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PubMed2005

[Clinicopathological features and prognosis of postirradiation osteosarcoma in nasopharyngeal carcinoma].

OBJECTIVE: Post irradiation osteosarcoma (PIOS) in patients with nasopharyngeal carcinoma (NPC) is rare and a potential late complication of radiation. We investigate its clinicopathological features and prognosis. METHODS: 426 cases of bone sarcomas in Cancer Center of Sun Yat-sen University, China between 1964 and 2003 were reviewed retrospectively. Fifteen patients were determined to have PIOS after radiation of NPC. Its prevalence rate, onset time, site, image features, and treatment were described. Kaplan-Meier analysis was used to determine the relative prognostic factors. RESULTS: In 12 patients undertaken radical surgery, one patient had residual tumor and six patients presented tumor recurrence five to 19 months (mean of nine months) after surgery. All patients survived seven to 41 months with a mean of 18 months. The one-year and two-year survival rates were 60% and 24% respectively. Female patients with large area of tumor bone formation in images had better survival than male patients without or few tumor bone formation. Age, radiation dosage, onset time of PIOS, tumor size, and treatment were probably not significant factors to prognosis. CONCLUSIONS: PIOS in patients with NPC is a high malignant disease and often has poor prognosis. Surgery with pre-and post-operative chemotherapy might be a way to improve its survival.

Adolescent↗
PubMed2005

[The clinical and pathological characteristics and prognosis of pseudomyxoma peritonei].

OBJECTIVE: To investigate the clinical and pathological characteristics, treatment measures and prognosis of pseudomyxoma peritonei (PMP). METHODS: The clinical records and follow-up data of the patients with PMP were retrospectively analyzed. Survival analysis (Kaplan-Meier method and Cox regression) was used to investigate the prognosis. RESULTS: Thirty-three patients (twenty-two women, eleven men) have a median interval between onset and definite diagnosis of 12 months with an average age of 50. The main clinical presentation includes bloating, abdominal mass and abdominal distention. A delay in diagnosis is common and many patients are labeled as other diseases (84.8%). Positive results were often found in the assistant examinations such as erythrocyte sedimentation rate, gastrointestinal tumor markers (carcinoembryonic antigen, carcinomatous antigen 19-9 and so on), imaging (B ultrasound and computer tomography) and abdominal paracentesis which was usually unsuccessful. The most frequently practiced approach is debulking surgery with the main assistant means of chemotherapy which was lack of the uniform rationale. Benign type of pathological samples accounts for 66.7% of all, while mid-type 21.2% and malignant 12.1%. The general median survival time is 70 months with a follow-up rate of 79%. The pathological type and chemotherapy are main factors which influence the cumulative survival rate (P < 0.05). Up to the end of 2004, sixteen patients died of various complications, multiple organ failure and severe infection, while ten patients survival and seven patients lost. CONCLUSIONS: PMP is a rare condition of borderline malignancy with its unique clinical and pathological characteristics. Gastrointestinal tumor markers, imaging and abdominal paracentesis are very important to the diagnosis. The existing treatment measures need to be improved further. The pathological type and chemotherapy are main factors which influence the prognosis.

Adolescent↗
PubMed2006

[The long-term prognosis of locally recurrent breast cancer after breast conserving treatment].

OBJECTIVE: To study the long-term prognosis of patients with locally recurrent breast cancer following breast-conserving treatment. DESIGN: Descriptive. METHOD: Data were collected on 266 patients in 11 Dutch centres; in these patients, an isolated local recurrence of an infiltrating mammary carcinoma for which they had received breast-conserving treatment was diagnosed before January 1st, 1994. The median age was 45 years (range 16-81) at the time of treatment of the primary tumour and 49 years (range 17-82) at the time of diagnosis of the local recurrence. The patients were followed through December 2002. The median follow-up after local recurrence of those patients who were still alive was 11.2 years. RESULTS: Of the 226 patients with an infiltrating local recurrence, 148 (65%) had died and 145 (64%) had developed distant metastases. Of the metastases, 61% appeared within 2.5 years and 87% within 5 years after treatment of the local recurrence. 10 years after treatment of the local recurrence, the overall survival rate was 39% (95% CI: 32-46) and the distant metastasis-free survival rate was 36% (95% CI: 29-42). The prognosis of patients with a local recurrence occurring at a different site in the breast was the same as that of patients with a local recurrence < or = 1 cm in diameter occurring at or near the original tumour site. Both of these groups had a better prognosis than patients with a recurrence larger than 1 cm at the site of the original tumour or patients with a diffuse recurrence. CONCLUSION: Almost two-thirds of the patients with an invasive local recurrence following breast-conserving surgery for invasive breast cancer developed distant metastases. Both the exact location in the breast and the size of the local recurrence appeared to be predictors of the risk of subsequent metastatic disease.

