Significant Predictive Factor For Recurrence Research Articles

Preoperative CT imaging as a tool to predict incisional hernia outcomes following abdominal wall reconstruction: A retrospective cohort analysis

Ventral wall hernia often causes significant morbidity and requires complex abdominal wall reconstruction (AWR). This study aims to determine whether subcutaneous abdominal fat thickness (AFT) measured with preoperative CT scans could predict postoperative outcomes in patients undergoing AWR. A retrospective cohort study was conducted on all patients who underwent AWR at our institution between 2009 and 2021, with a minimum follow-up of 12 months. Using preoperative CT scans, AFT was measured at the xiphoid process, umbilicus, and pubic tubercle, as well as the hernia dimensions. Demographic, operative, and surgical outcome data were also collected and analyzed using statistical tests. The results showed that 9 of 101 patients (8.9%) experienced hernia recurrence. Smoking was associated with an increased risk of hernia recurrence (p<0.001) with a predictive odds ratio (OR) of 18.27 (p=0.041). Increased AFT at the xiphoid (p=0.005), umbilicus (p<0.001), and pubic tubercle (p<0.001) were also associated with hernia recurrence and risk of infection. Only AFT at the pubic tubercle reached significance in the regression model predicting recurrence (OR=1.10; p=0.030) and infection (OR=1.04; p=0.021). A cut-off value of 67mm was associated with a positive predictive value of 42.14% (sensitivity of 67% and specificity of 91%). Hernia defect area was not associated with risk of recurrence or infection. Smoking and increased AFT at the pubic tubercle are significant predictive factors for recurrence and infection in patients undergoing AWR, and preoperative optimization should focus on reducing these factors.

Recurrence rates and long-term survival factors in young women with breast cancer.

Objectives:To evaluate the factors related to breast cancer (BC) recurrence as well as survival in women ≤40 years old.Methods:This is a retrospective medical record review of women aged ≤40 years diagnosed with BC stages I to III between January 2009 and June 2017 at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Demographic data collected included patients’ initial presentation (including age and date of diagnosis), imaging studies, tumor characteristics, type of surgery, systemic therapy (if any) received, and site of first recurrence. Data was analyzed to assess recurrence rate, disease-free survival (DFS), and overall survival (OS), and determine associated factors. Descriptive statistics were used to calculate the mean, median, standard deviation, and quartiles. Chi-square test was performed to test the association between 2 variables. Kaplan-Meier analyses were performed to assess survival distribution.Results:A total of 117 patients were included for analysis. Median follow-up was 16 months (range 0 to 99). Five-year DFS 57% and OS was 89%. Adjuvant chemotherapy was associated with a better DFS (hazard ratio of 0.204; 95% confidence interval, 0.050 to 0.832; p=0.027). Higher tumor, node, metastasis stage was significantly associated with worse DFS (p=0.034). Fewer postoperative follow-up visits significantly predicted recurrence (p=0.003).Conclusion:We found a high risk of BC recurrence among patients at our institution. Higher cancer stage, nonuse adjuvant chemotherapy, and low follow-up rate were significant predictive factors for recurrence.

Factors that predict recurrent spontaneous bacterial peritonitis in cirrhotic patients.

The recurrence rate of spontaneous bacterial peritonitis (SBP) is increasing in cirrhotic patients. Antibiotic prophylaxis should be prescribed in all cirrhotic patients after the first episode of SBP. However, antibiotics promote the development of antibiotic-resistant bacteria. To identify the factors that predict the recurrence of SBP after the first episode in cirrhotic patients to optimise the stratification for secondary antibiotic prophylaxis. This retrospective study included 145 cirrhotic patients who had their first SBP episode during 2011-2015. The 86 patients who survived were divided into either the SBP recurrence or non-recurrence group according to patient SBP outcome during the 2-year follow-up. Demographical, clinical and laboratory parameters were recorded at SBP diagnosis and before hospital discharge. SBP recurrence rate, recurrence-free survival and in-hospital mortality were also analysed. The recurrence rate of SBP after the first episode was 69.8% (60/86), and the median recurrence-free survival time was 142days. The in-hospital mortality rate was 40.7% (59/145). The significant predictive factors for recurrence of SBP were serum potassium≥4mEq/L (HR: 1.89; P=.028), serum albumin≤2g/dL (HR: 2.5; P=.003) at diagnosis of SBP and platelet count before discharge≤100000/microliter (HR: 1.93; P=.029). SBP frequently recurs in cirrhotic patients. Serum potassium≥4mEq/L, serum albumin≤2g/dL at SBP diagnosis and platelet count≤100000/microliter before discharge were identified as factors that may predict the recurrence of SBP after the first episode.

