Oat-cell carcinoma of the prostate. Diagnosis, prognosis and therapeutic implications

BACKGROUND: Any carcinoma of prostatic origin which is not an acinary adenocarcinoma of the prostate is considered to be an atypical carcinoma. One member of this group of atypical prostatic tumors is the oat-cell carcinoma, or small cell carcinoma (SCC) of the prostate. This variety of carcinoma constitutes the histologic basis of <1% of all prostatic neoplasms. METHODS: Between 1992 and 1997, four patients were diagnosed with SCC of the prostate at our hospital. In 3 of the 4 cases, the histopathological diagnosis was pure SCC, and in the 4th case there was a component of prostatic adenocarcinoma associated with the SCC. At the time of diagnosis, extracapsular extension of the tumor was present in all 4 cases, with T3 or higher stages in all of them (T(3A)N(0)M(1), T(3A)N(0)M(0), T(3B)N(0)M(1), and T(4)N(0)M(0)). Because of the presence of extracapsular extension, radiotherapy and radical surgery were ruled out for all 4 patients. They were all offered systemic chemotherapy with cyclophosphamide (1 g/m(2)), doxorubicin (50 mg/m(2)) and vincristine (1.2 mg/m(2)). This therapeutic protocol was carried out in only 2 cases. RESULTS: Survival was <1 year in the 3 patients with pure SCC, and the patient with a mixed tumor is alive with detectable disease 9 months after diagnosis. CONCLUSIONS: This poor vital prognosis in SCC stresses the need for early diagnosis a timely and appropriate therapeutic intervention in this condition.     

Paranasal sinus tumors: Peter MacCallum Cancer Institute experience

BACKGROUND: The purpose of this study was to evaluate the local control, pattern of recurrence, overall survival, and prognostic factors of patients with squamous cell carcinoma (SCC), adenocarcinoma, and undifferentiated carcinoma of the paranasal sinuses (PNS) and nasal cavity (NC) presenting to our center for curative treatment over a 10-year period. METHODS: Between 1991 and 2000, 60 patients with SCC (n = 32), adenocarcinoma (n = 25), and undifferentiated carcinoma (n = 3) of the PNS or NC were identified. Forty patients received surgery and postoperative radiotherapy, four surgery alone; 11, radiotherapy alone; three radical radiotherapy after surgical recurrence; one, chemoradiotherapy and surgery; and one, induction chemotherapy followed by radiotherapy. RESULTS: Forty-seven patients (78%) were seen with T3-4 disease; however, most (92%) were node negative on initial assessment. The predominant failure pattern was local disease persistence or recurrence. The estimated 2- and 5-year local control rates were 63% and 49%, respectively. Orbital and neural invasion significantly affected local control. The estimated 2- and 5 year overall survival rates were 57% and 40%, respectively. CONCLUSIONS: Local failure remains the dominant cause for poor outcome in this group of patients. Because of the proximity of critical normal structures, the ability to perform adequate surgery and to deliver effective radiotherapy is limited in many cases. The use of postoperative concurrent chemoradiotherapy warrants further investigation.     

原发性胆囊鳞癌和腺鳞癌临床病理学分析

目的 探讨原发性胆囊鳞癌(SCC)、腺鳞癌(ASC)的临床病理特征、诊断、治疗及预后。方法 对13例原发性胆囊SCC、ASC行HE和免疫组化SP法染色,分析其临床病理学特征并复习文献。结果 原发性胆囊SCC 7例,原发性胆囊ASC 6例,其中男3例,女10例,主要发生于老年患者,中位年龄为67岁。病理学分期T4期8例,T3期4例,T1b期1例。肿瘤部位：弥漫分布4例,胆囊底部5例,胆囊底部及体部3例,胆囊体部1例。其中9例非弥漫肿物最大径2.0～6.0 cm。合并胆囊结石12例。手术方式：行开腹手术7例,腹腔镜手术6例。截至2022年4月1日,11例患者获得随访,中位随访时间14个月(6～110个月),死亡7例,生存4例。6例行术后化疗或放化疗(化疗用药包括吉西他滨、吉西他滨+顺铂、替加氟),其中3例死亡,3例生存;5例未行放化疗患者中4例死亡,1例生存。结论 原发性胆囊癌以腺癌多见,而SCC、ASC少见。胆囊SCC、ASC肿物体积较大,预后较腺癌差,治疗以手术切除为主,术后放化疗疗效尚不明确。     

