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Background: The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-naïve stage IV breast cancer (BC) patients. Methods: At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Results: The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49–0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46–0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(–) (HR 0.64; 95% CI 0.45–0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38–0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23–0.98; p = 0.04). Conclusion: In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden. © 2018, Society of Surgical Oncology.

Objectives: This study aims to use mean volume of fluid, which is drained from a liver hydatid cyst with cystobiliary fistula developing after percutaneous treatment, for determining the type of treatment as surgery versus conservative. Patients and Methods: The cohort data was collected retrospectively from 10 out of 90 hydatid cysts in 10 out of 65 patients treated percutaneously with needle and catheterization methods. Groups were defined as surgical and conservative. The mean volumes until the 20th day after detection of the biliary fistula were used. In addition, the mean volumes until the 20th day of 42 catheterization patients without biliary fistula were used as controls for quantitative analysis. Results: All 10 cysts with cystobiliary fistulas were managed with small (8 F) catheters. All patients in the conservative group had < 211 mL/day mean drainage for the 20 days. For the patients that developed cystobiliary fistulas of liver hydatid disease, 30% required surgical treatment. After receiver operating characteristic (ROC) curve analysis, the cut-off value for success of hydatid cyst treatment was 206 mL/day of drained content. Conclusion: To reduce superfluous costs and time, cystobiliary fistula with < 206 mL/day mean drainage until the 20th day may be efficiently treated with percutaneous drainage using small catheters.

Background and Objectives The aim is to evaluate novel prognostic factors such as triple negative (TN) phenotype and ratio between positive nodes and total dissected lymph nodes (N-ratio) in stage IIIB breast carcinoma patients. Methods In this retrospective study, primary endpoints were local recurrence (LR), distant recurrence (DR), and overall survival (OS). Univariate and multivariate prognostic factor analyses were carried out using Cox and Kaplan–Meier methods in the data of 185 patients. Results The median observation time was 36 (range 16–86) months. Pathological tumor size (continuous [cont.], P = 0.002; Hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1–1.3) and N-ratio (cont., P

The aim of this study was to investigate predictive factors related to distant recurrence (DR) and to determine whether an association exists between locoregional recurrence (LRR) and DR in 956 patients. The multivariate time-dependent Cox regression analysis showed that tumor size (2 cm vsor=2 cm; p0.0001; Hazard Ratio [HR], 3.7; 95% Confidence Interval [CI], 2.2-6.0), pN status (pN(2/3) vs pN(1); p0.0001; HR, 2.3; 95%CI, 1.7-3.1), lymphatic vascular involvement (yes vs no; p=0.001; HR, 1.7; 95%CI, 1.2-2.3) and LRR (yes vs no; p=0.001; HR, dependent on time) were the important prognostic factors for DR. This study confirms a time-dependent association between LRR and DR. A DR occurred immediately after LRR is strongly associated with the LRR, but this association decreases over time, and therefore, a DR occurred lately after LRR is, possibly, not related to this LRR.

There is a current debate on whether triple negative breast carcinomas (estrogen receptor--ER-negative, progesterone receptor--PR-negative and HER2-negative) have a poor prognosis. Our aim in this retrospective study was to determine whether triple negative feature is a prognostic factor for disease-free survival (DFS) in 322 breast carcinoma patients, of whom 80 (24.8%) had triple negative tumor histology. In the multivariate analysis, tumor subgroup (triple vs non-triple, p0.0001; hazard ratio [HR], 4.2; 95% confidence interval [95%CI], 2.2-8.2) was a significant factor related to relapse, in addition to number of metastatic nodes (4 vsor=4, p=0.04; HR, 1.6; 95%CI, 1.2-2.4), lymphatic vascular invasion (yes vs no, p=0.002; HR, 2.0; 95%CI, 1.3-3.1) and HER2 (positive vs negative, p0.0001; HR, 5.9; 95%CI, 3.0-10.0). This result indicated that patients with triple negative histology had a poor disease-free survival and this histology was an independent significant prognostic factor for DFS.

