Large Cell Neuroendocrine Tumor Size >3 cm Negatively Impacts Long-Term Outcomes After R0 Resection

Background. The optimal radical surgical approach for rectal neuroendocrine tumor (NET) is unknown. Methods. This study evaluated the short- and long-term outcomes of 27 patients who underwent robotic radical surgery for rectal NET between 2011 and 2019. Results. The median distance from the lower border of the tumor to the anal verge was 5.0 cm. The median tumor size was 9.5 mm. Six patients (22%) had lymph node metastasis. The incidences of postoperative complications of grade II and grade III or more according to the Clavien–Dindo classification were 11% and 0%, respectively. All patients underwent sphincter-preserving surgery, and no patients required conversion to open surgery. The median follow-up time was 48.9 months, and both the 3-year overall survival and relapse-free survival rates were 100%. Conclusions. Short- and long-term outcomes of robotic surgery for rectal NET tumor were favorable. Robotic surgery may be a useful surgical approach for rectal NET.

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Long-term outcomes of patients with advanced-stage cutaneous T-cell lymphoma and large cell transformation

Blood ◽

10.1182/blood-2008-05-154609 ◽

2008 ◽

Vol 112 (8) ◽

pp. 3082-3087 ◽

Cited By ~ 103

Author(s):

Suzanne O. Arulogun ◽

H. Miles Prince ◽

Jonathan Ng ◽

Stephen Lade ◽

Gail F. Ryan ◽

...

Keyword(s):

De Novo ◽

Cell Transformation ◽

Early Stage ◽

Large Cell ◽

Tumor Stage ◽

Advanced Stage ◽

Long Term Outcomes ◽

Stage Disease ◽

Large Cell Transformation

Abstract Although mycosis fungoides (MF) is typically an indolent disease, patients with advanced-stage disease (stages IIB-IVB), including Sézary syndrome (SS), often have a poor outcome. A 31-year, retrospective analysis of our cutaneous lymphoma database, of 297 patients with MF and SS, was undertaken to study long-term outcomes and identify clinical predictors of outcome in patients with advanced-stage disease (ASD, n = 92) and large cell transformation (LCT, n = 22). Two-thirds of patients with ASD presented with de novo ASD. The median overall survival (OS) for ASD was 5 years with a 10-year predicted OS of 32%. Age at initial diagnosis (P = .01), tumor stage (P = .01), and clinical stage (P = .001) were found to be significant predictors of outcome. Patients who presented with de novo ASD demonstrated better outcomes that were not statistically significant than those with a prior diagnosis of early-stage MF (P = .25). Transformation developed in 22 of the 297 MF/SS patients (7.4%), with a transformation rate of only 1.4% in patients with early-stage disease, compared with stage IIB (27%) and stage IV (56%-67%) disease. The median OS from diagnosis of LCT was 2 years. We confirm that the incidence of LCT is strongly dependent on tumor stage at diagnosis, and we demonstrate a much lower overall risk of LCT than previously reported.

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Five-year Long-term Outcomes of Stereotactic Body Radiation Therapy for Operable Versus Medically Inoperable Stage I Non–small-cell Lung Cancer: Analysis by Operability, Fractionation Regimen, Tumor Size, and Tumor Location

Clinical Lung Cancer ◽

10.1016/j.cllc.2018.09.004 ◽

2019 ◽

Vol 20 (1) ◽

pp. e63-e71 ◽

Cited By ~ 9

Author(s):

Caitlin A. Schonewolf ◽

Marina Heskel ◽

Abigail Doucette ◽

Sunil Singhal ◽

Melissa A. Frick ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Tumor Size ◽

Stereotactic Body Radiation Therapy ◽

Tumor Location ◽

Small Cell ◽

Small Cell Lung ◽

Long Term Outcomes ◽

Fractionation Regimen

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PS02.098: LONG-TERM OUTCOMES OF ADDITIONAL THERAPY FOLLOWING ENDOSCOPIC RESECTION FOR T1B-SM ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.098 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 148-149

Author(s):

Tsuyoshi Tanaka ◽

Masaki Ueno ◽

Toshiro Iizuka ◽

Shu Hoteya ◽

Shusuke Haruta ◽

...

