A Comparison of Five Competing Lymph Node Staging Schemes in a Cohort of Resectable Gastric Cancer Patients

Background

New classifications for lymph node (LN) staging have recently been proposed to improve upon the UICC/AJCC N category staging convention. Ratio-based systems and logarithmic odds (LODDS) scores are two families of novel competing staging systems. We compared UICC/AJCC staging with 5 ratio and LODDS systems in predicting overall survival (OS) in patients with resected gastric cancer.

Methods

Using a large population-based dataset, we identified 12,184 nonmetastatic resectable gastric cancer patients between 1988 and 2004. We compared each subject’s UICC/AJCC N stage with five novel staging schemes. We analyzed the OS for each method. Our comparison metric was the log-rank Chi squared statistic; larger Chi squared statistics indicate improvements in N stage discrimination.

Results

Median OS was 2.1 years (95 % CI 2.0–2.2 years), while median patient follow-up for surviving patients was 8.3 years (range, 1 month–22 years). Although all 5 staging systems were either comparable or superior to the UICC/AJCC convention, a LN ratio method outperformed others in N stage discrimination based on log-rank tests for OS. This trend was independent of the number of LNs examined.

Conclusions

Novel LN staging methods have a higher degree of discrimination utility than the UICC/AJCC N convention. These methods may have a role in reducing the prognostic impact of LN count variability. Of the systems assessed, the LN ratio system that assigns greater risk attribution to cases with <16 LNs was the best classification method to predict OS in patients with resectable gastric cancer.     

Large Metastatic Lymph Node Size, Especially More Than 2 cm: Independent Predictor of Poor Prognosis in Node-Positive Gastric Carcinoma

The presence of metastatic lymph nodes (MLNs) is the most important prognostic factor for gastric carcinoma, with the number of MLNs thought to be predictive of the prognosis. However, there have been long-standing debates on how to classify node-positive patients into prognostic groups appropriately. Recent findings in patients with colon and esophageal cancer have suggested that MLN size, more than MLN number, is an important prognostic factor; but less is known about the impact of MLN size on the prognosis of patients with gastric carcinoma. We therefore assessed the prognostic impact of large MLNs, especially those ≥2 cm, in patients with gastric carcinoma. A total of 1190 patients who underwent curative resection for gastric carcinoma between 2001 and 2003 and had lymph node metastases were divided into two groups according to the size of the largest MLN: ≥2 cm (n = 51) vs. <2 cm (n = 1139). Clinicopathologic data, including tumor recurrence and survival, were reviewed retrospectively. The median follow-up for living patients was 47 months (range 30–80 months). Age, sex ratio, type of surgery, and histologic classification did not correlate with MLN size. The depth of invasion did correlate with MLN size (T1–2 vs. T3–4, p = 0.045) but not with the number of MLNs (N stage, p = 0.311). The two groups showed similar distribution of stage according to the UICC/AJCC TNM staging system. Disease-free survival (34% vs. 53%, p < 0.001) and overall survival (40% vs. 63%, p = 0.011) were significantly worse in the large MLN group. Univariate analysis with the log-rank test showed that MLN ≥2 cm, type of surgery, T stage, N stage, and histologic classification had a significant impact on overall survival. Multivariate analysis with the Cox proportional hazard model showed that MLN ≥2 cm was an independent prognostic factor (hazard ratio 1.76, p = 0.006), along with T stage and N stage. MLN ≥2 cm is an independent additional predictor of poor prognosis in patients with node-positive gastric carcinoma.     

