Independent Predictive Factors For Recurrence Research Articles

Factors influencing the risk of recurrence in patients with esophageal carcinoma treated with surgery: A single institution analysis consisting of 1002 cases

The aim of this study was to identify the risk of recurrence in patients with thoracic esophageal squamous cell carcinoma (TESCC) treated with curative surgery. The retrospective analysis included 1002 consecutive patients with TESCC who had been treated with curative surgery in Zhejiang Cancer Hospital, China, between 2003 and 2008. Univariate and multivariate analyses using the Kaplan-Meier method and Cox proportional hazards model, respectively, were performed to identify the independent risk factors for locoregional recurrence and all the recurrence events. The 2-and 5-year recurrence rates were 39.0 and 59.2%, respectively. More than 85% of recurrences occurred within 36 months. The variables associated with a higher rate of recurrence in the univariate analysis were gender (male), length of tumor (≥5 cm), depth of invasion (deeper), lymph node metastasis (greater), histological grade (higher) and vessel involvement (positive). By multivariate analyses, gender (HR, 1.7; 95% CI, 1.2-2.5; P=0.002), depth of invasion (HR, 1.4; 95% CI, 1.2-1.6; P<0.001) and lymph node involvement (HR, 1.4; 95% CI, 1.3-1.5; P<0.001) were independent predictive factors of recurrence. Post-operative radiotherapy or chemotherapy did not significantly prolong failure-free survival (FFS), particularly in patients with early-stage disease. Information regarding the depth of primary tumor invasion and the number of lymph nodes involved may help in evaluating the recurrence risk in patients with TESCC treated with curative surgery. Further studies are required to clarify the correlation between recurrence and the different multidisciplinary treatment approaches.

Expression and clinical significance of metastasis-associated in colon cancer 1 (MACC1) in HBV-related hepatocellular carcinoma

To clarify the expression and clinical significance of metastasis-associated in colon cancer 1 (MACC1) mRNA in hepatocellular carcinoma (HCC). The expression and distribution of MACC1 were assessed by quantitative real-time polymerase chain reaction (RT-PCR) and immunohistochemical staining (IHC) in a cohort of hepatitis B virus-related HCC, including 138 in early (A), 96 in intermediate (B) and 120 in advanced stages (C). The association of MACC1 mRNA with disease progression and outcomes was analyzed by univariate and multivariate Cox analysis. The intratumoral expressions of MACC1 mRNA in HCC stage I (0.001 76, range: 0.000 54 - 0.002 47), stage II (0.002 49, range: 0.000 55 - 0.006 78) and stage III (0.008 35, range: 0.006 86 - 0.009 88) were about 3-, 4- and 14-fold higher than that in the normal liver tissue (0.000 59, range: 0.000 57 - 0.000 60), respectively. Intratumoral expression of MACC1 mRNA increased with disease progression from stage I to stage III. HCC clinical staging classification, age, portal vein invasion and tumor differentiation were significantly associated with intratumoral high expression of MACC1 mRNA (All P < 0.05). Immunohistochemical staining showed that there was an increased MACC1 expression in cytoplasm of HCC cells and positive nuclear staining in some cases. Increased MACC1 mRNA expression could predict poor outcome and recurrence in stage A and B HCC postoperatively. The median tumor-free survival and total survival of patients with high MACC1 mRNA expression were 34.0 and 40 months, respectively, significantly lower than that in those with low expression (48.0 and 48.0 months) (all P < 0.01). Cox analysis showed that Child-Pugh grading and high expression of MACC1 mRNA were independent predictive factors, and high expression of MACC1 was an independent predictive factor affecting the tumor-free survival. MACC1 mRNA up-regulation is a feature of disease progression in HCC. MACC1 mRNA expression in the HCC may become an independent predictive factor for recurrence and survival in postoperative HCC patients.

