Tumor Capsule Invasion Research Articles

Postoperative adjuvant transarterial chemoembolization after curative resection reduces early recurrence of hepatocellular carcinoma

Objective To investigate the efficacy of transarterial chemoemblozaition (TACE) in preventing, detecting and treating recurrence of hepatocellular carcinoma (HCC) in patients after liver resection. Methods 166 patients who underwent liver resection followed by adjuvant TACE and 190 patients with liver resection alone were retrospectively studied. Multivariate analyses and subgroup analyses were performed to investigate the risk factors of recurrence. The recurrence and survival rates were calculated. The role of postoperative adjuvant TACE in enhancing sensitivity of CT/MRI to detect recurrence was also analyzed. Results Multivariate analyses revealed tumor capsule invasion, vascular invasion and multiple no-dules were risk factors of early recurrence (all P<0.05). HBsAg positivity was closely related to late recurrence. The 6-, 12-, 18-, and 24-month recurrence rates between patients who underwent liver resection + TACE and liver resection alone were 23.2% vs 59.4%, 68.4% vs 72.5%, 83.1% vs 89.2% and 90.1% vs 91.3% in the tumor capsule invasion subgroup; 26.3% vs 64.5%, 69.8% vs 78.4%, 87.4% vs 97.2% and 88.6% vs 98.1% in the vascular invasion subgroup; and 12.5% vs 31.2%, 36.4% vs 47.4%, 50.3% vs 60.1% and 56.8% vs 65.3% in the multiple nodules subgroup, respectively. The recurrence rates only significantly decreased at 6 months and 12 months in the group of patients after liver resection + adjuvant TACE (P<0.05). Among the patients who developed recurrence, the mean survival in these two groups was 25.3 vs 20.5 months, and the 1-, 2- and 3-year overall survival rates were 68.5% vs 50.3%, 49.3% vs 31.2% and 27.6% vs 20.3%, respectively all P<0.05. Furthermore, postoperative adjuvant TACE was effective in enhancing sensitivity of CT/MRI to detect <1 cm recurrent lesions. Conclusion Postoperative adjuvant TACE was effective in preventing, detecting and treating early recurrent HCC after liver resection. Key words: Liver cancer; Curative resection; Adjuvant TACE, postoperative; Early recurrence

Expression of Notch 1 receptor associated with tumor aggressiveness in papillary thyroid carcinoma.

AimThe aim of this study was to assess if the expression of Notch 1 receptor is associated with tumor aggressiveness in papillary thyroid carcinomas (PTCs).Patients and methodsBy searching the electronic medical record system of Xin Hua Hospital, all cases of PTC patients who underwent thyroidectomy in the hospital between 2013 and 2014 were retrieved. Then, the cases of patients who had a history of any other malignancy or whose thyroid tumor specimen was not available for assay were rejected. Finally, 68 cases of PTC patients were obtained. Formalin-fixed paraffin-embedded tissue blocks of these patients were studied by immunohistochemistry to learn the expression of Notch 1 receptor. Meanwhile, the clinical data of these patients including sex, age, size of the tumor, presence of node metastasis or distant metastasis, and presence of capsule invasion and tumor multicentricity were collected. Pearson’s chi-square test or Fisher’s exact test was used for measuring statistical differences in categorical variables. All the statistical tests were two-sided. A P-value <0.05 was considered to be statistically significant.ResultsA total of 19 male and 49 female PTC patients with a mean age of 44.8±13.6 years (range 18–78 years) were studied. Notch 1 receptor expression was found in 15/68 (22%) samples of PTC. The expression of Notch 1 receptor was significantly associated with tumor size (P=0.021), distant metastasis (P=0.008), capsule invasion (P=0.001), tumor multicentricity (P=0.018), and age (P=0.033). However, the expression of Notch 1 receptor was not significantly correlated with node metastasis (P=0.096) and sex (P=0.901).ConclusionThe expression of Notch 1 receptor is associated with tumor aggressiveness in PTC, and may be used as a molecular marker of tumor invasiveness in PTC. PTC patients who show positive expression of Notch 1 receptor may benefit from radioiodine remnant ablation.

Does chronic lymphocytic thyroiditis influence the staging of differentiated thyroid carcinoma?

AbstractThe association between differentiated thyroid carcinoma (DTC) and chronic lymphocytic thyroiditis (CLT) has been reported in literature.Aim: To evaluate the incidence of this association and to determine whether the CLT may influence on the early initial staging of DTC when associated with other variable risks.Study design: Historical (retrospective) cohort.Materials and Methods: Fifty two patients with DTC were evaluated from 1999 to 2009. They were divided into two groups. The first group had 35 patients with DTC without DLT; the second had 17 patients with CLT. Total thyroidectomy was the treatment chosen for all patients. Similarities shared in both groups such as age, gender, histological tumor type, tumor diameter, regional only or with distant metastases, extrathyroidal invasion, multifocality and presence of tumor capsule were considered. T-Student tests and Chi-square tests were applied to analyze the data.Results: The incidence of DTC without CLT was higher that of DTC+CLT (p=0.0126). We noticed no statistic differences between the common variables analyzed.Conclusions: CLT occurred in 33% of the patients with DCT. All cases of DTC were in the early stages.

