Association of trimodality therapy (TMT) with rate of local-regional relapse and rare luminal-only relapse for patients with esophageal and esophagogastric junction (E-EGJ) cancer: Implications for the surveillance strategy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 79-79
Author(s):  
Kazuki Sudo ◽  
Takashi Taketa ◽  
Arlene M. Correa ◽  
Maria-Claudia Campagna ◽  
Roopma Wadhwa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Median Overall Survival ◽  
Salvage Surgery ◽  
Distant Metastases ◽  
Evidence Based ◽  
Surveillance Strategy ◽  
Trimodality Therapy ◽  
Kaplan Meier

79 Background: For local-regional E-EGJ cancer patients, the preferred therapy is chemoradiation (CTRT) followed by surgery (TMT). Following TMT, esophagogastroduodenoscopy (EGD) and imaging studies are routinely performed but the literature lacks guidance for an evidence-based surveillance strategy. Methods: Between 2000 and 2010, 579 patients with local-regional E-EGJ cancer underwent TMT. We reviewed the patterns of relapse over time. Local-regional relapse was classified as regional or luminal-only. Overall survival was estimated by the Kaplan-Meier method. Results: For 579 patients, the median follow-up time was 57.4 months (95% confidence interval [CI]: 51.5-63.3 months). First relapses were as follows: 199 patients (34.4%) with distant metastases and 33 (5.7%) with local-regional relapse (of these only 10 [or 1.7% of 579] had a luminal-only relapse). 3 out of 33 patients underwent salvage surgery and survived >2 years from relapse. Sixteen out of 33 patients received CTRT and only 4 survived >2 years. Therefore, 7 (21% of patients with local-regional relapse or 1.2% of 579 patients) survived >2 years. For the 33 patients with local-regional relapse, the median overall survival from relapse was 15.3 months (95% CI: 11.0-19.6). Conclusions: After TMT therapy, local-regional relapses are uncommon (<6%) and luminal-only relapses are even rare (<2%). 91% of local-regional relapses occur within 3 years of surgery. Only 7 (1.2% of 579) patients survived > 2 years despite therapy. These data can contribute to an evidence-based surveillance strategy for E-EGJ cancer patients after TMT. Supported by UTMDACC and generous donors.

Association of relapse in patients with esophageal and esophagogastric junction (E-EGJ) cancer with surgical stage after trimodality therapy (TMT): Implications for customized surveillance.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 95-95
Author(s):  
Maria-Claudia Campagna ◽  
Takashi Taketa ◽  
Arlene M. Correa ◽  
Kazuki Sudo ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cancer Patients ◽  
Esophagogastric Junction ◽  
Distant Metastases ◽  
Evidence Based ◽  
Surveillance Strategy ◽  
Trimodality Therapy ◽  
Regional Metastases ◽  
First Relapse

95 Background: The surveillance strategy for E-EGJ cancer patients after TMT is currently not based on evidence and varies considerably. Literature does not provide guidance. Methods: Between 2000 and 2010, 579 patients with E-EGJ cancer who underwent TMT were analyzed. The type and timing of first relapse using 12-month intervals and their association the post-TMT surgical stage. Various statistical methods were utilized. Results: For 579 patients, the median follow-up time was 57.4 months (95% confidence interval [CI], 51.5-63.3 months). A total of 232 (40%) patients had a relapse. First relapses were: distant metastases (199 patients; 34.4%) and local-regional metastases (33 patients; 5.7%). Irrespective of the surgical stage, 95% of all relapses occurred within 36 months of surgery. The timing and frequency of relapses were significantly associated with the surgical stage (see Table; stage 0 or I vs. II or III; p= <0.001). Conclusions: Our data suggest that customization of surveillance is possible based on the surgical stage after TMT. These data can contribute to the development of an evidence-based surveillance strategy. [Table: see text]

