Risk Of Recurrence Research Articles

Metabolic syndrome and risks of breast cancer outcomes for luminal, triple-negative, and HER2-overexpressing subtypes.

We evaluated the association between metabolic syndrome (obesity plus two metabolic risk factors) and breast cancer outcomes according to molecular subtype. This population-based prospective cohort consisted of 3,267 women aged 20-69 diagnosed with a first primary invasive breast cancer from 2004-2015 in the Seattle-Puget Sound region. Breast cancer was categorized into three subtypes based on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression: luminal (ER+), triple-negative (ER-/PR-/HER2-), and HER2-overexpressing (H2E) (ER-/HER2+). We used time-varying Cox models to assess the association between prevalent and incident metabolic syndrome and risks of recurrence, breast cancer-specific mortality, and all-cause mortality. Metabolic syndrome was associated with a greater risk of recurrence (HR:3.24; 95% CI:1.13-9.33) and breast cancer-specific mortality (HR:5.34; 95% CI:2.32-12.31) only for the H2E subtype, and greater risks of all-cause mortality for luminal (HR:1.92; 95% CI:1.37-2.68), H2E (HR:5.09; 95% CI:2.51-10.32), and all cases combined (HR:1.90; 95% CI:1.42,2.53). We also observed heterogeneity in recurrence and mortality outcomes across specific components of metabolic syndrome and molecular subtypes. Metabolic syndrome is associated with all-cause mortality among women with breast cancer and with breast cancer-specific mortality among women with the H2E subtype. These results highlight the importance of managing comorbidities to decrease the risk for adverse outcomes among breast cancer survivors.

Giant ovarian mucinous cystadenoma complicating term pregnancy: a rare case report

Introduction: Adnexal masses in pregnancy are identified at a rate of 2 to 20 in 1000, which mostly are benign simple cysts. Although the majority of adnexal masses will resolve spontaneously by the beginning of the second trimester, some cases are persistent forms which can result in complications for both mother and fetus. Presentation of case: A 31-year-old pregnant woman was diagnosed with a left ovarian mucinous cystadenoma. The ovarian cyst was first detected in the 8th week of pregnancy, measured 5×5 cm and reached 40×30 cm at 38 weeks of gestation. The patient underwent an elective cesarean delivery along with a left salpingo-oophorectomy at term. An alive female baby of 3000 g was delivered with good APGAR scores at the first and fifth minutes. Histologic examination confirmed the diagnosis of a benign mucinous cystadenoma. Dicussion: The option of surgical intervention versus conservative management should be tailored to the patient’s physical symptoms, characteristics of the tumor, and gestational age. An elective cesarean section along with salpingo-oophorectomy can be adopted for a giant ovarian cyst complicating term pregnancy. There is a risk of recurrence after a removal of ovarian mucinous cystadenoma. Conclusion: Ovarian cysts coexisting with pregnancy should be followed up properly by routine ultrasound and regular antenatal care. The decision to postpone surgical management of a complex mass until the time of delivery must balance the risks and benefits for mother and fetus. After surgery, the patient needs to be provided an appropriate follow-up care to manage postoperative recurrence.

Long non-coding RNAs as prognostic biomarkers in non-muscle invasive bladder cancer: A systematic review