Tumor Enucleation for Sporadic Localized Kidney Cancer: Pro and Con

No AccessJournal of UrologyOpposing Views1 Sep 2015Tumor Enucleation for Sporadic Localized Kidney Cancer: Pro and Con Gopal N. Gupta, Ronald S. Boris, Steven C. Campbell, and Zhiling Zhang Gopal N. GuptaGopal N. Gupta More articles by this author , Ronald S. BorisRonald S. Boris More articles by this author , Steven C. CampbellSteven C. Campbell More articles by this author , and Zhiling ZhangZhiling Zhang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.06.033AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival. J Urol2014; 192: 1057. Link, Google Scholar 2 : Predictors of precision of excision and reconstruction in partial nephrectomy. J Urol2014; 192: 30. Link, Google Scholar 3 : Decline in renal function after partial nephrectomy: etiology and prevention. J Urol2015; 193: 1889. Link, Google Scholar 4 : Simple enucleation for the treatment of pT1a renal cell carcinoma: our 20 year experience. Eur Urol2006; 50: 1263. Google Scholar 5 : Simple enucleation is equivalent to traditional partial nephrectomy for renal cell carcinoma: results of a nonrandomized, retrospective, comparative study. J Urol2011; 185: 1604. Link, Google Scholar 6 : Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project). Eur J Surg Oncol2014; 40: 762. Google Scholar 7 : Pathologic characteristics and prognostic effect of peritumoral capsule penetration in renal cell carcinoma after tumor enucleation. Urol Oncol2014; 32: 15. Google Scholar 8 : Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma. Eur Urol2014; 55: 1410. Google Scholar 9 : Tumor enucleation vs. sharp dissection in minimally invasive partial nephrectomy: technical benefit without impact on functional or oncologic outcomes. Urology2014; 83: 1294. Google Scholar 10 : Positive surgical margins in renal cell carcinoma: translating tumor biology into clinical outcomes. Am J Clin Pathol2015; 143: 620. Google Scholar 11 : Initial experience with robot assisted partial nephrectomy for multiple renal masses. J Urol2009; 182: 1280. Link, Google Scholar 12 : Growth pattern, an important pathologic prognostic parameter for clear cell renal cell carcinoma. Am J Clin Pathol2013; 140: 500. Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMinervini A, Campi R, Lane B, De Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Noyes S, Mari A, Rodriguez-Faba O, Keeley F, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend J, Smaldone M, Uzzo R, Carini M and Kutikov A (2019) Impact of Resection Technique on Perioperative Outcomes and Surgical Margins after Partial Nephrectomy for Localized Renal Masses: A Prospective Multicenter StudyJournal of Urology, VOL. 203, NO. 3, (496-504), Online publication date: 1-Mar-2020.Laguna M (2018) Re: Histopathologic Analysis of Tumor Bed and Peritumoral Pseudocapsule after In Vitro Tumor Enucleation on Radical Nephrectomy Specimen for Clinical T1b Renal Cell CarcinomaJournal of Urology, VOL. 200, NO. 1, (25-27), Online publication date: 1-Jul-2018.Snarskis C, Calaway A, Wang L, Gondim D, Hughes I, Idrees M, Kliethermes S, Maniar V, Picken M, Boris R and Gupta G (2018) Standardized Reporting of Microscopic Renal Tumor Margins: Introduction of the Renal Tumor Capsule Invasion Scoring SystemJournal of Urology, VOL. 197, NO. 1, (23-30), Online publication date: 1-Jan-2017.Dong W, Wu J, Suk-Ouichai C, Caraballo Antonio E, Remer E, Li J, Zabell J, Isharwal S and Campbell S (2018) Devascularized Parenchymal Mass Associated with Partial Nephrectomy: Predictive Factors and Impact on Functional RecoveryJournal of Urology, VOL. 198, NO. 4, (787-794), Online publication date: 1-Oct-2017.Campbell S, Uzzo R, Allaf M, Bass E, Cadeddu J, Chang A, Clark P, Davis B, Derweesh I, Giambarresi L, Gervais D, Hu S, Lane B, Leibovich B and Pierorazio P (2018) Renal Mass and Localized Renal Cancer: AUA GuidelineJournal of Urology, VOL. 198, NO. 3, (520-529), Online publication date: 1-Sep-2017. Volume 194Issue 3September 2015Page: 623-625 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gopal N. Gupta More articles by this author Ronald S. Boris More articles by this author Steven C. Campbell More articles by this author Zhiling Zhang More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors associated with recurrence in patients with solid pseudopapillary tumors of the pancreas.

