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  1. Article ; Online: Effect of time to breast cancer surgery after neoadjuvant chemotherapy on survival outcomes.

    Al-Masri, Mahmoud / Aljalabneh, Basim / Al-Najjar, Hani / Al-Shamaileh, Tamador

    Breast cancer research and treatment

    2021  Volume 186, Issue 1, Page(s) 7–13

    Abstract: Background: Neoadjuvant chemotherapy (NACT) is a cornerstone in managing breast cancer. There is no defined consensus on the optimal time between NACT and surgery. We analyze the effect of time between the end of NACT and surgery on overall survival (OS) ...

    Abstract Background: Neoadjuvant chemotherapy (NACT) is a cornerstone in managing breast cancer. There is no defined consensus on the optimal time between NACT and surgery. We analyze the effect of time between the end of NACT and surgery on overall survival (OS) and disease-free survival (DFS) in breast cancer patients who received NACT followed by surgery.
    Methods: This is a retrospective analysis of 468 patients with breast cancer (stage I-III) who received and completed the same regimen of NACT (Anthracyclines and Taxanes B27 protocol) at King Hussein Cancer Center (KHCC) (2006-2014). Patients have been divided into three groups according to the duration between the end of NACT and surgery, <4 weeks, 4-8 weeks and >8 weeks.
    Results: Most patients were stages II-III breast cancer with only four patients with stage I. Almost all patients (99%) had either invasive ductal or invasive lobular carcinomas. Adjuvant radiotherapy was given to 96% of patients. Most patients were alive at the time of analysis (84%). Complete pathological response was achieved in 20% of patients. Local recurrence rate was 6.6% with a median follow up of 3.8 years (interquartile range 0.6-10.9). Analysis showed that the groups had equivalent DFS. However, OS was adversely affected if patients had their surgery after 8 weeks of NACT compared to those who had their surgery between 4 and 8 weeks.
    Conclusions: Breast cancer surgery post NACT within the first 8 weeks had no impact on survival. However, surgery after 8 weeks of NACT showed negative impact on OS. Therefore, delaying surgery after 8 weeks is not recommended.
    MeSH term(s) Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Breast Neoplasms/drug therapy ; Breast Neoplasms/surgery ; Chemotherapy, Adjuvant ; Female ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; Retrospective Studies ; Survival Rate
    Language English
    Publishing date 2021-01-21
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-020-06090-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Effectiveness of Cyanoacrylate in Reducing Seroma Formation in Breast Cancer Patients Post-Axillary Dissection: A Randomized Controlled Trial.

    Al-Masri, Mahmoud / Alawneh, Fade / Daoud, Faiez / Ebous, Ali / Hamdan, Basem / Al-Najjar, Hani / Al-Masri, Rama / Abu Farah, Marwan

    Frontiers in oncology

    2021  Volume 10, Page(s) 580861

    Abstract: Background/purpose: Seroma is a common complication after axillary dissection in women with node-positive breast cancer. We aim to determine the effect of Cyanoacrylate on reducing seroma formation in patients undergoing axillary dissection. This a ... ...

    Abstract Background/purpose: Seroma is a common complication after axillary dissection in women with node-positive breast cancer. We aim to determine the effect of Cyanoacrylate on reducing seroma formation in patients undergoing axillary dissection. This a randomized clinical trial.
    Methods: This is a single-center, randomized, single-blinded, and two-arm parallel study. Women with node-positive breast cancer eligible for axillary dissection were enrolled. Patients with a Body Mass Index (BMI) greater than 35 kg/m
    Results: 111 patients were randomized (Cyanoacrylate 57; control 54). 105 patients were analyzed. Sixty-nine patients underwent breast conserving surgery, and 36 underwent modified radical mastectomy. There was no difference in the total seroma volume between the Cyanoacrylate vs. control arms (1,304 (60-4,950) vs. 1,446 (100-5,223) ml,
    Conclusion: Cyanoacrylate did not reduce seroma formation and its use was not cost effective.
    Clinical trial registration: clinicaltrials.gov, identifier NCT02141373.
    Language English
    Publishing date 2021-01-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2020.580861
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Early surgical and oncological outcomes during adoption of a single port VATS lung resection in a tertiary cancer center: a retrospective analysis.

