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PubMed2006

[Recurrence patterns of esophageal cancer after Ivor-Lewis esophagectomy--a report of 196 cases].

BACKGROUND & OBJECTIVE: About one half of the patients with esophageal cancer may recur within 3 years after operation, but the recurrence pattern is still unclear. This study was to investigate the recurrence patterns of esophageal cancer after Ivor-Lewis esophagectomy. METHODS: Clinical data of 196 patients with squamous cell carcinoma of the middle third thoracic esophagus, who underwent Ivor-Lewis esophagectomy with two-field lymph node dissection from Jan. 1997 through Jan. 2001, were reviewed. The risk factors of postoperative recurrence within 3 years were analyzed with Logistic regressive model. RESULTS: Recurrence was recognized in 96 (48.9%) patients within 3 year after operation. The median time to recurrence was 12.2 months. Of the 96 cases of recurrence, 52 (54.1%) were locoregional, including 41 cases (78.8%) of mediastinal lymph node metastasis, and 8 cases (15.3%) of single cervical lymph node metastasis; 44 (45.8%) were hematogenous, including 10 cases of locoregional-hematogenous recurrence, and mainly located at liver, bone, and lung (39, 88.6%). The locoregional recurrence rate was significantly lower in the patients who received postoperative radiotherapy than in the patients have not received postoperative radiotherapy (23.3% vs. 41.3%, P<0.05). Logistic analysis showed that T3 and N1 tumor were independent risk factors of postoperative tumor recurrence. CONCLUSIONS: About one half of the patients would develop recurrent disease within 3 years after Ivor-Lewis esophagectomy, and most of them were with mediastinal lymph node, liver, bone, or lung metastasis. Postoperative radiotherapy is helpful to control locoregional recurrence.

Adult↗

PubMed1991

[The prognostic relevance of locoregional recurrence following mastectomy in breast carcinoma].

Local-regional recurrence following mastectomy is not always a sign of poor prognosis. In an attempt to determine these subgroups of patients we analysed 149 patients of our radiation oncology clinic treated between 1978 and 1988 with local or regional recurrence (LR) following mastectomy. Average follow up was 66 months, 47% of these patients developed their recurrence in the first two years, 78% in five years, 90% of the local-regional recurrence appeared in the first ten years. Prognostic features which predicted a poor prognosis in combination with locoregional recurrence after mastectomy were identified; early local recurrence (less than two years from mastectomy) (p less than 0.001), large tumor size T3 and T4 primary) (p less than 0.001), less than five involved axillary lymph nodes (p less than 0.001), negative hormone receptor status, histological grading 3 and 4, lymphangiosis carcinomatosa in the tumor site (p less than 0.05), the presence of tumor-necrosis in the primary tumor (p less than 0.001) and appearance despite of postoperative irradiation (p less than 0.05). Prognosis of patients with more than five involved axillary lymph nodes did not change by local-regional recurrence. The local recurrence did not influence survival in: late local recurrence (more than two years from mastectomy), small tumor size (T1 and T2), negative axillary status, positive hormonal status, histologic grading 1 and 2 and absence of tumor-necrosis or lymphangiosis carcinomatosa in the primary tumor. We conclude that local-regional recurrence is in fact under the above defined circumstances not a sign of systemic disease. With insufficient local therapy it can under these conditions be cause of progressive tumor spread. Thus we strongly support intensive local therapy for local-regional recurrence.

Breast Neoplasms↗

PubMed2006

[Risk factors for recurrence and metastasis after radical anterior resection for rectal cancer].

