Receptor status testing and its influence on following treatment selection in breast cancer patients with loco-regional recurrence / 上海交通大学学报（医学版）

Objective: To analyze the concordance rates of estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor-2 (HER-2),and Ki67 statuses between the primary and loco-regional recurrence (LRR) lesions and its influence on the following treatment in breast cancer patients. Methods: The breast cancer patients undergoing surgery in Comprehensive Breast Health Center,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2009 to September 2018,who were reported recurrence only in loco-regional site were retrospectively analyzed. ER,PR,HER-2,and Ki67 statuses were detected in primary and LRR lesions. Concordance rates and their influence on following treatment were further analyzed. Results: A total of 7 823 breast cancer patients received surgery,among whom 106 cases experienced LRR without distant metastasis. There were 56 patients having full information about ER,PR,HER-2,and Ki67 statuses of LRR lesions,with the positive rates of 48.2%,25.0%,35.2%,and 81.5%,respectively. Concordance rates of ER,PR,HER-2,and Ki67 between primary and LRR lesions were 76.8%,76.8%,89.1% and 77.8%,with κ values at 0.538,0.469,0.729,and 0.402,respectively. Hormone receptor (ER or PR) (14 cases) and/or HER-2 (6 cases) statuses were altered in 18 patients. The hormone receptor status changed from positive to negative in 9 cases,of which 4 cases did not receive following endocrine therapy. The HER-2 status changed from negative to positive in 4 patients,and 1 of them received following anti-HER-2 targeted therapy. Conclusion: The concordance rates between primary and LRR breast cancer lesions of ER,PR,and Ki67 are moderate,and the concordance rate of HER-2 is high. Changes in receptor status in LRR lesions may affect the choice of following treatment options.

Salvage Concurrent Chemo-radiation Therapy for Loco-regional Recurrence Following Curative Surgery of Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study is to report clinical outcomes of salvage concurrent chemo-radiation therapy (CCRT) in treating patients with loco-regional recurrence (LRR) following initial complete resection of non-small cell lung cancer. MATERIALS AND METHODS: Between February 2004 and December 2016, 127 patients underwent salvage CCRT for LRR. The median radiation therapy (RT) dose was 66 Gy and clinical target volume was to cover recurrent lesion with margin without elective inclusion of regional lymphatics. Majority of patients (94.5%) received weekly platinum-based doublet chemotherapy during RT course. RESULTS: The median follow-up time from the start of CCRT was 25 months. The median survival duration was 49 months, and overall survival (OS) rates at 2 and 5 years were 72.9% and 43.9%. The 2- and 5-year rates of in-field failure-free survival, distant metastasis free survival, and progression free survival were 82.4% and 73.8%, 50.4% and 39.9%, and 34.6% and 22.3%, respectively. Grade ≥ 3 radiation-related esophagitis and pneumonitis occurred in 14 (11.0%) and six patients (4.7%), respectively. On both univariate and multivariate analysis, higher biologically equivalent dose (BED₁₀) (≥ 79.2 Gy₁₀ vs. 80 cm³; HR, 0.403), and longer disease-free interval (> 1 year vs. ≤ 1 year; HR, 0.489) were significantly favorable factors for OS. CONCLUSION: The current study has demonstrated that high dose salvage CCRT focused to the involved lesion only was highly effective and safe. In particular, higher BED₁₀, smaller CTV, and longer disease-free interval were favorable factors for improved survival.

Avaliação da sobrevida livre de doença de pacientes com recidiva loco-regional de carcinoma epidermóide de cavidade bucal e orofaringe submetidos a tratamento de resgate / Assessment of disease-free survival in patients with loco-regional recurrence of squamous cell carcinoma of the oral cavity and oropharynx submitted to salvage treatment

OBJETIVO: A cirurgia de resgate é primeira opção terapêutica, principalmente nas lesões de estadio clínico inicial. O objetivo do estudo é avaliação da sobrevida livre de doença após resgate cirúrgico de tumores de cavidade bucal e orofaringe. MÉTODOS: Estudo retrospectivo de 276 pacientes tratados com cirurgia, sendo que 127 desenvolveram recidiva loco-regional. Noventa e sete pacientes eram de estadiamento clínico inicial e 178 de estadiamento clínico avançado. Vinte e cinco casos de lábio, 173 cavidade bucal e 78 de orofaringe. A radioterapia pós-operatória foi realizada em 121 pacientes com dose média de 60,8 Gy. RESULTADOS: Oitenta e nove pacientes foram submetidos a tratamento de resgate, sendo que 76 destes foram à cirurgia. As recidivas loco-regionais de cavidade bucal foram submetidas ao resgate cirúrgico em 65 por cento casos. A sobrevida livre de doença pós-cirurgia de resgate foi de 13 por cento nas recidivas até seis meses e 48 por cento nas recidivas após 12 meses de seguimento (p=0,0009). O tipo de resgate e o intervalo livre de doença foram fatores independentes de sobrevida na análise multivariada. CONCLUSÃO: A sobrevida livre de doença pós-resgate nos estadios clínicos iniciais (I e II) foi de 70 por cento.