膀胱小细胞癌(附4例报告)

目的：探讨膀胱小细胞癌（SCC）的诊断和治疗。方法：对4例膀胱SCC的病理及临床资料进行回顾性分析。结果：男3例，女1例，平均66.5岁。分期：T4N0M01例，T4N1M02例，T4N4M11例。根治性膀胱切除术加放疗2例，膀胱部分切除术1例，肿瘤无法切除而行右输尿管皮肤造瘘术1例。2例死于肿瘤复发或转移，平均生存时间6.5个月，另2例已分别生存6个月和3个月，仍在随访中。结论：膀胱SCC预后极差，行根治性切除术加联合化疗或放疗可提高治愈率。     

Proximal bile duct cholangiocarcinomas

AIM: The aim of this retrospective study was to report a series of 12 patients with hilar cholangiocarcinoma treated by curative resection. PATIENTS AND METHODS: Between 1980 and 1998, curative resection was performed in 12 patients out of 33 patients with a Klatskin's tumor. Preoperative biliary drainage was performed in 6 cases. Resection was limited to the extrahepatic bile duct in one case only. Resection was extended to the liver in 11 cases including segmentectomy I (n = 9), left hepatectomy (n = 7), right hepatectomy (n = 3) and segmentectomy IV (n = 1). Postoperative brachytherapy was performed in 3 patients combined with conventional radiotherapy. Conventional radiotherapy irradiation was performed in 2 patients and was associated with chemotherapy in 1 patient. RESULTS: There was no postoperative mortality. Postoperative follow-up was uneventful in 5 patients. Actuarial survival rate at 1, 2, 3, and 5 years was 81, 57, 28 and 28%, respectively. Prolonged survivals (88 and 114 months) were observed. CONCLUSION: Hilar cholangiocarcinomas have a poor prognosis. Curative resections are usually performed with major liver resections. RM cholangiography is now the most efficient examination for selection of surgical indications and choice of the best strategy. Long-term survival can be obtained with curative surgery. Adjuvant treatment has to be assessed by controlled trials.     

Distant metastases of adenoid cystic carcinoma of the salivary glands and the value of diagnostic examinations during follow-up

BACKGROUND: Adenoid cystic carcinoma (ACC) accounts for approximately 10% of all neoplasms of the salivary glands. Late distant metastases and local recurrences are responsible for a rather low long-term survival rate. AIM: To study the metastasizing pattern of ACC of the salivary glands in 51 patients. METHOD: Fifty-one patients with an ACC in the intraoral/sublingual salivary glands (n = 30), parotid gland (n = 8), submandibular gland (n = 2), maxillary sinus (n = 6), and nasal cavity (n = 5) have been studied. The male-female ratio was 1:1, the mean age was 54.3 (range, 19-81) years. In 30 cases treatment consisted of surgery and radiotherapy. In 13 cases surgery alone was carried out. The average follow-up time was 117.8 (range, 1-171) months. RESULTS: In 28 cases (54.9%) distant metastases occurred, and in 3 patients (5.8%) regional lymph node metastases occurred. In 12 of the 28 patients with distant metastases (42.8%), only the lungs were involved, whereas in 5 of the 28 patients (17.8%), the distant metastases occurred in other organs (eg, bones and brain). In 11 of the 28 patients (39.2%) metastases were found both in the lungs and other organs. Twenty-four of the 51 patients (47.0%) died because of their tumor. The average time between the occurrence of lung metastases and death was 32.3 months and between the occurrence of metastases elsewhere and death 20.6 months. CONCLUSION: Distant metastases of ACC of the salivary glands occur most often in the lungs. Although these lung metastases are the first to occur, these patients die later than patients with distant metastases in other organs. The value of annual chest films or other tests for the presence of distant metastases during follow-up after surgical removal of an ACC seems rather questionable.     

