Ipsilateral breast tumor recurrence in early stage breast cancer patients treated with breast conserving surgery and adjuvant radiation therapy: Concordance of biomarkers and tumor location from primary tumor to in-breast tumor recurrence

BACKGROUND Patients with an in-breast tumor recurrence(IBTR)after breast-conserving therapy have a high risk of distant metastasis and disease-related mortality.Classifying clinical parameters that increase risk for recurrence after IBTR remains a challenge.AIM To describe primary and recurrent tumor characteristics in patients who experience an IBTR and understand the relationship between these characteristics and disease outcomes.METHODS Patients with stage 0-II breast cancer treated with lumpectomy and adjuvant radiation were identified from institutional databases of patients treated from 2003-2017 at our institution.Overall survival(OS),disease-free survival,and local recurrence-free survival(LRFS)were estimated using the Kaplan Meier method.We identified patients who experienced an isolated IBTR.Concordance of hormone receptor status and location of tumor from primary to recurrence was evaluated.The effect of clinical and treatment parameters on disease outcomes was also evaluated.RESULTS We identified 2164 patients who met the eligibility criteria.The median follow-up for all patients was 3.73[interquartile range(IQR)2.27-6.07]years.Five-year OS was 97.7%(95%CI:96.8%-98.6%)with 28 deaths;5-year LRFS was 98.0%(97.2-98.8)with 31 IBTRs.We identified 37 patients with isolated IBTR,19(51.4%)as ductal carcinoma in situ and 18(48.6%)as invasive disease,of whom 83.3%had an in situ component.Median time from initial diagnosis to IBTR was 1.97(IQR:1.03-3.5)years.Radiotherapy information was available for 30 of 37 patients.Median whole-breast dose was 40.5 Gy and 23 patients received a boost to the tumor bed.Twenty-five of thirty-two(78.1%)patients had concordant hormone receptor status,HER-2 receptor status,and estrogen receptor(ER)(P=0.006)and progesterone receptor(PR)(P=0.001)status from primary to IBTR were significantly associated.There were no observed changes in HER-2 status from primary to IBTR.The concordance between quadrant of primary to IBTR was 10/19[(62.2%),P=0.008].Tumor size greater than 1.5 cm(HR=0.44,95%CI:0.22-0.90,P=0.02)and use of endocrine therapy upfront(HR=0.36,95%CI:0.18-0.73,P=0.004)decreased the risk of IBTR.CONCLUSION Among patients with early stage breast cancer who had breast conserving surgery treated with adjuvant RT,ER/PR status and quadrant were highly concordant from primary to IBTR.Tumor size greater than 1.5 cm and use of adjuvant endocrine therapy were significantly associated with decreased risk of IBTR.

Prognostic impact and reasons for variability by tumor location in gastric cancer

BACKGROUND Gastric cancer(GC)is a highly prevalent gastrointestinal tract tumor.Several trials have demonstrated that the location of GC can affect patient prognosis.However,the factors determining tumor location remain unclear.AIM To investigate the tumor location of patients,we went on to study the influencing factors that lead to changes in the location of GC.METHODS A retrospective evaluation was carried out on 3287 patients who underwent gastrectomy for GC in Zhejiang Cancer Hospital.The patients were followed up post-diagnosis and post-gastrectomy.The clinicopathological variables and overall survival of the patients were recorded.By analyzing the location of GC,the tumor location was divided into four categories:“Upper”,“middle”,“lower”,and“total”.Statistical software was utilized to analyze the relationship of each variable with the location of GC.RESULTS A total of 3287 patients were included in this study.The clinicopathological indices of gender,age,serum levels of carcinoembryonic antigen(CEA),carbohydrate antigen(CA19-9)and CA72-4 levels,were significantly associated with tumor location in patients with GC.In addition,there was a strong correlation between GC location and the prognosis of postoperative patients.Specifically,patients with“lower”and“middle”GC demonstrated a better prognosis than those with tumors in other categories.CONCLUSION The five clinicopathological indices of gender,age,CEA,CA19-9 and CA72-4 levels exhibit varying degrees of influence on the tumor location.The tumor location correlates with patient prognosis following surgery.