Traditional prognostic tools for non-muscle invasive bladder cancer (NMIBC) often overestimate progression and recurrence risks, underscoring the need for more precise biomarkers. While long non-coding ribonucleic acids (lncRNAs) have been reviewed in bladder cancer, no review has focused on NMIBC. The aim of this study was to address this gap by investigating the role of lncRNAs in predicting NMIBC survival and progression. A systematic review was conducted using PubMed, Scopus, and Cochrane databases as of July 31, 2024. Prognostic studies investigating the association between lncRNA expression and survival outcomes, such as cancer-specific survival, disease-free survival, recurrence-free survival, or overall survival, using Kaplan-Meier curves or hazard ratios, were included. A total of three studies were analyzed, involving 279 NMIBC patients and focusing on three lncRNAs: urothelial cancer associated 1 (UCA1), growth arrest-specific 5 (GAS5), and up-regulated in non-muscle invasive bladder cancer (UNMIBC). Increased UCA1 expression was strongly associated with poor disease-free survival (hazard ratio (HR): 1.974; 95%CI: 1.061–3.673; p=0.032) and progression-free survival (HR: 3.476; 95%CI: 1.187–10.18; p=0.023). Reduced GAS5 expression was significantly associated with poor disease-free survival (HR: 2.659; 95%CI: 1.348–5.576; p=0.005) and progression-free survival (HR: 6.628; 95%CI: 1.494–29.40; p=0.013). Higher level of UNMIBC was strongly associated with poor recurrence-free survival (HR: 2.362; 95%CI: 1.504–4.837; p=0.007). In conclusion, lncRNAs have potential as prognostic biomarkers in NMIBC, with UCA1 and UNMIBC overexpression and GAS5 underexpression being significant in predicting disease recurrence and progression, highlighting the clinical relevance of monitoring these lncRNAs to improve prognosis and guide treatment decisions.

TNFRSF10D expression as a potential biomarker for cisplatin-induced damage and ovarian tumor relapse prediction

Among gynecological malignancies, ovarian cancer (OC) presents the most challenging diagnostic scenario. Despite exhaustive efforts, up to 90% of patients treated with taxane/platinum-based chemotherapy experience relapse, leading to poor survival rates. Identifying new molecular markers that can characterize disease aggressiveness, chemoresistance, recurrence risk, and metastasis is crucial. This study aimed to assess the susceptibility of three ovarian tumor cell lines (TOV-21G, SKOV-3, and OV-90) to cisplatin and paclitaxel, and to investigate the influence of these treatments on the mRNA expression of TANK, RIPK1, NFKB1, TNFRSF10D, and TRAF2. Among the cell lines, SKOV-3 ovarian adenocarcinoma cells demonstrated the highest resistance to cisplatin treatment (0.125mg/mL), followed by TOV-21G (0.076mg/mL) and OV-90 cells (0.028mg/mL). Regarding paclitaxel treatment, the SKOV-3 cell line exhibited the highest resistance (1.4µg/mL), followed by OV-90 (1.3µg/mL) and TOV-21G cells (0.9µg/mL). Gene expression analysis after paclitaxel treatment remained unchanged; however, after cisplatin treatment, TNFRSF10D was observed to be upregulated nearly 100-fold in SKOV-3 compared to all other cell lines studied. SKOV-3 is described as cisplatin and tumor necrosis factor-resistant. Despite the defective signaling of the TNFRSF10D receptor for apoptosis, it can activate the NFKB transcription factor through non-canonical TRAIL signaling, contributing to a pro-inflammatory immune response. In light of this, damage associated with cisplatin increases TNFRSF10D expression and may promote cell survival through non-canonical NFKB pathway activation. This suggests that resistance to TRAIL-induced apoptosis in these cells could serve as a promising chemoresistance biomarker in OC.

Cognitive evaluations of water, urges to drink, and fluid intake in patients with kidney stones

Increasing fluid intake is a core recommendation for reducing risk of kidney stone recurrence. Thirst is often insufficient to motivate the volume of intake recommended to reduce risk, so this study examined cognitive and affective processes that support fluid intake (water and flavored beverages). Patients (N=230) with a history of kidney stones identified from medical records were recruited to complete an online survey. Participants who associated unflavored water with favorable bodily consequences and positive hedonic experiences were likely to have stronger non-thirst-related urges to drink unflavored water, and those who associated unflavored water with negative hedonic experiences were likely to have stronger non-thirst-related urges to drink flavored drinks. Non-thirst-related urges to drink unflavored water were positively associated with water intake volume, but non-thirst-related urges to drink flavored drinks were negatively associated with water intake volume. These findings establish the importance of affective processing as a target for promoting fluid intake in cases where thirst is not sufficient.

