Risk Of First Recurrence Research Articles

Risk of first recurrence after treatment in a population-based cohort of young women with breast cancer

PurposeBreast cancer (BC) in women under 45 is rare yet often aggressive. We aim to analyze loco-regional recurrences (LR), distant recurrences (DR), second breast cancers, and mortality in young BC patients.MethodsWe enrolled 776 women with non-metastatic BC ≤45 years diagnosed from 1970 to 2012. Variables included age, family history, tumor stage/grade, and treatment. We used multivariate Cox regression and competing risk models.ResultsAmong the participants, 37.0% were diagnosed before the age of 40. Most had stage I or II, grade II, ER- and PR-positive, HER2-negative tumors. Over a median follow-up of 8.7 years, 10.1% experienced LR, 13.7% developed DR, and 10.8% died, primarily due to BC. The majority of recurrences occurred within the first five years. Older age (>40) significantly reduced the risk of LR and DR. Advanced disease stage, certain surgical strategies, and positive margins increased DR risk. In the cohort diagnosed between 2001 and 2012, recent diagnosis, triple-negative cancer, and hormonal therapy were associated with reduced LR risk. Breast-conserving surgery appeared to offer protective effects against DR.ConclusionThis study highlights that BC in young women carries a significant risk of early recurrence, with age, tumor characteristics, and treatment modalities influencing outcomes. The findings emphasize the need for tailored treatment strategies for young BC patients, focusing on surgical precision and aggressive adjuvant therapy for high-risk cases. This research contributes valuable insights into managing BC in younger patients, aiding in improving long-term outcomes.

The Value of Negative Urinary Dipstick Tests for Haematuria in Patients Undergoing Surveillance for Low-grade Ta Urothelial Cancer: A Two-stage Prospective Clinical Study in 524 Patients

Background and objectiveThe risk of first recurrence beyond 5 yr for patients with low-grade (LG) Ta non–muscle-invasive bladder cancer (NMIBC) is low enough to consider discontinuing cystoscopic surveillance at that point. However, a positive urinary dipstick test for haematuria (UDH) during and beyond the period of cystoscopic surveillance can disrupt plans to cease surveillance because the association between UDH positivity and recurrence in LG Ta NMIBC is unknown. In a two-stage study, we evaluated this association and explored the role of UDH negativity in predicting the absence of recurrence. MethodsBecause of previously demonstrated changes in recurrence patterns over time, two prospective cohorts were assessed: an “exploratory” cohort (January 2007–March 2008) and a “validation” cohort (November 2017–August 2018). UDH was performed before flexible cystoscopy. Patient, operative, and surveillance data have been recorded prospectively using standard pro forma sheets since 1978 in our institution. Only patients with primary LG Ta pTa NMIBC were included for analysis. Key findings and limitationsWe assessed 231 patients in the exploratory group and 293 in the validation group. The proportion of smokers (67% vs 70%; p = 0.5) and mean follow-up (72.2 vs 79.9 mo; p = 0.2) were similar between the groups. The recurrence rate was higher in the exploratory group (19% vs 11%; p = 0.009), as was the UDH positivity rate (37% vs 11%; p < 0.001). The specificity and negative predictive value were 64% and 83% in the exploratory group, and 90% and 90%, respectively, in the validation group. These values increased further for the subgroup with solitary primary tumours the subgroup without recurrence for 3 yr. Conclusions and clinical implicationsUDH negativity has a high probability of being associated with the absence of recurrence in small LG Ta NMIBC and could be an inexpensive adjunct during surveillance. Ongoing validation, which started in 2019, is being performed in a now-nationalised Scottish protocol in which UDH replaces cystoscopy in years 2 and 4 for patients in the low-risk group. Patient summaryWe investigated the accuracy of a dipstick test for blood in the urine for patients undergoing surveillance for low-grade noninvasive bladder cancer. We found that a negative dipstick test result was highly associated with the absence of tumour recurrence, particularly for patients with the lowest risk. These findings have been introduced into a national protocol designed to reduce the frequency of telescopic inspection of the bladder during surveillance to reduce the burden for patients.

Smoking as a Risk Factor for Very Late Recurrence in Surgically Resected Early-Stage Primary Hepatocellular Carcinoma.

