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PubMed1984

Prognosticators in recurrent breast cancer. A 15-year experience with irradiation.

After initial surgery, 133 breast cancer patients, who did not receive postoperative radiation or chemotherapy, were subsequently irradiated for recurrences in the Department of Radiation Oncology, University of Maryland Hospital. All patients have been followed for a minimum of 5 years after the treatment of recurrences. An extensive analysis was done in search of prognosticators for outcome in recurrent breast cancer. Traditional prognostic factors, such as the initial axillary status, primary surgical procedure, initial menopausal status, time and site of recurrences, distant metastases and radiation dose and field issues, were investigated. No correlation was found between the initial axillary status and the overall prognosis after recurrence. The main prognosticators were: the size of the initial breast tumor, the radiation treatment for recurrences, and the presence of, or time to, distant metastases. Initial T1-T2 breast tumors were associated with a delayed onset of recurrences and a lower incidence of chest wall relapses; in turn, both the latter situations yielded the best outcome. Radiation doses of more than 4000 rad in 4 weeks delivered with locoregional fields achieved a local control rate of 72%, and the best 5-year post-recurrence survival (57%). In 52% of the recurrent breast cancer patients, distant metastases were discovered; 70% of them occurred within 2 years from recurrence. The overall post-recurrence 5-year survival for the entire series was 40%. Both the results achieved with radiation therapy and the need for a logical strategy to approach the problem of breast cancer recurrences are discussed. The situation for a large proportion of these patients is not hopeless, and many are salvagable . Combined modality approaches could offer the best possibilities of survival. However, the importance of radiation therapy in the management of these patients cannot be denied or ignored.

Adult↗

PubMed1993

Results of surgical treatment of nonhepatic recurrence of colorectal carcinoma.

The sites of first recurrence of colorectal cancer include liver (more than 30%), lung and locoregional disease (20-25%), other intraabdominal sites (15-20%), and elsewhere (10%). Isolated locoregional disease accounts for 5-19% of colon recurrences and 7-33% of rectal recurrences. Between 7% and 20% of locally recurrent colorectal cancer can be resected with curative intent. Overall, complete resection of a localized recurrence yields a mean survival of 33-59 months, with long-term survival achieved in 30-50% of patients. Regional recurrence of rectal cancer may require abdominal-sacral resection for adequate margins, with 5-year survival of 18-24%. Early identification (by close monitoring) and accurate staging of recurrence are essential for potentially curative resection. Long-term survival depends on extent of recurrence and completeness of resection. Symptomatic recurrence to the ovaries that requires reoperation occurs in approximately 2% of patients; presentation usually is as part of a diffuse intraabdominal process, and resection is rarely curative. Isolated pulmonary metastases occur in 2-4% of patients experiencing disease recurrence; such tumors are resectable in half of the patients. After the tumors are surgically resected, long-term survival can be expected in 30-40% of patients, with prognosis variably associated with disease-free interval, number and size of lung metastases, and location and stage of the primary tumor. Newer techniques of postoperative monitoring after resection of the primary lesion, more sensitive preoperative and intraoperative staging of recurrences, and the use of intraoperative radiation therapy may increase surgical salvage of recurrent colorectal cancer.

Colonic Neoplasms↗

PubMed1993

Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature.

BACKGROUND: The outcome of surgical treatment for early gastric cancer (EGC) generally is considered to be satisfactory. Although a small percentage of patients experience disease recurrence, the absolute number of such instances is too small for assessment of risk factors. METHODS: The authors investigated the follow-up records of 1475 patients with EGC treated at the National Cancer Center, Tokyo, with special reference to cancer recurrence. In addition, 20 Japanese reports on this subject were reviewed. RESULTS: Excluding operative deaths and patients with noncurative operations, 20 (1.4%) patients died of recurrent disease. The death rate associated with other causes (6.6%), including other malignant diseases, surpassed that associated with disease recurrence. Late recurrence (after 5 years) was seen in seven patients. By combining the data of patients reported in 20 articles in the literature, the authors estimated a recurrence rate for EGC of at least 1.9%, exclusive of cancers arising in the gastric stump. The incidence of recurrence was significantly higher in submucosal (3.6%), node-positive (10.7%), and histologically differentiated carcinomas (2.3%) than in mucosal, node-negative, and undifferentiated groups, respectively. Analysis of 123 instances of recurrent disease, the details of which had been reported, revealed that hematogenous metastasis was the most common mode of recurrence. The mean survival period of patients with recurrent disease was 40 months, and 23% of patients died more than 5 years after surgery. CONCLUSION: It is rare for EGC to recur, even in patients with tumors with a comparatively high risk of recurrence. Long-term follow-up of patients with positive nodes for hematogenous spread might facilitate early detection of disease recurrence.