Adolescent↗
PubMed2005

[Expression and prognosis significance of p73 and PCNA in laryngeal squamous cell carcinoma].

OBJECTIVE: This study was designed to investigate the expression of p73 and Proliferating Cell Nuclear Antigen (PCNA) and their association with clinical, histologic characteristics and prognosis in LSCC. METHOD: p73 protein and PCNA protein were examined by using immunochistochemical SABC staining method in 65 cases of LSCC and in 23 adjacency carcinoma cases. RESULT: p73 protein and PCNA protein in LSCC shows stronger expression than that in adjacency carcinoma, which is statistically significant (P <0.05). p73 protein positive expression shows stronger in stage III approximately IVof LSCC than that in stage I approximately II (P<0.05); it more often appears in recurrent cases than in primary cases (P <0.05). And p73 protein positive expression with distant metastasis was stronger than that in LSCC without distant metastasis (P <0.05). PCNA protein positive expression was stronger in stage III approximately IV of LSCC than that in stage I approximately II (P <0.05); it more often appears in recurrent cases than in primary cases (P <0.05). PCNA protein positive expression more frequently appears in poor differentiation of LSCC, compared to well/mediate differentiation (P <0.05); PCNA positive expression in cases with cervical lymph node metastasis and distant metastasis was stronger than that without metastasis (P <0.05). PCNA expression had a significantly stronger in patients whose survival time over 5 years than that in patients whose survival time less than 5 years (P <0.05). Analysing with multivariate Cox, the expression of PCNA is an important marker of poor prognosis (RR= 2.43, P <0.05). CONCLUSION: p73 protein positive expression may play a part in LSCC progression and function as an oncogene in the development of LSCC. PCNA positive expression was closely linked with the risk of LSCC; it can be an important predictor on evaluating the prognosis of LSCC. There was positive correlation existing between p73 protein and PCNA protein expression in LSCC.

Adult↗
PubMed2006

[Association of HER-2/neu expression with prognosis of gastric cancer].

OBJECTIVE: To investigate the association between the expression of human epidermal growth factor receptor (HER)-2/neu gene and prognosis of gastric cancer. METHODS: The expression of HER-2/neu in gastric cancer was detected by immunohistochemical technique and analyzed in relation with the follow-up and clinicopathologic data of the patients. RESULTS: Thirty-two of the 103 gastric cancer specimens (31.1%) were positive for HER-2/neu, but whose expression was not found in benign gastric lesion and normal gastric mucosa. HER-2/neu expression was not correlated with the patients' sex, age, tumor size and location or the degree of differentiation (P>0.05), but with the depth of invasion, clinical stage, lymph node and distant metastasis of the tumor and survival of the patients (P<0.05). CONCLUSION: HER-2/neu expression is closely related to invasion, metastasis and prognosis of gastric cancer and can be used to evaluate the biological behavior and prognosis of gastric cancer.

Adenocarcinoma↗
PubMed2006

[Current concepts in the genetics of hereditary and sporadic colorectal cancer and the role of genetics in clinical practice: sporadic and IBD-associated colorectal tumors, significance of genetic tests in diagnosis, prognosis and assessment of chemotherapy outcome].