    Abdel Jalil, Riad / Abou Chaar, Mohamad K / Al-Qudah, Obada / Al-Edwan, Ahed / Almajali, Omar / Ababneh, Hazim / U'wais, Ahmad / Al-Ghazawi, Munir / Al-Najjar, Hani / Abu-Shanab, Ahmad

    Journal of cardiothoracic surgery

    2022  Volume 17, Issue 1, Page(s) 26

    Abstract: Background: Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic ... ...

    Abstract Background: Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country.
    Method: Medical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized.
    Results: spVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05).
    Conclusion: All the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes.
    MeSH term(s) Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Humans ; Lung/pathology ; Lung Neoplasms/pathology ; Pneumonectomy/methods ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods
    Language English
    Publishing date 2022-03-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2227224-0
    ISSN 1749-8090 ; 1749-8090
    ISSN (online) 1749-8090
    ISSN 1749-8090
    DOI 10.1186/s13019-022-01777-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: "Whoops" fixation of proximal humerus pathological fracture ended with forequarter amputation - Case report.

    Abdel Al, Samer / Abou Chaar, Mohamad K / Zmaily, Mais / Asha, Wafa / Haddad, Hussam / Al-Najjar, Hani

    International journal of surgery case reports

    2020  Volume 75, Page(s) 53–60

    Abstract: Introduction: Even with the advancement of limb salvage surgery techniques, forequarter amputation (FQA) is still used in orthopedic oncology. Even though it might pose catastrophic sequelae on the patient's lifestyle, debilitating one's ability to ... ...

    Abstract Introduction: Even with the advancement of limb salvage surgery techniques, forequarter amputation (FQA) is still used in orthopedic oncology. Even though it might pose catastrophic sequelae on the patient's lifestyle, debilitating one's ability to perform regular tasks, FQA is still considered as a treatment of last resort for huge fungating tumors of the upper extremity.
    Case presentation: We present a case of an 18-year-old male patient, who was diagnosed in Libya with left proximal humerus fracture after a trivial trauma and underwent open reduction and internal fixation using k-wires as it was thought to be a simple fracture. Soon after, pain and swelling progressed severely and an open biopsy confirmed a diagnosis of osteosarcoma and imaging suggested metastatic disease to the lungs for which he was started on chemoradiotherapy. He was referred to our cancer center to continue his management and due to the aggressive nature of the tumor, the patient underwent palliative forequarter amputation followed by multiple lines of chemotherapy and radiotherapy, all of which failed to halt the progression of the disease. The patient was lost to follow up due to his decision to go back to Libya.
    Conclusion: "Whoops" surgeries are fixated upon repairing fractures without looking for the alarming signs on radiographs to exclude pathological entity. As in our case, the procedure done escalated the osteosarcoma into such a massive fungating tumor due to the violation of the osteosarcoma pseudo capsule, in which the only available option is to do a palliative forequarter amputation.
    Language English
    Publishing date 2020-09-03
    Publishing country Netherlands
    Document type Case Reports
    ISSN 2210-2612
    ISSN 2210-2612
    DOI 10.1016/j.ijscr.2020.08.052
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Fungating malignant peripheral nerve sheath tumor arising from a slow-growing mass in the forearm: a case report and review of the literature.

    Abdel Al, Samer / Abou Chaar, Mohamad K / Asha, Wafa / Al-Najjar, Hani / Al-Hussaini, Maysa

    Journal of medical case reports

    2020  Volume 14, Issue 1, Page(s) 91

    Abstract: Background: Malignant peripheral nerve sheath tumor is a rare and aggressive form of sarcoma that arises from a peripheral nerve, mostly in association with neurofibromatosis type 1. Half of the cases were reported in the extremities, with the lungs ... ...

