetric expansions off of vessels, and volumetric coverage was low for all. Common areas of recurrence include the aorticodiaphragmatic junction, retropancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery. A novel set of proposed neoadjuvant contours was designed to cover the central-most 80% of recurrences. ConclusionsThis is the largest collection of local/regional PDAC recurrences from a cohort of patients treated exclusively with TNT. Patterns of local/regional recurrence using TNT in PDAC vary significantly from those patients with PDAC treated with a surgery-first approach. Novel contouring guidelines presented in this study can help to ensure optimal coverage of high risk regions and avoid reliance on the current adjuvant guidelines to guide treatment planning.

Long-term Clinical Outcomes of Patients With Negative Pathology (pN0) at Primary Retroperitoneal Lymph Node Dissection

BackgroundPatients who undergo primary retroperitoneal lymph node dissection (pRPLND) for early-stage testicular cancer and have no cancer (pN0) found in the retroperitoneum are believed to have an excellent prognosis. However, some experience relapse, potentially due to limitations of current staging methods. We aim to describe long-term outcomes and relapse patterns among a contemporary cohort of patients found to be pN0 at pRPLND to identify opportunities for improved diagnostic approaches and optimal patient selection. MethodsWe reviewed our prospectively maintained database for patients who underwent pRPLND for nonseminomatous germ cell tumors at our tertiary cancer center during the period from January 1, 2000, through September 30, 2023 (n = 628). We excluded 282 patients with node-positive pathology for a final analytic cohort of 346 patients. Our primary outcome was recurrence-free survival (RFS). Secondary outcomes included timing and location of recurrence. ResultsOf 346 included patients with pN0 pathology, 23 experienced relapse with a 2-year RFS rate of 93% (95% confidence interval: 90, 96). Most recurrences (70%) occurred in the lungs and within 6 months of pRPLND. Serum tumor markers were positive in 43% of patients at the time of relapse. All patients who relapsed were treated with salvage chemotherapy; 6 patients required additional surgical procedures. There was no testis cancer–related deaths. ConclusionsTwo-year RFS for patients with pN0 pRPLND pathology is excellent. All recurrences were outside of the retroperitoneum, suggesting subclinical distant metastases at time of surgery and the benefits of a bilateral template dissection. Improved diagnostics may help better identify patients with disease within or outside of the retroperitoneum prior to pRPLND, helping guide treatment decisions.

765. PATTERNS, TIMING, AND SURVIVAL OF RECURRENCE FOLLOWING SURGERY FOR ESOPHAGEAL ADENOCARCINOMA IN THE EUROPEAN MULTICENTRE ENSURE STUDY

Abstract Background After surgery for esophageal cancer approximately half of patients will develop disease recurrence. A more accurate and detailed understanding of the pattern, timing, treatment and prognosis of initial recurrence sites can guide improvements in surveillance and therapy. Therefore, the aim of this study was to accurately describe the pattern and timing of esophageal cancer recurrence, and to assess the distinct survival patterns of these recurrence locations. Methods This study included all patients who underwent surgical resection for esophageal and junctional adenocarcinoma registered in the ENSURE study. ENSURE was an international multicenter study of consecutive patients undergoing surgery for esophageal and esophagogastric junction cancers between 2009 and 2015 across 20 centers in Europe and Canada (NCT03461341). The first recurrence site was recorded and recurrence-free survival (RFS) was estimated using Kaplan-Meier curves. Sites of first recurrence were stratified into different groups and survival outcomes post recurrence detection were estimated using Kaplan-Meier curves. Results Of 3397 eligible patients, 1310 patients had disease recurrence with comprehensive follow-up data available (median RFS of 12.1 months). First recurrence was detected at multiple distant sites (n=469; 37.3%) or at a single distant site (n=463; 33.7%), while isolated local recurrence occurred in 189 (14.4%) patients. Liver-only recurrence occurred significantly earlier (median 9.0 months), while lung-only (15.2 months) and local-only occurred later (17.8 months). Patients with multiple-sites and liver-only recurrence had significant worse median post recurrence survival (7.4 and 8.3 months, respectively) when compared with lung- or local-only recurrence (10.4 and 15.9 months, respectively). Conclusion This study demonstrates that specific recurrence locations of esophageal cancer possess distinct RFS curves. Furthermore, specific recurrence locations result in different post recurrence survival outcomes. This information can help guide improvements in surveillance after esophageal cancer surgery and decisions regarding treatment of esophageal cancer recurrence.

