The extent of resection and adjuvant treatment are beneficial to the outcome of secondary glioblastoma

Abstract Backgroud: to investigate secondary glioblastoma (sGBM) patients undergoing resection and evaluate the impact of treatment on survival of malignant progression (PMS) and the prognostic factors of secondary glioblastoma. Method: the prognostic factors of secondary glioblastoma were analyzed retrospectively including gender, age, the interval between first diagnosis and second, the extent of resection, adjuvant treatment, postoperative Karnofsky score (KPS), 06-methylguanine-DNA methytransferase (MGMT) status, IDH1 mutation status, and PMS in patients with sGBM. Result: Thirty-four patients with sGBM were included in this study. Sixteen patients were female and eighteen were male. Median PMS in females was longer than male patients with sGBM (17.38 (95%CI 10.63–24.12) vs 10.06(95%CI 5.32–14.79), p = 0.032). 22(64.7%) patients achieved gross total resection (GTR),12(35.3%) patients achieved subtotal resection (STR). Kaplan-Meier analysis showed that GTR significantly improved survival after malignant progression (PMS) compared with STR (17.18(95%CI 10.97–23.40) vs 7.17(95%CI 4.97–9.36), p = 0.004). Adjuvant treatment after resection was executed in 17 (50.0%) patients, radiotherapy in one (2.9%) patient, chemotherapy in seven (20.6%) patients, and radio-chemotherapy in nine (26.5%) patients. Median preoperative KPS was 80(range 30–100), and 85(range 30–100) after surgery. The difference in PMS probability was significant between patients having a good postoperative clinical status (KPS༞70)versus poor (KPS ≤ 70). Long term survival could be achieved in patients with a good clinical status (16.57(95%CI 10.54–22.60) vs 9.00(95%CI 3.66–14.34), p = 0.02). Patients with a greater interval after initial diagnosis had longer survival than those with intervals less than 26.5 months (18.62(95%CI 10.81–26.43) vs 9.22(95%CI 5.61–12.83), p = 0.025). Conclusion: GTR and any adjuvant treatment significantly improved PMS in patients with secondary glioblastoma. Gender, postoperative KPS, time interval since the first diagnosis are associated with prognosis.

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Efficacy of Surgery for the Treatment of Gastric Cancer Liver Metastases: A Systematic Review of the Literature and Meta-Analysis of Prognostic Factors

Journal of Clinical Medicine ◽

10.3390/jcm10051141 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1141

Author(s):

Gianpaolo Marte ◽

Andrea Tufo ◽

Francesca Steccanella ◽

Ester Marra ◽

Piera Federico ◽

...

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Prognostic Factors ◽

Liver Metastases ◽

Meta Analysis ◽

Multidisciplinary Treatment ◽

Review Of The Literature ◽

Term Survival ◽

The Impact

Background: In the last 10 years, the management of patients with gastric cancer liver metastases (GCLM) has changed from chemotherapy alone, towards a multidisciplinary treatment with liver surgery playing a leading role. The aim of this systematic review and meta-analysis is to assess the efficacy of hepatectomy for GCLM and to analyze the impact of related prognostic factors on long-term outcomes. Methods: The databases PubMed (Medline), EMBASE, and Google Scholar were searched for relevant articles from January 2010 to September 2020. We included prospective and retrospective studies that reported the outcomes after hepatectomy for GCLM. A systematic review of the literature and meta-analysis of prognostic factors was performed. Results: We included 40 studies, including 1573 participants who underwent hepatic resection for GCLM. Post-operative morbidity and 30-day mortality rates were 24.7% and 1.6%, respectively. One-year, 3-years, and 5-years overall survival (OS) were 72%, 37%, and 26%, respectively. The 1-year, 3-years, and 5-years disease-free survival (DFS) were 44%, 24%, and 22%, respectively. Well-moderately differentiated tumors, pT1–2 and pN0–1 adenocarcinoma, R0 resection, the presence of solitary metastasis, unilobar metastases, metachronous metastasis, and chemotherapy were all strongly positively associated to better OS and DFS. Conclusion: In the present study, we demonstrated that hepatectomy for GCLM is feasible and provides benefits in terms of long-term survival. Identification of patient subgroups that could benefit from surgical treatment is mandatory in a multidisciplinary setting.

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Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

Frontiers in Neurology ◽

10.3389/fneur.2020.598619 ◽

2020 ◽

Vol 11 ◽

Author(s):

Fabio Cofano ◽

Carlotta Giambra ◽

Paolo Costa ◽

Pietro Zeppa ◽

Andrea Bianconi ◽

...

