Pathomorphological and histological prognostic factors in curatively resected ductal adenocarcinoma of the pancreas

The fate of patients with potentially resectable carcinomas is not only determined by the pTNM tumor stage, but also possibly by tumor-biological factors. The aim of this study was to identify these prognostic factors in patients undergoing primary curative (R0) resection. The study retrospectively analyzed 113 patients with ductal adenocarcinoma who were operated on between 1986 and 1995. R0 resection was able to be performed in 93 patients. Lymph node metastases were found in 73%. The rates of lymph vessel and perineural invasion were 83.5% and 45%, respectively. Among the 25 carcinomas without lymph node metastases, 64% already had lymph vessel invasion and 48% had perineural invasion. The cumulative 5-year survival rate of the 91 surviving patients analyzed was 10.5%. Depending on the tumor stage we found a significant difference in 5-year survival rates between patients without lymph node metastases (26.5%) and those with lymph node involvement (5%) (P = 0.008). A multivariate analysis only identified lymph vessel invasion (L0/1), tumor size (≦/≦2 cm), and tumor grading (G) to have significant and independent prognostic value. Lymph vessel invasion, tumor size, and tumor grading proved to be independent factors determining long-term prognosis. Received: May 12, 1999 / Accepted: January 7, 2000     

晚期胆囊癌的外科治疗及预后分析

目的分析晚期胆囊癌(UICC III、IV期)的临床特点,总结外科治疗经验,探讨提高晚期胆囊癌生存率的方法。方法回顾性分析东方肝胆外科医院2002年01月至2012年12月收治的360例晚期胆囊癌的患者资料。Kaplan-Meier法绘制生存曲线,单因素分析采用Log-rank检验,多因素采用COX回归模型。结果 360例中312例得到有效随访,中位随访时间为42.0个月,中位生存时间为17.6个月。1、3、5年生存率分别为68.0%、30.7%及15.4%。单因素分析结果:术前黄疸、手术方式、意外胆囊癌、肿瘤位置、肝外胆管切除、手术切缘、肝侵犯、病理学分级、T分期、N分期、M分期均是影响患者预后的危险因素。多因素分析结果:N分期、病理学分级、肝侵犯、手术切缘、手术方式均是影响患者预后的独立危险因素。结论晚期胆囊癌预后差,积极的外科手术可改善患者预后。N分期、病理学分级、肝侵犯、手术切缘、手术方式均是晚期胆囊癌外科治疗预后不良的独立危险因素。     

Incidental detection beyond pathological factors as prognostic predictor of renal cell carcinoma

PURPOSE: To evaluate the prognostic significance of different detection modalities of renal cell carcinoma (RCC) in a large cohort of patients who had been previously submitted to surgery in two teaching hospitals in Italy. MATERIALS AND METHODS: We reviewed the clinical records of 1446 patients who had been submitted to surgical treatment for RCC at the Departments of Urology of Padua (n=747) and Verona (n=699) from 1976 to 2000. Patients were classified into two groups according to the detection mode: symptomatic and incidental. The cancer-specific survival probability was estimated according to the Kaplan-Meier method. In order to compare the survival curves the log rank test was used. The predictive independent value of the variables was examined using the Cox proportional hazards model. RESULTS: Six hundred and thirty patients (43.6%) were treated for incidental RCC and 816 (56.4%) for symptomatic RCC. In the incidental group, the size (p<0.001), the pathological stage (p<0.001) and the nuclear grading (p<0.001) of tumors were lower than those causing symptoms. The 5-year and 10-year cancer-specific survival probability were 84% and 75% in the incidental group, and 66% and 54.5% in the symptomatic group (p<0.0001), respectively. At a multivariate analysis, the mode of detection was an independent predictive variable (H.R. 1.559), as well as pathological stage (H.R. 1.809), nuclear grading (H.R. 1.411), size 相似文献   

乳腺导管内癌诊疗进展

近年来,随着乳腺癌钼靶筛查技术的应用和普及,乳腺导管内癌的检出率不断上升.熟悉乳腺导管内癌的临床表现、提高对乳腺导管内癌辅助检查结果的辨别能力,对诊断乳腺导管内癌至关重要.乳腺导管内癌的手术方式包括全乳腺切除、肿瘤局部广泛切除加放疗,以及单纯的肿瘤局部广泛切除;乳腺导管内癌常规不行腋窝淋巴结清扫已成为共识,前哨淋巴结活...     

