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PubMed1996

Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment.

STUDY DESIGN: A large prospective longitudinal cohort study (n = 1204) to identify prevalence of new or recurrent injury and risk factors in a rehabilitated chronic disabling spinal disorder patient group with matched control subjects. OBJECTIVES: To evaluate prevalence and risk factors for new or recurrent injury on a chronic disabling spinal disorder population. SUMMARY OF BACKGROUND DATA: The rate of symptom recurrence after acute low back pain, like the rate of initial back pain episodes, is extremely high (40-70%). However, although the incidence of recurrent back pain after chronic disabling spinal disorder represents a small subcomponent of these cases, there is a large socioeconomic impact. An individual attempting to return to work after a chronic disabling spinal disorder episode usually bears a stigma of "high risk" for recurrent injury and related work disability that may result in barriers to reemployment or work retention. Before the present research, no large scale studies had been conducted to evaluate whether recurrent spine injuries or new injuries to other musculoskeletal areas could be prevented by medical treatment. In addition, no studies had emerged to evaluate physical and psychologic risk factors of injury recurrence in this context to facilitate design of prevention programs. METHODS: The present study assessed the incidence of claimed recurrent spinal and new musculoskeletal injuries in a population of 1204 workers. A subgroup of 5.3% (n = 64) of treated patients with a new injury claim in the ensuing 12 months was matched for gender, age, race, length of disability, workers' compensation venue, previous surgery, and litigation status to an identically sized control group who did not report new or recurrent injuries. Demographic, physical, and psychologic measures were obtained prospectively on all patients, before and after treatment, to be analyzed as risk factors. RESULTS: During the year after treatment, 1.3% (n = 16) of patients reported another injury to the same spinal area, with only a 0.9% (n = 11) recurrent disability rate. A new injury to a different musculoskeletal area was reported by 4.0% (n = 48) of patients. Only 3.4% of the whole cohort, or 64.1% (n = 41) of the sample reporting reinjuries after returning to work, experienced lost work time (i.e., disability) after the reinjury. Only a modest predictive association was found between risk for new or recurrent injury and two self-report indices. CONCLUSIONS: The present study suggests that even a sample of the most severe chronic disabling spinal disorder workers' compensation patients who complete a tertiary functional restoration program are at relatively low risk for either a recurrent spinal disorder or new musculoskeletal injury claim (with or without disability). No major physical or psychologic risk factors for recurrent injury could be identified in this large cohort. These findings argue powerfully against employer bias in not rehiring employees with previous chronic disabling spinal disorder or discriminating in pre- or reemployment on the basis of putative reinjury risk factors after an appropriate rehabilitation program. Literature review documents a surprising paucity of quality studies examining variables predictive of this important socioeconomic outcome variable.

Adult↗

PubMed2006

Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes.

STUDY DESIGN: Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. OBJECTIVE: To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. SUMMARY OF BACKGROUND DATA: Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. METHODS: All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. RESULTS: The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. CONCLUSIONS: Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.

Adult↗

PubMed2004

Timing of death from tumor recurrence after curative gastrectomy for gastric cancer.

In Western literature, there are few studies investigating the predictors of early versus late recurrence after curative gastrectomy for gastric cancer. The current study analyzed (1) patients who died of recurrent gastric cancer and (2) prognostic factors, which can be applied to timing of death from tumor recurrence. Of 492 patients who underwent curative resection (R0) for gastric cancer in the Department of Surgery, Medical Faculty of Istanbul between 1994 and 2000, 142 patients who died of recurrence were included into study. None of the patients had received postoperative adjuvant treatment. The patients were divided into 2 groups: an early recurrence group that included 102 patients who recurred and died within 2 years after surgery, and a late recurrence group, which included 40 patients who died of recurrence more than 2 years after surgery. Clinicopathologic findings were compared between the early and late recurrence groups. Multivariate analysis was performed to investigate the independent factors, which are predictive for early versus late recurrence, and prognostic factors independently associated with the survival period. In multivariate analysis, the early recurrence group, when compared with the late recurrence group, was characterized by lymph node metastasis (N1-3 versus N0; P = 0.002). Overall survival was influenced by nodal status (N1-3 versus N0; P = 0.003), type of operation performed (radical total versus radical subtotal gastrectomy; P = 0.003), Eastern Cooperative Oncology Group performance status (PS 3-4 versus PS 1-2; P = 0.004), and tumor localization (cardia versus corpus and antrum; P = 0.046). In contrast, T stage of the disease was not prognostic for survival, although it was close to statistical significance (P = 0.066). Multivariate analysis showed that poorer performance status at initial presentation (P = 0.001) and lymph node metastasis (P = 0.032) independently correlated with overall survival (P = 0.002). Lymph node status was the most important factor predictive for early versus late recurrence and patients with lymph node metastases were at more risk of death within 2 years after curative operation for gastric cancer. Postoperative chemoradiotherapy should be especially recommended for patients at high risk of recurrence of adenocarcinoma of the stomach or who have undergone curative resection.