Complex fault system associated with the Molucca Sea Divergent double subduction zone revealed by the 2019 Mw 6.9 and Mw 7.1 Earthquakes

GNSS (Global Navigation Satellite System) data in northern Sulawesi and western Halmahera reveals a pattern of coseismic displacement that was caused by the 7 July 2019 (Mw 6.9) and 14 November 2019 (Mw 7.1) Molucca Sea earthquakes. The coseismic slip of these earthquakes are obtained via inversion on rectangular fault planes of surface GNSS coseismic deformation offsets. The 7 July 2019 earthquake ruptured on an east-dipping fault with a maximum slip of ∼35 cm located at ∼4 km depth and ∼ 100 km north-west of the epicenter. The 14 November 2019 earthquake also ruptured on an east-dipping fault, which has a maximum slip of ∼64 cm located at ∼22 km depth and ∼ 20 km south-west of the epicenter. The coseismic slip distribution of the 14 November earthquake is spatially aligned to that of an earthquake of similar magnitude that took place on 15 November 2014 in the same region. This observation points to the possibility of synchronization, thus raising the prospect of a future earthquake exceeding magnitude 7. If the stress was completely released during the 2014 event, it would have been necessary to reload that portion of the fault at a rate significantly larger than the observed convergence rate of ∼5.8 cm/yr. This suggests that partial ruptures are likely controlling the recurrence time of large earthquakes in the region.

Quantifying Bevacizumab Efficacy in Recurrent Respiratory Papillomatosis.

To develop and validate a novel method for quantifying the efficacy of Bevacizumab (Bev) in treating Recurrent Respiratory Papillomatosis (RRP), and to evaluate the clinical outcomes of a three-dose Bev induction therapy followed by surgical intervention. Twenty-one RRP patients treated with a three-dose Bev regimen were included. A novel efficacy evaluation method using ImageJ software was developed to calculate the standardized lesion volume from laryngoscopic images. This was compared with the Derkay score. Clinical outcomes, including reduction rate, cumulative reduction rate, efficacy grading, recurrence, and adverse reactions, were analyzed. In the study cohort, the reduction rate was significantly higher after the first treatment compared with subsequent treatments. The overall response rate increased from 75% after the first treatment to 100% after the third. Among patients with localized lesions who underwent surgery, 76% experienced recurrence with a mean recurrence time of 114.23 days. Most recurrent lesions were smaller than at baseline. Adverse reactions included increased blood pressure in seven patients, which resolved without intervention. The new method showed a significant positive correlation with the Derkay score. In conclusion, based on the above findings, systemic Bev treatment for RRP is a safe and effective therapeutic approach, though further research is needed. Moreover, the new efficacy evaluation method we developed can significantly aid in studying the effectiveness of Bev treatment for RRP. 2 Laryngoscope, 2024.

Impact of slit compared with nonslit mesh in laparoscopic groin hernia repairs—A comprehensive propensity score analysis of a cohort of 611 hernias

BackgroundThe slit-mesh technique for laparoscopic groin hernia repair remains controversial. We present the largest cohort of patients to date that have undergone laparoscopic hernia repair with this technique and aim to evaluate the impact of both techniques on postoperative recurrence and other secondary outcomes. MethodsA retrospective, single-institution cohort study of patients who underwent a laparoscopic groin hernia repair over a 5.5-year period was performed. Univariate and multivariate analyses were performed to identify factors associated with recurrence, chronic pain, complications, length of stay, and operative time. A propensity score analysis also was performed. Time to recurrence was then subsequently plotted on a Kaplan-Meier survival analysis. ResultsIn total, 611 laparoscopic groin hernia repairs (nonslit: n = 353; slit: n = 258) were reviewed. Mean follow-up duration was 6.6 months. On the multivariate analysis, body mass index was inversely correlated with recurrence (odds ratio, 0.792; 95% confidence interval, 0.656–0.956), whereas a slit mesh had lower recurrence (odds ratio, 0.228; 95% confidence interval, 0.064–0.809). In the propensity score–adjusted analysis, slit mesh remained significantly associated with reduced recurrence (adjusted odds ratio, 0.251; 95% confidence interval, 0.070–0.900), with no differences in chronic pain (adjusted odds ratio, 1.297; 95% confidence interval, 0.275–6.128) or postoperative complications (adjusted odds ratio, 1.808; 95% confidence interval, 0.429–7.620). Operative time also was reduced in the slit-mesh group (P = .009). ConclusionsThe slit-mesh technique was associated with a reduced likelihood of postoperative recurrence and shorter operative time, with no impact on postoperative chronic pain or complications. A lower body mass index was also correlated with increased likelihood of postoperative recurrence.