    Abstract Background: Malignant peripheral nerve sheath tumor is a rare and aggressive form of sarcoma that arises from a peripheral nerve, mostly in association with neurofibromatosis type 1. Half of the cases were reported in the extremities, with the lungs being the most common site of metastasis. We report a rare case of successful limb salvage surgery performed for a large exophytic malignant peripheral nerve sheath tumor of the right forearm with wide surgical margins followed by split-thickness skin graft and later a flexor carpi radialis tendon transfer to extensor digitorum communis tendon.
    Case presentation: A 51-year-old Bedouin Arabic man presented to our institution with an incompletely excised, large, fungating, malignant peripheral nerve sheath tumor occupying most of his right forearm. Staging imaging showed multiple lung nodules. He underwent wide local excision followed by skin graft and tendon transfer as a palliative measure to preserve the function of his dominant limb. The operation was performed without any complications, and the patient had an excellent postoperative result. Afterward, he was started on multiple lines of chemotherapy that failed because of disease progression, and the patient died 7 months after the operation.
    Conclusion: Clinicians must consider the possibility of soft tissue sarcoma even in a patient with a small, slow-growing, superficial mass. Furthermore, a wrong open biopsy or nononcological surgical procedure may lead to possible contamination and ultimately a more radical procedure than would have originally been necessary, where this can be prevented by an early referral to a highly specialized sarcoma center.
    MeSH term(s) Fatal Outcome ; Forearm/diagnostic imaging ; Forearm/surgery ; Humans ; Limb Salvage/adverse effects ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/secondary ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nerve Sheath Neoplasms/diagnostic imaging ; Nerve Sheath Neoplasms/pathology ; Nerve Sheath Neoplasms/surgery ; Sarcoma/diagnostic imaging ; Sarcoma/secondary ; Sarcoma/surgery ; Tomography, X-Ray Computed
    Language English
    Publishing date 2020-07-07
    Publishing country England
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2269805-X
    ISSN 1752-1947 ; 1752-1947
    ISSN (online) 1752-1947
    ISSN 1752-1947
    DOI 10.1186/s13256-020-02427-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Surgical Reconstruction Methods following Radical Excision of Distal Ulna Osteosarcoma in Both Skeletally Mature and Immature Patients.

    Abdel Al, Samer / Shehadeh, Ahmad M / Abou Chaar, Mohamad K / Asha, Wafa / Alsaadi, Nijmeh / Al-Najjar, Hani / Haddad, Hussam

    Case reports in oncology

    2020  Volume 13, Issue 2, Page(s) 558–568

    Abstract: The distal ulna has always been considered to be expendable and its removal has been advocated for a variety of post-traumatic degenerative and oncological conditions but recent studies showed that the distal radioulnar joint allows supination and ... ...

    Abstract The distal ulna has always been considered to be expendable and its removal has been advocated for a variety of post-traumatic degenerative and oncological conditions but recent studies showed that the distal radioulnar joint allows supination and protonation of the forearm and is important to one's grip strength and lifting ability. Several prosthesis models have already been made to replace the mechanical functionality of the distal radioulnar joint. We present two cases of females aged 22 and 12 years, respectively, who presented with wrist pain and swelling without any history of trauma and with terminal degree limitation in wrist movements due to tenderness and swelling. Both of them did not have any distant metastasis upon radiographic staging. The skeletally mature patient underwent radical excision of the distal ulnar osteosarcoma and received a distal radioulnar joint replacement prosthesis (Scheker prosthesis). The other skeletally immature patient underwent radical excision of the involved distal ulnar osteosarcoma with stabilization of the residual ulnar stump using the extensor carpi ulnaris sling in a modified version of the Goldner and Hayes technique. Both of our patients were treated according to the protocols of our multidisciplinary clinic sarcoma team by starting with neoadjuvant chemotherapy, followed by surgery and adjuvant chemotherapy. Both registered an almost complete restoration of the normal wrist and hand function and were in complete remission for 26 and 24 months, respectively. Based on our literature review, these are some of the extremely rare cases in which the osteosarcoma affected an unusual site (the distal ulna where they underwent a rare type of reconstruction status following radical excision of a malignant tumor).
    Language English
    Publishing date 2020-05-19
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2458961-5
    ISSN 1662-6575
    ISSN 1662-6575
    DOI 10.1159/000507284
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  7. Article ; Online: Laparoscopic Versus Open D2 Gastrectomy for Gastric Cancer: A Case-Matched Comparative Study.