Solid pseudopapillary tumors (SPT) are rare, generally low grade pancreatic neoplasms that occasionally display malignant behavior. To analyze the clinical and pathological features associated with increased risk of recurrence of SPT. Cohort study of patients with SPT who underwent resection of the primary tumor and in selected cases resection of metastatic disease from 1999-2013 at a single tertiary care Hepatopancreatobiliary center. Risk factors for recurrence were statistically analyzed. There were 32 patients. The mean age was 35.65 years (standard deviation: 12.26), 26/32, 81.25% were female. Median size of resected tumors was 4.7 cm (1.1-14.5). Most were solid and cystic (22/32, 68.75%), encapsulated (27/32, 84.4%) and located in the pancreatic body or tail (22/32, 68.75%). All displayed strong β-catenin, cyclin D1, CD56, and progesterone receptor staining with loss of E-cadherin. Most stained positive for vimentin (15/16, 93.75%) and CD10 (17/18, 94.4%). Median follow-up was 43 months (range: 3-207); 3/32, 9.38% recurred (all after 5-years from curative resection) and 1 died by the end of the study period, 11 years after diagnosis. Patients who developed recurrences (n=3) more commonly had synchronous metastases at presentation (P=0.006), lymphovascular invasion (P=0.04) and invasion of tumor capsule (P=0.08) compared to those who did not have disease recurrence. Lymphovascular invasion, synchronous metastases and local invasion of tumor capsule are associated with aggressive behavior. Since recurrences may occur >5 years from resection, this high-risk group should undergo extended follow-up. Progression and recurrence is slow, therefore, resection of liver metastases can offer long-term survival.

Relationship between clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer

Objective To investigate the clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer. Methods The clinical data of 236 patients who underwent radical resection of primary liver cancer at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from August 2000 to August 2011 were retrospective analyzed. The clinicopathologic factors affecting survival time of patients with liver cancer, gender, age, pathological classification, histological grade, cirrhosis, alanine transami nase (ALT) , aspartate transaminase (AST) , alkaline phosphatase (ALP) , glutamyl-transpeptidase (GGT) , alpha-fetoprotein (AFP) , hepatitis, hepatic lobe distribution, tumor diameter, gross type, tumor number, satellite lesions, capsule integrity, liver capsule local invasion, vascular thrombosis, TNM stage and lymph node metastasis were analyzed. The patients received serum AFP and B ultrasound reexaminations every 3 months after operation and chest X-ray film every 6 months. The recurrence of liver cancer in suspected patients were confirmed by abdomen CT scan and/ or digital subtraction angiography (DSA) . The ultrasound-guided puncture histopatho-logical examination was done if necessary. The follow-up was done till 30, December 2013 or death. The survival time was calculated from operation date to death or the end of follow-up. The measurement data with normal distribution were presented as ±s and analyzed usingt test, and the count data were analyzed using chi-square test or Fisher exact probability. The survival curve was drawn by Kaplan Meier method, and the survival rate was analyzed using the Log rank test. The univariate analysis and multivariate analysis were done using the one-way ANOVA and COX regression model. Results Of 236 patients with primary liver cancer, there were 23 patients with lymph node metastasis and 213 patients without lymph node metastasis. The incidences of lymph node metastasis in patients with hepatocellular carcinoma, cholangiocarcinoma and hepatocellular cholangiocarcinoma were 7. 93%(13/ 164) , 15. 00% (9/ 60) and 8. 33% (1/ 12) , respectively. The lymph node metastasis which located in hepa-toduodenal ligament, hepatic pedicle, pancreatic and multiple locations were in 10, 6, 4 and 3 patients, respectively. Univariate analysis showed that the pathological classification, level of ALP, hepatitis, TNM stage, lymph node metastasis were risk factors affecting the prognosis of patients (F =3. 386, 4. 064, 2. 857, 22. 988, 4. 087, P 120 U/ L, TNM stage Ⅲ and positive lymph node metastasis were independent risk factors affecting the prognosis of patients (HR = 1. 533, 1. 592, 2. 032, 4. 086, 95% confidence interval: 1. 008-2. 331, 1. 019-2. 489, 1. 214-3. 399, 1. 996-8. 363, P 0.05) . Conclusions The hepatocellular carcinoma, ALP >120 U/ L, TNM stage Ⅲ and positive lymph node metastasis are independent risk factors affecting the prognosis of patients with primary liver cancer, and lymph node metastasis is closely related to liver lobe distribution of tumor, satellite lesions and partial liver capsule invasion. There is different in the prognosis of patients with positive lymph node metastasis and different pathological classification of primary liver cancer. Key words: Liver neoplasms; Pathology, clinical; Lymph node metastasis; Prognosis

The Effect of Thyroid-Stimulating Hormone on Tumor Size in Differentiated Thyroid Carcinoma.

