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Objective:To investigate the role of three-dimensional dose distribution-based deep learning model in predicting distant metastasis of head and neck cancer.Methods:Radiotherapy and clinical follow-up data of 237 patients with head and neck cancer undergoing intensity-modulated radiotherapy (IMRT) from 4 different institutions were collected. Among them, 131 patients from HGJ and CHUS institutions were used as the training set, 65 patients from CHUM institution as the validation set, and 41 patients from HMR institution as the test set. Three-dimensional dose distribution and GTV contours of 131 patients in the training set were input into the DM-DOSE model for training and then validated with validation set data. Finally, the independent test set data were used for evaluation. The evaluation content included the area under receiver operating characteristic curve (AUC), balanced accuracy, sensitivity, specificity, concordance index and Kaplan-Meier survival curve analysis.Results:In terms of prognostic prediction of distant metastasis of head and neck cancer, the DM-DOSE model based on three-dimensional dose distribution and GTV contours achieved the optimal prognostic prediction performance, with an AUC of 0.924, and could significantly distinguish patients with high and low risk of distant metastasis (log-rank test, P<0.001). Conclusion:Three-dimensional dose distribution has good predictive value for distant metastasis in head and neck cancer patients treated with IMRT, and the constructed prediction model can effectively predict distant metastasis.
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Colorectal cancer is one of the most common malignant tumors in the world, with a high mortality, but with the continuous improvement of diagnosis and treatment technology and treatment concept in recent years, many patients can get timely and effective treatment. From the aspects of distant metastasis of colorectal cancer and the progress of diagnosis and treatment under multidisciplinary diagnosis and treatment mode, focusing on the significance of multidisciplinary diagnosis and treatment mode for metastatic colorectal cancer, and exploring a more accurate and effective treatment system, so as to provide some reference for the comprehensive treatment of metastatic colorectal cancer.
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Objective:To evaluate the efficacy and safety of thoracic radiotherapy in the treatment of patients with extensive-stage small cell lung cancer (ES-SCLC) with different metastatic sites.Methods:A retrospective analysis was performed among 830 ES-SCLC patients who were admitted to our hospital from 2010 to 2019. They all received the first-line chemotherapy and had no progression after chemotherapy. 341 patients of them received thoracic radiotherapy after chemotherapy. The main endpoint was overall survival. The Chi-square test was used to compare the categorical data including gender and age, etc. Univariate survival analysis was estimated by Kaplan-Meier method and the log-rank test was used to compare the survival curves between two groups. A multivariate prognostic analysis was made by the Cox proportional hazard model.Results:In all the patients, the overall survival (OS) was 12.4 months. The patients with thoracic radiotherapy had significantly higher OS than the patients without thoracic radiotherapy (15.2 months vs.10.8 months, P<0.001). Thoracic radiotherapy significantly improved the OS in patients without liver metastasis (16.0 months vs.11.4 months, P<0.001) in the oligometastatic patients. But for the oligometastatic patients with liver metastasis, the OS benefit was not significant (14.2 months vs. 10.6 months, P=0.072). For polymetastatic patients without liver metastasis, thoracic radiotherapy offered significant OS benefits (14.5 months vs.10.9 months, P<0.001), but for the polymetastatic patients with liver metastasis, the OS was not improved with thoracic radiotherapy (10.2 months vs.9.2 months, P=0.715). Conclusions:In ES-SCLC patients, thoracic radiotherapy provides significant OS benefits in patients with oligometastases ES-SCLC without liver metastasis and for the liver metastatic patients may also benefit from thoracic radiotherapy based on the effectiveness of chemotherapy. In patients with multiple metastases, thoracic radiotherapy only improves the OS in patients without liver metastasis, but does not improve the prognosis in patients with liver metastasis.
