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81.
Tumor volume as a prognostic factor for sarcomatosis 总被引:11,自引:0,他引:11
Bilimoria MM Holtz DJ Mirza NQ Feig BW Pisters PW Patel S Pollock RE Benjamin RS Papadopoulos NE Plager C Murphy A Griffin JR Burgess MA Hunt KK 《Cancer》2002,94(9):2441-2446
BACKGROUND: The appropriate therapeutic interventions for sarcomatosis, or sarcoma characterized by intraabdominal dissemination, remain unclear. The authors performed a retrospective analysis of their recent experience with patients diagnosed with sarcomatosis to determine the overall survival and the effects of clinicopathologic features on survival rates at two and four years. METHODS: A query of the authors' prospective soft tissue sarcoma database identified 51 patients with a diagnosis of sarcomatosis who were evaluated at the authors' institution between June 1996 and June 1999. Clinical and pathologic factors were evaluated, and survival was calculated using a Kaplan-Meier survival analysis. Disease was categorized as low or high volume based on findings at surgical exploration or computed tomography scan evaluation. Disease was classified as low/intermediate grade or high grade based upon histologic examination. RESULTS: Twenty five patients were male and 26 were female. The median time from the initial diagnosis of sarcoma to the development of sarcomatosis was 0.9 years (range, 0-26 years). Thirty nine patients were treated with surgery, whereas 32 received primarily nonsurgical treatment. Histology revealed gastrointestinal stromal tumor (GIST) in 33 patients and other histologies in 18 patients. The two year overall survival rate of patients with GIST was similar to that of patients with other types of sarcoma (38% versus 42%, respectively, P = 0.77). Patients with low volume disease had an overall two year survival rate of 82%, compared with only 24% for patients with high volume disease (P = 0.008). There was no difference in the overall survival rates of patients with low grade (n = 18) versus high grade tumors (n = 33, P = 0.29). With a median followup of 2.7 years (range, 0.5-26.4 years), the median time from sarcomatosis to death was 13 months (range, 4-42 months). CONCLUSIONS: Evaluating volume of disease at the time of diagnosis permits stratification of patients into prognosis based subsets. We found no significant difference in two or four year survival rates in patients with GIST and those with non-GIST sarcomatosis. 相似文献
82.
83.
Huang E Buchholz TA Meric F Krishnamurthy S Mirza NQ Ames FC Feig BW Kuerer HM Ross MI Singletary SE McNeese MD Strom EA Hunt KK 《Cancer》2002,95(10):2059-2067
BACKGROUND: To distinguish true local recurrences (TR) from new primary tumors (NP) and to assess whether this distinction has prognostic value in patients who develop ipsilateral breast tumor recurrences (IBTR) after breast-conserving surgery and radiotherapy. METHODS: Between 1970 and 1994, 1339 patients underwent breast-conserving surgery at The University of Texas M. D. Anderson Cancer Center for ductal carcinoma in situ or invasive carcinoma. Of these patients, 139 (10.4%) had an IBTR as the first site of failure. For the 126 patients with clinical data available for retrospective review, we classified the IBTR as a TR if it was located within 3 cm of the primary tumor bed and was of the same histologic subtype. All other IBTRs were designated NP. RESULTS: Of the 126 patients, 48 (38%) patients were classified as NP and 78 (62%) as TR. Mean time to disease recurrence was 7.3 years for NP versus 5.6 years for TR (P = 0.0669). The patients with NP had improved 10-year rates of overall survival (NP 77% vs. TR 46%, P = 0.0002), cause-specific survival (NP 83% vs. TR 49%, P = 0.0001), and distant disease-free survival (NP 77% vs. TR 26%, P < 0.0001). Patients with NP more often developed contralateral breast carcinoma (10-year rate: NP 29% vs. TR 8%, P = 0.0043), but were less likely to develop a second local recurrence after salvage treatment of the first IBTR (NP 2% vs. TR 18%, P = 0.008). CONCLUSIONS: Patients with NP had significantly better survival rates than those with TR, but were more likely to develop contralateral breast carcinoma. Distinguishing new breast carcinomas from local disease recurrences may have importance in therapeutic decisions and chemoprevention strategies. This is because patients with new carcinomas had significantly lower rates of metastasis than those with local disease recurrence, but were more likely to develop contralateral breast carcinomas. 相似文献
84.
85.
Evidence for a NOD2-independent susceptibility
locus for inflammatory bowel disease on chromosome 16p 总被引:11,自引:0,他引:11
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Jochen Hampe Henning Frenzel Muddassar M. Mirza Peter J. P. Croucher Andrew Cuthbert Silvia Mascheretti Klaus Huse Matthias Platzer Stephen Bridger Birgit Meyer Peter Nürnberg Pieter Stokkers Michael Krawczak Christopher G. Mathew Mark Curran Stefan Schreiber 《Proceedings of the National Academy of Sciences of the United States of America》2002,99(1):321-326
Heritable predisposition to inflammatory bowel disease (IBD) has been demonstrated by epidemiological and genetic analysis. Linkage of IBD to broad regions of chromosome 16 has been established by analysis of multiple populations. NOD2, located on proximal 16q, was recently identified as an IBD gene. As the linkage regions on chromosome 16 are large, we have investigated the possibility that NOD2 is not the only IBD gene located on this chromosome. A high-density experiment using 39 microsatellite markers was performed to identify additional regions of association, and to indicate areas of interest for further investigation. A triple-peaked configuration of the linkage curve with peak logarithm of odds (lod) scores of 2.7, 3.2, and 3.1 was observed on proximal 16p, proximal 16q, and central 16q, respectively. The cohort was stratified by coding individuals carrying the NOD2 single nucleotide polymorphism (SNP)8 and SNP13 "unknown." Significance at the central peak, corresponding to the genomic location of NOD2, then decreased from 3.2 to 1.2. The maximal lod scores on the proximal p-arm (lod = 2.1) and central q-arm (lod = 2.6) changed only moderately. An exploratory association analysis (TRANSMIT) yielded a strong lead at D16S3068 (P = 0.00028). The region around this marker was further investigated by using anonymous SNPs. An associated haplotype containing three SNPs was identified (peak significance P = 0.00027, IBD phenotype). On stratification based on NOD2 genotype, this significance increased to P = 0.0001. These results confirm the importance of NOD2 and provide evidence for a second IBD gene located on chromosome 16p. 相似文献
86.
