Adjuvant Chemotherapy and Prognostic Factors in Stage II Colon Cancer - Izmir Oncology Group Study

Background: Although adjuvant chemotherapy is a standard treatment in stage III colon cancer, its benefitis not as clear for stage II patients. In this retrospective analysis, we aimed to evaluate the survival of patientswith low-risk stage II colon cancer, the efficacy of adjuvant chemotherapy in high-risk stage II colon cancerpatients, and prognostic factors in stage II disease. Materials and Methods: One hundred and seventeen patientswho were diagnosed with stage II colon cancer between January 2006 and December 2011 were included inthe study. Patients were stratified into two groups as being low-risk and high-risk according to risk factorsfor stage II disease. Adjuvant 5-fluorouracil-based chemotherapy were administered to the patients with riskfactors. Results: Ninety-four patients were treated with adjuvant chemotherapy due to high risk factors and 23were monitored without treatment. Median follow-up time was 43 months. In terms of disease free survival andoverall survival, adjuvant chemotherapy did not provide a statistically significant difference. Univariate analysisdemonstrated that bowel obstruction was the major risk factor for shortened disease-free survival, while bowelperforation and perineural invasion were both negative prognostic factors for overall survival. Conclusions:The recommendation of adjuvant chemotherapy for stage II colon cancer is not clear. In our study, it was foundthat adjuvant chemotherapy did not contribute to survival in high-risk stage II patients. Due to the fact thatprognosis of stage II patients is good, many more patients will be needed for statistically significant differences insurvival. Adjuvant chemotherapy containing 5 fluorouracil is being used to high-risk stage II patients althoughit is not a standard treatment approach.     

Prognostic Analysis of Schistosomal Rectal Cancer

Background: Schistosomiasis is an infectious disease that affects more than 230 million people worldwide,according to conservative estimates. Some studies published from China and Japan reported that schistosomiasisis a risk factor for colorectal cancer in Asia where the infective species is S. japonicum. Hoqwever, there have beenonly few reports of prognosis of patients with schistosomal rectal cancer SRC. Objectives: This study aimed toanalyze differences in prognosis between SRC and non-schistosomal rectal cancer(NSRC) with current treatments.Materials and Methods: A retrospective review of 30 patients with schistosomal rectal cancer who underwentlaparoscopic total mesorectal excision operation (TME) was performed. For each patient with schistosomal rectalcancer, a control group who underwent laparoscopic TME with non-schistosomal rectal cancer was matched forage, gender and tumor stage, resulting in 60 cases and controls. Results: Univariate analysis showed pathologicN stage (P=0.006) and pathologic TNM stage (P=0.047) statistically significantly correlated with disease-freesurvival (DFS). Pathologic N stage (P=0.014), pathologic TNM stage (P=0.002), and with/without schistosomiasis(P=0.026) were statistically significantly correlated with overall survival (OS). Schistosomiasis was the onlyindependent prognostic factor for DFS and OS in multivariate analysis. Conclusions: The prognosis of patientswith schistosomal rectal cancer is poorer than with non-schistosomal rectal cancer.     

Site-Specific Evaluation of Prognostic Factors on Survival in Iranian Colorectal Cancer Patients: A Competing Risks Survival Analysis

Background: Colorectal cancer (CRC) is one of the most malignant cancers, but prognosis varies in differentparts of the world. Knowing the prognostic factors of the cancer is clinically important for prognosis and treatmentapplication objectives. However, evaluation of these factors overall does not provide thorough understanding ofthe cancer. Therefore, this study aimed to evaluate prognostic factors of colon and rectal cancers site-specifically,via a competing risks survival analysis with colon and rectum as competing causes of death. Methods: A total of1,219 patients with CRC diagnosis according to the pathology reports of our cancer registry, from 1 January2002 to 1 October 2007, were entered into the study. Demographic and clinicopathological factors with regard tosurvival of patients were analyzed using univariate and multivariate competing risks survival analysis, utilizingSTATA statistical software. Results: The results of univariate analysis showed that gender, body mass index(BMI), alcohol history, inflammatory bowel disease (IBD), tumor size, tumor grade and pathologic stage weresignificantly associated with colon cancer and BMI, personal history of cancer, pathologic stage and the kind offirst treatment used were significantly related to rectal cancer. In the multivariate analysis, BMI, IBD, tumorgrade and pathologic stage of the cancer were significant prognostic factors for colon cancer and BMI and thekind of first treatment used were significant prognostic factors of rectal cancer. Also 1, 2, 3, 4 and 5 year andoverall adjusted survival of patients with rectal cancer was better than those of colon cancer. Conclusion: Basedon our findings, CRC is not a single entity and its sub-sites should be evaluated separately to reveal hiddenassociations which may not be revealed under general modeling.     