OBJECTIVE: To investigate the risk factors for local recurrence and distant metastasis after radical anterior resection for rectal cancer. METHODS: Clinicopathological data of 957 patients who underwent radical anterior resection for rectal cancer from 1983 to 2000 were reviewed retrospectively. The risk factors for local recurrence and distant metastasis were analyzed. RESULTS: There were 150 recurrent or metastatic cases (15.7%) after radical resection during a median follow- up of 71 months. Recurrence and metastasis sites included pelvics(6.0%, n=57), liver (4.9%, n=47), lung (4.2%, n=40) and other sites (0.6%, n=6). The median recurrent interval was 18 months (2-85 months),with a median survival of 8 months (1-62 months) after recurrence. Re-resection of the tumors was performed in 23 patients(15.3% ), and the median survival of such patients was 30 months with a 5- year survival rate of 13.0%. There were significant differences in recurrence and metastasis considering age,family history of tumor,CEA level,T staging,lymph node metastasis,venous cancerous emboli and signet cell carcinoma or mucinous adenocarcinoma. Logistic regression analysis revealed that family history (P=0.001), high CEA level (P=0.033), T3- 4 (P=0.000), lymph node metastasis (P=0.000),venous cancerous emboli (P=0.001),and signet cell carcinoma or mucinous adenocarcinoma (P=0.012) were risk factors for recurrence and metastasis. CONCLUSIONS: There are several risk factors for recurrence after radical anterior resection for rectal cancer. The main recurrent or metastatic sites are pelvis,liver and lung. Resection of recurrent tumor can prolong the survival.

Adult↗

PubMed2006

[Long-term results after recurrence of completely resected primary lung cancer].

The recurrence rate of complete surgical resection and the long-term results following recurrence have rarely been reported. Whether patients with recurrence could be cured is still unknown. Patients who underwent complete surgical resection for lung cancer from 1981 to 1999 (n=945) and were followed-up for more than 5 years were retrospectively reviewed. Recurrent diseases were treated by chemotherapy and/or radiotherapy when surgical treatment was not indicated. Postoperative 5-year survival in 585 patients (62%) without recurrence and in 360 patients (38%) with recurrent diseases were 84 and 27%, respectively. The recurrence rates of stage I patients (n=164), stage II (n=55), stage III (n=127) and stage IV (n=13) were 26, 52, 68 and 93%, respectively. The 5-year survival rates of these patients were 36, 23, 19 and 7%, respectively. The period between the operation and the first recurrence was approximately 2 (0-9) years and the patients with recurrence died in about 1 (0-9) year. Four patients actually survived more than 10 years after the first recurrence. The recurrence rate after complete surgical resection of lung cancer was 38% in all and it increased along with the advanced pathological stages.

Adult↗

PubMed1985

[Clinical research on prevention of recurrence of superficial bladder cancer--comparative study on clinical efficacy of bleomycin intravesical instillation and bestatin].

Objectives and methods of the study: Although superficial bladder carcinoma can be surgically eliminated by TUR, recurrence is common. Various attempts have been made to prevent recurrence, but to date an excellent prophylactic method with few adverse reactions has not been established. We conducted a clinical trial study for prophylaxis of bladder carcinoma recurrence, using intravesical instillation of bleomycin, a drug which cause little local irritation, in combination with bestatin, a recently developed immunomodulator. Bleomycin was selected on the bases of experimental results. That is, in beagle dogs, the 1-hour intravesical instillation of bleomycin gained a drug concentration in the bladder wall of 2.08 micrograms/g, which is approximately 4 times higher than that in the intravenous administration of the same dose. The above bleomycin concentration was thought enough to obtain a good clinical effect. A total of 124 patients were randomly divided into the two treatment groups: An only bleomycin intravesical instillation group (60 mg on each treatment day) (58 patients) and a bleomycin with bestatin (60 mg per every day) group (66 patients). In the 2-year follow-up period the recurrence of bladder carcinoma in the two treatment groups was studied. Analysis of non-recurrence rate by life-table method and Kaplan-Meier method: The non-recurrence rate of the bladder carcinoma every three months was calculated by the life-table and Kaplan-Meier methods. The non-recurrence rate in the bleomycin group was approximately the same as the rates in adriamycin or mitomycin reported in the literature. In the bleomycin + bestatin group, the recurrence rates at 9 months and 12 months were significantly (at P = 0.09 and P = 0.08, respectively) lower, and in addition, even the 2-year overall non-recurrence rate curves showed a nearly significant difference (P = 0.179). Especially in the case of papillary pedunculated tumors, the difference in the non-recurrence rate curves was almost statistically significant (P = 0.104). The stratified analysis on the basis of various tumor factors, were as follows. Pathological grade: Although no differences were found in Grades 1 and 2, the bleomycin + bestatin group had a lower recurrence rate in Grade 3 cases (P = 0.1).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1989

[Recurrence after intestinal resection for Crohn's disease].