The risk of first recurrence of hepatocellular carcinoma (HCC) within years 5 to 10 after curative hepatectomy remains unknown. We aimed to assess the incidence and prognostic factors for very late recurrence among patients who achieved 5 years' recurrence-free survival (RFS) after primary resection. We retrospectively analyzed 337 patients with early-stage HCC underwent primary tumor resection and achieved more than 5 years' RFS. A total of 77 patients (22.8%) developed very late recurrence. The cumulative very late recurrence rate increased from 6.9% and 11.7% to 16.6% at 6, 7, and 8 years, respectively. Patients stopped smoking had a higher rate of very late RFS. The high rates of very late recurrence in HCC indicate that patients warrant continued surveillance, even after 5 recurrence-free years. Moreover, smoking is a risk factor for very late HCC recurrence, and quitting smoking may reduce the risk of very late recurrence.

Is melancholia a distinct syndrome? Recurrence, chronicity, and severity give evidence in the 50 year follow-up of the Lundby Study.

Whether melancholia is a distinct syndrome has long been debated. One aspect of a valid syndrome is whether it allows for determination of a prognosis. The aim of this study is to investigate the course of melancholic depression versus non-melancholic depression with a focus on: (i) time to and probability of recovery from the first depressive episode, (ii) time to and risk of the first recurrence, (iii) rate of recurrence, (iv) time with depression or antidepressant medication, and (v) suicide risk. The Lundby Study is a longitudinal community study on mental health that followed a geographically defined population (N = 3,563) for up to 50 years, 1947-1997. Subjects with first onset depression were assessed as melancholic (N = 46) or non-melancholic (N = 381) using the DSM-IV melancholic specifier. These diagnoses were made in retrospect using all available information from semi-structured interviews by psychiatrists, key informants, registers, and patient records. We found no significant difference between melancholic- and non-melancholic depression in time to and probability of recovery from the first depressive episode. The time to first recurrence was shorter in melancholic than in non-melancholic depression and the risk of first recurrence for the melancholic group was 2.77 (95% confidence interval [CI] 1.83-4.20) times the risk in the non-melancholic group. The median rate of recurrence was higher in the melancholic group, at 0.19 recurrences per year at risk (interquartile range [IQR] 0.08-0.47), compared to the non-melancholic group, at 0.10 recurrences per year at risk (IQR 0.05-0.21) (p < 0.03). The median percentage of time being depressed or on antidepressant medication was higher in the melancholic group, 17% (IQR 3-20%), compared to the non-melancholic group, 8% (IQR 7-33%) (p < 0.001). The risk of suicide was higher in the melancholic group, hazard ratio 4.13 (95% CI 1.49-11.48, p < 0.01). To conclude, melancholic depression had a more recurrent, chronic, and severe course with a higher suicide risk than did non-melancholic depression in the Lundby population. Although our use of retrospective diagnosis might limit interpretation of results, the findings indicate that melancholia may be useful in determining prognosis and may be a valid psychopathological syndrome.

The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study

BackgroundPsychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive–compulsive disorder (OCD) affect the recurrence of BPPV.MethodsA retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse.ResultsDuring the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence.ConclusionsThe presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.

Long-term follow-up of survivors of a first acute coronary syndrome: Results from the French MONICA registries from 2009 to 2017

AimThe objectives of the study were to characterize the long-term risk of first recurrence of acute coronary syndrome (ACS) among survivors of an incident ACS, as a function of the STEMI/NSTEMI/UA diagnosis. MethodsMen and women (aged 35–74) hospitalized between 2009 and 2016 for an incident ACS in the French MONICA registries and still alive on discharge were followed-up until December 2017. Recurrent events were defined as the first (non-fatal or fatal) ACS occurring after hospital discharge from the incident event. ResultsThe study comprised 15,739 incident ACSs with 63,777 patient-years of follow-up. The cumulative probability [95% confidence interval] of recurrent ACS was 6.7% [6.3–7.1%] at 1 year and 18.4% [17.4–19.5%] at 9 years. The cumulative probability of fatal recurrent ACS was 1.4% [1.2–1.5%] at 1 year and 4.3% [3.6–4.9%] at 9 years. The risk of recurrence did not depend on the type of the incident ACS after adjustment for confounding factors. The most frequent forms of recurrence were NSTEMI and UA. The presence of a major complication (OR = 1.59) and an impaired left ventricular ejection fraction (LVEF) (OR > 1.26) increased the risk of recurrence. The annual 1-year recurrence rates decreased from 7.4% in 2009 to 4.0% in 2016 (p < 0.001). ConclusionThe recurrence rate after an incident ACS remained high in France, and the risk of recurrence did not depend on the etiology of the first event. Our results emphasize the importance of targeting patients with a major complication and/or an impaired LVEF who are at a higher risk of recurrence.

