Clinical efficacy and prognostic factors of postoperative adjuvant radiotherapy for pediatric ependymoma / 中华放射肿瘤学杂志

Objective:To investigate the clinic opathological features, treatment and prognosis of children newly diagnosed with ependymoma.Methods:Clinical data of 127 pediatric ependymoma (EPN) patients (0-16 years old) treated with tumor resection and postoperative radiotherapy at Xinhua Hospital Affiliated to Shanghai Jiao Tong University between 2001 and 2021 were retrospectively analyzed. Among them, 53 children were female and 74 were male. Local control (LR), event-free survival (EFS) and overall survival (OS) rates were analyzed by Kaplan-Meier method. The relationship between clinic opathological factors and clinical prognosis, and the effect of treatment on clinical prognosis of patients were analyzed by Cox proportional hazards model.Results:At a median follow-up time of 29 months (3-251 months), the 3-year OS and EFS rates were 89.5% and 71.5%, respectively. For patients undergoing incomplete resection followed by postoperative adjuvant radiotherapy, the 3-year LR, OS and EFS rates were 78.3%, 65.8% and 85.7%, respectively. A total of 43 children were aged <3 years old when diagnosed and 84 aged ≥3 years old. The interval time between surgery and radiotherapy in children aged <3 years old was 91 d, and 35.5 d in those aged ≥3 years old ( P<0.001). For patients <3 years old, the median EFS was 90 months when initiating radiotherapy within ≤70 d after surgery, compared to 43 months for those who initiated radiotherapy at >70 d after surgery ( P=0.053). According to fifth edition of the WHO classification of tumors of the central nervous system (WHO CNS5), 39 children were classified as posterior fossa ependymoma group A (PFA group). The OS and EFS rates in the PFA group were significantly less than those in other groups (3-year OS rate were 69.2% vs. 94.6%, P<0.001; 3-year EFS rate were 46.9% vs. 79.1%, P<0.001). In the PFA group, 12 patients received postoperative adjuvant chemotherapy, 14 did not receive chemotherapy, and whether chemotherapy was given was unknown in 13 cases. No significant differences were observed in OS and EFS between patients treated with and without chemotherapy ( P=0.260, P=0.730). Univariate Cox analysis showed that tumor location and WHO CNS5 molecular classification were significantly associated with EFS, and WHO CNS5 molecular classification was significantly correlated with OS. Multivariate Cox analysis showed that tumor location in the posterior fossa was an independent risk factor for EFS ( HR=2.72, 95% CI=1.1~6.71, P=0.03). Conclusions:Patients newly diagnosed with pediatric ependymoma can obtain favorable survival after surgery combined with postoperative adjuvant radiotherapy. Patients with residual tumors can achieve favorable LC and survival after postoperative adjuvant radiotherapy. Delaying of radiotherapy tends to lead to poor survival for patients aged <3 years old when diagnosed. Children in the PFA group obtain worse prognosis compared to their counterparts in other groups. The tumor location in the posterior fossa is an independent risk factor for pediatric ependymoma.

Advances in indications of anatomical pulmonary segmentectomy for early-stage lung cancer / 中国胸心血管外科临床杂志

@#Whether anatomical segmentectomy can replace lobectomy in the treatment of early-stage lung cancer remains controversial. A large number of studies have been conducted for decades to explore whether pulmonary segmentectomy can treat early-stage lung cancer, which is actually to explore the indications of intentional segment-ectomy. With the development of scientific researches, it is found that many characteristics affect the malignancy of lung cancer, and the different grades of each characteristic affect the prognosis of patients. It is worth exploring whether different surgical approaches can be used for early-stage lung cancer with different characteristics and different grades. This article reviews the literature and studies to discuss the advances in indications of segmentectomy for early-stage lung in terms of tumor size, consolidation-to-tumor ratio, pathological classification and tumor location, respectively. The objective of this review is to help thoracic surgeons to objectively and scientifically select the surgical method according to the clinical characteristics of early-stage lung cancer.