Adenocarcinoma↗

PubMed2005

Urethral tumor recurrence following cystectomy and urinary diversion: clinical and pathological characteristics in 768 male patients.

PURPOSE: We evaluated the incidence and risks of urethral recurrence following radical cystectomy and urinary diversion in men with transitional cell carcinoma of the bladder. MATERIAL AND METHODS: Clinical and pathological results were evaluated in 768 consecutive male patients undergoing radical cystectomy with intent to cure for bladder cancer with a median followup 13 years, including 397 (51%) who underwent orthotopic urinary diversion with a median followup of 10 years and 371 (49%) who underwent cutaneous urinary diversion with a median followup of 19 years. Demographically and clinically these 2 groups were well matched with the only exception being longer median followup in the cutaneous group (p <0.001). Urethral recurrence was analyzed by univariate and multivariable analysis according to carcinoma in situ, tumor multifocality, pathological characteristics (tumor grade, stage and subgroup), the presence and extent of prostate tumor involvement (superficial vs stromal invasion) and the form of urinary diversion (cutaneous vs orthotopic). RESULTS: A total of 45 patients (6%) had urethral recurrence at a median of 2 years (range 0.2 to 13.6), including 16 (4%) with an orthotopic and 29 (8%) with a cutaneous form of urinary diversion. Carcinoma in situ and tumor multifocality were not significantly associated with an increased risk of urethral recurrence (p = 0.07 and 0.06, respectively). The presence of any (superficial and/or stromal invasion) prostatic tumor involvement was identified in 129 patients (17%). Prostate tumor involvement was associated with a significantly increased risk of urethral recurrence (p = 0.01). The estimated 5-year chance of urethral recurrence was 5% without any prostate involvement, increasing to 12% and 18% with superficial and invasive prostate involvement, respectively. Patients undergoing orthotopic diversion demonstrated a significantly lower risk of urethral recurrence compared with those undergoing cutaneous urinary diversion (p = 0.02). Patients without any prostate tumor involvement and orthotopic diversion (lowest risk group) demonstrated an estimated 4% year chance of urethral recurrence compared with a 24% chance in those with invasive prostate involvement undergoing cutaneous diversion (highest risk group). On multivariate analysis any prostate involvement (superficial and/or invasive) and urinary diversion form remained independent and significant predictors of urethral recurrence (p = 0.035 and 0.01, respectively). CONCLUSIONS: At long-term followup urethral tumor recurrence occurs in approximately 7% of men following cystectomy for bladder transitional cell carcinoma. Involvement of the prostate with tumor and the form of urinary diversion were significant and independent risk factors for urethral tumor recurrence. Patients undergoing orthotopic diversion have a lower incidence of urethral recurrence compared with those undergoing cutaneous diversion. Although prostate tumor involvement is a risk factor for urethral recurrence, it should not preclude orthotopic diversion, provided that intraoperative frozen section analysis of the urethral margin is without evidence of tumor.

Adult↗

PubMed2003

The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation.

