Controversial Issues Regarding Obligatory Adjuvant Chemotherapy for Stage IIIA Colon Cancer

PurposeTo investigate the survival outcomes of patients with stage IIIA colon cancer. In addition, risk factors that affect the oncologic outcome of stage IIIA colon cancer patients and the role of adjuvant chemotherapy were evaluated.Patients and MethodsData from 326 colon cancer patients with stage IIIA who underwent surgery between January 2000 and December 2016 were retrospectively reviewed. Patients diagnosed with hereditary cancer and those who received preoperative neoadjuvant therapy were excluded.ResultsThe 5-year recurrence-free survival (RFS) rate in stage IIIA colon cancer patients who underwent curative resection was 93.9%. Of the patients with recurrence, the survival rate of those who underwent surgical resection was better than that of patients who received palliative chemotherapy or no treatment (12/13, 92.3% vs. 2/4, 50.0%), respectively; P = .052). Multivariate analysis showed that high serum carcinoembryonic antigen (s-CEA) was an independent and statistically significant prognostic factor for RFS, and ulcerative gross-type disease tended to be a poor prognostic factor. There was no difference in RFS in patients with elevated s-CEA or ulcerative gross-type disease according to receipt of adjuvant chemotherapy.ConclusionPatients with stage IIIA colon cancer had a relatively favorable survival outcome. Even in patients with relapsed disease, long-term survival could be a result if surgical resection is accomplished. High s-CEA concentration is a significant poor prognostic factor for recurrence, and ulcerative gross-type disease tends to be a poor prognostic factor. Postoperative adjuvant chemotherapy may not provide a survival benefit for stage IIIA colon cancer, even in the presence of risk factors. Because of the rarity of this patient group and the low rate of recurrence, large-scale multicenter studies are needed to find and confirm the risk group that would receive a benefit from adjuvant chemotherapy.     

Five-year oncologic outcomes and prognostic factors for locally advanced low rectal cancer after low anterior resection

Objective： The aim of the study is to investigate the longterm oncologic outcomes including local recurrence, distant metastases and overall survival （OS） for patients with low rectal cancer underwent low anterior resection （LAR） with total mesorectal excision （TME）, and to analyze the prognostic factors for them. Methods： Between January 2001 and December 2009, 147 patients with clinical stage II and III rectal cancers located 3-6 cm from the anal verge underwent LAR with TME without temporary diverting stoma. The median distal resection margin （DRM） was 1.0 （range, 0.3-5） cm. Anastomostic leakage occurred in 29 （19.7%） patients. Thirty patients received surgery alone, 20 patients received preoperative chemoradiotherapy （CRT）, 43 patients received postoperative CRT, and adjuvant chemotherapy was administered for 108 patients. The median cycle of adjuvant chemotherapy was 6 （range, 2-20） cycles. The median followup was 74.8 （range, 30.1-146.3） months. Results： In all patients, 5-year recurrence-free survival （RFS）, disease-free survival （DFS） and OS were 70.4%, 54.2% and 60.5%, respectively. Forty-three （29.3%） patients suffered local recurrence. Patients received preoperative CRT with a downstaging yp0/1 who had a better 5-year RFS, DFS and OS, which were 100%, 90.9%, and 90.9%, respectively. For patients with pathologic stage Ⅱ and stage Ⅲ, the 5-year RFS, DFS, and OS were 79.2% and 60.1%, 67.9% and 39.1%, 72.1% and 48.2%, respectively. On multivariable analysis, RFS was associated with anostomostic leakage, DFS was associated with anastomostic leakage and pathologic N stage, and OS was associated with anastomostic leakage, pathologic N and T stage. For patients with anastomostic leakage, the 5-year RFS, DFS, and OS were 51.7%, 32.4%, and 38.3%, respectively, which were worse than that for patients without anastomostic leakage, the latter were 75.2%, 59.7%, 65.7%, respectively （P 〈 0.05）. DRM and radiotherapy were associated with RFS on univariable     

原发性阴道恶性黑色素瘤患者预后影响因素分析:32例病例报道及系统评价

目的 探讨原发性阴道恶性黑色素瘤(PMMV)的预后及其影响因素.方法 收集郑州大学第一附属医院2013年1月至2018年6月收治的32例和中英文文献报道69例PMMV患者的临床病理资料,汇总后系统评价PMMV患者临床病理特征、预后及其影响因素.结果 共纳入101例PMMV患者.平均发病年龄61岁,79.2％为绝经后女性...     