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OBJECTIVE: This study aimed to analyze the relationship of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) with clinicopathological characteristics of patients with differentiated thyroid cancer (DTC). METHODS: This retrospective study included 390 patients with DTC who had complete blood cell counts available at the time of surgery. NLR, PLR, and MLR were calculated, and the risk of cancer-related death, structural recurrence, and response to therapy were assessed using the eighth edition of the tumor-node-metastasis classification, American Thyroid Association (ATA) Risk Stratification System, and ATA Response to Therapy Reclassification, respectively. RESULTS: PLR was higher in patients with distant metastasis than in those without (133.15±43.95 versus 119.24±45.69, p=0.0345) and lower in patients with disease-free status (117.72±44.70 versus 131.07±47.85, p=0.0089) than in those who experienced persistent disease or death. Patients aged ≥55 years had a higher MLR than those aged <55 years (0.26±0.10 versus 0.24±0.12, p=0.0379). Higher MLR (odds ratio [OR]: 8.775, 95% confidence interval [CI]: 1.532-50.273, p=0.0147), intermediate ATA risk (OR: 4.892, 95% CI: 2.492-9.605, p≤0.0001), and high ATA risk (OR: 5.998, 95% CI: 3.126-11.505, p≤0.0001) were risk factors associated with active disease. NLR was not significantly different among the studied variables. Receiver operating characteristic curve cut-off values for NLR, PLR, and MLR were able to differentiate distant metastasis from lymph node metastasis (NLR>1.93: 73.3% sensitivity and 58.7% specificity, PLR>124.34: 86.7% sensitivity and 69.2% specificity, MLR>0.21: 80% sensitivity and 45.2% specificity). CONCLUSION: Cut-off values of NLR, PLR, and MLR differentiated distant metastasis from lymph node metastasis with good sensitivity and accuracy. PLR was associated with disease-free status and it was higher in DTC patients with distant metastasis, persistent disease, and disease-related death. MLR was a risk factor for active disease.
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Humans , Thyroid Neoplasms/surgery , Neutrophils , Prognosis , Thyroidectomy , Lymphocytes , Monocytes , Retrospective Studies , Lymph Nodes , Neoplasm Recurrence, LocalABSTRACT
Objective To establish a nomogram for predicting the distant metastasis risk of pancreatic neuroendocrine tumors (pNETs) in elderly patients. Methods We extracted data of patients with diagnosis of pNETs at age ≥65 years old between 1973 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. All eligible patients were divided randomly into a training cohort and validation cohort. Uni- and multivariate logistic regression analyses were performed on the training cohort to identify independent factors for distant metastasis. A nomogram was developed based on the independent risk factors using rms packages of R software, and was validated internally by the training cohort and externally by the validation cohort using C-index and calibration curves. Results A total of 411 elderly patients were identified, of which 260 were assigned to training cohort and 151 to validation cohort. Univariate and multivariate logistic regression analyses indicated the tumor site (body/tail of pancreas: odds ratio [
Subject(s)
Aged , Humans , Neoplasm Staging , Nomograms , Pancreatic Neoplasms , Prognosis , Risk FactorsABSTRACT
Metastases to the parotid gland are very rare. We report the second case of bilateral metastases to the parotid gland from a breast invasive ductal carcinoma. A 50-year-old female was treated for an early left breast cancer in 2007. A pulmonary metastatic relapse was diagnosed in 2013. A metastatic skin extension required several lines of treatment from June 2014 to July 2016. Bilateral parotid gland metastases from a breast invasive ductal carcinoma were confirmed in December 2016. The patient died on May 2017 from cerebral metastases. Only 16 cases of metastasis to the parotid gland from breast cancer have been reported in the literature. Only one case had a bilateral involvement. Prognosis is poor, and there are no specific guidelines for the treatment
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The most common primary malignant disease in the world amongst women is carcinoma breast. Metabolic activity of a lesion (SUVmax) has strong clinical correlation with various prognostic factors according to numerous literature reviews. The main aim of this study is to assess the correlation between maximum Standardized Uptake Value [SUVmax] and initial disease staging (as per AJCC TNM-8th edition). We wanted to study the correlation between metabolic activity [SUVmax] of the primary tumour in breast carcinoma, and size of the primary, nodal and distant metastatic status.METHODSThis is an observational study conducted over a period of two years in breast cancer patients [n=139] undergoing PET-CT as a part of initial staging. PET-CT was done using Siemens Horizon True-V PET according to institutional protocols.RESULTSSignificantly higher SUVmax values were observed in tumours with larger size [>2 cms]. However, there was no significant correlation between SUVmax of primary tumours and the status of axillary nodal involvement and distant metastases [p = 0.125 and 0.847 respectively].CONCLUSIONSMetabolic activity of primary breast cancer has strong clinical correlation with size; however, there is no such correlation found in nodal and metastatic spread of the disease.
