Tumor Size Distribution Research Articles

Percutaneous Radiofrequency Ablation of Hepatic Metastases from Gastric Adenocarcinoma after Gastrectomy

PurposeTo evaluate the efficacy of percutaneous radiofrequency (RF) ablation for treatment of hepatic metastases from gastric adenocarcinoma. Materials and MethodsOf 24 patients who underwent percutaneous RF ablation after gastrectomy for a hepatic metastasis from a gastric cancer during the period 2000–2013, 19 were enrolled (median age, 63 y) with 21 metastatic tumors (mean diameter, 2.3 cm). Patient overall survival (OS) and local tumor progression-free survival (PFS) outcomes were assessed and compared according to patient and tumor characteristics, including tumor size and lobar distribution. The difference in diameter between tumor and ablation zone was compared according to lobar distribution. ResultsThe median OS after RF ablation was 20.3 months, and the median local tumor PFS was 10.4 months. The OS rate was not significantly influenced by any patient or tumor characteristics. In multivariate analysis, independent negative prognostic factors for local tumor PFS were a tumor ≥ 3 cm in diameter (hazard ratio, 10.5; 95% confidence interval, 1.8–62.5; P = .009) and a tumor located in the left lobe (hazard ratio, 9.1; 95% confidence interval, 1.3–63.5; P = .026). The difference in diameter between the tumor and ablation zone was significantly different between the right and left lobes (right 1.8 cm ± 0.6 vs left 1.1 cm ± 0.70, P = .028). ConclusionsWith the appropriate selection of patients with tumors ≤ 3 cm in diameter and with the possibility of sufficient safety margins, RF ablation is a safe and feasible treatment option for hepatic metastases from gastric adenocarcinoma.

TH‐AB‐BRB‐10: How Many Lesions Can Be Treated with Radiosurgery? Whole Brain Dose From Radiosurgery of Multiple Targets

Purpose:Multiple brain metastases are a frequent indication for stereotactic radiosurgery (SRS). There is concern that as radiation doses to normal brain increase, neurocognitive toxicity increases too. In this report, we estimate how many lesions and what total volume of tumor(s) can be irradiated before a whole brain dose of 8 Gy is reached.Methods:Multiple tumor SRS was simulated in Matlab (Mathworks, Inc) using pre‐calculated dose distributions (kernels) created from single isocenter shots for 4mm, 8mm and 16mm targets, and composite shots for 24mm and 36mm targets in GammaPlan (Elekta, Inc Sweden). Tumors of varying size from 1–36mm were randomly placed throughout the brain and covered with dose until the mean normal brain dose reached 8Gy. Selection of tumor size, dose coverage, selectivity, normalization, and maximum dose were based off NYU Gamma Knife clinical metastases database. Scenarios were run both for mixed tumor sizes and a select few fixed tumors sizes.Results:The mean number of tumors treated, V12, and total tumor volume treated using mixed tumor size distribution were 40.1±8.6, 180.2±28.8cc, and 41.1±12.7cc. For the simulation runs utilizing tumor size fixed ranges of 0–4mm, 4–8mm, 8–16mm, 16–24mm, 24–36mm, the average contribution per tumor to a whole brain dose was 0.045Gy, 0.097Gy, 0.359Gy, 0.635Gy, and 1.203Gy, respectively.Conclusion:GK SRS would require an average of 6.7 24–36mm tumors, 177.3 0–4mm tumors, or 40.1 tumors of mixed sizes to be treated to reach 8 Gy whole normal brain dose for a single session. Therefore, this study alleviates the concern that radiosurgery for a large number of tumors or treating additional newly formed metastases after previous SRS can lead to high whole brain doses. The ability to safely retreat enables the physician to consider new SRS instead of whole brain radiotherapy when additional metastases appear.

