p53 Accumulation Is a Prognostic Factor in Intestinal-Type Gastric Carcinoma but Not in the Diffuse Type

Background: The prognostic value of p53 nuclear accumulation in gastric cancer is still unclear, as shown by the discordant results still reported in the literature. In this study, we evaluated the correlation between p53 accumulation and long-term survival of patients resected for intestinal and diffuse-type gastric cancer.Methods: Eighty-three patients with carcinoma of the intestinal type and 53 patients with carcinoma of the diffuse type were included in the study. Immunohistochemical staining of the paraffin sections was performed by using monoclonal antibody DO1; cases were considered positive when nuclear immunostaining was observed in 10% or more of the tumor cells. Prognostic significance of different variables was investigated by univariate and multivariate analysis.Results: p53 positivity was found in 51.8% of intestinal-type and 50.9% of diffuse-type cases. No significant correlation between the rate of p53 overexpression and age, sex, tumor location, tumor size, depth of invasion, lymph node involvement, distant metastases, and surgical radicality was found in the two groups of patients. A statistically significant difference in survival rate was observed between p53-negative and p53-positive cases in the intestinal type (P < .05), confirmed by multivariate analysis (P < .005; relative risk = 3.09). On the contrary, no correlation with survival was found in diffuse-type cases according to p53 overexpression.Conclusions: These results suggest that the immunohistochemical detection of p53 accumulation is a useful indicator of poor prognosis in the intestinal but not in the diffuse type of gastric cancer, and are indicative of distinct molecular pathways and pattern of progression in the two histotypes.     

Prognostic factors correlated with survival in AIDS patients

The authors present the AIDS cases (CDC '93) observed in Brescia from 1983 to 1994. They observed 1189 subjects (M 84%, F 16%) with a mean age of 32.7 years (intra-venous drug users 75.1%, heterosexuals 14%, homosexuals 9.6%). The mean survival observed was 56.7 weeks from the diagnosis of AIDS (mortality per year 78%). The most frequent AIDS-defining events were Visceral Candidiasis, P.carinii Pneumonia (PCP) and Neurotoxoplasmosis, while the longest and shortest mean survival was for Kaposi's Sarcoma (89 weeks) and Wasting Syndrome (8.4). The mean value of CD4+ lymphocyte counts on AIDS diagnosis was 72.6/l (1166 cases) and the highest and lowest were in non-Hodgkin's Lymphoma (NHL; 147.6/l) and Cryptosporidiosis (18.8/l). Antiretroviral therapy had been given for at least a month in 41.4% subjects (mean treatment duration of 74.8 weeks). The Cox model has demonstrated the favourable effect on survival of high CD4+ lymphocyte counts on diagnosis, antiretroviral therapy, the diagnosis of Tuberculosis (TBC) and PCP as initial markers and the diagnosis of TBC, PCP or Cytomegalovirus infection (CMV) during the entire clinical evolution. Moreover, the unfavourable effect of high age, diagnosis of Progressive Multifocal Leucoencephalopathy (PML), Wasting Syndrome and NHL as initial markers and diagnosis of PML or NHL in any moment of the disease has been demonstrated.     

Prognostic Significance of Proliferating Cell Nuclear Antigen (PCNA) in Squamous Cell Carcinoma of the Esophagus

Proliferating cell nuclear antigen (PCNA) has been shown tobe of prognostic significance in some gastrointestinal tumors.Immunohistochemical analysis was performed to determine whetherPCNA is useful for predicting the outcome of patients with squamouscell carcinoma of the esophagus. Using a mouse monoclonal antibody,PC 10, the expression of PCNA was studied in resected squamouscell carcinomas of the esophagus from 59 patients who had undergonecurative esophagectomy. None had received any preceding therapy.The proliferation rate was assessed in terms of the percentageof the PCNA-positive nuclear area relative to the total areaof cancer nuclei using a cell analysis system (CAS). Clinicopathologicalvariables including PCNA staining were assessed in relationto prognosis. Survival rate was obtained by the Kaplan-Meiermethod. The PCNA indices (percentage of the positive nucleararea) of the tumors varied from 4.4% to 96.2%. Among the clinicopathologicalvariables, only tumor size (5 cm) and depth of invasion werecorrelated significantly with PCNA index (P<0.05). Microscopically,PCNA was stained in non-keratinized cells but not in keratinizedcells. However the histological grade was not correlated withPCNA index. The survival rate was significantly worse in patientswith high PCNA indices (40%) than in those with low indices(<40%) (P<0.05). However, multivariate analysis revealedthat PCNA index was not an independent prognostic factor.     