We evaluated the correlation between serum thyroid-stimulating hormone (TSH) levels and tumor size and other invasiveness parameters of tumor in patients with differentiated thyroid carcinoma (DTC). Several clinical studies have reported that TSH may also have a role as a regulator of the development and function of the thyroid gland. It is currently not clear whether TSH is involved in the existence of thyroid cancer or progression of thyroid cancer or both. Patients with DTC who underwent thyroid surgery between 2003 and 2008 were included this study. Preoperative serum T3, T4, and TSH levels were compared with the size and invasiveness of cancer, retrospectively. DTC was observed in 110 patients over the 5-year period. Seventy-seven (70%) of them were euthyroid and classified as the "normal-TSH group" (NTG), and 33 (30%) have an overt or subclinical hyperthyroidism, classified as the "low-TSH group" (LTG). The mean tumor diameter in the LTG was found to be 8.91 ± 8.03mm; however, it was found to be 18.19 ± 16.24mm in the NTG. There were significantly differences among the groups related to the diameter of tumor (p = 0.001). Microcarcinoma was determined in 36 patients (46.8%) in the NTG and 23 patients (69.7%) in the LTG (p = 0.027). Although there were no significant differences, tumor capsule invasion (33.8 vs. 18.2%, p = 0.099) and lymphovascular invasion (16.9 vs. 6.1%, p = 0.130) rates were higher in the NTG. These findings suggest that TSH has effects on growing and proliferation of not only normal thyroid cells but also cancer cells in DTC. This study revealed that serum TSH level can be explored as an important factor that affects the size and invasiveness of tumor in DTC.

Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

Background: Hepatocellular carcinoma (HCC) is one of the most common cancer in the world. Liver resection (LR) is the most used therapy in well compensated liver cirrhosis and maybe used as a first-line treatment. Aim of the study is to evaluate survival rates in patients who underwent LR for HCC and to identify risk factors able to influence the prognosis. Material/Method: A retrospective study was carried out in 115 patients whounderwent LR for HCC. We evaluated overall and disease-free survival rates at 1, 3 and 5years (y) and a series of variables included: type of resection, clamping, blood loss, transfusions, tumor size, presence of capsule, satellite nodules and vascular invasion. Results: The 1-, 3-, 5-y survival rates were 90.2%, 67% and 52.7%, and disease-free survival rates were 75.3%, 44.7% and 28.4%, respectively. We have found presence/ absence of capsulated tumor (p = 0.05), satellite nodules (p = 0.004) and vascular invasion (p = 0.001) as factors able to influence the overall survival and the disease-free survival (p = 0.04 for capsulated tumor, p = 0.01 for satellite nodules and p = 0.006 for vascular invasion). Conclusion: LR is the best therapeutic option for HCC when liver transplantation is contraindicated, with good survival rates. Presence of capsule, satellite nodules and vascular invasion are the most important factors able to influence the prognosis.

Recurrence Patterns and Prognostic Factors in Patients with Hepatocellular Carcinoma in Noncirrhotic Liver: A Multi-Institutional Analysis

Hepatocellular carcinoma (HCC) primarily affects patients with a cirrhotic liver. Reports on the characteristics of patients with HCC in noncirrhotic liver, as well as predictors of recurrence and survival, are scarce. Between 1992 and 2011, 334 patients treated for HCC in noncirrhotic liver were identified from three major hepatobiliary centers. Clinicopathological characteristics were analyzed and independent predictors of recurrence and overall survival were identified using Cox proportional hazards models. Median patient age was 58 years and 77 % were male. Most patients had a solitary (81 %) and poorly or undifferentiated tumor (56 %); median size was 6.5 cm. The majority of patients (96 %) underwent liver resection (microscopically negative margins in 94 %), whereas a few had transarterial chemoembolization or transplantation (4 %). Median recurrence-free survival (RFS) was 2.5 years, and 1- and 5-year RFS was 71.1, and 35 %, respectively. Elevated alkaline phosphatase levels [hazards ratio (HR) = 1.82], poor tumor differentiation (HR = 1.4), macrovascular invasion (HR = 2.18), and the presence of satellite lesions (HR = 1.9), or intrahepatic metastases (HR = 2.59) were independently associated with shorter RFS; in contrast, an intact tumor capsule independently prolonged RFS (HR = 0.46). Median overall survival was 5.9 years, and 1- and 5-year overall survival was 86.9, and 54.5 %, respectively. Tumor size ≥5 cm (HR = 2.27), macrovascular (HR = 2.72) or adjacent organ invasion (HR = 3.34), and satellite lesions (HR = 2.18) were independently associated with shorter overall survival, whereas an intact tumor capsule showed a protective effect (HR = 0.51). Following resection of HCC in the setting of no cirrhosis, more than one-half of patients were alive after 5 years. However, even among patients with no cirrhosis, recurrence was common. Factors associated with RFS and overall survival included tumor characteristics, such as tumor capsule, satellite lesions, and vascular invasion.