9P - Patterns of Failure in Pathologic N1 Breast Cancer Patients Treated with Mastectomy and Radiotherapy

Introduction: Pakistan has the highest rate of breast cancer of any South Asian population and the majority of patients present with locally advanced or metastatic disease. We report on patterns offailure and survival in pathologic N1 breast cancer patients treated with mastectomy, adjuvant chemotherapy/hormonal therapy and post-mastectomy radiotherapy (PMRT). Materials and methods: Between 1995 and 2009, the hospital information system identified 400 women with pathologically confirmed N1 breast cancer. Axillary nodes were clinically palpable in 75% of the patients at presentation. All patients were treated with mastectomy (including level I-II axillary dissection). Distribution of pathologic tumor size was up to 2 cm, 2.1 to 5 cm, and more than 5 cm in 16.5%, 58.5%, and 25% of the patients, respectively. Distribution of dissected lymph nodes was one to five, six to nine, and ten and above in 9%, 6% and 85% of the patients, respectively. Median number of dissected lymph nodes were 14 (range 1–37). 92% of the patients received doxorubicin-based chemotherapy either in neo-adjuvant or adjuvant setting. All patients received PMRT, to chest wall only in 12%, to chest wall and supraclavicular fossa in 81.5%, and to chest wall, supraclavicular fossa and axilla in 6.5% of the patients. All patients with positive ER/PR receptors also received hormonal modulation. Median age was 44 years (range 21–83 years). Patterns of failure and disease-free survival (DFS) were determined. Results: Median follow-up duration was 4.4 years. Patterns of failure were, isolated local (LF) in 4%, isolated regional (RF) in 0.5%, distant failure (DF) in 32%, and loco-regional along with distant failure (LRF + DF) in 2.5% of patients. Cumulative incidence of loco-regional failure for patients with a pathologic tumor size of up to 2 cm, 2.1 to 5 cm, and more than 5 cm were 2.5%, 3%, and 5.5%, respectively. These incidences for one to five, six to nine, and more than ten dissected lymph nodes were 2%, 0%, and 9.5%, respectively. The 10 years DFS for the whole group was 55%. Conclusions: The role of PMRT may have some value in terms of loco-regional control in pathologic N1 breast cancer patients. This merits further evaluation in large-scale randomized trials. Disclosure: All authors have declared no conflicts of interest.

Modeling the Natural History and Detection of Lung Cancer Based on Smoking Behavior

In this study, we developed a method for modeling the progression and detection of lung cancer based on the smoking behavior at an individual level. The model allows obtaining the characteristics of lung cancer in a population at the time of diagnosis. Lung cancer data from Surveillance, Epidemiology and End Results (SEER) database collected between 2004 and 2008 were used to fit the lung cancer progression and detection model. The fitted model combined with a smoking based carcinogenesis model was used to predict the distribution of age, gender, tumor size, disease stage and smoking status at diagnosis and the results were validated against independent data from the SEER database collected from 1988 to 1999. The model accurately predicted the gender distribution and median age of LC patients of diagnosis, and reasonably predicted the joint tumor size and disease stage distribution.

MP40-17 THE METASTATIC POTENTIAL OF CHROMOPHOBE RCC IS DEPENDENT ON TUMOR SIZE: RESULTS FROM THE SEER DATABASE.

