Tumor Recurrence In Group Research Articles

Long bone shaft metastasis: a comparative study between cement filling and intercalary prosthesis

BackgroundMetastatic bone lesions in the extremities can cause severe pain and pathological fractures, significantly affecting patients’ quality of life. Timely intervention and effective management of long bone metastases can positively influence patient outcomes, including survival rates and subsequent treatment options.ObjectiveThe objective of this study is to compare the efficacy and associated complications of two surgical reconstruction techniques and propose a more effective limb reconstruction approach for long bone metastases.MethodsA retrospective study was conducted on 28 patients with complete clinical data who underwent a surgical procedure for long bone metastases of the extremities in our department between January 2017 and June 2022. The patients were divided into two groups based on their surgical methods. In group 1, the affected bones were curetted and filled with cement, then secured with plates or intramedullary nails. In group 2, the affected bone segments were completely removed and replaced with custom intercalary prostheses. Various factors, including general patient information, surgical details, surgical effectiveness, and common complications, were compared and analyzed.ResultsThere were no significant differences in general patient information between the two groups, including age, gender, surgical site, and primary tumor type. The operative times were 115.37 min for group 1 and 108.90 min for group 2, respectively (p > 0.05). However, intraoperative blood loss differed significantly between the groups, with 769 ml in group 1 and 521 ml in group 2 (p < 0.05). The postoperative MSTS scores were 91% for group 1 and 92% for group 2 (p > 0.05). Postoperative complications included two cases of internal fixation failure and three cases of tumor recurrence in group 1, resulting in a 33% incidence rate, while group 2 experienced a 15% incidence rate with two cases of internal fixation failure.ConclusionThe results of this study suggest that both surgical techniques are effective for the treatment of long bone metastases of the extremities. However, the custom intercalary prostheses technique in group 2 showed a lower incidence of complications and less intraoperative blood loss. Therefore, it may be a more effective limb reconstruction approach for long bone metastases. Further studies with larger sample sizes are needed to confirm these findings.

Does the urinary microbiome profile change after treatment of bladder cancer?

We sought to investigate the change in the urinary microbiome profile after transurethral resection of bladder tumor (TURBT). Urine specimens were collected from consecutive patients with bladder cancer. Patients were divided into those with bladder tumors ("Tumor group": de novo tumors or recurrent/progressed after TURBT ± intravesical therapy) versus those without evidence of recurrence after treatment "No Recurrent Tumor group". Samples were analyzed using 16S rRNA sequencing. Alteration in the urinary microbiome was described in terms of alpha (diversity within a sample measured by Observed, Chao, Shannon, and Simpson indices), beta diversities (diversity among different samples measured by Brady Curtis Diversity index), and differential abundance of bacteria at the genus level. Analyses were adjusted for gender, method of preservation (frozen vs preservative), and method of collection (mid-stream vs. catheter). Sixty-eight samples were analyzed (42 in "Tumor" vs 26 in "No Recurrent Tumor" groups). The median age was 70years (IQR 64-74) and 85% were males. All patients in the "No Recurrent Tumor" group had non-muscle invasive bladder cancer and 85% received BCG compared to 69% and 43% for the "Tumor" group, respectively. There was no significant difference in alpha diversity (p > 0.05). Beta diversity was significantly different (p = 0.04). Veillonella and Bifidobacterium were more abundant in the "Tumor" group (> 2FC, p = 0.0002), while Escherichia-Shigella (> 2FC, p = 0.0002) and Helococcus (> 2FC, p = 0.0008) were more abundant in the "No Recurrent Tumor" group. Bladder cancer patients with no recurrence and/or progression exhibited a different urinary microbiome profile compared to those with tumors.

Diagnostic Performance of Dynamic Susceptibility Contrast-Enhanced Perfusion-Weighted Imaging in Differentiating Recurrence From Radiation Injury in Postoperative Glioma: A Meta-analysis.

