Methods: We retrospectively analyzed medical data ofthe patients who underwent surgical resection with curative intent for PDAC between January 2007 and December 2016. The recurrence was defined as presence of either radiological or histological evidence, andthe postoperative 1 year as a value differentiating between early and late recurrence groups.
Results: Among 732 patients, 555 patients (75.8%) developed recurrence during the follow-up period. The 5-year overall survival rate andrecurrence free survival of all patients was 28.9% and 19%, respectively. Three hundred and fifty-eight patients (64.5%) reccurred within the first year after surgery. Prognostic factorsof early recurrence by univariate logistic regression analysis were significantly as- sociated elevated CA-19-9 ( p = 0.004), poorly differentiated tumor (p < 0.001), LN metastasis (p = 0.025) and preoperative tumor loca- tion (body to tail, p = 0.025). In the early recurrence group, metastasis occurred more in liver (n = 116, 30%) and in the late recurrence group, metastasis occurred more in lung (n = 37, 21.8%) and local recurrence (n = 64, 37.6%).
Kim et al. 7 reported recurrence patterns and risk factors influencing recurrenceof gallbladder cancer patients who had radical resection. Seventy-two of 166 patients (43%) had recurrence events that were classified as local, region- al and distant disease recurrence. Regional lymph node re- currence (20/166, 28%) was observed most frequently, followed by intrahepatic metastasis (16/166, 22%). They also reported that regional lymph node metastasis was an independent predictor of tumor recurrence by multivariate analysis. In the present study, although the number of cas- es was very small, regional recurrence was most fre- quently observed in patients who had disease recurrence after extended cholecystectomy. Based on this finding, re- gional lymph node recurrence was still the major patternofrecurrence for gallbladder cancer patients who had postoperative radiation therapy after curative resection.
Objective: The aim of this study was to investigate theprognosticfactorsand treatment outcome of patients with adeno car ci- noma ofthe uterine cervix who underwent radical hysterectomy with systematic lymphadenectomy.
Methods: A total of 130 patients with stage IB to IIB cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy from 1982 to 2005 were retrospectively analyzed. Clinicopathological data including age, stage, tumor size, the number of positive node sites, lymphovascular space invasion, parametrial invasion, deep stromal invasion (>2/3 thickness), corpus invasion, vaginal infiltration, and ovarian metastasis, adjuvant therapy, and survival were collected and Cox regression analysis was used to determine independent prognosticfactors.
II endometrial cancer, particularly if the patient populations underwent surgical staging [31-33]. Adjuvant radiotherapy in this population is justified given the high local control rates.
In our analysis, no patient who received initial pelvic external beam radiotherapy had a local relapse. The modality of radio- therapy remains an open question for this high risk population though there is some retrospective data to suggest that vagi- nal brachytherapy alone in this population may be sufficient local treatment. In one ofthe largest retrospective series to date that included only high risk patients defined by PORTEC, GOG 99, or Aalders et al. , McCloskey et al.  observed a 3.4% loco-regional recurrence rate with vaginal brachytherapy alone. As reported in other series, pelvic radiotherapy and/or brachytherapy reduces the risk of pelvic or vaginal recurrenc- es, but does not ultimately impact on the rate of distant recur- rence or survival [16,22]. A subgroup of these patients though remains at high risk of distant relapse as this analysis demon- strates and novel strategies to improve survival are needed. As studies have demonstrated, there is no impact on survival with LN dissection, and in patients with grade 1-2 disease, small vol- ume disease, and less than 50% myometrial invasion, the risk of lymph node metastases is very low [35-37]. In our analysis, the risk of relapse (64%) was high despite LN sampling in patients with deep myometrial invasion and grade 3 disease with the majority of relapses occurring in distant areas.
The overall response rate to the initial treatment was 75.8%, with specific response rates of 62.1% to CTx, 84.6% to CTx-WBRT, and 100% to CTx-ASCT. The complete response (CR) rate was higher with CTx-ASCT than in the absence of ASCT (77.8% vs. 43.2%;
P=0.025). After a median follow-up of 18.8 months, the median failure-free survival (FFS) and overall survival (OS) were 13.0 and 36.1 months, respectively. No systemic relapse without a CNS lesion was noted. Multivariate analysis showed that ASCT was predictive of better FFS but not of OS. Age andthe Memorial-Sloan Kettering Cancer Center prog- nostic score were predictive of survival.