You have accessJournal of UrologyKidney Cancer; Evaluation/Staging IV1 Apr 2014MP40-17 THE METASTATIC POTENTIAL OF CHROMOPHOBE RCC IS DEPENDENT ON TUMOR SIZE: RESULTS FROM THE SEER DATABASE. Michael Daugherty, Alexander Kutikov, and Gennady Bratslavsky Michael DaughertyMichael Daugherty More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1352AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Chromophobe RCC tends to be an indolent tumor with a lower propensity of metastasis. As a result, these tumors are often over treated especially when a radical nephrectomy is performed to remove the mass. We hypothesize that there is a difference in tumor size between localized and metastatic tumors and that larger tumors experience a higher rate of metastasis. Methods SEER 18-registries database was queried for all patients age ≥20 years treated surgically for chromophobe RCC between the years 2000-2009. Tumors with unknown extension, grade, nodal status and size were excluded from analysis. In addition, patients with unknown race, sex and age were also excluded. Patients were divided into two cohorts based on metastatic status. There were a total of 1,740 patients with localized tumors and 59 patients with metastatic tumors. Patient demographics and tumor characteristics were compared using chi-square analysis. Tumor size was compared between the two groups using an unpaired t-test. Results There were no differences in patient demographics between the groups, but there was a difference in tumor grade distribution (p<0.001). The mean localized tumor size was 5.9 cm (95% CI 5.7-6.0 cm), whereas the average metastatic tumor size was 11.7 cm (95% CI 10.4-13 cm). The interquartile range for tumor size was 3-8 cm and 8-14.5 cm, for localized and metastatic tumors respectively. The 2 groups were significantly different when comparing the tumor size distribution (p<0.001). Conclusions Present SEER analysis reveals that the size of chromophobe RCC affects the metastatic potential of the tumor. These results can offer an alternative management strategy of patients found to have chromophobe RCC on needle biopsy. These patients may undergo active surveillance until the tumor reaches size of 8cm or larger, in order to avoid unnecessary surgery to remove cancers with limited metastatic potential. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e441 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Daugherty More articles by this author Alexander Kutikov More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

DOP008 The absence of the Triggering Receptor Expressed on Myeloid Cells type-2 (TREM-2) induces a transmissible and protective intestinal microbiota for colitis and colitis associated cancer

Results: Villin-Cre Sphk1flox/flox mice had significant higher colitis with longer segment of ulceration compared to Sphk1flox/flox mice (p 3mm were significantly decreased in villin-Cre Sphk1flox/flox Apcmin/+ mice compared with littermates. Histologic grade was more severe in Sphk1flox/flox Apcmin/+ mice compared with villin-Cre Sphk1flox/flox Apcmin/+ mice (invasive caricinoma, 71% vs 13%, p < 0.05). The expression of Sphk2 and the b-catenin target genes cyclin D1/c-myc were decreased in Sphk1-deficient tumors. The activities of b-catenin (nucleus), cyclin D1 and c-myc and were significantly decreased in villin-Cre Sphk1flox/flox Apcmin/+ mice compared with littermates in both IHC and Western blot analyses. In AOM/DSS CAC model, tumor number and size were not significantly different between Sphk1flox/flox and villin-Cre Sphk1flox/flox mice but there was a change of tumor size distribution between two groups. Conclusions: Epithelial deletion of Sphk1 inhibits CAC in Apcmin/+-DSS model in mice by the modulation of b-catenin and its target signal pathway.

Comparison of transcatheter arterial chemoembolization and transcatheter arterial chemotherapy infusion for patients with intermediate-stage hepatocellular carcinoma

The aim of the present study was to compare clinical outcomes in patients with intermediate-stage hepatocellular carcinoma (HCC) who underwent the following treatments: transcatheter arterial chemoembolization (TACE) using an epirubicin-mitomycin-lipiodol (EML) emulsion at initial therapy (TACE group; n=145), and transcatheter chemotherapy infusion (TACI) using an EML emulsion at initial therapy (TACI group; n=81). Overall survival (OS) and treatment efficacy in the TACE and TACI groups were retrospectively compared. Prognostic factors associated with OS were examined using univariate and multivariate analyses. Treatment-related mortality was also calculated. The median observation periods were 1.8 years (range, 0.2-9.0 years) in the TACE group and 2.0 years (range, 0.2-8.7 years) in the TACI group. The median survival time and the 1-, 2-, 3- and 5-year cumulative OS rates were 2.68 years and 81.5, 63.4, 43.9 and 32.7%, respectively, in the TACE group, and 2.64 years and 85.0, 60.0, 43.2 and 26.0%, respectively, in the TACI group (P=0.691). The objective response rate was significantly higher in the TACE group compared to the TACI group (80.0 vs. 66.7%; P=0.009). Using multivariate analysis, the Child-Pugh classification (P=0.017), tumor number ≤5 (P=0.045) and des-γ-carboxy prothrombin level >100mAU/ml (P=0.002) were found to be significant predictors linked to OS. In all subgroup analyses involving Child-Pugh classification, maximum tumor size and tumor distribution, the differences in the two groups did not reach statistical significance in terms of OS. Treatment mortality was 0% in the two groups. In conclusion, patients with intermediate-stage HCC had a comparable prognosis when treated with TACI or TACE.