There has been a major improvement in our understanding in the area of the genetics of CRC in the last decade. Reason for this is partly that CRC has a strong hereditary trait and premalignant lesions are frequent and easily accessible. In the 1990-ies the mutations responsible for the adenoma-carcinoma sequence were discovered on after the other. In the second part of the review the authors discuss the genetic background of sporadic and IBD associated colorectal cancers as well as the role of genetics in the diagnosis, prognosis and prediction of therapy. Chromosomal instability (85%) and microsatellite instability with or without change in DNA methylation (15%) are the main mechanisms involved in the pathogenesis of sporadic colorectal cancers. It became evident that no ultimate mutations exist. Most of neoplasms are genetically heterogeneous, independent pathways and simultaneous tumorigenesis may exist within the same organ, also in the colon. Gene expression profile, clinical phenotype and prognosis may also vary according to the location. Similar genetic mutations may be found in IBD associated colorectal cancers, however, the typical sequence and importance of mutations is different. In future, fecal DNA testing may be an important screening tool for colorectal cancer; however, its routine use is still limited by its low sensitivity. Similarly, genetic investigation may play an increasing role in the prediction of prognosis, therapy and complication of chemotherapy. A more distant goal may be the individualization of the therapy.

Adenomatous Polyposis Coli↗
PubMed1991

[Long-term prognosis of adenoid cystic carcinoma of the trachea].

A study was made on the prognosis of 26 tracheal adenoid cystic carcinoma surgery cases reported in Japan between January 1978 and January 1984. The study was based on a questionnaire sent to doctors who reported prognosis as of May 1991. Twelve cases out of the 26 cases underwent postoperative irradiation. Seven out of the 12 cases survived 9 to 13 years after surgery without any recurrence. Two out of the 12 cases survived 8 and 10 years after surgery with multiple pulmonary metastases. Three out of the 12 cases died of a local recurrence 3, 3 and 9 years after surgery. Four cases received irradiation after a local recurrence was revealed postoperatively. Three out of the 4 cases survived 9, 10 and 11 years after surgery, but 1 out of the cases died 6 years after surgery. Four cases received no irradiation not only after surgery but also after detection of a local recurrence. All of them died within 9 years after surgery. There were six cases who underwent no postoperative irradiation and showed no local recurrence. One out of the 6 cases died of pancreas cancer 7 years after surgery, but the other cases survived 8 to 11 years after surgery without any recurrence. A study was also made on the prognosis of 9 cases with adenoid cystic carcinoma of the trachea who underwent surgery at Keio University and Tokai University until April 1982 (4 cases overlap with the above-mentioned cases). Six out of 9 cases received postoperative irradiation. Four cases survived 9 to 12 years after surgery without any recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

[Long-term prognosis of the patients of myotonic dystrophy with tube feeding].

We studied the long-term prognosis of the patients of myotonic dystrophy with tube feeding. Subjects were 51 patients (31 male patients and 20 female patients) of typical myotonic dystrophy who were at least once admitted in our hospital. We examined the age of the introduction of tube feeding, the cause of the introduction, respiratory and motor ability at the introduction, the duration of tube feeding, the cause of death and the extension of CTG repeats in the patients. Comparing with the patients with tube feeding and the patients without it, we also examined the prognosis after the introduction of tube feeding. Tube feeding was introduced in 13 cases. The mean age of tube feeding was 57.9 +/- 8.3 years old. The mean age of death of non tube feeding group was 55.9 +/- 5.5 years old. These show tube feeding was introduced in more elderly patients. Statstically the tube feeding was effective, but poor prognosis even after the introduction of tube feeding was suggested because the mean survival time after the introduction was about 850 days. We could not find any correlation between the age of the introduction of tube feeding and the extension of CAG report.

Aged↗
PubMed2006

[Clinical value of the sixth edition TNM stages analysing prognosis of colorectal cancer].

OBJECTIVES: To study the clinical value analyzing of colorectal cancer prognosis by the Sixth Edition TNM Stages. METHODS: 5481 cases with colorectal cancer and treated by operational methods, were collected. All the cases were separately staged by the Fifth Edition or Sixth Edition TNM Stages standards. The 5-year survival rates were analyzed by the life table method. RESULTS: The 5-year survival rates of the Fifth Edition TNM Stages of I, II, III and IV were 80.1%, 68.0%, 40.5% and 9.8% respectively. The 5-year survival rates of the Sixth Edition TNM Stages of II(A) and II(B) were 71.6% and 66.4% respectively, and of the stages III(A), III(B) and III(C) were 46.2%, 40.1% and 28.3% respectively. There were statistical differences among the sub-stages II and III, P < 0.05. CONCLUSION: The Sixth edition TNM Stages laid more stress on effect of the local infiltration depths and lymphatic metastasis in the prognosis of colorectal cancer, therefore, the stages were more fine, to analyze prognosis of the colorectal cancer were more precise. It is high clinical value for the individual complex treatment with every sub-stages.

