Primary management of limited laryngeal cancer by radiotherapy and surgical salvage: Results of 164 cases treated in a district hospital

A total of 164 patients with limited laryngeal cancer (all sites, stages T₁T₂T₃, N₀N₁) were treated between 1966 and 1979 at the Derbyshire Royal Infirmary by a policy of radical radiation therapy and surgical salvage.Of 122 cases of glottic cancer, 32 recurred of which 12 were successfully salvaged by laryngectomy. The corrected actuarial survival at 6 years was T₁ 95.1%, T₂ 83.0% and T₃ 31.3%. Of 38 cases of supraglottic cancer, 18 recurred but none was salvaged. The corresponding survival rates were T₁ 84.6% and T₂ 36.4%.A number of factors were analysed by a multivariate stepwise regression method to assess their impact upon radiation failure. These were: tumour status, nodal disease, the presence of symptoms other than hoarseness, histological grade, age, length of history and dose (TDF). Significant determinants in glottic cancer were tumour stage (P<0.0005), nodal disease (P<0.05) and presence of symptoms (P<0.05). In supraglottic cancer dose (P<0.0001) and severity of symptoms (P<0.005) were predictive.It is concluded that this policy was effective in the management of T₁ and T₂ glottic cases and that T₁ supraglottic cases responded well if an adequate radiation dose was delivered. The more advanced stages in both sites, however, did not fare as well, especially if initially node positive and in the presence of severe pretreatment symptoms. Surgical salvage had little impact on overall survival in this group.     

Clinical characteristics and prognostic factors for primary appendiceal carcinoma

Aim: Primary adenocarcinoma of the appendix is a rare malignancy. This study assessed prognostic factors affecting the clinical outcome in patients with appendiceal neoplasms. Methods: We performed a retrospective analysis of patients who had appendectomies between 1991 and 2007 at five centers in South Korea. Results: Overall 55 patients (19 men, 36 women, median age 61 years) were identified. Of these, 37 (67.3%) were mucinous adenocarcinomas, 14 (25.5%) were intestinal‐type adenocarcinomas, and four (7.3%) were signet ring cell carcinomas. The distribution of stages was: 26 (47.3%) with localized disease, five (9.1%) with regional disease, and 24 (43.6%) with distant metastatic disease. The overall 3‐ and 5‐year survival rates among all patients were 72.2% and 64.0%, respectively, with 20 deaths during the follow‐up period. In a multivariate analysis, high histological grade (hazard ratio [HR]vs low grade 15.7; P = 0.001) and pathological stage (distant vs loco‐regional, HR 6.2; P = 0.021) were independent predictors of overall survival. Of the 34 patients who underwent curative resections of primary appendiceal carcinomas, the 3‐ and 5‐year disease‐free survival rates were 66.4% and 53.3%, respectively. The recurrence rate was higher in patients with regional lymph node metastasis (HR vs node negative disease 23.4; P = 0.005) and high‐grade tumors (HR vs low grade 6.3; P = 0.029). Additionally, a right hemicolectomy reduced the risk of recurrence (HR vs lesser procedures 0.05; P = 0.005). Conclusion: High tumor grade and advanced stage were significantly predictive of poor survival outcome in patients with primary appendiceal carcinomas.     

Metabolic tumor volume of primary tumor predicts survival better than T classification in the larynx preservation approach

We aimed to determine whether pretreatment metabolic tumor volume of the primary tumor (T‐MTV) or T classification would be a better predictor of laryngectomy‐free survival (LFS) and overall survival (OS) after chemoradiotherapy in patients with locally advanced laryngeal or hypopharyngeal cancer requiring total laryngectomy. We analyzed 85 patients using a Cox proportional hazards model and evaluated its usefulness by Akaike's information criterion. A T‐MTV cut‐off value was determined by time‐dependent receiver operating characteristic curve analysis. Interobserver reliability for measuring T‐MTV was estimated by the intraclass correlation coefficient (ICC). After adjustment for covariables, T‐MTV, irrespective of whether a continuous or dichotomized variable, and T classification remained independent predictors of LFS and OS. Large T‐MTV (>28.7 mL) was associated with inferior LFS (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.97–8.70; P = 0.0003) and inferior OS (HR, 3.18; 95% CI, 1.47–6.69; P = 0.004) compared with small T‐MTV (≤28.7 mL). The T‐MTV model outperformed the T classification model in predicting LFS and OS (P = 0.007 and 0.01, respectively). Three‐year LFS and OS rates for patients with small versus large T‐MTV were 68% vs 9% (P < 0.0001) and 77% vs 25% (P < 0.0001), respectively, whereas those for patients with T2‐T3 versus T4a were 61% vs 31% (P = 0.003) and 71% vs 48% (P = 0.10), respectively. ICC was 0.99 (95% CI, 0.99–1.00). Given the excellent interobserver reliability, T‐MTV is better than T classification to identify patients who would benefit from the larynx preservation approach.     