Risk and tropism of central nervous system (CNS) metastases in patients with stage II and III cutaneous melanoma.

Recent data suggest that patients with stage III melanoma are at high risk for developing central nervous system (CNS) metastases. Because a subset of patients with stage II melanoma experiences worse survival outcomes than some patients with stage III disease, the authors investigated the risk of CNS metastasis in stage II melanoma to inform surveillance guidelines for this population. The authors examined clinicopathologic data prospectively collected from 1054 patients who had cutaneous melanoma. The χ2 test, the cumulative incidence, and Cox multivariable regression analyses were performed to evaluate the association between baseline characteristics and the development of CNS metastases. Patients with stage III melanoma had a higher rate of developing brain metastases than those with stage II melanoma (100 of 468 patients [21.4%] vs. 82 of 586 patients [14.0%], respectively; p =.002). However, patients who had stage IIC melanoma had a significantly higher rate of isolated first recurrences in the CNS compared with those who had stage III disease (12.1% vs. 3.6%; p=.002). The risk of ever developing brain metastases was similarly elevated for patients who had stage IIC disease (hazard ratio [HR], 3.16; 95% CI, 1.77-5.66), stage IIIB disease (HR, 2.83; 95% CI, 1.63-4.91), and stage IIIC disease (HR, 2.93; 95% CI, 1.81-4.74), and the risk was highest in patients who had stage IIID disease (HR, 8.59; 95% CI: 4.11-17.97). Patients with stage IIC melanoma are at elevated risk for first recurrence in the CNS. Surveillance strategies that incorporate serial neuroimaging should be considered for these individuals until more accurate predictive markers can be identified.

The risk factors of first recurrence in ischemic stroke patients in different periods after first attack

Objective: To investigate the risk factors of first recurrence in ischemic stroke patients at different periods after first attack. Methods: The subjects were from the screening population of China National Stroke Screening Survey (CNSSS) from 2013 to 2015. The basic demographic information, stroke history, influencing factors and modified Rankin Scale (mRs) scores were collected by using standardized face-to-face questionnaires. A case-control study was conducted to investigate the risk factors of first recurrence in ischemic stroke patients who relapsed for the first time within 12 months, 24 months and 36 months as the case group and non-recurrent ischemic stroke patients as the control group. Further, the subjects were stratified into different subgroups by age, gender and urban-rural distribution to investigate the risk factors of first recurrence in different periods. Results: Diabetes (OR=1.71, 95%CI: 1.08-2.71) and coronary heart disease (OR=1.55, 95%CI: 1.09-2.19) were significantly associated with the risk of first recurrence within 12 months after the first onset of ischemic stroke. The diabetes was significantly associated with the risk of first recurrence within 24 months (OR=1.94, 95%CI: 1.33-2.83) and 36 months (OR=1.64, 95%CI: 1.15-2.34) after the first onset of ischemic stroke. With the increase of mRs score, the risk of first recurrence within 12 months, 24 months and 36 months in ischemic stroke patients increased significantly. In the same period, the risk factors of ischemic stroke recurrence differed in patients with different age, gender and urban-rural distribution. Conclusions: The risk factors of first recurrence in ischemic stroke patients are diverse at different periods after the first onset of ischemic stroke. In different subgroups, the risk factors of first recurrence and the strength of its corresponding association are also different.