局部晚期中低位直肠癌新辅助同步放化疗58例分析

[目的]探讨局部晚期中低位直肠癌新辅助同步放化疗的疗效及其影响因素。[方法]58例局部晚期（T3-4N0-1M0）中低位直肠癌术前接受同步放化疗,放疗剂量50Gy,化疗包括奥沙利铂＋卡培他滨的联合化疗组及不含铂类药物的单药化疗组。共55例患者同步放化疗结束后2～10周内完成根治性手术,依据术后病理结果进行疗效评价。[结果]全组55例患者手术顺利,无严重手术并发症;术后病理示肿瘤完全消退8例（14．5％）,重度消退11例（20．0％）,中度消退20例（36．4％）,轻度及无消退16例（29．1％）;治疗前肿瘤（T）及淋巴结（N）临床分期与放化疗后肿瘤消退程度无关：奥沙利铂联合卡培他滨化疗组肿瘤完全消退与重度消退率为41．2％,不含铂类药物组为23．8％（P〉0．05）;与术前临床分期相比,同步放化疗后原发肿瘤（T）降期率为41．8％,淋巴结（N）降期率为58．8％。[结论]新辅助同步放化疗用于局部晚期中低位直肠癌的术前治疗可使大部分肿瘤获得不同程度消退：有关直肠癌同步放化疗疗效的预测指标以及高效的化疗方案有待进一步深入研究。     

Prognostic Factors and Adjuvant Treatments for Surgically Treated Cancers of the Biliary Tract: A Multicentre Study of the Anatolian Society of Medical Oncology (ASMO)

Background: Biliary tract cancers are rare, and surgical resection is the standard treatment at early stages.However, reports on the benefits of adjuvant treatment following surgical resection are conflicting. This studyaimed to evaluate the factors affecting survival and adjuvant treatments in patients with surgically treated biliarytract cancers. Materials and Methods: Patient clinical features, adjuvant treatments, and efficacy and prognosticfactor data were evaluated. Survival analyses were performed using SPSS 15.0. Results: The median overallsurvival was 30.7 months (95% confidence interval [CI], 18.4-42.9 months). Median survival was 19 months (95%CI, 6-33) for patients treated with fluorouracil based chemotherapy and 53 months (95% CI, 33.2-78.8) withgemcitabine based chemotherapy(p=0.033). On univariate analysis, poor prognostic factors for survival weregalbladder localization, perineural invasion, hepatic invasion, a lack of adjuvant chemoradiotherapy treatment,and a lack of lymph node dissection. On multivariate analysis, perineural invasion was a poor prognostic factor(p=0.008). Conclusions: Biliary tract cancers generally have poor prognoses. The main factors affecting survivalare tumour localization, perineural invasion, hepatic invasion, adjuvant chemoradiotherapy, and lymph nodedissection. Gemcitabine-based adjuvant chemotherapy is more effective than 5-fluorouracil-based chemotherapy.     

Postoperative radiotherapy for DukesB ‘ and C rectal cancer: Peter MacCallum Cancer Institute experience

This retrospective study reviews the outcome of patients with DukesB ‘ and C rectal cancer treated with adjuvant postoperative pelvic radiotherapy at the Peter MacCallum Cancer Institute from 1981 to 1990. Sixty-one patients (22 DukesB ‘, 36 DukesC ‘ and 3 unknown stage) received a median dose of 50 Gy of pelvic irradiation. Locoregional relapse occurred in 33% of patients. Estimated median progression-free survival was 1.7 years with 46% surviving without progression at 2 years and 30% at 5 years. There was no difference according to Dukesstage ‘. The estimated median survival was 2.6 years, with no difference according to disease stage. These results with postoperative radiotherapy alone are inferior to results achievable by combination chemotherapy and radiotherapy as adjuvant therapy which should now be considered standard therapy following surgical resection for DukesB ‘ and C rectal cancer.     

