Survival and prognostic factors in patients with resected epidermoid oesophageal carcinoma.

To determine long-term survival of patients with thoracic oesophageal tumor who underwent resection, and to identify possible associated prognostic factors, 58 patients underwent oesophagectomy alone (group A) and 16 combined with neo-adjuvant chemoradiotherapy (group B). Univariate and multivariate analysis of prognostic factors were performed for age, depth of oesophageal wall tumour penetration, node involvement, type of resection, TNM stage and degree of tumour differentiation. Long-term survival rates at 1-5 years were 81% versus 89%; 56% versus 67%; 30% versus 67%; 12% versus 44%; and 0% versus 33% for group A and B, respectively (P = 0.0543, NS). Univariate analysis revealed only depth of invasion (P = 0.0076) and TNM stage (P = 0.0452) as isolated prognostic factors for long-term survival and multivariate analysis did not demonstrate any independent factor. Despite the small number of cases, neoadjuvant chemoradiotherapy seems to improve prognosis as well as to allow resection in a greater number of cases due to tumor downstaging.     

Pathologic features of prognostic significance in adrenocortical carcinoma

There are currently no well-established pathologic prognostic factors helpful in distinguishing low versus high grade adrenocortical carcinomas. The effect of 11 pathologic parameters on survival was investigated in 42 cases of adrenocortical carcinoma. Only one variable, mitotic rate, had a strong statistical association with patient outcome. The 21 patients with carcinomas with greater than 20 mitoses per 50 high power fields (hpf) had a median survival of 14 months, whereas the 21 patients with carcinomas with less than or equal to 20 mitoses had a median survival of 58 months (p less than 0.02). The presence of atypical mitoses, capsular invasion, tumor weight greater than 250 g, and size greater than 10 cm each showed a marginal statistical association with poor survival (p less than 0.06), whereas other features assessed, such as nuclear grade, presence of necrosis or of venous or sinusoidal invasion, character of the tumor cell cytoplasm, or architectural pattern, showed no statistical significance in predicting survival. It is proposed that adrenal cortical carcinomas with greater than 20 mitoses be designated high grade, whereas tumors with less than or equal to 20 mitoses be designated low grade.     

Clinical features and prognostic factors associated with adrenocortical carcinoma: Lahey Clinic Medical Center experience

Adrenocortical carcinoma is a rare tumor associated with a commonly poor prognosis. However, data on the natural history and response to therapy of patients with this malignancy have often been conflicting. Our objective of this retrospective study was to evaluate the clinical course and survival of patients with adrenocortical carcinoma and to identify relevant prognostic factors. Between 1966 and 1996, 31 patients with histologically documented adrenocortical carcinoma were observed at the Lahey Clinic Medical Center. Patient information was obtained from chart review. At the time of diagnosis, 48 per cent of patients had endocrine symptoms with compatible hormonal studies, 19 per cent had involvement of the inferior vena cava by tumor thrombus, and 32 per cent had metastatic disease. The median survival time was 17 months (range, 1-205 months) for the entire group, and the 5-year survival rate was 26 per cent. Age <54 years, absence of metastatic disease at the time of diagnosis, and completeness of surgical resection were associated with better prognosis. Evaluation of survival with the Cox proportional hazards model suggested that age <54 years, absence of metastatic disease, and nonfunctioning tumor status were independently associated with improved survival. The prognosis of patients with adrenocortical carcinoma is poor but appears more favorable in patients <54 years, with localized disease, or nonfunctioning tumor status. Complete tumor resection may be associated with improved survival.     

Localized well-differentiated thyroid carcinoma: Survival analysis of prognostic factors and131I therapy

Background: Recommendations regarding therapeutic use of¹³¹I for patients with well-differentiated thyroid cancer remain controversial. Between 1969 and 1993, 1171 patients with papillary (including mixed) or follicular thyroid cancer were reported to the New Mexico Tumor Registry. Of these, 1075 cases (77.6% female, median age 41 years) were available for analysis of survival plots and previously recognized risk factors. Extent of operation was documented for 344 patients. Methods: One hundred twenty-seven (37%) patients underwent postoperative¹³¹I ablation. Median follow-up was 99 months. A proportional hazards model was constructed using age, gender, stage, histology, and use of radioiodine. The same variables plus extent of operation were examined in the smaller group. Results: Kaplan-Meier survival estimates at 12 years were 96.2% for patients younger than 45 years and 68.6% for those older than 45 years. Age, gender, and histology, but not stage, were important survival variables (P<.05). Adjusting for other risk factors, there was no apparent survival benefit associated with radioiodine following clinically appropriate thyroidectomy. Findings from the small group mirrored those of the large group. Conclusions: ¹³¹I may not be as efficacious as previously believed for patients with well-differentiated thyroid cancer confined to the neck.     

