pT2 Group Research Articles

Modern surgical results of lung cancer involving neighboring structures: A retrospective analysis of 531 pT3 cases in a Japanese Lung Cancer Registry Study

The aim of the present study was to identify the modern surgical results of pathologic T3 lung cancer and to examine the heterogeneity of this group from the nationwide database. The registered data of 11,663 cases from the Japanese Joint Committee of Lung Cancer Registry conducted in 2010 were analyzed, which included patients with resected lung cancer during 2004. Of these patients, 531 with invasive T3 lung cancer constituted the study population. Of the 531 patients, 466 were men and 65 women, with a mean age of 65.9 years. The 3- and 5-year survival rates and median survival time was 54.0%, 44.9%, and 46 months, respectively. A multivariate analysis showed incomplete resection, N2 disease, and no adjuvant therapy were independent prognostic factors of a poor outcome. However, pneumonectomy and N1 disease were not significantly associated with the prognosis. In terms of each involved structure, we detected 407 patients with T3 tumors involving the chest wall, 56 involving the mediastinal pleura, 45 with involvement of the bronchus within 2 cm of the carina, 31 involving the diaphragm, and 20 involving the pericardium. The corresponding 5-year survival rates were 43.2%, 40.1%, 55.2%, 42.6%, and 54.2%. The modern 5-year survival rates of patients with T3 lung cancer involving any neighboring structures have been 40% to 55%, and the current pT3 group was proved to have a relatively uniform prognosis.

Abstract 1164: MTUS1 as a potential progression marker at chromosome 8p in bladder cancer

Abstract Aims and background: The search for sensitive and specific progression and recurrence markers in bladder cancer is a major focus of many urological research groups. The aim of this study was to identify biomarkers on chromosome 8p in papillary urothelial carcinoma that give evidence for progression from non-invasive pTa to invasive pT1 stage. Candidate genes should be analyzed functionally in cell lines and validated immunohistochemically using tissue micro arrays. Material and methods: To find new progression markers 19 papillary urothelial carcinomas (9 pTa and 10 pT1) were investigated with array comparative genomic hybridization (aCGH) on Affymetrix Genome-Wide Human SNP Array 6.0. Therefore, tumor slides were manually microdissected, genomic DNA was isolated and DNA was hybridized on Affymetrix Chip together with reference DNA from 167 tumor-free patients. Computational analysis was performed with free Software “Genotyping-Console” from Affymetrix. MTUS1 gene and protein expression were investigated in bladder cancer cell lines and tumor tissue using qRT-PCR, Western blot and immunohistochemistry. Results: aCGH revealed more chromosomal aberrations overall as well as more deletions on chromosome 8p in pT1 tumors (50%) compared to pTa tumors (11%). Several putative progression-associated genes could be identified on 8p, for example SLC7A2, PDGFL, MTUS1, FGL1 and PCM1. MTUS1 (microtubule associated tumor suppressor 1) was chosen for further analysis, as in other tumor types this gene is known to be associated with frequent loss of heterozygosity at 8p22. However, to our knowledge, not much is known about its role in bladder cancer. Western blot analysis revealed expression of different isoforms in cell lines (140, 80 and 60 kDa) and tumor tissue (mainly 80kDa). Immunohistochemical staining of 128 papillary and 236 advanced tumors showed conflicting results compared to the aCGH findings. Conclusion: Whereas loss of genetic material at 8p22 harboring the MTUS1 gene is significantly associated with a pT1 stage in papillary urothelial carcinoma, pT1 tumors showed a significantly higher MTUS1 expression than pTa tumors as was shown by immunohistochemistry. At least in the pT1 group, expression loss contributed to worse overall survival, suggesting MTUS1 as a prognostic marker. Functional effects of MTUS1 overexpression will be analyzed in the future in RT112 cell line. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1164. doi:1538-7445.AM2012-1164

