Meta analysis of the relationship between the neutrophils/lymphocytes ratio and prognosis in patients with oral squamous cell carcinoma / 口腔疾病防治

Objective@#To clarify the prognostic value of the neutrophil to lymphocyte ratio (NLR) in oral squamous cell carcinoma (OSCC) patients.@*Methods@#literature on the correlation between NLR and the prognosis and clinicopathological features of OSCC was searched in PubMed, Web of Science, Cochrane and Embase. The outcome indicators, including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), tumor size, cervical lymph node metastasis, tumor stage, extracapsular lymph node invasion and peripheral nerve invasion, were analyzed by RevMan5.3 software@*Results @# In total, 6 180 patients were included in 23 studies. The analysis showed that NLR was significantly negatively correlated with OS [HR=1.62, 95%CI(1.38, 1.91), P < 0.001], DFS [HR=1.48, 95%CI(1.24, 1.77), P < 0.001] and DSS [HR=1.87, 95%CI(1.60, 2.20), P < 0.001]. In addition, higher NLR values were positively correlated with tumor size [OR=2.68, 95%CI (1.84, 3.90), P < 0.001], cervical lymph node metastasis [OR=1.59, 95%CI (1.35, 1.88), P < 0.001], tumor stage [OR=2.85, 95%CI (2.35, 3.47), P < 0.001], extralymphatic invasion [OR=1.72, 95%CI (1.23, 2.40), P=0.001], and peripheral nerve invasion [OR=1.70, 95%CI (1.29, 2.24), P < 0.001]. However, there was no significant correlation with age [OR=0.96, 95%CI (0.71, 1.29), P=0.77], sex [OR=1.08, 95%CI (0.88, 1.33), P=0.55], or degree of differentiation [OR=1.15, 95%CI (0.92, 1.43), P=0.22]@*Conclusion @#Elevated NLR was significantly associated with the prognosis and clinicopathological features of OSCC and might be an independent prognostic factor.

Analysis of clinicopathological characteristics and survival of 1 915 oral cavity squamous cell carcinoma patients: 24-year experience from a single institution / 口腔疾病防治

Objective @#To investigate the clinicopathological features and survival rate of oral squamous cell carcinoma patients in China.@*Methods@#The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of 1 915 OCSCC patients who received initial treatment at the Sun Yat-sen University Cancer Center from 1990 to 2013 were collected and analyzed. The clinicopathological characteristics, stage, treatment modality, and 5-year disease-specific survival (DSS) rate of OCSCC patients treated during the successive decades of 1990-1999, 2000-2009, and 2010-2013 were analyzed retrospectively to show the trends over time.@*Results @#The average age of all OCSCC patients who received initial treatment at this cancer center from 1990 to 2013 was 54.8 years (SD, 12.6 years). The sex ratio was approximately 2:1. The oral tongue was the site most prone for OCSCC, accounting for 63.6% of all cases. The proportions of early-stage (Ⅰ-Ⅱ) and advanced-stage (Ⅲ-Ⅳ) cases were approximate. Regarding the treatment modality, surgery-based treatment accounted for 80.4%. Survival analysis showed that the 5-year DSS rate of all cases was 57%. Survival decreased with age. The survival of females, nonsmokers, and nondrinkers was higher than that of males, smokers, and drinkers. The 5-year DSS rates of patients with squamous cell carcinoma of the lips, oral tongue, and other sites of the oral cavity were 81%, 63%, and 42%, respectively. The 5-year DSS rates of patients who received surgery-based treatment and nonsurgical treatment were 66% and 19%, respectively. The analysis of trends over time showed that in the period of 1990-1999 and 2010-2013, the age and sex ratio were relatively stable. The proportion of patients with squamous cell carcinoma of the lips and oral tongue gradually decreased, while the proportion of those with squamous cell carcinoma of the other sites of the oral cavity gradually increased. The proportion of surgery-based treatment increased from 77.7% to 91.3%. The 5-year DSS rate gradually increased from 53% in 1990-1999 to 64% in 2010-2013. The 5-year DSS rate of female patients increased significantly from 55% to 78%. However, the 5-year DSS rate of male patients was relatively stable. The 5-year DSS rate of patients who received surgery-based treatment gradually increased from 62% to 69%. @*Conclusion@#The 5-year DSS rate has steadily improved for OCSCC patients at this cancer center from 1990-2013, especially in female patients. The 5-year DSS rate of patients with squamous cell carcinoma of the oral tongue has reached the rate in developed countries worldwide. The proportion and survival rate of patients who received surgery-based treatment gradually increased. The survival rate of patients with squamous cell carcinoma of the other sites of the oral cavity was significantly lower than that of patients with squamous cell carcinoma of the lips and oral tongue, suggesting that more effort should be put into the treatment of patients with squamous cell carcinoma of the other sites of the oral cavity to improve the survival rate in the future.

