Disease-free Survival Rates Of Patients Research Articles

Oncological outcome of surgical site infection after colorectal cancer surgery.

This study evaluated the oncological outcome of surgical site infection (SSI) after colorectal cancer surgery. A total of 3675 consecutive patients with colorectal cancer who underwent curative resection from January 2009 to December 2011 were analyzed. The prognostic significance of SSI was evaluated. Risk factors for SSI were also identified using multivariate regression analysis. Overall SSI rate was 9.6%, in which 5.5% was superficial or deep SSI and 4.1% was organ/space SSI. Incidence of SSI varied significantly with tumor location (P < 0.001): 7.1% in colon cancer and 14.0% in rectal cancer. With a median follow-up period of 49.8months, the 5-year disease-free survival rates of patients without and with SSI were 87% and 83%, respectively (P = 0.018). SSI predicted disease-free survival in univariate analysis. However, SSI was not an independent predictor of survival in multivariate analysis. Body mass index, ASA score, preoperative WBC count, rectal tumor, open surgery, operation time, and transfusion during surgery were independent predictors of SSI. SSI predicted disease-free survival in colorectal cancer patients following curative surgery. Patient' demographics, tumor characteristics, and perioperative conditions were independently associated with an increased likelihood of SSI.

Association of specific gene mutations derived from machine learning with survival in lung adenocarcinoma.

Lung cancer is the second most common cancer in the United States and the leading cause of mortality in cancer patients. Biomarkers predicting survival of patients with lung cancer have a profound effect on patient prognosis and treatment. However, predictive biomarkers for survival and their relevance for lung cancer are not been well known yet. The objective of this study was to perform machine learning with data from The Cancer Genome Atlas of patients with lung adenocarcinoma (LUAD) to find survival-specific gene mutations that could be used as survival-predicting biomarkers. To identify survival-specific mutations according to various clinical factors, four feature selection methods (information gain, chi-squared test, minimum redundancy maximum relevance, and correlation) were used. Extracted survival-specific mutations of LUAD were applied individually or as a group for Kaplan-Meier survival analysis. Mutations in MMRN2 and GMPPA were significantly associated with patient mortality while those in ZNF560 and SETX were associated with patient survival. Mutations in DNAJC2 and MMRN2 showed significant negative association with overall survival while mutations in ZNF560 showed significant positive association with overall survival. Mutations in MMRN2 showed significant negative association with disease-free survival while mutations in DRD3 and ZNF560 showed positive associated with disease-free survival. Mutations in DRD3, SETX, and ZNF560 showed significant positive association with survival in patients with LUAD while the opposite was true for mutations in DNAJC2, GMPPA, and MMRN2. These gene mutations were also found in other cohorts of LUAD, lung squamous cell carcinoma, and small cell lung cancer. In LUAD of Pan-Lung Cancer cohort, mutations in GMPPA, DNAJC2, and MMRN2 showed significant negative associations with survival of patients while mutations in DRD3 and SETX showed significant positive association with survival. In this study, machine learning was conducted to obtain information necessary to discover specific gene mutations associated with the survival of patients with LUAD. Mutations in the above six genes could predict survival rate and disease-free survival rate in patients with LUAD. Thus, they are important biomarker candidates for prognosis.

Impact of re-excision of residual adjacent vulvar intraepithelial neoplasia (VIN III) and histological tumour-free margin (hTFM) on survival in primary squamous cell carcinoma of vulva.

