Tumor Poor Prognosis Research Articles

Radical Extensive Surgery for Renal Cell Carcinoma: Long-Term Results and Prognostic Factors

We studied 200 consecutive patients with renal cell carcinoma who underwent radical nephrectomy and extensive lymphadenectomy. Of the patients 25% already had distant metastasis at operation. Higher T stages tended to be associated with positive nodes (p less than 0.01) and distant metastasis (p less than 0.001). However, in patients with stage N0M0V0 tumors we found no statistically significant difference in survival in relationship to the T stage of the disease (5-year survival: stage T1 80%, stage T2 68% and stage T3 70%). Of all patients 10% had positive nodes without distant metastases and no venous spread of the tumor, and the 5-year survival rate was 52%.The 5-year survival rate of patients with distant metastases was 7%. Patient survival in the presence of a vena caval tumor thrombus is similar to that of patients with distant metastases. Based on our results the different stages in disease progression may be classified as having a good prognosis-intracapsular tumors (stages T1 to T2, N0M0V0) and tumors with involvement of perirenal fat (stage T3N0M0V0), an intermediate prognosis-tumors with nodal metastases alone (stages T1 to T3, N1 to 2, M0V0) and a poor prognosis-tumors with venous invasion and/or distant metastases. Histological grading and size of tumor can be used to assess prognosis but are not more accurate than pathological staging.

The Risk of Distant Metastases after Transurethral Resection of the Prostate versus Needle Biopsy in Patients with Localized Prostate Cancer

Although transurethral resection of the prostate provides an effective treatment for obstructive voiding symptoms associated with prostate cancer, there is growing concern about the possible role of transurethral resection in the dissemination of this malignancy. To determine the effect of transurethral resection on the rate of development of distant metastasis, we analyzed a large series of patients (379) treated at our institution with definitive radiotherapy for localized prostate cancer that was diagnosed by either needle biopsy or transurethral prostatic resection. In our series the presence of lymph node metastasis was documented by pelvic lymph node dissection in all patients.An initial univariate analysis suggested that patients diagnosed by transurethral resection had distant metastases significantly more rapidly than patients diagnosed by needle biopsy. However, transurethral resection usually was performed because of the presence of obstructive voiding symptoms and such patients were much more likely to have positive lymph node dissections than patients without obstructive voiding symptoms. A proportional hazards regression analysis showed that nodal status and the degree of obstructive voiding symptoms at diagnosis were independent and powerful predictors of the interval to distant metastases, along with stage and grade. The type of initial biopsy (transurethral prostatic resection versus needle biopsy) had no independent prognostic significance in this analysis. Among patients who had substantial obstructive voiding symptoms there was no significant difference in interval to distant metastases between the transurethral prostatic resection and needle biopsy groups.We conclude that the apparent adverse effect of transurethral prostatic resection results from the poor prognosis of tumors causing obstructive voiding symptoms rather than as a direct result of the resection itself.

Classification and Staging of Pancreatic Nonendocrine Tumors

Pancreatic nonendocrine tumors are classified according to their histogenetic origin. This results in tumor entities that differ in biology and prognosis. Ductal adenocarcinoma is the dominating pancreatic tumor. Although its morphology is well known, our knowledge of its biology is limited. A grading system is presented for a better individual characterization of ductal adenocarcinoma. The tumor's poor prognosis is due to an early spread to retroperitoneal tissues. This most likely accounts for tumor recurrence so frequently seen after "curative" resection. Tumors other than ductal adenocarcinoma comprise only a minority of pancreatic neoplasms but must not be neglected because of their particular biological features.

Prognostic criteria for experimental protocols in pediatric brainstem gliomas

Prognostic criteria were developed to select children with high-risk brainstem gliomas for experimental treatment with hyperfractionated radiation. Patients were required to have ( a) tumors confined primarily to the brainstem; ( b) positive findings in two of three groups of neurologic signs (cranial nerve deficits and long-tract and cerebellar signs), and ( c) symptom duration of less than 6 months. The 18-month survival of only 1 of 33 evaluable patients suggests that these criteria did in fact select tumors of poor prognosis. Such noninvasive predictors provide a valuable means of selecting for experimental treatment those children who would not be expected to benefit from standard therapies for malignant brainstem tumors. These criteria do not require routine biopsy for prognostic purposes, and avoid exposing the children to unnecessary risk.

