Spontaneous colonic perforation in adults (SCPA) is rare but important. Its clinicopathological features and outcomes remain unclear. Therefore, the aim of the current study was to explore and investigate the clinicopathological characteristics, clinical outcomes and potential risk factors for patients with SCPA. Data of seven patients with SCPA treated in our hospitals from January 2008 to December 2017, and 221 cases from research databases before 2018 were retrospectively analyzed. The description of SCPA included stercoral perforation of the colon (SPC), idiopathic perforation of the colon (IPC) and spontaneous colonic perforation (SCP) in the study. All SCPA patients presented with unexplained abdominal pain and peritonitis. The median age was 62.5 years. The definite diagnosis preoperatively was 20.6%. The commonest lesion location was sigmoid colon and Hartmann’s operation accounted for 59.3%. Histopathology of stercoral perforation (HSP) and histopathology of idiopathic perforation (HIP) were two histopathological findings. Postoperative complication was 67.7% and mortality was 31.1%. Univariate and multivariate analyses showed that chronic constipation was an independent risk factor for histopathological features ( p ≤ 0.001, p = 0.005). Age of patients was associated with both postoperative complication ( p = 0.012, p = 0.044) and mortality ( p = 0.013, p = 0.034). Univariate analysis showed that HSP was associated with postoperative complication ( p = 0.015). Our findings from the analysis pertaining to SCPA confirm those from previous studies, supporting the SCPA, as a uniform description, is an infrequent and life-threatening disease requiring early surgical intervention. We found that the elderly with chronic constipation was a high-risk category and those with HIP had a more favorable outcome than that of patients with HSP.

In the diagnosis of SAIS, MNT is a reliable and highly accurate maneuver and seems useful to distinguish this syndrome from frozen shoulder.

Background: Stage IV breast cancer was considered to be an incurable disease with a poor survival outcome. Among them, patients with de novo stage IV breast cancer (BC) account for approximately 25%. Systemic therapy has remained the cornerstone of treatment, and the role of local therapy (Surgical resection of the primary tumor and/or radiotherapy) for de novo stage IV BC remains controversial. Aim: This study was conducted to examine the clinical and pathological profile and survival outcomes of patients with de novo stage IV BC treated with local therapy at our institutions. Settings and design: The study was conducted at two Chinese tertiary hospitals and was retrospective in nature. Methods and patients: All de novo stage IV BC patients (all female) treated with local therapy and systemic therapy alone at our hospitals between March 2007 and November 2016 were enrolled in the study. Data were retrospectively extracted from the patients’ case records. Data were analyzed according the clinicopathological features and treatment outcomes. Overall survival was used as the primary study outcome. Univariable and multivariable Cox regression analysis were used to assess the association between local therapy and overall survival. Further stratified survival analysis was used to assess the effect of surgical resection of the primary tumor before or after systemic therapy on survival outcomes. Kaplan-Meier method was used for survival analysis and the outcome variables were compared using the log-rank test. Results: A total of 138 cases of de novo stage IV BC patients admitted to our institutions were included, of whom 80 underwent local treatment. There was no significant difference in age, primary tumor N-stage, Ki-67 index, ER/PR status, and HER-2 expression between local treatment group and systemic therapy group. But there were differences in tumor size and metastatic site between the two groups. Surgical resection of the primary tumor was performed in 71/138 (51.4%) patients and 26 cases of the patients had combined radiotherapy. The median duration of follow-up was 31±20.6 months. Median survival time of all patients was 32.1 months, and the 3-year and 5-year survival rates were 36.2% and 12.3%, respectively. The median survival time of local treatment group and systemic therapy group were 38.0 and 19.0 months (HR 0.50; 95% CI 0.34-0.73; p<0.0001), and the 3-year and 5-year survival rates were 53.5% versus 20.9% and 16.9% versus 7.5%, respectively. Similarly, patients who had surgery were found to have a better survival outcome than the patients with non-surgery therapy (HR 0.53; 95% CI 0.36-0.77; p<0.0001). While receipt of radiotherapy alone to either the primary and/or metastatic sites had no impact on overall survival (p=0.24). Interestingly, surgical resection of the primary tumor, whether before or after systemic therapy (p=0.0004; p=0.0005), was independently associated with improved overall survival when compared to systemic therapy alone. Conclusions: Our data support that local therapy mainly based on surgical resection of the primary tumor can improve overall survival in patients with de novo stage IV BC, but fail to demonstrate the survival benefit from radiotherapy alone. However, prospective evidence from phase-3 randomized controlled trials on the feasibility of local therapy in de novo stage IV BC is required before its routine use can be recommended. Key words: De novo stage IV breast cancer; Local therapy; Surgical resection of the primary tumor; Survival outcomes Research protocol number: 2017-AF29-058 Citation Format: Ren Chongxi, Sun Jianna, Kong Lingjun, Liu Hong. Local therapy and its association on survival outcomes in patients with de novo stage IV breast cancer: Results from a retrospective cohort study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-19.

