Clinical Staging Of Patients Research Articles

Two patients of left lung cancer with right aortic arch: review of eight patients

We report two cases of left lung cancer in patients with variant right aortic arches. Preoperative heart examination ascertained that neither patient had congenital heart disease. Patient 1 exhibited a right aortic arch with mirror-image branching of the major arteries. The patient's clinical stage was T1aN0M0 stage IA. Patient 2 exhibited a right aortic arch with an aberrant left subclavian artery. The patient received induction chemotherapy for cT2aN2M0 stage IIIA adenocarcinoma of the lung. In patients with a right aortic arch undergoing surgery, especially mediastinal lymph node dissection, it is important to consider the anatomical displacement of the vagus and recurrent laryngeal nerves in addition to the vascular abnormalities. In this study, we found that preoperative identification of anomalous structures using three-dimensional computed tomography was particularly useful in evaluating the anatomical location and position of the left recurrent laryngeal nerve from an embryological point of view.

Conditional survival (CS) in patients with stage II melanoma.

e19054 Background: While sentinel lymph node biopsy is recommended for those presenting with clinical stage II melanoma, it is not always performed. Future survival beyond the time already survived is captured by CS and is relevant to patient counseling and guiding follow up. We sought to investigate patterns of CS in patients with clinical (no nodal biopsy) or pathological stage II melanomas controlling for ulceration. Methods: The study included 5,370 patients diagnosed with primary cutaneous melanoma in 2004-2008 from the Surveillance, Epidemiology, and End Results (SEER) data. Three-year CS probabilities were estimated from the Kaplan-Meier survival curves (time to melanoma-specific death) at 6, 12, and 18 months from diagnosis. Newly developed biostatistical methods were used to evaluate the statistical significance of changes in CS as the time survived increased for four groups of patients: those clinically and pathologically staged with and without ulceration. Results: With increasing time survived up to 18 months, there was no significant change in the 3-year CS estimates for the cohort of pathologically-staged patients with non-ulcerated lesions (n=1702). For pathologically-staged patients with ulcerated lesions (n=1915), 3-year CS increased significantly only after having survived 1 year (86% to 87% p=0.001). A similar pattern was seen for the cohort of clinically-staged patients with non-ulcerated lesions (n=801), (85% to 87% p<0.001). For clinically-staged patients with ulcerated lesions (n=952), the 3-year CS estimates for those who had survived 6, 12, or 18 months were 74%, 78%, and 82%. After the initial 6 months of survival, there was a significant change in 3-year CS having survived 6 versus 12 months (p=0.002), as well as having survived 12 versus 18 months (p<0.001). Among patients with ulcerated lesions, CS for those clinically staged begins to change after 6 months whereas for those pathologically staged change occurs only after a year. Conclusions: CS provides up-to-date prognostic information to patients, their physicians and clinical trialists. Formal statistical methods, as illustrated here, identify when clinically meaningful CS estimates change in statistically significant ways.

18F-FDG Metabolic Tumor Volume and Total Glycolytic Activity of Oral Cavity and Oropharyngeal Squamous Cell Cancer: Adding Value to Clinical Staging

(18)F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant single-institution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV × mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P = 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P = 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (χ(2) value change, 1.16-6.71; P = 0.01) and when TGA was added to AJCC stage in model II (χ(2) value change, 1.16-4.37; P = 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P = 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P = 0.08), though the result was not statistically significant. Gradient-based segmentations of primary tumor MTV and TGA are potential (18)F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.

Trends in the incidence of germ cell testicular tumors (1976-2005)