Recurrent Cholangitis After Endoscopic Lithotripsy of Common Bile Duct Stones with Gallstones In Situ: Predictive Factors With and Without Subsequent Cholecystectomy

Common bile duct stones are a frequent complication of gallstones. Endoscopic retrograde cholangiopancreatography and sphincterotomy are often performed to evaluate the etiology of obstructive jaundice and for concomitant therapeutic removal of common bile duct stones. We aimed to evaluate the recurrence rate of cholangitis or cholecystitis after endoscopic lithotripsy with gallstones in situ and to identify associated predictive factors. We retrospectively reviewed 183 patients who had received endoscopic lithotripsy between July 2007 and June 2010. We divided patients into two groups: One group who had received subsequent cholecystectomy (n=66) and one observational group (n=117). Patients with previous cholecystectomy or without gallstones were excluded. All included patients were followed up at our outpatient department. Our end point was the presence of symptoms of recurrent cholangitis or cholecystitis. Subjects included 86 males and 97 females with a mean age of 62.5±16.3 years (range, 43-81 years). Cholangitis or cholecystitis recurred in 6 patients in the cholecystectomy group and 30 patients in the observational group. Findings revealed a lower recurrence rate and longer recurrence-free period in patients who received subsequent cholecystectomy. The recurrence rate of the observational group was significantly higher than that of the cholecystectomy group (25.6% versus 9.1%, P=.007). Univariate and multivariate Cox regression analyses revealed that common bile duct dilatation was an independent predictive factor for recurrence. Cholecystectomy is recommended after endoscopic lithotripsy. Common bile duct dilatation is associated with the rate of recurrent cholangitis or cholecystitis.

The apoptosis regulators p53, bax and PUMA: Relationship and impact on outcome in early stage (FIGO I-II) ovarian carcinoma after post-surgical taxane-based treatmen

The objective of this study was to evaluate the prognostic effect of the apoptosis regulators p53, bax and PUMA for recurrent disease and disease-free survival (DFS) in a series of 105 patients in FIGO-stagesI-II with epithelial ovarian cancer, all treated with post-surgical platinum-taxane chemotherapy. For the detection of positivity of the biological markers p53, bax and PUMA the techniques of tissue microarrays and immunohistochemistry (IHC) were used. In tumors the frequency of p53 positivity was 24%, that of bax positivity was 83%, and strong positivity was found for PUMA (43%). The bax status was related to tumor grade (P=0.029). Positive staining for bax was related to strong positivity of PUMA in the tumors (P=0.004). The p53, bax or PUMA status alone or concomitant (p53 bax, p53 PUMA and bax PUMA) were not related to age, histopathological subtype, serous/non-serous tumors or type of the staging procedure at primary surgery. In survival analysis p53-positive tumors (P=0.014) and concomitant p53-positive and weak PUMA-positive tumors (P=0.015) were significantly correlated with shorter DFS. Concomitant p53-negative and bax-positive tumors were significantly correlated with longer survival (P=0.019). FIGO-stage (OR=6.0) and p53 status (OR=4.1) were predictive factors for tumor recurrence in logistic regression analysis and independent prognostic factors (HR=2.4 for both) in multivariate Cox regression analysis. In a separate Cox multivariate regression analysis the p53 bax status (HR=2.2) was an independent prognostic factor for DFS. The p53 PUMA status (HR=0.4) was not an independent prognostic factor, however, a borderline significance (P=0.07) was noted. Our results indicate that FIGO stage and p53 status alone were independent predictive factors for recurrence and prognostic factors for survival. Furthermore, p53 bax status was an independent prognostic factor for survival in this study.

Pattern of recurrence after curative surgery in thoracic esophageal squamous cell carcinoma: A 6-year experience with 1,020 patients.