The impact of combined radiation and chemotherapy on outcome in uterine papillary serous carcinoma compared to chemotherapy alone / 부인종양

OBJECTIVE: To investigate the impact of pelvic radiation on survival in patients with uterine serous carcinoma (USC) who received adjuvant chemotherapy. METHODS: Patients with stage I-IV USC were identified from the Surveillance, Epidemiology, and End Results program 2000 to 2009. Patients were included if treated with surgery and chemotherapy. Patients were divided into two groups: those who received chemotherapy and pelvic radiation therapy (CT_RT) and those who received chemotherapy only (CT). Kaplan-Meier curves and Cox regression proportional hazard models were used. RESULTS: Of the 1,838 included patients, 1,272 (69%) were CT and 566 (31%) were CT_RT. Adjuvant radiation was associated with significant improvement in overall survival (OS; p<0.001) and disease-specific survival (DSS; p<0.001) for entire cohort. These findings were consistent for the impact of radiation on OS (p<0.001) and DSS (p<0.001) in advanced stage (III-IV) disease but not for early stage (I-II) disease (p=0.21 for OS and p=0.82 for DSS). In multivariable analysis adjusting for age, stage, race and extent of lymphadenectomy, adjuvant radiation was a significant predictor of OS and DSS for entire cohort (p=0.003 and p=0.05) and in subset of patients with stage III (p=0.02 and p=0.07) but not for patients with stage I (p=0.59 and p=0.49), II (p=0.83 and p=0.82), and IV USC (p=0.50 and p=0.96). Other predictors were stage, positive cytology, African American race and extent of lymphadenectomy. CONCLUSION: In USC patients who received adjuvant chemotherapy, adjuvant radiation was associated with significantly improved outcome in stage III disease but not for other stages. Positive cytology, extent of lymphadenectomy and African race were significant predictors of outcome.

Assessment of prognosis in patients with stage II colon cancer / Avaliação o prognóstico de pacientes com cancer de colon no estadio II

Pathologic staging is currently the most important prognostic factor in colon cancer, although individually this procedure does not provide a complete clinical outcome. This study aimed to determine the disease-specific survival of patients with colon cancer treated in the Braga Hospital from January 2005 to December 2013, according to the American Joint Committee on Cancer, 6th edition, and the disease-free survival and disease- specific survival of high- and low-risk stage II patients, whether in use, or not, of adjuvant chemotherapy. We obtained a total sample of 578 patients, with 145 and 65 high- and low-risk stage II patients, respectively. We observed a 5-year disease-specific survival rate of 93%, 27.4% and 75% for stage IIA, IIB and IIIA patients, respectively, where IIIA and IIB present statistically significant differences (p = 0.001). In high-risk stage II patients, disease-free survival (p = 0.107) and disease-specific survival (p = 0.037) were higher in the group submitted to chemotherapy. In low- risk patients, disease-free survival was higher in the group submitted to chemotherapy (p = 0.494), while disease-specific survival was lower (p = 0.426). The differences observed between stage IIB and IIIA survival can be explained by the consensual use of adjuvant chemotherapy in stage IIIA, and by its controversial use in stage IIB. Adjuvant chemotherapy showed to be effective only in high-risk stage II patients in terms of disease-specific survival. In the future, other markers, namely molecular ones, may be used to stratify the risk of stage II patients and determine who will benefit from adjuvant chemotherapy. (AU)

