Early gallbladder carcinoma: a single-center experience

AIMS AND BACKGROUND: Controversy continues regarding the best surgical treatment for early gallbladder carcinoma defined as a tumor confined to the mucosa (pT1a) or to the muscularis propria (pT1b) according to the TNM classification. This study evaluates the effectiveness of different surgical approaches in patients with early gallbladder carcinoma in terms of long-term survival. MATERIALS AND METHODS: From 1980 to 2001, 175 patients with gallbladder carcinoma were admitted to our department. Fifteen of them underwent resections for early gallbladder carcinoma: 4 patients for pT1a tumors and 11 patients for pT1b tumors. All patients with pT1a tumors and 8 patients with pT1b tumors underwent simple cholecystectomy. The remaining 3 patients with pT1b tumors underwent extended cholecystectomy. RESULTS: The 5-10 year cumulative survival rate was 100% for patients with pT1a tumors, 37.5% for patients with pT1b tumors who underwent simple cholecystectomy, and 100% for patients with pT1b tumors who underwent extended cholecystectomy. CONCLUSIONS: Simple cholecystectomy is the appropriate treatment for patients with pT1a tumors, whereas patients with pT1b tumors require an extended cholecystectomy.     

Pathologic T1 clear cell renal cell carcinoma: insulin-like growth factor-I receptor expression and disease-specific survival

BACKGROUND: A proportion of patients diagnosed with pathologic T1 (pT1) clear cell renal cell carcinoma (CC-RCC) will experience disease progression and death after surgery, whereas the majority remain disease free. The authors conducted a case-cohort investigation to examine the association of insulin-like growth factor I receptor (IGF-IR) expression and disease-specific survival in patients who underwent surgery for pT1 CC-RCC. METHODS: Eligible patients included those diagnosed with solitary, nonfamilial pT1 CC-RCC who underwent radical nephrectomy at the Mayo Clinic-Rochester between 1970 and 2000 (n = 886 patients). Among this group, 136 patients died of CC-RCC (cases). Archived tumor blocks were not available for 62 patients, leaving a final study group of 74 cases. Stratified, random sampling was used to select a cohort of at least 3 year-matched controls (no CC-RCC death) for each case (n = 263 patients). Detection of IGF-IR was performed using a commercially available monoclonal antibody. Cox proportional hazards models were fit to assess the association between IGF-IR expression and disease-specific survival. RESULTS: After adjustment for age, the risk of death from CC-RCC was greater for patients who had tumors that stained positive for IGF-IR compared with patients who had tumors that showed no IGF-IR expression (hazard ratio [HR], 1.5; 95% confidence interval, [95% CI], 0.9-2.4). In a stratified analysis, the risk was stronger among patients who had high-grade tumors (HR, 2.2; 95% CI, 1.1-4.3) compared with patients who had low-grade tumors (HR, 0.7; 95% CI, 0.3-1.5). Multivariate adjustment for tumor size and histologic tumor necrosis attenuated the association among all patients (HR, 1.3; 95% CI, 0.8-2.1) but strengthened the association among patients with high-grade tumors (HR, 2.7; 95% CI, 1.3-5.6). CONCLUSIONS: The current data suggest that IGF-IR expression is associated with poor survival in patients who are diagnosed with early-stage CC-RCC, especially among those with high-grade disease.     

