Nodal involvement as an indicator of postoperative liver metastasis in carcinoma of the papilla of Vater

Background/Purpose

Although lymph node metastatic involvement is one of the most important prognostic factors for carcinoma of the papilla of Vater, a detailed analysis of this factor in relation to prognosis has not been conducted.

Methods

From 1985 to 2003, 29 patients with carcinoma of the papilla of Vater underwent pancreaticoduodenectomy and dissection of regional lymph nodes at Yamagata University Hospital. We analyzed clinicopathologic variables in relation to prognosis and precisely evaluated nodal involvement in each patient to determine lymphatic flow. Furthermore, the relationship between recurrent site and nodal involvement was investigated.

Results

The overall survival rate was 55% at 5 years. The significant prognostic factors were morphological ulcer formation (P = 0.04), histological type (P = 0.03), nodal involvement (P = 0.002), and lymphatic invasion (P = 0.03). Multivariate analysis indicated no independent factor, but nodal involvement may be the strongest prognostic factor. The overall rate of nodal involvement was 41.4% (12 of 29 patients). The metastatic rates in the superior posterior pancreaticoduodenal lymph nodes, the inferior posterior pancreaticoduodenal lymph nodes, the superior mesenteric lymph nodes, and paraaortic lymph nodes were high (31.0%, 20.7%, 17.2%, and 13.8%, respectively). Patients with nodal involvement had a significantly higher rate of liver metastasis after surgery than those without it (P = 0.02). Ulcer formation and histological type were significantly correlated with nodal involvement (P = 0.05 and P = 0.002, respectively).

Conclusions

Nodal involvement is the most important prognostic factor in patients with carcinoma of the papilla of Vater. Patients with nodal involvement are at high risk of liver metastasis; therefore, adjuvant therapy may be necessary for the control of liver metastasis. Preoperative ulcer formation and histological type in the biopsy specimen are good indicators for extended lymph node dissection and adjuvant therapy, because these variables are correlated with nodal involvement. However, our data revealed only the sites of the positive nodes, without addressing the effect of extended lymph node dissection and adjuvant chemotherapy. To date, there has been reporting of extended lymph node dissection and adjuvant chemotherapy in patients with carcinoma of the papilla of Vater. Further studies will be necessary to resolve these problems.     

Impact of tumor control and presence of visible necrosis in head and neck cancer patients treated with radiotherapy or radiochemotherapy

Purpose: Tumor volume after the lymph node involvement is one of the most important single prognostic factor in patients of head and neck cancers treated with radiotherapy. We have recently demonstrated that the hypoxic subvolume is more important than the total tumor volume. We therefore propose the hypothesis that the presence of visible necrosis might be an important factor for cure by radiotherapy in squamous cell cancers of the head and neck. Methods: A total of 51 patients with locally advanced inoperable (T3-4 or N2-3) squamous cell cancers of the head and neck (mean age 57 years, range 41–75 years) were prospectively investigated with regard to a possible impact of tumor volume. All patients received CT examination of the head and neck according to a standardized protocol (spiral CT, contrast enhancement after automatic injection), and the total tumor volume was calculated as the sum of volumes of all visible macroscopic tumor sites. Poorly perfused and necrotic areas (no contrast enhancement) within macroscopic tumor sites were also calculated. Patients were then treated with accelerated-hyperfractionated radiotherapy in about 6 weeks. Seventeen patients were treated with only radiation. Patients without contraindications to cisplatin chemotherapy received cisplatin chemotherapy or a combination of cisplatin and paclitaxel (N=34). The allocation of patients to certain treatment regimens was based on individual decisions in each case and not randomized. Results: In patients treated with radiation alone, 12/17 (71%) got recurrence whereas in patients treated with radiation plus cisplatin, only 14/34 (41%) recurred (P=0.05). The 2-year overall survival was for radiation alone versus radiation plus cisplatin 0% vs. 62% (P<0.0008). Tumors with smaller amount of necrosis (necrosis volume<4 cm³) had a good prognosis irrespective of type of treatment (radiation alone or radiation plus cisplatin). However, patients with tumors with a larger amount of necrosis (necrosis volume≥4 cm³) had a significantly better outcome if they were treated with radiation plus cisplatin as compared to patients treated with radiation alone. In a multi-variate analysis using a Cox-regression model the type of treatment (radiotherapy plus versus without cisplatin) was the only independent prognostic factor for event-free survival (P<0.03) in the whole group. Conclusions: In this non-randomized retrospective investigation with limited sample size, radiation plus cisplatin was superior to radiation alone. This resulted mainly from a higher efficacy of the radiochemotherapy regimen in patients with large and especially necrotic tumors. The prognostic and predictive impact of visible necrosis should be further evaluated.     