Transanal endoscopic microsurgery: results of the first 50 cases

The aim of the study was to share the experience and first results of implementation of transanal endoscopic microsurgery (TEM) technique for the removal of rectal adenomas, early rectal cancer or rectal stricture in the Center of Oncosurgery, Oncology Institute of Vilnius University. Materials and methods. From October 2009 to October 2011, a total of 50 patients underwent TEM for rectal adenomas, early rectal cancer or rectal stricture. The patients were 25 women and 25 men, 31 to 87 years of age (average 65 years). Rectal lesions were from 0.9 to 7.0 cm in diameter, 3–13 cm from the anal verge. Full thickness excision with 1 cm safety margin was achieved in all cases except two (mucosal excision), followed by closing of the rectal wall defect in one-layer running monocryl 3.0 suture using silver clips. In one case (TEM was performed for T2 rectal cancer), abdominal cavity was penetrated and two-layer closure was preferred. Results. In these series of 50 patients there was 1 (2%) complication (cystitis). No postoperative exitus occurred. The hospitalisation period ranged from 2 to 13 days (average 6 days). Final histology revealed 30 (60%) tubular or villous adenomas, 6 (12%) carcinomas in situ (pTis), 7 (14%) T1, 4 (8%) T2 cancers, and well-differentiated neuroendocrine tumors in 3 (6%) were diagnosed. One patient underwent open partial TME in pT1 group; the tumor was in the upper third of rectum and preoperatively evaluated as pTis disease. In two cases (pT1 group) lymphovascular invasion was present on final pathology, so they were offered a postoperative adjuvant chemoradiotherapy. Other 4 patients in T1 group are under surveillance. All 4 patients with T2 lesions were offered adjuvant chemoradiotherapy, one patient refused further treatment. Conclusions. TEM is an alternative for transanal excision of rectal adenomas and early rectal cancer. Further follow-up is necessary to evaluate the recurrence rate of cancer in invasive cancer patients group.

T3 Subdivision Correlation with Nodal or Distant Metastasis in Colorectal Cancer; Is It Practically Useful?

See Article on Page 160-164 The pathological staging system has been regarded as a guideline for predicting the prognosis of patients and for deciding on the need for further adjuvant treatment. In this issue, the Yoo et al. [1] analyzed 555 colorectal cancer patients who underwent curative surgery, especially for pT3 cancer subdivided according to the depth of tumor infiltration beyond the muscle proper layer: 15 mm. These 4 types of pT3 subdivisions were shown to be deeply correlated to the known prognostic histopathologic factors. One thing they did not analyze was the relation between T3 subdivision and the 5-year disease-free survival rate. They only compared pT3 subdivision with nodal and distant metastasis; furthermore, their multivariate analysis revealed that pT3 subtype might be an independent prognostic factor in colorectal cancer. Some studies regarding the relevant risk factors for regional lymph node metastasis in submucosal adenocarcinomas have been performed, and some of those measured not only the submucosal depth of invasion but also tumor budding, lymphatic invasion, vascular invasion, etc. In rectal cancer, the circumferential resection margin (CRM) and tumor deposit also have been reported as important risk factors for predicting patient prognosis, but none of those are recognized as definite prognostic factors in the current American Joint Committee on Cancer (AJCC) staging system. However, several reports have already demonstrated extramural invasion depth to be related with nodal metastasis and distant metastasis in colorectal cancer. Interestingly, pT3 subdivision has been analyzed and has been reported as a prognostic factor in rectal cancer patients not colon cancer patients. Miyoshi et al. [2] analyzed pT3 rectal cancer patients according to a 6-mm cutoff value for the extent of mesorectal invasion, and there were definite differences in the overall 5-year survival rates between the two groups of patients. Kim et al. [3] reported an interesting study regarding how to select high-risk rectal cancer patients based on preoperative local staging using rectal magnetic resonance imaging (MRI). He compared the extent of mesorectal invasion between whole mounted rectal cancer histopathology and MRI using a 5-mm cutoff value to evaluate its value as a prognostic indicator. The overall accuracy of preoperative MRI was 88%, which means MRI can be used to select patient who show T3 with 5-mm infiltration beyond the muscle layer. Those patients could be candidates for preoperative chemoradiation. Unfortunately, T3 pathological subdivision is not accepted as a prognostic factor in the new AJCC tumor-node-metastasis staging system, Furthermore, cutoff points for the penetration depth of cancer invasion beyond the muscle proper layer have not been determined. Currently, most pathologists do not report T3 subdivision, and as far as I can determine, they seem in Korea to be reluctant to measure the distance of tumor infiltration beyond the muscle proper layer. If pT3 subdivision might be a clinically significant prognostic factor, two issues still remain to be solved. One is the lack of a consensus about cutoff points, which should be studied more based on a large patient cohort; the other involves the support and cooperation of pathologists. Based on personal experiences concerning pathological descriptions of the CRM, we have had long discussions and cooperative conferences with pathologists. Currently, CRM status documentation is mandatory in pathological reports submitted in Korea. I think this study showed us an important message about the heterogeneity of the prognoses for the pT3 group of patients. Conventionally, we have not paid attention to the prognoses of colorectal cancer patients in the same category of pT3 patients. Important feedback to the multidisciplinary team conference can allow patients with high risk of nodal and distant recurrence after curative surgery to be identified. Therefore, the strategy for treating patients with high risk may be changed based on preoperative modern imaging. Currently, some evidence exists that preoperative chemotherapy or chemoradiotherapy may have oncological benefits compared surgery first [4, 5]. A couple of well-known high-risk factors are CRM status, tumor deposit, vascular encasement of nodes, etc., and patients with such factors should be candidates for preoperative treatment. Hopefully, pT3 subdivision may be a candidate for use as another high-risk factor, but it seems to have a long way to go.