Preoperative Prognostic Factors and Effects of Adjuvant Therapy on Outcomes of Early Stage Cervical Cancer in Iran

Background: The aim of this study was to investigate the clinical and histopathological characteristics andthe pretreatment that might predict prognosis and to evaluate the impact of postoperative adjuvant therapy onthe outcomes of patients with early stage cervical carcinoma. Methods: A total of 203 patients with stage IB andstage II cervical cancers treated with radical hysterectomy and systematic retroperitoneal lymphadenectomywere reviewed at the Vali-Asr University Hospital from 1995 to 2002. The median follow-up period was 42months. Results: The depth of cervical stromal invasion, clinical stage, histology of pure adenocarcinoma andlymph node (LN) status were important histopathological prognostic factors of cervical carcinoma. Patients’prognosis could be stratified into three groups (low, intermediate and high risk), with five-year relapse freesurvival (RFS) rates of 93.5%, 80.6% and 64.7%, respectively (p=0.002), and overall survival (OS) was 95.3%,83.1% and 67.2% (p=0.001). Among the patients with pelvic lymph node metastases who were free of parametrialextension, those who received postoperative chemo-radiotherapy had significantly better RFS (p=0.021) and OS(p=0.030) than those who received no adjuvant therapy. Also of the patients without pelvic LN metastases but ata high risk of recurrence, the individuals who received adjuvant radiotherapy had a significantly more favorableRFS (p=0.038 ) and a marginally improved OS (p=0.064). Conclusion: Depth of cervical stromal invasion, clinicalstage and histology are independent predictors of outcome on multivariate analysis using a Cox regressionmodel. RFS is significantly improved with radiotherapy in patients who are without pelvic lymph node metastasesbut who are in a high risk group for recurrence.     

Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation

Background: To investigate the impact of the lymph node ratio (LNR) on the prognosis of patients with locallyadvanced rectal cancer undergoing pre-operative chemoradiation. Methods: Clinicopathologic and follow up dataof 128 patients with stage III rectal cancer who underwent curative resection from 1996 to 2007 were reviewed.The patients were divided into two groups according to the lymph node ratio: LNR ≤0.2 (n=28), and >0.2 (n=100).Kaplan-Meier and the Cox proportional hazard regression models were used to evaluate the prognostic effectsaccording to LNR. Results: Median numbers of lymph nodes examined and lymph nodes involved by tumourwere 10.3 (range 2-28) and 5.8 (range 1-25), respectively, and the median LNR was 0.5 (range, 0-1.6). The 5-yearsurvival rate significantly differed by LNR (≤0.2, 69%; >0.2, 19%; Log-rank p value < 0.001). LNR was alsoa significant prognostic factor of survival adjusted for age, sex, post-operative chemotherapy, total number ofexamined lymph nodes, metastasis and local recurrence (≤0.2, HR=1; >0.2, HR=4.8, 95%CI=2.1-11.1) and asignificant predictor of local recurrence and distant metastasis during follow-up independently of total number ofexamined lymph node. Conclusions: Total number of examined lymph nodes and LNR were significant prognosticfactors for survival in patients with stage III rectal cancer undergoing pre-operative chemoradiotherapy.     

Prognostic factors affecting the outcome of early cervical cancer treated with radical hysterectomy and post-operative adjuvant therapy

The purpose of this study is to investigate the clinical and histological features that may affect the survival of the patients and to evaluate the impact of post-operative adjuvant therapy on the outcomes of patients with stage IB and IIA carcinoma of the cervix. From August 1998 to January 2005, 140 patients with International Federation of Gynecology and Obstetrics stage IB and IIA cervical cancer were treated with radical hysterectomy and post-operative pelvic radiation therapy with or without chemotherapy. The median age was 55 years (range, 29-86 years). Seventy-six patients had stage IB and 64 patients had stage IIA disease. Tumour size was <4 cm in 96 patients and > or = 4 cm in 44 patients. One hundred and eleven patients had histology of squamous cell carcinoma, 12 patients has adenocarcinoma and 17 patients had other histologic types. Depth of stromal invasion was <2/3 in 20 patients and > or = 2/3 in 120 patients. Twenty-three patients had parametrial invasion and 117 patients had no parametrial invasion. Thirteen patients had lymphovascular space invasion and 127 had no lymphovascular space invasion. Nine patients had positive surgical margin and 131 patients had negative margin. Twenty-seven patients had pelvic lymph node metastasis and 113 patients had no pelvic lymph node metastasis. Seventy-five patients received concurrent chemoradiotherapy and 65 patients received radiotherapy alone. The 5-year overall survival (OAS) and disease-free survival were 83% and 72% respectively. In the log rank test, tumour size (P = 0.0235), pararmetrial invasion (P = 0.0121), pelvic lymph node metastasis (P < 0.0001) and adjuvant chemotherapy + radiotherapy (P = 0.0119) were significant prognostic factors for OAS, favouring tumour size <4 cm, absence of parametrial invasion and pelvic lymph node metastasis, and those who received adjuvant chemoradiotherapy. The patients who received radiation with concomitant chemotherapy had a 5-year OAS rate of 90% versus those who received radiotherapy alone, with a rate of 76%. For patients with high-risk early stage cervical cancer who underwent a radical hysterectomy and pelvic lymphadenectomy, adjuvant chemoradiotherapy resulted in better survival than radiotherapy alone. The addition of weekly cisplatin to radiotherapy is recommended. The treatment-related morbidity is tolerable.     