Prognostic significance of metastatic lymph node size in patients with gastric cancer

BACKGROUND: Patients with gastric cancer that has metastasized to the lymph nodes are a heterogeneous population with a variable prognosis. Stratification of these patients into prognostic groups is necessary for optimal adjuvant therapy. METHODS: The study comprised 715 patients who had undergone curative resection of a gastric neoplasm. Lymph nodes were sectioned, stained with haematoxylin and eosin, and the diameter of the largest metastatic lymph node (MLN) was measured. Patients with metastatic nodes were divided into groups n1 and n2 according to the size of the MLN. The cut-off level was set at 7 mm by a two-sample log rank test; patients in group n1 had a MLN size of 7 mm or less and those in group n2 had a MLN of 8 mm or more. RESULTS: Patients were stratified into significant prognostic groups by both the Union International Contra la Cancrum (UICC) node (N) stage and MLN size (n group). The UICC N-stage subcategories were further divided into prognostic groups according to MLN size (n group). On multivariate analysis the MLN size remained independently significant in terms of overall and disease-free survival rates, and the UICC N stage was not significant, independently of the n group. Node-positive patients with fewer than 15 lymph nodes removed at operation could also be stratified into prognostic groups by the n group. Stratification according to the TNM stage and by MLN size was superior to existing UICC TNM staging. CONCLUSION: This new method may help clinicians to design a more appropriate treatment strategy for patients with gastric cancer.     

Validation of the seventh edition of the American Joint Committee on Cancer tumor‐node‐metastasis (AJCC TNM) staging in patients with stage II and stage III colorectal carcinoma: analysis of 2511 cases from a medical centre in Korea

Aim The sixth and seventh editions of the American Joint Committee on Cancer (AJCC) tumor‐node‐metastasis (TNM) system for patients with stage II and stage III colorectal carcinoma (AJCC‐6 and AJCC‐7) were compared. Method Between 2000 and 2007, 2511 stage II/III colorectal carcinoma patients received primary surgical resection at the Asan Medical Center (Seoul, Korea). All patients were staged using AJCC‐6 and AJCC‐7 TNM systems. Patients with synchronous or other cancers, those given preoperative chemotherapy or radiotherapy and those in whom fewer than 12 lymph nodes were resected, were excluded. Overall survival (OS) and disease‐free survival (DFS) were compared. Results Of 2511 patients, 255 (10.2%) had different stages in the AJCC‐6 and AJCC‐7. For the AJCC‐7, the 5‐year OS by stage was 94.2% for stage IIA, 88.8% for stage IIB, 83.5% for stage IIC, 91.8% for stage IIIA, 81.8% for stage IIIB and 72.0% for stage IIIC. The OS and the DFS were not significantly different for the new substages IIB (n = 57) and IIC (n = 34) (P = 0.34 and P = 0.87, respectively). For the 187 patients with stage T3N2a cancer, the OS and the DFS were significantly different from stage IIIB other than T3N2a (P = 0.008 and P = 0.01, respectively) and there were no statistically significant differences in OS between the T3N2a group and the IIIC group (P = 0.46). Conclusion The study indicates that AJCC‐7 has better prognostic validity than AJCC‐6 for staging of patients with stage II and stage III colorectal carcinoma.     

The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma

Survival after curative resection for pancreatic adenocarcinoma remains poor; an important prognostic factor is lymph node (LN) status. Recent reports have established the number of LN examined as a separate prognostic factor in many malignancies. We retrospectively reviewed the charts of 128 patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer and obtained information such as overall survival (OS), disease-free survival (DFS), tumor characteristics, preoperative carbohydrate antigen (CA) 19-9, sex, and age. The ratio of metastatic to examined LN (LNR) was determined, and OS and DFS were analyzed in relation to the three groups: LNR = 0, LNR < 0.15, and LNR > 0.15. The median number of LN collected was 17. There were 46 N0 patients (median = 12) and 83 N1 patients (median = 19). The number of LN harvested had no impact on OS or DFS in the N0 or N1 patient populations. When LNR was examined as a continuous variable, it had a borderline impact on OS (P = 0.068). Examination of LNR by three groups showed an impact on OS (P = 0.037) and DFS (P = 0.013). After curative PD for pancreatic cancer, the ratio of metastatic to examined lymph nodes is an important prognostic factor and should be evaluated in stratification schemes for future clinical trials investigating adjuvant treatments.     