It is important to differentiate between radiation injury (RI) and tumor recurrence (TR) in patients with glioma after surgery and radiotherapy. Our objective was to evaluate the use of dynamic susceptibility contrast-enhanced perfusion-weighted imaging to distinguish between TR and RI in patients with glioma. Relevant studies published until October 2021 were identified in the PubMed, Embase, and Cochrane Library databases. Stata v12.0 and RevMan 5.3 were used for meta-analysis. In total, the meta-analysis incorporated 13 retrospective studies that included 513 patients with 522 lesions. Among the 522 lesions, 329 lesions were TRs and 193 lesions were RIs. The pooled relative cerebral blood volume value was significantly greater in the TR group ( P < 0.00001) with significant heterogeneity ( I2 = 88%). The pooled sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were 83% (95 confidence interval [CI], 77%-88%), 85% (95 CI, 77%-91%), 5.60 (95 CI, 3.61-8.70), and 0.20 (95% CI, 0.14-0.27), respectively. The heterogeneity of sensitivity ( I2 = 33.18%), specificity ( I2 = 24.01%), PLR ( I2 = 0.00%), and NLR ( I2 = 6.68%) is not significant. The area under the receiver operating characteristic curve was 0.91 (95% CI, 0.88-0.93). The 3.0 T magnetic resonance imaging, high-grade glioma, and Europe/America patient subgroups showed PLR greater than 5 and NLR less than 0.2. There was no significant indication of publication bias in the analysis ( P = 0.496). It is concluded that dynamic susceptibility contrast-enhanced perfusion-weighted imaging is effective for the diagnostic differentiation between TR and RI in patients with glioma.

Distinguishing Tumor Recurrence From Radiation Necrosis in Treated Glioblastoma Using Multiparametric MRI

The purpose of this study was to evaluate the diagnostic performance of single-parameter, unimodal and bimodal magnetic resonance imaging (MRI) in differentiating tumor recurrence (TR) from radiation necrosis (RN) in patients with glioblastoma (GBM) after treatment using diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), dynamic susceptibility contrast enhancement-perfusion weighted imaging (DSC-PWI), and proton magnetic resonance spectroscopy (1H-MRS). Patients with histologically proven GBM who underwent surgical intervention followed by chemoradiotherapy and developed a new, progressively enhanced lesion on follow-up MRI were included in our study. Subsequently, DWI, DTI, DSC-PWI, and 1H-MRS were performed. Then, these patients underwent a second surgical operation or follow-up MRI to prove TR or RN. MRI metrics include apparent diffusion coefficient (ADC) and relative ADC (rADC) values derived from DWI; fractional anisotropy (FA), axial diffusion coefficient (DA) and radial diffusion coefficient (DR) values derived from DTI; and relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) derived from DSC-PWI. Spectral metabolites such as choline (Cho), creatine (Cr), N-acetylaspartate (NAA), lactate (Lac), and lipids (Lip) were derived from MRS, and the ratios of these metabolites were calculated, including Cho/NAA, Cho/Cr, NAA/Cr, Lac/Cr, and Lip/Cr. These indices were compared between the TR group and RN group, and the receiver operating characteristic (ROC) curve was used to evaluate the performance in distinguishing TR from RN by using single-parameter, unimodal and bimodal MRI. There were significant differences between the TR and RN groups in terms of ADC (p=0.001), rADC (p < 0.001), FA (p=0.001), DA (p=0.003), DR (p=0.003), rCBV (p < 0.001), rCBF (p < 0.001), Cho/NAA (p < 0.001), Lac/Cr (p < 0.001) and Lip/Cr (p < 0.001). ROC analysis suggested that rCBV, MRS, and DSC+MRS were the optimal single-parameter, unimodal, and bimodal MRI classifiers for distinguishing TR from RN, with AUC values of 0.909, 0.940, and 0.994, respectively. The combination of parameters based on multiparametric MRI in the region of enhanced lesions is a valuable noninvasive tool for discriminating TR from RN.

Detection Rate of Carcinoma In Situ During TURBT Following Shift from Photodynamic Diagnosis to Narrow Band Imaging in a Single University Hospital

