Risk Factor For Recurrence-free Survival Research Articles

Laparoscopic Radical Nephroureterectomy: A Multicenter Analysis in Japan

BackgroundLaparoscopic nephroureterectomy (LNUx) is prevalent in Japan and throughout the world, but long-term outcome data remain limited. ObjectiveTo understand the present state of LNUx in Japan, we conducted a multicenter analysis of clinical outcome and long-term cancer control for patients who underwent the procedure. Design, setting, and participantsBetween January 1995 and December 2005, 1003 patients with urothelial cancer in the upper urinary tract were treated with LNUx at 51 institutions in Japan, and patient data were collected retrospectively. MeasurementsPatient profiles were gathered and analyzed for survival, intravesical recurrence, and risk factors influencing them. Results and limitationsMedian operative time was 320min. Median bleeding volume was 232ml. Complications occurred in 93 cases (9.3%) intraoperatively and in 107 cases (10.7%) postoperatively. Overall survival rate was 70% at 5 yr. Grade 3, pT3 or pT4, multifocal tumor, lymph-node metastasis, and previous or coexistent bladder tumor were independent risk factors for overall survival. Intravesical recurrence rate was 43% at 5 yr. Intravesical recurrence occurred more frequently in males, in patients with multifocal tumors, in patients with previous or coexistent bladder tumors, and in patients who underwent the hand-assisted approach. ConclusionsOur report represents the largest multicenter analysis of LNUx reported to date. Male sex and the use of the hand-assisted approach were shown for the first time to be risk factors for recurrence-free survival and intravesical recurrence. To further analyze the effectiveness of LNUx, a long-term outcome comparison with risk stratification must be made between LNUx and open nephroureterectomy.

Microvascular Invasion in Patients with Hepatocellular Carcinoma and Its Predictable Clinicopathological Factors

Macroscopic vascular invasion is known to be a poor prognostic factor in hepatocellular carcinoma (HCC). The aim of this study was to determine the outcomes and predictive factors after hepatic resection for HCC with microvascular invasion (MVI). One hundred ten patients who underwent curative resection for HCC without macroscopic vascular invasion were included in this retrospective study. The risk factors of these patients for recurrence-free and disease-specific survival were investigated, and the clinicopathological factors predicting the presence of MVI were also determined. Of the 110 resected specimens, 49 (45%) had evidence of MVI. By univariate analysis, MVI was found to be statistically significantly associated with greater tumor size, gross classification, histological grade, and intrahepatic micrometastasis. Gross classification proved to be the only independent predictive factor for MVI by multiple logistic regression analysis. By multivariate analysis, cirrhosis and MVI were identified as independent risk factors for recurrence-free survival. The 5-year recurrence-free survival rates for patients with and without MVI were 20.8% and 52.6%, respectively. By multivariate analysis, the number of tumors, presence of MVI, and intrahepatic micrometastasis were identified as independent predictors of disease-specific survival. The 5-year disease-specific survival rates for patients with and without MVI were 59.3% and 92.0%, respectively. The presence of MVI was the most important risk factor affecting recurrence and survival in HCC patients after curative resection. Furthermore, this study showed that gross classification of HCC can be very helpful in predicting the presence of MVI.

Recurrent hepatocellular carcinoma has an increased risk of subsequent recurrence after curative treatment

Local ablation therapy has been shown to be effective for small hepatocellular carcinoma (HCC); however, HCC recurrence is very frequent even after apparently curative treatment. In particular, recurrent HCC may be more prone to subsequent recurrence, although quantitative data are lacking. The aim of this study was to evaluate the difference in the risk for subsequent recurrence, if any, between primary and recurrent cases. A retrospective analysis was conducted of 376 patients with HCC (uninodular and <or=5 cm, or 2-3 nodules each <or=3 cm) who underwent local ablation therapy. There were 207 primary cases (group I), 100 with first recurrence (group II), and 69 with second or later recurrence (group III). After confirming complete ablation, each patient was followed up for recurrence. Risk factors for recurrence-free survival were analyzed using proportional hazard regression. The median time to recurrence, as estimated by Kaplan-Meier method, was 30 months in group I, 23 months in group II, and 11 months in group III (P < 0.001). Multivariate proportional hazard regression analysis reveled that group (i.e. previous recurrence) was the strongest predictor of subsequent recurrence; compared to group I, group II showed a hazard ratio of 1.456 (P = 0.015) and group III, 3.011 (P < 0.0001). alpha-Fetoprotein level >100 ng/mL, treatment other than radiofrequency ablation, HCV antibody positivity, and tumor multinodularity also remained as significant predictors. Hepatocellular carcinoma at second or later recurrence is three times as prone to subsequent recurrence as is primary HCC, when compared with adjustment for other tumor and hepatic factors.

