Cancer

In the current study, pathologic alterations induced by chemotherapy in patients with breast carcinoma are described in detail. Their nature and influence on various pathologic and clinical events, including parameters of survival, are discussed.

This is a retrospective review of a group of 202 patients with early breast carcinoma who were treated with concomitant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) chemotherapy and radiotherapy. The main finding of the current study was that concurrent treatment was well tolerated and appears to carry a low risk for serious complications. The authors concluded that when CMF is selected as adjuvant chemotherapy for early breast carcinoma patients, it is safe and feasible to administer simultaneous radiotherapy.

Community-wide evaluation of the diagnosis and treatment of patients with mammogram-detected breast carcinoma showed that there is wide variation in outcomes and that most providers treat a low volume of cases. Variation in outcomes for patients who were treated by high-volume physicians suggests that volume alone is not a surrogate for quality.

Although tumor size has been recognized as the strongest predictor of outcome in patients with invasive breast carcinoma, it has not been determined whether the correlation between tumor size and mortality is independent of the method of detection. In this report, the authors provide a method for translating tumor size at the time of treatment into a specific expectation of survival for patients with invasive breast carcinoma.

Carcinoma of the thyroid in children and adolescents has little risk of mortality but a high risk of recurrence. Younger patients present with a more advanced stage of disease and are more likely to have disease recurrence.

Many patients with colorectal carcinoma develop unresectable liver metastases that remain the life-limiting component of the disease, despite best available systemic or regional chemotherapy. In the current study, the authors analyzed a cohort of seven patients with colorectal carcinoma who underwent isolated hepatic perfusion (IHP) after failing both previous systemic and hepatic artery infusion therapy to determine the potential utility of IHP in this setting.

In patients with esophageal squamous cell carcinoma (SCC), decreased Smad4 expression was correlated with depth of invasion and pathologic stage. Lower Smad4 expression may contribute to the progression or development of esophageal SCC through its effects on the transforming growth factor-β signaling pathway.

This study assesses 532 sequentially accessioned stomach carcinomas in a multiethnic population and confirms that carcinoma of the cardia is predominantly a tumor of white males that develops in the absence of multifocal gastritis. Diffuse gastric carcinoma shows no ethnic predilection, but is clearly related to both gender and age.

Pretreatment prognostic factors in patients with advanced urothelial carcinoma treated with a novel regimen of paclitaxel, cisplatin, and gemcitabine (TCG) have been characterized. The analysis indicated that among eight potential pretreatment prognostic factors analyzed, two of them, performance status > 0 and visceral metastatic disease, are independent adverse prognostic factors for predicting survival in patients treated with this TCG regimen.

Thalidomide treatment is feasible and safe and produces rare, delayed clinical responses in patients with metastatic renal cell carcinoma. Prolonged stability of metastatic disease is seen in some patients, warranting further investigation in controlled, randomized trials.

Treatment results of our extragonadal germ cell tumor cases were analyzed and compared with those from other countries.

Immunohistologic, molecular, cellular, and clinicopathologic studies combined together demonstrate that the overexpression of the signal molecule, proline-directed protein kinase F_A (PDPK F_A), plays an essential critical role in disease progression and chemoresistance in patients with bladder carcinoma and indicates a poor clinical outcome in patients with PDPK F_A positive bladder carcinoma who have primary transitional cell carcinoma.

High proliferative activity and p53 overexpression were associated with recurrence of disease in 62 patients with superficial low malignant potential and Grade 1 papillary carcinomas of the bladder. MIB-1 immunostaining was the only independent predictor of recurrence-free survival in multivariate analysis.

Optimal secondary cytoreductive surgery is an independent predictor of survival in patients with recurrent micropapillary serous ovarian carcinoma. Surgical intervention should be considered for patients with recurrent disease. See also pages 675–6 and 677–80.

Cyclooxygenase-2 (COX-2) is expressed in a high percentage of primary endometrial tumors and its expression may be associated closely with parameters of tumor aggressiveness. The possible prognostic role of COX-2 in endometrial carcinoma deserves further study.

Associations of serum vascular endothelial growth factor (VEGF) levels with social support and depressive symptoms were analyzed in presurgical patients with ovarian carcinoma. Higher levels of social support were related to lower VEGF levels. This relationship between a biobehavioral factor and a proangiogenic cytokine suggests a novel mechanism by which biobehavioral factors may be related to disease progression.

A retrospective cohort study of 653 patients with hepatocellular carcinoma (HCC) who received percutaneous ethanol injection therapy (PEIT) showed that there was no difference in mortality from extrahepatic disease or liver-related disease between patients age ≥ 70 years and patients age < 70 years. These data provide support for the treatment of patients with HCC age ≥ 70 years with tumor ablation using PEIT.

The serum level of hepatocyte growth factor (HGF) represents the degree of the carcinogenic state in the liver of patients with C-viral chronic hepatitis and cirrhosis. Therefore, the determination of serum HGF concentrations may be useful as a third marker of hepatocellular carcinoma in detection and follow-up therapy.

Contrast-enhanced dynamic computed tomography scans enable the prediction of tumor angiogenesis in patients with lung carcinoma and lymph node involvement.

Histologic grade based on three criteria (tumor differentiation/histologic type, necrosis, and MIB-1 score) and disease stage are very strong prognostic factors in adult patients with the main histologic types of soft tissue sarcoma of the extremities and trunk. In addition, specific assessment of histologic type should be carried out before deciding on treatment strategies.

Limb-sparing treatment can be compatible with satisfactory oncologic results in patients with soft tissue sarcomas of the hand and foot. Re-excision of the tumor bed and radiation therapy can improve local control in properly selected patients.

The authors report the novel finding that human osteosarcoma expresses two specific ephrin profiles. Also, ephrin-B1 may be correlated with a poorer prognosis and is expressed by osteosarcoma cells and blood vessels, suggesting a possible role in tumorigenicity.

The authors used computer modeling to determine the potential impact of a PSA screening-induced shift from distant to localized-regional disease may have had on prostate carcinoma mortality rates.

The authors report on a male patient age 63 years who developed unusually severe periorbital edema after treatment with STI571 (imatinib mesylate; Gleevec) for chronic myelogenous leukemia. Histopathologic findings on the surgical specimin are discussed.

An incremental analysis explored the relationship between hemoglobin levels and quality of life (QOL) in cancer patients receiving epoetin alfa therapy in community based practice. A direct and robust relationship between epoetin alfa induced hemoglobin level increases and QOL improvements was identified, with maximal incremental gain in QOL occurring when hemoglobin levels were increased into the range of 11–13 g/dL.

Overexpression of β1-integrin protected hepatoma cells from cisplatin, etoposide, and docetaxel induced apoptosis via a mitogen-activated protein kinase dependent pathway. β1 integrin mediated signals from the extracellular matrix in hepatoma cells may contribute to chemotherapy resistance.