Prognostic factors in gastric cancer with serosal invasion--importance of the extent of cancer infiltration in the subserosal layer

The extent of cancer infiltration in the subserosal layer has been examined in 214 stomachs resected for cancer with a serosal invasion. The extent was 4 cm or less in 109 patients (Group A) and 5 cm or more in 105 patients (Group B). The resection was estimated as being non-curative in 26% of Group A and in 52% of Group B (p less than 0.001). Peritoneal dissemination was the outstanding non-curative factor in the latter. The five-year survival rate was 39% in Group A and 14% in Group B (p less than 0.001). The survival rate after the curative resection was 49% and 26%, respectively (p less than 0.01). In Group B, peritoneal dissemination was the main mode of recurrence after the curative resection.     

Carcinoma of the vagina. Factors influencing treatment outcome

A 33-year review from the University of Michigan Medical Center of 86 cases of primary carcinoma of the vagina included 68 squamous carcinomas, 13 adenocarcinomas, and 5 small cell carcinomas. There was a 26% incidence of prior cervical carcinoma and a 21% incidence of prior pelvic radiation therapy. The median interval between the diagnosis of invasive cervical and vaginal carcinoma was 20 years. Survival was strongly correlated with stage. There was no association between survival and involvement of a particular vaginal segment or the amount of vaginal surface area involved with tumor. Irradiation was the most frequently employed primary therapy for vaginal carcinoma. Local control was correlated with the mid-tumor irradiation dose, with predictable control obtained only with doses above 7500 rad. The use of interstitial therapy should facilitate local control without increasing the complication rate.     

Correlation between subserosal venous invasion by gastric cancer and the occurrence of liver metastasis

We have examined the correlation between the depth of venous invasion of the gastric wall and the occurrence of liver metastasis in cases of gastric cancer. In 244 patients examined, the incidence of venous invasion, and in particular of subserosal venous invasion, was appreciably high in cases of poorly differentiated adenocarcinoma of the medullary type. Synchronous and metachronous liver metastases were found in 13 and 18 patients, respectively. In these cases, poorly differentiated adenocarcinoma with a medullary growth pattern was the most frequent, and papillary adenocarcinoma was the next most frequent type of cancer. The incidence of liver metastases was appreciably higher in patients with subserosal venous invasion than in those with only submucosal venous invasion. Considering the above observations, we posit that subserosal venous invasion by cancer, especially by poorly differentiated adenocarcinoma of the medullary type, is indicative of the risk for development of liver metastasis in patients with gastric cancer.     

Male breast cancer. 6. Factors influencing prognosis

A series of 257 cases of carcinoma of the male breast in Denmark has been examined with a view to establishing the factors which might influence the prognosis. Observed and corrected 5-year survival rates of 36% and 46% respectively correspond well with the results in other series. Expressed by corrected survival rate, the prognosis appears to be somewhat more favourable during the period 1958-71 than during the period 1943-57. This improvement of prognosis can be related to a significantly better clinical stage of advancement during the latter period. Comparison of the 5-year corrected survival rates in series of male and female breast cancer shows that the prognosis in male breast cancer is not much worse than the prognosis in females. It has been proved that the duration of disease, the clinical stage and the histological degree of malignancy influence the prognosis considerably. The therapeutic results in our series correspond well with the results found in other series. We did not find any evidence to indicate that it would be better to carry out radical mastectomy than to do simple mastectomy since radical mastectomy has not given consistently better results. It is recommended that treatment of this rather uncommon disease be centralized as far as possible.     