Loss of p57 expression and RhoA overexpression are associated with poor survival of patients with hepatocellular carcinoma

p57 and Ras homology A (RhoA) have been implicated in the growth and metastasis of several types of human cancers. This study aimed to detect their expression in hepatocellular carcinoma (HCC) tissue specimens and to determine a possible association with clinicopathological data and patient survival. A total of 80 HCC and corresponding distant normal tissue specimens were processed for immunohistochemical and qPCR analyses of p57 and RhoA expression. The data showed that expression of p57 mRNA and protein was reduced in HCC tissues when compared to that in distant non-cancer tissues (P<0.05), while expression of RhoA mRNA and protein was significantly higher in HCC tissue specimens when compared to that of the distant normal tissues. Loss of p57 expression was associated with HCC with higher α-fetoprotein (AFP) levels (>400 ng/ml; P=0.044), larger tumor size (>5 cm, P=0.004), poor tumor differentiation (P=0.020), advanced TNM stage (P=0.027), capsule invasion (P=0.018) and tumor thrombosis (P=0.008), whereas expression of RhoA protein was significantly associated with poor tumor differentiation (P=0.042), capsule invasion (P=0.022), and tumor thrombosis (P=0.002). Furthermore, there was a strong inverse relationship between p57 and RhoA expression in HCC tissues, indicating that loss of p57 expression may contribute to RhoA overexpression in HCC tissues. The median survival time of HCC patients with p57+ and p57- expression was 13.0 and 9.0 months, respectively, whereas the median survival time of HCC patients with RhoA+ and RhoA- was 9.0 and 15.0 months. Univariate analysis revealed that the levels of AFP, tumor size, TNM stage, histological grade, capsule invasion, tumor thrombosis, p57, RhoA and co-expression of p57 and RhoA were all significant prognostic indicators for overall survival of HCC patients. Multivariate analysis showed that tumor size, TNM stage, p57, RhoA and combined loss of p57 with RhoA were risk factors for poor survival of HCC patients. This study indicates that the abnormal expression of p57 and RhoA contributes to progression of HCC and poor survival of patients.

Epidermal growth factor receptor overexpression is a marker for adverse pathologic features in papillary thyroid carcinoma

BackgroundEpidermal growth factor receptor (EGFR) overexpression (EGFR-H) is implicated in thyroid carcinoma disease progression; however, the clinicopathologic significance of EGFR-H in tumors that harbor EGFR and/or v-Raf murine sarcoma viral oncogene homolog B1 (BRAF)(V600E) mutations is unknown. MethodsTissue microarrays from 81 patients who had undergone thyroidectomy for carcinoma from 2002–2011 were scored for EGFR expression using immunohistochemistry. Somatic mutations in EGFR exons 19 and 21 and BRAF were analyzed. Correlations between the EGFR immunohistochemistry, EGFR, and BRAF(V600E) mutations and the clinicopathologic features were assessed. ResultsEGFR-H was detected in 39.5% of carcinomas (n = 32) from patients with papillary (PTC, 46.2%, n = 18), follicular (29.6%, n = 8), and anaplastic (100.0%, n = 6) but not medullary (0.0%, n = 9) thyroid carcinoma. BRAF(V600E) mutations were identified in 22.2% of the carcinoma cases (n = 18, 15 PTCs and 3 anaplastic thyroid carcinomas). No somatic EGFR mutations were detected in any subtype. On PTC univariate analysis, EGFR-H correlated with increasing stage, extrathyroid extension, tumor capsule invasion, adverse pathologic features (any demonstration of extrathyroid extension, tumor capsule invasion, lymphovascular invasion, lymph node metastasis, and/or distant metastasis), and BRAF(V600E) mutations. On multivariate analysis, EGFR-H correlated with BRAF(V600E) mutations. In BRAF wild-type PTCs, the correlation between EGFR-H and adverse pathologic features approached statistical significance (P = 0.065). ConclusionsEGFR-H could be an important biomarker for aggressive PTCs, particularly in BRAF wild-type PTCs. Despite EGFR-H in PTC, follicular thyroid carcinoma, and anaplastic thyroid carcinoma by immunohistochemistry, somatic EGFR mutations were absent. Therefore, future investigations of EGFR should consider histologic and immunohistochemical methods, in addition to molecular profiling of thyroid carcinomas. This multimodal approach is particularly important for future clinical trials testing anti-EGFR therapy.