Performance of different CT enhancement quantification methods as predictors of pancreatic cancer recurrence after upfront surgery

The prognosis of pancreatic cancer (PDAC) after tumor resection remains poor, mostly due to a high but variable risk of recurrence. A promising tool for improved prognostication is the quantification of CT tumor enhancement. For this, various enhancement formulas have been used in previous studies. However, a systematic comparison of these formulas is lacking. In the present study, we applied twenty-three previously published CT enhancement formulas to our cohort of 92 PDAC patients who underwent upfront surgery. We identified seven formulas that could reliably predict tumor recurrence. Using these formulas, weak tumor enhancement was associated with tumor recurrence at one and two years after surgery (p ≤ 0.030). Enhancement was inversely associated with adverse clinicopathological features. Low enhancement values were predictive of a high recurrence risk (Hazard Ratio ≥ 1.659, p ≤ 0.028, Cox regression) and a short time to recurrence (TTR) (p ≤ 0.027, log-rank test). Some formulas were independent predictors of TTR in multivariate models. Strikingly, almost all of the best-performing formulas measure solely tumor tissue, suggesting that normalization to non-tumor structures might be unnecessary. Among the top performers were also the absolute arterial/portal venous tumor attenuation values. These can be easily implemented in clinical practice for better recurrence prediction, thus potentially improving patient management.

Ancient Nova Shells of RX Pup Indicate Evolution of Mass Transfer Rate

RX Pup is a symbiotic binary that experienced a nova outburst in the 1970s. Here we report a discovery of a ∼1300 yr old nova shell around the system and a possible detection of a ∼7000 yr old nova shell. Together with the nova shell ejected in the 1970s, this makes RX Pup the first system with three nova shells observed. This triad of eruptions suggests a change in the nova recurrence time. The most likely explanation is an alteration in the mass transfer rate attributed to evolutionary changes of the mass donor in the system. Notably, comparative analyses with theoretical models indicate an increase in the average mass transfer rate by a factor of 3 over the past 10,000 yr. This makes RX Pup a unique system, which allows us to probe millennium-scale evolution of mass transfer rates in binary systems.

A joint time and spatial attention-based transformer approach for recognizing the behaviors of wild giant pandas

Wild giant pandas, an endangered species exclusive to China, are a focus of conservation efforts. The behavior of giant pandas reflects their health conditions and activity capabilities, which play an important role in formulating and implementing conservation measures. Researching and developing efficient behavior recognition methods based on deep learning can significantly advance the study of wild giant panda behavior. This study introduces, for the first time, a transformer-based behavior recognition method termed PandaFormer, which employs time-spatial attention to analyze behavioral temporal patterns and estimate activity spaces. The method integrates advanced techniques such as cross-fusion recurrent time encoding and transformer modules, which handle both temporal dynamics and spatial relationships within panda behavior videos. First, we design cross-fusion recurrent time encoding to represent the occurrence time of behaviors effectively. By leveraging the multimodal processing capability of the transformer, we input time and video tokens into the transformer module to explore the relation between behavior and occurrence time. Second, we introduce relative temporal weights between video frames to enable the model to learn sequential relationships. Finally, considering the fixed position of the camera during recording, we propose a spatial attention mechanism based on the estimation of the panda's activity area. To validate the effectiveness of the model, a video dataset of wild giant pandas, encompassing five typical behaviors, was constructed. The proposed method is evaluated on this video-level annotated dataset. It achieves a Top-1 accuracy of 92.25 % and a mean class precision of 91.19 %, surpassing state-of-the-art behavior recognition algorithms by a large margin. Furthermore, the ablation experiments validate the effectiveness of the proposed temporal and spatial attention mechanisms. In conclusion, the proposed method offers an effective way of studying panda behavior and holds potential for application to other wildlife species.

