Tumor budding is a valuable prognostic parameter in endometrial carcinomas

Background: Tumor budding (TB) is a morphological finding believed to play an important role in determining the prognosis in many cancers. Aim: Our aim is to evaluate the prognostic importance of TB in endometrial carcinomas. Settings and Design: Two-hundred-eleven endometrial cancers were obtained from 2008 to 2015 that were comprised of those having undergone surgical staging with a hysterectomy and at least 5 years followed up. Material and Methods: All hematoxylin and eosin stained slides were reevaluated for the status of TB. Statistical Analysis: Nonparametric tests, the Kaplan–Meier method, the Log-rank test, and Cox proportional hazard regression were used. Results and Conclusion: TB was found to correlated with larger diameter (P = 0.000), nonendometrioid (P = 0.038), mixed cell types (P = 0.005), higher grade (P = 0.000), deeper invasion of the myometrium (P = 0.000), cervical stromal invasion (P = 0.000), advanced pT (P = 0.011), lymph node involvement (P = 0.000), lymphovascular invasion (P = 0.000), and advanced stage (P = 0.000). The presence of TB worsens the 5-year overall survival (OS) (P = 0.0001). In cases such as grade 1, pT1, or stage 1 endometrial carcinomas, the presence of TB decreases the OS rate (P = 0.00017, P = 0.0016, P < 0.0001). Our result suggested that the presence of TB adversely affects the prognosis. It was concluded that TB could be a valuable prognostic parameter.

CK19 mRNA in peripheral blood combined with contrast-enhanced ultrasound: the predictive value of axillary lymph node involvement in breast cancer / 中华普通外科杂志

Objective To evaluate a model for axillary lymph node involvement combining CK19 mRNA with contrast enhanced ultrasound sonography (CEUS) score in operable breast cancer.Methods Operable breast cancer patients planned for sentinel lymph node (SLN) biopsy were enrolled.Preoperative CK19mRNA expressions in peripheral blood and CEUS score of axillary lymph nodes were tested before surgery.In the training set,postoperative sentinel lymph node (SLN) and non-sentinel lymph node (nSLN) pathological results were taken as the gold standard,effective modeling variables were screened,logistic regression was used to establish the prediction model.Parallel control studies were conducted between the validation set and the MSKCC model to evaluate the prediction accuracy and prediction efficiency.Results From Oct 2015 to Nov 2016,359 cases (training set) were enrolled and mathematical formulas for predicting SLN and nSLN were established,respectively.The sensitivity,specificity and AUC of predicting SLN involvement were 91.36％,94.92％ and 0.979 respectively.The sensitivity,specificity and AUC of predicting nSLN metastasis were 91.04％,90.53％ and 0.932 respectively.From Dec 2016 to Jul 2017,219 cases (verification set) were included.The sensitivity of SLN metastasis predicted by the model was 91.84％,the specificity was 96.69％,and the AUC was 0.979,significantly superior to the MSKCC model (0.739).The sensitivity,specificity and AUC of predicting nSLN metastasis were 95.35％,92.73％ and 0.945 respectively,significantly superior to the MSKCC model (0.873).Concolusions Combined with peripheral blood CK19 mRNA and CEUS score,the prediction model for axillary lymph node involvement for operable breast cancer,SLN/nSLN involvement probability can be calculated and qualitative judgment can be made.The overall accuracy and AUC of this model are better than the prediction model of MSKCC.

