Metastatic uveal melanoma: Is there a role for conventional chemotherapy? A single experience based on 58 patients.
Nieves PlanaFrancisco ValladaresJ. Maria Caminal MitjanaJ. PeraIsabel FernandesJavier Pérez SeguraXavier García del MuroC. GutierrezL. JiménezJosep M. Piulats
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e19006 Background: Uveal melanoma is a rare disease. Metastases develop in 6.5%-35% of the patients, most commonly in the liver. Metastatic uveal melanoma (MUM) survival is poor, with 5 to 7 months median survival. The aim of this study is to assess clinical characteristics and survival in patients with MUM. Methods: We reviewed retrospectively all patients with MUM diagnosed between 1990 and end 2008 at our institution. Results: We analyzed a total of 58 patients with a median age of 61 years (31-84). Median time for the development of metastases was 25,63 months (0.17-102.43). 56 patients had hepatic involvement, 63.8% bilobar and ≥ 7 hepatic lesions on 51.7%. Sixteen patients (27.6%) had two or more organs involved. Six patients (10.71%) were treated with surgery, 25 patients (44.67%) received systemic chemotherapy, and 23 (41.07%) had best supportive care (BSC). The median overall survival (OS) for the total of the patients was 10,83 months (6.92-14.74; 95%CI). Patients with local metastatic treatment were not assessable for individual OS. Patients who did chemotherapy presented 10,83 months (5.35-16.308; CI 95%) median OS survival and the patients without treatment had an OS of 8,033 months (2.46-13.61; 95%CI). There were more patients with poor survival characteristics such as worst ECOG in the BSC group. Only ≥ 7 hepatic lesions was significative in the univariate analysis. ECOG and ≥ 7 hepatic lesions were significative in the multivariate test. Treatment with chemotherapy was not statistically significant in the univariate neither in the multivariate analysis. Conclusions: Overall survival was poor in treated and BSC patients. Differences on survival are more likely related to patient characteristics, such as ECOG, rather than chemotherapy effect. Patients with MUM should be included in clinical trials evaluating other options with newer agents. No significant financial relationships to disclose.Keywords:
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The limited supply of organ donors has led some groups to reconsider the role of retransplantation. Historically, except for children with malignancies, extrahepatic sources of sepsis, or severe irreversible neurologic injuries, our institution has offered all children with failing liver grafts the option of retransplantation regardless of their current severity of illness. The purpose of this study was to examine the outcome of hepatic retransplantation in children in an attempt to identify factors predictive of outcome and to assess the results of our approach to retransplantation.Between October 1984 and December 1995, 314 children less than 15 years of age underwent a total of 441 liver transplants. Data were obtained retrospectively by review of hospital records.With a mean follow-up period of 5.3+/-2.7 years, the overall patient survival rates at 1 and 5 years were 77.1% and 67.1%, respectively. Primary allograft survival rates were 65.6% and 56.5%, respectively. Of the 137 patients who developed failure of their primary allograft, 92 underwent retransplantation (29.3% of all primary transplants). Both patient and allograft survival rates were significantly decreased after retransplantation (P<0.0001 versus primary transplants). Univariate and multivariate analysis of retransplanted patients revealed only two factors that were statistically related to patient and graft survival: age at the time of retransplantation (P<0.02 univariate and P<0.05 multivariate) and retransplantation with a reduced-size allograft (P<0.005 univariate and P<0.05 multivariate). In this series, the effect on patient survival of differences in medical condition as reflected by United Network for Organ Sharing (UNOS) status approached, but did not achieve, significance (P=0.08 for UNOS 1 versus UNOS 2 and 3). UNOS status did not affect graft survival. Neither the cause of primary allograft loss or the timing of retransplantation relative to the first transplant were related to outcome.These data demonstrate that the failure of primary hepatic allografts remains a major problem in pediatric liver transplantation and that the overall results of retransplantation were significantly worse than those associated with primary transplants. We have identified a group of children who experienced a significantly worse outcome after retransplantation. This group consisted of children less than 3 years of age retransplanted using reduced-size grafts. Based on this finding, we now attempt to avoid retransplanting young children with reduced-size grafts. By using this approach, we hope to be able to offer children the option of retransplantation with improved results and simultaneously minimize the negative impact on patients awaiting primary transplants.
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Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, and factors associated with the recurrence of PTs are poorly understood. This study sought to identify clinicopathological factors associated with the recurrence of PTs.From January 2009 to December 2019, we identified 100 patients who underwent definitive surgery for PT. Clinicopathological risk factors associated with the recurrence of PT were assessed.The median age of the patients was 44 y (range, 19-62 y), and the median tumor size was 4 cm (0.8-30 cm). At a median follow-up of 26.7 mo (0-103 mo), 22 of the 100 patients experienced local recurrence. In the univariate and multivariate analyses, body mass index ≥ 23 kg/m2 (P = 0.042 in the univariate analysis; P = 0.039 in the multivariate analysis), tumor size ≥ 5 cm (P = 0.006 in the univariate analysis; P = 0.036 in the multivariate analysis), and the presence of stromal overgrowth (P = 0.032 in the univariate analysis; P = 0.040 in the multivariate analysis) were associated with an increased risk of local recurrence. Resection margins and grade were not associated with local recurrence.Normal- or underweight patients and those with larger tumor sizes were more prone to local recurrence. Further larger, multicenter studies with a long-term follow-up are required.