Prediction of survival in gastric carcinoma related to lymph node grading by the new American Joint Committee on Cancer/Union International Contre le Cancer System or the Japanese system.

OBJECTIVE: To compare the classification of gastric cancer adopted by the American Joint Committee on Cancer and the Union International contre le Cancer (AJCC/UICC) (number of nodes involved) with the Japanese classification (sites of nodes involved). DESIGN: Retrospective study. SETTING: Teaching hospital, Turkey. SUBJECTS: 134 consecutive patients whose gastric cancer was treated by D2 resection. INTERVENTIONS: Kaplan-Meier survival analysis and Cox's regression model. MAIN OUTCOME MEASURE: Accuracy of prognosis. RESULTS: There were no significant differences in survival rates when pN1 and pN2 categories of the AJCC/UICC classification were subdivided into the n1 and n2 categories of the Japanese classification. However, when those in the n1 and n2 categories of the Japanese classification were subdivided into the pN1, pN2 and pN3 categories of the AJCC/UICC classification, survival differed significantly (p = 0.00001). When both classifications were combined in a multivariate analysis the pN category of the AJCC/UICC classification was found to be the most significant independent prognostic factor (p = 0.0001). CONCLUSION: Classification of lymph node status by number of nodes (AJCC/UICC) rather than anatomical site (Japanese) gives a more accurate prognosis.     

The role of postoperative radiotherapy in non-small cell lung cancer; a retrospective analysis of our experience

Sixty-one patients with completely resected non-small cell lung cancer followed by postoperative radiotherapy were retrospectively reviewed. Forty-six patients were male and 15 were female. Ages ranged 34-79 (median 64) years. Squamous cell carcinoma (scc) in 28, adenoca. in 31, large cell ca in 1 and adenoid cystic ca. in 1. Pathological stage was IIA in 1, IIB in 9, IIIA in 41 and IIIB in 10. Over-all 5-year survival rate (OS) was 56.0%, and 5-year disease-free survival rate (DFS) was 39.7%. For IIB, IIIA, IIIB patients, OS were 77.8%, 55.4%, 24.0% respectively. According to purpose of radiotherapy, patients divided into 3 types as local invasion (LI) group (T3-4N0-1, n = 12), lymphnode metastases (LN) group (T1-2N2-3, n = 38) and both advanced (BA) group (T3-4N2-3, n = 8). OS were 71.6%, 50.7%, 46.9% and DFS were 68.6%, 31.0%, 42.9% respectively. In LN group, half of patients with scc had no relapse, but about half of non-scc had distant metastases. All N2 patients divided 2 types as single-station N2 and multi-station N2. OS were 71.8%, 40.0% and DFS were 53.5%, 21.1% respectively. DFS was significantly different (p = 0.04). The advantage was remarkable in patients with scc-single-station N2 (OS was 88.9%, DFS was 77.8%). The effectiveness of postoperative radiotherapy is not showed, but our results suggest the possibility for existence of subgroup benefited from postoperative radiotherapy.     