Unfavorable prognosis of patients with stage II non-small cell lung cancer associated with macroscopic nodal metastases.

BACKGROUND: Patients with stage II-N1 non-small cell lung cancer (NSCLC) make up an intermediate group of patients with an unsatisfactory prognosis even though complete resection is usually possible. We retrospectively analyzed postoperative prognostic factors to devise guidelines for the proper management of this patient population. STUDY DESIGN: Among 546 patients with NSCLC who underwent surgical resection from 1979 to 1995, 43 patients were pathologically defined to be at stage II-N1 (T1-2N1M0). The influence of the following variables on postoperative survival was analyzed: gender, age, cell type, pathologic T factor, number of metastatic nodes, station of metastatic nodes (hilar or pulmonary nodes), status of nodal metastasis (macroscopic, gross involvement confirmed histologically; or microscopic, metastasis first defined by histologic examination), surgical methods, and adjuvant therapy (including 18 of chemotherapy and 2 of radiotherapy). RESULTS: The 5-year survival rates (5YSRs) of patients with microscopic (n = 21) and macroscopic nodal metastasis (n = 22) were 76.0% and 27.6%, respectively (p = 0.001). The 5YSRs of 20 patients who received adjuvant therapy and 23 who did not receive adjuvant therapy were 57.6% and 46.6%, respectively (p = 0.036). Other variables did not affect survival. The Cox proportional hazards model analysis indicated that the presence of a macroscopic nodal metastasis and postoperative adjuvant therapy were independent prognostic factors. Among patients with macroscopic N1 NSCLC, 9 patients who had undergone adjuvant therapy showed a more favorable prognosis than the 13 patients who had not received adjuvant therapy (3-year survival rate, 55.6% vs 18.5%; p = 0.037; and recurrence rate, 30.0% vs 77.8%), whereas no significant influence of adjuvant therapy on survival was observed among patients with microscopic N1 NSCLC. CONCLUSIONS: Stage II-N1 NSCLC was categorized into microscopic and macroscopic N1 diseases. The latter had a poor prognosis, which might be improved by adjuvant therapy, although a suitable regimen has not been established.     

黏膜相关淋巴组织淋巴瘤的临床研究

目的为提高对黏膜相关淋巴组织淋巴瘤（ＭＡＬＴ淋巴瘤）临床特征的认识。方法经我院确诊的ＭＡＬＴ淋巴瘤２４例,进行回顾性的临床分析研究。结果按原发部位可分为胃肠（ＧＩ）和非胃肠（ＮＯＮＧＩ）两组。ＧＩ组１８例（７５０％）,ＮＯＮＧＩ组６例（２５０％）,后者包括涎腺３例、肺２例和膀胱１例。手术治疗２１例,其中单用手术治疗１３例,术后合用化、放疗７例,合用放疗１例。单用化疗３例。随访１７例,失访７例,随访率为７０．８％。生存期４～１２１个月,平均３３个月,中位数１９个月。１７例随访病人中１６例已存活１～１０年,其中存活１年以上者占５８．８％、＞３年以上者占３５．３％、５年以上者占２９．４％、１０年以上者占５．９％。对临床分期和治疗措施与生存率比较显示差异无明显性（Ｐ＞０．０５）。结论ＭＡＬＴ淋巴瘤是非霍奇金淋巴瘤的一种独特亚型,具有起病隐匿、病程长、进展慢及患病率低、好发于中老年男性、Ｂ症状少见、易误诊为假性淋巴瘤、治疗疗效和预后良好等特征。     

黏膜相关淋巴细胞淋巴瘤的临床研究

目的 为提高对黏膜相关淋巴细胞瘤（ＭＡＬＴ淋巴瘤）临床特征的认识。方法 经我院确诊的ＭＡＬＴ淋巴瘤２４例,进行回顾性的临床分析研究。结果 按原发部位可分为胃肠（ＧＩ）和非胃肠（ＮＯＮ－ＧＩ）两组。ＧＩ组１８（７５．０％）,ＮＯＮ－ＧＩ组６例（２５．０％）,后者包括涎腺３例、肺２例和膀胱１例。手术治疗２１例,其中单用手术治疗１３例,术后合用化、放疗７例,合用放疗１例。单用化疗３例。随访１７例,失访     