BACKGROUND: Recurrent disease after liver transplant is a significant problem. Recurrent primary biliary cirrhosis (RPBC) is a histologic diagnosis. Clinical data is unreliable in predicting or diagnosing recurrence. RPBC appears to have a changing clinical presentation in recent years. MATERIALS AND METHODS: The diagnosis of RPBC after liver transplantation was made histologically. Data were obtained from our prospectively maintained liver-transplant database and evaluated statistically. RESULTS: Between 1985 and 1999, 1,835 liver transplants were performed, 169 for PBC. One hundred fifty-six patients were evaluated (one patient received retransplantation, and 13 were excluded). Seventeen (10.9%) experienced recurrence. Median posttransplantation follow-up time was 72.1 months. Median time to recurrence was 49.6 months. Median follow-up time after recurrence was 11.5 months. Neither acute rejection episodes (P=0.34) nor OKT3 use (P=0.36) before diagnosis of recurrence was significant. The combination of cyclosporine, azathioprine, and prednisolone demonstrated recurrence in 6 of 71 (8.4%). Six of 49 (12.2%) patients treated with cyclosporine with or without mycophenolate mofetil and prednisolone experienced recurrence. Six of 36 (16.7%) patients treated with tacrolimus and prednisolone with or without mycophenolate mofetil experienced recurrence. Patients treated with cyclosporine had numerically fewer recurrences than those treated with tacrolimus (P=0.11). CONCLUSIONS: Patients with RPBC demonstrated prolonged survival. Clinical factors did not aid in predicting RPBC. The clinical course of RPBC appears to be different than in the earlier years of liver transplantation. Immunosuppression may play a role. The use and type of antimetabolite drugs had no affect on recurrence. RPBC demonstrated a different clinical course with tacrolimus treatment (shorter time to recurrence) and increased incidence when compared with cyclosporine treatment. Controlled randomized studies are necessary to determine differences between tacrolimus and cyclosporine treatment, if any.

Drug Therapy, Combination↗

PubMedDate not supplied

Recurrent hepatitis C virus disease after liver transplantation and concurrent biliary tract complications: poor outcome.

Recurrent hepatitis C virus (HCV) infection is particularly aggressive in the post-liver transplantation setting, with rapid progression of liver fibrosis. Biliary complications remain a significant cause of morbidity following liver transplantation. Post-cholecystectomy biliary strictures are associated with advanced hepatic fibrosis. The aim of this retrospective study was to determine whether the presence of biliary complications affects survival in liver transplant recipients with recurrent HCV disease. The files of liver transplant recipients (53.7% male; mean age 52.7+/-10.3 yr) were reviewed for incidence, type and treatment of biliary complications, and findings were compared between those who developed recurrent HCV disease (n=47, 83.9%) and those who did not (n=9). Twenty-one biliary complications developed in 12 patients with recurrent HCV (25.5%). Treatment with endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography with balloon dilatation and stent placement or surgical revision was successful in nine (75%). Three biliary complications developed in three patients with no recurrence (p=NS). There was no statistically significant association between recurrent HCV disease and biliary complications. However, among those with recurrent disease, the recurrence was severe in nine of 12 recipients with biliary complications (75%) but in only nine of 35 without biliary complications (26%) (p=0.001). Death was documented in eight patients with severe recurrence (44.4%), including three (37.5%) with biliary complications and two (7%) with non-severe recurrence, neither of whom had biliary complications (p=0.003). Antiviral treatment was successful in nine of 25 patients (36%) who received it. On multivariate analysis, biliary complications were a significant predictor of severe recurrence (OR 27.0, 95% confidence interval 2.07-351.4) (p=0.012). Fibrosis stage in the second biopsy was significantly correlated with serum alanine aminotransferase (p=0.01) and with duration of biliary obstruction (p=0.07). In conclusion, biliary complications of liver transplantation strongly affect outcome in patients with recurrent HCV disease despite attempts to relieve the biliary obstruction and to treat the recurrent HCV disease.

Adult↗

PubMed2000

Analysis of variation in success rates in conjunctival autografting for primary and recurrent pterygium.

