Clinicopathological Features and Prognostic Factors of Young Patients With Surgically Treated Liver Cancer

This article compares the clinical characteristics and prognosis of young patients in different age groups with liver cancer (LC).In this retrospective study, we searched the Surveillance, Epidemiology, and End Results population-based database and identified 2641 patients who had been diagnosed with LC between 1988 and 2005. These patients were categorized into 2 different age ranges: Group 1 (≤35 years) and Group 2 (36–45 years). Five-year cancer-specific survival (CSS) data were obtained. Kaplan–Meier methods and multivariable Cox regression models were used to analyze the long-term survival outcomes and risk factors.There were significant differences between the age groups for stage and tumor size (P < 0.001). The 5-year liver CSS rate was 20.4% and 14.5%, respectively (P < 0.001). Univariate and multivariate analysis also confirmed the difference (P < 0.001). Further analysis showed that this significant difference existed in localized, regional, and distant-stage patients.Young patients with LC of age 18 to 45 years are inherently heterogeneous. Patients aged ≤35 years have better CSS than those aged 36 to 45 years, despite exhibiting unfavorable clinicopathological characteristics.     

Small-Cell Lung Cancer Transformation in Patients With Pulmonary Adenocarcinoma: A Case Report and Review of Literature

Despite the demonstrated benefit from epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) based therapies, EGFR mutant lung adenocarcinoma will eventually acquire drug resistance. Transformation to small-cell lung cancer (SCLC) is considered to be a rare resistance mechanism of EGFR-TKI therapy.We describe a case of a 46-year-old man presenting with refractory cough. Percutaneous transthoracic biopsy was performed and confirmed an EGFR exon 21 L858R lung adenocarcinoma. However, the patient relapsed after successful treatment with gefitinib for 1 year, at which point rebiopsy identified an SCLC and chemotherapy composed of platinum and pemetrexed was started. However, despite the brief success of chemotherapy, our patient died of aggressive cancer progression and complications of chemotherapy.Our case highlights the importance of rebiopsy when managing drug resistance and presents a possible origin of the transformed cells. We also summarize the clinical characteristics of cases involving transformed SCLC from previous studies and discuss whether it could be a new subtype of SCLC.     

Impact of Radiation Therapy in Surgically Resected Limited-Stage Small Cell Lung Carcinoma

Purpose

To elucidate the role of radiation therapy (RT) in the treatment of surgically resected limited-stage small cell lung carcinoma (LSCLC).

Methods

We queried the SEER database from 1998 to 2012 to identify patients who were diagnosed with LSCLC as their only primary tumor. Kaplan–Meier analysis was utilized to determine disease-specific survival (DSS) and overall survival (OS), while multivariate analysis was used to compare survival in terms of patients and treatment characteristics.

Results

Eight hundred twenty-three LSCLC patients were identified for inclusion within the study. 12-month DSS for patients who did not receive surgery or RT was 31.9% (95% CI 27.7–36.3), 93.3% (95% CI 71.6–90.5) for surgery alone, and 81.0% (95% CI 69.3–88.6) for surgery?+?RT. 12-month OS was 27.2% (95% CI 23.4–31.1), 74.7% (95% CI 62.6–83.4), and 78.3% (95% CI 66.4–86.4) for no surgery or RT, for surgery alone, and for surgery?+?RT, respectively. In terms of multivariate analysis, patients receiving surgery alone and patients receiving surgery?+?RT had a better DSS and OS than those who received neither treatment. However, OS (HR 1.60; 95% CI 0.93–2.75, p?=?0.09) and DSS (HR 1.34; 95% CI 0.72–2.51, p?=?0.37) were not significantly associated with patients receiving surgery alone compared to surgery?+?RT.

Conclusions

Surgery alone and surgery?+?RT were positively associated with DSS and OS compared to patients who did not receive surgery or RT. However, the addition of RT to surgery did not significantly predict DSS or OS compared to surgery alone.

     

Comparison of Once and Twice Daily Radiotherapy for Limited Stage Small-Cell Lung Cancer

Purpose

This study was designed to review outcomes of once- (QD) versus twice-daily (BID) radiotherapy (RT) for limited stage small-cell lung cancer (L-SCLC) treated at Dana-Farber Cancer Institute/Brigham and Women’s Hospital.

Methods

We reviewed records for all patients with L-SCLC treated with radical chemoradiotherapy at our institution between January 2005 and December 2010. Differences in patient, tumor, and treatment characteristics were assessed by Student’s t test and Fisher exact test. Outcomes were compared using Kaplan–Meier estimates and Cox proportional hazards regression.

