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Two interrelated studies were carried out to determine whether extent of sialomucin change adjacent to a primary colorectal carcinoma predicted local tumour invasiveness and risk of local recurrence. In the first, depth of tumour penetration was correlated with the length of the sialomucin band adjacent to 72 primary colorectal cancers. There was a significant (P < 0.05) increase in sialomucin band length adjacent to tumours invading adjacent structures compared with those which had not (Mann-Whitney U test), although there was no overall correlation between depth of penetration, Dukes' classification or degree of differentiation (Kruskal-Wallis test). A sialomucin band of > 3 cm was associated with a 70 per cent probability of adjacent structure (T4) invasion. These observations were then testedprospectively in a second study involving 256 patients to determine whether the presence of a > 3 cm sialomucin band could predict local recurrence. Presence of a > 3 cm sialomucin band was a significant (χ2 = 7.12, d.f. = 1, P < 0.001) and independent predictor of local but not distant recurrence. In addition both the interval to local recurrence and survival were significantly shorter if a > 3 cm sialomucin band was present. However the accuracy of > 3 cm sialomucin band as a predictive test for local recurrence was only 70 per cent. The extent of sialomucin adjacent to a primary colorectal cancer does provide a crude assessment of tumour invasiveness and risk of local recurrence.

The need for comprehensive adjuvant radiotherapy in patients with T3pN0 breast cancer is controversial. This retrospective analysis was performed to assess the frequency of local and distant recurrence in patients treated with mastectomy without postoperative radiation.A single institution database of 2362 patients with breast carcinoma treated from 1974 to 1994 yielded 101 patients who had T3pN0 disease and did not receive chest wall or nodal irradiation. The median follow-up time was 93 months (range, 10-256 months). Sites of first failure were categorized as isolated chest wall (CWF), regional lymph nodes (RNF, which in this case were considered to be either axillary or supraclavicular), or distant sites (DF). CWF and/or RNF were considered local recurrences. Patients with simultaneous CWF and DF or RNF and DF were scored as DF. A comparison was made to 286 T2pN0 patients, also treated between 1974 and 1994.Twenty-two T3N0 patients developed recurrent disease. Site of first recurrence was isolated local recurrence in 11 patients and distant in 11 patients. Four patients had simultaneous local and distant recurrences. Site of isolated local recurrence was CWF in 5 patients and RNF in 6 patients. Median tumor size was 6 cm (range, 5-10.5 cm). There was no difference in local recurrence for tumor sizesor =7 cm versus7 cm (P = 0.07). The crude recurrence rate for T3pN0 patients treated by mastectomy was similar to T2pN0 patients treated in similar fashion (P = 0.3).The risk of isolated local recurrence in patients with T3pN0 breast cancer and negative margins is moderately low and similar to T2pN0 patients. These results suggest that routine use of postoperative chest wall and nodal irradiation in all T3pN0 patients may not be required.

loco-regional+distant, n1⁄422, 19.0%). Median time to recurrence was 9.9 months (IQR 4.4-24.6 months). Several factors were associated with loco-regional recurrence including left sided ACC location (odds ratio (OR) 2.70, 95% CI 1.06-6.86) and T-stage III/IV (reference T-stage I/II, OR 3.19, 95% CI 1.25-8.12)(both p

Colorectal cancer is one of the most aggressive cancers usually occurring in people above the age of 50 years. In the United States, colorectal cancer is the third most diagnosed cancer. The American Cancer Society has estimated 96,830 new cases of colon cancer and 40,000 new cases of rectal cancer in 2014 in the United States. According to the literature, up to 55% of colorectal cancer patients experience a recurrence within five years from the time of surgery. Relapse of colorectal cancer has a deep influence on the quality of patient life. Infrared (IR) spectroscopy has been widely used in medicine. It is a noninvasive, nondestructive technique that can detect changes in cells and tissues that are caused by different disorders, such as cancer. Abnormalities in the colonic crypts, which are not detectable using standard histopathological methods, could be determined using IR spectroscopic methods. The IR measurements were performed on formalin-fixed, paraffin-embedded colorectal tissues from eight patients (one control, four local recurrences, three distant recurrences). A total of 128 crypts were measured. Our results showed the possibility of differentiating among control, local, and distant recurrence crypts with more than a 92% success rate using spectra measured from the crypts' middle sites.