Adenocarcinoma↗

PubMed1994

Are pelvic side-wall recurrences of cervical cancer biologically different from central relapses?

BACKGROUND: By using the Combined Operative and Radiotherapeutic Treatment (CORT) procedure, pelvic side-wall recurrences of gynecologic malignancies arising in a previously irradiated pelvis may be locally controlled. Local control of central relapses may be achieved by exenteration alone. If, in cervical cancer, both relapse patterns are biologically different (as hypothesized by some investigators), distinct disease courses after local treatment may be expected. METHODS: Since June, 1989, 32 pelvic recurrences of cervical cancer were treated for local control in this institution. The median size of the recurrent tumors was 5 cm (range, 2-9 cm); 84% of the patients had been extensively irradiated in the pelvis. Therapy of 14 centrally located recurrences was exenteration alone. In 18 patients with relapses fixed to the pelvic wall and histologically confirmed intralesional resection planes, the CORT procedure was applied. RESULTS: After a median observation of 24 months (range, 5-48 months) 7 patients with central recurrences and 11 patients with pelvic wall recurrences had progressive disease in the pelvis and/or distantly. The site of recurrent tumor progression was similar in both groups. Stratified Kaplan-Meier and univariate Cox regression analysis identified recurrent tumor size, age, and recurrence-free intervals, but not relapse location as prognostic factors. Only size of the recurrent tumor significantly influenced survival in the multivariate Cox analysis. CONCLUSIONS: These results suggest that central and pelvic wall recurrences of cervical cancer do not exhibit pronounced biologic differences. Patients with large (> or = 5 cm) recurrences have a poor prognosis in spite of extended radical treatment irrespective of tumor location. Efforts should be made to detect isolated pelvic relapses at a smaller tumor size to enhance the chance for long term survival after local control by exenteration and CORT.

Adult↗

PubMed2003

Early ischemic lesion recurrence within a week after acute ischemic stroke.

Previous observations suggested that multiple ischemic lesions on diffusion-weighted imaging (DWI) are common in acute stroke patients. We hypothesized that a source of these multiple lesions was the recurrence of ischemic lesions within a week after a clinically symptomatic stroke. We analyzed 99 acute ischemic stroke patients scanned within 6 hours of onset and at subsequent times within the first week. Ischemic lesion recurrence was defined as any new lesion separate from the index lesion. Recurrent lesions occurring outside initial perfusion deficit were termed 'distant lesion recurrence'. We estimated the hazard ratio (HR) of recurrence associated with clinical and imaging characteristics using log-rank test. Any lesion recurrence was found in 34%, with distant lesion recurrence in 15%, while clinical recurrence was evident in 2%. Initial multiple DWI lesions were associated with any lesion recurrence (HR, 2.83; 95% confidence interval [CI], 1.65-10.29; p = 0.002) and with distant lesion recurrence (HR, 5.99; 95% CI, 4.05-64.07; p < 0.0001). Large-artery atherosclerosis was the most frequent stroke subtype associated with any lesion recurrence (p = 0.026). These results may indicate a prolonged state of increased ischemic risk over the first week and suggest DWI as a possible surrogate measure for recurrent stroke.

Acute Disease↗

PubMed1985

Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients.

Local recurrence and its related mortality after potentially curative resection for rectal cancer have been analysed in a series of 1008 patients managed by one of the authors. Nine hundred and thirty-four were available for analysis of recurrence. One hundred and seven (11 per cent) patients developed local recurrence without evidence of systemic spread and 84 (9 per cent) both local and systemic recurrence. Local recurrence was less common (14 per cent) after resection of tumours of the upper third of the rectum compared with the middle (21 per cent) (P = 0.02) or lower thirds (26 per cent) (P less than 0.001). Local recurrence was related to both tumour stage and differentiation (P less than 0.001). There was no significant relationship between local recurrence and tumour size or the type of curative resection performed, restorative or non-restorative. The distal margin of clearance after restorative resection did not influence the local recurrence rate. Of patients who developed metastases recurrence was evident within 2 years in 60 per cent. Three hundred and thirty-two patients died from recurrence, 91 (27 per cent) with evidence of local recurrence only, 80 (24 per cent) with combined local and systemic recurrence and 161 (48 per cent) with evidence of systemic spread only. The corresponding median survivals were 35, 34 and 39 months.