Methods: Between 2007 to 2019, 130 patients who underwent curative hepatectomy for hepatocellular carcinoma were enrolled. The PNI was calculated, andthe cutoff value was identified through receiver operating characteristic curve analysis. According to the PNI, patients were divided into two groups. Univariate and multivariate analyses were performed to identify independent risk factors for recurrence.
non-radical methods of management might be considered suitable because of a good prognosis. However, the cases ofadenocarcinomaofthe cervix with stromal invasion depth of
≤5 mm and horizontal spread of >7 mm are seen occasion- ally. Thus, we analyzed patients with stromal invasion of ≤5 mm unrelated to the horizontal spread without macroscopic carcinoma for adaptation to non-radical methods of manage- ment. The clinicopathological features of cases of adenocar- cinoma ofthe cervix with a stromal invasion depth of ≤5 mm and horizontal spread of >7 mm were as follows. Twenty-five cases had stromal invasion of ≤5 mm and horizontal spread of >7 mm. The median depth of stromal invasion was 3 mm, ranging from 0.5 to 5 mm. The median horizontal spread was 13 mm, ranging from 8 to 60 mm. The median tumor volume was 937 mm 3 , ranging from 96 to 27,000 mm 3 . LVSI was pres- ent in 10 cases, and four cases were positive for pelvic lymph node metastasis. Though the previous studies reported depth of stromal invasion as the most critical for evaluating lymph node metastasis or recurrence [25-29], we aimed to investi- gate other prognosticfactorsof early invasive adenocarci- noma ofthe cervix, and to determine whether non-radical methods of management could be performed.
In addition to the previously mentioned prognostic fac- tors, smoking is a known oncogenic factor for urinary uro- thelial carcinoma, including UTUC, and people with any history of smoking have a 2- to 4-fold increased risk of these cancers [23-25]. Rink et al.  also reported that cigarette smoking was significantly associated with advanced disease stages, recurrence, and survival among patients who under- Table 4. Multivariate analysisof risk factors for cancer-specific survival among the 184 patients andthe 123 patients without a history of bladder cancer
the high rate of hematogenous recurrence. Further investigation is needed to clarify the effect of postoperative adjuvant chemotherapy on the prognosis of neuroendocrine carcinoma ofthe endometrium. Third, the effect of radiation therapy on prognosis was not evaluated in this study due to the small number of included cases. However, some patients with advanced stages or recurrence that were treated with radiation therapy experienced long-term survival, even though the effect on the prognosis was not evaluated. Two patients with a FIGO stage IV who had brain metastasis experienced long-term survival (144 and 88 months). These patients underwent resection of their brain tumors and received brain radiation therapy .
factors such as age and race, histopathological factors such as stage, mitotic index, and lymphovascular invasion [3,4].
Advances in imaging techniques in the last few decades have enabled timely detection of recurrent and metastatic disease in oncology practice. Data pertaining to the metastatic pat- tern of ULMS has not been adequately captured in any ofthe prior studies including the largest study of 1,396 patients with ULMS obtained from the Surveillance, Epidemiology, and End Results (SEER) data base . Most ofthe existing studies have focused mainly on the management andprognosticfactorsof ULMS [3,5-7]. The predictors of metastases, however have not been analyzed in any of these studies. With respect to the metastatic pattern, the literature is replete with several individual case reports of atypical metastatic sites [8-17]. In the large series, the emphasis has always been on lymph nodal involvement andthe need for lymphadenectomy . The pur- pose of our study was therefore to review a large database of patients with ULMS at our tertiary cancer institute to describe thepatternof metastasis in ULMS and provide a correlation with various clinical and histopathologic parameters.
