Significant Difference In 5-year Disease-free Survival Research Articles

Five-year long-term comparison of robotic and laparoscopic gastrectomy for gastric cancer: a large single-center cohort study.

Robotic gastrectomy (RG) has been reported to be technically feasible and safe for patients with gastric cancer. However, 5-year long-term survival and recurrence outcomes for advanced gastric cancer have rarely been reported. This study aimed to compare the long-term oncologic outcomes between RG and laparoscopic gastrectomy (LG) for gastric cancer. The general clinicopathological data of 1905 consecutive patients who underwent RG and LG were retrospectively collected at the Chinese People's Liberation Army General Hospital between November 2011 and October 2017. Propensity score matching (PSM) was used to match groups. The primary endpoints were 5-year disease-free survival (DFS) and overall survival (OS). After PSM, a well-balanced cohort of 283 patients in the RG group and 701 patients in the LG group were included in the analysis. The 5-year cumulative DFS rates were 67.28% in the robotic group and 70.41% in the laparoscopic group. The 5-year OS rate was 69.01% in the robotic group and 69.58% in the laparoscopic group. No significant differences in Kaplan-Meier survival curves for DFS (HR = 1.08, 95% CI 0.83-1.39, Log-rank P = 0.557) and OS (HR = 1.02, 95% CI 0.78-1.34, Log-rank P = 0.850) were observed between the 2 groups. In the subgroup analyses for potential confounding variables, there were no significant differences in 5-year DFS and 5-year OS survival between the 2 groups (P > 0.05), except for patients with pathological stage III and pathological stage N3 (P < 0.05). For patients with early gastric cancer, robotic and laparoscopic approaches have similar long-term survival. For patients with advanced gastric cancer, further studies need to be conducted to assess the long-term survival outcomes of RG.

Clinicopathological analysis and surgical strategy of primary appendiceal neoplasms

Objective: To investigate the clinicopathological features, surgical methods and prognosis of primary appendiceal neoplasms. Methods: A descriptive case series study was performed. Clinical data of patients diagnosed with primary appendiceal neoplasms in Peking University First Hospital from 2006 to 2017 were retrospectively analyzed. Patients who underwent surgery and were confirmed as appendiceal neoplasms by postoperative pathology were included. Cases of cecal tumor invading the appendix and other organ tumors implanting in the appendix and cases of recurrent appendix tumors were excluded Pathological classification was based on the 4th edition of the WHO classification of digestive tract tumors (2010 edition), and the efficacy of operation methods of low grade appendiceal mucinous neoplasm (LAMN) were analyzed. Results: A total of 115 patients were enrolled, including 52 males and 63 females with a median age of 59 (51, 71) years. Clinical symptoms usually manifested as dormant pain in the right lower quadrant, migrating right lower abdominal pain, fever and bloating. Twenty-four cases were accidentally discovered during surgery, and 21 cases were found by physical examination. The preoperative diagnosis rate of CT and ultrasound was 40.2% (43/107) and 25.5% (24/94) respectively. The postoperative pathological types contained 83 cases of LAMN, 12 cases of mucinous adenocarcinoma, 9 cases of appendiceal neuroendocrine neoplasms (aNEN), 2 cases of mucinous adenocarcinoma with signet ring cells, 3 cases of serrated adenoma, 2 cases of goblet cell carcinoid, 2 cases of lymphoma, 1 case of leiomyoma and 1 case of schwannomas. All the patients underwent surgical resection, including 41 cases of appendectomy, 21 cases of partial cecectomy, 48 cases of right hemicolectomy, and 5 cases of combined organ resection due to appendiceal tumor infiltration or dissemination. Eighteen cases were diagnosed with pseudomyxoma peritonei (PMP) during operation. A total of 98 patients were enrolled for follow-up. The median follow-up time was 58 (5-172) months. The 5-year disease-free survival (DFS) rate was 84.5% and 5-year overall survival (OS) was 88.2%. Multivariate analysis revealed that high-grade malignancy tumors (HR=25.881, 95% CI: 2.827-236.935, P=0.004) and PMP formation (HR=42.166, 95% CI: 3.470-512.439,P=0.003) were independent risk factors for prognosis. Patients undergoing right hemicolectomy presented longer operation time, more blood loss and higher morbidity of complication as compared to those undergoing appendectomy and partial cecectomy (all P<0.05), while no significant differences in 5-year DFS (P=0.627) and 5-year OS (P=0.718) were found. Conclusions: Primary appendiceal neoplasms usually have no typical features, accompanied with low preoperative diagnosis rate. The common pathological types are LAMN, mucinous adenocarcinoma and aNEN. Appendectomy or partial cecectomy for LAMN may achieve satisfactory prognosis. High-grade malignancy tumors and PMP formation are independent risk factors for prognosis.

