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Journal articles on the topic 'Risk of recurrence'
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Park, Joonseon, Il Ku Kang, Ja Seong Bae, Jeong Soo Kim, and Kwangsoon Kim. "Clinical Significance of the Lymph Node Ratio of the Second Operation to Predict Re-Recurrence in Thyroid Carcinoma." Cancers 15, no. 3 (January 19, 2023): 624. http://dx.doi.org/10.3390/cancers15030624.
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The purpose of this study was to establish the risk factors for re-recurrences and disease-specific mortality (DSM) in recurrent thyroid cancer. Patients with recurrent thyroid cancer who underwent initial thyroid surgery from January 2000 to December 2019 at Seoul St. Mary’s Hospital (Seoul, Korea) were assessed. Clinicopathological characteristics and long-term oncologic outcomes were compared between patients with one recurrence (n = 202) and patients with re-recurrences (n = 44). Logistic regression and cox-regression analyses were conducted to determine the risk factors for re-recurrences and DSM, respectively. Receiver-operating characteristic curve analysis was performed to determine the cutoff value for lymph node ratio (LNR) as a predictor of re-recurrences. DSM was significantly higher in the re-recurrence group compared with the single-recurrence group (6.8% vs. 0.5%, p = 0.019). Surgical treatment at the first recurrence significantly lowered the risk of re-recurrences. Age (≥55), male sex, and LNR (≥0.15) were independent significant risk factors for re-recurrences in patients who underwent surgery at the first recurrence. Surgical resection is the optimal treatment for initial thyroid cancer recurrence. LNR at re-operation is more effective in predicting re-recurrence than the absolute number of metastatic LNs.
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Puhr, Hannah C., Lisbeth Eischer, Hana Šinkovec, Ludwig Traby, Paul A. Kyrle, and Sabine Eichinger. "Circumstances of provoked recurrent venous thromboembolism: the Austrian study on recurrent venous thromboembolism." Journal of Thrombosis and Thrombolysis 49, no. 4 (October 17, 2019): 505–10. http://dx.doi.org/10.1007/s11239-019-01965-z.
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Abstract Patients with unprovoked deep-vein thrombosis (DVT) of the leg or pulmonary embolism (PE) have a high recurrence risk. How often these recurrences are provoked by a temporary risk condition is unknown. In a cohort of patients with unprovoked venous thromboembolism (VTE), we evaluated the clinical circumstances of recurrence. We studied patients with DVT of the leg and/or PE. End point was recurrence of objectively verified symptomatic VTE. Provoked recurrence was defined according to guidance criteria. 1188 patients were followed for a median of 8.9 years after withdrawal of oral anticoagulants. 312 patients had recurrent VTE, which was provoked in 42 (13%). Recurrence was related to a major risk factor in 19, to a minor risk factor in 22, and to a persistent risk factor in one patient(s). 14 recurrences occurred after major surgery and 5 during hospitalization. Ten recurrences occurred after minor surgery, eight after trauma and three during female hormone intake. Four recurrences occurred during heparin prophylaxis. The incidence of provoked VTE recurrence appears to be low. VTE can recur when prevention is stopped or even during thromboprophylaxis. Surgery and trauma are frequent risk factors.
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Yogi, Nikunja, Pankaj Raj Nepal, Dinesh Nath Gongal, and Upendra Prasad Devkota. "Analysis of risk factors predicting recurrence of chronic subdural hematoma." Nepal Journal of Neuroscience 15, no. 3 (December 31, 2018): 32–38. http://dx.doi.org/10.3126/njn.v15i3.23279.
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Recurrences after evacuation of chronic subdural hematoma are seen in 2-33% of cases with various surgical approaches. Various demographical, clinical, radiological, surgical and postoperative management strategies have been explored as the possible predictors of recurrence.
We performed a retrospective analysis in 160 patients with chronic subdural hematoma with an aim to analyze the post-operative recurrences and factors associated with it. Various socio demographic and clinico-radiological parameters were studied against the rate of recurrence after surgery using Chi square/Fischer Exact Test. Factors showing significant association on univarate analysis were then analysed using binary logistic regression.
The rate of recurrence of CSDH in our study was 5% and the mean duration of recurrence was 33 days. Chronic alcohol use (p=0.007) and intraoperative brain expansion ((p=0.001) were the two factors associated with recurrence of CSDH. On binary logistic regression chronic alcohol use (wald-6.467, p=0.011) and intraoperative brain expansion (wald=6.674, p=0.010) were both associated significantly with recurrence of CSDGH with an odds of 7.804 and 0.058 respectively.
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Shinnar, Shlomo, Anne T. Berg, Solomon L. Moshe, Christine O'Dell, Marta Alemany, David Newstein, Harriet Kang, Eli S. Goldensohn, and W. Allen Hauser. "The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up." Pediatrics 98, no. 2 (August 1, 1996): 216–25. http://dx.doi.org/10.1542/peds.98.2.216.
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Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood. Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.
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Flach, Clare, Walter Muruet, Charles D. A. Wolfe, Ajay Bhalla, and Abdel Douiri. "Risk and Secondary Prevention of Stroke Recurrence." Stroke 51, no. 8 (August 2020): 2435–44. http://dx.doi.org/10.1161/strokeaha.120.028992.
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Background and Purpose: With recent advances in secondary prevention management, stroke recurrence rates may have changed substantially. We aim to estimate risks and trends of stroke recurrence over the past 2 decades in a population-based cohort of patients with stroke. Methods: Patients with a first-ever stroke between 1995 and 2018 in South London, United Kingdom (n=6052) were collected and analyzed. Rates of recurrent stroke with 95% CIs were stratified by 5-year period of index stroke and etiologic TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtype. Cumulative incidences were estimated and multivariate Cox models applied to examine associations of recurrence and recurrence-free survival. Results: The rate of stroke recurrence at 5 years reduced from 18% (95% CI, 15%–21%) in those who had their stroke in 1995 to 1999 to 12% (10%–15%) in 2000 to 2005, and no improvement since. Recurrence-free survival has improved (35%, 1995–1999; 67%, 2010–2015). Risk of recurrence or death is lowest for small-vessel occlusion strokes and other ischemic causes (36% and 27% at 5 years, respectively). For cardioembolic and hemorrhagic index strokes around half of first recurrences are of the same type (54% and 51%, respectively). Over the whole study period a 54% increased risk of recurrence was observed among those who had atrial fibrillation before the index stroke (hazard ratio, 1.54 [1.09–2.17]). Conclusions: The rate of recurrence reduced until mid-2000s but has not changed over the last decade. The majority of cardioembolic or hemorrhagic strokes that have a recurrence are stroke of the same type indicating that the implementation of effective preventive strategies is still suboptimal in these stroke subtypes.
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Borger, J., H. Kemperman, A. Hart, H. Peterse, J. van Dongen, and H. Bartelink. "Risk factors in breast-conservation therapy." Journal of Clinical Oncology 12, no. 4 (April 1994): 653–60. http://dx.doi.org/10.1200/jco.1994.12.4.653.
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PURPOSE To identify clinical and pathologic factors associated with an increased risk of local recurrence following breast-conservation therapy (BCT) to assess the safety of this procedure for all subgroups of patients. PATIENTS AND METHODS The study population consisted of 1,026 patients with clinical stage I and II breast cancer treated between 1979 and 1988 at the Netherlands Cancer Institute. The BCT regimen consisted of local excision and axillary lymph node dissection (ALND) followed by whole-breast irradiation to a total dose of 50 Gy in 2-Gy fractions and boost irradiation (mostly by iridium implant) of 15 to 25 Gy. RESULTS With a median follow-up duration of 66 months, the actuarial breast recurrence rate was 4% at 5 years, counting all breast recurrences. Univariate analysis showed seven factors to be associated with an increased risk of local recurrence; age, residual tumor at reexcision, histologic tumor type, presence of any carcinoma-in-situ component, vascular invasion, microscopic margin involvement, and whole-breast radiation dose. Three factors remained independently significant after proportional hazard regression analysis: age, margin involvement, and the presence of vascular invasion. When the analysis was repeated, but counting only those breast recurrences that occurred before regional or distant failures, only young age and vascular invasion were independent predictive factors. In the third analysis, factors predicting the necessity of local salvage treatment were analyzed. In this analysis, the possible bias in the former analysis caused by censoring actuarial methods was avoided. The results were the same as in the second analysis, showing young age and vascular invasion as the only independent predictive factors. Breast recurrence rates were 6% for patients less than 40 years of age and 8% for patients with tumors showing vascular invasion. In the absence of risk factors, the breast recurrence rate is only 1% at 5 years. CONCLUSION Slightly higher recurrence rates were found in patients less than 40 years of age and in patients with tumors showing vascular invasion. The role of margin involvement is uncertain.
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Rose, Kyle M., Aram Vosoughi, Gustavo Borjas, Heather L. Huelster, Philippe E. Spiess, Anders E. Berglund, Wade J. Sexton, Anirudh Joshi, Nagi B. Kumar, and Roger Li. "Complimentary genomic, pathologic, and artificial intelligence analysis on low-grade noninvasive bladder cancer to predict downstream recurrence." Journal of Clinical Oncology 41, no. 6_suppl (February 20, 2023): 553. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.553.
