Predictive value of serum HIF-1α/HIF-2α and YKL-40 levels for vascular invasion and prognosis of follicular thyroid cancer.

OBJECTIVE: This study investigated the significance of serum hypoxia-inducible factor (HIF)-1α/HIF-2 α and Chitinase 3-Like protein 1 (YKL-40) levels in the assessment of vascular invasion and prognostic outcomes in patients with Follicular Thyroid Cancer (FTC). METHODS: This prospective study comprised 83 patients diagnosed with FTC, who were subsequently categorized into a recurrence group (17 cases) and a non-recurrence group (66 cases). The pathological features of tumor vascular invasion were classified. Serum HIF-1α/HIF-2α and YKL-40 were quantified using a dual antibody sandwich enzyme-linked immunosorbent assay, while serum Thyroglobulin (Tg) levels were measured using an electrochemiluminescence immunoassay method. The Spearman test was employed to assess the correlation between serum factors, and the predictive value of diagnostic factors was determined using receiver operating characteristic curve analysis. A Cox proportional hazards regression model was utilized to analyze independent factors influencing prognosis. RESULTS: Serum HIF-1α, HIF-2α, YKL-40, and Tg were elevated in patients exhibiting higher vascular invasion. A significant positive correlation was observed between Tg and HIF-1α, as well as between HIF-1α and YKL-40. The cut-off values for HIF-1α and YKL-40 in predicting recurrence were 48.25 pg/mL and 60.15 ng/mL, respectively. Patients exceeding these cut-off values experienced a lower recurrence-free survival rate. Furthermore, serum levels surpassing the cut-off value, in conjunction with vascular invasion (v2+), were identified as independent risk factors for recurrence in patients with FTC. CONCLUSION: Serum HIF-1α/HIF-2α and YKL-40 levels correlate with vascular invasion in FTC, and the combination of HIF-1α and YKL-40 predicts recurrence in patients with FTC.

Surgical margins and prognosis of borderline and malignant phyllodes tumors.

PURPOSE: To investigate the optimal surgical margin and prognostic risk factors for borderline and malignant phyllodes tumors (PTs). METHODS: A retrospective analysis was conducted on patients with borderline and malignant PTs at our hospital from 2011 to 2022. Univariate and multivariate Cox proportional hazard models were employed to analyze the effects of various variables on local recurrence-free survival (LRFS) and disease-free survival (DFS). RESULTS: This study comprised 150 patients, 85 classified as borderline and 65 as malignant. During a median follow-up of 66 months (range: 3-146 months), 34 cases (22.7%) experienced local recurrence, 9 cases (6.0%) exhibited distant metastasis, and 7 cases (4.7%) resulted in death. Irrespective of the histological subtypes, patients with surgical margins ≥ 1 cm exhibit significantly higher 5-year LRFS and 5-year DFS rates compared to those with margins < 1 cm. Among patients with initial margins < 1 cm, LRFS (P = 0.004) and DFS (P = 0.003) were improved in patients reoperated to achieve margins ≥ 1 cm. Surgical margin < 1 cm (HR = 2.567, 95%CI 1.137-5.793, P = 0.023) and age < 45 years (HR = 2.079, 95%CI 1.033-4.184, P = 0.040) were identified as independent risk factors for LRFS. Additionally, surgical margin < 1 cm (HR = 3.074, 95%CI 1.622-5.826, P = 0.001) and tumor size > 5 cm (HR = 2.719, 95%CI 1.307-5.656, P = 0.007) were determined to be independent risk factors for DFS. CONCLUSIONS: A negative surgical margin of at least 1 cm (with secondary resection if necessary) should be achieved for borderline and malignant PTs. Tumor size > 5 cm and age < 45 years were predictive of recurrence, suggesting multiple therapy modalities may be considered for these high-risk patients.

Single-cell analysis extracted CAFs-related genes to established online app to predict clinical outcome and radiotherapy prognosis of prostate cancer.