    Ammori, Basil J / Asmer, Huthaifa / Al-Najjar, Hani / Al-Bakri, Hebah / Dabous, Ali / Daoud, Faiez / Almasri, Mahmoud

    Journal of laparoendoscopic & advanced surgical techniques. Part A

    2020  Volume 30, Issue 7, Page(s) 777–782

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Adult ; Aged ; Female ; Gastrectomy/methods ; Humans ; Laparoscopy ; Lymph Node Excision ; Male ; Matched-Pair Analysis ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/surgery ; Treatment Outcome
    Language English
    Publishing date 2020-03-30
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1381909-4
    ISSN 1557-9034 ; 1092-6429
    ISSN (online) 1557-9034
    ISSN 1092-6429
    DOI 10.1089/lap.2020.0023
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: A Case-matched Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy.

    Ammori, Basil J / Omari, Balqees / Al Najjar, Hani / Abdullah, Niveen / Dabous, Ali / Daoud, Faiez / Almasri, Mahmoud

    Surgical laparoscopy, endoscopy & percutaneous techniques

    2020  Volume 30, Issue 3, Page(s) 276–280

    Abstract: Background: The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may offer benefits over open surgery [open pancreaticoduodenectomy (OPD)]. The aim of this study was to compare the outcomes of these 2 approaches at a ... ...

    Abstract Background: The laparoscopic approach to pancreaticoduodenectomy (LPD) is technically demanding, but may offer benefits over open surgery [open pancreaticoduodenectomy (OPD)]. The aim of this study was to compare the outcomes of these 2 approaches at a tertiary cancer center from the Middle East.
    Materials and methods: Fifty consecutive patients who underwent LPD (n=12) and OPD (n=38) between 2015 and 2018 were considered. One surgeon performed LPD for "all comers," while 3 other surgeons performed open surgery. Patients were randomly matched on a 1:2 basis for pathology (benign vs. malignant), malignancy size (±1 cm), and whether the pancreatic duct was dilated (>3 mm).
    Results: Six patients were excluded, leaving 44 patients, of whom 33 were matched (LPD n=11, OPD n=22). The groups were comparable for age (57 vs. 63 y, P=0.123) and sex distribution (female; 55% vs. 45%, P=0.721), tumor size (3 cm in each group), frequency of pancreatic duct dilatation (45% in each group), and malignant pathology (82% in each group). There were no conversions to open surgery. Although the operating time for LPD was significantly longer (680 vs. 313 min, P<0.0001), LPD was associated with significantly shorter primary (4.7 vs. 7.8 d, P<0.0001) and total hospital stay that included readmissions (4.7 vs. 8.9 d, P<0.0001). There were no significant differences in blood loss (200 vs. 325 mL, P=0.082), overall complication rate (36.4% vs. 59.1%, P=0.282), or clinically significant complications (9.1% vs. 22.2%, P=0.643) and readmissions (0 vs. 4 patients). In patients with malignant disease, there were no differences with regard to the number of lymph nodes retrieved (18 vs. 12, P=0.095) and frequency of R0 resections (77.8% in each group).
    Conclusion: In experienced hands, the laparoscopic approach to pancreaticoduodenectomy seems to offer advantages over open surgery in terms of reduction in hospital stay while maintaining an equivalent oncologic resection.
    MeSH term(s) Adult ; Aged ; Female ; Humans ; Jordan ; Laparoscopy/adverse effects ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Postoperative Complications/epidemiology ; Retrospective Studies ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2020-03-30
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1475108-2
    ISSN 1534-4908 ; 1530-4515 ; 1051-7200
    ISSN (online) 1534-4908
    ISSN 1530-4515 ; 1051-7200
    DOI 10.1097/SLE.0000000000000777
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  9. Article ; Online: Laparoscopic vs open insertion of feeding gastrostomy tube in adults with head and neck cancers: A case-matched comparative study.

    Omari, Balqees / Asmer, Huthaifa / Al-Najjar, Hani / Mohamad, Issa / Al-Saraireh, Omar / Ammori, Basil J

    International journal of clinical practice

    2020  Volume 75, Issue 4, Page(s) e13910

    Abstract: Background: Patients with head and neck cancers may require feeding tube gastrostomy (FTG) during their treatment. Surgical gastrostomy is indicated in patients who fail or unsuitable for endoscopic or radiologic FTG insertion.: Objective: The aim of ...