Treatment of early stage squamous-cell carcinoma of the glottic larynx: endoscopic surgery or cricohyoidoepiglottopexy versus radiotherapy

BACKGROUND: Both surgery and radiotherapy are recognized treatments of T1-T2 squamous cell carcinoma of the larynx. We retrospectively analyze and compare the oncological outcome of patients treated in a single institution, either by endoscopic surgery or partial supracricoid laryngectomy versus radiation therapy. METHODS: The medical records of 156 patients treated between 1983 and 1996 with either surgery (n = 75) or radiotherapy (n = 81) were reviewed. Male to female ratio, median age, and T-stage distribution were comparable. RESULTS: With a median follow-up time of 59 months, the 5-year cause-specific survival rate of 93% was identical for both groups. The actuarial incidence of metachronous second primaries was 7% at 5 years. Local control at 5 years remained 84% after surgery and 77% after radiotherapy. Anterior commissure infiltration was shown to represent a negative predictive factor of local control for radiotherapy (p =.01). Salvage treatment brought ultimate local control to 96% of patients after surgery and 94% after radiation therapy with long-term laryngeal preservation rate altered significantly (p =.05) in the group of patients who received radiotherapy (90.1% vs 97.4%). CONCLUSION: The treatment of laryngeal cancer is always a compromise between oncological efficiency and preservation of function. Our data suggest that, assuming proper selection of patients, radiation therapy and surgery yield similar local control and survival rates. The functional disadvantages after surgery are moderate and clearly counterbalanced by a significant decrease in long-term laryngeal preservation rate after radiotherapeutic treatment.     

经腹腔镜置入鼻胆管治疗有胆道手术史的胆总管结石应用分析

目的探讨经腹腔镜置入鼻胆管行引流治疗有胆道手术史的胆总管结石患者再行胆总管一期缝合术的安全性及可行性。方法选取2013年1月至2016年4月间成都市第二人民医院肝胆胰外科收治的56例既往有胆道手术史的胆总管结石患者,分为两组:鼻胆管组28例,行腹腔镜置入鼻胆管引流,并给予腹腔镜胆总管一期缝合术;T管组28例,行常规腹腔镜下胆总管探查、T管引流,观察并记录两组患者手术时间、术后白细胞及总胆红素下降水平、胆瘘、肠瘘、急性胰腺炎等并发症,以及术后带管时间和住院时间。结果 56例均手术成功。与T管组比,鼻胆管组术后胆红素水平恢复迅速,术后带管时间及住院时间明显缩短(P0.05),术后白细胞水平较低(P0.05),但两组手术时间、术后并发症(胆瘘、肠瘘、肝脓肿)发生率比较无明显差异(P0.05)。所有患者均随访6个月以上,复查MRCP未见结石残留、复发及胆道狭窄。结论经腹腔镜手术置入鼻胆管对既往有胆道手术史的胆总管结石患者行术后引流及一期缝合,是可行的且安全的。     

An evaluation of transanal endoscopic microsurgery for rectal adenoma and carcinoma.

BACKGROUND: Transanal endoscopic microsurgery was introduced in the early 1980s. Since then, increasing numbers of rectal adenomas are being excised by this technique. The aim of this study was to evaluate our institution's experience with transanal endoscopic microsurgery for rectal adenoma and carcinoma. METHODS: Seventy-five patients (adenomas, n = 58) underwent more than 90 TEM resections over a period of 5 years. RESULTS: Postoperative complications were minimal with 3% (n = 2) in the adenoma group requiring transfusion and 0% 30-day mortality. One patient in each group developed transient fecal incontinence. During the follow-up period, 6 patients (10%) in the adenoma group underwent further local resections for their recurrences. Two patients in the carcinoma group (1 each of pathological T1 and T2 stage) developed recurrence at 24 months. A female with a T2 tumor was found to have an inoperable lesion and underwent sigmoid colostomy. Five of 17 patients had postoperative radiotherapy, and 2 patients developed radiation enteritis. Four patients died during follow-up due to unrelated reasons. CONCLUSION: The transanal endoscopic microsurgery technique appears to be safe and associated with minimal morbidity. Careful selection of patients with thorough preoperative assessment is necessary for carcinoma patients. Patients with T1 lesions and favorable histology should only be considered for curative resection by this technique.     