AIMS: To evaluate the success rates of conjunctival autografting for primary and recurrent pterygium performed in a tertiary ophthalmic centre. METHODS: The outcome of 139 cases with primary pterygia and 64 cases with recurrent pterygia who underwent excision with conjunctival autografting was retrospectively reviewed. Outcome was evaluated in terms of recurrence of pterygia onto the cornea. The recurrence rates were determined using Weibull survival functions, in a mixture model that included a component allowing for cure. The suitability of this model was verified using Turnbull's non-parametric method for interval censored data (1974). Estimated recurrence free probabilities were based on the fitted Weibull survival curves. RESULTS: Mean follow up was 8.4 months in the primary group, and 9.5 months for the recurrent group. 29 out of 139 cases of primary pterygia recurred (20.8%) while 20 out of 64 cases in the recurrent group (31.2%) recurred. Recurrence rates varied widely among surgeons, ranging from 5% to 82%. Recurrence rates were inversely related to previous experience in performing conjunctival grafting. The recurrence free probability was 84% at 3 months, 73% at 1 year for primary pterygia, and 80% at 3 months, 67% at 1 year for recurrent pterygia. There was no statistical difference in recurrence rates between primary and recurrent groups (p= 0.80). CONCLUSION: The success of conjunctival autografting for pterygium in this series varies widely, and may be related to a significant learning curve or differing surgical techniques for this procedure. This may account for the wide variation in reported success of this procedure in the ophthalmic literature.

Adult↗

PubMed2005

Ten year recurrence after first ever stroke in a Japanese community: the Hisayama study.

BACKGROUND: Very few population based cohort studies have focused on the long term recurrence of stroke. OBJECTIVE: To examine 10 year cumulative recurrence rates for stroke in a Japanese cohort according to pathological type and clinical subtype of brain infarction. METHODS: During a 32 year follow up of 1621 subjects >/=40 years of age, 410 developed first ever stroke. These were followed up prospectively for 10 years after stroke onset. RESULTS: During follow up, 108 (26%) experienced recurrent stroke. The cumulative recurrence rates were 35.3% at five years and 51.3% at 10 years. The 10 year recurrence rates of subarachnoid haemorrhage (SAH), brain haemorrhage, and brain infarction were 70.0%, 55.6%, and 49.7%, respectively; the difference between SAH and brain infarction was significant (p = 0.004). Most recurrent episodes after SAH or brain haemorrhage happened within a year after the index stroke, whereas recurrence of brain infarction increased consistently throughout the observation period. Cardioembolic stroke had a higher recurrence rate (75.2%) than lacunar infarction (46.8%) (p = 0.049). The 10 year risk of stroke recurrence increased with age after lacunar or atherothrombotic brain infarction, but not after the other types or subtypes. After atherothrombotic brain infarction, cardioembolic stroke, or SAH, the type and subtype of most recurrent strokes were the same as for the index stroke, but recurrence after lacunar infarction or brain haemorrhage showed divergent patterns. CONCLUSIONS: Japanese people have higher recurrence rates of stroke than other populations. Recurrence rate after a first brain infarct increases consistently through the next 10 years.

Adult↗

PubMed2006

Gene expression profiles of primary breast carcinomas from patients at high risk for local recurrence after breast-conserving therapy.

PURPOSE: Several risk factors for local recurrence of breast cancer after breast-conserving therapy (BCT) have been identified. The identification of additional risk factors would be very useful in guiding optimal therapy and also in improving understanding of the mechanisms underlying local recurrence. We used cDNA microarray analysis to identify gene expression profiles associated with local recurrence. EXPERIMENTAL DESIGN: Using 18K cDNA microarrays, gene expression profiles were obtained from 50 patients who underwent BCT. Of these 50 patients, 19 developed a local recurrence; the remaining 31 patients were selected as controls as they were free of local recurrence at least 11 years after treatment. For 9 of 19 patients, the local recurrence was also available for gene expression profiling. Unsupervised and supervised methods of classification were used to separate patients in groups corresponding to disease outcome and to study the overall gene expression pattern of primary tumors and their recurrences. RESULTS: Hierarchical clustering of patients did not show any grouping reflecting local recurrence status. Supervised analysis revealed no significant set of genes that was able to distinguish recurring tumors from nonrecurring tumors. Paired-data analysis of primary tumors and local recurrences showed a remarkable similarity in gene expression profile between primary tumors and their recurrences. CONCLUSIONS: No significant differences in gene expression between primary breast cancer tumors in patients with or without local recurrence after BCT were identified. Furthermore, analyses of primary tumors and local recurrences show a preservation of the overall gene expression pattern in the local recurrence, even after radiotherapy.

Adult↗

PubMed1997

Association of local recurrence with subsequent survival in extremity soft tissue sarcoma.