Construction and Evaluation of Metastatic Risk Model in Left and Right Colorectal Cancer / 肿瘤防治研究

Objective To identify the influence factors and construct a predicted model for liver, lung, bone, or brain metastasis among patients with left or right colorectal cancer. Methods Patients with colorectal cancer with information on liver, lung, bone, and brain metastasis were retrospectively filtered and analyzed from 2010 to 2018 from the SEER database. These patients were divided into three groups based on their primary tumor location. Multivariate logistic regression analysis was conducted to identify the influence factors on metastasis. A nomogram that could predict metastasis was established and further validated by the AUC of ROC curves. Results A total of 49335 eligible patients were chosen from the SEER database. N stage and CEA were identified as risk factors for all metastases, which were unrelated to primary tumor location. By contrast, race had varying effects on liver metastasis between different groups (P < 0.05). The nomogram model predicting liver metastasis was successfully established, and the AUCs based on the three groups were 0.821 (95%CI: 0.813-0.830), 0.841 (95%CI: 0.833-0.848), and 0.796 (95%CI: 0.782-0.811), respectively. Conclusion The influence factors and predictive models on liver metastasis were different in patients with colorectal cancer and different primary tumor locations.

Management and re-thinking of low anterior resection syndrome based on present anal preservation strategy / 中华胃肠外科杂志

Low anterior resection syndrome (LARS) is defined as a syndrome characterized by various abnormal defecation symptoms, including increased defecation times, urgency, frequent defecation, and fecal incontinence. LARS commonly develops after sphincter-preserving operation or reduction of protective ileostomy. The symptoms of LARS will alleviate gradually, and some patients may return to normal or basically normal. However, 60%-80% of the patients remains to suffer from LARS. Their daily life and psychosocial functionare seriously impaired. At present, the etiology of LARS is not well understood, but many factors are associated with LARS, such as tumor location, radiotherapy and surgical techniques and so on.

Effect of the primary tumor location on the prognosis of breast invasive ductal carcinoma patients treated with radical mastectomy / 中华肿瘤杂志

Objective@#To analyze the clinicopathological features and prognosis of breast invasive ductal carcinoma patients receiving radical mastectomy according to the primary tumor location.@*Methods@#From January 2008 to December 2008, 993 patients with breast invasive ductal carcinoma received radical mastectomy in Tianjin Medical University Cancer Institute and Hospital. Patients were grouped according to the primary tumor location when breast cancer was diagnosed. The clinicopathological characteristics and follow-up information of them was collected and analyzed retrospectively.@*Results@#Of the 993 patients, primary tumor located in the upper-outer quadrant (UOQ) in 556 patients (56.0%), the lower-outer quadrant (LOQ) in 97 (9.8%), the central portion in 99 (10.0%), the upper-inner quadrant (UIQ) in 186 (18.7%), and the lower-inner quadrant (LIQ) in 55 (5.5%). Patients in the central portion tended to have larger tumors, and more patients in the upper-inner quadrant received endocrine therapy. The estimated 5-year disease-free survival (DFS) rates of patients with primary lesion in the UOQ, LOQ, central portion, UIQ and LIQ were 90.3%, 88.7%, 79.8%, 86.0% and 72.7%, respectively, with significant differences (P<0.001). The 5-year overall survival (OS) rates were 97.5%, 96.9%, 90.9%, 94.1% and 87.3%, respectively, with significant differences (P<0.001). Multivariate analysis showed that 5-year recurrence and metastasis risks were significantly increased in patients with primary lesion in the central portion, UIQ and LIQ compared to other groups (P<0.001), and 5-year mortality risks were increased in these three groups (P=0.002).@*Conclusion@#Primary lesion located in central portion and inner quadrant is an independent adverse prognostic factor for patients with breast invasive ductal carcinoma patients receiving radical mastectomy.

Tumor location and lateral lymph node metastasis in papillary thyroid microcarcinoma / 中国实用外科杂志

OBJECTIVE: To evaluate tumor location as a factor predicting lateral lymph node metastasis(LLNM) and to assess the accuracy of ultrasonography(US) in the diagnosis of LLNM.METHODS: The clinicopathological data of 134 patients with thyroid microcarcinoma admitted between January 2014 and December 2015 in Tianjin Medical University Cancer Hospital were collected,and the relationship between the location of cancer foci and lateral cervical lymph node metastasis was analyzed according to the ultrasonic localization and grouping.RESULTS: The incidence rates of lymph node metastasis in levels Ⅱ,Ⅲ,Ⅳ,Ⅴ were 30.6, 50.7, 57.5 and 11.3%, respectively. Tumors located in the superior/middle were prone to metastasize to the lateral lymph nodes than those located in the inferior portion(89.7% vs. 75.7%,P=0.038). Cases with exterior locations were more likely to have lateral cervical lymph node metastasis compared with those cases with interior, respectively(93.7% vs.81.4%,P=0.049). The sensitivity values for US for the prediction of LLNM in levels Ⅱ,Ⅲ,Ⅳ,Ⅴ were 43.9%, 85.3%, 85.7% and 14.3%, and the corresponding specificity values were 91.4%, 57.6%, 35.1% and 99.1%. The ultrasonographic prediction of lymph node metastasis in Ⅲ and Ⅳ was highly sensitive,and the specificity in Ⅱ and Ⅴ was high.CONCLUSION: The localization of primary carcinoma is correlated with lateral lymph node metastasis in papillary thyroid microcarcinoma,and ultrasound could provide a basis for clinical determination of the dissection range of lateral lymph node.