Aged↗

PubMed2006

Central nervous system recurrence in adult patients with acute lymphoblastic leukemia: frequency and prognosis in 467 patients without cranial irradiation for prophylaxis.

Recurrence of acute lymphoblastic leukemia (ALL) in the central nervous system (CNS) confers a poor prognosis, although to the authors' knowledge, only a few studies have analyzed this issue in adults. For the current study, the authors analyzed the frequency, predictive factors, and prognosis of CNS involvement and recurrence in adult patients with ALL who did not receive cranial irradiation for CNS prophylaxis. Four hundred sixty-seven adult patients (age > or = 15 years) with ALL were treated on 4 protocols: ALL-89 (standard-risk and high-risk ALL; n = 108 patients), ALL-93 (high-risk ALL; n = 222 patients), ALL-96 (standard-risk ALL; n = 84 patients), and ALL3-97 (Burkitt leukemia; n = 53 patients). CNS prophylaxis consisted of intrathecal methotrexate, cytarabine, and hydrocortisone together with high-dose systemic methotrexate and cytarabine. The mean age (+/- standard deviation) was 33 years (+/- 16 years), and 272 patients were males. ALL subtypes included an early pre-B phenotype (15%), a common phenotype (45%), a pre-B phenotype (5%), a mature B phenotype (11%), and a T phenotype (24%). CNS involvement at diagnosis was observed in 18 patients (3.9%). Of 159 recurrences, 22 occurred (5.8%) in the CNS (14 isolated and 8 combined). A lactate dehydrogenase level > 1000 U/L was the only factor associated with the risk of CNS recurrence. A complete remission was attained in 7 of 22 patients (32%). The median overall survival after recurrence was 0.7 years for patients with isolated CNS recurrence, 0.13 years for patients with combined recurrence, and 0.41 years for patients with bone marrow recurrence (P = .11). The only 2 survivors underwent stem cell transplantation. The frequency of CNS recurrence in adult patients with ALL who do not receive radiotherapy for CNS prophylaxis was similar to the frequency observed in protocols that included cranial irradiation. A lactate dehydrogenase value >1000 U/L was the only factor found to be associated with CNS recurrence. The prognosis for patients who develop CNS recurrence is poor, identical to that for patients who develop bone marrow recurrence.

Adolescent↗

PubMed2007

Prognostic factors and outcome of recurrence in childhood acute myeloid leukemia.

BACKGROUND: Outcome after recurrence of childhood acute myeloid leukemia (AML) is poor. We performed this study to identify prognostic factors for recurrence and for survival after recurrence of AML. METHODS: The clinical characteristics, biological features, treatment modalities, and outcomes of children with de novo AML who were enrolled on 3 consecutive clinical protocols from 1987 to 2002 at St. Jude Children's Research Hospital were studied. Regression modeling was used to identify prognostic factors for recurrence and for survival after recurrence. RESULTS: The outcome after recurrence was poor, with a 5-year survival estimate of only 23.3% +/- 5.7%. Multivariable analysis indicated that male sex (P = .005), autologous stem cell transplant before recurrence (P = .097), each additional month from diagnosis to recurrence (P = .041), and stem cell transplant after recurrence (P < .001) were associated with a better survival after recurrence, whereas M5 or M7 morphology (P = .001) were significantly predictive of a lower survival estimate after recurrence. CONCLUSIONS: Survival after recurrence was poor in children with AML. Novel therapies are urgently needed to prevent or to treat recurring AML.

Acute Disease↗

PubMed2003

Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery.