A new prognostic histopathologic classiifcation ofnasopharyngeal carcinoma

Background:The current World Health Organization (WHO) classiifcation of nasopharyngeal carcinoma (NPC) con?veys little prognostic information. This study aimed to propose an NPC histopathologic classiifcation that can poten?tially be used to predict prognosis and treatment response. Methods:We initially developed a histopathologic classiifcation based on the morphologic traits and cell differentia?tion of tumors of 2716 NPC patients who were identiifed at Sun Yat?sen University Cancer Center (SYSUCC) (training cohort). Then, the proposed classiifcation was applied to 1702 patients (retrospective validation cohort) from hospitals outside SYSUCC and 1613 patients (prospective validation cohort) from SYSUCC. The effcacy of radiochemotherapy and radiotherapy modalities was compared between the proposed subtypes. We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% conifdence intervals (CI) for overall survival (OS). Results:The 5?year OS rates for all NPC patients who were diagnosed with epithelial carcinoma (EC; 3708 patients), mixed sarcomatoid?epithelial carcinoma (MSEC; 1247 patients), sarcomatoid carcinoma (SC; 823 patients), and squamous cell carcinoma (SCC; 253 patients) were 79.4%, 70.5%, 59.6%, and 42.6%, respectively (P<0.001). In mul?tivariate models, patients with MSEC had a shorter OS than patients with EC (HR=1.44, 95% CI=1.27–1.62), SC (HR=2.00, 95% CI=1.76–2.28), or SCC (HR=4.23, 95% CI=3.34–5.38). Radiochemotherapy signiifcantly improved survival compared with radiotherapy alone for patients with EC (HR=0.67, 95% CI=0.56–0.80), MSEC (HR=0.58, 95% CI=0.49–0.75), and possibly for those with SCC (HR=0.63; 95% CI=0.40–0.98), but not for patients with SC (HR=0.97, 95% CI=0.74–1.28). Conclusions:The proposed classiifcation offers more information for the prediction of NPC prognosis compared with the WHO classiifcation and might be a valuable tool to guide treatment decisions for subtypes that are associ?ated with a poor prognosis.     

Comparing survival rate and appropriate surgery methods according to tumor location in T2 gallbladder cancer

BackgroundThe survival outcomes and optimal extent of surgery of T2 gallbladder cancers remain controversial. We aimed to investigate the difference in overall/disease-free survival rates and assess the prognosis of T2 gallbladder cancers.MethodsWe retrospectively reviewed electronic medical records of 147 patients who underwent surgical resection for pathologically confirmed T2 gallbladder cancer between January 2003 and December 2012. Patients were categorized into two groups according to the tumor location (T2a vs. T2b) and three groups according to surgery method (simple cholecystectomy, cholecystectomy with lymph node dissection, and extended cholecystectomy). We compared the overall and disease-free survival rates according to T2 subgroups and surgery methods. Cox proportional hazard analysis was performed to evaluate prognostic factors for the overall survival of T2 gallbladder cancer.ResultsOf all patients, 40 (27.2%) and 107 (72.8%) were diagnosed with T2a and T2b gallbladder cancers, respectively. The 5-year overall and disease-free survival rates were 75.0% vs. 73.8% (p = 0.653) and 72.5% vs. 70.1% (p = 0.479) in T2a and T2b gallbladder cancers, respectively.There was no difference in the survival rate among T2a gallbladder cancer according to the surgery method. However, in T2b gallbladder cancer, extended cholecystectomy showed a better overall survival than simple cholecystectomy and cholecystectomy with lymph node dissection groups (p = 0.043 and p = 0.003, respectively).ConclusionsThere is no difference in overall and disease-free survival rates according to the location of T2 gallbladder cancers. Extended cholecystectomy increases overall survival rate, especially in T2b gallbladder cancers.     

Common clinicopathological and immunological features of sarcomatoid carcinoma across organs: A histomorphology-based cross-organ study