Das Tumorrezidiv am Hals nach papillarem Schilddrüsenkarzinom Eine statistische Analyse zur Rezidivwahrscheinlichkeit nach Radikaloperation

Zusammenfassung 308 Patienten mit papillärem Schilddrüsenkarzinom (82,6% des Gesamtkrankengutes, Operation 19522–1987), die postoperativ als tumorfrei eingestuft worden waren, wurden retrospektiv analysiert. Die Beobachtungszeit reicht von 1 Monat bis zu 29,4 Jahren (mediane Beobachtungszeit 4,58 Jahre). Bei 32 Patienten (10,4%) wurde ein Tumorrezidiv am Hals diagnostiziert (lokal und/oder regionär). 8 davon sind am Ende der Beobachtungszeit nicht tumorfrei, 6 sind am Tumor verstorben (tumorbedingte Todesrate 18,8%, relative Mortalität 66,7%, im Gesamtmaterial 2,9% bzw. 29,0%). Die kumulative Rezidivwahrscheinlichkeit beträgt 9,98% nach 5 und 16,98% nach 10 Jahren. Die statistische Analyse der Rezidivwahrscheinlichkeit erfolgte nur an Patienten, die mindestens 5 Jahre beobachtet wurden oder innerhalb dieses Zeitraumes verstarben. Als Einflußgrößen wurden neben Alter and Geschlecht, tumorstadium und histologische Kriterien des Tumors berücksichtigt. Als bestimmend für das Auftreten eines Rezidivs nach 5 Jahren Beobachtungszeit erweisen sich der Status der regiondren Lymphknoten, der Differenzierungsgrad des Tumors und das Geschlecht der Patienten. Zur Verbesserung der Rezidivrate wird eine abgestufte therapeutische Radikalität in Abhängigkeit von den Einflußgrößen empfohlen.

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Cervical tumour recurrence after papillary thyroid carcinoma. A statistical analysis on the recurrence after potentially curative surgery

Summary 308 cases of papillary thyroid carcinoma (82.6% of our patients operated on between 1952 and 1987) who had undergone potentially curative surgery were analysed postoperatively. The follow-up ranges from 1 month to 29.4 years (median 4.58 years). In 32 cases (10.4%) a cervical tumour recurrence (local recurrence and/or cervical lymph nodes) was found. 8 of these are not free of tumour at the end of the follow-up, 6 had died of thyroid carcinoma (case fatality rate 18.8%, mortality rate 66.7%, in the entire material 2.9% and 29.0% respectively). The cumulative recurrence rate is 9.98% after 5 years and 16.98% after 10 years. A statistical analysis of the probability of recurrence was carried out only for patients who could be followed at least 5 years or those who died within 5 years. Age, sex, stage of tumour and histological criteria were taken into account as statistical variables. The state of cervical lymph nodes, the differentiation of the tumour and the patients' sex turned out to be determining factors for tumour recurrence after 5 years. In order to improve the recurrence rate a differentiated surgical radicality, depending on the above mentioned variables, is recommended.

     

Ⅰb-Ⅱb期手术治疗的宫颈腺癌卵巢转移及预后分析

目的　探讨Ⅰb—Ⅱb期手术治疗的宫颈腺癌卵巢转移的高危因素 ,并分析预后因素。方法　回顾性研究 32例Ⅰb—Ⅱb期手术治疗的宫颈腺癌的临床病理特点 ,应用 χ2 检验及logistic回归分析探讨 4例卵巢转移的高危因素 ;应用Kaplan -Meier法及Cox回归模型分析预后因素。结果　单因素分析提示卵巢转移的高危因素是临床分期和盆腔淋巴结转移 ,但多因素分析没有发现有统计学意义的危险因素。Cox回归提示肿瘤大小和盆腔淋巴结转移是独立预后因素。结论　对于有高危因素的宫颈腺癌 ,术中保留卵巢需要慎重。     

心脏继发性淋巴瘤65例临床分析

 目的　分析心脏继发性淋巴瘤 (SLH)的临床特征、治疗效果和预后因素 ,提高诊治水平。方法　回顾性分析 6 5例SLH的临床表现、病理类型、治疗疗效及预后因素。结果　初诊时表现为浅表淋巴结肿大的 17例 (2 6 .2 % ) ,纵隔淋巴结肿大 35例 (5 3.8% )。 5 4例 (83.1% )临床分析为Ⅳ期 ,心功能Ⅲ或Ⅳ级占 2 2例 (33.8% )。弥漫大B细胞性淋巴瘤、弥漫性小淋巴细胞性淋巴瘤、T淋巴母细胞性淋巴瘤和结节硬化型霍奇金淋巴瘤共占 4 7例 (72 .3% )。非霍奇金淋巴瘤 (NHL)和霍奇金淋巴瘤 (HL)的有效率分别为 6 3.2 %和 10 0 % ,中位生存期分别为 18个月和 4 7个月。结论　浅表或纵隔淋巴结肿大为SLH最常见症状 ,多数患者为晚期 ,多因素分析表明心功能分级 (P =0 .0 13)和治疗效果 (P =0 .0 0 6 )为独立的预后因素     