The value of the Van Nuys Prognostic Index in ductal carcinoma in situ of the breast: a retrospective analysis

The Van Nuys Prognostic Index 1996 (VNPI), based upon tumor size, pathological grade and tumor margins, is a guideline for the treatment of ductal carcinoma in situ (DCIS). It was thought to strongly decrease overtreatment. In 2003, age was added to the index as a fourth prognostic factor. We examined changes in treatment modality after applying the VNPI retrospectively and investigated if the addition of age to the Index causes a shift in treatment. The influence of each prognostic factor on disease-free survival (DFS) was calculated. We performed a retrospective file study of DCIS patients treated between 1985 and 2003 at the University Hospital, Antwerp. Patients were assigned a Van Nuys Score 1996 and 2003. The influence of tumor size, pathological grade, tumor margins and age on DFS was calculated with the Kaplan-Meier method and the log-rank test. We identified 104 DCIS cases with a median follow-up of 36 months. Twelve patients showed recurrence (11.5%), of whom seven were invasive (58%). Seventeen of the 29 women diagnosed before 1997 were undertreated according to the VNPI 1996 and six of them showed recurrence. The remaining three recurrences were correctly treated. Seventy-five patients diagnosed after 1997 were all treated according to the VNPI 1996 and only three had a recurrence. The introduction of age caused no significant shift in treatment modalities. Significant differences in DFS were seen between large (>41 mm) and small (<15 mm) tumors (p = 0.0074), old (>60 years) and young (<40 years) patients (p = 0.024) and Van Nuys Subgroup 2 and 3 (p = 0.04). Tumor margins and pathological grade showed no significant difference in DFS. The VNPI can be a useful tool in the treatment of DCIS. However, this Index is not evidence-based, using a relatively small retrospective series of patients. The validity of the modified VNPI must be prospectively confirmed with large numbers of DCIS patients.     

从胰腺癌患者的长期生存看预后因素及治疗模式

Pancreatic cancer has the characteristics of high malignancy, early dissemination within the pancreas,extrapancreatic nerve plexus invasion, lymph node metastasis and vascular invasion. The 5-year survival rate of pancreatic cancer patients was under 5% even for those who had undergone surgical resection. Based on the review of the literatures including 42 pancreatic cancer patients who survived for 5-20 years after the operation, we concluded that curative resection of pancreatic cancer was still a reliable means in achieving long-term survival; factors influencing the results of resection of pancreatic cancer were lymph nodes involvement, poor differentiated tumor, extrapancreatic nerve plexus invasion, tumor size, residual tumor, curative resection and adjuvant chemotherapy; early diagnosis, aggressive surgery for patients with indications of resection, appropriate surgical procedure and postoperative adjuvant chemotherapy are essential factors to ensure a long term survival of patients with pancreatic cancer.     

Risk factors for estrogen receptor positive ductal carcinoma in situ of the breast in African American women

BackgroundCompared to U.S. white women, African American women are more likely to die from ductal carcinoma in situ (DCIS). Elucidation of risk factors for DCIS in African American women may provide opportunities for risk reduction.MethodsWe used data from three epidemiologic studies in the African American Breast Cancer Epidemiology and Risk Consortium to study risk factors for estrogen receptor (ER) positive DCIS (488 cases; 13,830 controls). Results were compared to associations observed for ER+ invasive breast cancer (n = 2,099).ResultsFirst degree family history of breast cancer was associated with increased risk of ER+ DCIS [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.31, 2.17]. Oral contraceptive use within the past 10 years (vs. never) was also associated with increased risk (OR: 1.43, 95%CI: 1.03, 1.97), as was late age at first birth (≥25 years vs. <20 years) (OR: 1.26, 95%CI: 0.96, 1.67). Risk was reduced in women with older age at menarche (≥15 years vs. <11 years) (OR: 0.62, 95%CI: 0.42, 0.93) and higher body mass index (BMI) in early adulthood (≥25 vs. <20 kg/m² at age 18 or 21) (OR: 0.75, 95%CI: 0.55, 1.01). There was a positive association of recent BMI with risk in postmenopausal women only. In general, associations of risk factors for ER+ DCIS were similar in magnitude and direction to those for invasive ER+ breast cancer.ConclusionsOur findings suggest that most risk factors for invasive ER+ breast cancer are also associated with increased risk of ER+ DCIS among African American women.     

