Wet gangrene in hemodialysis patients with calciphylaxisis is associated with a poor prognosis

Calciphylaxis is a rare syndrome characterized by progressive vascular calcification and ischemic tissue loss in patients with chronic renal failure. We report our five-year experience with five patients who developed foot gangrene due to calciphylaxis. All five patients had characteristic clinical, laboratory, and radiologic findings of the disorder, but no diagnostic variable was uniformly present. All five had progressed to advanced gangrene at the time of surgical consultation. Despite aggressive local attempts to control infection, all five patients died of septic complications. Parathyroidectomy was performed in three patients but did not alter the course in any case. This small experience suggests that the outcome of foot gangrene associated with calciphylaxis is predicated on the degree of tissue loss. Aggressive local wound care does not appear to be adequate to control infection in patients who have already developed gangrene. Although parathyroidectomy may have important long-term advantages in patients with calciphylaxis, it does not appear to affect outcome in these advanced cases.     

淋巴结阴性乳腺癌的辅助化疗

淋巴结阴性乳腺癌是否需要辅助化疗或什么样病人应给予化疗 ,这是乳腺癌综合治疗的热点问题 ,现就有关的几个方面谈一些个人的体会。一、淋巴结阴性乳腺癌的自然病程及影响其预后的因素综合文献资料 ,在淋巴结阴性的乳腺癌病人中有约 70 %单纯通过局部治疗 (手术或加放疗 )而治     

Overview of adjuvant systemic therapy in early stage breast cancer

The benefits of adjuvant systemic therapy in reducing risk of distant relapse from breast cancer have been recognized for several decades. The intent of adjuvant therapy is to eliminate the occult micrometastatic breast cancer burden before it progresses into clinically apparent disease. Successful delivery of effective adjuvant systemic therapy as a complement to surgical management of breast cancer has contributed to the steady declines in breast cancer mortality observed internationally over the past 2 decades. Ongoing clinical and translational research in breast cancer seeks to improve the efficacy of systemic agents for use in the conventional postoperative (adjuvant) setting.     

KPNA4在胰腺癌中高表达并且与不良预后相关

目的 分析KPNA4在胰腺癌中的临床意义和潜在作用机制。方法 联合TCGA、GTEx和GEO数据库评估KPNA4在肿瘤和正常组织中的表达水平,收集临床样本通过免疫组化进一步验证。通过Cox分析和生存分析评估KPNA4对胰腺癌患者预后的影响,生物信息学分析用于预测KPNA4的相关功能和潜在机制。结果 生物信息学分析和免疫组化结果显示KPNA4的mRNA和蛋白表达水平在胰腺癌组织中均上调(P<0.05),相关性分析显示其mRNA表达水平与肿瘤大小(r=0.261,P<0.001)和淋巴结转移(r=0.193,P<0.05)正相关。生存分析显示KPNA4的mRNA高表达组患者的生存时间短于低表达组(P<0.001)。Cox多因素分析显示KPNA4是胰腺癌患者预后的独立危险因素(95%CI 1.132～2.808,P<0.05)。富集分析显示KPNA4参与了TGF-β信号通路、细胞外基质受体相互作用等多种肿瘤相关的生物学过程。结论 KPNA4在胰腺癌中异常上调,与患者的肿瘤大小和淋巴结转移呈正相关,并且预示着不良预后。KPNA4可能是胰腺癌诊断和治疗的潜在生物标记...     

Pan-immune-inflammation value is associated with poor prognosis in patients undergoing peritoneal dialysis

BackgroundImmune-inflammatory biomarkers (IIBs) have been shown to be correlated with prognosis in patients undergoing peritoneal dialysis (PD). In this study, we aimed to evaluate the relationship between a novel comprehensive biomarker, the pan-immune-inflammation value (PIV), and the prognosis of patients undergoing PD.MethodsWe retrospectively analyzed data from a multicenter, large-sample PD database. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count. The prognostic endpoints in this study were all-cause death all-cause, cardiovascular disease (CVD) and infection-related death. The Kaplan–Meier method, a Cox proportional hazards regression, Fine–Gray competing risk model, smooth curve, and subgroup analysis were used to analyze the independent relationship between PIV and the prognosis of patients undergoing PD.ResultsA total of 2796 cases of PD were included, and the study population was divided into Tertiles 1, 2, and 3, according to the tertiles of baseline PIVs. After adjusting for multiple model factors, patients in the Tertile 3 group had a significantly higher risk of all-cause death, CVD death and infection-related death compared with patients with PIV in the Tertile 1 group. Interaction tests showed no positive correlations for subgroup parameters. Regarding all-cause death, compared with the lowest tertile, the multivariable-adjusted hazard ratios (95% confidence intervals) of the highest and middle tertiles were 1.55 (1.25–1.94) and 1.77 (1.43–2.19), respectively; PIV (log2 processing) was associated with 17% excess of mortality in the continuous model.ConclusionsA high PIV at baseline was significantly associated with an increased risk of deaths due to all-causes, CVD and infection in patients undergoing PD.     