Analysis of HYAL3 Gene Mutations in Chinese Lung Squamous Cell Carcinoma Patients

In a previous study, we found a hyaluronidase 3 (HYAL3) gene mutation in exon 2 at position 188 by genome sequencing in a lung squamous cell carcinoma patient. The mutation results in substitution of serine for alanine. The aim of the study was to screen the HYAL3 gene mutation in Chinese lung squamous cell carcinoma patients and explore the correlation between mutation of HYAL3 with clinical and pathological characteristics in lung squamous cell carcinoma patients in China. We applied polymerase chain reaction to examine the HYAL3 gene mutations in cancer tissues and their adjacent normal tissues from 39 cases of lung squamous cell carcinoma patients. 1) The incidence rate of HYAL3 mutation in 39 cases of lung squamous cell carcinoma was 10.26% (4/39) and none in adjacent normal lung tissues (0/39). 2) The mutations of HYAL3 in the 4 cases were all heterozygous: 3 of them were located in exon 1 (G-T) and one in exon 2 (G-T). 3) Mutations of the HYAL3 gene were not correlated with the distribution of patient gender, age, tumor size, histological grade, smoking history, TNM stage or distant metastasis (P >0.05). The gene mutation was correlated with lymph node status (P = 0.044). Mutations of the HYAL3 gene are rare in Chinese lung squamous cell carcinoma patients and might contribute to lymph node metastasis.

Comparison of 211At-PRIT and 211At-RIT of Ovarian Microtumors in a Nude Mouse Model

Abstract Purpose: Pretargeted radioimmunotherapy (PRIT) against intraperitoneal (i.p.) ovarian microtumors using avidin-conjugated monoclonal antibody MX35 (avidin-MX35) and (211)At-labeled, biotinylated, succinylated poly-l-lysine ((211)At-B-PLsuc) was compared with conventional radioimmunotherapy (RIT) using (211)At-labeled MX35 in a nude mouse model. Mice were inoculated i.p. with 1×10(7) NIH:OVCAR-3 cells. After 3 weeks, they received PRIT (1.0 or 1.5 MBq), RIT (0.9 MBq), or no treatment. Concurrently, 10 additional animals were sacrificed and examined to determine disease progression at the start of therapy. Treated animals were analyzed with regard to presence of tumors and ascites (tumor-free fraction; TFF), 8 weeks after therapy. Tumor status at baseline was advanced: 70% of sacrificed animals exhibited ascites. The TFFs were 0.35 (PRIT 1.0 MBq), 0.45 (PRIT 1.5 MBq), and 0.45 (RIT). The 1.5-MBq PRIT group exhibited lower incidence of ascites and fewer tumors >1 mm than RIT-treated animals. PRIT was as effective as RIT with regard to TFF; however, the size distribution of tumors and presence of ascites indicated that 1.5-MBq PRIT was more efficient. Despite advanced disease in many animals at the time of treatment, PRIT demonstrated good potential to treat disseminated ovarian cancer.

Combretastatin A-4 Phosphate Affects Tumor Vessel Volume and Size Distribution as Assessed Using MRI-Based Vessel Size Imaging

