Predict Tumor Behavior Research Articles

The prognostic significance of nuclear DNA content in malignant epithelial tumors of the ovary

Recent studies have indicated that the nuclear DNA content of certain malignant neoplasms can be used as an adjunct in predicting their biologic behavior. The DNA content of 99 ovarian carcinomas was determined by flow cytometric analysis of nuclei obtained from paraffin-embedded tissue. Of the 99 tumors, 51 were diploid and 48 showed one or more aneuploid peaks. The 5-year survival for patients with diploid tumors (50%) was significantly higher than for patients with aneuploid tumors (22%) (P less than 0.01). Other factors which significantly affected survival were clinical stage (P less than 0.001), tumor pattern grade (P less than 0.01), DNA index (P less than 0.01), the presence of ascites (P less than 0.001), peritoneal carcinomatosis (P less than 0.0001), and residual tumor at second-look laparotomy (P less than 0.05). Diameter of the primary ovarian tumor, diameter of the largest peritoneal implant before debulking, and the percent S-phase had no significant correlation with survival. Of 16 patients with aneuploid tumors who underwent second-look laparotomy, nine (56%) had residual tumor, compared to six of 22 of patients with diploid tumors (27%). Of seven patients with aneuploid tumors and a negative second-look laparotomy, four (57%) died from recurrent tumor. By comparison, of 16 patients with diploid tumors and a negative second-look laparotomy, only four (25%) died from recurrent tumor. The determination of DNA ploidy in ovarian carcinomas may be used as an adjunct in predicting tumor behavior, response to chemotherapy, and late recurrence of disease.

Newer Diagnostic Techniques for Bladder Cancer

As described in the above paragraphs, efforts in the areas of immunology, cytogenetics, molecular biology, and cytopathology have been applied to the problems urologists face in treating the individual patient with bladder cancer. It is hoped that continued investigations in these disciplines will not only lead to earlier diagnosis of bladder cancer and better prediction of tumor behavior but will further our understanding of the molecular basis of oncogenesis.

The prognostic value of substaging colorectal carcinoma. A prospective study of 1117 cases with standardized pathology.

This study further assesses a previously reported clinicopathologic staging system for colorectal carcinoma. By using carefully defined anatomic criteria, various substages of tumor spread have been examined prospectively for their prognostic significance in a group of 1117 patients accessioned over 14 years and documented by the same pathologist. Spread from the muscularis propria into surrounding tissues was not associated with a significant deterioration in prognosis if the lines of resection were clear of tumor and there were no known metastases or free mesothelial surface invasion. Free mesothelial surface invasion by potentially curable tumors was associated with a significant reduction in patient survival. Patients with potentially curable tumors but with lymph node metastases had a significantly poorer probability of survival if the apical lymph node was involved. Among those with incurable tumors, there was no significant difference in survival depending on whether incurability was due to distant metastases or surgical transection of tumor. Substaging offers a means of refining the ability to predict tumor behavior.

OVEREXPRESSION OF THE c-erbB-2 ONCOPROTEIN IN HUMAN BREAST CARCINOMAS: IMMUNOHISTOLOGICAL ASSESSMENT CORRELATES WITH GENE AMPLIFICATION

Amplification of the human proto-oncogene c-erbB-2 was found in 12 of 36 human breast tumours and was associated with increased levels of expression of the c-erbB-2 protein, measured both by immunohistological staining and by western blotting. The use of immunohistological staining to detect the level of expression of the c-erbB-2 protein in human breast adenocarcinomas may be of value in predicting tumour behaviour.

Expression of the C-terminal peptide of human pro-bombesin in 361 lung endocrine tumours, a reliable marker and possible prognostic indicator for small cell carcinoma.