Hypofractionated Radiotherapy for T1N0M0 Glottic Cancer: Retrospective Analysis of Two Different Cohorts of Dose-fractionation Schedules from a Single Institution

AimsTo determine the influence of dose and fractionation on tumour characteristics, toxicity, disease control and survival outcomes in T1 glottic carcinoma.Materials and methodsBetween 1975 and 2000, treatment charts of 652 patients with T1 glottic carcinoma who received curative radiation with four hypofractionated schedules (50 Gy/15 fractions [3.3 Gy/fraction] or 55 Gy/16 fractions [3.43 Gy/fraction] or 60 Gy/24 fractions or 62.5 Gy/25 fractions [2.5 Gy/fraction]) were analysed. The patients were divided into two groups based on fraction size <3 Gy and >3 Gy. Local control and overall survival were calculated. Patient- and tumour-related factors affecting local control were analysed using univariate and multivariate analysis. Factors affecting late toxicity were also analysed.ResultsThe local control and overall survival at 10 years were 84 and 86.1%, respectively, for T1 glottic carcinoma. The response to radiation had a significant effect on local control with univariate analysis (P = 0.001). Other factors, such as beam energy, anterior commissure involvement and fractionation, did not affect local control. Persistent radiation oedema was seen in 123 patients (23.4%) and was significantly worse in patients who received radiation with a larger field size (>36 cm²) on a telecobalt machine (P < 0.001).ConclusionsRadical radiotherapy schedules incorporating a higher dose per fraction yield acceptable local control rates and late toxicity. Telecobalt therapy for early glottic cancer is a safe alternative to treatment with 6 MV photons on a linear accelerator in terms of local control and late toxicity as long as field sizes smaller than 36 cm² are used.     

Radical Cystectomy vs. Multimodality Treatment in T2N0M0 Bladder Cancer: A Population-based,Age-matched Analysis

BackgroundControversy still exists regarding efficacy of multimodality treatment (MMT) vs. radical cystectomy (RC) for urothelial carcinoma of the urinary bladder (UCUB).MethodsWithin the SEER database (2004-2016), we retrospectively identified patients with stage T2N0M0 UCUB. Competing risks regression (CRR) tested cancer-specific mortality (CSM) and adjusted for other-cause mortality after MMT vs. RC. Exact matching for age was applied. Subgroup analyses focused on differences in chemotherapy or lymph node dissection rates. In sensitivity analyses, we accounted for 40% understaging rate in patients who underwent MMT.ResultsOf 9862 patients with T₂N₀M₀ UCUB, 2675 (27.1%) underwent MMT vs. 5751 (58.3%) RC vs. 1436 (14.6%) radiotherapy (RT) without chemotherapy. MMT rate increased (annually +3.0%, P < .01) and MMT patient age was significantly higher (median 77 years) than RC patient age (68 years). In exact age-matched analyses, 10-year CSM rates were 44.3% vs. 25.9% for MMT vs. RC (multivariate hazard ratio [HR] 0.48); 44.1% vs. 22.8% for MMT vs. RC with chemotherapy (HR 0.43); 40.5% vs. 31.1% for MMT vs. RC without lymph node dissection (HR 0.66), and 55.6% vs. 27.3% for RT without chemotherapy vs. RC (HR 0.37, all P < .001). Sensitivity analyses that addressed understaging of patients who underwent MMT resulted in virtually the same CSM rates.ConclusionIn patents with T₂N₀M₀, MMT or even more so RT alone may be associated with higher CSM than RC, even in exact age-matched multivariate CRR analyses, which adjust for other-cause mortality. In consequence, patients with T2 UCUB should be informed of this possible CSM disadvantage outside of highly specialized centers.     