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553 Background: Low-grade noninvasive (LGTa) bladder cancer is a relatively quiescent but heterogenous malignancy, characterized by downstream recurrences requiring repeated transurethral resections and frequent surveillance. Investigations to elucidate drivers of recurrence have been sparse, but will help risk-stratify patients with LGTa and allow augmentation of follow up protocols. Methods: Patients with LGTa index tumors were stratified by those with no downstream recurrences (nonrecurrent) vs. those with later recurrences (recurrent). RNA sequencing identified differentially expressed genes (DEGs), deconvoluted for cell-type using xCell. Pathologic analysis was performed by a genitourinary pathologist, then a deep-learning artificial intelligence (AI) platform was leveraged to correlate recurrence risk and recurrence-free survival (RFS) based on deep-learning algorithm of segmented nuclei. Results: Thirty index bladder tumors/patients were identified, 18 (60%) of which had later recurrence (Table). There were 238 DEGs recognized, with recurrent tumors expressing signatures for epithelial mesenchymal transition, myogenesis, TNFα signaling via NFκB, and angiogenesis. Recurrent tumors also demonstrated a higher tissue micoenvironment, stroma, and cancer-associated fibroblast score. Pathologic TME analysis validated these findings, with recurrent tumors demonstrating a higher frequency of inverted growth pattern and a higher median stroma percentage. Finally, the AI-derived signature was predictive of recurrence and risk-stratified the cohort (HR= 5.43 [95% CI 1.1-26.76]) for predicting high vs. low risk of recurrence. Patients in the high risk group had a 87.5% recurrence rate while those in the low risk group had a 28.5% recurrence rate (p<0.01). Conclusions: Using a multi-disciplinary approach, we identified key signatures in recurrent LGTa bladder cancer. Characterization of these factors is a critical first step in the risk-stratification of LGTa tumors, and may allow risk-stratification of surveillance protocols and identification of possible targets for chemoprevention trials. [Table: see text]
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Veenstra, David L., Nathaniel Hendrix, Chantal M. Dolan, Kathryn Fisher, Deepa Lalla, Nina Hill, and Beverly Moy. "Abstract P3-16-01: Population effectiveness model of the consequences of recurrence after trastuzumab emtansine (T-DM1) treatment among U.S. patients with high-risk HER2+ early-stage breast cancer (ESBC)." Cancer Research 82, no. 4_Supplement (February 15, 2022): P3–16–01—P3–16–01. http://dx.doi.org/10.1158/1538-7445.sabcs21-p3-16-01.
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Abstract Background: To estimate the long-term consequences of disease recurrence following treatment with adjuvant T-DM1 among U.S. patients with high-risk HER2+ ESBC who did not achieve pathologic complete response (pCR) after neoadjuvant therapy. Methods: A Markov model was used to simulate local/regional and distant recurrence with 10 years of follow-up. This corresponds to the estimated number of U.S. patients with incident high-risk HER2+ ESBC in 2021 (n = 10,000), which was derived from SEER population-based estimates, the NEOSPHERE trial and expert clinical opinion. The probability of recurrence was based on the T-DM1 arm in the KATHERINE trial and long-term results from the HERA trial. We assumed that 80% of patients with any recurrence experience distant recurrence, while the remainder have local/regional recurrence. SEER data and literature review were used to estimate probabilities of survival, distant recurrence secondary to local/regional recurrence, and direct medical costs. We estimated indirect costs were equal to 15% of direct medical costs. Model outcomes included: recurrences, breast cancer-related deaths, non-breast cancer-related deaths, direct medical costs, and indirect costs (all undiscounted). Results were compared to a scenario in which there was no recurrence to estimate population impact. All outcomes were also projected over 10 annual incident cohorts, each with 10 years of follow-up. Results: We estimated the 2021 U.S. patient cohort would experience 2,279 recurrences, including 1,834 distant, and 1,559 breast cancer-related deaths over 10 years, resulting in 7,744 lost years of life and $632 million in additional spending, including $549 million in direct medical costs. Projection to 10 years of incident cohorts would lead to approximately 23,000 recurrences, 16,000 deaths, 77,000 lost years of life and $6 billion in direct medical costs. Conclusions: Patients with HER2+ ESBC who do not achieve pCR after neoadjuvant therapy are at ongoing risk of recurrence despite the effectiveness of treatment with T-DM1. There is substantial clinical and economic value in further reducing the recurrence risk among this population. Findings for 2021 Cohort Projected over 10 YearsWith recurrenceNo recurrenceDifferenceLocal/regional recurrences4450445Distant recurrence1,83401,834Breast cancer deaths1,55901,559Non-breast cancer deaths416457-41Direct costs$573M$24M$549MIndirect costs$86M$3.6M$82MLife years90,24997,993-7,744Costs$659M$27M$632M Citation Format: David L Veenstra, Nathaniel Hendrix, Chantal M Dolan, Kathryn Fisher, Deepa Lalla, Nina Hill, Beverly Moy. Population effectiveness model of the consequences of recurrence after trastuzumab emtansine (T-DM1) treatment among U.S. patients with high-risk HER2+ early-stage breast cancer (ESBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-16-01.
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Cohen, Adam L., and John H. Ward. "Risk Reduction Strategies for Ductal Carcinoma In Situ." Journal of the National Comprehensive Cancer Network 8, no. 10 (October 2010): 1211–17. http://dx.doi.org/10.6004/jnccn.2010.0088.
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Ductal carcinoma in situ (DCIS) is a premalignant condition that, if left untreated, may progress to invasive breast cancer. After lumpectomy, DCIS can recur, and about half of recurrences are invasive. In 4 randomized trials, radiation has been shown to decrease the local recurrence rate by about half, though it does not change survival. Based on the results of 3 randomized trials, tamoxifen probably decreases cancer recurrence by about 30%, particularly in young women. Low fat diets, weight loss, and physical activity decrease invasive breast cancer recurrence and may be recommended to certain women with DCIS. Prognostic factors include age, extent of DCIS, margin status, grade, and presence of necrosis, although how these affect adjuvant therapy is unclear. Research evaluating other drugs to reduce recurrence risk and on different ways of delivering radiation continues.
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Lippert, HL, O. Lund, S. Blegvad, and HV Larsen. "Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax." European Respiratory Journal 4, no. 3 (March 1, 1991): 324–31. http://dx.doi.org/10.1183/09031936.93.04030324.
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From 1975 until 1987, 122 patients without (Group I, mean age 34 yrs) and 20 with pre-existing lung disease (Group II, mean age 66 yrs) were treated for their first spontaneous pneumothorax. Mean follow-up was 5.2 yrs (max. 12.8 yrs). There were 32 chest X-ray verified recurrences, 72% occurring during the first 2 yrs. One, 5 and 10 yr cumulative recurrence freedoms +/- standard error in groups I and II combined were 85 +/- 3%, 75 +/- 4% and 69 +/- 5%, respectively. Using Cox regression analysis in groups I and II combined, pulmonary fibrosis, age greater than or equal to 60 yrs, and height/weight ratio were independent predictors of recurrence. Combinations of these risk factors identified four risk strata with 10 yr recurrence freedoms ranging from 83-0%. Independent predictors in group I alone were pulmonary fibrosis, age greater than or equal to 60 yrs, height/weight ratio, and nonsmoking, resulting in four risk strata with 10 yr recurrence freedoms ranging from 98-31%. Recurrences after first-time treated spontaneous pneumothorax showed a distinct time-related pattern and should accordingly be analysed as a time-related event. In both the total patient-population and in the group without pre-existing lung disease, independent predictors of recurrence were identified, which allowed the patients to be substratified into groups with widely different recurrence rates.
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Suttner, Tobias, Reiner Neu, Tobias Potzger, Tamas Szöke, Christian Grosser, Michael Ried, and Hans-Stefan Hofmann. "Burden between Undersupply and Overtreatment in the Care of Primary Spontaneous Pneumothorax." Thoracic and Cardiovascular Surgeon 66, no. 07 (December 31, 2017): 575–82. http://dx.doi.org/10.1055/s-0037-1609011.
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Background The optimal treatment of primary spontaneous pneumothorax (PSP) is still controversial. The purpose of this study was to analyze the incidence of recurrence, the recurrence-free time, and to identify risk factors for recurrence after PSP. Methods We performed a retrospective analysis of 135 patients with PSP who were treated either conservatively with a chest tube (n = 87) or surgically with video-assisted thoracoscopic surgery (VATS; n = 48) from January 2008 through December 2012. Results In this study, 101 (74.8%) male and 34 (25.2%) female patients were included with a mean age of 35.7 years. The indications for surgery included blebs/bullae in the radiological images (n = 20), persistent air leaks (n = 15), or the occupations/wishes of the patients (n = 13). A first ipsilateral recurrent pneumothorax (true recurrence) was observed in 31.1% of all patients (VATS: 6.25%, conservative: 44.8%). Including contralateral recurrence, the overall first recurrence rate was 41.3% (VATS: 14.6%, conservative: 57.5%). The recurrence-free time did not differ significantly between the treatment groups (p = 0.51), and most recurrences were observed within the first 6 months after PSP. Independent risk factors identified for the first recurrence were conservative therapy (p = 0.0001), the size of the PSP (conservative; p = 0.016), and a body mass index <17 (VATS; 0.022). The risk for second and third recurrences of PSP was 17.5 and 70%, respectively, for both treatment groups, but it was 100% after conservative therapy. Conclusion Surgery for PSP should be selected based on the risk factors and the patient's wishes to prevent first recurrences but also to avoid overtreatment. The treatment of first and subsequent PSP recurrences should be with surgery since conservative treatment is associated with a 100% recurrence rate.
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Escofet Peris, Marina, Maria Teresa Alzamora, Marta Valverde, Rosa Fores, Guillem Pera, Jose Miguel Baena-Díez, and Pere Toran. "Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort." Journal of Clinical Medicine 9, no. 12 (December 16, 2020): 4064. http://dx.doi.org/10.3390/jcm9124064.
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Background: Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI). Methods: The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk. Results: Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9. Conclusions: In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.
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Yekedüz, Emre, Ömer Dizdar, Neyran Kertmen, and Sercan Aksoy. "Comparison of Clinical and Pathological Factors Affecting Early and Late Recurrences in Patients with Operable Breast Cancer." Journal of Clinical Medicine 11, no. 9 (April 22, 2022): 2332. http://dx.doi.org/10.3390/jcm11092332.
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In this study, we aimed to assess clinicopathological factors affecting early and late recurrences in patients with operable breast cancer. Patients with early (≤5 years) and late (>5 years) recurrences were assessed. Prognostic factors for disease-free survival (DFS) were also evaluated in patients with recurrence. A total of 854 patients were included. There were 432 and 205 patients in the early and late recurrence groups, respectively. In multivariate analyses, HER2+ disease, lymph node metastasis, lymphovascular invasion (LVI), and high tumor grade were associated with increased risk of early recurrence, while HER2+ disease and LVI were associated with decreased risk of late recurrence. In multivariate analyses, presence of HER2+ disease and triple-negative breast cancer (TNBC) were poor prognostic factors for DFS in patients with early recurrence. Presence of LVI and perineural invasion (PNI) were poor prognostic factors for DFS in patients with late recurrence. Molecular subtypes and LVI were effective on the early and late recurrences. However, lymph node positivity and grade were only associated with the early recurrence. After 5 years, LVI and PNI were the prognostic factors for DFS.