BACKGROUND: Cancer-associated fibroblasts (CAFs) play a significant role in regulating the clinical outcome and radiotherapy prognosis of prostate cancer (PCa). The aim of this study is to identify CAFs-related genes (CAFsRGs) using single-cell analysis and evaluate their potential for predicting the prognosis and radiotherapy prognosis in PCa. METHODS: We acquire transcriptome and single-cell RNA sequencing (scRNA-seq) results of PCa and normal adjacent tissues from The GEO and TCGA databases. The "MCPcounter" and "EPIC" R packages were used to assess the infiltration level of CAFs and examine their correlation with PCa prognosis. ScRNA-seq and differential gene expression analyses were used to extract CAFsRGs. We also applied COX and LASSO analysis to further construct a risk score (CAFsRS) to assess biochemical recurrence-free survival (BRFS) and radiotherapy prognosis of PCa. The predictive efficacy of CAFsRS was evaluated by ROC curves and subgroup analysis. Finally, we integrated the CAFsRS gene signature with relevant clinical features to develop a nomogram, enhancing the predictive accuracy. RESULTS: The abundance of CAFs is associated with a poor prognosis of PCa patients. ScRNA-seq and differential gene expression analysis revealed 323 CAFsRGs. After COX and LASSO analysis, we obtained seven CAFsRGs with prognostic significance (PTGS2, FKBP10, ENG, CDH11, COL5A1, COL5A2, and SRD5A2). Additionally, we established a risk score model based on the training set (n = 257). The ROC curve was used to confirm the performance of CAFsRS (The AUC values for 1, 3 and 5-year survival were determined to be 0.732, 0.773, and 0.775, respectively.). The testing set (n = 129), GSE70770 set (n = 199) and GSE116918 set (n = 248) revealed that the model exhibited exceptional predictive performance. This was also confirmed by clinical subgroup analysis. The violin plot demonstrated a statistically significant disparity in the CAFs infiltrations between the high-risk and low-risk groups of CAFsRS. Further analysis confirmed that both CAFsRS and T stage were independent prognostic factors for PCa. The nomogram was then established and its excellent predictive performance was demonstrated through calibration and ROC curves. Finally, we developed an online prognostic prediction app ( https://sysu-symh-cafsnomogram.streamlit.app/ ) to facilitate the practical application of the nomogram. CONCLUSIONS: The prognostic prediction risk score model we constructed could accurately predict BRFS and radiotherapy prognosis PCa, which can provide new ideas for clinicians to develop personalized PCa treatment and follow-up programs.

Leptin and its receptor are overexpressed in breast cancer tissue of postmenopausal Mexican-Mestizo women with obesity.

The aim of this study was to investigate the expression of leptin (LEP) and its receptor (LEPR) in breast cancer tissue of postmenopausal women with different body mass indexes (BMI), as well as the relationship of this expression with the rate of recurrence free survival (RFS). Leptin and LEPR expression, determined by immunohistochemistry, were studied in breast cancer tissues of 154 patients. Qualitative and semi-quantitative analysis of protein expression was performed by the H-Score method, through the ImageJ's IHC Profiler software. Kaplan-Meier survival analysis and log-rank statistic were used to estimate RFS differences. Protein expression of LEP, was significantly higher in women with overweight or with obesity, when compared to women with normal BMI (P = 0.032 and P = 0.013, respectively). We also observed a significantly higher expression of LEPR in breast tumor cells of women with obesity (58.8%), when compared to women with normal BMI (32.7%) (P = 0.007). Five-year survival rate, regarding LEPR expression, was 82.4% when positive and 94% when negative (P = 0.024). In the Cox proportional-hazards regression model, LEPR expression represented a risk factor for disease recurrence after adjustment for confounding factors (HR = 4.67; 95% CI: 1.13-19.31; P = 0.033). In conclusion, postmenopausal women with obesity and breast cancer present higher LEP and LEPR expression in breast tumors, when compared to women with normal BMI. Independently from BMI, women with tumors LEPR positive have worst RFS, when compared to women with tumors LEPR negative.

Tumor-Infiltrating Lymphocytes in Patients with Melanoma: Which Is Its Prognostic Value?

Oncological impact of tumor-infiltrating lymphocytes (TILs) in melanoma remains controversial. We aimed to determine the significance of TILs on melanoma-specific survival (MSS), recurrence-free survival (RFS), and sentinel lymph node status (SLN). A retrospective analysis of patients undergoing melanoma resection during the period 2009-2019 was performed. Using the Melanoma Institute Australia grading system for TILs, the cohort was divided into two groups: group 1 (G1), patients with TILs grades 1, 2, or 3 and Group 2 (G2), patients with TILs grade 0. From a total of 386 melanoma resections, 151 (39%) were included in G1 and 39 (10%) in G2. Among the 151 patients who underwent SLN biopsy, the positivity rate according to the TILs grades 0, 1, 2, and 3 was 32%, 18%, 14%, and 0%, respectively, p = 0.02. With an average follow-up of 48 months, the 5-year MSS (G1: 86% vs G2: 75%, p = 0.002) and the 5-year RFS (G1: 81% vs G2: 60%, p = 0.004) were significantly higher in G1 than G2. Tumor-infiltrating lymphocytes in melanoma are associated with the SLN status and with a better MSS and RFS.

