Expression of Survivin and Its Correlation with Prognosis in Colorectal Cancer

PURPOSE: Survivin is involved in both the control of cell division and the inhibition of apoptosis. Specifically, its anti-apoptotic function is related to the ability to inhibit caspases directly or indirectly. This study examined the expression patterns of survivin in normal colorectal tissues and in colorectal cancer tissues to determine whether the expression of survivin is associated with either the colorectal cancer characteristics or the prognosis. METHODS: 4micrometer sections of the formalin-fixed paraffin-embedded samples of colorectal cancer tissues were the immunostained using antibodies for survivin. The immunostain was recorded as 0~3 depending on the stain intensity distribution in the cytoplasm and the nucleus. RESULTS: Survivin was localized in the nucleus and/or cytoplasm of tumor cells. We could differentiate between cytoplasmic and nuclear localization of survivin protein expression. Among the cancer expressions, 35.8% demonstrated nuclear staining, and 51.9% demonstrated cytoplasm staining. Statistical analysis revealed that cytoplasmic survivin expression was correlated with lymph-node metastasis, tumor stage, and patient survival. CONCLUSIONS: Survivin expression was correlated with clinicopathologic prognostic parameters and with the outcome. Thus, it can be both a useful diagnostic marker for colorectal carcinomas and an important source of prognostic information for patients with a colorectal carcinoma. Survivin will become a potential new target in anti-cancer therapy in near future.

Clinical Correlation of c-erbB-2, p53, bcl-2, and c-myc Expression in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.

Clinical Correlation of c-erbB-2, p53, bcl-2, and c-myc Expression in Patients with Breast Cancer

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.

The Predictor of Axillary Lymph Node Metastases in Breast Cancer

BACKGROUND: The presence of axillary lymph node metastases (ALNM) and tumor size are two most important prognostic factors in breast cancer. An axillary lymph node dissection (ALND) is usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. However this procedure results in lymphedema of the affected upper extremity, increased axillary drainage, sensory abnormality, and pain. If the axillary lymph node status could be predicted accurately prior to an ALND, selected patients with a low probability of ALNM could be spared the procedure. The purpose of this study was to determine the association between the incidence of ALNM and 14 clinico-pathologic factors by using univariate and multivariate analysis and to investigate the possibility of using those factors as predictors for ALNM. METHODS: We reviewed data from 253 patients with breast cancer who had undergone at least a level I/II axillary dissection between 1991 and 1998. The association between the incidence of ALNM and 14 clinico-pathologic factors (age, menstruation, tumor size, palpability of tumor, tumor site, pathologic type, nuclear grade, estrogen receptor status, progesteron receptor status, p53, c-erbB-2, Ki67, Cd34, and Cathepsin D) were analyzed by using univariate and, when significant, multivariate analysis. RESULTS: Approximately 38.7% of the 253 patients with breast cancer had ALNM. Univariate analysis showed that ALNM were associated with tumor size (P<0.01), pathologic type (P<0.001), palpability (P<0.01), and nuclear grade (P<0.01). However, independent predictors of ALNM in the multivariate analysis were tumor size and pathologic type. Among the patients with smaller than 1.0 cm in the tumor size and DCIS in the pathologic type, the ALNM was not founded. CONCLUSIONS: We conclude that the characteristics of primary breast cancer can help assess the risk for ALNM. Selected patients, who are assessed to be minimal risk, might be spared a routine ALND, if the treatment decision would not be influenced by the lymph node status.

CT for Preoperative Prediction of Axillary Lymph-Node Status in Patients with Breast Cancer

BACKGROUND: The clinical staging may serve to guide initial therapy based on all available preoperative data, such as history, physical and laboratory examinations, and biopsy material. Computed tomography is one of the most attractive methods of evaluating the clinical state of patients with breast cancer. In cases where the lymph nodes are enlarged, CT of the chest can accurately detect the level of axillary lymph nodes involvement. CT may also simultaneously play a role in evaluating the mediastinum and the supraclavicular areas for adenopathy, primary tumors and lung metastases. The aim of this study was to determine the appropriate size criteria for metastatic axillary lymph nodes on CT and to evaluate the validity of using CT to detect axillary lymph-node metastases due to breast cancer. METHODS: CT examination of the chest was performed before axillary lymph node dissection in 98 patients with breast cancer. We measured the sizes of the lymph nodes according to the short-axis diameters seen on CT. We estimated the sensitivity, the specificity, the ROC curve, and the predictability of CT based on lymph-node sizes. RESULTS: The diagnostic criterion for node metastases was 5 mm. At the 5 mm point, the accuracy of CT for axillary metastases was 70% with a sensitivity of 89%, a specificity of 60%, a negative predictive value of 90%, and a positive predictive value of 56%. CONCLUSIONS: In conclusion, CT is not an accurate assessment in the diagnosis of axillary lymph-nodemetastases due to breast cancer. However, CT data can be interpreted with sufficient sensitivity and negative predictability for CT to serve as a screening test.

Management for Obstructed Carcinoma of the Left Colon

The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.

Palliative Resection for Incurable Colorectal Cancer

Despite a recent trend toward increased screening and public awareness for colorectal cancer, 30% of patients present with incurable disease. This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colorectal cancer will benefit from palliative resection. Among 33 patients considered incurable colorectal cancer, twenty one patients underwent palliative resection and twelve patients had bypass surgery. Incidence of postoperative complication after palliative resection was 61.9%(13 cases), and after bypass surgery was 58.3%(7 cases). Among patients treated by palliative resection, one patient required reoperation for postoperative bleeding. The operative mortality after palliative resection was 19%(4 cases), and after bypass surgery was 25%(3 cases). The median survival was 11.4 months for patients treated by palliative resection, and was 9.7 months for patients treated by bypass surgery. These results show that palliative resection can be done safely and effectively in patients with incurable colorectal cancer. We believe this approach improved the quality of the remaining life in these patients.