Characteristics, management, and outcome of squamous carcinoma of the conjunctiva in a single tertiary cancer center in Jordan.

To evaluate the features and outcome of management of malignant conjunctival squamous tumors in King Hussein Cancer Center (a referral tertiary cancer center in the Middle East). Retrospective case series of 31 eyes for 31 patients with conjunctival squamous neoplasia. Main outcome measures included: age, gender, laterality, tumor location, pathological features, tumor stage, treatment modality, and outcome. Twenty (65%) patients were males and median age was 58y. Twenty-two (71%) eyes had the tumor in the nasal quadrant. Tumor invasion to nearby structures was seen in 19 (61%) eyes, including the cornea, fornix, eyelid, and orbit in 17 (55%), 1 (3%), 2 (6%), and 3 (10%) eyes, respectively. Eye salvage was achieved by surgical excision with cryotherapy followed by topical chemotherapy in 28 (90%) eyes, and orbital exenteration was necessary in 3 (10%) eyes due to orbital tumor invasion. Tumor recurrence was seen in 7 (23%) eyes, and the significant predictive factors for recurrence were tumor extension onto the nearby structures (P=0.04), tumor invasiveness (P=0.038), and tumor TNM stage (P=0.031). No significant change in visual acuity was seen, and disease related mortality was 6% (2 patients, both had orbital invasion by invasive squamous carcinoma). Conjunctival squamous carcinoma is more common in males. Advanced American Joint Committee on Cancer (AJCC) T-stage, tumor local invasion, more pathologically aggressive tumors, and surgical treatment alone (without adjuvant therapy) are associated with higher risk for recurrence, and orbital invasion is the most important poor prognostic factor for metastasis and death. Treatment strategies should be affected by tumor characteristics at presentation.

Does the depth of mesorectal invasion have prognostic significance in patients with ypT3 lower rectal cancer treated with preoperative chemoradiotherapy?

The prognostic significance of the depth of mesorectal invasion (DMI) in patients with ypT3 rectal cancer who undergo preoperative chemoradiotherapy (CRT) is unclear. The purpose of this study was to evaluate the prognostic significance of DMI in ypT3 rectal cancer. A total of 168 (y)pT3 patients were evaluated, of whom 93 received preoperative CRT and 75 underwent surgery alone. Patients were subdivided into two groups according to the DMI (T3ab=DMI ≤5mm and T3cd=DMI >5mm). Oncologic outcomes were compared between the T3ab and T3cd groups and the ypT3ab and ypT3cd groups. Relapse-free survival was significantly different between the pT3ab and pT3cd groups (74.1 vs 38.5%, P=0.0192) but not between the ypT3ab and ypT3cd groups (65.9 vs 61.5%, P=0.513). Multivariate analysis showed that DMI was an independent predictor of recurrence in pT3 patients (hazard ratio [HR]=2.980, 95% confidence interval [CI] 1.227-7.025; P=0.0169) and that ypN+ was an independent predictor of recurrence in ypT3 patients (HR=3.487, 95% CI 1.570-8.827; P=0.0016). DMI was not a significant predictive factor for recurrence in patients with ypT3 rectal cancer who underwent preoperative CRT, and ypN+ was the only independent predictive factor for recurrence.