Prognostic significance of tumour burden in Hodgkin's disease PS I and II

94 patients with Hodgkin's disease PS I or II, treated during the period 1969-78 and followed until death, or from 33 to 136 months after initiation of therapy, were analysed. 47 patients had been treated with radiotherapy alone (mantle field irradiation and, in all but 12 cases, irradiation of infradiaphragmatic lymph nodes), while the other 47 had been treated with mantle field irradiation plus 6 cycles of combination chemotherapy (MOPP or an equivalent regimen). Of the patients treated with radiotherapy alone, 13 relapsed whereas only 1 of the patients treated with radiotherapy plus combination chemotherapy relapsed. The initial tumour burden of each patient was estimated, combining tumour size of each involved area and number of sites involved. For patients treated with radiotherapy alone, a large tumour burden singled out the patients destined to relapse more accurately than other prognostic factors including pathological stage, B-symptoms, mediastinal involvement, bulky mediastinal involvement, and number of sites involved.     

Clinical hyperthermia, alone or with radiation therapy: results of a preliminary study on recurrences of cancers

Authors present results obtained by hyperthermic treatment (alone or associated with radiation therapy) on 50 patients (with a total of 66 sites) treated between September 1983 and August 1986. All patients had recurrent or metastatic lesions of pretreated malignant tumors. Among these there were 19 breast adenocarcinomas, 33 squamous cell carcinomas of head and neck, 9 melanomas and 5 subcutaneous metastases of adenocarcinoma of the cervix, rectum and colon. The clinical protocol was: hyperthermia alone (43 degrees -45 degrees C for 30 minutes, bi-weekly, for 4-5 weeks) or hyperthermia plus radiation therapy (4 Gy/fraction) for a total of 8-10 seances, in accordance with previous given doses of irradiation. In summary, complete response rates were 21.2% for head and neck tumors, and 51.5% for cutaneous or subcutaneous lesions. Results have also been analysed according to different prognostic variables related to tumor and treatment characteristics. These data are discussed.     

Nuclear expression of YB‐1 in diffuse large B‐cell lymphoma: correlation with disease activity and patient outcome

The aim of this study is to investigate the correlations among Y‐box binding protein‐1 (YB‐1) and P‐glycoprotein(P‐gp) and their prognostic significance in diffuse large B‐cell lymphoma (DLBCL). The expression of YB‐1 and P‐gp was examined immunohistochemically on 68 patients with DLBCL who were treated from 2003 to 2005. Samples were paraffin‐embedded newly diagnosed DLBCL tissues taken from the surgical specimens before adjuvant chemotherapy. We determined the prognostic significance of YB‐1 and its relationship with P‐gp in patients with DLBCL. Of the 68 tumors examined, 42 (61.8%) were positive for YB‐1 expression in the nucleus. The nuclear expression of YB‐1 was significantly associated with clinical stages, bone marrow involvement, extra nodal involvement, and poor response to chemotherapy. No associations were observed between P‐gp and clinical features, in context of the poor response to chemotherapy. Nuclear expression of YB‐1 was correlated significantly with increased expression of P‐gp patients with a nuclear YB‐1 tumor had a poorer prognosis than did those with a cytoplasmic YB‐1 tumor in all of the DLBCL patients (P = 0.035). Thus, correlation of YB‐1 and P‐gp emerged as a possible biomarker for unfavorable prognosis in DLBCL. It may provide useful information for clinicians to determine the appropriate therapy for each type of DLBCL.     