Allergen Immunotherapy for a Year Can Effectively Reduce the Risk of Postoperative Recurrence of Adenoid Hypertrophy in Children with Concurrent Allergic Rhinitis (IMPROVEII)

Allergen Immunotherapy for a Year Can Effectively Reduce the Risk of Postoperative Recurrence of Adenoid Hypertrophy in Children with Concurrent Allergic Rhinitis (IMPROVEII)

Analysis of the Incidence and Outcomes of Breast Cancer in Women with Schizophrenia

ObjectiveBreast cancer (BC) is the leading cause of female cancer death in the world and the second leading cause of female cancer death in the U.S, Mortality from breast cancer is even higher in individuals with schizophrenia. The aim of our project was to evaluate the incidence of breast cancer in women with schizophrenia and to compare outcomes between breast cancer patients who were or were not on antipsychotics prior to diagnosis. MethodsThis retrospective study used data from the TriNetX database. Women ≥18 years old diagnosed with schizophrenia were identified. The incidence of primary BC diagnosis between January 2011 and December 2023 was evaluated and stratified by ethnicity.We then conducted a retrospective cohort study to compare outcomes of women ≥18 years who did or did not use antipsychotics one year before BC diagnosis. Patients’ propensity score was matched based on age, obesity, tobacco use, socioeconomic status, cancer stage, chemoradiation, axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), and hormone therapy use. Outcomes of interest were 5-year overall survival, recurrence, chemotherapy need, and lymphedema. Results1,398,475 women ≥18 years old with schizophrenia were identified. Breast cancer incidence in these patients was 0.53% in 2011 and 0.53% in 2022, with a peak in 2017 (1.29%). Non-Hispanic patients were diagnosed with BC approximately 1.3 times more than Hispanic patients.The outcomes study included 183,062 matched patients, with 91,531 per cohort. 5-year survival with the Kaplan-Meier analysis was significantly greater in women not on antipsychotics (72%) compared to those on antipsychotics (60%), log-rank test p-value <0.0001. The risk of local recurrence (13.4% versus 22.6%, p-value <0.0001), chemotherapy need (41.2% versus 48.4%, p-value <0.0001), and lymphedema (7.7% versus 11.5%, p-value <0.0001) were also significantly lower in women who did not take antipsychotics. ConclusionBreast cancer incidence in patients with schizophrenia identified through TriNetX has not experienced a significant uptrend or downtrend over the past decade. Non-Hispanic patients with schizophrenia have a higher incidence of BC than Hispanic patients. Matched breast cancer patients on antipsychotics at least one year prior to diagnosis had higher mortality, recurrence, chemotherapy need, and risk of lymphedema.

A propensity score-matched cost-effectiveness analysis of magnetic resonance-guided laser interstitial thermal therapy versus craniotomy for brain tumor radiation necrosis.