PURPOSE: The aim of this study was to analyze local recurrence in a large cohort of prospectively followed patients with primary extremity soft tissue sarcoma. In particular, we analyzed the correlation of local recurrence with subsequent metastasis and disease-specific survival. PATIENTS AND METHODS: Patients who underwent treatment for primary extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial Sloan-Kettering Cancer Center were the subject of this study. Local recurrence, distant metastasis, and disease-specific survival were used as end points of the study. The influence of local recurrence on subsequent distant metastasis and disease-specific survival were examined using the Cox proportional hazards model. RESULTS: We treated 911 patients, of whom 297 (33%) developed recurrent disease. Local recurrence occurred in 116 patients (13%), metastasis in 167 (18%), and synchronous local recurrence and metastasis in 13 (2%). Of 116 patients who developed local recurrence, 38 subsequently developed metastasis and 34 died of disease. Metastasis after local recurrence was predicted in patients with initial high-grade (P = .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality after local recurrence was predicted in patients with initial high-grade (P = .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary tumors. DISCUSSION: These findings suggest that there is a strong association of local recurrence with the development of subsequent metastasis and tumor mortality, and that local recurrence is a poor prognostic factor. It would seem prudent to consider patients who develop local recurrence and have high-grade tumors as being at high risk for systemic disease and therefore eligible for investigational adjuvant systemic therapy.

Arm↗

PubMed2000

Ischemic stroke in young women: risk of recurrence during subsequent pregnancies. French Study Group on Stroke in Pregnancy.

OBJECTIVE: To assess whether subsequent pregnancies increase the risk of recurrent stroke and whether the occurrence of an ischemic stroke affects reproductive history. METHODS: The authors identified 489 consecutive women aged 15 to 40 years with a first-ever arterial ischemic stroke or cerebral venous thrombosis from the record system of nine French neurologic centers. Information on stroke recurrence and reproductive history was obtained by means of chart review, written questionnaire, and telephone interview. RESULTS: Data were analyzed from 441 women (373 with arterial ischemic stroke and 68 with cerebral venous thrombosis). During a mean follow-up of 5 years, 13 arterial recurrent ischemic strokes occurred. There were no cases of recurrent cerebral venous thrombosis. The overall risk of recurrence was 1% within 1 year and 2.3% within 5 years. The risk of recurrence was significantly higher in patients with stroke of definite cause. Eleven recurrent strokes occurred outside pregnancy (absolute risk of recurrence = 0.5%; 95% CI 0.3, 0.95) and two during pregnancy or the puerperium (absolute risk of recurrence = 1. 8%; 95% CI 0.5, 7.5). The relative risk of recurrence was significantly higher during the postpartum period (risk ratio = 9.7; 95% CI 1.2, 78.9) than during pregnancy (risk ratio = 2.2; 95% CI 0. 3, 17.5) itself. The outcome of the 187 subsequent pregnancies was similar to that expected from the general population. Thirty-four percent of women indicated that they would have desired more pregnancies after their initial stroke. The main reasons for not considering pregnancy were concern of a recurrent stroke, medical advice against pregnancy, and residual handicap. CONCLUSION: Young women with a history of ischemic stroke have a low risk of recurrence during subsequent pregnancies. The postpartum period, not the pregnancy itself, is associated with an increased risk of recurrent stroke. The outcome of pregnancies in these women appears to be similar to that expected in the general population. A previous ischemic stroke is not a contraindication to a subsequent pregnancy.

Adolescent↗

PubMed2003

Recurrence of olfactory groove meningiomas.