hTFM in primary vulvar cancer is an important prognostic factor. Ideally, a diameter of > 8mm should be achieved after primary surgery. The role of VIN III persistence after primary surgery in vulvar cancer is still unclear. The main objective of the current study was to study the role of residual VIN III re-excision and compare differences in disease-free survival among patients with different hTFM and in primary vulvar cancer. Forty-two patients with residual adjacent VIN III after primary surgery for vulvar cancer which were operated between 2000 and 2016 in our clinic were enrolled in this retrospective study. Re-excision rates for residual adjacent VIN III were calculated. According to the histological margin patients were divided into three group: < 3, 3-8 and > 8mm. Univariate and multivariate analyses were conducted using the Kaplan-Meier method and Cox proportional hazards models, respectively. The vast majority of patients had pT1b stage (57.1%), grading G2 (71.4%) and lymph node-negative (45.3%) disease at first diagnosis. The re-excision rate was 57.1%. The 5-year disease-free survival (DFS) rates in patients with < 3, 3-8 and > 8mm hTFM were 50.0, 50.0 and 81.0%, respectively (p = 0.032). The 5-year DFS rates in patients with re-excision and without re-excision for VIN III were 77.3 and 52.9%, respectively (p = 0.060). In univariate analysis was solely hTFM > 8mm a prognostic factor for DFS (p = 0.017). hTFM may be a potential prognostic indicator for DFS in vulvar cancer patients. Re-excision for residual adjacent VIN III could not be established as a prognostic factor for DFS after primary surgery in squamous cell cancer of vulva.

Overexpression of S100A13 protein is associated with tumor angiogenesis and poor survival in patients with early-stage non-small cell lung cancer.

BackgroundS100A13 plays a key role in tumor growth and metastasis. The purpose of this study was to investigate the prognostic significance of S100A13 expression, microvessel density (MVD), and survival in early stage non‐small cell lung cancer (NSCLC).MethodsIn silico analysis was performed to determine the associations between S100A13 and NSCLC. The data of 82 patients with early‐stage NSCLC who underwent radical resection were evaluated. Paraffin‐embedded tumor specimens were stained with S100A13 and CD31 (a specific endothelial marker) using immunohistochemical methods. Prognostic significance was assessed by univariate and multivariate analyses.ResultsS100A13 messenger RNA was overexpressed in NSCLC, especially in advanced stage. Of the 82 NSCLC specimens examined, 37 (45.1%) cases exhibited S100A13 overexpression and 31 (37.8%) showed high MVD. Univariate analysis indicated that gender, age, smoking status, histology type, tumor differentiation, and T stage were not significantly associated with prognosis. However, the overall and disease‐free survival rates of patients with S100A13 overexpression and high MVD were significantly lower than in the remaining cases. Multivariate analysis demonstrated that only S100A13 overexpression was an independent factor for poor prognosis in early‐stage NSCLC. Statistical analysis demonstrated that the MVD was significantly higher in tumors with high (67.6%, 25/37) compared to low S100A13 expression (13.3%, 6/45) (P < 0.01).ConclusionsHigh S100A13 expression is closely associated with high intratumoral angiogenesis and poor prognosis in patients with stage I NSCLC. Immunohistochemical evaluation of S100A13 expression, along with an examination of the perioperative extent of angiolymphatic invasion, has value for predicting prognosis.

Percutaneous Cryoablation of Solitary, Sporadic Renal Cell Carcinoma: Outcome Analysis Based on Clear-Cell versus Papillary Subtypes

PurposeTo evaluate treatment outcomes with percutaneous cryoablation (PCA) based on renal cell carcinoma (RCC) histology. Methods and MaterialsPatients treated with PCA for a solitary, sporadic stage T1a RCC from 2003 to 2016 were identified from a single institution’s renal ablation registry. Patients with multiple tumors, history of RCC, or genetic syndromes associated with RCC (n = 60); no specific RCC subtype determined from core biopsy (n = 66); RCC subtype other than clear-cell or papillary (n = 7); or less than 3 mo of follow-up imaging (n = 5) were excluded. In total, 173 patients met study inclusion criteria. Oncologic outcomes, clinical outcomes, and complications were evaluated based on tumor subtype. ResultsOf the 173 patients who underwent PCA for a stage T1a RCC, 130 (75%) had clear-cell RCC (ccRCC) and 43 (25%) had papillary RCC (pRCC). Median tumor size was 2.9 cm (range, 1.3–4.0 cm). Technically successful cryoablation was achieved in all 173 patients. Local tumor recurrence developed in 6 patients with ccRCC (4.6%), new renal tumors developed in 1 patient (0.8%), and metastatic RCC developed in 1 patient (0.8%) who also had local tumor recurrence. No patients with pRCC showed local tumor recurrence, new renal tumors, or metastatic disease. The 5-year disease-free survival rate in patients with ccRCC was 88%, compared with 100% in patients with pRCC (P = .48). Nine patients (5.2%), all with ccRCC, experienced major complications (P = .11). ConclusionsPercutaneous ablation is a viable treatment option for patients with clinical stage T1a pRCC and ccRCC. Percutaneous ablation may be a very favorable treatment strategy particularly for pRCC.