Adenocarcinoma↗
PubMed2006

[Nuclear expression of Survivin in glioma and its correlation to prognosis].

BACKGROUND & OBJECTIVE: Survivin, an inhibitor of apoptosis protein, is correlated to aggressive behavior, resistance to chemotherapy and radiotherapy, and prognosis of human cancers. It is expressed in both nuclei and cytoplasm. Recent research revealed that the nuclear expression of survivin is an important prognostic factor of human cancers. This study was to investigate the nuclear expression of Survivin in human glioma, and its correlations to clinicopathologic characteristics and prognosis. METHODS: The nuclear expression of Survivin in 88 specimens of glioma (33 at grade I-II, and 55 at grade III-IV) was detected by tissue microarray and immunohistochemistry. Its correlations to clinicopathologic characteristics and prognosis were analyzed. RESULTS: The positive rate of nuclear Survivin was 27.3% in the whole group. It was significantly lower in grade I-II gliomas than in grade III-IV gliomas (12.1% vs. 36.4%, P=0.013). Nuclear expression of Survivin had no correlation to patient's age (P=0.053), sex (P=0.376), Karnofsky performance status (P=0.486), and clinical stage (P=0.359). The 5-year overall survival rate and 3-year disease-freely survival rate were significantly lower in nuclear Survivin-positive group than in nuclear Survivin-negative group (22.7% vs. 47.7%, P=0.005; 13.7% vs. 39.5%, P=0.015). The median survival was slightly lower in high nuclear Survivin expression group than in low nuclear Survivin expression group (14.9 months vs. 20.2 months, P=0.089). CONCLUSIONS: The nuclear expression of Survivin is related to the pathologic grade of glioma, and might be a negative prognostic factor of glioma.

Adolescent↗
PubMed2006

Course and prognosis of sarcoidosis in a referral setting in Turkey; analysis of 166 patients.

BACKGROUND: Clinical manifestations and prognosis of sarcoidosis are heterogenous and the prevalence varies depending on the country, area and race evaluated. Also the organs involved and courses of the disease differ greatly between countries, areas, races and individuals. AIMS: To investigate the sociodemographic characteristics, clinical presentation and symptoms and to determine the severity and prognosis of sarcoidosis in Turkey as a referral center. METHODS: Between January and July 2003 we retrospectively evaluated the outcome of the patients with sarcoidosis whose first clinical visits were between 1965 and 2003 in the multidisciplinary referral setting RS at Cerrahpasa Medical Faculty of the University of Istanbul. Data collected about each patient included sociodemographic characteristics, clinical presentation, symptoms, date of diagnosis, date and age of onset, method and stage of disease at the date of diagnosis and at the date of last evaluation; the mortality and survival rate were calculated. One hundred and sixty six consecutive patients whose first clinical visits were between 1965 and 2003 in the multidisciplinary RS at Cerrahpasa Medical Faculty were enrolled. We contacted every patient in our cohort by telephone calls or home visits. All those contacted were called back to outpatient clinic for a formal evaluation between June and September 2003. A formal physical examination and thorax radiography were performed in patients who came to the hospital. Their radiological stage, signs, symptoms and associated extrapulmonary manifestations were recorded. RESULTS: At the initial presentation, the mean age of diagnosis was 40.3 years. The 31-40 age group is the group with the highest number of patients. Coughing was the most frequent symptom and erythema nodosum was the most frequent sign in both sexes. Thirty eight percent of patients had extrathoracic involvement. The most frequent extrapulmonary site of involvement was skin. The mortality rate was 11.6% (10.8% in females and 13% in males). Comorbidity was 3% (5 females, 1 male). Females, youngs and patients without extrathoracic involvement had higher survival rates. CONCLUSION: Clinical characteristics, course and prognosis of sarcoidosis vary in different studies. The results may vary accordingly to ethnic, geographic, social and economic conditions.

Adolescent↗
PubMed2006

[Heart failure with preserved ejection fraction. Effect of etiology on prognosis].