Keyword(s):

Esophageal Cancer ◽

Tumor Size ◽

Vascular Invasion ◽

Lymphatic Invasion ◽

Additional Treatment ◽

Long Term Outcomes ◽

Free Survival ◽

Risk Factors For Recurrence ◽

Recurrent Patterns

Abstract Background Esophagectomy is the standard treatment strategy for superficial esophageal cancer diagnosed as pT1b(sm) following endoscopic resection (EMR/ESD). However, chemoradiotherapy (CRT) is expected to be an alternative treatment option. This study retrospectively compared the long-term outcomes of surgery and CRT as additional treatments for EMR/ESD pT1b esophageal cancer. Methods In a retrospective single-center study, the data of 83 consecutive patients who underwent EMR/ESD and were diagnosed with pT1b(sm) from January 2002 to December 2013 were collected, and additional treatment was administered to 59 of these patients (26 surgery and 33 CRT). Long-term outcomes, recurrent patterns, and risk factors for recurrence were analyzed. Results Median patient age was 63 (range, 43–79) years, and male/female ratio was 54:5. Tumor characteristics were as follows: location, Ce/Ut/Mt/Lt/Ae/EG = 1/6/32/13/3/4; median size, 25 (range, 5–88) mm; depth, sm1/sm2 = 18/41; vascular invasion (ly, v), + / − = 37/22; and cut end (HM, VM), + or × / − = 17/42. Sex, Charlson comorbidity index, tumor size, macroscopic type, cut end, and resection state were not different between the two groups. Meanwhile, age, tumor location, histological type, tumor depth, and vascular invasion were different between the two groups. The 5-year survival rates (relapse-free survival rate; RFS) were 92.3% (92.3%; RFS) and 80.3% (70.4%; RFS) in the surgery and CRT groups, respectively. The surgery group was significantly superior to the CRT group in terms of RFS (P = 0.042). All tumor recurrence was observed in the CRT group (P = 0.030). Recurrent patterns were as follows: hematogenous metastases (lung, bone, and adrenal gland) in three patients and lymph node metastases (four regional and an extra-regional) in four patients. In multivariate analysis, tumor size (P = 0.048) and lymphatic invasion (P = 0.032) were revealed as significant risk factors for recurrence in the CRT group. Conclusion Surgery is recommended as the additional treatment for ESD/EMR-pT1b esophageal cancer for better recurrent-free survival. Although CRT could be an acceptable treatment choice, the indication should be carefully decided, particularly in cases with large tumor size or lymphatic invasion. Disclosure All authors have declared no conflicts of interest.

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Effect of vascular resection for perihilar cholangiocarcinoma: a systematic review and meta-analysis

PeerJ ◽

10.7717/peerj.12184 ◽

2021 ◽

Vol 9 ◽

pp. e12184

Author(s):

Yong Liu ◽

Guangbing Li ◽

Ziwen Lu ◽

Tao Wang ◽

Yang Yang ◽

...

Keyword(s):

Mortality Rate ◽

Meta Analysis ◽

Postoperative Mortality ◽

Morbidity Rate ◽

R0 Resection ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Short And Long Term