The aim of the present study is to prospectively investigate the presentation of germ cell testicular tumors (GCCTs) in terms of clinical stage (CS) or histology, as the incidence of this malignancy in increasing. Patients diagnosed with GCTTS between 1976 and 2005 were categorized into 3 period depending on date of diagnosis of GCTTs and presentation characteristics assessed. For purpose of analysis patients were assigned into 1 of 3 similar groups in term of duration (10 years) (1976-1985, 1986-1995, 1996-2005). These 3 periods were compared statistically to identify the possible changes in the presentation of GCTTs. Among 1935 patients, the number diagnosed in each period was 111 (6%), 695 (36%) and 1129 (58%), respectively. There was substantial rise in the percentage of patients with GCTTs during the period of 30 years, particularly in 3rd vs. 2nd and 1st decade (P<0.0001). Overall, 46% of patients were diagnosed with seminoma and 54% with nonseminoma. The greater proportion of the entire cohort of patients presented in CS I (65%). Also, seminoma and nonseminoma occurred more frequently in CS I (78% and 51%, respectively). The median (range) age of the whole cohort of patients was 34 (14-80) years. The median age for developing metastatic seminoma was 4 years more than in CS I disease (38 vs. 42 years, respectively), while the median age for the presentation of CS I and metastatic nonseminoma was identical (31 years). The proportion of seminoma increased significantly in time (40% vs 55%) and this was accompanied by a significant decrease of nonseminoma (60% vs. 45%)(P<0.001). The proportion of patients in CS I disease also increased significantly with time (45% vs. 77%), while the proportion of patients with metastatic disease decreased (55% vs. 23%)(P<0.001). There was a significant rise in proportion of patients with CS I seminoma (27% vs. 47%) (P<0.001) and nonseminoma (18% vs. 30%) (P<0.001), accompanied by a significant decrease in the proportion of patients presenting with metastatic nonseminoma (46% vs. 15%)(P<0.0001). However, the proportion of patients with metastatic seminoma remained largery unchanged (13% vs. 9%). The present study shows a progressive increase of GCTTs during the observation period of 30 years, with increase in the proportion of patients with GCTTs confined to the testis, as opposed to metastatic disease. The other finding is that there has been an increase in the proportion of patients presenting with seminoma rather than nonseminoma. The reason for this remain unclear and require further investigation.

A Case control study to evaluate oxidative stress in plasma samples of oral malignancy

Background:Imbalances between the oxidant –antioxidant status have been implicated in the pathogenesis of several diseases, including cancer.Aim:The aim of this study was to evaluate the extent of lipid peroxidation and antioxidants in the venous blood samples of oral squamous cell carcinoma patients of different Clinicopathologic stages in comparison with the healthy controls.Setting and Design:A Case control study was designed in a hospital (Rajah Muthiah Dental College and Hospital, Annamalai University) based setting.Materials and Methods:Twenty new histopathologically proven oral carcinoma patients, and equal number of age, sex and habit matched healthy subjects were recruited for this study. Their blood samples were subjected to evaluation of Thiobarbituric Acid Reactive Substances (TBARS) and antioxidant enzymes, namely, superoxide dismutase (SOD), Catalase (CAT) reduced glutathione (GSH) and glutathione peroxidase (GPx) using spectrophotometric methods.Statistical Analysis:The data are expressed as mean±SD. The statistical comparisons were performed by independent Student's t-test and One Way ANOVA. P value <0.05 was considered statistically significant. Karl Pearson correlation was performed for the biochemical parameters within the group and between the groups. For statistically significant correlations, linear regression was performed.Results:Significant enhanced lipid peroxidation (P<0.001) with decrease in antioxidants (P<0.001) was observed in the venous blood of oral squamous cell carcinoma patients as compared with the healthy controls. Accordingly, significant (P<0.001) pattern of progression in TBARS levels was observed at various clinical stages of patients. (GSH) showed significant (P<0.01) negative correlation with TBARS and positive correlation (P<0.001) with SOD. On linear regression analysis, GSH showed significance for SOD (P<0.001), GPx, CAT and TBARS (P<0.01). It was also found that, 70% of variance in SOD can be attributed to the influence of GSH alone.Conclusion:Enhanced lipid peroxidation and compromised antioxidant defense in plasma indicate development of oxidative stress. Amongst the antioxidant enzymes, (GSH) appears to have a profound role in carcinogenesis.

Fine needle aspiration cytology of unilesional mycosis fungoides d′emblee

Primary cutaneous T-cell lymphoma is a rare lymphoproliferative disorder accounting for 2% of all lymphomas. Mycosis fungoides (MF) is a rare, albeit commonest form of primary cutaneous T cell lymphoma. MF d’emblee is an uncommon variant which is easily mistaken clinically for epithelial malignancy. Diagnosis at cytology is challenging due to low degree of suspicion, rare occurrence and diverse morphology. We report a case of 51-year-old male presenting with a solitary nodulo-ulcerative lesion over right thigh. Smear showed atypical lymphocytes with hyper-convoluted cerebriform nuclei along with few mature lymphocytes consistent with MF. To our knowledge, this is the first report of unilesional MF d’emblee diagnosed at fine needle aspiration cytology (FNAC). Our case emphasizes that FNAC is an accurate method for early diagnosis and clinical staging of patients with MF.

