AbstractPurposeTo investigate clinical and radiological factors predicting worse outcome after (chemo)radiotherapy ([C]RT) in oropharyngeal squamous cell carcinoma (OPSCC) with a focus on apparent diffusion coefficient (ADC).MethodsThis retrospective study included 67 OPSCC patients, treated with (C)RT with curative intent and diagnosed during 2013–2017. Human papilloma virus (HPV) association was detected with p16 immunohistochemistry. Of all 67 tumors, 55 were p16 positive, 9 were p16 negative, and in 3 the p16 status was unknown. Median follow-up time was 38 months. We analyzed pretreatment magnetic resonance imaging (MRI) for factors predicting disease-free survival (DFS) and locoregional recurrence (LRR), including primary tumor volume and the largest metastasis. Crude and p16-adjusted hazard ratios were analyzed using Cox proportional hazards model. Interobserver agreement was evaluated.ResultsDisease recurred in 13 (19.4%) patients. High ADC predicted poor DFS, but not when the analysis was adjusted for p16. A break in RT (hazard ratio, HR = 3.972, 95% confidence interval, CI 1.445–10.917, p = 0.007) and larger metastasis volume (HR = 1.041, 95% CI 1.007–1.077, p = 0.019) were associated with worse DFS. A primary tumor larger than 7 cm3 was associated with increased LRR rate (HR = 4.861, 1.042–22.667, p = 0.044). Among p16-positive tumors, mean ADC was lower in grade 3 tumors compared to lower grade tumors (0.736 vs. 0.883; p = 0.003).ConclusionLow tumor ADC seems to be related to p16 positivity and therefore should not be used independently to evaluate disease prognosis or to choose patients for treatment deintensification.

2012-03-01·Gynecologic Oncology2区 · 医学

Immunohistochemical expression of estrogen and progesterone receptors and outcomes in patients with newly diagnosed uterine leiomyosarcoma

2区 · 医学

Article

作者: Robert A. Soslow ; Roisin O'Cearbhaill ; Carol Aghajanian ; Martee L. Hensley ; Elizabeth L. Jewell ; Mario M. Leitao ; Ginger J. Gardner ; Richard R. Barakat

OBJECTIVEWe assessed the IHC expression of ER and PR and their prognostic significance in uterine leiomyosarcoma (LMS).METHODSWe identified 43 "high-grade" uterine LMS cases from 7/82-7/07 for whom ER/PR IHC analysis was performed at initial diagnosis at our institution.RESULTSDisease was confined to the uterine body in 20/43 (47%). Eighteen (42%) of 43 were ER(+); 17/42 (41%) were PR(+). At last follow-up, 33 (77%) had recurred or progressed, and 23 (54%) had died. PR expression was associated with improved progression-free survival (PFS; P=0.002) and overall survival (OS; P=0.03) overall; ER expression was not. After adjusting for stage, ER expression was associated with PFS (P=0.01), not OS (P=0.3), and PR expression maintained a significant association with PFS (P=0.002) and approached a significant association with OS (P=0.05). Neither ER nor PR expression was associated with outcome in cases with disease outside the uterine body. In cases with confined disease, median PFS for ER(+) or PR(+) cases was not reached compared to 16.9 months for ER(-) cases (95% CI: 8.1-25.7; P=0.03) and 13.5 months for PR(-) cases (95% CI: 5.9-21.1; P=0.001). Only 1/10 PR(+) cases recurred and died; 9/10 PR(-) cases recurred, and 5 died. Two of 9 ER(+) cases recurred and died; 8/11 ER(-) cases recurred, and 4 died.CONCLUSIONER/PR expression is associated with survival outcomes in patients with high-grade uterine LMS confined to the uterine body. PR expression seems capable of identifying cases confined to the uterine body, which have better outcomes.

2011-08-01·Journal of Urology1区 · 医学

New N Staging System of Penile Cancer Provides a Better Reflection of Prognosis

1区 · 医学

Article

作者: Dai, Bo ; Zhu, Yao ; Zhang, Hai-Liang ; Zhang, Shi-Lin ; Yao, Xu-Dong ; Ye, Ding-Wei

PURPOSEWe determined whether the new N staging system, which was introduced in 2009, leads to more specific prediction of survival in patients with penile squamous cell carcinoma.MATERIALS AND METHODSWe analyzed the records of 60 patients in whom node positive penile cancer was surgically resected from 1990 to 2008. All cases were staged according the 6th and 7th N staging system after pathological review. Histopathological information on the number of positive lymph nodes, lymph node metastasis laterality, extranodal extension, pelvic lymph node metastasis and lymph node ratio were also recorded. We evaluated the added information on these nodal related prognostic factors to the current N classification. Recurrence-free survival was calculated. Predictive accuracy was assessed by the concordance index.RESULTSDisease recurred in 27 of the 60 patients (42.4%) at a median of 10 months. In the 33 patients without recurrence at the last visit median followup was 53 months. Using the 6th N classification the 3-year recurrence-free survival rate was 69.8%, 48.2% and 33.3% for the N1, N2 and N3 categories, respectively. Log rank survival analysis failed to show a statistical difference (p=0.054). For the new 7th N categories the 3-year recurrence-free survival rate was 87.5%, 57% and 31.8% in the corresponding N1 to N3 groups. Better survival stratification was observed on analysis (p<0.001). Adding lymph node metastasis laterality or lymph node ratio significantly increased the accuracy of the 7th N category to predict recurrence-free survival.CONCLUSIONSThe new N staging system better reflects the prognosis in patients with penile cancer.

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