影响贲门癌手术患者预后的相关因素分析

目的：探讨影响贲门癌患者生存时间的影响因素。方法：收集236例贲门癌患者临床资料和随访资料，使用单因素Log-rank检验、Cox比例危险模型对影响预后的因素进行单因素、多因素回归分析。结果：肿瘤长度、淋巴结转移、组织病理学类型和TNM分期对患者的预后有影响。结论：早发现、早治疗是提高患者生存率的关键。     

外周原始神经外胚层肿瘤形态学免疫表型及临床预后研究

目的：探讨外周原始神经外胚层肿瘤(PNET)的临床表现，病理及免疫组织化学特点及预后。方法：对15例外周原始神经外胚层肿瘤进行临床资料及预后，病理组织形态学和超微结构特点及免疫组化表型研究。结果：患者以男性为主，男女之比约为6．5：1，年龄6～35岁，年龄中位数为16，发生部位较多，可发生在直肠，腹膜后，腹股沟，淋巴结，胸壁，睾丸，鼻腔及骨组织等；免疫组化：肿瘤均弥漫表达CD99，并不同程度地表达NSE，SYN，CgA等，但不表达CK，Desmin，LCA等，其中1例表达组织化学染色PAS，随访最长时间为24月。结论：PNET是一种发生在年轻男性，进展迅速，预后非常差的恶性小圆细胞肿瘤，认识其临床病理特点及免疫组化表型对于该恶性肿瘤的诊断及临床治疗意义重大。     

Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma

Purpose: A randomized study was undertaken to assess the role of brachytherapy as a boost to external beam radiation therapy in the initial management of patients with malignant astrocytomas.

Methods and Materials: Inclusion criteria included the following: biopsy-proven supratentorial malignant astrocytoma of brain ≤6 cm in size, not crossing midline or involving corpus callosum, age 18–70, Karnofsky Performance Status (KPS) ≥70. Patients were randomized to external radiation therapy only delivering 50 Gray (Gy) in 25 fractions over 5 weeks or external radiation therapy plus a temporary stereotactic iodine-125 implants delivering a minimum peripheral tumor dose of 60 Gy. Patients were stratified to age ≤50 or >50, and KPS ≥90 or ≤80.

Results: There were 140 patients randomized between 1986 and 1996, 71 to the implant arm and 69 to external irradiation only. Pathologically 125 patients had necrosis noted in their tumor specimen. Factors associated with improved survival in univariate analysis were age ≤50, KPS ≥90, chemotherapy at recurrence, and reoperation at the original tumor site. The Cox proportional hazards model revealed the following significant factors: treatment at recurrence (chemotherapy or reoperation) with a relative risk (RR) of 0.6 (p = 0.004) and KPS ≥90 with a RR 0.6 (p = 0.007). Randomization to the implant arm was associated with a RR of 0.7 (p = 0.07). Median survival for patients randomized to brachytherapy or not were 13.8 vs. 13.2 months, respectively, p = 0.49.

Conclusions: We conclude that stereotactic radiation implants have not demonstrated a statistically significant improvement in survival in the initial management of patients with malignant astrocytoma.     

Outcome of combination chemotherapy in extensive stage small-cell lung cancer: Any treatment related progress?

During the past two decades many different treatment regimens of combination chemotherapy have been applied in extensive stage small-cell lung cancer (SCLC). This study was carried out to identify whether these modifications have resulted in an improved overall survival for extensive stage during the past two decades. In total, 1111 patients with extensive stage SCLC were included in six consecutive randomised trials in our setting from 1973 until 1992. Of these, 526 patients treated in the early period (1973–1981) were compared with 585 patients treated in the late period (1981–1992) with respect to pretreatment prognostic factors, staging, treatment and outcome. No change in the distribution of prognostic factors was detected and the frequency of patients with extensive stage was equal in the two periods, and no difference in overall response rates and survival was observed (P=0.49). Median survival in the two periods was 208 days and 215 days, respectively. No stage migration or treatment-related improved outcome was observed in extensive disease. We suggest restricting aggressive treatment to patients with favorable prognosis and long-term survival as a realistic aim.