PURPOSE: The efficacy of salvage treatment of recurrent head and neck squamous cell carcinomas (HNSCC) after primary curative surgery was evaluated. METHODS: The management outcome of 377 patients who had recurrent squamous cell carcinoma of oral cavity, oropharynx, hypopharynx, and larynx after primary curative surgery was reviewed. RESULTS: The surgical salvage rates of recurrence were 29% local, 30% tracheostomal, 56% unilateral nodal recurrence of previously undissected neck, 32% of unilateral neck recurrence after prior neck dissection, and 11% lung metastasis. The 5-year tumor-free actuarial survival rates of those patients who received surgical salvage was 35% for local recurrence, 32% for unilateral nodal recurrence of the previously undissected neck, and 18% for nodal recurrence of the previously dissected neck. One patient of six with tracheostomal recurrence salvaged with surgery and one patient of six with lung metastasis salvaged with lobectomy survived without tumor at 5 years. There was no 5-year survivor of all patients salvaged with other nonsurgical methods. The mean survival of patients without surgical salvage was 6 months. CONCLUSIONS: There was a moderate chance of cure after surgical salvage of locoregional recurrent HNSCC. Surgical salvage was, however, only feasible for early recurrent tumor. Close follow-up surveillance of early recurrence is essential after primary treatment of patients.

Adolescent↗

PubMed2005

Aberrations in the progesterone receptor gene and the risk of recurrent endometrial carcinoma.

A case-control study was performed in order to determine whether expression of the progesterone receptor (PR) and/or aberrations of the PR gene contribute to the development of recurrent endometrial carcinoma. Primary tumours from 44 patients with recurrence of stage I endometrial carcinoma (patients) within 3 years after initial treatment were compared with tumours from 44 matched patients who were free of recurrence for a minimum of 3 years (controls). Paraffin wax-embedded primary tumours (n = 88) and recurrent tumours (n = 32) were analysed immunohistochemically for PR expression. A staining index (SI = 0-9) based on the staining intensity and the number of stained cells was calculated. DNA extracted from paraffin wax-embedded tissues was subjected to PCR-restriction fragment length polymorphism analysis (PCR-RFLP) for determination of the PROGINS DNA sequence alterations and the +331G/A-promoter polymorphism. Low PR expression (SI < 1.0) was observed in 7% of primary tumours derived from controls, 25% of primary tumours from patients with recurrence, and 38% of recurrent tumours. The expression of PR was significantly lower in primary tumours from patients with recurrence (SI = 4.0 +/- 0.5) than in the tumours in the control group (SI = 5.6 +/- 0.5) (T-test for paired analysis, p < 0.05). The PROGINS and +331G/A-promoter polymorphism were not related to age at diagnosis, tumour grade or myometrial invasion. The +331G/A-promoter polymorphism was present in 14% of primary tumours from patients without recurrence, compared with 17% of patients with recurrence. The PROGINS polymorphism was observed in 16% of primary tumours from patients without, and in 34% of patients with, recurrence (OR 2.6; 95% CI: 0.9-7.6). Most interestingly, patients who carried the PROGINS variant and in whom a PR-expressing tumour was diagnosed were at significantly enhanced risk of relapse (OR 4.7; 95% CI: 1.3-17.1). In conclusion, low PR expression tended to be associated with recurrent disease, and PR expression in tumours from patients carrying the PROGINS allele was predictive of the risk of recurrence.

Age Factors↗

PubMed2001

Stratifying risk factors for follow-up: a comparison of recurrent and nonrecurrent colorectal cancer.

INTRODUCTION: The selection of patients for individualized follow-up and adjuvant therapy after curative resection of colorectal carcinoma depends on finding reliable prognostic criteria for recurrence. However, such criteria are not universally accepted, and follow-up is often standardized for all patients without regard for each individual's level of risk of recurrence. Such a system of follow-up is not cost-effective. METHODS: A comparison of operative findings, pathologic features, and follow-up data of 1,731 cases of nonrecurrent colorectal cancer (821 colon, 910 rectum) with 357 cases of recurrent colorectal cancer (164 colon, 193 rectum) following potentially curative surgery was made, and results were analyzed to ascertain criteria for stratifying follow-up according to risk factors. RESULTS: Single-factor analysis showed that Dukes staging and tumor invasion were significantly associated with recurrence in both rectal and colon carcinoma. Tumor fixation and grading were additional significant factors in rectal cancer. Recurrence rates, time to recurrence, site of recurrence (locoregional vs. distant), and pattern of metastatic spread were not significantly affected by original tumor site. Recurrence was not significantly affected by patient age and gender. Individual surgeon performance in this series had also no significant effects on tumor recurrence. With multivariate analysis only, Dukes staging and tumor invasion into adjacent tissues were found to be independent adverse prognostic factors for recurrence. CONCLUSIONS: Dukes staging and tumor penetration into adjacent tissues are the only significant adverse prognostic factors for tumor recurrence of colonic and rectal carcinoma. Tumor grade and tumor fixation are additional adverse prognostic factors in rectal cancer. Guidelines for follow-up may be based on these factors and follow-up thus stratified according to risk of developing recurrence.