Surgical treatment and adjuvant chemotherapy in hepatocellular carcinoma patients with advanced vascular involvement

BACKGROUND/AIMS: In advanced hepatocellular carcinoma (HCC) with vascular involvement of major vessels, patients have a poor prognosis after surgical treatment. METHODOLOGY: Patient outcomes after surgical resection and the usefulness of adjuvant chemotherapy were examined in 12 patients with major hepatic vessel involvement who underwent hepatectomy with combined resection of major blood vessels. RESULTS: The main portal vein was resected in 8 patients, the inferior vena cava in 3, hilar bile duct in 2 and hepatic artery in 1. Eleven patients underwent hemihepatectomy and 1 underwent segment 4 and 5 resection. The portal branch was repaired by venoplasty. The vena cava wall was repaired by suture closure. The hepatic artery was replaced by end-to-end anastomosis. The bile duct was repaired by Roux-en-Y hepaticojejunostomy. Although 2 patients had biliary leakage, there were no postoperative complications in 10 patients. The tumor recurrence rate was 83% in the early period and cancer death within 1 year was observed in 6 (50%), while 3 with tumor recurrence survived for more than 2 years and 2 survived without recurrence. In 233 HCC patients who underwent hepatectomy, 10 patients including 2 present cases received adjuvant chemotherapy at the time of tumor recurrence and 2 had complete responses. While in 11 patients receiving chemotherapy without resection, the response rate using Gemcitabine (66%) was higher than that using low dose Cisplatin plus 5-Fluorouracil (22%). CONCLUSIONS: Complete surgical resection combined with main vascular resection could be safely performed in most advanced stage HCC patients and adjuvant chemotherapy in the early period after resection would be necessary, which may achieve longer survival in some patients even in the advanced stage.     

Primary non-Hodgkin’s lymphoma of the breast: eight-year follow-up experience

The objective of this study is to analyze the clinical characteristics and treatment of patients with primary non-Hodgkin's lymphoma of the breast (PNHLB). Forty-five patients with PNHLB treated in our hospital during a 15-year period were retrospectively analyzed. Forty-four were females and one male, with a median age of 47 years. Forty-two patients were at stage I or II and 82.2% had diffuse large B cell lymphoma (DLBCL). Local control rate was 95.2 and 66.7% for patients with and without radiotherapy, respectively (P = 0.020). Median overall survival and progression-free survival (PFS) of all patients was 6.8 and 4.3 years, respectively. For patients with DLBCL or T cell lymphoma, median PFS was 6.5 years with chemoradiation and 3.9 years with chemotherapy or radiation only (P = 0.029). Patients who used rituximab had not reached median PFS, while those treated without rituximab had a median PFS of 5.1 years (P = 0.301). International prognostic index (IPI) score and bilateral breast involvement were two independent prognostic factors for survival. Chinese patients with PNHLB have early occurrence in lifespan. Radiation confers a better local control. Patients with intermediate or high-grade PNHLB might be treated with chemotherapy, radiotherapy, and for CD-20 positive disease, rituximab. Bilateral disease and IPI are two prognostic factors.     

Adjuvant therapy for stage II colorectal cancer: Who and with what?

Opinion statement The role of adjuvant chemotherapy for patients with stage II colon adenocarcinoma remains controversial. The high surgical cure rate for patients with "low-riskrd stage II colon cancer, ranging from 75% to 80%, and the available clinical trials and metaanalyses provide conflicting recommendations for or against adjuvant chemotherapy for this group of patients. For fit "high-riskrd stage II patients with clinical obstruction or perforation at presentation, in which the 5-year survival rate is 60% to 70%, there is little controversy, as these patients are routinely treated with adjuvant chemotherapy. Other potential high-risk factors, including high histologic grade, microsatellite instability, and loss of 18q, have yet to be validated in prospective trials. Patients with fewer than 12 regional lymph nodes identified in the surgical specimen have a statistically unclear risk of lymph node involvement. These patients may have stage III disease and should receive adjuvant therapy. The decision to use adjuvant chemotherapy to treat low-risk stage II colon cancer patients (no obstruction or perforation) should be an informed decision weighing the magnitude of a net 2% to 5% survival benefit, a 0.5% to 1.0% risk of mortality with chemotherapy in addition to 6 months of chemotherapy-related toxicities, other coexisting patient morbidities, and the anticipated life expectancy of each patient. As adjuvant chemotherapy is therapy addressing local or metastatic microscopic disease, and the effectiveness of systemic and biologically targeted therapy for advanced macroscopic colon cancer continues to improve rapidly, it remains to be determined by clinical trials whether therapies including newer agents such as cetuximab and bevacizumab administered in the adjuvant setting may affect survival for stage II cancer patients.     