Conservative Neck Dissection in Oral Cancer Patients: a 5 Year Retrospective Study in Malaysia

Objective: The impact of ablative oral cancer surgery was studied, with particular reference to recurrence andnodal metastasis, to assess survival probability and prognostic indicators and to elucidate if ethnicity influencesthe survival of patients. Methods: Patients who underwent major ablative surgery of the head and neck regionwith neck dissection were identified and clinical records were assessed. Inclusion criteria were stage I-IV oraland oropharyngeal malignancies necessitating resection with or without radiotherapy from 2004 to 2009. Allindividuals had a pre-operative assessment prior to the surgery. The post operative assessment period rangedfrom 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. Results: 87 patients(males:38%; females:62%) were included in this study, with an age range of 21-85 years. Some 78% underwentneck dissections while 63% had surgery and radiotherapy. Nodal recurrence was detected in 5.7% while 20.5%had primary site recurrence within the study period. Kaplan-Meier survival analysis revealed that the mediansurvival time was 57 months. One year overall survival (OS) rate was 72.7% and three year overall survival ratedropped to 61.5%. On OS analysis, the log-rank test showed a significant difference of survival between Malayand Chinese patients (Bonferroni correction p=0.033). Recurrence-free survival (RFS) analysis revealed that25% of the patients have reached the event of recurrence at 46 months. One year RFS rate was 85.2% and thethree year survival rate was 76.1%. In the RFS analysis, the log-rank test showed a significant difference in theevent of recurrence and nodal metastasis (p<0.001). Conclusion: Conservative neck is effective, in conjunctionwith postoperative radiotherapy, for control of neck metastases. Ethnicity appears to influence the survival ofthe patients, but a prospective trial is required to validate this.     

High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: significance of hepatitis virus infection, age, p53 and beta-catenin mutations

alpha-Fetoprotein (AFP) is often elevated in hepatocellular carcinoma (HCC). This study was to elucidate the significance and related factors of AFP elevation in HCC in 781 unifocal HCCs receiving curative hepatectomy. We showed that high AFP (> 200 ng/ml), which was associated with AFP mRNA expression in HCC (p = 0.00001), correlated with major clinicopathologic factors. Younger age (< or = 55 years; p=0.00001), hepatitis B surface antigen (HBsAg) in serum (p=0.00001), p53 mutation (p=0.008), large tumor (p=0.00001), vascular invasion (p=0.00001) and early tumor recurrence (p=0.00001) were significant associates of high AFP, while anti-HCV in serum and beta-catenin mutation in HCC had less frequent high AFP (p=0.013 and < 0.0001, respectively). We also showed that HCC with high AFP had a lower 10-year survival (p < 0.0001), particularly in large HCC (p < 0.0001). At univariate analysis, high AFP (p < 0.0001), HBsAg positivity (p=0.05), p53 mutation (p=0.0004), liver cirrhosis (p=0.0094), large tumor (p=0.0003), vascular invasion (p < 0.0001) and early recurrence (p < 0.0001) were significant unfavorable prognostic factors. In Cox proportional hazards regression analysis, high AFP remained a borderline significance (OR=1.2; CI=1.0-1.4) after adjustment for the effect of tumor size and tumor stage (p=0.0821). Furthermore, the detection of AFP mRNA in the liver of AFP mRNA-positive HCC was associated with more frequent early recurrence (p=0.0026) and might be a useful marker of intrahepatic spread. We therefore conclude that AFP elevation, more than a coincidental epiphenomenon, appears to contribute to vascular invasion and HCC progression and help to identify subsets of HCC patients with increased risk for early recurrence and poor prognosis after hepatectomy.     

影响中下段直肠癌患者根治术后生存的多因素分析

背景与目的：中下段直肠癌在我国发生率较高,如何提高中下段直肠癌治疗效果的研究一直受到关注。本研究旨在探讨中下段直肠癌患者根治术后临床及病理特征与预后的关系。方法：回顾性分析中山大学肿瘤防治中心1990年～1999年收治的599例中下段直肠癌患者的临床及病理资料。全组患者中行经腹会阴联合切除术（abdominoperineal resection,APR）355例,低位前切除术（low anterior resection,LAR）244例。采用寿命表法计算生存率,log-rank检验进行生存曲线比较,应用Cox比例风险模型进行多因素分析。结果：全组总的5年生存率为70．7％,其中APR与LAR依次为：67．5％、75．2％（P=0．026）。单因素分析显示,局部复发、围手术期输血、T分期、淋巴结转移、手术方式、肿瘤大体类型、组织类型以及肿瘤距肛缘长度与中下段直肠癌患者预后相关（P〈0．05）。多因素分析显示。局部复发、围手术期输血、T分期和淋巴结转移是影响预后的独立因素（P〈0．01）。结论：局部复发、围手术期输血、T分期和淋巴结转移是影响中下段直肠癌患者预后重要的指标。LAR正逐渐成为中下段直肠癌根治术首选的手术方式之一。     