Pure squamous cell carcinoma of the bladder in western countries. Report on 19 consecutive cases

INTRODUCTION: Pure squamous carcinoma (SCC) is a rare entity in western regions. The management of SCC still remains similar to that of transitional carcinoma, although it is a different entity. A retrospective review can be helpful in understanding the biological behavior of this uncommon vesical tumour. MATERIAL AND METHODS: Nineteen consecutive cases of pure SCC of the bladder, not related to bilharziasis or spinal cord injury, are herein reported. Fifteen patients were submitted to radical cystectomy, combined with emasculation in 1 case and unilateral nephroureterectomy in another. Partial cystectomy was performed in 1 patient and transurethral resection followed by radiotherapy in 3 more cases. Involvement of prostatic urethra and upper urinary tract was evident in 9 (47.3%) and 5 patients (26.3%), respectively. Four patients were submitted to neoadjuvant chemotherapy and 1 to presurgical radiotherapy without any objective response. Adjuvant chemotherapy was performed in 3 patients. At a mean follow-up of 52 months, 6 patients (31.5%) are alive without any evidence of disease. SCC antigen was monitored in 5 patients. The possible role of this marker in bladder SCC is discussed. CONCLUSIONS: Invasion of the upper urinary tract and prostatic urethra seems more common in SCC than in transitional cell carcinoma. Distant metastases are rare. Most patients die after attempts of locoregional control of the tumor have failed. Extensive surgery is recommended. Preoperative radiotherapy should be considered since pelvic recurrences are the leading cause of progression in squamous cell carcinoma.     

T stage as prognostic factor in irradiated localized squamous cell carcinoma of the nasal vestibule

BACKGROUND: To investigate the impact of T stage according to Wang on the prognosis of irradiated nasal vestibule carcinoma. PATIENTS AND METHODS: Treatment results of 47 patients were retrospectively analyzed. Treatment consisted of external beam radiotherapy (n = 26) or interstitial radiotherapy (n = 19) or a combination of both (n = 2) for a primary, localized, squamous cell carcinoma of the nasal vestibule. Mean follow-up was 5 years and 7 months. RESULTS: T1/T2 tumors: Local control was achieved in 40 of 44 patients; surgical salvage was possible in 2 of 4 local failures. Five patients had recurrences in the neck, and four of them could be salvaged surgically. One patient had distant metastases develop. T3 tumors (n = 3): no T3 tumor could locally be cured by radiotherapy. One patient was salvaged surgically but died of regional and distant metastases. Disease-specific survival is significantly correlated with T stage according to Wang (p =.0001). Most (85%) patients were smokers, and eight of them (20%) had a second primary tumor develop in the lungs. CONCLUSIONS: The effect of radiotherapy is significantly correlated with T stage (p =.0001) and hence less successful in T3 lesions as primary treatment option. The high incidence of second primary tumors in the lung is indicative for a similar carcinogenic influence of smoking on the nasal vestibule.     

Management of sinonasal undifferentiated carcinoma

BACKGROUND: Our aim was to report the outcomes of treatment for sinonasal undifferentiated carcinoma (SNUC). METHODS: Between September 1992 and October 2005, 15 patients were treated with curative intent with surgery (n=1), surgery and adjuvant radiotherapy (n=9), and definitive radiotherapy (RT) (n=5). Follow-up ranged from 11 to 151 months (median, 30); follow-up on living patients ranged from 12 to 151 months (median, 22). No patient was lost to follow-up. RESULTS: Seven patients (47%) developed a recurrence from 3 to 50 months (median, 9) after treatment. The 3-year outcomes were: local control, 78%; locoregional control, 65%; distant metastasis-free survival, 82%; cause-specific survival, 77%, and survival, 67%. The local control rates versus treatment modality were: surgery, 0/1 (0%); surgery and postoperative RT, 7/7 (100%); preoperative RT and surgery, 2/2 (100%); and definitive RT, 2/5 (40%). One patient (7%) treated with surgery and postoperative RT sustained a fatal complication. CONCLUSIONS: Combined surgery and adjuvant RT likely offer the best chance of cure compared with either modality alone. The impact of adjuvant chemotherapy is unclear.     