Sarcomatoid carcinoma (SC), which can occur in any organ, is a rare disease. To elucidate common characteristics of SC beyond organs, we evaluated clinicopathological and immunological features of SC defined by the single histological criterion beyond organs compared to randomly matched conventional carcinoma (non-SC) adjusted for the disease stage. Immunological features were assessed by multiplex immunohistochemistry, comparing immune cell density in tumor tissues and tumor programmed death-ligand 1 (PD-L1) expression. A total of 101 patients with SC or non-SC (31 lung, 19 esophagus, 22 pancreas, 15 liver, 4 bile duct, 6 kidney, 2 uterus and 2 ovary) were identified among 7197 patients who underwent surgery at our institute (1997-2020). SC was significantly associated with worse survival (HR: 1.571; 95% CI: 1.084-2.277; P = .017). The frequency of postoperative progression within 6 months was significantly higher for SC patients (54% vs 28%; P = .002). The immune profiling revealed the densities of CD8⁺ T cells (130 vs 72 cells/mm²; P = .004) and tumor-associated macrophages (566 vs 413 cells/mm²; P < .0001) and the tumor PD-L1 expression score (40% vs 5%; P < .0001) were significantly higher in SCs than in non-SCs. Among 73 SC patients with postoperative progression, multivariate Cox regression analysis showed that immunotherapy tended to be associated with favorable survival (HR: 0.256; 95% CI: 0.062-1.057; P = .060). Collectively, SCs shared clinicopathological and immunological features across organs. Our study can initiate to standardize the pathological definition of SC and provide a rationale for the investigation and development for this rare disease in a cross-organ manner.     

Adjuvant radiotherapy and survival for patients with node-positive head and neck cancer: an analysis by primary site and nodal stage

PURPOSE: Adjuvant radiotherapy (RT) is frequently recommended for node-positive head and neck squamous cell carcinoma (HNSCC) treated with primary surgery. The impact of RT on survival for various subgroups of node-positive HNSCC has not been clearly demonstrated. METHODS AND MATERIALS: Within the Surveillance, Epidemiology, and End Results (SEER) Database, we identified 5297 patients with node-positive (N1 to N3) HNSCC treated with definitive surgery with or without adjuvant RT between 1988 and 2001. The median follow-up was 4.4 years. RESULTS: Adjuvant RT significantly improved 5-year overall survival (46.3%: 95% confidence interval [CI], 44.7-48.0% for surgery + RT, vs. 35.2%: 95% CI, 32.0-38.5% for surgery alone, p < 0.001) and cancer-specific survival (54.8%: 95% CI, 53.2-56.4% for surgery + RT, vs. 46.2% for surgery alone 95% CI, 42.4-50.0%, p < 0.05). Use of adjuvant RT remained a significant predictor of survival on multivariable analysis (hazard ratio [HR], 0.75; 95% CI, 0.68-0.83; p < 0.001). Subset analyses demonstrated that adjuvant RT was associated with significantly improved survival for N1 (HR, 0.78; 95% CI; 0.67-0.90; p = 0.001), N2a (HR, 0.82; 95% CI, 0.67-0.99, p = 0.048) and N2b to N3 nodal disease (HR, 0.62; 95% CI, 0.51-0.75; p < 0.001). Adjuvant RT increased overall survival for node-positive patients with oropharynx (HR, 0.72; 95% CI, 0.57-0.90; p = 0.004), hypopharynx (HR, 0.66; 95% CI, 0.49 to 0.88; p = 0.004), larynx (HR, 0.66; 95% CI, 0.52-0.84; p = 0.001), and oral cavity (HR, 0.84; 95% CI, 0.73-0.98; p = 0.025) primary tumors. CONCLUSIONS: In a large population-based analysis, adjuvant RT significantly improves overall survival for patients with node-positive HNSCC. All nodal stages, including N1, appear to benefit from the addition of RT to definitive surgery.     