Marginal zone lymphomas

BACKGROUND:

A retrospective review and analysis of 275 patients with marginal zone lymphoma (MZL) was performed to determine prognostic factors. An effort was also made to establish a specific prognostic score for patients with extranodal MZL.

METHODS:

Patients were divided into 3 groups according to the type of MZL: extranodal, nodal, and splenic. Factors analyzed included age; gender; presence of B symptoms; Zubrod performance score; clinical stage; serum β₂‐microglobulin, lactate dehydrogenase, albumin, and hemoglobin levels; and presence of autoimmune disorder.

RESULTS:

The 5‐year overall survival rates of patients with extranodal, nodal, and splenic MZL were 87%, 89%, and 93%, respectively (P = .95). On multivariate analysis, splenic MZL patients had the best prognosis (hazard ratio, 0.18; P = .018). An elevated serum β₂‐microglobulin level (P = .010), B symptoms (P = .021), and male gender (P = .036) were found to be correlated with decreased recurrence‐free survival (RFS) on multivariate analysis. Using these 3 variables, a 3‐tier prognostic scoring system was created for patients with extranodal MZL: low‐risk with no adverse factors, intermediate‐risk with 1 adverse factor, and high‐risk with ≥2 adverse factors. The 5‐year RFS rates for the low‐risk, intermediate‐risk, and high‐risk groups were 80%, 71%, and 44%, respectively (P = .01).

CONCLUSIONS:

Patients with extranodal and nodal MZL have a similar prognosis, whereas patients with splenic MZL have a better prognosis despite the increased prevalence of negative prognostic indicators. With the use of 3 readily available factors, a prognostic scoring system was identified for patients with extranodal MZL. Cancer 2010. © 2010 American Cancer Society.     

Aberrant expressions of annexin A10 short isoform, osteopontin and alpha-fetoprotein at chromosome 4q cooperatively contribute to progression and poor prognosis of hepatocellular carcinoma

Chromosome 4q exhibits high frequency of allelic loss in hepatocellular carcinoma (HCC). This study aimed to elucidate the interaction of the frequent aberrant mRNA expression of alpha-fetoprotein (AFP), osteopontin (OPN) and a novel short isoform of annexin A10 (ANXA10S) at 4q in the tumor progression among 294 patients who received surgical resection of unifocal primary HCC. AFP overexpression, OPN overexpression and ANXA10S down-regulation correlated with high-grade and high-stage tumors, early tumor recurrence (all P<0.0001), and lower 10-year survival (all P=0.000001). The AFP overexpression correlated with OPN overexpression (P=0.0026) and ANXA10S down-regulation (P=0.00001), while OPN overexpression correlated with ANXA10S down-regulation (P=0.00001). Pair-wise combinations revealed interactive effects between these genetic variants for tumor grade, tumor stage and early recurrence (all P<0.0001). HCCs with more genetic aberrations had more frequent high tumor grade, portal vein invasion (stage IIIB-IV) and early recurrence (all P<0.0001). The 10-year survival rate for HCCs with all three genetic alterations was the lowest (7%), followed by those with two (22%) or one event (29%), and the highest for those without these changes (43%), P=0.000001. The prognostic stratification using these molecular factors was similar to that of histopathological staging. These three genetic alterations also helped to identify different subgroups of patients of stage II HCC but with different prognosis (P=0.015). In conclusion, the aberrant expressions of AFP, OPN and ANXA10S cooperatively contribute to tumor progression and poor prognosis, and are useful for molecular staging of HCC and the subclassification of stage II HCC without vascular invasion.     

Upper Urinary Tract Transitional Cell Carcinoma: Is There a Best?