The impact of primary tumor location in patients with metastatic colorectal cancer: a Korean Cancer Study Group CO12-04 study

BACKGROUND/AIMS: Colorectal cancer is associated with different anatomical, biological, and clinical characteristics. We determined the impact of the primary tumor location in patients with metastatic colorectal cancer (mCRC). METHODS: Demographic data and clinical information were collected from 1,115 patients from the Republic of Korea, who presented with mCRC between January 2009 and December 2011, using web-based electronic case report forms. Associations between the primary tumor location and the patient's clinical characteristics were assessed, and factors inf luencing overall survival were analyzed using Cox proportional hazards regression models. RESULTS: Of the 1,115 patients recruited to the study, 244 (21.9%) had right colon cancer, 483 (43.3%) had left colon cancer, and 388 (34.8%) had rectal cancer. Liver and lung metastases occurred more frequently in patients with left colon and rectal cancer (p = 0.005 and p = 0.006, respectively), while peritoneal and ovarian metastases occurred more frequently in patients with right and left colon cancer (p < 0.001 and p = 0.031, respectively). The median overall survival of patients with tumors originating in the right colon was significantly shorter than that of patients whose tumors had originated in the left colon or rectum (13.7 months [95% confidence interval (CI), 12.0 to 15.5] vs. 18.0 months [95% CI, 16.3 to 19.7] or 19.9 months [95% CI, 18.5 to 21.3], respectively; p = 0.003). Tumor resection, the number of metastatic sites, and primary tumor location correlated with overall survival in the univariate and multivariate analyses. CONCLUSIONS: Primary tumor location influences the metastatic sites and prognosis of patients with mCRC.

Effect of tumor shape and location on lung volume-dose parameters of intensity-modulated radiation therapy for non-small cell lung cancer / 中华放射肿瘤学杂志

Objective@#To evaluate the effect of tumor shape and location on pulmonary dose-volume parameters by intensity-modulated radiation therapy (IMRT) in patients with non-small cell lung cancer (NSCLC), aiming to provide a reference basis for establishing limits of the pulmonary dose-volume parameters during IMRT.@*Methods@#Clinical data of 208 NSCLC patients undergoing radical IMRT from June 2009 to June 2016 were retrospectively analyzed. According to the tumor shape and location, 208 cases were divided into the vertical bar group (n=127) and the horizontal bar group (n=81), the superior lung group (n=103) and the inferior lung group (n=105). Regression model curve was used to evaluate the effect of tumor shape and location upon the common pulmonary dose-volume parameters(V5, V20, MLD, AVS5 and AVS20).@*Results@#In all groups, the fitting curves of V5, V20 and MLD were manifested in the quadratic equation pattern, and AVS5 and AVS20 in the logarithmic equation manner. In the vertical bar group, the V5(P=0.015), V20(P=0.047) and MLD (P=0.012) were significantly higher, whereas the AVS5(P=0.044) was significantly lower compared with those in the horizontal bar group. No statistical significance was observed in AVS20 between two groups (P=0.490). The tumor location exerted significant effect upon V5 alone (P=0.009).@*Conclusions@#When the tumors presents in the vertical bar shape, the limits of the common lung dose-volume parameters are likely to exceed those of tumors in the vertical bar shape. Lung tumors located in the inferior lobe exerts a more significant effect upon the low-dose region volume compared with the tumors in the superior lobe.