Impact of boost irradiation on pelvic lymph node control in patients with cervical cancer

Radiation therapy (RT) for metastatic pelvic lymph nodes (PLNs) is not well established in cervical cancer. In this study the correlation between size of lymph nodes and control doses of RT was analyzed. Between January 2002 and December 2007, 245 patients with squamous cell carcinoma of the cervix treated with a combination of external beam irradiation with or without boost irradiation and high-dose rate brachytherapy were investigated. Size of lymph node was measured by computed tomography before RT and just after 50 Gy RT. Of the 245 patients, 78 had PLN metastases, and a total of 129 had enlarged PLNs diagnosed as metastases; 22 patients had PLN failure. The PLN control rate at 5 years was 79.5% for positive cases and 95.8% for negative cases. In cases with positive PLNs, 12 of 129 nodes (9.3%) developed recurrences. There was significant correlation between PLN control rate and size of PLN after 50 Gy (<10 mm: 96.7%, ≥ 10 mm: 75.7 % (P<0.001)). In addition, the recurrence in these poor-response nodes was significantly correlated with dose of RT. Nine of 16 nodes receiving ≤ 58 Gy had recurrence, but none of 21 nodes receiving > 58 Gy had recurrence (P = 0.0003). These results suggested that the response of lymph nodes after RT was a more significant predictive factor for recurrence than size of lymph node before RT, and poor-response lymph nodes might require boost irradiation at a total dose of > 58 Gy.

Expression of angiopoietin-2 and prognosis in hepatocellular carcinoma

Objective To study the relationship between the expression of angiopoietins-2 (Ang-2) and prognosis in hepatocellular carcinoma (HCC) after hepatic resection.Methods Sixty patients with primary liver cancer were retrospectively analyzed and the expression of Ang-2 in carcinoma tissues were assayed by immunohistochemical staining.The interrelationships among the expression of Ang-2,clinicopathological factors and the grade of differentiation of HCC cells were studied.The relationship between the expressions of Ang-2 and survival time was analysed.Results The expression rate of Ang-2 was 70％.Ang-2 staining had no correlation with clinicopathological factors (P ＜ 0.05),but it had a significant correlation with the grade of differentiation of HCC cells (x2 =5.424,P =0.025).Ang-2 of moderately and poorly differentiated HCC were higher (66.7％) than those of well-differentiated HCC.The disease-free survival rates of patients with high Ang-2 expression and low Ang-2 expression were 50％ (1-year),33.3％ (3-year),16.7％ (5-year) and 89.6％ (1-year),50.0％ (3-year),27.1％ (5-year),respectively.The disease-free survival of patients with high Ang-2 expression were significantly less than those of patients with low Ang-2 expression (x2 =6.477,P =0.021).Conclusion The expressions of Ang-2 are correlated with the grade of differentiation of HCC cells,but are not correlate with clinicopathological factors.The survivals of patients with Ang-2 high expression are lower than those of low expression.Ang-2 is a significant predictive factor for recurrence after hepatic resection in HCC patients. Key words: Angiopoietin-2 ; Carcinoma, hepatocellular; Immunohistochemistry

Limited resection for clinical Stage IA non-small-cell lung cancers based on a standardized-uptake value index

In a previous study, we found that a standardized-uptake value (SUV) index obtained from positron emission tomography (PET)/computed tomography (CT) data was significantly correlated with prognosis in patients with pathological Stage I lung adenocarcinoma. However, this value has not been studied in early stage lung cancer patients undergoing limited resection. In this study, we investigated if an SUV index could be used to identify patients with clinical Stage IA lung cancers that were appropriate for limited resection. This was a retrospective study of prospectively collected data from 183 patients with clinical Stage IA non-small-cell lung cancer undergoing both PET-CT examinations and surgery from May 2004 to December 2010. A corrected SUV was defined as the SUV index, which was calculated from the ratio of the tumour SUV(max) to the liver SUV(mean). The associations between survival, recurrence and several clinical factors, including the SUV index, were evaluated. The following pathological stages were identified: Stage IA (n = 133; 72.7%), Stage IB (n = 31; 16.9%), Stage IIA (n = 11; 6.0%), Stage IIB (n = 1; 0.5%) and Stage IIIA (n = 7; 3.8%). There were 50 upstaged cases (27.3%). The 5-year overall survival, 5-year cancer-specific survival and 5-year freedom from recurrence (FFR) rates after surgery were 83.5, 91.6 and 83.1%, respectively. Twenty-six (14.2%) patients developed recurrences. Multivariate analysis showed that an SUV index was a significant predictive factor for recurrence (P = 0.01). The 5-year FFR rates in patients with an SUV indices <1.0 and ≥1.0 were 100 and 77.1%, respectively (P < 0.01). The 5-year cancer-specific survival rates in patients with an SUV indices <1.0 and ≥1.0 were 100 and 88.7%, respectively (P = 0.04). In clinical Stage IA lung cancer patients, the SUV index was a significant predictive marker for recurrence. Patients with SUV indices <1.0 were less likely to have a recurrence. Thus, clinical Stage IA patients with SUV indices <1.0 should be candidates for limited resection.

