Metastatic lymph node size and colorectal cancer prognosis

BACKGROUND: Colorectal cancer patients with lymph node metastasis constitute a heterogeneous population with variable prognoses. In this study, my colleagues and I propose a simpler lymph node (LN) staging system for colorectal cancer. STUDY DESIGN: Four-hundred and twenty-three consecutive colorectal cancer patients were studied. Of these, 36 were excluded because another carcinoma was present. The remaining 387 patients entered the TNM staging analysis. In the survival analysis, 76 patients with distant metastasis were excluded and the remaining 311 patients (LN(-) = 204 and LN(+) = 107) were studied. The diameter of the largest metastatic LN (MLN) was measured on histopathological slides. After examination of various cutpoints and survival outcomes, patients with MLNs were classified into n1 (< or = 9 mm) and n2 (> or = 10 mm) groups, according to size of MLNs (n-stage). RESULTS: Using disease-free survival (DFS) and overall survival (OS) as outcomes, patients were separated into significant prognostic groups by MLN size (univariate, p < 0.0001) (5-year survival, DFS: n0 = 91.5%, n1 = 62.2%, and n2 = 34.4%; OS: n0 = 85.1%, n1 = 63.5%, and n2 = 42.5%) and International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) (N-stage) (univariate, p < 0.0001) (5-year survival, DFS: N0 = 91.5%, N1 = 60.5%, and N2 = 36.8%; OS: N0 = 85.1%, N1 = 65.3%, and N2 = 38.0%). But in patients with fewer than 15 LNs examined (n = 31), only the new nodal stage stratified patients into significant groups (OS: p = 0.003 and DFS: p = 0.001). Only the UICC/AJCC N-stage subcategories were further split into significant prognostic groups by MLN size (UICC/AJCC N1: DFS, p = 0.048 and OS, p = 0.11; N2: DFS, p = 0.04 and OS, p = 0.04). n-stage was an independent important factor both in the DFS and OS in multivariable analysis. CONCLUSIONS: MLN size is a strong prognostic variable in colorectal carcinoma. This new metric may help clinicians treating colorectal cancer patients, but additional studies are required before clinical application.     

T1期乳腺癌的临床病理特征及预后危险因素分析

背景与目的：T1期乳腺癌患者总体生存预后良好,但仍有少部分患者具有高度侵袭性,早期容易出现复发转移与死亡等不良生存结局,预后较差。本研究探讨影响T1期乳腺癌的临床病理特征及预后的危险因素,旨在早期识别高风险的T1期乳腺癌患者,为临床决策提供参考。方法：回顾性分析中南大学湘雅医院2011年1月—2015年12月经手术治疗的1 250例T1～T3期原发性浸润性乳腺癌患者资料,分析T1期与非T1期患者的临床病理学特征差异,单因素及多因素Cox风险模型分析影响T1期乳腺癌患者复发转移及死亡的危险因素,Kaplan-Meier法分析不同危险因素下T1期乳腺癌患者总生存（OS）和无病生存（DFS）的差异,Log-rank检验比较组间生存曲线差异。结果：1 250例原发性浸润性乳腺癌患者中,T1期261例（20.88%）,非T1期（T2和T3期） 989例（79.12%）。与非T1期比较,T1期患者BMI值低、腋窝淋巴结转移数目少、不利生物学特性少、生存预后好（均P<0.05）。T1期患者随访期间共15例死亡,40例出现复发转移。中位OS时间为94 (5～132)个月,2、5、10年OS率分别...     

Downregulation of caspase‐9 is a frequent event in patients with stage II colorectal cancer and correlates with poor clinical outcome

Objective To evaluate the clinical significance of caspase‐9 mRNA expression and investigate its prognostic value in stage II colorectal cancer. Method Quantitative real‐time RT–PCR was used to analyse caspase‐9 mRNA expression in cancer tissue and corresponding normal mucosa from 120 patients. Results Compared with normal mucosa, the expression of caspase‐9 mRNA was found to be downregulated in cancer tissue (P = 0.001). Poorly differentiated cancer showed lower mRNA expression than cancer with greater differentiation (P = 0.031). The Kaplan–Meier survival analysis demonstrated that patients with downregulated caspase‐9 showed a worse overall survival (P = 0.012) and disease‐free survival (P = 0.022). Cox’s proportional hazards regression model confirmed that expression of caspase‐9 was the strongest prognostic factor in stage II colorectal cancer. Conclusion The mRNA expression of caspase‐9 can be used as an independent prognostic factor for patients with stage II colorectal cancer.     