Loss of Raf kinase inhibitor protein expression is associated with human papillomavirus 16 infection in anal tumors.

There has been an increase in the incidence of anal cancer in the past two decades, with squamous cell carcinoma (SCC) being the most frequent histological type identified. Among the risk factors, high-risk human papillomavirus (HPV) infection is the most pervasive. Raf kinase inhibitor protein (RKIP) is expressed in a number of normal human tissues and previous studies have demonstrated the prognostic value of the loss of RKIP expression in several gastrointestinal tumors. Therefore, the present study aimed to evaluate the clinical implications of RKIP expression in a series of neoplastic lesions of the anal canal. The resected tumors of 48 patients [8 high-grade intraepithelial lesions (HSILs), 14 adenocarcinomas and 26 squamous cell carcinomas (SCCs)] were immunohistochemically evaluated for RKIP expression, and the results were correlated with clinicopathological data. The results identified a decreased 5-year overall survival rate in patients with adenocarcinoma (40.8%) compared with patients with SCC (76.7%), and a decreased 5-year disease-free survival rate in patients at clinical stages III/IV (37.3 vs. 62.5 and 82.6% for clinical stages 0 and I/II, respectively). Low RKIP expression was revealed in 62.5% of HSILs, 88.5% of SCCs and 100.0% of the adenocarcinomas. High RKIP expression was associated with patient ethnicity (37.5% in non-Caucasians vs. 7.5% in Caucasians) and patient age (33.3% in younger patients vs. 0.0% in older patients). Finally, high RKIP expression was correlated with HPV16 infection status (40% in HPV- vs. 5.3% in HPV+ patients). A correlation was identified between high RKIP expression and lesions with a generally improved prognosis, such as those diagnosed in younger patients, in situ lesions and lesions of lower clinical grades; there was also a negative correlation between high RKIP expression and HPV16 positivity in patients.

Clinical significance of tumor mitotic rate and lack of epidermal attachment in melanoma of the head and neck.

The primary purpose of this study was to identify the prognostic role of primary dermal melanoma and tumor mitotic rate in melanomas of the head and neck. A retrospective review of the histopathologic, clinical, and demographic data of 256 patients was performed to investigate the impact of primary dermal melanoma and tumor mitotic rate on sentinel lymph node positivity, recurrence, and 5-year overall and disease-free survival. Increased tumor mitotic rate, but not primary dermal melanoma, is a significant predictor of sentinel lymph node positivity and higher likelihood of recurrence. Survival analysis demonstrated that both increased tumor mitotic rate and primary dermal melanoma decreased the 5-year overall and disease-free survival rates of patients with head and neck melanoma lesions. Tumor mitotic rate and primary dermal melanoma may have prognostic significance for both overall and disease-free survival in patients with head and neck melanoma. A larger prospective study is warranted to further elucidate prognostic factors for melanoma in the head and neck region.

Reimplantation of the upper lobe bronchus after lower sleeve lobectomy or bilobectomy: long-term results.

