Prognostic Significance of the Circumferential Resection Margin in Invasive T3 Rectal Cancer

PURPOSE: Because depth of invasion by T3 rectal cancer can vary according to the extent of mesorectal invasion, the prognosis for invasive T3 rectal cancer is reported to be very different from that for minimal invasive cancer. Recently, with more emphasis on circumferential resection margin (CRM) status, the T stage, rather than the N stage, seems to be a more valuable prognostic marker in rectal cancer. Therefore, the aim of this study is to determine the prognostic significance of the CRM in invasive T3 rectal cancer. METHODS: Through reviewing 324 consecutive patients with rectal cancer who underwent a curative resection between January 1995 and December 2002 at Busan Paik hospital, 195 patients with invasive T3 rectal cancer, who had not received preoperative neoadjuvant therapy were selected. The patients were classified into a negative CRM group (negative group, n=173) or a positive CRM group (positive group, n=22), and the patients were subgrouped according to the presence of lymph-node (LN) metastasis and CRM status as negative LN and negative CRM (L-/CM-), negative LN and positive CRM (L-/CM+), positive LN and negative CRM (L+/CM-) and positive LN and positive CRM (L+/CM+). All pathological specimens were re-reviewed by a single pathologist, and the distance between the most advanced edge and the outermost aspect of the specimen was re-measured by using a microscope. Local relapse rates, disease free survival, and overall survival were compared using the Kaplan- Meier method. Multivariate analyses to identify independent prognostic factors were performed using the logistic regression model. RESULTS: Local recurrence rates in the positive group and the negative group were 38.6% and 15.3%, respectively (P=0.004, log-rank test). The multiple logistic regression model demonstrated positive CRM (hazard ratio 4.4, P=0.0007) and N2 nodal status (hazard ratio 2.4, P=0.02) as predictors of local recurrence. In the subgroup analysis, the overall recurrence rates and survival rates were, respectively, 12.3% and 86.5% in the L-/CM- subgroup, 53.1% and 50.3% in the L-/CM+ subgroup, 52.7% and 50.0% in the L+/ CM- subgroup, and 58.7 % and 33.8% in the L+/CM+ subgroup (log rank test for trend; P=0.0001 and P=0.0001, respectively). CONCLUSIONS: In the event of predicted CRM involvement in invasive T3 rectal cancer, adjuvant therapy should be performed to improve local control. Also, larger prospective studies are needed to clarify the prognostic role of the CRM in invasive T3 rectal cancer because the number of cases in this study was small, especially in the number of CRM positive cases.

Expressions and Clinical Significances of c-met, c-erbB-2, COX-2, and IL-6 in the Biliary Tract Cancers / 대한소화기학회지

BACKGROUND/AIMS: c-met, c-erbB-2, interleukin (IL)-6, and cyclooxygenase (COX)-2 expressions are considered to be implicated in the carcinogenesis and progression of cholangiocarcinoma, but the molecular pathogenesis of cholangiocarcinoma is still poorly understood. We aimed to analyze the expressions of each marker and their relationships with clinicopathologic factors. METHODS: One hundred and fourteen tissue samples were obtained from surgically resected specimens from patients with billiary tract cancer. The expressions of c-met, c-erbB-2, COX-2, and IL-6 were examined by immunohistochemically. The expression of each marker and correlations between these markers and clinicopathologic factors were analyzed. RESULTS: The expression rates of each maker were as follows: c-met 34/112 (30.4%), c-erbB-2 5/112 (4.5%), COX-2 53/113 (46.9%), and IL-6 68/113 (60.2%), respectively. c-met expression was more frequently observed in cases with invasion through the adjacent connective tissues (p=0.0263). IL-6 overexpression was more frequently observed in cases with absent lymph node metastasis (p=0.0325). Either c-erbB-2 expression or COX-2 expression was significantly associated with lymph node metastasis (p=0.0442). CONCLUSIONS: The expression of c-met was closely related to the invasiveness of cholangiocarcinoma. Co-expression of c-met, COX-2 and, IL-6 showed a significant correlation with invasiveness and lymph node metastasis and these could be useful marker to guide clinical outcome in patients with cholangiocarcinoma.

Significance of COX-2 Expressions in Carcinoma of the Gallbladder

PURPOSE: Enhanced COX-2 expression has been observed in various solid tumors. A gallbladder carcinoma often evolves from a gallbladder adenoma, or chronic cholecystitis with cholelithiasis. It has been postulated that COX-2 might have an important role in the carcinogenesis of a gallbladder carcinoma. The purpose of this study was to identify the role of COX-2 in the carcinogenesis of gallbladder carcinomas, and find the relationships between COX-2 expression and the prognostic factors, including the survival of patients. METHODS: Three tissue microarray blocks were made from 23 cases of cholecystitis, 40 cases of a gallbladder adenoma and 67 cases of a gallbladder carcinoma. Immunohistochemical stains for COX-2 were performed, and the staining intensity and patterns evaluated. The relationships between COX-2 expression and the histopathological parameters of the gallbladder carcinoma were analyzed, and a postoperative survival analysis also performed. RESULTS: The rates of COX-2 expression were 52.2, 37.5 and 47.8% in the gallbladder carcinomas, gallbladder adenomas and chronic cholecystitis, respectively, and showed no significant differences (p=0.334). The overall expression rate was 46.9%. In the gallbladder carcinomas, COX-2 expression had no significant relationships with the tumor size (p=0.197), histological grade (p=0.859), depth of invasion (p=0.978) and lymph node metastasis (p=0.730). COX-2 expression in the followed-up patients with gallbladder carcinomas showed no relationships with the survival of the patients (p=0.087). CONCLUSION: COX-2 expression may play a role in the carcinogenesis of gallbladder carcinomas, but does not act as a prognostic indicator of a gallbladder carcinoma.

Radical Subtotal Gastrectomy in Early Gastric Cancer Patient with Situs Inversus Totalis

Situs inversus totalis is a complete mirror image of the thoracic and abdominal viscera. There are many cases of malignant neoplasms being found in patients with situs inversus totalis. We report a case of situs inversus totalis with an early gastric cancer. The patient was a 50-year-old woman who presented with epigastric discomfort with a one-month duration. The chest X-ray showed dextrocardia and the abdomen CT revealed situs inversus totalis with wall thickening of the gastric antrum. The resected specimen showed a 2 cm sized eroded lesion in the antrum. Histologically, gastric cancer was diagnosed as a well differentiated tubular adenocarcinoma that was confined to the mucosal layer. The patient was treated successfully with a radical subtotal gastrectomy, even though situs inversus totalis was not familiar to the surgeon.