Abstract P4-12-13: Correlation of radiotherapy with the prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping

Abstract Objective:The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone-receptor-positive early breast cancer. Methods:A retrospective analysis of 327 patients aged ≥65 years with stage I-II, hormone receptor positive breast cancer who underwent breast conserving surgery and received endocrine therapy (ET) or radiotherapy plus endocrine therapy (ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease free survival (DFS), local relapse rate (LRR), overall survival (OS), and distant metastasis rate (DMR). Results:There were significant differences in 5-year DFS (HR 1.59, 95% CI 1.15-2.19, P=0.005) and LRR (HR 3.33, 95% CI 1.51-7.34, P=0.003), whereas there were no significant differences in OS and DMR between the two groups. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS, and DMR between the ET group and the ET+RT group. In luminal B type, there were statistically significant differences in 5-year DFS (HR 2.188, 95% CI 1.37-3.49, P=0.001), LRR (HR 5.447, 95% CI 1.65-17.98, P=0.005), and OS (HR 1.752, 95% CI 1.01-3.054, P=0.048) between the two groups. In the ET group, there were significant differences between luminal A type and luminal B type in 5-year DFS (HR 1.841, 95% CI 1.23-2.75, P=0.003) and OS (HR 1.763, 95% CI 1.07-2.91, P=0.026). Conclusions:After breast conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy. Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients. Keywords: disease-free survival (DFS), distant metastasis rate (DMR), endocrine therapy, local relapse rate (LRR), overall survival (OS), radiotherapy Citation Format: Jin Zhang. Correlation of radiotherapy with the prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-13.

Tumor Immune Microenvironment and Chemosensitivity Signature for Predicting Response to Chemotherapy in Gastric Cancer.

Current gastric cancer staging alone cannot predict prognosis and adjuvant chemotherapy benefits in stage II and III gastric cancer. Tumor immune microenvironment biomarkers and tumor-cell chemosensitivity might add predictive value to staging. This study aimed to construct a predictive signature integrating tumor immune microenvironment and chemosensitivity-related features to improve the prediction of survival and adjuvant chemotherapy benefits in patients with stage II to III gastric cancer. We used IHC to assess 26 features related to tumor, stroma, and chemosensitivity in tumors from 223 patients and evaluated the association of the features with disease-free survival (DFS) and overall survival (OS). Support vector machine (SVM)-based methods were used to develop the predictive signature, which we call the SVM signature. Validation of the signature was performed in two independent cohorts of 445 patients. The diagnostic signature integrated seven features: CD3+ cells at the invasive margin (CD3 IM), CD8+ cells at the IM (CD8 IM), CD45RO+ cells in the center of tumors (CD45RO CT), CD66b+ cells at the IM (CD66b IM), CD34+ cells, periostin, and cyclooxygenase-2. Patients fell into low- and high-SVM groups with significant differences in 5-year DFS and OS in the training and validation cohorts (all P < 0.001). The signature was an independent prognosis indicator in multivariate analysis in each cohort. The signature had better prognostic value than various clinicopathologic risk factors and single features. High-SVM patients exhibited a favorable response to adjuvant chemotherapy. Thus, this SVM signature predicted survival and has the potential for identifying patients with stage II and III gastric cancer who could benefit from adjuvant chemotherapy.

