Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary XXXX .

@entity1 @entity242 @entity5 @entity1822 @entity1821
OBJECTIVE: To determine the prognostic significance of histologic type/subtype in a large series of @entity1 with primary resected @entity242 . BACKGROUND: The histologic diversity and rarity of @entity242 has hampered the ability to predict @entity1 outcome. METHODS: From a single-institution, prospective database, 675 @entity1 treated surgically for primary, nonmetastatic @entity242 during 1982 to 2010 were identified and histologic type/subtype was reviewed. Clinicopathologic variables were analyzed for association with disease-specific death (DSD), local recurrence (LR), and distant recurrence (DR). RESULTS: Median follow-up for survivors was 7.5 years. The predominant histologies were well-differentiated @entity1821 , @entity1821 , and @entity1822 . Five-year cumulative incidence of DSD was 31%, and factors independently associated with DSD were R2 resection, resection of 3 or more contiguous organs, and histologic type. Five-year cumulative incidence for LR was 39% and for DR was 24%. R1 resection, age, @entity5 size, and histologic type were independently associated with LR; size, resection of 3 or more organs, and histologic type were independently associated with DR. @entity1821 and @entity1822 were associated with late recurrence and DSD (as long as 15 years from diagnosis). For solitary @entity5 , LR was uncommon (<10%), but early distant recurrence was common (36% at 5 years). Nomograms were developed to predict DSD, LR, and DR. CONCLUSIONS: Histologic type/subtype is the most important independent predictor of DSD, LR, and DR in primary @entity242 . Histology predicts the pattern and incidence of LR and DR and will aid in more accurate @entity1 counseling and selection of @entity1 for adjuvant therapy trials.