The expression of thrombospondin 1 and its gene hypermethylation in laryngeal squamous cell cancer / 肿瘤

Objective: To explore the mRNA and protein expressions of thrombospondin 1 (THBS1) gene and the DNA methylation of its promoter in laryngeal squamous cell cancer (LSCC), and to analyze their relationship to clinicopathological features of LSCC. Methods: Sixty-six pairs of fresh LSCC tissues and the matching adjacent normal tissues were taken from 66 cases of LSCC. The mRNA and protein expressions of THBS1 gene were detected by revere transcription PCR and Western blotting assay, respectively. Then their relationship to clinicopathological features of LSCC was analyzed by one-way ANOVA and t test. The methylation of THBS1 gene promoter was detected by the DNA methylation specific PCR, and its relationship to clinicopathological features of LSCC was analyzed by ?2 test. Results: The mRNA and protein expressions of THBS1 gene in LSCC tissues were significantly decreased as compared with those in the adjacent normal tissues (P < 0.05), and these expressions were also associated with lymph node involvement and TNM staging (P < 0.05). The positive rate of the hypermethylation of THBS1 gene in the LSCC tissues (48.50%±6.15%) was significantly higher than that in the matching adjacent normal tissues (6.06%±2.92%) (P < 0.05). The mRNA and protein expressions of THBS1 gene were associated with the hypermethylation of its gene promoter (P < 0.05). THBS1 gene hypermethylation status in LSCC tissues was associated with lymph node involvement and TNM staging (P < 0.05). Conclusion: The decreased expressions of THBS1 mRNA and protein and the high methylation of its gene promoter may play crucial roles in carcinogenesis and development of LSCC. Copyright © 2014 by TUMOR.

Seguimiento mayor a 10 años de pacientes operados por cáncer gástrico incipiente / Ten years survival of patients operated for an incipient gastric cancer

Background: Five years survival after surgery for incipient gastric cancer is high. However there is a paucity of information for longer follow up periods. Aim: To analyze long term survival after surgery for incipient gastric cancer. Material and Methods: Review of medical records of patients operated for incipient gastric cancer with an oncologic follow up of 10 years or more. Results: Data from 161 patients, aged 25 to 88 years, 55 percent males, was retrieved. Eight percent of tumors were multifocal and a mean of 17 lymph nodes per patient, were dissected. There was lymph node involvement in 11 and 3 percent of submucosal and mucosal lesions, respectively. Ten years survival was 78 percent. The causes of death were medical in 68 percent, another cancer in 18 percent and gastric cancer in 18 percent. Incipient gastric cancer 10 years specific survival was 95 percent. The figures for submucocal and mucosal lesions were 98 and 91 percent respectively. The figures for patients with or without lymph node involvement were 75 and 94 percent respectively. Conclusions: Ten years mortality due to incipient gastric cancer is exceedingly low and other causes will be the cause of death among these patients.

Introducción: Los resultados del tratamiento quirúrgico del cáncer gástrico incipiente (CGI) son satisfactorios en el seguimiento a 5 años. Sin embargo, en Chile, se desconoce el comportamiento a mayor plazo. Objetivo: Describir los resultados del tratamiento quirúrgico del CGI en el seguimiento mayor a 10 años. Material y Método: Revisión retrospectiva de los pacientes operados por CGI con seguimiento oncológico mayor a 10 años. El análisis de supervivencia se realizó a través de curvas Kaplan-Meier y el análisis univariado con el test de Fisher. Se consideró significancia estadística con p < 0,05. Resultados: La serie está constituida por 161 pacientes. La edad promedio fue 57 años. Un 7,6 por ciento son cánceres multifocales. Se disecaron 17,4 linfonodos en promedio por paciente. Se identificó compromiso linfático en 11,5 por ciento de las lesiones submucosas y 2,9 por ciento de las mucosas. La supervivencia general fue de 78,3 por ciento a 10 años. La mortalidad se distribuye: 67,7 por ciento por patología médica, 14,5 por ciento por otro cáncer y 17,7 por ciento por CGI. La supervivencia específica por CGI fue de 94,7 por ciento a 10 años. Según profundidad: las lesiones mucosas fue de 98 por ciento y de las submucosas de 91,3 por ciento (p = 0,186). La supervivencia en ausencia de ganglios comprometidos fue de 96,4 por ciento y 75 por ciento en presencia de adenopatías (p = 0,026). La muerte acumulada por CGI a los 10 años fue de 3,72 por ciento. Conclusión: El seguimiento a 10 años o más de los pacientes operados por CGI mostró que es más probable la muerte por otra causa que por cáncer gástrico, el riesgo de muerte por CGI persiste en el tiempo.

