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Factors associated with increased risk of loco-regional recurrence include young age at diagnosis, advanced tumor size, involvement of regional lymph nodes, high grade, vascular invasion, and omitting an indicated adjuvant radiotherapy . Surrogate definitions based on immunohistochemical measurements of the expression of hormone receptors (HR), human epidermal growth factor receptor 2 (HER2/neu), and other markers such as the Ki-67 antigen are used to classify BRC and correlate well with genetically different BRC subtypes [6, 7], which are associated with the risk of recurrence and outcome in addition to classic prognostic factors [8, 9].
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Treatment options of potentially curable loco-regional recurrence include complete surgical resection of the recurrent tumor, radiotherapy and systemic treatment based on histological examination of the cancerous tissue and re-staging. Occurring distant metastases are generally treated with palliative intent and therapy includes systemic treatment, radiotherapy or resection of metastases. Any treatment of recurrent BRC should be based on an interdisciplinary approach [10,11,12].
Descriptive analyses were used to summarize the patients with regard to age and tumor characteristics. The study sample included all BRC patients without distant metastases at the time of diagnosis. A summary of the provided local and systemic treatments was derived. For the analysis of the risk of recurrence, information on its type (loco-regional recurrence, distant metastases), date of first occurrence and date of death was used.
Table 3 presents the 5- and 10-year CI of cancer recurrence (both loco-regional recurrence and distant metastases) of BRC patients with local R0 resection by age, tumor characteristics and provided recommended treatments. Overall 5- and 10-year CI of BRC recurrence was 10 and 16%, respectively (unless otherwise stated, the 10-year estimate of the CI will be reported subsequently). The CI was higher of patients aged
A number of patients treated conservatively for breast cancer will develop loco-regional and distant recurrences. Our aim was to determine how their occurrence may be linked to the evolution of the disease.
We analyzed 238 women treated by conservative breast surgery and breast irradiation in a single institution. We evaluated the prognostic factors associated with loco-regional and distant recurrences and the prognostic value of local and regional recurrences on systemic progression.
In this study, we collected data on 238 women treated by BCS and breast radiotherapy in order to identify and assess the risk factors that might predict the occurrence of loco-regional and distant recurrence after BCS aiming at selecting the suitable patients with high risk of local breast recurrence after BCS.
Loco-regional recurrence-free survival of patients who underwent BCS was estimated using the Kaplan-Meier method and compared among different categories using log-rank tests (univariable analysis of risk factors for loco-regional recurrence).
The surgical treatment of breast cancer has been changed during the previous decades towards a less extensive surgery. Breast conservative surgery (BCS) is a model of this type of surgery which in properly selected patients provides local control of the disease. Based on the systemic disease concept of cancer breast, the removal of the primary does not obviate the risk of distant spread. Thus, our concern in the present study was to analyze the risk factors associated with loco-regional recurrence after BCS as local recurrence will obviate the purpose of breast conservation [12, 13].
Risk factors for loco-regional recurrence and distant metastases play an important role in the decision for the treatment of breast cancer. This decision-making can be optimized if patients at high risk for loco-regional recurrence can be identified.
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Validating individual risk factors and even more so multivariable prediction models of multiple risk factors for local, regional, or distant metastasis and recurrence is crucially important as these could guide management of the primary tumor and provide prognostic information for patients and their cancer clinicians. Prediction models may be more successful if they consider the most informative factors. This knowledge may eventually prove useful in managing CRC treatment with better-informed patient choices. Understanding the underlying validity and predictive performance of risk factors for locoregional recurrence is particularly relevant, given progressive moves towards organ-preserving approaches such as endoscopic resection (EMR), trans-anal microscopic surgery (TEMS), and neo-adjuvant chemoradiotherapy for rectal cancer , since organ preservation may be at the expense of elevated recurrence rates. The corollary also applies since the risk-benefit ratio of extensive locoregional surgery and/or radiotherapy may be detrimentally impacted by future distant metastases.
But what happened to the idea that the engine should be a tool to make as much money as possible for its owner? Was it a sound business decision to design and build such an expensive and heavy locomotive just to outperform another locomotive? Rather than admit a mistake, C&O went on and bought 60 of them.
Ed King is a die-hard eastern railroad advocate to the bitter end. Leave it to a C&ONW man to argue that the Allegheny was a better engine than the Big Boy. Nearly every other rail historian, however, agrees that the 25 Big Boys were the ultimate expression of the high pressure single articulated steam engine anywhere in the world. Built for a purpose which they performed admirably and usually without help, they hauled mile long manifest trains over 9500 Foot Sherman Hill and west through the Wasatch Mountains of Wyoming and Utah to their terminus in Ogden, the Crossroad of the West. They were both great locomotives but the operational evidence suggests that Big Boy was the superior locomotive and the un-doctored successful king heavy weight of all the final beasts of steam. Of course by 2019 one will again be in operation and then all the naysayers can see for them-selves what Big Boy was truly all about, coal or oil powered. 350c69d7ab