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Mutlak, Noufel Sh, Ramiz Al-Mukhtar, Nabeel S. Al-Dawoodi, and Tharwat I. Sulaiman. "Recurrent Breast Cancer Following Modified Radical Mastectomy and Risk Factors." Journal of the Faculty of Medicine Baghdad 54, no. 3 (October 1, 2012): 198–203. http://dx.doi.org/10.32007/jfacmedbagdad.543717.
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Background: - Recurrent breast cancer is cancer that comes back following initial treatment. Risk factors of recurrence are lymph node involvement, larger tumor size, positive or close tumor margins, and lack of radiation treatment following lumpectomy, younger age and inflammatory breast cancer.Objective: Asses the rate of recurrence for early breast cancer in Iraqi female patients, in relation to certain risk factors.Patients and methods: A prospective study was conducted on 100 consecutive female patients, with stage I and stage II breast cancer treated by mastectomy and axillary dissection by the same team. Patients were assessed postoperatively every three months and recurrences were detected by physical examination and ultrasound of the bed of mastectomy and axilla. Statistical correlation using univariant analysis between recurrence rate and certain associated variables was done.Results: Recurrence rate was found to be 13%. It was more common among both young (20-29) years &the (40 – 49 ) years age groups which was 16.7%. Most of recurrences (61.6%) occurred (within 12_19 months) after surgical treatment. Statistically significant associations were found between recurrence and the latency period between first complaint and surgical management, the grade of the tumor, the size of primary tumor, and the number of lymph nodes involved. There was no statistically significant association between the type of adjuvant therapy and the incidence of local recurrence.Conclusions: the rate of recurrence after modified radical mastectomy is relatively high in our study. The same known risk factors related to the stage, grade and delay of treatment were detected, and close follow up especially at the first 20 months after surgery is recommended.
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Lozano, Fernando, Carles X. Raventós, Albert Carrion, Carme Dinarés, Javier Hernández, Enrique Trilla, and Juan Morote. "Xpert Bladder Cancer Monitor for the Early Detection of Non-Muscle Invasive Bladder Cancer Recurrences: Could Cystoscopy Be Substituted?" Cancers 15, no. 14 (July 19, 2023): 3683. http://dx.doi.org/10.3390/cancers15143683.
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XBM was prospectively assessed in spontaneous urine collected just before flexible cystoscopy and washing cytology carried out within the first 2 years follow-up of 337 patients with NMIBC. Recurrences were pathologically confirmed in 49 patients (14.5%), 22 of them being high-risk (6.5%). The XBM sensitivity for detecting any type of recurrence was 69.4% and 63.6% in the cases of high-risk NMIBC. Negative predictive value (NPV) for XBM was 93% for all recurrences and 96.2% for high-risk recurrences. XBM could have avoided 213 invasive controls but missed the detection of 15 recurrences (30.6%)–8 of them of high-risk (36.4%). XBM false positive elevations were detected in 90 patients (26.7%), whereas 10 patients with the invasive method had a false positive result (3%), p <0.001. However, early detection of recurrences during the first year’s follow-up after an XBM false positive result was observed in 18 patients (20%). On the other hand, 19 recurrences were detected during this period among the rest of the patients (7.7%)—p = 0.003, and odds ratio (OR) 3.0 (95% CI 1.5–6.0). Regarding one-year follow-up recurrences, 10% were high-risk recurrences in the XBM false positive group and 3.2% in the rest of the patients—p = 0.021, and OR 3.3 (95% CI 1.2–8.9). Additionally, 11.3% of the patients without false positive results developed a recurrence, p = 0.897, for any recurrence, being 10% and 5.2%, respectively, and high-risk and low-risk recurrences, p = 0.506. After searching for the best XBM cutoff for detecting the 38 high-risk initial recurrences and the early high-risk recurrences after a one-year follow-up, a linear discriminant analysis (LDA) of 0.13 could have avoided 11.3% of cystoscopies and bladder wash cytologies, as this cutoff missed only 1 high-risk recurrence (2.6%). More extensive and well-designed studies will confirm if XBM can improve the surveillance of NMIBC.
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Vitko, Alexandra S., Pamela A. Martin, Sheng Zhang, Adam F. Johnston, Robert L. Ohsfeldt, Shen Zheng, and Astra M. Liepa. "Abstract P6-07-01: Costs of breast cancer recurrence after initial treatment for high risk early breast cancer using SEER-Medicare linked data." Cancer Research 83, no. 5_Supplement (March 1, 2023): P6–07–01—P6–07–01. http://dx.doi.org/10.1158/1538-7445.sabcs22-p6-07-01.
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Abstract Background: Despite the good prognosis with treatment for most patients with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) early breast cancer (EBC), ~ 20–30% of patients experience locoregional or distant disease recurrence. To assist in value assessments of novel therapies in the adjuvant setting, this study aimed to determine the costs of treated breast cancer recurrence following treated EBC. Methods: This retrospective study analyzed linked patient data from the US Surveillance Epidemiology and End Results (SEER) registry (2010-2014) and Medicare claims (2009 to 2019, which included data from Part A, B, and Prescription Drug Events [Part D]). Data were analyzed for patients aged ≥65 years with HR+, HER2-, node-positive EBC at high risk of recurrence (consistent with monarchE trial high risk criteria). Treated recurrences were defined based on treatment events/procedure codes, including surgery, radiation and systemic therapy, after a 90-day gap following the last treatment for initial EBC. Recurrences were classified based on Medicare claim diagnosis codes or SEER registry data. Extra cost was defined as cost attributable to treated recurrence. Cumulative extra costs were estimated by calculating cost differences between patients with treated vs non/untreated recurrence. Cumulative extra costs were analyzed over the first 6 years following first treated recurrence, a duration which ensured adequate sample size. Costs were inflated to 2021-US$. Results: We identified 3081 eligible patients (mean age at diagnosis 74.5±7.1 years, 97.4% female, 87.8% White). We identified 964 patients with treated recurrence (distant=432, locoregional=128, contralateral=9, unclassified=347) and 2117 patients with non/untreated recurrence. Six-year cumulative extra costs were higher for patients with distant recurrences ($168,656) than for patients with locoregional recurrences ($96,465) (Table 1). Conclusions: Cost of recurrence in patients with high risk EBC is considerable, particularly in patients with distant recurrences. Most patients who recurred in this population experienced distant recurrence. Delaying or preventing recurrence may reduce long term costs in these high risk EBC patients. Table 1. Mean cumulative extra costs attributable to treated recurrence. Citation Format: Alexandra S. Vitko, Pamela A. Martin, Sheng Zhang, Adam F. Johnston, Robert L. Ohsfeldt, Shen Zheng, Astra M. Liepa. Costs of breast cancer recurrence after initial treatment for high risk early breast cancer using SEER-Medicare linked data [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-07-01.
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Byrnes, Matthew C., Eric Irwin, Dana Carlson, Amy Campeau, Jonathon C. Gipson, Alan Beal, and J. Kevin Croston. "Repair of High-Risk Incisional Hernias and Traumatic Abdominal Wall Defects with Porcine Mesh." American Surgeon 77, no. 2 (February 2011): 144–50. http://dx.doi.org/10.1177/000313481107700210.
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Complex ventral hernias represent a significant challenge to surgeons. We hypothesized that a wide underlay technique in combination with a novel biologic mesh would result in repair with a low recurrence rate. Medical records of patients undergoing ventral herniorrhaphy with Xen-Matrix biologic mesh were evaluated. All patients were evaluated for hernia recurrence both immediately and after 2 to 3 years. There were 57 patients included in the study. The overall recurrence rate was 7.2 per cent; however, all recurrences were early and were likely technical failures. The average duration of follow-up was 30.6 months with no further recurrences after the early technical failures. The average number of previous recurrences was 1.5. Fascial closure was obtained over the mesh in 84 per cent of patients, with component separation being necessary in 36 per cent of patients. Lack of fascial reapproximation over the mesh was associated with early recurrence (0 vs 55%, P < 0.0001). Complex ventral hernias can be repaired with a low recurrence rate. Our technique in combination with the XenMatrix biologic mesh provides for durable repair. Whenever possible, the fascia should be closed above the underlay mesh, because this technique provides a more durable repair than using the mesh as a “fascial bridge.”
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Kim, Edward, and Jesse Roberts. "Recurrence Risk Related Rationale." International Journal of Radiation Oncology*Biology*Physics 112, no. 1 (January 2022): 38. http://dx.doi.org/10.1016/j.ijrobp.2021.07.1705.
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WA, Mauser, Rich SS, and Lee JRJ. "Risk of Seizure Recurrence." Nurse Practitioner 23, no. 6 (June 1998): 147. http://dx.doi.org/10.1097/00006205-199806000-00017.
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Bianca, Sebastiano, Carmela Ingegnosi, Antonella Cataliotti, and Giuseppe Ettore. "Multiple aneuploidy recurrence risk." American Journal of Medical Genetics Part A 140A, no. 17 (September 1, 2006): 1888–89. http://dx.doi.org/10.1002/ajmg.a.31401.
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Wasilewski-Masker, K., W. Leisenring, L. R. Meacham, S. Hammond, A. T. Meadows, L. L. Robison, and A. C. Mertens. "Late recurrence in survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study (CCSS)." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 9534. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.9534.