Prognostic Significance of Metastatic Lymph Node Ratio in T3Gastric Cancer

The fifth International Union Against Cancer tumor node metastasis (UICC TNM) classification, based on the number of metastatic lymph nodes (LN), has proved to be a reliable and objective method for predicting the prognosis of patients with gastric cancer. However, the prognosis of patients with T3 gastric cancer is still heterogeneous. This study was carried out to investigate the validity of metastatic LN ratio as a prognostic factor in T3 gastric cancer. A retrospective analysis was performed on a total of 833 patients that had either T3N1M0 (n = 504) or T3N2M0 (n = 329) gastric cancer by the fifth UICC classification. A preliminary analysis revealed the cutoff values for T3N1M0 to be 10% and for T3N2M0 to be 25%. The mean metastatic LN ratio was 9.0% for T3N1M0 cancer and 26.9% for T3N2M0 cancer. For the T3N1M0 stage, the patients who showed less than 10% of the metastatic LN ratio were grouped as N1-low with the others grouped as N1-high. For the T3N2M0 stage group, those who had less than 25% of the metastatic LN ratio were grouped as N2-low, the remainder as N2-high. The metastatic LN ratio decreased in proportion to the extent of lymphadenectomy and it increased in relation to the increasing scale of the fourth N classification. The rates of recurrence were significantly different according to the metastatic LN ratio in N1 and N2 classification of the fifth UICC classification (p < 0.05). The 5-year survival rates after gastrectomy decreased significantly by increasing the metastatic LN ratio in both T3N1M0 cancers (p =0.0026) and T3N2M0 cancers (p = 0.0057). The metastatic LN ratio was an independent risk factor for recurrence and poor prognosis. Our data suggest that the metastatic LN ratio is a significant prognostic factor for T3 gastric cancer. Furthermore, the application of the metastatic LN ratio can provide information not only about the extent of LN metastasis but also about the extent of lymphadenectomy in T3 gastric cancer.     

Prognostic Significance of the Number of Metastatic Lymph Nodes: Is UICC/TNM Node Classification Perfectly Suitable for Early Gastric Cancer?

Metastatic lymph node (MLN) is less frequently involved in early gastric cancer (EGC) and barely exceeds six in number. The prognostic value of the 5th edition of the UICC tumor–node–metastasis (TNM) node classification appears to be less accurate when applied to patients with EGC and needs to be further stratified. Three hundred twenty-three EGC patients were enrolled into this study. Prognoses of these patients were first assessed based on the 5th edition UICC TNM classification, followed by a reevaluation in which the prognoses of patients were further stratified according to the number of MLNs involved with an increment of one node at a time. A new node classification was proposed based on the correlation between prognoses and the number of positive nodes. According to the prognostic value, a new node classification was categorized as new N0 (0 MLN), new N1 (1–3 MLNs), new N2 (4–6 MLNs), and new N3 (>6 MLNs). While the survival of N0 and N1 groups based on the 5th edition UICC TNM classification appeared to be homogeneous (p = 0.0947), significant difference was unmasked between the new N2 and new N0/N1 groups (p < 0.001). In addition, differentiation status, vessel involvement, and new node classification were identified as independent prognostic factors by multivariate analysis for EGC. We conclude that subsets exist in patients with EGC at stage IB by UICC classification; patients with ≥4 MLNs are at higher risk of recurrence and surgical outcome in this population is relatively poor. Supported by grants from the National 973 Program (no. G1998051203) and the National Natural Science Foundation of China (no. 30672050).     

The prognostic value of different node staging systems in patients with ≤15 lymph nodes following surgery for gastric adenocarcinoma

Aim: Lymph node (LN) status is an important prognostic indicator in patients with gastric cancer (GC). Although American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) is the most widely used staging system, there is a challenge in predicting survival of patients when the number of total harvested LNs is ≤15. Our aim was to investigate the prognostic performances of seventh edition AJCC/UICC, lymph-node ratio (LNR), and log odds of metastatic lymph nodes (LODDS) on the overall survival (OS) of GC patients with ≤15 examined LNs after gastric resection.

Material and method: A total of 74 patients who underwent curative resection for gastric adenocarcinoma and had ≤15 LNs at the final histopathological examination were included in the study. The prognostic ability of three node staging models to predict OS was assessed using the area under the curve (AUC).

Results: Of the 74 patients, 15 (20.3%) had no LN metastasis whereas 59 (79.7%) had nodal involvement. The median OS was 26 months. When assessed as a continuous variable, LNR was the strongest staging system to stratify GC patients on the basis of LN status. LODDS had superiority on other node staging models when the number of LNs retrieved was modeled as categorical variable.

Conclusions: LNR (continuous) and LODDS (categorical) were the strongest indicators of OS in GC when the number of LN harvested was ≤15. Therefore, they may be considered as an alternative nodal staging systems for GC.     