Loss of ARID1A expression is associated with poor prognosis in invasive micropapillary carcinomas of the breast: A clinicopathologic and immunohistochemical study with long‐term survival analysis

Invasive micropapillary carcinoma (IMPC) of the breast is a highly aggressive and a rare subtype of breast cancer. In this study, we aimed to investigate differences between pure and mixed IMPCs of the breast in terms of clinicopathologic features, and also to analyze the significance of expressions of ARID1A and bcl‐2 regarding prognosis. Sixty‐nine of IMPCs consisting of 21 pure and 48 mixed type diagnosed at Pathology Department of Istanbul Medical Faculty between 2000 and 2011, who had complete follow‐up data, were collected to analyze ARID1A and bcl‐2 expressions immunohistochemically with prognosis. The median follow‐up period was 94 months. No significant difference was found between pure and mixed type IMPC, as well as in luminal subgroups in terms of prognostic and clinicopatologic features. ARID1A and human epidermal growth factor receptor‐2 (Her‐2) status were found to be independent prognostic factors of both overall survival (OS) (HR=6.1, 95% CI 1.4‐26.6, P=.02; HR=15.9, 95% CI 3.5‐71.5, P<.0001, respectively) and disease free survival (DFS) (HR=4, 95% CI 1.1‐14.9, P=.04; HR=7.2, 95% CI 2‐25.4, P=.002, respectively) in multivariate analysis using Cox regression. The loss of ARID1A expression was significantly related with 10 year‐OS (P=.001) and 10 year‐DFS (P=.05). Statistically significant effect of ARID1A expression was also stated on DFS and OS in Luminal B group (P=.05 and P=.001 respectively). Pure and mixed type IMPCs are similar in terms of clinicopathologic and prognostic features. The loss of ARID1A expression and Her‐2 positivity have significant adverse effect clinical outcomes of IMPC patients.     

Survival outcomes in men receiving androgen‐deprivation therapy as primary or salvage treatment for localized or advanced prostate cancer: 20‐year single‐centre experience

OBJECTIVES

To evaluate the overall survival (OS) and disease‐specific survival (DSS) in men receiving primary androgen‐deprivation therapy (PADT) or salvage medical ADT (SADT) for prostate cancer.

PATIENTS AND METHODS

After Institutional Review Board approval, we retrospectively reviewed patients receiving ADT for prostate cancer between July 1987 and June 2007. Variables included age at diagnosis and ADT induction, race, PSA level before ADT, ADT schedule (continuous/intermittent), clinical/pathological stage, hormone‐refractory prostate cancer (HRCP) status, PADT or SADT, and deaths.

RESULTS

In all, 548 men were analysed. The mean age at diagnosis and ADT induction were 70.1 and 72.3 years, respectively, and 321 (58.6%) were African‐American. The median PSA level before ADT was 16.3 ng/mL. ADT was administered continuously in 497 (90.7%) patients; 342 (62.4%) received PADT while 206 (37.6%) received SADT. At mean (range) follow‐up of 81.8 (2.1–445) months, 98 (17.9%) deaths occurred; 31 (31.6%) were cancer‐specific. The OS and DSS in the PADT and SADT groups were not significantly different (P = 0.36 and P = 0.81, respectively). Mortality rates/distributions were similar between groups (P = 0.68). Multivariate predictors of OS and DSS included age at diagnosis (P = 0.03) and ADT induction (P = 0.009), tumour stage (P < 0.001), and PSA level at ADT induction (P = 0.01). Progression to HRPC worsened OS and DSS (both P < 0.001).

CONCLUSION

PADT and SADT prolong survival in men with prostate cancer. HRPC portends a poor DSS. Age at diagnosis and ADT induction, PSA level before ADT, and disease stage predict both OS and DSS in this population. However, most men died from causes unrelated to prostate cancer, thus questioning the true value of ADT in prolonging patient survival.     