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9534 Background: An increasing percentage of childhood cancer patients are surviving their disease, but limited research suggests that late recurrences may impact overall survival. The goal of this study is to estimate late recurrence rates for the most common pediatric cancers and to determine additional risk factors for late recurrence. Methods: CCSS is a retrospective cohort study of five-year survivors of childhood cancer diagnosed before 21 years of age, between 1970 and 1986 at one of 26 consortium centers. Late recurrence was defined as first recurrence occurring > five years post-diagnosis. Recurrences were determined by self-report questionnaire or by confirmation through medical record, death certificate or pathologic review. Probability of late recurrence was calculated using cumulative incidence. Adjusted hazard ratios (HR) were obtained using Cox proportional hazards regression. Results: In 12,948 survivors with no recurrence = five years from diagnosis, 670 (5.2%) subjects had a first recurrence > five years after their primary diagnosis. Late recurrences ranged from 5 to 28.9 years from diagnosis (median 7.9 years). Cumulative incidence varied by diagnosis ( table ). In multivariate analysis, significant risk factors for increased late recurrence included a primary diagnosis of Ewing's sarcoma or CNS tumors (HR of 2.3 and 2.7 respectively vs. leukemia survivors), age = 10 years at diagnosis (HR 1.4 vs. age < 10 years), chemotherapy exposure (HR 1.5 vs. none), and radiation exposure (HR 1.4 vs. none) (p < 0.001 for all). At the time of last follow-up, 51.6% of subjects with a late recurrence had died versus 6.4% of those with no history of recurrence. Conclusions: Late recurrences occur in survivors of childhood cancers with a significant risk of mortality. This emphasizes the importance of long-term survivor follow-up into adulthood, particularly for adolescents and patients with Ewing's sarcoma and CNS tumors. [Table: see text] No significant financial relationships to disclose.
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Blankenship, Leann, Daniel Ezekwudo, Ishmael A. Jaiyesimi, Osama Alassi, Michael J. Stender, and Susanna S. Gaikazian. "Discordant breast cancer: Low risk genomic, high risk pathologic." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18160-e18160. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18160.
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e18160 Background: Studies using the 21-gene recurrence score (RS) have shown low risk pathologic features and RS breast cancers do not benefit from systemic chemotherapy (CTx). However, data is lacking for patients with discordant risk factors and which feature, genomic or clinical, plays more of a role in determining outcomes. Methods: Retrospective analysis was conducted to identify breast cancer patients with discordant features, defined as low genomic/high pathologic factors, from 2011 to 2016. Patients were hormone-receptor positive with RS < 18 and had ³ 2 high risk factors: tumor size ³2cm, lymph node (LN) positivity, or grade 2-3 disease. Results: There were 469 patients with low risk RS were identified of whom 118 met discordant risk criteria. Patients management is depicted in Table 1. Of the 118 discordant patients, 22 had breast cancer recurrence as either metastatic (1) or locoregional (21); 11 being ipsilateral while the remainder were contralateral. Patients with ipsilateral recurrences had partial mastectomy and radiotherapy as initial management. CTx was received in 30 patients despite low RS. Recurrences occurred in 31.8% of patients who received adjuvant CTx. The majority of recurrences occurred >5 years after initial diagnosis. Conclusions: Our results show both genomic and pathologic features were important in determining the need for CTx in early stage breast cancer but neither had a greater impact. Thus, we advocate a more comprehensive and individualized approach, taking into account comorbidities, genomic, and pathologic features, for addition of CTx to standard hormonal therapy. Further studies are needed to determine the proper treatment of this unique patient population. [Table: see text]
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Hankey, Graeme J., and Chee-Keong Wee. "Predicting Early Recurrent Stroke With the Recurrence Risk Estimator." JAMA Neurology 73, no. 4 (April 1, 2016): 376. http://dx.doi.org/10.1001/jamaneurol.2015.5047.
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Klemm, Jakob, Kensuke Bekku, Mohammad Abufaraj, Ekaterina Laukhtina, Akihiro Matsukawa, Mehdi Kardoust Parizi, Pierre I. Karakiewicz, and Shahrokh F. Shariat. "Upper Tract Urothelial Carcinoma: A Narrative Review of Current Surveillance Strategies for Non-Metastatic Disease." Cancers 16, no. 1 (December 20, 2023): 44. http://dx.doi.org/10.3390/cancers16010044.
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Non-metastatic upper urinary tract carcinoma (UTUC) is a comparatively rare condition, typically managed with either kidney-sparing surgery (KSS) or radical nephroureterectomy (RNU). Irrespective of the chosen therapeutic modality, patients with UTUC remain at risk of recurrence in the bladder; in patients treated with KSS, the risk of recurrence is high in the remnant ipsilateral upper tract system but there is a low but existent risk in the contralateral system as well as in the chest and in the abdomen/pelvis. For patients treated with RNU for high-risk UTUC, the risk of recurrence in the chest, abdomen, and pelvis, as well as the contralateral UT, depends on the tumor stage, grade, and nodal status. Hence, implementing a risk-stratified, location-specific follow-up is indicated to ensure timely detection of cancer recurrence. However, there are no data on the type and frequency/schedule of follow-up or on the impact of the recurrence type and site on outcomes; indeed, it is not well known whether imaging-detected asymptomatic recurrences confer a better outcome than recurrences detected due to symptoms/signs. Novel imaging techniques and more precise risk stratification methods based on time-dependent probabilistic events hold significant promise for making a cost-efficient individualized, patient-centered, outcomes-oriented follow-up strategy possible. We show and discuss the follow-up protocols of the major urologic societies.
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Stewart, Suzanne B., Stephen A. Boorjian, Sarah P. Psutka, John C. Cheville, Prabin Thapa, Robert F. Tarrell, Matthew K. Tollefson, Robert Houston Thompson, and Igor Frank. "EAU and NCCN surveillance guidelines for bladder cancer: Do they effectively capture recurrences following cystectomy?" Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 310. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.310.
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310 Background: The European Association of Urology (EAU) and the National Comprehensive Cancer Network (NCCN) provide general guidelines for bladder cancer (BC) surveillance following radical cystectomy (RC). However, it is unclear how well these guidelines capture recurrences after surgery. Herein, we assess the ability of current guidelines to effectively capture BC recurrence following RC and propose a risk stratified and recurrence site-specific surveillance strategy. Methods: We reviewed our institutional database of 1,800 patients who underwent primary RC between 1980-2007. Guideline effectiveness was assessed by calculating the percentage of recurrences detected within the prescribed follow-up periods: EAU—5yrs; NCCN—2yrs. Patients were then stratified according to stage: < = pT1Nx-0, > = pT2Nx-0, pN+, and recurrence site: urothelium, abdomen, chest, other. Recurrence free survival estimates for stage groups and recurrence site were assessed with Kaplan Meier models. Results: Of the 1,800 patients, 634 (35.2%) were classified as > pT2Nx-0 and 234 (13%) as pN+ and overall 228 (12.7%) received perioperative chemotherapy. Median postoperative follow-up was 10.6yrs (IQR 6.8-15.2), during which 716 (39.8%) patients developed recurrence. Of these recurrences, 492 (68.7%) would have been detected using the NCCN guidelines and 644 (89.8%) by EAU recommendations. However, ending oncologic surveillance at 5 years would only capture 81.7% of all recurrences for < = pT1Nx-0 patients and 83% of urothelial specific recurrences across all stage groups. Capture of 90% of recurrences, by stage group, in the urothelium, abdomen and chest would require surveillance for 8yrs, 8yrs and 4yrs, respectively in < = pT1Nx-0, 6yrs, 4yrs and 3yrs in > = pT2Nx-0 and 3yrs, 3yrs and 2yrs for pN+ patients. Conclusions: Duration of surveillance recommended for BC following RC by the EAU and NCCN do not comprehensively capture recurrences seen, specifically, in low risk patients and in cases of urothelial recurrence. Guidelines using risk stratification and site-specific recurrence patterns to assign length of surveillance may allow providers to better individualize surveillance regimens.
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Séka, EV, KD N’chiépo, GG N’da, BAW Mossé, S. El Majjaoui, and N. Benjaafar. "Retrospective analysis of para-aortic lymph node recurrence in locally advanced cervix cancers treated with “pelvic-only field” radiotherapy." African Journal of Oncology 2, no. 1 (January 1, 2022): 9–14. http://dx.doi.org/10.54266/ajo.2.1.9.mxhlpwr8ci.
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INTRODUCTION: Previous studies suggested that treating para-aortic lymph node micro-metastases with extended-field radiotherapy could result in higher rate of tumor control in high-risk locally advanced cervical cancers. Our study aimed to assess the patterns of recurrences following pelvic-only irradiation, with an emphasis on recurrence in para-aortic lymph node. MATERIALS AND METHODS: We retrospectively evaluated pattern of recurrences in patients with cervical cancers who were treated with definitive pelvic radiotherapy at our institution from 2013 to 2016. Univariate and multivariate analyses were performed to identify risk factors associated with para-aortic lymph node recurrence. RESULTS: We enrolled 463 patients in the study. The median of follow-up was 63.5 months. Five-years overall survival, recurrence-free survival, and para-aortic lymph node recurrence rates were respectively 78.9%, 76.2% and 6.5%. During follow-up, 23.33% experienced recurrences. Most often tumor recurred locally (42.60%). Para-aortic recurrences were found in 26 patients. Patients’ age (≤57 years) (HR=4.9, p=0.002), histological subtype (adenocarcinoma) (HR=2.7, p=0.035), presence of pelvic lymph node metastasis (HR=0.3, p=0.037) and absence of brachytherapy (HR=6.5, p<0.0001) were significantly associated with para-aortic lymph node (PALN) recurrence in multivariate analysis. CONCLUSION: Recurrences following pelvic-only irradiation were frequently observed in the pelvis. Clinical characteristics associated with a high risk of PALN recurrence were young age, absence of brachytherapy, presence of pelvic lymph node metastases, and the adenocarcinoma subtype. However, further studies with a greater number of patients need to be undertaken.
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Cagiannos, Ilias, and Christopher Morash. "Surveillance strategies after definitive therapy of invasive bladder cancer." Canadian Urological Association Journal 3, no. 6-S4 (May 1, 2013): 237. http://dx.doi.org/10.5489/cuaj.1205.
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Following definitive therapy for muscle invasive bladder cancer,patients remain at risk for local and distant recurrence. Additionally,recurrences can result from formation of new tumours elsewherein the urinary tract. We review patterns of recurrence and theprognosis associated with recurrence. Optimal surveillance strategiesare discussed.
