Serum Albumin as a Significant Prognostic Factor for Patients with Gastric Carcinoma

Background

The definition of prognostic factors in gastric carcinoma (GC) remains controversial. The potential of serum albumin as a prognostic factor for GC is emphasized because the technique to measure it is simple as well as being cheap and widely available. Our aim was to define the prognostic role of serum albumin in GC.

Methods

A cohort treated from January 1987 to December 2002 was studied. Relevant clinical, pathological and therapeutic variables were recorded. Kaplan–Meier and Cox’s methods were used to define prognostic factors associated with cancer-related survival.

Results

One thousand and twenty-three patients were included. Serum albumin did impact survival, showing a dose-response effect. This effect was present after adjustment for other prognostic factors, including Tumor-Node-Metastasis (TNM) stage, surgical resection and type of lymphadenectomy. In multivariate analysis, TNM stage [Stage Ia and Ib Hazard Ratio [HR] 1, Stage II HR 1.6 (95% confidence interval [CI], 0.56–4.7), Stage IIIa HR 4.4 (95% CI 1.7–11.3), Stage IIIb HR 5.6 (95% CI 2.6–17.2), Stage IV HR 6.8 (95% CI 2.7–17.5), high albumin HR 1, medium albumin HR 1.2 (95% CI 0.8–1.7), low albumin HR 1.2 (95% CI 0.8–1.8), very low albumin HR 1.8 (95% CI 1.3–2.6), D2 dissection HR 1, D1 dissection HR 1.9 (95% CI 1.3–2.97), and no resection HR 3.7 (95% CI 2.4–5.7)] were the most significant prognostic factors associated to survival (model P = 0.00001).

Conclusion

Pretherapeutic serum albumin level is a significant prognostic factor, which should be evaluated along with other well-defined prognostic factors in decisions concerning therapy for GC.     

Serum Neopterin as a Prognostic Indicator in Patients with Gastric Carcinoma

ABSTRACT?

Purpose: To evaluate the possible association between serum neopterin level and clinical and laboratory findings and their prognostic value of patients with gastric carcinoma. Methods: Serum samples were collected from patients (n = 38) and normal volunteers (n = 39) and stored at –80°C until analyzed. Neopterin, C-reactive protein (CRP), and IL-6 concentration were measured by ELISA. The clinicopathological parameters were determined by reviewing both medical charts and pathological records. Results: Mean neopterin levels were 15.26 ± 11.46 nmol/L in patients with gastric carcinoma and 9.87 ± 2.90 nmol/L in the control group. Serum neopterin concentrations were significantly higher in patients with gastric carcinoma than in the control group. The number of patients with elevated neopterin level was significantly correlated with stage, gastric wall involvement, the number of metastatic lymph nodes, and the level of serum CRP. The mean neopterin concentrations were significantly elevated in patients older than 60 years, in the presence of venous invasion and increased metastatic lymph node number, and in patients with elevated CRP levels. Neopterin level was also correlated with overall survival as an independent prognostic indoicator. Conclusions: Serum neopterin levels were elevated in patients with advanced gastric cancer and correlated with prognostic parameters and overall survival. Moreover, neopterin measured at the time of diagnosis can be used to predict the survival of gastric carcinoma.     

Laparoscopic Adrenalectomy for Large Adrenocortical Carcinoma

Background:

Adrenocortical cancer (ACC) is a rare disease that is difficult to treat. Laparoscopic adrenalectomy (LA) is performed, even for large adrenocortical carcinomas. However, the oncological effectiveness of LA remains unclear. This review presents the current knowledge of the feasibility and oncological effectiveness of laparoscopic surgery for ACC, with an analysis of data for outcomes and other parameters.

Database:

A systematic review of the literature was performed by searching the PubMed and Medline databases for all relevant articles in English, published between January 1992 and August 2014 on LA for adrenocortical carcinoma.