Aims To report the surgical management of carcinoma of the gallbladder. Methods A retrospective study in 65 patients who underwent simple (SC) or extended (EC) cholecystectomy for gallbladder carcinoma. Results 28 patients underwent extended cholecystectomy (EC) and 37 had simple cholecystectomy (SC). The multivariate analysis showed that lymph-node status (positive vs negative, p =0.001, Hazard Ratio [HR]:14.2, 95% Confidence Interval [CI]:3.1–62.8) and type of surgery (SC vs EC, p =0.01, HR:10.2, 95% CI:1.7–62.8) were the most important prognostic factors related to death. This analysis indicated that EC in those with pT 2 or pT 3 was associated with a reduce hazard of death by 90% in the follow-up period. Conclusions In gallbladder cancer patients who diagnose after simple cholecystectomy, those with pT 1 with clear margins need no further surgery. In patients with pT 2 or pT 3 incidental carcinoma, the completion radical re-operation is the only chance for long-term survival.

Aims: The purpose of this study is to determine whether the histopathologic features and outcome in invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) are different, and whether the histologic type is a prognostic factor for outcome. Methods: A retrospective cohort study was conducted in consecutive 510 stage I/II breast carcinoma patients who underwent modified radical mastectomy. The features of 65 patients with ILC were compared with those of 445 patients with IDC. In patients with median follow-up period of 44 months, univariate and multivariate prognostic factor analyses for cancer-specific death and relapse were carried out. Results: The median ages in patients with ILC and those with IDC were 52 and 41 (P=0.04). Tumor size, estrogen receptor positive expression and nodal positivity were not significantly different between the histologic types. Patients with ILC had more frequently (81.5%) low grade tumors and less lymphatic vascular invasion (9.3%) in primary tumor than those with IDC (P

Background Breast carcinoma is relatively uncommon in younger women and whether or not young age at diagnosis is an adverse prognostic factor in this disease has been controversial. Our aim in this report is to determine whether the histopathologic features and outcome in young and old are different, and whether age is a prognostic factor for relapse. Methods A retrospective study of consecutive 281 stage I or II breast carcinoma patients who had modified radical mastectomy was carried out. The patients with a median follow-up period of 45 months were divided two groups according to their ages. The histopathological features and survival of Group 1 and Group 2 were compared with each other. Univariate and multivariate prognostic factor analysis for relapse were carried out. Results The patients in Group 1 (younger than 35 years of age) had the worst histopathological features related to the prognosis than those in Group 2 and the difference between the two groups was statistically significant. Whereas the rates of 5-year overall survival were 65% in Group 1 and 98% in Group 2 (P < 0.05), the rates of 5-year relapse-free survival were 40% and 80%, respectively (P < 0.05). In univariate analysis of all patients, pathologic tumour size, pathologic axillary status, number of metastatic lymph nodes, pathologic stage, age, lymphatic vascular invasion were statistically significant factors associated with relapse. Multivariate analysis demonstrated that number of metastatic nodes (risk ratio RR:4.3 in more than three nodes) and age (RR:3.6 in Group 1) were the most important independent prognostic factors for relapse. In the patients without axillary involvement, both of univariate and multivariate analysis revealed that pathologic tumour size (RR:5.1 in pT2) and age (RR:4 in Group 1) were the independent prognosticators for relapse. Conclusions Young patients with breast cancer had the worst histopathological features and the worst survival than their older counterparts. Age was an independent significant prognostic factor for relapse. J. Surg. Oncol. 2000;74:267–272. © 2000 Wiley-Liss, Inc.

Background and objectives To evaluate the prognostic value of metastatic lymph node ratio in gastric carcinoma. Methods One hundred and sixty four patients who underwent D2 dissection for gastric carcinoma at Ankara Oncology Hospital were reviewed retrospectively. The prognostic factors including Japanese classification, AJCC/UICC TNM classification and metastatic lymph node ratio (1–10% and >10%) were evaluated in univariate and multivariate Cox regression analysis. Results The multivariate analysis showed that Borrmann classification, pN–category of AJCC/UICC classification and metastatic lymph node ratio were the most significant prognostic factors and a higher hazard ratio was obtained for metastatic lymph node ratio than pN category of AJCC/UICC classification (4.5 vs. 11.4). When the metastatic ratio groups of 1–10% and >10% were subdivided into pN1, pN2 and pN3 categories of the AJCC/UICC classification, there was no statistical difference between survival curves. When pN1, pN2 and pN3 categories of the AJCC/UICC classification were subdivided into the ratio groups of 1–10% and >10%, the survival rate of ratio group 1–10% was better than ratio group >10%. Conclusion With its simplicity and reproducibility, metastatic lymph node ratio can be used as a reliable prognostic indicator. J. Surg. Oncol. 2007;96:95–101. © 2007 Wiley-Liss, Inc.