Pattern of local-regional relapse and survival after bimodality therapy for esophageal cancer: Implications for the surveillance strategy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4083-4083 ◽  
Author(s):  
Kazuki Sudo ◽  
Lianchun Xiao ◽  
Roopma Wadhwa ◽  
Takashi Taketa ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Distant Metastases ◽  
Rank Test ◽  
Evidence Based ◽  
Test Results ◽  
Surveillance Strategy ◽  
Gastroesophageal Junction Cancer ◽  
Kaplan Meier ◽  
Regional Disease

4083 Background: Evidence for definitive chemoradiotherapy (bimodality therapy [BMT]) has been established for patients with esophageal and gastroesophageal junction cancer (EGEJC) who do not qualify for surgery. Surveillance for these patients is often recommended but the literature lacks guidance for an evidence-based surveillance strategy after BMT. Methods: We analyzed 276 patients with EGEJC who underwent BMT and had pre- and postchemoradiation endoscopic biopsies and imaging studies available for review. Patients who underwent planned surgery or salvage surgery (SS) within 6 months from BMT were excluded. We reviewed the pattern of relapse over time. Local-regional disease (LRD) after BMT was classified as regional disease (RD) or luminal-only disease (LD). Overall survival (OS) probabilities were estimated using the Kaplan-Meier method and compared using the log-rank test. Results: For 276 patients, the median follow-up time was 53.0 months (95% confidence interval [CI], 47.3-58.7). A total of 184 (66.7%) patients had a persistent disease or relapse after BMT: 120 distant metastases (43.5% of 276) and 64 LRD (23.2% of 276). Of 64 LRD, 58 (91%) were diagnosed within 2 years of BMT and 63 (98%) were diagnosed within 3 years (see Table). Twenty-three of 64 LRD patients underwent SS. For patients with SS, the median OS time from diagnosis of LRD was 58.0 months (95% CI, not reached), and that for patients without SS was 9.0 months (95% CI, 7.3-10.7); this difference was highly significant (p < 0.001). Conclusions: Our data suggest that 91% of LRD occurred within 2 years after BMT and the OS with SS for LRD was better than that without SS. These data can contribute to the development of an evidence-based surveillance strategy. [Table: see text]

scholarly journals Importance of Surveillance and Success of Salvage Strategies After Definitive Chemoradiation in Patients With Esophageal Cancer

2014 ◽  
Vol 32 (30) ◽  
pp. 3400-3405 ◽  
Author(s):  
Kazuki Sudo ◽  
Lianchun Xiao ◽  
Roopma Wadhwa ◽  
Hironori Shiozaki ◽  
Elena Elimova ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Salvage Surgery ◽  
Distant Metastases ◽  
Local Relapse ◽  
Salvage Treatment ◽  
Surveillance Program ◽  
Definitive Chemoradiotherapy ◽  
Trimodality Therapy ◽  
Frequent Relapses

Purpose Patients with esophageal carcinoma (EC) who are treated with definitive chemoradiotherapy (bimodality therapy [BMT]) experience frequent relapses. In a large cohort, we assessed the timing, frequency, and types of relapses during an aggressive surveillance program and the value of the salvage strategies. Patients and Methods Patients with EC (N = 276) who received BMT were analyzed. Patients who had surgery within 6 months of chemoradiotherapy were excluded to reduce bias. We focused on local relapse (LR) and distant metastases (DM) and the salvage treatment of patients with LR only. Standard statistical methods were applied. Results The median follow-up time was 54.3 months (95% CI, 48.4 to 62.4). First relapses included LR only in 23.2% (n = 64), DM with or without LR in 43.5% (n = 120), and no relapses in 33.3% (n = 92) of patients. Final relapses included no relapses in 33.3%, LR only in 14.5%, DM only in 15.9%, and DM plus LR in 36.2% of patients. Ninety-one percent of LRs occurred within 2 years and 98% occurred within 3 years of BMT. Twenty-three (36%) of 64 patients with LR only underwent salvage surgery, and their median overall survival was 58.6 months (95% CI, 28.8 to not reached) compared with those patients with LR only who were unable to undergo surgery (9.5 months; 95% CI, 7.8 to 13.3). Conclusion Unlike in patients undergoing trimodality therapy, for whom surveillance/salvage treatment plays a lesser role, 1 in the BMT population, approximately 8% of all patients (or 36% of patients with LR only) with LRs occurring more than 6 months after chemoradiotherapy can undergo salvage treatment, and their survival is excellent. Our data support vigilant surveillance, at least in the first 24 months after chemotherapy, in these patients.