Pretreatment CA 19-9 level as a prognostic factor in patients with advanced pancreatic cancer treated with gemcitabine

BACKGROUND: Serum levels of CA 19-9 correlate with survival among patients with pancreatic cancer treated with surgery or radiation therapy. In addition, CA 19-9 responses have been shown to predict for a better prognosis among patients with advanced disease treated with chemotherapy. The present study evaluates the predictive role of CA 19-9 pretreatment levels and response among patients treated with gemcitabine. METHODS: We retrospectively identified 28 patients with advanced pancreatic cancer and baseline elevations of CA 19-9 (> 37 U/mL) who were treated with single agent gemcitabine. CA 19-9 response was defined as a > or = 50% decline at any time after treatment. Survival was estimated with the Kaplan-Meier method, and curves were compared with the log-rank test. RESULTS: Eleven patients (39%) had a CA 19-9 response. The median survival of responding patients was longer than that of non-responding patients (13.8 vs 8 mo, p = .0272). When pretreatment CA 19-9 levels were analyzed, patients who had CA 19-9 below the median for the entire sample (1212 U/mL) lived significantly longer than patients with a CA 19-9 above the median (14.9 vs 7.4 mo, p = .0013). On multivariable analysis, pretreatment CA 19-9 level was an independent, and stronger predictor of survival (p = .0005) than CA 19-9 response (p = .0497). Other variables were not associated with survival. CONCLUSIONS: CA 19-9 may be a useful adjunct to response evaluation is this setting. In addition to CA 19-9 responses, prechemotherapy levels of this marker seem to have strong prognostic significance.     

Small bowel lymphoma

Opinion statement Treatment of small bowel lymphoma requires the expertise of medical and surgical subspecialists. The two most important factors that determine the optimal treatment are histology and staging of small bowel lymphoma. Other factors that may affect treatment include age, multiple areas of involvement, tumor size, and perforation. At present, the best treatment for gastrointestinal lymphoma (stage IE disease) is limited resection of the tumor, followed by postoperative radiotherapy. The cure rate is approximately 75% for stage IE patients, even for those with aggressive histologic types. Chemotherapy is reserved for advanced-staged tumors. In patients with regional nodal involvement or extranodal involvement confined to one side of the diaphragm (pathologic stage IIE disease), chemotherapy should be combined with radiation therapy. The best chemotherapy regimen depends on the histology of the tumor. For diffuse large B-cell lymphoma, the most frequently diagnosed subtype of non-Hodgkin’s lymphoma (NHL), the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) is still the gold standard. Clinical trials have been conducted evaluating the new monoclonal antibody rituximab, along with the CHOP regimen for primary NHL. Results have been promising. The use of rituximab in the treatment of extranodal lymphoma is still being evaluated. Low-grade lymphomas have a more indolent course and do not respond as well to combination chemotherapy agents as the high-grade tumors. Fludarabine alone or in combination with cyclophosphamide is effective as a first-line agent for patients with low-grade NHL. It has also been used to treat relapsed or refractory low-grade NHL. Some promising results have been reported using the chemoimmunotherapy agent rituximab alone or in combination with fludarabine for the treatment of low-grade NHL. However, clinical trials are still needed. In patients with nodal involvement on both sides of the diaphragm or other extranodal involvement such as bone marrow or liver (pathologic stages IIIE and IVE), the disease is managed primarily with combination chemotherapy. Radiation therapy is reserved for treatment of initially bulky tumor sites, treatment of residual disease following chemotherapy, or serious local problems. The disease can be controlled in 25% to 40% of patients with stage IIIE or IVE disease. As with stage IIE disease, the optimal chemotherapy regimen depends on the histologic subtype of NHL.     

Oncologic outcomes of primary and post-irradiated early stage rectal cancer: a retrospective cohort study

AIM： To evaluate the oncologic outcomes of primary and post-irradiated early stage rectal cancer and the effectiveness of adjuvant chemotherapy for rectal cancer patients. METHODS： Eighty-four patients with stage Ⅰ rectal cancer after radical surgery were studied retrospectively and divided into ypstage Ⅰ group （n = 45） and pstage Ⅰ group （n = 39）, according to their preoperative radiation, and compared by univariate and multivariate analysis. RESULTS： The median follow-up time of patients was 70 mo. No significant difference was observed in diseaseprogression between the two groups. The 5-year disease-free survival rate was 84.4% and 92.3%, respectively （P = 0.327） and the 5-year overall survival rate was 88.9% and 92.3%, respectively, for the two groups （P = 0.692）. The disease progression was not significantly associated with the pretreatment clinical stage in ypstage Ⅰ group. The 5-year disease progression rate was 10.5% and 19.2%, respectively, for the patients who received adjuvant chemotherapy and for those who rejected chemotherapy in the ypstage Ⅰ group （P = 0.681）. CONCLUSION： The oncologic outcomes of primary and post-irradiated early stage rectal cancer are similar. Patients with ypstage Ⅰ rectal cancer may slightly benefit from adjuvant chemotherapy.     