Overexpression of c-erbB-2 gene product is associated with poor prognosis factors in breast carcinoma

Oncogenes, the abnormal forms of proto-oncogenes, were shown to be involved in malignant transformation and in tumor progression. c-erbB2/HER2/neu is member of EGFR family and encodes the p185 protein, which functions as a tyrosine-kinase. Gene amplification and/or p185 overexpression were reported to be associated with poor prognostic in cancer. Our purpose was to investigate p185 immunohistochemical expression in breast carcinomas and in the corresponding axillary lymph nodes metastases and to identify possible correlation between p185 and other factors of poor prognostic, such as loss of hormonal receptors expression. In our study, 40.91% of cases were erbB-2 positive, p185 expression being maintained from the primary tumors to axillary metastases and associated with positive nodal status and with the absence of hormonal receptors expression (p < 0.05). These findings support the hypothesis the c-erbB2 is an advantageous acquisition for the aggressive behavior of the tumor cell and for its ability to invade and metastasize.     

乳腺癌患者内分泌治疗的服药依从性研究

目的 了解术后辅助内分泌治疗乳腺癌患者服药依从性现状,分析其相关危险因素.方法 选取在上海市某三级医院被确诊乳腺癌并需要接受术后辅助内分泌治疗的274例患者,通过门诊电子病历系统,回顾性分析2006～2012年所有内分泌医嘱记录,计算药物占有比(MPR).采用Logistic回归分析治疗第1年服药依从性不良的危险因素.结果 274例乳腺癌患者术后辅助内分泌治疗期间第1～5年的总体MPR平均值分别为91％、84％、85％、83％和71％;在治疗第1年,未化疗患者以及服用他莫昔芬的患者发生服药依从性不良的风险更高.结论 乳腺癌患者术后辅助内分泌治疗期间,治疗第5年总体服药依从性不良.在内分泌治疗的第1年,需要重点关注服用他莫昔芬以及未化疗的乳腺癌患者.     

乳腺癌的辅助内分泌治疗

内分泌治疗是乳腺癌综合治疗的一个重要组成部分,它有针对性强、疗效肯定、毒副作用小的特点.目前在高危健康女性预防乳腺癌中,其作为可手术乳腺癌术后预防复发转移的辅助治疗,以及复发转移乳腺癌的治疗中均扮演了重要角色.本文仅就乳腺癌辅助内分泌治疗进行讨论.     

Node-extranodal soft tissue stage based on extranodal metastasis is associated with poor prognosis of patients with gastric cancer

Background

The purpose of this study was to evaluate the effect of Node-Extranodal soft tissue（pNE） stage based on Extranodal Metastasis (EM) on recurrence and survival in patients with gastric cancer (GC).

Materials and methods

A total of 642 patients were divided into two groups according to statue of EM. Clinicopathologic features were compared among the two groups, the log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified by the Cox proportional hazards regression model. According to the number of EMs, EM was incorporated into the pN stage of gastric carcinoma. The 5-y overall survival (OS) and disease free survival (DFS) rates were 48.1% and 17.4%, 44.5% and 14.3% between the two groups. Patients with EM had a deeper tumor invasion and more number of lymph node metastases. Peritoneal dissemination and distant metastasis were more frequent with EM. EM is an independent risk factor for distance recurrence (odds ratio = 1.605), and it is the highest risk factor for peritoneal recurrence (odds ratio = 2.448). Multivariate analysis showed that depth of tumor invasion (P = 0.025), lymph node metastasis (P <0.001), and EM (P = 0.006) were independent factors associated with OS. Furthermore, EM (P = 0.0039) was also an independent prognostic factor for DFS. The differences in prognostic prediction between the seventh edition of the pN classification and the pNE classification were directly compared. We found the pNE classification (hazard ratio = 1.730, P <0.001) was more appropriate for predicting the OS of GC patients after curative surgery, and the −2 loglikehood of the pNE staging (4533.991) is smaller than the value of pN.

Conclusions

EM was closely associated with cancer aggressiveness and the presence of EM was a significant independent predictor of reduced DFS and OS in GC patients. EM is an independent risk factor for distance recurrence, especially for peritoneal recurrence, the selection of postoperative adjuvant therapy in systemic (intravenous or intra-arterial) and regional (intraperitoneal) based on EM may be a reasonable approach. The lymph node imaging techniques such as injecting nanocarbon during surgery should be applied. As an important prognostic factor, EM should be incorporated into N stage according to its number retrieved in postoperative samples.     