The relationship between HER-2 and TOPO-2A gene expression and clinicopathologic results in gastric cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14670-e14670
Author(s):  
Metin Ozkan ◽  
Esra Ermis Turak ◽  
Halit Karaca ◽  
Mevlude Inanc ◽  
Veli Berk ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Median Overall Survival ◽  
Intestinal Type ◽  
Negative Group ◽  
Diffuse Type ◽  
Her 2 ◽  
Gastric Cancer Patients

e14670 Background: HER-2 and Topo-2A genes are settled on a chromosome 17 and their co-amplification rates are high. In this study, early gastric cancer patients who received adjuvant chemo-radiotherapy and chemotherapy were evaluated with HER-2 and Topo-2A expression in association with clinical and histopathologic findings. Methods: A total of 103 gastric cancer patients were included the study. The HER-2 and Topo-2A levels were measured by immunohistochemistry in postoperative tumor materials. A standard evaluation method was admitted for HER-2 positivity, while Topo-2A nuclear staining 3+ and 4+ were considered as overexpression. Those with level 2+ or 3+ of HER-2, the FISH test were attempted. Results: The median follow-up was 19 months (ranges 2–70 months). Forty-six patients (44%) relapsed during follow-up whereas 60 patients (58%) had died. The median overall survival (mOS) was 23 months. Histopathologies of HER-2 positive patients were intestinal type in 7 (87.5%) and diffuse type in one (12.5%) patient. In the follow-up period 4 patients (50%) were died (mOS was 17 months in this group). Median overall survival was 23 months in HER-2 negative group (p=0.6). Histopathologies of Topo-2A positive patients were intestinal type in 9 (64.2%) and diffuse type in 5 (35.8%) patient. In the follow-up period 8 patients (57%) were died (mOS was 22 months in this group). Median overall survival was 23 months in Topo-2A negative group (p=0.8). Three patients (37.5%) who had HER-2 positive histopathologies also had Topo-2A positivity. Conclusions: Overexpression rates of HER-2 in gastric cancer were reported 6.8-34%. Racial differences and different scoring techniques thought to be impact the results. Co-amplification rate of HER-2 and Topo-2A was reported 34% in gastric cancer. In our study HER-2 and Topo-2A overexpression rates were 7.7% and 13.6% respectively and co-amplification of HER-2 with Topo-2A rate was 37.5% is also similar to the other studies. Stages of patients with HER-2 and Topo-2A overexpression were similar to the distribution of the overall patients. While intestinal subtypes showed a higher rate of HER-2 overexpression, the median survival times tend to be shorter in HER-2 positive patients.

Incidence of brain metastases following trimodality therapy (TMT) in patients with esophageal and gastroesophageal (E-EGCJ) cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 108-108
Author(s):  
Roopma Wadhwa ◽  
Takashi Taketa ◽  
Arlene M. Correa ◽  
Kazuki Sudo ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Brain Imaging ◽  
Cancer Patients ◽  
Clinical Stage ◽  
Cancer Center ◽  
Trimodality Therapy ◽  
Screening And Surveillance ◽  
Imaging Results