The impact of time to postoperative recurrence on the prognosis of patients with esophageal cancer post recurrence: exploratory analysis of OGSG 1003.

The association between recurrence timing and prognosis in patients with locally advanced resectable esophageal cancer undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy remains unclear. This study aimed to clarify this association using multicenter prospective clinical trial data. Among 162 patients enrolled in a NAC phase II study comparing the efficacy of cisplatin and fluorouracil plus docetaxel with cisplatin and fluorouracil plus adriamycin, 64 patients with recurrence after R0 resection were included in this study. We evaluated the association between recurrence timing and overall survival after recurrence (OSr), along with clinicopathological factors associated with recurrence timing and OSr. Among 64 patients, 46 (71.9%) and 59 (92.2%) experienced recurrence within 1 and 2years after surgery, respectively. Groups based on recurrence timing, including ≤ 6, 6-12, and > 12 months, had median OSr of 3.6, 13.9, and 13.4 months, respectively. The prognosis was significantly poorer for patients with recurrence ≤ 6 months after surgery than for other patients (P < 0.001). Multivariate analysis revealed pathological lymph node staging as an independent factor associated with early recurrence (odds ratio: 3.46, 95% confidence interval: 1.47-8.02, P = 0.0045). On the other hand, multivariate analysis for factors associated with OSr revealed pT (hazard ratio [HR]: 1.91, 95%CI 1.26-2.88, P = 0.0022), early recurrence (HR: 6.88, 95%CI 2.68-17.6, P < 0.001), and treatment after recurrence, with both local treatment (HR: 0.47, 95%CI 0.22-0.98, P = 0.043) and chemotherapy (HR: 0.25, 95%CI 0.11-0.58, P = 0.0011) as independent prognostic factors. Patients with advanced esophageal cancer experiencing recurrence within 6 months after esophagectomy following NAC have an extremely poor prognosis, suggesting that an advanced pN stage is associated with early recurrence.

Recurrent cervical cancer detection using DNA methylation markers in self-collected samples from home.

Early detection of recurrent cervical cancer is important to improve survival rates. The aim of this study was to explore the clinical performance of DNA methylation markers and high-risk human papillomavirus (HPV) in cervicovaginal self-samples and urine for the detection of recurrent cervical cancer. Cervical cancer patients without recurrence (n = 47) collected cervicovaginal self-samples and urine pre- and posttreatment. Additionally, 20 patients with recurrent cervical cancer collected cervicovaginal self-samples and urine at time of recurrence. All samples were self-collected at home and tested for DNA methylation and high-risk HPV DNA by PCR. In patients without recurrent cervical cancer, DNA methylation levels decreased 2-years posttreatment compared to pretreatment in cervicovaginal self-samples (p < .0001) and urine (p < .0001). DNA methylation positivity in cervicovaginal self-samples was more frequently observed in patients with recurrence (77.8%) than in patients without recurrence 2-years posttreatment (25.5%; p = .0004). Also in urine, DNA methylation positivity was more frequently observed in patients with recurrence (65%) compared to those without recurrence (35.6%; p = .038). Similarly, high-risk HPV positivity in both cervicovaginal self-samples and urine was more frequent (52.6% and 55%, respectively) in patients with recurrence compared to patients without recurrence (14.9% and 8.5%, respectively) (p = .004 and p = .0001). In conclusion, this study shows the potential of posttreatment monitoring of cervical cancer patients for recurrence by DNA methylation and high-risk HPV testing in cervicovaginal and urine samples collected at home. The highest recurrence detection rate was achieved by DNA methylation testing in cervicovaginal self-samples, detecting 77.8% of all recurrences and, specifically, 100% of the local recurrences.