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Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P<0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%.
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Humans , Male , Female , Adult , Middle Aged , Thyroid Neoplasms/surgery , Thyroglobulin , Brazil , Iodine Radioisotopes , Neoplasm Recurrence, LocalABSTRACT
Objective To evaluate the clinical efficacy and prognostic factors of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Methods From December 2011 to December 2015,152 cases of recurrent thoracic esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery were retrospectively analyzed.The overall survival (OS) after treatment failure,clinical efficacy and prognostic factors of different salvage treatments were analyzed.OS was calculated by Kaplan-Meier method.Prognostic analysis was performed by using multivariate Cox regression model.Results The median interval of the first recurrence was 10.6(2.0 to 69.1) months.The median OS after recurrence was 8.0(0.8 to 43.3) months.The 1-,2-and 3-year OS rates after recurrence were 36.0％,15.1％ and 5.2％,respectively.The median OS of patients with locoregional recurrence alone,distant metastasis alone and locoregional recurrence combined with distant metastasis was 11.3(1.8 to 43.3) months,6.7(1.2 to 28.6) months and 5.1 (0.8 to 22.9) months,respectively.Multivariate analysis demonstrated that neoadjuvant chemotherapy (P=0.009),ypTNM stage (P=0.012),comprehensive treatment after recurrence (P=0.000) and locoregional recurrence (P=0.026) were independently correlated with the OS of patients with recurrent esophageal squamous cell carcinoma.Conclusions Neoadjuvant therapy,ypTNM stage,recurrence pattern and postrecurrence treatment are the independent risk factors for clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy is not satisfactory.After recurrence,combined treatment mode should be adopted according to the site of recurrence and neoadjuvant treatment mode to maximize the benefits of salvage treatment.
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Background: LncRNAs is closely related to the development and progression of colorectal cancer, and its abnormal expression and regulation in tumor have high specificity. Aims: To screen the differentially expressed lncRNAs in colorectal cancer via The Cancer LncRNome Atlas, and to investigate the expression and clinical significance of LINC02363 in colorectal cancer. Methods: Microarray data of colorectal cancer patients from The Cancer LncRNome Atlas and TCGA database were extracted. The differentially expressed lncRNAs in colorectal cancer were screened. Real-time fluorescent quantitative PCR was used to detect LINC02363 expression in colorectal cancer cell lines and 53 colorectal cancer tissues from Shanghai Renji Hospital. Correlation of LINC02363 expression with survival and clinicopathological characteristics of colorectal cancer patients in TCGA database was analyzed. Results: Two up-regulated lncRNAs and 12 down-regulated lncRNAs related to prognosis of colorectal cancer were screened. Compared with normal intestinal epithelial cells, expression of LINC02363 was down-regulated in colorectal cancer cells. Expression of LINC02363 was significantly decreased in colorectal cancer tissue. Kaplan-Meier survival analysis showed that survival in low expression of LINC02363 group was significantly shorter than that in high expression of LINC02363 group. Low LINC02363 expression was positively correlated with distant metastasis of colorectal cancer. Conclusions: LINC02363 is down-regulated in colorectal cancer tissue, and patients with lower expression of LINC02363 have poorer prognosis and higher possibility of metastasis. It is suggested that LINC02363 can be used as a potential tumor marker to evaluate the development and distant metastasis of colorectal cancer.