108 Background: Brain metastases in E-EGJ cancer patients following TMT are considered rare. We reviewed the cumulative incidence of brain metastases in a large cohort of patients who underwent TMT and had a long follow-up. Methods: Data were analyzedretrospectively for 579 E-EGJ cancer patients who underwent TMT between years 2000 and 2010. None had screening or surveillance brain imaging. Results: Median follow-up time was 57.4 months (95% confidence interval [CI]: 51.5-63.3 months). Common patient characteristics were as follows: median age: 59.5 years (range, 39-74 years), Caucasian ethnicity (90%), male gender (85%), pre-treatment clinical stage III (65%), and adenocarcinoma histology (90%). 197 (34%) of 579 patients developed distant metastases and of these 20 (3% of 579 and 10% of 197) patients developed brain metastases. 18 (90%) patients had brain metastases within the first 24 months (12 in the first 12 months and 6 in the following 12 months) of surgery. 18 (90%) of patients were symptomatic at diagnosis. 15 (75%) of 20 patients had a single metastasis, however, only 4 (25%) patients survived >20 months (overall survival times were [in months]: 20, 30, 92 and 137). The median overall survival time of all 20 patients was 10.8 months (95% CI: 4.7-16.9). Conclusions: 3% of patients with E-EGJ cancer developed brain metastases after TMT and 90% of these occurred within the first 24 months of surgery. A few patients survived ≥20 months. These data rule out the use of screening and surveillance brain imaging for TMT-eligible patients. Supported by UT M. D. Anderson Cancer Center Clinical Research and Generous Donors.

scholarly journals Locoregional Failure Rate After Preoperative Chemoradiation of Esophageal Adenocarcinoma and the Outcomes of Salvage Strategies

2013 ◽  
Vol 31 (34) ◽  
pp. 4306-4310 ◽  
Author(s):  
Kazuki Sudo ◽  
Takashi Taketa ◽  
Arlene M. Correa ◽  
Maria-Claudia Campagna ◽  
Roopma Wadhwa ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Salvage Therapy ◽  
Local Therapy ◽  
Distant Metastases ◽  
Therapy Outcomes ◽  
Surveillance Strategy ◽  
Trimodality Therapy ◽  
Locoregional Failure ◽  
Esophagogastric Junction Adenocarcinoma

Purpose The primary purpose of surveillance of patients with esophageal adenocarcinoma (EAC) and/or esophagogastric junction adenocarcinoma after local therapy (eg, chemoradiotherapy followed by surgery or trimodality therapy [TMT]) is to implement a potentially beneficial salvage therapy to overcome possible morbidity/mortality caused by locoregional failure (LRF). However, the benefits of surveillance are not well understood. We report on LRFs and salvage strategies in a large cohort. Patients and Methods Between 2000 and 2010, 518 patients with EAC who completed TMT were analyzed for the frequency of LRF over time and salvage therapy outcomes. Standard statistical techniques were used. Results For 518 patients, the median follow-up time was 29.3 months (range, 1 to 149 months). Distant metastases (with or without LRF) occurred in 188 patients (36%), and LRF only occurred in 27 patients (5%). Eleven of 27 patients had lumen-only LRF. Most LRFs (89%) occurred within 36 months of surgery. Twelve patients had salvage chemoradiotherapy, but only five survived more than 2 years. Four patients needed salvage surgery, and three who survived more than 2 years developed distant metastases. The median overall survival of 27 patients with LRF was 17 months, and 10 patients (37%) survived more than 2 years. Thus, only 2% of all 518 patients benefited from surveillance/salvage strategies. Conclusion Our surveillance strategy, which is representative of many others currently being used, raises doubts about its effectiveness and benefits (along with concerns regarding types and times of studies and costs implications) to patients with EAC who have LRF only after TMT. Fortunately, LRFs are rare after TMT, but the salvage strategies are not highly beneficial. Our data can help develop an evidence-based surveillance strategy.

Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14537-e14537
Author(s):  
Hae Rin Kim ◽  
Christian K. Kollmannsberger ◽  
Devin Schellenberg ◽  
Winson Cheung ◽  
Howard John Lim
Keyword(s):  
Overall Survival ◽  
Median Overall Survival ◽  
Gastroesophageal Junction ◽  
Patient Characteristics ◽  
Operative Management ◽  
Treatment Modalities ◽  
Adjuvant Chemoradiation ◽  
Kaplan Meier ◽  
Trial Outcomes

e14537 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: Table 1 summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]

Comparison of adjuvant chemoradiation to peri-operative chemotherapy for the treatment of resected gastric and gastroesophageal junction adenocarincoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 103-103
Author(s):  
Haerin Kim ◽  
Christian K. Kollmannsberger ◽  
Devin Schellenberg ◽  
Winson Y. Cheung ◽  
Howard John Lim
Keyword(s):  
Overall Survival ◽  
Median Overall Survival ◽  
Gastroesophageal Junction ◽  
Patient Characteristics ◽  
Operative Management ◽  
Treatment Modalities ◽  
Adjuvant Chemoradiation ◽  
Kaplan Meier ◽  
Trial Outcomes

103 Background: Currently there are several accepted peri-operative treatment modalities for the resected gastric (GC) and gastroesophageal junction (GEJ) adenocarcinoma. In the 2008, peri-operative chemotherapy (CRT) using the MAGIC was adopted as the preferred approach to adjuvant chemoradiation with the MacDonald protocol (cXRT) in the British Columbia. An era to era comparison was performed to determine if there were differences in outcomes. Methods: Data from the pharmacy records of patients (pts) referred to 1 of 5 cancer treatment in BC were analyzed from 2001- July 2010. Pts that underwent curative resection for GC or GEJ were only included. cXRT cohort was defined from Jan 2001-Dec 2007, prior to the CRT era. CRT cohort started from Jan 2008-July 2010. Descriptive statistics were used to compare the groups. Survival analysis was performed using Kaplan Meier methods. Results: The Table summarizes the patient characteristics. In the CRT arm, there were more males, less pts with a LN ratio >0.2 and shorter median follow-up. 92.1% completed the pre-op chemotherapy and 44.7% completed post-op chemotherapy whereas 73.3% of pts completed cXRT (p<0.05). 1 yr survival was similar between the 2 cohorts. Median overall survival was not reached in the CRT arm and was 64.1 months in the cXRT arm. Conclusions: Delivery of CRT was similar to that in the MAGIC trial. Outcomes of CRT compared to cXRT appears to be similar in this cohort to cohort study with similar 1 yr survival. Pre-operative CRT results in less pts with a LN ratio > 0.2. Further follow-up is needed with respect to relapse and overall survival. Either modality can be considered for peri-operative management of GC or GEJ adenocarcinoma. [Table: see text]

scholarly journals Prostate cancer with low burden skeletal disease at diagnosis: outcome of concomitant radiotherapy on primary tumor and metastases

2020 ◽  
Vol 93 (1108) ◽  
pp. 20190353 ◽  
Author(s):  
Chiara Lucrezia Deantoni ◽  
Andrei Fodor ◽  
Cesare Cozzarini ◽  
Claudio Fiorino ◽  
Chiara Brombin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Distant Metastases ◽  
Clinical Relapse ◽  
Biochemical Relapse ◽  
Relapse Free Survival ◽  
Free Survival