The role of skin ulceration in breast carcinoma staging and outcome

Breast carcinoma with skin ulceration (SU) is considered a locally advanced disease. The purpose of the study is to investigate if SU is an independent adverse factor. Breast carcinoma patients with SU (n=111) were included in the study. A subset (n=38, study cohort) was matched with cases that had no SU (n=38, matched cohort); the survival analyses were compared between these groups. Then, cases (n=80) were staged independent from SU into stage I, II or III. Disease free survival (DFS) and overall survival (OS) were analyzed. Patients with larger tumors tended to present with distant metastases more often than patients with smaller tumors (P=.004). In the matched cases, the 5‐year DFS probability was 53% for the study cohort and 58% for the matched cohort; and for OS 75% for the study cohort and 84% for the matched cohort with no statistical significant difference. However, there was a trend towards worse DFS for the patients whose tumors had SU. When the cases were staged based on tumor size and node status (I, II or III), the OS was statistically significant (P=.047) but not the DFS (P=.195). Relatively small tumors with SU had an extent of disease similar to that observed in patients with early stages disease. The survival analysis suggests that SU may not be an adverse factor. However, more cases are needed to further examine this finding.     

Impact of histology on survival in retroperitoneal sarcomas

Background

The current American Joint Committee on Cancer AJCC staging system applies to all soft-tissue sarcomas and does not allow for consideration of many features unique to retroperitoneal sarcomas (RPSs). The aim of this study was to analyze factors predictive of recurrence and survival for patients with resected RPSs.

Methods

This was a retrospective analysis of consecutive patients with primary RPS who underwent resection. A 3-tiered histological classification was examined: atypical lipomatous tumors (ALTs), non-ALT liposarcomas (LPSs), and other. Univariate and multivariate analyses were used to identify factors associated with differences in disease-free survival (DFS) and overall survival (OS) among groups.

Results

Sixty RPS patients were analyzed: 16 patients (27%) had ALTs, 7 patients (12%) had LPSs, and 37 patients (62%) had other histologies. A comparison of the 3 groups showed a significant difference in OS among groups (P < .017). High-grade tumors favored shorter DFS (P = .06) but were not associated with decreased OS when compared with low-grade tumors (P = .86).

Conclusions

These findings support an alternative staging system for RPS, inclusive of histology, which may prove useful in operative planning and prognostication.     

Analysis of long‐term outcomes of double‐strut bone graft for osteonecrosis of the femoral head

Objective: To analyze the long‐term effect of double‐strut bone graft for osteonecrosis of the femoral head (ONFH). Methods: A total of 366 adult patients with ONFH in 466 hips underwent double‐strut bone graft from March 1988 to January 1999. Of them, 186 patients with 206 hips and an average age of 32.2 years (range, 20–60 years) were followed up for more than five years, up to January 2006. Based on the Association Research Circulation Osseous (ARCO) classification, there were 36 hips in stage IIB, and 30, 40, 40, 32 and 28 in stage IIC, IIIA, IIIB, IIIC and IV, respectively. The functional results of affected hips were evaluated by the hundred forked method. Results: Hip pain in all patients disappeared or alleviated greatly after the operation. The height of the femoral head improved to various extents, and the range of motion of the hip joint increased. The patients were followed up for 5–16 years, (average 10.5 years). The total scores increased significantly postoperatively (P < 0.01). The rate of excellent and good results was 83.3%, 80.0%, 75.0%, 65.0%, 40.6% and 28.6% in stage IIB, IIC, IIIA, IIIB, IIIC and IV, respectively (63.6% for the whole group). Conclusion: The long–term effect of double‐strut bone graft for ONFH is satisfactory in relation to staging of ONFH. Favorable results can be expected in young ONFH patients in stage IIB, IIC, and IIIA, IIIB.     

Therapeutic options in patients with early T stage and advanced N stage of tonsillar squamous cell carcinomas

Objective

To compare the therapeutic role of surgery followed by radiotherapy (OPRT) and concurrent chemoradiotherapy (CCRT) in patients with early T (T1/T2) and advanced N (N2/N3) stage tonsillar squamous cell carcinoma.