Outcome prediction of advanced mantle cell lymphoma by international prognostic index versus different mantle cell lymphoma indexes: one institution study

The aim of this study was to evaluate the prognostic significance of international prognostic index (IPI), mantle cell lymphoma IPI (MIPI), simplified MIPI (sMIPI), and MIPI biological (MIPIb), as well as their correlation with immunophenotype, clinical characteristics, and overall survival (OS), in a selected group of 54 patients with advanced-stage mantle cell lymphoma (MCL), treated uniformly with CHOP. Seventeen patients had IV clinical stage (CS), while other 37 had leukemic phase at presentation. Diffuse type of marrow infiltration was verified in 68.5% and nodular in remainder patients. Extranodal localization (25.9%) included bowel (20.4%), pleural effusion, sinus, and palpebral infiltration. All of analyzed patients expressed typical MCL immunophenotypic profile: CD19(+)CD20(+)CD22(+)CD5(+)Cyclin-D1(+)FMC7(+)CD79b(+)smIg(+)CD38(+/-)CD23(-)CD10(-). Median OS of the whole group was 23 months, without significant differences between IV CS and leukemic phase patients. Thirty-two patients (59.3%) responded to initial treatment, 9 (16.7%) with complete and 23 (42.6%) with partial remission. Negative prognostic influence on OS had high IPI (P < 0.01), high sMIPI (P < 0.001), MIPI (P < 0.01), MIPIb (P < 0.01), extranodal localization (P < 0.01), and diffuse marrow infiltration (P < 0.01). Testing between randomly selected groups showed that patients with lower proportion of CD5(+) cells (<80%) correlated with cytological blastoid variant and had shorter survival comparing with the group with higher proportion of CD5(+) cells (>80%) (P < 0.01). Using univariate Cox regression, we proved that IPI, sMIPI, MIPI, and MIPIb had an independent predictive importance (P < 0.01) for OS in uniformly treated advanced MCL patients, although sMIPI prognostic significance was the highest (P < 0.001).

Characterization of an Immunodominant Antigenic Epitope from Trypanosoma cruzi as a Biomarker of Chronic Chagas' Disease Pathology

Nowadays, the techniques available for chronic Chagas' disease diagnosis are very sensitive; however, they do not allow discrimination of the patient's clinical stages of the disease. The present paper describes that three out of the five different repeats contained in the Trypanosoma cruzi TcCA-2 membrane protein (3972-FGQAAAGDKPPP, 6303-FGQAAAGDKPAP, and 3973-FGQAAAGDKPSL) are recognized with high sensitivity (>90%) by sera from chronic Chagas' disease patients and that they are not recognized by sera from patients in the acute phase of the disease. A total of 133 serum samples from chagasic patients and 50 serum samples from healthy donors were tested. In addition, sera from 15 patients with different autoimmune diseases, 43 serum samples from patients suffering an infectious disease other than Chagas' disease, and 38 serum samples from patients with nonchagasic cardiac disorders were also included in this study. The residue 3973 peptide shows a specificity of >98%, as it is not recognized by individuals with autoimmune and inflammatory processes or by patients with a nonchagasic cardiomyopathy. Remarkably, the levels of antibody against the 3973 epitope detected by the sera from Chagas' disease patients in the symptomatic chronic phase, involving cardiac or digestive alterations, are higher than those detected by the sera from Chagas' disease patients in the indeterminate phase of the disease. It is suggested that the diagnostic technique described could also be used to indicate the degree of pathology. The amino acids F, Q, and DKP located in the peptide at positions 1, 3, and 8 to 10, respectively, are essential to conform to the immunodominant antigenic epitope.

Lower Extremity Lymphedema Index

Measurement of the circumference is the most commonly used method for evaluating extremity lymphedema. However, comparison between different patients is difficult with this measurement. To resolve this problem, we have formulated a new index, lower extremity lymphedema (LEL) index, which can be easily obtained from measurements of the body. We evaluated correlation between lower LEL index and clinical stage in patients with LEL. The LEL indices were significantly correlated with clinical stages and could be used as a severity scale. The LEL index makes objective assessment of the severity of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the index useful for evaluation of lymphedema severities between different cases.