Combretastatin A-4 disodium phosphate (CA4P) is a promising vascular disrupting agent (VDA) in clinical trials. As CA4P acts on dividing endothelial cells, we hypothesize that CA4P affects vessels of certain sizes. The aim of this study was to evaluate the effect of CA4P by the MRI-based vessel size imaging (VSI). C3H mammary carcinomas were grown to 200 mm(3) in the right rear foot of female CDF(1) mice. A control group of mice received no treatment, and a treatment group had CA4P administered intraperitoneally at a dose of 250 mg/kg. VSI was conducted on a 3 Tesla MR scanner to estimate the tumor blood volume (ζ(0)) and mean vessel radius (R). Vascularization was also estimated histologically by endothelial and Hoechst 33342 staining. ζ(0) and R showed different spatial heterogeneity. Tumor median and quartile values of ζ(0) were all significantly reduced by about 35% in the CA4P-treated group as compared with the control group, and the median and upper quartile of R were significantly increased. Histograms of ζ(0) and R showed a general decrease in ζ(0) following treatment, and values of R in a certain range (≈20-30 μm) were decreased in the treatment group. The drug-induced change in ζ(0) was in agreement with histology and our previous dynamic contrast enhanced MRI (DCE-MRI) data. Tumor blood volume and mean vessel radius showed a clear response following treatment with CA4P. VSI may prove valuable in estimation of tumor angiogenesis and prediction of response to VDAs.

Abstract B02: Modeling the natural history and detection of lung cancer

Abstract Background: Lung cancer is the most deadly cancer in men and women worldwide. The major reason for its high mortality rate is that it is less likely than many other cancers to be detected at an early stage. Age, gender, smoking status, tumor size, and disease stage at the time of diagnosis are highly related to the prognosis of patients with lung cancer. In this study, we developed a method for simulating the characteristics of, at an individual level, lung cancer in a population at the time of diagnosis, according to the progression and detection of the disease. Model framework: In this framework, the carcinogenesis, tumor-progression, and detection models work together with data on the lifespan of an individual from his/her birth to the time of lung cancer diagnosis. The carcinogenesis model combined with data on the patients' smoking duration and intensity generated by the Smoking History Generator (SHG) was used to predict the incidence of lung cancer in a person's lifetime, as well as to calculate the age of the patient at the initiation of lung cancer. The tumor growth (with parameters: ξ,μ_n,μ_m,k,θ) and detection models (with parameters: α,W_0,W_1 and W_2) were applied jointly to predict the age, tumor size, and disease stage at the time of diagnosis for the modeled individual. Estimation and prediction: Lung cancer data from Surveillance, Epidemiology and End Results (SEER) database collected between 2004 and 2008 were reconstructed to fit the lung cancer progression and detection model. We derive the least-squares function: F(f(x| ξ,μ_n,μ_m,k,θ,α,W_0,W_1,W_2)-Y ^(x)), where f is the simulated joint distribution of tumor size and stage and Y ^ is the observed joint distribution of SEER data, based on these parameters, and apply the Nelder-Mead method to achieve the best fit parameters in the model. The fitted model combined with a previously fitted carcinogenesis model was used to predict the distribution of age, gender, tumor size, and disease stage at diagnosis and the results were validated against independent data from the SEER database collected from 1988 to 1999. Result: The model predicted both the gender distribution (58.1% are male) among LC patients and median age (69 years old) at the time of diagnosis, whereas 58.8% male patients and the same median age were presented in SEER 1988-1999. The model predicted that about 26.5%, 22.4%, and 51.1% would be staged as N0M0, N1M0, and M1, respectively, whereas about 17.0%, 25.4%, 45.7, and 11.9% were actually staged as N0M0, N1M0, M1, and missing stage, respectively. The predicted tumor size (diameter; mean, 4.57; Standard Deviation (SD), 3.21) is comparable to the tumor size (diameter; mean, 4.44; SD, 5) in SEER. Conclusion: The model accurately predicted the gender distribution and median age of LC patients of diagnosis, and reasonably (but not exactly) predicted the tumor size and disease stage distribution. Citation Format: Xing Chen, Millennia Foy, Marek Kimmel, Olga Y. Gorlova. Modeling the natural history and detection of lung cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B02.