We examined the relationship between different expressions of positive axillary lymph nodes (PN) and the outcomes of node-positive breast carcinoma patients to determine the best predictor(s) among these expressions and to assess whether anatomic high level involvement is an independent prognostic factor. In this retrospective study, the primary endpoints were distant recurrence (DR), locoregional recurrences (LRR), and disease-free survival (DFS). Univariate and multivariate prognostic factor analyses were carried out using survival and regression methods in the data of 704 patients with PN. In multivariate analysis, the number of PN, ratio of PN, log odds of PN, and level III (L-III) involvement, separately, were significant factors for DR in addition to age, tumor size, and lymphovascular invasion (LVI). In the final model including all expressions of nodal involvement, age (continuous P = 0.001; hazard ratio [HR]: 0.98; 95% confidence Interval [95% CI]: 0.96–0.99), tumor size (continuous: P

Background : Surgical flap necrosis is one of the most common problems after procedures such as mastec-tomies and regional lymph node dissections. In this prospective randomized study, the effect of topical dimethylsulfox-ide (DMSO) on skin flap viability was analyzed. Material and methods : Sixty-six consecutive patients with breast cancer who had skin flaps created during mastecto-my were randomized into two groups. Topical DMSO was applied on surgical flaps of the patients in Group-1, topicalsaline was applied for those in Group-2. Necrotic flap edges were recorded during the follow-up period for each patient,then excised and weighted in a blind manner. Results : The mean weight of flap edge necrosis was 23.48 ± 9.5 (mean ± sem) µg in DMSO group and 126,27 ± 44.8µg in control group (p = 0.03). The hospitalization period was 9.6 ± 0.5 days and 11.8 ± 0.8 days in DMSO group andcontrol group respectively (p = 0.02). There were no side effects due to DMSO. Conclusion : The application of DMSO reduced skin flap necrosis and improved outcome of surgical flaps.

Background This study was performed to determine the prognostic factors for differentiated thyroid cancer, and to establish a mathematical prognostic model. Study design A retrospective study was conducted in 347 differentiated thyroid cancer patients. Univariate and multivariate prognostic factor analyses were carried out using the Kaplan-Meier and Cox regression methods. Results Without adjustment for treatment in the multivariate analysis, age, tumor size, angioinvasion, and distant metastasis were significant predictors of outcomes. The very low-risk, low-risk, high-risk, and very high-risk groups were identified from the logistic regression equation. Overall and event-free survival estimations at 10 years were 100% and 100% for very low-risk patients, 88% and 75% for low-risk patients, 30% and 16% for high-risk patients, and 5% and 0% for very high-risk patients. Inclusion of treatment in the multivariate analysis showed, in addition to other variables, that both total or near total thyroidectomy (versus thyroidectomy less than total and near total thyroidectomy, p=0.0002; hazard ratio, 0.4; 95% CI, 0.3–0.7) and adjuvant radioactive iodine treatment (versus no treatment with radioactive iodine, p=0.0001; hazard ratio, 0.5; 95% CI, 0.2–0.8) were associated with a reduced hazard of death in the followup period. By subgroup analysis, total and near total thyroidectomy, along with radioactive iodine, appeared to provide a survival benefit for all patients except those in the very low-risk group. Conclusions The proposed mathematical model is satisfactory for predicting outcomes. Total and near total thyroidectomy along with radioactive iodine treatment might provide a survival advantage for differentiated thyroid cancer, except for those with very low risk.