544 Background: Accurate assessment of the risk of late DR (5-10 yr after surgery) may be used to tailor the duration of ET for patients with HR+ EBC. The Prosigna (PAM50) risk of recurrence (ROR) ...

595 Background: Hormone-receptor positive (HR+), early stage breast cancer patients (pts) are at risk for late ( > 5 year) distant recurrence (DR) and are now considered for extended (10 year) endo...

1095 Background: Triple negative breast cancer (TNBC) and young patient age are both associated with an increased risk of local (LR) and distant recurrence (DR). In young women with TNBC it is uncl...

Phyllodes tumors of the breast are unusual fibroepithelial tumors that exhibit a wide range of clinical behavior. These tumors are categorized as benign, borderline, or malignant based on a combination of histologic features. The prognosis of phyllodes tumors is favorable, with local recurrence occurring in approximately 15% of patients overall and distant recurrence in approximately 5% to 10% overall. Wide excision with a greater than 1 cm margin is definitive primary therapy. Adjuvant systemic therapy is of no proven value. Patients with locally recurrent disease should undergo wide excision of the recurrence with or without subsequent radiotherapy.

The increasing incidence and overall survival of patients diagnosed with melanoma of the skin are leading to an ever-increasing population of individuals with a personal history of melanoma. These patients are at risk for developing local, regional, or distant recurrence and are also at greater risk than the general population for developing a new primary melanoma. This article presents the rational for implementing surveillance strategies for patients with a history of melanoma.

Aims To assess the outcome of treating patients with excellent prognosis (T1 G1 N0 ER +ve) breast cancers with breast conserving surgery alone. Methods One hundred and twenty-one women with grade 1, node negative, ER+ tumours, smaller than 20 mm who were treated by breast conserving surgery alone between 1991 and 2000. Margin width was always at least 5 mm. The following were recorded: local recurrence (LR), distant recurrence, new contra-lateral primaries and death. Recurrence rates were then compared to those in the largest series. Results One hundred and twenty-one women were followed up for a median of 68 months. Fourteen developed further breast cancer in the same side and eight new cancers in the contra-lateral breast. There was one case of distant metastasis and no deaths. Local recurrence rate was significantly higher than other studies ( p =0.006). Conclusions Although there is no detrimental effect on survival after this length of follow-up, the omission of radiotherapy and tamoxifen appears to increase the probability of LR. Patients with T1 G1 N0 ER+ breast cancer treated by breast conserving surgery should be offered both radiotherapy and tamoxifen.

Prostate cancer is the most common solid tumor in men. There are several treatment options for men diagnosed with clinically localized prostate cancer. There is an obvious need for decision-making tools that individual patients can apply to the specific parameters of their disease to reach an informed decision. In order to make accurate and informed decisions about treatment choices for prostate cancer, the patient and clinician must follow an orderly decision-making process. The most important starting point for decision analysis is to review the available literature for each treatment modality and elucidate the respective success rates in cancer control, including prostate specific antigen (PSA) recurrence, local and distant recurrence, and cancer-specific survival, and ascertain significant predictors of treatment success or failure. The decision-making process for prostate cancer is not straightforward. There are multiple treatment modalities with similar cancer control, especially for low-risk patients. Fortunately, the field of decision analysis and outcomes research is expanding rapidly and will improve the decision-making process in the years to come.