Long‐term outcome of concurrent chemoradiotherapy with elective nodal irradiation for inoperable esophageal cancer

Elective nodal irradiation (ENI) might improve overall survival in patients with inoperable esophageal cancer. We conducted a retrospective analysis to assess the long‐term survival and toxicity of esophageal cancer patients treated with ENI versus conventional‐field irradiation (CFI). All data in the present study were based on our institutional experience from 2000 to 2005 of patients with inoperable esophageal cancer treated with ENI or CFI plus two concurrent cycles of paclitaxel/cisplatin. Based on the inclusion and exclusion criteria, 89 patients were included in the analysis. Of these patients, 51 were treated with ENI, whereas 38 were treated with CFI. For the per‐protocol population, the patients in the ENI group significantly improved in terms of their 10‐year disease‐specific overall survival (43.1% vs 10.5%, P = 0.019), 10‐year disease‐free survival (36.7% vs 10.2%, P = 0.040) and 10‐year local recurrence‐free survival (47.2% vs 17.2%, P = 0.018) compared with the CFI group. Aside from radiation esophagitis, the incidence of grade 3 or greater acute toxicities did not differ between the two groups. Multivariate analysis showed that radiation field, tumor length and clinical stage were independent prognostic factors associated with OS. Concurrent chemoradiotherapy with ENI improves both disease‐specific overall survival and loco‐regional control in patients with inoperable esophageal cancer receiving per‐protocol treatment. The regimen has a manageable tolerability profile.     

Pharmacokinetic profiles of significant adverse events with crizotinib in Japanese patients with ABCB1 polymorphism

Crizotinib is a standard treatment for advanced ALK‐positive non‐small‐cell lung cancer (NSCLC). We undertook this study to investigate the pharmacokinetics of crizotinib and clinical and pharmacogenomic factors that may increase the risk of adverse events (AEs). We defined clinically significant AEs as grade 4 hematological toxicity, grade ≥3 non‐hematological toxicity, and any grade of interstitial lung disease. Eight subjects with ALK‐positive NSCLC scheduled to receive crizotinib 250 mg twice daily were studied. Six patients were female and two were male, and most of the patients had low body weight with a median body weight of 46.8 kg (range, 42.4–61.0 kg). All patients developed AEs, five developing six clinically significant AEs. Six patients required dose reduction. In pharmacokinetic analysis, blood samples were obtained on days 1 and 15. The mean area under the plasma concentration–time curve from 0–12 h (AUC_0–12) on day 15 was significantly increased in patients with clinically significant AEs (n = 5) compared with those without (n = 3) (P = 0.04). Genetic polymorphisms of ABCB1 were analyzed. One patient with the ABCB1 1236TT‐2677TT‐3435TT genotype was an outlier, with an AUC_0–12 and peak concentrations on day 15 of 2.84× and 2.61× the mean, respectively, compared with those with other genotypes. Our results suggest that some Japanese NSCLC patients treated with crizotinib developed clinically significant toxicities that were related to altered pharmacokinetics parameters due to genotype and body weight factors.     

Randomised phase II study of epirubicin-vindesine versus mitoxantrone-vindesine in metastatic breast cancer

The purpose of this study was to compare the activity and toxicity of epirubicin-vindesine (EV) with mitoxantrone-vindesine (MV) in patients with metastatic breast cancer. A total of 295 patients was randomly allocated to treatment with vindesine 3 mg/m² combined with either epirubicin 40 mg/m² or mitoxantrone 10 mg/m². All drugs were given by intravenous push, treatment cycles were repeated at 3–4 week intervals. 255 patients were available for response, and 283 for toxicity. EV and MV yielded similar objective response rates (34 and 26%, respectively), response durations, times to progression and survival. Median time to remission was 1.8 and 3.1 months (P = 0.006) with EV and MV, respectively. In patients with visceral metastases, response rate was higher with EV than MV (40 versus 23%; P = 0.03). Patients receiving MV had less nausea/vomiting (P = 0.007) and alopecia (P = < 0.001) of WHO grade 2. Bone marrow, cardiac and other toxicities were mild with both treatments. The observed differences in activity and toxicity between the two regimens appear to have clinical relevance. EV proved to be more active in visceral disease and to be able to induce remissions more rapidly. Accordingly, patients with visceral metastases or severe tumour-related symptoms may benefit from epirubicin-based treatment. Subjective toxicities, i.e. nausea/vomiting and alopecia, were less frequent and severe with MV. Thus, MV may prove useful in patients with more indolent disease and appears to warrant phase III evaluation in such patients.     