BackgroundThis study aimed to determine the prognostic and risk factors for bladder and systemic recurrence after nephroureterectomy (NU) in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC).Patients and MethodsData from 101 patients with nonmetastatic UUT TCC who underwent NU between 1987 and 2009 were retrospectively evaluated. Kaplan-Meier curves for sex, age, anemia, smoking, stone disease, or history of bladder tumor, primary tumor localization, multiplicity, and disease stage and grade were constructed to predict 5-year recurrence-free survival (RFS). Multivariate Cox regression analysis was used to identify independent risk factors for recurrence.ResultsBladder, distant, and local recurrence rates at a mean of 56.19 ± 5.30 months after NU were 38.5%, 19.8%, and 7.9%, respectively. Univariate analysis showed that among the patients with bladder recurrence, female patients had significantly lower 5-year RFS than did male patients (34.7% ± 0.13% vs. 62.4% ± 0.06%, P = .038); however multivariate analysis showed that both female sex and a history of smoking were independent risk factors for bladder recurrence (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.56-11.4; P = 0.005 and OR, 2.84; 95% CI, 1.1-7.4; P = .032, respectively). Univariate analysis showed that among the patients with local and distant recurrence, anemia, a positive history of bladder tumor, localization of the primary tumor, multiplicity, disease stage, and tumor grade significantly affected RFS, whereas primary tumor stage and grade were the only independent risk factors for 5-year RFS (OR, 4.48; 95% CI, 1.45-13.79; P = .009 and OR, 5.82; 95% CI, 2.08-16.26; P = .001, respectively).ConclusionFemale sex and a history of smoking were independent risk factors for bladder recurrence after NU. Such patients should be monitored closely using cystoscopy and urine cytologic examination. Invasive and higher grade UUT TCC was associated with worse local or systemic RFS.     

术前外周血中性粒细胞与淋巴细胞比值评估肝细胞癌根治性切除术后预后的临床价值

目的 探讨肝细胞癌(HCC)患者术前外周血中性粒细胞与淋巴细胞的比值(NLR)对根治性切除术后预后评估的临床价值.方法 收集行HCC根治性切除术的161例HCC患者的临床资料,根据患者术前NLR值情况,将患者分为高NLR组(NLR≥2.60,n=52)及低NLR组(NLR﹤2.60,n=109).应用Kaplan-Meier方法分析患者的生存率,并采用Log-rank检验差异;采用Cox回归模型分析影响HCC患者总体生存率的预后因素.结果161例HCC患者的中位随访时间为29个月,高NLR组的1、3、5年总体生存率分别为79.6%、70.8%、41.1%,中位肿瘤复发时间14.9个月;低NLR组的1、3、5年总体生存率分别为90.4%、79.6%、48.7%,中位肿瘤复发时间为20.1个月,高NLR组的1、3、5年总体生存率均低于低NLR组(P﹤0.05),中位肿瘤复发时间短于低NLR组(P﹤0.05);单因素分析结果显示:肿瘤包膜、TNM分期、术前AFP、术前高NLR、淋巴结转移、肿瘤大小与HCC根治性切除术后预后生存时间有关,差异有统计学意义(P﹤0.05);Cox多因素分析结果显示:TNM分期为Ⅲ~Ⅳ期、术前AFP﹤400 ng/ml、术前NLR≥2.60、淋巴结转移、肿瘤大小≥10 mm为影响HCC患者根治性切除术后预后的独立危险因素(P﹤0.001).结论 术前NLR是影响HCC患者根治性切除术后预后的独立危险因素,可作为评估患者预后的指标,术前高NLR者其预后较差.     

IASLC分级系统与Ⅰ期浸润性非黏液型肺腺癌患者预后关系的回顾性研究

目的：回顾性分析国际肺癌研究协会(IASLC)分级系统与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性及与患者预后的关系。方法：回顾性分析2015年1月至2018年12月就诊于天津市胸科医院的204例Ⅰ期浸润性非黏液型肺腺癌患者的临床病理资料及随访资料,根据IASLC分级系统对患者分组,采用单因素方差分析、χ²检验和Fisher精确检验分析IASLC分级与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性,及与肺腺癌患者预后的关系。通过Kaplan-Meier法计算浸润性非黏液型肺腺癌患者总生存率(overall survival,OS)、无复发生存率(recurrence-free survival,RFS);采用Log-rank法比较不同组间的差异性。使用单因素Cox回归、多因素Cox回归分析独立危险因素。结果：204例患者中IASLC分级为Ⅰ级108例,Ⅱ级66例,Ⅲ级30例。IASLC分级与性别(P=0.022)、吸烟史(P=0.041)、脉管侵犯(P=0.004)、胸膜累及(P=0.001)、病理分期(P<0.001)、肿瘤直径(P<0.001)均显...     