Evaluación del compromiso linfonodal en el cáncer gástrico mediante Dímero D / No association between serum D Dimer levels and lymph node involvement among patients with gastric cancer

Background: D Dimer levels can be predictors of lymph node involvement in gastric cancer. Aim: To evaluate the association between D Dimer levels and lymph node involvement among patients with gastric cancer. Material and Methods: In 32 patients with gastric cancer, aged 38 to 86 years (24 males), subjected to a curative surgery, D Dimer was measured in the preoperative period. Its levels were associated with the number of regional lymph nodes involved and the tumor stage, according to the pathological report of the surgical piece. Results: There was no significant correlation between D Dimer levels and the number of involved lymph nodes (r = 0.18, p = NS). Conclusions: In this series of patients with gastric cancer, there was no association between serum D Dimer levels and the number of involved regional lymph nodes.

Introducción: En el cáncer gástrico resecado el principal factor pronóstico es el compromiso linfonodal. Estudios han demostrado que en el adenocarcinoma esofágico los niveles plasmáticos de Dímero D, se correlacionan con el compromiso linfonodal. Recientemente, Kwon HC demostró lo mismo en el adenocarcinoma gástrico. Objetivo: Establecer si el valor plasmático de Dímero D en el preoperatorio se correlaciona con el compromiso linfonodal en pacientes con adenocarcinoma gástrico resecado. Métodos: Estudio correlacional Durante un año, a los pacientes con diagnóstico de adenocarcinoma gástrico operados en el Hospital Base Valdivia, se les solicitó niveles plasmáticos de Dímero D, dentro del estudio preoperatorio. Causas de exclusión fueron: rechazo de ingreso al estudio, presencia de coagulopatía, los puncionados 48 horas antes del ingreso, los irresecables o con linfadenectomía insuficiente. El resultado del examen se correlacionó con el número de linfonodos comprometidos y el estadio tumoral (TNM) que informaba la biopsia definitiva de la pieza quirúrgica. Software utilizado: XLstat. Resultados: Para el análisis se incluyeron 32 casos. La mediana de edad: 66 años, la ubicación más frecuente fue tercio superior (52,94 por ciento) y el 28,13 por ciento de los pacientes se encontraban en estadio IIIA. El coeficiente de correlación entre nivel plasmático de Dímero D y el número de linfonodos comprometidos fue de 0,18 (p = 0,3411). Conclusión: De acuerdo a los resultados obtenidos en este estudio, existe correlación positiva débil entre los niveles plasmáticos de Dímero D y el número de linfonodos comprometidos en el adenocarcinoma gástrico, no concordando con lo actualmente publicado.

Resultados del tratamiento quirúrgico del cáncer de colon: análisis de 439 pacientes / Surgical treatment of colon cancer: retrospective analysis of 439 patients

Background: Mortality for colon cancer duplicated in the last 15 years in Chile. Aim: To analyze immediate and late results of surgical treatment of colon cancer. Material and Methods: Retrospective analysis of 439 patients aged 22 to 92 years, 55 percent women, subjected to elective surgery for colon cancer between 1991 and 2007. Results: At the moment of surgery 86 percent of tumors were resectable and 25 percent were in stage IV Twenty one percent of patients had surgical complications, 4 percent had to be reoperated and 1 percent died. Ten years global survival for stages I to III was 82 percent. Survival significantly decreased for stages Illb and forward. Preoperative carcinoembrionic antigen, vascular permeation, the number of involved lymph nodes and chemotherapy were relevant prognostic factors. If TNM classification is included in the model, only vascular permeation and lymph node involvement remain as prognostic factors. Conclusions: TNM classification and lymph node involvement are the main survival prognostic factors in this series of patients with colon cancer.