OBJECTIVE: Despite apparent gross total resection, olfactory groove meningiomas have a high rate of late recurrence (average, 23%). In this retrospective study, we confirmed that the sites of these recurrences are the cranial base and paranasal sinuses. We postulated that these recurrences stem from conservative handling of the underlying invaded bone. Therefore, we analyzed patient outcomes according to the radicality of surgical resection. METHODS: Fifteen consecutive patients with a diagnosis of olfactory groove meningioma were treated surgically between 1992 and 2001 (nine new cases, six recurrent). Only patients with benign meningiomas were included; atypical and malignant meningiomas were excluded. Surgical resection included the dura and drilling of the underlying bone and resection of involved mucosa. We reviewed each patient's clinical records, radiological studies, sites of recurrence, grade of previous resection, and complications. RESULTS: Olfactory groove meningiomas invaded the underlying bone in 13 cases. All patients with recurrence had previously undergone a surgical resection corresponding only to Simpson Grade 2, which does not include the removal of underlying invaded bone. The sites of recurrence were in the cranial base or adjacent paranasal sinuses. The time to recurrence varied from 1 to 12 years (average, 7 yr; mean, 8 yr). Three patients had undergone one previous resection, two had undergone two previous resections, and one had undergone four previous operations. The ethmoid sinus was involved in all cases of recurrence, either with the sphenoid sinus or with an intracranial recurrence. Thirteen patients underwent complete resection of underlying bone and the invaded paranasal sinuses, then reconstruction of the anterior fossa. No patient died. There were three instances of cerebrospinal fluid leakage (one requiring operative repair), one case of delayed worsening vision after initial improvement, and two cases of transient cranial nerve palsy (Cranial Nerves III and IV). There was no recurrence at follow-up (average, 3.7 yr; range, 1-7.3 yr). CONCLUSION: The cranial base and paranasal sinuses are sites of predilection for recurrence of olfactory groove meningiomas. Recurrence is the result of a direct extension attributable to incomplete resection of involved bone and regrowth at the edge of a previous surgical field. Extensive resection of all suspicious underlying bone is a complement to radical removal of these lesions. Reconstruction with a vascularized pericranial flap to prevent cerebrospinal fluid leakage is crucial.

Adult↗

PubMed2004

Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome.

BACKGROUND: After treatment of peritoneal carcinomatosis of colorectal cancer origin by cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC), recurrences develop in approximately 80% of patients. This study evaluates the outcome of such recurrences after initial treatment by cytoreduction and HIPEC. METHODS: Between November 1995 and May 2003, 106 patients underwent cytoreduction and HIPEC. The progression-free interval, the location of the recurrence, and its treatment were recorded. Factors potentially related to survival after recurrences were studied. RESULTS: Sixty-nine patients had a recurrence within the study period. For patients who had undergone a gross incomplete initial cytoreduction, the median duration of survival after recurrence was 3.7 months (standard error of the mean [SE], .3). If a complete cytoreduction had been accomplished initially, the median duration of survival after the recurrence was 11.1 months (SE, .9). A shorter interval between HIPEC and recurrence was associated with shorter survival after treatment of recurrence (hazard ratio, .94; SE, .02). After effective initial treatment, a second surgical debulking for recurrent disease resulted in a median survival duration of 10.3 months (SE, 1.9), and after treatment with chemotherapy it was 8.5 months (SE, 1.6). The survival was 11.2 months (SE, .5) for patients who received radiotherapy for recurrent disease. Patients who did not receive further treatment survived 1.9 months (SE, .3). CONCLUSIONS: Treatment of recurrence after cytoreduction and HIPEC is often feasible and seems worthwhile in selected patients. Selection should be based mainly on the completeness of initial cytoreduction and the interval between HIPEC and recurrence.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1989

Survival following recurrent malignant melanoma of the head and neck.

A retrospective analysis of 877 patients who had malignant melanoma of the head and neck identified 366 patients who developed recurrent disease. Sex, race, age, histology, Clark level, thickness, ulceration, lymph node status, lymph node dissection, site of recurrence, and time to recurrence were analyzed to determine their effect on survival following the development of recurrent disease. Survival following the development of recurrence was found to be influenced by the site of first recurrence and the age of the patient at the time of recurrence. For a given age, patients who had initial recurrences at distant sites were three times as likely to die following recurrence than patients with local recurrence. Patients who had initial recurrences at distant sites were twice as likely to die following recurrence than patients with regional sites of recurrence (p less than 0.001).

Adult↗

PubMed2000

Recurrence of sellar and suprasellar tumors in children treated with hGH--relation to immunohistochemical study on GH receptor.

