• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6575-6579
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• 2015

Background: Breast cancer (BC) is the most frequent malignancy among females and is a leading cause of death of middle-aged women. Herein, we evaluated baseline characteristics for BC patients and also compared these variables across ealry and late recurrence groups. Materials and Methods: Between 1995 to 2014, among female breast cancer patients referred to our oncology clinic, eighty-six were entered into our study. All had distant metastasis. Early recurrence was defined as initial recurrence within 5 years following curative surgery irrespective of site. Likewise, late recurrence was defined as initial recurrence after 5 years. No recurrence was defined for survivors to a complete minimum of 10 years follow-up. Significant prognostic factors associated with early or late recurrence were selected according to the Akaike Information Criterion. Results: The median follow-up was 9 years (range, 1-18 years). During follow-up period, 51 recurrences occurred (distant metastasis), 31 early and 20 late. According to the site of recurrence, there were 51 distant. In this follow-up period, 19 patients died. Compared with the early recurrence group, the no recurrence group had lower lymph node involvement and more p53 positive lesions but the late recurrence group had lower tumor size. In comparison to no recurrence, p53 (odds ratio [OR] 6.94, 95% CI 1.49-32.16) was a significant prognostic factor for early recurrence within 5 years. Conclusions: Tumor size, p53 and LN metastasis are the most important risk factors for distance recurrence especially in early recurrence and also between of them, p53 is significant prognostic factor for early recurrence.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9277-9281
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• 2014

Purpose: To investigate clinicopathological features in patients with recurrent colorectal cancer within 1 year and more than 1 year after curative resection. Materials and Methods: We retrospectively evaluated 103 patients with disease recurrence before versus after 1 year of resection. Thirty-two patients (31%) were diagnosed with recurrence less than 1 year after curative resection for colorectal cancer (early recurrence) and 71 (69%) after more than 1 year (non-early recurrence). Results: The early recurrence group displayed a significantly lower overall survival rate for both colon cancer (p=0, 01) and rectal cancer (p<0.001). Inadequate lymph node dissection was a significant predictor for early relapse. There were no statistically significant differences in clinicopathological variables such as age, sex, primary tumor localization, stage, depth of invasion, lymphovascular invasion and perineural invasion between the early and non-early recurrence groups. However, a K-ras mutation subgroup was significantly associated with early recurrence (p<0.001). Conclusions: Poor survival is associated with early recurrence for patients undergoing resection for non-metastatic colorectal cancer, as well as K-ras mutation.

• Journal of Chest Surgery
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• 제46권6호
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• pp.449-456
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• 2013

Background: Tumor recurrence is the most common cause of treatment failure, even after complete resection of early-stage non-small cell lung cancer (NSCLC). In this study, we investigated the prognosis of patients with early recurrence in order to identify independent risk factors related to early recurrence. Methods: Between February 1995 and December 2012, 242 patients who underwent surgical resection for stage I NSCLC at Dong-A University Hospital were reviewed. The factors predicting overall survival (OS) and early recurrence were investigated. We also investigated the relationship between the patterns and period of recurrence and clinicopathological factors. Results: For patients with stage IA and IB NSCLC, the 5-year OS rate was 75.7% and 57.3% (p=0.006), respectively. A multivariate Cox proportional hazards model demonstrated that gender (p=0.004), comorbidity number (p=0.038), resection type (p=0.002), and tumor size (p=0.022) were the statistically significant predictors of OS. Moreover, the multivariate analysis revealed that smoking history (p=0.023) and histologic grade (p=0.012) were the independent predictors of early recurrence. Additionally, only histologic grade (poor differentiation) was found to be significantly associated with a higher frequency of distant metastasis; there was no relationship between the patterns and period of recurrence and clinicopathological factors. Conclusion: The present study demonstrated that smoking history and histologic grade were independent prognostic factors for early recurrence within two years in patients with early-stage NSCLC. Patients with these predictive factors may be good candidates for adjuvant therapy.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4759-4763
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• 2013