Adult↗

PubMedDate not supplied

Impact on survival by method of recurrence detection in stage I and II cutaneous melanoma.

BACKGROUND: The impact on survival by components of a surveillance program (physical examination, blood tests, and chest radiograph) used to detect recurrences in patients with cutaneous melanoma was assessed. METHODS: Data were collected from medical records and tumor registry information on a historical cohort of 1004 patients who presented with AJCC Stage I or II cutaneous melanoma at Roswell Park Cancer Institute from 1971 through 1995. RESULTS: Information on method of detection was available on 154 out of 174 identified first recurrences (89%). Physical examination detected 72% of recurrences, constitutional symptoms indicated 17% of recurrences, and chest radiograph revealed 11% of recurrences. Blood tests did not predict any recurrence. Only 9 of 17 patients with recurrences detected by chest radiograph alone underwent curative surgical resection. These patients had a statistically significant prolonged survival after diagnosis of recurrence compared to those surgical candidates who did not undergo resection. There was no statistically significant difference in overall survival between patients with asymptomatic pulmonary recurrences and those whose pulmonary recurrences were detected after symptoms of metastatic disease had developed. CONCLUSIONS: Most recurrences are detected on physical examination. Blood tests have no role in surveillance programs. Chest radiographs can detect pulmonary recurrences in a small number of asymptomatic patients at a stage when surgery may prolong survival.

Adult↗

PubMed2004

Oxygenation of tumor recurrences following fractionated radiotherapy of primary tumors. Studies on the rhabdomyosarcoma R1H of the rat.

BACKGROUND AND PURPOSE: Tumor oxygenation is well recognized as a major factor of tumor response to radiotherapy. In this respect, a number of studies have examined the response of primary tumors, whereas little is known about the oxygenation of tumor recurrences after radiotherapy. It was the aim of this study to investigate the oxygenation of tumor recurrences after preceding irradiation of the primary tumor. MATERIAL AND METHODS: Tumor oxygenation in primary tumors and recurrences of rat rhabdomyosarcomas R1H was measured by using pO(2) probes and Eppendorf pO(2) histography. Primary tumors were irradiated at a (60)Co radiotherapy facility with a total dose of 75 Gy, given in 30 fractions over 6 weeks. Oxygenation was measured in R1H tumors before and directly after completion of irradiation. In R1H recurrences oxygenation was determined, when they reached the same size as the previously treated primary tumors (V(o) = 3.1 +/- 0.5 cm(3)). Additionally, tumor microvessel density and the intercapillary distance of tumor blood vessels were determined on histological sections using a counting grid. RESULTS: Tumor oxygenation in R1H recurrences was significantly lower when compared to primary R1H tumors. In primary tumors a median pO(2) of 17 +/- 7 mmHg was measured. By contrast, the median pO(2) in R1H recurrences was only 5 +/- 5 mmHg (p < 0.05). The high frequency of pO(2) values < 5 mmHg indicated that R1H recurrences were significantly more hypoxic (58 +/- 5%) in comparison to primary tumors (22 +/- 4%). The histological sections of the R1H recurrences showed a higher heterogeneity in their tissue structure than primary nonirradiated tumors. The morphometric studies demonstrated a reduced microvessel density (91 +/- 21/9.04 mm(2) in the tumor periphery; p = 0.0001) compared with recurrent tumors (68 +/- 26) and an enhanced mean distance of tumor blood vessels, especially in the center of the R1H recurrences (184 +/- 20 vs. 243 +/- 70 mm; p = 0.0001). CONCLUSION: In R1H rhabdomyosarcomas tumor oxygenation in recurrent tumors following radiation therapy is significantly lower than in primary tumors. This observation has to be taken into account in cases of tumor recurrences where repeated radiotherapy, chemotherapy or combined treatment modalities are used.