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Ģībietis, Valdis, Dana Kigitoviča, Sintija Strautmane, Kitija Meilande, Verners Roberts Kalējs, Anastasija Zaičenko, Kristīne Maķe, Aivars Lejnieks, and Andris Skride. "Venous Thromboembolism Recurrence in Latvian Population: Single University Hospital Data." Medicina 55, no. 9 (August 21, 2019): 510. http://dx.doi.org/10.3390/medicina55090510.
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Background and objectives: Recurrence of venous thromboembolism (VTE) after a primary event is common; however, no sufficient risk scores have been widely introduced in clinical practice. The aim of this study was to assess the risk factors for VTE recurrences, as well as the effect of treatment strategies on the recurrence rate in a single-center patient cohort. Materials and Methods: The prospective cohort study included consecutive patients in a single center from June 2014 till June 2018 presenting with acute VTE confirmed by imaging tests. All patients were followed up for at least one year or till death. Statistical analyses were conducted using IBM SPSS Statistics 23 and Stata 13. Competing risk of death was considered. Results: A total of 219 eligible patients were identified during the study period. Pulmonary embolism with or without deep vein thrombosis (DVT) was present in 95.9% (n = 210), isolated DVT was present in 4.1% (n = 9) of patients. The total number of documented recurrences was 13 (5.9%). Incidence rate was 5.6 per 100 person-years. Recurrent VTE predicted significantly higher mortality rate (hazard ratio (HR) 6.64 [95% CI 2.61–16.93]). In univariate analysis, active cancer was associated with higher recurrence rate (p = 0.036). In competing-risks regression model (with death as the competing risk), active cancer (subdistribution hazard ratio (SHR) 2.11 (95% CI 0.58–7.76)) did not retain statistical significance for VTE recurrence. Discontinuation and duration of anticoagulant treatment (≤6 or >6 months), and drug class in acute or long-term therapy (parenteral, vitamin K antagonist (VKA), direct oral anticoagulant (DOAC)) were not associated with recurrences (p > 0.05). Conclusions: Patients who experienced recurrent VTE had 6.6-fold higher mortality rate than patients with no recurrences. The presence of active cancer was not a statistically significant risk factor for recurrence when taking into account the competing risk of death. Duration and drug class of anticoagulation did not seem to impact recurrence rate.
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Mohan, Keerthi M., Charles D. A. Wolfe, Anthony G. Rudd, Peter U. Heuschmann, Peter L. Kolominsky-Rabas, and Andrew P. Grieve. "Risk and Cumulative Risk of Stroke Recurrence." Stroke 42, no. 5 (May 2011): 1489–94. http://dx.doi.org/10.1161/strokeaha.110.602615.
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Negrut, Nicoleta, Simona Bungau, Tapan Behl, Shamim Ahmad Khan, Cosmin Mihai Vesa, Cristiana Bustea, Delia Carmen Nistor-Cseppento, Marius Rus, Flavia-Maria Pavel, and Delia Mirela Tit. "Risk Factors Associated with Recurrent Clostridioides difficile Infection." Healthcare 8, no. 3 (September 21, 2020): 352. http://dx.doi.org/10.3390/healthcare8030352.
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Clostridioides difficile (CD) is responsible for nosocomial diarrhea syndrome with possible severe progression. Recurrence of the disease induces higher health system costs, as well as exposes patients to additional health risks. Patients with recurrence of this disease are difficult to identify, so the purpose of this study is to quantify various demographic, clinical, and treatment factors that could prevent further progression to recurrence of the disease. In the period 2018–2019, about 195 patients were diagnosed with more than one episode of CDI in the three months following the first episode. The recurrence rate for CDI was 53.84% (60.95% for one episode and 39.05% for multiple episodes). Most commonly afflicted were 60–69-year-old patients, or those with higher Charlson Comorbidity Index (CCI). Multiple analyses associated cardiovascular (odds ratios (OR) = 3.02, 95% confidence intervals (CI) = 1.23–7.39, p = 0.015), digestive (OR = 3.58, 95% CI = 1.01–12.63, p = 0.047), dementia (OR = 3.26, 95% CI = 1.26–8.41, p = 0.014), immunosuppressive (OR = 3.88, 95% CI = 1.34–11.21, p = 0.012) comorbidities with recurrences. Risk factor identification in the first episode of CDI could lead to the implementation of treatment strategies to improve the patients’ quality of life affected by this disease.
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Bilici, Ahmet, Fatih Selcukbiricik, Bala Basak Oven Ustaalioglu, Deniz Tural, Mesut Seker, Mahmut Gumus, and Suheyla Serdengecti. "Prognostic significance of the recurrence pattern and risk factors for recurrence in patients with proximal gastric cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e15117-e15117. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e15117.
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e15117 Background: The proximal gastric cancer (GC) is usually diagnosed at advanced stage and it had relatively high recurrence rate after curative resection due to high incidence of lymph node metastasis. This study aimed to investigate the pattern and time of recurrence and to evaluate the risk factors for relapse of proximal GC. Methods: Between 2000 and 2012,110 patients with recurrent proximal GC undergoing radical gastrectomy were retrospectively analyzed.The prognostic significance of the recurrence time and pattern at the diagnosis of relapse and the relationship between the pattern of recurrence and the other clinicopathological factors were evaluated. Results: The median time to recurrence was 34 months, 52.7% of patients had relapse within 2 years. The most recurrence patterns were hematogenous and peritoneal metastasis, respectively (47.3 and 39.1%). Hematogenous and loco-regional recurrence were significantly associated with younger age (p=0.04) and proximal resection was related with higher incidence of all recurrence patterns (p<0.001). Moreover, advanced pT stage was significantly correlated with increased hematogenous and peritoneal recurrence (p=0.002). The median disease-free survival (DFS) and overall survival (OS) times for patients with distant-lymph nodes and hematogenous recurrences were significantly worse than those of patients with loco-regional and peritoneal recurrences (DFS, 9.7 vs. 23.4 vs. 35.4 vs. 43.9 months, p=0.014; OS, 19 vs. 46.4 vs. 70.2 vs. 66.8 months, p=0.04, respectively). Multivariate analysis showed that the time of recurrence [p<0.001, HR: 0.37), pN stage, clinical stage and surgery type were independent prognostic factors for OS. The presence of lymph node metastasis was an independent risk factor for both overall and early recurrence (p=0.004, OR: 0.51). Conclusions: Our results indicate that the time of recurrence, surgery type, lymph node metastasis and clinical stage were independent prognostic indicators for OS, while only the presence of lymph node metastasis was an independent risk factor for early recurrence. Total gastrectomy and adequate lymph nodes dissection were rational curative treatment option for proximal GC.
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Sloan, Diane M., and Susan G. Kornstein. "Risk of Recurrence of Depression During Long-Term Antidepressant Treatment." CNS Spectrums 12, S19 (November 2007): 1–7. http://dx.doi.org/10.1017/s1092852900028200.
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Major depressive disorder (MDD) is widespread, costly, and frequently chronic. Internationally, the burden of depression is large and growing. By the year 2020, this disorder is projected to be the world's second leading cause of disease burden. The costs associated with depression are enormous; people with depression tend to have approximately double the health care costs of unaffected individuals. There are few other major disorders that have a negative health impact of the same magnitude.Early onset of depressive symptoms, along with underdiagnosis and undertreatment, contribute to the burden of MDD, which is also characterized by chronicity, frequent relapses, and recurrences. Risk factors for depressive recurrence include the presence of residual symptoms, >3 prior depressive episodes, chronic depression lasting more than 2 years, a family history of mood disorders, other comorbidities (eg, terminal illness, diabetes), and late onset (>60 years of age). Patients who have any of these factors should be candidates for maintenance treatment.Naturalistic studies have demonstrated that most patients with MDD without sustained treatment will eventually experience a relapse or recurrence. Furthermore, depressive episodes tend to become more autonomous over time, with decreased linkage to stressful life events, more severe, and potentially more refractory with each new relapse or recurrence. Researchers and clinicians have observed that rather than only treat or manage relapses or recurrences of MDD, the best strategy may be prevention of depressive episodes. As a result, current strategies seek to treat patients to remission, which translates to a lower overall risk of developing relapses or recurrences compared with those patients who continue to demonstrate residual symptoms. Thus, a consistent body of evidence now supports continuous pharmacotherapy for the prevention of depressive relapse and recurrence.
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Vizza, Enrico, Valentina Bruno, Giuseppe Cutillo, Emanuela Mancini, Isabella Sperduti, Lodovico Patrizi, Camilla Certelli, Ashanti Zampa, Andrea Giannini, and Giacomo Corrado. "Prognostic Role of the Removed Vaginal Cuff and Its Correlation with L1CAM in Low-Risk Endometrial Adenocarcinoma." Cancers 14, no. 1 (December 22, 2021): 34. http://dx.doi.org/10.3390/cancers14010034.
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Objective: The aim of our study was to investigate the role of the excised vaginal cuff length as a prognostic factor in terms of DFS and recurrence rate/site, in low-risk endometrial cancer (EC) patients. Moreover, we correlated the recurrence with the expression of L1CAM. Material and Methods: From March 2001 to November 2016, a retrospective data collection was conducted of women undergoing surgical treatment for low-risk EC according to ESMO-ESGO-ESTRO consensus guidelines. Patients were divided into three groups according to their vaginal cuff length: V0 without vaginal cuff, V1 with a vaginal cuff shorter than 1.5 cm and V2 with a vaginal cuff longer than or equal to 1.5 cm. Results: 344 patients were included in the study: 100 in the V0 group, 179 in the V1 group and 65 in the V2 group. The total recurrence rate was 6.1%: the number of patients with recurrence was 8 (8%), 10 (5.6%) and 3 (4.6%), in the V0, V1 and V2 group, respectively. No statistically significant difference was found in the recurrence rate among the three groups. Although the DFS was higher in the V2 group, the result was not significant. L1CAM was positive in 71.4% of recurrences and in 82% of the distant recurrences. Conclusions: The rate of recurrence in patients with EC at low risk of recurrence does not decrease as the length of the vaginal cuff removed increases. Furthermore, the size of the removed vaginal cuff does not affect either the site of recurrence or the likelihood of survival.
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Peterson, Joseph R., Anu K. Antony, The SimBioSys Team, and John A. Cole. "Novel imaging marker for low- and mid-recurrence score patients at risk for recurrence." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e12565-e12565. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e12565.