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Objective@#To evaluate the clinical efficacy and prognostic factors of recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.@*Methods@#From December 2011 to December 2015, 152 cases of recurrent thoracic esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery were retrospectively analyzed. The overall survival (OS) after treatment failure, clinical efficacy and prognostic factors of different salvage treatments were analyzed. OS was calculated by Kaplan-Meier method. Prognostic analysis was performed by using multivariate Cox regression model.@*Results@#The median interval of the first recurrence was 10.6(2.0 to 69.1) months. The median OS after recurrence was 8.0(0.8 to 43.3) months. The 1-, 2-and 3-year OS rates after recurrence were 36.0%, 15.1% and 5.2%, respectively. The median OS of patients with locoregional recurrence alone, distant metastasis alone and locoregional recurrence combined with distant metastasis was 11.3(1.8 to 43.3) months, 6.7(1.2 to 28.6) months and 5.1(0.8 to 22.9) months, respectively. Multivariate analysis demonstrated that neoadjuvant chemotherapy (P=0.009), ypTNM stage (P=0.012), comprehensive treatment after recurrence (P=0.000) and locoregional recurrence (P=0.026) were independently correlated with the OS of patients with recurrent esophageal squamous cell carcinoma.@*Conclusions@#Neoadjuvant therapy, ypTNM stage, recurrence pattern and post-recurrence treatment are the independent risk factors for clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Clinical prognosis of patients with recurrent esophageal squamous cell carcinoma after neoadjuvant therapy is not satisfactory. After recurrence, combined treatment mode should be adopted according to the site of recurrence and neoadjuvant treatment mode to maximize the benefits of salvage treatment.
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The aims of this study were to determine the prognostic value of primary tumor surgery and identify optimal candidates for such surgery among patients with seminoma and distant metastasis at diagnosis. We identified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillance, Epidemiology, and End Results database. Among these patients, 434 had undergone surgery, whereas 87 had not. The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods, log-rank analyses, and multivariate Cox's proportional hazards model. Survival curves and forest plots were also plotted. Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival than those who did not. Multivariate analyses demonstrated that primary tumor surgery is an independent prognostic factor for overall survival and cancer-specific survival, along with age at diagnosis, M stage, and marital status. In addition, primary tumor surgery still had considerable prognostic value in the subgroup of patients with lymph node metastasis. Further, forest plots demonstrated that patients with M1a stage, N1 or N2-3 stage, and a younger age at diagnosis (<60 years) may benefit from primary tumor surgery. In conclusion, our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis. Furthermore, primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.
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Objective To investigate the correlation between CT texture analysis and synchronous distant metastasis in patients with lymph node-negative colorectal cancer. Methods The preoperative CT images of 82 patients with lymph node-negative colorectal cancer were analyzed retrospectively.There were 12 patients with simultaneous distant metastasis and 70 patients without simultaneous distant metastasis.The maximum plane of the lesion on plain scan and portal CT images was analyzed by TexRAD software.When the spatial scaling factor(SSF)was 0 and 2-6,six texture parameters were obtained,and the differences of texture parameters between the two groups were compared.The counting data were analyzed by chi-square test and the measurement data by Mann-Whitney test. Results There was a significant difference in the skewness of SSF=3 between the simultaneous distant metastasis group and the non-synchronous metastasis group on plain CT scan(
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Humans , Colorectal Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Neoplasm Metastasis , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Background: One particular cause of death from breast cancer is distant metastasis. In this study, we calculate and compare diagnostic value of Mitotic Activity Index (MAI) and Ki-67 expression in predicting distant metastasis.Methods: Study was conducted in Sanglah Hospital from January 2017 to February 2019. All histopathology results from open biopsy are examined, thus MAI and Ki-67 values were obtained. We divided this into 2 groups: MAI high (≥20/HPF), low (<20/HPF) and Ki-67 high (≥20%) and low (<20%). We compared with distant metastasis event as gold standard, obtained from radiology examination. We count all diagnostic characteristics (sensitivity, specificity, positive and negative predictive value, accuracy, and likelihood ratio). We compared these diagnostic validities from data area under curve (AUC) with p value <0.005 considered to be statistically significant.Results: A total of 173 breast cancer patients were participated in this study, 92 of them had distant metastasis (53.2%) and 81 patients didn’t have any distant metastasis (46.8%). MAI had relative high specificity (82.7%) and Ki-67 had fair sensitivity values (69.6%). There are 0.08 point AUC differences between these two variables. With p value higher than 0.05 (0.06), it can be summarized that these two variables are not different significantly and statistically.Conclusions: There is not any statistically significant difference between these two markers in predicting distant metastasis in breast cancer. We hope other researcher interest into exploring more about these markers and their function.