Expression of AEG-1 and p53 and their clinicopathological significance in malignant lesions of renal cell carcinomas: a microarray study

The aim of this study was to investigate the relationship of AEG-1 and p53 with the prognostic parameters of renal cell carcinoma (RCC). In this study, 50 paraffin blocks were histopathologically diagnosed at the Department of Pathology of the Medical Hospital of Duzce University, between 2005 and 2011. The cases consisted of 24 clear cell (CC) and 26 non-clear cell (NCC) RCC subtypes as follows: 24 (48%) clear cell RCC, 12 (24%) papillary RCC, 4 (8%) multilocular cystic RCC and 10 (20%) chromophobe RCC; none had sarcomatoid changes. By immunohistochemical analysis we investigated AEG-1 and p53 expression in carcinomas of the kidney, and by statistical analysis determined their relationship with clinicopathological parameters. Significant relationships were found between increasing tumor diameter and the increase of p53 (p = 0.028). In addition, p53 was significantly related to renal sinus invasion (p = 0.05) and Fuhrman grade (p = 0.026). There was a significant relationship between increased AEG-1 staining scores and CC and NCC carcinoma subtypes (p = 0.032), tumor capsule invasion (p = 0.01) and lymphovascular invasion (p = 0.015). There was also a significant correlation between tumor size and capsule and lymphovascular invasion (p = 0.02). We concluded that high AEG-1 and p53 expression correlates with the prognostic parameters in RCC patients, and in addition may be associated with tumor progression.

Hepatitis B virus surface antigen‐negative and hepatitis C virus antibody‐negative hepatocellular carcinoma

Although the incidence of hepatitis B virus surface antigen (HBsAg)-negative/hepatitis C virus antibody (HCVAb)-negative hepatocellular carcinoma (NBNC-HCC) is gradually increasing, it has been mostly ignored in previous studies. The objective of this exploratory study was to investigate the clinicopathologic characteristics and prognostic factors that influence recurrence and survival in patients with NBNC-HCC. A retrospective analysis was performed of 675 patients with NBNC-HCC and 3529 patients with HBsAg-positive/HCVAb-negative HCC (BNC-HCC) who underwent curative resection between 1997 and 2009. Intrahepatic recurrences were classified into early (≤1 year) and late (>1 year) recurrences. Multivariate competing risks analyses with Bonferroni correction were used to evaluate independent prognostic factors. There were no significant differences between the NBNC-HCC and BNC-HCC groups regarding overall survival, cumulative incidence of HCC-specific death, and recurrence. However, the patients with NBNC-HCC were much older (P < .001), were associated less often with cirrhosis or elevated α-fetoprotein levels (P < .001), and had a much lower ratio of men to women (P < .001). NBNC-HCC tumors were larger (P < .001), but were involved less often with vascular invasion (P = .004). Women, serum γ-glutamyl transpeptidase level, tumor size, tumor capsule, and tumor differentiation were identified as independent risk factors for HCC-specific survival in patients with NBNC-HCC. The cumulative incidence of HCC-specific death for women with NBNC-HCC was significantly greater than for men with NBNC-HCC (P < .001).Tumor capsule and vascular invasion were identified as independent risk factors for early recurrence of NBNC-HCC, whereas tumor differentiation was identified as the only significant risk factor for late recurrence. Patients who had NBNC-HCC had characteristics and prognostic factors that differed from those in patients who had BNC-HCC. Women with NBNC-HCC should be more closely monitored, and it may be worthwhile to evaluate estrogen administration for the maintenance of sex hormone balance and to improve these poor outcomes.

Diffusion-weighted imaging of hepatocellular carcinoma for predicting early recurrence and survival after hepatectomy.

The effectiveness of imaging (including apparent diffusion coefficient [ADC] of diffusion-weighted magnetic resonance imaging [DWI]) and laboratory variables for predicting early tumor recurrence and overall survival after surgery in hepatocellular carcinoma (HCC) patients are analyzed. The present study included 116 consecutive patients with HCC who underwent partial hepatectomy. Patients were classified into two groups: patients with and without early recurrence (<1year). Preoperative imaging variables (tumor number, size, shape, capsule, ADC, and venous invasion) and laboratory variables were evaluated to predict early recurrence using univariate and multivariate analyses. Overall survival was calculated using the Kaplan-Meier method. Twenty patients (17%) developed early recurrence after surgery. Multivariate logistic regression analysis showed that tumor ADC (p=0.0002), aspartate aminotransferase (p=0.0121), and serum prothrombin time activity percentage (p=0.0082) were statistically significant for predicting early recurrence. The optimal ADC cutoff value for predicting early recurrence obtained from receiver operating characteristic analysis was ≤0.898×10(-3)mm(2)/s. In patients with ADC ≤0.898×10(-3)mm(2)/s, the 3- and 5-year survival rates (77 and 56%, respectively) were significantly decreased compared with those in patients with ADC >0.898×10(-3)mm(2)/s (97 and 97%, respectively; p=0.0015). Low tumor ADC value by DWI was a risk factor for early postoperative HCC recurrence and was associated with lower patient survival rates.