Animals↗

PubMed2001

Increased chromosomal imbalances in recurrent pituitary adenomas.

Eight pituitary adenomas (four gonadotroph cell adenomas, three prolactin cell adenomas, one null cell adenoma) and their respective recurrences in the same patients were studied by comparative genomic hybridization. Chromosomal imbalances were found in seven of eight patients affecting two of eight primary and seven of eight recurrent tumors. Overall, pituitary adenomas showed an average of 1.6 chromosomal imbalances per primary and 3.4 per recurrent tumor (P < 0.01). Prolactin cell adenomas showed an average of 4.3 chromosomal changes per primary and 6.3 per recurrent tumor, which were significantly more common than in gonadotroph cell adenomas (0 vs 1.7 changes; P < 0.05) and the null cell adenoma (0 vs 1.0 changes; P < 0.05). The most common changes were gains of 4q (in three of eight recurrences), 5q, and 13q (in two of eight recurrences each) as well as losses of chromosome 2 (in both primary and recurring tumors of two patients), 1p, 8q, 10, and 12q (in two of eight recurrences). Minimal common regions associated with recurrent adenomas were gains of 4q31.2-34 (three recurrences), 5q14-23 and 13q21-31 and losses of 12q24.3-qter (two recurrences each). The average MIB-1 proliferation indices were 1.2% for primary and 1.9% for recurrent adenomas (P < 0.005). Our findings suggest that acquisition of certain chromosomal imbalances is related to and may underlie adenoma recurrence.

Adult↗

PubMed1998

Analysis of tumor recurrence following anterior skull base surgery.

In order to elucidate the predictive factors for tumor recurrence following skull base surgery and the significance of salvage surgery in cases of recurrence, we retrospectively surveyed the incidence, site, and time of local recurrences in 20 patients who underwent either anterior or anterolateral skull base surgery for malignant tumors invading the anterior cranial fossa between 1989 and 1995 at the University of Tokyo Hospital. Nineteen patients underwent total resections of malignancies, with recurrences and/or metastases occurring in 13. Local recurrences occurred at the skull base in 5 patients (group A), outside the skull base in 4 patients (group B), and in both locations in 2 patients (group C). The mean time interval between surgery and recurrence was 29 months in group A, and 4.2 months in groups B and C. The local recurrence-free rates were 51% at 1 year and 34% at 5 years. Both brain and/or dural invasion and a microscopic positive surgical margin were proven to be predictive factors for tumor recurrences. The 3-year local recurrence-free rate was 20% in patients with dural invasions and 83% in those without. The incidence of recurrence-free patients was 79% in cases with negative margins, with no patient being recurrence-free in positive cases. All recurrences found more than 6 months after the initial surgery resulted in patients being salvaged successfully by a second operation.

Adolescent↗

PubMed2000

The role of carcinoembryonic antigen for the detection of recurrent disease following curative resection of large-bowel cancer.

BACKGROUND AND AIMS: During recent years, a discussion about cost-effectiveness and importance of follow-up evaluation after curative resection of large-bowel cancer has developed. It is not known whether the determination of carcino-embryonic antigen (CEA) plays a crucial role in the early detection of recurrent disease. PATIENTS/METHODS: We conducted an analysis of the prospective follow-up database of 1321 patients after curative resection of colorectal cancer in our institution between 1990 and 1998 to evaluate the role of CEA in the early detection of recurrent disease. RESULTS: Of the 1321 patients included in our study, 306 developed recurrent disease following curative resection (23.2%). These patients with recurrent disease were divided into: Group I. No pre-operative CEA determination/insufficient follow-up (n=47; 15.4%). Group II. No elevation of CEA with primary cancer (n=156; 51.0%): (IIa) elevation with recurrent disease (n=62); (IIb) no elevation at any time point (n=53); and (IIc) role of CEA not completely elucidated (n=41). Thirteen patients of group II underwent curative relapse surgery (8.3%). Group III. Elevated CEA with primary cancer (n=103; 33.7%): (IlIa) no increase with recurrent disease (n=21); (IIIb) increase with other symptoms of recurrent disease (n=45); and (IIIc) increased values as an early symptom of recurrent disease (n=37). Sixteen patients of group III underwent curative relapse surgery (15.5%). In patients after relapse surgery, recurrent disease developed again after a median time of 12 months (mean 17.9+/-3.8 months). CONCLUSIONS: Our findings indicate that 2.8% of all patients (12.1% of patients with recurrent disease) who underwent curative resection of colorectal cancer profit from follow-up CEA determinations. With careful observation of CEA kinetics, 6.2% (n=82) of all patients or 26.8% of patients with recurrent disease could profit from routine follow-up CEA determinations. In 9.5% of patients with recurrent disease, curative resection of relapse was achieved and these patients remained disease free for a median time of 12 months. Regular CEA measurements remain an important part of routine patient care after curative resection of colorectal cancer.