Influencing factor analysis of the number of lymph nodes harvest after radical resection of colorectal cancer / 中华消化外科杂志

Objective To investigate influencing factors of the number of lymph node harvest after radical resection of colorectal cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 227 patients with colorectal cancer who underwent radical resection in People's Hospital of Changshou Chongqing from June 2010 to June 2016 were collected.The surgical method and resection extention were determined depending on the tumor location showed on imaging examinations,and all patients underwent radical resection and sufficient lymph nodes dissection.Observation indicators:(1) intra-and post-operative situations;(2) influencing factors analysis of the number of lymph nodes harvest after radical resection of colorectal cancer;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to October 2016.Measurement data with normal distribution were represented as (x)±s.Univariate analysis was done using the chi-square test or Fisher exact probability method.Multivariate analysis was performed using the binomial Logistic regression analysis.Results (1) Intra-and postoperative situation:all the 227 patients underwent successful radical resection of colorectal cancer,including 67 with radical resection of right colon cancer,16 with radical resection of left colon cancer,26 with radical resection of sigmoid colon cancer and 118 with radical resection of rectal cancer.Of 227 patients,118 received laparoscopic surgery,109 received open surgery including 8 converted to open surgery from laparoscopic surgery.Tumor located in right hernicolon,left hemicolon,sigmoid colon and rectum were respectively detected in 67,16,26 and 118 patients,same as results of imaging examintions.Operation time,volume of intraoperative blood loss and number of lymph nodes harvest in 227 patients were (192 ± 72) minutes,(94± 84) mL and 14 ± 4.Of 8 patients in 227patients with postoperative complications,2 received secondary suture due to wound infection,2 received reoperation due to intestinal obstruction,1 received transverse colostomy due to anastomotic leakage,and 3 received stoma reconstruction due to stoma retraction.Duration of postoperative hospital stay of 227 patients was (22±9) days.Postoperative pathological examininations:35 and 192 patients were respectively diagnosed with rnucinous adenocarcinoma and non-mucinous adenocarcinoma.Moderate-and low-differentiated carcinoma and high-differentiated carcinoma were respectively detected in 47 and 180 patients.(2) The influencing factors analysis of the number of lymph nodes harvest after radical resection of colorectal cancer:univariate analysis showed that tumor location and tumor pathological T stage were related factors affecting the number of lymph node harvest after radical resection of colorectal cancer (x2=10.066,P＜0.05).Multivariate analysis showed the tumor location and tumor pathological T stage were independent factors affecting the number of lymph nodes harvest after radical resection of colorectal caucer (OR=1.283,6.075,95％ confidence interval:1.031-1.597,1.215-30.385,P＜0.05).(3) Follow-up and survival situations:190 of the 227 patients were followed up for 4-72 months,with a median time of 32 months.During the follow-up,21 patients died,23 patients survived with tumor,and 146 patients survived without disease.Conclusion Tumor location and tumor pathological T stage are independent factors affecting the number of lymph node harvest after radical resection of colorectal cancer.

Relationship between Spinal Hemangioblastoma Location and Age

STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the relationship between tumor location and clinical characteristics. OVERVIEW OF LITERATURE: Hemangioblastoma is a rare disease that develops in the central nervous system. Magnetic resonance imaging (MRI) is useful to evaluate hemangioblastomas. Hemangioblastoma's location is designated as intramedullary, intramedullary+extramedullary, or extramedullary by MRI. METHODS: We analyzed 11 patients who underwent surgery for spinal hemangioblastoma. Using T1 contrast axial MRI data, the cases were divided into three groups (intramedullary, intramedullary+extramedullary, and extramedullary). Patient demographics, MRI findings, and preoperative neurological status were analyzed and compared for each group. RESULTS: The average age of patients with intramedullary, intramedullary+extramedullary, and extramedullary hemangioblastoma was 34.0, 64.4, and 67.5 years, respectively. Patients in the intramedullary hemangioblastoma group were younger than the other groups. Extramedullary cases had a smaller syrinx compared to the other groups. CONCLUSIONS: Age may play an important role in the hemangioblastoma tumor location and the subsequent diagnosis by an MRI.

Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer

BACKGROUND/AIMS: Extended cholecystectomy is generally recommended for patients with T2 gallbladder cancer. However, few studies have assessed the extent of resection relative to T2 gallbladder tumor location. This study analyzed the effects of surgical methods and tumor location on survival outcomes and tumor recurrence in patients with T2 gallbladder cancer. METHODS: Clinicopathological characteristics, extent of resection, survival rates, and recurrence patterns were retrospectively analyzed in 88 patients with pathologically confirmed T2 gallbladder cancer. RESULTS: The 5-year disease-free survival rate was 65.0%. Multivariate analysis showed that lymph node metastasis was the only independent risk factor for poor 5-year disease-free survival rate. Survival outcomes were not associated with tumor location. Survival tended to be better in patients who underwent extended cholecystectomy than in those who underwent simple cholecystectomy. Recurrence rate was not affected by surgical method or tumor location. Systemic recurrence was more frequent than local recurrence without distant recurrence. Gallbladder bed recurrence and liver recurrence were relatively rare, occurring only in patients with liver side tumors. CONCLUSIONS: Extended cholecystectomy is the most appropriate treatment for T2 gallbladder cancer. However, simple cholecystectomy with regional lymph node dissection may be appropriate for patients with serosal side tumors.

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: In the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC). METHODS: Between March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/− multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12–106) months. RESULTS: The 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures. CONCLUSION: Among breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.

Clinical Relevance of the Tumor Location-Modified Lauren Classification System of Gastric Cancer

PURPOSE: The Lauren classification system is a very commonly used pathological classification system of gastric adenocarcinoma. A recent study proposed that the Lauren classification should be modified to include the anatomical location of the tumor. The resulting three types were found to differ significantly in terms of genomic expression profiles. This retrospective cohort study aimed to evaluate the clinical significance of the modified Lauren classification (MLC). MATERIALS AND METHODS: A total of 677 consecutive patients who underwent curative gastrectomy from January 2005 to December 2007 for histologically confirmed gastric cancer were included. The patients were divided according to the MLC into proximal non-diffuse (PND), diffuse (D), and distal non-diffuse (DND) type. The groups were compared in terms of clinical features and overall survival. Multivariate analysis served to assess the association between MLC and prognosis. RESULTS: Of the 677 patients, 48, 358, and 271 had PND, D, and DND, respectively. Their 5-year overall survival rates were 77.1%, 77.7%, and 90.4%. Compared to D and PND, DND was associated with significantly better overall survival (both P<0.01). Multivariate analysis showed that age, differentiation, lympho-vascular invasion, T and N stage, but not MLC, were independent prognostic factors for overall survival. Multivariate analysis of early gastric cancer patients showed that MLC was an independent prognostic factor for overall survival (odds ratio, 5.946; 95% confidence intervals, 1.524~23.197; P=0.010). CONCLUSIONS: MLC is prognostic for survival in patients with gastric adenocarcinoma, in early gastric cancer. DND was associated with an improved prognosis compared to PND or D.

Anatomical and pathological evaluation of Ivor-Lewis and Sweet for esophageal carcinoma operation / 局解手术学杂志

Objective In order to improve the surgical treatment for midpiece esophageal carcinoma, different surgical ways were com-pared. Methods From January 2010 to June 2012, 110 patients with midpiece esophageal cancer in our hospital were divided into the Ivor-Lewis group (55 cases) and the Sweet group (55 cases) according to different surgical ways, that is to say Ivor-Lewis surgery via right chest and Sweet surgery through left chest. Length of specimens, rang of tumor invasion, distance of removal, incidence of residual carcinoma in the esophageal edges, number of lymph nodes removed in chest and abdomen, and positive rate of carcinoma infiltrated lymph nodes were compared between the two groups. Questions of surgical anatomy were investigated through questionnaire among surgeons of the two groups, and the scores of both groups were analysed. Results The length of resected specimens and number of lymph nodes removed in Ivor-Lewis group was significantly lager than that of the Sweet group (P<0. 01). The positive rate of carcinoma infiltrated lymph nodes in Ivor-Lewis group was 1. 82%, which was significantly lower than 21. 82% in the Sweet group (P<0. 01). Results of questionnaire showed surgeons have gieven higher scores to Ivor-Lewis group. Conclusion Ivor-Lewis surgery is recommend for upper and midpiece esophageal carcinoma while Sweet surgery is more suitable for cardial and lower esophageal cancer.