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SUMMARY INTRODUCTION: Glioblastoma (GBM) is the most frequent primary malignant tumor from the central nervous system in adults. However, the presence of systemic metastasis is an extremely rare event. The objective of this study was to review the literature, evaluating the possible biological mechanisms related to the occurrence of systemic metastasis in patients diagnosed with GBM. RESULTS: The mechanisms that may be related to GBM systemic dissemination are the blood-brain barrier breach, often seen in GBM cases, by the tumor itself or by surgical procedures, gaining access to blood and lymphatic vessels, associated with the acquisition of mesenchymal features of invasiveness, resistance to the immune mechanisms of defense and hostile environment through quiescence. CONCLUSIONS: Tumor cells must overcome many obstacles until the development of systemic metastasis. The physiologic mechanisms are not completely clear. Although not fully understood, the pathophysiological understanding of the mechanisms that may be associated with the systemic spread is salutary for a global understanding of the disease. In addition, this knowledge may be used as a basis for a therapy to be performed in patients diagnosed with GBM distant metastasis.
RESUMO INTRODUÇÃO: Glioblastoma (GBM) é o tumor maligno mais comum do sistema nervoso central em adultos. Entretanto, metástase a distância de GBM é um evento extremamente raro. O presente estudo teve o objetivo de realizar uma revisão da literatura para avaliar os possíveis mecanismos biológicos relacionados com a ocorrência de metástase a distância de pacientes com diagnóstico de GBM. RESULTADOS: Os mecanismos que podem estar relacionados com a capacidade de disseminação sistêmica do GBM são a quebra de barreira hematoencefálica (BHE) frequentemente vista em GBM, seja pela doença, seja por procedimentos cirúrgicos, dando acesso aos vasos sanguíneos e linfáticos, associada à aquisição de características mesenquimais de invasividade, resistência aos mecanismos de defesa do sistema imunológico e adaptação a hostilidades dos meios distantes por meio de quiescência. CONCLUSÕES: As células tumorais necessitam vencer diversos obstáculos até a formação de uma metástase distante. Apesar de não totalmente esclarecido, o entendimento fisiopatológico dos mecanismos pelos quais podem estar associados à disseminação sistêmica do GBM é salutar para a compreensão global da doença. Além disso, esse conhecimento pode servir de base para a terapia a ser empregada diante do paciente com diagnóstico de GBM com metástase a distância.
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Humans , Central Nervous System Neoplasms/pathology , Glioblastoma/secondary , Neoplasm Metastasis/immunology , Blood-Brain Barrier/pathology , Central Nervous System Neoplasms/immunology , Glioblastoma/immunology , ImmunocompetenceABSTRACT
Objective: To investigate the effect of different organ metastases on clinical prognosis in patients with small cell lung cancer (SCLC). Methods: A total of 10 347 SCLC patients with distant metastases (M1) obtained from the surveillance, epidemiology, and end results (SEER) database between 2010 and 2013 were enrolled in this study. The median duration of follow-up was 4 months and the median age was 67 years. According to metastatic sites, the patients were divided into six groups: bone metastasis group, brain metastasis group, liver metastasis group, lung metastasis group, none group (no metastasis found in the bone, brain, liver or lung) and multi-organ metastasis (MOM) group (2 or more organ metastases found in the bone, brain, liver or lung). The effects of different organ metastases on clinical prognosis in SCLC patients were analyzed. Results: MOM was the most common pathway of metastasis, accounting for 32.8% (3 396/10 347), followed by liver metastasis (19.0%, 1 971/10 347), brain metastasis (12.1%, 1 251/10 347) and bone metastasis (10.0%, 1 033/10 347). The mortality rates associated with bone, brain, liver and lung metastases and MOM were 77.2% (797/1 033), 74.1% (927/1 251), 82.4% (1 625/1 971), 73.4% (504/687), and 81.6% (2 770/3 396), respectively. Compared with the none group, the MOM and liver metastasis groups had higher hazard ratio (HR) (95% confdence interval [CI] of 1.80 (1.66-1.96) and 1.69 (1.54-1.85), respectively, followed by bone and brain metastasis groups with HR (95% CI) of 1.24 (1.12-1.39) and 1.28 (1.16-1.42) (all P<0.001). Lung metastasis group had a lowest HR (95% CI) of 1.07 (0.95-1.21) (P = 0.27). Conclusion: MOM and liver metastases are associated with the worst prognosis and the highest mortality in SCLC patients, followed by bone, brain and lung metastases. Therefore, for the SCLC patients with distant metastasis, different treatments should be carried out according to involved organs, and treatment should be strengthened in patients with liver metastasis and MOM.