Impact of Boost Irradiation on Pelvic Lymph Node Control in Patients with Cervical Cancer

Radiation therapy (RT) for metastatic pelvic lymph nodes (PLNs) is not well established in cervical cancer. In this study the correlation between size of lymph nodes and control doses of RT was analyzed. Between January 2002 and December 2007, 245 patients with squamous cell carcinoma of the cervix treated with a combination of external beam irradiation with or without boost irradiation and high-dose rate brachytherapy were investigated. Size of lymph node was measured by computed tomography before RT and just after 50 Gy RT. Of the 245 patients, 78 had PLN metastases, and a total of 129 had enlarged PLNs diagnosed as metastases; 22 patients had PLN failure. The PLN control rate at 5 years was 79.5% for positive cases and 95.8% for negative cases. In cases with positive PLNs, 12 of 129 nodes (9.3%) developed recurrences. There was significant correlation between PLN control rate and size of PLN after 50 Gy ( 58 Gy had recurrence (P = 0.0003). These results suggested that the response of lymph nodes after RT was a more significant predictive factor for recurrence than size of lymph node before RT, and poor-response lymph nodes might require boost irradiation at a total dose of > 58 Gy.

The Effects of Helicobacter pylori on the prognosis of patients with curatively resected gastric cancers in a population with high infection rate.

PurposeThe goal of this study was to assess the correlation between the Helicobacter pylori status of patients who underwent curative resection for gastric adenocarcinoma and their prognosis in Eastern societies where H. pylori infection is prevalent.MethodsBetween 2006 and 2007, 192 patients who had a curative resection for the treatment of gastric adenocarcinoma were enrolled in the study. Of these patients, 18 were excluded due to an inexact evaluation of the H. pylori status, thereby leaving 174 patients in the final analysis. Serologic testing for H. pylori was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G, and the histological presence of H. pylori was identified using the Giemsa stain.ResultsOf the 174 patients, 111 patients (63.8%) were confirmed for H. pylori infection. H. pylori status did not correlate with the overall or disease-free survival. For patients with stage III or IV gastric cancer, a positive H. pylori status was a significant predictive factor for recurrence over that of a negative H. pylori status (P = 0.019). Negative H. pylori status was a predictive factor for recurrence in multivariable analysis (relative risk, 2.724; 95 confidence interval, 1.192 to 6.228).ConclusionHelicobacter pylori status did not correlate with the clinicopathologic factors of gastric adenocarcinoma. However, a negative Helicobacter pylori status may be a predictive factor for recurrence in patients diagnosed with advanced gastric adenocarcinoma.

Recurrences After Surgical Resection of Intraductal Papillary Mucinous Neoplasm of the Pancreas

The detection of intraductal papillary mucinous neoplasms (IPMN) has increased over the last decade, but still, management remains controversial. The main problems are their potential for malignancy and risk of recurrence. The purpose of this study was to determine the predictive factors of recurrence after surgical resection. All patients with IPMN who underwent pancreatectomy with curative intent were considered. Data were collected from a prospective base. From 1994 to 2009, 104 patients underwent pancreatectomy. Twenty-one (20%) had recurrence, 15 on remnant pancreas (none on pancreatic cut surface) and 6 with distant metastases. Twelve patients had total pancreatectomy (1 awaiting surgery). Thirteen (38.2%) of 34 patients with invasive IPMN and 20 (25.9%) of 77 with main duct involvement (including combined type) had recurrence. In univariate analysis, American Society of Anesthesiologist score and histological and duct type had a significant impact on recurrence rate. In multivariate analysis, histological type (invasiveness) was the only significant predictive factor for recurrence. The risk of recurrence of IPMN after resection depends on the histological type. According to surgical margin, invasiveness, and the type of duct involved, we identified a high-risk group with invasive main duct lesion and a low-risk group with noninvasive branch duct lesion.

