Predictors of systemic recurrence and disease-specific survival after ipsilateral breast tumor recurrence

BACKGROUND: In patients with breast carcinoma, ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) is an independent predictor of systemic recurrence and disease-specific survival (DSS). However, only a subgroup of patients with IBTR develop systemic recurrences. Therefore, the management of isolated IBTR remains controversial. The objective of the current study was to identify determinants of systemic recurrence and DSS after IBTR. METHODS: The medical records of 120 women who underwent BCT for Stage 0-III breast carcinoma between 1971 and 1996 and who subsequently developed isolated IBTR were reviewed. Clinicopathologic factors were studied using univariate and multivariate analyses for their association with DSS and the development of systemic recurrence after IBTR. RESULTS: The median time to IBTR was 59 months. At a median follow-up of 80 months after IBTR, 45 patients (37.5%) had a systemic recurrence. Initial lymph node status was the strongest predictor of systemic recurrence according to the a univariate analysis (P = 0.001). Other significant factors included lymphovascular invasion (LVI) in the primary tumor, time to IBTR < or = 48 months, clinical and pathologic IBTR tumor size > 1 cm, LVI in the recurrent tumor, and skin involvement at IBTR. In a multivariate logistic regression analysis, initially positive lymph node status (relative risk [RR], 5.3; 95% confidence interval [95% CI], 1.4-20.1; P = 0.015) and skin involvement at IBTR (RR, 15.1; 95% CI, 1.5-153.8; P = 0.022) remained independent predictors of systemic recurrence. The 5-year and 10-year DSS rates after IBTR were 78% and 68%, respectively. In a multivariate Cox proportional hazards model analysis, only LVI in the recurrent tumor was found to be an independent predictor of DSS (RR, 4.6; 95% CI, 1.5-14.1; P = 0.008). CONCLUSIONS: Patients who initially had lymph node-positive disease or skin involvement or LVI at IBTR represented especially high-risk groups that warranted consideration for aggressive, systemic treatment and novel, targeted therapies after IBTR. Determinants of prognosis after IBTR should be taken into account when evaluating the need for further systemic therapy and designing risk-stratified clinical trials.     

Intra-abdominal recurrence from colorectal carcinoma: Differences and similarities between local and peritoneal recurrence

BackgroundPeritoneal recurrences from colo-rectal cancer can be isolated (PR) or associated with local recurrences (LR). The purpose of this study was to analyze patterns and outcomes of LR and PR.MethodsAnalyze from a prospective database of 108 patients treated with CCS plus HIPEC at two cancer centers between 2008 and 2015.ResultsThe population was divided into an LPR group (presence of LR with or without PR, n = 56) and a PR group (isolated PR, n = 52). The patients characteristics (age, sex, Charlson score, PCI) or perioperative treatments were comparable between the groups. The median number of resected organs for tumor involvement (respectively, 2 vs 1; p < 0.001), the percentage of patients with metastatic lymph nodes (LN+) from the resected specimen (respectively, 25% vs 7%; p = 0.016) and the mortality rate (respectively, 9% vs 0%; p = 0.023) were significantly higher in the LPR group. After a median follow-up of 32 (1–108) months, median overall survival was comparable between the two groups (respectively, 46 vs 42 months; p = 0.262).ConclusionsLR is associated with a higher incidence of organ invasion, LN involvement (25%) and postoperative mortality. Optimal surgical resection of LR with systematic lymphadenectomy of invaded organs seems mandatory.     

肝癌术后复发

Objective:To analyze pest-surgical recurrence of hepatocellular carcinoma (HHC) according to pathologic findings, primary tumor and angiographic features of the recurrent tumor. Methods:In this series, 100 cases of recurrent HCC were analyzed in following aspects: (1) size, tumor nodular numbers, gross and histologic findings of the primary tumor; (2) post-surgical recurrent time; (3) size, tumor nodular numbers, blood supply, staining property, and accumulation of lipiodol oil in the recurrent tumor. Following angiography, arterial chemoembolization was performed. Results:In the primary tumor, single nodules were seen in 80 cases, multiple nodules in 16 cases and multiple fused nodules in 4 cases. All tumors were classified as: trabecular type, 65 eases; compact type, 12; sclerotic type, 2 cases; mixed type, 15 cases and cholangiocareinoma type, 6 cases. 38 cases had incomplete or no capsule. Satellite tumor nodules were grossly identified during operation in 33 cases, but were proven microscopically in 66 cases. Tumor thrombi of portal vein was noted in 18 cases during oeration, but 85 cases in histopathological sections. The recurrent tumors were diagnosed post surgically within 6 months in 67 cases, 6-12 months in 15 cases and after 12 months in 18 cases respectively. On angiography, 67% recurrent tumors was rich in blood supply and with abundant accumulation of lipiodol after embolization. Conclusion:The post-surgical recurrence rate of the HCC patients with massive size, incomplete or no capsule, satellite tumor nodules and portal vein tumor thrombus was high. The patients shoud receive angiography in 1-2 months after surgery in order to detect early recurrence and, if confirmed, the patients may be treated by transcatheter arterial chemoembolization     