Keyword(s):

Clinical Outcomes ◽

Surgical Approach ◽

Spinal Canal ◽

Clinical Status ◽

Extent Of Resection ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Surgical Access ◽

The Impact

Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications.Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up.Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19).Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.

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Retrospective analysis of adjuvant treatment for localized, operable uterine leiomyosarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11072 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11072-11072

Author(s):

Jomjit Chantharasamee ◽

Karlton Wong ◽

Pasathorn Potivongsajarn ◽

Amir Aqorbani ◽

Bartosz Chmielowski ◽

...

Keyword(s):

Prognostic Factors ◽

Adjuvant Chemotherapy ◽

Adjuvant Treatment ◽

Tumor Size ◽

Disease Free Survival ◽

Mitotic Rate ◽

Stage I ◽

Uterine Leiomyosarcoma ◽

Recurrence Rates ◽

The Impact

11072 Background: Surgery is the standard of care for uterine leiomyosarcoma, but recurrence rates are high and outcomes are poor. Standard adjuvant treatment of localized uterine leiomyosarcoma(uLMS) has not yet been established as clinical trials to address this question have been small or hindered by slow accrual. Methods: We reviewed the medical records of patients with uLMS who underwent upfront surgery between 2000-2018. We evaluated the clinical characteristics and adjuvant therapy on outcomes. Patient characteristics and treatment outcomes were described using descriptive statistics. Kaplan-Meier survival analysis was used for DFS. Cox proportional hazard regression was used to compare difference between groups. Results: 59 patients with a median age of 52 years were analyzed and the median time from surgery to adjuvant treatment was 47 days. 48/59 (81.4%) underwent TAH-BSO. 64.4% were FIGO stage I, 16.9% were stage II and 6.7% were stage III. The median tumor size was 11 cm (range: 3-21cm) and the median mitotic rate was 13 mitoses/ 10 high-power fields (HPF), (range: 1-63). 34/59 (57.6%) of patients received adjuvant chemotherapy +/- radiation therapy and 25 patients (42.3%) did not receive adjuvant treatment. With a median follow-up time of 42.8 months, 42 patients (71.2%) had disease relapse and 15 (35.7%) had pulmonary metastases. The median disease-free survival (mDFS) for all patients was 23.1 months. Any adjuvant treatment (chemotherapy or radiation) had a trend toward longer mDFS than no adjuvant treatment (36.6 vs 13.6 months, p = 0.14). Patients who had adjuvant chemotherapy had a non-significant longer mDFS compared to who did not receive any adjuvant treatment (33.8 vs 13.6 months, p = 0.18). Patients with stage I disease had trend towards higher mDFS in the chemotherapy group, it was not statistically significant (29.7 vs 16.6 months, p = 0.59). Multivariate analysis found that the independent prognostic factors for worse DFS included tumor size larger than 10 cm, and mitotic rate over 10/ 10HPF. More morcellated specimens were found in non-adjuvant treatment arm (36%) compare to 8% in adjuvant arm. In the non-treatment arm, 14 patients had recurrences within 6 months. Conclusions: In a retrospective uLMS population, the mDFS was 23.1 months. Tumor size > 10cm and mitotic rate > 10/10 HPF were independent prognostic factors for lower DFS. The non-treatment group had a significantly higher number of patient with morcellization and relapsed within 6 months, confounding analyses of the impact of adjuvant chemotherapy.

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En bloc resection of pulmonary sulcus non-small cell lung cancer invading the spine: A systematic review and pooled analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e18503 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e18503-e18503

Author(s):

Stephane Collaud ◽

Elie Fadel ◽

Joachim Schirren ◽

Hiroyasu Yokomise ◽

Servet Bolukbas ◽

...

Keyword(s):