进展期胃癌患者腹腔镜下全胃切除术后并发症发生的影响因素分析

目的探讨进展期胃癌患者腹腔镜辅助下行全胃切除术后并发症的发生情况及其影响因素。方法选取2007年1月至2016年12月间邹城市人民医院收治的194例行腹腔镜全胃切除术的进展期胃癌患者,观察所有患者术后并发症的发生情况,分析并发症发生的危险因素。结果33例(17.0%)患者术后出现并发症,以肺部感染为主,占36.4%(12例)。单因素分析,术前合并症、病灶直径、癌变部位、既往腹部手术史、手术时间和中转开腹是影响患者术后并发症发生的相关因素,差异均有统计学意义(均P<0.05);多因素logistic回归分析,术前合并症和手术时间是影响患者术后并发症发生的独立危险因素,差异均有统计学意义(均P<0.05)。结论进展期胃癌患者行腹腔镜下全胃切除术前,应积极治疗合并症,尽量缩短手术时间,降低术后并发症,提高手术安全性。     

Factors affecting outcome in locally advanced breast cancer.

Patients presenting with locally advanced breast cancer (LABC) constitute a diverse group for which a variety of treatment modalities have been instituted. To assess which factors have a direct impact on outcome, we reviewed the medical records of 104 patients diagnosed with stage IIIA, stage IIIB and T3N0M0 breast carcinoma. When considered individually (univariate analysis), clinical stage, pathological stage, oestrogen receptor status and type of therapy were significant predictors for disease-free survival (DFS) and overall survival (OS). However, in a multivariate analysis, only clinical stage was a significant predictor for both DFS and OS, while ER status was a significant predictor for OS. There was a high degree of correlation between clinical and pathological staging. Nearly two-thirds of the patients developed a recurrence by 5 years. Loco-regional recurrence was the site of first recurrence in one-third of the patients by 5 years. The prognosis for patients presenting with LABC is poor, and they should be treated aggressively with loco-regional and systemic multimodality therapy. Although groups of patients with improved outcome could be identified by clinical or pathological staging, no group demonstrated an outcome good enough to be spared from multimodality therapy.     

胰十二指肠切除术后发生胃排空延迟影响因素的meta分析

目的通过meta分析,探讨胰十二指肠切除术后发生胃排空延迟的影响因素及其相关危险度。方法 通过检索Cochrane Library、Medline、Pubmed、Ovid、Embase,搜集近二十年发表的关于胰十二指肠切除术后发生胃排空延迟影响因素的相关文献,进行meta分析,计算每个危险因素的优势比(OR值)及95%CI。结果 meta分析共纳入研究文献26篇,其中6篇RCTs,9篇队列研究,11篇病例对照研究。经meta分析,计算合并OR值分别为:保留幽门2.35(95% CI,0.72-7.61),术后早期肠内营养0.93(95% CI,0.64-1.35),术后腹部并发症6.14(95% CI,3.47-10.85),Billroth I式胃肠重建(与Billroth II相比)4.30(95% CI,1.00-18.43),结肠前胃肠吻合0.12(95% CI,0.05-0.27)。结论 胰十二指肠切除术后,腹部并发症是发生胃排空延迟的一个危险因素;保留幽门不增加胃排空延迟的发生率;术后早期肠内营养与胃排空延迟发生无关;结肠前及Billroth II式胃肠重建可能会降低胃排空延迟的发生率。     

Significance of the lamina muscularis mucosae of the stomach in invasiveness of gastric cancer

Gastric carcinoma in the fundic gland area has a greater tendency to submucosal invasion than that in the pyloric gland area. In order to clarify the reason for this phenemenon, we investigated the thickness and structure of the lamina muscularis mucosae (LMM) of both the fundic and pyloric areas, using 15 subtotally resected stomachs. The average thickness of the LMM of the fundic and pyloric gland areas was 56 microns and 104 microns, respectively, the former being significantly thinner than the latter. On the contrary, no remarkable difference was seen between the two areas in the roughness of the mesh pattern made up of interlacing smooth muscle fibers. These findings suggest that the more likely occurrence of submucosal invasion of carcinoma in the fundic gland area is attributable to the distinct thinness of the LMM in that area through which the mucosal carcinoma invades the submucosal layer.     