e14557 Background: The knowledge of patterns of recurrence for patients with esophageal carcinoma will be of great value in a clinic when designing therapeutic strategies. The current study reports mode, timing and predictive factors of recurrence after curative surgery for thoracic esophageal squamous cell carcinoma (TESCC). Methods: A retrospective study in a series of 1,020 curatively (R0) resected patients from 2003 to 2008 at Zhejiang Cancer Hospital. Results: The 2 and 5 years recurrence rate were 39.0% and 59.2% respectively. Variables associated with a higher rate of recurrence on univariate analysis were male, length of tumor ≥5cm, deeper depth of invasion, more lymph node metastasis, higher histologic grade, vessel involvement positive, postoperative radiotherapy and postoperative chemotherapy. By multivariate analyses, gender (HR 1.7; 95%CI 1.2–2.5; p=0.002), depth of invasion (HR 1.4; 95%CI 1.2–1.6; p<0.001), lymph node involvement (HR 1.4; 95%CI 1.3–1.5; p<0.001) and postoperative adjuvant radiotherapy (HR 1.3; 95%CI 1.0–1.6; p=0.026) or chemotherapy (HR 1.5; 95%CI 1.2–1.8; p=0.001) were independent predictive factors of recurrence. Less than 10% patients with more than 10 metastatic nodes were free from relapse 3 years after surgery. More than 85% recurrence occurred within 36 months. Postoperative radiotherapy or chemotherapy didn't prolong failure free survival (FFS) significantely, especially in patients with early-stage disease. Conclusions: Gender, depth of invasion, lymph node involvement and postoperative adjuvant therapy were independent predictors of recurrence. Postoperative radiotherapy or chemotherapy didn't prolong FFS significantely. For patients with R0 resection of TESCC, postoperative adjuvant radiochemotherapy need to select appropriate patients.

Intention-to-treat analysis of liver transplantation for hepatocellular carcinoma: Living versus deceased donor transplantation

For patients who have cirrhosis with hepatocellular carcinoma (HCC), living donor liver transplantation (LDLT) reduces waiting time and dropout rates. We performed a comparative intention-to-treat analysis of recurrence rates and survival outcomes after LDLT and deceased donor liver transplantation (DDLT) in HCC patients. Our study included 183 consecutive patients with HCC who were listed for liver transplantation over a 9-year period at our institution. Tumor recurrence was the primary endpoint. At listing, patient and tumor characteristics were comparable in the two groups (LDLT, n = 36; DDLT, n = 147). Twenty-seven (18.4%) patients dropped out, all from the DDLT waiting list, mainly due to tumor progression (19/27 [70%] patients). The mean waiting time was shorter in the LDLT group (2.6 months versus 7.9 months; P = 0.001). The recurrence rates in the two groups were similar (12.9% and 12.7%, P = 0.78), and there was a trend toward a longer time to recurrence after LDLT (38 ± 27 months versus 16 ± 13 months, P = 0.06). Tumors exceeding the University of California, San Francisco (UCSF) criteria, tumor grade, and microvascular invasion were independent predictive factors for recurrence. On an intention-to-treat basis, the overall survival (OS) in the two groups was comparable. Patients beyond the Milan and UCSF criteria showed a trend toward worse outcomes with LDLT compared with DDLT (P = 0.06). The recurrence and survival outcomes after LDLT and DDLT were comparable on an intent-to-treat analysis. Shorter waiting time preventing dropouts is an additional advantage with LDLT. LDLT for HCC patients beyond validated criteria should be proposed with caution.

Positron emission tomography for predicting recurrence in stage I lung adenocarcinoma: standardized uptake value corrected by mean liver standardized uptake value

F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has become an important staging tool for patients with lung cancer, and determination of the standardized uptake value (SUV) is probably the most widely used method for evaluating patients. Although SUV is recognized as a powerful surrogate marker for lung cancer outcomes, SUV standardization and reproducibility in clinical practice remain major concerns. The aim of this study was to evaluate the corrected SUV as a universal marker for lung cancer recurrence. We conducted a case-control study in our institute. From May 2004 to February 2010, 141 patients with pathological stage IA and IB adenocarcinomas underwent PET-computed tomography scanning and SUV determination. The corrected SUV was defined as the SUV index, which was calculated as the ratio of tumor SUV(max) to liver SUV(mean). We examined the association between disease-free survival and several clinicopathological factors, including the SUV index. The 3-year overall survival rate after surgery was 94.3% and the 3-year disease-free survival rate was 90.4%. Univariate analysis showed that male gender (p=0.04), smoking (p=0.02), and SUV index (p<0.01) were independent predictive factors for recurrence. Multivariate analysis showed that the SUV index was significantly associated with a high risk for recurrence (p=0.03). No patient with an SUV index <1.0 experienced a recurrence. The SUV index is a significantly predictive and reproducible factor for recurrence in pathological stage I lung cancers. Patients with an SUV index <1.0 were more likely to have a good prognosis. Additional multi-institutional studies are needed to confirm these study results.