Objective To evaluate the effect of vascular resection (VR), including portal vein resection (PVR) and hepatic artery resection (HAR), on short- and long-term outcomes in patients with perihilar cholangiocarcinoma (PHC). Background Resection surgery and transplantation are the main treatment methods for PHC that provide a chance of long-term survival. However, the efficacy and safety of VR, including PVR and HAR, for treating PHC remain controversial. Methods This study was registered at the International Prospective Register of Systematic Reviews (CRD42020223330). The EMBASE, PubMed, and Cochrane Library databases were used to search for eligible studies published through November 28, 2020. Studies comparing short- and long-term outcomes between patients who underwent hepatectomy with or without PVR and/or HAR were included. Random- and fixed-effects models were applied to assess the outcomes, including morbidity, mortality, and R0 resection rate, as well as the impact of PVR and HAR on long-term survival. Results Twenty-two studies including 4,091 patients were deemed eligible and included in this study. The meta-analysis showed that PVR did not increase the postoperative morbidity rate (odds ratio (OR): 1.03, 95% confidenceinterval (CI): [0.74–1.42], P = 0.88) and slightly increased the postoperative mortality rate (OR: 1.61, 95% CI [1.02–2.54], P = 0.04). HAR did not increase the postoperative morbidity rate (OR: 1.32, 95% CI [0.83–2.11], P = 0.24) and significantly increased the postoperative mortality rate (OR: 4.20, 95% CI [1.88–9.39], P = 0.0005). Neither PVR nor HAR improved the R0 resection rate (OR: 0.70, 95% CI [0.47–1.03], P = 0.07; OR: 0.77, 95% CI [0.37–1.61], P = 0.49, respectively) or long-term survival (OR: 0.52, 95% CI [0.35–0.76], P = 0.0008; OR: 0.43, 95% CI [0.32–0.57], P < 0.00001, respectively). Conclusions PVR is relatively safe and might benefit certain patients with advanced PHC in terms of long-term survival, but it is not routinely recommended. HAR results in a higher mortality rate and lower overall survival rate, with no proven benefit.

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Case Report: Grade 2 Metastatic Pancreatic Neuroendocrine Tumor With Progression of One Metastasis After Pregnancy to Grade 3 Large-Cell Neuroendocrine Carcinoma: One Case Cured by Resection With Genomic Characterization of the Two Components

Frontiers in Oncology ◽

10.3389/fonc.2021.646992 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jean-Luc Raoul ◽

Marie-Françoise Heymann ◽

Frédéric Dumont ◽

Alain Morel ◽

Hélène Senellart ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Pancreatic Neuroendocrine Tumor ◽

Large Cell ◽

Genomic Signatures ◽

Pancreatic Net ◽

Genomic Characterization ◽

Poorly Differentiated ◽

Grade 3

Temporal and spatial tumor heterogeneity can be observed in pancreatic neuroendocrine tumor. We report the case of a young woman with long term stabilization of a G2 metastatic pancreatic NET that, after pregnancy, suddenly progressed into one single liver metastasis corresponding to a transformation into G3 large-cell neuroendocrine cancer. The patient underwent liver resection (the progressive and one dormant metastasis). With a 45 months follow-up the patient is without evolutive disease. Exome sequencing of the two metastases revealed completely different genomic signatures and gene alterations: the dormant metastasis was MSS without any gene alteration; the poorly differentiated tumor was MSI, with gain of many mutations including MEN1, BCL2, MLH1 and TP53 corresponding to a mutational signature 11. Could temozolomide play a role in this transformation?

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Is three years duration of adjuvant imatinib mesylate treatment sufficient for patients with high-risk gastrointestinal stromal tumor? A study based on long-term follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.130 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 130-130

Author(s):

JianXian Lin

Keyword(s):