Prognostic Factors ◽

Surgical Resection ◽

Adjuvant Treatment ◽

En Bloc Resection ◽

Bloc Resection ◽

Induction Treatment ◽

En Bloc ◽

Term Survival ◽

Total N ◽

Treatment Type

e18503 Background: Treatment of locally advanced NSCLC is debated. While survival for inoperable disease ranges between 3-17%, carefully selected patients can be cured when treated surgically in a multimodality concept. Here, we conducted a systematic literature review and pooled data analysis of patients after en bloc resection for pulmonary sulcus NSCLC invading the spine. Outcome and prognostic factors were described. Methods: The MEDLINE database was searched using the PubMed engine to retrieve all relevant articles related to en bloc resection for pulmonary sulcus NSCLC invading the spine. All articles’ corresponding authors were contacted to share their most updated anonymized patient’s data. Data were pooled and analyzed, focusing on outcome and prognostic factors. Results: Search strategy yielded a total of 134 articles. Out of these, only 6 were relevant and non-duplicative. Four out of 6 authors were able to share updated data for a total of 135 patients. All tumors were resected en bloc with the lung, chest wall and spine. Induction treatment was administered in 87 (64%) patients and consisted of chemotherapy (n=32), radiation (n=1) or concurrent chemoradiation (n=54). Spine resections included total (n=23), hemi- (n=94) and partial (n=18) vertebrectomies. Complete resection was achieved in 120 (89%) patients. Five patients died in the postoperative period (4%). Adjuvant treatment was administered in 70 (52%) patients and included chemotherapy (n=16), radiotherapy (n=22) or chemoradiation (n=32). Median follow-up was 26 months. Overall 3-, 5- and 10-year survivals were 57%, 43% and 27%, respectively. Results of the univariate analysis (Cox, Breslow tests) identified incomplete surgical resection (R0 vs R1/2, p<0.001) as the only significant prognostic factors among the variables tested (age, histology, pN stage, type of induction/adjuvant treatment, type of lung resection). Conclusions: Multimodality therapy including en bloc resection for pulmonary sulcus NSCLC invading the spine provides excellent long-term survival. Complete surgical resection is the only determinant for survival. No difference was shown for patients treated with induction vs adjuvant therapy.

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Time-varying effects of prognostic factors associated with long-term survival in breast cancer

Endocrine Related Cancer ◽

10.1530/erc-17-0502 ◽

2018 ◽

Vol 25 (5) ◽

pp. 509-521 ◽

Cited By ~ 2

Author(s):

Minlu Zhang ◽

Peng Peng ◽

Kai Gu ◽

Hui Cai ◽

Guoyou Qin ◽

...

Keyword(s):

Breast Cancer ◽

Prognostic Factors ◽

Cancer Survival ◽

Tumour Size ◽

Breast Cancer Survival ◽

Lymph Node Status ◽

Time Varying ◽

Term Survival ◽

Er Positive ◽

The Impact

The impact of some prognostic factors on breast cancer survival has been shown to vary with time since diagnosis. However, this phenomenon has not been evaluated in Asians. In the present study, 4886 patients were recruited from the Shanghai Breast Cancer Survival Study, a longitudinal study of patients diagnosed during 2002–2006, with a median follow-up time of 11.2 years. Cox model incorporating time-by-covariate interactions was used to describe the time-varying effects of prognostic factors related to overall survival and disease-free survival. Age ≥65 years showed a progressively negative effect on breast cancer prognosis over time, whereas tumour size >2 cm had a lasting and constant impact. Age significantly modified the effects of the tumour grade, nodal status and oestrogen receptor (ER) status on breast cancer survival. The detrimental effect of poorly differentiated tumours was time limited and more obvious in patients aged 45–54 years. Having ≥4 positive lymph nodes had a persistent and negative impact on prognosis, although it attenuated in later years; the phenomenon was more prominent in the 55–64-year age group. ER-positive status was protective in the first 3 years after diagnosis but was related to a higher risk of recurrence in later years; the time-point when ER-positive status turned into a risk factor was earlier in younger patients. These results suggest that older age, positive lymph node status, larger tumour size and ER-positive status are responsible for late death or recurrence in Asian breast cancer survivors. Extended endocrine therapy should be given earlier in younger ER-positive patients.

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Waiting time to radiotherapy as a prognostic factor for glioblastoma patients in a scenario of medical disparities

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140202 ◽

2015 ◽

Vol 73 (2) ◽

pp. 104-110 ◽

Cited By ~ 8

Author(s):

Luiz Victor Maia Loureiro ◽

Lucíola de Barros Pontes ◽

Donato Callegaro-Filho ◽

Ludmila de Oliveira Koch ◽

Eduardo Weltman ◽

...