Exploring diversity of Erwinia amylovora population in Serbia by conventional and automated techniquesand detection of new PFGE patterns

Forty Erwinia amylovora strains originating from different host plants and locations in Serbia and one strain from Montenegro were characterized by conventional, automated and molecular techniques. All strains were Gram-negative, nonfluorescent, facultative anaerobes, oxidase negative, levan positive, produced necrotic lesions followed by bacterial exudate on artificially inoculated immature pear fruits and caused HR on tobacco. Based on carbon source utilization, all strains tested with the Biolog system were identified as E. amylovora. Based on fatty acid profiles all tested strains clustered into three groups in which strains from north Serbia differed from strains isolated in central and south parts of the country. Restriction analysis of genomic DNA using XbaI and PFGE resulted in six different patterns differentiating the strains into six groups. Most of the investigated strains clustered in one group having the pattern type similar to Pt2 group described earlier as dominant in East Europe and the Mediterranean region. Two strains showed PFGE pattern similar to the previously described Pt3 pattern and one strain had pattern similar to Pt6. Based on size and number of the bands, new restriction patterns, assigned as Pt7, Pt8 and Pt9 were observed. PFGE results showed that the E. amylovora population in Serbia is not homogenous and was possibly introduced from different directions. This is the first characterization of E. amylovora collection of strains from Serbia using fatty acid analysis and PFGE.

The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer

To report the impact of microscopic extrathyroid extension (ETE) on outcome in patients with cT1/cT2 well-differentiated thyroid cancer (WDTC), and to determine the effect of extent of surgery and adjuvant radioactive iodine (RAI) treatment on outcome in patients with microscopic ETE. From an institutional database, we identified 984 patients (54%) who underwent surgery for cT1/T2N0 disease. Of these, 869 patients were pT1/T2 and 115 were upstaged to pT3 based on the finding of microscopic ETE. Disease-specific survival (DSS) and recurrence-free survival (RFS) were analyzed for each group using the Kaplan-Meier method. In the pT3 group, factors predictive of outcome were analyzed by univariate and multivariate analyses. There was no difference in the 10-year DSS (99% vs 100%; P = .733) or RFS (98% vs 95%; P = .188) on comparison of the pT1/pT2 and pT3 cohorts. Extent of surgery and administration of postoperative RAI were not significant for recurrence on univariate or multivariate analysis in the pT3 cohort. Outcomes in patients with cT1T2N0 WDTC are excellent and not affected by microscopic ETE. The extent of resection and administration of postoperative RAI in patients with microscopic ETE does not impact survival or recurrence.

Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland’s first robotic radical prostatectomy centre

We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system. The series data were gathered prospectively in a consecutive series. Focus was given to the outcome trifecta of oncological control, urinary continence and erectile function. We also report on complications reported using the Clavien-Dindo classification. Mean patient age was 58.86 years, with a range between 47 and 71 years. Positive surgical margin rates were 11.3% overall (n = 14); 7.8% (n = 8) in the pT2 group (n = 101) and 30% (n = 6) in the pT3/pT4 (n = 20) group. 93% (n = 125) of patients are continent at 6 months. Biochemical recurrence-free survival was 92.4%. 72% (n = 43) of patients under the age of 65 with normal preoperative erectile function are potent at 1 year post-operatively. No patient in this series required a blood transfusion. Some form of relatively minor complication occurred in 12.8% (n = 16) of cases; there was no mortality rate, and no complication was life-threatening or resulted in single-organ or multiple-organ failure. With a combination of high-level fellowship training of surgeons, a co-operative and combined approach to cases between surgeons, institutional support, and enthusiasm, encouragement and dedication from ancillary staff and colleagues, we have shown that a programme can be established with excellent levels of safety and efficacy.