PURPOSE: GH replacement therapy is required in the majority of children with GH deficiency after treatment of sellar and suprasellar tumors. Owing to the high cell proliferative ability of human GH (hGH), its influence on tumor recurrence has been debated. We retrospectively studied the immunohistochemical expression of the GH receptor in various tumor tissues, in order to investigate the relation between tumor recurrence and hGH replacement. METHODS: GH replacement therapy was performed in 25 patients (8 boys and 17 girls) after the treatment. Tumor recurrence was noted in 4 patients (craniopharyngioma: 2 patients, pilocytic astrocytoma and germinoma: 1 each). Immunohistochemical study of GH receptor in tumor tissue was carried out in those recurrent and recurrence-free cases, by using MAb 263 as a primary antibody. RESULTS: Two patients with recurrent craniopharyngioma were positive for MAb 263, but 1 recurrence-free patient was negative. Patients with pilocytic astrocytoma (recurrent and recurrence-free: 1 each) were all positive. Five patients with germinoma (1 with recurrence and 4 without recurrence) were all negative. CONCLUSION: In the patients with craniopharyngioma treated with GH, a positive immunohistochemical expression of GH receptor in tumor tissue may indicate a high probability of recurrence. In our cases, GH receptor was positive in astrocytomas and negative in germinomas, with or without recurrence. It is therefore speculated that each brain tumor may have its specificity in GH receptor expression.

Adolescent↗

PubMed1997

MR imaging evaluation with a transrectal surface coil of local recurrence of prostatic cancer in men who have undergone radical prostatectomy.

OBJECTIVE: The objective of this study was to evaluate the ability of transrectal surface coil MR imaging to reveal local recurrence of malignancy in men who have had radical prostatectomy for prostatic adenocarcinoma. SUBJECTS AND METHODS: We performed prospective analysis of 41 men who had undergone radical prostatectomy (range of time since surgery, 8 months to 5 years; mean, 26 months), 35 of whom had clinical suspicion of recurrent prostatic cancer and the remaining six of whom had no clinical evidence of recurrent prostatic cancer (controls). Our imaging used a transrectal surface coil on a 1.5-T MR scanner. Sagittal and axial fat-saturated T2-weighted fast spin-echo as well as axial T1-weighted unenhanced and gadolinium-enhanced MR images of the prostatic bed were acquired in all patients. Thirty-one of the 35 men with clinical suspicion of recurrent prostatic cancer had elevated prostate-specific antigen (PSA) levels (> or = 0.4 ng/ml), and 22 of these 31 men had a palpable prostatic bed module or induration. The four of 35 men with clinical suspicion of recurrent prostatic cancer who had PSA levels less than 0.4 ng/ml had a palpable prostatic bed nodule or induration. Transrectal biopsy of the prostatic bed was directed by digital palpation or transrectal sonography in all 35 men with clinical suspicion of recurrent malignancy. RESULTS: Thirty-one of the 35 men who had clinical suspicion of local recurrence of prostatic cancer had a soft-tissue nodule revealed in the prostatic bed by transrectal surface coil MR imaging. Compared with the adjacent muscle, all nodules were isointense on the T1-weighted images, hyperintense on the T2-weighted images, and enhanced with gadolinium administration. The 22 patients who had an abnormal MR scan and a palpable nodule or induration and the nine patients with elevated PSA levels, no palpable abnormality, and an abnormality revealed by MR imaging underwent transrectal biopsy; all had recurrent prostatic cancer proven by histology in the four patients with a palpable prostatic bed nodule or induration and normal PSA levels, MR imaging showed no distinct soft-tissue nodule or area of enhancement in the prostatic bed; transrectal biopsy of the palpable nodule or induration yielded fibrosis but no malignancy in all four patients. In the six control patients with no clinical evidence of local recurrence, MR imaging revealed no evidence of recurrent malignancy; all six control patients continue to have no clinical evidence of recurrent prostatic cancer with a minimum follow-up of 22 months. Thus, the sensitivity of MR imaging in revealing local recurrence of prostatic cancer was 100% (95% confidence interval = 89-100%), and the specificity also was 100% (95% confidence interval = 69-100%). The kappa coefficient was 1.0 (p < .001). CONCLUSION: MR imaging with a transrectal surface coil is a useful imaging tool to evaluate men who have undergone radical prostatectomy and are suspected of having local recurrence of malignancy in the prostatic bed.