Prognostic Factors in Adult Patients with Solid Cancers and Bone Marrow Metastases

Background: Solid cancers with bone marrow metastases are rare but lethal. This study aimed to identifyclinical factors predictive of survival in adult patients with solid cancers and bone marrow metastases. Methods:A total of 83 patients were enrolled consecutively between January 1, 2000 and December 31, 2012. Bonemarrow metastases were confirmed by biopsies. Patient clinical features and laboratory data were analyzed forassociations. Results: The median age of the patients was 54 years (range, 23–88 years), and 58% were male. The3 most common primary tumor locations were the stomach (32 patients, 39%), prostate (16 patients, 19%), andlungs (12 patients, 15%). The median overall survival was 49 days (range, 3–1423 days). Patients with EasternCooperative Oncology Group performance status 1, cancers of prostate origin, platelet counts over 50,000/ml,and undergoing antitumor therapies had a significantly better prognosis in the multivariate analysis. The mediansurvival times were 173 and 33 days for patients with 2-3 more favorable parameters (n=24) and those with0-1 (n=69), respectively (hazard ratio 0.30; 95% CI 0.17-0.52, p<0.001). Conclusions: Solid cancers with bonemarrow metastases are dismal and incurable diseases. Understanding prognostic factors to these diseases helpsmedical personnel to provide appropriate treatments and better inform patients about outcomes. Antitumortherapies may improve outcomes in selected patient cohorts.     

Pre-operative Predictive Factors for Intra-operative Pathological Lymph Node Metastasis in Rectal Cancers

Background: A number of clinicopathologic factors have been found to be associated with pathologicallymph node metastasis (pLNM) in rectal cancer; however, most of them can only be identified by expensivehigh resolution imaging or obtained after surgical treatment. Just like the Child-Turcotte-Pugh (CTP) and themodel for end-stage liver disease (MELD) scores which have been widely used in clinical practice, our study wasdesigned to assess the pre-operative factors which could be obtained easily to predict intra-operative pLNM inrectal cancer. Methods: A cohort of 469 patients who were treated at our hospital in the period from January2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal cancer, were included. Clinical,laboratory and pathologic parameters were analyzed. A multivariate unconditional logistic regression model,areas under the curve (AUC), the Kaplan-Meier method (log-rank test) and the Cox regression model were used.Results: Of the 469 patients, 231 were diagnosed with pLNM (49.3%). Four variables were associated with pLNMby multivariate logistic analysis, age<60 yr (OR=1.819; 95% CI, 1.231-2.687; P=0.003), presence of abdominalpain or discomfort (OR=1.637; 95% CI, 1.052-2.547; P=0.029), absence of allergic history (OR=1.879; 95%CI, 1.041-3.392; P=0.036), and direct bilirubin≥2.60 μmol/L (OR=1.540; 95% CI, 1.054-2.250; P=0.026). Thecombination of all 4 variables had the highest sensitivity (98.7%) for diagnostic performance. In addition, age<60yr and direct bilirubin≥2.60 μmol/L were found to be associated with prognosis. Conclusion: Age, abdominalpain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful forpreoperative selection.     