High Ki67 index and bulky disease remain significant adverse prognostic factors in patients with diffuse large B cell lymphoma before and after the introduction of rituximab

The aim of this study was to evaluate the impact of clinical variables and biologic features on response rate (RR), overall survival (OS) and progression-free survival (PFS) in 111 patients with de novo diffuse large B cell lymphoma (DLBCL). Fifty-three patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) and 58 patients were treated with R-CHOP (rituximab + CHOP). The variables predictive of RR in the CHOP group were B symptoms, age, clinical stage, bone marrow involvement, bulky disease, International Prognostic Index (IPI) and Bcl-2; in the R-CHOP group, these variables were bulky disease, bone marrow involvement, IPI and Ki67 expression >80%. Multivariate analysis showed that in patients treated with CHOP, the independent prognostic factors associated with PFS were age, bulky disease, IPI and Bcl-2 and those associated with OS were performance status, clinical stage, IPI and bone marrow involvement. In contrast, in patients treated with R-CHOP, the variable shown by multivariate analysis to be an independent prognostic factor associated with PFS was bulky disease, whereas Ki67 expression >80% was associated with OS and PFS. Our data show that a high Ki67 expression and bulky disease could represent possible predictive factors of poor prognosis, which would help to identify a high-risk subgroup of newly diagnosed DLBCL.     

Clinicopathological characteristics and treatment of patients with high-grade endometrial stromal sarcoma: A retrospective study of 40 cases

To investigate the clinicopathological characteristics of patients with high-grade endometrial stromal sarcoma (HG-ESS).The clinicopathological characteristics, treatments, and prognostic information of consecutive HG-ESS patients were collected from medical records and then evaluated.A total of 40 women were included in the analysis. The immunohistochemical profiles indicated that HG-ESS tumors tend to be locally or weakly positive for vimentin (100%) and CD10 (72.0%) but mostly negative for desmin (7.7%) and AE1/AE3 (9.1%). The progression-free survival intervals and the clinical benefit rates of patients receiving radiotherapy and/or chemotherapy were slightly longer and higher than those receiving simple observation (progression-free survival: 6 and 5 months vs 2 months; clinical benefit rate: 83.3% and 75.0% vs 28.6%). The 1-year disease-specific survival (DSS) rate was 62.7%. Tumor size, myometrial invasion, lymphovascular space invasion, cervical involvement, Federation International of Gynecology and Obstetrics (FIGO) stage, and residual disease all significantly affected the DSS rate (P < .001, =.002, <.001, =.004, <.001, and <.001, respectively). For patients with stage I disease, the 1-year DSS rate was as high as 91.7%, in contrast to 66.7%, 26.7%, and 0% for those with stage II, III, and IV disease, respectively.HG-ESS is associated with an adverse prognosis. FIGO stage could effectively predict the prognosis of patients with this lethal disease. Immunohistochemical markers, vimentin+/CD10+ (local or very weak), in combination with desmin-/AE1/AE3-, may be helpful for improving the diagnostic accuracy of this lethal condition. The therapeutic roles of adjuvant chemotherapy and radiotherapy warrant further investigation.     