Keyword(s):

Health Care ◽

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Retrospective Study ◽

Prognostic Factor ◽

Waiting Time ◽

Adjuvant Treatment ◽

Extent Of Resection ◽

Prognostic Impact

Objective To evaluate the effect of waiting time (WT) to radiotherapy (RT) on overall survival (OS) of glioblastoma (GBM) patients as a reliable prognostic variable in Brazil, a scenario of medical disparities. Method Retrospective study of 115 GBM patients from two different health-care institutions (one public and one private) in Brazil who underwent post-operative RT. Results Median WT to RT was 6 weeks (range, 1.3-17.6). The median OS for WT ≤ 6 weeks was 13.5 months (95%CI , 9.1-17.9) and for WT > 6 weeks was 14.2 months (95%CI, 11.2-17.2) (HR 1.165, 95%CI 0.770-1.762; p = 0.470). In the multivariate analysis, the variables associated with survival were KPS (p < 0.001), extent of resection (p = 0.009) and the adjuvant treatment (p = 0.001). The KPS interacted with WT to RT (HR 0.128, 95%CI 0.034-0.476; p = 0.002), showing that the benefit of KPS on OS depends on the WT to RT. Conclusion No prognostic impact of WT to RT could be detected on the OS. Although there are no data to ensure that delays to RT are tolerable, we may reassure patients that the time-length to initiate treatment does not seem to influence the control of the disease, particularly in face of other prognostic factors.

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Combined treatment and survival of medullary thyroid carcinoma patients

Open Medicine ◽

10.2478/s11536-010-0023-8 ◽

2010 ◽

Vol 5 (4) ◽

pp. 426-430

Author(s):

Zenonas Baranauskas ◽

Konstantinas Valuckas ◽

Giedre Smailyte

Keyword(s):

Prognostic Factors ◽

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

External Beam Radiotherapy ◽

Combined Treatment ◽

Term Survival ◽

Long Term Survival ◽

Medullary Thyroid ◽

The Impact

AbstractThe aim of this study is to analyze the impact of combined treatment (thyroidectomy and radiotherapy and radioactive iodine treatment) on patients’ long-term survival with medullary thyroid carcinoma. This is a retrospective study of 59 patients treated from 1977 to 2006 for medullary carcinoma at the Institute of Oncology in Vilnius, Lithuania. Survival was estimated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were used to explore the association of prognostic factors with long-term survival. The survival of MTC patients was 88.0% (95% CI 68.0–88.9), 67.9% (95% CI 52.3–79.4) and 60.5% (95% CI 43.2–74.0), respectively, 5, 10 and 15 years after diagnosis. In survival analysis, only the type of surgery and lymph node involvement were found to be significant prognostic factors. The results of this study suggest that treatment with radioiodine and external beam radiotherapy do not improve significantly the long-term survival of surgically treated MTC patients.

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Definitive Radiotherapy versus Postoperative Radiotherapy of Patients with Oro- and Hypopharyngeal Cancer: Impact of Prognostic Factors

Journal of Oncology ◽

10.1155/2012/391917 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Volker Rudat ◽

Salia Ahmet-Osman ◽

Oliver Schramm ◽

Andreas Dietz

Keyword(s):

Prognostic Factors ◽

Postoperative Radiotherapy ◽

Statistical Significance ◽

Univariate Analysis ◽

Hypopharyngeal Cancer ◽

Time Interval ◽

Definitive Radiotherapy ◽

Simultaneous Radiochemotherapy ◽

N Classification ◽

The Impact

Purpose. To compare the impact of prognostic factors of patients treated with definitive radio(chemo)therapy versus patients treated with surgery and postoperative radiotherapy for squamous cell carcinoma of the oro- and hypopharynx.Patients and Methods. 162 patients treated with definitive radiotherapy and 126 patients treated with postoperative radiotherapy were retrospectively analysed. The impact of the prognostic factors gender, age, total tumor volume (TTV), pre-radiotherapy hemoglobin level (Hb-level), tumor site, T- and N-classification, radiotherapy interruptions >5 days, radiotherapy versus simultaneous radiochemotherapy, R-status and time interval between surgery and radiotherapy were investigated.Results. The median follow-up time for the censored patients treated with definitive radio(chemo)therapy was 28.5 months and for postoperative radiotherapy 36.5 months. On univariate analysis, the TTV, Hb-level, and simultaneous radiochemotherapy had a significant impact on the survival of patients treated with definitive radio(chemo)therapy. For patients treated with postoperative radiotherapy, only the TTV showed a statistical trend for the survival (P=0.13). On multivariate analysis, the TTV and simultaneous radiochemotherapy maintained their statistical significance for patients treated with definitive raditherapy, and the TTV, the statistical trend for patients treated with postoperative radiotherapy (P=0.19).Conclusions. The TTV was the predominant prognostic factor for both, patients treated with definitive or postoperative radiotherapy.