A large French multicenter retrospective series of T1-T2N0 vocal cords carcinomas treated with exclusive irradiation

Purpose

The main objective of this study was to evaluate the 5-year efficacy of exclusive laryngeal radiotherapy without node prophylactic irradiation for localized cancers of the vocal cords.

Treatment of early carcinoma of the vocal cords by radiotherapy

A total of 145 patients with early carcinoma of the vocal cords (T_1,2N₀) were treated by radiotherapy from 1979 to 1989. Survival and local control data were available for 135 and 127 patients, respectively. The respective 5 and 10 year results for overall survival were 75 and 68%. The 5 and 10 year probabilities of local control by radiotherapy were 89 and 86%, respectively, for T₁ tumours and 70% at both time intervals for T₂ tumours. Tumour recurrence following radiotherapy was documented in 18 of 127 patients. Tumour stage predicted significantly for local control, with recurrence rates for T₁ and T₂ tumours of 11 and 27%, respectively (P= 0.02). There was a higher proportion of recurrences for total radiation doses ≦ 6200 cGy (17%) compared with >6200 cGy (8%), but the difference was not statistically significant. Increasing duration of treatment was related significantly to increased recurrence for T₂ (P= 0.01), but not T₁, tumours. Most recurrences (60%) were salvaged successfully by laryngectomy. Three patients required laryngectomy for laryngeal oedema without recurrent tumour; all had been treated using a large field size (7 × 6 cm). There were 20 metachronous tumours, including five lung and two head and neck tumours. These results are similar to previous reports and confirm that radiotherapy is very effective for early glottic cancer, with high local control rates and effective salvage if local recurrences are recognized early.     

Early glottic carcinoma: Results of treatment by radiotherapy

The purpose of the present paper was to review the results of treating early (stages T_1–2N₀) glottic, squamous cell carcinoma by radiotherapy in the Department of Radiation Oncology, Prince of Wales Hospital, Sydney. A retrospective review was carried out of all patients seen in the department from 1967 to 1994, inclusive. To be eligible, patients had to have newly diagnosed cancer and to have been treated with curative intent by radiotherapy alone. Three hundred and sixty‐nine patients satisfied the eligibility requirements. The mean follow‐up time was 12.2 years (maximum: 28 years). At 5 years the actuarial local control rate was 80% (84% for stage T₁ and 72% for T₂). The ultimate local control rate was 96%. The overall survival rates at 5 and 10 years were 73% and 52%, respectively. The risk of nodal recurrence was much higher after persisting disease or local recurrence. Our results confirm the high cure rates achieved with this modality of treatment and are comparable with those reported in the literature.     

High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: Final results of a phase II study

Purpose:to analyse toxicity and response to a new scheme ofneoadjuvant chemotherapy (CT) and concomitant radiochemotherapy (RT–CT)for locally advanced anal canal squamous-cell carcinoma (ACC). Patients and methods:Eighty patients with an ACC >40 mm and/orwith lymph node involvement were included (1 T₁, 52 T₂,14 T₃, 13 T₄, 18 N₀, 30 N₁, 32N₂–N₃). Two cycles of 5-fluorouracil (5-FU) andCDDP were delivered as neoadjuvant CT and two during RT–CT. Pelvic(± inguinal) RT delivered 45 Gy in 25 fractions of 1.8 Gy. Involvedfields were boosted after a one to two month gap (15–20 Gy). The medianfollow-up was 29 months. Results:One patient died of a pulmonary embolism on day 4. Allpatients received the entire treatment, with reduced 5-FU doses in 27%of the cases because of acute toxicity. Sixty-four grade 3 and five grade 4toxicities were observed. No toxic death occurred.Complete response (CR) and partial response (PR) rates were, respectively,10% and 51% after neoadjuvant CT, 67% and 28%after RT–CT and 93% and 5% after treatment completion(including 4 abdomino-perineal resections).The three-year actuarial overall, tumour-specific, colostomy-free,relapse-free, disease-free and event-free survivals were 86%,88%, 73%, 70%, 67% and 63%,respectively. Conclusions:Tolerance was good. After neoadjuvant CT, most of thepatients were objective responders. After treatment completion, all but fiveachieved CR. The long-term results confirm the durability of local control andlow toxicity on the sphincter. An ongoing phase III intergroup trial analysesthe impact of neoadjuvant CT, and the benefit of a high-dose boostirradiation, on local control and colostomy-free survival.     