Correlation of radiotherapy with the prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping.

108 Background: The present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone-receptor-positive early breast cancer. Methods: A retrospective analysis of 327 patients aged ≥65 years with stage I-II, hormone receptor positive breast cancer who underwent breast conserving surgery and received endocrine therapy (ET) or radiotherapy plus endocrine therapy (ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease free survival (DFS), local relapse rate (LRR), overall survival (OS), and distant metastasis rate (DMR). Results: There were significant differences in 5-year DFS (HR 1.59, 95% CI 1.15–2.19, P=0.005) and LRR (HR 3.33, 95% CI 1.51–7.34, P=0.003), whereas there were no significant differences in OS and DMR between the two groups. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS, and DMR between the ET group and the ET+RT group. In luminal B type, there were statistically significant differences in 5-year DFS (HR 2.188, 95% CI 1.37–3.49, P=0.001), LRR (HR 5.447, 95% CI 1.65–17.98, P=0.005), and OS (HR 1.752, 95% CI 1.01–3.054, P=0.048) between the two groups. In the ET group, there were significant differences between luminal A type and luminal B type in 5-year DFS (HR 1.841, 95% CI 1.23–2.75, P=0.003) and OS (HR 1.763, 95% CI 1.07–2.91, P=0.026). Conclusions: After breast conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy. Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients.

377P - Correlation of radiotherapy with the prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping

BackgroundThe present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone-receptor-positive early breast cancer. MethodsA retrospective analysis of 327 patients aged ≥65 years with stage I-II, hormone receptor positive breast cancer who underwent breast conserving surgery and received endocrine therapy (ET) or radiotherapy plus endocrine therapy (ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease free survival (DFS), local relapse rate (LRR), overall survival (OS), and distant metastasis rate (DMR). ResultsThere were significant differences in 5-year DFS (HR 1.59, 95% CI 1.15–2.19, P=0.005) and LRR (HR 3.33, 95% CI 1.51–7.34, P=0.003), whereas there were no significant differences in OS and DMR between the two groups. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS, and DMR between the ET group and the ET+RT group. In luminal B type, there were statistically significant differences in 5-year DFS (HR 2.188, 95% CI 1.37–3.49, P=0.001), LRR (HR 5.447, 95% CI 1.65–17.98, P=0.005), and OS (HR 1.752, 95% CI 1.01–3.054, P=0.048) between the two groups. In the ET group, there were significant differences between luminal A type and luminal B type in 5-year DFS (HR 1.841, 95% CI 1.23–2.75, P=0.003) and OS (HR 1.763, 95% CI 1.07–2.91, P=0.026). ConclusionsAfter breast conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy. Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients. Legal entity responsible for the studyThe author. FundingNational Natural Science Foundation of China (81672623). DisclosureThe author has declared no conflicts of interest.

Correlation of radiotherapy with prognosis of elderly patients with hormone receptor-positive breast cancer according to immunohistochemical subtyping.