Objective: We evaluated breast cancer immunophenotype and variables measured at CNS-relapse as prognostic factors in a cohort of Hispanic patients. Methods: We reviewed data from 2602 breast cancer women in stages I-III diagnosed between 2000 and 2005 at the Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú. According to immunophenotype, tumors were categorized in luminal A (RE+ and/or RP+, HER2−), luminal B (RE+ and/or RP+, HER2+), HER2 (RE−, RP−, HER2+) and triple negative (RE−, RP−, HER2−). Clinicopathological data at diagnosis and at CNS relapse were evaluated and used to calculate prognostic scores according to Recursive Partitioning Analysis (RPA) score, Graded Prognostic Assessment (GPA) Score, and Basic Score for Brain Metastases. Endpoints were time to CNS metastasis and Post CNS-relapse survival. Results: With a median follow-up of 7.5 years, 818 (31.4%) patients had locoregional or distant recurrence. In total, 159 (6.1%) patients developed CNS metastases, of whom 92 (3.5%) as the first site of recurrence and 22 meningeal metastases were detected. In triple negative, 51 (32.1%) developed SNC metastases, 46 (28.9%) in luminal A, 37 (23.3%) in HER2 and 25 (15.7%) in luminal B patients. Median time since breast cancer diagnosis to SNC metastases was 28.1 months (mo) and the variables influencing it were Clinical T (P < 0.001), clinical stage (P < 0.001), histologic grade (p = 0.005), estrogen and progesterone receptors ((p = 0.026 for both) and inmmunophenotype (P < 0.005). None of these factors was associated with post SNC-recurrence survival. In regard to variables measured at SNC relapse, we couldn't find differences in age groups ( Conclusions: Prognostic scores calculated from variables measured at CNS relapse are useful to identify groups with shorter post CNS recurrence survival while immunophenotype of breast cancer was unable to identify groups of different prognosis. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-20.

Purpose/Objective(s): To report early and late toxicity and biochemical outcome in a prospective series of 445 patients with intermediateor highrisk clinically localized prostate cancer treated with either HD-3D-CRT or with LD-3D-CRT+HDR-B. Materials/Methods: Between 12/1999 and 10/2005, 445 patients (pts) with PSA’10, Gleason score’6 and/or T2b-T3 N0 M0 prostate cancer entered the study. Pts were prospectively assigned to one of the two treatment groups: 76 Gy HD-3D-CRT to the prostate in 38 fractions (group 1; 223 patients) or 46 Gy LD-3D-CRT+ 16 Gy HDR-B given in 2 fractions of 8 Gy (group 2, 222 patients), limiting the maximum rectal dose to 85% of the prescribed dose. Both groups were well balanced taking into account patient’s as well as tumors’ characteristics. Toxicities were scored by the EORTC /RTOG morbidity grading scales. Special attention to local, regional or distant recurrence, survival, late effects, PSA and testosterone levels and quality of life was done. Results: All pts completed treatment. None pts included in the group 1 or 2 experienced grade 3 or more rectal toxicity. Twenty-eight pts of group 1 (12.5%) and 6 pts of group 2 (2.7%) developed grade 2 rectal toxicity (rectal bleeding or urgency). Fifteen pts in group 1 (6.7%) and 3 pts in group 2 (1.3%) developed grade 1 rectal bleeding (less than 2 times/week). With a mean follow-up of 84 months, the 8-year free-from-failure survival was 90.7% and 98.3% (p < 0.02) in group 1 and 2 respectively; free-frommetastases survival 96.9% and 97.9% (p < 0.08)for group 1 and 2 respectively; and cause-specific survival 97.4% and 98.3% (p < 0.09). Conclusions: High-dose 3D-EBRT + HDR brachytherapy was a safe and effective method of escalating the dose to the prostate without increasing the risk of late effects. Acute as well as late rectal complications were significantly reduced with the combined treatment, compared with what was observed with high-dose conventional, 3D-conformal radiation therapy. Control rates were better with in the HDR-boosted patients as expected by higher effective-dose. Author Disclosure: B. Guix: None. J. Bartrina: None. J. Tello: None. I. Henriquez: None. L. Quinzanos: None. T. Lacorte: None. I. Guix: None. G. Galdon: None. M. Espino: None. M. Espino: None.