Prognostic significance of sentinel node biopsy status in cutaneous melanoma: a 21-years prospective study from a single institution.

AIM: To analyze the accuracy of the sentinel lymphatic node biopsy (SLNB) and to investigate predictive factors for sentinel node (SN) status and prognostic factors for recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with melanoma. MATERIAL AND METHODS: Between June 1997 and June 2017, 440 consecutive patients, who underwent SLNB by a single surgical team, were prospectively included. Descriptive and survival analysis were performed. RESULTS: 119 of 440 patients (26%) had positive SN. SLNB's false-negative rate was 6.3%. Breslow thickness, Clark´s level, ulceration and histological subtype were statistically significant predictive factors of SN metastases. In a multivariate analysis, positive SN (HR = 2.21, p = 0.01), deeper Breslow thickness (HR = 2.05, p = 0.013), male gender (RR = 2.05, p = 0.02), and higher Clark's level (HR = 2.30, p = 0.043) were significantly associated with decreased RFS; and positive SN (HR = 2.58, p < 0.001), deeper Breslow thickness (HR = 2.57, p = 0.006) and male gender (HR = 1.93, p = 0.006) were associated with lower DSS. CONCLUSION: SLNB is a reliable and reproducible procedure with high sensitivity (93.7%). Positive SN metastases, Breslow thickness and male gender were statistically associated with poorer outcomes. Male gender was an independent prognostic factor of tumor thickness or SN status.

Respuesta patológica completa, cirugía conservadora y recidivas a distancia en tumores localmente avanzados: resultados en 30 años de tratamiento neoadyuvante / Complete Pathologic Response, Breast Conserving Surgery and Distant Recurrence in Locally Advanced Breast Cancer: Results within 30 years of Neoadjuvant Therapy

Introducción La quimioterapia neoadyuvante (qtn) es el tratamiento inicial para pacientes con tumores localmente avanzados, permitiendo la evaluación de la sensibilidad in vivo a los agentes antineoplásicos y la planificación de estrategias quirúrgicas con resultados cosméticos favorables. Objetivos Comparar la tasa de respuesta patológica completa (pcr), la tasa de conversión a cirugía conservadora (tccc), el tiempo a la recaída a distancia (trad) y la supervivencia libre de enfermedad a distancia (sled) a 60 meses en pacientes con cáncer de mama Estadio III que fueron tratadas con qtn antes y después del año 2007 Material y método Se trata de un estudio observacional de cohortes retrospectivo en el que se analizaron registros de pacientes con cáncer de mama Estadio III operadas entre 1987 y 2016 que hubieran realizado qtn . Se constituyeron dos cohortes: en la primera se reunieron pacientes tratadas entre 1987 y 2006; en la segunda se agruparon aquellas tratadas entre 2007 y 2016. Se estableció esta diferencia dado que a partir de 2007 hubo cambios en la modalidad terapéutica: se administró la quimioterapia en forma continua antes de la cirugía y se introdujeron los taxanos y la terapia anti-her2 neu en los esquemas de qtn . En total se registraron 202 pacientes, 146 pertenecientes a la primera cohorte y 56 pertenecientes a la segunda. La mediana de edad y el tamaño tumoral fueron similares entre ambos grupos, mientras que en el segundo grupo observamos mayor porcentaje de tumores Grado 3 y mayor carga tumoral axilar. Resultados La tasa de pcr fue del 2% (n=3) para el primer grupo y de 13% (n=7) para el segundo (p=0,0022). La tasa de conversión a cirugía conservadora fue del 27% (n=20) para el primer grupo y del 41% (n=17) para el segundo, observándose un 14% más de cirugías conservadoras en este último (p=0,11). La mediana de trad fue de 33 meses para el primer grupo y de 46,5 meses para el segundo (p=0,044). La sled a 60 meses fue del 58% vs el 74% para el primer y segundo grupo respectivamente (p=0,039). Conclusiones Los cambios en la modalidad terapéutica en qtn en nuestra práctica se tradujeron en mayores tasas de pcr, mayor porcentaje de conversión a cirugía conservadora, mayor tiempo a la recidiva a distancia y mayor supervivencia libre de enfermedad a distancia