ObjectiveThe present study examined the effect of radiotherapy on recurrence and survival in elderly patients with hormone receptor-positive early breast cancer.MethodsA retrospective analysis of 327 patients aged ≥65 years, with stage I−II, hormone receptor-positive breast cancer who underwent breast-conserving surgery and received endocrine therapy (ET) or radiotherapy plus endocrine therapy (ET+RT) was performed. Both groups were divided into luminal A type and luminal B type subgroups. Evaluation criteria were 5-year disease-free survival (DFS), local relapse rate (LRR), overall survival (OS), and distant metastasis rate (DMR).ResultsThere were significant differences in 5-year DFS [hazard ratio (HR)=1.59, 95% confidence interval (95% CI), 1.15−2.19; P=0.005] and LRR (HR=3.33, 95% CI, 1.51−7.34; P=0.003), whereas there were no significant differences in OS and DMR between ET group and ET+RT group. In luminal A type, there was no significant difference in 5-year DFS, LRR, OS and DMR between ET group and ET+RT group. In luminal B type, there were statistically significant differences in 5-year DFS (HR=2.19, 95% CI, 1.37−3.49; P=0.001), LRR (HR=5.45, 95% CI, 1.65−17.98; P=0.005), and OS (HR=1.75, 95% CI, 1.01−3.05; P=0.048) between ET group and ET+RT group. In the ET group, there were significant differences between luminal A type and luminal B type in 5-year DFS (HR=1.84, 95% CI, 1.23−2.75; P=0.003) and OS (HR=1.76, 95% CI, 1.07−2.91; P=0.026).ConclusionsAfter breast-conserving surgery, radiotherapy can reduce the LRR and improve the DFS and OS of luminal B type elderly patients, whereas luminal A type elderly patients do not benefit from radiotherapy. Without radiotherapy, luminal A type patients have better DFS and OS than luminal B type patients.

The appropriate surgical strategy for T1b gallbladder cancer incidentally diagnosed after a simple cholecystectomy.

Backgrounds/AimsThe appropriate surgical treatment was investigated for T1b gallbladder (GB) cancer through a retrospective analysis of the clinical outcomes of patients with incidental T1 GB cancer.MethodsPatients with T1 GB cancer who were incidentally diagnosed while undergoing a simple cholecystectomy at Chungnam University Hospital from January 2004 to December 2017 were enrolled. Overall, 39 patients with T1 GB cancer, 17 patients with T1a, and 22 patients with T1b were included. We retrospectively analyzed the patients' clinical and pathologic findings and follow-up results.ResultsAmong the 6490 patients who underwent cholecystectomy during the study period, 165 patients were diagnosed with GB cancer (T1=42 [25.5%]). The risk factor associated with recurrence and cancer-related death in patients with T1 GB cancer was lymphovascular invasion (recurrence, p=0.028; death, p=0.004). In the T1b group, the 5-year disease-free survival (DFS) rate showed a statistical difference between patients with and without lymphovascular invasion (45.7% vs. 83.6%, p=0.048). There was no statistically significant difference in 5-year DFS and overall survival rate between simple cholecystectomy and extended cholecystectomy in T1b GB cancer with lymphovasular invasion (p=0.054 and p=0.091, respectively).ConclusionsIn incidental T1b GB cancer, extended cholecystectomy was not superior to simple cholecystectomy in terms of the 5-year DFS rate and nor in overall survival rate or recurrence rate, even when lymphovascular invasion was identified after simple cholecystectomy. Therefore, simple cholecystectomy may be recommended as a primary surgical strategy for T1b GB cancer.

A Retrospective Survival Analysis of Anatomic and Prognostic Stage Group Based on the American Joint Committee on Cancer 8th Edition Cancer Staging Manual in Luminal B Human Epidermal Growth Factor Receptor 2-negative Breast Cancer.