Second Primary Cancers Following Colon and Rectal Cancer in Osaka, Japan

The frequencies of second primary cancers following colon and rectal cancers were estimated using the Osaka Cancer Registry's population-based data for Osaka, Japan. A series of 7,312 colon and 6,923 rectal cancer cases newly diagnosed in the period of 1966-1986 were followed up until the end of 1986. The average follow-up period was 3.6 years for colon cancer and 3.7 years for rectal cancer. Significantly elevated risks of second primary cancers following colon cancer were observed for cancers of the rectum (O/E= 2.0; 95% confidence interval (CI) = 1.1-3.4 among males, O/E=4.3; 95% CI=2.4-7.2 among females), corpus uteri (O/E=8.2; 95% CI = 3.3-16.9), ovary (O/E=4.3; 95% CI = 1.0-5.0), and female thyroid gland (O/E=4.7; 95% CI=1.7-8.8). These findings were more notable among right-sided colon cancer patients than left-sided colon cancer patients. The elevated risks of second primary cancers were particularly evident among patients younger than 50 years of age at the time of diagnosis of the initial cancer (colon cancer: O/E = 3.1 among males, 3.4 among females, rectal cancer: O/E=1.7 among males, 1.3 among females). These findings suggest that younger colorectal cancer patients should undergo more careful checkups throughout their lives.     

Prognostic Factors in Non-Hodgkin Lymphoma Stage I Treated with Radiotherapy

The results of treatment in 175 consecutive patients with non-Hodgkin lymphoma (NHL) clinical stage I treated between 1969 and 1984 were analysed according to different pretreatment prognostic variables. Treatment consisted of radiotherapy in 166 of the 175 patients. The estimated 5 and 10-year disease-free survival rates (DFS) were 63 % and 60% and the survival rates at 5 and 10 years 82% and 76% respectively. Lymphomas arising from gut-associated lymphoid tissue, i.e. Waldeyer's ring, the thyroid and the gastrointestinal tract had a more favourable clinical course (10-year projected DFS 83%) than nodal (50%) and other extranodal lymphomas. Although the number of patients with other extranodal sites was small, sites such as testis, nasal cavity, paranasal sinus and extradural space seemed to have a high relapse rate. Unfavourable clinical courses were also observed among nodal high-grade NHL if the lymph nodes were larger than 5 cm in diameter. Chemotherapy before radiotherapy may be recommended in NHL subgroups with a high relapse rate and which today are potentially curable with chemotherapy, i.e. high-grade NHL. This study indicates that large nodal lymphomas and some extranodal sites belong to this group.     

Prognostic factors affecting locally recurrent rectal cancer and clinical significance of hemoglobin

PURPOSE: To investigate potential prognostic factors, including hemoglobin levels before and during radiotherapy, for associations with survival and local control in patients with unirradiated locally recurrent rectal cancer. PATIENTS AND METHODS: Ten potential prognostic factors were investigated in 94 patients receiving radiotherapy for recurrent rectal cancer: age (or=69 years), gender, Eastern Cooperative Oncology Group performance status (0-1 vs. 2-3), American Joint Committee on Cancer (AJCC) stage (50 Gy), and hemoglobin levels before (<12 vs. >or=12 g/dL) and during (majority of levels: <12 vs. >or=12 g/dL) radiotherapy. Multivariate analyses were performed, including hemoglobin levels, either before or during radiotherapy (not both) because these are confounding variables. RESULTS: Improved survival was associated with better performance status (p<0.001), lower AJCC stage (p=0.023), surgery (p=0.011), chemotherapy (p=0.003), and hemoglobin levels>or=12 g/dL both before (p=0.031) and during (p<0.001) radiotherapy. On multivariate analyses, performance status, AJCC stage, and hemoglobin levels during radiotherapy maintained significance. Improved local control was associated with better performance status (p=0.040), lower AJCC stage (p=0.010), lower grading (p=0.012), surgery (p<0.001), chemotherapy (p<0.001), and hemoglobin levels>or=12 g/dL before (p<0.001) and during (p<0.001) radiotherapy. On multivariate analyses, chemotherapy, grading, and hemoglobin levels before and during radiotherapy remained significant. Subgroup analyses of the patients having surgery demonstrated the extent of resection to be significantly associated with local control (p=0.011) but not with survival (p=0.45). CONCLUSION: Predictors for outcome in patients who received radiotherapy for locally recurrent rectal cancer were performance status, AJCC stage, chemotherapy, surgery, extent of resection, histologic grading, and hemoglobin levels both before and during radiotherapy.     