Prognostic factors and long-term clinical outcomes for surgical patients with intestinal Behcetʼs disease

To date there have been few studies regarding the efficacy of surgical treatment and related prognostic factors following intestinal resection in patients with intestinal Behcet's disease (BD). Here we investigated the long-term clinical outcomes and related prognostic factors after surgical treatment for intestinal BD. We reviewed the medical records of 72 patients with intestinal BD who underwent surgery between March 1986 and May 2010. Prognostic factors were identified by univariate analysis using the Kaplan-Meier method, the log-rank test, and multivariate analysis using Cox proportional hazards regression models. Recurrence after surgical treatment was observed in 42 (58.3%) patients and reoperations were performed in 22 (30.6%) patients. The cumulative recurrence rates after surgical treatment were 29.2% at 2 years and 47.2% at 5 years; the cumulative reoperation rates were 12.5% at 2 years and 22.2% at 5 years. Multivariate analysis identified volcano-shaped ulcers, higher C-reactive protein (CRP) levels (≥ 4.4 mg/dL), and the presence of intestinal perforations detected by pathology as independent predictive factors for recurrence. Moreover, volcano-shaped ulcers, higher CRP levels (≥ 4.4 mg/dL), and a history of postoperative steroid therapy were independent predictive factors for reoperation. According to the current study, volcano-shaped ulcers, higher CRP levels, a history of postoperative steroid therapy, and the presence of intestinal perforations detected by pathology were factors of a poor prognosis. Careful follow-up is required in surgical patients with these risk factors, who are at high risk for recurrence and reoperation.

Failures in endoscopic surgery of the maxillary sinus

Objective To assess the prognostic factors of recurrence after endoscopic sinus surgery for maxillary chronic rhinosinusitis without nasal polyps. Study Design Prospective. Setting Tertiary referral center. Methods A total of 411 patients were operated on for maxillary chronic rhinosinusitis without nasal polyps (307 rhinogenic rhinosinusitis, 74 odontogenic rhinosinusitis, and 30 oroantral fistula cases) in a single institution between 2002 and 2007. Ten parameters were analyzed to study their relationship with recurrence: etiology of rhinosinusitis, partial resection of middle turbinate, smoking history, allergy, asthma, gastroesophageal reflux, preoperative endoscopic score, CT stage, maxillary sinus mucosa score, and bleeding score. Preoperative characteristics and recurrence rates were compared with the analysis of variance test. Failure was analyzed as a time-dependent variable by the Kaplan-Meier method. Variables identified on univariate analysis were entered into a multivariate Cox proportional hazards model. Results Recurrent rhinosinusitis developed in 28 (6.8%) cases. In the univariate analysis, preoperative endoscopic score, CT stage, and bleeding score were associated with recidivism. However, the multivariate analysis suggested that only bleeding is an independent predictive factor of recurrence ( P = 0.034, 95% confidence interval for odds ratio 0.92-7.21). Conclusion Intraoperative bleeding may be a risk factor for failure in endoscopic surgery of maxillary rhinosinusitis, but there is substantial uncertainty and future research is needed.