MP49-10 IMPACT OF SURGICAL APPROACH (OPEN VS. MINIMALLY INVASIVE) ON ONCOLOGICAL OUTCOMES AFTER NEPHRECTOMY FOR LOCALISED RENAL CELL CARCINOMA: A RECUR DATABASE PROJECT

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-10 IMPACT OF SURGICAL APPROACH (OPEN VS. MINIMALLY INVASIVE) ON ONCOLOGICAL OUTCOMES AFTER NEPHRECTOMY FOR LOCALISED RENAL CELL CARCINOMA: A RECUR DATABASE PROJECT Giuseppe Fallara, Alessandro Larcher, Saeed Dabestani, Nicola Fossati, Petrus Järvinen, Harry Nisen, Eirikur Gudmundsson, Thomas B. Lam, Lorenzo Marconi, Sergio Fernandéz-Pello, Richard P. Meijer, Alessandro Volpe, Christian Beisland, Tobias Klatte, Grant D. Stewart, Börje Ljungberg, Francesco Montorsi, Axel Bex, and Umberto Capitanio Giuseppe FallaraGiuseppe Fallara More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Saeed DabestaniSaeed Dabestani More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Petrus JärvinenPetrus Järvinen More articles by this author , Harry NisenHarry Nisen More articles by this author , Eirikur GudmundssonEirikur Gudmundsson More articles by this author , Thomas B. LamThomas B. Lam More articles by this author , Lorenzo MarconiLorenzo Marconi More articles by this author , Sergio Fernandéz-PelloSergio Fernandéz-Pello More articles by this author , Richard P. MeijerRichard P. Meijer More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , Christian BeislandChristian Beisland More articles by this author , Tobias KlatteTobias Klatte More articles by this author , Grant D. StewartGrant D. Stewart More articles by this author , Börje LjungbergBörje Ljungberg More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Axel BexAxel Bex More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The impact of open or minimally invasive surgery (either laparoscopic or robotic approach) on survival and disease recurrence in the management of non-metastatic renal cell carcinoma (RCC) remains uncertain. In this cohort study we assessed the impact of surgical approach on survival and on site-specific risk of first metastasis. METHODS: We used the RECUR database, a retrospective multi-institutional database of men diagnosed with RCC and submitted to renal surgery. We selected patient with pT1-3N0M0 RCC, and after propensity score matching (1:1 ratio, matching for age, year of surgery, gender, clinical size and pathological T stage surgical) a for open vs. minimally invasive surgery, either laparoscopic- or robot-assisted, the impact of surgical modality on overall survival (OS) and Progression-free Survival (PFS, including both distant or local recurrence) were assessed by use of Kaplan-Meier and multivariable Cox regression analyses. Site-specific risk of first recurrence, i.e. local recurrence or abdominal, thoracic and uncommon sites metastasis, was investigated by use of competing risk regression and cumulative incidence curves. In case of local recurrence propensity score matching model was implemented with surgical technique (partial vs. radical nephrectomy) RESULTS: After matching, 1027 patients in open and 1027in minimally invasive surgery were included in the study. After a median follow up of 62 months, 124 patients in open and 127 in minimally invasive group developed local recurrence and/or distant metastsis; no differences were found in terms of OS (HR 0.88; 95% confidence interval [CI] 0.71-1.04; p=0.24) and PFS (HR 1.05; 95%CI 0.81-1.35; p-value=0.73) between the two groups. A higher risk of local recurrence (sHR 2.65; 95% CI 1.42-4.97; p-value 0.002) and uncommon site metastases (sHR 1.6; 95 CI 1.02-2.52; p-value 0.042) was found for minimally invasive surgery. CONCLUSIONS: No differences were found in terms of OS and PFS between open and minimally invasive surgery. However, the risk for local recurrence and uncommon metastases was statistically higher for minimally invasive surgery. Given the overall low risk of recurrence, careful surveillance is the best management option for most patients. Source of Funding: © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e879-e879 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Fallara More articles by this author Alessandro Larcher More articles by this author Saeed Dabestani More articles by this author Nicola Fossati More articles by this author Petrus Järvinen More articles by this author Harry Nisen More articles by this author Eirikur Gudmundsson More articles by this author Thomas B. Lam More articles by this author Lorenzo Marconi More articles by this author Sergio Fernandéz-Pello More articles by this author Richard P. Meijer More articles by this author Alessandro Volpe More articles by this author Christian Beisland More articles by this author Tobias Klatte More articles by this author Grant D. Stewart More articles by this author Börje Ljungberg More articles by this author Francesco Montorsi More articles by this author Axel Bex More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement Loading ...