Pathologic features of prognostic significance for adrenocortical carcinoma after curative resection

OBJECTIVE: To identify the pathologic features of prognostic significance in patients with resectable adrenocortical carcinomas. DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Review of the Memorial Sloan-Kettering Cancer Center prospective adrenocortical carcinoma database from 1986 through 1996 identified 46 patients who underwent curative adrenalectomy for primary disease. All cases were reviewed by a single pathologist and each primary tumor was characterized by 16 separate pathologic parameters. MAIN OUTCOME MEASURE: Overall survival rates in the patient population. RESULTS: The 5-year overall survival rate for the entire cohort was 36% (median survival rate, 28 months). Of the pathologic factors analyzed, tumor size, number of mitotic figures, and the presence of intratumoral hemorrhage were independent prognostic factors. Patients presenting with primary tumors larger than 12 cm (n = 30) had a worse outcome compared with those with smaller tumors (n = 16) (5-year survival rate: 53% vs. 22%, P<.05). Mitotic count (> or =6 per 10 high-power fields) was a negative prognostic feature (n = 15) with a 5-year survival rate of 13% vs. 51% for 0 to 6 mitotic figures per 10 highpower fields (n = 31, P<.05). Intratumoral hemorrhage (n = 23) was also a negative prognostic factor compared with no evidence of intratumoral hemorrhage (n = 23) (5-year survival rate, 53% vs. 22%, P<.05). Overall survival rates were also calculated based on the number of pathologic risk factors. Patients with no risk factors had an 83% 5-year survival rate, which decreased to 42% with 1 factor, 33% with 2 factors, and 0% with all 3 risk factors. CONCLUSIONS: Tumor size, hemorrhage, and mitotic count correlate with survival rates for patients undergoing curative resection. Based on these pathologic factors, adrenocortical carcinomas may be divided into low- and high-risk groups.     

射频消融治疗肝细胞癌的生存率及预后因素分析

目的探讨射频消融(RFA)治疗肝细胞癌(HCC)的总生存率、无局部复发生存率和无瘤生存率及其预后因素。方法192例HCC患者行超声引导下RFA治疗。男151例,女41例。平均年龄59.2岁(24～87岁)。肿瘤平均大小(3.9±1.3)cm(1.2～8.0cm)。肝功能ChildPugh分级A、B、C级分别为106、77和9例。根据UICCTNM分期,Ⅰ、Ⅱ、Ⅲ、Ⅳ期肝癌分别为57、85、44和6例。单因素分析采用KaplanMeier及Logrank时序检验,多因素采用COX比例风险模型。结果192例HCC患者治疗后1、2、3、4年总生存率为84.9%、69.1%、60.4%和52.8%;无局部复发生存率为75.1%、53.8%、43.9%和40.8%;无瘤生存率为64.3%、43.2%、37.1%和25.0%。多因素分析获得的预后因素为:(1)总生存期:ChildPugh分级,规范化方案治疗和UICCTNM分期。(2)无局部复发生存期:ChildPugh分级,UICCTNM分期。(3)无瘤生存期:UICCTNM分期,ChildPugh分级,卫星灶。其中,ChildPugh分级和UICCTNM分期在3种生存率的预后分析中均为独立预后因素。结论根据RFA治疗结果分析,HCC肿瘤进展程度(UICCTNM分期和有无卫星灶)、患者肝功能以及治疗方法(是否应用规范化方案)是影响疗效的重要因素,此结果有助于在RFA治疗前、中和后3个环节中采取相应措施,以改善生存期。     

Differentiated thyroid carcinoma: prognostic factors

Factors influencing prognosis and long term outcome of thyroid cancer have been described by several groups. It is, however, not clear how the moderate iodine deficiency in Hungary can influence the previously described prognostic factors by other means than shifting differentiated cancer incidence toward the follicular type. Data of 423 out of 472 patients who had been operated on for papillary (372) and follicular (100) thyroid cancer between 1971 and 1997 at our institution have been analyzed retrospectively. Histological specimens were re-evaluated and, if needed, revised. Survival curves were compared using the Kaplan-Meier method. The overall 5 and 10 year survival rates were 93% and 89% for papillary, and 92% and 80% for follicular carcinoma. As an independent factor extrathyroidal invasion (papillary p = 0.000, follicular p = 0.000), lymph node involvement (papillary p = 0.000, follicular 0.011), distant metastases (papillary p = 0.000, follicular p = 0.000), and age over 40 years (papillary p = 0.000, follicular p = 0.000) had negative influence on survival. Multifocality, gender, type of surgery (total or near-total thyroidectomy vs. less than near-total thyroidectomy), and lymphocytic infiltration did not influence survival. Iodine intake did not influence survival, however, the incidence of follicular cancer was higher in iodine deficient regions. When analyzing the papillary and follicular groups separately by Cox regression, extrathyroidal invasion (p = 0.008), lymph node metastasis (p = 0.004), distant metastasis (p = 0.000), and age over 40 years (p = 0.000) were significant predictors in the papillary group, while only tumor extrathyroidal invasion (p = 0.019), and distant metastases (p = 0.000) were significant negative factors in the follicular group.     