Background:Current understanding of tumor biology suggests that breast cancer is a group of diseases with different intrinsic molecular subtypes. Anatomic staging system alone is insufficient to provide future outcome information. The American Joint Committee on Cancer (AJCC) expert panel updated the 8th edition of the staging manual with prognostic stage groups by incorporating biomarkers into the anatomic stage groups. In this study, we retrospectively analyzed the data from our center in China using the anatomic and prognostic staging system based on the AJCC 8th edition staging manual.Methods:We reviewed the data from January 2008 to December 2014 for cases with Luminal B Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer in our center. All cases were restaged using the AJCC 8th edition anatomic and prognostic staging system. The Kaplan-Meier method and log-rank test were used to compare the survival differences between different subgroups. SPSS software version 19.0 (IBM Corp., Armonk, NY, USA) was used for the statistical analyses.Results:This study consisted of 796 patients with Luminal B HER-negative breast cancer. The 5-year disease-free survival (DFS) of 769 Stage I–III patients was 89.7%, and the 5-year overall survival (OS) of all 796 patients was 91.7%. Both 5-year DFS and 5-year OS were significantly different in the different anatomic and prognostic stage groups. There were 372 cases (46.7%) assigned to a different group. The prognostic Stage II and III patients restaged from anatomic Stage III had significant differences in 5-year DFS (χ2 = 11.319, P = 0.001) and 5-year OS (χ2 = 5.225, P = 0.022). In addition, cases restaged as prognostic Stage I, II, or III from the anatomic Stage II group had statistically significant differences in 5-year DFS (χ2 = 6.510, P = 0.039) but no significant differences in 5-year OS (χ2 = 5.087, P = 0.079). However, the restaged prognostic Stage I and II cases from anatomic Stage I had no statistically significant differences in either 5-year DFS (χ2 = 0.440, P = 0.507) or 5-year OS (χ2 = 1.530, P = 0.216).Conclusions:The prognostic staging system proposed in the AJCC 8th edition refines the anatomic stage group in Luminal B HER2-negative breast cancer and will lead to a more personalized approach to breast cancer treatment.

Tumor biology, clinicopathological characteristics and prognosis of screen detected T1 invasive non-palpable breast cancer in asymptomatic Chinese women (2001-2014).

BackgroundMammography screening usually detects low-risk breast cancer in the western world. However, little is known about the ultrasound and mammography screen-detected T1 invasive non-palpable breast cancer (NPBC) in asymptomatic Chinese women.ResultsWith the increase of tumor size (T1a, b, c), lymph node positivity (8.7%, 18.3%, 26.0%, p = 0.018), pN (p = 0.028) and TNM stage (p = 0.035) increased accordingly. Tumor size (T1a, b, c) was correlated with high Ki-67 index (defined as ≥ 14%, 37.9%, 45.8%, 56.2%, p = 0.017), chemotherapy (20.4%, 35.2%, 57.3%, p < 0.001) and targeted therapy (2.9%, 9.9%, 15.1%, p = 0.008). T1a disease had higher chance of being luminal A and accompanied with ductal carcinoma in situ (DCIS), while T1c tumor being triple-negative and without DCIS. The 5-year disease free survival (DFS) of T1a, b, c NPBC were 99.0%, 96.9% and 92.9%, whereas the 5-year overall survival (OS) were 100.0%, 100.0% and 97.9% respectively. There was no significant difference in 5-year DFS or OS among the T1 NPBC subgroups or subtypes/immunophenotypes.Patients and methodsFrom 2001 to 2014, 4,574 screening positive women received biopsies in Peking Union Medical College (PUMC) Hospital, and 729 NPBC including 437 T1 unilateral invasive NPBC were diagnosed. With a median follow-up time of 32 months (6–163 months), the clinicopathological characteristics, treatment choice, 5-year DFS and OS were compared between T1a, T1b and T1c NPBC. The DFS and OS prognostic factors were identified.ConclusionScreen-detected T1 invasive NPBC could be regarded as low-risk cancer in Chinese women. TNM stage and LN metastasis instead of molecular subtype was identified as the DFS prognostic factors while radiotherapy as the OS predictor.

Risk factors for recurrence of gastric cancer after curative laparoscopic gastrectomy.