O estadiamento patológico é, atualmente, o fator de prognóstico mais importante do câncer de cólon, embora individualmente não preveja totalmente o resultado clínico. Neste estudo, pretendeu-se determinar a sobrevivência para uma doença específica (SDE) dos pacientes com câncer de cólon tratados no Hospital de Braga entre janeiro de 2005 e dezembro de 2013, de acordo com a 6a edição da American Joint Committee on Cancer e a Sobrevivência Livre de Doença (SLD) e SDE dos doentes em estadio II, classificados em alto e baixo risco, de acordo com a realização ou não de quimioterapia adjuvante. Obtivemos uma amostra total de 578 pacientes, dos quais uma parcela pertencia ao estadio II de alto ou de baixo risco (145 e 65 pacientes, respetivamente). Observamos SDE a 5 anos de: 93%, 27,4% e 75% para os estadios IIA, IIB e IIIA, respetivamente; IIIA e IIB apresentaram diferenças significativas (p = 0,001). SLD (p = 0,107) e SDE (p = 0,037) para o estadio II de alto risco foram superiores no grupo tratado com quimioterapia. Nos doentes de baixo risco, SLD foi superior no grupo tratado com quimioterapia (p = 0,494), enquanto que SDE foi inferior (p = 0,426). As diferenças de sobrevivência observadas para os estadios IIB e IIIA podem se dever ao uso controverso da quimioterapia em IIB e ao uso consensual em IIIA. O uso da quimioterapia adjuvante demonstrou ser efetivo nos doentes em estadio II de alto risco em termos de SDE. Futuramente, outros marcadores, nomeadamente moleculares, poderão vir a ser uti- lizados para estratificar o risco do estadio II e definir quem se beneficiará com o tratamento adjuvante. (AU)

FIGO 1988 versus 2009 staging for endometrial carcinoma: a comparative study on prediction of survival and stage distribution according to histologic subtype / 부인종양

OBJECTIVE: The surgical staging system for endometrial carcinoma developed by International Federation of Gynecology and Obstetrics (FIGO) in 1988 was revised in 2009. Given the importance of continuous validation of the prognostic performance of staging systems, we analyzed the disease specific survival for patients with endometrial carcinoma using FIGO 1988 and 2009 systems. Further, the stage distribution of endometrioid and nonendometrioid carcinomas was studied. METHODS: Eight hundred twenty-one women with endometrial carcinoma were retrospectively staged using FIGO 1988 and 2009 systems. RESULTS: FIGO 1988 IC was associated with an inferior survival compared with IA-IB. Survival overlapped for 1988 IA and IB, for 1988 IC and IIA, and for 2009 IB and II. FIGO 2009 IA-II patients with negative peritoneal cytology had a superior survival compared with 1988 IIIA patients with positive cytology only. The survival was similar for 1988 IIIA with positive cytology only and for 2009 IIIA. Cox proportional hazards model recognized grade 3 endometrioid and nonendometrioid histology, tumor spread beyond the uterine corpus and cervix, and positive peritoneal cytology as significant predictors of death. Among 2009 IIIC substages, the proportion of IIIC2 tumors was higher for nonendometrioid than for endometrioid carcinomas (p=0.003). CONCLUSION: Stage I with deep myometrial invasion and stage II endometrial carcinoma seem to have similar survival outcomes. Although positive peritoneal cytology does not alter the stage according to the FIGO 2009 system, it should be considered a poor prognostic sign. The high proportion of nonendometrioid carcinomas in the stage IIIC2 category may reflect different patterns of retroperitoneal spread among tumors with different histologic subtypes.

Longer Survival in Patients with Breast Cancer with Cyclin D1 Over-Expression after Tumor Recurrence: Longer, but Occupied with Disease / 한국유방암학회지