Association of single nucleotide polymorphisms in IL-12 and IL-27 genes with colorectal cancer risk

ObjectivesInterleukin-12 (IL-12) plays an important role in antitumor immunity. Interleukin-27 (IL-27) is a novel IL-12 family member. The present studies demonstrate that IL-27 mediates potent antitumor activity. However, No studies have examined the association of these polymorphism with colorectal cancer (CRC). Therefore, we investigated the relationship of IL-12 and IL-27 gene polymorphisms and CRC. Design and methodsWe analyzed polymorphisms of IL-12 gene 16974 A/C and IL-27 gene −964 A/G, 2905 T/G, 4730 T/C in 410 patients with CRC and 450 controls, using PCR-RFLP method. ResultsThere were no significant differences in the genotype and allele frequencies of IL-12 and IL-27 gene polymorphisms between the group of patients with CRC and the controls. Furthermore, no association was found between IL-12 family gene polymorphisms and different clinical stages in patients with CRC. ConclusionThese findings suggest that IL-12 and IL-27 gene polymorphisms may not be involved in susceptibility to CRC.

Neural correlates of disrupted interpersonal cognition and clinical stage in patients with schizophrenia: An fMRI study

Neural correlates of disrupted interpersonal cognition and clinical stage in patients with schizophrenia: An fMRI study

Correlation Analysis of JAK-STAT Pathway Components on Prognosis of Patients with Prostate Cancer

Janus kinases (JAK)/signal transducers and activator of transcription (STAT) pathway is activated constitutively in prostate cancer (PCa). Despite previous reports implying a role of this pathway in the development of clinical hormone-refractory PCa, the correlation of pathway members with the clinicopathologic features and prognosis of patients with PCa has not been elucidated. To address this problem, pJAK-1(Tyr1022/1023) and pSTAT-3(Tyr705) were evaluated by immunostaining in needle biopsies of the prostate from 202 PCa patients treated by definitive therapy (105 cases) or hormonal therapy (97 cases). The correlation of two protein expression with the clinicopathologic features and the prognosis of PCa were subsequently assessed. The expression levels of pJAK-1(Tyr1022/1023) and pSTAT-3(Tyr705) were both positively correlated with Gleason score and clinical stage of patients with PCa. Their expression was also significantly higher in patients with biochemical (prostate-specific antigen, PSA) failure than that in those with no PSA failure (both P < 0.001). In all patients, the recurrence-free survival (RFS) rates were significantly higher in those with low pJAK-1(Tyr1022/1023) and pSTAT-3(Tyr705) expression than that in those with high expression (both P < 0.001). Moreover, for patients treated by definitive or hormonal therapy, the RFS rates in those with lower pJAK-1(Tyr1022/1023) (P < 0.001 and 0.012, respectively) and pSTAT-3(Tyr705) expression (P < 0.001 and 0.015, respectively) were significantly higher than in those with higher expression. Cox multivariate analysis showed that the expression levels of pJAK-1(Tyr1022/1023) (P = 0.002) and pSTAT-3(Tyr705) (P = 0.005) were prognostic factors for PCa in addition to extraprostatic extension (P = 0.026) and Gleason score (P = 0.018). The results of pJAK-1(Tyr1022/1023) and pSTAT-3(Tyr705) immunostainings in needle-biopsy specimens are prognostic factors for PCa.

Sa1431 Minimally Invasive Sampling of Abnormal PET Targets by EUS-Guided FNA Improves Clinical Staging of Patients With Suspected Non-Small Cell Lung Cancer (NSCLC)