Prognostic significance of fascin-1 and E-cadherin expression in laryngeal squamous cell carcinoma

Fascin-1 and E-cadherin, both of which are related to cell motility and cell adhesiveness, are important factors in the progression and metastasis of cancers. The objective of this study was to explore the association between fascin-1 and E-cadherin expression levels with both the clinical characteristics and prognoses of patients with laryngeal squamous cell carcinoma; we did so through statistical analyses. In our study, tumor tissue samples from 150 patients with laryngeal squamous cell carcinoma were examined for fascin-1 and E-cadherin expression by immunohistochemistry. Fascin-1 expression was found to be an independent predictive factor for recurrence in patients with laryngeal squamous cell carcinoma (P = 0.021) and independently related to disease-free survival (P = 0.010). Although E-cadherin expression status was not an independent predictive factor for recurrence (P = 0.055) or disease-free survival (P = 0.063), when using subgroup analysis, the subgroup with high fascin-1 expression/low E-cadherin expression had the poorest prognosis (P = 0.000). Fascin-1 expression could be a potential prognostic predictor for patients with laryngeal squamous cell carcinoma. Simultaneous analyses of fascin-1 and E-cadherin expression could be more effective in evaluating the prognoses of patients with laryngeal squamous cell carcinoma.

Recurrence After Curative Resection of Early Gastric Cancer

Few studies have evaluated the recurrence of EGC after curative gastrectomy, due to its relatively low incidence. This study evaluated recurrence patterns and independent predictive factors for recurrence in order to determine appropriate follow-up and early detection of recurrence. We reviewed the medical records of 3,883 consecutive patients who underwent curative gastrectomy for EGC at Samsung Medical Center between February 1995 and January 2006 and were followed up until January 2008. The clinical and pathological characteristics and the predictive factors for recurrence were evaluated retrospectively. Eighty-five (2.2%) patients had recurrence, and liver was the most common site of recurrence (45.9%). The recurrence rates within 2, 3, and 5 years were 43.5%, 67.1%, and 85.6%, respectively. There were 106 overall recurrences, with 86 (81.1%) being detected by computed tomography (CT). Second primary cancer was the primary cause of death after gastrectomy, followed by recurrence. Old age (>60 years), tumor size (>3 cm), multiple tumor, N category, and N2 station metastasis were significant factors for recurrence by multivariate analysis, but depth of invasion was not a significant factor. Age, tumor size, number of tumors, N category, and N2 station metastasis were predictive factors for recurrence, with lymph node metastasis being the most significant factor. After curative gastrectomy, follow-up programs should be applied for more than 5 years for EGC patients, and computed tomography could be an essential diagnostic tool.

The Expression of Monocyte Chemotactic Protein-1 in Papillary Thyroid Carcinoma Is Correlated with Lymph Node Metastasis and Tumor Recurrence

Monocyte chemotactic protein-1 (MCP-1) is a chemokine ligand that has been associated with aggressive behavior in breast and prostate cancer. The present study was performed to determine if there is a relationship between the expression of MCP-1 in papillary thyroid carcinoma (PTC) and factors indicative of aggressive behavior in this disease. The subjects of this study were 115 patients with PTC. MCP-1 expression was determined using a semiquantitative scoring system for immunohistochemical staining of MCP-1 in resected PTC samples. There were four levels of immunohistochemical staining intensity, and the population of cells that positively stained for MCP-1 was graded at four levels. The scores for the intensity of immunohistochemical staining for MCP-1 and for the percentage of cells that stained for MCP-1 were used to generate a range from 0 to 9 for scoring MCP-1 expression. Positive staining for MCP-1 was observed in the cytoplasm of PTC cells and stroma cells in 79.2% of the specimens. Expression levels of MCP-1 in PTC cells were positively correlated with tumor size (p < 0.05) and lymph node involvement (p < 0.05). In addition, the expression of MCP-1 in PTC cells level was an independent predictive factor for recurrence of PTC in an analysis that included age, sex, tumor size, extrathyroidal infiltration, and lymph node involvement (p < 0.005). MCP-1 expression in PTC may stimulate the aggressive behavior of this tumor or it may be a marker for aggressive behavior. Previous reports with non-thyroid tumor cells favor the hypothesis that MCP-1 expression promotes aggressive behavior in PTC.