Although recurrence is one of the major problems in the surgical management of a patient with Crohn disease, the factors that influence recurrence rate remain controversial. To elucidate some of this controversy, the records of a consecutive series of 100 patients, who underwent resectional surgery for Crohn's disease, were analyzed to evaluate the effect of several clinical and histologic features on the recurrence rate. In this study, recurrence was defined as clinical and or laboratory findings of re-emergent disease confirmed by objective means after resection of all lesions. Recurrence rate seems lower in colitis than ileitis or ileocolitis, but this data did not reach statistic significance; the site of recurrence was conditioned by the initial location of the disease and the extent of resection into healthy tissue above and below the lesions and the histological findings of section lines did not modify the risk of recurrence. In conclusion the recurrence is almost inevitable. The multifactorial aspect of the recurrence cannot be ignored, however some clinical factors were more closely related to the recurrence. A part from Crohn's colitis, type of surgery (radical vs limited resection) had little chance of minimizing the risk of recurrence.

Actuarial Analysis↗

PubMed1989

Radioimmunoguided surgery in recurrent colorectal cancer: the role of carcinoembryonic antigen, computerized tomography, and physical examination.

From January 1986 to December 1987, 32 patients with recurrent colorectal cancer had second-look radioimmunoguided surgery (RIGS system). All patients had pathologic confirmation of recurrence. The RIGS system identified 81% of recurrences, and in six patients recurrent tumor was identified only by RIGS. All patients had physical examination, carcinoembryonic antigen (CEA) assay, and computerized tomography of the abdomen and pelvis. Detection of recurrence was based on symptoms in six, elevated CEA value in 25, and physical examination in one. The CEA was elevated preoperatively in 30 patients; two false-negative results occurred in symptomatic patients who had pelvic recurrence. The median CEA value in those with liver recurrence was 30 ng/ml (range 5.2 to 298) and for pelvic recurrence 13 ng/ml (range 1.9 to 31) (P less than .05). The overall sensitivity of CT was 41% (abdomen other than liver 37%, liver 56%, and pelvis 22%). The combination of elevated CEA, symptoms, and physical findings identified 100% of recurrences. We conclude that a rising CEA remains the most accurate indicator of recurrence. CT should not be done routinely to detect recurrent colorectal cancer unless CEA is elevated or the patient is symptomatic. In our study the intraoperative use of the RIGS system aided the surgeon in identifying occult tumors.

Adolescent↗

PubMed1988

[Improved treatment of thoracic esophageal cancer based on a retrospective study of recurrence following resection].

Recurrence after resection of thoracic esophageal cancer was classified according to site of recurrence into 5 categories; 1) local recurrence, 2) recurrence at the anastomotic site, 3) recurrence in cervical or mediastinal lymph nodes, 4) recurrence in abdominal lymph nodes and 5) distant organ metastasis. Although the combined resection of the trachea or aorta was performed in several cases with local extension, its clinical results were not superior to those from palliative resection. To prevent recurrence at the anastomotic site, we performed either pharyngeal anastomosis with laryngectomy or esophageal anastomosis just below the larynx. However, such anastomosis just below the larynx was liable to cause aspiration pneumonia. To prevent lymph node recurrence in the neck or mediastinum, we performed cervical and mediastinal lymph node dissection. However, lymph node recurrence in the upper mediastinum of the left side was occasionally observed in case receiving this operation, with lymph node recurrence being decreased by postoperative irradiation, though prognosis was not always improved. Anti-cancer agents CDDP and VDS or 5Fu were effective. To prevent abdominal lymph node recurrence, we recommend that abdominal lymph node dissection is necessarily performed as for cardiac cancer. To prevent distant organ metastasis, we recommend anti-cancer therapy following radical lymph node dissection.

Esophageal Neoplasms↗

PubMed1988

[Multivariate statistical analysis of the postoperative recurrence factors in uterine cervical carcinoma].