ObjectiveTo examine whether or not the detection rate of Carcinoma In Situ (CIS) was significantly higher after switching from Photodynamic Diagnosis (PDD) guided TURBT to Narrow Band Imaging (NBI) guided TURBT. Materials and MethodsPathological outcome regarding CIS detection was reviewed in all TURBT procedures in a 2 year period. A total number of 1132 TURBT procedures were reviewed. In period 1, starting from January 2018 to December 2018, 487 TURBTs were performed and in period 2, from January 2019 to December 2019, 645 TURBTs were performed. PDD was used as assistance to detect CIS in period 1 and NBI was introduced as assistance instead of PDD in all TURBT in period 2. ResultsA significantly higher detection rate of CIS was found in period 2 compared to period 1 (8.7% vs 4.9%, P = .02). In primary tumors, CIS was detected in 8.4% in period 2 vs 5.4% in period 1 (not significant) whereas in TURBs for recurrent tumor, CIS was detected in 8.6% in period 2 vs 4.6% in period 1 (P = .04). There was no difference in CIS detection in patients investigated following BCG treatment for CIS (18.1% vs 21.4%). ConclusionThe overall detecting of CIS is significantly higher in period 2 but not in the recurrent tumor group, neither in the control after BCG group. These data suggest that PDD is not superior to NBI. The reduced cost and the convenient logistics of NBI can most likely improve the overall CIS detection rate.

Elevated Serum Carcinoembryonic Antigen Is Associated with a Worse Survival Outcome of Patients After Liver Resection for Hepatocellular Carcinoma: a Propensity Score Matching Analysis

BackgroundThe relationship between serum carcinoembryonic antigen (CEA) and postoperative prognosis in hepatocellular carcinoma (HCC) has not been reported. MethodsData of 5410 consecutive HCC patients who underwent hepatectomy was retrospectively reviewed. Survival curves for overall survival (OS) and tumor recurrence (TR) were depicted using the Kaplan-Meier method and compared using the log-rank test. Independent risk factors of OS and TR were analyzed with Cox hazard regression model. Besides, a one-to-one propensity score-matched (PSM) subset was performed to reduce selection bias. Subgroup analysis was done according to hepatitis B virus (HBV) infection or not. ResultsSerum CEA ≥5.1 μg/L was an independent risk factor of OS and TR in the entire cohort and PSM subset (OS—hazard ratio = 1.218, 95 % confidence interval = 1.060–1.400; 1.383, 1.133–1.688, respectively; TR—1.256, 1.114–1.417; 1.258, 1.067–1.484, respectively). Subgroup analysis showed that CEA ≥5.1 μg/L was an independent risk factor of OS and TR in the HBV infection group (OS—1.234, 1.065–1.429; TR—1.231, 1.083–1.399) but not in the non-HBV infection group (OS—1.376, 0.895–2.117; TR—1.437, 0.989–2.088). ConclusionSerum CEA ≥5.1 μg/L was an independent risk factor of OS and TR of HCC patients, and patients with CEA ≥5.1 μg/L had poorer prognosis, especially for HCC patients with HBV infection.

Outcomes of stereotactic body radiotherapy for unresectable primary or recurrent cholangiocarcinoma.

PurposeTo report the results of stereotactic body radiotherapy (SBRT) for unresectable primary or recurrent cholangiocarcinoma.Materials and MethodsFrom January 2005 through August 2013, 58 patients with unresectable primary (n = 28) or recurrent (n = 30) cholangiocarcinoma treated by SBRT were retrospectively analyzed. The median prescribed dose was 45 Gy in 3 fractions (range, 15 to 60 Gy in 1-5 fractions). Patients were treated by SBRT only (n = 53) or EBRT + SBRT boost (n = 5). The median tumor volume was 40 mL (range, 5 to 1,287 mL).ResultsThe median follow-up duration was 10 months (range, 1 to 97 months). The 1-year, 2-year overall survival rates, and median survival were 45%, 20%, and 10 months, respectively. The median survival for primary group and recurrent group were 5 and 13 months, respectively. Local control rate at 1-year and 2-year were 85% and 72%, respectively. Disease progression-free survival rates at 1-year and 2-year were 26% and 23%, respectively. In univariate analysis, ECOG performance score (0-1 vs. 2-3), treatment volume (<50 vs. ≥50 mL), and pre-SBRT CEA level (<5 vs. ≥5 ng/mL) were significant in overall survival rate. In multivariate analysis, ECOG score (p = 0.037) and tumor volume (p = 0.030) were statistically significant. In the recurrent tumor group, patients with >12 months interval from surgery to recurrence showed statistically significant higher overall survival rate than those with ≤12 months (p = 0.026). Six patients (10%) experienced ≥grade 3 complications.ConclusionSBRT can be considered as an effective local modality for unresectable primary or recurrent cholangiocarcinoma.