Introduction Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer, allowing surgical planning with favorable cosmetic outcome and evaluation of in vivo response to antineoplastic agents. Objectives To compare pathologic complete response, breast conserving surgery conversion rates, time to distant relapse and distant recurrence free survival after 60 months in patients with Stage III breast cancer who received neoadjuvant chemotherapy before and after year 2007. Materials and method Observational retrospective cohort study analizing database and medical records of patients with Stage III breast cancer who had surgery after neoadjuvant therapy between 1987 and 2016. We divided the population into two cohorts, one with patients treated between 1987 and 2006, and another one with those ones treated between 2007 and 2016. We established that difference given that from 2007 and onwards there were major changes in treatment modality: chemotherapy was administered completely before surgery, and Taxane-containing regimens as well as Anti-her2 therapies were included. We registered 202 patients, 146 in the first group and 56 in the second. While median of age and tumor size were similar between groups, axillary tumor burden and histologic grade were higher in the second group. Results Pathologic complete response rate was 2% for the first group and 13% for the second (p=0.0022). Breast conserving surgery conversion rates were 27% vs 41%, with 14% more breast conserving surgeries in the second cohort. Median time to distant recurrence was 33 months vs 46.5 months (p=0.044) and distant recurrence free survival was 58% vs 74% (p=0.039) for groups 1 and two 2 respectively. Conclusions Changes in treatment modality in our practice resulted in better pcr outcomes, more breast conserving surgery conversion rates, longer time to distant relapse and a better distant recurrence free survival

Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma.

BACKGROUND: Central lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is common. But the association between primary tumor characteristics and specific features of metastatic lymph nodes in PTC has not been fully identified. Determining risk factors for LNM may help surgeons determine rational extent of lymph node dissection. METHODS: Data from 432 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. The relationships between LNM to central compartment or lateral compartment and clinicopathologic factors were analyzed. Cox regression model was used to determine the risk factors for recurrence-free survival (RFS). RESULTS: Central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were found in 216 (50.0%) and 65 (15.0%) patients, respectively. In the multivariate analysis for CLNM, patients < 45 years of age (OR 2.037, 95% CI 1.388-2.988, P < 0.001), extrathyroidal invasion (OR: 2.144, 95% CI 0.824-5.457, P = 0.011), vascular invasion (OR 13.817, 95% CI 1.694-112.693, P = 0.014), LLNM (OR 2.851, 95% CI 1.196-6.797, P = 0.014) and TNM Stage III-IV (OR 465.307, 95% CI 113.903-1900.826, P < 0.001) were independent predictors for high prevalence of CLNM. In the multivariate analysis for LLNM, tumor size more than 1cm (OR 3.474, 95% CI 1.728-6.985, P < 0.001) and CLNM (OR 5.532, 95% CI 2.679-11.425, P < 0.001) were independent predictors for high prevalence of LLNM. Moreover, tumor with T3-T4 stage, extrathyroidal invasion and CLNM were the significant factors related to the RFS. CONCLUSION: For patients with pre-operative risk factors of LNM, an accurate preoperative evaluation of central compartment or lateral compartment is needed to find suspicious lymph nodes. And prophylactic lymph node dissection should be performed in patients with high risk of CLNM. Moreover, we suggest performing close follow-up for patients with high risk of RFS.

Response to Loco-Regional Therapy Predicts Outcomes After Liver Transplantation for Combined Hepatocellular-Cholangiocarcinoma.

INTRODUCTION AND AIM: Combined hepatocellular-cholangiocarcinoma (HCC-CCA) is a rare liver malignancy distinct from either hepatocellular carcinoma (HCC) or cholangiocarcinoma. Liver transplantation (LT) is not recommended for HCC-CCA because of suboptimal outcomes. Non-invasive diagnosis of HCC-CCA is extremely challenging; thus, some HCC-CCAs are presumed as HCC on imaging and listed for LT with the correct diagnosis ultimately made on explant pathology. We compared HCC-CCA with HCC to determine the utility of response to pre-transplant loco-regional therapy (LRT) in predicting outcomes for HCC-CCA after LT as a potential means of identifying appropriate HCC-CCA patients for LT. MATERIAL AND METHODS: Retrospective review of 19 patients with pathologically confirmed HCC-CCA were individually matched to 38 HCC patients (1:2) based on age, sex, and Milan criteria at listing was performed. The modified response evaluation criteria in solid tumors was used to categorize patients as responders or non-responders to pre-transplant LRT based on imaging performed before and after LRT. Overall survival (OS) and recurrence-free survival (RFS) were examined. RESULTS: OS at 3 years post-transplant was 74% for HCC-CCA and 87% for HCC. RFS at 3 years was 74% for HCC-CCA, and 87% for HCC. Among responders to LRT, the 3-year OS was 92% for HCC-CCA and 88% for HCC; among non-responders, 3-year OS was 43% for HCC-CCA and 83% for HCC. Higher 3-year OS was observed among HCC-CCA responders (77%) compared with HCC-CCA non-responders (23%). CONCLUSIONS: OS was similarly high among.