The advantages of a bronchial sleeve resection are well established. A clear majority of reported cases are of upper lobe sleeve resection. Reimplantation of the upper lobe bronchus after a lower sleeve lobectomy or bilobectomy (the so-called Y-sleeve resection) is infrequent. Related technical peculiarities are the main issues. We present our experience and results in this setting. Between 1989 and 2015, we performed 28 Y-sleeve resections of the left lower lobe (n = 18) or right middle and lower lobes (n = 10). The lung-sparing reconstructive operation was performed for non-small-cell lung cancer in 23 cases, for bronchial carcinoid tumour in 4 cases and for a cystic adenoid carcinoma in 1 case. Anastomotic reconstruction was performed by interrupted 4-0 absorbable sutures (monofilament material). All the resections were complete (R0). Postoperative mortality was 3.6%. The rate of major complications was 10.7% (1 myocardial infarction, 1 anastomotic stenosis requiring dilatation and 1 anastomotic fistula). Among the 23 patients with non-small-cell lung cancer (18 men and 5 women; mean age 58 ± 12 years), 8 were Stage I, 9 were Stage II and 6 were Stage IIIa. At a mean follow-up of 46 months, the recurrence rate was 32%. There were 2 loco-regional recurrences. No endobronchial or perianastomotic recurrence occurred. The 3- and 5-year overall and disease-free survival rates of patients with non-small-cell lung cancer were 76.3% and 55.1% and 68.7% and 62.9%, respectively. A Y-sleeve resection with reimplantation of the upper load bronchus is a technically feasible and oncologically adequate operation.

Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors – a multi-institutional study

BackgroundMalignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs. MethodsPatients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses. ResultssNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2–3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11–20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively. ConclusionsIn sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2–3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered.

Impact of Brachytherapy use on Clinical Outcome of Elderly Patients of Carcinoma Cervix treated with Definitive Radiation Therapy

Brachytherapy (BT) is an integral component in the multimodality management of carcinoma cervix; however studies (both in developed as well as developing countries) have shown its sub-optimal use, consequently affecting survival. Elderly patients of carcinoma cervix (E-CC) are a challenging group of patients to treat. We aimed to analyse the impact of BT usage on clinical outcome of E-CC patients treated with definitive radiotherapy (RT) with or without chemotherapy (CT) at our institute. 100 patients of E-CC (≥ 60 years) registered between Jan 2009 and Dec 2015 was included in this retrospective analysis. Medical charts were reviewed for: patient demographics, stage (FIGO 2009), histology, RT and CT dose parameters and BT details. Acute toxicities were recorded as per RTOG acute morbidity criteria. Disease free survival (DFS) was estimated using Kaplan-Meier method. Statistical analysis was done with SPSS (version 21.0) and p<0.05 was considered significant. Median age was 65 (range: 60-85 years). 26 patients had stage IIB; 69 and 5 patients respectively had stage IIIB and IVA disease. Median Karnofsky performance stage was 80 (range 70-90). All had squamous cell carcinoma histology except 4 patients (adenocarcinoma). Median external beam radiotherapy dose (EBRT) was 50 Gy (range: 20-50 Gy). 25 patients (25%) received concurrent chemotherapy with weekly Cisplatin 35-40 mg/m2; median 5 cycles (range: 2-6). Acute haematological and gastrointestinal toxicity grade ≥ 3 was seen in 8% and 11% patients respectively during EBRT. 71 patients received brachytherapy; 62 patients received high dose rate intracavitary brachytherapy (ICBT; 7 Gy x 3 fractions, weekly), 7 patients received pulsed dose rate ICBT (70 cGy×39 hourly pulses, total dose 27 Gy) and 2 patients received interstitial brachytherapy 10 Gy in 2 fractions, each one week apart. 29 patients did not receive brachytherapy. 10 patients (34.48%) defaulted for planned ICBT after EBRT; 8 patients (27.58%) refused ICBT; 6 patients (20.68%) could not receive it because of poor general condition and co-morbidities and 5 patients (17.24%) received EBRT boost in lieu of BT. Median follow up was 23.6 months (range: 4-46 months). 1 year and 2 year DFS for entire cohort was 74.9% and 68.9% respectively. 1 years and 2 year DFS rate for patients not receiving brachytherapy was 24% vs. 85.9% and 11.9% vs. 82.4% respectively (p<0.001). Age (> 70 vs. 60-69 years), use of concurrent chemotherapy and stage did not impact DFS significantly. Non-receipt of brachytherapy continued to be a predictor for worse survival on multivariate analysis (HR 0.056; 95% CI 0.0183 to 0.1723). Exclusion of BT from the radiotherapeutic management of E-CC adversely impacts survival. Reasons of non-receipt may help in understanding and increasing the compliance of patients for BT and hence improving survival.