Antecedentes: La mortalidad por cáncer de colon (CC) se ha duplicado en Chile en los últimos 15 años. El objetivo es analizar los resultados inmediatos y alejados del tratamiento quirúrgico del CC en un hospital público docente. Pacientes y Método: Se incluyen todos los pacientes intervenidos en forma electiva por un CC entre 1991 y 2007. Los pacientes fueron etapificados según el TNM 2002. Los pacientes estadios I a III con R0 son considerados como cirugía con intención curativa. Las curvas de sobrevida fueron estimadas según el método de Kaplan-Meier, las que se comparan con el test log-rank. Para determinar los factores pronósticos más relevantes en el análisis multivariado se utilizó el modelo de regresión de Cox. Resultados: Se trata de 439 pacientes, 55 por ciento mujeres, con una edad promedio de 67 años (extremos 22-92). La resecabilidad fue de 86 por ciento, el 25 por ciento de los casos estaba en estadio IV, la morbilidad fue 21 por ciento, la tasa de reoperaciones fue 4 por ciento y la mortalidad 1 por ciento. La sobrevida global de los estadios I a III fue 82 por ciento a 10 años, con una clara inflexión negativa de las curvas a partir del estadio IIIB. El CEA preoperatorio, la permeación vascular, el número de ganglios positivos y la quimioterapia aparecen como factores pronósticos relevantes. Al introducir el TNM en el modelo, la permeación vascular y el índice ganglionar conservan la significancia estadística. Conclusión: La cirugía resectiva del CC puede efectuarse con bajos índices de mortalidad. El índice ganglionar junto al TNM puede ser un factor pronóstico relevante en la toma de decisiones terapéuticas sobre adyuvancia en los pacientes en estadio III.

Recurrence after Treatment of Salivary Gland Adenoid Cystic Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenoid cystic carcinoma of salivary glands has distinct characteristics of indolent but persistent growth, late onset of metastasis and eventual death of patients. We performed this study to find parameters affecting the recurrence and survival of patients with adenoid cystic carcinoma in salivary glands. SUBJECTS AND METHOD: A retrospective study was done on 55 patients who underwent surgery between 1990 and 2006. We analyzed the effect of patient's factors, characteristics of tumor and treatment modalities to local recurrence, distant metastasis and survival. RESULTS: There were 20 males and 35 females, with the median age of 50.2 years. The mean follow-up duration after treatment was 70.9 months. Patients who received surgery alone were 12 (22%), with radiation therapy were 34 (62%) and with concurrent chemoradiation therapy were 9 (16%). There were 7 patients who had local recurrence alone, 8 who had distant metastasis alone and 3 who had local recurrence with distant metastasis. There was no correlation between the above parameters and local recurrence. Distant metastasis was influenced by old age (p=0.018), lymph node involvement (p=0.005) and treatment with concurrent chemoradiation therapy (p<0.001). Eight patients died during the follow up period. Five-year overall survival rate was 88.2% and the disease-free survival was 72.9%. The multivariate analysis found that only lymph node involvement was associated with survival (p=0.043). CONCLUSION: Lymph node involvement was predictive of poor prognosis in salivary adenoid cystic carcinoma. Therefore, it is necessary to establish highly sensitive diagnostic tools with which surgeons can find lymph node involvement.

Afectación ganglionar en paciente con endometriosis profunda rectovaginal / Lymph node involvement in a patient with rectovaginal endometriosis

Se describe un raro caso de endometriosis rectovaginal con compromiso ganglionar en mujer de 33 años. La presencia de tejido endometrial en ganglios linfáticos pélvicos es rara y ha sido confirmada en la literatura en mujeres que han sido sometidas a cirugía por endometriosis. La presencia de endometriosis en los ganglios linfáticos pélvicos es muy improbable que surja de novo y sugiere extensión de la enfermedad.

A rare case of rectovaginal endometriosis with lymph node involvement is described in a 33-year-old patient. The presence of endometrial tissue in pelvic lymph nodes is rare and has been confirmed in the literature in subjects who underwent surgery for endometriosis. Involvement of pelvic lymph nodes by endometriosis seems unlikely to arise de novo and probably suggests lymphatic spread of the disease.