Small cell carcinoma of the lung is a highly malignant tumour. Its known biological products which include bombesin, do not allow the prediction of tumour behaviour. Molecular biology has revealed the amino acid sequence of human pro-bombesin, which consists of a signal peptide, the bioactive bombesin molecule and a C-terminal peptide. We have raised a rabbit antiserum to the first (N-terminal) 21 amino acids of the predicted C-terminal peptide. A total of 505 (361 neuroendocrine) surgically resected pulmonary tumours were evaluated for the presence of immunoreactive bombesin and C-terminal peptide. Strong immunostaining was obtained with the antiserum to the C-terminal peptide of human pro-bombesin in 70% of the small cell carcinomas (175/250), in 63% of atypical (aggressive) carcinoids (31/49) but only in 16% of benign carcinoids (10/62). In contrast, bombesin immunostaining was focal and only moderately strong and the relative proportion of positive cases was quite evenly distributed amongst the neuroendocrine tumours: 35% of carcinoids (22/62), 22% of atypical carcinoids (11/49) and 25% of small cell carcinoma (62/250). None of the squamous, adeno, or large cell undifferentiated carcinomas were immunoreactive for bombesin or the C-terminal peptide. Radioimmunoassay and chromatography of extracts of tumours recovered from wax blocks revealed high concentrations of C-terminal peptide immunoreactivity (241 +/- 66 pmol/g of tissue) in all 12 small cell carcinomas studied, moderate concentrations in carcinoid tumours (50 +/- 7 pmol/g) and none in non-small cell carcinomas. Patients with tumours showing immunoreactivity to the C-terminal peptide of human pro-bombesin had a significantly shorter survival time than those without immunoreactive peptide (185 +/- 16.49 days, mean +/- SEM, and with 1128 +/- 226 days, respectively P greater than 0.02). The apparent presence of the C-terminal peptide of human pro-bombesin in higher concentrations than bombesin in the more malignant class of endocrine tumours, mainly small cell carcinomas associated with the poorest prognosis, suggests that the antiserum to this C-terminal peptide is not only a useful pathological marker but may prove to be of value in investigating the biological behaviour of small cell carcinomas and predicting the clinical course of the disease.

Esthesioneuroblastoma

Thirty-nine patients with esthesioneuroblastoma are reviewed. The presentation of the tumor, symptomatology, investigation, and treatment are discussed. A recommended treatment regimen is outlined. Histologic typing is valueless in predicting tumor behavior. An illustrative and difficult case of recurrent base of skull esthesioneuroblastoma is presented. The resection performed is described, and the problem of extradural oropharyngeal communication is discussed. The solution was to use a temporalis and galeal frontalis flap. Reconstruction was with an external and intraoral prosthesis. Optimal treatment in a fresh lesion is radical surgery with or without radiation therapy. Esthesioneuroblastoma is a rare and often misdiagnosed malignant tumor of the olfactory epithelium. Originally described by Bergen et al. in 1924 as "esthesioneuroepithelioma olfactif," it was introduced into the North American literature by Schall and Lineback in 1951. Since then, fewer than 200 cases have been collected. The various terms used to describe it--olfactory esthesioneuroblastoma, esthesioneurocytoma, and olfactory neuroblastoma--all denote origin from the neural crest. The sensory nerves of smell are short bundles of fibers that originate in the olfactory bulb and pass through the cribriform plate to the olfactory area of the nasal mucosa. This mucosa is located in the most superior part of both nasal fossae. Thus the usual primary sites of occurrence include the superior nasal cavity or nasal septum, and turbinates, the ethmoid, or the cribriform plate, although an extranasal site of origin has been suggested. Symptoms are usually progressive and range from nasal obstruction or epistaxis to diplopia, ocular pain, and headaches in the more advanced disease state.(ABSTRACT TRUNCATED AT 250 WORDS)

Double blind comparison of T-antigen and ABO(H) cell surface antigens in bladder cancer

Transitional cell carcinoma of the bladder is a major cause of cancer deaths. Recently, much attention has been focused on ABO(H) antigen deletion in terms of prediction of prognosis. Furthermore, several studies have shown a correlation between T-antigen (a precursor of blood MN glycoprotein) expression in carcinomas of the breast, colon, and stomach. We have studied 56 specimens from 41 patients with transitional cell carcinoma of the bladder for T-antigen expression and ABO(H) antigen deletion. Results were analyzed with respect to tumor grade, tumor stage, and clinical course. The data indicate that T-antigen expression was not completely useful prognostieally; it did not correlate with grade, stage, or clinical course. ABO(H) antigen expression or deletion was found to be a better predictor of tumor behavior than tumorgrade, despite a false negative rate of 20 to 30 per cent in blood group O patients. We suggest that use of immunoperoxidase techniques will increase the sensitivity in group O patients, thus making ABO(H) deletion a useful predictive parameter of tumor aggressiveness. This is currently being evaluated in our patients.

Clinical role of the mixed cell agglutination test in the prospective management of superficial bladder tumors

The mixed cell agglutination test allows the selection of patients with transitional cell carcinoma of the bladder who are at risk to develop invasive disease. A review of our retrospective experience and that of others reveals an overall accuracy of 78% in the prediction of tumor behavior. Current prospective studies are described and a rational, selective approach to the follow-up of bladder tumor patients, influenced by the MCA test result, is advocated.