In 211 patients with postoperative cervical carcinoma, we studied the relationship between the recurrence and various factors, and the interrelation among the factors. 1) Lymph node metastasis, clinical stage, number of complaints, adenocarcinoma and adenosquamous carcinoma, and number of pregnancies were associated with recurrence. Signs of myelic injury and large cell non-keratinizing carcinoma were associated with less recurrence. Maintenance chemotherapy markedly improved the prognosis. 2) Lymph node metastasis was frequently associated with an advanced stage, adenocarcinoma or increased erythrocyte sedimentation. Increased sedimentation was rarely associated with greater numbers of pregnancy or keratinizing carcinoma. Signs of myelic injury were rare in cases of advanced stage or large cell carcinoma and frequent in cases of long periods of illness. 3) Intrapelvic recurrence was related to early recurrence and maintenance chemotherapy, and extrapelvic recurrence to increased sedimentation, late recurrence, adenocarcinoma and no chemotherapy. 4) Early recurrence was associated with shorter periods of illness, lymph node metastasis and no chemotherapy, but late recurrence was associated with longer periods of illness, no lymph node metastasis, maintenance chemotherapy and adenocarcinoma. 5) The prognosis and the required periods of maintenance chemotherapy could be determined by Z = 4.3817.X1 + 1.2366.X2-0.0916.X3 + 2.3257.X4-1.9606.X5 + 1.6477.X6-0.1967.X7- 7.3047, with rates of inaccuracy of 13.9% for cases of no recurrence and 15.1% for recurrent cases.

Analysis of Variance↗

PubMed1987

[Prediction of the recurrence of squamous cell carcinoma of the uterine cervix by monitoring serum TA-4].

In this study, serum TA-4 and CEA in 21 recurrent cases were examined in relation to the pretreatment levels and recurrent lesions. The positive serum rate on recurrence was 66.7% in TA-4, 23.8% in CEA, and the mean serum level was 22.2 +/- 38.2 ng/ml in TA-4, while 4.8 +/- 9.2 ng/ml in CEA. In cases with local and intrapelvic recurrence, the positive serum rate was 61.5% in TA-4, 15.4% in CEA, and the mean serum level was 9.4 +/- 12.1 ng/ml in TA-4, and 4.3 +/- 10.2 ng/ml in CEA. In the cases in which there was distant recurrence, the serum positive rate was 75.0% in TA-4, 37.5% in CEA, and the mean serum level was 43.1 +/- 55.7 ng/ml in TA-4 and 5.7 +/- 7.7 ng/ml in CEA. In the cases whose serum pretreatment levels were positive, the positive serum rate on recurrence was 100% in TA-4 and 40.0% in CEA, while in the cases whose serum pretreatment levels were negative, the positive serum rate on recurrence was 40.0% in TA-4 and 9.1% in CEA. In 61.9% of the recurrent cases, the increase in serum TA-4 preceded the appearance of clinical signs, while the increase in serum CEA preceded it in only 19.0% of the recurrent cases. The mean leading time for tumor markers in the diagnosis of recurrence was 77.9 days in TA-4 and 60.0 days in CEA. It is therefore concluded that serum TA-4 monitoring after treatment is able to be used in predicting the recurrence of squamous cell carcinoma of the uterine cervix.

Antigens, Neoplasm↗

PubMed1986

[Studies on multiple mucosal biopsy in patients with bladder cancer. 2. Evaluation on the relationship between the results of multiple mucosal biopsy and recurrence, and the clinical course of cases with carcinoma in situ and micro-invasion of carcinoma in situ].