INTRODUCTION AND OBJECTIVES: Heart failure with preserved systolic function accounts for almost 40% of heart failure cases. Prognosis is similar to that in patients with a low left ventricular ejection fraction (LVEF). However, it is not clear whether the etiology of heart failure with preserved systolic function has an effect on prognosis. METHODS: We assessed 95 consecutive patients admitted to our hospital with heart failure and a LVEF>45%. Twenty-five (26%) had an ischemic etiology and 70 (74%), a non-ischemic etiology. RESULT: The patients' mean age was 73 (6) years, 60% were female, and their mean LVEF was 61 (7)%. These characteristics were similar in the two etiological groups. After a mean follow-up period of 53 (8) months (4-69 months; median 46 months), mortality was higher in ischemic patients (17.88 vs 2.37/100 patient-years; P<.0001), as was the rate of cardiovascular admissions (24.58 vs 4.14/100 patient-years; P<.0001). The rates of mortality due to heart failure and sudden death were also higher in ischemic patients, at 7.82 vs 0.59/100 patient-years, and 7.82 vs 0.30/100 patient-years, respectively (P<.0001). The higher overall admission rate found in the ischemic group was due to higher rates of admission for heart failure (14.53 vs 0.89/100 patient-years; P<.0001) and acute coronary syndrome (8.94 vs 1.78/100 patient-years; P=.003). CONCLUSIONS: In terms of prognosis, heart failure with preserved systolic function is not a homogeneous disease entity. Morbidity and mortality rates are higher in patients with an ischemic etiology. Moreover, different mechanisms are involved.

Aged↗
PubMed2006

[Lung cancer--epidemiology, prognosis and therapy].

Lung cancer is one of the most common cancer diagnoses, sadly with a bad prognosis. The main risk factor is smoking. There are two major types of lung cancer: non-small cell lung cancer und small cell lung cancer. The difference is important for prognosis and therapy. The prognosis for patients with small-cell lung cancer is worse; the treatment is based on chemotherapy. In patients with non-small cell lung cancer surgery and radiotherapy are more important.

Bronchial Neoplasms↗
PubMed2006

[Related factors and prognosis of hepatic metastasis and peritoneal dissemination in gastric cancer].

OBJECTIVE: To investigate the related factors and prognosis of peritoneal dissemination and hepatic metastasis in gastric cancer, and the impact of palliative surgery on the prognosis. METHODS: The clinicopathologic and follow-up data of the patients with gastric carcinoma treated in our hospital from Aug. 1994 to Jul. 2005 were analyzed retrospectively. RESULTS: The clinicopathologic factors correlated with peritoneal dissemination included serosal penetration, whole stomach cancer, undifferentiated type, female and hepatic metastasis, while those correlated with hepatic metastasis included Borrmann IV, lymph node metastasis and peritoneal dissemination (P< 0.05). The postoperative one-year survival rate of the patients with hepatic metastasis (H group) were lower than that of the patients with peritoneal dissemination (P group)(P< 0.05). The one- year survival rate of the patients with peritoneal dissemination undergoing palliative resection was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy, and exploratory laparotomy (P< 0.05), while there was no significant difference among the three groups of the patients with hepatic metastasis. CONCLUSIONS: The short-term prognosis of the patients with hepatic metastasis is poorer than that of the patients with peritoneal dissemination. Palliative resection could improve the short-term survival rate of the patients with peritoneal dissemination, while it had no significant impact on the survival rate of the patients with hepatic metastasis.

Female↗
PubMed2006

[First experience with the modified program NHL-BFM-90 application in adult patients with primary diffuse large B-cell gastric lymphosarcoma with unfavourable prognosis].