Parathyroidectomy for nephrolithiasis in primary hyperparathyroidism: Beneficial but not a panacea

BackgroundNephrolithiasis is a classic indication for parathyroidectomy in primary hyperparathyroidism patients; however, the effects of parathyroidectomy on nephrolithiasis recurrence are not well studied. The aim was to determine effect of parathyroidectomy on time to first nephrolithiasis recurrence and recurrence rate per patient-years. MethodsA retrospective cohort study of patients diagnosed with primary hyperparathyroidism and at least one episode of nephrolithiasis was performed. The patients were divided into observation, presurgery, and postsurgery groups. Endpoints were time to first recurrence of nephrolithiasis and average recurrence rate per patient-years. ResultsThe cohort was comprised of 1,252 patients. In addition, 334 (27%) patients underwent parathyroidectomy and 918 (73%) were observed. The surgical and nonsurgical groups differed significantly in age, sex, Charlson, calcium, and primary hyperparathyroidism level. Overall recurrence rate was 31.3%. The 5-, 10-, and 15-year recurrence-free survival rates were 74.4%, 56.3%, 49.5%, respectively (presurgery), 82.4%, 70.9%, 62.8%, respectively (postsurgery; P < .0001), and 86.3%, 77.7%, and 70.6%, respectively (observation). The presurgery group had an increased risk of first recurrence compared with the observation group (hazard ratio 1.89; 95% confidence interval, 1.44–2.47). The average recurrence rates among all surgical patients who recurred were 1 event per 4.3 patient-years presurgery versus 1 event per 6.7 patient-years postsurgery (P = .0001). ConclusionRecurrent nephrolithiasis is a significant problem in patients with primary hyperparathyroidism. Parathyroidectomy prolongs the time to first recurrence and decreases the number of re-recurrences over time but does not eliminate recurrences. Observation may also be a reasonable approach in selected patients.

Androgen Receptor Predicts First and Multiple Recurrences in Non-Muscle Invasive Urothelial Carcinoma of the Bladder.

The aim of this study is to investigate the role of androgen receptor (AR) expression on clinicopathologic characteristics, first recurrence free survival (RFS), progression free survival (PFS) and multiple recurrences in non-muscle invasive bladder cancer (NMIBC). AR expression in 40 paraffin-embedded specimens of primarily diagnosed NMIBC after transurethral resection was examined by immunohistochemistry using a monoclonal AR antibody. Associations between AR expression and clinicopathologic features and prognosis were statistically assessed. Multivariate Cox proportional hazards model was applied for evaluating predictive factors on RFS and PFS. For multiple recurrences, we used the Andersen-Gill model. AR was positive in 20/40 (50%) cases. Twenty-three patients (57.5%) had no recurrence, 10 (25.0%) had one recurrence, and 7 (17.5%) experienced more than one recurrence. AR expression and clinicopathologic features were not significantly correlated (P >0.05). Univariate analyses showed that AR expression was significantly associated with RFS and PFS (P <0.05). Via multivariate analyses, positive AR expression was significantly associated with lower risk of first recurrence (hazard ratio (HR) = 0.265; 95% confidence interval (95% CI) = 0.084-0.829; P = 0.022). Multivariate analysis of PFS was not feasible in our cohort. Using the multivariate Andersen-Gill model, positive AR expression in the primary tumor was an independent factor predicting lower risk of multiple recurrences (HR = 0.387, 95% CI = 0.161-0.927, P = 0.033). Androgen receptor expression is associated with first and multiple recurrences in NMIBC.

Derivation and Validation of a Clostridium difficile Infection Recurrence Prediction Rule in a National Cohort of Veterans.