The predictive value of grade, number of tumor and histology of mucosal biopsy for tumor recurrence, the course of carcinoma in situ and microinvasion of carcinoma in situ were examined. The Kaplan-Meier's method was used for the estimation of the recurrence-free rate in the patients who had undergone transurethral resection (TUR) and the logrank test for testing the significance of difference in recurrence-free rate. The 5-year recurrence-free rate was 32.2%. The recurrence-free rate was 51.0% after 40 months postoperatively in patients with a single tumor, 12.8% after 42 months postoperatively in those with multiple tumors. The patients with a single tumor had a significantly higher recurrence-free rate than those with multiple tumors (P less than 0.001). The recurrence-free rate was analyzed according to the grade of main tumor, but significantly difference was not present. The recurrence-free rate was 44.4% after 42 months postoperatively in patients with normal histology of mucosal biopsy and 9.5% after 34 months postoperatively in those with abnormal histology. The patients showing normal histology in mucosal biopsy had a significantly higher recurrence-free rate than those with abnormal findings (P less than 0.001). the recurrence-free rate at the same area of biopsy site was analyzed according to the histologies of 537 mucosal biopsies. The recurrence-free rate was 76.7% after 42 months post operatively in areas with a normal biopsy, 44.3% after 35 months postoperatively in those with abnormal histology and the difference was statistically significant (P less than 0.001). Of the 15 patients found to have carcinoma in situ, 4 were primary carcinoma in situ, 6 were associated with superficial papillary tumors and 5 were associated with invasive tumors. Thirteen of the 15 patients were alive and free of disease 18 to 42 months later. Two patients associated with invasive tumor died 5 and 18 months after transcatheter embolization of internal iliac arteries. Of the 13 patients who were found to have microinvasion of carcinoma in situ, 4 were not associated with visible tumor, 6 were associated with superficial papillary tumor and 3 were associated with invasive tumors. Nine of the 13 patients are alive and free of disease 7 to 53 months later. A patient without any visible tumor who was treated with TUR and intravesical chemotherapy died and three patients with invasive tumor died irrespective of the mode of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Biopsy↗

PubMed1983

Ulcer recurrence two to twelve years after parietal cell vagotomy for duodenal ulcer.

An analysis is presented of the ulcer recurrence rate following parietal cell vagotomy in 333 patients with duodenal ulcer. The median period of observation for patients without ulcer recurrence was 54 months (range 1 to 128 months). Forty-two patients developed proven recurrent ulcer. The median period of freedom from recurrence was 33 months (range 3 to 113 months). Recurrent ulcer was suspected but not verified in an additional 12 patients. The calculated risk (by the life table method) of recurrence after 5 years was 13% (95% confidence limits 9-17), after 8 years 21% (14-28), and after 10 years 23% (15-31). The rate of recurrence remained constant throughout the study period. The analysis indicates a constant monthly recurrence risk of 0.23%. The patients with ulcer recurrence had a significantly lower reduction of peak pentapeptide acid output and higher rate of positive insulin test than patients without recurrence. The risk of recurrence did not depend on the location of the ulcer (duodenal bulb or pyloric-prepyloric area).

Adult↗

PubMed1995

[Does primary tumor affect the prognosis in postmastectomy locoregional recurrence in breast carcinoma?].

BACKGROUND: Prognosis following locoregional recurrence of breast cancer after mastectomy often is described as fatal. However, certain subgroups with better prognosis are supposed. We analysed established prognostic factors for their influence on post recurrence survival in order to discriminate favourable from unfavourable subgroups. PATIENTS AND METHODS: Between 1979 and 1989 163 patients with a local or regional recurrence of breast cancer following mastectomy were treated at the Department of Radiation Oncology of the University of Würzburg. One hundred and forty had an isolated recurrence, without evidence of distant disease at the time of recurrence. Median follow up for patients alive at the time of analysis was 102 months from diagnosis of recurrence. Thirteen prognostic factors were tested. RESULTS: Out of the 140 patients 94 (58%) developed distant metastases within the follow-up period. Metastatic-free rate was 42% at 5 years and 38% at 10 years following recurrence. Recurrences occurred in 50% of patients within the first 2 years from primary surgery, in 83% within 5 years. In univariate analysis statistically significant influence on survival rates was found for pT, pN-status, lymphatic vessel invasion, blood vessel invasion, tumor necrosis, hormonal receptor status, presence or development of distant metastases, time to recurrence and site and extension of recurrence. Two- and 5-year survival rates ranged from 64% to 81% and from 40% to 60%, respectively in the favourable subgroups compared to a survival rate ranging from 15% to 44% at 2 years and 0% to 29% at 5 years in the unfavourable subgroups. In patients with involved axillary lymph nodes, the absolute number of nodes did not prove to have significant influence on overall survival. Histopathological grading did not reach statistical significance levels although an influence on survival was observed. Preceding adjuvant radiotherapy did not influence post-recurrence survival rates. Also preceding adjuvant systemic therapy showed no significant impact on survival. Multivariate analysis demonstrated that primary axillary status correlated most strongly with overall survival (p < 0.001) followed by tumor necrosis (p < 0.01). CONCLUSIONS: The mentioned prognostic factors may be useful in determining the adequate (local and systemic) therapy and the best time for it. Our data support previous findings, that certain subgroups with favourable prognostic features exist and they might still have a chance for cure by an adequate local treatment, whereas subgroups of patients with unfavourable prognostic factors have to receive systemic therapy immediately following local therapy because of the forthcoming systemic progression.