Role of preoperative PET-CT in assessing mediastinal and hilar lymph node status in early stage lung cancer

BackgroundPositron emission tomography combined with computed tomography (PET-CT) is important in the assessment and workup of lung cancer staging. However, inconsistencies between clinical image results obtained and pathologic findings of surgical specimens are still very common, particularly in patients with clinical early stage lung cancer. We sought to clarify the role of PET-CT in predicting mediastinal lymph node status preoperatively in clinical early stage lung cancer patients. MethodsThe cases were collected retrospectively from January 2008 to February 2009. All patients were good surgical candidates, and clinically early-stage during the pre-op evaluation, which included CT, PET scan, and cardiopulmonary tests. All patients underwent surgery, with complete pathological evaluation of mediastinal lymph node (LNs). The pathological status and PET Standardized uptake value (SUV)max of mediastinal LNs were collected to calculate the ROC curve, and to determine the best cut-off value of PET SUVmax. Other cofactors, including sex, tumor size, tumor SUVmax, histology type, and lobar distribution, were analyzed utilizing correlation study, Chi-square test, and t-test for significance. ResultsA total of 83 patients were enrolled into the study. The majority of the cases were in pathological early stage (Stage I: 67.5%, Stage II: 12%). The cut-off point of mediastinal LN SUVmax was 1.6 calculated by receiver operating characteristic (ROC) curve (sensitivity: 40%, specificity: 88.7%, negative predictive rate: 95.1%). The hilar LN SUVmax was found to have a poor correlation to the final pathologic status of hilar nodes with insignificant p value (0.487). Tumor SUVmax and increased hilar LN uptake (SUVmax > 2.0) were found to be significantly correlated with the pathologic status of mediastinal LNs. The false positive rates by PET-CT scan in N1 and N2 nodes were 70% and 78%, respectively, primarily due to inflammatory process (as anthracosis the leading cause). ConclusionIntegrated PET-CT is a useful tool for predicting the negativity of mediastinal LN status pre-operatively in clinically early stage (Stages I and II) lung cancer but may be relatively inaccurate in predicting hilar LN status and largely confounded by false positives caused by inflammatory process.

Monte Carlo simulation-based approach to model the size distribution of metastatic tumors

The size distribution of metastatic tumors and its time evolution are traditionally described by integrodifferential equations and stochastic models. Here we develop a simple Monte Carlo approach in which each event of metastasis is treated as a chance event through random-number generation. We demonstrate the accuracy of this approach on a specific growth and metastasis model by showing that it quantitatively reproduces the size distribution and the total number of tumors as a function of time. The approach also yields statistical distribution of patient-to-patient variations, and has the flexibility to incorporate many real-life complexities.

Abstract PL04-04: Population impact: Using modeling to evaluate contributions of screening, treatment, and biology on disparities in breast cancer outcomes

Abstract Purpose: U.S. Black women have higher breast cancer mortality rates than White women despite lower incidence. The disparity is growing and the reasons for this disparity remain uncertain. The aim of this study is to investigate how much of the mortality disparity can be attributed to racial differences in natural history, uptake of mammography screening and use of adjuvant therapy. Methods: Two simulation models use common national race- and age-specific data for incidence, screening and treatment dissemination, stage distributions, survival and competing mortality from 1975 to 2010. Treatment effectiveness and mammography sensitivity are assumed to be the same for both races. We sequentially substituted Black parameters into the White model to identify parameters that drive the higher mortality for Black women in the current time period (2004–2006). Results: Both models accurately reproduced observed breast cancer incidence, stage and tumor size distributions and breast cancer mortality for White women. The higher mortality for Black women could be attributed to differences in natural history parameters (26–44%), use of adjuvant therapy (11–19%) and uptake of mammography screening (7–8%), leaving 38–46% unexplained. Conclusion: Black women appear to have benefited less from cancer control advances than White women, with a greater race-related gap in the use of adjuvant therapy than mammography screening. However, a greater portion of the disparity in breast cancer mortality appears to be due to differences in natural history and undetermined factors. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PL04-04.