Treatment trends for ductal carcinoma in situ of the breast

Background: As a result of clinical trial publications, breast conservation treatment has been increasingly used for invasive breast cancer. The patterns of care for ductal carcinoma in situ (DCIS) were analyzed for the years 1985, 1986, 1988, 1990, and 1991 to determine whether the same treatment principles had been applied to patients with noninvasive disease. Methods: Data submitted on 20,556 patients with DCIS during the 5 study years were analyzed with regard to basic demographics and treatment trends. Results: Breast-conserving surgery for DCIS increased from 20.9% in 1985 to 35.4% in 1991. Modified radical mastectomy remained constant at 42%. Axillary node surgery increased from 52% in 1985 to 58.5% in 1991. The use of radiation therapy for patients with partial mastectomy and no lymph node dissection ranges from 24.2% in 1990 to 37.7% in 1985, with 31.1% receiving radiation therapy in 1991. Patients undergoing lymph node dissection with partial mastectomy were more than twice as likely to receive postoperative radiation therapy than were patients without lymph node dissection. Conclusions: Modified radical mastectomy remains the most common surgical procedure, despite the eligibility of many women for breast conservation treatment. As of 1991 the majority of women were still undergoing axillary lymph node surgery despite a node positivity rate of ≈1%. Radiation therapy is significantly underused in patients with partial mastectomy, especially when no nodes were removed. Clinical trial results and professional education for DCIS treatment should change these trends. Presented at the 47th Annual Cancer Symposium of The Society of Surgical Oncology, Houston, Texas, March 17–19, 1994.     

原发性十二指肠乳头癌的预后因素分析

目的 探讨影响原发性十二指肠乳头癌预后的因素.方法 回顾性分析1995年6月至2005年6月厦门大学附属东南医院收治的73例原发性十二指肠乳头癌患者的临床资料.对患者性别、年龄、有无黄疸、肿瘤直径、病程时间、TBil、肿瘤分化程度、有无淋巴结转移、手术方式以及根治程度等10个因素采用Log-rank检验进行单因素分析,再采用Cox多因素回归模型进行多因素分析.生存时间用中位数表示,Kaplan-Meier法绘制生存曲线.结果 本组患者中位生存时间为34个月.患者年龄、有无黄疸、肿瘤直径、病程时间、TBil、肿瘤分化程度、有无淋巴结转移、手术方式及根治程度与预后密切相关(x2=18.315,4.562,7.989,10.660,11.138,7.995,5.423,114.464,83.383,P＜0.05);而患者性别与预后无关(x2 =1.720,P＞0.05).肿瘤分化程度、手术方式及根治程度是影响患者预后生存的独立因素(RR=2.039,2.178,5.798,P＜0.05).结论 肿瘤分化程度、手术方式及根治程度是影响十二指肠乳头癌预后生存的独立因素,标准手术方式的选择及根治程度对患者预后具有重要影响.     

Surgical treatment of metastases in patients with renal cell carcinoma

Summary The aim of the present study was to investigate the efficacy of surgical excision of metastases in patients with renal cell carcinoma (RCC). Eighteen patients with metastatic RCC underwent resection of metastases between 1988 and 1994 (pulmonary: n = 6; skeletal: n = 6; cerebral: n = 3; local relapse: n = 3). Two patients suffered from synchronous appearance of metastases, whereas in 16 cases a metachronous occurrence was observed. In 12 out of a total of 18 patients metastases were completely resected. These patients survived longer than patients in whom metastases were incompletely resected (30 vs. 12 months). Six out of these 12 patients with a complete resection of metastases are presently free of disease for a mean duration of 24 months (10–34 months). The resection of lung metastases seems to be associated with longer survival times. In conclusion, surgical resection of metastases – solitary or single organ site – especially in the lung appears to be justified in patients with RCC. The surgical excision of skeletal metastases at least improves quality of life.      

急性重症胆管炎的外科治疗及预后影响因素分析

目的探讨急性重症胆管炎（ACST）的手术时机、术式选择及预后影响因素。方法回顾性分析经外科治疗的189例ACST病人的临床资料。结果入院至手术时间≤24h123例,〉24h66例。手术原则均为胆道减压、胆汁引流。临床治愈163例,死亡36例,病死率19．05％。术后并发症68例。预后影响因素分析显示：年龄、术前脉搏、体温、血清胆红素、血白细胞、术前休克纠正与否、手术时机、术前合并症及术后器官功能不全为本病的危险因素。结论重视围手术期的处理,选择最佳手术时机和手术方式,对预后影响因素及时适当进行干预,可提高疗效,降低病死率。     

A review of the management of ductal carcinoma in situ following breast conserving surgery

Ductal carcinoma in situ (DCIS) is a heterogeneous, pre-malignant disease accounting for 10–20% of all new breast tumours. Evidence shows a statistically significant local control benefit for adjuvant radiotherapy (RT) following breast conserving surgery (BCS) for all patients. The baseline recurrence risk of individual patients varies according to clinical-pathological criteria and in selected patients, omission of RT may be considered, following a discussion with the patient. The role of adjuvant endocrine therapy remains uncertain. Ongoing studies are attempting to define subgroups of patients who are at sufficiently low risk of recurrence that RT may be safely omitted; investigating RT techniques and dose fractionation schedules; and defining the role of endocrine therapy. Future directions in the management of patients with DCIS will include investigation of prognostic and predictive biomarkers to inform individualised therapy tailored to the risk of recurrence.     