Aim: Identification of molecular determinants predicting late recurrence (>5 yrs) in stage I and II breast cancer has become clinically important in light of data demonstrating a benefit for 10 yrs of tamoxifen administration. Since the 21-gene Recurrence Score (RS) is commonly utilized in early stage BC, we wished to determine its utility in predicting distant recurrences beyond 5 yrs as a function of quantitative ER expression. Methods: The 21-gene RS was assessed in 1065 chemo and tam-treated, ER + , node-positive pts from NSABP B-28 and 668 tam-treated, ER + , node-negative pts from NSABP B-14. Cox PH models, KM estimates and log rank statistics were used to assess the association of the RS with risk of DR by quantitative ER expression, using the 21-gene assay, in pts event-free after 5 yrs. We established an ER cut-point (high vs low) in B-28, and tested the cut-point in B-14, formally evaluating the interaction of RS and ER. Results: Median follow-up was 11.2 yrs (B-28) and 14.5 yrs (B-14). 832 B-28 pts and 564 B-14 pts were DR-free after 5 yrs. A reference normalized ER cut-point of 9.1 CT was established in B-28 based on the association of the RS with DR after 5 yrs. Of the event-free pts at 5 yrs, 68% in B-28 and 88% in B-14 had ER > 9.1. In B-28 the RS result was strongly associated with DR after 5 yrs in the higher ER expressing pts (log rank P = 0.001), but not in the lower ER expressing pts (log rank P = 0.87). It was confirmed in the B-14 data that RS was associated with DR after 5 yrs in higher ER pts (Table) but not in the lower ER pts (interaction P = 0.03). The association of RS risk groups within clinicopathologic subgroups for the higher ER patients still at risk at 5 years will also be presented. Table 177P . DR Risk after 5 yrs in B-14 by RS Risk Group for pts with ER > 9.1 C T % DR KM estimate (95% CI) RS Risk Group N(%) pts 5 to 10 yrs (%) 5 to 15 yrs % Low 289 (58%) 4.7 (2.8 – 8.0) 6.8 (4.4 – 10.6) Intermediate 111 (22%) 4.1 (1.6 – 10.6) 11.2 (6.2 – 19.9) High 97 (20%) 12.6 (7.4 – 21.2) 16.4 (10.2 – 25.7) Log rank P = 0.01 Conclusions: For late recurrences (beyond 5 yrs), the RS is strongly prognostic in pts with higher quantitative ER expression (>9.1). The findings suggest that extending tamoxifen beyond 5 yrs may be most beneficial in pts with high (and intermediate) RS with higher quantitative ER expression and of limited benefit in pts with a low RS (>50% of population under study). Disclosure: F. Baehner, S. Butler, F. Jamshidian and A. Sing have decalred: I am an employee of Genomic Health, Inc. I receive a salary and company stock. S. Shak: I am an employee of Genomic Health, Inc and I serve in a leadership position. I receive a salary and I have company stock.All other authors have declared no conflicts of interest.

11003 Background: The Oncotype DX 21-gene Recurrence Score assay was developed in endocrine-treated patients (pts) and validated as a predictor of 10-yr distant recurrence risk and chemotherapy ben...

6580 Background: The Oncotype DX (Genomic Health, Redwood City, CA; GHI) RS estimates 10-yr risk of distant recurrence and CT benefit in patients (pts) with ER+, early-stage breast cancer (EBC). Af...

558 Background: Bone metastases are a common site of distant recurrence in breast cancer. Evidence from randomized trials, including a recent meta-analysis, suggests that adjuvant bisphosphonates c...

11024 Background: Identification of molecular determinants predicting late recurrence (>5 yrs) in stage I and II breast cancer has become clinically important in light of data demonstrating a benef...

570 Background: The OncotypeDX 21-gene assay Recurrence Score (RS) is widely used to risk-stratify ER+, node negative breast cancer to determine the 10 year risk of distant recurrence (RR) and the ...

532 Background: BCI is a genomic signature that significantly predicts risk of both early (0-5y) and late (5-10y) distant recurrence (DR) in HR+, LN- breast cancer. Previous results from the TransA...

e22085 Background: The Oncotype DX Recurrence Score (RS) assay has been validated for prediction of 10-year risk of distant recurrence and likelihood of benefit from chemotherapy in patients with E...