PLOD2 induced under hypoxia is a novel prognostic factor for hepatocellular carcinoma after curative resection

Under hypoxia, tumour cells undergo genetic and adaptive changes that allow their survival. Previously, we reported that high expression of hypoxia-inducible factor (HIF)-1 was a significant predictive factor for recurrence in hepatocellular carcinoma (HCC). Hypoxia also stimulates expression of procollagen-lysine, 2-oxoglutarate 5-dioxygenase (PLOD) genes via the HIF-1 pathway. The aim was to evaluate the relationship between hypoxia stress and expression of PLOD genes in HCC in vitro and to identify a new prognostic marker in HCC patients. The PLOD2 expression was assessed under hypoxia in hepatoma cell lines and characterized in 139 HCC samples following hepatic resection using microarray experiments, quantitative RT-PCR and immunohistochemistry. Prognostic factors in HCC patients were assessed using univariate and multivariate analyses. The PLOD2 expression was induced under the hypoxia in vitro. Disease-free survival in the high PLOD2 expression group of HCC patients was significantly shorter when compared with the low-expression group (P=0.002). In a subset of HCCs, we found that the PLOD2 expression of microarray was correlated with data of quantitative RT-PCR and immunohistochemistry. Of clinicopathological factors, PLOD2 expression was significantly correlated with tumour size (P=0.022) and macroscopic intrahepatic metastasis (P=0.049). In univariate analysis, six prognostic factors (tumour multiplicity, macroscopic intrahepatic metastasis, histological grade, microscopic portal invasion, microscopic intrahepatic metastasis and PLOD2 expression) were significant for disease-free survival. PLOD2 expression was identified as a significant, independent factor of poor prognosis (P=0.013). PLOD2 is a potential novel prognostic factor for HCC patients following surgery.

Ductal carcinoma in situ of the breast in younger women: A subgroup of patients at high risk

Background After breast conservative treatment (BCT), young age is a predictive factor for recurrence in patients with Ductal Carcinoma In Situ (DCIS) of the breast. The purpose of this study was to evaluate predictive factors for recurrence and outcomes in these younger women (under 40 years) treated for pure DCIS. Methods From 1974 to 2003, 207 cases were collected in 12 French Cancer Centers. Median age was 36.3 years and median follow-up 160 months. Seventy four (35.8%) underwent mastectomy, 67 (32.4%) lumpectomy alone and 66 (31.9%) lumpectomy plus radiotherapy. Results 37 recurrences occurred (17.8%): 14 (38%) were in situ and 23 (62%) invasive. After BCT, the overall rate of recurrence was 27% (33% in the lumpectomy plus radiotherapy group vs. 21% in the lumpectomy alone group). Comedocarcinoma subtype ( p = 0.004), histological size more than 10 mm ( p = 0.011), necrosis ( p = 0.022) and positive margin status ( p = 0.019) were statistically significant predictive factors for recurrence. The actuarial 15-year rates of local recurrence were 29%, 42% and 37% in the lumpectomy alone, lumpectomy and whole breast radiotherapy and lumpectomy + whole breast radiotherapy with additional boost groups respectively. After recurrence, the 10-year overall survival rate was 67.2%. Conclusion High recurrence rates (mainly invasive) after BCT in young women with DCIS are confirmed. BCT in this subgroup of patients is possible if clear and large margins are obtained, tumor size is under 11 mm and necrosis- and/or comedocarcinoma-free.

Predictive factors of outcome and clinical management of adjuvant S-1 chemotherapy for gastric cancer