Radiation necrosis is becoming an increasingly prevalent complication in patients with brain tumors given the growing utility of stereotactic radiosurgery in modern treatment paradigms. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive modality that has exhibited an efficacy comparable to craniotomy in treating radiation necrosis. No studies to date have compared their cost-effectiveness despite the significant additional expenses associated with MRgLITT use. This study aimed to evaluate the cost-effectiveness of MRgLITT versus craniotomy in patients with comparable presentations of radiation necrosis. The National Inpatient Sample (NIS) was queried from 2011 to 2020 for patients with radiation necrosis and treated using craniotomy or MRgLITT. Admission charges and costs were inflation adjusted to 2020 $US. Surgical cohorts were propensity score-matched according to demographic, clinical, and admission characteristics. Multivariable linear and logistic regression analyses identified associations between type of intervention and outcomes. A semi-Markov model was created to simulate treatment with craniotomy versus MRgLITT. Cost, transition probabilities, and health state utilities were derived from the NIS, individual patient outcomes from multiple institutions, and prospectively collected quality-of-life data from a single institution and verified against other studies. Monte Carlo simulation and probabilistic sensitivity analysis were used to evaluate the cost-effectiveness between the two modalities. In the designated study period, 2869 patients had been admitted with brain tumor radiation necrosis and were managed with neurosurgical intervention. After propensity score matching, MRgLITT, relative to craniotomy, was independently associated with a shorter length of stay (LOS; β = -1.81, p = 0.002), lower odds of complications (OR 0.18, p = 0.033), and higher odds of home discharge (OR 3.05, p = 0.041), but there was no difference in total admission costs between the two modalities (β = $6229, p = 0.081). On Monte Carlo simulation, patients treated with MRgLITT had a lower probability of disease (radiation necrosis or tumor) recurrence (13.5% vs 22.0%, p < 0.001) but an equivalent mortality risk (22.8% vs 22.3%, p = 0.429) compared to the patients treated with craniotomy at the 1-year follow-up. Over a 4-year time horizon, MRgLITT had an incremental cost of -$25,685 and incremental effectiveness of 0.14 quality-adjusted life-year (QALY), resulting in an incremental cost-effectiveness ratio of -$183,464 per QALY relative to craniotomy. MRgLITT was a more cost-effective treatment strategy than craniotomy in the management of patients with brain tumor radiation necrosis. The cost-effectiveness of MRgLITT may be attributed to a shorter LOS, lower complication odds, and higher home discharge odds in the immediate postoperative period and a lower risk of disease recurrence over the long-term follow-up.

Before, during, and after: An Argument for Safety and Improved Outcome of Thrombolysis in Acute Ischemic Stroke with Direct Oral Anticoagulant Treatment.

Direct oral anticoagulants are the primary stroke prevention option in patients with atrial fibrillation. Anticoagulant use before stroke, however, might inhibit clinician comfort with thrombolysis if a stroke does occur. Resuming anticoagulants after ischemic stroke is also problematic for fear of hemorrhage. We describe extensive literature showing that thrombolysis is safe after stroke with direct anticoagulant use. Early reinstitution of direct anticoagulant treatment is associated with lower risk of embolic recurrence and lower hemorrhage risk. The use of direct anticoagulants before, during, and after thrombolysis appears to be safe and is likely to promote improved outcomes after ischemic stroke. ANN NEUROL 2024;96:871-886.

P067 An interim analysis of the multi center retrospective study PROVIDENCE: Artificial intelligence-based models for estimating the risk of biochemical recurrence with clinical data

P067 An interim analysis of the multi center retrospective study PROVIDENCE: Artificial intelligence-based models for estimating the risk of biochemical recurrence with clinical data

Endoscopic Background Mucosal Resurfacing to Prevent Metachronous Recurrence of Superficial Esophageal Squamous Cancer After Curative Endoscopic Submucosal Dissection: A Randomized Pilot Study With 5-Year Follow-Up (with video)

Background and AimsMetachronous recurrence frequently develops in patients with superficial esophageal squamous cell carcinomas (ESCCs) after curative endoscopic submucosal dissection (ESD), especially in those with multiple (>10) small Lugol-voiding lesions (LVLs) over the esophageal background mucosa (i.e. speckled pattern). We conducted a randomized controlled trial to investigate whether endoscopic radiofrequency ablation (RFA) for esophageal background mucosal resurfacing (EBMR) can decrease the rate of metachronous neoplasia. MethodsPatients who received curative ESD and whose Lugol staining showed a speckled pattern over the background mucosa were randomly assigned in a 1:1 ratio to either receive RFA (EBMR group) or endoscopic surveillance alone (control group). EBMR with RFA was performed with a balloon device for circumferential ablation of the total esophageal mucosa 2–3 months after ESD. The primary outcome was the metachronous recurrence of squamous neoplasia during a 5-year follow-up period. The secondary outcomes were major adverse events. ResultsOf 112 patients screened, 30 were randomized to receive EBMR (n = 15) or surveillance (n = 15). The mean procedure time of EBMR was 30.7 min (range: 25–40 min). One patient developed post-RFA stenosis, which resolved after 3 sessions of endoscopic dilation. EBMR reduced the risk of metachronous recurrence (0% in the EBMR group vs. 53% in the control group, p = 0.001), with the number needed to treat being 1.9. Reversal of the Lugol staining speckled pattern to only a few LVLs occurred in all patients and persisted for at least 5 years in the ablation group. ConclusionIn this randomized trial of patients with multiple small LVLs over the esophageal background after curative ESD, EBMR with balloon-type RFA is a promising and safe procedure for preventing metachronous recurrence over 5 years of follow-up. Clinical trial registration number: NCT03183115.

Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study.

The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF). We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded. A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences. In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.

Clinical characteristics and outcomes of Takotsubo syndrome in patients with chronic obstructive pulmonary disease

Backgroundtakotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a relevant comorbid background, including chronic obstructive pulmonary disease (COPD). However, TTS patients with COPD are still not well characterized. Aimto describe the clinical characteristics and outcomes of patients with TTS and COPD. Methodsn = 440 TTS patients were dichotomized according to the presence of COPD. Endpoint of the study were in-hospital complications (composite of death, major arrhythmias, cardiogenic shock and acute pulmonary edema), TTS recurrence and long-term mortality at follow-up. Resultsmean age of the population was 72±11, 10 % males. COPD prevalence was 16 % (n = 69). On subgroup analysis, patients with COPD were more likely smokers (41 % vs 13 %, p < 0.001), with higher rates of dyspnea and physical triggers at presentation (52 % vs 18 %, p < 0.001 and 52 % vs 32 %, p = 0.001 respectively) and lower left ventricular ejection fraction (36 % vs 39 %, p = 0.035) In-hospital complications were more common in patients with COPD (26 % vs 13 %, p = 0.006), driven by higher rates of acute pulmonary edema (19 % vs 6 %, p < 0.001) and cardiogenic shock (10 % vs 4 %, p = 0.023). At multivariable logistic regression analysis, COPD was independently associated with in-hospital complications occurrence (Odds Ratio 2.10, 95 % CI 1.09–4.05; p = 0.027). At univariable Cox regression analysis COPD was associated with TTS recurrence (Hazard Ratio (HR 9.82, 95 % CI 3.2–30.12; p < 0.001)), at multivariable Cox regression analysis with long-term mortality (HR 2.97, 95 % CI 1.44–6.12; p = 0.003). ConclusionCOPD marks a vulnerable TTS phenotype including higher risk of in-hospital complications, long-term recurrence and mortality.

Recurrent peritonsillar abscess in adults: Incidence and risk factors in a prospective longitudinal cohort

ObjectiveThe incidence of recurrent peritonsillar abscess (7.4–22%) was estimated in retrospective studies. The aim of this prospective study was to estimate the cumulative incidence of recurrent peritonsillar abscess and related risk factors. MethodsWe performed a prospective longitudinal cohort study. The study included adult patients (≥18 years old) of both sexes who were attended in the emergency facilities of our tertiary hospital, without peritonsillar abscess background, diagnosed of a first episode of peritonsillar abscess and treated with standard of care (abscess drainage and antibiotics). Patients were followed for 24 months. Cumulative incidence of peritonsillar abscess recurrence was estimated and its 95% confidence interval was calculated; and predictive risk factors were assessed. ResultsBetween January 1st, 2019 and March 9th, 2020, a total of 181 consecutive patients were included. The cumulative incidence of recurrent peritonsillar abscess at 2 years of the diagnosis was 9.9% (18 out of 181, 95% CI: 6.4–15.2%). The only risk factor associated with recurrent peritonsillar abscess in multivariate analysis was low plasma glucose level at the time of emergency room attendance (HR: 0.46, 95% CI: 0.24–0.91, p-value: 0.026). ConclusionPeritonsillar abscess is an incident medical issue, with an established recurrence rate, but with unclear predictive risk factors of recurrence. Further studies are needed to assess the risk factor associated with recurrent peritonsillar abscess.