Association between serum ligands and the skin toxicity of anti‐epidermal growth factor receptor antibody in metastatic colorectal cancer

Skin toxicity is a known clinical signature used to predict the prognosis of anti‐epidermal growth factor receptor (EGFR) antibody treatment in metastatic colorectal cancer (mCRC). There are no biological markers to predict skin toxicity before anti‐EGFR antibody treatment in mCRC patients. Between August 2008 and August 2011, pretreatment serum samples were obtained from KRAS wild‐type (WT) patients who received anti‐EGFR antibody treatment. Serum levels of ligands were measured by ELISA. A total of 103 KRAS WT patients were enrolled in the study. Progression‐free survival and overall survival of patients with a high grade (grade 2–3) of skin toxicity were significantly longer than those with a low grade (grade 0–1) of skin toxicity (median progression‐free survival, 6.4 months vs 2.4 months, P < 0.001; median overall survival, 14.6 months vs 7.1 months, P = 0.006). There were significant differences in distribution of serum levels of epiregulin (EREG), amphiregulin (AREG), and hepatocyte growth factor (HGF) between groups of low/high grade of skin toxicity (P < 0.048, P < 0.012, P < 0.012, respectively). In addition, serum levels of HGF, EREG, and AREG were inversely proportional to grades of skin toxicity as determined by the Cochran–Armitage test (P = 0.019, P = 0.047, P = 0.021, respectively). Our study indicated that serum levels such as HGF, EREG, and AREG may be significant markers to predict the grade of skin toxicity and the prognosis of anti‐EGFR antibody treatment, which contribute to improvement of the management of skin toxicity and survival time in mCRC patients.     

Radiation therapy for early glottic cancer (T1N0M0): I. Results of conventional open field technique

From November 1977 through April 1982, a total of 91 patients with glottic cancer (T1N0M0) were treated with the open field technique of 4 MV X ray using bilateral parallel-opposed fields. Total radiation dose administered was 60 Gy in 30 fractions over a 6-week period. Actuarial 5-year disease-free survival rate was 89%. Significant prognostic factors of local control were tumor length (p = 0.021), tumor width (p = 0.001), tumor type (p = 0.004), tumor response to irradiation at 40 Gy (p = 0.000) and 60 Gy (p = 0.000) by chi-square test. Ultimate local control rate by radiation therapy and salvage surgery was 97% and voice preservation rate was 91%.     

Results of definitive radiotherapy in T1 and T2 glottic carcinoma: Institute of Rotary Cancer Hospital experience

Early glottic carcinomas (T₁ and T₂) constitute only 2% of all laryngeal cancers in our data. Seventy patients were seen between 1985 and 1992. All patients were treated by cobalt-60 small field radiotherapy using a beam directed shell. The total dose delivered was 60–65 Gy in 31 patients and 66–70 Gy in 39 patients. The follow-up period ranged from 5 to 126 months, with a mean follow up of 37 months overall and 55 months in the surgical salvage group. Radiation therapy controlled disease in 71% (50 of 70) of patients overall; 75% with T₁ and 67% with T₂ lesions. Total laryngectomy as salvage surgery was performed in 70% (14 of 20) of patients whose disease recurred. Ultimate control including surgical salvage occurred in 64 (91%) of 70 patients in the present study. The actuarial 5 year survival was 83 and 80% in T₁ and T₂ tumours, respectively (statistically insignificant). This report supports the policy of definitive irradiation, reserving surgical salvage for radiation failures in early laryngeal cancers.     

Regulatory T cells predict the time to initial treatment in early stage chronic lymphocytic leukemia

BACKGROUND:

Early stage chronic lymphocytic leukemia is characterized by a highly variable course of disease. Because it is believed that regulatory T cells (T_regs) are potent suppressors of antitumor immunity, the authors hypothesized that increased T_regs may favor disease progression.

METHODS:

T_reg levels (cluster of differentiation 3 [CD3]‐positive, [CD4]‐positive, CD25‐positive, and CD127‐negative) in peripheral blood from 102 patients were analyzed by flow cytometry. Statistical analysis was used to evaluate correlations with clinical data.