Gas6 derived from cancer-associated fibroblasts promotes migration of Axl-expressing lung cancer cells during chemotherapy

Alterations to the tumor stromal microenvironment induced by chemotherapy could influence the behavior of cancer cells. In the tumor stromal microenvironment, cancer-associated fibroblasts (CAFs) play an important role. Because the receptor tyrosine kinase Axl and its ligand Gas6 could be involved in promoting non-small cell lung cancer (NSCLC), we investigated the role of Gas6 secreted by CAFs during chemotherapy in NSCLC. In a murine model, we found that Gas6 expression by CAFs was upregulated following cisplatin treatment. Gas6 expression might be influenced by intratumoral hypoperfusion during chemotherapy, and it increased after serum starvation in a human lung CAF line, LCAFhTERT. Gas6 is associated with LCAFhTERT cell growth. Recombinant Gas6 promoted H1299 migration, and conditioned medium (CM) from LCAFhTERT cells activated Axl in H1299 cells and promoted migration. Silencing Gas6 in LCAFhTERT reduced the Axl activation and H1299 cell migration induced by CM from LCAFhTERT. In clinical samples, stromal Gas6 expression increased after chemotherapy. Five-year disease-free survival rates for patients with tumor Axl- and stromal Gas6-positive tumors (n = 37) was significantly worse than for the double negative group (n = 12) (21.9% vs 51.3%, p = 0.04). Based on these findings, it is presumed that Gas6 derived from CAFs promotes migration of Axl-expressing lung cancer cells during chemotherapy and is involved in poor clinical outcome.

Evaluación del tratamiento adyuvante en Cáncer Colorrectal estadio II.

Introducción: El 70 % de los casos de cáncer colorrectal se diagnostican en estadios en los que es posible la resección quirúrgica del tumor. Sin embargo, un 50 % de estos pacientes fallecen o recaen por enfermedad metastásica. El objetivo de este estudio es conocer la tasa de sobrevida global y libre de enfermedad en los pacientes con cáncer colorrectal estadio II. Métodos:El presente estudio es de tipo descriptivo, retrospectivo realizado en el período de enero de 2006 a diciembre del 2010. Se analizaron las características clínico-patológicas de pacientes con diagnóstico de adenocarcinoma de colon estadio II que recibieronquimioterapia adyuvante en el Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”, Solca-Guayaquil. Se reporta la supervivencia a cinco años y se compara con chi cuadrado. Resultados:64 pacientes fueron incluidos en el estudio. La tasa de sobrevida global (SG) y libre de enfermedad fue del 75 % a 5 años. 14 casos (21.9 %) presentaron recurrencia tumoral, con una sobrevida 2.7 años. Los pacientes que recibieron el protocolo Folfox4 tuvieron una SG de 78.4 % a 5 años, mientras que los pacientes que recibieron Folfox6 tuvieron una SG de 81.8 % a 5 años P=0.57. Los factores que significativamente disminuyen la supervivencia fueron resección de 1-3 nodos supervivencia 53.8% P=0.048, Recurrencia supervivencia 35.7% P&lt;0.0001. La edad &gt;50 años supervivencia64.3% P=0.294, Obstrucción intestinal 67.6%. P=0.193. Conclusión:En este estudio los factores que influyen en la supervivencia de los pacientes con cáncer colorectalestadio II fueron la resección ganglionar inadecuada, y la recurrencia de la enfermedad. La supervivencia global mejora con el protocolo Folfox 6.

Chemo-selection with docetaxel, cisplatin and 5-fluorouracil (TPF) regimen followed by radiation therapy or surgery for pharyngeal and laryngeal carcinoma.