Adult↗

PubMed1996

Late local recurrence after radiotherapy for tongue and early glottic carcinoma.

BACKGROUND/AIM: Late local recurrence after radiotherapy for tongue and early glottic carcinoma is rarely discussed. In the head and neck cancer, approximately 90% of local recurrence occurred within 2 years after radiotherapy. However, we found that late local recurrence after radiotherapy for glottic cancer was not rare. Our aim was to evaluate the late local recurrence after radiotherapy for early glottic and tongue cancer. PATIENTS AND METHODS: From 1967 through 1982, 633 patients with tongue carcinoma and 330 patients with early (T1T2N0) glottic carcinomas were treated at the Department of Radiology, Osaka University Hospital. Of these 821 patients, 329 patients with tongue carcinoma and 221 patients with early glottic carcinoma survived at 5 years after radiotherapy without local recurrence. For tongue carcinoma, patients were divided by T category. For early glottic carcinoma, patients were divided by the tumor response at 40 Gy. RESULTS: Late local recurrence occurred in 23 of 329 patients (7%) with tongue carcinoma, and in 9 of 221 (4%) with early glottic carcinoma. For tongue carcinoma, late recurrence occurred in 19 of 249 patients (8%) in stage I and II, and 4 of 80 patients (5%) in stage III and IV. For glottic carcinoma, late recurrence occurred in 8 of 137 patients (6%) with tumor clearance at 40 Gy and 1 of 63 patients (2%) with tumor persistence at 40 Gy. The incidence of double cancer was also evaluated. Of 329 5-year survivors with tongue carcinoma, 39 patients (12%) had another malignancy, and 26 patients of 221 5-year survivors with early glottic carcinoma (12%) had also another malignancy. Of 39 double primaries of tongue carcinoma, 10 patients (26%) had head and neck malignancies, and none of 26 double primaries of early glottic carcinoma. CONCLUSION: Late local recurrence was not rare in tongue and early glottic cancer. Poor prognostic group showed lower incidence of late recurrence than good prognostic group. This result suggests that secondary tumor at the same site of primary tumor is late local recurrence.

Carcinoma↗

PubMed1996

The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up.

OBJECTIVE: To assess the long-term recurrence risks after a first unprovoked seizure in childhood. METHODS: In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure. RESULTS: One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%, 37%, 42%, and 44% at 1, 2, 5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence. CONCLUSIONS: The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.

Child↗

PubMed1996

[Autologous conjunctiva-limbus transplantation in treatment of primary and recurrent pterygium].

The aim of the present study was evaluation of the efficiency of limbal autograft transplantation for primary and recurrent pterygia. The results of limbal autograft transplantation for advanced and recurrent pterygia are presented for 58 eyes of 50 patients. The pterygia were primary in 40 eyes and recurrent in 18 eyes. Free grafts from the superotemporal limbus of the same eye were used to cover the exposed sclera. Postoperative followup ranged from 2 to 26 months, with a mean of 13 months. The overall recurrence rate was 31% (22.5% in primary pterygia and 50% in recurrent pterygia). Recurrence rates were significantly higher in patients from southern Europe than in patients from northern Europe. Analysis of patients with recurrences (n = 18) revealed severe tear film abnormalities in eight cases. Seven patients were found to have transplants of insufficient size. Analysis of our results provides evidence that the experience of the surgeon is crucial for the success rate of this procedure. Three of six surgeons with limited experience had a recurrence rate of 50% or more. Additionally, 15 patients who developed recurrent pterygium had returned to unfavourable working conditions (e.g. dust, heat). Three of the 18 recurrences underwent repeated limbal transplantation and in one of these there was a further recurrence.