Discussion:

The search resulted in retrieval of 29 studies, of which 10 addressed the outcome of LA versus open adrenalectomy (OA) and included 844 patients eligible for this review. Among these, 206 patients had undergone LA approaches, and 638 patients had undergone OA. Among the 10 studies that compared the outcomes obtained with LA and OA for ACC, 5 noted no statistically significant difference between the 2 groups in the oncological outcomes of recurrence and disease-free survival, whereas the remaining 5 reported inferior outcomes in the LA group. Using a paired t test for statistical analysis, except for tumor size, we found no significant difference in local recurrence, peritoneal carcinomatosis, positive resection margin, and time to recurrence between the LA and OA groups. The overall mean tumor size in patients undergoing LA and OA was 7.1 and 11.2 cm, respectively (P = .0003), and the mean overall recurrence was 61.5 and 57.9%, respectively. The outcome of LA is believed to depend to a large extent on the size and stage of the lesion (I and II being favorable) and the surgical expertise in the center where the patient undergoes the operation. However, the present review shows no difference in the outcome between the 2 approaches across all stages. A poor outcome is likely to result from inadequate surgery, irrespective of whether the approach is open or laparoscopic.     

Liver Resection and Ablation for Metastatic Adrenocortical Carcinoma

Background

Adrenocortical carcinoma (ACC) is a rare disease without effective chemotherapy treated most appropriately with resection. The aim of this study was to evaluate our experience with liver resection for metastatic ACC.

Methods

This study is a retrospective review of patients who underwent liver resection or radiofrequency ablation (RFA) for ACC from 1979 to 2009.

Results

A total of 27 patients were identified. Of the 27, 19 underwent liver resection. Of the 19, 10 had a single liver lesion, and 18 of 19 were rendered free of disease in the liver, although only 11 of 19 were rendered completely free of disease because of extrahepatic disease (EHD). Of the 19, 13 had synchronous EHD. Also, 6 of 17 remained disease free in the liver at a median follow-up of 6.2 years (status of 2 of 19 was unknown). Of the 27 patients, 8 underwent RFA, 7 of 8 became free of disease in the liver, and 5 of 7 had EHD. No patients responded to prior chemotherapy. Median overall survival and survival of patients who underwent liver resection or RFA were both 1.9 years (0.2–12 + years); 5-year actuarial survivals were 29% and 29%, respectively. Disease-free interval (DFI) greater than 9 months from primary resection was associated with longer survival (median 4.1 vs 0.9 years; P = .013).

Conclusions

This study is a tertiary institution series of liver resection and RFA for ACC. Given the lack of effective systemic treatment options and the safety of resection and ablation, liver resection or RFA may be considered in selected patients with ACC metastatic to the liver especially with a long DFI.

     

Importance of Age as a Prognostic Factor for Tonsillar Carcinoma

Background  

We would like to evaluate the prognostic significance of young age (defined as 50 years old or less) for tonsillar carcinoma because of its association with HPV 16 virus infection.     

壶腹癌的外科治疗与预后分析

目的：评价不同手术方式对壶腹癌的治疗效果,并分析其与预后的关系。方法：回顾性研究81例壶腹癌患者的临床资料,根据治疗方法不同,50例采用肿瘤切除术治疗,31例采用姑息性手术治疗。分析不同治疗方法的术后并发症发生情况及预后。结果：肿瘤切除患者的术后并发症发生率差异有统计学意义(P＜0.05),肿瘤局部切除患者的术后并发症发生率比行胰十二指肠切除术低。行不同方法的姑息性手术患者,术后并发症的发生率差异无统计学意义(P＞0.05)。采用肿瘤切除治疗后,患者的生存时间差异无统计学意义(P=0.475),但采用不同方法的姑息性术式治疗后,患者的生存时间差异有统计学意义(P＜0.001)。研究发现,壶腹癌行肿瘤切除术后的中位生存时间比行姑息性手术长。姑息性手术方式中,行ERBD术后的中位生存时间比胆肠吻合和经皮经肝胆道穿刺引流治疗的长。结论：壶腹癌行根治性胰十二指肠切除术后并发症发生率相对较高,但术后生存时间长。     