Factors influencing survival in bilateral breast cancer

One Hundred And Four Patients With Bilateral Breast Cancers, Detected Clinically, Were Studied. Patients With Synchronous Lesions Experienced The Worst Survival. Lymph Node Metastases In The Second Mastectomy Had Obvious Adverse Effect On Survival. The Development Of Scirrhous Carcinoma In The Second Breast Did Not Alter Survival. A Maximum Of 21 Patients Might Have Been Adversely Affected By The Development Of A Second Cancer Because Of Lymph Node Metastases In The Second Breast Only. Survivorship Data Suggest The Adequacy Of Treatment Of Contralateral Breast Cancers When They Become Detectable By Clinical Means Alone.     

Factors influencing distress in Indian cancer patients

BACKGROUND: The current study set out to identify distress in cancer patients undergoing curative treatment within India. PATIENTS AND METHODS: This study was carried out to measure distress and contributory factors in 103 cancer patients undergoing treatment with curative intent. The patients were interviewed using the Distress Inventory for Cancer (DI-C). The data on social, demographic, clinical, treatment, and follow-up details was collected from case records. RESULTS AND CONCLUSION: The distress score for individual respondents ranged from 34 to 90 (mean 62.3). Patients with lower income, those who were single/widowed, or divorced, those living between 150 and 350 km (3-6 h commuting distance) from the cancer centre, presence of pain and patients with advanced tumours at presentation showed higher distress. A higher distress score correlated significantly with patients being lost to follow-up.     

Factors influencing the prognosis in bladder cancer

In the categories T1, T2 and T3NxM0 bladder cancer, diameter not exceeding 5 cm, the treatment in the Rotterdam Radio-Therapy Institute consists of interstitial irradiation with needles containing radioactive material. The results of treatment and the role of additional external irradiation are discussed. Category T3NxM0 tumors diameter exceeding 5 cm are treated by external irradiation followed by cystectomy; the results are presented here. Factors influencing prognosis appeared to be degree of differentiation, number of transurethral resections (TURs) prior to definitive treatment, intravenous pyelography (IVP), vascular invasion, T category after preoperative irradiation, and postsurgical histopathologically-assessed T category (pT).     

Comparative study of the subserosal versus submucosal dye injection method for sentinel node biopsy in gastric cancer

AimsTo determine the most efficient injection method for a sentinel node (SN) biopsy in gastric cancer.MethodsGastric adenocarcinoma patients without serosal invasion and distant metastasis were prospectively enrolled in this study. Isosulfan blue was injected into the subserosa (SS) of the first set of 71 consecutive patients and an intraoperative endoscopic submucosal (SM) injection of the same dye was injected into the second set of 50 consecutive patients. After the biopsy of blue-stained SNs, a gastrectomy with a D2 lymphadenectomy was performed. All dissected lymph nodes were evaluated for metastasis. The results of the SN biopsies were compared between the SS and SM dye injection methods.ResultsDetection rate (0.92 vs 0.94), mean number of SNs (2.5 vs 2.9) and sensitivity (0.61 vs 0.46) of the SN biopsies were not significantly different between the SS and SM injection methods (P>0.05). The operation time was significantly shorter in the SS than the SM injection method (159.7 vs 172.7 min, P=0.030).ConclusionsBoth injection methods were equally efficient in their roles for a SN biopsy in gastric cancer. However, the SS injection method was more preferable due to its easy technique and short operation time.     

Clinicopathologic characteristics and outcome indicators in node-negative gastric cancer

BACKGROUND AND OBJECTIVES: The relationship between the number of lymph nodes examined and the outcome in patients with node-negative (N(-)) gastric cancer was studied. We compared N(-) patients to those with nodal involvement (N(+)) to identify clinicopathologic characteristics of N(-) gastric cancer. Finally, we evaluated outcome indicators in this group of patients. METHODS: Of 367 patients, 130 (35.4%) were N(-). These patients were stratified according to the main prognostic variables, to assess differences with N(+) cases. A statistical analysis using the Cox model was performed to estimate outcome indicators. RESULTS: N(-) gastric carcinomas were significantly different from N(+) cases in terms of tumor depth and site, TNM stage, grading, residual disease, and vessel involvement. The overall 5-year survival rate was 72%. It was 82% in those patients with more than 15 nodes retrieved and 59% in the others. Serosal involvement, residual disease, and poor differentiation were independent prognostic factors. CONCLUSIONS: The clinicopathologic factors and outcome of N(-) cases were similar to those of early gastric cancer. At least 15 examined nodes appears to be necessary to define a case as N(-). The prognostic value of D2 lymphadenectomy in N(-) patients suggests a biologic role of micrometastases.     