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Objective To identify risk factors for local recurrence and distant metastasis in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).Methods We retrospectively reviewed 269 patients with UTUC who had performed RNU from 2003 to 2013 in the Affiliated Hospital of Qingdao University.158 were males and 111 were females,aged range from 37 to 86 years old,left side were 144 cases and right side were 125 cases,157 cases occurred in renal pelvis and 112 cases in ureter,the diameter of tumor ＞ 3 cm were 163 cases,≥ pT3 stage were 143 cases,presence of lymphovascular invasion (LVI) were 35 cases,high grade tumors (G3) were 185 cases,presence of hydronephrosis were 185 cases,multifocal tumors were 28 cases,sessile tumors were 86 cases,neutrophil to lymphocyte ratio(NLR) ≥ 2.0 were 109 cases,estimated glomerular filtration rate (eGFR) ＜ 60ml/(min · 1.73 m2) were 62 cases,plasma fibrinogen ≥3.2 g/L were 129 cases.Univariate and multivariate analyses were performed to identify independent prognostic factors for local recurrence-free survival (IRFS) and distant metastasis-free survival (dMFS).Results The median follow-up was 43.8 months (range 4.4-131.8).30 patients had a local recurrence with a median intermittent period of 19.4 months (range 4.3-71.3).35 patients had a distant metastasis with a median intermittent period of 17.7 months (range 4.1-51.4).In univariate analysis,sessile tumor(P =0.041),tumor multifocality (P =0.027),location in ureter (P =0.001),presence of LVI (P＜0.001),≥pT3 stage(P ＜0.001),eGFR ＜60ml/(min · 1.73 m2) (P =0.009) and plasma fibrinogen ≥ 3.2 g/L (P ＜ 0.001) were associated with lRFS.While high-grade tumor (G3) (P =0.012),sessile tumor (P ＜ 0.001),presence of LVI (P ＜ 0.001),presence of hydronephrosis (P =0.046),and NLR ≥2.0 (P =0.002) were associated with dMFS.Multivariate analysis revealed that location in ureter(HR =4.835,95 ％ CI 1.792-13.044,P =0.002),presence of LVI (HR =5.037,95 ％ CI 2.183-11.230,P ＜ 0.001),≥pT3 stage(HR =2.987,95％ CI 1.078-8.283,P =0.035) and plasma fibrinogen ≥3.20g/L (HR =4.281,95 ％ CI 1.454-12.603,P =0.008) were independent factors for lRFS.Sessile tumor (HR =6.097,95％ CI 2.536-14.660,P ＜ 0.001),presence of LVI (HR =4.191,95％ CI 2.035-8.633,P ＜ 0.001),and NLR ≥2.0 (HR =2.741,95％ CI 1.128-6.657,P =0.026) were independent factors for dMFS.We stratified patients into three risk groups of LR and DM based on the results of the multivariate analysis respectively.The 1-year,3-year,5-year lRFS rates were 99.0％,96.8％,95.0％ in the low-risk group;94.5％,91.2％,87.6％ in the intermediate-risk group;and 77.8％,58.8％,58.8％ in the high-risk group.The differences among groups were significant (P ＜ 0.001).The 1-year,3-year,5-year dMFS rates were 98.4％,97.6％,96.0％ in the low-risk group,88.0％,73.8％,71.8％ in the intermediate-risk group,and 63.7％,42.9％,28.5％ in the high-risk group.The differences among groups were significant as well(P ＜ 0.001).Conclusion Location in ureter,presence of LVI,≥ pT3 stageand plasma fibrinogen ≥3.2 g/L were independent factors for lRFS.Sessile tumor,presence of LVI,and NLR ≥ 2.0 were independent factors for dMFS.The risk stratification models may be useful for identifying the patients with high risk of LR/DM after surgery.