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In 221 patients with FIGO stage I and II endometrial carcinoma, the impact on survival of age at diagnosis, menopausal status, FIGO stage, myometrial invasion, tumor grade and histology was evaluated by univariate and multivariate analysis. At a median follow-up of 50 months (range 45-210), 42 patients had died, and therefore overall survival was 81% (179/221). Univariate analysis showed that age, menopausal status and histology did not influence survival, whereas FIGO stage, myometrial invasion and tumor grade were important prognostic factors. Multivariate analysis showed that tumor grade had a significant and independent impact on survival and confirmed that FIGO stage is the most important parameter influencing survival.
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Objective To evaluate and analyse the prognostic factors of cerebral glioma treated with radiotherapy. Methods Records of 162 patients with cerebral glioma. Cox model was used for univariate and multivariate analysis. Results Mean follow- up time was 30 months, 14 patients relapsed, and 45 patients died. Univariate analysis showed that histologic grade, histologic type, Karnofsky performance state before radiotherapy, extent of resection, and age were significant predictors in association with overall survival rate of patients with glioma. Multivariate analysis showed that histologic grade, histologic type, age, Kamofsky before radiotherapy, extent of resection,and radiotherapy technology were independent prognostic factors of glioma. Conclusion Low grade, AC and OD, age≤40 years, Kamofsky >80 before radiotherapy, and total resection axe independent factors for predicting better survival of glioma patients.
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Brain neoplasms; Glioma; Radiotherapy, computer-assisted; Prognosis
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To determine the prognostic factors from the view of clinic and pathology.A retrospective analysis was performed on a data set of 78 patients with Ewing's sarcoma treated at Peking University People's Hospital Musculoskeletal tumor center between July 1998 and July 2007. Five-year overall survival (OS), recurrence rate and prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors for OS.Fifty-three cases were followed up, follow-up time ranged from 8.0 to 101.0 months (median 37.6 months). The 5-year overall survival rate and local recurrence rate were 33.7% and 20.8% respectively. Univariate showed age < 20 years, metastases free at diagnosis, tumor located at extremities, tumor size < 10 cm, adequate surgical margin had better survival rate (all P < 0.05). Multivariate analysis demonstrated that metastases at diagnosis, primary site and tumor size were independent prognostic factors for OS.The independent prognostic factors Ewing's sarcoma are metastases at diagnosis, primary site, tumor size.
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Objective: First, to evaluate the sensitivity and positive predictive value (PPV) of intra-operative frozen section (FS) diagnosis in borderline ovarian tumors (BOTs), and to explore the factors affecting the diagnostic accuracy.Second, to assess the clinical outcomes of misdiagnosed BOT patients.Methods: We performed a retrospective study of all patients diagnosed as BOT through FS or paraffin section (PS) at Qilu Hospital between January 2005 and December 2015.Clinical and pathologic data were extracted.Univariate analysis was performed using standard two-sided statistical tests.We also performed a meta-analysis to further validate the findings.Results: In our retrospective study, 155 patients were included.Agreement between FS and PS diagnosis was observed in 127/155 (81.9%) patients, yielding a sensitivity of 92.7% and a PPV of 87.6%.Under-diagnosis and over-diagnosis occurred in 22 cases (14.2%) and 6 cases (3.9%), respectively.In our univariate analysis of our retrospective study, tumor size (p=0.048)and surgery approach (p=0.024) were significantly associated with misdiagnosis.The pooled analysis of 13 studies including 1,577 patients indicated that the accuracy (69.2%), sensitivity (82.5%), and PPV (81.1%) were low; also under-diagnosis (20.2%) and over-diagnosis (10.5%) were frequent.The meta-analysis results showed that mucinous histology (p < 0.0001, OR=2.03 [1.47-2.81])and unilateral tumors (p=0.001,OR=2.39 [1.41-4.06])were associated with the misdiagnosis of BOT.In our retrospective study, there was no statistical significance of clinical outcome such as extent of surgery (p=0.838),recurrence (p=0.586),fertility (p=0.560),death (p=0.362) between misdiagnosed and accurately diagnosed BOT patients.Conclusions: FS analysis of BOTs has low accuracy, sensitivity, and PPV.Under-diagnosis and over-diagnosis are frequent.Meta-analysis results verify that mucinous histology and unilateral tumors are associated with misdiagnosis of FS.Nevertheless, misdiagnosed patients have a good clinical outcome despite the high frequency of misdiagnosis through FS.
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