Adenocarcinoma↗

PubMed2003

Is p53 gene mutation an indicatior of the biological behaviors of recurrence of hepatocellular carcinoma?

AIM: To evaluate mutant p53 gene in primary hepatocellular carcinoma and to investigate the correlation between it and the recurrence of hepatocellular carcinoma. METHODS: Mutations of p53 gene were examined using anti-human p53 monoclonal antibody and immunohistochemical staining in 79 resected hepatocellular carcinomas. The correlations among variables of p53 positivity and invasiveness, disease free interval and survival were studied. In addition, in those who developed recurrence, the correlation among p53 positivity, clinical features and post-recurrence survival were also studied. RESULTS: Of these 79 cases, 64 (81 %) had p53 mutation. Those patients with mutant p53 positivity had significantly more tumor recurrence (76.6 % vs 40.0 %, P=0.0107). However, the COX proportional hazards model showed that p53 overexpression had only weak correlations with recurrence free interval and survival time (P=0.088 and 0.081), which was probably related to the short duration of follow-up. The invasiveness variables may be predictors of HCC recurrence. On univariate analysis, more patients with mutant p53 positivity had vascular permeation (78.1 vs 40.0 %, P=0.0088, O.R. (odds ratio) =5.3), grade II-IV differentiation (98.4 vs 80.0 %, P=0.0203, O.R. =15.7), no complete capsule (82.8 vs 53.3 %, P=0.0346, O.R. =4.2) and daughter nodules (60.9 vs. 33.3 %, P=0.0527, O.R. =3.1) than patients with negative p53 staining. On multivariate analysis, only vascular permeation and grade of differentiation remained significant (P=0.042 and 0.012). There was no statistically significant correlation between the status of p53 in the primary lesion and the clinical features of recurrent hepatocellular carcinomas examined, including extrahepatic metastasis (P=0.1103) and the number of recurrent tumors (P=1.000) except for disease over more than one segment in the extent of recurrent tumors (P=0.0043). The post-recurrence median survival was lower in patients in whom p53 mutation had been detected in the primary lesion with a weak significance (3.42 months vs 11.0 months, P=0.051). CONCLUSION: Our findings suggest that p53 mutation correlates significantly with invasiveness including vascular permeation, grade of cellular differentiation, incomplete capsule and multinodular lesions. Hepatocellular carcinomas with p53 mutations had more tumor recurrence and p53 mutation may also influence disease recurrence interval and survival time. Hepatocellular carcinomas with p53 mutations recur more extensively with a shorter survival. Therefore, p53 mutation in the primary lesion is useful as an indicator of the biological behavior of recurrent hepatocellular carcinomas.

Adult↗

PubMed1993

[Statistical analysis of recurrent factors in superficial bladder cancer. Natural history of superficial bladder cancer].

Three hundred thirty-six patients with superficial bladder cancers underwent their initial surgery at the Department of Urology of Okayama University School of Medicine from 1961 to 1985. They have been followed-up until December 1988 (the median: 68 months). Among the 336 cases, excluding 9 cases which were treated initially with total cystectomy or incomplete resection, the remaining 327 cases were reviewed in order to study the pattern of their local recurrences in the bladder. Major factors affecting recurrences of superficial bladder cancer were evaluated by the multivariate analysis using Cox's proportional hazard model. The examined factors included age on admission, sex, tumor's number, size, stage, histological grade and shape, operative method, intravesical chemotherapy, systemic chemotherapy, radiotherapy, frequency of recurrences and the date of operation. During the follow-up period, 179 cases out of the 327 cases did not show any recurrences. The remaining 148 cases recurred from once to 11 times, therefore, a total number of recurrences was counted to be 406. In the 406 recurrences, 338 recurrences were treated by TUR, SVR, or SR. The remaining 68 recurrences were treated with total cystectomy or untreated. Fifty-seven cases out of the 148 cases demonstrated recurrences more than 3 times. Only 4 cases were free from recurrences more than 24 months following the surgery for their last recurrences. The analysis in the 327 primary cases showed that the number of tumors was the most important factor. On the other hand the analysis in 338 recurrences showed that the second most important factor was the frequency of recurrences, following the number of tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Transitional Cell↗