Prior studies have identified risk factors for recurrent Clostridium difficile infection (CDI), but few studies have integrated these factors into a clinical prediction rule that can aid clinical decision-making. The objectives of this study were to derive and validate a CDI recurrence prediction rule to identify patients at risk for first recurrence in a national cohort of veterans. Retrospective cohort study. Veterans Affairs Informatics and Computing Infrastructure. A total of 22,615 adult Veterans Health Administration beneficiaries with first-episode CDI between October 1, 2002, and September 30, 2014; of these patients, 7538 were assigned to the derivation cohort and 15,077 to the validation cohort. A 60-day CDI recurrence prediction rule was created in a derivation cohort using backward logistic regression. Those variables significant at p<0.01 were assigned an integer score proportional to the regression coefficient. The model was then validated in the derivation cohort and a separate validation cohort. Patients were then split into three risk categories, and rates of recurrence were described for each category. The CDI recurrence prediction rule included the following predictor variables with their respective point values: prior third- and fourth-generation cephalosporins (1 point), prior proton pump inhibitors (1 point), prior antidiarrheals (1 point), nonsevere CDI (2 points), and community-onset CDI (3 points). In the derivation cohort, the 60-day CDI recurrence risk for each score ranged from 7.5% (0 points) to 57.9% (8 points). The risk score was strongly correlated with recurrence (R2 =0.94). Patients were split into low-risk (0-2 points), medium-risk (3-5 points), and high-risk (6-8 points) classes and had the following recurrence rates: 8.9%, 20.2%, and 35.0%, respectively. Findings were similar in the validation cohort. Several CDI and patient-specific factors were independently associated with 60-day CDI recurrence risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were strongly correlated with CDI recurrence. This clinical prediction rule can be used by providers to identify patients at high risk for CDI recurrence and help guide preventive strategy decisions, while accounting for clinical judgment.

Patterns and predictors of first and subsequent recurrence in women with early breast cancer

PurposeLittle is known about the occurrence, timing and prognostic factors for first and also subsequent local (LR), regional (RR) or distant (DM) breast cancer recurrence. As current follow-up is still consensus-based, more information on the patterns and predictors of subsequent recurrences can inform more personalized follow-up decisions.MethodsWomen diagnosed with stage I-III invasive breast cancer who were treated with curative intent were selected from the Netherlands Cancer Registry (N = 9342). Extended Cox regression was used to model the hazard of recurrence over ten years of follow-up for not only site-specific first, but also subsequent recurrences after LR or RR.ResultsIn total, 362 patients had LR, 148 RR and 1343 DM as first recurrence. The risk of first recurrence was highest during the second year post-diagnosis (3.9%; 95% CI 3.5–4.3) with similar patterns for LR, RR and DM. Young age (<40), tumour size >2 cm, tumour grade II/III, positive lymph nodes, multifocality and no chemotherapy were prognostic factors for first recurrence. The risk of developing a second recurrence after LR or RR (N = 176) was significantly higher after RR than after LR (50 vs 29%; p < 0.001). After a second LR or RR, more than half of the women were diagnosed with a third recurrence.ConclusionsAlthough the risk of subsequent recurrence is high, absolute incidence remains low. Also, almost half the second recurrences are detected in the first year after previous recurrence and more than 80% are DM. This suggests that more intensive follow-up for early detection subsequent recurrence is not likely to be (cost-)effective.

Risk Factors, Clinical Features, and Treatment Outcomes of Recurrent Mooren Ulcers in China.

To investigate risk factors, clinical features, and treatment outcomes of recurrent Mooren ulcers in China. Medical records of 139 patients (173 eyes) with Mooren ulcers, including 37 patients (38 eyes) with recurrence, were retrospectively reviewed. Clinical features and treatment outcomes were evaluated. The risk factors for ulcer recurrence were analyzed with logistic regression; the cumulative risk of recurrence was assessed with Kaplan-Meier analysis. The ratio of males to females with Mooren ulcers was 1.62:1. As to age, 32 of 106 patients aged >35 years and 5 of 33 younger patients (28 males and 9 females) had recurrence. Forty-one patients had bilateral disease (7 eyes removed before their visit to our hospital were excluded) and 98 patients had unilateral disease, with recurrence in 10 and 27 patients, respectively. Thirty eyes had recurrence around the primary lesion; 27 eyes had recurrence within 12 months after treatment. Of all eyes, 97.7% were saved and 81.5% retained vision better than 0.05. The cumulative risk of first recurrence at 6, 12, 24, 36, and 48 months was 10.4%, 17.1%, 22.5%, 27.2%, and 28.6%, respectively. Male sex (P = 0.043) and surgical treatment (P = 0.035) were significantly associated with an increased risk of recurrence. This study provided the clinical characteristics and treatment outcomes of patients with recurrent Mooren ulcers in China. The cumulative risk of first recurrence at 4 years after treatment was 28.6%. Male patients and patients with severe ulcers that required surgery had an increased risk of recurrence.

Areca Nut Chewing and an Impaired Estimated Glomerular Filtration Rate as Significant Risk Factors for Non-Muscle-Invasive Bladder Cancer Recurrence.