Transanal endoscopic microsurgery: A single centre experience

Introduction: The aim of this study was to evaluate the implementation of transanal endoscopic microsurgery (TEM) technique for the removal of rectal adenomas or early rectal cancer in the Centre of Oncosurgery, Oncology Institute of Vilnius University. Methods: From October 2009 to June 2011 a total of 41 patients underwent TEM for rectal adenomas or early rectal cancer. 19 were women and 22 men, median age was 64 years, range 31 to 87 years. Rectal lesions were from 0 9 to 7 0 cm in diameter, and 3 to 13 cm from the anal verge. Full thickness excision with one cm safety margins was attempted in all cases, followed by closing of the rectal wall defect in one-layer using a running monocryl 3.0 suture using silver clips. In one case (TEM for T2 rectal cancer), the abdominal cavity was penetrated and two-layer closure was performed. Results: In these series of 41 patients there were no complications or deaths. Hospital stay ranged from 2 to 13 days, average 6 days. Final histology revealed 24 (59%) lesions to be tubular or villous adenomas, in 6 (15%) foci of carcinoma in situ (pTis) were present. Five (12%) were TNM stagepT1 and 4 (10%) werepT2 cancers. Well-differentiated neuroendocrine tumors were found in 2 (4%). A 60 year old woman underwent open partial TME in the pT1 group; her tumor was in upper third of the rectum and preoperatively judged as pTis. In another case (pT1 group) in an 81 year old man, lymphovascular invasion was present on final pathology. He received postoperative adjuvant chemoradiotherapy. All patients are under surveillance. Conclusion: TEM is safe and is an alternative to transanal excision for rectal adenomas and early rectal cancer. Further follow-up is necessary to evaluate recurrence rates and oncological results in a subgroup of patients with invasive rectal cancer. Key words: Rectal polyp; Rectal cancer; Transanal endoscopic microsurgery (TEM) DOI: http://dx.doi.org/10.4038/sljs.v29i1.3577 Sri Lanka Journal of Surgery 2011: 29(1) 19-22

Lymph node dissection during laparoscopic (LRC) and open (ORC) radical cystectomy due to muscle invasive bladder urothelial cancer (pT2-3, TCC).

AimThe aim of the study was to compare the number of nodes dissected during laparoscopic and open radical cystoprostatectomy in men or anterior exenteration in women due to muscle invasive bladder urothelial cancer (IBC).Material and methodsFifty-one patients treated with laparoscopic radical cystectomy (LRC) and 63 with open radical cystectomy (ORC) were compared. The LRC group consisted of 47 pT2 tumours and 4 pT3, while the ORC group was composed of 27 pT2 tumours and 36 pT3. During ORC external, internal, common iliac and obturator lymph nodes were removed separately, but were added and analysed together for each side. Nodes dissected from one side during ORC were compared to en bloc dissected nodes in the LRC group.ResultsThere were no complications associated with extended pelvic lymph node dissection during LRC or ORC. There were significant differences in the mean number of resected lymph nodes between LRC and ORC for pT2 tumours. The laparoscopic approach allowed about 8-9 more lymph nodes to be removed than open surgery in the pT2 group. In 15% of patients with pT2 disease treated with open radical cystectomy node metastases were observed. Active disease was detected in 18% of nodes resected laparoscopically due to pT2 disease. Fourty-seven percentage of patients with pT3 disease treated with open surgery were diagnosed as harbouring metastatic lymph nodes. The laparoscopic group with pT3 disease was too small to analyse.ConclusionsWe have found that laparoscopic radical cystectomy can be performed without any compromise in lymph node dissection. The technique of lymph node dissection (LND) during laparoscopic cystectomy (LRC) resulted in sufficient resected lymphatic tissue, especially in patients with bladder-confined tumours with a low volume of lymph nodes.