Adult↗

PubMed2004

Colorectal adenoma characteristics as predictors of recurrence.

PURPOSE: The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians. This study was designed to assess the predictive value of initial patient and adenoma characteristics of the three-year recurrence. METHODS: The study population was composed of 552 patients with resected colorectal adenomas who completed the European Fiber-Calcium Intervention trial. At both baseline and three-year examinations, the characteristics of adenomas were recorded according to a standardized protocol. The main outcomes measured were the three-year overall recurrence, recurrence of multiple adenomas, recurrence of advanced adenomas (size > or = 1 cm or tubulovillous/villous architecture or moderate/severe dysplasia), and proximal and distal recurrence. RESULTS: A three-year recurrence was observed in 122 patients (22.1 percent), and more than one-half of them had recurrent adenomas on the proximal colon. After adjustment for patient characteristics and treatment allocation, the number of adenomas and their proximal location at baseline were the main predictors of recurrence. In comparison with patients who had one or two adenomas on the distal colon, patients with three or more adenomas with at least one of them located on the proximal colon had a much higher risk of overall recurrence (5.3; 95 percent confidence interval, 2.7-10.3), proximal recurrence (8.5; 95 percent confidence interval, 4.1-18), and advanced adenoma recurrence (5.5; 95 percent confidence interval, 2.4-12.6). CONCLUSIONS: Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon. The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas.

Adenoma↗

PubMed2004

Association between recurrence of sporadic colorectal cancer, high level of microsatellite instability, and loss of heterozygosity at chromosome 18q.

PURPOSE: Microsatellite instability and loss of heterozygosity of chromosomes 18q, 8p, and 4p are genetic alterations commonly found in colorectal cancer. We investigated whether these genetic markers allow for the stratification of patients with Stage II to III colorectal cancer into groups with different recurrence risks, and with different prognoses. METHODS: Tumors of 113 patients were evaluated for loss of heterozygosity of chromosomes 18q, 8p, and 4p and for microsatellite instability by use of six microsatellite markers. Genetic alterations involving each of these genetic markers were examined for association with disease recurrences and survival. RESULTS: Loss of heterozygosity of chromosomes 18q, informative in 96 percent of cases, in Stage III tumors was associated with higher risk of overall recurrence ( P< 0.001), local recurrence ( P< 0.001), distant metastases ( P< 0.001), decreased overall survival ( P= 0.002), and disease-free survival ( P< 0.001). The recurrence rates and survival rates among patients with Stage II colorectal cancer were independent of loss of heterozygosity of chromosome 18q. Stage III and loss of heterozygosity of chromosome 8p also were associated with a higher risk of recurrences when these factors were considered individually. In multivariate analysis, only loss of heterozygosity of chromosome 18q was independently associated with risk of recurrences ( P < 0.001) and with disease-free survival ( P= 0.001). No correlation was observed between microsatellite instability and recurrence rates. However, microsatellite instability was associated with improved overall survival ( P= 0.04) and with a longer disease-free interval ( P= 0.002). Only in five cases (16.7 percent) was it possible to perform resection of recurrences; two of these patients had microsatellite instability tumor. In no cases was it possible to resect recurrence of tumors with loss of heterozygosity of chromosome 18q. CONCLUSIONS: Loss of heterozygosity of chromosome 18q is an informative genetic marker, which in resected Stage III colorectal cancer can be used to predict recurrences and survival. Microsatellite instability identified cases that, even in the case of recurrence, have a more favorable prognosis.

Aged↗