RESULTS:

The relative T_reg numbers in CD4‐positive T cells were significantly greater in patients with chronic lymphocytic leukemia compared with the numbers in a control group of 170 healthy individuals (P = .001). Patients were divided into 2 groups using a median T_reg value of 9.7% (the percentage of CD4‐positive T cells). Patients with higher T_reg levels had a significantly shorter time to initial treatment (median, 5.9 years) compared with patients who had lower T_reg levels (median, 11.7 years; log‐rank P = .019). Furthermore, T_reg levels (the percentage of CD4‐positive T cells) had significant prognostic power to predict the time to initial treatment in univariate analysis (P = .023) and in multivariate Cox regression analysis that included the variables Rai stage, immunoglobulin heavy‐chain variable region gene mutational status, chromosomal aberrations, and CD38 expression (P = .028).

CONCLUSIONS:

Higher T_reg levels had significant and independent prognostic power for predicting the time to initial treatment in patients with low to intermediate stage chronic lymphocytic leukemia. Cancer 2011. © 2010 American Cancer Society.     

Therapy and prognosis of testicular carcinomas in relation to tnm classification

Eight-hundred and thirty-one patients with testicular carcinomas, either teratocarcinoma (405), embryonal carcinoma (406) or pure choriocarcinoma (20), treated mainly at our center from 1950 to 1976, were clinicopathologically staged according to the TNM Classification. The cancer was confined to the body of testis alone (T₁ N₀ M₀) or extended to paratesticular structures (T_2–4 N₀ M₀) in 37% of all patients. Para-aortic lymph nodes were found involved (N_1–3)in 33% and juxtaregional lymph nodes (N₄) in 9% of patients; distant metastases were detected initially in the lung alone (M₁) and other distant organs (M₂) in 21 % of the patients. Postorchiectomy treatment was retroperitoneal lymphadenectomy with or without regional-juxtaregional irradiation and systemic chemotherapy in 470 patients; the other 361 patients received external irradiation and/or adjuvant chemotherapy. Survival determined at 5 years was 58 % in teratocarcinoma cases, 41 % in embryonal carcinoma cases and 0 % in pure choriocarcinoma cases. Rates of 5-year survival according to the TNM staging were 81 % for T₁ N₀ M₀ tumors, 58 % for T_2–4 N₀ M₀ tumors, 44% for N_1–3 M₀ tumors, 33% for N₄ M₀ tumors and 10% for N_0?4 M_{1 or 2} tumors. In patients who underwent lymphadenectomy with or without external irradiation, the 5-year survival rates with and without adjuvant chemotherapy, respectively, were 96% and 86% for T₁ N₀ M₀ tumors, 100% and 60% for T_2–4 N₀ M₀ tumors, 66% and 42% for N_1–3 M₀ tumors, 54% and 40% for N₄ M₀ tumors and 38% and 0 % for N_0?4 M₁ tumors. In patients treated by external irradiation alone or following lymphadenectomy the rates of 5-year survival with versus without adjuvant chemotherapy were 100% versus 66% for T_1–4 N₀ M₀ tumors, 44% versus 18% for N_1–3 M₀ tumors, 41 % versus 22 % for N₄ M₀ tumors and 3 % versus 4 % for N_0–4 M_1–2 tumors.     

Locoregional recurrence of pT3N0M0 breast cancer after mastectomy is not higher than that of pT1‐2N0M0: An analysis for radiotherapy

The purpose of this study was to investigate the value of post‐operative radiotherapy in the treatment of pT3N0M0 breast cancer after mastectomy. We analyzed the clinical data of 1390 patients with pT1‐3N0M0 breast cancer who were admitted and treated from 1998 to 2007 at the Sun Yat‐sen University Cancer Center. All patients underwent mastectomy and did not receive radiotherapy. The locoregional recurrence‐free survival, distant metastasis‐free survival and overall survival of different T stages of breast cancer were compared. The median follow‐up duration was 72 months. The 10‐year locoregional recurrence‐free survival patients with pT1N0, pT2N0 and pT3N0 breast cancers were 95.3, 91.9 and 93.6%, respectively (χ² = 2.550, P = 0.279). The 10‐year distant metastasis‐free survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 88.1%, 81.0% and 78.4%, respectively (χ² = 8.254, P = 0.016). The 10‐year overall survival rates of patients with pT1N0, pT2N0 and pT3N0 breast cancers were 91.9%, 83.5% and 73.0%, respectively (χ² = 12.403, P = 0.002). Univariate analyses failed to identify any prognostic factors for locoregional recurrence in pT3N0 patients. Multivariate analysis showed that the T stage had no effect on locoregional recurrence. The locoregional recurrence rate in patients with pT3N0M0 breast cancer who underwent mastectomy and did not receive postoperative radiotherapy was not higher than that in patients with pT1‐2N0M0 breast cancer who received the same treatment, suggesting that routine adjuvant post‐operative radiotherapy should not be recommended in this patient population.     