Role of HER2-neu as a prognostic factor for survival and relapse in pT1a–bN0M0 breast cancer: a systematic review of the literature with a pooled-analysis

High levels of human epidermal growth receptor 2 (HER2) expression are associated with recurrence and death in breast cancer (BC) patients. We have performed a systematic review and meta-analysis in order to evaluate the prognosis for HER2+ pT1a–bN0M0 BC patients. A search of PubMed and Embase was performed. Studies were included if they reported hazard ratios (HRs) with a 95% confidence interval (CI) for multivariate analyses of relapse or survival in pT1a–bN0M0, HER2+ BC patients treated with surgery and chemotherapy and/or endocrine therapy, but not with trastuzumab. A total of 764 patients from seven studies were included in the meta-analysis. In the pooled analysis, HER2 had a detrimental effect on relapse-free (HR 4.68, 95% CI 3.05–7.18; p < 0.00001) and distant relapse-free survival, with a HR of 5.6 (95% CI 2.65–11.85; p < 0.00001). HER2+ status was also linked to increased risk of death (HR 3.4, 95% CI 0.86–13.41; p = 0.08) and worst BC-specific survival (HR 2.61, 95% CI 1.51–4.51; p = 0.0006), but these data were presented in few studies. HER2+ pT1a–bN0M0 BC is associated with a dismal prognosis. In these patients, HER2 has to be taken into account when deciding on adjuvant therapy, and trastuzumab should be considered.     

中晚期胆囊癌手术方式的临床分析

目的：探讨中晚期胆囊癌手术方式与预后关系。方法：回顾性分析1997年1月至2005年1月间收治的85例中晚期胆囊癌的临床资料，施行胆囊癌根治性切除术40例，扩大根治术25例，姑息性手术20例。结果：均获得病理诊断，腺癌51例（60％），最为常见。65例行根治术＋扩大根治术和85例总的术后的1年、3年、5年生存率分别为80．0％、61．5％、49．2％；67．1％、47．1％、37．6％。结论：胆囊癌根治术＋扩大根治术是提高中晚期胆囊癌切除率和疗效的有效方法。     

Laparoscopic cholecystectomy and gallbladder cancer

Heightened awareness of the possible presence of gallbladder cancer (GBC) and the knowledge of appropriate management are important for surgeons practising laparoscopic cholecystectomy (LC). Long-term effects of initial LC versus open cholecystectomy (OC) on the prognosis of patients with GBC remain undefined. Patients who are suspected to have GBC should not undergo LC, since it is advantageous to perform the en-bloc radical surgery at the initial operation. Since preoperative diagnosis of early GBC is difficult, preventive measures, such as preventing bile spillage and bagging the gallbladder should be applied for every LC. Many port-site recurrences (PSR) have been reported after LC, but the incidence of wound recurrence is not higher than after OC. No radical procedure is required after postoperative diagnosis of incidental pT1a GBC. It is unclear if patients with pT1b GBC require extended cholecystectomy. In pT2 GBC, patients should have radical surgery (atypical or segmental liver resection and lymphadenectomy). In advanced GBC (pT3 and pT4), radical surgery can cure only a small subset of patients, if any. Additional port-site excision is recommended, but the effectiveness of such measure is debated.     

Lymphatic spread of T2 gallbladder carcinoma: Regional lymphadenectomy is required independent of tumor location

BackgroundThis study aimed to investigate the incidence and distribution of regional lymph node metastasis according to tumor location, and to clarify whether tumor location could determine the extent of regional lymphadenectomy in patients with pathological T2 (pT2) gallbladder carcinoma.MethodsIn total, 81 patients with pT2 gallbladder carcinoma (25 with pT2a tumors and 56 with pT2b tumors) who underwent radical resection were enrolled. Tumor location was determined histologically in each gallbladder specimen.ResultsSurvival after resection was significantly worse in patients with pT2b tumors than those with pT2a tumors (5-year survival, 72% vs. 96%; p = 0.027). Tumor location was an independent prognostic factor on multivariate analysis (hazard ratio, 14.162; p = 0.018). The incidence of regional lymph node metastasis was significantly higher in patients with pT2b tumors than in those with pT2a tumors (46% vs. 20%; p = 0.028). However, the number of positive nodes was similar between the two groups (median, 2 vs. 2; p = 0.910). For node-positive patients with pT2b tumors, metastasis was found in every regional node group (12%–63%), whereas even for node-positive patients with pT2a tumors, metastasis was observed in regional node groups outside the hepatoduodenal ligament.ConclusionsTumor location in patients with pT2 gallbladder carcinoma can predict the presence or absence of regional lymph node metastasis but not the number and anatomical distribution of positive regional lymph nodes. The extent of regional lymphadenectomy should not be changed even in patients with pT2a tumors, provided that they are fit enough for surgery.     