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e12565 Background: The 21-gene (Oncotype DX) recurrence score (RS) has been utilized as a prognostic assay in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer. The results stratify patients into low-, mid- and high-risk of disease recurrence. Patients with a low recurrence score tend to have lower recurrence rates and are less responsive to chemotherapy. On the other hand, patients with high-recurrence scores are more likely to respond to chemotherapy. While for patients at the high end of the RS spectrum it is apparent that chemotherapy carries benefit, distinguishing chemotherapy benefit for low- and mid-recurrence score (RS-low/-mid) patients is less clear. Methods: To address this, we used a novel 2-paramenter pharmacokinetic modeling framework that allows biosignatures to be extracted from dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) studies that contain 3-6 timepoints spaced 60-90 seconds apart. These parameters, referred to as P1 and P2, represent leakiness from vessels to the extravascular space and vice versa. Results: Using this model, we performed a study in a cohort of 111 breast cancer patients with 21-gene assay RS and DCE-MRIs available. P1 and P2 were extracted from patient standard clinical DCE-MRIs. We performed univariate (Kaplan-Meier) survival analyses to test the prognostic value of the parameters covariate in predicting recurrence free survival (RFS). A pre-specified value of the median P1 and P2 across the patient population was used for stratifying patients into “low” and “high” groups, representing patients with “low” or “high” vessel leakiness. We analyzed patients according to RS. Low P1 showed better outcomes in RS-low and RS-mid patients (n=88, p≤0.028; log-rank test). Patients with a high P1 had a 20.2% chance recurrence at six years. The same trend was observed when considering just RS-mid patients only (n=23, p≤0.058). No recurrences were observed in patients with low P1 in either the RS-low or RS-mid categories. Additionally, there were no recurrences in the high P1, RS-low/-mid category that received chemotherapy, suggesting that chemotherapy could be beneficial in this category of patients, although the trend was not statistically significant (n=10, p=0.46). Similar results were seen for P2. Conclusions: Overall, we demonstrate how our prognostic imaging marker can identify a subset of patients with low-/mid-recurrence scores that could benefit from chemotherapy. This new prognostic approach has the potential to optimize treatment and improve personalized care by providing clarity on the use of chemotherapy in low-/mid-recurrence score patients.[Table: see text]
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van der Velden, Jacobus, Constantijne H. Mom, Luc van Lonkhuijzen, Ming Y. Tjiong, Henrike Westerveld, and Guus Fons. "Analysis of isolated loco-regional recurrence rate in intermediate risk early cervical cancer after a type C2 radical hysterectomy without adjuvant radiotherapy." International Journal of Gynecologic Cancer 29, no. 5 (May 27, 2019): 874–78. http://dx.doi.org/10.1136/ijgc-2019-000445.
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BackgroundThe efficacy of adjuvant radiotherapy in patients with intermediate risk early cervical cancer after radical hysterectomy is still under debate. Most guidelines recommend adjuvant radiotherapy, whereas others consider observation a viable option.ObjectiveTo investigate if patients with intermediate risk factors for cervical cancer who underwent radical hysterectomy may benefit from adjuvant radiotherapy.MethodsConsecutive patients with tumor confined to the cervix and intermediate risk factors (according to Sedlis), treated between January 1982 and December 2014 who were observed after a type C2 radical hysterectomy formed the basis for this study. The frequency of recurrences, specifically isolated loco-regional recurrences, and the risk of death from recurrences, were analyzed. Data were analyzed using SPSS, version 23.0 for WindowsResultsA total of 161 patients were included in the analysis. Median age was 40 (range 20–76). Stages IB1 and IB2 were seen in 87 (54%) and 74 patients (46%), respectively. Squamous cell and non-squamous histology was seen in 114 (70.8%) and 47 patients (29.2%), respectively. Of the 161 patients, 25 (15.5%) had recurrent disease, of whom nine had an isolated loco-regional recurrence (5.6%). Median time to recurrence for isolated loco-regional recurrences was 28 months (range 9–151). Treatment for an isolated loco-regional recurrence was radiotherapy (n = 4) and chemoradiotherapy (n = 5). Four patients (2.5%) died from disease as a result of an isolated loco-regional recurrence. Actuarial disease- specific survival was 93.0% for the total group. No variables were found that predicted an isolated loco-regional recurrence.DiscussionThe mortality from isolated loco-regional recurrence in patients with intermediate risk factors for cervical cancer who underwent only radical hysterectomy type C2 was 2.5%. Further studies should compare outcomes between patients who undergo a type C2 radical hysterectomy without adjuvant radiotherapy with those undergoing a less radical hysterectomy but with adjuvant radiotherapy.
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Akter, N., M. M. Rahman, S. Akhter, K. Fatema, and S. M. B. Billah. "Predictors of Recurrence after a First Unprovoked Seizure in Childhood: A Prospective Study." European Journal of Clinical Medicine 2, no. 3 (June 26, 2021): 77–80. http://dx.doi.org/10.24018/clinicmed.2021.2.3.42.
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The second part of the revised definition of epilepsy by ILAE in 2014 allows a condition to be considered epilepsy after one seizure if there is a high risk of having another seizure; if the risk factor is not precisely be known we have to wait for another seizure. This definition necessitates search for probable risk factors. We aimed this study to assess the recurrence rate and associated risk factors for recurrences after a first unprovoked seizure in children within two years of first attack. This prospective study was conducted on in Banglabandhu Sheikh Mujib Medical University (BSMMU) from June 2016 to December 2018. Among 137 children finally 120 children aged between1 month to 14 years after a first seizure were followed up for 2 years. Diagnosis of seizure was confirmed on the basis of diagnostic criteria and none of the children was treated by any antiepileptic drugs after first episode. Overall recurrence rate within 2 years of follow up was 38%. Majority of recurrence (65%) observed within 6-10 months of initial seizure. Significant risk factors were an abnormal EEG finding (p=<0.001), focal seizure (p=<0.001), seizure at sleep (p=0.001) and initial presentation with status epilepticus (p=0.001). Abnormal neuroimage findings were also associated with seizure recurrence, but it was not statistically significant. Age of the patients and underlying motor and cognitive delay was not a significant risk factor for recurrence. A great percentage of first seizure didn’t show recurrence but there are so many factors can determine the possibilities of recurrence, early identification of risk factors specially the focal pattern of seizure, seizure in sleep, status epilepticus and abnormal electrophysiology are the best predictive factors of recurrence, so identifying the high risk group of recurrence helps to initiate early antiepileptic drug and prevent further recurrence.
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Ishitobi, Makoto, Jun Okuno, Nobuyoshi Kittaka, Takahiro Nakayama, Hiroki Koyama, and Yasuhiro Tamaki. "Distant recurrence risk following early ipsilateral breast tumor recurrence." Oncology Letters 13, no. 5 (March 3, 2017): 2886–90. http://dx.doi.org/10.3892/ol.2017.5797.
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Sako, Keisuke, Kengo Furuichi, Yuta Yamamura, Megumi Oshima, Tadashi Toyama, Shuichi Kaneko, and Takashi Wada. "Association between the recurrence period of acute kidney injury and mortality: a single-centre retrospective observational study in Japan." BMJ Open 9, no. 6 (June 2019): e023259. http://dx.doi.org/10.1136/bmjopen-2018-023259.
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ObjectivesRecurrent acute kidney injury (AKI) is a recognised risk factor for mortality. However, it is unclear whether the period until AKI recurrence may have a major factor on patient outcome or not. To explore this issue, we (1) framed the hypothesis that early recurrence increases the risk of mortality and (2) evaluated the prognosis of recurrent AKI cases by setting 21 days as the cut-off period.MethodsAll studied cases were admitted and followed up at the Kanazawa University Hospital (Kanazawa, Japan) between 1 November 2006 and 31 October 2007. In total, 21 939 patients were retrospectively evaluated in their recurrences of AKI for 2 years and followed up until 31 October 2016. Risks for death were evaluated by the recurrences of AKI (Analysis 1). Patients who developed AKI recurrence before 21 days were defined as the early-recurrence group and the remaining cases as the late-recurrence group. Risks for death were evaluated by the two groups (Analysis 2).Results510 patients (2.3%) developed the first AKI. Of these, 151 developed recurrent AKI within 2 years. The number of early-recurrence cases was 44 and that of non-recurrence or late-recurrence was 357. A total of 196 cases (38.4%) died, and higher risk for death was observed in the recurrent AKI group (Analysis 1; p=0.015, log-rank test). We found that the rate of all-cause mortality was higher in the early-recurrence group involving 33.8 deaths per 100 person-years, whereas the non-recurrence or late-recurrence group included only 6.2 deaths per 100 person-years (Analysis 2; p<0.001, log-rank test).ConclusionsPatients experiencing recurrent AKI before 21 days from the first AKI clearly showed a relatively poor prognosis. Evidently, careful follow-up for at least 21 days after AKI would be highly useful to detect a recurrence event, possibly leading to a better prognosis after AKI.
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Pan, Hong-Da, Gang Zhao, Qi An, and Gang Xiao. "Pulmonary metastasis in rectal cancer: a retrospective study of clinicopathological characteristics of 404 patients in Chinese cohort." BMJ Open 8, no. 2 (February 2018): e019614. http://dx.doi.org/10.1136/bmjopen-2017-019614.
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ObjectivesThis study aim to investigate the incidence, timing and risk factors of metachronous pulmonary recurrence after curative resection in patients with rectal cancer.DesignA retrospective cohort study.SettingThis study was conducted at a tertiary referral cancer hospital.ParticipantsA total of 404 patients with rectal cancer who underwent curative resection from 2007 to 2012 at Beijing Hospital were enrolled in this study.InterventionsThe pattern of recurrence was observed and evaluated.Primary and secondary outcome measuresThe incidence and timing of recurrences by site were calculated, and the risk factors of pulmonary recurrence were analysed.ResultsThe 5-year disease-free survival for the entire cohort was 77.0%. The most common site of recurrence was the lungs, with an incidence of 11.4%, followed by liver. Median interval from rectal surgery to diagnosis of pulmonary recurrence was much longer than that of hepatic recurrence (20 months vs 10 months, P=0.022). Tumour location, pathological tumor-node-metastasis (TNM) stage and positive circumferential resection margin were identified as independent risk factors for pulmonary recurrence. A predictive model based on the number of risk factors identified on multivariate analysis was developed, 5-year pulmonary recurrence-free survival for patients with 0, 1, 2 and 3 risk factors was 100%, 90.4%, 77.3% and 70.0%, respectively (P<0.001).ConclusionsThis study emphasised that the lung was the most common site of metachronous metastasis in patients with rectal cancer who underwent curative surgery. For patients with unfavourable risk profiles, a more intensive surveillance programme that could lead to the early detection of recurrence is strongly needed.