Aim: In node-negative breast cancer patients, several factors for survival have been evaluated and currently, some of them are accepted for their prognostic and/or predictive values after validation in the separate data sets. The prognostic significance of increases in the number of pathologically detectable axillary lymph nodes in the node-negative patients could not been established clearly. To address this question, we have reviewed our patients' records. Methods: A retrospective cohort study was conducted in pathologically node-negative patients who underwent modified radical mastectomy for stage I and II breast cancer. Survival and multivariate prognostic factor analyses were carried out to determine whether the number of tumour-free lymph nodes in complete axillary dissection material in addition to known factors was significant for the outcomes. Results: Two hundred and seventy consecutive patients were eligible to enter the trial. The median observation time and the median number of tumour-free lymph nodes were 61 (from 30 to 120) months and 18 (from 10 to 44), respectively. The cohort was divided into the groups according to the number of nodes. The 5-year event-free and overall survivals were 92.5 and 98.3% for patients who had 18 lymph nodes or less, and 70 and 86.7% for those who had more than 18 negative nodes, respectively (P

BACKGROUND: The only possible curative treatment in gastric carcinoma is surgery, and there is still controversy surrounding the value of extended lymph node dissection. STUDY DESIGN: A retrospective cohort study was conducted in patients who underwent curative D1 or D2 resection for operable gastric carcinoma. Survival and multivariate prognostic factor analyses were carried out to determine whether dissection type was significant for outcomes, and which subgroup of patients would benefit from D2 dissection. RESULTS: Three hundred one patients who had potentially curative treatment were eligible to enter the trial. Although mortality rates were 3.1% in the D1 group and 4.3% in the D2 group (p = NS), morbidity rates in the D1 and D2 groups were 6.2% and 27.9%, respectively (p < 0.05). Multivariate analysis showed that lymph node dissection type, Borrmann type of tumor, number of metastatic lymph nodes, and depth of wall invasion were the most important independent prognosticators. Five-year disease-free and overall survival rates were 19% and 36% in D1, and 49% and 54% in D2, respectively (p < 0.05). After stratifying for pT and pN, the significant survival advantage with D2 was observed in subgroups of pT2, pT3 and pN1, pN2. The subset analysis showed a significant prognostic benefit with D2 dissection in patients in stages II and III-A. CONCLUSIONS: D2 dissections can be carried out with low mortality rates, but they have high morbidity rates and a survival advantage over D1 dissection of only 18%. In principle, a survival benefit with D2 is obtained especially when the tumor invades muscularis propria, penetrates serosa without invasion of adjacent structures, or metastasizes to fewer than fifteen regional lymph nodes. Data in this homogeneous population support the use of extended lymphadenectomy for selected group of patients with gastric carcinoma.

Aims. To carry out a retrospective study of male breast cancer over a 22-year experience. Methods. Data from 121 male patients with breast cancer treated between the years 1972 and 1994 at the Surgical Clinic of Ankara Oncology Hospital were reviewed. Distribution of cases according to stage was: 2.5% stage I, 28.9% stage II, 55.4% stage III and 13.2% stage IV (AJCC staging method). The surgical treatment for 23 of the patients (19%) was Halsted's radical mastectomy or modified radical mastectomy. Seventy-three cases (60.3%) had total mastectomy without axillary node dissection and 25 (20.7%) had local tumour excision only. Seventy-two of 121 patients had adjuvant treatment. Results. In general the prognosis of men with breast cancer was worse than for women. In the analysis of patients in stages I, II and III-A (operable disease group), the 5-year survival rates were 73% in axillary node-negative patients and 77% in those with tumours sized under 5 cm (P

We report herein the case of a 49-year-old woman with Pendred's syndrome who developed follicular carcinoma of the thyroid and invasive ductal carcinoma of the breast. To the best of our knowledge, this is the first case of different primary neoplasms developing in a patient with Pendred's syndrome.

Six patients with severe metabolic alkalosis were treated with intravenous hydrochloric acid (HCl) infusion. HCl was given through a central venous catheter, at a concentration of 0.1 mEq per ml. At least two of the following criteria were considered for initiation of the therapy: An arterial pH of greater than 7.45, a base excess (BE) of greater than +7 mmol/L, a PaCO2 of greater than 50 mmHg. The HCl amount was calculated using the BE formula, however, two thirds was infused for avoiding excessive acid loading. Patients were monitored by the blood gases, serum electrolytes, hemoglobin, hematocrit, bilirubin determinations and blood smear findings. While a significant decrease was noticed in pH and BE values, moderate changes were detected in PaCO2 due to different ventilatory status of the cases. All laboratory test results remained within normal limits and no complication was encountered. The advantage of the therapy is that less volume is needed for the correction of alkalosis, particularly in the cases requiring fluid restriction. HCl therapy, moreover, is a safe and time-saving method because of having rapid response to the treatment in the critically ill surgical patients.