Histogram Analysis of Intravoxel Incoherent Motion for Differentiating Recurrent Tumor from Treatment Effect in Patients with Glioblastoma: Initial Clinical Experience

Intravoxel incoherent motion can simultaneously measure diffusion and perfusion characteristics. Our aim was to determine whether the perfusion and diffusion parameters derived from intravoxel incoherent motion could act as imaging biomarkers for distinguishing recurrent tumor from treatment effect in patients with glioblastoma. Fifty-one patients with pathologically confirmed recurrent tumor (n = 31) or treatment effect (n = 20) were assessed by means of intravoxel incoherent motion MR imaging. The histogram cutoffs of the 90th percentiles for perfusion and normalized CBV and the 10th percentiles for diffusion and ADC were calculated and correlated with the final pathology results. A leave-one-out cross-validation was used to evaluate the diagnostic performance of our classifiers. The mean 90th percentile for perfusion was significantly higher in the recurrent tumor group (0.084 ± 0.020) than in the treatment effect group (0.040 ± 0.010) (P < .001). The 90th percentile for perfusion provided a smaller number of patients within an overlap zone in which misclassifications can occur, compared with the 90th percentile for normalized CBV. The mean 10th percentile for diffusion was significantly lower in the recurrent tumor group than in the treatment effect group (P = .006). Receiver operating characteristic curve analyses showed the 90th percentile for perfusion to be a significant predictor for differentiation, with a sensitivity of 87.1% and a specificity of 95.0%. There was a significant positive correlation between the 90th percentiles for perfusion and normalized CBV (r = 0.674; P < .001). A histogram analysis of intravoxel incoherent motion parameters can be used as a noninvasive imaging biomarker for differentiating recurrent tumor from treatment effect in patients with glioblastoma.

Application value of apparent diffusion coefficient in differentiation of brain radiation-injuries and glioma recurrence.

To evaluate application value of apparent diffusion coefficient (ADC) in differentiating brain radiation-injuries and glioma recurrence. Totally 23 patients [18 men and 5 women aged 32 to 67 years (mean: 47 years)] with previously resected and irradiated glioma were examined by using a 3.0T MR Scanner, including conventional and diffusion weighted image (DWI) sequences. All the cases were proved by pathology or clinical follow-up. Postprocessing of ADC maps was performed by using Functool software (AW 4.3, GE Healthcare), and the regions of interest (ROIs) were manually drawn on ADC maps in the area corresponding to the contrast-enhancing area on post-contrast axial T1-weighted images, avoiding the hemorrhage or necrosis. The ADC values were calculated automatically. ADC values were measured 10 times in order to reduce errors, and mean ADC value, maximum ADC value, and minimum ADC value were acquired. Both recurrent glioma and irradiated necrosis tended to have hemorrhage, necrosis, and edema. The mean ADC value and maximum ADC value were lower in the recurrent tumor group than in the radiation-injuries group, but no statistical difference was achieved. However, the minimum ADC value was significantly lower in the recurrent tumor group than in the radiation-injuries group (P=0.016). The minimum ADC value can be used as an useful tool in differentiating tumor recurrence from radiation-injuries.

Adiuvant huaier on long-term survivals after curative hepatectomy for primary liver cancer

Objective To study the effects of adjuvant Huaier on long-term survivals after curative partial hepatectomy for primary liver cancer.Methods 175 patients with primary liver cancer who received curative partial hepatectomy from January 2002 to January 2006 were divided into two groups:the treatment group (group A,n =87) and the control group (group B,n=88).Group A was treated with Huaier (60 g per day for 6 months) after the operation while group B received no Huaier treatment.Results The overall 1-,3- and 5 year survival rates and disease-free survival rates were 91.90％,73.90％,and 56.0％ and 68.1％,48.4％ and 40.2％,respectively.The overall 1-,3-and 5-year survival rates in group A were significantly higher than group B (91.80％,79.30％,65.2％ vs 92.0％,68.3％,46.6％,P 0.038).In addition,the 1-,3-and 5-year survival rates after tumor recurrence in group A was also significantly higher than group B (78.6％,46.9％,38.2％ vs 69.0％,16.8％,12.6％,P=0.040).Multivariate analysis showed that the use of Huaier,hepatitis infection,severity of cirrhosis,vascular cancer thrombus were the most important prognostic factors for overall long-term survival (P＜0.05).Blood transfusion and histological grade were independent risk factors for disease free survival.The use of Huaier and the clinicopathological type were significantly co-related to the survival from recurrence/metastasis to death.Conclusion The use of Huaier improved disease free survival and the survival from recurrence or metastasis for patients with primary liver cancer following curative hepatectomy. Key words: Primary liver cancer; Huaier; Recurrence; Metastasis

Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone

The authors report on the long-term outcome in 100 consecutive patients with meningiomas arising from the cavernous sinus (CS) with compressive extension outside the CS. The treatment in all cases was surgery alone without adjuvant radiosurgery or radiotherapy. The aim of this study was to evaluate the percentage of patients in whom surgery alone was able to produce long-term tumor control. All 100 patients harbored meningiomas with supra- and/or laterocavernous extension, and 27 had petroclival extension. Surgery was performed via frontopterionotemporal craniotomy associated with orbital and/or zygomatic osteotomy in 97 patients. Proximal control of the internal carotid artery at the foramen lacerum was undertaken in 65 patients; the paraclinoid carotid segment was exposed extradurally at the space made by the anterior clinoidectomy in 81 patients. For the petroclival tumor extension, a second-stage surgery was performed via a presigmoid-retrolabyrinthine or retrosigmoid approach in 13 and 14 patients, respectively. The mortality rate was 5% and two patients had severe hemiplegic or aphasic sequelae. The creation or aggravation of disorders in vision, ocular motility, or trigeminal function occurred in 19, 29, and 24% of patients respectively, with a significantly higher rate of complications when resection was performed inside the CS (p < 0.05). Gross-total removal of both the extra- and intracavernous portions was achieved in 12 patients (Group 1), removal of the extracavernous portions with only a partial resection of the intracavernous portion in 28 patients (Group 2), and removal only of the extracavernous portions was performed in 60 patients (Group 3). The follow-up period ranged from 3 to 20 years (mean 8.3 years). There was no tumor recurrence in Group 1. In the 83 surviving patients in Groups 2 and 3 combined, the tumor remnant did not regrow in 72 patients (86.7%); regrowth was noted in 11 (13.3%). The results suggest that there is no significant oncological benefit in performing surgery within the CS. Because entering the CS entails a significantly higher risk of complications, radiosurgical treatment should be reserved for remnants with secondary growth and clinical manifestations.

Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone

Object The authors report on the long-term outcome in 100 consecutive patients with meningiomas arising from the cavernous sinus (CS) with compressive extension outside the CS. The treatment in all cases was surgery alone without adjuvant radiosurgery or radiotherapy. The aim of this study was to evaluate the percentage of patients in whom surgery alone was able to produce long-term tumor control. Methods All 100 patients harbored meningiomas with supra- and/or laterocavernous extension, and 27 had petro-clival extension. Surgery was performed via frontopterionotemporal craniotomy associated with orbital and/or zygomatic osteotomy in 97 patients. Proximal control of the internal carotid artery at the foramen lacerum was undertaken in 65 patients; the paraclinoid carotid segment was exposed extradurally at the space made by the anterior clinoidectomy in 81 patients. For the petroclival tumor extension, a second-stage surgery was performed via a presigmoid–retro-labyrinthine or retrosigmoid approach in 13 and 14 patients, respectively. Results The mortality rate was 5% and two patients had severe hemiplegic or aphasic sequelae. The creation or aggravation of disorders in vision, ocular motility, or trigeminal function occurred in 19, 29, and 24% of patients respectively, with a significantly higher rate of complications when resection was performed inside the CS (p < 0.05). Gross-total removal of both the extra- and intracavernous portions was achieved in 12 patients (Group 1), removal of the extracavernous portions with only a partial resection of the intracavernous portion in 28 patients (Group 2), and removal only of the extracavernous portions was performed in 60 patients (Group 3). The follow-up period ranged from 3 to 20 years (mean 8.3 years). There was no tumor recurrence in Group 1. In the 83 surviving patients in Groups 2 and 3 combined, the tumor remnant did not regrow in 72 patients (86.7%); regrowth was noted in 11 (13.3%). Conclusions The results suggest that there is no significant oncological benefit in performing surgery within the CS. Because entering the CS entails a significantly higher risk of complications, radiosurgical treatment should be reserved for remnants with secondary growth and clinical manifestations.