Adult↗

PubMed1998

Risk factors, treatment, and outcome of central nervous system recurrence in adults with intermediate-grade and immunoblastic lymphoma.

To evaluate the incidence, risk factors, and outcome of central nervous system (CNS) recurrence in adult patients with non-Hodgkin's lymphoma, we evaluated 605 newly diagnosed patients with large-cell and immunoblastic lymphoma who participated in prospective chemotherapy studies. The Kaplan-Meier estimate of probability of CNS recurrence at 1 year after diagnosis was 4.5% (95% confidence interval [CI], 4.4 to 4.6). Twenty-four patients developed CNS recurrence after a median of 6 months from diagnosis (range, 0 to 44 months). In univariate analysis, an increased risk for CNS recurrence was associated with an advanced disease stage (P = .0014), an increased LDH (P = .0000), the presence of B-symptoms (P = . 0037), involvement of more than one extranodal site (P = .0000), poor performance status (P = .0005), and B-cell phenotype (P = .008). Bone marrow involvement (P = .005), involvement of parenchymal organs (P = .03), and involvement of skin, subcutaneous tissue, and muscle (P = .002) were also associated with an increased risk for CNS disease. Multivariate logistic regression analysis identified only involvement of more than one extranodal site (P = .0005) and an increased LDH (P = .0008) as independent predictors of CNS recurrence. Established CNS recurrence had a poor prognosis. Only 1 of 24 patients remains alive and the Kaplan-Meier estimate of probability of survival at 1 year after the diagnosis of CNS recurrence is only 25.3% (95% CI, 6.9 to 43.7). Intrathecal treatment provided symptomatic benefit in only 1 of 6 patients. Radiation treatment provided symptomatic improvement in 6 of 9 patients treated. However, remissions were short and followed by systemic or CNS recurrence. Serum LDH and involvement of more than one extranodal site are independent risk factors for CNS recurrence in patients with large-cell lymphoma. The presence of both risk factors identifies a patient group at high risk for CNS recurrence. Established CNS recurrence can be rapidly fatal. Transient responses occur after radiation treatment.

Adult↗

PubMed1998

[Significance of p53 protein expression and proliferative potential with MIB-1 on tumor recurrence of pituitary adenomas].

Total or subtotal removal on initial surgery was carried out in 103 cases of pituitary adenomas and followed up for more than 5 years in 97 cases. 22 (21%) of 103 cases had tumor recurrence after the initial surgery. The p53 protein (DO-7, Novocastra Lab.) expression and proliferative potential with MIB-1 monoclonal antibody (MBL Co.) were evaluated in the non-recurrent and recurrent pituitary adenomas. Tissue samples were embedded in paraffin after fixation in 10% formalin and 3 microns sections were activated by microwave heating before being immersed with the antibodies. The positivities of the immunostaining for p53 protein and MIB-1 were calculated as % values of tumor cell nuclei stained to 1000 tumor cell nuclei in several fields. Most of the recurrent pituitary adenomas were large macroadenomas with suprasellar extension. However, tumor recurrence was not correlated with tumor type in terms of the hormonal secretion, surgical approach, and radiotherapy. 15 cases of the non-recurrent group had values of 1.0 +/- 0.5% (mean +/- SD) for their MIB-1 positive nuclei, whereas 18 cases of the recurrent group had high values of 2.5 +/- 1.2%. A statistically significant difference was observed between the two groups. 11 of the 18 cases of recurrent pituitary adenomas revealed high values of MIB-1 in excess of 2.0%. p53 protein was not found in 21 cases of the non-recurrent group. However, 5 (28%) of the 18 cases of recurrent pituitary adenomas demonstrated p53 protein expression with positive nuclei staining at lower than 1.0%. It is concluded that evaluations of the p53 protein expression and proliferative potential with MIB-1 represent important factors in predicting tumor recurrence of pituitary adenomas.

Adenoma↗