Induction chemotherapy for patients with head and neck cancer is widely performed, and several advantages of induction chemotherapy have been reported. However, there is currently insufficient evidence to strongly recommend induction chemotherapy. In this study, we analyzed the outcomes for patients treated with induction chemotherapy and subsequent definitive treatments. Operable patients with untreated oropharyngeal, hypopharyngeal and laryngeal squamous cell carcinoma treated with induction chemotherapy were included in this retrospective study. We conducted induction chemotherapy using docetaxel, cisplatin and 5-fluorouracil and performed subsequent surgical treatment or radiotherapy according to the response to induction chemotherapy. A total of 65 patients were included in this study, and 50 patients (76.9%) had Stage IV tumors. The response to induction chemotherapy was CR in two patients, PR in 55 patients, and SD in eight patients. The subsequent definitive treatment was radiotherapy in 60 patients, and surgery in five patients. The 3-year overall survival rates for patients who received radiotherapy and surgery were 88.4% and 75.0%, respectively (P = 0.30). The 3-year disease-free survival rates for patients who received radiotherapy and surgery were 68.0% and 0%, respectively (P = 0.01). The 3-year laryngeal dysfunction free survival rates for patients who received RT and surgery were 77.8% and 0%, respectively (P < 0.01). We achieved favorable survival outcomes and high larynx preservation rates. Our results suggest that induction chemotherapy using TPF regimen is one of the optimal treatment strategies when treating head and neck cancers. Further prospective studies with a larger cohort are required to confirm our findings.

Diagnostic value of inflammatory cell infiltrates, tumor stroma percentage and disease-free survival in patients with colorectal cancer.

The anticancer immune defense mechanism involves humoral and cellular responses. The main effector mechanisms of antitumor responses involve the following: the activity of cytotoxic T cells; the activation of macrophages and neutrophils; the activity of cytokines secreted by T cells; and natural killer cell activity. Selected cell populations are responsible for the stimulation or suppression of the immune system against tumor cells. Therefore, the aim of the present study was to evaluate the location, extent and composition of the cellular inflammatory infiltration of tumors in patients with colorectal cancer (CRC). In addition, the correlation between cellular inflammatory infiltration, and anatomoclinical and histopathological features of patients was evaluated. The study involved 160 patients diagnosed with primary operable CRC. The local inflammatory infiltrate was assessed in the invasive front and center of the tumor using light microscopy with hematoxylin and eosin (H&E) staining, according to the Klintrup-Makinen criteria, tumor stroma percentage, and Glasgow microenvironment score. The inflammatory infiltrate in the invasive front of the tumor was correlated with gender (P=0.018), the invasion of blood vessels (P=0.020) and lymph vessels (P=0.038), the presence of tumor-infiltrating lymphocytes in the invasive front (P=0.033) and center (P<0.001) of the tumor, fibrosis (P<0.001), and the degree of desmoplasmic stroma (P=0.004). In contrast, inflammatory infiltration in the center of the tumor was associated with the tumor node metastasis stage (P=0.012), Dukes' stage (P=0.009), primary tumor stage (P=0.036), lymph node status (P=0.005), number of lymph nodes (P=0.006), invasion of lymph node pouches (P=0.021), size of lymph node metastasis (P=0.025) and the degree of desmoplasmic stroma (P=0.002). The low-group, who demonstrated an absent or weak inflammatory cell infiltrate in the invasive front of the tumor, had a statistically significant shorter disease-free survival (DFS) time (P=0.004). Inflammatory cell infiltrate in the invasive front was identified as an independent predictive factor in CRC (P=0.041). In conclusion, the degree of inflammatory cell infiltration in the invasive front of the primary tumor significantly affects various variables that determine disease progression and DFS rates of patients with CRC. Furthermore, the routine histopathological assessment of this parameter in tissue stained with H&E may have potential prognostic value.

Neoadjuvant Chemoradiotherapy for Stage II or III Esophageal Squamous Cell Carcinoma.