In situ injectable hydrogel encapsulating Mn/NO-based immune nano-activator for prevention of postoperative tumor recurrence

Postoperative tumor recurrence remains a predominant cause of treatment failure. In this study, we developed an in situ injectable hydrogel, termed MPB-NO@DOX + ATRA gel, which was locally formed within the tumor resection cavity. The MPB-NO@DOX + ATRA gel was fabricated by mixing a thrombin solution, a fibrinogen solution containing all-trans retinoic acid (ATRA), and a Mn/NO-based immune nano-activator termed MPB-NO@DOX. ATRA promoted the differentiation of cancer stem cells, inhibited cancer cell migration, and affected the polarization of tumor-associated macrophages. The outer MnO2 shell disintegrated due to its reaction with glutathione and hydrogen peroxide in the cytoplasm to release Mn2+ and produce O2, resulting in the release of doxorubicin (DOX). The released DOX entered the nucleus and destroyed DNA, and the fragmented DNA cooperated with Mn2+ to activate the cGAS-STING pathway and stimulate an anti-tumor immune response. In addition, when MPB-NO@DOX was exposed to 808 nm laser irradiation, the Fe-NO bond was broken to release NO, which downregulated the expression of PD-L1 on the surface of tumor cells and reversed the immunosuppressive tumor microenvironment. In conclusion, the MPB-NO@DOX + ATRA gel exhibited excellent anti-tumor efficacy. The results of this study demonstrated the great potential of in situ injectable hydrogels in preventing postoperative tumor recurrence.

Tumor recurrence and survival prognosis in patients with advanced gastric cancer after radical resection with radiotherapy and chemotherapy

BACKGROUND Advanced gastric cancer is a common malignancy that is often diagnosed at an advanced stage and is still at risk of recurrence after radical surgical treatment.Chemoradiotherapy,as one of the important treatment methods for gastric cancer,is of great significance for improving the survival rate of patients.However,the tumor recurrence and survival prognosis of gastric cancer patients after radio-therapy and chemotherapy are still uncertain.AIM To analyze the tumor recurrence after radical radiotherapy and chemotherapy for advanced gastric cancer and provide more in-depth guidance for clinicians.METHODS A retrospective analysis was performed on 171 patients with gastric cancer who received postoperative adjuvant radiotherapy and chemotherapy in our hospital from 2021 to 2023.The Kaplan-Meier method was used to calculate the recurrence rate and survival rate;the log-rank method was used to analyze the single-factor prognosis;and the Cox model was used to analyze the prognosis associated with multiple factors.RESULTS The median follow-up time of the whole group was 63 months,and the follow-up rate was 93.6%.Stage Ⅱ and Ⅲ patients accounted for 31.0%and 66.7%,respec-tively.The incidences of Grade 3 and above acute gastrointestinal reactions and hematological adverse reactions were 8.8%and 9.9%,respectively.A total of 166 patients completed the entire chemoradiotherapy regimen,during which no adverse reaction-related deaths occurred.In terms of the recurrence pattern,17 patients had local recurrence,29 patients had distant metastasis,and 12 patients had peritoneal implantation metastasis.The 1-year,3-year,and 5-year overall survival(OS)rates were 83.7%,66.3%,and 60.0%,respectively.The 1-year,3-year,and 5-year disease-free survival rates were 75.5%,62.7%,and 56.5%,respectively.Multivariate analysis revealed that T stage,peripheral nerve invasion,and the lymph node metastasis rate(LNR)were independent prognostic factors for OS.CONCLUSION Postoperative intensity-modulated radiotherapy combined with chemotherapy for gastric cancer treatment is well tolerated and has acceptable adverse effects,which is beneficial for local tumor control and can improve the long-term survival of patients.The LNR was an independent prognostic factor for OS.For patients with a high risk of local recurrence,postoperative adjuvant chemoradiation should be considered.