19例原发性胆囊癌疗效分析

目的:探讨浸润肌层的胆囊癌是否是局部疾病,行单纯胆囊切除术后是否要行二次根治手术治疗方法:回顾分析了19例浸润肌层的原发性胆囊癌患者,8例行单纯胆囊切除术,11例行根治性淋巴结清扫术68个区域淋巴结被检查平均随访时间97个月结果:组织学检查均未发现血管浸润,1例有淋巴管浸润淋巴结均未见转移10年生存率为89%,单纯胆囊切除术与根治术结果相比,差别无统计学意义.2例行根治术的患者死于肿瘤复发结论:多数浸润肌层的早期原发性胆囊癌仅是局部扩散,行单纯胆囊切除术后不需再行根治术。     

Low socioeconomic status is a poor prognostic factor for survival in stage I nonsmall cell lung cancer and is independent of surgical treatment, race, and marital status

BACKGROUND: Racial minorities exhibit poor survival with nonsmall cell lung cancer (NSCLC) that generally is attributed to low socioeconomic status (SES). In this study, the authors investigated the role of SES in this survival disparity among patients with stage I NSCLC. METHODS: A case-only analysis was performed on California Cancer Registry (CCR) data (1989-2003). Univariate survival analyses were performed using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios. RESULTS: In total, 19,702 incident cases of stage I NSCLC were analyzed. Low SES was identified more commonly in African-American and Hispanic patients and was associated significantly with men, unmarried status, stage IB disease, squamous cell histology, poorly differentiated tumors, fewer surgical resections performed, and less overall treatment received. Reasons for no surgery were associated strongly with low SES and unmarried status but not with race. In multivariate analysis, each incremental improvement in SES quintile was associated with statistically significant decreases in the hazard ratios (HRs) for death (second SES quintile [SES2] vs SES1: HR, 0.91; 95% confidence interval [95% CI], 0.85-0.98; SES3 vs SES1: HR, 0.90; 95% CI, 0.84-0.97; SES4 vs SES1: HR, 0.83; 95% CI, 0.77-0.89; SES5 vs SES1: HR, 0.78; 95% CI, 0.72-0.84; P(trend) < .0001). African-American or Hispanic race was not an independent poor prognostic factor for survival after adjustment for surgery, SES, and marital status. CONCLUSIONS: Low SES was an independent poor prognostic factor for survival in patients with stage I NSCLC and was independent of surgery, race, and marital status.     

Disease-free and overall survival after pathologic complete disease remission of cytologically proven inflammatory breast carcinoma axillary lymph node metastases after primary systemic chemotherapy