HER2表达水平对化疗失败的转移性尿路上皮癌免疫治疗疗效的影响

目的:探讨HER2表达水平对既往化疗失败的转移性尿路上皮癌(UC)免疫治疗疗效的影响。方法:回顾性分析北京大学肿瘤医院2017年6月至2021年4月行免疫治疗的77例既往化疗失败的转移性UC患者的临床资料。男49例,女28例;中位年龄为62(29~79)岁;肿瘤原发于膀胱28例(36.4%),肾盂25例(32.5%),...     

Intra-arterial chemotherapy for locally advanced bladder cancer

A total of 83 patients with locally advanced bladder cancer (T1, n = 5; T2, n = 28; T3a, n = 21; T3b, n = 21; T4, n = 8) were treated with intra-arterial (i.a.) cisplatin and adriamycin (or epirubicin) chemotherapy. In 51 of the 83 cases, we combined this treatment with radiotherapy. The pathological complete response (CR) rate was 68% for all patients, 84% for i.a. chemotherapy combined with radiotherapy and only 41% for i.a. chemotherapy. The 5-year survival rate was 57% for all patients, 71% for i.a. chemotherapy combined with radiotherapy and only 44% for i.a. chemotherapy. The 5-year survival as a function of the clinical stage was 82% for T1 + T2, 66% for T3a, 28% for T3b, 25% for T4 (T1 + T2 vs: T3b: p < 0.001, T1 + T2 vs. T4: p < 0.0001, T3a vs. T3b: p < 0.0263, T3a vs. T4: p < 0.0214, T3b vs. T4: p < 0.029). In 46% of all patients, we succeeded in preserving the bladder; especially noteworthy, is that in 65% of the patients undergoing i.a. chemotherapy combined with radiotherapy, we succeeded in preserving the bladder. These results demonstrate that i.a. chemotherapy combined with radiotherapy is a useful method for locally advanced bladder cancer which may make preservation of the bladder function feasible.     

Approach to the management of complex hepatic injuries

BACKGROUND: Complex hepatic injuries American Association for the Surgery of Trauma Organ Injury Scale grades IV and V incur high mortality rate ranging from 40 to 80%, respectively. The objective of this study is to assess the clinical experience with an aggressive approach to the management of these, the most complex of hepatic injuries. METHODS: This is a retrospective 6-year study (1992-1997) at an American College of Surgeons urban Level I trauma center of patients sustaining complex hepatic injuries whose interventions included surgery, angiographic embolization, endoscopic retrograde cholangiopancreatography plus biliary stenting and percutaneous computed tomographic-guided drainage. The main outcome measure was survival. RESULTS: A total of 22 patients sustaining complex hepatic injuries; mean age of 26 years (range, 10-52 years), mean Revised Trauma Scale score of 9.9, mean Injury Severity Score of 32 (range, 16-75), American Association for the Surgery of Trauma - Organ Injury Scale grade IV (13 cases); grade V (9 cases). Mean estimated blood loss was 4,600 mL; mean number of units of blood transfused was 15. The patients underwent the following interventions: surgery (n = 22), re-operated (n = 13), mean number of operations 1.6 (range, 1-4), extensive hepatotomy and hepatorrhaphy (n = 17), nonanatomic resection (n = 7), formal hepatectomy (n = 4), packing (n = 10), direct approach to hepatic veins (n = 3); angiographic embolization (n = 15); endoscopic retrograde cholangiopancreatography and stenting (n = 5); computed tomographic guided drainage (n = 6). Mean length of stay in the intensive care unit was 21 days (range, 2-134 days), mean hospital length of stay was 40 days (range, 2-147 days). Overall mortality rate was 14% (3 of 22 cases), hepatic mortality rate was 9% (2 of 22 cases), mortality rate by injury grade was 8% grade IV (1 of 13 cases) and 22% grade V (2 of 9 cases). CONCLUSION: In this select patient population, improvements in mortality rates can be achieved with an aggressive approach to the management of complex hepatic injuries, including surgery, early packing, angiographic embolization, endoscopic retrograde cholangiopancreatography and stenting of biliary leaks, and drainage of hepatic abscesses.     