AIM: To assess efficacy of a modified program NHL-BFM-90 in adult patients with primary diffuse large B-cell gastric lymphosarcoms (PDLBGL) with unfavourable prognosis. MATERIAL AND METHODS: Modified courses of NHL-BFM-90 were conducted in 5 patients aged 27-67 years from January 2004 to September 2005. Four patients received chemotherapy of the first line, in one patient block therapy followed monotherapy with chlorambucil and a CHOEP course. All the patients were in a severe clinical condition and had several initial factors of unfavourable prognosis: size of the tumor more than 10 cm; stage IE and more advanced; B-symptoms; proliferative activity above 70%. The program NHL-BFM-90 was modified because of the patients' age. Chemotherapy was conducted according to the middle arm of the original program NHL-BFM-90, but methotrexate was introduced in a dose 1 g/m2 for 12 hours, while leukovorin was given 18 hours after the start of methotrexate injection. In two cases the blocks were enhanced with rituximab, 2 patients had doxorubicin in block A, in one case block C was enhanced with methotrexate. A total of 23 modified blocks NHL-BFM-90 were performed: one patient was given 6 blocks, two patients--5, one patient--4 blocks and one patient--3 blocks. RESULTS: Four patients after block 2 and one patient after block 3 of polychemotherapy NHL-BFM-90 achieved remission of the disease of 6 to 22 months duration which still continues. Infectious complications related to hematological toxicity arose more frequently at the latest courses of chemotherapy. CONCLUSION: Treatment according to the modified program NHL-BFM-90 in adult patients with PDLBGL and unfavourable prognosis is highly effective. For a mean follow-up of 10.2 months no recurrences occurred. The number of courses can be reduced to decrease accumulated hematological toxicity and in case of rapid achievement of remission.

Adult↗
PubMed2006

[Relationship between programmed cell death 5 protein expression and prognosis of renal clear cell carcinoma].

OBJECTIVE: To study the role of programmed cell death 5 (PDCD5) protein in the oncogenesis and development of renal clear cell carcinoma and its association with the prognosis of the malignancy. METHODS: PDCD5 expression was assayed immunohistochemically in 46 cases of human renal clear cell carcinoma, and the patients' survival was followed up. RESULTS: PDCD5 staining in the adjacent normal tissue of the tumor was significantly stronger than that in the tumor tissue, and PDCD5 expression was significantly correlated with the tumor grade, stage and prognosis. The tumors of high grade with strong invasive ability had much less PDCD5 expression and lighter staining. The three- or five-year survival rates of patients positive for PDCD5 expression was much higher than that of patients negative for PDCD5 expression. CONCLUSION: PDCD5 is a potent inhibitor of malignant transformation of renal clear cell carcinoma and may serve as a major predictor for evaluating the malignant potential and prognosis of the tumor.

Adult↗
PubMed2006

[Fhit expression and its relationship with apoptosis and prognosis in nasal and paranasal sinus carcinomas].

OBJECTIVE: To assess the protein expression of Fhit and its correlation with spontaneous apoptosis, tumor clinicopathological parameters and prognosis in nasal and paranasal sinus carcinomas. METHOD: Forty-eight patients with NPSC treated by radical operations from 1991 to 2000 were studied retrospectively. Patients included 23 female and 25 male ranging in age from 20 to 71 years. Spontaneous apoptotic cells were visualized by TUNEL accompanied by HE and PI stain. Immunohistochemistry using SP method was used to assess the expression of Fhit. RESULT: The loss of expression of Fhit was found in 26 patients (54.17%, 26/48). Comparing with abutting non-neoplastic tissue, reduced expression of Fhit was found in 16 (16/29, 55.17%) patients. The adenoid cystic carcinoma showed stronger expression of Fhit than squamous cell carcinomas (P <0.05). The expression of Fhit correlated positively with apoptosis index (r = 0.379, P < 0.01). Patients with positive expression of Fhit had much better prognosis than those with abnormal expression (P < 0.05). CONCLUSION: The reduced expression of Fhit may be associated with carcinogenesis and prognosis of nasal and paranasal sinus carcinomas. It could be the tumor suppressor gene and realize its function through accelerating apoptosis in this kind of neoplasm. Fhit expression may provide a novel predictive indicator for disease-free survival after surgical resection and postoperative radiochemotherapy in nasal and paranasal sinus carcinomas.

Acid Anhydride Hydrolases↗
PubMed1991

[Prognosis of inoperable non-small cell bronchial cancer].

The article describes a retrospective study of the prognosis for 450 patients with inoperable non-small cell lung cancer discharged during the period 1970 to 1979. 81% of the patients were males. The predominant cell type was squamous cell carcinoma. One out of seven patients was inoperable because of poor cardiorespiratory function, six out of ten because of mediastinal metastases. Median survival was six months and was related both to staging of the tumor and to cell type. The prognosis was worst for patients with adenocarcinoma. Only 8% of the 450 patients were alive after two years. Specific and palliative therapy had a minor effect on median survival. Controlled clinical trials can probably settle whether an extension of the criteria for surgical treatment can improve the prognosis of this large group of patients.

Adult↗