BACKGROUND: Breast carcinoma axillary lymph node (ALN) pathologic complete response (pCR) after primary chemotherapy is associated with significantly higher recurrence-free survival (RFS) and overall survival (OS) rates. The purpose of the current study was to determine long-term outcome in patients achieving a pCR of cytologically proven inflammatory breast carcinoma ALN metastases after primary chemotherapy. METHODS: Patients with cytologically documented ALN metastases from inflammatory breast carcinoma were treated in three prospective primary chemotherapy trials. After surgery, patients were subdivided into those patients with and those patients without residual ALN carcinoma. Survival was calculated using the Kaplan-Meier method. RESULTS: Of 175 patients treated, 61 had cytologically confirmed ALN metastases. Fourteen patients (23%) achieved a pCR of the ALNs after primary chemotherapy. The 5-year OS and RFS rates were found to be improved in those patients achieving a pCR of the ALNs (82.5% [95% confidence interval (95% CI), 62.8-100%] and 78.6% [95%CI, 59.8-100%], respectively, vs. 37.1% [95%CI, 25.4-54.2%] and 25.4% [95%CI, 15.5-41.5%], respectively) (P = 0.01 [for OS] and P = 0.001 [for RFS]). Combination anthracycline and taxane-based primary chemotherapy resulted in significantly more patients achieving an ALN pCR (45% vs. 16%; P = 0.01). CONCLUSIONS: pCR of ALN metastases is associated with an excellent prognosis in patients with inflammatory breast carcinoma. The rates of ALN pCR are nearly 50% in patients with inflammatory breast carcinoma who are treated with anthracyclines and weekly paclitaxel before surgery. However, those patients with residual ALN disease at the time of surgery greatly require the introduction of novel therapeutic strategies.     

Surgical strategies in patients with gallbladder cancer: nihilism to optimism

INTRODUCTION: Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. METHODS: Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. RESULTS: Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. CONCLUSIONS: Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity.     

Extramural extension as indicator for postoperative adjuvant chemotherapy in Stage IIA (pT3N0) colon cancer

The usefulness of adjuvant chemotherapy (CMT) in patients with Stage IIA colon cancer remains unclear. The present study aimed to investigate extramural extension as an indicator for adjuvant CMT. Data were reviewed from 202 consecutive patients with Stage IIA colon cancer that underwent curative surgery between 1995 and 2007. The distance of the extramural extension (DEE) was measured histologically. The optimal prognostic cut‐off point of the DEE for oncologic outcomes was statistically determined. The eligible surviving patients had been followed for a median period of 75 months (range: 2–210 months). Patients were subdivided into two groups according to the optimal cut‐off point; DEE ≤5 mm (pT3a) and DEE >5 mm (pT3b). The pT3b was the most powerful independent risk factor for postoperative recurrence (P = 0.0324, HR: 3.04, 95% CI: 1.098–8.408), and was significantly correlated with distant metastasis (P = 0.0161 HR: 5.19, 95% CI: 1.765–15.239). The recurrence‐free and cancer‐specific 5‐year survival rates in patients with pT3b were significantly lower than in patients with pT3a (81.5% vs. 95.4%, P = 0.0003 and 85.9% vs. 97.4%, P = 0.0007, respectively). pT3b could be an important risk factor for distant metastasis in Stage IIA colon cancer. Postoperative adjuvant CMT may be indicated for patients with pT3b. J. Surg. Oncol. 2013; 108:358–363. © 2013 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.     

Bowel movement frequency, medical history and the risk of gallbladder cancer death: a cohort study in Japan

Few risk factors for gallbladder cancer have been identified with sufficient statistical power, because this cancer is rare. The present study was conducted to evaluate the association of bowel movement frequency and medical history with the risk of death from gallbladder cancer using the data set from a large-scale cohort study. A total of 113,394 participants (42.0% males), aged 40 to 89 years, were followed up for 11 years. Information on the medical history of selected diseases, history of blood transfusions, frequency of stools, and tendency toward diarrhea at baseline was collected through a self-administered questionnaire. The Cox proportional hazard model was used to estimate the hazard ratio (HR). During the follow-up period, a total of 116 deaths (46 males, 70 females) from gallbladder cancer were identified. After adjustments for age and gender, history of hepatic disease (HR: 2.28; 95% confidence intervals (95% CI): 1.24-4.21), frequency of stool, and tendency toward diarrhea (HR: 0.26; 95% CI: 0.08-0.83) were found to be significantly associated with the risk of death from gallbladder cancer. Compared with those who had a stool at least once a day, the HR was 2.06 (95% CI: 0.82-5.18) for those who had a stool less than once in 6 days (P for trend = 0.050). In this prospective study, constipation and a history of hepatic disease were found to elevate the risk of gallbladder cancer death, whereas a tendency toward diarrhea diminished it.     