Study Design

Historical cohort study.

Setting

A tertiary hospital.

Subjects and Methods

The medical records of 42 patients who met the eligible criteria (24 patients were treated by OPRT, 18 patients by CCRT) were reviewed.

Results

Mean overall survival (OS) and disease-free survival (DFS) were 49.0 months and 43.0 months in OPRT group, respectively, and 39.6 months and 35.0 months in CCRT group, respectively (P = 0.18 for OS, P = 0.29 for DFS between the two groups). There was also no significant difference in survival estimates between OPRT and CCRT group in terms of two-year OS (P = 0.18) and two-year DFS (P = 0.45). In the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, the scores for global health status and symptom scales did not differ between the two groups. However, the OPRT group reported better functional scales and significantly higher scores for cognitive (P = 0.008) and social function (P = 0.03). Among single items, a significantly lower score for insomnia (P = 0.007) was noted in the OPRT group. In EORTC QLQ-H&N35 modules, there were no significantly different scales between the two groups except scores for nutritional supplements, in which the OPRT group presented lower symptom scores (P = 0.02).

Conclusion

OPRT could be still a viable option for managing selected cases of advanced oropharyngeal cancer because one can expect comparable therapeutic outcome as well as quality of life.     

Dose variation and regimen modification of adjuvant chemotherapy in daily practice affect survival of stage I-II and operable stage III Taiwanese breast cancer patients

To assess the effect of a non-standard dose and regimen of adjuvant chemotherapy on the clinical outcome in stage I–II and operable stage III Taiwanese breast cancer patients. Variables studied included treatment variation (regimen and dose of adjuvant therapy), lymph node status, tumor size, histologic grade, and hormone receptor status. Cox's multivariate regression analyses were used to select prognostic factors significant for disease-free survival (DFS) and overall survival (OS). In the multivariate analysis, lymph node-positive, a tumor size greater than 5 cm, grade III, hormone receptor-negative status, and non-standard adjuvant chemotherapy were independent prognostic factors for DFS and/or OS. Node-positive patients treated with standard adjuvant chemotherapy had a significantly better DFS (HR = 0.6; P = 0.032) and OS (HR = 0.54; P = 0.025) than those treated with non-standard adjuvant chemotherapy. Breast cancer patients receiving standard adjuvant chemotherapy have a better DFS and OS than those receiving non-standard adjuvant chemotherapy.     

Efficacy of anthracycline/taxane‐based neo‐adjuvant chemotherapy on triple‐negative breast cancer in BRCA1/BRCA2 mutation carriers

This study aims to estimate the pathologic complete response (pCR) rate after neo‐adjuvant chemotherapy and to compare disease‐free survival (DFS) and overall survival (OS) between pCR and non‐pCR groups of patients with triple‐negative breast cancer (TNBC) and deleterious BRCA1 or BRCA2 mutation. We carried out a retrospective analysis of 53 patients including 46 BRCA1, 6 BRCA2, and 1 combined BRCA1 and BRCA2 mutation. All patients had been diagnosed with triple‐negative breast cancer (TNBC) between 1997 and 2014. Neo‐adjuvant therapy consisted of regimens that were based on anthracycline or an anthracycline‐taxane doublet. DFS included any relapse or second cancer. The Kaplan‐Meier method and the log‐rank test were used to compare pCR and non‐pCR groups. A pCR was observed in 23 (42.6% [95% CI, 29.2%‐56.8%]) of the TNBC included. The pCR rate was 38.3% [95% CI, 26%‐55%] among BRCA1 mutation carriers, and 66% among the 6 BRCA2 mutation carriers. Median follow‐up was 4.4 years (range 0.62‐16.2 years) and did not differ between the groups (P = .25). Fifteen relapses and six second cancers were recorded during the follow‐up period. Eleven deaths occurred, all of which were in the non‐pCR group. DFS (P < .01) and OS (P < .01) were significantly better in the pCR group than the non‐pCR group. This study shows a high pCR rate after neo‐adjuvant therapy in BRCA‐mutated triple‐negative breast cancer, and the survival results confirm the prognostic value of pCR in this group. These outcomes should be considered as a basis of comparison to be used by future studies about new therapies in this domain.     