Câncer de mama com 10 ou mais linfonodos axilares comprometidos / Breast cancer with 10 or more axillary lymph nodes compromised

A presença de comprometimento axilar e o número de linfonodos comprometidos são os fatores pronósticos mais importantes para o câncer de mama feminina. O objetivo do presente estudo foi analisar os fatores associados ao comprometimento axilar, recidiva e sobrevida global em pacientes com câncer de mama que se submeteram a mastectomia e que apresentaram 10 ou mais linfonodos axilares positivos. Foram estudadas 63 pacientes. O seguimento médio foi de 14 meses, apresentando sobrevida global de 79,9%. Em análise multivariada, nenhuma variável foi estatisticamente associada com o comprometimento axilar, enquanto o tamanho do tumor foi fator preditivo da recidiva local (p=0,02). O fator associado à sobrevida global foi recidiva sistêmica (p<0,01). A estratificação das pacientes quanto ao número de linfonodos axilares comprometidos não foi importante para a sobrevida

Lymph node involvement at diagnosis is the most important prognostic factor to breast cancer evolution. The purpose of this study was to analyze factors related to axillary involvement, recurrence and overall survival in patients with breast cancer treated with mastectomy that presented 10 or more involved axillary lymph nodes. A study of 63 patients was carried out. The patients were followed-up to 14 months, revealing 79.9% of overall survival rate. In a multivariate analysis, none of variables were statistically associated with axillary involvement, while tumor size was a predictive factor for local recurrence (p=0.02). The factor associated with overall survival was distant metastasis (p<0.01). The divisions of axillary lymph nodes weren't important for survival

A Case of Papillary Serous Carcinoma of Endometrium / 대한산부인과학회잡지

Uterine papillary serous carcinoma (UPSC) has been recognized as an aggresive tumor with early and deep myometrial invasion, frequent lympho-vascular space involvement, and a high relapse rate. It has also been shown that deep myometrial invasion cannot predict the risk of extrauterine disease. UPSC accounts for 2-10% of all endometrial cancer and generally occurs in postmenopausal women (mean age 66 years) who usually present with abnormal vaginal bleeding. Obesity, diabetes, hypertension, or a history of previous hormone replacement treatment, known as risk factors of endometrial cancer, are not usually seen in women with UPSC. In this paper, we present a case of uterine papillary serous carcinoma with obesity, hypertension, diabetes. The initial endometrial biopsy showed an endometrioid adenocarcinoma but the result of postoperative pathologic finding revealed UPSC with extension to less than half thickness of the muscle layer and involvement of pelvic lymph node.

Immunohistochemical Study of p53 and nm23-H1 Protein in Gastric Carcinoma

The p53 gene, which resides on the short arm of chromosome 17, has been described as a tumor suppressor gene playing a role of G1 checkpoint monitering DNA damage, but mutation of this gene has been shown in numerous types of human cancers. The nm23-H1 gene encodes human NDP(nucleotide diphosphate) kinase. The expression of nm23-H1 gene was postulated to inversely correlate with metastatic potential of malignant tumors. We examined immunohistochemical expression in 30 cases of stomach cancers including 10 cases each of early gastric cancers(EGC), advanced gastric cancers without lymph node involvement, and advanced gastric cancers with lymph node involvement, which were stained with mouse monoclonal antibody of p53(PB53-12) and nm23-H1. Positive nuclear staining of p53 was frequently found in advanced gastric cancers with lymph node involvement (80%). The lymph node positive group showed high expression of p53(80%), and low expression of nm23-Hl(30%) than lymph node negative group. There was no significant correlation of p53 and nm23-H1 expression with tumor size, invasion depth, TNM stages, distant metastasis and histologic differentiation. Based on the present study, the expression of p53 and down regulation of nm23-H1 are thought to be correlated with tumor progression and lymph node involvement, and may be a useful prognostic factor in gastric cancers.