Curative laparoscopic gastrectomy (LG) is associated with good outcomes when performed for early gastric cancers. The aim of this study was to identify risk factors for recurrence after LG. 212 patients with gastric cancer who underwent gastrectomy were enrolled (LG: 143, open gastrectomy, OG: 69). Univariate analysis was used to assess overall (OS) and disease-free survival (DFS) in LG and OG group. Multivariate analysis was used to assess risk factors for recurrence after LG. In LG, six cases of recurrence were observed (liver: 2, peritoneum: 4). Neither lymph node nor port-site recurrences were evident after LG. The 5-year DFS after LG was 91.4%. Based on univariate analysis of 5-year DFS, three negative prognostic factors-lymph node metastasis, lymphatic invasion, and venous invasion-were identified. The independent risk factor for recurrence of LG was lymph node metastasis. LG and OG showed no significant differences in 5-year DFS among Stage IA, IB, IIA, and IIB groups. Independent risk factors for recurrence after LG or OG were tumor invasion≥muscularis mucosa and lymph node metastasis. DFS following LG is comparable to that following OG. Lymph node metastasis is an independent risk factor for gastric cancer recurrence after LG. J. Med. Invest. 64: 79-84, February, 2017.

A retrospective prognostic evaluation analysis using the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system for luminal A breast cancer.

ObjectiveWe retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for luminal A breast cancer.MethodsUsing both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system, we restaged patients with luminal A breast cancer treated at the Breast Disease Center, Peking University First Hospital from 2008 to 2014. Follow-up data including 5-year disease free survival (DFS), overall survival (OS) and other clinic-pathological data were collected to analyze the differences between the two staging subgroups.ResultsThis study included 421 patients with luminal A breast cancer (median follow-up, 61 months). The 5-year DFS and OS rates were 98.3% and 99.3%, respectively. Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages. Significant differences were observed in both 5-year DFS and OS between different prognostic stages. Application of the prognostic staging system resulted in assignment of 175 of 421 patients (41.6%) to a different group compared to their original anatomic stages. In total, 102 of 103 patients with anatomic stage IIA changed to prognostic stage IB, and 24 of 52 patients with anatomic stage IIB changed to prognostic stage IB, while 1 changed to prognostic stage IIIB. Twenty-two of 33 patients with anatomic stage IIIA were down-staged to IIA when staged by prognostic staging system, and the other 11 patients were down-staged to IIB. Two patients with anatomic stage IIIB were down-staged to IIIA. Among seven patients with anatomic stage IIIC cancer, two were down-staged to IIIA and four were down-staged to stage IIIB.ConclusionsThe 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system. More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.

P1.05-038 Patterns of Recurrence in Curatively Resected Stage I Lung Cancer

The patterns of recurrence after curative resection for pathologically stage I non-small cell lung cancer (NSCLC) were investigated according to the cell type. The medical records of stage I NSCLC patients who undergone curative resection at Asan Medical Center between 2000 and 2009 were reviewed. Total 940 patients with pathologically proven stage I NSCLC were included. Patients with lepidic-type adenocarcinoma (LTA) were 74, other adenocarcinoma (ADC) 580, and squamous cell carcinoma (SCC) 246. Median length of follow-up was 62 months (3∼189), median survival was 146 months, and median disease-free survival (DFS) was 109 months. During follow-up, recurrence occurred in 221 patients (23.5%). Number of recurrence is grouped by every 6 months. Incidence of recurrence was peaked within 2 years after resection, then gradually decreased thereafter. Recurrence LTA (AIS/MIA) group was significantly rare (13.5%) throughout the all follow-up period (median DFI of 60months), and its distribution shows relatively even distribution. Comparing ADC and SCC, ADC seemed to show better 5-year OS in univariate analysis (p=0.003), but not in multivariate analysis. Furthermore, there were no significant difference in 5-year DFS (p=0.331). ADC shows higher proportion of distant metastasis, even though ADC group has lower T-stage. SCC shows higher incidence of local recurrence. Recurrence of ADC occurred within 2 years after resection, and shows higher proportion of distant metastasis (74.0% Vs. 57.2) even though ADC group has lower T-stage. Most of recurrence of both ADC and SCC groups were peaked within 2 years after resection. LTA group shows significantly delayed pattern of recurrence.