Supraclavicular lymph-node recurrence of breast-cancer

To describe prognosis and outcome of patients with a recurrence in the supraclavicular fossa (SCLNR) and to evaluate the role of different therapeutic options for recurrence on the outcome of these patients, clinical and pathological characteristics, treatment and time course of 55 patients with supraclavicular recurrence as their first relapse of disease were analysed. Thirty-nine patients had an isolated recurrence, i.e. no distant metastases were known at the time of supraclavicular recurrence. Median follow-up was 20.4 months from supraclavicular recurrence and 58.8 months from primary diagnosis. For evaluation of treatment only the 39 patients without distant disease before or simultaneous with supraclavicular recurrence were analysed. Mean age of the 55 patients at primary diagnosis and at diagnosis of recurrence was 56.7 and 61.2 years respectively. The majority of patients developing such a recurrence was younger than 60 years at the time of primary diagnosis, Evaluation of patient characteristics showed a high proportion of positive axillary status (65%) at the time of primary diagnosis with a mean number of 7.5 involved nodes. Tumor was located in the medial or central part of the breast in 53% of patients in whom primary tumor location was known. About 80% of patients developed their recurrence in the first 5 years from primary diagnosis of breast cancer. Global survival after SCLNR was poor. Survival rate from recurrence was 65% at 2 years and only 16% at 5 years. Among the 39 patients with an isolated SCLNR 88% developed distant metastases within 5 years from recurrence. The evaluation of different therapeutic options for a SCLNR (radiotherapy, surgery, systemic therapy) revealed no significant influences on survival rates. When local regional control was obtained, a trend towards improved survival was noted. Patients aged younger than 60 years at primary diagnosis, with high positive primary axillary status or tumor of the medial or central part of the breast seem to be at higher risk for developing SCLNR and internal mammary lymphatic route may be a more probable pathway to the supraclavicular nodes besides the common axillary route. SCLNR carries a grave prognosis. Most patients develop distant disease within short time, with only a small section surviving more than 5 years from the onset of recurrence. Survival rate of patients with SCLNR is clearly inferior to patients with local or regional axillary recurrence. From this we conclude that SCLNR should be considered as an indicator of systemic disease despite its lymphogenous genesis and not as regional recurrence. Local therapy of SCLNR is to be defined with palliative intent in most cases. Systemic therapy has to be applied additionally even if no other distant disease is known. Further prospective analyses will have to evaluate the role of systemic treatment for solitary supraclavicular recurrences.     

Psychological responses to cancer recurrence

BACKGROUND: There is a dearth of knowledge regarding the psychological responses to a diagnosis of cancer recurrence. METHODS: An ongoing randomized clinical trial provided the context for prospective study. Women with Stage II/III breast carcinoma (N = 227) were initially assessed after their diagnosis/surgery and before adjuvant therapy and then reassessed every 6 months. Eight years into the trial, 30 patients had recurred (R) and were assessed shortly after receiving their second diagnosis. Their data were compared with a sample of trial patients who had no evidence of disease (disease free [DF]; n = 90). The groups were matched on study arm, disease stage, estrogen receptor status, menopausal status, and time since initial diagnosis. RESULTS: As hypothesized, patients' cancer-specific stress at recurrence in the R group was higher (P < 0.05) than stress levels for the DF group at the equivalent point in time. Importantly, the R group reported stress for their recurrent diagnosis equivalent to that reported for their initial diagnosis. Identical results were found for measures of health status and symptomatology. In contrast, analyses for emotional distress and social functioning showed no pattern of disruption for the R group at cancer recurrence and levels equivalent to that of the DF group. CONCLUSIONS: To the authors' knowledge, this was the first controlled, prospective psychological analysis of patients' responses to cancer recurrence. The findings were consistent with a learning theory conceptualization of the cancer stressor. Patients' stress was "compartmentalized" and did not, at least in the early weeks, result in diffuse emotional distress and quality of life disruption, underscoring the resilience of patients when confronted with cancer recurrence.     

Late recurrence in endometrial carcinoma

This report describes a patient with a recurrence of endometrial carcinoma 26.5 years after diagnosis, a much longer interval to recurrence than previously reported. She presented at age 47 years with an International Federation of Gynecology and Obstetrics (FIGO) grade 2, Stage IA adenoacanthoma and was treated with an intracavitary radium implant followed by radical hysterectomy. Pathologic examination showed the tumor to be confined to the corpus with only superficial myometrial invasion. She subsequently developed an isolated lower vaginal recurrence histologically identical to the original tumor. The patient was retreated with radiation therapy, and is currently alive and free of disease. This report emphasizes the possibility of late recurrence of endometrial carcinoma even with favorable prognostic features (Stage I, superficial invasion, younger than age 50 years, adenoacanthoma, preoperative irradiation).     

