Predicting the prognosis of XXXX after first recurrence.

@entity1 @entity135 @entity957
OBJECTIVES: to describe the clinicopathologic features of @entity957 in @entity1 who develop locoregional recurrence of disease, to identify factors that predict prognosis in the subset of @entity1 treated with salvage surgery, and to determine the adjusted effect of time to recurrence. DESIGN: cohort study. SETTING: a @entity135 institute in Sydney, New South Wales, Australia. @entity1 : a total of 77 @entity1 who underwent salvage surgery for @entity957 that had been treated initially by surgery, radiotherapy, or surgery with postoperative radiotherapy. MAIN OUTCOME MEASURES: univariable and multivariable analysis of clinical and pathologic risk factors. RESULTS: median time to recurrence from initial treatment was 7.5 months (range, 0.9-143.9 mo), with 86% of recurrences occurring within the first 24 months. Surgical salvage was attempted in 77 @entity1 who had experienced recurrence at the primary site (n = 39), @entity135 (n = 27), and contralateral neck (n = 11). Time to recurrence, initial treatment modality, and site of failure were independent prognostic variables. CONCLUSIONS: the relationship of these prognostic variables displays a dynamic interaction. Initial combined-modality treatment and shorter time to recurrence were associated with worse outcome, while the effect of site of recurrence (local vs regional) was dependent on an interaction with the time to recurrence. The result of this interaction was that local recurrence was worse for those who experienced it early (eg, <6 mo after the initial treatment) and nodal recurrence was worse for those who experienced it late (eg, >=  6 mo after the intial treatment).