FIRST-PASS PERFUSION COMPUTED TOMOGRAPHY

To differentiate recurrent tumors from radiation effects and necrosis in patients with irradiated brain tumors using perfusion computed tomographic (PCT) imaging. Twenty-two patients with previously treated brain tumors who showed recurrent or progressive enhancing lesions on follow-up magnetic resonance imaging scans and had a histopathological diagnosis underwent first-pass PCT imaging (26 PCT imaging examinations). Another eight patients with treatment-naïve, high-grade tumors (control group) also underwent PCT assessment. Perfusion maps of cerebral blood volume, cerebral blood flow, and mean transit time were generated at an Advantage Windows workstation using the CT perfusion 3.0 software (General Electric Medical Systems, Milwaukee, WI). Normalized ratios (normalized to normal white matter) of these perfusion parameters (normalized cerebral blood volume [nCBV], normalized cerebral blood flow [nCBF], and normalized mean transit time [nMTT]) were used for final analysis. Fourteen patients were diagnosed with recurrent tumor, and eight patients had radiation necrosis. There was a statistically significant difference between the two groups, with the recurrent tumor group showing higher mean nCBV (2.65 versus 1.10) and nCBF (2.73 versus 1.08) and shorter nMTT (0.71 versus 1.58) compared with the radiation necrosis group. For nCBV, a cutoff point of 1.65 was found to have a sensitivity of 83.3% and a specificity of 100% to diagnose recurrent tumor and radiation necrosis. Similar sensitivity and specificity were 94.4 and 87.5%, respectively, for nCBF with a cutoff point of 1.28 and 94.4 and 75%, respectively, for nMTT with a cutoff point of 1.44 to diagnose recurrent tumor and radiation necrosis. PCT may aid in differentiating recurrent tumors from radiation necrosis on the basis of various perfusion parameters. Recurrent tumors show higher nCBV and nCBF and lower nMTT compared with radiation necrosis.

Peritoneal lavage with distilled water during liver resection in patients with spontaneously ruptured hepatocellular carcinomas

Spontaneously rupture of hepatocellular carcinoma is a life threatening and worse prognosis. Not only the lower rate of resection and hemodynamic unstable, but also the hepatic failure and recurrence. Distilled water irrigation had been applied in several cancer surgeries including colon, stomach, breast, ovary, and bladder; thus had good results in lowering the tumor spreading. We applied distilled water peritoneal lavage after liver resection in patients with spontaneous rupture of hepatocellular carcinoma to define the influence of prognosis. Thirteen patients with spontaneous ruptured hepatocellular carcinoma underwent distilled water peritoneal lavage after curative liver resection (Group A). Nineteen patients with spontaneous ruptured hepatocellular carcinoma did not undergo distilled water peritoneal lavage after curative liver resection (Group B). There were 11 patients of tumor recurrence in Group B; 2 in Group A. The mean disease-free time of Group B was 2.05 +/- 0.74 years; for Group A it was 3.59 +/- 0.60 (P = 0.045). Peritoneal lavage in this series resulted in significantly better survival time for the patients in Group A (P = 0.0158). That implies distilled water peritoneal lavage during liver resection would retard the tumor recurrence and further improve the survival rate in patients with spontaneously ruptured hepatocellular carcinoma.

Effects of systematic lymphadenectomy on length of survival in patients with gastric carcinoma

In the last few years there have been arguments between the Japanese and West European surgeons about benefits of systematic lymphadenectomies in surgery of gastric cancer. In this paper we would like to point out effects of systematic lymphadenectomies on survival of patients with gastric carcinoma. This investigation included two groups of patients. The first group of 126 patients with gastric carcinoma underwent peritumor lymphadenectomy D1. The second group of 114 patients with gastric carcinoma underwent more radical types of lympadenectomy (D2, D2+, D3). Survival analysis included investigation of the following: 1. depth of tumor invasion, 2. metastatic involvement of the lymph nodes 3. tumor stage, 4. tumor recurrence. Most of examined patients presented with invasion and serosal and subserosal penetration (about 75% in both groups). More than 42% of lymph nodes had metastases and patients with systematic lymphadenctomy had better survival. Patients without subserosal invasion did not have metastatic lymph nodes in II, III, IV drianaged groups. There was no difference in regard to length of survival between the two analyzed group. 5-year survival rate was highest in stage I of gastric carcinoma (86%), but in stage IV 5-year survival rate was only 3.8%. Local recurrence (26%) and lymph node metastases (53%) were common causes of tumor recurrence in group with peritumor lymphadenectomy. In all groups of patients with advanced gastric cancer patients undergoing systematic lymphadenectomy presented with higher survival rate. Patients with advanced gastric cancer presented with higher number of metastatic lymph nodes in III and IV drainaged groups. In this stage systematic lympadenectomy played the main role. In the group of early gastric cancer there were no patients with metastatic lymph nodes in drainaged groups. D2 lympahedenectomy is a standard procedure for a great number of patients with gastric carcinoma, with high survival rate. Only in the group of advanced gastric cancer, patients undergoing more radical types of lymphadenectomies (D2+, D3) presented with better survival rates.