Background: Prognostic factors of postoperative early and late recurrence in patients with hepatocellular carcinoma (HCC) undergoing curative resection remain to be clarified. The aim of this study was to identify risk factors for postoperative early (${\leq}$ 2 year) and late (> 2 year) intrahepatic recurrences in patients with single HCCs without macrovascular invasion. Methods: A total of 280 patients from December 2004 to December 2007 were retrospectively included in this study. Intrahepatic recurrence was classified into early (${\leq}$ 2 year) and late (> 2 year) and the Chi-Square test or Fisher's exact test and multivariate logistic regression analysis were performed to determine significant risk factors. Results: During the follow-up, 124 patients had intrahepatic recurrence, early and late in 82 and 42 patients, respectively. Multivariate logistic regression analysis showed that microvascular invasion (p=0.006, HR: 2.397, 95% CI: 1.290-4.451) was the only independent risk factor for early recurrence, while being female (p = 0.031, HR: 0.326, 95% CI: 0.118-0.901), and having a high degree of cirrhosis (P=0.001, HR: 2.483, 95% CI: 1.417-4.349) were independent risk factors for late recurrence. Conclusions: Early and late recurrence of HCC is linked to different risk factors in patients with single HCC without macrovascular invasion. This results suggested different emphases of strategies for prevent of recurrence after curative resection, more active intervention including adjuvant therapy, anti-cirrhosis drugs and careful follow-up being necessary for patients with relevant risk factors.

• Journal of Gastric Cancer
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• 제1권2호
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• pp.119-123
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• 2001

Purpose: The prognosis of operated early gastric cancer is quite excellent and the 5-year survival rate shows to be over $90\%$. The less extensive treatment has been considered to be attractive. However, lymph node metastasis remains a main risk factor for recurrence of early gastric cancer. The author performed this study in order to determine which clinicopathologic factors of early gastric cancer influence lymph node metastasis and recurrence. Materials and Methods: A retrospective study was conducted on 222 patients with early gastric cancer who had been treated by gastrectomy combined with D2 or more extended lymph node dissection between January 1991 and December 1997 at the Department of Surgery, Kyunghee University Hospital. Results: Lymph node metastasis was observed in 26 patients ($11.7\%$), and the depth of tumor invasion and tumor size among clinicopathologic factors affected lymph node metastasis. The 5-year recurrence rate was $4.4\%$, and it was revealed that lymph node metastasis and depth of tumor invasion had a greater effect on recurrence than other clinicopathologic factors. Conclusion: The high risk factors of early gastric cancer in recurrence were submucosal tumor invasion, tumor size more than 2 cm, and lymph node metastasis. Patients of early gastric cancer with such high risk factors should undergo radical gastric resection than limited surgery. (J Korean Gastric Cancer Assoc 2001;1:119-123)

• Journal of Gastric Cancer
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• 제11권1호
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• pp.46-54
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• 2011

Purpose: There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence. Materials and Methods: From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group). Results: Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes. Conclusions: The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.

• Journal of Gastric Cancer
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• 제12권2호
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• pp.88-98
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• 2012

Purpose: Local recurrence, due to residual tumor, may occur after endoscopic resection for early gastric cancer. The aims of this study are to evaluate the predictive factors for local recurrence, and suggest an appropriate follow-up biopsy strategy. Materials and Methods: We retrospectively reviewed 396 early gastric cancers from 372 consecutive patients, who underwent endoscopic resection between January 2002 and April 2008. Cumulative recurrence rates were determined by the Kaplan-Meier method, and Cox proportional hazard analysis was used to determine the risk factors for local recurrence. Results: Local recurrence at the endoscopic resection site was found in 17 cases, among the total 396 lesions, during a median follow-up period of 48 months. The 5-year cumulative local recurrence rate was 4.8%. Multivariate analyses determined that tumor involvement at the lateral resection margin [hazard ratio: 35.9; P<0.001], uncheckable lateral resection margin [hazard ratio: 16.8; P<0.001], uncheckable or involved deep resection margin [hazard ratio: 3.76; P=0.047], and piecemeal resection [hazard ratio: 3.95; P=0.007] were associated with local recurrence. If a lesion was positive for any of these risk factors, the 5-year cumulative recurrence rate was 27.0%, while local recurrence was not found in any lesion that lacked these risk factors. Most episodes of recurrence were found during the first or second follow-up endoscopic biopsy at the ulcer scar. Conclusions: Routine follow-up biopsies at the endoscopic resection site might be unnecessary in cases where an early gastric cancer lesion was endoscopically resected en bloc with tumor-free lateral and deep margins.