Preoperative Serum Carcinoembryonic Antigen Level as a Predictive Factor of Recurrence After Curative Resection of Colorectal Cancer

We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colorectal cancer (CRC). The study group comprised 638 patients. The optimal cutoff value for the preoperative serum CEA level was determined. Predictive factors of recurrence were evaluated using multivariate analyses. The relapse-free time was investigated according to the CEA level. All patients underwent potentially curative resection for CRC without distant metastasis, classified as stage I, II, or III. The optimal cutoff value for preoperative serum CEA level was 10 ng/ml. Elevated preoperative serum CEA level was observed in 92 patients. Multivariate analysis identified tumor-node-metastasis (TNM) stage and preoperative serum CEA level as independent predictive factors of recurrence. The relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml significantly differed in patients with stage II and III. However, there was no significant difference in relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml in patients with stage I. Preoperative serum CEA is a reliable predictive factor of recurrence after curative surgery in CRC patients and a useful indicator of the optimal treatment after resection, particularly for cases classified as stage II or stage III.

A clinicopathologic multivariate analysis affecting recurrence of borderline ovarian tumors

Objective To evaluate the risk factors associated with recurrence of borderline ovarian tumors that may be used as evidence of the efficacy of select preventive procedures. Methods Various clinicopathologic factors of 234 patients with borderline ovarian tumors admitted to our hospital between January 2001 and June 2007 were reviewed. Univariate and multivariate logistic regression models were constructed to evaluate the risk factors for odds ratio (OR) and statistical significance. The survival was assessed by the Kaplan–Meier method and proportional hazards model. Results Recurrence of borderline ovarian tumors was observed in 26 cases and the median time to recurrence was 29.4 months. Of these cases, 5 occurred involving the ipsilateral ovary, 9 involved the contralateral ovary, and 12 spread to the pelvic peritoneum, including 3 patients who had progressed to invasive carcinoma. No tumor-related deaths were reported. The results of the multivariate logistic regression analysis showed that conservative surgical procedures (OR = 2.304; p = 0.024), cyst rupture (OR = 2.213; p = 0.038), advanced FIGO stage (OR = 4.114; p = 0.000), microinvasion (OR = 2.291; p = 0.046), and peritoneal implants (OR = 2.101; p = 0.016) may be independent predictive factors of recurrence. The proportional hazards model identified surgical procedure (relative risk, RR = 3.752, p = 0.007), cyst rupture (RR = 1.985, p = 0.006), FIGO stage (RR = 3.746, p = 0.001), microinvasion (RR = 1.153, p = 0.009) and peritoneal implants (RR = 2.742, p = 0.010), as independently related to disease-free survival. Conclusions Although patients with borderline ovarian tumors have an excellent prognosis, the risk of recurrence remains. Identification of patients with high-risk factors is essential for offering more selective treatments to prevent recurrence.

Prognostic significance of Survivin and CD44v6 in laryngeal cancer surgical margins

To evaluate the prognostic value of positive Survivin and CD44v6 expression in surgical margin after curative surgery for laryngeal cancer. Immunohistochemistry was performed to detect the expression of Survivin and CD44v6 using polyclonal antibody on 112 pair of formalin-fixed, paraffin-embedded laryngeal cancer and negative surgical margin tissue samples, and results were compared with data from the prospective registry of laryngeal cancer by univariate and multivariate logistic regression model focusing specifically on recurrence. The survival was assessed by the Kaplan-Meier method and proportional hazards model. Survivin and CD44v6 expression in surgical margins were documented in 39.3% (n = 44) and 31.3% (n = 35) patients and were associated with a higher incidence of tumor progression and poorer disease-free survival (P < 0.01). Multivariate logistic regression analysis demonstrated that Survivin (P = 0.000) and CD44v6 (P = 0.001) expression in surgical margin, T-stage (P = 0.006) and histological grade (P = 0.001) were independent predictive factors for recurrence. The proportional hazards model identified Survivin (P = 0.005) and CD44v6 (P = 0.004) expression in surgical margin, T-stage (P = 0.006) and histological grade (P = 0.001), as independently related to disease-free survival. Using subgroup analysis, we found that the Survivin+/CD44v6+ subgroup has the poorest prognosis, whereas the Survivin-/CD44v6- subgroup has the best prognosis (P = 0.000). Immunohistochemical assessment of both Survivin and CD44v6 status in negative surgical margin may be a valuable approach for predicting recurrence and survival after curative surgery for laryngeal cancer.