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Li, Jiancheng, and Yina Lin. "PS02.118: THE RESEARCH ABOUT SITE AND RISK FACTORS OF THE RECURRENCE AND METASTASIS AFTER POSTOPERATIVE RADIOTHERAPY IN ESOPHAGEAL." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 154. http://dx.doi.org/10.1093/dote/doy089.ps02.118.
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Abstract Background To explore the risk factors of recurrence of postoperative esophageal cancer after radiotherapy, and analyze the regional and temporal regularity of this kind of recurrence. Methods Retrospective analysis the198 patients from Fujian Provincial Tumor Hospital Radiotherapy Department between January 2000 and December 2015 were collected of esophageal cancer after surgery, were treated with adjuvant postoperative radiotherapy, 198 patients were followed up for recurrence, To study the relationship between the observed indexes and the recurrence of esophageal cancer after radiotherapy. The recurrence site was divided into local recurrence and distant metastasis, and analysis of the relationship between the recurrence site and time, so as to take different treatment modalities for patients with different time periods. Results In 198 patients with recurrence and metastasis, 166 (84%) were found within 2 years.The patients whose metastasis and recurrence in 2 years, 43 cases (26%)had recurrence in the irradiation field, 85 cases (51%) had metastasis outside the irradiation field, 38 cases (23%) were both in and outside of the field. In 88 cases of recurrence within six months of the patients, only 18 cases (20%) recurrenced in the field, the recurrence rate was significantly lower than that of the outside the field. Multi-factor analysis results show that the lymph node metastasis and the start time of radiotherapy are the main risk factors affecting the recurrence, The postoperative pathological diagnosis in the control of N0, the risk of recurrence of N3 is 1.673 times of N0 (P = 0.036, HR = 1.673, 95%CI = 1.033 to 2.711); Less than 30 day recurrence risk is 2.482 times (P = 0.003, HR = 2.482, 95%CI = 1.364 to 4.520), more than 60 day recurrence risk is 1.42 times (P = 0.039, HR 1.42, 95%CI 1.019 to 1.979). Conclusion After radiotherapy after esophagectomy, 84% recurrence within 2 years, so should be closely followed up 2 years after the treatment, postoperative radiotherapy only control the radiation within the field of the recurrence rate within the next six months. Lymph node metastasis, radiation therapy, the start time is a risk factor for esophageal predicting recurrence after radiotherapy after surgery. Disclosure All authors have declared no conflicts of interest.
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Giannella, Luca, Giovanni Delli Carpini, Jacopo Di Giuseppe, Camilla Grelloni, Giorgio Bogani, Marco Dri, Francesco Sopracordevole, et al. "Long-Term Follow-Up Outcomes in Women with In Situ/Microinvasive Adenocarcinoma of the Uterine Cervix Undergoing Conservative Treatment—Cervical Adenocarcinoma Study Group Italian Society of Colposcopy and Cervico-Vaginal Pathology." Cancers 16, no. 6 (March 21, 2024): 1241. http://dx.doi.org/10.3390/cancers16061241.
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Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent variables associated with recurrence were evaluated. Logistic regression analysis and Kaplan–Meier survival analysis with Logrank test were performed. Results: Of 269 women diagnosed with in situ/microinvasive AC, 127 participants underwent conservative treatment. During follow-up, recurrences were found in nine women (7.1%). The only factor associated with recurrence during follow-up was positive high-risk Human Papillomavirus (hr-HPV) testing (odds ratio 6.21, confidence interval 1.47–26.08, p = 0.012). HPV positivity in follow-up showed a recurrence rate of 21.7% against 3.8% in patients who were HPV-negative (p = 0.002, Logrank test). Among women with negative high-risk HPV tests in follow-up, recurrences occurred in 20.0% of non-usual-type histology vs. 2.1% of usual-type cases (p = 0.005). Conclusion: HPV testing in follow-up is of pivotal importance in women with early glandular lesions undergoing conservative treatment, given its recurrence predictive value. However, women who are high-risk HPV-negative in follow-up with non-usual-type histopathology may represent a sub-population at increased risk of recurrences. Further studies should confirm these findings.
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Siqueira, Thayane Santos, Ariel Oliveira Celestino, Alexrangel Henrique Cruz Santos, Mariana do Rosário Souza, Amanda Francielle Santos, Beatriz Almeida Santos, Rosiene Batista Santos, et al. "Clinical - epidemiological aspects and spatial analysis of leprosy relapses in an endemic area of Brazil." Research, Society and Development 10, no. 10 (August 10, 2021): e267101018761. http://dx.doi.org/10.33448/rsd-v10i10.18761.
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Objective: to analyze the trend, spatial distribution and factors associated with leprosy recurrence in Sergipe. Methods: this is a population-based ecological study, using spatial analysis and logistic regression techniques. Data from all leprosy recurrences reported to SINAN (Notifiable Diseases Information System) in the state of Sergipe, Brazil, were used from 2007 to 2017. Results: there was a tendency for an increase in recurrences in the period from 2011 to 2017: APC: 14.69 (p-value = 0.003). The recurrence incidence map showed a heterogeneous behavior, with the Moran index (I = 0.16; p-value: 0.0159). The multivariate analysis showed a higher risk of recurrence in adults (aOR = 2.81) and young adults (aOR = 2.85) Conclusion: the risk factors associated with the appearance of recurrences are: the age group, the zone, the operational classification , the clinical form and the degree of disability.
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Park, Chan Hong. "Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression." Pain Physician 2, no. 22.2 (March 11, 2019): E133—E138. http://dx.doi.org/10.36076/ppj/2019.22.e133.
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Background: Transforaminal endoscopic lumbar disc decompression (TELD) has emerged as a treatment alternative to open lumbar discectomy, but rates of herniated lumbar disc (HLD) recurrence after TELD are higher by comparison. Objectives: We conducted this study to identify factors correlating with early HLD recurrence after TELD. Study Design: Retrospective study. Setting: The Department of Anesthesiology and Pain Medicine, Neurosurgery at Spine Health Wooridul Hospital. Methods: As a retrospective review, we examined all patients undergoing TELD between 2012 and 2017, analyzing the following in terms of time to recurrence: age, gender, body mass index (BMI), comorbid conditions (diabetes mellitus [DM], hypertension [HTN]), smoking status, nature of disc herniation (central, paramedian, or foraminal), Modic changes, migration grade (rostral vs. caudal track + degree), herniated disc height (Dht) and base size (Dbase), and the presence of spondylolisthesis on magnetic resonance imaging. Results: During the 5-year study period, 1,900 patients underwent TELD procedures, resulting in 209 recurrences (11.0%). In 27 of these patients (12.9%), herniation recurred within 24 hours after surgery. Recurrences most often developed within 2-30 days (n = 76). The smaller the size of a herniated disc, the earlier it recurred. Recurrences were unrelated to gender, BMI, DM or HTN, smoking status, migration grade, nature (Dht or Dbase of herniated disc), or the presence of spondylolisthesis. Limitations: In addition to variables assessed herein, other clinical and radiologic parameters that may be important in recurrent disc herniation should be included. Furthermore, only univariate analyses were performed, making no adjustments for potential confounders, therefore, independent risk factors could not be assessed. A prospective study would likely generate more precise results, especially in terms of standardized sampling and data classification. Finally, multiple causes for primary discectomy failures may have rendered our patient groups nonhomogeneous, and inequalities in surgical options or physician-dictated surgical choices may have had an effect. Conclusions: In patients undergoing TELD procedures, smaller-sized herniated discs are linked to early recurrences. Key words: Disc herniation, lumbar, endoscopic, recurrence, early
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Amar, Ali, Helma Maria Chedid, Otávio Alberto Curioni, Rogério Aparecido Dedivitis, Abrão Rapoport, Claudio Roberto Cernea, and Lenine Garcia Brandão. "Delayed postoperative radiation therapy in local control of squamous cell carcinoma of the tongue and floor of the mouth." Einstein (São Paulo) 12, no. 4 (December 2014): 477–79. http://dx.doi.org/10.1590/s1679-45082014ao3006.
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Objective To evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth.Methods A total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy.Results Local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49).Conclusion In the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance.
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Schiavone, D., R. Pianon, L. Comunale, and G. Mobilio. "I parametri clinici, endoscopici e patologici nella valutazione delle potenzialità evolutive dei tumori superficiali della vescica: Clinical, endoscopic and pathological parameters in assessing the potential progression of superficial bladder tumours." Urologia Journal 62, no. 2 (April 1995): 168–83. http://dx.doi.org/10.1177/039156039506200203.
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Clinical, endoscopic and pathological assessment provides the classical factors of prevision for bladder tumours. The risk of recurrence is different among primary and recurrent tumours. The risk of recurrence for primary tumours is correlated to the number of neoformations at diagnosis and to the cystoscopy at three months. The risk of recurrence for recurrent tumours is correlated to the number of neoformations and the previous recurrence rate. It seems that the number of recurrences doesn't imply a higher risk of progression. The most important endoscopic parameters are: number, shape and size of neoformations, and appearance of the vesical mucosa. The most important pathological parameters are: growth pattern, grade, stage, histologic aspect of the vesical mucosa and invasion of lymphatic vessels. All these parameters are correlated to the risk of tumour progression for groups of patients but they cannot predict the fate of the individual case. The predictive value of these parameters could improve with a critical revision of the definitions of grade and stage.