Results

Twenty patients received QD RT to a median dose of 61.2 Gy, and 26 patients received BID RT to a dose of 45 Gy. Median follow-up was 2.8 years. Overall survival (OS) was similar in both groups. 5-year locoregional control (LC) for all patients was 67 %: 80 % for the QD group and 57 % for the BID group (log-rank, P = 0.16). Grade 2 or higher dermatitis and pneumonitis were significantly higher in the QD group (15 vs. 0 %, P = 0.0014 and 13 vs. 4 %, P = 0.048, respectively), whereas Grade 2 or higher esophagitis trended higher in the BID group (44 vs. 24 %, P = 0.076).

Conclusions

Although there were no differences in OS with QD versus BID RT, there was a trend toward increased LC in the QD group. Dermatitis and pneumonitis were more common for QD RT, and esophagitis was somewhat more common for BID RT. Possible differences in toxicities depending on RT regimen may be worth further investigation, until results from CALGB 30610 become available.     

Exploring the Impact of Lung Cancer Screening on Lung Cancer Mortality of Smokers With Obstructive Lung Disease: Analysis of the NLST-ACRIN Cohort

BackgroundLung Cancer (LC) screening with low dose chest computed tomography (LDCT) in smokers reduces LC mortality. Patients with Obstructive Lung Disease (OLD) are at high risk for LC. The potential effect of LC screening in this population is unknown.ObjectiveTo determine if screening with LDCT reduces LC mortality in smokers with spirometrically defined OLD.MethodsThe National Lung Screening Trial-American College of Radiology Imaging Network (NLST-ACRIN) study included 13,831 subjects (55–74 years of age with ≥30 pack-year history of smoking) that had a baseline spirometry. Randomly assigned to LDCT or Chest X-ray, all had 3 annual rounds of screening. LC mortality was compared between the LDCT and chest X-ray arms during the 1st year and at 6 years of follow up. Landmark analysis explored LC mortality differences between arms after the first year.ResultsFrom the 4584 subjects with OLD (FEV1/FVC <0.7), 152 (3.3%) died from LC. Multivariable analysis showed that screening trended to decrease LC mortality at 6 years (HR, 95%CI: 0.75, 0.55–1.04, p = 0.09). During the 1st year no differences were found between arms (p = 0.65). However, after this year, LDCT significantly decreased LC mortality (HR, 95%CI: 0.63, 0.44–0.91, p = 0.01). The number needed to screen to avoid one LC death in these subjects was 108 while in those without OLD was 218.ConclusionsLC screening with LDCT in smokers with spirometrically diagnosed OLD, showed a trend to reduce lung cancer mortality but a study with a larger number of patients and with a more robust design would be needed to confirm these findings.     

Development of a New Lingual Range-of-Motion Assessment Scale: Normative Data in Surgically Treated Oral Cancer Patients

Surgical resection in oral cancer patients can result in altered speech, swallowing, and patient perception of quality of life (QOL). Oral surgery can result in reduced lingual range of motion (ROM). However, few studies have quantified the degree of lingual restriction after surgery. This pilot study describes a new measurement system to define tongue ROM in surgically treated tongue cancer patients. This measurement system was validated by comparing results in these treated surgical patients versus healthy individuals. This scale was further validated by correlating ROM with performance status, oral outcomes, and patient-rated QOL. Thirty-six patients who underwent oral tongue surgery and 31 healthy individuals were included. Tongue ROM was assessed using a novel ROM assessment system. This novel system was examined in these patients versus healthy subjects. This measurement tool was further validated by correlating tongue ROM in treated patients with performance status, oral outcomes, and patient-rated QOL. Tongue ROM was found to be significantly lower in the surgically treated patients than in the healthy individuals (p = 0.0001). Tongue ROM correlated with performance status, oral outcomes, and all QOL measures. This new tongue ROM measurement system defined tongue deficits in surgically treated oral cancer patients. This tool was validated by comparing results to those in healthy individuals, as well as by correlating tongue ROM to performance status, oral outcomes, and QOL. This measurement tool can be used to define baseline and postsurgery tongue ROM in oral cancer patients, as well as track change over time with recovery and therapy. Future studies should examine use of this measurement tool with other populations demonstrating tongue deficits.     

The Role of c-erbB-2 Expression on the Survival of Patients with Small-Cell Lung Cancer

The aim of this study was to determine the incidence and role of c-erbB-2 overexpression as a predictive/prognostic marker in small-cell lung carcinoma (SCLC). We performed a retrospective study on subjects with a biopsy-proven diagnosis of SCLC. A chart review for demographic and clinical data was performed on patients with SCLC diagnosed between 1998 and 2004. c-erbB-2 overexpression was evaluated using immunohistochemistry performed on archival paraffin-embedded specimens. Sixty-seven patients with SCLC were identified (6 females, 61 males; median age- 56.5 yr, range-34–75) all of whom had adequate tissue specimens available for c-erB-2 testing. Of the 67 specimens, 12 (17.9%) showed c-erbB-2 overexpression. Seventy-five of the cases were positive for c-erbB-2, had extensive disease. The median overall survival of patients with SCLC whose tumors were positive and negative for c-erbB-2 were 8 ± 0.9 months (95%CI 6.3–9.7) and 11 ± 1.5 months (95%CI 8.0–14.0), respectively. c-erbB-2 overexpression detected using immunohistochemistry is observed in 17.9% of patients with SCLC and has statistically significant prognostic value. Our findings suggest that c-erbB-2 may be a potential target for site-specific immunotherapy in SCLC. Considering one technique examined, further molecular investigation is needed to confirm these preliminary findings.     