AR is theoretically ideal for a patient with HCC from functional and oncological aspects, because the related portal vein and corresponding hepatic territory are removed. This reduces the ischemic area, minimizes any bile leakage, and lessens the possibility of any local re- currence ofthe tumor. However, the removal of a larger liver volume in the AR vs. NR procedure raises the possi- bility that the remaining liver mass might not meet the patient’s metabolic requirements. 9,10 Therefore, several studies have aimed to evaluate the effects ofthe extent of surgery for HCC. 4,5,11-13 In 2014, 3 studies used propen- sity-matching score analysis with the aim of identifying any benefit in patient survival after AR. However, none of these found conclusive results despite efforts to mini- mize confounding factors; in fact, they reported three dif- ferent results. Okamura et al. 14 showed that the overall andrecurrence-free survival in patients with HCC infected with hepatitis C virus were not superior in AR than NR procedure. In contrast, Cucchetti et al. 15 showed a lower early recurrence rate for patients with unfavorable tumor features after AR; while Ishii et al. 16 showed a statistically significant difference in overall patient survival, but not in disease-free survival, after AR.
delayed radiation therapy 19–21 . As we administered adjuvant RT to high-risk patients, the survival outcomes were worse in patients who received RT than in those who did not receive RT.
To determine the role of RT in each molecular subtype, we performed subgroup analysis. In ODG patients, the patients with GTR without RT and those with non-GTR and RT had similar survival outcomes, suggesting an effect of RT. The fact that no recurrence occurred in the patients who received GTR and RT could be criti- cized as overtreatment. Proper management after GTR, whether observation, RT or chemotherapy, should be evaluated in terms of survival, neurocognitive function, and quality of life 22 . A prospective study administering postoperative temozolomide for 1 year showed that patients with 1p/19q codeletion demonstrated a 0% risk of progression during treatment, andthe median PFS and OS rates of patients with 1p/19q-codeleted tumors were 4.2 and 9.7 years, respectively 23 . However, the choice of temozolomide over radiotherapy alone in patients with high-risk LGG is not supported by the evidence. The EORTC study to evaluate health-related quality of life in patients with high-risk LGG showed no difference between temozolomide chemotherapy and radiotherapy 24 . Although a randomized trial for high-risk LGG (RTOG 9802) showed that patients who received RT plus PCV had a longer median OS than those who received RT alone (13.3 vs. 7.8 years), only 10% ofthe patients received GTR, and oligodendroglioma patients were not separately analyzed. The efficacy of postoperative adjuvant ther- apy for ODG patients, whether temozolomide alone, RT alone, or RT followed by chemotherapy, still requires proper evaluation.
without a drug holiday. Therefore, it is predictable that, if a drug holiday was more clearly maintained, the incidence rate would be decreased.
The conservative treatment and surgical treatment are controversial, and evidence is lacking, but stage 1 MRONJ patients are recommended to undergo antibiotic gaggles, systemic antibiotics, and some local surgical procedures 39,40 . However, in stages 2 and 3, this conservative treatment is often inadequate, and these patients instead require surgical intervention 39-41 . When considering the failure of conservative treatment in this case, surgical intervention is widely recom- mended. Previous studies have shown that the success rate of surgical treatment was 84.2% to 89%, although there was a slight difference according to surgical method, operative object, and success criteria 42-44 . Similarly, a success rate of 76% was obtained in this study. Furthermore, various meth- ods such as low level laser therapy and recombinant human bone morphogenetic protein-2 have been used recently for MRONJ treatment 45,46 .
vs. 43% and 86% vs. 67%, respectively). 13
The exact cause for the diversity in treatment responses and prognoses of CIDP based on clinical phenotypes is un- known. It can be hypothesized that this is attributable to dif- ferent underlying disease pathomechanisms. Staudt et al. 17 reported stronger peripheral myelin antigen-specific T-cell responses with altered CD4+ memory subsets in atypical than typical CIDP. These differences in the immune respons- es between typical and atypical CIDP probably underlie the differences in treatment responses and prognoses. Kuwa- bara et al. 18 suggested that areas where the blood–nerve barrier is deficient are primarily prone to immune attack in typical CIDP. However, those authors pointed out that mul- tiple-sclerosis-like cellular immunity with a breakdown ofthe blood–nerve barrier is the primary pathomechanism of MADSAM. It is likely that the difference in pathomechanisms between typical CIDP and MADSAM are related to differ- ences in their phenotypes and electrophysiological features, producing differences in their treatment responses. Howev- er, the pathomechanisms underlying other phenotypes of CIDP are unclear. Further studies are essential to elucidate the primary pathomechanisms governing the various clinical phenotypes.