The Evaluation of Microcarcinoma in Differentiated Thyroid Cancers According to Old and New TNM Classification

Objective: In this study, we aimed to evaluate the tumor size for proximal and distant metastases when the new and old TNM classification is taken into account in differentiated thyroid cancers.Material and Methods: Two hundred sixty eight patients diagnosed with thyroid carcinoma, undergoing bilateral total or subtotal thyroidectomy treated with high doses of I-131 were examined retrospectively. The data of these patients were compared after classification, according to tumor size <1 cm and <2 cm, lymph node metastases thyroid and tumor capsule invasion at the time of diagnosis, and accumulation of abnormal activity in post I-131 treatment whole-body scan. I-131 uptakes besides physiological and thyroid bed were considered as abnormal activity uptakes.Results: A total of 268 patients with average age of 19-82 yrs (mean: 47.0±13.8 yrs) were included in the study. At postoperative histopathological evaluation, 228 (85.1%) of patients were reported as papillary, 13 (4.9%) as follicular, 23 (8.6%) as well differentiated tumor of unknown malignant potential, 2 (0.7%) as insular and 2 (0.7%) as Hürthle-cell carcinoma. In patients with known tumor size, 96 of 207 (46.4%) patients' tumor size was <1 cm and in 111 (53.6%) >1 cm. In the same group, according to the revised TNM classification, in 149 of 207 patients (72%) the tumor size was <2 cm, whereas in 58 (28%) >2 cm. Of 187 patients with negative lymph nodes, 15 (8%) showed abnormal activity accumulation in the first post I-131 treatment whole-body scan and 10 (40% of 25 patients) positive lymph node (p<0.05) involvement.Conclusion: Since the treatment of patients with microcarcinoma is controversial, tumor size should not be the only factor considered in patients with differentiated thyroid cancer Tissue tumor invasion, age, gender and multifocality should also be taken into account.Conflict of interest:None declared.

Clinicopathologic Characteristics and Surgical Outcomes of Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Hepatocellular carcinoma (HCC) has a high predilection for portal vein invasion. Furthermore, the treatment of HCC with portal vein tumor thrombosis (PVTT) is controversial. The objective of this study was to investigate clinicopathologic characteristics and surgical outcomes of HCC patients with PVTT. The clinicopathologic data and surgical outcomes of 88 patients HCC with PVTT and 211 patients without PVTT who underwent surgery were retrospectively reviewed. The risk factors and the prognosis of HCC patients with PVTT were determined. Cirrhosis, serum alkaline phosphatase (ALP) > 100 IU/L, tumor size > 8 cm, incomplete tumor capsule, and adjacent organ invasion were risk factors for PVTT in HCC on multivariate analysis. Furthermore, HCC patients with PVTT received more major hepatectomies, had more intraoperative blood loss and greater blood transfusion requirements, and higher incidence of postoperative mortality compared with HCC patients without PVTT. The median overall survival of HCC patients with PVTT after surgery was 9 mo, with the 1-, 2-, and 3-y overall survival rates of 31.1%, 18.3%, and 15.2 %, respectively. AFP level, adjacent organ invasion, and PVTT location predicted overall survival of HCC patients with PVTT. High serum ALP level, cirrhosis, large tumor, incomplete tumor capsule and adjacent organ invasion are predictors of PVTT in HCC. Surgery is a valid therapy for selected HCC patients with PVTT.

Simple Enucleation is Equivalent to Traditional Partial Nephrectomy for Renal Cell Carcinoma: Results of a Nonrandomized, Retrospective, Comparative Study

The excision of the renal tumor with a substantial margin of healthy parenchyma is considered the gold standard technique for partial nephrectomy. However, simple enucleation showed excellent results in some retrospective series. We compared the oncologic outcomes after standard partial nephrectomy and simple enucleation. We retrospectively analyzed 982 patients who underwent standard partial nephrectomy and 537 who had simple enucleation for localized renal cell carcinoma at 16 academic centers between 1997 and 2007. Local recurrence, cancer specific survival and progression-free survival were the main outcomes of this study. The Kaplan-Meier method was used to calculate survival functions and differences were assessed with the log rank statistic. Univariable and multivariable Cox regression models addressed progression-free survival and cancer specific survival. Median followup of the patients undergoing traditional partial nephrectomy and simple enucleation was 51 ± 37.8 and 54.4 ± 36 months, respectively (p = 0.08). The 5 and 10-year progression-free survival estimates were 88.9 and 82% after standard partial nephrectomy, and 91.4% and 90.8% after simple enucleation (p = 0.09). The 5 and 10-year cancer specific survival estimates were 93.9% and 91.6% after standard partial nephrectomy, and 94.3% and 93.2% after simple enucleation (p = 0.94). On multivariable analysis the adopted nephron sparing surgery technique was not an independent predictor of progression-free survival (HR 0.8, p = 0.55) and cancer specific survival (HR 0.7, p = 0.53) when adjusted for the effect of the other covariates. To our knowledge this is the first multicenter, comparative study showing oncologic equivalence of standard partial nephrectomy and simple enucleation.