Bone is the most common site of distant recurrence in breast cancer. The development of skeletal metastases involves complex interactions between the cancer cells and the bone microenvironment. The presence of tumor in bone is associated with activation of osteoclasts, resulting in excessive bone resorption. Bisphosphonates are potent inhibitors of osteoclastic bone resorption with proven efficacy in reducing tumor-associated skeletal complications. Several studies have investigated the adjuvant, or preventive, use of these drugs in breast cancer. Laboratory experiments have shown that the development of bone metastases can be inhibited by bisphosphonates. Three randomized clinical trials of bisphosphonates in nonmetastatic breast cancer patients have yielded conflicting results with respect to development of osseous and visceral metastases and survival. Defining the potential role of these agents in adjuvant breast cancer treatment requires further investigation in randomized, large-scale, multicenter clinical trials. The data available to date provide a strong impetus for continued clinical and laboratory work with bisphosphonates in breast cancer.

Forty-three patients with hepatocellular carcinomas (HCCs) who had undergone subsegmental transcatheter arterial embolization (sTAE) as initial treatment were studied retrospectively to evaluate the prognosis, recurrence, and effect of sTAE on liver function. Frequent recurrences were observed (disease-free survival rates were 51.2% at 1 year and 7.7% at 3 years), and in the recurrent nodules, 66.4% were distant recurrences. No significant difference was observed in the periods of distant recurrence compared with local recurrence, and also in the periods of distant recurrence with and without local recurrence, implying that strict control of the primary lesion did not prevent distant recurrence. Concerning the effect of sTAE on liver function, ALT and LDH were significantly elevated and albumin was significantly reduced after sTAE (p = 0.002, > 0.0001, and = 0.0009, respectively). But 4 weeks after sTAE, all these levels recovered to their previous values. Moreover transient hepatic reserve reduction after sTAE did not affect the prognosis. In conclusion, for HCCs with such levels of recurrence, strict follow-up and repeat treatments with minimum damage to the hepatic reserve are essential. sTAE is an appropriate and reasonable treatment for such HCCs because of low levels of damage to the hepatic reserve and the possibility of repeat operations. Using sTAE as the main treatment against HCC, survival rates of more than 70% at 3 years were achieved.

BACKGROUND Skin-sparing mastectomies (SSMs) are being used more frequently to treat many cases of breast cancer. This type of surgery maximizes breast skin preservation and facilitates immediate reconstruction, resulting in a superior cosmetic appearance after mastectomy and a more satisfied patient. Although SSMs are becoming more common, there are few data regarding the local and distant recurrence rates. METHODS A total of 231 patients treated with mastectomies from 1990 to 1998 were studied, including 77 SSM and 154 non-skin-sparing (NSSM) mastectomy patients. RESULTS The local recurrence rates for SSM and NSSM were 3.90% (3 of 77 patients) and 3.25% (5 of 154 patients), respectively. The local recurrence-free survival at 5 years was 95.3% for SSM patients and 95.2% for NSSM patients (P = .28). The distant recurrence rates of SSM and NSSM were 3.9% (3 of 77 patients) and 3.9% (6 of 154 patients), respectively. The distant recurrence-free actuarial survival at 5 years was 90.2% for SSM patients and 92% for NSSM patients (P = .07). CONCLUSIONS Mastectomies using the skin-sparing technique do not appear to result in any increase in local or distant recurrence and improve aesthetic results of the immediate reconstruction.

We have recently demonstrated an association between distant metastasis and the expression of the extracellular matrix glycoprotein tenascin-C (Tn-C) in the invasion border of small axillary node-negative breast carcinomas. Our purpose was to assess the relationship between the expression of Tn-C in the tumour invasion border and several histopathological and biological variables and to compare their usefulness in predicting local and distant disease recurrences. The original patient group consisted of 143 women with axillary node-negative breast cancer (one bilateral) treated with breast-conserving surgery and post-operative radiotherapy, and followed for a median of 8 years. Because of the small number of recurrences an additional group of 15 similarly treated women with recurrent breast cancer was also studied. The size of the tumour, its histology, including a possible intraductal component, and grade were re-evaluated. The expression of erbB-2, p53, Ki-67 and Tn-C was evaluated by immunohistochemistry. Ploidy and S-phase fraction (SPF) were assessed by flow cytometry. The only statistically significant prognostic factor for local recurrence was Tn-C expression in the invasion border. For metastasis Ki-67 positivity, tumour size and Tn-C expression in the invasion border were statistically significant, but Ki-67 positivity was the only independent prognostic factor. Tn-C expression in the invasion border was associated with a higher proliferation rate measured by Ki-67 and SPF, which is consistent with the suggested growth-promoting activity of Tn-C. Tn-C may be a useful marker in selecting patients for adjuvant therapies to reduce the rate of both local and distant cancer recurrences. Images Figure 1