Prognostic factors for local and distant recurrence in Stage I and II cervical carcinoma

: The effects of tumor size, parametrial involvement, and other variables on treatment outcome for patients with Federation Internationale de Gynecologie et d'Obsterique (FIGO) Stage I or II cervical carcinoma, as well as treatment complications, were analyzed retrospectively. : Records of 125 patients with FIGO Stage I or II carcinoma of the uterine cervix selected for curative radiotherapy between January 1980 and December 1990 were reviewed. Twelve patients (9.9%) underwent adjuvant extrafascial hyterectomy and 8 patients (6.4%) received chemotherapy. Median age was 55 years. Median follow-up time was 40 months, and minimum follow-up time was 24 months. The data were analyzed for site of first relapse, survival, overall incidence of complications, and incidence of grade 4 complications. : The overall 5-year was: Stage IA: 100%, Stage IB: 72%, Stage IIA: 90%, and Stage IIB: 72%. The 5-year survival with no evidence of disease (NED) was: Stage IA: 100%, Stage IB: 67%, Stage IIA: 90%, and Stage IIB: 50%. Patients with bulky (> 5 cm) tumors had a shorter overall and NED survival than patients with nonbulky tumors (53% vs. 83%; p = 0.0008 and 44% vs. 78%; p = 0.0001, respectively). Thirty-nine tumor recurrences (39 out of 125 = 31%) occurred and were scored as local (23 out of 125 = 18.3%), if initial failure had a local component, or distant (16 out of 125 = 12.7%), if initial failure was distant only. Patients with bulky (more than 5 cm) tumors (32 out of 125) were more likelyto experience a recurrence (18 out of 32 = 56%) than patients with nonbulky tumors (21 out 93 = 22%; p = 0.0004). The initial site of recurrence was more likely to be local for bulky tumors (14 out of 18 = 78%) than for nonbulky tumors (9 out of 21 = 43%; p = 0.03). The profitability of a recurrence increased with the number of involved parametria (none: 20 out of 78 = 25%; one: 12 out 34 = 35%; two 7 out of 13 = 54%; p = 0.04 for linear trend), as did the probability that the initial failure was distant rather than local (none: 4 out of 20 = 20%; one: 7 out of 12 = 58%; two: 5 out of 7 = 71%; p = 0.01 for linear trend). Positive lymph nodes, vessel invasion, and low hemoglobin level all correlated with an increased risk of a recurrence (RR 2.41, p = 0.004; RR 2.20, p = 0.01; OR 2.02, p = 0.01, respectively). There were 46 complications among 37 (29%) patients. The incidence of grade 4 complications was 8.8% (11 out of 125). History of pelvic surgery and bulky tumor were significantly predictors of a grade 4 complications (p < 0.0001 and 0.021, respectively). Also, a dose rate to point A of > 0.6 Gy/h increased the chance of a grade 4 complication (p = 0.007). : For patients with FIGO Stage I or II cervical carcinoma, tumor size was more predictive of local recurrence than was overall stage, and the extent of parametrical involvement was strongly predictive of distant recurrence, as was the stage. These findings suggest that tumor size and extent of parametrial involvement should be incorporated into the stagling system. Patients with bulky tumors had a shorter survival and were more likely to experience a grade 4 toxicity of therapy. Dose rate to point A of > 0.6 Gy/h was associated with the increased risk of grade 4 complications.     

Risk Factors for Rectal Cancer and Methylenetetrahydrofolate Reductase Polymorphisms in a Population in Northeast Thailand

Background and Aim: Polymorphisms in methylenetetrahydrofolate reductase (MTHFR) are known to beassociated with predisposition for certain cancers. This study aimed to evaluate the effects of lifestyle factors,family history and genetic polymorphisms in MTHFR C677T and A1298C on rectal cancer risk and possibleinteractions with lifestyle factors in Northeast Thailand. Methods: A hospital-based case-control study wasconducted during 2002-2006 with recruitment of 112 rectal cancer cases and 242 non-rectal cancer patient controls.Information was collected using a structured-questionnaire. Blood samples were obtained for assay of MTHFRC677T and A1298C genotypes by polymerase chain reaction with restriction fragment length polymorphism(PCR-RFLP) techniques. Associations between lifestyle factors, family history and genetic polymorphisms v.s.rectal cancer risk were assessed using logistic regression analysis. Results: Subjects with frequent and occasionalconstipation had a higher risk (OR_adj.=14.64; 95%CI=4.28-50.04 and OR_adj.=2.15; 95%CI=1.14-4.06), along withthose who reported ever having hemorrhoids (OR_adj.=2.82; 95%CI=1.36-5.84) or a family history of cancer(OR_adj.=1.90; 95%CI=1.06-3.39). Consumption of a high level of pork was also associated with risk (OR_adj.=1.82;95%CI=1.05-3.15). Interactions were not observed between MTHFR and other risk factors. Conclusions: Thisstudy suggested that the risk factors for rectal cancer in the Thai population are bowel habits, having hadhemorrhoids, a family history of cancer and pork consumption.     