Late mortality from pT1N0M0 breast carcinoma.

BACKGROUND: pT1N0M0 breast carcinoma (< or = 2 cm in greatest dimension, lymph node negative) is associated with generally favorable 5-year and 10-year survival, but to the authors' knowledge there are few data available regarding the long term outcome of these patients. METHODS: The authors identified women with breast carcinoma diagnosed between 1945-1984 in a geographically defined urban population using the files of the Finnish Cancer Registry and local hospital records (n = 1495). The clinical and autopsy records and histologic slides were reviewed. The series contained 265 patients with unilateral pT1N0M0 breast carcinoma treated with mastectomy and axillary lymph node dissection without adjuvant systemic therapy and who were followed for 10-44 years (median, 17 years) after the initial diagnosis or until death. RESULTS: The last death from pT1N0M0 breast carcinoma occurred 23 years after the initial diagnosis. The 20-year overall survival rate was 54% (95% confidence interval [95% CI], 48-60%) and the survival rate when corrected for intercurrent deaths was 81% (95% CI, 75-87%). The 20-year survival rate when corrected for intercurrent deaths was 92% (95% CI, 86-98%) in patients with T1a-b disease (primary tumor < or = 10 mm), but was only 75% (95% CI, 64-86%) in patients with pTc disease (range, 11-20 mm). None of the patients with well differentiated (World Health Organization Grade 1) pTa-b tumors died of breast carcinoma (n = 48) whereas the 20-year survival rate when corrected for intercurrent deaths was 81% (95% CI, 67-95%) in patients with Grade 2-3, pT1a-b tumors (P = 0.002). CONCLUSIONS: Patients with well differentiated pT1a-b tumors form a subgroup with excellent long term prognosis, but a significant proportion of women with either moderately or poorly differentiated pT1a-b tumors or pT1c tumors ultimately die of the disease.     

Systematic lymphadenectomy in ovarian cancer at second-look surgery: a randomised clinical trial

Background:The role of systematic aortic and pelvic lymphadenectomy (SAPL) at second-look surgery in early stage or optimally debulked advanced ovarian cancer is unclear and never addressed by randomised studies.Methods:From January 1991 through May 2001, 308 patients with the International Federation of Gynaecology and Obstetrics stage IA-IV epithelial ovarian carcinoma were randomly assigned to undergo SAPL (n=158) or resection of bulky nodes only (n=150). Primary end point was overall survival (OS).Results:The median operating time, blood loss, percentage of patients requiring blood transfusions and hospital stay were higher in the SAPL than in the control arm (P<0.001). The median number of resected nodes and the percentage of women with nodal metastases were higher in the SAPL arm as well (44% vs 8%, P<0.001 and 24.2% vs 13.3%, P:0.02). After a median follow-up of 111 months, 171 events (i.e., recurrences or deaths) were observed, and 124 patients had died. Sites of first recurrences were similar in both arms. The adjusted risk for progression and death were not statistically different (hazard ratio (HR) for progression=1.18, 95% confidence interval (CI)=0.87-1.59; P=0.29; 5-year progression-free survival (PFS)=40.9% and 53.8%; HR for death=1.04, 95% CI=0.733-1.49; P=0.81; 5-year OS=63.5% and 67.4%, in the SAPL and in the control arm, respectively).Conclusion:SAPL in second-look surgery for advanced ovarian cancer did not improve PFS and OS.     

Does CA 19-9 Have Prognostic Relevance in Gallbladder Carcinoma (GBC)?

Background

There is a scarce data on prognostic relevance of carbohydrate?antigen (CA 19-9). This retrospective study was undertaken to evaluate its prognostic relevance in different prognostic subsets of gallbladder carcinoma (GBC).