Squamous cell carcinoma of the buccal mucosa: an aggressive cancer requiring multimodality treatment

BACKGROUND: In our clinical practice, we have observed a high incidence of locoregional failure in squamous cell carcinoma (SCC) of the buccal mucosa. We analyze our treatment results of this cancer and compare these results with those in the literature. We intend to define the pattern and incidence of failure of buccal cancer and provide information for the design of a better multimodality treatment. METHODS: During the period from 1983 through 2003, 121 previously untreated patients with M0 stage SCC of the buccal mucosa were treated with a curative intent at our hospital. Twenty-seven patients received surgery alone, 36 had radiotherapy alone, and 58 underwent surgery plus postoperative radiotherapy. RESULTS: The 5-year locoregional control, overall survival, and cause-specific survival rates for all patients were 36.3%, 34.3%, and 36.9%, respectively. The locoregional recurrence rate was 57% for all patients, with 80% occurring in the primary site alone. Patients with T1-2N0 disease who received surgery alone still had a high local recurrence incidence of 41%. For patients with locally advanced disease, surgery plus postoperative radiotherapy achieved better overall survival and locoregional control rates than surgery alone or radiotherapy alone. T classification was the only prognostic factor affecting locoregional control and survival in the surgery alone group, whereas N classification and skin invasion predicted a poorer survival for the surgery plus postoperative radiotherapy group. CONCLUSIONS: SCC of the buccal mucosa is an aggressive cancer with a high locoregional failure rate even in patients with T1-2N0 disease. Possible reasons include inadequate treatment and an intrinsically aggressive nature. Postoperative radiotherapy has resulted in a better locoregional control rate for patients with T3-4 or N+ disease and should also be considered for patients with T1-2N0 disease for whom adjuvant therapy after radical surgery currently is not recommended by most guidelines.     

Surgical treatment of neuroendocrine tumors of the lung.

OBJECTIVE: This report reviews the pattern of neuroendocrine (NE) differentiation, lymph-node involvement, extension of surgery, and survival in 125 NE lung tumor patients. METHODS: Standard diagnostic workup included CT scan, bronchoscopy, bronchial biopsy or Fine Needle Aspiration Biopsy, (111)In-pentetreotide scan (OctreoScan) and mediastinoscopy in selected patients. NE differentiation was assessed based on the morphology and immunohistochemical reactivity for pan-neuroendocrine markers NSE, CGA, and Synaptophysin. For small cell carcinoma (SCC), only clinical stage I and II patients underwent surgery. Several different surgical procedures were utilized, from limited resections to lobectomy, pneumonectomy, and bronchoplastic procedures. Survival was assessed using Kaplan-Meyer method at 5 years. RESULTS: There were 79 typical carcinoid (TC), eight atypical carcinoid (AC), 18 large cell carcinoma (LCC) and 20 SCC patients. Mean age at diagnosis was 54.6+/-15.2 (ranges from 16 to 77 years) for TC, 68.5+/-9.1 (range 53-81) for AC, 68.7+/-4.6 (range 58-77) for LCC, 64.6+/-7.9 (range 48-82) for SCC. Male/female ratio was 1/1 for TC and AC, 2.6/1 for LCC and 9/1 for SCC. Lymph-node involvement was present in 14% of TC, 0% of AC, 31.5% of LCC, and 45% of SCC. Cancer specific survival was 96% for TC, 87.5% for AC, 37.5% for LCC, and 30% for SCC at 5 years from surgery. Presenting symptoms were invariably of respiratory-related. None had the carcinoid syndrome. History of tobacco abuse ranged from 46% for TC to 100% in SCC. Survival ranged from a minimum of 1 month for SCC to a maximum of 168 months with no evidence of disease for TC. Synchronous multicentric forms were found in 14% of TC. Twenty-one percent (4/19) of the patients with SCC treated by induction therapy and surgery, and in few cases by surgery and adjuvant chemotherapy are alive without the evidence of the disease for 5 years. CONCLUSIONS: Due to the high percentage of lymph-node involvement and multicentric forms found in our series lobectomy with radical lymph-node dissection appears, in our opinion, the most appropriate surgical treatment in well-differentiated forms, while more limited resection appears sub-optimal. Also, due to the finding of recurrences many years after surgery, the follow-up must be accurate and protracted in this subgroup. Only Small Cell Lung Carcinoma patients in clinical stage I and II underwent surgery with good long-term results.     