Investigating the timing and site of recurrence for ovarian clear cell carcinoma: Analysis of the JGOG/GCIG trial-JGOG 3017-A3

BackgroundThis study was conducted to determine the optimal monitoring after initial treatment of ovarian clear cell carcinoma (OCCC) using data from patients enrolled in the Japanese Gynecologic Oncology Group (JGOG) 3017 study. The JGOG study evaluated the efficacy of an irinotecan and cisplatin combination regimen compared with that of a paclitaxel and carboplatin regimen for OCCC patients who underwent primary surgery. MethodsYielding 619 total patients in this study, to analyze progression-free and overall survival, the hazards over time were estimated using kernel smoothing curves to identify the peak of event occurrence. The number of progression events was summed by progression site, and the cumulative incidence proportion was estimated for the major progression sites, considering competing risks. ResultsThe peak hazard for progression or death was observed at 12 months post-treatment, and most events were observed by 24 months. The hazard for death peaked at 18 months post-treatment, with most events being observed by 48 months. The hazard for lung, liver, and spleen metastases remained constant for 18 months post-treatment, with a decreasing trend thereafter; most events were observed by 18 months. The hazard for peritoneal dissemination was constant for 12 months, with a decreasing trend thereafter, with most exacerbations observed by 24 months. The risk of pelvic recurrence peaked at 6 months, with most exacerbations observed by 24 months. DiscussionThe incidence of progression events for OCCC peaked at 12 months and most progression events occurred within 24 months. Close follow-up for the initial 24 months post-treatment and fewer visits thereafter may be acceptable. However, closely monitoring symptoms and examining patients based on differences in progression rates at different sites may be important.

Probability and recurrence interval of large earthquakes (Mw ≥ 6) in the Himalayan seismicity zone

The Himalayan Mountains are one of the world’s most seismically active regions. Due to the active seismic status of the Himalayan belt and ongoing development activities in the region, it is important to keep the seismic hazard estimates updated by incorporating historical and new data. This study uses the Gutenberg-Richter relations for four seismogenic source zones (SSZ) to estimate the probability of earthquakes of a specified magnitude in a given time interval. We used exponential, Weibull, Rayleigh, and log-normal statistical models to assess the probability of earthquakes (Mw ≥ 6). The probable recurrence time of the large earthquake (Mw ≥ 6) can be estimated by maximizing the conditional probability estimates. This recurrence interval is calculated after the elapsed time since the most recent large earthquake in the region. We also apply an autoregressive (AR) forecasting technique to predict earthquake recurrence intervals. The results indicate that the approximate recurrence interval of the large earthquakes (Mw ≥ 6) may be 22.052 ± 5.65 years within the seismicity zones, as per our statistical estimates based on limited and available datasets. The results of this study may be useful for the agencies involved in assessing seismic hazards and developing mitigation and preparedness strategies in the region.

Early-Stage Colon Cancer Surveillance: Pattern and Timing of Recurrence and the Role of 5-Year Surveillance

Introduction: Colorectal cancer is the third most prevalent cancer among both men and women with 80% of patients having localized disease enabling curative treatments. Given the low recurrence rate in early-stage disease, there is a growing interest in reviewing follow-up protocols. The aim of this study was to assess the frequency and timing of recurrence in early-stage colon cancer, as well as recurrence patterns. Methods: The data from all patients with colon adenocarcinoma consecutively treated with surgery at the Instituto Português de Oncologia do Porto, EPE, between January 2013 and December 2016, were retrospectively reviewed. Results: A total of 1,372 patients with colon cancer were submitted to surgery during the study period. From this group, 51.4% (n = 705) were early-stage colon cancers. Regarding the pathological stage, 3.5% were stage 0, 37.4% were stage I and 59.1% were stage II. The overall recurrence rate was 6.7%. When considering the group of patients without risk factors, the recurrence rate was 5.6%. The majority of recurrences occurred in the first 3 years of follow-up. The recurrence was diagnosed in the majority of patients through carcinoembryonic antigen elevation, followed by imaging exams. The presence of one or more risk factors (high nuclear grade, vascular invasion, extramural venous invasion, and perineural invasion) showed a statistically significant association with recurrence rate. Conclusion: The recurrence rate was low in early-stage colon cancer, with the majority of recurrences occurring in the first 3 years. Our study results show that surveillance should be tailored according to individual risk factors.