Corrigendum: Clinical characteristics andrecurrence-related factorsof medication-related osteonecrosis ofthe jaw
Mong-Hun Kang, Dong-Keon Lee, Chang-Woo Kim, In-Seok Song, Sang-Ho Jun Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul, Korea
Copyright Ⓒ 2019 by The Korean Association of Hepato-Biliary-Pancreatic Surgery
This is an Open Access article distributed under the terms ofthe Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Annals of Hepato-Biliary-Pancreatic Surgery ∙ pISSN: 2508-5778ㆍeISSN: 2508-5859
In this study we have created a multi-parametric profile for brain tumors, aiming at a comprehensive tissue characterization. Both classification approaches (intra- and inter-patient with Bayesian and SVM classification) have the same underlying framework, namely combining conventional structural MRI with DTI, to train classifiers for the tumor types of enhancing and non-enhancing tumor, edema and healthy tissue. The distinction ofthe neoplastic tissue from healthy tissue, as well as the identification of different tumor components and edema, as can be seen in Figs. 4-5, indicates that this multi-parametric framework effectively integrates multi-protocol information into a comprehensive tissue profile that can systematically evaluate the extent and heterogeneous composition ofthe tumor, and accurately replicate the expert's outlining of these regions. Thus, knowing the probable extent of abnormality ofthe neoplasm in terms of enhancing or non-enhancing tumor type or edema, will help better target the treatment of these regions. Existing computerized methods for diagnosis suffer from the absence of validation due to the lack of ground truth. Conventionally, histopathological exam following a biopsy has been the accepted ground truth. However its outcome depends on the region sampled and given the heterogeneity ofthe tumor, may wrongly indicate the grade ofthe tumor andthe subsequent treatment. The probability measures of our framework are defined on each voxel, and therefore capture heterogeneous patterns of tissue pathology. Moreover, these maps may provide sufficient premise to histologically test regions with higher probability of neoplastic content. This would aid in making clinical decisions.
Although BAP-1 has been discussed in a broad spectrum of cancers, consensus has not been reached for it prognostic role. BAP-1 loss is associated with poor prognosis in clear cell renal cell carcinoma and uveal melanoma . In contrast, however, BAP-1 loss was found to have a protective role in malignant mesothelioma, which is consistent with our re- sults for PCa . These conflicting results support the view that BAP-1 may have many yet unknown biological func- tions, and that its activity might have a tissue-specific pat- tern. Especially in PCa cases, the BAP-1 gene may play an oncogenic role rather than a generally well-known tumor- suppressor role.
As with most retrospective studies, a number of limitations
need to be considered. Patients were enrolled from a single institution, andthe data was retrospectively reviewed.
Although these limitations are inevitable, this study analyzed data for patients who were followed up for at least five years after primary surgical resection. We, therefore, do not believe that these limitations detract from the importance of this study highlighting the presence of clinically different behavior between early and late recurrence. Unlike in colon cancer, neoadjuvant radiotherapy is an important therapy for the control of rectal cancer that can affect its recurrencepattern . However, our study cannot analyze this point because no patient in this study underwent neoadjuvant radiotherapy prior to surgical resection. Since neoadjuvant radiotherapy is now widely used for advanced rectal cancer, further studies are required to elucidate this issue. Finally, because we have already performed intensive surveillance during the initial 2 years after surgical resection, we cannot define an adequate follow- up schedule. However, this study suggested that CA19-9 should be added for surveillance and that patients with risk factors for early recurrence should be followed up more intensively for the first 2 years than in the subsequent 3 years.