Prediction of higher mortality reduction for the UK Breast Screening Frequency Trial: a model-based approach on screening intervals

Background:The optimal interval between two consecutive mammograms is uncertain. The UK Frequency Trial did not show a significant difference in breast cancer mortality between screening every year (study group) and screening every 3 years (control group). In this study, the trial is simulated in order to gain insight into the results of the trial and to predict the effect of different screening intervals on breast cancer mortality.Methods:UK incidence, life tables and information from the trial were used in the microsimulation model MISCAN–Fadia to simulate the trial and predict the number of breast cancer deaths in each group. To be able to replicate the trial, a relatively low sensitivity had to be assumed.Results:The model simulated a larger difference in tumour size distribution between the two groups than observed and a relative risk (RR) of 0.83 of dying from breast cancer in the study group compared with the control group. The predicted RR is lower than that reported from the trial (RR 0.93), but within its 95% confidence interval (0.63–1.37).Conclusion:The present study suggests that there is benefit of shortening the screening interval, although the benefit is probably not large enough to start annual screening.

Clinicopathologic Characteristics and Outcomes of Patients with Obstructive Colorectal Cancer

PurposeThe aim of this retrospective study was to analyze the clinicopathologic characteristics and short-term and long-term outcomes of colorectal cancer patients with obstruction compared to those of non-obstructive colorectal cancer patients. MethodsBetween January 1998 and December 2005, 1,672 colorectal cancer patients undergoing operation were enrolled in this study. Patients were classified into two groups according to the presentation: patients with complete obstructive colorectal cancer (COC, n = 215) receiving emergency procedures and patients with non-obstructive colorectal cancer (NOC, n = 1,457) receiving elective procedures. The data on the clinicopathologic characteristics and short-term and long-term outcomes of patients were analyzed retrospectively. ResultsAmong 1,672 colorectal cancer patients, 215 cases presented with complete obstruction. The distribution of tumor location and size, macroscopic type, depth of invasion, liver metastasis, peritoneal carcinomatosis, and TNM stage were found to be different between the COC and NOC groups. Logistic regression analysis showed that tumor location, depth of invasion, and peritoneal carcinomatosis were independent factors associated with obstruction. Patients with obstruction had an increased risk of death by a factor of 2.251 compared to patients without obstruction. Peritoneal carcinomatosis and TNM stage were independent factors for the survival of the COC group. Obstruction, peritoneal carcinomatosis, tumor macroscopic type, and TNM stage were independent indicators for postoperative recurrence. Postoperative mortality was significantly higher in the COC group than the NOC group. The overall 5- and 10-year survival rates in the COC group were 47.8% and 42.8%, respectively, compared to 67.2% and 59.8% in the NOC group, respectively (p < 0.05). The postoperative recurrence rates were 43.1% in the COC group and 32.8% in the NOC group (p < 0.05). ConclusionsObstruction is an independent indicator for the survival and postoperative recurrence for patients with colorectal cancer. Patients in the COC group have worse overall survival with high postoperative recurrence rate compared to those in the NOC group.

Race-Specific Impact of Natural History, Mammography Screening, and Adjuvant Treatment on Breast Cancer Mortality Rates in the United States

U.S. Black women have higher breast cancer mortality rates than White women despite lower incidence. The aim of this study is to investigate how much of the mortality disparity can be attributed to racial differences in natural history, uptake of mammography screening, and use of adjuvant therapy. Two simulation models use common national race, and age-specific data for incidence, screening and treatment dissemination, stage distributions, survival, and competing mortality from 1975 to 2010. Treatment effectiveness and mammography sensitivity are assumed to be the same for both races. We sequentially substituted Black parameters into the White model to identify parameters that drive the higher mortality for Black women in the current time period. Both models accurately reproduced observed breast cancer incidence, stage and tumor size distributions, and breast cancer mortality for White women. The higher mortality for Black women could be attributed to differences in natural history parameters (26-44%), use of adjuvant therapy (11-19%), and uptake of mammography screening (7-8%), leaving 38% to 46% unexplained. Black women appear to have benefited less from cancer control advances than White women, with a greater race-related gap in the use of adjuvant therapy than screening. However, a greater portion of the disparity in mortality appears to be due to differences in natural history and undetermined factors. Breast cancer mortality may be reduced substantially by ensuring that Black women receive equal adjuvant treatment and screening as White women. More research on racial variation in breast cancer biology and treatment utilization is needed.