972例结肠癌患者预后多因素分析

目的 通过对972例结肠癌患者临床病理等因素的分析,探讨影响结肠癌患者术后生存的因素.方法 对972例结肠癌患者的临床资料进行单因素及多因素COX回归分析,生存率采用寿命表法计算,生存率的比较采用Log.rank检验法.结果 单因素分析表明,年龄、围手术期输血、术前血清cEA(癌胚抗原,carcinoembryonie aIltigen)水平、肿瘤大体类型、肿瘤浸润深度、淋巴结转移、肝转移、其他脏器转移、肿瘤局部复发、腹膜种植、病理类型、TNM分期及淋巴结廓清术式均为影响预后的因素.多因素回归分析表明,年龄、术前血清CEA水平、肿瘤大体类型、淋巴结转移、肝转移、其他脏器转移、肿瘤局部复发、腹膜种植、病理类型、淋巴结廓清术式以及TNM分期是影响患者术后生存的独立因素.结论 淋巴结转移是影响结肠癌患者预后最重要的因素.     

Classification, staging, prognostic factors and risk factors in thyroid carcinoma

Thyroid carcinomas arise from follicular cells (papillary, follicular, Hurthle, anaplastic), parafollicular cells (medullary) and stroma (lymphoma, sarcoma). Gradation and prognostic factors are different for every one of histological type. Most patients with papillary and follicular thyroid cancer have an excellent prognosis. At the other extreme is anaplastic thyroid cancer whose usual mean survival can be measured in months. Exposure to external radiation and living in endemic goiter area increase the frequency of thyroid cancer. Medullary thyroid carcinoma is often familial and may occur in associations with the multiple endocrine neoplasia syndromes.     

Renal cell carcinoma: survival and prognostic factors

Three hundred twenty-six patients treated at New York University from 1970 to 1982 were studied for survival in relationship to surgical stage, type of therapy, and pathologic characterization of the primary tumor. At the time of diagnosis 25.5 per cent of tumors were Stage I, 15 per cent Stage II, 28.5 per cent Stage III, and 31 per cent Stage IV. The retrospective study showed that patients with tumor confined within the capsule achieved the highest five- and ten-year survivals of 88 per cent and 66 per cent, respectively. Survivals decreased as tumor invaded perirenal fat (67% and 35%) or regional lymph nodes (17% and 5%). Tumor invasion into the renal vein alone did not significantly change five-year survival (84%) but lowered ten-year survival to 45 per cent. Patients with metastases at the time of nephrectomy did poorly regardless of site of metastases or kind of adjuvant therapy, except for those managed by surgical extirpation of the secondary lesion. Certain tumor characteristics were associated with a better prognosis, e.g., size below 5 cm in diameter, lack of invasion of collecting system, perirenal fat or regional lymph nodes, and predominance of clear or granular cells growing into a recognizable histologic pattern.     

Survival and recurrence rates after resection for hepatocellular carcinoma in noncirrhotic livers

BACKGROUND: Hepatocellular carcinoma occurring in noncirrhotic livers is rare. The purpose of this article was to evaluate the outcomes and prognostic factors after hepatectomy in this setting. STUDY DESIGN: Between June 1998 and May 2005, 83 patients underwent liver resection for hepatocellular carcinoma in noncirrhotic livers at our institution. Preoperative treatment data, intraoperative details, pathologic findings, and information on tumor recurrence, treatment of recurrence, and survival were available for 80 of these patients. RESULTS: Postresection, the 3- and 5-year-survival rates were 48% and 30%, respectively. After R0 resection (n=66), the calculated 3- and 5-year-survivals were 54% and 39%, compared with 23% and 0%, respectively, after R1/2-resection (p<0.005). After a median followup of 25 months, tumor recurred in 40 of 63 (63%) patients after R0 resection. In univariate analysis, Union Internationale Contre le Cancer (UICC) stage, vascular invasion, and tumor grading were identified as important findings for recurrence and poor survival after R0 resection. For tumors without vascular invasion, the 3- and 5-year-survivals were 79% and 65%, respectively, which compared favorably with 21% and 7%, respectively, for tumors with vascular invasion (p<0.0001). Similarly, 3- and 5-year-survival rates (95% each) were considerably better for G1 tumors than the corresponding 36% and 22% rates in G2 and 60% and 30% in G3 tumors, respectively. CONCLUSIONS: The 3- and 5-year survivals of 54% and 39%, respectively, after R0 resections suggest that surgery is an option in hepatocellular carcinoma arising in noncirrhotic livers. Longterm results, however, are hampered by high recurrence rates. Union Internationale Contre le Cancer stage, vascular invasion, and tumor grades are predictors of tumor recurrence and diminished survival, and may help to identify candidates for potential adjuvant therapies.