Encapsulated Classic and Follicular Variants of Papillary Thyroid Carcinoma: Comparative Clinicopathologic Study

To compare the clinicopathologic features of papillary thyroid carcinoma classic variant (PTC-CV) and papillary thyroid carcinoma follicular variant (PTCFV), with a focus on the encapsulated form. In a retrospective search of computerized pathology files for 1996 to 1998, a cohort of 114 cases (58 cases of PTC-CV and 56 cases of PTC-FV) were selected for this study. Clinicopathologic data and long-term follow-up (serum thyroglobulin measurements, radiologic studies, and additional tissue sampling) through the date of compilation of study data were extracted from the medical records. The median patient age at initial diagnosis was 46 years for the PTC-CV group and 45.5 years for the PTC-FV group. Complete tumor encapsulation was seen in 40 PTC-CV cases (69%) and in all PTC-FV cases (100%). A higher rate of tumor capsule invasion (CI), lymphovascular invasion (LVI), extrathyroidal extension, and lymph node metastatic lesions was seen in PTC-CV than in PTC-FV: CI, 26% versus 18%; LVI, 17% versus 4%; extrathyroidal extension, 19% versus 7%; and lymph node metastatic lesions, 68% versus 29%. Clinical, radiologic, or pathologic follow-up data were available in 36 PTC-CV cases (62%) and 34 PTC-FV cases (61%). The median duration of follow-up for the PTC-CV group was 10 years and for the PTC-FV group was 9 years. Tumor recurrence was found in 10 patients with PTC-CV (28%) and 2 with PTC-FV (6%). Distant metastatic lesions occurred in 3 patients with PTC-CV (8%) and 1 patient with PTC-FV (3%) (P = .17); of these, 2 cases of PTC-CV were encapsulated and showed CI, LVI, and lymph node metastatic lesions. Our current study confirms previous reports that both encapsulated PTC-CV and encapsulated PTC-FV are indolent tumors and are associated with very low mortality.

What is the best approach to an apparently nonmetastatic adrenocortical carcinoma?

In suspected nonmetastatic adrenocortical carcinoma (ACC) a careful preoperative diagnostic work up is needed including comprehensive endocrine analysis as recommended by the European Network for the Study of Adrenal Tumors (http://www.ENSAT.org/ACC.htm). Staging prior surgery, in particular chest CT, is indispensable to exclude distant metastases. Open surgery is still the recommended approach in ACC. However, in localized non-invasive ACC with a diameter <10 cm laparoscopic adrenalectomy by an expert surgeon is probably similarly effective and safe. As many patients will suffer from tumor recurrence after seemingly complete removal of ACC, adjuvant treatment based on the individual risk status is recommended. Key factors for risk assessment are tumor stage, resection status and the proliferation marker Ki67. All patients considered at high risk for recurrence should receive adjuvant mitotane for a minimum of 2 years aiming at a drug level of 14-20 mg/l. In selected patients (e.g. R1 resection) we recommend additional radiotherapy of the tumor bed. Patients with a low/intermediate risk for recurrence should be included in the Adiuvo trial comparing adjuvant mitotane with observation only (http://www.adiuvo-trial.org). In low/intermediate risk patients who cannot be included in this trial observation only can be justified in cases with a tumor diameter of <8 cm and no microscopic evidence for invasion of blood vessels or tumor capsule. In all patients a structured follow-up for 10 years is strongly recommended.

Significance of superior vena cava reconstruction with EPTFE grafts in the surgical treatment of superior and anterior mediastinal invasive malignant tumors

The objective of this study is to demonstrate the significance of superior vena cava (SVC) reconstruction in the surgical treatment of superior and anterior mediastinal invasive malignant tumors, by using a total of 48 cases consisting of 36 invasive thymomas, 3 thymic cancers, 3 carcinoids, 2 germ cell tumors, 2 malignant lymphomas, 1 intrathoracic thyroid cancer and 1 malignant melanoma. In 22 of 48 cases there was only mediastinal pleural invasion or tumor capsule invasion, on the other hand, 26 cases had high ratios of invasion to adjacent organs, including lung, pericardium, great veins and the phrenic nerve. Sixteen of 26 cases had invasion to 1-2 adjacent organs, but 10 had 3-6 organ invasion. Among 12 cases invading SVC or brachiocephalic veins, 9 cases during the last 7 years underwent SVC resection and reconstruction with EPTFE grafts. The patency was good in the grafts with external ring support and no SVC symptoms were observed in all cases postoperatively. The longest patent and functional graft is 40 months postoperative. No statistically significant difference were demonstrated in the survivals between cases with SVC reconstruction and those with resections of other adjacent organs, furthermore, remarkable difference of survival was demonstrated in SVC reconstructed cases with complete resection and incomplete resection. The survivals in cases with combined resection of 1-2 adjacent organs was statistically significantly better than those with combined resection of 3-6 adjacent organs (p less than 0.05, Cox-Mantel test).(ABSTRACT TRUNCATED AT 250 WORDS)