直肠癌新辅助强化治疗后肿瘤降期状况与生存预后

目的探讨直肠癌新辅助强化治疗后患者肿瘤的降期情况及与术后无病生存的关系。方法回顾性分析2005--2012年间在北京协和医院接受新辅助治疗的135例局部进展期中低位直肠癌患者的临床和随访资料。放疗总剂量为50Gy,分25次完成;化疗采用氟尿嘧啶或卡培他滨联合奥沙利铂的方案,放疗结束后4-8周接受手术。通过术后病理分期（ypTNM）与术前临床分期（uTNM）的对比,研究肿瘤T分期、N分期和TNM分期的变化及与患者无病生存率（DFS）的关系。结果135例患者平均随访时间37．1（12～87）月,3年DFS为85．2％。其中T分期降期患者（76例）3年DFS为90．8％,明显优于无变化者（48例）的75．0％（P=0．040）;N分期降期患者（54例）3年DFS为98．1％,明显优于无变化者（53例）的77.4％和进展者（16例）的75．0％（P=0．009）。多因素预后分析显示,N分期下降在肿瘤预后判断方面更有意义（HR=0．793,95％CI：0．626．1．004．P=0．054）。结论直肠癌新辅助强化治疗后能达到T分期、N分期和TNM分期下降的患者具有一定的生存优势;N分期降期可能是一个独立的预后判断指标。     

Lymph node density vs. the American Joint Committee on Cancer TNM nodal staging system in node-positive bladder cancer in patients undergoing extended or super-extended pelvic lymphadenectomy

Purpose

We compared the prognostic value of the American Joint Committee on Cancer (AJCC) TNM nodal staging system with that of lymph node (LN) density in patients with LN-positive bladder cancer who received extended or super-extended pelvic lymphadenectomy.

Clinicopathological Analysis of 17 Surgically Resected Pulmonary Pleomorphic Carcinoma Cases

Objectives: To determine the outcomes and prognostic factors associated with pulmonary resection of pulmonary pleomorphic carcinoma (PPC).Methods: During 2008–2017, 17 patients underwent pulmonary resection for primary PPC at the Saitama Cancer Center, Japan. We investigated clinicopathological characteristics and outcomes of these cases. Overall survival (OS) and disease-free survival (DFS) rates were determined using Kaplan–Meier method and compared using log-rank test. Univariate analysis was performed to identify prognostic factors.Results: The 5-year OS and DFS rates were 27.2% and 51.0%, respectively. The median follow-up period was 30.8±24.9 (3.6–92.8) months after pulmonary resections. Patients with disease-free interval (DFI) <1 year of resection had poorer prognosis than those without (p = 0.001). Patients with N2 status and adenocarcinoma components had significantly poorer disease-free prognosis than their counterparts (p = 0.021 and p = 0.019, respectively). Univariate analysis revealed that DFI <1 year was an unfavorable prognostic factor for OS (p = 0.005); N2 pathological status and presence of adenocarcinoma components were unfavorable prognostic factors for DFS (p = 0.038 and p = 0.036, respectively).Conclusion: PPC patients with an adenocarcinoma component and N2 pathological status may have an earlier relapse and poorer prognosis than their counterparts. Further assessment of cases may help clarify the predictors of PPC.     

Lymph Node Harvest in Esophageal Cancer After Neoadjuvant Chemoradiotherapy

Background

This study was designed to determine the effects of lymph node (LN) harvest on survival in esophageal cancer after neoadjuvant chemoradiation (nCRT).

Methods

An analysis of surgically resected esophageal cancer patients after nCRT was performed to determine an association between the number of LNs resected and survival. Overall survival (OS) and disease-free survival (DFS) curves were calculated according to the Kaplan–Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model.