The present study sought to investigate the predictive value of preoperative clinicopathological variables, with a special focus on areca nut chewing, on disease recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC). Data from 242 patients diagnosed with NMIBC between 2008 and 2013 were analyzed retrospectively. Fifteen clinicopathological variables were analyzed to evaluate their prognostic value. During a mean observation period of 21 months, disease recurrence occurred in 140 patients (57.9%). On multivariate analysis, heavy-areca nut chewing (HR = 2.18, 95% CI: 1.37–3.47), current smoking (HR = 3.09, 95% CI: 1.99–4.80), moderately impaired estimated glomerular filtration rate (eGFR) (HR = 1.76, 95% CI: 1.09–2.83), severely impaired eGFR (HR = 3.32, 95% CI: 1.70–6.48) and tumor grade (HR = 1.94, 95% CI: 1.36–2.77) were independent factors for recurrence, based on which a risk factor model was developed to stratify patients into high, medium and low risk groups. In conclusion, our study suggests that in addition to quitting smoking, quitting areca nut chewing may also reduce the risk of first recurrence in NMBIC patients, monitoring and preserving their renal function may be beneficial as well. Further prospective studies are needed to verify the prognostic significance of these factors and the risk stratification model in this population.

Abstract ES4-1: Which patients can safely avoid radiation after breast conserving surgery?

Abstract Whether or not there is a subgroup of patients from whom adjuvant RT can be safely omitted after breast conserving surgery (BCS) for invasive breast cancer (IBC) remains controversial. The Oxford overview (1) shows that whole breast RT (WBRT) after BCS for IBC halves the risk of first recurrence. However the absolute reduction in ipsilateral breast tumour recurrence (IBTR) in ER+ older patients is modest.Guidelines on the omission of RT after BCS vary. The issue is complicated by falling IBTR rates after BCS, adjuvant endocrine therapy (AET) and RT, now around 2-3% at 5 years. The CALGB 9343 trial in women with T1, ER+ tumours receiving tamoxifen and randomized to WBRT or not showed a 3% reduction in local recurrence at 5 years from RT (1% vs 4%,p=&amp;lt;0.001) [2] At a median follow up of 10.5 years the difference in local recurrence had widened in favour of RT (2% RT+, 9% RT-)[3].The PRIME 2 trial randomised 1326 patients with T1-T2 (up to 3cm), pNO, hormone receptor positive tumours =/&amp;gt;65 years after BCS and AET to WBRT or no WBRT. It showed a 2.8% reduction in IBTR from RT (4.1% vs 1.3%,p=0.002) at a median follow up of 5 years(4). An unplanned subgroup analysis by ER status showed a 2.1% reduction in local recurrence (1.2% RT+, 3.3% RT-) from RT but should be interpreted cautiously. However omission of WBRT might be discussed with such patients as an option. Modest absolute improvements in local control from WBRT have to be balanced against increased rates of major coronary events (5).The risk of IBTR is influenced by local therapy, systemic therapy and biology (6).To refine selection of low risk patients, molecular markers of low risk are needed. If molecular signatures of radiosensitivity for breast cancer (7) can be validated from mature RCTs of BCS +/RT, selection of patients cured by surgery and adjuvant endocrine therapy alone could be strengthened.

Hospitalisation, surgical and medical recurrence rates in inflammatory bowel disease 2003–2011—A Danish population-based cohort study

ObjectiveThe aim of this study is to evaluate the cumulative probability of recurrence and admission rates in an inflammatory bowel disease (IBD) inception cohort diagnosed in 2003–2004. MethodsData on medications, phenotypes and surgery for 513 individuals with ulcerative colitis (UC, n=300) and Crohn's disease (CD, n=213) were obtained from medical records and linked to population-based health administrative database information. The admission rates and cumulative probability of recurrences were estimated, and the association with the baseline factors and medication was tested. ResultsThe cumulative risk of first recurrence after 1, 5 and 7years was 40%, 63%, and 66% in CD patients and 51%, 75%, and 79% in UC patients, respectively. The cumulative risk of first surgical relapse was 6%, 18%, and 23% at 1, 5 and 7years in CD respectively. One hundred and CD patients (66%) and 142 UC patients (47%) had at least one IBD-related hospitalisation. The hospitalisation rate decreased from 7.0days/person-year in year one to 0.9day at year 5 in CD, and from 4.7days to 0.4days for UC patients. Age above 40, current smoking, stricturing behaviour, and disease localisation (colonic, ileocolonic, and upper-GI) at diagnosis were predictors of recurrence in CD. In UC, age above 40 and former smoker status were predictors of recurrence and left-sided and extensive colitis were predictors of first-time hospitalisation. ConclusionIn an era of improved treatment options, the recurrence rates, but not the surgery or hospitalisation rates, have decreased for CD but not for UC. The phenotypic characteristics at diagnosis predict the risk of recurrence and hospitalisation.