乳腺癌患者术后胸壁复发及预后相关因素分析

目的 乳腺癌出现胸壁复发通常被认为是乳腺癌治疗失败的第一征象,是发生远处转移的先兆.本研究回顾性分析乳腺癌术后胸壁复发患者病例资料,分析影响乳腺癌患者术后胸壁复发及预后的相关因素,为规范的临床治疗提供有用的依据.方法 收集湖南省肿瘤医院2008-01-01-2009 12-31收治的130例乳腺癌术后胸壁复发患者的临床、病理及预后资料,其中Ⅰ期42例,Ⅱ期60例,Ⅲ期28例,分析其临床特点和胸壁复发时间,Kaplan-Meier法计算患者无瘤生存率,采用二元Logistic回归分析复发的影响因素,OR及95％ CI为评价指标,采用Cox回归分析生存期的影响因素,HR及95％CI为评价指标.结果 3、5年无瘤生存率分别为58.4％和33.7％,3、5年总体生存率为91.4％和83.9％,中位发病年龄为45岁,中位复发时间为25个月,中位生存时间为56个月.胸壁复发二元Logistic回归分析显示,肿瘤分期、肿瘤大小及细胞分化程度、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和Ki-67表达、淋巴结转移是影响乳腺癌患者术后胸壁复发的相关因素,均P＜o.05. Cox分析显示,肿瘤分期、肿瘤细胞分化程度、肿瘤病理类型及C-erbB-2表达是影响患者5年总体生存率的因素,均P＜0.05.结论 肿瘤分期晚、肿瘤偏大,肿瘤细胞分化程度低、存在4枚及以上腋窝淋巴结转移、ER和PR低表达及Ki-67高表达是乳腺癌术后胸壁复发的危险因素,而临床分期Ⅲ期、肿瘤细胞低分化、肿瘤病理类型为浸润型癌、C-erbB-2阳性表达是总生存的独立预后因素,对存在上述危险因素的患者,应根据患者情况选择个体化的综合治疗方案,加强随访改善患者预后.     

21-Gene recurrence score and locoregional recurrence in lymph node-negative,estrogen receptor-positive breast cancer

Purpose

To examine the clinical outcomes of postmenopausal African American (AA) women treated with strut-adjusted volume implant brachytherapy-based accelerated partial breast irradiation for early-stage node-negative breast cancer.

Methods

From January 2011 through April 2015, a total of 50 AA patients, meeting criteria to receive APBI as defined by the National Surgical Adjuvant Breast and Bowel Project B-39 (NASBP B-39), completed treatment with the SAVI breast brachytherapy device at Howard University Hospital.

Results

4% ipsilateral breast tumor recurrence and 2% breast cancer-specific mortality was observed. Median follow-up has been 3.8 years with a range of 0.29–4.69 years. Dosimetry parameters yielded a median V90 of 96.22% (range 77.86–105.00%), a median V150 of 31.27 cm³ (range 23.30–49.15 mL), and a median V200 of 14.53 cm³ (range 5.92–19.38 mL). Cosmesis was excellent. There were no infections, persistent seromas, fat necrosis, or telangiectasias observed to date.

Conclusions

This study is the first study to describe the use of SAVI as APBI in an exclusively AA population. This study has demonstrated excellent local control in appropriately selected patients, similar clinical outcomes to the general population, and good to excellent cosmesis in AA women to date.

     

骨软骨瘤复发因素的分析

目的分析可能造成骨软骨瘤手术治疗后局部复发的因素。方法回顾性分析我院1992年至2002年手术治疗的114例骨软骨瘤。男70例，女44例，平均年龄21．3岁（8～66岁）；单发91例，多发23例。单发骨软骨瘤病变部位：股骨35例，胫骨21例，肱骨8例，腓骨6例，肩胛骨6例，髂骨5例，胸椎4例，跖骨2例，骶骨1例，坐骨1例，肋骨1例，桡骨1例。均经手术治疗，术后病理证实为骨软骨瘤。总结6例肿瘤术后复发病例，1例为我院手术后复发，另外5例复发病例是外院手术后复发来我院就诊的病例，复发病例平均年龄10．7岁，部位：桡骨远端1例，胫骨上端2例，胫骨下端1例，股骨下端1例，股骨上端1例。结果平均随访51．6个月（36～72个月），我院手术治疗114例中有1例术后肿瘤复发，发生率0．9％。结论骨软骨瘤手术后复发是由于未完全彻底切除，残留部分继续生长。严格掌握骨软骨瘤的手术指征及正确的手术操作，彻底切除肿瘤，骨软骨瘤不会复发。     