High Expression of p300 in Human Breast Cancer Correlates with Tumor Recurrence and Predicts Adverse Prognosis

Objective：Transcriptional coactivator p300 has been shown to play a variety of roles in the transcription process and mutation of p300 has been found in certain types of human cancers.However,the expression dynamics of p300 in breast cancer （BC） and its effect on BC patients＇ prognosis are poorly understood.Methods：In the present study,the methods of tissue microarray and immunohistochemistry （IHC） were used to investigate the protein expression of p300 in BCs.Receiver operating characteristic （ROC） curve analysis,Spearman＇s rank correlation,Kaplan-Meier plots and Cox proportional hazards regression model were utilized to analyze the data.Results：Based on the ROC curve analysis,the cutoff value for p300 high expression was defined when the H score for p300 was more than 105.High expression of p300 could be observed in 105/193 （54.4%） of BCs,in 6/25 （24.0%） of non-malignant breast tissues,respectively （P=0.004）.Further correlation analysis showed that high expression of p300 was positively correlated with higher histological grade,advanced clinical stage and tumor recurrence （P0.05）.In univariate survival analysis,a significant association between high expression of p300 and shortened patients＇ survival and poor progression-free survival was found （P0.05）.Importantly,p300 expression was evaluated as an independent prognostic factor in multivariate analysis （P0.05）.Conclusion：Our findings provide a basis for the concept that high expression of p300 in BC may be important in the acquisition of a recurrence phenotype,suggesting that p300 high expression,as examined by IHC,is an independent biomarker for poor prognosis of patients with BC.

Risk factors of gastric cancer specific for tumor location and histology in Cali,Colombia

AIM- To examine histology- and tumor-location specific risk factors of gastric cancer （GC）.METHODS： This was subjects were 216 GC the period 2000-2002 non-cancer patients hospital. We obtained habits, and others by a a case-control study. The study patients newly diagnosed during and 431 controls selected from matching in age, gender, and information on lifestyles, dietary questionnaire.RESULTS： The subjects who were not eldest among his/her siblings were at a slightly elevated GC risk （OR 1.3; 95% CI 0.8-2.0）. Salting meals before tasting was related to an increased GC risk （OR 3.5; 95% CI 1.6- 7.3）. Frequent consumptions of fruits （OR 0.3; 95% CI 0.1-1.0） and vegetables （OR 0.3; 95% CI 0.1-1.0） were related to decreased GC risks. On the other hand, frying foods （OR 1.9; 95% CI 1.0-3.6） and cooking with coal （OR 1.8; 95% CI 1.3-2.6） were related to increased GC risks. Neither Lauren＇s histological classification （intestinal and diffuse types） nor tumor location significantly affected those associations except birth order. The subjects who were not eldest among his/her siblings had an increased risk of GCs in the distal and middle thirds, and their ORs were 1.7 （95% CI 1.0-2.8） and 1.9 （95% CI 0.8-4.3）, respectively. The corresponding OR in the upper third stomach was 0.3 （95% CI 0.1-0.9）. The differences of those three ORs were statistically significant （P = 0.010）.CONCLUSION： The present study shows that birth order, salt intake, consumption of fruits and vegetables, the type of cooking, and cigarette smoking are related to GC risk. In histology and tumor-location specific analyses, non-eldest person among their siblings is related to an increased GC risk in the distal and middle thirds of the stomach, and is related to a decreased GC risk in the cardia.

Liver transplantation for hepatocellular carcinoma on cirrhosis:Strategies to avoid tumor recurrence

Hepatocellular carcinoma(HCC) is one of the most frequent neoplasms worldwide and in most cases it is associated with chronic liver disease.Liver transplantation(LT) is potentially the optimal treatment for those patients with HCC who have a poor functional hepatic reserve due to their underlying chronic liver disease.However,due to the limited availability of donors,only those patients whose oncologic profile is favorable can be considered for LT.Despite the careful selection of candidates based on strict rules,10 to 20%of liver transplant recipients who have HCC in the native cirrhotic liver develop tumor recurrence after transplantation.The selection criteria presently employed to minimize the risk of recurrence are based on gross tumor characteristics defined by imaging techniques;unfortunately,the accuracy of imaging is far from being optimal.Furthermore,microscopic tumor features that are strictly linked with prognosis can not be assessed prior to transplantation.Pre-transplantation tumor downstaging may allow transplantation in patients initially outside the selection criteria and seems to improve the prognosis;it also provides information on tumor biology.Themain peculiarity of the transplantation setting,when this is compared with other modalities of treatment,is the need for pharmacological immunosuppression:this is based on drugs that have been demonstrated to increase the risk of tumor development.As HCC is an aggressive malignancy,immunosuppression has to be handled carefully in patients who have HCC at the time of transplantation and new categories of immunosuppressive agents should be considered.Adjuvant chemotherapy following transplantation has failed to show any significant advantage.The aim of the present study is to review the possible strategies to avoid recurrence of HCC after liver transplantation based on the current clinical evidence and the more recent developments and to discuss possible future directions.