643 WHAT ABOUT REPRODUCIBILITY OF DECISION MADE AT MULTIDISCIPLINARY TEAM MANAGEMENT?

You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011643 WHAT ABOUT REPRODUCIBILITY OF DECISION MADE AT MULTIDISCIPLINARY TEAM MANAGEMENT? Younes Bayoud, Johann Menard, Thomas Ripert, Marie Dominique Azemar, Rabah Messaoudi, and Frederic Staerman Younes BayoudYounes Bayoud Reims, France More articles by this author , Johann MenardJohann Menard Reims, France More articles by this author , Thomas RipertThomas Ripert Reims, France More articles by this author , Marie Dominique AzemarMarie Dominique Azemar Reims, France More articles by this author , Rabah MessaoudiRabah Messaoudi Reims, France More articles by this author , and Frederic StaermanFrederic Staerman Reims, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1545AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES to evaluate the reproducibility of thérapeutic decisions made at multidisciplinary team management (MDTM). We compared therapeutic decision of prostate cancer by presenting the same file of patient under a false identity, after a period of first presentation at MDTM. METHODS Forty-nine file of radical prostatectomy (RP) (28 pT2, 21 pT3) performed for clinical loalised prostate cancer were represented at MDTM. Patient's File was identical but the identitiy was false. Patients were represented at MDTM 6 to 12 months after the first presentation. The MDTM included urologist, oncologist, pathologist and radiologist. Therapeutic decisions were analysed using criteria as: TNM stage, Gleason score, margin status. The reproducibility was assessed statistically by Kappa (k) coefficient. RESULTS Forty-nine patients were presented a second time at MDTM. The distribution of cohort was as follows: 28 pT2c and 21 pT3 (14 pT3a, 7 pT3b). The mean age was similar in both groups. The mean PSA was 8.32 ng/ml (3.56–19.5) in pT2 group and 9.4ng/ml (3.8–22) in pT3 group. The margin status was positive in 25% and 47.6% respectively in pT2 and pT3 group. Decision made for pT2 group were the same in 100% case with k=1. In the group of pT3 (n=7), 33% of decision were different at second presentation at MDTM, especially for pT3b with only 29% reproducible decision with k= 0.1. Concerning a group of pT3a, 86% of decision were reproducible with k= 0.74. CONCLUSIONS This study showed a reliability and reproducibility of decision made at MDTM when guidelines were well defined. The therapeutic attitude were less reproducible in locally advanced prostate cancer but the decision concerning those cases should be made in the set of guidelines at MDTM. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e260 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Younes Bayoud Reims, France More articles by this author Johann Menard Reims, France More articles by this author Thomas Ripert Reims, France More articles by this author Marie Dominique Azemar Reims, France More articles by this author Rabah Messaoudi Reims, France More articles by this author Frederic Staerman Reims, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidence, management, and outcome of incidental gallbladder carcinoma: analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery

Little is known about the long-term survival of patients with incidental gallbladder carcinoma (IGBC). The role of radical resection for this disease is discussed controversially in the literature. We present the long-term survival and the results of re-resection versus simple cholecystectomy of the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) from 1994 to 2004. Eighty-nine patients with histologically confirmed carcinoma of the gallbladder were identified out of 30,960 patients undergoing laparoscopic cholecystectomy. Sixty-nine patients were included in our study. Long-term survival by different T-stage and comparison of patients with extended resection versus simple cholecystectomy were calculated using the log-rank test. The time-to-event data are demonstrated by Kaplan-Meier curves. The overall incidence of IGBC in patients who underwent laparoscopic cholecystectomy was 0.28% (89 of 30,960). Fifty patients underwent simple cholecystectomy [n = 2: carcinoma in situ (CIS); n = 2: pT1a; n = 10: pT1b; n = 23: pT2; n = 8: pT3; n = 5: pT4], whereas extended resection was performed in 19 cases (n = 2: pT1b; n = 11: pT2; n = 6: pT3). The comparison of simple cholecystectomy versus extended re-resection of the gallbladder bed and regional lymph node resections showed a significant benefit in overall survival for the pT2 and pT3 group (p < 0.05). The pT1b group showed no significant benefit in overall survival (p = 0.34). IGBC has a low incidence (0.28%). We present a large study of patients with IGBC, comparing the overall survival by different histological findings. We observed a significant benefit for the group with pT2 and pT3. Therefore we recommend extended resection of the gallbladder bed and the regional lymph nodes for patient with incidental histologically confirmed pT2 and pT3 carcinoma of the gallbladder after performance of laparoscopic cholecystectomy. For patients with pT1b stage no recommendations can be given based on this study.

Expression immunohistochimique de l’endothéline-1 sur biopsies prostatiques : marqueur pronostique d’adénocarcinome localement avancé ?