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PURPOSE: Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure. METHODS: The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group. RESULTS: Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively). CONCLUSION: Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.
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Humans , Adenocarcinoma , Capecitabine , Carcinoembryonic Antigen , Chemoradiotherapy , Lung , Lymph Nodes , Neoadjuvant Therapy , Neoplasm Metastasis , Rectal NeoplasmsABSTRACT
Background@#Breast cancer is the second most common malignancy globally. This study is a systematic review and meta-analysis assessing whole-body PET/CT using 18F-FDG in detecting breast carcinoma distant metastases as an update to the study of Xu et al.@*Objective@#To determine the diagnostic accuracy of whole-body PET/CT in distant metastasis detection among breast cancer patients.@*Methods@#The MEDLINE database was systematically searched for articles evaluating whole-body PET/CT in distant metastasis detection among breast cancer patients. Sensitivity, specificity, likelihood ratios and predictive values were derived by the three independent readers. Summary receiver operating characteristic curves were plotted.@*Results@#Fifteen studies (n=4175) were included with pooled sensitivities, specificities, positive and negative likelihood ratios, positive and negative predictive values (with 95% confidence intervals) of 0.98 (0.97-0.99), 0.98 (0.98-0.99), 86.6 (63.6-117.9), 0.01 (0.01-0.02), 0.94 (0.92-0.95) and 0.99 (0.995-0-.998), respectively. Pooled positive and negative predictive values with a prevalence of 13.6% are 0. 93 and 0.99, respectively.@*Conclusion@#Whole-body PET/CT with 18F-FDG provides excellent detection of distant metastases in breast cancer and is recommended in assessing patients in earlier stages of the disease, not only in the later stages, especially in more aggressive tumors.
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Fluorodeoxyglucose F18 , Carcinoma , Meta-Analysis , Breast NeoplasmsABSTRACT
Background & objectives: Locally advanced breast cancer (LABC) is associated with substantial risk of occult metastases. The patients with LABC have high rate of systemic relapse, suggesting inadequacy of the current conventional staging in detecting the occult metastatic spread. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) is a new modality in the staging of breast cancer patients. Hence, this study was conducted to evaluate the role of 18F-FDG PET/CT in initial staging of LABC and to compare it with conventional methods. Methods: This prospective study included biopsy-confirmed female patients diagnosed with LABC meeting the selection criteria and attending surgical, medical and radiation oncology departments of a tertiary care centre in south India, from April 2013 to December 2014. Conventional workup included serum chemistry, mammogram, bone scan, contrast-enhanced CT (CECT) chest and upper abdomen and ultrasound abdomen and pelvis. All patients following conventional workup underwent 18F-FDG PET/CT. Results: In this study, 61 women with LABC underwent both conventional workup and 18F-FGD PET/CT. The 18F-FDG PET/CT, in comparison to conventional workup, revealed unsuspected N3 nodal disease in 11 more patients, revealed distant metastasis in seven more patients and also detected extra sites of metastasis in five patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT to detect distant metastasis were 95, 98, 95, 98 and 97 per cent, respectively, whereas the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional imaging to detect distant metastasis were 65, 93, 81, 84 and 84 per cent, respectively. Interpretation & conclusions: The 18F-FDG PET/CT was found to be more accurate than conventional imaging for staging and modified stage and treatment in 30 and 38 per cent of patients, respectively. It was particularly useful in detecting occult distant metastasis and N3 nodal disease with an added advantage of examining whole body in single session. However, CECT chest was superior over 18F-FDG PET/CT for detecting pulmonary metastasis.