HER2 positivity is not associated with adverse prognosis in high-risk estrogen receptor-positive early breast cancer patients treated with chemotherapy and trastuzumab

Co-expression of human epidermal growth factor receptor-2 (HER2) and hormone receptor (HR) predicted worse prognosis in early breast cancer before trastuzumab was developed. We aimed to investigate whether HER2 positivity was still associated with worse outcome in high-risk estrogen receptor (ER) positive patients treated with trastuzumab and chemotherapy. In the present study, 227 ER+/HER2+ patients treated with trastuzumab and chemotherapy (HER2-pos-T group) and 1097 ER+/HER2-patients treated with chemotherapy alone (HER2-neg group) during 2009 and 2015 were retrospectively enrolled for the comparison of disease-free survival (DFS) and overall survival (OS). At a median follow-up of 59 months, 174 DFS events and 69 deaths were observed. The estimated 5-year DFS rate was 94.2% in the HER2-pos-T group and 87.4% in the HER2-neg group (Log-rank P = 0.014). HER2-pos-T group was associated with significantly better DFS in multivariate analysis (HR 0.38, 95% CI: 0.22–0.67, Log-rank P = 0.001). The estimated 5-year OS rates for the two groups were 97.2% and 95.7%, respectively (Log-rank P = 0.183). In multivariable analysis, patients in the HER2-pos-T group had significantly better OS compared with those in the HER2-neg group (HR 0.40, 95% CI: 0.17–0.95, Log-rank P = 0.037). We concluded that high-risk ER+/HER2+ breast cancer patients treated with chemotherapy and trastuzumab had superior prognosis compared with ER+/HER2-patients. Therefore, HER2 positivity itself may not be considered as an unfavorable factor for ER + patients in the era of trastuzumab.     

Cellular hyaluronan is associated with a poor prognosis in renal cell carcinoma

PurposeHyaluronan, a major glycosaminoglycan of the extracellular matrix, can act as an oncogenic component of the tumor microenvironment in many human malignancies. We characterized the hyaluronan content of renal cell carcinomas (RCCs) and investigated its correlations with clinicopathological parameters and patient survival.Patients and methodsThis retrospective study included data from 316 patients that had undergone surgery for RCC in Kuopio University Hospital in 2000 to 2013. The hyaluronan content of surgical tumor samples were histochemically stained with a biotinylated hyaluronan-specific affinity probe. The amount of tumor infiltrating lymphocytes was evaluated in each tumor. Kaplan-Meier and univariate and multivariate Cox-regression analyses were performed to estimate the impact of hyaluronan content on overall survival, disease-specific survival, and metastasis-free survival.ResultsDetectable cellular hyaluronan was associated with higher tumor grades and the presence of tumor infiltrating lymphocytes. Cellular hyaluronan identified a prognostically unfavourable subgroup among low-grade carcinomas. Multivariate analyses showed that measurable cellular hyaluronan was an independent negative prognostic factor for overall survival (hazard ratio [HR] 1.4; 95% confidence interval [CI]: 1.02–2.0; P = 0.039), Disease-specific survival (HR 2.07; 95% CI: 1.2–3.3; P = 0.002), and metastasis-free survival (HR 2.45; 95% CI: 1.37–4.4; P = 0.003).ConclusionsCellular hyaluronan was significantly associated with unfavourable features and a poor prognosis in RCC. Further studies are needed to investigate the biological mechanism underlying hyaluronan accumulation in RCC.     

Community-based assessment of adjuvant hormone therapy in women with breast cancer, 1991-1997

This study used population-based tumor registry data to describe the patterns of adjuvant hormone therapy and to examine the correlates of hormone therapy for women with breast cancer. The study population included 5101 women (age 20 years) who were diagnosed with breast cancer in 1991 through 1997 in the entire state of New Mexico. Overall, 32% of women with stage I, II, or IIIA breast cancer received adjuvant hormone therapy. The likelihood of receiving adjuvant hormone therapy increased with tumor stage at diagnosis. Women less than 50 years of age were significantly less likely to receive adjuvant hormone therapy compared to those age 50 to 54 years, but there was no significant difference in the use of adjuvant hormone therapy for women age 55 years and older. The use of adjuvant hormone therapy was influenced by hormone receptor status and lymph node status. Patients who received adjuvant chemotherapy were also more likely to receive adjuvant hormone therapy than those who did not. The use of adjuvant hormone therapy alone was relatively stable over time and the use of adjuvant chemotherapy alone increased, but the receipt of chemotherapy combined with hormone therapy decreased from 1991 to 1997. There was no significant difference with age in the use of adjuvant hormone therapy among 55-year-old women compared to those age 50 to 54 years, whereas women less than 50 years of age were significantly less likely to receive this therapy. The use of adjuvant hormone therapy varied significantly by tumor stage, lymph node status, hormone receptor status, and the receipt of adjuvant chemotherapy.