PURPOSE: The effect of cyclin D1 overexpression on breast cancer outcomes and prognosis is controversial, even though amplification of the cyclin D1 gene, CCND1, has been shown to be associated with early relapse and poor prognosis. In this study, we examined the relationship between cyclin D1 overexpression and disease-specific survival (DSS). We also analyzed survival in patients who experienced recurrence. METHODS: We retrospectively analyzed data from patients diagnosed with ductal carcinoma between April 2005 and December 2010. We examined clinicopathologic factors associated with cyclin D1 overexpression and analyzed the influence of cyclin D1 on recurrence-free survival and DSS. RESULTS: We identified 236 patients diagnosed with primary breast cancer who completed all phases of their primary treatment. Cyclin D1 overexpression was significantly associated with longer DSS (5-year DSS, 89.9% in patients without cyclin D1 overexpression vs. 98.9% in patients with cyclin D1 overexpression; p=0.008). Multivariate analysis also found that patients with cyclin D1 overexpressing tumors had significantly longer disease-specific survival than patients whose tumors did not overexpress cyclin D1, with a hazard ratio for disease-specific mortality of 7.97 (1.17-54.22, p=0.034). However, in the group of patients who experienced recurrence, cyclin D1 overexpression was not significantly associated with recurrence-free survival. Cyclin D1 overexpression was significantly associated with increased survival after disease recurrence, indicating that cyclin D1 overexpression might be indicative of more indolent disease progression after metastasis. CONCLUSION: Cyclin D1 overexpression is associated with longer DSS, but not recurrence-free survival, in patients with breast cancer. Longer postrecurrence survival could explain the apparent inconsistency between DSS and recurrence-free survival. Patients with cyclin D1-overexpressing tumors survive longer, but with metastatic disease after recurrence. This information should spark the urgent development of tailored therapies to cure these patients.

Long Term Survival of Synovial Sarcoma and Treatment Strategy / 대한정형외과학회잡지

PURPOSE: The object of the current study was to evaluate the long term survival of synovial sarcoma and to find an appropriate treatment strategy with a favorable prognosis. MATERIALS AND METHODS: Between August 1985 and June 2000, fifty nine synovial sarcoma patients without metastasis at presentation were analyzed and followed for 50.9 (8-161) months. Kaplan-Meier plots were used for survival analysis. Analyzed prognostic factors were sex, age, stage, location, surgical margin, chemotherapy, radiation therapy, local recurrence and metastasis. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. RESULTS: Fourteen-year actual and continuous disease free survivals (ADF/CDF) were 56.4 and 49.7%, respectively. CDF of stage I-IIa and IIb-III were 53.6 and 43.2%, respectively (p=0.55). For local recurrence according to surgical margin, 4 recurrences occurred in 44 wide margins, 1 recurrence in 6 marginal margins, and 1 recurrence in 2 intralesional margins. Among 10 cases of local recurrence, 4 cases had metastasis. Local recurrence, metastasis, and surgical margin had statistical significance in the univariate (p< 0.0001, p<0.0001, p=0.011) and multivariate analysis. CONCLUSION: Fourteen year CDF survival was 49.7%. The alleviation of local recurrence and metastasis is essential for long term survival. In the current study, the only factor under our control was surgical margin. A well designed surgical approach will reduce the recurrence rate.

Analyses of Prognostic Factors and Gastric Cancer Specific Survival Rate in Early Gastric Cancer Patients and Its Clinical Implication

PURPOSE: This study was performed to find out the risk factors for recurrence and prognosis of early gastric cancer (EGC) patients by evaluating the recurrence, overall survival, and disease-specific survival after curative resection. METHODS: Out of 4217 patients who had undergone gastric resections for gastric adenocarcinoma from 1987 to 1997, the records of 1264 curatively resected EGC patients were reviewed retrospectively. Risk factors that determined recurrence, overall survival, and stomach cancer specific survival were investigated by using uni-variate and multi -variate analyses. RESULTS: Among the 1264 patients, 62 patients (4.9%) were diagnosed as having recurrent cancer and 162 patients died during follow-up. Of these 162 patients, 53 (4.2% of 1264, 32.7% of 162) patients died of gastric cancer whereas 92 died of non-gastric cancer causes and 17 died of unknown causes. In uni-variate analyses, the depth of invasion and lymph node metastasis were risk factors for recurrence and gastric cancer-specific survival while age, histologic type, depth of invasion, and lymph node metastasis were risk factors for overall survival. In multi-variate analysis, lymph node metastasis was the only risk factor for recurrence and gastric cancer-specific survival, while age was the only risk factor for overall survival. In a detailed analysis of prognoses based on lymph node metastasis, recurrence and gastric cancer related death were more frequently noted in patients with 3 or more lymph node metastasis and with extra- perigastric lymph node metastasis. CONCLUSION: Although EGC patients treated by curative resection showed good prognosis, those with lymph node metastasis have risks of recurrence and gastric cancer- related death. Considering the high rate of recurrence and gastric cancer-related death, more attention should be given to EGC patients with 3 or more lymph node metastases and/or extra-perigastric lymph node metastases. Adjuvant chemotherapy might be recommended for these high-risk patients.