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BackgroundSchwannomas are benign, encapsulated, peripheral nerve tumours that arise from the Schwann cell. Approximately 25%–45% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck. However, schwannoma of the supraglottic oropharynx is rare.Case presentationWe report on a 35-year-old female who complained of progressive dysphagia, from whom a large schwannoma in the supraglottic oropharynx was excised through a transoral approach. No recurrence was seen after one year follow-up.ConclusionAlthough rare, schwannomas do occasionally occur in the supraglottic oropharynx. When dysphagia is present, a thorough diagnostic procedure should be performed to evaluate the morphology and function of the upper aerodigestive tract. MRI is sensitive and specific in the diagnosis of schwannoma. And the best treatment of choice is complete excision with preservation of functions.

Purpose: The clinical outcomes of de novo metastatic breast cancer (dnMBC) differ between estrogen receptor (ER)-positive and ER-negative patients, but the respective prognostic factors in these two subpopulations have not been established. This study aimed to investigate the survival and prognostic factors in patients with dnMBC according to ER status. Methods: Patients with dnMBC between February 2010 and December 2017 were retrospectively reviewed. Demographics, tumor characteristics, treatment types and survival data were collected. Patients were divided into ER-negative and ER-positive groups, and the propensity score matching (PSM) was used to balance the bias. Overall survival (OS) was compared between groups. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors in each group. Results: A total of 518 patients were included in the study. After PSM, there were 157 ER-negative and 165 ER-positive patients. With a median follow-up of 8.5 years, the median OS was 36 months (95% confidence interval [CI], 32-41) in the ER-positive group and 24 months (95% CI, 19-27) in the ER-negative group (P=0.001). Ki-67 index, endocrine therapy and radiotherapy for primary tumor were independent prognostic factors of OS in the ER-positive group, while initial chemotherapy cycles and chemotherapy after disease progression were independent prognostic factors of OS in the ER-negative group. Clinical T stage and initial metastatic sites were independent prognostic factors of OS regardless of ER status. Conclusion: For dnMBC, ER-negative patients are clinically different from ER-positive patients, with shorter OS. The identified prognostic factors could guide treatment selection in these two subpopulations.

e20505 Background: Lung ground-glass opacity (GGO), a hazy increased opacity on computed tomography with preservation of bronchial and vascular margins, has been shown to be associated with early-stage lung cancer. With the increasing prevalence of ground-glass opacity-type lung cancer (GGO-LC), more researches have focused on the diagnosis and treatment of this early stage lung cancer; however, the clinical characteristics and survival outcomes of this disease has not yet been fully elucidated. Aim: To analyze and review the clinicopathological characteristics for GGO-LC and to identify the optimal treatment strategies in this select population. A systematic review and meta-analysis of the literature were carried out. The study was registered (CRD42021228774). Methods: We did a systematic review and meta-analysis of observational studies published from database inception to June 30, 2020, which reported on clinicopathological characteristics, management and survival outcomes in patients with GGO-LC. Studies were identified by searches in PubMed, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and by hand searching of previous publications. We extracted the general information to perform the meta-analysis, mainly focusing on age, gender, and smoking status. We also extracted treatment and prognosis information to assess the effect of treatment strategies on overall survival (OS). Robustness of pooled estimates from random-effects models was considered with sensitivity analyses, meta-regression, and subgroup analyses. All statistical analyses were performed with Stata 16.0. Results: Data on 9444 patients in 27 observational studies were included. GGO-type lung cancer was typically characterized as non-invasively or minimally invasively low-grade adenocarcinomas. Therapeutic intervention for these early stage lung cancers was an important opportunity for decreasing overall mortality of lung cancer. The final pooled analysis showed that the average age at diagnosis, female proportion and non-smoking proportion of patients with GGO-LC was 57.7 (95% CI, 53.9-61.5, P < 0.001, I2 = 92.9%), 0.591 (95% CI, 0.563-0.619, P < 0.001, I2 = 86.7%), and 0.631 (95% CI, 0.556-0.706, P < 0.001, I2 = 98.3%), respectively. The pooled overall survival rate was 96.2% (95% CI, 0.954 to 0.970, P < 0.001, I2 = 78.9%). The results showed that the majority of GGO-LC patients had good survival outcomes, presenting a significant proportion of young, female and non-or light smokers. Conclusions: From our analysis, it demonstrates that the patients with GGO-LC may be relatively young females and non-or light smoking history, and had better prognosis. However, there are some limitations in the present study, and more evidence is necessary to wait for more results from RCT to draw a valid conclusion.

Background Many traditional methods are available to prevent unbalance of extension and flexion gap during total knee arthroplasty (TKA), but there are no reports on the use of measurement and positioning method before tibial osteotomy with self-made tools.We designed a self-made tool measuring the location before tibial osteotomy and determined the clinical effect. Methods The retrospective study included patients who received TKA at our hospital, between January 1, 2012 and December 31, 2015. A new method, named as the measurement and localization before osteotomy with self-made tools (MOST), was developed to measure the osteotomy position of the posterior femoral condyle during TKA. They were divided into two groups, one that received the new method (GroupⅠ), and the other that received the traditional method as a control (GroupⅡ). HSS score, Oxford score, VAS score and knee joint activity were evaluated in two groups. Results One hundred and eighty-seven of 210 eligible patients were included. The function of knee joint in all patients was improved and the pain was obviously relieved. Significant differences were found in the HSS score, Oxford score, VAS score, knee joint activity between two groups at 5-year follow-up (p < 0.05). Conclusions The use of MOST may contribute to improve the balance between flexion and extension gaps as well as the balance between internal and external gaps during TKA, and overcome knee flexion instability.