OBJECTIVE: Salvage surgery is the first therapeutic option for recurrent tumors of the mouth and oropharynx, mainly in early stage tumors. This study intends to evaluate the disease free survival interval after salvage treatment for recurrent tumors of the mouth and oropharynx. METHODS: Retrospective analysis of 276 patients with squamous cell carcinoma of the mouth and oropharynx treated with surgery. One hundred and twenty seven patients developed loco-regional recurrence. Ninety-seven were staged as early tumors and 178 as advanced ones. The tumor site was the lip in 25 cases, oral cavity in 173 and oropharynx in 78. Postoperative radiotherapy was indicated in 121 cases with a mean dose of 60.8Gy. RESULTS: Eighty-nine patients underwent salvage treatment (surgery in 76 patients). Loco-regional recurrences were treated with salvage surgery in 65 percent of cases. Disease free survival after salvage surgery was 13 percent in cases with recurrences diagnosed up to 6 months and 48 percent in those who recurred after 12 months of follow-up (p=0.0009). Modality of salvage treatment and the disease free interval were independent variables of survival in the multivariate analysis. CONCLUSION: In cases clinically staged as I and II, the disease free survival in five years after salvage treatment was 70 percent.

Factors Influencing the Recurrence of Breast Cancer Following Modified Radical Mastectomy / 한국유방암학회지

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in loco- regionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-re-gional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.

Factors Influencing the Recurrence of Breast Cancer Following Modified Radical Mastectomy / 한국유방암학회지

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in loco- regionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-re-gional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.

Factors Influencing the Recurrence of Breast Cancer Following Modified Radical Mastectomy

PURPOSE: We studied the risk factors for loco-regional recurrence and distant metastasis in patients following treatment of operable breast carcinoma with a modified radical mastectomy. METHODS: 374 breast cancer patients were treated by modified radical mastectomy between 1989 and 1999 at the Department of Surgery, Korea University College of Medicine. The median age of the patients was 48.3 years old. The duration of the mean follow up period was 53.6 months. By reviewing the patients' medical records, we constructed a database cataloguing disease recurrence, age, menstruation, pathology, tumor size, nodal status, stage and the presence of hormonal receptor. Statistical analysis was done by SPSS for Windows 9.0. RESULTS: Of the original 374 patients screened, one was excluded for the development of bone metastasis preoperatively. Within the remaining patients, 61 (16.3%) experienced recurrence following surgery. Among the recurred patients, loco-regional recurrence developed in 27 patients (7.5%) and distant metastases in 33 patients (9.1%). The 5 year survival rate was 90.5% in non-recurred patients, 34.9% in locoregionally recurred patients and 30.0% in systematically recurred patients respectively (p=0.00). On the multivariate analysis, tumor size (T stage), lymph node status (N stage) and overall pathologic stage were associated with loco-regional recurrence and the absence of estrogen receptor was associated with distant metastasis following the mastectomy. CONCLUSION: The risk factors for loco-regional recurrence following modified radical mastectomy were tumor size and nodal status. Moreover, distant metastasis was more frequent in patients lacking estrogen receptor. Due to the poor survival rate of the loco-regionally recurred patients, we should regard local recurrence as a poor prognostic sign.

Pattern of Recurrence after Curative Resection of Gastric Cancer / 대한암학회지

PURPOSE: Despite radical lymph node dissection and combined resection, the operative result of progressive gastric cancer remains unsatisfactory. The prognosis of gastric cancer has not been improved. In case of recurred gastric cancer, the problem is low curative resection rate. We tried to study the pattem of recurrence after curative resection for gastric cancer. MATERIALS AND METHODS: We had retrospectively analyzed the recurrence pattern of 191 patients who recurred after curative resection of gastric cancer. We analyzed the interval between operation and recurrence, primary tumor location, tumor histologic type, Borrmann's type, pathologic stage, DNA ploidy pattem and lymph node metastasis. RESULT: The number of recurred gastric cancer patients was 191. The M: F ratio was 2.03: 1. Seven cases were early gastric cancer. The interval between operation and recurrence was from 1 month to 130 months. The early recurrence within 24 months was found in 147 patients (77.0%), the intermediate recurrence from 25 months to 60 months was found in 38 patients (19.9%), the late reeurrence after 60 months was found in 6 patients (3.1%). The pattems of recurrence were as follows: loco-regional recurience, including lymph node and site of anastomosis, was found in 51 cases, liver metastasis in 37 cases, peritoneal metastasis in 74 cases, extraperitoneal metastasis in 29 cases including Virchows node. In undifferentiated cancer, peritoneal metastasis was higher than in other histologic types (p<0.05). 59 cases was found in stage IV, 47 cases in stage IIIb, 43 cases in stage IIIa, 31 cases in stage II, 8 cases in stage Ib, and 3 cases in stage Ia. We found peritoneal metastasis was very high in stage IIIb. The 5-year survival was better in loco-regional group than that of other patterns of recurrence. CONCLUSION: Recurrence after operation was found within 24 months, that in most of patients, so the follow up is very important in this period and the recurred pattem after curative resection for gastric cancer was related with cell differentiation of primary tumor and stage. In local recurrence, the survival rate was higher than the other pattern of recurrence.