Impact of parenchymal preserving surgery on survival and recurrence after liver resection for colorectal liver metastasis

Background

This study aimed to investigate the impact of non‐anatomical liver resection (NAR) versus anatomical resection (AR) in patients with colorectal liver metastasis (CRLM), with regard to perioperative and long‐term outcomes.

Methods

Analysis of prospectively collected data for patients with CRLM who underwent either AR or NAR between January 1993 and August 2011 was performed. The impact of AR and NAR on morbidity, mortality, margin positivity, redo liver resections, overall survival (OS) and disease free survival (DFS) was analysed.

Results

A total of 1574 resections for CRLM were performed. A total of 249 were redo resections and 334 patients underwent combined AR and NAR, hence, 583 were excluded. In total, 582 AR and 409 NAR were performed. The median age was 66 years (range 23.8–91.8). Median follow up was 32.2 months (interquartile range 17.5–56.9). The need for postoperative transfusion (11.6% versus 2.2%, P = <0.0001), overall complications (25% versus 10.7%, P < 0.0001) and 90‐day mortality (4.9% versus 1.2%, P < 0.0001) was higher in the AR group. R0 and R1 resection rates (AR 26.2% NAR 25%, P = 0.69) and number of patients with intrahepatic recurrence was similar between the two groups (AR 17.5% NAR 22%, P = 0.08). However, the need for redo liver surgery was higher in NAR group 15.4% versus 8.7% (P < 0.001). The OS (NAR 34.1 months versus AR 31.4 months, P = 0.002) and DFS were longer in the NAR group (NAR 18.8 months versus AR 16.9 months, P = 0.031).

Conclusions

A parenchymal preserving surgery (NAR) is associated with lower complication rates and better OS and DFS when compared with AR without compromising margin status. However, NAR increases the need for repeat liver resections.     

Impact of the bowel‐screening programme on the diagnosis of colorectal cancer in Ayrshire and Arran

Aim Bowel screening aims to reduce colorectal‐cancer mortality by the detection and treatment of early‐stage asymptomatic disease and the removal of precancerous adenomas. Bowel screening started in Ayrshire and Arran in September 2007. We report the impact of this screening on the diagnosis and stage of colorectal cancer and characterize screen‐detected cancers in comparison with those diagnosed through other pathways. Method Diagnoses were identified from an audit database. Referrals were grouped into screen detected, routine, urgent and emergency presentations. Results Between January 2001 and December 2010, 2289 diagnoses of colorectal cancer were made. From 2001 to 2006, the mean (range) number of new colorectal‐cancer diagnoses per year was 210 (198–220). Between 2007 and 2010, the mean (range) number of diagnoses per year was 256 (239–274), a significant (P = 0.008) increase. Since September 2007, 877 colorectal cancers have been diagnosed: 17% were screen detected; 11% were detected as a result of routine GP referral; 51% were detected after urgent GP referral; and 21% were emergency presentations. TNM stage increased with urgency of referral. Approximately two‐thirds (66%) of screen‐detected colorectal cancers were node negative vs 25% of emergency presentations (P < 0.001). Most screen‐detected cancers were distal to the splenic flexure (75%). Screened cancers had favourable pathology; lower T and N stages (both P < 0.001), less venous invasion (P < 0.001) and better differentiation (P < 0.05). Similar results were seen after stratification for TNM stage. Screening has not yet resulted in a significant shift towards early‐stage disease since 2007. Conclusion Screening has been associated with an increase in the numbers of both new and early‐stage colorectal cancers. Screen‐detected cancers are predominantly early‐stage disease with favourable pathology. At present, it remains to be seen whether screening will ultimately translate into an overall reduction in advanced‐stage disease.     

Long‐term follow‐up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer

Background:

Laparoscopic resection is used widely in the management of colorectal cancer; however, the data on long‐term outcomes, particularly those related to rectal cancer, are limited. The results of long‐term follow‐up of the UK Medical Research Council trial of laparoscopically assisted versus open surgery for colorectal cancer are presented.

Methods:

A total of 794 patients from 27 UK centres were randomized to laparoscopic or open surgery in a 2:1 ratio between 1996 and 2002. Long‐term follow‐up data were analysed to determine differences in survival outcomes and recurrences for intention‐to‐treat and actual treatment groups.