The study evaluated the immunohistochemistry expression of endothelin-1 (ET-1) by prostate cancer (PCa) in prostate biopsies as an extracapsular stage (pT3a) prognostic factor. Sixty-eight radical prostatectomies (RP) were performed for clinically localised PCa (35 pT2 and 33 pT3a according to the 2002 pTNM classification). Age, digital rectal examination, initial PSA, biopsy Gleason score, positive biopsies ratio, specimen Gleason score, biopsy and RP specimen perineural neoplasic invasion, PCa DNA ploidy, PCa Ki-67 DNA image cytometry and biopsy and RP specimen ET-1 immunohistochemistry expression for both group were compared. Semi-quantitative ET-1 staining assessment was realised by the same pathologist. pT3a group initial PSA was higher (p=0.032). No statistically difference was noticed between pT2 and pT3a groups for positive biopsies ratio, biopsy perineural neoplastic invasion and biopsy DNA ploidy determination. Biopsy Gleason score > or =7 was predictive of a pT3a stage (p=0.03). Statistically higher intensity of ET-1 PCa expression was observed in biopsies and specimens in pT3a group than in pT2 group (p<0.001 and p=0.01). In multivariate analysis, biopsy ET-1 PCa expression was an independent risk factor of pT3a stage with specificity 79 %, sensibility 69 %, predictive positive value 77 % and negative positive value 72 %. Combined with initial PSA > or =7, values were respectively 100 %, 76.9 %, 100 % and 57.1 %. Endothelin-1 (ET-1) prostate cancer biopsy expression in our study was an independent prognostic factor of extracapsular stage (pT3a). Further studies will assess the relevance of ET-1 expression study in clinically localised PCa for active surveillance, curative treatment or targeted adjuvant therapy management.

Contiguous invasion per se does not affect prognosis in colon cancer

Locally advanced colon cancer can result in serious clinical conditions unless treated appropriately. The aim of this study was to examine the feasibility of en bloc resection and the significance of depth of invasion by analyzing the outcomes of the procedure in colon cancer invading adjacent organs. Outcomes of 65 locally advanced colon cancer patients who underwent en bloc resections for contiguous invasion were compared with 285 pT3 colon cancer patients. En bloc combined resection was performed in 75 patients and 10 (13.3%) of them showed no true malignant infiltration into adjacent organs. In both pT3 and pT4 groups, there was no significant difference in major postoperative complications or mortality. The survival rate of pT4 group was similar to that of pT3 group (5-year rate, 64.0% vs. 72.7%; P = 0.287). In multivariate analysis, lymph node metastasis, lymphovascular infiltration, and perineural invasion were independently associated with patient survival. The prognosis of colon cancer, even in locally advanced cases, is mainly correlated with nodal status rather than depth of invasion. Therefore, en bloc combined resection in locally advanced colon cancer invading adjacent organs can improve survival as well as local control with acceptable morbidity and mortality.

Adiponectin as a potential marker of prostate cancer progression: studies in organ-confined and locally advanced prostate cancer

Serum levels of adiponectin were measured in patients with benign prostatic hyperplasia and prostate cancer of pT2 and pT3 stage. Adiponectin ELISA assay, immunohistochemistry, and selected metabolic and biochemical parameters measurement was performed in 25 patients with benign prostatic hyperplasia and 43 with prostate cancer (17 patients with organ-confined and 26 patients with locally advanced disease). Serum adiponectin levels did not differ between prostate benign hyperplasia and cancer clinical stage T2, but was significantly higher in pT3 relative to pT2 group (14.51+/-4.92 vs. 21.41+/-8.12, P = 0.003). Tissue immunohistochemistry showed enhanced staining in neoplastic prostate glands and intraepithelial neoplasia relative to benign prostatic hyperplasia without distinction between disease grade and stage. Serum adiponectin levels are higher in locally advanced relative to organ-confined prostate cancer and may thus serve as an auxiliary marker providing further improvement for discrimination between pT2 and pT3 stages.