The study was based on a population mammographic screening programme for women aged 40–74 years. Metastatic potential was analysed in 843 invasive breast cancers with regard to mode of detection and a number of prognostic factors. There was a higher metastatic capacity in clinically detected cases, but multivariate analyses showed that neither the mode of detection (hazard rate ratio of distant recurrence RR = 1.39, 95% CI 0.78–2.46 interval cancers and RR = 1.6, 95% CI 0.76–3.36 non-attenders) nor the duration between screening and diagnosis for true interval cancers (RR = 0.47, 95% CI 0.16–1.35 in tumours detected later than one year after screening) were independent prognostic factors. A correlation was found between metastatic potential and the SPF (RR = 2.94, 95% CI 1.57–5.50 in tumours with a high SPF), the oestrogen receptor status and the tumour stage. In conclusion, interval cancers intrinsically are not different from other breast cancers with equivalent characteristics; the duration between screening and diagnosis in interval cancers was not clearly correlated to the prognosis, but the S-phase fraction was a powerful predictor of prognosis.

Background: Extended adjuvant endocrine therapy beyond 5 years is known to be of benefit to some oestrogen receptor (ER+) patients. Given the significant burden extended endocrine therapy presents, individual prediction of late recurrence risk would be highly valuable. We have previously shown that the PAM50 based Risk of Recurrence (ROR) score is significantly correlated with late recurrence in both the transATAC and ABCSG8 cohorts. Here, we assess the value of the ROR score for predicting distant recurrence beyond 5 years in a combined analysis of these two cohorts. Methods: Long-term follow-up data and tissue samples were obtained from 2,485 postmenopausal women with hormone receptor positive (HR+) early breast cancer from the ABCSG-8 and transATAC trials. We used univariate and multivariate models to determine the prognostic value of ROR (with tumour size) for distant recurrence in years 5-10 in the combined dataset. Changes in likelihood ratio tests (DLR-χ2) are presented. Results: A total of 2137 women who did not have a recurrence in years 0-5 were included in the combined analyses of late recurrence risk. In the univariate and multivariate analyses, CTS was the strongest prognostic score in the late follow-up period (ΔLR-χ2 = 95.17, ΔLR-χ2 = 61.65, respectively) in all patients. The ROR score also added significant prognostic information in years 5-10 in the univariate and multivariate analyses, but somewhat less than the CTS (ΔLR-χ2 = 66.09, ΔLR-χ2 = 32.57, respectively) (Table 1). The risk of distant recurrence at 10 years for the low risk group was 5.7% (95% CI 4.5% to 7.2%), for intermediate risk 14.6% (12.0% to 17.6%), and for high risk 29.3% (25.5% to 33.6%). Patients with a luminal A subtype had a 70% lower risk of late distant recurrence than those with a luminal B subtype (HR = 0.30 (0.21-0.43), P Conclusions: The results of this combined analyses showed that the ROR score added prognostic information to CTS in all patients and in all patient subgroups in the late follow-up period. The risk of distant recurrence in years 5-10 was statistically significantly different for the low, intermediate risk and high risk groups. These results suggest that the ROR score may be used to separate patients into risk groups who could be spared or could benefit from extended hormonal therapy beyond 5 years of treatment. Hazard Ratio (HR) and changes in likelihood ratio test (DLR-χ2) for univariate and multivariate analyses according to all groups. Univariate Multivariate* HR (95% CI)ΔLR-χ2 (P-value)HR (95% CI)ΔLR-χ2 (P-value)All patients (N = 2137) CTS2.05 (1.80-2.34)95.17 ( Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S6-04.