Results:

Median follow‐up of all patients was 62·9 (interquartile range 22·9 ? 92·8) months. There were no statistically significant differences between open and laparoscopic groups in overall survival (78·3 (95 per cent confidence interval (c.i.) 65·8 to 106·6) versus 82·7 (69·1 to 94·8) months respectively; P = 0·780) and disease‐free survival (DFS) (89·5 (67·1 to 121·7) versus 77·0 (63·3 to 94·0) months; P = 0·589). In colonic cancer intraoperative conversions to open surgery were associated with worse overall survival (hazard ratio (HR) 2·28, 95 per cent c.i. 1·47 to 3·53; P < 0·001) and DFS (HR 2·20, 1·31 to 3·67; P = 0·007). In terms of recurrence, no significant differences were observed by randomized procedure. However, at 10 years, right colonic cancers showed an increased propensity for local recurrence compared with left colonic cancers: 14·7 versus 5·2 per cent (difference 9·5 (95 per cent c.i. 2·3 to 16·6) per cent; P = 0·019).

Conclusion:

Long‐term results continue to support the use of laparoscopic surgery for both colonic and rectal cancer. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Long-term outcomes of radiotherapy for stage II testicular seminoma–the Mayo Clinic experience

ObjectivesTo report long-term outcomes of patients with stage II testicular seminoma treated with radiotherapy (RT).Materials and methodsA retrospective review was performed of 52 patients who received megavoltage RT for stage II testicular seminoma at Mayo Clinic between 1974 and 2007. Forty-eight patients (92%) had computed tomography staging. Overall survival (OS), relapse-free survival (RFS), and cause-specific survival (CSS) were determined using the Kaplan-Meier method. Major cardiac event (MCE) was defined as myocardial infarction, coronary artery bypass grafting or stenting, or valve replacement. Second malignancy (SM) was defined as biopsy-confirmed malignancy occurring in the RT field.ResultsThe median patient age at diagnosis was 36 years. Stage was IIA (n = 24), IIB (n = 7), IIC (n = 17), and II not otherwise specified (NOS, n = 4). The median infradiaphragmatic RT dose was 30.7 Gy. Twenty-six patients (50%) received prophylactic mediastinal/supraclavicular (MSCV) RT. The median follow-up was 19 years. Estimates of OS, RFS, and CSS were 94%, 80%, and 96% at 10 years, and 83%, 72%, and 96% at 20 years, respectively. RFS at 10 years for stage IIA, IIB, IIC, and II NOS were 83%, 54%, 81%, and 100%, respectively (log-rank P = 0.21). Ten patients (19%) experienced disease relapse in the MSCV region (n = 7), para-aortic lymph nodes (n = 1), lung (n = 1), or peritoneal cavity (n = 1). Eight patients were successfully salvaged with chemotherapy and/or surgery, while 2 died of seminoma. Risk of MSCV relapse was significantly lower in patients who received MSCV RT vs. those who did not (10-year estimates: 4% vs. 21%, respectively, log-rank P = 0.01). MCE occurred in 10 patients (19%) at a median of 18 years (range 7–30) after RT. SM occurred in 5 patients (10%) at a median of 27 years (range 20–34) after RT.ConclusionsIn patients with stage II testicular seminoma treated with RT, relapse in the irradiated site was uncommon. Infradiaphragmatic RT alone was associated with a significant risk of MSCV failure. Most MCE and SM events occurred more than 20 years after RT, highlighting the importance of vigilant long-term follow-up.     