Influence of primary tumor location and resection on survival in metastatic colorectal cancer

BACKGROUND Patients with right sided colorectal cancer are known to have a poorer prognosis than patients with left sided colorectal cancer, whatever the cancer stage. To this day, primary tumor resection(PTR) is still controversial in a metastatic, non resectable setting.AIM To explore the survival impact of PTR in patients with metastatic colorectal cancer(mCRC) depending on PTL.METHODS We retrospectively collected data from all consecutive patients treated for mCRC at the Centre Georges Francois Leclerc Hospital. Univariate and multivariate Cox proportional hazard regression models were used to assess the influence of PTR on survival. We then evaluated the association between PTL and overall survival among patients who previously underwent or did not undergo PTR. A propensity score was performed to match cohorts.RESULTS Four hundred and sixty-six patients were included. A total of 153(32.8%) patients had unresected synchronous mCRC and 313(67.2%) patients had resected synchronous mCRC. The number of patients with right colic cancer, left colic cancer and rectal cancer was respectively 174(37.3%), 203(43.6%) and 89(19.1%). In the multivariate analysis only PTL, PTR, resection of hepatic and or pulmonary metastases and the use of oxaliplatin, EGFR inhibitors or bevacizumab throughout treatment were associated to higher overall survival rates. Survival evaluation depending on PTR and PTL found that PTR improved the prognosis of both left and right sided mCRC. Results were confirmed by using a weighted propensity score.CONCLUSION In mCRC, PTR seems to confer a higher survival rate to patients whatever the PTL.

Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke:A Prospective Cohort Study

Summary:Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence.However,the relationship between lesion locations and stroke recurrence is unclear.We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015.Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers.Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures.Flexible parametric survival models using the proportional hazards scale(PH model)were used to analyze the time-to-event data.Among 633 survivors,63.51%(n-402)had anterior circulation ischemia(ACI),and morc than half of all ACIs occurred in the subcortex.After a median follow-up of 2.5 years,117(18.48%)survivors developed a recurrent stroke.The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions(HR,2.79;95%CI,1.53,5.08;P-0.001).There was no increase in risk among survivors with left-side lesions(HR,0.97;95%CI,0.53,1.75;P=0.914)or both-side lesions(HR,1.24;95%CI,0.75,2.07;P-0.401)compared to those with right-side lesions.Additionally,there were no associations between stroke ecurrence and lesion locations that were classified based on vascular territory and brain anatomical structures.It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion,although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures.

Predicting the subcellular location of apoptosis proteins based on recurrence quantification analysis and the Hilbert Huang transform

Apoptosis proteins play an important role in the development and homeostasis of an organism. The elucidation of the subcellular locations and functions of these proteins is helpful for understanding the mechanism of programmed cell death. In this paper, the recurrent quantification analysis, Hilbert-Huang transform methods, the maximum relevance and minimum redundancy method and support vector machine are used to predict the subcellular location of apoptosis proteins. The validation of the jackknife test suggests that the proposed method can improve the prediction accuracy of the subcellular location of apoptosis proteins and its application may be promising in other fields.

Tumor size and location affect the treatment selection for solitary small recurrent hepatocellular carcinoma after initial hepatectomy

Objective:Tumor size and location may have highly important influence on the treatment choices for hepatocellular carcinoma(HCC).This study aimed to investigate the optimal treatment modality between radiofrequency ablation(RFA)and repeat hepatectomy according to tumor size and location for solitary small recurrent HCC(rHCC).