Early stage carcinoma of oral tongue: prognostic factors for local control and survival

The purpose of this study was to assess prognostic factors, treatment outcomes and patterns of relapse in patients with early stage (T1-2 N0) squamous cell carcinoma of oral tongue treated primarily by surgery. The medical records of all patients with early stage (T1-2 N0) oral tongue cancer, radically treated at King Faisal Specialist Hospital and Research Center between January 1980 and December 1997, were reviewed. Eighty-five patients were identified for analysis, 38 male and 47 female. With a median follow-up for surviving patients of 64 months, 5-year actuarial overall, disease-specific (DSS), and relapse-free survival (RFS) were 71, 75, and 63%, respectively. Univariate analysis for DSS showed survival advantage for patients with tumor thickness (TT) of 10 mm (P=0.0002) and distance from resection margin (DFRM) of >5 mm (P=0.005). The effect of TT of 10 mm was maintained (P=0.001) on multivariate analysis. Higher RFS was observed with TT of 10 mm (P=0.0002), DFRM of >5 mm (P=0.0002) and DFRM of >10 mm (P=0.007). On multivariate analysis higher RFS was also found for TT 10 mm (P=0.01) and DFRM >5 mm (P=0.01). Salvage of local tongue recurrence was higher than neck node failure, with 5-year DSS of 71 and 19%, respectively (P=0.007). Time interval for recurrence showed no significant impact on outcome. In T1-2 N0 oral tongue cancer, TT, and DFRM are significant prognostic factors for both local control and survival. Neck node recurrence is associated with poor prognosis and low salvage rate.     

High postoperative carcinoembryonic antigen as an indicator of high-risk stage II colon cancer

Postoperative carcinoembryonic antigen (post-CEA) has recently been reported to be a reliable prognostic factor for colon cancer. However, most clinicians decide whether or not to conduct adjuvant chemotherapy (AC) for stage II colon cancer according to major guidelines, which do not include post-CEA in their high-risk criteria. The present study aimed to assess post-CEA in stage II colon cancer for which the significance of AC is unknown. The present study analyzed 199 consecutive patients with stage II colon cancer who underwent curative surgery between January 2007 and December 2016. The CEA value was considered high when it was ≥5.0 ng/ml. The prognostic value of high post-CEA values was assessed. Overall, 19 patients exhibited high post-CEA levels. Kaplan-Meier survival curve analysis demonstrated that patients with high post-CEA levels had significantly worse relapse-free survival (RFS) and overall survival (OS) than those with normal post-CEA [RFS, 63.5 (high post-CEA) vs. 88.0% (normal post-CEA), P=0.003; OS, 76.5 (high post-CEA) vs. 96.8% (normal post-CEA), P<0.001]. Multivariate analysis demonstrated that high post-CEA remained a significant independent risk factor for worse RFS [hazard ratio (HR), 3.98; P=0.006]. The same was also demonstrated for patients without AC (HR, 5.43; P=0.008). To the best of our knowledge, the present study was the first to demonstrate that high post-CEA levels may be an indicator of high-risk stage II colon cancer, even for patients without AC. These results highlight the need for a multicenter prospective study.     

Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy.

PURPOSE: To document the clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision (TME) with or without 5 x 5 Gy preoperative radiotherapy (PRT) and to identify patient-, disease-, and treatment-related factors associated with differences in prognosis after local recurrence. PATIENTS AND METHODS: For 96 Dutch patients with a local recurrence who participated in a multicenter randomized clinical trial, data on treatments and follow-up were gathered from surgeons and radiation and medical oncologists. Twenty-three patients (24%) had previously been treated with PRT plus TME, and 73 patients (76%) had been treated with TME alone. Eighty-one patients (84%) were followed until death; median follow-up time of the alive patients after local recurrence was 21 months (range, 5 to 48 months). RESULTS: Survival after local recurrence in the PRT + TME group was significantly shorter than in the TME group (median survival, 6.1 v 15.9 months; hazard ratio for death, 2.1; P =.008). Patients with a local recurrence in the PRT + TME group had distant metastases more often (74% v 40%; P =.004), underwent surgical resection of local recurrence less often (17% v 35%; P =.11), and received radiotherapy for local recurrence at a total dose >/= 45 Gy less often (4% v 42%; P =.001) than patients without PRT. In a multivariate analysis, the difference in survival after local recurrence between randomization groups was no longer statistically significant (hazard ratio for death of PRT, 1.53; P =.16). CONCLUSION: The clinical nature and prognosis of patients with locally recurrent rectal cancer has changed since the introduction of PRT. The majority of patients who present with a local recurrence after previous PRT have simultaneous distant metastases, and median survival has decreased to 6 months.     