The goal of this retrospective study was to investigate the efficacy and safety of neoadjuvant chemoradiotherapy (CRT) in patients with Stage II or Stage III esophageal squamous cell carcinoma (SCC). Between January 2004 and December 2014, a total of 86 patients underwent surgical resection in conjunction with preoperative CRT for esophageal SCC in our Institute. A pathological complete response was achieved in 38.7% of patients with Stage II cancer and 20% of patients with Stage III. Postoperative complications were observed in 61.3% of Stage II and 76.4% of Stage III patients. The 5-year overall survival rate (OS) was 83.2% in Stage II and 22.8% in Stage III (p=0.0001). The 5-year disease-free survival (DFS) rate was 67.9% in Stage II and 29.9% in Stage III (p=0.0007). Neoadjuvant CRT may improve OS and DFS rates in patients with Stage II esophageal SCC.

Surgery for colorectal cancer in elderly patients: how can we improve outcome?

Patients over 70years of age are characterised by diminished long-term survival rates following resection of colorectal cancer (CRC) compared to younger patients. The aim of this study was to clarify whether reduced survival is a result of malignancy, comorbidities or the treatment received. All patients with CRC, who were admitted to our institution over a period of 10years, were selected from a prospectively maintained database. Disease-specific, disease-free and overall survival rates were calculated dependent on variables considered potentially relevant for the patients' prognosis. 915 patients were included in the study. Observed 5- and 10-year survival rates for the whole group were 48±2% and 40±2%, respectively, but 10-year survival rates dropped to 14±4% for patients aged 80 and older. Resection of the primary tumour was attempted in all cases independent of age. Emergency admission, Charlson index ≥2, ECOG ≥2, old age, second malignancies, distant metastases, high grading and non-resective surgery were identified as independent prognostic parameters associated with decreased overall survival. In contrast, disease-specific and disease-free survival rates for patients after elective radical resection in UICC-stage I-III did not show significant differences related to age. Tumour site, UICC-stage and resection status were independent statistically significant predictors of disease-specific survival. Similar disease-specific survival rates in all age groups speak in favour of tumour resection in curative intent even in old patients. Better outcome may be achieved, if regular screening for colorectal cancer is considered even in the elderly to avoid late presentation requiring emergency surgery.

Management of bilateral Wilms tumours.

Wilms tumour is named after Max Wilms. It is an embryonal tumour derived from the metanephros. It is the commonest childhood renal tumour and the third commonest paediatric malignancy. Synchronous bilateral Wilms tumours (BWT) represent 4-7% of all Wilms tumours (WT) and present at a younger age than unilateral Wilms tumours. At least 10% of synchronous BWTs have unfavourable histology, and up to 22% are associated with genitourinary abnormalities, aniridia, WAGR syndrome, Denys-Drash syndrome, hemihypertrophy, or one of the other overgrowth syndromes. The long-term disease-free survival rate for patients with unilateral WT is approaching 90%, and is around 70% for those with metastatic disease. For both synchronous and metachronous Wilms tumours the prognosis is less favourable with reported cure rates approaching 80% in the best centres and lower in resource poor settings. There is potential for a reduced quality of life due to renal insufficiency and the possible need for renal transplantation. The major clinical challenge in BWTs is preservation of functioning renal tissue using nephron-sparing surgical techniques, while achieving cure with minimum therapy-related morbidity. Mortality is generally associated with progressive disease of anaplastic tumours. Chemotherapy followed by nephron-sparing surgery has been able, in most cases, to eradicate the tumour while preserving renal function. Radiotherapy has largely been avoided because of fears of long-term radiation injury to the residual functioning renal mass. Patient selection, appropriate pre- and post-operative chemotherapy and skilled surgical techniques all contribute to excellent outcomes where these are achievable.