Combined Liver and Inferior Vena Cava Resection for Adrenocortical Carcinoma

Purpose Adrenocortical carcinoma (ACC) is a rare malignancy, usually diagnosed at an advanced stage when it has invaded or adhered to adjacent organs. We report our experience of performing combined liver and inferior vena cava (IVC) resection for ACC. Methods Six patients with clinical stage III (n = 4) or IV (n = 2) ACC underwent combined resection of the liver and IVC. Two patients underwent extended right hepatectomy, and four underwent segmentectomy. In four patients, the IVC was resected segmentally: it was replaced with expanded polytetrafluoroethylene (ePTFE) in three of these patients, and not reconstructed in one. In two patients, the IVC was partially resected and closed directly. Results Perioperative mortality was zero, and morbidity was 33.3%, with temporary liver failure in two patients and renal failure in one patient. Recurrence was found within 8.1 months in three (50%) of the six patients. The mean recurrence-free survival period was 20.1 ± 7.7 months (95% confidence interval [CI]: 5.1–35.4), and the median survival time was 6.1 ± 9.8 months (95% CI: 00–25.3). The 5-year disease-free survival rate was 16.7%. Conclusions Patients with ACC involving both the liver and IVC are candidates for partial hepatectomy and segmental IVC resection. Resection affords the possibility of negative margins, acceptable perioperative morbidity and mortality, and prolonged survival in some patients.     

Diagnostic and Prognostic Biomarkers in Melanoma

Melanoma is a lethal melanocytic neoplasm. Unfortunately, the histological diagnosis can be difficult at times. Distinguishing ambiguous melanocytic neoplasms that are benign nevi from those that represent true melanoma is important both for treatment and prognosis. Diagnostic biomarkers currently used to assist in the diagnosis of melanoma are usually specific only for melanocytic neoplasms and not necessarily for their ability to metastasize. Traditional prognostic biomarkers include depth of invasion and mitotic count. Newer diagnostic and prognostic biomarkers utilize immunohistochemical staining as well as ribonucleic acid, micro-ribonucleic acid, and deoxyribonucleic acid assays and fluorescence in situ hybridization. Improved diagnostic and prognostic biomarkers are of increasing importance in the treatment of melanoma with the development of newer and more targeted therapies. Herein, the authors review many of the common as well as newer diagnostic and prognostic biomarkers used in melanoma.Melanoma, an aggressive skin cancer, is currently the fifth most commonly diagnosed cancer in men and seventh in women in the United States with its incidence increasing 194 percent from 1975 to 2011.1,2 In 2014, approximately 76,100 patients will be diagnosed with melanoma in the United States, accounting for an estimated 9,710 deaths.1 Though recent advances in therapies for metastatic melanoma have shown some hope,3,4 melanoma with distant metastasis still carries a grim prognosis with a five-year survival rate of 16 percent.2 Given the poor prognosis for late stage melanoma, biomarkers are needed to aid in both the diagnosis and prognosis of melanoma and to determine which patients merit more aggressive therapy.     

Apoptosis as a Prognostic Factor in Colorectal Carcinoma

P < 0.05); in tumors showing evidence of moderate differentiation than in well-differentiated tumors (P < 0.05); and in tumors with venous invasion or lymph node metastasis than in those without these features (P < 0.05). Moreover, the subgroup of patients with a low AI of <4.1 had a significantly poorer survival rate than the subgroup with a high AI in tumors at Dukes stage C, the 5-year survival rates being 33% vs 68% (P < 0.05; Cox-Mantel). Our findings suggest that less apoptosis might result in a greater progression of colorectal carcinoma, and that the rate of apoptosis might be an indicator of the degree of malignancy. Thus it would appear that the frequency of apoptosis in tumor cells could be a useful prognostic factor in colorectal carcinoma. (Received for publication on Sept. 17, 1996; accepted on May 12, 1997)