Melanoma of the ear: prognostic factors and surgical strategies

The ear's specific anatomical and lymphatic characteristics impose special requirements on the treatment of melanoma of the ear. The aim of this prospective study was to define prognostic factors for melanoma of the ear and to evaluate surgical strategies for excision margins, histological evaluation and sentinel lymph node biopsy (SLNB) in order to achieve better cosmetic and functional results. One-hundred and sixty-one patients with stage I/II melanoma of the external ear were treated in the Department of Dermatology, University of Tuebingen, from March 1976 to March 2004 (median follow-up 62 months). Malignant melanoma of the external ear represented 3% of the stage I/II cutaneous melanomas and 20% of the stage I/II head and neck melanomas recorded in the Melanoma Registry of the Department of Dermatology at the University of Tuebingen. Twenty of 42 lentigo maligna melanomas (LMM) underwent conventional histological evaluation, 22 underwent complete three-dimensional histology of excision margins (3D histology) in a paraffin-technique, i.e. micrographic surgery. SLNB was performed in 28 patients with melanomas thicker than 1.0 mm. Clinical, histological and surgical risk factors were evaluated by univariate and multivariate analysis. The median thickness of the tumours in the present study was 1.08 mm (mean 1.51 mm; range 0.18-8.50 mm), and the median excision margins were 11.0 mm (mean 12.61 mm; range 2.0-31.0 mm). The 3-year disease-specific survival rate was 98%, and the 3-year recurrence-free survival rate was 83%. Tumour thickness and invasion level were the only risk factors significant for disease-specific survival. Tumour thickness, location of the tumour and extent of excision margins were independently significant risk factors for recurrence-free survival. LMMs removed surgically with accompanying 3D histology were thicker than those examined by conventional histology (median 0.93 mm vs. 0.83 mm). The use of surgery with 3D histology, i.e. micrographic surgery, made it possible to reduce the excision margins (median 5 mm vs. 10 mm) without an increased risk of recurrence. Two of 29 SLNBs were positive (6.9%). There were six preregional recurrences after negative SLNB and one after positive SLNB. None of the patients who underwent SLNB died of melanoma-related causes during the observation period. This is the largest series of ear melanomas reported so far. The overall survival depended only on the tumour thickness and Clark level of invasion. Local recurrence was more frequent with smaller excision margins, but this did not influence the overall survival. Smaller excision margins under 3D-histological control did not carry an increased risk of local recurrence. Our results do not permit conclusions regarding the prognostic impact of SLNB for patients with melanoma of the ear.

Pattern of recurrence after curative resection of local (stage I and II) non-small cell lung cancer: difference according to the histologic type.

The aim of the present study was to evaluate the pattern of recurrence after complete resection of pathological stage I, II non-small cell lung cancer, especially according to the cell type. We reviewed the clinical records of 525 patients operated on for pathologic stage I and II lung cancer. The histologic type was found to be squamous in 253 and non-squamous in 229 patients. Median follow-up period was 40 months. Recurrences were identified in 173 (36%) of 482 enrolled patients; distant metastasis in 70%, distant and local recurrence in 11%, and local recurrence in 19%. Distant metastasis was more common in non-squamous than in squamous cell carcinoma (p=0.044). Brain metastasis was more frequently identified in non-squamous mthan in squamous cell carcinoma (24.2% vs. 7.3%. p=0.005). Multivariate analyses showed that cell type is the significant risk factor for recurrence-free survival in stage I and stage II non-small cell lung cancer. Recurrence-free survival curves showed that non-squamous cell carcinoma had similar risks during early periods of follow-up and more risks after 2 yr from the operation compared to squamous cell carcinoma. Pathological stage and histologic type significantly influence recurrence-free survival.

Prognostische Faktoren und operative Strategien bei Melanomen des Gesichts

Zusammenfassung Hintergrund: Bei Melanomen, die im Gesicht lokalisiert sind, lassen sich die am Körper üblichen Sicherheitsabstände aus funktionellen und ästhetischen Gründen nicht realisieren. In der Literatur fehlen kontrollierte Studien zu Sicherheitsabständen bei Gesichtmelanomen. Bei den Melanompatienten der Universitäts‐Hautklinik Tübingen (1980 – 1999) wurde retrospektiv analysiert, welche klinische Parameter und operativen Strategien die Prognose bei Gesichtsmelanomen beeinflussen. Die Bedeutung der lückenlosen histologischen Kontrolle der Exzisatschnittränder (3D‐Histologie) sollte validiert werden. Patienten und Methodik: Die untersuchten 368 Melanome des Gesichts machten 9,3 % aller 3 960 Primärmelanome im klinischen Stadium I/II und 63 % der Melanome des Kopf/Hals‐Bereichs aus. Ergebnisse: Operationen, die mehrzeitig durchgeführt wurden, eine Exzisonsbiopsie zur Diagnosesicherung gefolgt von einer späteren Nachexzision mit definitivem Sicherheitsabstand oder eine Nachexzision bei histologisch unvollständiger Primärexzision, waren mit einer höheren Wahrscheinlichkeit für das rezidivfreie Überleben verbunden (p = 0,0007), jedoch ohne prognostische Bedeutung für das Gesamtüberleben. In der multivariaten Analyse waren Invasionslevel (p = 0,0049), Ulzeration (p = 0,011), 3D‐Histologie (p = 0,027) und die Einhaltung definierter Sicherheitsabstände (Tumordicke ≤ 1,00 mm: 10 mm; &gt; 1,00 mm 20 mm; LMM 5 mm unter Einsatz der 3D‐Histologie) (p = 0,033) unabhängige signifikante Risikofaktoren für das rezidivfreie Überleben. Für das Gesamtüberleben konnten Invasionslevel (p = 0,032), Ulzeration (p = 0,029), 3D‐Histologie (p = 0,0047) als unabhängige signifikante Risikofaktoren identifiziert werden. In der multivariaten Analyse konnte für den histologischen Tumortyp keine prognostische Bedeutung nachgewiesen werden. Schlußfolgerung: Aufgrund dieser Ergebnisse können auch reduzierte Sicherheitsabstände im Gesicht als ausreichend sicher eingeschätzt werden. Die 3D‐Histologie ermöglicht eine weitere Reduzierung der Sicherheitsabstände, kann subklinische Tumorausläufer erkennen und ist mit einer besseren Prognose bei Patienten mit Gesichtsmelanomen assoziiert.