The Clinical Relevance of Distinguishing pT2 Gastric Cancer According to the Depth of Invasion and a Difference of Prognosis

Purpose：A difference of a pathologic characteristic in proportion to depth of invasion analyzed in T2 gastric cancer and a difference of depth of invasion examined an influence to lymph node metastasis and prognosis. Materials and Methods：The clinicopathologic outcomes of 432 patients who underwent curative resection for pT2 stage gastric cancers from 1995 to 1999 were reviewed retrospectively. We are compared on lymphatic metastasis, stage distribution, histologic classification, Bormann’s classification, Lauren classification, vessel invasion, lymphatic invasion, neural invasion and 5-year survival rate of pT2 groups(mp vs. ss). Results：pT2b(ss) group compare to pT2a(mp) in Lauren classification, ratio of diffused type was higher(p<0.05) and in Bormann classification, infiltration type was higher (p<0.01). Vessel and lymphatic invasion, neural invasion showed significant difference between pT2a(mp) and pT2b(ss) (p<0.01). Difference noted between pT2a(mp) and pT2b(ss) group in a lymph node metastatic rate, degree of a metastasis and stage distribution (p<0.01). On stratifying patients according to depth of invasion, 5-year suvival rate for those with pT2a(mp) group was significantly greater than those with pT2b(ss) group(82.4% vs. 47.4%, respectively: P<0.01). In this study, appeared with the significant prognostic factor in 5-year suvival rate which multivariate analysis, depth of invasion(P<0.05) and lymph node metastasis (P<0.01) that enforced the total gastric cancer patient who had T2 gastric cancer with the object noted, but for patients with accurately staged pN0 group, suvival characteristics were similar for pT2a (mp) and pT2b(ss) gastric cancer (P=0.97). Conclusion：The subclassification of pT2 gastric cancer into pT2a(mp) and pT2b(ss) is necessary to demonstrate their different prognosis.

Long-term oncologic results of patients with distal rectal cancer treated by local excision with or without adjuvant treatment

The aim of this study is to review long-term oncologic results of local excision (LE) and to investigate the validity and feasibility of LE as a treatment option for distal rectal cancer. Seventy-six patients who underwent LE for distal rectal adenocarcinoma with curative intent from 1991 to 2000 at Severance Hospital Yonsei University Medical Center, Seoul, Korea were enrolled in this study. Preoperative transrectal ultrasonography revealed 3 cases of uT0, 55 cases of uT1 and 18 cases of uT2. Postoperative pathologic examination revealed 10 cases of pT0 (where no residual cancer cells remained), 11 cases of pTis, 37 cases of pT1, 16 cases of pT2, and 2 cases of pT3. Eleven out of 37 patients with pT1 tumors received adjuvant radiation therapy. Among 16 patients with pT2 tumor, 7 undertook salvage operation and 8 received adjuvant therapy. The median follow-up period was 84.9 months. Local recurrence was observed in six patients. The 5-year local recurrence-free survival rate (LFS) was 89.4% in the pT1 group and 75.0% in the pT2 group (p = 0.012). Among the patients with pT1 cancer, those who received adjuvant radiation therapy demonstrated a 5-year LFS of 100%, compared to those who did not, 76.0% (p = 0.038). Our results imply a potential role of LE and adjuvant radiation as an option for the treatment of distal rectal cancer, and that even for pT1 carcinoma, LE alone might not be a valid modality.

Prognostic value of morphologic and clinical parameters in pT2 - pT3 prostate cancer

Verify the efficacy of clinical and morphologic parameters currently applied, including an immunohistochemical panel, in the prognostic of prostate cancer, in specific stages of the disease. In the period from 2002 to 2005, 40 surgical specimens were selected from patients submitted to radical prostatectomy, with their respective diagnostic biopsies. Based on the pathological stage pT2 or pT3, the specimens were separated into two groups, each one with 20 specimens. The results were confronted with pre- and postoperative clinical data. Between the groups studied, the following was also analyzed: the profile of the expression of molecular markers such as PSA, E-caderin, chromogranin-A, synaptofisin, P53 and Ki-67, both in the material coming from the prostatic biopsy and from the surgical specimens of all patients. Data showed that patients with prostate-confined disease (pT2) presented lower PSA and Gleason score rates, in relation to the group with extra-prostatic disease (pT3). Quantitative measures obtained for the percentage of positive fragments from the biopsy revealed that patients from the pT2 group presented a lower mean percentage when compared to the pT3 group. Positive margins of both groups influenced the need for complementary treatment before biochemical progression. The comparison of the molecular marker expression in both stages was not significantly different. It is evident the need to improve new methods, predominantly morphologic and molecular, that are able to further exploit the study of the material from the prostatic biopsy. As to the profile of the molecular markers used in both studied groups, there was no significant difference in the sense of outlining an additional prognostic factor in the clinical practice.