Shoulder Dysfunction After Radiotherapy in Surgically and Nonsurgically Treated Necks: A Prospective Study

Our goal was to evaluate the shoulder dysfunction after radiotherapy in surgically and nonsurgically treated necks.A prospective pair matched design was performed. A total of 96 patients from 3 groups were enrolled in the study. The patients were asked to complete the shoulder domain section of the University of Washington Quality of Life questionnaire on 2 occasions: preoperatively and 12 months postoperatively.None of the patients had a shoulder impairment before the operation. At the follow-up session, 4 patients who had received radiotherapy only reported mild shoulder dysfunction, the mean score was 96.3, the difference was significant compared with the preoperative score (P = 0.046). For patients who had received neck dissection, 7 patients reported that the impaired shoulder function caused them to change their work and 14 patients reported that their shoulder function was affected a little; the mean score was 71.6. For patients who had received both neck dissection and postoperative radiotherapy, 9 patients reported that they had changed their work due to shoulder dysfunction and 16 patients reported mild shoulder impairment; the mean score was 65.3 and the difference was not significant (P = 0.304).Radiotherapy does not increase shoulder dysfunction in surgically treated necks, but it could induce shoulder impairment in nonsurgically treated necks.     

The Highest Metabolic Activity on FDG PET Is Associated With Overall Survival in Limited-Stage Small-Cell Lung Cancer

We evaluated the prognostic value of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) parameters for limited-stage small-cell lung cancer (LS-SCLC).We retrospectively enrolled 59 LS-SCLC patients who underwent pretreatment FDG PET/CT. Various PET parameters were measured in all malignant lesions, and we recorded the highest maximum standardized uptake value (SUV_max), and sum of metabolic tumor volume (MTV_sum) and total lesion glycolysis (TLG_sum). The relationship between the highest SUV_max and volumetric PET parameters was evaluated. The prognostic significances of PET parameters and clinical variables were assessed using Cox''s proportional hazard regression analysis. Overall survival (OS) and progression-free survival (PFS) were assessed by the Kaplan–Meier method.The SUV_max of the highest metabolic lesion had a significant positive correlation with MTV_sum and TLG_sum (P < 0.001). Upon multivariate analysis, the highest SUV_max was an independent predictor of OS (1 unit increase, hazard ratio [HR]: 1.133, P = 0.003) and MTV_sum was a significant prognostic factor of PFS (10-cm³ increase, HR: 1.027, P = 0.034) after adjusting for age, sex, performance status, tumor stage, and treatment modality. The highest SUV_max was a prognostic factor for PFS with marginal significance (1 unit increase, HR: 1.078, P = 0.053). Patients with higher SUV_max (≥11) were also characterized by a significantly shorter median OS (P < 0.001) and PFS (P = 0.002) compared with patients with lower SUV_max.The highest SUV_max is an independent prognostic factor for survival in LS-SCLC patients. Therefore, the highest SUV_max might be a possible imaging biomarker for risk stratification in LS-SCLC. A further study in a large cohort is needed to validate the prognostic significance of the parameter.     

Risk of Recurrence in Surgically Resected Stage I Adenocarcinoma of the Lung: Histopathologic and Immunohistochemical Analysis

STUDY OBJECTIVES: Stage I adenocarcinoma of the lung is the most common type of lung cancer. A better understanding of the histopathology and molecular biology of lung cancer might improve the capability to predict the outcome for any individual patient. The purpose of this study was to evaluate several histopathologic and molecular markers in order to assess their prognostic value in stage I adenocarcinoma. METHODS: Fifty-five patients at the Seoul National University Bundang Hospital were enrolled in the study. Histopathologic factors and molecular markers were selected. RESULTS: Multivariate analysis demonstrated that necrosis, lymphatic vessel invasion, E-cadherin, p53, and Ki-67 emerged as independent prognostic factors of recurrence. When patients were grouped according to low or high risk according to the number of factors involved, the difference in disease-free survival between these groups was statistically significant. CONCLUSIONS: In resected stage I adenocarcinoma, necrosis, lymphatic vessel invasion, E-cadherin, and p53 have been identified as independent predictors of disease-free survival.     