Radiotherapy Issues in Elderly Breast Cancer Patients

Breast cancer in the elderly is a rising health care chal lenge. Undertreatment is common. While the propor tion of older patients receiving adjuvant radiotherapy (RT) is rising, the proportion undergoing breastconserv ing surgery without irradiation has also risen. The evi dence base for locoregional treatment is limited, reflect ing the historical exclusion of older patients from randomised trials. The 2011 Oxford overview shows that the risk of first recurrence is halved in all age groups by adjuvant RT after breastconserving surgery, although the absolute benefit in older ‘lowrisk’ patients is small. There is level 1 evidence that a breast boost after breast conserving surgery and wholebreast irradiation reduces local recurrence in older as in younger women, although in the former the absolute reduction is modest. Partial breast irradiation (external beam or intraoperative or postoperative brachytherapy) is potentially an attractive option for older patients, but the evidence base is insuf ficient to recommend it routinely. Similarly, shortened (hypofractionated) dose fraction schedules may be more convenient for older patients and are supported by level 1 evidence. There remains uncertainty about whether there is a subgroup of older lowrisk patients in whom postoperative RT can be omitted after breastconserving surgery. Biomarkers of ‘low risk’ are needed to refine the selection of patients for the omission of adjuvant RT. The role of postmastectomy irradiation is well estab lished for ‘highrisk’ patients but uncertain in the inter mediaterisk category of patients with 1–3 involved axil lary nodes or nodenegative patients with other risk factors where its role is investigational.

Predicting atrial fibrillation recurrence with circulating inflammatory markers in patients in sinus rhythm at high risk for atrial fibrillation: data from the GISSI atrial fibrillation trial

BackgroundInflammation may play a significant role in the pathogenesis of atrial fibrillation (AF).ObjectivesTo examine the roles of three systemic inflammatory markers in predicting recurrent AF.MethodsThe association between the plasma concentrations...

Risk factors for ischaemic stroke recurrence after hospitalisation.

To determine risk factors for ischaemic stroke recurrence among patients admitted to hospital for a first-ever occurrence of ischaemic stroke. Retrospective study involving linked hospitalisation and death records. The cohort comprised 7816 people who were hospitalised for first-ever ischaemic stroke between July 1995 and December 1999 in Western Australia. Cox's proportional hazards model was used to identify risk factors for stroke recurrence. Time to first recurrence; cumulative recurrence risk; risk factors for recurrence. The median time to first stroke recurrence was 255 days. The cumulative probability of first recurrence was 5.1% (95% CI, 4.6%-5.7%) at 6 months, 8.4% (95% CI, 7.6%-9.1%) at 1 year and 19.8% (95% CI, 18.1%-21.4%) at 4 years. The risk of first recurrence was increased by advancing age (hazard ratio [HR], 1.03; 95% CI, 1.02-1.04), Aboriginality (HR, 1.50; 95% CI, 1.02-2.22), diabetes (HR, 1.27; 95% CI, 1.07-1.51), a history of cardiac conditions (HR, 1.18; 95% CI, 1.01-1.38), post-stroke urinary incontinence (HR, 1.27; 95% CI, 1.03-1.57) and transfer to another hospital on index admission (HR, 1.26; 95% CI, 1.08-1.46). Admission at first stroke occurrence to a hospital maintaining a stroke unit reduced the risk of recurrence (HR, 0.84; 95% CI, 0.72-0.99). The risk factors identified in our study have implications for planning secondary prevention strategies. In particular, Aboriginality and transfer to another hospital upon admission for first-ever ischaemic stroke were important risk factors. Research into the level of compliance and access to stroke treatment by Aboriginal patients to prevent further strokes is required.