Results

We identified 358 patients with a mean follow-up of 27.3 months. The number of LN removed was not impacted by the type of surgical procedure. The number of LNs removed (<10 vs. ≥10, <12 vs. ≥12, and <15 vs. ≥15) did not impact OS or DFS. We found a significant difference in OS and DFS by pathologic response. The median and 5-year OS for patients with complete, partial, and no response was 65.6 months and 52.7 %, 29.7 months and 30.4 %, and 17.7 months and 25.4 % (p = 0.0002). However, the number of LN harvested did not impact OS and DFS when patients were stratified by pathologic response. MVA also revealed that the number of lymph nodes removed was not prognostic for OS or DFS. Higher age, higher stage, and less than a complete response were associated with a decreased OS. Higher stage and less than a complete response were prognostic for worse DFS.

Conclusions

The number of LNs harvested during esophagectomy does not impact survival after nCRT. Stage and pathologic response continue to be the strongest prognostic factors for survival in esophageal cancer after nCRT.     

The superiority of ratio-based lymph node staging in gastric carcinoma

BACKGROUND: The need for a precise lymph node staging without stage migration is of paramount importance when comparing and evaluating international treatment results. METHODS: We reviewed 1019 patients who underwent R0 resection at Kansai Medical University between 1980 and 1997. The patients were classified according to the 1997 International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) pN classification or the N staging depending on the ratio between the number of excised and the number of involved lymph nodes (pN1, < or = 25%; pN2, < or = 50%; pN3, >50%). RESULTS: Among the 1997 UICC/AJCC pN subgroups, prognosis worsened with an increase in lymph node ratio. In contrast, the ratio-based classification showed more homogenous survival according to the number of involved lymph nodes. Multiple stepwise regression analysis showed that the ratio-based classification was the most significant prognostic factor, whereas the 1997 UICC/AJCC classification was not found to be an independent predictor of survival. In addition, the ratio-based classification showed a superiority to the 1997 UICC/AJCC classification with respect to stage migration. CONCLUSIONS: Ratio-based lymph node staging is simple and gives more precise information for prognosis with fewer problems related to stage migration than the 1997 UICC/AJCC staging system.     

Curative resection for colorectal cancer in the elderly. Prognostic factors and five-year follow-up

The purpose of this perspective study was to evaluate which prognostic factors predict long-term survival and disease-free survival (DFS) of elderly patients (> or = 65 years) who underwent surgery for colorectal carcinoma. Between January 1992 and December 1998, 196 colorectal cancer patients > or = 65 years (114 M; 82 F; mean age: 75 years; range: 65-92) underwent surgery. One hundred forty-five (74%) of them underwent curative surgery and emergency surgery was more common in patients > or = 75 years of age than among those younger than 75 years (39% vs 23%; p = 0.01). The overall peroperative mortality rate was 3% (n = 6). The median length of hospital stay was 18 days (range: 3-86 days). By univariate analysis, intraoperative bleeding (> or = 500 cc; p = 0.002), length of surgery (> or = 240 min.; p = 0.004), and rectal cancer (p = 0.0001) were associated with complications. By multivariate analysis, only rectal cancer (p = 0.002) was associated with complications. The overall 1, 3-, and 5-year survival rate and DFS rate were 97%, 82%, 74%, and 86%, 64% and 60% respectively. Using multivariate analysis only tumour stage (p < 0.0001) and peroperative blood transfusions (> or = 500 cc; p = 0.006) were associated with outcome. Treatment decisions in elderly patients with colorectal carcinoma should not be influenced by the chronologic age of the patient.     

Suitability of 7th UICC N Stage for Predicting the Overall Survival of Gastric Cancer Patients After Curative Resection in China

Background

Metastatic lymph node count (MLNC) is the most intensively prognostic indicator of gastric cancer. How to efficiently evaluate the best classification of MLNC is unclear. The purpose of this study was to evaluate the overall survival (OS) prediction of new UICC N stage in gastric cancer after curative surgery.