Public education programmes to encourage survival from malignant melanoma—the Glasgow experience

At a previous annual meeting we demonstrated the need for public education to encourage earlier presentation of malignant melanoma and thus treatment of thinner lesions and subsequently improved survival.1. A grant-funded public education programme was organized in the West of Scotland during the spring of 1985 with the specific aim of encouraging early recognition of curable melanoma. An integral part of this project was measurement of the increased workload generated with regard to all types of pigmented lesions. It was considered that an early marker of a beneficial effect of educational activities would be a rise in the proportion of thin, good prognosis melanomas 0–1.5 mm thick and a fall in both absolute numbers and proportions of poor prognosis tumours thicker than 35 mm. In 1984, the year prior to the campaign, 158 cutaneous melanomas were first diagnosed in the West of Scotland. Of these, 69 (44%) were in the thin, good prognosis group and 47 (30%) were in the thick, poor prognosis group. Intensive public education took place in May and June 1985. 192 cutaneous melanomas were first diagnosed in the West of Scotland during 1985, including 104 (54%) thin melanomas and 46 (24%) thick melanomas. Both the rise in proportions and numbers of thin tumours and the fall in proportions of thick tumours are statistically significant by comparison with 1984 figures and also for all pooled figures for the years 1979–1984 inclusive. Numbers of non-melanoma pigmented lesions referred and also numbers of such lesions subsequently excised were recorded, to give a measure of increase in non-melanoma workload. Small rises in such referrals for June and July 1985 were noted by comparison with June and July 1984 for three of four Glasgow teaching hospitals. The great majority of these referrals, however, were directed through the pigmented lesion clinic (40 patients June/July 1984 and 151 patients June/July 1985). This pigmented lesion clinic currently sees 25 non-melanoma pigmented lesions per new melanoma, a figure which compares favourably with 160 patients screened per new melanoma quoted by Arundell (personal communication) for American Skin Cancer Health Fairs. A survey of a sample of patients suggests that television is the most effective educational approach, with radio, leaflets and posters in descending order of efficacy. Numbers of pigmented lesions considered to require excision rose in the laboratory receiving material from the pigmented lesion clinic in 1985 by comparison with 1984, but numbers of similar lesions fell in the laboratory receiving material from the plastic surgery service. The Glasgow experience suggests that the public is receptive to public education and that a detectable increase in attendance with pigmented lesions is apparent 2 weeks after a public education exercise. Analysis of tumour thickness suggests that the proportion of thin tumours has risen in association with educational activities. Any increase in non-melanoma workload should be taken in context with the prior workload for these lesions and also with changes in referral pattern during the period of educational activities.

High-dose chemotherapy with frozen autologous marrow transplantation in patients with poor-prognosis tumors

High-dose chemotherapy with frozen autologous marrow transplantation in patients with poor-prognosis tumors

Complications of postoperative radiotherapy in uterine cancer

A report is given about reversible and irreversible complications following postoperative irradiation in cases of endometrial carcinomas. Intravaginal brachytherapy (Ra226, vaginal cylinder applicator) is given. In advanced cases or in cases with poor prognosis (tumor grading) percutaneous irradiation was added (Co60). Reversible complications (cystitis, proctitis) could be observed in 7%, irreversible complications (fistulas, stenosis) in 1.9% of the cases, respectively. The rate of radiation side effects after primary operation is lower than after primary irradiation of endometrial carcinoma. This is contrary to the results in postoperative irradiation of cervical carcinoma with a markedly higher rate of irradiation side effects. After postoperative intravaginal brachytherapy (Ra226) alone, only in 5.9% of the cases reversible and in 0.8% irreversible complications were observed.

Successful treatment of metastatic extragonadal endodermal sinus (Yolk Sac) tumor in childhood

Two children with metastatic extragonadal endodermal sinus tumor who had failed VAC chemotherapy were treated with combination chemotherapy consisting of cis-platinum, vinblastine, doxorubicin HCl (Adriamycin) and bleomycin (cis-VAB). There was a complete response in both patients with one child remaining tumor-free 3 1/2 years after metastasis and 2 1/2 years after stopping therapy. The main toxic reactions encountered were associated with the use of cis-platinum, but these were manageable and resolved upon completion of therapy. Cis-VAB appears to be a safe and effective regimen for the treatment of metastatic endodermal sinus tumor. A study of the efficacy of cis-VAB in a larger group of children with endodermal sinus tumor of poor prognosis seems indicated.