P50 Systemic lupus erythematous presenting as Kikuchi-Fujimoto disease complicated with haemophagocytic lymphohistiocytosis: a case report and review of the literature

Abstract Introduction Kikuchi-Fujimoto disease (KFD) or histiocytic necrotising lymphadenitis is a rare, self-limiting inflammatory condition that can be associated with autoimmune connective tissue disorders (CTD) especially systemic lupus erythematosus (SLE). The aetiopathogenesis remains unclear but it is thought to be triggered by an infection in individuals with autoimmune predisposition leading to T-cells mediated apoptosis and inflammatory cascade. This condition most commonly affects children and young adults of Asian descent with a slight female preponderance although it can affect any age and ethnic groups. Cervical lymphadenopathy and fever are the salient manifestations, and it can be fatal if complicated with haemophagocytic lymphohistiocytosis (HLH). Case description A 16 year old girl presented with a 2-month history of persistent fever, progressive bilateral cervical lymphadenopathy, generalised maculopapular rash, angioedema-like facial swelling, oral ulcers and B symptoms. Laboratory investigations revealed pancytopaenia, profound acute phase response and abnormalities consistent with HLH with an HScore of 200 points. A thorough infectious workup was unrevealing apart from serological evidence of past Epstein-Barr virus (EBV) infection. ANA, anti-Sm, anti-RNP and anti-B2GP1 IgG were positive. An ultrasound of her neck showed bilateral multilevel cervical lymphadenopathy and the excision biopsy of her lymph node confirmed features of histiocytic necrotising lymphadenitis and ruled out lymphoma. Notably, there were scattered EBV-positive blasts and the special staining for mycobacteria was negative. A CT scan has also demonstrated bilateral axillary and abdominal lymphadenopathy with no hepatosplenomegaly. There was thrombosis in her right internal jugular vein with no intracranial or cardiac extension of the thrombus. The patient was admitted to ITU for close monitoring due to concerns about possible airway compromise but she did not require any respiratory support. She received intravenous (IV) methylprednisolone pulses for three consecutive days, mycophenolate mofetil, hydroxychloroquine and treatment dose of enoxaparin with good response and did not require IV immunoglobulins (IVIG) and/or interleukin-1 receptor antagonists. However, she subsequently developed an abscess in her neck which was complicated by Staphylococcus aureus bacteraemia and underwent an emergency incision and drainage of the abscess. She recovered well with IV antibiotics and was followed up in the CTD clinic with continuous psychological support from the rheumatology clinical nurse specialists. Discussion KFD most commonly presents with acute to subacute tender cervical lymphadenopathy and fevers which can be associated with other systemic features such as arthralgia, various cutaneous manifestations with great histologic heterogeneity, and neurological manifestations including aseptic meningitis, meningoencephalitis, acute cerebellar syndrome and optic neuritis. Generalised lymphadenopathy has been reported in 22% of cases but hepato- and/or splenomegaly is uncommon (3-5% of cases). Various infectious agents including the EBV have been implicated as the potential trigger of this condition but the evidence remains inconclusive. Our patient’s lymph node biopsy has demonstrated EBV-positive blasts with serological evidence of past EBV infection but a causal relationship between these findings and KFD cannot be established with certainty. It remains a diagnostic challenge to differentiate KFD from the other more sinister pathologies such as lymphoma, various infectious lymphadenitis and autoimmune conditions such as sarcoidosis and Kawasaki disease. Therefore, early excisional biopsy of the affected lymph nodes is essential for establishing the correct diagnosis and may obviate the need for inappropriate treatments. Both KFD and SLE share a complex clinicopathological relationship as SLE may precede, occur concurrently as in this case or develop later following the diagnosis of KFD. Moreover, lupus lymphadenitis can mimic KFD clinically and these two entities can only be distinguished histologically by the demonstration of haematoxylin bodies in lupus lymphadenitis. Our patient developed thrombosis in her right internal jugular vein which was thought to be secondary to the compressive effect from her cervical lymphadenopathy rather than due the antiphospholipid syndrome as her repeat antiphospholipid screen was negative. Key learning points • Clinicians should be aware of this rare clinical entity to make an early diagnosis and avoid unnecessary investigations. Differentiating KFD from the other sinister conditions such as lymphoma remains a diagnostic challenge therefore an early excisional biopsy of the affected lymph nodes would avoid delayed diagnosis and obviate the need for potentially risky treatments. Patients with KFD should be carefully screened and monitored for SLE as it can precede, occur in conjunction with or follow the diagnosis of SLE. Most cases of KFD resolve within 1-6 months although recurrence has been reported in 3-4% and the mortality rate is estimated to be 2.1%. It is crucial to follow up these patients given the increased risk of recurrence which can continue for many years. Despite having a good response to treatments, our patient suffered from significant alopecia and post-inflammatory hyperpigmentation in her skin which has had a great impact on her self-esteem and mental well-being. We would like to highlight in this case the biopsychosocial ramifications of this condition and demonstrate the importance of a multidisciplinary approach in the management of young people with CTD.