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Darwish, Oussama M., Ganesh Raj, Ramy F. Youssef, Payal Kapur, Aditya Bagrodia, Michael Belsante, Yair Lotan, and Vitaly Margulis. "Novel stratification of the recurrence risk following surgical extirpation of clear cell renal cell carcinoma using tissue biomarkers in the mammalian target of rapamycin pathway." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 372. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.372.
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372 Background: Aberrant activation of the mammalian target of rapamycin (mTOR) pathway promotes invasiveness and metastatic potential in a variety of malignancies. The aim of the present study was to evaluate the association of altered expression of mTOR pathway components with recurrence outcome in non-metastatic clear cell renal cell carcinoma (ccRCC) patients. Methods: Immunohistochemistry for phos-S6, phos-mTOR, mTOR, phos-AKT, HIF-1α, RAPTOR, PTEN, PI3K, and phos-4EBP1 was performed on tissue microarrays of patients treated for non-metastatic kidney cancer between 1997-2010. Patients were defined as having a low (<) or high risk (≥) of nomogram predicted recurrence (2001 MSKCC RCC post-op) using an 8% cutoff. The relationship between individual marker expression, as well as combined marker score (low, intermediate and high defined as ≤ 3, 4-5, >5 altered biomarkers; respectively) with the actual and predicted relapse rates was assessed. Results: The study included 419 non-metastatic ccRCC patients (pT1-T2 79.5%, pT3-T4 20.5%, Fuhrman nuclear grade 1-2 in 69%, 3-4 in 31%). 219 and 200 patients had low (<8%) and high (≥8%) nomogram-predicted 5-year risk of recurrence respectively. With a median follow-up of 2.2 years, recurrences were detected in 5 (2.3%) of the predicted low risk and 30 (15%) of the predicted high risk patients. mTOR pathway biomarker profiles were not predictive for patients at low predicted risk of recurrences. For patients at high predicted risk of recurrence, low, intermediate and high combined marker scores were found in 84 (42%), 79 (39.5%), and 37 (18.5%), respectively. The actual rates of recurrence were noted for 8.3% of low, 13.9% of intermediate and 32.4% of high combined marker score in a statistically significant distribution (p=0.027). Conclusions: The cumulative number of aberrantly expressed mTOR biomarkers correlates with a higher rate of recurrence. The combined marker score may help further stratify patients with high nomogram predicted risk of recurrence. Our data supports prospective evaluation of these biomarkers to augment current clinico-pathologic predictors of outcomes in ccRCC.
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Krabbe, Laura-Maria, Oussama M. Darwish, Ganesh Raj, Ramy F. Youssef, Payal Kapur, Aditya Bagrodia, Michael Belsante, Yair Lotan, and Vitaly Margulis. "Novel stratification of the recurrence risk following surgical extirpation of clear cell renal cell carcinoma using tissue biomarkers in the mammalian target of rapamycin pathway." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 4581. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.4581.
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4581 Background: Aberrant activation of the mammalian target of rapamycin (mTOR) pathway promotes invasiveness and metastatic potential in a variety of malignancies. The aim of the present study was to evaluate the association of altered expression of mTOR pathway components with recurrence outcome in non-metastatic clear cell renal cell carcinoma (ccRCC) patients. Methods: Immunohistochemistry for phos-S6, phos-mTOR, mTOR, phos-AKT, HIF-1α, RAPTOR, PTEN, PI3K, and phos-4EBP1 was performed on tissue microarrays of patients treated for non-metastatic kidney cancer between 1997-2010. Patients were defined as having a low (<) or high risk (≥) of nomogram predicted recurrence (2001 MSKCC RCC post-op) using an 8% cutoff. The relationship between individual marker expression, as well as combined marker score (low, intermediate and high defined as ≤ 3, 4-5, >5 altered biomarkers; respectively) with the actual and predicted relapse rates was assessed. Results: The study included 419 non- metastatic ccRCC patients (pT1-T2 79.5%, pT3-T4 20.5%, Fuhrman nuclear grade 1-2 in 69%, 3-4 in 31%). 219 and 200 patients had low (<8%) and high (≥8%) nomogram-predicted 5-year risk of recurrence respectively. With a median follow-up of 2.2 years, recurrences were detected in 5 (2.3%) of the predicted low risk and 30 (15%) of the predicted high risk patients. mTOR pathway biomarker profiles were not predictive for patients at low predicted risk of recurrences. For patients at high predicted risk of recurrence, low, intermediate and high combined marker scores were found in 84 (42%), 79 (39.5%), and 37 (18.5%), respectively. The actual rates of recurrence were noted for 8.3% of low, 13.9% of intermediate and 32.4% of high combined marker score in a statistically significant distribution (p=0.027). Conclusions: The cumulative number of aberrantly expressed mTOR biomarkers correlates with a higher rate of recurrence. The combined marker score may help further stratify patients with high nomogram predicted risk of recurrence. Our data supports prospective evaluation of these biomarkers to augment current clinico-pathologic predictors of outcomes in ccRCC.
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Ivanov, Alexander A., Ali Alaraj, Fady T. Charbel, Victor Aletich, and Sepideh Amin-Hanjani. "Recurrence of Cerebral Arteriovenous Malformations Following Resection in Adults." Neurosurgery 78, no. 4 (December 21, 2015): 562–71. http://dx.doi.org/10.1227/neu.0000000000001191.
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Abstract BACKGROUND: Complete surgical resection of arteriovenous malformations (AVMs), documented by postoperative angiography, is generally felt to represent cure, obviating the need for long-term follow-up imaging. Although AVM recurrence has been reported in the pediatric population, this phenomenon has only rarely been documented in adults. Recurrence after treatment solely with embolization, however, has been reported more frequently. Thus, patients undergoing multimodal therapy with surgery following preoperative embolization may also be at higher risk for recurrence. OBJECTIVE: To determine if preoperative embolization contributes to recurrences of AVMs after complete surgical resection. METHODS: A retrospective study of patients undergoing AVM resection was performed. Those with complete surgical AVM resection, confirmed by negative early postoperative cerebral angiography and with available follow-up angiographic imaging –6 months postoperatively were included. RESULTS: Two hundred three patients underwent AVM resection between 1995 and 2012. Seventy-two patients met eligibility criteria. There were 3 recurrences (4%). Deep venous drainage and diffuse type of AVM nidus were significantly associated with recurrence. Although preoperative embolization did not reach statistical significance as an independent risk factor, radiographic data supported its role in every case, with the site of recurrence correlating with deep regions of nidus previously obliterated by embolization. CONCLUSION: AVM recurrences in the adult population may have a multifactorial origin. Although deep venous drainage and diffuse nidus are clearly risk factors, preoperative embolization may also be a contributing factor with the potential for recurrence of unresected but embolized portions of the AVM. Follow-up angiography at 1 to 3 years appears to be warranted.
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Smith, Timothy R., David J. Cote, John A. Jane, and Edward R. Laws. "Physiological growth hormone replacement and rate of recurrence of craniopharyngioma: the Genentech National Cooperative Growth Study." Journal of Neurosurgery: Pediatrics 18, no. 4 (October 2016): 408–12. http://dx.doi.org/10.3171/2016.4.peds16112.
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OBJECTIVE The object of this study was to establish recurrence rates in patients with craniopharyngioma postoperatively treated with recombinant human growth hormone (rhGH) as a basis for determining the risk of rhGH therapy in the development of recurrent tumor. METHODS The study included 739 pediatric patients with craniopharyngioma who were naïve to GH upon entering the Genentech National Cooperative Growth Study (NCGS) for treatment. Reoperation for tumor recurrence was documented as an adverse event. Cox proportional-hazards regression models were developed for time to recurrence, using age as the outcome and enrollment date as the predictor. Patients without recurrence were treated as censored. Multivariate logistic regression was used to examine the incidence of recurrence with adjustment for the amount of time at risk. RESULTS Fifty recurrences in these 739 surgically treated patients were recorded. The overall craniopharyngioma recurrence rate in the NCGS was 6.8%, with a median follow-up time of 4.3 years (range 0.7–6.4 years.). Age at the time of study enrollment was statistically significant according to both Cox (p = 0.0032) and logistic (p < 0.001) models, with patients under 9 years of age more likely to suffer recurrence (30 patients [11.8%], 0.025 recurrences/yr of observation, p = 0.0097) than those ages 9–13 years (17 patients [6.0%], 0.17 recurrences/yr of observation) and children older than 13 years (3 patients [1.5%], 0.005 recurrences/yr of observation). CONCLUSIONS Physiological doses of GH do not appear to increase the recurrence rate of craniopharyngioma after surgery in children, but long-term follow-up of GH-treated patients is required to establish a true natural history in the GH treatment era.
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Munguti, Cecilia, Miriam Claire Mutebi, Mukuhi Ng'ang'a, and Ronald Wasike. "Breast cancer recurrence rate in patients treated for early breast cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e12508-e12508. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e12508.
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e12508 Background: Recurrence rates for early breast cancer vary in different studies from 7% to 18%. Recurrent breast cancer is associated with poorer outcome and higher mortality rates. The recurrence rate in the Kenyan population remains unknown despite high prevalence of known risk factors. Methods: Single institution retrospective study of all women (18 -75 years) treated for early breast cancer at a single center private tertiary unit from 2009 to 2017. Results: 239 patient records were reviewed. The mean age at diagnosis was 51 (SD13.1). 98% of women presented with a palpable breast lesion. The molecular sub-type’s prevalence was: ER/PR+ (76%), triple negative (12.1%), HER2+ (2.9%). The overall recurrence rate was 7.2%, 66% recurrences were loco-regional, while 27% were metastatic disease, with 61% of the recurrences being detected initially on clinical/ self-breast examination. 77% of the recurrences were in women with ER/PR+ molecular sub-types. Recurrences in women with DCIS (2/27) were invasive breast cancers. There were no identified risk factors on uni-variate and multivariate regression analysis which conferred a risk of breast cancer recurrence. Discussion: The mean age at diagnosis in this group is younger than the western average (65 - 75 years). Majority of the women presented with symptoms – a presentation that differs from that of countries with a national breast cancer screening program. The molecular distribution of breast cancers is comparable to western populations. Conclusions: Recurrence rate for early breast cancer in this series is 7.2%, which is comparable with documented western data, with majority of the recurrences being detected initially on clinical/self-breast examination.