Impact of the Number of Nodes Examined on the Prognosis of Dukes B Colorectal Cancer

PURPOSE: Metastasis to the regional lymph nodes is the most important prognostic indicator in patients with colorectal cancer (CRC). The number of lymph nodes examined for adequate staging is still controversial. The aim of this study was to determine if the number of lymph nodes after curative surgery is associated with long-term outcome in patents with Dukes B CRC. METHODS: A retrospective analysis was performed in 174 consecutive patients with Dukes B CRC who underwent curative resection from 1990 to 1999. Patients were stratified according to the number of nodes examined as group A (less than 12 nodes) and group B (12 or more nodes). End-points were local and systemic recurrence and relapse-free survival. Comparisons between the groups were performed by Kaplan-Meier methods and chi-square test as appropriate. RESULTS: There were 115 men (66%). The mean number of nodes examined was 13.4 with the median of 11. No significant difference was found in the number of nodes examined between colon and rectum (16+/-10.6 vs. 13+/-10.0, P=0.675). However, the number of lymph nodes examined tends to be more in recent period of study and if the specimens were examined in the fresh status. With the median follow-up of 44 months, there were 5 local recurrences (2.9%), 22 systemic recurrences (12.6%), and 2 combined local and systemic recurrences (1.1%). Most of the recurrences were observed in group A (79%). The difference of 5-year relapse-free survival rates between the groups was also statistically significant (group A: 73.5%, group B: 91.7%, log-rank test, P=0.0114). The pT stage and number of lymph nodes examined were the independent variables associated with relapse-free survival in multivariate analysis. CONCLUSIONS: The number of lymph nodes examined has prognostic value in patients undergoing curative resection for CRC. Based on our analysis, we recommended at least 12 lymph nodes should be analyzed for accurate staging of CRC.

Urinary NMP22 and BTA tests as screening markers for bladder transitional cell carcinoma / 대한임상병리학회지

BACKGROUND: Urinary bladder cancer has been diagnosed by urine cytology and cystoscopy with biopsy. Recently, in vitro noninvasive diagnostic tests, measuring urinary nuclear matrix protein22(NMP22) and bladder tumor antigen(BTA), were introduced. We analyzed the usefulness of the NMP22 and BTA tests for diagnosing bladder cancer and compared those with voided urine cytology. MATERIALS AND METHODS: Single voided urine specimens were obtained from 27 patients with bladder cancer and 23 healthy volunteers. The urine specimens were assayed by enzyme immunoassay(NMP22, Matrietech(R), Newton, MA.) and latex immunoassay(BTA, Bard, USA). Urine cytology was performed in patients with bladder cancer. RESULTS: Mean urinary NMP22 level of patients with bladder cancer(144.6 U/mL) was significantly higher than those of normal controls(2.9 U/mL, P<0.01). The sensitivities were 89% and 74% for NMP22 and BTA tests, respectively, compared with 41% for voided urine cytology. The sensitivities of NMP22 and BTA tests were 88%, 63% at grade 1(G1), 82%, 73% at G2, and 100%, 88% at G3, respectively(P<0.01; NMP22, P=0.580; BTA). According to tumor stage, the sensitivities of NMP22 and BTA tests were both 79% at superficial, and 100% and 69% at invasive cancer, respectively(P=0.110; NMP22, P=0.678; BTA). The sensitivities of urine NMP22 and BTA tests combined with urine cytology were both 96%. In following of transitional cell carcinoma patients, agreement between urine cytology and BTA test was 75%(24/32). Among the various urologic disease, false positive rate for BTA test was 17%(8/47). CONCLUSION: Urinary NMP22 and BTA tests were more sensitive than voided urine cytology regardless of tumor grade and stage, so these noninvasive and simple tests can be used as screening tests for urinary bladder transitional cell carcinoma.

The protective effect of Cortical Infarction to the Neuronal damage following subsequent global ischemic insult in gebril

Prior brief ischemic insult was reported to protect the hippocampal CA1 neurons from delayed neuronal death following global ischemia. Mechanisms of such protective effects have, however, remained unclear. The study was conducted to confirm whether the preceding cortical infarction exerts protective effects on the adjacent hippocampal CA1 neurons against the subsequent global ischemia and to reactive astrocytosis to the mechanisms of protective effects. Male, mongolian gerbils, aged 12-15 weeks and weighing 70-90g, were anethetized with ketamine by intraperitoneal injections, and a small cortical infarction in the unilateral parietal cortex was made by infusing of magnetic ferrite particles which were followed by subsequent global ischemia for 5 minutes on 1, 3 and 7 days later. One week following the subsequent global ischemia, the neuronal degeneration in the hippocampal CA1 regions was examined by Hematoxylin-eosin stain. Immunohistochemistry using GFAP antibody was carried out for evaluating the time course of astrocytic reactivity after 1, 3, and 7 days of cortical infarction. The neuronal degeneration of CA1 regions in the ipsilateral hippocampus preceded by the cortical infarction was less severe than those in the contralateral ones. The differences of neuronal degeneration between both of hemispheres was clearly more prominent in animals whose global ischemia was induced at 1 and 3 days cortical infarctions than 7 days. However, the reactivity of GFAP astrocyte was minimal at 1 day but markedly increased at 3 and 7 days after cortical infarction. This present study confirmed that the preceding cortical infarction may protect the adjacent ipsilateral CA1 neurons from the subsequent global ischemic insult with its protective effect being most remarkable at 1 and 3 days but less at 7 days after cortical infarction. However, the degree of reactive astrocytosis measured by GFAP immunohistochemistry did not correlate well with the degree of neuroprotection, thus it did not fully account for the mechanisms of such protective effect.