The Expression and Clinical Significance of the Minichromosome Maintenance (MCM) 7 Proliferation Markers in Urothelial Carcinomas of the Bladder

Purpose: The antibodies for minichromosome maintenance (MCM) proteins have been reported as potential proliferative markers and prognostic indicators in various human malignancies. The present study examined the expression pattern of MCM proteins in bladder carcinomas, and we also evaluated their prognostic significance as well as their potential applicability as proliferation markers. Materials and Methods: Immunohistochemistry for MCM7 and Ki-67 was performed on paraffin sections from 47 cases of bladder carcinoma. The MCM7 and Ki-67 expressions were quantified and then analysis was carried out for determining the association between the expressions of MCM7 and Ki-67 and the clinicopathological parameters. Results: A significant correlation existed between the expression rate of MCM7 and the histological grade (p<0.0001). The Ki-67 expression rate was significantly related to the tumor grade (p=0.002) and the pathological stage (p=0.011). On multivariate analysis, MCM7 was not found to be an independent prognostic factor for predicting the recurrence of bladder carcinoma. Conclusions: The results suggest that MCM is a reliable proliferation marker, but not an independent predictive factor for recurrence of bladder carcinoma. (Korean J Urol 2008;49:12-17) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Clinicopathological characteristics and prognosis of patients with recurrent colorectal cancer

To investigate the clinicopathological characteristics and prognosis of patients with recurrent colorectal cancer. Clinicopathological characteristics and postoperative survival of 235 patients with recurrent colorectal cancer after radical resection were retrospectively analyzed, and was compared with that of 993 patients with radical resection. The overall 5- and 10-year survival rates after radical resection were 67.7% and 55.8%, respectively. The 5- and 10-year survival rates in patients with recurrent colorectal cancer was 43.9% and 28.1% (P=0.000), respectively. Among patients with recurrent colorectal cancer, the 5- and 10-year survival rates of the patients underwent second radical resection were 50.2% and 32.7%, while the 5- and 10-year survival rates of the patients without second surgery were 25.8% and 0, respectively (P=0.000). On univariate analysis, postoperative recurrence was associated with age at diagnosis, cancerous ileus, ascites, lymphs nodes involvement, gross types, infiltration of tumor and Duke's stage. Multivariate analysis revealed that cancerous ileus, ascites, gross types and Duke's stage were independent predictive factors for postoperative recurrence. Cancerous ileus, ascites, gross types and Duke's stage were independent predictive factors for recurrence and metastasis of colorectal cancer after radical resection. The 5- and 10-year survival rates and quality of life could be improved by second radical resection.

CA 15-3 is predictive of response and disease recurrence following treatment in locally advanced breast cancer.

BackgroundPrimary chemotherapy (PC) is used for down-staging locally advanced breast cancer (LABC). CA 15-3 measures the protein product of the MUC1 gene and is the most widely used serum marker in breast cancer.MethodsWe retrospectively investigated the role of CA 15-3 in conjunction with other clinico-pathological variables as a predictor of response and time to disease recurrence following treatment in LABC. Pre and post primary chemotherapy serum concentrations of CA 15-3 together with other variables were reviewed and related to four outcomes following primary chemotherapy (clinical response, pathological response, time to recurrence and time to progression). Persistently elevated CA 15-3 after PC was considered as consecutively high levels above the cut off point during and after PC.Results73 patients were included in this study. Patients received PC (AC or AC-T regimen) for locally advanced breast cancer. 54 patients underwent surgery. The median follow up was 790 days. Patients with high concentrations of CA 15-3 before PC treatment had a poor clinical (p = 0.013) and pathological (p = 0.044) response. Together with Her-2/neu expression (p = 0.009) and tumour lympho-vascular space invasion (LVI) (p = 0.001), a persistently elevated CA 15-3 post PC (p = 0.007) was an independent predictive factor of recurrence following treatment in LABC.ConclusionElevated CA 15-3 level is predictive of a poor response to chemotherapy. In addition, persistently elevated CA 15-3 levels post chemotherapy in conjunction with lympho-vascular invasion and HER2 status predict a reduced disease free survival following treatment in locally advanced breast cancer.