The Influence of treatment intervals on prognosis in young breast cancer patients: Insights from the French national cohort

BackgroundSuboptimal treatment delays is known to impact prognosis of patients with cancer but optimal timing in specific subgroups remains poorly studied. This study aimed to analyze treatment delays in young women treated for a breast cancer (BC) on and its impact on their prognosis using French Nationwide Data. MethodsUsing the CAREPAT-YBC Cohort based on the French National Healthcare System Database, we analyzed disease-free survival (DFS) in 22,093 young women (18-45 years) who underwent either surgery-chemotherapy-radiotherapy pathway (adjuvant setting, 15,433 patients) or chemotherapy-surgery-radiotherapy pathway (neoadjuvant setting, 6,660 patients), according to delays between the different pathways. ResultsFor the adjuvant chemotherapy-radiotherapy interval, the best timing was 17-31 days with increased risk above this delay. For the neoadjuvant setting, the optimal neoadjuvant chemotherapy-surgery interval was 17-31 days, while ≤15 days (HR 1.44, 95%CI 1.21-1.71) or ≥62 days (HR 2.07, 95%CI 1.36-3.15) showed poorer prognosis. Combining best timing into an "optimal pathway" was associated with respectively a 1.2-fold decreased risk for recurrence or mortality. ConclusionOptimizing treatment intervals enhance BC survival in younger age.

Disease recurrence in patients undergoing mastectomy for ductal carcinoma in situ.

With DCIS incidence on the rise, up to 30% of patients undergo mastectomy for Ductal carcinoma in situ (DCIS) (Nash and Hwang, in: Ann Surg Oncol 30(6):3206-3214, 2023). Local recurrence rates after mastectomy for DCIS are reportedly low, but risk factors for recurrence are not known (Kim et al., in: J Cancer Res Ther 16(6):1197-1202, 2020). We aim to define risk factors associated with ipsilateral breast cancer recurrence in patients undergoing mastectomy for DCIS. We aimed to identify risk factors that may contribute to recurrence of breast cancer following mastectomy for pure DCIS. We hypothesized that close or positive mastectomy margins, age at diagnosis, extent of breast disease and mutation carriers would be associated with increased risk of recurrence. We performed a retrospective chart review of patients who underwent unilateral or bilateral mastectomies for pure DCIS at a single academic tertiary referral center from 2013 to 2023. There were 165 patients who met inclusion criteria with an average length of follow-up of 39.9months. On final surgical pathology, the average span of DCIS was 33.7mm (± 24.6mm). Hormone receptor positive disease was identified in 80.6% of the patient cohort. For margin status, 23 patients (14%) had < 1mm margins on final pathology and of those, 1 received adjuvant radiation therapy and 4 returned to the OR for re-excision. Only 1 (0.6%) patient had ipsilateral disease recurrence during the study period. Recurrence after mastectomy for pure DCIS is a rare event and in our study sample, only one recurrence occurred. Risk factors for recurrence appear unrelated to margin status, age, extent of DCIS, or pathogenic mutation (ElSherif et al., in Am J Surg 226(5):646-651, 2023).