Colorectal cancer in elderly patients P039 Reduced risk of distant recurrence after adjuvant chemotherapy in elderly stage III colon cancer patients F.N. Van Erning*, G.J. Creemers, I.H.J.T. de Hingh, S.H. Goey, O.J.L. Loosveld, V.E.P.P. Lemmens. Research, Comprehensive Cancer Centre South; Internal Medicine; Surgery, Catharina Hospital, Eindhoven; Internal Medicine, TweeSteden Hospital, Tilburg; Internal Medicine, Amphia Hospital, Breda; Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands

598 Background: Treatment planning for patients with node negative, ER-positive, HER-2 negative breast cancer often incorporates the use of prognostic and predictive tools like Oncotype DX. Prior to the availabilty of Oncotype DX, clinicopathologic factors such as age, nodal status, tumour size and grade were used to determine risk of recurrence (ROR). RSPC represents a validated formal integration of oncotype DX recurrence score (RS) and clinicopathologic factors that further refines prognostic accuracy. RSPC does not improve the prediction of likelihood of chemotherapy benefit. The objective of this study was to compare distant recurrence risk assessment by RS and RSPC. Methods: We included patients with node negative, ER-positive, HER2-negative breast cancer who had Oncotype DX testing routinely or on clinical trial. We retrospectively reviewed patient charts and extracted clinicopathological and RS data. We calculated the RSPC using the RSPC educational tool. A comparative analysis was performed looking at the statification of patients into low (LR), intermediate (IR) and high (HR) ROR groups by RS and RSPC. The cut offs for low, intermediate and high risk by the RSPC were set to less than 12%, 12-20% and more than 20% risk of distant recurrence at 10yrs, corresponding to the risks of recurrence associated with the RS categories. Results: We identified 658 patients from 5 academic hospitals in Ireland and the US. Oncotype DX RS classified the following proportions of patients into three risk groups for distant recurrence: LR, n=334 (50.5%), IR, n=259 (39.4%), HR, n=67 (10.1%). RSPC classified the following proportion of patients into the three risk groups for recurrence: LR, n= 455 (69.1%), IR, n=110 (16.7%), HR, n=93 (14.1%). RSPC reclassified 72.6% (n=188) of the IR group (59.1% (n=153) from IR to LR and 13.5% (n=35) from IR to HR). RPSC reclassified 10.5% (n=35) of the LR group (8.1% (n=27) from LR to IR, and 2.4% (n=8) from LR to HR). RSPC reclassified 25.3% (n=17) of the HR group (17.9% (n=12) from HR to IR, and 7.4% (n=5) from HR to LR). Conclusions: RSPC reclassified 240 patients (36.5%) and was most helpful reassigning the IR group.

e18563 Background:The tumor recurrence after complete surgical resection occurs even in patients with clinical stage IA lung adenocarcinoma. The predictive factors of the distant recurrence have not been determined yet in such early stage lung adenocarcinoma patients. Methods:A total of 610 patients with clinical stage IA lung adenocarcinoma who underwent complete resection in multi-institutions were retrospectively analyzed . The correlation between clinicopathological factors andthe incidence of distant recurrence was examined. Results:Thirty six patients with distant recurrence had significant inferior overall survival. In the multivariate Cox regression analysis, solid tumor size on high resolution computed tomography (HRCT) and maximum standardized uptake (SUVmax) on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) were found to be independent predictors of distant recurrence. According to receiver operating characteristic analysis, 1.6cm or more of solid tumor size and 3.3 or more of SUVmax were indicated to be an optimal criteria to detect a high risk group for distant recurrence. In fact, distant recurrence and local recurrence were more frequently observed in patients whose solid tumor size and SUVmax met the criteria than the unmet patients (24 of 104 (20.2%) patients v.s. 12 of 506 patients (2.4%)). Conclusions:Solid tumor size on HRCT and SUVmax on FDG-PET/CT were indicated to be predictive factors of distant recurrence for the patients with clinical stage IA lung adenocarcinoma. It is highly possible that neoadjuvant chemotherapy is useful for such a high risk group.

Trimodality therapy has been shown in preliminary studies to increase survival in esophageal cancer. Distant recurrence remains the main pattern of failure. A case of aggressive treatment of two metachronous solitary visceral metastases is presented.