Neoadjuvant Chemotherapy Creates Surgery Opportunities For Inoperable Locally Advanced Breast Cancer

Neoadjuvant chemotherapy (NAC), the systematic chemotherapy given to patients with locally advanced and inoperable breast caner, has been proven to be of great clinical values. Many scientific reports confirmed NAC could effectively eliminate sub-clinical disseminated lesions of tumor, and improve long-term and disease-free survival rate of patients with locally advanced breast cancer (LABC); however, up to now, LABC is still a serious clinical issue given improved screening and early diagnosis. This study, with main focus on inoperable LABC, investigated the values of NAC in converting inoperable LABC into operable status and assessed the prognosis. Sixty-one patients with inoperable LABC were initially treated with neoadjuvant chemotherapy; their local conditions were improved to operable status. Radical surgery was exerted on 49 patients. Original chemotherapy was performed after surgery, followed by local radiotherapy. And endocrine therapy was optional according to the hormone receptor status. The quality of life for most patients with skin diabrosis was obviously improved because their local conditions were under control. For all recruited cases, the survival duration and life quality were significantly improved in patients who finished both NAC and surgery compared to those who did not. Further more, this study demonstrates improved prognostic consequences.

Androgen receptor is a potential novel prognostic marker and oncogenic target in osteosarcoma with dependence on CDK11

Osteosarcoma is the most common bone cancer in children and adolescents. Previously, we have found that cyclin-dependent kinase 11 (CDK11) signaling was essential for osteosarcoma cell growth and survival. Subsequently, CDK11 siRNA gene targeting, expression profiling, and network reconstruction of differentially expressed genes were performed between CDK11 knock down and wild type osteosarcoma cells. Reconstructed network of the differentially expressed genes pointed to the AR as key to CDK11 signaling in osteosarcoma. CDK11 increased transcriptional activation of AR gene in osteosarcoma cell lines. AR protein was highly expressed in various osteosarcoma cell lines and patient tumor tissues. Tissue microarray analysis showed that the disease-free survival rate for patients with high-expression of AR was significantly shorter than for patients with low-expression of AR. In addition, AR gene expression knockdown via siRNA greatly inhibited cell growth and viability. Similar results were found in osteosarcoma cells treated with AR inhibitor. These findings suggest that CDK11 is involved in the regulation of AR pathway and AR can be a potential novel prognostic marker and therapeutic target for osteosarcoma treatment.

Human U Three Protein 14a Expression is Increased in Hepatocellular Carcinoma and Associated with Poor Prognosis.

Background:Human U three protein 14a (hUTP14a) promotes p53 degradation. Moreover, hUTP14a expression is upregulated in several types of tumors. However, the expression pattern of hUTP14a in hepatocellular carcinoma (HCC) remains unknown. The aim of this study was to investigate hUTP14a expression and its prognostic value in HCC.Methods:The hUTP14a expression was evaluated using immunohistochemistry (IHC) in HCC tissue specimens. The correlations between hUTP14a expression and clinicopathological variables were analyzed. The Kaplan-Meier method was used to analyze the association between hUTP14a expression and survival. Independent prognostic factors associated with overall survival (OS) and disease-free survival (DFS) were analyzed using the Cox proportional-hazards regression model.Results:The IHC data revealed that the hUTP14a positivity rate in HCC tissue specimens was significantly higher than that in nontumorous tissue specimens (89.9% vs. 72.7%, P < 0.05). The hUTP14a expression was detected in both the nucleolus and the cytoplasm. The positivity rate of nucleolar hUTP14a expression in HCC tissue specimens was higher than that in the nontumorous tissue specimens (29.3% vs. 10.1%, P < 0.05). No significant difference was found between HCC and nontumorous tissue specimens of cytoplasmic hUTP14a expression (60.6% vs. 62.6%, P > 0.05). In addition, no significant correlation was found between nucleolar hUTP14a expression and other clinicopathological variables. The 5-year OS and DFS rates in patients with positive nucleolar hUTP14a expression were significantly lower than those in patients with negative hUTP14a expression (P = 0.004 for OS, P = 0.003 for DFS). Multivariate analysis showed that nucleolar hUTP14a expression was an independent prognostic factor for OS (P = 0.004) and DFS (P < 0.001).Conclusions:The positivity rate of hUTP14a expression was significantly higher in HCC specimens. Positive expression of nucleolar hUTP14a might act as a novel prognostic predictor for patients with HCC.