87.
Solorzano CC Middleton LP Hunt KK Mirza N Meric F Kuerer HM Ross MI Ames FC Feig BW Pollock RE Singletary SE Babiera G 《American journal of surgery》2002,184(4):364-368
BACKGROUND: Intracystic papillary carcinoma (IPC) of the breast is a rare form of noninvasive breast cancer. An appreciation of associated pathology with IPC may be critical in surgical decision-making. METHODS: The medical records of all patients with IPC treated between 1985 and 2001 were retrospectively reviewed. Three patient groups were identified according to the pathologic features of the primary tumor: IPC alone, IPC with associated ductal carcinoma in situ (DCIS), and IPC with associated invasion with or without DCIS. Types of treatment and outcomes were compared between groups. RESULTS: Forty patients were treated for IPC during the study period. Fourteen had pure IPC, 13 had IPC with DCIS, and 13 had IPC with invasion. The incidence of recurrence and the likelihood of dying of IPC did not differ between the three groups regardless of the type of surgery (mastectomy or segmental mastectomy) performed and whether radiation therapy was administered. The disease-specific survival rate was 100%. CONCLUSIONS: When IPC is identified, it is frequently associated with DCIS and or invasion. Standard therapy should be based on associated pathology. The role of radiation therapy in pure IPC remains to be determined. 相似文献
88.
Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy 总被引:15,自引:2,他引:13
Mirza NQ Vlastos G Meric F Buchholz TA Esnaola N Singletary SE Kuerer HM Newman LA Ames FC Ross MI Feig BW Pollock RE McNeese M Strom E Hunt KK 《Annals of surgical oncology》2002,9(3):256-265
Background Our aim was to identify predictors of locoregional recurrence (LRR) in patients with early-stage breast cancer treated with
breast-conserving therapy (BCT) and long-term follow-up.
Methods From 1970 to 1994, 1153 patients with stage I to II breast cancer underwent BCT and radiotherapy at our institution. Patients
with prior breast cancer or other primary malignancies were excluded. Clinical and pathologic characteristics evaluated were
age, race, tumor size, stage, pathologic tumor margins, axillary nodal involvement, estrogen and progesterone receptor status,
Black's nuclear grade, type of surgery, and use of adjuvant therapy.
Results Of 1083 patients, 54% presented with stage I disease and 46% with stage II disease. Median age was 50 years, and median follow-up
was 9 years. Axillary nodes were positive in 31% of the patients who underwent axillary dissection. LRR developed in 6%, LRR
followed by systemic recurrence in 5%, and systemic recurrence alone in 13%, 76% had no evidence of recurrence at last follow-up.
Age, tumor size, positive lymph nodes, and not receiving chemotherapy or hormonal therapy were independent predictors of LRR.
Disease-specific survival among patients with LRR was similar to that among patients with no recurrence.
Conclusions Multidisciplinary treatment strategies should be used to accomplish durable locoregional control after BCT.
Presented at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001. 相似文献
89.
Long-term complications associated with breast-conservation surgery and radiotherapy 总被引:5,自引:0,他引:5
Meric F Buchholz TA Mirza NQ Vlastos G Ames FC Ross MI Pollock RE Singletary SE Feig BW Kuerer HM Newman LA Perkins GH Strom EA McNeese MD Hortobagyi GN Hunt KK 《Annals of surgical oncology》2002,9(6):543-549
Background Breast-conservation surgery plus radiotherapy has become the standard of care for early-stage breast cancer; we evaluated
its long-term complications.
Methods We selected patients treated with surgery and radiotherapy between January 1990 and December 1992 (an era in which standard
radiation dosages were used) with follow-up for at least 1 year. Patients were prospectively monitored for treatment-related
complications. Median follow-up time was 89 months.
Results A total of 294 patients met the selection criteria. Grade 2 or higher late complications were identified in 29 patients and
included arm edema in 13 patients, breast skin fibrosis in 12, decreased range of motion in 4, pneumonitis in 2, neuropathy
in 2, fat necrosis in 1, and rib fracture in 1. Arm edema was more common after lumpectomy plus axillary node dissection than
after lumpectomy alone. Arm edema occurred in 18% of patients who underwent surgery plus irradiation of the lymph nodes and
10% who underwent surgery without nodal irradiation.
Conclusions Breast-conservation surgery plus radiotherapy was associated with grade 2 or higher complications in only 9.9% of patients.
Half of these complications were attributable to axillary dissection, it is hoped that lower complication rates can be achieved
with sentinel lymph node biopsy. 相似文献
90.
Bonhomme GR Loevner LA Yen DM Deems DA Bigelow DC Mirza N 《AJNR. American journal of neuroradiology》2000,21(2):353-355
Xanthomas are associated with a spectrum of medical conditions, most commonly disorders of lipid storage and lipid metabolism. They occur primarily in the subcutaneous tissues, especially along the Achilles tendon and the extensor tendons of the hands. Intracranial xanthomas are extremely rare. We present a case of an extensive xanthoma of the temporal bone in a patient with hyperlipidemia. 相似文献