Factors influencing p53 expression in ovarian cancer as a biomarker of clinical outcome in multicentre studies

The prognostic impact of p53 immunostaining in a large series of tumours from epithelial ovarian cancer patients in a two-centre study was analysed. The study population (n=476) comprised of a retrospective series of 188 patients (Dutch cohort) and a prospective series of 288 patients (Scottish cohort) enrolled in clinical trials. P53 expression was determined by immunohistochemistry on tissue microarrays. Association with progression-free survival (PFS) and overall survival (OS) was analysed by univariate and multivariate Cox regression analysis. Aberrant p53 overexpression was significantly associated with PFS in the Dutch and Scottish cohorts (P=0.001 and 0.038, respectively), but not with OS in univariate analysis. In multivariate analysis, when the two groups were combined and account taken of clinical factors and country of origin of the cohort, p53 expression was not an independent prognostic predictor of PFS or OS. In this well-powered study with minimal methodological variability, p53 immunostaining is not an independent prognostic marker of clinical outcome in epithelial ovarian cancer. The data demonstrate the importance of methodological standardisation, particularly defining patient characteristics and survival end-point data, if biomarker data from multicentre studies are to be combined.     

Factors influencing survival in 242 cases of primary gastric carcinoma

Two hundred and forty-two patients who underwent curative surgery for primary gastric cancer between 1965 and 1979 were reviewed, and the influence on survival of the type of surgical treatment, primary tumor location, operative mortality, and stage of disease was analyzed. Operative mortality was significantly increased in patients with multicentric primaries compared to all other sites (P less than .001) and in patients undergoing total gastrectomy versus subtotal gastric resection (P less than 0.001). Stage III-IV lesions had a significantly worse prognosis than stage I-II tumors (P less than .001). Our data confirm that early diagnosis could lead to increased survival.     

Surgical outcome in superficially spreading early gastric cancer

OBJECTIVES: Superficially spreading early gastric cancer is characterized by wide horizontal extension without deep vertical invasion. This study aimed to clarify the clinicopathological characteristics and prognosis of this rare disease. METHODS: We defined superficially spreading early gastric cancer as any tumor invading the submucosal layer that measured > or =60 mm in diameter. The clinicopathological characteristics and results of surgery were compared between 60 patients with superficially spreading tumors and 621 patients with the common type (<60 mm in diameter). RESULTS: For superficially spreading cancers,significantly higher numbers of female patients, undifferentiated and scirrhous types, infiltrating growth and lymph node metastases were seen. The number of metastatic lymph nodes was greater than in the common type. There was no significant difference in the distribution of metastatic lymph nodes between the two groups. For superficially spreading tumors, wide gastrectomy with extended lymph node dissection was frequently employed. Lymph node metastasis, but not tumor diameter, was a prognostic factor in uni- and multivariate analyses. CONCLUSIONS: Although superficially spreading early gastric cancer has histologically distinct properties, gastrectomy with lymph node dissection with sufficient surgical margin could be a suitable treatment.     

Factors affecting cosmetic outcome in breast-conserving cancer treatment--objective quantitative assessment.

A battery of objective measurements of cosmetic outcome was performed on 114 patients who had been treated by breast-preservation techniques for breast cancer. Cosmetic breast retraction, as determined by Breast Retraction Assessment (BRA) measurements, was significantly greater in patients who underwent extensive primary tumor resection, were more than 60 years old, weighed more than 150 lbs, or had a primary tumor in an upper breast quadrant. While use of a local RT boost, per se, was not a significant factor, those patients with high dose and/or large volume local boosts more frequently had marked retraction. Breast telangiectasia and depigmentation (T/D) was related to use of a local RT boost, patient age greater than 60 years, and use of separate nodal RT fields. Breast T/D was significantly more frequent with use of electron beam local RT boost which delivered a boost skin dose exceeding 1600 cGy. Objective quantitative assessments, such as BRA and T/D area measurements, provide data to determine factors related to each type of cosmetic change and thus provide guidelines for optimizing cosmetic outcome. Limiting the extent of primary tumor resection may minimize the amount of breast retraction. Omitting the local RT boost, particularly large volume, high dose boosts, may reduce the frequency of marked cosmetic retraction and skin T/D.     