Acute confusion in patients with systemic cancer

Objective To determine the incidence, the causes and the prognostic value for survival of acute confusion (delirium) in patients admitted to a general cancer hospital. Patients Hundred consecutive patients with confusion were examined; 78 had a metastatic disease, 11 had local tumor and 11 had no sign of tumor recurrence at admission. Patients with confusion represented 11.8% (95%CI: 9.7–14.2%) of admissions. Follow-up period lasted 18 months from the inclusion of the last patient. Results Structural brain lesions (SBL) were mostly metastatic and caused confusion in 36 patients. 57 patients had a toxic or metabolic encephalopathy (TME).The cause remained unexplained in 6 cases, and in one patient the final diagnosis was psychotic state. Most patients with TME had more than one abnormality which could cause confusion. Confusion was reversible in 34 patients, and the odds for its regression was 3-fold higher in patients with TME (P = 0.02). Survival was significantly shorter (P = 0.02) in patients with SBL (median: 3 weeks) than in patients with TME (median: 8 weeks). However, the survival was significantly longer (P = 0.007) in patients with only one toxic or metabolic disorder (median: 20.5 weeks) than in patients with multiple changes (median: 5 weeks). Conclusion Confusion is common in general cancer population. TME is the leading etiology and it is due to multiple causes in most patients. SBL causes confusion in one third of the patients. Patients with TME have a greater chance to recover, and survive longer especially if they have only one toxic or metabolic change.     

Preoperative Prognostic Factors and Effects of Adjuvant Therapy on Outcomes of Early Stage Cervical Cancer in Iran

Background: The aim of this study was to investigate the clinical and histopathological characteristics andthe pretreatment that might predict prognosis and to evaluate the impact of postoperative adjuvant therapy onthe outcomes of patients with early stage cervical carcinoma. Methods: A total of 203 patients with stage IB andstage II cervical cancers treated with radical hysterectomy and systematic retroperitoneal lymphadenectomywere reviewed at the Vali-Asr University Hospital from 1995 to 2002. The median follow-up period was 42months. Results: The depth of cervical stromal invasion, clinical stage, histology of pure adenocarcinoma andlymph node (LN) status were important histopathological prognostic factors of cervical carcinoma. Patients’prognosis could be stratified into three groups (low, intermediate and high risk), with five-year relapse freesurvival (RFS) rates of 93.5%, 80.6% and 64.7%, respectively (p=0.002), and overall survival (OS) was 95.3%,83.1% and 67.2% (p=0.001). Among the patients with pelvic lymph node metastases who were free of parametrialextension, those who received postoperative chemo-radiotherapy had significantly better RFS (p=0.021) and OS(p=0.030) than those who received no adjuvant therapy. Also of the patients without pelvic LN metastases but ata high risk of recurrence, the individuals who received adjuvant radiotherapy had a significantly more favorableRFS (p=0.038 ) and a marginally improved OS (p=0.064). Conclusion: Depth of cervical stromal invasion, clinicalstage and histology are independent predictors of outcome on multivariate analysis using a Cox regressionmodel. RFS is significantly improved with radiotherapy in patients who are without pelvic lymph node metastasesbut who are in a high risk group for recurrence.     

Female Gender Predicts Favorable Prognosis in Patients With Non-metastatic Clear Cell Renal Cell Carcinoma Undergoing Curative Surgery: Results From the International Marker Consortium for Renal Cancer (INMARC)