Prognostic factors influencing the survival of patients with colon cancer receiving adjuvant 5-FU treatment

Aim

Adjuvant chemotherapy is recommended for stage III colon cancer. The aim of this study was to identify important prognostic factors among patients with colon cancer receiving adjuvant 5-FU-based treatment.

Methods

Data sets of 855 colon cancer patients treated between 1992 and 1999 within a multicenter adjuvant trial comparing 5-FU modulation with folinic acid or interfereron-alpha were examined. Backward elimination in a proportional hazards model was used to identify prognostically relevant clinical and pathological factors.

Results

Tumor recurrence (p < 0.001), duration of adjuvant treatment (p < 0.001), tumor substage (p = 0.004), age (p = 0.005), grading (p = 0.016), treatment-related toxicity (p = 0.021), and treatment (p = 0.031) were identified in descending order of importance as prognostic factors for overall survival.

Conclusions

Adjuvant 5-FU-based treatment should be performed for at least 6 months with a stepwise adjustment of 5-FU doses until toxicity >WHO II. Substages should be reported separately and used for stratification in future trials due to their broad variation in outcome. In the future, this may result in adjuvant treatment of stage III colon cancer adjusted for the risk of substages.     

结肠癌患者全结肠系膜切除术后的生存状况及预后影响因素分析

目的 探讨结肠癌患者全结肠系膜切除术后的生存状况及预后影响因素.方法 选取行全结肠系膜切除术治疗结肠癌患者86例,收集患者性别、年龄、Dukes分期、病理类型等信息,分析全结肠系膜切除术治疗结肠癌患者的负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]及生存质量评价量表(FACT-G)、术后5年生存状况和影响因...     

Demographics,Pathologic Patterns and Long-term Survival in Operable Colon Cancers: Local Experience in Pakistan

Background: Colon cancer is a common malignancy with its incidence reportedly rising in Asian Countries,including Pakistan. There are no comprehensive data available from Pakistan which focus on associations ofvarious factors with long-term survival of colon cancer. We therefore present an analysis of findings from ourcentre. Methodology: In this retrospective study adult patients with colon cancer diagnosed through 2000-2003were included. A comprehensive questionnaire was filled for each individual through review medical and pathologyreports. Long term survival data was collected from contactable patients or their relatives. Results:A total of 93patients were assessed, 57 males and 36 females (M: F= 1.58: 1). Mean age of diagnosis was 54 years. Of the total,49.5% of the patients had right sided ( mortality rate 51.6%), 10.8% had transverse colon, (mortality rate37.5%), 7.5% had descending colon (mortality rate 66.7%) and 32.2% had sigmoid colon (mortality rate40.9%) cancers. Stage I disease on diagnosis was found in 16%, stage II in 42.7 (mortality 40 %) and stage IIIin 41.3% ( mortality 70 %). Tumors were well differentiated in 20.2% (mortality 42.9%), moderately differentiatedin 61.9% (mortality 43%) and poorly differentiated in 17.9%( mortality 70%). In 36.3% of the patients lessthan 12 lymph nodes were removed (mortality 55% Vs 43% in patients with > 12 lymph nodes removed). Marginswere free in most patients but a radial margin was reported in only 44%. Most patients had pure adenocarcinomawhile a mucinous type differentiation was seen in 19.7%, 3% had signet ring morphology, 1.5% adeno-squamouscarcinoma and similar number with neuroendocrine differentiation. Overall 5 year all cause mortality for allstages combined was 46.9%. Conclusion: Colon cancer in Pakistan commonly presents at an advanced stage,there is a male preponderance, and relatively mean younger age at presentation for males is seen. Advancedstage and lymph node involvement along with poorly differentiated pathology, signet ring or mucinousmorphology, location in descending colon, positive surgical margins and removal of less than twelve lymphnodes are factors associated with poor long term survival. There is a need to reinforce information about coloncancer and larger studies from the region are needed to confirm the factors analyzed here.