The recurrence of primary intracranial germinomas

Summary Twenty three cases of primary intracranial germinomas including five cases of germinomas with syncytiotrophoblastic giant cells are studied and analyzed, with special reference to the recurrence under radiotherapy. The follow-up period for all cases was 7 months to 12 years (average: 5.8 years) with that for pure germinomas ranging from 8 months to 12 years (average: 5.7 years) and that for germinomas with syncytiotrophoblastic giant cells ranging from 7 months to 11 years (average: 6.3 years). Late recurrence was observed in three cases (3/23, 13%), developing outside of the initial irradiation field.With regard to recurrence, significant correlation to radiation fields was evident, while it was not to radiation doses. Furthermore, germinoma with syncytiotrophoblastic giant cells showed a more significant tendency to recur than pure germinoma. The radiotherapy of germinomas is discussed and the clinical features of germinoma with syncytiotrophoblastic giant cells are presented.     

Locoregional recurrence in breast carcinoma patients

Aims

To assess the risk of locoregional recurrence (LRR) after mastectomy and to identify predictive and treatment factors that affect the risk of LRR.

Methods

The primary endpoint was local recurrence. Univariate and multivariate Cox regression analyses were carried out in the data from 1217 patients.

Results

The median follow-up was 74 months, and 63 (5.2%) patients experienced a LRR in their follow-up period. In the multivariate analysis, age group (≤35 years vs. >35 years, p < 0.0001; Hazard Ratio [HR], 5.0; 95% Confidence Interval [95% CI], 3.0–8.3), tumour size (>2 cm vs. ≤2 cm, p = 0.03; HR, 2.2; 95% CI, 1.2–4.7) and LVI (yes vs. no, p < 0.0001; HR, 3.2; 95% CI,1.9–5.2) were the independent prognostic factors for LRR. This analysis, in the final model, indicated that adjuvant radiotherapy and adjuvant tamoxifen were associated with a reduced risk of LRR by 90% and 75%, respectively, across the follow-up period, whereas age group remained as an important risk factor (p = 0.002; HR, 3.0; 95% CI, 1.5–6.2).

Conclusions

Although adjuvant therapies reduce the risk of LRR, young age is an independent risk factor for LRR.     

Late recurrence from salivary gland cancer

BACKGROUND: The purpose of the current study was to determine the incidence of late recurrences, which were defined as those occurring >or=5 years after initial therapy, among patients treated for salivary gland cancer. METHODS: Between 1960 and 2000, 145 patients underwent definitive therapy for localized carcinomas of the salivary glands and were clinically without evidence of disease at 5 years of follow-up. Cumulative probabilities for developing a subsequent late recurrence were estimated using the Kaplan-Meier method. RESULTS: The 10-year and 15-year cumulative probabilities of late recurrence in patients who were free of disease at 5 years were 13% and 18%, respectively. The crude rates of late recurrence by histologic subtype were adenoid cystic carcinoma (26%), mixed malignant tumor (25%), mucoepidermoid carcinoma (17%), adenocarcinoma (10%), and acinic cell carcinoma (8%). Sites of late recurrence included distant metastasis (17 patients), local recurrence (8 patients), and regional recurrence (2 patients). The median time to late recurrence was 7.1 years (range, 5.2-23.1 years) from the date of initial surgery. Salvage treatment varied according to location of disease recurrence and initial treatment characteristics. The 15-year estimate of overall survival was 39% for patients who experienced a late recurrence compared with 71% for those who remained free of disease (P= .001). CONCLUSIONS: A significant proportion of patients who are presumed to be cured of their disease at 5 years after initial treatment for salivary gland cancer will be found to develop late disease recurrence with additional follow-up.     

Blood transfusion and lung cancer recurrence

Recent reports have suggested that perioperative blood transfusions may adversely affect prognosis after resection of non-small cell lung cancer (NSCLC). To determine the impact of perioperative transfusion on the recurrence-free interval, the status of 352 patients who underwent pulmonary resection for pathologic Stages I and II NSCLC was investigated. Transfused patients were significantly older than untransfused patients (P = 0.0009) but were not significantly different in sex distribution (P = 0.12) or tumor stage (P = 0.09). Recurrence was not significantly different in transfused patients when compared with patients who received no blood (P = 0.23) even when stratified for stage (Stage I, P = 0.58; Stage II, P = 0.14). Furthermore, the number of units transfused was not associated with time to tumor recurrence (P = 0.58). Contrary to other reports, these results do not support the contention that perioperative blood transfusion is significantly associated with decreased recurrence-free survival.