Chronic myelogenous leukemia: a multivariate analysis of the associations of patient characteristics and therapy with survival

The prognostic importance of patient pretreatment clinical and laboratory features was investigated in a group of 303 patients with Philadelphia chromosome-positive benign-phase chronic myelogenous leukemia. Intensive chemotherapy was given to 97 patients, and 78 underwent an early elective splenectomy. The overall median survival time, dated from hospital admission, was 39 months. Patient characteristics associated with shortened survival were age 60 years or older, black race, the presence of hepatomegaly, splenomegaly, symptoms, weight loss, and poor performance status. Adverse blood and bone marrow parameters were anemia, thrombocytosis or thrombocytopenia, a high proportion of peripheral blasts plus promyelocytes or of basophils, a high proportion of marrow blasts or basophils, decreased marrow megakaryocytes, and cytogenetic abnormalities in addition to the Philadelphia chromosome. Several of these factors were interrelated. A multivariate regression analysis demonstrated that the combination blood basophilia, race, additional cytogenetic abnormalities, age and marrow basophilia had the strongest predictive relationship to survival time. This resulted in a model segregating patients into low-, intermediate-, and high-risk groups, with median survivals of 53, 39, and 25 months, respectively. Another model was derived that did not include the marrow features and identified splenomegaly and platelet counts as adding to the prognosis prediction by blood basophilia, race, and age. Evaluation of the effect of therapy, after adjusting for differences in prognostic characteristics, showed that intensive chemotherapy was associated with survival prolongation among patients at intermediate and high risk of death. We conclude that a combination of pretreatment factors identifies different risk subcategories in patients with chronic myelogenous leukemia and is helpful in assessing overall prognosis and treatment effect.     

Long-term survival and prognostic factors in stage II-III multiple myeloma treated with conventional chemotherapy]

In this retrospective study, survival and prognostic factors were analysed in 65 patients with stage II-III multiple myeloma with osteolytic lesions. Multiple myeloma was diagnosed from 1976 to 1984, and patients were treated with conventional chemotherapy. The response rate to initial chemotherapy was 46%. The median survival time was 31 months. The 10-year survival rate was 10%. Four variables were individually prognostic: response to initial chemotherapy, bone marrow plasma cell percentage, the Durie and Salmon staging system, a biological staging system derived from Durie and Salmon's biological criteria regardless of bone lesions. In the multivariate analysis, only two prognostic variables were retained, namely the response to chemotherapy and the biological staging system. No prognostic value was observed for the extent of osteolytic lesions. This study suggests that, in conventionally treated multiple myeloma, long-term survival has improved compared with the previous decade. It also indicates that the extent of osteolytic lesions has little value for the definition of high-risk myeloma.     

Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy

An analysis of preoperative multimodality adjuvant therapy with 5-fluorouracil, mitomycin-C, and radiation therapy revealed that 38 of 45 patients (84 percent) treated were rendered free of cancer after chemotherapy/radiation therapy. No recurrence of tumor has been noted in those patients rendered free of disease by the preoperative treatment. Seven patients (15 percent) with residual macroscopic or microscopic cancer after preoperative therapy have had recurrence, all in distant sites. These seven patients have died from the disease. The prognosis for patients in this series depended on the success of the preoperative therapy in eradicating all tumor prior to surgery. Mitomycin-C and 5-fluorouracil are cytotoxic for local disease and for microscopic distant disease as well. Abdomino-perineal resection is unnecessary for patients whose primary tumor is eradicated by the preoperative therapy. The role of the relatively low dose of radiation therapy needs to be further defined.     

Chemotherapy plus radiotherapy versus radiotherapy alone in patients with anaplastic glioma: a systematic review and meta-analysis

Object

The aim of this study was to answer whether overall survival and progression-free survival are increased in patients with anaplastic glioma who are treated with radiotherapy plus chemotherapy as compared with those who treated with radiotherapy alone.

Methods

Searches of the MEDLINE (PubMed), Embase and Cochrane Library from January 2001 to May 2012 for relevant trials were undertaken. Selected studies based on the following criteria: First, only randomized clinical trial of adjuvant radiotherapy plus chemotherapy versus radiotherapy alone was permitted. Second, overall survival and/or progression-free survival was compared with patients in the studies. Third, cases were medically confirmed of anaplastic glioma.

Results

4 randomized clinical trials were found eligible for this article (involving a total of 963 patients). The meta-analysis showed a significant increase in overall survival in patients treated with radiotherapy plus chemotherapy (HR = 0.84, 95 % CI 0.72–0.98, P = 0.031).

Conclusions

Results of our meta-analysis indicated that adjuvant chemotherapy played a beneficial role in the treatment for anaplastic gliomas. But the role of adjuvant chemotherapy in the treatment for anaplastic astrocytoma or anaplastic oligodendroglioma/anaplastic oligoastrocytoma still needs further large randomized trials to demonstrate.