Materials and Methods

One hundred forty-one patients of GBC treated between January 2012 and December 2014 were the subjects of this retrospective analysis. Baseline CA 19-9 levels of four cohorts of patients: extended cholecystectomy (EC), simple cholecystectomy (SC) with residual or recurrent disease, locally advanced disease (LAGBC) and metastatic disease were ascertained. The difference in its median baseline values among above groups was ascertained. The effect of clinicopathological variables, treatment-related variables and CA 19-9 on overall survival (OS) was also evaluated. AUC curve was computed to evaluate its performance.

Results

The median baseline levels of CA 19-9 were significantly different [10 units/ml, 24 units/ml, 48 units/ml and 75 units/ml in EC (n = 33), SC (n = 21), LAGBC (n = 38) and metastatic disease (n = 49), respectively, (p value 0.001)]. The median OS was also significantly different [24, 15, 7 and 6 months in EC, SC, LAGBC and metastatic disease, respectively, (p value 0.001)]. Univariate analysis revealed a significant influence of log transformed value of CA 19-9, CA 19-9 levels < or >20 units or 35 units, surgery vs. none and chemoradiation vs. chemotherapy on OS. On multivariate analysis, only treatment-related variables were significant (HR 1.1, 95% CI 1.026–1.19, p = 0.009). AUC curve was 0.63 for all patients and 0.72 for EC group.

Conclusions

The median values of baseline CA 19-9 predict the burden of disease. Raised levels of serum CA 19-9 beyond 20 units/ml should be used for prognostication purposes after EC. A level beyond 35 units has a trend towards prognostication in other prognostic groups and needs to be evaluated in large subset of patients.

     

Clinicopathological characteristics,treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study

Objective

Uterine carcinosarcoma (UCS) shared the same staging system with endometrial carcinoma in the International Federation of Gynecology and Obstetrics 2009. The aim of the present study was to compare the clinicopathological and prognostic characteristics between UCS and grade 3 endometrioid endometrial carcinoma (G3EC).

Methods

A retrospective analysis of 60 UCS and 115 G3EC patients with initial treatment at the Department of Gynecology in the Fudan University Shanghai Cancer Center between February 2006 and August 2013. Chi-square analysis was used to compare differences between variables. Prognostic factors were determined using univariate/multivariate analysis, and the survival rates were assessed using the Kaplan-Meier method. The Cox regression model was used to assess the independent prognostic factor.

Results

UCS had significantly worse overall survival (OS) compared with G3EC. Carcinosarcoma subtype was an independent factor (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0 to 5.8; p=0.039), stratified based on stage. Compared with G3EC, UCS patients had a greater incidence of ascites fluid (55.0% vs. 15.7%, p<0.001) and adnexal involvement (20.0% vs. 8.7%, p=0.048) and larger median tumor volume (4.6 cm vs. 4.0 cm, p=0.046). Subgroup analysis of the prognostic factors revealed that UCS patients exhibited worse OS than G3EC patients in such specific subgroups as patients at younger ages, with postmenopausal status, without ascites fluid, with early stage diseases, without vagina invasion, without lymph node metastases and receiving adjuvant chemo/radiotherapy. Adjuvant radiotherapy with chemotherapy was predictive of better survival in UCS patients compared with chemotherapy or radiotherapy alone (5-year OS, 71.0% vs. 35.8%, p=0.028). Multivariate Cox regression revealed that tumor mesenchymal component (HR, 4.6; 95% CI, 1.4 to 15.8; p=0.014) was an independent prognostic factor for UCS, whereas advanced stages (HR, 5.9; 95% CI, 1.0 to 33.9; p=0.046) and ascites fluid (HR, 5.1; 95% CI, 1.1 to 22.7; p=0.032) were independently correlated with poor prognosis for G3EC patients.

Conclusion

The distinctions in both clinicopathological and prognostic characteristics between UCS and G3EC suggest that this subtype should be treated separately from high-risk epithelial endometrial carcinoma.