Identify Primary Risk Variables Influencing the Recurrence of Cervical Cancer in Patients, Using Non-Parametric Methods at Tikur Anbessa Specialized Hospital

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: This study aimed to identify the primary risk variables influencing the recurrence of cervical cancer in patients, at Tikur Anbessa Specialized Hospital. Cervical cancer deaths in Ethiopia reached 4,595, or 0.76% of total deaths. The age-adjusted death rate is 18.51 per 100,000 of the population in Ethiopia. &amp;lt;i&amp;gt;Method&amp;lt;/i&amp;gt;: Among patients with cervical cancer, an institution-based retrospective follow-up research was conducted from January 2015 to March 2017 at TASH and is under follow-up. Out of a population of cervical cancer patients who were taking treatment in the hospital during that period, data on 420 patients is included in this study. Non-parametric methods, such as log-rank tests and the Kaplan-Meier method, were used to compare the rate of recurrence among the different explanatory variable categories. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: After the medical cards of women were reviewed among those patients with cervical cancer, 170 (40.5%) were recurrent, and the remaining 250 (59.5%) were censored. Out of the total patients, 6.2% were at stage I, 32.6% were at stage II, 51.7% were at stage III, and 9.5% were at stage IV. The recurrence proportions of stage I, stage II, stage III, and stage IV patients were 5.88%, 27.05%, 52.35%, and 14.705%, respectively. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Finally, the findings of this study implied that age, smoking cigarettes, stage of disease, initial treatment patients took, types of treatment patients took, and place were major factors related to the recurrence time of cervical cancer patients.

Clinical Characteristics of Local Recurrent Basal Cell Carcinoma After Surgical Excision: A Retrospective Study of the Patients From a Tertiary Clinical Center.

Basal cell carcinoma (BCC) is the most frequent form of skin cancer. The etiology of recurrent BCC is multifactorial, and the recurrence rate is variable. The aim of the study was to identify the risk factors of local recurrence after surgical excision in primary BCC. In our study, 934 patients histopathological diagnosed with BCCs between January 2017 and June 2022 were evaluated retrospectively. Among these, patients who were regularly followed up for at least three years were included in the study. Patients who underwent non-excision treatment were excluded. Allthe patients who had pathologically confirmed, surgically excised BCCs with safety margins and those with a clinicopathological diagnosis of recurrent BCCs. Demographic and clinical features of 78 patients with non-recurrent primary BCC and 55 patients with local recurrent BCC were compared. The mean age was 69.7±11.7 years. The gender distribution was M/F:1.3. The time from diagnosis to total surgical excision was 2.3±1.4 months, and the time of recurrence was 27.5±23.3 months. The age of the patients, the time from diagnosis to total excision, the lesion size > 2 cm, and the presence of risk factors (such as radiotherapy, malignancy, and immunosuppression) were higher in the recurrent group than in the non-recurrent group (p < 0.05). Location (high/medium/low-risk area) and the presence of multiple lesions did not differ significantly between the recurrent and non-recurrent groups. In patients with BCC, recurrence is often detected in the first three years after diagnosis. Our study determined age, lesion size, accompanying risk factors, and the length of time until total excision as risk factors for recurrence in BCC patients. The histological subtype and lesion localization did not differ between the group with and without recurrence.

Physics-based assessment of earthquake potential on the Anninghe-Zemuhe fault system in southwestern China

The seismic hazard of a fault system is controlled by the maximum possible earthquake magnitude it can host. However, existing methods to estimate maximum magnitudes can result in large uncertainties or ignore their temporal evolution. Here, we show how the maximum possible earthquake magnitude of a fault system can be assessed by combining high-resolution fault coupling maps with a physics-based model from three-dimensional dynamic fracture mechanics confirmed by dynamic rupture simulations. We demonstrate the method on the Anninghe-Zemuhe fault system in southwestern China, where dense near-fault geodetic data has been acquired. Our results show that this fault system currently has the potential to generate Mw7.0 earthquakes with maximum magnitudes increasing to Mw7.3 by 2200. These results are supported by the observed rupture extents and recurrence times of historical earthquakes and the b values of current seismicity. Our work provides a practical way to assess the earthquake potential of natural faults.