Minimally Invasive Sampling of Abnormal PET Targets by EUSGuided FNA Improves Clinical Staging of Patients With Suspected Non-Small Cell Lung Cancer (NSCLC) James P. Callaway, Ashutosh Tamhane, Gurudatta Naik, Ayesha S. Bryant, Whitney Jennings, Robert J. Cerfolio, Mohamad A. Eloubeidi Internal Medicine, University of Alabama at Birmingham, Birmingham, AL; Gastroenterology, University of Alabama at Birmingham, Birmingham, AL; Biostatistics, University of Alabama at Birmingham, Birmingham, AL; Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL Background: Current guidelines recommend that all abnormal lesions by PET scan should be sampled prior to thoracotomy in patients with lung cancer. EUSFNA has been demonstrated to be safe and minimally invasive in diagnosing N2/ N3 and metastatic disease to the adrenal glands. We currently report our updated large experience to determine the role of EUS-FNA in identifying abnormal PET scan lesions. The secondary objective was to determine predictors of lymph node malignancy. Methods: Consecutive patients (N 282) who underwent both PET and EUS-FNA between June 2003 and June 2009 at a tertiary care teaching hospital were evaluated. Targets sampled by EUS included: the adrenal glands and/or (N2/N3) stations 9, 8, 7, 5, 4L, or 2. All EUS examinations were performed by a single endosonographer. The reference standard included surgery or clinical follow-up ( 6 months). Abnormal PET targets were defined by a maximum standardized uptake value (SUV) of 2.5. Results: Mean age was 66 years and 66% were men. Mediastinal lymph nodes were solely sampled in 243 patients, while only Stage IV lesions in 18 and both in 21. In the 264 patients who underwent EUS-FNA of lymph nodes, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, of EUS-FNA were: 76%, 100%, 100%, 81%, 88% respectively and for PET: 84%, 53%, 64%, 78%, 69%, respectively for confirming N2/N3 disease. EUS-FNA confirmed PET staging in 168 patients while 63 were “downstaged” (25.8%) and 11 “upstaged” (4.1%); 22 patients were falsely downstaged by EUS-FNA. In 11 patients with false negative FNA results, the node was not routinely accessible by EUS. In multivariable analysis, the short axis of the lymph node by EUS (ORadjusted1.25; 95% CI: 1.091.44; p 0.002) and SUV of the lymph node (ORadjusted1.38; 95% CI: 1.12-1.69; p 0.002) were significant predictors of malignancy when adjusted for age, race, sex, lymph node long axis, primary mass SUV and location, and prior chemotherapy. EUS-FNA confirmed Stage IV lung cancer in 19 patients (1 gastrohepatic node, 1 perigastric node, 1 pancreas, 3 right adrenals and 13 left adrenals) and in 1 patient who had left adrenal involvement without PET uptake. Conclusions: EUS-FNA improved clinical staging in patients with suspected NSCLC. Its ability to accurately confirm the nature of abnormal PET scan targets, along with the ability to upstage and downstage false positive and false negative PETs, makes it an ideal choice for initial minimally invasive sampling. Lymph node short axis and lymph node SUV were the significant predictors of malignancy and may help guide endosonographers to which lymph node needs to be sampled first during EUS.

Striatal necrosis in type 1 glutaric aciduria: Different stages in two siblings

Two siblings born of a consanguineous marriage with history of neurologic deterioration were imaged. Imaging features are classical of glutaric aciduria type 1 (GA-1), acute (striatal necrosis) stage in younger sibling, and chronic stage in older sibling. GA-1 is an autosomal recessive disease with typical imaging features. Greater awareness about this condition among clinicians and radiologists is essential for early diagnosis and prevention of its catastrophic consequences. Striatal necrosis with stroke-like signal intensity on imaging correlates with clinical stage of patients.

A Pilot Study of Laparoscopic Extraperitoneal Lymph Node Dissection in Patients With Locally Advanced Cervical Cancer: A Trial Design Report

Introduction: Clinical staging of patients with advanced cervical cancer according to International Federation of Gynecology and Obstetrics (FIGO) is often inaccurate. The purpose of this study is to determine the feasibility of performing an extraperitoneal laparoscopic lymphadenectomy in patients with stage IB2-IVA cervical carcinoma. Also, this study will evaluate the rate of histologically-confirmed para-aortic lymph node metastases relative to preoperative regional imaging via positron emission tomography/computed tomography (PET/CT). Finally, we demonstrate the ability to effectively train an inexperienced surgeon to perform extraperitoneal laparoscopic lymphadenectomy within the predefined feasibility parameters of an experienced surgeon. Patients and Methods: Patients with a biopsy-proven stage IB2 to IVA cervical carcinoma who were candidates for treatment with radiation therapy and concurrent chemotherapy were eligible for inclusion. All patients underwent preoperative PET/CT and subsequent extraperitoneal para-aortic lymphadenectomy. The initial phase of the study enrolled 10 patients to determine the feasibility of the procedure. A second cohort of up to 20 patients was prospectively evaluated upon which data were gathered determining successful surgical evaluation and associated complication rates. A third cohort of 30 patients was enrolled from which 10 were to be performed by a second surgeon with no baseline facility with the procedure. The same feasibility criterion was leveraged against this physician. Data on this surgeon’s learning experience was gathered and recorded. Conclusion: The accumulated data from this trial awaits presentation at the 2010 Annual Meeting of the Society of Gynecologic Oncologists. However, of equal importance is the formulation of an objective measurement of the acquisition of more advanced surgical skills among experienced surgeons.