Prognostic value of visceral pleural invasion in the stage pT1-2N2M0 non-small cell lung cancer: A study based on the SEER registry

BackgroundVisceral pleural invasion (VPI) is considered an adverse prognostic factor in non-small cell lung cancer (NSCLC). However, the prognostic roles of VPI in Ⅲ/N2 NSCLC remain controversial. Therefore, this study aims to evaluate the prognostic value of VPI in patients with postoperative stage pT_1-2N₂M₀ NSCLC.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database, we screened for patients with stage T1-2N2M0 NSCLC who received surgery from 2010 to 2015. To reduce baseline differences between Non-VPI group and VPI group, two-to-one propensity score matching (PSM) was performed. Cox proportional hazards regression was used to identify factors associated with survival. Overall survival (OS) was between the Non-VPI group and the VPI+ group by the Kaplan-Meier analysis.ResultsWe identified 1374 postoperative NSCLC patients with stage pT_1-2N₂M₀. The majority of cases (N = 1047, 76.8%) are Non-VPI patients. The factors associated with VPI+ group included white race (P < 0.0001), and adenocarcinoma (P < 0.0001).When analyzed in the total study population, VPI status remained a significant independent predictor of worse OS compared with the Non-VPI group (HR, 1.343; 95% CI, 1.083–1.665 [P=0.007]). Besides, in a subgroup analysis by VPI status, the results showed that patients without treatment exhibited a higher risk level in the Non-VPI group (P<0.0001). However, we did not find statistically significant differences among treatments in the VPI+ group (P=0.199). Mean survival time was 49.5 months (95% CI: 45.7–53.3 months) for chemotherapy alone in the Non-VPI group, compared with 41.2 months (95% CI: 35.8–46.6 months) in VPI+ groups. In both the VPI group and the non-VPI group, there is no statistical difference between adjuvant chemotherapy combined with PORT and chemotherapy alone.ConclusionThis study emphasizes that the presence of VPI is a poor prognostic factor, even in patients with Ⅲ/N2 NSCLC. As the study shows, chemotherapy significantly improved overall survival of patients with postoperative stage pT_1-2N₂M₀ NSCLC, especially for Non-VPI patients. However, the significance of PORT is still worth further exploration.     

T2-3N0M0期食管癌R0术后失败模式分析——术后放疗潜在价值与意义

目的 比较pT_2-3N₀M₀期食管癌根治术后和术后放疗(3DCRT、IMRT)患者失败模式,探讨术后放疗及放疗范围合理性。方法 回顾分析2004—2009年本院收治的pT_2-3N₀M₀期食管癌病例581例,其中单纯手术543例、术后放疗38例(IMRT 31例、3DCRT 7例)。pT₂N₀M₀期153例、pT₃N₀M₀期428例。Kaplan-Meier法计算生存率并Logrank检验,Cox模型预后多因素分析。结果 两组患者一般临床资料比较中T分期、临床分期不具可比性。随访率为94.7%。单纯手术组失败率为40.3%,术后放疗组为 15.8%( P=0.003)。单纯手术组复发率最高为纵隔(18.5%),其次为锁骨上淋巴结和血道转移(均为10.7%),腹腔淋巴结、吻合口复发率均低(3.0%、3.8%)。pT₂NM₂、pT₃N₂M₂期失败率分别为43.6%、39.0%( P=0.329)。术后放疗组 5年DFS率高于单纯手术组(65.3%、50.8%, P=0.044), 5年OS率未达统计学意义(72.3%、59.2%, P=0.157)。多因素分析结果显示上切缘和脉管瘤栓是影响DFS和OS因素,而性别和细胞分化程度是影响OS因素。结论 pT _2-3N₂M₂期食管癌单纯手术后失败率较高,术后放疗可降低放疗部位失败率且提高DFS,但最终还需进一步加大样本量研究。