Factors influencing on the prognosis in breast cancer

TNM classification, tumor size, lymph node metastasis, histological type of primary tumor, ER status and biological tumor markers have been recognized as prognostic factors in breast cancer. The 673 breast cancer patients undergoing radical mastectomy at this department were analyzed for TNM classification influencing on the postoperative prognosis. Five-and ten- year survival rates were 93% and 89% in stage I, 83.9% and 75.5% in stage II, 67.3% and 60% in stage III. The most common histological type, namely, invasive ductal carcinoma, of primary breast cancer was classified into three types by Japan Mammary Cancer Society. The first type was papillotubular carcinoma, the second solid-tubular carcinoma, and the third scirrhous carcinoma. The prognosis of papillotubular carcinoma was best. Many investigators reported that the prognosis of ER positive breast cancer was good. But in the latest report, the opposite result is obtained. More study is necessary to evaluate the prognostic value of ER. The most common biological tumor markers were CEA, LDH and ALP. The CEA was the best prognosis-factor in biological tumor markers.     

Factors influencing axillary node metastasis in breast cancer

AIMS AND BACKGROUND: The status of the axillary lymph nodes at the time of diagnosis has been accepted as one of the most important prognostic factors for the overall and disease-free survival of patients with breast cancer. The aim of our study was to determine which factors influence axillary node involvement in invasive breast cancer. METHODS: The data presented here were obtained from 344 patients who were treated for invasive breast cancer at the Department of Radiation Oncology, Uluda? University Medical College, Bursa, Turkey. Possible prognostic factors were categorized as patient related and tumor related. The Mann-Whitney U test was used for univariate analysis and logistic regression was used for multivariate analysis. RESULTS: In univariate analysis, a familial cancer history (P = 0.0042), age < 40 years (P = 0.0276), higher T stage (P < 0.0000), nipple involvement (P = 0.0345), skin involvement (P = 0.0270), perineural invasion (P = 0.0231), and lymphatic vessel invasion (P < 0.0000) were correlated with increased axillary node involvement. A higher incidence of > or = 4 involved lymph nodes was associated with higher T stage (P = 0.0004), nipple involvement (P = 0.0292), presence of an extensive intraductal component (P = 0.0023), skin involvement (P = 0.0008), perineural invasion (P = 0.0523), and lymphatic vessel invasion (P < 0.0000) in univariate analysis. In multivariate analysis, age < 40 years (P = 0.0454), cancer history within the family (P = 0.0024), higher T stage (P = 0.0339), lymphatic vessel invasion (P = 0.0003), and perineural invasion (P = 0.0408) were found to be independent factors for axillary lymph node positivity. Age < 40 years (P = 0.0221), perineural invasion (P = 0.0408), and an extensive intraductal component (P = 0.0132) were associated with an increased incidence of > or = 4 involved nodes in the logistic regression analysis. In patients with breast cancer, the incidence of axillary lymph node involvement was independently influenced by age < 40 years, presence of cancer history within the family, higher T stage, lymphatic vessel invasion, and perineural invasion. CONCLUSIONS: In conclusion, absence of familial cancer history, presence of lymphatic vessel invasion, higher T stage, and age below 40 years independently increased the risk of axillary node involvement. Presence of perineural invasion and lymphatic vessel invasion, age below 40, and an extensive intraductal component of more than 25% independently affected the risk of having > or = 4 nodes involved. Patients characterized by these factors may be classified into a higher risk group for nodal involvement, but more data are needed to define factors that can help in the decision-making regarding the omission of axillary treatment.