Preoperative Toll‐like Receptor Expression in Monocytes is Associated with Host Immunological Responses Following Gastrointestinal Surgery

The present study was designed to evaluate the relationship between preoperative Toll-like receptor (TLR) expression in peripheral blood monocytes (PBMC) and the postoperative inflammatory cytokine secretion from PBMC, as well as the postoperative infectious complications in patients with gastrointestinal cancer. Peripheral blood monocytes were isolated from 26 patients on the preoperative day and on postoperative day 1 (POD1). The monocytes were stained for CD14, TLR2, and TLR4 surface expression and stimulated ex vivo with lipopolysaccharide (LPS), after which the culture supernatant tumor necrosis factor alpha (TNFα), interleukin (IL)-1β, and interferon gamma (IFNγ) concentrations were measured in the culture supernatant. Postoperative clinical courses were monitored. There was a significant positive correlation between preoperative TLR4 expression and clinical stage in patients with gastrointestinal cancer. A significant negative correlation between preoperative TLR2 or TLR4 expression and the preoperative TNFα and IL-1β production was found. Furthermore, there was a significant negative correlation between preoperative TLR2 or TLR4 expression and postoperative inflammatory cytokine production. Preoperative high expression of TLR on monocytes reduces the capacity for LPS-induced inflammatory cytokine production from monocytes. An analysis of preoperative TLR expression may therefore help to elucidate the systemic immunological response and the clinical course following gastrointestinal surgery.

Clinical significance of serum Dkk‐3 in patients with gynecological cancer

The expression of Dkk-3, as a number of the Dkk family was different in different cancer. Because Dkk-3 encodes a secreted protein, we investigated whether the Dkk-3 protein is secreted into the sera of patients with gynecological cancer. The levels of Dkk-3 protein were assessed by enzyme-linked immunosorbent assay in the sera of 104 patients with gynecological cancer: 36 with ovarian, 40 with cervical and 28 with endometrial cancers. The serum levels of Dkk-3 protein in patients with ovarian cancer [25.54 (7.99) pg/mL] was lower than in normal individuals [42.08 (14.89) pg/mL] (P = 0.000). But serum levels of Dkk-3 protein in patients with cervical [166.39 (300.68) pg/mL] (P = 0.013) and endometrial cancers [73.64 (23.36) pg/mL] (P = 0.000) were higher than in normal individuals. The serum levels of Dkk-3 protein were associated with clinical stage in patients with cervical and endometrial cancers. In patients with ovarian cancer, the serum levels of Dkk-3 protein were associated with lymphatic metastasis. In patients with cervical cancer, the serum levels of Dkk-3 protein were associated with tumor diameters. Dkk-3 protein detection using enzyme-linked immunosorbent assay as molecular markers can contribute to detection and diagnosis of gynecological cancer, especially for ovarian cancer and endometrial cancer.

The changes of molecular markers with neoadjuvant dose-dense doxorubicin hydrochloride, cyclophosphamide, and paclitaxel chemotherapy regimen.