Identification of the small interstitial deletion at chromosome band 1p34-p35 and its association with poor outcome in oligodendroglial tumors.

To narrow down the putative tumor-suppressor gene locus and to assess the predictability of clinical courses by genomic alterations, we analyzed 46 oligodendroglial tumors for loss of heterozygosity (LOH) in the distal region of the short arm of chromosome 1. LOH at 1p was found in 43 tumors (93.5%), including all 28 oligodendrogliomas, all eight oligo-astrocytomas, six of eight anaplastic oligodendrogliomas, and in one of two anaplastic oligo-astrocytomas. Thirty-seven tumors showed LOH patterns consistent with a large terminal deletion, whereas six tumors showed LOH suggesting interstitial deletions. Our data also showed two small regions of overlap at 1p34-p35 (approximately 5.7 Mb) and at 1p36.1-p36.2 ( approximately 12 Mb). Among the six tumors with interstitial deletion, the proximal region was deleted in five tumors, whereas the distal region was deleted in only half of them. Overall, 91% of tumors showed deletion including this proximal region. To examine the clinical significance of the LOH pattern, the samples were classified into three groups: tumors without 1p LOH (Group 1, n = 3), tumors with an interstitial deletion (Group 2, n = 6), and tumors with a large terminal deletion (Group 3, n = 37). Both overall and progression-free survival of patients in Group 2 was extremely poor compared with those included in Group 3 (P = 0.0006 and P = 0.003, respectively). As to the clinical response to chemotherapy, nimustine prevented tumor recurrence in Group 3 (P = 0.034) but not in Group 2. Our results demonstrate that a putative tumor-suppressor gene(s) in oligodendroglial tumors is localized at 1p34-p35 and that small interstitial deletions, in contrast to large terminal deletions, are strongly predictive of both chemoresistance and aggressive characteristics of these tumors.

Studies for Estimating the Biologic Behavior and Prognosis of Paragangliomas in the Head and Neck

Despite a large number of histopathologic and immunohistochemical studies, the biologic behavior and prognosis of paragangliomas (glomus tumors) of the head and neck still remain uncertain. In the present study 36 specimens from 32 patients who underwent surgery for a paraganglioma were examined. The examinations included routine histology, quantitative DNA analysis based on image cytometry, immunohistochemical detection of the proliferating cell nuclear antigen (PCNA) along with visualization of nucleolar organizer regions (AgNOR). According to LeCompte, the paragangliomas were histologically divided into three subcategories: 16 patients had a paragangliomatous tumor. 14 patients had an adenomatous tumor, and 6 patients had an angiomatous tumor. Quantitative DNA analysis revealed three categories of tumors with characteristical DNA pattern; DNA type I tumors were pure diploid, DNA type II tumors had stemlines at 2c and 4c and were therefore recognized as diploid-tetraploid. Aneuploid cells were not apparent in these two groups. DNA type III tumors had stemline ploidies exceeding 2c and 4c. Aneuploid cells were present in all of these tumors. The biologic behavior of these lesions therefore must be recognized as suspicious. DNA type III tumors and adenomatous tumors showed the highest values for the PCNA scores, indicating a higher proliferation rate and a more rapid growth pattern in these lesions. Twenty patients could be followed over a period of up to 110 months. Five of these patients developed a recurrent tumor. All of them had DNA type III tumors. The DNA indices showed significantly higher values in the recurrent tumor group. The 2c deviation index (DI) and the entropy value had the highest prognostic significance. No correlation to clinical follow-up was found for the AgNOR score. Based on these results, prognostic indices for paragangliomas were developed: patients with a tumor having a 2c DI exceeding 2.0, entropy value of more than 4.0. 5c exceeding rate more than 8.0, and a PCNA score more than 20.0% can be recognized as being at high-risk for developing recurrent disease.