Operable breast cancer of the inner hemisphere is associated with poor survival.

PurposeThis study investigated the clinicopathological features of operable breast cancer lesions located in different hemispheres of the breast and determined related survival outcomes.MethodsData from 5,330 patients with invasive ductal carcinoma were retrospectively analyzed based on tumor location.ResultsThe median follow-up time was 68 months (range, 18-176 months). Patients with breast cancer located in the outer hemisphere of the breast had lesions with more advanced nodal stages and more frequently received adjuvant chemotherapy than patients with breast cancer in the inner hemisphere. The 5-year disease-free survival (DFS) rates of patients with tumors located in outer versus inner hemispheres were 81.5% and 77.0%, respectively (p=0.004); the overall survival (OS) rates were 90.7% and 88.8%, respectively (p<0.001). The association between tumor location and the 5-year DFS rate was most apparent in node-positive patients (73.1% vs. 65.8% for outer vs. inner hemisphere lesions, p<0.001) and in patients with primary tumors greater than 2 cm in diameter (78.2% vs. 72.3%, p=0.002). Multivariate analysis showed that tumor location was an independent predictor of DFS (hazard ratio [HR], 1.23; p=0.002) and OS (HR, 1.28; p=0.006). There were no significant differences in 5-year DFS or OS rates between patients with outer versus inner hemisphere tumors when internal mammary node irradiation was performed.ConclusionThis study demonstrated that tumor location was an independent prognostic factor for operable breast cancer. Internal mammary node irradiation is recommended for patients with breast cancer of the inner hemisphere and positive axillary lymph nodes or large primary tumors.

Noninvasive Risk Stratification of Lung Adenocarcinoma using Quantitative Computed Tomography

Lung cancer remains the leading cause of cancer-related deaths in the United States and worldwide. Adenocarcinoma is the most common type of lung cancer and encompasses lesions with widely variable clinical outcomes. In the absence of noninvasive risk stratification, individualized patient management remains challenging. Consequently a subgroup of pulmonary nodules of the lung adenocarcinoma spectrum is likely treated more aggressively than necessary. Consecutive patients with surgically resected pulmonary nodules of the lung adenocarcinoma spectrum (lesion size ≤3 cm, 2006-2009) and available presurgical high-resolution computed tomography (HRCT) imaging were identified at Mayo Clinic Rochester. All cases were classified using an unbiased Computer-Aided Nodule Assessment and Risk Yield (CANARY) approach based on the quantification of presurgical HRCT characteristics. CANARY-based classification was independently correlated to postsurgical progression-free survival. CANARY analysis of 264 consecutive patients identified three distinct subgroups. Independent comparisons of 5-year disease-free survival (DFS) between these subgroups demonstrated statistically significant differences in 5-year DFS, 100%, 72.7%, and 51.4%, respectively (p = 0.0005). Noninvasive CANARY-based risk stratification identifies subgroups of patients with pulmonary nodules of the adenocarcinoma spectrum characterized by distinct clinical outcomes. This technique may ultimately improve the current expert opinion-based approach to the management of these lesions by facilitating individualized patient management.

An online gene expression assay for determining adjuvant therapy eligibility in patients with stage 2 or 3 colon cancer

Background:The decision whether to treat patients with non-metastatic colon cancer with adjuvant chemotherapy is determined by clinical staging, frequently resulting in over or undertreatment.Methods:Gene expression data and clinical information from 232 stage 1–4 colon cancer patients were analysed to identify expression patterns predictive of recurrence. The signature was evaluated on an independent series of 60 stage 2 and 3 patients. Multivariate analyses were performed to assess the clinical utility of the assay.Results:A 163-probe signature was able to stratify patients into high- and low-risk groups for disease-free survival (DFS) in both the training and validation series (stage 2: P⩽0.031, stage 3: P⩽0.057) and for disease-specific survival in the training series (stage 2: P=0.01, stage 3: P=0.0017). Multivariate analysis showed the classifier to be associated with approximately three- to fourfold increased risk of recurrence.Conclusions:The prognostic gene expression signature is able to stratify stage 2 and 3 colon cancer patients into groups with significant differences in 5-year DFS, information that may ultimately reduce deaths from colon cancer. Further validation work is required and at this stage the assay is available for evaluation at www.ChipDX.com.