A proposal for a novel staging system in renal pelvicaliceal urothelial carcinomas

Renal caliceal urothelial carcinomas, which have characteristic microanatomies in which the tumor directly interfaces to the renal parenchyma without intervening muscle propria, are often overstaged using the existing staging system. Relying on our analysis of 150 renal caliceal and/or pelvic urothelial carcinomas, we propose a novel staging scheme based on the extent of invasion relative to the corticomedullary junction (CMJ). Tumors were classified as category pT2 when renal parenchymal invasion was present within the CMJ and where the renal papillae and medulla were dominant. Tumors going over the CMJ were classified as pT3 with the proposed new scheme. It is very important to exclude pagetoid spread along the collecting ducts/ducts of Bellini to evaluate true invasion into the renal parenchyma. Using this revised staging scheme, 38.5% of tumors that were previously classified as pT3 were reclassified into the pT2 or pT1 groups. On multivariate Cox proportional hazard regression analysis, the extent of CMJ invasion and peripelvic fat invasion were the most significant prognostic indicators (P < .001, HR, 9.308; P = .016, HR, 2.538, respectively). In the new scheme, pT3 tumors showed a tendency to be classified toward the pT4 stage, whereas pT2 tumors were classified closer to the pT1 stage than to the pT3 (pT3 vs pT4, P = .0127; pT3 vs pT2, P < .0001). Renal parenchymal invasion beyond the CMJ has a strong prognostic impact for renal caliceal carcinomas. Using this new staging scheme, we can more precisely evaluate the level of tumor invasion.

Seasonal Food Use Strategies of Semnopithecus vetulus nestor, at Panadura and Piliyandala, Sri Lanka

Field studies on Semnopithecus vetulus have shown high folivory and the ability to feed heavily on mature leaves, which are constantly available. In research spanning 19 mo, I examined the feeding behavior of 2 free-ranging groups of Semnopithecus vetulus nestor in home gardens and rubber monocultures at Panadura (PT1 group) and Piliyandala (R1 group), Sri Lanka. Overall, results showed that >80% of their diet comprised seasonal plant parts, largely fruits. Despite differences in spatial and temporal food availability in their respective habitats, seasonal plant parts dominated the diets of both groups except briefly (2 mo) for R1 when mature leaf petioles were the main plant food. Both groups increased their use of seasonal foods with heightened seasonal food availability, and increased dietary diversity with declining use of their highest-ranked specific item of diet: fruits of Artocarpus heterophyllus (jakfruit, Moraceae). PT1, which was in a species-rich environment, maintained a high intake of seasonal foods year round by exploiting a large number of species, mainly for fruits. In contrast, R1, in a habitat with significantly lower tree species richness, had a less diverse diet but maintained an equally high intake of seasonal foods, primarily fruits and seeds, by exploiting a few species heavily. My study also highlights the dietary flexibility of a single colobine species in space and time. Such information is useful for conservation planning because rapidly occurring changes are taking place in natural colobine habitats.

Tension and Energy-Free Robotic-Assisted Laparoscopic Radical Prostatectomy with Interfascial Dissection of the Neurovascular Bundles

ObjectivesTo assess overall safety, histopathological outcomes, and early functional results after robotic-assisted laparoscopic radical prostatectomy (RALP) with a new lateral approach for the interfascial dissection of the neurovascular bundles without tension and any use of electrocautery. MethodsBetween April and September 2006, 100 consecutive patients with organ-confined prostate cancer (age<70 yr, PSA≤10μg/dl, Gleason score≤7, and IIEF≥17) underwent RALP by the same senior surgeon. Pre-, intra-, and perioperative data were recorded. The operative technique is described step by step. Patients were assessed at the 4-mo follow-up. ResultsRALP was successfully completed in all patients. Neither blood transfusions nor reintervention were necessary. One week following catheter removal, complete early urinary continence was achieved in 80% of patients, and spontaneous erections or penile tumescence was reported by 46 patients. Positive surgical margins were 12.1% in the pT2 group and 29% in the pT3 group. Ninety-three patients were available for analysis at the 4-mo follow-up. Of them, 92.4% were completely continent, 5.4% used 1 pad a day, and 2.2% used 2 or more pads a day. Concerning the IIEF-EF domain score, 64.5% of the patients reported a total score≥17, and 17.2% of them scored ≥26. ConclusionsThe novel approach described for RALP is safe and allows excellent dissection. It maintains good margin status and provides encouraging early continence and erectile functional results in selected patients. Long-term follow-up is necessary to assess the impact of this approach on oncological outcome.