Objective: To evaluate toxicity and clinical outcome in synchronous bone only oligometastatic (≤2 lesions) prostate cancer patients, simultaneously irradiated to prostate/prostatic bed, lymph nodes and bone metastases. Methods: From 2/2009 to 6/2015, 39 bone only prostate cancer patients underwent radiotherapy (RT) at “radical” doses to bone metastases (median 2 Gy equivalent dose, EQD2>40Gy, α/β = 1,5), nodes, and prostate/prostatic bed, within the same RT course, in association with androgen deprivation therapy (ADT). Biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were evaluated. Results: After a median follow-up of 46.5 (1.2–103.6) months, 5 patients died from disease progression, 10 experienced biochemical relapse, 19, still in ADT, presented undetectable prostate-specific antigen (PSA) at the last follow-up. Five patients who discontinued ADT after a median of 34 months (5.8–41) are free from biochemical relapse. The 4 year Kaplan–Meier estimates of biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were 53.3%, 65.7%, 73.4% and 82.4% respectively. No Grade > 2 acute events and only two severe late urinary events were recorded, not due to the concomitant treatment of primary and metastatic disease. Conclusion: Our results suggest that “radical” and synchronous irradiation of primitive tumor and metastatic disease may be a valid approach in synchronous bone only prostate cancer patients, showing mild toxicity profile and promising survival results. Advances in knowledge: To the best of our knowledge, this is the first analysis of clinical outcome in synchronous bone-only metastasis (neither nodal nor visceral) patients at diagnosis, treated with radical RT to all disease, associated to ADT.

scholarly journals A Pilot Clinical Study on the Prognostic Relevance of Plasmatic Exosomes Levels in Oral Squamous Cell Carcinoma Patients

Cancers ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 429 ◽  
Author(s):  
Samuel Rodríguez Zorrilla ◽  
Mario Pérez-Sayans ◽  
Stefano Fais ◽  
Mariantonia Logozzi ◽  
Mercedes Gallas Torreira ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Distant Metastases ◽  
Tumour Mass ◽  
Double Blind ◽  
Mean Values ◽  
Local Bone ◽  
Before And After

Background: To evaluate the relationship between the plasmatic CD63 and CAV1 positive exosome levels, in patients with OSCC before and after surgical treatment and to correlate it with their overall survival. Methods: A double-blind pilot study over 10 patients OSCC and T4 stage without distant metastases or local bone invasion has been performed. The average follow-up period was 37.64 months (34.3–40.84). We obtained 2 plasma tubes of 1 mL each before surgery and 7 days after surgery. Before performing the immunocapture-based analysis, EVs (Extracellular Vesicles) were isolated from the plasma and characterized with western blot analysis. Results: Mean values of CD63 positive plasmatic exosomes (EXO-CD63) after surgery decreased from 750.88 ± 286.67 to 541.71 ± 244.93 (p = 0.091). On the other hand, CAV-1 positive plasmatic exosomes (EXO-CAV-1) increased after surgery from 507 ± 483.39 to 1120.25 ± 1151.17 (p = 0.237). Patients with EXO-CD63 levels lower than the mean global value before the surgery had a survival of 36.04 months compared with the group with EXO-CD63 higher than the average who only survived 12.49 ± 1.67 months from the diagnosis, p = 0.225. When EXO-CAV-1 levels before surgery was lower than the average (813.94 ± 801.21) overall survival was 24.69 ± 22.23 months in contrast when it was higher that was only 11.64 months, p = 0.157. Patients with lower EXO-CD63 levels after surgery lived an average of 23.84 ± 23.9 months, while those with higher plasmatic levels of EXO-CD63 live 13.35 months, p = 0.808. When EXO-CAV-1 levels after surgery were lower, the average overall survival was 20.344 ± 15.40 months, in contrast when the EXO-CAV-1 levels were higher showing rather an estimate survival expectation of 1.64 months. Conclusions: Surgical treatment induced a dramatic reduction of the plasmatic levels of exosomes expressing CD63 as early as 1 week after resection. This first result suggests that the tumour mass is responsible of the high levels of circulating exosomes detected in cancer patients. At the same time point exosome expressing CAV-1 increased, possibly due to the inflammatory reaction immediately after surgery. Lastly, statistical analysis showed that lower levels of plasmatic exosomes both before and after surgery correlated with a better life expectancy of OSCC patients. Hopefully, this approach will prove useful in the clinical follow-up of cancer patients.

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