Apoptosis in epithelial ovarian tumours: Prognostic significance of clinical and histopathologic factors and its association with the immunohistochemical expression of apoptotic regulatory proteins (p53, bcl-2 and bax)

Objective The objective was to establish the importance of apoptosis-related genes and the apoptotic index (AI) as prognostic factors in patients with epithelial ovarian tumours. Material and methods Tumour specimens from 130 epithelial ovarian tumours were examined for expression of p53, bcl-2 and bax proteins. The apoptotic index was evaluated by modified terminal deoxynucleotide-transferase-mediated digoxigenin triphosphate-biotin nick end-labelling (TUNEL) methods and by haematoxylin–eosin (H–E) staining. Other clinical and histopathological variables were also analysed. Statistical analyses were performed using the SPSS 10.0 package. Results The apoptotic index detected by H–E and enzymatic assay was high in the majority of carcinomas (serous, endometrioid and clear cell ( p = 0.001). In the univariate survival analysis, high apoptotic index, high p53 and low bcl-2 expression, significantly correlated with shorter survival and shorter disease-free periods ( p < 0.01). In multivariate analysis the age ( p = 0.026; CI: 1.035–1.066 and p = 0.011; CI: 1.835–2.077), FIGO stage ( p = 0.017; CI: 1.385–4.514 and p = 0.024; CI: 1.217–1.940), p53 expression ( p = 0.03; CI: 1.017–1.627 and p = 0.02; CI: 1.050–2.350) and apoptotic index ( p = 0.019; CI: 1.375–1.750 and p = 0.019; CI: 1.442–2.085) were revealed to be independent prognostic factors for survival and recurrence, respectively. Conclusions Our results indicate that the apoptotic index and p53 nuclear accumulation are independent predictive factors of recurrence and short survival. Our data also suggest different patterns of alterations for the various tumour types.

Nuclear galectin-3 expression is an independent predictive factor of recurrence for adenocarcinoma and squamous cell carcinoma of the lung

The tumor stage is the most powerful prognostic tool for predicting the survival rates of lung carcinoma patients. However, prognosis of individual patients is difficult in part because of the marked clinical heterogeneity among such patients. Galectins are involved in cell growth, apoptosis and cell migration features, and their diagnostic and prognostic values have already been demonstrated in various types of cancers. In the present paper we analyze the potential prognostic value of immunohistochemical galectin-3 expression in lung adenocarcinomas and squamous cell carcinomas. In all, 165 squamous cell carcinomas and 121 adenocarcinomas were immunostained for galectin-3. In each case the immunohistochemical analyses consisted of an evaluation of the percentage of tumor cells stained and the intensity of staining. An IP score (ie Intensity × Percentage) was thus determined for each lung carcinoma. A large majority of cases displayed galectin-3 expression. While the cytoplasmic staining in the squamous cell carcinomas was focal and moderately intense, the staining in the adenocarcinomas was diffuse and intense. The IP scores were significantly (P=0.0001) higher in the adenocarcinomas than in the squamous cell carcinomas. The difference in nuclear expression profiles between the two cancer types was statistically significant (P=0.0005). Cox multivariate analysis carried out on the patients’ genders, the TNM classification and the galectin-3-related variables showed that of the galectin-3-related variables, only the nuclear location of galectin-3 was identified as a prognostic indicator of recurrence independent of the clinicopathological features characterizing the patients (P=0.02). The prognostic contribution of this latter variable was enhanced when the patients with relapse-free follow-ups longer than 8 months were considered (P=0.005). Galectin-3 immunohistochemical expression differs between squamous cell carcinomas and adenocarcinomas, but the nuclear expression of galectin-3 behaves as a significant prognostic predictor for all the cases as a group.