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Butterfly Glioblastoma - the Impact of Tumor Volumes and Treatment Strategies on Clinical Outcome

10.21203/rs.3.rs-1010346/v2 ◽

2021 ◽

Author(s):

Line Sagerup Bjorland ◽

Kathinka Dæhli Kurz ◽

Fluge Øystein Fluge ◽

Bjørnar Gilje ◽

Rupavathana Mahesparan ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Multimodal Treatment ◽

Median Overall Survival ◽

Treatment Strategies ◽

Cox Proportional Hazards ◽

Comprehensive Treatment ◽

Term Survival ◽

Dismal Prognosis ◽

The Impact

Abstract PurposeButterfly glioblastoma is a rare subgroup of glioblastoma with a bihemispheric tumor crossing the corpus callosum, and is associated with a dismal prognosis. Prognostic factors are previously sparsely described and optimal treatment approaches remain uncertain. We aimed to analyse prognostic factors in butterfly glioblastoma, and to evaluate treatment strategies and outcome in a real-world setting.MethodsWe conducted a retrospective population-based cohort study of patients diagnosed with butterfly glioblastoma in Western Norway between 01/01/2007 and 31/12/2014. Clinical data were extracted from electronic medical records. Molecular and MRI volumetric analyses were retrospectively performed. Survival analyses were performed using Kaplan-Meier method and Cox proportional hazards regression models.ResultsAmong 381 patients diagnosed with glioblastoma, 33 patients (8.7%) met the criteria for butterfly glioblastoma. Median overall survival was 5.5 months (95% CI 3.1-7.9) and three-year survival was 9.1%. Older age and mainly deep-seated tumour location were associated with poor outcome, with adjusted hazard ratio (HR) 1.06 (95% CI 1.03-1.10), p<0.001, and adjusted HR 4.58 (95% CI 1.15-18.20), p=0.03. Best supportive care was associated with poorer survival compared to multimodal treatment (adjusted HR 5.11 (95% CI 1.09-23.89), p=0.04).ConclusionOutcome from butterfly glioblastoma was dismal, with a median overall survival of less than six months. However, long-term survival was comparable to that observed in glioblastoma in general, and multimodal treatment was associated with longer survival. This suggests that patients with butterfly glioblastoma may benefit from a more comprehensive treatment approach despite the overall poor prognosis.

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Implications of prolonged time to pancreaticoduodenectomy after neoadjuvant chemoradiation: Analysis of the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.473 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 473-473 ◽

Cited By ~ 1

Author(s):

Annabelle Teng ◽

Trang Nguyen ◽

Anton Bilchik ◽

Victoria O'Connor ◽

David Y Lee

Keyword(s):

Surgical Resection ◽

Clinical Stage ◽

Neoadjuvant Chemoradiation ◽

Whipple Procedure ◽

Optimal Time ◽

Time Interval ◽

National Cancer Database ◽

Short Term ◽

Term Survival ◽

The Impact

473 Background: For patients with pancreatic adenocarcinoma (PA), the optimal time interval between neoadjuvant chemoradiation (CR) to surgical resection has not been well established. The National Cancer Database (NCDB) was used to evaluate the impact of radiation-surgery (RS) interval on outcomes. Methods: The NCDB from 2006-2014 was queried for patients ≥18 years old diagnosed with PA who received CR prior to surgery. Survival and short-term outcomes were compared between patients who had a Whipple procedure performed ≤12 weeks and > 12 weeks after completion of CR therapy. Results: 1610 patients met selection criteria. Average RS interval was 58.2 ± 39.5 days. 1419 patients had RS interval ≤12 weeks (mean 47.4 days) and 191 had RS interval > 12 weeks (mean 138.8 days). Age, race, gender, income, type of treatment facility, CA 19-9 levels, types of chemotherapy and radiation dosage administered were similar between the two groups. Mean tumor size was 32.2 mm in the ≤12 week group and 34.9 mm in the > 12 week group (p = 0.021). There was a higher proportion of patients with clinical stage III cancers in the > 12 weeks group than in the ≤12 weeks group (33.5% vs 14%). Short-term morbidity and mortality was not significantly different between the two groups in terms of length of stay, readmission within 30 days, 30-day and 90-day mortality. However, a long-term survival benefit was observed in the > 12 week group (median 25.8 months in ≤12 weeks vs 30.2 months in > 12 weeks, p = 0.049) that appears to persist. An interval > 12 weeks was associated with significantly prolonged survival on multivariate analysis (HR 0.80 (0.65-0.99 95% CI, p = 0.042)). Higher clinical stage and positive surgical margins were independently associated with worse survival. Conclusions: Surgical resection beyond 12 weeks after CR for PA did not worsen surgical outcomes. Waiting may contribute to better patient selection, especially those with larger tumors and higher clinical stage. In the absence of progressive disease, patients need to be continuously evaluated for surgical resection after CR.

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