    Abstract Background: Patients with head and neck cancers may require feeding tube gastrostomy (FTG) during their treatment. Surgical gastrostomy is indicated in patients who fail or unsuitable for endoscopic or radiologic FTG insertion.
    Objective: The aim of this study was to compare the outcomes of a novel laparoscopic technique to the insertion of feeding tube gastrostomy (FTG) in patients with head and neck cancer vs conventional open surgery.
    Methods: Patients were randomly matched on a 1:1 basis according to whether the procedure was therapeutic or prophylactic and whether a concomitant less major surgical procedure was required.
    Results: The groups (17 patients in each group) were comparable for age, sex distribution, ASA score, body mass index, serum albumin levels and the frequencies of previous upper abdominal surgery, hypoalbuminaemia and prior chemoradiotherapy and/or cancer surgery. There were no conversions to open surgery. No significant differences were detected between the groups with regard to the operating time (median, 40 vs 60 minutes, P = .053) and 30-day clinically significant morbidity (17.6% vs 23.5%, P = .180) or mortality (11.8% in each group). However, laparoscopy was associated with significantly shorter hospital stay (0 vs 2.8 days, P < .001) and greater proportion of day-case procedures (64.7% vs 0%, P < .001).
    Conclusions: Laparoscopic insertion of FTG is safe, can be performed as a day-case procedure, and is associated with shorter hospital stay compared with open surgery; it should be preferred over open surgery where local expertise exists.
    MeSH term(s) Adult ; Gastrostomy ; Head and Neck Neoplasms/surgery ; Humans ; Laparoscopy ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2020-12-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 1386246-7
    ISSN 1742-1241 ; 1368-5031
    ISSN (online) 1742-1241
    ISSN 1368-5031
    DOI 10.1111/ijcp.13910
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  10. Article: BRAF V600E mutation in papillary thyroid carcinoma: it's relation to clinical features and oncologic outcomes in a single cancer centre experience.

    Al-Masri, Mahmoud / Al-Shobaki, Tawfiq / Al-Najjar, Hani / Iskanderian, Rafal / Younis, Enas / Abdallah, Niveen / Tbakhi, Abdelghani / Haddad, Hussam / Al-Masri, Mohammad / Obeid, Zeinab / Jarrar, Awad

    Endocrine connections

    2021  Volume 10, Issue 12, Page(s) 1531–1537

    Abstract: Purpose: This study focuses on the oncologic influence of BRAF V600E mutations in a cohort of Middle Eastern papillary thyroid carcinoma (PTC) patients treated at a single centre. We tested the association of BRAF V600E mutation with papillary thyroid ... ...

    Abstract Purpose: This study focuses on the oncologic influence of BRAF V600E mutations in a cohort of Middle Eastern papillary thyroid carcinoma (PTC) patients treated at a single centre. We tested the association of BRAF V600E mutation with papillary thyroid carcinoma at King Hussein Cancer Center.
    Methods: Patients with histologically confirmed PTC who underwent surgical treatment between 2006 and 2015 were included in this study. Oncological outcomes, both short- and long-termed, were collected.
    Results: A total of 128 patients (68% females) were included in this study with a mean age of 38 years (±13.8). The median follow-up period was 50 months. The BRAF V600E mutation was found in 71% of patients. The tumour size for patients with a negative BRAF V600E mutation was significantly larger in comparison to patients who tested positive for the mutation (3.47 cm vs 2.31 cm, respectively, P = 0.009). The two groups showed similar disease-free survival (DFS) rates; positive = 75% (median 43 months (0-168)) compared to 78% for the negative BRAF V600E mutation (median 38 months (3-142)) (P = 0.162, HR = 0.731) Furthermore, both groups showed similar overall survival rates, positive = 94.5% (median 56 months (0-228)) compared to 94.6% for the negative BRAF V600E mutation (median 43 months (3-157)) (P = 0.941, HR = 0.940).
    Conclusion: BRAF V600E mutation had no effect on loco-regional recurrence, distant metastasis, overall survival, or DFS. These findings may be attributed to geographic variations or reflect that BRAF V600E may only serve as an indicator of poor prognosis in high-risk group as such.
    Language English
    Publishing date 2021-11-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2668428-7
    ISSN 2049-3614
    ISSN 2049-3614
    DOI 10.1530/EC-21-0410
    Database MEDical Literature Analysis and Retrieval System OnLINE

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