Evaluation of tumor infiltrating lymphocytes as a prognostic biomarker in patients with ductal carcinoma in situ of the breast.

To assess the association between tumor-infiltrating lymphocytes (TILs) in ductal carcinoma in situ (DCIS) samples and disease recurrence. This retrospective cohort study included women aged 18years and older who underwent treatment between January 2007 and December 2020. Male patients, individuals diagnosed with invasive or microinvasive disease based on anatomopathological examination of surgical specimens, and those with a personal history of any other cancers were excluded. Additionally, the presence of "touching TILs" (lymphocytes in direct contact with tumor cells) and periductal desmoplasia were evaluated as complementary methods to represent the immunological microenvironment. The primary outcome was relapse-free survival based on TIL quantification adjusted for potential confounders. Pathologists assessed TILs in the sample with the highest tumor representation and quantified them as a percentage. Survival was evaluated using Kaplan‒Meier curves, log-rank tests, and Cox regression models. A total of 191 patients met the eligibility criteria. The mean follow-up duration was 77.2months, with a recurrence rate of 9.2%. Patients with TILs ≥ 17% had a greater risk of recurrence (HR 2.97, 95% CI 1.17-7.51; p = 0.02). Additionally, focal necrosis (HR 6.4, 95% CI 1.39-34.71; p = 0.018) or comedonecrosis (HR 4.53, 95% CI 1.34-15.28; p = 0.015) were associated with increased recurrence risk. According to the multivariate model, comedonecrosis and TILs ≥ 17% were significantly associated with recurrence (p = 0.034 and p = 0.035, respectively). Regarding the evaluations of "touching TILs" and periductal desmoplasia, no statistical significance was found when assessing their association with disease recurrence. In our cohort, a high percentage of TILs (≥ 17%) and the presence of comedonecrosis were independently associated with DCIS recurrence.

Psychological impacts of lobectomy and total thyroidectomy in PTC measuring 1 to 4 cm with low to intermediate risk of recurrence.

To investigate the implications of Lobectomy (LT) or total thyroidectomy (TT) on psychological distress and sleep quality in PTC patients with a low to intermediate risk of recurrence and tumors measuring 1 to 4 cm. Patients who were admitted to our hospital between July 2021 and July 2022 were prospectively enrolled in this survey. Psychological distress and sleep quality were assessed at hospitalization, discharge, and 1, 3, and 6 months post-treatment using validated scales. Participants were divided into LT and TT groups, with propensity score matching (PSM) applied for analyses. Among 525 eligible PTC patients, 440 patients completed all the questionnaires throughout the follow-up. After PSM, 166 patients underwent LT, and 166 patients underwent TT were enrolled. The psychological distress and sleep quality of patients in the LT group remained relatively stable during the 6-month follow-up, but patients in the TT group may have faced greater sleep quality concerns in the longitudinal assessment. Additionally, the sleep quality of the TT group was also worse than that of the LT group postoperatively. The sleep quality rather than other psychological distress of patients with PTC with a low to intermediate risk of recurrence is associated with the extent of surgery.

P206 How is the efficacy of patient selection criteria for adjuvant pembrolizumab after curative surgical treatment of clear cell renal cell carcinoma with intermediate to high risk of recurrence? A real-life data analysis from single institutional experience

P206 How is the efficacy of patient selection criteria for adjuvant pembrolizumab after curative surgical treatment of clear cell renal cell carcinoma with intermediate to high risk of recurrence? A real-life data analysis from single institutional experience