The differences of clinicopathological factors for breast cancer in respect to time of recurrence and effect on recurrence-free survival.

PURPOSE: In the literature, small number of study has addressed time of recurrence in breast cancer. We analyzed clinicopathological factors predicting early or late recurrence in breast cancer patients and also prognostic factors related with recurrence-free survival (RFS) in recurrent patients. PATIENTS/METHODS: We evaluated retrospectively 1980 breast cancer patients. Relapsed was defined as early if it was occured first 5 year of follow-up (Group 1) and late if it was occured after 5 years (Group 2). The clinicopathological factors were compared in respect of time of recurrence. The prognostic factors were evaluated using univariate and multivariate analyses. RESULTS: Recurrence wase detected in 141 patient during follow-up. Tumors recurred after 5 years more likely to have lower stage (p = 0.05), tumors without lymphovascular invasion (LVI) (p < 0.001) and perineural invasion (PNI) (p = 0.01), and also HER2 negative (p < 0.001). The median RFS time and 5 years RFS rates were 42.9 months and 31.9 %, respectively. LVI (p = 0.01), PNI (p = 0.03), HER2 (p = 0.003), progesterone receptor (PR) (p = 0.04), the presence of neoadjuvant chemotherapy (p = 0.003), adjuvant hormonotherapy (p = 0.05) were found to be related with RFS. Axillary lymph node metastasis (p = 0.05) and the presence of PNI (p = 0.009) were poor prognostic factors for early recurrent group. PR-positive tumors (p = 0.001) and luminal subtypes (p = 0.03) had instances of late recurrences significantly. CONCLUSIONS: Clinicopathological factors predicting the recurrence time in breast cancer were important to modify adjuvant therapy.

Factores prognosticos en cáncer de mama, estadio clínico temprano (I-IIa) sometidos a cirugía como tratamiento de inicio / Prognostic factors in breast cancer patients in early stages (I - IIa) that underwent surgery as initial therapy

El cáncer de mama lidera las causas de muerte por cáncer en mujeres peruanas. Mientras los programas de control de cáncer se enfocan en incrementar el diagnóstico de estadios tempranos, es importante conocer bien los factores de prognóstico en este grupo de pacientes. El objetivo de este estudio fue Identificar factores prognósticos en pacientes con cáncer de mama en estadios clínicos tempranos (I-IIA) sometidas a cirugía como tratamiento de inicio. Se realizó un estudio observacional descriptivo de una serie de casos retrospectiva de pacientes diagnosticados con cáncer de mama en estad¡os I-IIA entre enero del 2000 hasta diciembre de 2005. Se incluyeron 952 pacientes. Se identificó el tamaño del tumor, número de ganglios comprometidos, estadio patológico, receptor de estrógeno, tipo de cirugía y a la hormonoterapia como factores prognósticos de sobrevida libre de recurrencia a distancia; mientras que para la sobrevida global las variables fueron la edad, el estadio T patológico, el tamaño del tumor, el número de ganglios comprometidos, el estadio patológico, los receptores de estr¢geno y progesterona, el fenotipo y la hormonoterapia. El análisis multivariado mostró que los factores de prognóstico independientes para la sobrevida libre de recurrencia a distancia fueron el estadio T patológico (HR=1,51, para T2, comparado a T1), y el estadio N patológico (HR=1,82, para N2, comparado a N1), mientras que para la sobrevida global fueron la edad (HR=4,14, para ≥70 años, comparado a <50), el estadio T patológico (HR=1,74, para T2, comparado a T1), estadio N patológico (HR=1,93, para N1, comparado a N0). En conclusión, la edad, estadios patológicos T y N, fueron los factores de prognóstico m s importantes.