High Risk ◽

Imatinib Mesylate ◽

Protective Factor ◽

Linear Regression Analysis ◽

R0 Resection ◽

Imatinib Treatment ◽

Long Term Outcomes ◽

Term Survival ◽

Risk Patients

130 Background: The therapy for gastrointestinal stromal tumors (GIST) has changed significantly since the use of Imatinib Mesylate (IM). However, the appropriate duration of receiving adjuvant IM for patients with high-risk GIST who underwent R0 resection is still controversial. Methods: From Jan. 2005 to Dec. 2014, 234 patients who underwent R0 resection and were treated with adjuvant IM were identified from a database. The effect of the medication duration on the long-term outcomes was analyzed. Results: In this study, the 5 year recurrence-free survival (RFS) rate and overall survival (OS) rate in the whole groups were 76.2% and 83.4%, respectively. The patient's prognosis was improved due to the prolongation of the time of receiving the Imatinib treatment (P < 0.05). According to the risk stratification analysis, the survival of the moderate-risk patients who received IM adjuvant therapy for 1 year, 1-3 years and more than 3 years showed improved, but the difference was not statistically significant (P > 0.05). However, in the high-risk patients, the RFS rates of the 1 year group, 1-3 years group, 3-5 years group and more than 5 years group were 36.5%, 68.7%, 71.2% and 90.8%, respectively, and the OS rates were 36.7%,76.6%, 84.0% and 97.4%, respectively (P < 0.001). Additionally, linear regression analysis showed that the long-term outcomes of patients with high-risk GIST significantly improved due to prolonged adjuvant IM treatment durations (P < 0.05). The RFS rate of patients receiving IM more than 5 years was significantly better than those receiving it for less than 5 years. Multivariate analysis in the patients with high-risk GIST showed that tumor located in small intestine was an independent risk factor, while receiving IM treatment was an independent protective factor for prognosis. Conclusions: The long-term outcomes of patients with high risk GIST improved due to the prolongation of the IM treatment. To reduce the recurrence and improve the long-term survival, we suggest that patients with high-risk GIST receive Imatinib treatment for at least 5 years.

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Clinical characteristics of nonosteogenic, non-Ewing’s sarcoma of the bone: Experience at the Toronto Sarcoma Program.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11029 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11029-11029

Author(s):

Zachary William Neil Veitch ◽

Peter Charles Ferguson ◽

Anthony Griffin ◽

Kanan Alshammari ◽

Esmail Mutahar Al-Ezzi ◽

...

Keyword(s):

Tumor Size ◽

Clinical Characteristics ◽

Malignant Tumors ◽

Osteogenic Sarcoma ◽

Tumor Location ◽

R0 Resection ◽

Data Series ◽

High Grade ◽

Term Survival

11029 Background: Non-osteogenic sarcoma of the bone is a rare entity comprising a heterogenous group of malignant tumors. Clinical characteristics and outcome data are sparse in the literature. We evaluated the characteristics and long-term outcomes of patients (pts) with this disease. Methods: Pts with non-osteogenic sarcoma of the bone treated at the Toronto Sarcoma Program from 1987-2017 were identified from our institutional sarcoma database. Patient characteristics (ie: age, gender, tumor size, histology, grade, necrosis, tumor location), treatment modality (ie: surgical management, chemotherapy, radiotherapy), and survival information were collected. Survival was estimated by Kaplan-Meier (log-rank). Multi-variate analysis (MVA) was used to evaluate characteristics for sarcoma specific survival. Results: Of 130 pts identified, 106 had non-metastatic disease with a median age of 46 (range 18-89). Male-to-female predominance was 1.5:1. Common histologies were undifferentiated pleomorphic sarcoma (UPS; 42%), leiomyosarcoma (21%), and fibrosarcoma (11%). Tumors were generally high grade (59%) and > 5 cm in size (73%). The majority of pts received chemotherapy (68%), with Cisplatin/Doxorubicin based regimens (95%). R0 resection was achieved in 85% of cases. Survival for the entire cohort, showed a median (m)DFS of 8.13 years (95%CI:2.52-18.02), and a mOS of 11.72 (95%CI:7.00-not reached [NR]). Median sarcoma specific survival was NR, however 15- and 25-year survivals were 60.4% and 52.6% respectively. MVA demonstrated axial tumor location (HR = 13.03; p = 0.005), no chemotherapy (HR = 4.50; p = 0.017) and tumor grade (G2: HR = 36.21; p = 0.012; G3: HR = 20.30; p = 0.015) as risk factors for sarcoma specific death. Tumor size > 10cm (p = 0.085) and necrosis > 90% (p = 0.082) trended towards significance. Conclusions: Non-osteogenic sarcoma of the bone is a rare tumor entity, with a predominant UPS histology. Patient outcomes are reasonable, with measurable long-term survival. Axial tumor location, absence of chemotherapy, and high-grade disease predict for worse survival outcome. Further evaluation with larger data series is warranted to more fully understand this disease.

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