Prognostic Factors in Long-Term Survivors with Glioblastoma

OBJECTIVE: The authors analyze the clinical characteristics of the long-term survivors and elucidate the biological factors responsible for long-term survival. METHODS: The 166 cases of histologically confirmed glioblastoma from Jan 1983 to Aug 1999 were included. Medical records and radiological findings were reviewed to analyze age, performance status, location and number of the tumor, the amount of peri-tumoral edema, the extent of surgical resection and history of radiation and/or chemotherapy. The overall survival was 13.6 months and the 1-year survival rate was 59%. The thirteen patients(6.9%), lived more than three years after diagnosis, defined as the long-term survivors. RESULTS: Performance status(KPS>or=70), number of masses(single with no CSF seeding), and hemispheric location(not involving basal ganglia and/or brain stem) showed favorable influence on the patient survival in univariate analysis. Also post-operative radiation and chemotherapy resulted in significant improvement of the survival. However, in multivariate analysis, age(under 40 years) was the most significant prognostic factor. All the other factors which was significant in univariate analysis except the location of the tumor, also verified as significant prognostic factors in multivariate analysis. The long-term survivors had at least more than five out of seven significant prognostic factors in multivariate analysis. And these factors occurred more frequently and showed significances in the long-term survivors than the other patient group except the debulking surgery. CONCLUSION: The age at the diagnosis and invasiveness resulted in multiple tumor and/or CSF seeding were the most significant prognostic factors.

Investigation of Long-term Survivors with Stage IV Gastric Cancer

PURPOSE: The prognosis of stage IV gastric cancer is very grave. However, some of these patients survive long periods after surgery. This study was undertaken to investigate various clinico-pathological profiles related to the prognosis for these long-term survivors. MATENRIALS AND METHODS: One hundred fifty-five patients with stage IV gastric cancer who underwent a gastric resection from 1992 to 1997 at Hanyang University Hospital were evaluated. Thirty-three patients who survived more than 5 years after surgery were designated as long-term survivors (LTS); on the other hand, one hundred twenty-two patients who died within 5 years after surgery were named as short-term survivors (STS). RESULTS: The rate of the patients with T4, preoperative serum level of CA19-9 greater than 37 U/g protein, and peritoneal dissemination was lower for the LTS than in for the STS (P=0.002, P=0.045, and P=0.0000, respectively). Tumors were smaller (7.3 cm vs. 8.9 cm, P=0.030) and metastatic lymph node were fewer (19.7 vs. 28.8, P=0.019) for the LTS than for the STS. Curative surgery (76% vs. 46%, P=0.002) and a subtotal gastrectomy (64% vs. 42%, P=0.026) were performed more frequently for the LTS than for the STS. From a univariate survival analysis, depth of invasion, distant metastasis, extent of gastric resection, postoperative chemotherapy, and curability were statistically significant factors. From a multivariate survival analysis, curability, depth of invasion, and extent of gastric resection were independent prognostic factors. CONCLUSION: If feasible, we have to exert our efforts to achieve curative surgery although the tumor is considered to be a stage IV gastric cancer. Thereafter, multi-modality treatments including chemotherapy can be considered to improve the prognosis.

Clinical Results in the Treatment of Extrahepatic Bile Duct Cancer and Long-term Survivors' Characteristics after Surgical Resection / 한국간담췌외과학회지

BACKGROUND/AIMS: The objectives of this study were to analyze actual long-term survivors' characteristics and investigate what affect long-term survival after resection for extrahepatic bile duct cancer. METHODS: 151 patients of the total 282 patients with extrahepatic bile duct cancer underwent surgical resection between 1986 and 1996. During study period, 23 cases of hepatobiliary resection (HBR), 25 bile duct resection (BDR), and 103 pancreatoduodenectomy were performed respectively. We analyzed survival results and prognostic factors after surgical resection. We also investigated clinico-pathological features of actual long-term survivors. RESULTS: The 1-,3-,and 5-year survival rates were 72.9%, 41.1%,and 32.5% in the resection group, and the 1-, 3-year survival rates were 35.4% and 1.6% in the non-resection group (p<0.001). The differences of survival rates according to the types of resection were not significant (p=0.083). After surgical resection, tumor histology and lymph node metastasis were the independent prognostic factors in multivariate analysis. CONCLUSION: The prognosis of the extrahepatic bile duct cancer depends on the curative resection. Regardless of the types of resection and tumor location, if tumor histology might be favorable and no lymph node metastasis exist, long-term survival could be expected.