e21028 Background: The aim of this study was to assess the clinical response (complete clinical response and partial clinical response) (CR) and pathological complete response (no residual invasive tumor in mastectomy material and axillary lymph nodes) (pCR) rate after neoadjuvant treatment in locally advanced breast cancer. Also we examine the change of biological markers before and after treatment. Methods: 63 patients with a histologically confirmed breast cancer were included in this retrospective study. Preoperatively all patients received 4 cycles of 600 mg/m2 cyclophosphamide and 60 mg/m2 doxorubicin hydrochloride (Adriamycin; CA) and 4 cycles of 175 mg/m2 paclitaxel (P) every 14 days. The surgery was performed 2 weeks after the completion of the last chemotherapy cycle. The CR and pR rate, the qualitative/quantitative changes of the ER, PR, HER2, and ki67 status on the initial biopsy and mastectomy materials were assessed. HER2 was detected by immunuhistochemistry. Results: The patients mean age were 49.2 ±10.7. Most (57.1%) were premenopausal. Clinical stages of patients were T2N1 and T3N2. Most patients (%87.3) have radical mastectomy. The overall CR rate was 92.1% (n=58); 47.6% (n=30) had a complete, 44.4% (n=28) had partial response; 7.9% (n=5) had stable disease. The pathological complete response rate was 15.9% (n=10). Treatment-related death was not observed. The assessment of qualitative change in ER, PR, cerbB2, and ki67 index were shown in the Table. We examine more than 50% changes in ER intensity in 15.7% tumors and PR intensity in 26.9% tumors with treatment. Conclusions: The dose-dense CA and P regimen has high overall response rate with acceptable toxicity. We observed significant changes in molecular markers of same breast tumors after neoadjuvant treatment. These changes may notably affect the treatment decision. The assessment of qualitative changes in ER, PR, cerbB2, and ki67 index Initial tumor Residual tumor % ER (n = 29) + + 75.8 + - 3.5 - + - - - 20.6 PR (n = 27) + + 48.1 + - 22.1 - + 11.1 - - 18.5 cerbB2 (n = 30) + + 6.6 + - 6.6 - + 10 - - 76.6 Ki67 index median (range) 10 (range;1-60) 1 (range; 0-2) p < 0.001 No significant financial relationships to disclose.

Serum thymidine kinase 1 correlates to clinical stages and clinical reactions and monitors the outcome of therapy of 1,247 cancer patients in routine clinical settings

Thymidine kinase 1 in serum (STK1) has been found to be a reliable proliferation marker in clinical trials. In this study, we examined the significance of STK1 in routine clinical settings. The concentration of STK1 was determined by a sensitive dot blot ECL assay. The STK1 value was correlated to clinical stage and reactions and used for monitoring the outcome of surgery and/or multidrug chemotherapy of 1,247 patients with five different types of carcinomas (lung, esophagus, gastric, head and neck, and thyroid) in routine clinical settings. The STK1 values correlated with the clinical stage in patients with lung, esophagus, thyroid, and gastric carcinomas. After treatment, STK1 declined in all tumor groups after treatments (P < 0.01). The STK1 was low (<2 pM) or decreasing during treatment in patients with clinical reactions of complete response (CR) or partial response (PR), but high (>2 pM) or increasing in patients with stable disease (SD) or progressive disease (PD), some of them showing metastasis. STK1 also reflected the differences in clinical reactions when surgery and chemotherapy were compared. We concluded that the concentration of TK1 in serum correlates to clinical stages and clinical reactions and monitors the effect of tumor therapies, not only in controlled clinical trials, but also in routine clinical settings.

Comparison of Pre-treatment Clinical Prognostic Factors in Patients with Gastro-Oesophageal Cancer and Proposal of a New Staging System

BackgroundClinical staging in patients with gastro-oesophageal cancer, is of crucial importance in determining the likely benefit of treatment. Despite recent advances in clinical staging, overall survival remains poor. The aim of the present study was to examine the relationship between pre-treatment clinical prognostic factors and cancer-specific survival. MethodsTwo hundred and seventeen patients, undergoing staging investigations including host factors (Edinburgh Clinical Risk Score (ECRS)) and the systemic inflammatory response (Glasgow Prognostic score (mGPS)), in the upper GI surgical unit at Glasgow Royal Infirmary, were studied. ResultsDuring the follow-up period, 188 (87%) patients died; 178 of these patients died from the disease. The minimum follow-up was 46 months, and the median follow-up of the survivors was 65 months. On multivariate survival analysis of the significant factors, only cTNM stage (HR 1.84, 95% CI 1.56–2.17, p < 0.001), mGPS (HR 1.67, 95% CI 1.35–2.07, p < 0.001) and treatment (HR 2.12, 95% CI 1.73–2.60, p < 0.001) were independently associated with survival. An elevated mGPS was associated with advanced cTNM stage, poor performance status, an elevated ECRS and more conservative treatment. ConclusionsPre-treatment mGPS improves clinical staging in patients with gastro-oesophageal cancer. Therefore, it is likely to aid clinical decision making for these difficult to treat patients.