Prognostic factors in ductal pancreatic cancer

Introduction: The diagnosis of pancreatic adenocarcinoma remains a devastating life event for most patients and their families. Many patients with this relatively common malignancy present at a stage of disease not amenable to cancer-directed resectional therapy, and are treated via nonoperative palliative measures, with median survival of 4 – 8 months post-diagnosis. Conclusion: A minority of patients present with disease limited to the pancreas and periampullary region and are candidates for resectional therapy. The prognosis for these patients is determined by several factors: clinicopathologic staging, tumor biology and molecular genetics, perioperative factors and the use of postoperative adjuvant therapy. Received: 23 February 1998     

Lymph node dissection in patients with differentiated thyroid carcinoma – who benefits?

Introduction: Papillary and follicular thyroid carcinomas are the most common thyroid malignancies and are usually indolent. Lymph-node involvement increases the rate of tumor recurrence and reduces long-term survival. However, characteristics such as age, long-term iodine deficiency, histological grade, extrathyroidal extension and distant metastases are clearly much more potent adverse factors than cervical lymph node metastases. Although there are no prospective randomised studies showing the overall benefit of routine cervicocentral lymph-node dissection in addition to total thyroidectomy, we propose this procedure as a standard part of primary surgery in differentiated thyroid carcinoma (DTC). Results: In specialised centres, morbidity is not higher than for thyroidectomy alone. However, there is a significant increase in morbidity after re-operation in the cervicocentral compartment. Modified neck dissection of the cervicolateral compartment should only be performed if there is clinical evidence of lymph-node involvement in this area. Conclusions: This strategy provides the optimal surgical treatment for all subgroups of patients with DTC and creates optimal conditions for effective postoperative radioiodine ablation, which is another prognostic factor strongly associated with recurrence and survival in these patients. Received: 31 March 1998 / Accepted: 18 May 1998     

Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study

PurposeTurkish Radiation Oncology Study Group investigated local recurrence rates and prognostic factors in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conservative surgery (BCS) followed by radiotherapy (RT) and Eastern Cooperative Oncology Group (ECOG) Study E5194 were compared with the original study.Patients and methodsTotally 252 patients were evaluated retrospectively. Prognostic factors that might influence local control (age, nuclear grade, comedo necrosis, surgical margins, tumor size, hormone receptor status) were compared. The eligibility criteria of ECOG 5194 were stratified into two groups as in the original study and were compared for local control.ResultsThe median follow-up time was 59 (21–220) months. Local recurrence was observed in 9 patients (3.6%) who had invasive carcinoma (3 patients) and DCIS (6 patients). Ten years local control rates was 91.8% respectively. We found that the risk of ipsilateral breast recurrence was significantly higher in women younger than 50 years old (p = 0.016). In addition, a statistically significant trend was found in patients with tumor larger than 1 cm and HER2 positive tumors (p = 0.051, p = 0.068 respectively). When 12-year results were compared with the ECOG 5194, adjuvant RT produced an absolute difference of 11% in low-intermediate and 20% in high grade in local control.ConclusionIn our study, the 10-year local control rate was 92% and younger than 50 years old was the most important unfavorable prognostic factor for local recurrence. There was provided 20% absolute local control with adjuvant radiotherapy which eligibility criteria of ECOG 5194 high grade group.     

Impact of hormonal status on outcome of ductal carcinoma in situ treated with breast-conserving surgery plus radiotherapy: Long-term experience from two large-institutional series