A retrospective analysis of breast cancer based on outcome differences

We reviewed tumors from two groups of patients with breast cancer, distinguished by differences in outcome. One group (85 cases) survived more than 8.5 years without tumor recurrence; the other 85 cases had recurrent disease within 2 years. Histologic and immunocytochemical studies on all cases were performed without patient identifiers and prior to review of clinical prognostic factors. As expected, lymph node and estrogen receptor status differed substantially between the groups, but menopausal status and family history for breast cancer did not. We noted that 27% of node-negative patients died within 5 years, and nine patients with four or more tumor-containing nodes were symptom-free for over 8.5 years. Histologic grade (degree of tubule formation) and nuclear grade (including mitotic rate) differed significantly between the groups, as did vascular invasion, including both lymphatics and blood vessels. Prognostic value attached to tumor border only when fat was invaded without fibroblastic or inflammatory response ( P = .012). Subgrouping cases of infiltrating ductal carcinoma (not otherwise specified) was prognostically informative in the B subgroup, 69% of whom were in the rapidly recurrent tumor group. Immunocytochemical staining for c- erbB-2 was positive in 19.3% of cases, but was equally distributed between the two outcome groups. We conclude that traditional histologic parameters are highly informative, and that c- erbB-2 studies do not increase the value of histologic diagnosis.

Diagnostic yield in CT-guided stereotactic biopsy of gliomas.

Twenty-seven patients underwent 29 computerized tomography (CT)-guided stereotactic biopsy procedures for untreated or recurrent malignant astrocytomas. Biopsies were obtained from the hypodense center, enhancing margin, and hypodense periphery as seen on contrast-enhanced CT scans, with diagnostic yields of (number of biopsies yielding tumor/number of biopsies obtained): 34/61 (56%), 68/101 (67%), and 8/22 (36%) from these three zones, respectively. Although tumor was identified in all three zones, diagnostic yield was significantly higher in the hypodense center and enhancing margin. Comparison of patients with untreated tumors to those with recurrent tumors demonstrated no statistical difference in tumor distribution, although there was a trend toward a higher yield from the hypodense periphery in the recurrent tumor group. Tumor was found up to 15 mm beyond the CT-enhancing margin, in addition to extending beyond the area of abnormality on T2-weighted magnetic resonance images. These findings suggest that serial stereotactic biopsies should be targeted to the hypodense center and enhancing margin for improved diagnostic yield. Biopsy material obtained from the hypodense periphery that demonstrates tumor also indicates that a tumor volume beyond the confines of the CT-enhancing margin should be considered when calculating dosimetry for interstitial radiation.

Kidney-preserving radical tumor resection in advanced neuroblastoma.

The possibility of kidney-preserving radical tumor resection in advanced neuroblastoma was evaluated. Eighteen patients with stage III and IV adrenal neuroblastoma underwent delayed primary surgery after chemotherapy consisting of high doses of cyclophosphamide (1,250 mg/m2). Radical tumor resection with nephrectomy was performed in 13 patients (group A) and kidney-preserving radical tumor resection was performed in six patients (group B). Macroscopic findings were evaluated in all patients; angiographic and microscopic findings were evaluated in group A patients and tumor recurrence in group B patients. Macroscopically, the tumors were observed within the tumor capsule (C1) in five, outside the tumor capsule but not beyond the midline (C2) in seven, and beyond the midline (C3) in six. In group A, under microscopic examination, the tumor invasion into the renal parenchyma was observed in only three patients among C2 and C3 cases. Tumor vessels from the capsular and/or perforating arteries plus from the intrarenal arteries could be visualized in all patients, three of whom had tumor invasion into the renal parenchyma. In group B, no tumor recurrence around the kidney occurred, and two patients have survived for greater than 2 years. The kidney-preserving radical tumor resection is recommended in surgical treatment of advanced neuroblastoma following preoperative chemotherapy, and is predictable preoperatively by angiography.