Pelvic Exenteration Affords Safe and Durable Treatment for Locally Advanced Rectal Carcinoma

Treatment of locally advanced rectal carcinoma (LARC) often involves exenterative surgery, which can be associated with high perioperative morbidity and mortality. To assist in patient selection for radical surgery, we sought to determine clinicopathologic factors influencing recurrence and disease-free survival (DFS) of LARC. Consecutive patients with LARC undergoing exenterative surgery were retrospectively identified in our institutional database. Factors evaluated included age, sex, primary versus recurrent tumors, neoadjuvant or adjuvant chemoradiotherapy, resection margin status, recurrence, time to recurrence, and survival. The primary outcome was DFS. Secondary outcomes were overall survival and perioperative morbidity. A total of 72 patients were identified; median age was 52 years, and median follow-up time was 30 months. The overall complication rate was 43%; rates were similar among the patients with primary (47%) or recurrent (37%) LARC. Primary or recurrent tumor status was the only factor significantly predictive of outcome after exenteration. Local recurrence rates were lower in the primary group (primary 22%, recurrent 52%, P = .05). A significant difference in 5-year DFS was found between primary and recurrent tumor (52% vs. 13%; P < .01). The median time to recurrence was longer in the patients with primary LARC (17 months vs. 8 months; P < .01). The complication rates for pelvic exenteration remain high, but the morbidity can typically be managed without a clinically important increase in hospitalization. In primary LARC, an aggressive surgical approach provides most patients 5-year DFS. Select patients with recurrent LARC will also benefit from pelvic exenteration.

Expression of the double-strand RNA activated protein kinase (PKR) and its prognostic significance in patients with locally advanced rectal cancer

3643 Background: The interferon induced, dsRNA-activated, protein kinase, PKR is a key regulator of translational initiation, playing an important role in the regulation of cell proliferation, apoptosis, and transformation. Increased expression of PKR has been shown to correlate with better patient prognosis in head and neck cancer ( Haines et al. Arch. Otolaryngol. Head Neck Surg. 1993). The aim of this study is to identify the prognostic significance of PKR in locally advanced rectal cancer. Methods: One hundred nine patients had potentially curative surgical resection and were treated with chemoradiation therapy followed by 5-fluorouracil based chemotherapy. Paraffin embedded tumor tissue was collected and evaluated in 92 patients. Samples were immunohistochemically stained with the monoclonal antibody TJ4C4. Overall scores for PKR expression were calculated based on staining intensity and percentage of immunoreactive tumor cells. Clinical information including tumor grade, stage, carcinoembryonic antigen (CEA), disease-free survival (DFS), and overall survival (OS) was evaluated and compared by PKR expression. Results: The median follow-up duration was 30 months. The PKR score was not related to the tumor grade, stage, CEA level. The relapse rate was lower in high PKR score group (>7.0) than low PKR score group, though statistically insignificant (27.5% vs. 41.5% p=0.158). There was no significant difference in 5-year DFS (70.2% vs. 47.1%, p=0.3575) and 5- year OS (74.3% vs. 53.9%, p=0.9283) between the two groups. Cox regression multivariate analyses showed that new AJCC stage and tumor differentiation were significant independent prognostic factors in both DFS and OS. Conclusions: The levels of PKR expression were not associated with clinical outcome in locally advanced rectal cancer patients. No significant financial relationships to disclose.