e15676 Background: Adjuvant S-1 chemotherapy has become a standard treatment for stage II and III gastric cancer, following the Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer (ACTS-GC). This study was designed to identify factors that can be used for predicting the outcome and clinical management of adjuvant S-1 chemotherapy in patients with stage II and III gastric cancer. Methods: We retrospectively examined 97 consecutive patients with stage II or III gastric cancer who received S-1 chemotherapy after gastrectomy to investigate factors associated with outcome and clinical management. S-1 (80 mg/m2/day) was orally administered twice daily for 28 consecutive days, followed by a 14-day rest period. As a rule, this protocol was continued for one year after gastrectomy. According to toxicity profiles, dose reduction or dose schedule modification was performed. Results: Patients consisted of 63 males and 34 females (median age, 59 years; range, 35–80 years), and those undergoing total gastrectomy/subtotal gastrectomy = 40/57. The median follow-up period after gastrectomy was 43.0 months (range, 5.3–73.4 months). As for adjuvant S-1 chemotherapy, dose reduction and dose schedule modification were conducted in 59% and 40% of the patients, respectively. Of the patients needing dose reduction, 79% underwent reduction within three months of treatment. The most common reason for dose reduction during the treatment period was anorexia (47%), followed by diarrhea (32%), leukopenia (24%) and rash (16%) with overlapping reasons. The duration period of the treatment was at least 3 months in 88%, at least 6 months in 82%, and scheduled 12 months in 73%. Twenty six patients discontinued treatment due to adverse event (20 patients), recurrent disease (2 patients) and other reasons (4 patients). The median duration until treatment discontinuation was 4.0 months. To date, 15 patients have recurrent disease. Significant predictive factors for recurrence were not statistically identified. Conclusions: Most patients (73%) could complete the scheduled treatment duration by dose reduction and dose schedule modification. No significant financial relationships to disclose.

The angiogenic and prognostic implications of VEGF, Ang-1, Ang-2, and MMP-9 for hepatocellular carcinoma with background of hepatitis B virus

The objective of this study was to investigate the expressions of angiogenic factors and elucidate their angiogenic and prognostic roles in hepatocellular carcinoma (HCC) with background of hepatitis B virus (HBV). We evaluated microvessel density (MVD) of HCC, and investigated immunohistochemical expression of vascular endothelial growth factor (VEGF), angiopoietins (Ang-1 and Ang-2), and matrix metalloproteinases-9 (MMP-9) in 67 specimens of surgically resected HCC, which were all positive for hepatitis B surface antigen. We investigated the relationship between their expressions and clinicopathological factors or prognosis. The microvessel density (MVD) of tumor tissue and surrounding normal liver tissue was 93.1 +/- 43.8/mm2 and 30.4 +/- 14.8/mm2, respectively. The MVD of well-differentiated HCC was significantly less than that of poorly differentiated HCC. MVD was positively correlated with VEGF and Ang-2 expression (P = 0.0023 and 0.0265, respectively). There was less tumor recurrence in low Ang-2 and low MMP-9 group than high Ang-2 and/or high MMP-9 group (P = 0.002). In Cox regression model, portal vein thrombus and intrahepatic metastasis was the risk factors of tumor recurrence (P = 0.003 and 0.001, respectively). Our study showed that the expression of VEGF and Ang-2 were positively correlated with MVD. Ang-2 expression and/or MMP-9 expression might be a significant predictive factor for recurrence after resection in HCC patients with the background of HBV.

Expression pattern of angiogenic factors and prognosis after hepatic resection in hepatocellular carcinoma: importance of angiopoietin‐2 and hypoxia‐induced factor‐1a

Hepatocellular carcinoma (HCC) is a hypervascular tumor and angiogenesis plays an important role in its progression. Angiogenesis is regulated by a balance between pro and antiangiogenic molecules. The aim of this study was to investigate the expressions of angiogenic factors and elucidate their roles in angiogenesis in HCC. We investigated immunohistochemical expression of vascular endothelial growth factor (VEGF), angiopoietins (Ang-1 and Ang-2), hypoxia-induced factor-1alpha (HIF-1alpha) and thrombospondin-1 (TSP-1) in 60 specimens of surgically resected HCC. We investigated the relationship between their expressions and clinicopathological factors or prognosis. Ang-2 staining had a significant correlation with the grade of differentiation of HCC cells (P=0.0082). VEGF and Ang-2 expression correlated positively with microvessel density (MVD) (P=0.0061 and 0.0374, respectively). MVD of well-differentiated HCC were significantly lower than those of moderately and poorly differentiated HCC. The disease-free survival time of patients with high Ang-2 and/or HIF-1alpha expression was significantly shorter than that of the low expression group (P=0.0278 and 0.0374, respectively). Our study showed that the expression of VEGF and Ang-2 correlated with MVD. Strong Ang-2 expression and/or high nuclear expression of HIF-1alpha is a significant predictive factor for recurrence after curative resection in HCC patients.