A Case Report of Borrmann 2 Type Gastric Cancer Complicated with Lung Cancer and Treated with Laserthermia

Abstract : A 52 year-old female was admitted to our hospital for lung cancer. We performed upper gastrointestinal endoscopy for her complaint of epigastralgia, and diagnosed Borrmann 2 type gastric cancer on the posterior wall of the angle. Chemotherapy with CDDP and VDS was commenced for lung cancer, and endoscopic Nd- YAG laser local hyperthermia (Laserthermia) was carried out for gastric cancer. Nd- YAG laser provided computer-controlled thermo-monitering system was irradiated in 3W, intermittently. Laserthermia could be applied safely to the clinical endoscopy. Conclusions were as follows; 1) Borrmann 2 type gastric cancer complicated with lung cancer was treated with laserthermia without severe complication. 2) This is the first report that the Laserthermia controlled by computer thermo-system was put in to clinical use. 3) Laserthermia with chemotherapy was more effective than laserthermia alone.     

Hepatocellular Carcinoma: A Multivariate Analysis of Prognostic Features in Patients Treated with Hepatic Arterial Embolization

The prognosis after hepatic arterial chemoembolization was retrospectively analyzed in relation to therapeutic modalities, stage of tumor, and degree of liver cirrhosis in 150 patients with solitary tumors of hepatocellular carcinoma. The analyses of life-table methods revealed that adjunct hepatectomy, tumor size, bilirubin, albumin, globulin, and the 15-min retention rate of indocyanine green are statistically significant prognostic factors for hepatic arterial chemoembolization. Results of Cox's proportional hazard analyses disclosed that adjunct hepatectomy (p = 0.0001), serum albumin level (p = 0.0032), and stage of tumor (p = 0.0194) are statistically significant and independent prognostic factors. These findings suggest that the prognosis after hepatic arterial chemoembolization depends on the hepatic functional reserve and stage of tumor in patients with hepatocellular carcinoma, and adjunct hepatectomy improves the prognosis in these patients.     

Changes in Demographic Features of Gallstone Disease: 30 Years of Surgically Treated Patients

Background/Aims

The aim of this study was to investigate changes in the clinical and demographical characteristics of gallstone disease in Korea, based on 30 years of surgically treated patients at a single institute.

Methods

In total, 7,949 gallstone patients who underwent surgery between 1981 and 2010 were analyzed. Patients were divided into six time periods: period I (1981 to 1985, n=831), period II (1986 to 1990, n=888), period III (1991 to 1995, n=1,040), period IV (1996 to 2000, n=1,261), period V (2001 to 2005, n=1,651) and period VI (2006 to 2010, n=2,278).

Results

The total number and mean age of the patients gradually increased, and the male/female ratio decreased. The proportion of gallbladder (GB)-stone cases increased, whereas the proportions of common bile duct (CBD)- and intrahepatic duct (IHD)-stone cases decreased. Differences in patient geographical origins also decreased. Based on the relationship between changes in the prevalence of gallstone disease and socioeconomic status, the prevalence of CBD stones showed a strong correlation with Engel''s coefficient (p<0.001).

Conclusions

Our study indicates that although the total number of cases and the mean age of gallstone patients have continuously increased, there are trends of increasing GB-stone cases and decreasing CBD- and IHD-stone cases.     

Prognostic Impact of Changes in Intrarenal Venous Flow Pattern in Patients With Heart Failure

BackgroundIt remains unclear whether intrarenal venous flow (IRVF) patterns in patients with heart failure (HF) could change over the clinical course, and whether the changes could have a clinical impact. Thus, this study aimed to clarify these characteristics as well as to identify the relation between changes in the IRVF pattern and renal impairment progression.Methods and ResultsPatients with HF with repetitive IRVF evaluations were enrolled. Doppler waveforms of IRVF were classified into the following 3 flow patterns: continuous, biphasic discontinuous, and monophasic discontinuous. Primary end points included death from cardiovascular diseases and unplanned hospitalization for HF. Finally, 108 patients with adequate images were enrolled. The IRVF in 35 patients (32.4%) shifted to another pattern at the follow-up examinations. The median brain natriuretic peptide level in the continuous flow pattern at follow-up was significantly decreased (183 to 60 pg/mL, P < .001), whereas that of the discontinuous flow pattern at follow-up was increased (from 339 to 366 pg/mL, P = .042) and the estimated glomerular filtration rate was decreased (from 55 to 50 mL/min/1.73 m², P = .013). A multivariable Cox proportional hazard model analysis revealed that the discontinuous pattern at follow-up (P < .001) and brain natriuretic peptide (P = .021) were significantly associated with the end points, independent of age, estimated glomerular filtration rate, and serum sodium level.ConclusionsThe IRVF pattern could be changed depending on the status of congestion. Persistent or worsened renal congestion, represented by discontinuous flow patterns, during the clinical courses indicated a poor prognosis accompanied by renal impairment in patients with HF.