Application of 18F-fluorodeoxyglucose positron emission tomography to detection of proximal lesions of obstructive colorectal cancer

In cases of obstructive colorectal cancer (CRC), preoperative diagnosis of the proximal lesion is often difficult when the primary lesion impedes the passage of the endoscope. The aim of this study was to evaluate the usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in such cases. A total of 52 obstructive CRC patients who underwent preoperative FDG-PET and subsequent surgical resection were retrospectively reviewed. The correlation between characteristics of the proximal lesion and FDG-PET findings was analyzed statistically. There was a significant correlation between the proximal lesion size and the maximum standardized uptake value (P = 0.00016). Abnormal FDG accumulation in the proximal colon indicated the existence of proximal cancer or adenoma with a sensitivity of 50% and a specificity of 100%. There was a significant difference in the distribution of tumor size between the cases with proximal abnormal accumulation and those with no proximal accumulation (P = 0.00014). A proximal tumor of ≥8 mm can be demonstrated by an accumulation of FDG with a sensitivity of 94.1%. FDG-PET can estimate the existence of a proximal lesion and its size. Results may contribute to decisions regarding the type of surgery in cases of obstructive CRC.

Relationship between tumor size and disease stage in non-small cell lung cancer

BackgroundWhether tumor size and stage distribution are correlated remains controversial. The objective is to assess the relationship between tumor size and disease stage distribution in non-small cell lung cancer (NSCLC).MethodsWe conducted a retrospective analysis of 917 cases of NSCLC that were resected in the Cancer Hospital of Fudan University and Shanghai Sixth Hospital between January 2000 and February 2009. Tumor sizes were grouped into five categories: ≤20 mm, 21 to 30 mm, 31 to 50 mm, 51 to 70 mm and ≥71 mm.ResultsAge and tumor size affected stage distribution: patients 60 years or older had a higher percentage of N0M0 disease than patients younger than 60 years (61.67% vs. 44.85%, p < 0.01). The smaller the tumor, the more likely the disease was N0M0 status (p < 0.05). For tumors ≤20 mm in diameter, the proportion of cases with N0M0 status was 70.79%, compared to 58.88% for 21 to 30 mm, 48.03% for 31 to 50 mm, 47.55% for 51 to 70 mm, 33.33% for ≥71 mm. The mean (± SD) tumor size of cases with N0M0 status was 37.17 ± 21.34 mm, compared to 45.75 ± 23.19 mm for cases with other status.ConclusionsThere is a statistically significant relationship between tumor size and distribution of disease stage of primary NSCLC tumors: the smaller the tumor, the more likely the disease is N0M0 status.

Improvement of long-term survival of colorectal cancer in Japanese-Americans of Hawaii from 1990 to 2001

To compare the long-term survival of colorectal cancer (CRC) during two 6-year periods using patients with similar characteristics of the same ethnicity in Hawaii. A retrospective review of Japanese-American patients in Hawaii with CRC surgically resected and followed more than 5 years in a single institution. Patients were divided into two groups by date that patients had surgery: Group 1; 1990-1995, and Group 2; 1996-2001 (introduction of newer chemotherapy, aggressive surgery for liver metastases including radiofrequency thermal ablation). A total of 344 patients in Group 1 (median age 69.5 years) and 330 patients in Group 2 (median age 71.7 years) were included. There were no differences between two groups in gender, age, anatomic site, carcinoembryonic antigen, tumor size, histologic grade, and TNM stage distribution, including pT, pN, and pM status. Overall 5-year survival rate difference approached significance between two groups (Group 1: 73.2% vs. Group 2: 78.9%; p = 0.097). Particularly, there was significant difference in stage IV patients (Group 1; 8.7% vs. Group 2: 26.0%; p = 0.030) and histologic grade 3 (Group 1; 41.67% vs. Group 2: 67.73%; p = 0.032). Subgroup analyses showed significant difference (p < 0.05) for more advanced cancers (larger tumor, node positive, metastatic disease, poorly differentiated cancer). In this study of patients with the same ethnicity, the better survival outcome in latter (Group 2) patients suggests improvement of treatment, especially for patients with more advanced and metastatic cancer (stage IV).