Survival at Tumor Recurrence in Soft Matter

Survival at tumor recurrence in soft matter, after chemotherapy, is assessed by RNA folding. It is shown that this recurrence is starting with development of a fluidlike globule;it changes the energy of soft matter;it proceeds as a resonant mixing;and at the end it causes diffusion. This diffusion is interpreted as metastasis in soft matter. A tumor memory is designed for its recurrence oscillations. These oscillations are marked as positive or negative according to their influence on life stabilization or destabilization. It is demonstrated that a tumor memorizes two types of recurrences. The intensity of chemotherapy in soft matter for a tumor with such memory is obtained. Survival at tumor recurrence in soft matter, after chemotherapy, is assigned to one of the five regions of the phase diagram of the “thermalized” tumor by microenvironment. To each of these regions is collated a breast cancer survival class. It is found that the survival at tumor recurrence in soft matter, after chemotherapy, well represents actual survival of 32 patients with breast cancer.

Survival Reassessment at Tumor Recurrence in Soft Matter

The paper reassesses a survival at tumor recurrence in soft matter. First, the stability of structural motifs under shear in clusters of dipolar spheres is characterized. Next, there are introduced transitions between polymer knots and rhythms of these transitions are obtained. The sensor is built for these rhythms. Treatment, with a tensile force protocol, is modeled, when the tumor in soft matter is observed by the above sensor. Survival probability, at tumor recurrence in soft matter, is defined for the treatment with a tensile force protocol. It is stated that the survival probability at a tensile force protocol treatment in soft matter confirms or specifies the prognostic survival of 32 patients with breast cancer.

Effect of autotransfusion system on tumor recurrence and survival in hepatocellular carcinoma patients

AIM:To investigate the therapeutic efficacy and safety of continuous autotransfusion system(CATS) during liver transplantation of hepatocellular carcinoma patients.METHODS:Eighty-three hepatocellular carcinoma(HCC) patients who underwent liver transplantation with intraoperative CATS(n = 24,CATS group) and without(n = 59,non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively.Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein(AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals.Inter-group differences in recurrence and correlations between demographic,clinical,and pathological data were assessed by ANOVA and χ 2 tests.Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.RESULTS:Of the 83 liver transplanted HCC patients,89.2% were male and the overall mean age was 51.3 ± 8.9 years(range:18-69 years).The CATS and nonCATS groups showed no statistically significant differences in age,sex ratio,body mass index,underlying disease,donor type,graft-to-recipient weight ratio,Child-Pugh and Model for End-Stage Liver Disease scores,number of tumors,tumor size,AFP level,Milan and University of California San Francisco selection criteria,tumor differentiation,macrovascular invasion,median hospital stay,recurrence rate,recurrence site,or mortality rate.The mean follow-up time of the nonCATS group was 17.9 ± 12.8 mo,during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients.The mean follow-up time for the CATS group was 25.8 ± 15.1 mo,during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients.There was no significant difference between the CATS and non-CATS groups in recurrence rate or site.Additionally,no significant differences existed between the groups in overall or disease-free survival.CONCLUSION:CATS is a safe procedure and may decrease the risk of tumor recurrence in HCC patients.

Impact of primary tumor volume andlocation on the prognosis of patients withlocally recurrent nasopharyngeal carcinoma

Introduction:The properties of a tumor itself were considered the main factors determining the survival of patients with locally recurrent nasopharyngeal carcinoma(NPC)treated with intensity-modulated radiotherapy(IMRT).However,recurrent tumors were mainly evaluated by using the American Joint Committee on Cancer staging system,which was modeled on primary tumors and did not incorporate the tumor volume.This study aimed to investigate the prognostic values of the primary tumor location and tumor volume,and to determine whether evaluating these parameters could improve the current staging system.Methods:Magnetic resonance(MR)images for 229 patients with locally recurrent NPC who underwent IMRT were analyzed retrospectively.Results:The skull base,parapharyngeal space,and intracranial cavity were the most common sites of tumors.There was a difference in the survival between patients with T1 and T2 diseases(77.6%vs.50.0%,P<0.01)and those with T3 and T4 diseases(33.0%vs.18.0%,P=0.04)but no difference between patients with T2 and T3 diseases(50.0%vs.33.0%,P=0.18).Patients with a tumor volume≤38 cm3had a significantly higher survival rate compared with those with a tumor volume>38 cm3(48.7%vs.15.2%,P<0.01).Conclusions:A new staging system has been proposed,with T3 tumors being down-staged to T2 and with the tumor volume being incorporated into the staging,which may lead to an improved evaluation of these tumors.This new system can be used to guide the treatment strategy for different risk groups of recurrent NPC.