• 한국간담췌외과학회지
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• 제27권2호
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• pp.158-165
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• 2023

Backgrounds/Aims: Within two years of surgery, 70% of resected intrahepatic cholangiocarcinoma (iCCA) recur. Better biomarkers are needed to identify those at risk of "early recurrence" (ER). In this study, we defined ER and investigated whether preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic-inflammatory index were prognostic of both overall relapse and ER after curative hepatectomy for iCCA. Methods: A retrospective cohort of patients who underwent curative-intent hepatectomy for iCCA between 2005 and 2017 were created. The cut-off timepoint for the ER of iCCA was estimated using a piecewise linear regression model. Univariable analyses of recurrence were conducted for the overall, early, and late recurrence periods. For the early and late recurrence periods, multivariable Cox regression with time-varying regression coefficient analysis was used. Results: A total of 113 patients were included in this study. ER was defined as recurrence within 12 months of a curative resection. Among the included patients, 38.1% experienced ER. In the univariable model, a higher preoperative NLR (> 4.3) was significantly associated with an increased risk of recurrence overall and in the first 12 months after curative surgery. In the multivariable model, a higher NLR was associated with a higher recurrence rate overall and in the ER period (≤ 12 months), but not in the late recurrence period. Conclusions: Preoperative NLR was prognostic of both overall recurrence and ER after curative iCCA resection. NLR is easily obtained before and after surgery and should be integrated into ER prediction tools to guide preoperative treatments and intensify postoperative follow-up.

• Journal of Gastric Cancer
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• 제1권2호
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• pp.106-112
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• 2001

Purpose: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. Materials and Methods: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients ($4.8\%$) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. Results: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type ($32.0\%$). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence ($18.5\pm17.7$months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. Conclusion: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.518-523
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• 2010

Objective : Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. There are different criteria defining the recurrence of CSDH. We evaluated the postoperative course of CSDH and tried to propose the reasonable criteria of recurrence. Methods : We retrospectively examined the medical records and pre- and postoperative CT scans of 149 consecutive patients who underwent surgery from January 2005 to December 2009. Diagnosis was confirmed by CT scanning or MRI. The postoperative courses were either resolved or recurrent. The resolved CSDH was one of the three types; early resolution, delayed resolution, or late resolution. The recurrent CSDH was one of the four types; recurrence without resolution, early recurrence after resolution, late recurrence after resolution, or recurrent-and-resolved type. Results : The CSDH was resolved within 30 days after surgery in 58 (39%) patients, between 1 to 3 months in 62 (42%), and after 3 months in 11 (7%) patients. The CSDH was recurred in 18 (12%) patients. Late resolution or recurrence was more common in the aged. The recurrent hematoma was seen on the same side in 11 patients, on the different side in 7 patients. Recurrence was significantly more common in the thick hematomas. Conclusion : For a working criteria of the recurrence of CSDH, we propose the early recurrence as return of symptoms or reaccumulation of the hematoma after a surgery within 3 months regardless of the location, amount or repeated operations. The late recurrence can be defined as reappearance or enlargement of a liquefied hematoma within the cranial cavity surrounded by the membranes or persistent CSDH beyond 3 months after surgery.