Spindle and giant cell carcinoma of the bladder. Report of 3 cases

3 cases of spindle and giant cell carcinoma are reported. 2 patients with T3N0M0 and T3N1M0 tumors underwent radical cystectomy. They died 8 and 9 months after cystectomy for local recurrence and tumor metastases. Neither radiotherapy nor chemotherapy were effective in these 2 patients. 1 patient with T1NXM0 disease underwent resection of the tumor through cystotomy. Although she had neither adjuvant chemotherapy nor radiotherapy, she is well without recurrence 6 years after surgery. Early surgical resection of the tumor may be the only currently accepted therapy of spindle and giant cell carcinoma of the bladder.     

Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer

BACKGROUND: Therapeutic decisions in recurrent oral and oropharyngeal squamous carcinoma (SCC) remain controversial. METHODS: Two hundred forty-six consecutive patients who underwent salvage surgery for recurrent squamous cell carcinoma (SCC) of the oral cavity and oropharynx were studied. The tumor sites were lip, 33 cases; oral cavity, 143; oropharynx, 70. The previous treatment was surgery in 73 patients, radiotherapy in 96, combined surgery and radiotherapy in 76, and chemotherapy in one. The clinical stage of recurrence was I/II in 51 cases and III/IV in 195 cases. The disease-free interval (DFI) was less than 1 year in 156 cases and greater than 1 year in 90 cases. RESULTS: The rate of recurrence was 54.9%, and the overall 5-year actuarial survival rate was 32.3%. The significant prognostic factors in multivariate analysis were restage (p = .049) and DFI (p = .045). CONCLUSION: Patients with recurrent oral and oropharyngeal SCC at initial clinical stages (rCS I and II) and with a DFI greater than 1 year had a favorable prognosis.     

A population-based study of tumor-node relationship,resection margins,and surgeon volume on gastric cancer survival

BACKGROUND: Gastric cancer surgery literature is conflicting. Two European level I randomized controlled trials refute Asian lesser level evidence promoting more radical resections. Population-based study evidence is undefined. METHODS: Using this study design we examined the overall survival, the tumor-node relationship, margins, and surgeon volume on gastric cancer survival in a Canadian province. RESULTS: Between 1991 and 1997, 577 (71 +/- 13 years 60% male) gastric adenocarcinomas were diagnosed in Northern Alberta (population 1.7 million). Respectively, median survival in months for stage I (n = 67) was 77, stage II (n = 55) 75, stage III (n = 155) 12, stage IV (n = 235) 3, and 65 unstaged (n = 65) 4. Five-year survival for T1N0 (n = 28) was 68% versus T1N1 (n = 7) 71% (P = 0.80); for T2N0 (n = 29) 58% versus T2N1 (n = 19) 58% versus T2N3 (n = 7) 29% (P = 0.08); for T3N0 (n = 33) 57%, versus T3N1 (n = 98) 9% versus T3N2 (n = 47) 0% versus T3N3 (n = 8) 0% (P < 0.0001). Median gastrectomy survival (months) in stage III was 15 months margin negative versus 8 months margin positive versus 6 bypass and 5 for no surgery (P = 0.0004). In stage IV it was margin positive 8 versus margin negative 6 (nonsignificant), bypass 3 versus no surgery 2. Five-year survival for surgeons doing fewer than 20 gastrectomies (n = 196 patients) was 29% (median 1.4 years) versus 35% (median 2.3 years; n = 72 patients) for surgeons doing 20 or more (n = 4; P = 0.325). CONCLUSIONS: From these population data we conclude that (1) few patients present with "curable" gastric cancer, (2) node negative or small gastric cancer survival is not influenced by nodal stage, (3) positive margin resection survival is better than bypass or no surgery in stage IV but not stage III disease, and (4) surgeon volume does not appear to influence patient survival.