Materials and Methods

Data from 456 patients who underwent curative resection were used to choose the most efficient classification of MLNC for evaluation the OS of gastric cancer.

Results

Using univariate analysis, both the N stage of 7th edition UICC TNM classification (7th UICC N stage) and N stage of 5th/6th edition UICC TNM classification (5th/6th UICC N stage) were associated with the OS of gastric cancer after curative surgery. However, Cox regression multivariate analysis showed the 7th UICC N stage was an independent factor for predicting the OS of gastric cancer instead of the 5th/6th UICC N stage. Besides, we used the case-control matched fashion for further validation of the superiority of the 7th UICC N stage in prognostic prediction of gastric cancer. Last, we adopted the cut-point survival analysis to determine the most appropriate cutoffs for MLNC of all gastric cancer patients after curative surgery. We demonstrated the cutoff of 7th UICC N stage was similar to that produced from the cut-point survival analysis.

Conclusion

The 7th UICC N stage appears to provide a reliable prognostic category of MLNC of gastric cancer than the 5th/6th UICC N stage, and it is the efficiently prognostic indicator of gastric cancer after curative surgery.     

Prognostic significance of tumor angiogenesis,Ki 67, p53 oncoprotein,epidermal growth factor receptor and HER2 receptor protein expression in undifferentiated nasopharyngeal carcinoma--a prospective study

BACKGROUND: This study prospectively examines the prognostic role of p53 oncoprotein (p53), Ki67-antigen (Ki67), tumor angiogenesis (MVD), epidermal growth factor receptor (EGFR), and HER2 receptor protein (HER2) expression in Chinese with undifferentiated nasopharyngeal carcinoma (NPC). METHODS: Seventy-eight Chinese were recruited from October 1995 to July 1997 at the Prince of Wales Hospital, Hong Kong. Pretreatment immunohistochemical preparations of the primary tumor were made, and clinical data were collected prospectively until October 30, 2000. The markers were correlated with overall survival (OS), disease-free survival (DFS), time to progression (TTP), and UICC stage. RESULTS: On univariate analysis, EGFR expression correlated with poorer OS (p =.0001), DFS (p =.01), shorter TTP (p =.0001), and advanced T stage (p =.036). Strong EGFR expression, when compared with weak or moderate, was associated with poorer OS (p =.04) and shorter TTP in a subgroup of patients with UICC stage III-IV disease. HER2 expression was associated with advanced UICC stage (p =.006). The presence of p53 expression correlated with poorer DFS (p =.01) and a trend toward shorter TTP (p =.06). No correlation was found with Ki67-antigen or MVD. On multivariate analysis, only EGFR expression was significantly linked to shorter OS and TTP. CONCLUSIONS: EGFR expression in undifferentiated NPC is associated with a poor clinical outcome. A prognostic role of p53 and HER2 expression is suggestive but not consistently defined in this study. The relatively high prevalence of positive staining for EGFR supports the use of molecular targeted therapy in this disease.     

Relationship between insulin-like growth factor II and prognosis of colorectal cancer

OBJECTIVE: To investigate the relationship between insulin-like growth factor II (IGF-II) and prognosis of colorectal cancer. METHODS: One hundred and forty-two colorectal cancer patients were enrolled. In colonoscopic biopsy specimens, the expression of IGF-II and PCNA were detected immunohistochemically, while TUNEL technique was used to detect apoptosis. All patients were followed up, and disease-free survival (DFS) and overall survival (OS) rate were calculated. RESULTS: The expression level of IGF-II was significantly higher in colorectal cancer than in normal colorectal mucosa. A correlation was observed between more IGF-II expression, high PCNA labeling index, and apoptotic index was demonstrated. Patients with lower expression level of IGF-II had higher DFS and OS. Multivariate analysis by means of the Cox proportional-hazards model revealed that the expression level of IGF-II was an independent prognostic predictor in colorectal cancer patients. CONCLUSION: The expression level of IGF-II is a new prognostic predictor for colorectal cancer.