Breast cancer is the leading cause of cancer death in Peruvian women and while the cancer control programs focus on increasing the diagnosis of early stages, it is important to know prognostic factors in this subgroup of patients. The aim of this study was to identify prognostic factors in patients with breast cancer in early clinical stages patients (I-IIA) with surgery as first treatment. We conducted a descriptive study of retrospective case series of patients diagnosed with breast cancer stages I-IIA is from January 2000 to December 2005 in the Instituto Nacional de Enfermedades Neopl sicas. During the study period 952 patients met eligibility criteria and were included in the study. The tumor size, number of involved nodes, pathological stage, estrogen receptor, the type of surgery and hormone therapy were identified predictors of recurrence-free survival at a distance, while for overall survival, variables were age at diagnostic, the pathological T stage, tumor size, number of involved nodes, pathological stage, estrogen receptor and progesterone status and the hormone phenotype. Multivariate analysis showed that independent prognostic factors for recurrence-free survival were pathological T stage (HR = 1.51, for T2, compared to T1), and pathologic N stage (HR = 1.82, for N2, compared to N1), whereas for overall survival were age at diagnosis (HR = 4.14, for ≥ 70 years, compared to <50), pathological T stage (HR = 1.74, for T2, compared to T1), pathologic N stage (HR = 1.93 for N1, compared to N0). In conclusion, age, pathologic T and N stages were the most important prognostic factors.

Tumor recurrence is independent of pancreatic fistula in patients after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.

BACKGROUND: Recurrence of pancreatic adenocarcinoma after pancreaticoduodenectomy (PD) can be increased in patients with pancreatic fistula (PF). The purpose of our study was to determine if a relationship exists between PF and tumor recurrence (both peritoneal and local) in patients after PD for pancreatic ductal adenocarcinoma. STUDY DESIGN: A single-institution, retrospective analysis of 221 patients who underwent PD from January 2001 to December 2009 was conducted. Electronic charts and medical records were queried for tumor characteristics, recurrence, and complications. Presence and grading of PF was determined using the criteria of the International Study Group on Pancreatic Fistula. Data were analyzed using chi-square and Kaplan-Meier survival statistics. RESULTS: There were 114 male and 107 female patients. Mean age was 66 years (range 35 to 91 years). The vast majority (84%) of patients had stage II disease; 143 (65%) had positive lymph nodes (median 2 positive nodes; range 1 to 17 positive nodes). Pancreatic fistula developed in 23 patients (grade A, n = 9; grade B, n = 13; grade C, n = 1; 10.2%). Peritoneal recurrence was noted in 20 patients (9%). Of the 23 patients with PF, peritoneal recurrence developed in 3 (13%). Of the 198 patients without PF, peritoneal recurrence developed in 17 (10%). Local recurrence occurred in 47 patients (21%), 5 (2%) in patients with PF and 42 (21%) in those without PF (p = NS). In Kaplan-Meier survival analysis, there was no significant difference in recurrence-free survival (p = 0.4) and overall survival (p = 0.3) for those with PF vs those without PF. CONCLUSIONS: Patients with PF after PD were not found to have a significant increase in local or peritoneal recurrence. Therefore, in this analysis, postoperative PF does not appear to serve as an adverse prognostic marker.

Prognostic impact of serum albumin levels on the recurrence of stage I non-small cell lung cancer

Objective: Patients with stage I non-small cell lung cancer who have undergone complete surgical resection harbor a 30% risk for tumor recurrence. Thus, the identification of factors that are predictive for tumor recurrence is urgently needed. The aim of this study was to test the prognostic value of serum albumin levels on tumor recurrence in patients with stage I non-small cell lung cancer. Methods: Stage I non-small cell lung cancer patients who underwent complete surgical resection of the primary tumor at Zhejiang Hospital were analyzed in this study. Serum albumin levels were measured before surgery and once again after surgery in 101 histologically diagnosed non-small cell lung cancer patients. Correlations between the pre- and post-operative serum albumin levels and various clinical demographics and recurrence-free survival rates were analyzed. Results: Patients with pre-operative hypoalbuminemia (<3.5 g/dl) had a significantly worse survival rate than patients with normal pre-operative serum albumin levels (≥3.5 g/dl) (p=0.008). Patients with post-operative hypoalbuminemia had a worse survival rate when compared with patients with normal post-operative serum albumin levels (p=0.001). Cox multivariate analysis identified pre-operative hypoalbuminemia, post-operative hypoalbuminemia and tumor size over 3 cm as independent negative prognostic factors for recurrence. Conclusion: Serum albumin levels appear to be a significant independent prognostic factor for tumor recurrence in patients with stage I non-small cell lung cancer who have undergone complete resection. Patient pre-treatment and post-treatment serum albumin levels provide an easy and early means of discrimination between patients with a higher risk for recurrence and patients with a low risk of recurrence. .