BackgroundDuctal carcinoma in situ (DCIS) is a heterogeneous disease, for which the best adjuvant treatment is still uncertain. Many attempts of risk-groups stratification have been made over time, developing prognostic scores to predict risk of local recurrence (LR) on the basis of features such as age, final surgical margins (FSM) status, grade, and tumor size. The aim of our analysis was to evaluate the patterns of recurrence from a two large-institutional retrospective series.Patients and methodsWe collected data on 457 patients treated with BCS and adjuvant RT between 1990 and 2012. Final analysis was performed on 278 patients, due to missing data about hormonal status (HS). Patients were treated at the Radiation Oncology Unit of the University of Florence (n = 195), and S. Maria Annunziata Hospital (n = 83) (Florence, Italy).ResultsAt a median follow up time of 10.8 years (range 3–25), we observed 20 LR (7.2%). The 5-year and 10-year LR rates were 4.9% and 10.2%, respectively. At Cox regression univariate analysis, estrogen receptor (ER) positive status (p = 0.001), HS positive (p = 0.003), and FSM <1 mm (p = 0.0001) significantly impacted on LR. At Cox regression multivariate analysis positive ER status maintained a protective role (p = 0.003), and FSM status <1 mm its negative impact (p = 0.0001) on LR rate.ConclusionsOur experience confirmed the wide heterogeneity of DCIS. Inadequate FSM and negative ER status negatively influenced LR rates. Tumor biology should be integrated in adjuvant treatment decision-making process.     

乳腺导管原位癌的超声特征

目的探讨乳腺导管原位癌(DCIS)的超声表现特征。方法回顾性分析经病理证实的54例乳腺DCIS的超声表现,包括病灶形态、大小、边缘、边界、内部回声、后方回声、微钙化、导管改变及血供,并与病理结果进行对比。结果54例均经术后病理证实为乳腺DCIS,其中高级别34例,中级别13例,低级别7例;5例伴微浸润灶,均未见腋窝淋巴结转移。声像图表现为片状低回声型20例(20/51,39.22%)、结节状肿块型17例(17/51,33.33%)、导管扩张型8例(8/51,15.69%)、单纯微钙化型6例(6/51,11.76%),3例假阴性,检出率94.44%(51/54)。超声正确诊断44例,准确率81.48%(44/54)。结论乳腺DCIS超声表现具有一定特征性;正确认识其超声征象能有效提高诊断符合率。     

乳腺导管原位癌的MRI特点分析

目的:分析乳腺导管原位癌的影像学表现及MRI的诊断价值,以进一步提高对乳腺导管原位癌的影像学认识。材料和方法:回顾性分析18例经病理证实为乳腺导管原位癌病人的临床资料,研究其乳腺磁共振图像的形态学特点、动态增强方式及扩散加权成像特点。结果:18例导管原位癌的形态学表现及增强方式大体可分为两类。一类是非肿块型13例(72.2%),包括不规则片状6例和段状改变7例,其时间-信号强度曲线呈Ⅱ型者12例,Ⅲ型者1例;另一类表现为肿块型,5例(27.8%),时间-信号强度曲线呈Ⅰ型者1例,Ⅱ型者2例,Ⅲ型者2例。弥散加权成像发现病灶15例,检出率达83.3%,表面扩散系数(ADC)1.30×10-3mm2/s有10例。结论:乳腺导管原位癌MR图像上多表现为非肿块的段状分布及片状分布的异常强化,少数也可表现为肿块型改变,弥散加权成像在定性诊断上能起重要的辅助作用。     

Gallbladder metastases from ductal papillary carcinoma of the breast

Breast cancer occurs primarily in women aged 25 years or older. Breast carcinoma has the potential for widespread dissemination, such as metastasis to axillary lymph nodes, bone, lung, pleura, brain, and soft tissues. Liver, gastrointestinal, and biliary tract involvement are infrequent. We report a patient, a 62-year-old woman, with symptomatic cholelithiasis. The patient proceeded to laparoscopic cholecystectomy. She had a previous history of mastectomy with axillary lymphadenectomy, performed for a breast ductal papillary carcinoma, 10 years prior to the cholecystectomy. The gallbladder was hydropic; the wall was thickened, with a focal broad-based lesion on the mesenteric face of the body. Histopathological evaluation of the focal broad-based lesion of the gallbladder revealed poorly differentiated adenocarcinoma infiltration, without mucosal involvement. Subsequent immunohistochemical examination showed the lesion to be cytokeratin 7(CK7)-positive and cytokeratin 20 (CK20)-negative. Estrogen receptor (ER) and progesterone receptor (PgR) were positive. The final pathological diagnosis was breast ductal papillary carcinoma metastases to the gallbladder. Mammography of the other breast was normal. Computed tomography (CT) scan of the brain, chest, abdomen, and pelvis was performed, without any pathological findings. Bone Tc-99 scintigraphy was normal. Six months after the surgery positron emission tomography (PET) showed no evidence of metastatic disease. Two years after the surgery, the patient died, in the absence of recurrence. A literature review revealed only a few more cases of metastasic breast carcinoma to the gallbladder.