广泛切除手术联合放、化疗治疗Ⅱ、Ⅲ期肢体软组织肉瘤的疗效分析

 目的 探讨广泛切除术后进行放、化疗与单纯化疗对Ⅱ、Ⅲ期（AJCC分期）肢体软组织肉瘤患者预后的影响。方法 回顾性分析2007年7月1日至2012年12月31日行广泛切除手术的81例AJCC分期Ⅱ、Ⅲ期的肢体软组织肉瘤患者的病例资料,放、化疗组59例,单纯化疗组22例。通过单因素及多因素分析影响无病生存时间和总生存时间的临床因素。结果 81例患者均得到随访。放、化疗组中位随访时间为29个月（2~66个月）,单纯化疗组为19个月（2~59个月）。放、化疗组局部复发13例（22%）,远处转移14例（23.7%）,死亡8例（13.6%）;单纯化疗组局部复发5例（22.7%）,远处转移10例（45.5%）,死亡4例（18.2%）。单因素分析显示中位无病生存时间与治疗方式（放、化疗组44个月,单纯化疗组14个月,χ²=5.87,P=0.015）和AJCC分期（Ⅱ期42个月,Ⅲ期24个月,χ²=4.404,P=0.036）相关。多因素分析显示治疗方式是影响无病生存时间的独立因素（P=0.02,OR=0.44,95% CI=0.221~0.877）。单因素分析显示不同治疗方式与中位总生存时间无关（放、化疗组57个月,单纯化疗组43个月,χ²=1.147,P=0.284）,中位总生存时间与肿瘤大小（≤5 cm 者60个月,＞5 cm者45个月,χ²=4.478,P=0.034）、组织学分级（G2级者52个月,G3 级者50个月,χ²=4.325,P=0.038）和AJCC分期（Ⅱ期 61个月,Ⅲ期 39个月,χ²=9.935,P=0.002 ）相关。多因素分析显示未发现影响中位总生存时间的临床因素。结论 对于经过广泛切除手术的Ⅱ、Ⅲ期肢体软组织肉瘤患者,放、化疗较单纯化疗可延长患者中位无病生存时间。     

The survival effect of E‐cadherin and catenins in colorectal carcinomas

Aim The E‐cadherin/catenin complex plays an important role in epithelial tissue architecture. Decreased expression of cell adhesion molecules (E‐cadherin, α‐, β‐ and γ‐catenin) have been reported to correlate with invasive behaviour. The aim of this study was to investigate the relation between the expression of adhesion molecules and clinicopathological characteristics and survival in colorectal carcinoma. Method The expression of adhesion molecules were studied by immunohistochemistry in 138 colorectal carcinomas. Results The mean age of the patients was 65 years (range: 21–89 years). In primary carcinomas, a reduction in membranous expression of E‐cadherin, α‐catenin, β‐catenin, γ‐catenin was demonstrated (70%, 68%, 73%, 77%, respectively). Nuclear expression of β‐catenin was found in eight (5%) patients. Decreased membranous β‐ and γ‐catenin expression significantly correlated with tumour differentiation (P = 0.013, P = 0.03, respectively). There was a significant association between advanced stage of the tumour and decreased membranous α‐catenin expression (P = 0.012). Decreased E‐cadherin and β‐catenin membranous expression correlated with short survival following curative resection of the primary tumour (P = 0.04, P = 0.03, respectively). Conclusion The decreased membranous expression of E‐cadherin and β‐catenin and increased cytoplasmic expression of β‐catenin might be used as a prognostic marker to monitor patients with colorectal cancer.     

Prognostic Significance of Vascular Endothelial Growth Factor,Basic Fibroblast Growth Factor,and Angiogenin in Patients With Resectable Hepatocellular Carcinoma After Surgery

Background: Hepatocellular carcinoma (HCC) is a hypervascular malignancy. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and angiogenin (ANG) are important angiogenic factors of neoangiogenesis. This study investigated the predictive value of serum VEGF, bFGF, and ANG in tumor recurrence, disease-free survival (DFS), and overall survival (OS) in HCC patients.Methods: Preoperative serum VEGF, bFGF, and ANG were measured in 98 patients with resectable HCC and in 15 healthy controls. The median follow-up time was 43 months.Results: Preoperative serum VEGF was increased in patients with resectable HCC compared with healthy controls (P < .05). Increased serum VEGF was correlated with tumor recurrence (P = .001). Univariate analysis showed that serum VEGF, tumor-node-metastasis stage, tumor size and number, macroscopic portal vein invasion, and microscopic vascular invasion were correlated with OS and DFS. Serum bFGF and ANG were not associated with survival. Multivariate analysis showed that serum VEGF was the most significant predictor of DFS (relative risk, 2.35; 95% confidence interval, 1.26–4.39; P = .007) and OS (relative risk, 3.44; 95% confidence interval, 1.81–6.57; P < .001) in HCC patients after surgical resection.Conclusions:Preoperative serum VEGF is a significant independent predictor of tumor recurrence, DFS, and OS in patients with resectable HCC.     