Significance of ipsilateral breast tumor recurrence after breast conserving treatment: role of surgical removal

Objective： To analyze the pattern over time （dynamics） of further recurrence and death after ipsilateral breast tumor recurrence （IBTR） in breast cancer patients undergoing breast conserving treatment （BCT）. Methods： A total of 338 evaluable patients experiencing IBTR were extracted from a database of 3,293 patients undergoing BCT. The hazard rates for recurrence and mortality throughout 10 years of follow-up after IBTR were assessed and were compared to the analogous estimates associated to the primary treatment. Results： In a time frame with the time origin at the surgical treatment for IBTR, the hazard rate for further recurrence displays a bimodal pattern （peaks at the second and at the sixth year）. Patients receiving mastectomy for IBTR reveal recurrence and mortality dynamics similar to that of node positive （N＋） patients receiving mastectomy as primary surgery, apart from the first two-three years, when IBTR patients do worse. If the patients with time to IBTR longer than 2.5 years are considered, differences disappear. Conclusions： The recurrence and mortality dynamics following IBTR surgical removal is similar to the corresponding dynamics following primary tumor removal. In particular, patients with time to IBTR in excess of 2.5 years behave like N＋ patients following primary tumor removal. Findings may be suitably explained by assuming that the surgical manoeuvre required by IBTR treatment is able to activate a sudden growing phase for tumor foci most of which, as suggested by the systemic model of breast cancer, would have reached the clinical level according to their own dynamics.

Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy

AIM To evaluate the relationship between the location of hepatocellular carcinoma(HCC) and the efficacy of transarterial chemoembolization(TACE).METHODS We evaluated 115 patients(127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to m RECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center(mm)/liver diameter(mm) on multiplanar reconstruction images rendered(MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response(CR) and non-CR groups in Child-Pugh grade A and B patients.RESULTS The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients(0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups(0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups.CONCLUSION Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.

Small bowel carcinoid: Location isn’t everything!

AIM: To investigate the prognostic significance of the primary site of disease for small bowel carcinoid(SBC) using a population-based analysis.METHODS: The Surveillance,Epidemiology and End Results(SEER) database was queried for histologically confirmed SBC between the years 1988 and 2009.Overall survival(OS) and disease-specific survival(DSS) were analyzed using the Kaplan-Meier method and compared using Log rank testing.Log rank and multivariate Cox regression analyses were used to identify predictors of survival using age,year of diagnosis,race,gender,tumor histology/size/location,tumor-node-metastasis stage,number of lymph nodes(LNs) examined and percent of LNs with metastases.RESULTS: Of the 3763 patients,51.2% were male with a mean age of 62.13 years.Median follow-up was 50 mo.The 10-year OS and DSS for duodenal primaries were significantly better when compared to jejunal and ileal primaries(P = 0.02 and 【 0.0001,respectively).On multivariate Cox regression analysis,after adjusting for multiple factors,primary site location was not a significant predictor of survival(P = 0.752 for OS and P = 0.966 DSS) while age,number of primaries,number of LNs examined,T-stage and M-stage were independent predictors of survival.CONCLUSION: This 21-year,population-based study of SBC challenges the concept that location of the primary lesion alone is a significant predictor of survival.

Predictive value of magnetic resonance imaging parameters combined with tumor markers for rectal cancer recurrence risk after surgery

BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.

Improving predictive accuracy of early recurrence in pancreatic ductal adenocarcinoma:Role of postoperative serum tumor markers

In a recent study by He et al,the nomogram integrates postoperative serum tumor markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen,thereby improving the accuracy of identifying high-risk patients compared to relying solely on preoperative markers,which has significant implications for customizing adjuvant therapy and potentially improving outcomes for this aggressive form of cancer.However,the study’s single-center design and short follow-up period may limit the generalizability of its findings and potentially introduce reporting bias.Future studies could consider additional confounding factors,such as adjuvant chemotherapy and variations in surgical techniques,to improve the model’s accuracy.Furthermore,it would be valuable to validate the nomogram in broader,prospective cohorts and explore the inclusion of additional markers like circulating tumor DNA to refine further its predictive power and applicability across diverse patient populations.