Different Prognostic Significance of Bcl-2 Based on Cancer Molecular Subtype / 한국유방암학회지

PURPOSE: B-cell lymphoma (bcl)-2 is an anti-apoptotic gene, and it is a poor prognostic factor in various malignant tumors. However, the prognostic significance of bcl-2 expression in breast cancer remains controversial. We investigated the prognostic significance of bcl-2 according to cancer molecular subtype. METHODS: We analyzed 411 patients with primary invasive breast cancer who underwent surgery at our institution between 1999 and 2001. The subtypes were classified as luminal (estrogen receptor [ER]+ and/or progesterone receptor [PR]+, irrespective of human epidermal factor receptor 2 [HER2]), triple-negative (ER-, PR-, and HER2-), or HER2 (ER- ,PR-, and HER2+). RESULTS: A total of 236 (57.4%) cases were positive for bcl-2, and bcl-2 expression was significantly associated with earlier stage, lower grade, expression of hormone receptor positivity, and HER2 negativity. No difference in disease-free survival (DFS) was observed based on bcl-2 expression. However, the prognostic significance of bcl-2 varied with subtype; bcl-2 was not a prognosticator in patients with the luminal and HER2 subtypes. However, patients with bcl-2(+) tumors of the triple-negative subtype showed significantly worse DFS than those with bcl-2(-) tumors (p=0.048). In a multivariate analysis, bcl-2 expression remained a significant predictor of recurrence in patients with the triple-negative subtype (hazard ratio, 3.26; 95% confidence interval, 1.40-7.59; p=0.006). CONCLUSION: The prognostic significance of bcl-2 varied with molecular subtype; bcl-2 expression was a poor prognosticator in patients with the triple-negative subtype, but not in those with the luminal and HER2 subtypes.

Effectiveness of Adjuvant Chemotherapy with 5-FU/Leucovorin and Prognosis in Stage II Colon Cancer

PURPOSE: The aims of this study were to investigate the survival results and the prognostic factors of adjuvant chemotherapy in stage II colon cancer in the sparsity of Korean data. METHODS: From 1993 to 2006, 363 curatively resected pathologic stage II colon cancer patients were enrolled. Six cycles of adjuvant chemotherapy was performed: intravenous bolus 5-fluorouracil (5-FU) 500 mg/m2 with leucovorin 20 mg/m2 for 2 hours daily for 5 days, followed by a 3-week resting period (n = 308). Fifty-five patients received only curative surgery. A high risk of recurrence was defined as the presence of one or more of the following factors: T4 tumor, lympho-vascular invasion, perineural invasion, perforation, obstruction, retrieved lymph node < 12, and poorly differention. The median follow-up period was 68 months (1 to 205 months). RESULTS: The five-year overall survival (OS) rate was 90.1%, and the five-year disease-free survival (DFS) rate was 84.7%. Among high-risk patients, the OS and the DFS rates of the treatment group were significantly higher than those of the non-treatment group (OS: 90.6% vs. 69.1%, P < 0.0001; DFS: 85.9% vs. 54.1%, P < 0.0001). Among low-risk patients, the survival results of the treatment group were also significantly superior (OS: 97.7% vs. 88.2%, P < 0.0001; DFS: 93.0% vs. 80.0%, P = 0.001). In the multivariate analysis, adjuvant chemotherapy was a significantly favorable prognostic factor for overall survival (hazard ratio, 0.41; 95% confidence interval, 0.22 to 0.75; P = 0.004). CONCLUSION: In our population, adjuvant chemotherapy showed superior survival to curative surgery alone and significantly reduced the risk of death. A nationwide multicenter randomized trial is needed.

The Changes of Clinical Pattern of Patients Who Underwent Hepatectomies for Hepatocellular Carcinoma according to Chronological Periods

PURPOSE: The purpose of this study was to identify changes over several years in clinical patterns of patients who underwent hepatectomies for HCC. METHODS: There were 502 patients who underwent hepatectomies for HCC between January 1986 and July 2009 at the Korea Cancer Center Hospital, Seoul, Korea. Period 1 (n=206) extended from the beginning to December 2000. Period 2 from January 2001 to December 2004 (n=146). Period 3 from January 2005 to July 2009 (n=150). The data for the different periods were compared retrospectively or prospectively. RESULTS: Compared to patients from Period 1, Period 2 and Period 3 patients had operations >6 months from diagnosis (p=0.002), high levels of preoperative AST and ALT (p<0.001), and poor scores on the ICG R15 test (p=0.047). The Frequency of Transfusion during the operation was decreased (p<0.001), but there was no difference in postoperative complication rates (p=0.403). In Periods 2 and 3, there was a higher frequency of multiple tumors (p<0.001) and microvascular invasions histologically (p<0.001). Differences between periods in disease free survival rates were not significant. CONCLUSION: The reason for the higher frequency, in more recent periods, of patients presenting at surgery with advanced HCC stages is the longer interval between diagnosis and operative time, and an increase in the number of non-surgical treatments before surgery. Because of differences in follow-up intervals, it was difficult to evaluate the influence of period on survival rates. Hence, a longer follow-up period will be required for an accurate evaluation of changes in survival with time.