Impact of early reoperation after resection for colorectal cancer on long-term oncological outcomes

Aim Whether reoperation in the postoperative period adversely affects oncologic outcomes for colorectal cancer patients undergoing resection has not been well characterized. The aim of this study was to determine whether long‐term oncological outcomes are affected for patients who undergo repeat surgery in the early postoperative period. Method From a prospective colorectal cancer database, patients who underwent resection for colorectal cancer between 1982 and 2008 and were reoperated within 30 days after surgery (group A) were matched for age (± 5 years), gender, year of surgery (± 2 years), American Society of Anesthesiology score, tumor site (colon or rectum), cancer stage and differentiation with patients who did not undergo reoperation (group B). The two groups were compared for overall survival (OS), disease‐free survival (DFS) and local recurrence (LR). Results In total, 89 reoperated patients (45 rectal, 44 colon cancer) were matched to an equal number of non‐reoperated patients. Anterior resection (39.2%) and right hemicolectomy (19.1%) were predominant primary operations. Indications for reoperation were anastomotic leak/abscess (n = 40, 45%), massive bleeding (n = 15, 16.9%), bowel obstruction (n = 11, 12.4%), wound complications (n = 9, 10.1%) and other indications (n = 14, 15.6%). Group A had significantly greater overall morbidity (100%vs 27%, P = 0.001) and required more blood transfusions (20.2%vs 7.9%, P = 0. 045). Adjuvant therapy use, on the other hand, was more common in group B (23.6%vs 12.3%, P = 0.1). The 5‐year OS and DFS were lower in the reoperated group (OS 55.3%vs 66.4%, P = 0.02; DFS 50.8%vs 60.8%, P = 0.06, respectively). Five‐year LR was slightly lower in the reoperated group (2.9%vs 6.3%, P = 0.34). Conclusions Compared with non‐reoperated patients matched for patient, tumour and operative characteristics, patients reoperated in the early postoperative period have worse long‐term oncological outcomes. Adoption of strategies to reduce the risk of reoperation may be associated with the additional advantage of improved oncological outcomes in addition to the short‐term advantages.     

Effect of increases in tumor volume after neoadjuvant chemotherapy on the outcome of stage II osteosarcoma regardless of histological response

Background  We assessed volume changes after neoadjuvant chemotherapy and evaluated relations between tumor size changes and clinical characteristics. In addition, we sought to determine whether tumor size change influences patient outcome. Methods  The records of 127 patients with stage II osteosarcoma who showed more than a 15% volume change after chemotherapy were retrospectively reviewed. Patients were divided into two groups depending on whether tumors increased or decreased in size. Fisher’s exact test was performed to analyze correlations between tumor size changes and clinicopathological variables. Five-year metastasis-free survival and overall survival were evaluated using univariate and multivariate analyses. Results  A total of 71 patients (55.9%) showed a decrease in tumor volume, and 56 patients (44.1%) showed an increase. An increase in tumor volume after neoadjuvant chemotherapy was found to be positively correlated with a poor histological response and subsequent metastasis. Univariate analysis identified the following parameters as poor prognostic factors: age ≤15 years (P = 0.03), American Joint Committee on Cancer (AJCC) stage IIB (P = 0.02), a subtype other than osteoblastic (P < 0.01), a poor histological response (P < 0.001), and increased tumor volume after preoperative chemotherapy (P < 0.0001). Multivariate analysis revealed that AJCC stage IIB (P = 0.006) and an increase in tumor volume after preoperative chemotherapy (P < 0.001) both independently shortened metastasis-free survival. However, a poor histological response lost its prognostic significance (P = 0.34). Conclusions  Increased tumor volume after neoadjuvant chemotherapy independently shortened metastasis-free and overall survival in AJCC stage II osteosarcoma patients. Tumor volume changes may serve as a basis for risk-adapted therapy when used in combination with other prognostic factors.