Analysis of Long-term Survivors after Pancreatoduodenectomy in the Patients with Pancreatic Cancer

PURPOSE: Pancreatic ductal adenocarcinoma is known to be very dismal. Although some publications reported marked improved survival data after surgical resection recently, many clinicians have pessimistic views on the treatment of pancreatic cancer. So we set the objectives of this study to evaluate the clinical results of pancreatoduodenectomy in pancreatic cancer and investigate what constitutes long term survival after pancreatoduodenectomy for pancreatic cancer. METHODS: We analyzed 286 patients with pancreatic head ductal adenocarcinoma hospitalized in Seoul National University Hospital between 1985 and 1995, retrospectively. We excluded the patients with cystic pancreatic tumor and solid pseudo-papillary tumor in this study. Of them, 67 patients received pancreatoduodenectomy. We re-reviewed the histologic specimens of resected cases and tried to find clinico- pathological features in long-term survivors after pancreatoduodenectomy. RESULTS: Median survival of total patients with pancreatic head cancer was 8 months. Significant survival difference could be found between resected cases (15 months) and non-resected cases (6 months) (p<0.001). Of the patients who underwent pancreatoduodenectomy, there were nine patients who survived more than three years. In the patients who underwent pancreatoduodenectomy, depth of invasion, lymph node metastasis, UICC stage, CEA level, adjuvant chemotherapy were the prognostic factors. After histologic re-review in the long-term survivors, there were only 4 typical ductal adenocarcinoma, and 2 cases of variant ductal adenocarcinoma (mucinous noncystic adenocarcinoma, undifferentiated adenocarcinoma), the others were re-diagnosed with bile duct cancer, papillary mucinous carcinoma, and pancreatoblastoma. When we excluded the patients with non ductal adenocarcinoma according to the pathologic review, the median survival of the patients with pancreatoduodenectomy (n=64) decreased (14 months). CONCLUSION: Only the 2% of all the pancreatic cancer and 11% of the resected cases could be considered as 'cure'. In the long-term survivors, there were various types of pathology associated with good prognosis, so typical ductal adenocarcinoma of pancreas would have poorer prognosis than expected. Careful pathologic review must be preceded in the analyzing the survival data.

Long-term Outcome and Prognostic Factors after Kasai Operation for Biliary Atresia

BACKGROUND: Kasai portoenterostomy has been the standard operative procedure in cases of biliary atresia (BA) since Kasai reported the first successful operative case in 1959. However, BA is still one of the pediatric surgical lesions that does not always show satisfactory operative results. METHODS: To evaluate the long-term results and the prognostic factors influencing the survival with the Kasai portoenterostomy for BA, we reviewed 80 BA patients treated at Department of Pediatric Surgery, Seoul National University Hospital from 1980 to 1990. Kaplan-Meier method and Log-rank test were used for statistical analysis. RESULTS: Overall 5-year and 10-year survival rates were 42% and 37%, respectively. Thirty-one patients underwent surgery at ages under 60 days, 31 at ages between 60 and 90 days, 11 at ages between 90 and 120 days and 7 at ages beyond 120 days. There were no statistically significant differences in survival rates among the age groups. In the liver biopsy, minimal hepatic fibrosis was noted in 2 patients, moderate fibrosis in 13, severe fibrosis in 25 and cirrhosis in 5. There were no statistically significant differences in the survival rates according to the degree of hepatic fibrosis but there was a statistically significant difference between patients with cirrhosis and without cirrhosis (p= .03). The size of the bile ductules at the porta hepatis was less than 50 micrometers in 18 patients, between 50 and 100 micrometers in 19 patients, between 100 and 200 micrometers in 4 patients and greater than 200 micrometers in 3 patients. There were no statistically significant differences in the survival rates according to the size of the bile ductules at the porta hepatis. Out of the 12 long-term survivors, survival of more than 10 years, 5 patients had abnormal liver function and 7 patients showed clinical manifestations of portal hypertension. CONCLUSIONS: Kasai portoenterostomy offers reasonable long-term survival and should be the initial procedure for biliary atresia, but a significant portion of the long-term survivors has abnormal liver functionand portal hypertension. Continuous and careful follow-up is needed not to miss the proper time for liver transplantation. Liver cirrhosis at the time of the operation was the only statistically significant prognostic factor influencing the survival.