Clinical Significance of the Pattern of Lymph Node Metastasis Depending on the Location of Gastric Cancer

PURPOSE: When performing a laparoscopic assisted gastrectomy, a function-preserving gastrectomy is performed depending on the location of the primary gastric cancer. This study examined the incidence of lymph node metastasis by the lymph node station number by tumor location to determine the optimal extent of the lymph node dissection. MATERIALS AND METHODS: The subjects consisted of 1,510 patients diagnosed with gastric cancer who underwent a gastrectomy between 1996 and 2005. The patients were divided into three groups: upper, middle and lower third, depending on the location of the primary tumor. The lymph node metastasis patterns were analyzed in the total and early gastric cancer patients. RESULTS: In all patients, lymph node station numbers 1, 2, 3, 7, 10 and 11 metastases were dominant in the cancer originating in the upper third, whereas station numbers 4, 5, 6 and 8 were dominant in the lower third. In early gastric cancer patients, the station number of lymph nodes with a metastasis did not show a significant difference in stage pT1a disease. On the other hand, a metastasis in lymph node station number 6 was dominant in stage pT1b disease that originated in the lower third of the stomach. CONCLUSIONS: When performing a laparoscopic-assisted gastrectomy for early gastric cancer, a limited lymphadenectomy is considered adequate during a function-preserving gastrectomy in mucosal (T1a) cancer. On the other hand, for submucosal (T1b) cancer, a number 6 node dissection should be performed when performing a pylorus preserving gastrectomy.

Clinical Analysis of Breast Cancer

The factors affecting the survival rate of breast-cancer patients were studied in 185 cases treated at the Department of Surgery, College of Medicine, Chonbuk National University from January 1987 to December 1996. The results are as follows: 1) The most prevalent age group was the 5th decade (57 cases, 30.8%). 2) The most common initial symptom was a palpable mass (167 cases, 90.3%). 3) In 134 cases (72.4%), the patients visited the hospital within 6 months of the onset of the first symptom. 4) The primary tumor was located on the left side in 101 cases (54.6%) and on the right side in 84 cases (45.4%), and the most frequent tumor location was the upper outer quadrant (113 cases, 61.1%). 5) The pathological types, according to the WHO classification, were an invasive ductal carcinoma (179 cases, 96.7%) and a medullary carcimona (22 cases, 11.9%) in that order. 6) According to the TNM system, the most common stage was stage II (100 cases, 54.1%). The overall 5-year survival rates according to pathologic stage were 96.0% for Stage I, 83.1% for Stage II, 67.8% for Stage III, and 12.5% for Stage IV. 7) The estrogen and the progesterone receptor status had no significance for the survival rate. 8) The most common type of operation was a modified radical mastectomy (Patey) (150 cases, 81.0%). 9) Axillary lymph node metastases were present in 77 cases (41.6%). 10) The most common distant metastasis was the bone (12 cases, 6.5%). 11) The overall 5-year actuarial survival rate after surgery was 76.6%. The 5-year survival rates according to the number of invaded lymph-node were 83.5% for 0 nodes, 77.6% for 1~3 nodes, 57.5% for 4~9 nodes, and 49.4% in cases of more than 10 nodes.

Surgical Outcome and Prognostic Factors of Spinal Intramedullary Ependymomas in Adults

Ependymoma is the most common spinal intramedullary tumor in adults. The authors reviewed clinical data of 31 patients with spinal ependymoma who underwent operations between 1979 and 1996. The ages of the patients ranged from 15 to 62 years with a mean of 36.9. We analyzed clinical manifestations, radiologic findings, extents of surgical removal, histologic subtypes and follow-up results. Most patients were presented with sensory symptoms as initial symptoms which had lasted for 36.5 months on the average. The most frequent location was conus region(10 cases, 32%) followed by cervical, thoracic and cervico-thoracic spinal level. All cases were divided into two groups histologically, 12 myxopapillary subtypes and 19 non-myxopapillary subtypes. Operative results were dependent on the locations and the histologic subtypes of the tumor. Total removal was achieved in 4 cases out of 10 cases with masses around the conus and in 19 cases out of 21 cases with masses at other regions(p=0.003). Tumors were totally removed in 97% of 19 non-myxopapillary subtypes, but in 42% of 12 myxopapillary subtypes(p=0.001). From the follow-up data, we found that mean progression free interval was 83 months and 5 year progression free rate was 70%. Extent of removal was the only significant prognostic factor on multivariate analysis. Other factors such as tumor location, histologic subtype and radiation therapy were not significant. Disease progression was noted in 2 cases out of 23 cases of total removal group, but in 4 cases out of 8 cases of incomplete removal group (p=0.008). Postoperative radiation therapy was done in 4 cases in incomplete removal group and tumor regrowth was noted more frequently in non-radiation group than in radiation group without statistic significance. We concluded that disease progression can be determined by the extent of removal which is related to the tumor location and histologic subtypes.