The N Ratio Predicts Recurrence and Poor Prognosis in Patients With Node-Positive Early Gastric Cancer

The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic significance of the ratio of metastatic to retrieved lymph nodes (N ratio) in identifying a high-risk subgroup with node-positive EGC. From a prospective database of 1264 EGC patients between 1987 and 1997, 156 (12.4%) were found to have histologically confirmed node metastasis. A number of prognostic factors, including the N ratio, were evaluated by univariate and multivariate analysis. The recurrence rate of node-positive EGC was 16.7% (n = 26). The overall 5-year survival rate of all patients was 84.0%. It was 26.9% and 95.4% in patients with and without recurrence, respectively (P < .0001; log-rank test). The cutoff value of the N ratio was set at .07. The 5-year survival rate of patients with an N ratio <.07 was 94.0%; this was significantly higher than the rate (72.6%) for those with a ratio >.07 (P < .0001; log-rank test). Both univariate and multivariate analysis identified the N ratio as the most significant predictive factor for recurrence and overall survival. Regarding stage migration, it shows superiority in comparison to the number-based N classification. The N ratio is a more effective and rational indicator for prognostic stratification of patients with lymph node-positive EGC than the current N classification of the tumor-node-metastasis system.

Is low antiepileptic drug dose effective in long-term seizure-free patients?

To investigate the value of leaving seizure-free patients on low-dose medication. This was an exploratory prospective randomized study conducted at our University Hospital. We evaluated the frequency of seizure recurrence and its risk factors following complete or partial antiepileptic drug (AED) withdrawal in seizure free patients for at least two years with focal, secondarily generalized and undetermined generalized epilepsies. For this reason, patients were divided into two groups: Group 1 (complete AED withdrawal), and Group 2 (partial AED withdrawal). Partial AED withdrawal was established as a reduction of 50% of the initial dose. Medication was tapered off slowly on both groups. Follow-up period was 24 months. Ninety-four patients were followed up: 45 were assigned to complete (Group 1) AED withdrawal and 49 to partial (Group 2) AED withdrawal. Seizure recurrence frequency after two years follow-up were 34.04% in group 1 and 32.69% in Group 2. Survival analysis showed that the probability of remaining seizure free at 6, 12, 18 and 24 months after randomization did not differ between the two groups (p = 0.8). Group 1: 0.89, 0.80, 0.71 and 0.69; group 2: 0.86, 0.82, 0.75 and 0.71. The analysis of risk factors for seizure recurrence showed that more than 10 seizures prior to seizure control was a significant predictive factor for recurrence after AED withdrawal (hazard ratio = 2.73). Leaving seizure free patients on low AED dose did not reduce the risk for seizure recurrence. That is, once the decision of AED withdrawal has been established, it should be complete.

Preoperative identification of meningiomas that are highly likely to recur.

Although generally they are well-circumscribed benign tumors, meningiomas recur even after complete removal. The aims of this study are to identify preoperatively groups of patients who have a high risk of meningioma recurrence by reviewing their clinicoradiological features and to plan appropriate treatments. One hundred one patients who underwent macroscopically complete removal of meningiomas were observed postoperatively for at least 5 years or until tumor recurrence. Preoperative radiological findings and clinical characteristics were assessed. Fifteen meningiomas recurred during the follow-up period, which extended to a maximum duration of 18 years. On univariate analysis, tumor size and shape, relation to the major sinuses, calcification, bone changes, and characteristics of the tumor-brain interface were significant predictive factors for recurrence. Patient age and gender were not deemed significant. Multivariate analysis revealed that only the shape of the tumor was significant; both "mushrooming" and lobulated meningiomas were more likely to recur than round ones. Recurrences most frequently occurred at the edge of the dural resection after a Simpson Grade I removal, whereas local recurrences were predominant after a Simpson Grade II or III removal. Meningiomas with mushrooming or lobulated shapes should be treated more aggressively with a wider dural excision. This is not usually necessary for round tumors, although it may be beneficial in younger patients.