BackgroundThere is no clear consensus regarding gender differences in the prognosis of patients with clear-cell renal cell carcinoma (ccRCC). In the present study, we investigated the prognostic value of gender in patients with non-metastatic ccRCC undergoing curative surgery using the inverse probability of treatment weighting (IPTW) method to balance the difference in baseline factors between females and males.Patients and MethodsWe retrospectively reviewed the International Marker Consortium for Renal Cancer (INMARC) dataset and included 2055 patients with cT1-4N0M0 ccRCC who underwent partial or radical nephrectomy. The IPTW method was used to adjust for baseline characteristics between females and males (age, race, surgery type, and pT stage), and the association of gender with recurrence-free survival (RFS) was evaluated.ResultsDuring the follow-up (median, 30 months), 162 (8%) patients had disease recurrence (5-year RFS rate, 88%). Female gender (n = 712; 35%) was significantly associated with a lower Fuhrman grade (unweighted, P = .022; IPTW-weighted, P < .001). Females had significantly better RFS compared with males (unweighted, 5-year RFS rate, 92% vs. 87%; P = .005; IPTW-weighted, 5-year RFS rate, 92% vs. 86%; P = .002). IPTW-weighted multivariate analysis showed that female gender was an independent predictor for better RFS (hazard ratio, 0.59; P = .005) along with lower pT stage and lower Fuhrman grade. The prognostic significance of female gender was also observed in the unweighted multivariate analysis.ConclusionFemale gender was significantly associated with a lower Fuhrman grade and better prognosis for patients with non-metastatic ccRCC undergoing curative surgery.     

High expression of interleukin‐11 is an independent indicator of poor prognosis in clear‐cell renal cell carcinoma

Interleukin‐11 (IL‐11), a member of the IL‐6 family of cytokines, exerts pleiotropic oncogenic activities by stimulating angiogenesis and metastasis in many cancer types. The present study aims to evaluate the impact of IL‐11 expression on recurrence and mortality of patients with clear‐cell renal cell carcinoma (ccRCC). We retrospectively enrolled 193 ccRCC patients undergoing nephrectomy at a single center. Clinicopathologic features, recurrence‐free survival (RFS) and overall survival (OS) were recorded. IL‐11 intensity was assessed by immunohistochemistry in tumor specimens. The Kaplan–Meier method was applied to compare survival curves. Cox regression models were used to analyze the impact of prognostic factors on RFS and OS. The concordance index (C‐index) was calculated to assess predictive accuracy. High IL‐11 expression is associated with increased risk of recurrence and poor survival for ccRCC patients (P < 0.001 and P < 0.001, respectively), especially those with early‐stage disease (TNM stage I + II). Multivariate analyses confirmed that IL‐11 expression was an independent prognostic factor for RFS and OS (P = 0.006 and P = 0.008, respectively). The predictive accuracy of well‐established prognostic models was improved when IL‐11 expression was integrated. In conclusion, high IL‐11 expression is an independent predictor of poor prognosis in ccRCC patients. It may help identify patients who could benefit from additional treatments and closer follow up.     

The clinicopathological significance of inferior mesenteric lymph node metastasis in colorectal cancer.

AIMS: There are few studies reporting survival or recurrence patterns in colorectal cancer patients with inferior mesenteric lymph node metastasis (IMLN+). The present study evaluated the prognostic significance of patients being IMLN+ or IMLN- in colorectal cancer. METHODS: Survival, recurrence pattern and treatment protocols were compared between 63 IMLN+ patients and 108 IMLN- patients with stage III and IV rectal and sigmoid cancer undergoing curative surgery. Lymph node sampling was routinely performed prior to inferior mesenteric artery ligation and excision flush with aorta. Limited principal node dissection including IMLN was performed in cases of identified node metastasis. RESULTS: The 5-year disease-free survival rates were 50% in IMLN- and 31% in IMLN+ patients (P=0.004). The 5-year disease-free survival rate was greater in the N1 group than the N2 group (P=0.038). Cox regression analysis showed IMLN+, lymphovascular tumour invasion, T4, M1, and pre-operative serum CEA level over 6 ng/ml were independently associated with unfavorable disease-free survival. The prognostic significance of M category was greater when the IMLN+ was included in the M1 as opposed to the N category. In patients undergoing absolute curative surgery, post-operative recurrence rates were 34% for IMLN- and 57% for IMLN+ patients (P=0.009; OR, 2.611; 95% CI, 1.313-5.194). For IMLN+ patients, post-operative adjuvant treatment independently correlated with disease-free survival (P=0.029). CONCLUSIONS: IMLN+ is an independent survival factor enhancing the prognostic significance of the M category in the AJCC staging. Curative radical surgery and post-operative chemoradiotherapy appears to be warranted for IMLN+ colorectal cancer patients as it resulted in 5-year disease-free survival rates of up to 31% compared to 50% in IMLN- patients.